When Your Clinical Exam Comes Up Empty
Have you ever finished an exam on a client and had no way to recreate their symptoms?
In this episode of the Unreal Results podcast, I walk you through a real clinical case that challenged the traditional biomechanical lens. On paper, this athlete had a clear diagnosis and had already done all the “right” things (mobility work, strengthening, injections) yet the issue kept coming back. I walk you through my full assessment process, from orthopedic test, the LTAP®, and general listening, and why the body ultimately led me somewhere completely unexpected.
In This Episode, You’ll Hear:
Why a “normal” biomechanical exam doesn’t always mean nothing is wrong
How to think beyond local tissue when symptoms don’t match the presentation
What central nervous system protection patterns can look like clinically
How sequencing your treatment changes outcomes
If you had this client and didn’t have other assessments such as the LTAP®, I’d love for you to send me a message letting me know what you would have done!
Resources & Links Mentioned In This Episode:
Join the Online Spring LTAP® Level 1 2026 cohort
Ep. 149: Rethinking the Popliteus in Knee Rehab
Ep. 150: A Clinical Case Study in Sacral Pain & Index of Suspicion
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 and welcome back to another episode of the unres Result Unreal Results Podcast. Um, hello. I, I'm like, how? Like it's only been a week. How does it sometimes feel like so long ago since I did this, but yeah, it, here we are. Um. Maybe it's because so much has happened since last week, or maybe not, I don't know.
Uh, last week was the, um, Artemis two landing splash down, that's what they call it, um, off the coast of San Diego. Such a cool, fun energy during the week of everybody, like being excited about that and like thinking that they could see it, which. 100%. I did not think that you would be able to see it from land based on where they were saying it was going to splash down.
They were like 50 to 60 miles off the coast of San Diego. Um, one report said between San Clemente Island and Catalina Island, which is up like North Northwest, uh, and then another. Much less talked about report was southwest of San Diego, kind of by the border of Mexico, but like pretty far west. And um, the, the one that was talked about mostly was the northwest one.
And then it was only at, um, FAA map that I saw of the air traffic containment that. I saw the Southwest location and so that should have been an indication that that's where it was gonna happen because, um, you know, media, everything was porting the Northwest location and they also didn't want a lot of people around.
And so. They probably reported the one and then decided on the other. Who knows though? Um, I wish I had an insider scoop, but I do not. Um, but anyways, that's where I ended up being in Southwest, uh, of San Diego. And, um, still so far out, so far on Instagram. I've only seen like one boat outside of the Navy boats that were there that was like close enough to visualize it.
Um, but since I do go whale watching on a regular basis. Like I appreciated like just how far offshore 50 to 60 miles is, and I was like, oh, no way we see it from shore. Um, you know, but there was thought that maybe we'd hear a sonic boom or like see the reentry, even though when you looked at the map of where reentry was happening, like reentry into the earth's atmosphere was like gonna be above Hawaii.
So, um. Anyways, though, um, it just highlights people's lack of knowledge on physics, math, and, um, geography maybe. But even though I knew you wouldn't be able to see it, even if it, let's say it was between San Clemente and Catalina, it would've been like so hard to see from shore. You can see those islands from shore, but like, not with any detail.
Definitely not with any details. So could you have seen the parachutes in it? I don't know, maybe, but very unlikely. And um, I was actually up in San Clemente, the town of San Clemente, the city of San Clemente. Um. Go. I just rode the train up for the afternoon to go to dinner with, um, my friend and business coach, uh, Jill Coleman, now Jill Lockwood.
And, um, we were out for a beach walk around the time that it was supposed to splash down and a lot of people were gathering at the San Clemente Pier to see. And so for like, let's watch it. So we watched on YouTube, the live stream, and then like looked for it and like were listening for the sonic boom.
Didn't see anything. It was however, really cool to see how many people are out excited about it and like looking forward to it. And even though it highlighted how many people that were like, I don't wanna say dumb, because I was out there and I knew I wouldn't be able to see it. So it's like. I don't know how many people were like me and were like, well, I'm gonna be out here just in case, but I know it's too far away to see.
