Assessment is Sexy (with guest Lex Lancaster)
My friend and colleague Lex Lancaster is back on the Unreal Results podcast, this time sharing about her experience with long standing shoulder pain.
While she was in San Diego helping me out with a course I was teaching we were able to find a 30min window to assess and treat her shoulder using the LTAP (locator test assessment protocol).
Her "historically problematic shoulder" which she described as stabbing 9/10 pain- gone with a 25-30 min assessment and treatment session directed at her liver and diaphragm, and C4. This one session allowed her to not only play 6hrs of volleyball over the next couple days, but in the same week lifted 1-2 upper extremity heavy focused strength training days without pain! I treated her again briefly 6 weeks later when I visited her in New Hampshire- which was more for my own curiosity of how her tissues and mobility felt and now 7 months later she is still pain free and doing volleyball and strength training without issue! She even admitted to not doing any of the home exercise program I gave her. Lol
In this episode we chat about how that changed her mindset about physical therapy and how it highlighted just how important the assessment is and how understanding the anatomy and connections of the viscera can help everyone treat from a new lens of view even without having training in visceral and neural manipulation techniques.
Other resources mentioned:
Unreal Results Episode 13- The Surprising Problem with Scoliosis
LTAP Level 1 course: https://www.movementrev.com/ltap-level-1-2023
Connect with Lex on IG: https://www.instagram.com/lexlancaster_
Lex Lancaster website: https://www.lexlancaster.com
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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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.
Anna Hartman: All right. Well, hello and welcome to another episode of the unreal results podcast. I have a guest and not just any guests, but a returning guest. Hello. Uh, Lex Lancaster is back on the pod with me. Um, she, and I thought it would be great to share her experience. experience working with me for some shoulder pain to give you all another example of how the LTAP works in action.
And um, since this week, uh, the doors are open to the online LTAP level one course, I thought it would be a great time to have her come on the pod and talk about it again. And then just so we have the episode for future, future. Digestion for everyone, because it is such a good example of sort of all the stuff that I, um, have been sharing about the visceral connections to musculoskeletal, uh, disorders and, you know, and just to give you an example, I know I talk about a lot, like, how powerful this work is and how you can really help somebody in not a lot of sessions.
In fact, the last episode I talked about, um, How I helped, um, Daniela with her shoulder pain, which was really more like rib lat pain. Um, in 1 session, she felt 95 percent better. And so, um, sometimes it's thinking about that potential outcome. It seems like. A little unbelievable, that happens over and over and over again.
Uh, and so that's, that's what I want to show with Lex too, is another example of it just really only took one or two treatments and That's it. Yeah. So, anyways, uh, like I said, the, the, this week, when this podcast drops, the doors will be open to the online course, which is a six week course, but then also for a while, the doors to the In person course have been open to enroll and in person course is November 18th and 19th in San Diego.
So even if it's not the week of this podcast, you're watching later, and you still want to come join me in the LTAP level 1 course. There is an opportunity in person. So, um, all right. I think that's enough housekeeping, but let's, uh, I'll have Lex give her. Let's give a little introduction and then we'll just start chatting about your
Lex Lancaster: case.
Sure. So, if anyone is not familiar with me, I am Lex, Alexis is my full name, but I always go by Lex, not Lexie, please. I'm a physical therapist by trade, but I don't practice anymore. I do basically digital. Creation website design stuff. So that's where I'm at. I help other health and wellness practitioners.
I work very closely with Anna as well. So I help other health and wellness practitioners essentially get tech systems in order, do all the automations and course building and et cetera. Um, I. I'm here today to talk about my shoulder pain that I don't have anymore, which is great. Um, I know that, you know, as a PT myself, I had never sought treatment for my shoulder because you know, I can do that myself.
We know, so I had never sought treatment. So, um, when I first talked with Anna and met Anna, I didn't, it didn't even cross my mind to get my shoulder treated and then stuff got bad, but we'll get into that shortly. Um, so yeah, that's really the gist about me, I guess. I've been to Anna's in person course and I just take photos, but being on the outside and, you know, watching everything and seeing how Anna does her teachings.
And then also seeing how she practices is just obviously changed the way that I would practice. So if I were just for what it's worth, if I was still practicing, this would be the first stuff that I would make sure I dive into more. Um, just because I see the difference that it can make both on myself, but also on all the people that I've watched her practice.
And yeah. New treatment on. So
Anna Hartman: thank you. I appreciate it. Um, I mean, and that means a lot too, because not only, I mean, were you a physical therapist, but you up until recently are still do you teach in a physical therapy program too? So it's not like, even though you might not be doing it, practicing it, like you're still very.
Much a part of the physical therapy industry.
Lex Lancaster: Yes. Yes. Yeah, absolutely.
Anna Hartman: Absolutely. Um, well, cool. So let's talk about it So when you finally did ask me to help you with your shoulder it was I mean In March of this year, right? March 20. Yeah. Yeah. So we're coming on like nine months.
Lex Lancaster: Yeah. Yeah. Yeah. No.
