EBP Police
In this week's episode I share a recap on a busy month and my thoughts on the evidence based practice police on the internet and why inherently all research is biased and no matter how strong the statistics are it still is not the end all be all on what is actually happening inside the human organism. That due to the nature of all the variables, it is nearly impossible to know exactly why and how our treatment strategies often work. So why can't we just all get along? Lol
Resources mentioned in the episode:
The Barral Institute: https://www.barralinstitute.com/
New Manual Articular Approach: http://shop.iahe.com/Workshops/New-Manual-Articular-Approach-Spine-Pelvis-MASP
Lisa Brady-Grant, DC, BI-D: https://www.iahp.com/lisabradygrant/
Lex Lancaster: https://www.instagram.com/lexlancaster_/
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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[00:00:00] 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.
[00:00:26] I'm glad you're here. Let's dive in.
[00:00:31] hey there. Welcome to another episode of the Unreal Results Podcast. I, um, I don't have like a real specific plan for today's podcast. Um, I mean, I have some ideas in my head, but I was like, you know what? I'm just gonna start talking and see where it leads and, um, mainly because, [00:01:00] My brain is a little bit mush, , maybe not mush, but my brain feels tired.
[00:01:06] Um, it's been a really busy month. I also just sat down to write like my monthly email review, and it just is crazy that March is over. Um, I knew March would be like this. It's. It's traditionally for me, one of my busiest months of the year, um, despite me wanting it to be, because typically Marsh is like one of my favorite months to be outside and enjoy the springtime.
[00:01:39] Though it rained a lot in San Diego, so I guess I didn't really miss anything but. March is always busy pretty much as soon as I get done with my vacation in February, um, which I usually do right after the Super Bowl. You go to Hawaii for the whale. Um, usually like [00:02:00] I kind of hit the ground running, um, and even end up working on that vacation because spring is when I launched all of my education stuff.
[00:02:11] And then also spring is when. A lot of my athletes start getting back into training. Um, it's really like when the football players start working out again to get ready for OTAs, and then when my track and field athletes, um, start transitioning into outdoor season. So it just ends up being busy for me. So.
[00:02:36] on top of all of that normal busyness. I also, uh, you know, I taught that course in Miami at the beginning of the month, which was awesome. An in-person l a p course. And then I also had my revitalized mentorship alumni mastermind weekend, which was a three day, in person.[00:03:00] , weekend and with 10 of my alumni, and it was so amazing.
[00:03:07] I realized, um, it was two weeks ago and I recorded last week's podcast, like right after that. And I realized I didn't even talk about it, which is crazy, but I think my brain was just still like a little overload from it. Last weekend, this past weekend I was in Salt Lake City for a continuing education course for myself.
[00:03:30] I went to the , at a Barral Institute class. I went to their new manual articular approach to the spine and pelvis. It was a great class. Um, it was hard to. Sit through three days of learning after just like such a busy month, for me, kind of in my brain, but sort of once I settled in, it was really great.
[00:03:54] In a really great class, amazing teacher. The teacher was Lisa Brady [00:04:00] Grant. She is a chiropractor. She lives in Jackson Hole, Wyoming. She's was excellent. Um, it was the first time I had her and. . I've heard people like rave about her before, but I'd never taken one of her classes. And so it was really cool to get to see why people write about her.
[00:04:18] She's an excellent teacher. So that was really helpful. And that class is, um, it was great. Uh, it is a very mechanical based class. Um, obviously it was all about the spine and pelvis. It was all about joints for the most part, and, um, was really, Great to see the osteopathic principles and treatment techniques, techniques and specificity and precision in, um, such mechanical techniques.
[00:04:50] And it, and it's very similar to how I was already sort of treating a lot of mechanical joint things, um, [00:05:00] intuitively, I don't know if that's the right word, but just using. , these philosophies and treatment approaches in the joints. So it's nice to see it done and like be a little bit more precise about the anatomy, and that's really what it always comes down to is understanding the anatomy even deeper and laying precision on top of that.
