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This is Brent president of the Brookbush Institute bringing
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you guys a technique that you may not
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use as often as some of the other
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techniques we've demonstrated in
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previous videos, and that's because we're
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going to demonstrate internal rotator
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activation. Now why you wouldn't use
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internal rotator activation is because
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most individuals have a propensity
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towards excessive glenohumeral or
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shoulder internal rotation during both
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static and dynamic postures, however
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there is also a group of individuals who
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are affected by shoulder hypermobility
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or glenohumeral laxity. Now
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in those individuals we have a
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propensity towards excessive anterior
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glide, and now we see where the
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subscapularis lying in front of the
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humerus, if it increases in activity may
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actually have a good fiber arrangement
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to help block excessive anterior glide.
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So I'm going to have my friend Melissa
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come out, she's going to help me
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demonstrate this exercise that actually
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took me quite a while to come up with
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because we have this problem when we try
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to do internal rotator activation. I'm
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sure some of you have seen internal
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rotator activation this way which is a
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good general idea it is internal
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rotation, other than we have two or three
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larger internal
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rotators being our pectoralis major,
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latissimus dorsi and teres
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major. So now the question becomes well
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how do I target my subscapularis because
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chances are my pectoralis major, my
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latissimus dorsi and my teres major
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aren't going to help me with this
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anterior shoulder laxity. So Melissa I'm
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going to have you take the band and do
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this, so it's across your back and
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you're going to put it right underneath
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the border of your deltoid so that it's
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literally wrapped around you.
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Alright so as she does that I know some of
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you guys are already thinking well he
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said he wants to hit the subscapularis and we basically
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have pectoralis major and latissimus dorsi
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that I need to reciprocally inhibit,
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If you are thinking toward some of
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the other activation videos we did. And
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pectoralis major I could
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probably reciprocally inhibit using
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horizontal abduction, and then my
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latissimus dorsi I probably can inhibit
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using flexion. So what would it look like
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to do horizontal abduction, flexion and
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internal rotation all at the same time,
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and how do I resist that. Now you know
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why this took me a few months to come up
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with. What you're going to
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do Melissa is go ahead and lie on your
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side. Now since the band is wrapped
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around her back
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I already have internal rotation
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resisted on this bottom arm. Just if
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she goes, so just take this out away for
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a second. If she goes like this, the band
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gets stretched around her arm, that'll
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resist my internal rotation. Now to
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inhibit my pectoralis major with
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horizontal abduction all I have to do
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is cue Melissa to take the shoulder and
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press it back into the wall. So we're
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using a plyo box just for video purposes, but
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you could just do this against
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any blank wall. Now to get the latissimus
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dorsi out I'm going to go ahead and use
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a little shoulder flexion, and the way
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I'm going to do that is i'm going to
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have Melissa take this hand and put it
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on top of the bicep. Alright so now she's
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she's getting pretty close to to what's
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going to end up being this kind of cross
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arm pose which is our goal. The only
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difference is I'm going to actually have
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her kind of cue this chicken wing
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maneuver where I have her think about
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going elbow up and hand down so that our
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hand just passes this elbow. So she's kind
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of grinding her elbow into the turf here
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going this way, while bringing her hand
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down this way, good and back up. So she
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started with her elbow kind of low, you
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guys don't have to be at 90 degrees of
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flexion necessarily. It may be more
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comfortable for somebody
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to come down to like 45 degrees of
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flexion, if she wanted to she could
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definitely go higher. Lets see can
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you go all the way up. Let's try this,
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how does that feel? A little tougher up there
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which you'll find unfortunately is
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although it's tougher to do it 90
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degrees of flexion, some individuals who
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have some shoulder pain already, they're
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already showing symptoms of inflammation,
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they may not like doing internal
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rotation at 90 degrees it just doesn't
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feel comfortable for them. Alright you
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just have them like I said keep trying to
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get this hand past this elbow. If you
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know how much internal rotation
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somebody is supposed to have in this
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position it should be between 50 and 70
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degrees, they should actually be able to
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get their fingertips
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pretty close to the floor, assuming
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they're going to do a little wrist
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flexion too. We can see Melissa is
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missing a few degrees there. Under
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normal circumstances we would have done
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some mobility techniques first. Alright Melissa
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do you want to try the other side see
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if you can get set up on your own. Good
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thing to work through with people is
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usually I'll show them one side and then
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I'll see how far they can get on their
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own without any cueing to set up the
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other side, just to make sure they're
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going to be able to do this in a home
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exercise program without my supervision.
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Make sure you're leaning back into the
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wall, there i go cueing again. Alright
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good how does that feel. A lot of people
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won't feel much, if they do feel
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something they might feel it deep in
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their armpit. If they start feeling a
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burn in their pectoralis major you know
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you're going to have to work a little
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harder to try to get them to inhibit
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their pectoralis major, and that might be
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leaning back into the wall a little bit
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harder, or messing around with how much
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flexion they had in the arm that they're
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working. From an assessment standpoint
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guys you're probably going to see
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something like excessive external
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rotation, maybe a hundred degrees of
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external rotation before implementing
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this technique; and oddly when compared
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to some of our other case studies that
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you might have gone through before, we're
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actually looking for a decrease in
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mobility after this technique has been
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performed like I said if we're using it
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for anterior shoulder laxity. Now I know
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some of you guys are going to use this
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potentially for individuals who have a
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decreased internal rotation range of
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motion which is okay. I might not use it
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for that based on some of the
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arthrokinematic dysfunction that's happening
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around that, but if that were the case
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then you would use internal rotation
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goniometry and actually expect an
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increase in internal rotation range of
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motion after doing this technique. So
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there you guys have it we have monster
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band resisted internal rotation,
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resistance is coming from the band being
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wrapped around their arm. So it's not
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like they're pulling on the band, the
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band is getting stretched around their
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arm as they're rotating inward. You're
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reciprocally inhibiting the
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pectoralis major through horizontal
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abduction, and you're resisting the
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latissimus dorsi be a little shoulder
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flexion. Ideal number of reps for all of
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our activation techniques is 12 to 20
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repetitions. Our tempo for something
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like this although I haven;t cued Melissa
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too harshly as you're just trying to get
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this set up, would be something like a
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2-4-2, where I have her hold for four
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second at the bottom if I really want to
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work on that range of motion. Or a 4-2-2,
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where she would go through, hold and then
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back nice and slow working on eccentric
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control, and all we need is one, maybe two
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sets of these activation techniques
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before we start moving into our other
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more complicated resistance training
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based movement patterns. I look forward
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to hearing your questions and i hope you
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enjoyed this video, and enjoy using this