Good morning. Happy Monday. I have neural coffee in hand and oh, it is perfect as usual. We have a very busy week this week, so I'm going to dig right into today's Q&A that comes from Alan. Alan's asking a pretty common question of late. A lot of folks are moving into this virtual online realm of training and coaching, and so there are a lot of questions as to how this should be done. And so Alan asks, what advice can you give me on what online assessments I should use? And so right away, Alan, your question infers a couple of things. Number one, that you're seeing the online situation as significantly different. I realize that the constraints are a little bit different than the in-person interaction, so I understand that part. But from an assessment standpoint, what we're not looking at is a cookbook situation of oh if this then that, and I think that goes for any assessment whether you're doing it in person or whether we're doing it virtually. And so what we may actually have then is a gap in understanding or a gap in knowledge that is presenting a limitation as to where you feel most successful or most safe. And so what we need to then fall back on is a process that is based on what you know or what you think you know and the experience that you bring into that situation. So step one under these circumstances is being aware of your own capabilities. This is somewhat painful at times in regards to actually sitting down and spending time in your own head and understanding what your capabilities truly are and in regard to what type of a client where you feel the greatest level of success and confidence. And this is where your energy should be focused. So if I was to give a wild example, a general surgeon does not perform brain surgery because that is a very specific set of skills. And so he does not take on those patients that would have a brain related issue that would require surgery. And so again, so do you have an experience that lends itself towards a specific type of client, and right away your confidence will improve and then the questions that you ask become much more easily answered or the riddles solved. And so again, this is also the first step of marketing. If you have a specific clientele where you feel this great level of confidence, this allows you to refine your message. Regardless of the type of marketing that you do, whether it be through social media, messaging, or email, or traditional methods, the goal is to always attract one specific type of client that you feel the greatest level of confidence in working with. Again, this is a really, really big deal.

I think that a lot of people are trying to maybe overstep their bounds or don't recognize that they're overstepping their bounds when they're trying to attract certain types of people because they say, 'oh, I want to work with everybody.' When the reality is, you should probably just stay in your wheelhouse and then be infinitely successful with that group of people and you'll get more of those people. If you are young in the industry and you say, 'I just don't have the confidence to work in this environment or I don't have the confidence to work with any specific clientele,' then you have just identified where you need to go. You need to take part in some form of an internship or a mentor-mentee relationship or an apprenticeship where you can safely gain the experience that you need to work with any client on any level. So we can move to a step two then that is based off this first step of being aware of what your capabilities are is only work with those types of clients that you have this great level of confidence. So again, you have to be honest with yourself and you have to know yourself. Because of my physical therapy background, because I've been doing this for more than 30 years, I tend to get a very complex type of client that has an extensive medical history, maybe multiple surgeries or multiple movement related problems and painful conditions and such. And so I have sort of earned to work with that type of a clientele. And so if you're unsure as to what type of an assessment you should be using, then perhaps you should work with those clients that don't have any significant history that might interfere with their fitness program. And so right away, you just simplified your process. So you need the minimum of any form of assessment beyond their ability to execute some of the most basic of exercises. So again, you have to identify your capabilities. You have to have some level of self-awareness. Let's just say that you're presented with a situation that you might not be comfortable with or qualified for, what should you do? Well, this is where we're referring out to someone that might be more qualified is actually a great move on multiple levels. Number one, you develop a relationship with somebody that may have experience that you can gain from them and you develop that relationship such that now they would refer back to you when they have a client that they consider like, 'oh, that person's not in my wheelhouse.' Maybe they're a little bit too easy for me and I can send them back to you. You also make a friend in a way they say, 'wow, I really respect the fact that you don't feel confident enough to work with me, but you have somebody that can help me.' I'm going to send you my friend who is a little bit less complicated than me. And so now you've developed two relationships. You've developed really good word of mouth and a great deal of respect among those people that you seek to work with.

