Yes. So they're never expressing pronation. So is that an energy leak? Or is it just that they're not accessing it?

So my question is going to be in regards to interpretations of traditional external rotation measures for the shoulder, for context, like a right-handed baseball pitcher. Got it. So I'm just trying to think it through. Assuming it's a high-level athlete, they're going to have some degree, most likely, of compensator or compression strategies that's going to potentially magnify the measure, where that would be like the turn to the right or they're tilting back on the table. But then, assuming they've been throwing for a while, they're also going to have some degree of retroversion that's changed what their theoretical norm is. So I'm trying to figure out, I guess, my question would be how do you start to approach the idea of figuring out what their norm would be? Because like the iterations from the shoulder to the hip, I wouldn't expect to see a gross magnification at the hip on that side relative to what the magnification might be solely due to the retroversion on that side. So I'm trying to figure out, if I'm trying to restore some degree of external rotation, what am I shooting for? And you're probably, I guess, part of that is you're probably not shooting for what their norm is because you don't want to bring them all the way back if they're an athlete. But I guess it's probably a good starting point to know where they should be.

Yeah.

OK, so what you're getting is a magnification of the pre-existing mechanism. The knee, like all the fluid inside of the knee, is secured by the connective tissues, which keep the synovial fluid in that space. Without the synovial fluid, bad things happen. As you stand on a knee, fluid gets compressed from inside the joint to the outside. You're pushing down the femur on the tibia, so they don't touch, but you're pushing fluid out from between the two bones to the sides. It bumps into the connective tissue, which based on how fast you load it and how much pressure you apply, behaves in a certain way. The connective tissue that surrounds the knee actually gets stiffer when you stand on that leg, which keeps the bones from touching but also gives you an element of control over where the synovial fluid is going. Now, taking more connective tissue and wrapping it around the outside of your knee really tight, you've taken a normal representation of the knee's behavior and augmented it with something external. You've increased the internal pressure by creating external force, which will limit to a degree where the synovial fluid can go. By squeezing from the outside and putting pressure from the inside, you're holding that synovial fluid around the outside of the knee and making it very stiff, making it harder to bend. You've got a knee that wants to stay straight based on where the fluid volumes are. Then stacking weight on top and intentionally trying to bend a knee that's now oriented to be much straighter, it's very stiff. As you descend, all of that mechanism will yield to a certain degree based on the magnitude of the load, the speed you're moving, and such, and it's going to store and release that energy all the while augmenting this normal behavior of the knee. Basically, you've made a super knee. That's how knee wraps work. If you have somebody that has patellofemoral pain, chances are you've also reduced the mechanism that is causing the focal load responsible for the symptom. You've altered how much the knee can orient and how much the bony relationship can change, keeping it within a certain range that no longer requires you to have a symptom. The exact mechanism would require further discussion to see what other changes took place, but essentially, you just magnified what would be a pre-existing mechanism.

Right.

So would that be something, depending on what the person can tolerate, would that be something as simple as having, so like in a quadruped position, if someone can kind of dissociate the pelvis into like a lumbar specific cat cow and then breathe into that with that?

Yes.

Yeah. There you go. There you go. Camilla, there's your ER test for shoulder. Can you lay on your side and support your head? See how easy this is? You just got to understand what the representations are.

So you have the, I've heard you mention it's a component of dorsal dorsal rostral expansion. And then I've also heard you, utilizing it as a technique of compression versus Russia compression on that side. So using it as an element of compression to expand the other side. So I'm kind of curious of, yeah, in what context is

Then that's what we have to do. On my end, I get the people that they come to see me and they go, Bill, it hurts. Then they come to see you and they say, Andrew, I can't get into that position and you say, here's how you're going to do it.

Okay. So when you are successful and you make a change, assuming you've got some key performance indicator you're following, I'm assuming you've got some range of motion measure that is telling you when you're successful. Basically a toe touch because she struggles to touch her toes before and then she can touch them with these after. Perfect, perfect. Okay. So like I said once again, you've got a measurement that is telling you that you're successful. If you're doing good stuff, now it's a matter of what else can I do that reinforces that? So when you have a favorable outcome, you've done something successfully. What else can you do that reinforces that change that may allow you to extend the duration of the change, allow her to self-manage it to a greater degree. So you've got to test retest. So that's useful as well. But again, you have to start looking at say, okay, what do I think it was that was driving this measure of success? And then how do I reinforce that? So now it's a matter of selecting activities. Number one is you eliminate interference as much as you can. Knowing full well that there's going to be certain things that she's going to do as an athlete that will probably create interference. That's why she kind of keeps going back to these strategies. So let's think about this for just a second. So when you say winging scapula, what we got is we got a thorax that's pushing forward. That forward force goes down into the ground. So that's how she produces force into the ground. And that might be the only way that she can do this under these circumstances as an athlete, which is why it keeps showing up. Your job then becomes management, right? Let's make sure that you can recapture some traditional relative motion. So now maybe you're looking at hip range of motion. You're looking at her ability to turn. And that's demonstrative of her ability to reproduce the expansion where she would typically use that strategy for performance. Cause we know that on every level, every athlete as they perform is going to move towards what we would consider a compensatory strategy under most circumstances because they have to produce high force. They have to produce high velocity. The only way you're going to do that is by moving body parts together, not with relative motions. So maybe your management strategy becomes, okay, let's look at this from a performance kind of a thing. I know what you're going to try to do here. And then the rest of the time we're trying to recapture the relative motions as the management strategy. So if we're looking at representation, so anytime you see like an external rotation or a flexion, those are all representations of expansive strategies, whether it be the internal rotation or the extension, you know that you've got a compressive strategy. And so some of this is going to be observation. Some of this is going to be direct measurement if you can do that. And you say, okay, here's the typical representation that we have.

