Good morning. Happy Tuesday. It is a great day. I had to come into the purple room for a little bit today, so I thought I would just shoot the video from here. So I brought the travel edition of neuro coffee and it is perfect. So I've been going back and forth on email with Eddie from Germany; Eddie's an osteopath in Germany. And we've been discussing how we would utilize half kneeling positions or split stance positions and how it would affect the orientation and behavior of the pelvis. So I thought I would shoot a video and sort of break down the half kneeling position a little bit more in detail than what we've been used to. And hopefully it will answer some questions that you may have as to how you're going to implement this in half kneeling or split stance activities to achieve the outcomes that you've been seeking. So I have my pelvis set up here on the stool in sort of a split stance orientation or half kneeling orientation. So we can manipulate it a little bit easier and show you some of the positions that are very common in regards to execution of certain activities in half kneeling or split stance or some of the things that you're going to see in your athletes or clients. And one of the most common things you're probably going to see is you're going to see people assume this half kneeling or split stance orientation with one hip higher than the other. And what I want you to recognize is that what you're typically seeing under these circumstances is that the pelvis is actually going to be oriented towards the downside leg, but it's also going to be positioned in a position of inhalation. So you're going to get extra rotation of both ilia and you're going to get counter-nutation of the sacrum. Now what this does is it creates a dissension of the pelvic diaphragm. So this is a very low pressure situation inside the pelvic diaphragm which pushes some of the effort towards the extremity musculature which is one of the reasons why you'll see people complain of quad tightness in a split stance or half kneeling position or they'll complain about tightness in the front of the hip or they'll complain about anterior knee pain because they're placing more demand on the extremity musculature. This increases pressure and tension at the joints. And so that might be what they're actually sensing. If we want to create a more stable structure through the pelvis, we have to create a concentrically oriented pelvic diaphragm. So we need an overcoming contraction and concentric orientation of that pelvic diaphragm. And the way we do that is by leveling the pelvis actively. So for those people that are presenting with that one hip higher than the other—so they're in extra rotation—what we need to do is actually push the front side hip downward.

In doing so, we actually create an internal rotation of that front side hip, which moves the ilium into internal rotation, which immediately nutates the sacrum and starts to bring the pelvic diaphragm upward towards concentric orientation. As I push this side down, I pick up activity on the inside of the downside thigh, which actually opens the outlet on this side, which also promotes a concentric pelvic diaphragm. So now I have a much more stable structure that I can perform my half kneeling exercises in or my split stance activities. And this should happen as I move actively through a split stance or as I assume a stable position in half kneeling. Once again, for those people that cannot create this concentric orientation or this propulsive phase in half kneeling or in split stance, they will typically complain about tightness or pressure or pain. Now, if I take us to more of a side view, you can see that I probably have this potential orientation issue to deal with as well. If I have an anteriorly oriented pelvis, I have lost the relative motion and therefore I have no relative position change capabilities. To overcome the anterior orientation I have to use the proximal hip musculature to capture the position of the ischial tuberosity relative to the femur. If I can capture this position then I can restore the relative position change that's necessary for me to capture the concentric pelvic diaphragm. This is going to allow me to be stable and comfortable in half kneeling or allow me to propel through my split squat. So let's take a look at these positions in half kneeling. So as I am resting here on my left knee, I can actually feel that my right hip is now higher. So that's going to be that inhaled position. So both sides of my pelvis are actually in an inhaled position and both hips are in external rotation. So for me to capture an internal rotation position of the hip in a concentrically oriented pelvic diaphragm, what I want to do is I want to cue a downward position with this hip. So I'm not sagging into the hip. I'm physically pushing it down. So think about pulling up with abdominals on the left side and pushing the right hip down. Now what I've done is I've oriented the acetabulum so they're now both facing forward into an anteriorly positioned orientation which captures internal rotation on both hips. Now, here's the kicker. I have to make sure that I'm maintaining The position of the ischial tuberosity relative to the femur first. If I don't do that, I don't get this relative position change and I can't capture the internal rotations. I'll stay in external rotation and those are the people that are going to complain about tightness in the front of the hip, tightness in the quad or knee pain on either knee.

