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
sacroiliac joint manipulation, the technique is commonly referred to as the
Chicago technique or the Chicago roll. I'm going to have my friend a Yvette come out,
she's going to help me demonstrate. Now this technique we could use for sacroiliac
joint stiffness. Obviously we want to base that on several assessments, not
just palpation skills. However, if you want to look up how to do a passive
accessory motion exam, which is basically a joint mobilization P-A check out
our sacroiliac joint mobilization posterior to anterior video, and you'll
get a good idea of all of the palpation and how to actually place your hands and
use that technique. Now the technique itself is one of those that is going to
look really easy when I do it, and then not feel so easy when you do it, so be
prepared. It is one of those deceptively hard techniques, but essentially what
we're going to do is we're going to set our patient up in supine, with the
involved side -the stiff side opposite us. So the way Yvette is set up now, we have
to assume that I am working on her left SI joint. Now I kind
of want to lock up that SI joint the best I can, and the way I'm going to do
that is I'm going to place this leg over the top of this leg, alright so maybe we
get a little bit of posterior tilting there, and then I'm going to go ahead and
side-bend that way. This is sometimes referred to as smile away
position, so you're making like a little smiley face. So she's all locked
up down there, now we have to rotate her torso to lock up all of the segments
above, right which would be all of her lumbar spine. So as you can imagine in a
way this is going to have some similarities to that lumbar manipulation
you saw in a previous video. Now what I'm going to have Yvette do is she's
going to go ahead and interlock her fingers behind her head, I'm going to use this hand
over the top of her ASIS to brace her pelvis. Now be careful, just because
you put the palm of your hand over there ASIS doesn't mean that I can't feel
very bony and very pokey to them. So adjust your hand so that you get nice
wide purchase, a lot of surface area right but you're nice and stable, so we
don't want any pinch there. I'm then going to try to lace my hand through her
arm. Now again I'm a lot bigger than Yvette is,
so I'm not going to be able to get all of my arm through her arm, but I can get the
back of my hand onto her sternum, and that's probably enough. I can feel her
chin on my hand, but I think that's okay. Now what we're going to do is keep this
down and rotate as far as we can into rotation, trying to make sure that Yette
keeps her hands nice and locked up; and when I start feeling a good amount of
force pressing in to my right hand here, I lock out and thrust, and that's
it. Again that's not particularly complicated, but it does take a little
bit of practice. Let me kind of go through one more time
and then give you a couple little pointers to try to get that feeling of a
lock, and to get all the force right here so that when you do that manipulation
you actually get a successful movement of the SI joint. So we said this leg goes
over this leg. This gets side -bent away. Now you could experiment with a little
side-bending of the upper-torso. All right so we get as much side bending as
you can and then again we'll put the hands back here. If you don't like this,
you could do this. All we need is rotation of the spine. So if I rotate
this way and maybe even like plant my fist into the table, and then I can kind
of straighten out my arm, right now I actually I feel a lot better in this
position. Especially me being unable to get my hand in between her her arms here
because her biceps are actually so huge that I can't get them in between her
forums, she works out a lot. But that being said, I get her rotated up, all
right so I got flexion, rotation, I got her locked out this way;
and actually I just, I lost it moving her around so much. All
right and this happens, like this is part
of the practice right. So let's try it again. We learned a couple things that
time. So we move this leg over this leg, smile away, we side-bent you this way when we
first did that, that actually helped, we locked you up really fast. Now,
we also learned in this last time for me personally that I don't like the arm
through. Now if you're a smaller person you might be able to get your arm all
the way through and hook your other arm on the other end of the table, I've seen
that right and then that kind of ends up looking, can you just hook your arm
around this arm, right like so that ends up looking something like this but with
her hands all the way hooked back, I've seen that. If she was doing this to me
that's what I would recommend. But for me on the other hand,
you can put your hands behind your head and be comfortable but we've
found that I get you all set up into side-bend, pull this way, use her forearms
a little bit to get me started, but then place my fist here. All right
rotate up by straightening my arm out, now that I have her all locked up, make
sure I get that force coming through this right hand, like I feel this coming
up like this and now I can, and thrust. How'd that feel? Better than the first
time? All right, big things to remember, leg far
away goes up, and you're going to side-bend, somehow I've seen this done where people
just side-bend from the bottom. I've seen it done where if people side-bend from
both sides. I think you need to experiment and try to figure out how
you're going to get locked position. You can go just hand through if you're a smaller
person, on a larger person you can go full arm through and hook through the
table, or you can start this way and then go behind and use your whole forearm
against their back to try to pull in as much rotation as you possibly can.
Now if you do that, keep in mind that you might have to continue to adjust so that
you don't lose all of your lateral flexion in the process. Your goal is to
get lock through here so that you start feeling pressure into this hand, so that
when you go down to press, you're pressing the innonimate through a
sacrum that's trying to rotate in the opposite direction. Boom.
Practice, a lot a lot of practice. Take some time to set this up with your
clients. Remember it's not a race, take as much time as you need. If you have
any questions about this technique please leave them at the bottom. 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.