[00:05:24] So, um, Yeah. And then now I'm home for a day and then I, um, start back up with my travel to my athletes today, actually in a few hours. And, um, then we're just on the, you know, on and off the road for the next while. Oh, this weekend I get back. I also teach, locally. Yoga one, San Diego. I teach anatomy for their 200 hour teacher training group, so we got a full weekend ahead of me too.
[00:05:59] Yeah, [00:06:00] so it was a crazy month. Um, and I'm, it, it was great. I enjoyed every single one of those things, so, I, you know, zero regrets, you know. Anyways. Actually do think, I wanna talk about sort of this concept of
[00:06:26] this concept of really
[00:06:32] what makes the. Techniques that the Barral Institute teaches and the um, sort of framework or philosophies that they teach so powerful and why it frustrates me. To get comments, and see people [00:07:00] like bashing on it, because of the lack of evidence of um, you know, random controlled trials and that sort of thing.
[00:07:09] So if you're new to listening to me, I'm not a big like evidence pace practice champion. Think research is great. I think it's helpful, can be helpful. It's needed, but I also believe that the human organism is so inter interconnected, intrinsically. And connectedness makes it difficult to ever really have a clean research study to determine what's happening because you can't isolate all of the different things.
[00:07:53] Um, so with that said, like I don't, you know, I always take research with a [00:08:00] grain of salt also. It's like, it's, it's behind the. Um, there's things that people will be doing practically for 20 years before someone actually researches it and like, quote unquote proves that it is doing what it, doing, what we think it's doing.
[00:08:23] And, um, in my opinion, I'm like, why would I, why would.
[00:08:33] Why would I wait around for the evidence to prove that what I'm doing is working when the person in front of me can prove that's what I'm doing working. And it's a little bit of like semantics because some people are just like, well, we're not arguing that it's working. We're just arguing on the mechanism of why it's.
[00:08:56] a lot of the times I don't really care why it's working , to be [00:09:00] honest. And I don't think a lot of people do, and I definitely don't think our patients do. Um, and so that's, that's always interesting. And then, you know, the other thing with evidence-based, people get so focused evidence. Practice police on the interwebs get so focused on like random controlled trials and meta analysises and systematic reviews.
[00:09:28] And, um, forgetting that there's other components to evidence, pace practice, there's um, that, and then there is your anecdotal evidence, your. Practice. Um, it's the patient's past experiences and beliefs, and then also it's this other sort of foundational wing of science. It's anatomy, it's [00:10:00] physiology, it's physics.
[00:10:01] And there isn't, honestly, there is not a ton of like actual research studies to support what we know is true in the. anatomy Um, in fact, that's why there's still like research papers coming out on anatomical structures that we'd have not even named yet. Right. And, um, so for me, the foundation of everything I do always goes back to the anatomy and the anatomy.
[00:10:39] For me often is enough evidence, um, and enough science to believe in a technique I do or believe in an exercise I do, or help the client understand what's going on in their body. And I guess [00:11:00] this is a big thing too, in terms of what I stress with people is. because the anatomy, everything is connected. We were once one cell, literally everything is connected.
[00:11:13] So the way you can connect it, you can connect it, embryologically, you can connect it, um, from a muscle or fascial standpoint, you could connect it from a nerve standpoint or vascular standpoint. You could connect it. A biomechanical standpoint, um, you know, ground force reactions through the body.
[00:11:37] However, you want to see how the body connects. There is a way for you to connect it and however,
[00:11:50] the connection, whatever connection, whatever map you're using to view the body. Um, is not [00:12:00] the story of why something hurts or why something is not moving well, we will never, I think, truly know why it's happening. And I think the pain science literature supports that. Um, you know, I think most of us have a better understanding about pain than we did 20 years ago when I was in school.
