Chris: Quadruped or the all-force position is a developmental position or an exercise activity position. See it in physical therapy, in training, strength and conditioning. It's a little bit misunderstood. So we're going to go over what the position has been typically used for in the past. ⁓ What we need to reconsider about using the position, the prerequisites for the position. All of that and more on this week's of. quadruped all force, ⁓ whatever you want to it. Knees, ⁓ feet, hands, all in contact with the ground you wrote an article recently on the UHP network, which is in the UHP plus area, which is of the. ⁓ paid mentorship side of the UHP network. There's the free side of the UHP network where you can come and learn about the UHPC model There's three or four courses there. Then there's the paid area, is called UHP plus, which is the place where people get access to you via weekly calls. ⁓ There's forums for people to post their case studies. it's sort of a community mentorship type thing. ⁓ HTTP colon backslash backslash UHP.network. So quadruped article. we can talk about why, what, what preempted you to write this article Bill: Just a look at what is best used mechanically. I think that typically used as some sort of transitional, I'll use the word posture, because that's a familiar word. I think it's used ⁓ as a transitional posture a sequential posture that people might use in an ⁓ exercise program Chris: We'll start with that. Bill: someone would be overcoming the and gravity making assumption okay, I can do something on the ground and the next thing to do is this without the concerns over what it actually takes to access that position, which is why... ⁓ And I think that anybody that's ever used quadrupeds sees a lot of these compensatory strategies that are associated with the inability to actually access the position because we're approaching an orthogonal relationship of extremities to axial skeletons. So the orthogonal is this 90 degree angle. And so then may often make the assumption that, OK, so if they can do ⁓ in ⁓ or prone or whatever it might be that, ⁓ this is the next thing to do. but still not having achieved sufficient access to the position. So I have to be able to elevate my shoulder to approximately 90 degrees. I have to be able to bend my hip to approximately 90 degrees without the compensatory strategies. And so we laid out some of those compensations are pretty common that again, a lot of people have already seen, ⁓ may not have recognized. Chris: Right. So I think that are watching this are probably coming from some background knowledge of the UHPC model, or they're coming from another place ⁓ they may have learned developmental kinesiology. And this happens to be one those positions. Like you talked about postures, you're talking about how a baby learns to get up off the ground and then. Bill: Mm-hmm. Chris: go to all fours, prop themselves up on something, stand upright, learn to walk. So a lot of times ⁓ people's perspective is gonna be that school of thought, I think the mistake that people need to reconsider is that this isn't something that ⁓ everyone should just get. It's not a position that every client, every patient should just start with, need to be able to sort of earn the position. And you were talking about elevating the shoulder and ⁓ bending the hip to certain degree. also ability to approximate the midline ⁓ as well. Bill: Right. ⁓ There's a lot of internal rotation that's required in this position. Right. So my ability to elevate extremity to degrees requires that have an axial shape actually allows me to do so or bend the hip 90 degrees. Again, ⁓ if I am that capacity and put somebody that position, that's where we start to see ⁓ these deviations. away from the orthogonal. So if I don't have internal rotation, I will attempt to make a space to put the internal rotation underneath me. And so this would be like a posterior orientation of a pelvis. So you'll see the lumbar spine will round. The pelvis will appear to, as they would say, tuck under in that circumstance. You'll see IR superior. to the lumbar spine. So you'll see people kind of sag towards the ground at that thoracolumbar junction. That's where they're actually applying the internal rotation because they don't have access to it through the hip and the pelvis shape. I'll see the same thing in the cervical spine. If I don't have the capacity to access internal rotation in the axial skeleton and the upper extremity, you'll see the cervical spine perform the exact same. behavior, well, you'll see the rounding of the cervical spine, or you'll see people that will try to retry their mandible and perform the traditional chin tuck type of behavior. And that is actually an attempt to create a space to put the extremity underneath the shoulder. And so it has value. So if I make the assumption that, oh, somebody should be able to achieve this, I can actually put them in this position and I can actually use it. from an assessment standpoint to identify whether they actually have that capacity to do so. The alternative would be somebody has anti-orientation of the pelvis, anti-orientation of the thorax, where I would see a magnified IR response. And those are the people that actually you sort of sag towards the ground. So you'll see the lumbar spine will sort of sag towards the ground, or you'll see the head. getting