Yes. So there you go. Does that give you a superpower?

That's it, I'm gonna let others—because you need the down pressure. Yes, sir. You need the down pressure. So it's gotta be where I have a really strong superimposition of IR. Got it. Got it. Thank you. Good morning. Happy Wednesday. I have neural coffee in hand and it is perfect. All right. It is Wednesday. That means that tomorrow is Thursday. That means tomorrow morning, 6 a.m., Coffee and Coaches conference call. As usual, I believe this is number 111 of these calls. We're getting pretty good at them. So you should probably join us, grab a cup of coffee. Great Q&A, great people, great questions, as usual. Lots of good information being passed around. So again, please join us for that. Digging into today's Q&A, this is a question that came from Paul. He's very apologetic. It's kind of funny that the very beginning of the call when he feels like he's interrupting, it's like that's what the call is for. But anyway, so Paul's question led us into one of my favorite concepts to talk about: dirty table tests. And when I say that they're dirty, it just means that what do you think you're measuring? You're probably not measuring. So when we're measuring a hip, we're not just looking at the hip joint itself, even though that's what has been expressed in many of the teachings. What we're actually looking at is the femur's relationship as it moves relative to the acetabulum, the acetabulum movement and position in space, the sacral movement and its position in space, the spine movement and its position in space. So all of those things are influences. Which again, that's why the tilt board becomes so important because we can actually identify these relationships so we can actually determine someone's physical shape relative to the table. But this is also why some of the traditional measures, like using motion palpation tests where we're palpating bony landmarks, can actually create confusion or can actually help us identify things. And so Paul's question kind of let us down that path. And so we break that out a little bit for you. So again, it's gonna be very useful, especially for those of you that are doing traditional measures on the table as we would in say a physical therapy environment. So again, thank you, Paul. Everybody have an outstanding Wednesday, we'll see you tomorrow morning, 6 a.m.

Yeah, but I'm assuming you're going to flip flop the upper extremities as well.

Okay. So what you might see is a strategy when somebody's wearing their flat shoe and it disappears when they've got their heel elevated shoe on. Right. And you, like you've seen, you've seen the pubic orientation stuff change. I'm sure you've seen that as soon as somebody puts on their Olympic shoes, it's like, Oh, okay. I just gave you the foot position that you needed to prevent this anterior orientation from occurring that you access when you are in flats. Gotcha. Makes sense.

Yeah.

So this is one of those really important things, though, in the issues of recurrence with knee stuff is that they might have to do a surgery to repair a constraint. And then they don't restore the mechanics that they need for force production because of the misunderstanding of knee extension at certain points in the propulsive phase. Middle propulsion is not the extreme tibial femoral ER that you see in a late representation. The screw-home knee is not the one that you produce force on. It's a reducing amount of force in that knee representation. So this is why restoring that knee mechanic of the tibial femoral IR becomes so important. That's why you've got to capture the force producing middle representation with the leg underneath the axial scales and pushing into the ground because that is a concentrically oriented VL pushing down into IR, a concentrically oriented VM pushing into ER simultaneously because it becomes one. You've heard me say this before. It's like, I got this superimposed ER and IR until I got to produce force and then they're the same. So if you have one or the other, that's where you're going to run into problems. Typically you're going to have too much ER represented. Okay. This is a middle, it's a middle propulsive representation straight into the ground. So this is a late IR representation is what you're trying to recapture because that's where your force is going to be produced. Again, people run into trouble. They run into knee issues when they're trying to produce the downforce with this ER representation of the knee.

Oh, picking on Dale. There you go. So Dale's going to be listening closely now. Okay. All right. Now, so your vertical axis, all right is now more perpendicular to your helical orientation. So your helical axis is more horizontal than it is vertical. So again, you're going to have to stop internal forces. So I've got to push myself into a position where I can do so. And so instead of the left side coming straight forward and you're gonna weight bear on the ball of your left foot, so on the left met heads, what you're gonna do is you're gonna turn on a helical axis which is gonna drop your center of gravity towards the inside edge of the right heel.

Yeah.

That is a good question. So that's the answer to your question.

