Ep. 28: Managing the spine: Exploring blind spots in manual therapy and S&C.

really developing this um this complete spinal management course. Um so we're running a another summit coming up for those who are interested. Uh the summit's either when is the summit we said?

uh and the like. So uh I guess we'll just get into it. We'll probably talk a little bit about the the kind of things that we've been researching, what we've been finding uh through our research right now. Of course we start all of our courses with a extensive literature review to try to get the landscape um so that we can provide the most up-to-date information. Now having said that we were just having a conversation which might be interesting to start with. Which is what is the new landscape of

literature regarding spinal care. Now I'll remind people that Doctor Chivis and I were in school I mean we were we we've been out of school for almost twenty years now it seems, right? Actually it doesn't seem that way. That's legit that's legit fucking that's legit fucking math. I can't say it seems that way because it it you can calculate it. So we've been out for twenty years.

If if you were in school with us and and maybe if people were haven't been in school for thirty years or forty years, I'm assuming you might be thinking the same thing. With regard to spinal care and spinal pain and spinal management, you you always have this epidemiological introduction. And the epidemiological introduction discusses how many millions of dollars are wasted a year on, you know, um

workmen's compensation, people being off work, hours lost, productivity lost, et cetera, et cetera. So you're you're given these monstrous numbers of You know, how much money is lost, how many people tend to have spinal problems, you know, eighty percent of the people have a low back, and then of that people within four weeks, whatever it is, eighty percent will be okay. So we we were given these numbers. Now it seems to me dug my heels into this this uh literature review.

that not much seems to have changed. In other words, you're a student hearing these words and you think to yourself, Okay, this is the gen this is the generation where we're gonna change this with all of the new things that we're gonna be taught. Um It hasn't changed.

one of the FRA lectures, it's probably on in in the lectures online. And it came from the WHO, which is, you know, uh the World Health Organization. So the one that's supposed to be on top of how we manage injuries and what's the latest and greatest in you know disease management and and health for the world. And specifically for their low back management. um an and where the research should be going and what's next and what are the advancements in

in you know management of spine pain. It's not actually in the management of spine pain. It's how can we make better disc replacements for surgical stuff? How can we like how can we add all these extra things to the management of of low back surgeries and

Things of that and and uh you know, facet joint surgeries, none of it is like how do we actually take care of And manage the the spine so that But it's interesting that the WHO is is you know, promoting that and research dollars should be going to these things. When like, you know, that's like the far end of of the spectrum. Um you know, we should be focusing more so on like how do we manage.

The biological stuff of the spine.

exercise therapy because it's as if exercise therapy denotes that if you take a hundred people and you divide them into like quarters, so twenty-five percent are gonna get exercise therapy and twenty-five are gonna get manipulation, twenty-five are gonna get this. But in that

those twenty-five people, when you say exercise therapy, that's not a thing, right? Exercise is not a thing. It's a it's a it's a conceptual framework in which things can be done. Just like when they say you know, movement is great for the the body or you know, exercise is is is a great way to prevent injury.

Well actually exercise is a great way to cause injury just as much as it's a great way to prevent injury. So what we should be saying is there's a specific amount of exercise applied to a specific area for a specific reason that shows that it's lacking something that it needs, ergo getting the capacity that it's lacking is good for the spine or good for the person. But I don't know that we can generically say, you know, movement is medicine Right?

Can't go wrong getting strong is another one. These are all great throwaway words that you can use and you can package them into a minute and thirty seconds for Instagram, but really L we've talked about this forever. You if your shoulder sucks, you can this shoulder's messed up, you can move the left shoulder around all you want, and technically you're moving, but you're not doing anything for that right shoulder.

the spine. Is it mm is it uh the Australian way or is it is it the McGill way? Well, it's actually neither of them because they're both important. Like everything is important. So I think specifically with the spine, the reason why it we haven't really moved ahead is because we are trying to find the next best thing rather than taking what we already know and putting it together in a framework that actually works.

