If you're a wide ISA, you're going to be biased towards an internal rotation of the ilium and a nutation of the sacrum, which would put you in a position that looks something like that, but with the nutation, I'm exaggerating for effect, of course. But chances are, again, based on the way that you're describing it, you're going to be anteriorly oriented and you're going to be compressed in the posterior aspect. So as you try to descend, you're not even starting in this normal ER position. You're probably not able to capture that. So you're going to hit IR pretty hard and pretty fast. So as you descend, what you're going to try to do is you're going to see this hip going out. And a lot of people perceive that as being extra external rotation. However, if the knee is going out and you're still descending, I want you to see this really, really closely. If the knee goes out and you descend, that actually turns you into internal rotation. So as the knee goes out, you're actually capturing the internal rotation at the hip, but you can't capture it in an arc that is reasonably close to what we would perceive as traditional flexion. You've got to deviate outward and try to capture it there. So what that's going to do, it's going to drive your knee outward, but your foot is grounded and you still need a propulsive foot to push off of when you're squatting. And so what's going to happen is the tibia is going to be forward on the ankle. So that's going to move you towards a late propulsive strategy in the foot. But if you use relative motion at the subtalar joint in that position, you're going to collapse towards the floor and you're probably not going to be able to get about your squat. And so what you're doing is you're locking up this position in this late propulsive strategy and it's going to drive you that way towards that visual representation of pronation, which is actually this late propulsive foot strategy. So I think that's what you're seeing more than anything else. So from a strategy wise then, what we probably want to do is let's move you to something that gives you a little bit more of that ER strategy at the beginning of the squat. So if I elevate your heel, I move this tibia backwards relative to the foot, and that puts us in an earlier phase of propulsion. So this is where you can actually capture some of your external rotation in that early phase of the descent of the squat, and then as you move towards your internal rotation, chances are the squat's going to get a little bit prettier that way because you're not able to access this early phase of external rotation in your descent because you've given it up with your anterior orientation.

So if we look at things from a geometric standpoint, we have this point in space. And if I put enough points together, I can make a line. And if I have enough lines together, I can make a plane. And if I put enough planes together, I can make a shape. And so the shape that we're going to worry about is this cylinder. So this is a stack of transverse planes, if you will. And so if I put this over the skeleton, this is what our representation looks like. And so I have a three-dimensional representation now of the transverse plane. And what you'll notice is that if I draw a line across any two points in this cylinder that crosses through the midline of the cylinder, I can make a plane in any direction. And so what I want you to recognize is that if I'm looking down this cylinder, the sagittal plane and the frontal planes actually fall within this transverse plane. And so there's nothing unique or special about the sagittal planes. They're just part of this three-dimensional transverse plane representation. And so if I go three degrees off the sagittal plane, what do we call that plane? It doesn't get a special name because it shouldn't be special. Neither should sagittal nor frontal. It's just a three-dimensional representation to help us have a conversation and nothing more. But it's not how we produce movement. We produce movement in rotations. So let me give you a, for instance, so when you were developing in your mother's belly and you were a flat plate of the embryo, and this embryo folds itself over like a burrito—thinking about Thursday chips and salsa already. So your burrito is actually a tube just like my cylinder, which means that you are all transverse plane. Every joint in your body moves on a helically oriented direction. So they move in helical movements, which are rotational movements. All the relative motions that we talk about between body segments are rotations that cancel each other out to produce motion in any direction, not just straight ahead, not just sideways. So again, we can eliminate those as being special planes. There's nothing special about them. Every movement is a cancellation of rotations. Your infraternal angle is representative of the helical angles of your axial skeleton. Therefore, it tells us what you're good at. How great are you going to be at rotation is going to be determined by your infraternal angle. When we talk about high force production like bench presses and squats and deadlifts and especially with these tremendous weights, what you have are human beings that are incredibly capable of canceling out rotations and directing it in one direction, which allows them to lift these gigantic heavy weights. So if we want to talk about sagittal and frontal planes, I'm okay with that. I really am. When we talk about directions and points in space and things, but when we talk about how we produce movement, we only do things in rotations, and if we can start to see that, our problem solving becomes spectacularly easy relative to trying to think in all of these multiple directions that just create confusion. Again, I encourage you to think this through a little bit. I know it's confusing because I just took away two things that have been ingrained in your brain as far as how we do move. There's nothing special about those planes. They don't really exist. They are a resultant of the cancellation of rotation.

So we're going to see it show up in the foot a lot. And so if we look at the way that the foot moves through space, we've talked about the heel rocker, ankle rocker, toe rocker thing. So as we hit with the heel rock and the foot goes to flat, we've got this supinated position at the subtalar joint. So we have no relative motion between the talus and the calcaneus. They're moving together as one. As we move through this middle propulsive phase, this is where we start to see the relative motion. So that would be typically described as closed chain pronation. So we have the talus and the calcaneus moving in relative motions in opposite directions. And then as we move through the late propulsive strategy, we get the calcaneus and talus moving again together with no relative motion. So typically when we have knee pain, either like a medial compartment load or a lateral compartment load on the knee that results in pain, we have this loss of this middle propulsive phase so that we have a loss of relative motion. And then what's happening is that the lower extremity is trying to recapture some form of relative motion somewhere else. So when we talk about medial knee pain, we're going to see an early propulsive strategy in the foot. And what this is, is we look up above at the pelvis. What we have is the left side of the pelvis that's trying to get ahead of the right side. And so if we can't delay that propulsive strategy on the left side, we're going to plantar flex and we're going to try to hold ourselves in this early propulsive phase. That's going to be medial knee pain if we continue to drive the left side forward and over. So this would be typically that somebody is going to be anteriorly oriented in the pelvis and tipped up on an oblique axis. It's going to drive even harder and it's going to push us anterior and lateral over the foot. It's going to drive us towards a late propulsive strategy and that's going to result in lateral knee pain. So let's see what that looks like at the knee. So if I take a knee, I'm gonna move the patella out of the way so we can see the knee joint. So if I'm utilizing this early propulsive strategy at the foot to reduce relative motion, that's gonna result in a tibial femoral ER position. If I continue this turn of the tibia into ER relative to the femur, I'm eventually gonna hit a constraint and that's gonna be a medial compartment load. So this is where we're gonna see this medial knee pain show up.

