Don’t Make It Weird Karen
You had to go and make it awkward, didn’t you Karen…? On this episode of the Unreal Results podcast, I unpack the crucial interplay between body positioning, ethical touch, and the nervous system's role in therapeutic outcomes. In this episode, you’ll hear about a Karen calling me out in the comments of a recent Instagram post regarding my body positioning in an assessment I was doing in one of my courses. I address the reasoning why I utilize that technique, but I also share a story from my past as a patient illustrating the significance of verbal & non-verbal consent. This episode serves as a powerful reminder for healthcare providers on the importance of communication and creativity in treatment approaches, all while maintaining a professional demeanor with your clients.
Resources Mentioned In This Episode
Episode 13: The Surprising Problem With Scoliosis
Episode 58: The Whole Organism Approach
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 in 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.
Okay. Hello. Hello. Welcome back to another episode of the Unreal Results Podcast. I am jumping in probably for a fairly quick episode, um, wanting to talk about body position and also consent and like just interacting with patients in my in-person courses. Especially a little bit in the online course, but definitely in my in-person courses when I'm demonstrating techniques, what often comes up is how to set up your patient for the best opportunity for a good treatment session and a healthy, good interaction that is.
Putting the patient is at a, in as much ease and feeling safe as possible. The important, this is the reason why this is more important or, or most important. Well, one is just fundamental human rights of like, I want people to feel cared for and safe and taken care of and get good results. But then the other reason it's important is because we know safety is related to the parasympathetic nervous system, and we know that that is the feeling one must have in their body.
In order to tap into the body's ability to heal itself from a rest, recovery and regeneration standpoint. So the way you set up the visit, the way you set up the room, the way you interact with the patient on the table actually goes a long way in ensuring all those things. And this is even not something new I've talked about on the podcast, like right, like.
The episode, I'll have Joe link in the show notes. The episode that Nicole Cozean and I did, we talked about this a lot. Me and her have very similar views on this sort of soft skill side of being a clinician and how important it is for the outcomes for our patients. So we talked about a lot in there. I talk about it a lot in the parasympathetic episode, just talking about safety and like feeling okay in your body.
Um, those are the two off the top of my head. I know I've talked about it, but I just wanted to do a quick podcast on it because I, today, I literally just got a comment on one of my posts on Instagram. You know how those things fire me up sometimes, and it was from a manual therapist who, you know, their comment was like, not to be a Karen, but you really shouldn't straddle your patient like that.
It makes, it makes for an awkward situation and um, you just shouldn't do it. And I was like. Basically the video, it was, it was not even, I wasn't teaching anything on the video. It was a ten second video of me in a lab session from the Tacoma course where I was demonstrating and talking through the steps for the SI joint locator test.
Um, assessment, which is like a supine mobility test, taking the innominate bone and providing an anterior to posterior glide on the sacrum. And my response to them was like, okay, well first of all, if you have to say not to be a Karen, then your intention is to be a Karen. And then also the less Karen-y thing would be to actually message me in
private message, like in a DM being like, Hey, have you ever considered that straddling your patient is inappropriate? And it awkward. Um, so I was like, yeah, hey, yeah, you're, you are being a Karen because you're choosing to bring this up in the comment section to like call me out. And um, also too, I don't. I don't feel called out at all.
And this is a conversation that we have about this assessment technique in the course. And I, not only do I provide context around why I do it this way, but I also provide context, not even context. I provide other options for ways to do it if it doesn't feel comfortable to you or your patient. And this is what it comes down to always for treatment.
In order to get good results from your assessment or treatment, you have to feel good in your body and your patient has to feel good in their body, so you need to set it up for both of those scenarios to happen. Part of the reason I do it is for my body to feel better because I recognized that when I had back surgery back in 2009 when I was 29, 28.
I recognized that whenever I stood on the side of the patient and shifted my upper body over to the left side, 'cause I'm left eye dominant, left-handed, it was a huge pain generator for my back. That shearing of the spine, and because I'm short and often working on tables that are higher, right? The shearing was coming from like
upper lumbar as opposed to some people are tall enough, the and the table's low enough that they can sort of like side bend over, right? It's not such as shearing stress. So I have changed my body mechanics to ensure everything I do doesn't hurt my own body, which is so important from a long-term health standpoint.
But with that said, I do recognize, especially when it comes to the pelvic area, that this is a very intimate and sensitive area of someone else's body. And if they don't know me very well, and they don't even know what I'm doing, if I just jump up on the table and straddle them, it can be very threatening and it can be construed as something not professional.
Okay, here's the context. Then, before I do that with my patients, I am like, Hey, is it okay if I get on the table with you? I need to push down on your pelvis gently to assess the mobility and. If they give me consent, great. I climb on the table and when I climb on the table, I actually climb down by their feet.
