Podcast Episode 8: A Clinical Case Study With Bill Hartman

Bill Hartman PT Is An Absolute Genius

Bill Hartman Interview


 

Scott: So today we have an awesome guest on the podcast and this is someone that I can consider my mentor and he’s one of the main reasons why I got into physical therapy. So, without further ado, you want to introduce Mr. Bill Hartman. And so before I let bill speak here on until everyone, a little bit about bill. So, Bill has over twenty five years of experience. He is a physical therapy by trade, but he also is an awesome performance coach. He is the owner of High fast physical therapy and sports and conditioning. He is an author, international speaker, and he is one of the US leading PT’s. So without further ado, please welcome Mr. Bill Hartman on the podcast today.

 

Bill: Thanks for having me Scott I appreciate it.

 

Scott: So bill, why don’t you tell our audience a little bit, some things that maybe I didn’t talk about. What made you get into PT? 25 years ago

 

Bill: I just didn’t have anything to do at the time. So I was working on my master’s degree in exercise and I was slowly turning into this lab rat where I was spending ridiculous hours, you know, sitting down in a lab watching people run on treadmills and ride bikes and, you know, measuring things for the metabolic carts and, either ways it was, it was great training. It wasn’t interesting to me at the time and having you know always been on the sports side of things and the fit side of things and the training side of things, I was already working as a personal trainer way back then, so this would be 1988, I think. And, so it just seemed like a way to take what I was already interested in and being able to apply it in some way, shape or form. And so literally I just started applying to PT schools at the time and, got into it and just slowly evolved over the last twenty seven years ago. Yeah, twenty seven years now you know, just trying to get better every day.

 

Scott: Yep, I think that’s one thing I took from you, my time mentoring you is you’re always evolving your thought process and your assessments, your treatment, and you’re always trying to further yourself. So I think that’s something I think all PT’s can take from you. Something I’ve learned tremendously from. So Bill go ahead, let’s talk a little bit about your case today. So you have a fourteen year old volleyball player and I was this obviously a female, I’m assuming.

 

Bill: Yes.

 

Scott: Why don’t you tell our audience a little bit about the subjective history of this patient?

Bill: So, I’ve got to tell you this girl is an animal when it comes to being an athlete. So we’ve known her since she was ten years old and she could not get a perfect set than Chin ups as a ten year old. So I’m quite the athlete, but just like, you know, the (unlear) compare athletes like her too, to like superheroes that don’t, how to control their superpowers. And, you know the things that make her greater things that can destroy her and so she can really push yourself hard. And so, you know, she has trouble with an on switch, so she’s started to develop this progressive lower back pain through her high school season. So she’s a freshmen that actually started on Varsity and obviously got pushed very, very hard. You know, being one of the younger, younger athletes, so developed some, some progressive extension based back pain. She’s very comfortable, lying supine.

 

Bill: She doesn’t experience a painted nighttime, but anytime that she’s challenged with a high intensity activity or develop some level of fatigue, she becomes quite painful. And so again, anything extension, basically you think about serving a volleyball or, any you know, extensive overhead reaching substance, just setting or whatever she’s going to be reinforcing that, that extension pattern, that’s where she gets a lot of her pain. Will wake up occasionally with, back pain as well but she didn’t show any peripheral symptoms. Nothing that would point towards anything that, that a neurologically related, if you will, that would warrant some extensive concern over nerve root issues are personalization. So that’s basically where we started.

Scott: Now was she more unilateral or the pretty centralized?

 

Bill: I pretty left sided but I mean you know with an extension based kind of a concept here. She’s going to be, be clenched it to central not really a major concern for me. I fully expect, you know, based on the model that I worked from that we’re going to see a little bit more left sided extension based activity in general. Just being a human we’re going to see that. So this is no surprise for me, the concern that I have is, is with her is you know how well does she manage her this is not something that that’s going to disappear. What this becomes is a management process and then, you know, making sure that she’s able to maintain her ability to extent she’s going to have to extend. So, we don’t want to take that away from it. We just want to be able to manage it and make sure it’s not painful.

