I have about two hours or so, a little over two. So here's how you break this down.

So let's get a general idea of what we're talking about. The average human being can probably get airborne for about half a second. Those athletes we see on TV that do amazing things can do that for a lot longer. For instance, I believe it was Michael Jordan who was around 0.92 seconds. That's almost twice as long as the average human being, which again makes them stellar at what they do. So not only do we have to be able to get these guts airborne, but we've also got a timing issue to execute this because if we don't observe the time constraint, we can't take advantage of the energy storage and release element of this and therefore we're not going to get off the ground. If we go too fast in our descent, we don't give ourselves enough time to yield. The connective tissues will behave too stiff, we get less energy in the yielding action, we have less energy storage, and therefore less energy release, and the jump is lower. If we go too slow or we take too long of a duration, the yielding action is actually going to get dampened; we release the energy at the bottom of the jump. And then once again, we can't jump very high. There is an element of skill here, but we can actually train this in the training hall to a certain degree. Let's look at the narrow ISA archetype and see what they're not so good at under these circumstances. Number one, we've got an eccentric orientation bias of the anterior pelvic outlet, which means that we're going to be better at going downward, so better at descending than actually stopping and ascending. We have a tendency to prolong the descent and we get that dampening effect. You'll often see in the descent that you'll see internal rotation of the hips as the knees sort of approximate. You'll see increased knee flexion under these circumstances because we've got the center of gravity somewhat forward due to the descent of the anterior outlet. And so they're also going to bring their knees inward in an attempt to try to stop that descent. When they pull in like that, they're trying to actually pull the anterior outlet open and concentrically orient it. But again, structurally, not quite as good. So we have a problems list here that we want to attack. Strategy number one is to control the outlet. I think you're already on point with this, Ryan, by using the box squat. The box squat creates a constraint that prevents the anterior outlet from descending farther. We can also sit back onto the box, which gives us a little bit of a mechanical advantage in regards to unloading some of the anterior outlet so we can actually capture some of that concentric orientation.

So if you've been living under a rock, a vasalva maneuver is an exhalation against the closed glottis. So if you've ever lifted anything heavy and you made a little grunting noise that prior to the grunt, which is the release of air, you did a vasalva maneuver. Under those circumstances, if you look at the research and they talk about percentages of 1RMs, if you're a practiced lifter of any kind, you can actually inhibit the vasalva maneuver up to about give or take 80% of your 1rm. At about 80% it's going to become automatic and you're going to need it because at some point in time you're going to have to reduce the relative motions to produce enough force to complete a lift under those circumstances. The thing that we want to recognize is it's not always going to be under these maximal effort conditions for most people. There's going to be a threshold that's idiosyncratic to that individual where they're going to need a higher force output and therefore they will automatically hold their breath. Let me give you a strange for instance, so my dad would have this noise, this mighty yelp that he would give as he was getting out of his recliner. Number one, it was to announce the fact that he was actually getting up to leave the room. But number two, it was because the effort that was required for him to get out of the chair required that much of an exhalation strategy to produce the forces to get out of the chair. So when we talk about the sticking point, we're talking about this high pressure situation that we need to produce. So when we're going to see these visalvis show up, it's going to be there's going to be a joint position where they're going to they're going to typically show up. So it's going to typically going to be in these these internally rotated biased positions. So if you think about as we talked about the sticking point at about 90 degrees of hip and knee flexion plus or minus 30, there's going to show up in these ranges. So anytime you have to produce a high force under these circumstances, again, an IR bias, we're going to see this high internal pressure, number one, be required, but it's probably not going to be easy to inhibit it under those circumstances.

But if we have this prolonged compressive strategy, then we're probably going to see this tendon change. If you look at the research and you look at the tendon itself where there is this degenerative change, you're going to see this proliferation of the proteoglycan content and water content around that area. So what that means is that the collagen is increasing around it, the water content increases, and this actually creates a compressive strategy. So it stands to reason that our solution is going to be restoring some measure of expansion. And so what we want to look at then is like, well, what is the situation that's creating this? You mentioned two-foot types in your question, one that's really close to max propulsion and then one that's in really late. And so you think that, well, we've got two-foot types. How can this possibly be? What we want to look at is, what is the commonality between the two here? And under these circumstances, what we're going to find in most situations is that in both situations, we're going to have an overcoming action in the connective tissue. So what we have are connective tissues that are loaded at a higher rate, and therefore they're going to behave in a certain way. And so we think about like a court athlete that's going to live really, really close to max propulsion or going to have people that are pushed all the way forward into this late, late propulsive strategy. And so their center of gravity is going to be shifted forward. And if we look at a couple of representations of this, we can actually see the difference in the appearance of the achilles. So if I have somebody that's got a center of gravity that shifted way, way forward, my expectation would be that it's going to be like the silly putty example where I'm going to have a lot of tension on that achilles. And so if I pull it long, it's going to appear a little bit thinner than the side that would be less loaded in this anterior center of gravity. And sure enough, we do see these things arise. And so we can actually see the difference. If you're not sure, I got a little before and after here, actually it's probably right there, that you can see this is the same person and you can see the before and the after. You can actually see the entire orientation of lower extremity change. You can see the foot change, especially if you look at the calcaneus where in the early stages you can see it looks like they're trying to lift that calcaneus off the ground because you can see the roundness of it where it doesn't have the pressure through the calcaneus and then later on as we recaptured this posterior orientation and able to hold the center of gravity back, we get more loading through the calcaneus, and then we get that sort of restoration of the shape of the tendon here.

