This is Brent of the Brookbush Institute, and in this video we're going over
static manual release of the tensor fasciae latae and gluteus minimus. I'm
assuming that if you're watching this video you're watching it for educational
purposes, and that you are a licensed manual therapist or student on your way
to becoming a licensed manual therapist. Personal trainers this technique
probably doesn't fall within your scope, although you could use the palpation
portion of this video in an educational setting to help you learn your Anatomy.
I'm going to have my friend Melissa come out, she's going to help me demonstrate
this technique. Now all of these techniques follow a very similar
protocol, over simplified that protocol would look something like palpate and
compress. We're going to break it down a little further than that. We want to be
able to palpate and differentiate these tissues from other muscles in the area.
We do get bonus points for knowing our trigger points, so if you know where the
common trigger points in the tensor fasciae latae are, the common trigger
points in the gluteus minimus are, you will narrow your search field a bit and
you won't have to search around quite so much to find those local points of
overactivity. We do have to keep in the back of our head is there any tissues in
this area that compression or abrasion might insult. So are there any nerves,
lymph nodes, arteries. There are some nerves in this area but usually they're
fairly small nerves, and if you happen to give somebody a tingling sensation or a
burning sensation, it's pretty easy to get out of the way of those nerves by
moving backward or forward. Last we have to figure out what position can we put
Melissa in that will add some tension to this muscle. So we've pinned down those
nodules, those trigger points, those locally overactive muscle fibers right.
We also have to make sure she's comfortable and possibly most
importantly, that we're comfortable that we're using our own body mechanics to
apply pressure, so that we don't wear ourselves out over the course of one
session or one day, one week or even one career. We don't want to be using so much
of our hands that we only get a couple of these
techniques before we're tired. Now let's start with our palpation and the anatomy
involved in the tensor fasciae latae and gluteus minimus here. The first thing
you're going to want to find is the top of the iliac crest here right. So the top
of her pelvis, because I'm going to want to follow that to her ASIS, I'm going
to go ahead and put the top of her pants over the top of her ASIS, so I know where
that's located. I'm then going to go ahead and find her greater trochanter.
We've actually put a little dot here on Melissa's pants right, so that we can
mark the greater trochanter so that you guys can see it, if not in this view in
the close-up recap. If I go from ASIS to greater trochanter, and then back up the
mid-axillary line to the to the iliac crest here, in that triangle is my TFL,
and right in the middle of that triangle is where the TFL trigger point usually
is and we have that marked off. Now the gluteus minimus is just behind the TFL
right, so the trigger point is also in the middle of that muscle,
generally speaking falls just behind the mid-axillary line above the greater
trochanter. So we're dealing in this little triangle right here below her
pelvis and above her greater trochanter. Now to add some tension to this muscle
I'm going to kind of use a modified Obers test right. I'm going to go ahead
and bring her leg back, and if you watched the vastus lateralis video I
talked about how we should put the vastus medialis on top of the calf,
because what you don't want to end up with is kneecap on top of ankle because
that hurts. When you start pressing, so we're going to take the meaty part of
her of her quad here put it on the meaty part of her lower leg, so that when I
start pressing, we're just compressing soft tissues we don't
have any problems there. Now I'm going to palpate across these faacicles. This is
a fan-shaped muscle right, a fan-shaped muscle whose fascicles run this way. So
I'm going to palpate from anterior to posterior to find the tightest fascicles,
and then I can start. Once I find some tight fascicles I can start moving a
little bit more distal, or a little bit more proximal to find the tightest point
within those fascicles, and then of course I'm just going to apply my
pressure. I can use a thumb over thumb technique. I can use my pisiform over
thumb technique. I can use my inner thenar groove over thumb technique here,
and then you'll notice I have the table pretty low here with Melissa, so that I
can just lean in until I get a little increase in tissue density here. I
don't want to go further than that. I don't want pain. I don't want the tissues
to all of a sudden guard on me because I'm pushing in so hard just right
up until I hit some tissue resistance, how does that feel Melissa? Yeah that's,
that's tender. This muscle definitely tends to get tender. A lot of people talk
about IT band tightness and iliotibial band syndrome, and runners knee, guys your
IT band is connective tissue it's not muscular tissue. Your IT band doesn't get
tight, but your TFL will get over active and short and pull your IT band tight. so
on a lot of these individuals what you'll find is they have very sensitive
trigger points in their TFL, and releasing them usually does them some
good. Sometimes you have to be a little gentler, so sometimes the 30 seconds to
120 seconds static hold doesn't work out as well as maybe the five seconds on
five seconds off, an increasing pressure a little bit each time.