Anna Hartman: Yeah.
Oh, seven months
Lex Lancaster: ago. Yeah. Yeah.
Anna Hartman: Yeah. So seven months ago, she was was in town taking pictures and helping me with my mastermind course for my mentorship alumni and was like, Hey, my shoulder's really bothering me. Do you, can you take a look at it? And of course I wanted to, but we were also very limited on time because she was only there for a couple days and I was teaching most of the time.
And so, but I really didn't. Want her to leave before I was able to get my hands on her. And so I just did a very quick treatment on her and we'll talk about, um, well, assessment and treatment, and we'll talk about what that is, but a little background on from you of what was going on your shoulder, like what made it hurt so bad?
leading up to them because I think there was like, even though you might've had shoulder pain on and off, it was like something right before you came to see me that really flared it up. Right? Yeah. It was
Lex Lancaster: more not, it was not anything acute, meaning like I didn't do anything and it started hurting, but what I noticed, I started lifting heavier and then it really started to bother me.
So it started back in, Junior year of high school. So I'm 30, so everyone else can do the math there. Um, so in junior high school, yeah, I played softball and I was the only pitcher on the team, so I pitched every inning of every game and. Everyone will tell you if you play softball or familiar with softball, that the form that you have to throw a softball as a pitcher, it technically mimics like normal motions.
If you have really good strategy, if you have good technique, you shouldn't have shoulder pain because you. It's a natural motion for me. I think there's a little bit more like that has to do with my elbow because I have a really, really large carrying angle. So I think that played into it, but also I, I never got formal pitching coaching.
It was kind of like in ninth grade, I was told that I'm going to be a picture. And then I just kind of stayed there. So I never got formal coaching. So I don't think my, my form technique was great. So anyway, junior year, I pitched every game of every. Or every inning of every game and at the end of this what
Anna Hartman: we call their training
Lex Lancaster: there.
Yes, it's terrible. Yes, it was bad. So I ended the season and at the end I used to have the I don't even know if they use them anymore, but it's like the full ice cuff that like literally literally a sleeve. Yeah. And after every practice, every game, I'm like in this ice sleeve, um, it was, it was a joy. So at the end of the season, I had said, you know, I can't do this anymore because I wanted to go to college and play something.
I didn't know if it'd be basketball or volleyball, definitely not softball, but I couldn't do it anymore. So I stopped playing. So I had pretty significant shoulder pain in the beginning of junior year that season, because it just. It had caught up to me after three years and then plus I'll be pitching.
So then I will say for the vast majority of the next 10, 12 years, like it didn't really ever bother me so much so that I couldn't do a lot of things. It was only really noticeable if I was doing CrossFit. So any sort of overhead motion and CrossFit would always just irritate it, but not make it so I couldn't do it.
I would do it anyway. Um, and then. I really never had any trouble with any sort of like kipping motions. Like I always thought that it was going to aggravate it, but that never did anything. It was mostly just like being overhead with weight. So anything weighted overhead. Um, and then I started, so I stopped doing CrossFit, I don't know, probably a couple of years ago, started doing more like lifting.
I will say, you know, I don't, I don't look like I lift very heavy weights, but I was progressing pretty, you know, relative to what I can do. And. in probably January, I started to have a lot. So I actually couldn't do a lot of internal rotation. So my internal rotation was probably limited to here and it was painful.
So it was like in the front of my shoulder, painful. And that has been for years. Um, whereas I have like, I can beat my hand in the mid, my mid back, you know, in the middle of my scapula, I can put my left hand. So I know that I have a mobility restriction there. And My right side. Um, but then has been not been painful as painful and as painful as it was until this January and it got to the point where like, I'm not doing this during the day.
So obviously that's not what bothered me, but every time I would lift, I would have a lot of really sharp pain in the front of my shoulder. Then, um, you know, I, I just dealt with it. It was one of those things where I think two weeks before I came to see you for your course, I was benching and that's when I, I was just.
On the descent and any sort of eccentric, it was so painful. And I was like, I just can't do this anymore. Like this doesn't work. So I lowered the way I was fine. Um, but it was just, it was bugging me when I came to see you, I was having trouble with a lot of like just range of motion, like it wasn't feeling good.
And I was noticing a lot of like, if I would pick something up, especially like. Long kind of the biceps type test and I would pick something up. I would feel like I wanted to give out like it wasn't feeling great. Um, and I was going to play volleyball. So when I come to California, I like to play volleyball.
So when I came to San Diego, I was like, I want to play volleyball this weekend. Yeah. I would love if you could treat me. Um, so yeah, that's the long, the long and the short, I guess.
Anna Hartman: Was this, I can't remember if this was before or after you did the bunch of the indoor volleyball back at home too.
Lex Lancaster: That was, uh, before.
That was before.
Anna Hartman: I feel like that was part of the, what might have flared you up to, is like, a full day of indoor volleyball.
