You see it? Yeah, that clarifies it a lot. Thank you.

Yeah, I have exactly right. Exactly right. I have to push back into the left. Again, like I said, this is typically going to be like your, if you're in a staggered stance, it's a right foot lead. If you're in a split stance, it's a right foot lead.

That's all I had. So I think that's it.

Right, and you have the bands essentially to unweight that situation a lot of times.

Yeah. You remember it?

Yes. And so when bones do touch, bad things tend to happen. So given that information, I'm looking to specifically visualize because sometimes I have a hard time visualizing things even though conceptually maybe they come a bit more easily. So for something like the lat or the pec, a lot of people who are in this hypertrophy world where we're looking to take origin to insertion, line of pull, we're trying to manipulate all those things, axes of rotation—how does the model sort of fit into hypertrophy? And I know you've discussed hypertrophy on sort of the level of your model before, but for something like a single arm lat pulldown or just anything with the pecs, those two muscles really, from a visual perspective, look like they're using the rib cage as leverage and I've heard a lot of people say that the rib cage serves as a fulcrum to that sort of rotation. So I was wondering from the perspective of your model how you conceptualize that with fluid movement, because with the rib cage it's a little bit trickier for me to visualize it rather than talking about something like a knee.

Okay.

Yeah.

Ultimately, that's what I want you to think about as you're learning and understanding these tests. It's really cool to throw somebody on the table and show the movement limitation, do something, and then make that movement limitation disappear. But ultimately what I want you to be able to do is go into the gym, have people move and perform their exercise activities, and then be able to coach and cue them with that understanding. We're going to dive right into today's Q&A. This is a conversation that I had with Andrew, who is in a really cool place in his evolution as a coach. He is working on becoming more reliable with his table tests and his interpretation. So we're actually going to talk through some of that. We're going to use a little bit more of a shoulder frame of reference in this one. But we also talk about some of the confirmations that we use as checks and balances in the hip. And so we're going to talk a little bit about iterations and such that are very important when you're learning how to interpret these things. Ultimately what we're going to try to do is we're going to try to eliminate the table tests from necessity and hopefully train the eye to be a little bit more effective using table tests only when we need to as confirmations or when we do get stuck. And we do get stuck because this is very complex, it is very gray, and as I like to say the measurements tend to be a little dirty anyway. So Andrew, thank you for your participation and your question. I will see you on the Coffee and Coaches conference call as we always do every Thursday morning at 6 a.m. So everybody have a terrific Tuesday, and we will see you tomorrow. And the clock has started. What is your question, Andrew?

Does that make sense? Yes, yes. Great call. Thank you. Thank you for taking time on a Saturday morning to talk to me. You're very welcome, sir.

And you're going to give an example or two. And then you're going to restate your point in another way to make it memorable. And then you have to figure out a transition into the next one.

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. But we're going to cover a lot of the mechanical aspects that I think are in play and are important to me in regard to how I perceive these things through my model. First things first, Johnny, we're going to invert your problem a little bit and we're going to say why is it bad if bones touch? So the bones touching thing probably comes from using dead guy anatomy as a model. So dead guys actually do have levers. And so to have a lever you have to have a fulcrum and so the bones touch on dead guys because they're dry and so they look like levers and so then in school they teach you that oh your joints move just like levers. The reality is in a living breathing human and the fact that we're full of water and we've got synovial fluid in our joints we don't have fulcrums. 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.

What is bending the bar for?

Because remember, I'm starting the superimposed internal rotation on this ER biased position on the support side. So again, we're taking advantage of the compensation. I'm going to push into the wall. Again, I want to control the ischial tuberosity. So I'm going to push into the wall. So you're going to feel a lot of activity in that support side hip. So if we wanted to pick on a muscle, we could say, well, you're going to feel a lot of glute max activity under those circumstances. Now I'm going to drive the opposite elbow towards the flexed hip and knee. And what this is going to do, it's going to create a space between the spine and the scapula. And so this is going to give us our yielding action in the upper thorax. From a breathing standpoint, we want to be able to breathe through this. So we're going to inhale, but we're going to think about bringing the knee and the elbow closer together on the inhale. And then my exhale strategy is going to be to push the wall away. So this constructs the entire exercise. Now, for some people, it's going to be very, very difficult to breathe. And so I would encourage you to capture the cues, but don't force the activity between the elbow and the knee because we do want to be able to move air. And so I want people to expand under these circumstances because most of the people that we're going to use this with are very, very compressed. And what we're going to find over time is as they gain this capacity to expand and compress, we're going to approximate that elbow in the knee much more effectively. You're going to get a stronger push in the wall. So let them evolve this exercise. Don't try to be perfect on the first try because you're going to capture a lot of good things as long as you maintain your contacts with the wall.

