Art of Assessment Low Back Pain Case Study | Week in Review 58

Most clinicians overlook the simple yet powerful system that can transform their approach to pain and movement dysfunction. In this episode, Taylor Lawrence, a rising star in the chiropractic profession, shares how adopting a systematic, functional assessment combined with movement-based interventions can dramatically improve patient outcomes — often faster than traditional methods.

Full Transcript

Beau Beard (00:00.707)

He texted me, were you cheese ball? what was he talking about? He was just talking about how much he looks up to you and how much you've been a mentor to him and he was like, Don't tell Bo that. He'll he'll yell at me if I if I s if I tell you. It's a good thing it's on a live recording. Yep. He'll listen to it and make sure since he made me a blanket with my face on it, I'll make him a teacher with his face on it.

Taylor Lawrence (00:00.782)

That's so funny.

Taylor Lawrence (00:25.07)

Go.

Beau Beard (00:29.849)

I'll manufacture tears into that blanket now. yeah. Yeah, you'll well, yeah, you'll see it in September. There's a slide. Well, not the blanket, maybe I'll bring the blanket. I don't know. there's a slide that I put at the end of all my talks that's like my face on the Riddler's body. It's just like, hey, questions. That's and it was a thing during R2P grand rounds. So like every two weeks they were seeing that slide. So then they showed up when

Taylor Lawrence (00:33.996)

He made a blanket?

Beau Beard (00:58.009)

Tristan was here and you and Kyle. No, Kyle wasn't actually here. god. She was here for the Christmas party and then yeah, I opened that up, which was I don't know. And you you pulled it. We played Dirty Santa and you pulled it. Like just by chance. Yeah, I forgot about that. Hilarious. Yeah. No. Now it lives in my daughter's closet, which is scary. Yeah. All right. We had a roll. Yeah. I know what we're starting with.

Taylor Lawrence (01:11.116)

That's what it is meant to be.

Taylor Lawrence (01:20.792)

That's a little scary. That's good.

Beau Beard (01:26.181)

We're starting with the triage show. That was Are You Not Entertained? Yeah. I was entertained. I actually watched it after Well, before we get into track sets, I mean, because she's showing up on this thing. Who's do you mind introducing yourself real quick, Taylor? We're just sitting here like getting to our thing and we just got Taylor's hanging out. She's like, Hey, I'm here. So just introduce yourself. tell us where you're at, where you're at in school and all that jazz.

Taylor Lawrence (01:34.818)

Thank

Taylor Lawrence (01:53.326)

Okay, well I'm Taylor Lawrence. I'm a current tri eight, about to go into tri nine in a couple weeks. So I just started clinic this past try. So it's been about 14 weeks in clinic, which has its own learning curves as all of you guys know. But I'm in Dallas at Parker. So I really love it. I'm ready to be into the next milestone and stage of it all, but gotta take the process.

Beau Beard (02:18.2)

Yeah. Don't rush it. Yeah. And we'll get to see you down here for the Art of Extremity, Lower Ex or Art of Extremity, Art of Assessment, Lower Extremity and Mastermind course a mouthful. And you did sign up for the mastermind, even though you thought we were going on this like hellacious trail run. We're not. We're gonna go for a hike. There might be some heavy rocks and things. We also just got that cleared so it went from a six mile round trip to I don't know, three and change.

Taylor Lawrence (02:27.725)

Yeah, I'm joking.

Taylor Lawrence (02:33.708)

I did.

said.

I can do this.

Beau Beard (02:47.594)

I like that. Yeah. So that'll be better. That'll be better for everybody.

Taylor Lawrence (02:51.309)

I know I told Ethan, I was like, I don't think I can do a trail run, but I'll do the rest of it.

Beau Beard (02:58.05)

Yeah, it'll be a hike, carry some rocks for fun, combo. Yeah. Is everyone up the what, the King's chair? Going to King's Yeah. So yeah, if anybody's interested in this thing and you're listening to this, we do I have to limit spots because a I have to take people back to the spot in my truck. I hope people are game for a little redneck adventure in the back of a pickup truck truck. on that limit space for just like I don't know.

Taylor Lawrence (03:16.525)

I'm going to

Beau Beard (03:24.02)

Ease of conversation for the mastermind and things. So I'd say max five spots. Really, we're supposed have three spots left. Yeah, Friday, September 18th, we'll meet up at Oak Mountain, which is literally right by the office. I'll drive people back to a certain it's called Bows Barrel. It's an old whiskey still barrel. Hike up to King's Chair, which is like one of the best overlooks in all of Birmingham. And then we'll do lunch, we'll do dinner later that day, but we'll be yeah, talking about all sorts of stuff, business and

Clinic and probably I don't know, who knows if Kyle's gonna be here. he said he was gonna be here. Yeah, he is. I told him about my barrel H moonshine. He's we're doing that. Plenty of Kleenex. then we have the course for the rest of the weekend, which is you know what we're actually coming for. So back to Josh Kerr is our jump off point. So if anybody has been following Josh Kerr, Great Britain, technically Scottish, but United Kingdom, he

Taylor Lawrence (04:08.654)

you

Beau Beard (04:23.15)

Few months ago set out, established the project 222. So 222 seconds, three minutes 42 seconds to attempt to break the world record in the mile. last Saturday, he did just that. And leading up to it, he ran a couple workouts that that made I mean looking at those workouts, I was like, he has a real shot at doing this. the world record was 27 years old, set by Hickamelgarouge in ninety nine from Morocco. The last time that a British

Guy has owned the world record with Sebastian Co. So 1993. and before him, I think it was Roger Manister. So first under yeah. And maybe I'm missing somebody in there, but notably there have not been a lot of British guys owning the world record of the mile. and so he ran, I mean, he perfectly executed this race. They broke down his 200 meter splits. It was twenty-two all between twenty-seven point four and twenty-seven point nine.

I mean eight two hundred meter splits within half a second difference. And ran, I don't know, three twenty-seven through fifteen hundred, which is PR for him, but he ran, I mean, the field was quick. What's crazy is we were talking about it. You watch going in the last lap, they through twelve hundred and two forty six. Two guys are hanging with him. He put four seconds. He put three seconds on second place, who is the American record holder, third fastest miler in history. And then fourth guy broke the

Or the sec the third guy broke the German national record. So running three forty five and three forty six and getting your doors blown off in the last lap is pretty insane. So he was you could tell, like we were talking, he's a pretty stoic guy, but he like finishing that race, he was super excited. and in the interview was pretty emotional afterwards. I just question his fashion choices. He he definitely is it a suit that he wears? Yeah, it's pretty a jacket. It's a jacket pant combo, but is that called a suit?

Taylor Lawrence (05:57.773)

you

Beau Beard (06:20.548)

wait, you're talking about in the race? No, just the things he wears around. Yeah, yeah. He looks like a luchadore. Like he's definitely should be a one of the three amigos for high fashion. I feel like I don't know what that is. Maybe it's middle distance running. It hasn't quite made its way into distance running because you don't see you don't see a lot of long distance runners with a lot of high fashion sense, but they don't have fashion sense. Yeah, the sprinters are where it's at. Sprinters okay. Maybe it's maybe it's because the low the shorter you race, the higher the ego goes. whoa, whoa. There's a match there.