Regardless of where you are, you want to try to remain the student. You're not stuck at your level of qualification. You're not stuck with your current level of capabilities. But you must deepen your understanding. You must gain knowledge and you must gain experience. There's a great story about Kirk Hammett. If you're a Metallica fan, you know who Kirk is. He's a guitar player for Metallica. When he first joined Metallica, he thought he wasn't good enough. So think about this. Arguably at the time one of the most popular rock bands in the world, he's the lead guitar player and he doesn't think he's good enough. So what he did is he hired Joe Satriani who was another amazing guitar player as his teacher. And so Joe challenged Kirk to actually get better. So we all have to go there. Regardless of our level, we must always try to remain a student. That's one of the reasons why Mike Robertson and I have IFAS universities. So we're trying to help pros get to the next level. We're trying to improve all of their understanding, their capabilities, and their ability to execute. It's why I work with mentees all over the world. Really, it's kind of weird that the internet made the world a small place. So I'm apparently now very popular in Europe, which is kind of fun. But again, that's why I work with those people one-on-one. It's that they're already experienced. They already have some capabilities and they want to get better. Another great example is Austin, who was just recently my iFAST fellow in the Purple Room, and he was also a gym intern. So he truly humbled himself. He said, I wasn't good enough. I wasn't confident in these certain areas. And so he took it upon himself to find ways to make himself better by going through our internship programs. Again, understand who you are, have some self-awareness, recognize what your strengths are, and emphasize those. Only work within those realms where you feel the greatest level of confidence and experience, the greatest level of success. But don't rest on your laurels. You can always get better. You can always expand what those capabilities are and eventually work with a much broader clientele. That should be what guides you in your process, whether we're talking about online assessments or assessments in person.

I got a really good question for today. This is from John and John has a question about relative elbow motion. This is a thing that I think people look at elbows so differently than other things and I don't think we have to. John says, 'I've heard you mention how examining relative motion of the elbow is very similar to the knee. I've had great success with utilizing the knee mobilization you posted for individuals who are unable to capture tibial IR on their own. Could the same concept be applied at the elbow? Is valgus carrying angle at the elbow the same as knee valgus as you have previously described?' John you are totally on point here. One of the things we have to appreciate is that all joints move on helical axes, so they all have a rotational element to this, and so the elbow is no different. But I think the visual representation of how the elbow moves throws people off, and so they kind of think of it as being something different or oversimplified in regards to just a simple hinging motion. And so then it's kind of like when you're missing some elbow range of motion they kind of treat it like a knee where they just push it harder into the traditional flexion extension rather than actually appreciating the fact that it does turn. So if we take a peek at a knee valgus, typically what we're going to see is we see this femoral internal rotation orientation on top of the tibial external rotation. And that's what produces a lot of this valgus orientation. And you are correct, sir, that the elbow is no different. The thing that we want to appreciate in the physical structure of the elbow, if we look at the trochlea of the elbow, it looks kind of like a twisted hourglass, if you will. And so what this does is it does give the ulna this rotation as it moves through the excursion of traditional flexion extension. So again it's like we have to look at this thing as a rotational joint just like everything else does. So when we're going to see this elbow valgus orientation what we're going to see is we're probably going to see a distal humeral ER relative to a forearm pronation orientation. One of the dead giveaways that you're going to see is the prominence of the medial epicondyle. You'll see this bulk of the pronator, teres musculature overlaying this, but you'll definitely see the prominence of the medial epicondyle. You may also see this go all the way down into the hand where you're going to see a thumb that's going to have trouble externally rotating. So the people that have this elbow orientation also can't create the little pistol position with the index finger and the thumb because they can't externally rotate the thumb. This is, I believe, traditional thumb extension, and so these people are in what we would consider traditional thumb abduction, which I would call this IR. I would call this ER just for the sake of argument to stay in our transverse plane concept there. But the advantages of recognizing this rotational influence at the elbow is now we can have effective strategies to recapture all of these relative motions. Now, I would also caution you that don't look at the elbow in isolation. You still need to look at this thing systemically, so we're probably going to have to look at axial skeletal orientation. We're going to have to look at scapular shoulder orientation before we get to the elbow. Because depending on the proximal strategy, we're going to have to decide whether we're going to use something that's going to be inhalation-based or exhalation-based. An inhalation-based activity would be one of our curling variations. Instead of looking at things like biceps training and triceps training, we can now look at this thing as recapturing the relative motions. Your typical curling activity is going to be associated with trying to recapture an inhalation-based strategy. Your triceps activities are going to be your exhalation-based strategy. For instance, if we're trying to drive an inhalation-based strategy, recapture the relative motion of the elbow, this is where we get to use all of our cool little curl activities that you've probably seen. I got a bunch of stuff up on YouTube in regard to some wrist and elbow reorientation strategies. So check those out. If we need to drive a little bit more of an acceleration strategy, we can start to use our side plank variations, but I would also make sure that you tend to hand and wrist position under these circumstances because again, it is going to be an influence in your ability to recapture all of those relative motions. Hopefully, John, that gives you a little hint as to where you need to go with this thing to recapture the relative motion of the elbow. It's no different than any other joint or any other area of the body that needs this relative motion to restore comfort in all of our movement options.

