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This is Brent of the Brookbush
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Institute and in this video we're going over
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a very commonly used exercise for lumbar
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mobilization- the open book. We're also
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going to discuss how it could be used
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for thoracic and sacroiliac joint
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mobility and maybe a great active
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stretch for the pectoralis major,
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pectoralis minor, posterior deltoid, and
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potentially even the piriformis. I'm
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going to have my friend, Melissa, come out and
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she's going to help me demonstrate. Now, I
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think you guys will quickly find that
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setup is the most complicated portion of
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this exercise, and it's going to take
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some time for you to teach, and remind,
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and reinforce your patients and clients
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to be able to do this with good form. Go
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ahead and lay on your side. This is where
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we're going to start. I'm going to go
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through these form cues from bottom up
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here. So, we're going to start by
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straightening out the bottom leg, so her
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bottom leg becomes kind of this pivot
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point. It should be in line with her
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torso and her head, so we should see a
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nice straight line from the top of her
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head through her spine, through her hip,
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knee, and ankle. She's then going to take
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the foot of her top leg and put it
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behind that bottom knee. We're then going
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to use some sort of space, or foam roll, or
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Hypersphere- something about this size to
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get the top knee level with her hip. That
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is, with her pelvis in a position that is
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kind of perfectly vertical here. Now
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she's going to take this bottom hand, and
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this bottom hand is going to be
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responsible for maintaining her knee
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position. Alright, so she's going to
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hook the bottom of that leg and keep it up
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in flexion, which is going to keep us a
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little bit posteriorly tilted which is
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going to help us with the lumbar
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mobility portion of this. She's then
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going to take this hand, and I want her
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to really tuck it behind her head. So,
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she's going to wrap those fingers all the
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way behind her occiput, maybe grab her
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ponytail with her web space here. Alright,
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so all the way around. I don't want to
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see any cheating with with fingers
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barely touching the head.
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This is the setup. This is how we get
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started. Now, the fun part is to see how much
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mobility Melissa actually has. She's
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going to start by trying to put this
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elbow down on the floor. This isn't so
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easy for a lot of people. This takes a
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lot of extensibility of her posterior
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deltoids, of her scapular muscles, and
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even some mobility of her thoracic spine,
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rib cage, and lumbar spine. But then, the
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really hard part for most people is
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trying to lay this arm flat down on the
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floor. Melissa, here, has pretty good
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mobility, but you can see she still has
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about an inch to go there. So, if she
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starts again, we're going to hold for two
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and then open up, hold for two, and I try
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to get my patients doing 10 to 20 reps
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with those two second holds. Don't let
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them rush through. I think you guys are
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going to find that a lot of your
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patients get stuck. They end up right
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about here- that's as far as they can get.
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You want them putting a little bit of
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effort here, holding that position, making
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sure they are trying to put an effort to
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go further. And then have them go back.
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Same thing on this side. Put some effort
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forth. Now, let's think through some of
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our kinesiology and where this may
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benefit our patients from a mobility
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perspective outside of just the lumbar
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spine. As I mentioned, when Melissa comes
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this way, that is a lot of horizontal
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adduction which is going to require a
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ton of mobility from her posterior delt.
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She's also protracting and upwardly
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rotating her scapula, which means she's
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going to need some extensibility from
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potentially her lower traps here as she
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protracts her mid traps, as she protracts
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her rhomboids, as she
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upwardly rotates and protracts. All of
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that's going to help as an active
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stretch here. Go ahead and open up. And
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then if she gets into this position, we
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see a ton of horizontal abduction,
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abduction, and external rotation of the
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shoulder, which is basically pectoralis
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major stretching.
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Let's try that one more time. You guys
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can see that she comes back, she also has
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to upwardly rotate this way.
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Upwardly rotate and posteriorly tip
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her scapula, which is going to be a pec
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minor active stretch. So, now we have
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something that's great for both
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posterior shoulder mobility as well as
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pec mobility. Now, just the posterior
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tipping thing- alright, the posterior
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tipping of her scapula against her
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rib cage is going to help to create a
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posterior to anterior force on that rib
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cage and mobilize those ribs. Your
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ribs have a lot to do with thoracic
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mobility, and we're adding that posterior
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to anterior rib mobilization to thoracic
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rotation. Now, something to keep in mind
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is all of this is happening as an aside
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to the main goal of this exercise, which
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is generally lumbar mobility.
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So this is all of the additional benefit
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we get from an open book. But, let's talk
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about this area right here, as this is
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generally why we
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use this exercise. This is the focus. As
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she's going back and forth, she's causing
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a ton of rotation at the spine, as
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well as this position is slightly flexed and
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this position is slightly extended. We
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have her locked into a posterior tilt,
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some flexion here, and I'm not allowing
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her to get any adduction at the hip. In
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this position, she can't internally and
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externally rotate at the hip, so we know
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that the motion is primarily coming from
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her lumbar spine. As you go back
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through here, you just can see that the
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position she's put in here- go ahead and
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open up- prevents her getting any
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mobility from her hip or pelvis. Maybe we
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get a little SI joint mobility as lumbar
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rotation this way would actually force a
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little posterior to anterior mobility on
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the bottom SI joint, and anterior to
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posterior mobility on
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top SI joint. But, almost all that
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rotation has to come from this lumbar
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segment. If I want to get really,
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really tricky, I can even put on
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my physical therapy hat, remember how I
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do lumbar manipulations or lumbar
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physiological mobilizations for rotation,
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and I could actually lock in what
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segment I want to rotate by using- sorry
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let me have you back in this position- by
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using how high her knee is to get a
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ligamentous lock from bottom up. If you
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know how to do that, if you've taken
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manual mobilization, manual manipulation,
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lumbar spine courses, you know what I'm
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talking about. I can do my little piano
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grip on her lumbar spine, and let's say I
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wanted her to focus more on- we'll call
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it mid lumbar spine, although I'd love to
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say that I could target L2 L3 segment,
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we'll call it mid lumbar spine. We'll get
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her right up to about here. I'll give her
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some cue like, "Hey, I need you to grab all
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the way up to second knuckle on that
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hamstring." So, I'll give her some
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cue that she can remember as far as
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where to bring this leg, and now when she
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opens up, she should feel that a little
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higher in her lumbar spine. If I wanted a
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little lower in her lumbar spine, of
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course, I could go maybe, "Alright, I just
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want your first knuckle on your
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hamstring tendon here," which is her
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biceps femoris tendon. If I wanted to get
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up even higher, maybe I can get up into
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that upper lumbar spine, maybe I go with
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whole hand and really get her up high, and
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again, have her do this exercise there. So
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there you guys have it. We have a ton
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going on in this exercise. It's primarily
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a lumbar rotation mobilization, because
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of the way we have the pelvis locked down,
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but we have some sacroiliac joint
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mobility. We also have a ton going on in the
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upper body from
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pectoralis major and minor, posterior
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delt active stretching, and we have rib and
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thoracic mobilization going on. This
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becomes a very dynamic, very versatile
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exercise to throw in somebody's
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program. It's something I use all the
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time in self-administered lumbar spine
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home exercise programs. It also ends
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up in a ton of my integrated warm-ups
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for the athletes that I train, as well as
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the recreational fitness member who we
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know sits at a desk all day. All of
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this stuff has a propensity towards
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either restriction or overactivity. I
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hope you guys enjoyed this video. I look
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forward to seeing your questions in the
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comments section. Feel free to post any
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question you have.