Yeah.

I got you. It's awesome. Perfect. It's one of those things where it's kind of a right-behind-left stance.

Perfect. Can I throw some of her range of motion measurements at you and see?

Okay. So if I'm loading just any exercise, is it yielding or is it possible to get some eccentric orientation? Because there's going to be muscular activity trying to allow the minimum amount of tissue length, correct?

Yes, it does.

I've started writing my PowerPoint for the Lunch and Learn and I want to run some ideas by you and see what would be the most beneficial ideas that I can share with therapists who are more used to the traditional ways of rehab and who've never heard these kinds of ideas or thought of these ideas before. The objectives I have right now listed the first objective would be to just review axial skeleton mechanics during respiration. How much time do I have? I have 45 minutes to an hour for the lunch.

I mean, there's still people that jump very, very high using this technique. But if we want to try to improve it, then we want to try to get a better decent in this public outlet. So we need to capture a little bit more emotion. So we have more time to create the yielding action. And so that's going to be our step number one. Again, let's go back to the tissue behaviors. The second thing we have to think about is they just don't have a yielding action available to them. So the degree of the exhalation bias, concentric orientation, and then if we superimposed any prolonged amount of heavy strength training on top of this, we have increased tissue stiffness. So the tissue behavior is biased towards an overcoming action. And so that tissue is much more difficult to deform. And so we don't get the yielding action that we want there. Especially when we talk about the internal mechanics, we want to make sure that we can get the guts to push down on that pelvic outlet and create sort of this trample-leaning of these internal forces. But because the internal pressure's in a wide, inferestional angle, tends to be very, very high and very, very consistent, we don't have any gradient. And so the guts just tend to sit on top of that pelvic outlet and keep it continuously loaded. So again, we have a tissue stiffness problem. And then number three would be the time constraint. Like I mentioned before, it's like we need enough time in the counter movement to load and create the yielding action and then create the release of that yielding action, which is the release of energy that allows us to jump.

So it's actually an ER muscle as well. And it's an elbow flexor by traditional representation. So it's doing a lot of stuff, but what it's going to do is it's actually going to pull in that medial condyle as you're trying to drive internal rotation on top of this ER oriented position. Now, let's go distal to proximal. We fixed the hand. So what the hand's going to try to do, it's sort of like a foot being on the ground. The hand is fixed. And so what we're going to do is we're going to start to drive internal rotation with the hand, proximally. And so because of our fixed hand, even if we're supinated, even if we're supinated, we're going to try to drive an internal rotation force. We're going to try to drive pronation from the hand approximately. Now, here's the other problem. If I get a compression on the front because I'm canceling out rotational forces, so if I push my pump handle down under these circumstances to create internal pressure and high force, I'm going to create a situation where I lose shoulder internal rotation. So again, down pump handle, loss of shoulder internal rotation, now I'm in compensation city.

And we're able to capture this delay strategy at slower speed activity. So for instance, if we were doing a staggered stance cable chop, that would be a very useful exercise to create this delay. The thing that we want to recognize though is that this is not at speed. So what we want to do is we want to challenge him to actually maintain this external orientation at higher forces and higher velocities. And so what we're going to do is we're going to modify a couple of his exercises. We're doing some chopping activities on a diagonal. But one of the key elements that you'll hear me say in the next part of the video is that we're going to try to maintain these activities on a diagonal that is relative to his helical angle. Remember, your infrastructural angle is a representation of the helical angle of your physical structure. And so what we want to do is we want to train on that angle to help us maintain a much more effective delay strategy. If the angle's too flat, for instance, relative to the helical angle of the axial skeleton, you'll still get a turn, but it's going to be a flatter turn, so we're more likely to create this pelvic orientation where the pelvis turns as a unit rather than creating a delay strategy that allows the right side to accelerate in a much straighter line towards home plate and help us reduce the stress throughout the system. So we'll get a distributed stress instead of a focal stress.

