This is Brent of the Brookbush Institute,
and we're going over manual release of
the gastroc and soleus complex. Keep in
mind this is a video for educational
purposes, and I'm assuming that if you're
watching this video to learn this
technique you are a licensed manual
practitioner, and you are going to pay
attention to the laws on scope of
practice in your state. Sorry personal
trainers this video doesn't fall within
your scope. I'm going to have Brian come
out, he's going to help me demonstrate
this technique. Now you can assume that
if I'm going to release the gastroc and
soleus complex, I have already done a set
of assessments that had given me an
indication that he either lacks
extensibility, over showing signs of over
activity in his gastroc and soleus
complex, that could be things like the
overhead squat assessment where feet,
flat feet turn out, or an excessive
forward lean may all indicate over
activity here. It might have just been
something as simple as a dorsiflexion
goniometry. I see a lack of
dorsiflexion these two muscles could
restrict that. I could have done my
gastroc soleus muscle length test and
that could have given me an indication
that there was some over activity here.
Now once we have determined that this is
an area we want to palpate and look for
further signs of over activity, it is
helpful to know your trigger points. All
right so your common trigger points are
very much related to motor points, which
is where we have the neuromuscular
Junction intervating the muscle, and
this is often a site of dysfunction
within these overactive muscles. All
right so you can see here I've I've gone
ahead and put circles where the common
soleus trigger points are, and then X is
where the common gastroc trigger points
are. It is helpful for me to kind of know
round about where those are, but i'm
going to show you guys how to find them
even if you didn't have them all
memorized. What I generally do is I take
one of the the pads of my thumb, and I
start kind of strumming perpendicular to
the fascicles, kind of like I'd be
rubbing over guitar strings.
Another little hint here guys is if you
use your thigh to press into
dorsiflexion a little bit, that helps put
some tension, helps lengthen out this
muscle, it'll help pop those fascicles
into your finger, so I can see here's a
tight fascicle. Now what I want to do is I
want to go proximal and distal to see if
what's causing the tightness in that
fascicle, is actually a nodule or a
specific location of a trigger point, and
so I can start doing my strumming, kind
of up and down and seem to be getting
cold there, warmer, warmer all right, right
there that's a nice spot. So once i found
that spot, to help my me pin that spot
down so that it doesn't end up feel like
I'm trying to put my finger on a marble
right, where it just kind of keeps
popping out, I want to go ahead and put a
little bit more tension by pressing them
into dorsiflexion. Actually let me have
you move down just a little bit Brian,
Be careful guys as you push
somebody into dorsiflexion you don't
push the front of their ankle into the
end of the table, that's painful. Alright
so find that little spot again. I'm going
to make sure I put a little stretch on
that muscle, that's going to help pull
everything down, help centralized that
trigger point, and then I'm actually
going to use a little distal to proximal
force with my thumb here, to kind of pin
it up this way. So rather than trying to
do this, I'm putting a little stretch and
pinning up this way, and then to add a
little bit more pressure i'm actually
going to go ahead and let this be my
dummy thumb. So i'm not using this hand
to apply pressure, i'm going to use this
hand to apply pressure. The amount of
pressure i apply is actually going to be
up to, I wouldn't say the first
resistance barrier, but the first
significant increase in resistance from
this tissue. I think you guys will find
that as you press into tissue it's
almost like an exponential curve right,
you have this nice linear increase in
how much pressure you get back, and then
all sudden it's like this really really
big increase in tension. So I'm going to
press right
up into that trough of that curve till I
got a significant resistance, but not
past it, and then all I have to do is use
my body weight, nice straight arms, nice
good posture, and hold it until that
point starts to go away; and then if i
have time, i can start moving through
some other trigger points that may exist
in this muscle. Okay so going through
this whole technique again, i went ahead
and put just a little bit of pressure
into Brian's foot here, that's going to
help dorsiflex his ankle, put a little
bit of tension into this system, lengthen
those fibers out so that they're going
to pop into my fingers a little bit. I
then run my thumb across the fascicles
of the gastroc or the soleus, in this
case alright I'm going to look for the
most tender fascicles. Once I find those
tighter denser fascicles, i'm going to
move proximal and distal and i find like
that's a pretty good spot right there.