But it's it's not a fair question in in a different regard. It's not a fair question in that at no point did we say that we're going to invent a new line of literature called FRC. What we did say was There's a pool of literature that you have at your disposal to use in order to construct a systematic approach to dealing with the person in front of you. And what we do is we take this large pool of literature

And when we say large, of course, especially for this just like when we're gonna do in this course, it's not just, you know, you're reading the spine journal and and and m uh manual therapy journals only. But if you take a holistic approach looking into Plastic surgeons and how they deal with pain or or or different lines of literature. There's this whole umbrella, this bird's eye view of the literature.

And where I think the magic is, getting back to what I said before, in that it's not like the literature is giving us the answers we're actually looking for. Where the magic is, is people taking in the literature, digesting it, and then Building a framework with which to guide how to treat people that is little which is better than just saying exercise is good.

Sure. Right. You can't have a you can't claim to be a good therapist and whenever when someone comes in you go, you know, uh you know, there's pain research that says we can't touch pain and you know, we can't be specific here, we can't do this, we can't do that. So just start training and you'll be fine.

Because the fact of the matter is that a lot of the reason why the person's in front of you to begin with is because they started taking these generic

Or maybe I didn't spend enough time in the sauna or I I didn't breathe at you know, seven A. M. before having my coffee so that my amygdala squirted out this juice at this particular time. That's not why your back hurts. Like I guarantee when you're sitting there doing your podcast for the two hours or whatever you're doing, likely you're

your shitty pot the way you're sitting is is affecting you. You know, your previous injuries are affecting you. If we took your your spine and we look went joint by joint, there's capacities that are lacking in particular areas of the spine which might be present in other areas which are lacking something completely different. All of which has nothing to do with how long you were in a cold plunge.

Uh people are gonna say, well where's the evidence for what you're saying? And so Most people would say, well, the evidence means that there has to be something that supports what you're doing.

You know, like that that's what we learn in Cairo school. Like it you know, if you wanna, you know, rub somebody or you wanna poke somebody with a needle or put ultrasound on or whatever, you had to have A piece of paper or a few pieces of paper stapled together that said, yeah, this shows that I could do that.

And that's why that question is totally fair, but at the same time really unfair, because you can't answer like w you want us to give you the fifteen hundred articles that we've read that supports why we do what we do. Mm-hmm. You know. fourteen hundred of them are not gonna be RCTs.

in nature because it it can't be anything else. And then if I study biology, you know layer by layer back through I end up Down at the beginning and oh, this is what happens at the beginning, and that's gonna affect the next thing, which is gonna affect the next thing, which is gonna affect the next thing. you wouldn't get from just saying, well, you know, is there is there an RCT for that? That just is not how it works in clinical applications.

when there is a lack of randomized controlled trials to justify what you're doing. And and I argue that if you're dealing with a a a human system that no amount of randomized controlled trials will account for the variability of that system versus

So the answer to that question would be like, okay, well specifically the question you asked isn't answerable, but if you ask me a more s answerable question, a more answerable question would be um in your you know FRC or F R or in your system, you know, you apply this particular input at this time. Why do you do that?

Like what happens at the s same argument which we get into with people who are saying, you know Soft tissue is useless, there's no reason for soft tissue. Look at this article on fascia. It shows that in order to rip through the fascia you need this many newtons of force. You can't put that many newtons of force. And then you go, hold on. I never said you were ripping through fascia, I never said that you were causing you know.

to the assessment of the spine is limited by our ability to perceive motion in the spine, which is severely hindered. What do I mean by that? When you give me a shoulder, I can move the shoulder around very specifically and tell you exactly what quadrants of shoulder motion are hindered. Mm-hmm. And then I can say, Well, to f move further into that quadrant, do this, this and this. With the spine Um you're dealing with a a segmented А segmented uh

Or our inputs are going to be random at best.

things about what low back pain is and and you know where it's coming from and what that means. So as to your point, you can't just say, well I'm gonna do this thing for low back pain and expect the same outcome every single time.

coherent um not coherent but a a predictable way because you're try that's what you're doing. You're trying to purse out the predictability factor. If you have fifty people with back pain and and you give them manipulation, how many of them get better? But that is also to say that those fifty people have to be assumed to have the exact same problem.

specifying movements of the spine. So I I take the foot for example. If you give me the foot of a hunter gatherer and you give me the foot of a modern day human and you ask how much real estate in the brain is is given to I would argue that in the hunter-gatherer there's going to be more real estate given to that foot.

