4 Mistakes Physical Therapists & Athletic Trainers Make
On this week’s episode of the Unreal Results podcast, I talk about the mistakes that I see physical therapists, athletic trainers, and other healthcare professionals make in their practice consistently. Most healthcare professionals are operating in an outdated paradigm that focuses solely on the musculoskeletal system, which I believe is the main contributing factor to these mistakes. Instead, I invite you to learn a different paradigm that considers your client as a whole organism by primarily utilizing the LTAP™ as an assessment tool that will lead you to better and faster results.
Resources Mentioned In This Episode
Episode 2: MovementREV Philosophy and Methodology
Episode 60: LTAP™ Core Beliefs
Learn the LTAP™ In-Person in one of my upcoming courses
Considering the viscera as a source of musculoskeletal pain and dysfunction is a great way to ensure a more true whole body approach to care, however it can be a bit overwhelming on where to start, which is exactly why I created the Visceral Referral Cheat Sheet. This FREE download will help you to learn the most common visceral referral patterns affecting the musculoskeletal system. Download it at www.unrealresultspod.com
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Anna Hartman: Hey there, and welcome. I'm Anna Hartman, and this is Unreal Results, a podcast where I help you get better outcomes and gain the confidence that you can help anyone, even the most complex cases. Join me as I teach about the influence of the visceral organs and the nervous system on movement, pain, and injuries, all while shifting the paradigm of what whole body assessment and treatment really looks like.
I'm glad you're here. Let's dive in.
Hello, hello. Welcome back to another episode of the Unreal Results Podcast. Happy 2025. We're in it. We're in it. This is the second week. It feels like the first week. I know I'm not alone in that because the holidays were on Wednesdays. Just means that we have like this two week. Two weeks of Holiday, um, so Getting back into it even though I feel like the year's just starting last year.
We already dropped a new episode of 2025 It's a little detail that I don't even know if everybody notices but I have the On the podcast, you can, um, create like seasons, you know, you're going to have episodes, serial episodes or, um, just individuals and you can put what seasons and episode numbers and that kind of thing.
I'm not a big, like, I do track the number for myself of what episode it is, um, but I don't name them that way.
But I do change the season still, even though I pretty much give podcasts all year round. Um, so I make the season what year we're in, year of the podcast. So, welcome to season three! Who'd have thought, who'd have thought that I would be consistent with this? Actually, yes, I would have known, because that is just me.
my personality. Um, so, um, happy you're here. Don't, you know, whether you're new or have been listening for the last two seasons, I'm glad you're here. And, um, I look forward to continuing to put these episodes out there. And I'll see you have you be exposed to a paradigm that looks at the whole organism, not just the musculoskeletal system, not just the biomechanics and one that considers the viscera and the nervous system and the organism itself in how that relates to common musculoskeletal pain, movement, dysfunctions.
injury, rehab, performance, etc. So super pumped to have you here. I have a few great guests lined up for this year and um, yeah, it's always, I, I'm not a big planner, so it's always just cool to see how it all unfolds. However, um, where my mind at is right now is New Year. Let's go. And also I have coming up the first in person LTAP level one course coming up.
And so I wanted to, I want, I wanted to have an episode to answer the question, a couple of questions that I'm getting. Practitioners who are new, who are new to Movement Rev, who are new to The podcast are new to what the LTAP is. I would love to have a resource for them, uh, besides the webpage that talks about the course.
Um, but an actual resource to talk about what the LTAP is, why, why I put it together, who it's for, what the problems are that I'm trying to solve with it. And, um, what the difference is between the in person and the online course. And then also, um, about the certification. And so I obviously talk about the LTAP, which is an acronym for the Locator Test Assessment Protocol.
I've talked about it on a lot of the podcasts. I can't not talk about it. And it's not just a, let me sell you on the course thing. It's like, because that's how I practice. And because when we're considering a whole organism approach, we appreciate the wisdom of the body and The LTAP is our assessment, is our way to listen to the body, to allow the body to direct us to where to start.
So whenever I do a podcast on any topic, you know, whether it's about foot injuries or shoulder pain, or the liver, or whatever it may be, I always I always go back to like, well, where did the LTAP direct us? Or where could it direct us? Or what would we see? And that, and that's the same too when I'm working with someone.
When somebody messages me and they're like, Hey Anna, I had this happen, what should I do? And I'm like, well, you really should get assessed. Because I want to know where your LTAP is directing. Ask where to start because it's just gonna be a lot faster process to getting someone feeling better if we are involving the body.
