Good morning. Happy Monday. I have neural coffee in hand and it is perfect. All right, man, very busy Monday coming up. Quick housekeeping item: IFAS University has a call at 1 p.m. Eastern Standard Time today. Please join us for that. If you're not a member of IFASUniversity.com, please go to IFASUniversity.com and get yourself signed up, then you can join us for the call at 1 p.m. Always great people and a really solid Q&A session today. Digging into today's Q&A, this was Zach. We had a case situation here, so we have a field hockey coach slash player with some situations. What this does is allow us to look at how we evolve from potentially reduced gravity situations. Say we're working on somebody on the table—we've taken gravity out of the equation to a certain degree, we're managing some of the internal forces—then what happens when we stand up? How do we test for that? This is where we can introduce the load propulsion test, which gives us a representation of how an individual manages internal forces when we bring them upright compared to when we get somebody clean on the table. Zach is very successful on the table with this individual but is having trouble with this transition in standing. So we definitely go over that. Thank you, Zach for bringing this up—it allows us to answer a lot of questions in regard to how people will progress their clients and patients. Everybody have an outstanding Monday, and I will see you tomorrow.

No, we're going to venture into just normal PT land with low back pain.

No, normal PT land. Well, Zach, if you have a patient that comes to you with low back pain, you just followed the low back pain protocol. Everybody knows that.

Yeah, it's just cause it's all the same and we're good to go. So I had two patients that have come in the last couple of weeks, different in terms of presentation-wise, as far as like archetype and their chief complaints, but similar in terms of low back pain, specifically with extension. So just trying to figure out kind of like where they are in terms of their shapes.

So when you qualify something like that, when you say specifically with extension, what do you mean?

When they lean backwards, that is the most provocative movement for them.

All right. So is it leaning backwards from standing, or is it coming up from a forward bend?

The former.

That means the first one, right?

Yes, they're upright. And then go back.

OK, gotcha. The latter thing always throws me a little bit.

Apologies.

No, it's OK. It's OK. I'm just an idiot.

I don't think we would all come on this call if we thought that was the case, but okay. So anyway, the first woman, she was like chessboard wise. And she was on like a pretty hard turn to the right in terms of like a bird that they can mute for me please. So she was on like a term magnification of the left IRs.

Thank you. Oh, good. All right. I know who it is. One second. I got it.

All right. So she was on like a term magnification of the left IRs. Her pain complaints are more like specific in the sense that when she goes back or leans backwards, not going to catch myself saying extension again. She was initially getting like right, ridiculous pain, like shooting down the leg, like to the knee. The other thing that really bug her is that she's a field hockey coach. Whenever she was doing like the sweeping or shooting motion, if she's like, they all do it righty. When she would like transfer her weight to the lead leg, the left leg, it wasn't the actual swing, but then coming up from that. Like even like with no weight on the right side, always on the left, but just.

Is that what you said?

Yeah, like just with you, totally with you. Her pain complaints are specific in that when she goes back or leans backwards—I'm not going to catch myself saying extension again—she gets, she was initially getting right, ridiculous pain, shooting down the leg to the knee. The other thing that really bothers her is that she's a field hockey coach. So whenever she's doing like the sweeping or shooting motion, if she's like, they all do it righty. When she would transfer her weight to the lead leg, the left leg, it wasn't the actual swing but coming up from that. Even with no weight on the right side, always on the left, but just that motion.

Yeah, it's kind of like a follow through with a golfer.

Um, yeah, but it's that side. It's that side of the way she's like way hunched over what she's totally fine. Like if she just stayed down there, she'd be totally fine. Yeah. She gets the right side of symptoms. Um, the other girl with low back pain is a college sprinter. Um, she was kind of someone who just like had no gradient for movement whatsoever. Um, And then she, while she had the pain with the extension also like flexion, just a very limited arc of motion both ways. I'm having more trouble with her than the first one. I'm trying to figure out like from a shape standpoint, because it's like, especially with the field hockey coach, I can like pretty much get relative, full relative motion or what I think is full relative motion within the course of a visit. It significantly reduces her symptoms.

Okay.

I sense that like instead of the pain going all the way down her leg, it's just kind of localized to her butt. Um, and she'll say that the sharpness is gone and now it's just more like a dull aching there. But still can't get rid of that pain. So I'm just kind of wondering from a standpoint, is this something that maybe she's fooling me on the table? Is there sensitivity that needs to resolve even though I've gotten full motion? Is that just a time thing? When I stand it up off the table, did she potentially lose what I thought I had on the table? So we're kind of like probably the question at any time with both of them, but probably- Who do you want to talk about? Let's do the field hockey coach.

Okay. So if you've got the magnification of IR on the left-hand side, what would promote that? I mean, that's a big turn. It's a big turn, right? Now, are you able to reduce that to something that would fall towards the average?

So for her, she was missing a lot of hip extension too. So I just started like in hook line right.

Okay. But, but, but you brought, you brought the IR back to, to something that's a little bit closer to the average. Did you also reacquire the ER on that side?

Yes.

Okay. So you're doing a lot of the right things. Okay. Correct. Okay. Um, did you get the late hip IR to go to zero?

On the specific.

Negative over test. Negative over test.

Are you asking about specific side or just?