Name: IMMACULATE DISSECTION: Ask Us Anything - Episode 11 - 7/5/20
Uploaded: 2024-08-30T13:45:30.000Z
Duration: 55 min
Description: Thousands of YouTube videos with English-Chinese subtitles! Now you can learn to understand native speakers, expand your vocabulary, and improve your pronunciation...

Hello, and welcome to Ask Us Anything, our Sunday free webinar where we talk about all things anatomical and answer questions from our amazing fans of Immaculate Dissection.

So excited to be here with two of the most amazing people on the planet, as well as some of our other live participants who we're getting to know, we're so thankful that you're here tonight.

My name is Dr. Kathy Dooley, I am a chiropractor, rehabilitation specialist, and an anatomy enthusiast of sorts, here with the amazing Dr. Anna Folkmer.

Hi everyone, I'm Dr. Anna Folkmer, one of your co-founders of Immaculate Dissection.

I'm an acupuncturist and herbalist, and also an anatomy enthusiast of sorts, and glad to be here.

And last but absolutely not least, Danny Quirk, our anatomic artist for Immaculate Dissection and co-founder.

Yep, the artist for Immaculate Dissection and giant anatomy dork as well, so always excited to attend these and be a part of them, so looking forward to tonight.

So if you're joining us for the first time in our anatomy dorkness, as Danny very eloquently put it, which I do agree with, we decided to get together on Sundays and chat, and we started at the beginning of the pandemic, so it was March 2020, and we've gotten addicted to it, we love it.

It sparks ideas for us for our ID Collaborative, our online learning series, and it gives us, you know, ideas of just getting people excited about anatomy and talking about some various questions that you have.

Sometimes people will come to our courses and ask questions that's not always appropriate for the subject matter, and so this is kind of an open forum, and it's free, and we'd love that you guys join us on Sundays for this, if not live after the fact.

So we have some pretty cool questions from the gallery, and we thought that we might cover them.

So do you want to start with the first question that was asked?

The first question regarding the kinesiotape, okay.

So the question that we got on Facebook was, can bracing using external support like kinesiotape and diastasis recti cause changes in blood pressure?

Okay, so the first thing that we want to cover as an ID family is that we don't use kinesiotaping for anything other than the demonstration of ligament location, and I'd like to demonstrate the ilial lumbar ligament and the importance of iliacus and quadratus lumborum attaching to it, and anterior thoracolumbar fascia attaching to it, but I have to go from experience.

I used a kinesiotape from 2006, 2007, very religiously, every single patient, every single visit.

In the last year of my internship for chiropractic, I saw a lot of patients, and to me, it was very cumbersome, and I didn't find it to be as useful as it was expensive or time consuming.

So I found that giving proprioceptive cueing and other type of things worked a lot better for me.

Anna, I know that you said that you use magnets a little bit more?

Something that has a little bit more weight to it, just so that you're able to simulate some of those proprioceptors, and I use magnets for, I use silver and gold ones, kind of depending on the circumstances, but I find them a little bit better for proprioceptive cueing than some of the kinesiotape, at least as far as my work's concerned.

Yeah, the problem I have, I guess, with the question is that kinesiotape is brought up as being a support, and I guess I don't know what they mean by support, because if they're talking about structural support, that's not what kinesiotape is doing.

Kinesiotape is in the literature and supported as being something that's for more proprioceptive reasons or to encourage circulation, but it's not used as a structural support, like athletic tape, and so that's part of the thing that's good about it, is that it doesn't limit movement, and that you tape in certain directions, and that pull that's on the skin creates a dermal traction, and the whole theory is that you're encouraging things to move in a certain direction that you want to move in, and I see the appeal, for sure.

I think that because when you change directors of force so frequently, I particularly don't really love taping in a certain direction, because I think it's willing to change very quickly, and your body adapts.

I also know, I can give you a test right now, to the fact that once you tape something, you're going to accommodate to it, so make sure that you feel the back of your shirt right now, feel the back of your shirt, feel it hitting maybe your scapular region, feel that really intensely, great, awesome, so five seconds ago, you didn't feel that, and

I brought your attention to it, so one of the benefits, I guess, of kinesio tape is that you can see it, maybe it brings attention to it, but it's only for a short period of time before you filter it out again, just like you just did, now I can bring it back to your scapular awareness, and you feel the shirt on your scapula, it only took you a few seconds of me talking to distract you away from feeling that tape, so I have not found it to be as useful as the education of my patient, so when it comes to diastasis recti, it's a huge education for us in immaculate dissection on breathing mechanisms, and a lot of people are taping diastasis recti, they're taping it in the middle, in immaculate dissection, that's our last focus, we're focusing on lateral expansion of muscles like transversus abdominis, internal abdominal oblique, external abdominal oblique, that are forming the rectus sheaths, the aponeuroses that form around this rectus abdominis, so the worst part about diastasis recti is its name, I know diastasis is the separating of two pieces, but rectus abdominis, its two muscles were always separated and combined at the linea alba, and it's not just the rectus that's separating from midline, it's the aponeuroses, the rectus sheaths that are separating from midline, and what we correct with diastasis recti in a lot of people is their dysfunction on the anterolateral abdominal wall, and not just rectus abdominis, so for us, what are you going to do, you're going to kinesiotape TVA, IAO, EAO, rectus, anterior lateral thracolumbar fascia, iliacus fascia, psoas fascia, it would be a lot of tape. The second part of that question is about blood pressure changes, and I'm assuming they're talking about diaphragm hiatus, and aortic pulse, it's a lot of assumption, I'm hoping that I'm answering their question, and the ID team maybe can help me too as well, if I find that the person has diastasis recti, and has diaphragm dysfunction at the basically thoracic jamming at T12, and a really visible aortic pulse, kind of like the Andy's video that he did for our Instagram, he was talking about the bounding aortic pulse, I think that certainly you can monitor blood pressure through breathing, that's very provable by you just taking your pulse right now, inhaling, and as you exhale, the pulse slows, so certainly if you're harmonizing diaphragm, and it's pressure on the inferior vena cava, and abdominal aorta, you can certainly change things, as far as taping and blood pressure, I'm not sure that we're the right crowd to really answer that specifically, I wouldn't use tape at all, because I don't use kinesio tape at all, I instead educate my patients on where I want things to come from, and let them start to tap themselves, and give themselves proprioception, educate them through where things are supposed to be coming from, and that's our bigger focus, we're not antagonists to using taping, if you want to do all that, and use taping, great, but for me, I've had enormous success with using IDQs, and not needing any tape at all, it's an extra expense for me, and the patient to buy it, but Anna, do you have more to say on that, I'm sure you probably do.

