WEBVTT 00:00:00.657 --> 00:00:01.276 All right, let's do this. 00:00:02.517 --> 00:00:09.019 All right, welcome to Orthostatic, 00:00:09.039 --> 00:00:10.179 a product of the Academy of 00:00:10.320 --> 00:00:11.580 Orthopedic Physical Therapy. 00:00:11.881 --> 00:00:13.721 I'm your host today, physical therapist, 00:00:14.121 --> 00:00:14.602 Jimmy McKay. 00:00:14.641 --> 00:00:14.881 Today, 00:00:15.262 --> 00:00:17.343 we focus on a critical and often 00:00:17.603 --> 00:00:20.024 under-discussed area of physical therapy, 00:00:20.344 --> 00:00:21.544 the treatment of pelvic 00:00:21.564 --> 00:00:23.184 floor dysfunction and related conditions. 00:00:23.644 --> 00:00:24.225 Our guest, 00:00:24.245 --> 00:00:25.245 a highly skilled physical 00:00:25.286 --> 00:00:26.425 therapist at UW Health, 00:00:26.525 --> 00:00:27.806 specializing in the spine 00:00:27.887 --> 00:00:28.586 physical therapy, 00:00:29.227 --> 00:00:30.349 as well as pelvic floor 00:00:30.408 --> 00:00:31.971 disorders and women's health. 00:00:32.151 --> 00:00:33.512 She treats a wide range of issues, 00:00:33.552 --> 00:00:35.856 including musculoskeletal 00:00:35.875 --> 00:00:36.576 and joint problems, 00:00:36.616 --> 00:00:38.219 but also things that focus 00:00:38.399 --> 00:00:40.161 on the topic at hand. 00:00:40.643 --> 00:00:42.445 Please welcome Keri Schwerer. 00:00:42.526 --> 00:00:43.286 Keri, welcome to the show. 00:00:43.914 --> 00:00:44.914 Thanks for having me, Jimmy. 00:00:45.316 --> 00:00:46.796 And before we hit record, 00:00:46.837 --> 00:00:48.018 you were live on the radio 00:00:48.078 --> 00:00:49.200 doing just this thing. 00:00:49.240 --> 00:00:50.261 We love when we see physical 00:00:50.320 --> 00:00:52.503 therapists out in the real world, right? 00:00:52.523 --> 00:00:54.164 When we talk to people in 00:00:54.204 --> 00:00:54.926 the community that can 00:00:55.006 --> 00:00:56.186 benefit from our insight, 00:00:56.207 --> 00:00:56.968 we like to say like the 00:00:57.027 --> 00:00:58.128 knowledge from our neck up, 00:00:58.149 --> 00:00:59.030 the things that we can do 00:00:59.090 --> 00:01:00.210 value-wise from our neck up. 00:01:00.530 --> 00:01:01.591 So thanks for doing that. 00:01:01.832 --> 00:01:02.914 And thanks for talking with us today. 00:01:03.915 --> 00:01:04.415 Absolutely. 00:01:04.456 --> 00:01:05.236 Thanks for having me. 00:01:06.016 --> 00:01:07.658 And also, before we hit record, you said, 00:01:07.697 --> 00:01:08.177 hey, listen, 00:01:08.299 --> 00:01:10.379 I could talk about this all day. 00:01:10.459 --> 00:01:11.599 And if someone looked at the 00:01:11.659 --> 00:01:12.581 topic and said, yeah, 00:01:12.600 --> 00:01:13.822 this is something I want to listen to, 00:01:13.841 --> 00:01:14.981 this is something I want to learn about, 00:01:15.543 --> 00:01:16.662 you are our expert. 00:01:16.703 --> 00:01:19.004 So how does women's health, 00:01:19.105 --> 00:01:20.926 which might be a different academy, right, 00:01:20.945 --> 00:01:23.326 a different component of APTA, 00:01:23.566 --> 00:01:24.388 how does women's health 00:01:24.487 --> 00:01:25.828 intersect with orthopedic 00:01:25.888 --> 00:01:26.748 physical therapy? 00:01:26.828 --> 00:01:28.750 When posed with that big picture question, 00:01:29.030 --> 00:01:29.771 where does your mind go? 00:01:30.519 --> 00:01:30.700 Well, 00:01:30.739 --> 00:01:33.060 I think we oftentimes get really siloed, 00:01:33.099 --> 00:01:34.361 but we need to get some 00:01:34.381 --> 00:01:35.921 bridges between silos. 00:01:36.001 --> 00:01:38.081 So when it comes to women's health, 00:01:38.141 --> 00:01:40.182 we really have a lot of things going on. 00:01:40.742 --> 00:01:42.561 The basis is the bony skeleton. 00:01:42.621 --> 00:01:45.543 So bone health issues are such a big deal. 00:01:45.683 --> 00:01:46.962 And that's also core to 00:01:47.102 --> 00:01:48.503 orthopedic physical therapy. 00:01:48.543 --> 00:01:49.643 But if I'm not considering 00:01:49.763 --> 00:01:50.602 age of my patient, 00:01:51.603 --> 00:01:53.463 where they are through their growth cycle, 00:01:53.864 --> 00:01:55.823 those are things that need 00:01:55.843 --> 00:01:56.584 to be considered, 00:01:56.644 --> 00:01:58.025 especially as people age 00:01:58.045 --> 00:01:59.885 and go toward menopause, women that is. 00:02:00.525 --> 00:02:02.146 So that's one way it overlaps. 00:02:02.206 --> 00:02:03.646 Then if I think about pelvic 00:02:03.665 --> 00:02:04.927 health specifically, 00:02:05.546 --> 00:02:06.927 all of those muscles have 00:02:07.028 --> 00:02:09.229 synergies with the orthopedic, 00:02:09.508 --> 00:02:10.229 what we think of as the 00:02:10.269 --> 00:02:11.729 traditional orthopedic system. 00:02:12.210 --> 00:02:13.389 You need the pelvic floor to 00:02:13.409 --> 00:02:14.670 work with the diaphragm and 00:02:14.691 --> 00:02:16.131 the hip muscles and the low 00:02:16.171 --> 00:02:17.512 back and everything to get 00:02:17.572 --> 00:02:18.572 meaningful movement. 00:02:18.693 --> 00:02:20.612 So I'm not really ever just 00:02:20.673 --> 00:02:21.834 treating the pelvic floor, 00:02:21.873 --> 00:02:22.854 but I'm looking at the 00:02:22.913 --> 00:02:24.435 balance among those systems. 00:02:24.875 --> 00:02:25.675 And if you think about it, 00:02:25.835 --> 00:02:26.996 it's suspended right off 00:02:27.015 --> 00:02:28.056 the bottom of the pelvis, 00:02:28.116 --> 00:02:29.536 which we all think of as 00:02:29.596 --> 00:02:31.257 being orthopedic in nature. 00:02:31.276 --> 00:02:32.556 And then if we take it 00:02:32.616 --> 00:02:33.796 another step further, 00:02:33.896 --> 00:02:34.877 in terms of pregnancy, 00:02:34.917 --> 00:02:36.397 there's lots of changes all 00:02:36.578 --> 00:02:38.318 over the body in terms of 00:02:38.418 --> 00:02:40.799 how loose ligaments may get 00:02:40.838 --> 00:02:41.799 during pregnancy. 00:02:42.318 --> 00:02:43.800 And if there's pre-existing conditions, 00:02:43.860 --> 00:02:45.020 there can be lots of pain 00:02:45.060 --> 00:02:46.580 that happens in that regard, 00:02:46.919 --> 00:02:47.800 but you're also dealing 00:02:47.820 --> 00:02:49.300 with a changing center of mass. 00:02:49.381 --> 00:02:49.520 So 00:02:49.968 --> 00:02:52.230 something to be kept in mind there. 00:02:52.591 --> 00:02:53.390 And then finally, 00:02:53.471 --> 00:02:55.513 I think about our oncology patients. 00:02:55.573 --> 00:02:57.033 So breast cancer is very 00:02:57.074 --> 00:02:58.754 prevalent in society and 00:02:58.835 --> 00:03:00.256 urogynecological cancers 00:03:00.415 --> 00:03:02.817 also are in society as well. 00:03:03.157 --> 00:03:04.498 And oftentimes the fields 00:03:04.579 --> 00:03:05.979 that they do radiation with 00:03:06.020 --> 00:03:07.700 can impact the shoulder or 00:03:07.741 --> 00:03:09.301 the hip to a large extent. 