WEBVTT

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All right.

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Welcome to Hands On, Hands Off.

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Today,

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we are diving into a topic that's

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often overlooked but deeply impactful,

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and that is the role of

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gender in OMPT practice.

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I'm your host today, Moyo Tillery,

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and joining me is Dr. Sarah Shaver,

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whose work and insights are

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helping us rethink how

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gender dynamics shape

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patient provider

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interactions in manual therapy.

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Dr. Shaver, welcome to the show.

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Thank you.

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I'm excited to be here to

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talk about gender and physical therapy.

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Outstanding.

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It's great to see you.

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So let's start with a little background.

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Can you just briefly

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introduce yourself and your

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journey into orthopedic

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manual physical therapy?

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Yeah.

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So my name is Sarah Shaver.

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I use she her pronouns and

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I've been practicing for

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about nine years now.

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I did my DPT at Husson

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University in Maine.

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I went on to do an

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orthopedic residency and

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become OCS certified.

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I did that out in Oregon.

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And then I gleefully moved

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back to the East Coast to

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Boston University where I

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did my fellowship in

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orthopedic manual physical therapy.

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And I am currently at the

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tail end of my SCD program

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at Bellin College.

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But in the meantime,

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I am working full time

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treating in a clinic in

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Providence in an outpatient

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orthopedic setting,

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working with a lot of young athletes,

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predominantly female or of

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the LGBTQIA plus community.

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But this topic of gender in

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practice is one that is

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near and dear to my heart.

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And I feel pretty passionate

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about its involvement and

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consideration in the role

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of health care in general,

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but even more specifically

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to physical therapy and LMPT.

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Yeah, I mean,

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I think you've queued us up

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perfectly with your

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background and your current

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work environment to dive

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right into this topic.

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So let's do it.

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What inspired your interest

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in exploring gender

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dynamics and then gender

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dynamics specific to OMPT?

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And perhaps before we even

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go deeper in our discussion,

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can we just level set for the listeners?

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Can you help us define

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gender in this context and

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perhaps why it's important

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to distinguish gender from

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sex when discussing clinical care?

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Yes.

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So, yeah,

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I think it is really important

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first to differentiate

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between gender and sex.

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For the majority of this podcast,

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when we refer to females

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and males and men and women,

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we're going to be referring

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to the cis female and the cis male.

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And that is those assigned

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female at birth and those

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assigned male at birth.

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Right.

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That is their sex.

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We're going to speak in this

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way largely because of how

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research has been conducted

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up until this point.

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Research today is still

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grossly and overwhelming

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lacking for the transgender,

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gender fluid and non-binary community.

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I fully recognize and

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validate that community.

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I'm a member of the LGBTQIA

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community myself,

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but for the purpose of this podcast,

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because of how research has

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been conducted,

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we'll be using male and

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female to talk about the

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cis male and the cis female.

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So the sex assigned at birth

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by the provider.

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That's awesome.

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Thank you so much for grounding us there.

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I know that when you and I chatted before,

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we talked about some of the

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things that maybe

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catapulted you into this

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line of research and work and practice.

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Some of them involving

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existing discrepancies,

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gender-related discrepancy in

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medicine and healthcare,

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but in PT specifically,

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and maybe some of your

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personal experiences,

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meaning you've observed

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some powerful antidotes in

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your clinical work,

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particularly around maybe

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female providers feeling

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somewhat misunderstood or

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invalidated by their patients.

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And again,

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that patient provider relationship.

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And, you know,

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leaning into your presentation at AOMT,

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you reviewed a large

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retrospective analysis with

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a huge number of cases,

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over three million.

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So can you tell us a little

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bit about maybe what you took from that?

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What did the data reveal

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about patient provider

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gender discordance?

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And how does it compare to

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maybe what we see in

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broader health care literature?

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Can you just kind of take us

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into your world there?

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Totally.

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So there were so many things

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that contributed to me

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heading down this road of

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interest and passion.

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And the first is that overwhelmingly,

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especially when entering my fellowship,

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a huge overwhelming

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majority of my direct mentors were male.

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I really actually had to

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think deep into this to

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realize I had one mentor

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early on in my residency that was female.

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But overwhelmingly in the world of OMPT,

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My official mentors were male.

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I didn't have a lot of

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female representation from

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the mentor side of things.

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And it feels kind of similar

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when you walk into the AOMT conference.

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Sure,

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there are females walking around and

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they're there.

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But overwhelmingly,

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we see a male presence.

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And we often see that even

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reflected on the stage in our presenters.

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So I think that that is

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improving with time.

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Um, so that was, that was the first thing,

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just feeling like,

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even though I'm technically

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or theoretically in a field,

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female dominated field,

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then when we look at OMPT,

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we see a much more male dominated,

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dominated specialty,

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but even more so than that,

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even more meaningful to me

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is that whether it's a

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result of internalized bias,

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internalized sexism or overt bias.

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I'm not sure.

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It's probably a combination of both,

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but overwhelmingly I've

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personally watched so many patients.

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I have personally experienced,

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I have seen and felt the

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collective experience of

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the female of walking out

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of a healthcare appointment

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and watching that patient

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feel invalidated, misunderstood,

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belittled, gaslit.

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Oh, maybe it isn't that bad.

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It's, it's, it's, I, um,

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isn't as bad as I thought it was.

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I'm not, it wasn't taken seriously.

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My tests were negative.

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I was dismissed.

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I'm not sure I got to say

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everything I wanted to say.

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I'm not sure they understood

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what I was saying.

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I just overwhelmingly was

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watching females feel

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invalidated and

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misunderstood when they

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left a patient appointment.

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And we see this reflected

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quite frequently when

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females intentionally go

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out of their way to request treatment.

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another female provider

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they're seeking someone

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that they think has the

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capacity to understand

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their perspective a little

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bit more and who perhaps

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will listen to their

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perspective a little bit

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more and listen I fully

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believe that physical

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therapists are in this

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field with good intention

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but this collective

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experience is so broad that

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it's impossible to ignore

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I mean, when we look at the ED,

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we see that men's pain is

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taken more seriously.

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They're triaged more quickly

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than the female.

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We see that female patients

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are interrupted more

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frequently than the male provider.

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We have all this data to say that somehow,

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for some reason,

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females aren't quite

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receiving the same

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treatment or response when

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they're seeing their healthcare provider

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And we can maybe perhaps

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extrapolate that to physical therapy,

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and we'll talk about that later.

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And then really what was the

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straw that broke the camel's back,

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if you will,

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is the study that you alluded to,

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which was by Wallace et al.

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And it was one point three

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million patients.

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It was a retrospective

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analysis looking at patient

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outcomes between surgeon

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and patient based on sex

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concordance or disconcordance.

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So whether or not the

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surgeon and the patient

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were of same or differing sex.

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And what was found, again,

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a retrospective analysis of

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over one point three

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million patients is that

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when the male surgeon was

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male and the patient was female,

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the patient within thirty

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days of surgery was at a

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statistically significantly

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increased risk for death,

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worse overall

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post-operative outcomes and

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readmission to hospital.

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And that was the first

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peer-reviewed paper that I

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had read that truly just

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validated and almost

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slapped me in the face of

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this is happening.

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It is undeniable and it is real.

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And that kind of cascaded my

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interest and my involvement, I think,

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in this area of physical

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therapy and OMPT.

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Yeah, that's scary.

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That's really scary.

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And anyone listening,

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you know at least one cisgendered female,

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right?

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You know at least one.

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And so if you're feeling

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separated or not connecting

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to this topic,

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you know at least one person, right,

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who could be the person who

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experiences these negative

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outcomes because of a lack

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of conversation around this topic.

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So this is serious and this

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is very scary and everybody

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has to be thinking about this.

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So I'm thankful to have, you know,

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clinicians and leaders and

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innovators like yourself in

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this space to bring us all

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to a level of practice that

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we should be at the level, obviously,

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of a fellow of manual therapy,

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but any clinician, even at entry level.

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So this is a crucial conversation.

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And you said something, Dr. Shaver,

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about kind of what led to this,

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the things you were hearing

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female patients say,

00:09:53.676 --> 00:09:55.496
and the female experience.

00:09:57.578 --> 00:09:58.480
And at the foundation of

00:09:58.519 --> 00:10:00.802
that is seeking concordance

00:10:01.462 --> 00:10:03.144
and seeking understanding.

00:10:03.605 --> 00:10:05.187
And I think that part of it,

00:10:05.307 --> 00:10:06.607
just to contextualize it

00:10:06.628 --> 00:10:07.629
again for the listeners,

00:10:07.649 --> 00:10:08.750
if you're feeling separate

00:10:08.791 --> 00:10:11.813
from this topic, any human being, right,

00:10:11.894 --> 00:10:13.515
regardless of sex and gender,

00:10:14.397 --> 00:10:17.659
race and other identity differences,

00:10:17.940 --> 00:10:18.980
most people just stop.

00:10:19.461 --> 00:10:21.743
speak concordance and understanding.

00:10:21.783 --> 00:10:24.063
That's just human nature, right?

00:10:24.104 --> 00:10:26.424
So just trying to frame this

00:10:26.465 --> 00:10:28.524
work contextually in different ways,

00:10:29.046 --> 00:10:30.125
everyone has to connect to

00:10:30.166 --> 00:10:32.147
this topic because it is crucial, right?

00:10:32.246 --> 00:10:33.287
And we don't need our

00:10:33.307 --> 00:10:35.687
patients to suffer and outcomes,

00:10:37.369 --> 00:10:38.708
like you mentioned,

00:10:38.908 --> 00:10:40.370
be perpetuated because of a

00:10:40.429 --> 00:10:41.730
lack of knowledge, awareness,

00:10:41.931 --> 00:10:44.371
or tools to kind of right the ship,

00:10:45.052 --> 00:10:45.432
right?

00:10:46.272 --> 00:10:47.953
I know that in your work as well,

00:10:48.014 --> 00:10:48.794
Dr. Shaver,

00:10:48.855 --> 00:10:53.860
you have specific clinical

00:10:53.940 --> 00:10:57.363
examples to further help us

00:10:57.403 --> 00:10:59.465
connect to this data and

00:10:59.504 --> 00:11:01.868
this topic and this work.

00:11:02.368 --> 00:11:03.369
You and I talked a little

00:11:03.389 --> 00:11:05.951
bit about maybe more common

00:11:05.991 --> 00:11:07.033
trends that we've heard of

00:11:07.113 --> 00:11:08.014
as physical therapists.

00:11:09.495 --> 00:11:12.917
ACL injury, tears, female versus male.

00:11:14.136 --> 00:11:14.398
You know,

00:11:14.437 --> 00:11:15.477
I think most of us know it's

00:11:15.538 --> 00:11:18.539
maybe more common for some

00:11:18.600 --> 00:11:19.679
reasons that we're kind of

00:11:19.740 --> 00:11:22.260
taught in a narrowed focus way.

00:11:22.341 --> 00:11:23.902
Q angles increased, right?

00:11:23.961 --> 00:11:24.903
But there's more.

00:11:25.023 --> 00:11:25.863
Let's talk about that.

00:11:26.923 --> 00:11:27.604
Can you give us some

00:11:27.624 --> 00:11:28.624
clinical examples that

00:11:28.644 --> 00:11:29.404
you've seen in your

00:11:29.445 --> 00:11:30.325
practice or that you've

00:11:30.365 --> 00:11:31.625
read about in your research

00:11:31.645 --> 00:11:33.986
that helps us parse this

00:11:34.147 --> 00:11:35.427
out a little bit further?

