This is Brent of the Brookbush
Institute, and in this video we're going over
static manual release of the adductor
magnus. If you're watching this video, I'm
assuming you're watching it for
educational purposes and that you are a
licensed manual therapist. That is, a
physical therapist, an athletic
trainer, a chiropractor, a massage
therapist, or an osteopath, and the laws in your
state cover your scope of practice to
perform manual release techniques. If you
are unsure please look those laws up.
Personal trainers, this video probably
does not apply to you. I'm going to have
my friend, Melissa, come out. She's going
to help me demonstrate. Now, all of these
static manual release techniques follow
very similar protocols. We have to know
how to palpate the muscle we're
targeting. We get bonus points for
knowing the trigger points, because that
will definitely narrow down our search.
We need to know if there's any tissues
that, perhaps, we should be watching out
for that don't like compression. In the
case of the adductors, we do have to be
aware of the femoral artery. The femoral
artery isn't huge underneath our fingers.
Remember that arteries aren't going to
be any thicker than your pinkie. So if you
do happen to feel a pulse while doing
this, don't freak out, just move up or
down or side to side and you should be
able to find a way to the targeted
tissues without compressing that artery.
And, of course, we need to know what
position we're going to put Melissa in
so that I'm comfortable and can apply this
pressure for a long, sustained period of
time being 30 seconds to 2 minutes
without fatiguing, and that Melissa is
comfortable, and I'm not putting in her in a
position of pain. We need to be adding
some tension to this muscle so that we
pin down those nodules, or points of
hyperactivity and don't start playing the
"put your finger on top of a marble" game,
or that marble will just keep slipping out.
Now, in the case of the adductor magnus, I
use the same position that I use for the
adductor magnus stretch. So, I
put her foot up on my ASIS. Now I have
total control of how much tension is in
her adductor magnus, because
I can just move back and forth this way.
If this is way too much of a stretch for her,
I can back off this way. If this isn't
enough tension, I can take a step forward.
And, of course, if I get my table up nice
and high, I can get my arms out straight
with my elbows nearly locked, and I'll just
be applying pressure by leaning forward
and using my bodyweight instead of
trying to use my hands, which is
eventually going to wear me out. Now,
finding your adductor magnus isn't
particularly difficult. It is the most
posterior of the adductor muscles, so if
I kind of attack the adductors from the
posterior side going this way, I'll be on
the adductor magnus. The only thing I
have to differentiate is where is my
adductor magnus versus where is my
hamstrings. In an athletic population, you
might see their hamstrings popping out
just by looking down. In Melissa's case, I
can actually see a nice little bump
where her developed hamstrings are
sticking out, and I know if I put my
fingers right above that bump, I'm on adductor
magnus. If you can't see that bump, if
you can't get a good visual
indication of where the adductor magnus
starts, use one hand and kind of use like
a nice, broad area to kind of grab the back
and inside of their thigh. Use your other
hand against the back of their
heel and have them flex their knee.
Remember, your adductor magnus doesn't
cross the knee, but your hamstrings do, so
you'll feel an increase in tissue
density- you'll feel their hamstrings
contract, but their adductors won't. All
you have to do is go just above that
contracting tissue. Go ahead and relax
for me. Alright, now I mentioned I get
bonus points for knowing where those
trigger points are. In the adductor
magnus, we have one that's like basically
right in the middle of the thigh and
then one that's very close to the
ischial tuberosity, so way up close
to the origin of the
adductor magnus. Now, I'm going to use these
posterior to anterior kind of swiping
motions to find the most dense, most
tight fascicles, and then once I find
them, I can start moving a little bit
more proximal. In this case, I started
just a little distal of the midpoint of
her thigh, and I find a nice tender point
right there. Once I find the tender point
in this position, I'm going to use a
thumb over thumb technique. Alright, I'm
going to kind of lock out my elbows here,
and then I'm just going to lean. I'm only
going to lean enough to get some good
pressure on those dense fascicles. Now,
remember, I said good pressure is kind of
where you push until you start feeling a
little give back but you don't get that
huge increase and give back, that huge
increase in resistance. Because at that
point, you're probably getting guarding.
You're probably going to get some pain,
and it's actually going to be harder to
get a release. We want to go just up to
the point where we start getting an
increase in tissue resistance, or an
increase and push back on our fingers.
We're going to hold this for 30 seconds
to 2 minutes, or until we
feel a release, likely closer to 30
seconds once you get good at this. Once
they get a release, I can move on to the
next trigger point. Now, I've said this in
many videos, before you put your hands on
somebody, you should be 80% sure that
that muscle is involved. You don't use
manual techniques as assessments, at
least initially. Of course, everything we
do is an assessment, but you should have
a good reason for putting your hands
there. This is especially true of the
adductor magnus trigger point at the
ischial tuberosity. Your hands are going
to be very close to somebody's groin.
This is something that you're going to
want to explain to your client. Build
rapport. Don't just put your hands
somewhere and not give your client a
good indication why.
