Well, okay, so I think the misunderstanding is that there is one shoulder that's turning into ER and one shoulder that's turning into IR in that test, and they're both IR strategies. Like, if you could pass it, you're looking at different representations of actually a late IR strategy.

Well, then I think someone might pause for a second when they hear that and be like, what do you mean? So I usually just tell people to try it, right? So if I reach my right hand up and over my head and try to touch the outside of my left shoulder blade, pay attention. All I need to do is pay attention to the position of my humerus, right?

So, if you reach straight out in front of you, palm up, you're going to externally rotate the shoulder to its maximum degree at shoulder level. And if I hold that ER all the way up, I can't touch the opposite shoulder blade. I actually have to turn into internal rotation to reach by my head, which is IR. You have to turn your hand into IR, you're going to turn your forearm into IR, and the humerus is going to follow into IR to get over to the opposite side.

Right. So in order to reach either above and across or below and across, you are internally rotating in both of those.

Yeah.

So that immediately just takes away the value of what people were using it for.

Well, it doesn't reduce value. I think it's just the recognition of what is actually happening. Neck, thorax. You see somebody sort of thrust their chest forward, and the IR, the entire spine, and you see the anti-orientation of the scapulae, which makes the scapula look like it's pulling off of the rib cage to get the arm behind the back. And then you look overhead and you see them thrust their head forward or you see the inability to actually internally rotate the humerus effectively. There's value in that because I can definitely tell you that you don't have the capacity for full internal rotation. So still useful, just maybe a better understanding.

Yeah. I mean, it would just be a measurement of how much compensation someone can drive through their neck.

You see somebody sort of thrust their chest forward, and the IR [internal rotation], the entire spine, and you see the anti-orientation of the scapulae, which makes the scapula look like it's pulling off of the rib cage to get the arm behind the back. And then you look overhead and you see them thrust their head forward or you see the inability to actually internally rotate the humerus effectively. There's value in that because I can definitely tell you that you don't have the capacity for full internal rotation. So still useful, just maybe a better understanding.

Right. So it's not an active test for ER and IR, like many people might think it is not. Okay. So that's why we wouldn't necessarily even use it.

If that's the information that you need to glean from an assessment useful. If not, then maybe if you understand the compensatory strategies that are associated with it, still useful. But again, not measuring what you think it might be measuring.

Yeah, it may be useful as a comparative as long as you know the compensations you're looking for. If someone improves, but understanding also kind of like we talked about last time, if that test improves but their measures aren't improving on the table, then there was just some other compensation thrown on top.

Yeah, you just magnified a compensatory strategy.

So what would be, let's offer an alternative then. If someone's trying to pay attention to how relative movement is happening in the upper half of the body, the upper quarter of the body, what's a better complex movement, maybe choice?

You can use it back to wall, traditional flexion tests.

Right, something that keeps you in more of that ER position as you do it. There are videos for this on the network and on Bill's YouTube. So you can look through that and sit back to wall like shoulder flexion. Yeah, OK. So that's good. We provide an alternative. So you can actually put them in a space to measure from that isn't one of just IR for both directions.

Yes. You have to maintain the ER. Part of the confusion is not understanding that you're measuring more than just the glenohumeral joint. You're not just measuring the glenohumeral joint in any circumstance. You've got a humerus, you've got scapula, you've got rib cage shape, you've got spine shape and orientation, and you'll have influences from the hand and form that influence the position of the humerus. All of these things need to be resolved, which is why we have the assessment course as it is. So you can actually understand what these influences are. You could have somebody with ER going through the entire extremity and an IRD hand orientation, which again has to be resolved segmentally first.

Yeah. And I think this is probably a good opportunity to say that we are close to releasing. By the time anyone watches this, they'll probably be ready to go. But on the UHP network, which is free, you can go there and we're close to finishing the assessment one on one course, which will go over the major table tests that we've talked about and also go over these major complex movements we talked about and give you some pictures and some description on how to utilize them and interpret them. So I don't necessarily want to go through every single one of those, but we're talking about some of the big hitters. We did something for the upper quarter, shoulder range of motion—whatever people are trying to measure with that. Let's talk about probably squats and toe touches. And then I want to talk about gate analysis and I'm making air quotes for everyone listening. Yeah, so the squat typically used—I mean, I've seen it used in a lot of different ways to try to show. A lot of times you'll see someone do like an overhead squat with their arms overhead to try to see like a full display of range of motion. We're looking for compensations there. Well, we're talking about it's not just that.