I mean, there was a lot in that question, that certainly worth discussing, and you hit all those topics, but we talked about the application of bracing, and things like that, in an ID collaborative episode, really early on, and we don't apply any sort of bracing in diastasis recti, when we're addressing this, so I think it's really important, how many ways are you trying to connect dots here, with your patient, correlation and causation aren't the same thing, we know that, and really fun research articles, that have lined up two things simultaneously, and shows ways in which they look like they're correlating, but they're actually not, I certainly think that you could talk about this from the angle of, well, if there's a diaphragm dysfunction, and it could miscue the obliques, and then there could be a tendency to have something like diastasis recti, which may be accompanied by a blood pressure issue, if there is some sort of diaphragmatic compromise around that hiatus, but it's trying to thread a little too much together, I think with this question, and because if you try to match the problem and the strategy together, a lot of times, that sort of confirms whether you're on the right track or not, because if you made this an if-then statement, and said, well, does taping address blood pressure, or does taping not address blood pressure, I would say there's entirely too many factors that go into what a person's blood pressure is doing, and none of them are a tape deficiency, and none of them are ever fixed with tape, so to me, it just seems a little unrelated from that perspective, but if you're curious about the application of a brace and someone's blood pressure, I know with people who wear big, thick belts and stuff, I would say be careful about that, because it's certainly possible that the external support that you're trying to apply to the patient may be giving them a diaphragmatic dysfunction, which could be then throwing off their blood pressure, so there's lots of different ways that you can look at the relationship or non-relationship of these things.

I think it's an interesting question, so hopefully, I'm a little unclear which part to answer, but hopefully, there's enough said about each one of those things that the person feels like their question is answered there. Yeah, unfortunately, it's like a bomb going off with the question, because first of all, it postulates that the person needs to be taped on the anterior, which we're very against in that section. We're very much against trying to get them to open up the lateral sides, and then that will create a natural bind in the front through the actions, through the tendons. Second of all, we don't use kinesio tape, but you certainly can. I mean, if you're supporting that lateral wall and if you find the tape to be useful, if you find anything to be useful, you probably should be doing it, but we're not kin tapers as far as the

ID teaching team, so we're probably going to support you in your kin taping with ID principles, which are get the lateral wall moving. I just wanted to show you, Danny had painted this on one of our amazing colleagues, Frank Desiderio, and I'm just going to share my desktop with you guys really quickly and just show you. You can go to YouTube, and if you type in my last name or just duly noted diastasis recti, this is Danny actually painting Frank, and we show the diastasis recti in this diastasis recti video. Let me just get to the point to where you can see that we're talking about the rectus sheaths and the fact that diastasis recti doesn't come from here. It's coming from the lateral side of the wall, and then we have Frank lay down, and we do breathing strategies in supine, which is very important to us in diastasis recti, and you can see that I'm going to start coaching him through the ability to laterally breathe, and Anna, I think you might be filming this, are you not? I'm trying to remember if you or

Danny were filming it. I think so, yeah. You can see me trying to point out to the lateral side that we're trying to get the person to expand laterally and that the person that has diastasis recti tends to expand too much here, so I think that's what they mean by trying to kin tape them down here, but rather than trying to tape them down here when rectus is really not what's causing the problem, it's the fact that there's tightness here, the diaphragm's dropping down and forward, as Anna describes in ID1, and in the way that Danny paints this, he shows that what you're looking for actually is for our IDQs to be set neck long, chin tucked, chest wide, and for the person to be expanding more laterally, and so if you want to kin tape to encourage better blood pressure through better diaphragm function, that's very indirect and I would say almost a little bit too indirect for me to feel comfortable saying that they're correlated, like Anna said, correlation versus causation. I think that the biggest thing for us in ID is trying to encourage the person to not breathe through their neck, to breathe through the sides of the ribs in diastasis, and 100% of diastasis recti patients, they breathe too anteriorly and not enough laterally, so hopefully you can help them control their blood pressure, you can use taping if you like, but please don't just tape them, you need to make sure that they get a lateral expansion, and if you want to learn how to do all this, we teach all of this, all the intricacies in ID1 core concepts.

