The Lung Connection To Foot Pain You Didn't Know About
In this episode of the Unreal Results podcast, I talk about the connection of the thoracic cavity, most notably the lungs, and its impact on athletic performance, particularly during allergy season. I specifically talk about a case study with an athlete of mine who was dealing with foot pain and how the LTAP™ lead me to treating his lungs, ultimately resolving his foot symptoms. I also give detailed techniques for treating restrictions in the lungs, including bronchial tube stretching. The episode is filled with practical advice on assessment and treatment strategies, which I hope you utilize the next time you work with a client similar to this.
Resources Mentioned In This Episode:
All Of The Books I Mentioned In This Episode*
Episode 56: My Favorite Books For Sports Healthcare Providers
Episode 38: Accessing the Parasympathetic Nervous System Without Focusing on Breath!
Episode 30: Using the 'LTAP™' to Guide Treatment of Costovertebral Joint Dysfunction
Episode 9: Left Sided Sciatica Or Right Shoulder Pain?
Video On How To Perform Bronchial Tube Stretch
Video On How To Restore The Thoracic Curve Through Prone Breathing
Considering the viscera as a source of musculoskeletal pain and dysfunction is a great way to ensure a more true whole body approach to care, however it can be a bit overwhelming on where to start, which is exactly why I created the Visceral Referral Cheat Sheet. This FREE download will help you to learn the most common visceral referral patterns affecting the musculoskeletal system. Download it at www.unrealresultspod.com
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Anna Hartman: Hey there, and welcome. I'm Anna Hartman, and this is Unreal Results, a podcast where I help you get better outcomes and gain the confidence that you can help anyone, even the most complex cases. Join me as I teach about the influence of the visceral organs and the nervous system on movement, pain, and injuries, all while shifting the paradigm of what whole body assessment and treatment really looks like.
I'm glad you're here. Let's dive in.
Hello, hello, and welcome to another episode of the Unreal Results podcast. Here we are, another week has gone by, and, um, I'm at home, as you might be able to tell, um, only for a quick weekend, and then back on the road. Um, I'm recording this at night because I have an early flight in the morning, and it was a beautiful day.
Absolutely beautiful weather this weekend in San Diego, and I needed a break, so I chose to do only a small amount of work in the mornings, tying up all the loose ends from the launch of the online LTAP Level 1 course. Sidebar, if you're in, so stoked to have you, so stoked to start this week, and it's gonna be a great group.
It's a huge group, which is always great energy. So cannot wait for that. But anyways, I chose to just do a little bit of work for that and then go to the beach the rest of the time or sit in my hammock. I read, I just enjoyed myself. But now that means in the last few hours of the weekend, I treated an athlete.
I did the laundry, packing. Have to do the dishes, take the trash out, like all the things, uh, rewater all the plants. It's getting to the time of year where I need to make sure the plants are taken care of when I'm gone. I use these like little bulbs you might be able to see right there. And there's one in that plant too.
So the little bulbs, you fill them up with water and then you stick them in. And they like help the plant to self water. So, um, Yeah, i'm doing all the things last minute Probably not going to get a whole lot of sleep tonight speaking of sleep I also don't have any makeup on today. I don't wear like I don't actually wear a lot of makeup um never Actually never really been a big makeup person But I will say most of the time I do at least put mascara on but on the days I go to the beach I just You It doesn't make sense to me.
Like, I literally don't put anything but, like, moisturizer and sunscreen on my face, and, um, I prefer not to have. I makeup on and um, sometimes I look in the mirror when I don't have makeup on and I'm like, wow, you look really young. I know it's funny because a lot of people wear makeup to look young because they feel like they look old, but I wear makeup to look older.
Weird. And then I was thinking about it. I was like, I hate getting older. I, well, yes and no. I don't mind getting older. I don't really. I don't know. I mean, not that it's bad to hate getting older. Like, I'm grateful that I'm getting older. I'm getting wiser. I'm getting, there's a lot of goodness that happens with, as you age, but also, I would prefer to be in my 20s or 30s, early 30s, maybe.
