So now we're continuing here, looking at that first rib cervical thoracic junction involving the area of the thoracic inlet. We're looking at treatment involved with this. We're going through treatment. We're going to go through a few different approaches with it. One, we're going to go through some generalized approach with it. We're going to look through some techniques, look at some soft tissue techniques, something with maybe a muscle energy variation and some myofascial release. And then we'll go through a very specific approach to using myofascial release and a method to help train, especially a novice learner in going through it. So in this section, it's trying to give some very practical approaches to doing things. So we've assessed the area themself. The person is determined by utilizing the method of driving a car to say, OK, which way we're rotating and side-bending by using the wheel of driving, brakes, and looking at the gas to see which way is side-bending to the right so I have a feel for which direction things are going. So now they have an idea of what's going on. I've found the diagnosis and declared where areosomatic dysfunction is. What techniques? So there's two techniques we're going to go through initially with us here. First, we'll look at a soft tissue techniques. And this one also has these soft tissue techniques. They also have some other variations with them. So the first one we're going to call, we kind of call the X. And that's kind of a cervical stretching, flexion soft tissue technique. It has a muscle energy variation. And we'll go through that. The other one is a trapezius pinch technique. It also has elements of it that have some kind of myofascial release and inhibition. But they're two fundamental techniques. And since we've spent time, also, when you're teaching this section is, why do you prep and go through some of the anatomy pieces? This is where we kind of, this pays off. When you were going before, you talked about the trapezius and how much of an extent it had. These two techniques are really impacting that primarily. So the first technique, the cervical stretching, flexion, or we call it kind of X soft tissue technique, is simply the position to put themselves in a position where they have one hand over the other behind the patient's head and over the anterior portion or the upper portion of the chest. Now, by doing this, they can help flex the head forward. Now, with a patient, you're going to feel what's comfortable going through it. So when you're teaching a novice learner, say, look, have no harmers are going through this, generally push them up to the extent the patient has flexibility. When the one kind of point here, too, is that different people have different level of flexibility. So example, my flexibility is not that fantastic, to be honest with you. But I have a lot of daughters who have fantastic flexibility. So sometimes what you call normal and abnormal just depends on that person themselves. So when you're doing this, you've got to be conscious of that. So to do this, simple steps. So when you're teaching a learner, go through the steps you do. Say, we're going to make an X with our hands. You're going to gently, we always use gently. We always use gently, because especially when anyone going through this fast in themself is pushing to a barrier. Now, you can just stretch the area out themself, or you can add a generalized muscle energy technique to it. Or you'll have them just gently push back against you. And we go back to the rules of threes we talked about. Do something three times, three pounds, three seconds, three second breaks. If we use those rules of threes, we can apply it here as well. And that way, you can go to a new barrier. You can take the head just in straight flexion, but at the same time, you can also add some variations to it. Sometimes you'll take the patient, and you'll bring their head to the side. And that way, you can stretch more that lateral aspect to the trapezius. Remember, you go back to talking to them about the trapezius. Remember I showed you the trapezius, how it affects us sometimes by taking that side bending. It stretches that trapezius a little bit more effectively when we're doing that. So that'd be one technique is going through that. The other technique in that supine position is the trapezius pinch. It's classified as a soft tissue section, but in reality, you can also take it to another level and have kind of a myofascial release variation with it and inhibition. What do I mean by that? Well, remember when you, again, you go back to the learner and say, remember I was showing you the trapezius and see that that central area of the trapezius is right there on the cervical thoracic junction. It goes all the way up the occipital way down to T12, the anteriorly, the clavicle, posterior to the spine and the scapula. So it covers a lot of area. But you're squeezing that center area of themselves. That simple inhibition, just think of that muscle and sometimes I use it to get an idea. I said, you know, the muscle seems like it's kind of a spasm. And sometimes I use my hand to do something to kind of get the point across. Well, with inhibition, I'm trying to quiet that inhibition and going through it. And so, and then people understand what you're doing. So I said, I'm gonna gently kind of squeeze the area