It is a Thursday. Happy Thursday. I have neural coffee in hand. And it is perfect, even though Dr. Mike Roussel is not on the call this morning. But you have to consider that I can demonstrate this concept on top of a femur. Each of these twists and orientations affects what I measure on the table. You also have to appreciate that as I move them, their weight shifts on the table. So not only do I have movement that I'm creating in my perceived perfect measurement style, but I must also account for their movement underneath my measurements based on where their weight shifts. And again, that's something they don't teach us in school because when we learn how to measure in school, the patient is perfectly centered and we are moving exactly what we think we're moving. So we have to appreciate that there's a lot happening as we move. Now, regarding the case you just described, I had a patient who was very similar. She had one measurement showing 80 degrees of external rotation and then everything else was zero or negative. But it was only on one side. What you start to recognize is that this represents a significant orientation issue. It's the whole pelvis being tipped on an oblique axis, which creates extreme measurements like that. Whenever you're unsure about what you're seeing, take all your measurements into consideration. Identify what you think you're observing, then intervene, perform a correction, and remeasure. Often we don't figure these things out until after we act—we can say this was the initial presentation, here's what I did with the intention of correction, and here's what happened. Then you look back and understand, oh, she was tipped up like this, this was turned that way, and that was turned this way. Or you realize, as I was measuring, the pelvis was actually turning toward me, which skewed my measurements. This is difficult to grasp because it adds another layer of complexity when looking at and measuring things. It makes everything very gray instead of black and white. Another thing you can do is apply a manual technique to induce some form of sensation and see what happens. For example, if you have extreme external rotation but no internal rotation, what manual technique would you use to recapture internal rotation? Try it and observe the results. The patient I was working with had exactly that—80 degrees of right hip external rotation and minus 10 degrees for internal rotation. I simply mobilized her hip to recapture internal rotation, and wonderful things happened. That's acceptable because these things are complex. We don't always know exactly what our representation will be, and there's nothing wrong with experimenting in this situation. We only figure these things out in hindsight.

I am trying to become the master of simplification and so I am looking at everything from the perspective of what you need to be able to do. So from an athletic standpoint, I am just looking at what is actually where do I have to get these people to from an athletic standpoint, the game related stuff. So rather than looking at it from trying to affect one element of the energy systems as we would look at them, right? So they break it up into the three primary contributors. And I don't do that anymore. I just look at the exposure of intensity, duration, and all the factors that I can access to what an athlete may be exposed to. And I move them towards that with the full understanding that if I get a guy that comes in with a ridiculously high heart rate, like you sitting there with a resting heart rate at 75 or something like that, I know full well that he's not going to respond well to a higher intensity output right away or he will, and it will top out very, very quickly. So in those cases, you have to start farther away from where they're going to end up, because there probably is an element of adaptation in regards to the stuff that produces the energy. So I don't want to talk about mitochondria specifically, because I've never measured the number of mitochondria in anyone's muscle cells. So I really don't know. I do have that understanding that there will be enzymes that have to be produced. There is machinery that needs to be produced that may be supportive of that. There's also influences from a neural aspect that are in effect. If I do have somebody that comes in with a high resting heart rate, these are the things that I can't measure. So I have to look at this from the perspective of, okay, what do they actually need, and what do they present, and then how do I close that gap? So it's a lot like writing any other program. It's like, what is your foundational exposure? My assumption is that if somebody comes in with a high resting heart rate that they have not had any exposure to a long duration endurance type of program that would actually provide a foundation for me to build something upon. So if somebody comes in and they've been trained before, you got to teach them that one, you got to teach them to do exercises and then you have to establish one foundation of physical capacity that you can superimpose intensity upon. So it's the same rules. And so I don't change that. It's just the means would be the difference, right? Whereas somebody comes in for strength training, obviously we're going to do something that's going to get more resistance whereas somebody comes in for an endurance-based thing, obviously it's a lower intensity of output per unit of time. And so your means are different. So then we drift towards something that is less discrete of a task and more of a continuous activity. So again, that would be my perspective, whereas probably back, what, 13 years ago, I was probably thinking that, oh, I'm affecting this. Whereas I have that understanding, like I have an understanding of the energy systems, but the reality is it's like, I have no idea when you're doing using one or the other at any moment in time. And if I can't tell that, then why should I worry about it in regards to how I'm writing the program? What I want is an outcome. And so I use the same structure that I would in the purple room within a session. So within a session, I test something, I intervene, and then I retest to make sure that I'm on the right track. So with an endurance-based program or a conditioning program, I test, I intervene based on those tests, right? I structure the workout, and then I can't do it as acutely as I do in the purple room because the changes might take a little longer. Again, because if machinery has to be constructed and adaptations have to be promoted, that might take a couple of weeks to even notice any difference. And so my testing is spaced out a little more, but it's literally the same process because I can't project 12 weeks out what the outcome is going to be. But I can make sure that I'm on track to get you to where I think you need to be. So I just have to have a beginning point and an end point and close the gaps just like I do with any other aspect of the program. I don't look at it any differently than anything else that I do.

