This is Brent of the Brookbush Institute, and
in this video we're bringing you another
manual technique. Now if you're watching
this video I'm assuming you're watching
it for educational purposes, and that you
are a licensed manual therapists
following the laws regarding scope of
practice in your state or region. That
means athletic trainers, chiropractors,
physical therapists, osteopaths, licensed
massage therapists, you are likely in the
clear to do these techniques. Personal
trainers this probably does not fall
within your scope of practice, although
you might be able to use the palpation
portion of this video, to aid in learning
your functional anatomy in an
educational setting supervised by a
licensed manual therapists. Now before we
place our hands on a patient or client
it is important that we assess, and have
a good rationale for doing so. And of
course if we're going to assess, then we
should be reassessing to ensure that the
manual technique we're using is
effective, and we have a good rationale
for continuing to use that technique. In
this we're going to go over static
manual release of the splenii muscles,
that's the splenius cervicis and the
splenius capitis. I'm going to have my
friend Melissa come out she's going to
help me demonstrate. Now we're going to
use the same four step process we've
done in other static manual release
videos. We're going to talk about how to
palpate and differentiate the splenii
from the other structures proximal
to it on the posterior lateral neck.
We're going to talk about any structures
that might be proximal to the splenii
muscles that we could insult or abrade
with compression. We need to talk about
trigger points a little bit because that
will help the efficacy and accuracy of
this technique, and we're going to talk
about client and practitioner
positioning, so that I am in a position that I
can comfortably hold this technique. and
my client can relax in the position
they're in so that we can actually get a
release. Now step number one of this
technique is by far the hardest, it helps
to know a little bit of functional
Anatomy. We have to figure out how we're
going to differentiate the splenii
from the upper trapezius and the levator
scapulae which it lies in between. Now it
is important to be able to differentiate
this structure because the upper trap,
splenii, and levator scapulae don't all
rotate the head in the same direction.
So for example if I assessed Melissa she
came in with some cervical dysfunction,
maybe even some cervicogenic headache,
and I noticed that she could not rotate
her head completely in this direction, I
need to know which of those muscles I
should release on this side, and which I
should release on this side. So let's
talk about functional Anatomy a little
bit. My splenii and this is splenius
cervicis and splenius capitis together,
originate from the spinous process
of T6 up through the ligamentum nuchae to
the spinous process of C3, and then they
kind of run off in this direction,
so from inferior medial to
superior lateral, towards the mastoid
process of the temporal bone, and you
guys can feel that little bump that's
behind your ear, that little point right
that's where these fibers are
heading to. You can imagine if I'm on
this diagonal that when these muscles
shorten, they'll create ipsilateral
rotation. So the rotation the splenii
muscles create matches the levator
scapulae, but opposes the upper trapezius
which rotates this way. So for example, if
I had Melissa here and she had great
rotation this way, we couldn't rotate
this way very well, lets say she's stuck
right there. What I would probably want
to do is release levator scapulae and
splenii on this side, but upper trapezius
and deep extensors of the neck on this
side. The more accurate I can be the
better chance I have of getting good
outcomes. So how do I get to this
structure. Well we need to skip to step
three real quick. Knowing where the
common trigger points are, where we're
likely to find those increases in tissue
density is going to help. So trigger
points are commonly just in line with
the C7 spinous process, which is usually
that most prominent spinous process of
the base of the neck. So you guys can
look for that and think
ok, I got one trigger point that's going
to be in here somewhere, and then the
other one just happens to be in line
with C2 which is the first spinous
process I can feel underneath the head, It's
nice and convenient so at least we have
two nice landmarks we can kind of line
up with. Now although I said that this
this trigger point here which happens to
be the trigger point for the splenius
cervicis, is in line with the spinous
process of C7 I can't just go ergh
that's not going to work. It might leave a
nice bruise but I'm probably not going
to get to the splenii muscles, I
actually need to get deep to the upper
trapezius, and the only way I can do that is
by finding the anterior border of the
upper trapezius and falling off this way. So I
don't know if you guys can kind of see
my finger there fall off in front of the
trapezius. Now we have to take another step
here and get a little bit more technical
and find the lamina trough, which is the
trough between the transverse process and
the spinous process here. So
between the spinous process and the
transverse process of a vertebra you
have this little little divot, you guys
can even kind of feel that if you
kind of palpate in the neck here. The only
difference is we need to find this
trough while anterior to the trapezius, and
heading down towards C7 spinous process.
