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This is Brent of the Brookbush Institute
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in this video we're bringing you another
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manual technique now if you're watching
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this video I'm assuming you're watching
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it for educational purposes and that you
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are a licensed manual therapists
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following the laws regarding scope of
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practice in your state or region that
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means athletic trainers chiropractors
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physical therapists osteopath licensed
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massage therapists you are likely in the
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clear to do these techniques personal
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trainers this probably does not fall
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within your scope of practice although
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you might be able to use the palpation
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portion of this video to aid in learning
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your functional anatomy in an
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educational setting supervised by a
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licensed manual therapists now before we
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place our hands on a patient or client
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it is important that we assess and have
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a good rationale for doing so and of
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course if we're going to assess then we
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should be reassessing to ensure that the
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manual technique we're using is
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effective and we have a good rationale
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for continuing to use that technique in
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this video we're going to go over static
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manual release of the upper trapezius
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I'm gonna have my friend Melissa come
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out she's going to help me
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demonstrate now all of our manual release
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techniques follow a very similar
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protocol step one is to be able to
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differentiate the target tissue from the
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other tissues around it step two is to
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think about any tissues that might be
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injured or insulted by compression that
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are around the target tissue step 3 is
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we get a little extra bonus for knowing
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our trigger point sites that will help
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with our accuracy of our palpation and
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finding the points that we need to
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release in step 4 is thinking about
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patient and practitioner position so
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that you're in a good position to be
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able to hold the Release Technique long
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enough to actually get the desired
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result now palpation of the upper
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trapezius if you know your functional
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anatomy is not that challenging right
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the upper trapezius is a very
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superficial flat muscle that runs along
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the whole posterior and lateral aspect
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of the neck into the spine of the
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scapula and all the way down onto the
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acromion shelf essentially this well
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what you're seeing is skin but just
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underneath the skin is the upper
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trapezius if you want to get a little
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bit more detailed you can kind of feel
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through here and you'll notice this bony
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ridge that goes all the way to the shelf
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of her shoulder
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when I talk about the shelf of the
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shoulder i'm talking about that bony
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shelf where you don't have any muscle
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regardless of how big your deltoids are
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this is your acromion shelf and then
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this right here is the spine of your
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scapula I can kind of palpate in
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through here fairly superficially follow
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that all the way up into the neck and if
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I let myself kind of fall off this
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this meat on the side of the neck here I
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get an idea of how thick and and and how
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the fibers course for the upper
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trapezius you can kind of feel how flat
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this muscle is unlike the levator
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scapulae which we talked about a
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different video that's very ropey and
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bundley this muscle has like a density
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but no ropeyness to it for lack of a
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better term once I have a good idea of
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how my upper trap feels I need to start
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thinking about well is there anything
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else in here that I should worry about
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before i start strumming these fibers
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and the answer is yes we do have one
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potential issue and that's if I get
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really really anterior on the upper
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trapezius I start to fall right along
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those transverse processes of the
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cervical spine which means I have a just
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a little bit of concern where if I press
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down really really hard I could stretch
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the brachial plexus and that could be
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problematic it's going to be very
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uncomfortable for the patient or client
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number one it might give them burning or
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tingling or a numbing sensation in their
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hands and if they are somebody who has
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had a history of radiculopathy you could
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flare them up a little bit but let's be
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careful let's make sure that we stay a
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little bit more posterior and that we
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don't search from the anterior aspect of
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the neck and then make sure when we're
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pressing we do keep in the back of our
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head that hey this is a superficial
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muscle I don't need to sit here and
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drive down with all the force I have or
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like sink and elbow down into the neck
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like my thumbs and a little bit of
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pressure is going to be fine
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considering the direction of these
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fibers I'm going to assume that the
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direction goes from the spinous process
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the ligaments and nuchi and external
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occipital protuberance which is the
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origin of the trap straight down to the
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spine of the scapula here to strum those
