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This is Brent and in this video I'm going to
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address a question that I get quite
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often. So in previous videos we've addressed individual signs, and then we
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took individual signs and realize that we almost never get a template where we
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get one box checked off. We started looking at patterns right these
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compensation patterns which are clusters of signs and how to address those, but
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what you've inevitably started to see is that even that isn't enough. Most of the
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individuals who come in and see us have not just a couple of signs or a pattern of
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signs, they have a couple of compensation patterns, they have little bits of
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upper-body dysfunction with lower leg dysfunction, or they have lower leg
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dysfunction with a little bit of lumbo-pelvic hip complex dysfunction.
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All of these things are happening together which then makes us wonder well
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which one should you address first, or how should you address all of these
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different dysfunctions. So here's the answer to the questions according to me.
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Here's the rubric that i use, here's the filter that i use to help my decision
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making process. Number one, I go after one compensation pattern at a time. To me the
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execution, the success of your program, is dependent on the completeness of your
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strategy. Now if I'm going to go after something like let's say lower leg
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dysfunction completely, I don't have time to go over lumbo-pelvic hip complex and
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upper body dysfunction completely as well. Each one of those things takes a
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significant amount of time, and if you're training as a personal trainer, or you're
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an ATC who is also responsible for a strength and conditioning program you
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know you have an even more limited amount of time. So first things first I
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go after one compensation pattern at a time, I address it completely. When I have
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that compensation pattern under control I reduce it to as little as I can. For
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example in lower leg dysfunction maybe somebody gets reduced down to calf
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release, calf stretch, anterior tibialis activation and that's all that remains,
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and then I can move on to the next dysfunction. Now how I decide which
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dysfunction I go after is based on this, first things first I'm going to go after
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what i call obstructive dysfunction. What I mean by obstructive is it is
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dysfunction that is getting in the way of them doing something they love, or
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something they need to do. So I understand that there may be worse
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dysfunctions in their body, but like let's say this is a power lifter, I have
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them do a overhead squat and I watch their knees kiss, we know this
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wouldn't be a very good thing for a power lifter. This isn't going to
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contribute to their performance very well, but they've come in to see me
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because after their bench press, after their chest work, after their upper body
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work they get shoulder pain, guess which dysfunction I'm going after first. I'm
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going to go after upper body dysfunction, because I need to address the thing
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that's actually getting in their way now. Even some of you I know are already
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thinking but knees bow in could be contributing to right shoulder pain, it
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could, there is a theoretical model, there there is the kinetic chain checkpoints
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we could go through to talk about how, let's say knee cave in on one side leads
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to anterior and automate rotation leads to sacral dysfunction, leads to
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latissimus dorsi tightness, leads to right shoulder. We can go over that, but
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the truth of the matter is is there some sort of upper body dysfunction present.
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We need to fix that first, and if we're successful hopefully this client or
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patient will let us address the rest of their kinetic chain so we get great
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long-term outcomes. So make sure you go after what needs to be gone after first.
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You have to set up a priority list. Second, asymmetrical dysfunction. We
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actually do not have research that says tightness a lack of mobility leads to
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injury. Now some of that has to do with faults in some of the research itself,
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but there is research to indicate that asymmetrical dysfunction will cause
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injury, and I do believe that nothing leads to injury faster than asymmetry
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right to left in the human body. If somebody had an overhead squat both arms
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fell forward to here, but I saw one right foot flattened and turn out, I don't care
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how bad the upper body dysfunction is providing it's not causing them pain or
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obstructing what they love to do, if i see the asymmetry on their right leg i'm
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going to go after that first. Very important that I get to that before it
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gets to them and causes injury. So somebody comes in, why are you here, is
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there anything you can't do, okay maybe there's nothing
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that they can't do, they're coming in to see me because of general health and
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wellness. Okay do I see anything asymmetrical, i'm going to go after that.
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If I don't see anything asymmetrical I'm going to go down to the next thing on my
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list, which is what is their worst dysfunction. This actually doesn't happen
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very often, but let's say somebody has a little bit of arms fall forward but
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their feet flattened, turn way out, knees bow in, I have to go after that. I got to go
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after that. I'm going to go after the worst dysfunction first. This will
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probably maintain for a little while, it's probably not setting them up too
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bad for injury, let's take care of the thing that you know when we see it we go
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oh we need to, we need to address that before once again it gets at them. Last,
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let's say somebody has all of the dysfunctions nothing is in particular
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bothering them, or they have a whole slew of things bothering them; the right ankle
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bothers them, their left knee, they get a little low back pain from time to time,
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left shoulder. Alright how am I going to address this issue, well providing I
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don't have one thing that's more obstructive than another, I don't have a
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huge asymmetry present, there isn't a worse dysfunction, i'm going to start
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from the bottom up. So i'm going to start at the ankle because I know that if I
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correct the ankle I will get good progress
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from ankle to ankle to, or lower leg let's say to lower leg to lumbo-pelvic
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hip complex dysfunction. That'll stay pretty good, and then I can go to upper
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body dysfunction, what does not work out. Well if I start with upper body
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dysfunction and this person has feet turn out, feet flattened every time they
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take a step, little bits when they walk are going to do this, which is going to
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tighten back up their latissimus dorsi as a lumbar extensor, and put them
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right back into the upper body dysfunction I just tried to correct, and
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in essence everything stacks on your feet. Alright so just to recap this guy's
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address what needs to be addressed first, not from your point of view but from
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your patient or clients point of view, that's priority number one. Second
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asymmetry probably the best indicator we have of potential injury. Third go after
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the worst thing you see, and then last and this is probably the one that will
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stick is you stay with a patient, or stay with a client over months and years and
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they keep coming back to you for different things, start from the bottom
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up, continue to keep corrective exercise in their program with this in mind, so
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that you keep them stacked on a stable foundation. I hope this helps your
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decision making process. I hope this and all of the previous videos makes your
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assessment skills much much more refined, much more skill than they were before. I
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look forward to talking to you guys soon.