Using The LTAP™ for a Complex Post-Surgical Ankle Case
One of the questions I often get asked is if the LTAP™ works for post-surgical cases. In this episode of the Unreal Results podcast, I dive into a recent client that I had who underwent a fairly complex ankle surgery, where I of course, utilized the LTAP™. You'll hear specific insights into her LTAP™ assessment and the treatment strategies I utilized, emphasizing the crucial interplay between the nervous system, visceral organs, and musculoskeletal system for optimal recovery. Whether you're managing post-surgical patients or not, this episode underscores the power of a whole-organism perspective to achieve significantly improved outcomes for all your clients.
Resources Mentioned In This Episode
Episode 3: Swelling Reduction Protocol That Works Like Magic
Episode 46: Using The LTAP™ With Post-Surgical Rehab
Learn the LTAP™ In-Person in one of my upcoming courses
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 in 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. Welcome to another episode of the Unreal Results Podcast. I have been doing all the things to, um, share about the LTAP level one course. I definitely, this is the first time I have done a four day open cart for the online course. And, um, it's intense. It's, it's. I don't love emailing people like 50 times a day, but at the same time today I was like, I'm sending it six or more emails because one people just don't open them sometimes.
So it's like the more you send, the greater the opportunity. People have to open them. But also I just still have so much to say. About the LTAP level one course and the LTAP itself and like just so much like I wanna share, like this is too, this just shows you like, I am so excited about it. So excited about sharing it with everybody because I get fired up on the results people get and not just me, right?
Like, yeah, I've been getting results like this for a while, but gosh darn, I love. I love hearing everybody's stories and I love hearing the results everyone else is getting, and it's just every time somebody shares it with me every time, it just reignites how passionate I am about how the industry needs to change.
Needs to change from a paradigm that only looks at the biomechanics and the musculoskeletal system. And starts to see it from the whole organism lens that considers the nervous system and the viscera and the musculoskeletal system and how they work together for the good of the organism, for the good of survival, and how that dictates the biomechanics, how that dictates our movement, how that dictates our motivation to move.
So much more deeply embedded in our being than the way we're doing it. So I am just so passionate about it, and I am, I, I hope that comes through. Um, the microphone comes through, your speakers come through the video that like, I am doing this because I wanna freaking change the industry like. And every time I share and every time I see people get results, it just freaking fuels me.
So thank you for being here, and thank you for like being part of this community. Like I cannot wait to see how it goes, how it continues to grow and uh, yeah. Yeah, that's it. I'm grateful. I'm stoked. I am excited to see who. The people are that are in the next cohort of the online course, and I'm excited to see who joins me in Durham in May and in San Diego in September, and Toronto in October, and San Antonio in November.
Like I just, I literally, I can't wait to meet you so. Anyways, this is an intro for a, um, episode that I actually just recorded within the Facebook group. I did a Facebook Live, and one of the things I want to talk about is a patient case I had this week, um, which is a, um, 18-year-old, um, softball player, uh, with a fracture dislocation of her ankle who has post-surgical tightrope procedure.
And one of the questions I get a lot within the LTAP course. Within the LTAP level one course often is, this is great and all, and I see how it works with like chronic injuries and like aches and pains and things like that, but does it work for post-surgical patients? And I'm like, oh my gosh, hold my beer.
It is so needed for postsurgical patients because we don't think about it. We think of the post-surgical patient as her ankle, as the tightrope procedure, as the swelling that comes with it, as the limited range of motion that comes with it as the atrophied muscles that come with it. But what I see is someone who had a lot happen to them in a very short period of time, that their body had to choose what to focus on and what not to focus on in order to survive.
And so all the rest of the things that happened to it in that span of the injury happening and the surgery happening. It just got sort of like packaged up and like put to the side in terms of like bodies like can't compensate for you yet. So we're just going to like go into protection mode around it and hope we could deal with that at a later time.
That is where the LTAP comes in and that is where this whole organism view comes in that. Man, when we see their a post-surgical patient, from that perspective, it makes sense why you wouldn't wanna just focus on their post-surgical part, right? They just had a very probably like traumatic thing happen to them, even if the injury wasn't traumatic.
