Always Check the Distal Pulses
In this episode, I discuss how important using the MovementREV Swelling Reduction Protocol is post-injury and even post-surgery. I share how critical checking the distal pulses is to ensure no stagnant swelling impedes the healing and rehabilitation process. And what it means to have persistent swelling and why this can help know if something is wrong vs. just normal healing timelines.
Resources mentioned:
Episode 46: Using the LTAP with Post-Surgical Rehab
Episode 3: Swelling Reduction protocol that Works like Magic
Episode 37: Swelling Protocol Update
FREE MovementREV Swelling Reduction Protocol Download
In-Person LTAP Level 1
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.
Hey, hey! Welcome to another episode of the Unreal Results podcast. Uh, if you watch last week's, you might be like, Anna, you're wearing the same shirt. You look really similar. I do. All I did was put my hair up in a ponytail. It is 10 minutes later. Um, I'm not usually one for like, batching podcast episodes, because I like to talk about what's on my mind currently.
But, super excited news. I am finally After over a year of doing all the podcast things myself, uh, well, and after 10 years of doing all business by myself, I am, um, starting to hire out more help. So, I am handing over podcast post production to my friend and colleague, Doc Joe Oh. Um, Joe is a PT and he does a Like digital media stuff.
Big YouTube guy. He actually helps me out with my YouTube channel quite a bit. And it's grown a ton since he helped me. Um, we've been working together for a year. And so I thought it was only natural for him to start helping me out with the podcast. When I was thinking about what things could I hire out so I can free up more of my time.
Um. He was my first thought of like it would be stupid not to ask him if he's interested and not to have him help me because The podcast feeds a lot of my content for social media for YouTube. So it's a perfect fit. Um So Joe you're gonna be listening to this before anybody. Thank you. And here we go Podcast number two in one day.
Great news. It, um, relates to the podcast from last episode, last week, um, that I just recorded because we're going to talk about the swelling protocol. This will officially be the third podcast. on the swelling protocol. But our friend Shante Cofield of the movement maestro, her business lesson always is, once is never.
So, just because I've talked about it once doesn't mean you remember it. Just because I've talked about it twice doesn't mean you remembered it. And then also, even if you remember me talking about it, maybe you need a little bit more education around it. Maybe you want to learn a little bit more practicality.
Practicality around it, and also maybe you haven't even downloaded the free guide yet. If you haven't downloaded the free guide, pull over your car if you're listening, just pause what you're doing if you're not driving, and click the link in the show notes to download your free copy of the MovementREV, Swelling, Reduction Protocol.
It is a great guide, I tell you all the spots, I give you a couple techniques for free, give you some discounts on if you want the whole online course, but, um, And then also if you haven't listened to those two previous podcasts on the swelling reduction protocol check those out, too Like spoiler alert on the first episode.
I basically detailed the entire protocol for you. So, um I feel very passionately Passionately about this and actually want now I've sort of like leaned into it more I realized that it's not just a swelling protocol. It is a healing protocol and it is um Good to do for everyone in every instance, but today specifically we're going to talk about using the swelling protocol with post surgical people and like fresh acute injuries because those are the questions I get a lot is Okay, it's basically like Anna, people are like Anna, are you full of shit?
Can you really get rid of swelling in one session or 24 hours? The answer is no, I'm not full of shit. That is true. And can you get rid of swelling in 24 hours to one session? 100%. Is it asterisked when it comes to fresh acute injuries and or post surgical? Yes, and I want to talk about why, and it's not what you think, it's not because it's not possible, because it is possible, but it's also like, who are we to say how much swelling the body needs or doesn't need in order for the healing process to happen.
So, I'm going to pause real quick because my, I just got a notification that my battery is low, but we're going to get started in a second, you won't even know I paused because it's just going to happen. You're just going to clip it back together and we're going to go.
Anna Hartman: Alright, so I'm back, I plugged in, now we're really gonna go into it. So, the swelling protocol, let's, let's review. The Swelling Protocol, I guess, well, let's just review from the beginning. So, the whole, the, like, origin of the Swelling Protocol was, gosh, probably like,
2017. It was probably 2017. I, two of my football players, both had, Significant sprained ankles during the season and their teams looked at the ankle, how swollen it was after the game on Sunday and was like, you know, they looked at it on like Monday or something and they're like, yeah, you know, get an MRI and they're like, Oh yeah, it's like grade two, grade three sprain.
