I play jazz.

It's kind of analogous to what you talked about, just like the back squat, how it seems slower than some movements, but it's actually a series of instantaneous loads.

Yes. What if there is not, they're so concentric that their ability to load the cuts is ineffective?

Early propulsion has a yielding action. Late propulsion has the overcoming action. So I'm storing energy at the bottom of a squat, and I release the energy at the top of the squat. If I'm stepping forward, I have stiff connective tissues as the leg is moving forward in the swing. As it hits the ground, I have to absorb the energy back into the connective tissues. That's the sacrum moving backwards on the ilium to create the yield and the energy storage action. Does that make sense?

You just made my life much easier with that framework.

And all I have to do is move it up and over top of that femur. So this is going to be an anterior orientation. So I will have traditional extension of the lumbar spine on the side where you get the magnified measure. And so that's going to take this pelvis forward and over top of the femur. And if I take it far enough, I'm going to start to pick up internal rotation because essentially what I'm doing is I'm untwisting the capsule and then I take my measurement and then that picks up all that laxity. It's not laxity. It's just slack in the capsule created by position. I take that up and then I hit the constraint somewhere about 60 because I'm using a dead guy zero position. So a nice representation that I can use is sort of this ringing out the towel concept. So if I look at the twisted towel as if this was the ligamentous structure of the hip, when I'm moving my intro rotation, it's already twisted. And so there's my constraint to intro rotation. But if I reorient the pelvis where it's over top of the femur, and I actually start to untwist the towel first, then I have all of this slack that I can take up in the hip capsule which is going to give me my magnified internal rotation. So remember that I have other internal rotation measures to compare against to make sure that I am dealing with this orientation problem. So for instance, if I lack hip traditional hip extension or ADduction. So traditional hip extension and adduction are internal rotation measures. So if I have a deficit in either one of those, then I know that my magnified internal rotation measure is most likely associated with this orientation. I also have my iterations to compare against as well. But here's the problem that you're going to run into when you see somebody with this magnified hip internal rotation. Chances are when you lay them on the table, what you would typically see is a loss of hip extra rotation associated with the anterior orientation. So your expectation is that the same side shoulder would have a loss of extra rotation, but that rarely shows up in this circumstance. Because of the extreme orientation, because of the traditional extension and intra-rotation of lumbar spine, what happens is I get a thorax that would normally be tilted forward, but it falls backwards on the table. This actually magnifies the extra rotation measures in traditional extra rotation and flexion. So it can be a little bit confusing if you don't have the awareness that the thorax can actually move as you lay them down on the table. So keep that in mind when you're making your comparisons of same side hip to same side shoulder. So Brian in a nutshell. Your strategy is to create the reorientation under these circumstances and not go to blaming laxity.

So for me to finish a chin up, I'm going to need posterior lower expansion, which means that you better be able to control your infrasternal angle by abdominal activity because what I have to do is I have to use my abdomen, my abdominal muscles to push volume posteriorly into the posterior thorax to keep that expanded so I can access the end range position. If you don't expand that, there is no external rotation range of motion available to you. Therefore, you cannot finish the exercise. So this is for those fine folks that are struggling to get their chest to the bar if they want to or their chin over the bar if they want to. Because what you can't do is you're not expanding that. So again, you're arching your back to produce your internal rotation; you compress to such a degree that you no longer have any range of motion available to you. So the compressive strategy is so great you don't have ER, you don't have IR, motion stops, and the chin up is done. You'll see this in a lot of very, like the massive body blows that go through this almost like just simple middle range excursions because they just don't have any range of motion available to them.

So you are 100% correct, Norman, that everything we are doing under this circumstance is an exhalation bias. By cueing a strong exhalation at lockout, you are going to enhance their ability to lock it out. Now, here is what I would caution you against. If you release too much pressure, if you release the pressure too soon through an exhalation, they are going to fail the lift. So there is an element of timing that is going to be associated with this. In most cases, what you are going to see is you are going to see people maintain their breath hold throughout, or you are going to hear like the smallest little grunt or groan as they are locking this out because we want to minimize, we want to minimize that release. We tend to let the air out under these circumstances so we can actually capture the position. So again, we need external rotation. We need some eccentric orientation to achieve positions, but we want to minimize that. So, Norman, thank you for that question. I hope that answers it for you.

