Okay. So a couple things, Johnny, when you write the word full and then you have numbers, you're sort of confounding your outcome. So just a little word of advice, just try to throw up numbers so you have a comparator there that's equivalent. It makes a little bit easier. But I think we've got enough to work with here that we can actually come up with something. First thing that we want to talk about is what is the coffee cup? So we talk about chessboards and coffee cups, and the coffee cups are the things that stand out the most. And so in looking at the information you gave me, you gave me one big giant 20 ounce coffee cup. And that's going to be the foot position. So let's talk about that first. So when you talk about having an athlete with a lower arch, so we're going to look at the early, an early propulsive foot, which is actually going to have a pretty decent arch there. It's a supinated ER foot. And as we move through this middle propulsive range where we have the ankle rocker. This is where that arch is going to come down low. And so this is going to be us moving through middle propulsion to get to max propulsion. So what you may have here is an athlete that is trying to stay as close to max propulsion as possible. Now he's a very big human being. He's 315 pounds. He's a defensive end. And so chances are, to move that quickly, that size quickly, he's going to have to be really, really close to max propulsion almost at all times. Now, if that's the case, this is a position of internal rotation. He's putting a lot of force into the ground already. But based on your measures, we don't have a lot of hip IR. So where is he getting the IR coming from? So now we got to start looking at pubic orientation. All right. So based on one of your other comments here where you actually said that when you measured his shoulder extra rotation as being full. You put it in quotes because the thorax was posteriorly tilted on the table. So that's very, very useful. That means we had a thorax that was anteriorly tilted prior to laying him down, which is a pretty good indicator that we've got an anterior orientation of the pelvis. Now, we've got a confounding factor here that makes us question whether we've got an anterior orientation of the pelvis because you've got 80 degrees of hip external rotation. Well, how the heck do we get 80 degrees? Because what I should see with an anterior orientation of the pelvis is a loss of this hip ER. So let me give you a little hint as to what's probably happening here, especially with somebody of his size. As you're moving the hip into traditional measures of hip flexion to measure your ERs, you're getting a left lumbar rotation on the table. So as you bring him up into hip flexion, the spine flexes on the left side. That's external rotation of the spine towards that side. And that magnifies the external rotation measure. Now, how can we say this? Well, your right hip flexion doesn't have a pinching sensation like it does on the left side. So we had that pinch on the left, which tells us that hip flexion stops there. We don't have that on the right side. And you said that shoulder flexion was about full compared to a very limited shoulder flexion on the left side. So what we have is we have a spine that is facing the right rather aggressively. And again, that's what magnifies our ER measures on that side. So the spine is oriented to the right. It's facing the right, so everything on the right side is going to have this really good look in ER. We're not going to get the compressive strategy in the front of the hip, and it's going to like all loosey-goosey. So what we have here, based on body mass, pelvic orientation, and such, is you probably got a wide ISA. You probably got a guy that has left post-ear compression like nobody's business that is cranking him around, and he is in the right-hand turn. So here's what we got to do. We got to undo this right hand turn.

And so chances are, to move that quickly, that size quickly, he's going to have to be really, really close to max propulsion almost at all times. Now, if that's the case, this is a position of internal rotation. He's putting a lot of force into the ground already. But based on your measures, we don't have a lot of hip IR. So where is he getting the IR coming from? So now we got to start looking at pubic orientation. All right. So based on one of your other comments here where you actually said that when you measured his shoulder external rotation as being full. You put it in quotes because the thorax was posteriorly tilted on the table. That's very, very useful. That means we had a thorax that was anteriorly tilted prior to laying him down, which is a pretty good indicator that we've got an anterior orientation of the pelvis. Now, we've got a confounding factor here that makes us question whether we've got an anterior orientation of the pelvis because you've got 80 degrees of hip external rotation. Well, how the heck do we get 80 degrees? Because what I should see with an anterior orientation of the pelvis is a loss of this hip ER. So let me give you a little hint as to what's probably happening here, especially with somebody of his size. As you're moving the hip into traditional measures of hip flexion to measure your ERs, you're getting a left lumbar rotation on the table. So as you bring him up into hip flexion, the spine flexes on the left side. That's external rotation of the spine towards that side. And that magnifies the external rotation measure. Now, how can we say this? Well, your right hip flexion doesn't have a pinching sensation like it does on the left side. So we had that pinch on the left, which tells us that hip flexion stops there. We don't have that on the right side. And you said that shoulder flexion was about full compared to a very limited shoulder flexion on the left side. So what we have is we have a spine that is facing the right rather aggressively. And again, that's what magnifies our ER measures on that side. So the spine is oriented to the right. It's facing the right, so everything on the right side is going to have this really good look in ER. We're not going to get the compressive strategy in the front of the hip, and it's going to be all loosey-goosey. So what we have here, based on body mass, pelvic orientation, and such, is you probably got a wide ISA. You probably got a guy that has left posterior compression like nobody's business that is cranking him around, and he is in the right-hand turn. So here's what we got to do. We got to undo this right hand turn.

