Practical Video for OB: Lateral Recumbent

00:02 Scapulothoracic myofascial release.

00:04 So what we wanna do here is mobilize the scapula on the thoracic spine.

00:09 Remember the scapula attaches to seventeen muscles and that goes into your upper extremity, the neck and the back.

00:16 So when those muscles are restricted, that could restrict proper scapular movement.

00:20 So what we wanna do is get good purchase on the scapula.

00:23 I'm gonna contact the scapula with my hands here and then I'm going to then now assess the freedoms of motion and for the scapula in three different planes.

00:32 So I'm gonna check superior, inferior motion and here the scapula is superior.

00:37 I'm gonna check medial and lateral and the scapula here likes to move more medial and now I'm gonna check clockwise and counter clockwise rotation and here it likes to move more clockwise and so I'm stacking all three freedoms here holding it and treating this indirectly.

00:57 You could also treat the scapula directly if you feel like the indirect technique is not really working.

01:02 We're gonna hold this until we feel release, come back and then reassess the motions of the scapula and there should be improved motion and mobility.

01:12 Another way to mobilize the scapula is to kind of get your fingers medial to the scapula and then you could add a little bit of a compressive force so then this then becomes like a mild fascia articulatory technique to try to mobilize the scapula and help loosen up the scapula and the tissue around it.

01:27 If the trapezius muscle and the supraspinatus is a little bit tighter, you could kind of shrug the shoulder up and then add the compression so this is a nice technique to articulate the scapula and help loosen up the tissures around.

01:39 You could also bring the arm up then address the tissue on the lateral scapular region with your thumb and again just mobilizing the scapula moving it in a circular fashion and mobilizing the scapula so all of the muscles around the scapula are more relaxed and after which you could bring the arm back and then recheck to see if the scapula is moving well.

02:01 And of course you could do this bilaterally to help loosen up both sides.

02:06 Lumbosacral soft tissue technique So with this technique, what we're going to do is to treat the patient in a lateral recumbent position.

02:14 So the patient's gonna lie down with the affected side up.

02:17 So we've assessed the regions here and we wanna treat the left side here.

02:22 We're gonna place our fingers along the lumbar spine, the paraspinal muscles here, we wanna assess the tissue to see where the tesion is and what we're gonna do is we're gonna apply a lateral traction by pulling towards us and the same time my forearm's are gonna be along the greater trochanter here and a little bit underneath the shoulder.

02:45 and what I do is as I traction and pull towards me, I'm gonna bring my elbows and spread out laterally.

02:51 And so this creates a little bit of a mild fascial stretch trying to treat the soft tissue I comb my fingers down the lumbar spine into the sacrum, this should feel comfortable for the patient.

03:05 You should try to apply the stretch slowly so you dont get a reflexive spasm of the spine and the muscles.

03:14 And so again, just hold it until you feel a release and you could move again up and down the thoracolumbar spine into the lumbosacral spine.

03:22 until you feel the muscles are relaxed afterwards, so you're gonna reassess after applying the technique and make sure that the technique was effective.

03:32 Supine diaphragm release.

03:35 so what we wanna do here is to address any sort of diaphragmatic restrictions by addressing the diaphragm's attachment to the lower rib cage and the spine.

03:45 And the diaphragm is a very important structure to look at cause as the fetus grows, it's gonna try to compress on the structures and add more pressure on the diaphragm.

03:54 Remember the diaphragm is a very important structure that ties into respiration, circulatory, lymphatic flow, and musculoskeletal; you also have the diaphragm's restricted, that could affect GI due to the lower esophageal sphincter and other issues.

04:11 So what we wanna do to treat it with diaphragm release is to make a contact, we're gonna place our thumbs underneath and on the costal margin and the rest of our fingers will kind of contact the ribs, remember the diaphragm attaches to rib six to rib ten anteriorly So we're gonna contact those ribs and then we're gonna find the freedom of motion here to treat indirectly, so I'm gonna do a little bit of translation and see if the ribcage here likes to translate right to left or left to right and here it likes to translate from left to right We're gonna do a little bit of rotation to see if it likes to rotate and then we're gonna see if it likes to sidebend looking at the pumped hand in motion of the ribs that likes to go into inhalation or exhalation.

04:53 We're gonna find all those freedoms and then we stop to freedom, and then hold that until we feel a release.

05:00 Once we feel a release, we come back and then reassess to check for diaphragm excursion and to see if the ribcage is moving a little bit easier.

05:10 AP pelvic unwinding.

05:12 So remember that the pelvis is an important structure to treat and look at especially with pregnancy we wanna make sure that there's not any musculoskeletal restrictions in the region and what we can do is utilize anterior and posterior contact on the pelvis and treat and release some of the tissues that attach, perhaps loosening up the pelvic diaphragm and also additional structures attaching to help with bony motion of movements in the pelvis So we're gonna have anteroposterior contact By posterior contact is gonna really have the fingers on the sacrum and to control the sacrum and almost reach down and have the coccyx also, and my top hand, I'm gonna have my palm and rest my hand across the pubic bone so make sure you explain that to your patient first so that they're aware where your hand contact is gonna be, so to reach underneath I find it easier to make the patient kind of bend their knee up and lift up your tub on a little bit and I find the sacrum and the coccyx here and then have them relaxed and then make them relax their leg.