You're not going to be able to play probably for like two to four weeks. And, um, then I come into their town and I work on them and next day swelling was almost completely gone. And then both of these athletes had the same thing kind of happen and then they ended up playing the following week. And so their sports medicine staff, their Themselves and me to be honest.
We're like, holy crap. Like that was amazing your body just like totally Eliminated that swelling almost overnight and you were able to play. So what I learned from this There's a couple things that I learned from this is like number one the body's gonna do whatever it needs to do to heal and it will be the determining factor of how much swelling needs to be present or not For that healing and more than likely the amount of swelling that we need to have happen for the inflammatory response to be like this healing response is way less than we sort of probably conditioned to appreciate.
Um, and then also another lesson that I learned was When you have an acute injury, and then you have a rapid decrease of swelling, you're going to be more sore. So that was sort of the, like, overarching theme of the week, is like, they got really, they got hurt, they had this swelling response. I treated them, their swelling went down significantly, and, which was great, but their soreness went way up.
But the soreness went away fairly quickly after sort of like moving the joint around and like, you know, within a day or two. You can almost think of it as like, extreme delayed muscle soreness almost, which it could have been, that's part of what it was, because you know, whenever we like spray in a joint the muscles around it.
Like tighten up to protect it and often get strange too. So that could have been some of the like soreness that they got. The other thing we realized is, holy cow! Everyone should notice. And so what would happen is over this year and over that year and the following years, my guys, whenever they had something come up that created swelling, they're like, no problem.
We'll just use your swelling protocol and I'll be gone in a day. And we're like back to business. And then they'd see their teammates. have the same sort of injuries, the same like ankle sprains or whatever it may be, contusions, and they would be out for a week, two weeks, three weeks, four weeks. And as teammates, they're like, you know, hated seeing their brothers suffer like that.
And then also are like, man, that guy wants back on the field. And if he had access to the swelling protocol, then, you know, maybe he would get back on the field. You know, and then the athletes were like, yeah, can I share this with my teammates? Can I share this with my athletic trainers? And I was like, honestly, yeah.
And you know what? You're right. I don't think any athlete should. Have to miss games for swelling reasons only but with that said I am also a big like Believer of like if you're really swollen if your joint is really swollen You probably shouldn't be playing on it because it just puts you at risk for other injuries So yeah like getting swelling out of there as fast as possible during the season is like the name of the game and Ideally as fast as possible on nature's choice not from drugs Right.
Not from draining it. Um, so once I, once I was like, yeah, I agree. This should be like commonplace knowledge. And like previously in my career, I'd say I was always pretty good at getting rid of swelling, but man, the, like when I started blending in the osteopathic philosophies to it. And like the, the visceral organ and nervous system pieces to it, it just like freaking supercharged it.
And so I was like, yeah, everybody needs to know this. And at that point in my business, I was like, I don't care. I don't care. Like I don't need to be paid for this. I don't need to make it a class I don't need like I just want to share it I just want to get it out to the world which PS for those of you own your own business That's a terrible business plan.
But also that's how passionate I was about it that I was like, I just want people to know this Because it works so good. Why? I don't want to gatekeep this. This should be general commonplace knowledge in the sports medicine field. So, so what did I do? Like after me and the athlete, like those couple athletes had that discussion that season.
I was like, you know what? I have a small email list. That's the best way I can reach other people in this profession. So, like, let's, let's, I'm going to send an email. And I literally just typed it out in an email, like, paragraph by paragraph. Hey, I've been using this spam protocol with really amazing results.
Here's what it is. Here's some videos to support it. And I sent it out, and then I started getting emails back from people being like, Oh my gosh! Holy cow, it's sending me pictures of before and afters from people's, random people's swollen hands, swollen knees, swollen feet, swollen ankles, swollen pecs, swollen elbows.
Like, literally I've gotten, it's like the sports medicine equivalent of a dick pic. Like, I get, like, before and after swelling pictures, pictures randomly from people I don't know. But who know me, and know this one on the protocol, and want to share me. And actually, I freaking love that. So if you, like soliciting, if you do have those, uh, kind of pictures, send them my way.
