When we're talking about the movement of the shoulder, I know we've talked about shoulder flexion. It goes from ER to IR to ER again. Does that same pattern hold when you're moving laterally? Like when you're raising your arm like this way? Like are you starting from ER to IR to ER again?

Now if I take a breath in here, I get pure dorsal rostral expansion. So that gives me the sensation. Now I can take that sensation and just carry it over to any other activity where I'm also trying to achieve that dorsal rostral expansion. So give that a try. If you're doing some kind of band pull apart activity thinking that you can alleviate your shoulder pain with bench pressing, you might want to think again. The band pull apart actually compresses the space between the shoulder blades that steals the range of motion in your shoulder that might be causing the pain in the first place. Instead, try this. Take a short band around your wrist like so. Put your forearms against the wall, keep your elbows below shoulder level. Take a little baby squat, tuck your hips under, push back to expand the space between your shoulder blades, and then pull your hands apart. You're gonna feel a little bit of burn on the back of the shoulder, but you're also gonna get that expansion in the upper back that's gonna restore the shoulder range of motion that bench press is stealing.

You know, some of my clients in the past have recovered pretty quickly and haven't had too many pelvic floor issues afterwards and others have had really bad issues after. So I'm curious if maybe creating like a yielding strategy on the pelvic floor to accommodate all of that upward pressure might give some women more of a tougher time to recapture that overcoming strategy post delivery.

So Bill, real quick, just to summarize from my understanding for not only athletes, but if you're in general trying to increase force production for whether it be like golf or shot put or anything, the idea is you would like to create more external rotation for the ability to create force. However, if you don't have that capacity, you're not going to be able to.

My question is, so as I see it, we could do a lot of things right with a client and restore a lot of movement variability, get the system to be more adaptable and all of that. But if they leave the training room and they start walking poorly with a bad gait pattern, then it'll essentially reverse those adaptations or it'll at least cause negative interference. So my question is, do we just assume that once we've restored movement variability to the system that they're going to walk better, or should we actually teach our clients how to walk if there's a significant problem with their movement variability?

That's where I can actually access it. As I descend farther into the squat, I'm going through a space where I have to increase the amount of internal rotation. The pelvis actually changes shape to get through that middle range. It moves towards what would look like an exhaled position of the pelvis. So the inhaled position of the pelvis is at the top—that's an external rotation bias. As I go through the middle range, I have to capture an exhaled bias, which is internal rotation. So the pelvis changes shape and the femur could maintain its position. But the overall representation of the pelvis and the femur at that point in time is internal rotation. As I descend farther, I have to re-expand and I have to go back towards my external rotation bias at the bottom of a squat. Now, how many times have you ever seen a perfect squat? Almost never, because most people can't assume the ideal shape to pass through those ranges and capture the full position because they don't have full adaptability. And a lot of that's just based on structure. So now we can go all the way back to what's your bias? Are you a wide ISA guy or a narrow ISA guy? That would bias you towards one end of the spectrum. So if I'm a narrow ISA guy, I'm really good at the top and the bottom of the squat. If I'm a wide ISA guy, I'm really good in that middle part of the squat, generally speaking.

That's why I'm here.

Yeah, it was an arm bar with your leg up. And I was wondering, can you explain why that works and the context of your model and whatnot? I mean, I can understand just locking out and having something there and rotating, but you had your leg up and you were breathing in a certain way. And so if you could go into that, that'd be great.

Where he goes back?

Going off that, if the goal is to get movement, you know, from narrow to wide or wide to narrow. And let's say you get that change. I'm assuming if it does change, and you can get movement, the longer that change lasts, the better. And with that assumption, do you find anything particularly helpful with having a longer change?

What would be kind of like your litmus test? Would it be the ability or like what would be your kind of KPI? Would it be the ability to get down below parallel and hold it or would it be a? I would want to be able to, I need them to get as low as possible without the posterior orientation. So, here's what we don't want to see. We don't want the pelvis and the lumbar spine to move as a single segment in a posterior orientation. So you don't want that lumbar flexion moment. Okay. You got to be able to identify the difference between the posterior orientation with the lumbar spine inflection versus somebody that can deep squat into counter-neutation with the lumbar spine following as it normally would, right?

Let's take the heels elevated squat, for example. I see people use varying degrees of heel elevation. With a super aggressive heel elevation, you're almost blocked from getting into a deep position or from achieving inhalation at the pelvis. It's almost like a scenario where you're so inclined that you can't achieve passive central orientation. Can you comment and reflect on what might potentially be going on with a super high heel elevation?

Bill, can you go more into yielding and overcoming strategies and when you use one versus the other?

