Movement Compensations Are Not The Problem

Welcome back to the Unreal Results Podcast!  After a little summer hiatus, I’m back to recording new weekly episodes.  In this particular episode, I talk about what I’ve been up to these past 6 weeks including working with one of my closest athletes, my birthday celebrations, and some personal health issues.  But the main topic for today’s episode revolves around the body’s compensation mechanisms and how healthcare & movement providers should not fixate on them.  You’ll hear why I believe compensations are actually great for the body, but more importantly how utilizing the LTAP™ for an individualized assessment is way more important for the treatment you provide, whether it’s to address the compensation or not.

Resources Mentioned In This Episode
Episode 36: Listening To The Body
Episode 46: Using The LTAP™ With Post-Surgical Rehab
Episode 47: Always Check The Distal Pulses

Upcoming In-Person LTAP™ Courses
LTAP Level 1 in Boston, October 2024

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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• Episode Transcript

  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, and welcome to another episode of the Unreal Results podcast. We are back after a short five or six week summer break, got our first new episode. Um, yeah, super excited to be back. Um. Mostly just because I love sharing and connecting and just doing new stuff. Um, but the break was much needed and I still I was hoping to be like a little bit more inspired And like ready to create when I came back, but that's just not how it goes.

  I am We'll give you an update on my life. Uh, I don't even remember what the update was when I last signed off other than like it was summertime starting um But um, it was you know Like I just gotten like returned home to san diego after being on the road for months like months And, um, working with my athlete with his rehab and, you know, having a very impossible goal of trying to get him back in time for the Olympic trials, which didn't happen.

  Um, and that was tough. I mean, in all, you know, now that we're through the weeds a little bit, um, the Olympics are over. Um. We can reflect back a little bit and, um, I think we're realizing, we're, we're realizing that yes, the, the, the goal we had was probably pretty impossible. Um, but who would we be if we didn't try in the first place?

  Right? So it's like, we were trying to do something nobody's ever done before. And, um,

  We really, you know, I think both of us didn't really like, of course, we wanted to believe it was possible. And we want to believe that if anybody could do it, it was us. And, um, but I think like deep down, we neither of us really thought it would work out. But we both wanted to try. And what happened was at the beginning of his rehab, we were crushing it and things were going so well that all of a sudden, I think both of us really felt like, holy shit, like this might happen.

  Like this could actually work out. And so then we got our hopes up and then. It didn't happen and so we went on this like roller coaster of emotions of feeling like it wasn't possible thinking it was possible feeling like it was getting close and then just not not doing it not being successful in what the goal we set out for and there was a big like sadness and disappointment with that and like having to go through probably the emotions that we were like putting off When the initial injury happened, which was these like feelings of grief and sadness and loss that occur when you have an injury and an injury that you know is going to affect a timeline and a goal that you've had for a really long time.

  And so, you know, both of us. Him and I have, have, have, have been going through quite the emotional, you know, roller coaster. And, I think both of us are starting to feel like more of ourselves and better. But, I will say that this summer, um, I definitely needed the rest and I've definitely needed the like time away and like just still probably not fully recovered and rested emotionally and physically from that whole experience.

  And also we're like, we're still going through it, right? Like he's still rehabbing. We're not a hundred percent yet. And um, Very, you know, he's very close. He's basically like training regularly now, but, um, you know, we still, I don't think either of us will feel like we're fully finished until he is competing again at the level that he was before he got hurt.

  So, um, there's still more to do. There's more time, but at least it's feeling like we're, we're feeling better. So, and I, and also to like, both him and I probably will share more about the experience. As we get to that point down the road and then we've been documenting everything like his program videos of it like literally documenting everything with the hopes of sharing it with the world.

  One day, because it is like pretty interesting. I've, I've been speaking to a colleague of mine, shout out Darcy, Darcy Norman. Um, he's a PT athletic trainer, but works as a, um, movement performance coach, uh, for, uh, USA soccer. And, um, we've been like going back and forth on like, performance return to performance protocols and like things that we've been doing and like things that we're doing and seeing like really unreal results with.