Now, with a field athlete, though, you're going to have a bias that's going to tilt that pelvis forward. So we'll see this in a lot of explosive and really, really fast athletes. Because they have to apply so much force into the ground, because that's where your force production is going to be, right? So we have to capture as much internal rotation as I possibly can. So if I anteriorly orient my pelvis, I can push harder into the ground. So my change of direction is better. My acceleration is better. My top speed is better. And so again, so this is one of those situations where if I just try to drive somebody into this symmetrical posterior tilt in an attempt to alleviate some measure of the so-called hip flexor tightness, you're probably gonna fail because what you're gonna end up doing is you're gonna get this full posterior orientation of the pelvis as a single unit. So we're not gonna get relative position changes that we would wanna see in regards to our performance on the field. but you're going to see a lumbar flexion substitution and this full pelvis orientation. So what I would recommend under these circumstances when you're trying to make a favorable change in these field athletes is they use something that is asymmetrical. So you're also probably going to see a lot of compressive strategies. So they're going to get that posterior lower compression. These people have limited hip flexion. And so we can't move people into even a hook line position or something where the hips will be bent 90 degrees. So we're going to start with something that's a little bit more close to full extension. And so this is where your supine cross connects come into play. It's a great place to start. We can actually use the compensatory strategy to our advantage to recapture some of the internal rotation, a.k.a. hip extension by tradition. which will alleviate some of the the pelvic orientation issues that might be producing some of the hamstring issues as well as the hip flexor tightness and then we want to move you into something that would be more like the the prone propulsive strategies and then we're going to move this upward into a standing activity where we'll go through a whole progression of A-marches, A-skips, etc. to try to teach them how to control this orientation in a dynamic environment but Malte, what your question has led me to is let's look at some structural issues that we might be able to utilize to tweak training a little bit more where we can identify these performance-related biases by physical structure. So this is actually kind of interesting. I haven't really talked about this a whole lot. So what we want to do is we want to take a look at the entire configuration of the axial skeleton.

So this is our typical right oblique and what we're going to see is we're going to see the impingement on this side. And so this is the inability to acquire a late propulsive strategy on that affected side. So from an interference standpoint we want to avoid the bilateral symmetrical activities for a while, because what we have to do under these circumstances is take that right side and push back into the left to overcome the oblique axis. So we can start in left sideline with a right propulsive type of an activity. In this case if we go into the gym we're going to use our Camp Rainy deadlift again with the heel elevated, but this time we're going to put in Ipsilateral load on that heel elevated side because what we want to do is we want to hold that back and push with the right foot. And that load's going to emphasize that right push. So again, we're turning back against the oblique. We can do a right foot forward, front foot elevated, right side loaded, split squat. So this is about driving that late propulsive strategy on the right side all day every day. Right suitcase carry is going to get us there. Go back to the video that we did about the suitcase carrying was a week or so ago and you'll see that we were talking about increasing max p on the opposing side but we're going to take advantage of the ipsilateral side under these circumstances where we would normally use like a cable chopping activity in the early phases of trying to recapture the turn of the spine under these circumstances I'm going to use a cable lift because I'm trying to drive that right propulsive strategy and it's much easier to do a cable lift under these circumstances and still capture the turn into the opposite side. A little bit of a finish, kind of conditioning thing. Your right to left sled drag is going to be a nice way to finish because again we're just emphasizing that right propulsive strategy. So Chris, I hope that is helpful for you and for the rest of you. Remember the shoulders and the hips aren't very much the same, so don't treat them any differently. Very, very useful in regards to your confirmations and checks and balances in regards to range of motion. So use them accordingly.

Once you can capture the full range of motion and want to start loading it, begin with the contralateral load split squat. This will bias you towards capturing a bit more internal rotation at the bottom of the split squat. So, Vicki, I hope this gives you an idea of how you may progress. There are many ways to get to this situation. This is just one representation. Again, it's a little nonspecific, as you didn't provide a whole lot of information to work with, but it should get you started and working in the right direction.