Once i have a spot i'm going to go ahead
and kind of go up this way with the
pressure on the gastroc and soleus, put a
little bit more pressure into his foot
so I dorsiflex them a little bit more.
I'm going to use the opposite hand to
press right up to that resistance
barrier, and then I'm going to hold that
until that goes away. There is one other
protocol with four six to eight second
holds, if you guys prefer that protocol
you can do that too. So I could sit here,
hold two, three, four, five, six, relax. Go
back in maybe a little deeper into the
tissue this time one, two, three, four, five,
six. If not if i'm going back to just
that static hold, and it's usually a 20
to 30 second static hold. After I've done
that release technique, in Brian's case
I'd probably go ahead and flip them back
over do some joint mobilizations. If I
thought maybe
is his talus was shifted anteriorly,
or whatever other joint mobilizations
that needed to do in his ankle complex,
and then follow that up with a
lengthening technique if I thought these
muscles were short. So I wouldn't use
release techniques alone, but this would
certainly be the first step, and be
helping to regain some ankle mobility
and calm down any over activity in the
gastroc and soleus complex. Just to go
over quickly guys in a more close-up
view so you can see exactly what it is
I'm doing, notice i have my thigh, the
bottom of brian's foot here, so i can
control dorsiflexion and plantar flexion,
and the amount of tension in the system.
I can use this thumb to kind of dig into
about midway through the gastroc there,
just unto the first signs of tissue
resistance, and I can kind of move across
the fascicles perpendicular to them, and
kind of strum to find the most dense or
the highest activity in those fascicles.
We're going to assume that those
increased activity in those fascicles is
a sign of this over activity and
dysfunction. Once I get there I'm going
to go ahead and move proximal, distal and
actually I can feel that there's not as
much tissue density, not as much give
back resistance here, as there is here, so
I know I'm getting closer. And then right
about here I actually do feel a nice
tight nodule. Now I kind of mentioned to you
guys before, it's a little hard to pin
down if you just kind of go thumb over
thumb on top. It's also very very painful
to do it this way, it might help, be a
little bit more helpful to go a little
bit more broad with your finger, use this
as your dummy thumb. So now no more
pressure in this hand, I'm going to go
ahead and push into dorsiflexion just a
little bit, so i feel that a trigger
point come into my thumb, and then i'm
going to use my other hand to press
until i feel that that big increase in
tissue resistance. As I kind of mentioned
I think of an exponential curve right,
and if it's an
curve that I feel resistance, I want to
be right in the trough So I'm going to go right here again, and I'm going to go ahead and
hold that for 30 seconds, or as i
mentioned earlier in this video we
could do four, eight second holds. I think
this feels pretty good though, I should
get a release here. Brian is starting to
feel it let go a little bit, yeah usually
it's a very tender spot at first, and
then within a few seconds everything
calms down. So there you guys have it,
manual release of the gastroc and soleus
complex. Grab a partner, grab a colleague,
get to practicing. This is probably not
something you want to do to the next
patient that walks in the door if you've
never done it before. The gastroc and
soleus do tend to be very tender muscles
when it comes to compression and manual
release techniques. I would definitely
get another manual therapists with
experience in these techniques if you
can, getting the feedback from another
manual therapists is education that
cannot be replaced. If not if nothing
else, get a group of you guys together so
you can start talking about whose
pressures felt the best, or whose hands
felt the best, and what you guys are doing
to help dial this technique in. I hope
you learned from this video, I hope you
will integrate this technique into your
manual practices. I look forward to
hearing about what type of outcomes you
get by adding this to your repertoire.