The Power of a Targeted Assessment For Lasting Results
This week on the Unreal Results podcast, I’m taking a clip from episode 33, Assessment Is Sexy, to highlight the importance of a good assessment. This was originally a guest episode featuring my friend, teammate, and colleague, Lex Lancaster, where we talk about treating her chronic shoulder pain. I of course highlight the use of the LTAP™ (Locator Test Assessment Protocol) as the basis of any comprehensive assessment to help guide you where the body exhibits any protection patterns. In this case study, you'll hear how targeting the liver and nervous system dramatically improved her shoulder pain and mobility.
Resources Mentioned In This Episode
Episode 33: Assessment Is Sexy (w/ guest Lex Lancaster)
Episode 60: LTAP™ Core Beliefs
Episode 55: A Different Way To Treat Achilles Pain - Track Athlete Case Study
Episode 46: Using The LTAP™ With Post Surgical Rehab
Episode 30: Using The LTAP™ To Guide Treatment Of Costovertebral Joint Dysfunction
Episode 16: Why The Shoulder Comes Last
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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. So, uh, just a reminder that the podcast for the summertime, so about a month and a half between the beginning of July and the middle of August 2024, We're going to be doing some, um, reruns, but not whole episodes, just clips of some of my favorite things that I've covered in the last 66 episodes.
I'm going to be focusing on more of the episodes that haven't got as many downloads as others. Um, just thinking that, you know, Not sure why you missed it, whether it was timing of the year, or the title, or whatever. Um, want to make sure you get the information, and then also I know that when you, when it comes to learning stuff, whenever you can hear it repeated again, it's going to have a better opportunity to sort of be absorbed and stick.
And then also, um, my experience and a lot of the mentorship alumni. Experience is when you re listen, re watch material, go back to it in a, you know, in another year, in another time, sometimes you hear and catch different things because often what we pick up in a class or what we pick up in a lecture is what we need to hear in that moment.
And you are a completely different person now than you used to be, um, a completely different practitioner, especially if you. been listening for a while and implementing some of these practical tips of utilizing a more true whole body approach, uh, that considers the viscera and the nervous system in your, uh, assessment and treatment plan.
So, um, Maybe it is exactly what you've already heard, but you're going to hear it in a different way and pick up different gems and different information from it. So I hope you enjoy it. I'm curating this specifically for you. And, uh, thanks for being here. Enjoy this episode.
Hello. Hello. Welcome to another episode of the Unrea, Unreal results podcast. We're still doing the rerun clips for summer. Uh, this clip is from an episode called assessment is sexy. It's actually a guest episode with my friend and colleague and team member, Lex Lancaster. We discuss how important assessment is in.
Getting good treatment outcomes. Even though It's not the same thing that sells. In fact, um, the majority of people when they're taking continuing education classes are so focused on treatments, treatment tools, and even in the session, right? People are so quick to dive into the treatment that they skip the assessment piece.
By skipping the assessment piece, we miss the opportunity to really figure out where to start treatment. Why start treatment there? And that's really also when we don't get the results that we want. When we take the time to do an assessment, especially one like the LTAP, that takes into consideration where the body is directing us.
The results are so much better and the treatment needed doesn't have to be as long. So I hope you enjoy this clip from this episode. It's a great episode. You get to hear about an assessment and treatment I did on Lex that took her 9 shoulder pain down to 0 to 10 in just 30 minutes. So enjoy.
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 adduction. 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, adduction 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 thoracolumbar 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 LTAP 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 Barrall 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 Rock 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 really cool.
Anna Hartman: 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 Barrall 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.
Lex Lancaster: I feel like 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 Barral 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 if you didn't have those tools?
Anna Hartman: 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