So now you've set up your hook line, you drive your hook line activities, we're going to recapture even more of that posterior orientation of the pelvis, we're going to reduce the concentric orientation that was limiting our hip flexion measures. And so now we have bought ourselves some hip flexion, which is great because chances are we're going to be able to move somebody into half kneeling progressions and split stance variations because we need the knee flexion position to untwist the distal femur. So let's go back to old school physical therapy where all knee problems were blamed on a weak VMO. Well, they weren't exactly wrong. They just had the wrong concept in mind. Typically what you're going to have when you have these tibial femoral ER situations is that you've got a distal vastus lateralis that is concentrically oriented and you get a vastus medialis that is eccentrically oriented. And so that's why we've got this nice little twist going on because the VL is an internal rotator of that distal femur. VM is an external rotator muscle for the distal femur and that's what we got to recapture. So this is why we want to put people in right knee up, half kneeling activities. We're going to superimpose some rotational force onto that so we have to drive that external rotation moment a little bit harder but we're going to respect 90 degree angles so we're 90 degrees at the pelvis relative to the imaginary frontal plane to 90 degrees of hip flexion 90 degrees of knee flexion And we got to capture our foot cues. So again, we can't ignore the foot cues because again, we got to eliminate the tail wagging the dog concept. So once we do that, we can untwist the knee, use your KPI of your knee flexion as your indicator of recapturing the positions. But remember, you got a foot, you got a knee, and you've got pelvic orientation to deal with here in regards to the orientation of the knee itself. a little add-on FYI. If you're able to capture the knee position manually or through your other exercises, but you find that you're not getting those changes to stick, what you may need to do is add in some tibialis anterior retraining. So tibialis anterior tends to be eccentrically oriented when we have this tibial femoral ER situation. So we need to teach it to become more concentric as we flex the knee and extend the flex the ankle. And so we retrain this and this is going to help you manage that proximal tibial external rotation. So ways to measure your success in this circumstance. So do I get the heel to butt flexion KPI to return to what we would consider normal? Do I have a normal knee orientation or do I still have a tibial tubercle that's trying to twist hard into external rotation? So pay attention to that.

Once we can capture 90 degrees of hip flexion, we have many options. We can start rolling activities and teach you how to roll into the affected side, driving propulsive strategies on the opposing side. Regarding gym activities, we can use a box squat with a touch-and-go approach. Remember, we have an eccentrically oriented pelvic diaphragm that we want to concentrically orient. If we unload on the box, we risk eccentric orientation and unwanted yielding action. Having 90 degrees of hip flexion allows us to turn into the side, capturing true external rotation. This is where the Jefferson split squat becomes useful: we start from an externally rotated position and hold that external rotation as we superimpose the normal internal rotation. We could also use split stance activities with an ipsilateral cable load. For example, with a left foot forward split squat, holding the cable in the left hand keeps the left side back while moving from an externally rotated to an internally rotated position. Additionally, 3D straps can be used to promote the desired external rotation orientation and teach resistance against internal rotation.

So we can actually start to use what would be traditionally looked at as a glute bridge position. In this situation, you're going to be moving the hip from a traditionally flexed position to an extended position, but what I'm going to recommend that you do is you put something between your knees that you can squeeze, and that's going to help you maintain the internal rotation moment as you're lifting the pelvis from the floor. Now, here's something that's really, really important. I want to make sure that you capture this bone right here on the ground. So this is your first metatarsal head. It's the bone right behind your big toe. I want to make sure that that stays on the ground as with your heel. So you're going to be moving from this position as you initiate your glute bridge. If you don't capture this first metatarsal head on the ground, if you don't feel it on the ground as you're pushing, you're not going to be able to initiate the propulsive element as you lift off the floor in your glute bridge, and you're not going to be able to move towards internal rotation. You're going to stay into that extra rotation bias. So very important for you. You're probably also going to want to use some gravity reduced propulsive activities, much like you can see on screen right now. And these can move from supine to sideline to prone depending on where you are in this process. But these are going to start to initiate your ability to push through the ground and start to elevate the pelvic outlet into a concentric orientation so you can start to capture that internal pressure. If you move to a quadruped situation, we still keep that pelvic outlet unloaded to a degree, but we're also going to be able to start to drive some of this anterior expansion. So we're going to get some up pump handle. We're going to get some anterior expansion in the front of that pelvis. So any number of activities in quadruped from simple lazy bears to crawling activities are going to work really, really well. If you can work towards an inverted position at some point in time, what you're going to do is you're going to help maintain that anterior expansion throughout the sticking point, which is your 90 degrees of hip and shoulder flexion plus or minus about 30, because you're going to have to maintain pressure through that sticking point as you move down into the split squat and push yourself back up. Now, so let's talk about creating the overcoming action with the concentric pelvic outlet. We can use the box squat here. I love to use the box squat here because as soon as you hit the box, you're going to reduce the amount of eccentric excursion that you've got in that pelvic outlet. So the box is going to stop it. You're not going to get any further descent. So it's a great way to start to initiate your ability to capture the concentric outlet and then start to create the overcoming action.