But also the fashion the fashion gets a bit WWE in this the sprinter world. Yeah. I mean between the nails. Yeah. If we look at the women's side, which what do we think is gonna happen with the whole change in the uniforms, camera angles, which is kind of an interesting I haven't heard that. you haven't seen that? No, what's what's that? They have to change the they can't have any cameras in the hole, so they have to take all the block cameras and switch them for females because they thought they were getting too many basically booty shots. They're gonna change the angles that are allowable for bottoms.

And I mean a bunch of women are already like, we wear these things because we want it the lightest kit possible. It's fast. And a couple of them said if we're being honest, like we're in the day of Instagram, like we're not trying to be sexual, but we're also trying to look good. So that's what they think looks good. So like why do you have to tell us what I don't know. I can see it both ways, 'cause you watch it and sometimes like Jesus. Like you can see a lot and you're like, it's an athletic event. And I'm like, I'm a guy, I wouldn't wear that and want my, you know, hot dog flying all over the place. But

If I want to wear the least amount of stuff, I don't know. But then the flip side is what? Wear the least amount of stuff and then wear nails and locks and chains that I'm like, What the hell? Yeah. Like who was the runner the other day? They What do you do with your wedding ring? 'Cause he's like, I take that thing off. That was Mondo. Yeah. And he was like, you know, he had it in his shoelacela. But he put it on his shoelace. Yeah, he ties it into his shoe. But he wants to steal vault with it. Yeah, I mean if you tie it in, it's not gonna go in. I don't know. So there's all that. It's just an interesting Yeah, I don't know.

Taylor Lawrence (08:00.015)

Yes.

Beau Beard (08:18.66)

There's a lot to it. But whatever. On the flip side of that, I just commented on this last night because I was thinking about Kerr in his form and how easy he said he eased off in that last like 400 and like had great form and you know gapped the field. And then I saw Truett Haynes out there on the track. That dude looks like he has put in max effort. He literally has a crease at his lumbar spine. And if you look at the picture which I'm gonna do a post on this, he has zero hip extension.

So if you look at his pelvis versus his actual femur, it is neutral and it's all lumbar extension. And I'm not saying like he's gonna drop five minutes if you fix that, but I can guarantee you look at any middle distance or distance runner, you're that's elite and you're not gonna see that happen. Yeah. You watch and he kinda like drives force through his like core and you're like, that's not gonna last very long. But he also made his lats basically big enough that he could fly on him there for a while. So Yeah, his background is certainly different then.

Yeah, and you look at the crease in his back, that's where Seracolombar fascia is like, mm, that's probably built, right? But you gotta undo those things, I think, a little bit. That's why I just said like he needs Chubbs Peterson off of Happy Gilmore to get in and it's all on the hips and get those things moving. okay. Anything else in track and feel is just random as shit. They did just approve of they're getting rid of all conversions. So I saw that distance altitude and altitude as being no longer. So I'm curious to see like what they're gonna put for like standards then at like the division one level.

Taylor Lawrence (09:32.334)

Thank

Beau Beard (09:47.119)

Well yeah, 'cause like if you qualify for think about like the conferences that are in the mid or the western, like in the Rockies and all that area, they're gonna be I mean, I guess they'd have to go either be good enough to qualify where they're running or go somewhere below sea level or you know, lower than six thousand feet to get a qualifying time. And it's really only gonna affect hurts the distance kids. It helps the spreaders. it it definitely does. Yeah. Yeah, I don't know. I can see both ways, to be honest with you. Yeah.

I don't know, it's yeah. I don't know what's more important, getting rid of booty shorts or yeah, no conversion. It's a minimal it's a minimal difference until you start getting up to three K, five K, ten K. Like those those you're gonna see seconds different. Mm-hmm. and D med distance medley. Yeah. I just know like with my school when I was in track, we made it to nationals two years in a row because we went and raced at altitude. The four hundred is the only way we made it. We went to altitude.

Taylor Lawrence (10:22.421)

Beau Beard (10:47.5)

Right. So it used it to your advantage. Yeah, right. The four hundred leg the four hundred leg wouldn't be affected. No, but it was eighteen, sixteen, yeah, yeah, twelve. All right. Anything else in track and field? USAs are this weekend and work. Yeah, we're talking there probably would be soon. It's I was talking to one of my patients 'cause you have USAs and Diamond Leagues. This is the one of the year we don't have world championships, so it'd be you're either gonna choose to run Diamond League championships or choose to run USAs. And they're making the new Ulti World Championship Ultimate.

Like no Lyles is doing that. It's like a have you heard of that? No. It's like an all it's like a basically if you are a Diamond League champion, a world athletics champion, or a like an Olympic medalist, you get invited to this special meet where they're only doing twenty seven events and it's across three days and it's like after the season. Yeah. This is like in like August, September. Yeah. And it's basically like you win your event, you get 150K.

It could I mean it certainly could be good for the money draw. I don't think you're gonna see great performances because it's already a stretch. And it's kinda I mean, maybe it gets built into it, but anything new like that, people are gonna backshelf it of like it's like a Pro Bowl game. Well what was the other end slam? Yeah, Grand Slam. They they went into lawsuits galore. Last thing on this, and then we'll get into the case that Taylor's helping us out with today, is we talked about this a little bit, the Sage Canada debate with like Cam Haynes and the clean sport thing, and now it's kinda blown up because

If again, this comes from the ultra world, but what is it, Mike McKnight? they call him the dark McKnight. He's won a bunch of two hundred mile races and stuff, and he came out that he took peptides because he showed his MRI with this giant disc bulge and he wanted to forego surgery, so took peptides. Now, Sage Candidate is a fucking nerd. Like, I just can't stand the guy to save my life. Do I think people should take drugs and be able to do sports? No. Do I think peptide is a performance sensing drug? No, I do not. Because if people can take prolo and

I mean you can take all that stuff and still not A, it it is allowed. You wouldn't be able to how could you test for stem cells? One of the maybe most potent healing things is gonna beat the pants off any peptide and we'd be like, that's totally fine. And those are maybe not might not be yours. So but Sage Candidates on this like crusade now of like clean sport, but then I saw Zach Miller, who's another ultrasound, say kind of agree that well, maybe they make a whole new sect, like a play off the enhanced games.

Beau Beard (13:15.428)

I was like, what what are we doing, dude? Just get a list of things. Like Camp Haynes is one thing was hey, if I'm not competing for the Olympics and I'm sixty, you can do medical waivers or medical necessity waivers for testosterone or something. Why wouldn't that be the case for injuries worth certain with certain things? Peptides, stem cells. You start playing around too much and be Yeah, you're you're over the edge. Like you're out or you have a washout period. You want to treat an injury with that thing? You have two, I don't know, two years or something. I don't know.

But it's all stupid and just Sage Canada is a nerd, so just want say that. yeah, let's get on with it. So do you want me to go through her checklist or do you want her to go through the checklist? Do you have your do you have it in front of you, Taylor? Let's let's so what we usually do with these just because we kind of we've thrown this together a little fast. Taylor's trying to get the link like ten minutes before we got her here. we have you just kind of give us I mean a very, very brief like complaint.

Taylor Lawrence (13:56.097)

I do, yeah.

