Why Expectations Shape Clinical Outcomes

In this episode of the Unreal Results podcast, I share a candid look at expectations in clinical practice, especially after learning a new framework like the LTAP®. I break down why early wins can create unrealistic internal pressure, how I think about my 1-3 session benchmark, and why managing patient expectations is often the missing piece in overcoming imposter syndrome. I also walk through a real case example of a Navy SEAL BUD/S candidate to show how I decide when to adjust the plan, refer out, or stay the course.

In this episode, you’ll hear:

• What “guaranteeing results” really means and what it doesn’t
• Why mismatching assessment precision with treatment precision can worsen outcomes
• How expectations (yours vs. your patient’s) shape confidence and results
• The six questions that dramatically improve clarity, buy-in, and clinical direction

If you’re a clinician who wants better results without burning yourself out or second-guessing every session, this episode will sharpen your reasoning and steady your confidence.

Resources & Links Mentioned In This Episode:
Ep. 119: Guaranteeing Results... Until You Can't
Ep. 125: You're Already Treating The Viscera... You Just Don't Know It
Ep. 126: How Many Sessions Do Clients Really Need?
Ep. 131: Raising The Bar On Patient Outcomes
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

=================================================
Watch the podcast on YouTube and subscribe!

Join the MovementREV email list to stay up to date on the Unreal Results Podcast and MovementREV education.

Be social and follow me:
Instagram | Facebook | Twitter | YouTube

Chapters

• 0:00 Welcome + Super Bowl Reflection
• 5:53 Why Early Wins After LTAP® Fade
• 9:11 What “1–3 Visits” Really Means
• 13:36 The Precision Problem: Assessment vs Treatment
• 21:01 The Expectation Trap
• 25:52 The 6 Questions to Ask Every Patient
• 35:19 Case Study: When 3 Visits Isn’t Enough

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 to another episode of the Unreal Results Podcast. Um, today might be a quick episode, but it's been, um, one I wanted to record for a little bit, um, as this keeps coming up a lot, um, in questions from people who have taken my course, the LTAP level one course from people in my mentorship program.

Um, and. I just felt like, yeah, I needed to give a little bit more context around it. But, um, one of the things I hear is this feeling from, this feeling from all of a sudden. Oh my gosh. Actually let's back up because I'm like, wow, I just like dove right in the podcast and I'm like, I feel like I need to give space to like give an update.

My athlete and his team won the Super Bowl, what literally won the Super Bowl. My athlete had a perfect game. Like literally a perfect game. He was the leading scorer for the team. He freaking crushed it and I am so proud of him. And it's just absolutely unbelievable. And um, I mean, you don't have to be like.

It's always like, ah, I don't love saying who my athletes are, but it's like once I start talking about them, it's like, well, if, if, if you follow me on social media, you've probably figured out who it is. And also like if I tell you how he did in the game, you're gonna figure out who it is. But so, um, he went five for five field goals, two extra points.

He scored 17 points out of the teams. 29. And um, also with that game became the leading score, like NFL record, the highest score in a season of all time, which is unbelievable. He's in this season, he scored 206 points highest ever of anyone which surpassed LaDanian Tomlinson, um, at 198 points. And so, like what?

Like literally the best game. He became the first kicker to kick that many field goals in the Super Bowl. So like, highest amount of field goals in the Super Bowl. So like multiple records. Perfect game. Like high score, arguably, potentially could have been the MVP of the game, but, um, and I felt actually didn't even have them listed in the MVP voting, um, because that's, it usually doesn't go to a kicker.

So, um, but unanimously online, obviously I'm biased, but a lot of people are being like, he was the MVP. Um, then there's some people are like, well, the team didn't get 'em close enough to kick. Then I'm like, whatever. That's how it always is. The MVP is often like the, like, yes, it's a team sport, so the rest of the team does matter and man, their team crushed it.

Their defense, they're special teams, absolutely crushed. And, uh, I mean, arguably too, like the defense and the punter could have been also MVPs. They had freaking phenomenal games. Um, so, so proud of the Seahawks. So proud of my kick, my athlete, the kicker. And, um, I can't believe it. He won the Super Bowl.

