Squatting, we use the ability of the angle to attain at least 15 degrees of dorsiflexion.
We say you can say 12 to 15 degrees of dorsiflexion.
So what are we really saying in the squat?
We're talking about tibial advancement.
I'm going to talk to you a little bit about this because we have a nice trainer here.
You knew this was coming to me.
Oh, yeah. You guys are ATC's, right?
No, okay.
They're PTO's, so personal trainer.
So what do personal trainers tell people to do in the squat?
In relation to their knees.
Keep their knees in front.
Not going past the toe.
They tell them to keep them above their ankles.
Do your knees go past your toes?
They won't like it.
Why?
Because they don't know.
She's going to get funny.
She's going to pass this over to me.
You don't have to do that.
That's why they do that.
Right, so what's the evidence for that?
If we could just find that person.
I feel better.
Yeah, nonsense, right?
When you look at the athletic position, where is it?
What does my skier look like?
What's the sumo wrestler look like?
What is the link tension relationship?
If I keep my knee at, not quite before my toe.
How long could I still...
We'll do the standing up.
How long can you stay in that position?
Five seconds.
Drive your knee past your second toe.
How long could you stay there?
I don't know.
So it's a no-brainer.
It makes no sense.
It was standing up, in fact.
So where did it come from?
It came from people who couldn't do it on one side.
And if you keep doing this,
you'll tear out a knee or a hip or a back.
The rule is keep your butt behind you when you lift.
Well, when we do this test,
if one leg can't go forward,
but you go forward with the good one,
you're twisting, you're not keeping your butt behind you.
So you get injuries.
That's where it comes from.
It's a functional adaptation saying,
we don't know why,
but we'll just tell people not to injure themselves there.
But what we're proposing is we actually fix it.
And then you're going to have to take their knee past their foot.
So it's that tibial advancement we're looking for.
Ideally, the knee should travel past the toes.
So we're looking from the front, looking at it from the side.
Like Neil's is saying, look at that symmetry.
One side and one the other.
That's going to tell us what's happening at the ankle more
than at the talus.
We're going to add this.
That wasn't in the notebook.
It's very easy to do.
After we do this.
Okay.
Operator stands facing the barefoot patient.
Feet are parallel and hip width apart.
Squat as far as possible without lifting their heels.
So we're looking for the first thing around the back.
Can they squat?
And again, what I tell my patients is,
I don't want you to drop your hips below your knees.
How far can you drive your knees forward?
Keeping your heels on the floor,
but keep your hips above your knees.
So we're talking about the ski jumper.
That's my squat.
This is not my squat.
That tells me nothing.
They fell back on their heels.
So we're not testing
trimelay or motion in that position.
We can only test that by driving
the tibia as far forward as we can,
keeping the heels down.
That's our measurement of ankle dorsiflexion.
Okay.
So trimelay and emotion is needed dorsiflex,
consisting of E version, four foot abduction
and posterior tailored glide.
Those three dysfunctions,
the last pass we gave,
we showed you how to treat those dysfunctions.
We're not going to do that this time.
We will show you how to do a talus.
It is a very common finding,
and we'll show you how to do some hip stuff.
So let's get your partner to stand up.
We have a foot in here,
and let's see what the squats are like.
So, again, we said basically
what we're doing is just dropping those knees forward
behind his body forward, ski jumper.
That's what I want you to do.
It saves a lot of talking.
Okay.
And if you see this,
what's the problem?
Where's the problem?
Right here.
This can advance, that can advance.
Is it in the tibia?
It could be.
It could also be hip.
Remember, this is weight bearing.
So it's the interaction of the hip
and the ankle.
And we're going to do a hip motion together.
That's why we'll do the Mitchell test,
which is just the ankle.
That's what we're going to do.
It's like non-weight bearing, weight bearing.
And then we'll do a hip test,
which tells us about hip.
Huh?
So weight bearing on the hip and ankle.
