So last week we talked about plantar fasciitis. Well, let's talk about its kissing cousin, Achilles tendon pain. Good morning. Happy Monday. I have neural coffee in hand and it is perfect. All right, solid weekend, great sleep, feeling good. Let's dig into Monday's Q&A. This is going to be about some Achilles tendon pain, which is a close cousin to our friend plantar fasciitis that we talked about last week. So again, a nice little lead in for the week from John. And John says, thanks again for all the great content. You're welcome, John. I've been seeing a lot of individuals with Achilles pain as of late in different foot presentations that are close to or farther away from max propulsion. Calf raising is often used with individuals to influence tendon properties, however, it seems that this could create interference with someone who is biased towards late propulsion. This is actually a really good thought, John, and I think I'm going to have an answer for you. How does your strategy change depending on the individual's foot type, and are there any other considerations for Achilles tendon pain? And I think that if we look at this from a little bit of a wide perspective first and foremost, we're going to get a really good representation of why this thing perpetuates in the first place. And then if we can understand that, I think we come up with a really good solution and we can rely on some of the useful research that is available to us. So let's think about what would have to happen under these circumstances. So to get any change in a connective tissue property, we have to say, well, where does this nutrition come from? And so we're going to say, well, under most circumstances, it's going to come from that bony side. And so if we look at the emphasis where the tendon attaches to the bone under most of these circumstances, we get a pretty significant bony change there. And so what this leads us to believe then is that we do have a situation where there's a high tension, it's prolonged tension and therefore we're going to get a reduction in blood flow. And so this is going to cause us to create some measure of a breakdown in the connective tissues. So the way that I look at this, John, is I'm going to break out my silly putty here for a sec. And so we think about, if I just put this prolonged tension on my silly putty, and I end up with something that looks kinda like that, and I'll show you the cross section here. If I snap this sucker, you're gonna see this middle part of the silly putty getting compressed, and the tendon behaves kinda the same way. So whether we're talking about patellar tendon or Achilles tendon, it doesn't really matter under those circumstances.

But if we have this prolonged compressive strategy, then we're probably going to see this tendon change. If you look at the research and you look at the tendon itself where there is this degenerative change, you're going to see this proliferation of the proteoglycan content and water content around that area. So what that means is that the collagen is increasing around it, the water content increases, and this actually creates a compressive strategy. So it stands to reason that our solution is going to be restoring some measure of expansion. And so what we want to look at then is like, well, what is the situation that's creating this? You mentioned two-foot types in your question, one that's really close to max propulsion and then one that's in really late. And so you think that, well, we've got two-foot types. How can this possibly be? What we want to look at is, what is the commonality between the two here? And under these circumstances, what we're going to find in most situations is that in both situations, we're going to have an overcoming action in the connective tissue. So what we have are connective tissues that are loaded at a higher rate, and therefore they're going to behave in a certain way. And so we think about like a court athlete that's going to live really, really close to max propulsion or going to have people that are pushed all the way forward into this late, late propulsive strategy. And so their center of gravity is going to be shifted forward. And if we look at a couple of representations of this, we can actually see the difference in the appearance of the achilles. So if I have somebody that's got a center of gravity that shifted way, way forward, my expectation would be that it's going to be like the silly putty example where I'm going to have a lot of tension on that achilles. And so if I pull it long, it's going to appear a little bit thinner than the side that would be less loaded in this anterior center of gravity. And sure enough, we do see these things arise. And so we can actually see the difference. If you're not sure, I got a little before and after here, actually it's probably right there, that you can see this is the same person and you can see the before and the after. You can actually see the entire orientation of lower extremity change. You can see the foot change, especially if you look at the calcaneus where in the early stages you can see it looks like they're trying to lift that calcaneus off the ground because you can see the roundness of it where it doesn't have the pressure through the calcaneus and then later on as we recaptured this posterior orientation and able to hold the center of gravity back, we get more loading through the calcaneus, and then we get that sort of restoration of the shape of the tendon here.