Beau Beard (14:12.728)

Like, hey, this patient came in with this, because we don't want too much. We're trying to put a puzzle together for people. Then you just start walking us through the checklist. And then if there's anything that we feel like needs clarity, we'll ask you. And you know, Ethan will help out on kind of guiding people a little bit. But what we're trying to do is we want to play the game of we should fully, hopefully, understand why you are doing what you're doing just by using these simple checklists. Cause we're trying to iterate to people, just like the course that Ethan and I are about ready to leave for tomorrow in St. Louis. Whoa, whoa. If we

Use a system, which you would think we're taught. And maybe we'll talk, let's talk about this after. So put a bookmark in. Let's talk about, you know, Taylor being how many weeks in the clinic you said? 12-ish. Let's talk about what you feel like not to dog Parker, it's all schools. You've obviously been taught all the basic sciences, the clinical stuff, but what's lacking in terms of like a systems approach, right? Outside of like regional and global exams and you know, review of systems and vitals.

Taylor Lawrence (14:54.251)

issue.

Beau Beard (15:12.398)

Let's wrap it up with that because that's why we do this class is because we feel like more people need this, not just students, not just new dogs, just everybody kind of lacks that system. So if we want to jump into it, give us a brief, you know, what who the patient was and what they come in for.

Taylor Lawrence (15:27.822)

So she's a student so obviously she has a lot of sit time

She was passed down to me in the clinic. So obviously that has its own struggles of kind of jumping into a case mid case but Struggles kind of came in came on in April low back pain no specific mo I anything that really provoked it I guess but got to the point where she did have numbness tingling into her her glute like SI stuff starting from

Beau Beard (15:58.181)

So let's leave it so let's leave it there. So that's all we want to know now. Cause now we know kind of approximate age, what she does most of her day, and what her chief complaints are. So from there, that would be even if hopefully the worst clinician in the world, they're probably gonna get that. We agree. Like somebody's gonna come in and they can see their sex, their age, you know, even if it's on the paperwork and they'll tell them what's wrong with them. So we we are all gonna get that info.

Taylor Lawrence (16:01.966)

Perfect.

Beau Beard (16:23.844)

So now we kinda go to the first question. So let's have you ask a question, Taylor answer just like it's in a little interview. Yeah. Is it an injury or no?

Taylor Lawrence (16:29.55)

It was no specific injury, no.

Beau Beard (16:33.304)

Okay. Does the area of complaint move?

Taylor Lawrence (16:37.024)

It did with pain. And that's, will kind of add, it has changed over the last four months. So when I got her, she's a little bit different of when she was super acute. So I kind of filled this out based on when I got her case.

Beau Beard (16:40.857)

Mm-hmm.

Beau Beard (16:49.496)

Yeah. Yeah. Okay. Does it move above and below the area of complaint?

Taylor Lawrence (16:55.916)

Yes, and fairly well, actually.

Beau Beard (16:57.838)

So we're again just to reiterate, we're saying low back is the area that moves with pain, but then we're saying she's mobile enough. Are we saying thoracic spine and hips? Is that yeah, cool. And then can she move her lumbar spine? So she has adequate motor control, which we would say is a a pseudo proxy for stability. It does not mean we're not talking strength. I think again, when you define things, it helps. I really like when Gray Cook says, you know, stability is synonymous with motor control.

Taylor Lawrence (17:11.768)

Chicken, yes.

Beau Beard (17:26.456)

That's what we're saying is if I put you through tests, I don't whatever you want to call it, cat, cow, pelvic motor control. Well, that's a a low grade test. Well, then it would also be for us like I put somebody that's a runner into modified Milgrams, right? Can you hold a position or get into it? Then can you hold it? Then can you maintain it while you breathe? That's still motor control or coordination. Then you get up to God, I'm blanking on what the test when we're testing extension.

Like I'm sitting on their legs and they could have their upper body off the end of the table. the preference, yeah. Yeah. Like that's more of an endurance test. Like there's coordination that has take place but over time. So that's our first step in the capacity function. You with me? So just we'd say she has some semblance of motor control or stability. We don't know how high level high level that is. Yeah. Now, can sh she apply said movement to specific skills with her low back?

Taylor Lawrence (18:04.856)

Yes.

Taylor Lawrence (18:18.476)

And that's kind of where the previous question is a yes, but it's does it do it well? She does movement well on the table. And then the minute it kind of goes to either floor or standing, that's when the motor control aspect comes in. Maybe a lack of an engine, quote unquote, if you want to use that. She can move it really well, but it takes her body a little bit to adapt into it and like control it well.

Beau Beard (18:44.228)

Cool. Is there any just anything specific that you tested or that she needs to be able to do based on like exercises, sports, activities she's involved in that you're kind of leaning into on that?

Taylor Lawrence (18:57.484)

Yeah, a big one that she told me was her golf swing. So Ethan and were kind of talking a little bit. That was more of her end goal. She golfed often and she was like...

It hurts often. She wanted to do it well and she's like, kind of just forced through it. So that was our main end goal that we test every time, but kind of doing smaller things in between. we'll do multi-segmental rotation and extension kind of on a patient or a visit to visit just to revisit that every time. So those are the main things that we look at at each visit being the golf swing and then rotation a lot of the time. Yeah.

Beau Beard (19:35.492)

Perfect. So moving on to the needs based assessment, just give us your pain audits that you have for your patient and your functional audits.

Taylor Lawrence (19:43.415)

Yeah, so again the big things were the multi-segmental rotation and extension. Extension is the big one. Rotation kind of differs from side to side which is also why it makes me think a little bit of a control.

Aspect of it just because it changes and her right is decreased to her left and her right is often the painful rotation side She is a righty golfer. And so that kind of made sense in my brain And then her squat her squat is painful at the end of it. So she comes up and kind of sits into like a Relaxed. Okay, I'm done. And then that's when her back pain comes on

Beau Beard (20:22.148)

So it just cause we can kind of like get behind the scenes on these questions too. So when so give us more of the details. So again, like multisegmental extension rotation hurts, we're kind of almost playing around in like, you know, a dorsopathy, something post so it was like a stork test positive. Did you ever think like, it's some sort of parse injury, or do you think it's hey, it's more soft tissue because of that relaxation to the end of the squat? Like, what are your ideas around that?

you know, a top tier movement and what was the specifics of like, hey, this gets into the diagnosis, which we'll get to, but what are you thinking as a clinician then?

Taylor Lawrence (20:56.076)

Yeah. My thought is, so I never did a stork or any of that side of ortho, only because prior to everything, they kind of ruled all that out immediately in the acute side of stuff with no specific MLI or anything of that nature, they ruled out like a pars or anything of like a stress fracture type.

Beau Beard (21:09.955)

Mm-hmm.

Taylor Lawrence (21:23.15)

But then my thought is more of a, I think she gets over adjusted often just because of being a student. And so I am almost wondering, is it moving too much? It's kind of where my brain is at. And do we need to anchor it down a little bit more, give her a little bit more of the control and the stability side of stuff. So.

Beau Beard (21:34.264)

Yeah.

Beau Beard (21:44.343)

Mm-hmm. Okay. Yeah. So then with that, we kind of talked about your pain audits being multi-segmental extension, rotation, and the squat. From here, what are functional audits that you are looking at from visit to visit?

