Visual System Finding in Basketball Player with Back Pain; High School Runner with Bilateral Hamstring Pain; Elite Gymnast/Crossfitter with Neck Pain

Transcript

Beau Beard (00:00.75)

This is high quality. Riverside, not sponsored. Shouldn't be though. This is fancy. You're looking. We can review 24. Right? We got, how did you get called out in football? What was your number? 87. Damn right! Yeah, I'm just about to have you with it. So we got John in from Arkansas now, not Palmer, right? And then the crew, we're not gonna introduce anybody. Everybody made it? How's your bottom side?

time. We were off for about a week. Yeah, I was unwell. That night I was pretty... We were about 18 hours of... Not great. Uneasiness. Do you think we do it again? I do it again. I've been eating the sauces like all week. Mine was...

I didn't feel good for about 18 hours and then whenever I exercised my stomach started feeling not good. We're just gonna give you the heads up. Just go Google how much the Hot Ones kit is. Alex just over your mouth on it for lunch. Well, I think my patient made me the ghost pepper ones I've eaten. Yeah. Oh, we should have tried that. We should have, yeah. I think like a... Shot next time. A week or two ago was Johnny Cash's birthday and I think it was just to summarize things like Ring of Fire. You can probably call it that. It was a bathroom experience.

the next day and that was propulsion and a couple rings of fire he said jetpack engaged here who's doing cases me Alex I think I am Seth rookies gonna lead off would you were you in the lineup when you play baseball

We're doing it. Dang right. Get on base. Let's get going. Alright. So I found out I was doing a case about 30 minutes ago because Daniel decided he wasn't doing his so we'll see how this goes. It's okay. He had a rough day. I get it. Harry Potter and the Half Truth. I'm kind of a fantastic guy.

Beau Beard (02:00.786)

Well, triple bucked at seven and made it three. And now I'm working out for the rest of the day. Triple bucked at seven. I'm just saving my energy for my children. All right, so, man, I got something in my throat. I just ate. He's still reliving the spice. Probably dairy. Oh, there's just dairy from the last one. That's probably why yours hurt for a week, we'll be honest. Yeah, for sure. All right, so my case, I had a...

16 year old, I guess at the time he was 15, he had a birthday in the middle of all these appointments, so he was 15 when he first came in. That's how long our treatment plans are. Yes, he came in, he complained of having, let's see, right-sided low back pain, that he only felt whenever he was standing at work or playing basketball. He's a, I guess a basketball athlete. What's he do for work?

He works at Publix. He just, like I said, he just turned 16, so his hours are fixed and start getting moved, so I don't really know what he's done up until this point. But I think he's like a bagger grocery and kind of takes things out to the cards at Publix. I think that's kind of what his job is. I'm only asking so people know, because it's about 50%. Is he special needs? No. The jury is not. Publix, right? Oh yeah. So we have to ask? Yeah.

I would say it is. For baggers, it's either young kids or it's gonna lean that way. And he'd be on the other end of the 50% young kids. But he could have been in both. He could have been in both, but he was just a singular. He did have a catch here one time and she chewed out the bagger. It was the worst one, special Nate and I was just like, I don't even know what to say here. Because he wasn't on his game? No, he was moving to life. It's Publix, man, you're good. Hey, you can't drop this kind of nuggets. This isn't Aldi, though.

Like, Aldi is a speed. Yeah. You can tell Aldi was started in Germany. They make you bring your own box and they got it. Like, I'm surprised you don't get a number on your arm to go in there. Like, why don't you get your shit done? Yeah. It's rough, man. That's why I don't go there anymore. Great prices, but customer service.

Beau Beard (04:09.326)

Okay, back to the case. Hey, you're good. He's still 15. No, he's not. He's 16. Almost 17 now. He, let's see, sorry, I gotta read my notes. He had this going on for about a year that he's noticed his low back not really too severe until as of lately. Went to an ortho, Dr. Davis, went to him.

for his low back, who referred him here. Nothing done, he had imaging done, had an x-ray, they saw nothing on it. Like I said, he stayed sustaining for long periods of work and also basketball, or what kind of causes him pain. It's good when he first wakes up, gets slowly worse throughout the day. He's also taken some ibuprofen, but has had no change in terms of pain and has not used any ice or heat.

He also said that he noticed his right side just feels tighter lately and then he states kind of a little bit later I guess in the in the visit that him and his mom have both noticed that he's having trouble kind of seeing things Like on a TV or at school. He's homeschooled. So he has like two days a week that he goes to a I guess a school that's connected with church co-op. Yeah, co-op. That's the word I was looking for

Um, yeah, so let's just take him through. I know I'm the youngest one here, I think, but I would say I'm the most mature of the moment. Interesting. This is what it's like at home ladies and gentlemen. Him getting dogged. Has anybody seen the videos you watch on?

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Beau Beard (06:04.174)

Listen here you snaggle tooth. Okay, so top tier cervical flex. Let's see. He was functional. No trauma. No trauma Literally just woke up about a year ago He said he kind of just started noticing it then but it never got severe enough to where he felt like he needed to get it seen He played basketball kind of over the summer recently made the high school basketball team

Beau Beard (06:30.882)

Yeah, sorry I thought we were like, alright we're done with positions. I don't know what position he plays. You a shooter or a driver? He's probably definitely a shooter. I'm gonna go based on height and weight. McGavin. He probably stands at three points for sure. Scientist. Yeah, professor. Pretty riveting. So let's go functional non-painfuls. He was good on cervical flexion, both rotations.

