You've got anterior compression, which is stealing some IR. You've got posterior compression, which is going to anteriorly orient you. So you're going to lose some ER there. So you've got a lot of compressive strategy in your pelvis, but that's advantageous when we're talking about lifting things that are really, really heavy and moving under load. If you're missing ER and IR, and as you move through this sticking point, you're gonna have to find some IR somewhere to break parallel. And so under those circumstances, what you can do is actually, if you deviate your knee laterally, so a lot of people are gonna say, well, you're actually rotating the hip through this excursion you are, but as you move through the squat, and I'm gonna try to show this on the camera here, so if I fix the foot to the ground, versus the way we would measure in an old-school open-chain measurement. When I fix the foot to the ground and the pelvis is lowering, I'm actually moving into internal rotation at the hip. So if I fix this, the knee is going to rotate and I'm going to internally rotate that hip. So when you deviate out, Tony, what you're actually doing is you're recapturing some internal rotation of the hip which is allowing you to break parallel. This is a common misconception and so it drives a lot of ineffective strategies to try to recapture hip ranges of motion. So what I would do Tony is I would start to work on one restoring your ability to move the pelvis through its full excursion. So you're probably anteriorly oriented. You probably need to learn how to capture the posterior orientation. We've got plenty of videos on YouTube to address that. And then I would start to work on some of this internal rotation that you're going to need, and it'll give you some more variability in your squat if that's your goal. When we're talking about force production, remember that we're trying to reduce the relative motion to allow us to produce a lot of force. And so there's going to be some give and take here. So if your goal is to increase the range of motion, you need relative movement between the segments, so between the sacrum and the ilium and the ilium and the hip and so on and so forth. Again, it's all going to depend on what your goal is. If you want to lift heavy things, you've got to reduce the relative movement to allow you to produce higher force. If you're trying to recapture relative motions, you might have to sacrifice a little bit of force production in the process, but you also might feel a little better as you're moving around during normal activity.

So we don't need to reteach them how to train. And that's what this middle range is for. We want to make sure that you're still exposing them to any number of sports and activities. So limiting the number of exposures is probably a bad idea because when they are faced with something novel that movement that they may be exposed to that they are unfamiliar with because they don't have good problem-solving skills in regards to movement can be seen as threatening and that actually ultimately limits their level of performance. So again, if you think about some of the best athletes in the world, many of them were exposed to any number of sports early on in their careers. So that's something to keep in mind. Formal assessments at this point are of minimal use. It doesn't mean that we never use them. It just means that they're not very valuable because when we think about the physiological development of kids, if I would assess you at the age 13 and I would come back and assess you at age 18, you're a totally different human at that point. So that 13-year-old assessment really didn't give me much information. So what we do is we're going to use a lot of observation in regards to just typical sports performance, or as we're exposing you to the training process and you're learning that process, those will be our assessments. So we're actually going to use the movements themselves as assessments. So in the later teen years, after puberty, we've got a much more adult-like physiology that's more adaptable than what we're going to be looking at is training with the intention of raising performance. So the tolerance is there. So one thing that we want to consider about little kids is that they have this broad adaptability, but they have a very low tolerance. And so what we want to make sure is we're limiting these specific exposures. And we want to make sure that that stays broad-scoped through those early years. So they're ready, like I said, for the specificity of the later teen years.

And the thing I don't want to do is overdrive the hip internal rotation because then all I'm going to do is get another pelvic orientation problem that's going to be driven from the left. So I want to think about being square at the pelvis. So I'm going to level the pelvis. I'm going to try to create a bunch of right angles through the hips and across the pelvis. I think I have a video on right lateral knee pain that's already up on YouTube. So look at that as a reinforcement for what I'm talking about. We're going to start statically so we can capture these middle range positions and then maintaining that posterior expansion as we're holding these static positions. Once I do that I want to transition into dynamic activity so now I want to start to move again that tibia over the foot dynamically. I can still maintain my right resistance so I can again teach myself to guide myself through this middle range of propulsion but I would start with something like a front foot elevated split squat so I don't have the massive amount of load on that front foot but again I'm going to work on driving that tibia rather aggressively over the foot I can bring my foot down to the ground then in a regular split stance and again thinking dynamically of bringing the tibia forward and then finally elevating the rear foot so I get a little bit more forefoot or front foot load rather. So we're just talking about graded activities here while maintaining the capacity to drive ourselves through this middle range of propulsion. Now a little bit about the foot because we've been talking about feet for what, two weeks now, three weeks now? So if I'm in this late phase of propulsion, I also want to think about some ground up concepts. And so I'm landing in a position where I don't have the relative motion in the ankle. And usually when I have this late propulsive foot strategy it's because the tibia is translating too quickly over the foot so the easiest way for me to delay this is to get a shoe that has a little bit of an arch in it and what that's going to do it's going to reduce the the rate at which that tibia can translate okay because a late propulsive foot is very very useful for high speed high explosive activities because that's where I produce my highest levels of force, but if I land in that and an ER and that ER trickles up, then what I can do is I can end up with what we're talking about, which is this lateral knee pain, or I'll end up with a hip thing or a back thing. So again, we've got ground-up influences, we've got top-down influences to address here, but Tony, I think if you look at this as a two-sided problem and if you look at it as trying to recapture that middle range of propulsive strategies, it'll be much more useful.