So what we want to think about then, John, is how does this type of arise? Well, we've got a center of gravity problem, so we've got, I think, axial skeleton. So we got to address that first. We got to make sure that we have enough shape change in the axial skeleton so we can move through this propulsive phase without biasing ourselves towards this overcoming action. So when we talk about this, what we're going to look at is we got to recapture some key performance indicators up into the hip. So we want our non-compensatory internal and external rotations. We want heel to butt flexion at the knee. And what this is for is to make sure that we've got tibial internal rotation. If we don't get the heel to the butt, then we know that we probably still have some orientation into external rotation at that proximal tibia. And so under many circumstances, especially in this late propulsive type of foot, that's what we're gonna see is this ER at the tibia. For those that are more biased towards that flatter arch, that's looking for internal rotation, so we gotta make sure that we recapture that. So again, so we got ER and IR at the hip, we got the tibial rotation back to normal, and then you wanna think about how can I be assured that I can move through this propulsive strategy without the overcoming action, and so we're gonna use sort of like the old knee to the wall test if you want, so flat foot, You want to be able to get the foot about three to four inches away from the wall where they can get knee contact and maintain the calcaneus on the ground. You may have to use some manual techniques under these circumstances to restore some of this tibial stuff, at least to buy you a window of opportunity so you might have to manually rotate that tibia at the knee to recapture the internal rotation. When we talk about activities, so we're going to start to move people back away from these later propulsive strategies. And so this is your heels elevated squats, your front foot heel elevated split squats for those people that are in late. So we want to bring them all the way back to early. If I have somebody that's got the flatter arch, I'm going to one, make sure that I do something to control the position of the arch. So remember that the low arch, allows that tibia to translate forward very, very quickly. I need to slow that down to slow the rate of loading onto those tissues. And so then this might be a shoe type or this might be an orthotic solution.

And then I'm going to use things like my front foot elevated split squat where I've got the flat foot where I'm teaching the tibia to translate over the foot with the control of the arch. Now let's talk about the tendon in and of itself. So here's where we get to rely on some useful research and I would point you towards Keith Barr, B-A-A-R and Jill Cook. They've got the most prominent research right now. We're going to use heavy static loads with extended durations and so we'll start with like a 10-second load on the tendon build up to about 30 seconds. And you want a total accumulation of about five to 10 minutes of loading. So you're going to build this up over time. So this is a number of weeks and months, et cetera. But I think the strategy that we want to use here in reference to your question is we want to make sure that we're using a yielding action to promote the stress relaxation of the tendon. So over time, as we hold these static positions, it's almost like a telescoping of the tendon where the superficial layers slowly elongate where we can start to expose the deeper part of the tendon that's most likely affected. And so again, we wanna use this yielding action versus something that would be overcoming. So when we talk about like a standing calf raise or something like that, we wanna make sure that we're using the yielding position. So we're not pushing up against the immovable resistance to create an overcoming action. That's a mistake that I've actually made in the past, is we wanna make sure that we're using a yielding static position. One of the easiest ways to do this is to pull out the old 1985 muscle and fitness seated calf raise machine. It's just an easy way to create the load because we need 80% plus of one repetition maximum loads and so the seated calf raise is money under these circumstances. So John, I hope that leads you in a direction and gives you some ideas in regards to how to deal with this. I think the rules apply across the board. Whenever we're talking about these peripheral connected tissues and how they get loaded, I think they're just under a lot of concentric orientation with overcoming actions, with the commonality being the overcoming action, because we can obviously have eccentric orientation and overcoming as well.