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fibers I'm going to need to go this way
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alright so either from superior lateral
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to inferior medial or from inferior
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medial to superior lateral and remember
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I told you that you get bonus points for
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knowing where the trigger point is the
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trigger point on the upper trap is
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almost right down in the middle of this
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meat here I know you guys can can walk
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up to somebody and kind of know what I'm
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talking about where you got this like
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little little triangular section of
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muscle right here on the side of the
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neck right and down in the middle of
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that tends to be the common sight for
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the trigger point in the upper trapezius
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if you start palpating across this way
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and looking for the most dense fascicles
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and we'll assume those are the most
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overactive fascicles and then you can
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start moving from distal to proximal
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towards the neck to find any nodule any
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increase acute point of increased tissue
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density and I feel one right there how does that
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feel a little more tender than the rest
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of it right alright so this is where I
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would hold my technique and of course
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now we run into the little problem of
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would I actually set myself up my patient
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and myself like this probably not this
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is not very comfortable for either one
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of us I'm kind of having to do this
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thing to see the trap at all I have kind
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of my patients kind of like spacing into
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my neck and chin and this isn't a great
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way for me to get any leverage on the
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traps themselves so holding this
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technique is going to wear my hands out
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so what I have to have Melissa to do
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here is go ahead and put her arm back in
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the sleeve of her shirt we only had it
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out for the benefit of you guys and
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being able to see some of the bony
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landmark's flip around much like the
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levator scapulae I don't have a problem
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palpating or releasing the upper
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trapezius through thin gym clothing or
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even like a t-shirt like there's no
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reason that to have to move around
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clothing and I think with a little
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practice you guys will be able to feel
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the landmarks enough that you won't need
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like to a visual reference on the skin
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per se now this is this isn't a terrible
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way to do it not my favorite way and
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seeted you're definitely better off
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posterior to the patient than you are in
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front of the patient you can kind of do
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the palm the head thing or the headlock
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thing although this is going to get a
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little trickier with the traps because
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the way to stretch the traps and again
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we're going to add lengthening to these
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tissues to try to pin down our
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overactive nodule right we want to we
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want to kind of pull it from either side
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so that when we press down on it it
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doesn't do that flop around thing all
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right we have a little support from
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either side with the upper trap with the
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levator scapulae I went this way which
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is nice because it just kind of falls
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into our arm with upper trap we need
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to go this way and so if you can get
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your hand on somebody's head it makes it
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a lot easier the kind of headlock
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technique we talked about before ends up
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putting you with hands crossed which
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isn't going to be real easy so I can go
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into contralateral flexion a little bit
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of flexion and then it's ipsilateral
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rotation and then I can use this
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hand to once again strum in this
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diagonal alright so superior lateral to
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inferior medial and so this way
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find those tight fascicles find the tightest
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nodule and boom you can see
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Melissa's face change and that's the
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tender point now not a terrible way to
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do this technique but I'm really not
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taking advantage
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of any sort of leverage I can definitely
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control Melissa's head and I can get
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enough pressure in this position but I
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prefer something that didn't require so
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much hand strength for me and maybe
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stabilize Melissa a little bit
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more so what we're going to do is go ahead
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and do this in supine
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and bring the table up just a little bit
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so the table is it about the same height
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as my elbow I can then use this hand
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underneath the occiput and what I'm
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going to do is kind of pull her head
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this way alright so that as I pull her
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head she's rotated in the same direction
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alright so this would be levator
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scapulae letting her fall off this way
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that would lengthen those tissues
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because those tissues connected to the
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transverse process well since these
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connected to since these tissues
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connecting to the spinous process I want
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to pull the spinous process away from my
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insertion now once I get there once
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again I'm going it almost works out that
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like when I put my hand down the
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direction of my thumb is going perfectly
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in that that obliquity that diagonal
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that I want to strum these tissues and
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I'm a little bit more on top of the neck
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or on top of these tissues than I was
