Good morning. Happy Monday. I have neuro coffee in hand as usual, and it is perfect, ladies and gentlemen. Okay, Huge Monster Monday. So if you're on the mentorship list, you're going to get an email, and chances are you've already gotten it. If you're watching this, that Mike Robertson and I are doing a Q&A at 3pm for the people that are on the iFastU list. So you're going to get notified for that. Very exciting. This is at no charge to you for today, and then it's going to be 100 people max, so it's going to be first come first serve, so hopefully we'll see you there for that, 3 p.m. Eastern time, me and my buddy Mike Robertson. Okay, so we got a bunch of Q&A backups to get through. So we're going to knock a couple out this morning if it's okay by you. First one comes from Austin. Austin says, I have a question about a video you posted a couple months ago on improving hip and trombotation with the toe touch video. You mentioned that using door deflection to achieve sacral nutation and maintain mid-to-max propulsion. You also mentioned plant inflection. Putting the individual in early propulsive phase. Can you talk me through how dorsiflexion and plant inflection influences sacral position? Absolutely. So I'm going to bring in a special guest. This is my classic Air Jordan that I got from my good buddy Jim Fierce. Got him in the shield colors as everybody should anyway. So we're going to use this as a representation of the foot as it moves through the gait cycle. And so when we look at the foot in its approach position, it's going to land in a supinated position heel first, so first heel contact is going to be lateral. So I've got a supinated foot position which is actually external rotation, so external rotation is inhalation expansion which puts the sacrum in a counter-nutated position just prior to ground contact. As I make contact, I have to start propelling, otherwise I'd collapse into the ground. But this is early propulsion, so now as the foot comes to flat, the body is still behind the foot. So what I'm going to do is I'm going to be a leg for a second, okay? So as I land, I hit the heel, I go into plantar flexion, but the body is still back and behind. So this is counter-nutation, this is inhalation, this is ER. As I move towards pronation, so I'm bringing the medial heel into contact with the ground so I can pronate, that's where I'm going to start to reach my mid and max propulsive strategies. So as I hit the ground and I come over top of the foot, and as the body comes over the foot I have to create a stable pelvic orientation above the foot. So now let's grab the pelvis and now we can actually see so as I land on here, as I'm stepping over, I bring the hip towards zero degrees of what we would call hip extension but this is where I'm going to get a concentric orientation of the pelvic diaphragm and so that's going to create the nutated position of the sacrum so now I have pronation down below, I've got intrarotation at the hip, I've got a concentric pelvic diaphragm, and I got a nutated sacrum. So that's how we can relate the plantar flexion and dorsal flexion to this sacral position. So when I'm plantar flexed, which is actually supination ER inhalation, I'm going to be counter-nutated. As I'm pronated, I'm going to be IR'd, concentric pelvic diaphragm, nutation of the sacrum. So hopefully that will answer your question Austin, and if it doesn't, please ask me another one. Okay, question number two from Matt. Matt asks, I know you have to work on knee valgus in athletes, and to what degree is it not something to worry about because it potentially helps produce power? I was wondering where you could find more input to read about it. I'm not sure that you're going to read a whole lot about using the valgus if you will, as far as like when it's beneficial, how much to use, and how you're going to make that judgment as to whether you're being effective with it. But let's just talk through what knee valgus really is because it doesn't really exist. There is no frontal plane. Frontal plane is a visual representation for you and I to have a discussion. What the reality is is what we're looking at. I'm going to bring this up close. What we're looking at with a knee valgus, this is actually a rotation in the knee, right? So what we have is we have a femur and a tibia that are in relative rotation. So this will be defined by the tibia under most circumstances. So it would be tibiofemoral external rotation. And so what we have is an internally rotated femur on top of the tibia. And what that does is that produces what people will typically identify as the appearance of a frontal plane position of valgus. Now, under certain circumstances, that's going to be very, very useful. So you are absolutely correct that when we are producing power, when we are at maximum propulsion, we're probably going to be approximating that position to some degree because it is an element of propulsion. However, there's people that walk around like that because of their physical structures, and because of their idiosyncratic physics, and the way that they deal with gravity, they actually live in that position. And so what happens is that they'll eventually give up the opposing rotation. So we have tibial femoral ER, we have tibial femoral IR. And what we want to make sure is that our athletes have access to both of those, because that would represent our ability to move through a full excursion of knee range of motion. Perform a traditional knee extension activity, you'll get tibial femoral ER as you perform the traditional knee flexion, you would get tibial femoral IR. And so to have full knee excursion, we have to have those rotations available to us. And so Matt, what I would say is you want to make sure that you can identify whether your athlete has given up one of those elements of tibia femoral rotation. That would be something I would say that would put you at risk because it does compromise the full excursion of knee range of motion. That would be my first priority. Secondly, once again, as they move through their maximum propulsive phase, are they capturing this knee position and then can they reverse it as they push out of it? So at early and late propulsive phases, I want to recapture the tibial femoral position of ER. And as I move through that maximum propulsive phase, I want to make sure I got tibial femoral IR available to me. So once again, hopefully that's helpful. If it's not, then again, please ask another question.