So what we want to think about then is once we can capture the expansion, once we can capture the ability to turn, is that we're going to just bring people up from the ground and then that's how we can sort of progress the programming. Now the one constraint that we have, again, to our advantage is as we have the floor available to us and so the floor is actually going to provide us an element of a compressive strategy which allows us to shape change without having to promote more active strategy so that is one consistent constraint and we're going to take advantage of that and so assuming normal movement capabilities Most of our rolling is going to be initiated similarly. So we have to have a shape change to initiate the roll. And it's actually going to look like we're going to roll in the opposite direction when we first create the shape change. But because we don't have active muscle compression on the one side, we're actually going to fall in the direction that we're going to roll. So that gives us a little bit of an advantage there. where things get really interesting is when we start them to get over towards the side. And so this is where we're going to see the differentiation between initiating with the upper extremity versus initiating with the lower extremity. So the simplest way to look at this is, again, we look at this as a gate pattern. So if we have a lower extremity lead, this is going to move us towards early propulsion because what we're going to do is we're going to create a yielding action on the upside posterior aspect of the axial skeleton. So we're creating a delay in the axial skeleton. So again, so if you look at the photo here, we got a left posterior expansion and we're going to lead ourselves from an externally rotated orientation into an internally rotated orientation towards maximum propulsion. So if I'm lacking Propulsion or internal rotation, then I'm probably going to initiate the rolling activities with my lower extremity lead. Again, I'm trying to create the delay strategy on this upside. Obviously, I'm creating an overcoming action on the downside, so don't forget about that. Now, if I'm going to go with an upper extremity lead, now we're talking about a late propulsive strategy. So what we're creating here is an overcoming action to advance one side of the axial skeleton forward. And so if I'm moving from say maximum propulsion, from interrotation to extrotation, then this is going to be the strategy that I'm going to use because I'm lacking the ability to move through this middle through the max propulsive actions to get to the end so I can get to late, late propulsion.

from the ground up where they learned how to stand they didn't stand and then squat and then stand back up they actually moved into a squat and then stood up so we want to look at the push up from the same perspective that the bottom position is actually going to be the start and so if we look at the upper extremity relative to the hand what we're going to see is that we're going to be in an early phase of propulsion this is going to be towards an external rotation bias if we move towards the top we're going to move towards middle propulsion but we're never going going to quite get there and so we're always carrying a little bit of this er bias with it even as the force production increases we need to hang on to extra rotation so malty your intention of maintaining this er queuing throughout the pushup is actually quite accurate we need to be able to hang on to that which means we're going to need some posterior expansion throughout because we're never really going to make it through towards that middle to max propulsive position through the upper extremity if we look at the shoulder girdle itself the shoulder girdle is going to maintain that your bias throughout and so the thing that we always want to remember is that this internal rotation is superimposed upon the field of external rotation but let's be clear here that this is not an arc is it a four dimensional space that actually changes shape depending on what position you're in and then the compression and expansion strategies that you're going to utilize because we're going to show a massive ir bias here at the end of this little talk where we actually take away a ton of the extra rotation if we move down to the hand we can look at the hand as it moves through higher force production very much like we do a foot so let me grab the foot real quick and so if we think about like an early propulsive foot we have this externally rotated tibia we've got an arch in the foot and then as the tibia translates forward we have this drop of the arch now if I started in an early propulsive strategy here and I move towards this middle but I don't quite get there you'll see that the arch does drop down to a small degree as the tibia starts to internally rotate and we're going to see the exact same thing going through the hand but because we're not going to reach max p we're not going to see a maximum pronation through the hand but we are going to see it move in that general direction so once again we do have movement towards internal rotation to produce the higher force but we're maintaining the air bus

And so chances are, to move that quickly, that size quickly, he's going to have to be really, really close to max propulsion almost at all times. Now, if that's the case, this is a position of internal rotation. He's putting a lot of force into the ground already. But based on your measures, we don't have a lot of hip IR. So where is he getting the IR coming from? So now we got to start looking at pubic orientation. All right. So based on one of your other comments here where you actually said that when you measured his shoulder external rotation as being full. You put it in quotes because the thorax was posteriorly tilted on the table. That's very, very useful. That means we had a thorax that was anteriorly tilted prior to laying him down, which is a pretty good indicator that we've got an anterior orientation of the pelvis. Now, we've got a confounding factor here that makes us question whether we've got an anterior orientation of the pelvis because you've got 80 degrees of hip external rotation. Well, how the heck do we get 80 degrees? Because what I should see with an anterior orientation of the pelvis is a loss of this hip ER. So let me give you a little hint as to what's probably happening here, especially with somebody of his size. As you're moving the hip into traditional measures of hip flexion to measure your ERs, you're getting a left lumbar rotation on the table. So as you bring him up into hip flexion, the spine flexes on the left side. That's external rotation of the spine towards that side. And that magnifies the external rotation measure. Now, how can we say this? Well, your right hip flexion doesn't have a pinching sensation like it does on the left side. So we had that pinch on the left, which tells us that hip flexion stops there. We don't have that on the right side. And you said that shoulder flexion was about full compared to a very limited shoulder flexion on the left side. So what we have is we have a spine that is facing the right rather aggressively. And again, that's what magnifies our ER measures on that side. So the spine is oriented to the right. It's facing the right, so everything on the right side is going to have this really good look in ER. We're not going to get the compressive strategy in the front of the hip, and it's going to be all loosey-goosey. So what we have here, based on body mass, pelvic orientation, and such, is you probably got a wide ISA. You probably got a guy that has left posterior compression like nobody's business that is cranking him around, and he is in the right-hand turn. So here's what we got to do. We got to undo this right hand turn.

If we're talking about a high jump, the moment that the high jumper plants his foot into the ground, there's going to be a peak resultant force, and then as he leaves the ground, he's going to re-expand. For a sprinter, it's the same thing upon hitting the ground: compression to expansion. If I'm throwing a baseball, there's a moment in time where everything squeezes tight. Time stops, and I produce this maximum output of force. It's just very, very brief, and so we don't see these things because our eyes can't stop time to recognize that. But we can measure these things with force plates and we can watch it on video. So Ryan, everything becomes this compression to expansion to compression. If we look at universal principles, we can get really theoretical here and say that spacetime has a very specific shape that looks like a light cone, because light behaves the same way, time behaves the same way, space, the influence of gravity, et cetera, all play into this sort of expansion, compression expansion. If you were theoretically near a black hole, you would probably recognize this shape as well. Again, this is all theoretical physics stuff, which is way above my pay grade, but it makes for a nice representation when we talk about our external rotation and internal rotation representations of how we move.

