Bill Hartman’s Weekly Q & A for The 16% – December 8, 2019

Links to this week on YouTube:

• Bill Hartman’s Weekly Q & A for the 16% – December 1, 2019: https://youtu.be/U_qdZevvS9U
• The IFAST Podcast #5 with Mike Robertson and Bill Hartman – How we train the pros: https://youtu.be/Onnpa5gsfa8
• A Simple Self-Test to Assess Your Breathing: https://youtu.be/djkJmqL1di0
• Simplifying Lower Cervical Mechanics: https://youtu.be/jGzj__fcYn8
• Power Output from The Inside-Out: https://youtu.be/pHBok2Iht2o

This week’s topics on Instagram (@billhartmapt):

• Thoracic outlet syndrome and breathing
• When to prescribe the prone Y exercise
• Get Client Buy-in Who can you help get better?
• Simple self-test for breathing
• Understanding secondary consequences of programming
• Is there such a thing as muscle weakness?
• Simple cervical mechanics
• For The 16% videos

This week’s Q & A questions:

• How does the orientation of the pelvis influence movement options available at the ankle? I am curious to your thoughts, specifically in the context of speed skating where top performs express a high degree of ankle flexion.

• When addressing elbow orientation via training, what is the deciding factor when choosing between an elbow flexion or extension driven activity? A specific case would be someone who has an ER’d humerus and pronated forearm You’ve touched on the fact that we don’t really know why people feel better after interventions. It makes sense to me that even if interventions are “specific” there are many things going on simultaneously. I was wondering if you could elaborate on this and possibly your own evolution regarding this. You recently shared a case on Dorsal-Rostral expansion helping improve a patient’s height and “corrected head forward posture” and although we aren’t necessarily after improving static positions posture, I’m wondering how expanding into the upper back would not result in more kyphosis / HFP?

• When you say the word “orientation” are you saying that relative to the spine? If so, why do you use the spine to establish orientation?

• When you say “inhaled” versus “exhaled” are you talking about ribs and spine or just spine? If both ribs and spine then why is a narrow ISA inhaled if their lower ribs are in an exhaled position?

• Have you ever seen cases where the pelvis appears to have changed “orientation,” but the ribs still appear to be wide or narrow? If so, can you explain the mechanism behind that and how you continued treatment from there?

• When treating someone, are there different criteria or things that you look for when deciding what to target first – ribs, pelvis, spine, etc?

• I have heard the concept of “tissue quality” being discussed with many typical musculoskeletal “diagnoses”. Do we as physical therapists and fitness professionals have a good definition of what good tissue quality is?

• What would you say are the biggest factors that impact somebody having an inhaled and exhaled skeleton (Wide Vs Narrow ISA)? How much does a person’s injury/training history come in to play? I can understand how strength athletes develop wide ISA’s but was wondering if there are any sports/events that can impact to position of the axial skeleton.

• I work with some volleyball players and I am trying to work on their squat using the box squat. Given that they do not get much lower than about a ¼ squat when they jump in their sport, what depth should I focus on getting them to? 90o? Just above 90o? Should the goal be to get 120o of hip flexion to give them full excursion of their respiratory cycle? Defensive/back row players sometimes end up in a deeper squat position when digging the ball, should it be lower for them?

• In the “How to Measure Infrasternal Angle” youtube video, I got the interpretation that a Wide ISA is indicated by an opening/increase in angle with inhalation without a legit closing with exhalation and that a Narrow ISA is indicated by a lack of opening with inhalation. Is this correct?

• Does the resting measurement of the ISA give us any useful information and if so what does it tell us and how does it guide intervention?

• Does the outcome of the ISA test (wide vs narrow) effect the prescribed exhalation or exhalation strategies (sigh vs pursed lip) used during prescribed interventions?

• What do you do when an ISA is dynamic one side or one side tests as Wide and the other narrow?

• If someone measures with a ISA of 60 degrees at rest and it widens but doesn’t completely close is this person considered a wide ISA? Would be considered to be an exhaled axial skeleton biased individual?

#infrasternalangle #wideISA #boxsquat

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