So anyways, um, um, I was like, actually, like, it's okay that I look younger. Though, in society, this is a tough part of being, like, raised and, and living. in our world, because when it comes to authority and teaching people, sometimes when you look young and female, people don't take you seriously. So that's also sometimes why I feel like I'm sensitive to it is, uh,
There's just a stigma. You can't, literally, if you are female in America, or anywhere probably in the world, no, you cannot ever make everyone happy because you either are old and therefore less valuable, or you're too young and less valuable. And gosh dang, the world isn't it nuts. So I'm like, I don't fucking care.
Oh, the other thing that is not related to the actual topic of the podcast, but I want to share is some of my friends were at Balanced Body, um, Pilates on Tour Rehab Summit in Phoenix, Arizona this weekend and I'm bummed I didn't go.
It's one of my favorite conferences. Um, but I saw that there was a new book, which I was like, wait a second, how do I not know about this book? Because it's by, um, colleague of mine, Brent Anderson. He's the, one of the founders of Polestar Pilates. That's where I got my, that's who I got my, um, comprehensive.
Pilates certification from. In this book, the principles of movement is basically a book form of their foundational course, principles of movement, which are big on how I also teach movement and like what I teach in my mentorship program and like just how I view the body and like, Oh my gosh, I was so excited to see this.
So, thank you, Steph, Stephanie Camilla, and Kiki Cordero, who both posted about it online. Oh my gosh! And also, Polestar, hello! Like, did you email us when this came out? Like, all of the graduates? Like, hey, Brent wrote a book. I'm just now hearing about it. According to the Amazon, it came out at the end of 2023.
So, Brent, shout out. So stoked about this book. Flipped through it. It's great. Those of you who have been learning from me for a while, you'll, you'll see a lot of things in here that should look familiar because I started actually integrating these principles in when I still worked at Exos when I was still creating content for Exos education and so.
A lot of it is in there. So really cool to have a reference. It's going to go on my Amazon page. So I'll link that. I have a feeling if I ever do a favorite book, um, podcast again, it's going to be there. So you know, and since we're talking about it, Joe, go ahead and link the Amazon page. And then also the podcast about my favorite books too.
So that's it for sort of housekeeping things. Uh, what I want to talk about today, hopefully it'll be shorter. Um, but you never know is, um, a little visceral stuff. So I want to talk about the bronchus and, and basically the lungs and the pleura. Um, but definitely. a little bit more focused on the bronchus, the bronchioles, the bronchi, whatever, the tubes of your lung.
So trachea and the bronchioles. Bronchi. And the reason I want to talk about this is because, well, two reasons. One, one of the things I'm working on this year for all of you is, um, some more support around treatment techniques, tools to treat from a visceral lens of view. Because even though I always stress to people that you have the tools, um, And people are like, I don't know what to do though.
So I'm going to putting together a resource for you to point out, to help you to hold your hand through it and to give you some more inspiration, some ideas to treat. So that's part of it is I'm just kind of going through all the organs and thinking about how we can affect them. But then also this time of year.
This is coming up a lot in my athletes and my clients, and I'm sure probably in yours too, because it's allergy season. And as allergy load goes higher, we have a very big connection to our immune function, our lymphatic function, um, Via or with the right, specifically the right bronchi. And so this is, I've had a few athletes, in fact, the athlete that came over tonight, that's where his, um, LTAP, his listening directed me to.
And also I was thinking about it. It's interesting. He came in with foot pain.
Maybe the third athlete in, in a while, I don't know, like not a recent while, but it's the third athlete who's come to me with foot pain and it came up long. And so, um, it's not a normal connection, but we can talk through maybe why, but really I just want to talk about the bronchi, about the tubes of the lung, about the pleura of the lung, about treating, the viscera of the thoracic cavity in general, and give you some ideas of how to treat it.
But I want to also give you some context for all of you that have gone through the LTAP level one course or thinking about the LTAP level one course or currently in it, I want to sort of always tie things back to that too. Um, so it may be even Maybe even you've recently gone to the results cheat code the missing link.
