#31 - Anthropometric's Influence on Biomechanics with Greg Hawthorne, Part 2

Factor, spelled F-A-K-T-R, stands for Functional and Kinetic Treatment with Rehabilitation. Over the past decade, this unique approach to treating pain and dysfunction has been utilized by healthcare providers on 6 continents, serving as a framework that guides clinical decision-making in patient visits around the globe on a daily basis. With this podcast, our goal is simple: to bring the best and brightest in clinical education to the forefront and empower practitioners with cutting-edge, evidence-based content that improves patient outcomes and inspires healthcare providers to continually evolve their approach to treatment. In each episode, we will feature a training or interview with some of the top minds in healthcare in a short format that is easy to digest with actionable information that you can implement into practice right away. Let's get started. Hi guys, welcome to a new episode of The Factor Podcast. I'm your host, Jessica Riddle. If this is your first time tuning in, welcome and thank you for listening. Today we complete part 2 of our training on anthropometrics influence on biomechanics with Greg Hawthorne. Greg Hawthorne is a licensed athletic trainer and performance coach who has spent time working in the NFL, Division I athletics, with youth athletes, and the armed forces. Greg has training in a variety of courses ranging from respiratory, acute care, advanced taping techniques, manual therapy, and neurology. Greg believes the body is widely complex, which allows people to move in different ways while achieving similar outcomes. He uses this understanding to look at every person as an n=1 study. In today's episode, we will be discussing how skeletal biases influence available range of motion, how a person's shape can influence their ability to perform a task, and the diaphragm's role in biomechanics. As I mentioned in episode 30, I highly encourage you to visit the link in our show notes to watch the webinar so that you can see the side-by-side comparisons and visual diagrams that Greg offers to really drive these points home. Anthropometrics, if you're not familiar, is defined as the science of measuring the size and proportions of the human body. By gaining a better understanding of how underlying skeletal shapes and measurements affect movement, you can better understand why people move the way that they do. And now let's cue the intro music and get started.

