Right. And I would be going after the eversion of the calcaneus and I want to twist the midfoot in the opposite direction. Would that be right? If I invert the calcaneus, I have to invert the forefoot.

Right. That's what childhood is for. That's what your youth is for—to do stuff. You have very low risk situations when you're young. It's like, what do you have to lose? Absolutely nothing. You don't own anything. You don't have any money. And so you just do stuff. Then you sort of find out, you know what? I'm really, really good at this. And I start moving in this direction. Then maybe it's a dead end. Who knows? But we all hit any number of dead ends through this process. What people end up doing is they do what they think they should do, or they follow a path that they've been told to follow. Sometimes it works out great. I'll give you an example. One of the kids I used to work with when I started working in high school and through college. He's now an orthopedic surgeon. Oh well. His dad was an orthopedic surgeon. And it turns out that he's a really good orthopedic surgeon. But what if he wasn't? What if he forced himself into that situation and found out, oh my gosh, this is just a horrible, miserable existence? Because it could have been. It just turned out that he's a lot like his dad. His dad was a really good orthopedic surgeon, and it turns out that he's a really good orthopedic surgeon. Everybody says, oh, he just followed the same path as his dad. No, he followed his strengths. And he could have been really good at something else based on those strengths. It just happens that there was a predisposition based on his familiarity with things. So he kind of followed the same general direction, but he's not his dad. He's not the same surgeon that his dad is, and potentially could be better. The point is, me expressing how I got here—you can't do it. It's not even feasible for you to even do it. But if that's the path you think you should take because it follows your strengths, you will find your way if the desire is sufficient. Do you need a credential? Okay, pursue that credential. Do you need a skill? Yes, pursue that skill. I don't know what your skill set is because it's different from mine. So me saying, well, I did this and I did this and you go, well, I'm going to do that too—wait, but that's not your path. The thing people need to recognize is they have to discover these things for themselves because then there's an emotional attachment and it becomes meaningful. If I tell you, here's what I did, everybody goes, wow, let's do that. And it's like, no, you can't do that. You can't do that. You have to find your own path. I will happily tell you my story for entertainment purposes, but I don't think it's terribly meaningful.

Okay. Easy enough. I'll try that today. So as far as getting the upper extremity, say, I'm trying to think of a way to organize the activity so that you can get that same gradient or differential that you're trying to create with the lateral sled drag with the hip attachment in the thorax as well. Is that kind of what you were saying with the bar kind of going wide? And then like, is there anything you could add to that activity?

You mess with this, like you try to teach them to roll and then they lift their leg up. Yeah, you know why? Because they're just going where they can go, right? So they can't, they can't scissor, they can't scissor their legs. They got to go like that, right? They're telling, like, if you, if you understand the language, it's like the patients tell you what to do. Right? It's like, somebody comes in. Okay. So here you go. Somebody comes in with a, with a complain of shoulder pain, Alex. They say, it's my right shoulder. I can't sleep on my right side. Um. And then when I lay on my left side, I got to put a pillow between my knees because my back starts to hurt. It's like they're telling you what to do. It's like, Oh, okay. I need, I need AP expansion on the right, on the right side because they can't access spaces. Right? They have to twist their spine to put their legs into a, into a position because they can't bring their knees close enough together. They literally have to turn their spine towards the, towards the, they have to IR the spine into the bed. And that's really uncomfortable cause it's compressive all night long. Well, how do you move them back into an ER orientation? Well, you put a pillow between their legs. You see it? Yeah. Yeah. That's why you do a subjective interview before you touch people is because they tell you what to do. But see, that's what all this like when you're in school and they said, these are the questions that you ask somebody when they come in with shoulder pain. These are the questions that you ask somebody when they come in with whatever, whatever, right? It's like, no, you just ask the same questions. Because you just want to find out what shapes that can acquire, right? You ever ask somebody like this, which hurts worse standing or sitting? Right. It's like sitting hurts. Okay. That means you're in a standing position, but you're trying to sit. Right. And then you go, oh, as soon as I stand up, I feel great. Okay. I know what orientation you're in before we even start. Get it?

I tell you, I tell you asked me to figure out where his. I misunderstood the question.

All right. That makes more sense.

I think that's another one. Whereas things like anterior compression would be like excessive forward head, probably an inability to even extend the arm overhead, probably a pronated hand if you don't have the IR at the shoulder.

More oblique.

Good morning. Happy Wednesday. I have my coffee in hand and it is perfect. All right. It is Wednesday, which means tomorrow at 6 a.m. is the Coffee and Coaches Conference call as usual. If you haven't participated in these Q&A calls, I suggest you do. They feature great people, and you should get yourself a cup of coffee. Please join us and bring your questions. I'm happy to answer those with everyone's involvement. So again, it's been great and we'll keep doing these. All right, let's dig into today's Q&A. This is with Ivan. Ivan's question had to do with knees moving inward during squats. He sees this with people descending in the squat and in some situations when they're ascending. He wanted to understand the reasoning behind that. A lot of times this gets blamed on ridiculous things like weak gluteus medius, which is just a misunderstanding of hip mechanics. So we need to understand the reasoning and break that down for you. We'll also discuss a few solutions. One thing you want to recognize is to avoid being myopic in your evaluation. If you're just looking at the knees and say you put a band around them to hold their position, you have to look at what else you did to the system. In many cases, you'll end up with another substitution. It's like giving a swing fault to a golfer to fix a swing fault. You must be aware of what you're looking at. For instance, you might actually increase the orientation of a pelvis that you didn't want to change. Just keep those things in mind. If you'd like a 15-minute consultation, email askbillhartman@gmail.com with '15-minute consultation' in the subject line. We'll arrange that at our mutual convenience. See you tomorrow morning at 6 a.m. for the Coffee and Coaches conference call. Everyone have an outstanding Wednesday, and I'll see you tomorrow. Hello, Bill. Greetings. How are you? Outstanding.

