That does make sense. Um, and then I think you talked about, and I guess maybe. if it still applies, but can you have all the information on the zoom call the like starter and that like lazy bear position and then just like gradually progressing her to upright squatting.

Good to see you. Bye.

So you use the right words. You said not as much. That's a key element because you're going to move in that direction because you've got to produce force. So if you're not going to get nutation as much, you still need to put force into the ground as you descend into the split squat. So if you don't get sufficient nutation of the sacrum, which is representative of your internal rotation capabilities, you're going to have to create a compensation to produce enough force into the ground. So we're going to see another IR strategy show up somewhere. So maybe the pelvis orients its entire position forward. Maybe we see an excessive pronation. Maybe we see a forward head. So again, this is why we see these compensatory strategies executed in the gym because people are still going to produce internal rotation. You have to. There's no way around it. You cannot produce force in these externally rotated positions. So that's why we see compensatory strategies. So you have just answered several questions for a lot of people because if I don't have internal rotation available to me, I will compensate. People say, well, why do you see the pelvis tilt forward? Why do they lack hip extension? Because these are all representative of people that are trying to produce force in an externally rotated pelvic position, but they're superimposing IR from somewhere else because it's not coming from the hip.

That's right. That's not possible. It's just not possible. You have to think about how people process that information. So four topics. Roughly, roughly, if you want to leave time for questions, you've got about nine minutes per topic. You're going to make a point.

So like I said, we'll be able to help a lot of other people and we'll be able to get your questions answered as well. So again, one more time, subject line, free 15 minute consultation request at askbillharmonageemail.com. Okay. So let's dig into a little bit of a Q&A question to wrap up the week for you guys leading into a great weekend. And this comes from Patrick. And Patrick says, hi, Bill. Hi, Patrick. He goes, is looking at joint levers totally, is looking at joints as levers totally useless? And I would say, Patrick, that I don't look at joints as levers for various reasons that we'll get into, but there may be some use in some of this two-dimensional representation that we typically use by Euclidean geometry. So they break things into the imaginary planes, and they try to calculate forces, and they look at joints as levers. There may be some good reasoning for that, because what it does allow us to do is potentially identify where we might be seeing loads or stressors being applied in certain aspects of movement, which might be helpful to determine causation of damage, pain, injuries, however you want to look at this thing. But from the reality standpoint, the reason that I don't like to look at joints as levers is because we need one specific thing for a lever system and that is a fulcrum. To coat our comedies, it's like give me a lever long enough and a fulcrum on which to place it, and I shall move the world. So without the fulcrum, you don't really have a good lever system. The problem with the fulcrum in a joint is that we have friction and we have heat. And both of those are going to be destructive to the hyaline cartilage at the ends of the bones. As durable as it may seem, it is still delicate in regards to its ability to wear away. The other aspect of it that we haven't talked about, I don't think before, is that this friction would actually slow down joint movement, which would make movement very, very difficult. So if we think about normal walking, the hip joint's gonna move at about 200 degrees per second. If we look at throwing a baseball, it's about 7,000 to 9,000 degrees per second. And so if you want to get an idea how fast that is, swing your arm around in a circle 20 times in one second, and that's how fast Major league baseball pitchers arm is moving. And so if we did have joint levers and we did have fulcrums and we did have that friction, I don't think we'd be able to produce these movements. And they would be incredibly destructive all at the same time. So rather than me digging deeper into this, what I'm going to do is I'm going to cut away. We're going to go to a video that I did previously where I was talking about why bones don't touch and why the joints aren't levers. Because I think it would be a good video for you to reference Patrick. So for the rest of you, have a great weekend. Have a terrific Friday. I will see you guys next week. We'll be digging into some Q&As and hopefully we'll get a few of these free 15 minute Zoom calls scheduled over the weekend. And we'll present some of those for you next week. Everybody have a great weekend. I'll see you later.

Being that you could like, manipulate the pull up, like if I have one hand supinated, one hand pronated, if I want to, does it make sense to bend the bar? You know, when they say bend the bar or just put your hands up and do the job.

