So excited to be here with two of the most amazing people on the planet, as well as some of our other live participants who we're getting to know, we're so thankful that you're here tonight.

很高興能和地球上最了不起的兩個人在一起，還有其他一些我們正在認識的現場參與者，我們非常感謝你們今晚能來到這裡。

My name is Dr. Kathy Dooley, I am a chiropractor, rehabilitation specialist, and an anatomy enthusiast of sorts, here with the amazing Dr. Anna Folkmer.

我叫凱西-杜利博士，是一名脊椎按摩師、康復專家，同時也是一名解剖學愛好者。

Hi everyone, I'm Dr. Anna Folkmer, one of your co-founders of Immaculate Dissection.

大家好，我是安娜-福克默博士，"無暇解剖 "的聯合創始人之一。

I'm an acupuncturist and herbalist, and also an anatomy enthusiast of sorts, and glad to be here.

我是一名鍼灸師和中醫，同時也是一名解剖學愛好者，很高興來到這裡。

And last but absolutely not least, Danny Quirk, our anatomic artist for Immaculate Dissection and co-founder.

最後一位是丹尼-柯克（Danny Quirk），他是我們《無暇解剖》的解剖藝術家，也是聯合創始人之一。

Hey everybody, yeah, Danny here.

大家好，我是丹尼

Yep, the artist for Immaculate Dissection and giant anatomy dork as well, so always excited to attend these and be a part of them, so looking forward to tonight.

是的，我是 "無暇解剖 "的藝術家，也是個大解剖學呆子，所以我總是很興奮能參加這些活動，併成為其中的一員，所以我很期待今晚的活動。

So if you're joining us for the first time in our anatomy dorkness, as Danny very eloquently put it, which I do agree with, we decided to get together on Sundays and chat, and we started at the beginning of the pandemic, so it was March 2020, and we've gotten addicted to it, we love it.

是以，如果你是第一次加入我們的 "解剖學呆板 "行列，正如丹尼所言，我們決定在週日聚在一起哈拉，我們從這一流行病的初期開始，也就是 2020 年 3 月，我們已經沉迷其中，愛不釋手。

It sparks ideas for us for our ID Collaborative, our online learning series, and it gives us, you know, ideas of just getting people excited about anatomy and talking about some various questions that you have.

它激發了我們對 ID 協作、在線學習系列的想法，也給了我們讓人們對解剖學產生興趣的想法，並讓我們討論你們提出的各種問題。

Sometimes people will come to our courses and ask questions that's not always appropriate for the subject matter, and so this is kind of an open forum, and it's free, and we'd love that you guys join us on Sundays for this, if not live after the fact.

有時，人們會來到我們的課程，提出一些並不總是適合課程主題的問題，是以，這是一個開放的論壇，而且是免費的，我們希望你們能在週日加入我們，如果不是事後直播的話。

So we have some pretty cool questions from the gallery, and we thought that we might cover them.

是以，我們從旁聽席上收到了一些很酷的問題，我們想可以把它們都寫下來。

So do you want to start with the first question that was asked?

那麼，你想從第一個問題開始嗎？

Sure.

當然。

Okay.

好的

Pull that back up.

把它拉上來

The first question regarding the kinesiotape, okay.

第一個問題是關於運動錄像帶的，好的。

So the question that we got on Facebook was, can bracing using external support like kinesiotape and diastasis recti cause changes in blood pressure?

是以，我們在 Facebook 上收到的問題是：使用外部支撐（如運動膠帶和直腸腹肌鬆弛症）進行支撐是否會導致血壓變化？

Okay, so the first thing that we want to cover as an ID family is that we don't use kinesiotaping for anything other than the demonstration of ligament location, and I'd like to demonstrate the ilial lumbar ligament and the importance of iliacus and quadratus lumborum attaching to it, and anterior thoracolumbar fascia attaching to it, but I have to go from experience.

好的，作為一個 "ID家族"，我們要做的第一件事就是，除了演示韌帶的位置外，我們不使用其他任何運動造影技術，我想演示髂腰韌帶，以及髂肌和腰四頭肌附著在髂腰韌帶上的重要性，還有胸腰椎前筋膜附著在髂腰韌帶上的重要性，但我必須根據經驗來演示。

I used a kinesiotape from 2006, 2007, very religiously, every single patient, every single visit.

