Okay.

Try, okay. Old school representation retraction.

All right. Yeah. That's why I wanted to ask because I was getting ER. But if I do it this way, I'm pushing them further forward on the right side. Because if I leave with my scapula, they will be laid on the right side, which will make things worse, right?

It's just downforce, right? And I won't say that the trunk's not important, but all I have to do is have a mechanical advantage against you where my force is below yours and moving upward, right? And as soon as, as soon as I have gained that mechanical advantage, I have lifted you off the ground so you can no longer push into the ground.

I'd say you wouldn't be able to go as deep.

Yes, you do something like that. And because again, what they're used to doing—their strategy that they're bringing to you—is I'm going to do everything symmetrically. Right. So that's why you get the butt squeeze kind of a thing going on. And that's what you're trying to eliminate under most circumstances. And so that's where the asymmetrical activity becomes very, very useful.

Okay. What if I shortened that distance? Would that be helpful to turn the tibia inwards?

I see. Okay. Oh, that's helpful. Thank you very much.

I used to train not teaching.

Yeah.

Which would make sense if I'm more translated forward on the right side, because you're gonna have less abduction available to me. So if I max that out, I'm losing all my room to move into, and then I turn the fridge.

Right? And then that's why you say- Is that why outflutter to curl hop whenever they

His right ulna just grew an extra centimeter relative to all the other bones in his body, and they want to cut off the end of his ulna. Has anybody ever heard that one? Have we ever seen a distal ulnar excision? Yeah, exactly. Yeah, it's like you take somebody that apparently has a fully calcified skeleton and then suddenly they say, 'Well, the ulna got too long.' That's kind of what you're dealing with, okay? And the ulna didn't get long. The radius got short, okay? In normal anatomy, if you have totally average everything with full-moving capabilities in pronation as you take the palm down, the radius moves over the ulna. You understand that concept right? Okay. Because you're taking a bone that was relatively straight and you're putting it on an angle, its distance from the elbow is shorter, right? It becomes sort of like... I don't wanna say it's the hypotenuse in the triangle because the triangle's changing shape, but anyway, the radius gets shorter relative to the ulna by its distance from the elbow, which makes the ulna appear to be longer. And that's normal. That happens under every circumstance, assuming normal anatomy, which means that you lose, in pronation, you lose ulnar deviation and extension by traditional measures. Okay? So if you put somebody in all fours and they get pain on the back of their wrist or they get ulnar side wrist pain, right? He is living sort of in this pronated representation. So when he was a waiter, and I'm just throwing this out there since you brought it up, when he was a waiter, he had to do like the early stage of an overhead press all the time. Chances are he eventually did do some overhead pressing with the position of the wrist that we're talking about. So if he has an adaptation in the radius that causes an inward rotation, that can be part of it. But there are a couple of things he might have to do. If he has a pronated hand relative to the rest, right, and that's... you can do the little apple test, okay? Where you go like that, and then you release it. And if it doesn't go any farther, chances are you've got eccentric orientation of abductor pollicis longus, which means you do have a pronated hand. Then you're going to need to untwist the hand, which is going to require supination relative to the rest of the forearm. So you could do like a supinated bent-over elbow extension with a cable, bent over in internal rotation. That'll get the hand orientation to come back. Sometimes you can do a curl in the same position with the thumb pressing into the dumbbell. So you get the constant orientation back along the radial side of the thumb. So those two positions are useful.

Do you think I'm going to turn him into a 60-40 ER to IR hip?

Matt, dirty little secret. You ready? Yeah. If you have somebody that sits down into a deep squat, the tibia moves forward over the foot. So the bottom of the squat and the tibia doesn't move backwards. So it stays forward over the foot. You got somebody that does not hit early propulsion. When somebody deep squats, when somebody deep squats and the sacrum is moving with its relative motions. So you start in late, you go to middle, you hit the bottom in early, the tibia has to move backwards as the secret moves backwards.