So, um, okay. So that's the background of the story. The background of the protocol. So the protocol, um, I've been using for a while now. And, uh, there are some, like, key things about it. So first, the area, the, the key areas of entrapment. Well, I guess, let's go back. Step back, what is the protocol and what makes it so special?
And I guess the other thing is, like, is compression and elevation. And rust's still important. I'd say, I'd say, you know, people have gotten away from the term rice because, you know, rust, ice, compression, and elevation because of the whole ice, anti ice movement, which that's a whole nother thing in itself, which I've probably talked about on all, on some podcasts, but, um, maybe to, I'll link my anti ICE people post in the show notes, because, uh, you can open that can of worms there, maybe that's just like a separate podcast episode, but anyways.
You know, so we're, like, a little bit away from that, but I'd say in general, like, normal, like, compression and elevation is still, like, a go to thing for Swell and Reduction. I think that compression devices over the years have gotten fancy, right? Game Ready, Normatec, those kind of things. Um, so,
so, yes, of course, those are things that are still valuable, and I'm a big fan of compression and elevation. I probably do less focal compression than I used to when I was younger. It's more circumferential compression, which if you look in just that compression research, that's not actually smart, right?
Focal compression is better. But I just noticed that it's not needed with this new lens of view of what I'm really trying to facilitate in the swelling reduction protocol. And that is vascular flow and lymphatic flow. Vascular flow, meaning arterial and venous flow to and from the injured tissue, and then lymphatic flow to and from the injured tissue.
Why is this important? So arterial flow to the tissue is important for healing. What's going to get the nutrients? You know, the inflammatory response to the area is partly this arterial blood flow and lymphatic flow is going to bring in all the little cells and things that need to come in the area to start the wound healing process.
And then the venous outflow, right? So the venous return and the lymphatics as well are going to help, what? Remove all the garbage, remove all the tissue breakdown that has occurred. And so, In the tissue turnover as tissue is changing and healing, right? So we need what, what, what hopefully you hear then is if vascular flow is important and lymphatic flow is important, then fluid flow in general is important.
And the key word being flow. And oftentimes what we see post injury or post surgery is a lack of flow, a stagnation of the fluid. And that's That's the problem. That is the problem. And when I say stagnation of fluid, or lack of flow, it doesn't always mean pitting edema. I think sometimes when people think of, um, swollen that's like old and not, like, flowing well, they think pitting edema, and that's just, that can be it, but that is not common at all.
I'd say that's like, less common than just, Swelling that doesn't seem to be going anywhere and that swelling is just hanging out and The industry as a whole and people of the whole Tend to sort of settle for like oh, well, I just got hurt So it's supposed to be swollen and I'm supposed to like have a really fat joint now And it's like yes, but also no and this is where this is kind of what I said one of the lessons I learned was And this is, you know, that, and I get this question from people, other practitioners a lot with the protocol is like, well, isn't swelling important, an important part of the healing response?
Yes, that is the healing response. That is the inflammatory response is also aptly named the healing response, right? It just depends on glass half empty, half full kind of person, right? Negative Nancy or positive Pam, right? So, so, um, but also who's to say that the amount of swelling
So, yes, is swelling important for healing? 100%. But, when the body's fluid flow channels are open, even after an acute injury, it should be fairly minimal. Fairly minimal. And so I'm not, again, like, it goes back to this concept of we're not forcing the swelling out. We're not forcing the body in a certain way.
We're simply helping the body decide on its own how much swelling is appropriate or not. And the way you know that is by always assessing and focusing on restoring the distal pulses. So if we're in the lower extremity, which oftentimes I'd say the majority of the times, that's what we're talking about.
Um, but it can be upper extremity can as well. It can be trunk too. Um, we're talking about restoring distal limb pulses. The reason why I care about distal limb pulses is because if you have strong pulses, radial pulses, and strong posterior tibialis pulses, strong Like suboccipital pulses, strong obturator pulses, like all these points on our body, like in the periphery, if your pulse is strong in those areas, then it is indicative of just good general vascular and lymphatic flow throughout the body.