This is one of the reasons why this half kneeling position is so important is because it's going to transfer to all of my split stance activities. If I cannot capture the maximum propulsive position in half kneeling, the chances of me capturing it in a split stance are minimal. Keep in mind there are some clients that are not qualified to be in half kneeling, nor are they qualified for split stance activities. Your goal under those circumstances is to recapture the intentional anterior and posterior orientation of the pelvis. This assures that I can maintain position of the ischial tuberosity relative to the femur, which gives me the capacity to restore relative positions within the pelvis.

And I can produce high levels of force. I use a lot of high pressure strategies. Again, I'm going to typically have this orientation. What Jimmy's describing though, requires that I have this final compressive strategy where I'm actually going to bend the sacrum down, so I'm going to compress this area. And under most of these circumstances, I'm going to lose both internal and external rotations. And so again, that's just layers of superficial compressive strategies on top of the normal archetype that's going to result in that. So I'm going to lose ERs and IRs. So I have very limited excursions available to me to use for activities. Before I would hit another compensatory strategy. So if I was to take somebody with this posterior compression that Jimmy's asking about, they won't even have 90 degrees of hip flexion available to me unless they want to compensate. So right away, I've taken a number of exercises off the table, so to speak, because I can't move them into this position. Because they just don't have the capacity to do so. But while it is a limiting factor, it also points my programming into a very, very specific direction. And so I'm going to hold up my little graphic. Here that I drew out for the camera. I have two cameras by the way, so I'm just going to hold it up there until I see it get visualized. So there it's clear in the little camera, and then there's one for the big camera. So what I want you to do is go ahead and take a screen capture of that. And again, so you have a representation. So you see the blue square in the middle, is any direction that we want to go but with limited excursion and then you're going to see the red rectangle is where we're going to try to expand movement first and foremost. Okay, so I want to have a wide ISA and I have this this compressor strategy all the way up and down. For me to try to force a turn under those circumstances is very, very difficult to do. They have limited hip flexion, they have limited hip abduction, they have limited hip extension, and then all their traditional ERs and IR measurements are gonna be limited. So I have to stay within this small square of movement. So instead of a split stance type of an activity, I'm gonna use a staggered stance. So my feet would be just offset. And then I'm going to drive a number of different reaching patterns or pressing patterns, but I have to use angles that are below shoulder level. So let me give you, for instance, on this. So we would have a staggered stance high to low cable press, which would keep the pressing motion below shoulder level, and I'm just offsetting the feet. And so I'm gonna gradually move into these turns.

Because again, if I try to go too far into a turn, all I'm going to do is create this massive orientation of the whole system, which is not really a turn. It's just changing what direction that I'm facing. And I want to create the ability to actually turn and rotate. So I got my water balloon. So another visual aid today. And so I have somebody that's that's compressed anterior to posterior. So this is looking down on somebody. And so they're compressed. So if I try to turn them too far, all I do is get this. And that's not really a turn. That's just a reorientation of the entire system. What I want to try to do is I want to try to create compression on one side expansion on the other side. And if I can do that, with my activities, that's going to actually start to restore my ability to create turns in these people and start to restore the rotations. And so if you go back to the red rectangle, those are going to be activities where I'm gonna start to deviate from center outward to the sides. So I'm gonna start with lateral stepping. So consider if I was doing conditioning with somebody like this, we'd be doing sideways sled drags, or I'd be doing suitcase carries, because what those activities do is they could create compression on one side, expansion on the other, compression on one side, expansion on the other. And this is how I'm going to start to improve the excursions and restore their ability to turn, because once again, if I try to force this, all I'm going to do is get compensatory strategies. So staggered stances, pressing and pulling below shoulder level, lateral movement. So this is where your side lunges, your side split squats, your low step ups come into play because that's what these people need because they only have a limited excursion in their peripheral joints and so we have to take advantage of what they do have and then slowly progress them out of that. So Jimmy, this is such a great question. If you're in the rehab side of things, these are the people that you're going to want to put into sideline because we take advantage of gravity. So if I put you on your side and you're compressed A to P, what happens is, and you can see in my balloon, so I get I get all the guts falling down towards the bottom and so that creates expansion on one side and compression on the other. So sideline becomes very important. I start to build people up from sideline. So now we're talking about immature oblique sits, mature oblique sits. This would be something that you would progress eventually into side planks and such if we're talking about moving into gym activities.

