So you're looking at one exercise and then you just gave me five different options of the potential utility, right? Yeah. So which one's right?

Oh, totally compensatory.

Yeah. Or you go on The Bachelor, right? The Bachelor TV show. And that's how you find the right one, right? You just weed them out. No, it's exactly the way you describe it. And everybody wants a shortcut process. And the reality is, is that you've got to get to know this person. How do they respond to certain elements? If you're dealing with the pain issue, obviously you have to induce enough adaptability to alleviate that first. And then you just start to superimpose the performance aspects back on and then you monitor for the changes. You kind of know where they started, which is really, really good because again, now you have a comparator from a performance aspect and you say, you know what, if I get close enough to that presentation, chances are our performance is gonna go up, but that's gonna be my indicator that I'm probably getting too close to where that they start to create their own interference. But this is why it's hard. This is why we don't have great answers or predictive capability because we just don't know. So I think that you've got to date your client a little bit and find out if she's the one. I mean, seriously, it's unfortunate. It'll be really nice if we had these hard and fast rules. You know, say, oh, when you have 17 degrees of hip internal rotation, that's bad. I don't know. Is it bad? What if it makes her faster? Right? You know, but maybe, you know, 15 degrees and now you've got interference. How are you going to know? You measure a bunch of stuff. You create the adaptability to alleviate anything that is interference, and then you re-superimpose everything. You just bring them back. That's ultimately what the return to play process is. I don't think return to play is very special. I don't even think we need a concept called return to play. We usually just call that training. Right? It's just that, where's your starting point? So if somebody's coming off of a surgery or an injury, right? They're just starting at a different place than somebody else that doesn't feel pain. But if we monitor them the same way, that's gonna be the best way to figure out what is the desired outcome.

So make a comparison. Get like a 10 degree heel elevation. And then do it flat footed and make the comparison. Because you'll feel the difference because the heel elevation will give you a yielding strategy more so than your heels flat under most circumstances. And that will give you even a better sense of what you're actually doing.

Okay, probably one of the better ways to actually consume that information. I always tell folks to read the first chapter of Outliers and then throw the book away because it's all in the first chapter as to what he's talking about. There's a story about this guy watching a tennis match, I think he's a tennis coach. It's been a long time since I read it. He's watching this guy serve and his predictive capability of when this guy is going to double fault is ridiculous. Like his accuracy is ridiculously high. He's just watching the match and he can't figure out what it is that he's seeing that tells him when this guy is going to double fault, but he sees it. And so we all have this to a certain degree once we start to capture some experience where we'll see things and we'll go, that's not really what I wanted to see, but I'm not really sure what to do. Then it's just about layering experience on top of that to allow you to identify when you see these things and then to figure out what that is. And that's essentially what we all do. I mean, the longer you're in this, I mean, I've been doing this for more than 30 years now. So it's like, people say, well, how did you see all that? It's like, well, because I've been staring at people for 30 years. Like, get more reps and you get better at it. So again, I think that what you're seeing is right on, right? So hang on.

Okay, hang on. Guess what? So something to learn really quickly. There's a lot of toys out there for kids that are all physics based, that they are great. My purple room is like a kid's dream. I have slinkies and balls and hoberman spears and all sorts of stuff. So you know what silly putty is, Dan?

Yeah, I think you know how things happen in like threes and like this happened multiple times like hell yeah and you're starting to question yourself is like is it just the way that I'm administering this which I don't think it is because well but that's a really good question to ask yeah that's a powerful question to ask because it allows you to examine your own bias. And what I do is I basically go back like the next session. I basically tell them I go, yeah, we're going to throw that one out. But I'm pretty confident in the way that I'm measuring it to at least get consistently like the same answer. It's just a matter of I'm not really sure where to go with that answer in terms of like trying to come up with my visual representation of what's going on underneath. Like I try and like paint that picture in my mind of like what's going on under this and what how could this actually like feed into my assessment to guide me or is this just like I'm just doing this because I'm doing this.

OK. So because of the position of load and the strategy to hold bar position, you're going to increase, you're going to create a compressive strategy in the upper thorax that's going to drive pressure downward. So the first question that you want to ask is why is this person accelerating towards the ground in the first place?

Which change are we doing?

Elevating knees, going forearms to the floor.

