And so, yes, you probably are looking at someone that is making their right turn. This is based on the expansion and compressive strategy that you're using. If you're observing this through the thorax, you're also going to see it in the pelvis, but it's a little bit easier to see in the thorax. So let me grab my typical little thorax model so we can see this. So Eli what you're looking at if you're looking up inside the thorax, so again my stick is always representative of the spine and I'm going to stabilize this sternum for you. What you're looking at is a shape change that looks like that. As they turn, so they're there. So this is a right turn, so you can see the shape change in the thorax. And so then your goal is to reestablish their ability to do that as well. And so really if you look at it from a strategy standpoint, you're going to pass through that middle range anyway, and so really what you're not looking to do is to create the uniform expansion; you're just trying to get them all the way to the other end of the turn so they can turn in both directions, although there's always going to be the bias of being a human from the asymmetrical forces standpoint that we all deal with on the inside. And so again, I think your perception of what you should be doing, since you asked this question, is yes, you do need to get them to be able to reorient their thorax, alter the compressive and expansive strategies to allow them to turn fully in the opposite direction. So I think your perception is correct, young man. So keep working on that.

You're probably looking at someone who is turning right. This is based on the expansion and compressive strategy you're using. If you're observing this through the thorax, you'll also see it in the pelvis, but it's easier to see in the thorax. So let me grab my typical thorax model. Eli, what you're looking at, if you're looking up inside the thorax, my stick represents the spine. I'm going to stabilize this sternum for you. What you're seeing is a shape change that looks like this as they turn. This is a right turn, and you can see the shape change in the thorax. Your goal is to reestablish their ability to turn. From a strategy standpoint, you're going to pass through that middle range anyway. You're not trying to create uniform expansion; you're just trying to get them all the way to the other end of the turn so they can turn in both directions, though there's always going to be a human bias due to asymmetrical internal forces. Your perception of what you should be doing is correct. You do need to get them to reorient their thorax and alter the compressive and expansive strategies to allow them to turn fully in the opposite direction.

Compensatory strategy or vice versa where I have an inhaled axial skeleton and you use an exhalation compensatory strategy. But we're talking about thoracic outlets specifically. What we're looking at is the area of the rib cage from above the second rib and above T4 in the back. So this is sort of like if you looked at the cap on the thorax, this would be that area there. And so you're looking at a compressive strategy primarily anterior where you're pulling the manubrium down as an exhalation compensatory strategy. And in doing so, we reduce the space between the clavicle and the upper rib cage. And so that's where that compression takes place. That's where you lose the full excursion of the neurovascular that comes from the neck and in the upper quarter down into the upper extremity. And so then the way to alleviate that is obviously to reverse these compensatory strategies. So what the ISA is, it leads me to determine what the sequence of compensatory strategies will be. Because if I have a narrow ISA, they tend to use a predominant anterior compressive strategy first, and then move to the posterior compressive strategy, whereas the wide ISA will start with a posterior compressive strategy and then move anterior. Ultimately, though, if I had a wide ISA with a thoracic outlet problem or a narrow ISA with a thoracic outlet problem, they're at about the same level of compensatory strategy because it does involve the same structures of the manubrium and the influence on the position of the clavicle, which creates the compressive strategy between the upper rib cage and the clavicle itself. And so again, ultimately the reason that you would want to identify the ISA dynamics is to determine where you are on these compensatory strategies, and then that determines what intervention I'll use to alleviate and try to restore this full excursion of breathing so I don't have to rely on the compensatory strategy that's causing the compression in the first place. So again, that's why I would use the ISA. I don't use it as a particular diagnosis. If it became a shoulder pain, neck pain, or hip pain, I would still be looking at the ISA because it's going to lead me in the direction of what compensatory strategies you're using that's creating this compressive strategy in the first place.

I'm trying to help a certain sect of people get better as I try to get better myself. And so if there's information that I can provide that they can utilize to help them improve whatever processes that they're utilizing, whatever profession they may be in, then hopefully that sect will benefit. And so that's who I'm talking to. It's just a very specific group of people, hopefully you're in that group. You're finding benefit to the information and you're able to utilize that to the best of your ability. So hopefully that answers that question again.