Versus people who really, truly thought it was possible to see and maybe, again, not dumb, just not, don't appreciate how far off the coast, 50, 60 miles and how hard it is to see that far. I was, especially like nowadays, like our visual field is so close to us all the time. Like when's the last time you actually walked outside and like tried to see something far away in the distance And, um, yeah, you can't see very far.
And again, this goes back to my whale watching experience and my, you know, like, do I go well watching all the time? No. Would I like to? Yes. Um, could I possibly be. Able to, yes, because I am volunteer crew for God whale watching in San Diego. Little advertisement best whale watching in Southern California.
But um, yeah, it's really hard to see far away things, especially small in such a vastness of the Pacific Ocean. So anyways, though it was so exciting. It was just the energy around the whole 10 day, nine day moon mission was just like so cool. And maybe it was cooler for me than you because I live here.
And so there was that extra added excitement about the splash down. And I didn't realize I would've tried my hardest. Um, I didn't realize until after it ended that, um, you could go on the Navy base and, um. After on Sunday. And so it happened on Friday, but on Sunday and Monday you could go on the Navy base and like view the capsule, view integrity, which is like, oh my God, that would've been so cool.
You just needed someone with a, um, military, ID like a C card to like get you on base. But it was open to the public and I was just like, wow, that would've been amazing to see. I wish I would've known. Um, but. Too late. Um, so anyways, like I think the other reason it was like so exciting for me and like, like besides the energy piece was um, you know, I remember in 1986 or 85, whenever it was the challenger, um, crew and like watching that um, on TV in kindergarten. And even though obviously it was a tragedy, and I think too, like as a kindergartner, even though you like watch it on TV blow up, like I don't think you understood the tragic ness of it because it's like, yeah, you're too young to understand. Um, so all you really, at least me, all I really thought about as a 5-year-old.
Was how freaking cool that was. And like, I wanna be an astronaut. And I, my whole life I've been very intrigued by space and stars and galaxies and planets and space travel and it's, it's, it's fascinating to me, and I guess maybe because I always think about like, well, what is it about it that appeals to me?
And honestly, I think it's just the curiosity and the vastness and like there's something, there's something to be said, and this is even on earth. What I love the most, like sometimes what I love the most about whale watching, or what I love the most about being out on the ocean or being at the beach and like viewing the ocean is like just this acute awareness of like how small you are.
Like, right, like how small we are as humans and like, but also just like how amazing we are and that we are like very much connected to this like bigger, amazing thing of planet Earth, which is then connected to this bigger, amazing thing of our solar system. And, uh. It just appeals to the like, curiosity, um, driver in me of like, wow, that's so cool.
Like, there's so much out there and there's so much we don't know. And like, and again, like this and going back to like, okay, like land the plane, right? Splash the capsule down, Anna. Um, how, going back to like, even when I think about like how this comes up in. The study of the human body is like the vastness and the richness and the complexity and the amazingness of the human body and how we go from one cell to billions of cells and go from one cell to like this human being that like thinks and is like so intelligent.
Has so much intelligence within each cell, like, gosh, how can you not be in awe of that? And again, like of our potential, of our capacity of our resilience, it's just freaking amazing. So anyways, I didn't know I was gonna like go into a 10 minute spiel on like my thoughts on the Artemis two mission. Um, but wow.
And also, God, gosh, we needed that. I don't know. Well, maybe not. I dunno. I needed that. Like, I didn't know I needed that, like nine or 10 days of like jaw joy and awe and like. Yeah, the world is crazy right now and it was just a nice little thing to focus on. So here we are another week that, so again, it's like, it's only been a week, but it feels like a lot.
Uh, I also went up to, um, Northern California to see my family celebrate my sister's birthday with her, and that was really fun. Even though it rained, um, I got some doggy snuggles in, which was nice. And then some auntie time and some sister time. And uh, yeah, it's just really grateful to be able to take a flight and hop up there and be there and, and then be home.