Because that foot is used as multiple things, as a tool that does multiple things, whereas now you stuff it into a shoe and then you kind of patternize what it does. So of course you're gonna you're gonna decrease the amount of neural uh specificity that goes towards that foot.

Oh that did well, maybe we should try this or that. I don't see that in the shoulder.

And therefore, the management of the spine is not specific enough. So if you use those two things as their own feedback loop, obviously there's a problem. There's a problem in because low back pain isn't going away. I mean, that's obvious from the number. So if if we just keep doing the same thing, we just create this whole positive feedback loop that just keeps driving the same behaviors, which is not necessarily

What we want to do is we want to try to look at the loop. And unfortunately if there's only two things in the loop and low back pain's not going away, the thing that has to change is the management of it to help create a new behavior of how we look at

The spine and how we manage the human spine and so on and so forth. The other thing that I think you have to add to this is That kinda that kinda comes from what you were saying is is that There's not general exercises for the spine that are just gonna make the spine go away, uh spine uh discomfort go away, but in addition. You you ever notice that in in in the experts as well, they always just fall to the to the natural history, which we never do anywhere else.

And and that seems to be the the the the management of the spine as well.

That can't be the case. But again, the the way that you frame something it it's going to it over twenty, thirty years, it's going to shape the way that you frame your management of that something. We talked about the spine, we talked about that homunculus idea. How about we talk about the damage being done by people who are approaching it generically. Let's talk about neutral spine. Right? What is neutral spine? Neutral spine

In the spine. Let's say that we take neutral spine and we start to explain it in the shoulder. If I were to say keep your shoulder in a neutral position all the time. You center it wherever you want it and then just kind of leave it there. And then as you move, just kind of that whole shoulder comes with it. Okay, so yeah, you might prevent more acute pain in that shoulder, but you're trading the acute pain for chronic problems.

Because you're not moving your shoulder. And I feel that about the spine specifically, that if you get people to walk around, you know, if you get people to walk around. In a neutral position all the time, and you bend up this way, you play hockey that way, you sit down very carefully so that you don't come out of neutral spine. You might prevent another acute incidence of spinal pain, but you are going to trade it up for the fact that you're not

You're you're just creating a fragile system. So and then that system needs to be braced and that system needs to be cared for. And then it becomes in order to maintain this neutral nothing's gonna hurt me again. Just get strong, bro. Like you can't go wrong with getting strong. So just start getting a strong core.

At all like you know what I mean? Like it it it has access to the supraspinatus, but it doesn't have a hundred percent access because you had that tear and now a significant portion of what used to be contractile tissue is now now not contractile tissue. You would say that that's going to throw a wrench in what I'm doing because now I have to reverse some kind of biological process in order to make it usable. But again, not in the spine.

So you get someone we know the history of multifidus, we we've talked about this before. You have someone with some Low back pain problem. There is going to be changes in the way the body calls upon the multifidus, how it's used. We know these changes. Mm-hmm.

Uh there's too many external variables over time that will influence a neutral position. But if you ask somebody to put themselves, particularly with the spine, uh and we talk a little bit about this in FRA. before we get into the spine assessment, just asking them their where they feel comfortable. Like where do you feel comfortable holding your spine? If you were gonna do X, Y, or Z movements, if I was gonna put you in a cat camel position, show me

in that position where you feel comfortable in your spine. Not a predetermined where I think you should be in your spine, but tell me where you feel comfortable in your spine and and that can give you a lot of information, just like a a shoulder or or Something else. Like where do you feel comfortable if you were gonna push

or pull, where do you like to hold your shoulders? Do you like to hold them like this? Well that c that's pretty good like give you some good information. Just like in the spine, it can give you some good information about, you know, where they like to be and can give you some information of uh where they're not gonna move well into. But it also so it's really allowing you to establish this movement bias and for the most part

people like to be in positions they feel comfortable in positions that are not actually that good for them. Right? Um and so uh Just getting onto that that neutral concept, I don't like that is a predefined thing. that we are trying to to overlay on people that isn't actually definable. But what can be definable and can give you some information with respect to the spline is where do you like to where do you like to hang out spinally? Like is that a little bit more

with an increased lordosis, particularly in the lumbar spine? Is that with a little bit more pelvic tucking and a little bit more flexion in the lumbar spine? Do you like to be really flexed in your thoracic spine? I think these are all valid things that informationally can provide some clues as to, you know, what you might see as outputs from that spine. But neutral does not 100% does not exist.