What we might actually do is start in a heel elevated position because that's where he's comfortable. Then, start to translate the tibia over top of the foot so we can recapture this normal subtalar motion. We put them in a heel elevated position and then slowly bring the tibia over the foot. Think about something as simple as a heel elevated goblet squat, allowing the tibia to translate forward while keeping the posterior foot loaded and allowing the tibia to translate. We're gradually exposing the foot and ankle to this load, which will allow this subtalar motion to occur. Now, a couple of other things you mentioned probably need to occur as well. You mentioned that he's missing some hip external rotation on both sides, left more so than the right. So now what we have here is a left-sided issue that's going to influence the right-sided constraint. He has an anterior orientation of the pelvis on both sides, as indicated by your hip ER measurement. He's left-sided more than right. So you've got a left side of the body that's trying to get ahead of the right side. The left side is winning, and the right side is putting the brakes on. So now he's plantar flexing on the right side to try to slow down his gait because the left side is propelling forward. So we're probably going to have to bring that left side back first. Think about activities that create left posterior expansion to help reorient the pelvis posteriorly and create a left hip shift, recapturing the ability to delay the left propulsive strategy. Once we don't have the demands on the right side that promote this plantar flexion, we can start to drive the right side work. So again, the goblet squat comes into play. The front foot elevated split squat will also allow the tibia to translate forward with a reduced load. We don't want to drive load over the right foot because the strategy is so strong that all you'll do is drive harder into plantar flexion, not recapturing the dorsiflexion you're chasing. So I would work on the left side, create posterior expansion, left hip shift, anything that increases left hip internal rotation to delay the left side, then start to bring the right side forward gradually. You'll have to expose the ankle rocker, so to speak, gradually with load. So again, rear foot elevated activities to start, allowing the tibia to translate over the foot. Then front foot elevated where the foot is flat to start driving the knee over the foot. Finally, bring the foot down to the ground into a normal split squat orientation, allowing the knee to translate over the ankle.

And so we would use a more relaxed mouth sort of, we always describe it as like fogging up a window, fogging up a mirror type of breathing, because if we can slow down the exhalation, we actually provide time to clear the air that would normally get trapped during the compensatory strategy that a narrow ISA would use. With a wide ISA, we tend to use a little bit more forceful exhalation because what we have to do is we have to close the wide ISA. And the way we do that is using superficial musculature like external oblique, which would then narrow that angle. So that actually does require a little bit more of an effortful exhalation. But here's the problem that people are running into, especially with the wide ISA archetypes. They're using high levels of muscle activity during the breathing activities and they're using a more forceful exhalation. The problem that you're going into with that is I've already got somebody that's utilizing a very, very strong exhalation concentric orientation type of strategy and then all you're doing is reinforcing that during the activities that you're attempting to use to restore movement capabilities. So what you end up doing is you just reinforce the strategy because by driving the exhalation too aggressively, they recruit their superficial strategy just like they're doing under most circumstances and then you don't get the changes that you want. And so we have to take the superficial strategies into consideration whenever we're trying to coach somebody through some form of breathing activity, especially when we're trying to restore movement. So, under those circumstances, we actually use a very relaxed, casual type of breathing with very slow, methodical movements. Very, very low tension, very, very low effort. Because again, if we have this really, really strong, wide ISA, superficial, concentric orientation, you're never gonna get your way out of that by trying to use more effort. Because again, you just reinforce the strategy. So again, I would caution you against thinking that there's only a way or there's only two ways. What we have to do is we have to consider what this person that we're working with is bringing to us. And then we have to reason our way through the strategies to alleviate whatever we're trying to change or reinforce what we're trying to reinforce. So from a performance standpoint, if I do have somebody that has to drive a lot of high force, then I do want to use a concentric strategy. I do want to use this aggressive exhalation. So always taking the individual into consideration is where we go. It's always N equals one. It's always in a gray. Everybody wants a black and white answer when it comes to all of these concerns. But the reality is that we have to adapt our treatment strategy or training strategy to the individual.

However, if he's promoting compression below the level of the scapula, what you've already started to do is taken away the ability to externally rotate the shoulder and I'm beginning my upward reach in an internally rotated position. If that's the case, then as I pass through this middle arc where I should acquire internal rotation, I'm starting from internal rotation and then that can promote compression within the shoulder joint that gets uncomfortable. This may be why doing activities that are creating more and more compression in this posterior upper back area are not helpful and actually may be detrimental to the solution. So from a solution standpoint, what we want to make sure is that we get expansion in the posterior lower part of the rib cage, we want to then promote the compressive strategy in the upper back once we have this intact so we can get the expansion on the front side as we pass through this middle range of motion. And then once again, we want to make sure that we get expansion in the upper back as we acquire our overhead reach. So David, based on your email, what I would do is I would back off a little bit on the amount of rowing that you're doing, an amount of upper back work that you're doing with your I's, T's, Y's, face pulls, et cetera, that are actually increasing the compressive strategy here. What it sounds like is you need to reacquire some of this posterior expansion to allow you to start from a better position before you go into your pressing movements or active range of motion above shoulder level. So David, what I would do is I would spend more time working on expanding that posterior upper back and the posterior lower rib cage with activities such as this seated dorsal rostral expansion activity where I'm supinating, externally rotating the arms by pushing my hands apart, gently pushing down into the table and keeping my upper back expanded as I breathe in and fill that space in the upper back with air. These are the activities that I would probably try to emphasize more so than your I's, T's, and Y's, which actually compress that. David, if you go to my YouTube channel or the Instagram page, you'll also find a number of exercises that can be easily modified to help you maintain the expansive strategies that you're going to need to help maintain your shoulder range of motion and keep training. So David, thank you for your question. I think it's a really good question because I think a lot of people are also dealing with this. It's not that I's, T's, Y's, face pulls, rows are bad exercises; we just have to be a little bit more selective as to when we're implementing these exercises and have good reasoning behind them as a strategy to help us stay healthy and train.