I am. Thank you for asking. Thanks for doing all these Q and A's. You're welcome. He says, I've got a wide ISA client who presents with limited shoulder internal rotation on both sides, more on the right. He also has limited shoulder flexion but more on the left. So it's more limitation on the left. Any experiences right shoulder pain when bench pressing. His right elbow likes to tuck in more. All his hip measurements are limited as well. We love your thoughts and solutions on this. Okay Ben, you didn't give me a whole lot to work with but you gave me some really, really good clues that I think we've got enough information to help you out. So let's dig into this. First and foremost, let's describe what's actually going on while he's bench pressing. So you're talking about a position where the left arm seems to be away from his body and his right arm seems to be tucked in. And so what that representation actually is, is his ribcage and thorax are actually turning to the right. So when you have your hands fixed on a bar, that's going to secure the hands in pronation, which is going to put us towards internal rotation, which is where we got to be anyway for a bench press. But point being, if I've got limited shoulder flexion, the typical compensatory strategy for limited shoulder flexion, especially in the early range of shoulder flexion, which you would be exposed to in a bench press, is to turn away from it. So again, so he's actually turning his rib cage on the bench. And so this arm looks like it's far away, and this one looks like it's tucked in. Now, here's the problem with that. is because what you've actually done is you've actually turned the right shoulder towards greater internal rotation. So I need internal rotation for bench press. I need internal rotation for my compressive strategy, constant regrain rotation and propulsive activities, and then I need to move through a space that demands I have internal rotation. So we got a triple whammy there and so you got a ton of compression in that right shoulder under these circumstances. And so that may be why your client is experiencing right shoulder pain. This is actually a really cool little little competitor strategy and it's probably not that uncommon So, probably what I'll do, as soon as I get a little bit of time, Ben, I'm gonna go into the gym, I'll probably grab Eric and we'll go through how this is actually happening. So, if I don't do that soon, please send me a reminder. All right. So what's our solution here? Step number one, because you're dealing with a painful situation, you're going to have to clear this client for any structural issues. And so if you don't have the capacity to do that, I suggest you get them to somebody that can.

And then we want to make sure that we're conserving the remainder of resources so they remain adaptable in other aspects because if we overshoot and we apply too much effort then all we're doing is drawing on resources that we could be using for other things like recovery and rest and regeneration. So again that goes towards conservation of resources. Principle humans are complex adaptive systems and will behave as such so there's an element of unpredictability in all complex systems so we have to appreciate that fact and so we have constraints so these are behavioral constraints or structural constraints that we have to pay attention to there's going to be a hierarchy of systems so I say hierarchy because we never know what element of the system is running the show per se we can say that certain things are predominant at certain times through experience we can determine what may be running the show, but ultimately we have to consider that we have this integration of a massive number of subsystems that we have to attend to. You have all sorts of concepts like degeneracy, acceptation, non-linearity, emergency, emergence, and self-organization that are also in play with complex systems. So we must pay attention to that. along the same lines with complex systems principle would be there may be more than one solution that will result in the desired outcome. And so these are one of those things that there is a cause and effect that's associated with elements of working with a complex system, but we just don't know what those are until we do something. So you'll see like in Kevin, we'll see like a probe sense respond kind of a concept. So what we have to do is we act to run an experiment to see what happens. And then that guides us into the next principle and knowing full well that there may be more than one solution. So if we looked at something as simple as choosing which exercise that we want to do, there may be multiple exercises that will provide us a solution to a problem. Simple principle. Do what is most important. Many things appear to be important and impact the system. But again, we have to consider the heterarchy when we're talking about what would be the best course of action. Sometimes we don't know. Again, we have to experiment. But with experience and time, we can reduce the probabilities and come up with a potential solution.

