because this is like somebody coming in and saying, I've been trying to fix my posture. It's like, good luck with that, right? And then they always come in, it's like, well, shouldn't you pull your shoulders back and you go, but how much? Is it six degrees? Is it 14 inches? Is it as far as it'll go? Or is it halfway? It's like, nobody knows the answers to these things.

Morning. Really? So I have a question about basically, you're trying to bring someone back and they have a lot of abdominal scarring from prior surgeries. I assume it's negative influence.

I wanted to ask a question. Is it influenced the fact that it's producing a restriction in movement by a tension related restriction or the fact that they can't manage the pressure in the abdomen? Because you're going to have two scenarios here depending on like the degree. Like is it, is it pinning? Is it turning into like a rectus strategy or is it more like a narrow ISA that can't pressurize and then they got the expanded representation in the belt.

In this circumstance, I'd call it the expanded representation, but I'd have to assume in some regards, it could be both.

Yeah, but like visually. Visually, it's expanded. OK. Yeah.

In this particular scenario. I'm with you. OK. Now I understand. But so I assume you can end up with some excessive yielding that allows the expansion while also some scarring down that prevents the movement.

I'm with you. Now I understand.

But so I assume you can end up with some excessive yielding that allows the expansion while also some scarring down that prevents the movement.

Right. But I think, again, from a starting conditions standpoint, your first thought process would be: this person is having pressurization issues. So it's like the shape. Gotcha. Right. It looks more like the guts are spilling over the top of the pelvis. Yeah. It's not that they couldn't be compressing from the top down like a two pests. Right. So the first question that I would ask though is: do I have something in the abdomen that's holding the sternum down? Right. And you can do that very quickly. You just throw them on their back and do some form of activity where they would need to produce the anterior posterior expansion and then see where it moves. Right. And if you get the sort of like the belly breath kind of a thing, then I would be working on making a space up top and then creating the IR position below it to allow them to push the pressure upward.

Okay. How much abdominal activity would you want in that circumstance?

Enough. Okay. to not to not overwhelm anything but enough to okay so and so here's like this is a real time coaching thing which is which is which is kind of nice. It's like we're just going to put them on their back in like a hook line position just to make life simple okay. And so, so when you think about the actual skill skeleton expanding during an inhalation we would expect everything to expand at the same time right. So the thorax is expanding because of the volume of air is increasing. That's pushing the abdominal contents down into the abdomen a little bit. So that's going to expand in a controlled manner. But if I have an acceleration of abdomen and no change in the thorax, it's like, I think it gets pretty clear as to where you got too much yield. Okay. So under that circumstance, you need to tune those connective tissues a little bit more effectively, which means that the emphasis is going to be on the sensation of posterior expansion.

So, not to not overwhelm anything but enough. Okay, so here's like this is a real time coaching thing, which is which is kind of nice. It's like we're just going to put them on their back in like a hook line position just to make life simple. Okay. When you think about the actual skill skeleton expanding during an inhalation, we would expect everything to expand at the same time right. So the thorax is expanding because of the volume of air is increasing. That's pushing the abdominal contents down into the abdomen a little bit. So that's going to expand in a controlled manner. But if I have an acceleration of abdomen and no change in the thorax, it's like, I think it gets pretty clear as to where you got too much yield. Okay. So under that circumstance, you need to tune those connective tissues a little bit more effectively, which means that the emphasis is going to be on the sensation of posterior expansion.

Makes sense.

Okay, because if you can get them to sense the expansion into the surface that they're laying on, then again, what you're going to do is like, you're not going to have the eccentrically oriented representation of abdominals per se, right? You're going to have more concentric orientation and then a controlled yield as it expands. Does that make sense?

Yeah.

Definitely. And so this is where that nice tubular shape that you get on narrow ISAs after about the third set of stuff, and it's like their ribs disappear and then they look like just a big hot dog laying on the table where they have this nice cylindrical representation. Yes, I know what you're talking about.

That's not normally how I think about it.

Well, there you go. It's like I've stared at enough people. I need to be creative, right? But that's kind of what, again, you're going to coach this in real time. But the idea is like, okay, so here's what you don't want to tell them to do. You don't want to tell them to contract the abdominal muscles ever. Because the minute you start doing that, what is their perception of what you just instructed them to do?

Their perception is whatever. They've been doing probably.

So it's like, okay. Oh, abdominal muscles. That's a crunch. That's the way it would feel on a plank, like they're going through all the snares in their head about, oh, this is what Alex means. It tends to make it worse. Absolutely it does because this is like somebody coming in and saying, I've been trying to fix my posture. It's like good luck with that. Right. And then they always come in and ask, should you pull your shoulders back? But how much? Is it six degrees, is it 14 inches? Is it as far as it'll go, or is it halfway? It's like nobody knows the answers to these things. So again, it's better to give them a mixture of internal and external cues, but generally speaking, it's going to be something external. It's like, I need you to feel the expansion going in a direction. And then usually the surface is great because it's a physical contact. This is why foot contacts are important, pelvis contacts are important, thorax contacts and so on and so forth. So you're going to direct that. And then number one, give them time to screw it up, okay? And then correct it. Right. And then you understand the visual representation of what you're going for. And if you can't get it, then you have to do it segmentally. So you're going to have to do one part at a time. This might be one of a PNF upper extremity activity, a reach, a static hold or whatever to promote a regional change—it's a small change—before you go after the systemic stuff. Or you're going to do it mechanically with your hands. You're going to become the compression so they can expand elsewhere. And again, that's just your manual technique, right?

Yeah. Yeah. I mean, I've definitely held people's ribs down on one side or both sides or whatever. So in regards to the other situation where they're not too expanded, too much yield anteriorly, but they do have some sort of restriction, would that be, would that potentially be a situation where you'd have to do something more manual? And so in this circumstance, you probably end up in the opposite scenario where they'd have some sort of bend creating, I don't know if you'd even call it. to your expansion, but yeah.

Yeah.

What was I going to say?

So in regards to the other situation where they're not too expanded, too much yielding anteriorly, but they do have some sort of restriction, would that be, would that potentially be a situation where you'd have to do something more manual? And so in this circumstance, you probably end up in the opposite scenario where they'd have some sort of bend creating, I don't know if you'd even call it. to your expansion, but yeah.

So, the way that you could treat it would be a little bit more like the reckless strategy. You ever have somebody that has the vertical scar that goes right down the linear area from sternum to pubis?

The vertical what?

Scar.

Oh, um, I'm not sure if I've seen that, but I mean, do you know the scars? Yeah. So you'd have to lengthen that the same way.

Yeah, and again, it's like, how old is the scar? How much adaptability do you have? That becomes a little bit of the problem. You have somebody that had that surgery 10 years ago and they've had this restriction for 10 years. Then you've got a whole series of adaptations. Now you're going to be like, okay, let's just say I can't change this. What can I influence in a favorable way? Then you're going to play that game. It's like, okay, I've got to determine what your adaptability is and use everything they possibly can as a substitution for it.

In that situation, would we be moving more, like in that circumstance, would you be moving more along the lines of rectus, or would you be trying to facilitate more of the normal pattern of the diaphragm movement?