Can we play off of this cutting example? Absolutely. If I've got somebody who's just very toned up, lots of training, they're going to go into this cut and they're going to maintain concentric orientation in most cases, which is what we want because then they can use the rebound of the connective tissues.

And then, so, I guess, 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.

That's it.

We're going to maintain our yielding action, but I would say you start with a higher box and work on controlling the descent of the pelvic diaphragm. Then slowly lower the box as much as is required to maximize the vertical jump. Now strategy number four. We want to really magnify this time constraint to a significant degree. So we're going to use something that's going to be much more impulsive. So we're going to use something like a kettlebell squat clean or we're going to use an oscillatory impulse type of squat to really narrow this time constraint. Because we've already trained the position of the pelvic outlets, we've got our concentric orientation. We want to make sure we maintain our yielding action. Now we want to just cut the amount of time that it takes to make the turnaround so we can maximize the return on investment as far as the yielding action and the release of energy to maximize the vertical jump.

So we need to be very particular about our exhalation strategies. But when it comes to performance, there's a timing and a duration that's going to be a very, very important influence in acquiring the desired outcomes. If you have any other questions, please go to askbillharmanetgmail.com. And I will see you guys tomorrow. Good morning. Happy Tuesday. I have neural coffee in hand and it is perfect. Okay. Already a solid Tuesday. Let's dig into today's Q&A. I got a series of questions about chin-ups and pull-ups. Some are associated with what are the compensations that you're typically gonna see. Some of it is associated with one gentleman was asking about elbow pain and we'll kinda get to those. Today I wanna sort of establish just a general framework of what we would expect to see and maybe some generalized compensatory strategies. First and foremost, we gotta talk about range of motion and force production. So remember, we always talk about the concept of having this expanded external rotation field. So we need an ER field so we can access range of motion around us and we superimpose internal rotation on top of that. So our internal rotation is a compressive strategy. It is force production and it is usually resistance of gravity. And so if we limit that ER field. If we reduce the ER field through compensatory strategies or compression, we've immediately limited our potential to produce internal rotation and force production and therefore also ranges of motion. So we want to keep that in mind as we go through talking about the chin-ups and pull-ups. So let's break the chin-up and pull-up into basically three segments. So we're going to talk about the initial position, we'll talk about mid-range, and we'll talk about about the finish. And so when we look at chin-ups and pull-ups, regardless of which one we're talking about, in this end-range position of the hang, the shoulder is going to be biased towards internal rotation under almost every circumstance. We've got the medial border of the scapula that is compressed against the thorax. We have an orientation of the glenate into ER. The humerus is going to be, therefore, in relative internal rotation. So under these circumstances, we need posterior lower expansion of the thorax, and we need an up-pump handle because a deficit in either of these areas is going to lead towards a compensatory strategy. So for some of you, that compensatory strategy might be spreading your hands apart. So you're going to take a wider grip on the bar, and hey, my shoulder's more comfortable because now what you've done is you've created an orientation into extra rotation. You've now sort of expanded your ER field, if you will, and that allows you to produce internal rotation in that position with less compressive strategy. Now, as we move through this chin up, we are essentially under load. So we are going to have an internal rotation bias throughout this entire thing. So this is just like a press. This is just like a bench press. It's just like a squat. We have a compressive strategy from start to finish, but we still need external rotation to allow us to access ranges of motion and therefore that's what we superimpose our internal rotation upon. So when we're doing our pull, this is going to require that we maintain some measure of posterior expansion. If you lack the ability to expand the dorsal rostro area and therefore access some measure of of ER that means we have shrunk the ER field and now we're going to need to figure out a way to superimpose this IR so what we end up doing is we'll typically throw a compensatory strategy on top of that so what you'll see is scapular retraction which turns the glenoid outward into ER or you're going to see traditional spinal extension under these circumstances because that is the substitution for interim rotation at the shoulder when I don't have access to it at the shoulder. Let's not forget about our dynamic ISA. So to get the arms into the overhead position to even start the pull up or chin up effectively, we have to be able to reclose the infersternal angle because what we have to do is we have to create compression in the lower part of the thorax to promote the expansion upwards. So we're squeezing the bottom to push the volume of air into the upper part of the thorax. And this is what allows us to get the pump handle and the dorsal rostral expansion. So we have our ER available to us, and then we can produce our IR on top of it. As we move through the middle range of the chin up, the demand of intranotation is actually going to increase under these circumstances. But I still need to have dorsal rostral expansion. Again, so I have some measure of extranotation that I can propose my IR on. Now, if I don't have that, what you're going to see is you're going to see that thorax compress even more. So you're going to see the space between the scapula get pushed forward. So you'll see this early scapula retraction. Again, this is turning the scapula into ER. So you'll see the arms moving outward away from midline. to try to capture this externally rotated position. So again, I can superimpose my eye are on. So a nice little comparison to this would be for those of you that have to squat with a really wide stance in the toe out. The reason that you do that is because you have to turn your hip sockets outward so you can have enough extra rotation so you can produce force into the ground as you're squatting. Now, let's go to the finish. So for me to finish a chin up, I'm going to need posterior lower expansion, which means that you better be able to control your infrastonal angle by abdominal activity because what I have to do is I have to use my abdomen, my abdominal muscles to push volume posteriorly into the posterior thorax to keep that expanded so I can access the end range position. If you don't expand that, There is no extra rotation range of motion available to you. Therefore, you cannot finish the exercise. So this is for those fine folks that are struggling to get their chest to the bar if they want to or their chin over the bar if they want to. Because what you can't do is you're not expanding that. So again, you're arching your back to produce your internal rotation. you compress to such a degree that you no longer have any range of motion available to you. So the compressor strategy is so great. You don't have ER, you don't have IR, motion stops, and the chin up is done. You'll see this in a lot of very, like the massive body blows that go through this almost like just simple middle range excursions because they just don't have any range of motion available to them. So quick review. common compensations for the lack of shoulder range of motion. You're going to try to find a way to orient into ER. So you're going to try to turn the scapula. So that's why you see the dorsal rostral compressive strategies to turn that glenoid outward. You're going to see traditional spinal extension as a substitution for the internal rotation. But keep in mind, the first thing you have to be able to do to effectively execute these pull-ups and chin-ups, I have to have enough expansion for my extra rotation field that I can superimpose internal rotation on top of it. If you have any questions pertaining to the chin-up or anything else for that matter, go to askbillharman at gmail.com, and we'll see you guys tomorrow.

And then I'm going to use things like my front foot elevated split squat where I've got the flat foot where I'm teaching the tibia to translate over the foot with the control of the arch. Now let's talk about the tendon in and of itself. So here's where we get to rely on some useful research and I would point you towards Keith Barr, B-A-A-R and Jill Cook. They've got the most prominent research right now. We're going to use heavy static loads with extended durations and so we'll start with like a 10-second load on the tendon build up to about 30 seconds. And you want a total accumulation of about five to 10 minutes of loading. So you're going to build this up over time. So this is a number of weeks and months, et cetera. But I think the strategy that we want to use here in reference to your question is we want to make sure that we're using a yielding action to promote the stress relaxation of the tendon. So over time, as we hold these static positions, it's almost like a telescoping of the tendon where the superficial layers slowly elongate where we can start to expose the deeper part of the tendon that's most likely affected. And so again, we wanna use this yielding action versus something that would be overcoming. So when we talk about like a standing calf raise or something like that, we wanna make sure that we're using the yielding position. So we're not pushing up against the immovable resistance to create an overcoming action. That's a mistake that I've actually made in the past, is we wanna make sure that we're using a yielding static position. One of the easiest ways to do this is to pull out the old 1985 muscle and fitness seated calf raise machine. It's just an easy way to create the load because we need 80% plus of one repetition maximum loads and so the seated calf raise is money under these circumstances. So John, I hope that leads you in a direction and gives you some ideas in regards to how to deal with this. I think the rules apply across the board. Whenever we're talking about these peripheral connected tissues and how they get loaded, I think they're just under a lot of concentric orientation with overcoming actions, with the commonality being the overcoming action, because we can obviously have eccentric orientation and overcoming as well.