breaks to your tissue that is accepting the load. Um so as soon as you if you're gonna argue that there is a particular way to sit and there is a particular way to be, Um I think that right off the bat you're you're missing a a very important point, which is that A lot of the things that you see people do are compensations for problems, but we have to remember that compensations are not necessarily a negative word. Compensations save you. It's your body's attempt.

to redistribute load such to give damaged pathology a break. So I don't I also don't think that our job is to look at someone's uh general way that they stand or the way that they sit and to tell them, No, no, do it this way. Mm-hmm. Just like I don't like doing that with runners. Like if you if you give me a runner and you say, Well, my running coach said I should be striking with this and doing this and doing that I would go to the running coach and say

You're contradicting however old that person is, thirty-five year thirty-five years of the evolutionary biological process w whereby that person might have altered their running gate based on Uh some genetic factors that you have no idea about. And that could have been just the way their biology is shaped. It's like you w watch people squat and you go, well, you should squat this way or that way. Well, how long are their feet?

How long are their tibias? How much rotat like how much torsion is in that person's femur versus that person's femur? There's way more variables to that we cannot that we cannot amalgamate into our thought process that have to be respected. And that's where I I I go off on posture. Sure. Because I I just because it looks good on a on a picture.

Anatomical position is only anatomical position because it in if you're doing it in a book, it shows you all of the anatomy. It shows all the stuff. It doesn't mean that if you take me this way and put me this way that you're somehow healthier in anatomical position. That can't be that can't be true. For sure.

So unless you want to go off of that. So I think what we're saying is in order to take the spine and have uh any chance of getting through the you know the the noise of what the literature taught we we have to be able to look at the spine in the same way or something similar to the way we look at a shoulder. In other words, every single segment Every segment is a shoulder.

To isolate segments in the spine. Definitely. That seems crazy. And here's an example. If I give you the clinical scenario of someone. You'll probably tell me what you feel is going on in that segment. Like if I tell you that the person in between they've had they had uh episode of low back pain where they were you know reaching over and they felt something go out.

And then you know they have a history of that goes away and it comes back and it goes away and it comes back. And when you go to L4, L5, when you go P to A on a spinous process, you get a jump sign. When you Um perpendicularly stress the supraspinous ligaments you get tenderness and soreness. what do you think about what I'm describing? Like what does that as a as a you know, a a very s sought after therapist. What does that tell you?

Whatever. Sixty percent of them. I'm I'm just using numbers. Which is you know, they throw their back out on a very simple task. One that they would do every day, probably multiple times a day, until one day it causes a problem.

Getting back to what we were talking about before, if I'm a therapist that doesn't really look at the spine as being all that important in in trying to hash out information about what is happening segmentally and region by region and then what happens globally in the spine, then I can say, well, realistically I'm just gonna try to

run through the natural history of this, prescribe some general exercise and some core strength, and therein lies the problem why that person has multiple episodes of low back pain. And so the second part of of what you said is that at least What we're trying to establish before we get into some more details is that there should be a more specific Of the spine. And so when you uh then push on a spine and you go segment by segment.

And we'll we we can maybe talk a little bit about that, uh where you're finding the spinous process and you're pushing down in a in a P to A fashion and you find that there's a different feeling to those or you create Yeah, I mean you you the jump sign is the throwing the back out. Like that that's what you're recreating. Um And then you go on to that segment where you get that jump sign and you go in between and you you palpate the sec uh the uh the ligament and it's tender.