Lex Lancaster: No, it was, no, it was after, the volleyball started after because I decided, basically I came here and I was like, I want to play more volleyball. Oh, gotcha. And then I started playing, but that was part of the test.
Yeah. Because I, because every time when I would come here. Yeah. After playing the times before this time, I would go home and my shoulder with hurt would hurt from swinging. Gotcha. Okay. So that was definitely something that always bothered it. Gotcha. Um, and I would notice that I didn't even mention this, but like in high school, my senior year of volleyball, like I had shoulder pain.
So yeah, that was what had aggravated it. Now it started a bit, but certainly
Anna Hartman: aggravated it. Yeah. All right. Yeah. So, cause I ended up seeing Lex twice in the last seven months. And so the first time, so yeah, she came to me and like she said, like a lot of range of motions were bothering her. She was not even comfortable really like laying on the table.
Lex Lancaster: Yes. Oh my God.
Anna Hartman: Yes. She kept on like her. She couldn't, she literally couldn't find a comfortable position for her shoulder. Yeah. And um, She, I'm, oh, I know how it came up even is I asked you because you were our model that for scoliosis and we chose like an overhead squat as your, or maybe not an overhead squat, but like a back squat, something that involved a barbell in your arm and you're like, Oh, well, my shoulder's been bothering me.
Yeah. And then I'm like, what? And so we started, we, we use as an example of how I meet the body where it's at was for scoliosis, which we, we, that was why you were on the last podcast. We talked about that whole experience. So I'll link that in the show notes. But, um, so then I was like, well, yeah, let's, let's make sure we treat your shoulder before you go up and play volleyball.
And. It was at nine o'clock at night. We had, we had just, we had done the whole day of teaching and then I always, for the mastermind, I, I treat my, the group to dinner. So it was after dinner and, um, and the, uh, You got home and you're like, I hate to ask you, but I was like, well, my shoulder, like, are we going to get to my shoulder?
I was like, yes, actually. Yes. Let's so I put the table up and I was like, if, if we only do 20 to 30 minutes, like, at least it's a start. Yeah. And so I did the L tap on her. And, um, so again, the LTAP is an acronym for the Locator Test Assessment Protocol and it basically is a series of tests that gets me to where the body wants me to start treatment in terms of it directs me to where the body is protecting because when the body is protecting something important like visceral organs or the central nervous system, then the whole musculoskeletal system sort of like.
Uh, goes into a, like a hug or like a, uh, a pattern of protection. I was, I, I just told people on the results sheet code this week, I was like, it's almost like the pattern you see when somebody has appendicitis, right? They're bent over and they're side bent to the right, like that is your body going into a severe protection pattern for something.
So same thing, like when we have a protection pattern on any. visceral organ from a, you know, disease standpoint, uh, uh, limited function standpoint, or just the organ is not able to move within the container because of its ligaments being stiff or the space being limited for whatever reasons, um, the body goes and it kind of sort of, um, arranges it, arranges itself around that structure.
Yeah. On top of that, you'll get visceral referred pain from the nerves in the relationship to the nerves to that organ and then the rest of the body. And so the LTAP helps us to figure out where, because when we can do treatment in that location, we, we get people out of their response and we see a completely different picture of their posture and their movement patterns when they're not in that protective pattern.
And so many times their protective pattern is what's making something hurt. So, um, so her assessment, um, directed us to her, um, liver. And her central nervous system, so the, so what I did on her is so, um, especially I guess if for those of you who've gone through the results, she code just coming off of the three free week of it.
So what her assessment would have looked like is. Her SI joint was hypomobile on one side. I don't honestly don't even remember what side it was hypomobile on, but it kind of doesn't matter. But one side of her SI joint was hypomobile, but when she held her breath, it became mobile. And so that directed me to the central nervous system or the viscera.
Now, the rest of the LTAP was able to tell me it was actually. First round was not central nervous system. It was liver. So I treated her liver first. And then before I treated her liver, we, we looked at her shoulder mobility and her shoulder function. And, um, like I said, in a supine position on the table, she had a hard time finding a comfortable position.
So just that passive. Like, I guess that would be passive shoulder extension was painful to her. Um, but then when I tested her abduction, she had resistance very soon in her abduction range, um, which is like technically a upper limb nerve tension test. Um, I think I also did an upper, like a traditional, like a median nerve glide and that had a lot of tension on it.
Like, pretty immediately when I started to extend your elbow, um, and she was lacking upward rotation and protract like general upward rotation of the scapula was lacking and definitely, like she said, limited internal rotation and very limited, um, horizontal a deduction. And, um, those 2 were painful. And I don't think the passive ABduction was painful though, but it was very resisted and I could, it's almost like your whole glenohumeral joint was not inferior gliding very well.
Yeah, I remember you saying that. Yeah. So, um, again, because we were in a... limited time crunch. I was like, this is enough objective information. Like, yeah, clearly your shoulder is limited in mobility and unhappy and your scapular mobility stability is not great. So let's see how it changes. So I did a really simple, um, liver treatment on you.
