Or don't even tell them anything. And just have them do it. And then you get to be the judge of like, oh, okay, we captured a better representation of iron at the bottom. We saw a stronger turnaround. They usually comment, they go, wow, that was so much easier. That's usually what happens. Gotcha. If I may, one of the things that you may wanna consider if you're having trouble in progressing that is you start them from the static representation where they actually have to just hold the position that you're trying to capture and then slowly increase the amplitude above and below, right? So they're doing an impulse literally at that level. And then you expand it, you say, now start here, come down and catch it and come right back up, come down and catch it and come right back up, come down and catch it and come right back up. So you just slowly expand the excursion that they're moving without resistance. So the drop, right? And then they have to catch. And so then you're increasing the rate at which they have to perform that progressively. And then doing so, then you get your nice little concentric overcoming where you get the nice stiff connective tissue response that goes along with them capturing the concentric orientation.

I see. Okay. Cool. Very helpful. Thank you.

Yeah, let's do it.

There's no question about that. It's like, if you ever see two people run together and they go, and they both fall back, that was pretty equivalent. But understand that you're multiplying the forces. So whatever force I brought this way, whatever force I brought this way, the collision is a combination of those two forces.

Um, so, so your weight is on your right foot and you're stepping. You're in middle P. You're like dead middle P is the foot on the ground moving faster forward than the other side.

It's an IR compensation because you move somebody so far into ER where they don't have any space. And so they had to orient the pelvis away from the leg, right? And the only way that they can move away from the leg is to create an IR compensatory strategy above the pelvis in the spine. You see it?

OK, so from my understanding, it's better to look at how much total range is available when I'm moving somebody on the table, instead of looking at where that range is oriented. Because that's just their bias, probably. And I want to get the average amount of rotation.

Yeah.

Okay.

Yeah, definitely. That makes a lot more sense. I think that's really all I had.

How are you, sir?

Absolutely. Position, breathing, shape, right? When we talk about the shape, right? Because we can actually identify those things. But again, it's having an understanding of what those representations may be. Also humble yourself a little bit and recognize the fact that you'll probably be wrong sometimes. And that's just real. I just don't hurt people, right? It's always a safe experiment. You're not putting people at risk under those circumstances. If you're unsure, you don't do it.

Not really. It's an interaction. I mean, it's a number of factors. It is their system that determines the final outcome because it is them. But think of all the things. Again, this is like an impossible thing that I'm asking here, but think of all the things that could potentially influence the outcome.

Okay, so if I hold a weight right here in this goblet position, okay. Is the load over my center of gravity or in front of my center of gravity?

Thank you. Yes. Thank you.

Okay.

Thank you so much.

The confusion lies in the degree. Okay. So there's a difference between doing a set of like your 12 rep maximum and your one rep maximum. Okay. So there's seven components of force that influence the way that connective tissues behave. All right, two of them, one is rate and one is magnitude of load. And so both have an influence. So the bigger the load, so again, like think max effort squat, that's a ton of weight. And so the way that that load would be distributed would be very, very quickly. So I would need my whole system to be, as they would say, stable to be able to manage that load, right? So there would be almost no yielding. So you got to think about degrees. One end of the spectrum is maximum yield and one end of the spectrum is maximum stiffness and overcoming, right? So all activities fall somewhere in between the two extremes. So you can think about this interaction, like this overlap. And you say, this activity would be more of a yielding action. This would be more of an overcoming action, right? But both are kind of happening at the same kind of places. So I think with Orion, did I talk about that? Was that a box jump in the max effort squat? Did I use that example?

Okay.

I tell you, like I said, it's not that there aren't right leg leaders; it's just the fact that it's a much more difficult element of control. Because again, you always have to look at the combination of influences: we've got the internal stuff that we always have to manage right as a human being, and then we have the superimposed loads on top of us with the barbells. If you look, like, at Olympic divers, there are people, and I think actually the guy that's ranked number one in the world can do this too—he can actually spin. He can actually spin to the left, which is usually very, very, very difficult to do. I'm sorry, he spins to the right, which is difficult to do. Most people go with it. That's why running tracks turn left; that's why race tracks turn left. Because they kind of figured out pretty early on, I would imagine, that if you try to turn right, you're kind of either slow or you get really sick to your stomach at 200 miles an hour. Yeah, it's a tough turn. It's a tough turn. All you have to do is run a 200 on a running track in the traditional direction, then run it against the typical direction, and you'll see how hard it is to make that right-hand turn.

