Good morning. Happy Tuesday. I have neuro coffee in hand and it is perfect. All right. Digging into a very busy Tuesday. We're going to go straight into today's Q&A. This is with Alex. Alex brings up a really good question. I fear that it's going to be one of those things that there's going to be like six people out there that are really, really interested in this. And everybody's going, oh, that's kind of cool. But anyway, I thought it was a great question. And it was in regards to the influence of how the vestibular system is affected based on positions, orientations, and such shape changes, if you will. One of the things Alex was observing is he's able to see some of these distorted representations in the cranium and mandible upper cervical spine. And it's like, well, what does that do to the vestibular system? And so you have the vestibular apparatus as part of the temporal bones. And so if we do have any shape change that involves upper cervical spine, mandible, cranium, you're going to get a change in the orientation of the vestibular apparatus. And so does that affect us? Absolutely it does. The question mark is how much? So if we have adaptations that influence the system fuel to a long term degree, then maybe the influence increases to a certain degree. But this is also positional. And I think I mentioned this in the video. If you look at a comparison between upright postures versus say a supine posture, you have a reduction in the vestibular influence in the supine position and increasing the dependence on vision for orientation. So context really matters here. But we also, as I said, have to consider the fact that we've got shape changes and positions that are also going to be an influence. So Alex, thank you for this question, truly appreciate it. It's gonna help a lot of people. Everybody have an outstanding Tuesday, and I'll see you tomorrow.

Morning. I've been trying to dive into some cranial stuff lately and figured out that positioning. Then I had a patient come in the other day whose ears were very different in position during a head-down forward scenario. He was young and had no particular issues, but it got me wondering what happens to the vestibular apparatus and different systems with different positioning like that, and how much that would affect them.

Greetings. So that's me waking up as I say that. I've been trying to dive into some cranial stuff lately and figured out that positioning. And then I had an opinion come in the other day whose ears were very different in position during a downward forward scenario. Well, he was young. He had no particular issues, but it got me wondering what happens to a particular apparatus in different systems with different positioning like that. And how much that would affect that.

So that's me waking up as I say that. I've been trying to dive into some cranial stuff lately and figured out that positioning. Then I had an opinion come in the other day whose ears were very different in position during a head-down forward scenario. He was young with no particular issues, but it got me wondering what happens to the particular apparatus and different systems with different positioning like that, and how much that would affect those systems.

You were cutting in and out just a little bit. You were cutting in and out a little bit. So I got like every other word. So, um, no, I just need to repeat the part after the ear thing.

Okay.

So I got like every other word. So, no, I just need you to repeat the part after the ear thing.

How does this show the problem's effect with the vestibular system?

Okay. So do you know how the vestibular system is organized as far as its orientation? You do understand. Like the semi-circular canals. They kind of look like this and they're on the horizontal plane. So you have the one that goes this way, the one that goes this way, and the one that goes this way. If we visualize this, that gives us a decent representation. And so if I have an alteration of the orientation of the temporal bones, because the semicircular canals are anchored in the temporal bones, I get a twist in the temporal bones. Guess what I get? I get a reorientation of the vestibular system. So instead of having this nice, even orientation where the canals move relative to one another almost evenly, I have a twisted orientation. Under normal circumstances, the system would move in a balanced manner, right? But now you have something that's distorted. So you will have a different reference point for midline. Think about that. The semicircular canals, if you look down upon them, kind of look like this, forming almost a square relationship to one another. If I twist and turn the temporal bones, it turns the midline—your perceived midline. Whichever way you're going, that's the direction it would go. But if you have a cranial bias under most circumstances, you're going to end up very much like a pelvis: it will go forward and left, moving to the right. If you're narrow, it's going to tip up on the oblique and move forward, just like you would see in the two archetypes. But as I said, it gives you a perception of where your middle is, which is one of the reasons why you see these people make adjustments in their center of gravity. You get a reorientation of your vision. So you asked a question about eyes last time. Think about changing the socket orientation and then changing your globe relative to the socket to keep your eyes fixed and useful in binocular vision. So if I have a position sense of where my midline is, I can also get a shift in the midline of your vision. The intersection of where your binocular vision lines up is actually kind of crooked too. So where your IR intersects, in regards to your vision—yeah, same kind of thing. There's definitely stuff going on there.

Okay.

Okay. So where your IR intersects, right? In regards to your vision, yeah, same kind of thing. So there's definitely stuff going on there.

So that will just position sense, but also where you're most comfortable putting force into the ground.

