So the correct answer to this is maybe. And then here's the maybe. How much load are you applying downward?

It is absolutely you are. But by tradition, the stuff that they taught you in school, what position is that in? Of the shoulders. Yes, sir. Some school. You're just ER, like when they, when they taught you in school and they said, put your arm in that position. And they said, what position is that shoulder in? And you go, well, it's this, it's this, it's three things, right?

And I'll put it up here in the video for everybody to see.

Yeah. And again, we have to consider the context. It's like the relative load that you're trying to move. So let's just say that we're really close to our peak capabilities. If I alter the shape of the pelvis as I am moving, it is changing. So that's the thing that we like, you know, if this is the full excursion of the pelvic shape change, I might be doing this. Which is one of the limitations of force output, by the way. So people that change shape a lot as they're moving weight don't lift a lot away because they can't maintain the force output. They can't maintain pressure. There's too much fluctuation in pressure. So the closer I get to peak output, the less motion I want because I need to maintain the pressure that provides me the force output. So the amount of relative motion in the pelvis has to be reduced to increase force production. For me to perform the activity itself, that hip joint has to move. For me to go down and pick up a bar off the floor and then to stand up with it, the hip joint's moving. And again, that's one of the limitations of picking the weight up. So those that can move the hip through a sufficient excursion to say that you're doing the lift, but yet still maintain the pressure via reduction of relative motions, they lift more weight. So you're gonna always move in that direction. And you can tell, you've done enough light squats versus heavy squats that you can tell that there's just a totally different sensation associated with max effort work compared to the lighter speed stuff or just a light warm up kind of a weight.

So they're always going to use compensatory strategies because they have to produce high levels of force very frequently and much higher levels of force than the average person. So you can't treat them like average ever. So I think you've had experience with this person over time. Am I correct? Okay. That's the best way to determine what the best course of action is, is to collect the data over time as you intervene and then see what happens. It's my understanding that you were doing really, really well and then you had a recurrence. Is that correct?

Okay, so I love the thought process first and foremost, because again, when you think about the superficial strategies, they're using them to control position against gravity and managing forces. And so if internally we're producing a biased force, we have to have a strategy to manage that. And so the easiest way is, number one, to simply reduce gravity first and foremost in any way, shape, or form. You do that, you immediately have a benefit to allow you to access different positions because the strategies can now change. Right sideline is going to reduce those internal forces to a greater degree than just about any other position because, again, they have to move against gravity, which they probably don't do a great job of because it's, you know, it is pressure-related. But again, it's harder to overcome. So from a right sideline standpoint, you're absolutely right. In regards to any other position, think about just a bag of water and then where everything is going to fall, so to speak. So if I move somebody to supine, there's a greater potential for some of those internal forces to be in effect, but because I'm laying down, everything tends to fall towards the table. So if you can just remember that representation alone, it's like wherever I'm positioning you, the guts are going to go in that direction as far as the table is concerned. And then all you gotta recognize the fact is like every time I take you away from that right sideline position, chances are I'm going to slowly allow those forces to become exposed just a little bit more, which is necessary from a progression standpoint. I need to slowly introduce something so you manage it here, you manage it there, and I keep turning you. Think about this for a sec though. So when you're in like all fours, everything's hanging off the spine. Which is kind of cool. When you think about it, it's kind of helpful. The bias is still there. But because, again, it's hanging. So my dog has a similar internal force problem, right, that we all do, but to a lesser degree. So it's still not as impactful as being upright. Grace is like just digging that one, right? Yeah. So all you're doing is, and again, your strategy in my mind is correct depending on what you're finding. So how do you know when to change the position?

The hammy strings usually get blamed for it, right? Because they see the butt going up, right? And they say, oh, you can't, they're looking at, they blame hamstrings for it.

So in one of your videos, you spoke about disc prolapses being a yield in the disc. So you're trying to pick up the yield somewhere and then somehow you get the disk and then you get the yield through it. And I was wondering what, theoretically speaking, there are people that have the superficial compressive strategy of the lumbar spine, and are people that create that flexion orientation through the lumbar spine. Which ones are more likely to get that prolapse through the disk? Are the ones that allow the yield to go all the way through and sort of yield even to a superficial musculature, or those who yield until the disk but hit the constraint of the superficial musculature?

Okay, all right. So if we start at the knee, distal femur turns inward. Proximal tibia turns outwards. So there's a twist right there. And we're talking about a bony change.