So the cable left hand hold in front of me into a deep squat with a right foot forward.

Because you're starting at a higher level. That's why I gave you 37 instead of 12. How do you decide what to do with a new patient or a client? Good morning, happy Friday. I have no coffee in hand and it is perfect. I have a much busier Friday than usual, so I'm going to dig right into today's Q&A. It's a little bit more on the decision-making end of the concepts rather than what we would typically talk about, where we're talking about cases or presentations or things. But it's a very important aspect of things because it does help us through our decision-making process as we work with a new client or a new patient. This will be skewed a little bit towards the physical therapy side of things as a background, but still going to apply to anybody that has to work directly with human beings, especially in the fitness and rehab industries. So this comes from Tim, and Tim's got a series of questions and we'll knock them out in sequence here. But Tim starts with, as a physical therapist, how do you go about evaluating someone who presents with a musculoskeletal related issue? For example, buttock pain. So Tim, it's going to depend on some information as to how we're going to evaluate this person or how we're going to make our decisions as we move through this process. And so what we want to recognize is that these presentations are a little bit different. So for instance, somebody comes in with buttock pain and so that's kind of vague, but what if they slipped and fell on the ice and landed on their butt and now they come in with buttock pain? So now we can categorize them into this what would be considered a clear or an obvious presentation. It's one of these circumstances we would evaluate them with a lot of good information that would lead towards okay, your butt hurts because you fell directly on it and so now that seems obvious, right? And so we're going to treat them a certain way. So this is protection, promote adaptability, and progressively restore normal movement. And so again, this is very straightforward. In fact, in some of these cases, they don't even need physical therapy because it is so obvious. They go, okay, I fell on my butt. I just need to protect it, take care of it, blah, blah, blah. And eventually I'll come back to normal. Let's just say that they've gone through that process. And so they've treated it as this obvious kind of a thing, but now they've got something that is persisting. And so now they have this buttock pain that it seems like this thing should have healed by now, but they still have an issue with this pain. And so now they come to see us, and now we might categorize them as a little bit more complicated because we do know that something has happened. In the past, we have that information available to us. And so maybe they've gone through some other diagnosis. So they come in with a known constraint change. And so they say, oh, I have this, this showed up on an X-ray or this showed up in an MRI. Or they're presenting with something that is mechanically familiar. So we see a relationship as we go through our evaluation. And so we can identify a little more of the cause and effect that may be interfering with normal behavior. So again, this would be a situation, somebody fell on the ice, they go through the acute recovery, it seems to have gotten better, but they still have issues. And so now maybe they have an adaptive strategy or an adaptive behavior that is promoting this ongoing pain. And so that's something that we can identify with our evaluation. Now we can go to a third realm here where we're talking about a much more complex situation. So this is the land of the unknowns and this is somebody that shows up with an insidious onset of buttock pain. So everything under these circumstances is going to be emergent. And so this is where we have to identify what we can identify. So we measure what we can measure, we intervene, and then we monitor the behaviors. And so this is where we see the emergent behavior, the response to the intervention, and then we would take the next logical step. So again, maybe we have some exacted behaviors here that are creating interference or not. But again, this is where we rely on our structure, our orientation, our muscle and connective tissue behaviors. And our goal under these circumstances where we start in this complex domain is we want to get moving into a complicated or even better a clear situation where we can actually apply a best practice situation because when we're in the complex domain, everything is emergent. We just don't know what's going to happen because there are too many unknowns. Okay? So Tim goes on and he asks, in the physical therapist world we tend to diagnose clients with particular syndromes or conditions to do so. We often use tests which have questionable accuracy. That's an understatement. or clusters of tests to reduce the likelihood of false positives. Using your model, do you solely rely on a battery of tests to establish whether someone is in a concentric or eccentric orientation and not focus on identifying specific signs or symptoms, which would be correlated with specific musculoskeletal presentations as commonly taught in PT school? And then he says, do you try to differentiate pathology? So Tim, I'm 30 years removed from physical therapy school. I would hazard to guess there's very little that I