So home now, getting ready for the online LTAP level, one kicks off this week. Um, spoiler alert. It's not too late to slide in. I have not like taken the sales page off the website. So if you are having FOMO and wanna slide into this, um, online, um, spring 2026 cohort, I wouldn't be mad if he did. Um, and then this weekend, um, I head to Washington, DC for the in-person course out there.
Um, this is the only in-person course on the East coast this year. So there is still spots available. If you are like a last minute Lucy, or last minute Larry, find yourself on the East coast and want to join us in Washington, dc It'll be, uh, great. It'll, it's gonna be a great group and small group. So lots of access to hands-on learning from me and, um, what else is going on?
That's it. Um, just, you know. Tying up loose ends with all my Navy guys that went through first phase of BUDS. Um, they're progressing on and doing great and then I got a new few coming up, starting up, and, um, around and round we go with them. So, um, what I wanna talk about today actually, um, is I wanted to share a case.
Um, in this case in particular, I. I don't necessarily think it's like unique or special. It just really like highlighted to me why having an assessment tool, like the locator test assessment protocol, or like general listening, um, is so valuable and so needed. Um, because oftentimes when I see clients, I, I like to, I like to have some reflection on like.
How I tr how I view their issue now and how I would've, before I learned all this, um, osteopathic work. And I, I think this one really highlighted like, wow, I'm glad I have this tool. And, and because, you know, and oftentimes a lot of the people I get are athletes. Are people who have already tried the things.
They're already, they're smart. They're, they're already like in the performance world, so they're already doing like self massage. They're already doing like mobility work. They're already doing exercises. They're already, they're already targeting a lot of the low hanging fruit that comes up when we have chronic injuries, aches and pains, even acute injuries, aches and pains.
So. I know by the time they come see me that it's like likely those things are not gonna be the thing that fixes them. Now, that's within context, right? Oftentimes what I'm doing with them for treatment ends up being like mobility work, manual therapy, stretching, like something that they're already doing, but in a very specific sequence.
Or in a different location than they were going because they tend to chase exactly where it hurts. Whereas like when you assess the whole body, you go somewhere else. Often. I always tell them too, when they reach out to me, like in the dms or via text message, if I can't put my hands on them right now, I'm like, if you've been trying this strategy for days, for weeks.
Perhaps just try that strategy in a different body part. If you've been doing it on the right leg, try it on the left leg. If you've been doing it in the legs, try it in the trunk or the rib cage, right? So, um, if you've been trying all those things, like try some stuff around your head and scalp and like neck area.
Um. But sometimes they're, they're literally done all those things. They've seen other practitioners who have also done those things and there's nothing's really helped. And so this is the case of a track and field athlete that came and saw me yesterday. Um, I've seen her in the past. She's actually, um, an athlete for another country.
Um, so she's just in the. In the area locally for like a spring camp. Um, and we've worked together in the past. Um, kind of kept in touch with her just when I was traveling with my other athlete in Europe. Like I'd see her at the different Diamond League meets and stuff. And so, you know, we always kept in touch.
And then on Instagram, um, she follows me too. So we, um. She reached out and let me know she was in town for a camp and was like, can I come see you? And I was like, absolutely. So, um, she comes in and she's a jumper and, um, she has been having some knee issues, which, you know, through her team and like doctors and, and physios, um, they've found like they're pretty confident that it's like patellafemoral.
Um. And it is like maybe she has some cartilage issues on the, um, back of her kneecap and they've been treating it fairly successfully, um, with manual therapy, stretching, strengthening, um. They've done PRP, they've done like hyaluronic acid type injections they've done and then prolo. Um, and it was like the last prolo injection that seemed to be the best actually.
And interesting enough, the injection was superior as, as opposed to like in the joint. It was like a little bit more like super tel, super patella, um, super patella like bursa area. Um, but anyways, um. It was one of those things that she, like, she complains mostly of the feeling of instability, um, that comes along with it, which is, I think what she's feeling is when she has little swelling in there and then the quad gets inhibited and you know, she's starting to see some quadrant.