Now, he had a lot of internal rotation on the left side as well. And so now, if he's on the table and I tip him up on this oblique axis, and you take him through the hip flexion, what's going to happen is he's actually going to roll on the oblique axis. And so what he ends up with is what was 130 degrees of hip flexion on one side, and then only 90 on the other. And so the thing that we have to recognize is that we get this oblique shift of the pelvis as you're moving through the range of motion. It's very, very difficult to see, but the leg can cause this weight shift through the pelvis as you're moving through the range of motion. So it's one of those reasons why you might get like a crazy straight leg raise where the pelvis actually rolls away from the straight leg raise. It's the same kind of thing that we saw here with the hip flexion. So it's just something that has to be appreciated in regards to when you're taking your measurements on the table. So this will happen with shoulder range of motion. This will happen with hip range of motion. in any number of different ways. Some of the other things that you might see is if you have somebody in sideline and you're doing hip abduction, abduction measures, you'll see all kinds of orientations in three dimensions as well. You have to be able to appreciate those measures or those adjustments as part of your measurement because some of them are not true. So maybe you're abducting or abducting out of plane, if you will, and you're getting a rotation or reorientation of the pelvis that skews your measurement. So again, it's just a really important thing for people to recognize and appreciate that there's a lot of movement going on underneath your measures.

So here we go. First question comes from Alex and Alex wrote me this synopsis of his presentation as a foundation for his question, but basically what he wants to know is in regards to the foot types, in my experience, the measures that you see further up the chain. Do certain ISAs mirror certain foot types? Can the foot type detail explain the compensations expected outside of the tibia, the talus, and the calcaneus? So is the foot representation going to give us any information as to what we should expect to see above the foot? And I think this is a great question, Alex. But let me clarify one thing for Alex. Alex, you don't have a late propulsive foot. You've got an early propulsive foot, early propulsive foot to be behind and externally rotated. I got a really high arch and I got a plantar flexed first right. So you're early, bud. Anyway. That was for him. So regardless of the foot type, however, what we want to recognize is that the foot is our main ground contact. It's supporting all the load from above. And it stands to reason that if I have an orientation or a presentation above the foot that alters the position of the center of gravity, then I have to have a foot that is going to adjust to that. And so Alex, your question is actually right on point. Unfortunately, this is a really long conversation. So if we're at the intensive and you ask me this question at the intensive, we are going to have about an hour long talk about this. So let me just give you a little quickie kind of a representation here. So we think about all the possibilities as far as the orientations and positions that the pelvis could be in. And we have to recognize the fact that I have to control my center of gravity. I don't want to fall. And so the way that I would do that is I would make adjustments in the foot. And so let's just say that I have some sort of concentric strategy that I'm utilizing the pelvis pushing me in the direction, I would also have to have some form of concentric strategy in the foot that's going to help me maintain my balance. And so yes, these things do become very predictable. Let me give you a case in point. So I'm talking to Mr. Camparini last night and I sent him a little foot thing and I always test him. I don't know why, maybe it's because he's a former powerlifter but I always want to challenge him and make sure he's on point. And so I said, hey, what do you predict above the pelvis? And he was really accurate because he has really dug into the model rather deeply and so I think you make a really, really good point here, Alex, is that we should recognize the fact that this foot is connected to everything else. There are relationships that are associated with the orientations above the foot. And yes, it is very, very predictable. It's probably something that we probably need to expand upon at some point in time. But I'm going to have to do it in some other form. And unfortunately, I think it's going to be more of an intensive oriented kind of a thing where we have plenty of time to break these things down. So this short form video kind of thing just doesn't do it justice because it is rather detailed but once you get it, it's incredibly powerful because just like we use iterations above and below in the axial skeleton to confirm our suspicions, we can use the foot in the same way where we would expect to see a presentation in the foot that we would see up in the pelvis as well. So thanks Alex, I appreciate that. Second question. So fellow Austin also threw me a really good question because of what he's observing in the purple room. He's got some sequencing questions. And so Austin's question is, when you're a patient with a narrow, inferior angle that is limited both ER and IR, how do you prioritize interventions to emphasize expansion where this need is so? So let's break this down first and foremost. So we've got some information, and let's just kind of see where we're starting from. And then that's going to tell us how we're going to intervene. So if we've got a narrow, inferior angle, we're going to assume that we have limited breathing excursion because we've lost ERs and IRs. So that tells us what we're looking at. So we've got an ER, Ilium. We've got a counter-neutated sacrum. We're just going to say that this person is symmetrical in that regard. So we can see this counter-neutation and ER. So I got my narrow ISA. I've got, like I said, the counter-neutation here, which is going to bias my acetabulum back towards external rotation. If I have my full internal external rotation available to me, my total physiological range of 100 degrees will be intact. So let's just say at the extreme of this. Let's just say I have 80 degrees of external rotation, 20 degrees of internal rotation. I know that I don't have any superficial strategies that are negatively influencing the position of the pelvis. However, Austin says, what if he lost ERs and IRs? Okay. So now we've got to think about sequencing, about how a narrow would lose their ranges of motion based on these superficial strategies. So because of the orientation of the sacrum relative to the ilium, I'm going to see an anterior compressive strategy coming on first. That's going to steal my IR. Then I'm going to see an orientation, most likely that's going to steal my ER. So now we know what comes first. So we got anterior compression first, and then we got the posterior orientation that is driving the loss of ER. One other thing that I know is I also have some posterior lower compression that's associated early on with the narrow ISA presentation. So I also have that to be concerned with. But because I have an orientation problem, that's going to prevent me from recapturing relative motions. So whenever I have the orientation situation in play, that's going to be strategy number one. I got to go after that. So my first intervention is going to be to try to reorient that entire pelvis. So as a unit, so we're not talking relative motion here, we're just talking about an absolute position of going from an anterior orientation to posterior orientation. There's any number of ways to do that. It's going to be a hip extension based type of an activity. You get your choice in that regard. Now because my next strategy would be the anterior compression, I want to go address that as well so that's going to be the next thing I'm going to do. One of the great ways to do this for narrows and get a big bang out of this because if I put you in a 90 degree angle, I'm going to get the expansion anteriorly. And so I got to think, okay, if I have this strategy in the pelvis, I'm going to have that strategy in the upper thorax as well. So quadruped works great under these circumstances for a lot of reasons. Not only does it going to get me the anterior expansion that I need here, but it's also going to help me reduce some of the compressive strategy in the posterior lower pelvis, posterior lower rib cage. So again, very, very useful to go quadruped under those circumstances. Last thing I'm going to do with my narrow ISA person is I'm going to try to restore the normal relative motion of that sacrum. So I'm going to try to bring the sacrum base back into counter-mutation. That's going to be more of your dorsal, rostral stuff in the upper thorax. And so it's going to mirror that. So again, from a sequencing standpoint, if we were to back up just a little bit, we're going to go orientation, then expansion, then posterior expansion for your narrow ISA client that has lost ER and IR because that's going to strip away those strategies in the sequence in which they occurred. So it's really, really simple. So I hope that's useful for you guys. Happy Wednesday. Have a great day. Don't forget to call tomorrow morning, 6 a.m. Join us for coffee and coaches. Chips and salsa day is tomorrow too. Have a great Wednesday and I'll see you tomorrow.