So if we look at the narrow, they're going to have a higher internal relative pressure. So they're overall— everything's a little bit higher internally. Again, this is based on the physics principles. So in order to move I can't just fold over, right? I can't just fold around these constraints of pressure, rib cage, and things like that. I kind of have to wrap around them. And this is going to lead to a softer, essentially connective tissue. So tissue that's going to be a little bit more mobile and apply for a lot more ranges of motion. At the same time, a wide is going to have the opposite. So their pressure isn't as much. They have this less constraints, especially since the rib cage doesn't drop down as low. And they're going to be able to fold in half at certain locations when they do things. They'll be able to move in certain locations as they do things and not Others. This wider person is also going to have to create a little bit more tension to create the pressure changes it needs to. So they're going to walk around with a general stiffer tissue. We tend to do good at things we're good at. And so based on Laplace's law, we're already stiffer. We're going to drive even that more stiffness solely for the movement factor of things. So you're going to have a stiffer individual usually with a wide person. When it comes to relativity, just the basics. We'll go in here in a second on a little bit more on this. So as before, sum up some of the stuff we talked about when it comes to basics is the anterior pelvic floor is going to drop on a narrow. As the rib cage drops, the external obliques are going to pull that ISA narrow, and we're going to have an eccentrically oriented diaphragm because of that. So if my diaphragm is attached to my ribs and my diaphragm drops, and then my external obliques are also attached to my ribs, and I wrap that around my guts. So where that movement comes into play, I am Wrapping the diaphragm essentially around the guts through the external obliques is going to lead to the stretch of the diaphragm, which now from a length-tension relationship standpoint as well, won't be as good at firing. Where vice versa, when it comes to a wide individual, they're going to have an ascended pelvic floor based on pelvic position. I need to inhale. These are compensatory concentric internal obliques. And so that's going to pull the rib cage open and wider. It's going to lead to a more concentric diaphragm. So that are kind of getting air in at that point and not as great as getting things out where we need to be. And this is all anteriorly. So if we look at that from a movement standpoint, we're going to have these angles that drive certain motions. So if we look at the helical angles, we look at the pelvis being a little more nutated for wide and the pelvis being a little more counternutated for narrow. What we're going to find out is that just like the leverages from a helical angle standpoint, We're going to have this ability. So we're going to go where our guts is because that is how we maintain center of mass from a balance standpoint. If my weight is forward, my guts are forward, I'm going to go forward. If my guts are down, I'm going to go down. My guts are back, I'm going to go back. Just from a center of mass standpoint, from physics, that's how we maintain our balance. So if we look at that from a wide versus narrow, we'll see that as they go to nutate and do things, an individual is going to nutate better if they're wide. So therefore they're going to be able to essentially deadlift better. They're going to be able to hinge better. Whereas someone who's narrow is going to tend to be able to squat a little bit better solely for the fact that they have this pelvic floor that the guts are going down and forward. They have that eccentric anterior pelvic floor down and forward where we have this more open posterior pelvic floor in someone who's nutated. So they're going to be able to get their weights back. We're going to go with our guts because we have to stay over our center of mass. Where if I go to squat with an individual who's wide, they're going to have to kick their butt straight back. They're going to have to do a little bit more of a hinge in their squat. And that's based on the setups of their natural positioning. And so you can see there, we're going to go over that here in a second, but I just want to hit on this real fast in regards to like a soft tissue. And we talk about the wrapping and the overall stiffness versus eccentric orientation and mobility. So someone who's narrow is going to have softer, more pliable soft tissue, and therefore they won't be able to utilize the soft tissue as well to store and release energy. So they're going to have decreased power production because they have to solely rely on muscular activity More so than someone who's a narrow or a wide. And this, again, this is the base level. And so they have to use more energy where— and so they have a tendency to use more contractile elements, which