And then this is going to help us learn to restore that much more symmetrical presentation in your squat. I think that I also have a video up here on one of the two simple videos where we used the offset left heel elevated left cable loaded squat variation. So this is going to get you into the deeper aspects of your squat and also help you maintain the ability to offset that left propulsive strategy that you're going to need to delay. to make sure that you can maintain your symmetrical squat and not shift to the right. So Alex, I hope this gives you some strategy in regards to the right shift.

Adam had questions about things like key performance indicators and assessments for his 13-year-old son. One of the things I thought would be interesting to clarify would be how we manage these younger athletes compared to the more mature, because the conversation I was having with Eric was about a more mature athlete and how we would handle those situations. I don't think that parents have been given a reasonable playbook as to how best to manage some of these young athletes, because I think there are better ways to handle this, especially with the growing concern over these adult type injuries that we're seeing in young kids. I could go another lifetime without seeing a 14 year old kid with a Tommy John surgery. So what I did this morning is I reposted a blog from 2014 that talks about this very specific topic of long term athletic development. So there's some opinions in there and a little bit of structure to give you an idea, but let's review things a little bit. Early on, when we talk about really young kids, we're talking about six, seven, eight years old, where they start to get exposed to some organized sports. Most of the training, if you will, would be free play. We want them to be exposed to a broad number of physical activities, a lot of physical problems to solve, and just expose them to a lot of movement and let them figure a lot of this stuff out all by themselves. So we don't need to structure games. They need to be creative. And like I said, get them exposed to as many things as possible. This makes for a really, really smart child first and foremost. And then, like I said, it exposes them to a number of different movement strategies that they will use later on in their development. If we had any structure to this, I would recommend that you expose your child to martial arts and gymnastics. And when I say this, I'm talking about the non-competitive kind, if you will, because the idea is not to develop the competitive, overuse, extensive type of training. We just want to expose them to a lot of different styles of movement. As they get into this pretty teen early teen stage, this is where we can actually start to expose them to a structured training program, but this is a learning to train situation. So this is not about setting personal records in weight lifts or worrying about top speed or anything like that. What we're trying to do is we're trying to expose these kids to a structured training program. So again, they learn to train because in three to five years later, when they do get to this age of specialization, when they do have a more adult physiology and they're more adaptable to that type of training, now they're going to be ready for it.

On the contralateral side where we're manipulating these phases of propulsion, definitely go there because that's going to help you get the left posterior expansion that you need. Now having done that, let's say we've eliminated this left posterior strategy, now we got to start thinking right side because we got to restore the relative motion in this right side. So one of my favorite things to do is crazy simple. I take people out of their shoes. I put their foot on the ground. I get them to feel first and fifth met heads in the center of the heel on the floor. So we get this relatively middle range, middle propulsive position of the foot. And then we start to bring the tibia over the foot in an alignment that would be in line with the middle of the foot. What we're trying to do here is we're trying to teach the runner to bring the tibia over the foot rather than landing in this later propulsive strategy. We want to teach them how to move through this by bringing the tibia forward. So this is not pushing the tibia forward. This is not trying to mobilize the ankle into dorsiflexion. What I want you to think about as a cue is pulling the tibia forward. If we had to pick out a muscle, we would say it's tibialis anterior. What the tibialis anterior is going to do is actually going to flex the knee, it's going to dorsiflex the ankle, but it's also going to internally rotate that proximal tibia, which is going to help me start to restore the relative motions. And that's going to trickle down into the foot. So I get this nice little middle range of propulsion where the relative motions occur. I get that back, which is definitely what I want to do. So once I can capture this, and it takes a little bit of practice to really drive this, and you'll get some of that nice little tibialis anterior fatigue. They'll get a little burning in the front of the shin. Now I can go out into the gym and I can start working on some things such as like half kneeling and split stance activities where I get a lot of this middle range relative motion. So I get the IR at the hip. I get the relative motion of the knee. I get tibial internal rotation and I can start to drive the ankle again through this middle range of propulsion. I'm going to start statically. We're probably going to have a resistance that's going to try to pull us to the right. So we have to create this resistance to hold ourselves through this middle range of propulsion.

They're going to result in one of these two strategies because on the first strategy where I have the person that can reposition themselves as they go into the curve, they have this capability. It's going to turn out to be a structural or a trained capability where you have more internal rotation on the inside leg. Whereas, again, the people that don't turn as well, they're going to tend to be your wider ISAs. They're going to tend to be more of your nutated people. they're going to have to rely on the plant from the outside foot and then make the hip turn there. So right away, you can start to see where these strategies for training may lie. So if I can improve someone's capability to capture internal rotation on this inside leg, I may actually improve their ability to make these cuts or these curve runs more efficiently. But keep in mind that you're going to run into some limitations with structure. So for my say an offensive lineman per se, his ability to make this anticipatory orientation into the cut is going to be less or so than my wide receivers, but their physical structures are also different. So this is why wide receivers look a certain way and offensive lineman look a certain way because again, their body types put them in those positions and make them more ideal for those situations.

So we need to make sure we include split stance activities, single leg activities that will also allow us to support ourselves through one side and again creating this reciprocal compression and expansion. When we think about just sort of trunk activities that many people will do, if we are biased towards this wide ISA increased compressive strategy, the difference between a cable chopping activity on a diagonal versus a cable lifting activity on a diagonal, we would want to use a strategy that actually reduces the influence of gravity, which would be our chopping element, which will actually promote a greater ability to expand ourselves anterior to posterior and overcome this compressive strategy. The simple way to look at what I'm talking about, if you would compare say a prone plank where you're on both forearms to a side plank where you're on one side, in the prone situation you're actually reinforcing the compressive strategy. So I rarely put these wide people in what would typically be utilized commonly in that prone plank because it does reinforce exactly what we've already done from our performance level. So these will be more people that you put in their side planks, which actually increases your ability to expand front to back. And so now we can start to throw in some creativity where we're doing some single arm supported activities through the ground. So things like your sit-throughs, kettlebell get-ups, and things like that are actually excellent choices to help maintain the ability to turn and expand. So I hope this gives you a couple of ideas as to what we're talking about when we're talking about strategies that you reinforce. The archetype can actually enhance performance, but again, we don't want to sacrifice those things that we use from a skill level perspective or a health level perspective.