I love it.

So I think that you're just going to make sure that he's exposed to a number of different environments and let him adapt. That's what we do. Like the worst thing you could do under those circumstances is to try to restrict his behaviors. We want to provide exposures of behaviors. Kids figure it out. And there are concerns like, oh, is this normal? Yeah, absolutely. It's normal. It's like they just found a strategy that worked and they're going to play with that for a while and then they're going to do something else. So it's not like there's something wrong with them. It's just a matter of like this is how he figured it out for right now. And the thing that you want to recognize is just expose him to a number of different environments so if you take him outside and you're like crawling around in the grass he's going to be in a totally different position and that's what we're shooting for. We just want lots of exposure.

Well, speaking of belief systems, I know we've talked about this before for sure. And we don't really control someone else's belief system, but we certainly do have the potential to influence it to a degree. I mean, what would be some of the ways that we would be able to more usefully influence that to where, you know, we can create some progress or what we would perceive as progress for them.

I don't know if there's such a thing per se. But this brings up a really interesting point as to what high blood pressure really is. Okay, so if we think about the circulation having two sides, right, you have the output side and the input side, okay, to make it simple. All of the fluid shifting that goes on, that's associated with circulation is based on gradients. It's just like we talk about with range of motion and things like that, and we talk about gradients of pressure and volume. So on the front side, so as the blood leaves the heart, the gradients are such that the fluid shift is away from circulation. So it's moving stuff into the cells. On the backside, the byproducts of cellular metabolism are coming back into circulation. So any ions, hydrogen ions, chloride, et cetera, et cetera, increases the concentration of the blood flow coming back into the heart. And then that increases the fluid volume coming back into the heart. The larger the ion concentration, the more fluid that comes back towards the heart, right? So that means I have more fluid coming back into the heart. So what the heart does is it doesn't actually create the pressure that manages the flow of blood because blood flows all by itself, okay? What the heart does is make sure that the flow gets vortex. So the heart actually spins. It doesn't pump. It spins blood to make sure that it's a non-turbulant flow that enters and leaves the heart. So if you were deconditioned, as it were, as the people that tend to get high blood pressure are, they will produce more ions. They will have a larger volume of fluid returning to the heart that the heart has to manage. And so that's why you're going to see higher resting heart rates with people that are deconditioned. But you'll also see higher pressures because it's a back pressure coming from the backside. So the fluid that's going back to the heart after cellulose metabolism creates the resistance, if it were, Okay. And so that's my spiel. And so if you become more aerobically conditioned, you don't produce the strong ion concentration that's associated with cellular metabolism like people that are deconditioned. And therefore you have a greater likelihood of lower blood blood pressure. Now, having said all that, I'm sure there are things that I don't understand that I don't know that can actually increase blood pressure. But when we're talking about the conditioning effect, that's where my head would be.

So early, mid, late?

There's no schedule plan.

