#32 - Understanding and Correcting Right-Side Bias, Part 1

FAKTR, spelled F-A-K-T-R, stands for Functional and Kinetic Treatment with Rehabilitation. Over the past decade, this unique approach to treating pain and dysfunction has been utilized by healthcare providers on 6 continents. Serving as a framework that guides clinical decision-making in patient visits around the globe on a daily basis. With this podcast, our goal is simple: to bring the best and brightest in clinical education to the forefront and empower practitioners with cutting-edge, evidence-based content that improves patient outcomes and inspires healthcare providers to continually evolve their approach to treatment. In each episode, we will feature a training or interview with some of the top minds in healthcare in a short format that is easy to consume. to digest with actionable information that you can implement into practice right away. Let's get started. Hi, guys. Welcome to a new episode of The Factor Podcast. I'm your host, Jessica Riddle. If this is your first time tuning in, welcome, and thanks for listening. Today, we begin a new 2-part training titled, Why Are You Always Right? Understanding and Correcting Right-Side Bias with Beth Keis. Beth Keis has dedicated her career to helping people attain maximum physical fitness and healthy function. After suffering multiple injuries in an auto accident, having to undergo surgery, and receiving traditional physical therapy without great progress, she embarked on a mission to help others achieve optimal fitness for their life goals. She considers herself a tireless researcher, providing the very best information to her clients based on their specific needs and the current literature. Beth is trained in Postural Restoration Institute methods, as well as dynamic neuromuscular stabilization exercise training. She's a certified strength and conditioning coach through the NSCA, Tissue Work certified, as well as a certified golf biomechanic from the CHEK Institute. She also holds her master's degree in education. Now, if you've been a clinician for any period of time, you've seen patients before that tend to lean a bit more to one side than the other. Seemingly in a constant state of asymmetry. Well, what if I told you that internal bias and modern lifestyle, while preferring being right, over time these compensations can wreak havoc on even healthy individuals, resulting in misalignment, awkward movement, and even leading to pain and injury? In this 2-part series, our guest instructor, Beth, will discuss how balancing the body requires both sides working together. And the important role that breathing serves in maintaining pain-free movement. Now let's cue the intro music and get started.

Well, excellent. Thank you so much for attending, everybody. I'm glad to have you here to talk about why we are biased towards our right side. Why are you always right? So I would ask if you've ever stood in line at a grocery store or even driven a car down the road and watched the oncoming traffic, left hand is on the steering wheel, the body's kind of slumped over to the right. Even standing in line at a grocery store, most everybody is standing on their right side. And this is not a new concept for us. At the turn of the 20th century, when most people were going ahead and doing dissections and studying the body, We realize that we are actually asymmetrical on the inside, despite our symmetrical appearance on the outside. And that our organs placement, it's not only helped us because we have evolved and become a higher species, but it's also serving quite an important function for us. And that is the function of reciprocation. So when we were constantly moving and walking and working and farming, this wasn't too much of an issue for us. As you can see here, this is where mostly it's the liver on the right side that goes ahead and kind of displaces our system. It also contains a lot of blood flow to it. So we have a lot of venous intervention in here as well. Our symmetry on the inside, we now know, fast forward 100 years, we are also asymmetrical as an entire functioning species. Our vision system is not the same from left to right. Our brain is obviously not the same from left to right, controlling different parts of our function and speech versus movement. And so what we've discovered is that we will actually achieve balance through our asymmetrical being, our constant, you know, moving with right hand with left leg and vice versa. That helps to keep us balanced and moving despite having these organs Weighted slightly more to the right side. And so, of course, what happened? What went wrong? We kind of stopped moving. We no longer farm or labor. We no longer work really much physically with our hands. Instead, we spend a lot of time sitting. And unfortunately, this phenomenon is not getting any better. The CDC recommends that we get about 150 minutes of exercise a day, including 2 weight training sessions. And in 2018, only 23% of us were able to achieve this. For our children, it's not getting much better. Childhood obesity rates for ages 2 to 5 doubled from '97 to 2008. It went up 400% for our children ages 6 to 11, and it tripled for our children ages 12 to 19. In 2018, roughly two-thirds of the American population were either overweight or obese. So we obviously have a difficult relationship with exercise and movement in this age of technology and in this age of sitting at school and sitting at working. We know that obesity in itself is a risk factor. It's linked to more than 60 chronic diseases, including type 2 diabetes, heart disease, hypertension, stroke, cancers, things that are— we would really like to avoid. And not being obese really helps that. Movement helps that. You would think that in our college and athletic populations, high school athletic populations, that this would somehow transfer over into movement and healthy adult lifestyle. And what we're finding in studies is that this is not the case, that athletic performance has become so specialized and kind of reserved for specific to practice and sport that it doesn't have much transfer over into later years. So roughly about 40% of college athletes actually