Yeah, this is great. Thanks, Bill.

Yep, that makes sense. Getting into like so off of that, which range of motion measurements would be like magnified or diminished if the lumbar spine is like facing one way versus the other in that scenario.

Let's do a case study on a client that's having difficulty managing a late propulsive bias. Good morning. Happy Wednesday. I have neural coffee in hand and it is perfect. All right. It is Wednesday. That means that tomorrow is Thursday, and I will see you at 6 a.m. on the Coffee and Coaches Conference call as usual. These calls have been great. Great group of people. We have our regular people and we get new people every week, so this is kind of exciting. They're great calls. I'm enjoying them. We go as long as we possibly can each call. So again, if you haven't joined in on those, please do try to make it because they've been very, very productive and very helpful for a lot of people. Okay, digging into today's Q&A. This is a call I did with Robert. And Robert has a client case that we went through where we sort of strategized how to deal with a situation where you have a client that's biased towards late propulsion. They're having some issues associated with that. How do we bring them out of that? So we talked programming and strategy. We talked about management of activities, which is always a tough call. It's like, what do I take away? What do I still allow your clients to do? So we talked a little bit about that. And we even got into some foot management stuff associated with bunions at the end of the call. I've had a couple calls on bunions. I'm going to try to put together one of these Q&As that's specifically about that. So that should be upcoming. I can't tell you exactly when, because it's going to require a little bit of editing on my part, and I am not technically skilled, even though it seems like I do such a fabulous job on these calls. Anyway, enjoy this call, post your questions, go to askvillhartman at gmail.com if you have any questions, or you would like to participate in a 15-minute consultation. So again, ask Bill Hartman at gmail.com, and I will see you guys tomorrow morning, 6 a.m., Coffee and Coaches Conference call. Have a great day.

Okay. And that is fair. But the question is, so let's just take like, here we go. An eight-year-old gymnast doing a back bend versus a 35-year-old female doing a back bend. I said, yes, 35-year-olds have been doing it back then. But let's make the comparison here. Which one do you think has the greatest capacity for the soft tissues to yield sufficiently to allow that to occur? The eight-year-olds. Yeah. So that's actually an element that we have to take into consideration. So if I have flexible pars on my spine, guess what? I have greater access to the compressive strategy on the posterior side than someone else. You ever see those little girls that can, they land their belly and they kind of prop up on their hands and then they put their feet on the back of their head? So they don't have hip extension. They don't have hip extension. They are there in the negative degrees of hip extension when they're doing that. What they do have the capacity to do is create the compressor strategy, the anti-orientation and the nutation position that allows them to access that position because that is an IRD position.

Sounds good.

Okay.

I want to show you some low level stuff and then we'll move towards things that are a little bit more dynamic and then at some point in time you're just going to treat these people like you would any other athlete which is actually kind of cool because there's nothing wrong with these people. They just need to move through a progression depending on what their initial conditions are. So what we may do is we actually throw them down on the table, and we may actually have to teach them how to capture some form of expansion. And so we might actually do this passively. Initially, we'll put them in static positions. We might actually use some form of implement to create this reciprocal compression expansion through the axial skeleton, using extremity positions to put them in force production on one side, expansion on the other. We might move them in the sideline, which is a great place to start to restore expansion strategies because what this is actually going to lead into is we'll get them down on the floor or, like I said, depending on your environment that you're working in, Austin, you would have like a mat table available to you to work on some of these things. But this is where we're going to start to work on some rolling activities. We want to make sure that we're driving these rules with lower extremity and upper extremity drivers. Because we never know what the situation may be. So let's just consider the fact that, OK, somebody does fall. They have to be able to move about. They have to be able to roll to change positions. They have to be able to get themselves back up off the floor, which is a big challenge under some circumstances. So this is one of the reasons why we might use say crawling progression. So we'll use quadruped activities and actually work on some of these crawling elements. So consider the fact that somebody falls, they have to roll from their back to their belly or vice versa. They have to be able to crawl over to a piece of furniture that might actually help them go from the ground all the way back up to standing. Half kneeling activities are actually great because what we can actually do is we can create this influence of moving into and out of the cut. And so the progression that you're looking at right now is actually the shape change that we would promote through the axial skeleton if we were moving into and then out of a cut. And so we can actually do this progressively. So we can actually capture the physical shapes that our client may need to change direction. And then we can take this and we can move this into a standing variation where we can actually move them into a cutting situation. Speaking of standing, we go into standing activities.