A spine like that is one where biologically there's not enough restraining mechanisms segmentally at that segment, and therefore certain things are becoming overloaded, capacity starts to go down, and now you have a segment. moves around a little bit.

whatever capacities we think were lacking. And you said at that particular segment, because that's not to say that two segments up or two segments down or one segment up or one segment down you have the same finding. Totally. If you have that segment which we're gonna call It's a hard word to define. Saying hypermobile sucks because unstable, hypermobile, these are like radiologically defined terms as well. So you don't want to Step on the toes of those definitions. But sloppy is a

loose comes to mind but that's really not a good term either. Uh I I know what you're I know what you're getting at with the hypermobile because it isn't it isn't necessarily a А деф а терма фор, вона relative to its peers above and below has more motion to it that is uncontrolled motion. Therefore You know, getting back to the to the brain concept, therefore the the brain is that segment is not being represented well and therefore becomes uncontrollable.

And that in four to six weeks the the signal for pain will no longer be sent anymore and everything's fine. Right? But that's also not the case. And now when you say just get strong bro, just strengthen the core, well there's a problem because if I told you you have a superspinatus rib, To tear, right? The answer is not just make that shoulder stronger. Go back in the gym and start pressing. You would tell me, well, no, there's specific.

Capacities that now the superspinatus could take this much force, now it could take this much force. So we have to come on with this much force in order to bump up that capacity over time. Such da da da da da but it's almost as if the pathology that occurs because there was a spinal segmental buckle. That's just gonna be fine. It's gonna be fine. Not only is it gonna be fine, but it's gonna be fine, and the body's gonna heal it in a way that will reestablish normal afferents.

Everything's fine again, right? It's just like the when you when you injure yourself, there's anatomical consequences to the injury. No matter what the injury is, there's anatomical consequences. If it's a very mild injury, sure, things will heal. But to say that it's just gonna heal properly and

approach. But that's not that's not what the evolutionary system is evolutionary biology was not looking for better ways. to manage its injuries. Arguably, if you got injured as a species, as an animal, the chances of you dying as a result of being lame means that you were taken out of the natural selective process a lot faster.

The more insult you have to tissues and when I say insult, this is doesn't have to be injured. Um the more the selective pressure is or th there's an increase in selective pressure to maximize

the ability for those cells to regenerate and to heal themselves and and so on and so forth. And as I said, that still needs guidance. There still is guidance there. But if we're looking at it purely from an evolutionary perspective, The more insult there is the more pressure from a selection perspective there is to minimize that insult in some But that then skews the continuum toward uh youth youth and vigor in the tissues such that the later you get on in your chronological age.

Now you have less ability to do that. So technically, your your the natural selection chooses to have. you know, robustness and and resilience in your biological stuff earlier on in your life. And because of disevolution now, and we're stealing that term from Dan Lieberman, that happens a lot earlier in life.

such that now we're not protected on the back end. We're where now we've we've skewed it so far because of of high amounts of stress in the world and all these other things, we've skewed that earlier in life such that now From a uh a longevity perspective and the longevity of the the biological stuff that makes up you, y you know, you're left.

Hung out to dry because you don't get that selective drive anymore. So now the tissue degrades a little bit quicker. We have less cellular uh regeneration, we get more cellular attrition. Um and and that impacts both white and red.

And then we add on posture advice, and then we add on the neutrality of spine advice, and then we add on the fact that. uh we haven't brought this up but as a as a as a consumer relationship which is unfortunately what healthcare is I'm I want you to feel nicer. Right the the the desire for the

Don't don't f don't move. Like just don't move and see what happens. So what does that do for this concept of senescence? Like what does stagnation do?

um unfortunately we get we get the people who are like at their wits end. We don't often see people who are like, Yeah, you're my first therapist. Yeah. We see people who are like, I've been everywhere else and nobody could help me because I just got the same shit everywhere. So the argument from a senescence perspective is that

Right? And so applying this to a low back pain case that is, you know, m managed in the the very stereotypical way of well let's just do some exercise and let's just, you know, do some stuff and hopefully within four to six weeks it goes away. Internally, from a from a biological perspective of that client, they are going through that process. Their body is saying, shit man, I need to I need to get out of this. There's some tissue insult here, I need to uh lay down more stuff.

