Pressure injuries, pressure ulcers.

Shom asks, can you talk about the power push-up rotating handles and how one can buy a shoulder internal external rotation improvements also would be similar to using rings for pull-ups and how would you manipulate breathing for supination, external rotation, and pronation, internal rotation to get expansion in shoulder changes? Okay. So now we've got to start thinking about being able to move through a fixed point. So if I put my hand on the ground, which is relatively stable, so I have a stable fixed point that I can access. I don't have to produce the fixed point myself. The ground is very fixed. This is going to allow typically under most circumstances a greater amount of relative motion. And so what relative motion is is the ability for segments of the body to move in opposition. To do this again, we have to have the pressure gradient available to us or it doesn't happen. And so under many circumstances, using the ground as the fixed point is a great place to start people. So this is your quadruped positions. These are ground-based activities, crawling, rolling, et cetera, et cetera, where we have this fixed point that we can move the body around. Now there's certain cases where people just don't lack the force capabilities and so they will use a high compressive concentric strategy just like they would for bilateral symmetrical activities with a barbell because they have to try to control their body in space. So that just means that we need to make these activities easier. So take them from quadruped and then you start to lay them down. You lay them on their sides and then again, we go back to rolling activities as one of those elements that might be useful in these circumstances. When we talk about moving the fixed point, so rotating handles or suspension trainers that demand that we create the fixed point, in many cases, when those are introduced, we will see these high pressure concentric strategies return because step one, we got to create the fixed point. Then we have to be concerned about moving. And so again, we're looking at graded exposures here. And so moving somebody to a suspended form of an activity, so moving from a bar-based chin up versus a ring-based chin up, demands more control so you're going to see more concentric orientation. This immediately increases the perceived difficulty of the exercise because now because I'm creating a fixed point and I have to produce the muscular effort of force to create whatever the movement demands are of that exercise, I have just increased my output and again, so it makes things seem harder. So again, we can raise the perceptual level of difficulty merely by putting somebody in a suspended environment. That's not necessarily the goal. Now over time, what we would hope is they learn to create the fixed point and learn how to create the gradients over time. So once again, we go back to the gymnastics example, which is a fabulous representation of somebody that can create the fixed point and they can move pressures because some of the stuff that they are capable of doing is remarkable. It doesn't make them the best movers in the world. It just means that they're really, really good at certain things. So again, we have to look at what is the goal here. If we're trying to recapture eccentric orientations and movement, we have to put people in the environments where they are most successful and then slowly grade the difficulty and the level of effort and make sure that they're demonstrating those things that we want them to demonstrate. So if the goal is to lock people up, mummify them, restrict movement, then we can immediately jump to some of these activities because they will immediately constrain the system into a much more fixed position. If our goal is to restore movement, then we may need to reduce those demands, the demands of instability, if you will, and put them in a position where they're much more successful, where they can move successfully and create those gradients.

Yes, when you can help in that perspective for sure. Yeah, so where do we go from here? So we've sort of established ourselves, obviously, in that first year. What do you think was the biggest change? Before we moved into this space, what do you think was the biggest change that we made from an evolutionary standpoint? Like from a business perspective, because you and I are both technicians, right? So we're like the classic 'me too' thing. We're both technicians. And then you had to take on, because of my schedule being the way it was in the clinic, and then you having the opportunity to actually be here more often, where do you think the biggest change was in that evolution from a business perspective? Because I think for me it's the hardest thing to understand, but it sort of fell on your shoulders. You don't really have a choice. I mean, it was forced upon you and you've done a great job with that. So talk about that.

I like to keep my outcomes at a certain level. And it's like, when anybody that's hard, I just pass them on. No, I'm kidding. I think you're absolutely right about where to start them. But the thing you're going to run into here is they're going to have so much anterior-posterior compressive strategy that's layered on. Like this is where you're going to have to lay some hands. You might be able to create a reduction in some of the concentric orientation with some like scapular PNF kind of stuff. But you're going to have to start passively. So it's almost like taking like a short arc roll on the side. And so you're going to trap the. So they're on there. Let's say they're on the right side. You got your left arm underneath their left arm. So your hands on the front of the shoulder, grow to all your right hands on the back. So you got to get really good control of the of the shoulder girdle. You can start to move them through some like scapular PNF diagonals, but you're going to do it like crazy slow, really easy. They're going to try to stop you from moving. You've got to get a reduction in the concentric orientation. That's the thing that you're up against the most. This is a really strong learned strategy of them really struggling to move air.

Actually, I'm talking about different parts along the gait cycle. So in the back leg, the femur is going external rotation.

They're trying to get in early. So here's Adelia. Let me see if I can do this visually. If I'm stepping toward you, they're trying to do this. They can't get the first metatarsal head down. So they would have to go, like that, to get the first metatarsal head down, right? So they have to toe out because their external rotation is going to be so far away from midline. So they're early over here. So they're trying to get the early foot, but they don't have any space there. So they're going to go out that way. And so they're going to roll, they're going to roll like that to try to get it down. So they'll have like a big pinch callus on the first metatarsal head or the inside of the big toe.