First and foremost, we have to eliminate interference. So the things you're going to want to avoid in training this human being are no toe touch activities and no deep squatting activities. Because of the way that we measured that left hip ER, we know that we're going to get lumbar spine substitutions under those circumstances. So we don't want to use those activities because all he's going to do is give us a lumbar substitution. We're not going to recapture what we want. So what we have to do is actually teach him how to create this left hand turn. So here's the progressions that we want to talk about. Number one, we'll put him on his back. We're going to start in a supine cross connect and we're going to teach him how to start to turn left. We've got the left hip extended. We're going to use the right hip flexion to our advantage. So we bring that knee up. It's going to actually turn us to the left and start our progression. Then we roll them to the left sideline. If he's a wide ISA, this is going to be really advantageous. We get the AP expansion and we start to magnify this left-hand turn. And then finally, we're going to turn them over into prone, and we're going to finish that left-hand turn. Once we get that, we got money, because chances are we're going to get a whole bunch of our stuff back. We're going to start to see the hip IRs come back. We're going to normalize a lot of that hip ER as well. We take him into the gym, so you think about our supine cross-connect. We can convert that into a supine arm bar and eventually turn it into the rolling variation of that as well. Hopefully we can get him up to standing, and we do standing cross-connects under those circumstances to teach him how to manage gravity and hang on to his left hand turn. We can also build in a bunch of sideline, oblique sit activities, driving that right hip forward again, always magnifying the attempt to turn left. We bring him up to his feet. We do a static or stance chopping activity again. We're teaching him to continue to create the yielding action on that posterior left-hand side, get some expansion there and get him turned in into the left. Sideway sled drags to the left is going to help us emphasize that left turn as well. And if you were paying attention to last Friday's video, we're going to put him in a right handed suitcase carry now. Hopefully we've acquired hip flexion under these circumstances and we can start to load a contralateral split squat or even a Jefferson split squat under these circumstances. He's a big dude. We want to give him some load and the Jefferson is a great way to do that.

Eventually we want to start to think about dynamics. We've got to start to load some of these connective tissues and rebuild this yielding strategy. So we're going to start with some A marches. That will eventually become some variation of an A skip. And then we can think about using something a little bit more dynamic. And so we're going to have him run uphill on boxes and to capture some of this yielding strategy so we can start to introduce that. But again, by moving him up levels, because he's such a big guy, he doesn't have to absorb all that stress into the connective tissues too quickly. But eventually we want him to be able to do so. So we want him to be able to bounce across the ground a little bit. Again, he's 315 pounds. So we take this with a grain of salt as to how dynamic we're going to make this. But like a triple A hop or something like that, if you could get him to do that, that would probably be great. But again, he's a big dude, so you're going to have to kind of figure out how dynamic you're going to make these things. So Johnny, this is actually a great little chess board to work on. It demonstrates the value of the things that stand out, those coffee cups that we start with, and then we can start to see the relationships that we build from there.

