Bill, I don't know if you have that chessboard that I emailed through.

You know when we, so as we lift heavier and whatnot, we lose relative motion, or at least we don't want relative motion as much.

Okay, Bill. So my main question is regarding an athlete that had to place basketball. He's been playing basketball for quite a while. Definitely has some changes to tendons, particularly at his knees. He has some different movement characteristics that I want to take into consideration. And so the main question is, knowing what I know about the way that he moves, what can I do to make sure that we're loading right and left knees appropriately from a tendon health standpoint?

Good morning. Happy Monday. I have no coffee in hand and it is perfect.

Maybe I was thinking about the first pull in a clean or a snatch. It's a little more of a squatting position than a hinge in a deadlift. And I noticed sometimes athletes will, instead of keeping their center of gravity closer to max P, they'll just shift back early and they'll let their hips rise. And so I was wondering, is that a lack of internal rotation at the pelvis? So then they're just trying to nutate and dump it forward to get the IR. Is that a way to think about it or is there too much so we can get into position? So they're not rounded or in a crazy position to begin with.

So this is going to be somebody that's gone through all of these superficial strategies and they're actually pulling the sternum downward with rectus abdominis. That has to be resolved first and foremost. So activities that are going to help us resolve this and sort of free up the sternum so we can get the normal up pump handle situation. Actually, your developmental postures work really, really well under these circumstances because we've also got the iterative effect of this increase in concentric orientation in the cervical spine as well. And so we're going to kill two birds with one stone. We're also going to be able to move the shoulder girdle into a position that does not require us to use a compensatory strategy. Our ERs move out and away from midline, and so we can actually use that space to our advantage to start to expand that space by reducing the concentric orientation of rectus abdominis and allowing the pump handle to come up. Now, chances are, because we're so far into these superficial strategies, you're going to be dealing with some anterior orientation of the pelvis and the thorax that's going to need to be addressed as well. So rectus abdominis has to be resolved first, then go after your reorientation of the pelvis and the thorax. Once you're able to reorient the pelvis, we can start to worry about building the expansion back up into the thorax. Remember, the lungs fill from the bottom up, just like a glass of water. So we're going to reduce the posterior lower compressive strategy. We're going to start to expand the dorsal rostrum. So activities like the seated Better Band pull apart, standing version of Better Band pull apart is going to be useful as well as you start to gain shoulder range of motion and we can get the shoulder above the horizontal without compensation. Now we've got activities that we can do in quadruped and some of our horizontal reaching activities are going to fit the bill here and this is where we're really going to start to see the pump handle start to come upward. Chances are if we want to restore full excursion of the scapula, we're going to work towards a position where the upper extremity is above shoulder level. And so this is where your inverted lazy bears are going to come into play. Some of your overhead reaching activities, some of your pull down activities actually will be useful under these circumstances. So Brady, what I want you to think about though is that you're going to deconstruct what you're looking at as far as the rounded shoulder posture is concerned. The shoulder is the result of the lack of expansion especially in regards to the sternum. So thoracic shape becomes your highest priority. Avoid interference. The intentional retraction activities in an attempt to fix the shoulder girdle posture is not going to be an appropriate strategy under most circumstances.

I have a representation that I would like to ask someone for guidance or more information about. Clinically, I often see that on the left side, there is a common representation where the femur moves toward the center while the foot collapses. These individuals typically have a loss of internal rotation at the knee. I often assess the knee's rotational range of motion and find they have an external rotation orientation. However, I've recently encountered other clients who have had similar pain for decades—further along in the process. They present a tricky knee presentation: the medial condyle of the femur protrudes, with a lateral shift of the tibia and a medial shift of the femur. These individuals have lost external rotation at the knee but retain some internal rotation ability from their resting position. The proximal tibiofibular joint has minimal movement, and at the distal end, the fibula appears to approach the calcaneus, with external rotation at the distal tibiofibular junction. There's usually high muscle tone and tightness in the anterior compartment.