pushed down and forward towards the ground, or you'll see the scapulae approximate, which is pushing the thorax forward. And so that's an IR substitution rather than the relative motion internal rotation that we would want to actually be able to assume this position. Chris: Yeah, and dynamically, you can see that sort of IR substitution. Just think about someone doing a really bad push up. So you got, yeah, you got a head and neck going towards the ground, you're collapsing between the shoulder blades toward the ground, like that. And their arms aren't even really bending, they're just moving their chest and their head like that. So that's just substitution. Bill: Yeah, yeah, yeah. Right. Right, Yeah, we have two representations that have to be explained. So if I put someone in quadruped, the thing you want to recognize is that gravity is now perpendicular to the axial skeleton, which is pushing them into the ground. I have to be able to push back up against that force. So I have a ground up IR that I produce. have a top down IR that is produced by the gravity. And then my ability to access the position and hold this position effectively is the interplay between those two because they both exist at the same time. And if one is greater than the other, then that would be represented. So if I don't have access, but I push into the ground anyway, that's where we start to see these ER substitutions. So you'll see sort of like the turtle back kind of a. kind of a position for those folks that are trying to magnify their ability to apply force into the ground against this resistance. And the people that lose that battle are the ones that we see ironing the spine towards the ground. Chris: So how we determine if someone qualifies this position, however you might want to think about it. I think there are two ways to sort of look at it. There's the using a coherent assessment process that might involve some more standardized measurements first would tell you what positions you could get into before trying to do the position or Bill: Mm-hmm. Mm-hmm. Mm-hmm. Right. Right. Chris: If you would rather make the experiment, the quadruped position, you get in there, you look at the compensations that you're dealing with, and maybe you adjust. you would go widen the stance, drop someone to the elbows, elevate the hands, like whatever it might be, moving away from midline to like where they actually have the motion. Bill: Mm-hmm. Correct. Yeah, all of those alterations of the position is actually a reduction of the demand for the internal rotation. So any time I move someone away from midline, that's going to be more ER space, which would reduce the demand. If I alter the thorax relative to pelvis in either direction, I am actually moving them away from that maximal IR demand. Chris: Yes. Bill: The problem that you run into there is if I make hips higher than shoulders, so I dropped somebody down to the elbows, I'm still increasing the influence of the downforce. So my extremities are moving towards a ⁓ lesser degree of internal rotation, but there's still a downforce that's associated with that. So I could still see like a head position or a cervical spine position. You'll see the IR of the cervical spine in that circumstance. And that's a pretty good indication that there is still too much downforce in that position to make it useful. So you might actually have to alter it in the opposing direction. So I elevate shoulders relative to hips. Hips have much larger muscles. can handle the IR demand to much greater degree than through the upper extremities. But that's how you might have to utilize that. We have a very strong midline ⁓ influence when we're talking about like a like a squared up quadruped, we're bringing the extremities towards midline. so, so we use this, this position a lot when we have scenarios where center of gravity might be moving ⁓ forward too fast. Because if you, if you look at this position and we use the acceleration of gravity as, getting pushed forward, forward is actually into the ground. And so like, that's me actually applying the resistance to that, to that downforce. And so. Very useful from an assessment standpoint, but if we wanted to look at some sort traditional measurement, if we were doing table tests, so your traditional hip flexion test should show approximately 90 degrees, your traditional shoulder flexion test should show approximately 90 degrees, just to gain access to the position. Now we have to take into consideration of the load. So if somebody has sufficient relative motion for the activity, but insufficient force production, to resist the downforce, then that's going to start to show up. And so this allows us ⁓ a determination as to whether this position is going to be useful. Chris: Right. then, so say someone does have access to the position or you're able to give someone a series of interventions that gets them access to that position. What becomes the utility of the quadruped position for most people? Why would a clinician or trainer want to use it? Why should they consider using it? Bill: The biggest influence is something that I've mentioned is actually getting this midline control. So one of the things that you find when you start to look at the relationships of your table tests. So I can have shoulders and hips that appear to demonstrate ⁓ a proportional. ⁓ measure of internal