I think for me, starting from like zero IR on the left hip and like being nice to myself, negative five in the right, going to 20, I think is maybe like a representative of like picking up a substantial amount.

Gotcha. So I was trying to drive yielding in a specific area. Can I just make that movement slower in essence?

Yeah, but there are two kinds of climber's elbow. Most people refer to golfer's elbow as climber's elbow, but there are also people who get tennis elbow from climbing. There are two kinds, and they all do these twisty things with the twisty bars and extensor work and all these things and stretching like the whole day, getting anything.

Yeah, yeah. We have two minutes. Okay. So I guess my next question is actually more with regard to assessment. Like, I know you've mentioned Diane Lee in previous videos about her thorax and pelvis approach. Her big thing is trying to find the individual's driver that influences their task. I was wondering for you how much do you get caught up in a person's injury history and things like that in guiding your assessment or treatment? Or do you just go off what you see and find and see how you can influence that?

So, everybody has a structure. They're going to have biases built into that structure. They're going to have certain strategies they use to move through space. The people who use strategies that drive those torsions stand out. Observers take a snapshot and say, 'This hip is shaped this way, this hip is shaped this way. That's how you are.' All they're telling you is what your bias will be based on physical structure. It doesn't mean they're unchangeable; it just means that's your bias. The degree to which someone can change has limits. You might have somebody biased toward the narrow ISA archetype with a proximal hip representation probably biased more toward ER. You'll have another with a wider representation biased more toward IR. Which do you think would show up in your study as the people with reduced torsion angle creating the IR representation?

Okay.

You have a great day.

Okay, so you're absolutely on point here. We have to attend to that again. We first have to decide what our intention is. Under most circumstances, when we're trying to recapture movement, the greatest excursion is directly on this helical angle. So some of the wider ISAs are going to be on a much flatter angle for any of those types of activities. And then we have to respect the fact that the depth of our stance is also going to be an influence. So when we talk about stances and we have two feet here, if I'm staggering my stance, it's like my narrow ISA I can put here because they have much greater potential for a much tighter turn. Whereas my wider ISA, again, if this is a parallel stance, I'm going to offset it this way, but I'm going to bias them more in a side-to-side stance because again, that's where that helical angle is going to fall on its greatest excursion. So less turn, right? So it's not an angle. And that doesn't mean that we can't get them to a steeper angle eventually. It just means that their bias will prevent us from going to any form of extreme if our goal is to recapture ranges of motion at least at the onset. It's like once we've established some measure of relative motion, we have greater potential for turns, but by the archetype, the one, the narrow bias is always going to have a greater potential for turn. They have a much tighter helical orientation that's going to allow that to happen.

Oh my golly it is. Okay, I'll take the month then. There you go. All right, brother. So much bill.

Right. And then you can relate that to how other movements look. And so the really easy representation of the split squat then can be built up on top of with your other representations of movements.

Yeah, yeah, I agree. I want to switch gears kind of to the last call we had. I don't think I framed the question well enough to get a good answer, a good discussion of it. We were talking about not taking credit for when a patient gets better, but also feeling or I guess maintaining responsibility for when they don't. And I feel like those two things kind of contradict each other. And I guess my question is how do you find that balance of not taking credit when a patient gets better? Because if you don't do that, how can you be responsible if they don't get better? You know what I'm saying?

Right, right.

Let's change the perspective on that just a little bit. Let's not call them norms. Norm implies normal. Let's call it average. Let's call them averages from now on. Because norm is idiosyncratic. Normal for one person is not normal for someone else. Physical structure determines what your capabilities will be. That's why certain structures are ideal for certain activities. Look at the Olympics on TV and watch the swimming. Before they start the race and they introduce everybody that's on the blocks, they all look exactly the same. Like their body types are exactly the same because that body type is ideal for swimming. And what you can tell them apart is the color of their caps. Everybody's movement is idiosyncratic. That's why I'm such a stickler about remaining process oriented. It's like, I want this guy to have more shoulder flexion. Guess what? He might not have it ever because his physical structure does not lend it to having that. Can he reach overhead? Yes. How does he do it compared to someone else? And let's use the Olympic swimmer example. Does an Olympic swimmer reach overhead the same way as a five-foot-ten, 310-pound strongman? Probably not. It doesn't mean that they both can't achieve a similar task. It just means that the way they're going to do it is going to be dependent on their physical structure. So again, I encourage you to look at this stuff from an idiosyncratic standpoint. Yes, we have generalities that we can use to describe things, but ultimately, what someone is capable of is not the same thing that someone else is capable of. We are making comparisons to an average. Is a 90-degree straight leg raise best for increasing your back squat? For someone, maybe it is representative of that. For someone else, maybe not. And again, I sound like a broken record some days, but that's why this job is hard. Because you're dealing with individuals. We have similarities that can guide us. But ultimately, when you're working with someone, you have to take into consideration their individual capabilities.

