Bye-bye. Let's design the perfect offensive lineman for a second. Good morning. Happy Tuesday. I have no coffee in hand and it is perfect if you're busy and somewhat stressful week this week. So this is actually our last week at IFAS 2.0. We've been in this building for 14 years. We're moving to a new location, bigger place, lots more space. So a little bit stressful. We're going to dig straight into today's Q&A. This is with Larry. Larry had some questions about working with offensive linemen because it's not something he's terribly familiar with. He's got some friends that do work with offensive linemen and I think he wants to be able to invest in that situation as well. So we talked a lot about how we would construct this perfect offensive lineman. This is an interesting situation where typically, we're talking about recapturing ranges of motion. We're talking about the negative consequences of increased force production. Under these circumstances, it's the actual opposite end of the spectrum. We're in situations where we actually want to reduce some of the ability to turn. We want to increase the ability to produce high forces because these athletes are going to be very specifically structured in a certain way. So we're going to be biased towards wide ISAs. They're going to be biased towards high pressure strategies and such. Again, an interesting conversation because we're skewing everything towards performance under these circumstances. So it'll be useful for many of you. If you'd like to participate in a 15-minute consultation, please go to askbillhartman.com. Put 15-minute consultation in the subject line so I don't delete it and we'll arrange that at our mutual convenience. Everyone have an outstanding Tuesday and I will see you later. Cameron is rolling. Clock has started. What is your question, Larry?

Got it.

OK, so crazy simple, right? It doesn't seem obvious, but so if I'm going to see if I can get this. So if this is in line, you see how the ischial tuberosity is hiding. So what direction do I need to move the pelvis to bring the ischial tuberosity back behind the femur?

Stick them in the middle. Right? And then train them to maintain that representation over a longer period of time. Like, did you, anybody see the light bulb go up in Jordan's head right now? Did you hear that? Or see it? Am I right? Am I right, dude? Many others. So we tend to talk about capture early, capture early, get relative motion, get relative motion. It's like, yes, but now I have to think about the structure. It's like, if I want that disk to regain some of its resiliency, I got to take the expansive strategy away. Right, otherwise I'm just prolonging, because it's already changed, right? I've got a tissue change now that I have to protect. It would be like if you had an inversion sprain of your right ankle, right? And then, because that, so when you have an inversion sprain of like anterior telephib, that is an early representation of a foot. Right? That's where a lot of relative motion is, but that's where the strain occurred. Do I want to leave it in early representation? Because that's where all the relative motion, it's like, no, I'm going to move you back to middle because that's where I'm going to be able to take the tension off of that ligament.

Yeah.

Yeah.

Yeah, I mean, you'll create the delay. But the question is, do you want the delay strategy on the rear leg? And I would say you probably want to push them towards late because you're just going to try to squirt. You're going to try to push the sacrum to square the front, right? Because they got to catch it if they're not in as much of an IR position underneath the jerk. And you try to catch that in a delayed ER representation. You're probably not going to hold position, right? You're going to be too mushy, so to speak, right? And so I would say that you want to keep them representative of middle with the least delay possible. And so like I said, it'd be a left suitcase and then a right waiters. And I think that's going to literally create the representation that you want because it would superimpose the same pubic orientation that you're trying to set up in the jury.

OK. Yep. Thank you.

I got an answer.

Yeah, that's why it's useful to have a larger repertoire of activities where one person will be great at a barbell deadlift, another person will be terrible at a barbell deadlift, but then you put them in, you give them a trap bar and it starts to look a whole lot better because it's a little bit more squatty than deadlifting, right? There you go. As I descend farther into the squat, I'm going to go through a space where I have to increase the amount of internal rotation by. So the pelvis actually changes shape to get through that middle range. So it moves towards what would look like an exhaled position of the pelvis. So the inhaled position of the pelvis is at the top. That's an extra rotation bias. As I go through the middle range, I have to capture an exhaled bias, which is internal rotation. So the pelvis changes shape and the femur could maintain its position. But the overall representation of the pelvis and the femur at that point in time is internal rotation. As I descend farther, I have to re-expand, and I have to go back towards my external rotation bias at the bottom of a squat. Now, how many times have you ever seen a perfect squat? Almost never, because most people can't assume the ideal shape to pass through those ranges and capture the full position because they don't have full adaptability. And a lot of that's just based on structure. So now we can go all the way back to what's your bias? Are you a wide ISA guy or a narrow ISA guy? That would bias you towards one end of the spectrum. So if I'm a narrow, I'm really good at the top and the bottom of the squat. If I'm a wide, I'm really good in that middle part of the squat, generally speaking.

