0:05 This is Brent and in this video we're going after a dysfunction that many of you 0:09 have had questions about, that's the asymmetrical weight shift. But this video 0:14 has been placed very purposely at the end of our signs contributing to 0:22 clusters, contributing to compensation patterns, because the asymmetrical weight 0:27 shift isn't just a sign of dysfunction it is actually a compensation pattern 0:32 unto itself, and there are going to be several signs that contribute to it. So 0:37 if we expect to be successful with our corrective exercise strategy, we're going 0:42 to need to understand how several joints work together before we just check this 0:48 box and think that we're going to get a real easy quick solution. So I'm going to 0:52 have my friend Melissa come out, she's going to help me demonstrate what's 0:54 going on here. Let's say for a second that I've seen Melissa squat, go ahead 1:03 and throw your hands up, and I noticed right off the bat maybe I even noticed 1:07 this when she was working out like doing squats or deadlifts out on the gym 1:10 floor, that she squatted down and she had an asymmetrical weight shift. Alright so 1:15 I've got that box checked off, the question is is where is that coming from, 1:20 and I know a lot of you guys think that right here is where asymmetrical weight 1:25 shift comes from. That's kind of what the solution tables out there have said that 1:29 this is where asymmetrical weight shift has come from, but that's not necessarily 1:32 the case. Asymmetrical weight shift can come from any one of our segments, so we 1:37 talked about upper body in a video, we talked about lower leg, i'm going to talk 1:40 about how that's probably the most common contributor to an asymmetrical 1:44 weight shift, and it can also come from here. Alright so if I've seen or do an 1:50 asymmetrical weight shift out there, I need to pay closer attention now. So i'm 1:55 going to set her up, second toe pointing forward. I got her pants on her ASIS and PSIS, 2:01 looking to see if those are within one inch of level, alright and I got our 2:05 hands up elbows locked. Now when she squats, go ahead and squat down i'm going to key into 2:13 every dysfunction I see, but what I'm really looking for is anything 2:18 asymmetrical. So any sign that happens on the right or 2:21 left only, or the right more than the left or left more than the right. So 2:26 let's say for a second that Melissa does this squat, we know she has an 2:29 asymmetrical weight shift but she squats down and her right foot turns out more 2:33 than her left, that is something for you to look out for. You really want to key 2:39 into that is worse than that side. Alright go ahead and stand up again, we 2:45 want to see about the knees, does one knee bow out and one knee bow in. Alright so if 2:50 she does an asymmetrical weight shift towards me. What that looks like to me 2:56 guys, I don't know if you can see this, that's technically knee bow out on her left 3:02 side and knee bow in on her right side. That's going to be real important. I'm 3:08 going to mark that down, right so she does that again and I would say knee bow out 3:15 left only, knee bow in right only. Good so let's go to lateral view, hands up squat 3:26 down. Maybe I start to see some other lumbo-pelvic hip complex signs right. I 3:31 know you guys have learned that asymmetrical weight shift is generally a 3:35 lumbo-pelvic hip complex thing, there is definitely a lot going on there. I still 3:39 see that excessive lordosis, I see an excessive forward lean. Alright go ahead 3:44 and come back up, obviously those aren't going to be right or left only. Then 3:50 let's see her upper body, let's see her arms alright. Go ahead and squat down, 3:56 occasionally what you will see is this, alright where she has one side where 4:03 the lat is really really geared up, if that was on the same side of her 4:08 dysfunction I'm definitely geering into that, I'm definitely thinking okay there 4:13 might be a connection there, where her lat on this side is pulling her 4:17 right pelvis anteriorly, which is causing her to shift on that side. 4:23 Good now the question is how I figure out where it's coming from, i just gave 4:28 you a lot of reasons why maybe her right side being more dysfunctional 4:33 than her left in lower leg could cause her to collapse and shift to that side. 4:38 We talked a little bit about the lumbo-pelvic hip complex, maybe just 4:41 right-sided knee bows in right, and then this side bows out, and then we also 4:47 talked about how a lat could contribute to a right anterior pelvic tilt and a 4:51 shift. So now we have to figure out some way to isolate, which just goes back to 4:57 our squat with modifications. So what I'm going to probably do in this case is i 5:03 won't do hands down and feet up at the same time, just to see if one at a time i 5:09 can kind of knock things out. If i have her hands up, wait hands up high heels, 5:17 all I'm doing now is try to differentiate between what's going on 5:22 and whether it comes from her lower leg and ankle. If she squats down and her 5:30 asymmetrical weight shift disappears, because I put her on high heels then the 5:36 problem is not at the lumbo-pelvic hip complex it's at the tighter ankle. 5:42 Basically what's happening there is go ahead and back off, this would be the 5:47 equivalent of let's say she has a tight right ankle maybe she sprained her right 5:52 ankle a year ago, if she can't dorsiflex on this side right she's going to 5:58 squat down, not be able to go any further, and she's either going to collapse this way 6:04 to try to get down, or she's going to collapse away from just like that 6:11 rotate that way, either one's going to cause an asymmetrical weight shift. You could 6:15 try to correct at her lumbo-pelvic hip complex all day, and if it's coming from 6:21 here it will not get better. So once again I have her on high heels, hands up 6:29 if her asymmetrical weight shift disappears it's coming from lower leg. 6:35 What if it doesn't disappear, well now I'm down to two options; is it coming 6:40 from upper body or is it coming from lumbo-pelvic hip complex. 