Postural Assessment / Goniometric Measurements - Session 8 in the Zoom Guided Training Program

Watch this video to continue learning about the OncoVie™ Cancer Exercise Specialist training. This video is provided with free access, and is the eighth session in the Zoom Guided training program with business support. (Exclusively from the Cancer Exercise Training Institute (CETI)).

Andrea Leonard, President and Founder of CETI guides you through the process of conducting a virtual postural assessment, taking goniometric measurements and collecting health history information in preparation for creating a customized exercise program.

VIDEO TRANSCRIPT

• Early morning, at least on the West Coast. Welcome! I know we. We're going to have people popping in as we go, and many people will be watching this as a recording. And it's so funny, you know, because
• 00:00:14
  Margie here and I met in a precarious way 20 years ago, through one of my 1st
• 00:00:23
  workshops that didn't take place, and she had driven there. It was from you drove to another State right like to Connecticut, or whatever she was at the location going, and then called me. She's like, Where are you? And I'm in, you know, another state going well, didn't you get the email.
• 00:00:40
  and.
• 00:00:41
  you know, obviously paid for everything whatever made it up to. And she's still here. 20 years later, after that big faux pas and unfortunately
• 00:00:53
  she has joined club and but but fortunately she is now here to help us learn, and also to, you know, basically be a spokesperson for
• 00:01:03
  the benefits of exercise for cancer patients and prevention. And just before we get started, just in like one sentence, just summarize what? Or 2 or 3 or 4, what your doctor just told you, because that wasn't being recorded, and I just think everybody needs good morning, everybody, or whatever time it is. My oncologist spoke to me recently, 2 weeks ago. Actually.
• 00:01:27
  he said, you must tell everyone this. He just came from a seminar where an educational seminar where they learned for Stage 3 and 4 colon cancer patients. They divided them. They did research, they divided them in half, half, had
• 00:01:43
  surgery, chemotherapy, radiation have had the same thing. But they added an exercise prescription to what they did. They had to follow.
• 00:01:54
  They had to do, and they found at the end of the research those people that did the exercise were astoundingly better that they saw so much improvement in prevention in their ability to continue to fight the cancer. He said it was astounding, and he told me when I speak. If I ever speak to people, he said, you have
• 00:02:16
  to tell them this is an amazing thing, and I think we knew it even 20 years ago. But I mean, I started this in 1995. I mean, literally, it was, you know, just breast cancer back then. But
• 00:02:30
  there was no research. I mean, this was like there were me individually, and 2 other people in the world, as far as I know that were even going going down this road, so to speak. So you know, here we are, many moons later. We're all a lot older, a lot wiser now there's the research to support it. But I had gone to meet with a breast surgeon
• 00:02:53
  a month ago, and you know, was sharing with her about what I do. And this this surgeon is actually a dancer, and she said she offered a free class to her patients. I mean, here's the surgeon saying, You know, come, come, do this, it's free. Nobody would show up. She's like they just don't. She's like they wanted to go meet for cocktail hour with their friends or and and so, you know, I've always kind of
• 00:03:18
  said it's the doctors that aren't telling the patients, but that may, in fact, not be true. I definitely think there's a drop off in many different areas. But that's not what we're here to talk about today. But I thought it was so compelling to hear this from Margie.
• 00:03:34
  I'm going to let Margie give you kind of the rundown of her situation, because it's it's very. I don't want to just sit here and read from a piece of paper. So let's, you know, talk about everything, cancer, anything orthopedic, in addition to any side effects you're having, and then we'll get into the assessment.
• 00:03:54
  Okay? Well, let's see, I was diagnosed with hepatocellular carcinoma, which is liver cancer. A year ago. It was July 17, th and it's amazing how you do not forget that date 2024. I was diagnosed, took several tests, several Mris and cat scans, and they couldn't believe I had it. But here I am. I have it. I was originally diagnosed with a larger tumor. It's all confined by the way it's confined to my left lobe of my liver.
• 00:04:24
  A larger tumor and 3 very small ones were in the left lobe of the liver. I felt nothing. I didn't know that I had it. I felt fine. I was diagnosed simply because I went to get my general blood work my lab work because I'm hypothyroid. So they went, and then they saw my liver. Enzymes were up and they went. Oh, that's odd! Let's test you again in a month, and they were up again, and so they went through the process and come to find out
• 00:04:48
  several doctors later. What they told me was that I'm a stage 3.
• 00:04:54
  The doctor said to me, it is. We cannot do any type of surgery on you because of the size. Now you are not spread, it is nowhere else, and they have checked me thoroughly, let me tell you, between blood work and scan after scan. It has never metastasized in me, which is a miracle in and of itself.
• 00:05:15
  They put me immediately on. The doctor took over. He was going to put me in a research study, said, Let's do our own thing. He put me on immunotherapy
• 00:05:25
  and targeted therapy. So I was on 2 different kinds. One is Avastin, and I still am Avastin, and the other one is tecentric.
• 00:05:33
  and they found through research that the combination of these 2 has been proven to be fairly effective on people with Hcc, that's the cancer that I have.
• 00:05:42
  I have been very fortunate. I have had some side effects, but I would call relatively minor compared to what you could get.
• 00:05:52
  My side, and I've had 14 infusions, by the way. So my side effects have included some skin rash. But that went away within the 1st
• 00:06:01
  few months. That wasn't so bad. Mouth sores. That's that's from the Avastin. So we we know that that's what that's from that's controllable with a special toothpaste. And you know you don't eat tomatoes, you know anything acidic. We also found that I had. I didn't have fatigue, which I was actually quite happy that I didn't have
• 00:06:24
  they found that
• 00:06:26
  the Avastin, which is what that does is, it actually attacks the vasculature of the tumor itself to try to break that apart and knock that down. And the Avastin. What happened was, it affects your blood pressure, it can affect your thyroid. Oh, here I am! I had excellent blood pressure, but here my blood pressures were going up and up and up. So I've been taking, and I have to monitor my blood pressure every day, and I adjust it with the pills that they've given me for that
• 00:06:56
  no side effects. From that I'm hypothyroid. I have been for almost 20 years, but that really took a dramatic dramatic effect on my thyroid.
• 00:07:05
  So I was getting very tired after a while, and I thought, What is this? You know? Maybe it's the whatever. But you could see in my blood work. The thyroid really took a hit. So again we've had to up the level of the thyroid. I went from 70 to now to 1 25 Mcgs. So they changed that, according to the effect that the immunotherapy is having.
• 00:07:27
  I do get some achiness. I do get a little bit of lightheadedness, but not that it's impossible for me to function. I get breathless, which for me I've always been into fitness, breathless like you could be anywhere at any time you're like. You can't believe that you've got this breathlessness, does it last long? No, sometimes your symptoms will last 2 or 3 days, and then they're gone.
• 00:07:53
  which is unbelievable after you get an infusion. Yes, and then you'll and then you might go into a different type of a side effect, and then that'll go, and a different side effect, and then that'll go away. So it's 1 of those things where you're just sitting there going. I never know what's coming.
• 00:08:08
  You go. I go every 3 weeks without fail. I have to. I am required.
• 00:08:12
  So after a certain amount of time, they of course they scan you again, they scan you again, and my largest tumor did shrink by 3 quarters of an inch, which is very good, and one of my smaller tumors disappeared, which is very good. So we decided I was stabilizing out. I was really stabilizing. It didn't seem to be having as much effect. But it was holding me back.
• 00:08:34
  So I, just 3 weeks ago, had something called Y 90 therospheres or radio embolization.
• 00:08:41
  And what they did to me was, they decided that they were going to do a catheter through my arm. They did my arm because my, I was fine through here. They went up through my arm
• 00:08:52
  into the left side of the liver, and instead of just trying to radiate the tumors, they're decided to radiate the entire left side of my liver because they thought I was healthy enough, and I could do this. Okay, all right. So they whacked me with what they told me was a high dose of radiation just in the left side of the liver, pulled out. Shut it off.
• 00:09:13
  So there's lots of side effects from that. You feel like you have the flu a fever I will to this day, as of yesterday, I get a fever in the middle of the day, 99 to 100 degrees
• 00:09:25
  just randomly. The necrosis. Yes, it's the necrosis or the death of the tumor. Your body gets so inflamed when they do that to you. Your body freaks. That's why you feel the flu symptoms. But every day a little bit better, a little bit better. So today it's been exactly 3 weeks. I'm feeling pretty good, a little tired, but not quite as fatigued.
• 00:09:48
  but it's all controlled by medication. So you know, you take Tylenol for the fever, and it goes away, or you take Zofran. If your stomach is upset, that goes away. So I'm undergoing that. And they said it was highly successful. They feel my tumor markers dropped crazy amount already.
• 00:10:04
  They are going to wait 8 weeks. They're gonna still give me the infusions, but they're going to see what comes after that to decide exactly what they want to do. Okay, yeah, it's good. It's a good thing. Now, me other than that.
