Bone Health, Loading, & Blood Flow

In this episode of the Unreal Results podcast, I explore why the femoral neck can be uniquely resistant to change and why this often has less to do with exercise selection and more to do with blood flow and neurovascular entrapment. A simple case study question opens into a deeper look at pelvic anatomy, vascular supply, and how circulation drives bone remodeling.

I break down the arterial anatomy of the hip, identify common neurovascular entrapment sites that limit blood flow to the femoral neck, & explain why checking distal pulses may be the assessment you’re missing. I also unpack the relationship between pelvic floor tone & inhibited blood flow to the hip joint and how addressing it can change femoral neck response.

Resources & Links Mentioned In This Episode:
Ep. 9: Left Side Sciatica or Right Side Shoulder Pain?
Ep. 75: The Colon Connection
Info from the handout I mentioned
- Femoral Neck Vascular Anatomy: Hip Joint Anatomy Article (pages 7-8) & Blood Supply to Head of Femur (slides 2-7)
- Vascular Entrapment Areas: Iliopectineal ligament and inguinal ligament, pectins/iliopsoas, quadratus femoris, sartorius, proximal rectus femoris
- General Pelvic Congestion: Episode 49 - Pain on the Sacrum
- Practical Treatment Area: Hip Flexor Release & Obturator Canal
- Practical Treatment Area: Posterior Inferior Pelvic floor Mobility
- Practical Treatment Area: Obturator nerve glide
- Practical Treatment Area: Adductor hiatus / distal sartorius soft tissue mobilization - decompression with flexible cup or self massage
- Practical Treatment Area: Hip Medial Glide
- Practical Treatment Area: Prone supported frog stretch
Tools To Support These Treatments
- Soft Ball for Self-Massage* & Flexible Cups*
Learn the LTAP® In-Person in one of my upcoming courses

*This link is an Amazon affiliate link, meaning I earn a commission from any qualifying purchases that you make

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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Chapters

• 0:00 Bone Health, Loading, & Blood Flow
• 1:07 Life Updates
• 7:19 Plyometrics and Osteoporosis
• 9:18 Blood Flow and Bone Health
• 13:30 Practical Strategies for Improving Blood Flow
• 16:49 Anatomy Deep Dive: Hip Joint and Blood Supply
• 25:35 Pelvic Floor and Vascular Entrapments

Transcript

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 back to another episode of the Unreal Results Podcast. Um, I filmed a episode yesterday and it was like the first episode back from like having a few weeks off. And I was like thinking, I was laying in bed this morning and I was thinking about like the previous episode and I was like, oh, that was like the end of the year wrap up.

And I was like, I shared about shocker my eyes. And um, I was in the, in-between of the ophthalmologist, basically like nonchalantly being like, oh, you might have early onset glaucoma. But no big deal. So I had shared, um, like my strategies that I was going to be using to like, address the ocular hypertension and um, you know, just navigate that like some supplements and stuff I was taking.

So, um, but when he had said that nonchalantly, he had, um, been like, you know, like, I don't, you know, we have to do more tests basically. Um. He has no idea that I am like a healthcare person. And so like, I think he didn't realize when he like kind of nonchalantly basically said I had, uh, the beginning of a, um, glaucoma.

Like I don't think he realized that I actually knew what that was and like all the information about it. But he was also like, well, you know, there's more tests we need to do. Come back in a month and we will recheck things and do the other tests. And, um, so my follow up appointment was the, like second first or second week of January.

And, um. When he remeasured me, my pressure was down. And so, um, it's still on the high side, like it's high. It's, it's in the normal range now, but it's high. And so he still doesn't love that. But then they also redid my peripheral vision test, which is like the best, one of the best tests for, um, optic nerve function.

And then they also took a picture of my optic nerve and, um. And the peripheral vision test I had, I had done previously, probably like a year before, and it was normal then during the throes of Pink Eye. Um, and then it was normal the other day when I did it. And so it really hasn't changed. So he is like, yeah, that's really good.

Like, um, and then the picture of my optic nerve. Like even as a lady took the picture, she's like, oh, it's beautiful. And I was like, oh, so, and he said it looked good too. So, um, I don't know what that means. I didn't ask him like what that means with the measurement of the nerve that he took the, that made him believe that I was like borderline atrophy for the object nerve.

But it's good that it looks good. It is functioning well. And then also great news that my. Eye pressure has come down. Of course, you know, he doesn't think it has anything to do with what I've done, but disagree. Agree to disagree, so still having to go back to see him every three months for a checkup. He wants to just redo my peripheral vision tests and pressure tests.

