Systematic Thinking for the Win: Week in Review 53

Most athletes and clinicians overlook the hidden systems behind injury and performance — until now. Discover how a structured, data-driven approach can transform your understanding of complex cases and unlock faster, more reliable results. In this episode, Beau Beard dives into the art and science of diagnostic reasoning using a clinical system that’s changing the game. From analyzing subtle movement restrictions to unraveling systemic influences like inflammation and nervous system sensitivity, Beau reveals how to go beyond surface pain and get to the root of dysfunction. This isn’t just theory — it’s a practical framework you can apply immediately, whether you’re working with high-level athletes or everyday clients.

Key Takeaways

• Systematic Approach: Using a structured assessment process helps uncover hidden dysfunctions and avoid missed diagnoses, enhancing diagnostic accuracy and practitioner confidence.

• Six Thinking Hats: Integrating tools like Edward de Bono's Six Thinking Hats balances intuitive, analytical, and creative thinking, leading to better decision-making and treatment plans.

• Local Tissue Behavior: Focusing on localized movement restrictions provides actionable insights, often revealing root causes masked by compensations elsewhere.

• Stability Over Range: Prioritizing stability and motor control through exercises yields better functional gains than solely increasing joint range, preventing injury recurrence.

• Adaptive Decision-Making: Managing ambiguities and pivot points consciously prevents premature conclusions, fostering nuanced and personalized care.

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Beau Beard (00:02.87)

We're back and we're back kind of with a special guest. were on an episode of the podcast when you were here as an intern, right? No, no, not one. thought you were too. Trent and Troy were, but you guys started up before I... Well, he would have been on, he's Ethan, but now he's on as Dr. Holton. So that's in practice. So that's the new face. If I thought he was on here for sure. yeah, my memory is bad, just like my back. Yeah, I hate to come from my profession, but we'll give it the trail trip.

and say that's what caused it. What's new in general, real quick, you don't get more than a minute, anything new in your life since December 22nd, or maybe it was before that. Yeah, there's a lot. Well, I moved from the great white north of Minnesota, shout out to Northwestern, all of my fam.

Yeah. mean, I'm in practice now making money, which feels good. Not paying it. Exactly. You'll be doing that just on the money you've borrowed here pretty soon. Yeah. Yeah. What about you, Alex? Oh brother. There's a lot. right. Telling him to make it short. I don't even know what I do. Uh, my weekends are packed with traveling seven hours one way or the other, uh, to Mississippi.

Yep. Cause my girlfriend lives in Jackson, uh, which I guess if our last episode was in December, she and I were dating at that point, but yeah, things have progressed very well. So cool. Yeah. What else to do? Hmm. Lost a roommate, gained a roommate. Is that a good thing or a bad thing? Seth left, Ethan came in. Um, yeah, took over. Yeah. It's kind of like just a takeover. Yeah.

Yeah, I feel like lots of family changes too, which has been good. Cool. Ready for the summer. Nothing new with me. Two kids, running a practice. That's it. Same old, let's get on it. So Ethan's going to be presenting a case before we that because we usually do this. Alex is going to give us, because it's our track and field, he's got little tism for it. So he's going to give us a little breakdown because there's been quite a few highlights and then we're getting into some...

Beau Beard (02:23.196)

just kind of a end of the season for high school as well. Yeah. They're this week, literally today starts the high school state track meet down on Gulf shores. so we don't have any results from that yet. They probably are starting right now. we got a lot of patients that'll be down there. So excited to see how they do. really a lot of the talk today is about the marathon. So we had the Boston marathon two weeks ago and then the London marathon last weekend, Boston marathon on the men's side course record.

And probably the highlight I wanted to mention it from it. If anybody knows Ryan Ford, he was a Huntsville native. We're about the same age. He, Dr. Seth, actually they grew up, they raced against each other, ran at UT Martin, progressed really well there. And then eventually onto the professional scene and has, has since then become, he was third fastest American at Boston. Last year ran 208, which is

As far as I know, the fastest marathon time to ever come out of Alabama, uh, for 10th place this year, which shows you the caliber of the field 12th place ran 205 46. Um, so definitely the fastest marathon Alabama. And that makes him one of four Americans ever under 206. which real quick, that marathon I was talking about was a 205 rookie. That was at the Toledo marathon. That's on here. he, Ryan was the number three.

American break 206 until the next weekend when Vincent Mari ran 205.53 at the glass city marathon in Toledo, marathon debut and completely by himself. Cause I didn't look to see what second place was, but that's not a, that's not a time somebody goes and runs a, just an open marathon, right? you're going to see a 205 at a major, not just a regular old marathon in Toledo, Ohio. so who knows? We might see him on.

That's viable for an Olympic team time. then I guess the big stat of the weekend was London marathon, top three men broke the world record, which I didn't know if we would see it anytime soon. Really the guy that I thought would break two hours in the marathon in an actual competition would have been Kelvin Kipton. but for those who know him was a world record holder, tragically passed away in a car accident, a year ago, two years ago.

Beau Beard (04:47.15)

And only at 24. So the time that he had of two hours, 35 seconds was broken by top three guys. Top two guys broke two hours. Sebastian Saway from Kenya, which I looked more into him because of the field, I knew him the least. He, that was his third marathon. 202.05 was his debut in Valencia two years ago. And he in 2025 with all the drug.

doping allegations, he voluntarily got tested 25 times so that he could, know, if there are any doubters out there, cause he ran 202, 202 and then 159.30, which if anybody doesn't know the paces for that, I mean, that's 433 a mile. Alex keeps looking at camera and pulling away from the microphone. So you might get a pretty face, but no sound. 433 a mile, recorded the fastest mile ever in any marathon at mile four, at mile

24 and a 412, which I'm guessing that's when he broke away from Kajelcha because he was just 11 seconds behind. A little bit about like everything else with the race. He and Kajelcha both, which is the second place guy, both ran in the new Adidas Pro Evo 3, which played its shoe is 3.4 ounces.