I wouldn't say unloaded. I would say that there's a threshold that you would have to cross where you would start to lose it. If I pick up my pen, that's loaded, technically speaking, and it's a really extreme example. This doesn't stop my relative motion because the load doesn't challenge me. However, if my pen weighed 40 pounds, I might have to change my strategy.

It felt like two minutes. Really, really good questions. Tough questions, actually, and kind of philosophical, but got a lot of great feedback on that, so I hope you can join us next Thursday, 6 a.m. for the Coffee and Coaches Conference call. Now, let's dig into today's Q&A. It's gonna allow us to examine some of our expansion to compression to expansion concepts, and we're gonna do it under the guise of a golf swing. This is a two-parter question. And like I said, we'll review some extra rotation and introvertation concepts. We'll look at the swing. And then we're gonna look at some of the negative secondary consequences of when we don't have this representation of expansion to compression. Because I think a lot of things show up clinically when people either lose their capabilities or they train away some capabilities. So, let's go to Johnny's question. Johnny says, hey Bill, hey Johnny, is hip abduction? And he puts it in quotes. Johnny's really smart. At 90 degrees of traditional hip flexion. Once again, I like the traditional. hip flexion considered ERI. Okay, so is this movement away from midline, interrotation or extra rotation? So let's grab the pelvis and let's take a look at this thing. So when we look at where we are at 90 degrees, so theoretically, if everything's all fine and wonderful, we're going to be starting from this position of interrotation. But we have to consider when we have movement away from midline, when we want to decide what's happening here at the hip, we have to consider the relationship between the femur, the inominate bone, the sacrum, and the lumbar spine because all of them are going to contribute to the position and the movement and so under whatever circumstances this may be occurring I can have a different outcome. So if I start from this position which we would say is traditional hip flexion at 90 degrees degrees, and I'm going to move away. If I have an inominant that is biased towards inhalation, as this moves away from midline, I'm going to see more of an external rotation. But visually, obviously, it's going to move in this straight line, if you will. But the reality is that I'm producing a rotation here at the hip joint. If I am biased towards an inhalation strategy at the pelvis, then what I'm going to see is I'm going to see it turn this way as it moves away from midline, and now I've produced an internal rotation. So, Jami, I think that when you're trying to determine which one it is, you're going to have to look at the context in which it's being applied. And so if I was in a split squat and I see someone to need deviate outward under most circumstances, you're going to show me that's going to be biased towards inhalation. That's going to be an ER kind of a situation. Sometimes as you see people move through that 90 degrees in a deep squat for them to actually achieve the deep squat. What they're doing is they're moving that hip into internal rotation, even as the knees are deviating away from midline. So again, I think you need to pay attention to those relationships.

Right. I'm understanding correctly, you're saying oftentimes there's a substitution occurring at the spine in the person with excessive external rotation, right? And then the internal rotation, the excessive internal rotation would be more like just because of the way the hip socket is oriented, there's just more IR available at that 90 degrees.

No. Who do you work with?

Right. Okay. So let's start, let's start really, really simple. Let's start really, really simple. When I take a breath in, do I internally rotate or externally rotate?

If you want to think like a structural reductionist, you know, modeler, that's fine.

Right.

So again, it's just a matter of perspective of what we're looking at. But feet are always a great representation of this. They're very confirming as far as some of your measures that you're going to find on up the chain, so to speak. So some of your top-down influences are going to be represented in the feet. If you can't manage this from a top-down influence, then it may be time to do something about this at the foot. So maybe this is your manual therapies for the foot. Maybe this is selecting activities that are specifically designed to improve the representation of sensation from the ground up. Maybe this is the person that you put in an orthotic as a solution to give them the capacity of adaptability. Performance is an intentional reduction of adaptability to create a higher level of output. Whereas when we're trying to make people more adaptable, such as the rehab situation, now we need to take away some of that reduction in adaptability, restore it to give them the ability to reset, reduce that concentric orientation and then restore ranges of motion. So hopefully that just gives you a little bit of perspective on what we're talking about when we're talking about the performance related foot and how it might be related to what we're measuring on the table or what we're seeing on the court or on the field.