Scott: Sure! So, based on your I’m just going through some of your objective tests that I saw that you sent me, so I was going to go ahead and kind of read those and then turn to the audience and then maybe we’ll look. You kind of describe why you tested some of those things? And why you kind of went that route with your exam? So, just off the bat, I see she’s got limited left shoulder flection, limited shoulder abduction, horizontal abduction on the left, left shoulder external rotation, limited, positive for limitation, positive hip abduction on the right angle, and she had a limited rotation into thoracic rotation to the left. So maybe this Bill kind of take us through your assessment process kind of overall, I think it’s a little bit different than your typical physical examination. So maybe just talk about that first and then we’ll get into some of your findings.

Bill: So, what I’m doing with my examination. So I don’t care what the diagnosis is, I don’t evaluate parts, I evaluate humans. And so I evaluate position and using the (unclear 8:43) skeleton mobility and movement to identify the axial skeleton position and movement. And so what this does is it just tells me how this person is managing their ability to move through space, and manage the pressures inside of their body. Right? And so if you think about put anyone in a stressful situation and if you challenge any system of the body, it will reduce its degrees of freedom. So if we look at blood pressure, right, if I stress you out, blood pressure goes up and it, and it will tend to remain elevated until the stressor is alleviated.

 

Bill: If I leave that stress around long enough, I’ll get peripheral adaptations that will stabilize what pressure at a higher level. So now I have a more cooler blood pressure, but it is elevated. So the movement system is very similar in that respect. So what I have is, is a person that’s exposed to repeated stressors and so, so this athlete is going to try to reduce or degrees of freedom to help her manage the stress. And so the easiest way to do that, it’s a shift her center of gravity forward and begin to function in a much more extended positioning. And so that’s what I’m measuring here with her assessment, if you actually look at the numbers that I gave you, you’ll see that she’s very symmetrical.

Bill: Although there’s some differences, certainly she’s very symmetrical. So she’s got extension going through her system from top to bottom, right. And this extension is actually occurring above the pelvis in the spin above the pelvis. So the pelvis is now oriented, it’s oriented into a position where a lot of people would call that an anterior tilt, but it’s not a tilt in the pelvis itself, it’s above the pelvis, which is why she’s got this wide (inaudible) infrasternal angle. So when I extend the spine, pelvis, I have to extend the thorax as I extend the thorax, the (inaudible) infrasternal angle angle going to widen and based on the role of internal obliques, pecs and such. And so what I have now is a person that cannot manage the pressures inside of her body.

 

Bill: So I have a descended diaphragm, I have abdominal muscles that can’t contribute to controlling the rib cage and allow the diaphragm to function as an effective response to a torn muscle. If it’s always descended then I have somebody that’s typically hyper inflated. So think about putting all of your air on to the lower granted your rib cage. Right? And if I can’t move that air pressure out of there, I have somebody that cannot bend forward so I cannot flex. Now she can touch your toes, but then the question becomes what’s the qualitative aspect of that measure is like, can she reversed her lumbar curve and she can’t. So everything that she does, she’s already in an extended posture. So she’s limited or degrees of freedom to allow her to manage whatever stressors she’s exposed to. And then this starts to interfere with her ability to access all of her movement options. So that’s what we’re measuring when we’re doing this evaluation and that’s why you’ve evaluated the whole human, because again, we have to use the (inaudible) axial skeleton to help us identify what that axial skeleton is actually capable of. And so again, that’s what we’re looking at with the evaluation.

 

Scott: So to sum that up basically for audience out there you know you are seeing a lot of this extension pattern because people are can’t deal with the local stresses, whether it be daily life, sport recovery, and so they fall within this extension, extended based posture, rest of the anti gravity tone and creates a cascade and limits your mobility and obviously she’s stuck in extension. So when she has mechanical back pain in the extended position.

