Month: July 2025

What’s up? Art of Wellness podcast. Today, we’re talking all things men’s health, men’s sexual health, and pelvic health with doctor Julia here, Julia Rosenthal, physical therapist like myself. What’s up, Julia? How are you?

I’m good. How are you? I’m doing great. I’m happy to have you. And we have a ton of things to talk about.

But first, let’s get a little bit of a background on you. Where’d you go to PT school, and what types of clients do you see in your practice? Sure. So, I went to PT school at Columbia University in New York City. And since then, I have had, like, a couple of different phases of my career.

In the beginning, I was working in a 100% dance medicine based, clinic, and that was, like, a hospital based outpatient. I was in a residency at the time, and so there was a lot of kind of study and treating happening at the same time. That was sort of phase one. Phase two was I worked in and out out of network, one on one care, private, physical therapy practice that was 100% pelvic health. So I saw a lot of really complex cases, a lot of chronic pain, a lot of, pregnancy and post partum and other things in that location.

And now I have my own practice, and I see a pretty good mix of both. So I see a lot of people with public health conditions, but I also treat a pretty good amount of orthopedic injuries, athletic injuries, post op care. Nice. And there’s, like, a pretty good healthy mix of what we’re doing here. But all of it is with the intention of being very movement forward and giving people tools to be well for the long term instead of, you know, a knee hurts, treat me type of approach.

Awesome. Yeah. That’s where we kinda connected was, like, I think we both started our practices maybe around the same time, like, during COVID. Right? Yeah.

I think we both I think probably a similar thing happened where it was, like, it was really hard to be working in a private pay clinic. Or even just, like, any outpatient practice. Like, there just weren’t clients coming in, and so, you know, businesses restructured, and it left a lot of people trying to figure out what was next. Yeah. And, like, I don’t know if you’re ever like me, but I I always had it in my head to start my own practice regardless.

So that just kind of accelerated the process for me. Was it the same thing for you? Not like that. Okay. I was like, I absolutely do not wanna have my own practice.

It’s not what I want. I wanna go into academia. I wanna told me that before. Yeah. Be a professor.

Yeah. Mhmm. Is that still your plan? No. No longer the plan.

I I kind of pivoted when I realized that, you know, I really like being around people. I like working with people. And as much as I like teaching, I think I like doing it in a context that is not, so fully academic and in a way that’s, like, a little bit more fluid and in a clinical settings. Right. Right.

Right. Yeah. I say we just jump in to all this stuff. Do it. What do you think?

Alright. Yeah. Let’s do it. So I kinda wanna go back and forth with you on this one a bit, but why do you think, you know, men in general well, don’t even know about pelvic floor PT, and why don’t you think they even seek it out as a form of of health care for them? I think there’s a lot of reasons.

I think, one, a lot of people of all genders don’t know that pelvic PT exists. And so it’s there have been a lot of barriers to care for all people to this type of care. And as people talk about it more and more, you know, even the section even the American Physical Therapy has different sections for types of physical therapy. And because there was such a need for care for people in the pregnant and postpartum period, initially, the section that was for this type of care was called the section on obstetric health. And so there was this very, like, women’s health focused, version of pelvic health that was out there because, frankly, there really was a need for that and a lot of women’s health issues were being overlooked.

Sure. But the more people started treating those issues, the more they realized, wait a minute. We are dealing with things that are really present in all kinds of different genders and different parts of the population that maybe haven’t even really been addressed. So it it was almost like the doorway to really open up this type of care to lots of different people. And I think that history really has played out in terms of who is aware that this is a type of care that’s available to them.

Yeah. I mean, lack of awareness is big, especially with this stuff. I think too, like, you know, from a guy’s perspective, a lot of times, like, we I guess, the if you wanna say, like, suffer in silence or whatever, like, we don’t wanna be like, oh, something’s wrong down there, you know, and tell somebody about it. Afraid to talk about it. Right.

And like I said, in general, people are afraid to talk about it. And I think from our point of view, it’s like, you know, hey, bro. We’re good down there. Like, I don’t need any help from anybody to figure these things out, whether it is erectile dysfunction, you know, ejaculation issues, stuff like that. But, it it is a very good thing.

And talk about what pelvic floor physical therapy Yeah. That was my next question. But yeah. Yeah. Yeah.

So, yeah, go ahead and explain what What do we do? Pelvic PT is and what you do with your clients. Yeah. So, when it comes specifically in men’s health, pelvic floor physical therapists in general, actually, pelvic floor physical therapists are treating people who have issues with bladder, bowel, or sexual dysfunction. So that’s across all genders.

And part of it’s it’s kinda like the way that I explain it to people is, like, it’s regular PT plus because we have skills in evaluating the muscles that are inside the bowl of the pelvis, and those muscles have a role to play in all of those functions. A lot of times, you don’t think about a musculoskeletal component to having to pee all the time or Right. Being really constipated or having issues with erections or any of the things we’ve sort of touched on. But there is a neuromusculoskeletal component to all of those things, and that is the piece of it that pelvic floor physical therapists are trained to manage. Yes.