• 00:10:17
  I
• 00:10:19
  I have sciatica in my right side now. I've had that for years, but it did go into what I call remission. About 4 or 5 years ago I felt great. I rarely felt it. But what happens when you get immunotherapy? It causes inflammation, and it can inflame anything at any time.
• 00:10:39
  I had a college injury in my left ankle all of a sudden. I'm waking up at night. My left ankle is killing me. I go. I can't believe it. So this left side does flare. My sciatica comes back.
• 00:10:51
  And it's okay. So one sec. So first, st I heard you say you had sciatica on the right on the right, I'm sorry on the right, left ankle right? Just just want to make sure. Okay.
• 00:11:04
  dancing here. Also, I'm trying to think if there's anything else that I need to tell you. I don't think so. I'm I'm an active person. I try to stay very active. I have found through all of this. I feel just as good and sometimes better, getting up and moving around as I do, sitting in that chair over there that you sometimes when you sit.
• 00:11:31
  you think, oh, this hurts that hurts that. What is that? Could that be this? Could that be that? And sometimes you just feel lousy. And to get up, and to be able to just move, just do anything whether I go out my backyard and pull a few weeds, or I try to fold the laundry, or if I clean my bedroom, whatever it might be.
• 00:11:48
  I feel better. So don't think that just because people are undergoing treatment means they always have to sit still. Sometimes they could just get out with nature. They could just, you know, I walk every day with my dog as much as I can.
• 00:12:03
  So just so, you know that that's an important thing to me that I don't feel I need to sit still. Yeah, I wanted to just point something out real quick before we get going, and then let you finish what you were saying. So one of the biggest problems that I have, and and this is going to. I'm not intending to contradict you, because what you're saying is absolutely true. But the problem is when the doctors say, do anything. Yes.
• 00:12:30
  you know what to do. You've been doing this for 20 years. But the problem is, the the average person does not know we're going to talk, you know, margin. So so they did not ever do a liver dissection.
• 00:12:43
  They only did a biopsy. They dissection on me because it was too big that the too large they can't. But now that they are trying to shrink the tumors down they can downstage me. I know what they're doing. They're trying to downstage me enough
• 00:12:59
  and shrink. That left lobe of my liver half kill that off as well, and then the right side. They'll cut out the left. That is our goal right now to do. But you're right, Andrea, you're right. They do tell you whatever you yeah. Well, or they'll always just say, Well, just walk, or whatever.
• 00:13:16
  Well, and and so you know, in terms of postural assessment and range of motion that we're going to do today, which is is mostly just to show everybody how to do it and whatnot, and you know you might have imbalances just from being you like most of us do. But when you're dealing with somebody who's actually, let's say she had a big incision. And there's scar tissue. There's adhesions, radiation, also scar tissue adhesions. It can change the posture. And so
• 00:13:42
  you've got postural issues. You've got range of motion issues. Then you've got neuropathy, all types of side effects. And when the doctor says, just exercise and the person's like, oh, well, okay, you know I have a treadmill at home. So what? I can't feel my feet, you know, and they go flying off the treadmill. And so that's why going through this 500 page manual and 32 videos and everything else is so important because
• 00:14:05
  people want just like a cookie cutter workout, and there isn't 1. Every single cancer patient has a different journey, and that that includes mental, physical. You know the whole shebang, and I don't care if it's a hundred women with a modified radical mastectomy and implant, you know, they all have the same exact thing. They're all going to have a different experience, and that depends on everything around them, from their support system to you know what they're able to.
• 00:14:36
  It could be a combination of of monetary or just availability in terms of quality, of food, mental health, counseling support groups, all of that comes into play. So now you may not remember what you were about to say. But was there a final thing before we put you? Okay, okay, so I'm going to spotlight you now. And
• 00:14:58
  Zoom has changed around. And it's all weird. Okay, there we go. Now you are the star.
• 00:15:04
  all right, you guys. So in in your handbooks. So once you've gone through, you've gone through all of the surgeries you identify. Where is the potential of the incisions? What are the side effects of the surgery? That's not an issue. Here, then you go through treatment, and she's just talked to us about the various treatments she's had. We know, the side effects, skin rash, which has come and gone.
• 00:15:27
  mouth sores which obviously don't affect exercise. They could affect nutrition for some people not being able to eat certain foods, and then, of course, high blood pressure. You're on medication, but need to be monitoring that lightheadedness, breathlessness, these are all things, particularly with somebody who is not real, familiar with their body, who is not a fitness professional that we need to really be aware of.
• 00:15:51
  because we don't want someone overdoing it and taking away what what little energy that they have, they should always leave their exercise session, feeling more energized, or at least the same, they should never leave feeling more fatigued than when they, when they showed up to start, or you've done too much, and it's not the end of the world. It just means next time you need to back it up.
• 00:16:13
  So sometimes it is one step forward, 2 steps back, and you want to keep up the morale and let people know. This is just, you know the general course and stick with it. It's going to make a difference, and it always always does. 35 years or 30,
• 00:16:29
  however many years since 1995, 30 years that I've been doing this I'm aging myself even more, and I've seen so many people with just remarkable outcomes and increasing longevity, and you were talking about the conference that just happened recently. I don't remember who actually held it, but it was a huge oncology conference, and they said, Hands down.
• 00:16:53
  Exercise is the key to prevention, to minimizing treatment side effects and to extending life as far and quality of life. Sorry I'm a bit thirsty. I might have to run and grab some water in a minute. But
• 00:17:05
  postural assessment. You know you may be doing this. Can everybody check and make sure you're muted, because I hear I'm watching this people pop on and
• 00:17:18
  everybody check and make sure you're muted, please. It'll be time for me to leave out of here, hold on a second guys.
• 00:17:25
  Yeah. 10 o'clock, 1010, 15. Got another hour. So I can get my hair done.
• 00:17:30
  There we go. Okay, all right. This is fun. So that'll probably happen again.
• 00:17:36
  all right. So when you're doing a postural assessment, you want to make sure that your client doesn't have socks and shoes on, you know, if it's the middle of winter, and there you go, and you know, particularly if somebody's going through Chemo, they don't have a whole lot of body fat. They're freezing. Then I'll have them, you know. Put their socks on, keep their socks on until I need them to take them off to see their feet, which will, you know, be the lower body part of the assessment.
• 00:18:02
  okay. And I do get a little. Add. So when people keep popping on and off, and their volume is up. Forgive me. I'll find my way back all right. If somebody has lifts in their shoes or orthotics that's going to throw off their posture, obviously, probably in a good way. But we don't want to see, you know the perfected version. We want to see where somebody is at right right here, right now and then. We're going to use this as a baseline
• 00:18:26
  that we can look back at much like your doctors are looking at. How the tumors are shrinking we're going to look at is your posture changing for the better? Is your range of motion improving is your energy level improving, and then make modifications accordingly.
• 00:18:40
  So when you're doing these on zoom, it's it's a little challenging. I mean, it's not perfect. I can't see. When she stands up. We're gonna have to adjust the computer. We'll do upper body and then we'll adjust it again, and we'll do lower body when you're in person. Obviously, you can. You can walk around the person. You can look at different angles. And you know we started doing this during Covid. But the great thing is, you know, Mark, where are you? New Jersey, or
• 00:19:02
  where do you live? Marcy? Yeah.
• 00:19:04
  yeah. Okay. And I remembered that from 20 years ago. And and I'm in Colorado. And you know, as long as we can figure out the time zone. We're good and we can do this live. So all right. So without further ado, let's let's get you to stand up. And yeah, just move your chair out of the way. Now I got on with her ahead of time. Just make sure the lighting's okay. You know.
• 00:19:27
  so that you can see clearly, and you do the best with what you've got, because you can't control what's going on in your client's house. When we do this I always ask my clients, and don't do it yet to close their eyes and march in place for 5 seconds. And I want them to basically then open their eyes and just hold still land where they land. Don't try, and, you know, stand like a soldier, and then, if Margie has to move, she's got an itch or a
• 00:19:52
  cough, or whatever. That's fine. We just march in place and reset again.
• 00:19:57
  It's not
• 00:19:58
  super clear. I can't see high definition, but I can see enough like immediately before we even get started. I can see that your head is rotated to the right, because I can see more of your left earlobe than I can your right, even though it's fuzzy, I can still make out, you know, kind of the outline. And so this is, you know how we're going to do this. We're going to start from the top and work our way to the bottom. Can't see her forehead doesn't, or top of her head. It doesn't
• 00:20:23
  matter because I'm looking. I'm starting at the earlobes and working down. So whenever you're ready, let's have a couple steps with your eyes closed. Try and just loosen up your body.
• 00:20:33
  Check it out, hey? When you guys are hopping on, please make sure you're muted.
