00:00:0400:00:07
This is Brent of the Brookbush Institute, and in
00:00:0400:00:07
this video going over static manual
00:00:0700:00:11
release for the vastus lateralis. Now if you're watching this video I'm assuming
00:00:1100:00:14
you're watching it for educational purposes, and that you are a licensed
00:00:1400:00:19
manual therapists, or your scope of practice in your state allows you to
00:00:1900:00:23
perform static manual release techniques. Physical therapists, athletic trainers,
00:00:2300:00:27
massage therapists, chiropractors, osteopaths you're likely all in the clear.
00:00:2700:00:32
Personal trainers this probably does not fall within your scope. I'm going to have
00:00:3200:00:37
my friend Brian come out, he's going to help me demonstrate this technique. Now
00:00:3700:00:43
all of our manual release techniques they follow similar principles. We have
00:00:4300:00:47
to know how to palpate the muscle, and in this case the vastus lateralis is huge
00:00:4700:00:52
and fairly easy to palpate being on the side of our leg. We get bonus points for
00:00:5200:00:56
knowing where our trigger points are because that will help direct our hands,
00:00:5600:00:59
and I got the trigger points marked off here on Brian. I don't know if you can
00:00:5900:01:02
see in this view, but when we go to a close-up you will be able to see those
00:01:0200:01:08
trigger points marked out. You should be aware if there's any contraindications
00:01:0800:01:12
to this technique, there's anything that could be damaged by compression. In the
00:01:1200:01:17
case of the vastus lateralis we don't have any major concerns, and the last
00:01:1700:01:21
thing is we need to know what the best position for release technique is, and
00:01:2100:01:24
that's usually based on what's comfortable for the therapist, as well as
00:01:2400:01:28
being able to put a little tension in that muscle. So as you go to press down
00:01:2800:01:33
on these trigger points, these little balls of overactivity, you don't start
00:01:3300:01:38
playing the trying to put your finger on a marble game. Now there's two positions
00:01:3800:01:45
we use for vastus lateralis release, and one of them in particular makes very
00:01:4500:01:50
little sense, that I think you guys will find in both techniques that moving the
00:01:5000:01:56
hip actually contributes to increase in tension in the vastus lateralis, which
00:01:5600:02:00
doesn't make a whole lot of sense if we think back to our basic anatomy courses.
00:02:0000:02:05
But if we take things up a notch we learned that the vastus lateralis
00:02:0500:02:10
actually does invest into the iliotibial band and putting tension in the
00:02:1000:02:16
iliotibial band, whether we go into extension and the TFL pulls a
00:02:1600:02:21
little tighter. Or we go into flexion and the glute max pulls a little tighter on
00:02:2100:02:25
the iliotibial band, that's also going to have an effect on those vastus lateralis
00:02:2500:02:30
fibers. The first position i'm going to show you guys is it's probably the one
00:02:3000:02:35
that's most obvious, or makes the most sense. I'm going to go ahead and take him
00:02:3500:02:41
into some knee flexion. I'm going to use my body to block knee flexion. I'm going
00:02:4100:02:44
to be pushing down on his vastus lateralis so i'm going to go ahead and
00:02:4400:02:47
take this leg, make them a little bit more comfortable and stable by bending
00:02:4700:02:53
it, and then i'm going to be careful to actually put his medial gastroc
00:02:5300:03:01
underneath his vastus medialis. So that when i press down i get meat on meat and
00:03:0100:03:05
I don't do one of these like knee cap on ankle bone things, because if i press
00:03:0500:03:12
down there it's going to hurt. So we go here. I'm going to do my palpation
00:03:1200:03:19
posterior to anterior to feel for the most overactive or the densest fascicles,
00:03:1900:03:26
and then once i found them i generally know that trigger points in the vastus
00:03:2600:03:31
lateralis usually happen pretty close to the knee, or right dead center
00:03:3100:03:36
between greater trochanter and me. So you guys notice even when I put my hand down,
00:03:3600:03:40
I put my hand down pretty close to the center of his thigh, because i'm hoping
00:03:4000:03:47
to get kind of lucky here and not only put my hand down on overactive fascicles,
00:03:4700:03:55
but be pretty close to a nice tight nodule, a trigger point without having to
00:03:5500:04:02
do too much searching moving from distal to proximal, or proximal to distal.