Okay. So, again, that’s more broad spectrum here. Let’s start narrowing things down here. So I mentioned erectile dysfunction, you know, other male issues like premature ejaculation, things like that. So how can pelvic PT in particular help with these things?

So there are, there are three layers of muscles in the pelvic floor. The anatomy of the actual musculature in the pelvic floor is very similar regardless of what type of genitals you have. And those muscles have a variety of functions. Some of the outermost ones are responsible for pumping blood into and keeping blood in the penis. So there’s a very clear relationship there between achieving and maintaining erection or potentially pain around arousal and erection because some of those structures could contribute to that also, and the nerves going into that area might be at play also.

Then you have a layer of muscles that is primarily involved in urinary function. In a male pelvis, there is a different path of the urethra Mhmm. Because the urethra goes through the prostate, the urethra is much longer, and so it will it actually dips down below the height of the pubic bone and then kinda comes back up. So there’s, like, a dip in the path of the urethra, and then it travels through the penis. So there’s it’s, unless there’s some kind of, like, reason, whether it’s a surgical reason or, you know, some other kind of more neurological reason, there’s there’s not usually just, like, stress incontinence that’s a little bit less likely in a male pelvis, but you might have things like post void dribbling where you go and then there’s, like, a little bit that came out that was kind of outside of your control.

Mhmm. Males will people with male pelvises will also complain a lot about, urinary urgency or, like, feeling like you have to go all the time or when you have to go. It’s like, I gotta go right now. I gotta find that bathroom. Yeah.

Those are more the types of urinary symptoms that, men will more frequently complain of. And then, there’s the next layer of muscles is like a bowl. It’s kinda, like, shaped like this. Mhmm. And all of your pelvic organs sit on top of it.

And those are the ones that people think of when they think of, like, the pelvic floor. Yes. They’re thinking of, like, the pelvic diaphragm. And those muscles work together with the muscles in your abdominal wall and your diaphragm, and are part of this pressure system that exists between your rib cage, the space in your rib cage, and the space in your abdomen to manage things, like coughing and sneezing or creating enough pressure for a deadlift or all kinds of things like that. And so you might have things that seem like musculoskeletal systems, like sacral area pain or tailbone pain, hip pain, low back pain.

And there may be a pelvic floor component to a lot of those things. Yeah. And we’ll talk about that definitely later on because as always, as we say, as PTs, everything’s always connected to each other, and you can’t separate out systems. Everything works together as one. So if one thing’s thrown off, it could throw off other things.

The whole regional interdependence of the human body is extremely important. How do you assess, like, if somebody is either tight or they’re weak? How do you assess their muscle tone when it comes to the pelvic floor? So I will start this by saying that a lot of people are afraid to come to pelvic PT because they are afraid to have an internal exam. Mhmm.

And I will talk about what the internal exam looks like in a second, but there is a lot of information that we can gather without ever doing that. And so if you are like, this is something somebody told me I needed, but I’m, like, scared because I don’t want somebody to do that, it’s okay. We can work with that. That’s completely fine. But if we’re gonna do a very specific hands on, like, palpation, feeling the muscles assessment, usually, it happens in two parts.

There’s an external component and an internal component. External component, we’re basically feeling for for the musculature that I was describing in the beginning. The the first layer, the layer that’s primarily responsible for pumping blood into and keeping blood in the penis, those muscles you can touch from the outside. If you lift the scrotum and feel along the bones in the area and then also in between that space, there are muscles that kinda feel like a tube. You can palpate a lot of those muscles.

Sometimes you can recreate pain. Sometimes you can feel that there is, like, a difference in tension from one side to the other or, like, a lack of tissue mobility in the area. So that is something we might do in the beginning in an external exam, pelvic floor specific exam. And then on an internal component for a person with a male pelvis, though, that deeper layer of muscles, the bowl of muscles is deep enough that mostly they need to be reached. If you’re gonna try to touch them specifically and directly, they will be accessed rectally in a person with a male pelvis.

And so what we’re doing is we’re looking for specific muscles within that group of muscles to see, am I recreating pain when I touch these muscles? Mhmm. Are you able to relax them? Are you able to contract them? After you contract them, can you relax out of that?

If you if you’re having constipation issues, like, what happens when you try to bear down? Or is the anal sphincter, which is, like, the outermost part of the canal, the the end of the canal, is the anal sphincter super reactive to movement? And so it are you maybe trying to have a bowel movement and every time something tries to pass through the passage, you’re clenching up and you can’t get anything out? Yeah. Maybe we need to retrain that a little bit.

So we’re looking for symptom recreation and then also patterns from, like, a musculoskeletal component. Weakness is like we’re when we ask you to contract, we’re looking for a close and a lift. You should be able to pull up and in for a successful pelvic floor contraction, which is also a Kegel. Mhmm. But a lot of the time, a lot of these symptoms are coming from increased muscle tone rather than decreased muscle tone.