Taylor Lawrence (22:00.338)

So again, I know Ethan and I talked about this a little bit being one of the big functional ones to me the golf swing stood out from The day one from when I got her but kind of breaking that down into smaller things Breathing an IAP was huge for me. She can do it well on the table. She knew it really well supine But doesn't get 360 so she knows how to breathe low but not all around So I was a big one and then trigger points and QLs and glute med

Beau Beard (22:29.973)

On that right side or bilateral?

Taylor Lawrence (22:32.242)

mostly on the right, occasionally the pop-up on the left, but mainly on right.

Beau Beard (22:38.338)

Okay. And then based off of what you have from your exam, your pain audits, your functional audits, what is your differential diagnosis list look like right now for your patient?

Taylor Lawrence (22:50.83)

So that's kind where I struggle a little bit just because it's almost like I could throw a bunch of things in that diff dialist.

but they said discogenic in nature right away, just because flexion, extension, and rotation were all provocative at beginning. And so they didn't know, maybe just with the pissed off disc, is everything angry. And so now moving into, what are we, three months, four months-ish, like post-acute, that's kind of where I've moved into like a quote unquote load capacity issue.

So know that's not like super specific and probably doesn't answer much, but that's kind of where.

Beau Beard (23:28.92)

No, I mean, well, first of all, you're a student coming on here, so we applaud you for that, right? Like we don't expect everything to be perfect, but you are also allowing other people to learn by, you know, you being brave enough to come on here and say this stuff. But you're also highlighting again reasons we do this class exist beyond like me wanting to just go travel to St. Louis and be away from my family. One of those would be you're like, Well, hey, you know, we even heard they

Taylor Lawrence (23:48.494)

Thank

Beau Beard (23:54.949)

Which I'm assuming like previous clinicians, you're over seeing clinicians like discogenic, and you're like you're like, okay, yeah. I could even tell you like, Yeah, sure.

Taylor Lawrence (24:02.456)

Maybe. Yeah.

Beau Beard (24:05.378)

You know, I just saw a post and again, I'm I mean, I love everybody in our field, but like I saw a post that Craig Levinson put up of Kat Dobrowski and they were talking about, hey, let's put people in categories. I can't remember what the second category was. I was trying to remember underdoers or overdoers. And then it might have been like respond or not. And I'm like, Okay, whoa, whoa, whoa, whoa. My shoulder is hurt for two months. So you're gonna tell me I'm either overdoing or underdoing something, but yeah, you lack capacity in this thing. I'm like, Okay, well, what about Josh Kerr?

Taylor Lawrence (24:23.277)

Yeah.

Beau Beard (24:32.568)

So if we said, hey, here's somebody that's being trained at an elite level, he shows up and he's dude, my right foot kind of hurts. And you're like, you're overdoing it a little bit, but you're underdoing this a little bit. And then I don't think you're responding over here. He's gonna go, hey, I'm going to fire you and find somebody else. Why I bring that up is they were saying you need to get away from a specific diagnosis. I think that is the worst thing we could do for our profession. Because what you're saying is, is you're like, I think it might be your disc. And

I would assume, I'm not gonna put words in your mouth or anybody's mouth, that camp would say, just yeah, great approach. Let's be very general. It's a low capacity thing. What matters there? If you don't define what the pain generator is, pain alters movement. If pain keeps altering movement and we think she has a slight motor control issue, right, in the skill progression, your brain will keep altering movement. And I just think it's we as clinicians need to be, I think, smarter instead of saying,

General, general, general, because we even say, you know, training or rehab is training in the face of pain or, you know, with pain existent. I'm like, with altered movement, compensation taking place all the time. I mean, that's what Nikki Kirk and I talked about. Like, so we pump the brakes and we say, maybe it is a disc, but then you're like, hey, she has transient pain that'll jump around, right? On test, left, right. I'm like, that sounds extremely like cutaneous, nerve driven, right? Like superficial nerve. And then you're like, how can I figure that out? Slap a cup on her back with the same movements. Does it get better or worse?

If it goes away, you're like, I doubt that's a disc. I can't suction cup a disc. now what's that? What's that do? For me, it doesn't mean that I now chain myself to this idea that she has cutaneous nerve irritation. I have to yap that away. I have to, I have to do all this. I'm just like, I bet I can change that person's pain really fast, which tells them something positive. Right? Let's say it doesn't. That might not be awesome. You might dig your own grave sometimes. You're like, ooh, it is a disc thing. And is that bad? Maybe not.

But if you can change somebody's pain, you start to create a narrative where it's like, you're not broke, right? You just keep bugging something. Are you bugging something because of motor control thing? Sure. But again, we're not dog and tailor here at all. But is the lack of motor control thing a diagnosis? No, it's the it's literally what we're working on, the treatment focus. So if we name the thing we're working on based on the functional capacity of it, we're back in the movement positivity land. I have no problem with that. We're a clinician.

Beau Beard (26:58.35)

So if I can change somebody's pain, I give them the tools that change their pain, what do we actually see? Probably faster progress. Because I can train without pain, right? Or the expectation of pain or swing my club without the expectation of pain. Or if I do, I have something to change it. Again, do I know it's cutaneous nerve? I have no clue. No clue, right? Could it be those trigger points? Sure. For for sure. Then we're like, why are those there? Maybe it's stability, but then you use the trigger point, all that stuff, you know all this.

But I think the biggest disservice we do is say, let's be more general instead of less specific. Because I think people thought forever that being more specific chained us to, okay, here's this protocol for this specific diagnosis. It's only because we're supposed to understand things like what drives pain, what's the pain response, what's the expected outcomes of pain at play? We do it we talk about it, right? We say, we love Annie O'Connor and she's like, Did you classify their pain? And you're like, Yeah, I don't know.

Taylor Lawrence (27:51.278)

you

Beau Beard (27:52.793)

Right. That's what she tells you to do that first. Then she's like, then do the general stuff when you know you're not going to he she said on our podcast, what do we do? Red flags. Every visitor, red flag rule out. Yeah, you know there's no red flags, right? Because of previous clinicians, you've done your work up. There may not be any red flags, but dear God, you don't have to focus on pain. But if you can change it real easy, why the hell wouldn't you? I I just don't. And if I know, I mean, we had somebody the other day, his elbow pain had been around for three months. I hate elbows.

I dri I pushed on a trigger point and he's I feel it on my elbow. I dry needle it. He kept sitting there, pushing. He's like, I cannot believe this is gone. What did I do on the back end of that? Nothing. Because his primary complaint was his left shoulder, his right elbow, and you're like, Well, that's kind of lazy. Is it? Pain alters movement. If I can abolish his pain and he's working on his primary complaint, his left shoulder stuff, he goes back to his normal everyday activities and he doesn't have a big compensation to play. How would I know that? It doesn't come back.

I think I'm actually doing the more human-oriented work because why? I'm not saying I need to go do forearm curls and reverse some goofy exercise because you're underdoing or overdoing. We don't even know why that trigger point existed. Until somebody can tell me that on equivocal, I'm like, why I don't know if you can underdo it or overdo it. Because I don't know what happened in the first place. So again, I know that's a bit of a diatribe, but you highlighted beautifully because you're like, yeah, I d yeah, I'm kind of gonna I'm I'm gonna take that.