So that's what this episode is going to be all about. Um, so I hope you enjoy it. I, I, I hope it, I hope it's helpful. So when, let me kind of backtrack. They're, when I'm mentoring people or when I'm listening to other practitioners or when I'm observing other practitioners or when I have athletes come to me and describe to me the type of care that they've received from other practitioners, I've noticed that clinicians tend to.
Well, I'm going to say clinicians tend to make like specifically four mistakes in their thought process and application of trying to get someone feeling better, moving better, performing better, et cetera. But part of the issue, and we talk about this a lot on the podcast, is they're operating in a. I mean, we're operating in a different paradigm than what I speak to on the podcast and, um, the paradigm that our profession, athletic training, physical therapy, and related fields, right?
So this can include like chiropractors, massage therapists, strength coaches, personal trainers, Pilates teachers, like movement teachers, right? So that's like, you might, you might be more than likely one of those people. And what happens is because the paradigm we operate in is solely based on the mechanics, like, and the orthopedics of things, we only like everything we do, the entire assessment and treatment.
and training process is only done through that lens of view. And so, of course, of course we don't necessarily consider the viscera and the nervous system because that's not part of that lens of view. So, so the LTAP, the Locator Test Assessment Protocol, is an orthopedic assessment, or an assessment, a series of assessments.
are orthopedically based, so it's in a familiar paradigm, applied in a new paradigm. And by applying this and practicing in this way, it teaches you and it opens your eyes to just how important this more whole organism lens of view and paradigm is and how that is an actual problem. Right? So, The problem is the paradigm we're operating in, but the mistakes we're making, sort of, we don't know at the time we're making them because we don't necessarily realize that it's the paradigm that we're in that is causing the problem.
Does that make sense? So, if you're an athletic trainer, if you're a physical therapist or a chiropractor or a massage therapist or strength coach, whoever, you may find that you're chasing movement dysfunctions, right? So you, yes, movement efficiency and mechanics matter, but the body's choosing the path of least resistance for a reason.
Ultimately it's driven by the organism's quest for survival and the protection of the organs at all costs. And movement dysfunction is the outcome the output of this deeply embedded neurological pattern. Why chasing the movement dysfunction can be frustrating and is the problem is because you're trying to change it by manipulating the output instead of understanding that it is an output from a deeply held neurological response of protecting something more important.
or moving in a certain way in relationship to the sensory information that we're receiving, right? So we find ourselves like banging our head against the wall, trying to get someone to improve their like squatting mechanics and giving them all these verbal cues, giving them tactile cues, using reactive neuromuscular training, using different props, whatever it may be to try to like get them in this.
perfect movement pattern with the underlying assumption, and it is a big capital A S S assumption, that improving their movement pattern will change their pain and change their performance. And that can also be kind of flawed. Another mistake I commonly hear a lot, a lot. It is thinking or saying that things take time, injuries, pain, take time to go away, and that, you know, it's impossible to help somebody in a short amount of visits, right?
So, I hear this from my athletes quite a bit. Um, who go to other practitioners for like, let's say achilles tendonitis and, um, oftentimes the diagnosis of achilles tendonitis is based on symptoms, not actual. Diagnostics, so whether or not the tendon is actually involved in a pathological tissue scenario is up for debate in the first place, but they're given that diagnosis and then they're given a series of exercises and maybe some manual therapy and they tell the athlete like this is going to take a lot of time.
It can take weeks or months to get better because it's a tissue problem. It needs specific loading. And then they come to me and I do things differently. I use the LTAP to direct me where to go, I do treatment there, I reassess the thing that was bothering them in the orthopedic sense, and then their Achilles tendonitis goes away.
It doesn't mean that I healed Achilles tendonitis in one visit. It means that their pain and inflammation or whatever it may have been, maybe wasn't that in the first place, and, or was a result of poor dynamic alignment, or, Um, altered movement patterns, right? Going back to the first one, this change in the output because of whatever information the body is receiving to begin with.
So, um, along with the excuse of things take time, it's also sometimes bundled up with this assumption that the problem is not the rehab plan or the problem is not the, um. clinicians, it's that the athlete themselves or the client themselves is the problem. The patient's the problem, right?
There's this assumption that if they're not getting better, then the patient is doing something or not doing something to support their plan of care and they're the problem, right? And that's kind of gaslighting your patients. Um, and some like, again, along with the time thing. These can be true. These can be true.
Sometimes tissues really do need time to heal, right? Surgery is a good example of this. I can help people. post surgically to decrease swelling, improve pain, and range of motion. By the end of the day, like the ACL has got to go from a tendon to a ligament, right? It has to go through this like physiological revascularization and change of actual tissue to a different thing, right?
