Table.

I would say so. OK, so the meniscus is on the left knee and the main complaint is on the right foot. We got that.

Okay, keep going. How do you move the ball from one place to another?

You're welcome. All right. Good morning. Happy Wednesday. I have neuro coffee in hand and it is perfect. All right. Well, it is Wednesday. That means that tomorrow is Thursday. That means 6 a.m. tomorrow morning. Coffee and coaches conference call as usual. Great calls, great people. Grab a coffee, join us for some Q and A. These things just get better and better. Great questions. Very deep discussion last week, so it was kind of unusual and fun all at the same time. Please join us for that. Okay, digging into today's Q and A, this is with Teya. Teya has a really common question actually that I think is going to be useful for a lot of people. We're talking about the dreaded winging scapula. So we're blaming the scapula for a lot of things that it's not its fault. What we have is a thorax that's changing shape. We have a thorax that's moving away from the scapula. The scapula is looking for a place to land, so to speak. And so we get a lot of muscle activity that's associated with this that's going to produce an appearance that makes the scapula appear more prominent. So that's why the attention gets drawn there. The solution is not to pick on the scapula so much as it is to worry about thoracic shape change. So we kind of cover that ground. We kind of show you how this thing involves so you have an understanding of it and then you can provide the appropriate solutions. So thank you, Teya, for this question. It is awesome. Like I said, going to help a lot of people. If you would like to participate in a 15-minute consultation, please go to askbillhartman at gmail.com, askbillhartman at gmail.com, put 15-minute consultation in the subject line, so I don't delete it. We'll arrange that at our mutual convenience, and please remember to include your question in the email. Everybody have an outstanding Wednesday. I will see you tomorrow morning, 6 a.m. Coffee and Coaches Conference call.

So we have to look at this as if the human defies entropy.

Is that motor learning?

OK. You have to pay attention to what?

Inside.

Yeah.

Well, if they're not on, they're not doing anything.

That was it. Here's my next question. What else had to happen to accomplish the outcome? Do you think that you only impacted that area?

Because that's exactly how he is.

No, absolutely.

Right. And there's still IR there.

Yeah, that's good.

Okay. How to box squat, but try to keep. You got to put them in a force producing position.

I'll see you on Thursday.

Did you see the air quotes, Chris? Alex just used air quotes.

Well, you're talking about an elderly population, right? So you have to understand it's like, okay, how much shape change do you have available to you by constraint? Right? And so that becomes an element of limitation. But it doesn't mean that they don't have any. It just means that it's just to a smaller degree. That's why I like getting like, when I used to work in the nursing homes, I demanded that I had a big mat table so I could roll people around and get the shape changes that way first. But there's always going to be limitations. I mean, and to use probably a little bit of a harsh term, they're kind of brittle.

Good.

And allow gradual change there.

Gotcha. Cool. This was very helpful, Bill. Thank you.

Yeah. So let's just look at an extreme representation of that. So, right away, she's in a little bit of pickle based on the diaphragm shape that does not allow a lot of, we're talking about internally now. So the compensatory strategy of the diaphragm does not create like a, posterior lower expansion in the lung because of the diaphragm shape. So she's going to be anteriorly expanded. It's going to shove her forward. She shoves herself back. Okay. So she, she, she chest backwards and then she falls backwards and then she pushes herself forwards and then she pushes backwards and she pushes herself forwards, right? So she just goes boom, boom, boom, boom, boom. And every one of these strategies is an exhalation compressive strategy. But the advantage of that is that she creates this orientation so that she's turning her glenoid laterally. Right? So that creates an ER space. Okay. It's not going to allow a whole lot of relative motion to occur. So chances are she's going to get for every element of ER that she gains, she gives up some IR. Right? And so where she's probably doing this back band is she's got this orientation, like crazy orientation into ER, right? And then that gives her just enough so she creates IR through the extremity so she can balance on her hands. Right? But I think you're correct that her ability to do that may very well have led to the fact that she ended up with this so-called shoulder impingement because it requires a tremendous amount of posterior compression to achieve that position. So think about it. It's like, if she's in a back bend with her hands on the ground and her feet on the ground. So she's in this inverted U-shaped, right? Okay. If she was a tube, which she is, she was a tube and I bend the tube and the underside of the tube is fully compressed here and then there's expansion on the other side, right? You see it? And so all of her ER measures in a relative sense should be limited. Now she's creating an orientation, but there's Misha thinking again because she's creating an orientation to capture the ER position. She's literally pinning her scapulae together and pushing it forward. Well, if I push it forward, it makes this look like it's not really expanded. She's pushing it forward to create ACAs. So she created a shape in a very compressed state, but that's how much compression she has relative to the anterior. So chances are you got somebody that's gonna have like a low pressure abdominal strategy, because she's gotta let it go somewhere to make the U shape, right? She's probably not doing it through her sternum. She's squeezing in her sternum, so she's gonna push stuff towards her gut. So her abdomen is gonna probably be where she's gonna give way the most.

Do you see the difference? And you always, it matters. The scapula has to move, but it has to move in the right way. I have to have the right starting conditions. Otherwise, I've immediately eliminated my ability to turn. I have to have posterior lower expansive capabilities. Otherwise, I can't create the relative motion in the scapula relative to the humerus relative to the thorax.

Okay, all right. So she stands up and she's fighting gravity, right? And you can see it, right? You see it in her feet, you see it in the knee orientation, you see it in the spine orientation.

Dude, like, there's too many unknowns. There's too many unknowns. You just get better. You just get better. You narrow the probabilities, right? Just don't get high on your own supply, right?

Piriformis is above that. So the piriformis actually changes its direction of pull as well. So the piriformis becomes an internal rotator. So we're talking about the gemelli brothers and the external portion of the obturator internus.

Yeah, I can't see. So you're lucky. Yeah. Is that major questions?

Thank you for your time.

So I was wondering if you could stretch that out a little bit.