FREE Quadrant Analysis Training 3/3 - "Crack the Case"

Hello and welcome to part 3 in this free training I'm doing on Quadrant Analysis. This is the system, the thought framework that has changed my career more than anything else. I've been using it for over 10 years and it's a real, real game changer. Now, we talked to the last couple of ones about some specific concepts that you can take from Quadrant Analysis. Number 1 was the idea of the pattern break, so being able to spot hidden dysfunction that is asymptomatic but may well be causing issues further down the chain, and that may be the reason why your patient keeps coming back with the same thing. If you can learn to spot and address those, not only are to get better and more lasting change for your patients, but they're going to feel like you're a wizard, and frankly, you're going to feel a little bit like one too. It's very, very cool. And then the last one, we talked about one of the trickiest types of patients to manage if you don't know what's going on, you don't know what to do, which is the abdominal patient, the abdominal subclassification. These are patients who just don't seem to respond, or just don't seem to respond consistently. And unless you know how to spot them and how to manage them, sometimes looking at things beyond just the care you're providing in the room, they can be incredibly frustrating and frankly can make you doubt yourself. Now I'm going to take a different angle on this third one What I wanted to do today is walk you through 3 specific cases that I've seen in practice where quadrant analysis has really, really made the difference for me. And you'll see why, and you'll see how you can learn from that as well. So the first one was a patient— this was actually one of my early successes, um, with QA. This was a patient who came in while I was still learning it. I was still fairly new to it, fairly at the beginning. And she'd come in, and she'd come in with a lot of neck tension and pain, very, very stiff, but also a lot of fear around being adjusted. She really, really, really, really did not want be adjusted. She was so scared of the idea. Now, you've probably seen cases like this before. It's the kind of thing where in the past I would have tried to talk her into it, and if she really didn't want to do it, I'd have mobilized, I'd have done some, you know, traction and stuff like that. I'd have adjusted her thoracics, and we probably could have got her feeling better, but I wouldn't have been able to fully crack it. Fortunately, with QA, one of the things it does is it gives you a sort of mental map of the body, and it helps you see what types of tissues and which regions tend to go together and which ones tend to go opposite. And essentially What that does is it allows you to take a full body assessment and then see which bits are standing out as going, oh, that wouldn't normally happen together. So for example, you would often see the hamstrings and the hip flexors, they tend to tighten up together. You would often see the glutes and the lumbar extensors on one side would tend to go together. And what that means is that when everything's going together, you kind of go, oh, this is like a normal abnormal, this is like a normal dysfunction, this is the typical pattern you tend to see. For example, you know, one shoulder tends to go lower, it also tends to come forwards. Now, if you see something that doesn't fit that pattern in quadrant analysis, that makes you pay real attention to it. And with this patient, I did what I always do now, which is a full body top-to-toe assessment, because I know exactly what I'm looking for and I know what sort of things are going to stand out as being higher priority. One of the things that stood out to me was that her glutes on the right side and her posterior hip was tighter on the right than the left. And looking at her pattern, I would have expected it to be the other way around. So everything was fitting within the pattern, within the map of QA, apart from that hip. And that made me go, oh, that's different. It wasn't a full pattern break, but there was a change in the pattern there, and that made me pay real attention. And because I was looking for other things that I could do to help this patient, I then drew her attention to it. I mentioned it, and she went, oh yeah, no, I used to horse ride a fair bit. I've had some issues around the back of that hip before. Clearly hadn't mentioned it, didn't think it was relevant to me. It's another cool thing is when you spot these things, they go, oh yeah, here's some relevant history for that. So anyway, I said to her, look, this is going to seem a little bit weird, but but that doesn't really fit with the rest of your body. Your hip's trying to do something different to what the rest of your body is trying to do. Do you mind if I try something?' And this is a phrase I use all the time in practice now because it lets— gets me permission to do something. The patient's gonna go, 'That seems weird, I'm here with neck pain, what's he faffing around with my hip for?' So I just said, 'Do you mind if I try something?' And she went, 'Yeah, that's fine.' So I explained what I was going to do. I adjusted her hip and I did literally about 60 seconds work just freeing up some of the glutes a little bit more. I sit her up, her neck rotation has gone from about 30 degrees either side to 70. She can go fully into extension, feels absolutely great, and is going, 'What on earth did you do? What is this sorcery? You haven't even touched my neck.' Now, that wasn't a one-and-done. She still needed more help. That hip had been an issue for a while. Eventually she did let me start to treat her neck because her neck did need some treatment. But first of all, I got her trust by doing something that seemed really, really weird and avoiding the thing that she really didn't want but getting results. And secondly, because started calming down the neck tension that in her case was actually being driven partly by what was happening in the hip, it meant that when it came time for her to say, okay, I'm happy to have some treatment there, it was much easier. She was tensing a lot less and it was much more comfortable for her. So the lovely thing with QA is it gives you options, it gives you other ways into the system. Now, if I'd just gone, just grit your teeth and get through it, talked her into it and adjusted her neck, could I have helped? Maybe, possibly, but she would have been tensing the whole time. I bet that would have been sore and I bet that would have undone a fair few of my adjustments. So