00:03:09.421 --> 00:03:11.543 And even with some of our myeloma patients, 00:03:11.883 --> 00:03:13.183 they may have radiation 00:03:13.223 --> 00:03:14.224 done over their sternum, 00:03:14.504 --> 00:03:15.406 which is going to impact 00:03:15.445 --> 00:03:17.146 how the ribs move as well 00:03:17.227 --> 00:03:18.467 as the spine itself. 00:03:18.608 --> 00:03:18.728 So 00:03:19.157 --> 00:03:21.179 There's a lot of overlap that can happen. 00:03:21.218 --> 00:03:21.618 And of course, 00:03:21.658 --> 00:03:23.901 myeloma is not a women's 00:03:23.941 --> 00:03:25.602 health issue specifically, 00:03:26.042 --> 00:03:27.222 but it does tie together. 00:03:27.301 --> 00:03:28.603 So we have these silos of 00:03:28.682 --> 00:03:29.984 maybe we have the Academy 00:03:30.183 --> 00:03:31.604 of Pelvic Health and we 00:03:31.645 --> 00:03:32.444 have the Academy of 00:03:32.504 --> 00:03:33.526 Orthopedics and we have the 00:03:33.566 --> 00:03:34.806 Academy of Oncology, 00:03:35.187 --> 00:03:35.986 but there's so much 00:03:36.067 --> 00:03:37.668 crisscrossing that happens 00:03:37.828 --> 00:03:39.348 and all of that needs to be 00:03:39.389 --> 00:03:40.349 taken into account. 00:03:40.849 --> 00:03:41.069 Yeah. 00:03:41.129 --> 00:03:41.770 So you're a physical 00:03:41.810 --> 00:03:42.850 therapist first and you're 00:03:42.871 --> 00:03:43.891 taking the person in front 00:03:43.912 --> 00:03:45.051 of you into consideration, 00:03:45.111 --> 00:03:45.693 whatever that means. 00:03:45.712 --> 00:03:46.193 Absolutely. 00:03:47.007 --> 00:03:48.008 And what their goals are, 00:03:48.048 --> 00:03:49.229 what they want to get out of it, 00:03:49.308 --> 00:03:50.911 because maybe they just 00:03:50.931 --> 00:03:52.451 want to be able to do everyday things. 00:03:52.512 --> 00:03:53.032 But, you know, 00:03:53.072 --> 00:03:53.853 we may have someone who 00:03:53.872 --> 00:03:55.615 wants to continue on with their sport. 00:03:55.974 --> 00:03:57.415 So we need to meet them where they're at. 00:03:58.356 --> 00:03:59.377 So let's get specific. 00:03:59.457 --> 00:03:59.638 Right. 00:03:59.677 --> 00:04:00.519 That sounds like you set the 00:04:00.579 --> 00:04:01.479 table and you set the tone. 00:04:01.500 --> 00:04:02.120 Good context. 00:04:02.199 --> 00:04:03.260 But what are some common 00:04:03.381 --> 00:04:05.082 orthopedic issues that 00:04:05.103 --> 00:04:06.963 might primarily affect women? 00:04:07.905 --> 00:04:10.026 So osteoporosis with 00:04:10.086 --> 00:04:12.248 menopause is one that's a big deal. 00:04:12.308 --> 00:04:13.550 And I actually with my 00:04:13.610 --> 00:04:15.070 orthopedic resident do menopause. 00:04:15.447 --> 00:04:16.689 a clinic once a month where 00:04:16.709 --> 00:04:18.351 we see people who've had fractures, 00:04:18.692 --> 00:04:20.314 they are primarily women. 00:04:20.754 --> 00:04:22.894 and it is primarily postmenopausal women. 00:04:22.995 --> 00:04:24.516 So you really need to know 00:04:24.656 --> 00:04:26.538 how bone health changes 00:04:26.677 --> 00:04:28.499 over the course of the lifetime, 00:04:28.918 --> 00:04:29.600 and that there's that 00:04:30.259 --> 00:04:32.622 susceptibility immediately before, during, 00:04:32.701 --> 00:04:33.742 and after menopause. 00:04:34.081 --> 00:04:35.083 And there's an education 00:04:35.122 --> 00:04:36.543 component there to be sure. 00:04:36.584 --> 00:04:37.944 And I think we as PTs have 00:04:37.964 --> 00:04:39.605 the opportunity to come up 00:04:39.665 --> 00:04:41.887 with more classes and 00:04:42.067 --> 00:04:43.367 public health options. 00:04:43.788 --> 00:04:44.968 Since we know there may be a 00:04:45.028 --> 00:04:45.689 health shortage, 00:04:45.730 --> 00:04:47.290 we need to be a little more creative. 00:04:47.331 --> 00:04:48.151 So that's something I'm 00:04:48.190 --> 00:04:49.192 hoping to move toward 00:04:49.678 --> 00:04:50.918 in the future in my clinic. 00:04:50.959 --> 00:04:52.420 So there's your bone health 00:04:52.500 --> 00:04:53.319 piece of things. 00:04:53.720 --> 00:04:55.141 Then if we look at pregnancy, 00:04:55.201 --> 00:04:57.862 like that is one big old ball of wax. 00:04:57.901 --> 00:05:00.583 So there is a lot of neck, low back, 00:05:00.742 --> 00:05:02.562 and pelvic girdle pain in 00:05:02.622 --> 00:05:04.283 pregnancy because there's 00:05:04.303 --> 00:05:05.624 so many changes happening. 00:05:05.723 --> 00:05:07.004 If we think about the fact 00:05:07.064 --> 00:05:08.264 that the center of mass is 00:05:08.365 --> 00:05:11.266 at approximately S2 in pregnancy, 00:05:11.305 --> 00:05:13.326 that center of mass moves anterior 00:05:14.024 --> 00:05:15.125 and superior. 00:05:15.266 --> 00:05:17.447 So there's always this changing, 00:05:17.826 --> 00:05:19.867 how are my muscles pulling on my joints? 00:05:19.987 --> 00:05:21.488 And for someone who maybe 00:05:21.528 --> 00:05:22.829 doesn't have coping skills, 00:05:22.889 --> 00:05:24.029 that can be challenging, 00:05:24.269 --> 00:05:25.750 or if they have previous 00:05:25.790 --> 00:05:28.232 low back pain or anything of that nature. 00:05:28.752 --> 00:05:29.952 When you come up to the neck, 00:05:30.314 --> 00:05:32.675 the diaphragm really gets pushed up, up, 00:05:32.834 --> 00:05:35.096 up, up, up by that growing baby. 00:05:35.615 --> 00:05:36.476 So you can't get the 00:05:36.557 --> 00:05:37.596 expansion of the ribs. 00:05:37.716 --> 00:05:38.958 And now patients will start 00:05:39.077 --> 00:05:40.699 using their SCM and 00:05:41.199 --> 00:05:43.084 and all of those accessory muscles, 00:05:43.163 --> 00:05:44.266 and that can develop into 00:05:44.326 --> 00:05:45.488 neck pain and headaches. 00:05:46.245 --> 00:05:48.067 I see a fair amount of that as well. 00:05:48.208 --> 00:05:50.490 And really it's something that, you know, 00:05:50.589 --> 00:05:52.151 I do as a women's health professional, 00:05:52.310 --> 00:05:53.291 but orthopedic, 00:05:54.233 --> 00:05:55.934 orthopedic PTs can do that as well. 00:05:55.973 --> 00:05:56.675 It just takes some 00:05:56.754 --> 00:05:58.596 creativity for how am I 00:05:58.615 --> 00:05:59.557 going to position them? 00:05:59.596 --> 00:06:02.560 I've got the basketball shape in the way, 00:06:02.920 --> 00:06:04.521 but we have a critical role 00:06:04.701 --> 00:06:06.362 there and it doesn't stop 00:06:06.403 --> 00:06:07.543 with just the joint pain. 00:06:07.603 --> 00:06:09.326 We have increased fluid 00:06:09.365 --> 00:06:10.485 that's required during 00:06:10.547 --> 00:06:12.468 pregnancy to really take 00:06:12.528 --> 00:06:14.529 care of keeping a pregnancy going. 00:06:15.334 --> 00:06:16.894 keeping that baby safe. 00:06:17.355 --> 00:06:18.475 And unfortunately, 00:06:18.514 --> 00:06:19.615 it's not just in the belly 00:06:19.634 --> 00:06:20.394 that that happens. 00:06:20.454 --> 00:06:22.115 It can happen in the neck 00:06:22.175 --> 00:06:23.596 and manifest this thoracic 00:06:23.755 --> 00:06:24.516 outlet syndrome. 