And so under those circumstances, what you're going to have is a bias towards an eccentric pelvic outlet, which is going to bias you towards external rotation and an inhaled position. And so oftentimes when people are lowering themselves into a split squat or any squat for that matter, they have to be able to capture enough internal rotation or enough exhalation bias and concentric orientation of that pelvic outlet to create enough internal pressure to distribute load evenly throughout the body. So what this looks like on the pelvis is that if we're biasing you towards an inhaled position, so there's your narrow IPA there, we have an eccentrically oriented pelvic outlet, so we have a lot of expansion in this downward direction. That's why you're such a good squatter and a toe toucher. But as you're passing through this middle range in the split squat, what we have to have is we have to have this exhaled position of the pelvis which widens that IPA, nutates the sacrum, and that's what allows that concentric pelvic diaphragm to push upward. So if we get that push upward internally, it makes life a whole lot simpler, because now we don't have to rely on extremity force to try to produce all the force to lower us down and then press us back up. So what happens is, if you have to rely on that extremity force, that's where you're getting that extra load on your knees that you don't like. And the nice thing is it shows up only in your split squat, so chances are, structurally the knee is intact. So we're making the assumption that that's the situation, but if your symptoms persist, go ahead and get it checked just to rule out any structural issues. Okay, so what we want to do then is we want to reconstruct your ability to produce the exhalation strategy and capture the internal rotation position as you're passing through the bottom of the split squat. So here's what we're going to do. First, number one, we want to try to eliminate any interference that you might have. So again, we don't have a lot of information to go on, so we're going to kind of make this kind of a broad scope recommendation. Number one, you want to try to reduce any compressive strategies that you may have. And so this is anterior-posterior in the pelvis, anterior-posterior in the thorax. What we want to try to do here, Vicki, is we want to capture the yielding capabilities on the posterior aspect of the thorax and the pelvis as you move from external rotation to the internal rotation position, and then also maintain enough anterior expansion so we can actually capture that true internal rotated position at the bottom of the split squat. So what we're going to do is we're probably going to look at some gravity-reduced situations here.

So we can actually start to use what would be traditionally looked at as a glute bridge position. In this situation, you're going to be moving the hip from a traditionally flexed position to an extended position, but what I'm going to recommend that you do is you put something between your knees that you can squeeze, and that's going to help you maintain the internal rotation moment as you're lifting the pelvis from the floor. Now, here's something that's really, really important. I want to make sure that you capture this bone right here on the ground. So this is your first metatarsal head. It's the bone right behind your big toe. I want to make sure that that stays on the ground as with your heel. So you're going to be moving from this position as you initiate your glute bridge. If you don't capture this first metatarsal head on the ground, if you don't feel it on the ground as you're pushing, you're not going to be able to initiate the propulsive element as you lift off the floor in your glute bridge, and you're not going to be able to move towards internal rotation. You're going to stay into that extra rotation bias. So very important for you. You're probably also going to want to use some gravity reduced propulsive activities, much like you can see on screen right now. And these can move from supine to sideline to prone depending on where you are in this process. But these are going to start to initiate your ability to push through the ground and start to elevate the pelvic outlet into a concentric orientation so you can start to capture that internal pressure. If you move to a quadruped situation, we still keep that pelvic outlet unloaded to a degree, but we're also going to be able to start to drive some of this anterior expansion. So we're going to get some up pump handle. We're going to get some anterior expansion in the front of that pelvis. So any number of activities in quadruped from simple lazy bears to crawling activities are going to work really, really well. If you can work towards an inverted position at some point in time, what you're going to do is you're going to help maintain that anterior expansion throughout the sticking point, which is your 90 degrees of hip and shoulder flexion plus or minus about 30, because you're going to have to maintain pressure through that sticking point as you move down into the split squat and push yourself back up. Now, so let's talk about creating the overcoming action with the concentric pelvic outlet. We can use the box squat here. I love to use the box squat here because as soon as you hit the box, you're going to reduce the amount of eccentric excursion that you've got in that pelvic outlet. So the box is going to stop it. You're not going to get any further descent. So it's a great way to start to initiate your ability to capture the concentric outlet and then start to create the overcoming action.