00:11:35.467 --> 00:11:35.548
Sure.

00:11:36.629 --> 00:11:37.029
Totally.

00:11:37.791 --> 00:11:37.931
Um,

00:11:38.010 --> 00:11:39.631
so there's kind of two parts there and

00:11:39.672 --> 00:11:41.153
I'll start with the more

00:11:41.212 --> 00:11:42.974
broader question here.

00:11:43.095 --> 00:11:43.434
Um,

00:11:43.514 --> 00:11:45.056
and then I'll dive into the little bit

00:11:45.096 --> 00:11:47.177
more PT and ACL side of things.

00:11:47.758 --> 00:11:47.857
Um,

00:11:47.977 --> 00:11:50.440
so I would like to zoom out because I

00:11:50.480 --> 00:11:51.259
don't know that we can

00:11:51.660 --> 00:11:52.701
analyze where we currently

00:11:52.841 --> 00:11:53.782
are and figure out how to

00:11:53.802 --> 00:11:55.023
go forward without looking

00:11:55.082 --> 00:11:56.943
left and right and without

00:11:56.964 --> 00:11:57.904
looking backward.

00:11:58.544 --> 00:11:59.605
Um, and by that, I mean,

00:11:59.686 --> 00:12:00.527
I wanna talk about a couple

00:12:00.567 --> 00:12:01.567
examples where there's

00:12:01.908 --> 00:12:03.708
clear differences in sex

00:12:03.788 --> 00:12:05.090
based outcomes in physical

00:12:05.110 --> 00:12:06.250
or in healthcare.

00:12:07.532 --> 00:12:08.732
And it goes all the way back

00:12:08.812 --> 00:12:09.933
to nineteen ninety three

00:12:09.953 --> 00:12:10.953
because it wasn't until

00:12:11.014 --> 00:12:12.034
nineteen ninety three that

00:12:12.075 --> 00:12:13.076
women and minorities were

00:12:13.115 --> 00:12:14.155
required to be included in

00:12:14.176 --> 00:12:15.057
a medical research.

00:12:15.496 --> 00:12:17.577
So we have this huge body of

00:12:17.697 --> 00:12:19.519
data that is really was

00:12:19.538 --> 00:12:20.779
done on men patients,

00:12:20.840 --> 00:12:22.280
male patients that

00:12:22.341 --> 00:12:23.621
researchers and health care

00:12:23.642 --> 00:12:25.663
have just chose to assume

00:12:25.822 --> 00:12:27.283
perfectly extrapolates to

00:12:27.323 --> 00:12:29.284
the cisgendered female patient.

00:12:30.365 --> 00:12:31.886
And the truth is, is that it doesn't.

00:12:31.907 --> 00:12:32.527
And that's starting to

00:12:32.567 --> 00:12:33.807
become more and more clear.

00:12:33.847 --> 00:12:34.508
And unfortunately,

00:12:34.528 --> 00:12:35.989
we're seeing it come out in our outcomes.

00:12:36.481 --> 00:12:38.143
We can talk about the world

00:12:38.243 --> 00:12:39.224
of pharmacology,

00:12:39.884 --> 00:12:40.825
where women are nearly

00:12:40.904 --> 00:12:42.746
twofold greater risk of

00:12:42.807 --> 00:12:44.187
experiencing an adverse

00:12:44.207 --> 00:12:46.509
drug reaction across all

00:12:46.590 --> 00:12:47.769
drug classes and are

00:12:47.850 --> 00:12:49.371
significantly more likely

00:12:49.392 --> 00:12:50.653
to be hospitalized as a

00:12:50.732 --> 00:12:52.514
result of these adverse drug reactions.

00:12:53.073 --> 00:12:54.475
We can talk about females in

00:12:54.514 --> 00:12:55.755
the emergency department,

00:12:56.116 --> 00:12:57.277
where a female is more

00:12:57.317 --> 00:12:58.298
likely to be wrongfully

00:12:58.337 --> 00:13:00.320
discharged from the ED with

00:13:00.379 --> 00:13:02.581
symptoms of unstable angina

00:13:02.721 --> 00:13:03.942
or myocardial infarction.

00:13:03.961 --> 00:13:05.082
That risk increases if the

00:13:05.123 --> 00:13:06.024
patient is not white.

00:13:06.529 --> 00:13:07.451
We can talk about how a

00:13:07.530 --> 00:13:08.932
female presenting to the ED

00:13:08.972 --> 00:13:09.734
with a myocardial

00:13:09.754 --> 00:13:11.436
infarction is two to three

00:13:11.475 --> 00:13:12.758
times more likely to

00:13:12.857 --> 00:13:14.620
survive when being treated

00:13:14.799 --> 00:13:16.062
by a female provider.

00:13:17.102 --> 00:13:18.565
We can get away from the ED

00:13:19.065 --> 00:13:20.086
and we can talk about

00:13:20.527 --> 00:13:23.370
non-alcoholic septohepatitis or NASH,

00:13:23.451 --> 00:13:23.750
which is

00:13:24.201 --> 00:13:24.801
experienced,

00:13:24.921 --> 00:13:26.802
fifty percent more likely by females.

00:13:26.981 --> 00:13:27.942
However, men,

00:13:28.121 --> 00:13:29.621
despite controlling for all

00:13:29.662 --> 00:13:30.442
sorts of variables,

00:13:30.562 --> 00:13:31.923
are eleven point nine more

00:13:31.982 --> 00:13:33.663
likely to receive a liver

00:13:33.682 --> 00:13:35.764
transplant plant and women

00:13:35.803 --> 00:13:37.384
are more likely to die

00:13:37.443 --> 00:13:38.404
while waiting on the wait

00:13:38.424 --> 00:13:40.024
list for their liver transplant.

00:13:40.144 --> 00:13:40.924
They're more likely to be

00:13:40.985 --> 00:13:42.245
removed from the wait list

00:13:42.405 --> 00:13:43.265
altogether due to

00:13:43.285 --> 00:13:44.846
deterioration from condition,

00:13:45.346 --> 00:13:46.486
and they're more likely to

00:13:47.106 --> 00:13:48.326
just remain on the wait

00:13:48.346 --> 00:13:50.087
list indefinitely and

00:13:50.408 --> 00:13:51.628
unfortunately experience death.

00:13:52.207 --> 00:13:53.327
we can again we can zoom out

00:13:53.389 --> 00:13:54.109
even farther we can look

00:13:54.149 --> 00:13:55.068
farther left or farther

00:13:55.109 --> 00:13:56.889
right we can look at a

00:13:56.950 --> 00:13:58.149
retrospective analysis by

00:13:58.210 --> 00:13:59.910
doria rose looked at over

00:13:59.951 --> 00:14:00.971
fifty five thousand

00:14:01.030 --> 00:14:02.611
individuals and looked at

00:14:02.631 --> 00:14:03.491
the performance of

00:14:03.591 --> 00:14:05.072
sigmoidoscopy is right and

00:14:05.092 --> 00:14:05.793
whether they're performed

00:14:05.932 --> 00:14:07.374
adequately or inadequately

00:14:07.714 --> 00:14:08.433
and we see females

00:14:08.474 --> 00:14:09.854
significantly more likely

00:14:09.874 --> 00:14:10.754
to have a procedure that

00:14:10.774 --> 00:14:11.475
was performed that was

00:14:11.514 --> 00:14:13.515
deemed inadequate and of

00:14:13.556 --> 00:14:14.076
those that had an

00:14:14.155 --> 00:14:15.076
inadequate seizure they

00:14:15.096 --> 00:14:16.216
were three times more

00:14:16.297 --> 00:14:18.037
likely to go on to develop

00:14:18.256 --> 00:14:19.418
colorectal cancer

00:14:20.509 --> 00:14:22.150
And you mentioned earlier, right,

00:14:22.171 --> 00:14:22.931
this is scary.

00:14:22.951 --> 00:14:24.732
This feels terrifying to me

00:14:24.913 --> 00:14:28.774
as a cis woman that has

00:14:28.855 --> 00:14:31.035
health needs just like any other human.

00:14:31.556 --> 00:14:33.317
And I know in physical therapy,

00:14:33.437 --> 00:14:34.798
we're unlikely to be

00:14:34.898 --> 00:14:36.658
detecting on the regular

00:14:36.719 --> 00:14:38.921
colorectal cancer or heart attacks,

00:14:39.081 --> 00:14:39.380
right?

00:14:40.240 --> 00:14:43.462
And when I give this information to people,

00:14:43.562 --> 00:14:44.923
what is most commonly said

00:14:44.943 --> 00:14:46.164
to me by other therapists is,

00:14:47.078 --> 00:14:49.923
But physical therapy is different, right?

00:14:49.942 --> 00:14:51.586
We see our patients often

00:14:51.645 --> 00:14:52.847
two to three times a week.

00:14:52.888 --> 00:14:54.570
We see them for extended periods of time.

00:14:54.610 --> 00:14:56.152
We form relationships in

00:14:56.192 --> 00:14:57.214
ways other healthcare

00:14:57.254 --> 00:14:58.154
professionals don't.

00:14:58.515 --> 00:15:00.418
And listen, I hear you.

00:15:01.445 --> 00:15:03.066
But it is really difficult

00:15:03.426 --> 00:15:04.527
for me to believe that

00:15:04.667 --> 00:15:05.748
somehow we see these

00:15:05.788 --> 00:15:07.609
discrepancies in the rest of healthcare,

00:15:08.090 --> 00:15:09.630
and somehow we as physical

00:15:09.691 --> 00:15:11.231
therapists are immune.

00:15:11.831 --> 00:15:13.352
It's really difficult for me

00:15:13.393 --> 00:15:15.315
to believe that somehow,

00:15:15.674 --> 00:15:16.875
given our current society,

00:15:16.916 --> 00:15:19.457
that these biases haven't

00:15:19.498 --> 00:15:22.279
permeated or affected physical therapy.

00:15:22.740 --> 00:15:23.961
And it's really difficult

00:15:24.160 --> 00:15:27.163
for me to hear you dismiss it so easily.

00:15:28.908 --> 00:15:29.827
I think that brings us to a

00:15:29.868 --> 00:15:32.089
couple more PT specific examples.

00:15:32.129 --> 00:15:35.551
And the ACL is a classic one.

00:15:36.851 --> 00:15:37.971
It's commonly talked about

00:15:38.032 --> 00:15:40.153
how women are more likely

00:15:40.192 --> 00:15:41.253
to tear their ACL.

00:15:41.273 --> 00:15:43.094
They have wider childbearing hips.

00:15:43.114 --> 00:15:43.955
They have estrogen that

00:15:43.975 --> 00:15:45.375
makes their ligaments more lax.

00:15:45.394 --> 00:15:47.475
They have a greater Q angle, right?

00:15:47.495 --> 00:15:48.256
This is, I would say,

00:15:48.336 --> 00:15:50.197
probably commonly known and

00:15:50.236 --> 00:15:51.457
accepted language.

00:15:52.076 --> 00:15:52.615
However,

00:15:52.956 --> 00:15:53.937
when we look at that a little bit

00:15:53.976 --> 00:15:54.437
more closely,

00:15:54.476 --> 00:15:55.817
there's several variables

00:15:55.837 --> 00:15:57.339
that really should make us

00:15:57.399 --> 00:15:58.600
question that women are

00:15:58.620 --> 00:16:01.480
inherently more likely to tear their ACL.

