Good morning. Happy Monday. I have no coffee in hand and it is perfect. All right. A very busy Monday. First item is a little bit of housekeeping in regards to the intensive. I'm getting a lot of questions about the next intensive since this is the new year. Looks like it's going to be somewhere around the middle of March. Start planning that. I should have the date locked down actually this week, so I'll probably announce that. If you're interested in the Intensive, the first group that gets dibs on application is on my email list. So if you go to the end of any blog on billhartmanpt.com, billhartmanpt.com, go to the end of the blog there. There's a place where you can get signed up for that list, so you get first dibs. So again, Intensive, Summer, Middle March, probably announced this week. Okay, digging into today's Q&A. This is with Victor. We've talked to Victor before. Victor's chiropractor and he's running into a couple of presentations that are very, very similar. Patients with a very flat appearance to the upper back, always complaining about lower cervical, lower neck issues. This tends to be a situation where we have a limitation in the dorsal rostral area. So if you look at Alfred here, it's going to be this area between the scapula. Upper DR is going to be here and that's going to affect the lower cervical spine position quite a bit. The compression is going to take away your rotations because you basically eliminated any gradient that is available to allow those turns to take place and so we talk about a treatment sequence actually that he can utilize to actually restore that gradient and then be able to apply his his typical manual therapies that he would do as a chiropractor so this is very useful discussion for those of you that are questioning like, okay, what is the sequence of events that we're using to resolve these issues? This would be a very, very good one. If you'd like to participate in a 15 minute consultation, just like Victor, please go to askbillhartman and gmail.com, askbillhartman and gmail.com. Please put 15 minute consultation in the subject line so I don't delete it. and we will raise that at our mutual convenience. Everybody have an outstanding Monday and I will see you tomorrow. Clock has started. We are rolling.

Go ahead. So I've run into a lot of particularly females in clinics so far with a lot of upper trap tension, neck tension that goes along with that, and they seem their shape of their thorax seems to be this wide shoulder, flat t-spine kind of a archetype, so to speak. I interpret that as dorsal rostral compression, but I just wanted to hear any of your thoughts of other things to consider. Of course, restoring dynamic ISA would be, I would assume, step one, but yeah, I just want to be here.

Well, let's talk about the end representation first. So we have an understanding of that. And then we can sort of progressively strip these things away. So if you've got somebody that has limited rotation, which I'm sure you're evaluating it in some way, shape, or form. So if you've got an upper DR that is compressed, people will complain about upper trapezius, lower cervical spine kind of stuff. They don't feel stiff; they're the people that try to back out of their driveway and can't turn their head. Hopefully they have cameras in their car where they can actually see themselves back out of the car. If you've got upper DR compression, you have a lower cervical spine that is in an IARD force-producing position, so it is going to be compressed as well and that is going to take away the turns. It doesn't mean they can't turn their head at all, but it's going to be upper cervical spine that's going to be producing that type of rotation. Now, if you were to apply some form of manual therapy, the goal would be to restore the expansive capability of those segments to allow them to start to turn again. So this comes down to what are you going to be your choices? Because you do manual therapy as part of your gig, right? And so now you're going to have to make a really well educated decision as to what approach you're going to take with this. Because if you've got upper DR compression, I got news for you: you got AP compression throughout under most circumstances. Are they wide ISA people?

The couple that I've taken the time to assess, yes, they are.

So number one, limited turning capability to begin with based on archetype. They're going to initiate after the diaphragmatic compensatory strategy to take the breath in, you're going to see a DR compression. So right away, you know where you're going to have to strip away, but they're going to lose both. So they're going to lose ERs and IRs. They're going to use orientations to create their internal rotation. And so again, this is why they start to get that lower cervical spine stuff because the thorax is anteriorly oriented and the spine is pushing downward, like I said, in that IR. Because remember IR is down, ER is up under these circumstances. And so all they're doing is putting downward pressure. You don't want to look at this in isolation. I would encourage you to consider the entire.

Then you don't say.

Well, just, you know, occasionally, you know, you can get symptomatic relief in isolation. I'm okay with that. I'm okay with that. But you want to look at this from the broader viewpoint of like, okay, everything works together, nothing works in isolation. And so, but again, ultimately, you're going to have to start thinking about, okay, this is going to end up being a situation where the DR and upper DR need expansion. So you restore the ER representation of the lower cervical spine because that's where all the motion is. Right.

Right. So let's say they are the couple that are wide. Is there, I mean, I guess kind of a goofy question, some efficient manual therapy set up to have them in sideline to help with that. Yeah.

So have you seen the scapular decompression video on my YouTube channel?

Yes, with their supine, I believe.

No, that's the depression you're thinking of. This is the sideline version where you're going to bring the scap off the thorax and then as you drive expansion, that's going to help. You're literally manually creating the DR space to allow that to expand under those circumstances. That's a great place to start from a manual perspective. So here's the thing. Have you manipulated yet?

Yes.

