So you take a full beer, right? Don't pop it. Don't pop the top on it. I know you have to buy canned beer because you're a student. You have no money. So, so you, but you can stand on a full beer can because you're compressing the, because the fluid inside holds you up. You, you chug your beer, put it down on the ground. You go and it crushes like a grape. Good morning. Happy Monday. I have no coffee in hand and It is perfect. All right. Wow, got a busy Monday coming up. Quick reminder for those of you that are IFAST university members, we have a conference call today at 1 p.m. Eastern Standard Time, so please be there for the live call if you can. Those are always great, great questions. Speaking of questions, today's Q&A is with Victor, and we covered a lot of ground in this call. A couple of main elements though was the influence of body position on the table as how it can change the perception of some of your measures and why you might see certain things in certain positions as you change position on the table and then why do we restrict relative motion to produce force and how this actually influences things. So I give a couple of examples that are hopefully useful under those circumstances. If you would like to participate in a 15-minute consultation, please go to askbillhartmanedgymail.com, askbillhartmanedgymail.com, put a 15-minute consultation in the subject line so we can arrange that at our mutual convenience. Got to run, got a busy day. You guys have a great Monday, and I'll see you tomorrow. So the camera is rolling. The clock has started. Victor. I've been calling you, Jenny, this whole time. What is your question?

All right, so I've been going through trying to get some expansion in my anterior thorax and posterior thorax just for my own progress, and I've noticed that when I lay supine now my ribs don't flare as much. What is that? The anterior inferior portion of my rib cage does not protrude, or I guess I'm not as posteriorly tilted in the thorax as much as I was when I lay supine. So the question became why getting expansion in the upper thorax—both the upper back and the anterior thorax—might help that. I actually pictured this as like lower posterior compression and your upper compression almost tilting the whole thorax posteriorly, but that's my thought. I just wanted to hear what you have to say about that.

What is that?

The anterior inferior portion of my rib cage does not protrude, or I'm not as posteriorly tilted in the thorax as much as I was when I lay supine. The question became why getting expansion in the upper thorax, both the upper back and the anterior thorax, might help that. I pictured this as like a lower posterior compression and an upper compression almost tilting the whole thorax posteriorly. But that's my thought. I just wanted to hear what you have to say about that.

Okay, so under most circumstances, what you're actually representing is the anterior orientation in the pelvis and in the thorax. But when you lay down, there's a tipping point where there's enough mass above this point where you're mostly tilted forward where everything will fall back. And so it creates this perception of the lower rib cage being positioned anteriorly. So people get confused. They say, 'I have a posterior orientation.' No, you don't. You have an anterior orientation. The constraint of the surface upon which you are lying is creating an upward force. And so then the shape of your thorax and pelvis actually change its orientation to whatever degree is allowed. Now, in some cases, there's so much compression that people don't tilt backwards on the table. And in some cases, they do. And so this is one of those things that skews measurement. So when I talk about the usefulness of iterations and then your checks and balances between your ERs and IRs, this is where a lot of people get confused because they say, 'Bill, my numbers don't match.' And I say, 'Yes, they do. You just have to account for the shape change that's associated with the constraints because it's no different than somebody actually having a true constraint change in a joint that creates a limitation in motion or an increase in range of motion.' I don't know, take a labrum tear in a shoulder. It will magnify a range of motion in one direction and take it away in another. That would be a representation of a constraint change that's internal that we do nothing about. But basically, that's what you've done. So that's the beauty, if you will, of the table tests is that it does create a constraint for us to make a comparison against, but you just have to know what the rules are in that regard. It's like in some cases people are going to reorient themselves relative to the table and in some cases they won't. And so again, if you understand that, then there's a tremendous amount of clarity and usefulness in your, if you're one of those people that do table tests, then they become very useful because there's checks and balances throughout that clarify what really is going on in regards to the shape of the individual.

Okay. So on your point of like somebody might be so compressed that they don't tip posturally, but somebody could also be compressed, but they will tip posturally.