• 00:20:40
  Okay? And then stand in place, Margie. All right. So try not to move as best you can, and you can take a pen, or you know, whatever a piece of paper, and you can literally hold it right up to the computer and go to the bottom of her earlobes. And so the 1st thing we're looking at is, are they level? Now, you guys are welcome to participate here. You can write in the chat box you can unmute if you want to speak as long as we don't end up having everybody speak at the same time.
• 00:21:09
  so as far as I can tell, and I've got that picture that's right behind her. And assuming that's level, that gives me a great thing to compare against, so it appears to me and correct me if I'm wrong. I think her left Earlobe appears a little teeny bit higher.
• 00:21:26
  and that I see more of the left, which means her head would be rotated slightly to the right, so I can see the left earlobe where I really can't see the right now. I know it's a little fuzzy on the computer. But you know, one of the things is, I've been doing this for so long. This is obviously easier for me than somebody who's never done this before, and I see things that you might not see. But let me know guys through chat or whatever. So I'm going to put
• 00:21:52
  slight elevation
• 00:21:57
  of the left ear. And I don't know that that's where it's originating from yet. We're just putting pieces together, slight rotation
• 00:22:06
  of the head
• 00:22:08
  toward the right. So I am, just, you know, making sloppy little notes like this. If you guys, those of you who are in the course already, and in your I think it's Module 3. Where the assessments are, or at the end of module, 4 actually are the forms, and there's actually an assessment form. You can also download it in your learning management platform. And then you just fill this in. You don't have to do. Scribble on a piece of paper
• 00:22:33
  all right. Next I am, and you can also look. It seems you can see more length if you will in the left side of her neck than the right, and then I go to the left trapezius, and without a doubt that left trapezius is more elevated or tighter hypertrophy. Not sure what you know. I'm not diagnosing things. I'm just using my eyes right now to tell me where I'm going with this. So I'm seeing left shoulder elevated.
• 00:23:01
  So that makes sense that it goes along with the ear. And, Margie, you can chime in any time if you like. Did you ever injure your shoulder? Do you carry your purse on your right side, or you carry? Walk around with a bowling ball? I have for probably 30 years carried all my fitness bags on my right. And I'm looking heavy stuff. So it's 1 bag, 2 bag, 3 bags this side and go.
• 00:23:23
  I'm sure of it. Okay, so probably, you know, I'm already telling myself, all right, we're going to be doing some good stretching for the left side. One thing, and I know you're standing like a you know, a soldier there, so I don't want to talk too much. But when they did a biopsy, do you know. Did they take lymph nodes?
• 00:23:40
  No, they did not. Okay, all right. So if they had taken lymph nodes, then Lymphedema is a concern for me. So and you didn't have external beam radiation? Right? No. Just the internal. Okay? All right.
• 00:23:52
  Okay. So now, let's, oh, yeah, I don't. Can you see me?
• 00:23:58
  Can I see you. Yes, okay, because sometimes people can't. So I want you to go to the top of your hips, to your iliac crest.
• 00:24:06
  Take your index finger and just right on top. Try and keep it level for me so that I can see if your hips are level. If you yeah, there you go. Okay. So they they look. They look totally level. It's funny, because in my mind's eye it looks like the right side is higher than the left, but your fingers show that they are level.
• 00:24:30
  Do you? Would you say that your right finger's a little higher than your left.
• 00:24:34
  or do they live all right? So we're going to go with hips or level.
• 00:24:40
  Okay? And when you're describing, you can relax your hands when you're describing this to a client, particularly if the client's heavy, you know, overweight, they're having a hard time finding these landmarks. Don't don't worry about it, you know. Just do the best you can. I never want to make somebody feel insecure or bad about themselves. I'll tell you one thing. I never do. Body fat measurements. People ask me that it's just not warranted. I mean.
• 00:25:04
  people know, you can look at somebody and know, okay, they have a high percentage of body fat. We know that's not good. We know we need to work on that, because that increases risks of future cancer, etc. But I don't need to say, Oh, you know, let's use a caliper or whatever, and tell them they have 40% body fat, because that's not going to do anything for their morale.
• 00:25:23
  All right, I am now. I am.
• 00:25:25
  I'm going to kind of look at the where the elbow creases are, and I'm also looking. Just just go ahead and let your arms hang. You're good looking at the wrists to see if they appear level.
• 00:25:39
  Which this is. This is interesting because your hands
• 00:25:44
  look level. If anything, your left hand almost looks like it's lower than the right, but your left shoulder's higher. So it's like, how can that be? Is your left arm longer than your right arm. So these are all these, you know, anomalies, you see with people. And you're like, Okay, well.
• 00:25:59
  we're going to work with this.
• 00:26:01
  The other thing I'm looking at is, if her palms are facing her body, or if they are rotated backwards, and yours are somewhere in the middle, so I would say, you know, slight to moderate, and what that is going to tell us is protraction of the shoulder, because.
• 00:26:18
  as the shoulder protracts, the hand rotates. So if you see somebody whose hands are completely like this. You know, they have extreme rounded shoulders, whereas if they're like this, you know anatomically correct.
• 00:26:32
  then then that's probably not an issue. Most people have some degree of rounded shoulders, protracted shoulders. Because we're on the computer. We're on our phones. We're on our ipads tablets, whatever. As if things weren't bad enough with posture before
• 00:26:50
  tech. Now it's way worse. So I'm going to put slight to moderate.
• 00:26:56
  Okay? All right. Now, I am moving along, and we're going to the knees
• 00:27:03
  once again. It's not super super clear in in person. You're going to see a lot more detail, but try and make out the patella.
• 00:27:12
  and determine is that Patel is centered, or is it slightly to the left? Is it slightly to the right?
• 00:27:20
  Now, as far as I can tell, they both look perfectly centered
• 00:27:24
  one way. So we're doing a static test right now. When we do a dynamic squat test which means moving. Then we can see. Do the knees bow out to the side, do the knees kind of collapse inward, and determine if there is any type of imbalance. Now I can't get any further. We're not going to see her, her feet in this view, but I want to also look from the side, and I want to look
• 00:27:48
  from the back. Give me one second. I just have to grab something to drink, because my mouth is parched, so shake it out for a second I'll be right back.
• 00:28:02
  1st thing I could grab it's a hundred degrees here.
• 00:28:08
  I cannot drink enough water. It's like insane. Okay?
• 00:28:12
  So now you can pick a side left or right and then I am going to have you do the same. The same dance march in place again, and just let yourself land where you land.
• 00:28:25
  Okay?
• 00:28:26
  Perfect. All right. So what I want you to imagine. And if you guys, you can really see with this shirt. I have very pronounced clavicles. Okay, so if you think of a clavicle kind of like a coat hanger, the earlobe should be coming down right in the middle. Okay? So if the earlobe looks like it's it's lined up on that front of the clavicle that's telling us they have forward head.
• 00:28:54
  so I can take my pen right up to the computer. I can go from her earlobe down now. I can't see her clavicle, but I know where it is, and I can also look at the curve in her neck. I can look at the thoracic curve of her spine of her upper back, and you can see she has what is typically known as Round shoulder syndrome, which is forward, head a little hold on one second, you guys, my dog had surgery yesterday. This, the timing of everything, couldn't be worse
• 00:29:21
  gazely from here.
• 00:29:23
  So I've got my son's dog here trying to.
• 00:29:27
  anyway. Sorry this is this is life. Alright so definitely seeing the forward head. I can see it in the neck, and I can see where
• 00:29:37
  the earlobe comes down to where the clavicle would be so. I just write down slight, moderate, round shoulder syndrome.
• 00:29:44
  I can look at. You know her spine. You see that that kyphotic curve, and then the thoracic, but the your low back looks somewhat flat. Do you? Do you tend to have more of a flat back, or is it just your shirt?
• 00:30:00
  Oh, am I? Sure? Yeah, there's your curve. Okay? So that's normal. All right, all right, cool and and we're gonna we're gonna point out asis psis. And and explain that to people as well. So just kind of looking at everything. Her hands now from the side. They don't look as as turned back as they did from the front. They look almost
• 00:30:25
  like they're facing her body. So that kind of makes me readjust that thinking also looking, it looks to me, and it's it's pretty fuzzy, because I see you know your one leg
• 00:30:35
  behind the other one. But are your leg? Are your knees kind of hyperextended.
• 00:30:41
  Do you stand with your legs locked out?
• 00:30:45
  Yeah, I do. Probably most. For the most part I do. So, cause I'm not.
• 00:30:50
  I don't stand in a flex knee position. Yeah, I probably locked out. Yeah.
• 00:30:56
  And that could. Just you know, it could be that you got really tight quads. And just when you're just by default, you end up locking out, because when your quads are tight it's going to pull. You know, it's going to lengthen the hamstring. So you have reciprocal inhibition. If I contract my bicep, my tricep has no choice but to stretch. If I contract my quadricep, my hamstring is is stretched or elongated, and so that ends up kind of flattening out the back of the leg.
