This is Brent of the Brookbush Institute, and in this video we're going over
manual therapy techniques, specifically instrument assisted soft tissue
mobilization. Now if you're watching this video I'm assuming that you are a
licensed medical professional, with instrument assisted soft tissue
mobilization within your scope of practice. Now there's some gray area here,
not every state has legislation around these tools. If you're not sure, check. I
would hate to see somebody getting in trouble because they watched one of our
videos and used it on a patient or client when things did not fall within
their scope of practice Act. Now these tools just like all of our other
techniques fall within a model of practice, and we are very big on assess,
address, reassess. So even though these tools are specific to perhaps facial
tissue, we're still going to base their use on reliable assessments. We're going
to use these techniques and then we're going to reassess, and if they're not
effective we're not going to use them again for that particular patient or problem.
In this video we're going to go over instrument assisted soft tissue
mobilization for the plantar fascia. I'm going to have my friend Sonja come out,
she's going to help me demonstrate. Now some of you are probably thinking wait a
second, isn't the plantar fascia a structure with a propensity to get long.
If you think of what happens to the plantar fascia when somebody goes into
PES planus, or feet flattened. If you think about what happens to individuals
who compensate by increasing dorsiflexion at the transverse tarsal
joint because of restriction in their posterior compartment here, and a lack of
dorsiflexion. All those things point to a lengthening of the plantar fascia, so why
would I be using a mobility technique? This is where things get a little
complicated, what happens to fascia when we stretch it or stress it with an
IASTM tool is not the same thing that happens when we like stretch or release
a muscle. In fact there's some research to point to repetitive stretching
leading to something called strain hardening, which actually increases the
stiffness of facial tissue; and if I think about increased stiffness that
could be a good for my plantar fascia in those who have
lower-extremity, particularly foot dysfunction. So what we're going to do now
is we're going to go ahead and do the same technique that we have been doing of
this kind of running these tools through the plantar fascia, in hopes that in
response due to this strain hardening which is both a hydration thing and
stimula is a stimulation of the sympathetic nervous system thing right
that we get an increase in stiffness that will support the arch a little bit
better. So usually I'll start in this position to do these techniques. We're
going to go ahead and use a little bit of our smart tools cream here. We
don't want to run through the skin before we affect the fascial tissue. Again
I can rub that in with my fingers and feel if there's any particular points
where I think there's an increase in tissue density, or abnormal tension. Or
maybe even my patient being abnormally sensitive in an area. One of the
responses we definitely get from these IASTM techniques of some desensitization.
An altered afferentation which might decrease pain a little bit.
So once I have her foot here, the first thing we want to do is we want to scan.
So just like we did with the crural fascia we're just going to start at the back
of the heel and kind of run one of our tools through the length of the foot.
You can see here I'm actually using this bat wing tool because it has
a double bevel, which means it's been shaved down from both sides which
is a little duller than those single bevels. The bottom of the foots really
sensitive, if I were to use this scanning tool it can be really intense.
Maybe I don't want to start that way. So I'm going to scan and notice
anything different in tissue tension or tissue feel. Usually you'll get a
bumpiness in areas where we think there might be
some dysfunction, and right in the medial longitudinal arch she does have a little
bit of that bumpiness. Now with that being said I now want to
kind of go through in different directions but because it's her foot I
want to be intentional and quick. If you keep at the plantar fascia you're going to
drive your client or patient right off the table. So I'm just going to go ahead
and go in a couple different directions here. If I felt like this tool was
too big I can go to maybe the shark tooth tool. Come in and go that
direction, go to this direction. Alright if I wanted to go across the foot I'm not
going to be able to use this surface, I might have to use just the tip here and
go this way. Alright remember the disordered collagen matrix alright is
going to go in any direction. I come through here. Now if I wanted to maybe frame the
different sides of the foot I could use this corner in here, kind of come across
like so and I might not be able to go in a lot of different directions there, but
at least I'm affecting that fascial tissue a little bit with repetitive
stretch and some shearing force. Come through this way.
