So it's not an internal rotation of the ilium that's producing that position. I have locked everything in because of the compressive strategies; I progressively lose relative motion between any segments that I can produce and everything starts to behave as one. But that doesn't mean that I can't push down. It just means that the way that I push down, I'm putting stuff together, right? Let's just say that I start with 25 different individual segments and through compression, I now only have 12 and then I compress myself more and now I only have eight. So I only have eight places that I could capture any relative motion to create this orientation that allows me to push down into the ground. So that's how internal rotation always has to stay inside of this extra rotation.

Oh, okay.

One thousand percent.

Okay, so look at it at the two ends. So if I am, let's just say I'm concentric overcoming. That is a muscle that is prepared, that is producing high force, and the connective tissues are stiff. So as I go into the cut, I don't yield as much. So the amount of energy storage that I use is somewhat limited. But my ability to come out of the cut is not. But the problem is that I never got the initial storage in the first place. So that's going to kind of slow me down coming out of the cut. Now let's take an opposing example where if somebody that doesn't create the stiffness as well. So they go into the cut, they absorb this massive amount of energy, and they're slow coming out of the cut because they can't turn it around and release that energy. There's a difference. And some of this is going to be genetically determined. This is why some people are faster than other people is because their connective tissues are just better designed to do these really, really cool things. But we can train this just based on the way that you're loading strategies in the gym. If I'm a power lifter, you think about, I want the minimum amount of eccentric orientation that I need, and I need just enough yielding action to store and release energy as I make the turnarounds in my lifts. Because if you have too much, then there's a lot of distance that could be created with expansion or a dissipation of my force production, which is what I don't want. I want it to be focused so I can create the lift.

Yeah, that makes perfect sense. Does that answer your question?

Well, so this is actually based on fatigue. So you can pound somebody with one topic, and then they need a recovery phase. So the one minute transition is so you can get them from one point to the next. So you leave yourself 10 minutes for questions.

Unless you have some scenario where it's going to be very, very clear that they have some form of condition that would actually promote this laxity. Use your comparative measures. Understand that all your measurements are dirty and we have to account for the position on the table. Ryan, I hope that answers your question for you. If it doesn't, please ask another question at askbillharmonedgmail.com, askbillharmonedgmail.com, and I will see you guys. So on Monday we talked about how to improve a vertical jump for someone with a narrow infersternal angle. Now let's talk about the wide infersternal angles.

I've got a question from Theo. And Theo says, hey, I'm experiencing this increasing pain in the inside of my elbow. I noticed it on just by any kind of gripping activity, but it comes much more severe, especially when attempting any kind of chin up or pull up. Any ideas why this might be happening? Yes. So Theo, I'm going to give you the most common representation that I see with this circumstance. But first and foremost, what I want to do is I want to cue you to watch yesterday's video. So that's kind of the setup for today's video because it gave us a little bit of a background on what our needs are and some of the compensatory representations that we're going to see in Chinooks and Pullups as to how people actually execute these things. The key element that I want you to walk away with from yesterday's video is that we've got to have extra orientation range of motion to superimpose the force of internal rotation on top. So there's going to be common compensations that are associated with the lack of shoulder range of motion that's going to produce orientations into external rotation so we can actually still produce the internal rotation force. Now, here's the problem with chin-ups and pull-ups. Because we've got both hands fixed on the same bar, we create a constraint. And that constraint reduces our ability to turn. So we have cancellations of turns which result in compressive forces and compressive strategies. We see the same thing with barbell activities. So again, no big deal. We just need to recognize these things. But what it does then is we create situations that are proximal to distal and then distal to proximal. And unfortunately, your elbow is dead center. And so we're going to have this sort of wave effect that's going to come down from the top and up from the bottom. So as force demands increase, what you're going to see is you're going to start to see these orientations, orientations into external rotation, which we need to create space. So we have to have a space where we can move and this allows us to produce internal rotation. What's going to happen though is we orient, we're going to drive this from the scapula in most circumstances, the humerus is going to follow the scapula into external rotation. And then we have to produce this internal rotation situation. So let's pick on a muscle where we're talking proximal to distal. People don't think about pronular teres as being a proximal muscle, but it does attach to the medial picondo. So what this muscle is actually doing as you're performing your chin up is it's producing internal rotation because it's a forearm pronular. That's why they named it pronular teres, but they screwed up because it's actually attached to the humerus. And what it actually does to the humerus is it twists the humerus into ER. So it's actually an ER muscle as well. And it's an elbow flexor by traditional representation. So it's doing a lot of stuff, but what it's going to do is it's actually going to pull in that medial condyle as you're trying to drive internal rotation on top of this ER oriented position. Now, let's go distal to proximal. We fixed the hand. So what the hand's going to try to do, it's sort of like a foot being on the ground. The hand is fixed. And so what we're going to do is we're going to start to drive internal rotation with the hand, proximally. And so because of our fixed hand, even if we're supinated, even if we're supinated, we're going to try to drive an internal rotation force. We're going to try to drive pronation from the hand approximately. Now, here's the other problem. If I get a compression on the front because I'm canceling out rotational forces, so if I push my pump handle down under these circumstances to create internal pressure and high force, I'm going to create a situation where I lose shoulder internal rotation. So again, down pump handle, loss of shoulder internal rotation, now I'm in compensation city. So what you're going to see then is we're going to see internal rotation compensations. So this is going to show up as back extension, traditional back extension. Postural orthorax compression, you're going to see increased pernation of the forearm, pernation of the hand, and then you're going to see like a shrugging action, which is actually dorsal rostral compression. And so again, you're going to see all of these substitutions start to take place, and then your poor little elbow in the middle is going to be where we have this point of compensation. Well, but what if we change the hand position? Because again, if that's the constraint, let's just manipulate that. Okay, so you may have noticed that, hey, when I play with my grip a little bit, if I go from like a supineater-apronated grip and I go to this middle range, kind of a neutral grip, that there's a little bit of a difference. Well, any degree of supination is going to start to drive some external rotation orientation from distal to proximal. So from hand proximally, which again, that's why these parallel groups kind of help. But the thing that I want you to recognize is that as soon as you start to load this to any significant degree, you're still going to drive a ton of internal rotation force. One of the other advantages that's possible, which is why we tend to push people towards neutral grip so they can keep training while they're trying to rehab this situation, there's a cool thing about brachioradialis in this neutral grip position that I want to point out. Everyone looks at Breaker 8S to say, oh, that's an elbow flexor. And that's a really good dead guy representation as to what it might do. But what it actually does is it creates a posterior force through the elbow. And that actually decreases the posterior compressive strategy that actually occurs under this same situation. So we get this posterior lateral compression that drives some of this orientation at the elbow as well, and so the neutral grip can actually resolve some of that just by this cool effect from brachioradialis. So let's talk solutions here real quick. So number one, we got to rebuild posterior expansion. We've got to have a true ER field that we can superimpose internal rotation upon. So the activities that we're going to start to select here are going to be posterior expansion. We're going to play with arm position a little bit. So we want to do activities that are below shoulder level. That's going to help us start to build this posterior lower thorax expansion. And then we want to be able to move through the excursion of traditional shoulder elevation where we're going to start to move upward and improve our dorsal, rostral expansion so we can eventually get the arm above shoulder level. Do this progressively. Don't try to do it all at once because chances are you're not going to have enough expansion initially. You might want to also try to superimpose a little bit of supination into the inverted activities that you might be using that are eventually going to get you a little bit of pump handle and dorsal rostral expansion at the same time. If you know somebody that has manual skills and is allowed to touch people, you can manually reorient the forearm. So we block the proximal elbow. a little bit of distraction there to reduce the posterior compression. And then we can actually mobilize that distal form to actually reduce the amount of pronation in the distal form relative to the proximal form. So that's a fun one. And it's rather remarkable in regards to how quickly you can see changes there. Then we got to restore anterior expansion. So we got to get true internal rotation available to us. Because of the elbow being a little uncomfortable, under many situations. We start in a high oblique set. This is a great place to start. We can keep the elbow extended. I do have a video on YouTube showing a high oblique activity where we start to play with inhalation and exhalation. So we're actually creating expansion posteriorly expansion anteriorly and we're manipulating the pressure through the hand so we're getting pronation supination erir through the shoulder at the same time so check out that video We want to move down then to the low oblique position where we can actually get the elbow flexed in this position because we're not pulling we're reducing the demands on premier Terry So now it can just be it's it's true little dead guy self where it's becoming the pronator of the forearm which is what we want to restore normal proximal pronation at the elbow and start to reduce some of this orientation. Eventually what you can do then is start to build these orientations into some direct arm work if that's what you'd like to do. And then I would also suggest that we move from activities where both hands are on a fixed bar to activities where we have a free moving hand and we're doing one side at a time in regards to your pulling activities because what this is going to allow is going to allow the normal rotations to occur so we're not getting symmetrical force production at the same time, which creates this anterior post-deer compression which got you here in the first place. So Theo, I hope that helps you a little bit and directs you in regards to your training.

