Good morning. Happy Monday. I have neuro coffee in hand and it is perfect. I had a great weekend. I have a really solid week coming up, so lots to look forward to. Today is a little different for our Q&A. Eric from iVest and I are working on off-season programming for some of our pro athletes who just started their off-seasons. We were obviously discussing some issues, and Eric raised a really good question that I think is common for many people regarding how we produce force in sports and how this influences velocity demonstration. This applies to sprinting, but is often seen in throwing, swinging a golf club, or tennis—rotational sports where we see very high velocities. We'll explore how this is created and how it relates to the actual model. So, we're cutting away from the home office to the purple room for a whiteboard session we haven't done in a while. Enjoy.

You said earlier that max velocity was demonstrated through ER, and I was always under the impression that we get to max velocity in IR. Can you explain that a little more?

In a nutshell, max velocity is not demonstrated in IR, but the forces that are producing the velocity are created and produced in IR. We must look at where the force is produced and where the velocity is demonstrated. We can view this as a continuum of activity, following the universal principle of expansion to compression to expansion. This is why we have extra rotation at either end, leading to the greatest compressive strategy, which is internal rotation. As time moves forward, the midpoint represents maximum force production, also called max propulsion in human movement. Max velocity is actually demonstrated at the external rotation phase. For high-speed movements, such as a baseball pitcher throwing at 8,000 degrees per second, the arm moves at the highest velocity we can create. To achieve this, there must be a singular moment of maximum force production. If the duration of force production is extended, the movement slows down, dampening the strategy and preventing achievement of maximum external rotation and thus maximum velocity. This principle determines how strong an individual needs to be: maximize force production without compromising the range of external rotation where maximum velocity is demonstrated. If strength training in internal rotation improves performance to the point where external rotation is sacrificed, maximum velocity decreases. However, if an individual has low force production but ample external rotation, aggressive strength training may still allow for maximum velocity production, a rare but advantageous scenario, especially in sports like baseball or tennis where athletes already have significant velocity. The key is careful programming of internal rotation max propulsive strategies to maintain maximum external rotation and thus maximum velocity. This concept applies to various movements, such as martial arts kicks or punches, where force is produced centrally and expressed in external rotation.

And so then we have to be very, very careful about how much internal rotation max propulsive strategy through programming because what I don't want to do is I don't want this to trickle back. I want to maintain maximum ER so I can demonstrate the velocity. So it doesn't matter whether we're talking, I mean take anything, this would be like a martial arts kick or a punch, it's the same concept. It's like straight training doesn't steal anything until it does. So if I need to throw a straight right hand as a boxer or a martial artist, I want to be able to demonstrate my ER because that's where the velocity of the punch comes from. But I'm producing the maximum force centrally and then expressing it in external rotation. So you see that its IR produces the force, ER allows it to be demonstrated at its peak. Does that make sense? Yeah. There you go.

This ER position to IR position so the arch comes down and then we've got a late propulsive strategy which is the toe rocker which brings us back to this ER position okay so we go ER IR ER as is commonly found in almost every motion that that we talk about. What you brought up was queuing lateral heel contact throughout the split squat. I understand where you're going with this, but there's a couple of things that we have to understand about these split mechanics as we come into this early propulsive strategy. We've got tibial ER, we've got traditionally a supinated foot, so we've got ER through the system. We've got first and fifth met heads down. We've got a calcaneus on the ground in this early position. One of the things we want to understand is that the deep posterior compartment of the calf, so the Tom, Dick and Harry. So we've got tibialis posterior. We've got flexor hallicus longest. And then we've got flexor digitorum longest posteriorly comes down around the medial ankle. So that muscle, that group of muscles is going to be concentrically oriented, but it's also going to be using an overcoming strategy at heel contact, but then this becomes a yielding strategy as the foot comes down to the ground. The reason we want a yielding strategy is because we want to distribute load through the tissue, so we have to create a yielding strategy so we have energy storage for the energy release. And so the yielding strategy is going to be through the bone, through the connective tissues, and through the musculature itself where the connective tissues lie. If we don't have that, then something's going to have to take up the slack. If I cue lateral heel throughout, what I'm going to do is I'm going to promote a strategy that maintains a concentric overcoming action throughout the excursion of the exercise. Maybe there's a circumstance that you might want that, but under most circumstances, we don't want that. So here's where that shows up in the real world. When you get your runner that comes in with a posterior tibial stress syndrome or shin splints or whatever you want to call it, they're typically using a concentric overcoming strategy as they run and so the bone then becomes the only source where we're getting any significant yielding strategy and so that's why you get tibial stress. This is what the end game is your your tibial stress fractures and so what we want to do is we want to teach people to distribute those loads for energy storage and release in a much more efficient manner. So Brian what I would do is I would take your little