00:06:24.836 --> 00:06:26.817 It can happen in the arms. 00:06:26.836 --> 00:06:28.276 So you may wind up with any 00:06:28.357 --> 00:06:29.437 of the peripheral nerves 00:06:29.478 --> 00:06:30.677 being a little bit impinged, 00:06:31.437 --> 00:06:32.577 thigh numbness and tingling. 00:06:32.819 --> 00:06:33.358 Thankfully, 00:06:33.418 --> 00:06:35.478 the lateral femoral cutaneous 00:06:35.519 --> 00:06:37.379 nerve doesn't have a motor component, 00:06:37.639 --> 00:06:39.300 but you also can get a foot 00:06:40.259 --> 00:06:41.100 with the tarsal tunnel. 00:06:41.120 --> 00:06:42.261 You can get some changes there. 00:06:42.648 --> 00:06:43.807 So all things that both 00:06:43.867 --> 00:06:45.009 women's health therapists 00:06:45.149 --> 00:06:46.889 as well as orthopedic 00:06:46.949 --> 00:06:48.850 therapists can all address 00:06:48.930 --> 00:06:50.071 those sorts of things. 00:06:50.591 --> 00:06:52.072 And then when you get to the flip side, 00:06:52.132 --> 00:06:53.232 baby's been delivered. 00:06:53.331 --> 00:06:53.572 You know, 00:06:53.612 --> 00:06:55.512 those abdominal muscles have stretched, 00:06:55.593 --> 00:06:56.713 stretched, stretched, stretched, 00:06:56.752 --> 00:06:58.093 stretched over nine months. 00:06:58.653 --> 00:07:00.574 So they're not working optimally. 00:07:00.615 --> 00:07:02.014 So there's opportunities for 00:07:02.055 --> 00:07:03.896 neuromuscular reeducation there. 00:07:04.348 --> 00:07:05.490 particularly if there's a 00:07:05.529 --> 00:07:07.750 diastasis rectus abdominis present, 00:07:07.790 --> 00:07:10.213 which is a splitting of the 00:07:10.492 --> 00:07:14.615 heads of the rectus abdominis muscle. 00:07:15.096 --> 00:07:16.437 And that just sort of leads 00:07:16.516 --> 00:07:18.197 to lessening of being able 00:07:18.237 --> 00:07:19.317 to generate force. 00:07:19.999 --> 00:07:20.619 And there's a lot of 00:07:21.139 --> 00:07:22.040 thoughts out there about 00:07:22.139 --> 00:07:23.701 how you best identify it, 00:07:23.761 --> 00:07:24.922 but it is one of the things 00:07:24.982 --> 00:07:26.562 that individuals come in with. 00:07:26.963 --> 00:07:27.843 And then that can bridge 00:07:27.923 --> 00:07:28.764 over to some of our 00:07:28.803 --> 00:07:30.785 incontinence issues and pain issues, 00:07:31.165 --> 00:07:32.305 which wouldn't be more... 00:07:34.127 --> 00:07:35.490 more continuing education to 00:07:35.531 --> 00:07:37.053 get really well versed in 00:07:37.093 --> 00:07:39.560 that area of things. 00:07:41.098 --> 00:07:43.519 So those would be, we have our menopause, 00:07:43.579 --> 00:07:46.418 we have our prenatal, postpartum. 00:07:46.778 --> 00:07:48.040 And I go back to the cancer 00:07:48.100 --> 00:07:49.360 population again, 00:07:49.420 --> 00:07:50.079 because some of the 00:07:50.120 --> 00:07:52.321 specific things we see is 00:07:52.420 --> 00:07:55.781 with breast cancers, axillary syndrome, 00:07:55.860 --> 00:07:58.221 axillary cording can be one 00:07:58.281 --> 00:07:59.242 thing that comes out and it 00:07:59.401 --> 00:08:01.463 really limits shoulder range of motion. 00:08:01.502 --> 00:08:02.762 So it's on our differential 00:08:02.802 --> 00:08:03.862 diagnosis list. 00:08:04.262 --> 00:08:05.884 Is this from the cancer or 00:08:05.963 --> 00:08:06.963 is this patient in 00:08:07.677 --> 00:08:08.016 you know, 00:08:08.877 --> 00:08:10.817 age group and has comorbidities 00:08:10.858 --> 00:08:12.658 that this might be a frozen shoulder. 00:08:13.079 --> 00:08:13.918 We need to work through 00:08:13.939 --> 00:08:15.639 those things and meet their goals there. 00:08:16.019 --> 00:08:16.980 And certainly if there's 00:08:17.019 --> 00:08:19.201 been any sort of pelvic radiation, 00:08:19.600 --> 00:08:20.641 it can decrease the range 00:08:20.682 --> 00:08:21.701 of motion of the hip, 00:08:22.041 --> 00:08:24.062 which the pain might not be at the hip. 00:08:24.142 --> 00:08:25.583 It might be at the lumbar spine, 00:08:25.622 --> 00:08:26.524 or it might be in a 00:08:26.584 --> 00:08:28.644 different angle or a different area. 00:08:29.324 --> 00:08:30.665 And there's always the 00:08:31.004 --> 00:08:32.586 challenges with cancer of 00:08:32.645 --> 00:08:33.826 some of the chemo brains, 00:08:33.946 --> 00:08:35.947 that fogginess and the fatigue. 00:08:36.942 --> 00:08:38.563 But with all of these populations, 00:08:38.703 --> 00:08:41.105 even though it sounds like, oh, 00:08:41.145 --> 00:08:42.385 these are special, 00:08:42.726 --> 00:08:43.466 what do we do from a 00:08:43.626 --> 00:08:45.187 cardiovascular perspective? 00:08:45.628 --> 00:08:46.708 It all comes back to the 00:08:46.749 --> 00:08:47.269 American Heart 00:08:47.288 --> 00:08:49.471 Association's 40 minutes of 00:08:49.630 --> 00:08:52.072 moderate activity most days of the week. 00:08:52.511 --> 00:08:53.932 We just mix it up a little 00:08:53.952 --> 00:08:55.394 bit and maybe spread it out 00:08:55.413 --> 00:08:58.115 for moms who are close to 00:08:58.176 --> 00:08:59.576 that delivering mark. 00:08:59.616 --> 00:09:01.437 They might be a little short of breath. 00:09:02.057 --> 00:09:02.578 We do that. 00:09:02.658 --> 00:09:03.519 We do the same thing with 00:09:03.578 --> 00:09:04.679 our oncology patients. 00:09:04.759 --> 00:09:06.400 And then we modify and use a 00:09:07.205 --> 00:09:08.926 rating of perceived exertion 00:09:08.985 --> 00:09:10.947 to be able to better manage 00:09:10.988 --> 00:09:12.668 where they're at with their symptoms. 00:09:12.749 --> 00:09:14.110 But I would say those are 00:09:14.129 --> 00:09:15.812 the biggest things I see. 00:09:15.912 --> 00:09:17.552 And I am not a lymphedema therapist, 00:09:17.592 --> 00:09:19.114 but if we talk about the cancer, 00:09:19.134 --> 00:09:20.775 there is also that piece of things. 00:09:21.416 --> 00:09:22.456 I have great colleagues that 00:09:22.496 --> 00:09:23.697 I refer to out for that, 00:09:23.738 --> 00:09:24.698 but sometimes there's still 00:09:24.739 --> 00:09:25.980 that orthopedic piece that 00:09:26.019 --> 00:09:26.820 needs to be done. 00:09:26.840 --> 00:09:27.941 Yeah. 00:09:27.980 --> 00:09:29.282 So it sounds as if this is 00:09:29.322 --> 00:09:30.143 paying attention to the 00:09:30.182 --> 00:09:30.962 patient population, 00:09:31.003 --> 00:09:32.083 the person you're sitting in front of, 00:09:32.303 --> 00:09:33.284 understanding what things 00:09:33.384 --> 00:09:34.546 could commonly and do 00:09:34.605 --> 00:09:35.547 commonly happen to those 00:09:35.586 --> 00:09:36.827 types of people and understanding 00:09:37.552 --> 00:09:38.393 what you as a physical 00:09:38.413 --> 00:09:39.234 therapist need to 00:09:39.293 --> 00:09:40.716 understand to get the most 00:09:40.796 --> 00:09:41.596 out of them in terms of 00:09:41.658 --> 00:09:42.938 education or intervention. 