So what I'm going to do is anteriorly orient my pelvis to get internal rotation and force into the ground. This helps drive the medial aspect of the ground to protect against another inversion sprain, but it results in a loss of external rotation. We must look at this systemically; it's not just an ankle problem. From a strategy, we will try to restore capabilities for middle propulsion. We also must impose rate and variability, because we move quickly through space. If we don't address these, we may not get the input information needed for protection at higher speeds. If you step on a pebble and quickly invert, you're more likely to resprain the ankle. For programming, since we're dealing with foot, knee, and hip positions, we'll first reduce that anterior orientation. An easy way is to place the foot on the wall in supine to capture foot and pelvic cues and reorient. This statically recaptures the pelvic position. Progressively, we'll stand the person up and do a cross-connect in an upright position for ground-up cues. This transitions into dynamic activity, like a single leg RDL with a landmine. Eventually, this becomes very dynamic or explosive, reinforcing yielding capabilities at higher speeds and teaching tissues to absorb and release energy. We'll use this process throughout the program. Next, we must translate the tibia over the foot to go through middle propulsion. We'll use split stance activities. Initially, we'll use a front foot elevation to reduce load on the affected side, allowing more effective tibial translation and capturing true internal rotation at the hip. This keeps the medial calcaneus and first metatarsal head on the ground to prevent external rotation and inversion sprains. From there, we progress the load by elevating the rear foot, still translating the tibia forward. Then we superimpose variability and rate using oscillatory impulses in that split stance to dynamically and explosively capture foot cues while maintaining internal rotation. We then play with directions, expanding the challenge by moving towards internal and external rotation while keeping those foot cues. This could include sled drags, more lateral lunge or split squat patterns, and cutting drills. We can also use elevation, like dynamic step-ups onto boxes to reduce ground contact forces, then build in change of direction. Eventually, we work on normal agility. We must adapt these for the individual; not everyone will need high-speed change of direction work like athletes.

Justin, this is a representation of the internal dynamics at the pelvic outlets. We're looking down inside of the pelvis and this is going to represent how we create the gradients and the internal forces that allow us to accelerate toward second base as quickly as possible. So I'm going to be starting from a relative position of symmetry here. So this is sort of a hinge position that you'll typically see in somebody that's taken their lead off of first base. And so because they're hinged, they've got a concentric overcoming strategy bilaterally anteriorly and a yielding strategy posteriorly. So this allows them to bend forward at the hip. Now I have to create my plyo step just like my buddy Lee Taft would coach. And so the way that I create this is I have to create what looks like an early propulsive strategy on the left side. So this would be, if I was stepping forward in normal gait, this would be even before my foot hit the ground. So literally what I'm going to do over here is I'm going to unweight my left foot and what that creates is the orientation inside the pelvis where I actually get my guts to start spinning into the left. I have to accelerate my guts in the opposing direction because what I'm going to do as soon as I reload that foot I'm going to actually start to spin my guts in the opposite direction. So I drew this really, really small because this moment in time happens so fast because it's going to lead me into my max propulsive phase. So this gets the guts spinning left. I switch my orientation as quickly as possible. That gets the guts spinning to the right and then I hit my max propulsive phase here. And so what happens here, this is where the gut acceleration just goes crazy. So I kick my guts as hard as I can to the right and that's spin internally is what accelerates me towards second base. Then it's just a matter of flip-flopping strategies again and I'm off and running. But again, so I go from a position of symmetry. I drop the guts down into the left anteriorly. That spins the guts to the left. I immediately flip-flop my strategies to spin the guts going to the right and then I accelerate them with max propulsion and that gets me towards second base.

However, if I sacrifice their ability to turn because of the shape changes involved or the reduction in movement, say through a baseball pitcher shoulder where I reduce this range of motion and I take away velocity, bad strategy. So I just don't know what those answers are gonna be. And so again, we can't just automatically say, oh, muscle mass is good, oh, increased force production is good. I have to look at what the results are and then how does that influence that individual's performance.

How would you address the orientation problem if it is an orientation problem?

Bill, I have a question about one of your videos. Unless somebody else has a question.