Atrophy because of that too. So it's just, you know, the biggest problem is actually not jumping, not sprinting, not doing stuff on the track. It's, um, the pain is limiting her from being able to load it in the weight room and so, and, and strengthen it adequately. Um. And in the last couple weeks it's kind of flared up, which has, um, left her feeling like a little hopeless because she's like, oh my God, I'm doing all the things.
I thought I was over the hump. Like, here it is bothering me again. And she was like, it feels like it's, she's like, it doesn't look swollen, but it feels swollen. Um, and she's like, so can you help me out? So. There's, um, obviously there's a lot to unpack there. Um, so the first thing too is I like whenever somebody comes in, like, I don't take their word for it in terms of like what they say is hurting, even if the doctor told them what they said are hurting and even if there's diagnostics with it.
Because diagnostic tests are not always accurate. And, um, well, they're accurate in terms of like, they do show you what's. There, but that what's there is often not actually the thing that's causing the pain. And so my assessment always is twofold. My assessment is one, do the locator test assessment protocol, and my general listening so I know where their body is protecting and where their body is directing me to go to perhaps find the deeper driver of what's going on.
And then two, still do my normal orthopedic and biomechanical assessment of like what could be going on that is like causing this from a mechanical standpoint and, um, gathering an index of suspicion. And then also, uh, like the third piece of that bit of the assessment is like, what is the pain generator?
What tissue is causing the pain? Um, and if it's not a tissue causing pain. Right. Like, so it's like, where's the pain coming from? Is the pain at an actual nociceptive experience because of some sort of tissue issue? Or is it just kind of an output thing of like increased sensitivity? And so, um, throughout my assessment, the body directed me to her central nervous system as the primary protection pattern.
And then her orthopedic assessment was really interesting in the sense that. Nothing really came up as like a huge, oh, you have this going on. Even her swelling was very subtle. Now, she did have swelling. The only way I could feel it was posterior boggyness and the posterior aspect of the knee joint. And then in full flexion you can kind of push the fluid from the medial side to the lateral side back and forth.
And it was definitely more than the other side. But ultimately, like what you have to base it on sometimes is like trust the athlete. Like if she says it feels swollen, it's swollen. She actually gets to feel her old knee joint, whereas like as a practitioner, you're only feeling the external piece. So I'm like, okay, it feels swollen to you.
I was like, does it just feel like really stiff and full? And she's like, yeah, that's exactly what it feels like. I'm like, yeah, then you're swollen. You don't mean need. You don't need me to tell you you're swollen. In fact too, it feels a little gaslighting if you tell me you feel swollen, it feels stiff and full to you.
And then I'm like, yeah, you don't have swelling. What? That doesn't make sense, but, so I was like, you know what? I think it is a little swollen. Um, I trust that it feels swollen to you. Um, I could, I see why other practitioners maybe think it isn't because it's very subtle. I was like, but let's measure your circumference because I know after treatment that'll probably change.
And so then we'll really know if it was swollen and that will inform us for the next time. And so I measured her and um. You know, at first I don't really necessarily know if it's, again, like the measurement isn't nothing other than a baseline and you could potentially compare it to the other side, but that's not so accurate sometimes.
Like it's not, and maybe not accurate is the right word, but like that's not so useful. And so I find the most useful is like just get a baseline and then see if it changes. If it changes and it feels better to her and me. But mostly to her then, yeah, it was probably swollen. So anyway, so that's what we did.
We measured that and then, you know, palpating around her patella mobility was not bad. Her alignment was pretty similar side to side. Her hip flexion was a little limited bilaterally, but not terrible. She does have reported like hip, like impingement issues. Um. She was lacking a little tibial internal rotation, but like not so, not so much that it was like, oh, this is the issue again, it was more of the on a reassessment, I was like, oh, you were lacking more than I thought you were.
She was not really lacking a ton of dorsiflexion on either side. Really. Like if you're looking at it from a pure biomechanical standpoint, like negative Oberst test. Good hip. Actually best on that, on the side of discomfort, she had great hip extension, much better hip flexion and internal rotation and external rotation.