You also see what the aftermarket resale is on those now. No, like $4,000. Oh God. They're 500 new, right? Like, I don't know. I mean, most of the play to choose, I guess like your Alpha fly variant is going to be like 350. So maybe also just sold at a female Puma. So it is suing. We were talking about that last night. That's, that's the real track and field. Yeah. Was that about faulty carbon plates or just carbon causing an injury?

We didn't read all into it, but she was saying that it was causing Haglund deformity in her Achilles, which not because the title read faulty carbon. Yeah. But was it just carbon plated footwear? That's what we don't know. We also because I didn't read it too far. He and I were like, I sure to God hope that she has it on both feet. Yeah. Because if not, I hate to tell you, Abby, you're going to lose that one. And there's already data on all the navicular stress fractures and stuff. So it's like the data is there and it's kind of like

Beau Beard (07:04.768)

unless they have to like tell them that stuff before they make a decision to wear it. don't know. You would also think that more people would be showing up with that or at least talking about it. More professionals. And it is fairly new and like track. Yeah. Because of spikes. It's harder to make a spike with a carbon plate. Yeah, there was. I mean, when we were in high school, the Nike Victory Elite had carbon fiber in it. was also our plate. And it was also broken in the middle, like right at the midfoot.

I don't think it was. Yeah, it was no, it was just like a, it was a very different. It didn't feel as stiff as what these are. but I thought that was, I mean, a 3.4 ounces is a Nike victory. Like that's a track spike weight in a shoe with a much bigger stack height. Yeah. and for those that want to get all gate weird, just go watch those videos of those guys hitting like toe off and wear their foot and that shoe and talk about like overpronation and.

It looks disgusting. I mean, they just broke the world record. there you go. Yeah. The third place guy, Jacob Kipalema was wearing a, it doesn't even have a name. It was a new developmental shoe from Nike. It looks like an Alpha fly also was so gross, completely black. Just McDonald. don't get it. Restaurant shoe. Why does a pro wear an all black shoe? Maybe that's the prototype they wanted it to be. And I guess the other thing to note last thing about, uh, so the second place guy, Yomifke Gelcha of Ethiopia.

I saw an interesting post in this current moment. He is basically our sports greatest number two ever. Second fastest man ever at 5k, second fastest man ever at 10k, half marathon and marathon. So really good at second place, which unfortunate, but nowhere to go but up. Yeah, that's right. I mean, imagine that's also his marathon debut. 159.41, breaking two hours and the world record in your first marathon.

but sorry you got second. Yeah, see what keeps happening. Also one more marathon add-on if you didn't, know some people follow it, but like Cam Haynes went 239 and change at the Eugene Marathon. When Truett went 232 and change at the London Marathon. Also I saw a comparison which I get that it's two different marathons. Cam Haynes would have won the outright Masters Division as London Marathon by about nine seconds I think. And then he's also, what was it?

Beau Beard (09:25.902)

I think 235 is the world record for over 58. So like we set a world record. So that's what he said his new goal is. Yeah, he's got it. So we'll see. Also people are calling it out. We want to see the showdown between Truett and Kim now. know, minutes is a lot. You're going to break our thing back off there, bro. Yeah, it's a lot. It's a lot. also that's about how much time Truett would have to drop to get qualifying time. Faster than that.

Yeah. Cause two nights at the job. Well now it's two 17 30. So I thought it was two 19 because his goal is two 16 or two 15, he dropped a sub two 30. I just, yeah, I think he ran a two 29 in a race that had too much downhill or something. A two 30 I think was his official. So we'll see. Yeah. I mean, we'd like to him do it. I think I saw he ran without a watch this time, which, uh, you know, it was intentional obviously.

Seems like when your goal is still running jeans. Yeah. I didn't, I don't remember seeing the picture. probably I don't follow much distance. I felt like he's, he's the guy though, that now I had a guy, a friend of mine comment when I reposted the marathon and he was like, dude, I'm really just, I'm excited. It's crazy. But, you know, I want to see what true at Haynes does. Cause he goes as a guy who just entered the running community, the root and form want to see what he does, which, know, I do too. I think it is definitely a bigger feat.

And maybe he's realizing like this is a lot harder than I thought it would be. Well, so I this is my opinion. I don't know exactly what he's doing from what I heard when he would talk about it is that he dropped all weightlifting was only doing some body weight stuff to lose all this like weight because he had a bunch of muscle mass campaigns also talked about like he went kind of from the the workmen. I'm just going to like run all the time. You whatever I want to like basically intermittent fasting like short feeding window all the recovery stuff taking peptides like trying to lose weight to get

So like they're approaching it kind of the same way, like let's get lean and, but then I'm like, well, you need to lift weights and work on stuff. Cause we've seen Truett get injured a couple of times. And it's like, so I think also like power output is going to go down massively. We lose that much muscle and to lose that much muscle, that's probably going to show up as an injury. Right. So I mean, you're talking, I think he needs a bigger cycle of training to kind of come out on the other, think another year, honestly. Yeah. Which we kind of talked about with how often he was racing. and sure you can race.

Beau Beard (11:51.426)

And that was why we didn't race as often as some other teams in high school. Cause you just can't, you don't get any better by racing. Yeah. Unless you go into a race as a training race and just drop it. You trained that week. Yeah. Yeah. All right. We've nerded out enough. Yep. Now we'll nerd out in a different respect. Yeah. what do you got? Well, before we do that, I'm going to just add to the Abby Steiner stuff and put a little track plug in there that Alison Felix is coming back. that's a big one. Yeah. That's a huge one. But I guess I'll be there to see it. yeah.

if she makes it that's that's she's got to make it she's 42 right now so she should be 40 or easily be the oldest female track athlete like in a sprints event yeah has to be but she's got some good competition right now yeah uh abby steiner she's suing not only puma but mercedes formula one because they helped design the spike so it's not the racing team itself but the team that helps develop the stuff

She's suing on multiple accounts, negligent products, liability for manufacturing and design defects, as well as failure to warn. There's a fourth count, the overarching umbrella of negligence and the last two counts focus on breach of warranty, specifically merchant ability and fitness for a particular purpose. She- So basically the products weren't field tested appropriately is what I'm hearing.