All right. Great Wednesday, going to be busy. We have to dig right into today's Q&A. It is from Jared2Rs10. Jared says, hi Bill. Hi Jared. Thanks for all the information you post. Most welcome. I saw the video you posted about risk positions and was wondering if you have any solutions for something like tennis elbow. It seems like elbow position would be something to be concerned about for a friend. Well Jared, let's see if we can help your friend a little bit. The first thing we want to ask when we're talking about lateral elbow pain, so unfortunately it gets branded as tennis elbow for some reason, not really sure where that came from, other than the fact that tennis players do experience this, but anybody can. You'll see it in the weight room quite a bit as well. But ultimately what we're dealing with is a situation where we have too much pressure or tension in one place and that's going to result in a pain experience. So it is an elbow result. It's typically not an elbow problem, although you can identify changes there that sort of take the blame a lot of times for why we do have pain. But we want to think about orientation of the elbow as a possible influencer and then as also as a possible solution. So we think like shoulder bones connect to the arm bone, arm bones connect to the elbow bone kind of a thing, but all of that is attached to the axial skeleton as well. And so we want to make sure that we have full adaptability through the axial skeleton, then we have full adaptability at the shoulder, elbow, hand, wrist, etc. And so if we don't have that full adaptability, approximately, then we're going to have to create some sort of compensatory strategy distally. Now let's talk about this elbow a little more specifically as far as why we might see this lateral elbow situation. If we think about any activity that's going to drive shoulder external rotation and elbow extension at the same time. I think one of the reasons why we can brand this as a tennis elbow thing is because if you're hitting a backhand, I need a pretty strong elbow extension and I'm driving shoulder external rotation at the same time. A little thing to remember about triceps. Triceps is branded as this elbow extender, which it is technically speaking, but it's a twister. Remember, everything moves on a helical angle. The elbow joint moves on a helical angle. Triceps is a twister. The cool thing about triceps is that it can actually assist with that shoulder external rotation. If I'm driving anything with a strong shoulder external rotation and elbow extension at the same time, what I'm going to do is I'm going to get a medial posterior, medial, compressive strategy above the elbow. So think about all the fibers that are medial to the line of the humerus that would be triceps compressing that space. Now, if that happens, that creates external rotation in the shoulder, which is really, really nice and handy. But the big problem that we end up with is that we have a situation where the lateral aspect of triceps is now eccentrically oriented. So if we looked at the elbow capsule, we get a compression on that posterior medial aspect of the capsule. We're going to expansion on the posterior lateral aspect. And now I don't have a really good elbow extension mechanism, like I normally would if both aspects of the triceps were intact. And so now I have a substitution problem. So anything that can potentially extend the elbow is going to try to help along. So now I got anconeus. It's a tiny little thing that's going to try to extend the elbow. Supinator is going to try to extend the elbow. Anything that's attached to the common extensor tendon is going to try to extend the elbow. And so now I have muscles that were not well designed to produce this force, trying to produce this force. And so I get a lot of pressure and tension at the lateral elbow. And so what I want to do is I want to show you a way to test this which is kind of counterintuitive. We're actually going to use elbow flexion as our assessment because if you think about if I create a posterior medial compression on the inside of the elbow. I'm also gonna then have a resultant expansion on the anterior medial aspect of the elbow. And so what happens is as I try to flex the elbow, because of the medial aspect being full of fluid, I can't compress there. So as I flex my elbow to end range, I'm gonna do it in a slightly pronated position. So the test that I'm looking for here, is supinated elbow flexion with full compression at end range. And so I took Eric into the purple room because I kind of figured that he would have a little bit of a deficit that we could actually show you in real time. So we'll show you the change. So the first thing I did is I put him up on the table there and we flexed the elbow fully in a supinated position. You can kind of see where the end range stops. But then I took him out of supination. I put him in a little bit of pronation. You can see I can compress the elbow more fully. Now we're going to go over to the left side as a comparison and right away we see that we do have this fully compressible supinated elbow flexion as our comparison. So basically Eric is showing us this elbow orientation that we're talking about. So here's the fix, if you will. What we're going to do is we're going to drive external rotation through the entire system on that right side. So we're going to start. We're going to do a dumbbell curl. We're going to cheat the hand over to the inside edge of the dumbbell. That's going to promote supination right away. Now Eric is pressing his thumb onto the inside of that dumbbell. And so that is ER of the hand. So we're driving external orientation from the hand up. Then if you look at his body orientation, we have the thorax, the shoulder, the humerus, and everything is ER'd as he does this dumbbell curl. And so it's really, really simple. We're just driving external rotation through the entire system. And what we're going to get is we're going to get a reduction of that concentric orientation of the medial aspect of triceps. We're going to restore the orientation of the elbow. And now when we put Eric back up on the table and we check our supinated elbow flexion, now we get this fully compressed look. And so again, it's just a matter of understanding the orientation at the elbow, and now what we should have then is a normal extensor mechanism on the backside of that elbow so we don't have to substitute with our tiny little muscles like anconeus, supinator, and the common extensor compartment. And so hopefully Jared, that gives you an idea of what you're looking at with this lateral elbow stuff and provides you a little bit of a solution. Keep in mind it is a solution, it's not the solution. There are other things that can be going on, but this is a really, really common one. So I hope it's useful. If you have any other questions, please go to Ask Bill Hartman at gmail.com.