So this allows just enough external rotation to occur through the shoulder girdle to allow them to make the contact with their chest with the bar so they can truly complete the bench press. You're also gonna see this, just a little FYI, you're also gonna see this occur most likely in the lumbar spine under the circumstances of somebody trying to gain depth in a squat. And so they go hand in hand. So whenever you see this cervical substitution, you're probably gonna see the lumbar substitution as well. So guys, Appreciate your questions. I hope they lead you in a good direction.

You see the little white arrow here in the picture. That literally is the tibial tubercle in its orientation of ER. I suggest you take some pictures to help you compare your befores and your afters in addition to your hip measures, your knee measures, and your foot orientation. So hopefully that guides you a little bit in regards to how you're gonna address some of these knee issues. So pelvic orientation, knee orientation, foot orientation. If you have any questions or concerns, send them to askbillhartman@gmail.com, askbillhartman@gmail.com, and I will see you guys tomorrow. If you can't run as fast or jump as high as you'd like to, blame your parents. Good morning. Happy Wednesday. I have neural coffee in hand and it is perfect. All right, Wednesday, tomorrow, 6 a.m. Thursday. Coffee and Coaches Conference call. Please join us. The last few calls have been outstanding. Big group last time. Looking forward to tomorrow morning already. All right, with that in mind, it's Wednesday, so it's always tight in the morning if we had to crank this one out. Okay. Let's go to the Q&A. This comes from Malty. I'm sorry, Malty. Malty was on the Coffee and Coaches conference call last week and she comes in with a question. She's a client that's a high-level field athlete who frequently suffers from hamstring strains and occasional hip flexor tightness. He's gone through a lot of PT with fairly inconsistent results. Is there anything I should be especially aware of in terms of his potential compensations? It seems like coaching a posterior tilt has just been beaten to death with this guy and has not much help. Okay, so we have to think about this for a second as to what being a field athlete entails. And I'm going to excuse me. I'm going to oversimplify this to a massive degree. We're talking about multifactorial issues here out the wazoo, but let's narrow this down. So I have a situation where I have to change direction, I have to accelerate, and then I have to achieve top speed. So we're going to talk about those three things. And so to do that, I have to be able to change the configuration of my pelvis to achieve these outcomes. And so let me grab the pelvis here. And so what I'm talking about is when we raise and lower the center of gravity, when we're changing direction or top speed, the pelvis actually has to change its configuration. So top speed configuration is actually going to be biased a little bit more towards what we would see in say like a narrow ISA type of thing; we're going to be biased a little bit towards that inhaled position. As I lower my center of gravity, I have to apply greater forces into the ground, I'm going to move towards that exhaled position. So my ability to move through these orientations