00:09:42.979 --> 00:09:44.160 So it sounds like it's 00:09:44.181 --> 00:09:46.344 really understanding is where it starts. 00:09:46.948 --> 00:09:48.190 Understanding is where it starts, 00:09:48.230 --> 00:09:49.311 and I think a healthy dose 00:09:49.350 --> 00:09:51.432 of humility in all of us to say, 00:09:51.451 --> 00:09:52.993 this is what I know, 00:09:53.013 --> 00:09:54.514 and this is what I don't know, 00:09:54.673 --> 00:09:56.235 and if I'm not the person to help you, 00:09:56.394 --> 00:09:57.336 I will get you to the 00:09:57.375 --> 00:09:58.897 person that's more qualified. 00:09:59.317 --> 00:10:00.357 With my patients who've had 00:10:00.398 --> 00:10:01.899 gynecological cancers, yes, 00:10:01.979 --> 00:10:03.539 I can do the pelvic health rehab, 00:10:03.899 --> 00:10:04.740 but if they also have a 00:10:04.780 --> 00:10:06.182 lower extremity lymphedema, 00:10:06.522 --> 00:10:07.802 I'm very clear to say that 00:10:07.863 --> 00:10:09.163 is not in my wheelhouse. 00:10:09.496 --> 00:10:10.517 But I have fantastic 00:10:10.576 --> 00:10:11.418 colleagues who are going to 00:10:11.457 --> 00:10:12.778 take care of you and we're 00:10:12.798 --> 00:10:13.619 going to coordinate and 00:10:13.658 --> 00:10:14.578 make sure everything 00:10:14.899 --> 00:10:16.279 happens the way it's supposed to. 00:10:16.360 --> 00:10:18.460 So I do think we all want to 00:10:18.500 --> 00:10:19.201 help our patients, 00:10:19.221 --> 00:10:20.240 but we also need to be 00:10:20.301 --> 00:10:21.721 humble enough to say you're 00:10:21.761 --> 00:10:22.282 going to get better 00:10:22.322 --> 00:10:23.422 outcomes with someone else 00:10:24.001 --> 00:10:25.363 on this particular aspect. 00:10:26.024 --> 00:10:29.005 You had touched on physical therapy, 00:10:29.145 --> 00:10:30.386 being able to address 00:10:30.486 --> 00:10:31.547 issues related to pregnancy 00:10:31.567 --> 00:10:33.687 and postpartum care. 00:10:34.227 --> 00:10:36.089 I feel like this is a good 00:10:36.188 --> 00:10:37.649 trend is we're seeing more 00:10:37.688 --> 00:10:38.809 and more people be very, 00:10:38.850 --> 00:10:39.830 very vocal in our 00:10:39.870 --> 00:10:41.971 profession and outside of 00:10:42.051 --> 00:10:44.652 this being a need and not a want. 00:10:44.672 --> 00:10:45.731 This is not a nice to have. 00:10:45.773 --> 00:10:46.873 This should be a need to have. 00:10:47.489 --> 00:10:49.389 It absolutely should be a need to have. 00:10:49.450 --> 00:10:50.509 If you think about that 00:10:50.610 --> 00:10:52.071 change in center of mass 00:10:52.130 --> 00:10:53.812 that occurs over nine months, 00:10:53.871 --> 00:10:55.172 and then the muscles that 00:10:55.211 --> 00:10:56.812 get stretched in different ways, 00:10:57.293 --> 00:10:58.393 it's not like you deliver a 00:10:58.432 --> 00:10:59.894 baby and everything is this 00:10:59.994 --> 00:11:01.534 really perfect rubber band 00:11:01.554 --> 00:11:02.774 that goes back to normal. 00:11:03.115 --> 00:11:04.275 There are things that change. 00:11:04.316 --> 00:11:05.296 The ribs are not going to 00:11:05.336 --> 00:11:06.496 come back down after the 00:11:06.537 --> 00:11:08.397 diaphragm's been pushed up forever. 00:11:09.118 --> 00:11:12.259 And in terms of pelvic health dysfunction, 00:11:12.839 --> 00:11:13.058 Yes. 00:11:13.158 --> 00:11:14.099 Maybe it's okay for the 00:11:14.139 --> 00:11:15.178 first four to six weeks. 00:11:15.259 --> 00:11:16.139 If you had a vaginal 00:11:16.179 --> 00:11:18.399 delivery and muscles got really stretched, 00:11:19.039 --> 00:11:20.759 maybe some incontinence is normal there, 00:11:20.799 --> 00:11:22.240 but it should not go on for 00:11:22.280 --> 00:11:23.500 a prolonged period. 00:11:24.020 --> 00:11:25.941 And the sad part of it is, 00:11:26.120 --> 00:11:28.022 is most of the time the baby has, 00:11:28.461 --> 00:11:30.121 you know, X day follow-up, 00:11:30.182 --> 00:11:31.642 two week follow-up, one month, 00:11:31.721 --> 00:11:33.222 and they have these check-in points. 00:11:33.763 --> 00:11:34.023 You know, 00:11:34.082 --> 00:11:35.102 the person who delivered 00:11:35.182 --> 00:11:36.383 generally gets a six week 00:11:36.462 --> 00:11:38.523 follow-up and it's mostly, uh, 00:11:39.183 --> 00:11:41.423 our tissues healed enough to, um, 00:11:42.471 --> 00:11:44.472 participate in sexual activity again? 00:11:45.113 --> 00:11:46.774 And are you experiencing any 00:11:46.833 --> 00:11:48.575 symptoms of postpartum depression? 00:11:48.914 --> 00:11:50.135 And from my perspective, 00:11:50.255 --> 00:11:51.496 postpartum depression isn't 00:11:51.697 --> 00:11:54.398 always identified that early on. 00:11:54.498 --> 00:11:56.678 It can come on quite a bit later. 00:11:57.239 --> 00:11:58.139 And, you know, 00:11:58.200 --> 00:11:59.360 they're not even necessarily 00:11:59.421 --> 00:12:00.120 screening for 00:12:00.910 --> 00:12:01.792 urinary symptoms. 00:12:01.971 --> 00:12:03.173 And I'm not saying everybody 00:12:03.232 --> 00:12:04.173 because I'm sure there are 00:12:04.493 --> 00:12:05.793 physicians out there who are, 00:12:05.874 --> 00:12:07.535 but there are these needs. 00:12:07.696 --> 00:12:09.277 And the American Congress of 00:12:09.376 --> 00:12:10.817 Obstetrics and Gynecology 00:12:10.957 --> 00:12:11.979 actually published a 00:12:12.019 --> 00:12:13.500 position paper that they 00:12:13.539 --> 00:12:14.779 called the fourth trimester, 00:12:15.120 --> 00:12:16.140 which speaks to some of 00:12:16.181 --> 00:12:17.302 these things as they should 00:12:17.361 --> 00:12:18.442 be more mandatory. 00:12:18.863 --> 00:12:20.484 and not a nice to have anymore. 00:12:20.604 --> 00:12:22.203 And we are way behind other 00:12:22.264 --> 00:12:23.924 countries in terms of our 00:12:24.065 --> 00:12:25.904 maternal care following delivery. 00:12:26.245 --> 00:12:27.865 Scandinavian countries, France, 00:12:27.905 --> 00:12:29.606 they have much better and 00:12:29.687 --> 00:12:31.907 more structured ways of doing this. 00:12:31.986 --> 00:12:33.768 So I would like to see in my 00:12:33.827 --> 00:12:35.408 lifetime a big switch to 00:12:35.448 --> 00:12:36.908 that being a standard screening. 00:12:37.129 --> 00:12:38.250 I mean, what's the harm in it? 00:12:38.409 --> 00:12:39.629 If everything's going well, 00:12:40.029 --> 00:12:41.510 you've at least had a check-in point, 00:12:41.551 --> 00:12:42.451 you have a baseline. 00:12:42.755 --> 00:12:44.197 But if something's not going well, 00:12:44.517 --> 00:12:45.977 you may be able to identify 00:12:46.038 --> 00:12:47.739 it soon versus it turning 00:12:47.778 --> 00:12:49.059 into this chronic low back 00:12:49.120 --> 00:12:50.600 pain that becomes more 00:12:50.660 --> 00:12:52.221 debilitating over the 00:12:52.282 --> 00:12:53.863 course of your kids growing up. 00:12:54.243 --> 00:12:55.604 And now you can't keep up with them. 00:12:55.644 --> 00:12:57.745 You can't do the activities 00:12:57.785 --> 00:12:59.046 with them that you'd like to. 00:12:59.125 --> 00:13:00.527 So if we could catch it early, 00:13:00.667 --> 00:13:01.807 it would be so much easier 00:13:01.868 --> 00:13:03.089 to treat versus letting it 00:13:03.428 --> 00:13:04.470 become a chronic condition. 