As Anna described too, just to show you, if you go to our website, maculardissection.com, you go to the ID Collaborative, we cover a lot of these breathing mechanics and the way that we coach breathing through the ID Collaborative, hopefully my internet will sustain here, folks, and I think it was episode three, yeah, this one right here, so you can just click on this one and it'll take you to where you can actually purchase this particular ID video just on the biomechanical breath, so if you're wondering how to navigate the website for these little videos, sorry, website's a little slow right now, my web is a little slow, it describes what you learn and what to do, and it's, you know, a pretty good 20 bucks spent, or you can sign up for the ID

Collaborative membership where we cover breathing, so that might prove to be really helpful, and we are on par this year to talk about diastasis recti as a separate unit, but you're welcome to, you know, enjoy the biomechanical breath and our discussions on what's actually happening in breathing, because that might benefit you more than just saying, let me throw some tape on the front of them, and hopefully that will help them bind up, I think that that bind up idea of trying to create tension in the front of the wall, those are tendons that are stretched out, they're tendons for muscles that are located out to the lateral side, so if you're wanting something to really bind in the front, you better get moving on the lateral side, dating also, oh sorry, I think we also covered diastasis recti in the third Ask Us Anything, maybe, and that should be up on YouTube, right, yeah, so there, it is, it's a topic we love to talk about, we talk about it so good, if you just join us for something, it'll probably come up, so yes, Danny, anything else to hit when it comes to diastasis recti, and you have an awesome video on our Instagram where you go over like sitting postures, and breathing, and the aortic pulse, and blood pressure, and how it's affected by the diaphragm, yeah, no, I mean, just basically, we're just going to add, and kind of just contribute to that though, again, like kind of, kind of, just kind of jump back off of what was kind of said before a little bit, but, but yeah, like really, really big important thing though, is to really kind of work on lateral sides of things, like even though the name, anterior located structures, it's really not the thing that's causing issues, and like,

I don't know, kind of the visual, I don't, hopefully it'll, hope it'll work this time, but

I had kind of done this beforehand, but you can kind of think of it like, let's see here now, so if you're doing too much, kind of pushing forward anteriorly, you're kind of split at the front, but you know, if you strengthen, strengthen from the sides, it's going to kind of take that, all that tension coming out from the front, and keep you more braced, and more supported, but I was kind of thinking about that though too, in terms of like, you know, in terms of braces, or in terms of things like that, like if it's, if it's giving support, but preventing any kind of movement from happening, you know, I feel, I feel like that could just cause like, any kind of like, you know, side-to-side movement from happening, that can definitely cause some issues as well down the road, and you know, it may not get you very far in that sense.

It's completely true, like the way you describe it too, is almost like a corset, like people get, they wear these binders after, like some people are assigned them after, you know, getting diastasis recti, the, the fallacy is that these people need to be compressed, these people need to be held in, because they think it's like a hernia, like a ventral wall hernia, and I do understand why people think that, but it's really because there's nowhere for the air to go, there's nowhere for the diaphragm to go, so it goes out to a path of least resistance, and because the linea alba is a bloodless plane, it's exactly like Danny showed you, it's bound up, the air, the pressure has to go somewhere, so it goes out to the front, it's not that the person needs a bind in the front that's extra, it's that they need to be opening through a 300, you know, degree breath, and they're so bound up on the lateral sides, especially after pregnancy, because the baby's expanding them so anteriorly, because the uterus is a midline structure, that the person could benefit not just from binding in the front, you, it's really hard to bind the front and not bind what's attaching to it, which are the, the muscles on the lateral side, so I love that analogy that you gave, it's great, it's perfect.

What I was going to say, too, is just kind of think about it as well, like from the days of doing landscaping, we would have, especially if you were like building walls or doing things like that, like it'd be like, you know, 100, 150 pound rocks that we're lifting at a time, and you know, our boss is really adamant about us using back braces for that time, and found that on days that actually wore the back braces would have more, would have more pain afterwards, because couldn't really take a really deep breath to really like, obviously, you know, learning, applying it to a physical moving environment like that, you know, just take really, really deep breaths, you know, really support that spine, really, really get that, that IAP going, and then, you know, being able to move like a lot more efficiently, and wouldn't have those restrictions, that those were the days that would feel sore the next day, as opposed to other days, so. Oh, I am not a proponent of bracing, and yeah, I think that that's such a good observation to make, that when I watch people wear braces, I know why they're doing it, they have mechanics anyway, and so they wear the brace to actually encourage poor mechanics, and you, if you would learn good mechanics, then you can use the brace only in a clutch, like I think that a good example is, similar to Danny's, is my business partner is a very heavy deadlifter, and he would only wear a brace in competition, because it gave him an edge, he would never wear it in training, he would wear it in competition, because it would compress everything, and he would be able to get out an extra rep, but he would only do it for three total reps of his entire year of training, and compared to like people that train with it, or work with it, and it weakens the tissue, because when you break, research is very supportive of this theory, when you brace something, you're shutting down the muscles relative to that, because if you're getting exogenous support, your body's going to shut down, it's going to down regulate its own need, it's like energy efficient, it's like, oh, something else is doing that, why would I turn on?

