Yeah.

Yeah.

Right. Hamstring strut.

Enough. Okay, so that is not a simple right? It would be great if I could tell you 29 degrees of rotation would be enough, right? We have to appreciate the fact that people will have a unique amount of internal rotation. I would say that if you only get five degrees, you probably don't have enough. If you had 35 degrees, you'd probably have enough. And I'm just using those as extreme representations. You would want to maximize the amount of relative internal rotation. If you lose external rotation and gain internal rotation, that's not hip range of motion. That's a spinal orientation and that's not the solution. If you understand what you don't want, you'll probably have a better understanding of what you do want. You run the experiment. Let's just say, They got zero IR to start with. You gain 25 degrees and you go, you know what? I'm going to try to turn you and you make the turn and it goes well. They had enough.

Okay? Because if I bring them too close together, right? And again, we're talking about world's greatest narrow. If I bring these feet too close together, that space doesn't exist for them, okay? Especially in a loaded situation. The minute I started adding load, I have just taken away more and more and more space. So the orientation of say a sumo deadlift becomes a better choice. Now you have a second problem. Their starting position is probably not too bad. Then it becomes how far down can they go in that position? And so that becomes the big question. So you think about where they have internal rotation, okay? So it's away from midline and then they can, like if these are feet, right? Move the feet away from midline and then push the feet into the ground. That's where they've got some internal rotation, okay? As they descend, there will be a point where they can no longer descend, continue to eccentrically orient the posterior outlet, and that's where the movement should stop. And then that's you as the coach going, that's about as far as you're gonna go. And so then this might be a rack pull or an elevated position for some people. There will be the exceptional few that might be able to get all the way to the floor. But the standard measure from the floor is the radius of a 20-kilogram plate. And that doesn't fit everyone, right? I would hazard to guess that if Dale and I go into the gym, I'm a little closer to the floor.

All right. So how would I cue that?

We just have to understand how this thing arises and then what strategy we would use to promote the favorable shape change. So some of the rules that have applied since the beginning of time as far as what they would teach you in school are still useful in regards to understanding why we might avoid certain things. For instance, we don't want to induce more internal rotation into the spine because spinal stenosis is based on the fact that this spine is trying to internally rotate thus the shape change. Now, when working with the elderly, we have adaptability issues. So they're not going to be as adaptable to say somebody in their 30s and 40s when you have somebody in their 70s and 80s, but the principal's still whole. So we're going to try to take advantage of whatever adaptability they have from remaining. But the cool thing about this question is, let's just say you do have somebody in their 30s or 40s that comes to you with a diagnosis of spinal stenosis. This is going to help you recognize why their symptoms may be as such, what shape changes that they're undergoing, and then how to address that. So again, thank you, Steven, for this great question.

I mean, does the fibula block it?

It wasn't just my power lifter. I was Mr. Texas, heavyweight and overall.

I think that leads into the second part of the question. I knew that. Yeah, we talked before this. So still in the first visit, basically did all that stuff, stood her up. Like before I did all that actually, like the squatting still reproduced that same central knee pain. Afterwards, the pain was gone. Second visit with her, like a little bit more inconsistent in that, like some of the reps would feel good, some of the reps would feel bad depending on whether they're doing like a squat, a squat. So like in my head, I'm just not, I'm not capturing that position on every single rep. Correct. is from a sequencing of events standpoint, would there be like a right versus wrong, like in one end, and hit measures, she's like all orientation, like 510 IR, like 50 ER sequencing of events. Like one end of the spectrum, I'm picturing exercises with like a traditionally like extended knee, like kind of like right underneath the center of mass, like get more of like a hip bias. Other end, I'm picturing like split squat type activities where I'm moving her through, like, you know, more have more knee excursion. Is there a right versus wrong there? Or is it more of like a do it and see?

Yeah, like am I driving something from like a wave standpoint as I do the motion into the hotel? So I guess I'm trying to head that direction with it because I guess I've only thought about it from an unweighting standpoint.

Yeah, I see it.

Trying to acquire IR, I guess is the only answer there, isn't it?

Yeah.

Good thing I'm known for being anti-climatic. So actually going back to Taya's case, an example, you talked about doing distraction of the leg in a prone position. My mind was going in a million directions. I didn't realize or think about that because I always do like that distraction in a supine position. Now that I'm thinking about it, I realize that it might be counterintuitive to do certain manual stuff depending on the whole pelvis position. So for the prone position, the distraction you're trying to elicit or help someone obtain a late propulsive phase. Cause they're prone.

You know, it's like, do you ever have anybody in a dinosaur plant?

It's all the same stuff. It's all the same. We're going to be sort of like a short arc roll, then I guess, right? If they're coming down and then they're yielding and then just like pushing back up again. Say it one more time. Sorry. Or it'd be sort of like a short arc rolling, like as they sit down, they're sort of like, you'll do. Dude, why do you think this, why is this any different?

A wide stance starts orienting distal to proximal. Yes. Because I have a hard time visualizing, I can see with the narrow stance that they will start with the proximal femur and then just superimpose external rotation until they get to the foot, and the big toe will come off. But with the wide stance, because they are still getting pushed forward, that's towards late stance. And in late stance, the big toe is the last one that is on the ground. So I would see the bunion forming sooner on the wide stance, maybe, because the first metatarsal head stays and everything else rotates relative to it as the weight is translating forward.

Yeah. So have you ever seen an AFO that positions an ankle and a foot into an ER representation? Toes down, heel up? Never. It's always, they're always approximating a middle representation, right? Exactly. Because that's the position that you need to push into the ground.

Okay.

Yeah.

Oh, okay. Gotcha. I thought you meant with towels or something.

Yeah.

Okay.

Okay.

You have to think about this. You've got a combination of factors there. People are going to do whatever it takes to assume a position that puts the weight in a space that they can hold it overhead. But again, this is where you get to be the great coach and you go, I'm willing to accept that technique under these circumstances. And then I'm willing to do so otherwise. You're going to do everything that you can to make sure people are doing things in a safe and effective manner because I know that you're a good coach. But yeah, you're going to see stuff like that. Especially think about this: somebody misses their groove by whatever degree and they're going to move wherever they have to go underneath the weight to make sure that they capture it so they get their score. Otherwise, miss lift.

Yeah. And you're going like, how is that even possible? You're absolutely correct. And that's, and that's kind of, that's part of your tell as to why you go, why do I have this magnified hip shift? And then you go up to the shoulder and you go, Oh, okay. I get it.

Yes. Yes. Okay. So even with something like that, I don't understand exactly where, like, how to select the joint position. I mean, I guess.

Generally speaking, yes. Again, because you're playing with that, you're playing with the angle. The closer you get to the floor, the less you're going to have a foot contact, like a whole foot contact.

Okay.