Chris: Many people view hook lying as a resting position or a starting position that anyone can acquire. We're going to talk a bit about what the position actually means, you should use it for, ⁓ considerations to make based on archetype and the person is showing you through assessment. this week's episode of. real quick before we get into this, ⁓ has told us that many of you that are watching this are still not subscribed. So if you've been around for a while and you've seen some of these episodes, if you could fix that, just one little click, subscribe to our YouTube channel. So yeah, hook lying, laying on your back, feet flat on the ground, knees bent. ⁓ Seems like a pretty open and accessible position for So I think a lot of people use it as their go-to for where to start someone that might have an issue with their knee or their back or their ribs or their shoulder. But what does that position actually represent? What's required to get into the position and then sort of set the frame for why people might be using it now and then reconsider why that they should use it going forward.

Bill: So it represents a state of slowing the system down. So this would be representative of one of our most early propulsive positions. So if we use the foot contact as a frame of reference, the entire mass of the system is essentially behind the foot contact. And so. That's one of the descriptors of early propulsion. So early propulsion will be a ground contact that's ahead of the center of gravity. And this gives us ⁓ a very useful position ⁓ using that frame. However, early propulsion is also the superimposition of internal rotation on the external rotation. So our bias in that position is towards ER, our ground contacts. So this is foot, pelvis. thorax head, those ground contacts represent the ability to superimpose the IR on the ER, which then makes it a little bit more difficult to acquire effectively without compensation. So we actually have to have access to the IR. That becomes the most difficult because most people, as they compensate, they create substitutions for internal rotation, and then they express a compensatory external rotation that would be associated with that. That takes us away from that midline. So our contacts are actually midline contacts. So we're talking medial foot contacts. Again, pelvis, thorax, head all towards midline. And so if we can't acquire that internal rotation, then it becomes more challenging to make that position useful.

Chris: So it's talking about, you talk a bit about the contacts. So the medial foot contacts, PSIS contacts, medial scapula contacts. What are those mechanically offering to somebody? Like what are those mechanically doing?

Bill: Well, again, that's the superposition of the internal rotation. So if you were sitting or standing and you roll to the outside edges of your feet, that's going to be more of an ER bias as you roll your feet back towards midline and you capture the medial foot contacts, that's going to be the IR representation. Right. And so our goal is to capture essentially what are four contacts. So if you think about like first, met head, fifth met head in the forefoot to two contacts in the heel, that four contact position on either side is what gives us the ability to superimpose the IR. Same representation going up through the system. So you can literally look at all of those contacts as trying to land a big giant foot. That's kind of how I picture it in my head is like, ⁓ I turn all of these contacts towards midline. There's my capture of the internal rotation. That requires the relative motion of the foot, relative motion at the knee, the ability to just shape change at the pelvis, the ability to shape change at the thorax.

Chris: Right. So before, when someone might've used this position because it eliminated gravity, it eliminated the usage of some joints that might've been compromised. What you're effectively doing is putting someone in a position, if they don't have this access to the early propulsion and the contacts that would allow them to have early IR.

Bill: Mm-hmm.

Chris: they're just going to orient themselves. And you'll see this with people's knees that want to fall apart, people on the outside, so their feet, with someone who's smashing, has to smash their low back into the ground to try to get flat, to be flat on the ground. And someone queuing, yeah.

Bill: Right. Mm-hmm. Yeah. Right. Right. So can see a lot of compensations associated with attempting to set up the position.

Chris: Right, and oftentimes you will see people forcing compensation in the position as well. They may not have knowledge of this, but anytime you try to tell someone to flatten their back to the table, you are driving a posterior orientation.

Bill: Right. And that's an ER compensation.

Chris: Yeah, or if I take, say I take like a band and put it around their knees and tell them to push out into the band to activate their glutes while I'm smashing their low back into the table, you're creating even more of that confidence.

Bill: That's a big, yeah, I was going to say that's a real, and the results show up in your measures, right? So in a lot of cases, this is why we talk about the relationships of the measures, because just increasing a measure doesn't guarantee that you have actually accessed relative motion. So let's talk through it sort of like from foot upwards, right? So.