of themself. I'm gonna hold it and wait about five seconds so I can squeeze a little bit more. What they're also doing by doing that is it honestly adds this, it's kind of a direct myofascial release because we're trying to hold the muscle and the tissue to help release. But also it's inhibiting that over-response of the nerves to the area of themself. And it promotes that release of the contracture of the muscle. So those two techniques themselves are a good starting point to helping to treat the cervical thoracic junction. So now we're going to the treatment phase of the first rib, the cervical thoracic junction, treating this area of the thoracic inlet. Kind of good to start with a few basic techniques that can be done to help with it. These are generalized techniques. So we've already diagnosed the area to determine which way is the motion of the cervical thoracic junction by using the analogy of driving a car and determining using the wheel to see which way we rotate, which way we side bend. So we kind of know the direction where it's going and what area of semantic dysfunction is there. Now we're gonna get these generalizable treatments of the area. So one thing we can do is somebody call, it's kind of a forward kind of flexion, soft tissue technique. Also means you call it the X. That's because you put one hand underneath the side behind the head and create an X. So when you're teaching this, you want to use easy terms. So I always use the word X because they see that. Someone can see that there's an X, your hands look like an X. So when you're setting it up, say, look, notice my hands are gonna look like an X. Let's think an X. Again, use kind of simple things to be able to remember that so when you're teaching it. It's flexion, you're trying to stretch the muscles and also remind them, remember we talked about that trapezius muscle and how we're stretching, it really goes to the clavicle. All the muscles behind here, it's impacting the cervical thoracic junction. Again, one hand over. Now we're stretching the full area through here. So the first thing you can just do is stretching themself to one area. You can also stretch by leaning off to the side. You can use your hand to stretch the area to one side and go to the other side. Just use this to help stretch the area themselves to lean in one direction or use the hand. So tell me how they can use that stretching to do that. But then say, you could take this technique to a next level. Said, you know, remember we taught the muscle energy. I mean, we've done muscle energy with very specific, but you can do a general application. So this is a good example to say, well, you can use a general application for this. Well, what do you mean? Well, if you set this up like we've gone through, you know, and I hold this up and I take it to a barrier, it's at say, okay, now push back against me. Three, two, one. And relax and back off and give it three seconds and tell them to put in three pounds against it. Go to a new barrier, start again. Three, two, one, back off. And then go to another barrier, push back. Three, two, one. You can add a variation going to the side just by even just leaning into the patient, holding it and tell the patient, okay, push into me. Three, two, one, relax. So when you're doing it, also, I kind of started teaching people to do it back from three down, because sometimes you say one, two, three, and by the time you get to two, they give up. So sometimes I've done that, people seem to be more successful. Again, helpful hints to make sure it's a more successful technique. And then talk about going to a barrier. So what do you mean by a barrier? Well, go to you feel some resistance. Okay, I get that. Okay, push against me. Three, two, one. Again, back off. I tend to back off away from barrier a little bit. It makes it more comfortable for the patient. I seem to get a better result. And then push again. Three, two, one. So we're also training people to say, well, if you're treating both sides, make sure you treat both sides. You know, lean at the other side as well. So don't be chintzy. Push back against me. Three, two, one. Back off. Give it time to reset. That three seconds is to reset it. Push again. And then again, push again. Three, two, one. So that's one technique that we can utilize. So again, a soft tissue stick with a kind of muscle energy variation. The next thing we're going to do is you can also do another technique called the trapezius pitch. So this, I remember we talked when you were training them before about the trapezius and where the trapezius is. You get anterior to the clavicle, posterior to the spine of the scapula, up to the occiput, down to T12. So when you're doing that, somebody said, you can feel the muscles through the trapezius. It's just use your thumb and your first finger to kind of grab the muscle themself. Now, especially a novice in your training, don't have them go too medial because then if they start squeezing on things called the carotids, it really doesn't help things. So again, novices, try to make it safe. So tell them about midpoint and going through it so it's a safe area. And just tell them to squeeze kind of gently. Make sure you say gently. When you're training people, always do gently because it makes it a little easier. If you don't, anyway, just gently. So have them hold it there and