with the index finger and the thumb because they can't externally rotate the thumb. This is, I believe, traditional thumb extension. And so these people are in what we would consider traditional thumb abduction, which I would call this IR. I would call this ER just for the sake of argument to stay in our transverse plane concept there. But the advantages of recognizing this rotational influence at the elbow is now we can have effective strategies to recapture all of these relative motions. Now, I would also caution you that don't look at the elbow in isolation. You still need to look at this thing systemically, so we're probably going to have to look at axial skeletal orientation. We're going to have to look at scapular shoulder orientation before we get to the elbow. Because depending on the proximal strategy, we're going to have to decide whether we're going to use something that's going to be inhalation-based or exhalation-based. An inhalation-based activity would be one of our curling variations. Instead of looking at things like biceps training and triceps training, we can now look at this thing as recapturing the relative motions. Your typical curling activity is going to be associated with trying to recapture an inhalation-based strategy. Your triceps activities are going to be your exhalation-based strategy. For instance, if we're trying to drive an inhalation-based strategy, recapture the relative motion of the elbow, this is where we get to use all of our cool little curl activities that you've probably seen. I got a bunch of stuff up on YouTube in regard to some wrist and elbow reorientation strategies. So check those out. If we need to drive a little bit more of an acceleration strategy, we can start to use our side plant variations, but I would also make sure that you tend to hand and wrist position under these circumstances because again, it is going to be an influence in your ability to recapture all of those relative motions.

Adam had questions about things like key performance indicators and assessments for his 13-year-old son. One of the things I thought would be interesting to clarify would be how we manage these younger athletes compared to the more mature, because the conversation I was having with Eric was about a more mature athlete and how we would handle those situations. I don't think that parents have been given a reasonable playbook as to how best to manage some of these young athletes, because I think there are better ways to handle this, especially with the growing concern over these adult type injuries that we're seeing in young kids. I could go another lifetime without seeing a 14 year old kid with a Tommy John surgery. So what I did this morning is I reposted a blog from 2014 that talks about this very specific topic of long term athletic development. So there's some opinions in there and a little bit of structure to give you an idea, but let's review things a little bit. Early on, when we talk about really young kids, we're talking about six, seven, eight years old, where they start to get exposed to some organized sports. Most of the training, if you will, would be free play. We want them to be exposed to a broad number of physical activities, a lot of physical problems to solve, and just expose them to a lot of movement and let them figure a lot of this stuff out all by themselves. So we don't need to structure games. They need to be creative. And like I said, get them exposed to as many things as possible. This makes for a really, really smart child first and foremost. And then, like I said, it exposes them to a number of different movement strategies that they will use later on in their development. If we had any structure to this, I would recommend that you expose your child to martial arts and gymnastics. And when I say this, I'm talking about the non-competitive kind, if you will, because the idea is not to develop the competitive, overuse, extensive type of training. We just want to expose them to a lot of different styles of movement. As they get into this pretty teen early teen stage, this is where we can actually start to expose them to a structured training program, but this is a learning to train situation. So this is not about setting personal records in weight lifts or worrying about top speed or anything like that. What we're trying to do is we're trying to expose these kids to a structured training program. So again, they learn to train because in three to five years later, when they do get to this age of specialization, when they do have a more adult physiology and they're more adaptable to that type of training, now they're going to be ready for it.