The surgery can be traumatic. The recovery can be traumatic. And I don't mean like big T trauma, which, but it also could be big tree trauma. I mean like actual tissue trauma to more places than just the surgery site. Most surgical complications are not at the surgical site, right? Like, well, yeah, I guess they can be at the surgical site, like infection and stuff, but it's like from the tourniquet, from the nerve block, from the anesthesia.
From the lack of moving. Those are, those are very big things that happen to the body in a surgical case and prevents us from getting good results from the patient. And I talk about in this episode how it could even, like the way you approach the first session can dictate the entire rest of the rehab.
So you wanna take that into consideration. So it's like, I almost like, I want to yell it from the rooftops that post-surgical rehab is whole organism.
It never can't not be. So I hope you enjoy this case. Um, I look forward to many more sessions with this athlete and, um. You know, sharing more about how I use the LTAP in her specific case. But, uh, this episode is all about our first visit and whether where the LTAP fit in and what it provided for us. So I hope you enjoy.
Anna Hartman: So the last thing I wanted to talk about today is, um. Again, I, a common question I get about the ltap, and sometimes this is more like in the course than before the course, but people ask how it works with postsurgical clients. So I have a, I have another podcast episode specifically about this knee.
Um, but I just had a post-surgical client. Excuse me, that I saw a couple days ago. So I thought, um, she would be a really great, uh, person's case to talk about. So my first answer to that question is, every single person that walks through my door for an assessment and treatment gets the same assessment. I always start with the LTAP in general listening, always it I have to.
Once you see how the body can guide you and the body can help you get results, why would you want to ever abandon that? So every single person gets it. So she's a new patient, never seen her before, never met her before. And um, she is a high school, hopefully soon to be collegiate softball player. And she recently sliding into ba base on a rainy, rainy day game.
Um. Her foot got stuck and she had a fractured dislocation of her ankle. So she had, um, you know, fairly emergency surgery within the next couple days and she had a tightrope procedure, so she had, and, um. Internal fixation. Right? An orthopedic, uh, internal fixation where they put a plate along her fibula.
Two big screws. Screw well, the plate along the fibula and small screws to set the fracture of the fibula. And then two long screws going from the fibula to the tibia to, um, help to, um. Fix the syndesmosis injury of the dislocation as well. It was a pretty bad one. So she also required the wire or rope, which is what the procedure's called the tightrope procedure.
So the rope wraps around, you know, securing that. Um, tib fib syndesmosis always. So it's a very, very big surgery and it's a very big rehab. And, um. So she came in, she is like three and a half, four weeks post-op. So she just recently got outta the hard cast and is now in a walking boot, but she's still non-weightbearing until week eight.
So, um, so she came in for treatment so I could like, you know, see how her wound's healing and get her started feeling better and then, you know, give her some more guidance along the passive range of motion exercises. You know, that her doctor tried to describe to her. And so when she comes in, like, you know, you could just be like, well, this is gonna be a long complex surgery, so I might as well just start at the ankle.
But no, again, when you see the power of the body's ability to guide you, where to start to make the biggest difference, you realize that this is true for everything, including surgery. And then also you start to appreciate that. There's more that happened to her in her body since the injury, and even during the injury than just the fracture.
Dislocation, obviously that's the big elephant in the room is like, oh my gosh, fracture, dislocation, major ankle surgery. But you also have the added whatever was happening in our body before that, and then you have the added. Pain response in the way her body changed in res in, in response to that, you have, um, the emotional trauma that may or may not have processed and been stored in the fascial tissue, changing things.
Then you have the surgical trauma. Well, you have the emergency room trauma of trying to decrease her pain and, um, reduce her dislocation before surgery. And then a few days later you have. Surgery, trauma and surgery. Um, things that can lead to issues too. So you've got general anesthesia. So we've got drugs, right, that have been administered to her body.
A tr a tube down her throat, IVs in her arm, tourniquet on her leg, and she had a nerve block. So, and then an injection into some really key nerve spots. So. When you can appreciate everything she went through. It's almost like, why would I ever think to only look at her ankle that first day? Right? So even, even let's say you don't believe me on the ltap, like helping us out here and like the body guiding us, like how could you not consider all the other stuff that somebody's going to come in with when they come in two weeks post-surgical tightrope procedure?