As the body comes over the foot, I have to create a stable pelvic orientation above the foot. Now let's grab the pelvis and we can actually see. As I land on it as I'm stepping over, I bring the hip towards zero degrees of what we would call hip extension, but this is where I'm going to get a concentric orientation of the pelvic diaphragm and that's going to create the nutated position of the sacrum. So now I have pronation down below, I've got internal rotation at the hip, I've got a concentric pelvic diaphragm, and I got a nutated sacrum. So that's how we can relate plantar flexion and dorsiflexion to sacral position. So when I'm plantar flexed, which is actually supination, external rotation, inhalation, I'm going to be counter-nutated. As I'm pronated, I'm going to be internally rotated, concentric pelvic diaphragm, nutation of the sacrum.

And so what happens is that they'll eventually give up the opposing rotation. So we have tibial femoral ER, we have tibial femoral IR. And what we want to make sure is that our athletes have access to both of those, because that would represent our ability to move through a full excursion of knee range of motion. When you perform the traditional knee extension activity, you'll get tibial femoral ER. As you perform the traditional knee flexion, you would get tibial femoral IR. And so to have full knee excursion, we have to have those rotations available to us. So Matt, what I would say is you want to make sure that you can identify whether your athlete has given up one of those elements of tibia femoral rotation. That would be something I would say that would put you at risk because it does compromise the full excursion of knee range of motion. That would be my first priority. Secondly, as they move through their maximum propulsive phase, are they capturing this knee position and then can they reverse it as they push out of it? So at early and late propulsive phases, I want to recapture the tibial femoral position of ER. And as I move through that maximum propulsive phase, I want to make sure I have tibial femoral IR available to me.

