Yeah, like a stepping foot.

Okay.

But the one thing that we want to make sure is that we're not using this anterior rotation as a substitution for internal rotation. So we start to think about strategies. In that regard, what we may want to start to do to capture some true internal rotation or middle propulsion is something that's going to slow this tibia down. So we could use a right foot forward split stance. If this is a right sided issue, right foot forward split stance, sort of a palloff press static holds, we could do the same thing. If they can access internal rotation, then we can do the same thing in half kneeling. We have our offset split squat that allows us to capture that internal rotation bias just by biasing the load in our favor. And then to slow the tibia down, this is where we would use say a front foot elevated split squat. So we elevate the foot on a box that slows the tibia translation down. So all of these strategies are in play. So you can see that this anterior orientation can be a pretty significant influence, and so we have to be really, really careful with our selections in regards to strength training, that if we have people performing these bilateral, symmetrical, high force activities, and we're promoting this anterior orientation, it may negatively influence the outcomes, especially when we're looking at changes of direction. So, program carefully.

Yeah, I do. I do.

I think you just lost control of all their boss. Does that help you at all?

Yeah. Yeah, that's awesome. Thank you.

Yeah.

No, no, you go. You go.

Okay. Interesting. Yeah. And then can I go back to really quickly the skeleton thing? So that has potential to drive force and power as well.

I appreciate that. How are we doing on time?

Yeah.

And I'm just curious to why you cut out on me for just a second. Please repeat it.

Yeah.

So here's one of these things. I got here with relative movement.

Right. Yeah, that makes sense. Yeah, because I wanted to understand how the guts react to these different implements. But it's good.

100% makes sense. And I say that in certain circumstances, that's very useful. And I'm not like in athletics, that plays a little bit more of a role in regards to stability and things like that, and like what you need to do. Yeah, pushing against you and things like, yep.

Absolutely. I don't do it to make people angry, but I need them to feel the frustration just a little bit, so they have to dig just a little bit deeper rather than me saying, here's an answer. It's like, what if you discovered it?

So here's the thing that you have to respect when you go from a standing representation to a supine representation on the table, because they're not the same. So there's a couple of potential things that could happen. If I have somebody that is oriented into extra rotation, that's how they create it. Segments are jammed together, so there's no relative motion in the thorax or pelvis. But they can orient the sockets outward to create a field of external rotation. This isn't relative motion, but it's still external rotation. Then they use another orientation—anti-orientation of the pelvis and anti-orientation of the thorax—to capture force downward. That's why external rotation is up, internal rotation is down—simple. But when they lie down on the table, two things can happen. First, they might have so much anti-orientation that they're in the same orientation as in standing, which steals their external rotation on the table. However, if they land on the table and the orientations tip backward, it magnifies external rotations. Now they get a straight leg raise they probably shouldn't have, or shoulder flexion they shouldn't have, or traditional external rotation measures they shouldn't't have. So you see someone with 120 degrees of shoulder external rotation and 10 degrees of shoulder internal rotation on the table. See what I'm getting at? Again, that's what happens. When we think about sequencing, the goal is to restore relative motion in most cases where we're working with people in pain, so we can distribute forces instead of making them focal like we would for performance. When we're trying to restore relative motions, the way to strip away these compensations is in the same sequence they were applied. For example, with a wide inter-scapular abduction (ISA), the last compensatory strategy in the thorax is often posterior lower compression. If we don't address that posterior lower compression first, that's our initial external rotation representation—like when reaching upward. We have to restore that first to expand the external rotation field. Then we can address more anterior strategies to restore internal rotations. It's not as simple as it seems. To simplify, we prioritize orientations first, because without restoring the capacity to reorient the pelvis forward and backward, there's no shot at restoring relative motions. You can't do it. When segments are oriented that way, everything's compressed into one unit, so there's no potential to restore the eccentric orientation required. So orientations first, external rotation somewhere in the sequence it was laid down, then internal rotation superimposed on top. If we're looking at a wide ISA with anti-orientation, we restore the capacity to move the pelvis forward and backward through space—essentially teaching posterior orientation. We expand the external rotation field from the bottom up, as that's how the lungs fill. We restore it from the bottom up—starting with the posterior lower thorax to get expansion there—then we can go after something like pump handle to get internal rotation. Does that make sense?

