0:05 This is Brent and in this video we're going from individual signs, to clusters 0:10 of signs that start indicating a compensation pattern. In this video we're 0:15 going over lumbo-pelvic hip complex dysfunction. So we can start off thinking 0:19 about which boxes would be checked in a lumbo-pelvic hip complex dysfunction 0:24 just by breaking this down a little bit. So we got lumbar, which is our lumbar 0:28 spine, pelvis, which is a bone driven by the lumbar spine and hip, and then we can 0:35 also look at hip signs as well. So you guys will notice anterior view knees bow 0:41 in, or knees bow out right. That can be driven by hip internal rotation or hip 0:45 external rotation. Those could be hip signs. And then when we come to my 0:49 lateral view, we have an excessive forward lean, which can be driven by hip 0:52 flexion, in excess of lordosis or anterior pelvic tilt, really that's the 0:59 sign at the heart of this dysfunction, anterior pelvic tilt, sometimes known as 1:02 lower cross syndrome definitely is where all of this starts building. And then 1:08 arms fall, stay with me here guys, I know the arms do not necessarily connect to 1:14 the hip, but if we look at an anterior pelvic tilt, it's hip flexion and lumbar 1:21 extension, my lats can become overactive as a lumbar extensors and cause my arms 1:26 to fall. So all of these signs guys right. We've been moving from checking a single 1:31 box to noticing that we never check a single box, and trying to recognize these 1:36 patterns, these are all the signs that could come from dysfunction at this 1:43 segment of the body. I'm going to have my friend Melissa come out, she's going to 1:46 help me demonstrate what this looks like. So first things first, I want to point 1:51 out something that Melissa and I have noted as we've done this a couple 1:54 times, is if she turns sideways and sets up her squat, so I have her second toe 2:00 pointing forward, her feet are going to be underneath your ASIS, which her hips 2:03 are just underneath, so bring your feet a little closer together. We can note that 2:08 if I put her pants on her PSIS and the front of her pants and her ASIS, those 2:13 should be within a centimeter to an inch of each other, all right depending 2:18 centimeter to an inch. If there's any more slope to that, you can see that from 2:25 this pant line she already has an anterior pelvic tilt. I don't need her to 2:28 do an overhead squat assessment. I can just from right here, go ahead and check 2:33 off this one box. In fact this particular sign, and if she throws her hands up it 2:38 actually gets a little worse. You guys can see how that line comes down, this 2:42 particular sign once they start the squat they might even tuck back under 2:47 and this might improve, but don't take notice of that, the sign is still here. 2:52 When you do your math and your corrective strategy, you still need to 2:55 solve for this dysfunction. Alright go ahead and turn back forward, so second 3:01 toe pointing forward, bring your feet in just a little bit. So in the anterior view we've 3:05 already been through what's up here. I'm going to be looking for knees bow in or 3:09 knees bow out, have her do her overhead squat like she always does. She squats 3:13 down, her feet turn out a little bit which is not a lumber pelvic hip complex 3:18 dysfunction sign, it's a lower leg dysfunction sign, but guys look we got a 3:23 little bit of femoral external rotation, a little bit of femoral external rotation 3:28 and her knees are bowing out a little bit, that could be coming from lower leg as 3:32 we discussed in a previous video, but that could also be coming from the 3:35 lumbo-pelvic hip complex. Let's go ahead and have you turn that way, arms up, good. 3:42 You notice this anterior pelvic tilt, check. Go ahead and have her into her 3:46 squat, and you guys can see we have an excessive forward lean which could be a 3:50 lower leg sign we've discussed that, but can also be driven by hip flexion. We're 3:54 going to need to check this out further. We also see the successive lordosis, do 3:59 her arms fall, just a little bit right, so we got these three signs coming into 4:05 play too. So go ahead and stand up. I could have her do a posterior view guys, 4:11 and you might note that an asymmetrical weight shift can be a lumbo-pelvic hip 4:15 complex dysfunction sign, but we're going to skip it in this video. I'm going to do 4:19 a separate video dedicated to the asymmetrical weight shift. So let's have 4:25 her turn around forward again, we have a couple things that we need to figure out 4:29 here. She had arms fall forward, which we know can come from over 4:35 activity in our latissimus