I believe I did. Um, I think I did a liver lift and then like maybe that one where I'm like hugging you from the side. Yeah. So I like, um, a three dimensional, like, induction of the diaphragm and the liver together. Um, and, um, then I was like, okay, we treated that and we laid you back down and re retested stuff.
Her SI joint was still hypomobile and it still changed with a breath hold. So it's telling me there's still another layer of protection pattern, either in her viscera or her central nervous system. This time it was her central nervous system, um, which is the second test of the LTAP. So I tested that and, um, that was confirmation and, um, then I retested, before I treated that, I retested your shoulder objective things and you were much more comfortable laying on your back.
In fact, we noticed too, like your rib pump from your scoliosis, like was totally different. Totally. Yes. Almost, almost neutral. I don't want to say, I hate the word neutral, but like, almost look like the other side. Like, you could barely tell that you even had a rib hump there. I forgot about that. Yes. And then, um, then your shoulder abduction, it was like, oh, no problem.
There was still like a little lacking in, uh, inter inferior glide, but like, it was like so much easier to go into hip, hip shoulder, a abduction. And then it gave us a little, um, a deduction and improved your internal rotation. And I, I think, I think already with just the liver treatment, you didn't have any pain, but I was like, I think I could get you better range of motion by doing the central nervous system piece.
So then I went to the central nervous system piece and I did a little work in like your um, C4 area, a little cranial piece, like greater nerve of Arnold sort of occipital nerves. And I think I did one little brachial plexus neuro manipulation thing. And then we retested everything and your nerve tension was almost completely gone.
The rest of your glenohumeral joint inferior glided and then your adduction finally could come across your body as, you know, as good as the other side. Yeah, you're like, Oh my, we were both like, Oh, there you go. Then, but then I was like, I know she's going to go play beach volleyball in the morning and like fucking jack it all up.
And then you messaged me because I was like, well, I was pretty confident that you would feel better. But I was like, I don't know the volume of volleyball she's going to play and how much pain you were in. I was like, hopefully she doesn't mess up what I just did, but, um, As with everybody, I'm like, let's, I'm just always curious.
I'm like, go do your thing. I never tell people not to do stuff. And so I'm like, go do it. Like, let me be your guide. And, um, from a home exercise program standpoint, I would have you do, um, breathing and liver work or like Sirocco lumbar junction, rotational stuff. And, um, See how you feel. And then what, like maybe five days later you sent me a Voxer and it was like, what the, I feel amazing.
And I was like, what? It's all that you tell that piece.
Lex Lancaster: Yeah. I I've had zero pain since then. So I've had nothing like, I will say you can see like my hand is in the middle of my shoulder blades right now. Like I have no, I have no pain. Yeah. Um, So that's that. That was great. That's been amazing to not have any sort of shoulder pain.
I will say I was surprised about volleyball because of the amount that we play and just how many swings the volume of swings in a weekend, a very short amount of time. And I had no pain at all. Um, I went right back to lifting. I went right back to doing all the things I had no issues at all. And I was skeptical.
Up until like month three and I was like, when is it going to return? I was waiting. I was waiting and waiting and never returned. And I was like, well, this is cool. Um, but I will say like, because I am going to be honest right now. Yeah. Um, throw myself right under the bus. Um, I'm the, I am the worst person to like do something about my pain.
So I have tried with my shoulder. I was like, all right. Cool. I'm going to do some overhead kettlebell upside down presses. We're going to work on some stability. We're going to do some, I was told over and over again by a couple of different people like you just need to work on your shoulder stability.
You'll be fine. Yada, yada, all the scapular squeezes. I've done all the, I lift with good form. And I'm like, okay, I'm a PT. It's still not going away. I'll just leave it. Like, and I wasn't going to go consult someone just for my shoulder. It just didn't bother me enough to do so. Right. And then it was like, until it did obviously.
But, um, so when that makes the reason I mentioned that is because when I got home, it's not like I was doing your home exercise. Like, I'll be honest and I don't want people to feel like, well, what did she do between? I did nothing. Like Anna, Anna sent me a video and I did one round of this like ball on my diaphragm ribcage area.
And I was like, I think I'm good. I'm good. So I, I did nothing and I did the only treatment. Um, and then, like I said, it was like a 30 second, I'm going to give this little ball a try.
Anna Hartman: Pain is a great motivator. Um, even though you didn't do the home exercise programs I recommended, you did start honoring your curves a little bit better.
Lex Lancaster: Yeah.
Anna Hartman: Yeah. Yeah. So again, like honoring her curves and scoliosis, I think, um, helped a ton with the, it sticking because then she was meeting when, when you honor it, where the curves are and when she propped herself properly, um, Her body naturally gave space around the area of the liver and then everything's going to function better.
So I think even though you don't think you did anything, I think the awareness and like the accepting that it was okay to meet your curves where you're at, because before that you felt like you had to like organize your body in some sort of weird way because you had scoliosis. And I was like, no, just.
Lean into it a little bit, let your body organize itself. And so I think that did help a lot. And then yeah, the second time I treated her was more because I was visiting her in May? April?