Will you still have success? Probably. But what are you not going to get out of it? A big pattern for next time. You're going to be like, I'm going to go into the next one and still have the same questions. And you're always trying to answer a question for yourself, right? Yeah, you want to get them better, but you're like, what did I learn out of this? You're not going to learn necessarily how to stabilize a lumbar spine better. You're going to be like, hey, I'm going to recognize when somebody has this transient pain that moves around, it could be X, Y, Z. I can use these tools to offload these muscles, but I can also use this as the pain thing.

it can work or not work. And then that's a much not better pattern, just a bigger pattern to like kind of see down the pipeline. So yeah. So last part of your needs based assessment, I mean kind of preluded to this just from Bo talking. What are you what is your treatment focus for your patient's low back?

Taylor Lawrence (30:09.42)

The big one is the motor control in the core. So kind of just figuring out how to move well without pain going into the future.

I do kind of think she has it in her. She has the capacity to do it. It just is showing her that she can do it in clinic. And that's kind of where I've seen success with her is we do stuff in a visit. We move the needle in the visit. And then I'm hoping that plays into outside stuff as well. But she almost comes back next visit and is almost back where we started the previous visit. I think

Beau Beard (30:43.842)

What do you think's driving that, Taylor?

Taylor Lawrence (30:48.768)

A lot of it is BPS stuff. So just, I want to be able to show her and her to show herself that she can move without pain and have it be okay that that pain is not going to be, doesn't have to be there all the time. So I don't like to say that pain is in people's head, but I think some of it is.

contributing to maybe why she's staying in this land. Only because I see good progress in the actual visit itself. So I know it's there and I know she can do it really well with me. I just want her to be able to do it on her own too.

Beau Beard (31:28.206)

When again, if we looked at let's say there, let's say we could unequivocally, because I think there's a little stuff, you know, there's stuff we could play with in this case to see, okay, are there actual physiologic pain drivers? But then when we say, you know, we say, there's a little BPS. I always like to clarify, like it's always BPS because there's an an immediate emotional, right? And then an immediate psychologic response to any pain. Like my daughter rolled her ankle for the first time ever, which I was dear God, she's not gonna be the stud athlete I thought she was. She stepped on a soccer ball, right?

Taylor Lawrence (31:57.038)

Shoot.

Beau Beard (31:58.071)

Right. So it happens, but her response was what? Cried a lot. And then I said, Hey, I see this all the time. You got to get up and walk around. Right. You got to move around on it. And then she said, Yeah, if I start running, it hurts every 30 sub. I go, okay, let's see if we can run five. And then she could, and then she stopped talking about it. There is a response. Next time she does that, she's in her subconscious, she'll make the subconscious choice. How bad is it gonna be? That's what we're also doing as clinicians. So if I agree, you're like, I think it's kind of an expected response of her like, I think it's gonna hurt.

Taylor Lawrence (32:10.05)

Yeah. Yeah.

Beau Beard (32:27.128)

We just said that with if you can change somebody's pain, that doesn't mean that you tie them to it. You educate them appropriately of this isn't damage. This is like irritation. This is sensitization. But if we really use our science brain, we also say the longer pain goes on, yeah, there is more chronic nature because why? You actually make physiologic changes at the spinal cord in the area of pain, right? More angiogenic changes, more neurogenic changes, more.

Cortical representation of that area. And some people say, well, less. No, it's just different, right? That smudging doesn't mean, it's gone. You have a different representation, which is sometimes larger. It's just less defined. So we say all this and we're like, that is all real. So when we, when again, patients will say, it's in my head, it's like, yeah, it is. Your head is also telling the rest of your body what to do all the time. And that can have downstream true true blue physiologic changes all the way to things like neurogenic inflammation that look like an injury, right?

So when we know that, then we can start saying what? Okay, if it's a movement positivity thing, cool. What you better be world class at realizing why they're expecting pain then. That's where it can get tough, right? Is it just what I've been told in the past? I don't I do have pain every time. And then you're like, is it how they're swinging the club? That gets or you're like, that's why we want to do what? Thoroughly rule out that nothing else is causing their pain because you will start telling somebody.

Hey, I think it's how we're swinging the golf club. Then they go to the next clinician, they slap a cup on their back. They're like, dude, my back pain goes away when I got this cup on there. Why is that happening? And you're like, I thought it was how you swing the golf club. And you're like, well, it is, but we can calm it down. And they're like, we'll use both. And I I just think we throw things out all the time. We shouldn't do that. We should use all tools and not trap people into a narrative. We should open up the narrative.

Taylor Lawrence (34:03.534)

Yeah.

Taylor Lawrence (34:15.203)

Yeah.

And that's the other thing too, is one thing about her, she's awesome. And she's like your ideal patient and she goes home and does everything at home. And she was like, I want to be good at this and I want it to be without pain. So she does go home and do like the way to dead bugs and the wall bugs and the stuff that we do in clinic, which is awesome because then she comes back and almost reports like I had this without pain, which I feel like is exactly what I want her to be. So she is really good that way too.

Beau Beard (34:45.89)

Mm-hmm. So it sounds like she's a responder. So we can also categorize, she responds. Seems like maybe I don't know what the coping responsibility is of, you know, her subconscious. It seems maybe that's not so great. I don't know. but then yeah, at the end of the day, and we talk about this all the time of like, how do you determine if somebody's actual mechanics, whether it's squatting, running, golfing, or driving it, you work your way up to that. You we never start there, right? You're like,

Taylor Lawrence (34:46.586)

Yeah.

Beau Beard (35:11.426)

God, the way you you know, the crunch factor you create on your right side when you swing at a golf club is going to keep you in pain. Like I could be the best in the world, educate you the best. And you're like, if you keep doing that, I bet your back's gonna hurt. The only way you can get there is to like exclusion, exclusion, exclusion, exclusion, not by, hey, let me see your golf swing. that's terrible. Because then we can go look at fifteen other people swing the golf club like and they're pain free and you're like, boy, I'm in trouble.

Taylor Lawrence (35:22.722)

the Empania.

Taylor Lawrence (35:30.51)

Mm.

Taylor Lawrence (35:36.355)

Yeah.

Beau Beard (35:37.71)

So then moving on to the systems matrix of our triage checklist, is your patient healthy or unhealthy?

Taylor Lawrence (35:46.159)

I would say definitely healthy. On the term of working out, she swims and runs every other day. Her runs vary from long runs to sprints. So one day she'll do like a six mile run and then the next day she'll do a three mile with sprints. And then her Friday is kind of her easier-ish run. And then so she'll swim every other and then also plays pickleball about two times a week. So.

Beau Beard (36:09.326)

Does she have pain with any of that stuff?

Taylor Lawrence (36:11.59)

no, shockingly, running, she runs pain free, swimming. She'll feel occasionally, but she feels good because she's in full. pickleball is where she'll feel it the most is kind of what she's told me just because pickleball is new or in her routine. and so that's kind of, we have a Cairo Olympics that she's training for, so she's, it's kind of in a spike. Yes. Yep.

Beau Beard (36:35.524)

Yeah. Okay. Heck yeah. does she lift weights at all?

Taylor Lawrence (36:42.924)

She, so she resistance trains, she said about three times a week on average. It's nothing ever really set with a plan. She kind of goes in with a sense of what she feels like she wants to do that day. So it's kind of also an entrance that I've wanted to take as well.