So right away you should start to be thinking about how you're going to be able to write this program for somebody like this. It's not difficult to write the program. What is difficult is identifying the representation of what you're looking at first and foremost. And then the program kind of just writes itself because when you understand the needs of this individual, again, it becomes very, very, very easy to write. So hopefully that gives you some guidance, Jimmy. If I didn't answer your question sufficiently, then please do so. Oh, by the way, the asymmetrical ISA element of this. No different than anything else. You just have two different representations. So you have a shape change on one side that is opposed to the other. You're going to follow the same rules that we just talked about. One side's gonna be able to go a little bit more into your posterior. One side's gonna have to go a little bit more side to side, but the rule still applies. So again, hopefully that answers your question.

So if we use dead guy anatomy, which is what a lot of, unfortunately, I think a lot of the information is based on, we have this perception somehow that this sucker doesn't bend, twist, move the way the way it actually does. And then we have this thought process that the hip joint is somehow fixed in space. When the reality is it moves a great deal, it re-orients, it changes direction. And so if I use dead guy anatomy and I say that I'm doing cadaver dissection, I say these muscles are extra rotators because when I pull on them, the hip does this. And so Rachel, in your model, you are absolutely correct. That's what would happen. But I don't think that's as close to reality as we can get. So I think we can have a little bit more of a refined model. So if we think about a posterior compression, so a posterior compression would be activity of the muscles that go across this upper portion of the posterior aspect of the pelvis that push forward. And what that actually does is it changes the direction of the acetabulum. So the socket actually changes its direction. And so if I change the direction, so if I compress here and I change the direction of the acetabulum, what happens is I pick up internal rotation and I lose external rotation. So that's what we're talking about when we're talking about these compressive strategies. So every compressive strategy either reorients or changes shape or has some other influence that produces an outcome. And the more understanding we have in respect of how this thing actually can move. So we have to refine our model. We can't use the dead guy anatomy as our representation like most books try to do and then they try to resolve these things and then we have this massively confusing model with multiple rules and no foundational principles. If we take the same concept up into the thorax, where I have the traditionally upward rotation of the scapula, that is a posterior compressive strategy in the thorax that reorients the glenoid and it produces an internal rotation element. So through that middle range of overhead reach, that's why that would become an internally rotated position that we would use as we talk about moving through inhalation to exhalation to inhalation. Again, we're talking about that posterior element. So I appreciate this question so much because I know there's a massive amount of confusion as to why these things exist. What it comes down to is evolving your model, adding detail, layers of detail. It doesn't matter where you start. You're not right and you're not wrong. All models have limitations and that's the one thing that we need to understand. It's just how much detail can we superimpose onto what we already know. So Rachel, take what you're already thinking because you're not wrong under certain circumstances.

But now you need to add to this model and say, OK, if I compress this now, what happens with understanding a little bit more about what the options actually are within a little bit more of a realistic model? We're never going to see reality. We always have to use a model because this is a really, really complex concept. When we talk about movement. And so hopefully that answers a little bit of your question. I apologize I had to rush today, but I got a lot of stuff going on this morning. You guys have a great Wednesday.

People think they make decisions based on logic, but we tend to make decisions based on emotion and then superimpose logic on top of that to reinforce our emotionally driven decisions, which is a neat process but if you're aware of that then it helps a lot. We're also irrational; we can't see reality and so we have to rely on modeling. So everything that we do, everything that we visualize or think we understand, it tends to be a model because the complexity of reality is probably too overwhelming for us to even recognize or understand. So, as you said, all models are wrong. And so I understand that. And I would refer you to a mental model that is very useful called the map is not the territory. So when we're talking about human movement, some of the models that we've used in the past are mere representations of what we think that we understand. So I make fun of dead guy anatomy a lot because it's very easy, but it's also a somewhat useful representation because there is some of that stuff that does influence how we can perceive movement to be created. But we also have to understand that the cadaver is not the human; cadavers don't breathe, they don't move. They tend to be dry and not fluid-based. Again, we have to recognize the limitations of that model. When the map is not the territory, what it means is that we're using something to help us create a smaller, more manageable representation of what the reality is. So let's just use a silly representation. So if I had a map of the United States that was actual size, so one mile equals one mile, not only would it be incredibly difficult to fold, but we can't even create this representation. It would be ridiculous. So we have to use a smaller version that is not the reality, but that is representative so we can manage the complexity. So that's what we're talking about here.