You guys got that,
anterior to the trapezius, into the lamina
trough, towards C7 spinous process
and then we hit the levator scapulae,
darn it, okay we're almost there. So
what we're going to do is we're going to
laterally flex, that's going to help
soften up the upper trapezius a little bit,
and then we're going to
ipsilaterally rotate. And although this is
going to shorten our tissues a little
bit, for the splenius cervicis here it's
going to allow me to get my thumb in
between the upper trapezius and the levator
scapulae which is just anterior, into
that trough so that I can start doing my
short stroke strumming perpendicular to
the splenii fibers,which remember
these fibers go up this way. So I'm
actually going to be kind of doing
these tiny little strums out this way in
the trough with her head in this
position, until I find the most dense
fascicles. I'm going to look for a nice
nodule once I find those fascicles and
it's right there. All right and then I
can use her head if I need to
add a little tension to kind of
stabilize that nodule, so I'm not playing
the finger on top of the marble game, I
can do that here. Now the other trigger
point which is going to be our splenius
capitis trigger point, all I need to do
is start searching in through here and
look for fibers that are heading from
the spinous process out towards this
mastoid process. The splenii
muscles have a unique fiber direction which
is kind of what I mentioned before, is
why we need to be able to differentiate
these tissues. They rotate differently
than the deep extensors of the cervical
spine underneath them. So i can have
Melissa to do all sorts of things to
help with my palpation, right like I can
kind of get my fingers in the right
place and I can go, hey do you mind
rotating towards me against my thumb,
right and then extend your head and turn
lateraly towards me, and then if I
do my my short strokes here, right so I'm
going to come down this way, I can kind
of see alright so I got her contracting
the right muscle; can I get them, can I
feel the ones that are going in the
right direction heading in the right
direction, and I can actually right here.
And then once I find those tight
fascicles is there any nodule or point
of acute density that i can press on. Now
a couple little things here guys; take
your time, this isn't a race, nobody's
expecting you to just put your finger
right down on a trigger point in a
muscle that's fairly deep and hard to
palpate. That doesn't show
proficiency to just kind of go aah, it
shows maybe carelessness more than
anything else. Your patient doesn't know
whether this should take you 15 seconds
to find, or three minutes to find. So if
you know your functional Anatomy you can
think of those fiber directions, you need
your client you need to move your
clients head around a little bit, you
need to have them contract the muscle,
that's all fine, that's all fine. Take
your time. I'd rather you took three
minutes to find the right point than to
spend 15 seconds and be totally wrong,
and not get any outcomes whatsoever. Now
although we don't have too much issue
here with sensitive structures, as long
as you don't jab your finger up in
towards the occiput that you kind of
stay going posterior to anterior, you
shouldn't run into any structures that
are particularly sensitive to
compression. You do have to be a little
careful with the splenius cervicis point,
because if you press down real hard, real
fast, and you're not real careful, you
could stretch the brachial plexus. So if
you get any burning, searing, tingling
they get that little jolt, right if they
get any numbness, or funky pins and
needles and their fingers, guys move, take
your time, move your fingers around get
off the brachial plexus. See if you can
mess around with some
ipsilateral flexion to get that brachial
plexus out of the way, and still get to
the muscle you're looking for. Now last
we do need to talk a little bit about
patient and client position. This is not
a good idea all right, this is kind of
weird, but I'm not I'm not just like
palming people's foreheads and
jabbing my thumbs in places where I
can't see, especially because I can't see
this trigger point here. This
is all for you guys to be able to see a
little bit of the anatomy, and how my
hands are placed relative to some other
structures. If I was going to do this in
a seated position which you can, I would
have Melissa swing her legs
over the end of the table here and I
would come sideways,and then I would
probably use that that kind of quasi
headlock position. I'll drop the table
down here a little bit, but we talked
about putting the forehead and the
crease of your elbow on another one of
our manual release techniques for the
neck. If I do this, I can now move
her head comfortably and she feels nice
and stable. I can use my body against her
shoulder, right like my rib cage and my
torso here a little bit, and then I can
take this thumb and get right where I
need to get. This particular technique
doesn't take a whole lot of pressure so
you might be okay. It's not ideal body
mechanics I can't really get my forearm
perpendicular to, or parallel to the
direction of force, but we're close to a
good position here. I personally prefer
to do this in supine, so i'm going to have Melissa
swing all the way around here. I think
supine is much more comfortable for both
the patient and the client, and I think
you guys will agree if I just slip this
hand underneath the occiput, I now have
total control of her head, and Melissa
is very relaxed right now because we've
done a lot of these videos and she
trusts me, poor thing. She has had
her neck worked on with me before.
It might take a second to get your
patients to completely relax, but you do
have really nice control this way, and
then I can take this hand and I'm going
to use kind of this technique of
reaching underneath her neck, and I can
see her trap right here drop my hand ,and
right anterior to it I'm going towards
that laminar trough, and since I can feel
C7 with these fingers, I can drop
my thumb right down in that direction.