That's a lot. So, um, so yeah, I started where I always start, I introduce myself and I told her I do things a little different and I explained why, and I explained how the LTAP works and how osteopathic principles worked. And I was like, does that sound good to you? And she's like, sure, sounds great. And um, then we started with the LTAP and you know, her.
SI joint was hypomobile, but changed with her breath hold. Um, I did general listening too, for those of you who trained in the osteopathic Barral Institute, general listening and her general listening was to. Her, uh, cranium. And so then the next test of the ltap com like also directed me that she had a central nervous system tension pattern.
So I was like, okay, great. Um, we're gonna work on that, but before I do, I wanna look at your orthopedics. And so, you know, we, we, we look at her ankle and it's definitely swollen and um, her pulse is really diminished on that side and very. Very apprehensive of moving. Doesn't really even like touch, like just overall you can tell she is like not feeling great when I ask her about like if she had done any of her rigid motion exercises outside of the brace yet.
Or outside of the walking boot yet. She's like, every time I try to, I don't like how it feels. There's something that makes my foot feel like it's not attached and that grosses me out. And so I, I don't do it. So I actually haven't been taking my foot out of the walking boot as much as the doctor was wanting me to because I don't like how it feels.
And I was like, okay. Um, not great, but Okay. So then we checked your range of motion and like. I mean, you know, like maybe five to 10 degrees of movement. Very little barely can wiggle her toes, right? Like she's just not feeling very good. But then I managed to check her hip mobility and both of them are pretty good.
Like in general, she's like a pretty standard. Got a lot of range of motion girl. And um. So I decide like, oh, this is enough. Let's just start making you feel better and let's do treatment. So I start at her cranium and she had a lot, you know. So now this is when I use my neural manipulation skills. I do a further assessment on her cranium to find out exactly what structure is so I can treat it, and then I use manual therapy to start to treat it.
And then as I am going, like things are changing. Things are feeling better. Her affect and her face is starting to change, which is usually what happens when you start to shift people out of this protection pattern. And um, so then as I'm continuing to do the cranial work, I feel it, um, directed me down into more of her like, um, spinal part of her central nervous system.
So reassess and sure enough. The cent, the, the main central nervous system tension is gone, but now directed to like the thoracic area and specifically the thoracic area around her stomach and esophagus and, um, you know, so then I asked her about. Symptoms after the surgery. I'm like, did you, were you like, you know, did any of the doctors or nurses or, or did you just feel like you were like extra nauseous or like, did you get sick or vomit?
Were you, did you have a really sore throat? And she was like, yes. All of the above. And she's like, and it lasted for quite a bit. So I was like, oh, interesting. So it made sense to me too, like, yeah, it makes sense that she's got some stuff going on in her stomach and esophagus, you know? Post surgery. So we treated that again with manual therapy.
I even cupped along the spinal segments related to those organs and around the organs themselves. Uh, visceral dermal reflex zone of the, um, cardiac sphincter, the, the gastroesophageal sphincter. Then I continued to, um. Connect that to the rest of the central nervous system. And then we went back to the Ltap retested, and then now it was Hypomobile didn't change on the, um Right.
Which was the side of her, um, injury. So, um, then it was like, okay, permission to be in that leg. Uh. Once I was in that leg, I used the ltap to guide me, like where in that leg. 'cause it would be easy to just like default to go right to the ankle. But um, it was taking me to actually run her knee joint. Um.
The lateral knee joint and like upper, um, tib fib joint. So we treated there first and then finally worked our way to doing just some general massage and like swelling reduction to her leg, though also by the time I got there, her swelling was noticeably less and her pulse was noticeably stronger. So by addressing the cranial piece and addressing the stomach piece.
And addressing the proximal tib fib. We already had swelling start draining, which I loved to see. And then we just continued with more traditional, what you would've maybe done right? Some like gentle massage, and especially around the Kees area where like swelling was very stuck and very stagnant. Um, very congested.