Every three months just to make, you know, monitor it for a little bit and make sure it is not progressing towards that direction. So, um, a couple of you have asked me, or like, like sent me messages regarding optic nerve stuff and so it just made me realize like, oh shoot, I never gave you an update. Um, the other thing that was interesting.

And previously when he kind of nonchalantly threw that out about the, um, glaucoma, um, he had told me that the good news was the white spots on my cornea were gone from the infection. And he's like, well, you could stop the medicine and you can, like, we won't put the plugs in your tear ducts. Um. And we'll see how you do.

He's like it probably, you'll probably still have dry eye problems, but you know, we can try it. Which is so wild that he wanted to stop both of the things at once. 'cause it's, then it's like you don't know which one was which. So since he didn't get put the plugs in, I stayed on the medicine. And then in the follow up in a month, first of all, that month was.

Significantly harder for me from a dry eye standpoint. I went through so many eye drops and I was just so uncomfortable over that month. And, um. So it was very clear to me that the, the plugs actually make, actually make a huge difference. So I asked him to put the plugs back in and like immediately felt so much better.

So I'm gonna use the medicine until I run out and then keep doing the plugs. And that's another reason why I have to go back every three months because the plugs only last for, for three months. So once I run outta the medicine, um, I'm gonna maintain just the plugs and then we'll see if I can go without the, um medicine 'cause um, it's pretty expensive and it also kind of burns when I put it in my eye, which doesn't feel very good. Um, so we'll see. There is potential that when I stop that medicine, the white spots could come back. So we'll see. But, um, anyways, that seems like a smarter way to go about doing it than just stopping everything at once.

So that's my eye update for you. I'm definitely less concerned though I don't love that. I have a little bit of a high pressure still, even though I'm in the normal. So it just, again, I'm gonna continue to do all the things that I know to change the pressure in my cranium and assume that if I'm changing the pressure in my cranium, I'm also changing the pressure in my eye.

And then continue to work on like all my lymphatic drainage, things that are going to support that, um, eye health as well. Um, and I'll keep you posted. So, um, all right. So this episode, um, is actually so inspired by a question that we got that the group, somebody in our, um, plyo intensive group had. Um, and it got my wheels turning and thinking about like, yeah, how would I support that?

Um, so it was really interesting. We were, um, the woman was talking about how. Adding in, um, plyometrics to her programming for her, some of her clients who had osteoporosis. Um, she's seen some really good changes in their osteoporosis, improve, you know, like their bone health. And, um, so the interesting thing was a lot of the areas of the bone that were osteoporotic, um, showed improvement except the femoral neck. And so her question was, was there a different way that she could target the femoral neck with different exercises, different um, plyometric variations that maybe they weren't getting that stimulus in the right area.

And for me, when I heard that, I was like, Ooh, interesting because. I would think that if the stimulus was enough to, um, remodel bone in like the shaft of the femur, and I forget where the other parts were, but in the other areas of the bone in the skeleton that were osteoporitic, like why was the femoral neck not responding?

And I mean, it could be a vector issue. It could be a loading issue, but my thought process is if the loading was enough to remodel bone in other places, like what else could be the issue? Um, for a lack of remodel in that area. And it made me think about some of the. Athletes that I've worked with, the people that I've worked with that have had, um, fracture healing problems like non-union fractures or, um, they had a, some sort of fracture where the doctor had to go in and do a internal fixation with, you know, plates, screws, et cetera, and they're trying to get those out, but the bone was not healing properly.

And what I saw, what often comes up in those cases is a diminished blood flow to the bone that is healing and not just a diminished blood flow because of the area of the bone, right? Because some non-union fractures are happening in areas of the bone that don't have good blood supply. So examples of that is gonna be like a fifth met fracture, like a Jones fracture or a scaphoid fracture in the wrist.

Wrist, those two bones. And there's other bones like that in the body too, but those bones inherently don't have a good blood supply throughout the bone. And so then when you fracture in those areas, you have to have internal fixation to keep the bone together because the healing is so delayed from a lack of blood flow.

Um, but then there's been just incidences in other areas of the body that people have broken. You know, broken their bone or had a stress fracture and is just taking longer than the doctor would like to see a callous forming and like bone remodeling. And I'll see this often when people are like, you know, they, they have the massive fracture, they get the in internal hardware to fixate it as they're healing.