We do have 90 degrees available to us so we can do all sorts of cool things. We're going to start in a staggered chopping action. We want to reduce the effects of gravity, but we also want to start to be able to turn the spine towards the affected side. And so in the staggered stance, we're not compressing that hip, and we can start to encourage the turn of the sacrum, turn of the spine in that direction. This is where we're going to start to use our Camperini deadlift because again, we do have 90 degrees available to us. We want to turn the spine. So I'm going to put a contralateral load on my Camperini deadlift towards the heel's elevated side, and again, to turn the spine and the sacrum. If I want to go into a split squat activity, I can do that as well, but I'm going to elevate the front heel under these circumstances. So again, I want to maintain that yield as I move into that 90 degrees. If I need to promote more expansion, more yielding action, I can start to move you into a propulsive activity as well. Ultimately, what I want to be able to do is to recapture an eccentrically oriented pelvic outlet in deep hip flexion. So my ultimate resolution here is going to be a heels elevated deep squat with a band around the knees but this is not pushing out into the band this is maintaining an orientation of the femur so I can get the pelvis to move around the femur and this is going to help me capture that eccentric orientation of the outlet in the bottom of the deep squat and so basically we're at the top of the squat we're going to take an inhale we're going to exhale to mid-range where we would typically have the concentric orientation and then I'm going to re-inhale to eccentric orientation of the pelvic diaphragm as I sit down into that deep squat.

So what you may want to do initially is use a reverse band variation of the box squat. This will reduce the differential between the rate at which your body drops and the internal organs. And so it'll help you eliminate the need for any rebound off the bottom because again, chances are you either have too much eccentric orientation or you don't control the yielding action very well. And so we're going to kind of kill two birds with one stone here with the reverse band. Progress this to a touch-and-go where you're just touching the box and getting off the box so you don't release the concentric orientation. And then I would work on an explosive concentric activity coming off the box as well with a very, very strong acceleration. So now we're coordinating the exhale strategy, the position of the pelvis, and the orientation of the pelvic outlet. Then start to increase load, but always make sure that you're maintaining your anterior and posterior expansion with your quadruped activities. As we want to work towards a feet into a split orientation, chopping activities are a great way to do this. So we can start with a side split chopping type of an activity. This actually reduces the gravitational demands on you in split stances. And then we can work towards a staggered stance, chop variation, and then progressively increase the amount of split that you're going to work into. And so again, we're lowering you down into this internal rotation orientation of the pelvis, this exhaled position of the pelvis. What you want to be able to do, Vicki, is get to half kneeling in these chopping activities without any sense of that anterior knee pressure or pain. Once you can do that, then we can start to worry about load and single leg orientations like a step-up activity where we're starting to really work on that propulsive strategy against gravity in a single leg. Then it's just time to start to work on the split stance, so you can start with some dynamic activities. You can do like a short stagger to a longer split in a static position, or you can make it dynamic with a shorter step length to start to introduce that overcoming action because remember the overcoming action is a rate dependent quality. We want stiffer connective tissues under these circumstances. Front foot elevated split squat is a great way to reintroduce your split squats that's going to reduce the load on that front leg and reduce the demands on that lead leg and hopefully take some stress off of the knee as well, as you again teach yourself to lower yourself into this internally rotated position.

Initially we're probably going to want to use a front foot elevated situation which is going to reduce the load on that affected side and allow us to translate that tibia a little bit more effectively, capture the true internal rotation through the hip that's going to allow us to keep the medial calcaneus in the ground and that first metatarsal head to prevent the ER-ing and that's going to result in our inversion sprains. From there we just progress loading and so what we can do is we can tip your backside up so we put a rear foot elevated here and again we've just increased the load but we're still translating that tibia forward and now we start to think about okay what else can I superimpose? I need some variability and I need some rate. And so here we might use some oscillatory impulses in that split stance to help us capture these foot cues dynamically and explosively and still hold on to our internal rotation. So again, we want to think about imposing these other elements of force as we progress through the program. Then we start to play with it with directions. So what we want to do is expand the challenge of moving towards internal and external rotation and again hanging on to those foot cues. First metatarsal head on the ground, medial calcaneus. So this could be something like a sled drag or we start to move our lunge patterns or split squat patterns more laterally. And then we start to work on maybe some cutting drills. We can use elevation. So we use our dynamic step ups onto boxes to reduce some of the ground contact forces. But then we can build in change of direction there. And eventually you just get somebody down on the ground and you work normal agility. Now, keep this in mind that we have to adapt these things for the humans. So not everybody's going to be doing the dynamic box work. Not everybody's going to need to work on their high speed change of direction like we would for some athletes. So let's adapt this program to those individuals.