The heel wedge or something like that, and I would be working the front foot in this heel's elevated position because what this does, it's gonna bias us towards that early propulsive strategy without altering the foot mechanics, and so we can still get our concentric yielding strategy. We're just biasing ourselves back towards that extra rotation element of the full propulsive excursion. So now let's move to the pelvis. Let's talk about the pelvis orientation because we can create that bias as well. And so I'm gonna hold the pelvis in this orientation so you can kind of see this. So real quick. So remember early phase ER bias, middle phase IR bias. So when we're talking about split squat, we're moving through rather ER to IR and then back to ER. And if we're talking about the lead foot. So what we can do though is we can bias this lead foot towards more extirotation, more entirotation. we're gonna go ER to IR under every circumstance. But again, we can create a little bit of a bias. And so what I can do is I can position the ilium in the sacrum in a little bit more of a bias. So what I'm gonna do is I'm gonna create this yielding strategy at the base of the sacrum here and I'm gonna be ERing this ilium. And so what this would look like would be to project the knee forward in the split squat. So before I even lower myself into the split squat, I'm going to create a stronger bias towards ER. And then as I descend, I'm going to get less IR as I go down through that middle range excursion towards what we would consider 90 degrees of hip flexion. So right away I get to bias it. If I wanted to do the opposite, what I would do is I would shift backwards and I would create a little bit more of a bias towards internal rotation. And then as I go down into that excursion, I get more internal rotation as I approach 90 degrees of hip flexion. So this is just your typical hip shifting kind of a bias that you would be using. But the cool thing about this is the load position now that you mentioned is also an influence. So what I can do is I can take the contralateral loading and I can I can bias it towards internal rotation. So I create those same hip mechanics that I just showed you the bias towards internal rotation to lower myself into the split squat. If I use the ipsilateral load, I create the hip bias towards external rotation. Now here's here's the question mark. It's like, what are you trying to achieve? Are you trying to improve my ability to maintain extra rotation? So under those circumstances, I create the hip mechanics that are biased towards extra rotation, and I use the epsilon load. It makes it easier to acquire those range of motion mechanics. However, at some point in time, what I may want to do is challenge that and actually produce force into external rotation. Under those circumstances, I'll bias it towards the internal rotation mechanics. So you have to push myself up and out of those internal rotation mechanics to create more external rotation. So Brian, this is a great question. Very, very useful. Just keep in mind that all we're doing is creating biases. Internal external rotation are superimposed. And so, again, it's like how we start is going to influence how we move through that middle excursion and then how we end.

It makes it easier to acquire those range of motion mechanics. However, at some point in time, what I may want to do is challenge that and actually produce force into external rotation. Under those circumstances, I'll bias it towards the internal rotation mechanics. So you have to push yourself up and out of those internal rotation mechanics to create more external rotation. So Brian, this is a great question. Very, very useful. Just keep in mind that all we're doing is creating biases. Internal and external rotation are superimposed. And so, again, it's like how we start is going to influence how we move through that middle excursion and then how we end.