tell them about five seconds or so and then kind of squeeze again. And do a little bit more. And the idea again with this is that this is kind of an inhibition. And it's from maybe a soft tissue technique to kind of a mild fashion release. In other words, it's kind of forcing, helping the muscle to relax and using kind of direct pressure against it. Squeeze each time again a little bit more. And you can use those analogies. I'm gonna say, imagine that muscle. Remember that muscle's kind of in a spasm. So again, use that. Sometimes I'll move my hands. I'll move something while I'm teaching with that and say, but then if I use that, I squeeze on it, also I'm kind of controlling that. So use visual things for them to see that as they're kind of going through it. And a lot of times you'll hold it and say, well, how long do I do this? I said, well, you know, don't be unended with the novice learner. Don't say, well, until you feel it release. Well, that's very confusing. Be a little more concrete. Say, well, you know, hold it for about five seconds. Feel it release. Do that and do that and keep and wait five seconds then squeeze a little bit more and do it again. You know, do it three to five times. Now give them a defined period of time to go through things to feel that. And you want to give them a time that honestly they'll get a result from it. And most people will notice that. And you say, ask the patient, you know, if they can tolerate it, but also can you feel the muscles release? So tell them, never regret asking a patient, you know, they're feeling it themself. So now what we're going to do is go through the first phase of some treatment techniques we can use for the first rib cervical thoracic junction to kind of treat the thoracic inlet area. We're going to go through both kind of a soft tissue technique that's using kind of forward flexion. We call it kind of the X technique itself, which has a muscle energy variation. And then we're going to do a trapezius pinch soft tissue, which also has kind of a direct myofascial release inhibition component. And those two techniques will go to the tables now and we'll perform them. So in this section, when you're going to be teaching this, when you're approaching things, you know, one thing you want to do is, you know, you want to make sure that you have a chance to, you know, kind of describe that you're going to go through two basic techniques. And remind the student when you're kind of teaching them things to say, look, you know, correlate with them that you kind of diagnose the area. And once you've diagnosed it, then you're going to use, you know, use manipulation to understand because these techniques aren't directly responding to your findings. They're like generalized techniques. In other words, before you evaluated and said, okay, we felt rotation and side bending, we rotated, we side bent to the right. And they said, well, what are you doing? Well, I'm going to do a generalized treatment. So like soft tissue is more of a generalized approach to it. And so with this one, the two techniques, you want to give them good examples for are helpful because both of them give, they're kind of soft tissue techniques, but they have variations for other technique modalities or other models of doing things. You okay with me going ahead and doing treatment? Okay. So I'm going to go ahead and go through how to do a couple of different treatment modalities to focus on the trapezius and what we were looking at was the thoracic outlet issues. So first off is just a generalized stretch. So what we usually do is like an X with our arms. And then the head goes right on top of the arms. Okay. Go ahead and lift your head for me a little. One arm. Yeah. I'm just going to take you up to where I feel a barrier. And then, is that feeling okay? Yeah. And then from here, I'm just going to hold this for about three seconds. Three, two, and one. Relax a little. And then I'm going to go ahead and take you up, hopefully to your next barrier. Does that feel okay? Yeah. Hold this for three, two, one. Relax. And I'll take you to your next barrier. Does that feel okay? Yes. Okay. Hold this for three, two, and one. And go ahead and bring it back down. Okay. And then another way we can actually use this is also through muscle energy. So we can do the same thing, but then while I'm holding forth about three pounds, you can go ahead and push back against me, okay? And we'll do that the same three times, okay? So let's go. There we go. Okay, go ahead and relax. And I'll lift you up to your barrier. And then go ahead and push against me. Three, two, one, and back. And then the other treatment is with the trapezius. So then we can go ahead and pinch it and hold that muscle belly until you, about five seconds, okay? And then what you're trying to do is you can do that up to three to five times to get it to relax. Okay, so I'm gonna go ahead and find that trapezius. Is it okay? Okay. I'm gonna squeeze for about five seconds. Okay, relax. And then again, a little bit more, and relax. Any questions? Okay. Okay, good. Okay. Hi, I'm Dr. Boone, Allergy and Immunology fellow. Today I will be showing three techniques used to treat cervical thoracic dysfunction. So the first one will be the forward flexion, or the X technique. The second one will be a side bending technique, and the third one will be a