Austin, thank you so much for this question. I think it's a very useful question. Hope it's useful for you guys as well. Have a great Tuesday, and I will see you tomorrow. Good morning. Happy Wednesday. I have neuro coffee in hand and it is perfect. Okay. It's Wednesday. Very exciting. Tomorrow's Trips and Salsa Day, so that's always something to look forward to. Also looking forward to the 6 a.m. Coffee and Coaches Conference call. Please join us for that. Push your coffee prep on Instagram and your story. Tag me. I'll share that for you and we'll all have a great time talking about whatever we talk about on the conference call. Sometimes it's very technical. Sometimes we're just blowing off some steam, but it's always a great time, always great people. So join us for that. On the Q&A today, I got a question from my buddy Charlie Reed. He has the perfect hair and amazing guitar playing ability, but also one of the better coaches around. So if you're in Charlie's area, it's R-E-I-D, track him down and do some work with him. Great question, though. That's gonna require a bit of a demo that I'm not gonna do today. And then we'll probably follow this up with something a little more accurate, but I wanted to talk about rotation because that's what Charlie's question is about because I think there's some misunderstandings about how rotation is actually produced, especially in sporting movements. Charlie says I had a question regarding improving and restoring trunk rotation. He did a nice video on improving shoulder term for sports that require a lot of rotational ability like tennis, golf, and baseball. My question is, do you have any suggestions for improving trunk rotation in the gym or at home that require new equipment? Absolutely. And so there's a lot of things we can do to actually enhance the ability to rotate with our athletes and our regular clients because they have lost that ability in many cases as well. But the thing that I want you to understand is how this rotation is actually produced. Because I think it is grossly misunderstood. People think that the two sides of the body are doing something different. And they think that the top and the bottom is doing something different. So when we talk about the bottom, we're talking about pelvis. When we're talking about the top, we're talking about thorax. People seem to think that they're rotating in opposite directions. If that was actually occurring, it would be one, very, very uncomfortable. Number two, it would not look very fluid. And number three, it would be very, very difficult to breathe. And so when you do have people that are producing sort of this counter rotation between the pelvis and the thorax, you're going to hear them do some form of this salve or a breath hold to get there because you have to use superficial compressive strategies to produce that type of movement. And it's not very fluid. So when we're talking about athletics, especially in producing rotation, Let's talk about how this is actually done. So let me grab my incredibly high-tech homemade thorax here. So we got a representation of a thorax and a spine. It might be looked down the line here. And so if I turn my spine, You'll start to see the shape change here where I get this expansion on this right side and I get a compressive strategy on the left side. If I turn it in the opposite direction, you'll see that sort of flip-flop. And I think this is one of the reasons why people seem to think that these expansion and compressive elements are creating an opposing strategy. The reality is from a muscle orientation standpoint in a rotational sport like golf or tennis or baseball, more often than not, if they're not using a compensatory strategy which some people will do then, if they're not using a compensatory strategy and they're creating this nice fluid rotation, both sides of the body are doing the same thing at the same time. The difference is going to be the use of an overcoming versus a yielding strategy. So let me give you a for instance, so if I am if I am swinging a golf club because I'm translating my weight shift from one foot to the other, it's actually representative of of gait. And so I don't have this pure turn where one side of body is going forward, one side is going back. I'm actually translating. And so as I rotate, both sides, if we talk about the posterior aspect of the body, both sides are constantly going to push me towards the one side. So if I'm a right handed golfer and I'm taking my backswing towards my right side, the constant of orientation on both sides posteriorly is pushing me to the right. The way that I produce the turn is actually have a yielding strategy. on the side to which I'm turning and an overcoming strategy on the side that's pushing me towards that turn and that's what produces the turn. So if I was coming straight at you, it would look like this. Both hands are still coming forward. One is on the delay and so that produces what appears to be the turn. I would just reverse gears and I would go through that to my follow-through if I was a right handed golfer as I translate to my left leg. And so again, so what we have are these alternating yielding and overcoming strategies, which is what produces the turn. On the front side, obviously I have an eccentric orientation and I still have the yielding and overcoming elements that again produce the turn. So if we were looking at a pelvis, And I look at the two ends of the golf swing. So again, back swing to this side, follow through to this side. Those are both inhalation strategies. They're both going to produce external rotation through the pelvis. And so if I was just to ER both sides of the pelvis equally, what I would see is this. But to produce the shift, I create a yielding strategy on the side to which I am turning. And so it looks more like that. So both sides are ER. Now what I'm not doing is I'm not showing you the IR element in the middle. So here's exactly what happened. So I go ER with the yielding strategy on the right side. If I'm taking my club into my right-handed backswing, as I come towards the middle, I will IR. This is where I produce my maximum force. So force is always produced. in an internally rotated manner, and then I would shift back to my ER strategy where I have the yielding strategy on the lead leg there. Now, if I'm turning, obviously I have a foot position that's coming up from the ground, I've got a knee position that's coming up from the ground, I've got a hip, I've got a femur turning into the acetalement that also contributes to my production of rotation, so I'm not ignoring that. I just want you to see the representation of what's going on in the axial skeleton because it is both sides of the body doing the same thing from a muscle orientation standpoint. The difference is the delay that's produced by the yielding and overcoming strategies. So right away we have elements of PNF that are in play to help us produce rotation. So those are your chopping and lifting patterns. Because what they're doing is that they're actually producing the concentric orientation on one side of the body, the eccentric orientation on the other side of the body. And then as you move through space, you're producing these yielding and overcoming strategies. And so that's why those contribute to rotation. Any number of rolling patterns are going to be contributors to this ability to create rotation. all of your arm bar progressions, the simple log rolling that we're doing, the unilateral shoulder rolls, et cetera, all contribute to these compressive and expansive strategies that we're going to use to produce training. If we think about the pelvis as something as simple as working through our split stance activities will actually help us produce this rotation. So again, we have a lot of things that we can utilize in the gym. I promise I'll produce a video that will demo some of these things so we do have a visual representation of how we would utilize these things. But I just wanted to throw that out there and let you see that rotation is probably not what you think it is. And again, both sides of the butter are doing the same thing at the same time. We just have a little bit of delay between one side and the other, and that's why we see the rotation. So hopefully that's helpful for you. Have a great Wednesday, and I'll see you guys tomorrow. It is Thursday. Happy Thursday to everyone. I have my neural coffee in hand and Dr. Mike, I think it's the best batch ever. It is perfect. Dr. Mike, how are you this morning? I'm doing wonderful. Yeah, you look good. You look good. You need a t-shirt hoodie, apparently.

So I do recommend that. Mike Robertson is on today for IFASTU for the Q&A call there. So if you're a member of IFASTU, be ready for that. That should be really fun and interesting as well. Okay. And I have a pretty cool question for today. A little off the beaten path, not really going to be like one of those typical, oh, do this and then this kind of a kind of a questions. So it's a little bit more of a reasoning type of question, but it's still very, very useful and very, very interesting. And this comes from Marcel. Marcel says, I've been implementing your model with some good success, but there seems to be a variation in how much of the changes we get to stick. Some clients, things change very, very nicely and stay that way. And others seem like an ongoing battle to maintain good movement variability. Can you talk about what factors influence things not sticking? and how are we going about working out what the client needs if it is hard to maintain changes? Well, Marcel, welcome to my world, okay? So this is not weird, it's not unusual. There are always people that change very readily and you may never see them again after that first visit because they do so well and then there's the people that are much more challenging. And that's just the broad scope variation of how humans have so many potential influences. So let's look at this from a broad perspective for a second. So there are always things that we can know and there's things that we don't know. When we talk about things being multifactorial, we don't even know how many things potentially influence, but let's look at the human as a broad system that's made up of subsystems and let's say that you have 12 subsystems in your body and one of those lacks sufficient adaptability and then promotes a deficit in movement which can ultimately result in pain and they come to see guys like you and me and let's say that we do an intervention and that intervention addresses that subsystem that is the limiting factor and then they have a great outcome and everything goes really really well they learn how to maintain their adaptability and they feel great. But now let's say that there's multiple subsystems that could be involved. So let's say that we've got two or three out of these 12. And let's say that our intervention covers eight of those. But unfortunately, the two or three that are low in adaptability are not affected at all. Now we don't make the change. And so those are the things that we have to understand is that this is why we never really know why people get better or why they don't get better. Because there's so many potential influences. And so what we're trying to do is we're trying to influence as many of those subsystems as possible with treatment and training to produce the desired outcome. So there's always that factor in play. The adaptations that we often utilize on the rehab end of things, before we get to sort of like the fitness and the conditioning and reconditioning elements, they tend to be learning based adaptations. So some people learn faster than others. Some people have more perceptual capabilities. Some people have a broader experience to draw on. So they do adapt faster. Some people are better trained. So again, we have these genetic influences. We have these cognitive influences. We have psychological influences that all determine what type of progress we're going to make with people. And so again, we have to take all of those things into consideration when it comes to things like training, personal behaviors, habits, et cetera. So now we have potential interference problems. So if I am training to produce high force, high strength, hypertrophy, et cetera, and I have these really strong concentric orientation, elements that influence the way that I move or can't move. Then we have actually an interference with training. So sometimes you got to take certain things away from people for a while so they can become more adaptable. Some people have unknown stressors or they don't perceive them as stress. So maybe this is a job, maybe it's a lack of sleep, maybe it's a relationship. All of those things can potentially influence our outcomes because it does influence the system at some level. And then that produces what you and I would measure on the table. So thankfully, we've got a really good proxy measure for the fact that there is some sort of influence that is affecting our patient or our client. We also have to consider structural adaptations and sensory adaptations that become influential. So if I have somebody that has a true structural change, many times we can overcome those. If they're small, and they don't influence our ability to shift volumes and pressures. But if we have something like, say, a shoulder labrum or a hip labrum injury that's extensive enough, we no longer have that intact mechanism of a synovial joint. And then we got to send it back to the doc and say, look, well, we gave this a shot. It didn't go well. Here's what I think. And then we get help from that perspective as well. When we talk about the sensory influences, all of your sensory systems have adaptability built into them. And so if I have a lens in an eye that can't change shape enough, then I have potential visual problems. If I have perceptual problems that are associated with vision, that needs to be addressed as well. So now we look to our behavioral optometrist for some help there. If we have a sensory issue in our mouths or a physical deficit, so we have people with a really small narrow palate, a narrow airway, all of those things influence our ability to breathe and move and be comfortable. And again, managing the way that we perceive that from a stress-related standpoint, all become these influences. So there's a lot of stuff here that we have to take into consideration. It makes it very, very difficult. Because again, a lot of these things are just unknowns, and we're doing this by processes of elimination. It's like, okay, so it appears this, it appears this, it appears this, and we start to take things away, or we say, look, at some point in time, we have to recognize that it is not within our scope to help this person. We may be able to identify that there is a problem, but it is beyond our scope, and so then we need to refer them to someone else that may be able to help. That might be their primary care physician, to become the case manager to start to manage this thing, or if we can identify a specific deficit because of our training, then we can refer them to the appropriate professionals. So there's a lot of things that are potential influences. The first goal I would say is to try to eliminate any interferences that are obvious. Again, this could be a training related thing or just a personal behavior thing that we think is an influence that we can usually manage those rather readily. But there's always going to be those unknowns. So that's what makes this a little more difficult than we would like. Sometimes it'd be great if everybody came in and made those changes on the first day. But sometimes it is a struggle. There are many influences, my friend. Hang in there. Hopefully this was helpful just to stimulate some thought process for you. Have a great Wednesday. Chips and salsa tomorrow. Coffee and Coaches call in the morning at 6 a.m. and I will see you guys later. It is Thursday. Coffee and Coaches Conference call. I have neuro coffee in hand and Dr. Mike, it is perfect. I am killing it on the neuro. I'm telling you, I believe it.

