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