They won the Super Bowl, super Bowl winners. Um, I wish I could have been there. Um, I was not there sadly enough, but, um. He had enough family and friends. He didn't need all of us who work with him hanging out, I guess. But, um, wow. What a game. I just, it still feels like very surreal. I can't believe he, I can't believe it and I'm, yeah.

I'm sure it feels even more surreal for him. So can't wait to see him in person and get to celebrate once he's back. Um, and uh, and uh, yeah, that's my update. What a great update. Freaking Super Bowl winners. Amazing. So, okay, now we can jump into the podcast. Um, so anyways, so as I was saying in the beginning.

And this is a question that comes up a lot after people take my course because when you take the LTAP level one course, you do like all of a sudden have this like, uh, rush of going back to your clinic or your athletic training room and you know, quote unquote fixing a lot of your patients very quickly.

And then things slowed down a little bit. And there's a little bit of a self-confidence piece that then is challenged and you feel a little ba bad, like you feel like a piece of shit because you're not getting the results that you think you should be getting or that you seek glimpses of. And so I wanted to speak to this because, um, there is.

There are some really tangible things that we can change to help prevent that feeling from happening. And I always say like, the first thing that I must address, which is like always kind of a little bit of the elephant in the room, is when I say I guarantee results in one to three sessions. Like, what does that mean?

Can you get it too? Like, because that's a little bit of my messaging when I bring people into my courses. Like, you'll hear me say things like that on the podcast, on my social media posts. And like part of that is because like, I wanna make it tangible for people, but then I'm also like, I'm literally being honest, right?

I, I'll have Joe link in the PO in the podcast notes. Um, I did an episode episode about guaranteeing results and about my success rate. Not too long ago, and I kind of broke down like what that means because, um, that is the elephant of the room. When I say I guarantee results in one to three sessions, people think that it's like, oh, like someone tears their ACL and has surgery and then you can get them better in three sessions.

I'm like. No, like, no, use your brain. There's always going to be nuance and context to everything we do. Um, but if you look at like, the majority of the patients that you see, like the majority of the patients that you see are probably not postop. Maybe they are, maybe, maybe they're, but I'd say in most people's settings, whether it be in the clinic or the athletic training room.

You're seeing people, a good amount of, the chunk of people that you're seeing are people that have, just have chronic pain, uh, acute pain, but like, um, or like mild in like nothing severe, like nothing that is post-surgical rehab or like major tissue damage, rehab. Of course, those take more time. Like yes, rehab from an ACL takes.

Six months to a year that like, no matter how you slice it, but it can go a lot easier when we're using the ltap and get good results on a regular basis. But it's like, am I going, are they gonna be done re rehab in three sessions? No, that's, that doesn't make sense. So when I say guarantee results in one to three sessions, like that is nuanced in what that could mean.

And, and so that's number one. Number two, that's me. I can guarantee results in one to three sessions. That is what I tell people and I give it to them with a context, but what it really means is I'm not, and this is that whole podcast episode, it means I'm not gonna sit and marinate and just like think things take time.

When they don't actually need to take time, like if we don't make some shifts in your pain, in your mobility, in your function, within three sessions, I'm like, Hmm, what am I missing? Go back to the da, like the drawing board, like, can I really help this person? If I can't help this person, what do they need?

And that's when I am like triaging them of like, do you need. A cortisone injection. Do you need to go see the doctor? Do you need an MRI Do you like, do you need a different, like a functional medicine type doctor? Do you, are, am I scanning you for red flags? Like, right. That's, that's a lot of what it is. So, um.

You know, that is the elephant in the room. And like in one to three visits, sometimes it is a total relief of pain. Sometimes it's just a okay, in one to three visits, I can figure out like how you're going to, like, how to manage this to be like no pain most of the time. But also like giving room for like, this might come back or if it comes back we know how to, we know how to address it sort of thing.

Um, and then the other thing too is like. And this is why, like this is what this is. I guarantee results in one to three visits also because I am confident at the rest of the skills I bring to the table, not just the LTAP, you know, I always say in the course, and this is the nature of teaching, I, I. I simply cannot teach you everything I know in a weekend course, in a seven week course, in a four month course, in a year course, right?