Um and so the selective pressure to try to maintain that youthful vigor in the spine is really, really high. Understandably, that is gonna come with a back-end cost. They don't know it yet, nor does the therapist, but that back end cost is Atrophy, white stuff that is supremely disorganized and non stiff.

We can get into that. And so on the front end, the management of that low back is, well, you know, whoever's managing is I'm doing a great job. I'm giving exercises. I'm getting strong. I'm doing all these things. The problem is is that th they're not accounting for that that long cost uh in in time. In addition The other factor is that we said that all these things like still need to be guided. So we have to understand that that cells have essentially a shelf.

Right? And I mean we talked about this in in the ISM a little bit. Shell cells have a shelf. Whereby they can only they're only in their prime for a certain period of time. And when they're in their prime, they have to be told what to do. Because when we have, you know, like normal cells, like this is a this is the supraspinus lake.

This is normal cells going in a certain direction. I have insult, I have insult, I have insult. What we want to try to do is we want to try to, when there's cellular accumulation there, which is part of that selective process, we need to guide that cellular accumulation. And if it's not guided appropriately, what happens is the cells move out of their prime, they divide, divide and divide, but they're dividing now

hazard ways, they're becoming directionless, they're not becoming part of the superspinus ligament anymore, they're just becoming white stuff. And ultimately what happens is that continues to go on and go on and go on and the less information there is the more cellular accumulation you have and then

At the end of accumulation you you actually get cell death. Like cells just die and they go away and now you have a structure that is biologically not the same, behaviorally not the same, and doesn't function like it's supposed to function You know, down the road. Right. And so um that would be an example of what that would do to white stuff. From a a red tissue perspective, getting to what you were saying, we have tons of evidence to support spinal atrophy.

segmentally and otherwise. Well it's it's kind of the same thing. If I you know i it on the front end of that, if if I have repeated insults, you know, that exercise prescription might do an okay job.

Well the I'm still in my prime and all the red tissue cells now are in their prime and willing to to to be added and so on and so forth. But again, if I'm not specific in that maintenance, over time what happens is And I'm not specific in my information to that region about how I want that region to function physiologically from an endurance perspective or whatever the case might be, then on the back end there's trade-offs to that.

Whereby now it it didn't get the information that it that it wants, didn't get the information that it needs, so from a longer term perspective, it's not gonna do what it's supposed to do. And so now you have senescence through the whole system. You have it in the white.

uh where behaviorally just can't function like it it needs to function. You have it in the red where behaviorally just can't generate the outputs of of strength or strength endurance that that you need, and now you have a system that becomes compromised for long.

And that's what's in it.

But if you notice when you're talking about bird dogs and plank What you're doing is you're 100% trying to avoid movement in the actual joint that has the injury.

And will allow for you to hinge through your hip so as not to disturb the spine. Sure. So it's almost like we're I I I don't wanna be a shit about this, but it's almost like everything that has been put forward has been put forward in the in the guise that if you have spinal problems, let's trust try to make them not bother you as much in time. So that we have a a general decrease in the number of people who have recurrent amounts of back pain. But it has n no bearing on your back.

And now let's go backwards once again. And we got to talk about our evidence and how where our evidence breaks down and how you have to bring in first principles. The fact is, is that there are receptors that we call mechanoreceptors. that provide information to your nervous system which we called afferents. And these mechanoreceptors live in normal tissues that surround the spine. So if you think of

your decision to move happens well after your body is actually going to tell you to move and your conscious ability to say, I'm going to move, is far later than your body's decision to move. So that means that there is that the body needs preemptive information of as to the status of that system. in order to say, okay, now if you want to move away from where it is, we have to know where you were, where you're going, and we need a plan to try to get there. And all of that information is based on

Except the spine. Except the spine. Except the spine. The spine is is is to its own accord. Now, I I before I don't know how much time we have, but I do want to bring in some of these concepts. So I think what we've been Maybe getting at is what I just described is what we can consider to be optimal, like a shoulder that's optimal. If you give me uh two baseball pitchers Same size, uh you know, male baseball pitches or female, whatever, all of the variables are are perfectly even.