Happy Wednesday. I have your coffee in hand and it is perfect. Can't wait to finish that. Okay. Wednesday is always a very, very, very busy day. Long clinic day, short morning, lots of stuff to do, but quick heads up. The first Q&A for IFSU members is up for your viewing pleasure. We've got a lot of questions that are rolling through the Facebook group as well. So that's pretty exciting. If you haven't gotten signed up for IFSU, I suggest you do that. We're building some great coaches in there already. So that's kind of exciting. All right. Quick Q&A for Wednesday. This comes from Julian. Julian says, I'm new to your channel and your content and cannot get enough, isn't that nice? Thank you, Julian. I've learned so much through your videos, especially during this time of COVID-19. I'm not sure if you've ever discussed hyperextension, the knees of so can you direct me towards information on that? If not, do you have any ideas on how to treat this problem? Yes, Julian, on all counts. So there's some information on me valgus on the YouTube channel that you'll find of interest because it's similar but not quite the same. So let's define a little bit about what we're looking at first. By calling something hyperextension, the implication is that there is some sort of position in the imaginary sagittal plane. And I would say that's more of just what it is. It's a cancellation out of ERs and IRs that produces that appearance that it's going backwards. So it's going into excessive extension. What you really have there is an external rotation problem. But we also have some relative position issues that are actually creating this appearance. So we can actually talk about elbow hyperextension, if you will, and knee hyperextension at the same time. Because they are the same as far as the etiology and then how it appears. So I'm going to grab my knee here. And so again, I got a plastic model that doesn't move like a real skeleton. So we have to kind of keep that in mind. When we're talking about the valgus, we have this tibial femoral ER relationship. And when we're talking about knee hyperextension, we still have that relationship, but there's going to be some differences that are trickling down and some stuff that's trickling up that make it go into what appears to be hyperextension versus the knee valgus. And you might see a little bit of both actually in some situations. But as the tippy rotates into external rotation, it hits its end constraint and it's going to take that distal femur with it. So we're going to get an ER here. We're going to get an ER here. But if we get a early propulsive strategy in the foot, this is where we're going to see concentric orientation of the anterior medial aspect of the musculature around the knee. We're going to see an eccentric orientation on the posterior side. So when we think about musculature that is eccentrically oriented, I think semi tendonosis is going to be eccentrically oriented. Your tibialis, the anterior is going to be eccentrically oriented, which is going to make it very, very difficult to flex the knee during gait. So again, so if we can't flex it during gait, then it's going to try to go into what we would perceive as being that high hyperextension. The short head of biceps is going to be concentrically oriented, the lateral hamstring, so bicep femoris, the full bicep femoris is going to be concentrically oriented as well. And so that's why we get this appearance of what looks like the hyperextension. It's actually a twist. It's an ER, bring the femur into ER, but an early propulsive strategy in the foot which is going to drive the force straight back through the knee. A lot of times what you're going to see up here is this is going to be your traditional sway back individual. So they're going to be probably narrow, probably posterior compression. You're going to see an eccentric um uh pelvic diaphragm and so again they're falling hard towards towards the center their center of gravity is going to be forward and and down through the middle but because they've got that early propulsive strategy in the foot they're going to drive that knee with what appears to be backwards into hyperextension. The elbows the same way. We get the same kind of twist in an elbow that creates the hyperextension. So instead of having the anti-medial compartment being concentrically oriented and the posterior lateral compartment being concentrically oriented, what you're going to get is you're going to get a posterior lateral compartment concentric orientation. So supinator and conius are actually going to create this really hard compressive strategy on the back side of the elbow, which again creates that appearance of hyperextension, but it's actually the twist of the radius hard into ER. When the anconius picks up its concentric orientation on the back of the elbow, it actually twists the ulna in the opposite direction. So we have this kind of a relationship of the radius and the ulna twisting this way, and it pushes that elbow forward into what appears to be hyperextension. So one of these circumstances, we got to get the elbow into it or the elbow or the knee, whichever one we're talking about. We got to get it into a position where we can recapture the relative motion in relative positions. So when we're talking about the knee, we've got to get the foot into a good orientation where we can capture that relative motion of the calcaneus, the talus, and then the distal tibia. And so that's going to be through this middle range of propulsion. So we're going to have to get to there so we can capture relative motions. The knee is going to be flexed so we can again capture relative motions. The hip is going to be flexed again so we can capture relative motions. And so what you're gonna have to do then is probably build somebody from the ground up. So these are the half kneeling people. You're gonna try to work towards a split stance. And if you wanna think about using the the hamstrings as rains on a horse to orient the tibia. So remember, if we're talking about knee hyperextension, then that medial hamstring, so semi-teninosis is going to be e-syntrophy-oriented, we need to pull that back to internally rotate that proximal tibia and try to hold that femur in its ER position relative to the tibia. So again, you're going to be using this is where people talk about weak VMOs and things like that. The reason that we have this weak VMO is because it's been out of position, if you will, for an extended period of time. So it's very, very difficult for it to move through its full excursion of eccentric to concentric orientation. So that's going to try to balance itself out just through the reorientation of the knee. but you're probably gonna be looking at medial hamstring to lateral hamstring orientation to get the tibia right, get the foot position correct, and then you just start to drive your chops and your lifts, your presses, all this stuff in half kneeling but really being particular about this half kneeling position to help you recapture this normal excursion of tibial femoral ER relationship to the femur, okay? So I hope that makes sense. If it doesn't, please ask a clarifying question as to where there may be some confusion. Like I said, it's very similar to the knee valgus stuff, but you get a different foot position that you're dealing with when you're looking at this hyperextension kind of a thing. but also keep in mind it's not really hyper extension. It's a rotation problem and it's people trying to go towards external rotation. So again, Julian, hope that's helpful. Have a great Wednesday and I will see you guys later.