So the higher I lift something, and then as I release it, I just moved it from a higher energy level to a lower energy level by dropping the pen, by releasing that potential energy as kinetic energy. And so for us to move through space, we have to do so through gradients. out of respect for the physical laws of the universe. And so now we have to respect the fact that we have to be able to orient in space, we have to perceive that space around us, and then we have to manipulate that space to achieve the desired outcome. And so what the sensory inputs provide us is information about that space, and then every physiological subsystem in the body will respond and contribute to a solution or an output that emerges. So let's pick on a sensory input that may be the most powerful or at least the best studied is that we talk about vision. And so vision uses compression and expansion just like we do when we think about the physical movement. So vision actually expands space. We use ambient vision where we spread our vision out or we bring it back into focal vision and compress that space. So it uses the same rules. Hearing does the same thing. So it compresses and expands space to help us actually determine what our environment actually is. Touch is very, very similar in that regard. And then again, physiology responds through the manipulation of gradients. would include all of those senses that respond to A-sense re-input. And then we have the autonomic nervous system that would respond as well, which behaves on a gradient. So the gradient of the autonomic nervous system is flight or fight to rest and digest, and will be somewhere along on that continuum as well. And so all of these subsystems interact and they produce an emergent output as a solution. So the model does consider all of these systems. You manipulate any one of these subsystems to a sufficient degree and you can change the emergent output. The goal then would be to determine which subsystem is most rigid or least adaptable and then favorably influence that system to produce the desired outcome. But in the environment that I work in and the limitation of my scope of practice limits what I can actually measure. So thankfully, movement capabilities is a useful proxy measure for the interaction of many, if not all of these subsystems. So I also get the benefit of movement feeding back into the system and affecting all of these other subsystems as well. So movement becomes this really, really powerful aspect that I can actually measure and then utilize as the intervention to influence any number of things that I can't measure. So whether we're talking about pain or a movement restriction, or we're talking about psychological disorders and chronic disease, movement becomes this really, really powerful solution.

As I move into the deadlift position, I'm going to be oriented to this 90 degrees that immediately biases me towards an acceleration strategy. So I'm going to get a concentrically oriented pelvic diaphragm. But the cool thing because of the shift in the pelvis this way, and because of the internal rotation I'm creating, I'm going to open up that space here. So I'm actually going to create that space. So that gives me the eccentric orientation that I'm looking for under those circumstances. Now, Mikey asked about the other leg. So the cool thing about the other leg is that chances are if I had this compressive strategy here, I had the expansive strategy on the opposing side. And that's what helped me turn the pelvis to the right. And so what I'm actually going to do is I'm going to create a compressive strategy here that opposes the expansive strategy on the other side, so it creates my eccentric strategy on the front side. So again, I'm sort of robbing Peter to pay Paul here. I'm compressing the right side to create the expansive strategy on the left side. And so then I get my return of my internal rotation. I should see the change in the straight leg raise, and I should see the change in the hip flexion as well. I'm also going to get carryover into the upper extremity because the chances are those measures were also limited in the upper extremity. So it's kind of a nice little big bang exercise. It's also got a limited excursion in regards to its stagger which would prevent me from moving into a compensatory strategy. So if I was to try to move somebody into like a split stance or a half kneeling position, chances are under those circumstances of the initial a compressive strategy with a constant orientation lower posterior aspect of the pelvis lower posterior aspect of the rib cage I would fail under the circumstances because I would immediately move them into their compensatory strategy and in many cases that's why exercise selection is so important is that you have to respect what strategies these people are using so you don't push them farther into their compensations. And then if the goal is to restore ranges of motion, we got to keep them within those active constraints. So Mike, I hope that answers your question for you. Again, if you have any further questions, in regards to that activity there is a video on YouTube. There's actually a couple representations I believe using that exercise to recapture hip internal rotation. So check those out if you have any other questions, please let me know go to ask bill Hartman in gmail.com have an outstanding Wednesday finish your coffee grab a workout go for a walk. It's a beautiful day here in lovely Indianapolis so we're going to take advantage of that today and I will see you tomorrow.

So I don't think that you're dealing with a situation that is any different but because of the changeability of these kids because they're not fully grown yet in many of the cases they're going to change over time so the strategies that they will use will change over time. So the kids that stand up really, really early probably use their structure is a little less changeable, a little less adaptable, but maybe a little skewed more towards first production. And then your later adapters, their structure changes over time and then allows them to finally demonstrate those capabilities. So that might be one of those early adapter versus late adapter things. Nate has a follow up here. He says his follow up question. Do you feel it would be smart to expose young or inexperienced athletes to the entire spectrum of the propulsive arc so they don't slip too far into inhale or exhale strategy. So I don't use that term propulsive arc, Nate. I do know what you mean by it. But so one of the things that you want to do with the kids is take advantage of some of their adaptability. So we don't have the extreme situation where we might have some of those early onset injuries. And so yeah, of course, you want to expose them to a broad spectrum of activities. If you're doing so, they're getting exposed to every element of propulsion stuff they're throwing and running and kicking, et cetera, et cetera. We definitely want to do that. But one of the things that we need to understand about that this broad scope application of activities for users were trying to figure out what they're actually really, really good at. So at some point in time, they are going to achieve an age of specialization, which tends to be associated with some of the structure after puberty, where they're going to start to approach some of their adult height, adult physical structures that allows them to stand out in certain ways, and then they can move towards their specialty under the circumstances but prior to that we want to take advantage of some of that adaptability as well and just to be protective more than anything else. There are always going to be kids that are going to stand out early and they're going to develop and some of them will continue to rise under the circumstances. Some of them will actually decline over time. The goal is to keep the young and healthy, if you will, and the way you'll do that is by this broad spectrum of exposure, even though they might stand out under certain circumstances. But I think that's how we're gonna try to address this the best that we can. But we're always using those strategies, especially when you see standout performances, because that's why their standout performances is because they do have the capacity to use these compensatory strategies to their advantage.

