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Welcome to The Dr. JJ Thomas Podcast! Here I'll be talking all things physical therapy, raw and unplugged, giving you the unfiltered insights you've been searching for in your cash-based physical therapy business. If you're caught in the grind of the traditional model, swamped with paperwork, or feeling like you're not reaching your full potential as a physical therapist, this podcast was created just for you.
That's what I was saying about ask them what do they do in their free time. Not just to be a nosy, you know, a nosy nurse, but like but truly because it's going to tell you how to counter the things that they're creating in their daily habits because you you can't avoid
Dr JJ Thomas:it. Welcome to the doctor JJ Thomas podcast.
Dr JJ Thomas:Hey, guys. Welcome to the doctor JJ Thomas podcast. I'm JJ. Happy to be here with you today. We have a special episode today.
Dr JJ Thomas:We're coming off the heels of our primal integration course. Those of you that don't know the primal integration course takes the concepts of primal foundations and it integrates it. Teaches you how to integrate it more into your clinical practice to get the results you really want. This was a really this was the first time we did this live, and it was a really rewarding experience for me because I got to watch the eyes of all the therapists who like had these moments and and clinically the method really clicked for them. And I think, what it comes down to is through the method, those of you that have spent a little bit of time with me know that what I often promote is that the movement tells the story for our patients, and that if we can take the opportunity to allow the movement to tell us the story and not be clouded only by their pain and symptoms, then we'll get a better picture of the causative factors, the underlying root causes, and really ultimately the direct the most direct path to get your patients better faster, which is just makes is a very makes for a very gratifying life.
Dr JJ Thomas:So I got to see all these moments in these clinicians, and what it really comes down to is we pulled a segment for you that's one of the most important piece in my opinion of using this movement to analyze the story, and it really reels back even further than analyzing movement. It really reels back to the art of observation. So not just looking at how your patients move, but slowing down the evaluation process and even analyzing the very small details of how their posture is in standing and looking at it from a very, unified but con comprehensive perspective. So we're gonna share that with you in this episode where we take through one of our, clinicians that was at this course, Brian, and we take him through the postural observation piece. I talk through with you some some of the things that I look for regularly throughout the evaluation process, and then we take that into the next step, which is the application of the movement assessment phase, where we take all these concepts and we'll tie them together as a group, and you'll see how it's actually integrated into clinical practice.
Dr JJ Thomas:So I hope you enjoy it. I know everyone in the live class really did enjoy it. We got a lot of great feedback, and, listen in. If you have any questions, please drop a comment or email me and subscribe so you don't miss future options. See you.
Dr JJ Thomas:Like, if I were to drop a string from the from the ceiling and kind of see where his line where his center line lines up with the string, is his head centered? Is his sternum centered? Is his abdominal region? Is his belly button centered? What's happening at his legs?
Dr JJ Thomas:Is one knee more bent than the other? Would you mind tucking your do you have, like, boxers you could tuck them in on? Like, is one hip more internally rotated than the other? And like, don't make yourself crazy about it. So feet together again, just to standardize.
Dr JJ Thomas:Don't make yourself crazy about it, but like, I do see, like, higher muscle tone on do you see that? Like, for Brian here, actually, like, his center lines are pretty good. His neck might be slightly to the right versus center. Like, he definitely has a slightly offset right everyone here is amazing, by the way. So we're going to nit park everybody.
Dr JJ Thomas:But just so you know, you're amazing, Brian.
Dr JJ Thomas:Rip me to shredding.
Dr JJ Thomas:I know. I know. I'm so sorry. But if I'm going to be nitpicky about postural, his neck and head are slightly offset to the right as compared to the rest. Like, his belly button and sternum are in line, but even from his, what is this called?
Dr JJ Thomas:I forgot. Sternal notch? Yeah. From then over, he gets kind of shifted on the head. Right?
Dr JJ Thomas:And then at the leg, really, the two things that stand out are the big difference in his left quad. His left quad, his VMO in particular, is like, oh, baby. And then the right one is not as much, but the right leg seems to be more internally rotated. Right? And then that also kind of shows up a little bit.
Dr JJ Thomas:Now if I let your feet come apart a little bit. I mean, I actually thought I was going to say that his right navicular drops more, but now that I'm looking at it, it doesn't. So I don't know. I'm gonna I'm gonna just ignore. I don't know what I I don't know what I thought I saw there, but it's not enough.
Dr JJ Thomas:So the point I'm actually glad that happened because what I want you guys to do is do almost like a screen. Right? Like the old, I don't know, Terminator movies or whatever where they're like you just do a screen, and whatever seems relevant, go back to it and decide if it's really relevant. And, really, the 2 big things that I see for for Brian are the head and then the 2 quad the 2 quad deficits. Like, I don't I don't know which one's a deficit, actually.
Dr JJ Thomas:I I assume that the right one is more atrophied than the left, but I don't I don't really know that yet. It's just, my ears are just perked. Right? So
Dr JJ Thomas:Do you want me to weigh in on it? Sure. Snowboarding, I load up this leg a lot more
Dr JJ Thomas:Perfect.
Dr JJ Thomas:Than I do this leg.
Dr JJ Thomas:There it is.
Dr JJ Thomas:I think it's just the way that I've, like, learned to move because of snowboarding.
Dr JJ Thomas:So that brings us to what do you do when you're not with us? Right? Like, the movement tells a story, the pasture tells a story. And it's great that that makes sense. Right?
Dr JJ Thomas:Like, it's great that he just confirmed what we saw, But what we need to now do is take that information and how does that relate to why he came to us? Like, what because the body is going to adapt to old injuries, but it's also going to adapt to things we do regularly. And maybe not in the best way because it's going to prioritize movements that we do regularly. It's going to start to deprioritize the movements that we're not doing regularly, and then we have imbalances. Yes?
Dr JJ Thomas:He has a little bit of bow bow legginess. Yeah. Is that a deep front line tension thing? Because it's adductor posterior to the I don't know if that's a I don't know, to be honest. I think that somebody would be able to like, I'm sure somebody has a like, probably Anatomy Trains has a take on that.
Dr JJ Thomas:I would assume it's more posterior, but I don't know. So I don't want to answer that. I wouldn't say that I use that when I'm like when I'm evaluating. I don't like I don't say because it's right, like I believe I see when I see anterior chain deficits, I see more valgus like, I would say tone deficits. But so I don't know if you can say the opposite.