So we're not talking about a performance-related adaptation that we're chasing here. We're talking about recapturing elements of the yielding strategy, which will hopefully promote health, reduce pain, et cetera. An alternative that you might want to consider then is to use a single leg variation of this. We take advantage of the prone position, but by driving through a single leg, we can actually maintain a yielding strategy on one side. We create a little bit more of a compressive strategy on the other side, and now we're actually creating a little bit of a turning relationship between the sacrum and so we can actually capture some of that yielding strategy one side at a time. This is actually one of my favorite ways to do this, especially with your bigger, stronger human beings because it's just a lot easier to drive compression on one side because they're already compressed on both. We magnify that compression just a little bit and we actually get the benefit of the yielding strategy on the opposing side. So we'll do this in any number of supine exercises. So we've used supine cross connects and things like that in a couple other videos previously. But when we're talking about the reverse hyper, we're using basically the same strategy by doing it unilaterally. So Charlie, thank you so much for the question. If I didn't answer your question effectively, go to askbillhartman at gmail.com, askbillhartman at gmail.com, and post another question. I will see you guys tomorrow.

And what this is going to do is start to apply a stronger posterior compressive strategy and again drive that volume forward anteriorly into the pump handle. So your key performance indicators in this situation are going to be a restoration of shoulder internal rotation as the external rotation will gradually decrease. At this point we can start to move the shoulder back into external rotation positions and a posterior compressive strategy. So this is where your T's, Y's, and I's fall into play. Your PNF patterns are going to show up here. And then face pulls as well. I'm still a big fan of doing these activities laterally rather than bilaterally because I just don't want to create a pure compressive strategy under most circumstances. There are situations where we may do that. Like if we're working with somebody that has to perform a lot of pressing activities, we might utilize that. But again, we also might be sacrificing some other things as a trade-off.

That's essentially what we all do when we're performing our lifts, and you probably have some experience yourself when you're doing your own squats: you sort of have to have this optimized amount of air volume in your rib cage. You have to have a certain amount of muscle tension available to you so you can perform the squat, because if you don't have enough expansion, then you're not going to be able to access the range of motion that you're trying to access during the squat itself. And so this is one of the reasons why, as people slowly put weight on the bar during a workout, you'll see their squat sort of change. In some cases, what you're going to see is a shallower and shallower representation of the squat, or you're going to see a bigger lordosis, or you're going to see more forward lean, or you're going to see changes in knee position. So what these people are doing is trying to access certain positions, but because of the context of the lift—the amount of load, the amount of expansion capabilities that they do have, the amount of compressive strategy that they do have—they have to actually change the shape of their body. If you inhale too much, what you may end up doing is creating too much expansion; you have too much ER, and then you can't squeeze enough. So you're gonna end up missing a lift. If I don't inhale enough, then you may have a force production issue as well. So think about if I don't inhale: I won't have my full ER excursion, which is going to immediately narrow the excursion I have available for internal rotation. So my sticking point is somewhere around 90 degrees of hip flexion, plus or minus 30 on either end. So I might have a 30 to 60 degree range of motion where I need to produce high force through internal rotation. But if my excursion of internal rotation is insufficient because I didn't expand enough, I don't have enough time to apply force. And so I'm going to miss the lift under those circumstances as well. So we can break this down into multiple factors: we can look at it from the expansion capabilities to access external rotation. I have to have internal rotation available to me; I have to create enough internal pressure and a compressive strategy, but I have to have enough inhalation so I can squeeze against that to create the pressure. And then I need to actually maintain the shape of my body so I have enough force production directly underneath the bar to lift it. Think about a front squat under certain situations. You'll see a lot of people dump front squats forward because they cannot maintain the anterior expansion of the bar.