If they're shortening? Yes. In general, it would be towards compression. So, okay. So here's a little dirty secret. At the two ends of the extreme, it's compression on both ends. So when a muscle contracts, okay. So just use your biceps as an example. Okay. So if I bend my elbow, I contract my biceps right and it compresses and it gets firm, it gets smaller like it's squeezed into that space right and then as I extend my elbow it expands. Right. And so it goes from the compressed state to its expanded state. But if I take it to the extreme stretch, it recompresses. But it's a different shape of compression that I had here. So this is compressed short and wide, right. Because I got big monster pythons for biceps. says a Joe grace got it. And then at this end, it's elongated. So it compresses long ways and it gets a little bit narrower and tubular. So there's compression at both ends. And this is how you produce tension, right? That's why you feel that at the end. Right? So the muscle itself compresses and expands. But when you're shortening, so if I'm moving towards concentric orientation of any kind, you're going to move towards a compressive strategy. The question mark is, where did you start? So if I started at the very end range, right. There might be a relative expansion as I alleviate that end range tension in the maximum eccentric orientation. There might be some measure of expansion, but again, in general, you're going to move towards compression. So you're correct.

Yeah.

In the outcome because that's the closest thing that I can probably get to truth and in reality So I see the same thing coming up over and over and over again Then I can I can start to reinforce that in my model to some degree But this is this is what science is so this is where we do the experiment so we experiment We see what happens. We experiment. We see what happens the more times you see the same thing arising So when I see that consistency that's those are the things that I start to intertwine and contribute to the evolution of the model. And then finally what I would say is remain patient. You've got time to evolve a model. But I say patience with a sense of urgency. So it's kind of like the duck on the pond. You know, you see the duck smoothly going across the water, but underneath he's kicking like crazy. And so always working, always trying to evolve, but understand that you need to be patient and let some of this evolution take place. That gives you a little bit of a framework as to how I see this whole model perspective. I try to recognize my limitations knowing full well that I am the greatest limitation on the evolution of how I model this complexity within the realm that I work or the world in general.

So you used a word that I really, really like. So the pelvis has an axis. The picture on the left is the pelvic axis, the green arrow. You see it? Take your head. Okay. And so that would be some measure of an in-between kind of a thing. Okay. And so you've got the, you've got the vertical pressures, you get the pelvic axis. And then if, if I, if I nutate the, the sacrum and I've exaggerated in the picture for effect here, you redirect the, the pelvic axis. So now that blue arrow becomes the new pelvic axis. Okay. So when, when you think about the outlet, So basically, you're reorienting the direction of the outlet. So if I move the, let's stop this, share for a second. So if I do that, right, you gotta look at where I actually created space. So the anterior outlet becomes concentrically oriented and will elevate. So it creates pressure upward, but I'm nutated there. And so I'm gonna follow the path of least resistance. Okay, and so under these circumstances, this is why you get hip flexion during certain types of exercises versus like a straight down descent. So what people would say would be like the difference between like an RDL and a squat, right? So the RDL is more nutated and that's why your behind moves backwards. because literally the guts are going to follow the path of least resistance. And so where the direction of the expansion is where you will move. Okay. Does that make sense? Yeah. Okay. Now, so you've also got the consideration that you've got the pelvic floor muscles are pushing upward at the same time. Okay. So you got what you got, pubo rectalis, pubic coccygis, is it ileococcygis? And opter. Anyway, so they're concentric and they're pushing up. And so while you have an element of expansion in that posterior aspect that's allowing the pelvis to move backwards, I also have pressure going upward. So the guts have to go somewhere. OK. If you're notated and under normal circumstances, that would be an exhalation. So I would be exhaling, I would be compressing, and then the guts would move up and forward. All right. If we're going to talk about like a compensatory strategy though, where like if you have somebody that has a wide infersternal angle and they're using a compensatory breathing strategy, they have a concentric thoracic diaphragm because of their breathing strategy, right? So they cheat to breathe in by pulling their diaphragm down into concentric orientation. So now I have concentric going up, I have concentric going down. Can you see it? Shoves everything forward. How about that? Yeah, exactly right. And it's a great way to express it because this is not a passive response. This is like, OK, I'm pushing down. I'm pushing up. I only have so much space to go down and back with. The rest has to push out the front.

No, it's water. I already drank two cups of coffee this size. I'm moving. I'm going.