And and and that person can pitch eighty five miles an hour and I need a ninety mile an hour fastball. And I say, Mike, you have the choice to w and and if you get them to ninety, I'm gonna give you a billion dollars. You have the choice to choose client A or client B. Client A has sustained a history of rotator cuff damage, right? They tore their supraspinatus, they had a little labral tear that was corrected surgically, blah blah blah blah. The guy on the right had no such stance.

And has never the shoulders great. The guy on the left, when you get him to move, you know, you let's say you get him to do cars, you see that there's compensations. There's you know, I can't get here, I get here, I move here, you see on the guy on the right, you see this. This this shoulder, which does exactly what a shoulder does. It can go up, it can go down, it has internal, and has external rotation. If I asked you who are you gonna deal with, which client are you gonna ask for?

And we just make the person strong and we we give them bird dogs and whatever. Like I said, we're leaving that system no afference and we're asking it to just function normally.

Which you would never ask of that shoulder. That does not make any sense. So getting back to here, it so what I was getting at is we can define optimal. It doesn't matter how stingy you want to be. There's no literature to define a normal shoulder. Well That's a little bit that's taking literature a little bit too literally. Clearly, we can all decide on which shoulder will function better just based on the first first principle.

Whereas the stiff side, which is arguably even more common in our practice, where you have the you know forty five year old construction. Who doesn't exercise, diet is not good, you know, they they their hobby is Netflix. these people have not explored their spine, right? So y that would bring this this idea of this this person who is incredibly stiff. Right? And and when you're incredibly stiff there's there's a whole list of

capacities here that we're missing which are going to be different than over there. Over there we would never have said, you know what we need? We need to increase the amount of workspace that that segment has. Because arguably that segment has uncontrolled workspace. It's more important to get that workspace controlled. Whereas over here, we would automatically be adding things like specific pails and rails in in our world in order to try to create the landscape in which motion can occur.

segment by segment, region by region, uh and should display normal neurological control of that segment. And you know we're not gonna hash that out per se, but there's gonna be ways that we're gonna provide that

help us define what that means. Right? Therefore we can say in optimal and this is really important because you've ha you've harped on it a couple times. We can say that optimal has full afferents. Therefore, it is being consciously, unconsciously monitored by the central nerve.

grants energy in order to build more tissue, such at the back end you have more tissue to generate more force to compensate for that that blah blah blah blah blah. But

That's exactly what bird dogging does. It it ha it has nothing to do with the actual spine itself. Nobody really cares about the spine itself. But I was gonna say this is the same problem.

Then we have inadequate movement distribution segmentally. We have poor control of that segment. That means the nervous system is not aware of that segment, therefore it can't control it, which means that afferents is poor. On the other side, you're on that side, but uh we can then say if we have optimal and we have this on the far right of the continuum, there's gonna be something on the far left of the continuum and it's gonna be the opposite of this.

And that is a segment that doesn't move. So therefore we've called stiff. Again, these terms might change. Um where there is inadequate segmental distribution. In a segment within the region, and also because now there's no movement, there can't be afferents without movement. That's right. So therefore there's poor afferents. Um and clinically I think we've also defined these.

And again, this is just very cursory, but over here on a segment that moves too much, you're gonna have uh a lot of the jump sign type things. supraspinous ligament tenderness, and then you're gonna have a lot more peripheral distribution of discomfort. So it's not gonna necessarily like these are the ones that if you push on that segment, they start to feel it down the leg or, you know. And again, that's all mapped out uh in the research where those peripheral distributions are.

And then over on the other side on the stiff, clinically, um probably a little bit more local in terms of the clinical presentation.

Maybe s some practitioners have brought it to this level, but to this point, there's no system in place that I know of that has broken down the spine in this way. Now, if I give you these findings to one of our practitioners who has been through our stuff If I you know if I say you know this is one of the findings, this decreased amount of afferents or this movement distribution or on this side that we have a lack of workspace, these words probably

Action. And the action is you've defined a capacity that's lacking. We've defined how the literature attacks a lack of capacity in order to improve the capacity. Ergo now we just have to direct the focus of our inputs into the spine. which is again has not been done. So of course the course will purse out. How do you treat the spine more like a shoulder? How do you break down these findings? How do you determine, you know, in this case we have optimal, optimal, optimal stiff, hypermobile stiff.

