Yeah.

Okay, so think about this for a second, Lalo. So using a vertical jump? Yeah, I'm using a vertical jump and then, yeah. Hang on. Okay, so what's the advantage of the vertical jump in this situation and then monitoring those symptoms that you describe? Why would vertical, hang on, why would vertical jump go down and then Achilles and lower back symptoms increase at the same time?

And I'm not going to say the shoulder too, right? So.

Shortening mid-propulsion.

The minute you steal that you're diving right into internal rotation and you're moving towards internal rotation but we got a scapula that can't move and so we have a very specific limitation and you start banging into the compressive strategy at about 90 degrees of shoulder flexion which would typically be one of our impingement tests. So What I would like to do, Mihail, is I would like to take this situation and let us look at three different impingements, because I think a lot of impingement gets packaged into one thing, and I think the current strategies for most PTs is to try to look at They're calling it subacromial pain syndrome rather than subacromial impingement. We don't want to look at these impingements the same because the source of the limitation that is creating the compressive strategy in the shoulder that results in pain is not the same. So we're going to look at three different situations here and we get to use old school PT school orthopedic textbook impingement tests because this is why those impingement tests were valuable at one point in time they just didn't know why so we're going to tell you why here so we're going to look at Hawkins Kennedy we're going to look at the near test and then we'll look at a painful arc okay now i don't use these tests because my table tests will tell me exactly where these compressive strategies are Just because somebody doesn't have pain with these positions, it doesn't mean that there's not a compressive strategy there. It just means that it's not sensitized. So everybody kind of ignores it. And then when somebody does have pain, they tend to blame the poor little rotary cuff. It's not his fault. He's just the result. And so let's talk about where this compressive stuff comes from. OK? So let's go Hawkins Kennedy first.

The acute traumatic injuries are the tougher ones. I'm trying to get more comfortable with the greatest because I just don't know until it's too late. In a lot of those cases, if they were able to distribute a proper, you try to teach them as best you can and you feel like if you're monitoring the certain KPIs, you don't know if they're going to overload until it's too late.

The left side got shorter.

Right. So if the tibia wouldn't come backwards as the heel comes up, your knee would get closer to the ground. So this would be like, if you were lunging forward with your left leg, the back leg would be in that position. But you see it? It would take the tibia forward and the knee would move closer to the floor. If we're walking, the knees gotta translate forward, not down. And so that's why the tibia is moving up and back. Does that help you see it?

Okay. It's the Nikki show. Go ahead.

Okay. It's, let me show you. You see me? Yes. OK. Right oblique. OK. OK. Where's straight ahead? Where is straight ahead now? Over here. Yep. And so they go like that.

Less than two minutes, my friend.

You watch Karate Kid for the philosophy, right? You know, 'gosh, man who catch fly and chopstick can do anything.' That's brilliant. So you're just looking at the same twist. What you have to discern is like how much of each twist do you have? Good morning. Happy Friday. I have no coffee in hand and it is perfect. All right. We're a little short on time at this point. It is intensive 13 day two. This is the painful unlearning day for those of you that have been through this before or just playing the home game. So we got to kind of cut to the chase. Today's Q&A is another segment from yesterday's Coffee and Coaches conference. We talked a lot about elbows. I think elbows confuse people because people think that the elbows are somehow different from everything else. The reality is we still have to worry about orientation. We still have to worry about the bony orientation. Bones bend, bones twist. And so muscle activity can alter positions. A lot of times the difference between lateral elbow pain—so the pain on the outside that we tend to refer to as tennis elbow—and the pain on the inside that we tend to refer to as golfers elbow—is how long they're exposed to these forces. And then we get a change in the orientation of the elbow. So we actually talk about that in the Q&A video today. So you will see that. That will give you a great idea as to what you're looking at. We also differentiate between a muscular or musculotendinous problem versus a potential injury to the passive structures a little bit in there too. So again, if you're working with throwers or golfers or tennis players, this will be a very useful video for you.

uh, once or twice.

