When you get to the point that you can do the scapular decompression, you know which one I'm talking about, the manual? So to speak, it's not peel it back, it's pull it off. When you lift the medial border of the scapula away from the thorax, the subscapularis has to eccentrically orient under those circumstances. So have you ever had those people where you try to get your fingers underneath the scapula and you can't because it's pinned? Like it's literally pinned against the thorax and you just can't get your hands underneath there. That is a subscapularis that is concentrically oriented under those circumstances that will not let that scapula move. So what you may need to do is go in there and it's kind of like lazy rolling where you're doing like the scapular PNF part of it. Maybe you need to do that to tone down all of that concentric muscle activity. The benefit of that is you can drive him towards early and late representations manually. When he starts to let some of that stuff go naturally, you're going to get lower cervical rotation, which is very important. You're going to get upper cervical rotation in the opposing direction, which is exactly what you wanted to get in the first place. Your strategy has been appropriate, but you're going to have to do something local. You're going to have to make a window of opportunity with your hands.

Yeah.

Teach them to exhale first. Exhale first.

I'm shocked by that.

Yeah.

Right. I was going to say, do you find it difficult using a table at first for a lot of them?

So you're not pushing out. So you're still not, so even in that wide sitting, it's still not a push out, it's still just.

Absolutely, absolutely. Yeah, so if you have a period of no interference, that's the time to magnify what you're chasing as the supportive element. If we're talking about whatever the representation of health might be, it's like that might be the time to capture that because you don't have to worry about the performance-related outcome as much. You still need a performance measure to track that because here's what you don't want it to. It's like, give them back all of their movement capabilities. And then whatever your performance measure just disappears. It's like, oh, so let's just say that you were working with a basketball player and I know you're not, but let's just say you were. And you're saying, well, we're going to use vertical jump as a representation. And you do a great job of recapturing relative motions on this guy. And his vertical jump drops 12 inches. It's like, oops. probably too far, right? You know what I mean? It's like you want to keep them close to their performance. So you're going to need a performance measure of some sort. So you don't see decrements too far into, you know, like force output or whatever you want to you want to measure. So maybe you're going to use like a like a four jump, and you're going to look at ground contact time for power output, or you're going to look at a medicine ball, kind of a thing. Whatever it is that you think is appropriate for this guy, make sure you carry that measure so you do have something if they're not throwing.

Last call of the day, dude. It's luck of the draw.

I hope so.

Right. You always see it like going through as an aid and stuff, you always see everyone telling them to pinch back and whatnot. Now I'm like, oh, wow. Okay.

Like band assistance.

Yeah, there you go.

I'm going to give you a number for a frame of reference.

If I have two different people, and I have one that's a really good dampener and one that's not, I can put them on the same hurdle jump activity, change a couple of things, and then I can support the needs of those individuals. So if I have somebody that already dampens but can't maintain the tissue stiffness that they need, they have to bounce across the ground without delay. Somebody that can't dampen has to land and stick and learn how to distribute those forces. And so again, it's like two different people, two different needs. It's not like they're going to go through some magical progression where this is exercise one a, this is exercise one b, this is exercise one c, and then when you accumulate so many reps, then I know that you're qualified. I don't know what that means. Grace. There we go. That you're qualified to do the next thing. It's like the next thing is like, what is the next need?

Okay. All right. So let's use the golf swing because I think it's a little bit easier to see. So a couple of simple rules. We have to have an external rotation space to superimpose internal rotation on top of it because they happen at the same time. They are not separate entities. They are superimposed. So external rotation creates somewhere to go. Internal rotation gets us there. So that's how I want you to look at this. And again, because we've got two ends of the golf swing that are somewhat similar, it's very, very easy to see. Now, so we have an extra rotation position that is represented in the pelvis that we want to talk about. And so what this is, is this would be the counter-neutated representation of the sacrum against the ilium. That would be our representation of what the ER looks like. And so I actually had my pelvis handy, so I'm going to show you. Okay, so it's going to be that relationship there. So I have the counter-neutation of the sacrum. So it's moving back relative to the ilium or the ilium is moving forward rather on that. So I have two representations. I can use the ilium to push in that direction counter-neutation or I can move the sacrum back. So when we're talking about the backswing for a golfer, what that actually is, is a representation of early propulsion. So we're actually talking about how we take a step forward. So an early propulsive representation is ER, it's counter-neutation, but it's the sacrum moving back relative to the ilium. So what's creating this? So it's actually a delay strategy. So what happens is, if we talked about the left hip in the back swing, this side is actually going ahead of the right hip. So to create the delay on the backside hip, if we're talking about a right-handed golfer, we're talking about the right hip. So under this circumstance, to create the delay there, what I'm actually doing is creating a yielding action via the connective tissues. So I'm already in an ER representation, but to create the delay, so this side has to go slower than this side, otherwise there would be no turn. So to create a turn, both sides are in ER. One side is overcoming, which creates the turn away from this side. So on the left side, I have an overcoming action of those connective tissues, which moves that hip forward. This hip creates a delay and it moves back. That's what creates a turn.

