Yeah, I could bend my spine.

You literally have to create a shape that would be very undesirable.

Yeah, and something would probably break in that case.

But this happens when people try to assume a deep squat. You see these big rounding shape changes posteriorly. What they're actually trying to do is create the slowdown, the delay strategy or the yield, and they're using physical structure to do so. This is why you wouldn't want to load somebody in those circumstances because now you're magnifying the downforce on a structure that's already hit its end constraint. This is why you'll end up with a ligamentous problem in the spine or you're going to get a compressive strategy in a vertebra or you're going to get a herniated disc or something like that in a worst case scenario.

Bill is trying his hardest not to use the terminology of 'butt wink,' but that's what he's referring to. Anyone that's thinking about squatting, assessing squatting, and watching squatting compensations understands and knows what a butt wink is when I say it. All that is—the pelvis rolling underneath—is just like an ER compensatory strategy at the lumbar spine.

It's an expansion of the posterior structure, which gives you the space.

But it can also lead to potential injury. There are consequences to it, absolutely. So the other things that came to mind are, for example, if someone lands from a jump with their legs locked out and then they hyperextend both their knees backwards and break something. That would be a posterior expansion that's not contained, and in that case the center of gravity would be moving backwards.

But no, no, the center of gravity would be contained. The expansion is definitely posterior. So they're making sure the center of gravity doesn't go forward. So there's a difference between it moving back and preventing it from going forward.

So other than falling, the center of gravity can't really move backwards.

Well, I can, but you would follow. You're absolutely right.

Yeah. There would be some sort of collapse involved with a backwards movement.

The idea is controlling the position of the center of gravity.

Right. So all these movements, all these exercises, we are moving forwards always, just like Bill's shirt. And we are just controlling the rate at which we're doing that. And a lot of times people, the rate at which someone's forward motion happens is too quick. And it sort of, it almost skips phases. That's where we will see like someone like skipping. I always had a good way to explain it. They just get really small.

So let me give you an example. When you look at somebody doing a powerlifting style squat, where the pelvis is well behind the ground contact, and they can't descend any farther in that circumstance. What that is, is the early phase is so abbreviated that you immediately go towards a middle propulsive strategy where there's a greater representation of internal rotation shape change. So the pelvis is holding onto its IR shape. You do not have an expansion of the anterior outlet of the pelvis. And so you're constraining the squat into its middle representation in that circumstance. They initiate the squat, performing an element of projection which starts to descend the center of gravity. But because they don't have the ER space available, they immediately move into the middle propulsive strategy. What you're actually adding is you're pushing harder into the ground, which abbreviates your ability to descend because you're already pushing up against the attempt to descend the center of gravity.

Right. And the example on the other side of that would be someone that can't really resolve like a late propulsive strategy. So they're sort of stuck in this ER representation.

And so what they do is they move their feet really far apart. That allows them to apply the delay so they can actually start to superimpose some measure of IR, and then they can descend as far as they can in that circumstance. But that's why you see these, like, especially the people that get higher and higher levels of compression. So as I add force production, what I might find is that my low load squatting behaviors I start to lose the capacity to descend the center of gravity, where I start to find myself turning away from midline more and more into ER, or I elevate my heels so I can add more ER space that would be available so I can actually descend.

This will probably require multiple episodes. We'll get into types of squatting as tools and strategic resistance, and we'll explore the differences between narrow and wide squatting for those types of individuals. I think we've covered the pattern, explaining why squatting is not really a pattern, what it is, and what it represents. We also discussed the forward motion principle, which applies to all exercises—it's about controlling the forward progression of movement.

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Many people like to use squats, gait analysis, and toe touches in all sorts of complex movements in order to assess their patients and clients. What we're going to talk about today is how to actually use those tests, what those tests are showing you, and much more on this week's episode.

Welcome to Reconsider. I'm Bill Hartman. This is the podcast to challenge you to ask better questions, to look beyond traditional models of thinking, and arrive at better health and fitness solutions.