And so when you do have people that are producing sort of this counter rotation between the pelvis and the thorax, you're going to hear them do some form of this salve or a breath hold to get there because you have to use superficial compressive strategies to produce that type of movement and it's not very fluid. So when we're talking about athletics, especially in producing rotation, let's talk about how this is actually done. So let me grab my incredibly high-tech homemade thorax here. So we got a representation of a thorax and a spine. It might be looked down the line here. And so if I turn my spine, you'll start to see the shape change here where I get this expansion on this right side and I get a compressive strategy on the left side. If I turn it in the opposite direction, you'll see that sort of flip-flop. And I think this is one of the reasons why people seem to think that these expansion and compressive elements are creating an opposing strategy. The reality is from a muscle orientation standpoint in a rotational sport like golf or tennis or baseball, more often than not, if they're not using a compensatory strategy which some people will do then, if they're not using a compensatory strategy and they're creating this nice fluid rotation, both sides of the body are doing the same thing at the same time. The difference is going to be the use of an overcoming versus a yielding strategy. So let me give you a for instance, so if I am if I am swinging a golf club because I'm translating my weight shift from one foot to the other, it's actually representative of of gait. And so I don't have this pure turn where one side of body is going forward, one side is going back. I'm actually translating. And so as I rotate, both sides, if we talk about the posterior aspect of the body, both sides are constantly going to push me towards the one side. So if I'm a right handed golfer and I'm taking my backswing towards my right side, the constant of orientation on both sides posteriorly is pushing me to the right. The way that I produce the turn is actually have a yielding strategy on the side to which I'm turning and an overcoming strategy on the side that's pushing me towards that turn and that's what produces the turn. So if I was coming straight at you, it would look like this. Both hands are still coming forward. One is on the delay and so that produces what appears to be the turn. I would just reverse gears and I would go through that to my follow-through if I was a right handed golfer as I translate to my left leg. And so again, so what we have are these alternating yielding and overcoming strategies, which is what produces the turn. On the front side, obviously I have an eccentric orientation and I still have the yielding and overcoming elements that again produce the turn.

And so what we're trying to do is we're trying to influence as many of those subsystems as possible with treatment and training to produce the desired outcome. So there's always that factor in play. The adaptations that we often utilize on the rehab end of things, before we get to sort of like the fitness and the conditioning and reconditioning elements, tend to be learning based adaptations. So some people learn faster than others. Some people have more perceptual capabilities. Some people have a broader experience to draw on. So they do adapt faster. Some people are better trained. So again, we have these genetic influences. We have these cognitive influences. We have psychological influences that all determine what type of progress we're going to make with people. And so again, we have to take all of those things into consideration when it comes to things like training, personal behaviors, habits, et cetera. So now we have potential interference problems. So if I am training to produce high force, high strength, hypertrophy, et cetera, and I have these really strong concentric orientation elements that influence the way that I move or can't move, then we have actually an interference with training. So sometimes you got to take certain things away from people for a while so they can become more adaptable. Some people have unknown stressors or they don't perceive them as stress. So maybe this is a job, maybe it's a lack of sleep, maybe it's a relationship. All of those things can potentially influence our outcomes because it does influence the system at some level. And then that produces what you and I would measure on the table. So thankfully, we've got a really good proxy measure for the fact that there is some sort of influence that is affecting our patient or our client. We also have to consider structural adaptations and sensory adaptations that become influential. So if I have somebody that has a true structural change, many times we can overcome those. If they're small, and they don't influence our ability to shift volumes and pressures. But if we have something like, say, a shoulder labrum or a hip labrum injury that's extensive enough, we no longer have that intact mechanism of a snowy joint. And then we got to send it back to the doc and say, look, well, we gave this a shot. It didn't go well. Here's what I think. And then we get help from that perspective as well. When we talk about the sensory influences, all of your sensory systems have adaptability built into them. And so if I have a lens in an eye that can't change shape enough, then I have potential visual problems. If I have perceptual problems that are associated with vision, that needs to be addressed as well. So now we look to our behavioral optometrist for some help there. If we have a sensory issue in our mouths or a physical deficit, so we have people with a really small narrow palette, a narrow airway, all of those things influence our ability to breathe and move and be comfortable. And again, managing the way that we perceive that from a stress-related standpoint, all become these influences.