 

Bill: Right! So, it’s just as we were saying she’s just living in extension. She actually utilizes it. The system learns that it’s an easier way for her to manage and it’s always going to be cumulative stress, you know, it’s never going to be one thing. We can’t ever isolate out any one particular thing. All systems are integrated so in essence, I have no idea why you know she’s extended. So I don’t worry about that what I want to do now from a treatment perspective is not to achieve an ideal of any kind. What I want to do is to restore the variability back to the system to make her more adaptive. She’s given up adaptability to manage what she was experiencing, whether it be physical, psychological, cognitive, however you want to look at it. And so now we’re gonna move to treatment. And again, my goal is not to try to introduce some ideal posture, some ideal movement. what I want to do is I want to restore all of her movement options that should be available to her and then her system figure out the rest.

 

Scott: That’s great, I think you know a lot of different people out there that think that there’s one way to move and they’re, like you said, just giving her variability and options as in sport. You know, you’re going to be in to some different positions in all three planes and you need to have that variability to, for the system to get in and out. Otherwise, you know, your options are limited. You’re going to be stuck in a position and you know, there goes an injury, right?

 

Bill: Right! And then not necessary injuries guys you know we don’t wanna again, injuries is such a build defined concept. All we are dealing is with an unpleasant situation, right? And, and you know to alleviate pressure, tension, load on a specific structure that the brain is going to recognize and it’s going to say, you know, what, to take the pressure off of this and so it’s going to make it hurt and where she can’t take the pressure off because you don’t know how to manage, you know the stressors. You don’t know how to, to shift pressures inside your body to allow you to access motions. So again, we don’t ever want to try to achieve an ideal. And the thing that I was teaching my students is like, okay, so if there is an ideal, how do you know when you’re there? I mean, what’s your measurement? We don’t have a measurement, you know we talked, you know, I hear therapist talking about neutral postures.

 

Bill: Well prove to me that you’re there. I mean there’s, there’s no way to tell. So in essence, let’s get that thought process out of our heads and let’s talk about restoring the normal variability to a system and then allow the system to adapt to the environment into the task, and that is usually the only solution that we can provide because again, pain is just one of those outputs from the brain. We need an adaptable system and then let the chips fall where they may, as we move people through graded exposures and such to allow them to return to their normal activities.

 

Scott: So, Bill maybe let’s talk a little bit about your objective tests now. I’m assuming this is pretty common pattern that you see with the extended posture. So you kind of alluded about the (inaudible) infrasternal angle angle, but maybe talk about that left shoulder. Why is that left shoulder really limited compared to the right? And what was your, kind of, your thought process behind that?

 

Bill: Which limitation we’re talking about there bud?

 

Scott: The fluxion, we’ll start with the shoulder fluxion there.

 

Bill: Sure! I mean with shoulder fluxions mildly limited, but let’s consider something I have somebody that’s laying on playing in Supine as I’m measuring this and there are also most likely extended the like the thor accent and spinal position or our extended. And so I’m just using that as a representation of, you know, again, what is the axial skeleton doing? So if I see a limitation in the ability to, to move overhead and this is a passive motion. My assumption is not that I have some sort of crazy shoulder limitation of any kind, but I look at the contributions of the entire thorax and the relationships between the thorax and the spine and the pelvis as far as what would be living.

 

Bill: And I’m not even concerned about which structure it is. I mean, you can argue that it’s going to be this muscle but that muscle but, but that’s telling me is, is I’ve got a little bit more of an extension pattern on the left side than I do on the right side. And this is not a shocker to me. And we know where we’re at, symmetrical beings and, and we tend to extend a little bit more on the left side anyway. If you look back in all the osteopathic literature, rich sending back into the early nineteen hundreds, you’re going to see this, this, this type of patterning identified. So again, as far as my mental model is concerned for a human, this is not unusual, but it does provide me a window into what this system is actually trying to do as far as a management strategy. And so again, the shoulder fluxion is just a, it gives me a, a measure of Sagittal, a position, if you will, that I’m going to have a little bit more extension on one side than the other.