Like, I don't, I can't do that in one session, but I can change a lot of other factors within one session to, to, um, Facilitate that happening in a more comfortable way or in a quicker not quicker like define Define gravity like define timelines but in quicker in terms of with not being slowed down from things impeding the healing process, right?
So, so yes, time can be true sometimes. And also just like that, it can be true that sometimes the patient is not an active participation, participant in their care. And sometimes the patient's extra curricular activities or lack of just generally taking care for themselves physically emotionally and, um, mentally can.
become a driver of the problem. However, most of the time I find, and we have to consider, that often these are just convenient excuses that we tell our patients and tell ourselves when we're not getting great outcomes, when we're not getting good results for our clients. Because sometimes the truth is, it is possible to help somebody in one to three sessions.
I see it all the time. The people who have taken the LTAP see it all the time. But maybe you just can't do that in this moment. And, um, Spoiler alert, if you can't tell from what I'm trying to get at, it's not you. That's the problem. It's the paradigm you're operating in. Another one of the mistakes we make, we make in like operating in this paradigm is learning more and more treatment techniques.
Going to all the Con Ed courses, taking all the con ed classes, learning all the exercises, learning all the different manual therapy techniques with different tools, right? You're gonna go learn, um. Instrument assisted soft tissue, you learn dry needling, you learn cupping, you learn, um, PRI, you learn DNS, you learn FRC, like all these different tools.
At the end of the day, they're just different tools. Right? They're all fairly pretty, they're all pretty similar tools.
And they're all, Still taught within this orthopedic musculoskeletal centric model, right? So we have more tools, more treatment tools, more techniques, more exercises than ever before because we have access to so much more information than we did when I was a new grad, right? Yet, outcomes for our patients continue to remain mediocre or good at best, taking weeks and months to improve.
Because again, it's the framework we're operating in that's the problem. Not the treatment tool itself. This is one of the things, I did a whole podcast episode that I'll have Joe link. Um, in the show notes on the LTAP core beliefs and this is kind of one of the core beliefs is realizing that whatever tool you choose for treatment, whether it be manual therapy or exercise or however else you want to categorize those things you do, right?
Because at the end of the day, they are basically usually in those two buckets. No matter what tool we use though, to, use those techniques. It actually doesn't matter at all. What matters is being in the right place and the right place is dictated by where the body is directing us, typically where the body is protecting and having a hard time compensating for, right?
So the, uh, another mistake people make is Um, chasing symptoms from session to session, right? They're chasing the pain, they're chasing the symptoms, they're chasing the complaint. Oftentimes this happens especially with complex cases, which, for those of you who work with more general population, this happens a lot, because they come in with 50 different things and you're like, whoa, like, can we do one thing at a time?
But if you can't shift one, then you're like, let's try the other thing. Right? Fundamentally, we know we should not be doing this, yet it still happens over and over and over again, especially when you have a lot of treatment tools and locations to possibly potentially need to work on to, to move the dial, right?
And this, this also is dependent on if you're even doing assessment. I am shocked at how little. People assess their patients throughout the session and then reassess their patients throughout the session to determine what's going on and what needs to be fixed, right? Um, they're either not assessing at all or assessing and getting this long laundry list of objective dysfunctions that need to be fixed and then just trying like one thing at a time.
And when you don't know where to start, you sort of do. You eventually just start off lazy or not lazy, maybe just because it seems like the smartest spot to start. You base where you do treatment often on their symptoms or their pain or your deeply held belief or bias about where you think the pain is coming from, right?
People with foot pain. or people with knee pain, most clinicians have a deeply held belief that knee pain is from hips, poor hip stability or poor ankle mobility. And so where they're going to start treatment almost always the hip or knee, sorry, the hip or foot around that knee pain. And oftentimes it's not either of those, but when you're operating on your deeply held biases that are steeped in this orthopedic, biomechanical, musculoskeletal based lens of view, of course you're only going to see it that way, right?
So, and like I said before, when you have a complex patient, as your frustration arises and the client's frustration arises, most of us as caregivers just want to make people happy and just want to make them feel better. And so the easiest way to do that is to touch the spot that's hurting. Right? But you get stuck in this endless cycle of repeating this over and over again.
So with these mistakes, what we're actually missing is not a treatment tool. It's not an assessment, like just any assessment. It is an assessment. Actually, that's not even the problem. That's not even what we're missing. We're missing, we're in the wrong paradigm to begin with. Because even without the LTAP, if you open yourself up to a different paradigm, one that appreciates the viscera and the nervous system, and the whole organisms drive for survival, then you start making choices differently and can often get better results and not fall into these mistakes, right?