It's taken me decades, decades to learn everything I know and to integrate it all into one thing, and you know, hundreds if not over a thousand like patients, right? So it's like it, it's. All of the tools, the assessment tools and the treatment tools and the pattern recognition that I bring to the table allows me to feel very confident that I can guarantee results in one to three visits.

And I didn't pull that out of the ether. I noticed that over time. I didn't start saying this until like probably six years ago, and was I getting results like that? For longer than six years. Absolutely. But it was like, not until about six years ago that I was like, somebody, one of my athletes pointed it out to me and I was like, well, damn.

Yeah, actually you're right. Or somebody asked me like, how many visits does it usually take to make some like, make, make a difference? And I'm like, oh yeah, like one to three. And then I did start noticing like. If in three visits I, we hadn't like moved the dial, I was like, hmm. Very confident that it was something else and referring out.

Whereas previously in my career, and I talk about this in that other podcast, is like, it was like two weeks. I would tell athletes very early on, on my days in athletes performance, EXOS, like, gimme two weeks and we can, we'll nip this in the bud sort of thing. And so, um. Part of it is like, don't feel bad.

About yourself if you're not getting these results, 'cause you're not me. You have to kind of reflect on your own practice and see what kind of results you're getting. And then like also give it time. Give time implementing the ltap into your practice and see what changes. And then you'll have a better idea of how you can, how many visits or how many weeks or whatever it takes before you, you know, that you feel comfortable guaranteeing.

And then also you don't have to guarantee anything. Like this is, you know, full autonomy. You get to practice in whatever way you want to. Um, so there's that. And then there's this concept, and again, I'll have Joe link this episode in the show notes that I did when we talked about, um, the need for, um, our assessment to be more precise and specific, and then where our treatment.

Specificity comes into play, and what I see over and over again is you, you have a, a group of clinicians that either treats fairly generally, or you have a group of clinicians that have learned a lot of techniques and treats fairly precisely. And specifically, I actually probably would say. That the people who treat more generally tend to get better results more regularly because they're not, usually because people across the board are not taking the time to get precise enough with their assessment.

And this is what the LTAP provides us, is it gives us a little bit more precision with our assessment. In directing us where to go. So then once we know the general area, we can do a general treatment technique and have a really great response. But if we have. A more precise treatment, we can get even a better treatment response, but it still takes a little bit further evaluation and assessment on the what, right?

We got the where now we need the what. Right? We narrowed it down to the, like the right upper quadrant of the abdomen. Which is around the liver. So we narrowed it down to the liver, but now we need to know what in the liver, is it the dispensary, ligaments, is it the liver, like parenchyma? Is it itself? Is it the, um, vascular structures to the liver?

Liver? Is it the venous, um, drainage from the liver? Is it the, um. Yeah, if it is a dispensary ligament, is it the coronary ligament? Is it the right side? Is it the left side? Right. The suspensory ligaments? Is it the falciform ligament? Is it just like the, um, capsule between the diaphragm and in the liver?

The more we know how to assess all those pieces, then I get to pull from one of my very precise treatment techniques that I learned in the Brawl Institute to treat that structure. I assess the liver and I'm like, oh, this is the, um, you know what? This is the hepatoduodenal ligament. Between the, the liver and the duodenum and the stomach.

It's this ligament. So I have a very specific technique for this ligament, so I'm going to use that treatment, and now my results are gonna be better because I, I was a, it's a sniper, right? It's like pulling in a sniper technique. A sniper sets up his position and assesses everything for a long time before he takes his shot.

There might be a moment. That they see their target. They see the target that they're going to be taking the shot on, but they're not going to like, they're not going to quickly decide to take that shot until they have like ensured that when they do take that shot, it's all they need. Right. So that's the same thing as what a precise assessment does is, is like we take, I take as much time as I need to to really assess.

To be like, oh, this is exactly where I need to do the treatment, and now that I know the exact where and the what, I can pick a treatment tool that has it. Now, some of us don't have those precise treatment tools, so it's like then you don't have to have an assessment. If you don't have a treatment tool for the hepatoduodenal ligament, then do you need to assess to know that it is the hepatoduodenal ligament?

No, probably not. Not at this point in time. So. We always need to match our assessment precision with our treatment precision, right? But in general, having the ltap to direct us where to start allows for any general treatment in that general area, right, is going to be pretty powerful. Okay. So, and this, and what happens is when I, when I talk to clinicians or when I observe clinicians who have a lot of skills, I've learned a lot of precise techniques.

