Oh, assessment tools. At this point, because a lot of stuff is also virtual, I still have relied on just basic movement patterns. Let’s take a look from a couple different angles with those, at this point again, millions of reps, let’s say. [laughs] In the course of my career, I think I’ve become a very good assessor of movement faults.
We break it down to the seven basic movement patterns that the primal body can do is push, pull, more in the upper body. Hinge, squat, lunge in the lower body. Twist, and then gait, or ambulate, so to speak, as the seventh. We look at as much of that as possible, and that gives us a lot of information.
In physical therapy practice too, we’re going to talk for 30 minutes. Make sure that you’re telling me your story, you’re telling me what’s going on. I’m going to pull out whatever information I deem most relevant of like, “I didn’t even realize my neck has a thing going on here, and I feel a little tingling in my arms.” Whatever that is, those things certainly add up to me.
The other big piece that I utilize is a handheld dynamometer which costs about a thousand dollars. I’ve had it for a while, and the batteries are very hard to find. In the old school practice, there used to be these huge Cybex machines which were the size of my room that I’m in currently or that you’re in now.
Those things cost tons of money, and they eventually got fossilled out, dinosaured out. They became extinct. They’re still use a bit in high level performance.
With my hand, being able to provide some resistance against, say, your arm holding out in front of you and pushing your arm down, in traditional physical therapy practice, we rate that on as on a manual muscle therapy scale saying, “You have a four-plus out of five.” There’s different ways that we categorize that.
In athletic populations, those numbers are very difficult to utilize, especially if I’m working with someone who’s really strong. I’m just not going to be able to break them, no matter how much force I put on or what mechanical advantage I take.
With the handheld dynamometer, it allows me to say, “Your right shoulder flexion provides, when I put the handheld dynamometer on, 72 kilograms of force. When I do it with your left, it’s only 52 kilograms of force.”
We’re doing this over a few reps, it gives us very objective numbers which the majority of us athletes that we’re talking about that we’re working with, they like to see, “How many kilograms of weight did I lift?” Or pounds, for some, [laughs] or stones for the British. “How much did I lift?”
It gives us that very clear number of 72 to 52, right versus left. It tells us something’s going on. It puts into that whole equation of everything going on. Unfortunately there’s no magical system. Sometimes people are looking for, “What’s the next thing? I need diagnostic ultrasound,” or “I need blood flow restriction training,” all these things.
There’s places where they fit. There’s things that each of these modalities will do, but I try to keep it old school, so to speak. Guys like Dan John, who you’ve had on, which was a great episode. People should go back and listen to that one.
It goes back to the simple assessments of how many kettlebell swings can you do in a certain period of time? If you don’t have pain with that, awesome. If you have pain with certain things, then we’re going to need to figure out why that’s going on.
It becomes this global ambiguous almost testing, but it’s definitely based out of, “Hey, this is the…” This is where, speaking of the current age, and we joked around about not going into political climate, but there’s a lot of AI coming along, technology, some of those conversations.
That’s where physical therapy might, we joke about it, but I don’t think it’s going to have a place for AI to come in and say, “If you have X, Y, and Z, we have to give you this intervention,” whatever it is. You need surgery if you have these things. There are some of these clinical prediction rules out there that the researchers have tried to come up with.
I just don’t foresee any time in the near future taking the science that we have and turning it into this very definitive thing. There’s this art form of coaching and art form of being a practitioner, which is why they call it physical therapy practice, or medical practice. We’re all out here.
If there was a rulebook, and let’s say it again, if David Tao blinks with his left eye, then we have to [laughs] give him a cortisone injection in his right knee. If it was like that, then we’d all be out of a job, but would it be a better world? I don’t know. I don’t know. That’s not for us to decide.