So we don't need to reteach them how to train. And that's what this middle range is for. We want to make sure that you're still exposing them to any number of sports and activities. So limiting the number of exposures is probably a bad idea because when they are faced with something novel that movement that they may be exposed to that they are unfamiliar with because they don't have good problem-solving skills in regards to movement can be seen as threatening and that actually ultimately limits their level of performance. So again, if you think about some of the best athletes in the world, many of them were exposed to any number of sports early on in their careers. So that's something to keep in mind. Formal assessments at this point are of minimal use. It doesn't mean that we never use them. It just means that they're not very valuable because when we think about the physiological development of kids, if I would assess you at the age 13 and I would come back and assess you at age 18, you're a totally different human at that point. So that 13-year-old assessment really didn't give me much information. So what we do is we're going to use a lot of observation in regards to just typical sports performance, or as we're exposing you to the training process and you're learning that process, those will be our assessments. So we're actually going to use the movements themselves as assessments. So in the later teen years, after puberty, we've got a much more adult-like physiology that's more adaptable than what we're going to be looking at is training with the intention of raising performance. So the tolerance is there. So one thing that we want to consider about little kids is that they have this broad adaptability, but they have a very low tolerance. And so what we want to make sure is we're limiting these specific exposures. And we want to make sure that that stays broad-scoped through those early years. So they're ready, like I said, for the specificity of the later teen years.

That's one of my pet peeves with the lighter construction shoes is that when you do change direction, you slide inside the shoe because the upper gives way, where you just slide into the toe box. Or if you do get anything with a good mid-foot construction, then the rear foot is mush. And so nothing really flips my skirt at this point. The thing that you want to be really careful of is that you don't try to use a straight ahead shoe for your agility based activities. So like a running style shoe is a bad idea. And I think there's probably too many people that try to get away with that. They're just not constructed to go side to side. When you have a high heel to toe ratio or you have a sort of like the base of the shoe is widest at the bottom and then it narrows as it goes towards the heel. It's like all you get is hit the outside edge of that shoe and you're looking at an ankle spring. Do you guys remember the pump shoes? Did they have those when you were kids? I'm not as old as you but yes the pump. Well, so I was already old by the time the pump shoes came out and so I didn't I wasn't attracted to them because I didn't care whether I could dunk or not and but the nice thing about them is that they did give you that nice little secure feeling of you know that that sense of the shoe around your foot.

And what do you think about like these minimalist shoes then that have like pretty much nothing as just the what in a case I guess you could call it.

I think you have to earn them. I just think that's not for everyone. And there's like a sect of people that they'll be perfectly fine with that.

Earn them in what way?

Well, you have to be adaptable, right? That's a very adaptable thought.

Discuss arm positioning using the reflection arc in general. You kind of talk about reaching or how you physically utilize that to gain something that they're looking for in exercise. Okay, so what do you want to acquire or reacquire? Yeah, so let's say you're trying to get lower thoracic expansion. Where, like, how would you place your arm to drive something in an exercise and stuff like that? And would you reach, would you move, would you have an extra rotation aspect, interrotation aspect, like, kind of this overall way of thought process, besides just that sort of jazz.