So if you have a middle foot during a squat, are your toes flat then? Like the whole thing is in the foot.

Awesome.

So my question is a fundamental question, but it's something that struck me on one of the intensive calls with Manuel a little while back. You were comparing two weightlifters and he was attempting to sort of figure out who was later in the pictures that he supplied. And it got me thinking about why we might see certain strategies used by some people as opposed to others outside of SA differences. But SA, for instance, we get people that have moved along the line of compensatory strategies and then you'll see some variations where you get, say for instance, both tibias, or you get heavily anteriorly oriented pelvises, which is other ones come through in the sway back, the traditional hyper extended knees, whatever, pronated feet, the supinated feet, all these little slight differences that you see in compensatory strategies. In my mind, and just tell me whether there's right or not, it's almost like there's a general path that people follow, but the way that they manage each part of that can be highly individualized. So it's not necessarily able of saying that person is later than that person because they've just used a slightly different strategy to get there as far as the progression's concerns and not everyone's going to follow exactly the same route from moving from their start condition to an end game position.

Of course, but you can facilitate the conditions.

Okay, is it a first metatarsal phalangeal joint that can bend or one that doesn't?

Yes. Yes. Yes. Okay.

Now, like the backswing starts before the club starts moving back. So we need some sort of a trigger or something to get. Yes. Absolutely. The slosh. The slosh.

Oh, okay. I just called something. Okay, got it. Yep.

So I'm sorry to take this long. So he's gonna, on the standing propulsive test, he's gonna lean over to his leg because he lacks that IR. Then what I'm gonna do is what would be an exercise that you would give him in the gym to get them started with rolling. That's not on the ground.

Yeah. I guess the second part of that makes a lot more sense to me. I don't know if there's the way I'm thinking about like the first part with the time dependent still seems almost like abstract or conceptual that like I understand. Like I get literally.

Jen works with a lot of baseball players and so we're talking about narrow stances in force production because we have to be really, really careful how we teach our narrow stances to produce force. They have a very small window of opportunity to apply force into the ground and if we extend that duration then all we end up doing is sticking them to the ground. So we started talking about static positions using an overcoming strategy and so under these situations, position is going to matter as to how we're applying force into the ground and then again the duration of the effort is going to be determined by their capabilities and so if we extend the duration of a high force application, again, we're actually going to slow them down. We want our narrow stances to produce as much force as humanly possible, but in time constrained activities, we have to be very, very careful. As long as they're applying high force within the constrained time, they're going to do great. But anytime that you increase the duration of force, it interferes with the velocity. So force and velocity can be really, really good friends, but we don't want them to hang out together too much because, again, of the interference. So this is a great question for a lot of people that work with tall slender folk that are trying to teach them how to produce force. So again, it's not about chasing weight room numbers. It's about how they produce force into the ground and for how long. So thank you, Jen. Go to the YouTube channel, make sure you subscribe so you get all the videos. The podcast will be up on Sunday as usual. Everybody have an outstanding weekend. I'll see you next week.

I think it's cool for now until I have another headache about that. But yeah, that makes sense.

Well, again, it's practice.

In the history of mankind, there's never been a narrow ISA that has done an RDL effectively, just so you know, like all the way back into like the 1700s. Can't do it.

Okay. So this is where you can start to see the orientation really starting to kick in. As she plants, the energy is going to go up and out and around this right hip instead of coming straight up through the pelvis. What we would want to see here instead of this orientation is something closer to a better alignment of the extremity to the ISA to the shoulder. You can see how she's kind of flat here and her belly. I would want this to be in a much better line. That would be representative of a more ideal presentation because then what you've got is the IR superimposed on the ER in that position. So now the energy can go up into the javelin instead of hitting her on the lateral aspect of the hip, coming around and popping her in the back. It literally will come around her and hit her on the back of the pelvis, near the base of the sacrum, the lumbar spine, because of this mutation. This is the position that stood out to me when I was looking at this.

Yeah. But see, here's the thing. You just made a comment that you need to alter your perspective a little bit. You said that you've done this in weight bearing.

Well, I can tell you, he's wide and he's compressed both in dorsal rostral and pretty smashed down upstairs.

No. No. Okay.

I'm not sure. Can I show my video? Sorry. Can I show my screen?

Gotcha. Okay.

Yeah. Yeah, it's just there. Their frame of reference is only like,

Because you created the stop there. So what shape change do you need to create? What is the goal of this activity then in regards to shape change? Is it to change the pelvis?

It depends on where you are.

Is it a muscle or is it connected tissue? Connected tissue. Yeah, because if you stretch a band and you let it go, did it change shape? No. It goes right back to where it started, right? So that's not a joint position change. So it's not a muscle orientation change with the rubber band. So what the bands are going to do is they're going to, they're going to take the connective tissue behavior that, that, that you're trying to influence and they're going to magnify that representation.