Chris: Yes. Yeah.

Bill: we can assist people in capturing these foot contacts. ⁓ But if I magnify those medial contacts and sacrifice the lateral contacts, so again, we emphasize first medial tarsal head, medial heel contact, but we lose fifth and then the lateral heel contact, that's gonna be an ir-compensatory strategy. A lot of times what you're gonna see is you're gonna see the tibia's gonna follow. in that position. So you'll see the knee drift towards midline. You'll see the anterior orientation of the pelvis. And we've just lost the contacts that we needed to superimpose IR and ER. And so what you end up with then are magnified internal rotation measures, which can appear to be favorable. However, if we lose the relationship with the early ER measures, then we know we don't have relative motions. We know that somebody was compensating. And so If we only measure certain things associated with an intervention, we can be misguided as to a favorable change. Take the banded example that you gave in pressing the low back down into the ground. It's like, ⁓ look at all this external rotation that we have in our hip measure, but we sacrifice the internal rotation to acquire that. That's really not the favorable change that we're looking for based on this position. We're trying to get the proportional representation of extranet rotation to internal rotation in this case.

Chris: Yeah. So we're trying, it's effective in the way of putting them into a bias ER position that they can start to acquire early IR from. But if you're pushing well past that ER state in a compensatory way, there's nothing you're going to be able to do to capture that. And also they may not have the requisite motion.

Bill: Yes, correct. Mm-hmm.

Chris: at the joints in order to get into the position to begin with. So what does that look like in terms of table measures or just general ERs and IRs that are necessary to get into the starting position?

Bill: Yeah. Well, if I have a system that's expressing a lot of external rotation, so this is your early hip ER measures or even late hip ER measures, that's someone that's biased far away from midline, makes those medial foot contacts a lot more difficult to capture. So I could have too much ER in the foot. I could have a differential in the tibia where I'm magnifying that ER representation. I could have the same differential in the femur, could have pelvis that's more biased towards ER than IR. And again, to reiterate that just makes those medial contacts much more difficult to acquire. If I see table measures with magnified IRs, so for instance, a proportional relationship of ER to IR would be more ER than IR. And if I see a relationship where the IRs are actually greater than the ERs, and I try to assume the hook line position, chances are you're going to see that IR compensatory strategy show up. So it's the inability to capture a pelvis contact. This is where a lot of people sort of overcompensate and they actually create the post-orientation in an attempt to capture those contexts. And once again, you're just superposing another compensation on top of a compensation in an attempt to acquire the position.

Chris: Right. what in the end, what we want to see are the medial contacts at the foot without losing the lateral contact. So thinking about it from like having having a centered heel with a slight bias toward the medial side and having the first and fifth med head on the ground, making sure that there is there is pressure on the first med head and it's not coming up.

Bill: You think? You think? Correct. Mm-hmm. Correct. Right. And now since you brought this up, you want to think about this as four contacts, but imposed on the surface as a singular contact. So we don't want to be overly heavy on the medial side. We don't want to be overly heavy on the lateral side. We want a forefoot and a heel that are approximating the same amount of pressure. Same reasoning all the way up through the system. It's like, don't want a really heavy foot contact and a light pelvis contact, because that would be somebody that's actually projecting themselves upward off of the surface. typically, and there's ways to coach people through this, but typically when you're setting this up and you're trying to teach somebody how to acquire this position because they might have to use it on their own, it's like you're trying to teach them how to even out this contact. So it's not a push up, it's a heaviness.

Chris: Mm-hmm.

Bill: through the foot, it's a heaviness through the pelvis, it's a heaviness through the thorax that allows all of those contacts to feel similarly as far as the amount of pressure that you're putting into the surface.

Chris: Yeah, and just, yeah, I was thinking about an explanation of what you're talking about, but there is specifically a video about capturing foot contacts that I believe is in the purple room on UHP+. So this will be our little plug to sign up for the UHP network if you haven't yet. Go through the free courses if you haven't yet.

Bill: Mm-hmm. Yes. Yes.