Quick reminder, tomorrow is Thursday, 6 a.m. Coffee and Coaches Conference call. The calls have been getting really, really good, with really smart people joining us, asking great questions, and having great discussions, so make yourself some coffee and join us at 6 a.m. tomorrow. Now, my little preamble was a hint here. I'm not really sure how this one's going to go. There's a lot of things potentially to talk about here regarding this question. So let me just read the question and we'll have at it. This comes from Robert, and Robert says: 'Thanks for putting out all the content that you do. You're welcome, Robert. It has been very helpful. Considering the extent of your model, are there any principles that you find are absolutely foundational to the successful application of your model?' Have a great day. Thank you for that, Robert. Yeah, I have some principles to live by or to follow. They are adaptable and ever-changing. I think that as you gain new information, they are going to change. So real quick, though, first and foremost, what I would say is the number one principle is you should probably draw out your model. So whatever you think that you know or how you do things, it needs to have some sort of physical representation. Get it out of your head. Get it on paper so you can actually see what you do. And so right there is a representation of where my model stands right now. It is adaptable and ever-changing. There are several things that change within that that are not represented in the graphic itself because each element of that graphic is then broken down into smaller and smaller parts. And so now let's kind of dig into some principles, and these are things that I sort of write down as I go that remind me of certain concepts. So again, it just keeps me on track and provides a framework for decision-making, structuring, and then determining the best courses of action. So principle number one is actually pretty simple, and it's based on the Hippocratic Oath: basically, do no harm, preserve the dignity of your client or patient, and then teach the next generation what you know. And I think that we have a responsibility for that. So that's a biggie. And again, it's kind of at the top of the list. Next principle: seek the minimum adaptation that allows the maximum output. So this goes towards conservation of resources. So it would be like if you took a drug that had an effect and then you took more drug, and then there's no additional benefit to that, that's a waste. So we do the same thing with resources. So if we're training someone or if we're rehabilitating someone, then we want to promote the desired adaptation. And then we want to make sure that we're conserving the remainder of resources so they remain adaptable in other aspects because if we overshoot and we apply too much effort, then all we're doing is drawing on resources that we could be using for other things like recovery and rest and regeneration. So again, that goes towards conservation of resources. Principle: humans are complex adaptive systems and will behave as such, so there's an element of unpredictability in all complex systems. So we have to appreciate that fact. So we have constraints: these are behavioral constraints or structural constraints that we have to pay attention to. There's going to be a hierarchy of systems. I say hierarchy because we never know what element of the system is running the show, per se. We can say that certain things are predominant at certain times, and through experience, we can determine what may be running the show, but ultimately, we have to consider that we have this integration of a massive number of subsystems that we have to attend to. You have all sorts of concepts like degeneracy, adaptation, non-linearity, emergence, and self-organization that are also in play with complex systems. So we must pay attention to that. Along the same lines with the complex systems principle, there may be more than one solution that will result in the desired outcome. And so these are one of those things where there is a cause and effect that's associated with working with a complex system, but we just don't know what those are until we do something. So you'll see, like in coaching, we'll see a probe-sense-respond kind of concept. So what we have to do is act to run an experiment to see what happens, and then that guides us into the next principle. And knowing full well that there may be more than one solution. So if we looked at something as simple as choosing which exercise we want to do, there may be multiple exercises that will provide us a solution to a problem. Simple principle: do what is most important. Many things appear to be important and impact the system, but again, we have to consider the heterarchy when we're talking about what would be the best course of action. Sometimes we don't know. Again, we have to experiment, but with experience and time, we can reduce the probabilities and come up with a potential solution. Principle: supplementary training is not done in isolation from all other demands, whether perceived or not. So this is one of those things where people start to throw things in, and they go, 'Oh, it doesn't make that much impact,' but you might actually be creating interference for yourself. So for those of you that are fond of the concept of a finisher in a workout where you're trying to kick somebody's butt so that they feel like they worked out before they walk out the door, you're doing this extra work, and you actually might be creating interference for something else if it is in conflict with the desired outcome. So keep that in mind. Principle: be comfortable with uncertainty and the unknown. So again, we're dealing with complex systems; we don't know what those outcomes are going to be. And so we have to sort of pay attention to what's going on, and that's going to help us determine the next course of action. All models are principles, and all models must be adaptive because behavior is an emergent property of a complex system. We don't know what's going to happen, and so we have to have a model that can adapt to the idiosyncratic elements as each individual is going to behave a little bit differently. We have concepts that we can follow; obviously, we have constraints that we can be aware of, but again, each person is going to have those little idiosyncratic elements that the model must be able to adapt to. Principle: once movement repertoire is dependent on the ability of the body to access full excursion of breathing. So when I refer to two strategies in one plane, the universal principle is that movement takes place through expansion and compression. We do the same thing. Breathing is one of those ultimate representations of our ability to expand as we breathe in, and the ability to compress as we breathe out, and especially with breathing, the fluid that we're using is air, and air is compressible and expandable. And so again, if we don't have that full respiratory repertoire, then the chances of us being able to move with full adaptability is slim to none because chances are we're going to be using some form of compensatory strategy; we're going to be using some form of superficial musculature that's going to prohibit our ability to fully access our movement options. Principle: there is no one best way to move. So again, if you've read the work of Nikolai Bernstein, you've read about 'repetition without repetition.' And so under these circumstances, we're not going to be able to reproduce the same movement over and over again. So even though it might look the same, let's take a baseball pitcher for example: they throw a baseball in a very specific manner, and each pitch might look exactly the same. What we know full well, and we can actually track these things, is those movements are never the same, although they are similar. So we're playing with signal and noise here where we want to minimize the amount of noise when we're talking about high levels of performance. So we can have a reproducible outcome even though it might not be exact, but there's not one best way. What we want to have is as many ways as necessary so the brain and the body can come up with a solution for any movement that would be within a specific context. Principle: neutral spine is immeasurable and unnecessary as a concept, so the neutral word is on the list of dirty words that we try not to use because we can't even tell if anybody would be there, nor do we know if anything is optimal. So what we're looking for, and let's just talk about the axial skeleton as a representation of this, is we want what we want is not one ideal; we want an adaptable axial skeleton that allows us to effectively distribute and transmit the forces that we're exposed to within a specific context. That's what's going to give us the best shot at a favorable outcome but also health at the same time. So let's get rid of the whole neutral word and let's move on to something that is more associated with making sure that we have that adaptability. Principle: any model of movement must be coherent with physics. This kind of seems a little obvious, but we have to appreciate the fact that we are part of this universe and so we must behave as such. So we have to follow the guidelines of physics. So again, when I talk about things like expansion and compression, that's a universal principle; it's like we can't deny that. All we have to do is then recognize, well, how do we respect that principle? Then we can actually have a deeper understanding of how we move. Principle: remember where they came from. So this is sort of a two-fold principle: it represents an embryological 'remember where they came from' and then a learning-based 'remember where they came from.' So if we can understand how we evolved in our own development, a lot of the reasoning behind how we achieve certain movement outcomes is much easier to understand. So that's why we want to learn the embryological foundations; they are underappreciated and they answer many, many of those questions. Secondly, when we're working with an individual, we want to remember where they came from. So they've already learned certain behaviors and certain strategies, and those are ingrained, if you will. And so when we're trying to make changes in someone's ability to move differently...