Absolutely, and also if those braces have to come off eventually, then we seem very vulnerable,

I know I have a patient right now that has a ventral wall incisional hernia, and he's not been able to do a lot of his rehab that he's used to being able to do, I think it sounds like in the, since the pandemic and everything closed down, there's been a lot of caution, and he's found, he wore a brace as advice to him by his surgeon, and his surgery was actually postponed, because the interesting thing about openings and things like that in the anterior abdominal wall is the bigger ones are usually less dangerous, it's the small keyhole ones that are problematic, because if stuff can pass freely back and forth, that's fine, but if it passes through and gets stuck on the other side, that's a problem, so for this patient, he had had, he had had an incisional one, and then a very small one, interestingly enough, the incisional hernia was created because of, there was an inguinal hernia, and then there was a surgery with mesh, the mesh came loose, created a bowel obstruction, and then there was a full incision to address the incisional hernia, so the whole thing actually started from hernial repairs in the first place, which is really interesting, I'm not against, you know, addressing something surgically when it needs to be done, but we have to at least, you know, look at the sort of cause and effect of all this, and so since being sort of locked in with coronavirus and the pandemic, he has been bracing much, much, much more than usual, and the last update that I got this week is that there are now four extra hernias, and now it is absolutely essential, because they're very small and sort of sporadic all over the anterior abdominal wall, so four additionals, there's six total now, and that's with somebody who's been in a brace, and my sort of hypothesis on what's happened there is that the brace is not on 24-7, and so once you get used to that kind of support, it's different than when it's like a one, you know, a PR, a one rep max, you can't be doing a one rep max for 24 hours a day, so if the minute you start to accommodate that, your tissue starts to accommodate to that sort of false sense of security, it'll come out, you still cough and sneeze and fart in the middle of the night, and you know, anytime something like that happens, you're going to have some sort of potential for pressure leak, and you know, things take the path of least resistance, so bracing is a really interesting thing that I think we are all on the same page about, and you know, everything is always case specific, so we try not to make general blanket statements about anything, but you know, look at this too, and really ask yourself, like, what are we actually doing here, and does this solution match the problem that we are sort of facing? Yeah, I can't agree with you more about, like, it's a tough observation to have with a patient that you know you don't agree with the bracing, and I think taping is a lot less, of course, than bracing, and I know we've probably gotten off topic by talking about the bracing, but the whole point of this is that that feeling that you have to brace this person up is not really super effective, and just remember Anna's story about the incisional hernias, and the more that you create a sense of bracing in the front, I know why they're taught that, because there's a hernia, and that's the best way to go through the wall is through coughing, sneezing, defecating, you know, but the real focus in the therapy should be opening the sides, and then aponeuroses are broad, flat tendons, and tendons have the tensile strength of steel, so if you're starting to breach away from midline, ask yourself, why are they pulling away from midlines? Because the sides of the muscles don't have extensibility, so improving the extensibility of the sides of the ribs, I'm sure that's something that Anna's working on with her patient, and once COVID's over, you can probably do a lot more of it in person, but also very, very good analogies put into place, and good examples of cases. So we had another question about hip compression, is that right? And they were asking, was it the mechanisms of hip compression, or? It was, review the signs and symptoms of a compressed femoral head in the acetabulum, just any information around that, signs, symptoms, things like that.

Yeah, this is in our DVD, Anna, you teach the iliacus portion, do you want to talk about iliacus, and I'll talk about pectineus? Yeah, sure, so iliacus is a really interesting muscle, obviously it's going to lie in that iliac fossa, and it's going to go down and have an attachment onto the lester trochanter, and what we see is people, iliacus is this really interesting option for people to try to compress their hip for a sense of stability that they may or may not have, and the reason why is because the obliques, the anterior abdominal oblique, internal abdominal oblique, excuse me, and transversus abdominis will actually start to blend in into the front of the hips with the psoas fascia, and so a lot of times when people,