Take a look. Oh, maybe a little guess. OK, why? Is it because of his dashing hairstyle? Yeah, exactly. So you see the neck, and you immediately go, wow, that neck goes on a really big, strong guy, right? OK. So literally, just by looking at someone, you made a judgment call, right? And you're probably right, right? Because again, the muscle mass kind of goes with the territory. But again, you just have to respect the fact that everybody's going to be a little bit different. And so they're going to process information a little bit differently, a little bit more slowly. In many cases, so if I have somebody that has what I perceive to be sort of one end of the movement spectrum capabilities, then I do everything slower. I might need to create a vocabulary for them because if they don't spend much time being aware of movement and I need to teach them how to do that, then that's where we get this difference between sort of like this internal, external queuing kind of a thing, right? because the internal cues are designed to provide a sensation that most people may not be able to acquire themselves. Why do you do manual therapy? Well, you do manual therapy to give them a sensation that they cannot acquire themselves, right? So again, we have lots of tools. So we have physical contact. We have verbal cues. We have movement-based activities. We have awareness. Drills and things like that that we would use and we use them all for everyone to varying degrees. Some people just need a much stronger influence in one of those than the other where you take a high level athlete And literally you just say, go over and do that. And they immediately know what to do. Like they just intuitively know what to do because their movement intelligence is so high. And then you take the guy that's been sitting behind a desk as an accountant for 25 years that can multiply three, four digit numbers in his head in 10 seconds. And we don't appreciate that, but we knock him for not being a great mover, right? Because that's what we do. And we have to approach that just a little bit differently. We have to respect what people are bringing to the table, so to speak, right? And again, it's just sometimes I got to go slow. Sometimes I can go fast. Sometimes I got to develop the movement in vocabulary so we can communicate because they don't know what we're talking about, right? And then don't ever And we all do this, but don't ever, don't ever belittle someone, even internally. Like when you're giving your best cues and everything, you think you just knocked into the park and they just go, what? Because they just don't have that understanding, right? So we just got to find a way to do that. And that is one of the levels of complexity of working with complex humans, right? We just have to figure out those ways to do that, right? So again, you just slow down and you just find a way. And one of the conversations that I have during the subjective is I always try to find out what people's background was when they were younger. So I say, what sports did you play in school? What was your favorite game? Or all that kind of stuff because that gives me an idea of a frame of reference. So if I get a guy that comes in And he goes, oh, I've done jiu jitsu for 25 years, right? And so now I have a frame of reference. So now when I'm teaching him a hip shift or something like that, or I'm trying to get him to feel something that's back, I go, now it's like, because when you lay them on their side, it feels like a hip escape and jiu jitsu to them. And so I say, now do your right hip escape. And they go, oh, so that's what, OK, now they know what it feels like. So you have to create a frame of reference. So again, you try to find that if you can. And then there's cases where everything just is like the uphill battle where, oh, yeah, I've never played a sport in my life. I've never really moved. I was a sickly kid. I had a lot of allergies. You're gonna have these scenarios that come up. You just, and again, I hate to default to this, but you just sort of find your way, right? But always respect what they're bringing to the table because they do have some, you know, probably specialized intelligence in some way, shape, or form. We just have to kind of figure out how we make that connection. So let's just talk about analogous structures for a second. So when you're looking at situations where you're looking for the analogous structure, you have to look at it from an embryological standpoint. So things that are derived from the same place, that's one possibility. The physical structures are the same. Right. The movement behaviors are the same. OK. And so, so when we look at, when we look at these things, that's how you identify analogous because they don't, they don't all look the same. And so that's what you're looking for. Right? So the point of confusion, when I say that there's five muscles in the glute max, I don't care what you call it. I'm just looking at it behaviorally. And it's like, where else? It does so many things, right? They just said, they just looked at it from a distance 2300 years ago. And the Greek guy looks at the other Greek guy and he goes, what do you want to call that? He goes, I don't know. It's a big one.

In most cases, it will be very difficult for somebody who is legitimately a wide interacetabular angle, so very horizontal acetabular angles, to create what you would consider any kind of posterior orientation of the pelvis. The amount of bending that would be required would be very, very difficult. But a lot of times you'll see these wide people and they will just be flat as a pancake across the backside, especially in the pelvis. And so it's not the sway that you would typically see with the pelvis with the narrow ISA because the orientation of the sacrum doesn't allow it. So I would have a nutated sacrum. And so to have what would look like the traditional sway back where you have the pelvis swayed underneath and they're almost standing in hip extension, you'd have to have a counter-nutated sacrum to acquire that kind of appearance. And so in most cases, they're pushed, like I describe it as, they're just pushed straight through between the two femurs. And so it becomes this really aggressive kind of internal rotation. So, if I'm starting wide like that, and then I compress that—this is, you see how the sacrum moves as a unit here, Matt? Under these hard compressive circumstances with the ISA, it does not orient as such. It literally just bends. So from here down, the sacrum bends underneath. And I have MRIs and functional MRIs that actually show this. And it's pretty hardcore. Like you get like a 90-degree angle bent through the sacrum. So again, there's a lot of compression here. And so where we'd have a narrow ISA, there would be counter-nutated and they look like they kind of just sway under like this. So these wide people kind of push straight through like that. Right. Okay. And so, how does a wide person get so externally rotated? This is how they just get so compressed posteriorly, they get pushed forward, and then what happens if you get this ER orientation all the way down to the ground? So these are the people that they're on the outside edge of their foot. There'll be an inverted calcaneus, they'll have an inverted look to their calcaneus, they may be bowed. And so all you gotta do is look at a really good powerlifter with a really strong sumo deadlift and you'll see kind of the same orientation. Yeah, she mentioned that he was pretty duck-footed like feet thrown out, and then—

