What is really the carpal tunnel? That's the problem. So what they do is they go in, it's a five-minute surgery. They slice your hand up and they can do this in the ER. I got a buddy that does them all the time. They slice through the carpal ligament. They release the pressure. Everybody's all happy for a little while, even though they might still be symptomatic. But now we have to think about where this nerve actually goes through the arm. It behooves you to understand the pathways because the median nerve has a really cool pathway that actually slides right in between two heads of the same muscle, so to speak. It's not the same muscle; it's two muscles, but they call it one. Your pronator teres has two pieces to it, and the median nerve goes right in between them. So if you have an orientation at the elbow that creates concentric or eccentric orientation to where there's tension on the tissue that would compress the nerve, that nerve no longer slides through the arm like a sleeve. Nerves like three things: movement, blood flow, and space. And I just took away all of those. So now I've got an angry little median nerve, but the symptoms show up down here. But that's what can happen. If you think about your flossing, what you want to look at is following the pathway of the nerve. The associated musculature will restrict its movement. The flossing activities can be beneficial because the nerve has to move, but if you've got concentric orientation that is interfering, if you alleviate that, in many cases, no flossing is required. You use your neurodynamic tests that they teach you in school. I hope they taught you how to do those. For lower extremity? They didn't teach you upper extremity? Not yet. Okay. So you use your neurodynamic tests as confirmation. The thing you want to recognize is that the neurodynamic tests are also demonstrative of the excursion. They may not be symptomatic. For example, if you do a straight leg raise with the medial plantar nerve bias—dorsiflexed and everted through the foot as you do the test—you may find that the excursion of the straight leg raise is less in that position, but it doesn't hurt and it doesn't give symptoms. If you take away the tension—take away the bias—and do the straight leg raise, you get 15 more degrees of excursion. That's a positive test to let you know that you have a limitation associated with the concentric orientation of the musculature that's influencing that nerve excursion. Do you understand?

Yeah, the opposite.

They would either bow their knees out or in the case of a narrow stand squat, I see more like lower back rounding. Like if I try to do a narrow stand squat.

And I think you mentioned about something that the motion and time stops at the middle side because that's where you're putting the weight through.

If we're hoping to create more gentle breathing, like nasal breathing, like exhalation strategy, how do you personally cue that? That's my first question.

Under load, time is slower because it's more of an IR representation. So if I'm trying to maximize range of motion, a loaded activity is less likely to produce it than an unloaded activity. Right. And so that's one of those considerations that I need to always take into mind as I'm doing my program. It's like, what is my goal here? It's like, if I'm trying to avoid stealing all of the range of motion, then that's my dead center middle kind of activity. So these are bilateral symmetrical heavy load stuff. And then out here is your body weight or less than body weight by reducing the influence of gravity out here. Does that make sense?

Okay. So if you had to say that, let's get two pitchers in mind. Okay. And you can see them both, one standing on the right, one standing on the left. The guy on the left, does he need more ER than the other guy or less?

Yeah, you gotta pull it back. It's still too far forward. That's what you're bumping into.

And so under those circumstances, you unkink them and they store energy and then they want to respond by returning to their previous structure. So, you know, rubber bands are a good representation, and we can use that. But when we talk about the why, okay, so connective tissues are surrounded by and imbibed with waters, right? So, you know, collagen fibers are just surrounded by. And so when you pull on a connective tissue very, very quickly, there's not enough time for the water to escape. So that's why the tissue behaves very stiffly. So water's incompressible, you squeeze it, and it doesn't move. But if I do it over a long period of time, there's plenty of time for the water to get squeezed out. That's why we see the two differences in behavior, especially with rate dependent behaviors. Right. Now you have to say it's like, okay, well what context am I asking for this yield to occur? Is it very, very quick? Or is it something that I can do under a circumstance where I can apply a load over a longer period of time?

They're just side lying. If I'm laying on my left side, I hold my arm out to the side to stay propped up and turn into and away a little bit at a time.

So everything goes in the same direction at the same time, right?

