The Bill Hartman Podcast for The 16% Season 9 Number 3 Podcast
So what we don't want to do is turn people like a refrigerator when we're trying to reestablish movement. Good morning. Happy Monday. I have neural coffee in hand and it is perfect. All right. This is going to be a busy week. The intense 14 starts this week. It's actually on Thursday. So I'm looking forward to that. So let's dig right into today's Q&A. This is with Charlie. Charlie's fairly new. I saw him sneaking in on one of the coffee and coaches kind of what's called last week. So he's had a few exposures and he's figuring some stuff out on his own, which is great. But he asked some really good foundational questions in this Q&A that I think a lot of people are going to benefit from. We touched on foundational archetypes. We touched on rate oblique orientation, dirty measures on the table. So we talked a little bit about that, about how these things can change using the table as your constraint and point of reference. So very important call probably for a lot of people. I think you'll benefit. If you'd like to participate in a 15-minute consultation, please go to askbillhartman at gmail.com, askbillhartman at gmail.com, put 15-minute consultation in the subject line, and please include your question in the email. And we will arrange that at our mutual convenience. Everybody have an outstanding Monday, happy intensive week, and I'll see you tomorrow. All right, Charlie, we got the video rolling. The clock has started. What is your question?
foundational movementreestablishing movementrate oblique orientationtable as constraintassessment
Bill, I don't know if you have that chessboard that I emailed through. I do. I was wondering if I could just go through what my interpretation was and you could maybe guide me and see if I was on the right track.
assessmentinterpretationguidance
And I'll put it up here in the video for everybody to see.
Okay. I was wondering if I could just go through what my interpretation was and you could maybe guide me and see if I was on the right track.
postural assessmentmovement analysiscompensation patterns
Yeah, let's go. Yeah.
So it's just starting off with a wide infraternal angle and an exhaled axial skeleton with bias toward reductions in flexion, abduction, and external rotation across the limbs. Regarding the pelvis, we've got a restriction in internal rotation as well. I think I understand that the common compensation is a concentric orientation of the posterior lower musculature at the pelvis. That's how I understand that.
infraternal angleaxial skeleton mechanicspelvis mobilitycompensation strategiesinternal rotation restriction
That's going to limit the early flexion measures. It's actually representative of the posterior lower compression limits the ER and the flexion in front of you. It moves extra rotation from in front of you out to the side. That's what that posterior lower represents.
hip mechanicsmovement compensationrotational strategy
Okay yeah so you're getting more ER space and you're using up the IR space that you have.
hip mechanicsrotation strategies
It's out there. It's actually less ER space, so you don't have any ER space in front of you—it's moved out to the side, so it's moved away from midline. That's what you want to understand about that. It's the anterior compressive strategy that's going to limit the internal rotation. So what it's showing you is that you've got a tremendous amount of A to P. So when you get that posterior lower compressive strategy, the thing that happened just prior to that is the anterior compressive strategy. That's why we talk about these things in a little bit of a sequence because it allows us to see how these superficial strategies are layered upon the axial skeleton. Okay. So don't misrepresent what they're showing you. Okay. Yep. So when you have posterior lower compressive strategy, you lose early traditional hip flexion. If we want to call it that, you're going to lose the straight leg raise is going to be limited. And then you're going to lose IR not because of the posterior compressive strategy, but because of what just happened prior to that, which would be the anterior compression. Okay. Okay. There's a sequence of events that those things represent, but it tells us where you are in space. That's the important thing. Okay.
anterior compressionposterior lower compressionsuperficial strategiesaxial skeletonhip mechanics
Okay. So is that an extra step between the inhalation bias strategy that comes with the exhalation bias on the
superficial strategiesinhalation biasexhalation bias
It's not extra. It's just part of the sequential layering of superficial strategies on top of the axial skeleton. There is a typical representation of the archetypes, and I think you understand that. What you have to understand is that the superficial strategies are going to appear in a relatively specific sequence of events based on where your center of gravity is over your feet. When you see posterior lower compression, your early flexion measures are very limited. So your hip flexion is limited, your straight leg raise is limited. So right away you go, 'uh-oh, we got a posterior lower compressive strategy.' If you have a posterior lower compressive strategy, you have all the other superficial strategies in play already because the last one to get layered on is posterior lower. Your assumption, so in your email, your assumption that this chessboard represents a right oblique representation is correct. So this is somebody that's tipping on a much more oblique axis as they are turning. That would be represented by your ER measures. When you see the deficit of ER on the right side, greater than the left side, you can make the assumption that you're on the right oblique. When you see the limitation of straight leg raise and early hip flexion, that means you're pushed forward. Tipped on the right oblique first, then got pushed farther forward. So the center of gravity is way over to the right and way forward.
superficial strategiesaxial skeletonoblique axisposterior lower compressive strategyER
Yeah, so is that oblique axis shift something that comes really early in the progression?
oblique axispostural strategiesprogression
For a wide ISA, yes.
intra-abdominal pressurepostural strategies
OK. Yeah. OK, thanks. So one thing I've been struggling to understand is the increase of external rotation at the shoulder. From my research this afternoon, going through videos, I got a clue that it could have been the anterior compressive strategy pulling the sternum down.
shoulder external rotationanterior compressive strategysternal mechanics
Okay, so that would be a restriction of internal rotation of the shoulder if the scapula is pushed down. Do this for me. Put your arm up in like a 90 degree angle there. There you go, perfect. Now, don't change the shoulder orientation, just bend backwards. Did your hand go back too?
scapular mechanicsshoulder rotationrespirationthoracic spine movement
Yeah, yeah.
