Using the LTAP with Post Surgical Rehab
In this episode, I share how the LTAP (locator test assessment protocol) and MovementREV lens of view, incorporating the whole organism (visceral, neural, and musculoskeletal systems) guides post-surgical rehab.
From swelling, range of motion, and exercises to manual therapy and facilitating safety and the parasympathetic nervous system, I share my approach to an ACL rehab in a true whole organism approach to care, one that meets the body where it is at and honors the body's innate wisdom and ability to heal.
Resources mentioned:
LTAP Level 1 in-person course April 6-7, 2024 in Phoenix, AZ at EXOS
Swelling Reduction Protocol that Works Like Magic Episode 3
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. Welcome to another episode of the NREL results podcast. Um, I'm getting to the, I'm like, what episode is this? I think this is like episode 45, which is amazing. I heard a stat a while ago of like how many. Well, there's a million podcasts out there, right? But like how many get past the first 10 episodes, the first 25 episodes, and then like people who get up in these numbers and then, you know, hundreds.
Um, it's very small. Very small percentage of podcasts out there. So, so grateful, so, so grateful for you listening and you giving me feedback on these and loving them. I definitely enjoy them. Um, with that said, one thing that gets a a little challenging is coming up with like new topic every week. Um, so if you have any requests, anything you're dying to learn or things that you want to review, even that we've already gone over, um, you know, whatever it may be, you know, feel free to shoot me a message on Instagram.
That's probably the best way, or you can always email me. Um, You know, even leave a YouTube comment if you're watching this on YouTube right now. So I definitely, you know, I make this for you all and, um, I want to make sure it's still resonating. Um, with that said, I was like thinking about like, what do I want to talk about?
Most of the time I'm talking about stuff that like comes up in conversation with my athletes comes up in conversation with my, um, The practitioners in my professional education programs, um, or maybe as a, like rebuttal to stuff I see on the internet as it's a time of year though. I'm not teaching. Um, right.
Like this time of year is, uh, frankly, usually when I go on vacation. Uh, and so I don't, I'm not currently teaching any cohorts. The next like official teaching thing is, um, Beginning of March, I have my in person Revitalize Mentorship Mastermind, which is a mastermind weekend, a three day weekend for people who have been through the Revitalize Mentorship or sort of on the path to the Revitalize Mentorship, meaning that they've already done the in person LTAP Level 1 course.
And so, super excited for that. It's in San Diego. I get to host a beach fire for people. I get to, you know, this year people are asking to go whale watching. So I get to like bring them on the whale watching boat that I'm crew of and, um, super stoked. And then I love it because. The whole point of a mastermind is learning from each other, not just the teacher.
And one of my favorite parts of the mastermind is like when we go through the owl tap, which is the locator test assessment protocol. If you're new here and we assess. Our fellow peers and you, you get to see what each practitioner there, how they would treat it because the whole thing is that it doesn't really matter what treatment tool you use.
It could be manual therapy, it could be movement, whatever. As long as you're in the right spot at the right time, right, where the body is directing you. And so it's really wonderful to get to see other practitioners treat in their wheelhouse. Because it opens up more ideas for you, right? Like, you know, the whole saying, like, If your only tool is a hammer, like of course your everything's going to look like a nail.
So same thing. Like even though some of us work in a world where we might do manual therapy and exercises, you know, you get in, you get stuck in a rut, you get stuck doing only manual therapy or only exercises. So it's nice to be exposed to other ways of doing and um, being. And so that, I, that's why I love the mastermind is one we're on the level.
Like same level in terms of like how we talk about the body, the lens, we view the body, right? They, you know, theoretically everybody's gone through the mentorship, um, has been exposed to the LTAP, is practicing the LTAP as well as in this new lens of view. And, um, maybe even is pulling exercises and things like that from the mentorship.
So it's awesome. And then of course we pick, um, Different body parts that we focus on and I like share everything I know on it and we go over like a little bit more specific assessment for that body part. And this year we're doing the spine and we're doing the knee. And so I'm super stoked about that.
Uh, the knee, especially when I plan to talk about the knee. It was before I realized I was going to be spending the first part of the year here doing a long term knee rehab for one of my athletes. So kind of ironic timing, but I'll definitely be able to share that with, uh, the mentorship alumni. So, and then the next teaching, um, I'm doing is the beginning of April.