06:15 And on my other hand, I'm gonna tell them that I'm gonna feel for your pubic tubercle so I'm gonna put a little bit of pressure in one start to superior and then weight down until you feel that bone.

06:25 Once you feel the bone, you could hold your hands so it's the thenar eminence is more on the pubic tubercle and so now with that AP contact, we're gonna find the freedoms of motion.

06:37 So I'm going to move and check for translation translating into the left, translate to the right and my bottom hand is gonna do the opposite from the top hand.

06:47 So as I translate I find that the freedom of motion here is to translate my top hand away from me and my bottom hand towards me We're gonna check for superior and inferior glide and so as I move my top hand superiorly, my bottom hand is moving inferiorly and the freedom here is to move my top hand towards the feet and my bottom hand towards the head and then the last motion is a little bit of a clockwise and a counter clockwise motion and again, your fingers, your hands in the top and bottom are moving in opposite directions and here, it likes to move counter clockwise so I stack all the freedoms up to perform an indirect technique and you hold this until you feel release.

07:28 It might be a little bit more of a softening or you may feel a little bit more of a breathing and expansion when the patient breathes.

07:35 And once you finish holding that, you come back then reassess the motions of movements again to see if there's improved motion after the technique was performed Sacral-iliac articulotory technique.

07:48 So the SI joint is an important place to look at, the ligaments in between sometimes can be strained especially with pregnancy that might potentially cause more restrictions there.

08:01 The patients also have hormone being secreted, the relaxin hormone helps to relax the SI joints a little bit more.

08:09 So to treat the SI joint, what we wanna do is to first assess for restrictions I'm gonna place my hands on the ASIS here and just compress gently to see which side feels a little more restricted.

08:20 On the right side here, it just feels like there is less motion and a little bit more difficulty compressing the right side so I have a right SI restriction here.

08:31 So we're gonna treat this by trying to mobilize the SI joint, I wanna utilize the leg and use the hip to try to move the innominate to free up the side joint.

08:41 So this is our articulotory technique, we wanna move the joint to its barriers, so I'm gonna slowly bring the leg up, flex the hip and ABduct, externally rotate during almost like a fibular technique technique and then coming back, I'm going to bring the leg down and then flex up again and then ADduct and internally rotate and bring the leg down.

09:06 So we kind of alternate flexion, ABduction, external rotation with flexion, ADduction, internal rotation.

09:15 And so you do this smoothly, several times back and forth and what it does is it helps to mobilize the SI joint a little bit more and helps to loosen up the ligaments in that area.

09:27 You could bring the leg back, and then we can go ahead and reassess by compressing on the ASIS to see if there's improved motion and movement.

09:38 Frog leg sacral balanced ligamentoust tension.

09:41 So with this technique, what we're trying to do is to treat the sacrum and we're gonna utilize the innominates in its rotation to help treat the sacrum.

09:51 And so the front leg portion of this is to have the patient start with their knees bent and then when the sacrum is balanced, we're gonna slowly straighten out the leg while we're holding the sacrum in the position of freedom or ease.

10:07 So the sacrum is a very important structure to take a look at especially with in its relation to the lumbar spine and the pelvis especially with delivery.

10:17 Remember that the sacrum will first counternutate and then nutate to allow for proper delivery so we wanna make sure that there's proper motion and movement in the sacrum.

10:27 So we're gonna start with the patient bending their knees up, and what I like to do is explain to them that 'I'm going to place my hand on your tailbone and I'm gonna have you, when I have my hand on your tailbone, let your knees fall out to the sides so first lift up a little bit and I place my hand on the tailbone- good you could relax, and I'm gonna put your feet together and slowly let your knees fall out to the side.

10:50 So this is the front leg portion.

10:52 Now I'm gonna treat the sacrum.

10:54 So while I'm holding on to the sacrum, I wanna see what phase the sacrum works better with during respiration.

11:01 So go ahead and take a breath in, and breathe out - good.

11:07 So it feels like the sacrum moves better in inhalation so Im gonna do an indirect technique, I'm gonna ask the patient to take a breath in and then hold it and when you feel like you can't hold it anymore, you're gonna let the breath out and then you're gonna spread your legs at the same time.

11:21 So it's a lot of coordinating to do what I'm doing with my hand on the sacrum here is to hold it and it's freedom so go ahead take a breath in - hold it, and with my hand here, I'm applying a little bit of pressure in my palm to bring the base more posterior and when you feel like you can't hold the breath anymore, you're gonna slowly breathe out and then straughten out your legs - perfect, And now she's straightening out her legs, I've applied a little bit of traction on my hand on the sacrum and then from here, I could reassess and just let my hand rest on the sacrum to see if it moves better with respiration, so go ahead and take a breath in again and breathe out.

11:58 So after the technique, now the sacrum is moving better with respiration and you can bend your knee and lift up, and that's the sacral VLT technique.