So yes, with many activities where the goal is restoring relative motion, I hadn't really considered that there's still a component where external and internal rotation are working together. So an accurate statement might be that the goal of the setup is to position the body so it can manage the entire spectrum of motion, but it's still advantageous because the cycling back and forth is what provides restoration as long as it's within a space they can handle.

Okay.

Now I have to rethink all my manual stuff, I think.

So looking down on the thorax, open it like a caliper. That's kind of where they're going to be.

It helps.

Coffee and Coaches conference call, Bill. I'm so sorry, I have one quick question related to the Wides and Narrows, having a left side that's either higher or lower. I just made all these little light bulbs go off with the Shamburger paper and the Dunnington papers you have us read. I don't know what you were getting at. Like the whole thing—leg lengthens, lying landmarks lower. Is that you could still use that, but that would help you identify a narrow versus a wide potentially?

Well, at first I was just thinking about isolating each movement first. So just okay.

Yeah.

I'm just wondering what I'm missing because it's hard for him to understand, and he feels pain if I put him in a split stance with the left leg.

Okay.

No, no, no. I mean, great, great representation of another archetype.

Okay, but do you see that I'm turning on a helical angle? So as I turn this way, Ian, I'm gonna do that. See it as I hit the constraint. So I gotta go to the end. So I can turn like this and then I start to hit the constraint and then I go down and then like that. That's the magnified IR. You see it, Zach? And so I'm just going to turn the mechanics. So I'm going to take my IR representation and I'm going to move it into an ER helical angle. See it? And in doing so, I create the ER up this away. You see it?

For acquiring middle propulsion, would there be?

Not.

So the apple test is a test of the hand position. So one is further out than the other, if you will.

Well, my thought is, if I need to pull them back on the right, I guess my question was, is that associated with choosing my words carefully? Is that associated with internal rotation in that hip? And if I need that, but it causes pain every time I internally rotate.

Awesome. So she went forward on the left. Okay. She got pulled down on the left hand side. Got it? You follow me so far. Okay. She went to the right. She got pulled down on the right. She got closer to the ground on the right, right? You understand? Okay. If I move her back, if I move her back, you pulled her down on the right. She was already down on the right. You just took everything and went like that. Okay. So you got to move her back to the left. So she starts to go up on the right where she came from. Then you move her back on the left. So she moves back up on the left where she came from. You have to see these things in multi-dimensions.

I was thinking like something that you could do to them. Ian, say it out loud, Ian. Is it the SI belt? Yeah, put an SI belt on them, like secure the ilia so that you're creating the compression. So you artificially create the IR representation of the pelvis. So now I got an AFO, again, SI belt. So now I got a foot that can capture a middle representation. I got a better shot. And I can't tell you how good this is going to be, but I got a better shot at creating the IR representation of the pelvis at the same time. Because I just need the shape change. Right? And then hopefully, hopefully I get enough of them, they have enough of the motor output available to them that they can actually access this position.

So you've got some twists that are occurring because she's got to put constant force into the ground. She's walking around. She's got an invisible 500 pound barbell on her shoulders.

Well, it works as transmitted to the ball and then the ball.

Yeah, sure.

That's not how I've been taught that. Okay, cool. Go on. Yeah, go on. Go on.

Yeah. Yeah.

Well, but it can be. But again, just recognize what you're looking at first and then you can start to determine the solution and trial and error is acceptable. It's very scientific, but just have a reason to do what you're doing. Don't just randomly throw things at people.

It's not a great mechanism, right? It'll drag the humerus and then eventually some of the synovial fluid may change, but you get those people that get diagnosed with anterior instability of the shoulder. You ever seen those? Or I had a young female volleyball player come in and they said that she had an expanded anterior capsule. So they looked at her on MRI and they go, oh, your capsule's too big. When reality was, it's like we did a little flippy flop of her muscle activity and we got all of her shoulder motion back and all of her symptoms went away and she's fine, right? So when you have something that's directly attached to the balloon, if you will, of the synovial joint that controls the fluid shift, I am creating the compression and expansion directly on that surface that's going to shift the fluid from side to side that allows the movements to occur in the first place. Right? So again, if I try to use a pec as an internal rotator, if you will, like a subscapular, this would be accused of being, I can certainly twist the humerus inward, but it creates, it's gonna drag the whole humerus forward, which doesn't create the fluid shift in the synovial joint. So the anterior shoulder remains expanded while I'm pulling the humerus forward. That would be somebody that would be accused of having the anterior instability of the shoulder. Because it's an eccentric orientation of subscapularis as I'm pulling the humerus forward. Do you see the picture? Yeah. So again, what you need is the thing that is closest to the joint that manipulates the fluid content. That's how movement occurs. And that's how you produce force. It's not the muscle that's ever lifting anything. It's the fluid compartment that you're compressing, because I can stack thousands of pounds on a column of water because it's incompressible. I can't stack thousands of pounds on a muscle. It would be destroyed in a heartbeat.

Yeah, so you're going to see all the extra rotation compensatory strategies start to show up because they don't have access to that range of motion yet.

OK. Hang on.

No, of course not. So the question would be, I guess, as I'm just thinking this through: if I've reduced that lumbar— I don't want to use the word flexion.

But hang on, where are you treating him? Like where in the space of the, it's an outpatient clinic, right? Where are you treating him? Out in the gym?

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.