We're testing motion and ankle and hip.
And they do it together.
Because we're reducing
internal rotation of the hip
when we squat,
internal rotation of the hip.
One thing I try to get all my patients to do
is that.
Can you do that?
Can you do that?
No!
I'm 60, and I can do that.
And I keep making sure I can do that.
You're 60.
Yeah.
But that's what we're saying.
It's that motion.
That's what we're saying.
To squat, we have to have that drive
head into the ground.
That's what happens when we walk. We screw our leg into the ground.
And to do that, I have to have dorsiflexion here
so my tibia can advance forward
over my foot.
Period.
So this is, how many people work with athletes?
This is the first test I do on my athletes.
So I'm going to squat.
Sorry.
You need to, yeah.
Because we've got to change these things.
They don't care what the sport is, you're not going to be able to do it as good as you can.
You can't squat.
There's everything in the lower extremity, this test.
And yep, femoral head
and ankle mortis.
If they got great motion there, they got great potential.
But if they got a kink in any one of those,
I work mostly with the swimmers.
Same thing. They got to squat.
Because the motions they do in the water,
their kick position, their turns,
all this kind of stuff requires that motion.
Okay?
So let's look at that stuff.
Look at their knees. Do their knees track straight forward,
roughly over a second toe?
Does that collapse in or does both sides collapse in?
One of their hind foot
collapse more than the other.
Does their heel pop out?
Can they stand straight to begin with?
Or is one foot
externally rotated because of a stiff hip on that side?
Okay.
So look at all those start things.
Look at the finished things.
Sure.
Okay, why don't we just run through a bunch of you
and we'll give you our clinical impressions.
Yeah.
Okay, so everybody who wants to be evaluated
on screen,
step on up here.
Candidates to start.
Okay.
Feet hips width apart.
Okay, so she doesn't,
we don't see any,
we see a little bit of external rotation on that leg.
A little.
It may or may not be fully significant.
Okay. Does the other shoulder,
let's have you do the squat, keep your knees.
Okay, what do you guys see?
I mean, just run to the back.
Does she get her knees to at least her toes?
No.
The right goes a little more on the left.
See the right? Better than the left.
Yeah, you see that? Yeah.
Does she cave in that really? A little bit more on the right,
but again, we can't look at that yet because
she's got a restriction going here in the hip on that side.
So again, all we can say is
she goes better forward on the right than she does the left.
She doesn't really complete the test in saying
that she's got the motion we want her to have.
You're done.
You can stop right there.
Okay, next.
Todd, let's have you do the step up.
We'll have one guy here.
More of a guy?
Okay, so let's just right off the bat.
What do we see?
Okay. How's it look?
Look.
Back up.
Turn sideways for us, Todd.
Okay, and do this.
If you're not sure about how far it's translating there,
get them sideways in both directions
and have them go out and see what you get.
Say, now look at his knee.
Draw a prom line straight down from the front of his knee
to his toe. What do you see?
Is he making it?
Or is he thinking?
Let's do this again.
You would think that his right leg is the problem.
Because he's cheating.
He's doing what your athletes do.
Do your squat.
Watch what he does here.
So he can get that right knee farther if he does this.
But it's the left knee that he's trying to make up for.
He's externally rotated here.
And so go down again, Todd.
Now look at where his, like Neil just said,
look at where his right knee finishes
compared to his left knee over the foot.
What's he doing?
Once we told him to quit, he's cheating.
His butt is kicking to the right.
Driving his left knee more lateral over his left foot.
So you have to look at the whole thing.
Because he was doing a great job of cheating.
He thought, I'll just rotate this way.
Now I don't have to internally rotate that.
But once he did this,
now we can see the left was actually a big problem.
If we lack motion in the sagittal plane,
we're going to spin.
If I can't flex forward fully, I'm going to rotate.
Almost.
Okay.
Watch your heels. Watch what happens here.