Upper extremity pattern one and two. Actually, let's just skip that. Dysfunctional non-painfuls, cervical extension, multi-segmental flexion, and single leg stance on the right was dysfunctional and painful. His back pain when he looked with the cervical extension? I said dysfunctional non-painful, sorry. He was DN. The only thing that was painful was multi-segmental extension and then single leg stance on the right.

Both of those were dysfunctional and painful. For back pain. All right, had him drop down, do a half kneeling inline lunge. That was functional non painful on both of those for his, I guess for time. Yeah, balance. Gait analysis, kind of noticed he didn't really extend through his right side of his hip, and he also had an early toe off on the right side. Or I guess heel lift, whatever you like to call it. Let's see, nothing positive on any orthos.

I don't know if that's just me or if that's, I don't know, if I just don't do orthos right, but I don't get people that have hardly anything that's positive on some orthos. In terms of one bar spine? Anything. Or just overall. Overall. Yeah. Like people come in and have pain like all over the place and there's really nothing that reproduces it. They're like, no, I really ain't doing it. I think the key word is actually. Yeah, actually. Actually, I don't have any. John heard it today. The actuallys are my favorite. I guess the only thing that was positive was a stork test on the right.

I'll take that one Let's see the other thing that's noted is you guys got a stork at Palmer. So we talked about this would The only birds we get taught pigeon But I don't know say classified first birds like for what it was for I mean that was a classic. I mean here you guys carry on. Yes, sir

Beau Beard (08:55.714)

He's got it. Straight leg raise is also limited bilaterally, so I'm not going to say it's positive, but it is just limited bilaterally. Neuro is normal. All right, so then I go through check and range of motion. Kid moves impeccable, I'll be honest. Nothing really.

Nothing is limited except for, I guess, if you take a straight leg raise. Palpation wise, he had a restriction in like mutation for sacrum and then he had right ankle dorsiflexion restriction. And then he had a trigger point in his right erector. That was kind of the big key pieces, I guess, that I found. Pain audits, I've got multi-segmental extension, right single leg stance.

And then functional audits is kind of those three things that I just listed. The trigger point in Rhyder Ector, Lumbosacral Nutation Restriction, and then right ankle dorsiflexion restriction. Those are my three functional. Let's see, what did I do? Had him do some press ups because he had the nutation restriction. My man, question. Yes sir. But his multisigmental flexion was dysfunctional painful?

Just this function non painful. Oh, that was extension was extension Central is painful. It was painful

It was painful. But he goes prone, no pain. No pain. Because he also said that I asked him what helps and he's, I forgot to mention that earlier in the history, I asked him what helps and he said, laying on my stomach makes my back feel better. Love to see it. So we love to see it. So I had him lay on, I had him repeatedly lay on his stomach 30 times. Repeatedly. A little clinician over pressure. Sorry, clerk over pressure. Sorry, clerkship over pressure. Sorry, Hogan.

Beau Beard (10:55.301)

He got up stork test and one-to-same mental extension. Both of those were still causing him pain. Single X stance on the right still caused him pain. Go back and check and he still has a restriction so adjusted into extension there. I guess notation, whatever you want to call it.

Adjusted had him stand back up again just to see okay. Is it just maybe need a little bit more I guess Attention thrown in there had him go back recheck all that still painful again After adjusting he still has a trick point his right erector you just say cry pain no I didn't Throw the yellow flag on the play your 55 sure I don't care about that questionnaire and then

Let's see, this is when he mentioned about the not being able to see because I just asked him, I was like, do you wear glasses or contacts? Because he had mentioned that he had trouble like seeing in school.

I can't remember how we got on that subject, I'll be 100% honest, but we got there. You probably looked at your giant Lego rocket and was like, what the fuck was that thing? Yeah, could he even focus on the exam with that Lego rocket? He's not facing that direction, Daniel. In case you guys don't know, Seth is from Madison or Athens, around Huntsville. Huntsville, up until this year, had, or it's getting taken out, right? Yeah, I was driving up last night to Ashland.

Does that mean... I don't know. That's not in our state. That is... I guess it's our state. That's up at the... That's at the check-in. Not the check-in, the rest stop. Good God! He said the rest stop is part of Alabama. Look, like I said, it is part of our state. Anyways, he has a replica of this rocket. It was the Saturn V for the Space and Rocket Center in Huntsville. Made at... About 3 feet below. Made at... About 3 feet below.

Beau Beard (12:58.366)

Great. Googley moogly. His replica, made of Legos, in his room. And when we asked Seth why he got it, he said it was a conversation starter. Has it worked? I've had, let's see... This kid couldn't see it, so... I've had a decent amount of people ask me about the Rocket. I also had a girl that came in, her dad is like really big into Legos. And we bonded over that. I will say, Legos have become more popular. Which I'm not a fan of, I feel like. You said what?