我非常虔誠地使用 2006 年、2007 年的一盤運動錄像帶，每一位病人，每一次就診都是如此。

In the last year of my internship for chiropractic, I saw a lot of patients, and to me, it was very cumbersome, and I didn't find it to be as useful as it was expensive or time consuming.

在脊骨神經科實習的最後一年，我看了很多病人，對我來說，這非常麻煩，而且我覺得它並沒有那麼有用，因為它既昂貴又耗時。

So I found that giving proprioceptive cueing and other type of things worked a lot better for me.

是以，我發現給予本體感覺提示和其他類型的東西對我來說效果更好。

Anna, I know that you said that you use magnets a little bit more?

安娜，我知道你說過你會更多地使用磁鐵？

I do, yeah.

是的

Something that has a little bit more weight to it, just so that you're able to simulate some of those proprioceptors, and I use magnets for, I use silver and gold ones, kind of depending on the circumstances, but I find them a little bit better for proprioceptive cueing than some of the kinesiotape, at least as far as my work's concerned.

我使用磁鐵，我使用銀色和金色的磁鐵，這取決於具體情況，但我發現磁鐵在本體感覺提示方面比一些運動錄音帶更好一些，至少就我的工作而言是這樣。

Yeah, the problem I have, I guess, with the question is that kinesiotape is brought up as being a support, and I guess I don't know what they mean by support, because if they're talking about structural support, that's not what kinesiotape is doing.

是的，我想，這個問題的問題在於，運動錄音帶被認為是一種支撐，我想我不知道他們所說的支撐是什麼意思，因為如果他們說的是結構性支撐，那運動錄音帶就不是在做這個。

Kinesiotape is in the literature and supported as being something that's for more proprioceptive reasons or to encourage circulation, but it's not used as a structural support, like athletic tape, and so that's part of the thing that's good about it, is that it doesn't limit movement, and that you tape in certain directions, and that pull that's on the skin creates a dermal traction, and the whole theory is that you're encouraging things to move in a certain direction that you want to move in, and I see the appeal, for sure.

運動膠帶在文獻中被認為是用於本體感覺或促進血液循環，但它並不像運動膠帶那樣被用作結構性支撐，是以它的部分優點在於它不會限制運動，你沿著特定的方向貼膠帶，皮膚上的拉力會產生真皮牽引力，整個理論就是你在鼓勵事物朝著你想要的特定方向運動，我看到了它的吸引力，這是肯定的。

I think that because when you change directors of force so frequently, I particularly don't really love taping in a certain direction, because I think it's willing to change very quickly, and your body adapts.

我認為，當你如此頻繁地改變力的方向時，我特別不喜歡朝著某個方向拍打，因為我認為這樣做會很快改變，你的身體也會適應。

I also know, I can give you a test right now, to the fact that once you tape something, you're going to accommodate to it, so make sure that you feel the back of your shirt right now, feel the back of your shirt, feel it hitting maybe your scapular region, feel that really intensely, great, awesome, so five seconds ago, you didn't feel that, and

我還知道，我現在就可以給你做個測試，一旦你用膠帶粘住了什麼東西，你就會適應它，所以確保你現在感覺到了你的襯衫後背，感覺到了你的襯衫後背，感覺到它撞到了你的肩胛骨區域，感覺非常強烈，很好，真棒，所以五秒鐘前，你沒有感覺到，而且

