Mm hmm.

With the complexity of the questions popping up, I'm going to take it back to simple. I want to ask about the knee, valgus and various presentations.

So according to what you said, as a physio and coach who is immersed in your own technical craft, how do you take the financial decisions in your life? How do you manage finance? What are your financial philosophies in life?

Okay.

Oh, I see what you're saying.

Okay. I was wondering if I could just go through what my interpretation was and you could maybe guide me and see if I was on the right track.

Right.

Very, very mild. I wouldn't necessarily call it a recurrence, but it was a signal like, hey, it's something's going on. Okay, let's start. We also had a UTC scan done.

Well, so sometimes what I'll do is I'll start on the right sideline. That's kind of like my default if they can't get something done. And then maybe I'll bring them to the left or I'll just like try a different position again. I have to earn and see if it was any easier.

Yeah, because it doesn't keep the knee flex.

Yes.

Yes.

We need to bring this side of the pelvis up and then we want to orient it in the opposite direction so we can start to pick up some true internal rotation. So one of the easier ways to do this is to elevate the front foot. So the picture that we're going to use here is we're going to show a front foot elevated split squat. You're absolutely correct. We want to put that pressure on the first metatarsal head initially because what we have here is an external rotation deficit representation with the first superimposition of internal rotation on top of that. So that first metatarsal head becomes very, very important. It's also going to keep us pushing back and to the left, as you said. We want to keep pressure against the right side of the sacrum to keep it forward, because as we descend, the sacrum is going to square to the front in our nutated internal rotation representation. Now the thing that we want to recognize though is as we descend we're going to move that pressure back towards the heel because what we don't want to do is we don't want to elevate the heel because that's going to move us in towards a late representation which is an externally rotated position with a reduction in internal rotation. So if we're trying to maximize our internal rotation at the bottom of the split squat we want to make sure that that center of gravity is staying back over the heel but we want the tibia to translate forward as far as we can with that heavy heel. That's what's going to give us the maximum representation of internal rotation at the bottom of the split squat. Another point that I want to make is to stop the descent of the split squat as the tibia reaches its maximum translation forward. If you exceed that depth, what's going to happen is you're going to shift a yielding action up into the lumbar spine, which is going to try to turn it in the opposite direction. So it's going to try to turn the spine to the right. We want to make sure that everything stays oriented to the left, so we can keep pushing back on that left oblique throughout the activity.

Because everything is locked in. So you're not getting any relative motion.

Okay. So in the past, you talked about how sometimes if you want to roll somebody to the left, first you need to teach them how to do like the overcoming strategy on the left side. That creates the shape.

Yeah, what you're trying to figure out is like, okay, if I take away, if I take away the yield, how much force does he produce? If I give him the yield, how much force does he produce? So is he elastic so he can store and release a lot of energy? So his counter movement jump is really, really high, but you have him hold for a count of four or five before he jump and it's not very high. Okay. Then you know he's very efficient with his connective tissues and you need to focus on magnitude.

So it's just starting off with a wide infraternal angle and an exhaled axial skeleton with bias toward reductions in flexion, abduction, and external rotation across the limbs. Regarding the pelvis, we've got a restriction in internal rotation as well. I think I understand that the common compensation is a concentric orientation of the posterior lower musculature at the pelvis. That's how I understand that.

I mean with a yeah I'm not sure if it was truly symptomatic yet but

Yeah.

Okay, so you're a big bag of water. Let's just make it really, really simple. You're a big bag of water. If you've ever used one of those big water bags in the gym, all you have to do is swing one around. That's happening inside of you all the time. The force that is produced has to be accounted for because number one, it allows us to do amazing things, like walk on two legs, throw a baseball at 95 miles an hour, jump really, really high. Those internal dynamics contribute to our ability to perform. They are also detrimental to performance. If we can understand a little more about how those internal forces interact with our ability to manage them in an environment based on gravity, space, and the external forces we have to manage, if we can understand that we have stuff going on the inside and stuff going on the outside, it provides us a better representation of reality. Again, we can't see it, but we can get close to it, right? It allows us to make better decisions in regard to our interaction. So it'll get us away from things that appear to be entirely superficial. When you see somebody like a volleyball player doing a box jump, they jump off a box and land in a certain way. Some people go, oh, she has weak something. When we see something happen, when you see somebody's knees moving down and inward as they land a jump, they say, oh, she has a weak something. It's like, well, actually, when you hit the ground like that, your guts come second. Your body falls first, your guts follow, right? Because they float, right? So when you hit, there's another hit that's coming. If you don't manage that, you have to be able to capture that force as well. So it's where people use these strong versus weak representations. If we can understand that we have management of internal forces that are beneficial or detrimental depending on our perspective and what we're observing in context, if we can learn how to manage those more effectively, again, our decision-making process is much more accurate and then much more useful.