She claims that the shoe designs as well as the carbon fiber plate and or nitro foam technology changed the foot and ankle mechanics during running that may contribute to or increase the risk of injury. Well, here's the thing. We've already known that. So then the thing, like I was saying, do they have to basically tell her that like almost like a disclosure statement? Yeah. If they didn't, she like, she's basically like, Oh, I didn't know that. It's awesome. Like, I think, I think she's going to lose because you'd be like, well, that's public information.

like that's what you can talk about on social media. So you're a track athlete, you need to make an informed decision. That informed decision is not necessarily, I would assume, on the company to be like, hey, did know this increase is like your ankle planar flexion angle and tendon load? I don't know. I don't know. Also, is she saying this specific pair of shoe or this shoe model in general? Has she had more than one of those and this has persisted? She switched shoes and it's gone away?

Beau Beard (14:03.822)

That's a great question. I feel like there's two. We can tie that into some injury stuff. So we've talked on the show about one of our runners that went from high school to college was probably training in carbon fiber play to too much, had a navicular stress fracture and over the bone screw. There's research on that specific injury with carbon fiber shoes on how it changes the basically the angle that you come into the ground because you have to wind that plate up and your, your nervous system is wildly adaptive and it's going to do what it needs to do to like basically make that efficient. That's why again,

Can you say that I don't, I just don't, she's not loose. Yeah. Cause like it says that she started being sponsored by Puma in 2022 and stating in the lawsuit, she wore them quote, with the reasonable expectation that they were properly designed, developed, tested, manufactured, marketed, promoted, advertised, sold, distributed. first question the lawyer is going to ask. Did you ever wear carbon plated stuff before? Right. NT she did. Yeah. I it's been around for much longer than that.

As much as I loved watching her run, I don't think she's going to win this. The thing is to sue. Okay. So now we're getting an interview. So if somebody let's just, and then we'll get into the case. Let's say a triathlete tried to sue a bike company because the bike came out with a different angle of drive from the frame, like a tri bike. And they're like, Oh, I started getting hamstring injuries. It's like, I just don't know that you, mean, that'd be a hard. Too many uncontrolled vehicles. also, I don't know if it was 2021 or 2022.

I remember her being in the news for how many times she raced. ran like 80, she ran like 86 races one year. stuff like that. I think she is still in college. Yeah. Which might've been right before that, but still. Now again, can that all those things are factors. What I would say is if I were a rugby soon, my team like around me, my coach, not the team that's given Puma is giving you the stuff. would assume your coach, I would hope has like way in on

I would hope your physio has weigh in on that and is also informed. Yeah, your physio isn't informed about that didn't worry about that Shame on them and then shame on you if they did and you went ahead and did it now You're trying to sue him after the fact like I just imagine if I was with a track and field athlete like hey You heard about this stuff like how much we wear in this like Yeah, I think that's more on her team Anybody yeah, I was just giving her stuff. She didn't have to use it. Well, I guess she does she wants to be sponsored Yeah move sponsors or just

Beau Beard (16:26.702)

Everybody has the same technology. So we have a very good friend that is on the Altra team. We were talking about shoes and he goes, they are literally all the same. It's all the same concoction of super phones and stuff. It's just like little tweaks here and there with the shoe design. He goes, it's all the same. Otherwise, like they wouldn't exist nowadays. So it's like everybody's doing the thing. Okay. We way nerded out. Okay. On to Ethan's case.

So how do you want me to, you want to go through all the visits I've done so far or what do you? So the way we're going to present, yeah. So let's go over our theme for, so this is the second episode of this season. So we just had Annie O'Connor on, hopefully you listened to that one. Great podcast. And then as we usually do every other week, we'll have a weekend review unless something goes haywire. What we're going to do now with our cases is kind of what we've been doing in the office. We're going to present those cases, whether it's, hey, a case went well.

you know, one of us asks questions about a case or there's an interesting something in art of assessment style. So that means is we have basically three questions or frameworks that we use of like a triage checklist and needs-based assessment and then assistance and matrix. And we have designed this in such that it's a, we'll kind of talk about it more, but like a communication platform for us internally, hopefully other doctors. So if you looked at this and you have like a functional approach, like, I can understand.

where you're coming from, but then it still allows us to ask better questions. Like instead of being like, what do you think about this? Or you being like, hey, I need help on the case. You're like, well, what specifically? Like we have very good data points. And then what I'm gonna play the role of a lot of times is we use an overarching thinking method called the six thinking hats, which is developed by Edward De Bono, which I reach out to their team, they always come back to me. So where I'm gonna kind of show you how we use that thinking method or methodology.

to work through a problem so that the six thinking hats is not made for the medical world, was made for businesses and in particular, if you're go through a big business decision, merger acquisition, a buy, a sell, something that you're like, hey, let's really suss this out or if I need creative thinking, right? I'm hitting a wall and I'm like, nothing's making sense. So I'm gonna play that role. So what I think we should do is just run through our three systems, you give the information, then let's give us

Beau Beard (18:44.526)

what visit you're at and then give us your like pointed question. Like if it's question and it could be, Hey, you know, it's, I don't know. Good case. need a question or it's got an interesting theme. think it's like a little bit of a good case, maybe a question, but then it's also interesting because of what happened at the last visit, which the shadow that was here got to see me kind of work through that. So that was interesting. Yeah. Uh, so is it injured? No. Uh, do you want like any like age, like just like

presentation or you want? Not yet. Okay. Injured? Is it injured? No. Does it move? No, it does not move. And I'll explain these. So we're just saying, is it an injury or not? So do we have a pathway anatomical issue? Somebody blows their ACL out. Second is doesn't move. So we're saying, where's the complaint? Shoulder neck region. Okay. So well in that, so are we looking at the shoulder or which one moves? Neither really move. Okay.

So what we're saying is if you have a shoulder, CT junction or whatever area, do those areas move? Like if we go to motion palpation, do they move? And it was no. Yeah. So CT junction extension does not move right shoulder. All range of motions don't really move well. So I made them into like primary and secondary. So the big ones that don't move are internal rotation, external rotation and extension. The ones that move somewhat but are still limited are flexion and abduction.