So what you may want to do initially is use a reverse band variation of the box squat. This will reduce the differential between the rate at which your body drops and the internal organs. And so it'll help you eliminate the need for any rebound off the bottom because again, chances are you either have too much eccentric orientation or you don't control the yielding action very well. And so we're going to kind of kill two birds with one stone here with the reverse band. Progress this to a touch-and-go where you're just touching the box and getting off the box so you don't release the concentric orientation. And then I would work on an explosive concentric activity coming off the box as well with a very, very strong acceleration. So now we're coordinating the exhale strategy, the position of the pelvis, and the orientation of the pelvic outlet. Then start to increase load, but always make sure that you're maintaining your anterior and posterior expansion with your quadruped activities. As we want to work towards a feet into a split orientation, chopping activities are a great way to do this. So we can start with a side split chopping type of an activity. This actually reduces the gravitational demands on you in split stances. And then we can work towards a staggered stance, chop variation, and then progressively increase the amount of split that you're going to work into. And so again, we're lowering you down into this internal rotation orientation of the pelvis, this exhaled position of the pelvis. What you want to be able to do, Vicki, is get to half kneeling in these chopping activities without any sense of that anterior knee pressure or pain. Once you can do that, then we can start to worry about load and single leg orientations like a step-up activity where we're starting to really work on that propulsive strategy against gravity in a single leg. Then it's just time to start to work on the split stance, so you can start with some dynamic activities. You can do like a short stagger to a longer split in a static position, or you can make it dynamic with a shorter step length to start to introduce that overcoming action because remember the overcoming action is a rate dependent quality. We want stiffer connective tissues under these circumstances. Front foot elevated split squat is a great way to reintroduce your split squats that's going to reduce the load on that front leg and reduce the demands on that lead leg and hopefully take some stress off of the knee as well, as you again teach yourself to lower yourself into this internally rotated position.

Once you can capture the full range of motion and want to start loading it, begin with the contralateral load split squat. This will bias you towards capturing a bit more internal rotation at the bottom of the split squat. So, Vicki, I hope this gives you an idea of how you may progress. There are many ways to get to this situation. This is just one representation. Again, it's a little nonspecific, as you didn't provide a whole lot of information to work with, but it should get you started and working in the right direction.

What we're talking about is a combination of load, muscle position, and then some element of time or volume. We have to have sufficient volume as well. What we want to be able to do then is we want to progress the amount of weight lifted over time to promote adaptation. When we talk about muscle position, we're actually talking about the ability to concentrically orient the muscle per unit of effort. Every time you go into the gym, you want to be able to recruit more muscle fibers and these muscle fibers have to be biased towards concentric orientation to produce tension because eccentrically oriented muscle fibers do not produce tension. So we have to keep that in mind. So increased force production is one of those things that we're going to need as a representation of this increased tension. And so what this does then is it increases the intramuscular, so the pressure inside the muscle, the intramuscular pressure, and it increases the intrathoracic pressure, so that's the pressure inside of your rib cage. And so the best way to do this is to squeeze the thorax as tight as we can from both sides. We only have two sides in regards to our ability to squeeze the thorax and that's the front and the back. There's no muscles on the sides that can actually do it. If we look at the representation here, you can see that I kind of drew what we would represent as some sort of average position of a thorax. We're looking at the thorax in cross-section here. If we sliced your right through here, then we're looking down on it. If we were going to try to increase and maximize pressure, what we would need to do is we would have to have a mechanism on the backside that squeezes from the back and mechanism on the front side. So thankfully the bench press does this quite well because we actually have a fixed bench that presses into our back. And so the more load that we use, the more pressure we're gonna get from the backside. The more weight we use, the more tension I can create through the front side, so through the pec. So I get this great high pressure, high tension, high force squeeze. And so what I need then are the fixed scapula on the backside. So what that does is I take two bones, I compress it into the back of the thorax, it's very rigid, it doesn't allow an expansion and it helps me to increase the ability to compress the backside. By fixing the scapula then, as I produce force with the pecs, what the pecs are going to do is they're going to squeeze as well. And so they're going to compress the front side back into the bench. So I get smushed front to back. I spread out side to side.

And that's basically how we're going to create this intrathoracic pressure. If I were to allow the scapula to move, what I would have is an expansion on the backside of the thorax. I would still be able to concentrically orient anteriorly, but the tension would be less because the intrathoracic pressure is much less. And so this is where your less qualified lifters tend to be. They can't produce the coordinative effect that is necessary to increase the intrathoracic pressure, so they don't recruit as many muscle fibers, they don't coordinate well, they don't create as much compression, and therefore less tension, so they're not as strong and they don't have as much hypertrophy. Over time, what they do is they learn to coordinate these things and they get better and better and better over time. If you think about how a bench press shirt works, this is exactly how it functions. A bench press shirt can't lift any weight; what it does is it magnifies the compressive strategy in the lifter. So the more weight that you put on the shirt, the more compression, the more tension there is in the shirt—it squeezes me tighter. If I can ramp up that intrathoracic pressure, my force production goes up because intramuscular pressure goes up, and that's how you produce force.