So we need a yielding action in the posterior aspect of the pelvis and the posterior aspect of the thorax. As you construct this exercise, you want to start from the foot upwards. So the wall becomes the ground under these circumstances. Therefore, we must get the foot contacts correct. Otherwise, we're not going to get the upstream activity that we want. So we want to make sure that we're capturing the first metatarsal head and the medial calcaneus on the wall. And so we've got the foot elevated off the surface. And what that does is it keeps the foot slightly in front of the pelvis, which would be our early propulsive positioning. But capturing the first metatarsal head and the medial calcaneus is important because that's that initial superposition of internal rotation on top of the external rotation bias. Then to hang onto those cues, we need that medial pressure on the foot. What people are going to try to do is they're going to try to internally rotate from the top down to try to capture this pressure on the wall. What it would encourage you to do is cue it through the ankle because what's going to happen if they try to drive it through internal rotation, you're going to get a little bit more knee flexion than you want. And then you're also going to get an anti-orientation pelvis. And so now we've just defeated the purpose of the exercise by letting them follow their compensatory strategy. The knee is going to be slightly bent under these circumstances because what I don't want to do is turn this into a knee extension activity per se because then it becomes all quad activity when I really want hip activity. So I'm going to try to drive this through the hip from the top down and then maintain that ankle position so I can maintain my foot cues on the opposing side. We're going to bend the hip and the knee, but where I want you to target the direction of the knee is towards the nose. So we would need to bring this knee towards midline because what you're going to see typically are two compensatory strategies at the hip. So number one, they're going to try to ER the hip or they're going to move the hip into an EO orientation and then try to drive hip flexion, traditional hip flexion, which is actually going to be IR in this position. And so we want to avoid those two compensatory strategies because we're going to take advantage of this compensation by making a turn into the support leg. So if I drive the knee towards midline, what's going to happen is if I can hold that position, instead of the lower extremity moving away from midline, I'm actually going to turn the axial skeleton away from the flexed hip and knee. That's internal rotation on the other side.

So, relative motions only happen in an unloaded environment.

Well, number one, I don't know that I'm successful. I'm happy, which is more important. Having a curiosity about what you do is one of the most powerful things because it drives you to continue to progress. I still have questions. I still look for answers. I think that's probably number one. The minute you stop being curious, you don't ask questions anymore, and then you make an assumption that you know enough. And then there's no growth. One of my greatest fears is that I'm actually an old man sitting in a nursing home in a wheelchair and all this is being imagined because that's where I don't want to be. I always want to be invested and excited about what I do. So I think the curiosity is the number one thing because it does continue to push you like when you're tired, but you still have to answer that one question because it's just burning up inside of you to have an answer. I don't know if I would have a top three to be honest with you because I just think that the curiosity drives the excitement. The excitement drives the motivation. And then the discovery is the reward. So people like to talk about, like they know something about the brain and they say, oh, it's your dopamine reward system. Let's just say that that is what's going on. Every time you discover something new or something of value or something that kind of makes sense, and you do get that excitement, like getting that perfect red velvet cake with the extra buttercream icing on it and then you put your favorite caramel flavored ice cream on top of it. Does everybody do that? Or is it just me? So it's that moment where it's just like this is perfect and you feel that and then you get driven again. But without the curiosity, I don't think there's a cascade like that. If you're not curious about this and then you're not going to do well because the struggle is therefore a reason to keep the challenge in front of you, which is really, really important. But if you're not curious and then you struggle, now you hate yourself and you hate every moment and you can't live like that.

When measuring somebody, bring them up to 90 degrees of traditional hip flexion and you're doing your ER/IR and you observe excessive ER, that indicates a spine turning towards you as you measure that hip ER. You will always have external rotation and internal rotation; it just might not be where you want it to be. When we measure at the hips and see extreme representation like we're discussing, that usually comes from somewhere else—changing the orientation that allows the extreme to be demonstrated where you would traditionally measure. That's something you must pay attention to. Understanding orientation is crucial for interpreting measurement outcomes. People blame things like laxity, saying, 'Oh, you have a lax whatever.' The reality is it's just the hip socket being oriented in a direction where constraints that normally restrict motion don't matter anymore. It's like untwisting a twisted tail—it becomes loose, if you will.

A large variety of people.

I'm asking more about the principles. For example, we were talking about lowering the center of gravity. So I was wondering what's missing for me is those principles, like for lowering gravity, I need internal rotation, right? And then I need a posterior pelvic tilt or something, depending on where I'm going, I need a different location where I can extend or where I can... Right. Those are just the thought processes I need to go through in my head or with someone.

Like try some extensions.