Dr JJ Thomas:If you notice when I talked about post air chain deficit trends that I see in evaluation, I talked more about this, and not about the position of valgus versus verus. Because I don't know that I've seen that, to be honest. But I don't know that it's not there either, if that makes sense. You know what I'm saying? In my experience, I haven't made that connection, but that doesn't mean it's not there.
Dr JJ Thomas:It just means that I don't want to say that to you because I can't say that I've tested it. You know what I mean? But good question. I've asked myself that but I but when I like when I was writing this I literally was like, well should I put Verus here because anterior chain is valgus? And I'm like, but I don't know that I've seen that.
Dr JJ Thomas:And so I intentionally didn't put it there. Great. So stay there. Let's turn sideways, actually. So just continuing on, like, pastoral chain like just yes, feet together.
Dr JJ Thomas:Good. Pastoral chain stuff. Plumb line wise, we would want to see like ear, shoulder, hip might be slightly forward in the hip there. Knee, ankle. Right.
Dr JJ Thomas:Nothing huge, but like very slightly forward. Okay. So again, is that like, cumulatively, we don't have a reason for that. Right now, we're just screening. We're just like having our ears perked up onto things we want to pay attention to, and then hopefully, they'll make sense later when we do the movement breakouts.
Dr JJ Thomas:And then face the other way for me, so face away from us. And usually, I just walk around people, by the way. It is like slightly awkward, but I think they realize the need for it. And then same thing, just gross. Usually, try to see PSIS.
Dr JJ Thomas:If you can, you're good. But that's great. And then just seeing if anything comes up for you, like, I think that right internal rotation is still a little bit apparent. But again, I'm being but his whole leg size is much less on this side. Right?
Dr JJ Thomas:And how many how long did you have you been a snowboarder since you were young? Okay. Okay. Cool. The other thing that I should have mentioned that I didn't, I actually, I actually probably should put it on here for observation, is like, look at the space of the shoulders, like how they lie.
Dr JJ Thomas:And like on his left shoulder, there's apparently more space in between. And that gives Yeah, it will Or, or, protraction of the scapula, and then when that happens, they get this like compensatory elbow flexion. They're kind of here. Turn around. I'll show you.
Dr JJ Thomas:I'm sorry. I was leaving you out of that. So your your left side, you can see it here too. It just kind of hangs out a little bit more. But I think what we're really seeing is a little bit of rotation and elbow flexion because of that.
Dr JJ Thomas:So already I'm thinking, Okay, we might see something with, with that left shoulder. I can it actually correlates. So he has that right So now that I'm really looking at him and I'm starting to put the pieces together, this right shoulder does sit more forward. Peck looks like it might be tight. We'll see on movement testing.
Dr JJ Thomas:That correlates to pulling on this side, which is pulling on the neck. Everything is like starting to maybe take shape. That also I don't know if that's a diagnostic sling or not, but we'll find out. So maybe because he's putting so much weight on this, you know, but I don't want to speculate right now. I just want to go for the big rocks.
Dr JJ Thomas:So for me, the big rocks here are the side bend it's not the side bend, it's more like a side glide of the head, Potential right shoulder, and then something with just the size of both legs. And that's it. That's it as far as, like, basic observation. But but recognizing, like one of the biggest ones I see here is this belly button difference on people. And usually that takes me to a, like, old trauma or injury that it could be hip or it could be abdominal surgery related.
Dr JJ Thomas:But a lot of times that's a big one that if you look at is often very helpful. And then so from there, as you're saying these things, sometimes that's where the conversation becomes more normal to say like, well, kind of like Brian was excited. Just like Brian was like, do you want me to tell you? Because you picked. Like, it's kind of fun for people too, when they're like, wow, they pick I that makes sense to me.
Dr JJ Thomas:It's a puzzle for me too. I spend a lot of time weight bearing on this leg. It makes sense that it's bigger. So a lot of times that will, if you just casually say to them, like, so here's what I'm seeing. And then they're like, oh, well I do this, that might make sense.
Dr JJ Thomas:Or I had this injury. So that's part of how you can get the conversation going into their old trauma. And if they're not very conversational, try to pull it out of them because it will help without making them self conscious. Surgical history, go back to it. I've had plenty of people, like I said, where they don't think it's related.
Dr JJ Thomas:They forget that they tore their peroneal tendon off the bone, and then and, you know, when they were in high school. And then when you look at them, you're like, I just have you know, I don't know, but the right foot something's going on with the way the right foot's positioned. Oh, I did have that. I had to have surgery when I was in high school, you know? So, just kind of talk about it with them, and something will usually come up.
Dr JJ Thomas:I do have the emotional trauma thing here as a checkbox. Like, again, you may not feel comfortable with all your patients day 1. They you you certainly don't wanna lose you don't wanna hurt a potential rapport with them if they don't feel open to those questions on the first visit. But if they do seem like they're open, and a nice way to test the waters is when sometimes when I see a lot of rib flare in people, you know, I may say, some like, I noticed your ribs flare out a little bit. Sometimes I see that when it's related to, like, past trauma or or breathing difficulties.
Dr JJ Thomas:Have you had any of that in your life? Like and then if they you'll know right off the bat if they're ready to go there or not because if they're like, That girl? Like, That girl looked at me? Then you're like, Okay, we're they were not ready for that. Or if they're like, oh, thank God, somebody's, like, I wondered if it was related to my mother passing and me being very upset, you know?
Dr JJ Thomas:So that's, wait, you're not anywhere near done, my friend.
Dr JJ Thomas:I thought you gave me the nod, like, get out
Dr JJ Thomas:No, it was the nod like, you're the best. Thank you for standing there half naked for me while I go through all this. Did you go any time?
Dr JJ Thomas:I should have.
Dr JJ Thomas:You should have. Next time, next time. And then the last part of this is the change in activity piece. Like, that's the other piece that if we just take 10 seconds to be like, let's talk about the timeline. That's how I say it to people.
Dr JJ Thomas:Let's talk about the timeline of when this stuff started. What were you doing at that time of your life? Was there something different in your job? Was there something going on with your kids or family? Was there an intervention?
Dr JJ Thomas:Did you have some dental work? Did you, decide to wear new orthotics? Did you decide to try out a new pair of shoes? Like literally just start throwing things like that out there, and then all of a sudden they oftentimes will think of something that may or may not be related to what you just said. But but like help guide them there.
Dr JJ Thomas:And then with this is did I cover everything? Arch, femoral position, pelvic tilt, belly button position, ribs flared or depressed, plumb line straight, shoulder resting position, head position. Yeah. We covered everything. So now we're ready to move.