 

Scott: Sure! Okay so your thought process was a little bit more extended on the left. So,

 

Bill: Yeah, I mean, yeah. Yeah. And again, and again, I’m not gonna, I’m not gonna weigh one measure more than any other than what you have to do. And then again, that w we don’t want to become isolated in our thought process here because everything is integrated. All these movements are integrated. All three planes or are they here? This is one small measure that has to be integrate it with all the other measures because you’re to look, you know, you look down the evaluation itself and you’re going to see other, other areas that she’s limited. Like she’s limited on both sides you know to a degree. And so again, we have to take that stuff into consideration as well.

 

Scott: Yeah! so, let’s talk about it what are some of the other things did you find during that projective testing?

 

Bill: Sure! Well, again, so first and foremost, it’s like the inability to, to add a, so the ability for the hips to cross midline is associated with a position of the Acetabulum as it is oriented. So it’s a retroverted position of the Acetabulum that will limit the ability to add to the hip. And so that provides an element of, of orientation of, again, what you’re looking at from the pelvis and then on up as you go, you know, you can use your shoulder flexion measurement like we talked about before, and then they’re gonna look at how does she manage a pressures inside of her body. So that’s going to be a respiratory related scenario.

 

Bill: So then, so then we look at infrastructural, analytical, why this element of, of dying from attic position, as far as her ability to, to achieve a normal respiratory cycle and if the diaphragm is descended and she is a hyper inflated individual, which she is, which means she, she puts a lot of air pressure into the anterior lower rib cage. We’re going to see a reduction in air pressure into the upper rib cage. And so when that happens, you’re going to have a reorientation of the sternum and the upper rib cage. Which is going to position the Scapula as such, that it’s going to limit the ability to enjoy, rotate the shoulders, and you can see that she’s limited bilaterally in that regard.

 

Bill: Now, if you consider the constraints of the upper thorax. So we’re looking at the like the true ribs, if you will, so two through seven plus the sternum and the upper thoracic spine. When you think about the constraints of that area of the thorax, I’ve got a lot of transverse plane capability there and so I should see a fair amount of rotation in the upper thorax. But if you look at her horizontal abduction measure, which is a great measure to utilize to identify whether that upper thorax can rotate, you’re going to have some limitations on both sides. Because what I’m looking for there is something in the 30 plus range to give me a normal measure if you will, and she’s going to be limited on both sides.

 

Bill: So now I have an upper thorax that doesn’t rotate either, which makes total sense to me because if I have an extended system as I in this, you know, this is like, like basic Ortho. One to one stuff that if I shift somebody into, into one plane Moreso than the others, I’m going to steal emotional plane. So if I have an extended human being, I’m going to see a limitation in rotation. And so again, we see that understanding rotation. We see that in her seated rotation and then we see that in the upper thorax rotation based on our horizontal abduction measure. So again, that’s what all of these measures together will tell me is that I haven’t extended human being, but you cannot rely on just one simple metric.

 

Scott: Well Bill talk a little bit about I think it’s about her right hip. You had a positive hip abduction you maybe talk about, I’m assuming the extended base posture is going to change the limit of the Acetabulum and allowing the hip, a hip mobility.

 

Bill: We’re talking about the abduction?

Scott: Yeah, that’s what I’ve seen on your thing.

 

Bill: Yep! And so what, what that indicates to me, Scott, is that even though I have an extended human being that has moved forward in the sagittal plane. I actually have somebody that, that is his right lateral realized. Okay! So stance, she’s, she’s going to be shifted to the right a little bit more. And so what you’re going to see in that scenario is you’re going to see, see, I’m more abduction activity on the, on the right side than the left side. So again, it just from, from a modeling standpoint, you know we’re left brain dominant, controls the right side of the body, and so, as I have a human that is defending itself or, or assuming a defensive posture and I’m going to see the limitation of degrees of freedom. I’m also going to see them shift them to the right, a normal occurrence that I’m going to see under most situations with an extended posture.