Move her head however I need to, I can
start doing my strumming out
perpendicular to those fibers. Find the
tightest fascicles, find my tight nodule, add
a little tension so
that I have that nodule pinned, and then
wait for a release.
And believe it or not the splenius
capitis trigger point is even easier
because all i have to do is move my
fingers like this, right so i leave these
digits kind of facing up, and i'm just
going to use the weight of her head.
I'm going tofind C2 which is
that first by the spinous process I feel
underneath her occiput. I'm
going to look for the fibers that go in
the right direction and I might have her
like, okay can you rotate into this side
here. I might have her rotate a little
bit and then try to strum those fibers,
find the most dense fibers, find the most
dense nodule, and then once again just
have her totally relax. The nice thing
here is like my hand is curled, and then
I just have the weight of her head hold
for me until we get a release. Stay tuned for
the close-up recap. So now for a close-up
recap of the splenii static manual
release. We're starting here with the
splenius cervicis manual release. You can
see my thumb is actually just anterior
to the anterior border of the upper trap
here, that my hand is wrapped underneath.
I'm going to fall off the anterior
border down into the lamina trough,
which is the space between the
transverse process and the spinous
process on the posterior aspect of the
cervical spine. I know that my common
trigger point is down near the C7
spinous process. So i can even palpate
the C7 spinous process with these two
fingers and give myself an idea of where
that is, and then kind of push my fingers
towards one another. But unfortunately
the first thing I run into actually is
my levator scapulae. So the way I get my
levator scapulae out of the way is I do a
little ipsilateral rotation, and
although this takes some tension off my
splenius cervicis, it's the only way
for me to sink my finger down between my
upper trap and levator scapulae. Once I've
sunk my finger down in there I can then
use my short strokes,
kind of this lateral to medial stroke,
and these are very short strokes
just a couple fascicles at a time, to
find anything to me that feels
overactive, feels tauter than it should be.
Once I find those taut
fascicles I can kind of move inferior to
superior, superior to inferior to try to
find the densest nodule, and then i can
actually once i've located that nodule
go back into a little contralateral
rotation, contralateral flexion to add
some tension back in those tissues and
help me pin that point of hyperactivity.
Once I get a release, of course I can
move on and of course this is the more
complicated of the two release techniques
for your splenii muscles. The
splenius capitis muscle has a trigger
point that's commonly at the level of
your C2 spinous process, which your C2
spinous process is the first spinous processs
you feel underneath the occiput. So
that's fairly simple, and we know
that the splenii have this kind of
unique fiber arrangement thats this way.
So all we have to do is kind of go just to the
side of C2 spinous process here, and look
for fiber direction this way. Find her
tightest fascicles by strumming this way,
kind of from in the same direction that
her shoulder to her ear would be.
So we're strumming perpendicular
to those fibers. Once we find them -find the
tightest fibers that is, we can kind of go
lateral to medial to see if there's a
nodule and point of hyperactivity. And
then I'm just using that kind of curved
hand position and the weight of her head
to do all the work, and once i get a
release we're good to go and I would
reassess. So there you have it knowing
your functional Anatomy will definitely
help your manual technique. It will help
you differentiate structure so that you
can place your hands where they need to
be.
As well as make you aware of these
sensitive structures around the tissue
that you're trying to target. Things like
nerves, and lymph nodes, and arteries. Make
sure that if you're going to place your
hands on a patient that you have done an
assessment, and have a good rationale for
placing your hands on that patient. And
if you're going to assess, make sure you
reassess to ensure that your technique
was effective and you have a good
rationale for using that technique again.
Now with manual therapy one-on-one live
education is incredibly important. Please
be looking for opportunities like
workshops, and mentorships, and maybe even
classes at your local university that
can get you some one on one individual
instruction. Or at least some live classroom
instruction so you've had a chance to be
critiqued and mentored, by somebody
senior to you with some experience in
manual therapy techniques. And before you
bring this stuff back to your rehab,
fitness, or performance setting, please
practice on colleagues. There is no
substitute for practice, and it is going
to take a while to get accustomed to some
of the techniques that we show in these
manual technique videos. Don't expect to
learn them in two, or three,. or even five
minutes. You want to have hours of
experience under your belt working on
various different body sizes and shapes.
So that when you do get that first
paying client, first paying customer, and
you're really trying to make a good
positive impact, really trying to promote
better outcomes, you feel comfortable
with that technique. I look forward to
hearing about your outcomes and hearing
your questions in the comments section
of this video, I'll talk with you soon.
you
Subtitles by the Amara.org community