This is maintaining a parallel orientation of the femurs in line with the knees in line with the feet as they're squatting, so what you're doing is you're holding position against the resistance of the band and what that does is it allows this musculature at the base of the sacrum to eccentrically orient. Now you're going to start to see the ability to counter-nutate normally as you would see with an inhaled bias of the axial skeleton. Because what your narrows with this posterior compression have is they can't get the sacrum to move under those normal circumstances. So the band becomes very, very useful under those circumstances. You have alternative strategies as well. So in some cases, body weight is just too much load for some people to manage through these dynamic movements. And so you have to unweight them. And so this is where we start to use alternative positions like quadruped, prone inversion activities work really, really well. Something as simple as a child's pose in yoga can be the solution here. Once you recapture enough hip extension, then move them to half kneeling progressions and you'll see a pretty monster change at that point. But you've got to get them from this position where they've got this anterior orientation first. And like I said, one of the easier strategies is just simply to add the banded squat rather than just using the heel's elevation as the only influence there.

Well, it just so happens that any position where the scapula is moving towards the traditional upward rotation would actually create that concentric orientation and would push the volume of air forward. So that's gonna put us somewhere in the general range of a reach forward or quadruped or something under those circumstances, which would be ideal. And so that's going to be your primary strategy to try to get this pump handle up. So forward reaches and anything that you would be in like a bear position, a bear crawl. The second place that you can capture this actually is positioning the arm at your side because that is where internal rotation again begins. And so some of your crab walking activities, so good old fashioned gym class kind of stuff works really, really well here. You can do some propulsive activities with your arm at your side, so triceps activities. If you go back to last week or week before where I was doing the tricep kickback activity for the gym, so that's actually a really good exercise to help you recapture some internal rotation of the shoulder. So anything in those two ranges are going to be of the greatest benefit to bring the pump handle up. So that's a generalized response. Now, let's talk about Andrew. So Andrew's talking about a golf swing. I'm gonna make an assumption, Andrew. You're talking about like a left arm situation for a right hand golfer where they have to take the arm across their body in the golf swing. And you're gonna see some sort of compensation for that when you do not have that cross body adduction, which requires that you internally rotate that left shoulder if we're talking about a right handed golfer. Same thing that we just talked about with Sarah. I have to get the left pump handle to come up otherwise I will not be able to reach across my body because again you're asking Andrew is it a scapular issue or is it a thorax issue and I would say that if you're looking at it from that perspective you're always going to be lost because you're only going to get pieces. So think about this for a second. So for me to get the left pump handle to come up, that also means that I need right dorsal rostral expansion at the same time. Otherwise, what you're going to see as a strategy for a right handed golfer, they take the club back into their backswing. This is where you're going to see the people that roll out to the outside edge of their right foot because what happens is is because they don't have right posterior expansion. They can't shift towards the right hip. And so then they lose the relative motion in the hip, the knee, and the ankle.

But in general, Jake, what you want to do is you want to do enough work that you get the outcome that you desire. And so again, we're in the gray with this answer. It's not an absolute thing, but typically, when you're at rest, it's just normal quiet nasal breathing. You should be able to access that without the compensatory strategies. If you have to, then that might be an answer as to why maybe you're having a performance related issue or dealing with some sort of movement limitation. So hopefully that answers that question for you, Jake.

But there are a good number of them. In fact, I posted a couple of really simple progressions in a low oblique sit and high oblique sit that you can reference on Instagram and YouTube. So check those out. But all you have to do is go through YouTube and you can look at any number of progressions. The goal when you're working with a client is just to make sure that you're putting them in a position to be successful. So whatever your intent is, then you have to put them in a situation where they can execute and be effective. And so then we're always going to use a test, intervene, retest scenario, however you determine that to be. So hopefully Michael, that answers your question in regard to the shape change of the thorax with the wide ISA and why we would use the side plank. Ron Dell was on the free Q&A call that Mike Robertson did to introduce the updates to the IFAS University. He had a question in regard to the expansion of the thorax. We're still talking about the answer to your expansion, but he wanted to make the comparison between the narrow ISA and the wide ISA. And I did make a comment that I would typically start with my wide ISAs face up and my narrow ISAs face down because of, once again, the shape of the diaphragm. So the diaphragms are shaped totally differently in these two archetypes and so, with my narrows I'm going to have this sort of like increased anterior-posterior diameter and a narrow side to side, and with my wides I'm going to have an increased side to side diameter and a narrow anterior-posterior. And because of that, the diaphragm is actually in a different shape and so we have to respect that. So once again, if I was to take a wide ISA and put them in a prone position or an inverted position so hips higher than shoulders in prone, I may get an effective anterior-posterior change, but it's probably not going to be as significant as it would be if I put them in supine to take advantage of the load of the guts on the posterior aspect of the thorax as far as promoting a favorable shape change to the diaphragm and then working it unilaterally.

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.

So what we need to do is create a strategy that creates anterior expansion. It brings the pump handle back up, moves the pubis forward. One of the things we can do is flip people onto their side. We'll do more sideline activities. For someone who might typically do a prone plank in the gym, which would be symmetrical and reinforce this compressive strategy, a side plank would not be recommended. Instead, moving into a side plank position is beneficial because the internal organs fall toward the ground due to gravity, creating nice anterior-posterior expansion. If we're talking about planks for a wide ISA, I would use side planks all day, every day. Gravity provides a mechanical advantage with the gut position. We also need to recognize that wide ISAs don't have good turn capability. Bilateral symmetrical exercises are typically not advantageous when trying to create anterior-posterior expansion and restore turn. An exception might be recapturing hip internal rotation with a modified deadlift followed by a wide stance, heels elevated deep squat. This can restore internal rotation for those wides showing limited straight leg raises, probably below 70 degrees, but more limited than that. You'll see a return on investment in hip internal rotation because the musculature below the trochanter is concentrically oriented and limiting internal rotation. This is one exception to the bilateral symmetrical rule. Typically, we want to emphasize split stance orientations and single arm pressing and pulling. When pushing and pulling with a single arm, we get a compressive strategy on one side and an expansive strategy on the other, helping restore the turn element. When thinking about the sternum, you have a right and left. Compressing on one side compresses the pump handle on that side, allowing expansion on the other. On the thorax's backside, you get reciprocal expansion and compression. Use unilateral strategies when trying to create expansion for wide ISAs.