I truly appreciate your participation because you actually fulfilled my prophecy, which was that I was going to get some blowback on that. So I knew it was going to happen because people will only take in certain bits of information. So even if they were fully informed, even if they read the entire explanation of what I was talking about, they saw it through a limited lens. And so then they reacted emotionally and they responded appropriately based on those circumstances. So that was awesome to see. So I do love dissenting opinions. They're valuable opinions because even though they're incredibly wrong and misinformed and emotionally based, they are useful to help us check our own work and so again I do value that. And so then I have to take my experiences into consideration too and so let's just say that you work with developing athletes, young developing athletes and then another guy works with high-level professionals and you're having a discussion. you're going to speak through those lenses and so you might actually have disagreements as to what is most valuable in developing an athlete, but you're only speaking from your experience and you're speaking from the information that you see valuable. But this is why we see these silly arguments on social media about certain things. So there was one on Twitter not too long ago where they were people talking about return to play aspects and what you had to measure and what was important. And so you had a group of physical therapists that do the return to play conditioning and then you had some strength conditioning coaches that do some of the end elements of that return to play. And they're speaking from their own experiences and so of course they're gonna have disagreements as to what needs to be measured and what needs to be valued. If you branded yourself a manual therapist, a manual physical therapist, you're going to see through that lens and so of course then your arguments are going to be based on that. I have cognitive biases just like everybody else does that prevent me from accepting information. I also seek information to confirm my biases because I am human. That is just one of our behaviors. But again, recognizing those facts helps me sort of get over that to some degree, but I always know that that's going to exist. And so that's why I am such a stickler about avoiding the singular viewpoint. So I challenge people to not fall into a singular system because it immediately becomes a limitation because everything that you do When you adopt that singular viewpoint is I will acquire a tool that supports that or I will acquire more information that supports that and you become more and more limited. It doesn't mean you can't be successful because there will be points of times where that viewpoint will be very useful. But then you've immediately limited yourself in your scope of application.

But then you've immediately limited yourself in your scope of application. So how do we overcome these? Well, one, recognize the fact that your model is not reality. You can't see it. You're just using a representation so it can't be right. It doesn't mean it's not useful. It just means it's not right. But the recognition that you're not seeing reality lets you know that there is probably a better model that is closer to the truth. And so the goal then is to refine and seek out the truth and to continuously evolve your model so don't get stuck in one place when you're developing the model. Try to avoid the emotional reaction to opposing viewpoints and other models. Not all opinions are valid and I totally agree with that, but we can leverage the opposition to our advantage. So again, if I get a dissenting opinion that I don't agree with and I recognize that they're just not fully informed or they're ignorant or they're naive or they're just merely reacting emotionally. I can still use that to my advantage. I can still leverage that information to allow me to check my own work or allow me to identify it. Is there a gap in my reasoning? Is there a gap in my thinking? So I do take those things into consideration, but the goal is to not react emotionally because once you do that, then you're immediately blocked from accepting any new information. Get comfortable with the gray areas get comfortable with not knowing and understanding that the complexity that we deal with reduces our ability to predict things and so we're always playing off of probabilities but our experience in time and influences allow us to narrow those probabilities over time. And that's how we get better. I have friends that are really, really smart, really creative thinkers. And then I have also friends that are not in the same environment that I work in. And so I consider them my naive experts. So they're really, really smart people. And if I ask them questions, they can ask the questions that I wouldn't even think to ask. And so that becomes very, very valuable to have people like that. I share information a great deal because I want the opposing viewpoints. I don't need yes men, I just need people that are good thinkers that have other viewpoints and other experiences because I can't know everything, I can't be involved in every environment and so I can't have all the answers but other people have other answers that might be assisting me in evolving my model. Ultimately what I look for when I'm trying to overcome these things is I'm looking for consistencies. So when I intervene or when I'm evolving a process or I'm asking questions, I'm looking for the consistency in the outcome because that's the closest thing that I can probably get to truth and in reality. So I see the same thing coming up over and over and over again. Then I can start to reinforce that in my model to some degree. But this is what science is so this is where we do the experiment so we experiment. We see what happens. We experiment. We see what happens. The more times you see the same thing arising. So when I see that consistency, those are the things that I start to intertwine and contribute to the evolution of the model. And then finally what I would say is remain patient. You've got time to evolve a model. But I say patience with a sense of urgency. So it's kind of like the duck on the pond. You know, you see the duck smoothly going across the water, but underneath he's kicking like crazy. And so always working, always trying to evolve, but understand that you need to be patient and let some of this evolution take place.

