We gave you this guy here to go in the bird's front of your lab.
So we talked just a little bit about that yesterday.
We talked about palpation and stereognosis and Vypacul in terms of palpation.
What's part of the hands we use and why.
I think most of you got a pretty good drift yesterday.
If we picked on you that little bit yesterday, we're going to really pick on you today.
Again, where you're touching and how you're touching will define your diagnosis.
We can't say that enough.
You have to be precise.
You're going to get way better outcomes.
All of you have the capacity to learn these techniques and do them well.
It's the palpation of observation and finding what is the problem is the key.
Also in this section, there's the other information about the theory of counter strength.
The current theory of counter strength is in here.
You can read through that.
We're not going to take time to go through that because we want to get right in the lab.
There's a nice little section in here that came from the August class.
We put that in here.
Page 16, keys to remember.
Only 16.
Page 16, keys to remember.
Again, these are all things that float through a meal-nised mind over the years that we've written down.
Euphemisms, bearisms.
These are things that think about parts of the body.
I would definitely spend some time reading through those.
Most of the things in this section here apply to this class.
How we talk about different body parts.
Things like page 18, the key lumborum tightness is associated with T12 rib dysfunction
and diaphragmatic rib dysfunction no matter what.
Again, these zones in the body talk about what's going on there.
We talked about QL a little bit yesterday.
We're going to get into QL in depth today about why this is an important area to make happy
because it influences everything.
Especially when we talk about pelvis, that QL has to be happy.
We'll talk a little bit more about what QL dysfunction does.
So, spend some time reading through that.
And then a little overview of what we did yesterday.
Yesterday we did scan exams.
Again, these exams to help target regions of dysfunction.
So, they're not diagnosing.
They're telling us where to go and look.
We started out with the pupillary line test.
We had somebody stand.
We had a vertical line through the midline of the face.
We had a horizontal line through the pupils.
We said if that vertical line in standing was not vertical, it was bent.
We said that was a lower circle of dysfunction.
If the horizontal line was skewed from one eye lower than the other,
we said that was an upper and lower circle of dysfunction.
We said if they went from sit to stand, or from stand to sit,
and when your findings were understanding, change compared to sitting,
we said that was a pelvis lower extremity.
So, for this class, yeah, right up the bat, I know.
They may have a neck issue.
I can see that one of those tests was positive.
But when we went from stand to sit, it changed.
So, I know right now, just that test alone,
we got a pelvis lower extremity problem.
We did the jump test.
We had five variations here to look at.
Again, in particular, about saying,
we got those fingertips on the ABCs of the SC joint.
Start in the middle, roll on top.
We got those fingers flat like that.
Not like this, not angled in.
I got to be vertical and bent over the top,
so I can see those levels with my eyes.
Then we had them slowly abduct the arms with the palms down overhead.
The variations we were looking for was, of course, either no change.
They started level, they ended level.
They started level, one side went up.
That was the upslit.
They started uneven.
Arms went up, they leveled out.
Uneven to even.
T10 and down was my area to look at.
We started uneven and we switched.
T6 and up.
They started uneven, finished uneven.
This was the variant.
We said somewhere between T6 and T10,
the bottom of T6, the top of T10,
dysfunction in that area.
Also, a structural functional leg length.
One SC will be high.
You'll see a scoliosis presentation with that person.
We said that they had a fracture clavicle in the injury
of the SC joint or EC joint that negates the test.
Can't use it or they have restricted range of motion
of the arms and general.
Obviously, you can't use that test.
In a scoliotic person, is that the only reading
they'll ever get from them?
Or can they act also sharp with other things?
Oh, absolutely.
They can change up.
They say, okay, we're going to do this thing here,
and then I'm going to fill it with you,
and then we're going to see what you really look like.
Because that's what's going to happen.
After we've treated a few areas,
especially the crossover points in scoliosis,
where the convexity and concavity
meet each other in the middle there,
that's where they get stuck.
Classic being T12, T9, T8 in those areas.
To get those areas to wobble,
you stand them back up and they look completely different.