00:16:02.001 --> 00:16:03.763
And the first is that we've

00:16:03.802 --> 00:16:05.344
watched over time the rate

00:16:05.384 --> 00:16:07.684
of male ACL tears decreasing.

00:16:08.018 --> 00:16:09.580
decline and we've seen the

00:16:09.600 --> 00:16:11.422
rate of female ACL tears

00:16:11.501 --> 00:16:12.964
either incline or stay the

00:16:13.004 --> 00:16:14.085
same kind of depending on

00:16:14.125 --> 00:16:15.145
what you're referencing.

00:16:15.787 --> 00:16:18.990
So why do we have this graph

00:16:19.030 --> 00:16:20.152
that doesn't match,

00:16:20.572 --> 00:16:21.953
especially when we have

00:16:22.274 --> 00:16:23.515
known and cited and

00:16:23.576 --> 00:16:26.679
researched ACL tear prevention protocols

00:16:27.259 --> 00:16:29.022
that have been designed for females,

00:16:29.062 --> 00:16:30.943
like the PEP program that the IOC,

00:16:30.984 --> 00:16:32.664
the International Olympic

00:16:32.725 --> 00:16:33.426
Committee put out.

00:16:33.745 --> 00:16:35.288
We have these known programs

00:16:35.307 --> 00:16:36.749
that can decrease ACL tears

00:16:36.788 --> 00:16:38.571
by the right of sixty to eighty percent,

00:16:38.591 --> 00:16:39.471
depending on the literature

00:16:39.490 --> 00:16:40.753
that you're looking at.

00:16:40.773 --> 00:16:41.852
And they're not being used.

00:16:42.374 --> 00:16:43.475
And again, my question is,

00:16:43.514 --> 00:16:45.616
why is that ignorance?

00:16:45.876 --> 00:16:48.399
Is that overt sexism?

00:16:48.580 --> 00:16:51.001
Is it subconscious bias?

00:16:53.359 --> 00:16:54.960
But inherently female ACL

00:16:54.980 --> 00:16:56.740
tears don't have to be at

00:16:57.000 --> 00:16:58.522
the rate that we are.

00:16:58.902 --> 00:17:00.142
And truly we could even back

00:17:00.202 --> 00:17:02.124
up even farther and we

00:17:02.163 --> 00:17:03.583
could look at studies of

00:17:03.644 --> 00:17:04.765
dancers that started when

00:17:04.805 --> 00:17:05.505
they were young.

00:17:05.845 --> 00:17:06.766
And the unique thing about

00:17:06.786 --> 00:17:08.047
these young dancers is that

00:17:08.126 --> 00:17:09.166
men and women often start

00:17:09.186 --> 00:17:10.688
dancing at the same age and

00:17:10.708 --> 00:17:12.169
they train for years.

00:17:12.628 --> 00:17:13.729
And what we see in dancers

00:17:13.788 --> 00:17:14.829
is that there's very little

00:17:14.869 --> 00:17:16.471
difference between males

00:17:16.510 --> 00:17:17.811
and females between their

00:17:17.852 --> 00:17:18.632
jumping mechanics.

00:17:19.053 --> 00:17:20.213
their landing mechanics

00:17:20.253 --> 00:17:21.013
between their quad to

00:17:21.134 --> 00:17:22.595
hamstring ratio and their

00:17:22.674 --> 00:17:24.576
ACL tear rates are about the same.

00:17:25.217 --> 00:17:28.699
You contrast that to something like soccer,

00:17:29.740 --> 00:17:30.799
where females are largely

00:17:30.859 --> 00:17:32.260
starting playing in their

00:17:32.381 --> 00:17:33.821
post-pubescent years.

00:17:34.001 --> 00:17:35.042
Males are starting to play

00:17:35.063 --> 00:17:36.523
in their pre-pubescent years.

00:17:37.144 --> 00:17:38.865
And we zoom out even farther

00:17:38.964 --> 00:17:40.326
and we see difference in

00:17:40.486 --> 00:17:41.646
strength training and kind

00:17:41.686 --> 00:17:43.127
of cultural upbringing in

00:17:44.402 --> 00:17:46.123
based off of gender, right?

00:17:46.343 --> 00:17:47.363
My brother was asked to

00:17:47.442 --> 00:17:49.523
stack wood and carry the groceries in.

00:17:49.544 --> 00:17:53.585
I was asked to sweep the ground, right?

00:17:53.924 --> 00:17:56.265
So even from a really super young age,

00:17:56.565 --> 00:17:59.465
we are strength training in

00:17:59.546 --> 00:18:02.446
a really gender segregated way,

00:18:03.007 --> 00:18:05.248
our males and our females differently.

00:18:06.423 --> 00:18:07.944
And then we're starting our

00:18:08.025 --> 00:18:09.567
sports at different times

00:18:09.666 --> 00:18:10.848
based off of women,

00:18:10.949 --> 00:18:12.250
females go through puberty

00:18:12.330 --> 00:18:15.335
one to two-ish years before males, right?

00:18:15.375 --> 00:18:16.636
So males are strength

00:18:16.656 --> 00:18:17.397
training and doing their

00:18:17.417 --> 00:18:18.940
sport at the peak of their puberty,

00:18:18.980 --> 00:18:19.941
at the peak of the time

00:18:19.980 --> 00:18:20.961
where their muscle building

00:18:20.981 --> 00:18:22.565
and bone density mass is

00:18:22.704 --> 00:18:23.486
most influential.

00:18:24.008 --> 00:18:25.848
females are starting after their puberty.

00:18:26.189 --> 00:18:27.190
And then we're socializing

00:18:27.210 --> 00:18:27.690
and training them

00:18:27.730 --> 00:18:28.431
differently and not

00:18:28.471 --> 00:18:29.511
initiating and providing

00:18:29.551 --> 00:18:30.112
them with the same

00:18:30.152 --> 00:18:33.114
resources and knowledge to

00:18:33.294 --> 00:18:34.375
strength train and work on

00:18:34.394 --> 00:18:35.375
these mechanics, right?

00:18:36.556 --> 00:18:37.195
So I really like to

00:18:37.215 --> 00:18:37.997
challenge the idea that

00:18:38.017 --> 00:18:38.896
women are just inherently

00:18:38.936 --> 00:18:41.038
more likely to tear their ACLs.

00:18:41.078 --> 00:18:43.619
And maybe this comes down to

00:18:44.240 --> 00:18:45.481
societal expectations,

00:18:45.541 --> 00:18:49.503
how we are gendering tasks

00:18:49.523 --> 00:18:51.905
that we give our children and even

00:18:53.202 --> 00:18:53.942
um,

00:18:53.962 --> 00:18:55.324
the information that we're giving them

00:18:55.384 --> 00:18:57.023
in sports and in physical therapy.

00:18:57.044 --> 00:18:58.144
I feel really frustrated.

00:18:58.163 --> 00:18:58.923
It happens all the time.

00:18:59.444 --> 00:19:00.444
Females come into the clinic

00:19:00.484 --> 00:19:02.085
and they're like, oh, you know,

00:19:02.144 --> 00:19:03.125
it's just like women are

00:19:03.145 --> 00:19:04.846
more likely to tear their ACL.

00:19:04.885 --> 00:19:05.806
I'm the fourth person on the

00:19:05.865 --> 00:19:06.865
soccer team this year.

00:19:06.885 --> 00:19:08.126
That's torn their ACL.

00:19:08.166 --> 00:19:09.047
Like it's just going to

00:19:09.067 --> 00:19:10.227
happen to the other side.

00:19:10.267 --> 00:19:11.567
You know, it's just more likely a woman.

00:19:11.587 --> 00:19:12.448
And there's this inherent

00:19:12.468 --> 00:19:13.807
sense of I'm weaker.

00:19:14.087 --> 00:19:14.748
I'm frailer.

00:19:14.827 --> 00:19:15.888
I'm been defeated.

00:19:16.189 --> 00:19:17.288
I'm probably going to tear

00:19:17.308 --> 00:19:18.229
the other one next year

00:19:18.249 --> 00:19:18.689
because that's what

00:19:18.729 --> 00:19:19.750
happened to women in soccer.

00:19:20.349 --> 00:19:20.470
Um,

00:19:21.836 --> 00:19:22.478
I would really like to

00:19:22.498 --> 00:19:23.559
challenge that notion.

00:19:25.548 --> 00:19:26.489
Yeah,

00:19:27.230 --> 00:19:28.730
you're challenging it right now in

00:19:28.769 --> 00:19:29.211
real time.

00:19:29.391 --> 00:19:29.951
It's happening.

00:19:29.971 --> 00:19:33.172
And it starts with increased awareness.

00:19:33.393 --> 00:19:35.993
I sincerely appreciate your zooming.

00:19:36.213 --> 00:19:38.815
You're zooming out and taking us back to,

00:19:39.875 --> 00:19:43.737
you know, where the yardstick is off.

00:19:43.817 --> 00:19:45.278
If we're measuring something

00:19:45.357 --> 00:19:48.598
against something that is not accurate,

00:19:48.898 --> 00:19:50.099
everything from there is

00:19:50.140 --> 00:19:51.099
going to be inaccurate.

00:19:51.119 --> 00:19:51.621
And that's

00:19:52.361 --> 00:19:52.821
essentially,

00:19:52.862 --> 00:19:54.605
it sounds like that's what we're seeing.

00:19:54.925 --> 00:19:56.868
And that is really powerful

00:19:57.651 --> 00:19:59.394
to kind of back it up and say that.

00:19:59.854 --> 00:20:00.655
And, you know,

00:20:02.137 --> 00:20:03.039
I've never thought about

00:20:03.240 --> 00:20:04.102
what you just said,

00:20:04.162 --> 00:20:05.503
which is we're training

00:20:06.876 --> 00:20:08.018
kids, right?

00:20:09.259 --> 00:20:10.159
I've never thought about the

00:20:10.199 --> 00:20:12.401
biomechanical implication

00:20:12.560 --> 00:20:14.221
of boys do this and girls

00:20:14.261 --> 00:20:16.242
do that and gendering and

00:20:16.343 --> 00:20:17.624
roles and things like that.

00:20:17.683 --> 00:20:18.964
I mean, that is really powerful.

00:20:19.005 --> 00:20:19.965
Maybe others have,

00:20:20.046 --> 00:20:22.327
but I find that really

00:20:22.367 --> 00:20:24.249
insightful within the

00:20:24.288 --> 00:20:25.509
context of this conversation,

00:20:25.569 --> 00:20:27.931
but of course, after that, beyond that.

00:20:28.070 --> 00:20:31.012
And continuing to zoom out,

00:20:31.534 --> 00:20:32.493
you said something that I

00:20:32.534 --> 00:20:35.836
find also really powerful, which is

00:20:37.345 --> 00:20:38.125
It's an excuse.

00:20:38.224 --> 00:20:39.365
We as physical therapists

00:20:39.405 --> 00:20:40.786
are part of the health care system.

00:20:41.006 --> 00:20:43.406
And so whenever, you know,

00:20:43.446 --> 00:20:44.907
and I think in the company

00:20:44.948 --> 00:20:46.008
of fellows in this

00:20:46.048 --> 00:20:47.308
community of practice where

00:20:47.368 --> 00:20:48.689
I think we tend to think

00:20:48.729 --> 00:20:50.190
outside the box by default,

00:20:50.250 --> 00:20:51.470
which is sometimes why we

00:20:51.509 --> 00:20:52.770
pursue fellowship training is.