What we want to do is look at the measures Jason took and start by reconstructing the pelvis because the pelvis representation is a little easier to see than in the thorax, but we'll try to give you an example of what this actually looks like. So let me grab the pelvis for a sec. Again, this is a guy with left shoulder pain that's been diagnosed as an impingement, but we've got some pelvis measures which are great because our iterations give us confirmations of positions. Like I said, it's a little easier to see in the pelvis. When in doubt, we're going to start with the basic foundation. So Jason says that this guy is a narrow ISA. So right away, we know we're going to see a representation that's going to start to externally rotate these. We're going to start to counter-nutrate this sacrum. He throws us some information on the left side. We've got left hip ER at 60 degrees and IR at 20 degrees on this side. So remember when we're talking about narrow ISAs that we're always going to be biased back towards an ER position. So we're going to have more ER than IR. If we have full excursion to hip under those circumstances, we're going to have about 100 degrees of total excursion. So right away when we start seeing 60 degrees of ER, 20 degrees of IR, we know we're in a deficit. And so we probably have some measure of loss of that extra rotation that we would naturally gain from just being a narrow ISA. So we're going to start thinking that, oh, we've got an anterior orientation going on here. Now if we flip over to the other side, we go to the right hip and we get 45 degrees of ER, 45 degrees of IR. So now what that's going to tell us again, we've got an anterior orientation, but we've got a lot more going on the right side. So right now we got to start thinking like, okay, I'm on this oblique axis because I've got a greater loss of ER here. If I've got 40 degrees of internal rotation under these circumstances, I got a pretty decent tilt here because the only way that I'm going to pick up 45 degrees of IR under the circumstances to get the acetabulum facing down. So I've got a situation that looks like this. And actually, if we want to get really technical, watch this close, it's going to look kind of like that. That's more like what we're going to see with this type of a right oblique axis, where you're going to see sort of like an elevation of this ilium. The reason I bring this up is because what it's going to look like in the thorax is going to be very similar. So it's going to look kind of like that.

Okay.

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. So hopefully, guys, that answers your questions. Shyam and Thomas, I truly appreciate you guys asking those. Everybody have a great day. Happy Friday. I hope you guys lead into a great weekend. Keep doing great work. Hang in there and we'll talk to you next week.

So like business wise, what did we do?

At this point with something like that, I'm just like 'Relax, breathe through your nose, just stop with your head off the table.'

And the other side better be an external rotation too, because you've got a sacrum that is oriented such that they should both be moving towards external rotation.

If you're trying to cue foot contact in that person and you don't do it effectively, are you going to expect that person to start to have pain on the inside of your heel or the inside of your ankle?

The foot will be much flatter.

What's the problem? Okay, you seem to understand. Yeah, I get the basics, but okay, let's take that from the beginning. Before the foot makes contact with the ground. And in my mind, I have that cross section with the four quadrants you did with the wiper.