What they actually do for us is they provide us an understanding of what the rules actually are. For instance, a while back we talked about the higher performance foot and what we should expect to see from that. Let me cut away to that for a short explanation. So we can get a representation of what I'm talking about when we're talking about their idiosyncratic structures and behaviors and how they influence performance. As I move through middle, this is where the arch is going to move down towards the ground. So this is your traditional pronation. This is tibial interrotation. So this is a lower arch. Here's the key element of this that I want you to understand is that the maximum force into the ground is that maximum pronation. And where that is, max propulsion is just as that medial calcaneus re-brakes from the ground. And so this is actually a low position of the arch because right after that I'm going to get a bunch of concentric orientation on the plantar aspect of the foot. This is what they traditionally call that windlass effect. I'm going to crank that sucker back into an externally rotated position. That is traditionally considered this high propulsive foot with the force application came just prior to that. And so this is the demonstration of what happens after that force production. And so when we talk about a performance related foot, this is why we're going to see lower arches on a lot of these really, really high performance. And so people look at these feet, and they go, oh, these are really crappy feet because pronation has always been described as this accommodative foot position, which is not untrue, but the highest force production also happens in maximum pronation. So that's where our max propulsion is. So now if we're talking about training the developing athlete, we still need to consider the same attributes. The model is the same that we would use for the high performer. However, what we might have in comparison to the high performer are a deficit due to structure that the high performer has naturally or a potential lack of development and this allows us to now target our interventions for the developing athlete. So let's just say that we had an athlete that was jumping down from a box and we see the knees moving close together. And so what this actually may represent is knee-centric orientation of the pelvic outlet, which is a low power landing. So where a high performer may actually have a narrower pelvic outlet, by structure or the ability to create concentric orientation, this individual whose knees are coming together can't do that. So now what do we do? Well, this allows us to target our interventions. So what we might do is we might create a compensatory strategy in regards to how we load this individual based on their physical structure.

It also makes this synovial fluid in that middle very, very slippery which is kind of good so it keeps the joints from squeaking just like the motor oil in your car engine. So again, very, very useful on multiple levels. We also have connective tissue behaviors that surround the joint. So if we were talking about, say, a knee joint, if you look at the connective tissue, we've got connective tissue that go in all sort of witchways. But there's a strong horizontal element to that. And so when we compress the knee joint, so we put weight on the knee joint, that connective tissue becomes very, very stiff. It's loaded very, very quickly. So this is actually the overcoming action that we talk about in the connective tissues when we're talking about any kind of movement. And so that makes the knee joint very, very stiff. And so it compresses the fluid inside the joint. And so now we have an external compression that actually pushes those bones apart. And so we need all of these mechanisms to be intact. So we have this nice, nice healthy knee joint. But we also need to be able to shift this fluid around to have normal movement. So as you stated in the concentric on concentric orientation, so let's just say that we only have two sides of a knee joint here. If we have concentric on one side, concentric on the other side, we have a resultant pressure that is straight through the joint. So we have this compressive strategy throughout the joint. The problem here is this hyaline cartilage that creates our electromagnetic element of our protection, if you will, against the bone's touching is going to be affected by this. So the nutrition that supplies this hyaline cartilage comes from the subchondral bone. And so if I put enough pressure on the subchondral bone over a long enough period of time, I'm going to reduce the ability of the nutrients to diffuse with a gradient rather, to diffuse from the bloodstream to the hyaline cartilage. And then so what we eventually get is a breakdown of this hyaline cartilage from the bony side. And so if this cartilage breaks down, I lose my electromagnetic capabilities, I can no longer keep the joints separated and so now I have this high potential that I'm going to develop some form of arthritic condition as this hyaline cartilage starts to break down. That's concentric on concentric. So I think you're correct, Brian, that this is a mechanism. But now I want you to think about a specific circumstance. So let's talk about, let's just say somebody with a narrow ISA. So here's what we know about those folks with narrow ISA that have limited breathing excursion is that I have an inhalation biased axial skeleton with a compensatory exhalation strategy. And what that does, Brian, is it's gonna bias towards external rotation throughout the peripheral joints.

How would I determine how to test or know when I see this issue in somebody, how do I know it's either down pump handle or too much compression on the posterior side?

And so what we're going to lose here from a measurement standpoint is our traditional measures of shoulder internal rotation, which you would measure at 90 degrees of traditional abduction. If we go farther up, if the compression strategy is moving upward and we're going to get a manubrium that gets pulled down, this is where we're going to see symptoms at the costoclavicular space. And what we're going to lose here is we're going to lose internal rotation behind the back. So your old school aptly scratch test where you reach behind your back, try to touch the opposite shoulder blade, you're going to lose internal rotation there. As we move up the sequence of events in regards to compressive strategies, if we get compressed in the upper dorsal rostral space, this is where we're going to start to see the issues in the scalene triangle. So we're going to lose lower cervical rotation to the affected side. You're going to get some pain with rotation away from the affected side as well. You might get cervicogenic headaches. You're typically going to have some symptoms that are well above the clavicle under those circumstances. So again, your traditional tests are going to be cervical rotation, as well as the traditional abduction external rotation test, which looks like that doorway stretch, which we'll talk about here in just a second. But what we may not lose, and this is kind of an important thing to pay attention to, is we may not lose our early flexion range of motion because we may not be looking at end range strategies because what we probably see under these circumstances more often than not is anything that's dorsal, rostral, or sternal and above being the primary influences in regards to the compression. Now, let's talk about traditional strategy first under many circumstances so that the stretch and strengthen model that many will default to for some unknown reason may actually work occasionally. But it's kind of iffy. And I think it's even iffy in the research when you look at it. So you'll look at something like the traditional pec doorway stretch, like I mentioned just a minute ago. Under those circumstances, you're trying to influence a concentrically oriented muscle by yanking on it. So you might get a yielding strategy out of that and get maybe some temporary symptomatic relief if you can hit a breath under the right circumstances. So if I had like a down pump handle but I don't have dorsal rostral compression, yet that position actually might bring the pump handle up if I take a breath at the right time, and then I actually do favorably influence symptoms. But if I have dorsal rostral compression, at the same time, then it's going to be an exercise in futility.