Oh, okay. So, but you work with power lifters. Yeah.

Absolutely. And so it's kind of like the same thing that we were talking about. It's like, okay, do you want her to climb hills on that thing? Probably not. So we want her in the saddle. We want a position that allows her to expand posteriorly. The advantage of the spin bikes is that you can work through different arm positions. So I can work on arms extended to create the posterior expansion, or I could go through elbows to get the posterior expansion. So now you have some options to play with, and you say, which one provides the best posterior expansion for you? Which one gives you the best head and neck position to allow her to breathe? And so you can use that in your favor. The question that I would always offer is like, you're just going to have to monitor the level of effort for her because the minute you start driving the effort up, she starts to squeeze again. And so she's going to be the one that does probably a lot more steady state than somebody that would be working like hard intervals. Like I said, you don't want to climb on hills on a bike because all that's going to do is like, it's all propulsion. She's going to be driving hard from the back and she's going to be trying to shove herself forward. We want her to go backwards. But I do like those bikes because they do allow us to capture positions that allow that posterior expansion. So all you got to do is look at this stuff and say, what influence do I need? Okay, she's flat on the back. She's compressed in the back. How can I get her to expand and allow her to exercise at the same time? Relative intensities matter, positions matter, and all you got to do is reinforce it.

You see it? So is that why you get this incredibly late propulsive foot that's almost completely flat? Because that's their internal rotation. Is the foot the last thing to come forward in internal rotation?

Rounded shoulders in an internally rotated position. What if I fix the humerus? So you're using that 'dead guy' representation of the lats. Are you sitting at a desk? Stand up and put your hands on the desk with your arms straight and leaning on them. Now pick up your right hand, push through your left hand, and turn your body to the right without moving your arm. That's the latissimus dorsi turning you to the right.

Potentially. You have uneven forces in the abdomen relative to the influence of gravity, the volume of the guts, and the weight of the guts all creating demand. So I have a huge small intestine in there that's going to be biased in a certain position. I've got a big liver that's biased in a certain position. And I talk about those because their volumes are actually very, very great and they actually create forces in the same direction. So I have a lot of internal volume that produces a lot of uneven force, and so I have to control that. The diaphragm is one element of that. We have a lot of musculature in the axial skeleton and superficially that's going to control those positions. Once I superimpose other demands, other than just gravity against whatever structure I have while I'm breathing, I also have the influence of movement. And you know, as well as I do, that as soon as you put a heavy barbell in somebody's hands, a lot of stuff changes too.

All right. I know no hobble. I'm good. Every Thursday every Thursday. So there you go. Okay. What's your question my friend?

Because if there are two possibilities to get my arm into that position, but it's dependent on the context, then there can't be one solution that I call flexion. Is it? Right. But then it's not helpful anymore. You see?

It is true.

I agree. For people who are younger or don't know that, they're going to think there's something wrong with them.

This is a management and a strategy, right? Like we're taking advantage of these things. It's the people that lose their capacity to take advantage of it that have problem.

It depends on how far forward the center of gravity is.

Yes. Yeah. In terms of right ball foot heel.

Okay. Yeah, that makes sense.

If you look at jumping off a box, sticking the landing and holding, versus landing and jumping, the relative timing is different. When you look at the position on the ground where they would land and stick, the duration they're in that position would be similar under both circumstances, but the time spent in that position would differ. Under the first circumstance, the dampener is the connective tissue behavior, right? That would be the yield in the landing versus the yield to overcome in a shorter time window. It would be the connective tissue behavior that's associated with the transfer of energy in both circumstances. One is dampening and dissipating it; the other is storing and releasing it in a direction.

It would move them. So you're going to push them towards whatever light, I mean, their chances are they're already in a light representation and you're going to stick them there. Like you're not going to give them any opportunity to shift the center of gravity back at all on that right side. You'll get a magnification. You might get a further magnification of the ER compensatory strategy, right? You'll twist an acetabulum into ER, you'll bend the femur into ER, knee will follow.

Talk about this, but it's just walking.

Yeah.