Okay. Understood.

Okay.

Okay, it's going to depend on the goal because we can manipulate the positions. Generally speaking, at the top of the split squat and depending on loads and other factors, we'll set load aside because load restricts relative motions. We're talking about someone with a fair level of force production where body weight isn't the strongest influence. Running through a split squat, your external rotation representation will be demonstrated at the top of the split squat. With one leg in front and one leg back, there's generally a bias toward external rotation. Both feet are on the ground, so there's already an element of internal rotation superimposed. How this is done depends on the individual and their strategy. Generally, the bias at the top of the split squat is external rotation. I can make that lead leg an early representation by orientation or bias it toward late by creating a delay strategy on the front side. There are various ways to do this, such as turning the sacrum toward the lead leg or unweighting it and turning the sacrum toward the lead leg. Again, I can create any bias needed. As you descend into the split squat, generally, you'll move toward internal rotation if capable. Grossly speaking, external rotation at the top, internal rotation at the bottom, but now we must discuss how to bias the activity to achieve the intended goal, considering who we're working with and their strategies. Do they even have the capability to capture internal rotation at the bottom? If not, we'll see compensatory strategies—like uneven pelvis or knee valgus away from midline—because they're trying to perform the movement in an external rotation representation rather than internal rotation. This means they create a space of external rotation, then superimpose an internal rotation strategy on top of it, knowing internal rotation is down and external rotation is up.

OK.

Okay, so I mean, to this point, I feel like we've managed it fairly well. There was only one period. She was a freshman last year. There was probably like a three week period where she had to be out before the season started just because I was probably negligent on the front end when she first came in and I had her do all the activities in the weight room that everyone else was doing. It was lighter, but she was trap barring, she was benching, all that stuff. And also just that with the spike in, you know, practice time and all of that stuff. She ran into, like, just really debilitating pinching in kind of her thoracic spine, like under her scapula basically to where it was even uncomfortable to breathe. And both her scapulae wing, like immensely, like it's pretty wild. I've, we've been, I told her that she needs to come see me every single day. So we've been working six days a week and we have like five breathing drills that we've done just continuously and there's pretty decent before and after effects.

Never?

This is a fairly simple idea. I need more time to slow it down. Yielding is a time-related behavior of connective tissues, right? So the faster the load, the stiffer they are. So if I catch it here and I stop it at my chest, that's a short period of time. If I absorb it all the way through into my externally rotated position, now I'm creating my yield strategy on that side. I'm increasing the yielding action of those connective tissues for the absorption. Right? So again, what do I want? Let's go back to your original question. Okay. How can I induce? How can I induce the nutated position, the IR moment with a medicine ball throw? I'm going to throw it really hard at you and say, stop this thing as quickly as you can. Right? It's different connective tissues, less rotation, more nutation of the sacrum and a lot more high force IR into the ground. Do you see the difference?

We call it pro hop in baseball. You take your right foot, your last right foot step and then you leave the left foot. So as your right foot lands and it's turned outward, you're going to create max propulsion on that right side as you're stepping into the left side. The inside edge of your right foot is going to make contact with the ground, but the inside edge of your right heel is not going to be very heavy. So you're going to have almost max propulsion on the right foot as you're stepping into the left side. Because I live in the United States, we talk about baseball a lot more so than cricket, but they're very similar in a lot of the elements because we have to have these positions of propulsion to allow us to put the force into the ball. So when you land on your right foot, your heel contact is either non-existent or very, very light, very much like a sprinter lands on the ground when they're at top speed. So you're going to push off of that right foot into the lead foot. The lead foot is going to land in an early propulsive position. So as you come down and you're going to hit that heel rocker position, you're going to land in that early propulsive position. So your tibia is going to be in external rotation and that's your first metatarsal head. So when that sucker hits the ground, that's where you're going to start to superimpose internal rotation on top of the external rotation position because that's what this is. This early propulsive position is external rotation and you land here. Then as your tibia starts to translate over, this is where you're going to start to really superimpose a lot of internal rotation. So this is your high force into the ground as you move over that foot.