And so when I'm faced with something like this, I think I'm a little bit more competent and a little bit more comfortable in working with this level of complexity. Where somebody with only 30 days of experience may not. And so again, I think that we stay in our wheelhouse as to where we feel most effective or where we've demonstrated our effectiveness. And so again, when we talk about competence, let's try to stay within that. Just don't be satisfied and keep working to expand your knowledge, your understanding, and then your competence will obviously grow. So now let's look at this from the client perspective. I think most clients probably recognize to a certain degree based on the information available that their behaviors are not necessarily ideal, but what they're having trouble with is the behavioral change that's associated with that. Because I don't think there's a smoker alive that doesn't know that they've increased their risk of cancer by smoking. So again, information is not the decision-making factor here. What is the decision making factor is their beliefs and their emotions. So people will make decisions based on those beliefs and emotions and then they will superimpose the logic or information on top of that that would support that. Well, this is why I do this because I can't or whatever. So their belief system becomes a limiting factor. So how do we alter those beliefs? Well, number one, if we can integrate them into our culture. So we look at our behaviors and we're fit, we exercise, we eat well, and we didn't make those changes all in a day so we can't expect our clients to do the same. And so we integrate them into our culture with our gym culture or the environment to provide them with the social proof that, yes, this is possible. So now we're starting to impact some beliefs in that because they see other people that we associate them with. And so people become like the people that they associate with. And so that's a very important part of this whole process is to provide them with the social proof. So it's not just showing people testimonials and things. It's literally integrating them into the culture so they start to associate. Secondly, if we want to look at behavioral change, people only have so much energy and so many resources to contribute towards a change of behavior because it is uncomfortable. It does take energy. And so what we want to look at is where can we make the smallest change with the least amount of effort. They start to recognize that they can change and so they can alter their identity. One of the easiest ways for, say, a smoker to quit smoking is to recognize the fact that I am no longer a smoker. I am a non-smoker. How does a non-smoker believe? Non-smokers don't buy cigarettes. They don't carry a lighter. They don't associate with other smokers, etc. And that's an extreme example. But what we want to start to look at is, okay, so what's the smallest change that you can make that takes the least amount of effort, which might be, hey, just show up to the gym twice a week. All I need you to do is get here. Right? Start with that. Just show up. Maybe just put on your workout clothes at home and change into those, right? Maybe that's the smallest adjustment that you make. And again, that's sort of like an extreme example, but that is also a potential reality. It's like, what is the least that you could do that is different and doesn't take much effort and is not painful and allows you to recognize that change is possible. We can go as far as asking people certain questions. So what would happen to you if you did make this favorable change? How do you perceive your life to be? And then they start to recognize themselves that, hey, if I make this favorable change, then I'm more likely to be happy, healthy, and successful. We can also reverse gears and we can ask a much more painful question. So if you decide not to make this change, how do you foresee your life to move forward? And again, it's a little bit more painful, but it does provide them a recognition of how their beliefs and their behaviors do influence an outcome. So I think we try to integrate them into a process. Everybody wants to create this lofty goal or these extreme behaviors or make these massive changes. And I think we have to do this incrementally. And so we look saying, where can I make the impact first and foremost on any level? The simplest change to allow them to recognize and change the beliefs that are actually limiting them and promoting the behaviors that are interfering with their progress.

It expands on one side, compresses on the other, and it slowly works its way through space however it wants to move. You're basically a worm, and so we would move through space in the same way. From a global perspective, we create expansion or compression that allows us to change our shape and allows us to move through space. So from a broad scope, we either have an expansion strategy or a compressive strategy. Now, if we go one step deeper and we're still staying global, we think about how we influence our ability to expand and compress. One of those strategies is through breathing. As we breathe in, we expand, creating more volume inside the body. As we exhale, we reduce that volume. That's one of our primary strategies to create this expansion and compressive strategy. So we can say that if we're using inhalation to influence our expansion, we can discuss that element of the strategy. If we're talking about exhalation and compression, we can talk about that aspect of the strategy. Now, we don't have to move air to create compression and expansion strategies. Under those circumstances, we might not use the terms inhalation and exhalation, but if breathing is one of the primary drivers, we want to include that in the description. So we have expansion and compression, and we have inhalation and exhalation, and those are synonymous. Again, those are the broad scope global strategies. Now, if we think about how breathing influences the position of the entire body, as I breathe in, it tends to be an external rotation-based overall strategy of the human. As I exhale, it tends to be an internal rotation-based strategy. What this does is it changes the position and direction of many of our joints towards internal or external rotation. In doing so, muscles that surround those joints will pick up either a concentric or an eccentric orientation based on the position of the joint. This is going to allow certain motions to occur and prevent certain motions from occurring, and that's why we want to use the concentric to eccentric orientation as a descriptor. We're looking more at a local strategy around a joint or a smaller area of the body. So let me give you a for instance. If I eccentrically orient the posterior hip, that's going to allow hip flexion to occur. If I eccentrically orient the posterior hip, chances are I'm going to get a concentric orientation on the opposing side. Here's the really cool thing: we can take our global expansion-compression strategy that we talked about that grossly describes movement, and we can move that to the local level when we talk about concentric and eccentric orientation. So let's use the hip example again. If I expand the posterior hip, that's eccentric orientation. If I compress the anterior side, that's concentric orientation. So I take this global representation of expansion and compression and I can look at that locally because it's going to be the exact same strategy.

and making the return up out of the squat and so what Eric did brilliantly was actually started on a couple of box squat variations but now she's going to learn how to control that concentric orientation pelvic diaphragm still yield so she can squat or so she can execute a counter movement if you would in some form of jumping activity and so what she's doing now is she's squatting to the band so the band is actually just representing a target for her so she knows how deep she was and so the the target would be representative of where the box was and so now she squats to the band so she's now learning how to control and execute concentric orientation with pelvic diaphragm but still capture enough yielding to allow her to move. And then she's able to recapture that concentric orientation as she comes up out of the squat. So it's just a simple progression from the box squat. But now, like I said, it's just an element of control that she now needs to learn how to manage herself without the use of the box. And then eventually the band gets taken away as well. And then she progresses to more dynamic activities of higher rates of speed and then greater levels of challenge. So nothing magical. She's not bouncing off the band. She's just using that as a target. And like I said, it's just a transition from something that was a little bit more stable, a little bit more limiting, like the box squat.

