We talk about pec minor, a big one. The costoclavicular space is a big one. And then the scalene triangle are all big ones. If you look for references in regards to behavior of the nervous system, you want to look at Butler, Shacklock, and Louis. And so those are the guys that are gonna talk about the movement of the nervous system. And in each case, what you'll find is that the nerves like three things. They like space, they like movement, they like blood flow. And thoracic outlet or pec minor syndrome or whatever they're gonna call this thing immediately takes away all three. So we lose our space, we lose movement, and we lose blood flow because you get that neurovascular sleeve that tracks out of the neck underneath the clavicle, in front of the rib, and under the pec minor down into the arm. And so if we have any form of compressive strategy under those circumstances, we're probably going to get some variation on the theme of any of those symptoms. But if we look at this from a progressive nature, so if we talk about symptoms at pec minor under those circumstances, typically what we're going to have is a down-pump handle under those circumstances.

And so what we're going to lose here from a measurement standpoint is our traditional measures of shoulder internal rotation, which you would measure at 90 degrees of traditional abduction. If we go farther up, if the compression strategy is moving upward and we're going to get a manubrium that gets pulled down, this is where we're going to see symptoms at the costoclavicular space. And what we're going to lose here is we're going to lose internal rotation behind the back. So your old school aptly scratch test where you reach behind your back, try to touch the opposite shoulder blade, you're going to lose internal rotation there. As we move up the sequence of events in regards to compressive strategies, if we get compressed in the upper dorsal rostral space, this is where we're going to start to see the issues in the scalene triangle. So we're going to lose lower cervical rotation to the affected side. You're going to get some pain with rotation away from the affected side as well. You might get cervicogenic headaches. You're typically going to have some symptoms that are well above the clavicle under those circumstances. So again, your traditional tests are going to be cervical rotation, as well as the traditional abduction external rotation test, which looks like that doorway stretch, which we'll talk about here in just a second. But what we may not lose, and this is kind of an important thing to pay attention to, is we may not lose our early flexion range of motion because we may not be looking at end range strategies because what we probably see under these circumstances more often than not is anything that's dorsal, rostral, or sternal and above being the primary influences in regards to the compression. Now, let's talk about traditional strategy first under many circumstances so that the stretch and strengthen model that many will default to for some unknown reason may actually work occasionally. But it's kind of iffy. And I think it's even iffy in the research when you look at it. So you'll look at something like the traditional pec doorway stretch, like I mentioned just a minute ago. Under those circumstances, you're trying to influence a concentrically oriented muscle by yanking on it. So you might get a yielding strategy out of that and get maybe some temporary symptomatic relief if you can hit a breath under the right circumstances. So if I had like a down pump handle but I don't have dorsal rostral compression, yet that position actually might bring the pump handle up if I take a breath at the right time, and then I actually do favorably influence symptoms. But if I have dorsal rostral compression, at the same time, then it's going to be an exercise in futility.

This is also a situation where I wouldn't want to use like the traditional lower trapezius strengthening or scapular muscle strengthening because all I'm doing is reinforcing the compressive strategy A to P and I'm really not going to impact symptoms. In fact, you're probably going to produce symptoms during the treatment in and of itself. So what we really want to do here, Zach, is we want to start to create expansion from the bottom up. So the lungs fill from the bottom up. So let's think along those lines as far as strategy is concerned. How we're going to approach this from narrows to wides is not a whole lot different. It's just going to be where we're going to start our influence. So if I'm talking about a wide ISA, I'm going to start with dorsal rostral expansion as my primary target. Under these circumstances we've got any number of activities that we're going to utilize to try to expand that dorsal rostral space. Because of where we're trying to influence this, because of the influence of shoulder girdle position I'm going to stay below that 90 degree level of traditional shoulder flexion to start so I can drive the expansion posteriorly and then again work my way up. If I'm progressing a wide after the dorsal rostral expansion, now I'm going to go after pump handle. But with the narrows, I'm probably going to start with these pump handle activities. So now I am moving the shoulder towards that 90 degrees of flexion. So I've got quadruped activities that I could start with. My arm bar progressions, I can also start with. The cool thing about the arm bar progressions is that I can probably start to superimpose some of the neck range of motion on top of that as long as I'm not reproducing symptoms under those circumstances. Now, if I have limitations that are below the clavicle, then I may not need to go any farther and this might be my solution. However, if I start to see symptoms above where I am getting the neck pain, the headaches that are associated with this, now I definitely have to go after my upper dorsal rostral expansion because I need in-range shoulder flexion and I need lower cervical rotation to the affected side. So under these circumstances what we would look at when I have this upper DR compression is I have a scenario where I cannot get into an early propulsive strategy. And so that's what these activities are going to be driven towards. So again, I can start to use my arm bar progressions with cervical rotation. If you're a kettlebell get up guide, go do the get up to elbow and then drive the shoulder rotation and cervical rotation simultaneously just like you do with the arm bar superimposed and breathing on top of that. And you get a nice big bang exercise just in FYI.