met the CDC guidelines of 150 minutes per week plus 2 strength training levels after they had completed their competition years. And for this, it was really no different than non-athletic peers. So the fall-off is the same for athletes as it is for the regular general population. And the thought is that this, the intense specialized training of the athletes really doesn't translate well into a fitness and wellness program. And if you take a look at some of these training programs, even within them, I— what I did, pulled the top popular exercises that are involved in every collegiate, high school sport, and even in the gym. And what you'll notice is that there's really here an overemphasis on single-plane training, whether it be flexion and extension or in our sagittal plane or abduction and adduction. That really seems to be the exercise that people gravitate to and want to do. However, this does not help us with our issue of being heavier on the right side and in a right-side bias because there is no forceful pushing towards the left anymore. So without actually moving the body in opposition, and we talked about right hand with left leg, left hand with right leg, again moving that body, moving the hips over to the left. Once again, though, our training programs kind of keep us stuck in this right bias, right stance position. So let's take a look at kind of what this looks like in a postural analysis. If you just want to take a peek at this gentleman, take note of just the different landmarks and positions in his body, head position, shoulder position, rib position, hip position, and that kind of stuff. See what you see. Take some notes.

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So what we know is that in the postural implications of limited activity, limited walking and running, limited climbing, limited throwing, we know that the weight of the liver and heaviness on the right side of the body is going to go ahead and have us settle in on the right side. This puts us in kind of a right sit or a right stand position with more of our body weight in the right hip, the right pelvis, right knee, the right foot. In this position of right sit or right stand, so you remember our people driving down the road with the hand on the, left hand on the steering wheel and sitting to the right. We know that the right hip is going to have to tilt backwards and posteriorly. And as I'm sitting here, my right abdominals are tight. They're actually supporting my, the weight of my torso. My right leg is going to end up being closer to the midline so that my right inner thigh, my adductors, my hip internal rotators are going to kick in and to support that position. At the same time, my left hip is going to be tilted forward or anteriorly. And as it moves anterior, in order for the thigh bone to actually be able to move in the socket, it has to move away from the midline. So the thigh has to abduct and it also must externally rotate. And that's just so that you can actually allow some movement of the thigh bone in the hip joint while the hip is in flexion. So, and again, with this left hip coming forward and these right abdominals tightening, that just further accentuates that idea of being in the right side, the right position. And again, it's in anticipation of it. Sometime we were going to go ahead and get left. So let's go ahead and take a look at what this really looks like. If you notice, we're going to take a little deeper dive into this gentleman's chest. You can see the tight right abdominals drawing down on the right ribs. actually lowering the right side of the chest. And then on the left side, we have the left ribs coming upward and actually elevating that left side of the chest. If you take a look, you can actually see how the body is starting to orient itself to the right. There's a large C-shape from the center of his chest curving downwards towards the belly button, which has now been actually moved over towards the right. And if you look at the hips, you'll notice that at the very top of the black line on the left, that left hip sits lower than it does on the right side. And if you notice too, you can see the inside arm of the right, but not so much on the left. That left palm is turned backwards. So again, noting that we had the tight right abdominal muscles, which were actually pulling the right ribs down. And what does this mean for our breathing? Well, if the right ribs are being pulled down, Then we know that the right lung can't really expand very well. The right rib cage cannot expand very well. On the left side, we know that the ribs are being pulled upward, and this too means that with the left chest elevated, the diaphragm is also not able to expand properly. It's pulled upward into the rib cage, and as a result, when the diaphragm cannot contract, we know that it's not able to pull down on the lungs properly, so it's not going to actually compress the contents of the abdomen well. And it's also not going to be able to draw up on the crus of the diaphragm, it's not going to be able to draw up on the lumbar spine. So this sense of that cylinder of intra-abdominal pressure the diaphragm creates and the balance that the diaphragm creates with the psoas by using the crus to pull up on the lumbar spine, Doesn't happen. So without that pressure, we know that our rib cage is not going to be well supported, our spine is not going to be well supported, and our hip and pelvis position is not going to be supported. So that intra-abdominal pressure created by the diaphragm and the pelvic floor, in addition to the transversus abdominis, that spinal stability is lost. So if you take a good look, this is what it kind of looks like on the inside. So here we have our diaphragm. And then you can see how the right side is being pulled down and inward, which is going to prevent proper expansion as the left side is being pulled upward as the ribs sit up, preventing it from being able to pull down on the lungs and properly compress the abdomen. You can see the crus of the right and left side of the diaphragm where it attaches into the lumbar spine and how closely related they are to the psoas. You know, the psoas attaches from T12 to L4.