rotation, external rotation that would imply relative motions. But I have midline measures. so a midline measure is actually your traditional hip flexion and shoulder flexion. So these are axial tests. These are not extremity based tests. They're actually the axial skeleton being able to change. And so if I see deficits in those midline measures, then I know I have access through the peripheral joints, but I don't have access. in the middle, which means I need to be able to slow it down. And so that's where this position becomes useful. And any midline activity, so you mentioned pushups as one, like the prone plank, same thing. We're actually resisting. We're actually trying to slow the system down relative to the ground against that gravitational force. And so this is teaching us to slow down the midline. If somebody demonstrates any of those compensations that we mentioned previously, then the force is still too high. So I need to find a different position ⁓ to ⁓ progressively load the system so there's not too much force too soon that drives these further compensation. So again, to reiterate, very useful as an assessment as to someone's capabilities to slow down their midline. Chris: Right. And the things that you might need to use alternatively to get yourself the ranges of motion, relative motion that you might need to acquire this position could be like we talked about last time, half kneeling and variations of half kneeling. It could be side lying in order to change the thorax shape ⁓ and how you can turn and rotate. ⁓ Bill: you Right. Right? Yeah. Yeah. So yeah, let me just touch on that because I can use side-lying activities. Rolling behaviors are useful in that circumstance, partial rolls in that circumstance, just to coordinate the spinal position that I'm going to eventually use in the quadruped shape. I can create that. But again, it's like, it's like we're putting somebody in a higher force position that because again, I have body mass that's that's going through the extremities. I gravity pushing down. I have breathing capabilities that are, that are going to be an influence here. So if I have someone that is, that is biased towards exhalation strategy, so this would be like an anterior posterior compression on the, on the thorax and pelvis. It's like, I have to be able to inhale against that, that gravitational force to be actually to be able to access. this effective quadruped position. So breathing becomes an influence as well. Chris: Right, and this all sort of carries over into our ability to move through space. If we're talking about propulsion, early, middle, late propulsion. People who are experiencing any type of movement related issue, pain, know, issues with whatever it might be in their body. These people oftentimes are, yeah, movement limitations. These people oftentimes are lacking the ability to Bill: Correct. Yeah. Yeah, just a movement limitation. Chris: this sort of middle force producing full stop straight down into the ground position. So they kind of skip over it and they live in ER. And that's where you get your calf strains, your hip flexor strains, your hamstring strains, because instead of being able to acquire this orthogonal position to push straight down, they have to kind of live on the outsides of their feet. Bill: Yes. Correct. Correct. Chris: and move in this of ER compensatory way. So this is like you were talking about rolling behaviors where you get a shape change back and you utilize that overuse of ER to your advantage. You acquire the shape to get into the middle position and then you allow someone to, where it might seem completely unrelated that a quadruped position might help someone's midpoint of their squat or help them jump. Bill: Right, right. Chris: off of one foot for a layup or come to a dead stop as like a lineman or whatever sport you might do. Or even like, you know, be able to play outside with your kid. It's all about like that ability to acquire that position and use it without compensation into that ER compensatory action. Bill: Right? Right? Correct. Yes. Chris: Yeah. So yeah, go ahead. Bill: Well, there are recommendations for activities. Let's use a bird dock, which is really, really common in rehab and even in performance training in those circumstances. so the perspective might be like, ⁓ I'm trying to create stability ⁓ in that circumstance. so then the assumption is like, ⁓ you need more stability. I'm going to put you here, but yet they don't actually have access. Chris: Yeah. Right. Yeah, yeah. Bill: to the ability to produce that force. So rather than trying to force someone in, allowing them to compensate, it's like, all you gotta do is watch somebody that doesn't have the IR access to a bird dog, and you're gonna see all these twists and turns, and you'll see the extended lower extremity or upper extremity, and you'll see the spine turn and twist. This shows up in a lot of the single-side loaded activities like. like single-leg or deals and things like that. When you see these, these twists, these are the people that actually don't have access to this internal rotation that we're talking about. And so what we have to do is we just have to reduce the force in that circumstance. So we could, we could progressively build them up in reclined positions or progressive sidelines. So I go from sideline to say like a low oblique sit type of an activity