is that the contralateral arm, so if we're looking at the left foot at max propulsion, the right arm is going to be pointing straight down towards the ground. This is important when we're talking about this contralateral versus ipsilateral influence. Because if we go to a suitcase carry and we start to look at how a suitcase carry works, what that suitcase carry is doing is it's actually holding the arm down at this max propulsion moment in regards to what the upper extremities are doing during walking. So now we have to say, 'What is this ipsilateral load or contralateral load depending on which foot we're looking at really influence this?' So if we're looking at the left foot with a right suitcase carry, we've got a right arm that's going to be held down in its max propulsive moment. And so what we're going to do is then we're going to actually enhance the contralateral max propulsion moment in the foot. And so what we're going to see is we're going to see an increase in the loading during max propulsion. And so we're going to have a very, very strong IR internal rotation force into the ground with the left foot with this right suitcase carry. So if you watch the video here you'll actually kind of see that there's a little bit of a limp that would be associated with this ipsilateral carry. This is obviously can be magnified; like the heavier the weight that you carry, you're going to see a much more bigger compensatory strategy here, but the thing that once you recognize is that this ipsilateral load does change things. So now if we look at this from an ipsilateral standpoint, and so I'm carrying the weight in the right arm, what I should see then is a reduction in this medial heel contact that we would associate with our max propulsive phase. And that's exactly what happens. And so what we have now is we have the right suitcase carry on the right side, inducing a lightening of this max propulsive force during the right foot contact. So this ER actually reduces the max pronation moment. This maintains extra rotation through the gate cycle. And so what we end up with is an enhancement of the posterior overcoming action on the right side with the right suitcase carry. Now, let's take this concept and let's move it to the split squat because we're going to see the exact same thing in the split squat. So if we look at this from a contralateral perspective, I've got weight in the right hand and what this is going to do is it's going to induce a little bit more of the internal rotation on the contralateral side. So my left leg lead is now going to be able to internally rotate easier. If we looked at this from the ipsilateral perspective, then so now I'm going to have a right foot forward split squat with a right side load. What I'm going to see is I'm going to see again the inducement of a little bit more of an ER bias. It's going to enhance my ability to create the overcoming action coming up out of the split squat. So again, all we have to do is we have to look at the concepts of normal walking and then how does this ipsilateral versus contralateral load influence. And so again, if we're looking at the contralateral, we're going to enhance our ability to produce either max pronation or internal rotation. And if we're looking at it from an ipsilateral standpoint, we're going to enhance the ability to ER or reduce that max propulsive phase as we're walking.

And so now your system, which could have absorbed it if you did it more gradually, just can't do it and it breaks instead. You just have to look at this from an adaptability standpoint. There are going to be some people that, as I am fond of saying, are like there are some people that would have been food for something else in a more primitive situation because they're not well designed to remain upright nor move quickly across the ground. I mean that's just the reality. I don't know what animals were around when man first showed up. But I imagine there was a lot of big, angry animals that were very hungry and the really slow people didn't survive. We're just talking about the same thing. We're just talking about an adaptability problem, right? Some people can run barefoot and be perfectly fine. Some people can't. Some people can run on asphalt. Some people can't and not everybody has the adaptability to do anything that they please.

I have a question related to this. I'm wondering then, is there ever a point like when does the shape actually change? Is it more just gradual? How can you ever associate like, I guess an identifying label? There are my air quotes. ERIR. Do we ever end up at 50-50 in which the bias shifts?

But there's like a framework or something. Well, so we're talking about a model here, Marbella, right?

Right. How do you know which one that is? It's okay. You're on the right track. Say it. I know what you're going to say.

Yeah, because you're expanding the posterior pelvis.

And so what that's going to do, when we talk about the forces down into the ground, we're going to move that foot towards its position of late propulsion, right? So as I would shift my foot forward, so the center of gravity is moving forward over the foot, what should happen is like if I was walking, I would be able to pick that heel up. But because we've got this posterior weight shift, the heel is going to get stuck to the ground. So I've got a foot that's moving into an ER position, but I also have a pelvis that's moving into an ER position. So I have a constraint problem that I'm going to run into. So as I nutate this, and I start to flex forward, I get posterior expansion, but I can only expand so much in this direction. And so then what I'm going to have to do, because I'm increasing the degree of hip flexion, I'm moving towards an ER inhale position, I'm actually going to counter-nutate. I'm going to move towards counter-nutation. So I'm going to get a posterior expansion this way, which is still going to help me keep my center of gravity backwards over my foot, but I've got this foot in a late propulsive strategy. So this is where we're gonna see that ER position. Now, if everything's moving towards this ER position, even though I'm still forward bent, I still need to have an internal rotation force into the gram. And so where we're gonna see that occur is in the thoracolumbar junction. So we're gonna see that above the lumbar spine. And that's gonna give us enough downward force. So we need to have a position of the center of gravity that's towards the middle of our stance and slightly in front so we can maintain our balance. And so what we end up with in this scenario as we pass the IR element of this hinging activity is we're going to get concentric overcoming posterior lower pelvis and thorax. We'll get a concentric yielding at the sacral base and in the dorsal rostrum. And so it'll look something like that.