So then our next questions would be, can they move it? So that question's already moved because it doesn't move. So like it's gone. And then the next one would be, can they apply that to a specific like activity or skill? That's no, because they can't move it. So we're literally already like an end road. So then for our system, we can jump to the audits. So pain audits, have upper extremity one and upper extremity two from the top tier. And then active shoulder arc are my pain audits.

functional audits, right shoulder range of motion passively, and then CT junction extension. And then diff dies, I have cervical derangement, frozen shoulder, rotator cuff strain, and then treatment focus right now is end range extension. Cervical spine. Correct. Cut. So system matrix. And just so we can break this down, I want people to realize he determined it wasn't an injury through his orthopedic testing and like kind of flexion, abduction arc and stuff, but he found pain, right?

Beau Beard (21:07.31)

reproducible pain patterns in there that he uses a pain audit. Those things of looking locally, right? Not playing this crazy kinetic chain game of like, it's your left ankle causing your right shoulder stuff might be true. I think it pays dividends to start local and be like, does it move? And he's like, no, so I'm going to pay attention to those audits, right? Those movements, not necessarily saying that's what I'm treating. like we got to, that's the next question he's going to answer for us is after the diff die-off.

What am I treating to get CT junction moving and get the extension I need and get a shorter or yeah, he he his shoulder moving. So systems and matrix. I had a hard time deciding if he was healthy or unhealthy because like when you look at him, he doesn't look like fit, but like he says he works out three times a week and does like spiking running. So was like, I put him in the healthy category, but like not as healthy as he could be, I think.

Pain or no pain, he's in pain. And then for my four by four matrix portion, I have 80 % MSK, 15 % peripheral nervous system, 0 % CNS, 5 % FunkMed. And then to break that system down, so we kind of stole from Selective Functional Movement Assessment and said, hey, is somebody, like if we paired up healthy or unhealthy with in pain or no pain.

I would say we lean more and we're going to be cleaning up our systems to go through this. We lean more on that question like they do if something's kind of like, they'd say it's painful every time, right? If somebody's like, so we're always going to lean towards unhealthy because that's probably the win in today's day and age, right? 70 % of people metabolic syndrome. So unhealthy or healthy, we're going to put him back in the unhealthy just because we're questioning it. So yeah, we're over there because we could always work on it and that's why we answer it that way. So we'd be like, Hey, there's some stuff.

then it's pain or no pain, well he's obviously in pain. So right now we're saying we have an unhealthy person that's in pain, we would like to exit them from the office as a healthy person that's not in pain, which means we don't just stop at the musculoskeletal side or get in their shoulder move and it's like, what else could we give them? So we're taking care of them as a person, not just their shoulder injury. Second, what Ethan was talking about were the four major systems of the organism, if you want to say that of, and we're trying to pain categorize here, so then by the end of our

Beau Beard (23:23.182)

those first five questions, which we call the triage checklist, those next audits, which is a needs-based assessment, and then the systems matrix, it's kind of like you're looking at a profile of a person rather than having to read his whole note. So it's like a quick communication platform with checks that we can go through and then we can check that every visit very quickly, and that's what's the top of our note, more or less. So he said MSK was 80%. So what he's saying there is something from a joint tissue is

derivative of the pain or the thing that's like causing most dysfunction. Second, peripheral nervous system was 15%. So that's like a peripheral neurogenic pain, whether that's neurodynamics, neurogenic inflammation, continuous nerve irritation, something in the peripheral nervous system is sensitive, irritated, whatever. Central nervous system, you'd think, that we're not saying brain per se, we're saying central sensitization, chronic pain, effective, maybe even motor autonomic. And then the last one, functional medicine.

the systemic stuff. That's why we put him back in the unhealthy because he put a 5 % where we're like, hey, this guy's not the healthiest in the world. Maybe he has more inflammation because of that. So again, very clear picture from a data standpoint. We're not having to read the note and then be like, what do mean here? It's just, okay, if we put in the right information here, we should be able to work through it. So now what we want to hear is, you know, how many visits are you in? Where are you at? What's the interesting take? And then maybe what's the question. Yeah. So

We just completed visit four on Monday. Going into visit four, he said that he was feeling a lot better that he likes doing the CT junction retraction extensions that I've been having to go home with. But then like every time I go back to check my audits, like particularly like shoulder range of motion, nothing really changes. So I was like, OK, like I like that you're liking the retractions because most people don't like doing them.

And then why is your shoulder not moving? So I like, I had to kind of put on a little bit of the intuition hat from the six thinking hats of like, what else could be going on? So I was like, is there a shoulder derangement potentially? Cause like, obviously there's an intro, all everything's limited. So it's like, what would be like the lowest hanging fruit for me to go after? Well, I can kind of couple external rotation or not external rotation, internal rotation and extension together. So I went with like standing shoulder extension.

Beau Beard (25:43.596)

And that changed his internal rotation, extra rotation by like large margins. has like maybe five to 10 degrees of internal rotation passively before we do any treatment in like 15 to 20 degrees of extra rotation. So he's really locked down. There's some trap and peck trigger points on the right side as well. I had them written in the wrong spot. So those are also some audits. like,

I did a bunch of that and I was like, okay, that's interesting that like his shoulder range of motion is improved now after doing end range shoulder extension. So I'm still working in a treatment focus of energy extension is not changing a little bit of like which one is. And my guess, my question would be like, should I have kept on the CT junction extension for one more visit before I decided to change my course of direction since we're only four visits in. Yeah. And let's, let's give the overview of the six thinking hats. So like,

There are six hats. I've kind of modified the description of each hat to really be clinical. So the blue hat is the exact same as Debono's. It's the conductor of orders just telling us what to do. For us, that's how we go through our exam, right? For us, or at least, you know, what I've kind of developed, it's like everybody takes a history, then we're gonna watch them walk, then we're gonna go through top tier movements, then we're gonna do maybe a specific movement, something that like, you know, think MDT land, like, okay, what caused your pain? Or what can I do like flexion, abduction arc?

put you back through those ranges of motion. Then we get hands-on, that's everything from palpation to soft tissue to orthopedic testing, obviously neurologic testing, then we have breathing as a subset. That is our playbook that we're just like, don't miss anything. And then can also go back to that if you're like, am I missing something? The second hat in those orders is gonna be the red hat, or sorry, the white hat, that's objective data. That white hat we put on after we've done our exam and we're gonna...

fill in those audits. That's where Ethan made the decisions on, okay, what am I gonna use for my pain audits? What am I gonna use for my functional audits? Differential Diagnosis, guess that's not, that's still objective data, because you're making a decision. And then the Treatment Focus is, I guess not objective, because that's subjective from your standpoint, but it's really those audits. Then we have the Red Hat, which he mentioned is intuition. The Red Hat kinda, and again, think we're putting these hats on, like physically in an art of assessment course, but you're doing that in the treatment room or with anything you do in your life.