Chris: If you want to be in the mentorship community of UHP plus and have access to videos of stuff where we're talking about capturing foot contacts on the table and setting up hook line position, then there's a free three day trial for that. So you can check that out there. ⁓ but basically what, what you're talking about is like an even distribution, having these contacts on, on the ground so that when force and pressure is put into the foot, there's effectively a turn. to the opposite side of the foot, or more importantly, it's more of like ⁓ a redirection of force back up on that side.

Bill: When you say up, it's towards the head because we're in supine.

Chris: Yeah, from ground up towards head. the difference would be, if I push through a foot that's ER'd on the outside of the foot, I will effectively just kind of roll my ankle or have to sort of fall in the opposite or fall in one direction and fall to correct myself. But an effective ground contact when you push down through that foot is going to have the energy go up.

Bill: Right.

Chris: towards the head. Yeah, and then.

Bill: towards the head. Yeah. So if you think about the setup of the position, so if you started in just supine with legs straight, I bend the knee and I capture the foot contacts. I've actually moved mass superiorly towards the thorax. ⁓ Essentially, yes. The benefit of that is, so when we have people that show a lot of the thorax compensatory strategies that are pushing the system down, that creates a lot of these ER compensations.

Chris: Yeah, it's reclined. Mm-hmm.

Bill: As soon as we lay somebody down, there's a benefit to that because we've reduced the downforce. By moving mass superiorly, we've also given ourselves an advantage to create a pressure inferiorly that resists this superior pressure that causes a lot ⁓ of the lower extremity compensatory strategy. again, we're playing with mass, we're playing with center of gravity, we're playing with an ER bias position, and then the superimposition of IR that teaches people to resist. these downward forces, but it's ⁓ in a much more controlled environment, assuming we have the capacity to superimpose the IR on the ER.

Chris: Right. Which your assessment would show you. Or there just lack of ability to set up in the way that we're kind of going through here. So that was the foot. Moving up, moving up to the pelvis, we have, we're looking for like PSIS contact, sort of an even, sort of an even representation of pressure between the sacral base on the right and left side.

Bill: You Right. Mm-hmm. Right, we're using the PSIS contact as sort of a frame of reference for the SQL base in this circumstance.

Chris: Yeah. so, it's, and it gives, can give you, ⁓ so having that the contact sort of is you're sort of securing each segment of the body with an anchor. So the heel contact of the foot and then the heel contact of the pelvis would be that sort of PSIS. And then, and then the heel contact of your thorax would be like that medial border of the scapula.

Bill: Huh? in this circumstances. Correct. Right. That media border, that media border again, that's what allows us to superimpose the IR on the ER.

Chris: And then you would even want to consider the base of the cranium as well as the sacral base. Yeah. So you want an even distribution of pressure there, and then you want to be even distribution. you can start, we'll do things like a rock, a reach and roll where you're sort of pumping and alternating from contact to contact. And you can use those reference points to feel the whole system sort of walking from heel to heel on either side.

Bill: Oxford. Yeah, Oxford, Oxford. Right. Absolutely. Right. Right. Because a lot of times in the initial setup, you'll see some of the compensations that your table tests would reference. You'll see those in the setup and then an active setup of the hook line position allows some of those to resolve. In many cases, just capturing a foot contact, capturing a pelvis, you're going to see thorax measures change just by setting up the activity correctly.

Chris: Yeah. Yeah. Right. then, so the activity setup, we've given the reference points and the markers. What we do after that is important too. So that could be as simple as just watching someone breathe. If you're just giving them, you know, in through the nose, out through the mouth style, you might, we've talked a bit about this in the past, but softer breathing strategies for narrower individuals and maybe harder breathing strategies ⁓ for wider individuals.

Bill: ⁓ from an exhalation standpoint. And I would be very careful when you say harder, right? We have to, it's graded, it's graded. It's not like more effortful kind of a thing.

Chris: from an exhalation standpoint, yes. ⁓ Yeah, we will, yeah, we'll come back to that, because we'll get into the archetype differences, but I wanted to just offer a way to audit the position through breath. So if you can see, when you see the circumferential expansion of the rib cage and the thorax, everything sort of moving together, you can kind of see the pelvis breathing as well.