And so this, some of this should sound familiar to you. So how do we even get to the bronchi in the first place? Well, one, I just told you this time of year, it's pretty common. In fact, I did last year around this time, I did a podcast, Joe, let's link this podcast. Um, which was like right shoulder and left sciatica.
And it talked about the role of the liver and the lung. Um, in seasonal allergy load and those common complaints, right? So maybe you find yourself at the bronchi, at the pleura of the lungs or the lung itself because of seasonal allergies. Maybe you've been sick. Maybe you've had some grief. Um, there's a lot of reasons, right?
But, hopefully, you're getting there because the body directed you there. So, if you're trained in the Baral work, your listening took you here. If you have gone through the LTAP, then the first LTAP, the SI Joint Mobility Locator Test, changed what? It was hypomobile on one side and then changed with the breath hold.
So it took you to viscera and central nervous system. So it took you to the second test, central nervous system. You cleared that. There is no central nervous system tension pattern. And then you went to the third test, which is the thoracic decompression test and thoracic inhibition test. And you found that, Oh, Yep, right bronchus, or maybe even left, or trachea, or pleura, pleural dome.
You found that this changed the inhibition test quite dramatically and maybe even there was a decompression lag on the sternal or thoracic decompression. So, so now you know that we need to treat organs of the thoracic cavity. And so there's an interest, the interesting thing about the organs in the thoracic cavity, and this is probably true also for some of the other hard framed organs, is it's, it's more challenging to directly treat The viscera.
And so the more you can understand the interaction between the viscera and the hard frame, the better you can pick out how to treat where to treat on the hard frame. So, the, the, we're going to take this from a standpoint of that, of like, okay, let's just assume that you don't have any visceral manipulation skill set and you cannot evaluate besides the inhibition test that you learned in the LTAP, but you cannot further evaluate the viscera to get specific viscera, but you can affect the viscera through the hard frame.
So, In the thorax, you've got three frames, basically you've got the hard frame, which is the bones and the joints. And in the thorax, you have a hundred and fifty joints. That's a lot. A hundred and fifty joints. That's a hundred and fifty places that you could do some sort of joint mobilization. Okay, so a hundred and fifty joints.
That's a hard frame. Bones. Joints. Okay? Then you have the soft frame. The soft frame is the fascia. The ligaments. Um. The muscles, all the connective things. Okay. You got a lot of those in the thoracic area, right? All the intercostals, the internal, the external intercostals, the different layers of fascia.
There you've got the pleura. The pleura, which very closely is connected to those intercostals very closely. The parietal pleura. Yeah, the parietal pleura. And then you've got the. Suspensory ligaments of the pleura, the pleural dome ligaments that attach to the hard frame. So the pleura attaches to the backside of the fascia as well as the hard frame.
The ligaments that hold the lungs and hold the heart in space, in the space and connects it to the hard frame, those are all soft frame. And then you have the visceral frame itself. So the visceral frame itself is the skeleton of the lungs, the bronchi, the skeleton of the, um, heart itself. That frame, the visceral frame, has a very high
mobility. Those organs are two organs that move a lot. And then you've got the connective tissue that needs to move. And then you have the hard frame that also needs to move because of those layers, right? The deepest layer moves the most, and then everything out from there needs to move too in order to keep that visceral frame healthy and allow for the movement.
Which is why then it makes sense that there's 150 joint articulations in the thorax itself because the thorax, even though we think of it as a very hard cage, it's super mobile. It should be super mobile, but you and I both know that a lot of our patients do not have very good mobility. So this is actually A good example of once you determine that the body is in that protective pattern around the bronchus, the lung, the pleura, whatever it is, anything, the pericardium, whatever it is in the thoracic cavity.
Once you know that, then what do you do? You can just do general treatment if you want, or you can assess the hard frame. So you want to do your normal assessment of the hard frame. So that might look like checking thoracic mobility of the thoracic spine. That might look like checking the facet joints of the thoracic spine.