And again, it's essentially a reduction in the influence of gravity. We're going to start with foot contacts, so what we want to do is we want to think about being right foot heavy if we're going to move somebody straight back on that right side. We're going to keep them right foot heavy and we're going to be biasing them back into the right. The way we're going to do that is by keeping the weight along the inside of the right foot. So if you think about putting pressure on the first metatarsal head and then moving the center of gravity back towards the right heel, that's going to start to move you in the correct direction. If we apply a little bit of pressure on the left first metatarsal head under these circumstances with the right foot back, then what we're going to get is we're going to get this perfect representation where everything's going to move us back into the delay strategy on the right side. The angle of pull is going to follow right along that line between the first metatarsal head and the medial heel on the right side. Exhale on the exertion, so we get the breathing mechanics to match the axial skeletal mechanics. That would be step one, so that's going to start to move us back on the right. The way you're going to know is that you're actually going to recapture that right hip internal rotation under those circumstances. Now we still have the situation where we have a sacrum that is oriented to the right, and so we want a left-facing sacrum under these circumstances. The reason that we want to do this is we're going to put the base of that sacrum on the right side. We're going to push that forward so it's actually squared to the front, without the late propulsive strategy that was initially applied to the pelvis. And so now we're just going to flip-flop our stance. And what I would suggest that you do is instead of having that direct line of pull down along that line on the right, you simply take a step to your left. And so now we're going to pull down on an oblique angle. So that line of pull is going to change its direction. It's going to go from a straight back to an upper right to a lower left. So we're going to aim for the inside edge of that left medial heel with our angle of pull. As far as our foot contacts, you're going to apply pressure to the medial heel first. That's going to ensure that we're getting the appropriate angle of pull. Then apply pressure to the right heel and then the first metatarsal head. And what you're going to feel is you're going to feel that pressure against the backside of the pelvis that's going to start to push the right sacral base forward to square to the front.

I had a couple of more questions on rolling activities. One variation that I saw you perform, I don't remember which really it was, but you had the hip and the shoulder at 90 degrees. And the person was rolling like as one unit. So basically they were rolling in middle propulsion.

Go ahead. Fire away. So first question: When you initiate a roll to the left, the first thing you need to do is to compress on the left side so you can fall to the left.

I compare that to my rating of technique and then I make the decision as to whether we're going to move that weight up, stay the same or lower it down or once again, moving on to a new activity. We could use range of motion as a KPI to monitor and that would be something that we would do over time. So for instance, if I had a baseball pitcher that requires a certain amount of shoulder range of motion to be an effective baseball pitcher, and we're in the gym working on maximum force production, what I don't want to do is create interference for that range of motion. So I would monitor that over time. One of the cool ways to monitor fatigue in the gym is just to perform a training maximum for the day. So let's just say that I was going to train at a five rep maximum for that day. I want to perform sets of three at five RM and then I would accumulate volume based on how many sets I can perform of three at that 5RM, but I would have to train up to that 5 repetition maximum for the day. If I monitor that over time, what I can see is I can see fluctuations in the 5 repetition maximum and determine how we're going to identify fatigue in that regard. So we're always training at an optimum level so that your 5RM may fluctuate and so we can adapt the workout to your level of fatigue in that manner. And then as we discussed in this Q&A with Lalo, we talked about using vertical jump as a measure of fatigue. All we have to do is accumulate data points over time. So we'd have the athlete come in, they warm up, they perform their vertical jump test at the beginning of the program or any other field test that you feel is valuable and valid at the time. And we monitor that over time and we look for change there. We can compare that to any of our other perceptions, perception of fatigue, technique, etc. And then we get an idea of how this athlete behaves over time. That just allows us to make better training decisions and better decisions on the fly during the workout itself.

Bill, I don't know if you have that chessboard that I emailed through. I do. I was wondering if I could just go through what my interpretation was and you could maybe guide me and see if I was on the right track.

All right, so I've run into this archetype, if you will, a couple of times in clinic. It's an older male with more adipose tissue than abdominal cavity that is probably needed, or a pendulous belly, if you will. Diastasis recti, I'm sure that's how you pronounce it. Diastasis. Low back pain. And obviously looking at your model and talking about reorientation and things like that, in my head of course I want to try to reorient ribcage and pelvis and things like that. I'm finding that that's not required to get people out of pain. But my question is I don't want to miss the forest for the trees either. Of course, it might be better for them to lose some weight as well for overall health, but if I were to try to go about reorientation and kind of things that you talk about with gaining relative motions with somebody like that, what are some considerations to take into account and in general how would you go about that?

All right, so as I set you, so I have this chessboard with one of my clients and... I had the feeling that he was on the oblique axis. So I appreciate you confirming that over the email. Now, from an intervention standpoint, I'm a little lost because initially when I think of like someone being on the oblique axis, I think of bringing them back to the left. Correct. Well, you have a butt.

