Good morning. Happy Monday. I have neuro coffee in hand. And it is perfect. Okay. It's a rainy, rainy Monday. So if you're right in the background, that would be why you might hear a little bit of buzz. But we do have a Q&A for Monday. And this is a really cool question because it's one of those things that a lot of people don't think about. And it involves working with the younger folk, with the young athletes and the little kids. And so Nate comes with a question. Says I work a lot with athletes in the age group of 11 to 25 and I was curious if you think ISA compensations take time to manifest and therefore harder to detect in younger or prepubescent people. No. So here's the deal. So the rules don't change, right? Structure dictates what their capabilities will be. With the younger athlete though, what you have is an individual that is probably a little bit more adaptable as a general rule. So not always, but a lot of the times. And so you have this broad spectrum of capabilities. And then you have this broad capacity for adaptability which means that their performances aren't spectacular at either end of the spectrum, but that also makes them more adaptable. And so they're a little bit more changeable, and so they may not rely on a singular strategy for performance. If you look at this thing as a normal curve situation though you do have some extremes and so these are the kids that tend to perform really really well under certain circumstances and they do use they do use compensatory strategies and that's one of the reasons why they stand out so if you have a kid that runs faster than everybody else jumps higher than everybody else throws harder than everybody else he is using some form of strategy that allows him that high level of force production now because of his age he might be a little bit more adaptable and so while he performs exceptionally well he may be a little less adaptable in other things and so this might be one of the reasons why we see some of the injuries like we see in youth sports is you take a kid that is somewhat biased towards being really, really good at something. So let's pick on baseball pitching because it's really easy to do in youth pitching especially. So he's really good at force production. He has lesser adaptability overall than everyone else in comparison that allows him to stand out as a thrower and then you superimpose a bunch of training on top of that. So lots and lots of throwing, lots and lots of specificity and then you slowly take away all the other adaptability that he does have and then bango you get an injury because now he's no longer adaptable so that's what the excessive throwing would do.

So I don't think that you're dealing with a situation that is any different but because of the changeability of these kids because they're not fully grown yet in many of the cases they're going to change over time so the strategies that they will use will change over time. So the kids that stand up really, really early probably use their structure is a little less changeable, a little less adaptable, but maybe a little skewed more towards first production. And then your later adapters, their structure changes over time and then allows them to finally demonstrate those capabilities. So that might be one of those early adapter versus late adapter things. Nate has a follow up here. He says his follow up question. Do you feel it would be smart to expose young or inexperienced athletes to the entire spectrum of the propulsive arc so they don't slip too far into inhale or exhale strategy. So I don't use that term propulsive arc, Nate. I do know what you mean by it. But so one of the things that you want to do with the kids is take advantage of some of their adaptability. So we don't have the extreme situation where we might have some of those early onset injuries. And so yeah, of course, you want to expose them to a broad spectrum of activities. If you're doing so, they're getting exposed to every element of propulsion stuff they're throwing and running and kicking, et cetera, et cetera. We definitely want to do that. But one of the things that we need to understand about that this broad scope application of activities for users were trying to figure out what they're actually really, really good at. So at some point in time, they are going to achieve an age of specialization, which tends to be associated with some of the structure after puberty, where they're going to start to approach some of their adult height, adult physical structures that allows them to stand out in certain ways, and then they can move towards their specialty under the circumstances but prior to that we want to take advantage of some of that adaptability as well and just to be protective more than anything else. There are always going to be kids that are going to stand out early and they're going to develop and some of them will continue to rise under the circumstances. Some of them will actually decline over time. The goal is to keep the young and healthy, if you will, and the way you'll do that is by this broad spectrum of exposure, even though they might stand out under certain circumstances. But I think that's how we're gonna try to address this the best that we can. But we're always using those strategies, especially when you see standout performances, because that's why their standout performances is because they do have the capacity to use these compensatory strategies to their advantage.

And that goes for any sport. It goes for any level of activity. Anybody that stands out in anything means that they are able to superimpose something on top of what they are and take advantage of their physical structures. And so we're going to see that no matter what age, just that kids change over time. They tend to be a little bit more adaptable like I said, and so that's why again, we don't need to change the rules. The rules are the same. Just take into consideration what the kids are bringing to the table that some of the older kids or the adults don't have.