So Sandy says, I'm stuck trying to understand how a regular squat, inhale down to yield and exhale up to overcome converts to a competition squat. So she's talking about power lifting, where you set the pelvic position for both yielding and overcoming at the top and hold until the lift is complete. When inhaling at the start to get counter-nutated sacrum, which isn't ideal for overcoming at the bottom, how would you coach that at the pelvis? And she wants me to use the pelvis to demonstrate, so that's going to be kind of easy. But the thing that we need to understand here is that, so Sandy, your interpretation is actually not correct, so you don't have a clear understanding of what we're talking about with the yielding and overcoming because you're looking at yielding as this overarching kind of position thing where you're including the counter-nutation and the ilium public floor and guts etc in this. So what I want you to understand about yielding and overcoming is the yielding and overcoming actions are the distribution of the forces through the connective tissues. We don't want to include the contractile element the musculature in that because that's what's actually going to alter the rate at which the connective tissues are loaded which determines whether we have a yielding or an overcoming strategy. So when I load connective tissues very, very quickly they become very, very stiff and overcoming. When I load them very, very slowly they actually yield and that's where we start to see the expansive capabilities even with situations of concentric orientation of musculature. So a concentric yielding strategy is a constant orientation, so a muscle that is moving into a shorter position, but the connective tissues are allowing the expansion to occur at the same time. And that's how we distribute some of these forces.

So we've got a lot of influences here when we're talking about knee valgus, but understand what it is. It's a gravitational problem that's associated with the idiosyncratic physics of the individual. So it's not about tight muscles. It's not necessarily about weakness. It's literally about controlling the center of mass and the position. Matt, I hope that gives you a little taste of what you're up against when you're talking about dealing with knee valgus. If you have any more questions or concerns, please let me know. Go to askbillhartmanngmail.com and we'll try to get your question on here and I'll see you guys.

So the differences between the wide and the narrow as they approach the end strategy are all strategies that we're superimposing on top of these archetypes are exhalation strategies. So they're very concentric orientation heavy stuff. So they're squeezing, squeezing, squeezing to try to hold position against gravity. And so what you're looking at, Matt, is the wide at the very end. So let's look at a pelvis to show us what we mean by that. So when we look at a wide ISA, they're gonna have the IR iliums and a nutated sacrum. So the sacrum's gonna be forward and the iliums gonna be IR, which means that I'm gonna have a sacrum that kinda looks like that. So I'm exaggerating for effect, but that's the nutated position of the sacrum. At end game, the last superficial strategy that they'll have is to actually bend the apex of the sacrum down and underneath them. So this is a really hard IR or ER force against the sacrum. And so the difference is that you're gonna see with the wide and the narrow. So the narrow is already gonna be compressed in this scenario. So these are the ones that look like the true sway back. So you're gonna see something that looks kind of like that where the pelvis is sort of ahead of the femur here. With the wide, it's because this is the last compressive strategy, what you're gonna see is they're gonna kind of push through the hip. They're going to push straight through the hip, and so they end up with this really kind of hard ER position. So they'll stand almost in what looks like a sway back, but their butts are going to be clenched really, really tight. They're going to stand in a little bit of knee flexion because of the orientation of the femur at the tibia, puts them in a little bit of a tibial IR. So they're standing in deflection and where the narrows may be pronated in this position, your wides might look a little supinated because what they're actually doing as they're driving this hard ER through the pelvis, they actually claw the ground, especially with the lateral two toes, they'll claw the ground. So it looks like their toes got kind of chopped off at the end. The forefoot will look a little short under the circumstances because they are really grabbing the ground and pulling themselves forward in this compressive strategy. As far as the anterior thorax goes, they're still going to be pulling the sternum down with rectus. They're going to try to pull up on the pubis. But because of the orientation of the pelvis, it's not going to sway underneath like it would for the narrow. But again, Matt, you're still dealing with a massive compressive strategy here. So gravity is not your friend.

Yes. He's walking on his ischial tuberosities. And if you watch him walk, you will see that the pelvis and the thorax advance at the same time in the same direction in the same way. The iterations are what is going in the same direction. So the pelvis and the upper thorax are both turning the same direction at the same time. And you'll see that just about any activity. That is, they will turn together. So when we're talking about relative motions of the ankle. Right. Before you hit a constraint. You'll have opposing movements. So if I have, if I have a pronating, like a closed kinetic chain that defined pronating ankle and foot, and the talus is adducting and plantar flexing, the tibia is externally rotated until you hit the constraint and then it follows the talus. Okay. So which is it? Is it tibial internal rotation or is it tibial external rotation? Until you clarify your point of reference, you're not really certain how things are being described. And so, again, I think that creates a lot of confusion. Because when things start moving together, then you don't have the relative motions to describe the movement. So you have to be very, very clear as to where you are in all of this. And again, we have to appreciate that because that's how you end up turning anyway. If you just reduce the relative motions. And then things start to move in concert because they're at the constraint. And so then they bring stuff along. And that's how we actually turn. Because as long as you have relative motions, the external rotations and internal rotations cancel each other out. And that allows you to go in a straight line, which is why we can talk about there's no sagittal plane if you want to talk about that.

But again, I want to really, really simplify this to a great degree. But when you're trying to drive sagittal motions, there are things that can interrupt this because it can stop the rotation that would naturally occur within the mortise, within the sub-tailor joint, the movement of the calcinius, and the movement through the remainder of the foot. So in the sled drain video, if you watch that video, I was walking to my left. And so I have a right foot in hand. So we're going to talk about the right foot as far as how we're going to gain this ankle mobility. And one thing that I want you to recognize is this fifth ray has its own little axis of rotation. And so we're going to use that to help us acquire ankle mobility. So we need this little guy to have its normal rotation. So if you have one of those little pinky toes that tucks under the fourth toe, what I want you to recognize is that fifth ray and my definition is externally rotated. and what we need is to capture normal ankle mobility is we need to make sure that it can externally rotate which would supinate the foot and it needs to internally rotate which would provide us a measure of pronation and so I think a lot of people are lacking this fifth ray mobility and so they get stuck in these early phases of propulsion and they either roll off to the medial aspect of the foot or they have some other compensatory strategy. So as we walk through As we walk through, I'm going to use this as a surface, as we walk through this lateral sled drag and we land in this supinated position. So we're going to land in relative tibial external rotation, but the talus is already moving towards the traditional plantar flexion adductive position of closed chain pronation. But I'm going to land on this lateral aspect. And what I can do is I can actually put pressure through the fifth ray right there and I can capture what I would call internal rotation of that of that fifth ray and in doing so as I land I've got a planar flexed adducted talus and I can move the tibia from external rotation to internal rotation so I start to capture a much more realistic and effective pronated position of the subtalar joint. I'll land on the medial aspect of the first ray which will prevent me from going into too much pronation. I'll capture what we would traditionally call dorsiflection as I have a normal closed kinetic chain pronation position of the ankle and then as I push off from the medial aspect of the foot, I'll have a useful, propulsive first rate to push off of because of the landing mechanics, of landing towards the inside of that first ray as I push off. So I get this full rotation of the tibia across. I capture a normal sub-tailor joint position for pronation, which will allow me to access a lot of the ankle mobility that people are lacking. Once again, they tend to get stuck in this position where I don't have normal rotation through the fifth ray. It limits my ability to dorsiflex. And so if I can capture that with that lateral sled drag motion where I'm rolling from the outside of the foot to the inside of the foot and rotating the tibia across as I go, I pick up a lot more ankle mobility.