Okay. So let's think about this. You're talking about the posterior lower rib cage, is that what you said? Yes. So there's a couple of ways I can go about this. I know that I need to expand the backside of the rib cage below the level of the shoulder blade. That is emphasized in the early phase of raising the arm up from your side. So if we had to pick a number, we would say that first 60 degrees is going to be that influence.

Yes.

Okay, so there's a couple of ways that I can go about this. I know that I need to expand the backside of the rib cage below the level of the shoulder blade. So that is emphasized in the early phase of raising the arm up from your side. So in what we would say, if we had to pick a number, we would say that first 60 degrees is going to be that influence. Correct? OK. So anything where I position my arm in that relative angle is going to help promote that expansion. So I have to have a compressive strategy anteriorly to move the fluid volume posteriorly. So just take a high to low kind of a cable press concept as I'm pressing down and reaching. I would have to compress anteriorly to accomplish that task, which would promote the posterior expansion. Right. Yes. Okay. So that's one strategy. The other would be to create a compressive strategy where I don't want the air to go right would be through that middle range. So you think about like if I wanted to compress the dorsal rostral area around the scapula, I would position that arm through that roughly the 90 degree of shoulder flexion range, right, plus or minus about 30 degrees. And that will create, like I said, that upper posterior compression, but what it doesn't do, it doesn't compress the posterior lower. So now I'm using another strategy that will block the expansion in one area and try to promote it in another. So there's multiple ways to go about this.

Right.

Okay. So anything where I position my arm in that relative angle is going to help promote that expansion. So I have to have a compressive strategy anteriorly to move the fluid volume posteriorly. So just take a high to low kind of a cable press concept as I'm pressing down and reaching. I would have to compress anteriorly to accomplish that task, which would promote the posterior expansion. Right. Yes. Okay. So that's one strategy. The other would be to create a compressive strategy where I don't want the year to go. right would be through that middle range. So you think about like if I wanted to compress the dorsal rostral area around the scapula, I would position that arm through that roughly the 90 degree of shoulder flexion range, right, plus or minus about 30 degrees. And that will create, like I said, that upper post-year compression, but what it doesn't do, it doesn't compress the post-year lower. So now I'm using another strategy that will block the expansion in one area and try to promote it in another. So there's multiple ways to go about this.

Okay.

Okay. Does that make sense?

Yes. Like if you're doing something like positioning those structures, like an isometric either internal or external rotation, would that help drive one thing based on the actual superficial strategies within the shoulders? Like the rotator cuff activity, would that help pull the scapula away from the rib cage to drive a certain activity? So if I was in a zero to 60 degree range and I were to perform like an isometric external rotation with some breathing, would that help open up even more because the rotator cuff muscle is going to be pulling the scapula away from the thoracic wall.

So the way that I perceive those exercises is not relative to the humeral motion, but what's happening between the humerus and the scapula. So if you're doing the traditional external rotation kind of thing, or as you describe the isometric in that lower 60 degree range, as you promote the extra rotation at the humerus and scapula, the scapula are going to turn. So it's not the humerus that would be necessarily turning, but the scapula would turn and create space between the two scapula. And so that would allow that posterior expansion to occur.

So have you played around much with the angle of shoulder flexion in the single arm cable pec deck fly exercises? How can you use that to influence movement—specifically, to help someone move air better in those exercises?