Bombs here. Heals want to pop in.
Right.
So based on that, what would you say?
What could be causing that?
A problem below the pelvic pain line.
Because she's doing both sides.
Right? That's what she said.
Both sides are doing it.
That means it has to have neurology from both sides.
Where's the first place she has nerves
from the left and right side of her body?
That's going to be the rest of the class.
But her hips are involved here.
But her hips are involved.
Big time.
I have a question.
Okay.
What does that mean?
It means that you're not.
You don't have the motion.
So you're forcing yourself.
You're using muscular effort.
Which is why you would have plantar fasciitis
or shin splints when you run.
So what would you say if it's Alice?
That's right.
So let's do that.
Has anybody done this before?
You guys need to keep going and do that.
Can you do me?
Let's see if the talus was involved.
That's it.
The talus is involved.
The hip is involved.
So what do we see here?
The lateral rotation on the right leg.
Again, the talus is not good.
Look at the right compared to the left.
Where does she start?
With the right leg.
She's extremely rotated.
We know she's got a stiff femur on the right side.
So if she comes in now,
she's going to collapse immediately on the left
to compensate for the stiff right hip.
She'll move the right knee
toward the midline
to accommodate for the stiff,
extremely rotated right hip.
She has bilateral bunions.
Herology from both sides of the body
is involved.
She's a chronic grasper.
Toe grasper.
And that's why she has a really flat,
long bar spine that does not move.
She couldn't attain
this part of it.
That's the pelvic part of it.
Because what do bunions do?
What do bunions make the body do
at the hips and pelvis?
Because they don't want to go off the first rate.
I don't want to roll off it here.
That hurts.
So I'm going to have to externally rotate the system
to walk like a cowboy.
To keep my feet from hurting.
What's the cost?
I cannot walk like that.
I believe nobody's safe in here since.
But these are patterns that you see
to go, well, why is that?
When somebody comes up with bunions, what do you know
pretty much what they're about?
Which side's worse? Well, that's my externally rotated hip.
So I know where you're not rotating from.
So you're going to start piecing that together
by mechanically.
Now you guys have that.
If your hip's externally rotated, you're going to fall off
the first ray inappropriately.
You're not going to be able to come over the top.
You're not going to be able to come over the top
in an externally rotated position.
As you come over the top, the hip has to be able
to internally rotate to get pressure over the first ray.
The hip's externally rotated.
And they're going to get medial knee pain.
We can also,
then would that also cause
like the
SI to constantly
not stabilize?
It's going to jam in the back and gap in the front.
This will back
this thing from hip pain, low back pain,
neck pain.
I mean, people with bunions and flat feet
what are their complaints?
Yeah, for different reasons,
but they're still going to ding the same reasons.
So is it coming from the
first manifesting in the feet,
or is it happening in the feet and traveling up?
Yes.
No, but you understand why, right?
I mean, yeah, the feet have to
make the world flat.
They have to keep my eyes level.
Hypothalamus demands it.
And it gets really ticked off,
if not,
what Neil's Leckers is about.
If I can't keep my eyes level, the neurology's got to
go nuts.
I got a hole here, and I got a hole here,
and I got a hole here, and I got a hole here,
and I got a hole here, and I've leveled.
Oh, okay.
But you see that patient come in and go
that's down, up here.
So you start putting those pieces together.
It's okay, who's holding up the system here?
Because hypothalamus can't make the correction,
So it facilitates areas in the body
to maintain that ability to keep the eyes low.
But there you guys start to ground up and say,
oh, okay, who's digging me?
Yes, a lot of areas, okay.
So did everybody finish the squat?
Yep.
Okay.
Foot squeeze.
We're gonna turn it down a little bit.
I see where we're gonna do the whole list, okay.
So let's, yeah.
Why don't you look at them?
Foot's off.
Let's do Mitchell.
Yeah.
Mitchell, oh, okay.
So let's have somebody.