I brought your attention to it, so one of the benefits, I guess, of kinesio tape is that you can see it, maybe it brings attention to it, but it's only for a short period of time before you filter it out again, just like you just did, now I can bring it back to your scapular awareness, and you feel the shirt on your scapula, it only took you a few seconds of me talking to distract you away from feeling that tape, so I have not found it to be as useful as the education of my patient, so when it comes to diastasis recti, it's a huge education for us in immaculate dissection on breathing mechanisms, and a lot of people are taping diastasis recti, they're taping it in the middle, in immaculate dissection, that's our last focus, we're focusing on lateral expansion of muscles like transversus abdominis, internal abdominal oblique, external abdominal oblique, that are forming the rectus sheaths, the aponeuroses that form around this rectus abdominis, so the worst part about diastasis recti is its name, I know diastasis is the separating of two pieces, but rectus abdominis, its two muscles were always separated and combined at the linea alba, and it's not just the rectus that's separating from midline, it's the aponeuroses, the rectus sheaths that are separating from midline, and what we correct with diastasis recti in a lot of people is their dysfunction on the anterolateral abdominal wall, and not just rectus abdominis, so for us, what are you going to do, you're going to kinesiotape TVA, IAO, EAO, rectus, anterior lateral thracolumbar fascia, iliacus fascia, psoas fascia, it would be a lot of tape. The second part of that question is about blood pressure changes, and I'm assuming they're talking about diaphragm hiatus, and aortic pulse, it's a lot of assumption, I'm hoping that I'm answering their question, and the ID team maybe can help me too as well, if I find that the person has diastasis recti, and has diaphragm dysfunction at the basically thoracic jamming at T12, and a really visible aortic pulse, kind of like the Andy's video that he did for our Instagram, he was talking about the bounding aortic pulse, I think that certainly you can monitor blood pressure through breathing, that's very provable by you just taking your pulse right now, inhaling, and as you exhale, the pulse slows, so certainly if you're harmonizing diaphragm, and it's pressure on the inferior vena cava, and abdominal aorta, you can certainly change things, as far as taping and blood pressure, I'm not sure that we're the right crowd to really answer that specifically, I wouldn't use tape at all, because I don't use kinesio tape at all, I instead educate my patients on where I want things to come from, and let them start to tap themselves, and give themselves proprioception, educate them through where things are supposed to be coming from, and that's our bigger focus, we're not antagonists to using taping, if you want to do all that, and use taping, great, but for me, I've had enormous success with using IDQs, and not needing any tape at all, it's an extra expense for me, and the patient to buy it, but Anna, do you have more to say on that, I'm sure you probably do.

我讓你注意到了它，所以我想，Kinesio 膠帶的好處之一就是你能看到它，也許它能讓你注意到它，但這只是短暫的，然後你又會把它過濾掉，就像你剛才做的那樣，現在我可以把它帶回到你的肩胛骨意識中，你感覺到肩胛骨上的襯衫，我只用了幾秒鐘的時間來分散你對膠帶的注意力、所以我發現這對病人的教育並沒有那麼有用 所以說到腹膜膨出，在無暇解剖中對我們的呼吸機制是一個巨大的教育 很多人在綁腹膜膨出的時候，都是綁在中間，而在無暇解剖中，這是我們最後的重點，我們的重點是腹橫肌等肌肉的橫向擴張、腹內斜肌、腹外斜肌，這些肌肉形成了

I mean, there was a lot in that question, that certainly worth discussing, and you hit all those topics, but we talked about the application of bracing, and things like that, in an ID collaborative episode, really early on, and we don't apply any sort of bracing in diastasis recti, when we're addressing this, so I think it's really important, how many ways are you trying to connect dots here, with your patient, correlation and causation aren't the same thing, we know that, and really fun research articles, that have lined up two things simultaneously, and shows ways in which they look like they're correlating, but they're actually not, I certainly think that you could talk about this from the angle of, well, if there's a diaphragm dysfunction, and it could miscue the obliques, and then there could be a tendency to have something like diastasis recti, which may be accompanied by a blood pressure issue, if there is some sort of diaphragmatic compromise around that hiatus, but it's trying to thread a little too much together, I think with this question, and because if you try to match the problem and the strategy together, a lot of times, that sort of confirms whether you're on the right track or not, because if you made this an if-then statement, and said, well, does taping address blood pressure, or does taping not address blood pressure, I would say there's entirely too many factors that go into what a person's blood pressure is doing, and none of them are a tape deficiency, and none of them are ever fixed with tape, so to me, it just seems a little unrelated from that perspective, but if you're curious about the application of a brace and someone's blood pressure, I know with people who wear big, thick belts and stuff, I would say be careful about that, because it's certainly possible that the external support that you're trying to apply to the patient may be giving them a diaphragmatic dysfunction, which could be then throwing off their blood pressure, so there's lots of different ways that you can look at the relationship or non-relationship of these things.