Mike Robertson and I recently posted the first part of a tutorial on superimpressing, so it just seemed like bench press is very prominent in my mind right now, so we're going to go with it today and we're going to attack two questions specifically about this. So the first one comes from Norman. And Norman says, in my past coaching experience, I've accidentally come across a strategy for helping power lifters lock out better for those who stalled the lock out. The strategy was to cue a forceful exhalation. Is this because the exhalation aspires towards extension and internal rotation, according to your model? And does that cue in the bench press allow you to capture that extension and internal rotation? Can you please expand on this thought? So I think you're on point here, Norman. First things first, let me point you towards, there's a couple videos on YouTube that you'll find in regards to lockout strategies that may also be of interest to you. So please go there. One of the things we want to recognize about lifting heavy things in all situations is that we are looking at an exhalation bias. So when we look at capturing range of motion, we're going to use inhalation, expansion, eccentric orientation, all those concepts are geared towards us acquiring positions. But when it comes to force production, it is exhalation, compression, concentric orientation. And again, this is where all the force production lies. And we need both, obviously, to execute any exercise. So we have some form of excursion of the joints that we have to move through to execute a bench press, but we want to minimize the eccentric orientation because eccentrically oriented muscle doesn't have tension on it. It doesn't produce force. And so, again, when we're looking at these strategies across the board, when we're talking straight training, we want to maximize concentric orientation, exhalation, compression. So if we consider the setup of the bench press, everything is designed for maximizing compression. So we talked about the arch position. So that's a posterior compressive strategy that we're using to minimize any form of expansion. We've got a scapular position that is compressing two bones against the back of the thorax so it cannot expand. The bench in and of itself, the pressure under the bench, enhances all of those things. We want to think about neck position. So in this circumstance, you're going to see an orientation of the cranium on top of the neck, such that it pulls the hyoid bone up. So the hyoid bone goes up, it compresses the airway, and so we minimize our ability to expand, and it also helps us to perform the Valsalva maneuver, which is an exhalation strategy. So Valsalva is an exhalation against a closed glottis, so that is another attempt to raise pressure internally. And so again, we do all these things to minimize eccentric orientation so our force production goes up. So you are 100% correct, Norman, that everything that we're doing under this circumstance is an exhalation bias. And by cueing the strong exhalation, at lockout, you're going to enhance their ability to lock it out. Now, here's what I would caution you against. If you release too much pressure, if you release the pressure too soon through an exhalation, they're going to fail the lift. So there's an element of timing that's going to be associated with this. And so in most cases, what you're going to see is you're going to see people maintain their breath hold throughout, or you're going to hear like the smallest little grunt or groan as they are locking this out because we want to minimize, we want to minimize that release. We tend to let the air out under these circumstances so we can actually capture the position. So again, we need external rotation. We need some eccentric orientation to achieve positions, but we want to minimize that. So, Norman, thank you for that question. I hope that answers it for you. Now second question comes from Anthony. And Anthony says, I'm noticing a lot of stronger lifters are lifting their heads off the bench in a bench press. Why is this happening? So, Anthony, I got a video recommendation for you. Go to, I believe it's June of last year. We're answering a question for Vikram in regards to neck position during the bench press. And so what you're going to see is you're going to see a cervical flexion orientation in many cases. And again, part of this is this anterior compressive strategy in the neck to help reduce the airway size to create compression, force production, enhance the Valsalva and the exhalation bias. But we have situations now where we have people that are getting very, very strong and so they are really maxing out their ability to constantly orient to IR and exhale. Well, these are force production positions and they also stop ranges of motion from occurring. And so what we need now is the minimal amount of extra orientation, eccentric orientation to acquire position. So in many cases, so these are going to be your stronger individuals. They're going to be more hypertrophied. They might be using some assistive equipment, like a bench press shirt, to even maximize the compressive strategy even farther. But they still have to touch the bar to their chest. And so what you're going to see is actually is cervical flexion substitution that's going to allow enough movement for that bar to get to their chest so they can truly complete the bench press. So if we look at a cervical flexion range of motion substitution. So what I have here is an individual who is compressed into your posterior in the upper thorax. And so you can see as he bends his head forward, you can see the prominence of the lower cervical spine moving towards flexion. And so what this is is this is an external rotation substitution. So this allows just enough external rotation to occur through the shoulder girdle to allow them to make the contact with their chest with the bar so they can truly complete the bench press. You're also going to see this, just a little FYI, you're also going to see this occur most likely in the lumbar spine under the circumstances of somebody trying to gain depth in a squat. And so they go hand in hand. So whenever you see this cervical substitution, you're probably going to see the lumbar substitution as well. So guys, Appreciate your questions. I hope they lead you in a good direction. If you have other questions, go to askbillhartman at gmail.com, askbillhartman at gmail.com.

So you are 100% correct, Norman, that everything we are doing under this circumstance is an exhalation bias. By cueing a strong exhalation at lockout, you are going to enhance their ability to lock it out. Now, here is what I would caution you against. If you release too much pressure, if you release the pressure too soon through an exhalation, they are going to fail the lift. So there is an element of timing that is going to be associated with this. In most cases, what you are going to see is you are going to see people maintain their breath hold throughout, or you are going to hear like the smallest little grunt or groan as they are locking this out because we want to minimize, we want to minimize that release. We tend to let the air out under these circumstances so we can actually capture the position. So again, we need external rotation. We need some eccentric orientation to achieve positions, but we want to minimize that. So, Norman, thank you for that question. I hope that answers it for you.

