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Overhead Squat Assessment 12 - Sign Clusters: Lower Leg Dysfunction
The Overhead Squat Assessment 12 - Sign Clusters: Lower Leg Dysfunction is a diagnostic tool used to identify any dysfunction of the lower leg muscles. This assessment specifically focuses on the hip and ankle muscle groups, looking for any asymmetries or weaknesses in order to help diagnose the cause of any musculoskeletal pain or dysfunction. This is a great tool to help identify any structural abnormalities, and aid in the development of an effective treatment or prevention program.
Transcript
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This is Brent and in this video we're
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taking our overhead squat assessment up
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a notch. Now in our previous videos we went through sign by
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sign. We discussed what each sign implicates as far as long and short
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muscles. Which muscles are overactive an underactive. What you've already
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started to notice is that you never get an overhead squat assessment where you
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look down at your template, and you have one box checked, that's a nice thought. I
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hope to meet that individual eventually where I get a very simple corrective
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exercise program. But most of the time we start to see several boxes checked off.
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If you've really been paying attention and you've really done a lot of overhead
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squat assessments, what you've probably started to recognize that is that
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there's a pattern to which boxes get checked off. Now these patterns develop
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into clusters, these clusters start to implicate compensation patterns. Now in
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this video we're going to go over the lower leg dysfunction compensation
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pattern. So we're going to see certain signs packaged together, and you're going
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to see this over and over and over again. So now we're taking our ability as
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assessors, to go from seeing one sign to seeing the entire compensation
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pattern package together. I'm going to have my friend Melissa come out, and
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she's going to demonstrate what this looks like, which I know you guys have
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seen a million times before. If I get her all set up, second toe pointing forward,
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arms up over her head, her feet are hip-width or in line with her ASIS, and I
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go okay, and she's going to exaggerate this for me. I go go ahead and squat, we watched
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her feet turn out, her feet are flat and her knees kissed, how many times have you
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guys seen that? You guys would have seen that a ton right, and then if you looked at
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her from the lateral view, go ahead and turn, face that way for me. She does the
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same thing right, knees kissed, feet turn out, feet flattened, but then you guys also
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notice she has excessive forward lean, a little anterior pelvic tilt. And then
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when we turned her around, she may or may not even have an asymmetrical weight
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shift. How many of you guys have seen all of this package together. Well
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mechanically we can describe this lower leg dysfunction.
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I was going to say there was a route to lower leg dysfunction, lower leg
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dysfunction starts with the inability to dorsiflex far enough. Alright remember
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dorsiflexion is just not foot up this way, but the ability to translate the
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knee forward. That ability to translate the knees forward, so go down into your
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squat a little bit, it also keeps her center of mass, right we can think like
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kind of in this core area, that's what keeps it over her base of support. So we
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can already explain the excessive forward lean, if she can't dorsiflex far
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enough, she has to, her butt ends up way out behind her, and she has to throw
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her upper body mass over, creating that excessive forward lean, just to keep her
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center of mass over her base of support. Let's get a little bit more technical
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though, some you guys have heard of this concept of relative flexibility. So if I
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have hypomobility a restriction at one joint, I start compensating with
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hypermobility at other joints, she can't dorsiflex enough. So just for her body to
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try to get some more motion, her feet flattened out, which is going to cause
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problems, and then she steals even a little mobility from her knees by doing
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this. Go ahead and go down in your squat, this little turnout thing all right. So
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she can't dorsiflex here, she's stealing from here and here. Well hypomobility hyper
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are sorry, hypermobility hypomobility, and then of course that leads to hip
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dysfunction, because tibial external rotations, femoral internal rotation
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which drives tightness in her tfl which is also a hip flexor; and that's going to
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cause an anterior pelvic tilt. So I know I just said a lot these signs aren't
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separate though, they're actually all mechanically linked as Melissa's body
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here tries to figure out how to work around this one restriction that started
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with an inability to dorsiflex. If you guys go back and look at all of your
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solutions tables, you'll even notice that the muscles involved in like let's say
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feet flattened, and feet turn out, both the lateral gastroc
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will flatten the feet and turn out the feet, and you guys saw that. Feet turn
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out knees bow in -lateral gastroc, biceps femoris, tfl. Knees bow in -lateral
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gastroc, biceps femoris tfl and gluteus minimus. You see all of this
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overlap, it's almost disingenuous for us to start the way we did, which is with
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individual signs. It's actually these entire patterns that the body tries to
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create. So going back to our overhead squat assessment now, you guys just took
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yourselves up a notch by realizing that it's not individual signs, but clusters
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of signs that we're looking for. The one thing we have to make sure we do now
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though, is make sure that it is the ankle that is driving this dysfunction and not
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the lumbo-pelvic hip complex. Some of you guys have already seen that squat with
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modifications for further assessment, so stay with me here for a second. Sure
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knees bow in can be driven by the fact that her feet turn out alright, so that's
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tibial external rotation which causes relative femoral internal rotation, and
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causes her knees to collapse as she goes down into a squat. But she can put her
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feet back here, if she just had like an anterior pelvic tilt which was driving
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over activity of her tfl, gluteus minimus and anterior adductors, that could also
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drive her knees in. Go ahead and squat for me, but that would be coming from the
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lumbo-pelvic hip complex. So before I start fixing here, I need to make sure
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that the dysfunction is being driven here in her lower leg, versus being
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driven by the lumbo-pelvic hip complex, and that's actually fairly easy to do.