So Bill, when an athlete shows up at your door, do you typically do these table tests or do you have some other assessments that you go through in order to have a clear picture of where somebody is?

Not when they're running. Don't tell them to feel anything when they're running. Let them run. When you're training to recapture motion, yes, you do use those contacts as feedback. OK? Yes. You shouldn't think when you sprint, right?

Okay? All right. Thanks. You're welcome.

Okay.

So, okay, anybody ever have, how many therapists do we have on the call? Give me like a wave or a thumbs up. Okay. Anybody ever have somebody come in with a horrible, miserable diagnosis that they always give these people of trochanteric bursitis? Trochanteric bursitis is a shape change problem. Okay. They can't lay on their side because it hurts right on the greater trochanter because it's pointing into that table because they have AP compression. They have a hip socket that's pointing straight into the table. They're laying directly on top of a bone.

So that's when those superficial muscle strategies come in is when the need for higher force production, right?

Explain complex things pretty simply.

Number one, this is a turning problem, right? So we know that there are turns that are creating everything that you're seeing. So there are areas that you're going to see that are expanded and you're going to see areas that are compressed, literally based on the shape of the thorax. The rule will still apply is that you're going to see this expressed in the extremity measures. Good morning. Happy Tuesday. I have no coffee in hand and it is perfect. All right. OK. Quick housekeeping. So I just announced not too long ago the July intensive dates. I believe it was July 22nd through the 25th. I will be opening up applications soon. I have to get the current crop of folks that are coming to the June intensive. We got to get through another phase of PrEP. And then I'll be able to announce the applications for that. So be looking for that. They're in a really cool phase right now. They're going through where they're posting representations of their current model so they can identify their processes. If you're interested, there's a YouTube video where I talk about this on my YouTube channel, so please go there and subscribe to that. Today's Q&A is with Adam. Adam is an intensive alum, a strength coach out west. He's dealing with an athlete that's got a little bit of a special problem in regards to some scoliosis. The thing we want to walk away when we're dealing with scoliosis is the fact that because movement is always based on shape change, the rules really don't change. What we have is it changing a little bit of the constraint, but we can still use extremity measures as our KPIs. We can still use that to drive our thought processes. So again, we're presented with a little different concept in regards to the initial conditions, but the rules don't change. And so we talked through that with Adam. This is a really, really good Q&A, especially if you're dealing with some athletes that do have to manage their scoliosis. If you would like to participate in a 15 minute consultation, please go to askbillhartman at gmail.com and we will arrange a consultation at our mutual convenience. Just don't forget to put 15 minute consult in the subject line so I do not delete it. Have an outstanding Tuesday and I'll see you tomorrow.

Okay, so that's a lot all at once, isn't it? So let's go with this piece by piece, okay? Let's talk about the probability thing. So the probability thing is recognizing the fact that there are so many things that we don't know. And I think that there's an element of a desire to want to know and then to have a limited perspective on what is actually possible and what is actually happening and then how much of an effect do we have on all of that? Like what can we influence? And I think that the younger version of ourselves, because of the limited scope of perspective, it implies that we know something that we don't. Because if I only think that there's three possibilities and I understand those three and then something good happens, I give credit to one of those three things. And that's wrong. So by living a life and having experience, what you start to recognize is there's a lot more influences than we ever thought were possible or that we could ever understand. And so the mature representation is that, okay, I can affect certain things. I can influence certain things. And then there's more unknowns than I could possibly imagine that I do not influence. And so what I try to do now is I try to manage those things that I do have an influence over. And then I observe. And I look at the outcome and I say, was this favorable? If yes, I try to do more of what we just did. And if it's a no, then I have to change something. Knowing full well that I may not have the solution when it comes to doing something else. However, I do have experience. And so I fall back on that. So in the past, when this situation arose, what did I do that was successful? And so I lean on that to help me determine what to do next. So that's why we're playing probabilities because we don't know what the answer is going to be. So maybe, maybe I have a 70% likelihood of being successful by following a certain intervention strategy, but I still have 30% against me, which means that both possibilities, a successful intervention or a failure are always possible because I don't know, I don't know so many things. And so 70% of the time, maybe I'm infinitely successful and 30% of the time, it's nowhere near what I would want it to be. And then everything kind of falls somewhere along that line of probability. But that's how we do everything. And so again, it's like I just respect that. And so understanding that puts you in a place where your humility better kick in because if you still think that you know something that you don't, that can lead to some arrogance and then you're starting to put people at risk.