Mm-hmm.

So they provide that perfect balance for each other. Inhale and exhale, flexion and extension. You can see on the right side, the pelvic floor will be down and back. On the left side, the pelvic floor will be pulled up and back. So left side up, right side down. And then with the right hip turning posteriorly as the abdominals tighten, and of course anteriorly as the psoas takes over to stabilize. On that left-hand side. So let's go ahead and return to our first person, our first candidate, and note the postural changes that he had just in the upper section of the torso. So in this right-side bias, you can clearly see here with our little marker lines that the head is shifted to the right side. It is no longer sitting even and center with the sternal notch. If we take a look at the shoulders, the right shoulder sits slightly higher than the left. You can see the contraction on the right side of the abdomen as the tightness of the muscles actually provides some striation. You also, in this gentleman, you can see that curvature of the torso, the belly button now sitting to the right of center as well. And the right hip in the front, because it's tilted backwards or posteriorly, the right hip is going to be higher in the front than it is on the left. The left one is going to go forward and down. So let's take a look at what actually— what muscles are kind of contributing and helping out to hold this person in this position. Well, with the head shifted to the right, we know that the right side of the neck is going to be tight. The sternocleidomastoid, scalenes, levator scapulae. On the neck side, the left side of the neck, they'll be a little bit longer. The right side, the shoulder is elevated for 2 reasons. With the abdominals pulling down on the ribs in the front, it rotates them upwards in the back. So that helps to push that right shoulder blade upward. But then we also have on the right-hand side, we have the levator scapulae, the scalenes, the SCM, which are all pulling up to try and help to bring oxygen into that right side of the lung. Remember, there's— it's tamped down in the front. So the only place it can really get air is up in the top. So the neck helps to lift that up to try and bring air in. Then we also know that, of course, on the left side, with the ribs being up higher, that that's going to go ahead and lift that left side chest, which is going to cause the diaphragm to not be able to balance with the crus, the forceful pull of the psoas. So that left hip is going to go ahead and rotate forward. So right hip backward. A measurement less than 1 to 1.5 centimeters for a man. And of course, on the left side forward, and a measurement greater than 1 to 1.5 on that left side for the ASIS-PSIS. Now, from the backside, you can really get the sense of that head shift, that right shoulder elevation. And we talked about the internal rotation of the left shoulder. So you can actually see the palm of the left hand, whereas you see the back blade of the right hand. You can see the hyperextension of the left knee. And with the weight being shifted to the outer edge of the right foot, the right arch is going to go ahead and lift. But that's also going to shift as the body shifts over to the left. That's going to put the weight onto the inside of the left heel. So with that leg pushing out and away, everything has got to be on that inside of the right heel as we roll and move over towards the right. So with the hips moved over and on the right side, we know that that right leg is going to be in closer towards the midline. Weight placement is all going to be on the outer edge. The left hip is going to be moved away from the midline with the weight placement being on the inner heel. And what are the muscles that hold this all in the position that it should be? So on the right side, we've got SCM and scalenes and the levator scapulae, which would help to elevate that right shoulder. On the left side, however, we've got a tight latissimus dorsi, which is going to bring that shoulder into extension, and it's also a very powerful internal rotator of the shoulder. On the left side, latissimus dorsi is also a very powerful accessory respiratory muscle in that with the left ribs being held up and the left hip being down, in order to try and get any more air into that left lung side, Diaphragm's challenged, it can't pull down. What the latissimus dorsi will do is be to help extend the low back on that left side to try and bring air into the left lung. As the right hip sits tilted backwards, we know we have tight right hamstrings helping to pull down on that ischium on that right side and the abdominals pulling up on that right side. We have the opposite on the left side. We know that we have a tight psoas, a tight hip flexor, Pulling that hip down and forward. And supporting that position is going to be a tight low back, erector spinae area. On the right side, the hip sits towards— in towards the midline. So when you have tight right adductors, we also know that it turns in. So we have tight hip internal rotators. On the left side, hip sits away from the midline. So you have tight abductors. And it also sits externally rotated. So we have a tight glute max. With the weight on the outer edge of the foot, we know that the anterior tibialis is going to be tight on that right side, lifting that arch, as well as the peroneus longus, with the weight on the left side being anteriorly tilted and on the inside heel, most of that weight goes into the forefoot, the front toes. It's kind of like wearing a lift, a heel lift, or on that left