As you overhead press, you'll see this on any number of people. If they do a one-arm press at a time, they tend to move away from the implement and keep their palm facing forward. They actually turn their body away or lean away or perform some strategy that allows them to get that position overhead because they have to capture the internal rotation. Again, it's an exhalation-based, internally rotated-based propulsive strategy against the load. When I just reach, I just expand and get my arm up overhead. Most likely, Eli, here's what you're going to need to do. You're going to actually have to develop some anterior expansion that's going to allow you to finish your presses overhead in the internally rotated position without too much compression. Here's what you're going to do. If you look back at a couple of my videos, I've got a series of arm bars and such that we can start with using kettlebells in the gym. So we don't have to do anything unusual here. You can actually build this into your training. So start with the supine arm bar. I just did one for a bench press lockout, and you're gonna actually gonna use that strategy to recapture some internal rotation at the shoulder. So it's gonna be an exhalation-based strategy as you internally rotate the kettlebell. So you're doing a supine screwdriver where you're gonna turn and we're gonna exhale. Then you turn that into the rolling version of your arm bar, so you're going to roll away from the kettlebell. Again, do the screwdriver with the internal rotation, extra rotation, exhaling on the internal rotation to start to develop the pump handle action. That's not an overhead position of the arm. So now we're going to take a standing activity. So we're going to use a kettlebell windmill to actually help you recapture the overhead position. But here's what I need you to be able to do. The kettlebell windmill is going to move you from an externally rotated to an internally rotated position overhead because of the load in your hands, but I need you to respect the end range. Don't force the end range. It will come over time and with repetition, but using that sequence of building you from sort of the ground up to recapture this expansive position on the front side of the rib cage, so getting your sternum to move when you breathe, and timing your sequences appropriately, you're going to develop the ability to inhale and exhale anteriorly, which will support your press overhead and allow you to maintain the range of motion that you're going to need to avoid the impingement at the top.

So shoulder flexion, just reaching overhead requires that you have extra rotation of the shoulder to finish true shoulder flexion. That's a posterior expansion. It's dorsal rostral expansion. A press is a compressive strategy of that same area that requires internal rotation to finish at the top. In the jerk portion of a clean and jerk or for people who just press overhead in a standing position, you'll see them shift their entire body under the load and what they're doing is they're pushing the thorax forward to compress the upper back so that the shoulders can internally rotate and finish the press. This is also one of the reasons why it's difficult for a lot of powerlifters to make transitions into strongman with overhead pressing because of the limitations in shoulder range of motion that are associated with a really big bench press, making it very difficult to press directly overhead. So Eli, I hope that helps. Remember, it's supine arm bar, rolling arm bar to kettlebell windmill. That's going to be your sequence as your gym fix for this shoulder issue. I hope that helps.

