This is Brent of the Brookbush Institute, and in this video we're going to go over a joint
based manual therapy technique. If you're watching this video I'm assuming you're
watching it for educational purposes, and that you are a licensed professional
with joint based techniques within your scope; that means osteopath's, chiropractors,
physical therapists, you're probably all in the clear. Physical therapy assistants,
athletic trainers, massage therapist you need to check with your governing body
in your state or region to see whether this is within your scope of practice.
Personal trainers this is definitely not within your scope of practice. Of course
all professions could use this video for purely educational purposes to help with
learning biomechanics, anatomy and of course palpation. In this video we're
going to do our superior to inferior, or cranial to caudal clavicle on sternum
mobilization. So this are our caudal sternoclavicular mobilization, I'm going to
have my friend Melissa come out and help me demonstrate. Now this is an
interesting technique that I want you guys to keep in your back pocket, I find
it very very helpful for those stubborn stiff shoulders where you can't quite
figure out how to get that last five degrees of shoulder flexion, or five
degrees of shoulder external rotation; and I know some of you guys are thinking
well wait a second, how does the sternoclavicular joint contribute to
shoulder range of motion? And this, this gets a little deep into biomechanics but
we do have some research to suggest that those with shoulder impingement or
shoulder dysfunction, do not get enough elevation and posterior rotation of the
clavicle during elevation of the arm. So if we're not getting enough motion of
the clavicle, we might want to start thinking towards well could we have
stiffness in the SC and AC joint. Now in this video we're going to focus on an SC
joint mobilization, so why would I go superior to inferior, well if I'm
thinking about trying to get more elevation of the clavicle based on the
way the clavicle is shaped being a saddle joint, we can presume that it
follows concave on convex rules in the frontal plane right. So this joint wants
to as the clavicle elevates, roll superiorly,
which means we also need the glide inferiorly; hence why we come back to
this superior to inferior glide that I want you guys to keep in the back of
your brain, to try to help elevation of the clavicle, which just may help you get
those extra few degrees with that stubborn stiff shoulder. So from here we
kind of need to know how do we place our hands, how are we going to make this
technique work, and that all starts with your knowledge of anatomy and and being
able to palpate, and I would start with just palpate the clavicle, try to try to
outline the clavicle. If you've never done that before, I mean we all know
where our collarbones are that's fine, but start visualizing the shape of the
clavicle and try to find the rounded end of the clavicle. One rounded end, the
distal end would be the AC joint, but that proximal end is right where the
sternoclavicular joint is, and if you keep exploring the border of that
rounded proximal end you can actually feel like a depression, like a line
between the flat sternum, in this case actually the manubrium which is the top
of the sternum, and the rounded edge of the clavicle. And what I'm going to have
you guys do is once you find that, without jabbing somebody in the neck
which I know I jus jabbed Melissa in the neck there,
but without jabbing her in the neck I want you guys just to take two fingers
and put them right right over the joint line, we're going to use these as our
feelers of joint glide. Once again it's one of those things
where I just don't see taught often enough in joint mobilizations is if you have a
free hand, if you have the opportunity to use your fingertips to feel a joint line,
it's always a good idea to do so. It's going to help you determine when your
first motion happened at the joint, and of course when the end of arthrokinematic
motion or the end of glide happened as well. Now the way I'm going to mobilize
this joint is a little different than this technique which I've seen
traditionally in texts and and in some videos.
This is pokey like you guys could just see Melissa's face kind of like uhh, and I think
some clinicians are ok with with a little pokeyness sometimes if they have
to, and and not that I want to say that there's a problem with that, but there is
an alternative way to do this technique where you just don't need to be poking
at somebody's bony sternoclavicular joint. Use these two fingers to feel the
joint line, and then just use your your thenar eminence close to the joint line
on the clavicle; and so if I do this you guys can see now notice I have my
fingers pointed up here right ,like we don't want roaming fingers over
somebody's chest no need to get yourself into trouble, but
if I just put my thenar eminence nice and close to the joint line and I
press in an inferior direction, I can immediately feel the clavicle move
against my fingertips. No need to do this, nice broad surface area not pokey, and
providing I don't let my hands slide down over the top of Melissa's neck like
I'm going to choke, her like we definitely don't want anything like that.
