0:06 This is Brent and in this video I'm going to address a question that I get quite 0:09 often. So in previous videos we've addressed individual signs, and then we 0:13 took individual signs and realize that we almost never get a template where we 0:17 get one box checked off. We started looking at patterns right these 0:21 compensation patterns which are clusters of signs and how to address those, but 0:26 what you've inevitably started to see is that even that isn't enough. Most of the 0:31 individuals who come in and see us have not just a couple of signs or a pattern of 0:36 signs, they have a couple of compensation patterns, they have little bits of 0:41 upper-body dysfunction with lower leg dysfunction, or they have lower leg 0:45 dysfunction with a little bit of lumbo-pelvic hip complex dysfunction. 0:49 All of these things are happening together which then makes us wonder well 0:53 which one should you address first, or how should you address all of these 0:58 different dysfunctions. So here's the answer to the questions according to me. 1:02 Here's the rubric that i use, here's the filter that i use to help my decision 1:07 making process. Number one, I go after one compensation pattern at a time. To me the 1:15 execution, the success of your program, is dependent on the completeness of your 1:21 strategy. Now if I'm going to go after something like let's say lower leg 1:25 dysfunction completely, I don't have time to go over lumbo-pelvic hip complex and 1:31 upper body dysfunction completely as well. Each one of those things takes a 1:35 significant amount of time, and if you're training as a personal trainer, or you're 1:39 an ATC who is also responsible for a strength and conditioning program you 1:44 know you have an even more limited amount of time. So first things first I 1:48 go after one compensation pattern at a time, I address it completely. When I have 1:54 that compensation pattern under control I reduce it to as little as I can. For 2:00 example in lower leg dysfunction maybe somebody gets reduced down to calf 2:04 release, calf stretch, anterior tibialis activation and that's all that remains, 2:10 and then I can move on to the next dysfunction. Now how I decide which 2:16 dysfunction I go after is based on this, first things first I'm going to go after 2:22 what i call obstructive dysfunction. What I mean by obstructive is it is 2:29 dysfunction that is getting in the way of them doing something they love, or 2:35 something they need to do. So I understand that there may be worse 2:40 dysfunctions in their body, but like let's say this is a power lifter, I have 2:47 them do a overhead squat and I watch their knees kiss, we know this 2:53 wouldn't be a very good thing for a power lifter. This isn't going to 2:56 contribute to their performance very well, but they've come in to see me 3:00 because after their bench press, after their chest work, after their upper body 3:06 work they get shoulder pain, guess which dysfunction I'm going after first. I'm 3:13 going to go after upper body dysfunction, because I need to address the thing 3:17 that's actually getting in their way now. Even some of you I know are already 3:22 thinking but knees bow in could be contributing to right shoulder pain, it 3:26 could, there is a theoretical model, there there is the kinetic chain checkpoints 3:30 we could go through to talk about how, let's say knee cave in on one side leads 3:36 to anterior and automate rotation leads to sacral dysfunction, leads to 3:40 latissimus dorsi tightness, leads to right shoulder. We can go over that, but 3:44 the truth of the matter is is there some sort of upper body dysfunction present. 3:47 We need to fix that first, and if we're successful hopefully this client or 3:52 patient will let us address the rest of their kinetic chain so we get great 3:56 long-term outcomes. So make sure you go after what needs to be gone after first. 4:02 You have to set up a priority list. Second, asymmetrical dysfunction. We 4:08 actually do not have research that says tightness a lack of mobility leads to 4:15 injury. Now some of that has to do with faults in some of the research itself, 4:19 but there is research to indicate that asymmetrical dysfunction will cause 4:24 injury, and I do believe that nothing leads to injury faster than asymmetry 4:30 right to left in the human body. If somebody had an overhead squat both arms 4:37 fell forward to here, but I saw one right foot flattened and turn out, I don't care 4:44 how bad the upper body dysfunction is providing it's not causing them pain or 4:48 obstructing what they love to do, if i see the asymmetry on their right leg i'm 4:55 going to go after that first. Very important that I get to that before it 5:00 gets to them and causes injury. So somebody comes in, why are you here, is 5:07 there anything you can't do, okay maybe there's nothing 5:12 that they can't do, they're coming in to see me because of general health and 5:15 wellness. Okay do I see anything asymmetrical, i'm going to go after that. 5:19 If I don't see anything asymmetrical I'm going to go down to the next thing on my 5:23 list, which is what is their worst dysfunction. This actually doesn't happen 5:28 very often, but let's say somebody has a little bit of arms fall forward but 5:32 their feet flattened, turn way out, knees bow in, I have to go after that. I got to go 5:38 after that. I'm going to go after the worst dysfunction first. This will 5:43 probably maintain for a little while, it's probably not setting them up too 5:47 bad for injury, let's take care of the thing that you know when we see it we go 5:52 oh we need to, we need to address that before once again it gets at them. Last, 5:58 let's say somebody has all of the dysfunctions nothing is in particular 6:04 bothering them, or they have a whole slew of things bothering them; the right ankle 6:08 bothers them, their left knee, they get a little low back pain from time to time, 6:12 left shoulder. Alright how am I going to address this issue, well providing I 6:18 don't have one thing that's more obstructive than another, I don't have a 6:23 huge asymmetry present, there isn't a worse dysfunction, i'm going to start 6:30 from the bottom up. So i'm going to start at the ankle because I know that if I 6:36 correct the ankle I will get good progress 6:39 from ankle to ankle to, or lower leg let's say to lower leg to lumbo-pelvic 6:44 hip complex dysfunction. That'll stay pretty good, and then I can go to upper 6:48 body dysfunction, what does not work out. Well if I start with upper body 6:52 dysfunction and this person has feet turn out, feet flattened every time they 6:59 take a step, little bits when they walk are going to do this, which is going to 7:06 tighten back up their latissimus dorsi as a lumbar extensor, and put them 7:10 right back into the upper body dysfunction I just tried to correct, and 7:13 in essence everything stacks on your feet. Alright so just to recap this guy's 7:19 address what needs to be addressed first, not from your point of view but from 7:25 your patient or clients point of view, that's priority number one. Second 7:31 asymmetry probably the best indicator we have of potential injury. Third go after 7:39 the worst thing you see, and then last and this is probably the one that will 7:44 stick is you stay with a patient, or stay with a client over months and years and 7:49 they keep coming back to you for different things, start from the bottom 7:53 up, continue to keep corrective exercise in their program with this in mind, so 8:00 that you keep them stacked on a stable foundation. I hope this helps your 8:05 decision making process. I hope this and all of the previous videos makes your 8:10 assessment skills much much more refined, much more skill than they were before. I 8:16 look forward to talking to you guys soon. 8:26