We have two strategies. We have expansion and we have compression and the interaction of those so that you're always doing both at the same time. Just certain aspects will be biased towards one and certain aspects will be biased towards another. So if we think about a body weight squat, I have to maintain my center of gravity. I have to expand in the right place. I have to compress in the right place to achieve a position in space. And so with a weighted squat, the same thing happens. It's just that now I have taken all of the loading-based forces. We haven't talked about loading in a long time. We talk about compression all the time. But when we talk about loading, those are the forces that we have to manage. And so with a weighted squat of any kind, we have to manage now those forces as well. So our strategy may change. So let's look at the back squat in the front squat real quick when we talk about loaded squats. They're both loaded, but they're not the same. So by the position of the load, I have to create expansion differently. So if I put a bar on somebody's shoulders right behind their neck and I create the compressive strategy on the backside of the upper back, I have to drive more expansion anteriorly, otherwise I would collapse the load. So I fill myself with volume, I compress that volume to make it stiff, and now I can rest a lot of weight on top of that. Okay, if I was in the front squat, I have to get enough distribution anteriorly and posteriorly underneath the weight. So from a shape change perspective, I have to expand myself so that the bar is sitting relatively in the middle of the expansion. Otherwise, I would dump the weight forward if I did not expand anteriorly, but I also have to create a utilizing strategy posteriorly to create expansion. So again, I have the weight centered relatively over this cylinder, if you will, of volume that I am squeezing. So again, the shapes are different, but the strategies are the same. It's just this interaction between the compression and the expansion. If I'm sitting down into a deep squat of any kind, I have to have some form of expansive strategy to lower me into that position. If I'm looking at just a body weight squat, I have my weight based on the effects of gravity upon me that will allow my expansion downward in that direction. So I have to expand downward to allow that to occur. So I have to have eccentric orientation in certain areas and I have to have yielding strategies in certain areas to allow that expansion to occur. If I superimpose a weight on top of that, so now I took a barbell and put it on your back, what I'm going to do is I'm going to have less of an eccentric orientation as a contribution to the expansion and more of a yielding strategy. So I'm going to distribute that load into the connective tissues on a much greater level because if I release the muscles into eccentric orientation, I will accelerate into the ground, which might be okay if I have the capacity to get back out of it based on the load. However, if I put 800 pounds on my back and I accelerated into the ground, I could just become a big wet spot, which would be a bad thing. So again, we have to look at this from compression and expansive strategy. So the shape of my body is going to be based on what the demands are. So if I put a load on me, I have to expand and distribute the shape of my body to support the load. I have to squeeze that load. And again, that's going to create a restriction in movement. So think about it, it's like I want to be more stable underneath the heavy load, so I're going to use a much more compressive strategy. But I need to be able to move through space to create my squat, which is going to be more of an expansive strategy. So under those circumstances, heavy loads, I yield a little bit more, less loads, I essentially orient a little bit more, but I'm still using both expansive strategies at the same time. To come up out of the squat, it's all about compression. So if I'm pushing up out of the body weight squat, I don't have the force demands that I might have under other circumstances. I use my concentric overcoming strategy to come up out of the squat. So I will move more towards an eccentric orientation to a concentric orientation. When I'm in a loaded situation, I don't release the concentric strategy nearly as much. And that's why I have to use the yielding strategy to get me into the bottom of that squat position. Otherwise, I may not be able to stand back up. So I hang on to my compressive strategy. I hang on to more concentric orientation even as I lower myself into the squat so I can overcome and push myself up out of a loaded squat.

If I superimpose a weight on top of that, so now I took a barbell and I put it on your back, what I'm going to do is I'm going to have less of an eccentric orientation as a contribution to the expansion and more of a yielding strategy. So I'm going to distribute that load into the connective tissues on a much, much greater level because if I release the muscles into eccentric orientation, I will accelerate into the ground, which might be okay if I have the capacity to get back out of it based on the load. However, if I put 800 pounds on my back and I accelerated into the ground, I could just become a big wet spot, which would be a bad thing. So again, we have to look at this from compression and expansive strategy. So the shape of my body is going to be based on what the demands are. So if I put a load on me, I have to expand and distribute the shape of my body to support the load. I have to squeeze that load. And again, that's going to create a restriction in movement. So think about it, it's like I want to be more stable underneath the heavy load, so I'm going to use a much more compressive strategy. But I need to be able to move through space to create my squat, which is going to be more of an expansive strategy. So under those circumstances, heavy loads, I yield a little bit more, less loads, I essentially orient a little bit more, but I'm still using both expansive strategies at the same time. To come up out of the squat, it's all about compression. So if I'm pushing up out of the body weight squat, I don't have the force demands that I might have under other circumstances. I use my concentric overcoming strategy to come up out of the squat. So I will move more towards an eccentric orientation to a concentric orientation. When I'm in a loaded situation, I don't release the concentric strategy nearly as much. And that's why I have to use the yielding strategy to get me into the bottom of that squat position. Otherwise, I may not be able to stand back up. So I hang on to my compressive strategy. I hang on to more concentric orientation even as I lower myself into the squat so I can overcome and push myself up out of a loaded squat. So conceptually, I hope that's a little bit helpful for you to kind of understand how these interactions take place because I think that some of the biomechanical models are a little bit rigid, if you will, in regards to how these things actually occur.