So this allows just enough external rotation to occur through the shoulder girdle to allow them to make the contact with their chest with the bar so they can truly complete the bench press. You're also gonna see this, just a little FYI, you're also gonna see this occur most likely in the lumbar spine under the circumstances of somebody trying to gain depth in a squat. And so they go hand in hand. So whenever you see this cervical substitution, you're probably gonna see the lumbar substitution as well. So guys, Appreciate your questions. I hope they lead you in a good direction.

And we're able to capture this delay strategy at slower speed activity. So for instance, if we were doing a staggered stance cable chop, that would be a very useful exercise to create this delay. The thing that we want to recognize though is that this is not at speed. So what we want to do is we want to challenge him to actually maintain this external orientation at higher forces and higher velocities. And so what we're going to do is we're going to modify a couple of his exercises. We're doing some chopping activities on a diagonal. But one of the key elements that you'll hear me say in the next part of the video is that we're going to try to maintain these activities on a diagonal that is relative to his helical angle. Remember, your infrastructural angle is a representation of the helical angle of your physical structure. And so what we want to do is we want to train on that angle to help us maintain a much more effective delay strategy. If the angle's too flat, for instance, relative to the helical angle of the axial skeleton, you'll still get a turn, but it's going to be a flatter turn, so we're more likely to create this pelvic orientation where the pelvis turns as a unit rather than creating a delay strategy that allows the right side to accelerate in a much straighter line towards home plate and help us reduce the stress throughout the system. So we'll get a distributed stress instead of a focal stress.

So as we do that, what we're going to get is an orientation of the pelvis and the thorax towards me, which is a flat turn. So yes, you'll make a turn in this direction, but we've created a very long loop, if you will. So when we're talking about a baseball pitcher, we want to get as tight a turn as possible. So what we're going to do is we're going to modify the exercise a little bit. We put it on the same diagonal as his axial skeleton's navel. Now, when he turns, there you go. And you can see this deeper diagonal. So what we've got here is actually creating the delay strategy on the back left. Okay, so again, we want to keep it on that level. Okay, so that's step one. We use the water bag. I'm going to talk about some velocity. So we're going to take the medicine ball there. This is apparently a medicine ball. So what I'm going to do here, same kind of orientation, same angle. What I want you to do is I want you to hit that spot right in front of the left foot. So it's going to be pretty tight. So go ahead and reach up and then slam it down as close as you can. There you go. And then what I want you to do is go ahead and turn around.

Okay.

So what I'm going to do here, same kind of orientation, same angle. I want you to hit that spot right in front of the left foot. It's going to be pretty tight.

So go ahead and reach up and then slam it down as close as you can. There you go. And then what I want you to do is go ahead and turn around.

And where I want you to go is I want you to kind of zero in on the left hip and the left low back a little bit. Step back and make sure that we can see this. So come on back, come on back, come on back, come on back. Okay, Eric go ahead. So as he slams, you can see that he's creating this delay strategy. Let me move you this way a little bit so we can get just a little bit of a highlight on this. There you go. So there you go. So you can see the hip, there you go. So there's the delay that we're trying to create. The right hip going forward, we've got the left hip going back. And so this is a much tighter turn. And so now we're talking about emphasizing this shortest distance between two points kind of a thing where it's a much tighter turn versus something that would be out and loopy, right, or would create it.

There you go. So there you go.

So you can see the hip. There's the delay that we're trying to create. The right hip going forward, we've got the left hip going back. This is a much tighter turn. Now we're talking about emphasizing this shortest distance between two points kind of thing where it's a much tighter turn versus something that would be out and loopy, right? Happy Thursday. I have neuro coffee in hand and it is perfect.

When thinking about mechanisms of change and restoring relative motion, there seems to be a point where you lose the improvement in relative motion and you begin to drive compensatory actions to increase force production, such as when somebody starts wincing and holding their breath. My question pertains more to the mechanism of change and how you know the stimulus you're providing is doing what it's supposed to be doing.

