So the narrow can get into the squat better, but the wide can actually come out of the squat better.

Probably not.

Not as stiff.

Right. So I start to create a yield and distribute the force. What you have is a representation of a very focal force application on the bone. First and foremost, I want to teach how to distribute that force. It helps alleviate symptoms. So I get less focal load. There might be shape issues associated with foot position, tibial orientation, femoral orientation, pelvis orientation. You still have to address those. Then you bring him back to have the ability to apply the same force that brought him to you, but teach how to distribute it more effectively. So maybe capturing enough internal rotation somewhere that he doesn't have to do it through the bone. Learn how to distribute that force more effectively. You're not wrong—you need both. But when thinking about treatment initiation, don't do the same thing that got him there. Chances are that's not optimal. It's like how you fix a hangover—drink more alcohol? Not usually the best solution. The thought process is solid, but change the application. You have many options, and chances are he doesn't respond well to one of them—apparently it's the high rate, high force because he's not distributing it well. Does that make sense?

He was limited internal rotation on the right and more internal rotation on the left.

Okay. So think about this. Is it coming from the hip?

You're going to guess no. Okay, so think about the orientation. What should have dropped off is hip IR on the left side, right? That's typically what you're going to see from a process standpoint. So I will give you a hint, Zach. It's probably not coming from the hip. Okay, so where's it coming from?

Yeah. So when you move the hip, the pelvis is already going forward. The spine turns away from you as you measure the internal rotation. So you get a magnification. Even if you got zero right and you get 20 on the left and you say, 'Well, that's not an exaggerated internal rotation measure.' Yes, it is because he shouldn't have any. So you have a spine that's turning away from you as you're measuring that left hip IR. So now think about the orientation of the pelvis. How do you get internal rotation on this side of the pelvis when you don't have any internal rotation here? I'm going to demonstrate that. So now I've got an acetabulum that's facing straight down and jamming this leg into the ground. That seems like a recipe for maybe a little bit of bony stress.

Maybe so. Maybe so. But what you might end up with, and this would be potentially a little confusing, is you might go, but he's got a lot of hip flexion. Right? It seems like he might have more hip flexion than he should. Or he's got a little bit more straight leg raise than you thought he would have.

Yeah. He's got like 90 degrees straight leg raise on both sides.

He's 26.

Okay. So he's 26 years old and his right side just grew an extra centimeter relative to all the other bones in his body and they want to cut off the end of his ulna. Has anybody ever heard that one? Have we ever seen a distal ulnar excision? Yeah, exactly. Yeah, it's like you take somebody that apparently has a fully calcified skeleton and then suddenly they say, well, it has ulna got too long. That's kind of what you're dealing with, okay? And the ulna didn't get long. The radius got short, okay? In normal, like if you had like totally average everything full-moving capabilities in pronation as you take the palm down, the radius moves over the ulna, you understand that concept right? Okay? because you're taking a bone that was relatively straight and you're putting it on an angle, its distance from the elbow is shorter, right? It becomes sort of like the, I don't wanna say it's the hypotenuse in the triangle because the triangle's changing shape, but anyway, radius gets shorter relative to the ulna by its distance from the elbow. which makes the ulna appear to be longer. And that's normal. That happens under every circumstance, assuming normal anatomy, which means that you lose, in pronation, you lose ulnar deviation and extension by traditional measures. Okay?

His right ulna just grew an extra centimeter relative to all the other bones in his body, and they want to cut off the end of his ulna. Has anybody ever heard that one? Have we ever seen a distal ulnar excision? Yeah, exactly. Yeah, it's like you take somebody that apparently has a fully calcified skeleton and then suddenly they say, 'Well, the ulna got too long.' That's kind of what you're dealing with, okay? And the ulna didn't get long. The radius got short, okay? In normal anatomy, if you have totally average everything with full-moving capabilities in pronation as you take the palm down, the radius moves over the ulna. You understand that concept right? Okay. Because you're taking a bone that was relatively straight and you're putting it on an angle, its distance from the elbow is shorter, right? It becomes sort of like... I don't wanna say it's the hypotenuse in the triangle because the triangle's changing shape, but anyway, the radius gets shorter relative to the ulna by its distance from the elbow, which makes the ulna appear to be longer. And that's normal. That happens under every circumstance, assuming normal anatomy, which means that you lose, in pronation, you lose ulnar deviation and extension by traditional measures. Okay? So if you put somebody in all fours and they get pain on the back of their wrist or they get ulnar side wrist pain, right? He is living sort of in this pronated representation. So when he was a waiter, and I'm just throwing this out there since you brought it up, when he was a waiter, he had to do like the early stage of an overhead press all the time. Chances are he eventually did do some overhead pressing with the position of the wrist that we're talking about. So if he has an adaptation in the radius that causes an inward rotation, that can be part of it. But there are a couple of things he might have to do. If he has a pronated hand relative to the rest, right, and that's... you can do the little apple test, okay? Where you go like that, and then you release it. And if it doesn't go any farther, chances are you've got eccentric orientation of abductor pollicis longus, which means you do have a pronated hand. Then you're going to need to untwist the hand, which is going to require supination relative to the rest of the forearm. So you could do like a supinated bent-over elbow extension with a cable, bent over in internal rotation. That'll get the hand orientation to come back. Sometimes you can do a curl in the same position with the thumb pressing into the dumbbell. So you get the constant orientation back along the radial side of the thumb. So those two positions are useful.

If he's missing a lot of shoulder internal rotation, you can do like a side plank-ish, oblique sit kind of a thing with pronation. So you're going to internally rotate, internally rotate, internally rotate, internally rotate together. But I would caution you that with the hand in the pronated position, I would take a folded towel and put it under this part of the hand because I don't want this part of the hand to pronate. I want this part of the hand to pronate. His chances are he was pronating this part already. So if I block this part like that, then I can get all internal rotations without the excessive pronation of the hand orientation because that's where he's symptomatic. So you have to reorient the hand first to restore IR, IR, IR, IR, and then IR here. So you have to reorient the hand first. That's going to require a supination activity and then turn everything into orientation together.