I'm now becoming aware of new perspective changes. I think it's indicative that my assessment and the information I'm taking in and then integrating to form a goal or a conclusion needs to change because it's not sufficient at this point. And so I'm wondering now as your career has developed, what has it been like to have a significant change in perspective?

No, this happens. I don't know what else to say. So yeah, so what they did is they took the end game compensatory strategy and they built it. So they tightened up her rectus abdominis basically. So they pulled the pubis and the sternum closer together by accident. So typically, so picture this for a sec. When you have a diastasis recti, the abdominals are going to behave very much like a wide ISA. So the pregnancies will spread the diastasis, right? And chances are it was probably more cosmetic than anything else under most circumstances. But if you can get the finger measurement, are you familiar? where they take their fingers and they say, how many fingers wide is your diastasis? And if you get to like three, they go, ah, you may want to tighten that up. And so chances are that they pulled everything in and they pulled it down and in as they closed the diastasis, right? And so you took your wide person and then you pulled the sternum down at the same time. So they tried to close the ISA surgically, okay? And then they pulled it down. So you have to treat this person as such. You're going to have to slowly work them back out of it, and you're going to have to recap. So here's an interesting little twist of day. You're probably going to have to drive them into some form of old school traditional extension. OK. Getting flexion. with an exhalation. So what's going on is she cannot fill the upper ribcage right now at all. So she's getting pulled down, right? So her flexion is gonna be limited. And so that's probably gonna be your primary KPI as far as how you're gonna follow this, okay? But that's the goal. You're gonna have to get air up. Because she's not actively closing the ISA, which is a requirement for reflection. They created an AP compression. So she's getting squished and pulled down. She'll have some form of inversion in her program. Eventually, you're going to want to get her to hang maybe one arm at a time or something like that. to try to create the expansion upward, but again, monitoring her ability to close the ISN. But stuff like sideline becomes important for her, because you can expand one side. So you remember the slinky that I had in the purple room? So you're going to side bend her like a slinky from side to side.

Well, you have to be adaptable, right? That's a very adaptable thought.

I have a young patient currently a senior in high school. He's a lefty and he's got probably the largest cue angle I've ever seen. And he is sent to me status post UCL repair. And he's a narrow and I already know, even though he's still in a brace, I know that he's going to be pronation biased. So I wanted to ask Bill the mechanisms that create the UCL with a presentation like that.

Speed breeds efficiency. Yes. This is in reference to what?

I see that a lot too.

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 bit 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 will stop socializing, and well, actually we can continue to socialize as much as we want because we can do anything we want on this call. So if you got any questions, comments, gripes, complaints, fire away. Anything that you want to talk about, Nikki? I saw you were checking your notes.

Yeah.

So everybody's story is based on their perceptions, right? Nobody sees reality; they just see whatever their perceptions provide. So you need to establish rapport to find out what their story is. We do that through subjective questioning and so on to understand their thought process. Then you start there and work toward where you want to take them. They're at point A, you're at point B, and you've got to close the gap. The best way to do that is to move from their story to your story. People walk in with structural reductionist thought processes because that seems reasonable to most. We have a broader perspective influenced by other factors. You have to take them from their current mindset to your broader perspective. The best way to do that is to demonstrate change. People ask, how do you succeed with clients? Find a limitation you can influence. If there is one, influence it favorably and get them to recognize it. For instance, I had a CrossFit competitor in yesterday—top three in her age group, really good. But she couldn't turn to save her life. I had her do rotation interventions she could feel, then we retested. Right away, she smiled and said, 'Now I get it.' While doing the interventions, she was questioning it because she'd rather be lifting heavy or running with a weight vest. She's not used to gentle interventions. We shifted everything in one direction, making her loosey-goosey for the first time in a long time. She felt the difference. Now she's my friend and wants to know what else she can do.