Dr JJ Thomas:Relax your arms. And most people that's the other thing. You have to cue them to, like, relax because they feel like they're being tested and they sort of are. But they're gonna if you don't tell them to relax, they're gonna, like, they're like this, and that's not their normal posture. So their movement is going to be off right off the bat.
Dr JJ Thomas:So I usually tell them like, I actually do this. Like, I'm like feet together, relax, and then and I sometimes I say, like, pretend I'm not looking at you and then just look down as far as you can. Okay? And can you go any further? Okay.
Dr JJ Thomas:So limitation there. And then back to center, and then look up as far as you can. Good. Back to center. Remember to look for if he opens his jaw or not there.
Dr JJ Thomas:If he opens his jaw, I'm definitely looking at the neck and the upper cervical as a potential factor. But he didn't and he moved decent into extension actually. How about look to the right? I love when people you see them do that with their hands. So good.
Dr JJ Thomas:Look to the right as far as you can. Go again. Come back to center. Make sure your teeth are together on that one for me. Don't clench them.
Dr JJ Thomas:Just make them approximated. And then look right again. So he's definitely limited there. There's like a side bend component at the end, if you guys I'm sure you all see that. And then come back to center.
Dr JJ Thomas:Now, right from there, I'm going to say, let's take your right arm and hold across on the opposite side, and then just relax it, and then look right. Different, right? He still side bends, but he goes further. So he gets further range. So that's a piece of the puzzle, but not all of it.
Dr JJ Thomas:Come back to center. Does it feel different to you when your arm is up?
Dr JJ Thomas:It does.
Dr JJ Thomas:You feel like you're going further. Yeah. Yeah.
Dr JJ Thomas:I know this feels like it's stretching more.
Dr JJ Thomas:Yeah. Like now you've accessed an area on the left that you didn't. And so right off the bat, so this is already the slide that we had up where the guy's looking lost, like, where do I start? This is already starting to confirm what we saw originally on observation was that there was a potential something going on in that right front shoulder. Relax that side.
Dr JJ Thomas:Now look left as far as you can. No, no, stay there. Not really. They can walk around. So that side's limited too, actually.
Dr JJ Thomas:Come back to center, And then let's cross the left side and go left. Come back to center. I'm not sure on that one. Put it down again. Go left again.
Dr JJ Thomas:They're pretty close, like maybe 2 degrees further with the arm up, but not enough. Let's see let's go left again. I'm sorry. Arm down, look left. Back to center, let's put the right arm up.
Dr JJ Thomas:Other side. And look left. I think that was easier. So again, all signs are pointing to right pec for him. Let's now have you sit on the table all the way back so that you're flexed to 90 degrees.
Dr JJ Thomas:Even can you go any further back or is the that's too much. Sorry. That's overkill. Okay. So, so interesting actually let me just back up for a second.
Dr JJ Thomas:In sitting, his belly button is now offset. Do you guys see that? So in standing so this is gonna this tells me something's going to come up posterior chain for us. Because in standing, he's able to have he's able to compensate and be centered. But when we stretch his distal his lower posterior chain, he starts pulling to the right on that abdominal region.
Dr JJ Thomas:So, so again, like once you start taking these variables and basically it comes down to slowing down with your evaluation, and really deliberately looking at the whole body's picture. And then you'll see these more and more, and then it'll be like that picture thing where you can't unsee it. So but let's get back to the neck. Now in this position I want you to just relax your arms again. Yeah.
Dr JJ Thomas:And then look to the right. Definitely easier. Does it feel different to you? And I'd say there's even a little less side bend. Back to center, and how about left?
Dr JJ Thomas:That one looks the same to me. Yeah, that one does not look any better to me. Oh, sorry, I messed with the thing. Hopefully you can hear me. Okay, good.
Dr JJ Thomas:So, so far, let's review. So we had definite right pec involvement, something potentially right upper neck, and then abdominals also, or hip flexors because it improved even more when he sat. Like, right rotation improved even more when he sat. And then we have to see what's happening posterior chain that caused the belly button to be offset. Yeah.
Dr JJ Thomas:Which it might my guess is it's glute. Like, so I do think we're seeing this diagonal. So think about overuse patterns. This side is this side right side seems like it's lower tone in general, but I think what we're seeing is a large overuse of the left side. So potentially a tightness, which we're going to tease out, or an overuse syndrome of the left hip, which is manifesting into a cross pattern as well with the right shoulder.
Dr JJ Thomas:Makes sense? So let's continue. So that's the cervical breakout. Now we're going to go to the we're going to go to the neck to the shoulder breakout and see what that shows us. So now we're going to stand again.
Dr JJ Thomas:But we have, like from that, we pinged essentially right pec and abdominals for sure. Maybe hip flexors and maybe something posterior chain but we'll look further in a minute. So for this one, let's just do shoulder patterns. So you're going to go straight up, elbows straight. Good.
Dr JJ Thomas:Come back up, and come back down, I mean. And I want you to really keep your elbow honestly straight. Wait, don't go. It doesn't have to be next to the ear. It can be like in a, like, a straight plane, and then pause at the top here.
Dr JJ Thomas:Really good. From there, try to touch behind. Good, that looks really good actually. Come back down. Right?
Dr JJ Thomas:Let's do right arm now, straight back. That does not look as good. Touch behind, back to center. So again, all signs are pointing to right pec again. I'm actually surprised his right flexion was so good because a lot of times, I'll see that we'll see that.
Dr JJ Thomas:You guys, I'm sure, see that all the time where pec limits that end range flexion sometimes. But he did a good job there. Left arm straight up. Elbow straight. Straight back.
Dr JJ Thomas:That one might have to be a little limited. Touch behind to the opposite. Yeah, that one's a little limited. Did you see how it was harder for him to bend the elbow there? So maybe tricep something on that side.
Dr JJ Thomas:We'll see. That's one where we'll see it better when we break it out. But at least now I've flagged it as like, okay, that's worth a check face down against gravity. Straight back. Also peck, touch behind.
Dr JJ Thomas:That looked great. Cuff on that side looked great. But peck on both sides was tight. So now let's put you sitting and see what shoulder patterns look like. So right arm straight, go straight up as far as you can.
Dr JJ Thomas:Touch behind. Back down. And then it's a little hard in the sitting position, but try to get the arm back as far as you can. It's a little further. And then touch behind.
Dr JJ Thomas:So this again points to shoulder extensions a little better when we shorten the abdominals. So I'm definitely gonna treat abdominals and maybe hip flexors on that right on well, maybe both sides. We have to tease that out still. And then left one goes but the shoulder didn't seem to change. So I'm not thinking anything there.