And so let's represent this with a little bit of a chessboard. The chessboards get kind of ugly under these circumstances because you see a loss of just about everything. So everything is going to be in deficit. So all of our ER measures are going to be in deficit. All of our IR measures are going to be in deficit. And so when we have the loss of ER, we have the loss of IR, we're typically going to see a knee under these circumstances that is sort of stuck in a screw-home position. So we've got that tibial femoral ER. They're going to have a relatively high arch with the traditionally referred to plantar flexed first ray. This is an anterior tilt of the pelvis. And as I said, it's a tibial femoral ER at the knee. But the thing we have to represent here is that we've got a distal femoral IR and a proximal tibial ER. So there's actually a twist in the bones here that we're going to deal with. And then we've got this foot that is also following the same representation, and it's trying to represent an early propulsive foot, but it cannot get that first metatarsal head down. So we're not even there yet. So we've got a foot that's still in a compensatory position under many of these circumstances. And so the foot position is going to be a big deal as we talk about this in our approach to recover. To reiterate, if we went proximal to distal, we've got ER at the hip, IR at the knee, ER at the knee, IR at the ankle, and then we've got the same representation in the foot. So we've got a rear foot in ER, we've got a forefoot in IR. That's the plantarflexed first ray. And so you'll see the big toe getting jammed into the ground so you get a nice little fat big toe without the metatarsal head on the ground. So the way we're going to address this, because we've got the anterior tilt of the pelvis, we want to recapture that first. Now we've got a secondary problem because we've got this foot position that's going to make it very very difficult for us to capture our typical position, say in a supine hip flexion, which is probably where we want to start with, because we have this pretty significant deficit in hip flexion. So if we try to move somebody to 90 degrees of hip flexion for anything, we're already pushing them into a compensatory strategy. So what we may need to do first is mobilize the foot. So go to the video on YouTube that I did to recapture this middle propulsive foot. So we need a foot that we can push against in internal rotation because right now you got a foot that cannot do that. So you might need to mobilize the foot. You may also need to mobilize the knee.

I think you need to continue with your cues for the ER bias, but also make sure that you're modifying the exercise appropriately so people can actually execute a decent push-up. If you have any other questions, please go to askbillhartman at gmail.com, askbillhartman at gmail.com, and I will see you guys tomorrow. So a while back we did a video on three shoulder impingements, three strategies, three solutions. Wouldn't it be cool if the hip was the same? It is. Good morning. Happy Tuesday. I have neuro coffee in hand. That's really good. I just got off a mentorship call, so I'm a little fired up. It was a really, really good one. It was very, very, very much fun. So let's go ahead and dig into Tuesday's Q&A, and this comes from Chris. Chris and I were having a discussion, and he says, I really appreciate the three impingements, three strategies, three solutions for the shoulder that you did. Would there be something similar going on in the hip regarding impingement? And if so, could you do the same thing for the hip that you did for the shoulder? Thanks. So Chris, you're not going to believe this, but this hip impingement thing is exactly like the impingements in the shoulder. We just have to look at it from the appropriate perspective. And so when we did the shoulder thing, we talked about the three classic impingement tests that we would use, and then we gave solutions. And so what I'm going to do is I'm going to compare these hip representations directly to the shoulder representations and you'll kind of see how this all plays out. And so we'll talk about like what interferes and what doesn't and then we'll give some exercise progression. So there'll be a fair number of exercise examples in this I think as we go through this. So let's break this down a little bit. So we had in the shoulder, we did the Hawkins Kennedy, we did a Mears test, and then we did like the classic painful arc. And so the way that these are going to be represented in the hip is going to be through our hip flexion, traditional hip flexion measures, and through our abduction measures. And so all of these are going to be representative of external rotation measures, but the interference is going to be internal rotation in every case. And so we're going to have a situation where, because of the orientation, we're going to give up some ER. We're going to have an overemphasis on the IR, and that's what causes the compressor strategies that can actually result in pain, or as we would say a diagnosis of impingement. And so let's look at the Hawkins Kennedy test first. So if we look at the shoulder, we're going to see that it's internal rotation at about 90 degrees of traditional flexion. And so that would be representative of internal rotation superimposed on a little bit of hip flexion at 90 degrees in the hip. And so there's our commonality. But what we've got as far as findings are concerned is this is going to be a situation where we've got posterior lower compression. So we're going to lose early hip flexion because hip flexion under these circumstances would be in this early stage of hip flexion. The problem is we got to think about this in 4D. Remember, it's not an arc. So if I'm coming up this way, that would normally be external rotation. The problem is under these circumstances with the posterior lower compression, external rotation is way up there. And so external rotation goes this way, not straight up in front. If I go straight up in front, I'm moving into internal rotation, which means I'm going to max out my internal rotation too soon. And then under those circumstances, I keep driving harder and harder into orientation, and I bang into it right at 90 degrees. And so there's my compressive strategy. So what we have here is an outlet, a pelvic outlet that wants to remain narrow, wants to remain eccentrically oriented. As far as interference goes we want to eliminate all this bilateral hip extension kind of stuff because again ER is way out there we want to restore it here in the middle so so this means that those of you who are just fond of your hip thrust because you want glute development let's get off of that train right now no low cable pull-throughs and then your reverse hypers are also going to be off the table under those circumstances. So from an exercise standpoint we want to reorient the pelvis. And we're gonna stick with unilateral activities. And so you know how I love my cross-connects. And so we're gonna use a cross-connect, but I want you to pay attention to something very, very important here. And this is gonna be your foot contacts. And so if we're doing a supine cross-connect, we wanna make sure that we're capturing the foot position on the wall. This is first met head on the ground. So to speak, the ground is now the wall. And we got that medial heel contact. We wanna maintain that throughout, because this is where we're starting to initiate internal rotation from an externally rotated position. And this is what we have to recapture when we're talking about reorienting the pelvis. And then we want to move to something that's a little bit more hip flexion. So we can move into a hook lying situation. We still want to induce some internal rotation. So we're going to put something between your knees to hang on to that internal rotation, but from a position of external rotation first. Once we can capture 90 degrees of hip flexion, we got a lot of cool stuff that we can do. So we can start some rolling activities and we're going to teach you how to roll into the affected side, and we're going to drive propulsive strategies on the opposing side. As far as some gym-related stuff, we can use our box squat, but we're going to use a touch and go. So remember, we've got an eccentrically oriented pelvic diaphragm. We want to concentrically orient that sucker. And so if I unload on the box, I'm going to get some of that eccentric orientation and some yielding action that I don't want. Then again, because I have 90 degrees of hip flexion, I can start to turn into that side so I can start to capture a true internal rotation at the right point. And so that's going to be my Jefferson split squat. It's going to become real handy because I'm going to start from that ER orientation. I'm going to hang on to ER orientation as I start to superimpose the normal IR on top of it. We could use split stance activities that are using an ipsilateral cable load. So if I was doing a left foot forward split squat, I could put the cable in the left hand, hold that left side back, and again, I'm going to move from an ER position to an IR position under those normal circumstances. 3D straps that are going to push you into the original orientation and teach you how to resist and move into it, another great opportunity to recap for these positions. Let's move on to the next one. So we talked about the Neer, which is impingement above 120 degrees in the shoulder. So we're going to represent this kind of the same way. So this is going to be the end range hip flexion measure where we're going to start to feel that impingement. And so what we have here is a situation where what I need under those circumstances to have a normal hip flexion end range is that I have to have a lumbar spine that can turn towards that measurement side of the hip. So the ipsilateral side. If a spine can't turn that way, then I'm going to end up with that end range impingement. So this is going to be a wide ISA that can't close. And so now I have a concentrically oriented pelvic diaphragm. So right away, my interference is going to be hinging activity. So I got to minimize hinging activities. The exception might be a higher box squat with a delay strategy on the box so I can get the outlet to eccentrically orient and capture some yielding action so that might be the exception to that. We do have 90 degrees available to us so we can do all sorts of cool things so we're going to start in a staggered chopping action we want to reduce the effects of gravity but we also want to start to be able to turn the spine towards the affected side. And so in the staggered stance, we're not compressing that hip, and we can start to encourage the turn of the sacrum, turn of the spine in that direction. This is where we're gonna start to use our Romanian deadlift, because again, we do have 90 degrees available to us. We wanna turn the spine. So I'm gonna put a contralateral load on my Romanian deadlift towards the heel's elevated side. And again, to turn the spine in the sacrum. If I want to go into a split squat activity, I can do that as well, but I'm going to elevate the front heel under these circumstances. So again, I want to maintain that yield as I move into that 90 degrees. If I need to promote more expansion, more yielding action, I can start to move you into a propulsive activity as well. Ultimately, what I want to be able to do is to recapture an eccentrically oriented pelvic outlet in deep hip flexion. So my ultimate resolution here is going to be a heels elevated deep squat with a band around the knees but this is not pushing out into the band this is maintaining an orientation of the femur so I can get the pelvis to move around the femur and this is going to help me capture that eccentric orientation of the outlet in the bottom of the deep squat and so basically we're at the top of the squat we're going to take an inhale we're going to exhale to mid-range where we would typically have the concentric orientation and then I'm going to re-inhale to eccentric orientation, the pelvic diaphragm as I sit down into that deep squat. Okay, so that covers the Hawkins Kennedy and the shoulder with the equivalent of the hip, the Neer in the shoulder with the equivalent hip. And so now we have to have a painful arc. And so under these circumstances, what we're going to use is the traditional hip abduction measure, also an external rotation measure. And so what we're going to see here is we're going to have a hip that has a lot of internal rotation and not a lot of external rotation. And we're going to see that limitation in hip abduction or external rotation. And we're going to get more of a lateral type of a discomfort. Where this is going to commonly show up is we're going to see people with the right oblique orientation of the pelvis. And so where we get the compressive strategy is here and it's going to drive this left side up and over the right side.