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All I have to do is take my ankle out of the movement. If i take my ankle out of
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this and everything recklessly gets better, then i know that's where the
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dysfunction comes from, and that's what I'm going to correct. So I'll
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have her do her overhead squat and I'll do all of my signs alright, so let's go
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ahead and see the the overhead squat hands over your head,
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do your squat, we see feet turn out, we see knees bow in, that's our anterior
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view. Alright lateral view hands up over her head, she squats down, I see an
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excessive forward lean, an anterior pelvic tilt. Posterior view good and I
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see a little asymmetrical weight shift to the left, great now what I'm going to
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do is go okay where is this coming from. I'm going to have her get on high heels
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so I'm gonna put her in a whole bunch of plantar flexion, so now that dorsiflexion
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restriction is not an issue. I do get a lot of questions on how high this needs
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to be, you guys need to pick a platform whether it's a couple weight plates, foam
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a half foam roll, rolled up mats, the backs of someone's shoes, it does have to
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be high enough so that they don't show their ankle signs, basically feet
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flattened, and feet turn out. If they still feet turn out and feet flattened,
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your platform here for their high heels isn't high enough. For this I think she's
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going to be fine. So she's going to go ahead and throw her hands up over her
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head and squat, you noticed that all of this stuff gets cleaned up. So we know
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that her knee and her ankle signs of course were actually coming from lower
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leg dysfunction. If I turn her sideways
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she squats, notice how that excessive forward lean disappears, I know that was
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coming from here. We do see something interesting with Melissa she still has
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an anterior pelvic tilt all right, so that anterior pelvic tilt is probably
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coming from a lumbo-pelvic hip complex dysfunction. I can even double
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check if I have a put her hands on her hips, all right and go ahead and stand up.
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Do one more for me, you still see that anterior pelvic tilt. So most of our
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signs are coming from lower leg dysfunction, that's probably what I would
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aim for first. But chances are i'm going to have to come back and look at the
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lumbo-pelvic hip complex specifically, and write a program to fix this. If I go
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posterior view, we said in the posterior view before we saw an asymmetrical
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weight shift, she was faking it, but let's pretend that she thought we saw an
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asymmetrical weight shift, and then we put her in high heels and shift went away.
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A lot of you guys have been asking me for an asymmetrical weight
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shift video, and I'm going to do just one specifically dedicated be asymmetrical
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weight shift. But I do find a lot of people have an asymmetrical weight shift,
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not because of something that's going on here, but because they actually had one
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calf or one ankle, or one sided lower leg dysfunction, that when they squatted down
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was forcing them over. You're not going to correct this then, even though it's an
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asymmetrical weight shift I wouldn't go after this. I would go after the tighter
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side of their lower leg dysfunction. Thank You Melissa. So big step guys, you
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just took a huge huge huge step. We just went from looking at signs of
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dysfunction to what the body actually really tries to do, which is create a
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compensation pattern. Now before you freak out and go oh my goodness that is
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a lot of stuff I have to correct, it's actually not that bad, and you start
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looking at how overlapping the muscles and those signs were, how mechanically
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linked those joint signs were.
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You start realizing it's not a very long list at all. Despite all of the stuff we
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just saw, it only comes down to lateral gastroc, soleus, fibularis, biceps femoris,
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TFL VL, ITB complex and gluteus minimus. That's six release techniques. If you go
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back and look at some of the stretching videos, the lateral gastroc, soleus and
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fibularis muscles get stretched together in that modified slant board
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stretch I've shown. So we're already condensing down pretty quick. This gets
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its own stretch. The gluteus minimus, tfl gets stretched together. Tibialis
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posterior, medial gastroc get activated together. So that still only leaves us, let's see here, five
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activation techniques, and then we have our integration techniques. Even when we
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get really really complicated it doesn't amount to more than 20 techniques let's
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say, 25 techniques. Or even if you're really really sophisticated you can do all
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this different manual stuff 30 techniques. Try to keep in mind this
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isn't like resistance training, I'm not having them do multiple sets of this
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stuff over and over again. I'm going through each muscle doing what I need to
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do one set a piece, people do not get rest between sets. I guarantee at the
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minimum let's say this takes 16 or 17 techniques to correct, everything from
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ankle all the way up to here, I can get somebody to do that in 20 minutes. It
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might take two or three sessions before they can get through it in 20 minutes,
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but eventually that's one minute per technique, and they're just rocking
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through it; and you're fixing the entire compensation pattern which makes sure you
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leave a lot less behind, so that your outcomes are a lot better, your carryover
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from session to session is a lot better, and this is what gets really cool. So I
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want you guys to look up this article on brentbrookbush.com that I wrote, it's
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under postural dysfunction and movement impairment, called lower leg dysfunction.
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You'll be able to see where I start combining these signs, and it starts
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implicating all of this other cool stuff. Like we can start looking at subsystem
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activation. In this dysfunctional pattern we see that the deep longitudinal
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subsystem and anterior oblique subsystem become
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overactive, but the posterior oblique subsystem and lateral subsystem become
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under active. You can't really even look at that stuff though until you see the
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entire package. Everybody's talking about fascia, everybody's talking about it. But
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we know fascia isn't a single joint, a single sign thing, it spans several
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joints, it connects lots of muscles. Well once we're looking at several joints we
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do start to see a little bit of that fascial connection. We see the TFL VL ITB
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complex come in. Alright we see the tibial internal rotators which have this
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this tendinous fascial connection at the medial knee come in, lots of stuff going
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on here. If you guys look back at the deep longitudinal subsystem you'll see
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that that's actually a huge fascial system, including the sacrotuberous
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ligament, and the deep layers of the thoracolumbar fascia. So we're taking a
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big step guys. I know we're taking a huge step going from signs to patterns, to
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integrated functional anatomy, and some really sophisticated exercise techniques
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and routine design, but that gives us a whole lot more to work with. I think you
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guys are going to have a whole lot of fun with it. It's basically unending what
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you could possibly do with all of this information. I hope you guys have fun. I
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look forward to hearing about your outcomes.
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