In the outcome because that's the closest thing that I can probably get to truth and in reality So I see the same thing coming up over and over and over again Then I can I can start to reinforce that in my model to some degree But this is this is what science is so this is where we do the experiment so we experiment We see what happens. We experiment. We see what happens the more times you see the same thing arising So when I see that consistency that's those are the things that I start to intertwine and contribute to the evolution of the model. And then finally what I would say is remain patient. You've got time to evolve a model. But I say patience with a sense of urgency. So it's kind of like the duck on the pond. You know, you see the duck smoothly going across the water, but underneath he's kicking like crazy. And so always working, always trying to evolve, but understand that you need to be patient and let some of this evolution take place. That gives you a little bit of a framework as to how I see this whole model perspective. I try to recognize my limitations knowing full well that I am the greatest limitation on the evolution of how I model this complexity within the realm that I work or the world in general.

In cases where this represents the top of the thorax, if we have an anti-air post to your compression in the top of the thorax, you get a toothpaste tube that looks like that, so all the stuff gets squished down to the bottom. And what we'll see then is we'll see limitations in shoulder range of motion if we're looking at this from the thoracic perspective. In that case, what we need to do is increase the volume, the expansion in the upper part of the thorax. It makes it very difficult because gravity works, and gravity pushes air volume down, so air is affected by gravity just like everything else is. If we flip somebody upside down to a degree, what we can do is invert the airflow that goes into the lungs. If I take this person and turn them upside down, this now becomes the bottom of the lung, and it makes it easier for that air volume to get pushed towards the top of the lung, which is now the bottom of the lung if I'm upside down. You have to be careful because certain types of inversion are good for certain situations and are in conflict with what you're trying to achieve in other circumstances. More inversion is not necessarily better. Because of the way the diaphragm is shaped and the way it descends, in many cases, for instance, if I take a wide ISA and put them in some sort of prone inversion, I can actually magnify the problem under certain circumstances. If I have somebody with extensive compression on the posterior aspect of the thorax, especially below the level of the scapula, a lot of these inversion techniques that require support on the elbow are actually bad choices because you're driving them into a compensatory strategy as you're trying to achieve the expansion, especially posteriorly. You won't capture it because there's too much posterior compressive strategy on the backside of the thorax to allow the expansion. Those are just bad choices. You will probably see greater success with prone inversions with your narrow ISAs under most circumstances because, again, of the way the diaphragm is shaped as it descends, it's just a more favorable strategy for those people. With wide ISAs, starting them in supine is probably where you want to start inverting people, especially if you go to the video where I did the three strategies I use on myself, because I am one, you'll see that I started in supine. I would caution you against greater and greater inversion. What we're trying to do is just create a bias or a relationship where it makes it easier for that upper portion of the thorax to fill up with air versus saying, oh, more is better, because all you're going to do is magnify the current strategy they're using if you're too steep. Take that into consideration. You've got prone inversions and supine inversions. Remember that we're all toothpaste tubes. If we're squeezing down from the top and pushing those forces down, we just have to flip it upside down and squeeze from the bottom up, and then we have a nice full thorax, and then you get your shoulder range of motion back. Always test, intervene, and retest to make sure you're on track.

What we're trying to do is just create a bias or a relationship where it makes it easier for that upper portion of the thorax to fill up with air versus saying, oh, more is better because all you're going to do is magnify the current strategy that they're using if you're too steep. So take that into consideration. I hope that's useful. So again, you've got prone inversions. You've got supine inversions. And again, it's beyond the scope of this capability here of sitting behind my desk to actually demonstrate these things. But at least this gives you a little bit of a ballpark estimate of what you're up against when you're looking for inversion. Remember that we're all toothpaste tubes. If we're squeezing down from the top and pushing those forces down we just got to flip it upside down and squeeze from the bottom up and then we got a nice full thorax and then you get your shoulder range of motions back. So always Test, intervene, and retest to make sure you're on track. Hope that's useful for you, Vic. And then it's Friday. Enjoy your neuro coffee. Get your business done today, and we'll be rolling into a really solid weekend, and we'll try to come up with some really, really good stuff up on YouTube this weekend. So I'll talk to you guys later.