我的意思是，這個問題有很多值得討論的地方，你提到了所有這些話題，但我們很早就在一個ID合作項目中討論過支撐的應用，以及類似的問題，我們在解決這個問題時，並沒有在直腸腹膜膨出中應用任何形式的支撐，所以我認為這真的很重要，你有多少種方法試圖在這裡與你的病人聯繫起來，相關性和因果關係並不是一回事，我們知道這一點，還有非常有趣的研究文章、我當然認為你可以從以下角度來討論這個問題：如果膈肌功能障礙，可能會導致斜方肌功能紊亂，然後可能會出現直腸腹膜膨出等症狀，如果在裂孔周圍存在某種膈肌損傷，可能會伴有血壓問題，但這試

I think it's an interesting question, so hopefully, I'm a little unclear which part to answer, but hopefully, there's enough said about each one of those things that the person feels like their question is answered there. Yeah, unfortunately, it's like a bomb going off with the question, because first of all, it postulates that the person needs to be taped on the anterior, which we're very against in that section. We're very much against trying to get them to open up the lateral sides, and then that will create a natural bind in the front through the actions, through the tendons. Second of all, we don't use kinesio tape, but you certainly can. I mean, if you're supporting that lateral wall and if you find the tape to be useful, if you find anything to be useful, you probably should be doing it, but we're not kin tapers as far as the

我覺得這是個有趣的問題，所以希望我不太清楚該回答哪個部分，但希望每個部分都有足夠的論述，讓人覺得他們的問題在這裡得到了回答。是的，不幸的是，這個問題就像一顆炸彈爆炸了，因為首先，它假設患者需要在前部綁上膠帶，而我們在這部分非常反對這樣做。我們非常反對試圖讓他們打開側邊，然後通過動作和肌腱在前部形成自然束縛。其次，我們不使用肌動膠帶，但你當然可以。我的意思是，如果你在支撐側壁，如果你覺得膠帶有用，如果你覺得任何東西有用，你或許都應該這麼做，但我們並不支持錐形，至於

ID teaching team, so we're probably going to support you in your kin taping with ID principles, which are get the lateral wall moving. I just wanted to show you, Danny had painted this on one of our amazing colleagues, Frank Desiderio, and I'm just going to share my desktop with you guys really quickly and just show you. You can go to YouTube, and if you type in my last name or just duly noted diastasis recti, this is Danny actually painting Frank, and we show the diastasis recti in this diastasis recti video. Let me just get to the point to where you can see that we're talking about the rectus sheaths and the fact that diastasis recti doesn't come from here. It's coming from the lateral side of the wall, and then we have Frank lay down, and we do breathing strategies in supine, which is very important to us in diastasis recti, and you can see that I'm going to start coaching him through the ability to laterally breathe, and Anna, I think you might be filming this, are you not? I'm trying to remember if you or

我是 ID 教學團隊的一員，所以我們可能會支持你根據 ID 原則進行親屬綁帶，也就是讓側壁移動。我只是想給你們看看，丹尼在我們的一位了不起的同事弗蘭克-德賽德里奧身上畫了這個，我只是想很快地和你們分享我的桌面，給你們看看。你們可以去 YouTube，輸入我的姓氏，或者直接輸入 "直腸腹膜膨出"，這就是丹尼給弗蘭克畫的畫，我們在這個直腸腹膜膨出視頻中展示了直腸腹膜膨出。讓我開門見山地告訴你，我們說的是直腸鞘，而事實上，直腸舒張並不是從這裡開始的。它來自側壁，然後我們讓弗蘭克躺下，我們做仰臥呼吸策略，這對我們

Danny were filming it. I think so, yeah. You can see me trying to point out to the lateral side that we're trying to get the person to expand laterally and that the person that has diastasis recti tends to expand too much here, so I think that's what they mean by trying to kin tape them down here, but rather than trying to tape them down here when rectus is really not what's causing the problem, it's the fact that there's tightness here, the diaphragm's dropping down and forward, as Anna describes in ID1, and in the way that Danny paints this, he shows that what you're looking for actually is for our IDQs to be set neck long, chin tucked, chest wide, and for the person to be expanding more laterally, and so if you want to kin tape to encourage better blood pressure through better diaphragm function, that's very indirect and I would say almost a little bit too indirect for me to feel comfortable saying that they're correlated, like Anna said, correlation versus causation. I think that the biggest thing for us in ID is trying to encourage the person to not breathe through their neck, to breathe through the sides of the ribs in diastasis, and 100% of diastasis recti patients, they breathe too anteriorly and not enough laterally, so hopefully you can help them control their blood pressure, you can use taping if you like, but please don't just tape them, you need to make sure that they get a lateral expansion, and if you want to learn how to do all this, we teach all of this, all the intricacies in ID1 core concepts.