As soon as you said sacral nutation, we're going to be starting from a wide ISA archetype bias. So let me grab the pelvis here and we'll kind of talk through that a little bit real quick. If my sacrum is nutated, then I know I'm going to be in that orientation. This biases me to an inverted hip socket. It buys me towards an IR-dominant hip. And then from a pelvic outlet standpoint, I'm going to have a concentric orientation of this anterior outlet. And because of the sacral position, I'm going to have a bias towards an eccentric orientation of this posterior outlet. So that's where our starting position is. Now, let's superimpose a pregnancy on top of that. And so we have downward pressure. We have an anterior expansion of the abdomen. And so then what we're going to end up with is we're going to actually change the axis of the pelvis. So the pelvic axis enters the pelvis at an angle and usually goes straight down. But under these circumstances, because of the orientation of the sacrum, we're going to have a reorientation of the pubic axis. And so what that's going to do, it's going to promote more of this posterior expansion. We've got a posterior compression in the superior aspect near the base of the sacrum that's going to be pushing us forward. And we're just going to kind of keep going, going, going, going, going. So right away, we start to think about, okay, what kind of measures are we going to be looking at with these folks? And so with the anterior orientation, you're going to see this loss of external rotation. Now, we also have to think about a progressive element of strategies here because we've got a change in the center of gravity. And we're talking about the pregnancy factor here a lot. So I have an anterior expansion that's going to push me forward. I've got to push myself back. So chances are you're going to get this anterior compression as well under most circumstances. And so now I've got a pelvis that's getting compressed anterior to posterior. So what happens is I'm going to lose the diameter of this anterior-posterior space, and I'm actually going to widen it side to side. So if I took a hoop and I squeezed the hoop, I get wider. Away from the compression, I get narrower towards the compression. So that's the kind of situation that we're talking about. That's all well and good. So under that circumstance, we've still got this eccentric orientation posteriorly. We've got concentric orientation anteriorly. And until we reach a certain position, we probably don't really have any incontinence problems. But I think there's two scenarios that we have to consider under these circumstances where we will start to see the incontinence problems.

What I want you to think about here, Tom, is that if I keep pushing this back, pushing this back, pushing this back, the pelvic outlet musculature is getting more and more lengthened. And it might lengthen to the point where it can no longer produce its optimal level of force. So at that point in time, as that sacrum goes farther and farther forward, I'm going to now lose my control of urine flow at that point, okay? So this is more of what I would look at as a passive insufficiency kind of a representation. So I'm moving the two ends of the muscle farther and farther apart and I lose my ability to produce optimum force. That's scenario one. Scenario two is if I get this posterior lower compressive strategy, and again, this is a center of gravity control issue. So if this keeps going forward, forward, forward, I'm going to eventually have to compress this down. And so I'm going to compress down here. And so I'm actually going to see a bend in the sacrum. And I got an MRI right here, hopefully it's right here, somewhere there, that shows how this sacrum will bend under. So under normal circumstances, I'm going to see this nice, normal-shaped sacrum with my eccentric orientation. But if I get the concert orientation pushed to your lower, it's going to bend the sacrum underneath. Now, if I bend the sacrum farther and farther and farther, and this space in the outlet gets narrower and narrower and narrower, I'm going to have the opposing strategy. So this is going to be more like an active insufficiency where I bring the two ends of the muscle closer and closer together. And once again, I can't produce optimum force, and this is where I'm going to have the urine control problems, okay?

So if I have a pelvis that's kind of smushed front to back and gets a little bit wider, if I put pressure through the ilium, then I can start to reshape the pelvis and get some rounding back there, okay? And that's under certain circumstances. And again, especially with these women that have had multiple pregnancies, the ilium will open because of the downward pressure, it will open like a flower that's blooming, and until we can bring that shape back into a more circular representation, they're not gonna get good muscular control the way we want to. Another thing that you can do, and this is kind of off the beat path too, is the old school foam rolling, take your foam roller, and you have them lay on their side and you're just going to roll that ilium across the foam roller as such and that's going to start to promote some of this rounding and shape change as well. So this then becomes some of your sideline activities, some of your rolling activities. Progressing into like maybe an armbar series if you take them back into the gym, but you might have to do something a little bit more Rehab-ish to promote this this public shape change that you need We work in split stance inside line. That's also another great way to to start to reshape the pelvis. Once you recapture the hip IR, then you can move to things like half kneeling. You can start box squatting in one of my favorite ways to restore the pelvic outlet behaviors. And then your good old fashioned Camperini deadlift. Once you get that IR back, because that would be indicative of, like I said, of a more normal behavior of that pelvic outlet. Once you recapture all this stuff, this is going to be somebody that you're going to reeducate in their hinging activities to help maintain this strategy. And we want to try to optimize that. So keep monitoring your ERs and IRs to make sure that you're not creating the anterior orientation. So again, your loss of ER is going to be indicative of that. So Tom, I hope this is helpful.

There's no experience in strategies. So I'm making sure it's only compression. For what? For muscles. It's only compression by the way they work, just with sarcomere shortening.