dorsi, which we know can also come from either upper 4:40 body dysfunction or lumbo-pelvic hip complex dysfunction. So how am I going to 4:45 figure this out? Well I'm going to put her hands on her hips that's going to 4:50 shorten her lats, lats are now no longer part of this assessment. If her anterior 4:58 pelvic tilt disappears then I'll know it originated with tight lats coming from 5:04 upper body dysfunction. If her anterior pelvic tilt stays, then I know it's 5:11 coming from lumbo-pelvic hip complex dysfunction, because her upper body is no 5:15 longer part of the assessment. Knees bow in and bow out, same thing. She has 5:21 knees bow out, how do I figure out if this is eversion on foot our tibial eversion on 5:26 foot, or femoral external rotation. Well I'm going to take her ankle out of the 5:32 movement, ankle dysfunction starts with a restriction in dorsiflexion. So 5:38 if I put her way up in plantarflexion 5:43 and all of a sudden her knees don't bow out, then I knew that that was coming 5:48 from lower leg. Right i have taken the ankle out of the dysfunction, now she 5:52 does this assessment and her knees still bow out, I know it's coming from this 5:57 segment. You ready, all right let's go, and we have an even more confusing thing 6:07 happened, which is she still has knees bow out but it got better. So we're gonna 6:13 use our deductive reasoning a little bit, here would be my guess, she has lower leg 6:18 dysfunction, but the knees bow out is coming from both her lower leg 6:24 dysfunction and some dysfunction of the lumbo-pelvic hip complex, so that makes 6:29 sense. If it had disappeared completely I would know it was lower leg, 6:34 if it had got no better, or got worse I would know that it was coming 6:39 from lumbo-pelvic hip. Let's go ahead and turn sideways now. 6:45 Let's see what happened to all of these signs when I had her hands down 6:54 and her feet, her heels elevated, and what we'll notice is, is that her excessive 6:59 forward lean more or less goes away. So i'm going to guess once again that her 7:03 excessive forward lean was being driven by her lower leg dysfunction, but we 7:07 still have an excessive lordosis, so that's definitely coming from our 7:11 lumbo-pelvic hip complex. Alright as well we have her arms down, so my guess 7:19 would be is that that anterior pelvic tilt isn't even being contributed to by 7:24 upper body dysfunction, this got no better, all right so I'm going to guess she 7:27 doesn't have upper body dysfunction. She has a significant amount of lumbopelvic 7:32 hip complex dysfunction, which we could look at fixing, and as you guys have 7:36 heard me go through this, she probably has a bit of lower leg dysfunction as 7:41 well. We're going to concentrate on this in this video, in a future video also 7:45 kind of describe to you guys how I decide which dysfunction I'm going to go 7:48 after first. Thank you Melissa. Now this is our cluster of science guys, hopefully 7:56 you kind of understood the logic of how I got here. Now I know some of you guys 7:59 are going holy cow that's a lot to fix, but as I had mentioned before in a 8:05 previous video, a lot of this stuff overlaps. If you guys go to brentbrookbush.com, 8:10 you go two categories, you look under assessment you look under 8:14 solutions table, overhead squat assessments, and you started putting 8:19 these signs on top of each other, you guys would notice that a bunch of the 8:24 muscles overlap. All of these muscles for like let's say knees bow in and 8:30 excessive forward lean, a lot of those TFL, gluteus minimis on both sides of the 8:36 graph, gluteus maximus and gluteus medius is on the other side of the graph 8:40 of both of these. So once I turn this board over, you're going to see you don't 8:44 have as much to work on as you thought you did. So here we go, here's the list, 8:51 here's the list for lumbo-pelvic hip complex dysfunction, and before you freak 8:55 out about this side of the graph, let me kind 8:58 break it down for you. All I did was list my hip flexors, my femoral internal 9:04 rotators, and my lumbar extensors. We'll talk about this in a second. That seems 9:10 like a lot of muscles to release, but when you really think about it, you can't 9:15 self-administered release your psoas and iliacus, my manual therapists you can 9:20 get in there with your hands, great stuff. My personal trainers and people who are 9:26 watching this just to help themselves, please don't shove things into your 9:29 abdomen to try to release this. You rectus femoris and Sartorius are both on 9:33 your anterior thigh, you guys are probably even hitting both of these 9:36 things, you just didn't know that this one