is a higher energy rate. They have to use a lot more muscle firing versus utilizing some connective tissues. Where here we have a stiffer tissue with a wide individual. And so they have increased power production because they're very good at utilizing the stiff connective tissue that naturally occurs based on that structural setup of the individual. We have all that, and we mentioned before how we have these positions of the pelvis and how wide someone is. So if I look at an individual who is a narrow, they're going to be biased towards external rotation measures. How does that work out? They have this AP expansion. If you look at their hips, they're going to have this positioning of their hips here. So we have their hips, they have this retroverted hip. This is going to allow for full excursion of external rotation of the hip. At the same time, because they're down and they're in, so they can get all the way out here, but because they start off in somewhat of an internal rotated position, when we go to measure or we look at it, they're already started there in that position. So they won't have as much active or passive motion necessarily in that position. So if we were to measure someone, we'd assume that on the table, someone who's a narrow will measure with larger degree of external rotation naturally, with a little bit lesser degree of internal rotation. Comparably to a wide. And so this plays out into what we would expect when it comes to movement capabilities and range of motion, essentially when we test on the table. As I mentioned before, when we go to hinge, someone who's a wide will hinge differently than someone who's narrow based on their overall position, naturally occurring structural. Same thing with the shoulder. If we look at how these shoulder blades are, the shoulder can wrap around more. This now puts— if we look at it from a movement standpoint, This is here. We have these muscles as we do a lot of reaching, a lot more active motion within our upper body, a lot more overcoming actions, versus we kind of rely on gravity a little bit more when it comes to lower body. We push against it. What we're going to have with a shoulder is as these shoulder blades wrap around, I have to do things. I have to survive. I have to reach because we're a world species. The muscles that drive external rotation are typically going to be a little bit tighter. And so I'm going to have more motion into external rotation with the narrow based on the muscles and structural setup, where the wide is going to be the exact opposite. So when we look at these individuals and the underlying reasons, this is why we have these certain positions and why certain motions are going to be the way they are. So we look at these 2 individuals, neither of them can really touch the toe, but they're going differently. If we look at Why they go where they go. So if I have this individual here, what we can see is a very flat spot here, very flat here, where this individual, they're flat more right here. This round more here, where this, we have a little bit of a round here and a lot more round here. So what this is letting us know is where we have our movements. So as I mentioned before, we have this wide ISA. We have these constraints. He doesn't have anything here that limits his movement. Like, literally within his rib cage, he can fold right there. So if you take that rib cage, we're going to drive it straight across. We have like the infrasternal angle right here. They can fold there, which gives him that ability to essentially reach down and touch his toes. He has less pressure in here as he does so because of the wide and things we talked about before. However, his sacrum is nutated, so therefore he has this flatness going on here. So that doesn't really counter-nutate too well, where vice versa is going on with the narrow. So we have this individual again, both can't touch their toes, both are very tight. This individual has this very flat spot because he can't fold here. He has these ribs that go all the way down. He has this pressure, this diaphragm that's descended all the way down. It's creating this pressure internally here, so he cannot fold Where he needs to, it just stays flat. So he has to wrap around it up top and wrap around it down low. So he has this counter-rotated sacrum, and he can fold under there, or he can fold here. And we'd expect this. So this is not one of those things where it's like, oh, I need to get him to look like him, because they're 2 different individuals, and the way they get to what they're doing is going to be different based on these underlying principles, these underlying physics. of the body themselves. So we have to appreciate these things when it comes to intervention. So if I'm trying to get better movement out of someone, I'm going to drive a different strategy with each of these individuals in order to get them to— if I wanted them to touch their toes, if that was the goal. We have to understand that that is what's going on.