They become more popular. I'm just saying I'm not a fan of it. If you want to have old nimbly bimbly fingers, not know how to chop down a tree, cool. That's fun. Go chop down a tree and come inside and work on a Lego. That's all I'm saying. They have become more popular. That's funny. Once I have a tree in my backyard. What do you mean? He couldn't see a baseball game on TV. It's on the other side, it looks like a fence. Look at that one in the middle. Okay, anyway. Keep going. Bye. All right.

Beau Beard (13:53.698)

You're like, what do you actually need to practice? I was like, well, I remembered it, so I'm renewing my license. Let's see. So, this is gonna be a 25 minute case on visit one. I had him just go on his back, because I just want to check his breathing. That's another part of, I guess, my exam that I do. I had him bend his knees, lay there. I can't really figure out how to mathematically breathe.

Worked with him a little bit. He picked that up relatively quickly. Had him progress where he picked his legs up. Kind of used some like dead bug progressions. Went back and checked all of my audits. None of them changed at all. So no, the trigger point in his right erector didn't change. The only thing I guess that changes because I adjusted it was the... Nutation. Ankle hasn't, still hasn't changed yet either. So then I...

sat him back up and at this point I'm kind of like, all right, what am I missing? So I have my exam flow written on my whiteboard in my room, so the last thing that I haven't done yet is visual, vestibular kind of testing. So I take him through carnal signs of gaze.

As I'm watching him, every time I take his left eye, I guess, to the right, he has to converge, he has a little bit of an nystagmus there, and then when I have him converge at all, his left eye...

doesn't converge as well as the right side does, and then it also kind of starts trailing back towards the middle. So just to clarify, because this is also for hopefully educational purposes, so was it during tracking that he has a blip? So that's a saccade. Yeah. So nystagmus is an end range. Like if I hold it there. Yeah, so if I had him hold, that's the other thing, I guess, like he had a nystagmus when I had him go and hold at the end range, that's all the saccade, and then I held it there. So he had a blip and? Yeah. Okay, cool. So then I had him bring it, I guess,

Beau Beard (15:53.048)

converge he it's still kind of blipped a little bit when he converges on I hold it there as I start to kind of trailing out his left eye so I was like okay that's something to maybe look at so I have him cover his right eye I have him go and try and converge again and his left eye has again no blip no little cicada or anything it's smooth whenever he converges there so I had him go

do some like the pencil push-ups basically, where he has the eye convergence drills, covering the right eye, have him go through like 10 of those, go back and check his ankle, his ankle like completely opens up. And he even mentions to me, he goes, he's like, my ankle feels completely different after that. He goes, that just feels- And you haven't explained anything to him? I haven't explained anything to him at this point. I was just, I was having- Like why you're doing the eye stuff, hey. No, I'm not, I did not mention anything about his eyes being connected to his body like Alex did to his patient. If you didn't know that,

pieces that the eyes are connected to the body. Yeah I just told him I was like I'm just gonna check your eyes and stuff like that they get they could have a connection but outside of that I'm just kind of ruling everything in and out. I again check his ankle and he goes that just feels like completely different he's like does that feel better than the than the left and I was like they're almost identical now.

So at that point I then had him flip over, checked his trigger point and his rider rector. That's like completely gone as well. So since my audits are pretty much clear, I stand him back up, have him go through multi-segmental extension and stork and single leg stance. All those, he has no pay on any of those. And when I edit this I'm going to throw in the, what's the, let the Holy Spirit come through you. And then, Samba!

Beau Beard (17:44.595)

All right, so here we are. Visit one. That is visit one. So quiz time. Before we do that, we're gonna take a advertisement break on a stork test. So sensitivity is 91%, specificity is 78%. I mean, that's about as high as Thessaly's is probably. They went higher than that on a standalone test. I can't believe that's not taught.

Which is insane. We learned Vesalis. We did. I didn't learn it. I learned Vesalis. That's crazy. This also says it's in like a Geley test. We got taught Geley's test is different than that. Yeah, we got taught. That was an aside. Can you explain or what is your summation of why working on convergence would change that stuff?

Let's see. Okay, I guess I forgot to mention as well, in talking to him, he said that he's noticed in basketball, he has, I mentioned he has pain, like in his low back playing basketball, but he has a friend that he's been growing up with, like his entire life. He notices that they're exactly the same speed, they both made the team at the same time, and he said that he noticed now as of recently.

The other kid hasn't been strength training any more than he has. They work out together. They basically do like everything together because I think they're both homeschooled in the same program. But he said every time the kid drives to my right, he goes, I just feel like he's just blowing past me, going to the hole now. He goes, going to my left. He's not. He goes, I don't understand because my right side is my strong side. But he just kind of mentioned that.

That's kind of one of the reasons I started diving back into looking at his eyes as well. Um, let's see. Cause that's what everybody's going to wonder. If somebody was here, like what's that? How in the world is that connected? How's that going down? How would you?

