00:04 - 00:07This is Brother The brookbush Institute and I'd like
00:07 - 00:11to go over my lumbar spine movement
00:10 - 00:13assessment. So I'm gonna have my friend a vet come out.
00:13 - 00:16She's gonna help me demonstrate. Now. If you guys have
00:16 - 00:19watched some of our videos, you know that the overhead squat assessment
00:19 - 00:22is our top tier assessment. That's what I start with. That's
00:22 - 00:25how I know what compensation pattern I'm going after
00:25 - 00:28and what segment I'm gonna address first, but there are
00:28 - 00:31a couple small problems with the overhead squat assessment one of them being
00:31 - 00:32it's kind of weak.
00:33 - 00:36On lumbar spine. So the way
00:36 - 00:39I get through a little lumbar spine movement assessment is
00:39 - 00:43this I'm going to go ahead and sit because a
00:42 - 00:45vet is just a little shorter than I am.
00:46 - 00:49I am a little bit tall. So what I'm gonna have you do with that is I'm gonna have you turn in
00:49 - 00:50face away from me.
00:51 - 00:54And bring your feet close together. All
00:54 - 00:57right, so I want I want your toes and heels
00:57 - 01:00touching. Now. The reason why I have toes and heels touching is to
01:00 - 01:03try to decrease any chance that I have has plan
01:03 - 01:06a specialty asymmetrical pest planets. Now,
01:06 - 01:09the next thing I'm going to have of it do is go ahead and cross your
01:09 - 01:12arms so that she's touching up as it shoulders but lightly
01:12 - 01:15And then with her feet facing away
01:15 - 01:18from me. I'm gonna have her turn as much of
01:18 - 01:21her body as she wants and can to face
01:21 - 01:24back towards me. So let's go
01:24 - 01:25ahead and do that event.
01:26 - 01:29All right, good faith. Turn your head all of it
01:29 - 01:32good and what ideally you would see and
01:32 - 01:36we'll show this facing the camera is her in
01:35 - 01:38this case right shoulder would get a little
01:38 - 01:41farther than her left shoulder, right? So she'd actually
01:41 - 01:44surpass right and left shoulders being in
01:44 - 01:46line. And then let's see the other side.
01:49 - 01:53And that's interesting. She's
01:52 - 01:54a little tighter on the left side.
01:55 - 01:58So this first couple of
01:58 - 02:00tests, right? So rotation right rotation left.
02:01 - 02:04Are referred to as multi-segmental rotation tests
02:04 - 02:07by gray cook and the FMS guys
02:07 - 02:11and I really happen to like these tests for
02:10 - 02:13general movement, and I'm only looking
02:13 - 02:14for three things.
02:15 - 02:19I'm looking for gross or obvious restriction.
02:19 - 02:22I'm looking for asymmetry and I'm looking
02:22 - 02:24for concordant sign.
02:24 - 02:28All right. So before anybody gets on my case about reliability and
02:27 - 02:30whether I can measure how much
02:30 - 02:33rotation that's that's not what I'm measuring here.
02:33 - 02:36All I'm seeing is can I get one shoulder past the
02:36 - 02:39other especially is one side tighter than
02:39 - 02:42the other in a vet's case. She's actually Tighter and
02:42 - 02:45left rotation then right rotation. Did
02:45 - 02:46you have any pain there?
02:47 - 02:50And she had no pain in rotation. So something for
02:50 - 02:53you guys to keep in mind in the back of my head. I'm already going so I
02:53 - 02:56can't use this as necessarily her
02:56 - 02:59her test retest because this
02:59 - 03:00doesn't bring on our symptoms.
03:01 - 03:04The Next Step I would do is go. Okay. Can you
03:04 - 03:05touch your toes?
03:06 - 03:09Alright, and she can bend her knees a little bit. And again, I'm looking
03:09 - 03:11for obvious restriction.
03:12 - 03:15I'm looking for pain and I'm looking for asymmetry. So
03:15 - 03:18does she like end up more on the right side
03:18 - 03:21or more on the left side good and you can go ahead and stand back up.