So let's build this out as far as expectations go. Under any normal circumstance, if I have a mutated representation of the sacrum, I have an ilial representation that's going to follow. So the ilium is going to be IR. That brings the anomaly into IR. And that changes the orientation of the acetabulum. So the acetabulum is going to move up and forward. So that's the inverted representation of the acetabulum. So my expectation there is, I'm going to pick up some internal rotation capabilities of the hip and I'm going to lose some ER representation. So right away I have this foundational representation of what I should expect structurally as far as their bias is concerned. And remember it's always a bias because both ERs and IRs are always there. It's just how are they producing them? If I have somebody that, and again, you'll never see this guy. I'm using it as a representation. If I have a wide ISA individual that has full breathing excursion, I might see a bias towards a little bit more intro orientation and a little less extra orientation, but he's still going to have some pretty decent movement capabilities where you're going to approach like the total motion representation is probably going to be about average. And so again, it's like, you got to consider that guy. Like I said, we never get to see him because we don't see those people that have full movement capabilities, because when they do, they tend to feel pretty good. But at least you can start to create the bias. And so then this is going to translate up into the axial skeleton and down into the feet, because it has to, because I've got these iterative aspects to anatomy. So the upper thorax and the pelvis tend to behave the same. The foot is going to be oriented in a certain way based on center of gravity. And so I have a center of gravity shift that's associated with the mutation, right? So that's gonna grab my center of gravity forward. So I should expect to see the arch moving down towards the ground as they're translating the tibia forward over the foot. Again, it's like these nice little representations. Now, there's a lot of other strategies that can be superimposed on that, but at least we have this foundational representation from which we can start to work. And we say, okay, this guy started in middle propulsion. So he's like literally right over his feet. And then I shifted to the center of gravity forward, what should my expectations be under those circumstances? And then that's where you start to see the changes in the average range of motions start to disappear. When I start to get superficial stuff laid on top of this, we're gonna start to lose more and more ranges of motion because we've taken away turns that we need to create these ranges of motion.

Morning. I already finished it, yes. So my question is about the hip joint. And it goes a little bit in the direction of Manuel's question, regards to reading stuff and implementing that information. So I read an article about CT imaging of the femoral neck angle and the torsion angle. And I watched your video about the magnified internal rotation measurement on the table from the hip joint. And I've had one patient who presented like that, like with more than 60 degrees of internal rotation, both sides. And I was wondering how much do these anthropometrics, like the differences between individuals in hip architecture, let's call it like that, influence my table tests and maybe is there a way to differentiate between those factors and the orientation factors that I'm looking for. Or is it even necessary to consider that because the actual underlying principles don't really change because I'm looking for improving relative motion and improving orientations. So I was wondering, is this information in the article Something that is valuable for myself as a clinician.

Yep.

Yeah. Do I have any more time?

I think we'll just table it right there. It's a good time to cut it off.

Yeah. You know, I don't want you to stick with your rules, stick with your compression and expansion rules, right? Use your key KPIs to guide you, right? Teach her how to understand this, right? And that way she doesn't feel unusual when you don't want her to feel unusual. Because everybody else is doing this activity, she's going to have to modify it to this degree. And technically speaking, you can do that with any group of athletes that you work with.