So go there. Don't forget to subscribe and I will see you guys tomorrow. And then I had a great mentorship call almost immediately after that, and that's where today's Q&A questions is gonna come from because it was a really neat, really neat presentation a little bit off the beaten path and initially a little bit confusing as to what my mentee was really looking at, and then it just, it becomes clear once you sort of put the pieces together. So we're gonna use that, like I said, to drive to today's Q&A. So let me give you this scenario. The confusing presentation was that the client that he was working with had a limited straight leg raise, limited hip flexion, limited hip IR, but a really high arch in the foot, which again, that looks like a combination of a very late propulsive strategy in the pelvis and the hip, but an early propulsive foot. And so again, there's a little bit of confusion there, but if we break this down, there was one telling representation in the foot that sort of gives it away as to what's really going on. First and foremost, let's talk a little bit about airplane wing physics because if we can understand a little bit about an airplane wing, so bear with me here, if we understand a little bit about an airplane wing, we're gonna understand a little bit more about an arch. So that the way that an airplane wing works is as the air passes over the airplane wing, it creates a low pressure above the wing and a high pressure below the wing and that's what creates a lift. If we look at the arch of the foot we're going to see a very similar representation here. So if I look at my early propulsive foot, I have an arch. And so what I actually have is I have a lot of concentric orientation underneath the foot in this early propulsive strategy. So this is a concentric yielding strategy on the bottom of the foot, which means that I have this eccentric strategy on top. So eccentric is high volume, low pressure. Underneath we have concentric orientation, which is low volume, high pressure. So this is literally just like an airplane wing. And so again, low pressure on top, high pressure on the bottom. And that's what's gonna help me maintain that arch as I move through the three rockers so so I have my early propulsive phase which is my my heel rocker and then my ankle rocker so to have a normal ankle rocker what I have to be able to do is I have to be able to flip flop the pressures so I have to be able to create the eccentric orientation on the bottom so the low pressure strategy here and the high pressure on top and so if I can't create the transition in pressures, I can't translate the ankle over the foot. And so it looks like I might be stuck here.

And they actually measured this. And there's actually this tiny little face, and I've been talking about this for a while and I call it maximum propulsion, which is where the release of the force actually takes place. It's when the heel actually breaks from the ground. So we're thinking about sprinting, or if you think about footwork associated with combat is moving around. Yeah. So, so, so the heel doesn't actually have to touch the ground. It's actually just the position of the release of force. But if I come from a position where my foot is grounded, it's going to be when the heel immediately breaks from the ground. So you're going to go through this middle propulsive phase. So if I was going to deliver a strike of any kind, where I have to take force from the ground, I'm going to be pushing through the medial heel. I'm going to be pushing through that first, the first metatarsal head. So right behind the big toe. and there's the heel breaks from the ground. maximum release of energy.

Great. So yeah, my question comes to, you know, when it comes to performance and generating force, How do you determine when restoring some level of relative motion is beneficial versus not? Does it depend on the sport, right? Like a powerlifter versus, you know, baseball athlete. Does it depend on the individual? Obviously KPI. And maybe to give you a little more context, I work primarily with pitchers. And so this one particular pitcher, he's in the major leagues, quite efficient at what he does. He serves 98, but not considered a good mover from a traditional sense. He appears to be at end game, straight-legged at 40 degrees bilaterally, hip flexion at 80, hip IR 5, and if I'm being generous bilaterally, hip ER at about 40. In the past, he's dealt with some low back tightness, no kidding, bicycle tendinopathy. I'm wondering if I'm right here in my thinking, like he's clearly minimized these relative motions to be able to generate a lot of force, but by doing so, has created a great deal of focal loads at these tissues. It also doesn't seem very efficient in that he's a very linear in his delivery versus rotational.

