Hi, guys. Welcome to another episode of the Factor Podcast. I'm your host, Jessica Riddle. Welcome, and thanks for listening. In today's episode, we wrap up our 2 part series titled Body Mechanics and Beyond, crafting a sustainable manual therapy practice with doctor Ti Pence. In part 1, we learned about the importance of alignment and conservative force generation techniques when performing joint manipulation. We also talked about the key red flag mistakes that can quickly lead to overuse injuries resulting in the above the belt soreness that can develop into career ending injuries over time. Today, doctor Pence will teach us his 90, 90, 90 rule for shoulder, elbow, and wrist positioning.

We will also learn the optimal way to configure your treatment space for maximum efficiency and comfort and why it is important to be able to generate force through fluid balanced movements. So whether you're new in practice or are a more seasoned practitioner that knows exactly what I mean when I say above the belt soreness, Be sure to listen up and take notes. Let's cue the intro music and dive in.

Now let's quickly try to get through some entries. Another really cool study. I was gonna break this all apart in the results section, but the summary was so good. I this also violates my, like, don't put a whole bunch of words on one slide. But, man, every part of this is useful. The scary part to me is that the number of years in practice is considered a risk factor. And the risk factor is when in the first 5 years of practice. This is when you haven't gotten conditions out of seeing patients.

You still got the bad mechanics you were probably taught in school. This is not to talk negative about how to teach mechanics in school. If I was in there trying to force you from quarter 1 to learn good mechanics, you probably wouldn't see the value in what I was trying to teach you. You don't see it until you get injured. Unfortunately, that happens in the 1st 5 years. And, ironically and there is some obvious argument here. The most common way that this happens is doing some sort of side posture, low back manipulation. This is one of the most common things that any provider does who's doing manual medicine in their practice.

So it's not shocking that that's the most common way to do it. The way we can improve on that is that if you watch how people perform these low back manipulations, there is frightening things that people do that are setting themselves up for injuries. First one, clamshelling. I don't know a better way to explain this, but if you're just falling over at your hips or your low back and hoping that gravity is going to solve the problem of how to generate force through your patient, you are destroying your low back. The only other thing you're doing is giving yourself whiplash as your neck is bouncing up and down all day. You're doing it worse if your neck, if your head is over the patient. So if your head ends up on the opposite side of the table of your feet, by the end of the manipulation or the technique you performed, you're going to hurt your neck. It's just a matter of time.

That's clamshelling. Really, if you've got back pain or neck pain when you're adjusting or manipulating patients, you're probably doing this. This is just too great a picture to not talk on for a minute. If instead of a pool table, we put a patient under this guy, it would look like a lot of what practitioners are doing in their own practice. They're all on their front foot. They're not using their back leg as a way to generate extra force by contacting with the leg and rotating or using it to to create rotation in the low back. It's just sitting up there. They're hinging on their front hip.