00:20:53.451 --> 00:20:55.010
whenever I hear something is

00:20:55.270 --> 00:20:57.471
inherent or like you're

00:20:57.511 --> 00:20:58.932
predisposed to something

00:20:59.632 --> 00:21:00.832
especially when it comes

00:21:00.932 --> 00:21:03.472
with um the context of

00:21:03.512 --> 00:21:04.573
something really narrow

00:21:04.613 --> 00:21:05.893
like gender or height or

00:21:06.053 --> 00:21:08.094
age or race or upbringing

00:21:08.134 --> 00:21:09.913
or it just it's a red flag

00:21:09.933 --> 00:21:11.874
for me so I I appreciate

00:21:11.913 --> 00:21:12.773
that you're pushing back

00:21:12.814 --> 00:21:14.654
and challenging this this

00:21:14.835 --> 00:21:16.474
well you know she's gonna

00:21:16.494 --> 00:21:18.015
be more lax because she's a

00:21:18.055 --> 00:21:19.296
dancer or she's gonna be

00:21:19.336 --> 00:21:20.695
more flexible because she's

00:21:20.736 --> 00:21:21.576
good she's a dancer

00:21:22.175 --> 00:21:22.695
Maybe not.

00:21:23.376 --> 00:21:24.156
Maybe there's more.

00:21:24.297 --> 00:21:25.817
And what I'm hearing you say

00:21:25.836 --> 00:21:26.678
is that there is more.

00:21:27.917 --> 00:21:30.419
But the research to support

00:21:30.459 --> 00:21:31.740
that is lacking,

00:21:32.759 --> 00:21:34.461
at least specific to physical therapy.

00:21:35.201 --> 00:21:36.361
I have so many things...

00:21:37.954 --> 00:21:38.174
you know,

00:21:38.214 --> 00:21:39.895
that I want to ask you about and

00:21:39.915 --> 00:21:40.736
chat with you about.

00:21:40.796 --> 00:21:41.936
But for the sake of time,

00:21:42.656 --> 00:21:47.199
can you bring us into maybe

00:21:47.239 --> 00:21:48.118
where you are now,

00:21:48.199 --> 00:21:50.279
some of your parallel

00:21:50.319 --> 00:21:51.941
collaborations and maybe

00:21:52.121 --> 00:21:53.020
others that you've

00:21:53.800 --> 00:21:55.082
networked with and talked

00:21:55.102 --> 00:21:56.402
to who have worked in or

00:21:56.481 --> 00:21:57.762
around this space?

00:21:59.567 --> 00:22:01.429
What are those conversations like?

00:22:03.270 --> 00:22:04.471
What are you finding,

00:22:04.731 --> 00:22:07.233
whether it's in certain

00:22:07.253 --> 00:22:09.855
groups of athletes or certain ages?

00:22:10.717 --> 00:22:11.798
Can you just talk to us a

00:22:11.837 --> 00:22:12.498
little bit about the

00:22:12.538 --> 00:22:13.960
research side and the

00:22:14.000 --> 00:22:16.381
scholarship side of what's happening,

00:22:16.401 --> 00:22:17.301
what's developing,

00:22:17.362 --> 00:22:18.742
maybe where you see things

00:22:18.823 --> 00:22:20.003
going as far as your

00:22:20.064 --> 00:22:21.625
specific work in this area?

00:22:23.207 --> 00:22:24.087
Yeah, I mean...

00:22:25.919 --> 00:22:27.919
the scholarship in this area

00:22:28.118 --> 00:22:29.039
and the progression in this

00:22:29.119 --> 00:22:30.819
area is in a really really

00:22:31.019 --> 00:22:33.180
fun time um one of my

00:22:33.220 --> 00:22:35.121
favorite places to network

00:22:35.161 --> 00:22:36.340
and discuss with other

00:22:36.401 --> 00:22:38.060
clinicians and providers

00:22:38.300 --> 00:22:40.221
interdisciplinary is the

00:22:40.301 --> 00:22:42.061
female athlete athlete

00:22:42.102 --> 00:22:42.942
conference I'm going to

00:22:42.961 --> 00:22:44.182
give a little plug here

00:22:44.522 --> 00:22:45.502
female athlete conference

00:22:45.542 --> 00:22:47.123
happens in boston

00:22:47.522 --> 00:22:49.242
massachusetts every other

00:22:49.303 --> 00:22:49.884
year and it's an

00:22:49.963 --> 00:22:52.003
interdisciplinary conference

00:22:52.423 --> 00:22:55.987
full of physicians, orthopedics,

00:22:56.086 --> 00:22:57.307
physical therapists,

00:22:57.867 --> 00:22:59.390
nutritionists that are

00:22:59.430 --> 00:23:02.372
coming together to overall

00:23:02.451 --> 00:23:05.074
discuss physiology, pathology,

00:23:05.094 --> 00:23:06.634
and the treatment of truly

00:23:06.674 --> 00:23:07.435
the female patient,

00:23:07.476 --> 00:23:08.036
but a little bit more

00:23:08.076 --> 00:23:10.018
specifically the female athlete,

00:23:10.818 --> 00:23:11.778
and where I get to hear and

00:23:11.818 --> 00:23:12.859
talk to a lot of really

00:23:12.920 --> 00:23:14.821
cool researchers and hear

00:23:14.862 --> 00:23:17.223
some really novel research in the area.

00:23:17.784 --> 00:23:18.765
It was at this conference a

00:23:18.785 --> 00:23:19.685
couple years ago that my

00:23:19.726 --> 00:23:21.386
perception of very similar

00:23:22.230 --> 00:23:23.590
kind of concept, the ACL,

00:23:23.611 --> 00:23:24.431
my perception of

00:23:24.530 --> 00:23:26.333
concussions was challenged.

00:23:26.813 --> 00:23:29.394
I think really similarly to ACLs,

00:23:30.075 --> 00:23:31.076
providers often think about

00:23:31.135 --> 00:23:32.416
concussion and think, ah,

00:23:32.436 --> 00:23:33.636
females have worse outcomes

00:23:33.676 --> 00:23:34.837
when it comes to concussion.

00:23:35.198 --> 00:23:35.939
And I, you know what,

00:23:35.959 --> 00:23:37.599
I'm sure there's data that says that.

00:23:38.299 --> 00:23:39.500
But Christina Masters

00:23:39.861 --> 00:23:40.842
presented at the Female

00:23:40.902 --> 00:23:43.344
Athlete Conference and

00:23:43.403 --> 00:23:44.523
specializes in concussion

00:23:44.544 --> 00:23:45.105
and works for the NFL and

00:23:45.125 --> 00:23:46.846
the National Women's Soccer League.

00:23:47.165 --> 00:23:48.686
But she put out a paper in

00:23:50.781 --> 00:23:52.323
looking at over a thousand

00:23:52.343 --> 00:23:54.424
concussions from thirty

00:23:54.484 --> 00:23:56.125
different institutes and

00:23:56.346 --> 00:23:57.227
really challenged the

00:23:57.267 --> 00:23:58.067
notion that females have a

00:23:58.106 --> 00:23:59.307
worse prognosis because she

00:23:59.347 --> 00:24:01.890
found that within these D one schools,

00:24:02.470 --> 00:24:04.432
when time to concussion to

00:24:04.491 --> 00:24:06.113
referral and first seeing

00:24:06.133 --> 00:24:07.614
the provider was the same,

00:24:08.114 --> 00:24:09.174
the prognosis between the

00:24:09.214 --> 00:24:10.796
sexes was the same.

00:24:11.676 --> 00:24:12.676
She then went on to look at

00:24:12.698 --> 00:24:13.357
the same thing with the

00:24:13.397 --> 00:24:14.739
pediatric population and

00:24:14.798 --> 00:24:16.180
found the same outcome.

00:24:16.817 --> 00:24:18.498
This is just another topic

00:24:18.518 --> 00:24:19.698
where I constantly hear

00:24:19.758 --> 00:24:21.038
presented and talked about

00:24:21.098 --> 00:24:22.618
how women have worse outcomes.

00:24:22.700 --> 00:24:22.960
I mean,

00:24:22.980 --> 00:24:25.621
it's been drilled into my head for

00:24:25.641 --> 00:24:27.080
a really long period of

00:24:27.141 --> 00:24:28.942
time to really be

00:24:29.803 --> 00:24:32.463
questioned and not

00:24:32.503 --> 00:24:33.683
supported by this research

00:24:33.703 --> 00:24:35.025
that Christina Masters is doing.

00:24:35.384 --> 00:24:36.664
It's just another area where

00:24:36.724 --> 00:24:38.506
we're letting preconceived

00:24:38.546 --> 00:24:40.027
beliefs and notions

00:24:41.699 --> 00:24:43.759
have a strong influence on

00:24:43.900 --> 00:24:45.420
our practice because we

00:24:45.460 --> 00:24:46.779
haven't taken the time as a

00:24:46.839 --> 00:24:47.861
society or healthcare to

00:24:47.921 --> 00:24:50.961
really look at this sex specific data.

00:24:52.521 --> 00:24:53.162
But other,

00:24:53.501 --> 00:24:54.842
so Christina Masters did that

00:24:54.922 --> 00:24:56.262
work on concussions,

00:24:56.282 --> 00:24:56.962
and I'm sure she's

00:24:57.002 --> 00:24:58.383
continuing to research that.

00:24:59.183 --> 00:25:01.064
But also in this area, I mean,

00:25:01.084 --> 00:25:02.183
you can find references

00:25:02.223 --> 00:25:04.865
through the Australian Sport Institute,

00:25:05.285 --> 00:25:08.486
FASTR, F-A-S-T-R, through Stanford,

00:25:08.746 --> 00:25:09.125
where there's

00:25:09.655 --> 00:25:11.336
constantly updated research

00:25:11.356 --> 00:25:13.337
about female physiology and pathology.

00:25:13.377 --> 00:25:14.417
And it's one of the places I

00:25:14.458 --> 00:25:15.578
go to kind of look for some

00:25:15.659 --> 00:25:16.638
new female specific

00:25:16.679 --> 00:25:17.819
research or an area that

00:25:17.880 --> 00:25:19.361
I'm trying to learn more about.

00:25:21.821 --> 00:25:22.041
Yeah.

00:25:25.019 --> 00:25:26.319
Thank you for sprinkling

00:25:26.700 --> 00:25:29.201
some of those resources for us,

00:25:29.261 --> 00:25:29.962
for all of us.

00:25:32.265 --> 00:25:33.586
Appraising the evidence I

00:25:33.605 --> 00:25:34.948
think is something that we

00:25:35.087 --> 00:25:36.909
all as in this community of

00:25:36.929 --> 00:25:38.131
practice can really

00:25:38.171 --> 00:25:40.373
appreciate and bridging the

00:25:40.413 --> 00:25:41.733
gaps in where we are as

00:25:41.794 --> 00:25:43.035
individual practitioners

00:25:43.474 --> 00:25:44.355
relative to some of the

00:25:44.395 --> 00:25:47.318
topics that we talk about on this podcast,

00:25:47.338 --> 00:25:49.099
but obviously in clinical practice.