Again, the more tension that you want to produce, the more hypertrophy. Just expect to give it up. So there are exceptions to the rule. We have to accept this fact that there will be somebody out there that is genetically predisposed to carry a lot of muscle mass. They're really good shape changers so they can compress when they need to compress and they can expand when they need to expand. And so they're the exceptions to the rule. And these are the people that are probably trying to sell you a program that does a certain thing. So it's kind of like those people that promote the extreme flexibility programs or whatever. And they were gifted in having this extreme flexibility capabilities so they can demonstrate it. And so they say, well, everybody should be able to do this. And I'm sorry, it just doesn't work that way. So when mom said that you can be anything that you want to be, all you have to do is want it bad enough, she was lying to you to make you feel good and you can pick up your participation trophy on the way out. So the only way that you're going to find out what you're genetically predisposed towards is to train. And so if there's something that you like to do, then you pursue it and then you monitor for change and you see what you're capable of, that's the best way to do it. So, Tarek, I hope that answers your question for you. In a nutshell, if you want to produce tension, you want to produce high-perch free, you want to produce force, the scabs aren't going to move during your bench press. They're going to move minimally. Let's put it that way. Is that fair? Okay, if they move a lot, you're not going to produce a lot of tension, and you're going to see a reduction in the outcome.

You know, some of my clients in the past have recovered pretty quickly and haven't had too many pelvic floor issues afterwards and others have had really bad issues after. So I'm curious if maybe creating like a yielding strategy on the pelvic floor to accommodate all of that upward pressure might give some women more of a tougher time to recapture that overcoming strategy post delivery.

Yeah.

That's maybe one of the main driving mechanisms of pelvic floor dysfunction.

I don't want to say main because I don't think that's fair. I think that would be a leap, but it does happen. So think about this. If you put extra weight down on the pelvis, the bones have to absorb that. And so the bones yield just like all the other connected tissues. And so it's really not that different. Now, let's put that load on there for three or four months and see what kind of adaptability that you end up with. So literally they're going to get a pelvic shape change that's associated with the load that is based on how they're yielding almost every waking moment of the day. And so one of the things they end up having trouble with is they will have essentially a shape of a pelvis that is shaped like an inhale that will bias the pelvic diaphragm. And so it's very, very difficult to create enough pressure upward. So they can't close the inlet of the pelvis like they would for an exhale. So if they can't do that, then it's a battle of downward force of the internal organs on top of something that can't push back up. And so then they have incontinence problems. They have just simple efforts of squatting or getting up out of a chair or climbing stairs and like all sorts of force related problems because they don't have that pressure mechanism back.

If we look at this from the shape change perspective, it's like, how do I make that impact? What is the deficit, which you can sort of identify when you think about it? It's just like working with a narrow ISA person that can't create the constant orientation when they jump off a box and their knees kind of go together. You're going to see similar behaviors with, like I said, squats and step ups and having them trying to get it a half kneeling is typically uncomfortable for them. Because again, they can't create the exhale position of the pelvis, which gives them the IR to comfortably be in a half kneeling position. So you'll get all sorts of like knee pain and hip impingement symptoms and things like that. So just looking at it from the shape change perspective usually buys you a lot of real estate in regards to recovery. The inlet is the inlet. The inlet has to close to create the exhaled position of the pelvis.

Okay.

Got you just making sure when the inlet is expanded. Again, that would promote the eccentric orientation, right? Just by normal, like an inhale to exhale representation of the pelvis. So these women are having trouble creating the upward pressure with the pelvic diaphragm, but I need a shape change in the pelvis for that to actually happen. And if they've been, you know, if you put weight on top of the pelvis and it sort of flattens it out and opens it up like an inhale, they can't close it. So you have to retrain that. You have to mobilize it. Like I said, that's why we use the belt for the compressive element to help close the outlet so they can pressurize inside the pelvis. And this goes for anybody, just for the record. It's like, you'll see this on people that are trying to squat. It's like, if you can't create a sufficient concentric orientation against internal forces. If I put 400 pounds in your back and you're trying to stand up from a squat, I got news for you. It's the upward pressure internally that you have to create. Otherwise you're not going up.