If they're shortening? Yes. In general, it would be towards compression. So, okay. So here's a little dirty secret. At the two ends of the extreme, it's compression on both ends. So when a muscle contracts, okay. So just use your biceps as an example. Okay. So if I bend my elbow, I contract my biceps right and it compresses and it gets firm, it gets smaller like it's squeezed into that space right and then as I extend my elbow it expands. Right. And so it goes from the compressed state to its expanded state. But if I take it to the extreme stretch, it recompresses. But it's a different shape of compression that I had here. So this is compressed short and wide, right. Because I got big monster pythons for biceps. says a Joe grace got it. And then at this end, it's elongated. So it compresses long ways and it gets a little bit narrower and tubular. So there's compression at both ends. And this is how you produce tension, right? That's why you feel that at the end. Right? So the muscle itself compresses and expands. But when you're shortening, so if I'm moving towards concentric orientation of any kind, you're going to move towards a compressive strategy. The question mark is, where did you start? So if I started at the very end range, right. There might be a relative expansion as I alleviate that end range tension in the maximum eccentric orientation. There might be some measure of expansion, but again, in general, you're going to move towards compression. So you're correct.

You're doing like abduction or anything like table tasks. Yeah. Like you're measuring something on the table. Yeah, if their presentation is something you've seen before, but the interventions seem like they're potentially pushing it away from where you want it to go.

Like I made a mistake and I did the wrong thing.

Either just like an anomaly or maybe that too.

Most of the time it's just me screwing up. Everything that we do is based on probability. I measure my chest board, I have my three-dimensional representation of this human, and I have to make the best judgment based on my understanding. Then I intervene and retest. So I have no judgment in the whole process—it's just: here's what I thought I had, here's what I did because of that, here's what happened, and then I just do next. It would be rare because I have checks and balances within my process that help me confirm what I think is going on. But I miss the target. There's a percentage where I miss the target because it's all based on probability. To quote Annie Duke, we're playing poker. So 76% of the time I'm correct, 24% maybe not. Under certain circumstances, maybe sometimes I hit it out of the park and I'm 92% correct. The point is you've got to be prolific with everything you do—that's how you get good. Because, as Jolly Park wrote 3000 songs, but not very many were great, but she wrote a lot of them, and that's how you get great. So the number of failures you need to get really good is very high, but you got to do it in a safe atmosphere. That's why I'm such a proponent of mentorship and apprenticeship models, especially for what we do—it is the only way. In fact, it's the only way to learn how to do this is to do it under the direction of someone else first because that's how you're going to get your reps in a safe manner. So if you're just out of school, you must find somebody you can follow and work under and do it for free if you have to, so you get your reps, so you get your exposure, so you learn to see things. There is no book that's going to teach you what we talk about on these calls—this is all experiential. That's why it's so important. That's why internships are important, that's why apprenticeships are important, that's why having a mentor is so important because you need guidance. Because you can learn anything, but the stuff that we do cannot be taught—it has to be experienced.

Gotcha. Okay. An ISA question. Ever heard of it? I've seen this presentation a couple of times this week. With testing, it presents as narrow, but my hands are so far apart from each other. And they all have different histories. There are a couple of them that had past pregnancies that were an issue, and others that don't have that easy of an explanation as to why you can explain what's going on. I actually ran this by Campo because I had a question, but I was trying to decipher whether to trust my hands or if whatever changed anatomically is going to change our expectation of what's going on at the Axial Skeleton.

When you place them at that transition point between the inhale and the exhale with the arm position, that's where the decision-making capability is as to whether it's moving and how much it moves. That's the best place to observe it. I have no issue with saying I don't know and then doing something and just seeing what happens. There's nothing magical about the ISA other than it's going to lead you in a direction. You still have to follow the same process: you still have to say I think this is this, here's my intervention, here's what happened, and then what's going to happen over time. Again, you've been doing this for a while, but what's going to happen over time is your judgment gets better and better. So when you see these kind of iffy ones, if someone says I was 110 and now I'm 90, I don't really care about the number. And they ask how is that possible, you probably started really close to 90 as a human and your training flattened you out, making it look a little wider, and then you sort of overcame that and now it's kind of back to where you started because there are people who are in the middle range.