was included to. TFL and glute min 9:41 same thing. You're TFL's here., your glute min's here. You're probably getting both 9:46 of them when you do just above your greater trochanter on the side of your 9:48 hip. You've probably been doing inner thigh. Your lats and erector spinae you do with that 9:55 thoracic spine foam roll, you might not even have been aware of that. So with 10:00 your release techniques you're really still only doing the same release 10:03 techniques, it's only four areas maybe. Same thing with the stretches you're psoas, 10:07 iliacus, rectus femoris, sartorius, TFL, gluteus minimus, all of those are partly 10:12 or completely lengthened by a kneeling hip flexor stretch. So you knocked out a 10:18 whole bunch of things. Your lats and erector spinae are stretched very well, 10:23 lengthened very well with something like a modified Child's Pose. Same thing on 10:28 the long side, glute max and glute med are the big ones for this dysfunction 10:33 that we need to activate. I'm always talking about everybody needs bigger 10:37 glutes, everybody needs stronger glutes, everybody needs more active glutes. Now 10:41 you guys start to see why in lower leg dysfunction these guys were weak. 10:44 Lumbo-pelvic hip complex dysfunction these guys are under active. You could 10:50 add your semi's to this list, of course semi's on my website is listed under 10:54 tibial internal rotator activation. I find more use for the semitendinosus 11:00 activation or tibial internal rotator activation for lower leg dysfunction, but 11:04 you could add it here. Notice that biceps femoris, piriformis and adductor Magnus have 11:09 stars by them. They're on the long side of this graph, 11:13 but they're overactive. They adopt that weird long and overactive relationship. 11:18 It's most commonly associated with synergistic dominance, since they're 11:22 overactive we don't want to activate them, and since they're long we don't 11:26 want to lengthen them. What we can do is release them. We can release them and try 11:30 to calm down their activity, so that our prime movers have a better chance of 11:36 becoming as active as they should be. Now as I've mentioned in other videos you 11:42 have the opportunity when you start looking at bigger patterns to start 11:46 looking at more research, more theory. You start looking at things like fascia, 11:51 arthrokinematic dysfunction, synergistic relationships, we can start looking at 11:57 things like subsystems. You guys notice I have deep longitudinal subsystem on the 12:03 overactive side of the graph, and then your intrinsic stabilization subsystem 12:09 which is your TV a and friends, anterior oblique subsystem which is this one 12:13 right, external obliques rectus abdominis contralateral adductors, and your 12:18 posterior oblique subsystem your glutes and contralateral lats, they're all on 12:23 the under active side. So once you guys get past your release, you're lengthening, 12:27 your individual muscle activations, these are the people you get to have a lot of 12:32 fun with with their core works. Right you can do all your TVA activations stuff, 12:37 so that's all the quadrupeds and the quadruped variations. That anterior 12:41 oblique subsystem, all those chopped patterns are wonderful for this group, 12:45 and that your posterior oblique subsystem is all those wonderful squat to row, or 12:49 step up to row, or lunge to row progressions that make for some very 12:53 tough workouts. Right you guys can also start looking at some fascial stuff, your 13:00 abdominal fascia, your thoracolumbar fascia. We can start looking at our arthrokinematics, 13:04 so what is happening to the hip right in that anterior superior 13:08 glide. We get to do all of this and we start looking at bigger compensation 13:12 patterns. I want you guys to look up an article for me go to brentbrookbush.com 13:16 go to postural dysfunction and movement impairment, and go to 13:21 lumbo-pelvic hip complex dysfunction, and you'll see me tear 13:26 this stuff apart, give you much much more detail, as well as there's links to 13:31 sample routines, repertoire of corrective exercises, there's case studies there, as 13:38 well as the next video we're going to go into, which is our asymmetrical weight 13:43 shift and sacroiliac joint dysfunction, which is a dysfunction within this 13:49 dysfunction. I look forward to hearing about the great outcomes that you guys 13:52 get now that you're able to address this model completely. I think you will get 13:55 much much better outcomes, much much faster single session type of 14:00 improvements, that have much better carry over to your next session. Talk to you 14:05 soon. 14:13