Dr JJ Thomas:And that one. Good. Go. And then touch behind. Sorry to stand right in front of you.
Dr JJ Thomas:Now that, come back to center, did that feel any different to you in standing versus sitting? Yeah.
Dr JJ Thomas:It did. Is it a little better? Yeah. Good. The first time, like, it definitely, like, I felt like my body was, like
Dr JJ Thomas:Fighting it? You you kind of leaned forward more when you were standing.
Dr JJ Thomas:Yeah. Okay.
Dr JJ Thomas:And I'll say, like, I part of me was like, I think that was better. But I also was trying to not lead him. That's why I said, does that feel any different to you? Because he could also say the opposite. But if I said to him, does that feel better in sitting, then I don't know if I've led him or not.
Dr JJ Thomas:So the word choice, I try to be careful with. I'm not always great about it. But I do try to deliberately say, does that feel different to you? And then let them tell me so that but that again points back to what we were thinking, which is anterior chain more for him. Like, yeah, exactly.
Dr JJ Thomas:So now straight back here. And that's also a little further extension than he had in standing. And then touch behind. And that looked good the first time. So the rotation piece of that looked good the first time.
Dr JJ Thomas:So that's good. Now let's go prone. So now we'll do the shoulder breakouts in prone and see what comes up. So we'll just do we'll just do straight prone and you could do head yeah, head rested. We'll just do active versus passive here.
Dr JJ Thomas:So elbow straight, lift straight up. And can I bring him further? Yes. So there is a motor control deficit on that side. Again, it might be it might be related to that sling.
Dr JJ Thomas:Sometimes, I don't do this often, but if you're curious and you want to see connections, sometimes you can just give input to their opposite side and lift up. It's no different, honestly. I would say that's no different. And then let's see the other side. So you could do all 3 breakouts there, but because we're looking a lot at, at flexion for him, let's just go with that.
Dr JJ Thomas:So elbow straight here, lift straight up. Really hard on that side. Uh-huh. Really hard. And that that is was not as apparent in, in standing, I'd say.
Dr JJ Thomas:But, but let's actually put him in sit. Let's put you in, the child the locked position, the lumbar lock. So put your right hand behind your back. And then I do have to block him from side bending here. So just push down and rotate up.
Dr JJ Thomas:So I can bring him a little further. So a little bit of a motor control. Let's put this on your head and then rotate up. Definitely worse. So there's that pec thing.
Dr JJ Thomas:But his abs are short, so does that change when we lengthen his abs? Right? So wait. Let's get an image again of what so let's do let's do both patterns again. So arm into functional internal, and then rotate up.
Dr JJ Thomas:You guys have an image of that in your head? And then the other one, I think here he has a he doesn't even wanna put it on his head. Go ahead. Yeah. Now check prone.
Dr JJ Thomas:Like prone propped. So lump so abs are now on stretch, but relax like yeah. Exactly. Now do internal rotation first. So right arm behind the yep.
Dr JJ Thomas:And then press down, rotate up. Worse. Way worse. Right? Like that is so much harder.
Dr JJ Thomas:And then hand on your head and rotate up. Way worse. So all these that's what I mean. Like it seems overwhelming to do all these tests, but what you see is basically you're just by the time I have a patient and I've done all these tests, I know that when I treat his pec, I'm going to change whatever he came in for. And it gives me more confidence to go out of the, like, out of the expected area because I've not needled him, but I've still discovered like, I just did 6 tests that all pointed us to the right pec.
Dr JJ Thomas:And maybe other parts of the right shoulder, but certainly the right pec. So now my big rock right now for him is the right pec. Make sense? Let's see what the left side does. So we'll start let's start in the Child's Pose position again.
Dr JJ Thomas:Yeah. And, now this was the one that was more limited in shoulder flexion, standing versus sitting. So here, internal rotation on this side. Push down through this arm, rotate up. Much better than the other side.
Dr JJ Thomas:I mean he has a motor control deficit, but not as bad. And then hand on your head. It's honestly, I mean, it's about this. It's a little more limited, but not the same deficit, right? Like not my big wrap for sure.
Dr JJ Thomas:And what about if you go flat? Let me block you. Good. Good. Go head up.
Dr JJ Thomas:That's worse. I mean, I think it's the same worse. So same thing though, that points us to abdominals. Because he has less thoracic rotation with his abdominals on stretch, similar to how shoulder flexion was worse in standing with abdominals on stretch versus sitting. When you shorten the abdominals, he moves better.
Dr JJ Thomas:Make sense? And then are you going to treat shoulder, retest the symptoms, and then go to Bingo. Oh no. Well, so my first the biggest rock to me was the right shoulder Because neck rotation changed off that, trunk rotation changed off that. I just think multiple signs pointed to that and the abs.
Dr JJ Thomas:So I will do right shoulder first, then retest. Sometimes you'll see that they have acceptable like sometimes the abdominals are the factor because of that fascial attachment of the big rock of the pecs. So what we might see is that after we treat this, his left you guys want to do it? But so, yeah. So that's why you have to retest every time because we know that his anterior chain is affecting both of these but we don't know how deep it goes.
Dr JJ Thomas:Like, it might be his abs but it might be his abs because of that right pec. So treat the one that seems the most relevant, that's away from the area of symptoms, and then retest everything. And some things might clear up just from that. That's the other benefit to doing the whole like, kind of the whole body evaluation right off the gate. Because in the end, when you have 6 or 7 or 8 tests that point to one area, and you have 2 that point to another area, oftentimes when you treat the more dysfunctional area, the other ones just resolve.
Dr JJ Thomas:And then you're not, like, chasing everything. You save time in the long run. So if they had shoulder pain, then they Yes. Yes. And then they would look even further than that?
Dr JJ Thomas:Exactly. Exactly. Exactly. Yeah. And to be honest, like, we I think we should continue the like, these are exactly the questions I want but let's also continue the rest of the movement of Al.
Dr JJ Thomas:So okay, real life scenario. If I had a 30 minute slot with him, I would probably stop here and treat the pack to get him some relief, get some information that's going to be useful for future sessions, be able to, like, be able to start building that rapport that we're solution oriented and that he needs you know, that we're going to be able to get him better. But if I had an hour for him, I would still choose to do the rest of the movement tests. And then that way, I can put the picture with exercise integration. Day 1, better.
Dr JJ Thomas:You know? So like, let's see. But if he has a diagonal sling issue, like, let's say right shoulder and left hip really are a thing that we expect to see and then we do see it, then I might choose to do, like oblique plank toe taps where, like, I'm going to get asymmetrical stability patterns this way. Right? And I'm also getting sort of a functional pec stretch at the same time.