That's what I did when I constructed the wide ISA and narrow ISA archetypes. I was looking for behavioral bias that would help me determine the best intervention for this person to restore some capacity of adaptability. The ISA represents a structural element that this person will be biased for life. It is a genetically determined structural element that tells me what type of muscle activity they'll be biased towards, what type of breathing strategy they're biased towards, concentric/eccentric orientation, and whether they're biased towards internal or external rotation. That's why my archetypes are so important for me because they allow me to determine the best possible intervention to restore adaptability. I'm not trying to chase a number or push people towards something they have no capacity to reach. The ISA helps determine part of the structure that determines the behavioral bias of this human being. Most of our resting breathing should be relaxed and comfortable and not require any thought. When discussing the archetypes, we talk about using different breathing methods to reinforce a change. While it appears to be a dichotomy of inhalation and exhalation, they're actually occurring at the same time. Because the diaphragm does not descend uniformly in the two archetypes, different breathing approaches are needed when restoring movement capabilities. For narrow ISAs, because they trap air in the thorax, using a high pressure strategy reinforces the compensatory strategy and fails to create desired changes. We use a more relaxed mouth breathing, like fogging up a mirror, because slowing exhalation provides time to clear trapped air. For wide ISAs, we use more forceful exhalation to close the wide angle using superficial musculature like the external oblique. However, a problem with wide ISA archetypes is they're using high levels of muscle activity and forceful exhalation during breathing, reinforcing their concentric orientation strategy instead of creating change. So for wide ISA individuals with strong exhalation tendencies, we use very relaxed, casual breathing with slow movements and low effort to avoid reinforcing the strategy. We must consider what the individual brings to us and reason through strategies to alleviate or reinforce what we're trying to change. For performance, if someone needs high force output, we may use a concentric strategy and aggressive exhalation. We always take the individual into consideration.

Okay.

Unless somebody else has a question.

What we're going to do is we're going to drive external rotation through the entire system on that right side. So we're going to start. We're going to do a dumbbell curl. We're going to cheat the hand over to the inside edge of the dumbbell. That's going to promote supination right away. Now Eric is pressing his thumb onto the inside of that dumbbell. And so that is ER of the hand. So we're driving external orientation from the hand up. Then if you look at his body orientation, we have the thorax, the shoulder, the humerus, and everything is ER'd as he does this dumbbell curl. And so it's really, really simple. We're just driving external rotation through the entire system. And what we're going to get is we're going to get a reduction of that concentric orientation of the medial aspect of triceps. We're going to restore the orientation of the elbow. And now when we put Eric back up on the table and we check our supinated elbow flexion, now we get this fully compressed look. And so again, it's just a matter of understanding the orientation at the elbow, and now what we should have then is a normal extensor mechanism on the backside of that elbow so we don't have to substitute with our tiny little muscles like anconeus, supinator, and the common extensor compartment. And so hopefully Jared, that gives you an idea of what you're looking at with this lateral elbow stuff and provides you a little bit of a solution. Keep in mind it is a solution, it's not the solution. There are other things that can be going on, but this is a really, really common one. So I hope it's useful. If you have any other questions, please go to Ask Bill Hartman at gmail.com. Ask Bill Hartman at gmail.com. Tomorrow morning, we got coffee and coach's conference call. So please don't forget that. We'll see you at 6 a.m. tomorrow morning. Have a great day.

We want just enough to get competition depth and then get back up. So the power of the squat is all about staying as close to this maximum concentric orientation as possible. We're going to use a compensatory breathing strategy throughout the entire lift. Because if you think about where you're going to position the bar in a back squat, you're going to try to retract the scapula to a degree. That's going to create upper back compression. So dorsal rostrum is going to be compressed. Upper dorsal rostrum is going to be compressed. You're going to engage the lower posterior rib cage musculatures like lats and things like that. So we're going to try to compress that. You're going to compress everything that you can across the backside of the pelvis to make a very, very stable structure. You're going to use your final compensatory strategy in the lower part of the pelvis where you're going to drive the extra rotation moment. You're going to try to compress this apex of the sacrum. So we want the minimum amount of eccentric orientation to allow us to get into that position, because the minute that you release the concentric orientation to any significant degree, you are going to accelerate towards the ground under maximum loads, which is really not effective, especially in competition, because you tend to not get your white lights under those circumstances. So again, so we're gonna actually limit this. So we don't wanna go past this concept of orientation. So your setup that you're talking about at the very beginning of the squat, yes, you're gonna charge your thorax with air, and then you're gonna squeeze the bejesus out of it, cut it off at the throat with a vasalva, right? Because we wanna create this incompressible body that we can stack a bunch of weight on top of. And I cannot release that at any significant degree during the lift otherwise I am going to lose my position rather rather readily and again I'm going to miss my lift so the breathing that you're talking about in the the competition squat is a compensatory strategy all day every day it's it's concentric on concentric and and so we're not going to follow the normal mechanics that we would under a normal circumstance when we're talking about a regular if you will or a body weight squat where we have this transition from expansion to compression to expansion again. The power lifting squat is compression on compression on compression with the most minimum of eccentric orientation. That's why the box squat so popular with power lifters is because it does allow them to capture eccentric orientation at a depth But it's the minimum allowed, and then they learn how to yield throughout the entire system.

