FREE Quadrant Analysis Training 1/3 - Pattern Breaks

Okay, so last week I was talking all about quadrant analysis and why it's made such a massive difference to the way I practice and why I'm really excited to finally be able to share more of this stuff with you guys as well. So one of the problems that quadrant analysis addresses is that we, you know, when we're assessing our patients, we have a tendency to kind of really want to know where is the pain coming from. And we'll do that with our orthopedic tests, with our palpation, with all the tests that we normally do. You don't need me to tell you how you do that. But essentially, we're trying to find the pain-generating structure, whether that's a facet joint, whether whether that's a disc or a nerve root or a muscle or something else. And that's a really important thing. We need that for our diagnosis. We need to know what's causing their symptoms in order to know how we go about treating it. However, that isn't enough. You will have seen this very, very often in practice yourself, that you can have two patients who have the same diagnosis and they have the, you know, the same pain-generating structure. Maybe both have an L5 nerve root, for example, that's causing it, both caused by some irritation in the disc. But those two people might need very, very different treatments in order to get them better. So the structural diagnosis matters, but it doesn't actually tell us what we need to do to get this patient better. And that's where quadrant analysis comes in, because before that you have technique systems that have flowcharts, and they're kind of based on the belief that certain dysfunctions are more important than others. So in SOT, for example, you're gonna try and balance the pelvis no matter what. Now that can be really valuable and that can really help some cases, but not all. Um, others might— ART might go, it's really about just reducing restrictions in the fascia. Again, can be really useful, it's not going to solve it for all of them. So one of the things I love with QA is it looks at what's called a subclassifications, and these are— I think of them as physiological diagnoses. So you have the structural diagnosis, which is the what, The sub-classification is the why. Why is there a problem in this? Now, there are multiple different sub-classifications within QA, and obviously I can't go into all of them now. One of the ones that for me really, really stood out and started making practice a lot more fun when I knew how to recognize these was what's called a pattern break. A pattern break is a break in the normal pattern that the body tries to use to compensate. Essentially, it is an abnormal abnormal. Now, old-timey chiropractors used to talk about this in different terms. They would talk about what they called the primary subluxation. Essentially, you would have an area that isn't exhibiting symptoms in itself, but it's driving compensation and causing symptoms elsewhere. When you find these, these are those weird cases where the patient looks at you like a wizard, like you adjust their ankle and their hip pain goes away, or you adjust their jaw and then, you know, their mid-thoracic pain goes away. You know, you kind of go, wow, this thing was driving it and causing problems somewhere else. Now, like I said, Technique Systems can be useful for this, but they're very good at spotting a particular type of pattern break that the originator was really interested interested in, but they won't help if the pattern break is somewhere else. Now, there are many different lenses and approaches we use within QA that I couldn't possibly teach you all now to identify if there's a pattern break and know how to solve it. But there is a quick approach that actually I also learned from Leonard Fay. Those of you who've been around a while probably know of Len Fay. Um, Len retired last year in his mid-80s. He's been teaching chiropractic and teaching adjusting and palpation skills for decades. He was one of the founding faculty members at AECC. And, uh, I remember when I started learning from Len and I to one of his seminars, I realized, oh, he's talking about a kind of pattern break here. Because Len would say that, yes, the patient will come in with certain symptoms. However, what he would do is he would go, well, I need to find out where that's coming from. And Len's approach was to take a full body assessment, and he would assess joint play in all the joints throughout the body in all of his patients. And then essentially, he would use that to determine where is the biggest dysfunction, where is the biggest problem. So if you come in and you go, oh yeah, my neck's really tight, and he identifies that C6-7 is is the most restricted, well, of course you would adjust there. However, if you came in and said, my, you know, I'm really tight in my neck, and he found that your radioulnar joint was incredibly restricted compared to other joints, he would say, well, we need to start there. And by doing that, what he's looking for is areas of silent dysfunction. And the extremity part is important here because as chiropractors, we generally do a very good job— and I include myself in this— in finding spinal reasons for extremity conditions. If somebody has tennis elbow, we're pretty good at seeing maybe that's coming from the upper quarter, maybe that's coming from the cervical spine or the thoracic spine, and then identifying when that's an issue and treating extremities, uh, conditions by treating the spine. However, what we're generally not trained to do— and again, this is myself for years— is to look for issues in the extremities that could be driving a chronic spinal issue. And in my experience, the majority of my chronic spine pain patients who come in, it is being driven at least in part by an extremity dysfunction. And if I don't go looking for that, I can't help them. Now, for some, that might mean we get them better but not as good as they could be. For others, sometimes we need to address