Is that why I get a spasm sometimes that will just lock me up to the right for a week?

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, we will try to intervene to make that change, but a lot of times when 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 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.

Yeah.

So I guess my question is just I want to make sure I'm thinking about this passive strategy correctly and trying to relate it back to her symptoms. Is this just another manifestation of the idea that she has no proximal to distal force production strategy and cannot propagate the wave?

And I love everything you're saying.

So what would that be a solution for?

Okay. All right. So, um, so you're talking about concentration of loading, right? Essentially. So it's concentration of something. So, yeah, Greg, I'm going to assign you 10 different projects. Okay. That you have to get done. Right. And I'm going to give you two hours to work on those 10 projects, okay? And I want them done in two weeks, right? So you get two hours, four times a week to work on 10 different projects. And I need to get them done in two weeks. If work a little bit on each project, okay? And you got 10 projects, you only got two hours at a time. What do you think the likelihood is that you get all 10 of those projects done? Not good, none of them leads into a high quality. Okay, so you're minimizing the capability of getting something to the finished representation by having so many things to do, right? And so, or would it be better, it would be better to get all one project done and then all the next project done and then all the next project done and then all the next project done you get more finished right by the end of the two weeks than if you try to do a little bit of each. Right. Right. So that's kind of what we're talking about. So you have a fixed amount of time. You've got fixed windows of exposure. And then you have to say, OK, what is the most important thing that we have to get done? Like what is the linchpin, if you will, of this athlete's performance. Like if I get this to the point where it is optimized, what is the greatest adaptation that I need to seek. And that's where I would spend a majority of my initial time because it's gonna have the greatest impact on the outcome. It doesn't mean that I ignore everything else, it just means that there will be a priority that if I don't spend enough time on it, I will not get any desired outcome because the efforts will be insufficient in regards to the concentration of the effect. Right. So if you do one set, if you do one set of max effort work. Okay. One set. There's an attitude that's associated with that. The question mark is, is that sufficient? Is that sufficient to raise that physical quality? Or is it enough to maintain it? Or is it just going to slow the decline? So those are your basic options, right? I'm going to raise it. I'm going to maintain it. Or it's going to slowly decline over time. And I control that. And so when you're organizing this, you have to consider like, okay, and you run in the same tickle that we do, like we'll get somebody for like six weeks, eight weeks, right? Like we're squeezing them in between a season or something like that. And so a lot of the training literature is associated with long-term training adaptations as far as its organization is concerned. And so you have to take that in consideration. It's like, well, how much time do I have? What's the most important thing? If I got a kid for a year, I got lots of time. I can start to spread this stuff out to a certain degree. But you'll always have something that would be primary, something that might be on maintenance, and then something that you're trying to prevent the decline of. So let me give you an example. Let's just say you develop somebody's oxidative capacity for field sport. And one of those elements would be the cardiac side of development where I need to assure that he can recover between outputs, right? So football player, soccer player, whatever, okay? And so we initially develop his cardiac capacity, resting heart rate goes down, recovery times are shortened, et cetera. But then I got to skew towards higher force production. I got to go towards some cross-sectional area development or something like that, that would be interference to the oxidative element. So then the question mark is like, okay, how much of that do I need? How much can I allow this oxidative component to decline? Right? How can I maintain that in the midst of all this? And so what I might do is I make sure that he has this oxidative capacity and then like every two or three weeks, we do a couple of days of concentrated load of the cardiac development stuff. So it either maintains or prevents the decline of that physical quality. What in the midst of knowing fully well that would it would interfere normally with my force production stuff. Okay, potentially, but I'm only doing it over a very small window. So the degree of interference becomes minimized. Right. You for Charlie Francis stuff right.

OK. I'm going to say hi to Jim Laird while Alex is getting himself situated. Hi, Jim. I haven't seen you in a long time, but you look good. You should lift weights. All right. So this is awesome. We don't need to see what your legs are doing because we'll be able to kind of picture this. We're going to exaggerate this for effect. Can you see yourself on camera? You can see where your head is relative to the door. Here's what I want you to do. I want you to make like a Barbie foot, like a stiletto heel on the right side. Go way up onto the ball of your foot, just on the right side. You should feel yourself go up and see your head go up towards the door. Come back down. Now don't let your knee bend. I want you to do the exact same thing with your foot, but don't change your height. Tell me where you have to bend to stay at the same height and elevate the heel at the same time.

It does.

Yes. So, yeah.