 

Scott: Let’s talk a little bit about your breathing assessments. So obviously the director position, they have a hyper inflated and this individual. What kind of tests are you looking at just for more of a qualitative standpoint? If her rig cage can move on all three planes? What are you looking for in that regard?

 

Bill:    (Unclear 23:14) in that regard, I’m going to give you a great deal of information as to what the diaphragm is in with, with a wider, for struggling or like, like she was demonstrating. If you think about the bucket handle activity of the throax that we typically talk about in the lower rib cage. What we’re looking at is that she is in an installation (inaudible) position which would be descended, diaphragm. So right away, I know where she is capable of putting air inside of her thorax, which it’d be the anterior lower aspect of the thorax and this is actually the path of least resistance for humans in general because of gravity and our structure. But in this case if I have the wide infrasternal angle angle, and she’s driving airflow anterior inferior than I know that I’m not going to get it into the superior aspect of the thorax.

 

Bill: And again, I can rely on my shoulder a motion assessment to help me identify the position of the upper rib cage, the capabilities of the rib cage. Therefore, the again the limitations in the movement position with the Scapula. Therefore, the movement and position of the Humerus will be eliminated as well. So I don’t need to do an extensive you know, observational type of an assessment, although there are many different ways to do that if you need to, if you’re questioning things. In her case, I’m just using that infrasternal angle. Ankle can start to drive your treatment and as to what needs to be done.

Scott: So speaking of that, so let’s move along a little bit into your treatment. So I would say if you’re objective findings, you see a lot of extended base symptoms and patterns. How are you getting the infrasternal angle (inaudible) angled down already getting air out of her lungs?

 

Bill:Okay! So, this is just a little bit of simple I’m chewing and, and reading retraining if you will. Again, I want to emphasize that I’m not looking for some sort of magical ideal type of breathing. What I want her to be able to do is to access to the extremes of individualization to excellence. And then if that’s available to her, then she has all physicians in between. So it just stands to reason, right? If I have the two extremes, then I can fill the gaps. So if I’m starting with a wide infrasternal angle (unaudible) going, what I want is somebody that can actually close that infrasternal angle (unaudible) angles. So if we think about anatomy for a second as to what muscles have the advantage to, to close that, that infrasternal angle angle, I’m looking at external obliques. And so from a, a breathing perspective, what I’m going to do then is I’m going to have her drive her explanations (unaudible) a little bit more aggressively because I need to recruit those external obliques and being a much more superficial muscle.

 

Bill: They’re a little bit harder to recruit, especially when they’re in a position where they’re at length. And so what we do is we do a little bit more aggressive excalation and I’m a little bit more prolonged and the way that I would describe it for you and I, I don’t have the study handy to talk about this, but as far as recruitment of the abdominal muscles in regards to how do you exhale? The way I describe it is with like a relaxed, open mouth as if you were trying to fog up the world’s biggest window with your breath. We don’t want to create a lot of high pressure at the mouth because what that will do. I’m sorry, let me reverse that. I do want to create some pressure at the mouth, my bad, cause I do want to recruit the external obliques.

 

Bill: Sorry, I was thinking about somebody else for second. I do want to create a little bit under pressure at the house, so we’re going to do like a person with excalation. I might even use a balloon to create some resistance to close that infrastructural angle. So, basically she’s in supine we’ll put her in like a hook line and position and that, what should we literally start to coach the breathing, teach her, how to get a full exhalation. a little bit more exhalation like I said, and then, once she is capable of doing that, then we can move on to, some form of activities to starts to work on, changing the muscle activity that does lending that’s limiting her capabilities. Sorry about the confusion there, but let me just review real quick. As far as the explanation, because when I have a wide infrasternal angle angle, I want a much more aggressive type of exhalation and I do want to create resistance at the mouth so it would be like a personal effects exhalation.