[00:12:25] But understanding that pain is an output, and pain has influences not just from, , the sensory information coming in from the body, you know, the nociceptive information or the, um, non nociceptive sensory information. But, um, it has to do with different chemicals. It has to do with your past experiences, your current state of your nervous system.
[00:12:51] Um, there's so many layer. to which pain has influence, like is influenced. [00:13:00] And so, um, so when we often explain our treatments or when a patient explains our treatments to someone, it is always us literally making up a story. how everything's connected. This is on my mind because, um, during the mentorship alumni weekend, I worked on Lex Lancaster or Brunelle, when she was in town for the weekend.
[00:13:38] She, she is a physical therapist. She, um, is also my. . I call her my like coo. She's like my digital operations manager sort of thing. Like anytime I need like tech stuff, and like support on the backend [00:14:00] things of tech for my business. Like Lex is the person I use, she's. So freaking smart. Um, she's so good at tech, um, but she's also a physical therapist and, um, she's also teaches like, she, she's a like a adjunct professor at a university and she teaches pt, so it's not that she doesn't, um, get it right.
[00:14:25] Anyways, she was here. , she also, on top of all those things, she also is a, Photographer and so she does brand photography for, um, businesses as well. And so I flyer out for this mastermind weekend because I, um, think it's important for her as someone that works in my business to understand my business and understand what I'm teaching and understand what I have to offer.
[00:14:52] Plus, since she's a physical therapist, she's like my target. Person, right? Physical therapists and athletic trainers. [00:15:00] That's always who I'm wanting to speak to, and so I fly her out to basically just spend the weekend with me and my people and also be learning even though she doesn't necessarily treat clinically anymore.
[00:15:14] I want her sort of learning about the movement, rev philosophy and beliefs in methodology. Um, so she can better help me, on all the on, on all the things for my online education business and, um, because she has this photography thing too, I'm like, Hey, like, perfect, bring your camera out. You can also take pictures for me, which is so good to always have.
[00:15:39] Photos, plus I can share them with the people that attended the course and give them photos of them doing clinical stuff too. So it's like a win-win for everyone. Anyways, she was coming up and she was having some shoulder pain. and she was supposed to be going up to LA to go play volleyball with, um, the [00:16:00] movement maestro for a few days.
[00:16:02] And she asked me to treat her while she was here and I was like, absolutely, I'll treat you. And we kind of ran outta time for a full treatment session. , you know that the days go by fast, especially when you're teaching all day long. And, uh, but I was able to treat her Saturday night before she left Sunday, and I did just a very quick, um, assessment using the Ltap on her, and it led me to, , the area around her liver and diaphragm and.
[00:16:36] Her cervical spine and so I treated, treated her right. Well, I evaluated her shoulder and she was limited. She had very high pain and she had pain just lying on the table. And, um, she was limited in. A lot of ranges of motion, shoulder flexion, abduction, um, internal and external [00:17:00] rotation. Actually, um, her glenohumeral joint was not inferior, gliding or depressing.
[00:17:05] , when I was, , going through these ranges of motion and, um, I just stuck to like a pretty passive, Orthopedic assessment just for the sake of time. It, I felt like it gave me pretty adequate information of what was going on with her. And so I then I treated her based on where the l a directed me.
[00:17:24] And so I treated her, I did like, I think all I did was, well, I started to do a liver lift on her, but it was not, her body was not really letting me get in there, and so I was like, okay, it feels like her diaphragm is just like protecting this and so stiff that I think in order to even have any chance of mobilizing her liver, I need to treat her diaphragm.
[00:17:51] So we did this seated diaphragm technique and really just felt her diaphragm. It was so stiff. I've actually [00:18:00] never felt such a stiff diaphragm before. Um, and I feel like I've, I've, I've met a lot of stiff diaphragms. So anyways, um, I did this treatment on her and it like slowly slowed, slowly started to change.