You get a lot of lumbar spine motion and you don't capture the relative motion in the hip and the pelvis like we would. So quick review, make sure you get your foot contacts. We're going to be biased very, very heavy towards this left medial heel. Under most circumstances, remember your line of pull. We're going to be pulling more from right to left initially and then we're going to pull more back and to the left. Exhale in the exertion. If you're having trouble capturing the early representation on the left side, pause at the bottom of your pull, take an inhale, make sure you're capturing the expansion. Hopefully that helps a few of you people to separate the difference between your narrows and your wides in regards to your cable chops.

There's no point.

That is correct. So if you look at the cross-sectional shape of the thorax as the roll initiates, the left side goes flat and that actually makes the right side, if you're looking at it from ground level, slightly higher. That creates this downward gradient towards the left side that gets everything moving in that direction. It's very quick, but it does happen.

Okay, so like take test of an ultimate stab, standing still, and also like a rebound.

Yeah, let's go. Yeah.

Okay, so first and foremost, you have a relatively unchangeable constraint. Because the chances of them, if you tell somebody, 'Your internal body fat is so big that it's now interference, right? To make the changes that you want.' So to alleviate pain, you just need adaptability. If you got somebody that is internally rotated in the spine, so internal rotation would be like the anterior orientation of the pelvis, spine goes forward, people would describe that as an increased lordosis. That's IR. If you can actually take them farther into that IR and you create literally a window of adaptability—right direction or wrong direction—you actually may alleviate pain. Because all I need is change. Is it ideal? No. But you created a window of adaptability. So this happens a lot when people are trying to make a change. So let me give you a for instance. So somebody walks in, whatever presentation they might have on the table test or whatever. Somebody does an intervention and they gain internal rotations, but no external rotation. So that means you created more orientation somewhere. If I capture more internal rotation in a shoulder, but I don't capture the extra rotation that goes with it, all I did was teach the spine to turn a little bit farther than it did before. So internal rotation of the shoulders is spinal rotation away. So if I use your ability to turn your spine away, guess what? I gave you a bigger window of adaptability that actually may alleviate the symptom. Did I restore normal adaptability to where I can trust that you will have greater access to all relative motions? No. But I did make you feel better. Now we have an interesting game. You literally have a constraint that is interference. So now it's like, 'Okay, where can I create motion that will not make this scenario worse?' Give them a window of adaptability so they are at least comfortable. And then maybe with enough time, we can start to restore some of this relative motion that they truly need, right? Because that's what people do. So you ever have a patient with a herniated disc? A herniated disc is a connective tissue delay strategy to slow that side down. I created an expansion in the connective tissues, which is a yielding action just happened to be the disc because nothing else could yield to create the delay. So I had to use my spinal disc to do it. So that slows them down, right? That's a yielding action, just like I would want in a relative motion situation. It just happens to be an isolated one, and then it alters the structure, which can be risky. But that's how you get it. So people with an asymptomatic herniated disc, like the stuff just shows up on MRIs all the time.

Okay. So from a strategy standpoint, you have to create a delay on the right side. You actually have to create the expansion on the right side first. So that's going to be anything that's ground based. You can use arm bars. You can use cross connects. I would roll this guy. He's a good sized human being. Correct. Yeah, so he's a wide guy. And so when you see this degree of forward center of gravity, when you see this degree of compressive strategy where you're losing a ton of ER, a ton of IR, I roll these people quite a bit on their sides because the ground expands them anterior to posterior. It makes life really, really easy, especially when you're not like a manual therapist that typically can lay hands. It's a lot easier to do this stuff. Just roll them on their side. Right away, you're probably going to pick up some ER and IR because of the expansion that you're going to capture. Then it's going to be a lot easier to move them backwards. Then you can do, like I said, your armbar series. You can do cable chops in a staggered stance, things like that, things that unweight him. You want to think about that kind of a thing. What you don't want to do right away, would be like a side split squat or anything like that where the load is pulling him down. You want to think about unweighting him. So the cable activities tend to be a better choice under these circumstances because they reduce gravity rather than adding to it. And so then he won't be so overcoming. You'll capture the yielding actions a lot more easily under those circumstances. Then once you recapture that, you make your turn. And now you're in splits dance, probably going to be doing some form of front foot elevated kind of a thing, again, to create the delays. And then same thing, his thorax is the same orientation as his pelvis is. So heavy presses, heavy pulls, bilateral symmetrical activities, not going to be the best choice for him right now. doesn't mean you can't train. It just means you got to be really, really selective with your activities, making sure that you're capturing turns and not just orientation. So that space between his scaps, you know, you got to move that back too, just like you're doing with the pelvis. But thankfully, it's like as you're using the extremities in the, in like the cable activities, you're going to get some of that expansion. But you're probably going to be looking at, like, something like a high low cable press in a staggered stance, things like that, things that, like said, you got to turn them in a very small radius first. Okay. Another reason why I like the rolling because it is a very small radius turn, but we're getting the expansion with the floor. Does that help you at all?