He wrote some really cool stuff about how we influence breathing and how some of it is actually even meditative, which I thought was really, really cool. But the thing that he asked in the Q&A is basically how to distinguish between genetically determined structure of being a narrow versus a wide. And a body that starts, for example, as a wide, does a ton of compressive hardcore weight work and results in a narrow with excessive external oblique and that has to deal with two or three layers of compensatory strategies over one of the body. Well, first and foremost, you're never gonna turn a wide into a narrow or narrow into a wide. Okay, what we're gonna see are compressive strategies that may make things look a little bit differently. But the genetically predetermined structure is always going to be there. Think about this for a second. If I wanted to turn a narrow into a wide, I would have to smash them down. I would have to take away their height to change the helical angles. And so we're not actually doing that. What we're doing is we're probably bending a few things to make it look a little bit differently. So let me give you a, for instance, people often will say that they had a narrow that is now a wide. The reality is it's just a shape change because of the superficial musculature like rectus abdominis and pecs behaving as such that they compress the actual skeleton. I can take a narrow so when you lay your hands on a narrow your hands might be in that shape right there but if they do a lot of compressive strength work it'll start to square off in the front like that but they'll still be a narrow but because they're getting compressed flat it will seem like the ISA is actually wider and it's not. So you still treat those people like a narrow. It would be really really difficult to take a wide individual and turn them into a narrow to begin with once again because you can't change the helical angles but because other than the external oblique there is nothing on the on the sides of the body that are squeezers because we really don't have that plane to play in as humans. Point being though, because we're dealing with superficial strategies here, Ed, the thing you got to do is you got to get the ISA to move. So your comment at the end of your question is, yes, you have to get the ISA to move, but I will offer you this. The deeper that people go and do these compensatory strategies, the more help they're going to need. So chances are you're going to have to lay hands on them. You're going to have to do some manual therapies to get the rib cage to move because of the compensatory strategies being exhale based their concentric orientation. And so you have to teach one side of the body to eccentrically orient as you compress the other. So you're actually going to have to increase the compressive strategy on one side of the body manually so they can eccentrically orient on the opposing side. So start there. Get your manual therapist. If you're a trainer or coach in the gym, this is where laying people over pads over on their side to create a compressive strategy on one side and expand the other is where you're going to be playing. You can also use some like a side bridge or side planking type activities with some active motion as they're breathing so you're creating compression expansion compression expansion. So this is where some some dynamic stuff in the gym gets really really interesting because what you're trying to do is restore sort of like that worm like quality to the to the thorax so it can bend and turn and twist and so doing static holds under these circumstances is not necessarily the best choice. So people that are trying to lock the rib cage and the abdomen into a place thinking that, oh, more stability is better, this is the exact wrong strategy under those circumstances. We want the rib cage to move. We want the spine to move. We want the pelvis to move. We always want to have that mobility available to us. So constantly training these anti-positions of the anti-rotation, anti-bend, not always a good strategy, especially when you've already got somebody that's very, very rigid.

And so you have to teach one side of the body to eccentrically orient as you compress the other. So you're actually going to have to increase the compressive strategy on one side of the body manually so they can eccentrically orient on the opposing side. So start there. Get your manual therapist. If you're a trainer or coach in the gym, this is where laying people over pads over on their side to create a compressive strategy on one side and expand the other is where you're going to be playing. You can also use some like a side bridge or side planking type activities. With some active motion as they're breathing so you're creating compression expansion compression expansion. So this is where some dynamic stuff in the gym gets really really interesting. Because what you're trying to do is restore sort of like that worm like quality to the thorax so it can bend and turn and twist. And so doing static holds under these circumstances is not necessarily the best choice. So people that are trying to lock the rib cage and the abdomen into a place thinking that, oh, more stability is better, this is the exact wrong strategy under those circumstances. We want the rib cage to move. We want the spine to move. We want the pelvis to move. We always want to have that mobility available to us. So constantly training these anti-positions of the anti-rotation, anti-bend, not always a good strategy, especially when you've already got somebody that's very, very rigid.

Typically with a narrow, you're not going to see a lumbar lordosis because I have sacral counterneutation and that's going to reduce the appearance of the lordosis in the lumbar spine. Chances are I'm taking a wild guess here, Brian, that if you're seeing a lordosis, that you're actually seeing a turn. And so what you got is a narrow with an anti-orientation and a turn. And so what's going to happen is we're going to see this issue of tuberosity getting closer and closer to the femur. So what you're going to end up with is chances are if you've lost ER by traditional measures with the hip at 90 degrees of hip flexion, you're probably also losing abduction at the same time. Then you know you're on a non-oblique axis there. And so you're going to have to push back on an oblique. So instead of trying to bring the pelvis straight back this way, you're actually going to push from the right and go back to the left. So you're going to push back on that oblique axis because chances are you lost more ER on the left than you did on the right. Okay, so again, I'm taking a little bit of a leap there based on the information that you gave me, but just put that on the floor for now. But if I'm wrong about that, then please get back to me through the askbillhartman@gmail.com, and we will clarify what those needs actually are. So thank you for that, Brian.