00:13:06.225 --> 00:13:06.306 Now, 00:13:06.346 --> 00:13:08.106 when we get our physical therapy license, 00:13:08.147 --> 00:13:09.769 we can treat almost anybody. 00:13:10.028 --> 00:13:11.149 But what specialized 00:13:11.230 --> 00:13:12.390 training do you think 00:13:12.510 --> 00:13:14.692 should be focused on the 00:13:14.731 --> 00:13:15.993 physical therapist working 00:13:16.173 --> 00:13:16.734 in women's health? 00:13:17.621 --> 00:13:17.861 Well, 00:13:17.981 --> 00:13:20.023 I do think the physical therapist 00:13:20.423 --> 00:13:21.942 that's working in women's health, 00:13:22.003 --> 00:13:23.163 it sort of depends upon 00:13:23.263 --> 00:13:25.384 which niche they decide to go to. 00:13:26.464 --> 00:13:26.764 You know, 00:13:26.943 --> 00:13:28.644 I started out my career thinking 00:13:28.684 --> 00:13:29.384 I was only going to do 00:13:29.445 --> 00:13:30.504 prenatal postpartum. 00:13:30.585 --> 00:13:33.985 And my first boss out of school said, well, 00:13:34.066 --> 00:13:35.966 you can do that if you also 00:13:36.046 --> 00:13:37.187 do incontinence. 00:13:37.206 --> 00:13:39.726 And I was like, well, postpartum women, 00:13:39.886 --> 00:13:41.727 they have that issue some of the time. 00:13:41.768 --> 00:13:42.648 So great. 00:13:43.383 --> 00:13:44.504 You know, I'm going to do that. 00:13:44.605 --> 00:13:46.366 And then it turned into this other niche. 00:13:46.466 --> 00:13:47.908 And then once you start 00:13:47.948 --> 00:13:48.789 seeing pelvic health, 00:13:48.870 --> 00:13:50.292 it's sort of like drinking 00:13:50.331 --> 00:13:51.092 from the fire hose. 00:13:51.153 --> 00:13:52.455 If you're on the front end of it, 00:13:52.794 --> 00:13:53.375 they're like, oh, 00:13:53.416 --> 00:13:54.957 we have someone who treats incontinence. 00:13:54.998 --> 00:13:56.058 And now you're getting men 00:13:56.119 --> 00:13:57.240 and you're getting, okay, 00:13:57.279 --> 00:13:57.921 you're incontinent, 00:13:57.941 --> 00:13:58.982 but you've had oncology. 00:13:59.462 --> 00:14:00.203 things going on. 00:14:00.303 --> 00:14:02.304 So, you know, we've developed over time, 00:14:02.325 --> 00:14:03.907 but if you're going to go more oncology, 00:14:04.307 --> 00:14:06.788 you would want coursework in that regard. 00:14:07.229 --> 00:14:08.750 Anybody who wants to work 00:14:08.791 --> 00:14:11.092 with women who are pregnant or postpartum, 00:14:11.413 --> 00:14:12.634 I think going to courses 00:14:12.774 --> 00:14:14.816 for that are really critical. 00:14:14.995 --> 00:14:16.017 And this is where we talk 00:14:16.037 --> 00:14:17.096 about the Cross Academy. 00:14:17.157 --> 00:14:18.418 I know the Academy of Public 00:14:18.458 --> 00:14:20.100 Health has a certification 00:14:20.139 --> 00:14:21.941 program for that, but you know, 00:14:22.000 --> 00:14:23.623 the Academy of Orthopedics 00:14:23.682 --> 00:14:25.124 has also had independent 00:14:25.163 --> 00:14:26.325 study courses for that 00:14:26.669 --> 00:14:27.691 And that was actually the 00:14:27.750 --> 00:14:28.931 first independent study 00:14:28.990 --> 00:14:30.392 course I took out of school 00:14:30.773 --> 00:14:32.293 was a women's health issue 00:14:32.474 --> 00:14:34.695 one that I think was six monographs. 00:14:34.735 --> 00:14:36.676 But it addressed the osteoporosis, 00:14:36.716 --> 00:14:39.677 the adolescent development pieces. 00:14:39.778 --> 00:14:41.219 And that helped guide me to 00:14:41.318 --> 00:14:42.980 branch out into some of 00:14:43.019 --> 00:14:44.780 those other areas as well. 00:14:45.341 --> 00:14:46.782 So it's really figuring out, 00:14:46.802 --> 00:14:47.602 do you want to do an 00:14:48.383 --> 00:14:50.104 overarching theme or do you 00:14:50.144 --> 00:14:51.245 want to go in one area? 00:14:51.725 --> 00:14:53.206 one specific direction and 00:14:53.246 --> 00:14:54.086 that can guide it. 00:14:54.167 --> 00:14:55.668 But a solid basis of 00:14:55.749 --> 00:14:57.549 orthopedics is absolutely 00:14:57.990 --> 00:15:00.351 crucial because I, you know, 00:15:00.413 --> 00:15:01.072 said I was going to do 00:15:01.113 --> 00:15:03.634 women's health and I was like, okay, 00:15:03.715 --> 00:15:04.375 I'm doing this, 00:15:04.956 --> 00:15:06.057 but I need to be better at 00:15:06.096 --> 00:15:07.057 the spine and the hips. 00:15:07.077 --> 00:15:08.219 So I actually came back and 00:15:08.239 --> 00:15:09.840 did an orthopedic residency 00:15:10.280 --> 00:15:11.221 and I still practice my 00:15:11.280 --> 00:15:12.562 orthopedic skills every day. 00:15:12.623 --> 00:15:13.582 It's like you said earlier, 00:15:13.623 --> 00:15:14.903 I look at the person in 00:15:14.965 --> 00:15:16.605 front of me and say, okay, 00:15:17.148 --> 00:15:18.208 These are your concerns. 00:15:18.249 --> 00:15:19.188 This is what I'm seeing. 00:15:19.328 --> 00:15:20.730 How do we get to your goals? 00:15:21.190 --> 00:15:22.551 So I haven't buried any of 00:15:22.610 --> 00:15:23.851 those skills in any way, 00:15:23.912 --> 00:15:24.613 but it gives me an 00:15:24.753 --> 00:15:27.073 overarching ability to to 00:15:27.114 --> 00:15:28.995 have that those nuanced conversations. 00:15:29.315 --> 00:15:29.455 Yeah. 00:15:29.816 --> 00:15:31.297 When you're talking about all these things, 00:15:31.697 --> 00:15:31.917 right. 00:15:31.937 --> 00:15:32.857 Statistics are great. 00:15:32.898 --> 00:15:34.678 We can throw statistics left and right. 00:15:34.698 --> 00:15:35.278 There's lots of them 00:15:35.438 --> 00:15:36.399 mentioned position paper. 00:15:36.440 --> 00:15:37.821 I'm sure it's full of statistics, 00:15:38.181 --> 00:15:39.782 but I want a story or two. 00:15:40.402 --> 00:15:41.621 an example of a success 00:15:41.662 --> 00:15:43.363 story or something that you 00:15:43.423 --> 00:15:44.903 came across that related to, hey, 00:15:44.943 --> 00:15:46.864 being able to combine these skills, 00:15:47.283 --> 00:15:48.325 really it's combining your 00:15:48.365 --> 00:15:49.644 profession as a physical therapist, 00:15:49.884 --> 00:15:51.525 but being able to combine 00:15:51.546 --> 00:15:53.405 these skills in terms of 00:15:53.466 --> 00:15:54.886 women's health or pelvic 00:15:54.907 --> 00:15:57.227 health and orthopedics to get a really, 00:15:57.307 --> 00:15:59.107 really great outcome for a person. 00:15:59.268 --> 00:16:00.908 When I say that, what comes to mind? 00:16:02.802 --> 00:16:03.982 I guess there's a number of 00:16:04.264 --> 00:16:05.844 women that I've seen over the years. 