do that is leftover from that other than working with humans. So technically speaking, I do not try to identify pathologies, but my model does it for me. So for instance, as I test and I intervene and I re-measure these behaviors that emerge because of the iterative nature of the movement system, I have a series of checks and balances that allow me to identify these little outlier measurements. And so if I see interference that might be representative of a constraint change or an exacted behavior, again, we will try to intervene to make that change, but a lot of times when we're shooting for this, sorry, that's my little alarm that went off. So a lot of times as we're shooting for this, we might have some form of interference that we can identify as a constraint change or as you would indicate a pathology. So again, if I have a true pathology, that inconsistency shows up. So for instance, if I have a look at shoulder and hip range of motion measures, and so they should mirror one another because of the iterative nature of the movement system. And so if I have one measurement in the shoulder that is unchangeable and symptoms persist, then I might find that I do have a constraint problem. So I would need to send people out for more tests. So if we go back to your buttock pain example, let's just say that we had our person that fell, they go through the acute phase, we move them through the process, we look at them from a complexity standpoint and we find that something is unchangeable, and so now we say, oh, I might have a synovial joint that can no longer behave normally. I've got to send you out for more tests. And so they we send them back to the doctor or however your referral system would work wherever you were. Okay. Tim goes on. This is another question. So patients seem to seek a diagnosis. We want to know what's wrong with them. What narrative do you use to not overwhelm them with the complexity if you're a model? Well, first and foremost, Tim, my model is actually quite simple once you get to using it. But the thing that you want to recognize is, first and foremost, is don't speak jargon, but speak patient. They don't really need to know my model. In fact, they already come to me with a model in their head. So one of the elements of the subjective is to determine what their concerns are. And as you do so, they're going to provide you with a series of beliefs or what their reality may be. And unfortunately in many cases, because they can go consult Dr. Google, they're going to distort reality towards case scenarios based on the information that they think that they understand. So you become the one that has to reorient them to reality and hopefully avoid that concept of catastrophization that many people run into. I don't think that they seek a diagnosis per se. What they seek is understanding and they want to know that they're going to be safe. So calling something a diagnosis tends to put it into this clear, obvious category for a lot of people from a thought standpoint and that's comforting because obviously if it's clear and obvious then there's a way to get rid of it or a way to resolve the problem. The goal then is to explain what the possible outcomes may be and how your findings and interventions may actually influence all of these possible outcomes. So again, I've actually had situations where people will come in and we kind of chuckle about this but they may have sprained their ankle. And they might be 40 years old. They've never done anything physical in their life. They've never had a painful situation. So they don't know that the ankle sprain is actually resolved and you can walk normally again. And so in that situation, their reality was like, I've never felt this before. What does it mean? I don't understand it. And we give them that understanding and we can immediately put them in these saying, oh yeah, this thing usually resolves in about six to eight weeks and in many cases, you go back to normal life and you'll forget about it. So again, keeping them safe and maintaining a continuous narrative as you go through the process is very comforting for them. So we'll do this with how you execute and provide instructions. So whenever possible, you have them give them a situation of cues to provide internal awareness or an external reference so they can have an element of control and that provides them an element of that sense of safety as you go through the process and you just keep them aware of what's happening. And so again, Tim, I think that you've got a lot of great questions here. Hopefully, I touched on something that is useful for you so you can kind of see how this process works and how we would differentiate the different ways that we would look at these situations because I think that this is one of those things that doesn't get expressed enough. It's a very complex situation. We're working with humans. There's different presentations that are going to come into play. There's different ways of looking at things. But again, this is where falling back on an effective model, useful heuristics, good rules of thumb, because we're working in so many possible unknown situations that I think the decision-making process and process in general as you're working through these situations is so important. So Tim, thanks for the question. If you guys have any other questions, go to askbillhartman at gmail.com, askbillhartman at gmail.com, and I'll see you guys next week.