• 00:31:23
  All right, let's explain asis psis. So when you poke around at your hips. You've got a bony protrusion in the front. You've got a bony protrusion in the back.
• 00:31:34
  And so
• 00:31:35
  if I sit here, I kind of like I can just knock. I can feel this this bone right here and same thing back here now again with somebody who's larger. I'm not putting them through this I can simply look at the waistline of their pants. But, Margie, what I want you to do, if you can, is take your right hand to your left, Asis. So that's anterior, superior iliac spine. So look, look at me in the in the camera.
• 00:32:04
  So so you're facing this way, but I want you to put your finger on this this bone right here. I gotta look at you
• 00:32:13
  right here. Okay, right? And psis, okay. But for us to see it. You're gonna bring it around. So I I want to see like this.
• 00:32:23
  So you're gonna have me go like this and like this, okay, hold on. Just just think so. We can see it alright. So like this
• 00:32:30
  other way, other way. Okay, so take your index finger on your right hand and find that that hip bone in the front should be more in the front. Got it? Okay. Now, just use your index finger. Now take your index finger on your other hand and find the one in the back.
• 00:32:51
  And if you if yeah, there you go, if you can try and like level them out as much as possible.
• 00:32:57
  Hello!
• 00:32:59
  And you're not looking for the soft spot you're looking like. If you were to knock on your hips you would feel it. Okay, so can't really see your finger on your left arm, can you? There you go, all right.
• 00:33:10
  so I can't see her fingertip, but I can tell that it is higher. Okay? And look at the angle of her hips. You you can see just
• 00:33:21
  if you took a pen up. There's almost a line that you can see from where her back finger is to to the front, not where her front finger is, but just like like where her waistline would be so that is a slight anterior pelvic tilt. It's not severe. Go ahead and relax. So this is called lordosis sway back.
• 00:33:42
  Most people have a little bit we have that normal lumbar curve. It's when it's really excessive that people start to have low back pain, and and that can also increase sciatica. So
• 00:33:57
  have you ever been treated for the sciatica? Yes, I have actually I I mean, I got diagnosed with the sciatica. My L. 4 l. 5
• 00:34:09
  are arthritic, and there's a lot of you know little spiky things on there that were pinching off the nerve. But but I went to an actual massage therapist who was amazing.
• 00:34:21
  and she had told me often, one side is higher and one side is lower with my hips. So what you're saying I can't remember which, but what you're saying is making sense to me. So there is. There's a little bit of a shift there that that's happening. But I didn't have like. I didn't have surgery. I didn't have.
• 00:34:39
  I did acupuncture, and I did massage therapy, and I stretched stretch, and I went to a chiropractor, and I got rid of it. For now, okay. And have you ever been diagnosed with scoliosis? Yes, I have scoliosis. I forgot about that scan. They did my cat scan all right. And and do you know like, do you have a side to side? S. Curve?
• 00:35:03
  Or is it more front to back. You know, you know what I mean side to side. Okay, so that makes sense. So if the spine is doing this, you're going to have probably an imbalance at some point along the line, and that may also be attributing, you know, the the elevated hip, the elevated shoulder, the elevated ear. If everything's on one side that makes perfect sense. Okay.
• 00:35:30
  all right. The other thing that you can try and see
• 00:35:35
  again. It's very difficult, virtually, but is winged scapula, and let me see if my scapula. Normally, I'm not in a tank top. But let me.
• 00:35:45
  Let's see if I can let me spotlight me for a second. So you guys can see what I'm talking about here. Now.
• 00:35:51
  do I get to be spot, add spotlight. Look at that, all right. So let's see?
• 00:35:59
  See that? How my shoulder blades popped out. I'm trying to make it do it. But that is what winged scapula looks like. Okay, I'm forcing it. But I do have it to some extent, and let me unspotlight myself again.
• 00:36:15
  Remove spotlight. Okay? So especially when we're dealing with breast cancer patients when they have lymph nodes removed, they can cause nerve damage, and a temporary ceasefire to the serratus anterior, which basically goes from front to back here, and it stabilizes the shoulder girdle. So oftentimes, when we see winged scapula we go all right. We've got weak, Serratus. We've got tight rhomboids, and I'll teach you
• 00:36:42
  next week, or whatever day we do the actual exercise programming, how to use the handbook and actually put together the workout based on muscle imbalances. So.
• 00:36:52
  Margie, I I can't tell, you know, with a black tank top and this and that do. Do you know, if you have winged scapula, I don't really. I never felt like I did. Okay, okay, all right. And
• 00:37:06
  again, I can see it. I can't see it, you know. Sometimes you just have to ask your client to kind of participate some people. It's so funny. I've had people just take their shirt off because with women with breast cancer, they're like, I don't care. I'm just like, okay, you know. But you can certainly see more. Now, mind you, Margie does not have breast cancer. I'm just using that as a comparison. So I'm gonna have you face that back wall
• 00:37:30
  now, and we'll complete the top part of your body. Do the marching in place again for me.
• 00:37:38
  and then just hold still. All right.
• 00:37:41
  relax. So we have a little different view here. Now you can see this is very interesting. So you can definitely see the right hip is higher, you see more space between the right elbow and her body. You see, you've got light coming through. Go ahead and relax your arms you like tightened up. There you go. So you've got that little bit of space there. So we're like, okay, why, I can see that left shoulder higher. I can see that left ear higher.
• 00:38:10
  and normally you would think that the left leg would be higher. But this could be the scoliosis, because, you know, unless back in the whatever early eighties they used to put you in like a cage to straighten out your body. I don't know if they do anything anymore.
• 00:38:28
  Okay. We already looked to see, you know, earlier, when I was having her do the fingers. So I don't need to do that from the back. We're looking.
• 00:38:36
  it!
• 00:38:38
  It's interesting. Why, your arm is further away from your body. I feel like
• 00:38:44
  there is the S curve where your left side is kind of pushed out one direction, and your right side is pushed out another direction, because it's it's almost like you're not stacked up and down. Your body is kind of shifted a bit from your torso, shifted a bit over to the left. Now no one would notice this if you were walking down the street. But we're here to pick you apart. And and, you know, potentially come up with corrective exercises.
• 00:39:10
  Now, whether or not we're going to correct something with scoliosis, you know. Probably not. But there are certain things, certain exercises I definitely think, that can help relieve some of the sciatica. So I see that lean to the left and
• 00:39:26
  check this out. Your left leg appears more hyperextended than the right, because you're weight bearing on the left side. So whether that is because of the scoliosis, or because you're compensating it all, it starts to make sense. Okay, so
• 00:39:43
  there's not much else, you know that I can. I can really see. You know you just look at these these landmarks. And if anybody sees something that I don't see, please feel free to to chime in. But otherwise we're gonna lower your computer screen so that we're pretty much just honed in on your feet.
• 00:40:03
  and yeah, you could. No, no, you. I can't see your feet. So can you. Can you adjust your computer? What are we doing here? Am I doing it? Just we just want to see your feet. There we go. So
• 00:40:14
  right right there is going to be perfect. So go ahead. We got a march again. Now before before we really focus here. We're looking to see if her feet are are forward, if they're rotating outward. Now, interestingly.
• 00:40:29
  and I, you're you're that left foot dominant, straightened out bodies totally askewed. Is that your natural stance, or did you just kind of land weird?
• 00:40:40
  Well, I think it probably is my natural stance. I mean, this is how I landed. Okay, I got a hammer toe over here which I never had. If I ever have problems with my feet, it's my left foot. Okay? So I've had Morton's neuroma. It's always the left. Okay? So you have had left plantar fasciitis
• 00:41:01
  left Morton's neuroma.
• 00:41:04
  And I do have hammer just got started getting a hammer toe on my left.
• 00:41:09
  But obviously with this, with all this cancer stuff going on, I haven't been yeah. Yeah.
• 00:41:15
  Well, it's very obvious to me that I mean that this this imbalance that is going on it's it's interesting.
• 00:41:25
  just just the weight shift and whatnot.
• 00:41:28
  And and I do think that it's scoliosis. I don't think it's just a muscle imbalance, but you know we see both feet are slightly turned out. They're not going straight ahead. I mean, very few people do have that perfect alignment. But normally, if people's feet are really turned out, you also see their knees rotating outward. And so whether you know, if if people, the next thing we're going to look at is whether you're supinated or pronated. So
• 00:41:55
  this is very difficult for me to see now which toe is hammer toe your your second toe.
• 00:42:05
  Yes, okay,
• 00:42:08
  It looks to me
• 00:42:10
  like you are more pronating on that left foot. Do you feel the pressure more medial on like your big toe? Or do you feel like you're rolling out on your pinky toe.
• 00:42:22
  or neither.
• 00:42:26
  Well, I kind of want to say the pinky toe. Maybe I feel sort of equal, maybe a little more, on the pinky, but certainly not
• 00:42:36
  coronation, not going in at all.