So does that make it look like there's more external rotation?
shoulder mechanicsexternal rotationassessment
Yep. Okay. Was it more external rotation in the shoulder? Not relative.
shoulder external rotationjoint mobility assessmentbiomechanical constraints
No, that is correct. So when you see a magnification, your ERs match in your shoulder and your hip, which means you should know already before you even measure somebody. It's like I know that unless there's a constraint problem, like if you tore a labrum or something like that, then that changes the rules a little bit because the constraints have changed. But when you're measuring somebody, if you measure an ER, you should have a similar limitation in ER in the epsilon extremity. But it looks like you don't. It looks like, wow, we've got a lot, especially on the one side, it looks like, wow, we've got a lot of ER, don't we? But the reality is, if you're anteriorly oriented, and I lay you on a table, so the table becomes a constraint. So if you lay on the table and then you roll backwards on the table as many people do, you don't see the restriction of ER in the table measure, right? But the magnification tells us that chances are you felt backwards on the table, assuming all the constraints are intact. Because you do have situations where you'll have like this one outlier measure, like everything matches. And then you see this like crazy kind of like an external rotation that'll show up, like cricket bowlers, baseball pitchers and stuff like that. They have a lot of rollback on the table. Like they all rollback on the table, which gives them a truly magnified ER representation. They get twists and bones that magnify the ER. So there's a lot of stuff that you kind of need to know under those circumstances, but typically what you're looking at here is you're looking at a layback on the table. The layback is actually more in this situation on the right side, correct? If we saw more on the right, yeah. We saw more on the right than we did on the left, because when you're laying on the table, the left side of your body is probably not touching the table relative to the right side. So you're kind of measuring like this.
shoulder external rotationhip external rotationmagnification effectconstraint problemsmeasurement techniques
Uh-huh.
Okay.
Get it?
Yeah, I do. I do.
Yeah. So it's sneaky. But if you understand what the possibilities are, then it helps you get out your chest boards, right? Okay. Yeah. As I say, all measurements are dirty, which means that the whole body is represented in each of your measures. So let me give you another instance. When you look at the shoulder internal rotation measure on the left side, right? You got a pretty decent measure there compared to what your left hip was representing. The left hip IR is only about five, and you get 60 IR on the shoulder, and you go, what's going on there? Well, if you're laying on the table and you're twisted this way, guess what? Your neck is turning this way, right? Your lower cervical spine is going this way. That's going to magnify your internal rotation measurement of your shoulder because you're not measuring just shoulder motion. You're measuring internal rotation. And so if that spine is turning away, that magnifies your internal rotation. So that's how you identify these things.
measurement errorshoulder internal rotationcervical spine influencebiomechanical compensationsassessment validity
And the hip is easier. It's more of a true representation because it's harder to cheat. What's heavier?
measurement accuracyjoint assessmenthip mechanics
Yeah.
So always remember that you're measuring in reference to the table. It's like the arm really doesn't weigh as much as the leg does. So if you had like a big, gigantic arm on one side and a normal sized arm on the other side, chances are you try to internally rotate it with a big, giant arm. It wouldn't have turned the spine nearly as much. And so you would have a measurement that would be more representative of a limitation. So again, it's like what's moving as you perform these measures. When you bring the leg up over the hip and it pushes the hip into the table, you'll get a true representation of the limitation of internal rotation. The arm being lighter, everything just kind of turns with it. That's how you got to discern these things. Whenever you're measuring a limb, you're measuring the entire body moving. If the question is how much does the hip move? How much does one side of the pelvis move? How much does the spine move as you're performing these measures? That's how we figure this stuff out.
shoulder measurementhip measurementbody mechanicsspinal compensationmovement assessment
I think so. So with the weight shifted forward anteriorly, is that representative of an anterior pelvic orientation? What's that?
pelvic orientationanterior pelvic tilthip measurement
Well, you have an anterior orientation, for sure, based on your measures, right? So your HIPPR measures give you that piece of information. So you know that you're forward. The lack of IR, the limited straight leg raise, again, that's a push forward. So you're moving towards a later representation of propulsion. So you're farther forward. You're trying to get past middle, trying to get into a late representation there. That's what this is.
anterior pelvic tiltHIPPR assessmentstraight leg raisepropulsion phase
So the first step would be to bring that back.
pelvic orientationpostural correctionbiomechanics