And they are not doing the assessment to go with it, they actually get worse results than the clinicians that are using the general technique. Right? Because like, again, going back to the sniper technique, not that I'm like big on like guns, but it, it provides a good analogy for us when you have, when you know exactly where, where to go, um.

You use a general technique, right? If we know the, the target is over here on the right side above a certain level, right? We have a general area. If we use a weapon that is more general, right, like a, a shotgun that has like splay, we're gonna get it. We're going to reach the target. Now, are we going to totally take that target out?

Possibly not. It might take more treatment sessions, right? It might take more, more wounds to take it down, versus a sniper who can like assess like, oh, not only is it on the right side, but it's on the right side at this degree, in this very spot. And then take one more powerful. Bullet in this case and like nail the very exact spot that actually takes a whole target out.

Like that takes more time to narrow it in. But it has a better result because it's exactly where it needs to be. But if I didn't have, if I hadn't taken the time to narrow it down like that, and I was just in the general area, if I'm taking that one little bullet and going to the general area, I might miss the target altogether and have no effect.

So I see that a lot actually of these clinicians that have gone to all these classes and have all these techniques and they're like, okay, I am gonna do this. Especially with the Barral Institute courses. Oh, I learned a hepatoduodenal ligament technique, so. Uh, the LTAP or my listening got me to go to the liver and instead of assessing the liver and actually knowing that that's the technique you knew need, they're like, oh, I'm just gonna try this technique and hope that it works because it's a liver technique, so it should support the liver.

And I'm like, Hmm, no, that's actually not so helpful. So. There's, there's always that, right? We always have to think about that graph. And in the course, I, I draw out the graphs. There's a visual to this graph of like, as assessment and precision increases and treatment precision increases, the results can be better.

But if the assessment precision never increases and you pick a treatment that's pretty precise, you actually get worse results. And so, um, that's something to consider too, is a lot of people. And this goes back to what I'm gonna say next about expectations. When you have the expectation that you're gonna fix somebody in one visit.

Sometimes it makes you feel rushed to get to the treatment because you think the treatment is the thing that gets the result, and so you skip all of the assessment because you feel pressured by time. And then. That gets you in a bad spot, right? Because then we're going back to the, we're using a really precise treatment in a, without a precise location and it's not so good.

It would've been better off to do a general treatment when you're rushed better off to do a general treatment in the right spot. So, um, so that brings me to like. Let, let's talk about our expectations. So when you have this expectation to help somebody guarantee results in one to three visits, um, you have to realize that this is your expectation and.

Of course it's okay to have your own expectations, but at the end of the day, and what's going to make you feel more confident is not only meeting your own expectations, but knowing what the patient's expectations are and meeting those. Because it really is all about the patient's outcomes and the patient's results, not your outcomes and your results.

There is a very distinct difference between the two. I'd say the majority of my clients that I see, they do not have the same expectation as me. I have the expectation of I want to help them figure things out, get them pain free and good. Performance in one to three visits, I would say probably zero of them have that same expectation.

So if I'm basing my whole confidence off of that expectation, I am setting myself up for failure a lot of times, or at least setting myself up for frustration. And when I start to feel frustrated, I start to increase my anxiety. And when I start to increase my anxiety, I narrow my, like neurologically, narrow my focus and miss actually being able to listen to the body, miss all the information I'm gaining from my assessment that should be able to get me better results, right?

So then you get in this cycle. And the, the result is never going to be that great. So part of, um, part of managing expectations so that we can be operating from a, a confident spot is asking, is shocker communicating and asking our patient what their expectations are, right? Like, take a second and think like, have you ever asked your patient.

What their expectation is is for their visit. You've probably asked 'em a lot about what their pain is, what brings them in today, and like that kind of thing. But have you asked them what they would consider this appointment to be successful? I don't know about you, but like I, I've had, I don't know if I've ever had a healthcare practitioner ask me that question before.

Maybe I've offered it, especially as I start to like manage my own expectations. But, um, I, I can't remember when I've been asked it and so. Making sure we're asking our patients what their expectations are really, um, demers us and takes our may, moves our expectations of guaranteeing results and moves it to the back burner.