You have the eccentric orientation of the diaphragm creating a positive pressure and then you exhale. So there's a slight little tweak of abdominal activity at the end of an exhalation that's almost non-existent. In fact, for a long time they said that there wasn't any, and then there's a little bit of research that says that there is. But the point is that most of our resting breathing should be relaxed and comfortable and not require any thought. Now, when I started talking about the two archetypes, when I started talking about wide ISAs and narrow ISAs and classifying them in regards to their tendencies, we started to talk about using different ways of breathing to reinforce a change just to get someone to the opposite end of this. It appears to be this dichotomy of inhalation and exhalation. They're actually occurring at the same time. So it's not really a true dichotomy. But because the diaphragm does not descend uniformly in the two archetypes, it requires that there are two different types of breathing when we're trying to restore movement capability. So with the narrow ISAs, because of the way that they trap air in the thorax, if we use a high pressure strategy, all we do is reinforce the compensatory strategy. We continue to trap air and we don't make the changes that we've been attempting to change. And so we would use a more relaxed mouth, sort of, we always describe it as like fogging up a window or 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 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've been running into with that is that 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.

If we did not have the connective tissue behaviors, we would not be able to do anything. We would be like boneless chickens. It is Intensive Week. Intensive 12 starts Thursday. I'm very excited. We haven't done one of these in a long time. Looking to shake off the ring rust and have a great time with this group. They have done all of their preparatory work so they are going to be ready to go. By the way, we've selected the Intensive 13 people for July. Had to go to an alternate this time so this happens on occasion where somebody gets selected and they eventually can't come so we had to replace them. So that's exciting for our first alternate. I know he's excited about it. Today's Q&A is with Clint, my martial arts instructor. Clint is trying to refine his teaching method and his technique. We were talking about how we produce forces for striking and things. We got into a really good discussion, so I said, hey, we have to record this, because it's going to be useful for a lot of people because it's a great review. As we looked at the propulsive phase through the foot, we talked about how connective tissues are utilized for force production. Again, a lot of great topics, great review, so I think you'll find this useful.

So, let's talk about what the orientation is that we're typically seeing under these circumstances and then we can kind of, as you asked for, we will unpack this to a degree. If I'm looking at the orientation of the acetabulum and if I look at the ligament to structure of the hip has this cool little spiral kind of an orientation to it. And so the orientation in itself is if I try to turn this thing into internal rotation, it creates a constraint because it's already twisted in that direction to a certain degree. So this is one of the dirty little secrets about lower extremities. is they're already twisted into internal rotation. That's why the dorsum of your foot is on top when it should be on the bottom. And so this is the twist. So if I try to twist this farther, I hit the constraint. But if I look at orientation of this anomaly, I can actually put this in a position where I actually untwist the orientation of the hip. And all I have to do is move it up and over top of that femur. So this is going to be an anterior orientation. So I will have traditional extension of the lumbar spine on the side where you get the magnified measure. And so that's going to take this pelvis forward and over top of the femur. And if I take it far enough, I'm going to start to pick up internal rotation because essentially what I'm doing is I'm untwisting the capsule and then I take my measurement and then that picks up all that laxity. It's not laxity. It's just slack in the capsule created by position. I take that up and then I hit the constraint somewhere about 60 because I'm using a dead guy zero position. So a nice representation that I can use is sort of this ringing out the towel concept. So if I look at the twisted towel as if this was the ligamentous structure of the hip, when I'm moving my intro rotation it's already twisted and so there's my constraint to intro rotation. But if I reorient the pelvis where it's over top of the femur and I actually start to untwist the towel first, then I have all of this slack that I can take up in the hip capsule, which is going to give me my magnified internal rotation. Remember that I have other internal rotation measures to compare against to make sure that I am dealing with this orientation problem. So for instance, if I lack hip traditional hip extension or ADduction. So traditional hip extension and adduction are internal rotation measures. So if I have a deficit in either one of those, then I know that my magnified internal rotation measure is most likely associated with this orientation. I also have my iterations to compare against as well.

So my question is kind of in the same vein as our last talk where we talked about the value of mentorship and when that might maximize and when to seek other avenues. And so thinking about that same process, my question was, when you're trying to learn something and we talked about the value of struggle, what's a system or a heuristic you use to say, okay, the time value is greater than what I'm putting in or maybe what I'm getting out of that learning process and maybe it's time to seek out help or seek expertise from somewhere else. Because I know I don't know if it was within the past year, I know you had posted something where you were asking someone for help regarding like some quantum physics or something like that. You saw it and so I was like, okay, what made you decide that process and what kind of goes into your thought process with that question of when to seek help outside health?