That might look like checking the thoracic The facet joints of the cervicothoracic junction. And we're going to talk about the importance of that area in a second. That might mean you're looking at rib mobility, both from a, um, intercostal function standpoint, as well as the joints that connect the ribs to the spine, and the cartilage, the costocartilage joint that connects the rib to the front of the, um, thorax.
and then the joints between sternum itself. All of those things are important. And then maybe even to the diaphragm mobility or the diaphragm function. Though, if you listen to, I think I did a breathing I think I've talked about this on a podcast. I'm not really not sure if I think of it, I'll let Joe know to link it.
But, um, I think of the diaphragm more as a, like, how am I changing as an output? Since it's more of a muscle that to me is more of a, like, I should see change there as I manipulate or Um, address hard frame issues or visceral issues in itself. So anyways, those are all the things that you could do. So, so before you treat, just like you would any other joint, you would want to assess those structures however you like to assess them.
And, and like I said, there's a lot of them to assess.
Now, with that said, once you assess them, then you can let that orthopedic exam direct you where to do treatment because anywhere you treat in the thoracic cavity is going to affect the entire cavity and all of the contents because of how they're all set up anatomically. This is because the three, like, parts of the cavity, which is the right Pleural space and lung, the left pleural space and lung and the mediastinum, all of those cavities were once embryologically one, and then they sort of separated, but stayed connected, and then also are intimately connected with the diaphragm, and then connected in to the spine and the heart frame.
And so, when you treat one area. It's going to have a collective or reflexive effect on the entire thoracic cavity, and, um, that's pretty cool because that means again, this is why sometimes general thoracic cavity treatment can be so powerful, but as with anything, the more precise and specific we can get on where.
And sort of zones of strategic areas that have a lot of, um, bang for your buck, then, you know, even more powerful to affect. So that's a little bit of what I want to talk about here. So one of my favorite, well, let's just talk, okay, let me back it up before I just get into treatment. The other thing we got to think about is going back to the hard frame, soft frame, and visceral frame.
Um, Okay. We want to treat the hard frame. So if there's a restriction at certain joints, let's treat those first. Then you want to treat the soft frame and part of the soft frame is the plura and the plura and the muscles are, are intimately linked together. and the skin, right? This is another thing that's cool about the thorax.
So you're not a whole lot of adipose tissue between. And so treating on the skin can be really reflexively powerful to treat the soft frame and the visceral frame. And then I want to treat the viscera. And I think the easiest way to treat the viscera of the lungs is through the tubes, through the bronchi.
And so that's usually my general visceral technique of choice, which is why I actually share it in the LTAP Level 1 course. And it's on my YouTube channel, I believe, maybe, Joe, we can link that, but so now because of this order, right, we talked about assess the hard frame, treat and don't treat it yet, but assess the hard frame because we're going to assess a couple of other things first too.
So, um, having your Mind like where you where the hard frame is taking you and then you want to assess the three different sort of parts of the pleura and that can be separated into like superior Inferior and middle the superior part of the pleura is called the cervical pleural area I guess I don't you know whatever, but it's basically like the pleural dome and the suspensory ligaments that attach the pleural dome to the cervicothoracic junction and the first rib.
So those pleural dome ligaments, there's multiple of them. They go from the pleural dome at the top of the, um, thorax here, like right in the sweet spot above your In your thoracic inlet, those ligaments go from, one of them goes from the top of that dome to the first rib, one of them goes from the top of the dome to the transverse processes of C7, and the top Then another couple go from the pleural dome to the body of C6 and C7 and T1.
And then there is some connective tissue that also connects to the trachea and the esophagus and the subclavian artery.
So there is a lot of connections in this area, this cervical pleural area.
The way we can tension this to see its mobility, because it's a big sack, and whenever we have like big containers, we want to make sure the container can expand and stretch. So, to test it on this, on this, if we're testing whatever side, side we're testing, we're going to move our head away from that side.
So we're going to rotate away. We're going to take the same side arm and bring it in abduction and actually rotation. And then you're going to put your hand at the bottom of it. And sort of like pull it down. So the bottom of this area would be like at the level of your clavicle, basically. So you're going to be at the level of your clavicle and you're going to think like, I'm not at the skin.