Eventually we want to start to think about dynamics. We've got to start to load some of these connective tissues and rebuild this yielding strategy. So we're going to start with some A marches. That will eventually become some variation of an A skip. And then we can think about using something a little bit more dynamic. And so we're going to have him run uphill on boxes and to capture some of this yielding strategy so we can start to introduce that. But again, by moving him up levels, because he's such a big guy, he doesn't have to absorb all that stress into the connective tissues too quickly. But eventually we want him to be able to do so. So we want him to be able to bounce across the ground a little bit. Again, he's 315 pounds. So we take this with a grain of salt as to how dynamic we're going to make this. But like a triple A hop or something like that, if you could get him to do that, that would probably be great. But again, he's a big dude, so you're going to have to kind of figure out how dynamic you're going to make these things. So Johnny, this is actually a great little chess board to work on. It demonstrates the value of the things that stand out, those coffee cups that we start with, and then we can start to see the relationships that we build from there.

So if I increase force production, if I reduce my external rotation field, but I don't need that range of motion to perform my activity, then again, I'm not creating interference. So all of these activities are great activities. We use them all the time. We have to buy bigger trap bars because we have people that can pull so much weight that we don't have enough room to put the weights on. And so again, these are not bad things. Bilateral symmetrical activities are very, very useful at certain times for certain people in certain circumstances. What you have to do is is you have to understand that this is always an N equals one experiment and we're talking about an individual here and then their response to training. So again, we've always got the expansion, compression expansion on the table as a representation of movement. We superimpose force production on top of that to determine what is going to be the best course of action under a specific context.

There tends to be the camp that says yes, it's representative of a normal aspect of performance that actually enhances our ability to move quickly and change direction. And then there's the other camp that just doesn't understand it and so then they say whether it's a negative and it creates interference and I would be in the camp that says that it's a normal aspect of performance for various reasons. And we're going to talk about those. Calling it a false step immediately creates this negative connotation and so again, it's either representative of a human's inability to name things poorly or they're just trying to convince you that it's a negative. My buddy, Lee Taft has done a great job in reframing this exceptionally well by referring to it as a plow step and then showing how it's beneficial. He's done it repeatedly over and over again. You'll see the athletes will use this naturally. You're never going to coach somebody out of it; it's actually necessary to redirect forces. So we're talking about internal forces and the external forces to move quickly in the direction that is desired. And so you can do all the drills you want to try to get rid of it, but once the athlete is performing in context, it comes right back because it is essential. It's a combination of Newton's third law, connected tissue behaviors, muscle orientation, skeletal orientation, and then optimizing internal forces. So let's talk about these internal forces a little bit. Because I had a question on IFAS University about this too, and we kind of touched on it. But basically when we're talking about internal forces, we're talking about gut movement and gut orientation and things like that. And so one of the kickers here is that if you can't get your guts moving in the right direction and if you can't get them moving quickly, you are not going to move in the right direction and you are not going to move quickly. And so it doesn't matter what we're talking about. If we're talking about a squat and we're coming up through the sticking point of the squat, you have to be able to elevate your guts against the downward pressures that are associated with the internal pressure and then the external load. And if you can't push the guts up, you're not going to finish your squat. And so we're talking about changes of direction. We're talking about acceleration. We're talking about accelerating from a static position. If you can't redirect your guts and if you cannot accelerate them, you cannot accelerate yourself. Now I have a video that talks specifically about this and I actually lay it out through the concentric and eccentric orientations, the yielding and overcoming strategies. So literally I take it step by step.