00:25:50.442 --> 00:25:51.321
I think you and I had

00:25:52.022 --> 00:25:55.644
another discussion where you, you know,

00:25:55.684 --> 00:25:56.885
provided some insight and

00:25:56.925 --> 00:25:58.928
really enlightened me on

00:25:59.969 --> 00:26:00.689
something that I think

00:26:00.729 --> 00:26:02.029
clinically I sort of

00:26:03.151 --> 00:26:04.412
witnessed and just

00:26:04.652 --> 00:26:07.173
uncomfortably brushed away as well,

00:26:08.535 --> 00:26:10.957
which is the use of manual

00:26:10.997 --> 00:26:13.679
therapy in chronic pain.

00:26:15.615 --> 00:26:16.076
And, you know,

00:26:16.317 --> 00:26:17.717
the impact of this being

00:26:17.797 --> 00:26:19.896
more negative towards women versus men or,

00:26:20.057 --> 00:26:21.278
you know, female versus male.

00:26:22.077 --> 00:26:24.038
Do you mind just telling,

00:26:24.598 --> 00:26:26.919
retelling that story from

00:26:26.979 --> 00:26:28.240
your perspective and just

00:26:28.380 --> 00:26:29.500
any other nuggets that you

00:26:29.539 --> 00:26:32.201
have around the topic of, you know,

00:26:33.500 --> 00:26:34.961
the maybe inconsistent use

00:26:35.181 --> 00:26:36.582
of or inappropriate use or

00:26:37.001 --> 00:26:38.561
disuse of manual therapy to

00:26:38.622 --> 00:26:39.561
address chronic pain,

00:26:39.602 --> 00:26:41.522
which has that influence on women?

00:26:42.796 --> 00:26:45.696
Yeah, so a couple of things come to mind.

00:26:45.777 --> 00:26:48.257
Women, anything can be disproven,

00:26:48.277 --> 00:26:49.698
but women often have more

00:26:49.738 --> 00:26:51.077
chronic pain than males.

00:26:51.617 --> 00:26:52.597
We see higher rates of

00:26:52.617 --> 00:26:53.778
things like cervicogenic headache,

00:26:54.318 --> 00:26:56.138
autoimmune diseases, right?

00:26:57.398 --> 00:26:59.160
So I think if I was to ask

00:26:59.180 --> 00:27:00.200
you to close your eyes and

00:27:00.240 --> 00:27:02.201
picture the chronic pain patient,

00:27:02.641 --> 00:27:03.921
I don't love that language,

00:27:03.941 --> 00:27:04.701
but picture a patient

00:27:04.721 --> 00:27:05.780
you've had with chronic pain,

00:27:06.461 --> 00:27:09.461
most providers probably picture a female.

00:27:10.762 --> 00:27:12.323
And a really recurrent motif

00:27:12.713 --> 00:27:14.115
I've seen in the clinic,

00:27:14.134 --> 00:27:16.214
it's kind of one of two

00:27:16.255 --> 00:27:17.316
things that more commonly

00:27:17.375 --> 00:27:18.355
are providers being like,

00:27:18.635 --> 00:27:19.936
this is a chronic pain patient.

00:27:20.336 --> 00:27:21.297
This is not someone we do

00:27:21.396 --> 00:27:22.458
manual therapy for.

00:27:22.657 --> 00:27:23.798
We need to do X, Y,

00:27:23.817 --> 00:27:25.138
and Z to address their pain,

00:27:25.499 --> 00:27:26.338
but we shouldn't do manual

00:27:26.378 --> 00:27:27.740
therapy for a chronic pain patient.

00:27:28.339 --> 00:27:29.160
And first I really want to

00:27:29.180 --> 00:27:30.760
challenge the notion that

00:27:30.820 --> 00:27:31.941
any one diagnosis,

00:27:32.122 --> 00:27:33.221
no one should have something.

00:27:33.771 --> 00:27:35.211
Similarly to every one of

00:27:35.231 --> 00:27:36.992
your patients shouldn't have one thing,

00:27:37.073 --> 00:27:37.393
right?

00:27:37.712 --> 00:27:38.032
We don't,

00:27:38.512 --> 00:27:41.394
we need to be individualizing our care,

00:27:41.693 --> 00:27:43.115
but this concept of, Ooh,

00:27:43.174 --> 00:27:44.615
hands off for chronic pain

00:27:44.634 --> 00:27:46.655
patients is

00:27:46.895 --> 00:27:49.056
disproportionately impacting

00:27:49.576 --> 00:27:50.576
female patients.

00:27:51.416 --> 00:27:53.097
It starts off with a tone of

00:27:53.238 --> 00:27:54.238
I'm inherently making a

00:27:54.278 --> 00:27:55.178
judgment and deciding you

00:27:55.198 --> 00:27:55.978
don't get this treatment.

00:27:56.778 --> 00:27:58.138
It's belittling.

00:27:58.875 --> 00:27:59.796
And doesn't allow for a

00:27:59.855 --> 00:28:00.997
thorough assessment because

00:28:01.017 --> 00:28:01.857
you've already made a

00:28:01.917 --> 00:28:02.758
decision based on a

00:28:02.818 --> 00:28:03.598
diagnosis and what

00:28:03.618 --> 00:28:04.480
treatment this patient is

00:28:04.519 --> 00:28:05.820
or isn't getting without

00:28:05.840 --> 00:28:08.682
considering their history,

00:28:08.884 --> 00:28:09.963
the other health care that

00:28:09.984 --> 00:28:12.787
they've received, other personal,

00:28:13.067 --> 00:28:14.087
socioeconomic,

00:28:14.167 --> 00:28:15.328
racial things that might be

00:28:15.368 --> 00:28:16.390
going on that we might need

00:28:16.410 --> 00:28:17.611
to consider with this patient.

00:28:17.631 --> 00:28:19.571
You've pre-decided based on

00:28:19.593 --> 00:28:21.233
a diagnosis what is going on.

00:28:22.886 --> 00:28:23.788
and what you need to do and

00:28:24.169 --> 00:28:25.310
not do about it.

00:28:25.391 --> 00:28:25.571
Again,

00:28:25.592 --> 00:28:27.434
we see this with autoimmune conditions.

00:28:27.454 --> 00:28:28.396
We see this with chronic

00:28:28.416 --> 00:28:30.039
pain and the cervicogenic headache,

00:28:30.721 --> 00:28:31.843
where we've pre-decided a

00:28:31.883 --> 00:28:33.145
treatment route based off

00:28:33.226 --> 00:28:34.808
of maybe an area

00:28:36.577 --> 00:28:38.378
that I think most therapists

00:28:38.638 --> 00:28:39.699
or a lot of therapists

00:28:39.819 --> 00:28:41.319
prefer not to treat even

00:28:41.380 --> 00:28:42.121
and have decided they're

00:28:42.141 --> 00:28:43.740
not going to receive manual therapy.

00:28:44.162 --> 00:28:45.602
Just like not everybody

00:28:45.662 --> 00:28:46.982
needs manual therapy.

00:28:47.423 --> 00:28:48.443
We don't get to say, hey,

00:28:48.463 --> 00:28:49.903
this diagnosis doesn't get it at all.

00:28:49.923 --> 00:28:50.263
That's really

00:28:50.284 --> 00:28:51.704
disproportionately impacting

00:28:52.164 --> 00:28:53.226
female patients.

00:28:53.246 --> 00:28:53.846
Yeah.

00:28:53.865 --> 00:29:00.009
And that brings me kind of

00:29:00.028 --> 00:29:01.609
to the thought process of

00:29:02.490 --> 00:29:05.872
really similarly therapists saying, oh,

00:29:05.932 --> 00:29:06.112
like,

00:29:07.224 --> 00:29:07.964
I'm not biased.

00:29:07.984 --> 00:29:09.204
I treat everyone the same.

00:29:09.726 --> 00:29:12.665
This is a really similar concept.

00:29:13.547 --> 00:29:15.926
And I hear that you saying I

00:29:15.987 --> 00:29:17.467
treat everyone the same has

00:29:17.527 --> 00:29:18.827
really positive intent.

00:29:20.107 --> 00:29:20.827
I don't think it has

00:29:20.928 --> 00:29:23.088
positive outcomes and does

00:29:23.108 --> 00:29:24.588
not play out the way you want it to be.

00:29:25.249 --> 00:29:28.210
Equality and equity are not the same.

00:29:28.597 --> 00:29:29.739
And if we are treating

00:29:30.038 --> 00:29:31.699
everybody in the same capacity,

00:29:31.739 --> 00:29:33.000
I treat everyone the same, right?

00:29:33.039 --> 00:29:34.560
That sounds so inclusive.

00:29:35.060 --> 00:29:35.740
What you're doing is

00:29:35.780 --> 00:29:37.821
fundamentally excluding and

00:29:37.922 --> 00:29:39.002
not considering certain

00:29:39.022 --> 00:29:41.104
factors that may impact one

00:29:41.163 --> 00:29:43.105
individual or a group of people.

00:29:43.365 --> 00:29:44.585
And it leaves us a lot more

00:29:44.644 --> 00:29:45.806
susceptible to practicing

00:29:45.965 --> 00:29:48.007
with bias and unconscious

00:29:49.387 --> 00:29:51.249
or internalized sexism or

00:29:51.348 --> 00:29:54.471
racism or other discriminatory ism.

00:29:55.372 --> 00:29:57.272
We have to consciously and

00:29:57.313 --> 00:29:58.574
intentionally consider the

00:29:58.614 --> 00:30:00.796
things that are different

00:30:01.056 --> 00:30:05.019
from ourselves in order to

00:30:05.038 --> 00:30:06.559
give our patients the best treatment.

00:30:07.728 --> 00:30:09.608
Yeah, no, this is so good.

00:30:11.549 --> 00:30:12.550
There's so many things in

00:30:12.590 --> 00:30:14.951
what you just said that

00:30:14.991 --> 00:30:18.114
boil down to why this matters.

00:30:18.755 --> 00:30:19.295
Previously,

00:30:19.335 --> 00:30:21.676
we talked about even delayed

00:30:21.836 --> 00:30:23.136
access to care, right?

00:30:23.176 --> 00:30:25.078
Like maybe female injured...

00:30:26.038 --> 00:30:27.079
young females are not

00:30:27.099 --> 00:30:28.941
getting sent out for care.

00:30:29.161 --> 00:30:29.602
And of course,

00:30:29.622 --> 00:30:31.442
that's going to impact outcomes, right?

00:30:31.462 --> 00:30:34.484
But then more concerningly, maybe,

00:30:34.525 --> 00:30:37.467
or equally concerning is the topic of

00:30:38.775 --> 00:30:40.477
these preconceived notions

00:30:40.616 --> 00:30:42.638
that still serve as a

00:30:42.719 --> 00:30:44.240
barrier once these

00:30:44.299 --> 00:30:46.342
populations are in our care.

00:30:46.642 --> 00:30:48.824
Oh my gosh, that is really scary.

00:30:49.144 --> 00:30:51.846
So it's one thing to not get the care,

00:30:51.926 --> 00:30:54.249
but then to finally be in a

00:30:54.308 --> 00:30:55.329
position to get it,

00:30:55.410 --> 00:30:59.634
but the practitioner with good intention

00:31:01.259 --> 00:31:02.701
The outcome is still negative.

00:31:02.740 --> 00:31:04.442
The impact is still negative.

00:31:04.622 --> 00:31:07.363
I mean, who wants to be that clinician?

00:31:07.482 --> 00:31:08.183
Not me.

00:31:08.344 --> 00:31:10.085
So I want to be enlightened

00:31:10.785 --> 00:31:13.326
to not treat everyone the same.