Okay.

Okay, so she is anteriorly oriented, anteriorly oriented, and getting pushed really hard from posterior left. Therefore, flexion measures and external rotation measures are magnified. The external rotation on the table is the dead giveaway because she measures in a magnified manner; on average, it would be 90 degrees, but she's at 115. She is laying back on the table, which means you've got a pretty significant amount of anterior orientation that you're dealing with. Let's apply the concept we discussed at the beginning of the call: the anterior downward force. Her internal rotation is coming from the anterior orientation of the pelvis and the thorax. She is way forward, so she has a lot of load on the anterior knee all the time. First, you must reduce the anterior orientation. She is getting pushed from posterior left and is anteriorly oriented. If you try to bring her back or turn her too soon, it will be a block kind of movement, like when we talked about moving the refrigerator and everything turns together. What we want to restore is relative motion within the pelvis so she can create the yielding action posteriorly to take the load off the tendon and allow everything to yield. She cannot yield right now. You must posteriorly orient the pelvis first and foremost. You will not get any relative movement back until you do that. Once you do, she becomes your typical kind of left roller. You have to get her to turn, so you must create the yielding action. You will have to bring her back to early propulsive strategies, most likely on both sides, but to alleviate the load on the left knee, you will have to bring her back on that left side for sure. Depending on how much range she has, how far she is into her recovery, and how much knee flexion you can load her in, you can proceed.

Good. I hope it's helpful. If you have questions, just send me an email. You know how to get a hold of me.

The sacrum is turned to the right.

You don't have time for it.

What would be the next thing to do to make it just a little bit harder, but maintain the same circumstance of controlling tibial translation? I'm asking you a question.

Yeah.

So it'll change by position as well, won't it? Like there's movement during the activity, right? Depending on what I'm doing, again, it's like how stressful is this activity? How hard is it for you to break a deadlift off the ground? It's like that's going to determine how much effort you put into it. It's going to determine how much position you need to acquire to produce that force. But you're always going to apply force into the ground with a degree of interrotation. Where it comes from varies. How much varies. So there's not one answer. What we have to understand is how the segments are influenced through the motion based on load, based on technique. Everybody wants to chase like, ah, they want one answer. They want the answer. I don't think there is one, other than simple rules like you got to push into the ground. Okay. What if you had a supinated foot and you still need internal rotation? Do you think you can acquire it somewhere else? Of course you can. All I got to do is tip my pelvis farther forward. Now I've got more internal rotation because that's a downforce, right? Even though I've got a crappy supinated foot, but the supinated foot is going to be a limiting factor because it's not going to allow me to maximize my pressure into the ground. So you see how the influences interact. A high-force foot, maximizing the force into the ground, is going to have a lower arch, and you're going to be biased towards producing an internal rotation force, which is very, very difficult to do if I'm on the lateral aspect of the calcaneus because that would bias me towards ER. IR is my force-producing position. So it stands to reason that I would see more IR. How much? I don't know. Who are we talking about? How hard is it for them? Is it above their threshold where they can't maintain a certain foot position? And so there's an advantage to understanding this because now you can just watch a client move and do something and you can identify like when are they really driving these internal rotation forces rather aggressively because now you can start to identify where their thresholds are and you can say that was a really good lift but I don't think we want to go any farther today, so then it becomes very, very useful. But if you say it should be this, it should be that, I think you identify what is and then you determine whether it is appropriate for the circumstance.

That allows me to capture an internal rotation to produce force against the ground so I can lift the weight.

Yeah. Do you think it's normal to feel lost at some point in your career?

But is it like Kegel exercises or is it something different?

Yeah, you train them and you go, what can you do?