Now, with that said, let's say you've been listening to the podcast, or you've followed me for a while, or maybe you are a clinician that has already started. a continuing education path, like through the Barral Institute or the Upledger Institute or from Dr. Perry's Stop Chasing Pain and in Europe or even like neurology based stuff.
And you're appreciating that the viscera and the nervous system can alter our biomechanics system, right? You, you're already going down this path, but unfortunately what those, what, what, what. is tough about those education courses. And what I hear from a lot of the fellow practitioners I meet in the Barral Institute classes, right, in the visceral manipulation, in the neural manipulation courses, is they become almost siloed themselves.
They step into this paradigm that the viscera is driving things or the nervous system is driving things and they don't know how to bring it back to the orthopedics, bring it back to the movement, bring it back to the musculoskeletal system. And so then they're making certain mistakes because now they're not appreciating the other side of the whole organism, which is the musculoskeletal and orthopedic biomechanical piece, right?
And so that becomes a problem in itself, right? You're going to these things, you're learning all these visceral techniques and tools, but you don't know necessarily when to know how, when to apply them as well as how it relates back to movement and orthopedics or movement and performance or movement and pain.
And so that, that is why I created the LTAP. The LTAP, the Locator Test Assessment Protocol, is five orthopedic based assessment tests in a, utilized in a lens of view that is a little bit more osteopathic, considering that the viscera and the nervous system and the drive for survival are three key components that will significantly affect the body's mobility.
Strength, stability, and performance and pain. And so we must have the tools to be able to assess those and see how that is relating to someone's joint mobility, someone's movement pattern, someone's performance, and then understand the anatomy well enough that we can use any of our tools to then have an effect on those other systems.
And this is This is the, this is, you know, what I said, one of those core beliefs is like, you actually don't need to be trained in visceral manipulation to affect the viscera. Spoiler alert, movement, manual therapy, breathing, things we're doing already is affecting the viscera where, whether you realize it or not, because it's all attached, right?
It's all connected and is all attached to the musculoskeletal system. So you actually don't need those specific tools. Are they wonderful and great to have? Absolutely. Are they necessary to understand when someone's shoulder pain is being driven by the liver, or the lungs, or the stomach, or the colon?
Not really, right? So, Um, this, this is why I created the LTAP to help people blend this osteopathic and orthopedic lens or osteopathic and orthopedic principles into a new lens of view, a new paradigm that considers the whole organism, not just the musculoskeletal skepticism, not just the orthopedics and the mechanics.
Okay? And it's within utilizing and applying the LTAP that you start to really appreciate this lens of view and, and, and learn how to integrate it all, right? So the LTAP is the vehicle to which we get better results, right? Don't make these four mistakes that I talked about. Um, but then also start to see the body as a whole organism and not just movement dysfunction or not just musculoskeletal pains.
So hopefully that's helpful. So and I think I talked about this in, I don't know if I've talked about this in the core beliefs thing, so I'm just going to talk about it now. The way I came up with it. It is utilizing the skills that I learned in the osteopathic courses from the Barral Institute and their assessment of general listening and local listening, which listening is an osteopathic word for what you're feeling in your hand and appreciating that the body, when it is protecting something, it sort of organizes itself around that structure and then you can feel in your hand the lines of tension or attraction to that area as well.
So you know where it is. Start treatment in the area that the body is protecting the most by following what you're feeling in your hands. Now that is a very difficult school skill to learn because it takes trusting what you feel, which is not the area that we operate in, in this world. And so it was my attempt to use orthopedic tests to get at that same
spot because the way our body organizes itself from a musculoskeletal standpoint around those protection patterns is very distinct. And I started seeing patterns in my orthopedic assessments and I noticed like, Oh, interesting. Everyone who has a visceral protection pattern, I see this happen in their SI joint.
And it changes with this inhibition test. Inhibition test is something I pulled from the osteopathic world, but you can apply them to orthopedic tests to give us a lot of information. So that's what the LTAP is. These five assessment tests are basically five different inhibition tests to narrow things down on, is the body protecting something important like the viscera of the nervous system?
If it is, what is it? Is it the brain? Is it the spinal cord? Is it the lungs? Is it the ligaments that hold the lungs to the spine? Is it the pericardium? Is it the liver? Is it the stomach? Is it the bladder? The uterus? Whatever it may be. Which organ is it? Or, if it's not the viscera or the nervous system, Is it a peripheral neurovascular nerve or vascular entrapment thing causing tension in the whole system?