00:16:06.384 --> 00:16:07.663 I collaborate with my sports 00:16:07.725 --> 00:16:09.164 colleagues downstairs and 00:16:09.205 --> 00:16:10.625 they have a running clinic 00:16:10.664 --> 00:16:11.966 where they'll look at. 00:16:12.186 --> 00:16:13.426 So sports ortho, 00:16:13.546 --> 00:16:15.167 those things go together right away, 00:16:15.567 --> 00:16:16.527 but they'll actually do a 00:16:16.586 --> 00:16:18.727 running assessment and they 00:16:18.768 --> 00:16:19.648 are trained in screening 00:16:19.687 --> 00:16:21.207 for pelvic health dysfunction. 00:16:21.707 --> 00:16:23.009 So they may say, okay. 00:16:23.828 --> 00:16:24.850 we don't think your hip pain 00:16:24.889 --> 00:16:25.830 is coming from your low 00:16:25.870 --> 00:16:26.551 back because you've had 00:16:26.591 --> 00:16:28.672 lots of PT for that and it 00:16:28.731 --> 00:16:29.491 hasn't gotten better. 00:16:29.552 --> 00:16:30.653 So let's have you do a 00:16:30.793 --> 00:16:31.952 pelvic health consult. 00:16:32.494 --> 00:16:33.413 So I've had a number of 00:16:33.494 --> 00:16:35.595 people who were having pain 00:16:35.695 --> 00:16:36.775 with running or having 00:16:36.816 --> 00:16:37.897 leaking during running or 00:16:37.956 --> 00:16:39.738 both that actually were 00:16:39.798 --> 00:16:41.057 able to complete marathons 00:16:41.177 --> 00:16:43.440 without having any leaking 00:16:43.519 --> 00:16:45.260 and without having the back pain. 00:16:45.900 --> 00:16:45.941 Um, 00:16:46.912 --> 00:16:47.432 And like I said, 00:16:47.451 --> 00:16:48.653 that's more than one patient. 00:16:48.673 --> 00:16:50.995 I know if you ask for a specific example, 00:16:51.054 --> 00:16:52.636 but that's more than one patient. 00:16:53.136 --> 00:16:54.138 Another patient that comes 00:16:54.197 --> 00:16:55.698 to mind is a patient who 00:16:55.759 --> 00:16:57.620 had quite a bit of low back pain, 00:16:57.660 --> 00:16:59.642 which wound up being SI 00:16:59.841 --> 00:17:01.144 joint dysfunction when I 00:17:01.183 --> 00:17:02.605 did all the clusters of testing. 00:17:03.044 --> 00:17:04.526 And she was a yoga instructor, 00:17:04.746 --> 00:17:06.147 pregnant with twins and a 00:17:06.208 --> 00:17:07.429 high risk pregnancy. 00:17:07.568 --> 00:17:09.690 So we had to be a little 00:17:09.750 --> 00:17:11.511 careful with how we went 00:17:11.951 --> 00:17:13.794 along and we got her low 00:17:13.814 --> 00:17:15.634 back pain under control before delivery. 00:17:16.915 --> 00:17:18.837 Usually when I'm seeing someone prenatally, 00:17:19.038 --> 00:17:20.339 I'm proactive and I reach 00:17:20.400 --> 00:17:21.421 out to the referring 00:17:21.500 --> 00:17:23.041 provider because they're 00:17:23.083 --> 00:17:24.344 not real thrilled about 00:17:24.903 --> 00:17:26.846 direct access when there's 00:17:26.885 --> 00:17:27.987 another human on board. 00:17:28.468 --> 00:17:28.968 And I'll say, 00:17:28.988 --> 00:17:30.130 I would like to see this 00:17:30.150 --> 00:17:32.311 patient six weeks after delivery. 00:17:32.632 --> 00:17:33.772 Will you sign off on that? 00:17:33.833 --> 00:17:34.614 And they usually do. 00:17:34.693 --> 00:17:36.476 And I schedule them for, 00:17:36.715 --> 00:17:37.957 as we talked about earlier, 00:17:37.997 --> 00:17:40.220 more of that proactive piece of things. 00:17:40.279 --> 00:17:40.400 So 00:17:40.875 --> 00:17:43.818 She came back in, we really, 00:17:44.038 --> 00:17:44.578 and she had to have a 00:17:44.598 --> 00:17:46.280 C-section because of twins. 00:17:46.881 --> 00:17:48.883 So we got her C-section scar 00:17:48.923 --> 00:17:50.064 taken care of and she was 00:17:50.104 --> 00:17:52.566 back to instructing yoga by 00:17:52.566 --> 00:17:53.906 10 weeks postpartum. 00:17:53.987 --> 00:17:54.907 And she didn't think that 00:17:54.948 --> 00:17:56.148 that was anything she would 00:17:56.189 --> 00:17:58.750 be able to do just based on how quickly 00:17:59.317 --> 00:18:00.337 With the pregnancy, 00:18:00.498 --> 00:18:02.118 she wasn't able to do that. 00:18:02.239 --> 00:18:03.858 So she was just ecstatic to 00:18:03.898 --> 00:18:06.940 be able to do that in and of itself. 00:18:07.500 --> 00:18:08.920 And then this last example 00:18:08.960 --> 00:18:10.220 happened quite a long time ago, 00:18:10.259 --> 00:18:11.101 but it sticks with me 00:18:11.121 --> 00:18:14.221 because it was a little embarrassing. 00:18:14.621 --> 00:18:15.721 I was treating a patient who 00:18:15.741 --> 00:18:17.821 had had pelvic floor pain 00:18:18.201 --> 00:18:19.403 since she delivered her son 00:18:19.403 --> 00:18:19.803 25 years earlier. 00:18:21.824 --> 00:18:23.846 So she had not had sex in 25 00:18:23.846 --> 00:18:24.887 years and we got her to the 00:18:24.928 --> 00:18:26.549 point that she was able to do that. 00:18:26.890 --> 00:18:28.291 And it wasn't just her pelvic floor, 00:18:28.332 --> 00:18:29.433 it's her hips had gotten 00:18:29.513 --> 00:18:31.056 stiff and she wasn't mobile 00:18:31.415 --> 00:18:32.477 in her lumbar spine. 00:18:32.498 --> 00:18:33.298 So we got her a good 00:18:33.378 --> 00:18:35.060 exercise program besides 00:18:35.101 --> 00:18:37.022 the pelvic floor things and 00:18:37.423 --> 00:18:38.184 discharged her. 00:18:38.285 --> 00:18:39.626 Six months later, I see her. 00:18:40.196 --> 00:18:41.498 in the Overture Center, 00:18:41.538 --> 00:18:43.259 which is our symphony building. 00:18:43.599 --> 00:18:44.941 And she comes running up to 00:18:45.000 --> 00:18:47.343 me and she's like, thank you. 00:18:47.502 --> 00:18:48.963 I've been able to have sex again, 00:18:49.044 --> 00:18:49.865 very loud. 00:18:50.444 --> 00:18:51.546 So there's all these people 00:18:51.605 --> 00:18:53.468 around that are staring at us like, 00:18:53.667 --> 00:18:55.430 oh my gosh, what does that woman do? 00:18:55.990 --> 00:18:58.592 And I was taken aback and I'm like, well, 00:18:58.711 --> 00:18:59.732 that's fantastic. 00:18:59.833 --> 00:19:01.273 I'm so happy that you've had 00:19:01.314 --> 00:19:02.075 those outcomes. 00:19:02.154 --> 00:19:04.696 And then my husband who's beat red is like, 00:19:04.997 --> 00:19:06.157 we need to find our seats. 00:19:06.258 --> 00:19:06.679 So- 00:19:07.259 --> 00:19:08.359 That one sticks with me 00:19:08.440 --> 00:19:10.201 because he and I have a system. 00:19:10.240 --> 00:19:10.361 Now, 00:19:10.401 --> 00:19:12.221 if I see a patient or a past patient 00:19:12.261 --> 00:19:13.363 coming up, you know, 00:19:13.403 --> 00:19:14.663 I kind of tug on my hair 00:19:14.722 --> 00:19:17.204 and he he splits so that 00:19:17.265 --> 00:19:18.425 that doesn't happen again, 00:19:18.445 --> 00:19:19.486 because I think he was more 00:19:19.566 --> 00:19:21.067 embarrassed than I was. 00:19:21.146 --> 00:19:21.426 Yeah, 00:19:21.887 --> 00:19:24.429 I think that's just a testament to 00:19:24.469 --> 00:19:25.769 the impact that something 00:19:25.789 --> 00:19:26.430 like that could have. 00:19:26.609 --> 00:19:29.471 I mean, 25 years, 25 years. 