Good morning. Happy Monday. I have neural coffee in hand and it is perfect. All right. Man, busy week coming up. Busy day today. So we're going to dig straight into this Q&A. This was Alex. And Alex was looking at some of the anatomical iterations that we talk about and some of the connected tissue behaviors, especially with some of the bony relationships and So he's looking at something in the lower extremity relative to the pelvis. And we get to talking about how we'll see bony twists and torsions and things like that. And we get to the pelvis. And we talked about a representation of how the sacrum is going to behave, especially in the sort of like an early propulsive representation, where you've got some distal tibial IR relative to the proximal tibial ER. We're going to see a similar representation in the pelvis. This is going to be our typical early representation. Now plastic model doesn't bend like a real pelvis so what we want to consider though is that as we're looking at the connected tissue behaviors especially this the yielding action that we're going to see um if we were stepping forward with the right side of the pelvis right foot lands we've got an apex that is relatively fixed and then as we see this this er of the enominant it's actually going to take the the sequel base with it. So we have the sequel base moving back on this Ilium as we have the ER denominator. The thing we want to recognize is that this is going to be a much more externally rotated representation here relative to the apex of the sacred. So that's what we're talking about. And this is just part of the normal connected tissue behaviors, but it is useful in understanding when we have people that are biased in certain aspects of propulsion that becomes interference. We also want to make sure that we're addressing this from an iterative standpoint. A lot of your activities that you choose are going to address this, but in certain cases where maybe we have a local change that is not taking place, we might need to use a local or a a focal strategy which would be a little more effective from a regional perspective so we might have to do something in this specific the powers when we have to do something that would be specific at the tibia in this circumstance so alex thank you so much for asking this question certainly will be helpful for a lot of people everybody have an outstanding monday and i'll see you tomorrow alex do we have another mandible question

Well, it sounds like you have the same answer for everything. So sorry. What's the sign? So when you have a twist in the distal tibia, like an IR twist, I'm wondering how that's represented in the sacrum. And I'm wondering if that's like some kind of like concentric muscle activity posteriorly that kind of like, I don't know, almost folds it a little bit in. That's sort of what happens.

I can stop doing these calls. It's just getting way too complicated.

What's the sign? So when you have a twist in the distal tibia, like an IR twist, I'm wondering how that's represented in the sacrum. And I'm wondering if that's like some kind of like concentric muscle activity posteriorly that kind of like, I don't know, almost folds it a little bit in. That's sort of what happens.

Sort of. I mean, so the hard part here is the amount of twist that you would see in the sacrum is it's much more difficult to see that. But if you understand the bony position of ilium relative to the sacrum, you can kind of see how the sacrum would follow into the ER representation and then hold the distal position.

So fix the apex. Okay.

Then turn the ilium into the ER position, take the sacral base with it. But don't let the apex turn. And then you start to see the twist through the sacrum.

And that's the IR twist.

Yes, sir. Relatively speaking. Yeah. So the sacrum's always been taught like this, but the reality is it's not.

That kind of a thing. Gotcha.

So that's actually, I think it's the opposite of what I was thinking in my head. If the ilium is moving toward ER, how does that end up with the IR twist of like the distal tibia?

Okay. Do you have your pelvis?

Like a physical pelvis model? Yes.

Is it close by where you could just reach over and grab it?

It's upstairs.

Don't worry about it. All right. You understand how the relative motion would occur between the ilium and the sacrum if I was moving the ilium into its ER representation? Yeah. Okay. You understand that there is a ligamentous structure on the anterior aspect of that sacroiliac joint.

Yeah.

Okay. I'm going to hold the sacrum still. Yeah. And I'm going to move the ilium into the ER representation. I'm going to hold on to the apex. I'm going to hold on to the apex with my, we're going to do the right side. I'm going to hold the apex of the sacrum with my left hand. So it cannot move. And then I'm going to do that to the, to the, uh, ilium into ER. And it's going to try to pull that iliac base with it. It's going to create a bend that turns outward. And I'm going to fix this into IR relative. Do you see the picture? Yeah. So it looks like that.

Yeah.

Okay. And I'm going to move the ilium into the ER representation. I'm going to hold on to the apex. I'm going to hold on to the apex with my left hand. We're going to do the right side. I'm going to hold the apex of the sacrum with my left hand so it cannot move. And then I'm going to do that to the ilium into ER. It's going to try to pull that iliac base with it. It's going to create a bend that turns outward. And I'm going to fix this into IR relative. Do you see the tilt? Yeah. So it looks like that.

So the apex is the most relatively IR part of it. So in terms of like some concentric muscle activity, like so I'm asking this question is I'm thinking like you see someone with back pain and walk-ins and they have like crazy twisted dyslotymia and just like an easy way to access like an eccentric orientation to just make them feel better. Yeah, we're in that situation where I'd be going, like if I want to do some just general manual like to be closer to the apex.

Relative to the proximal, relative to the base in this circumstance, yes.

Yeah.

So in terms of concentric muscle activity, I'm asking this question because I'm thinking about someone with back pain who walks in with crazy dysautonomia and twisted posture. An easy way to access an eccentric orientation to make them feel better would be ideal. In that situation, I would be considering a manual approach closer to the apex.

What do we call the posterior lower compressive strategy they're younger?

the posterior lower compressive strategy?

Well, okay, what representation do they typically come in with? Are they everybody stuck in early representation where they're okay? So when you're in a late representation, and I have concentric orientation of posterior lower, what do you think's holding the sacrum still so it doesn't move? Then I push the left ilium forward against the sacrum base. Then I twist the sacrum base into an ER representation relative to the IR representation of the apex of sacrum. I'm talking about the same thing again, Alex. Why do I always have to answer the same question for you? That's all I'm asking.

What can I do to answer?

Do you see it though? Do you see how it's made, if you will?

Yeah, yeah, yeah.