[00:18:17] In terms of the tissue quality, it wasn't so indurated, right? It wasn't so hard. And. Then it, I did like just a real simple liver technique. , in addition to that, a seated one, but not the liver lift like I was gonna do in the beginning. If you don't know what a liver lift is, don't worry about it. It's just a very specific, visceral manipulation technique.
[00:18:44] So really, I ended up just treating her diaphragm for the most. And, um, then, , I treated C4 on her neck. , I just did a real simple little technique, to [00:19:00] sort of the. Facet joint and the kind of hard, probably the joint, a little bit of the joint capsule, the facet joint capsule, and then like probably even a little bit of the actual, um, joint capsule around the body of the vertebrae.
[00:19:18] And then I did real simple little, brachi Plexus Glide, that's it. And then we rechecked her shoulder and actually I rechecked her shoulder between the diaphragm technique and the neck technique. And the majority of everything that was going wrong, whether her, um, range motion or her shoulder was corrected after just the diaphragm technique.
[00:19:40] So, and then I, I finished with the neck technique and, and c4, if you, um, listen to the last podcast is another one of the areas of the spine that tends to be closely connected to, um, liver issues. Uh, because of the role the phrenic nerve plays [00:20:00] as a sensory nerve to the liver, the area around the liver, sort of the joint capsule of the liver, the area of the peritoneum.
[00:20:09] in that upper abdominal cavity as well as in glistens capsule, which is the area, um, that the, um, diaphragm and the liver sort of connect to make a little joint capsule on the superior posterior border of the liver. So, um, often the phrenic nerve, because of the information coming from that area will.
[00:20:35] Create an irritation at the nerve roots and cause some, um, Restrictions around the facet joints, around Thera, around the actual joint capsule in, um, tissues, um, of C4 usually, but could be c3, c4, or c5 with, those are the nerve roots of the phrenic nerve. [00:21:00] So I did those and I rechecked her and she had full range of motion, no pain.
[00:21:03] Her, um, she has scoliosis and her rib, um, her traditional rib hump. always noticeable on her. Actually sort of shifted back into, you know, quote unquote neutral and, um, so significant changes in just a 25 minute session of assessment and treatment, which was great. And then she went on to play volleyball the next day, the day after.
[00:21:29] With zero pain, ended up doing like four strength training workouts, two of them primarily upper body prd on like bench and overhead press all within that week of treatment. So what a win. And so she, um, posted about this on Instagram and. , you know, just was posting about how grateful she was and like how mind-blowing it was to receive a treatment like that and, and that she was encouraging [00:22:00] people to, if you haven't checked me out, check me out.
[00:22:02] And then also check out the l a level one because, um, you can learn in that course how to figure out when you're directed to deliver. And then of course, a, um, evidence-based practice, internet troll. Commented on her post about it and was like, why are you championing visceral manipulation? Um, haven't you read this one article in post, like, I don't even know what, or article.
[00:22:30] It was some like, um, systematic review about visceral manipulation not being effective or not doing what I said it as. I don't even know what it was. Basically when, and he tagged me on the post too, and, When I get people like that, I know there's no change in their mind. Um, and they're definitely not gonna change my mind,
[00:22:52] So to me it's just like he. Likes to argue and he thinks he knows [00:23:00] better. And he is, um, an angry elf. And so I don't even engage with people like that. I actually just block them and delete them. I couldn't delete the, the delete it cuz it was her post and not mine, but I blocked him from me and I didn't even, didn't even reply.
[00:23:18] Lex did replay, however, and, um, It was, uh, back, of course it was back and forth because he's just trying to use someone, you know, he's just trying to make himself look good. But my, it was funny to me cuz I'm like, well use one systematic review to totally say, visual manipulation didn't work and what, and he was like, oh, I don't, I'm not saying that.