Beau Beard (19:41.21)

A, maybe explain that to him and then what is your like clinical explanation for that? Yeah, so I told him, I said whenever he's having to drive to your right side, your left eye is going to have to go to the right in order for you to be able to keep up with him. I said if you're- Or you have to turn your whole body which just lay down. Either one. Whole body has to move. So I said-

One, that's going to require you to be able to focus on just the object in front of you. Two, you have to use your peripheral vision. I said, peripheral vision as an athlete is pretty vital for what you have to do. And I said, if you're not getting a clear image of all of that together and kind of putting the pieces together with the rest of your body while you move, I said your body could throw up some little, kind of some breaks. And I kind of gave him the...

image of what you have with your kid where the kid was like slow as molasses, had the kid wear glasses and then he just was like an entirely different runner. I gave him that and he said, oh, okay, that makes sense. But I guess for clinically for me, I guess it's that's very, I wouldn't really go too much farther beyond kind of what I said, but he also is probably going to, if he has to go to his right, he's growing.

one he's gone through like a growth spurt of like four or five inches in the last year i believe two since he moved really well video coming out on growth spurt this week too and two since he moved really well he already kind of has just decreased proprioception um... because he's just growing super fast has no idea how to use his entire body um... and if he's having to

One, if it's maybe his vision or something like that that's just blurry, like again, he's just not being able to put all the pieces together. So you're kind of having a hodgepodge of a human trying to be an athlete. And if vision is gonna lead, you know, 10 to 20% of per perception, like I feel like that's a pretty big piece. And especially if he moves really well. But.

Beau Beard (50:17.898)

I think maybe if I knew more on the Z-Health room, because for myself if I would have just tested visual and I saw no lack of convergence, or that's pretty much the main thing that I look for there, if I didn't see that I wouldn't have done anything. But you, whereas, because we were talking about the other day, just because there's

things that would be noted in the visual exam that I just have no idea about. Right, for me I guess it's the, just because you don't see it, it's the, like if you don't see it then you just move on. Like in my opinion, like it's glaring. So it's like. Gather all data. Right, like we always sit there and we argue at home or get mad at each other, but like we don't like. If you only eat rice and beef, something's going to come to that. Yeah. We'll go through that train time. Well it's just because sometimes like, you know, we, since we're still like young figuring it out it's like.

We just, you don't see these things. When people say you see like a lack of convergence, it's like, okay, what does that actually look like? Cause we test on each other and it's like, I mean, if you like look hard enough, you might be like, you might could like maybe see it shift and you're like, no, just skip on past that. It was just like, for my kid, at least it was like, it was pretty glaring. I mean, it was almost like his eye didn't move in. Yeah. I see that over and over it, the course I taught, right? Like passive range motion, joint restriction, like dude, it is obvious, obvious.

you're making shit up. You're just making it up to make yourself feel like, and if you're like, oh, let me go back and check it. No, you're the knower, you know. It's not, oh, I'm not very good at knowing. You will know, I promise you. And then you have to be confident that what you found is true. That's the kicker. Not that like, oh, I don't know, no. Do you think it's true or not? And then the only way to find that out is treat. Go back and prove right or wrong. I even think like, I bet you're the same way.

where it's like, after you do the whole exam, the whole history, everything in SFMA, it's like, do you have a pretty good idea if I'm even gonna even check the eyes? 100%. And then it's like, and so if Brett was here, it's like, that's what I'll be talking to him about, it's like, well yeah, I'm not gonna check it if all these other things aren't already there. Yeah, it'll be very interesting when the Yaakov's info comes out from this dissertation and stuff, like it'll just be, I don't.

Beau Beard (52:25.694)

So Keith Yoho and I were talking about this probably like, I don't think it's gonna change anything because a principle of DNS has always been eyes. I mean, it comes from a neurologic standpoint. I mean, literally, I pull up those three slides from the early DNS A course that's talking about the visual system, how much they lean on the visual system. It's been a little bit, I don't know.

subdued within there because it's become more exercise-based, movement-based. It's like this is all in it as a neurologist, right? Like, polycholage came from like training from neurologists. Like that's what they're looking at. And then if, like I said, you look at a baby, like the first couple of things are polyconnected movement, yeah, visual cues, and then the whole body starts following. It's like that's all I'm looking at. And then I could really, and then you look at like, COBS stuff, which I think it would say like, oh, looking at Z-Health. No, we're looking at neurology, right? He's looking at it and he's like, hey, if we're going to do some sort of visual

input where you usually start. So you're kind of going back to almost like in a way a developmental kinesiology model, or I go to a lower level.

So Daniel with the SFMA and stuff, what are some key pieces where if you see a discrepancy in it that kind of points you to like, hey, let me check their vision. I feel like the easiest is single leg balance and rotation. It's like if those two are there, it's like you're going to check a number of things. If you have passive range, then it's like, okay, why are they not getting there? They have it. So usually it's like, hey, what am I not finding? Yep.

visual system. So as soon as you see an SMCD, check it. Like that should be your literally if you're a student like see an SMCD that's that glaring, go look.

Beau Beard (54:05.734)

Continue. This is a two. So he was able to run twice over the weekend, three and a half miles. Didn't have any pain. He's gonna try to run a workout that week or after I saw him a second time. And then they raced the next weekend. Multi-six liter run. Is your beard red? Holy shit. That was a redhead.

You're a redhead? No hair. Well I was a redhead. I was blonde when I was born. God, I was his clinician. I did a terrible job. You asked that question a long time ago. Makes way more sense. I was red for like, I don't know, a year. I think with the- That's enough time. The beard color though, it's copper. And I think the beard hair is like, as strong as copper wire. I think it's Alabama red dirt clay. That's Georgia. Yeah, it could be.