It'll be really nice. So I can take any muscle, which is so ill-defined, it's not funny. I can take any muscle in your body and I can position you as such to make it appear that it cannot produce force. And then in return, I can also position you to where it can. That's typically why therapists on here, it's like any old school manual muscle tests that you do, they're still useful in the fact that it will help you confirm positions. So let's just say that you were testing hip extension or you were testing glute max. So the traditional manual muscle test would be a prone hip extension kind of a thing where you're testing glute max, right? And I believe they would bend the knee to try to eliminate hamstrings as you would. But the reason that that would test weak is because you lack the ability to capture the traditional hip extension position because the fluid volume in the synovial joint is too far posterior you can't compress it therefore you cannot move into that space and therefore you cannot produce force there. And so again it's like there's nothing wrong with the muscle tissue itself. The muscle tissue produces force. What the concern is is where are you in space and can you even access that space to produce force? If you can't get there you can't produce force there. That's all. It's real simple.

So they're going to have a little bit more of an internal rotation capability than, say, our guys that are better horizontal projectors. And so they'll have a little bit better hip flexion, a little bit better straight leg raise. So if we look at a couple representations of feet, I'll try to show you the subtle little difference. So what we have right there is a pair of feet that can run a 4-4-40. So he is very, very good at acceleration. He is very, very good at change of direction. So this is a Division I football player. And he played four years of high level Division I football. This other representation right here looks very, very similar, but this is a better vertical jumper than a horizontal projector. And so this is actually a very, very high level basketball player. And so he's got a better vertical jump than horizontal projection. And so again, subtle differences as to how close these guys are to their maximum propulsion phase. Now, let me show you another pair of feet that don't jump very well and not very fast, but also on a very high level basketball player. So this individual has a much higher arch. He has positioned much more into an earlier phase. So he's a little bit slower. He doesn't jump as high and he's not as fast. Doesn't mean that he can't play high level basketball. It just means that he's going to rely on other things. This person also happens to be exceptionally tall. And so again, we have all of these representations. So again, everything's multifactorial from a performance perspective. There are many different different ways that these people can perform. But what we want to start to think about is like, okay, I have these different feet. They're going to be better at different things. And it is one element that supports this high level of performance. Now, let's take this into the clinic. I can take these same concepts and I can start to look at my, quote, unquote, normal people from a very, very similar perspective. When I see a pair of feet that might be more pronated, so the arch is lower to the ground, I might have this person that is struggling with gravity. And so they're in a situation where they're constantly producing a higher force into the ground because they're just not managing gravity as well. You will have the compensatory strategies that we'll typically see help a lot of concentric muscle orientation and therefore a lot of limitations in range of motion. Under those circumstances, we probably want to move him away from maximum propulsion to give him the capacity to move through his extra rotation to intro rotation strategies. And this allows him to move away from the ground to reduce the concentric orientation and then restore a lot more of the active range of motion that he's missing.

Was anything particular, like near elbow pain? I definitely feel less confident treating that. So particularly like anterior knee pain where it's not, you know, medial or laterally focused. If they have like decent hip range of motion, where are you going from there?

I would say the first. The jump? Assuming you're not just like collapsing down.

You can definitely do that, right? So there's a few ways to do that. But yeah, that's what a reverse band type of the squat is: to reduce the downward forces that are associated with the load. Velocity has demonstrated using an expansion-based external rotation strategy. Internal rotation and compression slow down time. They literally just slow it down. So you can't be as fast as you produce for. Since you and I talk baseball all the time, if I'm trying to throw a baseball 90-plus miles an hour, I better not be in a concentric orientation for very long because all I'm going to do is slow myself down. The idea is just to be prolific. And that's how the good ideas arise. I talk about Dolly Parton a lot. I'm a fan of her. I'm not a fan of her music, because she has constructed something like all by herself. But there's a documentary on Netflix about her, and she has written over 3,000 songs in her career. My point is, she wrote 3,000 songs, but we can only talk about maybe four or five, and yet we all know who Dolly Parton is. Right? So, it's not about the fact that she wrote 3,000 great songs that will live forever. It's the fact that she wrote 3,000 songs and these five will stick in everybody's head forever.