03:22 - 03:25Any pain on the way back up? Keep that in mind guys. It's not just
03:25 - 03:28pain on the way down. It's pain on the way up. It has been
03:28 - 03:31my experience that pain on the way up is usually indicative of
03:31 - 03:34more stability type problems. That
03:34 - 03:37doesn't mean that there's no Mobility restriction, but
03:37 - 03:40it does mean that stability is a big part of the issue. The last
03:40 - 03:43thing I'm going to have her do is hands up
03:43 - 03:44over her head and extend.
03:47 - 03:48good and again
03:50 - 03:53Obvious restriction asymmetry or pain.
03:53 - 03:54How does that feel?
03:55 - 03:58Good and then turn sideways for me. I want
03:58 - 04:01to see you from the side on the toe touch and
04:01 - 04:03the extension test. So you're going to face your feet towards the camera.
04:04 - 04:06All right, go ahead and touch your toes.
04:07 - 04:10And guys, I'm only taking this lateral view because now I can see if
04:10 - 04:14there's any obvious restriction I can see if there's any obvious
04:13 - 04:16weirdness or lumbar spine. Like
04:16 - 04:19maybe I noticed she hinges at one point like some of
04:19 - 04:22you guys who who've been therapists for a while. You'll notice that like flat
04:22 - 04:25lumbar spine and like a hinge at the thoracolumbar junction.
04:25 - 04:26Go ahead and
04:28 - 04:31Stand up good and he paid on the way back up. Good go ahead
04:31 - 04:32and hands up over your head.
04:33 - 04:37And lean back as far as you can right and I'm just looking, you
04:36 - 04:39know, can she get her hips kind of close to her
04:39 - 04:42toes like is she getting some curvature back
04:42 - 04:45here and she actually looks pretty stiff and her thoracic spine. If
04:45 - 04:48you guys saw from the side her thoracic spine is like straight. So
04:48 - 04:51that's just some stuff. I want to keep in mind now.
04:52 - 04:56Let's go back to uses usage
04:55 - 04:59why I've chosen these tests and
04:58 - 05:01where we're going to go next. So I
05:01 - 05:04mentioned to you guys. This is my movement assessment
05:04 - 05:07for the lumbar spine. I am not trying
05:07 - 05:11to suggest that these are diagnostic tests.
05:10 - 05:15These are tests specifically chosen or
05:14 - 05:17I should say borrowed from Gray cook and
05:17 - 05:21the functional movement screen because they help me direct
05:20 - 05:23my intervention plan
05:23 - 05:27my corrective exercises or my manual therapy techniques,
05:26 - 05:29right? So if I have asymmetry and
05:29 - 05:32rotation for example with the vets
05:32 - 05:35and she was more asymmetrical to the left, right she
05:35 - 05:38lacking some left rotation. Maybe that means when I give her
05:38 - 05:42a home exercise program I'm doing open books right to
05:41 - 05:44work on rotation with right side down
05:44 - 05:45only.
05:46 - 05:49So that she's working on left-sided rotation to get
05:49 - 05:49even again.
05:50 - 05:54Right. I find like that's really helpful to notice those asymmetries flexion
05:53 - 05:56and extension more often than not
05:56 - 06:00those are great tests for
06:00 - 06:03finding a concordant sign to latch onto right so
06:03 - 06:06you can test retest but if I saw a gross
06:06 - 06:09restriction inflection, I might start thinking okay.
06:09 - 06:12I need to do some release techniques for
06:12 - 06:15the Erectors. I could start thinking towards instrument
06:15 - 06:18assisted soft tissue mobilization of the thoracolumbar fascia,
06:18 - 06:21like all those Mobility techniques if she was
06:21 - 06:24lacking range of motion into extension,
06:24 - 06:28maybe I'm thinking about joint mobilizations, right even
06:27 - 06:30some self-administered stuff like a thoracic spine
06:30 - 06:32foam roll would probably do a vet. Very good.
06:33 - 06:37Some of you guys might be thinking who know a little bit more of the traditional lumbar
06:36 - 06:39spine exam why I don't
06:39 - 06:40do lateral flexion.
06:41 - 06:42And this is a case of pruning.
06:43 - 06:46Right. So what do I mean by pruning if the test doesn't have
06:46 - 06:48an impact on your intervention?