Now, if it was a negative test, what would happen is I would have already maxed out my extension and my ulnar deviation. There would be no change when I break the opposition. So then you know you've got a hand that is actually capable of pronation. And so there is the difference. So that Apple test is going to be very, very useful for you to confirm your suspicions that you've got a hand that's supinated relative to the forearm. Now, if we can understand this, then we understand that the solutions are going to be really, really fun because this is where we actually get to use arm training exercises, traditional arm training exercises that people do for whatever biceps and triceps and the brachialis and brachioradialis, et cetera. So go back to 1985, pick up Flex Magazine and look at the latest arm training article. And what you'll see is a lot of solutions for your shoulder, elbow, and wrist problems. So what we want to understand though is when we're looking for these solutions is that the shoulder is pretty easy to identify. Our traditional shoulder ER and IR measures are very, very useful in this circumstance to know where our starting position is in regards to the thorax and the shoulder girdle. Elbow position can get a little hairy because the long bones can actually twist and that creates some ER and IR differences proximal and distal. The thing I want you to keep in mind here, brain physio, is that when we're talking about end range elbow flexion, so that is an ER position, so that's your inhalation position, so I need dorsal rib cage expansion, I need ER at the shoulder, and I need supination at the forearm at the wrist to get that full end range elbow flexion. For elbow extension, it's the opposing strategies. Obviously, it's going to be an up pump handle. It's going to be internal rotation. It's going to be maximum pronation through the forearm and through the hand. Again, you get to pick your arm exercises. You just have to be able to identify where you are in space. Using your confirming test at the wrist is going to help you identify the wrist. If you know where the shoulder is, the elbow can be the resolution of those two. Now if you see something that looks like elbow hyperextension, don't make the assumption that you've got an appropriate orientation and this is just an exaggeration. What you actually do have here is a twist. So you actually have supination at the proximal elbow that is creating this scenario. So under these circumstances, you're going to have to use some form of elbow extension activity in pronation to resolve it so it's going to look something like that. So keep that in mind when you're looking at the elbow orientation relative to the wrist.

So this behavior of this tissue is a good representation of how the stiffness can be altered. When we think about the magnitude of the load, it is going to cause more deformation of tissues. Depending on where we apply the magnitude of load, those tissues are going to respond. So it's going to be very contextual. For instance, if I need to deform bone versus fascia or a tendon, it's going to take a lot more load or force applied to get this tissue to deform. So I can actually target the skeleton under many circumstances. If I think about duration, the longer I apply a load to a connective tissue, I will get a stress relaxation response and so I can actually promote more of a yielding action. If we look at a couple of examples, if I took an overcoming static squat, we're seeing a squat where we're pushing up into the pins. The rate of loading is very quick, so I'm promoting a lot of stiffness through the system. The force application is very high because it's maximal effort up into the pins, and the duration is short due to the effort involved. So my connective tissues are behaving in a stiffer manner, which would be primarily an overcoming bias. If I change the context to a yielding static position in the squat, the initial loading rate is similar to the overcoming, but the duration is longer. I'm dealing with a little less load here, so I can do this over a number of repetitions and extend the duration of exposure to the connective tissues. I'll get more of a yielding action, teaching the connective tissues to store more energy. If you look at the tendonopathy research where they're talking about extended isometric protocols to increase the amount of load on the tendon, you'll see this stress relaxation response and how this yielding strategy will evolve. The box squat provides us another element where we can redirect the load to a specific location. If I'm doing a box squat and I'm deloading my weight onto the box, I'm actually reducing the amount of muscle activity. So I'm distributing that load now to the connective tissues, including the skeleton, which is very important, especially for big strong powerlifters or offensive linemen who need these high force components where we need to load the skeleton and release that energy for the highest forces possible. When we de-load to the box, that's how we can direct the load towards very specific elements of the connective tissue system, getting a yielding strategy through the skeleton. We have to be careful with loads as far as how we're doing this. A less qualified lifter will use a higher percentage of their 1RM in a box squat to create this yielding strategy because they need more energy to deform the skeleton. As you get stronger, that percentage drops because I only need so much load to deform the skeleton. If I increase the load too much, I deform the skeleton too much, creating too much of a yielding strategy and then I don't get any recoil off the box, losing that element of explosiveness where I can store a lot of energy but can't release it unless I use the optimal load. That's why you see percentages going down: for a less qualified lifter maybe it's 70% of 1RM on the box squat, while for a very high qualified lifter it might be 45-55% of 1RM.

So if I consider an early propulsive foot, I have a tibia that is externally rotated and the tibia is actually behind the malleolus here. What I have to be able to do though is I have to bring this tibia towards internal rotation and I have to have an arch that will go downward, but I also have to maintain contact with my first metatarsal head here and my big toe here. So that's our middle propulsive foot. And so if we lose that contact, then we really don't have a strong middle propulsion from the ground up. And so if we see, in the representation of any question, what we actually see is we see an ER position of the foot. So we actually lose that medial heel contact. We lose the first metatarsal head. And so in this case, it looks like we're actually producing force into the ground in external rotation, which really isn't possible because external rotation actually moves us away from the ground. It's an expansive strategy, which actually lifts us up and reduces—this is a weird one—it reduces your total density, which is kind of interesting. So we're not really producing force in external rotation. So to stop the motion, that means that we have to have a compensatory strategy somewhere. And so if we don't have hip internal rotation, if we don't have a middle propulsive foot, then what we have to do is compensate with what is traditionally referred to as spinal extension. And what this actually is, it's a substitution for the distribution of internal rotation bias through the system. And so we're going to see the spine extend in multiple places, which is typically going to be a diagnosis of a posterior lower compressive strategy in the thorax and in the pelvis. So what you're going to see is a concentric orientation below the level of the trochanter. You can see concentric orientation below the level of the scapula in the thorax. You're also going to see it up into the cervical spine, which you'll also be able to identify by head position as people are swinging their kettlebell. Now, how does this happen? Well, so people will present with these strategies because this is just a gravitational management strategy. So they may actually walk in the door with it or it's a coaching error. And so this is really, really common. It's a concept that gets coached inappropriately in my mind with say a deadlift or any kind of hingey kind of stuff where they're trying to hit the end range rather aggressively, like a glute bridge and then like a bilateral hip thrust—really common in a bilateral hip thrust. And so what happens is as you're coaching this hard end range hip extension, you're actually moving the pelvis between the femurs, you're moving it forward between the femurs, and to get into that position I actually have to re-ER the hip. So instead of driving forces into the ground through this middle propulsive foot, what we end up with is this ER position throughout the system and then we have to promote some form of substitution.