00:31:13.586 --> 00:31:13.787
I mean,

00:31:14.547 --> 00:31:16.307
I feel like maybe some of us

00:31:16.347 --> 00:31:18.769
listening are uncomfortable

00:31:18.809 --> 00:31:20.990
with that because now I

00:31:21.030 --> 00:31:22.771
think historically we hear, well,

00:31:22.791 --> 00:31:24.133
don't focus on the differences.

00:31:24.173 --> 00:31:25.953
Focus on what we have in common.

00:31:27.201 --> 00:31:28.281
In this case, right,

00:31:28.402 --> 00:31:30.143
equitable care and

00:31:30.363 --> 00:31:31.884
equitable clinical decision

00:31:31.923 --> 00:31:33.263
making and practice,

00:31:34.104 --> 00:31:35.605
the distinguishing factor

00:31:35.765 --> 00:31:38.066
is what helps you individualize the care.

00:31:38.226 --> 00:31:39.306
So we can't ignore that.

00:31:39.365 --> 00:31:39.586
I mean,

00:31:39.605 --> 00:31:42.247
that it seems like an

00:31:42.366 --> 00:31:43.626
oversimplification of a

00:31:43.686 --> 00:31:45.528
pretty complicated concept.

00:31:46.461 --> 00:31:46.902
thing,

00:31:47.422 --> 00:31:49.502
but we have to pay attention to what

00:31:49.563 --> 00:31:51.584
makes each patient different,

00:31:52.025 --> 00:31:53.244
specific obviously to this

00:31:53.285 --> 00:31:54.165
topic of gender.

00:31:55.105 --> 00:31:56.987
So thank you for kind of

00:31:57.047 --> 00:31:58.347
going there with us and

00:31:58.667 --> 00:32:00.028
really shedding light on

00:32:00.749 --> 00:32:02.009
maybe when our intention

00:32:02.048 --> 00:32:03.690
doesn't match our impact

00:32:03.910 --> 00:32:06.311
and that sort of ongoing reflection.

00:32:07.531 --> 00:32:10.535
That needs to happen, you know,

00:32:11.096 --> 00:32:12.537
with clinicians from

00:32:12.596 --> 00:32:13.778
patient to patient and

00:32:13.857 --> 00:32:15.880
sometimes with the same patient.

00:32:16.340 --> 00:32:17.942
We've got to step back and reassess,

00:32:18.001 --> 00:32:18.261
you know,

00:32:18.321 --> 00:32:19.482
what worked last time may not

00:32:19.502 --> 00:32:21.444
work this time because they

00:32:21.464 --> 00:32:22.625
have experienced something

00:32:22.645 --> 00:32:23.707
in the health care system

00:32:23.748 --> 00:32:24.909
that is now challenged

00:32:25.910 --> 00:32:27.590
their thought of where they're going,

00:32:27.631 --> 00:32:29.133
their recovery patterns.

00:32:29.593 --> 00:32:30.473
That's something else that I

00:32:30.513 --> 00:32:31.815
think we chatted about.

00:32:31.855 --> 00:32:32.516
Please go ahead.

00:32:33.038 --> 00:32:33.618
Yeah.

00:32:33.638 --> 00:32:36.240
Good intentions only go so

00:32:36.280 --> 00:32:38.103
far because you can't see

00:32:38.182 --> 00:32:40.305
or address what you're not looking for.

00:32:41.266 --> 00:32:44.189
I'm thinking of a paper by Stenberg et al.

00:32:44.209 --> 00:32:45.569
This was twenty twenty one.

00:32:45.670 --> 00:32:47.332
It's entitled Gender Matters

00:32:47.372 --> 00:32:48.532
and Physiotherapy.

00:32:49.073 --> 00:32:50.173
Please go read it.

00:32:51.355 --> 00:32:54.478
But this paper looked at men and women,

00:32:54.557 --> 00:32:57.221
cis men and women, and found that

00:32:58.529 --> 00:32:59.130
this was in a study,

00:32:59.150 --> 00:33:01.250
this was kind of a collection of review,

00:33:02.010 --> 00:33:03.691
but that men often viewed

00:33:03.730 --> 00:33:06.112
their pain as proof of hard labor,

00:33:06.731 --> 00:33:07.592
where women were more

00:33:07.632 --> 00:33:09.712
likely to feel shame and

00:33:09.813 --> 00:33:11.373
self blame for pain.

00:33:11.653 --> 00:33:12.773
This was after leaving a

00:33:12.814 --> 00:33:14.134
primary care appointment

00:33:14.554 --> 00:33:15.513
and that men tended to

00:33:15.554 --> 00:33:17.255
place blame outside themselves.

00:33:17.275 --> 00:33:18.075
They tended to blame their

00:33:18.115 --> 00:33:19.855
pain on external factors.

00:33:20.134 --> 00:33:21.296
Women were a lot more likely

00:33:21.336 --> 00:33:22.836
to internalize feelings of

00:33:22.955 --> 00:33:24.396
guilt and see causes within

00:33:24.436 --> 00:33:26.096
themselves for pain, right?

00:33:27.087 --> 00:33:29.729
At face value, your patients,

00:33:30.148 --> 00:33:31.029
cis men and cis women,

00:33:31.069 --> 00:33:33.150
are coming to you likely in

00:33:33.170 --> 00:33:34.651
a very different place.

00:33:34.891 --> 00:33:35.971
They have different health

00:33:36.071 --> 00:33:37.491
care experiences.

00:33:38.673 --> 00:33:40.873
They might even feel fearful

00:33:40.972 --> 00:33:41.894
of what you're going to say

00:33:41.933 --> 00:33:43.034
or fearful of how you're

00:33:43.054 --> 00:33:44.015
going to perceive them or

00:33:44.134 --> 00:33:46.115
fearful of being judged.

00:33:46.316 --> 00:33:47.096
They're foundationally

00:33:47.155 --> 00:33:49.676
coming to you at a different place.

00:33:50.237 --> 00:33:52.378
And I treat everyone the same or, oh,

00:33:52.439 --> 00:33:53.720
I just treat the patient in

00:33:53.740 --> 00:33:55.942
front of me leads us for so

00:33:56.001 --> 00:33:57.323
many blind spots.

00:33:57.363 --> 00:33:57.742
Because, again,

00:33:57.762 --> 00:33:59.544
we cannot see what we're

00:33:59.584 --> 00:34:01.605
not looking for when we're

00:34:01.645 --> 00:34:02.465
treating our patients.

00:34:03.086 --> 00:34:03.826
And I always kind of come

00:34:03.847 --> 00:34:05.848
back to this thought process,

00:34:05.868 --> 00:34:08.070
this like gut check.

00:34:08.251 --> 00:34:08.490
Right.

00:34:08.530 --> 00:34:10.612
Like if I'm sitting here and

00:34:10.652 --> 00:34:11.793
saying this and your gut

00:34:11.833 --> 00:34:14.034
reaction is I'm good, I'm not biased,

00:34:14.856 --> 00:34:16.137
then truly I'm very

00:34:16.197 --> 00:34:18.057
specifically and directly talking to you.

00:34:18.077 --> 00:34:18.998
Right.

00:34:19.402 --> 00:34:22.423
If your internal dialogue is, oh, well,

00:34:22.443 --> 00:34:23.324
I don't think I'm biased,

00:34:23.344 --> 00:34:24.985
but how could I assess

00:34:25.005 --> 00:34:26.065
where there is something

00:34:26.085 --> 00:34:27.606
that I'm doing impacting my care?

00:34:28.005 --> 00:34:29.847
How can I dive deeper into this?

00:34:31.226 --> 00:34:32.307
Then I support that.

00:34:32.387 --> 00:34:33.268
That is what your internal

00:34:33.327 --> 00:34:34.088
dialogue should be.

00:34:34.148 --> 00:34:35.088
But if you're hearing this

00:34:35.108 --> 00:34:36.148
and you're thinking, that's not me.

00:34:36.248 --> 00:34:36.809
I'm not biased.

00:34:36.889 --> 00:34:38.309
I treat my patients great, right?

00:34:38.610 --> 00:34:40.391
I'm not letting this seep into my care.

00:34:40.530 --> 00:34:43.512
Then truly, I'm directly talking to you.

00:34:44.452 --> 00:34:45.753
That sense of defensiveness

00:34:46.592 --> 00:34:47.994
that you're coming up with,

00:34:49.157 --> 00:34:50.018
that tells me that maybe

00:34:50.057 --> 00:34:51.079
some bias is seeping into

00:34:51.239 --> 00:34:53.518
your care and that you're

00:34:53.599 --> 00:34:54.800
unwilling to assess it.

00:34:55.360 --> 00:34:56.119
Yeah.

00:34:56.840 --> 00:34:57.900
You just said it, right?

00:34:57.920 --> 00:34:58.920
You took the words from me,

00:34:58.960 --> 00:35:02.262
which is sitting with being

00:35:02.461 --> 00:35:04.581
uncomfortable is good, right?

00:35:04.641 --> 00:35:06.262
We all sort of know that

00:35:06.282 --> 00:35:07.802
that's where growth and

00:35:07.842 --> 00:35:09.384
transformation happens.

00:35:09.443 --> 00:35:10.784
We tell it to our students.

00:35:10.824 --> 00:35:12.143
We tell it to our patients.

00:35:12.204 --> 00:35:13.864
And behavior change models is

00:35:15.030 --> 00:35:16.132
Are you willing to change?

00:35:16.172 --> 00:35:17.072
That means you're willing to

00:35:17.112 --> 00:35:18.592
step into a place of discomfort.

00:35:18.713 --> 00:35:20.132
And so that obviously

00:35:20.172 --> 00:35:21.773
translate into our own

00:35:22.094 --> 00:35:24.215
reflections on our practice.

00:35:25.916 --> 00:35:27.577
I've never met an orthopedic

00:35:27.617 --> 00:35:29.077
manual physical therapist

00:35:29.197 --> 00:35:32.518
or fellow who doesn't care

00:35:32.980 --> 00:35:34.739
about improving their practice.

00:35:34.960 --> 00:35:36.981
And if you're wondering why this matters,

00:35:37.061 --> 00:35:38.362
why we're talking about this,

00:35:38.382 --> 00:35:39.342
this is because

00:35:40.123 --> 00:35:41.206
We're telling you it will

00:35:41.306 --> 00:35:42.568
influence your practice.

00:35:42.688 --> 00:35:44.293
It will drive your outcomes.

00:35:45.335 --> 00:35:46.657
And that awareness is really

00:35:46.719 --> 00:35:49.123
exciting to now go back and practice.

00:35:50.188 --> 00:35:53.148
what you're hearing, even without maybe,

00:35:53.268 --> 00:35:55.170
if you haven't gone into the research,

00:35:55.489 --> 00:35:57.291
you know, to the extent that you have,

00:35:57.331 --> 00:35:58.652
Dr. Shaver is like,

00:35:59.452 --> 00:36:01.092
I am now being fed some

00:36:01.213 --> 00:36:02.293
information that should

00:36:02.353 --> 00:36:03.873
trigger some reflection.

00:36:05.135 --> 00:36:05.835
So I love that.

00:36:05.875 --> 00:36:07.014
Thank you for this conversation.

00:36:07.054 --> 00:36:08.175
It's so important to

00:36:09.657 --> 00:36:11.117
understand how this is

00:36:11.157 --> 00:36:11.918
going to influence our

00:36:11.958 --> 00:36:12.858
day-to-day practice.