I'm not at the clavicle itself. I'm behind it. So like have the intention of being a little bit down and then you're going to take a breath and you're going to see how easy it is to take a breath. Pretty easy for me on that side. So I'll check my other side. And on that side, I can't take as big of a breath.
So that's telling me that on this right side for me, this is my right. Yeah. My right side, cervical pleural, part of my pleural system, part of my soft frame needs some Mobility needs some stretch. It's limited, right? It's, it's affecting my inhalation capacity because it won't, it doesn't have extensibility anymore.
So that's a quick, easy test of that. Then we've got this costo mediastinal recess, which is basically like where the pleura. Connect into the, the edges of that, um, the septum of your mediastinum, right? Remember I said amylogically, they were all the same before, so they're still pretty much connected, but you're going to put, um, to test that you can put one hand on your sternum and the other hand, sort of, I think, like, right around, like, maybe right above the nipple, like, nipple.
So, like, T4. Sorry, not T4. Rib 4, a round rib 4, flat hand. You can do that same thing. So you're going to have the tension of being just below the surface of the hard frame and slide your hand, your same side hand, so it would be my right side hand apart. I'm going to have my head that way. Now your hand is going to be on the patient.
Their hand is going to be up in this position and then you're going to take another deep breath. Uh, it doesn't feel as restricted as above, but it is a little difficult to get a full breath in, but let's test the left side because who knows. Oh yeah, easy. I can, I can expand on the left, no problem. So that part of the pleura too, though if I were comparing, I'd say the upper part, the, uh, cervical pleural part of my, uh, right side so far is, uh, the more restricted.
area. And then the last bit is the lower bit. It's the costo diaphragmatic recess, which is the space underneath the lungs. That's sort of like negative space that allows for the lungs to, um, fill in to on an inhale breath. So that's going to be more around like rib 10.
So right underneath kind of like where your ribs curve around that rib 10 area. You're going to again, think not, you're not pinning the ribs down, but you want to have this intention of sort of like stretching that plural space out with your hand. Again, the practitioner's hand or the opposite. So you can have the other one up and then rotate, take an inhale breath.
And that's actually not terrible. Let me try the other side.
That feels actually pretty similar side to side. So for me, the area of restriction is the right cervical pleural part of my soft frame. Okay, great. If I found this and I'm suspecting there is a higher like allergen load in me, like it makes sense that it's right sided. But, And also, like, I have some issues right side, so it could just be that.
But that's a quick way to assess, um, what part of the plural. Now, w w what do you think? I'm asking, like, there's people to answer my question. But, what I would, um, Then think in my head is like, hmm, how does that correlate to the hard frame? And that means like did I assess C6, C7, T1, T2, T3, T4? That upper part.
And how do I assess that? I like just a general like facet. Assessment inflection and extension and then I also check the first rib. Oh, that's the other thing I want to check right because one of those ligaments attached to the first rib and maybe I find that my I can't even feel it in my neck my first rib doesn't want to descend on that side and Then I would check Uh, just general and prone, how, when somebody lifts their head, does it feel like T1 through T4 are moving at all?
And I would check those. And so then I'm going to treat the area and I'm going to treat the area by whatever skill set I have. But here's a quick, easy thing. The test that I just showed to assess is also the treatment. You can get really specific with your hands. Cervical pleural area is going to be related to those suspensory ligaments.
So I might put a finger on C6, a finger on T7, might span the first rib and scalenes as I have their head rotated. And then the other hand is going to be right around the clavicle area. And as they inhale, I'm just going to see what I feel, feel the tension, and Then on the exhale, see if I can add a little stretch or maybe on an inhale and see if I can add a little stretch.
The secret is not forcing things. So if you feel the body starts to tense up and not like what you're doing, you're forcing it. So try the reverse thing. And some people's body really likes a direct technique going into the direction of stretch. And some people really respond to a direction of ease. So you just got to see now, um, you could also do.
Neck anew, that is the cortisball skin stretch around that area. Remember because I said those ligaments also attach to the trachea and the esophagus, you could do all of those things while swallowing. You could do a platysma stretch. You could do clavicle mobility because it relates to the thoracic inlet.