So you were a swimmer before you were a walker, you came up on land, and you had to figure out a way to put pressure into the ground, and that is through internal rotation. So, again, that is our propulsion. So, if I have lost internal rotation anywhere in the system, I will find a strategy that will allow me to do so. And oftentimes, what we'll see is this tibial femoral ER strategy. We're going to turn the femur inward into internal rotation to create our downward force. So when we see terms like knee valgus, or we see situations of hyperextension of the knee, what we're actually talking about is we're talking about somebody that's utilizing an internal rotation strategy because that's what the resultant is going to be. So we don't really have a hyperextension. What we have is a lot of internal rotation of the femur on top of the tibia. When we have the valgus, what we have is a change in the center of gravity to an anterior medial strategy and then that twists the femur inward, turns the tibia outward and we will put pressure down and forward into the ground and so we have to do that through the knee. So the elephant in the room then becomes this pelvic orientation situation and so an anterior orientation of the pelvis is me looking for an internal rotation strategy. That's why we lose extra rotation of the hip when the pelvis anteriorly orients because I'm looking for more internal rotation and I have to sacrifice my ability to externally rotate. So this is why hip extension extension activities then become very, very important when we're talking about restoring normal knee excursion because I have to establish my external rotations first so I can delay propulsion and then recapture internal rotation. If we go all the way down to the foot, now we're talking about a situation where I might have a foot that's following that tibia into external rotation. Under those circumstances, I'll have an early propulsive foot. That means that I'm going to have an externally rotated foot I've lost inter rotation at the ankle and foot. Inter rotation at the ankle and foot is represented by my ability to dorsiflex and pronate. And so if I lose that strategy, now I'm going to have to recapture that. So my goal then is to retrain my tibia to be able to move through the full excursion of middle propulsion. and that's where I recapture that dorsiflexion, and nicely I capture interrotation all the way up the chain into the hip, assuming I have managed that pelvic orientation. So the bottom line here, Mike, is we have to stop looking at the knee as some sort of hinge joint. We have to respect the fact that it turns as it moves. And so measurements like heel to butt flexion become hugely important because it represents my ability to internally rotate that tibia fully. Capturing my five to ten degrees of knee hyperextension by definition in textbooks is my representation of my ability to recapture the extra rotation of the tibia. So now we have a really, really simple way to look at this knee. If I don't have those excursions, I don't care about anything else about that knee until I can recapture those things because they represent the normal representation of what my knees should be capable of. So, re-establish ER, re-establish IR on top of the ER. Get your dorsiflexion back and you're gonna save your knees a world of hurt.

The heel wedge or something like that, and I would be working the front foot in this heel's elevated position because what this does, it's gonna bias us towards that early propulsive strategy without altering the foot mechanics, and so we can still get our concentric yielding strategy. We're just biasing ourselves back towards that extra rotation element of the full propulsive excursion. So now let's move to the pelvis. Let's talk about the pelvis orientation because we can create that bias as well. And so I'm gonna hold the pelvis in this orientation so you can kind of see this. So real quick. So remember early phase ER bias, middle phase IR bias. So when we're talking about split squat, we're moving through rather ER to IR and then back to ER. And if we're talking about the lead foot. So what we can do though is we can bias this lead foot towards more extirotation, more entirotation. we're gonna go ER to IR under every circumstance. But again, we can create a little bit of a bias. And so what I can do is I can position the ilium in the sacrum in a little bit more of a bias. So what I'm gonna do is I'm gonna create this yielding strategy at the base of the sacrum here and I'm gonna be ERing this ilium. And so what this would look like would be to project the knee forward in the split squat. So before I even lower myself into the split squat, I'm going to create a stronger bias towards ER. And then as I descend, I'm going to get less IR as I go down through that middle range excursion towards what we would consider 90 degrees of hip flexion. So right away I get to bias it. If I wanted to do the opposite, what I would do is I would shift backwards and I would create a little bit more of a bias towards internal rotation. And then as I go down into that excursion, I get more internal rotation as I approach 90 degrees of hip flexion. So this is just your typical hip shifting kind of a bias that you would be using. But the cool thing about this is the load position now that you mentioned is also an influence. So what I can do is I can take the contralateral loading and I can I can bias it towards internal rotation. So I create those same hip mechanics that I just showed you the bias towards internal rotation to lower myself into the split squat. If I use the ipsilateral load, I create the hip bias towards external rotation. Now here's here's the question mark. It's like, what are you trying to achieve? Are you trying to improve my ability to maintain extra rotation? So under those circumstances, I create the hip mechanics that are biased towards extra rotation, and I use the epsilon load. It makes it easier to acquire those range of motion mechanics. However, at some point in time, what I may want to do is challenge that and actually produce force into external rotation. Under those circumstances, I'll bias it towards the internal rotation mechanics. So you have to push myself up and out of those internal rotation mechanics to create more external rotation. So Brian, this is a great question. Very, very useful. Just keep in mind that all we're doing is creating biases. Internal external rotation are superimposed. And so, again, it's like how we start is going to influence how we move through that middle excursion and then how we end.