Beau Beard (37:01.404)

Mm-hmm. Then pain or no pain. Obviously, our patient's still in pain here. and then when it comes to the breakdown of your matrix of MSK, PNS, CNS, FunkMed, what would you put percentages at for each of those categories?

Taylor Lawrence (37:07.842)

Yes, yes.

Taylor Lawrence (37:19.436)

So again, Ethan, know we talked about it and I agreed a lot with, I think she's about 85 MSK, 10 CNS just to the attributing to biopsychosocial factors and then funk med about five.

So relating diet, water wise, think she does really well. think maybe in the recovery aspect, I do think she's very, there was one point where she was doing two a days. So between the swimming and the running, not that I think that's a bad thing, but I think we were running on something that maybe was not suited for it in her pretty acute stage. And so that's also something we started implementing was just talking about more recovery, probably upping her water intake just a little bit and then maybe resting here and there.

want to take her out of activity as well.

Beau Beard (38:08.076)

Okay. Now where in this case, so we've kind of went from top to bottom of our checklist, where in this case are you still having issues with, or are there certain questions that you have for us that we can potentially help guide you towards treatment when you see this patient next?

Taylor Lawrence (38:26.188)

Yeah, I think a big one that I touched on a little bit was how, like what to do next in the sense of making progress in an appointment, but then feeling like they come back right back where they were.

when they started. Like I feel like she sits down and it's the same conversation in the first 10 minutes, which is awesome because it's, know kind of where to go in that appointment, but I want to start making improvements. and I feel like we have started to make improvements cause we are doing a lot of base stuff, which is really good. but yeah, I guess I think that's my main, my main thing right now.

Beau Beard (39:02.712)

And then in the four months that you've seen this patient, how many visits has that been?

Taylor Lawrence (39:08.11)

She consistently comes two times a week. There's been a couple weeks where it's been either one or we've had to take a week off, but she's very consistent that way, whatever that math is. Like 30-ish. Is that that math? Four times four is 16. Yeah. Yeah.

Beau Beard (39:19.041)

Roughly

Beau Beard (39:23.286)

Eight times thirty two ish. Thirty two visits in four months. And what's her pain done in that time? Like is it kind of just been up and down? Like she'll come in with pain sometimes, sometimes good.

Taylor Lawrence (39:35.24)

it's definitely, when I've seen her, it's been the same when I shadowed her because I shadowed her previous intern.

And she was definitely in more pain at that point. I also see her like a Monday, Wednesday, occasionally like a Tuesday, Friday. And so the really interesting thing is she comes off the weekend and is in significantly less pain than she is later in the week. That's kind of where my brain went into the, think you're getting adjusted too much because she also comes to MPI and then goes to our adjusting stuff that they have to do later. And then I would also sit there and adjust her as well. And I'm like, I just don't think.

That's what we should be doing.

Beau Beard (40:16.546)

Yeah, and so again, for you know, doing this, hopefully we can also help with the case. If that's, you know, I mean, I know that wasn't the end goal is just kind of present so everybody could learn. But I think even, you know, the nuance of if you're trying to be a really good clinician, it's the things that you see, but then what are you getting out of the information? So, like we said, the transient pain we already talked about, the bottom of the squat for me, when you see somebody let off, right? They they're going to this passive, you know, whatever it is.

And you're like, there's pain, you know, you can use that type of information. We talk about rebound pain. Like if you resistance test and they have pain after you let go, somebody gets a bomb position. We're always thinking like passive tissue. You're like, ooh, that would kind of play into the you're getting your lumbar spine blown to pieces all the time. yeah, that plays into that. Then how do you play around with that? I mean, that to me, let's you know, can you test a single tiny little ligament in your lumbar spine and that's a pain generator? Probably not. You're probably seeing local irritation.

I would go back to cutaneous nerve stuff because we also know that like dorsal root, you know, is gonna have its own cutaneous nerve your innervation. You're like, I'd play background with that a ton to see can I manipulate pain. But you just picked out three kind of big patterns, or what I heard. She does a bunch of other stuff without pain, running, swimming, right? Which are I would say heavily extension based for a lot of people, even though they might not should be. Rotary stuff gets her.

Right. And then it seems like school, whether that's sitting more, getting adjusted a lot, but goes through the weekend, and I'm sure she's still active because she just sounds like an active person, but she's always better. Those patterns are also showing us what? That's probably peripheral irritation that's just getting like lit up from XYZ. So I think the big play here is is honestly a pain alleviating thing, which a lot of people are like, my God, look listen, this guy is such an idiot. I thought his whole thing was function. It's like, yeah, the goal.

Taylor Lawrence (41:45.155)

Mm.

Beau Beard (42:14.242)

The whole reason we have jobs is not because somebody comes into us off the street and they're like, I heard you could help me with my valgus knee crash. They come in because they're like, My my knee hurts. And then we're like, I think this is happening, and we think this is why that is happening. And in these sports activities, that's going to show up like this usually. And then the other camp would be like, you're an idiot. You just need to generally train or like after we do that specific stuff. So I'd say look for a pain alleviating thing.

Whether that's, you know, some sort of superficial decompression technique. you know, when you okay, so let's say, and maybe this isn't the case. I don't know. Beginning of the visit, we do extension and rotation, she has pain. Let's say you do your typical stuff. Do you usually have zero pain by the end?

Taylor Lawrence (43:02.048)

Not zero pain. There's some days that are, yes, like she borders that, wow, that didn't hurt at all. And then there's some where it's, it's almost always less. Like that's a pretty consistent pattern. Yes, it can change, which is reassuring. I don't know if there's ever been a visit that she's left completely out of pain.

Beau Beard (43:13.582)

Mm. Can change it, yeah.

Beau Beard (43:24.419)

Mm-hmm.

Taylor Lawrence (43:25.55)

There has been a lot where she was like, no, I feel really good. And I kind of asked her to dive deeper into that. And she's like, I mean, it hurts a little bit still. Like I can still feel it, but it's never gone. The other thing I will say is I did try dermal tractioning just because I also had that thought a little bit of, it be cutaneous? And it didn't really seem to change a ton. I don't know if I did enough of it, I guess. But that was one thing.

Beau Beard (43:32.248)

Yeah.

Beau Beard (43:37.667)

Beau Beard (43:54.809)

And then I'm just again imagining in my head the scenario because I'm assuming your pain, you said it's more right sided, even though it jumps, right? I'm assuming it's pretty local, like or close to the spine, right? Like it's in the gutter. yeah, I'd just be jabbing a giant needle and like deep erectors. So like that's kind of the thing here. I know you're handcuffed. I don't you guys can't dry needle in clinic, right? Yeah.

Taylor Lawrence (44:11.51)

Me too.

Beau Beard (44:19.182)

Do you need to dry a needle? No, cause like DNS and stuff, we're still trying to turn off like deep erector groups through all that stuff. And maybe that's why some days it is better. But I mean, I always this kind of lives in my brain rent free of when Rich Holmes told us like he treated this. I can't think she was a weightlifter or something. Like recurrent lateral hip pain with slight radiation. He goes, Dude, I knew it was a trigger point. I could palpitate the trigger point. We could treat her, the trigger point would go away. She kept coming back. And it would just kind of be the same, right?