All right, so I've been going through trying to get some expansion in my anterior thorax and posterior thorax just for my own progress, and I've noticed that when I lay supine now my ribs don't flare as much. What is that? The anterior inferior portion of my rib cage does not protrude, or I guess I'm not as posteriorly tilted in the thorax as much as I was when I lay supine. So the question became why getting expansion in the upper thorax—both the upper back and the anterior thorax—might help that. I actually pictured this as like lower posterior compression and your upper compression almost tilting the whole thorax posteriorly, but that's my thought. I just wanted to hear what you have to say about that.

We are recording. Timer has started. Jordan, what is your question?

All right. So I was in my head, and I get a little bit confused about the difference between more that kind of flatter oblique turn from like the left side versus up and over to the right side. And yes, I guess I was just kind of wondering if you can kind of clarify that difference.

So I wanted to talk about using different implements for strength training. We were talking earlier this week on the coffee call about weight releasers. You mentioned that because the weight is heavier with those, it creates more stiffness and it lessens the yielding action.

All right, Greg, we are rolling. Clock has started. Let's talk. What's going on?

We are recording and the clock has started, Vic. What is your question?

Go ahead Kyle. Alright, so I have kind of two questions that kind of overlap like a Venn diagram. They're separate questions that overlap. So if you don't mind, I'll throw both at you and you can take them as you will. My first question is, as I wrote to you last time we spoke, you mentioned how external rotation is a field within which internal rotation has to exist. And that kind of had me thinking about the concept of internal rotation. I know when we need to create force to move through the world, we need to create some sort of internal rotation strategy. So it got me thinking of internal rotation as a point on a plot, essentially a moment in time. Is that correct? Is internal rotation really just a moment in time, and if so, what are the applications? How do we use that as a useful model? And then the other half of the question that overlays into that is: when you have someone with multiple layers of compensatory strategies, like I follow a lot of Zach Long's stuff, and he talks about sequencing of treatment based on how we imagine these compensatory layers are added. For example, if you have the same measurements for someone with a narrow infraternal angle versus a wide infraternal angle, you're going to go about sequencing that treatment differently because of that infraternal angle presentation. So traditionally, I would imagine that for someone with a wide infraternal angle, if they've lost internal rotation-based measures, you'd want to get those measures back. Like if they're compressed A to P, you'd work on that anterior expansion before posterior expansion, which in my mind would recapture a lot of those internal rotation measures. But when I think about this in the concept that internal rotation needs to exist within external rotation, I wonder: would it make more sense to treat these people like we need to get the external rotation measures back first, regardless?

So a couple of months back, you talked about median sternotomy and how that might affect, depending on how things heal and how it might affect measurements. in the extremities because of what's happening internally. The first part of the question is, could you kind of talk through maybe some of that in terms of what you might want to see? And then my second, like asking for a friend kind of thing, except you know, it's me, obviously. The thing I'm trying to do is get left shoulder flexion back because I play upright bass. Um and so upright bass.

So I was hoping to follow up on that ACL graft site pain conversation. And I have a specific patient with some range of motion measurements. I'm kind of working through that. The person I want to clarify is talking about how the pelvic diaphragm is pushing down and she's unable to concentrically orient, which is causing those tissues to behave more stiffly.

All right, I want to kind of dive into some more of the nuance with the eccentric, concentric orientation versus the yielding and overcoming. And so I think the biggest thing is, to what extent is it useful to prioritize a yielding strategy over gaining some eccentric orientation? I know, with an athlete, it can be very dependent on what the needs of the sport are. But to my way of thinking and the conversations we've had, the only way I'm going to get eccentric orientation is more or less to stop training. So I want to make sure that I'm understanding this.

So my question is about early and late propulsion as it relates to the squat and the split squat. From watching a couple of your videos, as far as I understand, in the beginning of the squat, at the top part of the squat, that will be late propulsion. And then the bottom part of the squat, there will be early propulsion. My question is, first of all, if somebody needs to get early propulsion and they don't have access to mid propulsion, there's no way you can put them at the bottom of the squat. They're not going to be able to get there. So the better duration will be a split squat.

I have about two hours or so, a little over two. So here's how you break this down.