丹尼在拍我想是的你可以看到我試圖向側方指出，我們正試圖讓人橫向擴張，而有直腸腹膜膨出的人往往會在這裡擴張過多，所以我認為這就是他們試圖用膠帶把他們綁在這裡的意思，而不是試圖用膠帶把他們綁在這裡，因為直腸腹膜膨出並不是真正導致問題的原因，而是這裡太緊了，橫膈膜向下和向前下垂，正如安娜在ID1中描述的那樣、是以，如果你想通過改善橫膈膜功能來改善血壓，那是非常間接的，我想說的是，這幾乎有點太間接了，我不太願意說它們是相關的，就像安娜說的，相關與因果關係。我認為，對我們來說，ID 最大的作用就是鼓勵患者不要用頸部

As Anna described too, just to show you, if you go to our website, maculardissection.com, you go to the ID Collaborative, we cover a lot of these breathing mechanics and the way that we coach breathing through the ID Collaborative, hopefully my internet will sustain here, folks, and I think it was episode three, yeah, this one right here, so you can just click on this one and it'll take you to where you can actually purchase this particular ID video just on the biomechanical breath, so if you're wondering how to navigate the website for these little videos, sorry, website's a little slow right now, my web is a little slow, it describes what you learn and what to do, and it's, you know, a pretty good 20 bucks spent, or you can sign up for the ID

正如安娜所描述的那樣，如果你訪問我們的網站 maculardissection.com，進入 "ID 協作"，我們通過 "ID 協作 "涵蓋了很多呼吸力學和呼吸指導方法，希望我的網絡能在這裡維持下去，夥計們，我想是第三集，是的，這一集就在這裡，所以你只需點擊這一集，它就會帶你到你可以購買這個特殊的ID視頻的地方，只是關於生物力學呼吸、如果你想知道如何瀏覽這些小視頻的網站，抱歉，網站現在有點慢，我的網絡有點慢，它描述了你學到的東西和要做的事情，你知道，花20塊錢很划算，或者你可以註冊ID

Collaborative membership where we cover breathing, so that might prove to be really helpful, and we are on par this year to talk about diastasis recti as a separate unit, but you're welcome to, you know, enjoy the biomechanical breath and our discussions on what's actually happening in breathing, because that might benefit you more than just saying, let me throw some tape on the front of them, and hopefully that will help them bind up, I think that that bind up idea of trying to create tension in the front of the wall, those are tendons that are stretched out, they're tendons for muscles that are located out to the lateral side, so if you're wanting something to really bind in the front, you better get moving on the lateral side, dating also, oh sorry, I think we also covered diastasis recti in the third Ask Us Anything, maybe, and that should be up on YouTube, right, yeah, so there, it is, it's a topic we love to talk about, we talk about it so good, if you just join us for something, it'll probably come up, so yes, Danny, anything else to hit when it comes to diastasis recti, and you have an awesome video on our Instagram where you go over like sitting postures, and breathing, and the aortic pulse, and blood pressure, and how it's affected by the diaphragm, yeah, no, I mean, just basically, we're just going to add, and kind of just contribute to that though, again, like kind of, kind of, just kind of jump back off of what was kind of said before a little bit, but, but yeah, like really, really big important thing though, is to really kind of work on lateral sides of things, like even though the name, anterior located structures, it's really not the thing that's causing issues, and like,

今年，我們將把直腸腹膜膨出作為一個單獨的單元來討論，但歡迎你來，你知道，享受生物力學呼吸和我們關於呼吸中實際發生的事情的討論，因為這可能比只是說，讓我在他們的前面扔一些膠帶，希望這將有助於他們綁起來更有益於你、我認為，想要在腹壁前方創造張力的綁定想法，是那些被拉伸的肌腱，它們是位於外側的肌肉的肌腱，所以，如果你想要真正綁定前方的東西，你最好在外側活動，約會也是如此，哦，對不起，我想我們在第三次 "問我們任何事 "中也提到了腹膜直腸膨出，也許，YouTube上應該有、是的，就是這樣，這是一個我們喜歡談論的話

I don't know, kind of the visual, I don't, hopefully it'll, hope it'll work this time, but

我不知道，從視覺上來說，我不希望這次會成功，但

I had kind of done this beforehand, but you can kind of think of it like, let's see here now, so if you're doing too much, kind of pushing forward anteriorly, you're kind of split at the front, but you know, if you strengthen, strengthen from the sides, it's going to kind of take that, all that tension coming out from the front, and keep you more braced, and more supported, but I was kind of thinking about that though too, in terms of like, you know, in terms of braces, or in terms of things like that, like if it's, if it's giving support, but preventing any kind of movement from happening, you know, I feel, I feel like that could just cause like, any kind of like, you know, side-to-side movement from happening, that can definitely cause some issues as well down the road, and you know, it may not get you very far in that sense.