OK, so I need this date documented because this would be the second time that I've gotten Manuel to get a full facial smile. He's usually this serious kind of dude. That was good. When we think about connective tissue behaviors, we have to look at it in a much more broad scope, in my opinion, because of the differences in stiffness and then certainly the way that things are loaded. All the connective tissues are viscoelastic in nature with different quantities of various components. Some have a little bit more elastin, some are a little bit more collagenous. Bones have hydroxyapatite to make them a little bit stiffer, et cetera, right. I always use the rubber band example when we're talking about these things because it's useful. The really thick wide rubber bands in the gym are hard to deform, but if you do deform them, there's a lot of force behind it. The skinny rubber bands are easy to deform; they move very quickly but don't produce nearly as much force. All you have to do is do a banded squat sometime to get a sense of what I'm talking about. When we're talking about the stretch-shortening cycle, they have been a little too focused on certain things. They imply that muscles are movers, so anything attached to the muscle and then to the bone is how we produce this elastic kind of thing. To a great degree, I think they're correct, but it's short-sighted not to include all of the connective tissues because of the way forces are distributed through the body. If we don't address that, it would be very difficult. That's probably one of the reasons why it's easier to look at tendon behavior than to look at the entire distribution of connective tissues. Some studies do measure the shape change of bones, which gives us clues. But to say that it's just the musculotendinous unit producing this force makes the math wrong. If I'm distributing these loads, forces, and elasticity throughout all the tissues, and I don't measure the one that can store and release the most energy, then I'll say that the tendon has to absorb and release a whole lot of force. When we consider the skeleton, all the other connective tissues associated with this, and the fluid change that creates expansion and compression producing force, it falls a little short. It would be very difficult to truly measure how that is distributed, but not mentioning it as being included in this whole process is where it falls short.

I've been looking through the work about the right anterior, right posterior, left anterior, left posterior pelvic floor through gait. I'm just not quite understanding. So if I've taken a right step and I'm at right max propulsion, why would the right posterior pelvic floor be eccentric in yielding? To my mind, it should be overcoming.

Initially. Because again, there's not one oblique, there's not one axis that this would tilt on, and how far forward is the center of gravity?

Okay. Then it's not being delayed, is it?

So stick the foot to the ground first and foremost. Now, what you also need to understand is where does the vastus medialis attach to the femur? And then where does it attach to the tibia? Which it kind of doesn't, just for the record. The vastus medialis is a grossly misunderstood muscle. It's actually not one muscle; it's probably a minimum of three. But the point is, based on the attachment sites and the direction of pull created, if you have an anatomy app, Manuel? If not, here's what I would do: either get a book that shows the vastus medialis in isolation, or use an anatomy app, which does it really well because you can literally select one muscle and see how it's attached to its bony attachments. If you look at the way it's attached to the femur and then follow the attachment where the VM attaches to the quad tendon and the patella, and then that attaches to the tibia, you will see that if I anchor the foot to the ground and that muscle contracts, it actually twists the femur into external rotation from the knee up. It'll turn it outward, which is external rotation. And if you want to get really in-depth, the vastus lateralis would be the opposing muscle; it would turn it inward.

Thank you, Zanero.

So again, start thinking about transitional positions between the inverted position, which takes as much weight away from the outlet as possible, right? So she can drive a concentrically oriented outlet in that position because there's nothing pushing down on it. So she can push it up. So you need to start to transition her progressively to bring her to upright because upright clearly is too much. Okay. But see, that's the advantage of the water. That's the advantage of cables. That's the advantage of bands and things like that or reclined positions, right? You see where I'm going?

Propulsion for an arrow. So because you do that with a white.

Right. So again, if you would want to use that for some form of mobilization, I guess I'd be okay with that. Again, that's where it would have some value, but I wouldn't necessarily want to reinforce that dynamically because I don't see the advantage. Like it's not going to be some sort of direct transfer. You're literally just doing a straight ahead mobilization by tilting this and then tilting the foot all the way up. Yeah, I see now. So who are we going to use that on?

So, you've got, she can't get the tibial IR.

So like an early representation of the foot from the ground up and things like that. They do pretty well. The thing you're going to have to be respectful of is how much space do they have in front of them? Because it's always going to be limited to a degree. That's one of the things. Because they don't turn. They don't turn their helical axes like Nero's do. When they're stepping forward, you're going to see a lot more pelvic orientation if they're trying to get the foot straight out in front of them. And you just got to be careful with that because what's going to happen is you're going to start to stick them in a space where like a split stance kind of a thing. They just don't have that space.

So they're gonna be concentrating. Now you guys go, okay, well, what do I have up above? It's like, well, okay, I got all that musculature that's coming down from the hip and the femur, right? Also going to be concentrically oriented. So you have an extremity position that is preventing you from dropping into that medial foot contact. It's trying to lift you up all the time away from the ground. And then you just have to find a strategy that allows you to push down. And you do. You do. It's just not distributed.

Yeah.

So that's an ER to IR representation.