He goes, I he and you know, he has choice words. He goes, I treated this bitch eight ten times. You know, he's joking. and he goes, I saw her like eight to ten times, and every time it's the same. And then he goes, like that eleventh visit, she came in and she's like, you he's like, How you doing? She Do hips awesome? And he goes, great. She goes, I went and got a massage. And he goes, What do you mean? And she goes, Yeah, I got a massage, and like it's gone. And he goes, I wasn't doing any treatment on the trigger point. I was using movement and stability and all the stuff. And he goes, That's where I'd realized, like,

Taylor Lawrence (45:01.538)

Mm.

Beau Beard (45:15.4)

Yeah, the trigger point, whatever you want to call that, that phenomenon, yeah, is neurologic in nature, but still I always say it's like ringing a bell and the bell keeps ringing, right? Because it's pinging the WDR and the p posterior horn. You're like, why that thing doesn't have to go away? And maybe that's what we're doing is you have to blockate that. Then you work on the whole reason it came in the first place. And if you don't do both, you literally don't change it. And the other part of that story is I taught a whole course on that in Florida and I still remember presenting that to Greg Rose.

And he goes, so you're just treating the side of pain. I go, I get what you're saying, but I go, I think if you don't, you're gonna miss it. And then I worked up the same case that Gray did the next day and like destroyed the entire case of like using that methodology, kind of to toot my own horn, but to kind of say, like, literally we changed numerous things by treating the side of pain while doing the same stuff, right? Treating why we think it caused it. And I really think if you don't do both, you just leave people hanging, you prolong stuff, we move them into this

You know, general movement strategy stuff just way too soon. Maybe you get lucky and they stumble across it, or you're like, God, you know, for us, if we saw somebody that many visits, we'd be like, God, is something actually going on? Right. It may literally just be scenario. You're getting adjusted too much. You're just your back's getting pounded, and you're like, and you know, if it was our world, like, you got to stop doing that. You're like, maybe you can't. I don't know, right? Or you don't want to. so there are variables in there, but I think you're

Taylor Lawrence (46:37.378)

Yeah.

Beau Beard (46:42.958)

Paying attention to everything, you know, it's kind of toying around with it. I think the takeaways are we're always because we look at your system matrix like, you know, MSK, maybe, but then we have to, if we're gonna say something's 85% MSK, do we have to say? We know 100% what the pain generator is. Because we we're saying that something is musculoskeletally causing that, and you even kind of him hawk, like, I don't know if I buy the disc thing. So we're like, So then when we say BPS, what we're saying is.

Taylor Lawrence (47:07.266)

Yeah.

Beau Beard (47:11.032)

their response to pain has changed over time. Okay, it's maybe expected. Well if it's expected, how do we change that? You have to trick You have to do things that are the same movements and not get a pain response. That literally is what rehab is for the to me. Then you have to add capacity on it and then you have to obviously tackle the environmental variables, which you're already talking about, which is amazing. yeah, do you guys have any other input on that? When you tested DTM, did you was it

Taylor Lawrence (47:13.442)

Yeah, I agree.

Beau Beard (47:40.972)

You tested in those painful movements, the multisegmental rotation, the squat with it on.

Taylor Lawrence (47:46.825)

I so I did not do I only did it into extension So that was kind of where I was like, I don't know if I tested enough Just because I do know that there's obviously other motions that were provocative with it. So I didn't the other thing I don't I don't do a squat with her often because every time she does it she's out for like four hours after that So Yeah, so

Beau Beard (47:51.524)

Okay.

Beau Beard (48:10.473)

Like it hurts for four hours? Mm.

Beau Beard (48:17.09)

Yeah. And I know this is I know people who are listening to this like, you gotta talk about it. And I know it's probably been addressed. There and I know Rich Olm would kick me if I didn't say it. He's probably like, dude, it's derangement. And I know you're like, dude, there's no way because she's getting adjusted. She's probably been in range loaded to the end of time. That's what they would say. And my thing, again, nobody knows why derangement causes pain. So we're back to what the hell is the pain generator, right? The emotion joint or emotion segment that's not moving. You're like, it's moving too much.

Could could possibly be that yeah, that's a stability plan. It's like you have to stop the insole. If that's it, then I mean, God, we know the answer is just can you get her to do it? but I can hear people listening to this saying, I don't know. Especially with the squat thing that like she does a movement, because that sounds very McKinsey. Hey, if I do a squat, I'll have pain for four hours. How so? Cause they're gonna ask, Hey, what thing causes your pain? That would be their main audit. And then they're gonna be like, What can I do to reduce

Taylor Lawrence (48:57.036)

Yeah. Yeah. Yeah.

Beau Beard (49:13.88)

the amount of time that you have that pain via a repetitive in range motion or XYZ. I guess what tells you that it would be repetitively in range load that you're Don't know. Might be your hip too. Versus like

Maybe it is the same instrument. How she's doing the squat. Cause she's you're saying a deep like a tested S FMA squat, I'm assuming. Or yeah. Should she just do it? So again, we're not looking at form on that. That's why we put in that 'cause it's just kind of a test position. Could it be? Sure. But then I'd be like, You're pretty chained to do it a certain way there.

Taylor Lawrence (49:37.078)

Yeah, just like, keep your head just...

Taylor Lawrence (49:50.391)

Yeah, and other thing, her squat, and I know this is pretty subjective, but her squat looks good. Like she, it moves well, she does really well. It's always just at the end of the movement. Like she comes up from a set and is like, yeah, that hurts. And then seems to can't really move for a little bit after that. So, and Mackenzie was tested as well and it never really seemed to move the needle a ton either. So I don't know. Yep.

Beau Beard (50:01.667)

Mm-hmm.

Beau Beard (50:17.55)

Flexion and extension. And lateral, yeah. Yep. And again, those are all things in my one advice, piece of advice to everybody listening, and then to Taylor. And again, part of this is what you're not supposed to do in student clinic. No different than if even one of these guys saw somebody, and vice versa, from me to them. If I saw somebody for six months, I tell them the same thing. Don't, don't read what I put in there.

Do your own assessment. And if you come up with something wildly different, like tell me. But we would hope if we're decent, not that like I'm training them to think like me or if I like you're like, we should kind of come to the same conclusion, hopefully. Maybe it's nuanced a little bit like, hey, I worked on their ankle for their knee and I worked more on their hip, and but we knew both were involved. But like I would always do everything. Cause you're like, Well, yeah, they had this ruled out because you worked for performance, like, you just never know.

'Cause some people miss little details that matter. and again, I know you're kind of chaining student clinic to or you know, clinic of like what you're supposed to kind of where you're supposed to start. I get that. But again, if we're in a clinical practice, whether that's getting an outsider referral, an internal referral, somebody writes down what they thought and it's even somebody you respect, do your full exam. Do not start at the presumption of, okay, this is here.

because that is I mean, I put up the Richard Feynman quote today, the easiest person to fool is yourself. Like you will literally just start and be like, yeah, that's that's what it is. And you're like, Mm, I don't know. And then what? Eight visits in, you're like, I don't think they said at all. And then you get frustrated. So just always do it thoroughly, and then if you agree, cool. You didn't waste any time, you just realize like, hmm, I you know, if we do a thorough exam, we do come to the same conclusion. That's what you learn. Any other input or any other questions? Overall, any questions? I think you had

Taylor Lawrence (52:05.038)

you

Beau Beard (52:05.7)

question for her that you want to the end. Yeah. So you know, being in school still and being in clinic now, what I'm just curious because I honestly do not know. And this isn't trying to front load my course or anything. Like, what are you guys taught in terms of like clinical process? Not I guess your exam would be one, but then what are you taught in terms of like, hey, we're supposed to recheck. Is it just recheck orthos? Is it recheck pain? Like you get to obviously do some of your own stuff.

yeah, what are you guys given in school as a template?

