So now we're going again with the first rib, the cervical thoracic junction. We're treating this thoracic inlet area. We're getting a myofascial release technique. What I'd like to do is, you know, some of this myofascial release, a few things just to bring a few points on. One is there's kind of a direct and indirect when you describe it. You know, direct basically means we're going to come towards the barrier. Indirect, wait for the barrier. So when you're teaching, especially novice learners going through it and they hear myofascial release, describe that, you know, we're trying to release the muscles, the tightness, the contracture that's occurred with them. And there's two ways you can do it. You can either go towards the barrier or the restriction, or you go away from the barrier and restriction by using it. So for them to understand that using this technique, it has these two variations. Now, one thing to be very conscious of is with, you know, especially more of a novice learner, and even people who start getting experience, that's not as easy as it sounds. Oh, it's direct, it's towards, indirect, it's away. Because sometimes feeling which way it wants to go takes time. So what you want to do is make sure you never make a learner feel, you know, you want to kind of, again, you want to do the, as Dr. Hostofer talks about, the demystify. You want to kind of break it down a little bit. You want to make sure that they feel safe because the learner feels safe in their learning environment. So again, we're going back to the driving the car model. We use that model to help diagnose it. We're going to use it also to treat the area themselves. We're going to go back to the idea of rotation, that right side bending. We're going to step on the gas. Then side bending left, we're going to, is the self is stepping on the brakes. And in beginning, we always start with that neutral, that neutral point themself of where we had it before, where the patient's hands are. We did that before we were going through the patients and we were assessing themselves. We want to make sure that right position because that's where we're starting, that thumbs and that posterior first rib and those fingers anterior of the clavicle. So always when you're doing this, make sure that you're working with the learner to make sure they got their hands in the right place and starting off with it. Now, here's a decision. There are different ways to approach this. When you're dealing with a novice learner or someone who's beginning or someone even has been out for, but says, you know, I'm just not as, it's a basic technique, but they say, you know, I'm not quite as great at this. Take away the barriers and maybe not the barriers and indirect direct, but the fact that all things we do to make it more difficult. So one piece that we're going to do with this is, we're going through it, is the concept of direct and indirect. I'm also going to say that's a secondary thing. Instead, what I wanted us to do is take this, is we're going to go into a few different motions with this. One is, is really a concept called steer right and steer left. So if we understand everything we talked about, that we have this wheel, this rotation, this side bending to the right, we step on the gas, side bend to the left, we step on the brakes, and people get that idea, we start from that neutral position where we're at, and then we begin and say, okay, we're going to steer right. So what happens that time? We're going to tell the learner to rotate it to the right, and then we're going to side bend to the right. So we're going to turn the wheel to the right, and we're going to step on the gas. Now, steer left is the opposite. We're going to rotate to the left and side bend to the left, which means we're going to turn the wheel to the left, and we're going to now step on the brakes. One of the concepts that's going to be hard when we talk about myofascial release again is this direct, this indirect kind of piece of it is, I'm not saying it's unimportant. It is, but that's a higher function. That takes a little more time. So to help, especially a novice learner, get through that, let's take that concern out of it. Let's make that a secondary thing. You're going to figure out which is direct and indirect, and let's just take it both in one direction. Set parameters. So when you're teaching this, instead of being vague, and I'm going to feel the releases and doing that, that makes people, they don't know where to begin with that. They don't feel releases. Honestly, the most experienced people, after a while, they realize, I don't really think I feel these releases very well. That takes time. So we are going to, by using the steer right, steer left concept, let's just set a parameter. We're going to steer right. We're going to rotate, and we're going to turn the wheel. We're going to step on the gas. We're going to side bend right. We're going to hold it there for 10 seconds. Then we're going to, in itself, after we hold it 10 seconds, now we're going to steer left. We're going to rotate left, or side bend left. Now we're going to step on the brakes. Hold that for 10 seconds. And then we're going to go back and repeat this three times. So as you use muscle energy three times, you're going to use three times here. Why