You think a class in method acting would serve most trainers and physical therapists and coaches well?

So if you want to call that co-contraction, I'm totally cool with that because you've got stuff going on anteriorly and posteriorly. You're more likely to get the posterior compression to be towards the base of the sacrum, which pushes you forward. And so I don't fall on my face, I got to push back with the front side. And then my last strategy is to bend the sacrum down and underneath to kind of squeeze everything together. And now I don't go forward or back. I'm just stuck in the middle. And so you get your waddlers, your people that waddle when they walk. They look wide too. I mean, they've got the wide pelvis, they'll have the wide thorax, et cetera, et cetera. And so the reason that they waddle is because they no longer have any turn.

But that's super easy, but it's not. But it could be.

Okay.

Okay, because if you look at his hand, he's going to fail the Apple test because he's definitely got a hand that's also in relative pronation to the distal radius. So he's really cranking over into pronation rather aggressively because he can't access the position without a compensatory strategy.

I agree 100%.

Yes, that would be my best guess. So you've got to think about, when you're lacking flexion, and you think about the musculature that would have to be concentrically oriented to limit that, like to bring the hip towards flexion. It's got to be down low on the posterior aspect of the pelvis, right? Correct. And then you say, OK, well, if this is concentrically oriented, what is that going to do as far as the position is relative to the femur? It's going to shove it forward, right?

I think it's a matter of are you trying to expand adaptability for health purposes or are you narrowing capabilities, narrowing adaptations to reach a level of performance, because they are not the same. I'm actually reducing the broad scope adaptability of the system to reach a level of performance because you have finite resources that are available. I can't distribute them broadly under all circumstances. But to capture health, you do need to have that broader element intact. Because you never know how many systems are going to be affected. And so you have to try to get as many as you can.

So pain's no different for me than the weight loss concept is like, I'm just not going to talk about that. I'm going to talk about the stuff that matters that you do have control over. So that's how I look at that, if that is my expansion on that.

Do you nasty?

Yeah, I actually suggested meditation to her, but she didn't do it very consistently.

Yeah.

They're cutting, right? So their foot tends to stay towards that later propulsive strategy, right? So chances are their center of gravity is already forward, right? They can't turn. And so, yeah, so it becomes this, right? Push off, push off, push off. So they're literally doing like a slalom you know, jump from foot to foot as they walk.

That brings up a really good question. It's like, well, okay, so if I'm biased towards external rotation because of my inhalation bias, then how do I lose the ER? That would be associated with the compressive strategies that we see in this upper posterior region on the pelvis. This musculature changes its direction of pull based on the orientation of the pelvis. So anything above the trochanter, as the hip orients forward, if I get a compressive strategy posterior here and I get a push from behind, that's going to increase the anterior orientation, and that's where you're gonna start to lose your external rotation because all the musculature above the trochanter re-orients its structural pull from external rotation to internal rotation. So the more anterior orientation that I have, the more ER that I'm going to lose. If we would go forward symmetrically in this situation, I would lose external rotation on both sides. If I have a lead with the left side, then I'm going to see a greater loss of ER on the left side. If I'm tilting on an oblique axis over to the right, then this side's going to lead a little bit, and so that's going to show a decrease in external rotation to a greater degree on the right side. A cool little thing that we can do is we can also confirm this from the ground up in some situations. So if I have this left side leading and I see this reduction in external rotation greater than it is on the right, typically what I'm going to see in this side, the foot on the same side foot, which would be the left side, is I will see a mid-propulsive kind of a foot, which would be typically described as a closed chain pronation of the foot, and so that kind of goes together. So that'll give you a little clue. In many situations, not in all situations, but in many situations, you're going to see those two things go together. When I get this tilt over to the other side, what you're going to see is you're going to see a late propulsive foot under those circumstances, and so I'm going to see what would be considered an open chain pronation where I'm actually pushing through that medial aspect of the right foot when the right hip is a little bit more forward based on the oblique tilt of the pelvis to the right.

It applies to everything in the physical realm when we're talking about it. I'm just curious, how do you explain that to people for somebody who maybe you're like really skeptical about, you know, being like, well, why do you do that? That seems like stupid, you know?

So he's doing D2s, he's doing a bilateral.

Yes. Yeah. Um, is that am I more likely to have an increase in ulnar deviation if I don't have full pronation?