The reality is if we look at this thing from two strategies—compression and expansion—it's just an interaction of the two. How do I utilize that? Eccentric orientation, yielding to expand; concentric orientation, overcoming to compress. And that's literally how you're going to move through space. So this squatting thing is a great representation of how those things interact. Hope that's useful. If it's confusing, ask questions. Love the questions coming in.

No, I put my rowing machine in the backseat. Do you know how those like pop up like dance things? I just pull my roller out somewhere and start rowing. Sweet. Bill, you saw Terry yesterday? I did. How did you do it?

He kicked some booty. Did he? Yeah. As always. So he walked in. If anybody doesn't know, go on Instagram and you'll see pictures of the Terry project. And it's a little background. So Terry's a guy that I've known for, well, since I passed open, which was almost 12 years ago. And Terry's got hip replacements and knee replacements. And but he's a golf instructor and a tango dancer. And so he, he purchased a program that everybody knows about that is designed to improve your posture. And under and other things like they promise many, many things in regards to the outcome of their program. So he purchased this program and Terry is the guy that works diligently. Like if you ever ask him to do something, he will do it tenfold. And so he committed himself to this program and was incredibly successful to such a degree that it did the exact opposite of what he wanted it to do. Right, so he comes in with this hunchback kind of posture and massive kind of forward head ish kind of a thing and just a whole bunch of muscle activity that he didn't want Campos was student at the time. And so he got he got the So he saw him from the get-go and saw the changes like this evolution, like literally it looks like evolution. If you put all the pictures together, which is pretty cool. But anyway, so Terry's been on his own for about a month. Apocalypse for the dog thing, he's very excited. And so we always measure him as we would a regular patient. And so he was missing maybe five, 10 degrees of internal rotation yesterday. And that's it. Like he came in almost clean as it was. Yeah, it was pretty good.

As always.

So he walked in. If anybody doesn't know, go on Instagram and you'll see pictures of the Terry project. And it's a little background. So Terry's a guy that I've known for, well, since I passed open, which was almost 12 years ago. And Terry's got hip replacements and knee replacements. And but he's a golf instructor and a tango dancer. And so he purchased a program that everybody knows about that is designed to improve your posture. And under and other things like they promise many, many things in regards to the outcome of their program. So he purchased this program and Terry is the guy that works diligently. Like if you ever ask him to do something, he will do it tenfold. And so he committed himself to this program and was incredibly successful to such a degree that it did the exact opposite of what he wanted it to do. Right, so he comes in with this hunchback kind of posture and massive kind of forward head ish kind of a thing and just a whole bunch of muscle activity that he didn't want Campos was student at the time. And so he got he got the So he saw him from the get-go and saw the changes like this evolution, like literally it looks like evolution. If you put all the pictures together, which is pretty cool. But anyway, so Terry's been on his own for about a month. Apocalypse for the dog thing, he's very excited. And so we always measure him as we would a regular patient. And so he was missing maybe five, 10 degrees of internal rotation yesterday. And that's it. Like he came in almost clean as it was. Yeah, it was pretty good.

That's awesome.

Yeah, he came in pretty clean. And then I tweaked, like I turned the statics into dynamics. And then you saw the after picture, like that was literally him moving through space rather than doing anything static.

That's so great.

Yeah, so I'm gonna let them go for a couple months and then we'll just follow up. But again, it's worth the look just to see the changes in the pictures. If you go through my Instagram account, there's a whole bunch of them spread out and you can kind of see the evolution. Like literally the changes. So when people talk about posture and things like that, I don't look at it from a static perspective, although in this representation, they are static photos, but it's been pretty cool to see. And it is, we did the exact opposite would be what you would perceive based on what Terry was doing and much more successful in outcome.

What were some of the final activities that you were doing with them?