You could do A joint mobilization T4, any of those areas. You could do, um, muscle energy technique. You could do cupping. So cupping works really great and the backside there too. There's a lot of possibilities. The other one I really like for the suspensory ligaments is using a yoga tune up ball in the thoracic inlet and moving the head around.
This connection, these ligaments, they connect. to the cervicothoracic junction, but then they're continuous with that pleura and they go down and attach to the diaphragm and so This is why sometimes when people have an inhale, they like they can't fully drop their diaphragm down on an inhale is because it's pulling at their neck too much.
So playing around with that interaction is really helpful in this too. So I might do some breathing exercises, but with my in supine with my head flexed, so my diaphragm can drop down and I might be working on bringing my head back in space and stretching out that relationship between the cervical thoracic junction and the base of my diaphragm to get that whole pleural line.
Okay. And so if we had found tension in the different area, we could have done that similar technique that we did with the hand down lower or down at the side, or you can mix it up and use the gorgeous ball instead of a hand, put the gorgeous balls in those spots. Turn the head the opposite way and then do the breathing.
You can use the cordless ball on the floor or you can use the cordless ball on the wall. All great options. You could cup. You could do a cupping technique where you do a skin lift and then you play around with real gentle head and arm movement into abduction and external rotation while maintaining the skin lift.
So many possibilities. Now, um, And all throughout that area, right? Three dimensionally too, right? So if you free stuff up on the front, don't forget to check the backside too because that pleura is a three dimensional structure. So that the next thing, so remember I said, treat the hard frame, treat the soft frame, and now treat the, um, visceral frame.
So now the visceral frame, I can go and find the tubes in the bronchial tube stretch. Okay. I already asked Joe to link it. I definitely have this on YouTube. Um, it's a favorite, like, self care technique. Uh, but let's talk about how this relates to the heart frame a little bit. The trachea comes down, right, from your nose and mouth.
Um,
for this ease of this podcast, we're not going to talk about all the things you could do in your neck for that part of it. We'll assume we've already talked about the trachea itself because now we're talking about the bronchi, the bronchi. So. Once we're down in the thorax, the bronchi split from the trachea at the level of the angle of Louie.
The angle of Louie is the sternomanubrium junction. So manubrium and the sternum come together, make a little ridge, that's the angle of Louis. It's usually right next to the second rib. That is directly opposite T4. T4 is a really key spot that you want to make sure moves well. You can even do a little wonderful compression technique with one hand.
on you know fingers on t4 or palm on t4 however you like and then the other one on the angle of louie and you can kind of compress and let go compress and let go one of my favorite self care exercises for the thoracic cavity in the medius dynum is restoring the thoracic curve But what is it really when we look about it?
It's a cordless ball or a towel roll right at that spot. Breathing into T4. So we're basically doing that compression and expansion with the breath. So you can do it with your hands. You can do it with a ball. Whatever you want, you can do it with the cup, but that connection between the front and the back, T4 and the angle of Louis, Ooh, it's a great technique to do.
Once you do that, then you're going to use that angle of Louis as a landmark. That's where those tubes split off. And you're going to find the tube on the right and the left. The tube on the right is more vertical. My mentor and friend and colleague, Veronica Campbell. She was recently at the in person LTAP and she, I, this, I always get confused with this and she told me, she's like, one time I asked the anesthesiology, anesthesiologist about it and he said that whenever they do put a tube down someone's throat for an airway and when they look down to see if it's See the airway they always go to the right because they can see sort of like straight down the right because it's so vertical So that one's going to be more vertical from the midline.
It's going to be 30 degrees from the midline, right? So it's a more vertical The left side is going to be a little bit less vertical because of the heart and it wraps right around Not all around, but the, um, aorta goes right over that, right? So this is kind of the angle. So the aorta is this like usually right above rib two, and this is going to be like right at rib two.
I also teach people in the course and in this video tutorial that you'll see to find the tube by the hard spot. That's on an oblique angle like that. Once you find this tube. I bring my head forward. I drop my chest down a little bit and then I imagine the tubes and I lengthen them and spread them apart.