This is where we're going to see concentric orientation of the anterior medial aspect of the musculature around the knee. We're going to see an eccentric orientation on the posterior side. So when we think about musculature that is eccentrically oriented, I think semi-tendonosis is going to be eccentrically oriented. Your tibialis anterior is going to be eccentrically oriented, which is going to make it very, very difficult to flex the knee during gait. So again, if we can't flex it during gait, then it's going to try to go into what we would perceive as being that high hyperextension. The short head of biceps is going to be concentrically oriented, the lateral hamstring, so bicep femoris, the full bicep femoris is going to be concentrically oriented as well. And so that's why we get this appearance of what looks like the hyperextension. It's actually a twist. It's an ER, bringing the femur into ER, but an early propulsive strategy in the foot, which is going to drive the force straight back through the knee. A lot of times what you're going to see up here is this is going to be your traditional sway back individual. So they're going to be probably narrow, probably posterior compression. You're going to see an eccentric pelvic diaphragm, and so again they're falling hard towards the center. Their center of gravity is going to be forward and down through the middle, but because they've got that early propulsive strategy in the foot, they're going to drive that knee with what appears to be backwards into hyperextension. The elbows are the same way. We get the same kind of twist in an elbow that creates the hyperextension. So instead of having the anti-medial compartment being concentrically oriented and the posterior lateral compartment being concentrically oriented, what you're going to get is you're going to get a posterior lateral compartment concentric orientation. So supinator and anconius are actually going to create this really hard compressive strategy on the back side of the elbow, which again creates that appearance of hyperextension, but it's actually the twist of the radius hard into ER. When the anconius picks up its concentric orientation on the back of the elbow, it actually twists the ulna in the opposite direction. So we have this kind of a relationship of the radius and the ulna twisting this way, and it pushes that elbow forward into what appears to be hyperextension. So one of these circumstances, we got to get the elbow into, or the elbow or the knee, whichever one we're talking about. We got to get it into a position where we can recapture the relative motion in relative positions. So when we're talking about the knee, we've got to get the foot into a good orientation where we can capture that relative motion of the calcaneus, the talus, and then the distal tibia.

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 rostrum is going to be compressed. Upper dorsal rostrum 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 going to actually limit this. So you don't want to go past this, this concept of orientation. So you're set up that you're talking about at the very beginning of the squat. Yes, you're going to charge your thorax with air and then you're going to squeeze the bejesus out of it, cut it off at the throat with a vasalva, right? Because we don't want to, we want to 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 readily and again I'm going to miss my lift. So the breathing that you're talking about in the competition squat is a compensatory strategy all day every day. It's concentric on concentric. 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.

We can put more effort into the lift itself and stay in a groove because if we create a situation that physically limits our range of motion, then all that energy that we would normally have to use to control the position, we don't have to worry about. Now there are secondary consequences which we'll talk about, but for now let's talk performance. So what we want to do, regardless of your physical structure, so we talk about narrows and wides, what we want to do is create as much anterior-posterior compression as possible because the stronger the exhalation strategy, the greater the force output into the extremities and then the more weight that I can lift. Now there's a subtle difference between wides and narrows. So with the wides you're going to want to emphasize the latissimus dorsi element of this posterior compression. So we're talking about below the level of T8. So we're talking about bilateral symmetrical lifts like barbell rows and lat pulldowns being staples for the wide ISAs because what we want to do is we want to create as much compression on that posterior aspect of that rib cage because the advantage that the wide ISAs have is the angles at which the musculature associated with their skeleton like their rib cage and their pelvis is generally more horizontal. Tremendous advantage for force output in things like a bench press or a squat or a deadlift. So if we can compress that lower posterior part of the rib cage, you immediately increase your arch. You immediately increase your compressive strategy. You immediately increase the amount of weight that you can lift. With a narrow, they tend to have greater expansion in the upper back compared to the wides. And so what we want to do is we want to emphasize more of the upper back type of compressive strategies that you would see associated with bilateral symmetrical face pulls, I's, T's and Y's. Okay, so there's the subtle difference now. They'll still do lat pulldowns and they'll still do their rowing in a bilateral symmetrical manner, but we're talking about emphasis as far as the subtleties between structures. The wides are also probably going to benefit a lot more from doing the back extension type of things or reverse hypers because what they have to do to actually maximize their arching capabilities in the bench press, but also to carry over to the other lifts, is they have to close the lower posterior aspect of the pelvis as well just like the lower posterior rib cage. On the narrow side of things they are going to want to do things that are more associated with like a glute bridge or the barbell hip thrusting thing because what that does is it compresses the back side of the pelvis. So we get a pelvis that instead of being nice and round like this, we want to flatten it out as much as possible.

This would be somebody that if you could get them in a pool to move around, they're probably going to love that because it's going to help them decompress everything. I love the fact that you're going sideline because it does help eliminate a lot of the gravitational influences that they're going to be dealing with. But you got to think really, really kinder and gentler. So the side planking might even be too aggressive because there's still going to be some breathing difficulties here. When you're driving breathing on these people, it has to be the gentlest of breath. It's not about hard exhales. It's not about being aggressive at all. It is a calm, relaxed, just movement of airflow. You want minimal energy output under these circumstances. Very low effort movement, you're gonna try to start to restore some gentle rotation. So you might even just start with head turns inside line. You're gonna start with some thorax shifting inside line, some hip shifting inside line. What those hip shifts and thorax shifts are is a subtle rotation through the axial skeleton. So it's a great place to start. That's why I like to use the Scapier PNF or pelvic PNF patterns in these because we can actually help guide these people into rotation again. And then just like I said, gently guiding the breath because again, if you try to breathe aggressively under these circumstances, all you're gonna do is kick on the superficial strategies again. Once you get them to a place where you're starting to see the restoration of rotation, then you can start to flip them over onto their back and start to work on like ipsilateral connects, re-bringing same side elbow to same side knee. So now we're starting to get a compression and expansion almost laterally. It's still rotation, but again, we're trying to induce as much of this compression expansion as we can. But again, it's got to be this kinder, gentler kind of strategy. Once you do the ipsilateral connection, we work towards cross connects, and then once you start to do that, then you can start to use some leading resistance. So now we can bring resistance back into the game, where we can get some reaching activities in here, where you're going to compress one side, expand the other. So I hope that gives you a little bit of strategy on this one, Matt. These are the toughest ones to use.

