Good morning. Happy Monday. I have neural coffee in hand and it is perfect. All right, a very busy Monday. Quick housekeeping item: iFAST university members, we have a call at 1 p.m. Eastern Standard Time today. If you are not a member of iFAST university, please go to ifastuniversity.com to get yourself signed up so you can join us on that call at 1 p.m. Eastern time. iFAST university. Digging straight into today's Q&A, this is with Temus. Temus had a question in regards to having some difficulty making some changes in a narrow ISA individual, but this deviated off into some connective tissue behavior discussion and then talking about adaptive potential. When we talk about the principles upon which my model is based, one of those principles is adaptive potential, and we have to take this into consideration. So this is their structure, which could be genetically determined, influenced by behaviors and training, or be age-related changes and such. And so we have to take into consideration what the adaptive potential is for this individual because it's going to help us determine our strategies, how long things might take, and what adaptations we might be chasing and so on and so forth. So this is a great question from Temus. Thank you very much. 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. We'll arrange that at our mutual convenience. Everybody have an outstanding Monday and I'll see you tomorrow.

So with these endgame narrows as well, I've been doing a lot of manual work because they're difficult to expand due to pre-existing thoracic bends. Looking at cases with significant compensations—people who see a physical therapist for the first time in 30 years, having had pain since their 20s and now being in their 50s—I sometimes find spinous processes sticking out in the mid-cervical region. It appears there's a bend in both the lumbar and cervical spine, which typically occurs together. The representation is somewhat similar on both sides. If I imagine a bent spine, this would be a compensation for external rotation (ER), representing a false expansion back. For whatever reason, this segment seems to be the stiffest. You cannot move it. No anterior-posterior pressure, side-to-side mobilization, or translations produce movement. It just doesn't move at all. I was wondering why that is, considering it's a compensatory ER strategy, which should allow some movement due to the expansion element inherent in such a strategy.

Yeah, should we ask Alex about this one?

Go ahead, yes.

Just put them on the spot. I saw his reaction.

There's no follow-up question. I just have to answer off that.

OK, so Alex, what do you think the rate of muscle behavior would be in the circumstance that Temus is describing? It would be very, very high. That is correct. So this is a strategy that they're using and that at a moment's notice they have access to because they have learned and they have practiced over time, either intentionally or unintentionally. And so we have a very high rate situation here. Now, let's talk about connective tissue behaviors in general as to how it would behave. If we were training somebody and we did a very, very high rate activity over time. So let's take a power lifter as a representation. We're going to use near maximal loads. We're going to do it with a high degree of frequency. And so what is going to happen to the number one muscle activity capabilities and number two, what is the connected tissue behavior going to be?

It would be very, very high.

It would be very, very high. That is correct. So this is a strategy that they're using and that at a moment's notice they have access to because they have learned and they have practiced over time, either intentionally or unintentionally. And so we have a very high rate situation here. Now, let's talk about connective tissue behaviors in general as to how it would behave. If we were training somebody and we did a very, very high rate activity over time. So let's take a power lifter as a representation. We're going to use near maximal loads. We're going to do it with a high degree of frequency. And so what is going to happen to the number one muscle activity capabilities and number two, what is the connected tissue behavior going to be?

So, the connective tissue behavior will be very stiff.

So, do you get adaptations in regards to the collagen content of connective tissues when you load it repeatedly over time?

Oh, yeah, yeah, certainly.

Okay, so now you've got what used to be some elasticity in that connective tissue, and now it just takes more effort to deform it. And again, when you talk about some of my patient population when you say that, oh yeah, they've had pain since they were 20 and they come in, they're 55 years old. Yeah, I see those people too. And it's a very difficult situation because you're battling 30 years of adaptation. And so it does reduce the potential for change in the acute phase. Now, it doesn't mean that we can't make progress. It just means that we might not be able to make as much progress. Now, in addition to that, let's take the water out of the connective tissues, because we all dehydrate as we age. So now I have an adaptation for 30 years. I have reduced potential for change. And now you're in a pickle. So we have a combination of factors here that are all in play. Now, if I'm dehydrating, if I have a compressive strategy over 30 years, what do you think the spacing between the joints is going to look like in the cervical spine or lumbar spine? It doesn't matter which one we're talking about. What do you think those are going to look like?

Well, are they normal sized spaces or are they smaller space? No, they'll be smaller. They'll be definitely smaller space.

So now I have smaller space. So I have lesser potential for even restoring movement, don't I? Yes.

Yes.

So you have a combination of factors here that are all playing together. To what degree? I have no idea. But I do know that all of those will exist in addition to who knows what else. Right. But again, it's like when you start to look at it that way and you go, OK, we've got a pretty big challenge here. Right. And so then the big challenge is OK, how do I make space.

So if that person that we just talked about, if the person would come to you at the moment when the compensation of that bent just took place, would you theoretically expect to be able to move it? Would you expect to have some more mobility there comparing to the other places? And then over time, it reduces and becomes stiff because of all the changes that you mentioned just now?

I think so because again, we're talking about a time dependent change, right? You ever work with like a 15 year old athlete and then a 35 year old athlete?

Less of 35 year old athletes, but I get sometimes, yes.