And the doctor told them, you know, that they eventually could get the hardware removed, but like. The bone's not showing that it's ready for that yet. And so they're like so frustrated because oftentimes the body does not like that hardware in it and it's painful, and so they really wanna get that hardware out.

But bone hasn't healed yet, so the doctor keeps pushing it back. And so I've seen them and been able to improve blood flow to the area and within. A couple weeks actually see changes in the bone healing on the imaging. And so that's been pretty powerful. And, and the, the way that I really have assessed that is through monitoring people's distal pulses of their limbs and with the assumption that if you have a good, robust, um, resonant distal pulse.

That, that is indicative of good blood flow throughout, um, the body and throughout the limb, especially the, especially the involved limb. And so, um, I don't think it would be any different in the case of osteoporosis, right? We, we need blood flow to the area to help with the remodeling of the bone and, um.

When it's limited, it's going to be very challenging no matter what stimulus you place on the bone to create that, um, bone growth stimulus. So, um, what I did for the group, so, um. What I did for the group is, you know, I gave them my thoughts on like, this is what I think. I think it's a blood flow issue, and also there's so many areas that around the hip joint and around the pelvis.

That arteries get arteries and nerves get entrapped, then I'm like, I would, I would bet money I'm not, I don't even, I'm not a gambler, but I put money on the fact that there's some sort of neurovascular entrapment going on that is decrease in blood flow to the neck of that person's femur. And if, if you could target those, you might see a better response with the plyometrics you're already doing so.

I put together like a whole handout for them, um, for the people in the group of like, here's what I would try if this was my patient. And so I wanted to share that with you today on the podcast. And talk a little bit more about, um, the femoral neck and, uh, blood flow to the femoral neck, uh, to the hip joint, um, the Cox femoral joint and, um.

Give you some practical ways that you could go about affecting this. Now, is this only useful for people with osteoporosis or like femoral neck fractures? No, this is great for just general hip function, general hip mobility, like. Freeing up the neurovascular structures at this area of the hip is not only going to affect the hip, but it's gonna affect the SI joint.

It's gonna affect, affect the pelvic organs, the pelvic floor, the knee joint, the ankle, like literally it's going to affect a ton of structures. So these are really high payoff spots that I end up treating my athletes quite a bit. Sometimes I find that the areas of entrapment of these very important neurovascular instructors are around areas of the pelvis that traditionally most people, manual therapists, a avoid touching because it's near private areas and now, I'm not saying like carte blanche, just go palpate away in here and like do a million massage techniques in here. Uh, because consent matters and reading the room matters and your comfort level matters and the patient's comfort level matters, your scope of practice matters. But I'm also saying that if you're a healthcare provider and it's within the scope of your practice and you're still weirded out.

About touching these areas, you have some work to do because, um, it, there's, it's such important anatomy and it's such important areas that need treatment. Like you really can't avoid it. And if at the end of the day if you truly want to avoid it because you truly feel uncomfortable or your patient population is just not okay, um, then.

You need to understand still at least anatomy, so you can provide self massage strategies or exercises or movement strategies that'll target the same tissue in the area. Is it often as good as manual therapies? Mm. Specific in price? Precise manual therapy? No. General manual therapy? Yeah, it's probably just as good.

So, you know, that's a little bit of, a bit too, it's like again, and like, that's what I mean too, is like, I don't want anybody just like digging around in these areas. You need to have an informed touch. You need to understand a precise treatment and know that there are practitioners out there with those skills.

Um, and or classes you could take to gain those skills. And, um, but at least starting out a fundamental understanding of the anatomy and a fundamental understanding of where that is on the body, I think is super important. So. Let's kind of dive into that. So I did, um, and I'll make sure Joe links basically the handout I gave everybody in, um, the plyo intensive.

Um, I'll make sure Joe links all these things in the show notes for you too. Um, two of the things I linked was, um, two anatomy resources. The first one is a, um, journal article, um, proof that I read journal articles. People always think I don't, I'm not evidence-based, but I literally study anatomy like every day.

And when I study anatomy, it's not just looking at pictures, it's usually reading anatomy journal articles like this. So this journal article from the Biomedical Journal of Scientific and Technical Research, um, is an article called The Hip Joint Embryology Anatomy and Biomechanics. It's a great article actually.

Really? Um. Number one, it's free. And we always love free access, open access, um, research articles. It was published in 2019, but it goes through everything like embryology, um, and then all the pieces of anatomy. And so, um, when we look at civically, the vascular anatomy, um, it's helpful to understand kind of like where.