I start humming and I see how free my trachea can get and can I bring my head back into extension? And then cervical extension. And I might do that a few times. That's a great, great, great visceral technique that anyone can do on themselves or you could try it on your patients too. Just don't push too hard.
You're not doing CPR. Be intentional. But from a self care standpoint, Ooh, it's really good. So that's it. Those are like my top things. Of course, you can do other things. You can, you can figure out like what intercostals man, if you could find which rib and where on the intercostals is not extending and do a little specific treatment there, that's going to have an effect on the long fissures, the pleura, mediastinum, kind of everything.
So that's a really good technique to do too. But um, that's it. I also want to just share with you the case because I think it's interesting that I just Worked on because it was connected. He came in and I was like, how funny that this is going to be where your body is directing me when I was literally planning that the podcast on this, but he came in with right foot pain, kind of insidious onset, um, at a track meet a couple of weeks ago.
Um, he's been feeling good and it just kind of came out of nowhere. Just a sharp pain, sort of like the vicular area, especially when he was, um, Running. And, uh, and he's gotten a bunch of treatment and nothing's really helping and all the treatment he's getting to the midfoot to mobilize the joint is really good, really specific from really great practitioners, but, um, nothing's helping.
And I was like, well, that's a good, that's a good indication that we should probably do something other than that. So let's see where your body's taking us. And sure enough, his body took us to the right bronchus. I've actually treated this on him recent, recent ish, um, before and also changed a lot of things going on in his body.
This foot pain is new though. And the cool thing is, so before I treated the spot, right, so LTAP took me to the right bronchi. Then, I do an assessment. I did an assessment of his foot, and I did an assessment of his low leg, legs, and then I did an assessment of the thoracic spine, the cervical thoracic spine, and this is what I found.
His foot, yep, he was stiff right at that joint that's hurts, but really actually not lacking a ton of dorsiflexion. This is where it's nice that I treat him often because I know what's normal for him. He normally has pretty stiff feet and actually didn't feel too bad, but I could feel that specific bone, like between.
I don't know, navicular and, um, cuneiform wasn't really moving very well and when he dorsiflexed, uh, or when I passively dorsiflexed him, he was limited in tibial internal rotation, especially at 90 degrees of knee rotation. Function. He was limited in long axis, internal rotation. The tension was coming from above his knee.
And he was very limited in hip adduction. Meaning he, I could not bring his leg much farther past the midline. And that tension was very much up in his, uh, thigh. Like a t band ish, maybe even a little bit more even in his trunk. I decided to do an inhibition test with that hip adduction. And since I couldn't reach his bronchus, because he's really tall, I thought about having him inhibit it, but I was like, you know what, I'm just going to use a breath hold.
Because breath hold, as we know, is an inhibition test. It's what we use for the first LTAP test. But also, since I I was like, this is to do with his breathing apparatus. It should be really a wonderful inhibition test to use. So I had him, I tested his hip AB duction, ad duction and his internal rotation.
And then I said, oh yeah, this is a little tight. And then I had him hold, hold his breath, and he hold, held his breath. And then I tested again and it was like full range of motion. And he's like, what is that about? And I was like. Interesting, isn't it? And so I was like, this means that I'm pretty confident that whatever I'm going to treat in your chest related to your breath is going to change.
And let me just reiterate that The breath hold, even though it relates to his breath, it was more about confirming that there was a visceral component than anything else. So then, um, I was like, okay, I've got what I need around your foot. Like I can see why your foot's not feeling very good. Your whole leg is not moving very well.
You're not absorbing force very good when your foot hits the ground. And so then I was like, let's, um, assess your, Cervicothoracic junction in your thoracic spine. And he was, uh, first rib was not moving on the right. He had a facet restriction at T2. So first rib on the right, T2 on the right, T4 on the left.