  And though I don't recommend necessarily having the focus of your next ACL protocol being so accelerated like me and my athlete was trying to do, I think what We've really learned some great things from it that can be applied in any sort of rehab to facilitate and optimize healing, tissue repair, tissue synthesis, tendon regeneration, um, which is really important.

  I'm going to be talking about how to optimize healing and return to performance in whatever timeline you want. So, let's get started. So that, that's coming at some point. I probably don't see it happening until 2025, to be honest. So, um, but it's there and it's just really exciting. To share. And some of it, you know, there's been episodes that I've already shared a little bit about it.

  So, you know, I'll make sure Joe links those. Um, one, I talked about how important utilizing the swelling reduction protocol was through this whole process, as well as LTAP was through the whole rehab process. So there's definitely been episodes that I've talked about it, um, from a post surgical rehab standpoint to that.

  You know, I can already share and know that it was like a huge part of getting ready for it. So the other bit of this, I said it was a couple things, right, of like feeling like not 100 percent rested just yet, even though I've taken some time off, is um, man, I got off of my thyroid medicine. The beginning of the year.

  I don't know why I'm so obsessed with like not being on medicine. Um, But partly it was because I never thought it was really doing anything for me but now here I am eight months later and I've had my blood work done once to test to see how I did off of it And of course, you know after like a month or so off of it I did see like things diminish and I was supposed to get it done again And I just got too busy and didn't and then a little bit of me is like just being stubborn Of trying to like heal myself And, like, overcome without it, which is silly because it was so hard to, like, be healing myself while I was on it.

  I'm not really sure why I thought being off of it would make it, like, be easier other than I really was. Not feeling like it was doing that much. However, I'm getting my blend work done tomorrow because I have just been like, really, really tired. And, um, it's, it is hard whenever I come off of a season.

  It's hard for me to know if this tired is tired or just finally able to rest. And what I'm also noticing the last month or so is not only am I tired, but, um, my body hurts. Um, my delayed onset muscle soreness is like a little bit more noticeable from my workouts, even though I shouldn't probably be feeling it because I've been pretty consistent in my workouts.

  Um, when I go on walks, my feet are extremely sore and sore in a different way than they haven't been in the past. And just like, I just. I have like increased muscle aches and pains and I had this realization the other day. I'm like, oh my gosh I think that's actually a sign of hypothyroidism is muscle aches and pains and and So I think yeah, so finally I was like, okay, so maybe That medicine was doing more than I thought, and even though I didn't necessarily notice a huge energy burst when I took it or like a big decrease in weight, Um, maybe it was doing stuff because now that I don't have it, I'm like, yeah, I have been like way more sore.

  Then normal and my, like, general bloating and lymphatic issues have been a little bit harder to control, um, since coming off of it too. So, I don't know, though, this is all like, just guessing, um, getting my blood work done tomorrow and we'll figure it out. But, um, you know, I think, you know, one of podcast, right, is to introduce you all to a more whole organism approach to.

  The body and to aches and pains and injuries and appreciating how the viscera and the nervous system can be reflected in musculoskeletal pain and dysfunction and so To me, that's a really good example of like one of the main symptoms of hypothyroid or even hyperthyroid but basically thyroid dysfunction is muscle aches and pains and You know, like, which can feel like constant upper trap stiffness and soreness.

  It can feel like sore feet all the time, especially in the mornings. And it's just like, as your joints get inflamed, right? Like in so many autoimmune diseases are like that. And I think sometimes we forget about that as musculoskeletal, biomechanical based practitioners. We forget to ask the questions that could lead us to understand, like, it's something else.

  It's something visceral. It's something You know, and from a visceral standpoint, it could be functional or it could be structural. And so figuring out how to appreciate that. And that's the, that's a little bit of a dance that we talk about a lot in the LTAP is like, you can only do so much with manual work and movement to support the organs.