Dr JJ Thomas:Or I might do, single arm crab reaches where I'm getting glute activation. So it would be here. So I'm getting like a functional stretch of the right pec while I'm getting glute activation integrating it. But and I still might give him that anyway, just based on what I've seen so far. But if I have the ability to measure all that, like, in that first hour and then give him, send him home that 1st week with something that's going to address all those things at once right away, then maybe we knock off like lots of weeks of his therapy.
Dr JJ Thomas:So if you put so with the limited time thing Yeah. If he would, say he had right shoulder pain Yeah. In your exam though, would you then more do more lower extremity first I would. No. Instead of Or abs.
Dr JJ Thomas:Like at least remote enough, like I know like, let's say I didn't have time to check lower extremity Well that's the thing, but if you're trying to get away from the painful, would you start there maybe? I would Do the whole I would honestly still probably start abdominal. I would do everything we just did. I would do everything we just did and I would because I always start that way anyway because of the developmental patterns. Yeah.
Dr JJ Thomas:So I always pretty much start head to toe. And then because we got that far and we found things, I would go with the If you could just treat what you found more than just maybe Exactly. And if I had 3 more minutes and I wanted to feel hip passive range like, let's do it. Let's say, so this is a 30 minute scenario. Right?
Dr JJ Thomas:So lie on your back. So I don't really have time so we're detouring a minute but I think you guys are all with me. Right? So I don't really have time to do the full evaluation but I still suspect something in this left hip. So I might just say, you know what?
Dr JJ Thomas:Just I know I'm going to I want to treat your abdominals, but let me just check one thing in your hips real quick. And so just relax your legs for me. And I'm going to just feel what his passive hip range is. And oh, thank you for plugging it in. I thought I would do without it but you knew me better.
Dr JJ Thomas:So that doesn't feel too bad. What I but almost what I what I see and feel is his whole hip is coming up here. Like it's more of a it is more of a glute thing. Let's see what rotation yeah, that's what I thought I felt. So he has 30 degrees of external rotation without me getting pelvic compensation there.
Dr JJ Thomas:So yeah, in that case, if I lock down here yeah, that's his favor. So right. If I had just done this, then I might do glutes on that side first. But if I had to give you my gut right now, I still think I'd do because I had more tests that pointed to the abs. But I would certainly give him an exercise that's going to integrate this, too.
Dr JJ Thomas:Let's continue the regular eval then, okay? Sound good? How you feeling?
Dr JJ Thomas:I'm doing good.
Dr JJ Thomas:Good. Do you ever notice tightness in that hip?
Dr JJ Thomas:Both my hips feel very tight.
Dr JJ Thomas:Okay.
Dr JJ Thomas:But, yeah, I would say this hip is tighter, and I think it, again, goes back to snowboarding because I lower the
Dr JJ Thomas:hips on.
Dr JJ Thomas:Yeah. And, and
Dr JJ Thomas:it's interesting.
Dr JJ Thomas:It's the tighter one. And then when I do single leg things, this leg is also less it's more difficult to stabilize.
Dr JJ Thomas:For sure. As strange as because it's like, f you. I do the work all the time. Where are you, right leg? Yeah.
Dr JJ Thomas:Like, it's mad at you.
Dr JJ Thomas:Yeah.
Dr JJ Thomas:Your hip is my surgeon's hands. Right? Like, that's what I was saying about ask them what do they do in their free time. Not just to be a nosy, you know, a nosy nurse, but like, but truly because it's going to tell you how to counter the things that they're creating in their daily habits. Because we can't avoid it.
Dr JJ Thomas:If it's a desk board, if it's a person that's sitting all day long, we're going to have to give them things to counter that. If it's a surgeon that's using their hands all day long, we're going to have to give them things to counter that. If it's a snowboarder that's predominantly leaning weight on their left side all the time, we're going to have to give them things to balance that. Yeah. Cool.
Dr JJ Thomas:All right. So stand up.
Dr JJ Thomas:Real quick.
Dr JJ Thomas:Yeah.
Dr JJ Thomas:If I had, like, an issue with the rotational movements, that's when you'd have me prone doing
Dr JJ Thomas:Yeah. External? Well, no. Honestly, I just tried to pick the biggest, like, the most gross patterns that could show us correlations between the body. I you know, again, if I had an hour, I probably would check external and internal right there.
Dr JJ Thomas:If I had 30 minutes, I might just check flexion there and just see if there's a motor control versus a tightness thing. And then look for relationships that way. Good question. Let's face this way for the flexion test. So for this one, yeah, feet together, knees really straight, and I want you to just bend forward as far as you can.
Dr JJ Thomas:Good. And then come back up. And then I'm gonna slip my hand in between here and I want you to squeeze my hand nice and hard. Don't be afraid. Come on.
Dr JJ Thomas:Give it to me, Brian. There you go. Now keep it squeezed. That's the hardest thing for people. They don't want to squeeze you.
Dr JJ Thomas:Keep it squeezed as you bend forward. Keep it squeezed. Keep it squeezed. Keep it squeezed. Keep it squeezed.
Dr JJ Thomas:Keep it squeezed. How'd that feel to you? Come back up.
Dr JJ Thomas:Not all that much different.
Dr JJ Thomas:Okay. Come back up. Go forward one more time. So we're looking at range. Good.
Dr JJ Thomas:Come back up. And then squeeze nice and hard for me. Squeeze, squeeze, squeeze. Keep it squeezed. Keep it squeezed.
Dr JJ Thomas:Good. Keep it squeezed. Keep it squeezed. Keep it squeezed. Keep it squeezed.
Dr JJ Thomas:Does it look different, or does it look the same? Yeah. It felt like he went easy, but it's not but maybe it's not big enough rock for me, to be honest. But it definitely is a little different, but he doesn't feel it. I did make him squeeze more the second time because I feel like he was still afraid to push me.
Dr JJ Thomas:But I want it to be these tests should be pretty obvious if they're going to be worth your time. So it's not I agree. I don't know that it's obvious enough for me or him that I'm going to spend too much time here. Let's go, let's go sit here, arms overhead, and extend back as far as you can. Good.
Dr JJ Thomas:Looks really good. So come back to centre. So by our, like, movement standards, that would be a really functional extension. Right? But what we want to make sure is that we're measuring everyone to their own capabilities.