The blood supply is coming from and then understand even further up the chain what's going on. So, um, it basically says the hip joint receives this blood supply from several source sources. The Ace Tablum. So the, the pelvic side of the hip joint is supplied by three main arteries, the opterator artery, the superior gluteal artery, and the inferior glute artery.

The superior gluteal artery supplies both the superior and posterior portions of the acetabulum and the inferior gluteal artery supplies the inferior, um, and posterior portions. Um, and it can goes and it continues to talk about acetabulum. So now what we really care about, um, specifically for this femoral neck issue is arterial supply to the proximal end of the femur.

So, um, and it, as with many important body parts, it's a redundant, it's a redundant blood supply, meaning that there are multiple arteries going to. Encapsulate the entire femoral neck, the entire femoral head with blood supply. So I'm not sure about you, but like when I was a student in school, I remember learning about like if someone, if someone dislocates their hip and tears the ligament, ligamentum teres, that's like a main blood supply to the femoral head. And then your femoral head will die and you're screwed. And it's like, yes, that's true, but also there's a little bit more redundancy in the hip that, that, that is not, is detrimental as maybe they made a misbelief.

Is this still not a good thing? Absolutely. But um, there's other blood supply. To the farmwell head, um, than that. But when we look at it, um, basically it's divided in, um, it's divided in multiple different ways, but at the end of the day, what happens is the blood flow that comes to this area is basically from the, Medial circumflex femoral artery and the lateral circumflex femoral artery. That is what is supplying the majority of the femoral neck with blood supply. The obturator artery supplies the artery to the ligament of teres and also supplies to the head of the femur. Where these, um medial circumflex and lateral circumflex femoral arteries not only supply the femoral neck, but they also supply the femoral head with blood supply too.

So that's a little bit of this redundancy I talked about. So. Um, what we're caring about when we're talking about the femoral neck is this medial circum, circumflex femoral artery, and the lateral circumflex e femoral artery. The medial circumflex e femoral artery especially, I think is, um, the greatest area to target here.

Um, when you are looking, when you're looking at the pictures of the anatomy, you, you, you really do. See, um, how much more of the branches really come from the medial circumflex artery, and that comes off of, um, the femoral artery. Um, as it travels through the tendon of the hip flexor, the iliopsoas..

That also, um, I think the other piece of it.

Well, not even the other piece of it. The other part of like my target strategies was to the opterator artery, um, in the obturator area anyways, because two reasons, because of the role on the aceta and the femoral head. But then also when you look up the chain. Whenever we're talking about vascular entrapments, there is the obvious vascular entrapment of the, the final area right before it gets to the femoral neck, which is through the iliopsoas tendon.

But farther up, we have entrapment areas that are possible in the inguinal canal. We have entrapment areas that are possible in the pelvis itself, and any bit of pelvic congestion is going to really d have a potential to diminish or entrap blood flow of the, um, of this downstream branch of the femoral artery.

The pelvis right above the inguinal canal, that artery is the, in either the internal or the external iliac artery, and then above that is a common iliac artery, and then it goes into the aorta. So there's areas in the abdominal cavity and in the pelvic cavity that these can get affected as well. So we wanna make sure that you're kind of addressing all of these spots, right?

Um, the local areas, but then when we're affecting, especially when we're affecting the area where the opterator artery comes out, which is at the obturator canal, we're all, the area of the obturator canal is also an area where the adductor mangus, the adductors connect into the pelvis and, um. What's the right word?

Anastomosis or interdigitate or become continuous with the pelvic floor fascia. And the pelvic floor fascia is going to be on the, on the external side of the internal pelvic fascia, which is the endopelvic fascia, which is a very, very rich vascular network of VV veins and arteries. Um. And so this is why when we can affect that sweet spot at the Ator canal, at that medial side of the hip joint, we clear up a lot of possible entrapment sites.

So where I have listed, and, and you'll see by reading this anatomy article and looking at this, the other, um, anatomy resource I gave is like, um, somebody put together a blood flow to the femur head. Um. Um, slides share. Um, so I included that 'cause I had some good pictures of it. Um, but what you're gonna see is vascular entrapment areas that are possibly the iliopectineal ligament.

The inguinal ligament itself, the pectineus and iliopsoas, um, muscles or tendons, the quadratus femoris. Um, that is an area that is gonna affect the lateral circumflex artery. Uh, the Sartorius is a common entrapment site, um, as well as the proximal rec femme. So all of these, that's gonna be for the lateral circumflex artery as well.