In my mind, it is conceivable that someone could have overly developed specific muscles through poor training programs and actually benefit from selective hypertrophy of the antagonistic muscles provided that there are no compensatory strategies being reinforced, as this could alter their center of mass favorably. Is there any merit to this thought process? And let's give that a big fat maybe. So we have to start thinking about what the secondary consequences are here, Andrew, because it's not just muscles that we're talking about. So we're always talking about other potential influences. So the consequences of hypertrophy training. So we got to think about this. So we get superficial muscle cross-sectional areas. So that might be favorable. Increased force production might be favorable. Exhalation strategy may be favorable. Compression may be favorable and then shape change may be favorable. And so I always say maybe because we just don't know and we'll talk about this a little bit at the end of the discussion as to how we want to approach this from a training perspective. But one of the things that we always want to recognize is that we always have tension in the system itself. And so the way that the shape of the system influences that is it's going to increase or decrease tension. So I got my little Hoberman sphere here as a representation of what our starting conditions may be. So this is a sphere. So we're going to make an assumption that our compression and tension elements are rather evenly distributed. And so what I want you to recognize is if I create a compression on this side and a compression on this side and I'm going to change the shape of it and you can see my little X in the middle changes its orientation and now I have greater tension through the system. So the same thing is going to happen under the circumstances when we talk about hypertrophy training because we're focused primarily on this superficial musculature. So we're talking about pecs, we're talking about rectus abs, we're talking about trapezius, we're talking about the lats. So the big stuff that's on the outside and what we want to recognize is that those muscles are going to be squeezers. And so they're always going to create this anterior, posterior, compressive strategy, which is going to change the shape and sometimes favorably, sometimes unfavorably. And so because there's always tension in the system, if I lose the ability to produce a gradient, so I have to have expansion and compression to create a gradient, I may sacrifice something that's important. This may or may not influence performance. So if force production goes up, that could be a good thing. If movement is not negatively affected, then I might have a favorable outcome.

Well, it's a lack of physically keeping the bar close, and I know it's a technique issue.

But I want to start to work the shoulder from that 90 degrees and above range. So I'm going to start doing my walkouts from my knees, if I can get to an inverted activity like an inverted lazy bear, then I'm going to go there. Ultimately what I want to be able to do is to hit that end range flexion without symptoms. So I might end up using like a cable activity. But the thing that I want to make sure of, especially with my wide ISA, is that I can close that ISA with that overhead reach. So to get expansion all the way up on a wide ISA, the ISA has to be able to close. Also keep in mind, the idiosyncratic movement strategies associated with the wide ISA typically do not have in-range flexion included there, so be very, very careful with that. Now some counterintuitive stuff which is always kind of fun to play with because there's always challenges with your patients and you may not be able to drive the upper extremities the way you want to without creating symptoms. So now we're going to use some iterative structures to our advantage here. So if I put you in a prone propulsive position, what I'm doing is I'm creating an early propulsive strategy in the lower axial skeleton. So I'm turning the sacrum. I'm turning the lumbar spine, which is analogous to my upper dorsal and lower cervical. And so I actually may be able to drive expansion that way to start to create the early propulsive strategies through the axial skeleton. My offset heels elevated squatting activities will also produce a similar effect so keep those on the table don't forget about about how we can influence this especially when you're when you're really jammed up and you can't seem to drive symptoms or if somebody is too symptomatic in the affected area. One of my favorite totally counterintuitive kind of things is using this curl and press activity. The thing you want to make sure of is that you're doing the curl and the press on the asymptomatic side because what I'm actually doing is I'm pressing that dumbbell overhead and turning my head away as I'm intentionally creating a compressive strategy in the upper dorsal and lower cervical region on the pressing side but in return I get expansion and I get rotation to the opposite side so that's going to actually help alleviate some of the symptoms above the clavicle so this would be much like if you go back to the reverse hyper video how we used the single leg reverse hyper to create some of the turning through the sacrum. We're doing the exact same thing in the dorsal, rostrum, lower cervical space there.

One of the things we want to understand is that the deep posterior compartment of the calf, so the tibialis posterior, we've got flexor hallucis longus, and then we've got flexor digitorum longus. Posteriorly comes down around the medial ankle, so that muscle, that group of muscles is going to be concentrically oriented, but it's also going to be using an overcoming strategy at heel contact, but then this becomes a yielding strategy as the foot comes down to the ground. The reason we want a yielding strategy is because we want to distribute load through the tissue. So we have to create a yielding strategy so we have energy storage for the energy release. And so the yielding strategy is going to be through the bone, through the connective tissues, and through the musculature itself, where the connective tissues lie. And if we don't have that, then something's going to have to sort of take up the slack. So if I cue lateral heel throughout, what I'm going to do is I'm going to promote a strategy that maintains a concentric overcoming action throughout the excursion of the exercise. Maybe there's a circumstance that you might want that, but under most circumstances we don't want that.

He says, more specifically, I'm curious if you suspect that powerlifters find benefit in the reverse hyperextension exercise because it attempts to create some of the mechanisms that I've described from being able to deep squat such as counterneutation, posterior expansion, stimulating blood flow from the bone above and below the spinal disc in more favorable cellular adaptations as far as maintaining disc health. So this is actually a really, really good question because, again, there's certainly some elements of powerlifting that are going to challenge maintaining some elements of health because we're dealing with, if we made a problems list, you got high levels of compressive strategy to lift heavy things, which again, we want to minimize the expansion strategies because the minute that we release any of our concentric orientation, we're going to accelerate potentially in the wrong direction, which would be downward under most cases. We don't have an effective yielding strategy because we want high levels of stiffness in the tissues. And this is obviously just a byproduct of magnitude of load. You're going to get some spinal compression that's associated with this. So we have compressive strategies throughout. But because of the loss of range of motion that's going to be associated with lifting heavy things, we have to create orientations that are going to allow us to, one, access motions to execute the exercises. And number two, we have to create propulsive strategies into the ground. So we have to produce IR to the ground. So that's going to require some orientation issues, especially with the pelvis. And then we get a lot of that spinal compression. This, in turn, reduces blood flow to the disc, so the disc is dependent on blood flow from the bone above and below. If we compress the bone, we can actually reduce that blood flow, and then we start to get the degenerative changes in the disc. What we have is this one big giant compressive exhalation strategy that is very, very useful for lifting heavy things. It's fun to do. But there are secondary consequences. And so what we may want to do to restore some measure of health, some measure of movement capability, comfort, such as pain reduction, et cetera, is we want to try to restore some of these inhalation mechanics that will provide some yielding strategy, improve our ability to turn So we're not relying on on compensatory strategies just to produce normal movement throughout the day So what we want to look at then is what do these inhalation mechanics look like? So I've got a little representation of a video. It's very subtle But hopefully you can actually see this and so what I did is I put Eric prone on the table in the purple room And I just had to breathe a little bit.

Mentorship calls this morning, big clinic day coming up, so we're going to dive right in at the Q&A, and this one comes from Jimmy. So Jimmy watched the three impingements, three strategies, three solutions video. And at the end of that, if you watch it all the way through, shame on you for not watching it all the way through, there's a little bonus comment about the fourth impingement. And so that's what Jimmy's question is about. He says, I watched your latest video on children impingement. I was wondering if you could go into more detail about the posterior internal impingement. and how this presentation usually occur in regards to the architects. And so it can present itself in both architects. It's going to be a little bit more of a bias towards one for reasons that you'll see. Excuse me. But the thing that we want to recognize that is in common with this is that this is a down pump handle sternum problem in all circumstances. And so basically we just have to look at the archetypes and what their biases may be and we'll kind of see this. So the easiest one to see is to look at the narrow and we've kind of looked at this before. Well we start with some sort of normal representation and then the narrow archetype is going to initiate the compensatory strategies with more of a down pump handle situation so we get a lot of anterior compression through the sternum. What that does is it creates a posterior expansion relatively speaking. I'm going to grab my shoulder model here for a second. And so we got the backside of the shoulder here. And so what we'll see then is this would be where the dorsal rospital area is. We'll see a turn this way and we get a compressive strategy right here on the backside of the shoulder. And so that again, that's why people reach over their shoulder and they point to that area probably the most accurate test that you'll get. So it's this angulation of the scapula relative to the tumor. So anytime we have that situation, we have the potential for this type of a compressive strategy. For the wide, it's a little bit different because they have to get there with one prior step. So with the wide, when we look at the compensatory strategies, we're typically going to see a dorsal rostral compression first. Under those circumstances, we don't get that angulation of the scapula relative to the humerus, so the internal impingement doesn't really show up too often. If we get the next layer of compensatory strategy where we get an anterior compression that follows, and this is a center of gravity issue, so we're trying to maintain center of gravity, so we push back against the sternum, we compress that downward, now we bring the lateral aspect of that scapula forward to compress against the thorax, and now we can pick up this angulation that we're talking about between the scapula and the humerus that would cause this internal impingement. There's a little bit of a difference here because when we talk about the the the Y's this will typically show up in some somebody that still has the posterior lower expansion the root cage so this is not typically going to show up in an end game presentation and so where we are talking about the narrow where we have this kind of anagulation with the with the wide They pulled this part of the scapula back forward to the thorax, and then there's a little tilt this way. So this is the posterior lower expansion that tilts this on a little bit of an anterior orientation. And then we get the compressive strategy a little bit more superiorly than posteriorly as we would see in the narrow. Now, in an asymmetrical presentation, we can still get this situation as well. It's going to be very similar to what the narrow kind of looks like because the term that's associated with the asymmetrical ISA presentation, we get the posterior expansion on the side, we get the same kind of an angulation as we would see in the narrow.