Yes. That's still important and like I want everyone to feel like they can do that at some point. And again, doesn't have to be one to three visits. It can be whatever makes sense to you, but the thing that. Is most important is this is the patient's expectation being met, met, not just yours. And, um, you know, part of this too also sets you up for a, like a, a, a client that is going to be most appropriate for you.

And already like stack the cards in your favor to have good outcomes because we know across the board, typically the people who have better results are people who feel like active, not even feel, but then are active participants in their care. And part of being an active participant is your care is letting your expectations be heard, letting you be heard and seen as the patient.

And so. We can simply make sure we add these three to six questions in each session, so not only they feel heard and listened to and are an active participant in their care, but you get to manage the expectations of the entire experience, not just always using your expectations. Most of the time, your expectations as a practitioner are very different than the expectations from the actual patient.

So, and I am stealing, not, I'm stealing. I am going to be sharing the six questions I'm going to be sharing, or actually I learned from, um, Shante Cofield, Dr. Shante Cofield, AKA, The Movement Maestro. Um, years ago I took her moving with the maestro course and she had this slide and I was like, wow, this is so important.

This is so important. I've, I've done it a little bit in the past, but not consistently. And it is like, when you remember to do this consistently, it just sets you up for so much more feelings of success and fulfillment in what you're doing, regardless sometimes of if you're meeting the expect expectation of getting rid of their pain completely, like changing their life in one to three sessions.

So she says the six questions you need to be asking is. Number one, what do you think caused your injury or your symptoms? So often the patients tell us exactly what happened, and you might not catch this with their normal history. Right? You might not catch this with their normal history because this will come out when we be like, you know, sometimes it feels like this only happens like.

At this time of the month and like, I almost wonder like, or it's like, oh, you know what, this started happening like eight weeks ago and you know, that was right after like, I changed this medicine and I was like, oh, interesting. And like that starts to give you more information in their history that might be helpful in their care.

Um, the second one, what do you think is going on? So like instead of telling them a story about their body, like just ask them, do you have any idea what's going on? Oftentimes they do. Um, a third one. What do you feel like needs to be done to improve your symptoms? Number four, a big one. What can I do for you?

I always say, what can I do for you? What brings you in today? And number five, also very important. What would make this session a success? This is their expectation. You're basically asking what is your expectation of this session? Um. Then another one is, what is the number one thing that your pain is stopping you from doing?

This is really good because, um, not to tie this back into a business lesson, but this is going to be a business lesson in terms of this thing. The number one thing that you're pain is stopping you from doing. This is messaging gold. Messaging gold. This is when you're marketing to get other people. If you can nail this.

You, you will have not a problem getting people in the door. And so that's an important thing to do too, because they're not being like, oh, just my knee hurts. They're like, oh no. The number one thing my pain's stopping me from doing. Like, I would like to be able to like, you know, be able to bend down to get on the floor and get up from the floor again to play with my kids.

Like, that's the messaging. Okay, so. But the, the three questions I think are the most important in terms of like, make, like identifying the expectations for this, this session is what would make today a success? What would make this session a success? How can I help you? And just what is your expectation for not only today, but the, the.

The experience or the journey of coming to see me and working with me for this issue, and I think most of the time, most of the time, what people are looking for. Is to know someone is there to help them, that someone is smart, that someone values their opinion, values their story, right? That, that that person is seeing them, is hearing them, is listening to them, is not gaslighting them.

And also that that person is dedicated to figuring it out, dedicated to figuring it out, and helping.

That being the driver of their care. Most of the time, that is what people are looking for, but this also gives you a moment to set the expectation accurately given the physiology, right? If somebody does come in immediately post. Acute injury or immediately post-op and they're like, I want you to take all of my pain away today in one session.

And you know, that is like literally maybe impossible. It gives you a moment to be able to have a conversation around how that expectation might be unrealistic. And I, and I don't want you to like use it as like an excuse. But it also is like, oh wow, they do have this expectation. And so like you right here too, is a good opportunity to be like, wow, I have that expectation all the time too.

But here's why it might not work in your specific case. And I always tell them, but I'm still gonna try. I'm still gonna try, if I can get rid of your pain in one session, I'm, I am. Like, that is what I'm always trying for. But also we have to take it with some context. But I'll tell you what, most of the people do not have that expectation.

