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Vastus Lateralis Static Manual Release

Vastus Lateralis Static Manual Release is a massage technique that is used to improve the gluteus medius strength as well as release tight hip flexors and improve range of motion. This technique combines tissue compression, compression-release, and stretching to target the various muscles and functions of the gluteus medius. It can be used to reduce pain and tension in the lateral thigh, hip, and buttocks, and is an important treatment option for many musculoskeletal

Transcript

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This is Brent of the Brookbush Institute, and in
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this video going over static manual
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release for the vastus lateralis. Now if you're watching this video I'm assuming
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you're watching it for educational purposes, and that you are a licensed
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manual therapists, or your scope of practice in your state allows you to
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perform static manual release techniques. Physical therapists, athletic trainers,
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massage therapists, chiropractors, osteopaths you're likely all in the clear.
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Personal trainers this probably does not fall within your scope. I'm going to have
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my friend Brian come out, he's going to help me demonstrate this technique. Now
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all of our manual release techniques they follow similar principles. We have
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to know how to palpate the muscle, and in this case the vastus lateralis is huge
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and fairly easy to palpate being on the side of our leg. We get bonus points for
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knowing where our trigger points are because that will help direct our hands,
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and I got the trigger points marked off here on Brian. I don't know if you can
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see in this view, but when we go to a close-up you will be able to see those
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trigger points marked out. You should be aware if there's any contraindications
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to this technique, there's anything that could be damaged by compression. In the
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case of the vastus lateralis we don't have any major concerns, and the last
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thing is we need to know what the best position for release technique is, and
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that's usually based on what's comfortable for the therapist, as well as
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being able to put a little tension in that muscle. So as you go to press down
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on these trigger points, these little balls of overactivity, you don't start
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playing the trying to put your finger on a marble game. Now there's two positions
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we use for vastus lateralis release, and one of them in particular makes very
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little sense, that I think you guys will find in both techniques that moving the
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hip actually contributes to increase in tension in the vastus lateralis, which
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doesn't make a whole lot of sense if we think back to our basic anatomy courses.
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But if we take things up a notch we learned that the vastus lateralis
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actually does invest into the iliotibial band and putting tension in the
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iliotibial band, whether we go into extension and the TFL pulls a
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little tighter. Or we go into flexion and the glute max pulls a little tighter on
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the iliotibial band, that's also going to have an effect on those vastus lateralis
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fibers. The first position i'm going to show you guys is it's probably the one
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that's most obvious, or makes the most sense. I'm going to go ahead and take him
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into some knee flexion. I'm going to use my body to block knee flexion. I'm going
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to be pushing down on his vastus lateralis so i'm going to go ahead and
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take this leg, make them a little bit more comfortable and stable by bending
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it, and then i'm going to be careful to actually put his medial gastroc
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underneath his vastus medialis. So that when i press down i get meat on meat and
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I don't do one of these like knee cap on ankle bone things, because if i press
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down there it's going to hurt. So we go here. I'm going to do my palpation
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posterior to anterior to feel for the most overactive or the densest fascicles,
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and then once i found them i generally know that trigger points in the vastus
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lateralis usually happen pretty close to the knee, or right dead center
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between greater trochanter and me. So you guys notice even when I put my hand down,
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I put my hand down pretty close to the center of his thigh, because i'm hoping
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to get kind of lucky here and not only put my hand down on overactive fascicles,
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but be pretty close to a nice tight nodule, a trigger point without having to
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do too much searching moving from distal to proximal, or proximal to distal.
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How's that feeling? That's a little more tender. Okay so now that I found this
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nice hyperactive point, I'm going to go ahead and this is going to be my dummy
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hand, I'm just going to let this totally relax. I'm going to take this hand
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straighten it out, alright so I'm noW using this hand to apply force. I'm just
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going to go ahead and lean over, and I'm going to wait for 30 seconds to 2
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minutes until that tissue density starts to decrease. The over activity starts to
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decrease, Brian tells me he just can't handle it anymore, which of course you
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need to listen to your patients and back off a little bit. Or of course he tells
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me that he's not feeling anything at all, the discomfort has subsided, that's
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probably a good sign we can move on. Now we can move on to other points right, so
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I can go back to, all right we did the one in the middle of his thigh, does he
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have anything near his knee. I feel a point right there, go ahead and put down
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some pressure. One thing that often gets mistaken with this technique, is once
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again I said this is vastus lateralis static manual release. I think a lot of
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people would look at me doing this and being like oh its IT band release. You
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can't really release your IT band guys. Trigger points are muscular phenomenon.
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There are some fascial techniques that might be able to help with gliding of