You elaborate on that because I'm trying to figure out what about the expanded repetition of the muscle is allowing for that better strength expression. My first thought when this kid was talking to me was that he had some ability to utilize the connected tissues and storage and release, but the variations they're doing for the most part are a lot of really slow tempos and pause reps and almost taking the connected tissue behavior out of it. So is it that the expanded repetition of the muscle is allowing for that better strength expression?

Okay.

So essentially buying her some space back on the left hand side is going to be of an advantage.

I understand. Trust your judgment. Don't force your judgment. Right? Don't try to get something because what's going to happen is if you do have enough internal rotation, they will be effective in their turn and you'll get really good results on both sides. The thing we want to recognize under these circumstances is that the reason this situation arises—a bunion in the first place—is that we have a limitation in relative motion in one segment and then we have to somehow produce more motion in another segment. And so in all cases, we will have to have external rotation for space, internal rotation for force production into the ground, and that's what a bunion basically is. It's a place first to apply an interim rotation. We're going to have to magnify an external rotation orientation as a substitution for a lack of motion, and we're going to get bunion formation. And so we have a situation that will have to be either managed or we have a way to restore the relative motions and alleviate the stress upon the big toe in this case.

Yeah, so Dale's a giant, right? And so I'm closer to the floor, so I might have a better shot. If we could turn Dale into a narrow, first of all, miracles on miracles. Yeah, really. We would, you remember the press at the end of the Terminator, Dale? Yeah. Yeah, we did that press and then we probably still break it. But the point being is we still have to, we still have to consider the excursion that they would have available to access this space. So your thought process is great because you're buying room. Okay. But you, but that doesn't immediately mean that we can take somebody to the floor.

Well, I'm assuming if I'm here, I'm going to be there.

Is this extended care? Or is this walking into the clinic kind of stuff? Outpatient. Okay. So they walk in. Yep. Okay. When you say geriatric health, 80 plus. One is 95. So, okay. That's a side question. All right. You're in a bit of a pickle. You have very low adaptability. So you have dehydrated people. So we always talk about fluids and water and you don't have a lot of water to play with here. So you're a PT then I'm assuming you said patients. In school, what did they say to never do with a lumbar stenosis patient? Extension. Okay. So that's an internal rotation that's fine. Right? Why do you not do that? To put more pressure on the posterior aspect of those vertebral segments.

Yeah. It exerts an influence on it.

Well, if you're from Texas, you think you're the biggest thing.

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?

You understand? Okay. Can we talk? It stops.

Yeah.

Well, the compensations, the IAR compensation that I'm seeing is either going to be a forward head or the reaching shrugging of the shoulders. So they generally from scap up, rotate the anterior thorax from there.

Okay. That's no good for today. Thank you, sir.

It's really hard to say, isn't it? The whole leg? I guess depends how hard I pull.

Yeah, it's like torturous. You know, I'm not big on that, but I understand that if you need the joint excursion, then you need to sprain the joint. I get it, right? It's just not something I like; it makes me uncomfortable. But I do understand the reasoning behind it.

Do you see it? Yeah, I guess I finally just understood what you mean when you say, 'bring it back and like an earlier IR'—if they're wide in that situation where I feel like I've always been trying to think of like, oh, let's get this counternutation, get expansion everywhere.' It's like, no, no, no, no, no—don't do that.

Because I'm getting ER of the metatarsal and the first toe is staying in IR. That's more of the bow legged.

If I can't produce the IR force, I have to do it somewhere. Now, let me give you another example, a non-stroke patient. So I just had this recently. The patient came in with years of right SI joint pain. He has the same delay strategy you just described. Now it's not the magnified lurching you see in stroke patients, but it's the exact same strategy, except he comes in with an L5S1 herniated disc and the expansive strategy in the back of the knee. It's the same problem. Do you see why they are constructing a strategy to allow them to do what we normally do when we have access to full relative motions? They have to create a delay just like everybody else, they have to create a downforce just like everybody else, but they don't have the motor output to do so anymore. That's why you put the AFO. The lesion won't allow them to capture the IR foot that I need to absorb forces coming up and deliver force back into the ground. I'll stick their foot in that middle representation where it will go. Then you give them an assistive device as needed—either a cane or a walker—so they can create the middle representation under whatever circumstance they can. That's how you decide how to give them an orthotic to allow them to capture these representations.

Now what if you orient the band so that it's pulling you, such that you have to produce IR on the lead leg? So the band is pulling you into ER, and then your IR counters it. Are you referring to the pelvis still around the knee?