Shirley Sarman participated in this study with another practitioner I'm assuming named Zeller in 1983. It's in a supplement from the physical therapy journal, which apparently doesn't exist. I can't find it anywhere. But they talked about 83 degrees as some sort of average or optimal. I think the Koreans found something that was just shy of 90 degrees. So it's almost like they said, okay, well, you know, it's kind of like that. So let's just say 90 is the standard. And so a lot of people are using 90 as the standard. The New Zealanders are using 90 as the standard. But I think it's a little bit of horse hockey. It's kind of like just throwing a dart at a dart board and going, oh, 90, okay, we'll call it that. Because there's really no foundation for it. It doesn't really represent anything useful for us to try to chase a number and say that this is optimal. This is the standard and we need to push people towards this because again, it's just not very useful. The one number that I've used and talked about is the 108 thing. And where that comes from, Zoe, is from tube behavior. So Graham Scar did some work in 2013. And he was looking at the helical orientation of a tube. And so the helical angle is where everything crisscrosses, right? So it looks like an ISA. And then they measure from the vertical. And what he found was that when you have an angle from the vertical at about 54.44 degrees, I have a tube that can elongate and expand in both directions equally. And so what that would be representative of somebody that would have say the ability to inhale and the ability to exhale effectively. And then we say, well, there's the optimal, but the reality is it's like, no, that's just somebody that has that capacity when they have that kind of an angle. So chasing it is useless because trying to put somebody into a standard is like trying to change somebody's height or their shoe size and say, oh, I'm sorry, sir, you're six foot six, you're way too tall. If we can make you six foot three, you'll feel so much better. And so we can't look at this thing as something like that. So we're not chasing an optimal, we're not chasing a standard and we're not chasing a number. Get the numbers out of your head, except for one reason, and I'll tell you that here in just a minute.

So what are they doing to get there? So they don't have extra rotation and they're squeezing their shoulder blades together to get extra rotation. How do you get extra rotation? You have to expand the space. You have to expand the space between the scapulae, right? We call it dorsal rostral expansion for fun. Does that make sense, that term? Okay, so you need to do some of those activities. So have you ever seen the video I did, the Better Band Pull Apart? Yes. Great one for that, especially for people that are performing on their feet. So that will enhance your ability to expand that area. But you're still going to have technical issues because they've been using that technique for who knows how long, right? And they're just following their path. They're executing based on what their body has the capabilities to do. And yeah, yeah, and I know there's a lot of ways the lifts can go wrong where you can push it out there, and that's why I wanted to minimize those aspects because the one thing you want to recognize in that type of a lift is that if the bar is moving away from the body, they're moving away from the bar somewhere. Right? It is a substitution. Yeah, it becomes simple physics. Mm-hmm, yeah. If it's a technique, like I said, when you're seeing a technical problem, right? You already know there's a problem. You just have to recognize like in that position under those circumstances, what movements do I need to be able to access? Okay. If they have a problem at that point, then I say they probably can't do X, right? So I look at say, where's the relative position of the hip? Where's the relative position of the shoulder? What would be the greatest limitation under those circumstances? And then that directs my thought process. Do I have an ER problem or an IR problem?

OK.

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 extra 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, 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.

When inhaling at the start to get tight counter-nutated sacrum, which isn't ideal for overcoming at the bottom, how would you coach that at the pelvis? And she wants me to use the pelvis to demonstrate, so that's going to be kind of easy. But the thing that we need to understand here is that, so Sandy, your interpretation is actually not correct. So you don't have a clear understanding of what we're talking about with the yielding and overcoming because you're looking at yielding as this overarching kind of position thing where you're including the counterneutation and the the the ilium public floor and guts etc in this. So what I want you to understand about yielding and overcoming is the yielding and overcoming actions are the distribution of the forces through the connective tissues. We don't want to include the contractile element, the musculature in that because that's what's actually going to alter the rate at which the connective tissues are loaded which determines whether we have a yielding or an overcoming strategy. So when I load connective tissues very, very quickly they become very, very stiff and overcoming when I when I load them very, very slowly. They actually yield and that's where we start to see the expansive capabilities even with situations of concentric orientation of musculature. So a concentric yielding strategy is a concentric orientation, so a muscle that is moving into a shorter position, but the connective tissues are allowing the expansion to occur at the same time. And that's how we distribute some of these forces. So right away we have a little misunderstanding that hopefully that explanation is going to help. Now, let's compare two squats. So you mentioned what we would consider traditional, maybe like a body weight squat or something like that. So as we start at the top we would be in a relatively inhaled sort of a counter-nutated position at the top. So we're going to start bias towards an inhale as we move through this middle area of the of the squat. So plus or minus 30 degrees of your sticking point. What we're going to see is we're going to see movement towards a more concentric orientation of pelvic diaphragm, internal rotation of the hip joint, and nutation of the sacrum. To get below that level, we're going to have to re-counter-nutate. So we're actually going to see more movement at the ilium in this case to achieve this deeper hip flexion position. To get into that depth, we have to have eccentric orientation of the pelvic diaphragm to get there. If we don't have that expansion downward, you're never going to get into that deep squat. Now let's take this over to powerlifting. Under most circumstances there are exceptions to the rule but under most circumstances when we're talking about a powerlifting style squat we don't want as much eccentric orientation. In fact, we hardly want any at all. We want just enough to get competition depth and then get back up. So the power of the squat is all about staying as close to this maximum concentric orientation as possible. We're going to use a compensatory breathing strategy throughout the entire lift. Because if you think about where you're going to position the bar in a back squat, you're going to try to retract the scapula to a degree. That's going to create upper back compression. So dorsal kyphosis is going to be compressed. Upper dorsal kyphosis is going to be compressed. You're going to engage the lower posterior rib cage musculatures like lats and things like that. So we're going to try to compress that. You're going to compress everything that you can across the backside of the pelvis to make a very, very stable structure. You're going to use your final compensatory strategy in the lower part of the pelvis where you're going to drive the extra rotation moment. You're going to try to compress this apex of the sacrum. So we want the minimum amount of eccentric orientation to allow us to get into that position, because the minute that you release the concentric orientation to any significant degree, you are going to accelerate towards the ground under maximum loads, which is really not effective, especially in competition, because you tend to not get your white lights under those circumstances. So again, so we're gonna actually limit this. So we don't wanna go past this concept of orientation. So your setup that you're talking about at the very beginning of the squat, yes, you're gonna charge your thorax with air, and then you're gonna squeeze the bejesus out of it, cut it off at the throat with a valsalva, right? Because we wanna create this incompressible body that we can stack a bunch of weight on top of. And I cannot release that at any significant degree during the lift otherwise I am going to lose my position rather rather readily and again I'm going to miss my lift so the breathing that you're talking about in the the competition squat is a compensatory strategy all day every day it's it's concentric on concentric and and so we're not going to follow the normal mechanics that we would under a normal circumstance when we're talking about a regular if you will or a body weight squat where we have this transition from expansion to compression to expansion again. The power lifting squat is compression on compression on compression with the most minimum of eccentric orientation. That's why the box squat so popular with power lifters is because it does allow them to capture eccentric orientation at a depth. But it's the minimum allowed, and then they learn how to yield throughout the entire system. So all of their connective tissues are providing the yielding strategy to even get into position, which is why we tend to see connective tissue issues with a lot of power lifters. We see a lot of bony changes with a lot of power lifters over time because of the dramatic, compressive strategies that they're utilizing. That affects blood flow to the joints, affects blood flow to the connective tissues, We got a whole world of hurt in our futures if we don't take care of ourselves. So I hope that clarifies a little bit of the yielding and overcoming strategy. If we're looking at the power lifting style squat at the bottom, you're going to be as nutated as you can, but also compressed underneath. So I can't even create the position with my pelvis model because you're going to probably bend the sacrum underneath you to a significant degree. So, you know, from a health standpoint, from a power living standpoint, it would behoove you to work on both styles of squat, one squat, obviously for your maximum effort, for competition purposes, and the other one to help you maintain some health and mobility. So again, I hope that helps you, Sandy.