And each one of those is represented in the human body by internal and external rotation. And so all movements are based off of those two rotations, which fall into the transverse plane. So again, two strategies, one plane. I put together the archetypes as the wides and the narrows. What I did is I was constructing the archetypes to represent the two extremes. So one is this massive compressor, one is this massive expander. And so that's why they have these biases towards certain strategies. The thing that you want to recognize, regardless of the archetype, is that as we apply forces into the ground, we are superimposing internal rotation on top of external rotation. And so one of the limitations that I think most people have because of the way that they've been educated and because of the way the information is presented is that there's certain areas of your body that internally and externally rotate and there's certain areas that don't or they do the opposing and the thing we're going to recognize is that internal and external rotation is systemic. So it's the entire system that is moving into and out of internal and external rotation. It's supported by the breathing mechanism as we internally and externally rotate. And so when we run into compensatory strategies or other limitations that are superimposed upon us, that's where we might have problems that arise because now we have to strategize how to maintain our two strategies under some certain circumstance or limitation or some other context. Again, if we want to look at this thing as how we distribute these things, we can look at the foot, and David mentioned this, is that, okay, so what I want to be able to do to alleviate the pressure on the knees, I need to be able to acquire this middle propulsive strategy where this arch goes down and I get the tibial internal rotation. If I can't do that, so if I have an orientation or I have a strategy that I have to use where I'm trying to maintain a supinated foot, I have just eliminated my ability to distribute internal rotation throughout the system, and now I might get a focal load. So maybe that shows up as a knee compensatory strategy. And now I have too much internal rotation force that's applied locally, and then that might result in a pain experience. So structure and strategy are going to help us determine how we're going to produce these forces. And once again, if we don't distribute them well, we're going to find a way. You're going to find a way to internally rotate. What I want you to start to recognize is that anytime you use the words extension, adduction, or internal rotation, we're talking about the exact same thing. This is a force that goes into the ground. So we will find a way to apply force into the ground.

So we're going to tell you why here. So we're going to look at Hawkins Kennedy. We're going to look at the near test and then we'll look at a painful arc. Okay. Now I don't use these tests because my table tests will tell me exactly where these compressive strategies are. Just because somebody doesn't have pain with these positions, it doesn't mean that there's not a compressive strategy there. It just means that it's not sensitized. So everybody kind of ignores it. And then when somebody does have pain, they tend to blame the poor little rotary cuff. It's not his fault. He's just the result. And so let's talk about where this compressive stuff comes from, okay?

We would see this naturally in just about any rotational athlete at some point in time during their performance where we would see a sharper turn, we're going to see this representation of the asymmetrical presentation through the thorax and through the pelvis. Again, this is not something unusual. Again, we're probably looking at a change in yielding strategy. If I magnify the overcoming strategy on one side, if I magnify the yielding strategy on the other side, I get a bigger turn. So essentially what I've done is I've moved myself further away from the dead center of middle propulsion. So I'm moving one side towards a later propulsive strategy. I'm moving the other side towards an earlier propulsive strategy. And so now what we have to say is okay, what's the goal? Are we trying to increase the degree of adaptability? Am I trying to raise performance and then what is the interference? And so this just becomes basic training. We have to identify what constraints are the limiting factors. How am I going to address those? And so when we talk about, well, do I need to work on symmetry first? I think the question that we first ask is, is symmetry even important under the circumstances? Or am I just trying to capture enough adaptability to alleviate pain? Am I trying to encourage adaptability to achieve a goal? Am I trying to raise some measure of performance? And so like I said, it just becomes a training process. Here is presentation A, the goal is presentation B, and then I train to close the gap. So however it's necessary for me to expand the available strategies, I have to just decide, it's like, okay, do I need to just unbalance this program to achieve those goals to become more adaptable or to raise the performance? And so then we have to just decide, okay, how much of this do I need to do? How often my frequency, my intensities to maintain this favorable change to achieve the desired outcome? So the big takeaway here is that the principles do not change. It's just a representation, like I said, of the greater turn. So we identify the presentation just like we normally would. We determine what our intention is, what is the goal, we identify the limiting factors these become our key performance indicators that we're going to track over time as we train we determine the best approach and the way we do this is we this person becomes their own experiment just like every other person that we read a training program for is we identify what we think we see, we intervene, and then we monitor for the changes and we track our KPIs to determine that we're on the right process and we're moving towards the desired goal. So just adapt the program to the individual. So it's always going to come down to those principles.