So if I'm at the very top of the push-up, I tend to put weight through the hypothenar aspect of the heel of my hand, right? And then as I am in the lowest part of the push-up and about to create my propulsive phase, I am actually going to pronate into the ground. So I'm pressing the thumb side of the heel of my hand into the ground to push myself back up. So we have this transition from inhale to exhale through the push-up. So now we have a potential solution for your clients that are having trouble with push-ups. The people that cannot get depth, the people that can't get depth in their push-ups, cannot capture this propulsive strategy at the bottom, which is why they can't produce enough force. So they never access that range of motion through the push-up. So now you can think about, okay, that's one of the reasons why you elevate these people is so they can learn to capture these different positions of inhalation and exhalation so they can manage the pressures that allow them to produce force. So Matt, that's a great question. I'm so glad you asked that.

And then over time, what we can do is if we identify areas of compression and expansion, we can associate changes in shoulder measures that are associated with where this thorax is compressed or expanded. So if we can simplify this to a degree, we can look at the division of the thorax from the scapula down. So we look at the inferior angle of the scapula about T7 or so. Anything below that will expand and it's going to provide us an element of motion in the shoulder that is typically going to be in the early stages of shoulder flexion. So if this area was compressed, what I would see is an early limitation in shoulder flexion. So typically what that's going to be is going to show up as a shoulder flexion measured below 90 degrees. This area is also going to be associated with the influence of the strategy at the ISA. So if I get a wide ISA, this area is typically going to be expanded. And so I will have access to that lower measure of shoulder flexion. As I go up, now I have the scapula and the associated spinal scapular muscles as a constraint here. And so if that would be compressed, I would look at a measure that is farther through the level of elevation of the upper extremity. And so this would be more associated with the limitation in horizontal abduction and anything above the T4 level, I would associate with end range shoulder flexion. And this is just to do with the shape change of the thorax, how it positions the scapula, and then what motions would be available at the shoulder. So this is something that you can make a comparison with over time to confirm or deny this. The nice thing about this is that we also have these constraints on the front. So again, I have the ISA that's associated with this lower posterior aspect. But I also have the sternum and the manubrium, which provides some constraints that are also associated with these posterior measures. So as I draw my horizontals through the thorax, I have an association anteriorly as well. So at the level of this scapula, as I go forward, of course, I've got the ISA, as I go up to the spine of the scapula, that is areas associated with the synchondrosis between the manubrium and the sternum, so the angle of Lewis depending on your resources. So there is actually a potential to bend the sternum at this level, so I can actually get a down pump handling up manubrium, which would provide a different resulting measure in the shoulder. And so this is how we start to divide the areas of compression and expansion in the thorax to be associated with certain shoulder measures. So it's just a matter of paying attention over time.

The chances of you finding this direct association in the literature is probably slim to none. But again, if you start to pay attention to your measures and you start to look at where these areas of compression and expansion actually occur, it's not difficult to make these associations in the shoulder measures. So Jiang, I hope that's helpful for you. I truly appreciate your questions and I will move these skeleton off to the side.

And I want to be able to move between those two strategies, and that would represent my full capabilities of inhalation to exhalation, as well as my full capacity to move my neck through its full excursion. So again, I don't think that we want to look at this as one better or worse. We want to say what is and under certain strategies. So if I'm producing high levels of force, the hyoid will be up because I'm going to use an exhalation propulsive strategy. And so that would actually help me increase the internal pressures and help produce force. When I'm looking to access eccentric orientation, a little bit more broad spectrum movement capabilities, I want to make sure that I can open my airway at will. Again, hopefully that gives you an idea of what we're actually looking at when we're talking about respiration at the neck. And again, you will see these same associations with some of the iterations and the actual skeleton. So the descended hyoid position will typically be associated with your people that are biased towards an inhalation strategy in the axial skeleton, your elevated hyoids are probably going to be biased more towards your people with an exhalation strategy in the axial skeleton. So again, Marcos, I hope that that's helpful for you. If you have any other questions about that, please feel free to ask them. Everybody have a great Tuesday. Again, happy birthday to mom and I'll see you guys later.

