So with the medial aspect, what's the sequence in time that leads to that, where you have the I guess it's called tennis elbow. I always get confused which one is which, because I've seen people that don't play those sports.

Dude, I hate to say this. We're out of time. It's okay. It's all right. We're out of time. We can pick this up later. It's not pinching the glutes together as if you're trying to hide a quarter between your butt cheeks.

So, focus on the untwist. Don't worry about whether you have one leg longer than the other kind of a concept. Don't worry about the asymmetries and the musculature. It's just a representation of what's going on and it tells you exactly what to do. Okay.

Yeah.

During that moment, does that affect the strategy on the posterior side, like the yielding or overcoming strategy on that posterior side?

Yes, and could you expand just a little bit? Could we talk more about the way that internal rotation affects the helix and the way that external rotation affects the helix because I'm trying to visualize that. I know that collagen is like a three-strand structure, right? Okay. Together, real simple. Real simple. Take a towel, a wet towel, and wring it out. Which way does it tighten as you twist it?

So you're gonna be, you just need to figure out the best way to manage it, right? So let's really define this. Let's narrow this down. What is the biggest concern or biggest problem that you have with this athlete right now?

Yeah, all the day.

Yeah. Yeah. Yeah. That's very cool. Yeah.

And so that also creates a downward force into the ground through the knee. This magnifies that internal rotation into the ground. A tremendous amount of downforce is required to create the wave of internal rotation that goes up into the extremity. We are always superimposing this internal rotation on top of this external rotation position. As the wave of internal rotation goes up through the body, an expansion follows behind it. When landing in this early propulsive position, we've created a delay strategy on the lead foot to allow the throwing side, the throwing arm, to translate ahead of that lead foot. That ER wave is the delay that comes right behind the high force. For a right-handed thrower viewed from the right side during a throw, you should see the right hip start to translate ahead of the left. It's like your left back pocket stays back while your right back pocket goes forward. You'll see this go up into the lower back, showing that delay strategy on that side as the right side translates forward. If you don't see the delay strategy, both sides are trying to move together with no differential, reducing throwing velocity. With no differential, you have a longer distance to travel because the whole pelvis turns as a unit, going around the left lower extremity instead of straight through it. To maximize velocity, you always want the straightest line toward the throwing direction. When planting the left foot and capturing that early propulsive strategy, the sacrum moves backwards on the ilium, creating expansion on the left side while the right side goes through its movement, which is where velocity comes from. I have to slow the left side down to let the right side go forward. If both sides try to go forward simultaneously, it's no longer a straight line but a longer curve. For the right foot to land and translate forward, I must create the delay here. As I step forward with my left foot, my foot isn't on the ground yet. When the foot hits the ground, there must be a quick turn; the sacrum has to turn toward the lead leg. As I step forward with my left foot and the ball is behind me, my hip does the exact same thing. As I reach forward with my left arm to throw, my hip goes forward. Upon landing and pulling the arm back, the sacrum turns toward that side. Both the upper rib cage and the pelvis face the same direction at the same time as they turn. Then, as the ball is pulled through, that side goes forward. This mirrors the shoulder blades doing the same thing.

Well, do you think she's going to behave normally with pain?

Can I stop you? We can't flex a bicep.

We did a quick assessment. I know her for a while. I just haven't seen her throughout COVID and she's definitely wide in a pro-sternal angle. She's limited in pretty much everything. T-spine and rib cage are all kind of restricted, yes. A little bit of external rotation but definitely no flexion, neither in the hips or the shoulders. Got no internal rotation. Did you do any complex movements like squatting or split squats or anything like that? Were they all without kind of restricted and uncomfortable? So her toe touch is not too bad, but she definitely doesn't have a curve that you can see.

So the magnification of the external rotation on the right side and the lumbar spine is facing towards that side.

