If internally we're producing a biased force, we have to have a strategy to manage that.

Good morning. Happy Monday. I have no coffee in hand and it is perfect.

Very busy Monday. We're going to dig straight into today's Q&A. This question comes from Alex, and Alex's question was in regard to selecting the appropriate position for patient intervention. This is more of a rehab kind of a question, but it does apply to gym activities as well. One of the things we have to consider is how our patients or clients are managing internal and external forces. We're talking about gravity and then the internal forces that we produce through the internal movement of our bodies. This is why we see the superficial strategies that we talk about that can create interference with movement. So if we can better select interventions in patient positions, we can be much more effective with those interventions and then progressively teach our clients to manage these forces and have much more successful outcomes. And so that's kind of where this question took us. One of the things that I want you to walk away with is understanding that number one, always have an intention, a very specific intention, and therefore you're going to need a key performance indicator. You're going to need something that you're measuring as you intervene to assure that you are being successful. So take that time, intervene and always re-measure so you know that you're being successful. If you would like to participate in a 15-minute consultation, please go to askbillhartman at gmail.com, askbillhartman at gmail.com, and we'll arrange that at our mutual convenience. Everybody have an outstanding Monday, and I'll see you later.

I'm trying to get better at which positions on the table to put people in, like whether it's right side, left side, from the spine, that initially. So I was wondering if I could ask you questions about diaphragm position in wides versus narrows and what you want them to do. And then maybe some other factors, like what else would play into whether I put them in right or left sideline? Because generally I put them in right sideline, because my impression is based on the way the guts move, it takes away the internal forces. But that doesn't always seem to be the best option. So I was wondering if you could elaborate on that.

Okay, so I love the thought process first and foremost, because again, when you think about the superficial strategies, they're using them to control position against gravity and managing forces. And so if internally we're producing a biased force, we have to have a strategy to manage that. And so the easiest way is, number one, to simply reduce gravity first and foremost in any way, shape, or form. You do that, you immediately have a benefit to allow you to access different positions because the strategies can now change. Right sideline is going to reduce those internal forces to a greater degree than just about any other position because, again, they have to move against gravity, which they probably don't do a great job of because it's, you know, it is pressure-related. But again, it's harder to overcome. So from a right sideline standpoint, you're absolutely right. In regards to any other position, think about just a bag of water and then where everything is going to fall, so to speak. So if I move somebody to supine, there's a greater potential for some of those internal forces to be in effect, but because I'm laying down, everything tends to fall towards the table. So if you can just remember that representation alone, it's like wherever I'm positioning you, the guts are going to go in that direction as far as the table is concerned. And then all you gotta recognize the fact is like every time I take you away from that right sideline position, chances are I'm going to slowly allow those forces to become exposed just a little bit more, which is necessary from a progression standpoint. I need to slowly introduce something so you manage it here, you manage it there, and I keep turning you. Think about this for a sec though. So when you're in like all fours, everything's hanging off the spine. Which is kind of cool. When you think about it, it's kind of helpful. The bias is still there. But because, again, it's hanging. So my dog has a similar internal force problem, right, that we all do, but to a lesser degree. So it's still not as impactful as being upright. Grace is like just digging that one, right? Yeah. So all you're doing is, and again, your strategy in my mind is correct depending on what you're finding. So how do you know when to change the position?

Well, so sometimes what I'll do is I'll start on the right sideline. That's kind of like my default if they can't get something done. And then maybe I'll bring them to the left or I'll just like try a different position again. I have to earn and see if it was any easier.

Let me back up. What measurement are you using? So you put something in the right sideline. How do you know you're successful?

Usually it's just positionally. Do they feel what I'm talking about? Can I get them to move that way?

Okay. So you need an objective measure.

Should I be monitoring like IRs or something?

Well, you should be measuring something.

Yes.

Okay, so think about the strategy that when you take your initial measurements, they're going to give you a representation of the strategy that you're using to manage yourself. Right? So based on that, after you put somebody in a position, you should have an intention of what you're trying to change or influence. What am I trying to influence? After you do that activity, did it change? If it didn't, do something else along the same lines of thinking, if you still think that you're correct. But the point is, before you choose an intervention, you need to have an intention. Don't just randomly throw stuff at the wall and hope that it sticks. We want to have an idea. So if I'm going to put you in sideline, I think about: If I took away the influence that made you create this movement strategy in the first place, I have to have a measure that tells me that you stopped using it. So maybe it's like, okay, I recaptured external rotation and was able to superimpose internal rotation on top of it. So let's just say that they were like, 50 degrees of external rotation, zero internal rotation. You land them on the right side, they mess around a little bit, and they go 60, 20. Way to go. That tells you that that left-sided strategy is no longer in play. So now it's like, okay, I probably need to get more of the internal rotation. So I might do another activity in a similar position, or I might move them into a slightly more challenging position and see if they can hang on to what they just gained and then pick up some more. So that might be going from right sideline to supine. Okay? Do you follow where we're going here?