Dr JJ Thomas:So I'm still even though that looked good, I'm still going to check it against his arms down. So let's do hands at your hips and extend back as far as you can. I still think that's about the same. So if it had changed, I would say I want more. But it looks the same.
Dr JJ Thomas:So I'm not actually that worried. Something to caution to you guys about our patients, many patients, what they'll do, especially females that do yoga or whatever, they'll push themselves forward. And I don't want that either. Like, I don't want it to be like an active assistive motion here. I want to see what they're doing with their arms up versus their arms down.
Dr JJ Thomas:So try to make sure you're keeping an eye on that. Like, I'll just have them like, just place your arms on your hips. Not like, drive yourself forward, you know? Because then it's a whole different I feel like really being deliberate with our testing. So just keep your eyes out for that.
Dr JJ Thomas:Let's check rotation now. Let me make sure I'm following my thing here. So yeah, yeah, yeah. So flexion, extension, rotation. So face that way.
Dr JJ Thomas:This one, I like to watch from behind. And that's because I usually, I like to look at the separation between, like, upper trunk rotation and pelvic rotation, and also, I guess, what's happening down at the at the legs. I think it's important to standardize. Like, I usually have them in this, like, what do we call this? Whatever position.
Dr JJ Thomas:Anatomical position? Yeah. I think if they're like too far out, it gets the tendency is to use their arms. Like, people will do just relax for a second. I notice when people are here versus here sorry, Brian.
Dr JJ Thomas:When people are, like, up here versus down here, they tend to, like, let their arms really move, and it's really confusing. But if you keep them locked in this, like, anatomical posture, then they're gonna move like a rotisserie chicken more, which is what we want. They do. They do. But if you have them, like, if you're, like, keep your arms right here for me, palms facing front, and then I usually cue them like this to rotate, then I can get a better view of, like, upper trunk and lower trunk versus, like, otherwise, the arms are everywhere.
Dr JJ Thomas:And I'm like, what is happening? So Brian on this, his upper trunk looks great in that position. This, I would like to see a little bit more of. Yeah. But it's right.
Dr JJ Thomas:And I'm trying to think if this correlates to what we saw up there. So it was it was worse prone versus sit lumbar lock. Right? So and that prone would be more correlative to, like, standing. Let's see what the left side looks like.
Dr JJ Thomas:So arms at your side. Rotate. That side. That left side is like no. Thank you.
Dr JJ Thomas:I have been working way too hard, putting weight on the snowboard, and you all suck. So but, again, upper trunk doesn't look that bad, but left hips are not happy. The things you have to look for here compensate so, Brian, you're you're, like, maybe 15 degrees of anything. Like and when I measure this, it's like I'm looking for so this is the angle. Right?
Dr JJ Thomas:And then this would be my zero line. So, like, his hips are, like, there, maybe 20 degrees. And we want 50. So we want it to look like that. A compensation that people do without knowing it all the time is they bend that opposite knee or they let the big toe come up.
Dr JJ Thomas:Yeah. So even more subtle, like, they'll do it subtly, Brian. Like, they'll, like, they'll they're sneaky, man. They'll, like, they'll just do it like this, like, ever so slightly. So you just have to really, like I'll say to them, be really honest with yourself, keep those knees really straight, and then rotate.
Dr JJ Thomas:And he yeah. So you just have to look for that. And when you make people be honest about that, sometimes you'll see, you know, tightness even down in the distal compartments. So just again, it's a checkbox that you're like, okay, maybe I'll go back to that if I'm still looking for contributing factors. I think I see a lot of people do, especially hypermobile, is awesome.
Dr JJ Thomas:Yeah. Side bend to rotate. Yeah. Yeah. Stand there.
Dr JJ Thomas:Yeah. Definitely. I think that's where, like Tara, can I use you for a sec? Turn around. I think that's where, like, when I cue people, I usually just go like this.
Dr JJ Thomas:And that way, for whatever reason, I don't know if it's because I'm, like, in their space or what, but they tend to not they don't tend to go out of that as much. Sorry. So the left hip on him confirmed what we thought we saw, even before we test the left hip out in supine, which is the left pelvis is not happy. And it's definitely worth going back to. But let's see now how that manifests into other patterns.
Dr JJ Thomas:So like the single leg stance pattern. So shoes are off. And this one, I'll have them start feet under your hips, and then just raise one knee as high as the other. Good. And hold your balance.
Dr JJ Thomas:And here I'm looking for like, do they hip hike? I always make sure I get a side view. Like, does their opposite do they have a hard time keeping that plumb line in this plane? Like, a lot of people with, either tightness on the downside or inhibition issues, they'll, like, either lean back, right, or they'll be flexed here, and they can't get over that hip. So looking from both front and side view is really important on that.
Dr JJ Thomas:Let's check to the other side. Knee as high as your hip. Yeah. And that one, I feel like I do see a little bit of that hip hiking that I thought I felt, in the, in the supine hip posture. And then if I come to the side keep it up there for me.
Dr JJ Thomas:And his plumb line looks great there, actually. Go into half kneel. This is a SFMA breakout, guys, to give them credit. Yes, exactly. So let me talk everybody through it, Brian.
Dr JJ Thomas:I know you know what to do. But start like a normal half kneel stance, and then have them walk. So 90 degrees at the hip and at the oh, no, no. 90 degrees in this plane. Yeah.
Dr JJ Thomas:So that to standardize it, make sure their knee is at 90 degrees and not past. Otherwise, we're not standardizing each time. And then already in that position, you can see his pelvis is a little bit higher there. So definitely, that's pointing me to hip because I've taken the ankle out of it. And then walk that foot over so it's in line to get a narrow stance, pelvic view.
Dr JJ Thomas:Relax. And then hold your balance. And even though his left side is his tighter side, that looks a little hard. And you can just see that right that left hip coming up, right? And then try to shut your eyes.
Dr JJ Thomas:Yeah. Okay. And that mat is cushy so like that it's definitely going to, amplify. It's definitely the mat. So let's switch sides and start at that 90, 90, 90.
Dr JJ Thomas:So bring that knee out just a tad. Yeah, yeah. And then walk it over to in line with the other leg right there. That hip goes up too. That hip might go up more, actually.
Dr JJ Thomas:You can
Dr JJ Thomas:see, like, my pelvis lifting and stuff?
Dr JJ Thomas:Yes. But again, like, remember the adductors attach together onto the pubic bone? So it could be even it could still be the right adductors I mean, the left adductor's affecting that, but we need to tease out both hips for sure. And you didn't even shut eyes yet. Not yet.