Is there something that you would like to change when you look back on your life?

All right, so you've mentioned before that both sides of the thorax are moving forward—one just slower than the other—which makes sense now that the whole body is moving forward in space. But obviously it appears, so like let's use right leg is in stance phase as the example, that the right side of the thorax is moving backwards. It appears that way because the relative movement, the displacement forward is different. So my question is, why is the right side moving slower than the left? Is it because the right side of the body is internally rotating and that slows down time, which slows the rate of loading on the connective tissue?

So what happens at the back hip at that point in time? Generally, most people say that we get that internal rotation of the back hip, right? But generally we want that early propulsion strategy at the back hip while the hip is turning. How does that relate to what we are doing? Like at the backside, when that backside is turning, right? We get that internal rotation of the hip, like the femur and the foot and everything's going on. What do you want the ilium to be like at that point in time? Are you talking about with your right foot contact as you're going?

Absolutely. Okay. So use those, right? Because you understand how vibration and waves work, right?

Anyway, so how do you do that? Do you put him on a Swiss ball with dumbbells? And you say, Arnold, I'm going to put you in this unstable atmosphere where you have to try to manage yourself in space, or do you lay them down on a flat bench that's very, very stable, stops motion from occurring so I can actually produce motion in another direction and then create an area of emphasis of the movement. So that's where the stimulus occurs. You see what I'm getting at? Yeah, so all those people that like poo poo machine training really need to rethink their thought process in regards if hypertrophy is the goal, right? Again, if you don't really give a rat's patootie about movement capabilities, by all means, you better be doing some machine training if hypertrophy is the goal. There's advantages there. I just don't care how you get the stuff in there. They just respond to a stimulus. So a machine-based activity where I would have an artificial stability gives me an IR advantage because it stops motion from occurring. It helps me to stop movement.

Yeah, I've never seen people in my life.

All right, so my question was about kind of your process for selecting exercises. So within your model, you'll look at, from my understanding, you'll look at a lot of these different range of motions and kind of decipher what movement options these people have available. And then when you're in the process of actually choosing that exercise, if you were to want to increase someone's hip internal rotation, for example. Okay, I've decided already I've gone through the process of knowing that this is my move. Now let's pick something that's going to accomplish that task. There are multiple moves that could probably accomplish that task. How are we going about trying to get the best one for this specific individual? So some of the other variables that I've contemplated are, inferstional angle presentation, things like training age and just their other table tests and how those are going to play into it. But I'm really interested in like all the variables you factor in and kind of deciding like, yes, this was the right choice for this person.

Okay, cool. And then prior to sort of training, if there was going to be any running going on, is it sort of a good idea to try and use some of those types of activities prior to running to get a bit more of a yielding action?

No, because think about it. They're going to use a posterior compressive strategy. They're going to use anterior expansion and orientation. So they're actually going to tip the thorax back backwards. They're going to be in an IR position with the arm overhead because under most circumstances, especially for a gymnast, if their arm is overhead, they're producing force. And I cannot produce force in an ER position. So there's a big difference between acquiring ER relative motion and producing an overhead arm position under force because it's got to be IR up there. And so you've got to create the IR orientation. That's why we got to talk about creating space for movement and producing force and movement because people want to get carried away with like, oh, this position is always ER. No, it's not, because it depends on the physical shape of your body in space. That's what determines whether we're talking about ER and IR. When we're talking about relative motions, we have nice transitions between expansion, compression, and expansion again. When we're talking about performance, it's IR, because that's where the force is produced. Velocity is demonstrated in ER. They're not the same.

The reason is she doesn't have that ER field to superimpose the IR on. So everything becomes an orientation for her IR. So she's driving everything into the ground by orienting it forward. And then her whole center of gravity is way over her foot.

Right. So thank you. Yeah. I hadn't thought about who my perfect client is. So thank you.

Okay, so that performance versus health concept is very, very helpful. And I don't think there's—It's huge. It's huge. Because it's, you know, you're thinking in a way that's, you know, a bit different than my experience with most trainers and PTs, which is like, we need to give you what the textbook says is this level of internal rotation, and that'll fix your problems. But it's maybe the problem isn't the discomfort.

Okay. Do I need to stop my forward movement?

Why do they pass out?

Take care.

Can you stand up? Can you stand up? So all I want you to do, oh, look at you.

Go from early.

Okay. So the greatest space is posterior into the right. That's why they go there.

I can't do anything about it. You can send me some of yours. I would advertise for you.