We have two strategies. We have expansion and we have compression and the interaction of those so that you're always doing both at the same time. Just certain aspects will be biased towards one and certain aspects will be biased towards another. So if we think about a body weight squat, I have to maintain my center of gravity. I have to expand in the right place. I have to compress in the right place to achieve a position in space. And so with a weighted squat, the same thing happens. It's just that now I have taken all of the loading-based forces. We haven't talked about loading in a long time. We talk about compression all the time. But when we talk about loading, those are the forces that we have to manage. And so with a weighted squat of any kind, we have to manage now those forces as well. So our strategy may change. So let's look at the back squat in the front squat real quick when we talk about loaded squats. They're both loaded, but they're not the same. So by the position of the load, I have to create expansion differently. So if I put a bar on somebody's shoulders right behind their neck and I create the compressive strategy on the backside of the upper back, I have to drive more expansion anteriorly, otherwise I would collapse the load. So I fill myself with volume, I compress that volume to make it stiff, and now I can rest a lot of weight on top of that. Okay, if I was in the front squat, I have to get enough distribution anteriorly and posteriorly underneath the weight. So from a shape change perspective, I have to expand myself so that the bar is sitting relatively in the middle of the expansion. Otherwise, I would dump the weight forward if I did not expand anteriorly, but I also have to create a utilizing strategy posteriorly to create expansion. So again, I have the weight centered relatively over this cylinder, if you will, of volume that I am squeezing. So again, the shapes are different, but the strategies are the same. It's just this interaction between the compression and the expansion. If I'm sitting down into a deep squat of any kind, I have to have some form of expansive strategy to lower me into that position. If I'm looking at just a body weight squat, I have my weight based on the effects of gravity upon me that will allow my expansion downward in that direction. So I have to expand downward to allow that to occur. So I have to have eccentric orientation in certain areas and I have to have yielding strategies in certain areas to allow that expansion to occur. If I superimpose a weight on top of that, so now I took a barbell and put it on your back, what I'm going to do is I'm going to have less of an eccentric orientation as a contribution to the expansion and more of a yielding strategy. So I'm going to distribute that load into the connective tissues on a much greater level because if I release the muscles into eccentric orientation, I will accelerate into the ground, which might be okay if I have the capacity to get back out of it based on the load. However, if I put 800 pounds on my back and I accelerated into the ground, I could just become a big wet spot, which would be a bad thing. So again, we have to look at this from compression and expansive strategy. So the shape of my body is going to be based on what the demands are. So if I put a load on me, I have to expand and distribute the shape of my body to support the load. I have to squeeze that load. And again, that's going to create a restriction in movement. So think about it, it's like I want to be more stable underneath the heavy load, so I're going to use a much more compressive strategy. But I need to be able to move through space to create my squat, which is going to be more of an expansive strategy. So under those circumstances, heavy loads, I yield a little bit more, less loads, I essentially orient a little bit more, but I'm still using both expansive strategies at the same time. To come up out of the squat, it's all about compression. So if I'm pushing up out of the body weight squat, I don't have the force demands that I might have under other circumstances. I use my concentric overcoming strategy to come up out of the squat. So I will move more towards an eccentric orientation to a concentric orientation. When I'm in a loaded situation, I don't release the concentric strategy nearly as much. And that's why I have to use the yielding strategy to get me into the bottom of that squat position. Otherwise, I may not be able to stand back up. So I hang on to my compressive strategy. I hang on to more concentric orientation even as I lower myself into the squat so I can overcome and push myself up out of a loaded squat.

We've had a series of great calls, great people coming on there, so it's been really fun, so I want to continue with that. And we'll try to continue with that as long as we can, even when things try to get back to normal, we're going to try to maintain that. So very cool. Now, let's go to the Q&A. So we've got a question from Greg. And Greg says, under what circumstances might you see a narrow ISA presentation with significant limitations in dorsal rostral expansion? Would you consider it common for these findings to be restricted on one side? And then he wants to know a little bit about intervention. So let's talk about this. Let me bring in the model here. Okay, so dorsal rostral, the space up here in the upper back. So this is where you have a lot of expansion during a breath in. And so if this becomes restricted, you get an alteration of scapular position. And if I change the scapular position, I immediately create a constraint as to what motions will be available. And so when we talk about dorsal rostral, I'm gonna leave that here for a second. We talked about dorsal rostral expansion. When we lose that, we lose our external rotations. And so if you've been following along, you know that all we have are ERs and IRs. We don't have all these other imaginary planes to play in. And so we're gonna have to monitor our external rotation. So it's not just the pure external rotation. So we're talking about horizontal abduction. We're talking about flexion. So when I lose dorsal rostral expansion, I'm gonna lose my ERs. under what circumstances with a narrow, now we're talking about a compensatory sequence. And so when we look at the sequence of events that arises from people with an axial skeleton that is biased towards inhalation with a compensatory exhalation strategy, so it's a narrow ISA. Under those circumstances, the dorsal-rosperal compression happens a little bit later in the sequence. So a lot of times what you're gonna see is you're gonna see loss of internal rotation in the shoulder first, followed by the loss of external rotation. So in most cases, when you have a dorsal rostral compression in a narrow ISA individual, you're going to lose measures in both directions. So keep that in mind. And that's how you're going to be able to distinguish rather easily, whether you've got this dorsal rostral compression on the narrow. So as far as seeing it unilaterally, absolutely. So you're gonna see people with a number of strategies to manage all the internal and external forces. And so some of those people are going to be utilizing a much more asymmetrical strategy. So it's very, very common in fact, to see a more bias strategy on one side versus the other. And so dorsal rostrum compression is just like any other compensatory strategy. If I need it, I'm going to use it. And so very often you'll see it at one side and the other. And then it's just a matter of using an asymmetrical activity when we're trying to restore movement options. So if I'm trying to restore expansion to the dorsal rostrum area on one side, both sides of the body are not going to be doing the same thing. It doesn't mean that you couldn't use asymmetrical activity and be successful. It just means that you're probably going to be more successful and more likely to recapture the movement options that you wanted if you're using a more asymmetrical activity. Now, when we talk about those compensations, and then our strategies to intervene. I've got a number of resources up there. So if you go to the YouTube channel, Greg, there's a bunch of stuff for Dorsal Rostrel. There's a seeded variation of Dorsal Rostrel expansion, which I love to give to people that work at desks because they can intermix this activity with their regular desk activities all day long. You'll see another one that uses a squat variation when we're talking about a better band pull apart. There's a video up on, I believe, Instagram and on the YouTubes as far as that goes. So those are really, really good strategies. The thing that you're going to want to do though when we're talking about creating expansion in this area is you're going to avoid that 90 degrees of shoulder flexion position for the shoulder and for the hip, at least initially. And the reason I say initially, because eventually you want to be able to utilize that position and create a yielding strategy in the dorsal rostral area, because we do need the ability to expand and delay our ability to compress that area when we're talking about turning athletes, so baseball pitchers, tennis players, golfers. They need to be able to compress that area to create their force output, but they also need yielding and overcoming strategies to be able to alternate to actually produce their turning. So this is a great question, Greg. But understand, let's back up a little bit and do a quick review. Narrow ISAs, the dorsal roster is going to compress a little bit later than if I was a wide ISA. I need to recapture that so I can recapture my external rotation measures. It will present unilaterally, so I need to make sure that I can produce eccentric orientation of that area to create that full expansion but then I'm going to have to superimpose a challenge to it to allow it to be concentrically oriented but yielding to produce rotation in high speed, high force rotational athletes. So Greg, I hope that's helpful for you. Great question. Keep them coming. Happy Wednesday to everybody. Remember chips and salsa tomorrow and the Coffee and Coaches Conference call in the morning at 6 a.m. I'll post the link. on my Facebook page right before the call tomorrow morning. So I'll see you guys tomorrow.