And then the opposing archetype is someone that has an exhaled axial skeleton with an inhalation compensatory strategy. That doesn't mean that they can't present with very similar peripheral measures. Now, having said that, Greg, since you didn't give me a full chest board, we can't give you an exact recommendation as to how we would move forward and intervene with these two people, but you do have some tells there. So you do have a couple of coffee cups. So when you look at the hip extra rotation limitation, and then you look at the excessive extra rotation on the right. So those two measures, so the extra rotation of the shoulder you mentioned was greater than 90 degrees on the right. and the hip external rotation measure was less than normal on the right as well and so what those are indicating to you is that you've got an anterior orientation of the pelvis and a posterior orientation of the thorax on the right side and so those are very telling in regard to what you might need to do to intervene because you've got a superficial strategy there. You've got a strategy that's above the pelvis and below the scapula that you're going to need to address first once you've established the dynamic ISA. So take your ISA measure that's going to initiate your interventions and then you've got to eliminate the superficial strategy. So hopefully that gives you a little bit of guidance in regard to what you're asking me. But again, without laying out the full chess board, we can't give you a first intervention. You're going to have to do that one on your own.

We discussed thoracic shape and its influence on shoulder internal/external rotation measures. This was a significant point. The quarterback doctor podcast highlights and videos for the 16% were posted on Instagram this week. Let's address this week's questions. The first question comes from Taylor. Taylor asks: when squatting, what is the risk/reward of using old shoes and some form of heel lift? I recognize the obvious benefits and risks, but in your opinion, which outweighs the other? Does it significantly increase knee stress? Does it improve pelvic alignment? I'm assuming he's asking whether it enhances hip internal rotation. I believe people seek black-and-white answers, but reality is never that simple. We must consider the n-of-one concept—who are we discussing? Elevating the heel certainly alters load distribution throughout the system. There's a possibility load shifts toward the knees, and anterior knee compressive forces increase during deep squatting. We must evaluate the individual: Are we talking about an adaptive Olympic weightlifter, my 86-year-old mother, or a sedentary accountant? For example, with someone who has tibial-femoral external rotation limitations affecting knee flexion, I might avoid this strategy unless we first restore full knee flexion. We must understand both favorable aspects and potential detrimental effects of heel-elevated squats to apply them appropriately. These strategies must always be individualized. Taylor, I know this isn't the simple answer you wanted, but I hope you appreciate the multifactorial nature of these decisions. Expanding our understanding allows us to make informed choices while providing safe-to-fail experimental environments when introducing new variables.

And so oftentimes what we find is that the typical orientation of the pelvis to manage internal forces is the exact opposite of what we need for speed skating. So thank you, Levi. That's a really good question. So our next question comes from Artem and Artem asks, when addressing elbow orientation by a training, what's the deciding factor when choosing between an elbow flexion or extension driven activity? A specific case would be someone that has an ER humerus in a pronated form. Well, clearly the orientation at the elbow would be wanting to relatively internally rotate the humerus and supinate the form. But then the deciding factor is, am I going to do a push or a pull essentially? And so this is going to be determined by some other measures that you need to attend to that will identify what is going on in the dorsal rostral space and whether we have an upper or a down pump handle. So specifically if we look at dorsal rostral expansion, that would be clarified by our ability to reach overhead in a normal short of flexion. So if I have normal short of flexion, then I have expansion in the dorsal rostral area. And so for me to reorient the elbow, I would want to use a propulsive activity, which would be more of an elbow extension driven activity. So we would say like a triceps muscle activity with the appropriate orientation of the elbow. Now if I wasn't able to achieve a full overhead reach or horizontal abduction then I would know that the dorsal rostral space is actually closed and I would need to expand that. So in that case I would use more of an elbow flexion driven activity so we would typically associate that with a biceps curl and that would promote expansion of the dorsal rostral space and then promote reorientation proximally and then progressively distally. So we would get the dorsal rostral space in the appropriate position, the scapular or shoulder girdle in the appropriate position, and then the elbow in the appropriate position. So we have the appropriate sequence to restore normal variability at the elbow.

You're probably looking at someone who is turning right. This is based on the expansion and compressive strategy you're using. If you're observing this through the thorax, you'll also see it in the pelvis, but it's easier to see in the thorax. So let me grab my typical thorax model. Eli, what you're looking at, if you're looking up inside the thorax, my stick represents the spine. I'm going to stabilize this sternum for you. What you're seeing is a shape change that looks like this as they turn. This is a right turn, and you can see the shape change in the thorax. Your goal is to reestablish their ability to turn. From a strategy standpoint, you're going to pass through that middle range anyway. You're not trying to create uniform expansion; you're just trying to get them all the way to the other end of the turn so they can turn in both directions, though there's always going to be a human bias due to asymmetrical internal forces. Your perception of what you should be doing is correct. You do need to get them to reorient their thorax and alter the compressive and expansive strategies to allow them to turn fully in the opposite direction.