So a couple of these for the medial circumflex, and then a couple of these for the lateral circumflex, the general pelvic congestion is gonna really affect, especially the internal iliac artery and the obturator nerve arteries. As well as the femoral nerve artery, the inguinal ligament itself. So here's another connection from pelvic floor, right?

Going back to the adductor mangus and why opening up the adductors is gonna be really helpful to affect the pelvic floor, because when we have a lot of tension in the pelvic floor, right? Here's a pelvic floor here. When we're a tight ass and our ischial tubes are kind of coming narrow or together.

Together, what happens is that the inguinal ligament on the front side. Has a little extra compression across it, and that extra compression of inguinal ligament is going to have a tendency to have an entrapment of the femoral nerve or femoral artery itself as it transverses underneath in the adductor canal.

And also have more of a tendency to press on the ileoanal ligament. The iliopectineal ligament is a ligament underneath the inguinal canal that maintains the space of the top of that, um, adductor canal, so that when we go into hip flexion or hip extension, we're not compressing the femoral artery. So that's a real important thing to know that one of the ways to treat that is not just going to be treating directly at the inguinal canal or directly at the iliopectineal ligament here.

It's going to be actually to treat the pelvic floor, to take that stretch off of it in the first place, right? So again, pelvic floor mobility is gonna be really helpful in this. In this sense to have more of a reflexive effect on the, um, inguinal ligament, the iliopectineal ligament, as well as the blood flow to the pelvic arteries, which have such a connection to the femoral neck.

So, um, huge, huge pieces. Where do I wanna go with this? Ah, the internal, so the internal iliac artery is actually, um, one that's like really hard to palpate because it's very deep in our abdomen, but in general it is. It is in general about three fingers below where the aorta, abdominal aorta, bifurcates. It is like you're okay, so medially and caudally. So towards the midline and down towards your feet. Three fingers below the aortic bifurcation. You can find the aortic bifurcation pretty easily because it's pretty easy to feel such a loud pulsing of the abdominal aorta. Sometimes it's right around the belly button. For some people it's a little higher.

For some people, it's a little lower. Everybody's different where the bifurcation is, you're gonna feel pulse, feel pulse, feel pulse, and then all of a sudden the pulse goes away right below it. That's right where that bifurcation is. So if you can find that, um. Aortic bifurcation. Then to find the internal iliac artery, you'll just go down on a diagonal, a little bit of a diagonal, three fingers, and you'll kind of push in and feel a very light potential for very, very light pulsing.

So. Uh, we learn a technique for this in the visceral vascular manipulation class for the Barral Institute, but it's very hard to feel so, but what this tells me is it's, again, a reason for just some general visceral self massage in this area, or even the need to do like a belly button, generic belly button technique to address.

General tensions of the visceral container in this area because if you change the general like space or like, you know, awareness in this area, you have the potential to change some blood flow without even doing a visceral manipulation technique. Um, also coming from the sides of the body and like bringing things into a direction of ease can be very powerful for this. So, you know, if it's the side, what this would look like is what I would probably start with is some visceral self massage, like sideline Coregeous ball, self massage, laying on the area, laying on the side of the side of the femoral neck.

Um. That is the concern. If it's both sides, you'll just do both. You can also just do both anyways, but this is going to push sort of everything medially and kind of like slack things to give them space to work themselves out. And then when you let go of that self massage, then it goes into like a little stretch and you could even add a little sensation of a stretch by bringing your spine up into extension.

Side bending away, rotating away. You can, you can add that because at the end of the day, vascular structures do love to be stretched. Um, so that is internal iliac artery, inguinal ligaments. Treatments. I'm going to be doing pelvic floor mobility in the pelvic floor. Mobility I love is like self massage with a soft ball.

You could do just a prone stretch of the adductors. You could do a supported adductor stretch, like a frog stretch. You could do, um, a standing or a half kneeling hip flexor type stretch with your leg out to the side. Focusing on that like, um, hip abduction. There's a lot of options that you have from a pelvic floor standpoint and in the, in the, um,

I'm like, did I even go give these? I don't even think I, oh yeah. I gave one example of the self massage of the ball. That is like my go-to. That's the sweet sauce. And the reason I like that too, and it's like the go-to is because, um, it also sort of helps your body map where your pelvic floor is, where your sits bones are, where, where the what the base of your pelvis is right. And having that understanding in your brain as the client, it really helps to like have a little bit of awareness even from a movement standpoint when you go into a movement standpoint, like where you should feel the stretch or the opening of the pelvic floor. Um, the other things, ator nerve guide really helps to mobilize the pelvis in general and also, um reflexively affects the visceral container of the pelvis because the opterator nerve is one of the nerves that innervates the peritoneum, um, hip flexor release, uh, especially targeting around the ob obturator canal Right above the, um, medial insertion of thein ligament grate, high payoff spot. Um. The other end of the adductor canal can be really powerful as well.