  Because really at the end of the day, you're supporting their structure and their function at the same time. But sometimes it's not enough. Sometimes you need help from nutrition or from pharmaceuticals or from some sort of intervention that needs to be led from a doctor or a different type of healthcare provider.

  You know, you need them on their team, on your team. And so it's so important to know when to refer people for things like that. And, um, I always think to like, man, what would the general population do if they didn't have my knowledge? Right? Like someone in my same situation would just like feel like shit for a really long time before somebody figured out that it might be their thyroid.

  So anyways, that's why I share it too, um, is not only just to share what's going on in my world, but also just to kind of like, Share that, like, and share, like, this is, this is why I have this podcast, like, just to keep it on your radar. That musculoskeletal aches and pains and injuries, though they seem biomechanical a lot of the times, that's not the only piece.

  Can there still be a biomechanical piece? Of course. Do I still care about movement? Of course. But the driver of that biomechanical thing might be something. Deeper like a visceral or a neural thing functional health sort of thing. So Um, yeah, what else has gone on in the summer? I had my birthday. I am officially 44 years old now, which is Um, the alternative is that I'm not around, so I'm happy to be here, and I'm happy to be 44, even though I would prefer to be like, mm, 28, 32 maybe would be my preferred age at this point in my life.

  Um, I had a great time, I didn't really do a ton, my sister came down from Sacramento, surprised me, which was really sweet of her, we had a great day, we went out. Plant shopping I added to my garden, both indoor and outdoor. And then we had a nice dinner and went to Coronado and saw the sunset and had dessert.

  It was great. And then the next day, we went to Disneyland with, um, two of my friends and their kids. So 10 of us descended on Disneyland and California adventure and had quite the day. We walked equivalent steps of 14 miles in like, 14, 15 hours, which is insane to me. When you think of it as an hourly mileage, it doesn't seem that's crazy, but.

  total mileage, 14 miles during the day. I woke up the next day and I could barely walk. Um, which again is part of the reason why I was like, Oh, this something's going on. Because it's not like I don't walk. And it's not like I don't work out like 14 miles is a huge training error. But at the same time, like there was something, there was something about my feet.

  Feet soreness the next day that has actually lasted a whole week that just is different than my normal My feet hurt after disneyland sort of thing. So anyways, uh, that was really fun though um Other than that just kind of been enjoying been reading a lot of books um, which is great because I associate reading fun books with rest and feeling rested, um in my brain, if that makes sense.

  Like, um, sometimes when I'm so stressed out or I'm so busy or so overwhelmed with things, I actually just don't feel like I even have the bandwidth to read books and I have been consuming them so much lately. And that is, it just makes me happy. In fact, that's kind of like all I want to do right now is read.

  So it's a little bit of a challenge to like put the book down and like start to dive back into work. Um, yeah, so, things looking forward to, uh, what's on the calendar for the rest of the year. We got two in person LTAP Level 1 courses coming up. We got space only left in one of them, so, uh, there are seven seats left in the Boston, uh, course in October, and that's it.

  That's, that's the only available in person LTAP level one seats available for the rest of the year. I'm finalizing some dates and locations for courses in 2025 and then the online six week course starts, um, is going to start October 8th, I think, whatever. Let me look at the calendar. Sometime the first week, uh, week of October, uh, October 7th is When the LTAP starts, so we'll be running the results cheat code again.

  That's gonna run September 22nd It's going to be the version of that's called the missing link super excited for that So get ready to have that on your radar And then I have a new product coming out in November that I'll be sharing with you all soon And then, gosh, it's the end of the year, which is crazy.

  But, um, super, super excited to take the next group of people through the LTAP Level 1. Oh, and that's what else is rolling out in the fall is the certification. So, super excited. I'm sending out emails actually this week to my, um, Teaching assistants and my mentorship alumni, offering them to sort of like be the first people to go through the certification.

  So that's going to be really exciting to roll out in the fall as well. So, um, I know that makes a lot of my general population happy because the amount of emails I get daily asking for a practitioner in their area. So I can't wait to have a group of people to actually refer out to. Um, that's it for the housekeeping stuff, I believe.