There is a level one LTAP course in person in Phoenix, Arizona. It's going to be hosted at Exos. So sort of my old stomping grounds, which I'm excited about. I'm excited. One of their physical therapists, at least one of them, um, is coming is going to be at the course. And so. Really excited, kind of full circle moment to be teaching there.
Right now there's only four spots left, so only four seats left. So if you've been dragging your feet, if you're on the fence trying to decide if you want to be in the LTAP level one course in Arizona, in person course, Now's the time, pull the trigger, make sure I'll, uh, I'll put the link in the show notes of course.
So, um, would love to have you join. And then, um, around a similar time, it will be the online LTAP course too. I'm pushing back the date just a little bit because by popular demand, people have been asking for CEU approval. I'm working on getting CEU approval for the online course, in person course, and This year, rolling out a certification, so finally offering it as a certification, I get so many messages every, I don't want to say every day, that, that would be a lie, I get so many messages per week, probably, of people asking to either see me or get a referral to someone who practices in the movement rev sort of philosophy and, um, Now I'm going to be able to have like a directory on my website of people who are certified in the LTAP and then certified in the mentorship and I just am so excited to roll that out this year.
So, um, where was I going with that? I'm going, I'm going there, meaning that, yeah, my brain has been like racked, like, I've been like, what am I going to talk about? Because literally the only thing on my mind is. My rehab with my athlete, um, he had, um, ACL surgery the beginning of January and we were just freaking locked in and focused on that.
And I'm sure him and I will be sharing more in the future. I, I can, like we've talked about maybe, you know, documenting some of the progress on the podcast. So I'm sure he'll come on the podcast maybe. Um, but you'll definitely probably start seeing some, a little bit of what we're doing on social media, you know, I'm not a big fan of like sharing my athletes and sharing their stories on my.
Stories, if that makes sense, like sharing their not like stories, like Instagram story, but like, it's his journey to share if he wants the world to know about his rehab, then he can put it out there. And, um, I don't feel like even though it's partly my journey and partly, you know, what I. Have to offer the world.
It's just not mine to share yet. You know, eventually maybe I'll share some videos. Um, but of course, no, if I am sharing videos, especially early on is because he wants to too. And so, um, I'm really, I'm really always big about that with my athletes is why I don't share a lot about them because I don't feel like it is mine to share.
It's their journey and I'm happy to be a part of it. And, um, yeah. Not everybody, like I'm always like more of a like let's move in silence, not everybody needs to know every freaking step people take and so, um, yeah, anyways. So that's that, but that's where my mind's at. And I'll be sharing as much as I can, you know, keeping it vague, but also hopefully super helpful.
And, um, The, where else is my mind? My mind is also in San Diego. The orcas are still in town and my friends on the boat have gotten some really great moments watching them. And, uh, every time I see it on Instagram, I'm both saddened because I'm not there to witness it in person myself, but then also like.
Really happy for them that they're getting this like it literally does kind of feel like once in a lifetime insane Like this has never happened. Like you've you can see orcas in San Diego like You know, anytime it's possible, but it's like you'll see them and then you won't see them again for months or even years.
So the fact that they've just been hanging around in Southern California between, you know, Mexico and Ventura is like a little wild for the last two months, like right before Christmas has started. So it's kind of even maybe longer than that because we saw that same pod in October. And so maybe it's just a new thing.
Maybe they're like. You know, who knows? I, I don't know, but, uh, that, that's where my brain's at. Um, so what I wanted to talk about, what I decided on, what finally got me to sit down in my chair and press record was, I want to talk about how I utilize the LTAP. within a post surgical rehab, because that is actually a question I get quite a bit from people that go through the results cheat code, people that go through the LTOP level one, and people actually even that go through the swelling reduction protocol online course.
And I'm going to talk about kind of all those pieces in it, but to just give you a highlight of like how it works in real time, in a more traditional sense, because It's, you know, normally when I'm working with my athletes, it's more of a maintenance thing. You know, I see them, I fly in, I work with them for a day or two, I clean up sort of whatever little aches and pains they might have from the game and then get them good and then I leave for a week to three weeks before I come back and like do it all over again.