do we pick 10 seconds? Is that an absolute? No. Dr. Evans and I were kind of looking at models for developing this. We said, we have got to create a model that most people in that situation will get a result. So if you have a novice person, you know, could it be five seconds? It could be, but it's probably a higher chance of taking care of a 10 second. So we picked our number. We went with 10 seconds. So we're going to hold it, steer right for 10 seconds, left for 10 seconds. So we're using a combination of direct and indirect. Now, which is direct? Which is indirect? Well, you know, honestly, we kind of pulled it out of the equation. Because what we're doing with this is we're giving them a chance to try in both directions. After time, they're going to start feeling, it seems to go easier this way than this way. But if you held it and said, you have to go direct and indirect, you might have lost them out of the gate. So by doing this method, it pretty much allows you to effectively treat with myofascial release and to do direct and indirect. But it takes the equation out of it, because they're going to go in both directions. And that way, they can guarantee the patient will have a result, you know, from that. And then reinforce to assess, treat, and reassess. So now we're going to go part of the treatment for the first rib, the cervical thoracic junction, between the area of the thoracic inlet. We're going to look at myofascial release. We're going to go through a model to make this a little bit easier for our learners when you're teaching this. We kind of did the assessment. We talked about driving a car. We talked about rotation, using a wheel. We're using about right and left side bending by stepping on the gas, stepping on the brakes, and how this works. Well, one thing that helps with myofascial release in the area themselves, that hand position helps determine this technique. We have to look at a way to help a learner get through some concepts which are not as easy. And one concept is direct and indirect myofascial release. It really refers to how it relates to a barrier. So direct means that we're feeling an area where it feels a barrier. Direct, we're going right into that barrier. And indirect, we're going away from that barrier. And that sounds simple, conceptually. But honestly, you know, for a novice, intermediate, and people that are around for a while, that's honestly not as easy as it sounds. And those are, honestly, it creates a barrier for them learning and doing things. So let's take those barriers out of it. So we're going to begin this. Remember our hand position. So our hand position is, again, our thumbs are going to be right over that first rib posteriorly. Our other hands are right above the clavicle, holding over that first rib area themselves, over that cervical thoracic junction. So the motions we're going to do with this is, with the myofascial release, we have to find a certain position. This allowed us, when we were assessing, to look at rotation, to look at side bending. With myofascial release, what we're going to do is we are going to take the whole cervical thoracic junction, and we're going to work on this rotation side bending component. And typically, things rotate and side bend to the right or rotate and side bend to the left. One is typically more the direct. One's more the indirect. Well, it takes a while to really appreciate that. So let's just really treat both. Let's use a combination. And to make it, let's make some simple rules. One is, if we're going to rotate and side bend to the right, that means we're going to turn the wheel to the right, and we are going to side bend, step on the gas, let's take there and hold it there for 10 seconds, giving 10 seconds so it's enough time to get a release. Then, once you go to the right, let's now steer left. Steer left, what's that mean? It's our model again. We're going to turn the wheel to the left. We're now going to step on the brakes. Hold it there for that 10 seconds to help release that. Then, we're going to go back. We're going to do this whole process now three times. We're going to steer again to the right, rotate and side bend to the right. Hold that for that 10 seconds. And do that again to the left. Rotate and side bend to the left. Hold it for 10 seconds. And one more time. So we do this three times. Rotate and side bend to the right. Again, turn the wheel, step on the gas, 10 seconds, and back. So again, our hand's in that position. This is what we're going to do. Make sure you got that is return the wheel to the right, step on the gas, and hold it there. Give that 10 seconds. Again, the learner may say, well, gee, you know, which ways go easier and which is harder? Well, sometimes they may not feel that initially, but when they're in the middle of treating this, they'll start noticing that. Now, turn it to the left and side bend to the left. So here, you know, I notice that when I start rotating to the left, it's a little more difficult for me. So that's probably more the direct technique. But it's not, let's say it's not important. It is important, but it's not, you know, most primary thing. But here, I want to do is I want to get a good result from initial learner. So after 10 seconds, I'm going to take it the other way. Rotate it to the right, side