Many people like to use squats, gait analysis, and toe touches in all sorts of complex movements in order to assess their patients and clients. What we're going to talk about today is how to actually use those tests, what those tests are showing you, and much more on this week's episode.

Welcome to Reconsider. I'm Bill Hartman. This is the podcast to challenge you to ask better questions, to look beyond traditional models of thinking, and arrive at better health and fitness solutions.

Okay. So last time we talked about table assessments, we talked about the assessment course that Bill has put together. Part of the assessment course outside of doing table tests and interpreting table tests is complex movements. So we're going to talk about which are the main movements that we use and why. And then I think a lot of people like to talk about gait analysis and watching walking and being able to determine what's going on by walking. And I think if we kind of talk about that and look at it from the perspective of the UHPC model, it will clear a lot of things up for some people or maybe let them understand that the things that they were looking at were probably not that important or incorrect. Okay. So let's, let's talk about, let's just talk about the main movements that we would use in complex movements and what they sort of, what they tell us. And maybe compare that to like, we can compare it to like legacy perspectives or models and why that might not be the whole picture.

First, let's emphasize whether you do table tests or not, you should probably understand them because they provide an understanding of how external rotations and internal rotations are produced by the shape of the structure itself. That's important because what we're going to do is take those potential changes and change the context. Instead of having the constraint of the table that helps us manage these things and emphasizes an upper extremity versus a lower extremity, we now take the whole system. We say, 'Okay, I'm going to put you upright against gravity, I'm going to have you perform an activity that we can hesitate to use the word standardized, but we'll use it as a comparator.' The great value of complex movements is that we can see differences in before and afters, but we have to understand what those shapes represent and what the changes would represent. We limit our approach by selecting some specific movements that are a bit easier to see. Ultimately, what we would want to be able to do is take any movement because all movements are complex when we're moving upright against gravity. In this circumstance, you can take typical complex movements like toe touches, squats, split squats, turning—whether it's seated or standing rotation. Each of those elements of the propulsive cycle is represented in those activities. Some where both sides appear to be doing the same thing at the same time, and some that are more asymmetrical like your turns and split squats. We use those to compare. For example, 'Okay, let's say I have somebody that's totally clean on the table—everything appears that I would have full relative motion in the entire system. Now I'm going to move you upright and say, Can you organize the system to access that relative motion, or is the stress of gravity the interference?' We can determine this, and it helps us with exercise selection—whether we need to take somebody out of a normal gravity situation, reduce gravity with cables and bands, or have them lie down on the ground. Complex movements give us information about what this person is capable of doing from an exercise selection standpoint. We don't have to create new tests; we just have to recognize what these movements actually represent.

Right. So the ERs and IRs and measurements we get on the table are going to tell us what range of motion this person has and more importantly, where they tend to end up within their base of support or outside their base of support when they are compensating, when they are using their behavioral strategies. Once we work back those strategies to giving them relative motions on the table, then we put them upright to put them into the gravity field, have them stand on two legs and move around, and we start to see where their compensation strategies come up. Because as soon as you put them upright against gravity, all of those internal and external forces that had them come see you are just all coming back. Movement is a strong behavioral influence, so you're always going to revert to your previous tendencies. So they may need some type of assistance or ways to help shift their center of gravity within their base of support to allow them to reorganize and move in a way that's not going to knock them into their compensatory strategy too quickly. Yeah. So the tests we would use, we've kind of mentioned a couple of them. I would also like to talk about an upper quarter test, like a scratch test or something, even though I know we don't really look at this typically in the UHPC model. I think it would be useful to talk about because a lot of people are going to want to know, as that is a pretty commonly used test, like trying to reach over or behind my back. Right. Also, I think aptly came up with a bunch of different tests, it wasn't just that one.

Very limited value.

Right. So I want to talk about why, because a lot of people are going to want to know, because that is a pretty commonly used test, correct? Like trying to reach over, trying to reach behind my back. Right. So like aptly, let's, yeah, let's talk about, I don't know how aptly it is. Right. Also like didn't aptly come up with a bunch of different tests. It wasn't just that one.

Yeah. I think there's a knee test there.

Anyone who is osteopathic, like a historian or PT historian, can tell us in the comments if they know of any other Aptly tests. But yeah, the Aptly test tries to measure shoulder range of motion. What is it really showing us? Because it could be useful to see if someone tries to do this and how they compensate when they try to do it.

Well, yeah, the compensations are infinitely more valuable because I don't know that I've ever seen anybody pass the test.

So let's talk about why it might not be so useful and why you can't really measure what you're trying to measure in that position.

Well, okay, so I think the misunderstanding is that there is one shoulder that's turning into ER and one shoulder that's turning into IR in that test, and they're both IR strategies. Like, if you could pass it, you're looking at different representations of actually a late IR strategy.