So, um, so yeah, this is this what we're gonna talk about today is a question I get a lot so like more traditional rehab whether you're in a clinic or an athletic training room is You know an athlete gets hurt has surgery and then they're rehabbing and so you're seeing them Probably, you know, at least three days a week, if not every day.
And, um, so I often get a question from people, like, Do you use the L Tap every day? Like, how often do you do it? How often do you sort of chase where the body is directing you? And the overarching answer is always, like, every day. But also the honest answer is not every day. So the way, how we are right now, like we're week four of his rehab and he's doing great.
His swelling is minimal. If like very minimal range of motion is almost full and we're strengthening and we're doing stuff every day. Some days we're doing exercises, you know, cumulatively exercises, mobility, like movement type. Therapies for five hours a day and then some days it's two hours a day on the days that it's less we tend to do a little bit more manual therapy, um, but also it kind of just depends on how he's feeling and You know, but what the situation is so there are some things that I am always monitoring to make sure and That's that's a daily thing so I want to talk about that And then I also want to give you some insight of how it, like where we started because I, so he got hurt on a Friday, um, he lives across the country.
So he got hurt on a Friday. I was able to be there the next, I got flu on Monday night, so Tuesday. So how many days after injury is that? Like one, two, three, three days post injury. So when he, when I got there, three days post injury, he was pretty swollen, he was in a, the team had put him in a brace, and, um, you know, so, so what I do, what I always do, I start with LTAP, I start with listening the body, figuring out where it wants to take me, even though I know my primary goal for him in that moment was, um, get swelling down as fast as possible and range of motion back and get him out of the brace and off crutches as soon as possible so we could have surgery as soon as possible.
Um, and so I could have easily just dove into that, right? There's plenty to do. And also with the mindset of like, he just had an injury. It's like, The swelling protocol is amazing, but it's not making him not swollen the next day, but it should significantly decrease it. And the key to even making the swelling protocol successful in that moment, most successful in those moments of acute injury or post surgery is leaning into the LTAP2, is having this locator test assessment protocol to determine where the body is directing me.
Because, um, There's multiple areas that can be clogging up the swelling and, and decreasing the body's ability to heal itself. And so, I want to streamline the process and figure out where to go first to make the biggest impact. And that's what the LTAP helps me to do. So even in that first day, I started with, where is your body taking me?
And honestly, it's been so many weeks now, I don't remember where it was, but there is potential that it was. An organ, it's a potential that it was the nervous system or it's a potential that it was that leg. Um, and I, every day of treatment, I started with that until the LTAP consistently was directing me to the lower extremity on the side that he was injured.
So, I can't remember how many days it was and sometimes it alternated. I do remember it being not his like the first day or the second day, but maybe it was the third day and then it kind of went. You know, and then, you know, a couple of days go by and it went back to something else. And so I'm, I'm always checking in and this is also too why the LTAP actually doesn't take that long.
And in fact, it's the first test of the LTAP that I teach in the results cheat code that is like the biggest determiner of where to start. It's like either I do the SI joint mobility test, it changes with the breath hold or it doesn't. And that directs me to either start. at the visceral or nervous system or start at the side of the lower extremity that's hypomobile.
So it doesn't take a lot of time at all. So why wouldn't I do it if it really helps direct me? Um, fast forward to now four weeks post op or sort of just in that part of post surgical rehab that's just kind of grindy and you're exercising and strengthening and, you know, being careful. But aggressive, um, I'm, I keep telling him and his coach, I'm like, we're carefully aggressive right now.
Um, we've got a timeline. That's why we're being aggressive, but we're being careful because there's some sort of like, you know, healing milestones that we just need to honor. And then also like slow in at this point, if any rehab slow and steady risk wins the race, right? Primary goals are still decrease swelling and, um, restore full range of motion.
Uh, so With that said, though, like, every day, though, I check his pulse. So the pulse is, uh, his posterior tibialis pulse, his lower extremity pulse. And this is because it gives me insight into how well he is dealing with his swelling and deal and, like, maintaining good blood flow to the area, which is gonna be so key in healing and regenerating tissue, especially his muscles, right?