• 00:42:38
  So let's let's do this for a second. Grab your shoes behind you.
• 00:42:41
  and let's look at the wear pattern, and this is another way you can tell. So do you see any? And maybe you won't see anything. But do you see any uneven wear on either the left or the right side of the shoes. They look pretty new.
• 00:42:58
  I can't see them. They're too high.
• 00:43:00
  Oh, no, I'm looking. Hold on. Oh, okay, no, and you can look. I don't need to look.
• 00:43:05
  But yeah, it's it's too hard to tell from here. But can you tell if one side is more worn than the other.
• 00:43:14
  If it's not obvious, it's not a big deal. I know it's not obvious. Okay? So like, I can look at my husband's shoes and like the the outside is completely worn off, and and the inside is is fine. So that tells me he supinates, which means he he rolls out and he's in physical therapy now, because I've been trying to correct this on him for years. But he won't listen to me.
• 00:43:36
  So the thing about these muscle imbalances and you don't have to be a cancer patient. Every single human being should have this done to them. Because this is this is what we call functional fitness. You cannot put together an exercise program for somebody without understanding their anatomy and their biomechanics. I mean, that's what I was saying about doctors going? Oh, yeah, just go exercise. I mean to some degree like walking. Sure, that's fine, you know. But if you
• 00:44:01
  going to start lifting weights or doing anything that's strength training related, you're potentially going to cause a worse imbalance if you're doing the wrong exercise. So we have to look at all of these things because you don't think about like, oh, I'm going to go to the gym, and I'm going to have foot exercises. That's my goal.
• 00:44:21
  But the problem is, if you don't correct these imbalances. That that ankle that foot, then it's the knee, then it's the hip, then it's the shoulder. It's everything's connected through the kinetic chain. And so this is preventative as well as right here right now, because we don't want that sciatica to progress. We don't want more arthritis on L. 4 l. 5, and I have the same thing, I mean, I have hellacious arthritis in my cervical spine and in my lumbar spine.
• 00:44:51
  and I had back surgery last year, and I had debilitating sciatica. You know you kind of go. Oh, sciatica, you know. You hear people say that. Let me tell you the worst pain worse than childbirth, the worst pain I've ever known. It's literally like somebody taking a lightning bolt and sticking it in your spine and sending it down your leg
• 00:45:12
  so a lot of times now mine was a cyst growing in my spinal column, so there was no amount of exercise that was going to change that they had to remove the cyst.
• 00:45:24
  but sometimes it's a muscle imbalance, and you've got an impingement on a nerve. So when we, when we do the proper stretches and we strengthen the opposing muscle groups, we see an improvement in that so so going back to the feet, can we get you to stand up one more time. I want to look from the back. I want to look at your Achilles tendons, so just march in place again. Can you get in front of the white thing? It just kind of just it. Look, it centers you. Can you walk forward a little bit?
• 00:45:53
  There we go, and then just stop whenever okay, all right.
• 00:46:00
  So I'm trying to read what you're saying. Here, Marcia, what I can see is the left foot is slightly pronated. See, I see that now, don't you? Now, now that you're standing, you're definitely pronated on the left foot, you can see the left. Well, 1st off you can see the left foot is more rotated. Externally. You can see it kind of rolling inward, and you can see the Achilles tendon, the one on the right is straight up. The one on the left is kind of
• 00:46:29
  going inward. So it's interesting. You're very asymmetrical, as we all are. Okay, so left foot.
• 00:46:41
  But this is what happens, because I mean definitely, most of the things are on the left side. So that's what I mean. Like, everything is connected through through the kinetic chain. All right, let me ask you this, Margie. Is there any way I don't know if your computer is on a desk. Is there any way to move it further back, so that we can see all of your body or more of your body?
• 00:47:03
  It's pulls back.
• 00:47:05
  Oh, yeah.
• 00:47:09
  wait, wait, let me tilt me. Hold on.
• 00:47:12
  Okay. Now, speaking of tilting, that that's great. But you do have to be careful sometimes, and if people do this on tablets. It's always awful, because the tablet like it does something like it just automatically turns their body sideways, or I don't know what it does. Don't use tablets if if you don't have to.
• 00:47:31
  But when they're using when they're tilting their computer screen, you're perfect right now, but sometimes it can skew. The way you're looking at your client, you know, like one part is is high. I don't know how to explain it in words, but they just don't look level.
• 00:47:45
  When you're doing this, you want to look straight at that person. Not like you're looking down on them or looking up at them, or it's gonna be off. Okay. So what we're going to do now is we're going to do a squat test. Now, before I have you do this I'm going to ask you, can you do a squat comfortably? Okay.
• 00:48:04
  now, if your answer is yes, but my knees hurt, I'm going to say, do you think you could do a couple of them just to see? Because people whose knees hurt doing squats still have to do squats never seen somebody go to the bathroom except for a guy standing up for Number one. But number 2, everybody's going to have to sit down, so everyone has to do a squat. If you're going to get up and down from a chair, you're doing a squat. You're getting in and out of your car. You're doing a squat. So that means we have to make the knees stop
• 00:48:33
  hurting. We have to identify what muscles are, you know, working too hard, which ones aren't working hard enough, and then we have to come up with corrective exercises, and I guarantee you their knee pain either subsides or is drastically reduced. I can say that almost every single client I have ever worked with I have almost eliminated their pain without doing a postural assessment. There is no way, unless you're you know.
• 00:49:01
  What do you call it? A mind reader, or whatever a soothsayer that that you're going to know what somebody needs. You have to do. The postural assessment. This is the number one thing in your toolkit. Now, if you're a group exercise instructor, obviously,
• 00:49:16
  you're not doing this. If you guys don't follow me, go to on Instagram, Citi, Andrea and I posted a couple really interesting posts the last couple of days. But there's 1 on creating a Yoga class for a group. And even if you don't teach Yoga, it talks about how to orchestrate a group class versus one on one. So I think that's very informative.
• 00:49:42
  important. If you're a Yoga instructor, a Pilates instructor, les mills, you know whatever aquatics, how you can do this as a group so that you can still give people more individualized exercise programming, even in a group setting. All right. So doing a squat. We're going to start with your arms up overhead.
• 00:50:03
  Now, let's say it's somebody who who can't do that. They just had breast surgery or a neck surgery, or whatever. Then they can put their arms across their chest. Okay.
• 00:50:13
  but ideally, I want to see the arms up because we're looking to see if her arms are bowing out, or if they are falling forward when she does the squat, we're going to look from the front, the side, and the back. We're going to look and see if she bends at the hip. So if her if her body is bending forward, hold on one second, let me show you guys something. Just relax for a second, Margie. This this will help because I have this book here.
• 00:50:41
  Okay, so this is Module 3. This is the squat test.
• 00:50:46
  Okay, so this is her starting position. And see, it wasn't perfect to begin with, because the knees and the arms should actually be be parallel like this. So it's kind of like a Z.
• 00:50:58
  But when she did the squat. You see how her arms fell forward. Okay, so these are the imbalances we're looking for. We're seeing if the knees bow out, or if the knees knock in, we're seeing if the arms come out to the side. So this is all in your module. 3. This is going to be your resource. Oh, you can't see me. Okay. Great. See? That's what I it's so weird sometimes.
• 00:51:22
  Okay, add spotlight. Alright. Let's go back to that. Then, real quick. So maybe, Margie, maybe you're the only one that can see me.
• 00:51:31
  Very strange right now. I gotta find it again. Guys. Hold on.
• 00:51:36
  Course they went right to it the 1st time.
• 00:51:39
  Here we go alright. Now, can you guys see? Everybody can see?
• 00:51:44
  All right. So you see here, ideally.
• 00:51:49
  people's alignment should be like this. So it's it's the arms and the the shins, if you will, are lined up.
• 00:51:58
  When she does this her arms fall forward.
• 00:52:02
  and then what I'm also looking for is to see are the knees bowing out? Are the knees going inward, and are the arms bowing out to the side? So you guys can all see this? Can somebody just text me and say, yes. Otherwise I'm
• 00:52:17
  just being silly here.
• 00:52:20
  You still can't see me.
• 00:52:23
  Oh, okay, alright, we're good. Now let's get rid of me because we don't really want to look at me, anyway.
• 00:52:30
  All right, let's do a squat test.
• 00:52:33
  So arms up
• 00:52:36
  and then stand in a normal, squat stance. You probably want to go a little wider legs, you know, whatever you feel is comfortable for you, and if you could just do a couple of them very slowly.
• 00:52:48
  Okay.
• 00:52:53
  okay, you can go a little faster if you feel like it's giving you instability. So
• 00:53:01
  definitely see those feet inward.
• 00:53:06
  Now, Margie, can you raise your arms all the way up so that they're perfectly okay. Try. And now don't force them to stay that way. But let's see if it changes when you do it.