Beau Beard (28:02.966)

What am I gonna have to eat tonight? Like you're doing all these. We're just trying to make it more surface level so you think about how you think. So if you do hit inroads with a case or you're hitting inroads with a type of pathology or something that you're like, how could I use a method of thinking to work through this rather than just sit there and be like, I don't know, I'm gonna call somebody and ask for advice. Not that that's bad either, but like do your part first. So the intuition hat is existent through all of your case, right?

the time you read their paperwork to every visit. And that's what Ethan's kind of alluding to. Like, I don't know, I felt like I should go to the shoulder, but was I right? And then you kind of want to lean on all the other hats. Your intuition hat is also going to grow with the more experience you have, especially with certain cases. And also you got to know when to listen to it and when not. That's kind of the hard part. The green hat is divergent thinking. So he did a really good job coming up with a differential diagnosis and then all the possibilities that you have to rule out from like red flag stuff.

right, the bad stuff up front, flyers, like things that you're like, you know, metabolic disorder, you know, causing, you know, frozen shoulder, playing a part in it. All of those go in there. And then you always have that list available, even though we prune it via the yellow hat, which is convergent thinking. But some of those differentials might come back as you get further into case, cause you're like, dude, this isn't playing out or it's becoming more apparent that like, I'm not saying it's this guy, like metabolic dysfunction is an issue.

So again, green hat, like mind explosion, thinking about all the possibilities, yellow hat, converging or pruning. And then you have your black hat, which is your pivots. And for us, that's like right from the beginning, like, e, I don't like how this sounds. don't like how this is presenting. I might need imaging at this point. It may lead to this referral or pivots in terms of, hey, if this isn't working, I'm working on CT junction to get shoulder to change. I might work on the shoulder.

And then the way I would have to answer your question would be what? This is hopefully what we do this list. So if I put on the black hat and I realized, okay, one of my pivots was should I have started at CT or should I have started at shoulder? Neither one is right. Neither one's wrong. And that's the hardest part in our profession is like, you got to pick something. We would usually lean on start central for all sorts of reasons. McKenzie would tell us to, and we're like, okay, he knows, he knew a lot. it makes sense, right? It's like the chassis or shoulder supermobile it attaches in at that area.

Beau Beard (30:25.55)

So you'd have to do what? Treat that for a number of visits. A trial of care is usually four to six. See what changes with both pain audits, right? And then functional audits. And know, Ethan got the opposite of what most people get. He got somebody coming back, maybe not necessarily saying I was having less pain. He's like, these feel good. And you're like, nothing's changing. Most people come back and they're like, what? I don't feel any better. I'm worse. And then we see function is changing. That's actually more likely. And then we have to kind of be like, oh, pain is weird. And we're going to deal with your pain.

So I'd say did the working on the shoulder change the CT junction at all? I should have checked my palpation a little bit better after working on the shoulder, but I think we were running close on time that I kind of just forgot to. So he's coming in tomorrow. So I can definitely do some shoulder stuff first and see if the CT junction changes. Cause it feels better on palpation before I like adjust it. And like just from visit to visit, the palpation is like not as stiff and it's easier to adjust.

So I would say yes, the CT junction moves better, but then it's like, am I just getting a stiff area moving that has nothing to do with the shoulder and the shoulders actually. I mean, they're married. Yeah. And then the toughest thing is how much are they married? So like, should we be picking one or it's I mean, those are close enough. So if you told me somebody's knee didn't have terminal extension and they also didn't have like a plane reflection in their ankle. So we're trying to walk. And I'm like, well, which one is it?

I don't think you're also wrong to be like, can I do terminal extension in their knee and like do some plantar flexion, like why not both? Now, if you're trying to tell me I'm going to do for this guy, like CT junction stuff and then go down to his left ankle or dorsal flexion for that, I'd be like, really? Like what about, and then you're like, a shoulder step, like do those. So I don't think it's wrong and this isn't to, you know, the public shaming podcast. But what Ethan also told us was he needed to put back the blue hat conductor of order.

check his white hat findings and just make sure. I mean, you might learn something. I've had crazy cases. So I'll tell a story real quick. The guy that I've seen forever had right low back SI joint pain, not SI joint derivation like most people, but, and then his right kind of ankle eversion, extremely stiff. was a quarterback in college, both ankles are stiff. And I kind of wrote this

Beau Beard (32:45.772)

you know, biomechanical narrative, which, you know, Andy O'Connor would say, shame on you. Like, I think his ankle was really changing his hip because his hip was stiff and internal rotation. So I told him, I go, hey, we're just going to work on your foot. Cause at this point in my career, I've kind of earned the right with my patients, you know, cause I can talk them into it to be like, he'll just work on one thing and see, right? Early in your career, sometimes like I do both because I'm going like get them better faster. So they like get buy-in. We just worked on his foot. came back and he's telling me, yeah, it feels a little better. I feel his foot and his head. I'm like, no.

I go up and work on his hip, but work on his hip in a high kneeling sit, which for us is not E version of your ankle. It's technically not even loading your foot. We do like eight reps of that. We come back in, his foot moves like amazing. like, what the hell? Now, had I not rechecked his foot, we still got his hip moving. It felt better, but I wouldn't have learned, which I don't know if I learned anything, so can't make heads or tails of it. Well, his ankle moves better. Could be, you know, how he's using stuff through the myofascial chain. I don't know, but it changed.