00:36:12.918 --> 00:36:14.599
I remember, you know, during

00:36:15.608 --> 00:36:16.931
residency and fellowship training,

00:36:16.990 --> 00:36:18.614
just really enjoying the

00:36:18.653 --> 00:36:19.956
training because I always

00:36:20.036 --> 00:36:21.938
walked away with tangible

00:36:21.978 --> 00:36:24.061
tools that I could implement directly.

00:36:24.461 --> 00:36:25.423
And I think a lot of times

00:36:25.824 --> 00:36:26.746
that's what we're looking

00:36:26.786 --> 00:36:29.951
for as clinicians is not this abstract,

00:36:30.210 --> 00:36:30.590
you know,

00:36:31.652 --> 00:36:33.293
study, those are great,

00:36:33.313 --> 00:36:34.574
but how do I translate that

00:36:34.634 --> 00:36:35.914
into clinical practice?

00:36:35.934 --> 00:36:37.056
And that's what you're giving us.

00:36:37.076 --> 00:36:37.956
So thank you for that.

00:36:39.257 --> 00:36:41.257
And kind of along this conversation,

00:36:41.297 --> 00:36:42.277
you've sprinkled

00:36:42.358 --> 00:36:44.139
beautifully lots of tools

00:36:44.179 --> 00:36:47.659
and resources for us, the listener,

00:36:48.860 --> 00:36:52.882
to help us be aware of our bias,

00:36:53.023 --> 00:36:53.782
but then to also

00:36:55.961 --> 00:36:58.005
start to move the needle a little bit.

00:36:58.045 --> 00:37:00.048
This is a continuum and a journey.

00:37:00.208 --> 00:37:03.233
And I remember thinking too, you know,

00:37:03.313 --> 00:37:04.356
patient to patient,

00:37:04.416 --> 00:37:05.498
depending on who the

00:37:05.518 --> 00:37:06.519
patient is in front of you,

00:37:08.494 --> 00:37:09.815
It's almost an ongoing

00:37:09.916 --> 00:37:13.759
within a day of as a new patient comes,

00:37:14.079 --> 00:37:15.259
I'm in a different place in

00:37:15.298 --> 00:37:17.181
my continuum of growth and learning.

00:37:17.521 --> 00:37:18.420
And that's OK.

00:37:18.460 --> 00:37:19.442
Patients are supposed to

00:37:19.481 --> 00:37:22.384
challenge us to meet them where they are.

00:37:22.523 --> 00:37:23.644
And we say that a lot,

00:37:23.704 --> 00:37:25.065
but we can't meet patients

00:37:25.085 --> 00:37:26.126
where they are if we don't

00:37:26.146 --> 00:37:26.846
know where they are,

00:37:28.106 --> 00:37:29.847
which I think is where a

00:37:29.907 --> 00:37:31.668
lot of what I'm hearing

00:37:31.728 --> 00:37:33.170
from this conversation as well.

00:37:35.255 --> 00:37:36.717
Dr. Shaver,

00:37:37.757 --> 00:37:39.938
I'm always curious about what

00:37:40.297 --> 00:37:42.298
people are doing related to

00:37:42.318 --> 00:37:43.739
or not related to this topic.

00:37:43.820 --> 00:37:44.940
But before we go there,

00:37:45.699 --> 00:37:48.161
are there any other things

00:37:48.201 --> 00:37:49.641
that you want us to be aware of?

00:37:49.762 --> 00:37:51.663
Any strategies or

00:37:52.762 --> 00:37:54.284
suggestions just specific

00:37:54.304 --> 00:37:56.704
to our topic of OMPT,

00:37:57.864 --> 00:38:00.065
gender considerations in OMPT practice?

00:38:00.085 --> 00:38:01.166
Is there anything else you

00:38:01.186 --> 00:38:03.527
want to kind of just give us today?

00:38:04.797 --> 00:38:05.498
Yeah.

00:38:05.577 --> 00:38:05.838
I mean,

00:38:06.177 --> 00:38:08.480
I wish I could give you one

00:38:08.500 --> 00:38:10.581
succinct clinical pearl,

00:38:11.382 --> 00:38:13.222
but if there was one thing

00:38:13.503 --> 00:38:15.384
you were going to do is to

00:38:15.623 --> 00:38:17.025
intentionally and

00:38:17.065 --> 00:38:19.567
consciously spend the rest of your day,

00:38:19.947 --> 00:38:20.768
your week,

00:38:21.447 --> 00:38:23.449
thinking about what biases you

00:38:23.510 --> 00:38:25.271
may or may not have,

00:38:25.311 --> 00:38:27.072
like to truly take a deep

00:38:27.092 --> 00:38:29.893
dive into your practice and say, oh,

00:38:30.373 --> 00:38:31.574
did I use language that

00:38:31.614 --> 00:38:33.096
happened to set that patient up?

00:38:33.952 --> 00:38:35.552
to feel like it was her fault?

00:38:36.414 --> 00:38:39.115
Did I skew my manual therapy

00:38:39.155 --> 00:38:41.496
practices in a way that was

00:38:41.536 --> 00:38:42.637
not beneficial to them

00:38:42.757 --> 00:38:45.139
because of their gender or sex?

00:38:45.500 --> 00:38:47.221
How do I change this in the future?

00:38:47.541 --> 00:38:49.583
How do I better validate and

00:38:49.702 --> 00:38:50.963
listen to my patients that

00:38:51.043 --> 00:38:52.085
have historically been

00:38:52.525 --> 00:38:54.445
invalidated and felt belittled?

00:38:54.847 --> 00:38:56.887
Like I want you to truly

00:38:56.927 --> 00:38:58.929
take the time to

00:38:59.309 --> 00:39:00.610
intrinsically process and

00:39:00.630 --> 00:39:01.291
think about that.

00:39:01.731 --> 00:39:04.211
And the truth is, almost inevitably,

00:39:04.311 --> 00:39:05.271
you've probably let a bias

00:39:05.311 --> 00:39:06.132
seep into your practice in

00:39:06.152 --> 00:39:07.793
the future or in the past.

00:39:08.452 --> 00:39:09.193
And almost inevitably,

00:39:09.213 --> 00:39:10.413
it'll probably happen again

00:39:10.554 --> 00:39:11.213
in the future.

00:39:12.494 --> 00:39:13.833
And that's okay as long as

00:39:13.853 --> 00:39:14.934
you're willing to reflect

00:39:15.054 --> 00:39:16.974
on it and acknowledge it and grow.

00:39:17.275 --> 00:39:18.775
It's when it goes unchecked

00:39:19.016 --> 00:39:19.835
that it's a problem.

00:39:21.115 --> 00:39:22.496
And reach out to people that

00:39:22.556 --> 00:39:23.137
are of different

00:39:23.483 --> 00:39:25.005
sexes and gender from yourself,

00:39:25.065 --> 00:39:26.007
talk to them,

00:39:26.228 --> 00:39:27.268
ask them what works for them,

00:39:27.309 --> 00:39:28.090
what they have seen,

00:39:28.389 --> 00:39:30.132
like bring this to your clinic,

00:39:30.172 --> 00:39:31.835
bring this to your place of work,

00:39:31.875 --> 00:39:32.454
bring this to your

00:39:32.516 --> 00:39:34.016
university and discuss it

00:39:34.036 --> 00:39:34.858
with people and make it an

00:39:34.998 --> 00:39:37.041
active conversation.

00:39:37.061 --> 00:39:38.483
This can't be a passive,

00:39:38.523 --> 00:39:39.304
this can't be a passive

00:39:39.324 --> 00:39:39.985
change for the field of

00:39:40.005 --> 00:39:41.206
physical therapy or OMPT.

00:39:42.324 --> 00:39:45.367
My second recommendation is to read.

00:39:45.588 --> 00:39:48.170
It doesn't need to be in the

00:39:48.210 --> 00:39:49.711
depths of your university library.

00:39:49.731 --> 00:39:50.293
It doesn't need to be

00:39:50.333 --> 00:39:51.693
peer-reviewed journals.

00:39:52.074 --> 00:39:54.275
Pick up Roar by Stacey Sim

00:39:54.356 --> 00:39:56.257
and learn about female physiology.

00:39:56.577 --> 00:39:56.958
Pick up

00:39:57.778 --> 00:39:59.579
Unwell Woman by Eleanor

00:39:59.820 --> 00:40:01.740
Klanghorn and learn about

00:40:02.081 --> 00:40:03.541
the history of gender

00:40:03.581 --> 00:40:05.643
discrepancy in the

00:40:05.722 --> 00:40:07.784
healthcare in the United States.

00:40:08.003 --> 00:40:09.043
Pick up He, She,

00:40:09.085 --> 00:40:10.965
They by Skylar Baylor and

00:40:11.025 --> 00:40:14.347
learn about non-binary and

00:40:14.367 --> 00:40:16.387
transgender individuals and

00:40:17.829 --> 00:40:20.309
like intentionally read

00:40:21.237 --> 00:40:22.599
even outside of your field,

00:40:22.639 --> 00:40:23.059
and learn about the

00:40:23.079 --> 00:40:23.880
collective experience of

00:40:23.900 --> 00:40:24.639
the people that are most

00:40:24.920 --> 00:40:26.280
different from you so that

00:40:26.300 --> 00:40:27.402
you can best help them when

00:40:27.422 --> 00:40:28.161
they're in front of you.

00:40:29.623 --> 00:40:30.844
I love that.

00:40:31.824 --> 00:40:33.646
Those are outstanding resources.

00:40:33.746 --> 00:40:34.166
Once again,

00:40:34.806 --> 00:40:36.067
you're giving us things we can use,

00:40:36.126 --> 00:40:36.847
and I love that.

00:40:36.927 --> 00:40:38.429
And I want to take a second

00:40:38.469 --> 00:40:41.971
to just hopefully everyone

00:40:41.990 --> 00:40:43.052
can see the parallel

00:40:43.112 --> 00:40:44.432
between what you said as

00:40:44.472 --> 00:40:45.492
far as refining your

00:40:45.552 --> 00:40:47.474
practice and ongoing reflection.

00:40:48.891 --> 00:40:50.512
It's sometimes something

00:40:50.532 --> 00:40:51.753
that I feel like we drill

00:40:51.793 --> 00:40:53.132
down when we talk about

00:40:53.193 --> 00:40:54.193
psychomotor skills.

00:40:54.233 --> 00:40:54.614
And again,

00:40:54.653 --> 00:40:55.914
we're orthopedic manual physical

00:40:55.954 --> 00:40:57.615
therapists, we're using our hands,

00:40:58.135 --> 00:40:59.896
you apply a technique, it didn't go well.

00:40:59.996 --> 00:41:01.318
So you take a step back and

00:41:01.398 --> 00:41:03.239
you figure out what went well,

00:41:03.259 --> 00:41:03.800
what didn't,

00:41:03.840 --> 00:41:05.701
get the feedback and then improve.

00:41:06.181 --> 00:41:08.101
Can we just apply that to

00:41:08.161 --> 00:41:09.601
what we're talking about here?

00:41:09.981 --> 00:41:11.643
You know, it's the same framework.

00:41:11.682 --> 00:41:13.063
It's just a different thing

00:41:13.182 --> 00:41:16.704
at the center of that practice.

00:41:16.844 --> 00:41:17.925
And so I love that.

00:41:17.965 --> 00:41:18.445
For me,

00:41:18.505 --> 00:41:21.206
that is a parallel that I really

00:41:21.246 --> 00:41:22.065
connect with.