Optimal, which is a very common pattern to see in the lumbar spine. Or if we have a hip that doesn't move, we might have Uh an SI that is hypermobile again, hypermobile is just the I don't want to argue with that word, but and then that might make the joint above and below become stiff to try to compensate. These are definable qualities, and not even with new literature. These are definable qualities with the information that we have.

Right? Yep. Um so again it's a matter of taking first principle concepts and then specifically applying them to this problem, which is a problem born out of biological tissue.

It it's biology and the pathology of that biology which leads to aberrant neurological function which needs to this ongoing problem. So if we can define the biological problem and we can define how to reverse the biological problem And we know that the nervous system has this way of correcting for itself if the uh right amount of information is given to it, which is from the biology, now you have a very specific system of spinal assessment, uh diagnosis, treatment, management, which doesn't even

f it doesn't even sound like the the what we've had up to this point. Like and and we can go further and say like up to this point. This idea of biology versus neurology was not a thing. So the neurology was like, remember the days where, oh, your glute is inhibited? Right?

So up to this point, we've only been privy to discussions about point-to-point interaction. Then we have stuff like um what's that guy we were talking

Such that the responding nerve doesn't just take it and say, Okay, you want me to depolarize? Fine. No. It it it it can send a very specific signal such that Seth Grant would say that there is a degree of logic. that occurs in the synaptic cleft, which we're just learning about now. But there's even more to it. Some papers f funny enough about cephalopod intelligence. Um And octopuses and how their nervous system how they have these

these grand scale nervous systems, but most of the nervous system is dedicated towards the movement of the comp the complex movement of the limbs and it might not be towards cognition. But anyway, a point there was brought up about the idea that These point to point interactions, discharge or not, that is one form of

neurological communication. However, at any given point, if you're looking at the nerve, there is small amounts of ions that continuously fluctuate across the membrane. Right? Which nobody ever talks about. Right? But if you take now an xy coordinate and you map the range of those fluctuations, so in time, if we give x to be time.

This depolarization moves in time, right? Such that you get uh you get something like this with regards to the range. Now, if something happens at this point, which is closer to the threshold. that's going to cause that depolarization to occur quicker. Versus if it happened here, you're in a state where you're not close to the threshold, so the depolarization might not occur. Well that means that there's a lot of extrinsic factors that might be influencing the nervous

You can talk about fields and magnetic poles. And this is a whole bunch of stuff that a lot of people took too far and energies flowing throughout the body. point to point interactions, you have point to point interactions which in and of themselves have logistical complexity, and then you have a fluctuation across the membrane where this particular cell may be more or less excitable depending on

The the sun, the the nutrition, your hydration. What am I saying here? I'm saying that this nervous system is way more fucking complicated. Glute's gonna come on and off. Yeah. And the only thing that we know about it is that this nervous system is dedicated to the it is dedicated to the the the utilization of the biology, which is what gives it the information that it has to go by. Again, neurology, biology. You can't just strengthen your core. You can't just turn on your glute.

Let the evolution heal the back such that it gets back to normal and the nervous system just goes back on to normal point-by-point uh information. It's just it's just it's a lot more complicated than that, I think, is the point.

Um so I think the point here is that in this course that we're developing in the literature review, we're finding that well we're not f we've been practicing this way the whole time, but we're trying to put it into a a logical flow. We're finding that there are ways to

Look at the spine to define it segmentally to make decisions segmentally as to what it has or what it doesn't have. And then if you run that through the guides of the functional range systems and FRC and FR and what do and FRA and how do we assess these things. It fleshes out a very specific way to manage not low back pain, but spinal function on an ongoing basis.

the rules of the spine being different, i it's it's if for sure there's enough to talk about just for the spine that that that lends itself to its own course. So I guess that was a good uh that was a a good introduction to what we're doing and what we've been working on um with this and a whole bu a bunch of other whiteboards, but uh Anything else to add?