00:19:29.652 --> 00:19:31.232 That's that's not a small deal. 00:19:32.067 --> 00:19:32.448 It's not, 00:19:32.508 --> 00:19:34.710 but a lot of women are told this 00:19:34.789 --> 00:19:36.551 is normal after pregnancy. 00:19:37.031 --> 00:19:39.233 So, you know, just deal with it. 00:19:39.294 --> 00:19:40.595 But that is not the case. 00:19:40.634 --> 00:19:42.395 And I'm glad over, you know, 00:19:42.435 --> 00:19:43.656 the 20 or so years of my 00:19:43.737 --> 00:19:45.278 career that that message is 00:19:45.378 --> 00:19:47.539 changing because initially it was always, 00:19:47.599 --> 00:19:49.442 well, you just have to deal with it. 00:19:49.801 --> 00:19:51.423 Wetting your pants after you have a baby, 00:19:51.564 --> 00:19:52.384 completely normal. 00:19:52.503 --> 00:19:54.365 Organs falling out, completely normal. 00:19:54.786 --> 00:19:56.146 Your back pain will go away 00:19:56.186 --> 00:19:57.788 within four to six weeks after, 00:19:57.909 --> 00:19:59.650 and it's 10 years down the line. 00:20:00.387 --> 00:20:01.169 And they're like, 00:20:01.229 --> 00:20:02.630 I can't deal with this pain anymore. 00:20:02.650 --> 00:20:04.010 And I just say, well, when did it start? 00:20:04.050 --> 00:20:06.893 Well, during my second or third pregnancy. 00:20:07.413 --> 00:20:11.195 So that story is changing gratefully. 00:20:11.215 --> 00:20:13.057 And there's not as much 00:20:13.137 --> 00:20:14.298 stigma attached to these 00:20:14.358 --> 00:20:15.480 things anymore either. 00:20:15.539 --> 00:20:16.820 I think we as a profession 00:20:16.840 --> 00:20:18.402 are doing a better job of saying, 00:20:18.801 --> 00:20:19.102 you know. 00:20:20.063 --> 00:20:21.064 This is not normal. 00:20:21.104 --> 00:20:23.066 Like when the CrossFit video 00:20:23.346 --> 00:20:24.548 went viral that said, 00:20:24.567 --> 00:20:26.970 I lifted so much weight, I wet my pants. 00:20:27.410 --> 00:20:28.490 My colleagues in the Pelvic 00:20:28.571 --> 00:20:30.693 Health Academy were quick 00:20:30.733 --> 00:20:31.954 to respond to that and be like, 00:20:32.015 --> 00:20:32.955 that is not normal. 00:20:32.976 --> 00:20:34.738 That is not something we want happening. 00:20:34.798 --> 00:20:35.979 So I think we as a 00:20:36.038 --> 00:20:37.240 profession have taken 00:20:37.721 --> 00:20:39.182 bigger stances and more 00:20:39.221 --> 00:20:40.644 assertive stances on what 00:20:40.784 --> 00:20:41.924 is and is not normal. 00:20:42.368 --> 00:20:43.369 And I think we found these 00:20:43.430 --> 00:20:44.590 other venues like what you 00:20:44.611 --> 00:20:45.912 do with your podcast that 00:20:46.752 --> 00:20:48.034 resonate with people that 00:20:48.094 --> 00:20:50.096 we didn't have 20 years ago 00:20:50.115 --> 00:20:51.676 when it was mostly, you know, 00:20:51.696 --> 00:20:53.259 the print sorts of things. 00:20:53.298 --> 00:20:54.960 So we have more vehicles by 00:20:55.000 --> 00:20:56.821 which to deliver our messages as well. 00:20:57.195 --> 00:20:57.375 Yeah. 00:20:57.875 --> 00:20:57.977 Uh, 00:20:58.037 --> 00:20:59.678 speaking about vehicles to deliver 00:20:59.718 --> 00:21:00.077 messages, 00:21:00.117 --> 00:21:00.998 you said one of the first 00:21:01.057 --> 00:21:04.921 resources that you, uh, used, um, 00:21:05.381 --> 00:21:06.582 was an Academy of 00:21:06.642 --> 00:21:08.363 orthopedic physical therapy resource. 00:21:08.742 --> 00:21:09.324 There's, you know, 00:21:09.344 --> 00:21:10.284 just looking on their website, 00:21:10.344 --> 00:21:11.744 ortho pt.org and the 00:21:11.825 --> 00:21:12.905 independent study course section, 00:21:12.925 --> 00:21:14.606 the female athlete through the lifespan. 00:21:14.626 --> 00:21:15.548 That's a course right there. 00:21:15.567 --> 00:21:15.548 32.2. 00:21:17.048 --> 00:21:17.608 What are some other 00:21:17.628 --> 00:21:18.869 resources you might recommend? 00:21:18.910 --> 00:21:19.789 Cause if someone's still 00:21:19.849 --> 00:21:21.530 listening 20 minutes in, they're saying, 00:21:21.590 --> 00:21:21.852 okay, 00:21:22.531 --> 00:21:23.893 She's got me. 00:21:23.952 --> 00:21:25.294 I call it on the end of the diving board. 00:21:25.314 --> 00:21:26.134 She's got me on the end of 00:21:26.154 --> 00:21:26.595 the diving board. 00:21:26.634 --> 00:21:27.496 I'm ready to jump in. 00:21:27.996 --> 00:21:28.715 What are some things that 00:21:28.756 --> 00:21:29.537 you've found useful? 00:21:30.417 --> 00:21:30.577 Well, 00:21:30.637 --> 00:21:33.240 I have found the Academy of Pelvic 00:21:33.299 --> 00:21:34.780 Health's courses for 00:21:34.881 --> 00:21:36.362 prenatal postpartum as well 00:21:36.402 --> 00:21:38.462 as pelvic health to be extremely, 00:21:39.423 --> 00:21:40.744 extremely beneficial. 00:21:41.363 --> 00:21:42.903 They do have certification programs, 00:21:42.924 --> 00:21:43.944 which when I went through, 00:21:44.605 --> 00:21:45.346 they weren't a thing. 00:21:45.567 --> 00:21:46.847 And I did not do the 00:21:46.907 --> 00:21:48.549 remedial work to get those 00:21:48.589 --> 00:21:49.871 certifications just because 00:21:50.290 --> 00:21:51.372 life happened with kids. 00:21:52.053 --> 00:21:54.234 But they are both excellent resources. 00:21:54.695 --> 00:21:55.777 Not to continue to stay 00:21:55.817 --> 00:21:57.097 completely with the APTA, 00:21:57.137 --> 00:21:58.419 Herman and Wallace also 00:21:58.558 --> 00:22:00.240 have an incredible... 00:22:01.233 --> 00:22:03.816 And very similar certification program. 00:22:03.915 --> 00:22:05.997 And then both of those resources, 00:22:06.116 --> 00:22:07.878 I consider them to be very, 00:22:08.058 --> 00:22:10.579 very reputable resources. 00:22:10.640 --> 00:22:12.402 They have more niche topics too. 00:22:12.541 --> 00:22:13.642 Once you get past there, 00:22:13.682 --> 00:22:15.384 like there's some oncology 00:22:15.443 --> 00:22:16.584 and then there's male and 00:22:16.624 --> 00:22:17.904 you can dive deeper into 00:22:17.944 --> 00:22:18.905 those sorts of things. 00:22:19.465 --> 00:22:20.987 I also think any course on 00:22:21.027 --> 00:22:22.428 menopause and how the 00:22:22.488 --> 00:22:23.848 hormones change and what it 00:22:23.888 --> 00:22:24.809 does to bone health. 00:22:25.369 --> 00:22:26.951 I think any therapist would 00:22:26.990 --> 00:22:28.291 benefit from that because 00:22:28.672 --> 00:22:29.712 if you're not in women's health, 00:22:30.009 --> 00:22:31.509 you're probably still seeing 00:22:31.588 --> 00:22:33.430 the 50 plus subset. 00:22:33.829 --> 00:22:35.430 And it might be important to know, 00:22:35.869 --> 00:22:37.050 you know, what you're dealing with, 00:22:37.131 --> 00:22:39.191 what changes may be happening there. 00:22:39.611 --> 00:22:41.092 So those are all incredible things. 