Hey Bill, jumping off Paul's question. Is there a way to train those pelvic muscles directly? Yes. That's part of a compound movement.

Yeah.

And how do you do that? Like Kegel exercises or something? But is it like Kegel exercises or is it something different?

Say again?

But is it like Kegel exercises or is it something different?

Okay, so Kegel exercises in isolation are not very helpful or effective because they don't respect the position of the pelvis. What you want to be able to do is create a shape change in the pelvis. We can do that through various positions. For instance, when you lie on your side, you get compression from side to side and can create an anterior-posterior diaphragm expansion. That's the advantage of being in a sidelying position. If you're having trouble creating a concentric orientation of the pelvic diaphragm, you need to first capture that position. If you've seen any of the inverted lazy bear exercises where you're in a quadruped position with your head down, that approximates what looks like a squat but is an unweighted pelvic outlet. This gives you a mechanical advantage to create the concentric orientation. That's why we put people in those positions. If I put your hips up and head down with the pelvic diaphragm unweighted and teach you to exhale in that position, I've captured the hip position I need. I can start to drive the pelvic orientation I want and get a concentrically oriented pelvic outlet based on the breathing pattern. Just like progressive resistance exercise by adding weight to the bar, all you need to do is progressively change the body's position. I slowly bring you to upright activities while continuing to drive the same strategy of exhalation and concentric orientation. Eventually, the inverted lazy bear exercise, where you're in quadruped or on your elbows with your hips up, becomes a box squat. We're going to talk about how external rotation measures get manipulated.

I think one measurement I can picture from your videos is that increased external rotation on one side usually is interpreted as that hip being farther anterior than the other due to constant re-gaiting of the posterior hip on that side. I know this is a very complicated process. That's probably best going over the intensive. Yeah, we probably do that at the intensive. But I was wondering how to determine which way the pelvis is tipped on an oblique axis when determining if reflection or straight leg raises are true. Okay, so Cameron, I think, and I'm hoping that we had a little bit of a typo there because we got a little bit of a misinterpretation as to what we're looking at with these external rotation measures. So let's do this. Let's go through how we would measure external rotation, what our expectations would be, and then how this measure can get pretty dirty as far as what is the representation and then what are the influences so we can actually determine what's really, really going on here.

So now I have these orientations where the pelvis starts to move as a single unit. And this is what we start to look for when we're talking about looking at ER measures as a diagnostic for the orientations. And so if I am anteriorly oriented, let's just say I'm doing this symmetrically, what I'm going to see is I'm going to see a loss of the external rotation measure at the hip. Because I have musculature that's above the level of the trochanter that as I tip this forward, these muscles reorient their direction of pull. They become internal rotators and they start to steal my external rotation. So right away I can just say anterior orientation reduction in external rotation. Now, if the left side, if I have a stronger compressive strategy on this left side, and that left side gets a little bit ahead of this right side, which means that the anterior orientation is going to be more on the left, I'm going to lose external rotation on that left side. If I get tipped on an oblique and what that oblique is, it's this. It's where that left side is going up and it drives me up and over the right side. That means the right side starts to lead. It gets a little bit more anterior orientation on that side and I lose external rotation on the right. So it's actually a loss of external rotation that you're going to use to diagnose this anterior orientation, whether it's a left or a right. And it's going to be typically when it's on the left side, it's going to be a little bit more of a flatter turn. When it's tipped over on the right side, it's going to be a steeper turn. It's going to be up on that oblique axis. Now, having said that, let's think this through for a second. So there are situations where you're going to get a magnified external rotation. So if I was looking at my archetype, so if I had a narrow archetype where I'm biased towards that external rotated position of the pelvis and inhale position of the pelvis, right away, that's going to give me a magnification of my external rotation, but there's another way that this external rotation magnification can occur. So think about the end range and traditional hip flexion as you're measuring. I have to have that lumbar spine turning towards the measurement side, the ipsilateral side, to get that true end range external rotation measure. But if I am anteriorly oriented, so I'm anteriorly oriented like this, so that should take away my external rotation, but when I lay people on the table and I have anterior orientation, I can get this type of a turn where the pelvis is moving as a single segment, but the lumbar spine is still free to move. And so under those circumstances, what I'm gonna start to get is this magnification of the external rotation measure. So if I have a spine that is facing the right and I've got an orientation of the pelvis that is turned strongly to the right and I take somebody into a hip flexion measure and they turn towards that hip flexion as I measure it, I can get a magnification of my external rotation. So when I try to turn someone into external rotation and the pelvis turns towards me, what I'm going to get is this magnification of external rotation. So this is where you're going to get a lot of these measures of 80 degrees, sometimes up to 90 degrees of hip external rotation, which is associated with the turn of the spine, even though the pelvis is anteriorly oriented.