As soon as you said sacral nutation, we're going to be starting from a wide ISA archetype bias. So let me grab the pelvis here and we'll kind of talk through that a little bit real quick. If my sacrum is nutated, then I know I'm going to be in that orientation. This biases me to an inverted hip socket. It buys me towards an IR-dominant hip. And then from a pelvic outlet standpoint, I'm going to have a concentric orientation of this anterior outlet. And because of the sacral position, I'm going to have a bias towards an eccentric orientation of this posterior outlet. So that's where our starting position is. Now, let's superimpose a pregnancy on top of that. And so we have downward pressure. We have an anterior expansion of the abdomen. And so then what we're going to end up with is we're going to actually change the axis of the pelvis. So the pelvic axis enters the pelvis at an angle and usually goes straight down. But under these circumstances, because of the orientation of the sacrum, we're going to have a reorientation of the pubic axis. And so what that's going to do, it's going to promote more of this posterior expansion. We've got a posterior compression in the superior aspect near the base of the sacrum that's going to be pushing us forward. And we're just going to kind of keep going, going, going, going, going. So right away, we start to think about, okay, what kind of measures are we going to be looking at with these folks? And so with the anterior orientation, you're going to see this loss of external rotation. Now, we also have to think about a progressive element of strategies here because we've got a change in the center of gravity. And we're talking about the pregnancy factor here a lot. So I have an anterior expansion that's going to push me forward. I've got to push myself back. So chances are you're going to get this anterior compression as well under most circumstances. And so now I've got a pelvis that's getting compressed anterior to posterior. So what happens is I'm going to lose the diameter of this anterior-posterior space, and I'm actually going to widen it side to side. So if I took a hoop and I squeezed the hoop, I get wider. Away from the compression, I get narrower towards the compression. So that's the kind of situation that we're talking about. That's all well and good. So under that circumstance, we've still got this eccentric orientation posteriorly. We've got concentric orientation anteriorly. And until we reach a certain position, we probably don't really have any incontinence problems. But I think there's two scenarios that we have to consider under these circumstances where we will start to see the incontinence problems.

So we're going to assume a narrow ISA. We're going to assume because we have limited extremity excursion that we don't have normal breathing, so we don't have full excursion breathing, so we know we're going to have a narrow IPA as well. We've lost external rotation on both sides, so by the archetype, I still have about 100 degrees of excursion, but I've lost external rotation on both sides. That means I've got to have an anterior orientation. Now, I'm limited in hip flexion and I'm limited in straight leg raise, which is rather severe, especially in the straight leg raise. That means that because I've got an anterior orientation here, I know that I've got posterior compression above the trochanter, but my hip flexion measure and my straight leg raise tell me that I've got this compressive strategy below the level of the trochanter as well. Now, the one confounding measure is that we have what appears to be normal hip internal rotation on the left versus the right. So what we have here is a little bit of a right-hand turn. If we go through space-time, we're going to go through our archetype and anterior orientation, and there's going to be a little bit of a left rotation here, like so. And what that's going to do is it's going to point the acetabulum down and forward, and that's where you actually recapture some of that internal rotation. Now, where this is actually coming from is we've got a twist that's up here right above the pelvis. The way we know this is because if we had a left turn of the lumbar spine and we had a sacral base that could yield back on the left-hand side, our hip flexion measures and our straight leg measures would go up, even if we did have this posterior compression, because what we would do is we would get a rollback on the measure as they're laying on the table, which would magnify the hip flexion and straight leg measures. Since we don't have that magnification, we know that we've got this compression and a turn to the right. We also know that we have traditional extensions pushing forward on both sides because we've got the anterior orientation on both sides, but it's just biased a little bit towards the left. And again, that's why we pick up this hip internal rotation. Another thing to remember is that if I've got this scenario in the lumbar spine and the pelvis, I'm going to have the same scenario in the upper thorax and the lower cervical spine. So often this might be why you're seeing left-sided neck pain and left-sided low back pain. Now, we can't say exactly why, but that might be it. So you're going to want to pay attention to left shoulder flexion. As you recover left shoulder flexion, it's also going to be indicative of the fact that you're reducing the right rotation that you've created through the lumbar spine and the pelvis because you're bringing it back in the upper thorax and the lower cervical spine at the same time.