Now, yes, it's a solution from a pain standpoint, but I also may be sacrificing shoulder range of motion. So you're going to have to make a choice there as to if you want to use that strategy or not. Under some circumstances, it may not be a problem. If I'm a powerlifter and I'm concerned about pushing my numbers up on the bench press, this actually might be performance enhancing to a degree and alleviate some shoulder discomfort because I'm not really concerned about maximizing shoulder range of motion from an athletic standpoint or a gen pop standpoint. For a general population, it might not be the strategy we want to go with, but I just wanted to throw that out there because it does happen, but I don't want everybody to think that it is the solution for every circumstance because it can cause secondary consequences. Jimmy, great question. Thank you for following up on that video. I really appreciate you for doing that. If I didn't answer your question, please ask me another one at askbillharman at gmail.com.

So that's another shape change that we have to consider as well. Johnny, I hope I answered your question for you. This is a really, really interesting topic. So if I didn't, please ask another question at askbillharman.gmail.com and I will see you guys tomorrow. So let's talk about three different shoulder impingements, three strategies, and three solutions. Good morning. Happy Wednesday. I have neuro coffee in hand and it is perfect. All right. It's Wednesday, so that means tomorrow's Thursday, which means that we have the Coffee and Coaches Conference call at 6 a.m. Eastern Time. Go to my professional Facebook page. If you would like to join us, we've had amazing groups the last three or four calls, so please join us. Discussion is getting really deep. Everybody's getting smart, so I really like this. Let's dig in. I got a really, really good lead-in question. That's going to take us in a little bit different direction, which will be kind of cool. So this is from Mihail. Mihail says, hey Bill, hey Mihail. He said, during shoulder flexion test, when measuring it the right way. So he's making reference to my YouTube video on how to measure shoulder flexion. He says, what's happening when the elbow starts to move laterally? Is there a normal motion available at the shoulder girdle? And the only way to get the arm overhead is through shoulder internal rotation. So if you keep raising the arm overhead while allowing the internal rotation to happen, is movement happening only at the shoulder joint with no movement, the scap, clavicle, et cetera. Mihail, you are on point. So this is a very, very specific situation where we've got a posterior compressive strategy that is going to limit shoulder elevation because it's going to eliminate the external rotation, of elevation. The minute you steal that you're diving right into interrotation and you're moving towards interrotation but we got a scapula that can't move and so we have a very specific limitation and you start banging into the compressive strategy at about 90 degrees of shoulder flexion which would typically be one of our impingement tests so What I would like to do, Mihail, is I would like to take this situation and let us look at three different impingements because I think a lot of impingement gets packaged into one thing and I think the current strategies for most PTs is to try to look at They're calling it subacromial pain syndrome rather than subacromial impingement. We don't want to look at these impingements the same because the source of the limitation that is creating the compressive strategy in the shoulder that results in pain is not the same. So we're going to look at three different situations here and We get to use old school PT school orthopedic textbook impingement tests because this is why those impingement tests were valuable at one point in time. They just didn't know why.

So 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. I hope that's helpful.

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 yourself 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 and 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 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 Phillip, I hope this gives you a little bit of a representation of what I was talking about. And again, keep in mind, this is not an absolute progression of any kind. There's a lot of baby steps you can take in between all of the things that I've shown today.

So if we use dead guy anatomy, which is what a lot of, unfortunately, I think a lot of the information is based on, we have this perception somehow that this sucker doesn't bend, twist, move the way the way it actually does. And then we have this thought process that the hip joint is somehow fixed in space. When the reality is it moves a great deal, it re-orients, it changes direction. And so if I use dead guy anatomy and I say that I'm doing cadaver dissection, I say these muscles are extra rotators because when I pull on them, the hip does this. And so Rachel, in your model, you are absolutely correct. That's what would happen. But I don't think that's as close to reality as we can get. So I think we can have a little bit more of a refined model. So if we think about a posterior compression, so a posterior compression would be activity of the muscles that go across this upper portion of the posterior aspect of the pelvis that push forward. And what that actually does is it changes the direction of the acetabulum. So the socket actually changes its direction. And so if I change the direction, so if I compress here and I change the direction of the acetabulum, what happens is I pick up internal rotation and I lose external rotation. So that's what we're talking about when we're talking about these compressive strategies. So every compressive strategy either reorients or changes shape or has some other influence that produces an outcome. And the more understanding we have in respect of how this thing actually can move. So we have to refine our model. We can't use the dead guy anatomy as our representation like most books try to do and then they try to resolve these things and then we have this massively confusing model with multiple rules and no foundational principles. If we take the same concept up into the thorax, where I have the traditionally upward rotation of the scapula, that is a posterior compressive strategy in the thorax that reorients the glenoid and it produces an internal rotation element. So through that middle range of overhead reach, that's why that would become an internally rotated position that we would use as we talk about moving through inhalation to exhalation to inhalation. Again, we're talking about that posterior element. So I appreciate this question so much because I know there's a massive amount of confusion as to why these things exist. What it comes down to is evolving your model, adding detail, layers of detail. It doesn't matter where you start. You're not right and you're not wrong. All models have limitations and that's the one thing that we need to understand. It's just how much detail can we superimpose onto what we already know. So Rachel, take what you're already thinking because you're not wrong under certain circumstances.