even if I could have gotten the neck straight away. I'm fairly certain with this one that actually taking the hip and getting that moving just made things happen a lot quicker. And most importantly, my patient was more comfortable and more trusting of me as well. So that was one, and that was one of the first ones where I literally messaged Rob and I was like, oh my God, this was so cool, I can't wait to tell you about this case. Because I felt like, hey, I'm getting this, and like, I actually feel like I can help people at this higher level there. Now, about a year or so later, I had another patient come in to see me, and this is a patient who'd been seeing another chiropractor, and her thoracics were incredibly jammed. I mean, she was really, really stuck did not want to move, did not want to extend through here. And she was getting a lot of, shockingly, you know, upper, upper shoulders, neck, upper trap pain. And she'd had about 8 sessions with the other chiropractor, and she came to see me. She's like, it's just not working, I just wanted to get a second opinion, it's not really shifting, I'm getting a bit fed up, and I've spent a fair bit of money here. Now, I could see that she was really, really seized up, and I knew I want to adjust her thoracics, I want to get those moving, we definitely, definitely need to do that for her. However, I also knew that, well, if I just start doing the same thing as his last chiropractor maybe it's not going to work. As much as I'd love to go, maybe I'm just a better adjuster, maybe I'll get it, you know, one of the things I know now is that just repeating the same thing other people have done, the odds of you getting them better are a fair bit lower. One of the things I did spot with her, which is to do with last week's video, is that she was quite clearly a very tense abdominal subtype, and she had a lot of muscle tension and a lot of guarding, and her whole system just seemed quite pressurized and quite stiff. And when you know what the signs are for this, they really do jump out. So we ended up having a conversation, and I said to her, look, I can treat your upper back, and I, I do think you need it, and that should definitely help. However, it seems like just starting with that hasn't really got you where you want. Fortunately, I know a very, very good traditional acupuncturist. He's really good with these kind of cases. I referred her to see him. She came back to me a week later and was like, oh my God, I haven't felt this good in a long time. Like, I really felt like things relaxed. That guy just— I don't know what he did, it's weird, but it really, really helped me. And she had a few more sessions with him while I was treating her, and she would see him and things would relax. And I would treat her and she would go, wow, that's really freed up the movement. So it allowed me to spot this is a case where co-management was needed. I didn't refer her out and say, go see the acupuncturist, because as much as he helped, he wasn't going to get the tissues moving again. That's not what acupuncture does. But it did help take the stress out the system, and it allowed me to spot that. The really cool thing with making a good referral like that is I get some of the credit. She was really grateful to me for knowing that this acupuncturist is someone who'd be able to help her. So even though he got the things moving and he actually did the first bit of work, she came back to see me so happy with me. And then when I said, great, that means I'm confident we can start to get you better results. She was happy to see me for treatment. She's been a maintenance patient of mine ever since. Um, occasionally sees the acupuncture as and when, but doesn't need to that much anymore. But it allowed me to spot this is a case where some co-management and actually creating a little bit of team between us is going to be really useful. And the result was a patient who's much, much happier, getting much better results, who's really grateful to me and really, really trusts me. So that's a slightly different angle there. The third one, um, this is kind of one of my pillar cases. This is one of the ones that I think of first of all when it comes to QA because A, it was another sort of very cool, very, very quick improvement for somebody, but B, it highlights one of the lessons I've learned from QA, which is that we sometimes, as chiropractors, we tend to focus on the spine, right? If somebody comes in with a spinal issue, okay, you'll focus on the spine. If somebody comes in with an arm or a leg issue, you're probably focusing partly on the spine, even if you're a sports car, even if you do extremities, that kind of thing. We are very, very good at spotting when there might be a spinal component to an extremity issue. However, I would argue that one thing we are not particularly good at as a profession, and one thing that QA has massively helped me spot, is that sometimes there are extremity components that are driving a chronic spinal issue. And this last case was a really, really clear example of that. This was a chap who, he came to see me. He'd been seeing another chiropractor up in London for this chronic neck tension. He was— it was really stiff, really tight. He had a stressful job, he worked at a desk a lot, he had two young kids, and, you know, he couldn't like put his kids on his shoulders. Because it would just spasm. And he'd been seeing a chiropractor, he'd had about 20 visits, and, you know, he'd been seeing twice a week for about 6 weeks and then once a week for another month or two. And he came to see me because he wasn't going to be working in London anymore and he wanted somebody a bit more local. And he came in basically, yeah, I've been having that, it's a bit slow going, but it is helping. I think I just need a lot more treatment. And I had a look, you know, I was chatting to him, they were adjusting his neck and adjusting his upper back, and, you know, we sat and spoke and I said, yeah, I can continue that if that's working, if that's what you need, we can absolutely do it. But in the back of my head, I was thinking, that's quite a lot of treatment. I wonder if there's something else going on. One of the things I did, and again, his neck did not really rotate past 45 degrees either way. When he came in to see me, he'd had it go and he'd had it spasm a couple of days ago, and he was very, very limited in rotation there. And one of the things I did is when I did my full body assessment, I noticed, because I knew what to look for now, his right hand and his right forearm were incredibly tight, and he