Yeah, I think you know how things happen in like threes and like this happened multiple times like hell yeah and you're starting to question yourself is like is it just the way that I'm administering this which I don't think it is because well but that's a really good question to ask yeah that's a powerful question to ask because it allows you to examine your own bias. And what I do is I basically go back like the next session. I basically tell them I go, yeah, we're going to throw that one out. But I'm pretty confident in the way that I'm measuring it to at least get consistently like the same answer. It's just a matter of I'm not really sure where to go with that answer in terms of like trying to come up with my visual representation of what's going on underneath. Like I try and like paint that picture in my mind of like what's going on under this and what how could this actually like feed into my assessment to guide me or is this just like I'm just doing this because I'm doing this.

I think that the answer is that if there's a question mark in your head, you flip a coin in your head and you go, that's closer to this or that's closer to that. And that's just your, it's just a starting point. Literally, it's just a starting point. It's like, I measure it once. I don't re-measure, right? Because it doesn't matter. I just want it to move. More than anything else, I want it to move. And then it's represented in the extremity motion. You know? Because it's just a baseline structure. It's not an answer to every question. I think the novelty gets people excited and they go, what about this one? What about this one? What about this one? It's like, no, just measure, do, and process.

If we had a fulcrum, there would be a lot of pressure and heat that would be released every time we moved and we would destroy our joints in no time. And so we don't want fulcrums in our joints. In fact, if you do have a fulcrum in your joint, you're probably talking to the orthopedic surgeon right now. So now what we have to understand is that we have to have mechanisms that keep these bones from touching. So let's break these down. Now let's start with structure. So your 99% water, 1% stuff, your 1% stuff is almost all the same and it's all viscoelastic tissue. And so I have representation of viscoelastic tissues in my silly putty. And so this is viscoelastic, so it's going to behave very similarly. And so this tissue will behave differently depending on the forces that are applied. So if I stretch this gently, I get this nice elongation of my silly putty, but if I pull it really hard and fast, it snaps off clean. So what that means is the tissue behavior changes based on the forces that are applied. And so when I apply a high rate of force, I get very, very stiff viscoelastic tissue. So this is the overcoming action that I always talk about when we're talking about concentric overcoming or eccentric overcoming behaviors. So I have an increased stiffness of tissue. So if I had an orientation of fibers as such, that if I loaded them at a higher rate, I can make them really, really stiff. And so we actually have that. So when we look at the fascia that surrounds everything. So we talk about the periosteum. We talk about the fascia that surrounds all of the ligament structure and all the structures around the knee. So the knee is very busy when you look at it from a connective tissue standpoint. And so what happens is when we load that joint, those viscoelastic tissues behave very, very similar to my silly putty. They get very, very stiff, and they create this rigidity around the knee, and that actually pushes the bones apart. So now we have a mechanical protective mechanism that helps us keep those bones apart. So that's very, very useful. It's a little counterintuitive too by the way when you think about it. It's like you think of these are like tension elements and stretchy stuff. They become very, very stiff. So keep that in mind.

If we talk about the knee, so at the end of the femur we have hyaline cartilage. On the tibia we have hyaline cartilage. And so when the water is right next to it, it promotes the separation of the water into positively and negatively charged water. So the negative charged water is right along the hyaline cartilage on both sides. And then the positively charged water is going right through the middle of the knee. So if you took the north end of two magnets and tried to push them together, you can feel the repulsion between the two magnets. So this positively charged water is constantly trying to push its positive charges apart. And so now we've got this electromagnetic force that is now pushing the knee apart. So now we have an electromagnetic effect to create this separation. And so there's a cool study from 1980 from teriyama, it's Japanese. And they took fresh cadaver knees within synovial joints and they applied downward pressure through the joint about 220 pounds into the knee joint and they compressed and then it hit sort of like a maximum position, but the bones didn't touch. They got really, really close together, but they did not touch. And so right away, even in a joint that's not living, but it's intact and we have all the structures available to us, it still behaves similarly. So it keeps the bones apart. So again, very, very strong electromagnetic effect. How do we know? Well, in the same study, they took a hip joint that had arthritis. So on the weight-bearing surface, there was no cartilage. They did the same compressive test, and they got the subchondral bones to touch because there was no cartilage in the way to create this electromagnetic effect and keep the joints apart. So kind of a big deal. Now, synovial fluid has little protein things that are floating around. Proteins are negatively charged, and then they would attract positive charges, just like two magnets. So you take the north end of one magnet, the south end, and then they snap right together. And so we have these proteins that are surrounded by positive charge. We have more positive charges. And so now the synovial fluid itself helps us create that middle positively charged area that keeps the joints apart. So for those of you that have had arthritic changes and some wonkiness in your knees, if you will, that have had the synvisc injections, what they're doing is they're injecting you with water that has protein and it helps restore some of that mechanism, which is why you might feel better for a little while until the effect is no longer intact. So we have structure, we have mechanics, we have electromagnetic forces that keep the bones apart.