And their center mass is different. They're going, whoa, wait a minute.
I wiggle where I'm supposed to wiggle now.
Yeah.
Then they can get to their toes.
We did the hip drop test.
So this was, again, looking at the lumbar spine's ability
to accommodate or adapt to an unlevel sacral base.
And that was done quickly.
We dropped the knee.
We see how the lumbar's adapt to that drop knee.
So we looked at, are those curves symmetrical?
Does one look like a good curve?
The other one's straight.
No side bending to that direction.
We said, okay, that was a low lumbar dysfunction.
We did the test.
They got a curve up high with one leg.
They got a curve down low with the other leg.
Two different apices, we said,
go look in the thoracics.
Okay?
There's a lot of information there.
But again, what it was telling us
in terms of somatic dysfunction, of course,
is what they can do.
I dropped my right knee,
my lumbar side bend to the left.
Left side benders, left rotators are tight.
They go that direction.
And they don't go to the right
if we drop the left knee.
So right after that,
if it's a low lumbar dysfunction, right,
we're thinking, okay,
probably flex lesion there.
I got to confirm with my palpation
that probably flex lesion there.
Left side bend to the left,
FRSL, flex rotated left side bent left dysfunction.
And then we confirm that
and we get in front and do the Sphinx test.
Okay, look at me as we get in.
We did the squat test.
Again, we're looking for that.
15 degrees of dorsiflexion
or tibial advancement.
And we went through that thing about getting the knees
over the second toe, right,
looking at the ankle wrinkle,
looking at the knees and thinking, do they dive in?
Does the heel collapse on one side more than the other?
Do the heels pop out?
Does the butt shift to the direction here
to accommodate one knee coming forward
compared to the other?
We're looking at all those variations there,
but the main thing being
15 degrees of ankle dorsiflexion.
You got to have that
for a really good function in the lower studies
so you don't beat the pelvis up.
As we get a jammed palp,
TALUS, what begins to happen.
If my TALUS is jammed
and I can't fully dorsiflex,
what do I have to do in my gait?
I'm going to walk like a pirate, right?
To avoid from stubbing my toe
because I can't get my toe up.
I have to elevate my hip.
So here comes the classic hustling.
Start firing my QL
to walk.
And you'll see that arm on that side
doesn't swing well either.
Right?
It gets stiff.
So a very, very classic pattern.
Again, most issues
with low back pain
always have to go look at that TALUS first.
You're going to see a jammed TALUS on one side.
That's causing some sort of twist into the pelvis.
Swap, hip drop.
Mental test
to, again, to look at
the TALUS function.
We had them seated.
Once in the roster with TALUS
we brought the heels to 90 degrees
and looked for close to your glide
one versus the other.
Again, you're going to see
if it's positive,
TALUS is exquisitely tender.
We'll do a TALER release today
just to go over that so people have that.
Most often, the TALUS is going to
again, glide anterior-latterly
is where it's going to go.
Forward and lateral
is where it's going to get stuck.
So it slides out of the mortise here
and then tips
with jams there, I can't
dorsiflex the ankle.
To get into the treatment, again
it's going to bring it back close to your medial
and we'll demonstrate that.
There's certainly counter-strength points
around the ankle there that are helpful
to do if you can't get it to go.
We talked about
hip, taking the patient
put in the supine here
legs straight, lift the legs
rotate in, compare
internal rotation, external rotation
side to side.
Again, looking for obvious changes there.
Is the hip stiff? Does it lock completely?
Does the head of the femur?
Does it go posterior? Compare one side to the other.
We're looking for quad or TFL
tightness if it's really stiff as well as the
deep hip rotators are going to be involved.
We differentiated between
legs straight
in 1990.
What are we looking at there? With the legs straight
who was the primary external rotator
of the hip?
One of them.
So has.
Who else?
Antiquity.
Operator buddies.
Gemelli buddies.
Quadratus femoris buddies.
Even the ligaments involved with this.
We bought them in 1990 and we said
it was the primary external rotator.
We bought.
So internal rotators, same thing.