Okay, so I would argue that we never really know what the mechanism of change is. Because we associate that with an intervention and the intention and then what are the probabilities? So number one, to identify whether you're getting the change that you want, you have to know what change it is that you're shooting for. So you have to have an intention first and foremost. Then you have to intervene in some way shape or form based on whatever it is that you've got in your head as a representation of what this person is capable of doing, how the system interacts. And that's whatever model that you use. And then you apply the intervention and then you retest and you say, okay, that was good. I'll do more of that. Or that was not good. I need to not do more of that. So there's a lot of all of these things that we do that are determined just through the interaction. Because again, we're not predictive outside of a small range of behaviors. We're not very predictive and people aren't very smart. We just don't know stuff. So the way that we figure stuff out is we do something and then we see what happens. And we can discuss mechanisms. There's a lot of influences. We can talk about the nervous system. We can talk about pressures and we can talk about volumes and fluid shifts and sensory inputs and all of that. But when are they not active? Like every single one of them is active all the time. You just don't know which one you're influencing the most. And I always say this. It's like, I don't know why my patients get better. I just play probabilities. And if you can get comfortable thinking that way, then you'll do a whole lot better. But if you start thinking that you're changing tissues, when you're not changing tissues, and if that's your model, then you fail a lot because the chances of you changing that in some acute way is slim to none. That's why you'll hear me use the word behaviors, because behaviors change instantaneously based on context. You have constraints. Some of them are the physical structural constraints that do change, but they change over a long period of time. And then you have the stuff that is, like I said, practically instantaneous. When you talk about neurotransmitter release and again, emotion and behavior, that stuff changes instantly. And movement has a very strong element of that type of behavior. That's why we can change it quickly. Thankfully, otherwise we'd be kind of screwed. So what position would you expect to see at the highest level of force production into the ground? What would be your thought process on that?

A compressive strategy inside edge?

Yeah, well, okay. So you have, so here's the rule. I have to push into the ground really, really hard, which means that I have to have some measure of internal rotation, which is my downward force into the ground. Can you do that in a supinated foot? You can't. It's just not very effective, right?

Your potential would be higher, right? Like in a supinated foot. To then compress? Isn't EIR happens in an ER space? So if you start supernatally.

If you're actually rotated, you're moving away from the ground. So that means you're not putting maximum force into the ground.

OK. So starting with more of a compressive strategy from the get-go, not start.

So it'll change by position as well, won't it? Like there's movement during the activity, right? Depending on what I'm doing, again, it's like how stressful is this activity? How hard is it for you to break a deadlift off the ground? It's like that's going to determine how much effort you put into it. It's going to determine how much position you need to acquire to produce that force. But you're always going to apply force into the ground with a degree of interrotation. Where it comes from varies. How much varies. So there's not one answer. What we have to understand is how the segments are influenced through the motion based on load, based on technique. Everybody wants to chase like, ah, they want one answer. They want the answer. I don't think there is one, other than simple rules like you got to push into the ground. Okay. What if you had a supinated foot and you still need internal rotation? Do you think you can acquire it somewhere else? Of course you can. All I got to do is tip my pelvis farther forward. Now I've got more internal rotation because that's a downforce, right? Even though I've got a crappy supinated foot, but the supinated foot is going to be a limiting factor because it's not going to allow me to maximize my pressure into the ground. So you see how the influences interact. A high-force foot, maximizing the force into the ground, is going to have a lower arch, and you're going to be biased towards producing an internal rotation force, which is very, very difficult to do if I'm on the lateral aspect of the calcaneus because that would bias me towards ER. IR is my force-producing position. So it stands to reason that I would see more IR. How much? I don't know. Who are we talking about? How hard is it for them? Is it above their threshold where they can't maintain a certain foot position? And so there's an advantage to understanding this because now you can just watch a client move and do something and you can identify like when are they really driving these internal rotation forces rather aggressively because now you can start to identify where their thresholds are and you can say that was a really good lift but I don't think we want to go any farther today, so then it becomes very, very useful. But if you say it should be this, it should be that, I think you identify what is and then you determine whether it is appropriate for the circumstance.

It's not so much off topic, but real quick. I just want to say it was so cool about the configurations, especially with martial arts. And then Michael just mentioned Jordan Burroughs, like with wrestlers, why they're always short, wide and stocky. It just makes so much sense. First is like those long guys who are like, have a certain style. It's just really cool. You can apply it to any sport.

This is a coffee call. There is no off topic.

I just want to say it was so cool about the configurations, especially with martial arts. And then Michael just mentioned Jordan Burroughs, like with wrestlers, why they're always short, wide and stocky. It just makes so much sense. First is like those long guys who are like, have a certain style. It's just really cool. You can apply it to any sport.