Okay. So last time we talked about table assessments, we talked about the assessment course that Bill has put together. Part of the assessment course outside of doing table tests and interpreting table tests is complex movements. So we're going to talk about which are the main movements that we use and why. And then I think a lot of people like to talk about gait analysis and watching walking and being able to determine what's going on by walking. And I think if we kind of talk about that and look at it from the perspective of the UHPC model, it will clear a lot of things up for some people or maybe let them understand that the things that they were looking at were probably not that important or incorrect. Okay. So let's, let's talk about, let's just talk about the main movements that we would use in complex movements and what they sort of, what they tell us. And maybe compare that to like, we can compare it to like legacy perspectives or models and why that might not be the whole picture.

First, let's emphasize whether you do table tests or not, you should probably understand them because they provide an understanding of how external rotations and internal rotations are produced by the shape of the structure itself. That's important because what we're going to do is take those potential changes and change the context. Instead of having the constraint of the table that helps us manage these things and emphasizes an upper extremity versus a lower extremity, we now take the whole system. We say, 'Okay, I'm going to put you upright against gravity, I'm going to have you perform an activity that we can hesitate to use the word standardized, but we'll use it as a comparator.' The great value of complex movements is that we can see differences in before and afters, but we have to understand what those shapes represent and what the changes would represent. We limit our approach by selecting some specific movements that are a bit easier to see. Ultimately, what we would want to be able to do is take any movement because all movements are complex when we're moving upright against gravity. In this circumstance, you can take typical complex movements like toe touches, squats, split squats, turning—whether it's seated or standing rotation. Each of those elements of the propulsive cycle is represented in those activities. Some where both sides appear to be doing the same thing at the same time, and some that are more asymmetrical like your turns and split squats. We use those to compare. For example, 'Okay, let's say I have somebody that's totally clean on the table—everything appears that I would have full relative motion in the entire system. Now I'm going to move you upright and say, Can you organize the system to access that relative motion, or is the stress of gravity the interference?' We can determine this, and it helps us with exercise selection—whether we need to take somebody out of a normal gravity situation, reduce gravity with cables and bands, or have them lie down on the ground. Complex movements give us information about what this person is capable of doing from an exercise selection standpoint. We don't have to create new tests; we just have to recognize what these movements actually represent.

Right. So the ERs and IRs and measurements we get on the table are going to tell us what range of motion this person has and more importantly, where they tend to end up within their base of support or outside their base of support when they are compensating, when they are using their behavioral strategies. Once we work back those strategies to giving them relative motions on the table, then we put them upright to put them into the gravity field, have them stand on two legs and move around, and we start to see where their compensation strategies come up. Because as soon as you put them upright against gravity, all of those internal and external forces that had them come see you are just all coming back. Movement is a strong behavioral influence, so you're always going to revert to your previous tendencies. So they may need some type of assistance or ways to help shift their center of gravity within their base of support to allow them to reorganize and move in a way that's not going to knock them into their compensatory strategy too quickly. Yeah. So the tests we would use, we've kind of mentioned a couple of them. I would also like to talk about an upper quarter test, like a scratch test or something, even though I know we don't really look at this typically in the UHPC model. I think it would be useful to talk about because a lot of people are going to want to know, as that is a pretty commonly used test, like trying to reach over or behind my back. Right. Also, I think aptly came up with a bunch of different tests, it wasn't just that one.

Very limited value.

Right. So I want to talk about why, because a lot of people are going to want to know, because that is a pretty commonly used test, correct? Like trying to reach over, trying to reach behind my back. Right. So like aptly, let's, yeah, let's talk about, I don't know how aptly it is. Right. Also like didn't aptly come up with a bunch of different tests. It wasn't just that one.

Yeah. I think there's a knee test there.

Anyone who is osteopathic, like a historian or PT historian, can tell us in the comments if they know of any other Aptly tests. But yeah, the Aptly test tries to measure shoulder range of motion. What is it really showing us? Because it could be useful to see if someone tries to do this and how they compensate when they try to do it.

Well, yeah, the compensations are infinitely more valuable because I don't know that I've ever seen anybody pass the test.

So let's talk about why it might not be so useful and why you can't really measure what you're trying to measure in that position.