Well, then I think someone might pause for a second when they hear that and be like, what do you mean? So I usually just tell people to try it, right? So if I reach my right hand up and over my head and try to touch the outside of my left shoulder blade, pay attention. All I need to do is pay attention to the position of my humerus, right?

So, if you reach straight out in front of you, palm up, you're going to externally rotate the shoulder to its maximum degree at shoulder level. And if I hold that ER all the way up, I can't touch the opposite shoulder blade. I actually have to turn into internal rotation to reach by my head, which is IR. You have to turn your hand into IR, you're going to turn your forearm into IR, and the humerus is going to follow into IR to get over to the opposite side.

Right. So in order to reach either above and across or below and across, you are internally rotating in both of those.

Yeah.

So that immediately just takes away the value of what people were using it for.

Well, it doesn't reduce value. I think it's just the recognition of what is actually happening. Neck, thorax. You see somebody sort of thrust their chest forward, and the IR, the entire spine, and you see the anti-orientation of the scapulae, which makes the scapula look like it's pulling off of the rib cage to get the arm behind the back. And then you look overhead and you see them thrust their head forward or you see the inability to actually internally rotate the humerus effectively. There's value in that because I can definitely tell you that you don't have the capacity for full internal rotation. So still useful, just maybe a better understanding.

Yeah. I mean, it would just be a measurement of how much compensation someone can drive through their neck.

You see somebody sort of thrust their chest forward, and the IR [internal rotation], the entire spine, and you see the anti-orientation of the scapulae, which makes the scapula look like it's pulling off of the rib cage to get the arm behind the back. And then you look overhead and you see them thrust their head forward or you see the inability to actually internally rotate the humerus effectively. There's value in that because I can definitely tell you that you don't have the capacity for full internal rotation. So still useful, just maybe a better understanding.

Right. So it's not an active test for ER and IR, like many people might think it is not. Okay. So that's why we wouldn't necessarily even use it.

If that's the information that you need to glean from an assessment useful. If not, then maybe if you understand the compensatory strategies that are associated with it, still useful. But again, not measuring what you think it might be measuring.

Yeah, it may be useful as a comparative as long as you know the compensations you're looking for. If someone improves, but understanding also kind of like we talked about last time, if that test improves but their measures aren't improving on the table, then there was just some other compensation thrown on top.

Yeah, you just magnified a compensatory strategy.

So what would be, let's offer an alternative then. If someone's trying to pay attention to how relative movement is happening in the upper half of the body, the upper quarter of the body, what's a better complex movement, maybe choice?

You can use it back to wall, traditional flexion tests.

Right, something that keeps you in more of that ER position as you do it. There are videos for this on the network and on Bill's YouTube. So you can look through that and sit back to wall like shoulder flexion. Yeah, OK. So that's good. We provide an alternative. So you can actually put them in a space to measure from that isn't one of just IR for both directions.

Yes. You have to maintain the ER. Part of the confusion is not understanding that you're measuring more than just the glenohumeral joint. You're not just measuring the glenohumeral joint in any circumstance. You've got a humerus, you've got scapula, you've got rib cage shape, you've got spine shape and orientation, and you'll have influences from the hand and form that influence the position of the humerus. All of these things need to be resolved, which is why we have the assessment course as it is. So you can actually understand what these influences are. You could have somebody with ER going through the entire extremity and an IRD hand orientation, which again has to be resolved segmentally first.

Yeah. And I think this is probably a good opportunity to say that we are close to releasing. By the time anyone watches this, they'll probably be ready to go. But on the UHP network, which is free, you can go there and we're close to finishing the assessment one on one course, which will go over the major table tests that we've talked about and also go over these major complex movements we talked about and give you some pictures and some description on how to utilize them and interpret them. So I don't necessarily want to go through every single one of those, but we're talking about some of the big hitters. We did something for the upper quarter, shoulder range of motion—whatever people are trying to measure with that. Let's talk about probably squats and toe touches. And then I want to talk about gate analysis and I'm making air quotes for everyone listening. Yeah, so the squat typically used—I mean, I've seen it used in a lot of different ways to try to show. A lot of times you'll see someone do like an overhead squat with their arms overhead to try to see like a full display of range of motion. We're looking for compensations there. Well, we're talking about it's not just that.

And that constrains the bottom of the test. Like right off the bat, it constrains the lowest portion of the test. So it's a great way to induce a compensatory strategy where you see the sort of like the expanded representation of the lumbar spine, which is like that's a system that's looking for space to descend, right? So that's an ER compensatory strategy by constraining the scapulae into a forward projection, which is what the overhead position is in an overhead squat.