Yes. So to really, really simplify this, you're absolutely correct that at the moment where someone has to hold their breath, you have somebody that is trying to reduce the degrees of freedom of movement. Degrees of freedom would be all of the options available. So let's say you have 244 degrees of freedom. There's more than that, but we won't talk about those. But let's just say there's 244. So I have 244 possible movement segments that are available to me to use for movement. However, the higher the force production that I need to utilize, the more I want to restrict those. It stands to reason because if I have this total freedom of movement, all I'm going to do is I'm going to dampen the forces throughout the system, which is useful. But again, if I'm trying to produce force, I'm trying to be fast or whatever, I need to move segments together so I don't dissipate the force. So I can actually store and release that energy in the system rather than dampening it. So if I squeeze myself really, really tight to limit segmental movement, it stands reason I have to hold my breath to do that, because I can't really breathe in. If I'm squeezing, that's higher internal pressures, which would make me exhale. However, I close off the air flow, right? And then I hold my breath and I squeeze against that. Now I'm a very, very stable structure and now I can produce very, very high forces. The thing that you have to understand is that those forces are relative to the individual. So if I have a 40-year-old accountant that has never played a sport in their life and I'm asking them to perform something physical, what they may find is that they have to hold their breath just to sit down onto a box. Whereas I have a very high-level athlete that is highly trained and has demonstrated high levels of force production in the gym; their strategy may be a whole lot easier to sit down onto that same box because the relative force applied is much, much lower for them than it is for our 40-year-old accountant that's never played a sport before. So all of those things are relative, but you're absolutely right. Like one of the easiest ways to tell when somebody is trying to limit motion is that they'll hold their breath. And then one of the other cool things that you have to recognize is that it's typically going to occur at a similar time regardless of the individual. So at the peak element of force production is typically where you're going to have to limit segmental motion. So this would be at maximum propulsion. So if I'm just walking across the ground, there is a moment in time where the foot that's on the ground is applying its maximum force for that circumstance, for that context. It's not the maximum force that they can apply, just the maximum force in that circumstance. Right? And so that is a compressive strategy. So I move towards that. So if I'm at the two ends of gate, right? So I'm stepping forward over this foot and I'm about ready to leave this foot. So that's the extreme. As I move my center of gravity over the one and they get closer and closer to being in the middle, that middle propulsive strategy, which is internal rotation, which is high force into the ground. So I'm out here, my force into the ground is less, and it gets more, and more, and more, and more, and more, and more. Then it's max, and then it's less, and then it's less, and then it's less, and then it's less, and then it's less. So at this point, at the transition where I am applying the greatest force into the ground, that's where I'm going to restrict the greatest amount of relative motion. That's where I'm most likely to reduce my ability to breathe under those circumstances. And it's going to be context dependent. But that's basically how it works. Every movement that you perform has that built in because at some point in time, assuming I'm influencing the ground and the ground is influencing me, so I have my equal and opposite forces. Under those circumstances, I'm always going to have a point of maximum propulsion. And this includes, if I'm just rolling across the ground, there is a point where I'm putting maximum force into the ground. If I'm walking across the ground, there's a point where I'm putting the maximum force for that context on the ground. If I'm doing a split squat, it's the same thing. If I'm doing a squat, it's the same thing. If I'm jumping off the ground, it's the same thing. If I'm landing on the ground, it's the same thing. There has to be a point where I'm applying that force, right? The question is, am I capable of releasing that strategy when I need to, or am I carrying it around all the time because the relative load for me, as an individual, is always very, very high? So these are the people that are walking around with compressive strategies that become interference. And under many of those circumstances, these are the people that experience discomfort because they're not changeable enough. Okay? Let me give you another extreme. We can always use power lifters because they are representative of the greatest force producers of all time, right? Like they lift the heaviest things that anybody's strong men, power lifters kind of in the same way. To create that degree of adaptation to allow them to produce those forces, they have to be able to maintain those all the time. So their adaptations become so strong that they give up resources. They have to shift all of their resources in one direction. And again, we would see this under any circumstance where somebody has taken something to the nth degree where they are super specialized under certain circumstances. And we're talking about physical, but this could be applied to cognitive as well. And so their adaptability becomes limited, but because their adaptability is limited, they demonstrate superpowers because of it. And so again, we just have to appreciate that. When we're talking about like general population clients who we want to make sure that we're influencing health in a favorable way, we want to make sure that they're able to apply the compressive strategies when we want them to and then able to reduce them when we want to.

Do you remember when you were applying to school and you had to get all your prereqs done and they said, we need you to take two semesters of physics? I never told you why. This is why. This is so you understand why it works this way. But now the important thing to understand is, okay, so now I'm a human and I have these physical constraints, right? I have a structure, I have behavior, like there's fluid mechanics, there's compressed expansion, there is behavior of tissues, et cetera, right? That all have to follow the same rules because they're fixed, right? You know, Newton kind of figured out most of this stuff, at least on a useful level, right? Some of the stuff he's wrong about, but on a useful level, on an observational level, he's right. So we just have to say, okay, well, if I'm a human being, how do I do this? If I was a worm, how do I do this? And so now you go to school, like your specialized school, and they say, well, here's how these tissues behave in a world that follows these governing laws. If hopefully they did that. I mean, sometimes they do, sometimes they don't. But it's not just to make sure that you're smart enough to get into school. What it was for was to teach you how this behavior applies within a human in this world, in the space around you. This is why I talk the way I do. Because literally, if you can conceptualize this stuff, it provides answers to how you do things to enhance some form of behavior. So if I need a baseball pitcher to throw a baseball faster, I identify what his capabilities are. And I say, well, if you want to do this faster, you're going to have to be able to do this. And then there's going to be limits. Some people's tissue behavior do not allow them to throw 100 miles an hour. Some people's movement capabilities do not allow them to throw 100 miles an hour. Some people's force production does not allow them to throw 100 miles per hour. That's why that's a very specialized group of humans. Their physical structure predetermined that. I mean, God smiled upon them and they turned their arm into a thunderbolt as the saying goes, right? If you watch the movie, you would understand that. Okay.