Taylor Lawrence (52:38.606)

So what I think they do really well is bringing you through, like kind of like you said, is really not red flags. So I think that's the first thing to really look at first and I think that's really important. So I think school-wise they do a really good job of that and then giving you a good flow of like the vitals kind of going from least invasive to most invasive. So kind of that flow of vitals, neuro, range of motion, palpation, ortho.

So think that's really good. I think a blessing that we have is having Shemeck, obviously the DMAX, we do have that resource, which is phenomenal. So they are probably are in into like finding an audit.

and finding something to test functionally and then go from there. Outside of that, I think a lot of us get our knowledge from R2P and MPI. I don't know if they do the best about do something and then test or like retest unless you have professors that do that themselves. So I think in certain courses and certain professors, if you get the right professor, I guess, then that's where it's taught.

But I would say in tri-six when we have our PT2 and G max class, those are really where we hone in on it. But then it's almost like for a try, then it's lost. And a lot of people tend to either forget those things, don't remember how or why I'm doing that or when to do it. So I would say we Yeah.

Beau Beard (53:55.566)

Yeah.

Beau Beard (54:10.468)

Yeah, the why the why of what you're doing is what matters. The how it does in the beginning, because you have to have a process that you can repeat so you don't miss steps. I mean, that's that is a that'll be a big part of what we talk about, right? But the bigger part is okay, when I see somebody have repeatable pain at the bottom of a squat in a passive position and that pain persists for four hours, what does that mean? Right? Like it could mean a lot of different things, but you're trying to again, y there's never a hundred percent black and white answer with a human. Never.

Taylor Lawrence (54:14.508)

Good. Yeah.

Beau Beard (54:40.9)

But you can have a pretty good supposition and then you work off that just like a theory, right? But then we got to put time limits on those theories so we don't just run forever and no expected change because what? We have audits to determine better we're saying. But I think one of the things that we really need to highlight with all of this is again, because I think it can sound like we're saying you need to be like diagnostically accurate to get that pain generator, to treat that person with your hands on tools and do all this stuff to change how they move because they're moving dysfunctional.

Maybe, but if you look at our flow chart, the top of the flow chart looks like what? Health stuff, functional medicine, the gym, all because we're trying to do what? We would fast track somebody as fast as we could to that stuff if we can. We are not trying to keep them in rehab purgatory. We're trying to say, you probably have been in rehab purgatory because of too generalized of approach, putting a protocol on your pathology.

not realizing there's an underlying effective or emotional, you know, chronic pain sensitization thing going on. And you do a really good job of realizing who is in front of you, what they're dealing with, and how you can hopefully help them or not. And then using every tool you have, which is also including your root referral network, and then that's how you treat somebody. And versus we're not trying to be accurate to keep them in here treating, you know, okay, they have a

L405, right, posterior lateral disc herniation, and our protocol is three times a week for three weeks and then two times. No, that's not. That's the least, you know, or that is the farthest thing that we're trying to do. It's the exact opposite. So I think some people might misconstrue art of assessment specifics as like going that rehab route. Yeah, for the shortest time possible, because why? You are a clinical sniper, like Winchester would say, and a sniper is going to be far more effective and efficient than somebody that's just like.

Taylor Lawrence (56:17.475)

Mm-hmm.

Beau Beard (56:27.894)

Yeah, general movement strategy for four months. And I think your pain will get better because you're an underdoer. Sounds like I'm being very pessimistic about that. I'm not, but like we're also not just dealing with 70 or five year old women that come in that can't do a set to stand test. That's I get that. Okay, that person, cool. I had one the other day. She literally came in, her back keeps hurting. And I go, Can you get up off the bench with one leg or the plow boxes? She couldn't. We know where we're at. Let's get better at that.

Before we expect our back to feel better. That is one of those scenarios. That is not everybody. Yeah. If Alex comes in and his back hurts, and I'm have him say, or if I say, You're grossly underdoing your kickstand deadlifts, and I need to really load your right hip, I'm probably like, I d I don't know. This guy's been training for over a decade, his training age is high. Like, could he be overdoing it? Sure. Could he be doing some things too much? And then how he's doing it is affecting it, and then his emotional status affecting that, and then his diet and stress. Yep.

That's probably more likely all those things. Well, which one do you that's why we have a matrix? Which one do you pick? Probably the one that you categorize most, we would hope, right? well, Taylor, thank you so much for again coming on here and being willing to do this. I hope this is helping you have having this going through school and going through clinic. I'm excited to see, you know, what else you've kind of learned or implemented when we see in September, which is you know, about a month out. And then yeah, for anybody listening,

Taylor Lawrence (57:32.674)

Yeah.

Beau Beard (57:53.913)

You know, there is a course here in Birmingham that weekend in September. we do have a course tomorrow. I don't unless you're, you know, giddy up and sign up for that thing. but we'll be doing more of these. There's an online course, there's a free video out there that really explains the systems behind that. I will give you this checklist for free to use. Like I just think more people need this and we need a better platform to just operate around patients with instead of just exam, orthopedics, pathology or function. And then we just go off our, you know.

Varied paths.

Taylor Lawrence (58:25.292)

Yeah, I was gonna say it's definitely helped kind of organize. It's really easy, I think, to go, especially four months, and be like, man, there's been a lot that's happened in the last four months, and then to like sit down and put it on paper. You don't realize like how much or what is moving parts and what's improving and what's changing. So I definitely think it was beneficial.

Beau Beard (58:45.646)

And last thing before we jump off here, she Taylor's also highlighting like the last part of the art of assessment course is like a review system. Like if you don't have some way to sit down and review or have team meetings, that's what I mean, it's called the weekend review, right? Like we're supposed to be doing it, just started with doing cases. If you don't do that, you'll learn nothing. You could think you're learning and visit and maybe you are, but if you don't sit down and start kind of putting patterns to go, like, I didn't realize that, you know, her pain was showing up like this until you literally wrote it down.

Taylor Lawrence (59:04.13)

Thank

Beau Beard (59:15.298)

I think that's a huge thing because people are busy, they, you know, they're doing their notes, they got families, and it's like you gotta have some time to sit down and kind of look at your hard cases, look at your wins, look at what you're not doing well, talk to people about cases and then pretty soon you're like, hmm but that's why I'm such a huge fan, which is one literally we talk about specifically is writing stuff down that you're having a hard time with that you're winning with, or patterns that you're seeing emerging. if you're trying to, you know, be really good at your job, which I would hope we are if you're just trying to make a bunch of money and

see people like Cogs and Wheel, go for it. don't get this checklist. Don't come to my course. Don't do any of that. Do pass go. So all right. Thanks again, Taylor. We appreciate it. All right. Have a great day.

Taylor Lawrence (59:51.855)

Yes, thank you. You too.