Okay. And so let's just say somebody is very stiff getting into the cut. They can't really get into the position. That could be one of the solutions.

What is your capacity to reach, like where's 90, 110, wherever it is, and then how can you work to restore that perhaps over time? I think that's a central element to it, because otherwise, compared to regulatory strategies.

Yeah, there are two types of constraints when you look at things. There are constraints that can change instantaneously. When we talk about certain types of muscle activity or connective tissue behavior, some of those things can change instantaneously. Some of those things are adaptations that have taken time to be acquired, and therefore they take time to change. If you look at force production, I can instantaneously change force production to a certain degree. But putting 100 pounds on somebody's back squat in one session is pretty hard to do. It doesn't mean you can't do it, but it takes time because some things have to be constructed. So you need a greater density of myofilaments. You have to have more stuff in the muscle cell that can produce more pressure, therefore increasing strength levels over time. That's something that has to be constructed. It would be like somebody walking into your clinic and saying, 'Hey, I want to train for the Boston Marathon. Have you ever run before?' No. 'Okay, go run 26 miles and you'll be ready.' It doesn't work like that. You have to realize that mitochondria have to be constructed, you have to have enzyme production for oxidative metabolism, and so on. So you have these adaptations that take place over time. Some of those things are what people are bringing to the table, and some of those things can change instantaneously. So you have to have an appreciation for both. That's why you say, 'Okay, what do we need from this process?' Change the things that you can change quickly, monitor those, and then you have to look at the key performance indicators that would be associated with the desired outcome and say, 'What other things have to change?' If I have a patella tendon that has been affected by surgery—which you did on that young lady—so you've got an adaptation there that has five months of stuff before you even get to it. Some of that stuff will change: like I can change some of the muscle activity instantaneously, I can change some of the orientations instantaneously. But some of that adaptation might take time. I have some remodeling that might need to take place for me to make the effective change that she's going to need to have the desired outcome.

You totally get it. Absolutely.

In more volume of the same good stuff.

So I guess like a narrow, but like, so narrow, they get to be biased towards ER, but now they've lost extra rotation.

They increase in number over time, okay? So this is an experience thing which you will acquire over time just like everybody else does. The one thing you have to remember is that it is an investment of time, right? It's not about following a cookbook and saying, oh, this does this and that does that. It's about understanding that we're playing in a very gray, complex area with a very complex system that doesn't behave the same way twice. And that's why this is hard.

Compressed posteriorly, but.

That's right.

Right.

This sucker is actually very durable and very, very strong under most circumstances until you take away its nutrition and then it starts to break down. And so over time then what we have is a situation where you have about a weakening of this posterior aspect of the disc. And so what I'm going to offer you Zach is that this whole situation starts with the disc becoming yielding strategy that we would normally use in early propulsion. So let me give you an example of how this looks in the thorax. So if I take a cross section of a thorax and I'm going to create a turn or I'm going to create a delay. So what you're looking at is you look at the small arrows on the posterior aspect of this thorax and that would represent a concept or yielding strategy that we use in the posterior aspect of the thorax is about taking a step forward or making a turn. So the yield creates a delay to allow the other side of the body to get ahead as if I was taking a step forward. Now if we look at what a disc protrusion looks like you will see this scary kind of similarity as to how this process is going to be initiated. And so all I have to do is have reduction in the resiliency of this posterior disc. And now I can create a greater degree of expansion on one side or the other. And so again, the disc becomes this fractal representation of a larger representation in the thorax or in the pelvis. And so because early propulsion requires that I have a yielding strategy on that side, what if I can't yield? And so under the circumstances of say an anterior orientation of the pelvis, I'm actually going to get a reduction in the yielding strategy. So what this would look like, Zach, is if I anteriorly orient the pelvis, I can't create this yield. So the yield is where I'm going to see this counter-neutation and an ER in this posterior aspect of the pelvis. So this is my delay strategy as this foot lands on the ground. So if I was looking at a foot, let me grab my foot here. What I have to have in this early propulsive strategy is a foot that looks like that. And so again, this is a delay strategy. So this is my early propulsive strategy, which creates the delay that allows the other side of the body to get ahead. And so, again, if I have an anterior orientation, that produces this posterior compressive strategy in the vertebral body. It's gonna reduce the blood flow to the disc or the diffusion to the disc, and then I get my breakdown. So now I start with my bulge, my protrusion, my herniation, my extrusion, or my sequestration, depending on the degree that this process is allowed to evolve.