Going back to your statement about anatomy and its limitations, what is your current understanding of internal dynamics when it comes to movement? Well, beyond the fact that it's been underappreciated, what is it, for people who have never maybe heard about the concept of internal dynamics, what it actually is?

High tech. OK. Hang on. What measures are looking at?

Hopefully that gives you a little perspective on what we're talking about regarding the performance-related foot and how it might relate to what we're measuring on the table or what we're seeing on the court or on the field. Yesterday we talked about the low arch performance foot. Apparently it's turning into foot week. We're going to talk about the higher arch representations. Remember, we have two positions of the foot where we see this higher arch. So in our early propulsive foot where the toes are in line with the first metatarsal, we have first contact with the first metatarsal medial heel. This is where we start to superimpose internal rotation on top of the external rotation field, so we have an externally rotated foot, but this is our first representation of IR. What we're going to see mostly in the hip is preservation of a straight leg raise, access to early hip flexion, and partial availability of internal rotation up into the hip. When we look at the later representation, where the heel is off the ground and we're moving back into ER but now we have extended toes under this circumstance, we're going to see all those measures start to drop off. We're going to lose straight leg raise, lose early hip flexion, and start to lose internal rotation. This is really important when we see this high arched foot because we have a couple of representations; we have to figure out where people are. If you'd like to ask me a question, go to askbillhartman@gmail.com. If you'd like a 15-minute consultation, make sure you put 15-minute consultation in the subject line, and we'll arrange that at our mutual convenience. We're going to cut away to a YouTube video where we talked about this high arch foot representation. We'll see compensatory strategies and strategies on how to deal with that. If you're interested in catching up on the videos, they're all up on YouTube. Don't forget to subscribe, and I'll see you guys tomorrow.

foot.

It is perfect. I hope everyone had a successful Memorial Day weekend and you celebrated appropriately and remembered the heroes as we should. Digging into today's Q&A. We had a busy week. We had to dig right into this. Had a great Q&A with Jen. Jen works with professional baseball pitchers. Big concern there is how do we manage relative motions in regards to force production. How much do we need to restore? This is a really important point that we made during the conversation: we have to look at these people as n equals one because while there are certain things that all pitchers have to do, they will achieve their outcomes very specifically to their idiosyncratic structure and ranges of motion. This was a big concept that we talked about. We also talked about key performance indicators and then how we look at the different ways that they do produce internal and external rotation. Again, it's very idiosyncratic. Great conversation with Jen. Thank you so much for your participation there. If you would like to participate in a 15 minute consultation, go to askbillhartman at gmail.com and put 15 minute consultation in the subject line so we don't delete it. We will arrange that at our mutual convenience. Don't forget to go to the YouTube page and subscribe there as well so you can go back and look at all of these videos that go way back a couple of years now. All right, so gotta run, busy Tuesday. You guys have a great day. I'll see you tomorrow. The clock has started, Jen. What is your question?

Yeah that's kind of the crux of my question was that like when do you say for example with anatomy and that's kind of where this was born from where okay I'm trying to formulate a question and then try to answer that question so obviously you've done you've gone through this process and when were you trying to figure out okay keeps running each time that I try to answer this question I will learn more and more and more. And it seems like there's not really any point where I say okay let me pull back because maybe my foundation is not there yet to kind of build and say oh my question isn't specific enough that it's broad and I'm building that. And so when you were kind of coming up with your model and you were posing these questions to yourself and answering when did you say okay let me even if it's like a book or maybe I'm gonna go to Google and try to get or when do I for my example when do I ask Bill and say is this the right one or is this the iteration that we're looking for or do I just keep kind of chipping away and answering that question answering that question because there's value in that. So I'm trying to figure out you know spending like you know 45 minutes to an hour you know on what question is that and what when you ran into that what did you do did you just keep going or you said Google and then kind of make a cut from there and kind of go you're still in the same path but maybe different trajectory.