Today's training is brought to you by Southeast Professional Education Group. Are you a healthcare provider interested in teaching? Have you developed content or a curriculum but have no idea how to get started in continuing education? Maybe you sit on the board for an association or group that wants to offer a virtual summit or live conference, but the logistics, planning, and marketing are just too much for your volunteer-led group. If these statements have you shaking your head yes, then it sounds like you could use our help. For almost a decade now, Southeast Professional Education Group, also known as Southeast Sports Seminars, has helped individual instructors, membership organizations, higher ed institutions, and group of all sizes create memorable virtual and live events in the healthcare continuing education space. We have the experience, the know-how, and the infrastructure to help you bring your event or course offering to life. For more information, visit the link in our show notes to schedule a call with a member of our team. We can't wait to speak with you.

Now, those are just the 2 basic underlying things. And we just take that out. I'm gonna show you some pictures real fast. of what we have a tendency to do as well. So I know you say, oh, no one's just these catch-all archetypes. No one's just wide. No one's just narrow. I see people of various different sizes, yada, yada, yada. And I 100% agree with you. But what we see here primarily is these structures here. So we can just say they trend in this way. So we'll have like the V'd up individual, the wide hip individual, and then the really broad, the general cylinder type. So we have someone who's just a rectangle, someone who's very V'd up, And someone who has kind of like a narrow top, wider bottom. That's going to influence how we move, primarily, as we mentioned before, the different pressure changes needed to do things. So if we look at these 3 individuals— so all 3 of these are athletes— all 3 of them present differently. So this is someone, as we can see, wider hips, narrower shoulders. We're on the farther end spectrum. We have wider shoulders, narrower hips. If you look at them just from the get-go, you can see they look differently. If you were to pull his shorts up a little higher, his thighs are a little bit thicker compared to his. Now, obviously, this guy's flexing. He's a kid trying to show off a little bit. But you see he's different where this guy in the middle is about the same, or AKA he's asymmetric. Actually, you can see the left shoulder higher than the right shoulder. He is more of a wide on the right, narrow on the left. And they're both force-producing athletes. All these guys are athletes. They need to create a lot of force. So what we have occurring here, if we look at this and we compare these, It's all about the pressures. He has a super narrow rib cage, this wide pelvis. If he wants to produce force, he has to create that intra-abdominal pressure. He has to create a sense of increase in blood pressure to help drive movement. And so he has to drop that pelvic floor super far down because if we have a little bit of stuff, so we have this narrow opening down into this wide bowl, in order to create the pressure needed internally, He has to drop that diaphragm, create a lot of pressure down because it has to go so far down because there's this big bowl to fill from this little itty-bitty faucet, if you will. So that push down where this individual has the exact opposite. He has this wider, big bowl twist up in a little bowl. So as he inhales or as he does things, it's a drastic increase in pressure. So the pressure increases quickly. So therefore he's able to produce force, this intradominal pressure. The different type of forces a lot faster than this individual here. And we can see that the strategy in order to produce this force into the ground, for these forces to get recoil, to get strength, increase power, they're going to have to use different strategies to do so. This individual right here who has the V is going to jump higher compared to this individual. If he— and this individual, in order to jump higher, he's going to squat down a lot more. He won't be as elastic. He's going to trend more towards what would be in the lower body. A lot more narrower archetype, a lot more tissue, a lot more muscle activity, contractile elements needed, where this individual is going to trend more towards a wide from a lower body standpoint and get more stiff. And this is based on the pressures created, the pressures needed to do things. We can see from the side how they present it. The guy on the left, huge, huge, what we would say like humpback, if you will. Right. Strong anterior shoulder, strong forward head. This individual, not so much. He's kind of in between because he's about the middle. But also we can look at the guts here. He has this morlordosis going on, a little bit more lordosis, not so much. He's had to create so much pressure. You can see the abs on here. In order to create the pressure he needed to perform, he had to turn the rectus abdominis on to create this pressure. And this is based on what he wanted to do and based on his archetype, his bodily structure. This was the only way he could produce the forces he needed to produce. Where this person doesn't have to do nearly as much. We'd expect him to be faster, springier, A little bit faster out of the hole. This individual will have a little bit more longevity, going to probably run a little bit longer, won't be as fast, but maybe going to move a little bit better within the hips. Up top, he's going to be super tight, probably super stiff. From the back, we can see the same idea. Look how wide this is up here in regards to wrapping and rolling around, and how wide this pelvis is and the hips based on this, trying to create this tension to create the movement that we need. And same idea with this individual is going to be the opposite. So we can see that based on the underlying constraints, that different individuals are going to require different strategies to produce the forces that they need and the movements that they need in order to achieve their goal. I'll go here and we look at now weight difference, obviously, but Dwight Howard's known for jumping out the gym and how beat up he is. He always been known, super wide shoulders, super small hips, where Shaq was more of a mass guy, the strong power, couldn't jump. The knock on him was couldn't jump over a pencil coming outta college, right? But his setup isn't made to jump very high on top of the other things. And so he is strong though, sturdy, thick legs. Vice versa, skinny legs, quick, bouncy, strong up top, but maybe a little top-heavy. I want you to understand with this presentation of how the body sets itself up based on these underlying principles, underlying structures, they're going to drive essentially how we perform these movements. So we can't expect 2 people like this or 3 people like this to move the same based on literally their bone structure is different, their internal organs are different. In order to survive, they have to do different strategies just to get the air in. We can influence them through our strategies, but we can never make someone who's wide and narrow— they're going to utilize different strategies to perform. So we can never make someone who has this wider hip, wider shoulder, look like this individual. We can bias it a little bit, right? We can make it a little bit better, get anything— interventions that kind of squeeze the hips in, widen up the chest, and vice versa with this individual. But we're never going to make them different. They're always going to have these underlying structures for— we have to appreciate that when it comes to looking at what's the range of motion, how are they moving the way they're moving, and why do they move the way they do, and why certain interventions work better with other individuals. And so that's what this— hopefully you got that understanding and see how these structures of internally, just the rib cage, the pelvis drives so much of the movement when it comes to biomechanics and how we essentially accomplish the tasks that we want to accomplish.