Let's call it that. Can we do that? Yes. He's walking on his ischial tuberosities. And if you watch him walk, you will see that the pelvis and the thorax advance at the same time in the same direction in the same way. The iterations are what is going in the same direction. So the pelvis and the upper thorax are both turning the same direction at the same time. And you'll see that just about any activity that they will turn together. So when we're talking about relative motions of the ankle. Right. Before you hit a constraint. You'll have opposing movements. So if I have a pronating, like a closed kinetic chain that defined pronating ankle and foot, and the talus is adducting and plantar flexing, the tibia is externally rotated until you hit the constraint and then it follows the talus. Okay. So which is it? Is it tibial internal rotation or is it tibial external rotation? Until you clarify your point of reference, you're not really certain how things are being described. And so, again, I think that creates a lot of confusion. Because when things start moving together, then you don't have the relative motions to describe the movement. So you have to be very, very clear as to where you are in all of this. And again, we have to appreciate that because that's how you end up turning anyway. If you just reduce the relative motions. And then things start to move in concert because they're at the constraint. And so then they bring stuff along. And that's how we actually turn. Because as long as you have relative motions, the external rotations and internal rotations cancel each other out. And that allows you to go in a straight line, which is why we can talk about there's no sagittal plane if you want to talk about that.

So I get this full rotation of the tibia across. I capture a normal subtalar joint position for pronation, which allows me to access a lot of the ankle mobility that people are lacking. Once again, they tend to get stuck in this position where I don't have normal rotation through the fifth ray. It limits my ability to dorsiflex. And so if I can capture that with that lateral sled drag motion where I'm rolling from the outside of the foot to the inside of the foot and rotating the tibia across as I go, I pick up a lot more ankle mobility. So Eric, I hope that answers your question. The foot's a really, really confusing place to look, but I think there are some elements that we can always utilize to simplify things. There are also iterations of the foot up the chain, which we can talk about at a future date. But anyway, I wanted to get that out to you and give you an idea of why I think that lateral sled drag is a useful activity to recapture some of that ankle mobility.

If I superimpose a weight on top of that, so now I took a barbell and I put it on your back, what I'm going to do is I'm going to have less of an eccentric orientation as a contribution to the expansion and more of a yielding strategy. So I'm going to distribute that load into the connective tissues on a much, much greater level because if I release the muscles into eccentric orientation, I will accelerate into the ground, which might be okay if I have the capacity to get back out of it based on the load. However, if I put 800 pounds on my back and I accelerated into the ground, I could just become a big wet spot, which would be a bad thing. So again, we have to look at this from compression and expansive strategy. So the shape of my body is going to be based on what the demands are. So if I put a load on me, I have to expand and distribute the shape of my body to support the load. I have to squeeze that load. And again, that's going to create a restriction in movement. So think about it, it's like I want to be more stable underneath the heavy load, so I'm going to use a much more compressive strategy. But I need to be able to move through space to create my squat, which is going to be more of an expansive strategy. So under those circumstances, heavy loads, I yield a little bit more, less loads, I essentially orient a little bit more, but I'm still using both expansive strategies at the same time. To come up out of the squat, it's all about compression. So if I'm pushing up out of the body weight squat, I don't have the force demands that I might have under other circumstances. I use my concentric overcoming strategy to come up out of the squat. So I will move more towards an eccentric orientation to a concentric orientation. When I'm in a loaded situation, I don't release the concentric strategy nearly as much. And that's why I have to use the yielding strategy to get me into the bottom of that squat position. Otherwise, I may not be able to stand back up. So I hang on to my compressive strategy. I hang on to more concentric orientation even as I lower myself into the squat so I can overcome and push myself up out of a loaded squat. So conceptually, I hope that's a little bit helpful for you to kind of understand how these interactions take place because I think that some of the biomechanical models are a little bit rigid, if you will, in regards to how these things actually occur.

If I need it, I'm going to use it. And so very often you'll see it at one side and the other. And then it's just a matter of using an asymmetrical activity when we're trying to restore movement options. So if I'm trying to restore expansion to the dorsal rostrum area on one side, both sides of the body are not going to be doing the same thing. It doesn't mean that you couldn't use asymmetrical activity and be successful. It just means that you're probably going to be more successful and more likely to recapture the movement options that you wanted if you're using a more asymmetrical activity. Now, when we talk about those compensations, and then our strategies to intervene. I've got a number of resources up there. So if you go to the YouTube channel, Greg, there's a bunch of stuff for Dorsal Rostrel. There's a seeded variation of Dorsal Rostrel expansion, which I love to give to people that work at desks because they can intermix this activity with their regular desk activities all day long. You'll see another one that uses a squat variation when we're talking about a better band pull apart. There's a video up on, I believe, Instagram and on the YouTubes as far as that goes. So those are really, really good strategies. The thing that you're going to want to do though when we're talking about creating expansion in this area is you're going to avoid that 90 degrees of shoulder flexion position for the shoulder and for the hip, at least initially. And the reason I say initially, because eventually you want to be able to utilize that position and create a yielding strategy in the dorsal rostral area, because we do need the ability to expand and delay our ability to compress that area when we're talking about turning athletes, so baseball pitchers, tennis players, golfers. They need to be able to compress that area to create their force output, but they also need yielding and overcoming strategies to be able to alternate to actually produce their turning. So this is a great question, Greg. But understand, let's back up a little bit and do a quick review. Narrow ISAs, the dorsal roster is going to compress a little bit later than if I was a wide ISA. I need to recapture that so I can recapture my external rotation measures. It will present unilaterally, so I need to make sure that I can produce eccentric orientation of that area to create that full expansion. but then I'm going to have to superimpose a challenge to it to allow it to be concentrically oriented but yielding to produce rotation in high speed, high force rotational athletes. So Greg, I hope that's helpful for you. Great question. Keep them coming. Happy Wednesday to everybody. Remember chips and salsa tomorrow and the Coffee and Coaches Conference call in the morning at 6 a.m. I'll post the link. on my Facebook page right before the call tomorrow morning. So I'll see you guys tomorrow.

