SPEAKER_11 23:25–26:17
Good morning. Happy Wednesday. I have no coffee in hand and it is perfect. All right. Today is Wednesday. That means that tomorrow is Thursday. That means tomorrow morning, 6 a.m., Coffee and Coaches conference call as usual. If you are not participating in these calls, what is taking you so long to get here? Because these are great calls. Great people, great groups. Obviously, you're seeing bits and pieces of these calls. These calls go about two hours. We share these Q&As during the day, about 30 to 40 minutes. So please join us for these calls. They are excellent. Like I said, great people, bring some coffee, bring a question. We'll have a great time. Okay. Today's Q&A comes from Frederick, and Frederick has a client with a spondylolisthesis. We talked strategy here. But let's talk about what spondylolisthesis is. So first of all, let's give you a little bit of a graphical representation. So on the screen right now, hopefully, if my technology is effective, you are now looking at what is represented as a spondylolisthesis. So this is the slippage of the vertebra forward on top of another and not a great situation. Many people are asymptomatic under these circumstances and they never know that this existed, and in some cases, it's going to cause or promote, I should say, a great deal of potential pain. Now, from a strategy standpoint, if we think about what this thing really is, what we have is this forward movement of the vertebra on top of another vertebra. That is actually an internal rotation strategy. So typically what you're going to have is you're going to have some form of a more extreme ER orientation. This is a compensatory strategy to produce the internal rotation. And therefore, the spine is the location of the compensation. In this situation, what we're trying to do then is we're going to try to drive an early representation of propulsion. So this is going to be the sacrum base moving backwards on the ilium. Because if we were to drive, say, a late strategy where we're moving the ilium forward on the sacrum, remember that late is going to be a very strong IR representation moving towards ER, where early is an ER where we have an early superposition of internal rotation. If we can move the sacrum back, we have a chance to reduce the IRD strategy in the spine. And so that's going to be the strategy that we talk about here with Frederick. And we talk through this. He's got another complicating situation that you'll see as we go through this that could produce some interference. So you always want to take that into consideration as well. The activities that people select tend to not be the best ones. The things that they like to do can actually become a potential influence as to why they are symptomatic. Frederick, thank you so much for this question. It's going to help a lot of people because this is a fairly common condition in the clinic. I think it's a very small percentage of the total population, but we see a fair amount of this in the clinic, especially with people that do what would be considered extension-based activities, like gymnastics would be one that stands out in my mind. So again, thank you for Frederick. If you would like to participate in a 15-minute consultation, please go to askbillhartman@gmail.com. Put '15 minute consultation' in the subject line so we don't delete it. We'll arrange that at our mutual convenience. I will see you tomorrow morning, Thursday, 6 a.m., Coffee and Coaches Conference call. Have an outstanding day.
spondylolisthesisspinal mechanicsinternal rotation strategyearly vs. late propulsionsacroiliac joint mechanics