Now, if I was to try to do this in internal rotation like a lot of people think, I'm going into IR, the Ilium, I'm gonna nutate the sacral base on this side. If I nutate the sacral base on the right side, and I try to move in that direction, I've just blocked the sacrum from turning to the right. I've just blocked the lumbar spine from turning to the right. If I try to twist a thorax on top of that, well, enjoy your spine surgery or your hip replacement because that's essentially what's going to happen. You're now turning against the mechanics that allow you to turn comfortably and efficiently. And so again, this is ER at the top of the backswing. It doesn't mean that there's no IR occurring because remember they're superimposed. I'm just biasing it towards extra rotation. Now, let's just suppose you don't have enough external rotation and you can't capture that position. What's your golf swing going to look like? Well, you're going to have a number of swing faults. Keep in mind that all of these swing faults are going to be substitutions of the lack of being able to acquire this external rotation position. So you're going to try to supinate your right foot as you take the club back. So you're going to roll to the pinky toe side of your foot. That's an external rotation of your foot. That's a substitution for external rotation up the chain towards the hip. You're going to orient your knee outwards. So you're going to turn your lower leg and your thigh outward. So you're going to point your knee out towards right field as a substitution for the lack of external rotation. You're going to try to side bend away from that side, or you'll reverse pivot, which is also a substitution for a lack of external rotation to the right. So all of these are substitutions for this inability to acquire the position at the top of the backswing. Now, here's a little hint. The same thing's happening in the upper thorax. So don't get confused. It's going to be an ER position at the top as I accelerate the club head and move towards impact. That's where your internal rotation is going to be infinitely more important because that's going to be where max propulsion lies. That's an internal rotation strategy. That's exhalation based. And that's where you're going to produce all of this force. So when I have to acquire range of motion, I need to be ER'd, inhaled, and that's going to be the top of the backswing, and if I transition into IR at that point, I'm going to have to compensate. So I'm going to challenge a constraint, or I'm going to create a swing ball. Hopefully that clarifies that for you. If you have any more questions, please, please ask. Go to askbillhartman at gmail.com.

But point being, if I've got limited shoulder flexion, the typical compensatory strategy for limited shoulder flexion, especially in the early range of shoulder flexion, which you would be exposed to in a bench press, is to turn away from it. So again, so he's actually turning his rib cage on the bench, and so this arm looks like it's far away, and this one looks like it's tucked in. Now, here's the problem with that. Because what you've actually done is you've actually turned the right shoulder towards greater internal rotation. So I need internal rotation for bench press. I need internal rotation for my compressive strategy, constant regrain rotation and propulsive activities. And then I need to move through a space that demands I have internal rotation so we got a triple whammy there as you get a ton of compression in that right shoulder under these circumstances and so that may be why your client is experiencing right shoulder pain. This is actually really cool little little competitor strategy and it's probably not that uncommon. So, probably what I'll do, as soon as I get a little bit of time, Ben, I'm gonna go into the gym, I'll probably grab Eric, and we'll go through how this is actually happening. So, if I don't do that soon, please send me a reminder. Alright, so what's our solution here? Step number one, because you're dealing with a painful situation, you're going to have to clear this client for any structural issues. And so if you don't have the capacity to do that, I suggest you get them to somebody that can. Let's rule out anything that may be important under these circumstances. Because whenever we're dealing with pain, we've got to clear those structural issues. Number two, take a break from a bench press. You basically got two options here. Either take the bench press away because it is problematic or you keep training the heck out of it as hard as you possibly can until it breaks and then you have to take a break from the bench press. Either way you're gonna have to take a break. I suggest you do the the first option there, much safer and much more caring for that client. In fact, what I would do then is I would remove all barbell exercises from his program at this point. You're basically fixing the extremities under any circumstance, whether we're talking about a squat, a deadlift, a row, or any kind of pressing, you're fixing the extremities in a position that are going to promote more internal rotation. From a rehab standpoint, again, if you don't do manual therapies yourself, you're probably going to want to find somebody that does. If this person has any level of hypertrophy or is actually a very, very strong human being, you're probably going to need some help getting this rib cage to move. So you've got to get a dynamic, infrasturnal angle. So that might require some manual therapy. We need sternal movement because if you're missing internal rotation, you don't have pump handle movement in the anterior thorax so we need to recapture that. Clavicles are going to be limited in the ability to rotate. When you've got to get the ribs to move more effectively, you're going to have to decompress the scapula from the dorsal rostral space. So that's a manual technique, by the way. I have a video of that on YouTube. I also have one for the scapular elevation. So look at those two. And again, if you don't do manual therapies, get somebody that can apply those techniques. You may have to have somebody that's good with their hands. to help reduce some of the concentric orientation as well. Basically, you've got a guy that's really, really compressed and you've got to get a whole bunch of expansion here to restore His ability to move freely through space. Okay, from a rehab exercise standpoint, I got a couple videos on YouTube specifically for dorsal rostral expansion. So there's a seated variation, and then there's a better band pull apart video that is also really effective for dorsal rostral expansion, one seated, one standing. You can immediately go to some sort of high oblique sit activity. which is going to help start to reshape the the thorax a little bit get some of that anterior posterior expansion and and as you can move into a lower obliques type of an activity which would be closer to what looks like a side plank variation you'll start to get some some pump handle activity from that you can do supine cross-connect so they should be in a non-provocative position based on the upper extremity and then a sideline propulsive activity will also be helpful. Again, sideline is a great way especially for these wide people to get some of that anterior posterior expansion because we're taking advantage of gravity. Once you can capture 90 degrees of shoulder reflection without pain, supine arm bars are now on the table. You can throw in a screwdriver on top of that. to promote some internalized storm rotation and then you can eventually move to a prone propulsive activity which is going to get you a ton of that posterior expansion and yielding strategy that your client is lacking. If you want to take you into the gym, we've got suitcase carries that are probably on the table right now. Eventually, you can play turn it into a rat carry so we can get some ER and IR out of that. Backward sled drags with two handles to promote the unilink strategy posteriorly. So you get some expansion, you get some pump handle action. You're also going to get some hip mobility out of that as well. High rep tricep push downs with a band. Also, it's going to keep you close to that transition. between internal and external rotation and give you some of the yielding strategy posteriorly in that dorsal rostral space. Again, you're going to need that. So dumbbell curl variations. There's a bunch of videos on my YouTube channel for that that you can also use to help keep that dorsal rostral space expanded. The key element with any of the resistive activities that I've just mentioned is that you can breathe through it. The minute you have a breath-holding strategy under any circumstance during these activities, you are promoting the limitation that you are trying to alleviate. So keep that in mind. So in a nutshell, what you got is you got something that's very, very compressed. They're using compensatory strategies during the activities in question. So in the bench press, maybe they're carrying them around. I don't know, but either way, when they're bench pressing, this is what they're using. So you have to reduce the compressive strategies and eliminate the interference through all of the activities that you're doing. So you might have to restructure some programming. Unilateral activities are going to be much more effective than bilateral symmetrical activities and take the barbell out of their hands. So Ben, I hope that gives you something to work with. If it doesn't, if you need more, go to askbillhardman.gmail.com and we will provide you another solution if you have another question. Everybody have a great Wednesday and I will see you. Oh, coaches, come to the Coffee and Coaches Conference Call tomorrow morning, 6am. It's going to be Thursday. It's Chips and Salsa Day tomorrow. Have a great day. Happy Thursday. I have neuro coffee in hand and it is perfect.