And so he's going to maintain tibial internal rotation, medial calcaneus on the ground, hip internal rotation. Once we can do this statically and maintain control where we have the maintenance of hip internal rotation, now we want to start to add some dynamic element to it. So he's just going to drop into the split squat and then try to capture this exact same position. So he's got to absorb some more force. He's still got to be able to maintain the medial calcaneus contact and again continue to capture internal rotation. Next, we can add a rotational element into this externally rotated position. So we're driving a force into external rotation that he's going to have to resist to hang on to that medial heel, hang on to the internal rotation. And again, we've increased the forces that he's going to have to withstand. We can magnify that even further. So we're going to use a water bag in this situation, which has some momentum to it that he's going to have to control as well. So this teaches us how to manage some of these internal forces that we produce within ourselves that we also have to manage as part of this dynamic movement. Once we do that, we can move through this full middle propulsive phase with something as simple as a sprinter step up. So he does the step up, he's moving the ankle through an earlier phase of this middle propulsion and he goes all the way through to the end of propulsion and we can actually increase load and stress. And so now we've established this relationship from the ground all the way up. So we've got control at the pelvis, we've got control at the ankle. Once we do this, we bring it back to the ground and we just slowly increase the dynamics and the forces. So we might start with something that looks like an A-march. And this is going to take the foot into the position of max propulsion where the calcaneus is going to start to break from the ground. And this is actually the point where we're going to produce maximum force. And then, once again, we just increase the dynamics so this becomes and a skip we can eventually break people into to any number of like the mock drills or any kind of sprinting drills if we're working on change of direction we move them into the dynamics of sort of flatter cuts where the load is a little bit less and then finally we get to where we were produced maximum force with a really sharp cut where we're moving in and out. All the while, we're gonna monitor him for the ability to make sure he gets the medial calcaneus to the ground. We can do so in any number of means, but again, I think hip internal rotation is always a great way to monitor that because if we can hang on to the internal rotation, then we know we have at least the mechanics that are available to us to keep that medial calcaneus to the ground.

So right away you should start to be thinking about how you're going to be able to write this program for somebody like this. It's not difficult to write the program. What is difficult is identifying the representation of what you're looking at first and foremost. And then the program kind of just writes itself because when you understand the needs of this individual, again, it becomes very, very, very easy to write. So hopefully that gives you some guidance, Jimmy. If I didn't answer your question sufficiently, then please do so. Oh, by the way, the asymmetrical ISA element of this. No different than anything else. You just have two different representations. So you have a shape change on one side that is opposed to the other. You're going to follow the same rules that we just talked about. One side's gonna be able to go a little bit more into your posterior. One side's gonna have to go a little bit more side to side, but the rule still applies. So again, hopefully that answers your question.

We're talking about gradients and superimposition. So things are overlaid on top of one another. It's never all one, it's never all the other until you hit the very extreme end ranges. When we talk about internal and external rotations, we're talking about a bias. So we'll be biased towards external rotation at the top of the backswing. Let's use a right-handed golfer as an example. All rotational sports are just variations of walking, and the golf swing is walking with your feet fixed. The backswing is like taking a step forward when walking. As I step forward with my right foot and swing my arms, I turn to the right. If I fix the foot and use the same mechanics, it becomes the backswing. Now we need to identify the early propulsive strategy, focusing on the hip position. For a right-handed golfer, in the early phase of hip flexion (0-60 degrees), I am biased towards external rotation. This is where the backswing movement occurs. To transfer weight to my right foot and turn right, I must create a position within the pelvis that allows that turn. This position requires a counter-neutation and a concentric yielding strategy posteriorly in the pelvis, allowing the sacrum to turn right. Without this, the lumbar spine cannot turn right. As I create this shape, I also retrovert the acetabulum, putting me in a position of external rotation at the end of the backswing. If I try this in internal rotation, the ilium nutates the sacral base, blocking the sacrum from turning right and blocking the lumbar spine from turning right. Attempting to twist the thorax on top of this would lead to potential injury. So it's external rotation at the top of the backswing. It doesn't mean no internal rotation is occurring—they're superimposed. I'm just biasing it towards external rotation. If you don't have enough external rotation to capture this position, your golf swing will show substitutions: supinating the right foot, orienting the knee outward, side bending away, or reverse pivoting. These are all substitutions for the lack of external rotation. The same applies to the upper thorax. At the top as I accelerate toward impact, internal rotation becomes more important for max propulsion, which is an internal rotation strategy and exhalation-based. To acquire range of motion, I need to be externally rotated and in an inhaled state at the top of the backswing. Transitioning into internal rotation at that point would require compensation.

Like a split squat for me to access 90 degrees of hip flexion in a split squat I know I need to be able to access hip internal rotation under those circumstances Otherwise, I'm going to have to use a compensatory strategy and so These situations are not dependent under most circumstances because most of the people that come to see me are typically neurologically intact. And so again, I just wouldn't use it under those circumstances.

