Good morning. Happy Monday. I have neural coffee in hand and it is perfect. All right. Man, already a very busy Monday. Got a day straight in today's Q&A. This is with Teya. This is actually a very short video with a lot of information in it in regards to identifying knee orientations. We talk about this a lot in regards to the femoral position potentially being an ER versus IR, tubular position being ER versus IR. And if we can identify these positions, number one, we might be able to produce a much more effective middle propulsive representation, which is actually protective of a lot of knee injuries. Because if we're trying to produce force with an ER representation of this knee, that is not a force producing position. And so a lot of bad things can result from this. And so this is a brief talk about how we use a heel to butt measurement to identify the knee position. So we talked about patella position. So if you've ever seen like the skyline x-ray views where there's a representation looks like the patella is the sun over the mountains, so to speak. You'll be able to identify the relative patella position and so we can actually do that with the heel to butt measurement as well. So we talk about that. A lot of it comes down to doing a lot of heel to butt measurements so we can identify whether we have an eccentrically oriented vastus medialis that allows the heel to reach the butt in the ER position or whether we have a true middle propulsive representation in these. So thank you, Taya. This is a really important video for a lot of people. If you'd like to participate in a 15-minute consultation, please go to askbillhartman at gmail.com. Put 15-minute consultation in the subject line so you don't delete it. Please include your question in your email. Everybody have an outstanding Monday and we'll see you tomorrow.

Hey Bill, can I just ask how could you differentiate between the right and wrong heel to butt knee flexion if they weren't okay?

So when you're actually executing the heel to butt, pay attention to the patella. If the patella gets pulled to the extreme lateral aspect of the knee as you're bringing the heel to the butt, you'll see the patella move laterally. Now it's going to go there anyway, but to the degree in which it does so, and then pay attention to the tibial tubercle as well. So if you have a tibial tubercle that is turning into external rotation as you bend the knee and you get good heel to butt, and most people that have an eccentrically oriented vastus medialis obliquus as you flex the knee by tradition, it's very, very soft—like crazy soft. And so it's very easy to take the heel to the butt under those circumstances. The way that you're going to understand it is by executing many of them. So every opportunity that you have to do a heel to butt measurement, do it and then pay attention to what you're doing and then pay attention to what you're observing.

And how do you observe the patella if the person is lying prone?

I wouldn't do a heel to butt in that position. I would always do it in supine. You have too much interference in regards to heel to butt in prone. I would say I would never do any measurements in prone. I just don't do any; they're more like checks and balances for me versus the decision makers.

Okay.

You have too much interference with heel-to-butt in prone position. I do not perform any measurements in prone. I would say I never do any measurements in prone; they're more like checks and balances for me rather than decision-makers.

Okay.

Yeah.

Yeah, because in school they learned about heel to butt in prone. That's okay.

There's too much potential for interference in regards to the pelvic orientation. It's like, okay, here you go. The people that would get accused of tight quads, right? They never have heel to butt prone, but they could have heel to butt supine. You see the difference. So I'm looking at the capabilities of the knee itself. I don't want to make a judgment call on muscle orientation as far as the limiting factor. It ends up creating an ineffective representation and people make bad choices as to what needs to be done.

Okay, I get it.

It's like this: the people who would get accused of tight quads never have heel to butt in prone, but they could have heel to butt in supine. You see the difference. So I was analyzing what I'm looking at, which is the capabilities of the knee itself. I don't want to make a judgment call on muscle orientation as far as the limiting factor. It ends up creating an ineffective representation and people make bad choices as to what needs to be done.

Thank you so much.

Good morning. Happy Tuesday. I have neuro-coffee in hand and it is perfect. All right. This is clinic day today. Got a day straight into today's Q&A. This is with Andrew. At the last Coffee and Coaches Conference call last Thursday, 6 a.m., please join us. We talked a lot about what are pet positions, bear crawls, etc., like how we can utilize these, how to coach through them, and Andrew brought up some really good points about okay, this is what I'm seeing as a representation of their outputs, like their technique. Then how do I coach them out of it, and then does this give me a reason to say okay, this is not the appropriate position? So a lot of people make mistakes and try to work through these things when people just don't have the capacity to assume this position. It's very useful position, very useful to capture your internal rotations as it is a middle representation, but not everybody is qualified. And so understanding how to coach people through this and especially, like I said, when they're incapable to recognize that and allow you to move on to a more successful activity. So thank you, Andrew, for this. If you would like to participate in a 15-minute consultation, please go to askbillhartman@gmail.com. Please put '15 minute consultation' in the subject line so I don't delete it. Include your question in the email if you would please. We'll arrange that at our mutual convenience. Everybody have an outstanding Tuesday and I will see you tomorrow.

When considering a quadruped position, such as hands and knees, I am torn between two approaches. One is focused on creating dorsal rostral compression with relatively straight arms pushing the sternum forward, which some individuals can achieve. The other involves a more relaxed disposition where the body sinks toward the ground, which subjectively feels like the abdomen expands with the sternum and pubis. I am asking about the differences and merits of performing a quadruped hold with a deliberate push into the ground versus one where you are simply propped up.

Okay. Let's reorient thought process for just a moment from Quadruped. Okay. Let's just say, so you're on the ground, all fours and the ground, the direction of the ground is now forward. Instead of being down, we're going to call it forward. Okay. And if I push into the ground and you feel that the yield in the dorsal rostral thorax, are you still going forward?

No.

Strike one.

Okay. Well, yeah, I guess your head is moving back, but yeah, you're pushing forward.

Dorsal rostro thorax is concentrically oriented. That's a compressive strand. If I push through the ground and I'm still going forward, gravity doesn't stop. It's still there. You're still going in that direction. But you're slowing down. It's the yield. If you give way, if you allow yourself to move in that forward direction, scapulae are going to approximate.

Yeah.

Okay. If you give way, if you allow yourself to move in that forward direction, scapulae are going to approximate, are they not?

Right.

Okay. So depending on how you're executing this, you might just get pure scapular retraction, which is actually an anterior posterior compression, which will elevate the scapula on the thorax. Do you notice that when somebody kind of collapses in quadruped that they kind of look shruggy? That's because the scap is going superiorly relative to the axon skeleton. Okay. So that's the anterior, that's an anterior posterior compressive strategy.

Yeah.

That's because the scap is going superiorly relative to the axon skeleton. Okay. So that's the anterior, that's an anterior posterior compressive strategy.

Right.

Okay. And so again, those are the decisions that you make. What is the intention here? What are you trying to do?

Okay.