Or is it none of those things, which then leaves more traditional muscle bone joint things, right? So That's what the LTAP is doing and we would do it on everyone regardless of what in, what complaint they're coming with because it's letting us know where the underlying driver might be coming from, what is holding the body in this protection pattern that's not allowing it to shift into a state in the nervous system that can facilitate healing and decrease pain, right?
We don't do it in lieu of a normal physical exam for like, if somebody is coming with shoulder pain, I still want to evaluate their shoulder, but we're doing it in addition to, so we have better information of where to start so we can start seeing all those orthopedic things change quickly with our treatments and then be left over with more specific things that we need to work on, not just fighting against protection patterns in the body.
Okay. So, because The assessment
teaches us, right, I said the assessment also, the LTAP also, is the vehicle which teaches us about this lens of view. Because I can talk about the lens of view. in this new paradigm telling blue in the face. But it really doesn't sink in until you start seeing it for yourself in your patients. And so I'm a big believer of actually teaching people how to use the assessment first and instantly implement it in your practice.
So you can see things change in the body and recognize how mind blowing it is to to to see something change so quickly and notice the deeply held belief that you had previously about it. And it's only when we see those deeply held beliefs challenged about how mobility, stability, strength, movement patterns change so quickly when we do treatment in the right spot with regardless of what tool we use.
It's only when we see that with our own eyes That we start to be more open to this paradigm So that's actually two, you know, I said the beginning I want to talk about the difference between the in person and the online course the in person course I Mean the obvious difference it's in person you get to practice with your hands with my hands on you with my teacher Teaching assistants and fellow teachers hands on you You get to learn the five assessment tests from the LTAP and instantly how you implement it within a normal session with your practice.
It is a two day course and it is 90 percent lab time. Like by the end of the course on Monday, you will be 100 percent able to apply it with your clients and get amazing results. But like I said, once you see all of that change, now you're going to have questions about why you're going to have questions about why and you're going to want to know more about the visceral anatomy, more about the neural anatomy and how everything's connected and how it influences the musculoskeletal system.
We can spend more time diving deep into that in the online course. The online course is over seven weeks. We learn one test a week. We learn one test a week because since we don't have the hands on component in person, like in the lab time in the online course, we need a little extra time to like fumble through it on our own and just get repetition.
As well as it gives us time to have one call a week to dive into the anatomy more, to dive into the why more, to dive into the questions that come up more. So I actually designed the course to be like the most complete by doing both of them, the in person and the online course. So it's not one or the other, it's more of a question of like, which one do you want to start with?
To fully understand how to use the locator test assessment protocol and how to get the most out of it with your clients, to get the best results, to be able to change things in one to three visits, to guarantee results for your patients and to identify red flags that come up quickly.
The complete education is key. And along with the complete education becoming an certified LTAP provider. And what that is, is once you've gone through the in person and the online course, you do a certification exam with me, which is a written exam, three case studies that we then hop on a phone call and like break down and discuss and I mentor you through and then three short answer questions and then that's it.
Then you're a certified provider. This, this is the complete education to the Locator Test Assessment Protocol to really be able to like understand this new paradigm, this new lens of view and get really good results with it. Is that the end of learning? Absolutely not. Because then it's opened this door and all this vast information is beyond that now you're curious about and now you want to learn.
And so there's more learning within movement rev education, but there's, you know, this opens the door that you might want to learn more specific techniques with the Barral Institute or with the Upledger Institute or something similar to those. Or maybe it means that you want to do something different. I don't know, but.
It's the beginning of the journey, not the only part of it. The other part of the reason that I put the certification out there is the more I share about this stuff on the podcast, the more I share about it on Instagram, on YouTube, on my website, the more general population people and athletes reach out to me being like, I want to work with you.
Um, but I don't live in San Diego or I don't, not a professional athlete cause really I really only work with athletes. What should I do? And so it's a way for me to solve that problem and be able to refer people, right? And the LTAP, it works in a virtual setting too. And so not only can I refer you clients in your area potentially, but I can refer you clients from all over.
If you are a practitioner that's virtual. Um, care as well. So that's hopefully that was a helpful like episode to sort of talk about like what, what, why do we even need the LTAP, right? What it is, why we need it, what it offers us, and um, How it helps solve our problems. So we stop making these common mistakes, right?
These common mistakes like chasing movement dysfunctions, thinking time, patient, or pain is the problem, learning more and more treatment techniques in the same paradigm, chasing symptoms session to session, and, and, and, and, and. or learning even this lens of view and these treatment techniques, but not understanding how to connect it back to the orthopedics and the movement dysfunction, right?
These are the mistakes we're commonly making. The problem is the paradigm and linking the two paradigms. The solution is the locator test assessment protocol. So thank you for being here. We'll see you next week. Have a great day.