We have a biased towards increased ER, decreased IR, which is what you're kind of representing. Now, your hip ER measures look like they're in the normal range. But remember, we're biased towards the narrow ISA. So what we should get is a magnification of ER and a reduction of IR. But you're kind of sitting really close to normal. So that's going to be indicative of the fact that you probably lost a little bit of that ER. Some answer orientation that we're dealing with. Now, you are absolutely correct. Because of your ER measures, that's going to be your tell as far as being tipped on this oblique. So we got a little bit of an oblique tilt going this way, and that's why you've got the deficit in your ER. So now we've got a representation of what we're looking at. So your key performance indicator is going to be this right hip IR measure, but you're going to need to get the ER back first. Then we can superimpose the internal rotation on top of that. So we're going to monitor ER first, but we're going to go after this right hip IR. You only gave me a partial chest board, but I think we got enough to work with here. But let me offer you this, that if you complete your chest board, you're going to be a lot more clear on what you're going to need to do. Chances are this person is going to have a limitation, a right hip abduction. You're going to have limited hip extension on both sides. And I would suggest that you do this in sideline. Don't use a Thomas test. Hate the test. It's never been terribly useful. Use your upper extremity measures as a confirmation. Remember we've got iterations in the thorax. So just little hints here. A couple other things. You get some outlier measures here that are a little bit off. So your hip flexion and your straight leg raise are a little bit magnified. Now that's not unusual for a narrow ISA, but when you've got the right end, when we've got the anterior orientation around there, we want to be really careful about how we measure these things. So if there's one thing that I've evolved over the last, oh, five years or so is getting very particular about how we measure. So I got a couple videos up on YouTube on shoulder flexion, hip flexion, on how to go about those things. Chances are you're getting a little bit of a roll on the table as you're doing these measures. So it's magnifying your straight leg raise a little bit. It's magnifying your hip flexion quite a bit. So you're getting some rollback on your hip flexion. So please pay attention to how you're doing that.

We have somebody that has this left posterior compressive strategy on the back of the pelvis and it's pushing that sacral base forward and maybe over to the right. And so now what I know is that from my assessment process that I'm going to need that yielding strategy on this left side of the sacral base. And so there's any number of ways that I can get this. So you mentioned in your questions a few exercises. So let's just say that, okay, I want to use either the Camperine Deadlift or the Front Foot Elevated Split Squat. Well, both of those are going to help me create that yielding strategy at the sacral base. So both of them appear to be on the table, but now we have to understand what the secondary consequences of each one of those are. And so if I'm using a Camperine Deadlift or I'm using a Front Foot Elevated split squat while I can certainly achieve that yielding position at the left sacral base, as I move out of those two exercises I have to create a concentric overcoming strategy which may actually reinforce the reasoning behind why this position existed in the first place and if I can't manage that strategy then all I'm doing is actually reinforcing what the limitation is. And so those are the secondary consequences that are associated with that type of an exercise. So let's just say that I can actually create an unloaded situation. So if I use a staggered stance or a side split squat with a cable chop, I'm actually moving into the same orientation of the pelvis where I'm capturing that yielding position. But now I'm doing it in a much more reduced load environment where I'm using the cable pull down to actually reduce gravity in my favor. So now I can actually capture the change and actually reduce the amount of concentric strategy that I'm going to have to use to get out of that. Now, let's just say that I have this additive in regards to my pelvic strategy that I've got this posterior pelvic compression. And so I immediately eliminate a few things, which would be the Camperine deadlift and the front foot elevated split squat, because that posterior pelvic compression is going to be interference. I may have to actually resolve that first. So now I'm thinking about a strategy where I might use like a heels elevated toe touch which is going to move me way back to that earlier propulsive strategy to help me reduce some of that posterior pelvic concentric activity in my world where I'm dealing with a lot of pain and people tell me that, oh, I have pain or discomfort in a standing activity that immediately tells me that, okay, I need to move you into a position where I have to reduce gravity.

You said earlier that max velocity was demonstrated through ER, and I was always under the impression that we get to max velocity in IR. Can you explain that a little more?

In some cases we like it, in some cases we don't; we just have to turn this into a management process. Now, the thing we want to keep in mind is as we move through this, as we compress and we start to lose rotations, our wide ISA biases towards internal rotation. So as we compress, we're going to be biased more and more towards that. Then, our external rotation strategy becomes an orientation. So what happens is every time we press, move towards IR, we lose ER, and we turn our external rotation strategy into orientation. We turn the sockets into external rotation. So we change the shape of the ilium, we change the shape of the thorax, and we start turning our sockets outwards. So eventually they point straight out to the sides. Then, what ultimately happens is we lose our gradient within the joint. So we have a fluid gradient that allows us to move through space, and we will eventually lose that. So if there's no gradient, there's no movement. Again, this is very useful if my goal is high levels of force production, like say a powerlifter or something like that, where I'm willing to give up range of motion for higher force production and, for lack of a better term, greater stability. But ultimately it becomes so stable that it just doesn't move well. So our first goal here, Josh, is to restore a gradient first and foremost, whether we're talking about internal or external rotation.

In doing so, we actually create an internal rotation of that front side hip, which moves the ilium into internal rotation, which immediately nutates the sacrum and starts to bring the pelvic diaphragm upward towards concentric orientation. As I push this side down, I pick up activity on the inside of the downside thigh, which actually opens the outlet on this side, which also promotes a concentric pelvic diaphragm. So now I have a much more stable structure that I can perform my half kneeling exercises in or my split stance activities. And this should happen as I move actively through a split stance or as I assume a stable position in half kneeling. Once again, for those people that cannot create this concentric orientation or this propulsive phase in half kneeling or in split stance, they will typically complain about tightness or pressure or pain. Now, if I take us to more of a side view, you can see that I probably have this potential orientation issue to deal with as well. If I have an anteriorly oriented pelvis, I have lost the relative motion and therefore I have no relative position change capabilities. To overcome the anterior orientation I have to use the proximal hip musculature to capture the position of the ischial tuberosity relative to the femur. If I can capture this position then I can restore the relative position change that's necessary for me to capture the concentric pelvic diaphragm. This is going to allow me to be stable and comfortable in half kneeling or allow me to propel through my split squat. So let's take a look at these positions in half kneeling. So as I am resting here on my left knee, I can actually feel that my right hip is now higher. So that's going to be that inhaled position. So both sides of my pelvis are actually in an inhaled position and both hips are in external rotation. So for me to capture an internal rotation position of the hip in a concentrically oriented pelvic diaphragm, what I want to do is I want to cue a downward position with this hip. So I'm not sagging into the hip. I'm physically pushing it down. So think about pulling up with abdominals on the left side and pushing the right hip down. Now what I've done is I've oriented the acetabulum so they're now both facing forward into an anteriorly positioned orientation which captures internal rotation on both hips. Now, here's the kicker. I have to make sure that I'm maintaining The position of the ischial tuberosity relative to the femur first. If I don't do that, I don't get this relative position change and I can't capture the internal rotations. I'll stay in external rotation and those are the people that are going to complain about tightness in the front of the hip, tightness in the quad or knee pain on either knee.