Well, yeah. See, okay. Watch the Olympics. You're talking about the athletes at the highest level that are highly specialized. And why did the figure skaters pick figure skating? Well, there was thousands of little girls that picked figure skating, but only three of them had the right body type that could take them far enough. If you look at the Olympic swimmers, they all look the same. Big giant hands, big giant feet, short legs, big long torsos with scapulae that are oriented into ER. That's how you get the shoulder motion. And so again, the configuration determines what you're going to be good at. That was my light bulb moment of the call. So let's break down the supine cross-connect. Good morning. Happy Friday. I have neural coffee in hand and it is perfect. All right. We are wrapping up a very solid week this week. Great call yesterday morning on the coffee and coach's call. My oldest friend showed up on the call. He's a baseball coach. We talked a little bit about baseball and some of the things that we saw the highlights from yesterday that was just a small clip of two hours. So hopefully you can join us next Thursday for that. We're going to wrap up the week with a little bit of a breakdown of the supine cross-connect. It's an exercise that I use quite a bit in the purple room. And then we translate that into a lot of activities out in the training hall and then as we're evolving people or progressing them into the high-speed dynamic activity. So it's a very useful foundational activity. I had a bunch of requests to actually break this down so this is how we're going to wrap up Friday. As far as who we're going to apply this to and when we're going to use this under specific circumstances, in many cases we're looking at somebody that is biased towards a later propulsive strategy. So we're going to get somebody with an anterior rotation. We're going to see loss of early hip flexion. You're probably going to see loss of both internal and external rotation. The anterior rotation is going to take away the external rotation. You're typically going to have an anterior compression that goes along with that. So we're going to see the loss of both ERs and IRs. And then you're definitely going to see a limited straight leg raise in most of these situations. So what we're going to try to do is we're going to try to recapture this early propulsive strategy which is an ER bias but we want to make sure that we're controlling the orientation of the pelvis so we have to control the position of the ischiotuberosity to get that posterior orientation relative to the anterior. It's an ER bias, but it's also where we're going to actually start to superimpose this intramutation on top of it. So we need a yielding action in the posterior aspect of the pelvis and the posterior aspect of the thorax. As you construct this exercise, you want to start from the foot upwards. So the wall becomes the ground under these circumstances. And so we have to get the foot contacts correct. Otherwise, we're not going to get the upstream activity that we want. So we want to make sure that we're capturing the first metatarsal head and the medial calcaneus on the wall. And so we've got the foot elevated off the surface. And what that does is it keeps the foot slightly in front of the pelvis, which would be our early propulsive positioning. But capturing the first metatarsal head and the medial calcaneus is important because that's that initial superposition of internal rotation on top of the external rotation bias. Then to hang onto those cues, we need that medial pressure on the foot. What people are going to try to do is they're going to try to internally rotate from the top down to try to capture this pressure on the wall. What it would encourage you to do is cue it through the ankle because what's going to happen if they try to drive it through internal rotation, you're going to get a little bit more knee flexion than you want. And then you're also going to get an anti-orientation pelvis. And so now we've just defeated the purpose of the exercise by letting them follow their compensatory strategy. The knee is going to be slightly bent under these circumstances because what I don't want to do is turn this into a knee extension activity per se because then it becomes all quad activity when I really want hip activity. So I'm going to try to drive this through the hip from the top down and then maintain that ankle position so I can maintain my foot cues. On the opposing side, we're going to bend the hip and the knee, but where I want you to target the direction of the knee is towards the nose. So we would need to bring this knee towards midline because what you're going to see typically are two compensatory strategies at the hip. So number one, they're going to try to ER the hip or they're going to move the hip into an EO orientation and then try to drive hip flexion, traditional hip flexion, which is actually going to be IR in this position. And so we want to avoid those two compensatory strategies because we're going to take advantage of this compensation by making a turn into the support leg. So if I drive the knee towards midline, what's going to happen is if I can hold that position, instead of the lower extremity moving away from midline, I'm actually going to turn the axial skeleton away from the flexed hip and knee. That's internal rotation on the other side. Because remember, I'm starting the superimposed internal rotation on this ER biased position on the support side. So again, we're taking advantage of the compensation. I'm going to push into the wall. Again, I want to control the ischial tuberosity. So I'm going to push into the wall. So you're going to feel a lot of activity in that support side hip. So if we wanted to pick on a muscle, we could say, well, you're going to feel a lot of glute max activity under those circumstances. Now I'm going to drive the opposite elbow towards the flexed hip and knee. And what this is going to do, it's going to create a space between the spine and the scapula. And so this is going to give us our yielding action in the upper thorax. From a breathing standpoint, we want to be able to breathe through this. So we're going to inhale, but we're going to think about bringing the knee and the elbow closer together on the inhale. And then my exhale strategy is going to be to push the wall away. So this constructs the entire exercise. Now, for some people, it's going to be very, very difficult to breathe. And so I would encourage you to capture the cues, but don't force the activity between the elbow and the knee because we do want to be able to move air. And so I want people to expand under these circumstances because most of the people that we're going to use this with are very, very compressed. And what we're going to find over time is as they gain this capacity to expand and compress, we're going to approximate that elbow in the knee much more effectively. You're going to get a stronger push in the wall. So let them evolve this exercise. Don't try to be perfect on the first try because you're going to capture a lot of good things as long as you maintain your contacts with the wall. So hopefully that gives you some ideas on how you're going to utilize this activity, how to break it down, how to teach it. If you have any questions, go to askbillharman at gmail.com, and I will see you guys next week.