Exactly. Okay. And all you have to do is, if you're not sure, just put your hands in a mixed grip and then exaggerate them, and you will feel the direction that you're going to go. Okay. All right. So think about this, Matt, like, there's your orientation on the backside. You have two paddles. You have two paddles on your back that you're twisting against the thorax that are going to emphasize this turn. So one of the strategies that you may use when you're trying to prevent this rotation from potentially worsening or creating more compression on one side is just teaching them to flip-flop their mixed grip. Yeah. Yeah, because that's the option to turn. So do you ever get the power lifters with that? They come in, they got that neck thing.

So then how do I use the apple test, right?

But if you say, I need to push your expansion behind the right ear. Is that helpful? Yeah. Actually it is under the circumstances. But no, my point is, you want to clarify this because think about this: look at the starting conditions of a wide ISA versus a narrow ISA pelvis. They're not the same. So when we say posterior expansion on a narrow, are we talking about the same expansion strategy on a narrow as we're on a wide? Well, no, because the starting conditions were different. So when you say, I need posterior expansion, where do you want to get it?

Oh,

Oh, you mean literally?

All right.

Okay. How does the ball move?

Well, what if we quit blaming the scapula if we're just doing what it likes to do? And let's blame the appropriate structure, okay? So can we just change the name?

Right. OK, so let me throw my picture up here again. So you see the circles? Yeah. OK, so each one of those circles represents either a balancing loop, which would be a restorative capability or a reinforcing loop, which is like an output, right? Okay. So if inputs and outputs are equivalent, then my entropy is zero. Theoretically.

Awesome. Okay, hang on. We could use Taya's question from before, okay? If I increase the number of motor units that can produce concentric muscle orientation and lift more weight, is that motor learning? Yes, it is, right? So the fitness part is still motor learning. Like it's all motor learning if you want to get technical about it.

That's definitely not a solution then.

Probably not that likely.

Yeah. Yeah, yeah, so you basically create better circumstances in a staggered stance because if you put someone like that in a half kneeling position, their foot would probably just go out on the, yeah, maybe.

OK.

I'm not saying you did anything wrong. I'm just saying, do you think that you just impacted that one area?

Yep, yeah. That makes a lot of sense. Now I just gotta figure out how I'm gonna.

Like you said, he's tough. He's a really hard worker. What I will say is, so what led to this surgery was about close to 10 dislocations, where ultimately they said, 'all right, we got to fix this if you want to keep playing.' So there is a lot of like fear, rightfully so. Like anytime we're moving that shoulder specifically, laying it back and it popping out. So like this is what you're describing in terms of like that guarding where he's kind of just like pulling the scapula. It makes sense that he would be doing it because he doesn't want it to pop out.

Well, I need downward force, right? Yeah. So what orientation do you think you're going to end up with at the knee under that circumstance? So if I don't have, if I can't drive a public orientation that can capture the IR, where are you going to land? Where's the weight on your foot under that circumstance?

So will this be valsalva or pressurized? It can be.

All right, back to baseball. But this time it's not a pitcher, it's a position player. So I have a wide, he's a right-handed hitter, and he's getting some crash in that back knee as he's kind of transitioning.

This is protection. Maybe. So if you recapture relative motions in the pelvis, that's what you're saying. When you say recapture ER space, you're talking about recapturing relative motions in the pelvis. So let's just say we have somebody that is oriented, the pelvis orientation is an extra rotation representation with compression. So they don't have relative motions. They're using a lumbar spine compensatory strategy as their delay. So there's our starting conditions. You do some form of activity to restore relative motions in the pelvis. Chances are, assuming no other constraint changes are in play, you will also normalize the behavior of the lumbar spine in its association with the pelvis. If you don't, then you have another issue to address. But like I said, typically, if you're able to capture relative motions, you're going to get the associated behavior change in the lumbar spine as well. However, if you don't get that change—if you don't recapture relative motion in the pelvis—you might need to influence this from the lumbar spine to get the relative motions to behave appropriately. So now you have to start thinking of a position where you can move the spine from its delay strategy to a late representation of propulsion to create a turn in the lumbar spine and then bring the pelvis along with it. Have you ever seen anybody manipulate a lumbar spine and the patient gets up and says, 'oh, that feels so much better'?