And if I just kind of keep right on top of the clavicle and I push that way, how
does that feel? A lot better than this right. Okay yeah pokey, not pokey. A couple
precautions before we get started with our protocol here guys, watch
their sternocleidomastoid, keep in mind that your sternocleidomastoid like
goes right over the top of your sternoclavicular joint. So if somebody
starts tensing up and starts really guarding on you, you're not going to get
a good mobilization. It's also going to make them feel a lot more uncomfortable
because it's going to put a lot more tense muscle in your way which, we don't
want anything bearing down on the neck. So fingertips here, thenar eminence here.
I'm watching to make sure that her sternocleidomastoid aren't getting
geared up, and then I'm just going to go okay where's my first resistance barrier,
and it's right there, and then where is the end, is right there.
I'm going to back off to 50%, and then I can either do my grade 3's by coming all
the way back to the first resistance barrier, and doing like a larger
amplitude mobilization here. Or I could do my grade 4, going all the way down
arthrokinematic end range, back off 50% and stay right there at 50%, being a
little bit more intense than our grade 3. Now one thing I do want you guys to
notice is how straight this arm is, like I'm basically locked out here, and I'm
using my my core muscles to push. So don't think because you're seated you're going
to get away with like muscling this technique. You don't want to turn this
into like a chest press, like this is not a good thing, notice all like I'm just like
rocking her whole body anyway. What I really want to do is have my arms pretty
much straight out, be straight on to the table with my feet, and then like I'm
just using the weight of my trunk to push into Melissa's clavicle, Stay tuned
for your close-up recap. To give you guys a different view of our superior to
inferior sternoclavicular mobilization, the first thing we're going to do is
palpate the clavicle right. So hopefully you guys can kind of see how I'm
outlining the clavicular bone, and I actually want to follow the clavicular
bone medially until I fall off the clavicular bone. I can feel this nice
round bump here, and it approximates the rather flat manubrium which is the top
of my sternum. So you guys can see here my fingers are on this flat sternum, and
then if you watch me kind of go like this medial to lateral, you guys can see
my fingers kind of bump up over the rounded edge of the clavicle. Now what I
want to do is actually use my other hand to palpate the joint line. I'm going to
palpate my joint line, and that's going to help me determine
when my arthrokinematic motion starts with this mobilization, when I've had hit
end range arthrokinematic motion, and I mentioned before I'm just going to use
my thenar eminence here close to the joint, without being on top of Melissa's
throat, and without having to be on top of my fingers because that's not going
to be verycomfortable for me. So right here is probably good, and I can feel as
soon as I push down, I can actually feel with these fingers that joints start to
move. So there's my first resistance barrier just that easy, and then I can
feel the end of arthrokinematic motion and then back off to 50%; and I can do
either my grade 3s by starting at first resistance barrier and going to 50% in a
larger amplitude, or I can stay at 50% in small amplitude and do my grade fours.
Notice this is fairly comfortable for both Melissa and myself since I have my
arms straight, and I'm just using my torso, my core muscles essentially to
create the oscillatory motion. I'm not using my hand strength, I'm not using my
arm strength, it's really just the weight of my torso leaning forward and a little
core strength to create that oscillatory motion. Once I finish one to two
oscillations per second and start to feel a decrease in arthrokinematic
stiffness, I'll then go ahead and reassess. So there you have it assess,
address, reassess. Make sure that every time you choose a joint based manual
therapy technique it is based on an assessment, and that you return to that
assessment after you've finished the intervention to see if it was effective
for the individual, the patient or client that you had in front of you. Ensure that
you continue to learn your Anatomy because your Anatomy is going to help
you with your hand placement, with understanding what a joint can do, with
understanding what you may gain from this particular technique. And of course
practice, you have to practice these techniques hopefully not for the first
time on a patient or client who just walked in the door. If you can, find a
more senior instructor or a mentor to give you some really good hands-on
instruction. Use your peers for some good feedback, and of course always look for
live education to help with your manual therapy techniques. I know these videos
make education very convenient, but there is no substitute for learning manual
therapy in a live setting. I look forward to talking to you guys again
soon.