And when I see that, I That's great. That's what we want, because we want the body to choose, like homeostatically, how much swelling is needed or not needed. So, um, I want to keep this conversation to like acute injury and post surgery, um, but This is, uh, you know, when you, when you think about chronic, people with chronic swelling, people with circulatory problems, it's hard to find their distal pulses.
They're very diminished, and that's why, because they have all this fluid sort of backed up and like stagnant and like overwhelming the fluid systems, clogging it up. And so you, the pulse starts to be diminished. So, so with an acute thing, um, that's what we want to check. And The, the, um, key is to Gino, it doesn't mean, so this is like, okay, so let me give you some examples.
So, acute injury. Previously, we'll go non limb too because I think it's interesting. So previously this season one of my athletes broke multiple ribs. I was able to see him, um, two days after, um, he broke them in the game and he was pretty swollen on his ribcage. A lot of swelling. Kind of right over the ribs that he broke, a little bit into the axilla on that side.
And so what did I check on him? What pulses did I check on him? I checked the distal pulse of his radius on both sides. But the side that was diminished was the side that the ribs are broken. Sometimes it's different, but in this case it was the same. So his ribs were Of course, of course they're swollen.
He broke them in multiple spots. So, most people would have been like, oh, well, it's supposed to be swollen. But I was like, oh, it's pretty swollen. Interesting, I can see how swollen it is. But your pulse is diminished. And to me, if your pulse is diminished and you're swelling, to me that's like, oh, I think you actually probably have more swelling than you need.
Because things are clogged up, so let's just see if we can restore your pulse and then recheck the swelling because the swelling is an output and so We, you know, I use the LTAP to figure out where to go first on his body and like took me to his cranium We did some cranial stuff and we did some stuff around his neck and then I rechecked his pulse and it was Restore pulse was strong on both sides.
And so then what did I do? I went back to his ribs and I looked and Within that treatment session his swelling went down It went from a wide area on his ribs to a very narrow Or very like localized spot like right above right around the bone area where he So to me, that was like, Oh, great. That's how much swelling your body needs right now to start like the callus formation on that bone.
But all the rest of the swelling, it was actually just blocking. I always like think of little cartoons in the sense, right? We have these little like helper cells in the vascular and lymphatics trying to get to the area. And there's a bunch of. Helpers that had already helped, but now are just like sitting around not doing anything.
They're in the way. And so, restoring the pulse helps to get all those guys out of the way, so the helper cells can go to the area and do their job. Okay? So, it's a great example of, um, Of, of, of how the pulse was, um, indicating how much was too much swelling. And interesting enough, I, I didn't share, but I like, I also not only checked his radial pulses, but I checked his posterior tibialis pulses too.
And after treating the neck area on him, and I checked his posterior tibialis pulse, that was better too. So I restored blood flow through the whole body by unclogging the area that was clogged. That's, that's why the LTAP's great to blend it in, is because the LTAP helps him figure out where in the body the clog is.
In absence of the LTAP, there's some key spots where things tend to get clogged, right? The key entrapment sites are the thoracic duct, left side specifically, the, around the liver and diaphragm area, uh, The anterior hips, so specifically the underneath the inguinal ligament, and then in the adductor canal, both at the proximal and the distal end of the adductor canal, and then in the, um, lower compartments of the leg.
Regardless, these are areas regardless of where the swelling is. Whether it's your ribs or your knee, these are the common entrapment sites for the entire vascular and lymphatic system. And so you, you'll want to make sure you're clearing all those points. So, um, but the LTAP allows me to get to the clog site fastest.
It's like at the car dealership when you can plug your car into the machine and it tells you exactly what's wrong with it while you're checking engine lights on. That's kind of like the hell town. So, um, another example is Afi, who I talked about on last week's podcast, you know, when he hurt his knee originally, he tore his ACL.
His, his, I got to, when I got there a few days later, his knee was huge, he was so swollen. But guess what? Not only was it so swollen, his distal pulse was like so diminished. And so again, I used the LTAP to direct treatment. The first place it took me was his liver. I worked on his, around his liver. The liver, not only is the liver a big vascular organ, but it also has a ligament that goes around the vena cava and the abdominal aorta.