  Um, so let's get into this episode. So this episode, um, you know, I was, I, I asked for help from you all for recommendations of, What topics to talk about and thank you for those of you who messaged me or emailed me I appreciate it. A lot of them were like really complicated things Which I might I definitely don't have any experience in certain.

  Um, diseases or certain, um, issues Clearly your patients are having these. Um, So I will do my best to to address those questions You Um, but, and actually that's kind of where I want to start. And this is what comes up a lot when I'm teaching in the LTAP too, is inevitably, believe, or even in the mentorship in general, when I am mentoring practitioners, the question will always come out of like, Oh, this person has a history of this surgery or this.

  issue. What, what should I do for them? And so like, for example, um, Kirsten, Dr. Kirsten, uh, Wischloff, uh, chiropractor in Canada. Um, she sent me in a question for the podcast and this is a good example of it. And sort of kind of with the feedback I told her, she said, Hey, I had this patient with pelvic pain who recently had um, gastric surgery, like a gastric bypass or something like that.

  And, um, I, she said, I'm, I'm interested to hear your, um, thoughts on how it's connected. And, you know, and she had seen this client before. And so she gave me a little bit of like feedback on the situation, but, you know, my answer is what I want to share with everyone. Cause like I said, this is when I'm mentoring people, this kind of question comes up a lot is like, this person has this, what do I do?

  And. This is the annoying part is because the answer From me is always it depends and I hate giving it depends answer because that doesn't help you at all But also it's important for us to realize when we're looking at this whole organism approach that

  the body is designed to compensate for things that happen to it and Including, sometimes, surgeries, injuries, traumas, whatever it is. What makes us absolutely magical, amazing at being human beings is that This drive for survival, survival of the species, survival of our own body, allows us this robust capability to have this resilience of having a lot of shit happen to us.

  And we just keep going. It, I see it on a daily basis from my elite athletes, from my elite, like special forces, operators in the military, what makes them better than me and you is this above the neck capability and maybe even this nervous system capability to keep going despite the messages from their body telling them to stop.

  Despite all of the load, all of the Things that have happened to them in their body, they keep going. And, um, it reminds me, too, of this quote from Jean Pierre Barral about disease, like disease, right? That it is not, like, basically he says that the, um, When the body loses the ability to compensate, that's what creates the disease.

  That's what creates the injury, the pain, the dysfunction, is the body loses the ability to compensate. It is not the compensation itself. And if you're like me, when you hear the word compensation, you instantly think of movement dysfunction or movement compensation. And that's a very good explanation.

  Like, that's a very good way to kind of think about it too, is that when someone has knee pain in the old biomechanical model, maybe we would have blamed their movement compensation and the movement compensation being like, I don't know. You know, knees, too much internal rotation and AD, like, ADduction, like valgus upon loading, right?

  Which could be driven from lack of ankle mobility, could be driven from lack of hip mobility, could be driven from lack of hip stability, could be foot stability, could be core stability causing all of those things, right? Those are com movement compensations that we think are driving this knee pain. But what happens with our patient?

  We see their, often, their pain goes away, their tissue heals itself, but they still have the compensate, compensation. So, so you have to ask yourself, was it the compensation that was the problem? Or was it the, uh, like something else? And so, It helps you to reframe that the compensation is not the problem.

  It's when we lose the ability to compensate, that's the problem. And this becomes sort of like the, um, more pain science thought process of the threat bucket. Or like when I would, before I knew it was called the threat bucket, I would say, it's like a cup of compensation that we have this This resilience in our nervous system, this resilience in our tissues, in our body, in our organism, that we can have a lot of stuff happen and not have a problem.

  But all of a sudden, we can reach our fill point and then when we reach our fill point of compensation, the body can't compensate anymore and it breaks and breaking might be It physically stops. It makes you sick. It creates disease, whatever it may be, or, you know, or just pain. And so we look at this threat bucket or we look at this cup of compensation and we think, how do we support it by decreasing the amount of shit that's happening?