Scott: Yep! That clarifies it now you start more supline, upline. What would be like a progression increased I mean you use three sets and reps and resistance or are you then change position to put more load on the how do you go about progressing that progression?

Bill: So first rule always put people in a position where they can be successful. And so what I have is a person that when she’s standing, she’s battling position, so she wants to extend, she wants to push pressure forward or body. So what I’m gonna do is I’m going to put her in a very supported simple position so I can put art back. And you know, put her feet up into, to a heel supportive position on a bench, ninety degrees of knee bend. And what that does right away is it helps reduce some of that extension through the system. If I have her push her heels down on a bench, I get some hip extension activity which is going to help me rotate the pelvis post dearly because against she’s oriented forward. So I want to orient that published posts dearly.

 

Bill: And so now I have the hip extensor muscles that, that can help reduce some of that extensor activity above the pelvis. And then I tried the exhalation. And so, the first activity that we actually did with her was to help her to recruit those external obliques even further by doing an overhead reach. And I say like you would with a like a pullover position if you will. So we’ll give her a little lightweight and our hands and then she can reach back over about forty five degrees. And so she’s in this feels elevated position with our feet on a bench. She pulls down hamstrings and, and that for the glute Max, the attaches to the posts of your femur there to her postal rotate the pelvis, inhibit the low back. And then by reaching over head, I put those extra bleach on a little bit of stretch, which allows her to recruit them a little bit more effectively as she exhales aggressively.

 

Scott: Okay! Very nice, so, I’m assuming after you kind of fix that, this shoulder mobility increased, the trunk rotation increased. So maybe talk a little bit about that. I think a lot of people sometimes get caught up and they think everything’s a biomechanical. So let’s just mobilize the crap out of these joints but sounds kind a like you’ve mobilize the throax with position just change based on the (inaudible) I mean you change that and everything kinds of frees up am I right?

 

Bill: So, we have to understand what the current constraints of the system. Right? So, we American the school we all learned about the different types of joints and how they move and we can’t forget those things because those provide us with what the movement options should be. But we have to also understand that not everybody is starting from this perfect position that provides the most options available to us. And so if I reorient the sockets, I’m going to, to either promote motion in the indirection or I’m going to reduce motion and indirection. And so a lot of times when we can alter the pressures inside the thorax, shift the pressure inside the abdomen. What we get is a, is a reorientation of, of the hip sockets and the glenoid and what that allows us to do is immediately free up motion because now I have a reduction of also tell him that I don’t need anymore and I have provided them with options.

 

Bill: So I’ve actually restored the movement variability to the system. And so we typically see a change in the appendicular measures. And again, that’s why we use those measures to identify the axial positions. So that’s how I know when we’re making an effective change. That doesn’t negate the manual therapies that we were taught there. There, I look at this from a hierarchy perspective. If you look at something that affects the entire system as your primary go to, a lot of times we don’t need the manual therapist, but there are situations that if I look at something that is a systemic effect like respiration and such, and I don’t do the changes that I need them, maybe I do need a little more local stimulus to get the effect that I want. So we don’t negate any treatment and we have to consider these people as, as their own within subjects design.

 

Bill: Some people you know, just carry, appear to carry a little bit more protective, capabilities and therefore their muscle tone might be a little bit higher or they have learned over time a much stronger pattern or position. And so maybe we need a little bit of a local mobilization. So, I don’t negate that stuff, I still occasionally maybe some soft tissue or some joint mops or whatever I need to do to, you know, the system and get a window of opportunity and mobility. But a lot of times when you do these systemic related activities, you just don’t need to do that.

 

Scott: I like that answer, Bill I think a lot of times someone so far and I think the breathing and stuff is tool in our toolbox and you can’t forget, you know, some of our traditional stuff as PT’s and it’s just as you said, it can kind of help expedite the process if they’re not getting what you want with, you know, as you kind of set up with your retraining. So, that’s a great point now, one last thing here in regards to your treatment here, Bill, I noticed in your initial Evalu head 10 degrees of hip internal rotation bilaterally, but then after treatment you had about thirty. And so maybe talk about this. I think as PT’s, if we were to evaluate that hip and we saw so much by what I said. Okay, yeah, that’s their normal tell me why you did the hip just free up from the returning of the breath. So, maybe we talk about that.