So again, you have to have that representation, but I really need to move to the next call. If you have any questions, just let me know. We can still move our center of mass in a very compressed state, but understand that you're going to do it with a lot less relative motion.

Okay.

So this still relates to our discussion, and if you couldn't tell by now, I work with powerlifters, so I like to see how your model fits into the people I work with, and it's been really useful. There's this whole discussion about whether the scapulae should or shouldn't move during the bench press, especially during max effort attempts. I think this relates to our discussion because I'm always thinking about where external rotation is occurring, because it has to occur somewhere for the bar to move. When I consider this really arched position, I'm not getting expansion in the lower posterior, upper posterior, or anterior areas when I'm on the rack. So, visually, where can expansion occur other than the lower most rib cage anteriorly, since those are usually flared up and out? It's like, how do we even generate movement if that's really the case, when the expansion seems so far from where the movement is actually occurring?

Yes, yes.

Let's talk about running really fast. Good morning. Happy Wednesday. I have neuro coffee in hand and it is perfect. It's Wednesday, and that means that tomorrow morning at 6 a.m., we have the Coffee and Coaches Conference Call. As usual, the link to that call will be on my professional Facebook page just prior to the call, so I hope you join us. I received some direct messages from a couple of people who will be joining us for the first time, so this will be fun and exciting. Like I said, it's a great group of people with great questions, and I really enjoy these calls. We'll keep doing them as long as other people enjoy them as well. Time is always short on Wednesday mornings, so we have to dig right into today's Q&A. This is with Thomas, and we got to talk about some fun things regarding running really fast and sprint mechanics, which I don't get to talk about very much. We discussed yielding and overcoming actions present in running and how they're applied, along with how much internal rotation (IR) and external rotation (ER) relationships we need to demonstrate. Then we extended that discussion from running into the training hall for some split-squat work, which was again really fun. I had a great time with this call; we went a little long. It was one of those last calls of the day when I was really enjoying the conversation. I hope you guys enjoy this as well. If you have any questions and would like to participate in a 15-minute consultation, go to askbillhartmanedgmail.com. Don't forget to put '15 minute consultation' in the subject line so I don't delete it. I'll see you guys on the coffee and coaches conference call tomorrow morning at 6 a.m.

I'm wondering if you worked hard enough around that, would you expect that to change at all? Or is that kind of cemented in now.

Okay.

She's wide and she has a bit of concavity. I see what you're saying. And the biggest thing is that she can get to shoulder flexion, but we can't. It seems as though she would have full shoulder flexion, but we can't get to where we can load shoulder flexion without pecs taking over all the motion and biceps.

So is an overhead press the same as reaching overhead?

So yeah, so it's not a bigger parachute. It's just where, where is it?

So some of those are going to involve yanking and pulling exercises and some of those are going to involve force production or strength, and then some of them are associated with respiration and things like that. What you're going to have to do is resolve that and you need a guide—a mentor—because there isn't a book that will solve your problems. You need someone with experience who can offer insights rather than relying solely on book learning. While foundational principles from texts can be useful, their application is experiential. For example, Mike Campurini, my former student, had all this book learning from school, but when we put him in the 'purple room' where he became very uncomfortable for a long time, he understood the value of that miserable failure in grasping how this actually works. If you read something in a book or follow someone's principles—like Yanda's—you might have some success, but that model has limitations. Then you move to the next model, superimpose it on top, and that one has limitations too. You need someone who can help you move beyond the isolated structure of a model and see this as one integrated system. No book can do that for you.