So much fun.

Okay. That's cool.

Okay, so the foot should reflect that, right? The tibia position should reflect that. Right? Because if you would be in a true late representation, in a true early representation, it's very difficult to produce maximum force. And that's what a lot of people try to do because they can't access their full internal rotation capabilities. And so that's why you see substitutions in split squats and lunges and step ups and just pick any exercise really.

I quit for a year and did something else because I thought it was going to be a big thing, but it turned out to be nothing. Coming back from that was important for me. I recognized that there are only a few things I'm good at. I always emphasize to people that you should focus on your strengths because your weaknesses will always be weaknesses. That year was a period of discovery where I realized I was really good at the other thing and that's where I should spend my time. That's where the drive started to come from. My curiosity after that year was exceptionally high, so I started asking a lot of questions and looking for answers. This was during the early days of the internet, which made more information available. In the past, we had to read books and go to libraries to get journal articles, using a card to make photocopies instead of downloading a PDF in seconds. I would spend weekends at a medical school library downloading articles. There was a moment of recognition where I realized I should stick with what I'm good at and develop that as hard as I possibly can. I had guidance from a couple of people early on from PT school and worked with one of my mentors for a couple of years.

So this doesn't change. They're just literally like, if I sit in my chair and I face this way, that's all they're doing. So they get turned right and then they get shoved right forward. Well, if you're asking them to not move the axial skeleton in a relative manner, that's what he was asking them to do, because he was saying, I don't know, he said they were doing a hinging motion. So if my axial skeleton is actually facing that way now. So it looks like it's going this way, but it's going that way, because I can turn my head a little bit and it looks like I'm going straight ahead. I can make sure my feet are going in that same direction as my face, but everything else is facing this way. Which is not all they're doing—all they're doing is literally they're doing exactly what he's asking them to do. It's just that the orientation is taking them over there.

Well, you're adding unnecessary constraints potentially. Yeah, right. That become limiting factors rather than enhancing factors. Right. So everybody thinks that more strength would be better. But the reality is, is like, well, how did you achieve that? Because if I need to change the physical shape of a rib cage and I take away a turn that you need it. So strength training eventually will change the physical shape. All you got to do is like, look at the extremes for a second. It's like, go take the world's biggest bodybuilders and you see how wide they are and then they turn sideways and you can see the flattening of the rib cages. So that flattening is a reduction in the ability to turn. Up to a degree, that increases force production potentially in a favorable way. And then you sort of cross a threshold where it now becomes interference. And so somebody, somebody that you work with may benefit from developing a double body weight back squat that would enhance their ability to throw. If you applied that across the board and you said every, if one guy does it, then everybody must need it. And then you just took away that somebody else's superpowers because you didn't consider them as an individual as to what they may need. We can't just, we can't make these blanket applications of method. What we have to do is we have to respect the principles upon which the skill is based. That's what we're talking about. And then you have to say like, okay, what enhances my ability to access that skill and what potentially creates interference for that skill?

Inside would be, part of the elbow is protruding.

Okay. All right.

Yeah. Oh, okay.

It may. And again, we have to have an observation of sorts. We have to say, 'OK, this is what you did under those circumstances. And so this is the strategy that you used.' Each one of those has a representation that we would identify. And again, in the gym, we can do this visually to a degree. We don't have to throw people on the table to identify these things. We just have to understand what's going on.

Yes.

My own understanding of the issue.

Okay. So there are certain types of athletes that thrive in situations where there is a tremendous amount of unknown factors. They have been in tough situations before and have been successful after being in those difficult situations. From that comes self-confidence. So they are participating in an environment that is based on their strengths, and they are able to apply those even in situations where the probability may be against them. Again, we're playing probabilities. Let's just go back to the 70-30 example. Let's say it's 70% against you of being successful, but there's a 30% chance that you will be successful. Those people that have been exposed to these environments, and they know what their capabilities are, and they're comfortable in this uncertainty. There's still a 30% likelihood that they'll be successful, and they're playing off of that. That's self-confidence. Ego is a tool. Ego is a tool that we apply in certain situations that allow us to take advantage of our self-confidence. However, when ego is applied to the extreme, when it's outside of our capabilities, where we think that we are too important or we think we are capable beyond what we have ever been able to demonstrate, then it becomes dangerous because that leads to arrogance. And then again, that's where the risk starts to increase, and then we put other people at risk under those circumstances. So for me to have this call with you, I have to have a certain degree of self-confidence; I have to apply an element of ego so I can express myself, so I can speak to you on a level that provides you something of value. But if I say that, oh, you wouldn't understand because it's so far beyond what you could ever imagine because I am so great, I am so good, one, you're unlikable; it doesn't help you. And so I would say that when you apply ego in the service of others, then it becomes useful. When you apply ego in the service of yourself, then it's not useful. So ego is a tool. It's something that you tune up and tune down based on the environment, based on the situation.

So velocity, mass of the ball, position, all of these things, all of these things matter because you can't just say it's one or the other. That's the thing I want you to remember from this, right? You gotta look at the interplay of all of these things.

Yeah.

Normally in what sense?

If I flex my biceps and my elbow flexes. Thank you. If I can track my biceps and my elbow flexes.

Does she shift way behind her heels when she does her toe touch?

So here's the kicker for you there, but if I get somebody that is counter-neutated, they've got the associated lumbar flexion that you would expect to see with counter-nutation, that's a spine that's gonna turn all day every day. And so if I do an ER measurement, that sucker rolls towards me. If I take you into hip flexion, it can roll away and it can magnify it. Right? If I have somebody that is oriented, like they're laying on the table, but they're oriented right, I can get a diminished hip flexion so it doesn't roll back towards me, right? It rolls far enough that it doesn't turn, but the right side will be magnified. So again, it's just a matter of saying what is possible, okay? And then looking at your measures. And that's why the upper extremity, lower extremity comparisons are so important because again, as I'm moving a leg, the leg has a lot of mass, right? That can drive a lot of movement. Arms tend to not move the thorax mass nearly as much. And so, again, it'll help you clue in as to what you're actually looking at.