Much better hip abduction than the other side, the non-involved side. She had, um. Zero hip internal rotation and a little bit of limited, um, and definitely limited hip flexion. And then she was limited in hip extension, specifically seemed mostly driven by TFL, but also she had a prone knee bend positive like nerve tension test on that side.
So again, non-involved side, so a little femoral nerve tension. Um. Which kind of matched she was having some like calf tightness feelings too, even though her calf did not present tight, sometimes that in itself can be just like a neural tension pattern. So that matched. And then the only other thing that was really noticeable was like the weight of her legs.
When I lifted her legs up on the involved side, that leg felt heavier. So it's a funny word to use heavier because it's not actual. Weight mass difference. It is a, when, a, a increased resistance to allowing me to lift her up. Inflection. It's like a protective pattern of her body being like, I don't really want you to lift my leg up.
So it it, it presents as the feeling of heaviness that the patient can feel and the, the clinician can feel. And so that was really all there was. And oh, and then the only other thing was I could recreate her pain. Well, she could recreate her pain with like a quarter squat, um, which was her main complaint of like, yeah, I can't do any squatting type motions in the weight room because I get to this range of motion and it hurts.
Um, which also means like, um, power cleans like Olympic lifting has been a challenge for her too, which is, is a big deal for track athlete. 'cause they do a lot of olympic lifting. Um, but then I could, um, recreate it by palpation of the underside of the lateral facet of her patella because she had good patella mobility.
I was able to like squish it over, lift it up and get my fingers under there to actually push on the lateral patella facet. And it was like, oh yeah, she was super tender there. So I'm like, oh yeah, confirmed patellofemoral pain syndrome. That no doubt is the pain generator. And um. Other than that, like knee flexion was good, knee extension was good.
Tibial rotation was like, literally, there was no mobility issues at all. I actually didn't test her strength a ton. Um, I guess I could have gotten a little bit more, um, specific on her, like hip strength and stuff, but I was just like. She's not presenting that way in that. And also I was just learned over time that I'm like, yeah, I can strengthen the fuck out of her glutes, but she's probably still gonna have, uh, hip pain.
And then also, she's a track athlete. She's strengthening the fuck out of her glutes. Like, um, doing a set of like Jane Fonda exercises or clam shells with me, or glute bridges or like single leg RDLs, band walks, all that little like bullshit. Rehabbing hip strengthening stuff, probably not gonna be the hugest dial mover, I don't think, again, didn't test it.
Maybe it could have been, but, um, for treatment session one didn't feel pulled to it. But again, why am I sharing this with you? Because now you're faced with like, again, what would I have done without? My listening and ltap assessment skills is like, I would've looked at her knee and been like, oh shit, like I don't know what to do.
I don't know where to start. Maybe then I would've checked her strength. Or what happens is you default to like, okay, well I'm gonna treat this like every other patella for oral joint pain. And even though you don't present as being tight, I'm gonna like smash the shit outta your quad. I'm gonna do it band stuff.
I'm gonna do TFL stuff. I'm like mobility things. I'm gonna release your hip flexor, I'm gonna, um, work on your calf and like lower leg mobility. I'm gonna like. Mobilize things like, you know what I mean? Like that's what I what? That's what people you would've probably defaulted to. And I'm like, that probably wouldn't have been helpful at all.
Like at all. This is like one of those things like, like right outta the gate, like you're like, wow, I don't know where to start because there's not a clear starting point because she's actually presenting. With, you know, when we go back to think about the index of suspicion, which I created a, you know, I have a whole podcast episode about index of suspicion that I'll have Joe link in the show notes, but it's like, man, when you're trying to find an negative index of suspicion of like, how do I help?