• 00:53:19
  Yeah, that that left arm wants to wants to bend. So relax for sex squat test.
• 00:53:28
  Yeah, definitely pronating definitely pronating. I see that, too. So left arm bends.
• 00:53:37
  and it appears that both feet pronate. When we do that, let's take a closer look. Let's do one more from the front.
• 00:53:44
  Hold on. I'm trying to write and talk at the same time, and I don't try and force your knees. Just let them do what they do. Okay, so just let's kind of loosey goosey do this without overthinking it.
• 00:53:55
  So arms up.
• 00:53:57
  Go ahead.
• 00:53:59
  Yeah. I don't really see any any. Let's call it knock need but definitely the knees. The feet are pronating. So let's go ahead to the side. Now. Face either direction perfect. And now what we want to see is if her arms and her shin stay kind of parallel. So start with your arms straight up overhead like you did before.
• 00:54:20
  Okay? And then go ahead and do your squat.
• 00:54:24
  Okay? So she definitely hinges forward at the hips.
• 00:54:31
  Okay, that's what I need to see so
• 00:54:36
  and also in Module 3. As I was showing you the pictures of the squat test. It shows you a chart of muscle imbalances, and why each of these things happen as it does with the whole whole body. I think it's page 16. Is the entire body, like round shoulders, forward, head wing scapula, and then a few pages later, you get the squat test. Now let's do one from the back. So, looking at your white cabinet
• 00:55:03
  arms straight up.
• 00:55:08
  You see that that shift, the right hip goes out, the body goes to the left.
• 00:55:15
  and you can see the knees collapsing from the back. You see that?
• 00:55:20
  Okay, go ahead and relax. Not terrible. But they're definitely wanting to go inward. So I'm gonna put
• 00:55:28
  knees medially rotate and hip shifts
• 00:55:39
  to write. All right. So I have all of my
• 00:55:47
  my notes. Okay, as I said in the back of Module 4, which I don't have with me.
• 00:55:54
  You do have the forms where you can just literally be filling it in. But of course you can download it on your learning management, either Kajabi or teachable, and then you you can have multiple copies. Let me read that in a second, Marcella.
• 00:56:09
  but I just I'm so used to doing it this way. But if I wanted to share this with a doctor, I'm not going to send them this. I want to send something more professional.
• 00:56:17
  So
• 00:56:19
  back to getting rid of me, and then we're going to go to the goniometric measurements. Pronating feet. Seems like she's tilting forward head and hunching back when she's squatting absolutely. And that's why I'm seeing that we're. I think we're describing the same thing.
• 00:56:35
  And and you know that's the thing we we may use different words, but we're saying the same thing, and then we just have to compare it to like the charts and see if it fits in a neat little bow.
• 00:56:45
  All right. So goniometric measurement.
• 00:56:49
  This is Papa goniometer, and this is the baby goniometer.
• 00:56:54
  Oh, you can't see me. Gosh, I hate this.
• 00:56:59
  Okay.
• 00:57:00
  I'm taking over for a second, Margie. You can relax so you can get these on Amazon, or you can go to a medical supply store. The baby one is great for doing these on zoom, because I have a 12 inch or 13 inch computer. So obviously, this is going to be very difficult to like hold up to the computer. Plus the little baby guy is very flexible, which makes it much easier to do if I'm kind of manipulating this against my computer.
• 00:57:30
  the big one here, get it out of its little path, but
• 00:57:37
  is very stiff, which is good. We want it so that when you're taking a measurement it can. It can hold its position when it the more it gets used it. It starts getting kind of wonky. So at that point you need to get a new one. But I want to describe this to you. So
• 00:57:56
  the this base, the circle, is attached to the stationary arm. So this is always going to be known as the stationary arm.
• 00:58:07
  This is your axis of rotation, and then the movement arm, which is like a hand on a clock should always be on the front. Okay, otherwise you're going to be reading the numbers backwards. And of course you're seeing a reflection. So it's hard to tell if mine are front or backward. Anyway.
• 00:58:24
  there are 3 sets of numbers. Okay? And you're going to be looking at these ones in the middle. The black ones in this particular case that are 0 to 180 degrees. Now you might be a physical therapist, and you're working with a baseball player for external rotation. And so you need more than 180 degrees. Then you're going to use a different set of these measurements. But we, we are focusing on the 0 to 180.
• 00:58:53
  Alright. So I'm going back to spotlighting Margie, and you're in your chair, which is good.
• 00:58:58
  Well, I'm on a bed. Should we get in the chair?
• 00:59:01
  Oh, you're not. Yeah. Sorry I just I didn't. I couldn't see all of you at the time.
• 00:59:07
  Hear back.
• 00:59:08
  Okay, perfect.
• 00:59:11
  When you're doing this in person, in a perfect world, you are doing this on like a massage table, and you know most of us don't have one hanging around, so we have to do the best we can
• 00:59:23
  when somebody is doing range of motion in an upright position. It is mostly mostly a function of strength. It is not as much flexibility as it is
• 00:59:39
  strength. Sorry that I gotta turn that off.
• 00:59:42
  meaning when somebody is in supine position.
• 00:59:45
  let's say, as a physical therapist, I move my client's arm and I can get them back to 180 degrees.
• 00:59:52
  Okay, if there were scar tissue or adhesions, even with assistance. My arm is not going to go back that far.
• 00:59:59
  and I figured this out when I had shoulder surgery. Yes, I've had surgery on everything, and I could not lift my arm up. So imagine me lying on a massage table, you know, knees bent, and I'm trying to raise my arm up as it's next to my leg. I'm trying to raise it overhead, and I could not lift it.
• 01:00:16
  but my physical therapist could take me through full range of motion. So what that tells you is it's a strength issue, because it's it's not a range of motion issue. There's no scar, tissue or adhesions holding me back, because actively I could not raise my arm, but passively it could go through full range of motion. So this is explained more in your handbook, I mean, that's a whole whole other lecture, active and passive range of motion.
• 01:00:42
  But when we do this upright we need to take into consideration that she is working against gravity, and that the range of motion might be different than if we did it supine. So if I were there in person I would do it in supine, and if your range of motion was, you know.
• 01:00:59
  if you didn't meet the minimum in supine, then I'm not even going to waste my time doing it in an upright position, because we know that 1st we need to work on range of motion before we work on strength. If that makes sense, it's just like I'm not going to have somebody start doing strength training until they have what we consider full range of motion. So your norms are in your handbooks.
• 01:01:21
  So, for example, for flexion and abduction, it's 150 to 180, which means that her arm should be almost straight up and down, or almost, you know, straight out to the side and up.
• 01:01:33
  If not, if we don't have 90% of that bottom number which would be 135 degrees. Then we should not be doing strength training. We should not be holding a yoga pose for an extended period of time, you know, because isometrics are going to strengthen as well. We've got to work on fluid motion and getting the range of motion back
• 01:01:51
  first, st or we potentially limit the outcome. And we we, that's why everything there's a method to this madness. So when you're when you're doing this, sitting up, you want a chair like like Margie has, without arms, if possible, and have her sit like she just did, on the edge of the chair. Now I'm going to start. Since you're facing forward, we're going to go ahead and do abduction. So I think I do have to do a split screen here. So you guys can see what I'm
• 01:02:20
  what I'm doing. Also, all right. So the axis of rotation is literally going to be right at the armpit.
• 01:02:27
  So what I'm gonna do on the screen is I'm gonna line this goniometer up
• 01:02:33
  so that the axis of rotation is right at the armpit. The stationary arm is going up and down, and then, as you go into abduction, I am going to follow you with my movement. Arm here. Okay.
• 01:02:47
  this is the hard part about doing it virtually is I can't be there to actually, you know, hold your arm in position if you will. So I want you to imagine that you are standing against a wall or sitting against a wall.
• 01:03:03
  and that you have a hand on either side, kind of keeping your arm moving between 2 panes of glass. In other words, I don't want you moving forward into flexion. I want strict abduction.
• 01:03:17
  so let's go ahead and start with your right arm and do it, you know. Don't go to the point of pain, if there's any, you know. If somebody had shoulder, surgery, neck, surgery, breast surgery. You want to be really sensitive to this. Obviously, that's not the issue with you, but I still don't want you to be in pain. So try and do a snow angel keeping that arm. Imagine me kind of pushing your hand back so that it doesn't come forward. Your thumb is pointing to the ceiling.
• 01:03:47
  and and I want to watch and see if she starts tilting her body. I don't want anything moving but that shoulder.
• 01:03:54
  Okay, so her head is still perfectly upright and in alignment.
• 01:04:00
  Okay, right about there, Margie, would you say? Okay. So now I take my movement arm and I go up to her elbow, not to her fingers, because I only want to go to the elbow joint. Go ahead and relax
• 01:04:14
  and
• 01:04:16
  hold on a second. Okay, do me a favor. Do that. Do that one more time, because even I sometimes do this backwards. Okay, go ahead one more time. Now. The second time she might be a little bit better. That's the that's the risk I take.