trapezius pinch. And then relax. We'll do the same thing again. Press towards my hand. You can do this also is if you can have them face backwards. Press towards my hands again. And then, and relax. Back off, and you can relax. Okay, so this forward flexion technique, what I showed was a muscle energy technique. Additionally, you can also do a soft tissue stretch. Which you just bring the patient to a barrier. Go back into the barrier one last time. Push back through, two, one, and then relax. The second technique is the side bending technique. You take one of the arms, and you lift your head again. You can also, okay, and you can relax your head here. And that would just be one part of it. And you can do this as a soft tissue technique as well, or a muscle energy technique. The third technique, which is a trapezius pinch technique, is where I place my thumb over the trapezius muscle. You want to be careful not to do it too medially, or towards your neck, because that's where the carotid arteries are. So what you want to do is locate the trapezius. You don't want to go too medial. And this time, I'm just going to increase pressure every five seconds, okay? Five more. And again, you can tell me, do this three, two, one, eight, four, five. Increase the pressure again. One, two, three, four. Now, how do you feel? Pretty good. At the end of these treatments, we would ideally want to reassess our patient by placing our hands over the cervical thoracic area and doing the steering wheel to assess if she has improvement in her rotation and side bending. So in summary, today, we did three techniques used to treat her for cervical thoracic dysfunction. The first one was the forward flexion technique, or the X techniques. With that, you have the soft tissue technique, or the variation with the muscle energy. The second one was the side bending technique, side bending her left, side bending her right. And the third technique is the trapezius pinch technique. For that, it's an inhibition technique where we slowly increase the pressure every five seconds. That way, we can help release the muscular tension and contracture. Obviously, we're just trying to increase the range of motion. Any questions? That was great, thank you. Okay, that was the best one you have done today. That was excellent. Okay, you introduced yourself. You talked to, at this time, the camera, like you could be assuming that that would be another student. You did each technique. You described it from start to the finish, all the way down. You actually did a nice thing where you included the muscle energy, as well as the soft tissue stretch. The trapezius one, you went down all the way, and then you summarized very well. I'm going to grab some of the clavicle rotation so they can fall. Oh, good, thank you. Excellent. So the first thing I'm going to be doing is muscle energy of the trapezius via the X maneuver. So the first thing I'm going to do is I'm just going to lift up the head. I'm going to grab the clavicle with, sorry, with one hand and come up with the other hand underneath that. Do the same, and I'm just going to stand. I'm going to just stretch the trapezius until I have some resistance, and I can go ahead and hold this positioning of the stretch until I feel release, or I can do this also with muscle energy. So this is just the standard muscle energy protocol. Also with this, I would approach the barrier and just have her with about three pounds of pressure just go ahead and resist against me. Good, three, two, one, and then I'm going to have her relax. Good, and then I'm going to approach a new barrier. And I'm going to have you do the same thing. Three, two, one, good, relax. And then one more approaching that barrier. Same thing, come down, three, two, one, good. Passive stretch, and then turn into neutral. We can also do lateral stretches of the trapezius as well. So I can do this by one hand underneath the head and clavicle, or I can just do this with a stretch, I guess, of the hand itself. It depends on, and you know, the body having this sort of elevation, right, that gives somebody with a big head, it can be heavy, so. So I would just go ahead and. And you'd want to incorporate using your body as a lever, your forearm as a lever. And then same thing, I can go ahead and add muscle energy to this as well. And have her just go ahead and press against me. One, two, three, good, relax. Approach a new barrier, and then same thing. Two, three, and then one more. Good, good, turn into neutral, then obviously I'd want to reassess for any hypertensity or release of the muscle. And lastly, it's the trapezius pinch technique, so I'm gonna go mid-clavicular. Mm-hmm. Okay, so as you said, today I'm doing this to help it for the belly of the muscle. Yeah, the belly of the muscle, and then I just hold it. Yeah, you just apply pressure to where you feel some resistance. There you go, and then you just hold it for five seconds. And then at the same position, you just go down further. Oh. So. Yeah, and so you can repeat that. You can tell them, you know, they can repeat that three to five times, or until they feel release, or if the patient's like, oh, I can't take this. I can feel that too much. So those are three different modalities.

cervical thoracic junction

first rib area

soft tissue techniques

myofascial release

X technique

trapezius pinch