Correct. Let me give you an example. Okay, so you're measuring traditional shoulder flexion on somebody. The person that doesn't tilt back has a very significant degree of shoulder flexion limitation. So let's just say they have 100 degrees of traditional shoulder flexion, okay? And then you have the person that tilts backwards. So let's just say they have 100 degrees of traditional shoulder flexion. They have about 70 degrees of traditional shoulder external rotation as you would measure on the table, okay? Take the other person, the person that hits the table, rolls backwards, they now have a magnification of those two measures. So even though shoulder flexion may be limited to a significant degree, they might show like 150 to 180 degrees of shoulder flexion, and they'll show you 120 degrees of shoulder external rotation by traditional measures. And so what happens, incorrectly, is these people get branded with that so-called concept of laxity, and that doesn't happen, right? It's just an orientation on the table in this circumstance. It's not looseness anywhere. But if that's the model that I've used, because it is the structural reductionist way, they say, oh, anytime you get an excessive measure because their concept is like, I'm looking through this singular lens, I'm just looking at your shoulder and I'm not considering the fact that ER and IR are systemic measures. They're not isolated to an area until you have the superficial compressive strategies, then they are isolated to that area. That's why the measures suck. So when I have limitation in a joint range of motion of significant degree, that's pretty indicative of that superficial compression, right? Because when I move a shoulder, everything has to move.

Okay.

The person that doesn't tilt back has a very significant degree of shoulder reflection limitation. So let's just say, if you're using comparisons to the averages that they teach you in school, which are absolutely wrong, then we would say that this person, let's just say they have 100 degrees of traditional shoulder flexion, okay? And then you have the person that tilts backwards. Okay, let me back up. So let's just say they have 100 degrees of traditional shoulder flexion. They have about 70 degrees of traditional shoulder external rotation as you would measure on the table, okay? Take the other person, the person that hits the table, rolls backwards, they now have a magnification of those two measures. So even though shoulder reflection may be limited to a significant degree, they might show like 150 to 180 degrees of shoulder reflection, and they'll show you 120 degrees of shoulder external rotation by traditional measures. And so what happens, and incorrectly, is these people get branded with that so-called concept of laxity, and that doesn't happen, right? It's just an orientation on the table in this circumstance. It's not looseness anywhere. But if that's the model that I've used, because it is the structural reductionist way, They say, oh, anytime you get an excessive measure because their concept is like, I'm looking through this singular lens, I'm just looking at your hip or I'm just looking at your shoulder and I'm not considering the fact that ER and IR are systemic measures. They're not isolated to an area until you have the superficial compressive strategies, then they are isolated to that area. That's why the measures suck. Right? So when I have limitation in a joint range of motion of significant degree, that's pretty indicative of that superficial compression, right? Because when I move a shoulder, everything has to move.

Yeah.

And that's what's underappreciated because, again, at school, they teach you like the shoulder moves this much. It's like, no, when you measure ER at this point in this way, it has this much. There are many contributors to that range of motion. It is not. Just because you're saying I'm measuring the shoulder doesn't mean you're measuring the shoulder. You're absolutely wrong, right? You're measuring the system.

Yeah, it's kind of like being called Johnny and it's just not my name.

But that's your own damn fault. You're the one—your email comes to me and it says, right? It's like, come on, what am I gonna say? And then you didn't correct me, that's your phone.

So I have a perfect example of that. I was working with my dad who had right shoulder pain from racquetball for the last 20 years, with super limited shoulder range of motion on that side. I performed tractioning of the scapula, turned his head towards me, and facilitated big breaths to expand the upper back. His external rotation improved. Then I worked to get his ribcage more flat on the table by bringing it from a posterior orientation. This made his external rotation worse. The old me would have been confused about why it worsened in that moment. Then I realized what you just said—it was a whole reorientation. We didn't actually get the expansion; you have to get the whole orientation first, then get the expansion.

There's a chance that you just, by traditional representation, is that you flexed the thorax. You did not expand it posteriorly. If I bend the spine forward, that is not necessarily expansion.

Yeah. OK. What is before it? So I measured his ER, it was like maybe like 20 degrees, 30 degrees, pretty horrendous. Yeah. And then so I just did, he was laying supine, took his right arm traction to kind of like AB induction of the scapula, turned his head towards me and get some big breaths. And then his ER just dropped like 90 degrees. Yeah, and then we worked on some more respiration. Ribcage looked a little bit more, like I said, actually tilted or flat on the lower post to your part and his ER got worse again. And that's, I was like, okay, well, might as well start here, I think. Cause I think I've heard you say before, like that's kind of the first, like reorient first and then work on the expansion.

You see what you did?

Yeah. What came before it? I measured his external rotation, which was about 20-30 degrees—pretty poor. So I had him lying supine, applied traction to his right arm to induce some scapular depression, turned his head toward me, and had him take some deep breaths. His external rotation then improved by about 90 degrees. Then we worked on more respiration. His ribcage appeared somewhat flattened in the lower posterior region, and his external rotation worsened again. That's when I thought, okay, I may as well start here. I recall you've mentioned before that this is the first step—reorient first, then work on expansion.