Yes. Yes. Very important for creating end-range rotations. Because the end range rotation is using a compensatory strategy to finish the turn, right? The more extreme and the more forceful or the tighter the turn that has to take place. So when you think about like a change of direction, a very, very aggressive change of direction, when they're coming out of the cut, to get that the last bit of turn to reorient the body into a straight line. That requires that. So we don't talk about this very much, but the scapular retraction towards the spine has to occur to create enough velocity out of the cut. If you don't do that, you don't get enough expansion to redirect into a straight line. You're talking about the single arm kind of a cable thing. The end range position of that is the position that you're going to use to produce the last element of turn to redirect out of a cut. But again, if you just watch the arm position, you'll see them trying to move the scapula to create the turn because the scapula are those paddles that block things really, really well because they're very solid. They create a compressive strategy. And then if you know that if somebody's trying to retract their scapula to make a turn, you know they're trying to drive expansion on the other side. Question is, is do they even have expansion on the other side? Good morning. Happy Friday. I have no coffee in hand and it is perfect. All right, we are squeezing this one in between mentorship calls this morning. So I'm going to dig right in. We got a neck question. This is kind of exciting. I haven't had one in a long time. It comes from Adrian. Adrian says, I have an athlete with a great deal of neck limitation who appears to be very compressed in the upper ribs. Are there any good tests that can lead me toward a solution or let me know that I'm making progress short of trying to assess neck mobility directly? Does compression of the manubrium affect neck position and movement? So this is actually a really, really good question. Trying to assess neck mobility directly by hand can be somewhat unreliable. And if you're not a manual therapist and you're not constantly touching people, then it difficult to develop that feel. So it would be helpful to have some fairly reliable tests that would give us an idea of what might be influencing neck range of motion. And I think we do have a couple of really good ones. So you asked about the manubrium. And there's a great way to test whether we have this mobility in the manubrium. So when we have a down pump handle, the manubrium is going to follow a little bit later in the compensatory sequence. An easy test to determine whether we have a down manubrium is actually the old school aptly scratch test. So this is where you reach behind your back and try to touch the opposite shoulder blade. And this is internal rotation behind the back. And actually to access this range of motion, we have to be able to eccentrically orient some of this anterior musculature. So if we think about if we're going to pick on a muscle, clavicular pec for instance would have to be able to eccentrically orient force to reach behind our back and touch that opposite shoulder blade. So if it's concentrically oriented and creating a compressive strategy that's pulling the manubrium down, you're not going to be able to reach behind your back. When we think about another potential influence on the neck position, especially the lower cervical spine, we have to have dorsal rostral expansion to have normal rotation through the lower cervical spine. So our big test for that would be end range shoulder flexion. And so now we have two really powerful tests to let us know whether we're getting this anterior posterior expansion especially in the upper rib cage. Now from a strategy standpoint, we want to monitor these tests as we're intervening to make sure that we're on the right track. But the first thing that we want to look at is we're going to have differences in our Y's and in our T's. And so when we think about the compensatory sequence and how they arise, so if we're looking at a T, we may still have some upper dorsal rostral expansion in many cases. So their in range shoulder flexion might still be good, but they're not going to be able to reach behind their back. So in this case, we're still going to have some lower cervical rotation, but upper cervical rotation is going to be restricted. And so what you'll typically see is that typical forward head posture. We have the upper cervical extension, lower cervical flexion by traditional representations, manubrium will be depressed. If we're looking at a Y under the same situation, you're probably going to have dorsal rostral compression, again based on the way that these compensatory sequences arise. So in this case, we're going to have a limited amount of lower cervical rotation, but we're probably still going to have upper cervical rotation available to us, but this is going to be a more military-style posture where you're going to see the mandible pulled backward actively, which is going to pull the hyoid bone up. As far as the treatment training strategy goes, first step, let's not do anything that interferes. So we want to eliminate that. So bilateral symmetrical pressing activities tends to be a bad idea because it's just going to emphasize the compressive strategy that we may have that's pulling that manubrium down. If we have the dorsal rostral compression as well, then we want to take away symmetrical pulling activities, especially things like face pulls, T's and Y's. Because if it's already compressed, we don't want to emphasize more concentric orientation to drive more compression there. So when we go into the gym and we start to train these people, we're going to start to think about for our Y's, we're going to use like a high low cable press. So we're going to play in this angle that would emphasize the inhalation capabilities, as well as maybe some say chopping activities to again promote this posterior expansion. Once we can recapture that posterior expansion, now we can start to work on a little bit more of our reaching activities at 90 degrees and start to emphasize that anterior expansion. For the T's, we're just going to reverse the process. We're going to start somewhere in this 90 degree shoulder flexion reaching activities, and then we're going to try to expand that posterior aspect of the thorax. Adrian, I hope this gives you some ideas to work with. You've got a couple of tests that you can follow. You've got some strategy as well as a representation of probably what you're looking at. So if you have any other questions, please let me know at askbillhartman at gmail.com, askbillhartman at gmail.com. Have a great Friday. Have an outstanding weekend. I'll see you next week.