So don't forget that. So how can I tell whether I have that upper dorsal rostral expansion? So now we have to go to your shoulder flexion measure. So near-range shoulder flexion. About the last 60 degrees or so of shoulder flexion on the ipsilateral side demands that you have this upper dorsal rostral expansion. So if I have somebody that comes in with a neck complaint and I'm not attending to this shoulder flexion measure, I might be missing something. So put them on the table. If you don't have near-range shoulder flexion, then chances are you don't have near-range lower cervical rotation to the ipsilateral side. Let's just say that it looks like you do have shoulder flexion when they still can't turn their head to end range rotation to that side and you've checked out upper cervical. Upper cervical looks great. You take lower cervical out of the equation, you check it, you say, well, I've got 45 degrees of upper cervical rotation. And it looks like I've got full shoulder flexion. Go to the ipsilateral hip. Check the ipsilateral hip because the mechanics in the sacrum and the lumbar spine interact exactly the same way as the dorsal rostral and the cervical spine do. And so under almost every case, you will have sort of this mirror relationship between the pelvis and the thorax that will help you identify whether you do have this dorsal rostral limitation, even if it appears that you have shoulder flexion for whatever reason, because there might be a table orientation of the thorax that makes it look like you have full shoulder flexion. But I would go down and I would check the ipsilateral hip's conformity. So here you go. So for the cervical spine, you've got a shoulder conformity and you've got a hip conformity that will help guide you as to whether you're recapturing this full rotational capabilities of the lower cervical spine. So Rick, I hope that helps you. It guides you a little and helps you clean up the rest of this stuff.

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 re-orient or change the 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 now 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. But now you need to add to this model and say, OK, if I compress this now, what happens with an understanding a little bit more about what the options actually are within a little bit more of a realistic model? We're never going to see reality. We always have to use a model because this is a really, really complex concept. And when we talk about movement,

My femurs, my hips are facing straight ahead. So I've got that kind of a squat. So as I squat, my straight down is actually back into the left. And so that's why you see the left hip shift, okay? Now, let's take another layer of strategy. I start from that same compressive strategy that I saw with the left shift, but now I'm going to superimpose an anterior compressive strategy on the left side in addition to that. So what happens is I get a shape change around the acetabulum, which is actually going to turn it a little bit. So I actually pick up concentric orientation of the external rotation muscles right off of the trochanter here, but that's going to bring the femur and the sacrum a little bit closer together on this side, and so I get an oblique tilt of the pelvis in this case, and now I've tipped my right side a little bit farther forward than the left side, so that's what the orientation looks like. So I'm closing this space right here and that will push it forward on the left. Now on the right side, I still have the right side tip forward. Remember, I've lost my hip external rotation, and so as I squat under these circumstances, this stays forward, and then I take advantage of the internal rotation that I do have, and I open up that space right here. So if I create space there, that's the direction that I'm going to go. So as I sit down, because I've got more compressive strategy on this side, holding this forward, this side stays open more as I squat, and then I'm going to shift over into that right space. Now, in this case, I'm definitely going to have a decreased left straight leg raise, decreased left hip flexion. In the first case with the left shift, I'm going to have a normal straight leg raise in most cases, but still lose the end range hip flexion. So keep that in mind.

So if I'm at the very top of the push-up, I tend to put weight through the hypothenar aspect of the heel of my hand, right? And then as I am in the lowest part of the push-up and about to create my propulsive phase, I am actually going to pronate into the ground. So I'm pressing the thumb side of the heel of my hand into the ground to push myself back up. So we have this transition from inhale to exhale through the push-up. So now we have a potential solution for your clients that are having trouble with push-ups. The people that cannot get depth, the people that can't get depth in their push-ups, cannot capture this propulsive strategy at the bottom, which is why they can't produce enough force. So they never access that range of motion through the push-up. So now you can think about, okay, that's one of the reasons why you elevate these people is so they can learn to capture these different positions of inhalation and exhalation so they can manage the pressures that allow them to produce force. So Matt, that's a great question. I'm so glad you asked that.

As I push this side down, I pick up activity on the inside of the downside thigh, which actually opens the outlet on this side, which also promotes a concentric pelvic diaphragm. So now I have a much more stable structure that I can perform my half kneeling exercises in or my split stance activities. And this should happen as I move actively through a split stance or as I assume a stable position in half kneeling. Once again, for those people that are presenting with that one hip higher than the other, so they're in extra rotation, what we need to do is actually push the front side hip downward. In doing so, we actually create an internal rotation of that front side hip, which moves the ilium into internal rotation, which immediately nutates the sacrum and starts to bring the pelvic diaphragm upward towards concentric orientation. If I take us to more of a side view, you can see that I probably have this potential orientation issue to deal with as well. If I have an anteriorly oriented pelvis, I have lost the relative motion and therefore I have no relative position change capabilities. To overcome the anti-orientation I have to use the proximal hip musculature to capture the position of the ischial tuberosity relative to the femur. If I can capture this position then I can restore the relative position change that's necessary for me to capture the concentric pelvic diaphragm. This is going to allow me to be stable and comfortable in half kneeling or allow me to propel through my split squat. So let's take a look at these positions in half kneeling. So as I am resting here on my left knee, I can actually feel that my right hip is now higher. So that's going to be that inhaled position. So both sides of my pelvis are actually in an inhaled position and both hips are in ER. So for me to capture an IR position of the hip in a concentrically oriented pelvic diaphragm, what I want to do is I want to cue a downward position with this hip. So I'm not sagging into the hip, I'm physically pushing it down. So think about pulling up with abdominals on the left side and pushing the right hip down. Now what I've done is I've oriented the acetabulum so they're now both facing forward into an anteverted position which captures internal rotation on both hips. Now, here's the kicker. I have to make sure that I'm maintaining the position of the ischial tuberosity relative to the femur first. If I don't do that, I don't get this relative position change and I can't capture the IRs. I'll stay in ER and those are the people that are going to complain about tightness in the front of the hip, tightness in the quad or knee pain on either knee. This is one of the reasons why this half kneeling position is so important is because it's going to transfer to all of my split stance activities. If I cannot capture the maximum propulsive position in half kneeling, the chances of me capturing in a split stance are minimal.