00:22:41.251 --> 00:22:42.991 I love going to CSM and like 00:22:43.432 --> 00:22:44.932 picking off the menu, the buffet, 00:22:44.972 --> 00:22:45.593 so to speak, 00:22:45.813 --> 00:22:47.073 all sorts of different things, 00:22:47.153 --> 00:22:48.492 because that helps to drive 00:22:48.553 --> 00:22:51.253 me into specific areas as well. 00:22:51.594 --> 00:22:52.775 But as you get into some of 00:22:52.835 --> 00:22:55.894 these niche areas, you can also, you know, 00:22:55.934 --> 00:22:57.435 go into more oncology things. 00:22:57.476 --> 00:22:58.695 So I know sometimes my 00:22:59.304 --> 00:23:01.285 Oncology colleagues will be like, okay, 00:23:01.325 --> 00:23:02.506 this association is doing 00:23:02.586 --> 00:23:04.406 this and PT registration is 00:23:04.446 --> 00:23:05.468 less than a physician's. 00:23:05.827 --> 00:23:06.848 Might you be interested? 00:23:06.868 --> 00:23:09.270 The ISHWISH, 00:23:09.330 --> 00:23:11.251 which is the Sexual Health Society, 00:23:11.751 --> 00:23:12.792 I've done some programming 00:23:12.833 --> 00:23:13.534 through there because when 00:23:13.554 --> 00:23:14.554 you get into pelvic health, 00:23:14.953 --> 00:23:15.615 you have that. 00:23:16.494 --> 00:23:18.376 Really solid basis of lumbar 00:23:18.457 --> 00:23:19.497 and sacral spine. 00:23:19.837 --> 00:23:20.678 Crucial if you're going to 00:23:20.698 --> 00:23:22.839 be seeing prenatal, postpartum, 00:23:22.920 --> 00:23:23.740 and just getting some of 00:23:23.779 --> 00:23:24.800 the creativity involved. 00:23:25.140 --> 00:23:26.101 of treatments in there. 00:23:26.141 --> 00:23:28.203 So there are so many options 00:23:28.263 --> 00:23:29.044 that are out there. 00:23:29.064 --> 00:23:30.685 I would just say if you are 00:23:30.705 --> 00:23:32.387 an in-person learner, 00:23:32.689 --> 00:23:34.269 you're going to have those options. 00:23:34.349 --> 00:23:35.531 I'm a kinesthetic learner, 00:23:35.571 --> 00:23:37.574 so I really like those in-person things. 00:23:38.335 --> 00:23:39.296 But if you feel like you can 00:23:39.316 --> 00:23:40.317 get it from webinars, 00:23:40.356 --> 00:23:41.397 there's tons of those. 00:23:41.438 --> 00:23:42.559 There's melded learning. 00:23:43.000 --> 00:23:44.161 Again, 20 years ago, 00:23:44.201 --> 00:23:46.243 it was mostly you go in person or you do 00:23:46.865 --> 00:23:48.205 a read independent study, 00:23:48.266 --> 00:23:50.586 but now we have that melded version, 00:23:50.626 --> 00:23:53.407 which can help with defraying, you know, 00:23:53.728 --> 00:23:55.148 cost of needing a hotel 00:23:55.189 --> 00:23:56.528 room for X number of nights, 00:23:56.648 --> 00:23:57.489 those sorts of things. 00:23:57.548 --> 00:23:59.049 But there are a lot of 00:23:59.250 --> 00:24:00.730 really smart PTs out there 00:24:00.769 --> 00:24:02.151 before I could out there 00:24:02.191 --> 00:24:02.951 that I've learned from. 00:24:03.351 --> 00:24:04.231 I couldn't even begin to 00:24:04.311 --> 00:24:05.252 name all of them because I 00:24:05.272 --> 00:24:06.452 would inadvertently leave 00:24:06.512 --> 00:24:07.713 some of them off the list. 00:24:07.794 --> 00:24:09.015 But, you know, 00:24:09.095 --> 00:24:10.777 connect with somebody who's interested, 00:24:11.477 --> 00:24:13.519 shadow them if you have that opportunity, 00:24:13.778 --> 00:24:14.358 and, you know, 00:24:14.519 --> 00:24:15.460 get together a really 00:24:15.759 --> 00:24:16.881 robust group of people that 00:24:16.901 --> 00:24:18.481 want to talk about the same thing. 00:24:19.222 --> 00:24:20.304 We have journal clubs here 00:24:20.364 --> 00:24:21.604 for our public health team. 00:24:21.625 --> 00:24:23.266 And in our orthopedic team, 00:24:23.306 --> 00:24:24.807 we also will discuss new 00:24:24.886 --> 00:24:26.147 articles and things like that. 00:24:26.228 --> 00:24:26.307 So 00:24:26.743 --> 00:24:27.845 It doesn't always have to be 00:24:27.865 --> 00:24:28.905 the really formal. 00:24:29.006 --> 00:24:32.068 I think some formality is necessary, 00:24:32.128 --> 00:24:33.210 but if you get in there and 00:24:33.250 --> 00:24:34.230 you love it and you don't 00:24:34.250 --> 00:24:34.770 know where to go, 00:24:34.830 --> 00:24:35.892 just connect with people 00:24:35.991 --> 00:24:37.854 who are like-minded and are 00:24:37.874 --> 00:24:38.775 going to help you get those 00:24:38.835 --> 00:24:39.895 resources and help you when 00:24:39.915 --> 00:24:40.876 you get to a stuck point. 00:24:40.916 --> 00:24:42.298 Because even when we know the stuff, 00:24:42.317 --> 00:24:43.558 there might be a little 00:24:43.598 --> 00:24:44.680 twist on the patient that 00:24:44.720 --> 00:24:45.780 you haven't seen before. 00:24:46.942 --> 00:24:47.923 And those are your best 00:24:48.002 --> 00:24:49.744 resources in those instances. 00:24:49.765 --> 00:24:50.204 Yeah. 00:24:50.373 --> 00:24:50.853 Great advice. 00:24:50.873 --> 00:24:51.094 All right. 00:24:51.114 --> 00:24:52.193 Last thing we do on 00:24:52.334 --> 00:24:53.515 orthostatic here is called 00:24:53.955 --> 00:24:54.855 words of wisdom. 00:24:55.416 --> 00:24:56.537 So what words of wisdom 00:24:56.557 --> 00:24:57.117 would you want to leave 00:24:57.157 --> 00:24:58.179 with the audience today? 00:24:58.199 --> 00:24:59.759 It can be a personal mantra, 00:24:59.799 --> 00:25:00.720 soapbox statement. 00:25:01.141 --> 00:25:02.321 What would you want to wrap up with? 00:25:03.041 --> 00:25:04.682 I would just say the day you 00:25:04.722 --> 00:25:06.023 want to stop learning is 00:25:06.104 --> 00:25:07.365 the day you should hang up 00:25:07.404 --> 00:25:08.726 being a physical therapist 00:25:08.786 --> 00:25:10.887 because things are always changing. 00:25:12.189 --> 00:25:13.529 That's the great thing about 00:25:13.650 --> 00:25:15.730 science and research and us 00:25:15.810 --> 00:25:16.451 learning more. 00:25:16.471 --> 00:25:16.511 So 00:25:17.313 --> 00:25:18.633 If you no longer have a 00:25:18.673 --> 00:25:20.193 desire to keep learning and 00:25:20.273 --> 00:25:21.294 pushing yourself to be the 00:25:21.334 --> 00:25:22.074 best you can be, 00:25:22.535 --> 00:25:23.454 it might be time to 00:25:23.515 --> 00:25:25.015 consider hanging up the hat. 00:25:25.536 --> 00:25:26.455 That might sound harsh. 00:25:27.476 --> 00:25:28.856 That's a great way to look at it, 00:25:28.896 --> 00:25:30.176 but challenges you to be a 00:25:30.297 --> 00:25:31.076 lifelong learner, 00:25:31.096 --> 00:25:31.958 which is a phrase we love 00:25:31.978 --> 00:25:32.958 to use in this profession. 00:25:33.998 --> 00:25:34.978 Carrie, appreciate your time. 00:25:35.018 --> 00:25:35.499 Thanks for coming on 00:25:35.558 --> 00:25:36.759 Orthostatic and sharing your knowledge. 00:25:37.378 --> 00:25:38.680 Oh, thank you for having me, Jimmy. 00:25:38.700 --> 00:25:39.500 This has been fun.