Bill: Mm-hmm.

Chris: You see that on an inhale, aren't sacrificing any of their contacts. They're not getting like, their pelvis isn't coming off the ground. They're not going under the outsides of their feet. They're not squeezing their shoulder blades together. That type of thing. Like that will be, I would say before you go, that would be the way to sort of audit the position to know that they're able to maintain those contacts, those early IR contacts.

Bill: Right, Right. Yeah. Okay. So, so the, IR contacts, when we talked about the heaviness of the setup, it's like, as, so as you take a breath in, we would actually feel those contacts more grounded in that circumstance. So if you feel those contacts lighten, that's going to typically be associated with a compensatory inhalation strategy where I'm, I, I'm trying to expand and I'm expanding away from the surface. So a lot of times Like when people struggle, like you acquired the setup, but they struggle to maintain those. If you just think about maintaining the heaviness of those contacts as you take your breath in, that's what's going to promote your AP expansion, especially in the Thor.

Chris: Yeah. then heaviness is actually the space, the volume expanding into the grounds. it's almost like you want to feel those contacts get heavier, but you're almost lifting, your body is almost an airbag inflating and getting away from the floor. Like you actually will get a bit of a almost feeling of rising away from the ground associated with the heaviness of those contacts, of course. Yeah.

Bill: Correct. Correct. Mm-hmm. Yeah. That is correct. That is correct. Yeah.

Chris: Otherwise you're just projecting and squeezing all of those muscles on the backside that are probably part of your issue to begin with.

Bill: Yeah, and then you'll see the knees drift away from midline. You'll see the pelvis anteriorly orient in those circumstances. So there's an ⁓ assessment element to the execution of the activity.

Chris: Right. And those things, you know, it's the combination of providing enough information to the person that they're not constantly trying to fight themselves. And then you as a coach to sort of seeing the result of them breathing in that position. So you don't want to over, you don't necessarily want to over cue somebody because you're going to end up. Someone trying to force the feeling of groundedness in any of these positions is more often than not gonna be some type of anterior orientation strategy, in my experience. They're gonna jam their, yeah.

Bill: Well, they're to constrain the inhalation.

Chris: Yes.

Bill: And again, if relative motion is the goal, we've got to be able to get air into the system in that circumstance, because those are your starting conditions for access to relative motion is to have that anterior-posterior expansion versus spreading out sideways, which would be ER.

Chris: and Yeah. Right. And the, and that's where your coach's eyes got to come in. are they, like you had mentioned the exhalation and inhalation stuff. it, is it a forced inhale? Is it, they holding their breath as they're trying to perform their activity and hold the position? All of those things are going to kind of direct you. Okay. So let's talk about a little bit more. We mentioned it a little bit, but archetype specific considerations to make for the position, like how you might use it.

Bill: Mm-hmm.

Chris: for just that when that with considering the archetypes.

Bill: Yeah, well, your narrow ISAs are going to be biased more towards ER. So this makes the capture without compensatory activity a little bit more challenging in that regard. They're going to be biased towards a compensatory exhalation. So we have to be very careful as to how we're coaching the breath in because, again, for them to hold their contacts, that's where you're going to see this sort of effortful. behavior where we're going to see people pressing the lumbar spine into the surface in an attempt to hold onto those contacts. You're going to see compensatory neck strategies and such as they're trying to take the breath in. so ⁓ we want to be certain that we're not driving this hard inhalation behavior, at least to some degree initially. And so just queuing like a silent inhale through your nose usually does ⁓ a sufficient job so that they don't over breathe. They don't try to take too big a breath in. I make an effort to never tell people to take a big breath in because a big breath implies effort. Right. You say, OK, I to breathe in through your nose, but I don't want to be able to hear it. And that typically suffices to start to teach them. to not drive this more effortful inhalation. We talk about the, ⁓ like a wide ISA, typically you're gonna see a lot more compensatory IR behaviors because of their bias towards IR. And so in that circumstance, the exhalation becomes more important. They're using a compensatory inhalation strategy, ⁓ thus the wide ISA. And so in that circumstance, we want again, I hesitate to use a word more effortful. tend to prolong the exhale versus saying exhale harder, because once again, any time you increase effort, you're going to magnify compressive strategies that are going to actually limit your ability to access the relative IR.

