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 fascial
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 cervical fascia and cervical thoracic
junction fascia with instrument assisted soft tissue mobilization. I'm going to have
my friend a Yvette come out, she's going to help me demonstrate. Now the easiest
position to do this technique with, is actually sitting with them facing away
from you. Make sure if you're doing this technique on a female that they are
aware that you need to have access to all of this skin. So they might want to
wear a sports bra something where they can move the straps around pretty easy,
or you're going to need to find some like shirts in your clinic that you can cut
the neck out of. Obviously this stuff doesn't work over clothes. So I'm going to
go ahead and have Yvette move this strap over her shoulder, perfect. That's all we
need. We're going to do all this area here so this is our cervical thoracic
junction, and then we're doing all of this cervical fascia. Now we're going to add
just a little bit of this cream because we don't want to just
exfoliate the skin or irritate the heck out of the skin, we actually want to be
able to apply some force to the fascia underneath the skin which means I need
to protect the skin with a little lubricant.
Once I get this rubbed in, the other thing you might want to have handy is
hair ties because we have to get their hair out of the way, otherwise they
will get this lotion or whatever cream or oil you happen to use, we use smart
tools cream here, I happen to like the smart tool set a lot, and I like the
smart tools cream so that's what we use, but you could use other stuff. Most of
the stuff is pretty simple lotion or vitamin E oil, so it's not going to do any
harm to somebody's hair. Now first step is always to go through our scanning
strokes. Now as I've mentioned in the past we think of these IASTM techniques
as superficial facial techniques, which means I'm going to treat this whole
area like one piece. This to me is just cervical fascia, I'm not really thinking
about trap or levator scapula, or scalenes at this point, just
investing cervical fascia. So I'm going to start here, I'm going to have
her stretch out this fascia just a little bit for me by tilting her head away,
maybe a little bit of flexion, and then I'm going to go ahead and stroke down this
way; and what I noticed is everything was pretty smooth until I got to this point
right here, and then we'll go here and again right in here, and then I'm going to
come through here, and again I feel just a little bumpiness as I kind of went
over the superior angle of the scapula there. I felt a little bumpiness
in the facial tissue too, and then some of you probably already have
seen the thoracic fascia, infraspinatus fascia and deltoid video, so I can come
straight across here the same way I did in that video. You can see how
those two videos blend together really well. A lot of people will need this
whole area done if they have that combination of cervical and upper body
dysfunction. Now once I've done my scan you might be able to see from some
previous takes, I did find some bumpiness in here, some bumpiness in here and some
bumpiness in here. From those previous takes we have a little bit of redness
already. The first thing I'm probably going to go after
is think about disrupting those areas a little bit, so I think of those fascial
sheaths and the fact that if we have any sort of tissue injury, and that could be
very sub-acute very subclinical tissue injury that just causes enough of an
inflammatory process that we got some binding of those collagen, or binding of
those fascial layers via some additional collagen being laid down. We want to
break that up, and the way we're going to do that is I'm actually going to switch from
this fairly sharp scanning tool to two tools here, I'm going to use the shark fin
tool and I'm going to use this little Batarang tool, comes pretty handy. I'm
going to start down here. I'll go low to high this time, and I'm just going to try to
do strokes in a bunch of different directions. Now since this is the neck
and the neck gets flared up pretty quick, I see petechiae pretty quick, I'm
probably only going to do two to three, two to four strokes in each direction
because I want to make sure I can go in a lot of directions. So you
just saw me go this direction, this direction, this direction. Maybe I go up a
little bit, I come and do this thing where I'm pinning one side and just
going around a little bit, go sideways, come down this way and then this way a
little bit all right, and again 15 to 20 strokes is probably good for one area.
She's already pretty red in that area, if I see petechiae I know I've done enough
because after petechiae becomes bruising, I don't think petechiae have anything to
do with the therapeutic effect, personally I haven't seen any evidence
to make me think that petechiae are healthy. But again petechia themselves is
a good little indicator that, you know if we do this much further we could create
a little painful stimulus ourselves just by creating some bruising. Now the next
thing I felt that was in here. Maybe since we're so close to the neck and I
have less space I'll go to this smaller tool. Again let's get as many directions
as I can, this way, this way, this way
break that all down, and then of course I could do the same thing on the neck. Of
course if we get into here in these smaller areas it definitely gets a
little harder to get in there, right so I'm using this end of the tool, just
taking it easy. I have the tool set at like 30-degrees here. I'm really
only pushing hard enough, that I'm just feeling the layers of tissue underneath
the skin. So there's no need to create a bunch of redness,
that's not the goal. Now that I've gone through and I have broken
up the binding of those collagen fibers between layers of fascia that I felt
didn't feel the way the other fascia felt, maybe the next thing I could go after is
trigger points. Now trigger points I've found it helpful to just literally
almost do like a cross friction shearing force in all directions. So we'll go like
this all the way around. Now this could be desensitization, this could be
breaking up more of that disorderly collagen matrix that's being laid down
from a dysfunctional motor endplate, and acetylcholine and other cytokines, and
inflammatory chemicals launching that inflammatory process. But what I
found from an outcomes perspective is that when I do this I get a little bit
better carryover. So I get less sensitivity from session to session in
those trigger points. Trigger points have a tendency to come back less, or at
least with less strength. We know we always take a little step back between
sessions, but I find that that step back is a little less when I do it this way.
The last thing we want to do, and this is obviously the most intense technique, is
the pin and stretch with these tools. The reason I do them despite their
intensity is because think of how wonderfully functional that is, so
if we want to get mobility back the idea of pinning some of this
dysfunctional tissue, and then making sure that we pull other layers of fascial
and muscle through that tissue, is probably exactly what we're trying to
get at with some of these fascial intended techniques. So here I'm kind of
going over the fascia that is connected to my levator scapulae. A good way to
stretch out my levator scapulae and that fascia would then be to stretch the
levator scapulae. I can just pin this way, and then if I remember my Anatomy, I
would go into flexion, lateral flexion and contralateral rotation to stretch.