Lex Lancaster: No, it was March. March? it was like two weeks after.
Anna Hartman: No, it was longer than that. April? Oh, it was, it was... I think it was April.
Yeah. The third week of April? Yeah. Yeah, so like maybe a month later, I, I... was on the East Coast and had a few days off. So I, I went up to New Hampshire to see her and like more just socially, but while I was there, I was like, Hey, I want to do the diaphragm and liver treatment on you one more time because of what I felt in my own hands.
Because when I treated you in March, it was, it was literally the stiffest diaphragm I've ever felt before. I remember you saying that. And I was like, Oh, which is another reason why I was like, no way this is going to stick. Yeah, without, especially without you doing the exercises. And so, um, I was like, Lex, I would just really like to get my hands on you also out of curiosity, because I wanted to feel your diaphragm again, because I was like.
In my head, I'm like, is it, did it make that much change with one treatment that you're still not having pain? And I was like, I, I just feel like it would be better for the both of us, my brain and your body, if I could get my hands on you again. So I did another treat, and I didn't even do a full treatment on you.
It was literally like, I did the assessment to make sure that was like, like. That I was close to what your body wanted. Yeah. It was, it was where you're listening, like where your L Tap was taking me again. And so, I was like, okay, perfect, we'll do it. And I did it, and her diaphragm, though still stiff relative to other diaphragms, I feel, was so much better then.
It was a month before, and it was, um, I mean, it was so much better that it was, it, it didn't feel like it didn't feel out of the ordinary. It felt like a lot of other people's diaphragms that I feel. And so that was really cool too, for me to see, like, how well you did keep it, which again, I think is because you were honoring where your curves were and letting your body organize itself.
And then I did just give it enough information. And I, and I, I feel like too, that one of the other reasons why things, got such good results for you is because we didn't do a lot for treatment. We went right to the, where the body needed me to do something and we did something there. And so then the body, the brain could focus on what it needed to do to keep that area happy.
And I didn't confuse it with a bunch of manual therapy and other places, which is probably, I know it's the hardest thing for me to do with my patients is like, No, when Enough's enough. Um, in the Brawl Institute, you know, Jean Pierre is always like, it's, you know, leave a little something, like leave some on the table, like let the body do its job.
Like don't over, don't over treat is like a message of their courses. And I mean, I feel like every single practitioner that goes through their work, like over treats. I feel like. Um, every practitioner in general over treats. And so I actually think the fact that we only took 30 minutes to treat you the first time is part of the reason why you had such great outcomes as well.
Yeah.
Lex Lancaster: I feel like on that note, there's two things that I want to say. Yeah. I feel like people might not be hearing yet you, the, the way that your treatment feels, right? So like I, like I said, I don't seek treatment, but I have treated people. So the way that your treatment felt was very minimal. Like I was like.
Did we do anything like, honestly, like it didn't hurt. I wasn't like biting a pillow and you like, you know, taking a Brock blade. Not that you would ever do a rock blade, more or less like any sort of like, you know, instrument where you're pushing me to like cry. Like there was none of that. There was no sort of, um, you know, I'm going to, I'm going to pin and stretch you do all this stuff.
Like all the touch was very gentle. You didn't really touch my shoulder. No, you didn't treat my shoulder. Assess it really. Yeah. Yeah. Like you assessed it, but the treatment was not there. And for me, you know, yes, I, we all, we all feel that, you know, you're going to have to do something to that area for the person, obviously like put up the fire out, touch the area, whatever.
But like we had limited time and in that limited amount of time, you didn't treat my shoulder, you treated everything else. And I feel like had I gone somewhere else, I would have had my shoulder treated. Yeah, for sure. And I don't know what that would have looked like, you know, whether it's, it was dry needling, cupping, whatever it may be, I think that would have been a huge, a miss because now I have multiple visits when you treated me in 30 minutes.
Yeah. Yeah. You know what I mean? So it's like, I don't. I don't know if I understand the treatment is going to be different for each person, but like when for me internally, I was like, wow, I just saved myself a ton of time. And I'm, I feel fine. I feel perfect with that treatment. And there's no need to now go three times a week for however long, or even once a week for six months, like, you know, um, I also prepared,
Anna Hartman: I mean, I had gotten the cups out and the needles.
You did. Yeah, this is gonna like, yeah, her shoulder really hurts. I like, we were both surprised at the outcome and that's like, that is like every day I treat someone, I am constantly surprised because my assumptions based on my first 10 years of practice. Mm hmm are always blowing out of the water with what actually happens in front of me when I'm paying attention to the body Yeah And also it's just goes to show is like, you know Like you said you've done a million exercises and and even with the scoliosis like don't like I let your body organize itself Movement is an outcome.
And so like, how can I change the inputs so that I get the preferred outcome? And I, you know, that was a really good example of what we did. So yeah. Yeah. So, and so yeah, I treated you that second time and then yeah, you've literally done nothing and you play volleyball all the time and you lift and
Lex Lancaster: I'll say I literally play volleyball probably eight plus hours a week.