Maybe last I I take it all the way up to the heel, and we we used this on that
crural fascial video, but I'm going to use this smaller curve here and just
go straight through the heel, maybe in a couple different directions just trying
to affect the plantar fascia as much as I can. Now we talked about the strain
hardening, we could also talk about mobility between fascial layers. Although
in the case of the foot the restriction we're probably more worried
about, is if any of these tendons for the toes get bound down to their sheaths or
other layers of fascial tissue. So what we might want to do is some of
our more active pin and stretch style techniques. So what I'm going to have
Sonia do is flip over for me, and again you're going to want to go at this
within intent, know what you're doing, don't mess around. This is not comfortable,
but I'm going to go ahead and right up underneath the ball of her foot I'm
going to pin down and then I'm going to have her dorsiflex and pull up her toes.
How's that feel? Tough. Alright good, and we've talked about how that might be the
first step just pin down and up. Alright pinned down have her pull up, and
then I could try pinned down as she pulls up, I'm pulling through a little
bit. I'd be a little bit more intense, pinned down pull up, pull through a
little bit, and then of course if I wanted to be really tough I can get down
into position here and what I'm going to do is I'm going to use my chest to help add
some overpressure and pull her toes back. So I'm going to pin down have her pull
up, and then just give her a little bit of overpressure right and down, have her
pull up, give a little bit of overpressure.
So there you have it, all you're doing is basically going through
nice long strokes through the plantar fascia. You can do some
cross friction with this tool. It is going to be very hard to go in a bunch
of different directions, but we can get some with the cross friction and then
don't forget to add a little bit of these more active mobility techniques
with kind of like the pin and stretch. Supine is a little easier, so you're
going to have them pull up their foot as you pin, pull up their foot as you pin,
and then of course you can add overpressure by placing your chest or
the bottom of your rib cage over the top of their foot and pulling back their
toes. Stay tuned for the close-up recap. For your close-up recap,
and you use just a little bit of cream here on the bottom of the foot.
Notice I never stick my fingers inside the cream that's just a good way to
kind of spread any dirt and grime that might be on your hands.
Rather use a freshly-cleaned tool before each session and then I'm just going to go
ahead and rub this in. Once again I'm noting any changes in tissue texture or
differences in tissue density. You will notice that I just have her
foot stabilized against my stomach in the bottom of my rib cage here, again I
used just a little too much cream. So we'll go ahead and take that and just
kind of moisturize Sonja's ankles here. That's okay we're going to go ahead and use
this Batarang tool from smart tools. Notice it's a double beveled which
means each side has been sanded down, and these are just a little duller
than the single beveled ones. So what I'm going to do is just pull through the
tissue noticing any differences. You see how I push in until I just get a
little kickback from the tissue. So I'm going through the softest top layers,
softest most superficial layers, and then just dragging through noticing
any differences. I definitely notice a little bit of
difference here in the medial longitudinal arch, so I could do some
down strokes this way, some up strokes this way, but if I want to do different
fiber directions I'm probably going to have to use a smaller tool like the shark's
shark thin tool, and then I can kind of do some like almost cross fiber or cross
fiction type stuff. You will notice I'm still at about that 30-degree angle,
so I'm not flat to the tissue. I want to make sure I'm dragging some tissue
underneath the point of this tool and then I can use this corner to
frame the foot, get at some of those other parts of the plantar fascia. I
really try to affect as much as I can, once again going for that strain
hardening and that stimulation of the sympathetic system which might increase
tissue tone a little bit, via those myofibroblasts ;and then if I want to
go over the heel we're going to use this little hooked piece, and they use
actually a smaller surface even though the smaller surface happens to be a
single beveled. I'm just going to watch how hard I press as opposed to the double
bevel of the larger one of these, kind of come through here, go in both directions
and then it would be really hard for to show you in this position how I
would do the pin and stretch technique. You saw a better view of that in
the full-body view, but just remember all you're doing is you're starting this way
pinning down some tissue, going to your 30-degree angle and then, go ahead and
dorsiflex for me Sonia, then having her pull her foot down
and her toes up, and then of course you could add overpressure. So you're pinning
down this way, and you see that the depth that I'm getting into the
tissue there with a tool, and you'd continue to push through. So there you
have it, instrument assisted soft tissue mobilization. Make sure to assess, address
using the intervention and then of course reassess; and if you get the
chance, these videos are not a replacement for live education of course,
if you get the chance you should take live workshops or find a mentor who's
experienced using these tools. Or maybe a friend that wants to learn them too so
at least you can practice on each other and give each other some tactile
feedback of what you feel, how you felt the next day, what results you felt that
you got. I hope you enjoyed this video, please feel free to leave your
questions below.