Well, let's go back to the beginning of this portion of the question: did you ask the right question? So number one, you accumulate information, you try to capture an understanding, and then you apply. This is one of the mistakes that people make is they think that the answer is strictly in the information. Because people say, where can I get a book on understanding more about compression expenses? Well, hey, first understand what it really means. Then you got to go to anatomy and you got to say, well, what are the constraints, et cetera. Then you got to either go into the gym or you go into the clinic or whatever your environment is, and you start to apply it because that's where the true question is going to be answered because that's real life. Now you have a situation where the things that cannot be expressed in a textbook or on a video or in a blog or whatever it is—that's the experiential element that is essential, especially for what we do when you're interacting with other humans because it's unpredictable, it's complex, and you don't know what the answers are going to be. What the experience then does is as you apply and you go, oh, that didn't work. And the information that I've accumulated says that it's a possibility, but now I know what the other possibilities are. This is what we call the tacit knowledge. So this is the stuff, if you've ever tried to explain something to someone that you feel like you've got a terrific grasp on it, but the words just don't make any sense when they come out of your mouth—that's the tacit. That's like, I have this understanding; I want to show you where I want to teach you. But the only way that you can do this is to actually execute it. You could talk about, you could explain what a back squat is to someone in great detail. And then they have to go try to execute it off of that. And it's a totally different world once you're under the bar, right? That's the things that you could not express. You couldn't say, here's what it feels like to have the bar on your back. Here's where your foot position is. And then as you descend, you're going to do this. You're going to do that. It's like, you can't tell anybody that. You have to experience that. But what the experience does—those are your safe-to-fail experiments. This is where you actually test your knowledge and test your understanding. And then you see what the possibilities are. And in many cases, this helps you formulate a better question. And now you can start the process all over. So it's just this continuous loop of question, test, outcome, based on this, what is the next step? So you're always, hopefully, always refining and evolving.

Okay. So on your point of like somebody might be so compressed that they don't tip posturally, but somebody could also be compressed, but they will tip posturally.

Okay, so as long as you're clear on that because essentially what it is, it's the position just doesn't allow that area to expand as you breathe in. So we get an anterior expansion on that inhalation or actually in the exhaled compensatory strategy that starts this whole process of the narrow ISAs behaviors from that point forward is that anterior aspect is where that expansion persists. So even on the exhale, they still have the anterior expansion.

62.

So let's say for a squat. Let's use a squat as an example. Absolutely. That would be like the place where it would be most commonly represented, I would think. Okay. Let's make a comparison between two barbell lifts first as a representation. So let's say that you've got 100 kilograms on the bar for a squat, and then you've got 200 kilograms on the bar for a squat. One will behave in a stiffer manner. The connective tissues will behave in a stiffer manner. So the magnitude of load. So I've increased the load by 100 kilograms, which means that number one, as I descend in the squat, the tissues will be stiffer. And number two, even though as I lower the weight down, I'm using fewer motor units than I would to lift it, okay? So my motor units have to drop off or I can't move, right? I am putting greater load, so I'm recruiting more muscle in the descent with the heavier barbell than I am with the lighter barbell, correct?

So like if I'm pushing into the band, so okay, so let's take it back to the first ten yards in a sprint. So you're accelerating, your ground contact time is longer compared to top speed. But if I'm moving into greater resistance, I'm getting pushed into the ground longer when I actually want my ground contact time to get shorter. So I'm actually training myself to produce a longer duration of force when I need to teach them to produce a shorter duration of force. And so, again, I'm just not a big fan. Like I said, like a first step, maybe not too bad. The more you get into it, again, where you see decreasing ground contact time, not a big fan. When you think about certain activities where, like, the highest force production in a loaded squat of some sort is through that middle range plus or minus the sticking point. That's where you would produce the highest amount of force. If you're only using elastic resistance, then the highest resistance is at the top when I'm standing up. So again, it's like, is it useless? No, is it best? No, right? There's some resistance there, but it's not where you would want them to be. So if I'm trying to enhance their ability to produce force at that end range, then by all means we're okay because we've got an increasing requirement of force production to deform the elastic element, right? So again, it's like, where are you applying this? How can we use this to our advantage? Okay, so if we're talking about, and you know, I like to talk about box squats and banded squats and things like that. If the highest force production is at the top of the squat, I can take advantage of that because if I lower myself onto a box very quickly from a position where the force is actually higher at that initial position, I can accelerate myself towards the box, which provides me any number of advantages. So I can get the body to descend faster than the internal organs would be applied by just my internal organs. So they actually float. So if I can go faster than the guts fall, I get my body down onto the box, I create the yielding action there, and then the guts follow down, and now I get this trampolining kind of effect. So I'm actually creating something that's very, very similar to the yield and overcome action of what people would classify as plyometrics. So under those circumstances, I'm actually going to enhance my ability to spring back off the box because if you can picture the pelvic outlet like a trampoline, right? So I come down, I set the trampoline down on the box, the guts come down right after the body does, I get this nice little recoil and it throws me back up on the box.

One of the most valuable things is that you've talked about as kind of the principles as the filtering system. And so I work with someone who has a lot more experience than me a couple of days a week and they have a totally different perspective. But using that filtering system, I'm able to see the value and even how it fits within my model and how, oh yeah, they're saying essentially the same thing, they may be saying it a little bit differently, but the principle is the same. And so that's been really valuable to be able to kind of facilitate my thinking, my thought process and clinical judgment.