Today's training is brought to you by Southeast Professional Education Group. Are you a healthcare provider interested in teaching? Have you developed content or a curriculum but have no idea how to get started in continuing education? Maybe you sit on the board for an association or group that wants to offer a virtual summit or live conference, but the logistics, planning, and marketing are just too much for your volunteer-led group. If these statements have you shaking your head yes, then it sounds like you could use our help. For almost a decade now, Southeast Professional Education Group, also known as Southeast Sports Seminars, has helped individual instructors, membership organizations, higher ed institutions, and groups of all sizes create memorable virtual and live events in the healthcare continuing education space. We have the experience, the know-how, and the infrastructure to help you bring your event or course offering to life. For more information, visit the link in our show notes to schedule a call with a member of our team. We can't wait to speak with you.

That's it for me. I try to keep it to an hour, and I think it's a pretty solid discussion there. I don't know if you have questions. I'm definitely available for those now. Thank you again for your time. I really appreciate it.

Wonderful. Thank you so much. This has been a super informative presentation. Again, I know a few of you had to drop off a bit early due to kind of getting back to clinic. Totally understand that. But those of you that are still there, if you have questions, feel free to chat those in. I went ahead and recorded the questions that have come in so far, and we'll go ahead and ask those while you guys are thinking of some others. Going back to the beginning of your presentation, Greg, you mentioned that your education has come from several different sources and mentors. What advice would you give to a new graduate in regards to how they develop their plan for continuing their education after school?

So I'm a big fan of going vast to narrow, so start wider. And so you want to find out what your goal is overall. So what do you want to be? Where do you want to go? Where do you want to end up being? And so look at things based on first principles, trying to find things that teach you the basis the good base of something. From there, I think you pigeonhole down more so into what you focus on, what's going to be more beneficial, more useful for you. So I like to look at courses that have a good vast knowledge, and then from those courses you then go even more specific. I like to take courses, I like to read papers. I think all those things really matter because how you see one thing, how someone else sees something, can be completely different.

Absolutely. I completely agree with that. And that's something that obviously as an education company, we value. Someone was saying too that, and they were reiterating what you were saying in your entire presentation here, that we really need to look at each individual's body as unique. You talked a lot about 2 main archetypes, and I know obviously there are more nuances within that of the narrow and the wide.

Right.

What are some ways that you assess to determine what body type your patient has?

So the big assessment I'll utilize, one is when they walk in, I would tend to look at how they're shaped based on athletics first. So if they are the funnel versus the inverted funnel, so the guy on the left versus the guy on the right. And then from there, I will use an infrasternal angle. So the rib cage position I check. So essentially, there's several videos from Bill Harmon. I'll also post those too. But we go over this is you place your thumb or fingers underneath the rib cage on the infrasternal angle, and you see how they breathe. When they breathe, does it widen? Or does it not widen? Does it just come straight up and close down on the exhale? That lets us— informs us to know what musculature they're utilizing to create this inhalation and where the fluid in the guts are moving as they do so. So I do an infrasternal angle check. It's supine, arms up reaching overhead without their low back arching too much or at all, preferably. And so you just hold— you just mark there right below the rib cage, let them breathe. And does it do this and stay there, or does it do this and then come back like that?

Great. Absolutely. Now, you also had talked a little bit about how this wide versus narrow structure affects things like the pelvic floor. We've learned, especially in recent months with some of the other trainings we've had, that pelvic floor dysfunction affects athletes, men and women, not just our postpartum cases and things of that nature. How have you found that this wide versus narrow structure has presented when it comes to pelvic floor dysfunction cases in your practice?