I mean, this is a really actually cool thing to talk about right after we talked about diastasis, because again, if this person doesn't have that lateral rib expansion that we are looking for in our assessments, and they start to, you know, sort of brace, and aren't able to get some of that tissue extensibility, they will start to compress their hips via this iliopsoas fascia that starts to blend in at the front of the hips, and they'll start to jam the femur into the acetabulum for a sense of stability that's, you know, not really an authentic place of stability, it's just sort of a strategy, and so we see this happen a lot in people who start to get these C-shaped signs and symptoms, they'll get these pinchy-pinchy kind of popping, clicking stuff rolling around, you put them in like a tabletop or a supine 90-90, or any sort of hip flex position, and they start to get a lot of referral down into the anterior thigh. You're really just sort of looking at a redirection of force, and so, you know, your body's efficient, it's going to get something done, but it may not always get it done with the most optimal structures to do that with, and so we want to make sure that we get appropriate force transfer from the abdomen, and we get that pelvic stability there to then transfer into the lower extremity, and, you know, a possible pathway for that, if someone doesn't have it, is iliacus, and so we talk about, you know, the appropriate ways to decompress the hip, and versus what the typical ways that people try to decompress their hip are, which gets really dramatic in a lot of people, and they, you know, they start to look for love in all the wrong places, and try to, you know, stretch their hip flexors out, and it's not really a hip flexor problem as much as it's a hip flexor that's sort of trying to kick in and give you a sense of stability, so we do show ways to maintain your IDQs and decompress the hip in a way that it is safe, and not something that is, you know, going to put you at a risk of, like, a labral tear, or something like that, where someone all of a sudden breaches some tissue capacity, and goes into a tissue sensibility that they don't necessarily have, and just point out what you're talking about, Anna. Anna covers iliacus in a lot of detail in IDQ, and then the three of us discuss pectineus. Danny does some really great art on that, but when it comes to hip compression, it's intra-abdominal pressure loss from conjoint tendon, the connection to iliopsoas fascia, so you always want to check with someone who has the signs and symptoms of just feeling like a hip is jamming in its socket, pelvic inclination on that side, hip hike on that side is usually present, and then you can see, I think in the DVD I'm talking about this, typically you'll get Anna talking about this, but she's talking about iliacus, and does such a beautiful job of demonstrating that, but in this free video that we have on the OTP website, you can listen to a little excerpt of our DVD, where we give you a little sneak peek into IDQ, into when Anna describes this in a lot more detail, but you can see me on Dr. Jake Altman here showing that the person's in kneeling position, we're putting tension into the iliopsoas fascia here, to centrate the femur, and the person's breathing into the sides of the ribs, you see me cueing the sides of his rib cage, this is because muscles like transverse abdominis, internal abdominal oblique, they're attaching to that iliopsoas fascia that Anna's describing, and helping with force distribution, and what's actually flexing the hip, the irony of the matter, is not the hip flexors like Anna's describing, it's actually you get gut pressure, and then you cue this tissue to come up, and it's a reflexive cue, which is pretty fantastic to think about, because people blame the hip flexors for so much, and they end up weakening their hip flexors, and then they don't train them in flexion, and in ID we would never do that, we train things in all of their phases, so if we know that psoas and iliacus are contributors to this hip compressive thing, through their attachment to fascia, and their attachment to the chondroit tendon, then just nearby is pectineus, and pectineus is an adductor that's innervated by the same thing as iliacus, femoral nerve, so pectineus is innervated by part femoral nerve, that's the part that flexes the femoral nerve, and then there is the adductor portion, which is obturator, because the bowels go together, right, if you want to adduct, you use obturator nerve, and so the obturator nerve part of this jams the femur and the socket even more through adduction and internal rotation, so now your flexed adducted internally rotated position is what we call hip compression, and hip compression is healthy, it's present during the loading phase of ambulation, where see how Jake's leg is forward here, that's a hip compressed state, and that's a healthy state, he has a hip decompressed state on this side, meaning you have extension, abduction, and external rotation, so the de-approximation of the femoral head from the acetabulum, so in this phase, you'll see him EQing his breathing, having him annealing, and we're trying to decompress his hip, so for people in ID, what we try to get them to do is meet them where they're at, take them where they're not, try to analyze if it's the iliacus, it's the pectineus, if it's a breathing problem, or all three, and then we help them centrate the femur relative to their breathing and pelvic position, we do these things called pendulums, where we move them back and forth, and I was trying to find the YouTube of looking for love in all the wrong places, because Anna inspired us to do an Instagram of it, I'm trying to remember if I put it on the YouTube, let me see if I did put it on the YouTube, it looks like I didn't, so you'll have to go to our Instagram to find it, but if you go to our Instagram and look up iliacus pendulum, or hip flexor pendulum, actually I think it's called hip flexor pendulum, hold on, and then you'll see me showing the demonstration of looking for love in all the places, but watching Anna Falkner do it can never beat, I mean it's so good, it's so good, but let me look up hip flexor pendulum really quickly for you, see if I can find it, are you guys seeing my screen now, yes, yeah, basically if you see somebody trying to stretch their hip flexors, and it sounds like they should have like chariots of fire playing in the background, and you want to give them a streamer, they're probably doing it wrong, I know right, I was fairly certain that I had put it on YouTube, but I must not have, so which is a real shame, because it's really, really good, and I'll stop the share just so I can find it, but the way that we cue hip compression, the signs and symptoms of course are hip jamming at socket, you want someone to yank it out, pelvic inclination on that side, internal rotation with flexion bias, when they do a toe touch, usually their knee will bend, when you have various activities, you'll, the person always says they get relief when someone tractions their hip, so they've probably been assigned hip flexor stretches out the wazoo, and it's not going to get it done, just as Anna described, because first of all, the person feels an enormous amount of load in that position, so they may not actually like it, and so if they don't like it, they may not do it, oh I almost found it folks, if you go to our Instagram and our IGTV and you find it, it's called the hip flexor, I just scrolled past it on accident, my sincerest apologies, now I can't find it, so unfortunately you're going to have to do some hunting until I can upload it onto our YouTube, so I thought that