06:49 - 06:50Don't do it.
06:51 - 06:55Tests have two basically when we do assessment in
06:54 - 06:57our world, right? We have two types of
06:57 - 06:59tests. We have tests that help us clear a patient for
07:02 - 07:05Being under our care. So those are like our diagnostic tests.
07:05 - 07:09Is this person have you know something really?
07:11 - 07:14Serious that may not work so well with conservative physical
07:14 - 07:17therapy treatments we need to refer them out. Right so we have
07:17 - 07:20those type of tests. And then our other tests are how is this
07:20 - 07:23going to help me make a plan for her that's going to help her feel
07:23 - 07:25better. And if it doesn't fall into one of those two categories
07:27 - 07:27It's gone.
07:28 - 07:31So with lateral flexion, I just happened to notice that I don't use lateral
07:31 - 07:34reflection for anything. It's very rare that somebody has pain and
07:34 - 07:38lateral flexion and doesn't have pain and rotation flexion or extension. So
07:37 - 07:41it just got rid of it. And I think my programs
07:40 - 07:43are more efficient for it last thing.
07:43 - 07:46I'm going to have you do with that for the camera so that they can see what I was
07:46 - 07:48seeing is I want you to go ahead and face away from the camera.
07:50 - 07:53All right. Let me have you take a little step this way. So you're a little
07:53 - 07:56bit more centered good. All right guys, and what I want you to see is is
07:56 - 07:59what I was seeing. She's gonna bring her feet together. So we don't have any
07:59 - 08:02chance of having Pez planets, especially on one side
08:02 - 08:05or less chance of has planted on one side. She's gonna go
08:05 - 08:08ahead and do this, right and what she's gonna try to do is turn around
08:08 - 08:09and face the camera as far as she can.
08:11 - 08:14Good Fortune turn turn and ideally she
08:14 - 08:17would get her right shoulder past her left and she'd
08:17 - 08:20be more or less straight up and down. So you guys can even see she like leans
08:20 - 08:20a little bit.
08:21 - 08:22All right, then. Let's try the other side.
08:26 - 08:29Oh, right. You guys can see she's like a little limited and this
08:29 - 08:30side in this case.
08:31 - 08:34Is it this side go all the way let's try the
08:34 - 08:34other way.
08:35 - 08:38Maybe she's not asymmetrical. She's not looking a little bit more even she's just
08:38 - 08:41kind of looking a little restricted on both sides. Maybe you guys have
08:41 - 08:44a better view than I do now and are seeing the
08:44 - 08:47same thing I did which this side was actually rotation to the
08:47 - 08:50left was more restricted. Of course, she can then go into flexion.
08:51 - 08:52All right, so touch your toes.
08:53 - 08:56And I would look for asymmetry. Does this bring on pain and
08:56 - 08:59does she have any gross restriction so she couldn't barely touch her knees. That's
08:59 - 09:02a problem. Go ahead and stand up make sure you ask about
09:02 - 09:03pain on the way up.
09:03 - 09:06Right because those stability problems have
09:06 - 09:09a way of people are fine on the way down and then
09:09 - 09:12they try to get themselves back up and it's like that's when everything
09:12 - 09:13kind of like seizes on them.
09:14 - 09:14Hands up.
09:15 - 09:16Ben back
09:17 - 09:20Again in this position, I would look for you know
09:20 - 09:23asymmetry. Is she leaning to one side or the other
09:23 - 09:27is their pain and of course I can see if there's a little bit of extension
09:26 - 09:29here range of motion overall for flexion
09:29 - 09:31extension are probably best viewed at
09:31 - 09:34From the side. I think
09:34 - 09:37you guys putting these tests in
09:37 - 09:40we'll get some good indications of what you
09:40 - 09:43should do as far as treatment to help improve motion
09:43 - 09:46of the lumbar spine. I hope you guys enjoyed
09:46 - 09:49this little video of one of
09:49 - 09:52our little breakouts from the overhead squat
09:52 - 09:55assessment for individuals specifically with issues
09:55 - 09:58kind of in that lumbo pelvic hip complex region.
09:58 - 09:59Talk to you soon.