So what I've noticed is you'll see that you have 2 kind of different types of pelvic floor issues. So I like to say, well, for me, I'll sum up to 2 separate things. You have the one who kind of pee their pants, and then you have the guys who can't poop. And so you'll have people who can't hold it in. And so essentially what that is letting us know is a lot of times you're going to see that more on a narrow individual. Now you can see pregnancy changes things completely. So I will say that that does change some things up overall because of just all the soft tissue effects and how it affects the bones and how much laxity can occur. But overall, what we're looking at is generally when you have a pelvic floor issue, you either have a— you're at the 2 ends of the spectrum. So you have an extremely, extremely inhaled diaphragm where you're pushing the guts down on pelvic floor, so it can't now contract. So as I jump, I get this extra stretch. So the pelvic floor becomes very eccentrically oriented. So length, tension relationships are all jacked up. It can't raise the guts out of the pelvis, which is why when we jump, it is— you drop down and boom, the muscles have to relax, they give, and then you get a little leak. Where you have the opposite individual where the pelvic is so tight, everything's so squeezed up, everything's so tight that you can't pass bowel movements based on the fact that their pelvic floor is too tight itself, right? It's too concentric. It can't relax enough to actually let things drop, let things pass through it. And so that's where you'll get some constipation. And things along those lines. So what we notice is in order to help with that, you have to unload the pelvic floor. So utilizing the physics principles, a narrow versus a wide, a narrow is generally going to have to get them inverted and get the guts moving away from the pelvic floor and dropping more anterior to them to create some space, open up that rib cage to get it go in that direction. Where wide, you want to invert them a lot of times is going to be from an orientation If we have the same thing with the loose and orientation of the pelvis where everything drops forward, have strong anterior tilt, if you will, strong lordosis. And what we're trying to do now is trying to get that back and push that spine, utilize the weight of the guts, invert them to come back on the lumbar spine so they can help push that down and create more of a new counter-rotation of the pelvis. Does that make sense? You'll trend towards a narrow, having more of the eccentric pelvic floor.

No, that's great. I think those are great guidelines to look at as well. When it comes to a lot of the breathwork training that you're doing with your patients, I know that was kind of a big focus of this presentation was making sure that they can create pressure in the right way, that they're breathing properly. How does your breathwork training change for a very narrow frame versus a wide? Because it sounds like If you can get them breathing properly, that really unlocks a lot of other places where they may be having some dysfunction.

Very much so. So I say breathing properly, but it is very much about getting that diaphragm to go where you want it to do, and then getting help from the superficial muscles, the muscles on the outside that we discussed, like the IOs, EOs, and the transabdominis, to assist in driving the guts to move in the right position. So if we have someone who has strong external obliques— so external obliques are very strong What we would say exhalation muscles, they pull the rib cage down, they close the ISA. If we want to open that up, we need to make sure they don't fire as fast. They do— we delay their onset of firing. So we bias a sigh of an exhale. So you do a nice little, nice sigh out, or just nasal breathing even, but that's going to decrease the external obliques function and utilize the other exhalation muscles more so. So we're trying to slow down the time that it takes to get external obliques turned on. At the same time, it may bias a certain reach that drives more of a smushing of the pelvis, of the rib cage to help that as well. But then with that, and you're trying to close up that infrasternal angle. So if you have a wide individual to close that up, you would do a more forceful exhale, either through pierced lips, through a straw, through a hand blowing into a balloon. Any of those things are going to help bias the external obliques. To help close up that rib cage, because it's going to be a faster, stronger, more forceful exhale, and that's going to help initiate that.

How do you feel things like yoga fit into a treatment plan for, for both of these groups? Obviously, you also mentioned how that wide versus narrow body type can also present with sometimes some flexibility issues, either one way or another. One group may be more flexible than another. How does something like yoga factor into helping with both the breathing aspect but then also the flexibility and the tissue?