I had, but I evidently did not, but if you go under our YouTube IGTV, you'll find it, it's hip flexor pendulum, so you can see me doing the dramatic version and the non-dramatic version, and that's a way to teach centration of the femur, because really what hip compression is, is de-centration with a bias towards flexion, adduction, and internal rotation, and so you're trying to get them to do that during healthy phases, and not doing that during phases where you want them to leave that position, it is healthy to compress the hip, particularly during the loading phase of ambulation, it is not healthy during the terminal stance phase, during the mid-stance phase, and so if they're carrying that hip compression into multiple phases of gait, it tends to become uncomfortable pretty fast, they show signs of iliopsoas bursitis, they show signs of just a jam sensation in the hip, an overstretched sensation in the posterior hip is usually present, none of which are comfortable for the patient, so those are your signs and symptoms, and what you can do about it is probably take ID2 and be a good idea to learn all the intricacies, because it's not as simple as saying, hey let's put them in kneeling and hope for the best, you have to know what to look for in that kneeling position, you have to know how to center them up, okay, I mean it's like taking 15 hours of instruction and putting it into like a 10 minute question, it's pretty tough, so hopefully we've been succinct enough to inspire you to study, and then we do have this article on OTP, you just type in OTP hip compression, and not only are it's basically a write-up about what we discuss, and also a free video, so you get a little sneak peek into that, so OTP hip compression, On Target Publications is the one who filmed our video for us, when we were fledgling at that point, we just had three IDs, now we have six, so we appreciate the question, okay, so we are still looking for questions from our live participants, if you guys have anything, I didn't miss anything, right? Nothing that was on Facebook, but one of our attendees that's in the chat right now has raised her hand, so person with hand raised, if you want to, if you're asking a question or you want to comment, maybe you can put that in the chat box, good, while they're thinking and typing, the chat box is to the left of the share screen at the bottom of your screen, we tend to not turn on your audio, just because we have to mute ourselves, even when we're talking, after we're talking for the feedback, for the recording, we want the recording to be a higher quality for you guys, so if you don't mind typing in the chat box, we can answer your question there, in the meantime, we've got some pretty exciting things coming up on the ID Collaborative this week, if you guys haven't heard of it, it is our learning series that we do, and every week we have two topics, and on Tuesday, we're talking about debunking psoas myths, and Anna and Danny made an absolutely awesome video on this, and it's like a one minute little snippet that we're going to tease you with during the talk on Tuesday, but we want to debunk a lot of myths about the psoas, one, the most important of which is that it's a hip flexor, which it's not that it doesn't act when in hip flexion, it's definitely active in hip flexion, but both of your psoas are active during one hip flexing, which means it's more complicated than most people think, and we also want to stop giving it for credit for things it doesn't deserve, and give it credit for things that it does deserve, like lumbar stability, but we want to take away the fact that everything that's wrong with your hip ever, especially in the front of it, is psoas. Notice how Anna was talking about hip compression, and we barely mentioned psoas. We mentioned psoas fascia, and we mentioned iliacus and pectineus, nearby brothers of psoas, but not psoas itself. Psoas gets blamed for so many things it doesn't deserve, and it's actually got a highway systems of nerves running through it, so that if psoas were really the problem all the time, then your genitalia, your front of your hip, your side of your hip, and your butt would constantly be numb, and luckily for all of us, we're not experiencing that on a regular basis, yet we're all still blaming psoas for all of our problems, and how it got named as the muscle of the soul, I still don't know. Now, Anna, you're vegan.

I know it's not the muscle of your soul, and psoas means loin, and definitely not.

You teach a lot about psoas, and ID, and you talk about it, you know, being the filet mignon.

Yeah, so I hear. I've never had one, but I've seen one in the lab a lot, and so, you know, it maintains that soft, supple, tender nature for a perfectly good anatomical reason, and it's to protect everything that runs through it. We talk about it, you know, like Kathy said, it has an inner state of neurovasculature that runs through there, and so psoas sort of packs around it and protects and acts as this really nice insulatory structure for a lot of the things that pass through it, and so, you know, there's a couple ways you can look at that. One, that tells you exactly why it needs to have that type of personality and quality, and the other reason is maybe the things that people are constantly doing to it aren't totally necessary, because when you look at it, it's very soft, and supple, and tender, so.

They want to maul it to death, and tenderize it, and beat it, and do intra-abdominal intense work on it, and what's so fascinating to me is that there's so many organs that are nearby, like, you know, we have a psoas sign for kidney dysfunction. We, you know, you have an appendix and a cecum towards the right side. You have intestines galore, you know, covering the psoas, and in order for Anna and Danny and I to see it in the human dissection that we've done, and we've done some of it together, and, like, we just, like, pick up, like, the bouquet of small intestine, you know, and large intestine, you just pick it up like a bouquet, and still you can't see the psoas because the psoas is covered in that iliopsoas fascia that's actually transversalis fascia named for the muscles that cover it, and so this transversalis fascia is that same fascia that's covering pectineus, so it's really the reactivity of everything around you, not this one particular muscle, and so it's always strange when a muscle gets blamed for a lot of problems. I mean, it, you know, we need to debunk that myth hardcore for you guys on Tuesday, so if you guys are interested in learning more about psoas and maybe peeling apart things that you may have been taught that are just starting to question them or starting to think independently about what psoas is and how it contributes around things around it, I think that would be really fascinating to look at. Awesome, so we have another talk this week, and I'm trying to remember the topic now, it's not, it's failing me. Root canal. That's right, the root canal, and we'll be talking about the anatomy of the root canal, and if Anna is nice enough, maybe she can share her personal experience with it. Sure thing, super looking forward to it. I've unfortunately learned a lot about root canals lately, so opinions formed. She's got an absolute litany of literature, and she had to make a really tough decision for herself of to do or to not to do, and we're going to talk about the possible pitfalls and also the possible benefits and hopefully help you anatomically to understand what's happening in root canal, and I know that Anna's got tons of research collected probably already for us on this, and that she's really ready to share it. Okay, we got a question about the tips from exercise classes. Oh, a hip flexor is being taught.

Got tight hip flexors in exercise class. What's so interesting to me is that people think that the hip flexors are tight all the time, and they don't do any kind of orthopedic assessment of it, they don't do any kind of analysis of it, they just say, oh it's tight. Well, first of all, you have fascia lata on the front of your thigh that's incredibly tight, and that fascia is usually mistaken for hip flexors. That same fascia is usually pretty tight on the posterior part as well, but the femoral nerve is sitting just deep to the fascia lata and intertwining and coming out superficially to get to the skin, and so people have a bigger perception of tightness. They have a more sensory awareness typically of that tightness than they do on the posterior chain. If you have these tight hip flexors all the time, you have these tight hamstrings all the time, those two things are antagonists, so the feeling for the need to stretch those things all the time, that to me is very erroneous.