Well, there are subtle differences in shape that will be influential as to how much somebody can do something. Okay. So let me give you an example. A professional basketball player, six foot eight and wears a size 18 shoe. That's a big foot, really long. He's also very tall. And then I got a five foot eight soccer player that wears a size nine shoe. Who has more time and distance to anteriorly orient? The time and distance, right? So the six foot eight with an 18-inch shoe versus a base of support that's this long with a size nine shoe—who has more time to translate forward? Absolutely. And so the potential for anterior orientation is magnified because he has more time and distance to turn things towards the ground. It's also longer, so I have these big long curves that would potentially be present in his spine versus the five foot eight guy that moves forward and hits the end constraint very, very quickly. So he might not appear to be as oriented as somebody that would be much taller and has greater distance forward, right? If I have a wider pelvis structure, I have more space to spread out sideways. So it alters, it alters time. It alters the time of the exposure. And so again, it changes it. It doesn't change the process. It just says how much of something might be present because I just have capability. I have more. Yeah. If I have a longer femur, I have greater capacity to shorten it by constraint. You see the slender folk with a lot of bends and twists. You can see it very easily. But they may have, relatively speaking, more space to turn things within the constraint. So you might see it more obvious in one representation than the other, but the same process is happening. So, you know, there's only so many strategies that are available within the constraints of a human being. Within those constraints, there will be subtle differences that would be associated. I could show you 14 different representations of the pelvis. And each one will follow the same path just to varying degrees. Because again, if I don't have anterior-posterior space, I can only go forward so far before I hit the end constraint. Whereas if I have a much longer distance, then this is why you see differences in feet. It's like, why do some people drop the IR into their rear foot? Why do some people drop it straight through the subtalar joint? Why do some people drop it right in front of the ankle? Why do some people drop it in the first metatarsal-phalangeal joint? It's because the structures above that determine how far and how fast they can go forward or will go forward. So there are differences, individual differences that determine how quickly things happen. And then that determines where we would see the adaptive behavior.

Okay. So what condition, what condition could you facilitate in this circumstance? It's the same thing that we're talking about. I'm going to support your head in a position where the airway would be most open with the lowest degree of muscle activity, right? And you would start here because they're going to move at nighttime. Everybody moves at night.

It shouldn't, but it does though.

Yeah. You have to be really careful. Like people just randomly throw heel lifts and unfortunately they go, 'Oh, you have a short leg. Well, let's put a heel lift in.' It's like, well, if you're a wide ISA that's already forward on the right, guess what? You just made the problem worse. Good morning. Happy Thursday. I have neurocopy in hand and it is perfect.

That's a great way to look at it. That's a great way.

Yeah. Well, what I'm saying is like you emphasize the duration I think you're going to have to extend the duration of the impulse because he's telling you that within this time constraint, this is the amount of force that I can produce. And so you might have to extend the duration of the impulse to teach him the yielding strategies first. Right? So he's, like I said, anything that's going to emphasize the yield, so prolonged hold on the box, the sticking, sticking the landings, anything that creates the delay, right? Just a delay emphasis. Yielding statics. Right? You already going with this?

What do you mean rolling that's not on the ground?

How much time do you have? Well, so you're going to sprint. Okay. You ready? You're going to sprint. How many steps does it take for you to reach peak velocity? I'm just saying there's a time that so you have to do something for a certain amount of time to reach your peak velocity.

Okay, so take two, yeah. So, you know, I guess I'm having a hard time wrapping my head around improving force production in a narrow stance and how to get creative with that and make it useful. And I think you already answered my question, but I'll ask it anyway. Overcoming isometrics. And my initial thought was like pushing into an object that's immovable.

Okay, but you have to appreciate the shape. The shape is going to tell you that that's the external rotation to internal rotation representation. Then, you're going to figure out, oh, I have feet that don't show you any internal rotation as far as the shape is concerned. Which means you're going to have a ton of internal rotation somewhere else to keep them inside of their base of support.

Yeah.

OK. All right. Let me ask you this next one to see if this helps me clarify, because I feel like I'm still a little bit off. And this next idea was kind of borne out of this.

So my assessment of her, having looked at the way that she does things, is essentially she's got a massive anterior pelvic tilt. And pretty much everything she executes, even excluding her javelin throwing and just moving around the gym, is done with that kyphotic spine. She obviously achieves a throwing position relying on that quite a bit as well, as we can sort of see.

She is weight bearing.