• 01:04:29
  But you wanna make sure that the movement arm is on the outside.
• 01:04:33
  Okay, all right.
• 01:04:37
  And you get like the sticking point where you see your client trying to push further. Okay, go ahead and relax. Let me
• 01:04:43
  show you this all right. So if you look right here
• 01:04:52
  you are at 146 degrees.
• 01:04:56
  All right. So that is, we just did the right side, and that was abduction.
• 01:05:03
  You want to make sure you write it down, and you write it down on the right side, because it's easy to get yourself confused. So then let's go ahead and do the same exact thing on the other side. And yeah, go ahead.
• 01:05:15
  I had a porticath. I didn't even think of it, but I did port a cat put in on the right side about 4 months ago, or 5 months ago, some surgery here, but minor. And it's not.
• 01:05:26
  It feels wonderful. I mean, it's not any issues. But just so you're aware of that. Okay, so if you guys don't know what that is, it's a surgically implanted catheter. Where they can do blood draws. They can give infusions, chemotherapy, immunotherapy. What have you medications that way? They don't have to keep trying to find a vein every time somebody goes in for treatment. So if somebody's.
• 01:05:47
  there are various reasons for doing it, and some are implanted, some are externals, you know. They're usually up in the chest. Sometimes they can also be in the pelvis. You'll read about that in module 2 in treatments. Okay. But yeah, there there could potentially, you know, sometimes be some scar tissue or adhesions, or if the it's not in there anymore, right?
• 01:06:05
  Oh, it's here. Oh, it is. I thought you said you had it removed. Okay, gotcha gotcha some. I've had. People say that they hurt that they felt like there were like little needles pricking into them. So everybody has a different different response. But for you, it's okay.
• 01:06:22
  Okay. All right. So let's go ahead and do the other side now, just like you did.
• 01:06:36
  and we're comparing side to side. And you know, seeing our is once, I mean, we see a difference here. So once again I am going
• 01:06:45
  to the elbow, and that side is 152. So it's not a whole lot different. It's only 8, 8, and 4 6 degrees different. So I do think, however, there's probably a little more difference, because I had you do it twice on the right side, and just naturally, you're going to get a little little more range of motion. So
• 01:07:07
  what I say to myself is all right. Her norm is probably 152, which is what it is on the left. So we could definitely work on some range of motion exercises on the right side to to get it a little bit better. However, both of them are at least 1 35 degrees, meaning 90% of the lowest number of 150 to 180. So if I want you to do a warrior 2, I don't have a problem with that, because you have
• 01:07:31
  good range of motion for those of you who don't know what a warrior 2 is. You're standing basically with your arms out parallel to the floor
• 01:07:38
  at shoulder height. So if somebody had limited abduction, we don't want them doing that till we get their range of motion back.
• 01:07:44
  All right. Next, I'm gonna have you? You can turn your chair around, or you could just turn sideways on your chair to do flexion and extension. Now, the axis of rotation
• 01:07:54
  is, it's about 2 inches below your shoulder joint. So right where the humerus comes into
• 01:08:05
  the shoulder girdle, there's this space there, and that's that's basically where I want my axis of rotation. Now, if I were there in person, I can palpate it, but I pretty much know, just because I've done this a thousand times. You know, about 2 inches below the shoulder, so I want to make sure. So I don't screw this up, that my movement arm is on the outside. We'll do flexion first, st which she's going to go forward, so I can just kind of get this out of the way. I know it's going to go forward, and this stationary arm is in line.
• 01:08:35
  her body. Okay. So now, Margie, what I want you to think of is me pushing your arm inward. So, in other words. Now, I don't want you to go into abduction. I want you to think of raising that arm in front of you as if you have 2 panes of glass on either side of it, and it stays in strict flexion. Okay? And you're also trying to go to 180 degrees.
• 01:08:57
  Now, I want to make sure that when you're doing you you can go ahead. I'm just talking. I want to make sure her back isn't arching, that her head doesn't start moving forward. You know, we're looking for compensations.
• 01:09:10
  Okay? Once again, I go right up to the middle at the elbow, and I've got 160 degrees. So that's the right side.
• 01:09:19
  Go ahead and relax.
• 01:09:21
  And the reason I do the center of the elbow is because if I go either to the lateral or medial aspect of it. It could be like 10 degrees off.
• 01:09:28
  While you're in that position we can do extension. So now we're going to go backwards. The axis of rotation is exactly the same. Now, what I really want to look for is I want to make sure her head doesn't migrate forward, and that her trapezius her shoulder, does not elevate while she is doing this. So you and here's where you can really see that you're having to work against gravity, because if you were lying supine on a table, you could just let your arm
• 01:09:52
  fall down and see what the passive range of motion was but now active range of motion. We have to rely on your strength to lift your arm up behind you, so whenever you're ready, I'm ready. Keep that arm in, you know, close to your body.
• 01:10:07
  and only go as high as you can without compensating.
• 01:10:13
  Okay, so right about there. And I'm going to the midline of that elbow again, and she is at 65 degrees, so that is 65 degrees on the right side.
• 01:10:24
  Now Norm is 40 to 60. So so far, all of the measurements you are. You're good. There's no limitations. Let's go ahead and do extension on the other side.
• 01:10:36
  Same thing.
• 01:10:38
  the front, this the back. We already? Oh, yeah, either way, either way, it doesn't matter which one do you want to do first? st
• 01:10:46
  Oh, yeah. Well, okay.
• 01:10:52
  okay, alright. So I have 60, just a little bit less on that side.
• 01:11:02
  All right, let's go into flexion. Now in the front.
• 01:11:06
  Keep that arm in that plane.
• 01:11:10
  Good.
• 01:11:12
  Okay. So on. That guy
• 01:11:15
  got 1 55. Okay, beautiful. All right. Now, we have external and internal rotation. And then we're done.
• 01:11:25
  Now the problem with external internal rotation is, if I do it here and I have you do this, and this. I need to rely on you holding your arm up, and most people can't do that. So I need to get you down to the floor. If you're okay with that, I don't know if you want to put a mat down, or anything that'll make you more comfortable and we'll have to tilt your camera down a bit
• 01:11:47
  first.st
• 01:11:49
  Now, if you have a client who cannot get down to the floor, then I'm not going to make them do that. Can I put a pillow under my head or not. Yes, absolutely so. What? What I? What I want, what I would like you to do is show people what it looks like without a pillow under your head. First, st because there's 2 reasons for the pillow.
• 01:12:07
  and
• 01:12:10
  just be careful of your head. Obviously, as you go back. Okay, can you move? The the pillow is going to be in the way of what we're seeing.
• 01:12:17
  Thank you, my dear, and you're going to have your knees bent.
• 01:12:21
  Okay, notice how her head tilts back.
• 01:12:25
  Okay, go ahead and put that pillow underneath there. That is because of the forward head. And so when you have somebody with a forward head. You definitely want to put like, I mean, that's probably higher than I would like. And I'm gonna have to yeah, get it, get it. So it's just under the neck. We want their head level. So when somebody has severe forward head and you have them lie down. That's what happens, their head tilts back, and it's like, you know, has it impedes their breathing as well.
• 01:12:51
  So now, for internal and external, I need to align you a little better if you can move the lower half of your body closer towards your furniture.
• 01:13:01
  Does that make sense that one?
• 01:13:04
  Yeah. I guess I don't know what's on the other side of your room. Okay, perfect. Now you're going to bring your arm out at 90 degrees. Bend your elbow.
• 01:13:15
  Okay, beautiful. Your palm is facing your feet.
• 01:13:18
  so the axis of rotation is at the elbow joint. Now the great thing about zoom is, I can hold my goniometer right up there right up, even though if I were in person I wouldn't be able to get the axis of rotation at her elbow, because I would need my goniometer to go into the floor. So
• 01:13:35
  zoom the floor doesn't exist. I'm just basically going further into the, you know, into zoom space. But this axis of rotation needs to be lined up right at her elbow. Then the movement arms either going to go, you know, forward or backward. Let me let me make her bigger real quick here.
• 01:13:55
  Okay, so going backward. Now, if somebody, for example, you've got that Porta Cath there that could make it a little difficult to go into external rotation because you're pulling against that. Who knows? Maybe maybe not. We'll see how it compares to the other side.
• 01:14:10
  So go ahead, make sure you maintain that 90 degree angle at your elbow joint. Keep your back flat. That's partially why we have her knees bent. We want to make sure she's not arching her back and compensating, and only go as far as you can without pain. So is that it?
• 01:14:29
  Okay? So we are at 65 degrees. Go ahead and relax.
• 01:14:37
  So that is the right arm. I want to make sure I get it. Get it correct
• 01:14:42
  all right. Now, going to internal rotation. This is the one that's the easiest to mess up, because people will tend to push their arm forward. So what I want you to imagine is that your back of your shoulder is Velcroed to the floor. Okay.