Chris: Right. Okay. So yeah, it's not the, the, the mindset that a lot of people are going to come into patient client wise is that trying harder involves effort and they'll try to squeeze and they'll really try to do what you're telling them to do. So it's, it's, it's bringing enough attention to something and then watching what they do with that cue.

Bill: Mm-hmm. Right. Right. It's always a process. It's always a process because everybody wants to do well for you. Like I said, immediately when you cue breaths, everybody tries to take these, you know, big giant breaths and, and, ⁓ you'll tune it in process because again, the, the, the greater the effort, the more you're to see compensatory stuff. Like you'll see, ⁓ you'll see like abdomen expansion, but no thorax expansion. Right. So it looks like a belly. It is a belly breath actually.

Chris: That's important here. Yeah. Mm-hmm.

Bill: We really don't want to see that. Like that's not something that you would want to want to cue separately. What we're looking for is this uniform expansion of thorax and abdomen. ⁓ The really cool thing that happens is like as people get better and better at this and you you see prominence of ⁓ ribs or abdomen and eventually you start to see this nice cylindrical behavior on the inhalation. And then you don't see the forced exhalation that sort of compresses the sternum. ⁓ downward which is going to take away your internal rotation capabilities.

Chris: Right. So is there any, is there any specific things with the setup of this activity that you might change depending upon the archetype configuration of a person or like what you might allow more of for one or the other?

Bill: The goal is similar. The representations are just slightly different based on what you're going to see. If you had to pick an influence that might help you is reference of the sternum and then reference of the ISA. It's like when you see a narrow, starting in hook line,

Chris: Mm-hmm.

Bill: you're going to tend to see ⁓ more of the compression of the sternum. In the wide ISA, because of the thorax compression, you're going to see the widening of the ISA. And so those two cues can sort of help you frame how you're going to the breathing, making sure that you have the effective contacts on the surface.

Chris: Right. And I'd say that understanding the variety of what a foot with proper ground contact might look like for a narrow or a wide and understanding that they're not, if you have all these different people that you're setting up and hook lying, their foot position contact wise might be similar, but the foot shape may actually be more yard for a narrow. ⁓

Bill: Mm-hmm. Mm-hmm.

Chris: It's giving yourself the ability to see these things for what they are and not try to force everyone into the same representation.

Bill: Right. Well, yeah, it's it. mean, because we're in a position that spies towards early propulsion, it's going to be an early propulsive foot. actually have a tutorial on that ⁓ on I believe it's on Instagram and it's on the network as well.

Chris: Okay, great. So let's talk about as a precursor to the position, if someone doesn't have access to what we had talked about and it doesn't look right and they can't really acquire the position in a way that we would want them to, where might they need to go first? And then after we can get into the position, Where do we go from there? Like, what do we use that for? Say that's our base position to do a certain number of activities or a variety of activities. Let's kind of talk about that to finish up here.

Bill: Okay. So frame the first part again.

Chris: So you have people who can't acquire the position. are the, so we've talked about a whole bunch of other positions leading up to this conversation. So we might be able to play those into this as well.

Bill: ⁓ yes. Okay. All right. Yeah. Yeah. Yeah, so we're in a position where our goal is to acquire the greatest degree of relative motion. And so ⁓ if you have compensatory strategies that magnify the ERs, magnify the IRs, then that's going to be muscle activity that could interfere with the foot shape. That's going to be muscle activity that could interfere with the ability to internally rotate the tibia. So as I... capture a medial foot contact, I should see a tibia that can internally rotate. So that's relative motion at the knee. I have to be able to superimpose IR on an ER pelvis. That's a shape change that's associated with the pelvis. And then we would have ⁓ a consistent representation up through the thorax as well.

Chris: I was more thinking how you strategically use, how you would strategically use sideline or maybe some type of prone positioning to help capture the position.