Or patellofemoral pain syndrome, you're basically like, oh, I, I'm not sure if I'm gonna be able to help you. Maybe you need surgery, or maybe you need a cortisone shot or something like that. And so. Um, and that's not helpful. She's already done those things and you know, can only get them so often, and maybe, I guess if you believed that there was some swelling, maybe you could use a swelling reduction protocol on her and get a little bit of relief that probably if I had tested her strength, that would've probably made her quad then test stronger, probably would've made her hips test stronger, just getting rid of the swelling.
Um, but yeah, like without, yeah, you would've been like, oh, this is interesting. You're not presenting tight. And I see this again, again, because I see a lot of guys and girls like athletes who just have tried everything and nothing's worked. And so when they've tried everything, it's like, yeah, they're actually mobility and stability and like things are actually better on the side that hurts.
Then on the other side, so you could go to the other side. I could have been like, okay, let's fix this hip extension problem on the contralateral side. Let's fix the hip flexion and internal rotation on the contralateral side. That would've been a valid place to start. Um, but again, like. Would it have made a difference?
I don't know. The, uh, other orthopedic thing that I think is relevant, um, and maybe would've led you somewhere to go with both? Well, initially it was, um, her, again, contralateral SI joint that tested hypomobile, um, that changed. It was a, it was a SI joint hypomobility that was just strategic. It changed with the breath hold.
So it wasn't necessarily structural though she did end up having a structural, um, si, joint hypomobility actually on the involved side. But that didn't present itself until a couple of layers were pulled back, so you wouldn't even seen that at the beginning. Um, so. Yeah. This is again, just again highlighting like, wow.
Every once in a while you do get somebody that you're like, all the things that I know that should be leading to patellofemoral pain syndrome are actually not a thing. So now what to do? What do you do? If you were listening to this, send me a message on Instagram or an email and like, tell me what you would've done.
Like, I'm literally curious because I think back to like, what would I have done? I would've just defaulted to the thing I do for everybody with knee pain, ankle mo. Like I would've dug in her calves. I would've focused on like, even though she didn't present with a, like a super lack of dorsiflexion, I probably would've done that.
I probably would've like scraped her quad. I would've maybe tried some taping, some positional can. Um, I don't wanna say trickery, some positional guessing on like, can I change your pain? Like, right. Like that would've been like, my approach is like, can I change your pain? Can I try this? Does it change your pain?
Can I try this? Can, does it change your pain? Maybe you would've been just like, oh, there's nothing biomechanical, so let's go functional neurology and try to like, just get her pain sensitivity down by giving her more information. Vestibular, visual, maybe assessing those things. Don't know. Yeah, like what would you, where would you have gone?
Just core and hip strengthening. Just assuming that, oh yeah, if you have knee pain, you have lack of lumbopelvic control. Do you see how these are all just assumptions because again, her assessment did not point in that direction. So I'll share what I did do. So her LTAP, um, in general listening led me to her cranium central nervous system tension, and I worked in her cranium.
It was actually very stiff. She had a lot of, um, uh, joint restrictions on the right side. Which was the same side of her pain. Um, so it did quite a bit of manual therapy using my neural manipulation skills in her cranium. And then, um, from there, connected it to her tail elbow. Um, that's when I also started to feel the si joint actual true structural problem on that side.
But I didn't chase it because I was like, let the body take me there first. So I did central nervous system tension stuff, got rid of that pattern, and then retested her and her pulses. I didn't even tell you that her pulses were a little diminished bilaterally, but her pulses got better. Um, her. Mobility in the hip flexion improved her, um, prone knee bend.
Nerve tension on the other side improved. Her heaviness still remained a little bit in the leg. Um, but her, her, um. Swelling, decreased 0.8 centimeters, almost a full centimeter of swelling decreased, which I didn't even think she had that much swelling in there. So that was kind of mind blowing for both of us.
And then she was like, oh, wow, that that is, that does feel better. And so then I did another round of listening slash the LTAP.. It directed me to her contralateral hip superior gluteal nerve. That took care of the TFL stiffness and improved her hip extension on that side. Also improved her hip internal rotation drastically on the uninvolved side.