So we got a little bit more of a compressive strategy that's pushing this left side forward, which means that everything's going to be turned to the right. Now, if we look at the upper thorax, he says I've got a right anterior thorax compression, which means that I'm going to lose some shoulder internal rotation on this side. And guess what? We have a loss of hip internal rotation on that right side too. So Ryan, you've got a little bit of an anterior compressive strategy going on here in this right pelvis as well. So again, we've got this great match. Now, let's talk about the forearm and the foot because this is really cool. So, Ryan was smart enough to check all the way down into the forearm and the wrist to identify what he's actually looking at, which is an awesome thing to do. Remember, we're treating the whole person here. And so, he identified the fact that this person does not have normal pronation in that right upper extremity. And then he says, well, we got an early propulsive foot, too, so let's take a look at that. So, my early propulsive foot is an ER tibia. The tibia is behind the malleolus here. And I'm going to have a decent arch in the foot. So that's my early propulsive strategy in the foot, which means that I have a foot that's going to be biased towards external rotation slash supination. And so they can't pronate the foot either. So we have this beautiful, beautiful iteration from all the way from the ground all the way up to the upper extremity, which means that if we really want to clean this thing up, we may have to go into the upper extremities to make sure that we have a full restoration of movement capabilities throughout the axial skeleton and throughout the extremities so this person does not have a recurrence of this strategy during their running. What are we going to do? A couple of strategies. If you want to go manual, if you're a manual guy, you might want to use the right lower extremity manipulation that I show on YouTube to try to recapture that middle propulsive strategy from the foot on up. That's a nice little video for you to watch. When we talk about the upper extremity situation, we also have manipulations up there too. I would probably look at something that utilizes the radius at the elbow where you can drive pronation from distal to proximal through the wrist. We get a nice little manipulate at the elbow and that's going to drive shoulder internal rotation as well. But there's a number of strategies that you can do up there as well. We've got scap decompression that we could use. Also, I have a video of that on YouTube as well. That's going to get you that dorsal rostral expansion and get you the restoration of some of your external rotations.

Okay. So I've heard of people saying that you should not get your orthotics made if you're pretty dysfunctional. So if someone gets their orthotics made, they're just reinforcing what they have going on and they should try to correct it first.

So if you lose in range shoulder flexion, you're gonna lose some of that adaptability in the lower cervical spine. So that would be something that you wanna monitor as far as an activity that you might wanna use to sort of offset some of the secondary consequences of the neck strengthening is what I call just lazy rotations. If you lay on your side with your head supported on a pillow and you're just turning your head from side to side with normal quiet nasal breathing just learning how to turn your head with the lowest energy possible. You can actually reduce some of this concentric orientation and that might help you restore some element of airway adaptability. Worst case scenarios, You may have an organ pharyngeal coordination problem that might be resolved with some myofunctional therapy solutions. And some of those activities are very useful as far as tongue positioning, maybe concern. Again, another worst case scenario, maybe you have a palate shaped problem that does not allow you to position your tongue appropriately. So that's something that might be looked at by your dentist to determine whether that's causal in any effect and then also go see your ENT to make sure that you have all structural issues taken care of. So Phillip, I hope that gives you a couple of things to think about and a little bit of understanding about what might be going on. If it doesn't, then please ask me another question at askbillhartmanatgmail.com. Everybody have a great weekend. Enjoy the rest of your Friday. I'll see you guys next week.

Bill, I was kind of thinking about this yesterday. I'm going to go back to basics. So you get counter-nutation of the sacrum and you get a retroversion of the acetabulum. If the femur stays fixed, when you get a concentric orientation of musculature on the front of the trochanter and an eccentric orientation of musculature behind it, then wouldn't that set up a better environment for internal rotation as opposed to external rotation?

Could you go over the mechanics in the pelvis? So you said, for instance, the first one was the compression in the dorsal rostral area, typically, to push their center of gravity forward. Would the mechanics for that in the pelvis be above the trochanter?

That's what makes it so difficult to explain this to other people or when people visit the gym and see that I have a large demographic of high school volleyball girls who all fit the same shape and movement category. They're all doing some variation of box squat on Monday or Wednesday. The interns see that and label everyone as doing the same thing, but different breathing is recommended for each, along with different tempos. They see band squats and box squats as the same thing, but a box squat is a hard stop that provides force to push off, while a band squat is a soft squat. There are many variations that people just see as the same thing applied across the board for everyone in that shape category, but it's not. You have many options there.