What I would suggest you do is you want to work with runners because those people are going to experience a lot of tissue loading over short periods of time. Again, if they're exposed to longer durations, they're going to accumulate a lot more of these issues. At the reduced rate of loading when we see with walking, the tissues are less stiff. We're going to see a lot more yielding action associated with that because again, we have to dissipate those forces over a much longer period of time and that's going to help slow us down as we walk. So again, the yielding strategy provides us that delay that's necessary to hold the center of gravity back so we can get the other leg out in front of us. So again, we're talking about rate-related issues here. The faster we move, so whether we walk faster or run, we're going to see a reduction in the amount of rotation that's available to us. So we've got a time constraint that's associated with this for sure, because again, we have to consider the time from ground contact to max propulsion. So when we're walking, we're going to land in a fair amount of external rotation. We're going to move through internal rotation through that max propulsive phase, and then we're going to go back to external rotation. Well, if we're running at top speed, especially, we're landing it at almost immediate max propulsion. So the amount of rotation that we have one available to us because we don't have time for that, it's going to be a very, very quick internal rotation that's going to be associated with that. So this is why we're going to see biases in runners like the anti-orientation, the pelvis gets us closer to that internal rotation moment that we need at max propulsion. So that's why every sprinter kind of looks the same in that regard. It's because it's just a trained bias that allows them to perform something very, very quickly. So in a nutshell, walking and running are going to demonstrate some very, very similar characteristics because it's still locomotion. We still have to be able to propel ourselves against gravity, move ourselves forward. So again, we're going to have a max propulsion. But the rate at which we would see any form of bias occur is going to be different. The ranges of motion that we're exposed to are going to be a little bit different. The breathing strategy is going to be biased a little bit differently. And certainly the tissue behavior is going to be a little bit different. So again, I would point you towards the yielding and overcoming strategy video to get a little bit of understanding about that. Because at the higher rates of loading, we're going to see a lot more overcoming action. At the slower rates we're going to see a more yielding action.

We can move to oblique sit variations with elbow extended and start to work on some of this internal rotation, recapturing normal pronation of the forearm to reduce the proximal supination element. We can start to do that. We're going to move down to side plank variations. I'm starting first elbow extended and then again going down to elbow flexed with normal pronation. What I may also have to do is I may have to reduce the pronation influence that's coming distal to proximal. So I'm going to pad up my hand if I'm doing this in elbow flexion. So I got a shoulder and internal rotation. I've got normal pronation in the forearm but I'm going to block the hand so I don't get that distal to proximal influence. From there, we can move on to more dynamic activities, but we always have to respect the orientation of the shoulder, the position of the elbow, and then what the hand is driving from distal to proximal. So if we're going to do any form of elbow extension activities, we'll do an internal rotation, pronation with a limited amount of wrist deviation. So we want to keep this orientation of the hand to the wrist relatively fixed, so we're not driving, again, the distal to proximal element of pronation. Steve, and I hope that gives you at least a place to start, a little bit more understanding of what I think is going on with this situation. Again, let's not blame the owner for this. Let's look at the orientations, look at the shape change, because the owner is just following along where everybody's given it a new path.

If we have an anterior orientation, anterior orientation, the entire pelvis that is orienting forward, so the sacrum and the ilium are moving together, you're going to experience a loss of total hip excursion. So where we have to combine 60-40 of ER and IR, now we're going to see less than 100 degrees, most likely under those circumstances. And when we have this anterior orientation, because of the reorientation of the musculature above the trochanter, we're going to see a loss of external rotation measures. And so that's going to be your giveaways as to whether you have this anterior orientation to begin with. So it's going to be less than 100 degrees total excursion, and you're probably going to be in an ER deficit. OK, now. Let's talk about strategies here, Bradley, because I know that's what you really wanted to listen to. Step number one under all circumstances is to eliminate the interference. Anything that creates the posterior compressive strategy that's going to push that pelvis forward has to be eliminated. So now we're going to take things off. off the list like Romanian deadlifts. Most of your deadlift variations are probably going to be off the table for a short period of time. Back squats also creates that upper dorsal rostral compression which is going to be duplicated at that circle base under most circumstances, so we want to eliminate those. Kettlebell swings. Anything that is very, very hingey and propulsive probably needs to be taken off the table for a while until you can recapture enough adaptability through the pelvis. Now, let's talk about activities which are going to bring the pelvis back, promote some yielding and posterior expansion of that pelvis, and then recapture the hip extension. If we think about activities that are on the ground, so we've got supine arm bars, promoting the hip extension element on the extended extremity. Anything that delays this propulsive strategy is going to be heavy on the heel, heavy on hip extension, so like a cross connect step up is still a viable choice for your exercise programming. If we talk about trunk related activities, we could do a TRX mountain climber. That's going to move us towards the two ends of the early and late propulsive strategies, which will help us create the inhaled position, especially for your wives. Along the same lines, like a Swiss ball jackknife with a reciprocal leg movement, if we need to drive more hip extension, we might have to do some activities in hook lines. So these become your glute bridging activities. We can progress those to say an alternating hip lift with your back supported on a bench. And then any number of, again, activities that represent the two ends of the propulsive base when we capture this hip extension. So you can even consider like a high step cable chop.

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.