And so then, um, I checked the, His pleura. I did the test that I walk you through and it was really all the entire length of his pleura on the right was pretty restricted and he noticed how difficult his breath was and So then I was like, okay, let's treat you and so I did hard frame treatment first I did muscle energy technique at t2 then I did Rib first rib technique, which is actually the first rib technique I use is actually also a plural ligament technique and then I did the T4 to angle of Louis compression and, um, I did a bronchial.
tube slash pleural stretch and seated until it felt like his body kept taking me into like almost laying him down on the table. So then I switched on the table. That's actually when I did the compression, um, and decompression between the T4 and, um, angle of Louis. Oh, and I forgot to say one of the other things I looked assessed at him was prone head extension and mobility from T1 to T4.
And it just confirmed that T4 was not really moving at all. And so then I was like, yeah, we need to get that guy moving. So after I did all those hard frame techniques, I then did cupping. on the posterior in that same area and a little bit of like regular massage active release type thing, um, along his spine on the right.
And, uh, I already said the visceral stretch I did and seated, and then I laid him back on the table and I did the bronchial tube stretch as well. And then I reassessed him and his LTAP was now Hypomobile, did not change with the breath hold on the right and I reassessed his right leg. That's the painful leg he had and his navicular and cuneiform were moving better.
He had full hip A D duction. He Had improved internal rotation, but it was still a little stuck, especially at 90 degrees of knee flexion. And then at zero degrees, um, or long axis internal rotation, it was better, but I could feel like he was like lower leg was jammed up a little bit. So then I did, um, figured out where on his leg to start, which was actually up at his femoral, um, nerve area, like inguinocanal, a little pectineal ligament.
So we did that, that cleared up the knee. Proximal tibial internal rotation. And then, uh, the last little bit I did was, um, on his anterior compartment of his low leg. And then I rechecked his foot. And I was like, honestly, I don't feel like I need to mobilize anything in your foot. It feels really good to me now.
And that was it. And he felt good off the table. The real test will be how he feels on the track. But I'm like, I'm really confident that you feel good. And then we talked about managing it. And, you know, When you're looking at it from a musculoskeletal standpoint, people want to manage him by doing load management and like putting him in the alter G, making him swim, like taking him out of practice.
And I'm like, I'm not convinced it's musculoskeletal because after we talked about how it's in his lung. I said, Hey, you know, also you sound a little congestion. Have you had allergies or anything lately? And he goes, Oh, actually right before that track meet that my foot started hurting, I got sick and I had some sort of like cough and like lung thing.
He's like, yeah. And I've just not really felt great since. And I was like, Oh, isn't that interesting. Your foot was fine. And then you got this. lung thing going on and then your foot hurts, I was like, so do you see how maybe it's not about your foot. It's that your body was organizing itself around protecting whatever's going on in your lung and it changed the alignment of your whole leg and how, how your body absorbed force when you hit the ground.
So now our home exercise program or like what I need you to focus on is not necessarily about your foot, but about your thoracic cavity. And the other interesting thing was about that is in the last couple of weeks, as he's been trying to manage this, he noticed that he feels pretty good at first, you know, at the beginning of the workout, when he's going through his warmup and stuff, when the intensity increases, if his foot starts to hurt, I was like, isn't that interesting that maybe it's not a volume thing, but an intensity of the breathing.
I was like, and maybe as your breathing intensity went up and your body was trying to get more extensibility in the pleura and like get those tubes to stretch. Your body was like, we can't do that. And so lock things up and change your alignment and like made your foot hurt. Because again, like mobility and like loading patterns was altered because of it.
I was like, so isn't that interesting. I was like, so tomorrow, when you go out there, I was like, warm up. If you start to feel it a little bit. Stop what you're doing. Do the quarters ball work around your, um, rib cage and then try it again and see if it's changed. I was like, this will give us some good information on if we're on the right track.
I was like, but based on how your body responded tonight, like, I think it's this. I was like, and you're good to go. You don't have to load management. It's not about the foot. It's about the rest of your body. So super interesting case. I'll try to keep you posted on it. as long as he keeps being posted on it.
Uh, but at least was a nice case to iterate like how this looks in in real life. So hopefully helpful. Sorry, Joe for all the links. I'll help you out, but uh, we'll see you next week.