We're going to be pushing back into the left with that right side. We're going to start with an ipsolateral loaded split squat. The ipsolateral load is going to allow us to come out and maintain that ER orientation because if we lose the ER in that right hip, we have no place to superimpose our IR. Once you can consistently recapture your external rotation of that right hip, now we're going to move to the contralaterally loaded split squat which is going to push us into the split squat in IR. So now we're going to capture the IR there and then we're going to have to push out against the resistance and maintain our ability to control the pelvis and hang on to our externally rotated position. You can also use a right foot front foot elevated right propulsive split squat. Here's a representation up here should be if my technology is good. And what you're doing here is you're actually reaching forward with the right side. And so again, we're creating an overcoming action on the right side by biasing that right side lead. And what that does is it teaches us to go through the middle propulsive phase, hanging onto the ER, and then we can superimpose the IR on top of it. Once we can become more dynamic, we can shift to a backwards sled drag with a left handle only stepping back with the left foot only. So again, it's teaching us to push backwards and to the left with that right foot. Once we do that we can move to playing in this middle propulsive area so we get normal middle propulsive capabilities and so then the sled drag becomes the crossover sled drag because that's playing in middle propulsion all day every day. We can go right suitcase carries to help us maintain some measure of IR and then hopefully we can just restore all of our normal dynamics and build out variations from there. You might have to consistently apply a little bit of this in the early phases of training just to make sure that they're maintaining their capabilities of hanging on to that extra rotation and pelvic orientation on the right side, but in general, this should move you towards a solution.

That's really good. So it's Tuesday, a very busy day. We're going to dig right into today's Q&A. It comes from Mike, and it seems like a very simple question, but we're going to stack some stuff on top of this and make it really interesting. Mike asks, can you walk me through the relative motions of the femur and the tibia and how different positions would limit knee flexion and/or extension? He gives an example of an internally rotated femur on an externally rotated tibia. Let's talk through this and see if we can simplify it to a certain degree. Then we'll look at some influences superimposed on the knee joint that might explain these issues so we can strategize our way out of them. One thing to recognize is that all joints move on helical angles. We tend to look at these in imaginary planar views, which complicates things. We see the knee and say it has sagittal motion, calling it flexion-extension. The reality is it's turning as it moves through space. As we extend the knee, the tibia externally rotates relative to the femur. As we flex, it internally rotates relative to the femur. We always talk about two strategies in one plane—the transverse plane. This is where the secret to the knee lies and needs to be respected. If we look at resources like Newman's kinesiology book, it discusses a 40-45 degree range of rotation with a 2:1 bias of external rotation over internal rotation. If we understand this rotation concept, we can ask what limits knee extension. If I need tibial external rotation for normal knee extension, anything that limits my ability to externally rotate the tibia becomes a restriction to extension. It could be as simple as fluid accumulation in the knee. A small amount of fluid, whether anterior-lateral or posterior-medial, would restrict my ability to externally rotate the tibia, leading to a lack of extension. This must be a consideration, especially for those who blame quad inhibition after knee surgery. I would look towards measures of fluid accumulation in the knee that keep the quadriceps eccentrically oriented, causing them to test weak or atrophy. In the opposing strategy, when we talk about tibial internal rotation, if we have anterior-medial or posterior-lateral fluid, we'll lack flexion because I won't be able to internally rotate the tibia effectively. For those experiencing posterior-lateral knee pain in deep squats and looking for a problematic structure, I can't rule that out. But if the knee checks out and the pain persists, what might be happening is that you're squatting with a tibia oriented more for extension. As you squat, you're sitting down on an area of fluid accumulation on the posterior-lateral side of the knee, compressing it and causing discomfort. Now let's consider what might promote these knee orientations. I don't think the knee is a very intelligent joint—it's more responsive to what goes on around it. So we have to talk about pelvis and foot orientation. The knee isn't very intelligent. Let's focus on tibiofemoral external rotation. With a fixed beam, the femur moves relatively. So it's externally rotated. Why does this orientation predominate? This tibiofemoral external rotation strategy is the system looking for internal rotation. I have a femur internally rotated on the tibia because I need to apply force to the ground to stay upright against gravity. Thinking about embryology and evolution, external rotation came first. We were swimmers before we were walkers. Coming to land required figuring out how to apply pressure into the ground through internal rotation for propulsion. If I've lost internal rotation anywhere in the system, I'll find a strategy to create it, often this tibiofemoral external rotation strategy. When we see terms like knee valgus or hyperextension, we're talking about someone using an internal rotation strategy. It's not true hyperextension; it's a lot of femoral internal rotation on the tibia. With valgus, we have a change in the center of gravity to an anterior-medial strategy, twisting the femur inward and the tibia outward to apply pressure down and forward through the knee. The pelvic orientation becomes crucial. An anterior pelvic orientation is me looking for an internal rotation strategy. That's why we lose external rotation of the hip when the pelvis anteriorly orients—we're seeking more internal rotation and sacrificing external rotation. This is why hip extension activities are vital for restoring normal knee excursion. I must establish external rotation first to delay propulsion and then recapture internal rotation. Looking at the foot, I might have a foot following the tibia into external rotation, creating an early propulsive foot. This means an externally rotated foot where I've lost internal rotation at the ankle and foot. Internal rotation at the ankle and foot is represented by my ability to dorsiflex and pronate. If I lose that strategy, I have to recapture it. My goal is to retrain the tibia to move through the full range of mid-propulsion, which recaptures dorsiflexion and, nicely, internal rotation up the chain into the hip, assuming I've managed the pelvic orientation. The bottom line, Mike, is we must stop seeing the knee as a hinge joint. We have to respect that it turns as it moves. Measurements like heel-to-butt flexion become hugely important because they represent my ability to fully internally rotate the tibia. Capturing 5-10 degrees of knee hyperextension, as defined in textbooks, represents my ability to recapture the external rotation of the tibia. We now have a simple way to look at the knee. If I don't have those excursions, nothing else about the knee matters until I can recapture them, as they represent the normal capabilities of my knees. Re-establish external rotation, re-establish internal rotation on top of external rotation. Get dorsiflexion back, and you'll save your knees from a world of hurt.

