Erector Spinae and Multifidus Static Manual Release (Soft Tissue Mobilization)

Erector Spinae and Multifidus Static Manual Release (Soft Tissue Mobilization)


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 therapist 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
therapist. 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 video, we’re going to go over static manual release
of the erector spinae muscle. I’m going to have my friend Melissa come out, she’s
going to help me demonstrate. We’re going to use the same “palpate and compress”
technique we’ve been using for all of our static manual release videos, using
that that four-step process of differentiating, knowing where our common trigger points are, knowing what not to press on, and of course getting our
patient and client in good position and us in good position so that we have good
technique. Starting with a differentiation of tissues, your erector
spinae are fairly superficial, and providing we’re not talking about trying
to differentiate the various erector spinae muscles, they’re actually not that
hard to palpate. The 3 muscles combined create a column of tissue on
either side of the spine. I think you instinctually knew this. This
this valley is created by the skin and underlying fascia being tacked down to
the spinous process, and then the thoracolumbar fascia and
fascia along the spine here, all the way into our cervical thoracic fascia
create these columns wrapping around the erector spinae muscles that create hills
on either side. For our palpation, the only thing we have to consider outside
of knowing where these hills are, is what direction of a diagonal these fibers go
in, because we’re going to want to go back to that stroke perpendicularly to
find the densest fascicles, and then go parallel along the dense fiber to find
the nodule, hyperactive point, trigger point. Here’s how the
diagonals work. Most of the erector spinae, in fact, all of the erector spinae
have a diagonal that goes from lumbar spine essentially to shoulder. If you
think in that direction from inferior-medial to superior-lateral, and then you
just drew parallel lines in your head, that’s the direction of the erector
spinae. The only muscles that are a little different being erectors of the spine that can also develop trigger points is our
multifidi, which our trigger points for our multifidi are usually in our lumbar spine,
here is what we’re talking about, and they go in the other direction. They go
from inferior-lateral to superior-medial. If I’m going to palpate tissues that run
this way again, so we’re back to a erector spinae, I’m going to set up my hips so
they’re even with Melissa’s hips and then my hands are going to be going in
the direction of Melissa’s head, and that would be my perpendicular stroke. So
that’s not too bad. When I do my erector spinae I’m facing this way, and then I
can just survey the length of my erector spinae. I’m just kind of picking up my
hand, strumming over the tissues. Now, it helps
to know where your trigger points are. Your 2 common trigger points that
we’re usually releasing in the erector spinae are right in the middle of the
lumbar spine, in line with somewhere between L-2 and L-4, and then just above
the thoracolumbar junction, there tends to be another trigger point. So if I know
that, I might go right to those points first just to see if I can
narrow this this search down a little bit, and when I find really dense
fascicles, again, I’m then going to go in line with the fiber, search the whole fiber
here for a nodule, an acute point of density, an acute point of overactivity,
And then you guys can use one of your various comfortable hand grips, either
thumb over thumb just again leaning in, you can use the technique I like to
use as you know which is kind of having that dummy thumb underneath, or
putting my pisiform hamate over my thumb, or putting my thumb in my thenar
groove here. So in this case, I’m going to do is pisiform hamate, and I’m just
going to hold 30 seconds to 2 minutes. To kind of pin down the tissue, notice I am I’m not pushing straight down, I’m kind of pushing this way, that
does help to keep me from playing that game of put your finger on top of a
marble just and it just like keeps shooting out this way. I tend to not
only push down but push a little bit so that I’m kind of bowing this tissue
this way, which holds that trigger point underneath my thumb. Now if I want to
switch around and do the multifidi, maybe I have done all of my erector spinae, but I want to switch around and do my multifidi, I’m then going to put my hips level with
Melissa’s shoulders, and I’m now facing her opposite hip. I can then go through,
and these are going to be lumbar spine, otherwise as we get
up in the thoracic spine the multifidi are not well developed in the thoracic spine, and of course, when we we do the neck that’s a whole different set of techniques which
we talked about in different video. So if we’re doing multifidi, it’s going to be
lumbar spine. We’re going to go this way, this direction, a little closer to our
spinous process until we find an acute point of overactivity or density. It does
help to kind of bring the pants down a little bit, so that you don’t have to
feel through another layer of clothing. You already have
the skin to feel through, you already have some adipose tissue, fascia, there’s a
lot going on back here that we got to feel through to just feel these
small increases in tissue density. And in fact, the common trigger point here is
actually somewhere between, in that little divot between our PSIS and then
the spinous process of L-4 L-5. Right in here, there’s a very common
trigger point. If I push in there, how does that feel Melissa? Yeah a
little a little tender. This is definitely a common trigger point. As far
as is there anything in this area that maybe we shouldn’t put our hands on, well
no. Providing that we’re staying close to the vertebral column, our transverse
processes, for the most part, protect us from being able to do damage to things
that would be deeper and more sensitive. It would be pretty hard, for example, for
me to push down so hard that I damaged a nerve or damaged an internal organ. You’d have to be way out here to get to some of your internal organs, and
I know people worry about that, but the transverse processes protect us pretty