You just scooped some up and went like... Red clays tray? Red clays trays. There you go. Coming to Birmingham. Proceed. Proceed, sir. Multisieminary rotation right. Functional non-painful now. We continued, we didn't change what we were doing. We were just working on the breathing. Continuing to make it better. Progressed it to intradominal pressure. And then we took out support from chair, bench, whatever he's been doing at home.

And then he was going to do that workout and then race before I saw him. Um, or no, sorry, do the workout. I saw him before the race third visits still has, he's doing great. No pain, his hamstring. I'm saying hamstrings. We know it's not as interesting. Um, and so from there, I was like, all right, we're, we're doing good. Now let's actually like, give you some things to do that are going to help you.

continue improving running and you need to be able to control rotation to the right or just rotation in general as well as extension which is what I was doing the breathing for right because he like he Multisignal multisignal rotation he passed but it was like he is the unit kind of shaking extension. Yeah And then obviously he's not great at creating pressure With which he'd be an interesting one to look at the gate to see if you yeah, yeah Yeah, especially with some of the structural

Beau Beard (56:29.405)

So that day we did a kneeling and standing split squat, Paloff, we just did the hover. David Weck would slap you upside your head. Yeah, oh well. Did anybody watch his Instagram chat? Yeah. David Weck is on a mission for the anti-stiff core. He just thinks that's the devil.

Literally just get on a David Weck kick for your Weck method. I've talked to him on the phone and stuff. He gave us sort of his little pulse pros. He's a nut job. He is. He invented the BOSU ball, if you know what that means. That guy's Weck. Yeah. That guy. So it's the thing that you're supposed to like stiffen up on? No. It's supposed to be mobile, labile to get stable. Mobile, agile, hostile. I'm feeling hostile. He's an interesting guy. He'll probably somehow hear this and all hear of it.

So he ran great at the race, then I saw him for the fourth visit. I just have that he's rocking and rolling. Clinical outcome measures. Was that your diagnosis? We are... Diagnosis rocking? You're out. We were dead bugs today.

because I was like, look, this is literally you running, being able to differentiate limbs, creating a neutral on our spine with intra-bondal pressure. You're doing the rotational stuff at home. And then, you know, I had planned on us kind of talking about, because I don't think they get it with their program, just a general resistance training, because that's what he needs, right? He needs to be challenged outside the sagittal plane. I was gonna say, do you think he needs more? Yeah, I just think he needs to keep doing that, right? And then- But like that level, or like needs to keep up in the challenge?

to add weight, right? We've done some banded things. Impact, plumbing. Which is what we'll do next, but at the same time, so he's a junior in high school. This week he went on a bunch of college tours like with their school. He runs for a really small school around here, and you know, he's around 1930, he's not running a college. Well. He's going to welding school. Yeah. Well actually, he'll probably end up being some kind of engineer, like, he'll make a ton of money. But.

Beau Beard (58:45.45)

It would just I'm assuming that he doesn't talk by a bear turn away Yeah, because most runners like even if they're not gonna run in college like it's a sport that you can continue doing right inside one in the end usually

that's the only thing they've done, right? Like they haven't played basketball or other sports or things that they're gonna continue doing after. So they latch onto that and they will just keep doing it. So. Two key takeaways for me from this. It's kinda like seeing everything. I'm like, wow. Like you can have a huge impact if you just kind of like clarify and work, you know, with a runner that's primarily in a sagittal plane of movement, introducing other planes of movement and some cross training style stuff.

and then number two there's more just a comment I think this is the most polite patient that I've ever seen. Oh yeah. It's always like yes sir and no sir and he's just like you know you tell me what I need to do and I'll do it. That's cool. Who's your dad's neighbor? My dad's neighbor? Yeah the one who me and Bo both seen who says all that time.

Oh, not neighbor but friend. Yeah. Yeah They would ride they would that might be him in about 40 years Any so I just carry on constantly

Beau Beard (01:00:16.27)

Great guy, love you too. Oh yeah, he's seen almost everybody. You see him now, have you seen him? Yeah. How about saying, is that what I wrote in my hand? Yeah. I said, let me read the text right. And that's how I see him.

Yep. Good. Alright. Bring us home. Anybody got a two by four for Daniel? It's a karate chop. Yeah. Right now, just test the integrity of that bone. I'm going to play top ball this week. He had dingers too. Everything else was sore, my hand wasn't. You didn't boon-tip? I wish. Slow pitch bun would be a little bit tough, huh? I'm not blind.

Alright, let's bring it home. This is actually, this case is about a, maybe the biggest fan of Week in Review, at least locally. This is a former elite gymnast, now high level cross-fit athlete and medical resident with a plan to some of this. Reports on July 17th with complaint of left trapezius, neck, tingling numbness. So that's the main complaint, it's tingling numbness, not pain really. That just kind of spreads across the upper trap.

Works with overhead movements, in particular handstand pushups. The amount of handstand pushups will come out here in a minute. She's been working on an average of 80 hours a week. She's resident. She's getting crushed. And then working out at night by herself. If that gives you an idea what type of person you're dealing with. No prior similar complaints. I mean, collegiate gymnast, so multiple injuries. My wife had seen her for a bunch of injuries. She was a gymnast for Alabama. No prior treatment for the complaints she's coming to me with. So that's kind of the general.