If I didn't cover something that you wanted to talk about, please ask me another question at askbillhartman@gmail.com and I will see you guys tomorrow. Good morning. Happy Wednesday. I have neuro coffee in hand and it is perfect. All right, today's Wednesday, that means tomorrow is Thursday, 6 a.m. Please join us for the Coffee and Coaches Conference call. We usually have a great group of people that come together and we talk about all things professional, technical, and every once in a while we grab and complain just to get some things off our chest, so it's all very, very helpful. But it's a great time. So again, please join us for that. I've got a squat hinge question. These questions seem to be very, very popular. People seem to have a lot of questions as to the distinguishing characteristics. And this is actually a pretty good one from Mihail. Mihail says, can you please go over what's going on in the lower posterior rib cage during squatting and hinging? I used to think that hinging will compress the posterior rib cage and squatting will expand it. For example, when performing Goblet Squat with heels elevated, here at us below 60 degrees, the lower rib cage will expand. But you've also said that during hinging the posterior lower rib cage expands. My guess is since the rib cage moves the pelvis there'll be more posterior lower expansion during a hinge. And because it's a new thing, but that contradicts the hinge being more of an exhalation based activity. Thank you for the great info. So the last part of your question gives us an opportunity to really clarify a couple of things that we haven't talked about probably in a long time that is kind of important in regards to just normal breathing as to where we drive some of this expansion. And so I'm gonna bring in the skeleton to give us a little bit of a representation here. So obviously when we breathe in the diaphragm descends and theoretically we're gonna get this sort of uniform expansion throughout the lung because the gravity is gonna fill from the bottom up if we're standing upright And so that's kind of like this normal representation. But when we talk about concerted muscle activity, in addition to the diaphragm that's going to promote thorax expansion, this is why we talk about dorsal rostral expansion a great deal because concerted muscle activity of these intercostals is also going to promote this upper posterior expansion. We're going to get the up pump panel. So the parasternal intercostals, also inhalation bias to create this expansion. But in doing so, We have to consider what's happening in this posterior lower aspect that you mentioned because it is kind of interesting when we talk about squatting versus hinging.

It's the only ones we got. Let's leave the other stuff out of it. It's just confusing at this point. And so as we move through our space on Earth here and we're dealing with the load of gravity, there are forces that we have to apply upward against gravity to hold our positions to move heavy things and such. And so under those circumstances, what we have to do is we have to capture the propulsive strategy. And at some point in time, the forces ramp up. So we would call that max propulsion under certain circumstances. And the forces are variable depending on what we're doing. If we're just walking, the max propulsion is going to be a certain level of force. If we're running, it's a little bit different. If we're lifting heavy things, it's going to be a little different. But the point being is that we have to be able to capture a position that allows us to apply this upward force. That's going to be done with sufficient relative internal rotation and exhalation strategy and compression. And so that always goes along with that upward force. So when we're dealing with impingement issues, what we have done is we've created a resultant that does not allow us to distribute this force sufficiently throughout our entire system and so now we're going to use a focal strategy, a focal compressive strategy to apply this maximum propulsion depending on what activity that we're going to do. And so it's a quest, if you will, to sort of acquire sufficient internal rotation and compression to maintain our position or do whatever activity that we're doing.

The thing that I want you to understand here, Bradley, number one is you have to look at your programming and start to eliminate the interference and then understand what you're looking at. So take your archetypes into consideration and then capture the posteriorly oriented position. It's not about trying to find this one ideal. It is about moving people back and forth between these full excursions so we have full adaptability through the pelvis and the hips. I hope that's helpful for you, Bradley. Have a great day everybody. I will see you tomorrow.