And so an easy test to determine whether we have a down maneuvering is actually the old school aptly scratch test. So this is where you reach behind your back. You can try to touch the opposite shoulder blade. And this is intro rotation behind the back. And actually access this range of motion. We have to be able to eccentrically orient some of this anterior musculature. So if we think about if we're going to pick on a muscle, clavicular pack for instance would have to be able to eccentrically orient force to reach behind our back and touch that opposite shoulder blade. So if it's concentrally oriented and creating a compressive strategy that's pulling the miniburm down, you're not going to be able to reach behind your back. When we think about another potential influence on the neck position, especially the lower cervical spine, we have to have dorsal rostral expansion to have normal rotation through the lower cervical spine. So our big test for that would be end range shoulder flexion. And so now we have two really powerful tests to let us know whether we're getting this anterior posterior expansion especially in the upper rib cage. Now from a strategy standpoint, we wanna monitor these tests as we're intervening to make sure that we're on the right track. But the first thing that we wanna look at is we're gonna have differences in our y's and in our narrows. And so when we think about the compensatory sequence and how they arise, so if we're looking at a narrow, we may still have some upper dorsal rostral expansion in many cases. So their in range shoulder flexion might still be good, but they're not going to be able to reach behind their back. So in this case, We're still going to have some lower cervical rotation, but upper cervical rotation is going to be restricted. And so what you'll typically see is that typical forward head posture. We have the upper cervical extension, lower cervical flexion by traditional representations, higher bone will be depressed. If we're looking at a wide under the same situation, you're probably going to have dorsal rostrum compression, again based on the way that these compensatory sequences arise. So in this case, we're going to have a limited amount of lower cervical rotation, but we're probably still going to have upper cervical rotation available to us, but this is going to be a more military-style posture where you're going to see the mandible pulled backward actively, which is going to pull the hyoid bone up. As far as the treatment training strategy goes, first step, let's not do anything that interferes. So we want to eliminate that. So bilateral symmetrical pressing activities tends to be a bad idea because it's just going to emphasize the compressive strategy that we may have that's pulling that manubrium down. If we have the dorsal rostral compression as well, then we want to take away

Symmetrical pulling activities, especially things like face pulls, eyes, T's and Y's. Because if it's already compressed, we don't want to emphasize more concentric orientation to drive more compression there. So when we go into the gym and start to train these people, we're going to think about for our wides, we're going to use like a high low cable press. So we're going to play in this angle that would emphasize the inhalation capabilities, as well as maybe some say chopping activities to again promote this posterior expansion. Once we can recapture that posterior expansion, now we can start to work on a little bit more of our reaching activities at 90 degrees and start to emphasize that anterior expansion. For the narrows, we're just going to reverse the process. We're going to start somewhere in this 90 degree shoulder flexion reaching activities, and then try to expand that posterior aspect of the thorax. Adrian, I hope this gives you some ideas to work with. You've got a couple of tests that you can follow. You've got some strategy as well as a representation of probably what you're looking at. So if you have any other questions, please let me know at askbillhartman at gmail.com. Have a great Friday. Have an outstanding weekend. I'll see you next week.