Yeah, absolutely.

But every time you intervene in your situation, so we're talking about a rehab setting here just to be clear because it's like you don't want to test your gym clients after every exercise that they do, right? Because some of those exercises are intentionally designed to take away motion. But in our situation, every time you intervene, you got to check a KPI. Otherwise you don't know if you're successful. So if you did three activities, let's just say you did three activities and nothing changed, you just wasted that amount of time. And so again, all you just have to have is just one key measurement that makes sense to you that will tell you that the strategy is changing. And that will be your God.

Okay, that's fair. Does that help you? Yeah, definitely. I mean, I do it a lot of time, not all the time. But so when would you switch someone, when would you, if I'm looking at a person, and I say, this person might do better in left side lying, what person would I be looking at?

So what do you have to have to lay somebody on their left side to assure that they can move across that left side? You've just anchored the, so if you put somebody in left, okay, hang on. Remember how I talked about what the table represents and why you measure against it?

Yeah.

What does it represent?

I'm standing on a thick surface.

Is it early middle or late?

Middle. If I put you in the left sideline, what should you have on the left side? I should have middle on the left side, shouldn't I? I have to be able to approach it. So that means I have to have a superimposition of internal rotation on the left side to even put you in left sideline to be successful. Exceptions to the rule, certainly. If I got somebody that's pointy and I need to go manual on somebody, I might put them there. But generally speaking, to do an activity, an intervention on the left side where they're actively participating, I would need to have some internal rotation on that side.

If I put you in the left sideline, what should you have on the left side? I should have middle on the left side, shouldn't I? I have to be able to approach it. So that means I have to have a superimposition of internal rotation on the left side to even put you in left sideline to be successful. Exceptions to the rule, certainly. If I got somebody that's pointy and I need to go manual on somebody, I might put them there. But generally speaking, to do an activity, an intervention on the left side where they're actively participating, I would need to have some internal rotation on that side.

I mean, that's sort of the right side too though, right?

To a degree, yes. Again, if I'm the guy applying the forces, and I'm trying to induce the shape change manually, that's totally different from you doing it actively. You have to have some sort of access to a position in movement. Again, take somebody that is fully compressed, very late representation, end game, and then ask them to do an active intervention under those circumstances. It's very, very difficult to do. You need to position the foot and put the force into the ground. I have to have external rotation to get their internal rotation to produce force. Good morning. Happy Tuesday. I have neuro coffee in hand and it is perfect. We can dig straight into today's Q&A. This was with Lalo. Lalo works with sprinters. Some of those guys have some pain-related issues, and so he's monitoring them over time, and he's collecting some data on ranges of motion. He's identified some deficits. One of the deficits you're typically going to see with sprinters in general is that they're going to lack hip internal rotation. The question is, how much of that do we need to give them back to protect them, allowing them to produce force? Because we're always going to use external rotation to position ourselves. We're going to use internal rotation for force production. And so we talked a little bit about key performance indicators. Lalo's using a vertical jump, actually, to help monitor some of these things. And we talked about how we can integrate that. We covered a lot of ground in regards to external rotation for position, internal rotation for force production, key performance indicators, and then how to monitor over time. So again, probably useful for a lot of you people that work with people that have to run really, really fast. If you would like to participate in a 15-minute consultation, please go to askbillhartman@gmail.com. Put '15-minute consultation' in the subject line so I don't delete it. We will arrange that at our mutual convenience. Everybody have an outstanding Tuesday and I'll see you there.

Is it normal for elite runners and sprinters to have barely any adduction? I mean, they'll have it because of the anterior tilt, if I, you know, if I bring their knees up, they'll have it at a certain degree.

Where are you? What do you mean?

So I'll lay them down on the table. I'll lay them on their side. I will bring their knees to 90 degrees. I will pull back the knee, but I don't want to pull back enough to where the nominist starts to roll.

So you can't bring it back all the way.

Right. I can't bring it back all the way. So I'm not, because I already know I'm not going to have that hip extension. It's normal that they don't because of the anterior tilt, but at that certain point, if I started to bring down to test adduction, their knees are going forward.