If you really, really want to learn and really want to get better at what you do, you have to continue to question things. The reason that you want to continue to question things even when you're successful is because everything that you do and everything you see is your interpretation of reality. So it's not reality. And so there's always going to be a gap, which means that within that gap is where we can improve. And so if we can push ourselves forward to see more of what we think reality is and expand our understanding of what the possibilities are, this is what's going to help us to progress and evolve. And so one of the first things you would do, regardless of the outcome, whether you consider your outcome a success or a failure, is what relationships did I think were apparent? So what did I see? What did I think I was measuring? What did I think those relationships represented? Because I have to have a framework or an understanding of what I think is going on. And the more refined that perspective of those relationships are, the better my starting point in this process. So then based on my outcome measures and my intent when I intervene, it's like, did I interpret those measures correctly? So here's the power of hindsight. So I have a before representation and I have an after representation. And so if I intervened as I intended and I got a correct outcome or the intended favorable outcome, I can still look back and try to interpret those measures. So a lot of times you figure these things out in hindsight. So I think I have a representation, I see what I ended up with, and then I work backwards. Because maybe not everything went exactly as planned, so why not? Why didn't it go exactly as planned? So maybe it's favorable for the client. So the client feels better, they move better, they accomplish some sort of task. But the reality is that if I really, really objectively look at my measures, I can look backwards and I can say, okay, was my interpretation correct? The more often you can do that, the more you're capable of narrowing what the probabilities will be that next time. And so again, we use every opportunity of our interactions with a client or a patient or whomever it may be as an opportunity for next. Now, again, because we have this gap between our perceptions and reality, we have to ask ourselves, what else could it have been? So if I think I know something, is there something else that it could have been? What were the possibilities? Are there other possibilities? So now we have to think about, okay, as I study these things or as I'm trying to learn something new, where else can I look for possibilities? Where else can I look for understanding? And where else can I look to gain a perspective on these relationships? And so now this is where education comes in. And this is where they fail because what education has become is teaching a bunch of concepts without without a coherent model to represent things. And so, you know, when you go through PT school, for instance, they teach you embryology. Well, why do they teach you embryology? They never told you why it's important. And the reality is, it's like, that's where you came from. And so when you start to see how these relationships evolved through development, you start to see how they are represented in this fully grown human that we're interacting with. And then it becomes very, very powerful. And so that's why we have to go back and we have to start looking at those things. We look at comparative anatomy between animals because other animals behave very similarly to how we do. So how does it work for them? And then we can start to get ideas of how it might work for us. Finally, we start to say, okay, does this make sense? Is it coherent with what my understanding is? And so think about this for a second. We have universal principles that are applied everywhere. So I talk about compression and expansion a lot. The reason being is because it is a universal principle. So when I say universal, I am talking about the universe in and of itself. So we talk about compression and expansion. So that's what the universe does. It expands. So space expands and compresses. Time compresses and expands. It's light compresses and expands. So we have to follow those rules too. So wherever we have some physical principle in the universe, we need to behave within that rule as well. So is it coherent? Is it consistent with those rules? The rules are very, very simple. When we look at the complexity of a human, we can get distracted by sharp shiny objects all over the place, but the reality is, if we can start to simplify things, we look at the simplest of rules, that is how complexity evolves. So if you look at things like Conway's game of life, and you can look that up on google and then go play with it a little bit, and what you'll see is there's there's three simple rules that this game is based on, but you'll see the most amazing complex structures that evolve from those simple rules. We are the same. And so again, if I see something or I see information presented that requires that I have to learn another rule, I immediately question it because again, I think we're based on very, very simple rules, very simple processes that are just repeated. And because of the new starting conditions, that's what evolves the complexity that we see.

I think the conversation that I will always have with clients is when they'll say like, how much weight can I lose? I have no idea. Here's XYZ principles that we know work. Let's see how your body responds to it because you don't really know the backlog of metabolic distress or over color. You don't know all the other things that are in the background that you're dealing with.

Yeah, that's a huge one. That's missing.

The old Apli scratch test will work in this situation because if you can't do that with the upper extremity chance, you're not going to be able to capture the internal rotation position that we're talking about in the lower extremity either. So now we've identified what it actually is. Now how do you train to recapture the quote unquote hip extension? And so what I would say is, the first thing you got to understand is what position actually allows it to occur. And if you can understand that, then the rest is going to be kind of easy. So if we take our pelvis, and so we're talking about motion in this direction. So what we're actually doing is we're going to be inchly rotating to allow the center of mass to pass over the leg. So that's the motion that's going to be occurring. So that's internal rotation. So under those circumstances, what I need to be able to do is I need to be able to eye our the Ilium and create an antiverted position of the acetabulum, which means I need to be able to mutate the sacrum. So those are the conditions that allowed this to occur. And so all we have to do now is be able to identify what our starting conditions are. And then we move you towards that internally rotated Ilium, mutated position of the sacrum concentric pelvic diaphragm, if you will. And that's going to allow us to recapture this internal rotation in the position as we pass the body over the limb.

What interventions did you use to try to restore? You had a cough.

Thank you.