Trying to desensitize that area a little bit. Be gentle with people, you crush
somebody right off the bat they might not come back, and if they don't come
back you're not going to have a chance to fix their problem. Now after I get a
release in the tensor fasciae latae I can just keep moving my thumb back, keep
using that same anterior to posterior strum of her fascicles to find other
tight fascicles. The gluteus minimus guys is basically the tensor fascia latae's
nasty cousin. Both muscles do the same joint actions, both muscles are
involved in the same dysfunctions. The only difference is the gluteus minimus,
it does not have an attachment to the iliotibial band. Once I find some tight
fascicles I'm going to narrow in by going proximal to distal, or distal to
proximal to find the the tightest point within those fascicles.
And again I'm going to apply my pressure, I could do the five-second holds on and
off, increasing pressure each time if she was really sensitive. Or I could go in so
I meet tissue resistance, hold for thirty seconds to a hundred and twenty seconds.
Alright guys in the next video you'll see or in the next section, you're going
to see us do a close up recap so you can see exactly where I'm putting my hands.
Alright guys for the close-up recap let's start with palpation. The top of
her iliac crest is right here alright. I'm going to put the front of her
pants over the top of her ASIS, and then we'll kind of adjust here. Make sure our
little markings there are over her greater trochanter. So we used this
little beige button to mark the greater trochanter, ASIS, greater trochanter, up
the mid-axillary line. In between this triangle right here is her tensor fasciaE
latae, that nice fan-shaped muscle. And you can see we've marked off that trigger
point which is basically in the middle of that muscle. You notice just posterior
to that trigger point is another trigger point, marking this one representing the
gluteus minimus which again falls behind the tensor fasciae latae, but doesn't
have an attachment to the iliotibial band. So as far as my palpation I'm going
to use those anterior to posterior kind of strumming, with a broad thumb
here. Find the the most overactive fascicles there, and then move. In this
case since I'm starting so proximal, I'm going to go ahead and keep moving distal
until I find the tightest point, maybe even a little nodule within those
fascicles that's where I'm going to apply my compression. I'm going to use my dummy
thumb and then either my inner thenar groove here, or my pisiform to go ahead
and apply pressure. I do find it helpful to add a little bit of a distal to
proximal angle to this to help pin down that trigger point. I'm just going to go
up to tissue resistance, and then hold it for 30 seconds to 120
seconds. I did mention that this area does get very tender on people. You guys
have heard of iliotibial band syndrome, runners knee, a lot of that comes from
the tensor fasciae latae being overactive in those individuals and pulling on the
iliotibial band, and it'll get it'll just get tender to the touch. So that five
seconds on, five seconds off, five seconds on a little harder, five seconds off to
help desensitize is sometimes a better way to start this technique. Then of
course after I finished releasing this trigger point I can just keep going with
my anterior to posterior strums, and I'll find my next trigger point in the
gluteus minimus, and again just use my my pisiform over thumb grip here, apply
pressure until I hit that first tissue resistance, and hold for 30 to
120 seconds. So there you guys have it, ASIS, iliac crest, greater trochanter, TFL,
gluteus minimus behind it, and trigger points right in the middle of those
muscles. So there you guys go that was static manual release of the tensor
fasciae latae and gluteus minimus. As I've said in all of our other manual
release videos, make sure that by the time you put your hands on somebody you
are 80% sure that those are muscles that need to be targeted with manual release
techniques, and you should know that from your movement assessments. Manual
release techniques by themselves make terrible assessments, be practising these
techniques often, and if you can with your fellow professionals. The ability to
practice with somebody who also does manual release techniques, to have these
techniques done on you is learning that you are not going to get from this video,
and no matter how well I speak, or how well we demonstrate this stuff on video,
you need to have that practical application before you try this on
our patients and clients. I hope you guys enjoyed this video. I hope you learned a
lot from our video and this technique. I look forward to hearing about your
outcomes.