But I want to start to work the shoulder from that 90 degrees and above range. So I'm going to start doing my walkouts from my knees, if I can get to an inverted activity like an inverted lazy bear, then I'm going to go there. Ultimately what I want to be able to do is to hit that end range flexion without symptoms. So I might end up using like a cable activity. But the thing that I want to make sure of, especially with my wide ISA, is that I can close that ISA with that overhead reach. So to get expansion all the way up on a wide ISA, the ISA has to be able to close. Also keep in mind, the idiosyncratic movement strategies associated with the wide ISA typically do not have in-range flexion included there, so be very, very careful with that. Now some counterintuitive stuff which is always kind of fun to play with because there's always challenges with your patients and you may not be able to drive the upper extremities the way you want to without creating symptoms. So now we're going to use some iterative structures to our advantage here. So if I put you in a prone propulsive position, what I'm doing is I'm creating an early propulsive strategy in the lower axial skeleton. So I'm turning the sacrum. I'm turning the lumbar spine, which is analogous to my upper dorsal and lower cervical. And so I actually may be able to drive expansion that way to start to create the early propulsive strategies through the axial skeleton. My offset heels elevated squatting activities will also produce a similar effect so keep those on the table don't forget about about how we can influence this especially when you're when you're really jammed up and you can't seem to drive symptoms or if somebody is too symptomatic in the affected area. One of my favorite totally counterintuitive kind of things is using this curl and press activity. The thing you want to make sure of is that you're doing the curl and the press on the asymptomatic side because what I'm actually doing is I'm pressing that dumbbell overhead and turning my head away as I'm intentionally creating a compressive strategy in the upper dorsal and lower cervical region on the pressing side but in return I get expansion and I get rotation to the opposite side so that's going to actually help alleviate some of the symptoms above the clavicle so this would be much like if you go back to the reverse hyper video how we used the single leg reverse hyper to create some of the turning through the sacrum. We're doing the exact same thing in the dorsal, rostrum, lower cervical space there.

I think it's going to help a lot of people. Truly appreciate you. If you've got any other questions, go to askapilharmonatgmail.com, and I'll see you guys tomorrow. This segment seems like it's all about the bench press lockout, but it's so much more. Good morning, happy Tuesday. I have neural coffee in hand and it is perfect. Okay, a little something different for today. I wanted to post up another segment from last week's Coffee and Coaches call. It was such a good call. We went 90 minutes and you've only seen like a small segment of this. The foundation of this question is about bench press lockouts and methods to address issues with that. But there's so much more in this question, as far as reasoning and decision making, along with the technical aspects of how you might work through this situation where you're trying to improve someone's bench press lockout. So thanks to Manuel for this question to lead us into it. And so let's just go right into the segment from the call.

Bill, I have a question about one of your videos. Unless somebody else has a question.

OK.

Unless somebody else has a question.

Are you going to make me go back and watch one of them?

No, no. I can describe it. No, it's a demo video about improving your bench press lockout.

Oh yeah, with the arm bar thingy?

Yeah, it was an arm bar with your leg up. And I was wondering, can you explain why that works and the context of your model and whatnot? I mean, I can understand just locking out and having something there and rotating, but you had your leg up and you were breathing in a certain way. And so if you could go into that, that'd be great.

So exhalation, intramotation, pronation, all that stuff is force producing. And so what you were looking at is the cognitive effect of that.

OK. Why is your leg up? You had one leg up. I think it was the opposite leg.

Right. Because I'm trying to create a posterior yielding strategy on the opposite side to get expansion on the anterior side so I can capture the internal rotation. I believe I was turning the kettlebell inward, which was in rotation. So I have to have concentric orientation posteriorly. So I'm at 90 degrees of shoulder elevation, which would put the scapula in an upwardly rotated position. But I need concentric orientation there so I can create enough expansion anteriorly as I internally rotate. I need to coordinate internal rotation with pronation and the exhale strategy. The lockout tends to be like an elbow-ish kind of concept.

Yeah. And so in that case, would you also do some supplementary tricep work? Why? Some direct arm work or? Why? or bench press lockouts with the off a board or off.

So what would be most specific to training your lockout?

Doing like rack lockouts or something like that or off a board.

So you're looking at one exercise and then you just gave me five different options of the potential utility, right? Yeah. So which one's right?

I tend to go with the one that has the most carryover, the one that's the most similar.

Right. How do you know which one that is? It's okay. You're on the right track. Say it. I know what you're going to say.

I mean, because it looks like the movement.

Yeah. You just do it because it looks like the right thing to do. That's a good answer. That's legal. Right? It stands to reason if I'm having a bench press lockout problem, I should probably work on the lockout. But what if I identified an element of coordinate deficit? So I couldn't get enough internal rotation. I couldn't get the elbow to extend at the same time. I can't get enough of the yielding strategy that I need to even get the position. But here's what happens. If I bench press a lot, eventually I create so much compression that I can't move. Yeah. So people top out in force production because they create so much pressure, they can't get any stronger because they have no yielding strategies to allow the motion to occur. So it stops the lockout from actually occurring. Very counterintuitive. Like literally, if I compress my sternum hard enough, so think about it. Okay, if you're bench pressing and you're a bodybuilder, why are you bench pressing? Simple answer.

Big chest.

Big chest. Okay, great. So that chest is attached to your sternum. And if the sternum is compressed, I can't internally rotate my shoulder, but to finish my lockout, I need some internal rotation. But what if I compress my chest so much that I can't finish the lockout? I need another strategy that's going to help me coordinate the rotation so I can get the elbow to fully extend. So then launch outs don't work.

Right?

It might be my first experiment because it looks just like I'm trying like, and it might work just fine. But what if I need another strategy?

Like try some extensions.

If you want to think like a structural reductionist, you know, modeler, that's fine.

Maybe I'm trying to move away from that.