Okay, so under most circumstances, what you're actually representing is the anterior orientation in the pelvis and in the thorax. But when you lay down, there's a tipping point where there's enough mass above this point where you're mostly tilted forward where everything will fall back. And so it creates this perception of the lower rib cage being positioned anteriorly. So people get confused. They say, 'I have a posterior orientation.' No, you don't. You have an anterior orientation. The constraint of the surface upon which you are lying is creating an upward force. And so then the shape of your thorax and pelvis actually change its orientation to whatever degree is allowed. Now, in some cases, there's so much compression that people don't tilt backwards on the table. And in some cases, they do. And so this is one of those things that skews measurement. So when I talk about the usefulness of iterations and then your checks and balances between your ERs and IRs, this is where a lot of people get confused because they say, 'Bill, my numbers don't match.' And I say, 'Yes, they do. You just have to account for the shape change that's associated with the constraints because it's no different than somebody actually having a true constraint change in a joint that creates a limitation in motion or an increase in range of motion.' I don't know, take a labrum tear in a shoulder. It will magnify a range of motion in one direction and take it away in another. That would be a representation of a constraint change that's internal that we do nothing about. But basically, that's what you've done. So that's the beauty, if you will, of the table tests is that it does create a constraint for us to make a comparison against, but you just have to know what the rules are in that regard. It's like in some cases people are going to reorient themselves relative to the table and in some cases they won't. And so again, if you understand that, then there's a tremendous amount of clarity and usefulness in your, if you're one of those people that do table tests, then they become very useful because there's checks and balances throughout that clarify what really is going on in regards to the shape of the individual.

Yeah.

So that's all this is is just a strategy. Okay. And then how tall are you? I'm 62. Okay. So you're taller than me. So it stands to reason that my strategy and your strategy would be somewhat different just because of our physical structure, correct?

The way down. We have to be really specific where the extra load is.

What would that do?

But you have to recognize the fact that they are biased just like everyone else is, assuming they're human. Right, because we're all biased, whether you like it or not. It's one of those things that I constantly had to battle because I have a very, very strong perspective on certain things that can be interference with myself. I can slow myself down because I'm not willing to give up something because I get emotionally attached to ideas just like everybody else does. But at least I have the recognition that I get emotionally attached like everybody else does. And so always having that awareness as you go through this process. And so again, so there's going to be a point in time where somebody that's providing you some sort of value is going to be so important to you. And then they're not. And that's okay. It doesn't mean you're a bad person. It doesn't mean that you're allowed to disagree as well, because if you gain some measure of experience that person doesn't have, guess what? You now have another filter that they don't have available to them. And so maybe they, maybe at that point, they're holding you back.

Let's make ER and IR a simple representation. IR is movement downward into the ground. The reason you move downward is to hold yourself up; you have to push against the ground to stay upright. If I stand on your shoulders, you have to push harder into the ground to hold yourself up because I'm trying to shove you down. That's IR. ER is an expansive strategy that moves you away from the ground, right? It holds you up but reduces your density. If I blow you up like a balloon, you're expanding, moving everything away from each other, which reduces density and reduces how gravity impacts you. So I have a compressive force and an expansive capability. I can't have this outside; there's nothing outside of you that can push you in. I have to create that within the framework, whatever that barrier is—whether it's your skin or your electromagnetic field, whatever we want to talk about. I have to produce force within that because I can't do it outside of me. The forces I produce are inside. That's my internal rotation capability—my pressure downward. I must do that within this framework, however we want to define it. For now, let's say it's within the framework of your body. I have to produce the force within that because I can't do it outside. There's nothing outside of me that I can do it with. That's why internal rotation always stays within external rotation. But if I squeeze you down, I make your space smaller, and if I can't produce anything outside of me, I've narrowed the field within which you can produce internal rotation. It doesn't mean you don't have a strategy to produce force into the ground; it means the more compressed you become, the less relative motions you have available to do this. This is why we see strategies like an anterior orientation of the pelvis that allows continued force into the ground, but that's not relative motion within the pelvis. It's not internal rotation of the ilium producing that position. I've locked everything in due to compressive strategies; progressively, I lose relative motion between segments, and everything starts to behave as one. That doesn't mean I can't push down; it means the way I push down is by putting things together. Say I start with 25 individual segments; through compression, I now have 12. Compress more, and I have eight. So I only have eight places to capture relative motion to create the orientation that allows me to push down into the ground. That's how internal rotation always stays within external rotation.

Yeah, so what do you play? What kind of music?