[00:23:47] I'm not saying that you didn't get relief from the treatment, but you can't say it was from mobilizing your liver. Now. Um, it's one of those things that I'm like, [00:24:00] shake my head because I'm like, listen dude, get off of your high horse. Um, evidence prac based practice is more than studies and if you look at the history of.
[00:24:12] of visceral manipulation, even though it's been around for hundreds of years, , um, people have been doing work in the abdomen, treating the viscera functionally and manually for a long time. Um, even Jean Pierre was not the first to do it. It's. Just to say that because there's been no studies that show it works, doesn't work is ridiculous.
[00:24:41] The other thing that I thought was interesting, and I I thought that it was very important to point out is that, um, there are different, Methods of visceral manipulation, much like there's different methods of joint mobilization, [00:25:00] right? And not all of them are created equal. They are not all the same. And Jean Pierre Als, I would say from what I have seen in the, in the, from people, um, Jean Pierre Bras seems to be, um, a lot more specific and a lot more precise, and he has done a lot of studying of the anatomy to make it So, um, with that said, Jean Pierre is only in his seventies and so.
[00:25:37] Um, I doubt that he started putting out this information in the first two to three decades of his life. And so if he's only in his seventies, he's only been putting out this information for maybe 30 years, maybe more, maybe 40 years. I don't know, but I'm. [00:26:00] How can you say his work doesn't work? when or it doesn't work when it's a different type of technique than other visceral manipulation techniques that maybe have been out there longer.
[00:26:18] And how do you know within one systematic review? Like, what were they even looking at? I'm not gonna go read the review because I don't really care. I don't need the evidence that. Works, but it's just funny to me how people just assume because one systematic review or one meta-analysis found that however many research articles didn't come to the same conclusion that it doesn't work and I'm not a researcher.
[00:26:48] I don't understand the statistics very well, but I do understand like, um, common sense. And I do understand that though human organism is much more complex [00:27:00] than we could ever, , dial down in research because I have done research and I do know how hard it is to control a lot of variables, and there are so many variables going on in the body like.
[00:27:13] How can you like really determine that? So anyways, my, my whole point with this is like, not to like complain cuz I'm like, whatever people are people that are gonna, there's always gonna be dudes like that and most of the time it is dudes and, and, I will not go down that whole rabbit hole. But, , it is just one of those things that we need to.
[00:27:41] We need to appreciate that the anatomy that we know and work with on a regular base is a very small amount of the actual anatomy that's going on in the body, and that the more you can study that and the more you can appreciate that. and think about how you can feel the different [00:28:00] qualities of texture in your hands and the treatments and be in very specific and precise locations with your treatment or with your exercises, whatever it may be, whatever technique it may be you that you could influence the organs and their mobility.
[00:28:16] And there has been research articles to. That some of these techniques do in fact change the ability of the organs and to move from the influence of the diaphragm. So, and to me to, to be like, there's no way to prove, like the mechanism of taking away shoulder pain wasn't truly treating the shoulder.
[00:28:42] I'm like, I don't. . I just don't understand how someone could say that if you understood the anatomy, because you can. I, I'm fine. You can argue every day that what I'm treating, if I'm treating the liver, if I'm really having an effect on the liver or not. You can argue that every day though. Some tests will tell you that yes, the [00:29:00] function changes, the mobility changes.
[00:29:02] Whether I do or not, I don't know, but the area I was treating anatomically is innervated by the phrenic nerve and when. Speaking directly to the phrenic nerve. I'm going to change breath patterns. I'm going to change all of the nerve messages at the nerve roots, and those nerve roots are shared with the nerves that go to the brachial plexus and are going to influence.
[00:29:33] The entire upper extremity, those nerve ropes are also shared with the cervical plexus, which also influences the supraclavicular nerves, which is gonna influence general shoulder pain, you know, and then the reevaluation told me it changed things so, She appeared to have Z like none, no inferior glide of the glenohumeral joint, yet after treatment, [00:30:00] not to the glenohumeral joint.