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for levator scapulae where my thumb was
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was way underneath now i'm here i'm
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going to look for the most tender spot
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which i'm thinking is right about there
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so i did my strumming and cross the
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fibers and then I went distal to
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proximal to find the nodule and now i'm
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going to press and the advantage here
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guys comes from the fact that once i
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have her in position i can i can set my
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arms down and essentially let the
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friction between my arm and the table do
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all the work like I don't have to hold
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her head up once I've moved it there I
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can just let my hands rest on the table
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let the let her occiput just kind of fall
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into my hand pressing it into the table
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with the pressure here once I have the
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pressure I can put my forearm down on
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the table and the table prevents me from
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from being pushed out of her upper
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trapezius I'm not saying this is ideal
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once again with cervical dysfunction and
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working on the neck it is a little bit
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more tiring on the hands and some of the
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other techniques we use I have seen
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other videos where individuals work on
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the traps in prone my only problem with
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those techniques is the finger on the
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marble game it's very hard to add any
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length to the tissues in prone not
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impossible but a little bit more
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difficult stay tuned for the close-up
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recap out for a close-up recap in this
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video you can see how this line right
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here is actually the border of Melissa's
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upper trapezius if I pulled her into a
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upper trapezius stretch using that that
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offhand at the bottom of her occiput that
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border becomes even more clear now I
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have the trigger point the common
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trigger point that is marked off for the
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upper trapezius and you can see how well
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my thumb comes in it automatically
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assumes that superior lateral to
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inferior medial medial diagonal but I'm
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going to use for my strumming and then
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I'm going to find the most dense
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fascicles I can find and then I can move
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from distal to proximal to try to find a
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nodule or acute point of hyperactivity
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that we're going to assume is the
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trigger point so that I can then just
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lay my arm down and hold this pressure
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for 30 seconds to 2 minutes until I get
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a release I can communicate with my
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patient hey Melissa how does it feel
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good alright so not too much tenderness
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not too much intensity not too much pain
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as it's starting to dissipate but it'll
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start to dissipate after 15 10-15
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seconds you want to hold it until you get a
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nice complete relief and then you can
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move on to your next trigger point or on
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to the next muscle that you've assessed
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as overactive so once again I'm just
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going to move Melissa
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into lateral flexion a little bit of
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flexion here and ipsilateral
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rotation I'm going use my superior lateral
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to inferior medial diagonal to locate
00:13:3800:13:41
taught bands I'm going to go then going
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to go from distal to proximal to find a
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tight nodule and then I'm going to press
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in lay my arm down so that the table is
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essentially holding me there and I'm
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going to hold to get a release so there
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you have it knowing your functional
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Anatomy will definitely help your manual
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technique it'll help you differentiate
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structure so that you can place your
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hands where they need to be as well as
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make you aware of these sensitive
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structures around the tissue that you're
00:14:0500:14:07
trying to target things like nerves and
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lymph nodes and arteries make sure that if
00:14:1000:14:11
you're going to place your hands on a
00:14:1100:14:13
patient that you have done an assessment
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and have a good rationale for placing
00:14:1500:14:17
your hands on that patient and if you're
00:14:1700:14:19
going to assess make sure you reassess
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to ensure that your technique was
00:14:2100:14:23
effective and you have a good rationale
00:14:2300:14:25
for using that technique again now with
00:14:2500:14:29
manual therapy one-on-one live education
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is incredibly important please be
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looking for opportunities like workshops
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and mentorships and maybe even classes
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at your local university that can get
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you some one on one individual
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instruction or at least some live
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classroom instruction so you've had a
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chance to be critiqued and mentored by
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somebody senior to you with some
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experience in manual therapy techniques
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and before you bring this stuff back to
00:14:5900:15:02
your rehab fitness or performance
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setting please practice on colleagues
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there is no substitute for practice and
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it is going to take accustomed
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to some of the techniques that we
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show in these manual technique videos
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don't expect to learn them in two or
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three or even five minutes you want to
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have hours of experience under your belt
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working on various different body sizes
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and shapes so that when you do get that
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first paying client first paying
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customer and you're really trying to
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make a good positive impact really
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trying to promote better outcomes
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you feel comfortable with that technique
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I look forward to hearing about your
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outcomes and hearing your questions in
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the comments section of this video I'll
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talk with you soon