So when we look at the structure of the synovial joint, on either end, as long as we maintain our hyaline cartilage intact, it appears that we can keep our bones apart. So we have to look at what affects that hyaline cartilage, and we say, oh, pressure, tension, blah, blah, blah, blah. But the reality is, Highland Cartilage gets its nutrition from the bony side. So you'll see the little arteries that I drew on my picture here. And that blood supply is what gives the nutrition to the cartilage. So it diffuses from the bloodstream towards the Highland Cartilage on the bony side. Well, if I put enough pressure and tension on those bones, those trabecula will compress. If the trabecula at the ends of the bone compress enough, I restrict the blood flow to the ends of the joint. Now, these trabecula can also fracture. So, you know, you play 15 years in the NBA, you're probably going to get some fracturing of those trabecula. They're kind of like shock absorbers. If you've ever driven on the on the interstate and you see the trash barrels right below the abutment of the overpass and what those are, they're trash barrels filled with water so if you drive off the road and you hit them it'll slow you down so you don't slam right into the bridge. Tribecula kind of the same way they're kind of like shock absorbers so they're filled with with space and water and so when you land they compress but they can fracture over time and then you compress and then the subconvial bone actually gets denser and so you'll see this in arthritic research well this they'll see the the precipitating changes of the So condor bone gets denser and denser and denser. Well that's gonna reduce our blood flow to the cartilage. The cartilage will slowly wear away and it gets thinner and thinner and thinner. So now we're losing our electromagnetic effect. So now we can't keep the joint farther and farther apart. And so now we do get compressive strategies that will actually become destructive. And so again, on that end, that's pretty much how I see a lot of these arthritic changes occurring because it's a pressure-related phenomenon. It's a blood flow-related phenomenon. nutrition to the cartilage. By the way, discs do the same thing. Okay, don't tell anybody. Now, how do we get medial compartment versus lateral compartment? So now we've got to think about our propulsive strategies. So our propulsive strategies are what we apply into the ground. And so propulsion in and of itself is biased towards internal rotation. So we have to apply pressure into the ground. So remember when, when we evolved, we were, we were actually rotated. We were swimmers. We came up on land. We had to learn how to internally rotate and press into the ground. Johnny, when we talk about the internal rotation, I got to internally rotate my femur. because I got to drive down into the ground through internal rotation. So more often than not, I'm going to be applying a little bit more force towards that medial compartment as I internally rotate the femur to push into the ground. And so if we talk about the pressure mechanism that we just talked about in regard to the arthritis, that's why we would probably see the bias towards more medial compartment problems than lateral compartment problems because we're applying forces into the ground. We have to just because of gravity. Okay, so I'm going to breathe for a second. That's a lot to cover. Hope you guys have some questions. I'd be happy to answer those to the best of my ability. But that's kind of what we're talking about. Bones not touching and how we develop arthritis in a nutshell. I hope it was useful for you. Have a great weekend and I'll see you next week.

And so, Johnny, when we talk about the internal rotation, I have to internally rotate my femur because I need to drive down into the ground through internal rotation. So more often than not, I'm going to be applying a little bit more force towards that medial compartment as I internally rotate the femur to push into the ground. And so if we talk about the pressure mechanism that we just talked about in regard to the arthritis, that's why we would probably see a bias towards more medial compartment problems than lateral compartment problems because we're applying forces into the ground. We have to, just because of gravity. Okay, so I'm going to breathe for a second. That's a lot to cover. Hope you guys have some questions. I'd be happy to answer those to the best of my ability. But that's kind of what we're talking about—bones not touching and how we develop arthritis in a nutshell. I hope it was useful for you. Have a great weekend and I'll see you next week.