And then as I'm explaining what I do to them, I keep my weight back on my heels. I. So I'm at the end of the table and I'm explaining with them, and what this is doing is it's sort of warming up the scenario that I'm gonna be on the table with you and I'm going to be closer to the middle of your body, and are you okay?
And this whole time that I'm explaining to them what I'm doing. I am also reading their body language because consent is verbal, but consent is also body language. And so if I get a verbal yes, but their body is clearly telling me no, what would I do? I get off the table and I choose a different way. And in the class I demonstrate this assessment in multiple ways.
And with multiple props and with multiple scenarios so that if that comes up, you're not like, how am I supposed to proceed? Because they said no, but this is the only way I know how to do the test. And so that's, you know, uh, an important sort of like thing to realize is number one. You are not bound to the supine position to a table, to like you're not bound to a certain way to do an assessment or treatment.
If you feel bound to a certain position or way to do something, that's probably an indication that you don't fully grasp what you're trying to do to that joint, to that tissue, with that assessment, with that treatment. Because if you fully grasp what we were trying to do, you could use creative thinking to figure out different positions that you could test the same thing in, or treat the same.
Thing or maybe just choose different tools to get out the treatment, right? Does that make sense? And so this is one of the things I'm really passionate about teaching other clinicians is like you have to understand the anatomy around what you're doing, the why behind what you're doing. You're the nervous system piece, the consent piece, like all these pieces go together between patient and clinician to set you up for success.
And so, um, it's nuanced, right? This is also why it's like you can't teach that in a ten second reel on Instagram, even though I wasn't even trying to teach that, right? It was just like background video that the person decided to like have a problem with. My other point to them too, in my response was, the only way you make it like sexual and awkward or weird is if you make it that way.
So sometimes people are ask, oh, Anna, when you're doing manual therapy on your athletes, like, um, groin area, like, how do you navigate that? And I'm like, I say the words like I if, if their genitals are in my way, right? If I need to get somewhere that their genital is laying on top of it, I literally tell them that.
And I'm like, Hey, could you move this? Over. And you know, I might not like, be like, Hey, can you move your penis over? But sometimes like all the little other words I'm using, they're not getting like all the little like hints I'm giving, they're not getting, and so then I'm like, Hey, yeah, your penis is in the way.
I would like to touch that area of your hip or the area of your leg. But I'm not intending to touch that. Could you move it or could you place your hand here for me so then I can place my hand next to it and make a clear boundary. And so this is the same thing. If I'm on the table and I bring my upper body above their pelvis, which is not bringing my lower body, I keep my lower body very back towards their knees and feet as much as I can, and then bring my upper body above their pelvis.
Um. If I'm doing that and I'm thinking, Ooh, this is awkward and sexual, guess what vibe I'm giving off to the patient. Awkward and sexual. So if I approach it as a professional and a clinician and being like, this is why I am doing it, I appreciate that. This is a sensitive and intimate area. I've already told you why I'm there.
I've asked your consent if it's okay to be there. I'm reading your body language the whole time to make sure consent is maintained. And I'm not weird about it because I'm not trying to be sexual or weird. Like the interaction goes so much better and it does feel safe. And most of the time the patient doesn't care because the patient just wants to feel better and they view you as a healthcare professional, not a sexual predator.
So the only person thinking that is you or bros on the internet who have a problem with me putting my body mechanics first to ensure my body feels safe, but then also to ensure that I don't get hurt at the expense of trying to help my patient and taking outta the context of the fact that I set up the whole scenario appropriately and it wasn't awkward at all.
Only person who's making it awkward now is them. So. Um, the bigger picture of this podcast episode isn't even to, like, complain about that comment 'cause I'm not, it was just like a, a big teaching piece because I think oftentimes maybe we are in classes or we are doing a treatment on someone and like. It could be awkward.
It could be weird, or you might forget how important it is to ask consent, and sometimes when my, my athletes who've worked with me for years, I still ask consent every single treatment session. Every single evaluation. And so every once in a while, one of 'em be like, you don't have to ask me anymore. I know what you're gonna mean to do.
And I was like, oh, I appreciate that, but I'm gonna ask you every time anyways, because that's how consent works for everything. I can tell you, yes, it's okay today, but tomorrow it's not. I can tell you yes, it's okay today, but later today it's not. I want the patients to always have the autonomy and the realization that they can say no.
And in fact, my athletes especially, I, I like go outta my way to talk to 'em about this because there is an assumption sometimes that because they're athletes and, um, they're used to getting worked on all the time or they're used to being in settings where maybe there's like journalists and reporters in their locker room.
