You don't want to push them forward if they're already going forward. They can't unweight that side. So if you put a heel lift in, the right side does not go up. You are literally just squeezing the right shoulder and the right heel closer together. Like you're not going to get an elevation on that side. There's too much weight on that side.

Yeah. So, internal rotations come in this way in the backswing on a right-handed golfer. Internal rotations go that way. Away from me. There's the turn. See it?

Yeah.

All right, that's what I had in mind. Good, thanks for that.

So I was just going to say for your friend. Okay. So let's do a quick rundown of potential influences that would prevent it from happening. So that's kind of where you want to start with your assessment. It's like, okay, if I need the subtalar joint to move the foot into the mid-propulsive representation. Okay. So there's inversion bias, traditional pronation, that kind of thing. Okay. There's a big muscle right off the bat that's going to be problematic.

Awesome. Okay. How many reps of dynamic effort box squats? So let's just say that you're really fast and you can do three reps in two seconds. How many times does my pitcher need to be able to do that?

So number one, we expect the anti-orientation, right? I would never expect to alleviate that entirely for someone that does what she does, okay? But can you appreciate the fact that the left side is ahead of the right side under this circumstance?

It's going to be posteriorly.

If he keeps it straight, he's just going to do the screw home and get it through the knee.

No. Therapists treating themselves is not a law of physical therapy. You have the least objectivity with yourself. I can vouch. Fair enough. Fair enough. You're going to spend most of your time trying to get a true ER representation back in the hip. And then reducing the anti-orientation. And then she's probably going to be a pretty happy camper. Cause I think not only will you alleviate symptoms, but most likely you'll, she'll get a bump in performance too.

Yeah. I guess we just need to be better about putting all the different pieces of the puzzle together.

Who's somebody else? Somebody else said, Liam too. Who was that? Was that Don? Maybe. Good call, Don. I'm going to meet you though. Okay. So wouldn't it be cool if I had a paddle and a rudder in the leg to help me direct that as well?

You're OCD. A power lifter with obsessive compulsive disorder, I find that very difficult.

Bingo. Yeah, so she was in proximal; she had the proximal tibia ER relative to the femur, which is one of the most common reasons you get posterior lateral knee pain with a compressed knee bend. That's real common. This is also probably one of the reasons you would get a posterior horn injury with a deep knee flexion injury, like a skiing injury or a deep squat or something like that. Because you've got a fluid compartment there that is incompressible. That's what they're feeling. Take that same fluid compartment and compress the posterior lateral knee with a deep knee bend. There's your posterior horn injury.

It's a thousand years old, Nicky. So Adam Campbell gets the byline on that one, right? Yeah. Adam is a dear friend of mine. Yeah, we go way back to like 2003, I think was the first article I wrote for him.

Hey, dude, don't discount that. You did an amazing thing in a very short period of time because of your reasoning. That's great. I love it.

Okay, so here's what I would do is I would try to understand the sensations that are associated with how connective tissue behaves. Again, so there's different types of receptors that respond to different things that promote a different, like entirely different responses. So your response to pressure and your response to tension are not the same. And so that's what we're talking about here. That's why certain activities are better for reducing concentric orientation. Some activities are lousy at it. That's why, again, static stretching has a place. When people say it doesn't work, they don't understand what it does. It just doesn't do what people think it does or want it to. It has its place. It has use. But when we're trying to reduce motor output, okay? Positions, pressures, et cetera, are the bigger influence here, okay?

And then again, make sure that you have all of your foot contacts as well. Okay. Yeah.

Gotcha. So I feel like this keeps coming back to just either like if we want to simplify it, just either a rate dependent quality or the ability to do the position.

Yes. A re-ER. So that's when we do see that E-R-I-R-E-R. But you actually, so in the bottom of a deep squat, you're gonna actually lose lateral knee contact, so to speak. I mean, it's not actually touching or anything like that, but it's very passively compressed under that circumstance. And so there's that turn into ER, where they've got pictures of this on MRIs where they do the extreme end range of passive knee bending. You actually see the tibial plateau slide away from the femoral condyle where they will say that it loses contact, but it was never touching in the first place, but you will see it almost disassociate. So if I'm trying to get the only way that happens is with an ER turn, ER turn.

Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah.

Yeah. She probably doesn't know how the disc is herniated either. Right.

Can't produce the delay.

It's instead of having this small influence of muscle activity, I have to use too much muscle activity right and now I don't create spaces, I don't create a compression and an expansion which would move me. The key element here, when we talk about compressed space and expansion, it's the gradient between the two that provides the movement. Okay. Take a water balloon: I squeeze one end of the water balloon, the other end gets fat. That's movement in that direction. Okay. But if I have so much pressure that there's no gradient, now there's no movement. And then you hear this because they can't breathe or you hear the right. And that's indicative of an exhalation. Right. So again, conceptually, I think you understand it's just that what you may need to do is look at your repertoire of activities, and say, okay, what else could I do under this circumstance? What other position can you use? So you ever put anybody in a quadruped? Okay. You ever see anybody fail miserably at that?

Scoot to the front edge of your chair. Make sure your feet are on the ground, OK? Take two fists and put them between your knees. Gently squeeze and you'll feel like your inner thigh activity increased, right? Now I want you to drop your pelvis back into a posterior orientation. It's going to feel like you took some pressure off your fists to do that, okay? Now squeeze your knees together and you're going to feel more butt activity as you're squeezing your knees together at the same time. So approximately you're increasing the ER. Even though you're squeezing your knees together, you're ER-ing and then pulling your knees together. So you've got way too much extra orientation represented. You cannot produce the early representation of internal rotation. You're actually creating a late strategy in the posterior lower, which is not what you want.

Yeah.

So you can sort of use this diagnostically. When they're doing the step together, look at their feet, and they'll tell you whether they have left hip internal rotation based on where the left foot lands. It'll be slightly in front of the direction that they're facing. So they'll step out and then slide this foot here instead of here. You understand? They might accidentally drag in a diagonal.

Not at all. They roll over?

You see the curve right there? See that curve. That's the toes, the toes curved. If I do this, the spine is just curved forward too. It's an IR representation where you need the expansion, right? See, it all starts to look the same after a while, doesn't it?

Okay. So what's your concern?