So now we just have to say, okay, what is this fit in and then what problem does it solve? And so if we take a look at what it does, and then we have a person that would say, well, they already have the ability to sustain the propulsive phase where they already have tissue stiffness, this really wouldn't be the solution for them. If we apply it to someone that lacks these things, now we have a useful intervention. So let's go through a couple of examples. as a representation. So somebody comes in, they have narrow ISA, they're going to be biased towards an eccentrically oriented pelvic diaphragm. Now if this person lacks force production, so again they don't propel well, they lack tissue stiffness, so instead of being able to store and release energy from their connective tissues their dampeners so again they just don't produce force very well then this inertial trainer actually may be part of the solution because if we can increase the propulsive force and we can teach them to manage tissue stiffness more effectively now we actually have an increased vertical jump potential or whatever the parameter that we're training for may be. Somebody comes in with a wide ISA they're biased towards force production all day every day they have very high tissue stiffness so let's just say they've already done a bunch of heavy strength training and so tissue's already stiff and now we apply the same modality, what's going to happen is we may not get any effect whatsoever it may not be demonstrated or if we magnify what they're already good at we may see an increase in, like say, further strength output, but what if we increase their tissue stiffness even further? We've taken away their yielding strategy, so now they can't store release energy either, and so now we've actually reduced their explosiveness or done absolutely nothing for them. where I can see the eccentric or inertial trainers really coming in handy though Mark is at one end of the rehab or if we want to use the term prehab we can we can call it that. The extended duration of loading in the prolonged overcoming action that's produced in the tissues is actually beneficial from a tendon adaptation standpoint. Very similar to what we would see with the static protocols that have actually shown to have some benefit in cases of different types of tendinopathy. And so, again, it's just a matter of identifying what this tool is useful for. So I hope you can see how number one, you need to evolve a principle-based model and then everything just kind of falls into place once you're better able to identify what the needs of the individual are. It's not about what I like or what I think is superior under the circumstances is what this person can execute based on what their needs are.

If I grab Fred here, Fred actually has a pretty wide ISA, so his infraternal angle's gonna be right there. One of the properties when I have an exhalation bias is I have to look at the pelvis because we're talking about hips. With the bias of the wide ISA, I'm gonna have a nutated sacrum, a concentrically oriented pelvic outlet, and a wide IPA as well. So my goal to restore the hip abduction—which is actually an external rotation measure—is to be able to close this IPA, which is representative of a non-compensatory inhalation. Right away, what I should recognize about the first compensatory strategy, which is a diaphragm compensation in the wide ISA, is that I have a diaphragm that's going to move against the axial skeleton to allow me to breathe in. I get this wide IPA, which means I'm going to have a limitation in abduction right off the bat, because I'm going to increase the concentric orientation of that musculature, which promotes internal rotation of the hip. Remember, my wide ISAs are biased towards internal rotation, which for those traditionalists is going to also allow that adduction to occur. The one thing you're going to have to pay attention to is if I have any other compensatory strategies superimposed. So if I get a posterior compression at the base of the sacrum, if I have any anterior orientation, I'm going to pick up even more concentric orientation of the musculature that's going to limit my external rotation measures. And so you're going to have to pay attention to that. So if I do have an anterior orientation, a dead giveaway is going to be a loss of ER at the hip as well. What I have to do is reorient that pelvis first. So I got to recapture the ability to posturally orient. That's going to be hip extension activities because I got to bring that ischial tuberosity closer to the femur. So I got to bring it this way. The way I'm going to do that, again, is with hip extension activities. So my preference would be to do something unilateral under these circumstances. Because if we do bilateral hip extension activities, there's a concern that we're going to create that posterior lower compressive strategy, and then that we just created more interference for our ability to try to recapture a normal movement. So it could be something as simple as some form of glute bridging. And as we advance people through these hip extension type activities, we can look at arm bar variations that are going to promote this hip extension as we get people to standing up. Then we're looking at some variations of like a sprinter step up or a crossover step up at the much more advanced level.

If I can't do that, then the toe touch is going to be limited, but I can still squat and I can still get a good hip flexion measurement. However, we're going to have to look at the compensatory strategy that's occurring. So on the table when we're looking at hip flexion under these circumstances, because you're narrow and because you're anteriorly oriented, you're more likely seeing a posterior orientation of the pelvis and the lumbar spine as you're moving into hip flexion, which is why you're getting such a good hip flexion measurement, but you can't access the toe touch. The squat is going to be a very similar representation. So as I squat, the substitution for the hip range of motion that I need to access as I sit down into the squat is again, it's going to be posterior orientation of the pelvis and the lumbar spine as a unit that's going to allow me to capture that depth, or I've got a unilateral compressive strategy on this side and I'm using it sort of like a hip height cheat as I go through this middle range of the squat which is going to allow me to access some internal rotation and that would be my substitution. So the hip height or a side bend through the trunk is going to provide me that substitution that's going to allow me to look like I have a pretty good representation of a squat. But the fact that you don't have the toe touches, kind of the dead giveaway, that we still have this posterior compressive strategy. Now, from a solution standpoint, like I said, I really like where you're thinking about this in that 30 to 60 degree range, but here's what you're going to have to do. Because you most likely have some element of concentric extension with this posterior lower compressive strategy, you're going to have to maintain hip internal rotation prior to the reorientation of the pelvis. So you're going to try to get a posterior orientation. The problem that's going to happen is if you don't do something to maintain hip internal rotation, which would be traditional abduction based on the position that you're describing, what's going to happen is I try to posteriorly orient. What you're going to get is you're going to get the little butt squeezer kind of person. So they've already got some constant extension here. They're going to magnify that as they try to posteriorly orient. And you're going to get the same substitution that you got on the table with hip flexion and the same substitution that you've got with the squat. And all you're going to do is compress this even more. So what you're going to try to attempt to do is try to utilize hamstring to get posterior orientation. All you're going to do is emphasize this compressive strategy.

