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This is Brent of the Brookbush Institute,
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and in this video we're bringing you
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an interesting integrated exercise for
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all of those with lower extremity and
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lumbo pelvic hip complex dysfunction.
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This is resisted walking. I'm going to
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bring Melissa out, and we're going to torture
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her a bit. This is a tough exercise. All
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you guys need is something to wrap
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around your waist. We're going to start
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by setting up on the cable column. So,
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I've seen a lot of creativity used here.
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I think this was originally one of those
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weight belts to attach weights to for
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a resisted pull-up. I've used the
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cuffs that go around elbows for hanging
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leg raises. I've even used thick pull-up
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assist bands hooked to a cable column, just
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so that I can put something around the
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hip joints, or around the pelvis just in
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front of the ASIS here, and get it hooked
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up to a cable column so I can create an
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anterior to posterior force. Now, before we
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start resisted walking, which sounds like,
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"Oh, we're just going to walk and there's
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going to be some resistance," which is all
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well and good. But we don't want to
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reinforce compensation patterns, we want
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to improve patterns. When we do
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integrated exercise, what we're trying to
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integrate is the muscles we had
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previously assessed as underactive. In
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the lower extremity, that tends to be the
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glute complex, the medial stabilizers of
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the knee, and my inverters. Alright, so
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here's what it's going to look like.
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First things first, I'm going to have
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Melissa get into a little bit of a
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quarter squat position here, so we got a
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little bend of the knee, and I want her
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to drive through whichever leg is going
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to end up in the back here, squeeze her
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glute, lock her knee, and push off from the
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ball of her foot. Let me see that. Boom, push.
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Alright, like she's trying to take off, like
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she's going to sprint. Let's see one
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more step. Good. You can see nice
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squeezed glute, right, her knee's locked,
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and she's up on the ball of her foot.
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Back nice and slow. Now, if you're on a
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cable column, you're going to have to
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keep this to like two steps
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and then switch legs. An advantage
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to the cable column is that eccentric
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loading is also very difficult and maybe
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beneficial unto itself. Let's see the
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other leg. Good, nice and slow on the way
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back. Whoo, nice and slow. Alright, so
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let's talk about some cues that I use
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often with this. So, the first
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thing I want to make sure Melissa does
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is that she doesn't do this. Just
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walk. Right, I see this a lot with
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resisted walking, which drives me nuts.
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People hook their heal in and then
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pull with their hamstring. Yeah, great
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athletes, great movers don't pull, they
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push. If she pulls, you can think about
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how that might reinforce
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synergistic dominance of her hamstrings
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over her glute max. As opposed to pushing,
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which is going to be her very first cue
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to get that glute drive, so that she gets
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a much more efficient movement pattern.
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Just think of how much larger your
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glutes are than your spindly little
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hamstrings. Alright, so first things first,
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lean forward a little bit and then push
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by squeezing the glutes. Alright, so we
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lean forward a little bit to load the
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glutes and then push to squeeze the
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glutes. If I couldn't get that to happen
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what I could intentionally do is, maybe,
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add back in, if I hadn't already, some
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glute max activation exercises. Maybe
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even add some bridges during her core
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integration exercises, so that when she
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got to this exercise in her movement
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prep, or her warm-up or her rehab routine,
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her glutes were ready to go. Now the next
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thing we might see is she goes ahead and
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steps forward, but this time she doesn't
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walk out her knee. Well, maybe now what
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I'm thinking is, okay we still have a lot
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of synergistic dominance from the from
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the hamstring and they don't want to let her
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fully extend through the knee, or maybe
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she's a little weak in her medial
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stabilizers. I'm going to go ahead and
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cue or to, "Ok, this time when you step
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forward, I want you to lock your knee. You
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have to squeeze your glute and lock your knee
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out." Good.
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And even if I have to do it one step at
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a time initially, okay step back, start
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over again. Let's do it again. Even if I
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have to do that to get her to
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really learn how to step and lock out,
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that's what I'm going to do. Again, if I
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hadn't already put it in her program, I
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could use something like a TKE, a
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terminal knee extension exercise,
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or tibial internal rotator activation, and
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start working on those medial
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stabilizers of the knee to get them
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strong enough to get her to lock out.
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Alright, the next thing I see a lot of is
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somebody will push but leave their heel
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on the floor. I see a lot of that. How
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are you going to get a good step off, a
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good bounce, if your heel-- you just
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just left a joint out when you did
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that. Right, you just left out your ankle.
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I'm not going to move my ankle today.
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That's not a good thing. We have a lot of
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people who have ankle dysfunction. We
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need to make sure they integrate their
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ankle, and if you've been using tibialis
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posterior activation, then all of these
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cues will already be set up. This is one
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of the reasons why I preach, "It's
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important to fix the pieces before you
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try to assemble the puzzle." In
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other words, I believe you have to
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activate individual muscles before you
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try to integrate new movement patterns.
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One of the reasons is because it sets up
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all of our teaching cues. So, you remember
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your tibialis posterior activation? Good.
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So, toes up, push through the ball of your
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foot. I want you to kind of, like- yeah,
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press off. Good, oh good, and back a little
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bit. She's getting more and more powerful.
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She's pulling more and more on
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the cable. This is really good. So you
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guys can see how we're starting to integrate
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all that in. And the last trick I'm going
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to show you is you'll get those people
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who collapse into their step. Right, they
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try to take a step and they do this sort
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of thing, also known as a positive
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Trendelenburg sign. It's the collapse of
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that pelvis, also known as gluteus
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medias weakness. So, of course, I could
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integrate back in gluteus medius
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activation and see if that fixes the
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problem. A little additional cue I can give
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you is rather than have somebody step
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straight out,
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you could have them step out this way,
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which is going to integrate a little bit
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of abduction which is going to force
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their gluteus medius to fire. So, let's
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try that. Right, and the next step. So
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this isn't quite the waltz step that we
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see in sidestepping. We're not
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quite doing this, we're just doing a
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little bit of abduction, just a little
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bit of a little of a wide shuffle or
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wider shuffle than our normal walk to
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make sure we're getting good gluteus
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medius activation. And from here, let's
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say I've set all of that up, then I can get
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even more torturous. Now, I'm not going to
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be able to show you how much I would do,
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because of the width of this camera
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angle. But what I really like to do is
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take somebody off the cable column, use
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something like a pull-up assist band, and we
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end up setting up something that looks
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like we're training for the Iditarod.
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Maybe that's not a joke you want to use with
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your patients, some people do not like to
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be referred to as huskies. But, nonetheless,
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I think if you guys wrap your wrists
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around a band like this,
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you've done a
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good job cueing up to this point, you
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guys can set up a pretty significant
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distance. Okay, we're going to do
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resisted walking for the next 50 feet.
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Good, take another step. Good, take
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another step. And now she gets that
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nice, repetitive being able to work on it-
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you can go ahead and relax. She can work on
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one step after another after another
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after another, rather than
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the somewhat disjunct of having to take a
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step and then come back. Right, so we can
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progress from working on all of our cues
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individually joint, joint by joint, segment by
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segment, and then go, "Okay, let's really
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try to get more transference out of this
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exercise by having you do it 20 times in
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a row, 40 times in a row, 50 times in a
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row. Let's have you do this for a hundred
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feet." Guys, I hope you enjoy this exercise.
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I hope you have some fun with you
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patients and clients. I look forward to
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talking to you soon.