This is gonna affect the adductor mangus. This is going to affect the sartorious, so you're going to have an effect on the medial circumflex artery as well as the lateral circumflex artery. Um, and then hip medial glide. Prone frog stretch. These are all great for improving hip ab duction. And again, opening up that rural sweet spot in the medial, pelvic growing ish area that is gonna affect so much, not only of the medial hip itself, but of the pelvic floor, and, um, really affect that blood flow in that area.

So. Kind of a lot. I mean, I know I'm throwing a lot of anatomy out at you, and this is why it's like, definitely check out the show notes for not only the anatomy to look at, but then also the, um, exercises I gave. But this is. This is a big piece. And actually what I would check the before and after, I would check besides like just general hip flexion, um, passive hip flexion would be really interesting to check because what happens often when you free up the space is all of a sudden when you go to flex the hip, it becomes like really loosey goosey.

Like as you move into hip flexion, you just feel the femur like free to rotate in the socket, um, like zero resistance moving into hip flexion. So that's a really good sign. And then the other thing I would test pre and post interventions is the distal pulse. So the posterior tibials pulse, which is the pulse right behind the medial malleolus of the ankle.

I want to. See if I can make that feel more robust. Um, the femoral nerve or the femoral artery pulse, you can check that before and after, but it's less, I think it's less indicative of a, of a. Big change in the entrapment than the posterior tib pulse. The post tib is a little bit more reliable 'cause especially since we're doing treatment in the area of the femoral artery up at the, um, groin area, it's just like, you don't know if it's just post-treatment, um, artifact or like actual good changes of blood flow in that area.

So I actually think a more distal pulse is gonna be more indicative of if you made a big change to the blood flow in the entire leg. So, but also it's like, don't take my word for it, just check 'em both. But you, I think your work is not done until you've changed the pulse at the posterior, the the posterior tip.

And with this said too, you know, a reminder that all of this is great, but it could be a blood flow entrapment issue, even higher up the chain from something else somewhere else. Could be more visceral. I mean, obviously I talked about how pelvic congestion can play a big role in the, um, blood flow to the hip.

And so that's a, that's a big piece. Like is there pelvic, you could have pelvic congestion from a liver issue. In a backup of the portal vein and the balance between the liver and the lower part of the colon. And I talk about that in, um, one of, I'm sure I've talked about it in multiple episodes. I've probably talked about it in the swelling episode.

I might have talked about it in the, I know I talked about it in the episode. That talks about the liver and right shoulder pain and left sciatica. Um, so I'll have Joe link that in the show notes. I probably also talked about it in the episode about constipation. So, so this blood flow problem to the femoral neck can be somewhere other than these most related entrapments.

This is why we use thing. We use an assessment like the LTAP to direct us where our where to go. But the thing that I'm gonna really care about always in relationship to femoral neck issues is how does it change their hip flexion mobility? Do I, can I free it up to find that nice loosey goosey rotation?

And then also, how does it affect their distal pulses? Because I want to know I had an effect on the blood flow. The LTAP might take you somewhere else, which is good and valid and helpful for them, but you still may have work to do around the hip itself. So you can't just assume that where the body takes you is the only place you need to treat, do treatment.

It's just you have to go in the sequence that the body wants. I can't just dive into these entrapments around the hip. I mean, I could, I could dive into these treatments that on the hip, but they're not going to stick. They're not going to stay if I don't do it in sequence with the other more important things that might be up or down the chain.

So I let the body direct me in the sequence, but understanding. All these possible areas of entrapment, all these possible interventions that I could do that could have an effect on improving blood flow to the area. This opens up a lot of treatment connections and treatment options for me, when we do get to the point where the body's like, yeah, do treatment wherever you want, or directing you to the spot, these spots specifically.

So I know that was a lot in a really short period of time, but like I said, I'll have Joe link in the show notes, the, um, handout I gave everybody so you can kind of see it and then, uh, have fun. Let me know how it goes. I, I love this kind of thing. I love these kind of troubleshooting cases. So, um, yeah, totally different perspective of an answer for like what to do for osteoporosis.

Right. The load is so good. The load is so good, but if we don't have good blow flow, we're not going to maximize the effects from that load. This is what it's all about. Have a great day.