We talked about synovial joints and how one would develop arthritis over time based on the behavior of how synovial joints work. We also talked about training to dissociate early propulsion. And so, again, that was a nice little topic of interest. And of course, then you got your daily 16% videos to go on for a little bit of personal motivation and just reminders about how to behave and how to think. So there you go. Little heads up. So I talked with Drew Keele this week on the quarterback ducks podcast. So that's gonna be out. He said it probably in three or four weeks but he did send me the video from that call. So I'm gonna throw up some snippets of that if I can get to that maybe today and we'll throw some of those up this week. It's sort of a little bit of a preview but to give Drew a heads up they're doing some really good work. So check them out. And that's about it for the review, so let's dig into the Q&A. So let's get started with this week's Q&A. I'm going to start with a discussion about some pelvic orientations and its relationship to the ISA. So this is going to be a combination of questions from Tim and Katie. Basically, what they wanted to know is what kind of a compensatory presentation we were looking at that would result in a significant loss of hip external rotation and a significant gain in hip internal rotation. And Katie wanted to bias this discussion towards the narrow ISA presentation. So the narrow ISA, if you recall, is an inhaled axial skeleton with a compensatory exhalation strategy. And so this will present with certain orientations that are based on this compensatory strategy, but to get to where they want this discussion to go, we're going to have to go through a sequence of compensatory strategies that are superimposed on top of this first exhalation compensatory strategy. So let me grab my pelvis and we're going to talk through this in sequence. So first and foremost, let's be clear that this is not a real pelvis. It does not move like a real pelvis. And it does not bend and twist like a real pelvis because all bones bend, twist, elongate and compress. And so we have to have that understanding because what's going to happen to create this orientation is we're going to have shape change that's involved. This shape change is very, very easy to see in the thorax because the constraints in the thorax are just a little bit less and it's a little bit easier to bend ribs and move scapulae as opposed to moving ileum and creating compression here. So I just want to throw that out ahead of time so everybody has an understanding that this model is just not representative of what's really happening, but we'll talk through it.

With a client with an inhalation axial skeleton archetype, which is typically a narrow infrasternal angle, I want to use an exhalation strategy because they are biased towards an eccentric pelvic diaphragm. I would use a box squat at 90 degrees and coach the explosion off the box with a strong exhalation concentric strategy. For an exhalation axial skeleton archetype with a wide infrasternal angle, I would promote an inhalation strategy. Use a deeper box squat, promoting more yielding and descending of the pelvic diaphragm. In general, yes, but we must first decide the goal. If the goal is to maximize variability within the system using the movement system as a proxy measure, then the assumption is correct with a few caveats. I could bias someone with a high box squat towards an inhalation strategy because through the middle range, around the sticking point, you'll be biased towards a more nutated position, a more concentric pelvic diaphragm. The understanding of where to place a person who needs a more concentric pelvic diaphragm strategy or an exhalation-based strategy is correct at that 90-degree angle, but remember we can bias them above or below depending on the needs. Some people, when placed on a low box from a technical standpoint, use a spinal flexion-based strategy, which is not what we want to reinforce. What we're looking for in the lower box squat is the ability to counter-neutate, which is not the same thing. I don't want to create confusion because many people don't distinguish between spinal flexion and a counter-neutated position, as the lumbar spine does move backward, reducing its lordosis when you counter-neutate, versus spinal flexion above the pelvis, which we do not want to utilize as it places excessive load on posterior spinal structures, whereas counter-neuteration really doesn't do that to any great degree. So I think you are on track with that; your understanding is correct, which is awesome.

Yeah, so this case was really exciting to me. I had a patient come in because she's been dealing with symptoms of disc herniation since February. She was a yoga teacher. And she began initially what they thought was a joint pain. She attributed it to pushing her body into position she wasn't ready for, which I feel like we see a lot in some of these yoga practitioners, especially as they're going through teacher training. At that time she tried PT for three months at what we consider a traditional clinic and their plan focused on trunk and core stability as you would expect. She didn't really feel any better after three months and they discharged her saying there's nothing else they could really do, but she wasn't happy with that. She's very active, she's a kid, trying for another one, and this is something she didn't want to continue with as she continued to try to live her life. She has a young kid and wasn't able to pick him up off the floor, not able to get down on the floor with him without pain. And then in this time before she saw me, she's been trying myofascial release, cupping, and cine acupuncture what she described as 20 plus times. She said that would make her feel good for about a week, but if she doesn't stay on top of it, the pain comes back. There was a little bit of, to me, something missing in the equation because the pain wasn't resolving. She went back to the physician October, so a month ago, and she got a cortisone shot which didn't provide any relief. In an effort to kind of continue to stay active, she connected with one of my friends who's a personal trainer, a kettlebell focused personal trainer, to kind of stay active and be more guided and exercise so she could try to exercise without pain. The trainer then said, why don't you try my guy? He thinks a little bit differently. I've had great outcomes with him and then we can coordinate the care, right? As Lauren, her personal trainer is going to be a huge part of her process as Lauren came into the session and now we're able to coordinate and through the process and maybe this patient feel pretty good at the end. So basically came in with a diagnosed herniation and hasn't had any relief with much of anything. Two out of 10 pain at its best, so it's always there and 10 out of 10 at its worst. Again, it was really, she can't sit for extended periods, driving's a pain, can't bend over, touch her toes, pick up her kids or lift objects. Looking at her, she definitely had some soft tissue restriction through her right low back and into her right glute. That was where she was tender on palpation, which you can kind of see why some of the manual interventions with the acupuncture might have helped provide a little bit of relief. But in my opinion, it wasn't lasting because you're not making a change in the system to promote better position, better stability with that lumbopelvic complex.

11 years in the making. 11 years in. 14 if you count how long we've known each other.