我事先已經做了一些準備，但你可以把它想象成，讓我們現在來看看，如果你做得太多，向前推，你就會在前面分裂，但你知道，如果你加強，從兩側加強，它會採取那種，所有的張力從前面出來，並保持你更支撐，更支持，但我也在思考這個問題、就像，你知道，在支架方面，或在類似的東西方面，就像如果它，如果它給予支持，但阻止任何一種運動發生，你知道，我覺得，我覺得這可能只是導致像，任何一種像，你知道，從發生側向運動，這肯定會導致一些問題，以及在路上，你知道，它可能不會讓你很遠在這個意義上。

It's completely true, like the way you describe it too, is almost like a corset, like people get, they wear these binders after, like some people are assigned them after, you know, getting diastasis recti, the, the fallacy is that these people need to be compressed, these people need to be held in, because they think it's like a hernia, like a ventral wall hernia, and I do understand why people think that, but it's really because there's nowhere for the air to go, there's nowhere for the diaphragm to go, so it goes out to a path of least resistance, and because the linea alba is a bloodless plane, it's exactly like Danny showed you, it's bound up, the air, the pressure has to go somewhere, so it goes out to the front, it's not that the person needs a bind in the front that's extra, it's that they need to be opening through a 300, you know, degree breath, and they're so bound up on the lateral sides, especially after pregnancy, because the baby's expanding them so anteriorly, because the uterus is a midline structure, that the person could benefit not just from binding in the front, you, it's really hard to bind the front and not bind what's attaching to it, which are the, the muscles on the lateral side, so I love that analogy that you gave, it's great, it's perfect.

這是完全正確的，就像你描述的那樣，幾乎就像緊身胸衣，就像人們在穿上這些捆綁帶後，就像有些人在得了直腸腹膜膨出後被分配給他們一樣，謬論是這些人需要被壓縮，這些人需要被固定，因為他們認為這就像疝氣一樣，就像腹壁疝氣一樣、就像腹壁疝氣 我也理解人們為什麼會這麼想 但其實是因為空氣無處可去 橫膈膜無處可去 所以它會選擇阻力最小的路徑它被束縛住了，空氣和壓力總得有個去處 所以它就跑到前面去了 並不是說一個人需要在前面有額外的束縛 而是他們需要通過300度的呼吸來打開胸腔因為胎兒在前方擴張，因為子宮是一箇中線結構，所

What I was going to say, too, is just kind of think about it as well, like from the days of doing landscaping, we would have, especially if you were like building walls or doing things like that, like it'd be like, you know, 100, 150 pound rocks that we're lifting at a time, and you know, our boss is really adamant about us using back braces for that time, and found that on days that actually wore the back braces would have more, would have more pain afterwards, because couldn't really take a really deep breath to really like, obviously, you know, learning, applying it to a physical moving environment like that, you know, just take really, really deep breaths, you know, really support that spine, really, really get that, that IAP going, and then, you know, being able to move like a lot more efficiently, and wouldn't have those restrictions, that those were the days that would feel sore the next day, as opposed to other days, so. Oh, I am not a proponent of bracing, and yeah, I think that that's such a good observation to make, that when I watch people wear braces, I know why they're doing it, they have mechanics anyway, and so they wear the brace to actually encourage poor mechanics, and you, if you would learn good mechanics, then you can use the brace only in a clutch, like I think that a good example is, similar to Danny's, is my business partner is a very heavy deadlifter, and he would only wear a brace in competition, because it gave him an edge, he would never wear it in training, he would wear it in competition, because it would compress everything, and he would be able to get out an extra rep, but he would only do it for three total reps of his entire year of training, and compared to like people that train with it, or work with it, and it weakens the tissue, because when you break, research is very supportive of this theory, when you brace something, you're shutting down the muscles relative to that, because if you're getting exogenous support, your body's going to shut down, it's going to down regulate its own need, it's like energy efficient, it's like, oh, something else is doing that, why would I turn on?