And there you go, absolutely. Little fun fact: this was in the Journal of Vision, I think in 2016. Don't quote me on the date, I'm not really sure. But they were looking at what sensory input was most important depending on body position. They looked at supine, sitting, and standing positions. As you become more upright, the vestibular system becomes more influential and reduces the demand on vision. In non-upright positions, vision tends to be more predominant. So that's a little fun fact. One of the reasons for taking people off their feet and reorienting gravity is for this purpose. When people are upright, the vestibular system is a bigger factor. If we can reorient people and influence shape change before bringing them to their feet, we're more likely to succeed, especially in more severe cases. Good morning. Happy Thursday. I have my neural coffee in hand, and it is perfect. Hi, sir.

All right. I wanted to ask you, I was thinking about the narrows and their ability to concentrically orient their pelvic outlet. Like the anterior pelvic outlet. Because my end game narrows, when they're squatting, their strategy is top down. I'm now thinking and trying a few different things in between, like with the box squat with full unload and tap and go. And I'm thinking because they have a tendency to compress from top down, as they're lowering to the box, they're already kind of compressing top down to stay upright to lower down slowly. With some people, I see it visually looks better if I fully unload them and then use that response to help them actually let go of their strategy, which is to compress top down and just relax the pelvic floor and then exhale and create pressure from bottom up versus just keeping them in their compensatory strategy when they're compressing top down and not letting them fully unload on the box. I feel like they cannot shift the pressures if I don't let them fully unload on the box.

Yeah, but keep in mind that you've got a connective tissue behavior going on here. So the box is going to stop the outlet wherever the box is, right? Yeah. All right. And then if you reload onto the box, you've got a yield, you've got an energy storage element there, depending on how long you leave on the box, they're getting a recoil under that circumstance as well. You superimpose the forceful exhale as they leave the box. Now you've ramped up to concentric orientation and you get even more of the energy release available to you because they're sort of stiffening the connect, or yeah, they're stiffening the connector tissues as they're coming off the box.

All right. I got a yield.

So the box is going to stop the outlet wherever the box is, right? All right. And if you reload onto the box, you've got a yield, you've got an energy storage element there, depending on how long you leave them on the box, they're getting a recoil under that circumstance as well. If you superimpose the forceful exhale as they leave the box, now you've ramped up to concentric orientation and you get even more of the energy release available to you because they're sort of stiffening the connective tissues as they're coming off the box.

All right. And if I, if I just do the tap and go, I keep the pelvic outlet concentric.

There's less differential in the storage and release of energy in the connective tissues.

All right. And if I don't unload them and especially the pile of people would anteriorly orient right at the point where they should tap and go.

That might be a useful strategy because then you're seeing where they have to apply the greatest amount of force and then that might be where you want to train them to not have to use the orientation so they can manage the pressures. All right, that would be associated with the force.

Yeah. Yeah.

All right.

Yeah. Yeah. Because I was seeing better results with especially these end-game people by fully unloading them. But I know my end goal is to tap and go them, but they have to control it first and be able to—That's what the box is for.

So the box helps you control the joint position. That's the muscle orientation, okay? The behavior on the box is going to influence the connective tissue behavior. So it's important that you differentiate between the two.

Yeah. And especially the end game people are like, they have a hard time reorienting the muscle activity. So that's why I would help them with the tap and go, just not to keep the pressures pushing them down to unload and recall.

If you're having trouble with muscle orientation and joint position, it's best to start them on the box and have them stand up first. Because if you make them start at the top and they're all tensed up and they've got to get to the box and they want to please you so they want to get to the target, they might be too tense and then they're stuck using an incorrect orientation to get to the box. Whereas you can set them up on the box, okay? Teach them the joint position, stand up first, then you can go top to bottom, back to the top. But I would start them at the bottom and go up.

All right, understood.

If you're making them start at the top and they're all tensed up and they have to get to the box, they want to please you so they want to get to the target. You might be too tense and then they're stuck using an incorrect orientation to get to the box. Whereas you can set them up on the box, teach them the joint position, stand up first, then you can go top to bottom, back to the top. But I would start them at the bottom and go up.

All right, understood. And after that, I was playing with some, let's say I'm seated on the box as they can go up and down and back up. If I want to add like the duration component of it, could I make them lift their legs up and as they contact the ground like feet up and as they contact the ground, I'm getting that distal to proximal IR. So I'm basically pressurizing from bottom up and just use the feet contact to make the duration as fast as possible.