Concept Two makes the rower, skier, and now a bike. They run challenges throughout the year. In April, they had the April Fools Challenge, aptly named, where on April 1st you row 1,000 meters, April 2nd you row 2,000 meters, April 3rd 3,000 meters, and so on through April 15th with 15,000 meters. I actually got my kids to do it. Three of my kids participated, and my youngest, who is five, did scaled-down versions of 100 meters, 200 meters, 300 meters. Then they challenged me to do double. So I would row 1,000 meters and then ski 1,000 meters. It was manageable until around day five, and days 10 through 15 were particularly difficult. I typically had to do it after the kids went to bed, starting around 8:30 PM. I would ski 12,000 meters and then row the remaining distance. Yesterday was day 15, completing 15,000 meters on the erg and 15,000 meters on the skier. I am not rowing today.

I would say it's kind of pushed me towards stuff that I wanted to do before this was happening, right? Like I needed a better presence with online type work, right? Shooting videos, content. You didn't really see my face, you know, in all my Instagram and Facebook stuff, but I just didn't like doing that stuff. And now I'm videoing in my face every day. And so I think I've developed a good comfort with all that stuff.

I think for me, one of the coolest things was having to be creative with my big workout exercises. Being here and being quarantined kind of shows you what kind of the raw stuff that you need and forced me to really be creative on how I can use those raw materials to create exercises that were meaningful and intentional.

So I had some antique furniture that I got. And it just happened to be enough height to put a barbell on and do squats off of. It was also heavy enough to do RDLs on. And then we tossed in some overhead, laundry basket, squats, heels elevated. Like you said, man, you get creative.

finding different ways to communicate even though we can't really be physically there. And then aside from that, like also understanding what's essential and what isn't, not only in what we do as practitioners, but what we do in everyday life.

I totally agree that I think this is again it's sort of like a forced circumstance but it also allows you to recognize some of those things that you know what this is really important or this is really what I want to do or there are so many opportunities available right now and granted I think everybody's feeling the stress I don't think there's any question about that so I don't want to negate you know the the downside. But looking at this from an opportunistic standpoint I think is really powerful.

Absolutely.

But looking at this from an opportunistic standpoint I think is really powerful.

I want to introduce myself and gain a good network of folks while learning as much as I can about what everybody does, and invest my time—which I obviously have now—into gaining knowledge in this realm.

What are you doing yourself to organize this for yourself so you can test-retest and understand physics? What are you doing to capture this information? Are you just a note-taker? Are you using some kind of system or app? What are you doing for those that don't understand the best way for them to go about capturing information?

Right now, yes, I'm a note taker. I really like pen and paper, so that's mostly what I use right now. I try to capture information through video as well.

Sorry, I feel a little young for pen and paper.

Yes. Can you touch on a little bit about narrow interest during angles? And you mentioned a few times, I may have interpreted this wrong, but how the pull of the diaphragm kind of changes or inverts.

The way it descends farther. So you have a tall skinny tube instead of a short fat tube, right? Yes. So to create the internal pressures required for control of position, it has to descend farther to create that pressure. People who are narrow are narrow forever till death do us part. There's nothing you're going to change about that because it is a structural adaptation. It would be like changing somebody from a narrow to something else means that you could manipulate their height at will, right? Yeah. Absolutely. So there are structural things that you can identify. Then you have to train them and you have to say, okay, we're making really good progress with this, but we can't make a change with that. So let's emphasize what they're really good at. If we're honest with people when we say we're here to improve your son, daughter, or whatever athletic system you have, we're here to improve you. So we're going to make you better, but we can't make the comparison between anyone else.

I've pictured it as well, too, just since we're on narrow ISA. Is that going to influence the elasticity of the lungs? I mean, obviously, the chest wall, but I mean, the lungs as well. Do you feel that structure actually genuinely gets stretched so compliance changes laterally when picturing, when queuing with doing some of the respiratory interventions that they think about from an inhalation perspective above and beyond the opening, that it needs time for it to open, that you have to kind of go slow to create the lateral expansion in whatever position they're putting them in.

It's a yes or no question, but let's take a step back for just a second. Totally unable to answer. Yes or no question.

What?

Totally unable to answer. Yes.

No question. Say what? Totally unable to answer. Yes. No question.

You step off into a box, like a depth drop. If you could drop down deeper in space and manage that position, and that was like, a deeper squat? Yes. And then that was a representation of, oh, you managed Golgi tendon inhibition to such a degree that it allowed you to get into that position.