Dr JJ Thomas:Yeah. But that makes sense with the posterior sling because in left glutes are having a hard time stabilizing. Right? But this again, like, I still would probably so if he came in for his shoulder, back to the original question, prioritizing, if he came in for his shoulder, I would do abs and left glute, probably. I mean, I didn't feel the right hip yet, but based on what I felt from the left hip, and knowing that there's that diagonal sling potential, I would probably treat abs and left hip, like lower glutes and maybe adductors, and then retest shoulder and neck.
Dr JJ Thomas:Make sense? You want to do it? You guys want to try it? Yeah, I think it's fun to see the real thing. So let's do it.
Dr JJ Thomas:Yeah, that'd be great. The reverse. Exactly. Yes, thank you. I meant to say that and I forgot.
Dr JJ Thomas:So yes, if he came in for hip pain, I would do the reverse. I would do right shoulder, probably abdominals, and then retest. The hip hike that you're seeing Yeah. You're not cued in to say like, oh, this is definitely one particular muscle you have to then you feel like you have to further I'm so glad you asked that because, like everything we do, it's like zooming out and then taking multiple steps to zoom in to get a better picture. And it's the same thing with that.
Dr JJ Thomas:Like, we know that both hips are hiking. And we checked the range on one hip. We know it's limited. I still want to palpate that hip, but it felt like it was tight. Lower glutes, obturator, internus, adductor, all that stuff.
Dr JJ Thomas:It might be high hamstring too. It might be hamstring in general. But I'm on the wrong side. But I want to feel the other side too. But it's not just like it's feeling everything, but then also palpating on top of that.
Dr JJ Thomas:So it's like that multiple tier checklist. Cool? All right, good. So do you have pain anywhere? Just to see if this scenario is like, can we make it a real scenario or not?
Dr JJ Thomas:When I do like pressing exercises, this shoulder does hurt.
Dr JJ Thomas:All right, good. So we'll treat this first then. That sounds good. So yeah, this hip actually feels a little pinchy to me in like TFL, maybe even rectus. And so again, like these are all on the page 2.
Dr JJ Thomas:Which would his belly button move when he's back? Maybe. Although Maybe not. Right. Like theoretically, if it's the front structures on the right side because it moved right, I think it's more that the I don't honestly know.
Dr JJ Thomas:We have to feel. We have to look and see. But I think it's from the posterior chain, because he sat, which stressed the posterior chain. So I think it's from the left posterior chain. But, let's go to rotation.
Dr JJ Thomas:It's a little tight on rotation on this side too. Not as bad as the left. And then Faber, don't forget to lock down As is. Again, tight, but not as bad. The right was like really tight.
Dr JJ Thomas:So we may have to treat both, but let's treat the right first. Yes, that one. Yes. I was not intending to trick you guys. That one, whatever that is.
Dr JJ Thomas:So now just palpating areas that, like yeah. He definitely is tight lower, like, lower glutes. And that makes sense. Right? Like, with snowboarding, he's in, like he's shifting and internally and externally rotating in, like, a deepest position, potentially.
Dr JJ Thomas:Yeah. So and then let's feel adductors, which also seemed Adductor is huge. You feel that, Brian? Chelsea does. Oh, God.
Dr JJ Thomas:So, you know I want to do it, Chelsea. So Brian, there's a way I've been getting these lower glutes that Chelsea knows because she and I have been doing it a lot lately, where we have the patient come off the table. Let's do it. We did
Dr JJ Thomas:that yesterday. I was gonna ask you about it.
Dr JJ Thomas:We're gonna do it right now. Good thing. Let's do it. So actually your head won't be able to be in the hole anymore. Yours might be because of your lateral shift of your head, but so mean.
Dr JJ Thomas:I'm sorry. Wait. Don't go down yet because I don't want you to have to hold on as much. Like, you'll, I'll support you once you get there, but I'm just gonna swab it first so that you're not, like, so fatigued. Those lower those lower hip rotators, when we flex the hip up, and put it on, like, slight tension, I found we can I feel like I can access it better?
Dr JJ Thomas:Whereas, like, here, it's kind of it's shortened and it's buried, like, under glute max, and it's just harder to get. And it's harder to I also think it's harder to feel the bony like, I want to kind of go to bony landmarks for these. And when the glute is shortened, it's just harder to feel. Whereas when I flex them up, I can feel the bony landmarks better, and I can target those muscles better. Now there's pros and cons.
Dr JJ Thomas:Right? Like the con is, like, I also tend to be pretty close to the nerve here. So if you get electric, just let me know. I'm gonna go slowly, and it won't hurt you. But just let me know, and we'll just redirect if so.
Dr JJ Thomas:Okay? So now you're gonna put your leg off, and I have them flex up there. And then I use my foot to, like, help support them. And and then I use my other knee. There you go.
Dr JJ Thomas:So I kind of like I'm literally, like, driving their leg up and then sandwiching their leg in between my knee and, my foot. Do you feel okay? And then now I'm gonna palpate Again, and it's, like, out here where the greater, troke is. So I'm going through glute max, probably getting quadratus femoris. You good here?
Dr JJ Thomas:As it attaches onto the trochanter. Sliding my fingers to get different aspects of the muscle. So you're you're looking for greater trochanter as well? Yeah. Yeah.
Dr JJ Thomas:I mean, honestly, like, by the time I have them in this position, I'm I'm sniping out tension. And really, what I'm looking for is I'm trying to get whatever tension I feel that is not like, sometimes I am going right where the nerve is, but if I can get it without being right where the nerve is, then I'm gonna try. Like, he's still tight here by, like, the ischium. So now I'm gonna angle I'm gonna push this musculature into the ischium and then angle onto the ischium that way, or towards the ischium. So that's ischium.
Dr JJ Thomas:Like, it's like the superior aspect of ischium, right? Like I'm not bitter. Okay, here we go. Here's another one. So yeah, I'm just kind of following the tightness now.
Dr JJ Thomas:You good, Brian? Now I'm not really on Ishiom there anymore, but I'm just using depth. And he's tight there. Okay. Let's do 2 more.
Dr JJ Thomas:And then I do I know his adductors are gonna need it, but because it's my first visit treating him, I kinda wanna see what this does. So I am gonna do finish with the gluteals and then retest. So now I'm gonna go for it'll it'll be more like the bottom surface of the ilium. So that's ilium. You saw I went through glute max.