So we need a yielding action in the posterior aspect of the pelvis and the posterior aspect of the thorax. As you construct this exercise, you want to start from the foot upwards. So the wall becomes the ground under these circumstances. Therefore, we must get the foot contacts correct. Otherwise, we're not going to get the upstream activity that we want. So we want to make sure that we're capturing the first metatarsal head and the medial calcaneus on the wall. And so we've got the foot elevated off the surface. And what that does is it keeps the foot slightly in front of the pelvis, which would be our early propulsive positioning. But capturing the first metatarsal head and the medial calcaneus is important because that's that initial superposition of internal rotation on top of the external rotation bias. Then to hang onto those cues, we need that medial pressure on the foot. What people are going to try to do is they're going to try to internally rotate from the top down to try to capture this pressure on the wall. What it would encourage you to do is cue it through the ankle because what's going to happen if they try to drive it through internal rotation, you're going to get a little bit more knee flexion than you want. And then you're also going to get an anti-orientation pelvis. And so now we've just defeated the purpose of the exercise by letting them follow their compensatory strategy. The knee is going to be slightly bent under these circumstances because what I don't want to do is turn this into a knee extension activity per se because then it becomes all quad activity when I really want hip activity. So I'm going to try to drive this through the hip from the top down and then maintain that ankle position so I can maintain my foot cues on the opposing side. We're going to bend the hip and the knee, but where I want you to target the direction of the knee is towards the nose. So we would need to bring this knee towards midline because what you're going to see typically are two compensatory strategies at the hip. So number one, they're going to try to ER the hip or they're going to move the hip into an EO orientation and then try to drive hip flexion, traditional hip flexion, which is actually going to be IR in this position. And so we want to avoid those two compensatory strategies because we're going to take advantage of this compensation by making a turn into the support leg. So if I drive the knee towards midline, what's going to happen is if I can hold that position, instead of the lower extremity moving away from midline, I'm actually going to turn the axial skeleton away from the flexed hip and knee. That's internal rotation on the other side.

Because remember, I'm starting the superimposed internal rotation on this ER biased position on the support side. So again, we're taking advantage of the compensation. I'm going to push into the wall. Again, I want to control the ischial tuberosity. So I'm going to push into the wall. So you're going to feel a lot of activity in that support side hip. So if we wanted to pick on a muscle, we could say, well, you're going to feel a lot of glute max activity under those circumstances. Now I'm going to drive the opposite elbow towards the flexed hip and knee. And what this is going to do, it's going to create a space between the spine and the scapula. And so this is going to give us our yielding action in the upper thorax. From a breathing standpoint, we want to be able to breathe through this. So we're going to inhale, but we're going to think about bringing the knee and the elbow closer together on the inhale. And then my exhale strategy is going to be to push the wall away. So this constructs the entire exercise. Now, for some people, it's going to be very, very difficult to breathe. And so I would encourage you to capture the cues, but don't force the activity between the elbow and the knee because we do want to be able to move air. And so I want people to expand under these circumstances because most of the people that we're going to use this with are very, very compressed. And what we're going to find over time is as they gain this capacity to expand and compress, we're going to approximate that elbow in the knee much more effectively. You're going to get a stronger push in the wall. So let them evolve this exercise. Don't try to be perfect on the first try because you're going to capture a lot of good things as long as you maintain your contacts with the wall.