And so then we have to be very, very careful about how much internal rotation max propulsive strategy through programming because what I don't want to do is I don't want this to trickle back. I want to maintain maximum ER so I can demonstrate the velocity. So it doesn't matter whether we're talking, I mean take anything, this would be like a martial arts kick or a punch, it's the same concept. It's like straight training doesn't steal anything until it does. So if I need to throw a straight right hand as a boxer or a martial artist, I want to be able to demonstrate my ER because that's where the velocity of the punch comes from. But I'm producing the maximum force centrally and then expressing it in external rotation. So you see that its IR produces the force, ER allows it to be demonstrated at its peak. Does that make sense? Yeah. There you go.

As far as training goes, you're going to want to use short staggered stances because again we can't go into the deeper elements of flexion because we're just going to dive right into some form of compensatory strategy that we probably don't want to reinforce. So again, staggered stance. There's some arm training videos that I have posted that will show useful stances and useful positions of the upper extremities. So then as you gain hip and shoulder range of motion and so we can approach this 90 degree of traditional shoulder flexion, now we can start to reinforce with reaching activities, pushing and pulling activities, half kneeling strategies and such. I posted a half kneeling breakdown last week. You might want to check that one out because it's going to reinforce some of the concepts that we're talking about here when we're talking about what you see in certain orientations in half kneeling. The one thing that I would stress to you, Josh, if your goal is to recapture ranges of motion, then you're going to make sure that you got to breathe through these activities because the minute you start associating a breath hold or using any form of forced exhalation strategy during these activities, you're just reinforcing the compressive strategy. You're not going to recapture your gradients and you're not going to recapture your internal and external rotations.

And I can produce high levels of force. I use a lot of high pressure strategies. Again, I'm going to typically have this orientation. What Jimmy's describing though, requires that I have this final compressive strategy where I'm actually going to bend the sacrum down, so I'm going to compress this area. And under most of these circumstances, I'm going to lose both internal and external rotations. And so again, that's just layers of superficial compressive strategies on top of the normal archetype that's going to result in that. So I'm going to lose ERs and IRs. So I have very limited excursions available to me to use for activities. Before I would hit another compensatory strategy. So if I was to take somebody with this posterior compression that Jimmy's asking about, they won't even have 90 degrees of hip flexion available to me unless they want to compensate. So right away, I've taken a number of exercises off the table, so to speak, because I can't move them into this position. Because they just don't have the capacity to do so. But while it is a limiting factor, it also points my programming into a very, very specific direction. And so I'm going to hold up my little graphic. Here that I drew out for the camera. I have two cameras by the way, so I'm just going to hold it up there until I see it get visualized. So there it's clear in the little camera, and then there's one for the big camera. So what I want you to do is go ahead and take a screen capture of that. And again, so you have a representation. So you see the blue square in the middle, is any direction that we want to go but with limited excursion and then you're going to see the red rectangle is where we're going to try to expand movement first and foremost. Okay, so I want to have a wide ISA and I have this this compressor strategy all the way up and down. For me to try to force a turn under those circumstances is very, very difficult to do. They have limited hip flexion, they have limited hip abduction, they have limited hip extension, and then all their traditional ERs and IR measurements are gonna be limited. So I have to stay within this small square of movement. So instead of a split stance type of an activity, I'm gonna use a staggered stance. So my feet would be just offset. And then I'm going to drive a number of different reaching patterns or pressing patterns, but I have to use angles that are below shoulder level. So let me give you, for instance, on this. So we would have a staggered stance high to low cable press, which would keep the pressing motion below shoulder level, and I'm just offsetting the feet. And so I'm gonna gradually move into these turns.

By 50% I'm half-inhaled, half-exhaled. If I exhale a little bit more, I'm just biased towards exhalation, went in, and a little less inhalation. So we have to recognize these things as being superimposed. That's why you always hear me talk about a bias because what I'm expressing to you is, yes, all of those things that you think are external rotation? There's still internal rotation there. It's just biased towards more external rotation. And so we're going to talk about this as we talk about a golf swing. A couple other concepts: for us to access movement, we have to be biased towards expansion, otherwise we have to create some form of compensatory strategy. To produce force, we have to be biased towards a compressive strategy, so more of an exhalation concept. So again, breathing is our way that we can help ourselves bias towards the expansion element and the compression element. Okay, now let's go to the golf swing. So should you breathe during a golf swing? Yes, because you're going to need to be able to access movement and force production. So think about this for a second: if we're going to move ourselves into the backswing, we're going to be biased towards external rotation throughout the system, which means that we're going to be moving towards an expansive strategy. Otherwise, we cannot access ranges of motion that are necessary to accomplish an effective golf swing. So all you have to do is go out to the range and take a breath, squeeze it as tight as you can, and then try to move. It doesn't really work too well. So I have to be able to inhale to capture these positions at end ranges. Now, at about the point where I'm coming down from the backswing, where my arm is about parallel to the ground, I start to bias myself towards an exhalation strategy because I have to produce force. I actually have to stop my body from moving so I can translate the force into the clubhead. So this is where the clubhead is going to start to pick up its acceleration. I'm going to hit the maximum exhalation strategy at the point of impact. This is max propulsion for golf swing, just like when we talk about gait or running or whatever, we have to have our max propulsion. After the impact with the ball, I have to move again towards my ability to actually rotate, my ability to inhale, inhale and expand because I have to recapture the external rotation bias in the follow-through. So the same sequence occurs no matter what sporting event that we're actually talking about. If I'm swinging a tennis racket, a golf club, a baseball bat, if I'm throwing a ball, any kind of implement sport, any kind of rotational activity, all of these things are going to occur because I need to have an external rotation, inhalation bias to access positions and movement, and then I need to capture an exhalation, internal rotation, compressive bias to produce force. And so again, they're always superimposed; I'm just biasing myself in one direction or the other. So it's always two strategies, one plane. It's all that you have. And all we have to do is understand is how they interact, how they're superimposed, and how we bias ourselves towards one or the other. And that answers so many questions about how we do things.

So, Mihail, I hope that gives you a little bit of strategy, a little bit of understanding. Just make sure that as you go through these activities that you can breathe through the entire activity. If there's a breath hold involved, you're going to have to use some form of compensatory strategy.