So Terry was doing a lot of PNF diagonals and things like that. And literally I just turned him into dynamic activity. So he's now, you know, D2s, he's doing a bilateral. One of the two extensions and stuff like that. So like I said, just took everything that we've done statically, positionally, and then superimposed the breathing on top of that. So exhale on exertions, inhale on recoveries. And again, it's not about anything special per se. It's just doing the right thing at the right time versus making these blind assumptions that everybody's going to have the same needs. And like I said, Terry being so compliant, he's like the dream client that anything you ask him to do, he'll do.

So he's doing D2s, he's doing a bilateral.

One of the two extensions and stuff like that. So like I said, just took everything that we've done statically, positionally, and then superimposed the breathing on top of that. So exhale on exertions, inhale on recoveries. And again, it's not about anything special per se. It's just doing the right thing at the right time versus making these blind assumptions that everybody's going to have the same needs. And like I said, Terry being so compliant, he's like the dream client that anything you ask him to do, he'll do.

Continuing on from the question last week about dorsal rostral breathing. You said you were comparing it to a dented car fender and just reaching from the inside and poking it out using air. So is that just literally how it sounds where you kind of get a little protraction, thoracic flexion, and then just start breathing?

Generally speaking, yes. I'm not a heat. We got to do something really important here. I didn't have the case. Generally speaking, you have the right idea. Now, we don't want to think about this as just a pure protraction, which would not be representative of a position of the scapula for breathing purposes. The scapula moves through this four-dimensional movement as you move airflow. Depending on what position you're in with your extremity, it's going to determine what strategy you're going to be using in the dorsal rostral area to create expansion. So if we want the dorsal rostral to expand, I can put the scapula into a position of inhalation or I could put it in a position of exhalation and yielding. The two strategies are not the same, but they both create expansion under different circumstances. We have to consider the desired outcome. Randomly wanting dorsal rostral expansion is all fine and wonderful, but we typically want to have a purpose to it. If there is an extremity motion that we're trying to recapture, that expansion becomes very important. Anytime that we have an external rotation limitation, the dorsal rostral area tends to be compressed, right? So it's the dented fender, if you will. And that limits external rotation because it changes the orientation of the scapula relative to the humerus, which changes the constant of the eccentric orientation of the musculature around the shoulder. And then it creates that external rotation limitation. Again, depending on the desired outcome, we determine by extremity position what type of expansion we're going to get, whether we actually move muscles into an orientation, whether they're eccentrically oriented, whether they're at length, or whether they're concentrically oriented, creating a compressive strategy. Or we want that to yield and allow that to expand while those muscles are still concentrically oriented. We have to make a decision as to what the intent is. There's our purposeful, right? It just depends on what the needs are.

Got it. Thanks, Bill.

Because when we do different positions, we have different outcomes.

Right, right. Okay. And the other question is, I was trying to help a buddy of mine who lives across the country in Atlanta, though he's in Chicago right now. We were on a Zoom call, and he was talking about how he has pain in his neck and shoulder area after prolonged sitting. This was due to his job—he sits a lot and reaches forward while taking notes. When he does this, he experiences pain. I was wondering if you could help me through my thought process here. I realized if he were to come in, I would do a range of motion assessment, which I was able to do. But he gets pain after prolonged sitting or in that same posture, so it wasn't something I could replicate at the time. Some of the objective measures I thought I needed, like a manual muscle test or something to test his muscle strength—I would have done that. Why? Well, I figured it's more of an endurance issue because if he's just in the same static position for a long time, his muscles might be getting stuck or fatiguing after too long. That was my thought process. I didn't know what else to do.

What muscles would you want to check that would be useful to have an understanding of?

I mean, just from my limited understanding of the stuff we learned in school, it would be mid-trap strength or deep neck flexors. But that's why I wanted to pick your brain on this a little bit because I realized that objectively I didn't have a solid baseline of what I wanted to check, since I couldn't replicate the symptoms.

Okay. So, what you, here's the best that you can do. Is you want to have all movement options available to you. So if he is static, right, and then becomes uncomfortable, have you ever sat on a hard chair for a long time?

Okay.

Is you want to have all movement options available to you. So if he is static, right, and then becomes uncomfortable, have you ever sat on a hard chair for a long time? And if you sit on the hard chair long enough, your butt starts to hurt.