Like there's Yeah. I have no issues. And I will say, like, I'm sitting here touching my ribs because that was like an aesthetic, like aesthetic thing for me. I hated that. So like whenever I lay down on my back, you could very much so see a discrepancy in my ribs. And it was always something that I was self conscious about.
And I just didn't, I just I didn't love it. And I always thought like, this is the way it is. This is the way it's going to be. And when that was the same, I almost lost my mind. Yeah. You got a little like, I got emotional. I was like, what? Like this is different. And I'm touching it now. And like, it's definitely way less pronounced.
Yeah. Oh, I'm sure. Yeah. Way less pronounced. And like the, when you talk about my diaphragm being the tightest that you ever had felt like it all makes sense. Yeah. Um, but. For, for that to be a big change to like mentally for me, that was, that was awesome.
Anna Hartman: Well, and it goes, and again, like, I think too, like diaphragm was the tightest I ever felt, but yet it just took one treatment for it to change.
And, and the reason being is that the tightness was a neurological thing. Yeah. Yes. Yeah. It wasn't. I mean, I'm sure there's a little bit of layered upon like stiffness in certain areas from your, your scoliosis, but the majority of what was happening was this, the diaphragm was splinting the liver. The diaphragm was like, I don't want you to, like, we cannot move.
Like, we're not going to allow any more movement here because something might, the visceral organ. Yeah. And so, as soon as we, Like did the treatment around the organ itself and got it to gently move and like she said yes Everything's really gentle and and even even I did I did a visceral manipulation technique on her Which is gentle gentle in general even when I do cupping or even when I do exercise Anything I do I'm always doing it over in that protection position and so it never is gonna feel like Threatening and forceful.
And of course, too, then I back off depth if it does, or I back off intensity if it does, because I know that the safety is like such an important thing that the patient needs to feel in order to tap into the body's ability to heal. Then why would I do anything to contradict that? Yeah,
Lex Lancaster: I liked watching you cup in that way.
Yeah. Because I saw you do that. That was the first time I had seen someone go with the way that if like the least
Anna Hartman: restriction into the ease. Yeah. The direction. Yeah.
Lex Lancaster: Direction of ease. I've people don't really do that. They go in the opposite direction because that's what needs to be mobile. Yeah. But so when I had watched you cover, I think you were cupping Shante.
Yeah. This is
Anna Hartman: really cool. Yeah. Oh, yeah. I forget that you did see me treat her one day. Yeah. Um, yeah, the other thing, too, is like, you know, it doesn't mean that I never do, because that's called an indirect treatment. Um, it's not like I never do direct treatments and like, go against, you know, go into the tension, but I, I only go into the tension when the body takes me there and like, clearly wants.
To do that, and in my experience, it's usually only after I've gone indirectly into the, into the, um, ease that sort of reorganizes itself and then opens up into the tension and we can get more out of it. So, and that's a little bit too of, like, you know, I always give everybody goes through my education and even in the podcast, I did like an intro to movement rev.
Methods and philosophies and because that is a very osteopathic philosophy that I learned through the visceral and neural manipulation from the Baral Institute. And it's not like, I mean, it's not like they out and say it, but it's like, as you're learning the osteopathic Osteopathic techniques through them, those principles are conveyed, and I recognize that it was in direct competent, like, direct opposition of traditional sports medicine, and I really felt like if I was going to.
take this stuff on, then I couldn't just be doing half my other treatments this way. It didn't make sense, right? There was a lot of dissonance between the two. And I was like, if I'm really going to assimilate the information together, they need to resonate with each other, which means I need to decide what philosophies make sense to me.
And see, and here is this is almost like a way to prove like things are true. If the philosophies are truly true, they should be able to work with any technique. Yeah. And so then I took the techniques from the traditional stuff that I love to use, like the cupping, and I was like, well, let's just do it on this philosophy and see what results I get.
Cause I already get good results from just the tool. And then that was when I was like, wow, I get even better results. And so that's when I realized too that it's like, no, the principles are more important, which, you know, and always goes back to the, um, Emerson, not Ralph Waldo Emerson, but um, Harrington Emerson quote about principles and techniques.
You know, the fact that we learn techniques in order to understand principles, but once you understand the principles, you can make up your own techniques. That is exactly what I've done is taken these principles of osteopathic medicine and applied them. in a new way with old tools. Right. And that's what you felt is it was very gentle and it was gentle yet so profound and impactful.
I feel like
Lex Lancaster: I'm going to pretend like you planted this question. She didn't plant this question for anyone watching or listening, but I want to ask it because I feel like people who are like me, I have not taken any brawl classes. I know nothing about osteopathic listening, you know, other than what I've watched Anna teach.
But for me as a PT, if I were you. And I was treating someone like myself for the treatment. Obviously you used osteopathic principles to treat me. Like you did the diaphragm release. You did a liver treatment tools. Yeah. So what would you do differently
Anna Hartman: if you didn't have those tools? Yeah, I, I would have cut, I would have used the dynamic cupping around the anatomical borders of the liver or like around the whole area of the liver.