to actually start to acquire. this in a lesser load before I bring them up into a quadruped position and I make that more effective. Chris: Yeah, and those things are what you had mentioned. So like a single leg RDL would be a good example. Someone that you would want to be in a more of an orthogonal like T position at the bottom of a single leg RDL, if that opposite hip to the grounded side is elevated and they're sort of rotating away, they're performing that activity in ER the whole time basically. Bill: Yeah. Right. Right. So they're trying to figure out a way to push down into the ground. And so the way they have to do that is actually turn away from this orthogonal IR position, and then they're going to push into the ground in the ER shape. And so we're not really accomplishing the intention of the activity in that circumstance. It's just a tell, right? And again, it's like, if I have somebody that demonstrates relative motion in a reduced gravity situation, I put them in a higher gravity situation, it's like, Chris: Right. Bill: This makes it useful as the assessment. Chris: Right. And it might not, it might not always come down to lowering the difficulty of the position or activity. There may be a root cause of some type of overuse of muscle activity that needs to be addressed or a bony shape change that has to be addressed directly strategically with some level of focus in order to get that to work. Bill: Correct. Yeah. Yeah. no, no, you go, you go. Chris: So if you're, let's keep talking about single leg RDL, because I think a lot of people will be able to relate to it and it'll resonate with them. That inability to get into that end position, that T orthogonal position might be because of a pelvic shape change or a posterior lower musculature that will not yield. It might need hands, it might need a lacrosse ball, it might need a Bill: Right. Right. It doesn't allow access to the IR position at all. Chris: sacral belt, you know, it could be all these different influences that could be used strategically. So it's not just about, ⁓ well, that person needs to do hip airplanes to open up their hip mobility, because you could give someone that. Bill: Yeah. Correct. Correct. Right. That would be a demonstration of the capacity to access the position, but it doesn't necessarily make it the solution to the problem. Chris: Sure, but if, yeah. Yeah, because oftentimes what I sort of mentioned earlier is giving everyone these positions and exercises as this is what everyone should be able to do is not the most intelligent way to do things. It's not the most reasonable way to do things because you're not testing for anything first. You're not having them prove to you that they can do the things that are required to get into the position. ⁓ And then you have a hip airplane that might look better. Bill: Yeah. Chris: but you end up giving way somewhere else. So you create a lumbar ER strategy or you create a strategy at the neck that makes it look like they can get. Bill: Yeah, it's really common. It's really common to see that the thorax compensatory turn relative to the pelvis, because if I'm grounded through a leg or I'm grounded through a knee, this is where you're going to start to see. So the same thing that we were talking about before with the post-orientation, trying to create more of an ER shape so I can actually push down into the ground. We're going to see the same thing show up in that single leg RDL. Chris: And that would be the thorax going towards the ground, pinch between the shoulder blades, head shooting forward, ⁓ pelvis, yeah, pelvis turned away at the same time. So it may look better. The body looks like it's flatter with the ground, but you see a back leg that's turned out. You see a neck that's pinched to the side. They're telling you what. Bill: but pelvis turned away from the ground in ER. Uh-huh. Yeah, yeah, yeah. Right. Chris: what they can and can't do through the activity. Bill: there you go. are demonstrating their capabilities as to whether this is an appropriate activity. Chris: It's just your, yeah, your coaching eye and perspective may not be to the level yet to see that. So you instead are looking at a picture of an exercise. This is the single leg RDL. Everybody gets it on week three of this program, no matter who it is. It needs to look like this picture that I'm looking at. And they go, yeah, it kind of does. I'm just gonna jam them in there and. Bill: Mm-hmm. Right. Right. Yes. Chris: If they twist their upper body and I give them a weight and then they put a band around their knee and tie it to a post, then it looks great. It looks like the picture. But think about the secondary consequences of all of the things you were trying to do to make someone look like a picture instead of. Bill: Mm-hmm. Mm-hmm. Yeah. Right. Well, again, if they don't have IR access, they're going to do one of two things. They're going to try to ER and push into the ground, or they're going to use a compensatory IR strategy. Right. And so if I use a compensatory IR in quadruped, I'm actually creating an increase in pressure on that anterior side of the hip. If I go up to an RDL and I see the same thing, again, even bigger pressure in that anterior hip. that your people that that have the pinchy hips, right? When they're sitting, squatting, ⁓ any time that they have to bend the hip to any significant