Let's say that I have a female volleyball player who presents with a narrow infrasternal angle and is eccentrically oriented in her pelvic diaphragm. We're trying to teach her to elevate, or get off the ground. She has difficulty capturing the concentric orientation of the pelvic diaphragm to produce upward force. In this case, we can apply a flywheel strategy by increasing the concentric overload. This forces her to capture the concentric orientation sooner in her descent. Our next strategy is to teach her to capture this concentric strategy quickly after she's learned to achieve it. So we'll use high resistance eccentric overload to build that capability, then reduce the eccentric overload to teach her to perform the movement quickly. This allows her to get off the ground and develop explosiveness. In contrast, if I'm working with someone who is concentrically oriented and uses a strong exhalation strategy, and my goal is to make them more explosive, I would not use a high force eccentric overload strategy. I might still use a flywheel but with very light resistance and emphasize velocity. The key is knowing when to use a tool based on the individual and the context. There are times when eccentric overload is beneficial and times when it's detrimental to performance. For example, if the goal is to make someone fast and explosive, using a strong eccentric overload is counterproductive because it just amplifies their current strategy and prevents the desired changes.

I think people misunderstand meditation, believing it's about not reacting to the environment. However, you can't stop your brain from reacting. Instead, meditation provides a 'big brother' element where the prefrontal cortex can assess situations and prevent overreaction. This self-regulatory aspect is the most important part for lowering stress levels and recognizing that things aren't as bad or as good as they may seem, keeping you on an even keel. I had to stop using the meditation app because it started interrupting my thoughts. You begin with guided meditation and gradually transition away from it, learning to recognize when you don't need external guidance. While Andy from Headspace is brilliant and soothing initially, the app eventually becomes an interruption as you anticipate the voice rather than addressing your own thoughts. People also don't realize that the thoughts that arise during meditation are you processing your own issues. This can be scary because it brings up heavy things like past behaviors you're not proud of, but that's where you confront and release them. I highly recommend spending at least an hour alone with your thoughts—it's scary but incredibly useful for dumping anxieties, past regrets, and ruminating thoughts that interfere with focus and concentration. It's the most powerful thing I've ever done.

I think it's in the first half of the book where you're going to get a fair amount of that. There are a lot of papers involved. Don Tigny has a lot of papers. But if you search on things like sacroiliac joint mechanics, the pubic symphysis, pelvic floor, acetabulum orientation, or just type in human pelvis into Google, you're going to get plenty of information. But I would say that try to stick to some of the more peer-reviewed and professional resources, at least in the beginning to establish your ability to filter that information and determine what is going to be useful for you and what is not.

So my next question comes from Justin and just asks, can you break down the shape change of the pelvis and behavior of the pelvic floor during acceleration of max velocity sprinting? Absolutely. Justin, what I want you to do is I want you to see the cutting video that's on YouTube because the public diaphragm mechanics are going to be very, very similar to entering and leaving the cut because the pelvic diaphragm is behaving such to position the extremities and then to produce whether the positioning strategies or the propulsive strategies and so if I grab my pelvis here if I'm orienting the extremity, whether I'm accelerating or whether I'm at top speed. So basically we're looking at that type of an orientation. But to position the extremity in line, so we're near that zero degrees of hip extension or we're talking about a max propulsive strategy. So to position my extremity, the anterior pelvic diaphragm is going to eccentrically orient to allow that extremity to be positioned there. As I apply force to the ground, I need an overcoming strategy. So now I'm going to become more concentrically oriented and overcoming to produce the force. And so again, the difference between acceleration and the top speed mechanics in this circumstance is how quickly all of this occurs. So when I'm accelerating, I have a lot of ground contact time. And so the transition from the eccentric to concentric will be much, much slower because again, I'm not moving as fast when my ground contact times are longer. At top speed, as I strike the ground, I'm there for a split second. And so I'm landing and propelling very, very close to max propulsion. So in the flight phase of top speed, where I'm no longer in contact with the ground, My anterior pelvic diaphragm is going to essentially orient to position the extremity below me, relatively speaking. And then as I hit the ground, I get this incredibly fast propulsive phase that allows me to continue to propel myself. And so again, that would be the biggest difference between acceleration and top speed, but as far as the ability to orient the body in those positions, the same strategy has to occur because they're relatively the same position. Again, the only difference would be how quickly the forces that are being applied create this transition from an eccentric to a concentric orientation. So hopefully that sheds a little bit of light on that for you. And again, if I need to clarify that more, please ask another question. So that wraps up this week's Q&A. Hope it was useful. If you have any further questions, please post them or send them to me at askbillhartman at gmail.com. Happy to answer those. I got a couple questions that I'm gonna roll over into some morning Q&A for next week during the holiday week. So be looking for those. Enjoy the rest of your Sunday.