Okay, wait a minute. Are we talking about elbow? Are we talking about knee? Just knee for right now. The two big tests that I use for knees is extension inflection. where the pain is, is initially less of a concern. Like the location can kind of tell you a little bit about the knee. So if I have like a medial knee pain, I tend to have a femur that's internally rotated on an externally rotated tibia. If I have lateral knee pain, I tend to have a tibia that is so far externally rotated that it dragged the femur with it. So they're both kind of turned outward, right? So under those circumstances, you can tell the medial lateral stuff. when you have an anterior, like just kind of like that broad generalized kind of anterior knee pain kind of a thing. So think about it's like I'm driving force through the knee from posterior to anterior under most circumstances, which means that I don't have turns available to me, right? So I'm gonna load it straight through the knee. And so when you think about, you understand what a screw home is, right? Okay, so do they have screw home, which means that I should have some representation of if we talk about traditional extension measures you're probably going to get five to 10 degrees of hyperextension in a knee passively, and then I should have healed to butt flexion. Okay. Those are the two biggies for me. It's like, can I extend the knee and can I flex the knee fully? And so if I can't, that means I have a rotational problem. So when you say decent hip range of motion, not really sure what that represents, but let's just say that you've cleaned up the hip and the pelvis and the actual skeleton and so everything looks all fine and wonderful there and then you go to the knee and you go, oh, they're like four or five inches from heel to butt. And so that would be indicative of somebody that probably can't internally rotate the tip enough to bend the knee to normal range. And so that's where I would spend my time.

Okay, so we're not collapsing down. So you're saying that the tissues are loaded faster if I jump off the box, is that correct? Yeah, and you just like land on the ground. Yeah, it's just a normal, just jump off the box and land, stick it. Perfectly, like great technique, the whole thing. My argument would be that it's actually the exact opposite because the minute I have that weight on my back, I'm loaded. It's instantaneous. Are you saying when you unrack it and then you're standing, you've got the weight on your back and you initiate the squat. Okay, the tissues are instantaneously loaded; the rate of loading is instantaneous. It's already there. As you jump, so what I want you to do is I want you to look at the two activities in slow motion in your head. As you jump off the box and I make the initial contact. Okay, I make the initial contact. The tissues are loading over a longer period of time. It's not a long period of time. It's just a longer period of time. The back squat example, the load is already there. It's instantaneous. The jump off the box, the tissues elongate over a longer period of time. That's actually a yielding action because I have to store the energy in those connective tissues. If I'm loaded from an instantaneous standpoint in the back squat, I need an overcoming action because if I would yield, you're accelerating towards the ground.

Let's get into some of the numbers and talk about why they don't matter. And then we're going to talk about the best way to go about utilizing this element of structure as to where it lies on the scale of importance. So from a history standpoint, the physical structure's been around for a long time. We've paid attention to it for a really long time. So let me show you a little representation there. So you can see the differences in the physical structure. This is the slender and the stocky types from Joel Goethwaite's book, 'Body Mechanics', originally published in 1934. So we've been talking about this kind of stuff for a really, really long time. Fast forward to the 1980s and you've got like Upleasure talking about it. You've got even the Ralfers were talking about the differences in structure. Leading to the 2000s, Shirley Sarman talked about it in her books as well. And there's use in some of her reductionist approach to that. There's a couple of practitioners in New Zealand that have actually registered a trademark. So they named the inferestional angle. They gave it a funny name and then they registered the trademark. Nobody really cares about it because nobody uses that name as far as I know. And then if we get close to the 2020 here, there's been a couple Korean studies where they were looking at ISAs and they're trying to find a good way to measure it. And they're trying to find sort of like some averages or some sort of weird optimal. And then they were trying to determine inter-rater reliability, which turned out to be very, very high inter-rater reliability. So that's good for us because it gives us an opportunity to say, okay, we're all going to be pretty good at determining what is a wide and what is a narrow. But where do these numbers come from? So Shirley Sarman participated in this study with another practitioner I'm assuming named Zeller in 1983. It's in a supplement from the physical therapy journal, which apparently doesn't exist. I can't find it anywhere. But they talked about 83 degrees as some sort of average or optimal or something weird like that. I think the Koreans found something that was just shy of 90 degrees. And so it's almost like they said, okay, well, it's kind of like that. So let's just say 90 is the standard. And so a lot of people are using 90 as the standard. The New Zealanders are using 90 as the standard. But I think it's a little bit of horse hockey. It's kind of like just throwing a dart at a dart board and going, oh, 90. Okay, we'll call it that. Because there's really no foundation for it. It doesn't really represent anything useful for us to try to chase a number and say that this is optimal. This is the standard and we need to push people towards this because again, it's just not very useful.