Bill: Yep! So, initial yes so let’s look at this again. What we’re doing because we’re looking at an individualistic around within subjects design, right? So we perform an intervention and then as soon as we performance intervention. We immediately have to retest some of our measures to identify whether the intervention was effective. Right? And so as we do the respiratory activities, as we do some of the physical activities to improve recruitment of certain muscle groups and reduce the activity of some of the muscle groups. So, we have concentrically oriented muscles, we have eccentric (unclear) muscles. And what we want is joints that can move through their full excursion. And so if I can reorient or reduce the movement limitations just through pressure control and alternate position of the pelvis and therefore the Acetabulum itself, then I should see a change in and hip mobility because again, if I have a retroverted Acetabulum, I’m going to see some form of of hip range of motion limitation.

 

Bill: If I can provide the system more variability through whatever mechanism, whether I’m wiggling and joint with a mobilization or through respiration or through muscle activity. If I’m effective in restoring variability, that system, I should see the change in range of motion. So that’s what you see as we go through. Now, it wasn’t symmetrically gained and so we go through a process. And so the way you, the way you measure and re-measure as you move through this process is going to guide your treatment as to where in the system you need to restore variability. So, let’s go back to the initial bounce for a second and we’d go back to that passive hip abduction measure. And I’ve got this a symmetrical capability in the frontal plane.

 

Bill: You can see it. So we’re hip abduction was fifteen on the left and thirty on the right, so I know I’m right lateralized and as I provided her a stimulus that allowed her to restore variability in the sagittal plane. I still had a little bit of a funnel plane limitation. So, I think about two exercises in we saw hip and rotation is thirty five on the left and 20 on the right. So, while it’s improving, it wasn’t perfect yet as far as what I’m assuming she is capable of. And again, it’s an assumption on my part, right?

 

Bill: So we moved from sadly oriented activity to more of a frontal plane, transverse plane activity. And then you saw the restoration of hip internal rotation on both sides and you also saw the hip abduction measure basically restored to normal.

 

Scott: Right that’s great, so Bill we are about right out of time. So let’s finish off our podcast interview today with a clinical Pearl. Something that maybe you found interesting or something that’s helped you tremendously in regards to your process that young PT’s or you know, veteran PT’s can take away from you?

Bill: I think the assumption as we’re measuring people that they’re somehow in some ideal position and then when we see these movement limitations that is a local phenomenon is something that really needs to be understood a little bit more. We all will develop patterns and positions based on how the entire system interacts with the environment with the task involved. And so we need to understand that when we see a limitation, it’s not something we need to pull and Yank on. It may just be the system that is defending itself against something. We’re protecting itself against something and then when you need to provide a stimulus than, so then treat from a hierarchy, Okay, what can I do that affects the most systems and restore the most variability? And then work down from there, from, from more of a systemic effect to a local effect. And I think if you can, if you can grasp that concept and then start to apply it, you’re going to be much more successful.

 

Scott: That was awesome clinical pearl, I think a lot of, help a lot of people out there and can change their thought process. So Bill, where can people find out more information about you?

 

Bill: I’ve (inaudible) University is a great place. We do some, some online education there and that’s, you know, from the fitness perspective and some of the Rehab stuff is there and then they’ll (inaudible) heartburn.net is my personal site and so they can find you there. I’m also floating around and all the social media if you want to check me out there.

 

Scott: Perfect. Well bill, thanks again for taking the time to get on the podcast today, it was a pleasure having you.

 

Bill: I appreciate it. Scott.

 

Show Notes:


To learn more about Bill and his practice you can go to:

www.indianapolisfitnessandsportstraining.com

www.billhartman.net 

https://ifastuniversity.com/

 

 

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