If I compress the posterior thorax by pushing it forward in an exhale fashion, I get an anterior shift of my center of gravity. With my feet anchored to the ground, as the thorax shifts forward, I have to compensate. The pelvis will eventually follow to resist this. I can resist to an extent, unless I use another superficial compressive strategy that would sway the pelvis under, and that does happen but much later in the compensatory sequence. Typically, the earlier compensatory strategy is to compress the posterior aspect of the pelvis, causing it to orient forward, just as compressing the thorax shifted it forward. This forward shift of the center of gravity, because the hip joint and lower extremity are anchored, means the pelvis is going to tip forward with it. So, Tim continues, if an anterior pelvic orientation yields a mess of hip internal rotation, we have to be pretty far forward for it to get a lot of hip IR. What's the situation of the wide power-lifting type folk that live in the anterior orientation yet have a zero internal rotation? So here, Tim, we're talking about a massive amount of compressive strategy. My ability to produce force against massive loads that create internal pressures of significant magnitude means I need a massive amount of compression. So power lifters end up compressing the anterior-posterior pelvis rather aggressively, which increases the concentric orientation of superficial musculature on the anterior and posterior aspects of the pelvis, and the resultant is that I compress the hip joints straight into the hip socket. Oftentimes, you'll see them lose a tremendous amount of external rotation and internal rotation. For instance, I had a high-level power lifter whose total hip excursion was roughly 25 to 30 degrees, and he was biased into external rotation to such a severe degree that under normal circumstances based on the typically taught zero point, he had minus five degrees hip internal rotation. That's typically why you see that type of measurement on really high-level power lifters. They are anterior oriented, they are nutated to begin with, they are compressed. This is very deep into a compensatory strategy that is a performance enhancement for lifting heavy things. It's not something we typically recommend for health, but this should give you an idea of why you see that type of measurement.

So Tim actually has a third question. He asks, in a perfect world, do we start at the first compensation? Teach the wides to exhale. So that's a compensatory inhalation strategy if they are wide ISA. So he wants to know if we teach the wides to exhale and if we teach the narrows to inhale. I would say yes, because what we need, Tim, is a dynamic ISA, which would be representative of the ability to move the diaphragm. So if we can't move the diaphragm into an inhaled or exhaled position, it becomes very, very difficult to change anything else. And a lot of times, just by getting the ISA to move dynamically, getting more excursion of the thoracic diaphragm and the pelvic diaphragm, we see a lot of good things happen. So a lot of times on the first intervention, you'll see a lot of changes in regard to how much internal and external rotation you can recapture in both the hip and the shoulder just by your intention being to get the ISA to move much more effectively. So yes, you would go there first.

So that's how that happens. If I was to try to maintain my ability to expand anteriorly and posteriorly, I might not be able to produce as much internal pressure. Therefore, I might not be able to lift as much weight and therefore I might not gain as much hypertrophy. It doesn't mean you can't gain any. It just means that that might become a limiting factor. So there's probably somebody out there that falls at one end of this imaginary normal curve that can do it all, that can maintain all of their mobility, that can maintain their anterior posterior expansion and still gain massive amounts of hypertrophy, but I think they're the exception to the rule. So we have to respect the fact that there are outliers, but they are not representative of the normal population, nor are they typical. And so I would say under normal circumstances, typical circumstances, if you try to maintain full movement capabilities, that you will actually limit your ability to produce force. So you will limit your strength ultimately. You will limit your hypertrophy development. But that doesn't mean that you don't perform well under sporting circumstances and so forth. It just means that if you were to try to take it to the extreme, you'll probably have to give something up as a secondary consequence in return for whatever hypertrophy and strength you desire.

I would never use this technique under extreme loads, but I might have them sit to the box and then take the inhale while they're there and then an exhale as they move towards the sit to stand portion of the exercise. So again, there's a lot of ways that you can bias this if my goal is to restore the eccentric capabilities of the pelvic diaphragm or to overcome the compensatory inhalation strategy. But again, I would try to bias them towards inhalation from the get-go by position. So again, there's lots of ways that we can modify the box squat depending on what our specific needs are or the intervention that we desire. And that's one of the reasons why I love that exercise so much.