degree, all they're doing is increasing the amount of pressure on the hip. then, so you're not being successful, you're being successful in producing a compensation that you most likely don't want. Chris: Yeah. So let's, let's kind of connect just to finish. Let's play a game of connecting the dots between what we were talking about with quadruped and the single leg RDO. So there are lots of intermediary steps. So say we, we, as an experiment, we, get someone, we try to get someone into quadruped. We see a hips that are really tucked under their, their pants, the back of their, their seat gets wider as they get into that position. Bill: Uh-huh. Sure. Mm-hmm. He Chris: So I see some type of lack of ability to get into an IR pelvic position. So instead of trying to get them to pull a band apart between their wrists or pack their neck in to try to straighten their spine, you go to a different position or maybe you foam roll the posterior lower hips, you do like a step over on a foam roller and some rolling activity, and then you try your position again. Bill: Yeah. Yeah. Right. We want to create an IR shape and access to relative motion IR at the hip or in the shoulder, regardless of which iteration that we're talking about. Chris: Yeah. Yeah. So the next thing is let's ride with this example of there's a pelvic orientation happening in order to acquire the quadruped position. Say we do some soft tissue work, we do some shape change stuff on a foam roller. They're, getting into that position better instead of saying, Hey, that's great. Let's do a single leg RDL. Maybe you take some steps in between to get there. So you talk about like maybe crawling first, doing something more. Bill: Mm-hmm. ⁓ Mm-hmm. Yeah. potentially. Chris: propulsive that can show the ER and IR end of that middle position. Bill: Right. Right. Well, we could, you know, since I brought this up before, it's like, like you could use a bird dog. a bird log, a bird dog is, an assisted position, right? So I have upper extremity ⁓ support as well. And if I can achieve an orthogonal position of the hip and an uncompensated bird dog, that would imply like, okay, so I do have, I still have the iron shape. I have actually increased the force. Chris: Yeah, so let's maybe just use that. Bill: that's going through the lower extremity and the pelvis. And then it's a matter of, well, what's the next thing that they can do where I can actually increase the load before I would go to this unsupported activity where I'm supporting myself through a single limb and then making an assumption that I have an axial skeleton that can actually hold this IR position without support. Chris: Yeah, because you'll see you'll see similar compensations to what we were talking about with the single leg RDL. Bill: Right. Yeah. this is where ⁓ like the kickstand variations are helpful, where I'm adding a support. I'm transitioning between something that had a lot of upper extremity support to assist with the lower extremity. I take that away, but I'm still using some measure of load reduction in that circumstance. That's what that... that other ground contact is, it's like that's to share some of that IR load as I'm training someone to actually acquire this orthogonal position through a single room. Chris: Right. So you do a bird dog, you see what happens when you go to single limb support. You can tell if, so you add this sort of dynamic nature to it, you see what happens with either them turning away, them diving towards the floor, something happening with the neck or thorax, it try to counterbalance or create a top-down pressure to force the activity to happen. Bill: Right. Chris: And then that looks clean and that looks good. Then maybe that becomes something more dynamic with crawling or a split squat, even as a way to sort of show you that they can build themselves up. still, so we're still using that same perspective that you might've come into this conversation with from the developmental approach, but it's a lot more strategic. Bill: Right. Yeah. Yes, that's a great word. Chris: And that's sort of the goal of this UHPC model is a better framework, better reasoning, feeling actually like the inputs are going to get you the outputs you want. have strategic resistance, strategic lows, strategic soft tissue work. It's all of these inputs that are going to give you the result that you're looking for without having to force it. Bill: Right. Correct. Chris: I think a lot of people get into a problem with that because they have certain expectations that everyone should be able to do something. So they'll make it look like they can or just force them to, because they just know that on that sheet that on week three, they should be doing bird dogs. Bill: Potentially, potentially. It's being more effective versus just doing work. Chris: Yes. And some people, yeah. And some people get away with, they get away with just doing the work. So if you're okay with 80%, 70 % and you just give everyone the same program that has bird dogs on week three, it might work most of the time. Bill: Right? Because we're doing it for a specific result. And we need to keep that in mind. Chris: And it may, even when it's not working, it might be giving someone a compensation that's valuable from a symptom or a fitness goal perspective. But it's just what, are you okay? Are you satisfied with being sort of inefficient