You see it?

Yes.

Let's say we have someone who has a dorsal rostral space that we're trying to expand, and it's predominantly more on one side than the other. So we might see a push forward on the right side. If we were to write some programming based on trying to achieve some hypertrophy, two questions in respect to that.

Someone that you feel like the degree of limitation is so significant that you're not going to get him anywhere close to early. Does that mean that you really don't even play around with early biased activities? Or is it just that you could do early with the understanding of it's not going to get him there?

Where have you been, man? I said, where have you been? It's like, did you see me do this?

Yeah. So I guess my question is: to create posterior expansion, is that associated?

Okay. So if you bring her back on the right, was she ever there?

But my point is, it's helpful. Because again, you've got to have signaling somewhere to promote the shape change that is associated with the position of force production. So everything that you do is to help them create the IR representation. They're already trying to do that. So the right side of the pelvis is accelerating into the ground. How are they producing force into the ground right now? Do they lean over that right side? Oh yeah, yes. Why do they do that? They're trying to get force into the ground. So what do they do? They expand on the left side. That allows compression on the right side and that is their best case scenario for force production. So you have to take this as your assessment. So when you're assessing and evaluating a patient like this, you're trying to find out what motor outputs they have available to them. That's what you're evaluating. If somebody would have told me that in PT school, it would have been great to explain it this way. It's like, there's a representation where you produce force. Can they get into that position? Where are they relative to that position? How much motor output do they have? Find that out. Now you have the concepts like, what strategy can they produce? Let's use that to the greatest degree that they have possible. Let's train them as hard as we possibly can for them to be able to utilize this. And then I have to add stuff. In that pelvis, if I get an ER representation of a pelvis, what constraint can I add to the pelvis to create an IR shape?

So her toes are like this, and then her big toe looks like it's pointing out towards right and left field. So she's got the same twist underneath. So she had a degenerative meniscus, or did she have an incident?

Well, you have to make contact with the ball with the head of the club.

But you're doing a great job.

Oh, I know they don't. I know, I know. Right.

It's part of it. And monitor the ranges of motion. Absolutely. Then, as far as clearing up the limb, now that we have that range of motion available, what kinds of things—motor learning do you like to use? What's not motor learning? Yeah, that's right. What part is not motor learning? Very true. Simply that—

Yeah.

Awesome. I love this. Synovial joints are awesome. Okay. Where does pectoralis major attach? Okay. Not to the capsule, right? No. Okay, cool. But it does attach to the humerus. Okay. Where does subscapularis attach?

That's a really good strategy. I use the same strategy. It's just a really good strategy. You have to control the other elements first because again, think about this. Somebody literally just asked me why they have to worry about the extra rotation at the hip first and can't just untwist the knee. I said that sometimes you can if you need to get symptomatic relief, so I go after the knee right away. If it's really bad. But I also know that if I don't address the hip, that knee goes right back to where it started because the mechanics that drove the desire for the knee to twist inward in the first place are still there.

So you got a hundred kilograms in your back. You're going to lower it down into a squat and you're going to stand up with it. On the way down versus on the way up, which one recruits more motor units? When you're going up. So if I am concentrically orienting, I increase the number of motor units to go up and fewer to go down, correct?

So in that example, in that example there, the clearing up of the squat pattern was me observing that lumbar flexion, if you like, midway, but, and then that not being present once we, after we executed that, that, that restoration of a little bit.

You're inflicting pain unnecessarily, or you're lifting a very, very heavy weight. I'm doing, I'm at the bottom of the bench press. I'm at the bottom of the standing calf raise. You're stretching a muscle that does not want to eccentrically orient. So now you got to start thinking it's like, okay, you stretch and stretch and stretch and stretch and nothing good happens from this. Stop. That's not the solution. It's never going to be the solution because it doesn't work. Period. You could stretch him for six minutes straight. You know what's going to happen? Nothing. Other than the fact he's not going to like you very much. So you got to start thinking strategy. If I have somebody that is in an ER representation in the ankle and the foot, I need an IR representation there. If you can't manually achieve that, then you got to start thinking up. Getting his head to turn is going to start to reduce the concentric orientation you're going to create a wave that starts at his head and it's going to move towards his feet. The rolling activities that we always talk about are going to come in really handy here, but you're going to have to teach him how to do that.

Yeah, so it's gonna be the same measures that you're taking in the shoulder, right? You gotta make sure that you're capturing it in the pelvis too, right?

Yesterday I was going for a walk and was thinking about walking downhill as if you were hiking down a fairly steep grade. When you land, you almost quickly land on a flat foot because it's not much of a heel strike, since you're almost coming down. This gives you enough traction on the surface you're on, like when you're doing one of those scoot-like walking down the hill maneuvers. In that case, you're still in a plantar flexed position. So for people who have a lot of anterior knee pain when they come down a hill like that, in an ideal scenario to avoid falling down the mountain, you have to land quickly into an early mid-propulsive situation.

So I have been putting them on the decline board still because it helps them maintain a better looking squat from whatever subjective criteria I'm defining that as, but I'm limiting the depth.

When it comes time to stand them up from a seated position and you got this ER spine representation, what do you got to teach them to do?

Yes.

I didn't have a question. So I'm okay.

Right. Are they still using that same lumbar spine delay strategy when they walk? And that circumstance just at relatively different positions of the spine.

Cool. Very helpful. Thank you.

So let me offer you this. Think long-term obviously; you want to have the 20,000-foot perspective and say, 'I know that I need this measured by the end.' If you had two weeks, if you only had two weeks to make the change, what would you do?

Yeah. And again, as they evolve, as they get better at that activity, the goal is to, if you're going to be a successful power lifter, the exception or the expectation is that you need more adaptation, more adaptation, more adaptation. The question is, do you understand what adaptation we're talking about here? It's more superficial muscle. It's more compression. It's more squeezing, and that means you're going to lose relative motions under most circumstances.

Back bend?