Cool, and you can feel it under the tool as that that tissue gets pulled
underneath the tool. So just passive with the tool pinned statically would be the
first step. The next thing I could do is ask Yvette to do that actively, okay so
now chin down, good and look over this way; and then I could add a little
overpressure. So now we got active but this stays static with
overpressure, and then the most intense technique would be as she's going active
and I add overpressure. I'm also pulling the tool through the
tissue, and that gets real intense and you can see she reddened up a lot. Be
careful with these techniques 2-5 strokes in any one spot with those
pin and stretch is plenty. Don't think that you have to do 10, 15, 20 repetitions
like we normally would with an exercise. A little bit of this goes a long way. Just
what I did here the 15 to 20 strokes over each spot in different directions,
the trigger point stuff and the 2-5 pin and stretch strokes, that's a lot of
therapy. I'm not suggesting that you necessarily do
all of those techniques on the first session with a patient. So you might
start with your scanning strokes and then just trying to break up any
adhesive or abnormal feeling area, and then just see how the patient comes back
to you the next time, did that help. If they felt really good, good. Now maybe go
ahead and add the trigger point stuff in, and then maybe the third session you
could add the pin and stretch. Or maybe the second session you did the break
up in the pin and stretch, and in the third session you add the trigger point
stuff. Just keep track in your notes on how they're responding to each
one of these techniques, and of course be reassessing to make sure that we are
having the intended outcome and this is having an effect on your objective
measures, for example something like what the cervical lateral flexion goniometry.
So there you have it, stay tuned for the close-up recap, i'll show
you the petechiae that we created on this side, and I'll go ahead and treat
this side of the neck in that close-up. Alright so for the close-up recap
when I grab a little of our smart tools cream here, throw a little lotion and get
the skin nice and lubricated so we can get to those deeper layers without
abrading the skin. Maybe I used a little bit of too much lotion, I tend to use a
little too much lotion, maybe more often than not. I guess it's better too much
than too little. You will see if you use too little lotion it like feels like
a rug burn real fast. So we get that all in there, alright good stuff.
Now we're going to start with our scanning strokes, but before I do that I
want to lengthen out this cervical fascia. Then I'm going to go ahead and just gently
take the tool, 30-degree angle, push it in to where I feel muscle kickback, and then
just do nice little organized strokes so that as I'm going through each little
strip of skin I can take note on where I felt dysfunction, and I feel a little bit
up in here, a little bit right here.
If you felt nothing at all going through all of this you could
probably try to go a little deeper, but generally speaking you don't have to go
that deep, you don't have to go that hard with these tools. I felt a little bit in
here. Alright so we got a little bit here, a little bit here, a little bit here,
and then we can come through this thoracic fascia this way. We can even
bring in some of that infraspinatus fascia if you saw those videos. Now once I've found
the spots that I want to go back to, to do a little bit of treatment on, and
think of those binding of those tissue. Maybe I'll start up here at the
top of the neck and I'm just going to go in this way. I'm going to almost treat
this one like I treated the trigger point, the previous one, because I have
such a small surface area to go after it's going to be hard for me to get various
directions. Maybe I can get a little bit this way, but I'm probably just as well
grabbing the tip of this shark-fin tool. I'm trying to break things up that way.
Remember I'm going to go in multiple directions because fascia,
the collagen fibers don't necessarily match the muscles underneath them.
Alright you can see I got a little bit of petechiae right there, and so then
I went this area next. So I can go in this direction right towards her neck,
then maybe I go at a diagonal towards the front of her neck, diagonal towards
the back of her neck. I can go maybe across this way and back,
just breaking up as much as I possibly can and as many directions as I can. I
don't know if you can see, if you just lean back just a little bit, there you go.
You can see I developed a little bit of petechiae. Once again I don't think
there's anything therapeutic about the petechiae, but I do think it's a good
indication that maybe we should stop, and you can see I only did about 15 strokes
there. If we get past petechiae we start getting bruising. So the next
spot we're going to do, let me have you lean forward just a little bit, there
you go, it's this spot here which we felt a little disruption, and now I'm just
using this concave side and I'm just doing my little sweeping strokes.
I do think way too much tension is paid to the name of
strokes and the fanciness of strokes, you're really just trying to get a 20 to
45 degree angle and pull tissue across other tissue, you're trying to create
shearing forces. So as long as you're going in multiple directions I think
we're going to be as congruent with what the research is indicating as we can at
this point. Now the next thing I might want to do is go after trigger points,
and now it's funny because the common trigger points sites we already went
after that's where we felt the most abrasive or the most abnormal tissue
anyway, so I'm not going to go back over this, but you can imagine I just use
the end of this shark fin tool and go around in a circle like so,
really trying to break up that tissue as much as I can.
Sometimes I get a petechiae, sometimes I don't, but it definitely
helps with that carryover; and then last the pin and stretch techniques, we
actually could use this tool, right and go just like so, get that 30-degree
angle and then pull through. But we also use some of the other tools, like
we used this tool, fit the trap mound we'll call it, fit the trap mound
real good. So maybe I come down over like this, and then we kind of
some different levels of intensity. We had pin and passive pull through, we had
pin and active pull through with overpressure, and then we had pin
apposing pull through with the tool, and active pull through with overpressure.
Let's do that one more time just like so, and then I go this way, and you
only need two to five strokes like that, it's a very intense technique. I
hope you enjoyed this video, if you have any questions please leave them in the
comments box below. 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.