And that constrains the bottom of the test. Like right off the bat, it constrains the lowest portion of the test. So it's a great way to induce a compensatory strategy where you see the sort of like the expanded representation of the lumbar spine, which is like that's a system that's looking for space to descend, right? So that's an ER compensatory strategy by constraining the scapulae into a forward projection, which is what the overhead position is in an overhead squat.

Right. Well, it's just, it's also a late propulsive position and the bottom of the squat is an early propulsive.

That is correct. That's why there's a cost reflect and that's why you'll see more compensatory strategies. And they say, well, but it cleans up when I elevate their heels. Yes, because now you're putting the entire system into a late propulsive strategy. So now you don't have the mismatch between thorax and pelvis in that circumstance, or even the foot for that matter. So at least you're being coherent with a late propulsive strategy. So of course the movement will look better.

Right, so now let's talk about, so that's a legacy way of testing a squat and why it doesn't really show you the full picture. It gives you a very limited representation of something very specific, but that's not really what people are looking for or looking at from our perspective. So, how would we utilize a squat differently and what information are we looking to glean from the squat?

A squat goes from the bottom up as far as its representation goes. Early propulsion requires enough ER space. ER creates space for descent. I need to superimpose internal rotation on that space. It's not maximal internal rotation at the very bottom of a squat. It is the first supreme position of internal rotation, so I don't need maximum internal rotation to descend into the deepest possible squat. I do need enough ER space and to superimpose some measure of internal rotation. If I compensate and create a big ER compensation, someone can have crazy limited motion on the table when emphasizing certain segments, yet still stand up and perform what appears to many as a very good deep squat. It's compensatory in that circumstance. That's the value of understanding table tests versus complex movements. Someone appears to have a very deep squat and they say, look at all the range of motion you have. I would say, look at all the compensatory strategy you have. Understanding this becomes much more important because you may accidentally load someone in a squatting activity and magnify the strategies, leading to consequences like stagnation of energy and loads on structure.

Okay, so that was squat. Let's talk about what else do we say we're going to talk about the toe touch. So typically, I think typically the toe touches to look at people are concerned about looking at. I don't even know anymore. I'm trying to remember back to what I was told, what we were looking at, hamstring tightness.

People will talk about that because they'll feel muscle activity and connect to tissue tension when they've been forward. Then, of course, wherever I feel it gets blamed when it's actually a strategy to try to resist you from doing that. So again, you're dealing with muscle activity that there is similarity between the squat and a toe touch in the fact that the axial skeletal shapes will follow. So when you initiate a toe touch, you're actually in late propulsion, you're actually moving forward. And then what happens is you slow forward down and that's where you arrive at the bottom of the toe touch. So we're trying to reduce the influence of the extremity behavior so we can refine our perspective on whether we have more axial behavior that could be interfering with activity or the lower extremity. And so that's the advantage between those two. So they kind of go hand in hand. We've got two rotation tests that we'll use that in a very similar manner where we're actually using the extremity. So let's just lead into that. We're doing a standing rotation test, which would involve the lower extremities. It's an asymmetrical test, which is different from the from the squat and the toe touch. And so what we get on either side is a differing representation of the phase of propulsion. So the direction that you would turn in a standing rotation test would be towards early propulsion and away from late propulsion and obviously vice versa. And then if we take you to a seated representation once again, we're trying to take the extremities out of the equation so we can actually refine whether we're looking at something that is more axial in origin versus extremity.

Right. So that's an important distinction. I kind of want to repeat that for everyone listening. So the toe touch being an axial representation of what's going on through early, middle, and late propulsion. And then a squat is less constrained. The joint, the appendicular skeleton can bend and turn. So it's more showing you the whole system.

We have axial plus appendicular in a squat. We have primarily axial in a toe touch. We have axial plus appendicular in standing rotations. And then we have more axial in a seated rotation.

Right.

We have axial plus appendicular and standing rotations. And then we have more axial and a seated rotation.

So it's just zoomed out, zoomed in. Yeah. It's like, what is contributing to whatever degree? Yeah. OK. Right. Okay. So then I think instead of talking about split, I think let's just talk about gait cause I talked about it a bit. Split squat, we talk about a lot on the network. So it's not an advertisement for that, but in the UHP plus we have like a case studies. We have case study episodes, which are basically like a podcast series of you and I talking about different case studies. And we look at a lot of split squats. So we use, we use that as a way, it's a pretty, huge big bang for your buck. At this point, if I had to just look at one complex thing that someone would do, it would probably be that and maybe a toe touch. Check that out. A bunch of stuff with that. Like I said, free assessment course is going to be available soon. It has a big split squat part in it. Let's talk about walking. Let's talk about what people seem to care about when it comes to gait analysis and walking, and then I think what people should actually be paying attention to when they watch someone walk?