Well, one of the things that is of value, and I've talked about this in some of my 16% videos, is that people tend to ruminate on thoughts in their head. There's tremendous value in expression, like actually talking out loud to express an idea, because when it becomes reality, it's a bit easier to see and understand. So either write it down to get it out of your head and make it real, or express it out loud. My wife thinks I'm a little crazy because I walk around the house talking to myself, and all I'm trying to do is figure stuff out, because that's how you do it. There are plenty of times where I would have to just sit and say, 'I don't know.' The thing about having a lot of experience is you get to say, 'I don't know, but...' or 'I don't know.' By opening the discussion that way, you can start to draw on other resources, rather than just blanketing it with 'I don't know.' I try to solve the problem then and there, just as you would if you were trying to figure something out on your own and seeking out resources. I do the same thing; I have to follow the same process because I need access to information. I have to have filters, just like everybody else. But when you express it out loud, you sort of have greater access to all of those filters that you pass information through. You ask, 'Well, how does this look? What does it look like? Okay. Is there something else I've experienced that this looks like? Okay. What happened under that circumstance? Does this apply in the same way? And if it does, how would that happen? What are the constraints I'm working within?' By expressing those, these questions come up, and then you start passing it through more filters. It's by far the best way to learn something new when you can make that comparison. Like I said, it's one of the reasons I do a lot of the things I do from a software perspective—when you teach something, you benefit just as much as the student does.

And there you go. So there you go. So this is what you're doing. You're actually restoring the capacity for a gradient to exist because the greater and greater squeeze that I superimpose, I'm taking away gradient, right? So think of it like the most extreme possible case, right? So you compress everything as hard as you possibly could. If there's no gradient, there's no movement. That'd be like your greatest output against resistance. Right? I think about like the heaviest squat you've ever done and you lifted it and you just stopped dead, you know, right? The sticky move. Yeah. And until you release, until you release the pressure and then you go the wrong way, right? Yeah. Exactly.

So if you hold a static stretch and you get that discomfort at the end of the stretch, that is that distribution of tension through the connective tissues that, of course, we're going to sense. So again, that's what we're talking about. When we talk about tight, we're talking about a sensation, so not necessarily a useful representation as far as decision making is concerned until we identify joint position, muscle position, etc. And then we can determine what an intervention is. So this is a common mistake where people will say, 'Oh, you feel tight, you need to stretch.' When the reality is, it's like that tissue is already under tension under some circumstances, especially if I've got an eccentrically oriented muscle and a yielding action. It's like all you're trying to do is just pull on something even harder than it's already getting pulled on, and it's already in an eccentrically oriented position. It just becomes an exercise in futility. The reality is what we need to do under those circumstances is just restore the full excursion of movement under those circumstances. And then we feel nothing because under situations where we have full concentric and eccentric orientation of muscles—which would be representative of a full breathing excursion or full joint motion, however you want to perceive this—we feel nothing. The reason there's such difficulty here is that when we're at this endgame narrow situation, we have a tremendous amount of concentric orientation that limits hip mobility to such a degree that it's almost like we really don't have anything available to work with in regards to positioning. So everything looks like it becomes a compensatory strategy. And so let me show you what we're talking about. We'll grab the pelvis here. So we'll start with our narrow ISA presentation, which is going to look something like that. And remember, plastic model, not perfect, but it'll give us a representation. So we're kind of starting there. We get a lot of constant degradation in this posterior lower aspect, such a degree that it creates this push from behind and it sort of orients the ischial tuberosity in line with the femur. And so these external rotation muscles actually start to pull the femur back inwards. So it's not just ER; you end up with this presentation that looks like they're actually rotated but adducted at the hip. And so when we talk about common findings, these are the people with the really, really horrible looking toe touches. And so they're the people that if they can get below their knees, they're pretty happy. So we have extreme deficits in that. Hip abduction is very, very limited. So it's often 10, 20 degrees of hip abduction. Straight leg raises are very limited. Many times we can throw some manual therapies at this and reduce some of that concentric orientation, maybe that buys us a little bit of hip mobility that we can work with. But if we're going to rely on exercise, sometimes we can maybe put them into a prone situation and do something like that, that will give us some of this eccentric orientation that we need in that posterior lower aspect, but it tends to be a challenge. It's almost an exercise in futility in many cases. A lot of times what we have to actually do is start with some form of hip approximation activity. So what we're talking about is creating a situation in the back of the pelvis that looks something like this. And so what we're doing is actually inducing a very, very small amount of rotation through the pelvis through hip approximation. And so an activity will look something like that that you're seeing on screen right now. And what this starts to do is it starts to actually increase the amount of eccentric orientation in this reciprocal fashion. So we're creating almost like a really tiny variation of the gait cycle through this hip approximation. In many cases we get really good results from this, and then we actually pick up enough hip flexion that we can now start to move people towards some activities like, maybe we do some hook lying. We continue to work on yielding and overcoming strategies in this hook lying position or we can move them into a sideline propulsive activity with an increasing degree of hip flexion and we can superimpose some reaching on top of that. So you got to remember that you've got this iteration that's going on in the thorax at the same time. So if we can superimpose some reaching on top of this propulsive strategy, we get a much bigger bang. One of the activities that's kind of off the beaten path is actually this army crawling that we might want to do. So when we think about the posterior lower compressive strategy that's going to limit the degree of hip flexion in the traditional imaginary sagittal plane, what we can do though is we can deviate the knee laterally and we can go get some external rotation in that position. So that can actually help us increase the amount of eccentric orientation in this posterior lower strategy as well. So it's probably considered a developmental position for some of you depending on what your background is, but we want to turn this into an army crawl. This is also great for kids with this scenario, because they like to crawl around and pretend to be animals. So a little FYI there. If we move to a standing position, what we probably want to do, because we don't have a lot of hip excursion to start with, is start with a very narrow stance chopping activity with a little bit of weight shift. And again, that's going to help us start to capture this little bit of rotation. And again, we're going to sort of move them through a gait cycle. We're going to go from one chop to the other in a reciprocal fashion to recapture this eccentric orientation. Once we start to gain some hip abduction, we gain a little bit of hip rotation back. Now we can move to a bit of a staggered stance chopping activity and then we can move into like a high-low cable press. One of the things that I like to do at this point is I'll just call it sneaky arm training. So we'll actually have them do biceps and triceps activities, if you will. But what we're going to do is be very particular about what stance they're performing these in. And so again, we get to reinforce what we're chasing with this concentric-eccentric orientation in the posterior lower aspect while they get to do fun stuff, if you will. As you start to gain hip motion, obviously now we can move into split stance activities. And ultimately what we want to be able to do is move into a deeper split stance. And this would be indicative of the fact that we've got plenty of eccentric orientation at this point. And then ultimately what you may want to be able to do then is move to some form of toe touching, some kind of progression in that manner. And then ultimately that might be what you use as a maintenance strategy. So again, this is a really, really difficult scenario because of the degree of concentric orientation and the compressive strategy that goes on. Take your time, be patient. You have to be very, very patient in these scenarios. But again, work with what you have, work within the constraints, don't force, don't drive compensatory strategies too hard, because it just becomes a point of frustration.