That's going to get you that dorsal rostral expansion and get you the restoration of some of your external rotations. If you're a soft tissue guy, identify your concentric orientations and that's where you're going to want to spend your time reducing that. So if you've done all of that, now we want to think about, well, I need this person to actually learn how to manage this thing themselves. So when we teach them how to reduce this anterior orientation situation, we're going to use some form of hip extension. The question is, how much hip flexion do you have available to work with under this situation? If you do not have 90 degrees, so if I don't have hip internal rotations, then chances are I don't have 90 degrees of hip flexion to work with. So I can't use anything in that range. So I might have to drop them down into hook lying. I might have to work on some posterior orientation activities in the pelvis so I can work through an excursion of that hip that I do have available. Once I do that, I have to create a delay strategy on the left side. So we're going to do some form of hip shifting. We got to push back on that left side to create some yielding strategy on the left to create the delay of the propulsion because that's what's pushing everything forward. So what it's going to look like, it's going to look like that picture right there. If my technology is friendly today, you're going to see a picture of a before situation that's probably going to look a lot like Ryan's patient here. And then what we're going to do is we're going to teach them how to expand posteriorly on the left with the yielding strategy. And then it's going to look like that picture right there. So again, hopefully my technology is working and you've just seen a before and an after of this situation. Now, once you recover pelvic orientation, yielding strategy, now we got to flip flop our strategy. We got to get the right leg ahead of the left and push back into the left. We've got to train the right side through middle propulsion. So in a lot of situations what I'll do is I'll take people out of their shoes, get their foot on the ground so we can translate that tibia over the foot actively to start to drive through that middle propulsive phase. So those of you that are thinking heel rocker, ankle rocker, toe rocker, this is your ankle rocker as well. If you need to go into the upper extremity, you're going to want to try to drive something very, very similar in the upper extremity that we just talked about with the right lower extremity lead. But in this situation, it's going to become like a right oblique sit with the form and pronation. It's going to progress into some form of side plank in the gym. If we continue on into the gym, you might not be able to use 90 degrees right up the bat because if I put somebody in half kneeling, they can't recapture their internal rotation right away in an upright position because I've got an external rotation on both sides of the pelvis which tilts the pelvis on on a bit of an oblique axis. However, I can bring them up into a staggered stance situation and so now I can get my cable chops. I can do a high low cable press and I can work some backwards sled drags and so now I can be effective in the gym. I can maintain my posterior expansion, the yielding strategy on the backside. I can push off that right foot into into the backside, and now I have just reoriented everything and I'm maintaining all of my changes. So Ryan, I hope that gives you a few ideas on how to approach this so you can go manual. You gotta recapture the positions and then reinforce that stuff in the gym, but it's a great representation of the iterations. Thank you so much for the question. If you have any questions yourselves, ask billhartman at gmail.com. Ask billhartman at gmail.com. Have an outstanding weekend, and I will see you guys later.

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 you're weight-bearing through the extremity?

Correct.

But this is why these programs, like our apprenticeship, mentorship style programs have to exist. It's because people just don't know what the options are. They don't even know what they are. And you have all of these superimpositions on top of the exercise. If you talk to, like say, a powerlifter, because their intent is basically the same in powerlifting, it sort of gets mixed down to this limited number of options, right? There's only a couple of things that you can do. There is a way for you to do this. Right. And then when you start to branch out and we get into these dynamics that we're trying to support from a sporting aspect, it's like, oh wait a minute, that's actually going to be detrimental if I do it that way, whereas if I just tweak it in one respect. The duration of time on the box, the touch and go, the foot position, all of these things can be manipulated to create just a point of emphasis that will support this individual's capacity. And again, it's like the only way that you're going to get that kind of understanding is this experiential type of an environment, right? It's like if I can't access it at the quote unquote normal place in a joint, I'm going to get it somewhere. I need something that re-orients me to go forward when I want to walk forward. Knowing full well that people are going to be biased back towards external rotation under most circumstances. ER is our home, so to speak. From an evolutionary standpoint, external rotation came first, internal rotation came second. Because we were swimmers before we were walkers. And swimmers are externally rotated. Walkers have to internally rotate against gravity because the propulsive phase is different on land than it is in the water. I appreciate you all for being here. Have a great week. Hang in there. Keep doing good work and I will see you next time.