00:41:23.626 --> 00:41:23.905
You know,

00:41:23.965 --> 00:41:26.126
refining my skills goes beyond my

00:41:26.186 --> 00:41:28.827
hands-on skills, right?

00:41:29.407 --> 00:41:30.248
It's more than that.

00:41:30.289 --> 00:41:31.670
There's so much more to that.

00:41:31.710 --> 00:41:33.811
So thank you for those tips.

00:41:34.891 --> 00:41:35.873
That's awesome.

00:41:36.753 --> 00:41:38.894
And as we're kind of closing,

00:41:39.536 --> 00:41:41.336
I want to talk about maybe

00:41:41.376 --> 00:41:42.217
some hot topics.

00:41:43.958 --> 00:41:45.039
You talked to me about a

00:41:45.099 --> 00:41:47.061
course that you're involved in,

00:41:47.081 --> 00:41:48.302
a female athlete course

00:41:48.322 --> 00:41:50.182
that touches a little bit

00:41:50.242 --> 00:41:52.545
on transgender athletes as well.

00:41:52.585 --> 00:41:56.067
Can you tell us more, some takeaways,

00:41:56.126 --> 00:41:57.068
maybe some things for us to

00:41:57.128 --> 00:41:58.449
consider related to that work?

00:41:59.434 --> 00:42:00.135
Totally, yes.

00:42:00.255 --> 00:42:01.657
So I teach a course to some

00:42:01.677 --> 00:42:02.960
sports residents entitled

00:42:03.000 --> 00:42:03.740
The Female Athlete,

00:42:04.141 --> 00:42:05.364
but I have basically an

00:42:05.443 --> 00:42:07.407
entire lecture dedicated to

00:42:07.467 --> 00:42:08.668
the transgender athlete or

00:42:08.730 --> 00:42:10.893
treating the transgender individual.

00:42:12.030 --> 00:42:13.612
And when I talk about this,

00:42:13.831 --> 00:42:15.934
what I hear so commonly is, oh,

00:42:15.954 --> 00:42:16.534
that's such a small

00:42:16.554 --> 00:42:17.715
percentage of the population.

00:42:18.255 --> 00:42:20.376
That's not really entry level material.

00:42:20.476 --> 00:42:21.797
I really want to challenge

00:42:22.079 --> 00:42:23.840
that here and now, because first,

00:42:24.239 --> 00:42:25.021
in the United States,

00:42:25.041 --> 00:42:26.001
there's an estimated one

00:42:26.021 --> 00:42:28.682
point three million transgender humans.

00:42:29.224 --> 00:42:29.483
Right.

00:42:29.884 --> 00:42:31.985
That is a huge percentage.

00:42:32.405 --> 00:42:34.047
That's a huge amount of the population.

00:42:34.126 --> 00:42:34.987
And in my clinic,

00:42:35.148 --> 00:42:36.389
it's an overwhelming amount

00:42:36.429 --> 00:42:38.851
of the population,

00:42:39.090 --> 00:42:40.512
a large amount of the population.

00:42:40.692 --> 00:42:40.751
So

00:42:42.132 --> 00:42:44.554
And truly, like in DPT school,

00:42:45.034 --> 00:42:47.735
I did sharps debridement on an orange,

00:42:47.896 --> 00:42:49.177
okay?

00:42:49.197 --> 00:42:52.338
If that is entry-level information,

00:42:52.920 --> 00:42:53.880
then learning about the

00:42:54.059 --> 00:42:56.561
musculoskeletal rib and

00:42:56.601 --> 00:42:57.922
chest pain that an

00:42:58.043 --> 00:43:00.384
individual may acquire if

00:43:00.423 --> 00:43:01.945
they are improperly using

00:43:01.985 --> 00:43:02.945
their chest binder,

00:43:03.465 --> 00:43:05.887
that's entry-level too and

00:43:05.907 --> 00:43:08.309
should be in our residency programs.

00:43:08.889 --> 00:43:11.391
If my learning how to use ultrasound-

00:43:11.695 --> 00:43:13.177
as entry-level material,

00:43:13.536 --> 00:43:14.916
then so is learning about

00:43:15.036 --> 00:43:16.597
shoulder mobility and pain

00:43:16.717 --> 00:43:20.139
after top surgery, right?

00:43:20.219 --> 00:43:21.559
Deciding that an entire

00:43:21.599 --> 00:43:23.460
minority of the population

00:43:23.980 --> 00:43:28.501
is not entry-level material

00:43:28.641 --> 00:43:30.882
or is not enough of them to

00:43:31.043 --> 00:43:32.222
teach the material in your

00:43:32.262 --> 00:43:33.744
residency or in your DPT

00:43:33.764 --> 00:43:36.905
program is an example of discrimination.

00:43:37.728 --> 00:43:39.329
I think this material is not

00:43:39.389 --> 00:43:40.829
difficult to teach,

00:43:41.351 --> 00:43:43.070
but should be in our curriculum,

00:43:43.090 --> 00:43:45.733
both in residencies and in DPT programs.

00:43:47.233 --> 00:43:48.134
And you've probably treated

00:43:48.153 --> 00:43:49.233
a transgender individual

00:43:49.434 --> 00:43:50.914
whether you know it or not also.

00:43:52.246 --> 00:43:52.907
That's powerful.

00:43:52.967 --> 00:43:53.909
That's really powerful.

00:43:53.969 --> 00:43:55.610
We talk about inclusive practice.

00:43:55.650 --> 00:43:56.490
This is what it is.

00:43:56.530 --> 00:43:57.612
This is what it looks like.

00:43:57.672 --> 00:44:00.434
And you're preaching to me, right?

00:44:00.474 --> 00:44:02.215
Because I do feel like I

00:44:02.235 --> 00:44:03.478
have a sense of awareness

00:44:03.597 --> 00:44:05.259
about some of these topics.

00:44:05.318 --> 00:44:08.121
And yeah, I practice inclusively,

00:44:08.302 --> 00:44:09.682
but I can tell you that

00:44:10.722 --> 00:44:11.623
I have work to do.

00:44:12.324 --> 00:44:13.945
After speaking to you and

00:44:14.005 --> 00:44:16.027
learning about there are

00:44:16.068 --> 00:44:18.210
still gaps and how

00:44:18.269 --> 00:44:20.411
inclusive are we truly in our practice?

00:44:20.490 --> 00:44:22.532
Now, granted, we are, you know,

00:44:22.632 --> 00:44:24.894
subspecialists in the world of OMPT,

00:44:24.914 --> 00:44:25.795
which is why I was really

00:44:25.835 --> 00:44:27.056
interested in chatting with

00:44:27.077 --> 00:44:29.298
you about this is, you know,

00:44:29.438 --> 00:44:34.503
gender topics spans OMPT practice.

00:44:34.523 --> 00:44:36.085
It goes way beyond that.

00:44:36.945 --> 00:44:37.865
But if we're going to be

00:44:39.137 --> 00:44:41.719
specialists within a specialty practice,

00:44:42.239 --> 00:44:43.880
we have to consider the

00:44:43.940 --> 00:44:45.340
minority population, right?

00:44:45.360 --> 00:44:46.822
Like fellows, we do tend to,

00:44:46.961 --> 00:44:48.322
I can speak maybe for

00:44:48.362 --> 00:44:49.784
myself and a lot of my

00:44:49.824 --> 00:44:52.005
colleagues in OMPT practices,

00:44:53.346 --> 00:44:55.646
you might get that complicated patient.

00:44:55.666 --> 00:44:56.487
They tend to give you that

00:44:56.507 --> 00:44:57.568
complicated patient because

00:44:57.588 --> 00:44:58.148
you're the fellow,

00:44:58.168 --> 00:44:59.128
you're going to figure it out.

00:45:00.489 --> 00:45:02.670
And so even within our subsets of

00:45:03.291 --> 00:45:04.351
of patients,

00:45:04.532 --> 00:45:06.592
we have to consider the

00:45:06.652 --> 00:45:07.994
minority patient because

00:45:08.014 --> 00:45:09.554
they may be more likely to

00:45:09.594 --> 00:45:11.516
come and see us because no

00:45:11.577 --> 00:45:13.538
one else could figure out what was wrong.

00:45:13.617 --> 00:45:14.719
So that is, I mean,

00:45:15.358 --> 00:45:16.199
I think what a great

00:45:16.320 --> 00:45:18.101
representation and picture

00:45:18.240 --> 00:45:21.003
of inclusive practice and how to do that.

00:45:21.063 --> 00:45:21.822
So thank you again.

00:45:21.923 --> 00:45:22.164
I mean,

00:45:22.244 --> 00:45:24.204
so many nuggets I think that you

00:45:24.244 --> 00:45:27.686
have given us and tangibles.

00:45:28.128 --> 00:45:30.168
I have to now poke you a

00:45:30.289 --> 00:45:31.429
little further and say,

00:45:33.291 --> 00:45:35.193
What's next for you in this

00:45:35.213 --> 00:45:36.996
space or in other spaces?

00:45:38.197 --> 00:45:40.000
Maybe in your career trajectory,

00:45:40.039 --> 00:45:41.101
are there studies or

00:45:41.360 --> 00:45:42.782
initiatives you're excited about?

00:45:42.822 --> 00:45:43.704
Tell us a little bit more

00:45:43.724 --> 00:45:45.726
about that and then we'll wrap it up.

00:45:47.393 --> 00:45:47.893
Sure.

00:45:48.132 --> 00:45:49.153
My future is a little bit

00:45:49.193 --> 00:45:50.434
vague at the moment.

00:45:50.514 --> 00:45:51.855
I'm currently finishing the

00:45:51.974 --> 00:45:54.396
DSC at Bellin and I would love,

00:45:54.436 --> 00:45:55.596
my ultimate goal is to kind

00:45:55.615 --> 00:45:57.396
of transition into academia

00:45:57.936 --> 00:46:00.077
and then very intentionally

00:46:00.117 --> 00:46:01.478
dive into the world of research,

00:46:01.518 --> 00:46:03.079
of researching both gender

00:46:03.099 --> 00:46:04.780
discrepancy and working and

00:46:04.840 --> 00:46:07.101
researching the LGBTQIA community.

00:46:08.413 --> 00:46:08.992
Enough said.

00:46:09.333 --> 00:46:10.034
Nothing to add.

00:46:10.074 --> 00:46:10.853
That's amazing.

00:46:11.675 --> 00:46:13.155
And there's a lot of work ahead for you,

00:46:13.195 --> 00:46:13.876
so get ready.

00:46:14.815 --> 00:46:16.396
As you can see, in your own work,

00:46:17.016 --> 00:46:18.137
you've discovered this.

00:46:18.858 --> 00:46:19.918
Thank you, Dr. Shaver,

00:46:20.539 --> 00:46:22.719
so much for joining us and

00:46:22.739 --> 00:46:23.900
for challenging us to think

00:46:23.960 --> 00:46:27.041
really critically about gender in OMPT.

00:46:28.202 --> 00:46:30.262
For those of us listening,

00:46:30.302 --> 00:46:31.364
those of you listening,

00:46:32.043 --> 00:46:32.903
we will be sure to get

00:46:32.923 --> 00:46:34.244
these resources out to you

00:46:35.588 --> 00:46:38.134
And until next time, everyone stay curious,

00:46:38.155 --> 00:46:39.217
stay reflective,

00:46:39.297 --> 00:46:41.342
keep your hands on and your minds open.

00:46:41.543 --> 00:46:42.425
Thank you, Dr. Shaver.

00:46:42.445 --> 00:46:43.469
Thank you.