Absolutely.

But so wasn't it my decision to impose whatever intervention that led to the outcome?

So in terms of biasing a certain movement towards a particular phase of gait with whatever you're trying to recapture, for the sake of this question, let's say going after early propulsion and using a heels elevated or a full foot heels elevated squat. I can see how the representation at the tibia, in terms of how it's interacting with the foot, resembles that early propulsion phase of gait. Like my question is how exactly does all of that work its way up the chain in terms of getting those early propulsion mechanics at the pelvis and the pelvic diaphragm to get those expansive qualities.

Okay, so I don't know how to measure a ridiculous amount. Conceptually speaking, yes, you do, right? Yes. Yeah. You wouldn't use a rounded back position to try to get a maximum effort squat, right?

Like what a great epiphany, right? But it demonstrates the law. If the harder I squeeze, the more force I can produce, but I still need a space to move in too. Otherwise, the bar doesn't move. So when the guy puts on the bench shirt, he tries to lower the bar to his chest and he can't touch. There's so much compression. ER is gone. You see it?

Correct. Absolutely. So you're on the right track. You're doing good stuff. But like I said, give her the sensation of when it turns off so she can feel it and then she can direct herself to find it.

I do too.

So if I am compressed in that area and I don't have the extra rotation space to create space for movement, I immediately go toward my internal rotation behaviors. Then I run out of internal rotation at 90 degrees. And that's why people walk in and they say, 'My Hawkins Kennedy is positive. And they say, I got impingement.' And everybody goes, 'Oh, you have a rotator cuff problem.' Okay, you have a rotator cuff problem, potentially. But it is a compressive strategy that changes your physical shape, which means the space around you changes as to where you can access motion or how you access motion. It doesn't mean you can't put your arm in that space; it just means that the way you're going to do it is not going to be with what we would consider normal relative motion, which provides us ease of motion. You're going to have a limitation based on the physical shape of your body. Now, the way that you described it, with the latis—extender, is that what you said?

Yeah, we've talked about that. That's why.

Yes. So you're trying to find range of motion. That is an orientation into external rotation, but your side bend is actually going to be you trying to find the internal rotations to produce force into the ground. So what you do is you create the external rotation position. You're going for an area or a space where you do have access to external rotation so you can superimpose the internal rotation on top of it. But when you're walking, your right side bend is the internal rotation. That's how you're getting force into the ground. So chances are you've got a pelvis that is tipped over to the right on an oblique axis and pushed way forward.

Oh, no, no, no.

Okay. You don't have that percentage yet.