I have NeuroCoffee in hand. And it is perfect. Outstanding. Another tremendously busy day. So this is really good. The clinic is starting to pick up again, which is great. Able to help a lot of people that have been sort of sequestered as we all have been. So this is really good. I got a great question on the Q&A. It's stuff that we haven't talked about in a while. So I was kind of excited about this. And so the question came from Rick and Rick says, I'm having trouble helping my neck patients. I've used a number of techniques with good success, but not great success. I'm getting close to restoring full ranges of motion and also helping patients with pain relief. But I feel like I'm missing something. Do you have any thoughts or ideas that can help me clean up the leftovers when you know there's more change available? Quite possibly. So there's a lot of resources out there on the cervical spine and a lot of the fine mechanics and such and that can drive you relatively crazy because it does seem like this really really complex area. So let's really try to simplify this. There's a couple of things that stand out in the cervical spine, especially the lower cervical spine. So a lot of times when we're restoring neck range of motion, the upper cervical spine actually is fairly easy to restore in many cases. And so a lot of people to do manual therapy get really, really good responses. But then when it comes time and you're checking those end ranges and you still have that little bit of pressure or pain at end range and they don't quite have this full comfortable range of motion, there's a couple of things and a couple of tells that will let you know where you need to go. So let me grab my little skeleton guy here. So we're going to talk about a little bit of dorsal rostrum on lower cervical spine. So the shape of the facets in the lower cervical spine are not the same shape as they are higher up. So the facets in the lower cervical spine are kind of dome shaped, which means that you need to restore lower cervical flexion, if you will, if we're thinking old school, it'd be flexion, to create rotation to the ipsilateral side. So if we're looking at the left side of the neck, I need lower cervical flexion to recapture left rotation. Now, there's a combination of factors here to help you restore that motion. And that means I also need dorsal rostral, upper dorsal rostral to be specific, upper dorsal rostral expansion on the same side that I'm trying to turn the neck towards. So if I am restricted in the dorsal rostral area and I'm trying to get the cervical spine to capture that in range rotation, good luck with that if this doesn't expand.

As I externally rotate and I breathe in, I turn the spine. As I internally rotate and breathe out, I hold that position and create a yielding strategy on the left side because I'm staying left side heavy throughout that exercise. So basically we get this inching around to the left orientation of the spine. We recapture that and then that allows us to recapture the hip position that's going to help restore that external rotation. So we actually bring the pelvis back and then turn it back to the left, which gives us back our external rotation. So hopefully that also answers your question, Marcos.

I got a very busy Wednesday so I want to dive right into this Q&A because it's kind of a cool one because I posted a couple of videos on Instagram recently about activities to offset a left shift of the squat and a right shift of the squat and it produced a lot of questions and I think even Tim on Instagram asked if I could give him a little bit of a chess board so we'll try to do that too but let's talk through this because what we're dealing with is normal squat mechanics and then we're superimposing some altered initial conditions which produces a left shift or a right shift in the squat. So let's go through these. Let me grab the pelvis. Typically, we're going to see this with somebody that's biased towards a wide ISA. When I say that, it doesn't have to be the extreme. It's just somebody that does not close the ISA very well. They're going to have this tendency to have this nutated position of the sacrum as part of their starting mechanics. If we look through normal squat mechanics at the top where we would have the hip near zero degrees of extension, we're going to be towards an inhaled position. It's going to be an externally rotated position at the hip as I pass through the sticking point. That's our primary internal rotation position. And so we're going to see a widening. We'll see a widening of the IPA and internal rotation of the hip through the middle. And then at the end, we're going to see the hip flexion. We're going to see the re-external rotation, if you will, of the pelvis. So we get sacral movement and ilial movement at the top of hip flexion, which would be the bottom of the squat. So those are our normal mechanics. External rotation, internal rotation, external rotation. Okay. So if I disturb those in any way, I'm going to see something happen in the squat. So in most cases, what we're going to see, I'm going to tip it this way. If I start in this nutated position for the wide, but I have a compressive strategy in this upper posterior left. So I'm holding the left sacral base forward. What's going to happen is I'll get a tip of the left side of the pelvis that goes forward more than the right. This steals external rotation from this hip, but because I'm biased towards the wide, I preserve my internal rotation. Now, as I squat, what happens is, I have to take advantage of my internal rotation as I get there, and because I can't re-externally rotate as I pass through the sticking point, the sacrum is going to stay biased to be turned to the right. I have the same strategy going on in the thorax. So essentially what I've done is I've turned the whole axial skeleton to the right, but my femurs, my hips are facing straight ahead. So I've got that kind of a squat. As I squat, my straight down is actually back into the left. That's why you see the left hip shift. Now, let's take another layer of strategy. I start from that same compressive strategy that I saw with the left shift, but now I'm going to superimpose an anterior compressive strategy on the left side in addition to that. So what happens is I get a shape change around the acetabulum, which is actually going to turn it a little bit. So I actually pick up concentric orientation of the external rotation muscles right off of the trochanter here, but that's going to bring the femur and the sacrum a little bit closer together on this side, and so I get an oblique tilt of the pelvis in this case, and now I've tipped my right side a little bit farther forward than the left side. So that's what the orientation looks like. I'm closing this space right here, and that will push it forward on the left. Now, on the right side, I still have the right side tip forward. Remember, I've lost my hip external rotation, and so as I squat under these circumstances, this stays forward, and then I take advantage of the IR that I do have, and I open up that space right here. So if I create space there, that's the direction that I'm going to go. As I sit down, because I've got more compressive strategy on this side, holding this forward, this side stays open more as I squat, and then I'm going to shift over into that right space. Now, in this case, I'm definitely going to have a decreased left straight leg raise, decreased left hip flexion. In the first case with the left shift, I'm going to have a normal straight leg raise in most cases, but still lose the end range hip flexion. So keep that in mind. Hopefully that gives you a little bit of a taste. I'm sure there'll be more questions in that regard because it does require a little bit of complexity in regards to the compressive strategies that we're using, but this should get you started. So feel free to ask questions. I'll be posting this up on YouTube as well, so you'll be able to access that there and we can clarify things as we go, because like I said, I know I threw a lot at you at once here, and I'd be happy to go through it again.

Typically with a narrow, you're not going to see a lumbar lordosis because I have sacral counterneutation and that's going to reduce the appearance of the lordosis in the lumbar spine. Chances are I'm taking a wild guess here, Brian, that if you're seeing a lordosis, that you're actually seeing a turn. And so what you got is a narrow with an anti-orientation and a turn. And so what's going to happen is we're going to see this issue of tuberosity getting closer and closer to the femur. So what you're going to end up with is chances are if you've lost ER by traditional measures with the hip at 90 degrees of hip flexion, you're probably also losing abduction at the same time. Then you know you're on a non-oblique axis there. And so you're going to have to push back on an oblique. So instead of trying to bring the pelvis straight back this way, you're actually going to push from the right and go back to the left. So you're going to push back on that oblique axis because chances are you lost more ER on the left than you did on the right. Okay, so again, I'm taking a little bit of a leap there based on the information that you gave me, but just put that on the floor for now. But if I'm wrong about that, then please get back to me through the askbillhartman@gmail.com, and we will clarify what those needs actually are. So thank you for that, Brian.