Yeah, absolutely. So with the heavy question first, I'm not used to this. I'm used to talking about like, you know, casual things. Like what kind of thoughts are you having tonight? Exactly. I'm having the best salsa. It's actually indoors. I get to go in and everything. Okay. So, yielding and overcoming are descriptions of how the forces are distributed beyond the muscle fibers. So it goes into the rest of the stuff. So the rest of the stuff would be connective tissues. So here's what I want you to think about. I want you to think about a trampoline. And so you're going on trampoline? Okay, good. Okay. This is awesome then. So when the trampoline is all set up and it's got the springs that attach it to the frame, right? Okay. And then you have the center part, which is what you bounce on, right? So what I want you to do is fix the size of the thing that you're bouncing on. So the surface that you actually bounce on on the trampoline is fixed. Okay. What we're going to do is manipulate the tension on the springs. Okay, so if I loosen the springs and I get on the trampoline and the trampoline gives way, that's yielding. Okay. If I tension up those springs and make them really, really, really tight, so now the surface is more taut, but the surface is exactly the same as it was when it was loose. Now when I get on the surface, there's not as much give, right? And because the springs are stiffer, then more of that tension actually goes into the frame and into the ground, okay? That's overcoming, right? Now I want you to stand on the trampoline when it's yielding, so on the loose springs, okay? The trampoline's not gonna change size, but I'm gonna tension the springs while you're standing on it. And so you're actually gonna go up, you feel that, you understand? Okay. So you just went from a yielding action to an overcoming action, okay? The way that this happens inside of us is based on the rate of loading associated with the activity. The slower the rate of loading, the more yielding you'll have. So the tissues that approximate the musculature that's doing the work will basically elongate. And that creates a dampening effect, right? So let me give you an example of that. Have you ever done a box jump? Okay. So if you jump off of a box and you come down and you land and you absorb the landing so you're really quiet, but you feel that you lower your center of gravity and it takes time for you to come to a halt, okay? All right, that would be a representation of yielding in a dynamic activity, okay? If you land and you land hard at the very end of the jump, so instead of absorbing it gradually, you go, okay, really hard, overcome. There's a yielding moment. There's always a yielding and overcoming that happen at the same time. I need you to understand that. It's just a bias. So we're doing this to varying degrees. There's a gradient of activity here that we're talking about. And so that is the representation of what yielding and overcoming is. So we're talking about cutting. As I said, I'm dynamically moving, I'm doing whatever I'm doing, whether I'm doing a drill, I'm playing sports and I'm going to go cut off my right foot, okay. So I reach out with my right foot. Okay. It touches the ground and then everything moves in that direction. Okay. And so unless I want to hit a big hard jolt, I got to be yielding. Get it? Okay. So initially I'm yielding, but I'm also decelerating. Okay. I'm also changing joint angles. So I have muscles that are changing links and then I have connective tissues that are absorbing force. The rate at which I absorb that force determines whether the tissues are really, really stiff overcoming or whether they're softer in yielding. So you see how there's a combination of things, but we tend to just represent the description by the bias, okay? So where you're gonna see the biggest overcoming element is at the, like right at the turnaround. You get it? So I move into it. I'm yield, yield, yield. Less yield, more overcome. Less yield, more overcome. Yes, less yield, more overcome. Boom, overcome going in the other direction. Get it? But this is happening all the time, just varying degrees. And so the stiffness of tissues behave differently under those circumstances based on the rate, the rate at which they're loaded.

As always.

Our gym offers both boxing and strict conditioning, among other services. We have mostly dropped group classes and transitioned to one-on-one sessions to accommodate space. Our facility is 10,000 square feet, which is quite large. This change was primarily due to having many youth clients. They actually want to train more frequently, but we are limiting access at this point. Additionally, if people are present to work out, we require masks and implement extra cleaning protocols beyond our normal standards.

It's coming back for Halloween now. Oh, yeah? I'm going full dodgeball. Just in terms of from a conceptual standpoint, in terms of building out my model as a coach, something that I struggle to do. In application, it's fine. Once I've got the context of an individual, it becomes so much easier to kind of explain and conceptualize and talk about my model when I've got an individual with whom to apply it to. What I really struggle to do is to do that when I don't have the context of an individual with which to apply it to. And I'm also finding that when I run up against something that I haven't come across before, obviously my model, I'm reaching the boundaries of my model and the limitations of it. What have you found most useful in terms of, because I'm super visual, so I really like graphical representations of things. I'd just be interested to know what your experience have been in terms of developing those models and if you've found anything useful in terms of graphical representations of them.

Oh yeah. The problem was all right, but the backside was pretty ugly. It was pretty rough. It was a mess.

If you're working with, say, a basketball player, there are going to be elements of context that you know there are going to be positions and activities that he's going to need to be able to access. And so everything becomes graded exposure at some point in time. Everything's multifactorial, right? When you look at an outcome, whether we're looking at changing body composition or raising some performance level, right? It is good to have that foundation so you have some sort of mental reasoning behind why you're going to do something.

Concept Two makes the rower, skier, and now a bike. They run challenges throughout the year. In April, they had the April Fools Challenge, aptly named, where on April 1st you row 1,000 meters, April 2nd you row 2,000 meters, April 3rd 3,000 meters, and so on through April 15th with 15,000 meters. I actually got my kids to do it. Three of my kids participated, and my youngest, who is five, did scaled-down versions of 100 meters, 200 meters, 300 meters. Then they challenged me to do double. So I would row 1,000 meters and then ski 1,000 meters. It was manageable until around day five, and days 10 through 15 were particularly difficult. I typically had to do it after the kids went to bed, starting around 8:30 PM. I would ski 12,000 meters and then row the remaining distance. Yesterday was day 15, completing 15,000 meters on the erg and 15,000 meters on the skier. I am not rowing today.

So putting the ball between the knees and a band around the knees just increases the complexity of the activity and it may be totally unnecessary. Now, if your goal was to increase concentric orientation of the pelvic diaphragm through that middle range of the squat, there are definitely better solutions than using a heel's elevated version, which is biased towards the inhalation. So what I would do then under those circumstances would probably use some sort of box squat variation that would create the constraint of stopping the squat at a certain point so I don't get too much eccentric orientation of the pelvic diaphragm. I can use a much stronger exhalation strategy and create that upward movement off the box with the impulse of a concentrically oriented pelvic diaphragm. So I like the way you're thinking on that. I just don't think you need to add that kind of a complexity to the squat pattern. I think there's enough things that we try to think about and we tend to create a lot of complexity in a lot of these exercises anyway. But like I said, I do appreciate your thinking.