And then do it flat footed and then make the comparison. OK. Cause if you feel, cause you'll feel the difference because the, the, the heel elevation will give you a yielding strategy more so than your heels flat under most circumstances. And so that, that will give you even a better sense of, of what you're actually doing.

OK. So Matt's got a hat on, Nate's got a hat on, and Vinny's got a hat on. I am the guy that invented the backwards hat just for the record. I was born before all of you. I just want to make this very, very clear. I was eight. I started the trend, and it just spread like wildfire. Grace, break out your notebook. We need a question. Come on. Help me out.

OK, so silly putty. OK, so this is viscoelastic. So you're 99% water and 1% stuff, and your 1% stuff is all viscoelastic tissue, except for the mesenchymal stuff, but we don't talk about that. So when I pull on this slowly, it stretches, right? And then when I pull it really fast, it snaps clean, OK? And so what that means is that something that's viscoelastic has different mechanics depending on the forces that are applied and how they are applied. So what I just demonstrated was a rate dependent response of the viscoelastic tissues. When you pull on a viscoelastic tissue, it gives way slowly, right? Which means it can absorb the force.

If we had a fulcrum, there would be a lot of pressure and heat that would be released every time we moved and we would destroy our joints in no time. And so we don't want fulcrums in our joints. In fact, if you do have a fulcrum in your joint, you're probably talking to the orthopedic surgeon right now. So now what we have to understand is that we have to have mechanisms that keep these bones from touching. So let's break these down. Now let's start with structure. So your 99% water, 1% stuff, your 1% stuff is almost all the same and it's all viscoelastic tissue. And so I have representation of viscoelastic tissues in my silly putty. And so this is viscoelastic, so it's going to behave very similarly. And so this tissue will behave differently depending on the forces that are applied. So if I stretch this gently, I get this nice elongation of my silly putty, but if I pull it really hard and fast, it snaps off clean. So what that means is the tissue behavior changes based on the forces that are applied. And so when I apply a high rate of force, I get very, very stiff viscoelastic tissue. So this is the overcoming action that I always talk about when we're talking about concentric overcoming or eccentric overcoming behaviors. So I have an increased stiffness of tissue. So if I had an orientation of fibers as such, that if I loaded them at a higher rate, I can make them really, really stiff. And so we actually have that. So when we look at the fascia that surrounds everything. So we talk about the periosteum. We talk about the fascia that surrounds all of the ligament structure and all the structures around the knee. So the knee is very busy when you look at it from a connective tissue standpoint. And so what happens is when we load that joint, those viscoelastic tissues behave very, very similar to my silly putty. They get very, very stiff, and they create this rigidity around the knee, and that actually pushes the bones apart. So now we have a mechanical protective mechanism that helps us keep those bones apart. So that's very, very useful. It's a little counterintuitive too by the way when you think about it. It's like you think of these are like tension elements and stretchy stuff. They become very, very stiff. So keep that in mind.

They can't manage pressures internally.

Does anybody want to take this one? Does anybody want to take it?

Mandible. Okay. So, but the hyoid is down and that opens the airway. And so if you look at the green in the upper left, you can see that her airway is a little bit more open. And then you go to the upper right and you see that the airway is more round. And again, it kind of does. So now you just got to say, okay, If I put you in this position, clearly you cannot expand sufficiently and you're creating another interference. So you just have to put them in a position where there's no interference. And it might be that you have to start upright. That's okay, right? But you learn something really valuable here is that, you know, while you can kind of follow the rules a little bit, it's like, oh yeah, you're compressed A to P up top. I'm gonna flip you upside down. Not everybody can go upside down.

The summer before physical therapy school, I took an acting class. I was horrible in interpersonal situations. So I basically threw myself to the lions. You have to do improv. I've actually been paid three times to be an actor. It's not a bad idea just because of that. The discomfort of trying to interact with somebody. I don't believe in lying to people and I don't think that you should fake anything. It's just a matter of getting comfortable with the discomfort.