But now you need to add to this model and say, OK, if I compress this now, what happens with understanding a little bit more about what the options actually are within a little bit more of a realistic model? We're never going to see reality. We always have to use a model because this is a really, really complex concept. When we talk about movement. And so hopefully that answers a little bit of your question. I apologize I had to rush today, but I got a lot of stuff going on this morning. You guys have a great Wednesday.

Have an outstanding Wednesday, and I will see you guys at the Coffee and Coaches call tomorrow morning. Good morning, happy Thursday. I have neural coffee in hand and it is perfect.

So that might require some manual therapy. We need sternal movement because if you're missing internal rotation, you don't have pump handle movement in the anterior thorax, so we need to recapture that. Clavicles are going to be limited in their ability to rotate. When you've got to get the ribs to move more effectively, you're going to have to decompress the scapula from the dorsal rostral space. So that's a manual technique, by the way. I have a video of that on YouTube. I also have one for the scapular elevation. So look at those two. And again, if you don't do manual therapies, get somebody that can apply those techniques. You may have to have somebody that's good with their hands to help reduce some of the concentric orientation as well. Basically, you've got a guy that's really, really compressed, and you've got to get a whole bunch of expansion here to restore his ability to move freely through space. From a rehab exercise standpoint, I've got a couple videos on YouTube specifically for dorsal rostral expansion. So there's a seated variation, and then there's a better band pull apart video that is also really effective for dorsal rostral expansion, one seated, one standing. You can immediately go to some sort of high oblique sit activity, which is going to help start to reshape the thorax a little bit and get some of that anterior-posterior expansion. And as you can move into a lower obliques type of an activity, which would be closer to what looks like a side plank variation, you'll start to get some pump handle activity from that. You can do supine cross-connect, so they should be in a non-provocative position based on the upper extremity, and then a sideline propulsive activity will also be helpful. Again, sideline is a great way, especially for these wide people, to get some of that anterior-posterior expansion because we're taking advantage of gravity. Once you can capture 90 degrees of shoulder flexion without pain, supine arm bars are now on the table. You can throw in a screwdriver on top of that to promote some internal rotation and then you can eventually move to a prone propulsive activity, which is going to get you a ton of that posterior expansion and yielding strategy that your client is lacking. If you want to take them into the gym, we've got suitcase carries that are probably on the table right now. Eventually, you can play and turn it into a farmer carry, so we can get some ER and IR out of that. Backward sled drags with two handles to promote the uni-lateral strategy posteriorly, so you get some expansion, you get some pump handle action, and you're also going to get some hip mobility out of that as well. High-rep tricep push-downs with a band also are going to keep you close to that transition between internal and external rotation and give you some of the yielding strategy posteriorly in that dorsal rostral space. Again, you're going to need that. So dumbbell curl variations; there's a bunch of videos on my YouTube channel for that that you can also use to help keep that dorsal rostral space expanded. The key element with any of the resistive activities that I've just mentioned is that you can breathe through it. The minute you have a breath-holding strategy under any circumstance during these activities, you are promoting the limitation that you are trying to alleviate.