Yeah, that makes a lot of sense.

Right?

Excellent. All right, man. I'll see you Thursday. Let's talk about some wide ISA intervention strategies. Good morning. Happy Tuesday. I have neuro coffee in hand, and it is perfect. All right, man, it's already a busy Tuesday. Got a clinic day coming up, so looking forward to that. We'll dig right into today's Q&A, which reminds me that if you would like to participate in a 15 minute consultation, go to askbillhartman@gmail.com, and put '15 minute consultation' in the subject line so I don't accidentally delete it. The videos are going up on YouTube. I'm getting a lot of questions on the YouTube channel, so I would suggest you go there and subscribe so you can get the first dibs on when those videos go up. So please do that. And then let's go ahead and dig into our call with Camilla that we did over the weekend. So we were talking about one of our clients who presents with a wide infrasternal angle and a lot of superficial muscle strategies that we talk about. So there's a lot of concentric orientation, a lot of compressive strategy to the degree that Camilla is actually identifying a lot of accessory muscle breathing activity. And so we talked about strategies of how to adjust intensities for these people. So we're not promoting any further compensatory strategies. So literally just how to position somebody to promote this expansion that they need. So they need to enter their posterior expansion and then how to take advantage of some of the things that this client's already doing. So this client likes to go to spin classes. So how to adjust the spin bike to take advantage and to promote some of that posterior expansion that these people are lacking. So this is going to be a useful call for a lot of people, because I think there's a fair amount of this that we tend to see. And again, not like life's been stressful for the last year or so, which is just additive to all these situations. So again, thank you, Camilla, for your participation. And again, go to askbillhartman@gmail.com. If you have a question, subscribe to the YouTube channel, and I will see you guys tomorrow. Okay, clock is running, Camilla. Give me your question please.

Okay, so this is going to be in the, it depends because it depends. So yeah, it always is, right? When the lumbar spine turns certain things will get magnified. So you ever get those people with a hip rotation that's like 80, 90 degrees of hip rotation? So that's a lumbar spine that's turning towards that hip as you're turning it. When you get a magnification of like a straight leg raise or hip flexion, that tends to be somebody that's going to be rolling away from you. And so you're not actually measuring in that imaginary sagittal plane anymore. You're measuring away from that midline.

Yeah. OK. So if I am in a late propulsive strategy on this side of the pelvis, what that means is that I'm going to be turning the sacrum away. Right. So it's going to try to turn the sacrum to the right. So I'm going to push from behind here and it's going to turn the sacrum this way.

I wouldn't have thought of that.

Yeah.

Okay, where do mom and dad hang out? Where do they direct their attention? Do they hang out on TikTok?

So their goal, if they're doing a press, their goal is to say, Manuel said, I got to press this overhead, I'm going to press it overhead. And so then they use that strategy to the best of their ability. So it's always going to be there. Remember when we were talking about Sulaimanaloo coming up out of the clean at the Olympics? And you see his hips kick to the right and he goes into this harsh hardcore kind of a side bendy kind of thing, right? You got the lift done. So what he was doing, is he had all of these combined forces, internal and external, and you saw the result of how he had to manage all of those forces at that moment in time. And so that's what he did. That was his solution to the problem. So when you see the turn, it's a solution. And you might not like it because it's not pretty, but they don't have a choice at that moment in time. So if you don't like it and you want to make a change, then that's why you have to impose activities upon them to give them alternatives or better management strategies in your mind. So it's, and again, it's kind of like the same thing we're talking about on the IFAS you call. It's like, you know, when you see the knees coming in, that's a solution to the problem. And again, you might not like it, but it's a solution nonetheless. Here's about somebody that is doing a PR bench press.