00:04:0300:04:09
How's that feeling? That's a little more tender. Okay so now that I found this
00:04:0900:04:14
nice hyperactive point, I'm going to go ahead and this is going to be my dummy
00:04:1400:04:18
hand, I'm just going to let this totally relax. I'm going to take this hand
00:04:1800:04:24
straighten it out, alright so I'm noW using this hand to apply force. I'm just
00:04:2400:04:28
going to go ahead and lean over, and I'm going to wait for 30 seconds to 2
00:04:2800:04:36
minutes until that tissue density starts to decrease. The over activity starts to
00:04:3600:04:41
decrease, Brian tells me he just can't handle it anymore, which of course you
00:04:4100:04:46
need to listen to your patients and back off a little bit. Or of course he tells
00:04:4600:04:49
me that he's not feeling anything at all, the discomfort has subsided, that's
00:04:4900:04:57
probably a good sign we can move on. Now we can move on to other points right, so
00:04:5700:05:00
I can go back to, all right we did the one in the middle of his thigh, does he
00:05:0000:05:08
have anything near his knee. I feel a point right there, go ahead and put down
00:05:0800:05:15
some pressure. One thing that often gets mistaken with this technique, is once
00:05:1500:05:19
again I said this is vastus lateralis static manual release. I think a lot of
00:05:1900:05:24
people would look at me doing this and being like oh its IT band release. You
00:05:2400:05:29
can't really release your IT band guys. Trigger points are muscular phenomenon.
00:05:2900:05:37
There are some fascial techniques that might be able to help with gliding of
00:05:3700:05:42
the iliotibial band over the vastus lateralis, but these static compression
00:05:4200:05:48
techniques are muscular techniques for a muscular phenomenon, for the most part
00:05:4800:05:52
being trigger points, and what we're really trying to do is decrease that
00:05:5200:05:58
over activity. How's that feel?
00:05:5800:06:02
Good, let's go ahead and have you on your back.
00:06:0200:06:08
Now the other position that you can do for vastus lateralis manual release is
00:06:0800:06:15
similar to what is called the Iron Cross stretch, right cross stretch. This
00:06:1500:06:19
is the weird one where I have them in knee extension, I'm taking it further into
00:06:1900:06:26
flexion, but somehow the increased tension in the iliotibial band allows me
00:06:2600:06:36
to have enough tension in my vastus lateralis to still find hyperactive bands,
00:06:3600:06:43
and of course tight nodules. Which I of course then want to release. Now be
00:06:4300:06:48
careful with this technique. If you have somebody with low back pain this isn't a
00:06:4800:06:53
great technique or a great position to put them in. Notice I have a whole lot of
00:06:5300:06:58
hip adduction, his pelvis is rotated this way, I'm pulling them further into spinal
00:06:5800:07:06
flexion. Hip or low back this could be a somewhat a compromised position. This
00:07:0600:07:09
position does come in handy though if you're doing a lot of different
00:07:0900:07:12
techniques, and you happen to be working on the biceps femoris and then you can
00:07:1200:07:18
just go on to the vastus lateralis. I do find this an effective position.