bend to the right. Hold it there. Again, this allows the, enough time to hold it to get the muscles to get kind of a release. And after the person, again, has gone through that 10 seconds, I'll go the other direction. And again, the idea of doing this whole thing, holding in 10 seconds in each direction, you know, is also helps it to give maximal time to help release muscle in that cervical thoracic junction. So now I've rotated and side bend to the right, which is our steer right. And we steer left. And we steer right again and steer left. And we're going to do it for the third time. So now I'm going to steer right, which means, again, I'm going to rotate and I'm going to side bend. Turn the wheel to the right. Press on the gas. Hold it there. Hold there for that 10 seconds or so. We can count it. We get kind of a feel for that much time, 10 seconds. And then our last time, steer left, rotate left, side bend to the left, which means we're going to step on the gas and turn the wheel to the left. And hold that for that full 10 seconds to get this area to hopefully release. So after that 10 seconds is up, we have to remember our rules. Our rules is, you know, that we assess, you know, we treat, we reassess. And we reassess and say, gee, it seemed to be moving easier in rotation and side bending. Let's see if we freed up the motion. And the motion seemed to be improved with that. So that is a model, again, using to treat using myofascial release for the first rib cervical fascic junction using the steer right, steer left approach to use myofascial release, which both incorporates direct and indirect myofascial release. So, now we're going to go to the lab looking at treatment using myofascial release, using kind of the method we have with, we're going to look at treating the rotational side bending components. We're going to use a different model that we're going to look at, which is kind of that steer right, steer left model to rotate and side bend to the right and to rotate and side bend to the left using the model of the car analogy to turn the wheel to the right, step on the gas, and then turn the wheel to the left and step on the brakes. We're going to hold it for 10 seconds in each direction and do that three times, so we can effectively treat the somatic dysfunction for the first rib, the cervical thoracic junction. Afterward, you know, we're going to turn the wheel to the left, we're going to step on the brakes. We'll hold it for 10 seconds in each direction, and after 10 seconds, we'll go back the other way and repeat it all three times. And then we'll, again, we assessed it, we treated it, we reassess. And again, so this is the model we are doing it, again, decrease barriers from novice learners to say, look, guys, we kind of did this, you know, so you're very kind of just, we already have the model, we're doing it. Now we're going to take the model to the next level, and that's how we're going to make this work. Okay? Remember, we talked about the cervical thoracic region, how to treat it, generalize. You remember the car analogy used for the diagnosis? We're going to be doing the same thing, using the same hand techniques, hand placement. Now this time, we're going to go through the motion, engage the rotation and the side bending on one side, hold for 10 seconds, and then take to the other side, engage the side bending and the rotation, and hold that position for 10 seconds. We're going to do that for three times on each side. Okay. Sounds good? Sounds good. Okay. Let's get started. Yep. Okay. So, again, find the posterior, first rib, and then my hand placement here. Okay? So I'm going to start with rotating to the right, and then side bending to the right, and then hold that for 10 seconds. Let me know if you're uncomfortable. I'm good. Thanks. Second time around. So one thing with this, it's good that you did all the right techniques, but I would articulate more the concept of steer right, steer left. Because with them, these hands go here and goes there. With the NOM, especially, you want to make sure it's crystal clear where hands go. So steer right means the wheel goes to the right, hands go on the gas. Because you're clearly moving, rotating the side bend to the right. Okay, now I'm going to steer left. Because otherwise, it's like, I'm kind of moving here, because you take away vaguety from them. And the idea here is you sit real clear about it. Why did we say 10 seconds? A more seasoned person would say, I feel released in three seconds. I'll stop there. You can, but they're not there yet. You're real rigid with them. You're saying, I want you to hold this here. You're going to do this. Then you're going to do this and this. Now, after a while, all of a sudden, they start noticing, well, it goes easier and that's harder. Then they understand direct and indirect. But right away, you see indirect, direct, they wig out. Even experienced people said, you know, it's hard for me to feel that. Okay. Okay. So now we're going to go ahead and go back to our analogy of driving a car and put it into treatment. Okay. So same hand placement as before. So it's no different. So don't remember two things there. So remember the thumb goes back behind the first rib and the fingers go up to the front to the clavicle. Okay. So we go ahead and feel for