Typically, if things are tight for us in immaculate dissection, it only means one thing, and that's worthy of your attention during assessment. It's not a need to stretch things all the time, and the grand irony of things is that if it's tight, it might also be locked long, it might be eccentrically loaded, and if you're yanking and pulling on nerves and fascia all the time, it tends to send sensory awareness up to the parietal lobe that things are tight, and it doesn't necessarily mean that they need to be stretched, and so if you watch our video with the very dramatic hip flexor stretching, you'll see that most people aren't even stretching their hip flexors anyway when they're doing demos, and we put people in immaculate dissection too.

Anna puts them through the kneeling hip flexor pendulum for iliacus, and people are doing this very small movement. They're like, holy crap, I feel like so much happening, and these are people that usually feel nothing on a hip flexor stretch. I was one of those people. I know Anna was. We're like super flexible, but not flexibility, mobility, very different things. Mobility has the stability to control it. Flexibility is just loose connective tissues and just flopping all over the place, and so a lot of people, they're given these hip flexor stretches. Oh, I feel so tight, and then stretch it, and then they actually create more dysfunction in the tissue, and so we're not big hip flexor stretch people. We're more like assessment people.

Why is something tight? Is this tight on both sides of the joint? Is it worthy of my attention?

Is it the tightest thing associated with the person's chief complaint, and so we have these rules and idea of tightest thing associated with chief complaint has certain clinical process associated with it and dysfunctional on our assessments, and if you don't follow those four rules, it doesn't matter if you're tight. You can be tight for lots of reasons. You can be tight because you're low on circulation. You can be tight because you're low on neurotransmitter function. You can be tight because for so many systemic reasons, dehydration, so it's not enough to say, hey, my hip flexors are tight because I work behind a desk all day, and I'm in hip flexion. Not really. You're passively in hip flexion. You're not doing active hip flexion, so I don't know that you need to be stretching things all the time, and so we are really passionate about that idea, and we know that it sometimes goes over like a fart in church because people are so used to hip flexor stretching, and it feels good or whatever, and I'm like, okay, fine. If it feels good and it also serves you a purpose that you find result in, then do it by all means, but for us, what we usually find in our assessments with hip compression is that if iliacus is locked short, you have to teach it how to be short and how to be long and how to share load back and forth, not just flex or stretch and see how long you can make yourself.

It's not typically something that we're after in ID, so that was fun like lead-in to gut pressure with diastasis to hip compression, hip compression to debunking psoas myths.

Root canal is a little far from that, but there are some people that think that certain teeth link to certain muscles, and I have no evidentiary support for that, so I don't think that psoas has a tooth, but psoas does have a pathway, meridian pathway possibly, that you might be able to far reach. We're not far reachers much in immaculate dissection. We mostly want you to study the anatomy and learn the big causative agents behind assessment, and the whole point of anatomy of the root canal is to most people don't even know what a root canal is, and they just kind of sign up for it without doing any research into why they may need it, and you may want to really do your research first. Anna does her research. She was not going to dive into anything lightly, and she's going to talk a lot about that on Friday from a personal perspective. I'll try to share as much as I can anatomically with it. I'm very honored to teach at a college of dentistry. We talk a lot about root canals, and I don't know what I would do in that situation. It's a really hard decision to make, but you want to have an informed one, and what we want to do is provide an informed one, and Anna will give you a personal perspective that I can't give you as well as a very professional perspective anatomically. Danny, have you had a root canal? Do you mind if I ask? Is it violating HIPAA if I ask? You don't have to answer. Yeah, I actually had one after I graduated from college. Whoa, you have two? I feel like I'm so left out. Oh, it was only one. It wasn't really necessarily painful or anything, but it was just like, I don't know, I guess maybe possibly too much information, but I just noticed that there was just really bad breath all of a sudden. Oh, that's not too much information. That's bacterial overfill. But there was never any pain associated with it or never any issues like that, so I remember just checking in the back of the mouth, and like half the tooth is gone. Oh, it's scary because it's like, yeah, there's so many things that are linked to bacterial overgrowth, and I'm sure we'll talk about that. It's not just fluoride deficiency. A lot of people think there's so much to it that's very systemic, and I think what's going to be such an interesting talk is that some people have pain, some people don't. Some people have deadening nerve, and they don't feel anything, which is way scarier, which is a big point of the root canal. There's Anna, and I don't want to spoil Friday because I know you guys will have, so I am so excited to hear you guys talk about it because I've never experienced it. I've experienced wisdom teeth removal and a couple cavity drills, but nothing all that significant, but I'm fascinated by root canal, and I hate that you guys had to go through that because I heard it sucks, but I'm so interested to teach people about it so they can make very informed decisions for themselves.

Yeah, no, it's definitely an interesting process for sure. I know just kind of speaking on my end there, though, I was hyped up for it to be this terrifying experience. It was actually pretty smooth, considerably speaking, but I can certainly see why it can be a little nerve-wracking for people, for sure. Someone in the panel had mentioned tooth regeneration and some of the research is going into that. That is a very slow process. There's a lot of discussion about different amalgams and stem cells. As much as it's exciting, it's kind of like piggybacking on Megan Colbert's talk on Friday with spinal cord research. We'd hear all these clickbait about stem cells and spinal cord injury patients, but the progress has been very slow. It is very promising, but very slow. Before you start getting stem cell injections to grow that, know that a lot of those research studies are done on very small N values. It's not super cleared yet for that, but it's very exciting. It's very exciting, the idea of being able to regenerate enamel and regenerate dentin and even regenerate the nerve if it's dead. Those are very exciting possibilities, not probabilities. If you get an abscess tomorrow, it is a probability that you may have to consider doing a root canal. We in ID want to be very open-minded, but we also want to be very consistent with things that we're reading and staying up on things for you.