Um, general presentation, which is something that I look at more. I think I used to be just more like, well, let's get into S and A and stuff. Just like how's this person like present? Like what do they look like? What do you even call that posture? Whatever. Um, what did she say? What was her analogy of herself? I look like a 10 year old boy that just learned. Oh, I did have a 15 year old boy that just learned about a chest on about peanut butter. Pretty funny.

Beau Beard (01:02:22.806)

She only does bench press or something like, yeah, she's pretty self-deprecating in the best way possible. Um, she probably listens to this. So we love it. Um, bilateral anterior shoulder. So I'm going to try to present if you're watching the bilateral anterior shoulders, thoracic kyphosis, increased lumbar, lower dotted curve, and generally a little bit ramped up. Um, she has built like she's built like a gymnast, right? And that's a big part of this case. Uh, so top tier dysfunctional and painful is bilateral upper.

Pattern one, multisegmental flexion, multisegmental extension, left rotation only, and then bilateral single leg stance and deep squat. Nothing was painful, just some dysfunctional stuff. Gait didn't really pertain to it other than her past history, which isn't, we'll talk about it in a little bit. Specific movement testing, four point rocker, if you're not familiar with that, you're in quadruped, just rocking about, four to five inches forward on locked elbows. Increased T-spine kyphosis, curvature reflection, she lives there.

upper trapezius and pec major activity and then she's an apical breather in general. She's just hanging out and you can literally see her hanging out like this. Range of motion, so prior history with her and the biggest thing that Sloan sawler for and that was just, I had seen her for, she had an osteotomy of her right hip so she has pretty decent external rotation limitation of her right hip with some pain and she's doing high level crossfit stuff and she's not limited by weight.

reps or anything. To talk about the handstand pushup rep scheme that she came in. It wasn't the first visit, but second. First visit she came in, she had done some handstand pushups, some overhead work. I think it was a snatch or something. She comes in the next time, she's like, I'm doing better or was doing better. Then it got worse because I did 120 handstand pushups as part of something else. Like I said, this is by herself in a gym at like 10 PM at night. It's what we were told. Maybe that one.

Yeah, it's good news is she didn't feel it after a hundred. Yeah. Yeah, it's a good call didn't show up at a hundred I was like, yeah, I think I'd have pain in a lot of places Neuro-normal So I'm palpation TL junction rotation extension restriction and lack of posterior IEP Like that's a big deal with her is like it's very hard for her to get like kind of that breath into the posterior aspect We're admin

Beau Beard (01:04:46.27)

right gluteus medius trigger point, right gastroc medial trigger point, and then CT junction, left rotation extension restriction. And that plays all real quick plays into the ortho. So when you load in maximum frame of compression left, she's like a pinpoint pain, but also some of that numbness on that first and second visit into the trap, which is a weird presentation. That's not a ridiculous opathy. We'll talk about, I'll give you the, you know, legit diagnosis in a sec. And then a trigger point in the left upper trapezius.

And then as I said, orthos, MFC on the left, positive with left pain. So my pain audit is maximal foraminal compression. I mean, it's literally reproduces her chief complaint. Functional audit, CT junction restriction and upper trap shoulder point. So she has a restriction extension, left rotation on that side. Giant shoulder point on that left trap. Treatment focus is T-smite extension though. I mean, she and her, like that dead zone, T4 to T6 is just like.

has a hard time conceptualizing in this video for this podcast, I'm gonna put a video of her in quadruped trying to figure out just how to kind of get into neutral. You're gonna see around like, kind of a middle trap, like where serratus anterior should kick in on the medial border of the lower scapula, you're just gonna see a big divot when we cure up. Like she has a really hard time figuring that out. And then, so treatment focus, T-spine extension with improved scapula thoracic stability.

Diagnosis, I'm not gonna give you an ICD-10, but like facet discogenic referral, but I would say it's more a cloward side, like legit disc referral. That's why it's this like specific numbness tingling. Maybe you could call it sclerotogenous, but it's numbness. It's not pain, which is a little bit of pain when we like load, which is a true what? Derangement. You have restriction pain, right? Now that'll play into the treatment here. So first visit.

We adjust all the things that I said restriction-wise. So what was that? TL junction, CT junction, T-spine extension, dry needle upper trap. And we actually leave her with what? Cervical flexions, which I know seemed backwards. She has, we're talking she needs a T-spine extension, but she has that kind of upper T-spine scallop within a little kyphosis at CT junction, which is why she is extended or restriction extension.

Beau Beard (01:07:12.782)

extension restrictions, I said it backwards. So when we flexed her, we could then load her into extension, she's like, I don't really feel anything. So like, I even told her, I go, I don't think it's the home run, but I think this is the best palliative thing we're gonna get fast, right? Which obviously it kind of worked. So homework from that first visit was just cervical flexions, nothing else. Now in visit, we did a little bit of DNS and start position, like Sarah's prayer, but I didn't send her home with that.