I've been going back and forth on email with Eddie from Germany, Eddie's an osteopath in Germany. We've been discussing how we would utilize half kneeling positions or split stance positions and how it would affect the orientation and behavior of the pelvis. I thought I would shoot a video and sort of break down the half kneeling position a little bit more in detail than what we've been used to and hopefully it will answer some questions that you may have as to how you're going to implement this in half kneeling or split stance activities to achieve the outcomes that you've been seeking. So I have my pelvis set up here on the stool in sort of a split stance orientation or half kneeling orientation so we can manipulate it a little bit easier and show you some of the positions that are very common in regards to execution of certain activities in half kneeling or split stance or some of the things that you're going to see in your athletes or clients. And one of the most common things you're probably going to see is you're going to see people assume this half kneeling or split stance orientation with one hip higher than the other. And what I want you to recognize is that what you're typically seeing under these circumstances is that the pelvis is actually going to be oriented towards the downside leg, but it's also going to be positioned in a position of inhalation. So you're going to get extra rotation of both ilia and you're going to get counter-nutation of the sacrum. Now, what this does is it creates a descent of the pelvic diaphragm. So this is a very low pressure situation inside the pelvic diaphragm, which pushes some of the effort towards the extremity musculature, which is one of the reasons why you'll see people complain of quad tightness in a split stance or half kneeling position, or they'll complain about tightness in the front of the hip, or they'll complain about anterior knee pain, because they're placing more demand on the extremity musculature. This increases pressure and tension at the joints and so that might be what they're actually sensing. If we want to create a more stable structure through the pelvis, we have to create a concentrically oriented pelvic diaphragm. So we need an overcoming contraction and concentric orientation of that pelvic diaphragm. And the way we do that is by leveling the pelvis actively. So for those people that are presenting with that one hip higher than the other, So they're in extra rotation. What we need to do is actually push the front side hip downward. In doing so, we actually create an internal rotation of that front side hip, which moves the ilium into internal rotation, which immediately nutates the sacrum and starts to bring the pelvic diaphragm upward towards concentric orientation.

And so rather than just blindly applying certain methods or blindly programming and just like once again just relying on hard work trying to be the solution to a problem. We can be very, very specific. So essentially what we're talking about with flywheel training is this ability to overload the eccentric element. So we can turn this into a broad scope discussion of just eccentric overload methods. So we could say, oh maybe you're using weight releasers to emphasize the eccentric element and we'll get a similar effect here. But what we want to consider is do we want to amplify the current strategy that our patient, client or athlete is using or do we want to dampen that strategy and try to recapture some element of adaptability that they don't have. And so that's the first thing that we have to decide based on what they're presenting with. So let me give you a for instance, let me grab my pelvis real quick. So if I have somebody that is concentrically oriented in the pelvic diaphragm, so somebody that is reliant on high force outputs, and so they've trained themselves to maintain some measure of concentric orientation in the pelvic diaphragm, so they would have the nutated sacrum, they emphasize exhalation strategies And again, there are just so many that produces high-force. So power lifters or an offensive lineman, somebody that has to spend a lot of time producing prolonged efforts at high-force output. So what we could do is we could say, well, I want to continue to emphasize this. I want to magnify it to the nth degree. And so I'm going to use my flywheel strategy. So I'm going to use a very, very heavy resistance. So a very, very strong eccentric load. And I'm going to have them try to resist that because I want to magnify the exhalation strategy. I'm going to magnify the concentric orientation. I do not want descent of that diaphragm under any circumstances because in the situation of a power lifter squatting a very, very heavy load, the minute that they become too eccentrically oriented, they accelerate towards the earth, which is what they don't want to do. And so they want to continue to try to produce as much force output throughout. And so once again, so this will train them to magnify the current strategy, which actually may enhance performance. However, if my goal is to make someone more explosive, have them move quickly, then these circumstances may not be a benefit. Because again, to move quickly, I have to move into an eccentric orientation to a concentric orientation very quickly. If the strategy does not allow them to capture the eccentric orientation to begin with, then while they can still produce high levels of force, they can't do so within a time constraint. So again, they can't be quick. They can't be explosive. And so under those circumstances, this eccentric overload strategy really isn't a benefit.

And so under these situations, this is where stretching is going to fail. So maybe you get an increase in stretch tolerance, maybe you get a temporary change in viscoelastic properties of tissues, but ultimately this is why stretching is going to fail. So what happens when stretching does work? So say for instance, say I'm doing a long seated toe touch, and I do it over time and eventually I find that my flexibility improves where I can actually take my forehead to my knees and I say, wow, my hamstrings really increased in their length. That's not really happening. What you're actually doing is you're actually creating this scenario in a favorable way where you're actually able to capture a gradient that allows greater motion to occur at the hip joint which might allow you to bend forward more or you're allowing the posterior aspect of the thorax and pelvis to expand to capture its inhalation capabilities and then I again capture gradient that allows me to move better. So the bottom line of this entire situation is for normal movement to occur or for your ability to recapture range of motion, you have to be able to create a gradient inside the joint or inside the space. So inside the space would be inside the thorax, inside the joint would be inside any synovial joint. If I cannot move the fluid from side to side across the joint, I cannot recapture range of motion. That's why using breathing and position and trying to acquire concentric orientation of eccentric musculature and in trying to capture eccentric orientation of concentric musculature is so important in reacquiring range of motion because I have to have this scenario. I have to have a gradient that exists to allow movement to occur.

And so let me give you an example of where muscle and tendon can be actually stiffer than a bone, and that would be in the case of a avulsion fracture. So under those circumstances, because the tensile components of force were applied in some way shape or form at that moment in time to these tissues, the muscle and the tendon became stiffer than the bone and so it rips a piece of the bone loose. So at that point, the bone is actually less stiff, so that would imply that the muscle and tendon at that point could have been a compressive element and then the tension element was represented by the bone. And so I don't think that we can blindly say that these are the compressive elements and these are the tension elements because I think it matters what the context is. And under those circumstances, again, I think tensegrity is probably the best representation that we do have because of the way that we are constructed because of the forces that we are able to withstand, and it just stands to reason that this is how we would distribute these loads because if you think about the way that a lot of these loads are calculated through Euclidean geometry they far exceed what we should be able to tolerate. And so the only way that we can tolerate a lot of these forces is to distribute the load throughout the entire system, which would be a tensegrity-based system. So, do I think it's a literal tensegrity structure? I don't know and I don't care. I just think it's the best model that we have right now.

and so if we move up into the thorax and we close off that dorsal rostral area, which is equivalent to nutation, you're definitely gonna see the neck move into extension just as you described. So well done, Eli. Keep up the great work and keep up your offerings. I truly appreciate it.

Now you may have a situation where we have a structural adaptation that is influencing the outcome and that might be when we have to make the consult with the orthopedic surgeon under those circumstances. But that's how you're going to determine this, Ryan. It's going to be part of the process. It's not about making an immediate leap because people overcome things all the time. People walk in with rotator cuff tears that they will overcome those people come in with these perceived laxities and they're able to overcome those so again I always default to you make the attempts first you run yourself through the process and You see what they can reacquire you see what they get they can learn to control and if that doesn't work That's when you start to make the assumption that okay, maybe I do have a situation where structure has changed to such a degree and that I need to bring in another element of service or integration. So hopefully that answers that first part. When we talk about a tissue, would you call it a tissue extensibility limitation? So the thing that pops into my head under those circumstances or situations where maybe we have a person that comes in that has been diagnosed with a frozen shoulder and so under those circumstances what would happen as you run through the process as you attempt your global or more systemic influences In treatment, you'll see that you don't get the local changes that you expect. In that circumstance, now you need to think about what you have in your toolbox that will address those local issues. Maybe you do have a tissue adaptation that can occur under those circumstances. And so again that's going to be just a longer process and so your strategies will be a little different because if you're truly looking at a tissue adaptation it's rare, it's rare I think that those situations actually occur. I think there's a lot of other influences that are going on in regard to the way that the nervous system is behaving. and based on the way that those changes take place because some of those adaptations, if they were true, I don't think all of those would be recapturable, especially with some of the capsular adaptations and then the aggression with which you would have to apply forces to make those changes. Having worked with a fair amount of people that have been diagnosed with frozen shoulders and seeing what is truly able to be recaptured, I don't think we're looking at those adaptations necessarily. I think we're looking at a lot of influences of the nervous system which can occur locally We do have local environmental changes in regard to the shape change of the proteins themselves. So we talk about the contractual elements changing. And so those environments can change with different forms of manual therapy, different influences of medication, etc.