side, or like wearing high heels. So that's going to tighten up the calf, the gastrocnemius, and the soleus on that left side. What are performance issues? When it comes to being in this right stance, right bias? Well, we have an overall loss of balance. Our center of mass is completely shifted to the right with it being on the right outer edge of that foot, predisposed rolling over to that right side. And we also know that trying to get back to the left now is increasingly difficult because of the position of the left hip and the left thigh. So we're going to have a limited right shoulder internal rotation as that shoulder is lifted up and held tight. That's going to alter the joint relationship between the head of the humerus. It's going to prevent some internal rotation. On that left side, we talked about the tight latissimus dorsi being an internal rotator and of course an extensor. So we're going to have limited shoulder flexion. And limited external rotation. So in the absence of being able to turn my shoulder out, what happens? I have to oversupinate my left elbow as I try to take my arm up overhead. If my latissimus dorsi is tight, I'm going to have to flex my arm to be able to do it, or again, that good old lumbar extension to try and complete that movement. I will have a reduced ability to turn my torso To the left, remember, because everything's sitting over towards the right. So it's going to be difficult for me to turn towards the left. And when I do try to turn left, particularly to reach back, what someone will try to do is to actually either go ahead and retract the shoulder or increase that lumbar extension. So if you notice, my torso really hasn't rotated much. I just extended my low back or just retracted my shoulder blade. We know that on the right side, we're going to have reduced right hip flexion, reduced right hip abduction, and reduced external rotation. Why? Because our hip extensors, our hip abductors, and our hip internal rotators are very tight. So this is going to decrease my power production in acceleration and push-off, and it's also going to reduce my ability to dissipate power in Deceleration and landing. Same is going to be true for the left side for slightly different reasons. We reduce in hip extension, adduction, and internal rotation on the left. Why? Because I am stuck in hip flexion, abduction, and external rotation. A decrease in power production acceleration and power dissipation and landing. We'll have limited knee extension both right and left. On the right side because the hamstrings are tight. On the left side, because in anterior forward tilt, that left hamstring is being pulled at its maximum length at the top, which is going to reduce my ability to extend the knee. We have reduced right arch plantar flexion, but the weight on the outer edge of that foot actually getting that arch to sink down and provide a nice spring for us is not going to be possible, which means then. I'm going to land hard on the outer edge and boom, where does all that pressure go? It goes right up into the sacroiliac pelvic joint. On the left side, again, remember I've got like my little left heel lift, so I can walk around in a high heel on my left foot all the time, which is going to tighten my gastrocnemius and soleus, which means it's going to limit me in ankle dorsiflexion as I land.

That's it for today's episode. Be sure to tune in for episode 33, where we wrap up our training on right-side bias with part 2 of this series with Beth Keyes. We'll be diving into the causes of right-side bias and how this contributes to the loss of intra-abdominal pressure. We'll also talk about the implication of this bias on performance and activities of daily living, As well as the importance of developmental multiplanar movement in preventing this phenomenon. Guys, this information is absolutely fascinating, and I highly recommend you click the link in our show notes to watch the webinar presentation so that you can see the visual presentation as well. You won't want to miss it. Episode 33 drops in 2 weeks. In the near future, we're also planning a few special Q&A episodes with our past instructors. As well as a special exclusive interview with one of the healthcare providers that was recently at the World Games in Birmingham, Alabama. So please be sure to click on the Q&A link in our show notes, ask any burning questions you may have so that we can feature those on a future episode. You can subscribe to The Factor Podcast on Apple, Spotify, iHeartRadio, or the podcast app that works best for you. Please give us a 5-star rating to help us grow the show. Every little bit helps. And last but certainly not least, be sure to visit the show notes for a link to download the PDF of today's full presentation, as well as learn about any special offers that we featured in today's episode. We'll see you next time. Hey guys, if you like what you heard today, I encourage you to visit our website at factor-store.com. That's spelled F-A-K-T-R-store.com. To find out more information about all that we have to offer. We have a variety of online offerings as well as our hands-on Factor Rehab System course scheduled in cities around the globe. Be sure to also check out our event calendar and bookmark any of these upcoming live webinar dates coming up in the near future so you can join us live. And of course, the biggest compliment we can receive is for you to help us spread the word to your friends, colleagues, and classmates. You'll find all the important links as well as info about our sponsors in the show notes, so be sure to check those out.