00:07:1800:07:23
Next a little close-up recap. Alright guys this is your close-up recap, just so
00:07:2300:07:28
you can see my hands, the position of the leg, how I search for a trigger point. I'm
00:07:2800:07:32
going to go ahead and pull him into knee flexion. I'm going to use my body to
00:07:3200:07:37
block his leg, so now I'm not doing any work. I got both my hands-free. I'm going
00:07:3700:07:42
to go ahead and I'm going to use, I mean since is this vastus lateralis and it's
00:07:4200:07:47
very thick, very dense, chances are i'm going to use both thumbs to even search
00:07:4700:07:52
for overactive fascicles. And then you can see here, I happen to know that the
00:07:5200:07:55
trigger points are closer to the knee, or right in the middle of the muscles. So
00:07:5500:07:59
i'm going to put my hands pretty close to where i think those are, and then i'm
00:07:5900:08:05
going to search by finding the most overactive fascicles, and moving either
00:08:0500:08:11
proximal or distal, there's a nice one right there. Alright once i found that, i'm
00:08:1100:08:13
going to use my dummy thumb. I'm going to relax
00:08:1300:08:16
this hand. I'm gonna use the other hand to apply pressure, and when I say use the
00:08:1600:08:19
other hand to apply pressure i'm actually just pushing through my arm
00:08:1900:08:26
into my palm, and then making sure that we're meat on meat here, vastus medialis
00:08:2600:08:33
to gluteus, I'm sorry vastus medialis to medial gastroc. I'm going to go ahead
00:08:3300:08:40
and push down until I get a nice release, make sure you guys don't do this thing,
00:08:4000:08:46
because if i push down his kneecap into his ankle that's not going to feel
00:08:4600:08:53
good at all. To show you guys the other position, go ahead and have Brian move
00:08:5300:08:57
away from me a little bit, and then he's going to go into this kind of Iron Cross
00:08:5700:09:02
stretch. Now the trigger points would be in the same places on this other leg
00:09:0200:09:05
closer to the knee, or right in the middle of the muscle. And generally
00:09:0500:09:09
speaking I'm moving my hands in this direction, with this one alright. So I am
00:09:0900:09:13
applying a little bit of a distal to proximal force. I'm going to find those
00:09:1300:09:17
tight fascicles, that's a nice tight fascicle there. Let's see if I can find a
00:09:1700:09:24
nodule within that tight fascicle. A little marble, well there we go once i
00:09:2400:09:29
find that, again just apply a little pressure and lean in, and i am leaning
00:09:2900:09:36
this way guys, so I'm not pushing straight down per se. This position can
00:09:3600:09:40
be a little problematic for those individuals with low back or hip pain. So
00:09:4000:09:45
keep both these techniques in your repertoire, that first technique is
00:09:4500:09:50
probably your go-to. I think you guys will find this technique sometimes
00:09:5000:09:54
convenient if you were combining it with a bunch of other release techniques. I
00:09:5400:09:59
hope you guys enjoyed static manual release of the vastus lateralis. Remember
00:09:5900:10:02
if we have somebody up on the table, we're about to perform the manual
00:10:0200:10:06
release, we want to be eighty percent sure that's what they need based on our
00:10:0600:10:10
movement assessment. If we're talking about the vastus lateralis, things get a
00:10:1000:10:14
little complicated in the sense that we have to include the vastus lateralis in
00:10:1400:10:21
the tensor fasciae latae, iliotibial band, vastus lateralis complex, and then we
00:10:2100:10:25
start to see that the vastus lateralis gets included
00:10:2500:10:30
whenever the TFL does, on things like our overhead squat assessment. So that would
00:10:3000:10:36
be signs like feet turns out, knees bow in, excessive forward lean, anterior
00:10:3600:10:42
pelvic tilt. If I was doing goniometric assessment while the vastus lateralis is
00:10:4200:10:46
a knee extensor, so if I saw a limitation in knee flexion that might
00:10:4600:10:52
give me an indication in a limitation in hip extension, as well as hip internal
00:10:5200:10:59
rotation, may also be indications of vastus lateralis over activity. Once
00:10:5900:11:04
again please mind your scope of practice. if manual release techniques do not fall
00:11:0400:11:09
within your scope do not attempt this. If you can find individuals to practice on
00:11:0900:11:14
before you actually attempt this on patients, that would be beneficial. There
00:11:1400:11:21
is no substitution to having a mentor or taking a manual therapy course, but even
00:11:2100:11:26
just practicing on your colleagues will be very beneficial. Being able to talk to
00:11:2600:11:32
another manual therapists about hand position, and what things felt like, and
00:11:3200:11:36
body position, and whose pressures felt the best is invaluable information. I
00:11:3600:11:41
hope you guys enjoyed this video. I look forward to talking to you soon.