So this is like, depends, right? As everybody says, this is a very dependent-based question, and that's based on the instructor. So it depends on the instructor, the training, and how things are and what they tend to bias. So the concern I have When it comes to doing yoga with narrow individuals is they already have this tendency to have this floppy tissue. So someone, especially someone who has like the inversion, especially in the hips, this funnel where they're narrow up top, wide down the bottom, they tend to have this flimsiness overall. Their pelvic floor tends to be very descended. So they already have this tissue that's really stretched out, that's really easily pliable. And because of that, they can lack a sense, like they can't get a good stretch in their tissue. Yoga feels good to a certain extent because it drives that stretch, right? It can drive this range of motion within those joints and the different tissues. But the issue is they're already stretched out. And so now you're just stretching something that's even more stretched to get a stretch, if that makes sense. And so we have— we can have this issue with leading to too much of an eccentric orientation, too floppiness within these individuals. Now, again, it all depends on the yoga. I know yoga instructors that drive more of an active contraction. More of an active strategy. And incorporating breathing with that is very important. So you have to make sure that you add the breathing like you're supposed to when you do do the arc, and not to try to strain through things. Because now all we're doing is creating more of a stretch. Like, say if I'm trying to do a certain position and I don't let the guts move where I need them to move, I don't create the rib cage positions I need to present, I'm going to just wrap around it even more and creating more of this bias into that position, if that makes sense. Where it comes to an athlete in general or a wide individual, it can be more beneficial from giving you some wiggle room to create the movement that you need to within the joints and within the interthoracic kind of cavities, right? So if you have really stiff tissues, they may just lock up really tight whenever you try to move. If I can decrease their sensitivity to activation, so like increase their ability to be more pliable, It'll make it harder for me to contract the muscle, create the tension and stiffness that I need that would normally occur, which will allow me to create better movement within that individual, if that makes sense. But again, it's all based on how the instructor goes about it, the yogi. Absolutely.

And again, as you mentioned before, and that was the whole basis of all of this, it's very individualized based upon what that specific person needs. Another person wrote in about that question in regards to weight training. I know oftentimes, especially if you're doing heavy Loaded training, people tend to hold their breath. Breathing goes out the window, especially when you're doing Olympic lifts and things of that nature. How would you encourage both your wide and your narrow patients to make sure they're breathing properly, make sure they're bracing themselves and their, their diaphragm properly when they're doing those heavy weights?

One of the things I mentioned here, the slide right here. So when you're lifting something heavy, you're going to brace, right? I say brace. You want to hold your breath. Why? Because we're trying to limit motion. If I'm lifting something heavy, I'm trying to not fall to the ground. I'm trying to move just enough to hit the depth I want to, create the tensions I want to, and then come back up. And so I'm going to want to hold that breath, maintain that stiffness internally, have that pressure internally, because that's going to help me create force that I need to force. As I mentioned before, that intradominal pressure creates the force, increases blood pressure, all these other things that help you drive and move that weight. The issue is that setup. And so I have this slide here. It says, essentially, respiratory compensation that occurs limits the ability partially due to the fact that you're already starting at a point to a degree in that direction. If I am in narrow or wide and I stay in that position and I like to say, take a breath, right? And I hold that position in that breath position. So if I'm in narrow, as I'm dropping down into that squat and I'm holding my breath, I'm holding that position. I'm not allowing movement to occur with the maxilla skeleton. So when I get closer to 90 degrees, this aspect of it more when we actually put out the full biomechanics course idea. As I get closer to 90 degrees, I require some internal rotation to bias the appropriate muscles within the hip to hold me up. So if I don't have that position as I drop, I'm going to have to cheat or I'm just going to fall to the floor. I'm going to drive some kind of orientation of the spine, or I'm going to just fall directly to the floor because I can't produce the force needed. And so you have to set up your position at the top of that squat, get the right breath position, then maintain that to allow for the motions that you need to in order to hit your depth if that's your issue, or in order to produce the force needed to come out of the squat if that's your goal. So it's going to slightly change based on the individual. All right, I need you to set up, get a more counter-rotation when you go to set up the squat, get a nice big inhale to push you, push the air down, create a little pelvic floor, or We need to get a better exhale at the start and then get a nice inhale based on that position. So it could be either or.

