This is Brent of the Brookbush Institute, and in this video we're going to go over
manipulations or high-velocity thrust techniques. I assume that if you're
watching this video you're watching it for educational purposes, and that you
are a licensed professional with high-velocity thrust or manipulation
techniques in your scope of practice. If you are not sure check with your state
board, most physical therapists, chiropractors and osteopaths you're in
the clear. I believe that ATC's you can't do manipulations in the United States,
although other countries again check your scope. Of course massage therapists
and personal trainers these are generally not within your scope. Of
course you could continue to watch these videos just for educational purposes,
learn a little Anatomy, learn a little biomechanics. If you're going to do these
techniques please make sure that you have a good rationale for putting your
hands on a patient, this should be based on assessment and if you're going to
assess I'm hoping that you'll assess, use these interventions and reassess to
ensure that you're getting the result that you're looking for and have good
reason to continue using this technique. In this video we're going to go over carpal
manipulation, I'm going to have my friend Yvette come out, she's going to help me
demonstrate. Now keep in mind if we're doing manipulations they're always based
on subjective and objective measures. In this case maybe we would be looking at
pronation, supination, flexion and extension of the wrist. All right we
could try some goniometry for flexion and extension of the wrist,
it's questionably reliable. I think you are going to find this technique is
actually super simple and kind of fun. So go ahead let's do your your left wrist,
there we go. So what you are going to do is you're going to palpate to the end of
the radius and ulna. Now at the end of the radius and all that you know
you have a proximal and distal row of carpal bones. Now we could go through all
of these different bones and all that fun stuff, but we actually don't have to
for this technique. All you need to do is you can do like
posterior-anterior glides to check passive accessory motion. You could
even keep your hands, thumbs on the rows and test flexion and
extension and see if any of the bones
feel stuck to you, and you can just move over in a real segmental
fashion. Remember these bones were pretty small, so as you're moving through good
okay, well now you found something that you think is stiff. Once you find
something that you think is kind of stiff, maybe I think right there is stiff,
what we're going to do is we've got to lock out this joint. So how are we
going to lock out this joint, we're going to pull a little bit into
traction I'm going to pull to the end of extension. Now as I'm pulling to the end
of extension, what I'm doing is I'm actually applying, what are we gonna
call this, a volar to palmar, there you go look those words up
force. So we're going from the back of the hand to the front of the hands
force this way, so I'm pushing down with my thumb as I pull into extension.
Once I have our lock out I'm now going to do that ever so fun whip. So we
get her here, and then and boom we got a nice little cavitation. All right and
then if I wanted to I can move over, okay right there and boom we got another one.
Then I can move over again and we got another one, isn't that great. Now the
thing that people forget is you don't have to just go into extension, if I feel
like there's stiffness into flexion I can now go opposite. This gets a little
tricky, I tend to use like this knuckle right here to palpate the bones
from underneath, and then once I get good purchase I'm just going to whip into
flexion. Are you ok, am I pinching? I'll try not to pinch. So it's
probably better as I'm taking my thumb's here, the mistake I made on
the first one is I had my thumb's a little too high, so I was pushing into a
lot of soft tissue, pushing that soft tissue into these tiny little bones. If I
cross my thumbs over her metacarpals it's a little less pinchy, I'll try to
get a little lower here too, that's it. So there you have it,
these manipulations are super simple. I'll go ahead and do a close up
recap for you so you can see how my thumbs are moving across, but essentially
again you're going this way when you're going into extension and it's a whip, and
you're going to push this way and pull into a flexion when you do a
whip this way. Stay tuned for your close-up recap. So I just wanted to show
you a little closer on what I'm palpating. So if I come to the end of my
radius and ulna I'll feel my little carpal bones, which feel like little
pebbles. As I move them from dorsal to volar, my mistake in the
previous video for saying volar and palmar are as opposites, those are synonyms
so dorsal to palmar or volar. I can see if there's stiffness,
and I feel a little bit of stiffness right here. Now once I feel stiffness I'm
just going to go thumb over thumb, I'm going to pull to end range extension
so you can see here this is what I'm doing with my other fingers.
Once I get to end range I just give it a little whip, that's it all
right real easy. I can move to the next segment over, all right so that's if I
was here which might be her hamate, and then I can move over here and I can
pull all the way down and do it again. Alright if I wanted to go more medial I
could do that, alright thumb over thumb, and if I want to go into flexion work on
maybe flexion range of motion I could do that. I could then go from palmar to
dorsal, see if I feel any stiffness that way. Now this time I'm going to use
more like this part of my fingers here to push up this way, and so without
getting too mean to Yvette's hand here I'm just pushing up this way
using my knuckle as my fulcrum. Then I can pull all the way
into flexion, and then just a little whip. So there you have it, give
those a little experimentation with friends and colleagues first, and then of
course you can try them with patients. If you have any questions leave them in the
comments box below. A couple of points to recap. knowing your anatomy and knowing
your biomechanics will certainly help you choose the right technique for the
right patient. If you're unsure whether manipulations are appropriate due to
their higher intensity it's okay to do mobilizations. Most research points to
manipulations being slightly more effective but mobilizations being very
effective, and of course we have those videos for you if you want to start with
those less intense techniques. Make sure that if you are doing any technique that
is based on assessment, and of course that you're reassessing ensuring that
the technique is effective for the patient that you're working on, and when
it comes to all manual techniques, manipulations maybe more than any other,
look for opportunities to get live education. Although I know videos are
convenient and I'm happy to have these up for you to watch, it would be so
much more helpful to use those videos as a recap of one-on-one attention with
somebody who's experienced with manipulation techniques. At the very
least grab a colleague, grab a friend and start practising these before you bring
them into clinic and start using them on patients and clients. I hope you enjoyed
this video, if you have any questions please leave them in the comments box
below.