Second visit, she comes back and she's like, I'm better, but that was a visit that she's like, I did handstand pushups, I took 100 of them to hit the symptoms. Symptoms she did say were better. And she says the referral is closer to like a local, like around CT junction. So it's not as far out in her trap. So a second visit, adjust. Instead of dry kneading, I just do some stecho around like cervical extensors, around kind of middle lower trap and then upper trap.

and then we go back to start position and then I send her home with strange prayer that time. Strange prayer for her is tough. I mean, she literally, I told you, she's a little ramped up type A. So when we get her into DNS position, she's the person that right away is just like, literally like vibrating, sweating, but she's such a good athlete, she'll get it right away. It's just hard. Like, I think that's why it's hard. I think she gets into a good position fast and then like gets cooked. And I think that's the hardest position to cue. And like,

I think maybe in DNS, it's like the stride of spirit. When you know it's like upper T-spine. Which I'll give you what, so I just got that a couple weeks ago from Prologue and one of their kind of prioritization lists for that position or working on upper T-spine extension or axial extension was create lateral expansion of the shoulder, shoulder blades first. So you're creating like a, basically, we think of the elbows as the pump and fix them, it's actually the shoulder blades, right? That's what's.

pulling the T-spine, either if it was hyper flexed in the neutral or scalloped in the neutral, right? It's just like you're popping a dent out of a hood, like this way. Then you go after axial extension. Somebody cue like, hey, elongation and things. Final move would be nine times out of 10 extension, right? So for her T4, T6 extension, or it could be flexion if somebody scalloped through the entire T-spine. Versus what we typically do is what?

Beau Beard (01:09:32.482)

go right after extension or flexion. Like we want to approximate the shoulder blade or the rib cage one way or the other. So it's like, they had a very clean, like no, one, two, three. So take that. I've started doing that and that's, I feel like it's made the big difference. Which the lateral expansion of the shoulders, that feel is tough for people to get, but when you get it, it's a key because what are you doing? You're putting an eccentric load on the middle trap or an omboy, which literally gives a stable point for the mid T-spine to work off of, which is why we think so many people have a problem.

That's the dead zone. Do you feel like you're still getting like a lap and relax from there? Yeah, probably more so because a lot of people, what's their first move and start position. It's like a backward traction. So if you have lateral expansion, like literally do it yourself. So if you're at home, like put your elbows on a table, pull back towards your hip flexors, you're gonna feel your lat engage and then think east and west or left and right, like give feedback and you're not gonna feel it at all. You're gonna feel the outside of your shoulders with no lat.

That is the hardest thing for people when you're working in these kind of three month prongs, start position, quadruped is laugh and peck, right? Now here's the key, there is some activity, or peck in particular if you're in quadruped. You can't not hang out with your peck, it's just not dominating the movement. So we sent her home with Strayedish Prayer and just kind of said, hey, hang here, maybe you start rocking a little bit. She comes back and she's like, it's way better, but it's still kind of there, which.

I'm gonna be honest with you, she's probably listening to this. At that point I was like, I think it's pretty much fine. Like, I mean, we load her up, she can kind of feel it. She's doing great. So that's where Seth was helping me out in this visit. And we, I mean, we still adjusted, did stekko. Then we started doing like high bared, a downward dog, then elevated high bear, so her feet were up on a step. I mean, she's doing handstand pushups. So we gotta work her into these higher level things. It was really hard for her to conceptualize up writing.

in her mid T-spine when she started to go through these transitions. I mean, really hard. So we didn't leave her without, we just said, the first thing that she always did is like, you were trying to, yeah, you were trying to get her to like, get her shoulder separate from her mid back. Yeah. And she always like, as soon as you wanted to go like overhead, it was just like flex my T-spine and then I'll go overhead. So it was like, but that's what gymnasts are taught. Yeah. And that's what we kind of talked about. Like they are taught to fixate inflection because you can use your rectus abdominis.

Beau Beard (01:11:52.878)

but then they'll have to hyper flex their shoulders and then what do they end up with? Shoulder pathology and one more spine pathology but now we're seeing what? Compression fractures in mid T-spine because the compressive force is being driven either from loading here or basically rotation. And she gets all this stuff. I mean she's a medical professional now, was a extremely high level gymnast, but it was still really hard. So she competitively, you can tell she's kind of like, and I was like, cool.

But we didn't leave her without, she went home with a high oblique sit that day. Cause we were like, we like what we're doing here. Let's take it down a notch and just figure out how to load your left side. Was staying upright and start moving around it. And we'll move you back into quadruped from high oblique sit. So that was, you know, first, second, third. Um, it's literally, we've seen her two more times since then. And it's just been playing around with this stuff since then. I mean, last time we went back to quadruped to downward dog, just seeing like tolerances and that's where.

the video I'm gonna put up is from the last visit I saw her. You're gonna see when we really start to get in the nuance of cues, we have her hang out for maybe 10 seconds. She fatigues out and literally her shoulder really just like pops off of her rib cage. So now it gets down to what? Kind of awareness, motor control, and then endurance. And then you kind of build that in, but I mean, think of a hundred reps of handstand push-up, and she's literally just gonna do whatever she can. So I mean, she just literally, and I'm not gonna tell her not to do it, but just run right over her tolerance all the time, which is gonna start her back into the older.

old motor program makes our job harder but she's pretty much out of pain. I told Seth this or I think I did, I think she could have been done the fourth visit and even the fifth visit I was like I don't think she needs to come in but I think she needs the reassurance of am I doing it right, all that stuff. Literally the last visit she was like I'm feeling really good. Always going to be stuff to work on because she's beating the hell out of herself, she's working 80 hours a week. Yeah, any questions on that one?