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the iliotibial band over the vastus lateralis, but these static compression
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techniques are muscular techniques for a muscular phenomenon, for the most part
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being trigger points, and what we're really trying to do is decrease that
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over activity. How's that feel?
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Good, let's go ahead and have you on your back.
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Now the other position that you can do for vastus lateralis manual release is
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similar to what is called the Iron Cross stretch, right cross stretch. This
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is the weird one where I have them in knee extension, I'm taking it further into
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flexion, but somehow the increased tension in the iliotibial band allows me
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to have enough tension in my vastus lateralis to still find hyperactive bands,
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and of course tight nodules. Which I of course then want to release. Now be
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careful with this technique. If you have somebody with low back pain this isn't a
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great technique or a great position to put them in. Notice I have a whole lot of
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hip adduction, his pelvis is rotated this way, I'm pulling them further into spinal
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flexion. Hip or low back this could be a somewhat a compromised position. This
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position does come in handy though if you're doing a lot of different
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techniques, and you happen to be working on the biceps femoris and then you can
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just go on to the vastus lateralis. I do find this an effective position.
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Next a little close-up recap. Alright guys this is your close-up recap, just so
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you can see my hands, the position of the leg, how I search for a trigger point. I'm
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going to go ahead and pull him into knee flexion. I'm going to use my body to
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block his leg, so now I'm not doing any work. I got both my hands-free. I'm going
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to go ahead and I'm going to use, I mean since is this vastus lateralis and it's
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very thick, very dense, chances are i'm going to use both thumbs to even search
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for overactive fascicles. And then you can see here, I happen to know that the
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trigger points are closer to the knee, or right in the middle of the muscles. So
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i'm going to put my hands pretty close to where i think those are, and then i'm
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going to search by finding the most overactive fascicles, and moving either
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proximal or distal, there's a nice one right there. Alright once i found that, i'm
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going to use my dummy thumb. I'm going to relax
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this hand. I'm gonna use the other hand to apply pressure, and when I say use the
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other hand to apply pressure i'm actually just pushing through my arm
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into my palm, and then making sure that we're meat on meat here, vastus medialis
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to gluteus, I'm sorry vastus medialis to medial gastroc. I'm going to go ahead
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and push down until I get a nice release, make sure you guys don't do this thing,
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because if i push down his kneecap into his ankle that's not going to feel
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good at all. To show you guys the other position, go ahead and have Brian move
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away from me a little bit, and then he's going to go into this kind of Iron Cross
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stretch. Now the trigger points would be in the same places on this other leg
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closer to the knee, or right in the middle of the muscle. And generally
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speaking I'm moving my hands in this direction, with this one alright. So I am
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applying a little bit of a distal to proximal force. I'm going to find those
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tight fascicles, that's a nice tight fascicle there. Let's see if I can find a
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nodule within that tight fascicle. A little marble, well there we go once i
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find that, again just apply a little pressure and lean in, and i am leaning
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this way guys, so I'm not pushing straight down per se. This position can
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be a little problematic for those individuals with low back or hip pain. So
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keep both these techniques in your repertoire, that first technique is
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probably your go-to. I think you guys will find this technique sometimes
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convenient if you were combining it with a bunch of other release techniques. I
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hope you guys enjoyed static manual release of the vastus lateralis. Remember
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if we have somebody up on the table, we're about to perform the manual
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release, we want to be eighty percent sure that's what they need based on our
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movement assessment. If we're talking about the vastus lateralis, things get a
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little complicated in the sense that we have to include the vastus lateralis in
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the tensor fasciae latae, iliotibial band, vastus lateralis complex, and then we
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start to see that the vastus lateralis gets included
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whenever the TFL does, on things like our overhead squat assessment. So that would
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be signs like feet turns out, knees bow in, excessive forward lean, anterior
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pelvic tilt. If I was doing goniometric assessment while the vastus lateralis is
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a knee extensor, so if I saw a limitation in knee flexion that might
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give me an indication in a limitation in hip extension, as well as hip internal
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rotation, may also be indications of vastus lateralis over activity. Once
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again please mind your scope of practice. if manual release techniques do not fall
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within your scope do not attempt this. If you can find individuals to practice on
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before you actually attempt this on patients, that would be beneficial. There
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is no substitution to having a mentor or taking a manual therapy course, but even
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just practicing on your colleagues will be very beneficial. Being able to talk to
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another manual therapists about hand position, and what things felt like, and
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body position, and whose pressures felt the best is invaluable information. I
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hope you guys enjoyed this video. I look forward to talking to you soon.