I don't think that they occur as much as many people blame them on. I think that we just need to look at expanding our perspective and toolbox. But under those circumstances, if you do have a true tissue limitation, then maybe you're looking at a very, very long-term strategy in regards to trying to add length to tissues. And that would be using some of your dinosaur plant strategies, perhaps a lot of time and effort applied by the client to restore that range of motion through repetition and avoiding situations where you're creating a negative influence associated with pain and discomfort in ranges, and just reacquiring some of that range of motion through desensitization strategies. So I think there's many ways to go about this, but again I caution you to make against making that leap that you're making an assumption that you do have a tissue change. They do most likely occur, I just don't think they occur as often as we think. The second half of Ryan's question piggybacks off a question from last week, where you asked what tests or measures do you apply to determine whether the elbows are oriented towards external rotation pronation or internal rotation supination. Ryan, this is actually pretty straightforward because, assuming we're doing table tests and such, we would have our axial representation. We would have extremity measures that we would have taken that would tell us whether we have a humeral position in external rotation or internal rotation, again based on those table tests. And then it's just a matter of looking at the pronation and supination available at the elbow. And so if we have identified a shoulder that is in humeral external rotation, we would stabilize the epicondyle at the elbow, we would check our pronation supination, and come up with a determination of what we're looking at in the forearm. However, I would offer you that you probably need to look at the wrist for confirmation of that forearm position because in some cases you may have eccentric orientation at the elbow or concentric orientation at the elbow that will skew your perspective. So if we add the wrist measures into this, so we've got a shoulder, we've got an elbow, and then we've got the wrist measures, if you have a deficit in ulnar deviation and extension, you most likely have a pronated forearm. And if you have a deviation into flexion and radial deviation, then you probably have a supinated forearm. And that's just the orientation of the distal radio-ulnar position. When the forearm is pronated, there is this perceived retraction of the radius that would position it more towards radial deviation and the ulna would appear long under those circumstances, so we would lose that ulnar deviation. So that's what occurs in pronation as the radius crosses over the ulna.

So if I am already a wide ISA, I can certainly make myself wider through some form of training that increases my compressive strategy. For instance, with powerlifting, where it's all about compression, it's all about exhalation strategies, I can use my superficial musculature to compress my pelvis and thorax even more and make me seem even wider. If I was a narrow and I undertook those same activities, I might be able to achieve some measure of compressive strategy that might make me look a little bit more wide because I am going to create some measure of compression, but chances are I'm never going to be as wide as somebody that is born with a wide ISA. So again, this tends to be structural. Any activity that requires a strong exhalation strategy or compressatory strategy is ultimately going to result in an anterior-posterior compression of the thorax.

So that's how that happens. If I was to try to maintain my ability to expand anteriorly and posteriorly, I might not be able to produce as much internal pressure. Therefore, I might not be able to lift as much weight and therefore I might not gain as much hypertrophy. It doesn't mean you can't gain any. It just means that that might become a limiting factor. So there's probably somebody out there that falls at one end of this imaginary normal curve that can do it all, that can maintain all of their mobility, that can maintain their anterior posterior expansion and still gain massive amounts of hypertrophy, but I think they're the exception to the rule. So we have to respect the fact that there are outliers, but they are not representative of the normal population, nor are they typical. And so I would say under normal circumstances, typical circumstances, if you try to maintain full movement capabilities, that you will actually limit your ability to produce force. So you will limit your strength ultimately. You will limit your hypertrophy development. But that doesn't mean that you don't perform well under sporting circumstances and so forth. It just means that if you were to try to take it to the extreme, you'll probably have to give something up as a secondary consequence in return for whatever hypertrophy and strength you desire.

And so, again, we can't say that one is optimal or not. We can talk about ranges of like 120 to 60 through this full excursion. We can also mention, as we talked in the earlier question about the 108.8 concept, which is, again, an angle that we need to pass through to optimize the expansion and compression strategies that are associated with inhalation and exhalation. So, but again, this is going to be one of those things that we have to individualize. So we're in a very, very great area as to what optimal is. And so you have to look at this in combination. What I would offer you is that if you have an ISA that does not open and close sufficiently, you will see extremity ranges of motion that are most likely limited. Whether this is good or not depends on what the goal and intent is. Are we trying to raise performance? And so we might have a restriction intentionally. Are we trying to optimize health where we're going to try to expand the adaptability of the system? So again, you have to make these decisions based on the individual, but you're on the right track as far as this thing needs to open and close as a representation of our movement capabilities. So I think you're right on track, Michael.

the dynamic anatomy so learn the anatomy in a context rather than looking at the the dead guy on the slab as a we would a cadaver look at this as a as a fluid model and I think that that's going to provide you a much greater useful model in the future. So I wish you luck. The thing that I would also encourage you to do is get really good at what you do first. So spend a lot of time learning, spend a lot of time practicing you're going to fail a lot it's important that you fail but you fail safely you never hurt anyone but it's important that you fail and then i would say you need to find a mentor someone that can lead you because there are elements of of understanding that can't be written down they can't be expressed easily this is what we call tacit knowledge and this is what you acquire from a mentor, from experience. And so this is where your focus needs to be for the next three to five years. And by then, you should start to get better at determining from a probability standpoint what would be the best course of action. This is how you're going to get good as a physical therapist. So hopefully that provides you a little element of guidance in this regard. And by all means, keep asking questions, always ask questions. and try to answer them yourselves and then seek out the answers from other people and other resources. But keep the questions coming towards me. I'm happy to help you. I love working with students, especially when they are enthusiastic and motivated. So thank you, Alexa, and good luck.

Yeah. So what you literally have here is something that is stuck in a very compressive type of strategy. And you can see it right away that you've got inhalation and exhalation measures that are very limited. So this is a superficial strategy that we wish to talk about.