So when we talk about posterior lower, we're looking at the inferior angle of the scapula down to about T10, because that's where the bottom of the lung actually rests in most circumstances. If we talk about the same representation in the pelvis, we're talking about the lower aspect of the sacrum and the coccyx. That's how far down we're talking about now. The cool thing here is we can use my archetypes to represent the two extremes of a hinge versus a squat because we do have a bias by structure that's going to help us identify this representation. So if we talk about someone that is a wide infrastructural angle, their bias is going to be towards an exhalation strategy by design. With the wide ISA, we're going to see much less expansion in the upper thorax. So dorsal rostrum is going to be biased towards an exhalation strategy, and the sternum is going to be biased towards an exhalation strategy. But because of the shape of the diaphragm as it descends in a wide ISA, we're going to see this posterior lower expansion as a compensatory strategy. So we're biased towards an exhalation strategy, which would nutate the sacrum and the coccyx together. As I move into this hinging pattern, that's what I'm going to see. We can't just talk about the sacrum; we also have to talk about this posterior lower aspect. If I perform an effective hinge, then I'm going to see the eccentric orientation of this posterior lower glute max. We're just going to allow this full nutation to occur. So it's not just the sacrum; we also have to talk about the coccyx. I do have more of a compressive strategy at the base of the sacrum, and I do have expansion posterior lower. If I go to my narrow archetype, then we're going to reverse gear. So now I'm going to be biased towards AP expansion, with a little bit more compression, which is what we're going to see in the pelvis from a squatting perspective. So we're going to be biased more towards counter-nutation here, which is my inhalation bias, with the base of the sacrum going back.

I might be orienting my pelvis to such a degree that now I get focal load in the facet joints of the lumbar spine. So once again, all we're trying to do is acquire a position that allows us to apply sufficient force to hold our positions and allow us to move through space. So if we understand that this is the issue, then what is the solution? So this is why we talk about the importance of normalizing breathing, because what normalizing breathing represents is our ability to move through full excursions of internal and external rotation, which is representative of the relative motions of every segment of our body. And if we have that relative motion available to us, or we have sufficient adaptability available to us then we distribute the forces rather than creating these focal loads of impingement. So it'd be really nice if we had like this hip impingement cookbook or we had a low back impingement cookbook or we had a sub-occipital impingement cookbook But really it just goes back to understanding what these representations are. So this is why we're looking to measure internal and external rotations. This is why we're looking to identify where the compressive strategies are. They're always exhalation strategies. We identify where these compression strategies are that are limiting our ability to recapture the relative motion. So the solution at the bottom line is we have to normalize breathing to whatever degree that we need to to acquire sufficient adaptability in the system to distribute forces rather than creating these focal loads. So once again, this is going to be an n equals one situation. And in many cases, there are similarities certainly between my wide and my narrow archetypes. But in general, the rules are the same. We're trying to acquire a substitution for the lack of relative motion, typically trying to utilize an internal rotation strategy, exhalation based strategy and compressive based strategy that is creating the focal load.

Okay, we've talked about this before, but it's worth going over again. Some of these things get really confusing, and then we've got layers of competitive strategy to talk about. So if we're going to talk about a wide ISA, so we've got a wide IPA to go with it, we've got a mutation to the sacrum, so we've got an expansion to this posterior lower aspect. So under these circumstances, this would antivert the acetabulum, which would give us plenty of IR. However, because of the expansion posteriorly, we've got a center of gravity issue that's going to knock me backwards. And so my first strategy from our wide ISA is to create that compressive strategy near the base of the syndrome. So I'm going to push the top of the pelvis forward, which is going to take me in that direction. And so now I have a center of gravity issue that's going to push me forward. So I will compress from the front side under those circumstances. So I'll compress the front side of the pelvis. I get a shape change in the SEM which picks up the external rotation concentric orientation and so right away I start to lose my IR capabilities. Now very very late in these compensatory strategies I got to think about post-year lower so when this initiates its concentric orientation very very late where I'm going to bring the sacrum I'm going to bend that sacrum underneath. That will also pick up some of that ER concerted orientation at least initially until we get another shape change in the pelvis. And so late in the compensatory strategy, I'm going to lose some IR under those circumstances. So there's a couple of ways that we can influence this. And it just depends on how far and how deep into these compensatory strategies we actually are. But again, another really good question.