Step up variations would be biasing someone more towards middle. Doing like any kind of step up variation, like, uh, like middle ish.

I'm trying to land in early, but you took away my early foot.

Cause again, it's like you're not always going to be able to see this stuff. Right. I mean, yes, you need to be reliable with yourself, and try to be as consistent as you can with your measures. But I got a little distracted there. We're talking about interpretation. No, sometimes you're literally not going to see it because there's so much motion at the spine that there's no anterior glide on the shoulder and you feel freedom of movement. It's just the fact that it's not coming from a distributed relative motion from the humerus to glenoid scapula ribcage spine, it's literally just a bunch of spine turn. And it moves very, very easily because the orientation is so strong in that direction. So you won't feel it. But again, it's like, that's why you lay out a chessboard on every patient. So you can see the relationships, and then the question becomes, okay, how can I possibly have this representation? Knowing full well that I've got my checks and balances on the ipsilateral side. Knowing I've got three confirmations of external rotation, I've got three confirmations of internal rotation.

Bill, I have a quick follow-up on Zach's last question. Would you say, if someone is coming back from some sort of acute injury, you could use video of their pre-injury mechanics to compare to post-injury mechanics? Then, if you see improved distribution of load based on what you're seeing now compared to before, that might be an indication of improvement?

posteriorly on the left right now that is correct forward so I'm trying to create the delay and expand the posterior the left posterior yep that's good yeah because so again you want the sacrum to go straight ahead relative to where the barbell is right I want a sacrum that's in the same if there was such a thing as a plane I want the sacrum in the same plane as the barbell Right. So to do that, you're going to have to create the sacred orientation, which is what you're doing.

Well, in other words, not all the force is going into the ground. It's being dispersed.

I don't have a specific person in mind. Do you not have a couple of pictures right now that I'm treating for like medial elbow pain?

Okay. Hanging your head into the steering wheel.

Right. So we can't glean anything from an inability to yield tissue or anything like that.

Yeah, mostly.

Again, I look at it in isolation. So what's the time aspect of that?

Okay, so with the sacral position, when you're trying to determine what that is for an individual, yes. Part of that coming from their ISA position and secondary to that. Do you use the position of the lumbar spine as well to give you an indication as to what that new patient is going to be? So if someone is like hyperlordotic or a little bit flatter through the lumbar in addition to the ISA measure.

No, that's just answered everything. That's why I couldn't.

So let's talk about this very specific movement for a second because it will coincide with what you were just talking about from the Grecovetsky book. Okay? So when he's talking about storage and release of energy with the flex spine, that's how you pick up a stone. Okay? Now, are you at the end range? Hopefully not, because when you get to the end range and you think about the more sensitive structures that would be exposed as the yielding structures. But that's literally, so when you see somebody pick up a stone and they sit the stone in their lap, they regress, right? And then they come up fairly quickly in most circumstances, right? So what they're actually doing is they're using the yield and the overcome, the elastic recoil within the axial skeleton to pick that stone up. That's why they use that technique because it's incredibly efficient, right? And again, that's exactly what Grecovetsky's talking about. It's typically, if done really, really well, so you get somebody that's high level strongman, they are very, very skilled in that. And so they're not really exposed, I mean, again, heavy loads always expose you to risk, right? But they are minimizing it by being very efficient under those circumstances.

So I'm an undergrad in exercise science.

Always. Right. Simple measurement. Simple measurement. This is one of those great examples because it's really easy for people to find. Anybody that's watching this or listening to this can actually do this. All you have to do is go to Google. And put in the search bar, Olympic weightlifting snatch, and look at a series of photos of people sitting in the deepest possible squat with the barbell overhead. People will see the knees being positioned away from midline. And so right away everybody says, external rotation. But these people are producing force into the ground at a very high level. What you have is people that are orienting themselves into a position where they can access a space, which we would call external rotation orientation, so they can produce force into the ground. Their hip joint, if we were to look at the hip joint, the relative position of the hip joint, is internally rotated, because it has to be, because it has to be pushing down into the ground. But because of the amount of compression that they have to use to hold a weight overhead in that position, there is no way that they have the normal capability to access extra rotation because you don't produce force in extra rotation. You can capture a position in extra rotation. You can demonstrate velocity in extra rotation, but you don't produce force well in extra rotation. It is limited. So I need high levels of internal rotation capabilities under those circumstances. Again, it's like this is one of those things that by rule—see, the rule was moving away from midline. You said it at the very beginning: moving away from midline, external orientation; moving towards midline, internal rotation. It's like we have to look at this differently because it creates a massive amount of confusion because of what the reality is. The reality is that we have to push down for our internal rotation to produce force. So people mis-measure things. They go, oh, you have this much external rotation when the reality is, but the position is actually internally rotated.