  So we're always at a standpoint where we can compensate. And this is where Understanding, like, all the things that we do to facilitate rest is important, and how, what rest looks like, it's not just stopping what you're doing, it's not just sleeping, it's like the social engagement co regulation, it's like all these parasympathetic things we're doing to our nervous system that may be related to sleep, that may be related to eating, digestion.

  but also just helps us have space in our threat bucket or have space in our cup of compensation. And so how this relates to the question is when, when we see someone come to us with this history, And this is, this is also why in the LTAP, I encourage people to not start with a subjective history. Because it biases you to what you think the problem should be.

  If I know they had stomach surgery, and I have this belief that this, even the incisions, the scars are going to cause havoc on the abdominal cavity, on the chest. Fascia and change the way we move because of it, um, I'm going to then bias all of my evaluation and all of my treatment around that belief.

  But what that does is it doesn't allow for me to see what the body is doing a good job compensating for. If the body's compensating for it, why do I need to fix it? Maybe fixing it could be helpful. But it might not be the first thing that I need to deal with. It's sort of like, it's the elephant in the room.

  We don't want to get distracted by it. It can be so distracting when we know they have this issue. It can be so distracting. So we don't want to be distracted by it. And the only way you can not be distracted by it is two things. One,

  well, I think, I think really the only way to not be distracted by it is realizing that number one, the body is really good at compensating for things and dealing with things on its own. And it doesn't need you. There are plenty of people who have surgeries, um, and heal just fine and go on and move well, feel well, do well.

  They don't need someone's hands on them or someone telling them how they move or doing exercises with them. I hate to break it to you. There's plenty of people in the world that do just fine after injuries and after surgeries without intervention, but then there's people are not that don't. Right. And so It's sort of like up to us to decide how we want to interpret what their body is telling us in prioritization of if it really is affecting their ability to compensate or not.

  So, um, this is why I teach the LTAP. This is why I believe so much in the general listening with the hands of the osteopathic listening and the locator test assessment protocol is because it's a way to ask the body, like, what is going on with you? Where are you having a hard time compensating? Where are you having a hard time Dealing with whatever is going on and whatever is going on can be anything.

  It doesn't have to be The elephant in the room the biggest thing that's ever happened to them or the most current thing that's ever happened to them And so it's important for us to take someone's history and like be considerate of it But not to get distracted by it because everything is connected Everything anatomically is connected.

  We were once one cell So it's all connected. My tongue is connected to my toe, and if I know the anatomy really well, I can give you any, any connection. I can tell you the neural connection. I can tell you the vascular connection. I can tell you the lymphatic connection or pathway. I can tell you the fascial pathway, the muscle pathway, like, whatever, the bony pathway, right?

  The more I know in anatomy, the more stories of connection I can tell you. But what I can always tell you is that we started as one joint cell, and we developed from that, so everything is connected. And so, of course, could someone's stomach surgery be related to their pelvic floor problem? 100%. But is it always?

  Not necessarily. I will only know if their stomach is influencing their pelvic floor if I test it. So you have to assess the pelvic floor. You have to assess the stomach, and then you have to do some sort of inhibition tests to see if it's having an influence over it. And these are some of the principles that I teach in those courses.

  Is inhibition testing, and how can this help us? But just the LTAP itself is going to direct us of if it's important or not. So, um, you know, of course, I answered her question and I gave her the most common anatomical relationship to how it would be affected. But at the end of the day, I said it's important to not get distracted by their story and actually have a way to assess the body to figure out where to start.

  Because it may not be a problem for the body at all. The body might be compensating for that surgery lovely. And if you mess with it, If you mess with the area that the body is actually dealing with fine, you actually chance fucking things up and making life worse for that patient. And so this is also like, why would you mess with it?

  Their cup of compensation is operating well in that scenario for that specific elephant. So um, understanding this. This resiliency in the body, what makes this so magical is important. Understanding that the body is smarter than us and we can't assume that because there was a surgical trauma or a physical injury or an emotional trauma or whatever it may be to a certain tissue, that that is the problem.