Always reorient. Because you can't re-acquire all of the relative motions without reorientation because the orientation is caused by the superficial musculature locking segments together. If they all move together, there's no relative motion there. If there's no relative motion, then there is no expansive capabilities where things have to move, they literally have to move apart to create the space. And so if they can't do that, then you're not going to get the change. You might actually get some other reorientation, where the whole segment turns, and that sort of magnifies some of your ERs and IRs as well, but again, it's not the true relative motions. And the way you would know that is because you would just measure all your other stuff and you make your comparisons, you can go, wait a minute, that doesn't really fit. And that's how you know that you had something like a whole segment of the body turned, like the whole pelvis turned or the whole thorax turned, because you get a magnification of one measure, but you don't get restoration of the others.

I gotcha.

That's why there's checks and balances that are built in. And so we take advantage of those. Again, that's how you know what you're looking at and you know whether your intervention actually works because people throw these little parties when they make these subtle gains in motion and all they're getting is changes in orientation, not the relative motions, if relative motion is the goal. And in many cases, when you're dealing with people that they're dealing with pain related issues, the starting point is to restore relative motions, first and foremost. You eliminate all other possibilities as to what it may be.

Yeah, that makes sense. When you were talking about relative motions, this brought up another question that I've had. Why increasing relative motions seems to decrease force production and vice versa. I'm having a hard time understanding why that would be.

And I'm just curious to why you cut out on me for just a second. Please repeat it.

If I increase relative motions, that would decrease force production capabilities, and vice versa. Yes, I'm having a hard time understanding why that would be.

Okay. So I live in Indianapolis. I'm going to tell you an Indianapolis story. And I know very little about racing. The Indianapolis 500 is big here for some reason, not really sure. It's probably like one of the oldest races ever. Anyway, so here's one of the things I did learn about these cars. The older cars were made out of the fewest number of pieces possible. They were very heavy and they were one piece. The drivers would hit the wall at high speeds, and accidents happened. When they hit the wall, the cars would be held together, and the driver would absorb all of this force. So you had one car, one driver, basically two pieces. They hit the wall. The car doesn't collapse. Like literally these things were made out of metal and stuff. The driver absorbs the force, so they had so many more injuries and deaths associated with the accidents. What the cars do now is they explode. When the car hits, it breaks into as many pieces as it can break apart into. Each of those pieces absorbs some of the impact and spreads the impact out. Then the driver doesn't absorb the force; all the little pieces do. This dissipates the force among many parts. The driver doesn't absorb it, so the driver doesn't get hurt. Their survivability is increased, and the risk of injury goes down dramatically. That's relative motion. All of these little pieces represent moving parts, and each one absorbs some of the force. This dampens all the force so the driver doesn't absorb it. You are the same way. The more moving parts you have, the more you distribute the force. If you distribute the force, it can't be focal enough to have any significant input. So you have to lock things together to produce the maximum forces. Then you release that, and that's what allows you to demonstrate velocity. Let's go back to the car example. Those pieces go flying at hundreds of miles an hour. They go really fast. They fly apart really, really fast—it's like an explosion. We follow the same rules. We have to compress and squeeze and limit relative motions to produce high forces. Velocity is the other end of the spectrum. We have to have lots of expansive capabilities available to demonstrate the velocities because they're not the same. Does that make sense?

It does. So I guess my confusion still is like, let's say I'm squatting, I have like a 500 pound barbell on my back and I'm gonna do a back squat. So I still have to produce, well probably more than 500 pounds to actually move the bar. Whether I dissipate the forces through across my whole body versus locking everything down, I still have to produce the same amount of force. So I guess my confusion is, why does decreasing the relative motions and making the force focal help me specifically like limiting the relative motions? Why is that beneficial? Because in my mind, I would have to produce the same amount of force anyway. This is my question.

It makes sense. But see, okay, so what direction do the forces go? If you're not locked into a single piece, what direction do they go? Do they go up into the bar or do they go all different directions like the exploding car? Yeah, you see? So again, it's like you have to direct the force to produce the outcome that you want, right? There's no way to do it if you don't lock everything into one piece.

Get it? Okay. Yeah, that makes way more sense, especially with your model with the more like fluid-based physics perspective, like that makes more sense to me.

Well, you lift heavy things with columns of water. Always remember that. Because muscles can't lift them.

Got it.