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. 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 is going 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 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. If we're looking at representation, so anytime you see like an external rotation or a flexion, okay, those are all representative 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.

So I think the fact that we are going to go away from this planet after a point of time. I think that feeling actually humbles people. It should.

What is increasing or decreasing? Velocity. Okay, gotcha.

As my left arm leads forward, my right arm stays back so there's my position. This foot lands and then I push through like so. Yeah, yeah. So I was confused at that middle stage like you said right we get that on our right side when the ilium goes into like early propulsion. This goes forward so the turn takes place at the orientation.

Okay. If I throw a medicine ball at you and you catch it, right? And you stop it. There's this waveform that goes through you into the ground, right? So if I put her in a position that she can tolerate and I have her doing medicine ball throws, do you think that process is not going down through that extremity into the ground?

So if I'm a powerlifter, I want the least amount of ER necessary to create the movement, right? Because the less ER I have, the more IR I can produce, and the more force I can produce. Now, keep in mind, I need enough ER because if I don't have enough ER, I can't even finish the motion, right? And you've been pinned under a bench press once or twice in your lifetime, I'm sure, right? We all go for it at some point in time. So what is that? So that's a point where I can no longer produce enough ER force. So I've recruited all of the muscle that I can possibly recruit. I create a squeeze to such a degree that my ER force goes, it shrinks up, and time stops. And all I have, there's no place to move anymore, right? So literally it's like, think about like a bench press as an ER field. And then as you fatigue and you recruit more and more muscle mass, you eventually lose, and not like you have no more eccentric orientation. Everything is squeezing. Everything is compressed. Time stops. And so the bar stops movement.

I had her trying to rotate.

They've just turned towards ER and that allows them to get enough internal rotation down on the ground. So an example of this would be, why do you see power lifters switch to sumo style deadlifts? Because they can turn their hip sockets out and then they can capture more internal rotation. So the guys that struggled to even get into position in a traditional deadlift, they don't have enough ER space. So they don't have enough IR to even get into the position of a traditional deadlift. So they start moving their legs outward and now they can find they can find their internal rotation. So from a principle standpoint, what we just said is orientation first, ER field second, and then we can superimpose the IR on top of that. Now, having said that, you can increase internal rotation measures without expanding the IR field. But what you did is you distributed it somewhere else. You just made them IR harder in another place. So you got to be really, really careful with that because that can alleviate pain and things like that. But you didn't improve the situation, you just moved it somewhere else. Now, if I have someone that is highly coordinated, right, just based on their physical history. You have somebody that's like, I'll have people that come in that they teach group exercise classes. It's like, okay, so I know this person's moved in their lifetime. I can use a much more complex activity. I might be able to do something on their feet right away. So for instance, if I'm trying to capture left hip internal rotation on an individual, and they are a chronic exerciser and they've got a sports history. I can give them a right suitcase carry and I can capture that into my rotation because the way that the load interacts with the system as they're walking produces a stronger middle propulsive action on the opposite side. And that gets me my hip intramountation. But if I have my 45 year old accountant that's never played a sport in their life and all they do is sit down all day, that's gonna be probably too complex. So what I might have to do there, I might have to go as far as to eliminate gravity Do something with them laying down that allows them to reacquire that left hip interrotation.

Okay, very clear. And suppose there's a little bit of a follow on from that. So, kind of all those clients that actually, when he's training, the movements, they look pretty good, right? So, a slightly different point, but there are clients out there that sort of hide compensations quite well, if you like, or better than others anyway. Is that a fair thing to say? I was just wondering if that's the case, it's certainly in a scenario where we might be doing more digital type sessions and that kind of stuff. If that's the case, then what's the only strategy you might use to, because you can't necessarily do sort of checks and balances with those kind of clients before and after or you can, but yeah.

Cool. Yeah. You've got two minutes.

She's just jamming into the ground. So that pronation, again, is her IR into the ground because she's got to use some form of orientation to create it because she doesn't have the ER first. You've got to buy her an ER space, then she can IR under normal circumstances with normal relative motions. Okay.

They're the 16%, right, Bill?

Okay. If I'm going to come to a stop, so if I'm running forward and I want to run backward.

No, it's not the breath.