我還想說的是，想想看，在做園林綠化的日子裡，我們會有，特別是如果你喜歡砌牆或做類似的事情，就像它會像，你知道，100，150磅重的石頭，我們一次抬起，你知道，我們的老闆是真的堅持我們使用背支架的時間，並發現，實際上穿背支架的日子會有更多，會有更多的痛苦之後、因為無法真正深呼吸，無法真正像那樣，很明顯，你知道，學習，把它應用到那樣的物理移動環境中，你知道，只是真正地深呼吸，你知道，真正地支撐脊柱，真正地，真正地得到那個，那個 IAP 去，然後，你知道，能夠像更有效率地移動，不會有那些限制，那些是第二天會感覺

Absolutely, and also if those braces have to come off eventually, then we seem very vulnerable,

當然，如果這些支架最終必須取下，那麼我們就會顯得非常脆弱、

I know I have a patient right now that has a ventral wall incisional hernia, and he's not been able to do a lot of his rehab that he's used to being able to do, I think it sounds like in the, since the pandemic and everything closed down, there's been a lot of caution, and he's found, he wore a brace as advice to him by his surgeon, and his surgery was actually postponed, because the interesting thing about openings and things like that in the anterior abdominal wall is the bigger ones are usually less dangerous, it's the small keyhole ones that are problematic, because if stuff can pass freely back and forth, that's fine, but if it passes through and gets stuck on the other side, that's a problem, so for this patient, he had had, he had had an incisional one, and then a very small one, interestingly enough, the incisional hernia was created because of, there was an inguinal hernia, and then there was a surgery with mesh, the mesh came loose, created a bowel obstruction, and then there was a full incision to address the incisional hernia, so the whole thing actually started from hernial repairs in the first place, which is really interesting, I'm not against, you know, addressing something surgically when it needs to be done, but we have to at least, you know, look at the sort of cause and effect of all this, and so since being sort of locked in with coronavirus and the pandemic, he has been bracing much, much, much more than usual, and the last update that I got this week is that there are now four extra hernias, and now it is absolutely essential, because they're very small and sort of sporadic all over the anterior abdominal wall, so four additionals, there's six total now, and that's with somebody who's been in a brace, and my sort of hypothesis on what's happened there is that the brace is not on 24-7, and so once you get used to that kind of support, it's different than when it's like a one, you know, a PR, a one rep max, you can't be doing a one rep max for 24 hours a day, so if the minute you start to accommodate that, your tissue starts to accommodate to that sort of false sense of security, it'll come out, you still cough and sneeze and fart in the middle of the night, and you know, anytime something like that happens, you're going to have some sort of potential for pressure leak, and you know, things take the path of least resistance, so bracing is a really interesting thing that I think we are all on the same page about, and you know, everything is always case specific, so we try not to make general blanket statements about anything, but you know, look at this too, and really ask yourself, like, what are we actually doing here, and does this solution match the problem that we are sort of facing? Yeah, I can't agree with you more about, like, it's a tough observation to have with a patient that you know you don't agree with the bracing, and I think taping is a lot less, of course, than bracing, and I know we've probably gotten off topic by talking about the bracing, but the whole point of this is that that feeling that you have to brace this person up is not really super effective, and just remember Anna's story about the incisional hernias, and the more that you create a sense of bracing in the front, I know why they're taught that, because there's a hernia, and that's the best way to go through the wall is through coughing, sneezing, defecating, you know, but the real focus in the therapy should be opening the sides, and then aponeuroses are broad, flat tendons, and tendons have the tensile strength of steel, so if you're starting to breach away from midline, ask yourself, why are they pulling away from midlines? Because the sides of the muscles don't have extensibility, so improving the extensibility of the sides of the ribs, I'm sure that's something that Anna's working on with her patient, and once COVID's over, you can probably do a lot more of it in person, but also very, very good analogies put into place, and good examples of cases. So we had another question about hip compression, is that right? And they were asking, was it the mechanisms of hip compression, or? It was, review the signs and symptoms of a compressed femoral head in the acetabulum, just any information around that, signs, symptoms, things like that.