and potentially just kicking the can down the road for something to happen in a couple years or? Bill: Well, the concern is when it doesn't work. Right? Because you're going to have Chris: Yeah, right. That's why you that's why you're 70%. You're not 100%. Bill: Right. It's like, you know, some people will be satisfied with and they are potentially delivering value. Chris: Absolutely. Bill: But are you delivering value to everyone that you can? Are you just merely satisfied with where you are? And by all means, like, you know, it's okay. It's okay to do that. But when you're looking for more and better, it's like, and I want to increase that percentage of success. It's like, that's where a little knowledge goes a long way. A little observation goes a long way. A little bit more capable of measuring goes a long way. Chris: Just a more coherent model and framework to work off of goes a long way. You might, you might be satisfied with in a lot of environments, 70 % is a great batting average. And for the people that you can't help with the same five things that you always do and trust me, there's nothing wrong with that. use probably like three things with most people at this point. Bill: Yeah. Pretty good. Yeah. Chris: And you're fine having a team where you can kick it to the Cairo or the PT or vice versa. PT sends somebody to a doc to get surgery done. It's fine. There's nothing wrong with it. It's just we're looking for the people and we're here to challenge the people that aren't okay with having 25 to 30 percent of your people it not work for. And you thinking to yourself, well, this worked for the last four people. Why isn't it working now? Bill: Mm-hmm. Chris: and I don't know why, and that should, for the people that we're trying to speak to, that should sort of boil your blood a little bit. And you're thinking about it like when you're taking a shower after work, you're like, why is it that every time this type of person comes in and we try to do this thing, it does not work? It's like, I can tell you with much confidence, like there is a reason. Bill: Right. Right. Yeah. It's like that frustration is motivation for some people and then a deterrent for others. And that's fine. It's not fine. We're not talking to everybody. Which is... Yeah. Chris: Yeah, because they'll just punt. Yeah, right. Which is, I think our audience might know that by now, I hope. We get comments that are like, this is not a beginner level podcast. It was. So if you watched the first few episodes, it certainly was attempting to be that. But I don't think you or I enjoy talking like that. Bill: Yeah. No. Chris: So yeah, and I think, you know, anyone that's listening to this is probably pretty invested in this stuff so far. One thing we didn't mention, well, first of all, thank you for listening. And then one thing we didn't mention earlier is a lot of what we're doing with the half kneeling and the quadruped, and then we'll use other positions in the later episodes is based on Bill's current work just being dug into the programming and interventions course that he's developing, the two courses that he's developing. Bill: Yeah. Chris: So it's fresh in his mind. It's sort of fresh in the article space on the network. So we're going to keep doing that. We're going to keep talking about positions and stances and strategic loads and strategic resistance and strategic interventions, just because it's thematically what we're working on. Bill: I think one of the, well, one of the limitations I think that people run into is ⁓ options when it comes to exercises. Getting a better understanding of what certain positions do, what is the effect of where I put a or take load away. And so this starts to expand their repertoire of activities where people can still be active, they can still train, but now I'm avoiding some of these compensations that can be detrimental later on. Chris: Cool. ⁓ I think maybe leave a comment about... So if you've been doing this for a while, you've been in the health and performance space for a while, leave a comment about what one of those things is or was that always tripped you up. Like me, for years, anytime someone came in with a shoulder impingement issue, I just had no idea what to do. Because doing all of the normal stuff, which a lot of it in training from like a traditional training perspective is a lot of top down pressure. It just wouldn't help. would be, they would eventually just get back to their problem. And the answer couldn't, when you're training somebody, the answer can't be, well, just stop training upper body. Although people do that sometimes. And then they try to do like single sided stuff. Bill: Mm-hmm. Right. Chris: which interestingly enough might actually push volume in the direction that it needs to go. But then you create a strategy, compression strategy on the other side, and then your left impingement lessens and you got a right impingement now. it's yeah, but it's stuff like that. post what you with before ⁓ learning about model, what you currently struggle with if you're new to this model. We just want to kind of hear what you've got going on in the comments. Bill: Yeah. Chris: Anything else? Bill: Read the article. Chris: Yeah, read the article. It's a free week coming soon on the network. It'll be around the end of April if you're listening to this around that time. So be ready for that.