Well, you have to. Like I said, the forces inside of you allow you to walk on two legs easily, easily in air quotes for grace compound. Okay. Easily. That's why we're good at it most of the time, most of the time. But they don't go away. And like I said, some people have a structure that makes it harder to control them. Good morning. Happy Tuesday. I have neuro coffee in hand and it is perfect. All right. Man, still basking in the glow of yesterday's IFest University call. It was great. We won a couple hours. Great questions. Great discussion. You should have been there. If you're not, go to ifestuniversity.com. Get yourself signed up. Also, don't forget the Reconsider podcast with yours truly, and my buddy Chris Weikis. It has been growing and so you can listen to that anywhere that you listen to your podcast or you go to the YouTube channel and actually see the video which is actually kind of fun. Chris is really, really good with the edit and so kind of fun to watch as well. Digging in today's Q&A, this is with Paul. This question is in the context of pole vaulting, but here's the takeaways. It's important that you understand the position of the axial skeleton and the extremity as you're applying force into the ground. So Paul's working on his pull. He's making a comeback. He gets a little wonky in the Achilles tendon. And so we have to consider the position that we're applying into the ground. I think Paul's actually pretty good with this. However, we also have to consider how long we're applying force into the ground. So this is the impulse of force times time is your impulse. And so if we prolong the impulse, we could be exposing tissues to tolerance beyond their capabilities. And we could also be dampening some of our force application into the ground. So this is an important part. We give a couple of examples during the discussion to help you gain some understanding in regards to what we're talking about there. But Paul, this is a great question in context, but again, really valuable takeaways. So thank you. Everybody have an outstanding Tuesday, and I'll see you tomorrow. Actually, it's hang on, hang on. So the guy that we were talking about, that the pole vaulter, the coach, 17 years ago, I found this 10 years ago, he went 14 six.

Just a quick side note. You were correct. She did have an ER foot in non-weight bearing. So, as usual, but anyway, she has done really well on the table so far. Like again, she's one of those tall, very slender girls who just got her motion back very easily. She flops on the table with very minimal input. So once we had an early representation last visit, I stood her up and then did the activity. It was one foot on a box and one foot straight underneath her, chopping down, just to try to basically reteach underneath her and build out a little bit in the midline. Her immediate strategy was very similar to her initial standing posture where she hyperextended the knee and then rested on the front of her hips.

Love that. So you don't lose the heel, but you're going to move the tibia forward. Okay. Yeah. And then real simple. What do I have to capture on the left side?

What's the concern right off the bat?

So I'm just thinking about the organization of training a little bit in terms of when we select activities, obviously we want to be clear about the adaptation that we're going for, or careful not to muddy the waters where if we're looking for an output-based activity like force production, for example, we don't want to water that down too much. We still might want to accept that it's going to cause some interference in the sense that if we're trying to get somebody into a better spot, but we still have to raise some performance qualities at the same time. I've been thinking about how I go about it and wondering if traditionally we talk about using some rolling activities or ground-based activities to create a window of opportunity, then take that into training to utilize that window. If we're going to put things in there that we know are going to be higher force and their force limit movement a little bit, does it make more sense to use a high-low type approach throughout a week? So say this day or these two days are going to be more performance-based or output-based. If that's the case, does it make more sense to open that window of opportunity post-training more so than pre-training? I'm thinking we still want to do some things upfront to move around, but maybe from a time standpoint, if we have two hours to train with a group, do we hit something a little more general upfront because the training is going to take away some movement, then spend more time on the back end doing things that traditionally we would have done upfront on a day geared towards utilizing that window? So they're leaving training in a more toned-down state than they came. As far as exposures, if I had an athlete in that phase where we were going to introduce more output-based activities, I might litter those through a training week in smaller amounts. Then they're ending up touching that four times a week. Does it make more sense to condense that into one or two days that are a little heavier on the volume of that, but then have more days where we're not getting those exposures? So they're spending more time not touching those.

Do you mind standing up?

Yes.

Good morning, Bill. Greetings. I was watching your IY's and T's video where you talk a little bit about like your Terry project, your traditional kyphosis and stuff. I think I'm on the right track of understanding, you're trying to create expansion back there so that you can move in that direction. Can you help me understand the physics or the treatment strategy of what is bringing your spine up again? Gravity, or so, like, how are you restoring that?