Without further ado, let's dig into some of the questions for this week. First question comes from Tim. Tim says, would love to hear your comments on heel versus forefoot striking for distance running as it pertains to early and late propulsion. Heel striking is typically labeled as bad, but seems to be a reasonable strategy to ensure that we capture appropriate orientation of the hamstring and pelvis. Midfoot striking seems good, but may lead to an overly concentric push dominant strategy. And so there's a lot of stuff in play here. So let's kind of hash this out first and foremost. Let's sort of eliminate this whole optimal foot striking thing because I don't think it really exists. And if you look at enough of the literature, you're going to find out that there's really a lot of things in play. I think the barefoot influences have created this belief system that the forefoot strike is somehow healthier or better in some way shape or form. That's just not reality. I think there was a book that came out a while back that is probably mostly to blame for that because a lot of people just didn't have the alternative perspective. And as I always say, you want to have an earned opinion. And so when they say, well, look at all these primitive cultures that use a forefoot strike, well if you look up a study by Hatala from 2013 you will find the exact opposing strategy in a primitive culture that uses a different shoe type, etc. So what you'll find is that like I think it was seventy-some percent of the people that were evaluated were actually landing on heel first and not forefoot first. So again, that immediately eliminates a big chunk of opinion in regards to whether the forefoot is a natural predisposition under those circumstances. There's also a study by Larson from 2011, I believe, that was looking at marathon runners, and then they were looking at some of the barefoot runners in that regard because there was a fair amount of barefoot runners, and they were landing on the rear foot as well. So even in bare feet, there's a whole lot of variability in regards to what type of foot strike is ideal. I don't think there's one. I think you should have several. But when we're talking about foot striking, there's again a lot of influences. And so the type of shoe you wear, the speed that you're running, the degree of fatigue, and any number of other elements, for instance, anything above the foot in regards to your pelvic and thoracic strategy, your physical structure, your breathing capabilities, et cetera, are all going to influence these. And so I don't think that there is this one optimal. I think that from a health standpoint we want variability. From a performance standpoint though, you may be biased towards one type of heel strike or foot strike rather over another. And so when we think about some of the slower speeds, what you're probably going to see is you're going to see this almost an essential element of heel striking first just because of the speed of performance. Because as you look at faster and faster runners, you're going to see that the foot strike because the ground contact time is reduced that the foot strike is going to have to change to allow the propulsive element to continue. So the faster you go, you're probably going to see people get biased more and more towards a mid to forefoot strike. And so if we look at the extreme, I think I got a question about sprinters here. Yeah, so I'm going to kill two birds with one stone here. So this first question was from Tim, and I think that it was Alex that asked, can we talk about the propulsive phases applied to sprinting? So let's combine these two questions. So the slower I go, I'm going to heel strike, and I'm going to roll over the forefoot as you would think. So I'm going to go through all phases of early, mid, and late propulsion. With sprinting it, especially at top speed, what you're going to see because the ground contact time is so brief, I have to hit this maximum propulsive phase. The propulsive foot is actually a pronated foot. So what you're going to see in a top-level sprinter in many cases is it will appear that the heel doesn't actually make contact with the ground. So the cool thing about this is this matches up with some of the shoe research is that maximum pronation actually occurs as the heel breaks from the ground which means that maximum propulsion would be at that moment as well. So in a top speed sprinter, when the heel doesn't make physical contact with the ground, they're probably still in max propulsion. So again, I think the running speed is going to play a major role in what type of foot strike you're going to see and what is optimal under those circumstances. So Alex and Tim, I appreciate that question and hopefully I gave you enough information to satisfy your needs. I'd be happy to kind of flesh this out a little bit more, but again so to wrap it up, let's consider running speed one of those primary parameters as to what type of foot strike you're going to use, but in addition we have to consider all the things that are above, but that's a big long conversation, I think.

I also posted on Instagram some propulsive strategies, specifically late propulsive strategies, using an old classic—though I think Charles Poliquin probably popularized it at one point—the Peterson step up and also a low box rear foot elevated step up. So check those out. And then I posted an Instagram story this week on a bunch of activities I've been doing to reestablish some eccentric orientation with load. So that's an interesting little twist on that. So check those out and let's dive into this week's Q&A. I got a ton of questions. I tried to narrow it down as much as I could. Just remember that askbillhartman at gmail.com, and put in the subject line, 'Ask Bill Hartman question.' So I know that you're really asking me a question and not trying to sell me something. So let's get started with those. This is TS training systems. Bill, can you give a quick overview about the propulsion phases? Yes, I can. So you didn't ask me an open-ended question. So there's the answer. Kidding, of course. When we talk about the propulsive phase, let's first talk about the difference between load and propulsion. Load is what pre-exists based on gravity, the internal forces you produce yourself, and the external forces applied to you based on all the physics around you. So if I put a barbell on your back, I've just altered the loading parameters. If I move laterally, I've altered the loading parameters. So those are all three things combined. The propulsive strategy is what I use against those to produce the desired intent or movement. When we talk about propulsive phases, we can break these down to make it a little simpler into something we would consider an early propulsive phase, sort of a mid or maximal propulsive phase, and then an end propulsion. At either ends of the propulsive spectrum, we're moving through a compressive, internally rotated, pronated strategy towards a more supinated one. I land in supination, I move through my propulsive phases as I move to internal rotation, pronation, exhalation. And then at the end of that phase, I resupinate, I move back towards external rotation and inhalation. So the two ends of the propulsive spectrum kind of look the same, but they're not the same. While one's moving from a more inhaled to an exhaled strategy, the other's moving from more of an exhaled to an inhaled strategy. They end up looking similar, but the orientation of the pelvis is just slightly different. As we go through the mid propulsive phase, that is where the maximum concentric strategy would be as I move against all of the external forces that are applied to me and the internal forces that I produce. Again, if we use gait, we're landing in supination, we'll move towards pronation, which is my propulsive phase, and I will resupinate the foot at end range. So I will have activities, exercises, and elements of performance that will emphasize one of these phases or another. If I can identify where the limiting factor is in performance, I can then select the appropriate activities with the appropriate positions to emphasize each of those propulsive phases. So we have this endless array of exercises. Once we can identify where these limitations are in our propulsive capabilities, the exercise programs kind of write themselves. This is a really huge topic that we cover at the intensive, especially during the practical component, because a lot of people think that there's some sort of standardized exercise progressions when the reality is the progression needs to be individualized towards the client or the athlete that we're working with. What do they do well, what do they not do well, and what is our intent? Are we trying to emphasize something that they're already good at, or are we trying to work on a weakness or a limitation? Again, as we look at this from the beginning of the propulsion to the end of the propulsion, there are definitely things that we need to emphasize. But just to wrap that up, remember that early propulsion is moving from an inhaled state towards an exhaled state. The maximum propulsion is where I am maximally pronated through ground contact and I move again towards the inhaled state towards the end. And I can again self-select the activities that would be most appropriate for each of those phases. So hopefully that gives you a little taste of what we're talking about, and I'd be happy to expand on those if you have a very specific question on that.

Okay.

Okay, so continuation kind of a pause line, I thought, but you know where I'm gonna take this, right? I'm taking it to the golf swing.