[00:30:02] Then she had it, and so it's like what changed? The messages to the joint changed that. There was no need for a protective mechanism anymore. The me, the messages to the, uh, nerves that innervated the rotator cuff clearly changed, and allowed for better inferior gliding depression of the glenohumeral joint.
[00:30:28] And, this is all it's really about is like, can we strategically. Figure out where we can do treatment to change the output in the joint that's causing pain to determine is that joint really the problem. Her shoulder pain, the joint was never really the problem. It appeared to be. Be of what our, of what we knew previously because.
[00:30:59] Yeah, [00:31:00] lacking into rotation, lacking shoulder flexion. Her, I'm sure if I looked actively, her scapula was probably not moving in full upward rotation, but those are not even, those are problematic. They changed in an instant, so they were never actually the problem. It was not a stiff glenohumeral joint or a weak rotator cuff that was not creating that inferior glide.
[00:31:27] It was. Altered messages to those muscles from the nerves that was creating that mechanical biomechanical disadvantage, that dysfunction, if you will, that could or could not have been where her pain was coming from. We assume pain is coming from those dysfunctions, but that is not true because like we talked about at the beginning, pain is not that simple.
[00:31:56] And also, Cuz she [00:32:00] could have had those dysfunctions and no pain and vice versa. She could have had no dysfunctions in pain. The pain could have been simply a visceral referral pattern. A visceral, somatic referral pattern, much like we see with a pain from a heart attack or pain from indigestion or pain from.
[00:32:22] Surgical, like laparoscopic surgery to the gut. Like your doctor will tell you, you will have intense shoulder pain after the surgery more than likely, and it's just from the irritation to the peritoneum. So, which again is like if you're not taking any research, if you're not taking in into consideration all of those factors, how is any research then reliable?
[00:32:48] and how is any research fact of what is happening is actually happening. All research, no matter how much you control the variables when it comes to humans, [00:33:00] is biased by the person doing the research, biased by the person doing the stat. I know enough about stats that I also know that there was just multiple ways you could run different stats to prove that your research was like good or not.
[00:33:16] So that doesn't necessarily mean it was really good. It means that you have a really smart stats person trying to find the right statistic to prove your hypothesis, to prove your bias. , which is what it is. Like this is, we operate in the world always with our own biases and our own belief system, but don't shit on a technique or shit on a, theory of how things are connected, when there's literally no way to separate it out and know exactly what the I.
[00:33:53] there is no way to know is her shoulder pain from the biomechanics that were going on wrong or [00:34:00]just the vasogenic influence, or a combination of both or nothing. Right? Because then you can't even discredit the fact that, you know, the psychological effect of like being cared for by another human. The co-regulation that happens in your nervous system, and this is my whole point, is.
[00:34:21] I'm not against evidence. I'm not against practicing based on the evidence, but you also have to inherently see the bias that is in every single article that you've ever read and base your work on, because there is no way to account for all of the variables in the human body, period.
[00:34:47] I guess that's it. That's it. It kind of leads into the other thing I had wanted to talk about, which is just about the nervous system and like the autonomic nervous system and how you can work with your patients to use [00:35:00] that power of the autonomic nervous system and the power of the parasympathetic nervous system to facilitate the body's ability to heal itself.
[00:35:09] But we'll talk about that. . So hopefully you enjoyed this rambling and maybe it gave you some food for thought. This is not necessarily me defending one thing or the other, but also just defending anatomy and defending being precise and specific with your treatments and being open to see that there is more influencing musculoskeletal problems than the biomechanics.
[00:35:38] Therefore, perhaps some of the evidence that we use to support what we do is even wrong in the first place cuz it never even considered the other things in the research paper. So that's it. I have to go ahead to the airport, jump on a plane. Thank you for being here. Thank you for [00:36:00] listening and I'll chat with you next week.
[00:36:05]