Is that just, you know, some magical happenstance? Cool. might be, but I'm like, and he's now has stayed better if we want to say better. So again, it's always checking because you don't know what you don't know. And if you don't check, you literally don't learn anything. So if you work with somebody's shoulder, I don't think you're wrong to switch it for visits or the fifth visit. And all of sudden you're like, man, their CT junction maybe isn't perfect, but it's better. You know, maybe you're like, oh, they had an injury in their shoulder. Maybe they're like using that.

Compensatory motion that's like locking their CT junction if they get some a fair and input in their shoulder They can take a break off. don't know that's theory right? Yeah, is that right? No, but like you're learning something So that's why these hats come in because if you don't go back and do it You don't get that opportunity to learn then if he gets that opportunity to learn. What's he doing? The next time he sees a case like this He's got the red hat like on and he's like I'm gonna pay attention

really close to the relationship between those two things within the visit and visit to visit. Like I'll pick one, but I'm gonna really hone in on how do they feel when I treat one another, right? So say you treat their shoulder and their shoulder doesn't change, the same visit you treat their CT and you're like, oh, the shoulder changed a little bit. He comes back all over the same. You just might flip it next time, right? And you're just like, who cares about the second visit? You're still working both. So again, this isn't like, the art of assessment isn't to me like some like,

Beau Beard (35:04.554)

genius, like, look at this course. It's very basic. But I think that's what a lot of us are lacking is like basic. Can you follow your system and be methodical? Can you plug stuff in so we can all talk about a case without being like, well, I do DNS and I do ART. And then we talk about it from the diagnostics of those methods rather than just diagnostics. Like diagnostics should be. They're, I don't say this, they're influenced by those things.

Right? I use neurodynamics. I use MDT things. I use DNS things for assessment, but we should be getting down to like the same data. We shouldn't show up and be like, I'm trying to think of something specific. we might, I'm going to, not slamming neurodynamics, but like we were like, Hey, they have a closing dysfunction with a peripheral myofascial sliding dysfunction. I'm just making stuff up. like, what does that tell you anything? If you've never done neurodynamics, not a whole lot versus Hey, if that joint doesn't move, that joint needs to move.

Right? Do they have a trigger point or myofascial trophic change in that area? Sure. Where's that going? Audit based on palpation. And then you can have the same communication. I'll be the, you know, methods differing. anything else on that case? Yeah. I don't think you jumped too early and I think you're doing everything, but it's, know, if you miss that opportunity to check something, that opportunity is gone. Yeah. You'll kick yourself, but then you won't do it as much. guess the only thing else I would maybe ask would be if

Let's say shoulder extension comes back like markedly different. What would be an ideal exercise to work like stability of that shoulder extension? Cause there's not like a lot of things that I can think of right now. think that's a very good question because I don't think you have to work the range of motion that's stiff specifically to improve the range of motion. If it's a stability thing, I think that's a very common mistake, maybe not mistake, misconception. So what I mean by that is

Think of how we, one of the big things that we lean on, and I hate to be a little protocolish, but in ankle sprains, we'll almost always start somebody with plantar flexion, like regain plantar flexion because dorsiflexion usually hurts, like to drive somebody into. And a joint's a joint, right? Affair and input, especially if we're talking like DNS, which conceptually, that's how I look at it, of if we had to explain centration, what is it? Right? It's basically like uniform synergistic action of the muskets hurt around a joint with a joint.

Beau Beard (37:31.406)

trying to use Rich's definition, I'm butchering it here, with the best approximation of the joint surfaces. Well, that doesn't mean that it has to be an extension. That might be a specific motor pattern, but if it's a stabilization issue, we could use any position to make the shoulder work better and then almost use that any position to then see if extension gets better. Gotcha. Now, I think that gets into our question on the triage checklist. We said, okay, can they move it now? Like, okay, their shoulder moves better.

can they apply it to specific skill, then we're in that land, which is like, well, can they do, you know, like a, I don't know, like a crab press, or could they do a dip, right? Which is shoulder, those are more specific, but you need stability of your shoulder in general before you go do a dip. Does that make sense? Otherwise your shoulder is gonna get torched regardless of position, whether that's, you know, overhead hanging or pushups. So it's like stability of your hip.

and maybe people could argue with me, I don't think it's position dependent. You may be less stable at in ranges and you may be less stable because you're stiff. You like don't have great feedback. But if I get the joint moving and I get it stable in general, I should see that like it performs better overall. And then I think it gets into skill acquisition. Gotcha. I mean, the good thing with your direction you could go is he's not good at any of them. No, I know. And you're kind of telling you like, yeah, shoulders sucks, which again,

This is the one, yeah, good question. I'm glad you brought that up. Greg Rose would say, you know, a joint restriction is going to be an equal opportunity employer. Like all ranges are stiff. But then I also think that leads right back to like, that's a stabilization issue, which, know, in DNS language, that's what's causing the joint restriction in the first place. And you're like, it's probably like an unstable scapula thoracic glenohumeral relationship. Yeah. And I got a little bit of like a cue to that because I sent him home with three months prone and he was like, I love this exercise, which is like,

Okay, that's another thing that I would have never guessed because most people hate three month prone. But did it did it also change? Those trigger points in his you trap and peck Latin peck. No, they didn't like I after the pen. Those might be there. mean those are hard. Yeah, so to get rid of like he's I you might want to see him decrease but then the likelihood of those going away with a lot of people's like yeah, they didn't go away. But like the tone around them definitely changed like

Beau Beard (39:54.924)

This has been also going on for six months and he's still trying to do things that if the pack and lat are overcompensating because the shoulders and stable like those trigger points are to be holding on a lot harder. I think because he's still doing the motions that hurt and he's still doing like the most like he's using his pack to like help him throw or help him swim. So it's like it's like you're feeding fuel to the fire. And I think this is again, I.