Dr JJ Thomas:I'm kind of on the lower borders, probably, of piriformis and edging towards that was glute max again. But I'm on Ilium every time there. It looks like, like, I think in this region, most people don't needle in this region because they're so afraid of hitting the sciatic nerve. But if you go slowly, it's a really fruitful region that will help like, we have a woman who has had chronic plantar fasciitis and some also, not coincidentally, chronic hamstring tendinosis. And, like, treating this area and this position just cleared her up, like, a lot.
Dr JJ Thomas:Like, 70 to 80%. Go back up. Lie on your back. And she was funny because when I was treating it, that's what made me think of it. I was really near the nerve there.
Dr JJ Thomas:And when I was treating it, I told her, I'm like, you might feel symptoms down your leg. Just let me know. No big deal. We'll go slowly. And then as we were doing it, I did approximate nerve, and she's like, oh, I feel that into my heel.
Dr JJ Thomas:And she's like, but that was, like, that was my plantar fasciitis pain. And I was like, good. Let's go. Like, let's see. And then she came back after that treatment, and, she's like, my foot pain is so much better.
Dr JJ Thomas:I like side lying. I just I get so good like, try this and see if you like it for some people, too. Like, I'll do side lying for somebody who doesn't feel as, like, strong. Like, I mean, you kind of even though I'm supporting him, they have to be strong enough to be able to, like, be comfortable in that position. So I would say I use sideline more for the people that are either in, like, an inflammatory state, and maybe I'm nervous about them trying to hold that position, or they're just generally not as strong.
Dr JJ Thomas:Like Brian, I know can tolerate that position. So I would say I prefer this position for those that handle it that can handle it. But side lying is also great. And I'll use it also for and that might just be personal preference. Like, it might just be because I can feel the things I need to feel there and maybe you feel them better in side lying.
Dr JJ Thomas:You know? I'm on the right leg, right, guys? So that's better. But I do feel adductor there now. Do you feel it?
Dr JJ Thomas:Hold this down. Way better. And I'm so glad I retested because I would have thought that I had to do adductor more to get this relief. And I'm not saying he doesn't need it. Not out of the woods.
Dr JJ Thomas:But out of curiosity, let's have you stand and relax arms and then look down. Right? And then center and then look to the right. It looks better but it's hard to tell, right? It did.
Dr JJ Thomas:What do you think, Brian? Does that feel the same or different? Still better when we do the shoulder. But the quality now that he shuts the shoulder is even better. Like he's not side bending at all when he uses when he shuts when he shortens the pack.
Dr JJ Thomas:When I
Dr JJ Thomas:was checking is when I did this the last time, that's when I got
Dr JJ Thomas:a
Dr JJ Thomas:big stretch. Yeah. And it's not as it's
Dr JJ Thomas:still stretching, but it's not as intense. Okay, cool. So let's go up here. And then touch yeah, no, that was right. And then touch behind.
Dr JJ Thomas:That one's subtle for me, that one's really hard for me. So let's go and then let's just check rotation. Please. Should I
Dr JJ Thomas:check this one?
Dr JJ Thomas:Oh, yeah, sure. So extension looks a little easier. Like, everything's a little bit better in that shoulder. Turn that way, feet together, palms facing front, rotate right. Yep, good job keeping the knees straight.
Dr JJ Thomas:And then rotate left. That one's still limited. It's like slightly more, but not enough. So let's go to, let's go to adductor like we wanted to. And then that'll be cool because we'll check neck again to see how much adductor is related to the abdominals.
Dr JJ Thomas:So we'll go face let's go face down because I felt a lot in adductor, Magnus. Here we go. I think I'm going to after this one. We might go the other direction, too, and get it from face up. I'm just following the tension, guys.
Dr JJ Thomas:Okay. Let's go face up. Flip over. And let's go up a little bit. Yeah.
Dr JJ Thomas:Up or down so your head's not falling in the hole. Is that better? Mhmm. So it's hamstrings like, it's not just mat. It's hamstrings too, is what I can feel from this.
Dr JJ Thomas:Here we go. So I'm going to get adductors and hamstrings here. Good job. I am still there. Look at that.
Dr JJ Thomas:That's better. I mean right? Yeah. There's your answer. No.
Dr JJ Thomas:Just kidding. Right? So let's see, and I'm really lacking him here, but like, it's falling. Let's see what everything looks like. Let's check a couple things.
Dr JJ Thomas:Let's check, yeah. Feet together. Look down and up. Good. That was better.
Dr JJ Thomas:So that's that anterior chain, right? Adductors, anterior chain. Back to center. Look over the right. That's definitely better.
Dr JJ Thomas:So again, like the sling there's posterior sling but there's also anterior. Sling. Like these diagonal slings are like adductor. Left adductor is gonna definitely tie to abdominals and cross pattern of the right pecs as well. He definitely doesn't.
Dr JJ Thomas:You're right. Like his neck is not over as much. And then let's go shoulder, let's go right pec. So straight back and touch. That one still needs some help, but it I'd say it didn't change from that last intervention.
Dr JJ Thomas:Look right again. Like look right. And then that's so much better. Come back to center. But let's see if it changes when you cross again.
Dr JJ Thomas:Look right. It does. So I'm still going to do, like, that PEC. And so but now he's coming for his shoulder, and I'm like, Okay, good. Now I feel like we're at a place where we got the foundation in a better place.
Dr JJ Thomas:Now when I do this PEC, I'm going to give you exercises to keep all of that, and then you're not going to need as many visits with us, essentially is what it comes down to. Let's check rotation. So face away from me. Multi segmental rotation. Feet together, palms facing front.
Dr JJ Thomas:Rotate to the right. Look behind me to the back wall as far as you can. Awesome. And then left. Much better.
Dr JJ Thomas:Yeah. So he's closer to 30 degrees there. Obviously, we still have some work to do. What I would do clinically from here is check side bend. Like, is his back so well, there's 2 things.
Dr JJ Thomas:So let's go side bend. And how does the arc look here? Doesn't look bad. How about the other way? That sucks.
Dr JJ Thomas:So right? You guys, like, both overall range, like, he doesn't even get to his joint line here, and angle wise, he's got like a sharp so left low back here would maybe where I go next. However, go back to center. Let's we know that the right arm kept pegging, So let's do right hand across your chest. Left hand stays like this.
Dr JJ Thomas:Now rotate left. Look behind. Look for me. Look for me. It's the same.
Dr JJ Thomas:I will go to left low back next. But some people, you shorten the other thing that kept sneaking up on you, and then it'll change. And then I'm like, I don't care if he's coming for shoulder pain. I'm going to treat the right pec because everything keeps going to that right pec. Makes sense.
Dr JJ Thomas:Cool. All right. I think we should stop and move on.