We're going to the purple room. Have a great Friday. I will see you guys later. There will be some stuff coming up. The podcast will be up this weekend. Things like that. Instagram will be busy as usual. And then please send questions to askbillhartman at gmail.com. Or post them up on Instagram. I will see you guys at the purple room in just a sec. So I got a question from Jennifer, and then we had a situation that came up in the Intensive Facebook group that I thought would be a really good Q&A to answer here in the purple room. And I'm going to use Alfred here as our model, which he is. He is a representative model of a skeleton. And one of the assumptions I think that confounds people, especially when they're doing table tests and we have the constraint of the table, is not getting an idea of what this initial representation is. Some people, and I think this is one of those situations where when you first come out of physical therapy school or however you've been educated, is that we're taught this dead guy anatomical position in the assumption is that when you lay in the table, that's the position I'm actually starting in. And it's not even close to that representation. I'm going to use Alfred sort of to demonstrate this. And so one of the things that I want you to recognize is that, yes, the table provides this constraint to measure against. But as someone is laying on the table, we cannot make the assumption that they're in some magical position where everything is even. And we have this equal starting point. So I can do something as simple as turning Alfred's head, and if you look down at his feet or at his legs, I'm actually changing his leg length just by turning his head. And obviously you can see that I move the thorax and the shoulders a whole lot more because they're a little bit closer to the head, but I'm even manipulating his leg length and foot position just by changing the orientation of his head. So right away, just consider the fact that if I have a patient or a client laying on the table and I'm making the assumption that this is somehow even, if they have their head turned slightly, just to one side, I've immediately changed the starting conditions for all of my tests. This is why getting a full chest board, a full measurement of orientations and positions helps you determine what the next intervention should be. So now let's talk about a specific test like the straight leg raise and how this situation of the initial conditions can influence your interpretation of the test. So if I measure a straight leg raise test, and let's just say that Alfred has about 70 to 80 degrees here, and I raise this leg, and I get 70 to 80 degrees here, if my assumption is that he's somehow magically laying on the table in this perfectly even dead guy anatomical position, I would have to say that well both hips are showing me the exact same measure. So my assumption is that orientation positions, muscle activity is equal on both sides. However, I can't make that assumption because I can't rely on that one singular test. One is a representation of position. So all I would have to do is tilt his pelvis on an oblique axis, and I've changed the initial conditions. So I've reoriented both of the acetabulum, both of the hip sockets have changed position. Now when I raise up this leg to 70 degrees, I have a totally different orientation of the hip than I have on this side to get the 70 to 80 degrees. So if this hip is already beginning in a more flexed position because the orientation of the pelvis started in hip flexion, if they end in the same place, I actually have more hip flexion on this side than I had on this side. So to make the assumption that both sides are equal, my intervention may fail simply because my interpretation was wrong to begin with. So I have to take into consider these initial conditions. How do you do this? Well, that's why we measure all the other movements and then we create a three-dimensional or four-dimensional picture in our head as to what the orientation of the body is in space. Then we can be a little bit more secure in our decision-making in regard to the interventions that we'll choose because we've narrowed the probabilities of what's actually going on. We can't have a faulty assumption that everybody's starting from this ideal position like we learned in school because that really doesn't exist. And so again, take into consideration initial starting conditions and then the representation of the end conditions and that's going to allow you to determine where things are in space, narrow down your probabilities and your interventions will be much more successful.

That's a really good question. So there are certain stressors that are associated with this whole thing, right? We all get stretched in one way or another, but you've got a great point. It's like people are probably sleeping a lot more than they did before, either intentionally or unintentionally, because they have the capacity to now. I mean, think about that as an impact. That's brilliant to bring that up.

It's a great strategy like the number one rule of improv. And Bill, this was actually the end of thinking in bets too, is the idea that you never say no. So if you're doing improv, you never say no. All you say is yes and, right? And I think we, you know, because you basically are accepting whatever they're saying, and you're going to add to it. Whereas they oftentimes are default in the coaching scenario is yes, but. Right. It's like, you throw in the yes to like make them feel like you're listening, even though you're not. And then you say, but this is actually what's going on. And training yourself instead to say yes and, you know, like, yes, you might still have arthritis despite everything showing not. And I still think we should look at XYZ.