Bill: ⁓ to capture the position? Yeah. ⁓ so yeah, because we've talked about sideline. Sideline gives us an advantage as far as how there is pressure on the system. So that would promote the anterior-posterior expansion that might allow us to actually capture the posterior. contacts on the surface that we would use in hook line. oftentimes, we'll end up using, say, a right side line position prior to, which would give us access to some of the shape change that we would see in the lower extremity pelvis and thorax. And then if you just think about a sequential roll, rolling is propulsion phases. Let me say that again. Rolling.

Chris: Fasha.

Bill: Rolling is a representation of the propulsive phases. And so what we're doing is we're just segmenting it. So we're saying, OK, I need to capture this initial position. So right side line provides us an advantage of ground contacts. AP expansion, we roll to our back. And now we can actually superimpose more of that internal rotation on the ER position. And then if we were to continue, then that is actually the right side projecting rolling over to our left side. And then that's the left side slowing down. So we get this nice little emphasis of each phase of propulsion. So that's how we can use other positions to help us acquire this position, which often provides a great deal of the relative motions.

Chris: So let's say just continuing off of that, we tried hook lying. There were some restrictions, some constraints there. We did some soft tissue work, self applied or with tool assisted manual hands, whatever. We use side lying as a way to acquire the shape of the body in order to capture these positions. Now we're in hook lying. What do we open up?

Bill: Mm-hmm. Mm-hmm. Mm-hmm. Mm-hmm. Yeah.

Chris: what sort of activities do we open up to use that are really useful for further imposing IR onto this early propulsive position.

Bill: Once we capture and measure ⁓ a relative movement, then we can start to increase the gravitational influence. Think about a ⁓ reclined activity that's just more upright. I could be doing something where I'm supported against a wall in a shallow squat. That's actually the same shape of hook line. When we look at the foot contact, we look at knee position, we look at pelvis position. but it's much more gravitational challenging, which means the top-down gradient is now increased. And so the goal here would be the capacity to maintain the superimposition of IR on the ER to resist that increase in the top-down pressure.

Chris: Right. And then from that, you have that position. You can also do things like a marching hook line, march a straight leg raise from hook line, ⁓ prone or supine propulsion on the wall, where you're pushing your foot into the wall, where you're starting to use. can, that, and that way you can maintain those contacts of the pelvis and the thorax while moving the lower body through.

Bill: Mm-hmm. Mm-hmm. Mm-hmm. Right. Right. Right. We're teaching people to sequence this in a reduced gravity environment. Right. And that's determined based on outcome. Right. So if I bring somebody into like a upright reclined position and I see a loss of the relative measures in that circumstance, it just might be too difficult. I bring them back to a more grounded position, but I can use these sideline and supine positions as phases of propulsion.

Chris: other phases of propulsion. Yes.

Bill: that teach the system to create the resistance to the top down gradient that's associated with these more upright activities. So you're just walking people essentially across the ground in a reduced gravity. That's what rolling is. Rolling is just walking without the downforce of gravity.

Chris: And this Yeah. Well, and the supine position is really helpful once you've established the contacts to be able to feel yourself wanting to go forward too fast. you know, the feeling the ground having those contacts represents the delay that you need in order to not immediately compensate as you try to put IR into the ground and move forward.

Bill: Correct. That is correct.

Chris: So yeah, that and a lot of the stuff, the strategy, the sequencing, all of this stuff is sort of directing people towards programming and interventions, which is a course that Bill has been working hard on. And that will be coming at the end of this year, 2026, November will be the first time we do a live version of that. And if you want to qualify for coming to that course, we have the...

Bill: Mm-hmm. Yeah. Mm-hmm.

Chris: principles and concepts course and the assessment course as the prerequisite. Those are both bundled together now on education.uhp.network so you can check those out there. And then ⁓ next time we're gonna be kind of talking about this sequence and progression that we've been discussing. So we did sideline, we did hook line and now we're gonna kind of go up into some more oblique sitting position. So low oblique and high oblique as they would be described in this model. probably need to clarify a couple things because I think people use those positions in a very inefficient and ineffective way, or they don't really know why they're doing them. So we'll talk a lot about that next time. See you later.

Bill: Hmm?