So there's no great subjective or objective way to measure tissue quality. Now, having said that, I do think that with practice we can identify some vague representation of tension in the system. So if you were to concentrically orient your biceps muscle aggressively, you can tell that it gets more firm. And as you relax, you can tell that it becomes more flaccid. So those would be some extremes. So if we can tell the difference there, then through practice, we may be able to identify a little bit of difference in regards to how much tension there is in the system. But we wouldn't be able to tell whether something is necessarily concentrically or eccentrically oriented. What we might be able to tell is, is there a difference? Is that difference favorable? I think that is determined by the outcome, maybe based on subjective information from your client or patient, or maybe some identification of sensitivity of that area, perhaps. But as far as trying to rate it or make some form of comparison, There might be, like I said, with experience, some qualitative level of identification. I don't think it's very useful. I don't think most musculoskeletal diagnoses by name are very useful. So, Michelle, you've asked some really, really good questions here, but I think that a lot of it is just unfortunately not very useful in what we do for a living. And so I would hope that we can sort of throw that one out along with any number of words like the C word, the F word, and the N word. And so I'm talking about core, functional, and neutral. And so let's put tissue quality on that list as well. Why don't we go ahead and do that?

So Tim actually has a third question. He asks, in a perfect world, do we start at the first compensation? Teach the wides to exhale. So that's a compensatory inhalation strategy if they are wide ISA. So he wants to know if we teach the wides to exhale and if we teach the narrows to inhale. I would say yes, because what we need, Tim, is a dynamic ISA, which would be representative of the ability to move the diaphragm. So if we can't move the diaphragm into an inhaled or exhaled position, it becomes very, very difficult to change anything else. And a lot of times, just by getting the ISA to move dynamically, getting more excursion of the thoracic diaphragm and the pelvic diaphragm, we see a lot of good things happen. So a lot of times on the first intervention, you'll see a lot of changes in regard to how much internal and external rotation you can recapture in both the hip and the shoulder just by your intention being to get the ISA to move much more effectively. So yes, you would go there first.

Coach Ledesma asks something referring to the infrasternal angle after establishing a wide versus a narrow, what will be your next step? The reason that we use the concept of wide versus narrow is because it allows us to determine what the compensatory strategy may be in a situation where somebody does not have full excursion of exhalation. That's simple and that guides our interventions and allows us to make better decisions based on probabilities. They're not absolute, which is a very great area. So always keep that in mind. And this concept is going to be idiosyncratic to that individual because their physics are going to be individualized. So that would be step one. He continues: 'What is done with individuals who do not have a wider narrow? So you could say you're 108.8. what strategies would be used there?' So the 108 thing is the vortex angle. We're using the ISA as an estimate of the vortex angle, which would be representative of the ability to move through this full excursion of compression and expansion, or inhalation and exhalation, as we would say for us humans. But what we're looking for is not some ideal measurement. We're looking for the dynamic ISA. So we want an ISA that will open into inhalation and close into exhalation sufficiently to be able to access extremity and actual skeletal range of motion so we can do all the fun things that we like to do from a sports perspective. So we're not really looking for any specific one angle. And again, people are going to be idiosyncratic because people's structures are different, and so what their optimal is going to be determined by those individual physics. So hopefully that touches on what you're looking for. But to reiterate, We're using the assay to identify the first level compensatory strategy to allow us to select the best intervention for that individual. So again if somebody's narrow we're going to make an assumption in regards to their orientations that would benefit from certain positions like quadruped for instance. Wides tend to not do as well early with quadruped activities and will tend to be more biased towards the sideline strategy in most cases for those wide. So hopefully that gives you a little bit of information as to how you want to start based on the infrastructure angle presentation.

So again, I don't like to use that type of a cue because I just don't know what kind of a strategy that I'm going to get. In fact, many times, we actually have to cue people out of that strategy to restore the full movement capabilities of the pelvis and the sacrum to coordinate with the breathing cycle. So again, I don't use that cue at all. But I thank you very much for those questions. Those are really good questions, Dana. So my next question comes from Alexa. She's a physiotherapy student in Scotland. So I'm about to graduate and will soon be entering the workforce. Congratulations, Alexa. You have mentioned in some of your past videos, important fields of science that should be considered in PT practice such as dynamic anatomy and physiology. I was wondering what fields and areas of science you would recommend an entry level PT to study and read. Additionally, do you have any advice for a new PT about to embark on this epic journey of starting in the field? So my biases in regards to the sciences that you're going to use are going to be more towards the physics side of things. So when we think about everything that relies on first principles and how we move, when we talk about pressures and volumes and fluid shifts and gradients and things of that sort, that all comes from physics. So the better that you understand that as a foundation of everything that we do, I think the more logical everything will start to seem. Superimpose that with the dynamic anatomy concept. So understand the foundations of how you evolved embryologically. So knowing where you came from is a phrase that I use a lot with the Padawans. And so you have to learn how to capture the meaningfulness of the anatomy with the underlying understanding of the physics involved. And so I think that that's where our thought processes really need to go. Rather than looking at the structural reductionist model that's typically taught in physical therapy school, I think that understanding that we are morphing, we are shape changing versus a series of levers and pulleys that behaves in this Euclidean geometric manner, which doesn't really apply, because when you look at the forces, the forces probably aren't realistic. If you look at where we came from, going way back from the evolutionary perspective, if we think about how we evolved from a single cell, the principles would have to be the same even on this macro level. The thing that we understand about complexity is that it started from simple rules and we just repeat those simple rules. I would say that spend your time understanding the physics of how we move. Look at how fluid works. Look at how gradients influence how those fluids shift, and that should be the foundation of your thought processes and then superimpose the dynamic anatomy. So learn the anatomy in a context rather than looking at it as we would a cadaver. Look at this as a fluid model, and I think that that's going to provide you a much more useful model in the future. So I wish you luck. The thing that I would also encourage you to do is get really good at what you do first. So spend a lot of time learning, spend a lot of time practicing. You're going to fail a lot; it's important that you fail, but you fail safely. You never hurt anyone, but it's important that you fail. And then I would say you need to find a mentor, someone that can lead you, because there are elements of understanding that can't be written down; they can't be expressed easily. This is what we call tacit knowledge, and this is what you acquire from a mentor, from experience. And so this is where your focus needs to be for the next three to five years. And by then, you should start to get better at determining from a probability standpoint what would be the best course of action. This is how you're going to get good as a physical therapist. So hopefully that provides you a little element of guidance in this regard. And by all means, keep asking questions. Always ask questions and try to answer them yourselves and then seek out the answers from other people and other resources. But keep the questions coming towards me. I'm happy to help. I love working with students, especially when they are enthusiastic and motivated. So thank you, Alexa, and good luck.

So going through her evaluation, she's going through yoga teacher training, but her active straight leg raise was 65 degrees on both sides. So that's a big thing right there. Her hip internal rotation was 25 degrees on her right and 15 on her left. That was another one that really stood out. Then looking at shoulder flexion for her bilaterally, it was 130 degrees. So that was okay; we need to clean up hip internal rotation and shoulder flexion, and then with that, hopefully the straight leg raise improves.