Okay. So you did the T one through three kind of stuff and then the lower cervical, right?

Yeah. Yeah, I understand.

Everybody loves that one, but with limited success.

It's actually, so I'll get a cavitation.

I'm not talking about that. I'm not talking about making noises. I'm talking about the restoration of turns.

Yeah, I wouldn't. I didn't go back and reassess.

OK, you need to. You need to. Here's my point. Here's my point. When you've got an AP compression and you're trying to restore turns, one of the limiting factors in the desired outcome, which is the restoration of those turns, is the fact that you don't have a big enough gradient. Okay. So if you got something that's AP compressed, listen, if you got something that's AP compressed, you can create the cavitation at the joint level, but you might not get the change in muscle orientation that you need to create the joint movement. Okay. So here's what I would suggest. You do activities or manual therapies to create the expansive strategy first, then deliver your manual therapy. Now you've got a bigger gradient. So when you create, when you manipulate, you're creating an IR force. If you've got a position of the spine that's already IR'd, you might not have a big enough gradient to make the muscle change. Okay. Anytime, like if you do, you're Kyra, right? Okay. You do ART.

Right.

Here's my point. When you've got an AP compression and you're trying to restore turns, one of the limiting factors in the desired outcome, which is the restoration of those turns, is the fact that you don't have a big enough gradient. Okay. So if you have something that's AP compressed, you can create the cavitation at the joint level, but you might not get the change in muscle orientation that you need to create the joint movement. Okay. So here's what I would suggest. You do activities or manual therapies to create the expansive strategy first, then deliver your manual therapy. Now you've got a bigger gradient. So when you create, when you manipulate, you're creating an IR force. If you've got a position of the spine that's already IR'd, you might not have a big enough gradient to make the muscle change. Okay. Anytime, like if you do ART. Okay. So here you go. So you do your lower cervical, upper thoracic, ART stuff to create the expansion. So you're going to be going like upper trap, rhomboid, serratus posterior superior, right? All those. You get all of those, you do your lower cervical stuff as well with the turns. So you're going to do that, then deliver your high velocity stuff and you're going to get a much better response. You'll always get a better response with a better gradient. And it's not just the cavitations I'm talking about, I'm talking about the muscle orientation change because when you manipulate, you create an IR force on one side and the ER on the other side, you will get a reorientation of muscle and you will get a bigger turn. Do you see how it works?

Yes.

Okay. So here you go. You do your lower cervical, upper thoracic, ART stuff to create the expansion. You're going to be targeting upper trap, rhomboid, serratus posterior superior. You get all of those, and you do your lower cervical stuff as well with the turns. So you're going to do that, then deliver your high velocity stuff and you're going to get a much better response. You'll always get a better response with a better gradient. And it's not just the cavitations I'm talking about, I'm talking about the muscle orientation change because when you manipulate, you create an IR force on one side and the ER on the other side, you will get a reorientation of muscle and you will get a bigger turn. Do you see how it works?

Yes, that totally makes sense. I've been thinking a lot about the gradient aspect over the last couple of weeks, but that's a whole topic in itself.

Sometimes you have to create the gradient first and then all of the manual stuff that, again, the deeper manual stuff that would be skeletal in its response works so much better. You've got to give yourself an opportunity; no gradient, no change.

Yeah, it's simple enough that makes total sense.

It sounds simple, but now you're working with humans.

Right? Yes, yeah. There's that part.

Good morning. Happy Tuesday. I have no coffee in hand and it is perfect. All right, digging into a very busy Tuesday. Quick reminder, the next intensive will be in March. We're narrowing down the dates right now. Should have those announced by the end of the week. Get yourself signed up on the mentorship list. Go to any blog on billhartmanpt.com. At the end of the blog, you'll find a place where you can put your email address in there. You'll be the first notified. You will have first dibs on application to the intensive in March. Digging into today's Q&A. This is with Jack. Jack asked some great foundational questions that I think is going to be helpful for a lot of people. We started off discussing a very specific activity, the Better Band Pull-Apart, and as to why it would influence the dorsal rostral expansion and not posterior or lower. So that was an interesting clarification and again probably very useful for a lot of people. Then we moved into just some influences of anterior posterior expansion and shoulder rotation and then some very specific considerations in regards to narrow ISA individuals and why we see the relationships that we do. So thank you, Jack. Great foundational questions. Very useful again for a lot of people. If you'd like to participate in a 15-minute consultation, please go to AskBillHartman at gmail.com. AskBillHartman at gmail.com. Please put 15-minute consultation in the subject line so I don't delete it. We'll arrange that at our mutual convenience. Everybody have an outstanding Tuesday. Get yourself signed up on the mentorship list so you can get first dibs on application to the intensive, and I will see you tomorrow. All right. We are recording. Clock has started, Jack. Go ahead.

Bill, so I got some questions about posterior expansion. I've seen you use exercises like the dorsal rostral and the band pull apart to get some like dorsal rostral expansion.