And then, you know, did a little skin stretching around her wound. Um. And then she went through some real gentle, active assisted range of motion in open chain and enclosed chain non-weight-bearing. Some foot intrinsics. We incorporated some opposite hand mobility, hand and wrist mobility, finger mobility to neurologically connect the two, you know, to get some neuro functional neurology support from it, which also really helped.
And then at the end, she was like literally a whole different person. She had this huge smile on her face and just was like so much brighter. And so much happier and more friendly and more talkative and, um, um, she was like, oh, I feel so much better. She's like, my whole leg feels lighter. She's like, and I feel like I can start moving it now and I can do more.
Like the doctor wanted me to like, you know, thank you so much. And I was just like, oh, you're welcome. And I talked to her mom a little bit. I was like, isn't that cool how different she looks? And I'm glad it helped. And you know, I gave them some guidelines from how to work on it all at home. And um, that was it.
And I just thought that was the coolest session because since I never met her before and I have a teenage niece, I kind of was like, this is just. Is this just like teenage angst I'm getting is this sad panda because her high, you know, her, her, her high school softball career is now done and it puts in question her collegiate career or like, I wasn't really sure or just, is this just.
Her affect. You know, I wasn't sure, I obviously had a feeling that she was just kind of down in the dumps and not feeling great, but also like there's no way for me to know I've never met her before. Um, but it was really cool to see that all change by the end of her session. 'cause I was like, oh, okay.
Okay. We shifted through a lot in that session and that session was so much more than just getting her swelling down and starting range of motion exercises and teaching her what to do at home. It changed her nervous system. It changed her like 10, like full body neural tension. It changed her lymphatic and vascular system.
It changed her. Her whole like emotional wellbeing around it. So now too, when, when a patient goes from that to that within a session when they leave, I'm like, oh yeah, I have no doubt she's gonna do her exercises now. One, because I showed her it was possible, but two, because now she's not in a like fight flight, freeze mode.
She's in a like, okay, I can, I can take action now. I can, I can, I can handle this now. Her nervous system was like, I've just had so much go on. I don't know if I can handle this right now. So, um, yeah, I loved it. And actually I talked to, I actually saw her at a friend's clinic here in San Diego and I just talked to, um, that physical therapist there and I was talking about the case 'cause I'm gonna have her help me on it a little bit when I'm outta town and, um.
She was just like, wow. It was really cool to see how much she changed in that session with, you know, implementing the other things that you did. I was like, right. So cool. I mean, I think it's cool. Her mom thought it was cool. Obviously she did, but it's like really nice for other people to witness it too.
'cause I'm like, oh yeah, like this was a big deal and this is out of the ordinary. So hopefully that gives you some context of how I use it, like. Do we still make changes in her ankle and like, did we still do what the goals were? Decrease pain, decreased swelling, improve range of motion? Absolutely did.
Was it gentle? 100%. She did it on her own. I like barely did it. I mean, I did monotherapy on her foot, but it was not forceful. It was very gentle the whole time and like she just opened up so nicely. And I think sometimes post-surgically part of the reason why we have such a hard time. Getting range of motion is because it hurts and because not only does it hurt is the body is still in protection mode from sometimes the injury itself or the surgery itself or whatever surrounds that in their, in their world, right?
It's like a emotionally, physically, environmentally, right? So sometimes the reason why. Working on range of motion and decreasing swelling can hurt and, and be challenging in post-surgical cases is because their body is like in a don't fucking touch me mode. And then here you come in and ignore it and start touching it.
And so this work can be so profound in post-surgical cases because you meet the body where it's at and you work with it to shift it into a state where it's like, okay. I feel safe for now. You can go ahead and do stuff and I'm not gonna, I'm not going to view it as a threat. And can you imagine if you start off a treatment like that when the body automatically thinks that is, is a threat, do you think that sets you up for success in future treatment?
No, that sets your body up for, oh my gosh, we're going to rehab and they're gonna force things and it's not gonna feel good. So it's an instant threat. It remembers that you didn't honor where their body was at, you didn't honor that. They didn't feel safe. And then so it's like instantly goes into that protection mode, even by just going to therapy, right?
Rehab therapy. So this can be so powerful. Yeah, that's it. Mic drop.