Yeah. But he's oriented as if he's trying to lift his heel from the ground. Okay. So what I have here is a situation where I have a lot of concentric orientation here. I'll be concentrically oriented all the way down the extremity because I'm trying to propel myself forward. I'm trying to get my center of gravity forward and 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. So 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 a person. So what we can do is we can take him to a place where we still have concentric orientation of the same musculature, but we have 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. So when we talk about this kind of a thing, we're talking about the heels elevated element, because what that does is it takes a foot. I'm going to use a foot here real quick. It takes a foot and it moves it into this early propulsive representation. So the difference between the late and the early, it looks very much the same. So if I tip up the late here, and I tip up the early, it looks very similar. But the difference is that I'm getting the elongation of connected tissues. So this is anything that is not contractile tissue, including the skeleton. So I get this resilience. um returning to the to the cancass just where they can expand and actually start to store energy because right now all you have is a perpetual state of load and we have to reduce that okay so again we start to move him back so and again using just a simple representation of that we would use like the heels elevated squat concept um we would use uh if we're doing like a split squat you've got a front foot elevated split squat but I would do a heals 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. Okay, now, so let's just talk programming here. Okay. Under most circumstances, I got to create the delay. I got to slow the left side down. Under those circumstances, I'm going to want to shift my center of gravity backwards towards that left heel. Think about all the other activities that you could probably do in the gym that would do this.

In a minute. Oh, I like your shirt. It looks very good. Okay, so the first step would be to get some sort of answer your expansion.

You make your point, you give examples, and then you make your point. So it goes point example point, four times. Little transitions in between to get you from one point to another. Patient walks in, here's the findings. Step one. Step two, here's what those findings mean. Step three, here's where we're lacking shape change to allow this movement to occur. Step four, here's an intervention that I can show you will reacquire the internal rotation of the shoulder that caused the positive test in the first place. Talk done. Any questions? So let's look at a few challenges of working with people with narrow ISAs versus wide ISAs. Good morning, happy Tuesday. I have no coffee in hand and it is perfect. All right, already a busy Tuesday, had a mentorship call this morning, leading into a clinic day, first clinic day after vacation, so that would be fun. Today's Q&A is a conversation that I had with Eli. Eli is a coach here in Indiana, go Indiana. And we talked about a couple of presentations, one with narrow ISAs with the extreme hip intro rotation. So I would refer you to the video that we did on YouTube about that. So you get an idea of what you're looking at there. And then we moved into some wide ISA questions that I think a lot of people run into. So we have clients with a lot of body mass and that actually becomes some interference to recapturing some movement and shape change that we talk about. And then we actually narrowed it down very specifically to a shoulder issue, again dealing with somebody that presents with the wide ISA archetype. So I think that this conversation will be useful to many people. So thank you to Eli for your participation. I appreciate you. And everybody have a great Tuesday. We will be back tomorrow morning with another Q&A. So have a great day.

There you go. So you just developed your own social media strategy to address the clientele that you want to work with most specifically. So now you have to figure out how to communicate with a parent on Facebook and a kid, a baseball player on TikTok and Instagram. Okay, awesome. Done. If that's where you need to go. So let me tell you a quick story. One of my mentees is a physical therapist that owns his own practice. He was on social media and just pumping out content with zero response. He wrote a Q&A for the local newspaper, and every time he does that and talks about a specific diagnosis, he gets a minimum of six new patients a week with that diagnosis. I would never have told him to go to the newspaper; I didn't think people still read it, but apparently that's where his clientele spends their time. So guess what? He's not on social media. He's pumping articles into the newspaper and killing it. Now it might exhaust at some point, and he has to change strategy, but the reality is it doesn't matter. Like social media, everybody's on it. That's fine. But again, if that's not where your audience is, that's not where you go. There are a lot of ways to access people. You just have to know who you're going to work with first.

And they finished? Yes. You know why they did that? It was their strategy, right? They had to. They're at a threshold where staying even wasn't going to work. I made myself uneven and I finished the lift. And again, I'm not saying whether that's good. I'm not saying whether it's bad. I'm just saying that that is the strategy that they're using under the circumstances. I mean, you have to accept it. It just means that you have to make a decision as to what are you willing to accept and then consider the context.

OK.

Well, that would block airways or airflow.

And people probably can't picture this, but literally we have people that don't know who our professional athletes are. It's a thing. So they just think that they're just the big kid that you know, and I think about when Dwayne used to be Dwayne Allen used to train here and he would just come in and just be hugging. They had no idea who he was. He was just the nice boy that comes in and says he's making sure wrong. But he had no idea who he was. And so that was one of those wonderful things. But they get along because they're all training with purpose. And so they saw Dwayne behaving a certain way, and then Dwayne sees them behaving a certain way. So there's this instant sharing and instant rapport, which I think has been really cool.

Sideline tends to be your better option. This is where you pull out gentle techniques. Short arc rolls for the cervical spine. You could use an old Feldenkrais technique. Place their hand on their forehead inline. Then instruct them to turn their hand with their neck as slowly and gently as possible. This becomes the exercise. The patient is lying on a pillow inline. First, perform a head-driven roll, then a hand-driven roll. The goal is to help them sense what is driving the movement. When you teach them to move their hand, it teaches them how their neck moves. When they move their hand, the neck learns to relax. It's a trick to make them aware of muscle tone.

That's right. Yeah. Right. So what is happening if the spine is in ER? What is happening to the ilium in that side?

Yeah.