Anna, I know you went through the gamut. I'm so excited to hear you talk about it because Anna's not only a really brilliant person, but she's very open-minded. It's hard to find that in a person. I find Danny to be that too. You guys are always just wide open and really want to read before you make a decision about something. Anna, you really struggled with that decision. I remember talking to you about it in February. Yeah, for sure. I think that you have to be open-minded about these things. If you practice holistic medicine or holistic rehabilitative therapies long enough, then you know that there is no one-size-fits-all answer for anything.

I think that there's a lot of scary research that gets posted and sent around Facebook.

There's a lot of validity to some of it. I think ultimately, it just comes down to case-by-case. Unfortunately, I'm as a patient a huge pain in the butt, a really terrible patient.

I'm that person that will really drill my clinician. I need to know what your answer is based on. What do you think of this? What do you think of that? The way that I medical shop a little bit for my personal practitioners and my personal health team is the people that will have those conversations with me and not just do something because somebody told them it was a good idea or do something because, hey, that's just what we do as a medical community. It's the age of information. Those answers are no longer good enough. I don't want to talk about root canals yet because we got to talk about it on Friday. I will say shop around for people who will have informed discussions with you because there are doctors. I know we are certainly those clinicians for our patients. We shop for those people to trust our own health with. There's a lot of cool stuff to learn about yourself and a lot of cool things that you can help other people with. You just got to ask around. Ask people what they think. Ask people why they think what they think. That's a pretty telling question. If someone doesn't know the answer to that, I don't want your hands in any of my orifices if you don't know why you're doing what you're doing. It's a nice litmus test. I think that you're going to have so many fun things to say. I know we have another ID teaching team member who's been through a lot of dental stuff with root canal. One dentist told her root canal. Another one told her not root canal.

There's a lot of debate whether to do it or not to do it. I think it's so important to have someone that you can communicate with. One of the panelists said make sure you have a good dentist. I'm like, oh, there are so many good dentists that also have conflicting ideas. I think that you have to have an informed decision that you then decide to do for yourself. When it comes to root canal, it's very controversial. You've got full books written about the perils of root canal. Then you've got a lot of research studies that support how it can really save you. There's a lot of debate. I'm sure there is a case-by-case basis of what you're going to decide. We'll go into some of the depths of the research and then personal experiences from Danny and Anna and hopefully one of our other ID teaching team members. Hopefully she can make it next Friday and come in and talk about her experience. She's been what you would probably describe as the pain in the butt patient, which I think is a patient person who's patient with trying to get answers. I find that if you don't do that for yourself, don't expect anybody else to do it for you. You have to be your own advocate. I love when my patients think that they're being a pain in the butt with me, but they're just asking me really good questions. As an informed doctor and wanting to be a good doctor,

I would love a patient like Dr. Anna Folkmer. It would be the best. I know she's going to read about it. She's going to do a lot of things to help herself and honestly take the pressure off me to make all the decisions for her. Well, we thank you guys so much for joining us tonight.

What a fun time. Awesome. We'll post this on our Immaculate Dissection Facebook page so that you guys can find it later if you found it to be useful and want to go back and hear anything again. Thank you so much for your time and attention. I'll make sure to include the links to the things that we discussed in the write-up under the YouTube. If you want to read the OTP article or if you want to watch the video of the hip compression, we have that for you, a diastasis recti video will also be there. Just look under the description and there'll be hyper links. You can click on those and go to those videos. Thank you so much for joining us tonight.

Dr. Folkmer, anything else to share with the crowd? Thank you so much. We really appreciate all of your questions and your interest and your support and your participation.

Thank you. Danny, any last words for this amazing crowd?

Just a similar vein right there. Just thank you guys for joining and for partaking and coming along. Always nice when we have participants and everyone who goes by and checks it out.

Happy that you spent some time with us this Sunday and excited for next week's.

Absolutely. We will see you folks hopefully in a week, if not sooner, on the ID Collaborative.

If you ever want to check out one of our courses, they are all online now,

ID123456. You find them at ImmaculateDissection.com. Just click on its very home page and make sure you cannot miss it. All of our stuff is basically online. You can find us.

We would love to educate you. If you ever do seminars again in person, you can use that as tuition towards an in-person course. It has to be the same level that you took. If you took ID1, you have to use it towards ID1. We would love to be able to get you in person one day. Until then, we would love to help you online. If you are doing telehealth visits with clients, we have study groups for telehealth. We show you how we use our ID with telehealth. I know

 Ann and I are doing a litany of telehealth appointments. It is helping our clients so much. In a time where it is really hard to get to your therapist, we don't maybe love doing telehealth as our primary source, but we can certainly make a lot of things happen and get a lot of things done with telehealth. We help you integrate your ID flow, our charts into an interactive experience with your client and telehealth. We would love to help you if you let us. Hopefully, you can join us for an online course in the future. If not, we will see you next Sunday at our free webinar or ask us anything. Have a good night, everybody.