We want the blood flow to that area. Kind of a, actually this reminds me like, side note, this is why I actually don't like um, BFR. It's another hot take. Man, last week I gave you the hot take, I don't like cars. This week's hot take, I don't really like BFR. You can tell me all the studies about the growth hormone and I'm just gonna go back and say it doesn't make sense fundamentally because blood flow is such an important thing and swelling is such a negative impact and Yeah, sometimes I think blood BFR training is good for you If you have a limited timeline of being able to actually do strength training in a proper way with proper loading Or if you're in a situation where you're still having a lot of pain and you can't load so of course Special, special considerations, but for everyone, I don't, I think it's overrated.
All right, back to actual conversation. So, um,
so right now, um, I check every day before we do our exercises, I check in, see how his swelling is, see how his pulse is, then ask him, how do you feel? And if something doesn't feel good to him, right, like general soreness, that's no big deal. But if he's like, oh, when I extend my leg, I feel pressure here, and he points to an area around his knee.
Or when I bend my knee, I feel pressure here. Or, you know, as I've been walking, like something feels like it's catching, right? If there's one of those complaints, um, I'm like, hmm, maybe I need to do a little manual therapy before we get started just so I know you're going to be comfortable during the exercises.
So what do I do? I go to the first test of the LTAP, the SI joint mobility locator test, and I do it and I see how is this SI joints moving and then I do it with the breath hold. Did it change it? If it changed it, then I know I need to look further into what's going on because it's a visceral or neurovascular thing.
And if it doesn't change it, then I'm like focused in on the side of the lower extremity that it didn't change on. And if it's the side that is the surgical side, then great, we're going to be doing all the exercises and all the things. And then it's up to me if I want to do some manual therapy or just see how he feels with movement.
Right. So that is like, I check it, we check in every day. Because that check in too is important because let's say we did a bunch of exercises the day before and the next morning we have this plan for more exercises and if he got swollen or if his delayed onset muscle soreness is really high, or even his just general joint soreness is really high, then I'm gonna, you know, game time decision, create a different plan for the day.
Um, I love having a plan for the week, but it's always flexible based on how the person is. Last week he got a really shitty night's sleep. And so, you know, the, the next morning we, we were like, we chatted and we're like, yeah, let's change the plan. Let's just do a rest day and push your lift to the next day.
And so being flexible is important like that. The other thing too, I think is important to note, and it's not necessarily how I use the L tap within a post surgical thing, but how I, how I. Even how I even use this lens of view post surgically, how it's different than previous post surgeries. So with this lens, the biggest thing that comes out of this whole lens of view of considering the nervous system and the bachelor system is the overarching idea that the body needs to be in a more parasympathetic state to rest, restore, regenerate.
Also. That when we force the body to do things, we're facilitating more of that sympathetic response, and that's just not the way because realizing that when the body is presenting us with a limit, limitation in mobility or limitation in strength or muscle that's, you know, quote unquote, not turning on or off, it's usually in a response to something bigger than just the movement itself.
Great example of that. A quad that gets inhibited from swelling. Is it a quad strength issue or is it a swelling issue? We all know that the quad is a very unique muscle, the quad, the multifidier like this, in that when there is a presence of swelling, it neurologically gets inhibited. It's why it atrophies so fast after injury, right?
Part of the reason. And so, is the answer to strengthen the shit out of it? No, sometimes the answer is to get the swelling out as fast as possible and then strengthen it. And so that's like a good example of the body is doing things on purpose for a reason and it's the smartest one in the room, not you.
And so realizing like, hmm, like How could we meet the body where it's at and strengthen it from there as opposed to like building out this set of rules and forcing people to do whatever we want it to an Actual another great example of this and I was just discussing this with my athlete this week I was like so he's in so, you know spoiler alert.
He had ACL repair and Hamstring, hamstring autograft and, um, they put him, of course, in the normal post surgical knee, like, T scope brace. Same looking brace that, you know, I had 20 years ago. It's cooler. It's easier to put on. The, the type of brace he's in is a Breg model. Like, I don't know, they might all be like that now, like Donjoy, Breg, whatever.
Um, but this Breg is like, first of all, it looks super comfortable. It's easy to, um, Fit onto the leg, especially as the leg size changes and then the way it clips in and out is just really quick. And so because we're doing this aggressive ish, carefully aggressive rehab, we've been doing some strengthening exercises with his brace on versus brace off.
And honestly, I'm like In my head, I've been thinking back. I'm like, I don't know why I've never considered doing some of the strengthening exercises with the brace on and I'm love. I'm kind of loving it. And part of the reason I'm loving it is because it meets him where he's at psychologically and physically.