I think what we need to do is look at the relationships of how all of these parts interact to produce expansive and compressive strategies because that's ultimately how we move. Our last question for this week's Q&A comes from Misha. Misha, could you please go over in more detail how the anterior posterior compression of the pelvis restricts hip motion? Absolutely, I can. I'd be happy to. Misha, I would also, before I dive into this with the pelvis, I would say that the exact same process occurs in the thorax. It's really easy to see in the thorax because the distance that the gradients travel in the thorax for the compensatory strategies are just much easier to see. So we got a lot more time per se for these transitional strategies. In the pelvis, the gradients are very, very narrow. So let me show you what I mean. I'm going to grab my pelvis here. So if we look at the front of my pelvis and we look at the pubis here. So there's my pubic synthesis between my two fingers there. And then if I was to look at my sternum, my sternum is that wide. So again, I have more distance to cover with my inhalation, exhalation, gradients. And so what happens in the pelvis is that these transitions occur very, very quickly to the point where they almost seem to be simultaneous. They are occurring simultaneously just to different degrees but again I would encourage you to look at the compensatory strategies as they evolve in the thorax because it's just much easier to see and then just translate that to the pelvis. Since you asked about the pelvis we will go ahead and we will run through that. And so if I am utilizing a compensatory breathing strategy that promotes a compressive force on the front side of the pelvis, what's going to happen is I will lose internal rotation capabilities at the hip. Reason being is, if I compress the front, that means that the volume that comes down in the pelvis will be biased posteriorly, so I get expansion here. Now if you look straight down in the pelvis, and this is a plastic model that doesn't move, the pelvis actually changes shape. When I push more volume into the pelvis, it will change shape. So if I have a compressive strategy here, I get an elongation in this direction of the pelvis. That changes the orientation of the muscle fibers that attach posterior to the trochanter. So what happens is they pick up concentric orientation. So I get eccentric orientation of the front, concentric orientation of the back. And so what happens when I compress the front and expand the back, I pick up ER. and I lose the IR because if I have eccentric orientation here, I have a fluid volume in the front part of the hip joint that I cannot move into. I cannot compress that fluid because I have concentric orientation on the backside. Now, if I reverse gears and I say I have a posterior compressive strategy, which means that I'm going to push the volume into the anterior part of the pelvis, what's going to happen there is I'm going to pick up concentric orientation on the front side of the hip and I'm going to gain internal rotation because on the backside that because of the compressive strategy, Or yeah, because of the compressive strategy here, I changed the shape of the pelvis. So now I get a widening of the pelvis here that increases the length of the muscle fibers on the backside that happen. So now what happens is I have an eccentric orientation here. I have a volume expansion here. And I can't move into that, into extra rotation. And so what happens is I get pushed in this direction by the concentric strategy here, eccentric strategy here. And it turns inward. Typically what you're going to see under most circumstances again because these gradients are occurring very very quickly because they typically present visually and from a measurement standpoint they're going to present from the bottom up okay as I fill up the pelvis like a glass of water with the volume that comes down. You're going to see a lot of these strategies occur simultaneously. So that's why it becomes very, very important for us to distinguish between how much ER and IR capabilities we have. So we know where the compressive strategies are. We know where you're capable of expanding if you are. And then we know what kind of shape change that we have for the pelvis. that we have to intervene with to make the physical changes. So do I need to create more expansion? Do I have to restore the inhalation capabilities of the pelvis? Or do I need to increase the compressive strategy of the pelvis to overcome the limitations that are demonstrated in the hip joint? So hopefully Misha, that answers your question. If I was unclear, then please ask that question again and we will try to go through it again next time. That's all I have from Q&A standpoint for this week. So hopefully you have a great week. Check me out. I shouldn't say check us. I'm the only one here. So check me out on Instagram because I will be there all next week and we'll be throwing up videos on the YouTube channel as well. If you have any special requests as to what you would like to see on YouTube or on Instagram, please throw those up on those platforms as well. Or you get to email me directly at askbillhartman at gmail.com, askbillhartman at gmail.com and I will answer your questions on that platform as well.

I cannot compress that fluid because I have concentric orientation on the backside. Now, if I reverse gears and I say I have a posterior compressive strategy, which means that I'm going to push the volume into the anterior part of the pelvis, what's going to happen there is I'm going to pick up concentric orientation on the front side of the hip and I'm going to gain internal rotation because on the backside that because of the compressive strategy, or yeah because of the compressive strategy here, I changed the shape of the pelvis. So now I get a widening of the pelvis here that increases the length of the muscle fibers on the backside that happen. So now what happens is I have an eccentric orientation here. I have a volume expansion here. And I can't move into that, into external rotation. And so what happens is I get pushed in this direction by the concentric strategy here, eccentric strategy here. And it turns inward. Typically what you're going to see under most circumstances again because these gradients are occurring very very quickly because they typically present visually and from a measurement standpoint they're going to present from the bottom up okay as I fill up the pelvis like a glass of water with the volume that comes down. You're going to see a lot of these strategies occur simultaneously. So that's why it becomes very, very important for us to distinguish between how much external rotation and internal rotation capabilities we have. So we know where the compressive strategies are. We know where you're capable of expanding if you are. And then we know what kind of shape change that we have for the pelvis that we have to intervene with to make the physical changes. So do I need to create more expansion? Do I have to restore the inhalation capabilities of the pelvis? Or do I need to increase the compressive strategy of the pelvis to overcome the limitations that are demonstrated in the hip joint?