Spine that is facing the right and I've got an orientation of the pelvis that is turned strongly to the right and I take somebody into a hip flexion measure and they turn towards that hip flexion as I measure it I can get a magnification of my ER. So when I try to turn someone into extra rotation and the pelvis turns towards me what I'm going to get is this magnification of extra rotation. So this is where you're going to get a lot of these measures of 80 degrees, sometimes up to 90 degrees of hip ER, which is associated with the turn of the spine, even though the pelvis is anteriorly oriented. Firm what's going on on the table. So we have imprecision that we're dealing with, we have uncertainty that we're dealing with, but we do have checks and balances. So the checks and balances are looking at all of your external rotation measures. So remember that flexion, abduction and traditional extra rotation measures are all ER. I have to have all three of those go through, go to normal measurement to assure that I have normal expansion capabilities where I need expansion to get my ERs. If one of those is in deficit, then all three are going to be in deficit. So even though two might look like they're normal and one is in deficit, all three are in deficit. I just have a compensatory strategy that is allowing that measure to look like it is full on the table. I also have my iterations to fall back on so now I have the same side hip and the same side shoulder that I can compare to and I can assure that I'm measuring correctly. So this is how you start to refine your measurements and we take these dirty imprecise measurements and we make them more precise and allows us to intervene more effectively. You're still going to be wrong sometimes just accept that fact. Our goal is to get better at this stuff so we can narrow the probabilities and get more effective with the interventions that we choose and then gain success along the way. So now I'm going to show you a clip from yesterday's Coffee and Coaches conference call where Andrew helped us out and he actually went through a little bit of a demo where we can actually feel how the spine provides this compensatory strategy for internal and external rotation of the hip. So watch through that and then we'll be right back. So let's talk about the opposing extreme. Okay. People that rely on lumbar flexion for their ER show 80, 90 degrees of hip external rotation at 90 degrees where we would traditionally measure. So that's literally the exact opposite of what you're describing. So that's how you know you got rollback on the table. Like when you were measuring somebody, you bring them up to 90 degrees of traditional hip flexion and you're doing your ERIR and you go, wow, look at the ER on this guy. That's somebody that's got a spine that's actually turning towards you as you're measuring that hip ER. You will always have external rotation and internal rotation. It just might not be where you want it to be. So when we measure at the hips and things like that, and you see the extreme representation that like we're just talking about, that's usually coming from somewhere else that it's changing the orientation that allows the extreme to be demonstrated where you would traditionally measure. So that is something that you have to pay attention to. That's why orientation is so important to understand as to how it influences the measurement outcome. People blame things like laxity, Right? They say, oh, you have a lax whatever. And the reality is it's just on pointing the socket in a direction where those constraints that normally would restrict motion don't matter anymore. It's like untwisting a twisted tail. Right? And so it becomes loose, if you will.

When measuring somebody, bring them up to 90 degrees of traditional hip flexion and you're doing your ER/IR and you observe excessive ER, that indicates a spine turning towards you as you measure that hip ER. You will always have external rotation and internal rotation; it just might not be where you want it to be. When we measure at the hips and see extreme representation like we're discussing, that usually comes from somewhere else—changing the orientation that allows the extreme to be demonstrated where you would traditionally measure. That's something you must pay attention to. Understanding orientation is crucial for interpreting measurement outcomes. People blame things like laxity, saying, 'Oh, you have a lax whatever.' The reality is it's just the hip socket being oriented in a direction where constraints that normally restrict motion don't matter anymore. It's like untwisting a twisted tail—it becomes loose, if you will.

Right. I'm understanding correctly, you're saying oftentimes there's a substitution occurring at the spine in the person with excessive external rotation, right? And then the internal rotation, the excessive internal rotation would be more like just because of the way the hip socket is oriented, there's just more IR available at that 90 degrees.

Okay? So just pay attention to those.