Absolutely. And guys, again, here's— I've got a few final questions here, but again, if any of you have other questions, please feel free to write in with those. These have been great so far. We're still continuing to watch the chat and take those. One of the final questions I have here has to do with body type again. And obviously you have assessed that in the beginning when a patient comes in. What type of conversation do you have with the patient in regards to their body type? Do you explain the things that you're looking for, what you find, and then how that affects your treatment program for them?

That depends, right? Like everything, it depends on the individual wants and needs. Like, so that, that's— that comes down to more philosophical thought process. I want— I, I try to tell the individual what I think is going to be best to get them to do what they need to do, because there are people who like, oh, you have this body type and have this, and also they're neurotic about it. And they can't— everything, they feel everything. And then I'll like, oh, I can't do this. I have this issue. I have this. And I enable essentially some form of compensation mentally, right? And they tend to fall down a path where another individual who's a hard worker, who tends to thrive on certain challenges, I may say, this is the issue. We have to do it this way because of this. They'll understand a little bit better potentially. They may utilize that now as fuel. So I tell them what they need to hear. And then I explain, I utilize kind of the positions of this is why you're in this position. And this is potentially what we need to do to achieve it. If I believe that's going to help them better understand the intervention we're applying or better understand the overall general purpose of the program. And so it's utilized based on what I feel the individual needs to achieve their goal.

Absolutely. And I think that definitely echoes the sentiment that we've heard from so many instructors that are evidence-based in their practices. It's again, very individual in terms of How that patient is going to take whatever type of information you're providing them with. And as you mentioned, for some people, they need all the details and they use that as fuel. But then for others, you certainly don't want to create new issues to go along with some of the dysfunction or the, the challenges they may already be facing. Well, guys, if no one else has any other questions, we're going to go ahead and sign off for today. I know we ran a little bit over 1 hour, but this has This has been a great discussion, wonderful presentation. Thank you so much, Greg. This has been incredible. We really appreciate you joining us today and for this great presentation.

No, thank you guys for being— spending the time with me, and I appreciate you guys staying through. Hopefully you can use some of this, make you think about things a little bit differently.

All right guys, that is it for today's episode. Be sure to tune in for episode 32, where we take a break from our typical training format for an interview with someone who has achieved a great deal in his profession. We'll be talking in depth about his journey and the steps that you can take to expand your career beyond what you can see right now. You won't want to miss it. Episode 32 drops in 2 weeks. In the near future, we're also planning a few special Q&A episodes with our past instructors. So again, be sure to click that link in our show notes and ask any burning questions you may have. If you've found value in the content we provide, the greatest compliment you can give us is to leave us a 5-star review and tell others about our podcast. Every little bit helps. You can subscribe to The Factor Podcast on Apple, Spotify, iHeartRadio, or the podcast app that works best for you. Please give us a 5-star rating to help us grow the show. Every little bit helps. And last but certainly not least, be sure to visit the show notes for a link to download the PDF of today's full presentation, as well as learn about any special offers that we featured in Hey guys, if you like what you heard today, I encourage you to visit our website at factor-store.com. That's spelled F-A-K-T-R-store.com to find out more information about all that we have to offer. We have a variety of online offerings as well as our hands-on FACTOR Rehab System course scheduled in cities around the country. And around if you're interested in learning more about the FACTOR Rehab System, the globe. Be sure to also check out our event calendar and bookmark any of these upcoming live webinar dates coming up in the near future so you can join us live. And of course, the biggest compliment we can receive is for you to help us spread the word to your friends, colleagues, and classmates. You'll find all the important links as well as info about our sponsors in the show notes, so be sure to check those out.