Okay, good morning. So does the yielding from early increase all the way through middle until max P and then go to overcoming?

Right. And then if they have to keep orienting, you know what happens?

Yeah. Yeah.

Right. And then the more capability someone has to be able to alter like the behavior of their eyes, which is why it's a behavior and not just like a measurement indicates their ability to create and move into more spaces.

Yeah, yeah, yeah.

So this person with a spondy is a horseback rider?

Okay. And so they changed some stuff. And so the behavior is going to be modified. So you've got a centrally driven issue. And then you've got the constraint that is altered. And then you have the response of the entire system of not wanting to propagate the wave into the shoulder. It's going to try to stop it. Right? So that when people say, oh, you're guarding, right? They say that you couldn't, that's just muscle activity, right? For a reason, for a reason, okay? So number one, you need to make sure that you are capturing the early representation throughout on that side, okay? Because if you think about what's most likely going on as he is erring the shoulder, do you think he's actually erring at the glenohumeral joint?

So that's why, because I couldn't, the way I was doing it, I always thought, all right, I want to get ER. And I would get ER even if I roll with the, but I would get, I would push them into late, right?

And then I have to superimpose the endurance on top of that. So now how many times can I produce that same measure of power output?

My question is about confirming my thought process with exercise progressions and knowing when someone is ready to progress. Context: I have several post-op ACL patients in a similar rehab phase. I'm teaching them force absorption at higher velocities prior to plyometrics. Most are narrow stances and low force producers. When performing an exercise like a kettlebell clean on a slambord with cues to wait for the weight and then drop with it, I'm trying to teach the initial yield. However, they just drop down as if gravity is pulling them through, without controlled deceleration. I'm considering keeping the same exercise but having them aggressively drop underneath the weight to teach concentric orientation of the diaphragm. My question is: I find it easier to assess progress when the goal is recapturing range of motion because it's a clear pass/fail. When transitioning from a yielding bias to a concentric orientation bias, is assessment strictly visual? Do I look for specific cues like them not 'bottoming out' like they used to? Or are there specific indicators that would tell me they've successfully made this transition?

In hook line.

It's a biggie. It's a biggie. That's a biggie. Look where it's attached. Look where tibialis anterior is attached.

Okay. Great. So the question I have is, do you see any utility in performing an unloaded unilateral exercise while breathing in as you produce force instead of breathing out? Because after our conversation about the boxing punch, the thought I had is that you want to maintain external rotation (ER) space and then quickly impose internal rotation (IR) and return to ER. So you want to maintain that expansion. I was thinking that if you are able to breathe in while producing force in a certain vector, you might create more local compression while maintaining expansion in surrounding areas. Would you see any utility in that, whatever you can share?

Okay.

Well, I guess to that question would be, it depends. Like it's just, you don't know until you do it, but how do you go about bringing someone back more slowly or not as far versus bringing them back more quickly and further with a given exercise?

Yeah.

Yeah.

Yeah, I'm still piecing a lot of your elbow stuff together and hand stuff. So I will have questions to come.

Yeah. At a previous clinic I worked at a number of the practitioners had done her integrated systems model training and they kind of used that. So her big thing is, you know, trying to find the individual's driver that influences their task. So I was wondering for you how caught up do you get in a person's, you know, injury history and things like that with that kind of guiding your assessment or your treatment? Or do you just go off what you see and what you find and see how you can influence that?

Exactly. It stands to reason that people are going to be represented by their structure. So that's when you see that Annabird femurs, retroverted femurs, and all those representations, that's just a byproduct of strategy that's associated with physical structure. It doesn't mean that they're unchangeable. It just means that you might have a limit as to how much change you're going to make. But as you stated in your question, it's like the principles still hold. It doesn't change what you do. It just might put the cap on what your expectations should be, right? Versus, you know, maybe, so I had a Padawan long time ago, long time ago. 90 degrees of hit by R. Okay. Okay, 90.

That is correct. So the thing you got to look at, Matt, is what's going on. The best representation of this is at the sacrum, as far as understanding the representations. So if you look at sacral orientation, at the beginning of the squat because you're standing. So we're always biased in standing. You're gonna be biased more towards the compression at the base of the sacrum. So the base of the sacrum is gonna be pushed forward. But we want to have the ER representation because we're going to move into a position that's going to be very, very strongly internally rotated as you pass through the middle range. So the sticking point is where you produce the greatest amount of force. And so that's going to be where you're internally rotated. So we use the internally rotated representations for force production. ER can't do it. People that try to do it in ER usually have discomfort. Okay.