It gives him a little extra support. It gives him improved proprioception, right? Braces and taping. Many studies show that it's just more sensory information, right? Which is needed because you know, when, when we do incisions, we have surgery, we lose, we kind of get a blurry map of the area. Um, and so we're utilizing it to meet him where he is and make his body feel safer.
And so what happened, what do you think happens? When we make him feel safe and then do this exercise, he has a good movement experience. He's more likely to keep what he has learned in that movement exercise, whether it's a movement pattern or just like neurological activation of, you know, the muscle fibers.
And so then we're quicker the next day or the next week when we go back to that exercise. He feels safer and Then if we take the brace off, it's great. Like we're not, we're not having like a big, like jump in terms of like him feeling really uneasy and like apprehensive with exercises. And I think this is why, because I'm, you know, using props, I'm using things, including the brace as a prop to meet him where his body's at and always make sure he's safe and always make sure that he's getting this sense of safety in his body.
before proceeding. And, um, it's been like, it's been great. And maybe this is not like profound to you. Maybe not, you know, it's been a while since I did post surgical rehab. Not a while. It's been like two years, but a while. Most of you do them on a daily basis. Um, but even before that one, a couple of years ago, like I'm thinking like the last post surgical rehab I did, like I did, like when we were in rehab, we took the brace off and we went.
And part of that was probably just because it was like, A pain in the ass to get on and off. So it's from a time standpoint, there was that thing. And that's, this is why I'm like the new brace is freaking awesome. I remember when I had my ACL surgeries. Back in the day. I hated that brace. It was always falling down.
I was always trying to retighten it and never really helped. It was, I couldn't wait to get that thing off of me. And, um, so many of my athletes in the past too, they couldn't wait to get out of it. And then they probably came out of it a little bit too soon. If I'm being honest, and, uh, then too, like it's just, the rehab is a lot slower at the beginning, right?
Because you've got to bring back that safety in a different way. So, um, yeah, hopefully that provides some insight, you know, overarching goal of this conversation today was just to share how I use the LTAP in, um, post surgical things. And it's like, yeah, I use it daily. Ish, daily ish, I'd say if we do five days of treatment, which we've been doing, I probably, three of them, three of them for sure, four of them maybe even, I'm starting with the LTAP to, to help direct me where to go, and I'm using the pulses to help direct me where to go, and as a general, like, how are you doing?
How are you doing? And of course, so if you listen to the swelling episodes, which I'll link in the show notes, you know, I've done two of them so far. Like one of the whole things with the pulses is telling me if we have persistent or stagnant swelling. His pulse has been pretty good this whole time. The swelling is still there.
That means it's persistent, but, but that makes sense. We're 26 days post op. So there's the, the, the ligament is still changing in there. The bones are healing. The incisions are healing. There is an a active inflammatory and healing response going on. So I should expect continued swelling to develop, right?
The problem is when it becomes stagnant or when we've reached the milestones of healing where there shouldn't be that much swelling anymore and we're getting swelling. Now we're having a problem. But the only way I know it is persistent or stagnant is if I'm checking someone's pulse. And so this. ends up being a really important checkpoint for us the whole time.
Uh, and then the other lens of view were, you know, like I said, one of the lens of view is meeting the body where it's at, and the other lens of view is like when we see muscles that don't want to turn on or are tight, quote unquote tight, before we smash the crap of them or strengthen a crap of them, we take a step back and we look at where's the nerve come from.
is the nerve free to move and act and do its part. So for example, like the, before we do hamstring stuff, we do tibial nerve glides and common perineal nerve glides. Before we do quad stuff, we do femoral nerve glides and, um, obturator nerve glides. So we're utilizing these same principles. He's visceral lens of view principles with everything we do, and we're layering them on meeting the body where it's at.
And the movement experience has been great. The, the movement patterns that he's improved in these last three weeks of rehab are wild. And I cannot wait to see him in his sport because this is, this is how you come back better. Not just come back. Right. And that's what I want for every athlete has an injury is not only to rehabilitate from it and feel good, but to come back better.
So those are my thoughts. Love to hear your feedback. Um, hopefully this was helpful and, uh, yeah, we'll see you next week.