Real quick, let me point you to some stuff that's on my YouTube channel that will be helpful. So there's already discussions about the propulsive phase on YouTube. So check those videos out. There's also videos on yielding and overcoming actions which will be very important because we're going to talk about that a little bit in this context. And then I would also look at some of the hip rotation videos as well. And so those will guide, oh curve running is also might be of interest to you since we're going to talk about running versus walking. There's some cool stuff in there as well. But anyway, let's dig into this. So we're going to have some stuff that's in common and we're going to have some things that are different because we got differences in viscoelastic tissue behavior. And to be honest with you, we could probably talk a whole week about this. And I'm not talking about a whole week of these kind of videos. I'm talking about like literally a whole week about this because there is a lot of detail that we could get into. But let's just consider some of the commonalities because we're talking about two forms of locomotion. So they're going to have aspects that are very, very similar. So both walking and running, regardless of speed, we're going to have a max propulsive base. So this is a point where we're going to be applying maximum force into the ground. The cool thing about that is that under almost all circumstances that that position of the foot is going to be the same and so the max propulsive foot it's actually when the heel breaks from the ground so it's not like way up here um it's actually right where the where the heel breaks the ground and so when we're talking about walking we're going to we're going to move through ankle rocker the heel is going to come up if we're talking about sprinting we're coming down from the ground And as we apply force to the ground, the heel is just going to barely miss the ground. It's going to stay slightly above the ground. So we're talking about the same propulsive position of the foot regardless of whether we're talking about any form of locomotion in regards to two feet on the ground kind of a thing. So that's kind of cool, which is really helpful. The ground contact, regardless of running speed or walking, is always going to be slightly in front of the center of gravity. This actually has to happen. So there's actually a little bit of a breaking force, even at top speed running. Because what we have to be able to do is we actually have to be able to create the compressive strategy with ground contact that stores the energy to release it, whether we're walking or running. Now obviously at very high speeds that distance in front of the center of gravity needs to be minimized because we want to minimize the breaking force to run really really fast but it still has to happen otherwise we don't get the compression and expansion that's associated with the the storage and release of energy. The pelvis is still going to move through its inhalation and exhalation bias but obviously the faster we run the faster that's going to occur and actually the excursion is going to be limited and much more biased so the faster we go the more we're going to be biased towards an exhalation strategy and so So now let's go deep into some differences. So walking has a longer period of time between ground contact and max propulsion compared to running. So what this means is that the forces are going to be dissipated over a much longer period of time because of the slower rate of locomotion. We need a longer delay in the propulsive strategy so we can swing the other leg out in front of us so we don't fall on our face. So running has a much shorter period of time, regardless of what running speed we're talking about. There's a shorter period of time between ground contact and max propulsion. At top speed, the elite sprinters, they'll hit ground contact as brief as 0.08 seconds. So it's nearly instantaneous as to how they're landing, which again, it's going to lend us to trying to understand, okay, what is this hip or pelvis actually doing at the point of ground contact and why we have such a strong bias. We still need a delay to swing the other leg through, but it's going to be very brief. One of the coolest things about walking versus running for me is just the behavior of viscoelastic tissue. We're talking about differences in force. There are seven components of force that influence the viscoelastic tissue. Tissue behavior. So we got magnitude, location, direction, duration, frequency, variability, and rate. So I can only say I'm in that order, but there's seven of them. But we're going to talk primarily about the rate-related issue because that's the easiest one that we can visualize with walking versus running because we're dealing with a time constraint. So the higher rate of loading, the higher the rate of loading, so the faster we load tissues, the stiffer that they're going to behave, the harder they become to deform But when we do deform them, they can store a heck of a lot more energy and therefore they can release a lot more energy, which is what we see at higher running speeds. But we also see a lot of cool stuff like stress fractures and tissue related issues that are associated with these high forces over longer periods of time. So if you want to start a great business, what I would suggest you do is you want to work with runners because those people are going to experience a lot of tissue loading over short periods of time. Again, if they're exposed to longer durations, they're going to accumulate a lot more of these issues. At the reduced rate of loading when we see with walking, the tissues are less stiff. We're gonna see a lot more yielding action associated with that because again, we have to dissipate those forces over a much longer period of time and that's gonna help slow us down as we walk. So again, the yielding strategy provides us that delay that's necessary to hold the center of gravity back so we can get the other leg out in front of us. So again, we're talking about rate-related issues here. The faster we move, so whether we walk faster or run, we're gonna see a reduction in the amount of rotation that's available to us. So we've got a time constraint that's associated with this for sure, because again, we have to consider the time from ground contact to max propulsion. So when we're walking, we're gonna land in a fair amount of external rotation. We're gonna move through internal rotation through that max propulsive phase, and then we're gonna go back to external rotation. Well, if we're running at top speed, especially, we're landing it at almost immediate max propulsion. So the amount of rotation that we have one available to us because we don't have time for that, it's gonna be a very, very quick internal rotation that's gonna be associated with that. So this is why we're gonna see biases in runners like the anti-orientation, the pelvis gets us closer to that internal rotation moment that we need at max propulsion. So that's why every sprinter kind of looks the same in that regard. It's because it's just a trained bias that allows them to perform something very, very quickly. So in a nutshell, walking and running are going to demonstrate some very, very similar characteristics because it's still locomotion. We still have to be able to propel ourselves against gravity, move ourselves forward. So again, we're going to have a max propulsion. But the rate at which we would see any form of bias occur is going to be different. The ranges of motion that we're exposed to are going to be a little bit different. The breathing strategy is going to be biased a little bit differently. And certainly the tissue behavior is going to be a little bit different. So again, I would point you towards the yielding and overcoming strategy video to get a little bit of understanding about that. Because at the higher rates of letting, we're going to see a lot more overcoming action. at the slower rates we're gonna see a more yielding action. So David, I hope that kind of points you in a little bit in the right direction.

So we have the medial epicondyle along with the rest of the elbow structure making this nice squared off cubital tunnel that allows the ulnar nerve to move through its normal groove. But if we have something that would change the shape of that tunnel, and I think that we do, then we're going to have the ability of this ulnar nerve to move a little bit differently. So rather than having this nice squared off shape, what we end up having is it becomes more of like a half moon kind of a shape or a little bit more curve, which allows the ulnar nerve to slide up and out of the cubital tunnel as we flex the elbow. So these symptoms typically show up around 90 degrees of elbow flexion, which is where we put a lot of tension on the ulnar nerve. So the ulnar nerve has to bend around the elbow at this 90 degree point. And if it doesn't have this squared off rigid tunnel to hold it in place, it's just going to slide up and out. And that's basically what happens.

First things first. There are many representations that get labeled as anterior pelvic tilt, and I believe this stems from some of the methods used to identify it, with people chasing an ideal static orientation. We must always think dynamically rather than statically. We are not trying to capture an ideal posture. There is no such thing as a neutral spine or similar concepts; we need to discard these ideas and start viewing humans as movers rather than as static postures or ideals. I think one of the methods used to identify what's optimal is comparing the ASIS to PSIS orientation. Whenever we see the PSIS higher than the ASIS, it gets branded as an anterior pelvic tilt, but this doesn't account for the relative motions that occur between the sacrum and the ilium. It's just an assumption about the entire orientation of the pelvis. We have a better way to identify this than relying on most palpation tests, which have been shown to be quite unreliable in most situations. But let's discuss why this might occur in the first place to understand the entire orientation of the pelvis. A few factors are at play. Some structural issues may be an influence. We discuss our archetypes: the wide and the narrow. These present in various ways, from a foundational representation to superimposed superficial strategies, and we will build on that. Structure is definitely an influence. You must consider everything you do from a movement perspective. How much or how little you move is an influence. There are training influences; when we chase certain adaptations, they will have an impact. However, the thing we must stop immediately is blaming muscles as if they are separate from everything else. It's like saying, 'You have tight hip flexors and weak glutes.' Let's abandon that line of thinking; it's not helpful. What you start to recognize is that the end result of what you observe and the limitations you have are the predominant adaptations associated with everything you do. Now, let's discuss representations. I have my archetypes: the wides and the narrows. One thing we want to represent is that with a narrow representation, you will have a counter-nutated sacrum relative to the ilium. If you are a motion palpation person, you would immediately say this person has an anterior pelvic tilt, even though the sacrum is counter-nutated. It would be better to look at the hip rotation representations. Under normal circumstances for our narrow ISA archetype, if they are biased towards inhalation, they will have about 100 degrees of total hip excursion, but they will be biased toward more external rotation and less internal rotation. According to textbooks, normal hip rotation is 60 degrees ER and 40 degrees IR, but these individuals will be biased toward a bit more external rotation and a bit less internal rotation. Let's say they are biased toward 80 degrees of external rotation and 20 degrees of internal rotation. You would conclude this person likely represents the narrow ISA archetype. The goal in this scenario is to take an inhaled pelvic representation and teach them to capture an exhaled pelvic position, which will help reorient the ilium into internal rotation and capture some nutation. You will do this using a series of 90-degree angles: the hip at 90, the knee at 90, and the ankle at about 90 degrees. This is the easiest method because, considering how the hip moves through space and the associated movement of the ilium, it's around these 90-degree angles where we begin to recapture the exhaled position of the pelvis. This is where you will train these individuals and perform any rehab-style exercises. Now, for our wide archetype, we see a pelvis that looks like an exhaled representation. We want to move them toward an inhale representation. The easiest way to do this is with early propulsive strategies, such as heel-elevated activities with the hip closer to traditional extension. This will help expand the posterior aspect, creating a yielding strategy posteriorly and helping us recapture the hip extension we are likely missing. Remember that for your wide ISA individuals, as a standard representation, they will be biased slightly toward internal rotation and slightly less external rotation, but as long as they achieve about 100 degrees of hip excursion, they are only showing their structural bias. If we have an anterior orientation where the entire pelvis, including the sacrum and ilium, moves forward together, you will experience a loss of total hip excursion. Instead of the combined 60-40 split of ER and IR, we will likely see less than 100 degrees. With this anterior orientation, due to the reorientation of the musculature above the greater trochanter, we will see a loss of external rotation measures. These are the key indicators of an anterior orientation: less than 100 degrees of total excursion and likely an external rotation deficit.