You also are going to want to probably
have a post-test. So, I had an
assessment, I think this might help, and I'm
going to do this post-test to show you
why I put my hands there. If you guys just
put your hands where I'm about to put my
hands and have no explanation, you
could get yourself into trouble. So, the
adductor magnus's origin is all the way
at her ischial tuberosity, which is
essentially what's holding her up on
this table right now. Those are the
bones deep in your backside. So, if I come
down closer to her backside and feel these
same tissues, I can feel a trigger point
right here. Same thing- notice, guys, I kind
of have my hands turned this way, right, I
don't want my hands over somebody's
groin.
If you needed to, if somebody felt more
comfortable, you could have them place
their hand over their groin, or use a
towel, or have them place a towel and
their hand over their groin so that they
feel safe. And, again, I'm going to go
ahead and hold for 30 seconds to 2
minutes until I get a release. How does
that feel? Starting to relax? Good deal.
And then, at that point I'd probably be
like, "Okay, why don't you get up and do a
squat?" Maybe that was where she was
feeling this pain. In the next segment,
we're going to do our close-up recap. Alright,
guys, for your close-up recap I'm
going to take her thigh into flexion and
abduction, just like I would for an
adductor magnus stretch. I'm going to
put her foot on my ASIS so that I can
control how much tension is within her
adductor magnus just by leaning forward
or leaning back. Now, we know that her
adductor magnus is the most posterior of
the adductor muscles, so we just have to
differentiate between the adductor
magnus and hamstrings.
Melissa has some pretty
well-developed hamstrings, but to show
you guys how I would differentiate on
somebody who, maybe, wasn't quite as
athletic or quite as well-developed, I'd
use a nice, broad part of my hand, so
that I could feel all of the inner thigh
and all of the posterior thigh. I add a
little pressure there so I know I'm
feeling through any adipose tissue. I'd
use my other hand to block the ankle,
and then have them flex their knee and
"boom" their hamstrings pop right out.
Remember, your adductor magnus doesn't
cross the knee and is not responsible
for knee flexion. So, if I go right above
those now contracted dense fibers of our
hamstring, I know I'm on adductor magnus.
Now, you guys can actually see this on
camera. If I just have Melissa go ahead
and flex her knee, being that she's
athletic and has these well-developed
hamstrings- go ahead and relax and flex
again. you can see her hamstrings just
pop out, and if I go right above those
hamstrings, I know I'm right on adductor
magnus.
Good. Go ahead and relax for me. Now, with
the adductor magnus, I know her trigger
points are going to be right about the
mid portion or middle of the length of
her thigh. Right around here.
And then there's another trigger point
that's pretty close to the origin of
this muscle near her ischial tuberosity.
So, I'm going to go ahead and take these
posterior to anterior strokes, making
sure I stay off the femoral artery, but I
look for the densest fascicles. Once I
find them, I can then start moving a
little bit more proximally here since I
started a little distal to the midpoint
of her thigh. Once I find that point, I'm
just going to go thumb over thumb, lock
out my elbows, and apply some pressure
until I get a little kickback from
that tissue. I'm going to try to hold as
still as I can ensure that Melissa is
fairly relaxed here. Hold 30 seconds to
120 seconds, and then hopefully I get a
release.
Now, the other trigger point we have is
very close to her ischial tuberosity
and close to her groin. I mentioned that you
could drape this area. You could have
your patient or client cover their
groin, so that you don't risk bumping
into it. Melissa is going to go ahead and
uncover herself, so that you guys can see
my hands for this particular technique.
Her ischial tuberosity are
essentially the bones that are holding
her up on the table. Those are
those that pelvis bones that are deep in
your gluteal area. But, if I kind of
start there around the origin of this
muscle,
you will notice that there's some
tightness, some density, these hyperactive
local points just two or three inches
distal from that origin. And then, again,
I'm going to go ahead and use my thumb
over thumb technique here. I'll hold for 30
seconds to 120 seconds. As I mentioned
before, guys, this is an important time for
you to have assessed and have a very
good reason for your hands to be here.
This might be one of those
techniques where I test right after I do
the technique to go, "Alright, this is
why we did the technique. Do you feel
better?" I hope you guys enjoyed the
close-up recap. There you have it- static
manual release for the adductor magnus.
Remember, if you're going to do a manual
release technique, you should be 80% sure
that that muscle is involved from your
movement assessment. Don't use manual
techniques alone as assessments,
especially in the case of this technique.
You're going to want to pre-test and
post-test, and then give your client or
patient confidence that you put your
hands where you put your hands for good
reason. I would definitely suggest, in the
case of this and all manual release
techniques, that you grab a friend,
grab a fellow student, grab a colleague,
grab a fellow professional. If you can,
grab an experienced manual therapist to
practice this technique on first, before
trying it on a client or patient. There
is no better education than being able
to practice this on a fellow manual
practitioner and have it done to you by
that practitioner and start exchanging
notes. These videos are great, but they do
not make up for the practical
application component that you will need
to feel comfortable in practice. I hope
you guys enjoyed this video. I look
forward to seeing your comments, your
questions. I'm happy to answer anything
you guys ask. I'll talk with you soon.