  That is an assumption on our part and you know what? Assuming does. Right? Makes an ass out of you and me, because we don't want to assume based on this belief that everything that happens to the body, right? Every compensation is bad. Compensation is not bad at all. Compensation is actually good. We want the body to be able to compensate.

  A healthy, well performing body compensates really well all the time. We want the body to have robustness and resiliency within its tissues, within its biomechanics, within its nervous system to be able to compensate. How do we say this in the biomechanical world that's popular now? Movement variability.

  Right? Do, have you all noticed that? That like, back in the day, or maybe currently for you, like, it depends on what mode of teaching you use. Movement compensations are bad, but now all of a sudden it's like, oh, you gotta have movement variability in different, you know, capacity for movement variability to stay healthy.

  So it's like, make up your mind. Is it Compensations are bad or compensations are good, we're just going to call them variability. And I'm going to say they're good. It's a variability. And also compensations are showing robustness and resiliency in our threat bucket or in our cup of compensation.

  Resiliency is robustness in our tissue quality, in our biomechanics, in our nervous system's ability to heal itself. So this is what we want, compensation. We want to be able to compensate. And so understanding that allows us to realize that when we take a thorough subjective history, which do it, I'm not saying don't do it.

  It's how you catch a lot of red flags that are going to help you decide to refer someone back to a doctor, but also don't let it distract you from your actual physical examination of the body. And your actual examination of the body, which should, I think, include the LTAP or a way to do something like osteopathic listening that helps you communicate with the body to determine where the body thinks the biggest problem is.

  Where the body is. is directing you that the driver is from, which may or may not be something significant in their subjective history.

  So, this is why every question I get from my mentors are, is, depends. This is why I require people People to go through the LTAP and use the LTAP in order to go through my mentorship program because if I'm going to mentor you and I'm going to help you with your patient, when you come to me and say, what should I do with a patient who has pelvic pain after a gastric bypass, I'm going to say, who cares?

  Who cares really about their gastric bypass except if the body is directing me there. Now I care about it, and then I'm gonna evaluate other things around it. But if that's your patient and they come to you and the LTAP is directing you to their right ankle, I'm gonna say great! Treat their right ankle and see how their pelvic pain changes and All the biomechanical stuff around pelvic pain because if somebody presents to you with pelvic pain, you have an orthopedic biomechanical list of things that you think might be driving it.

  And now we want to always see how that changes after we treat where the body's directed us. So we treat the right ankle and it changes all these. biomechanical or orthopedic things that may contribute to their pelvic pain. That's great because then I know I'm probably going to affect their pelvic pain or pelvis dysfunction quite a bit.

  Did it have anything to do with their gastric bypass? No, not necessarily. So, this is, this is why. This is why, because we can't assume that everything that happens in the body Is a problem for the body because the body is designed to compensate period Resiliency robustness of all of the systems in our body is what makes us magically human And makes us able to do all the freaking magical things that the body Does including heal itself?

  So that's where i'm going to leave you with this podcast episode is understanding that Even on these podcasts, when I suggest common visceral referrals for certain things, like knee pain, okay, it's commonly urogenital, kidney, like, let's check that first, doesn't mean it always is. I am always going to defer to, where's the body directing me?

  And then doing an orthopedic assessment, collecting all the information of things that I would love to change in their body that I think may be creating this tissue problem or this pain problem. And then I'm going to go treat where the body directed me and I'm going to reassess, treat, reassess, treat, reassess, see what we're left over with and then dig in more there.

  So, hopefully that's helpful. Or not so helpful. But it definitely gives you food for thought. And hopefully, the next patient you see when you take a subjective history, you don't give it so much weight.

  Okay. Have a great day. We'll see you next week. As always, if you have any suggestions or things you want to hear about, please send me an email, or shoot me a DM on Instagram. It's the best place. Happy to be back, and we'll see you next week.