So I had a 16 year old volleyball player in last night and you want to talk about somebody that's changeable. It was very easy, it was like one of the easier visits of all time. Right. Then I had an older American football player in, and that was like pulling my teeth out. It was tough because again, it's like talking about two different worlds and two different levels of adaptation. Right. So again, it's like you're not representing anything unusual, but like understanding all of the potential or we're never going to stand at all the potential influences. You just want to get as many of those in play in our thought process because when you start thinking about, okay, I've got tissue representations, I've got muscle representations, I've got joint positions. If you can look at it through all of those lenses, it starts to present the options that will be available to you to try to influence this. You see it? That's the important thing about your question. It's like, what are my options? What do I have available? Where else can I go to create movement? If I can't create movement somewhere, where can I safely create movement elsewhere that literally they may have to use a compensatory strategy?

Yes. Yes.

It was very easy. It was like one of the easier visits of all time. And then I had an older American football player in, and that was like pulling my teeth out. It was tough because again, it's like talking about two different worlds and two different levels of adaptation. So again, it's like you're not representing anything unusual, but understanding all of the potential influences is something we're never going to stand at all. You just want to get as many of those in play in our thought process because when you start thinking about tissue representations, muscle representations, and joint positions, if you can look at it through all of those lenses, it starts to present the options that will be available to you to try to influence this. You see it? That's the important thing about your question. It's like, what are my options? What do I have available? Where else can I go to create movement? If I can't create movement somewhere, where can I safely create movement elsewhere that literally they may have to use a compensatory strategy?

Then theoretically, if all these things are ready to place up, we just discussed before, restoring better adaptability and restoring that universal expansion, would you expect the spaces between the joints to increase at least a little bit to get a bit more fluids in it?

What is their potential for change?

Not big, but if it is, you don't know until you try. Yes.

Right. So I think your premise, your thought process, is very useful. It's like, okay, so let's try to make space. How many different ways can you make space? You've got a few options. You have to run the experiment. You have to say, okay, this potentially gives me space. This position potentially gives me space. This manual technique potentially gives me space. And you have to run your experiment. You use your best reasoning, you apply it, and then you re-measure. So that's the mistake that a lot of people don't do: they don't follow through and re-measure to see what their outcome is, so they know if they're on the right track or not. Because we do get acute changes associated with many of the things we do. Some are longer-term strategies, like changing somebody from really stiff connective tissues to really yielding connective tissues can take time if they have the potential for it. I was watching—has anybody seen the Chinese sprinter that broke the 60-meter world record? Did you see how long he had to train to do that? He ran against Usain Bolt in 2012. I don't think he was even in the finish line picture. So he was slow—not slow, just not as fast as the rest of the world. He trained for nine years to break the 9.9-second 100-meter barrier and then ran the world's fastest 60-meter sprint. But he needed nine years of adaptations to change his physiology into a more favorable representation that ultimately made him one of the fastest people in the world. Think about that for a second. I want to say this because I think it's really important that people don't understand: the reason I brought up the training for nine years to create the adaptations to make the world's fastest 60-meter runner. How many hours does somebody need to invest to make the changes you're trying to make? Are they willing to commit eight hours a day? This is an extreme example. Are they willing to commit eight hours a day for six years to undo all of those changes? So you're backed into a corner to a degree as to what someone is willing to do. How long do they need to invest in this? A lot of people don't recognize the severity of adaptations needed for us to undo them, if it's possible. It might be possible, but you know what, 10 minutes of exercise twice a day ain't gonna do it. And we have to accept that.

A lot of people are willing to go to the gym two or three hours a day to put on gigantic amounts of muscle mass because they're driven by that. It's not as exciting to just spend three hours a day trying to get a shoulder to move back. You see I'm getting that. But what if that's what it takes and just people aren't willing to do it? Like, you're giving them the best program, the best strategy. And you say, and they go, how long is this going to take? It's going to take you six years, three hours a day. They go, screw that. I'll just live with it.

Right?

You see I'm getting that. But what if that's what it takes and just people aren't willing to do it? Like, you're giving them the best program, the best strategy. And you say, and they go, how long is this going to take? It's going to take you six years, three hours a day. They go, screw that. I'll just live with it. Good morning. Happy Tuesday. I have neuro coffee in hand and it is perfect. Okay, well, Tuesday, big clinic day. We're gonna dig straight into today's Q&A. This is a question from Borey, and she's working with someone that was diagnosed with an inguinal hernia. But based on the signs and symptoms and the findings, I'm not too concerned that that is necessarily the case. And so I think what we have in this Q&A is more of a positional pressure and tension related problem. But the equinole area tends to be one of those areas that gets confusing for people because I think they're looking at it differently. And I got a pseudo equinole ligament here. that I've constructed. And this thing is going to have tension on it. It's going to get compressed and it's going to twist along with the shape change that's associated with the pelvis. And if we look at what's attached to it, now we say, oh, we have eccentric orientation under certain circumstances for this muscle. We have concentric orientation for another. So we've got this interplay of the obliques under those circumstances. And again, based on the shape change, so if we widen that space, we're going to put more tension in the inguinal ligament. As we get compression and expansion in the anterior aspect of the pelvis, we're gonna see a twisting of it. So we make a reference to like twisting a towel so you can sort of unsee the twisting and the untwisting under those circumstances. So this will be a really good Q&A for those of you that have questions in regards to things like inguinal hernias, sports hernias, groin issues, pubalgias and things like that. So thank you, Bori, for the question. If you would like to participate in a 15-minute consultation, please go to askbillhardtman at gmail.com, askbillhardtman at gmail.com, put 15-minute consultation in the subject line so I don't delete it. We'll arrange that at our mutual convenience. Everybody have an outstanding Tuesday and we'll see you tomorrow.