• 01:14:57
  we don't want your shoulder to protract or to round any further forward to assist your arm in internal rotation. So you're just going to essentially let your arm slowly drop forward, maintaining that 90 degree angle at the elbow joint. Now I'm watching to make sure I don't see any added protraction in her shoulder.
• 01:15:18
  Okay, so I'm starting to see some movement there.
• 01:15:21
  Do you see? Do you see how you're flinching your shoulder. Yeah. So back there you go. There you go. Okay. So I'm going now to the pinky.
• 01:15:31
  Okay? And I've got 65 degrees, so go ahead and relax. So I don't know if you guys caught that, then we're going to switch you around to the other side, Margie. I don't know if you guys could see that where there was some movement in the shoulder you just have to like, really pay attention, and you can see you could see her shoulder kind of come up. Just look at the shadows, look at, you know. Pick a spot that you focus on, and you can see, can you scooch a little further down, like towards your dog bed?
• 01:16:00
  You can see my dog. Then I think that's what it is. It looks quite familiar.
• 01:16:07
  Yeah, actually, alright. So same same thing.
• 01:16:13
  Go ahead. Yeah. Yeah. So bring that left arm up.
• 01:16:17
  hey? You know you're good. You you landed. But no, now. Your legs are too far over. You look like you're you're doing a stretch. Okay, there we go. So go ahead and bend your arm. Arm. Hand up
• 01:16:27
  perfect. Let's go. Let's do external rotation first, st
• 01:16:31
  and this one is pretty easy for most people. There's not many compensations, you know, other than looking to see if their back is arching, which, of course, is impossible to see right now, because the shadows and the black shirt. But she's she knows what she's doing all right. So hold on a second.
• 01:16:48
  You are at about 75 on that one. Okay, so that is external rotation on the left.
• 01:16:56
  So there is a 10 degree difference between difference between sides. Could it be the porticath, perhaps? Okay, so nice and slow. Again, being aware of that movement in your shoulder
• 01:17:13
  right about there, right about back up, come back a teeny bit. I know, I know. Okay, so you are at just about 60 on that side. All right, go ahead and hop up. Get yourself comfortable. I'm going to summarize, and then we're going to be done
• 01:17:39
  all right.
• 01:17:41
  So in Module 3.
• 01:17:47
  This is page 16. This is your muscle imbalance chart. So forward, head, rounded, shoulders, elevated shoulders, wing, scapula. Everything's here. You're going to look at the muscles that are too tight. You're going to look at the muscles that are weak. We need to stretch these. We need to strengthen these. So on our next session. That's where we will go through. See which of these
• 01:18:11
  I've got 2 pieces of paper here.
• 01:18:14
  Which of these, you know, pertain to her so elevated shoulder, rounded, shoulder forward, head and then we're gonna choose exercises. Now the cool thing is in the Handbook. If you go a few pages further, you also have like suggested exercises, which is, which is pretty cool. So you know, you can use your own individuality, or you can just look at that
• 01:18:38
  then we look at the squat test, and also we've got our little
• 01:18:44
  sheet of muscle imbalances, so we can go excessive. Forward, lean, for example, when her body went forward, got tight. Calf muscles, tight, hip flexors tight rectus abdominis external, oblique, and weak anterior tibialis gluteus maximus and erector spinae so when we start to choose exercises. It's going to be keeping these things in mind and choosing exercises that are potentially going to correct that.
• 01:19:10
  Then when you go to goniometric measurements. Now, you have these
• 01:19:16
  pictures in your book that are very clear. You also have a video online in teachable or Kajabi. And and you can see it professionally done with lighting on a massage table and everything. But it is going to tell you what the norms are okay. And so I can go. Here's
• 01:19:36
  here's there's 1st off I'm looking for differences, and of course this is coming across backwards. But there's a 10 degree difference in external rotation between the left and the right and then
• 01:19:50
  everything else is only about 5 degrees difference, which I wouldn't pay much mind to, but everything falls into 90% or better. So I will look at both the left and the right and go. We've got a difference. There, that's higher. I'll show you what I'm doing in a second.
• 01:20:10
  Okay?
• 01:20:11
  So each of the ones circled in pink is is better on that particular side. So that simply means we work a little bit on each of these range of motion, because every single 1 1 side is better than the other. So we just add some range of motion exercises that you can do in the shower, or, you know, sitting around watching TV at night, whatever but it's it's not anything that's going to keep you from doing
• 01:20:34
  whatever exercises you want. So, Margie, if you can like later today, or whenever is convenient for you, if you can email email me with
• 01:20:45
  whatever exercise you're doing. I know you said you walk your dog. But like, if you're doing any specific strength training, or Yoga Pilates. If you can give me as many specifics as possible, then that will help
• 01:20:56
  as a starting point, you know, for for putting together an exercise program for you. And as I said, Margie, you don't have to attend that one either way. I'll give you the recording. If you want to be there. Great. We'll give you the link, but it's not something that you have to be at in person. So before I end, I'll open it up to questions from anybody, you included Margie.
• 01:21:19
  Otherwise we are. We're good to go. I'm trying to get this so everybody can be on here again. But it doesn't wanna work.
• 01:21:27
  I just want to say something real quick if I can. That's on here, or might be viewing it sometime in the future. I took this course with Andrea 20 years ago, and I had. I have had, oh, at least 200 clients at least, with every type of cancer, every stage of cancer, every age, everything I could tell you.
• 01:21:50
  I learned the way I know how to do what I do with my cancer clients was from Andrea, because it is the most common sense practical. Here's what it is. Here's what you do, and I swear by it. So I always have, and I'm not just saying that because I like her I didn't pay her, I swear. No. And if you, if you missed the beginning, Margie, they have to hear this, because 20 years ago I was
• 01:22:14
  just starting teaching live workshops. I used to carry a dry erase board. I didn't know how to use a Powerpoint, and I'd fly across the country to teach, you know, 5 people.
• 01:22:23
  And I barely knew how to use the computer. And so I had didn't have enough people. Margie drove to Connecticut. I think it was. And I had. You know, the couple people that had registered I left emails for or whatever, because I didn't have their phone numbers when they registered. So she calls me the morning of the workshop, and I still can picture myself driving in a car wherever the heck I was, and she's like I'm here for the workshop. I thought I was gonna die.
• 01:22:50
  I literally like felt my heart drop. And I'm like, didn't you get the message, and she's like, no, I just drove here from New Jersey, and I'm here, and I paid for a hotel, and I literally it gives me goosebumps. Now it was like one of those worst moments that you just wish you could crawl and crawl in a hole and die, and
• 01:23:09
  she's such a lovely person, I mean, I was like, you know, let me pay for your travel this, that she could have been horrible about it. But this just goes to show you, you know, I guess when the universe aligns that not only did you forgive me, I went. I went to your next seminar.
• 01:23:25
  and she's been doing this for 20 years, you know. Yeah, because my healthcare. I was working for a hospital system at the time that was had medical health, I mean medical health. Gym, you know. So it was so important to me that I do this, and they wanted me to really get this, too. And I went. Let me tell you, it didn't stop me from going the next one she had, and the next
• 01:23:45
  course that she had was packed. Andrea, I'll never forget the one that I went to had all these physical therapists in it. And I was like, look at this, there were a lot of us. There were well over 20. So yeah, and I haven't done a live workshop since before Covid. They just people just don't want to do live anymore. But I'm open to it if anybody wants to host a workshop. But
• 01:24:07
  did. Was there more you were saying? Because, I interjected. But you were on a roll about. I just wanted to say it's proved invaluable to me, and I still will go and get my books out. I just had another trainer the other day. Say to me, ask me a question, and I said, Get your book. The only way you're going to know is to get your certification manual. Look it up. That's right. There, you know, it's your Bible.
• 01:24:31
  You'll always use it. Okay, you'll go back to it and back to it. And I have probably 9 additions.
• 01:24:37
  Yeah, exactly. Exactly. So. We're now in the 14th edition, revised. Well, I so appreciate you, you being here for this today. And although you know, we have lots and lots of case studies in our library, and you can see, you know, different different situations, different scenarios, because everybody's different. And you know I'm glad you're not cut up. But obviously that could that could cause a different issue.
• 01:25:02
  You know. Cross that bridge when you come to it. So we didn't get anything like really exciting, but you know what a journey that you've been on and helped so many people, and now hopefully can help you a little bit, and you can continue to do the great work you do.
• 01:25:18
  So yeah, anybody else have anything to say. Let me know. Otherwise you can always email me at Andrea, at thecancer specialist.com. And like, I said, Check out Citi Andrea on Instagram. I've posted a couple pretty poignant posts the last couple days. So
• 01:25:35
  all right, my dear Margie, thank you so much, and thank you for being here at this time.
• 01:25:40
  and we'll see you guys later.