Beau Beard (01:13:51.83)

She's got an interesting one just because she's such a high level athlete. Like it's easy to work with, but you also like, it's like everybody you'd want, but then you kind of get to see if everybody did exactly what you wanted to. Like see it change, but then see that it's not even perfect still. Like, oh man, you can do everything you want, but then you're kind of like, yeah, it's not perfect. Keep going, keep going, keep going. It's another thing of, again, just like, almost anybody who's high level, how well they can compensate. So again, it goes back to just like.

how well their tissues are, how good their tissues are, take it where they can feel theirself really well, but then it's just like their body can compensate and tissues can tolerate that, so it's like, where is the actual breakdown? It takes an 80 hour resident doc week working out solo and 120 handstand push ups before it's kind of like, yeah, I get some numbness down my arm. It's kind of like, that's pretty impressive. 50 year old one, overweight office worker. He goes on a walk for a mile down the road and it's like, dude, I've got this.

bathroom ceiling. The bathroom ceiling, like dude I'm dying. It's like how many Alabama gymnasts from like those championships have we seen where it's like as soon as they get some of these positions I'm like, you do it so easy. It's not fair. It's not fair but also you see how, so a big point of contention in our profession is, well could you train an idealized position or movement? It's like well they definitely got trained or not idealized and they hang onto that for like with a death.

and try getting somebody out of like one bar lower doses, like hyper-kyphosis and then like not hyper-flexing their shoulders is like, and that slumming literally just hits home runs just trying to like break that pattern all the time. Which in like, this is one, you kind of see it here a little bit, but it's like this is one off showcase all the time. I can't see it. It's like mud learning. We'll put it, send me the slide, we'll put it up on the video. Yeah. It's like I always think that like, okay, it's like of course if I've been doing it one way.

When we're talking about autonomous, like 100, 300,000 reps, and it's like now I'm trying to learn a new way. It's like your body one time efficiently did it, but maybe in the first year of life and then it hasn't done it since. And then the thing that we talk a lot about with runners is you hit a fatigue point, so you can have great control when you're, you have great neurocognitive function, then you hit a literal metabolic fatigue point, no matter how great neurocognitive function you have, like that goes downhill, then you gotta do two things, what? Kind of.

Beau Beard (01:16:13.474)

push that metabolic gap a little bit while you're working the neurocognitive. And I mean, that's literally time and training and all this stuff. So, I don't know if she's competing or anything, but I mean, it just gets down to, she probably is also under immense amount of stress by not eating awesome, not sleeping awesome. And then how much of that is just driving the bus? I don't know, probably a lot. But again, look how far it took until something finally broke the heads. Right, yeah, so again, Winchester talked a lot about you're the functional metis.

Medicine side of things is just like the buffers around like when you break down and how fast you recover, which is why we should have that conversation, which she knows all the stuff. Implementation is everything though. You can know everything is fine and everything. But this patient may introduce herself because she might bring a case on here pretty soon. So, yeah. She's had some doozies so far when she's bringing them up in clinics. So. I've got an ATV. Yeah, it'll probably, yeah. It was a good chance. Last one was, I'd never have guessed it.

Oh, any final comments? Anything from Peanut Gallery? Nope, just one more. There you go. So we got some show notes stuff to put in there. Z-Health chart, what else we got? The video of her. The video for you. Pajeped Rock. Pajeped Rock, also put in stork test evidence. So you should also put in a picture of a belt where they're like trying.

pull it together and make it snap. So Yana, or John at Yana from Prague was basically saying like, which everybody was like, I don't know what that analogy, like a horse tied to two posts. And if that horse tried to walk forward or backwards, it's gonna like tighten the rope. So it's only got one option. It can move up or down, right? I've heard, you know, Rich talk about this. Everybody explains it a different way, but like.

The best thing you can think of is I think of like popping a dent out of a car. You don't hit the dent, you hit the side. Right. And if you literally hit on both sides of it, you have a higher likelihood of like popping that thing out versus hitting one side because then it could just like deflect. So what you're doing, you're trying to create tension on both sides of the spine and tension being the musculature, right? Not just moving stuff around. But the biggest key there is in particular, I think this gets missed is it doesn't matter if you're starting from a flex position or a hyperextended position. It's moving somebody to neutral to move into axle.

Beau Beard (01:18:34.796)

extension so like it's like it's the same regardless which makes your job easier cool more boots more octoberfest more spin drifts and maybe one more we got to start doing the wild turkey on camera though should have done that we didn't start no you were in a different realm already

Okay, two weeks from now. Also, if you have a case that you want us to present or you would like, you have questions on there or something, start sending those in. Yeah. Dr.obierd.gmail.com and we can either answer questions, we can help present it, and I think we'd like to start doing that because it'd be a little more fun too. So we could do like two of our own and then one of somebody else's. See y'all next time. Bring it on.