6:45 Let's say here she still did it, so we're weight shift right right towards 6:49 me good and now all that's that's still there. Alright so let's try arms down 6:55 and now the asymmetrical weight shift disappears, well then I know where the 7:02 problem is, the problem is on whatever side is more dysfunctional in her upper 7:08 body, and I'm going to address that side and that side only in my corrective 7:12 strategy. Now i have to admit of all of the possibilities i'm talking about here, 7:17 upper body dysfunction contributing to lumbo-pelvic hip complex asymmetry is 7:23 fairly rare, but it does happen. Now if i've taken her ankle out of it and i've 7:29 taken her upper body out of it, she squats and she still has an asymmetrical 7:35 weight shift, that's an asymmetrical weight shift coming from the 7:40 lumbo-pelvic hip complex. Alright and actually I kind of keyed into how you 7:47 solve this problem a few minutes ago. Notice very carefully how this is 7:53 actually bowing in this knee, and this is bowing out, there is the solution. Right 8:00 in that sign is the key to how you get somebody out of this asymmetrical 8:05 pattern. Alright so thank you Melissa, much appreciated. Let's go to our graphs 8:14 and talk about what this ends up looking like. Number one, if it came from the 8:24 lower leg you're going to go back to the lower leg dysfunction video, use the 8:29 lower leg dysfunction solution which you guys can get from my website 8:34 brentbrookbush.com at the overhead squat assessment under the assessments 8:39 category. Or you could go to lower leg dysfunction under postural dysfunctions 8:42 and movement impairment. If it came from upper body same thing you're only 8:47 going to fix the one upper side, upper body dysfunction, and again you can find 8:51 the upper body dysfunction article under postural dysfunction of movement 8:55 impairment, or you can go to the solution tables under overhead 8:58 squat assessment. If it just so happens that it is coming from the lumbo-pelvic 9:02 hip complex here's the solution. What you end up having is knee bow in on one side, 9:11 knee bow out on the other. So the knee bow in side i'm going to go after all of my femoral 9:20 internal rotators- TFL, gluteus minimus, adductors, short head of the biceps 9:28 femoris, alright that's femoral internal rotation via relative tibial external 9:33 rotation; and then on the knee bows out side I'm going to do external 9:41 rotators those overactive synergists piriformis, adductor Magnus is an 9:47 external rotator, and biceps femoris long head. And then from an activation 9:54 standpoint I'm going to go after my glute max and my glute medius on the side 10:00 of the shift. So once I've released and stretched these overactive muscles, or 10:05 released and lengthen these overactive muscles, I'm going to activate the glute 10:11 on this side to help push me back to centre, be careful though you want to 10:18 start here, make sure you clean this up. I find more often than not as soon as I 10:25 clean this up all of a sudden out of nowhere that next layer of the onion is 10:31 one of their feet flattens. A very common occurrence is we have this thing 10:38 going on and I end up having to fix the internal rotation of this femur, and foot 10:44 flat on that side, so foot flat was over activity of the everters and under 10:50 activity of the inverters. So you just go back to your solutions table, fix this 10:55 side for lower leg dysfunction, fix this side for knee bows in dysfunction. If you 11:04 got that far and for whatever reason you still didn't fix this dysfunction, 11:10 there is a dysfunction within this dysfunction that's fairly common which 11:14 is sacroiliac joint dysfunction. Most often these individuals need some sort 11:19 of mobilization for either the lumbar spine or sacrum, which means my personal 11:25 trainers you're going to have to refer out and this is not a bad thing, this is 11:28 an opportunity for you to create a connection with somebody who could be 11:31 referring back to you right, they might need some sort of manual mobilization or 11:36 manual manipulation. Alright for all of my PT's and ATC's my DC's, if this is the 11:44 muscular model you guys are the ones that if you see an asymmetrical weight 11:48 shift are going to need to go into those further assessments for the sacrum, 11:53 further assessments for the lumbar spine, and probably further assessments for the 11:58 hip, as well to see what sort of arthrokinematic dysfunction exists within this. 12:04 I know this is a little complicated guys, I hope you start figuring out how it's 12:11 actually one asymmetrical compensation pattern. So like lower leg 12:16 dysfunction on one side, or really just lumbo-pelvic hip complex dysfunction 12:20 on one side, contributing to this asymmetry, and the muddied water start to 12:26 clear. If you practice this I think you will actually find that it is not a more 12:30 complicated dysfunction than any other dysfunction we've been over, it just 12:35 happens to have that weird thing that somehow we all mess up, which is right 12:39 and left. We can all memorize our origins and insertions and all of these 12:43 muscles and learn all these great techniques, but then you throw right and 12:46 left into it like Melissa had right sided asymmetrical weight shift, so 12:53 that would be right side knee bows in, she'd do release and stretch here, left 12:58 side knees bow out she'd do here, and then she'd only do glute max and glute 13:03 meius on the right side, and somehow just because I said right left that made this 13:09 graph more complicated, Take your time, take a second practice it. Grab a few 13:15 people who maybe are your colleagues that you have seen with a little bit of 13:19 asymmetrical weight shift, try to solve for it and get some practice before you 13:22 throw it at a client or patient. I look forward to hearing about your outcomes 13:25 guys. I think you guys will have great success with this, and those of you those 13:30 people who have asymmetry that you do correct, you're going to watch their 13:33 performance go through the roof. I look forward to talking to you guys soon. 13:44