Um, there can be this belief system that they're used to it and they won't feel violated. Like I can, like lift up the edge of their pants and like pull it down to access their hip or like put my hand inside the, you know, elastic band of their pants to release their hip flexor or whatever I'm doing without asking because they're used to it.
And I'm like, no, that's not appropriate. They, you always need to ask, no matter how many times this person. Has had that done on them even by you. You gotta ask. And um, I remind my athletes actually that at any point in the treatment with me, with anybody else, they always reserve the right to change their mind and say, no.
To speak up and let the clinician know or let the professional know that they don't feel comfortable. They, they don't feel okay. They would like you to stop treatment and it is the job of the practitioner to stop. This goes for body part areas like this, but this also just goes for if you decide you don't want that treatment anymore.
Right. I was young. Professional, probably like 23, like straight outta college. And we had, at Athletes' Performance, we, we would have the, you know, whenever we had an opportunity for another professional to come in and do like an in-service to like show us what they do and teach us a little something. We always took it up, took them up on it, and we had this woman who was in town
visiting one of the coaches and she was like a long time, like Rolfer or like structural integration therapist worked with like many great people, was well respected and um, oh, I know too. It was, she was there because she knew Don Chu. Don Chu was a, um, strength coach, therapist, like very well known in the industry who was actually showing us, um, soft tissue.
Um, like tool assisted soft tissue back in like 2003, like very early on in the tool assisted soft tissue days. So he was demonstrating to all of us, and then she was like, oh, let me demonstrate how I would do this with my hands. Very similar to the tools. And I was the guinea pig. I was like the dem, you know, the, the subject and fresh outta school, like didn't know I could say no to things, a female.
Didn't know that I could actually speak up and tell somebody that I was uncomfortable in this situation, you know? And so she starts working on my quad, which was already, um, had already had worked on from the tool assisted method. And then she starts in like rolfing it, which is very painful. She was doing a skin rolling technique.
I literally had never had manual therapy before. And I had multiple surgeries on that knee mo, multiple injuries in high school and in college, and it was so painful. I was like squirming away on the table crying. Crying. If you're squirming away on the table and crying, even if you're saying yes, that's, that's body language that's saying no.
So that's, you should stop as a clinician. You should stop and, um. But that was also my experience in physical therapy because in high school it was the same scenario. They couldn't get my knee range of motion back after my surgery, so they strapped me to the table and did it while I was crying, and again.
So many examples of what you should not do. But, so this is my background. So I didn't speak up for myself. I was just crying and like hating my, hating this. And so she got done with the treatment and I was so bruised already just immediately after treatment and within the next 24 hours, my leg got black.
Like it looked like somebody took a two by four to my thigh. It was black and purple and hot and swollen, and I could barely walk on it for like days afterwards. And I remember one of the coaches at Athlete's Performance, who is still one of my dear friends and mentors to this day, Darryl Atto Coto. He's like, Anna, I am so sorry I didn't stop her.
He's like, because you were in so much pain and clearly. This was not going well. And he is like, I am so sorry. And he's like, but also like you should have like, he's like, he basically was like, you can say stop whenever you're in that scenario. 'cause he had, he's a strength coach, but he had once upon a time, been a massage therapist too.
So he's like, understands like touch therapy and consent. And he was like, Anna, you have permission to tell a clinician to stop. You need to speak up for yourself. And it was the first time that a professional like told me that I was allowed to do that in a healthcare ish setting. And it was, I mean, I'm getting tears in my eyes thinking about it because it was like so powerful and I think.
Because of those experiences and then layer on what I've learned about safety in the nervous system and how much it influences our treatment outcomes, I have, I have like become such a huge advocate for it. So obviously when that person left that comment on my post I, I got a little fired up in terms of like, you have no idea how I address this.
All the time when I am teaching because I am so passionate about how important it is to get consent to read body language, to ensure safety, to ensure good biomechanics for your own body and safety. To also understand what you're doing so well, that you are not limited by the ways you are taught from a position standpoint of how to work with people, that you can use your brain and be creative to get the same scenario from a treatment and assessment standpoint.
This is why I am so obsessed with sharing and teaching and getting people to learn the anatomy and like really the principles. Of what you're trying to do as opposed to just teaching everybody techniques. So anyways, that's it. Hope this was helpful. Um, and just know that if you're coming to an in-person course with me, we're gonna talk about this a lot.
And it might not like officially be in the curriculum, but it's often one of the more powerful parts of the class. Um. And actually maybe too, I'll even have Joe share in the notes with the links the episode I did with Lex about scoliosis. Um, this is like the concept of meeting the body where it's at is another concept of
acknowledging safety and recognizing safety in your nervous system, in your body language, and like making sure you're checking all those boxes before you're doing treatment, before you're doing an assessment. 'cause it's gonna set you up for success. So anyways, thanks for being here. See you next time.