Then, um, we retested, um. Knee flexion on her side, that hurt. And it was like, oh wow, this is way better knee flexion. It was interesting 'cause she had like full knee flexion technically prior. Um, but it was like a whole different quality of feeling into knee flexion. Which was interesting after treatment.
Oh, actually this was not directly after the contralateral leg. This was, I did one more round of listening and the LTAP and it finally took me to her involved side. So I got to treat her SI joint ligament sacrotuberous, sacrospinous ligament, were super stiff. So worked on those and then I worked on her popliteus..
Just knowing that she's been protecting her knee for a while. I just said cupping to the popliteus and some just general deep tissue, which, um, I was glad I left it to the end. It was a little sensitive for her, but like, it would've been so much worse had I like started there. Then I rechecked her knee flexion.
It was like, wow. We didn't think, like, neither of us were, like, both of us were like, oh my gosh, didn't realize your knee flexion was restricted. But now that it's not, it is like. That's how knee, knee flexion is supposed to feel nice and easy and open. So whether her knee flexion was restricted because of the popliteus thing, and again, if you haven't listened to the podcast episode on the popliteus, I'll have Joe link in in the show notes because this is really relevant here.
Um, or her knee was stiff because of, um, the swelling or a combination of two more likely is what it was. And then, um, I rechecked her. Internal rotation of her tibia, and it was much better too. So now I too, when I see her again, if I see her again before she goes back to Europe, um, I already know, like if she's gonna be lacking, um, tibial internal rotation, which when somebody has knee pain, like that's almost a given because again, your popliteus just, is a protector and it like tightens up to like, not, it's trying to not let you
bend your knee. It's trying to not let you unlock your knee. And so, um, that tends to be a thing. So after that, I had her stand up and check her squat, and she's like, oh, that feels so much better. I feel so much better. I was like, great. Let's see how you go. I did suggest, I was like, you know, I, I think I, I was like, if I were you, if I were your coach, I would actually consider adding in yielding, like oscillating deep tier motions to work on that.
Retraining the popliteus that it's safe to move into knee flexion, to overcome that protective pattern of keeping the knee locked in extension. Um, I think that would go a long ways because there is a, a quite a degree of inhibition going on, um, especially because she does clearly have cartilage irritation on the lateral patella facet.
So it's like, I didn't change that. That's still gonna be there, so this is gonna be something that she has to manage. And so hopefully, I really hope that the central nervous tension pattern that she had that was changing her dynamic alignment just a little bit. Um, I really hope that that like gives her a lot more space and capacity to deal with this.
But then two, like understanding the popliteus and the role of it being a protection pattern and then like, you know training this like loading and like reteaching your brain that you're safe to flex your knee even though like you have an injury patellofemoral, like she's doing such a good job managing all the like potential quad hip ankle tightness stuff.
Like there's not a whole lot of compression going through there and the joint. And so it's like, yeah, you need to know like teach your body that you're safe. So that would be like the one exercise I do add in for her. And we talked about that so. Um, but overall, like, I don't necessarily think, like this episode is not about the patellofemoral joint necessarily.
This, this is like a bigger picture conversation of like, yeah, sometimes you have people that come to you and like biomechanically, like nothing is like pointing to like, why, what is happening. And so this is, you know, why having the locator test assessment protocol or general listening type skills is like.
So important so you can have some direction on like what is happening? And it's like, yeah, no wonder this was still an issue for you because like nobody's done any cranial work on her and not saying that cranial work is always going to be the answer. When something is hard like this, it often is, but it's not always the answer.
It just happened to be that was her primary protection pattern. But then as I followed her body around the sequence, it was central nervous system and then it was contralateral leg, and then it was finally the same side leg, specifically the SI joint, um, and popliteus. So super interesting case. I hope. I hope that, I hope it was an interesting.
Thing to listen to. And, and I am truly curious, like, do send me a message if you can. I am curious where you would've, where you would've started in a, in a scenario like that if you didn't have the LTAP or if you didn't have general listening, and maybe that's where you're at now. Um, so I'm curious where would you have gone for her?
But that's it for now. See you next week.