I have to hang on to my right heel. I push into the constraint of the first met head on the right. And then that stops me from going too far forward, which is what would happen if I allowed the center of gravity to go forward on the right as they would commonly do. You understand?

Where?

Yeah, that makes sense. I'm just trying to put in the picture of which activities and when.

Well, help what? What are you trying to do with a heel lift, boss? Are you trying to get the heel closer to the ischial tuberosity?

Yes.

Okay.

It's Christmas jingles. I'm in Korea right now, in Seoul, and they are really embracing the Christmas vibe here. It's okay, though my ears hurt a little. I'm trying to walk away from it, but there are lights everywhere here, so I'm photobombing a lot of selfies as I do this. But it's fine. Um, so I actually had a squat question as well. Sometimes I'll get complaints from an athlete that there's not much difference between their front and back squat. Normally, your back squat should be a little stronger than your front squat. With some of these athletes, there's very little difference, if any at all. So I'm wondering, is it because they tend to have narrow stances as well? Is this a case where they're so compressed that they're producing downward force without getting any gradient between the two squats, making them end up being the same?

That makes sense. Thank you.

Yes. You can also use visual representations. If you've ever done a dynamic effort box squat, you can perform box squats for time. For example, measure how long it takes to complete three reps of a dynamic effort box squat and monitor that time for drop-off. Consider this: how long does it take to throw a pitch?

Probably not.

Okay. So if I push like that, and if I could keep pushing, it would do this.

Right, okay, right, man.

Yeah.

Cause they don't have any space to translate anymore. The other one does.

Of course.

So you just have to think about a sequence of events that's going to be helpful to you. Harder to do, harder to do, but not impossible at all. And there are different ways that you can secure the bands. Like we do it all the time with our coaches that don't do manual therapy. They use the bands for mobilizations all the time. All right, you just teach them to secure it. And then you run them through the exercise. We did that at the intensive when you were there, right? Yeah. Yeah. So again, you just use those banded mobilizations, right?

I have a two-part question regarding a girl I saw last week. I believe both parts are brief. The quick history is that she's about a year and several months post-ACL. I'm seeing her for the first time. She completed her rehab at a different school and transferred here this year. She suffered a right-side ACL injury while playing softball last spring. Throughout her rehab, she experienced deep central knee pain, described as discomfort deep inside the joint. She was able to pass all return-to-sport testing but felt poorly. After the season, she returned to the doctor for re-imaging. The MRI showed significant scar tissue, and the X-ray revealed a screw slightly protruding through the joint line. They ultimately performed a second surgery to remove the scar tissue, but the surgeon decided not to touch the screw, which remains in place. I'm seeing her for the first time a month after that procedure. My first question is about testing her range of motion. I'm seeing early deflection with tightness across the front, and she experiences the same deep knee pain post-test with lateral tightness and pinching. I started with late tibial internal rotation, which provided no relief. Then I tried early tibial internal rotation, which eliminated all discomfort in combination with some patellar mobilizations. My first question is whether the decision-making for early versus late tibial internal rotation is literally as simple as choosing the position that reproduces symptoms or restriction—supine versus prone.

Yeah. It's just, I noticed that compared to just say like a narrow, like a more funnel kind of type with the pylons, they, yeah, the head position is more important because they tend to get really shruggy or just they really want to push down even when you're inverting or inside line compared to the narrow narrow.

Okay. Left one spine as he comes out. Um, so just like throwing him on the table had like a massive ER orientation. And you go. On the right side. Um, and then like a, the same twist at the knee. Yep. So just really quick, basically just like laid on his pelvis and then manually untwisted the knee being gone. Hip pain greatly reduced to the point that he felt like he could practice.

Okay.

Yeah.

What's wrong with that? Is that science? Yeah, that's what we call science. It's like you hypothesize. So you're going to take as much information as you have available to you, and you're going to formulate a profile for this individual. And you're going to say, I think that this is going to be the influence. And sometimes you're going to be right, and sometimes you're going to be wrong. But you ran the experiment, and then that's what guides your process. And then you know what? When we have this conversation 25 years from now, when I'm sitting in the old folks home and you're helping me move around with the tennis balls on the end of my walker, you know? And you say, hey, remember that coffee call where we were talking about running the experiment and actually figuring stuff out as you go instead of knowing ahead of time what's gonna happen? It's like, yeah, that was really good. No, you just have to run the experiment.

What kind of an activity are we doing?

Okay.

No, but she's got a meniscus tear on the left side that she's about to get surgery on. No real, like, And she's just athlete her whole life, but no real injury history that she offered up.

Okay. Let's just say you are walking. You put your foot down, you land in an early propulsive representation. Okay. Does that side that you just put on the ground—if I want to step forward with the other leg—does that side have to slow down? Yes. Awesome. How do you, how do you do that? Like, where do you produce the delay strategy?

Yeah.

I use hook line activities a little bit, but okay.

I mean, odds are, when you've got a minus number relative to dead guy zero in the hip like that, you've got a lot of muscle activity that is interfering that you're going to have to reduce. Like I said, sometimes you can just get them on their side and roll them and they'll be okay. But if you do that and it doesn't change, you've got, you like, I always tell people to bring an extra shirt to work because you're going to sweat through this one, trying to get the muscle orientation to change on this person.

Okay. You see it. So we keep her, we're capturing the foot cues. We're putting load into the ground. So she learns how to IR into the ground on the medial aspect of the foot, but we can never take her so far into the compensatory strategy because then we're just reinforcing what she's trying to eliminate in the first place. So we change the program gradually over time. We don't have to change the exercises at all. We just change the orientation of her feet, which is the change in the program as she captures the internal rotation.