I'm an equal opportunity employer of knocking all systems because all systems just need to learn from one another. So if you look at like MDT and it's like, always say rule out central rule out spine. I think a lot of times we think rule out spine means for everything. So we're like, he has shoulder dysfunction. So if I move his CT junction, that's central and I'm doing good. think what using the red hat and using this process over time, you're going to realize like he's showing gross dysfunction at a shoulder and mild dysfunction, which is very common area, right? Transitional areas.

to have dysfunction and then if you had trigger points in your, know, pack and your lat and your upper trap, I mean, you're going to lock down your CT junction because you have a ton of compression. So it's like, it's very hard to chicken and egg stuff. And again, should we chicken and egg stuff? But then you're like, what are they showing me? Flexion abduction arc was painful, right? So you're like, they're showing me a bunch of stabilization, like the shoulders junkie. So I think that maybe leads you back to like, maybe I should have started the shoulder.

paid attention to the CT junction. Not that you wouldn't be adjusting there. Like, yeah, we got, you can get a lot of a fair input at the spinal cord level to the shoulder, but is that restriction causing a short? Probably not. Like, you know, we're always like, what's the most likely? Yeah. Most likely that your shoulder sucks, especially if it's asymmetrical. Yeah. That's way better than I go. Book seems, you know, why would a central component be right? Only go that way. Yeah. But I think that's a knock, not a knock on any T, but us.

falling on the method or the system too much, We always rule it out. You're going to be a little slower than somebody that's got a lot of clinical intuition, right? If they're like, why not? Why would I rule it out? at their shoulder versus they come in and they're like, their shoulder moves fine. And they have a lot of shoulder pain with a restriction at CT junction. That doesn't seem like a destabilized dysfunctional shoulder. That seems like a pain mechanism that may be centrally derived, right? Then you're like, I'm to really work on the central axis.

Beau Beard (42:16.686)

Does that make sense? Yeah. So would it be better for like the students in the audience to like, it's a better, not a knock on MBDT, but rather it's a better like system for dummies to look central before you look peripherally. We always, I say that in our assessment, like always rule out central. It's like on every slide it's in our RX3, like every time I present pathology, I'm always saying rule out central. That doesn't mean, so what that means is pain. So if I have pain in an ankle and

I guess we need to add that in there. Maybe it needs to be an asterisk drop down. And you have a pretty functional, we're not saying like pretty functional area of pain, right? So say we answer those first few questions, is an injury? No, right? Does it move? Yeah. And then you're like, does it move above or below? Then you're at rule of spine, which is why we have that triage checklist because if it moves and you're having pain, the likelihood of something around that, that it was an injury and it's moving pretty good, causing pain is pretty damn low. And I think we'd all agree with that. So, but for the students out there,

If somebody sprains their ankle, they're three weeks post ankle sprain, they come into you and their ankle is stiff as bricks, whatever, subtailer joint, mid foot, whatever, and you determine, their lumbar spine is stiff. Are you wrong to go do press ups and think that you're gonna get rid of the ankle pain? No, but I also think it's gonna take you a lot longer than it would me. I'm gonna get the ankle moving, I'm gonna get A for an input, and then I'm gonna be like, well, that's probably gonna allow them to move their hip and lumbar pelvic junction better. So again, again,

just use common sense. Don't lean on people's methods and like put yourself in jail of like, I'm always going to rule out central. It's like, what makes the most sense here? You will know. Like, is it injured? No. Does it move? Yeah. might not be pain local. Cool. Rule out central. Does their lumbar spine stiff now and their ankle moves fine? Cool. Like MDT them all day long. Yeah. So I wonder if that guy had come in and you noticed rather than there being mostly an extension restriction at CT junction, if it was a unilateral lateral flexion,

would you then think, okay, this could line up more with contributing to the single-sided shoulder than, I have an extension restriction and it choosing to be one-sided. Then maybe you go after central heavily, more heavily in terms of function instead of just pain. And I think a lot of that's sussed out in the history. I mean, that's where in MDT, their history is huge, right? Because it's a lot of, hey, what bothers you?

Beau Beard (44:42.54)

What positions bother you? And then you're trying to theorize. And again, I have no clue what this guy, that story is here, but let's just kind of make a story up of, it's, sleeping. if I'm doing bench press, have no pain, right? If I'm doing overhead movements, it gets a little spicy. If I'm trying to do, pushups, it's the worst. And you know what? Sometimes when I deadlift, get pain in my shoulder.

I'd be like, Ooh, that sounds like your CT junction. It sounds like you're hammering extension versus if they're like, I don't know the opposite. And they're like, every time I'm like loading CT junction or something, they're like seemingly doing fine, but they're worse things or where, you know, I was using bench because they should be completely offloaded. He's like, yeah, the worst thing is where I'm like stabilized. It's just shoulder work. I think that sounds like more shoulder, you know? So like your history is a big deal here. And that's, we had a shadow in and we had somebody that was having heel pain and like,

10 minutes in, just say, can we have a teaching moment for the guy shadow? And she goes, sure. go, this is a hundred percent or low back. I go, can't say, you know, can't say a hundred percent, but I go, it's her back. We're going to rule it out. We'll probably find X, Y, Z in the exam. And then I'm playing a game and I told her it's, you know, it's roulette. I'm to put a bunch on red, but I might have to move some over black through the exam or switch all the way over. But if I'm right, I'm building better intuition by playing the divergent convergent game before I get my hands on it. Because why I want to be able to talk to people and be like,

What are you dealing with? Have really good questions to lead me into a path of like, Hey, make sure you check this, right? Use your intuition is a weapon instead of just something like catch you like, Hey, they might have a triple eight. Well, yeah, those are cool. But like, what do you think's going on here? That's what intuition should be not ART tells me, look at this MDT tells me, look at this. And because they say it's like this is what it is. That's not your brain. That's just literally turn your brain off. And that's

the antithesis of our assessment for us. like use your brain, use your thinking process, hopefully answer your own questions eventually. Our real goal would be whether it's us in here, you out there listening, you get this art of assessment kind of process and all of a sudden you're having a hard time, you're five, six, five is in a case, you're filling out your stuff and you're like, I didn't check CT junction after I worked on a shoulder, I need to do that next time. Cool, that could be the end of it. You're just like, I'm not wrong, I'm just gonna go check. And then you learn something or.