I probably would have gone and done some sort of spinal mobility, either manual therapy or, um, just movement at the segments that innervate the liver, and then, um, which are I think T7 through T9, maybe T10, um, and then, uh, I would have gone to C4, C3, 4, and 5 and done some manual therapy there. Even your body took me there anyways, but I would have probably done it anyway.
Either way, because that's where the phrenic nerve comes out and that's the sensory to the liver. I would have done some side bending and like the self, the exercise I gave you for home care, like the quarters fall, the side lying breathing. I maybe would have, I probably also, the other exercise I gave you was the da Vinci rolling pattern.
So I love the rolling patterns for that area of the body. Yeah, the reason why I love Da Vinci rolling specifically is because it does opposition and it twists. It emphasizes rotation at the area and the diaphragm. That's like the best way to stretch it isn't rotation. So the Da Vinci rolling with actually a pause while you're.
twisted and breathing into that area. Like that's, that's how I would have mobilized the diaphragm the most. And then probably done some sort of like segmental spine thing to work on the articulation of the liver and the diaphragm, like a ball and socket joint.
Lex Lancaster: Cool. I ask because I want people to know you don't have to understand osteopathic tools in order to treat.
Yeah. You don't have these principles. Right.
Anna Hartman: You don't have to have visceral manipulation or neuromanipulation tools. You just, um, and that's what I teach in my courses and, you know, in terms is like you already have tools that I can. affect the viscera. It's just you don't realize that they are affecting the viscera.
So I'm just giving you a new lens of view so you can see that a spinal roll down is this articulation of the diaphragm over the liver. And you can even cue it that way. And when you cue it from the deep, from you, when you use the organs as imagery cues to cue cues movements, the, the movement quality is very connected and very deeper and it's a totally different experience.
And so, um, but yeah, like tools that I've been using my whole career that I just use now for different reasons. Yeah. Yeah.
Lex Lancaster: And like, we've talked about it between us two of like treatment is. Chalked up to be super sexy. Like yes, do all these sexy things for treatment. But like if you don't actually start where the body is telling you to start, it doesn't matter.
Great. Now you're either wasting the person, not wasting the person's time, but you're making them come for longer. You might be missing something. So it's just, I think the assessment part like learning from Anna and watching Anna teach and being a part of her community has definitely, you know, drove home the principle that assessment is the sexy part.
And when you nail the assessment, Then the patient is happy, you get good results, there's really no, you know, there's no negative when you're nailing the assessment.
Anna Hartman: 100%. 100%.
The assessment is the sexy part, but
Lex Lancaster: yet it doesn't sell. No, it doesn't sell. All that, all those tests, they don't sell because we had to memorize 60 shoulder tests for a comp. And everyone's like, Well, and
Anna Hartman: that's the thing too. Like assessment is sometimes different than special tests. I think, I think both physical therapists and athletic trainers were beat over the head with orthopedic special tests in school for our assessment and you don't need to use them at all.
Nope. Because half the time, the doctors, like, I mean, like, I guess you can use them. It's always nice to arrive at the same diagnosis as the doctor. And I do use them occasionally. But when somebody comes to me with ankle pain, I'm not doing the, the anterior drawer and the, like, I'm not looking at all the different ligaments.
Right? I'm being like, what's your general range of motion? What's your swelling like? Yeah. Is your fibula moving? Yeah. And what's your mobility, like, again, what's your mobility like? Oh yeah. And what's your strength like? Can you rise up on your heel with a straight and bent leg? Like, um, so I think, I think we were so mind fucked over assessment being special tests.
Yeah. Instead of actually focusing on the word that it was called special tests. Yes. Special tests mean you're going to use it at a very special, specific time. Yes. Not always for every assessment. And I remember finishing school, and I'm sure you were like this at a PT, you get your first shoulder in and you do like the clunk test and the slap test and the this test and then that test.
And then you're like, well, what the fuck am I supposed to do? I think it might be a labral tear, but do now?
Lex Lancaster: Everything hurts.
Anna Hartman: And it's like, yeah. But then also they probably came from the doctor who already told you it's a liberal tear. And how did they know is because they did the special test in the office and then sent them for an MRI.
And physical therapy. And so it's like, what the fuck? Special tests is not an assessment. No. Period. No. So. Boom. So it's like, yes, assessment. And as I showed with Lex, I still do a movement assessment. Like I still look at passive range of motion and active motor control and strength and all those things.
But I'm not surprised when I do a simple technique on the liver, and then it totally changes everything. It takes a, a shoulder who tested like a two out of five on a manual muscle test, and all of a sudden it'll test five out of five. Yeah. So it's not a strength problem, right? Or sometimes it is a strength problem.
And. And it becomes more and more clear than, like, the, the last podcast episode talking about Daniela, like, she did have a strength issue, but it actually got more obvious that how weak she was, the better her body was organized, getting rid of the protection pattern. Yeah. Because it wasn't allowing her to compensate.