well. Of course, if somebody was or had acute lumbar pathology, a nerve root
adhesion that was kind of new. Or they were experiencing some pretty
significant sciatic symptoms, or you had a lumbar herniation, obviously be
careful. Don’t go in and push down as hard as you possibly can. It’s
not so much that this is one of those things that you need to watch where you
put your hands, but maybe how you put your hands. If I knew somebody was very
sensitive to posterior to anterior pressure, I might even bring the table up a little higher, so that I can get a little bit
more of a horizontal pressure so that I’m not getting so much of this.
We can still pin tissues pretty good by pushing them towards the spinous process. How does that feel, Melissa? It’s still very tender, of course she has no lumbar pathology that
we need to worry about, but you can kind of imagine how this would be
helpful. Back to client position, notice when I wanted a more horizontal
direction I raised the table, when I want a more vertical direction of course I’m
going to lower the table. What you don’t want to do and this is just if you think
about it some common sense, you don’t want a high table and trying to be
pushing down. We don’t want arms like this. We want
arms straight. We want to use our fingers maybe to palpate just because we need
that sensitivity, but then when we’ve palpated the tissue that we need
and we’re just applying pressure, we really want to apply pressure not with
hand strength and arm strength, but just by leaning our body and using body
weight. I’m actually not using any strength at all here. My elbows are just
shy of locked, my arms are nice and straight, and I push down. I can tell you this is where having mirrors in your office comes in handy. I know not
everybody has that, but if you have mirrors in your office check your own
posture every once in a while. I know we put mirrors and offices for assessments
of our patients, but I think sometimes we need as much assessment on our technique and posture while we work. Just a real quick recap, common
trigger points just above the thoracolumbar junction right in the
middle of the lumbar spine, and then in that little soft area between the PSIS
and spinous process of L-4 L-5, usually a multifidi trigger point, erector spinae-
perpendicular strokes are this way, because those fibers run this way
multifidi run this way, so we set up this way. Stay tuned for a close-up recap. You can see the trigger points I’ve marked
out here are the most common trigger points in the erector spinae and the
multifidi. One just above the thoracolumbar junction, the other right
in the middle of the lumbar spine, and then of course that multifidi trigger
point often occurs right between the PSIS and the spinous process of L-4 L-5
in that soft tissue divot there. Now if we’re going to palpate and release the
erector spinae because they had a inferior-medial to superior-lateral
diagonal, I want to line my hips up with Melissa’s hips and then my hands are
kind of going in the direction towards her opposite shoulder. I’m going to do my
perpendicular strokes, strumming these fibers just like guitar strings, looking
for the densest or tensest guitar strings. Once I find the densest tissues,
I then go along the length of that tissue to see if there’s any sort of
nodule or acute point of hyperactivity, a trigger point. Once I find that point
then I can go -the palpating thumb becomes my dummy thumb, – and I can just place either my thenar groove over that thumb, or my pisiform hamate
over that thumb. Straighten out my arms, lean in, apply pressure for 30
seconds to 2 minutes. Once I get a release there, then maybe I keep
palpating, keep strumming all these fibers looking for any other shorter
points. You have to remember that your erector spinae is made up of tons of
fascicles that all run in parallel this way.
So it is possible to have multiple trigger points in multiple different
levels. These are simply the most common trigger points. Now for the multifidus,
remember that instead of going this way, since the multifidi go superior-medial
to inferior-lateral, I have to go this way, that I have to turn myself around, so now
my hips are in line with Melissa’s shoulders, my hands going towards her
opposite hip, and it’s a little different palpation,
it’s a little different feel than these big erector spinae muscles. The
multifidus are usually a little flatter. But you’re going to look for the densest fascicles. Once you find them, once again we’ll go along that fascicle to find any tender nodule, and
then once I find it, I can either do my thumb over thumb, pisiform hamate over thumb, or I can even do thenar groove over thumb like this, holding for
30 seconds to 2 minutes, until I get a release. So there you have it, knowing
your functional anatomy will definitely help your manual technique. It’ll help
you differentiate structures 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 then 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.

8 Comments

  • King Alleyne says:

    Why can't people speak normal English for simple people lol#melissia looking good as usual.🙃🙃🌼🌼#do a video lower body exercise for strong legs & glutes and same for best core exercises 😁#or send me the links to videos

  • Dluu22 says:

    Chiro student here, love your videos. Great review of anatomy too!

  • Fitness IQ says:

    You should get a Nobel Peace Prize that was an excellent video on functional anatomy and manual therapy

  • Lindy Smith says:

    I learn more from your very specific anatomy videos than all the ACE tutorials I'm viewing for my personal training exam…I will never do this body work in my scope of practice (I get it!) but it is so helpful to carry over into the test questions about muscles and kinesiology. You are like a mechanic opening the hood of a car explaining how it works, and I am grateful for your sharing!

  • Keegan Poggenpoel says:

    If that’s your studio, it’s beautiful

  • pin.,. t says:

    Hi , I suffer from having trigger points in my thoracic multifidus muscles especially on the right side , Is there a cure or exercises for my condition? thank you

  • Thelonius Monk says:

    Could have said all that in 1/3 of the words.

  • Christine Campbell says:

    Licensed Massage Therapist here. Thank you for sharing!!

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