Beau Beard (47:04.366)

God, I thought it was, what was some of your diff dies? Cervical derangement, frozen shoulder, rotator cuff strain. Yeah. And then you're like, let me go back and check those orthopedic tests, make sure your rotator cuff is cool. Right. And then say you exhaust all that stuff and your eight visits in and you're like, this guy isn't the healthiest dude in the world. You just ask more questions in that realm. Have you had your A1C checked? I don't know. I'm not saying that's the exact case.

Using a system allows you to not miss stuff, not missing stuff allows you to learn faster. You learn faster, you're better than everybody else. You probably see more people make more money. You're more happy. Um, yeah, you probably have a mansion. I don't know. But that's the goal is you have your own learning process. You don't have to lean on people, right? Cause the people I wanted to say this because I saw, I don't know what it was called neuro adaptive technique. Some guy talking about another, uh, you know, method and I was like,

There's a reason that there's so many methods and techniques is because they're all bullshit, but they're also all good. Why are they both? Because if you can have that many methods and techniques and they all kind of work with people, all you're saying is people are wildly variable. So any system is going to work a little bit. What we're trying to say, this isn't a system of do this, don't do that. It's find your data a certain way and use your data to create your own learning process. Because if I go learn something like FRC,

And I come back, I'm gonna look at everything as like FRC. You literally get blinded for a while. You're gonna see stuff in the good way you wouldn't have seen. You're also gonna miss a bunch of stuff because you put on your FRC glasses. And then you're gonna like those glasses fade and they become like multicolored again. You're like, oh, I can kind of see everything. Then you go to a DNS seminar, you come back, everything is DNS class for a while. And then it starts to fade back. You need to get away from that somewhat and have the DNS seminar and then come back and be like.

When I use the DNS stuff to look, I'm going to make sure I plug it into a system. Does it still make sense? And I'm not just getting like, you know, the shades of that. Right. That's what I'm trying to do because I did that forever. We still, I'm still going to do it. I'm guilty. I go to a seminar. like, I'm going look at all this. I'm going to apply this. And if you're doing that to test and you're comprehending that you're just doing it, you're aware of your own thought process. Cool. If you're just doing it, cause you don't know what's going on. You're like, I'm just going to FRC. I mean, we all do that sometimes, but that's the hope is that.

Beau Beard (49:18.978)

Better learning system, not a system of do's and don'ts. Any other input on this one? When do you see them next? Tomorrow. So what are you gonna check? I'm gonna recheck CT Junction, but then I'm gonna check it just from like a mobile perspective when I do mobile on everyone before I see them. Not really touch it besides mobile and then go look at the shoulder and then repel CT Junction just to see what happens. And if it's still stiff, I'd be blowing that shit up.

It got blown up on Monday, that's for sure. that's the thing, Rich Ulm or everybody says everything is after a fair input. And largely I agree because then it's what you do with the a fair input for motor output and that gets into motor learning and then load management. And that's where we got it. Like you said, well, what's the good stability over that? If they got good feedback, you can do anything. Push up shorter extension. It doesn't matter what the movement is. And I think we're movement dependent sometimes.

They don't have hip extension. I'm going to put them a, you know, a split squat and work the back leg and that might not be how your brain works. It probably is not right. now when it gets sports specific, I do think that does matter because you're trying to do a skill, not just broad movements. It looks very different. So if somebody had a specific, like tennis player, like right at like impact of forehand, like that's when my elbow hurts every time I'm like, I'm highly aware of like what's happening at impact, right? Like what

mechanics need to be applied. Now that might not be true or not. Now, no, need to train that position. Probably not. Right. I could still use other movements to improve what's happening at impact, but I need to know what needs to happen at that point to say, Oh, you need more pronation. need, you know, shoulder internal rotation, abduction. Oh, you don't have abduction. Okay. Let's get that range motion. You got it. Now we can just train whatever. Yeah. And again, I know if people would argue with me, cool, we're back in the, every system works a little bit and every system doesn't work.

What else we got? Anything else before you hop off here? Go treat real patients instead of talking about, well, I guess that's real patient.

Beau Beard (51:22.542)

I'm going to go treat myself after falling down the trail and getting some disease from my kids. you need one of those like plastic so as release. I like the two things. So again, everything works a little bit. Okay. One of the most profound relief things I get. was laying around on the floor of shakes, my back just like vice down. Um, I laid on like a ball on like my son hasn't got up like, Oh, I can walk around for a little bit. I can't went back, like, yeah, stuff works.

And again, we throw stuff in the trash heap because why people lean on it. So people are like, you can so as release is going to solve the world. That's why said, no, it's not like if you need it, cool. If you don't need it, it's not going to help you. And then there also is a lot of anatomy. don't think most people that don't understand anatomy should just jab a piece of plastic in their dominant wall. Most people, everything's good with a grain of salt. so here's something for the, people listening. If you would like.

One of these art of assessment sheets, I'm more than game to give one to anybody that asks, right? So at this point, we're not gonna just put it out there. If you want one, you can send me an email, drbeaubeard@gmail.com You can DM us on social media. You can get one of those, start using it. We'd like people to present cases using this method, right? Like, do have a question? Do you have a success of using the system? Where are you gonna learn the most? Go to seminar. So here's the sales part. We have art of assessment, lower extremity here, Birmingham, Alabama, September 19th to 20th.

It's home turf. only have seven spots left because we're keeping it small because we also have a mastermind meetup the Friday right before that for only a $55 additional charge. And I can guarantee it's well worth the price of admission because also your dinner is going to be covered with more than $55 per person. Guarantee that. But that's going to be good. We also have one in St. Louis, July 24th. 25th, 26th. Come on RTP, get a registration page up for these people. That's happening.

can't register yet until they get that invite right up. But that's happening too. That's gonna be actually an upper extremity one at St. Louis Sports Clinic. So thank you to them for allowing me to come in and do that. And yeah, I think that's it for right now. There's an online course too. So go to thefarmuniversity.com to learn more about the whole course or take the online course or sign up for a live course. See you next time.