So in many cases, I'm going to need a strategy in the ankle and the foot that keeps me from tipping over forward. And so this is where you're going to see some concentric overcoming activity in the musculature, especially down in the foot and the ankle that are going to prevent me from coming forward. So a lot of times this is what you're also going to see. So this is why the heels come up when they walk. This is why the heels come up when they squat. But this is also one of the reasons why the heels elevated stuff in the gym kind of works. So if I give you a representation of the foot, so if we have an early foot, we're going to have a tibia that's going to be in relative external rotation. I'm going to have an arch that's up rather high and I'm going to have a toe on the ground. So I get this really, really high arch. Well, if that arch stays up, because this is a center of gravity issue, I can't translate the tibia over the foot because to do that the arch has to go down. And so I have this arch that comes up. So my alternative strategy then is if I just elevate if I elevate the heel, so this would be where the foot would rest, if I drop the toes down and keep the heel elevated, I've essentially dropped the arch out of the way. And so now I can actually translate my tibia forward. So now I can capture the yielding strategy at the beginning of the movement. So if I was doing the heels elevated squat or some form of split squat with heels elevated, what I've done is I've allowed myself to reduce the overcoming element of this concentric strategy posteriorly. I've created a yielding strategy, which is the expansion, which is the delay that I needed to acquire to allow this tibia to translate over. And so again, that's why we start with heels elevated under these circumstances. So the people are telling you exactly what they need. I don't need to throw people on the table and measure. I just need to understand the representation that I'm seeing. So from here, once I have this yielding strategy captured, whether I have to adapt it with the heels elevated, then I got to start thinking training strategies. So again, I have to promote the reduction of the anterior orientations that are thrown the center of gravity forward. I have to overcome the compressive strategies that are limiting my anterior posterior expansion because if I don't have posterior expansion, I don't have a yielding strategy to help me delay this max propulsion like I need to. So again, you go from heels elevated to a front foot elevated and then teach them to translate the tibia over the foot with a reduced load.

I'm going to talk you through a sequence here, and then I'm going to throw you a couple of measures that will help guide you that you might need to do, but hopefully give you something that's useful. So let's go through this scenario a little bit. I'm going to grab the pelvis so we have it in hand as we go through this. Okay. So we're starting with a narrow ISA. So we know that we're going to have an outlet that looks something like that that immediately biases towards greater external rotation, less internal rotation. So that kind of fits your bill so far because we had the right hip IR in deficit. I'm assuming it's a she. She has palms to the floor touch, which means that you probably got an anterior orientation and we have an eccentric orientation of this posterior lower musculature that allows the pelvis to move through this full excursion. The straight leg raise of 100 degrees is going to be useful. That is excessive to a slight degree. Again, we're making an assumption that's going to be the right straight leg raise. So here's what we're going to do. We're going to use the straight leg raise to guide what this pelvic orientation means to us. And then once we understand that, now we can define a strategy. So I got 100 degrees straight leg raise on the right. What I want you to do is I want you to take that straight leg raise and I want you to compare it to the left. So if the right straight leg raise at 100 degrees is greater than the left straight leg raise, you most likely have a posterior compression on the left side that is turning the pelvis to the right. And that's going to result in a reduction in left hip external rotation. So that's going to be a flatter turn into this right hip. When you do the straight leg raise, what's happening while you get the excessive straight leg raise is as you bring it up, it's allowing the pelvis to turn away and that's why you get 100 degrees on that side. Now if you compare straight leg raises again and you get a left straight leg raise that is greater than the right, what you've got is a pelvis that's tipped on an oblique axis so it's actually tipped up like that, so it's tipped over in that direction, which means that you have greater eccentric orientation on this posterior left lower side than you do on the right side and it tips it up. So when you do this straight leg raise, you're not actually raising it up in flexion, you're raising it up closer to an abducted position.

The lack of ER on this left side also reinforces the fact that you've got this compressive strategy and that's bringing the orientation of the pelvis forward more so on the left than it is on the right. So we have kind of a unilateral issue here. Both sides are affected obviously as they always are, but we're going to focus in on this left side. So the first thing that we're going to want to do is we're going to reduce this anterior orientation. Now, your client complains of left hamstrings, which is not a shocker because she's got an eccentrically oriented hamstring on this side. So when the pelvis gets pushed forward, it's oriented forward. This ischial tuberosity moves further from the femur, which means I've got an eccentric orientation here. And then I've got, like I said, the eccentrically oriented hamstring. So every time that you put it into a hinging scenario, you've got a lot of eccentric orientation there, which is going to increase that load on the hamstrings, probably why she gets sore. So what we're going to have to do is we're going to bring the orientation back by grabbing all of this ischial tuberosity. Now, how do you do that? Well, we have to consider that we really want the proximal musculature of the hip to control the position of the pelvis relative to the femur. But the further forward you go and the further away from the femur, the ischial tuberosity, the more we're going to use the hamstring as an assist. Because if we look at this from a geometric standpoint, we lose the glute max moment arm as we flex the hip and then the hamstring moment arm actually increases. So we're going to use the hamstring to help us pull this back. So now we're talking about hook lying activities. We're looking at just your classic glute bridge progression. A couple of things that you may want to consider under these circumstances is that if you do find that as she performs her glute bridge, her knees separate, we want to put something between her knees like a yoga block or a ball or a band or something like that that we can keep the knees together. So we don't move into this externally rotated position because what we're trying to do is we're trying to recapture this hip extension and as close as we get the hip extension, that's more of our hip IR moment. And so we don't want the knees to be separating under those circumstances. But like I said, you work from this hip extension progression to where you can get the hip fully extended. So I would refer you to an arm bar video that I did a while back where you can actually see the progression to the fully extended hip with the foot on the wall during an arm bar.

