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 the
talocalcaneal manipulation. I'm going to have my friend Yvette come out she's going to
help me demonstrate. Now keep in mind if I'm doing a man it for the tailor
calcaneal joint I've already done some sort of dynamic or transitional postural
exam like the overhead squat assessment and I have a continuous interval measure
to measure my progress something like Gani amma tree and maybe even like a
special test to go back and retest concordant signs i'm not gonna rely on
palpation alone although it is important that we know how to do a passive
accessory exam to try to indicate whether this is needed now in order to
do a passive accessory joint motion exam and then of course the manipulation the
first thing we need to be able to do is find this joint and this is the joint
between your tailless and your calcaneus now I know what some of you are thinking
that joint doesn't move a whole lot and you'd be absolutely right but it does
move a little so let's figure out how to how to figure out how much it's moving I
think I've shown you guys in several other videos that if you slide your
fingers pincer style right thumb and index finger right around
right underneath rather than malleolus that you'll end up on the tailless right
especially that anterior just in fear and anterior to the maleo why we end up
on the neck of the tailless and that's been an important landmark throughout
many of our manual technique videos now of course the calcaneus guys is your
heel so if I can wrap my hand around the tailless just inferior to the maleo lie
and then wrap my hand around the calcaneus and wiggle there should be
some wiggle now again this is a stiff joint this isn't like the taylor cuboid
joint or it doesn't even move as much as like the taylor and a Vick euler joint
which doesn't move that much either this join us stiff we have to think like yeah
it needs to be stiff right it takes on heel strike but here's the problem
if it gets stuck and that's what it'll feel like if somebody really needs this
if it doesn't move at all it does kind of wreak havoc on mechanics and
especially that absorption of ground reaction forces you can imagine like if
it's like stepping into a block like right like you're just walking on bricks
that's gonna affect your ankle that's gonna affect the way your foot moves
that might track up and you might not absorb force all the way as well through
your knee and hip right we can end up with all sorts of like lower extremity
symptomology anything from a Keeley's tendonitis to like knee pain now once we
know that this is stuck and we'll say for the sake of this video that a vets
joint is stuck here now we have to go well how am I going to manipulate that
joint and what we're gonna kind of do is manipulate it into e-version right so
we're almost gonna assume that we have calcaneal varus and we're gonna try to
manipulate it into valgus which is what I've found at least in clinic most often
the case so I need to figure out how to stabilize these bones I need to figure
out how to get lock position which we keep talking about in all these videos
lock position being able to wind up that joint is is 90% it's all set up and then
you know or our thrust should just be the icing on the
the cake so what I need to do is figure out how to stabilize the tailless and
the calcaneus wind it all the way up and then thrust what that's gonna end up
looking like is we're gonna have this cross hand technique
I'm gonna use my pisiform hamate or maybe my hypothenar eminence on the
neck of my tailless all right so just anterior and medial to my maleo lie I'm
kind of bracing all that you guys notice I'm already pushing down pretty hard
and the reason I'm already pushing down pretty hard is because I have to get
through the cushion of this table so some of you guys with really really
cushion two tables you probably want to find a little firmer surface for this
particular minute all right so we're all the way through the softness of the
table I'm then gonna take my other hand right now let's put my calcaneus right
here between my thenar em and I and I'm gonna lock everything up right so I'm
just gonna push down and literally what I'm doing is taking those two bones and
what it feels like in my hands is I'm pushing my calcaneus this way and my
tailless this way I'm just pushing them all the way down taking up all the slack
and everything in the cushion of the table whoops this way there we go
alright so I got got on like this and then of course my high velocity thrust
how am i client take a nice deep breath and she's not taking a deep breath
because breath is exactly related to manipulation at least as far as I can
tell it's more of a distraction just to make sure that they're not tensing up on
you and then I'm gonna do my little thrust all right and keep in mind I
moved right so this is a low amplitude high velocity thrust and of course I got
the velocity part down and usually what I see from people is good velocity but
you do have to have enough amplitude to get through all the tissue slack to get
through all the soft tissues to ensure that all that's left is moving that bone
past that stiff point all right so I'm gonna get I slowed this hand just medial
and and terior to the malleolus stabilize the
tailless came over the top like this right saddam on the calcaneus and then
just whoa that's it and then i can retest my passive accessory motion exam
and then of course if I had a concordance I an exam for example like
during the eccentric step-down test that replicated her symptoms I went back to
that it helped a little bit looked at her overhead squad I could do my
goniometer II right and see if this was actually an effective technique to
determine whether I would use it again guys stay tuned for your close-up recap
all right guys for your close-up recap you got your tailless right here as
we've mentioned in several videos you can you can kind of grab the neck of the
tailless just distal and anterior to the bottom of the maleo lion of course you
can stabilize that joint by just sliding your pincer grip right underneath the
Mallee oli and I think you guys all know that your calcaneus is your heel bone so
if I stabilize this joint real good and then grab my calcaneus to see if there's
any motion in a lateral to medial direction right or an aversion to
inversion or varus to valgus direction however you prefer to think of it you
should have just a little it's the people that have almost none that we
need to start thinking about doing this manipulation on because no motion
between these two joints is going to create some problems when we talk about
gait and absorbing those ground reaction forces now how you're going to
manipulate this join us to stabilize the tailless with your pisiform hamate or
your thenar eminence by going just medial tight to your maleo lion I'm
really kind of like putting my hand right here so I'm really over the Taylor
neck as well as some of the rest of the tailless and then this hand goes over
the top like so and I'm putting the calcaneus right here so I'm taking up
all the softness in this table and really as much slack as I can and the
tailless first with this hand then pushing down on the Kahless calcaneus
rather to get all of the motion that way taken out so now I've pushed this far
into a version of they can so that when I do this thrust
it's gonna push me past that resistance barrier all right tell my client to take
a nice deep breath and if she breathes out I'll just kind of and that's it
that's it remember it's all about setup it's all about stabilizing this joint
getting that lockout position by pushing all the way into valgus this way and
then you're just real quickly bending a little further to get past that that
locked position past the point of stiffness 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 guys
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 guys 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 practicing 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
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