So again, we just want to think about eliminating interference as much as we can, but that should give you an idea of one, what you're looking at and some strategy that you can use to bring this person out of this. I hope it's helpful. If you have any other questions, please let me know. Everybody have a great Monday. Let's kick off a great week and I'll see you tomorrow. Good morning, happy Tuesday. I have neural coffee in hand and it is perfect. Great Tuesday, clinic day, very, very busy. We're gonna dig right into Q&A. Alex was on YouTube, apparently yesterday. He saw the commentary about the left shift and some of the sequel compression that we were talking about. And so Alex's question basically plays off of yesterday's video, where he said, would you use the same strategies to apply for a right shift? Or would it be somewhat different? And he also mentioned that, yes, we've shown a number of different approaches on how to address these things. But let's go ahead and talk our way through this because I don't know if I've actually laid out much strategy for the right shift. We've shown some exercises for it, but let's talk a little bit about strategy. But let's build this thing from how we get from this left shifted orientation to the right shifted orientation because it does tend to be a little bit of a progressive kind of a thing. So when we talk about the left shift, like we talked about yesterday. Remember that we're going to start with a left sick world-based compression. So we're going to be compressed here. It's going to push the sacrum. So it's going to be oriented to the right. Now we're still going to have some expansion in this left posterior area. So these will be typically people that will have a decent straight leg raise. But what happens, because we get this sacral base compression here, we're going to get the irritative effect in the dorsal rostral area and the thorax, and so we get this orientation of the entire axial skeleton to the left, so as they squat, they shift back to the left. Now, if we superimpose the anterior compression on top of this, what's going to happen? We get the shape change in the left posterior aspect of the pelvis. So we're actually going to turn this issue a little bit. And what that's going to do, it's going to externally rotate. The hip a little bit, it's going to approximate our sacrum to the femur. And so we're going to start to get this oblique tilt. We get the same iterative effect in the posterior lower rib cage, which is going to push forward. And so now we've got a pelvis that's tilted on a right oblique axis. OK, so if that happens, we're going to lose the extra rotation on this right side.

I got a really good question for today. This is from John and John has a question about relative elbow motion. This is a thing that I think people look at elbows so differently than other things and I don't think we have to. John says, 'I've heard you mention how examining relative motion of the elbow is very similar to the knee. I've had great success with utilizing the knee mobilization you posted for individuals who are unable to capture tibial IR on their own. Could the same concept be applied at the elbow? Is valgus carrying angle at the elbow the same as knee valgus as you have previously described?' John you are totally on point here. One of the things we have to appreciate is that all joints move on helical axes, so they all have a rotational element to this, and so the elbow is no different. But I think the visual representation of how the elbow moves throws people off, and so they kind of think of it as being something different or oversimplified in regards to just a simple hinging motion. And so then it's kind of like when you're missing some elbow range of motion they kind of treat it like a knee where they just push it harder into the traditional flexion extension rather than actually appreciating the fact that it does turn. So if we take a peek at a knee valgus, typically what we're going to see is we see this femoral internal rotation orientation on top of the tibial external rotation. And that's what produces a lot of this valgus orientation. And you are correct, sir, that the elbow is no different. The thing that we want to appreciate in the physical structure of the elbow, if we look at the trochlea of the elbow, it looks kind of like a twisted hourglass, if you will. And so what this does is it does give the ulna this rotation as it moves through the excursion of traditional flexion extension. So again it's like we have to look at this thing as a rotational joint just like everything else does. So when we're going to see this elbow valgus orientation what we're going to see is we're probably going to see a distal humeral ER relative to a forearm pronation orientation. One of the dead giveaways that you're going to see is the prominence of the medial epicondyle. You'll see this bulk of the pronator, teres musculature overlaying this, but you'll definitely see the prominence of the medial epicondyle. You may also see this go all the way down into the hand where you're going to see a thumb that's going to have trouble externally rotating. So the people that have this elbow orientation also can't create the little pistol position with the index finger and the thumb because they can't externally rotate the thumb. This is, I believe, traditional thumb extension, and so these people are in what we would consider traditional thumb abduction, which I would call this IR. I would call this ER just for the sake of argument to stay in our transverse plane concept there. But the advantages of recognizing this rotational influence at the elbow is now we can have effective strategies to recapture all of these relative motions. Now, I would also caution you that don't look at the elbow in isolation. You still need to look at this thing systemically, so we're probably going to have to look at axial skeletal orientation. We're going to have to look at scapular shoulder orientation before we get to the elbow. Because depending on the proximal strategy, we're going to have to decide whether we're going to use something that's going to be inhalation-based or exhalation-based. An inhalation-based activity would be one of our curling variations. Instead of looking at things like biceps training and triceps training, we can now look at this thing as recapturing the relative motions. Your typical curling activity is going to be associated with trying to recapture an inhalation-based strategy. Your triceps activities are going to be your exhalation-based strategy. For instance, if we're trying to drive an inhalation-based strategy, recapture the relative motion of the elbow, this is where we get to use all of our cool little curl activities that you've probably seen. I got a bunch of stuff up on YouTube in regard to some wrist and elbow reorientation strategies. So check those out. If we need to drive a little bit more of an acceleration strategy, we can start to use our side plank variations, but I would also make sure that you tend to hand and wrist position under these circumstances because again, it is going to be an influence in your ability to recapture all of those relative motions. Hopefully, John, that gives you a little hint as to where you need to go with this thing to recapture the relative motion of the elbow. It's no different than any other joint or any other area of the body that needs this relative motion to restore comfort in all of our movement options.

What this is going to do is it's going to restore my right hip external rotation. If I have a deficit in external rotation on the opposite hip, that's how I know when to switch the weight over to the ipsilateral side. Now a little trick here: you have to be really, really careful because the weight will try to reorient you back into the old strategy. So we have to actually resist this. As you can see in the video, I'm maintaining that left posterior expansion throughout the lift to make sure that I'm not losing the ability to delay that propulsive strategy on the left side.