I think that a lot of people are trying to maybe overstep their bounds or don't recognize that they're overstepping their bounds when they're trying to attract certain types of people because they say, 'oh, I want to work with everybody.' When the reality is, you should probably just stay in your wheelhouse and then be infinitely successful with that group of people and you'll get more of those people. If you are young in the industry and you say, 'I just don't have the confidence to work in this environment or I don't have the confidence to work with any specific clientele,' then you have just identified where you need to go. You need to take part in some form of an internship or a mentor-mentee relationship or an apprenticeship where you can safely gain the experience that you need to work with any client on any level. So we can move to a step two then that is based off this first step of being aware of what your capabilities are is only work with those types of clients that you have this great level of confidence. So again, you have to be honest with yourself and you have to know yourself. Because of my physical therapy background, because I've been doing this for more than 30 years, I tend to get a very complex type of client that has an extensive medical history, maybe multiple surgeries or multiple movement related problems and painful conditions and such. And so I have sort of earned to work with that type of a clientele. And so if you're unsure as to what type of an assessment you should be using, then perhaps you should work with those clients that don't have any significant history that might interfere with their fitness program. And so right away, you just simplified your process. So you need the minimum of any form of assessment beyond their ability to execute some of the most basic of exercises. So again, you have to identify your capabilities. You have to have some level of self-awareness. Let's just say that you're presented with a situation that you might not be comfortable with or qualified for, what should you do? Well, this is where we're referring out to someone that might be more qualified is actually a great move on multiple levels. Number one, you develop a relationship with somebody that may have experience that you can gain from them and you develop that relationship such that now they would refer back to you when they have a client that they consider like, 'oh, that person's not in my wheelhouse.' Maybe they're a little bit too easy for me and I can send them back to you. You also make a friend in a way they say, 'wow, I really respect the fact that you don't feel confident enough to work with me, but you have somebody that can help me.' I'm going to send you my friend who is a little bit less complicated than me. And so now you've developed two relationships. You've developed really good word of mouth and a great deal of respect among those people that you seek to work with.

So what we want to do is alleviate the bias that's putting us at one end of this middle propulsive phase. We can describe this with our pelvis. Essentially, we're talking about this bias of the sacrum being biased in one direction or the other by the orientation of the pelvis. If somebody is biased towards the early phase of this mid-propulsion, typically you're going to see someone who can probably squat to parallel but when they do a hinging exercise, you'll see a little bit of a shift off to one side or the other. They can typically flex their hip past 90 degrees, and you're typically going to have a reasonably good straight leg raise, so it'll probably be 70 degrees or more. If we look at somebody that's biased towards this later stage of the middle propulsion, right before max propulsion, these are typically going to be people who don't squat well to parallel. You're going to see hip flexion that's less than 90 degrees. You're going to see a very limited straight leg raise. In some cases, 45 degrees or less. And that's because they've got this additional compressive strategy in the lower aspect on the posterior side of the pelvis. These people are really pushed forward in one direction, again because of this concentric orientation of the musculature below the trochanter there. Again, that's how we're going to divide this up. We're going to see somebody that's a little bit more compressed at the base and then we're going to see somebody that has a lot more compressive strategy that's getting pushed way over in that late propulsive strategy.

And so what we'll find is that the maximum propulsion is going to occur as the calcaneus breaks from the ground. So if I have my foot, my reposition of the foot, so I landed early, I've got a high arch, I'm externally rotated, I've got a plantar flexed first ray, and as I moved the tibia over the foot through this middle phase, The belief is that that is going to be the late stage of propulsion. Now it's late in regards to how we designate the segmentation of propulsion but it's not the highest force. The highest force actually comes right as I break the calcaneus from the ground because this is the point where from a traditional standpoint maximum pronation actually occurs. So here's what we want to do. We want to think about this from an evolutionary standpoint. So we were swimmers before we were walkers and so our biases towards inhalation to float and external rotation because we didn't have to produce force against a fixed point and so we used a lot of external rotation as swimmers. So just watch the frog swim and you'll get the idea. When we come up on land and we have to deal with gravity, this is where we started to learn how to internally rotate and produce force. So the point of maximum internal rotation is actually the point of maximum force production. And this occurs at the very end of this middle propulsive phase where traditional pronation is at a maximum. Where else will we see this? Well, we're going to see this in any rotational sport where we have to stop our turn to create some sort of forward momentum and do an implement. So if I'm throwing a baseball, if I'm swinging a golf club, if I'm swinging a tennis racket, All of these sports will demonstrate the same element where I will have a maximum propulsion where actually have to stop motion and I translate that into the implement and that is the point of max propulsion during those activities. So if we think about a baseball pitcher, it's when the lead leg that's stepping towards home plate hits its point of maximum propulsion is as they're landing through the heel and because they never get towards this end propulsive phase except through follow-through, which is actually an external rotation moment, which is actually a re-inhalation, if you will, as they're following through. So again, maximum propulsion is not in this late phase of the propulsive continuum, regardless of what activity that we're talking about, whether we're talking about gait, whether we're talking about sport. It's actually at the point of the maximum pronation that is an internal rotation strategy that is an exhalation bias. So, Slasher, I hope this helps you. I hope it helps all of you because it's gonna help you make some really good decisions in regards to how you're gonna rehab some of these people.

So these people have great bodyweight squatting capabilities, but they might not be terribly strong because the requirements to get into this deeper squat pattern in this relative motion that occurs require a lot of eccentric orientation to capture these deeper squat patterns. And so if you don't develop this concentric capability to overcome the loads that you may want to actually lift if you're one of those people that are chasing numbers, you might find that you're just not meant to be that strong, but you do have a pretty squat, so people will be jealous of you for that reason alone. But let's talk about the two other ends. Okay, so we've got an early propulsive foot with the high arch, and then we've got this late propulsive foot, which actually has a much lower arch but different force producing capabilities. So those people that are biased towards this early propulsive strategy with the higher arch and the plantar flexed first ray will tend to have a squat and a deadlift that are very comparable in their force producing capabilities. So let's just say you got a 300 pound squat, you probably got a deadlift that's probably in the same general vicinity. Okay, if you're biased towards the other end of the extreme, so you're in the late propulsive capabilities, you're gonna have an amazing deadlift and a pretty parochial squat, relatively speaking. So maybe you can deadlift 500 pounds, but your squat's only like three. So there's a big gap there. And so now what we want to think about is, okay, how do I sort of even this out to some degree? What are the ways that I can take this big differential between my squat and my deadlift and sort of bring my squat up? Because you're always going to be a good deadlifter when you're in this late propulsive strategy. And so we can use our box squatting as a point of reference or an exercise of reference as to how we want to modify training to sort of even this thing out. So we talk about the people that have this huge differential between squatting and deadlifting. They are concentric overcomers all day every day. They're very, very high force producers. Their center of gravity is always forward. And so what we need to teach them to do is to capture some measure of a yielding strategy. And so the way that we're going to do this is we're going to use the box squat. And so this is going to be very much like a traditional powerlifting style box squat. So if you've ever read anything from Louis Simmons or West Side where they talk about deloading their body weight onto the box, that's going to be your number one strategy to help bring up your squatting capabilities to your deadlift. Because what deloading on the box does, this allows you to create this yielding strategy.