that first rib and then to the clavicle here. And then what we're going to do is we're feeling for the restriction. Okay. And then we can go ahead and treat based on pushing, steering the car to the right or to the left, pushing the gas versus the brake. Okay. So we're going to steer to the right and then push the gas so that in that way, what we're doing is we're side bending and rotating to the right and we hold that for 10 seconds. And then we release. And then we do that to the other side. We go ahead and turn to the left and then push on the brake. And that's side bending and rotating to the left. We hold that for 10 seconds. Doing okay? Yeah. And then we do it again on the right. Okay. So we steer to the right, side bend to the right, and we hold that for 10. And relax. And at this point, then we're going to go ahead and recheck and see how our motion is. Okay? It's the same thing like before. We're just going to go ahead and keep our hands in the placement. And then we go ahead and we check for motion. Pushing the brake and the gas and then the rotation with the steering wheel. Okay. Any questions? No. That was good. That was great. Good. So that's good. I mean, and that's good. I think it helps. You know, I mean, the key things with this is clear ideas. Make it easy. You know, again, this is the model. You know, take it out of it. We're going to steer right. We're going to steer left. Steer right. We rotate and side bend to the right. Steer left. Rotate and side bend left. What's that mean? That means we turn the wheel to the right. Press on the gas. That means we turn the wheel to the left. We step on the brakes. I said, again, we're going to do it 10 seconds in each direction, three times. So it's a one-minute treatment. You know? And, you know, if you don't understand that, and we're going to treat it. We're going to assess it. Where we saw it go, we're going to treat it. We're going to reassess to see if we've got improvement. So I think that worked out really well. Hi, I'm Dr. Wu. I'm an Allergy and Immunology fellow. And I will be showing the myofascial technique for cervical thoracic dysfunction. Hello. Hi. I'm Dr. Wu. How are you? Good, thanks. Okay, so I'm going to start by placing my hands over your clavicle. And my thumbs over the first rib, okay? And just like driving a car, I will be rotating her right. Side bending her to the right, which is like pressing on the gas. So I hold this for 10 seconds. Bring her to neutral. And I do the same thing again. So I rotate her to the right. Extend the wheel of the car to the right. Side bend her to the right. Just like pressing on the gas. And hold it for another 10 seconds. At the same time, you want to make sure you do it to the other side as well. So this time I'm going to rotate her to the left. And side bend her to the left. And hold that for 10 seconds. Same thing again. And I would do it for the third time, the same thing. Rotating her to the left and side bending her to the left, which is like pressing on the brake. So then at the end of this myofascial release treatment, I would reassess just to see if this technique has freed up any of her range of motion. Again, like driving a car, I would rotate her to the left and to the right. To see if she has any restriction in motion. And she's pretty balanced. And then I would press on the brake, which is side bending her to the left, or press on the gas, which is side bending her to the right. To see if she has any restriction. Pretty good. Do you feel any different? Yes. I feel better. So in the end, in summary, what I did today was demonstrated the myofascial release technique to treat the patient for her cervical thoracic dysfunction. Good. The technique that we taught you is to do rotate right and side bend right, but then rotate left and side bend left. So that's one cycle. Then go to the second cycle, right then left. Then go to the third cycle, right then left. My hand placement around the thoracic inlet. So my fingers anteriorly will be in front of the clavicle. And then posteriorly, I'm going to find the posterior aspect of the first rib. And then I'll first be assessing the motion. So I will do the steering wheel motion to assess for rotation. I would say she rotates easier towards the right side. And then I'll assess the side bending with the gas pedal. Side bending right and the brake pedal side bending left. I would say that she side bends a little bit easier towards the right side. So in order to treat that indirectly, I would go into the ease. So I will be rotating right and side bending right. Pushing on the gas pedal. Yeah. And then I'll hold that for 10 seconds. And turn to neutral. And then to do that direct, I would do the opposite. So I'd be going into the barrier. So I'll be rotating left, so turn the steering wheel left. And then pushing down on the brakes to side bend left. And then hold that for 10 seconds. And turn to neutral. And then reassess the motion to see if it's evened out. So check the rotation. I think it's a little bit improved to the left. And a little bit freer with side bending. Yeah, and each of those, you do one indirect and one direct. And that would be a set.

myofascial release

cervical thoracic junction

first rib

direct and indirect techniques

steer right steer left model

novice learners