This allows me to maintain a more posteriorly expanded orientation of the pelvis and of the thorax because I'm biasing my foot towards a concentric yielding strategy. So these are for the people that have difficulty with posterior expansion. So another exercise that you may have chosen for this person would be like a heel's elevated goblet squat. So these are people that cannot yield, they cannot delay the propulsive strategy on one side so they're constantly pushing one side forward we want to make sure that we bias that side backwards so we can use a heels elevated version to emphasize that that yielding strategy and hold them back towards this early propulsive strategy. If I want to improve their excursion to move through So I might have somebody that's biased towards this early propulsive strategy. I wanna get them to the end of this propulsive strategy. Now what I'm gonna do is I'm just gonna put their front foot up on a box. I start in early, I've deloaded the foot and then I'm allowing that tibia to translate all the way through. And then it's just a matter of progression. Like I said, I can bring my foot back down to the ground that immediately increases the load and I continue to train this tibial excursion or I continue to try to hold them back. with the heel's elevated version. So, like I said, you can see that there's multiple ways to do this. It's just a matter of understanding that the principles behind it take the same exercise, keep tweaking it. There are other ways that we can manipulate this split squat farther up when we talk about the pelvis, but that's for a later video.

But it could be.

Yes. Like if you're doing something like positioning those structures, like an isometric either internal or external rotation, would that help drive one thing based on the actual superficial strategies within the shoulders? Like the rotator cuff activity, would that help pull the scapula away from the rib cage to drive a certain activity? So if I was in a zero to 60 degree range and I were to perform like an isometric external rotation with some breathing, would that help open up even more because the rotator cuff muscle is going to be pulling the scapula away from the thoracic wall.

Yeah. Why not? Why not? Absolutely. Absolutely. Just to kind of teach him to feel the orientation a little bit differently. He's not walking on his hands or anything like that. But like I said, to teach him some of that, to reorient the elbow, changing it

Sleep comes up every once in a while. This may sound like a cheesy statement, but have you read my book? The whole section in my book addresses this. I'm not a sleep expert, so I tend not to get too deep about it. However, as I said, it does come up on occasion. The execution of the things I have to have them do and the acute element within the appointment remains my priority. But obviously sleep is important. From a stress response standpoint, actually I had somebody come in yesterday, and we did mention it. So we'll talk about it from a recovery standpoint with our athletes who might be dealing with some issues. Every time I do a mentorship call, I talk about it at every call because I want everyone to understand that when you're trying to be productive, energy is everything. Sleep is foundational; if you don't get enough, everything gets worse. I think you just try to get the big rocks under most circumstances. Make sure people hit a sleep time, wake time kind of thing—probably one of the biggest things is just the regularity of sleep. If anything, I might emphasize that.

It's got to be down low on the posterior aspect of the pelvis, right? Correct. And then you say, OK, well, if this is concentrically oriented, what is that going to do as far as the position is relative to the femur? It's going to shove it forward, right?

I have an answer, hopefully.

We all do. And I'm not perfect. I screw up sometimes too. But the thing about it is, regardless of the situation, no matter what we're talking about, the focus needs to be on the things that you do have a measure of control over. And it should be, we never really have to talk about the other stuff. It's a byproduct. It's like a goal. It's like, okay, a goal is an end. If you want to lose weight quickly, cut off a limb, okay? And the people go, well, that'd be crazy. Yeah, it is crazy, but it does work, right? So that's not the goal. The goal is the behaviors, right? The intent should be to focus on the behaviors. So that's what I try to do in the clinic.

Yeah. And then you have to have like one semester of gym class in four years of high school. Am I correct?

No, no. She wants to change it as well. So I gave her some suggestions, but she is like, she has I don't know, she's not really doing the meditation very consistently.

The sequence of events that resulted in that, okay, is not what the surgery addresses. It addresses the structure and nothing else. You know and then we have to rely on the rehabilitative process after the fact. You know, we're not just reconditioning people in these post-surgical scenarios, right? Right. We have to, you know, recapture their ability to manage themselves in space. If you don't do that, then whatever was causing the problem in the first place can still be there because we did a few tricks with her and her are turned into 10 degrees of tibial IR after we messed around with it. Yeah. Right. Exactly. And it's like, okay, so she's changeable. So what's the limiting factor? So we're going to see her next week and we're going to spend a couple hours with her actually next week. So I might have something really cool to report on the next call. At least I hope to do because I'm fascinated by this one.

Nope. Um, I would, Michelle, I would get that one.

When in doubt, the answer is to determine what your needs are through a test, you intervene, and then you retest to see if you're actually accomplishing what you intended to accomplish. But as a general rule, the greater the load, the greater the compressive strategy, the greater the breath hold, et cetera, you're going to actually reduce and constrain segments. And if that's your goal to reduce more force, then more power to you. If you're trying to recapture ranges of motion, then your ability to breathe through an activity will allow you to capture those relative motions that tend to restore ranges of motion, comfort, et cetera.

It's like, you tell me that this happens, but I have reasons to believe otherwise. Right. And again, it's just getting more and more information and then trying to, as you said, integrate all of this into one large model. So it doesn't matter. And, you know, there's nothing wrong with starting wherever you start. There's no right. There's no wrong.

Continuing on from the question last week about dorsal rostral breathing. You said you were comparing it to a dented car fender and just reaching from the inside and poking it out using air. So is that just literally how it sounds where you kind of get a little protraction, thoracic flexion, and then just start breathing?