really didn't have a lot of wrist extension. And he did not have much supination. I mean, he was getting to about there instead of about there. It was very, very tight and limited through there. So that jumped out to me and I realized this is a lot of tension. Again, it's not a pattern break, but that's quite unusual. And then I asked him a little bit more about his job, and it turns out, yes, he works at a desk and he works long hours. It's a stressful job, but all his computer work was with a mouse. He never really touched the keyboard much. All his work was, was point and click through the mouse, and his hand had basically got stuck in that pronated mouse position. And again, use the same line. This is going to seem a little bit weird, but do you mind if I try something? And he went, okay. And, you know, having learned through this through QA, I identified there's a couple of muscles. There's the web of the thumb was very, very tight, and then pronator teres was very, very tight as well. I spent, and I'm not kidding, 60 seconds just doing some light work on those. I wasn't doing loads of soft tissue, just a little bit of trigger point work. Um, you could use a needle as well if that's something that you do. And then I adjusted the base of his thumb, the first carpometacarpal joint. Sat him back up, full range, completely pain-free. And he's going, I haven't felt like this in like 2 years. Like, how did you do this? What's going on? I said, well, look, if you're really tense through there, that can create tension through here. I, I could work out the pattern, but again, it jumped out to me because I knew that's a huge amount of tension to be pulling around there. The really cool thing, by the way, it was right hand issue. All his pain was the left. It was all left shoulder, left upper traps. Now, before QA, A, I wouldn't have checked the forearms on this guy at all, I'll be honest. I wouldn't, I I would have looked at the shoulder, maybe the elbow. I was not going to go down further than that. But also, I'd have been thinking the issue was definitely going to be in the left hand, right? If it's left-handed upper trap bone, you know, some of you who have done a lot more sports work or, you know, really know regional independence, stuff like that, will already know what I didn't know then, which is sometimes you have to go further. But the key was that the issue was in the extremity, and he was going, my last chiropractor never even looked at my arms. And, you know, I wasn't trying to rubbish the guy or anything like that. I wasn't going to throw him under the bus, but in my head I'm going Yeah, we don't really do that. We should be doing that a lot more. And again, needed a couple more visits and now comes to see me once every 4 to 6 weeks. He's a very, very loyal maintenance patient, you know, gets great results of that. But in a couple of sessions just working on an extremity, I got more results than the last chiropractor I got with 20 sessions working on the spine. Did I still work on his spine? Of course, there was a lot of tension, there was things to do here. But without getting the hand unlocked, he was just going to keep getting pulled back around into the position and really tensing up through there. So So those are just kind of 3 cases there, you know, and it really highlights the importance of not looking just where the pain is, of not looking just what you're used to, and not just focusing on the spine and considering when is there something else going on that might be helping this. Because again, I could have treated this last guy all I wanted. What made the difference for him was getting an ergonomic mouse, because I knew that, well, if I'm putting him back to do this all the time, we're just going to keep jamming up there. Got him an ergonomic, one of those kind of half sideways mice, and it's held so well since then. And he's going, I can't believe it was my mouse. I wish someone had told me this before I'd spent I know, over £1,000 on chiropractic treatment before. So there's some 3 cases there. Now, if you want to be able to do this, I'd love to tell you that, oh yeah, there's a quick thing, these 3 things will do that. Obviously, this little series here, I want to give you some usable things, some usable takeaways there. Um, if I would stress one thing from today, it's please just look at the extremity, just get your hands on them and feel them, and if something jumps out, see if you can do something about it and see if you notice a change. But if you really want to dive into this stuff, I've got some really great news. Rob and I are putting together an introduction, like a foundation course in quadrant analysis. It's going to be online, it's going to be on demand, it's going to be probably about 6, maybe 7 hours that you can watch in your own time. Um, it's not group coaching or that kind of thing. There are some options for that, there will be down the line, but it's also going to be very, very inexpensive. We're pricing this incredibly cheaply. We should be, you know, we could justifiably put a huge price tag on this because it is worth so much to you in your career, but neither of us are doing this for money. We really want to get this out there and get this accessible and help more of you learn this so you can start to feel like You're a little bit of a wizard. Start to feel like a detective, a problem-solving chiropractor, somebody who really dives into it, knows how to look for things beyond just the, oh, where is it hurting, or which part of the spine is stiffest, and start getting results for your patients that they won't be able to get anywhere else. This is how we have become the go-to clinic in our area. We are the clinic. I'm really proud of this reputation that we've earned and others have given to us with when no one else can help you, come see this clinic because we'll be able to spot things that I know that others have missed there. And I really want that for you too. So that'll be coming out very, very soon. Keep an eye out. On the website. Keep an eye on the newsletters and the posts as well, because I can't wait to share that with you. And for those of you who want to do this, who want to become a problem-solving chiropractor, who don't just want to pop and pray, who don't just want to flying 7 everybody, who don't want to just be stuck always second-guessing yourself and wondering if you're doing the right thing— that's going to be coming very, very soon. Any questions in the meantime, let me know. Otherwise, I really hope you've enjoyed this training series, and I have more content coming soon.