In the supine position
who's the primary internal rotator?
Leg straight.
Hamstrings are part of it.
Yeah.
Gluteus medius, gluteus minimus.
Internal rotator of the hip.
It's the guy when he gets in trouble
he gives us a false radiculopathy down the leg.
It looks like a radiculopathy.
You've got a gluteus minimus
that's really irritated.
They think they've got a herniated disc.
It's not.
It's gluteus minimus. It looks just like a radiculopathy.
We'll show you how to treat that
when we do counter strength.
Okay.
And squish test.
So here we have this
viscoelastic structure.
We do a compressed area
of getting in here and again determining
which side the stiff, which side it wasn't.
We talked about the female
valve was being about 45 degrees of
angulation here.
Getting on the anterior spines.
Slowly you'll find one around.
What did you realize?
You're moving too hard. You're moving too fast.
You've got to slow down.
You've got to wait for it to give.
It starts to give and just follow it
and see when it stops.
You've got that 45 degree angulation.
Male is going to be a little steeper.
So take that into account when you're doing that.
You never want to push hard and fasten that.
Again, the squish test determines
the side of the pelvic dysfunction
whether it's the pube or iliosacral.
You do the pube first,
clear it, then you retest the squish test.
At that point we're looking at iliosacral dysfunction.
So we're going to use that
a lot today as we go through this.
Yes.
The sphinx test
we've kind of already talked about.
Again, we're going to use that
yesterday.
Again, the purpose of the sphinx test,
of course, is to take the slack off
the posterior pelvic muscles
so that area will relax.
So we can get the sacrum to be a neutral.
Hands up under the chin there
to get the cute little Mormon company
to stabilize the muscles of the trunk
to relax so we can identify
what kind of this process is all about.
We're also using that position
to lift the sacral socus when we do
sacrum today as well.
Okay.
How patient.
So we did anterior pelvis.
Our T findings here we're looking at
with the anterior spines, of course,
ASIS.
We looked at tubic tubercles.
What have we seen, males versus females?
Yeah, quite a bet.
Like a male like Rob, you're going to go,
holy cow.
Pardon?
Yeah, fine.
Okay, we had the disc in the center.
We looked for tendons in the tubicles.
We looked for tendons in the disc space
itself. I think those are going to be all
identifiers as we keep the pelvis today.
Those are our anterior landmarks.
We went to the posterior landmarks.
We had the PSISs.
Those little mounts roll over.
Use those as a
guide mark here to get into the socus in L5.
We had the L5S1
interspace again with a flex lesion
and any kind of lumbar dysfunction that's going
to be tender in that zone.
We talked about rotating the thumbs 45 degrees
and falling in. That gave us our location landmark
for the transfer processes in L5.
We rolled the thumbs
medial off the PSIS and slightly inferior.
That gave us our landmark for the depth
of the sacral socus.
We went down the sacrum
to the ILAs here by finding the sacral hiatus
at upside down horseshoe. We went lateral to them.
We got our posterior locations
now of the ILAs.
We slid the fingers inferior to the ILAs
here now. On the base of the ILAs
we got the inferior location
of the ILAs. Again, we're going to use these
when we do sacral identification dysfunction.
We went to the tip of the coccyx.
Was it tender? With the lateral sites tender.
Remember, pubococcyxias
attaches down here on the coccyx.
Glutus maximus
has huge attachment
over the sacrum and the coccyx.
Glutus maximus has huge attachment
over the sacrum and the coccyx.
So if you have an inhibited glute
because you have a
facilitated quadratus lumborum
you have a sacral coccyx
dysfunction
which means you have a pelvic floor
dysfunction.
No matter what.
So we're back to the QL again
and rib 12.
If that area is jacked up
this is all gone.
So as we get to the counter strain
we're going to see these key points
to go treat in those areas
to get that system to work.
To dampen down that aberrant neurology
hitting those areas.
Yeah.
Okay, so let's do just a little
get your note paper ready.
Okay, five minute break.
Wow.
We don't need
to copy over that one. Yeah.