So what we have to do with going into and out of the cut is make sure that we know what direction those internal forces are going, and then we have to be able to redirect them. And so that's the big challenge of getting into and out of the cut. And so the internal and external rotation representations are the same going into and out of. So one is not external rotation, one is not internal rotation.

So again, I don't think I've worried so much about whether we would brand somebody in this situation as a wide or a narrow. I would just probably measure, make my best estimate, intervene and see what happens. So that wraps up this week's Q&A. So enjoy the rest of your neuro coffee. I will enjoy mine. We got a bunch of questions that are left there from this week's Q&A, so I'll probably spread those out during the week. Also, of note, got a bunch of applications for the intensive. So we had a record number of applications within less than 48 hours, so I had to shut it down because I'm already overwhelmed with the number of applications. Normally it takes about a week to get even close to this many and we did it in 48 hours. I appreciate your interest in the intensive. For those of you that don't get selected from this round, keep trying. I can only take eight at a time to keep this thing as powerful as it is. So again, I appreciate your interest. Keep watching the videos, keep commenting and keep asking questions. Ask Bill Hartman at gmail.com and I'll answer as many of those as I can.

For instance, with the toe touch, typically what you would need for a toe touch is the ability to inhale posteriorly where you can get a counter-irritation to the sacrum to allow you to touch your toes. However, there are many people that have compensatory strategies that allow them to touch their toes without counter-rotation. The same thing applies to the squat. There are many variations of a squat that you may actually be able to squat below parallel but you don't have full counter-rotation. So I prefer asymmetrical tests as representation with the two simplest being the back-to-wall flexion and the single knee-to-chest, because as I inhale on one side I have to exhale on the other. Therefore, you could use those strategies as your self-test to determine what your movement capabilities need to be.

So again, I would encourage you not to think of anything in isolation short of something that's very, very clinical that maybe needs to be done to allow us a window of opportunity to do something that's a little bit more global and integrated. So again, thank you for that question, Nick. That was pretty awesome.

Right. And again, that's indicative of somebody that literally is not expanding or compressing. They're sort of in this middle ground superficial strategy, not allowing the axial skeleton to behave normally.

And Wolf Run is at the extreme northwest.

So what you need to do then is you have to create a position and use a strategy that will take all of that concentric orientation on the backside of the body and eccentrically oriented. So again, you might have to eliminate gravity, so maybe we have to lay somebody on their back or we have to lay them on their side and allow them to capture that eccentric orientation because when they move against gravity, they tend to be biased towards this compressive, exhaled concentric strategy. There's any number of exercises that can do that. Something as simple as putting yourself in prone in what approximates a fetal position and then driving respiration in that position promotes expansion on the posterior aspect of the body. So something that could be that simple. It could be a heel's elevated goblet squat could do that for you. There's any number. We do forwards and backwards rolls as an element of this to restore those eccentric capabilities on the posterior side of the body. so there's any number of activities that you could use it depends on the environment that you work in it depends on the individual that you're working with you know so if you had somebody that was you know uh worked behind a desk for 40 years and was non-athletic and a non-exerciser you might have to use a totally different strategy than someone that is an athlete that's trying to to recapture this eccentric orientation so whereas one might be very very active and we take them over to an area and it looks like a fourth grade gym class with a lot of rolling pattern and such versus somebody that might be on their back on a table and trying to recapture this eccentric orientation. So again for me to give you an absolute as to what would be the first exercise it depends on the person and so you have to take that into consideration. The thing that we don't want to do that I encourage people not to do is don't turn people that are active and athletic into rehab clients. There's been a lot of influence of dragging rehab into the performance realm and it does not need to happen. They are two different environments and should be treated as such.

Everybody wants to feel like they can train and kick their own ass every once in while, right?

Yeah.

Okay. So at high speed. It's a velocity based problem, right? Yes. Okay. So as long as she can capture it, awesome. She's capturing it against gravity, awesome. So your progression is the exposure to the forces that she has to capture the internal rotation within. So the problem is not the ability to access the position. The problem is to be able to access the position in real time at speed in context.

I'd be cool with that.

We're talking about the left side, right?

There you go. So how many exercises can we come up with that utilize this relative position? That's all you got to do. So is there more weight on your left side than your right side? Yes. Absolutely. There has to be because I have to unweight the right side to make it go up, don't I? Uh huh. Okay. Is your right leg straight and pushing you from right to left and posterior to anterior? Yes, it's the late E.R. actually in the right. That is exactly right. That's what you're trying to achieve when you're trying to bring somebody up from that lowered center of gravity, for sure. Don't you have to E.R.?

Right.