So what would be happening is that the center of gravity is traveling forward over the foot. Now, when he's standing still, he's still on the ground. But he's oriented as if he's trying to lift his heel from the ground. So what I have here is a situation where I have a lot of concentric orientation all the way down the extremity because I'm trying to propel myself forward and get my center of gravity forward with my heel up. So what I have is a constant state of load on that extremity. Because the load is instantaneous, the connective tissues of the foot, the lower leg, and the pelvis are all going to be in an overcoming state. That's a very stiff representation of connective tissues. It would be really nice if I could just reel that in, but I don't think that's the easiest way to do that with this type of person. So what we can do is take him to a place where we still have concentric orientation of the same musculature but with a different load on the connective tissue. So we can actually reduce the rate of loading on the connective tissues by moving him all the way back to an early propulsive strategy. When we talk about this kind of thing, we're talking about the heels elevated element because what that does is it takes a foot and moves it into this early propulsive representation. The difference between the late and the early propulsive strategies looks very similar. But the difference is that I'm getting the elongation of connective tissues. This includes anything that is not contractile tissue, including the skeleton. So I get this resilience, a returning to the canvas where they can expand and actually start to store energy because right now all you have is a perpetual state of load that we have to reduce. So again, we start to move him back, and using a simple representation of that, we would use something like the heels elevated squat concept. If we're doing a split squat, we'd have a front foot elevated split squat, but I would do a heels elevated split squat under those circumstances because if I can bias the foot towards early, I'm going to bias the entire system towards that delay strategy on the affected side. Does that make sense?

Yeah. That's an orientation all day, every day. There's no expansion. There's no expansion on the backside of their body there, which is advantageous from a gymnastics standpoint, because everything that they do is based on that orientation. That's why we see the PARS defects and such in all the young gymnasts that we see. Some of them are actually, I mean, that's a byproduct of performance and they use it to their advantage, right? It gives them the movement capabilities that they need.

Yes.

Instagram and TikTok.

Sure.

Roughly.

If I put enough pressure on your throat, what would happen?

And I think that's one of the coolest things is when you start to look at it through that lens, it's like, oh yeah, all the stuff that we do in here is cool, but it's the stories that you get from the weekend, right? Like, oh, you know, oh, I'm still playing rec league softball at you know mid fifties or sixties or I don't have any knee pain when I garden like yeah it's not as maybe exciting as yeah oh I scored 20 points but it's still cool to that right right and it comes down to understanding their vision for themselves and helping them clarify that and then understanding how the gym can help them achieve right those goals that I think that's why you see the rapport

Yeah, because they all lie on the table like,

I never said the F word. OK. OK.

Right.

Of length, like the wider.

Okay, so we're going into the cut. The anterior outlet is going from eccentric orientation to concentric and the posterior from concentric to eccentric as we're moving in. So right before maximum propulsion, the amount of yielding action would be at its maximum. Yes. All right. That's what I was not sure about.

I try to avoid using those terms, right? Like there are dirty words that I don't use or try not to use. But when we talk about feet, we talk about where the internal rotation is present within the base of support, defined by where the center of gravity is. If I say a bunion is a pronated first metatarsal phalangeal joint, that doesn't help much. But if I tell you there's an extreme amount of IR present approximately in that first metatarsal, that makes more sense. Or I can say the internal rotation is dropping through the midfoot, and you realize that's a different strategy than the bunion. The influence is still internal rotation. It just tells me how the center of gravity moves from the back of the base of support to the front during propulsion. It's about speed, because I know IR must go through the foot—it will go from the rear foot to the tip of the toe always. What I'm trying to determine is where the IR is most impactful, to what degree it's being applied, and whether it's distributed IR. We rarely see a perfect foot initially, though we see improvements over time. I need to determine how quickly IR goes through the foot and where it's most prominent, as that tells me where the center of gravity ends up. I want to control the center of gravity through the base of support to achieve an even distribution of IR through the foot, as those are relative motions.

I don't want them to sense anything. I want them to close their eyes and get eight hours of sleep so that they feel so much better the next day that they can do stuff. And I realize that this is not an easy thing. I don't want to imply that, oh, this is so easy. Just let them sleep. It's like, I get it. Like, I get it. Like, some people, like, why can't some people lie on their left shoulder at nighttime? Cause it hurts. It's like, okay, they're the wrong shape. Are you going to change that shape by lying on it at nighttime? Probably not. That's going to be really horribly uncomfortable. So you're working on shape changes when they're awake and conscious. And then you'd go, oh, look, I can now lie on my left side.

Okay.