that first to unlock the system. And frankly, without doing that, I wasn't going to see that even, you know, any results in the first place there. So I do think it's a really important thing. I tell all my patients, we are going to do a top-to-toe assessment. I'm going to assess not just your spine, but I'm going to be looking at the arms and legs as well. But here's a simple thing that you can do now to start looking for this and start spotting certain types of pattern breaks of joint palpate pattern breaks in your patients. Essentially, just wiggle all the joints. So obviously you're probably checking the spine as you're a chiropractor, but get your hands on the extremities. Just palpate the— just grab the shoulder and just move the humeral head around. Grab the elbow, just check it in pronation, supination, extension, flexion. Grab the radial head. You're just trying to wiggle these around, and what you're looking for is, is there a big difference side to side? You know, is that right radial head way tighter than the left side? If so, we want to pay attention to that. And the way Len would look at it is he would say you adjust the joint in all the different ranges, and the joint that is the most restricted in the most number of ranges, that's where he would go first. So yes, you might have an L5 segment that is very tight and doesn't want to laterally flex at all, but if it can flex and extend, maybe we're not so interested in that, versus up at T12, it won't laterally flex or flex or extend or rotate. That is a bigger restriction. It's restricted in more planes of motion. That could be considered a type of pattern break. It's the kind that Len was an expert at spotting, and it's something that as chiropractors we can do quite quickly. We're very used to assessing joint play and accessory motion. So that's something you can do right now to start spotting some of these pattern breaks, is check through the— not just the spine, but check the extremities as well. Look for the area that is the most restricted, and if you find it, do something to try and loosen it and then recheck the— whatever the painful movement, whatever the goal-based outcome is. If the patient says, 'I want to be able to put my shoes and socks on,' and I find that, 'Wow, you know what, that tibia is really jammed up,' I'm going to adjust the tibia, and then I'm going to recheck it. 'Right, now we've got that moving, and I can feel it's better. Try and put your shoes and socks on.' And if they notice there's some improvement, now I have some data that's relevant. They go, 'Oh, that is a bit easier.' I might go back and do some more work and start looking for other things around them. It doesn't have to be an adjustment. If you are fairly new in practice, or if you're somebody like most chiropractors, to be honest, who maybe isn't very experienced with extremity adjusting, then that doesn't mean you can't do it. Drop tables are fantastic. You know, I— if I have a patient sitting and I just engage the drop and I pull down on the tibia, we can get an impulse in there. Um, you could use lower force stuff, you could use mobilizing as well, but just get your hands on that joint and just try and wiggle it and introduce some movement. If you can do it with an adjustment, great. If you do some mobilizing, that's fine. But when you feel okay this joint is moving better, recheck the painful movement. If you've got some improvement, now you have some data that you're onto something. It's also pretty cool to do for the patient because they're going, how did you make my back better by treating my ankle or my knee? It's the kind of stuff that makes you start to feel like a wizard. It doesn't mean that I'm therefore going to ignore the back. It doesn't mean that all I care about is that one joint, but I've rapidly found an area where there's some silent dysfunction that I've proven is driving their pain, is playing a role in that. So you have— you do want to use a test-treat-retest approach for this as well. I'm constantly— and that's something where, where Rob, when he was developing QA, he differed from Len. Len would, um, his test-treat-retest was basically, have I restored joint motion? Do I feel it's better? He was happy with that. Rob would also say, well, no, we need to make sure the patient's happy with it as well. So we're ideally looking for improvements in things that they can do. Sometimes you don't see it straight away, but if it's a few sessions we're not seeing it, okay, we may need to look elsewhere as well. So this is what I love about QA. It's a very patient-centered approach. So that's one type of pattern break, which is one type of side of dysfunction. You can do that right now. Do the full body assessment, just start getting your hands on joints and wiggling them. Compare side to side, see if one feels particularly seized up, and then look for is it restricted in multiple directions. If so, higher priority, do something to it, treat it, loosen it out, and then see if that improves. And trust me, when you get those and it does improve, it feels really, really cool. You feel like you really know what you're doing. The patient has a lot of trust in you as well. If you try that and you've done a couple of things and nothing's shifting it, okay, move on and do something else. It's— QA will not tell you, ah, when you found that, you have to do this. It will say, oh, if you'd find that, you probably want to start there. So give this a go with your patients this week. I'm going to be sharing another video next week. We're going to be diving into a very different, um, subclassification, one that trips up a lot of us as practitioners, and one that used to frustrate me for ages because I couldn't work out why these patients weren't getting better. And now I know I've been able to help them a lot more to spot when I need to change my approach, but also when we might need to do something beyond a fairly typical chiropractic approach as well. So I'll share that with you guys next week.