Most of the people are like, man, I've had knee pain for 20 years and I've seen a bunch of different people and I'm just here for, um, I'm hoping like maybe you have a different perspective and I'm hoping like, um, maybe we can like shift my pain. In a direction that feels like we're on the right track or whatever it may be, right?

So I think it's so important to ask the patient what they're looking for. It is shocking to me actually how little this happens. And I think this is often like the magic sauce in getting rid of this or getting over this imposter syndrome or this like, um, feeling like a piece of shit sort of feeling when you can't get people results.

Your expectation, right? Because when you set the expectation that you wanna help people in one to three visits, and then one to three visits go by and you haven't, you feel like a dick. Like, you just feel like an asshole, right? And so, and it makes you feel bad about yourself. And, um, then you start down going down the spiral of like, I'm a terrible practitioner, like blah, blah, blah.

And none of that is necessarily true. It's because you have this expectation that. Maybe was realistic, maybe it was not realistic, but you didn't make it. And so if you can have some other expectations that are guiding you and knowing that you are, because at the end of the day, we are all people. People.

We, we love helping people. We care for people. We want to help them. That's why we're in this field. And so if you ask them what their expectation is and you know you're meeting that. Like you already know that you've done a good job you, which will give you the confidence to like be more present for the assessment, be more present for the treatment, and to be okay with if you don't meet your expectations of the one different three visits.

I talked about it in the previous podcast that I, you know, shared about with the guarantee and the results and my success rates. And I was like, yeah, most of the time it is one to three visits, but then there are outliers, right? Like you guys have heard me talk about my shin splint, my difficult shin splint case, which I hate calling it shin splints 'cause it probably wasn't, it's not shin splints, it's like a form of exertional compartment syndrome.

But, um. I did not help, like I did not fix him in one to three visits, but in one to three visits, I identified that it was not normal shin splints, that it was probably compartment syndrome, and this was gonna be a long journey. And then it took us 45 visits before he was at a pain-free level of full participation.

Right? So. The, had I not managed my own expectations and asked what his expectations were from the get go, it would've been an even more frustrating situation than it already was. Right? So I had a, actually, you know, to share, to give you a, um, example of this in my practice, um, LA the last two weeks, two, three weeks, I've been working with a new bud.

S. Um, candidate, a new or new BUDs student, a Navy Seal candidate, and he's had a lot of surgeries, um, and coming to me for knee pain. What, what appears to be patellofemoral joint pain. He's never really gotten, um, MRIs or anything on his knees, only x-rays and, um. But he, you know, it presents very patellofemoral..

One side's worse than the other. So that's kind of like the side we're focusing on. And the first visit, like I felt, I followed the LTAP, we treated like cranium hip ankle, and we really moved the dial on some. Objective dysfunctions that I thought was leading to his patellafemoral pain. You know, like lack of hip extension, mobility, like, um, some lateral tightness, some ankle tightness.

Like all these things that usually help people's patellafemoral pain quite a bit. And it even, and it did it, like in the, in the session, it like felt a little bit better and. All of his objective measures improved by a ton, and even his patella mobility improved. And so I was like, oh, I feel really confident about this, that your pain's gonna decrease.

And like, we're on the right track. Well, he comes to see me like maybe a week or so later, and we're talking and he doesn't feel any better, like literally didn't have any change of pain, which I'm like, Ugh, I hate that. But I'm like, well, let's reassess all your objective things and I wanna see if things maintained.

Because, you know, I was going on this index of suspicion that the patellafemoral pain syndrome was from these tightnesses or whatever that he had. And when I'm, when I'm reassessing him, I'm like, oh, actually, like everything, everything held really well. That improved hip mobility that you got from treatment, improved ankle mobility.

Better. Like your patellafemoral, like patella mobility is like a little tight again, but not like it was like overall everything's improved, but your pain hasn't. So I'm like, Hmm, this is a little bit of a yellow flag. But we will give it another treatment and see what happens next. And so I treated him again and we focused on some other things.

But again, I let the LTAP guide me. And again, we made some great changes in objectively. And within that treatment session, he got off the table and he was like, oh, I feel a little bit better. I'm like, great, okay. Focus on these things and then like get back to me. And so then he comes in for his third session and he is like, Anna, I hate to report it, but like my pain hasn't changed.