Right. So I was like, oh yeah, look at that, your charade is really weak, you can barely do two wall push ups, two single arm wall push ups. Like, that's a strength thing. Yeah. Yeah. But, but, also, her pain and her strength, we like to correlate those two things. And just like you, your pain and your strength, did you have some weaknesses?
I'm sure. But your pain and your strength had nothing to do with each other. Yeah. We blame, we blame strength. We, we blame strength as the pain driver so often when it's not. Yeah. And it's a lot easier to strengthen something when it doesn't hurt. So first we got to get rid of the pain somehow. And so it's like, and I always tell people it's bullshit to tell them, tell your patient that the reason something hurts is because they're not strong.
Yeah. That is like telling an overweight person that their knee pain is because they're overweight. They're going to fucking lose the weight and their knee is still going to hurt. Yeah, they're gonna get strong and their knee's still gonna hurt. So Yeah.
Lex Lancaster: I'm just picturing like, how you, how I would've reacted if you would've told me like, oh, just do some strengthening.
I'm like, fuck off. I already do that, and it hurts. Like I'm not gonna do more. Yeah.
Anna Hartman: So that's, um, that's the, yeah. You know, thing too is like the, the more we can undo the layers of the protection pattern, the clearer and clearer what the true actual objective dysfunctions become. Yeah.
Lex Lancaster: Oh, and then just get rid of the rib pump.
And that's a total, you know, just a side benefit that I absolutely love.
Anna Hartman: Yeah, exactly. I love it. All right. Well, um, any, any like parting words of wisdom? That was a good, I liked that question from you. Um,
Lex Lancaster: I want to say that I want to, this is my thinking face. I have to think, I have to put the words together first, you know, I'm not very quick on my feet.
Well, that's
Anna Hartman: funny, your eyes are directing me that you're thinking about, uh, auditory something. Really? Yeah.
Lex Lancaster: I, I want to say that if being in the clinic, right? So I've had a lot of different education when you come out of school. You don't really, you feel like, you know, nothing, quote unquote, you could probably do, like you said, all the special tests in the world.
And then, you know, putting things together, it's kind of like, eh, and it really depends on your CI. Like how, how well were you educated on your clinical rotations, et cetera, at least for a physical therapist standpoint. Yeah. And then I was exposed to a lot of like pain science, rock tape, all of that stuff.
Loved it. implemented it really well, really started to put the pieces together, you know, went through Herman and Wallace, did a lot of like learn about pelvic pain, did McKenzie treatment. Right. And I feel like as a PT, um, I can make people feel really good. Like I knew that I was, I did my job very well, but for me, I, I think back to the patients that if I had the skills that you teach how Fewer visits they would have had, but also just that little 10 percent that I could have just like, they were at 90, like, could I have gotten them to a hundred percent?
And they're like walking around the world right now. And I'm just thinking about them and I'm like, I wish I could go back in time. Right. So like, if I, if I had like words of wisdom, I would say like, this would be something to invest in because it's such a. When you think about assessment being sexy, the assessment that Anna teaches, it's not like it's going to take over your entire practice.
Right. Right. So it's like, she's not telling you to ditch everything you've ever learned and just learn what she is teaching you. It's more or less like, this is where, this is, this is what's missed. We do come out of school and we're like, we're the PT. I'm going to solve your pain rather than being like, okay, what can I learn from you too?
And that's something that I've learned from you over and over again, over the past, you know, five years of like hearing you talk, like we're not the expert. We have to understand where the body is coming from. And inherently, I think we all know it. We all know that everybody's different. We all know that the bodies, my, you know, my, Shoulder pain is very different from someone else's shoulder pain.
So if we think in that realm, if we have the same exact injury and we respond differently, why wouldn't we want to consult the patient's body first? Right. So I'm like, it makes sense. And so if anyone is wondering, like, yes, I've seen Anna teach in person. I do recommend, you know, getting to an in person class because it is great to just feel Anna's hands and like understand what things feel like.
Um. But if you have the chance to take any of her courses that teach, like, the LTEP course, like, that is what I would, I would recommend it, 1000%. Um, and that's not just because I'm like, I, I support Anna and I work very closely with Anna, it's because I've seen it happen, like, make a huge difference not only in my life, but a lot of other people.
Yeah. It's wild. Well, thank you. It's the best. Of
Anna Hartman: course. I appreciate that. I'll pay you later. No,
Lex Lancaster: I'm just kidding. She told me to say all that. I have a script on my computer.
Anna Hartman: We all know I'm not that prepared..
Lex Lancaster: I literally was. No. I love you. You'll get a, you'll get a riverside link right before. And I was like, I expected nothing else.
And yeah.
Anna Hartman: All right. Well, I appreciate you. Thank you for being here. I'll drop all the things in the show notes and, uh,
Lex Lancaster: thank you so much for having me. This is great. We had a great 20 minute episode.