And this cisterna chyli, so, uh, arterial venous and lymphatic clog point right there. And sometimes when we're just not moving around it, which happens a lot, right? After injury, we stop, we don't walk around a lot. And that trunk rotation is often what's keeping us mobile and keeping all those fluids kind of pumping.
So that was a big like. Um, clog point for him. I worked on that area and then I rechecked his pulse. It was a little bit better. Remeasured his knee swelling and it was a little bit less, right? And so again, like I don't have to spend hours like milking, massage, like getting the swelling out and elevating and compression.
Those things are helpful, but if I can figure out the clog spot, then I can facilitate things a lot better. And then his was a good example of like, There was a lot of trauma going on in his knee and so even though I unclogged it and I restored his pulse What was happening every day? There was still some swelling because there was still like a big like healing response initiating And so it's like, you know, yeah, his knee was still swollen the next day.
I did the swelling protocol on him I restored his pulses, but the next day his knee was Still swollen. Was it a little bit less swollen? Yes. Was it as Less swollen as after treatment the day before? No, but it was better than what we started. So that's an improvement. In general, I want to see a gradual decline.
That's the same thing post surgical. Post surgical You just were cut on you'd like things are in a new fresh Healing response. And so of course if I restore the pulse and get fluid moving May the swelling overall decrease? Yes, but is there still swelling being created? Yes, that's what I call persistent swelling.
This is actually a couple years ago how I knew that one of my Patience, one of my athletes Um, knee surgery failed. I was like, it, we got to a point in his rehab where swelling should have been almost gone or like at least trending downwards and he just kind of stuck. And his pulse was good so I knew it wasn't stagnant but it kept getting swollen and that means something is persisting inside the joint creating that inflammatory response.
We know certain milestones of healing, right, of tissue, of wound approximation of, you know, tissue regeneration. And those milestones were coming and going and swelling was still happening. And so that was like, uh, we need, we called the doctor up and it was like, something's wrong. Let's get another MRI.
Like something's wrong. Let's get an MRI. Let's get a deeper look at this. And so that was a really helpful thing to know. But the only reason I knew that is because I can appreciate what the distal pulses are telling me. So this is actually like something I can't emphasize enough is how important it is to be measuring our pulses.
Um, and to appreciate in instances of acute injury and post surgical, yes, of course, the swelling, some swelling is going to remain for a certain timeline, but it should always be trending down. Not flatlining or going up, right? So if the flatlines are going up, that's how, you know, that's a concern. Is it trending down and then maybe you do some exercises it goes up for a day and then trends back down?
Of course, that's kind of a normal rehab progress, right? A rehab process. Like every once in a while we choose exercises that were maybe like a little too much. Um, Didn't feel good. So we have a little bit of a swelling. Think, you know response again, but it should continue to trend down when we're on that healing journey.
So Tracking that is important. That's the one thing I also I measure every day on my Patients when they're post acute injury or post surgical is every day We look at pulse and every day we look at volume of swelling as best as we can I don't have a dunk take I can't do like an actual volume measurement, but I'm doing circumference measurements with the same measuring tape to try to keep it as consistent as possible.
So, um, yeah, I mean, overall, the answer to the question is, isn't swelling necessary and expected after injury? Yes, but probably not as much as you think needs to be there. And let the body decide. How much you don't settle for our super swollen dorm, you know, going back to those original football players, the whole reason I like created this one protocol and put it out there to the world is because they were told like, your injury is so severe, your ankle is so swollen, we don't see you being able to play for the next two to four weeks, we got rid of their swelling within And One to two days and then they played that following week
So it was up to their body like their body like had an inflammatory response send as much swell You know Swelling as was needed for the healing response to happen and then it was pretty minimal and they were very functional on it after that so don't make assumptions and don't settle for mediocrity and don't settle just because Swelling is considered normal.
Of course it's normal, but not as much swelling as we think needs to be there. And, you know, especially post surgical, when you're trying to restore people's range of motion, the easiest and least painful way to restore range of motion is to get rid of their swelling.
Period. So, it's also a good indication of when you can't get their full range of motion that they're probably swelling. So Maybe you need to recheck and check their pulses and start the protocol. Anyways, I hope this was helpful. Um, looking forward to hearing your feedback as usual. If you have any requests, dedications, feedback for future episodes, I would love any ideas.
Have a great day.