And I'm like, Ugh. This is frustrating. I was like, but I said, okay. I was like, here's the deal. I was like, we'll see what comes up on this, uh, treatment and um, we're gonna change things up a little bit on this treatment. Instead of doing a lot of manual therapy, I'm gonna do some exercises with you and teach you some things that I think will be helpful and we're gonna reassess as we go.

And so we did some like rest postures, erector sizes type stuff and actually changed his mobility. And changed his listening better than my manual therapy. So I was feeling really good about that and he, again, left the session feeling better. But I told him in that session, I said, here, here's the thing. I was like, you know, I always feel like if I can't help you one to three sessions, like we're missing something, that we need some support somewhere else.

And so I was like, here's the thing. I kind of feel like we're at bat with you. We're changing all the objective measures that should change your pain and your pain's not changing. And I could give you some bullshit thing, like it takes time and I could give you some, not bullshit, but true, but also probably not true in this case.

Thing about pain and how it's complex and it comes from the brain and maybe you have some like of that going on, but I'm like, that's not true too. This is presenting very clearly as patellofemoral pain. I don't doubt that he has like, um, the cartilage degeneration that is actually the nociceptive driver of this pain.

And so I said, you know, I want you to still do these exercises and like report back to me if it helps your pain. I was like, but at this point I'd like your refer you to a doctor for cortisone shot. I was like, because you've never tried it before. And, um. I think we're moving the dials well on all this stuff that maybe led to these issues in the first place, but we need some support on the pain management side.

And I was like, I would love to get you a cortisone shot so we can get the pain down and continue with the plan from a rehab standpoint and like. Knock it out because I, I we're doing all the right things. I don't think we're missing something in terms of like, there's another driver of your pain. I just think that we need some support from something greater than manual therapy, especially given that he can't rest right now.

Like he gotta keep running. He is gotta keep lunging. He is gotta keep loading because that is where he's at in the pipeline. There's not time to be taken off. And so, and there's not even time to like decrease mileage. There's not, all we're gonna be doing is increasing from here on out. And so I'm like, yeah, we're at the point in that we need like some other stuff.

So that's a little bit of like an example of, no, I'm confident we were doing all the right things and I'm not gonna make him do like. 10 more appointments with me and have the same outcome over and over again. I'm like, no, if we haven't shifted it, when we've shifted all the orthopedic things, but not the pain in three visits, we need some help.

Um, and then two, like knowing, you know, I told, I tell my athletes what my expectations are. I say, Hey, this is my expectations. I hope to help you in one to three visits. And then I'm like, what's your expectation? And he's like, my expectation is like I've always been the guy that is, has a million injuries and gets hurt, and I have heard good things about you from the other guys, and I'm really hoping you can help me kind of troubleshoot this and figure this out because I've done all the things and nothing has helped.

And so I'm like, yeah. Which that information too is like, he's looking for like checking the box of Yep, yep. We are doing it all the right way, but we're missing something. So he's looking to me to direct him for somewhere some, something else, something to go. Doesn't mean he's gonna lose my care, but he's like, I'm looking for someone to help me manage it.

So expectation is being met, I'm helping to manage it. And um, that makes me feel less bad about not being able to like, change his pain in one to three visits. I'm like. Yep. Bummer that we couldn't, but this sometimes happens and so it was like, yep, this is my milestone. The three visit milestone for me is like a checkpoint of being like, do we need to change?

What do we need to change? What have we missed? What do we need to add? What do I think this is? Do I need to change my index of suspicion or am I still like firm in what it is and for him firm in what it is? I just need outside help. So, and then his expectation is, oh, great. I have this person that is part of my team that is managing it and is not gonna just settle for status quo and settle for doing the same thing over and over again and expecting a different result, which is.

What his experience was with every other therapist before me. So hopefully that, that, that is a good kind of like anecdotal wrap up to this kind of whole conversation, and hopefully this conversation is helpful for you. But what I want you to get out of it is like understanding that your expectations are often different than your patients' expectations.

And then also, do you even know what your patient's expectations are? Are you asking the right questions to them? So. Enjoy. We'll see you next time.