Unless there’s some kind of, like, surgical reason why somebody is unable to recruit the muscles. Gotcha. Okay. And I was gonna kinda go down the list with each one of these. So, like, you know, let’s start with I know it it depends, and everybody’s different.

There’s different everybody presents differently. But, like, in a very general sense, like, erectile dysfunction, for example, would you say it’s just mostly, like, a a tightness type issue or the blood flow to the genitalia just isn’t getting there? I mean, I I know it’s not just that, but is that part of it? From a musculoskeletal standpoint. Right?

Obviously, their, you know, erection is multifactorial. Yep. There is also a significant cardiovascular component. There was actually a study that came out that was, it’s basically talking about erection as, like, a vital sign. And so Yeah.

For people I think it was men 40, if you’re having problems with erection, the recommendation is to go have a cardiovascular assessment Right. To make sure that that is not the reason why it’s a thing. So, you know, there are some things to sort of, like, check off the list as potential contributors before we’re gonna realize pelvic PT on pelvic PT for the answers. But typically, yes. There well, it could go both ways because you need the muscles to be strong enough to pump blood into the penis and then hold it there.

So there is a strength component. But tight muscles are also weak, so we also need them to be able to lengthen enough to do their job. Mhmm. Plus, if they are holding a lot of tension, it’s hard part of the job is to hold fluid in the penis. So if they can’t relax enough, it’s harder to get fluid in there to begin with.

And then that can be a part of the reason why it’s difficult to have Mhmm. A full erection. Gotcha. Yeah. And I think, you know, from what I’ve seen in the podcast space, I would argue that most people don’t know that musculoskeletal part of erections.

I would say more people know about the cardiovascular stuff, honestly, because pelvic floor, like you said, most people in general don’t even know about it. So I think, you know, the podcast I’ve seen, like, they’ve talked about cardiovascular stuff, hormonal stuff. They don’t even mention the pelvic floor. And I’m like, SPTs, we’re like, hey, like, you’re missing this whole other component of sexual health. So And the reality is a lot of those people will be put on medications.

Yeah. Like, usually, Cialis, and they don’t always have success with that. And that’s so frustrating for a person who’s struggling with erections. It’s like, okay. I’m literally on the meds, and it’s not even working.

Yeah. What is going on? You know? And and to and, unfortunately, the reality is they end up, like, spinning because nobody is telling them that there is another piece of the solution. Yeah.

I mean, you know, those guys are like, oh, it’s a testosterone problem. It’s a hormonal problem. Let me check my blood, you know, blood flow. Let me take more blood flow supplements. And again, like I said, they’re just missing the musculoskeletal component of the muscles down there that contribute to all these things.

And I think it’s it’s important to talk about this where, you know, we’re the conservative health people. Like, this is something that can be fixed, and we’re not using, like you said, pills or Right. Things like that. So it’s a very important part of health care, I would say. There’s a time and a place for sure.

Like, I’ve had Of course. I’m not working that out. Yeah. Maybe need the meds, but also had better, more full, more successful erections Mhmm. With the meds plus the PT.

Yeah. You know? Yeah. In conjunction, it it works great. I’m always just saying, like, on the totem pole of, like, where people look in health care, We’re still, like, down here where I think we should be equal with, you know, looking at all these things in a, like you said, in a in a biopsychosocial approach, multifactorial, looking at the whole person, not just, like, it’s just blood flow, it’s just hormones, it’s just this.

Like, let’s look at everything and completely assess the patient in front of us. But, you know, we get on these health care tangents, and I wish we could help everybody. But unfortunately, the health care system, like, likes to throw people in different directions. And, you know, my my goal with this podcast is to hopefully, you know, spread the good word about us as PTs and Yeah. Get people to recognize that we are an important part of health care, and we are very, it’s more conservative.

And that’s okay. Yeah. You know? And that’s a good thing, honestly, because it’s more sustainable in the long run. But I think especially you know, I think part of part of being a pelvic PT is recognizing that I’m probably, like, the tenth person that you saw about this.

You know? And you probably spun and spun and spun until you finally got here. And and even within pelvic PT, and this is true for all PT. Right? But even within pelvic PT, there’s so much variability in what you’re gonna get Yeah.

From provider to provider. And so, you know, the the unfortunate truth too is that, like, people will come to me and be like, listen. I went to this place, and all they did was, like, these internal releases, and I never really feel like I felt like I got better. And then they come here, and I’m like, you have zero hip internal rotation. Like, no wonder your pelvic floor can’t relax.

There’s no room for it to. You know? So there is, even within us and our scope, a need to kinda, like, zoom out Oh, yeah. A little bit more to make sure that we’re covering all of our bases. Yeah.

And there’s different layers to that the, for lack of a better term, the crappiness of health care these days is, like yeah. Like, maybe somebody does go and they get PT from some clinic that is overbooked, and they’re all overstressed, and they’re the PT is seeing three people at a time. And that’s not very good PT. And then, like you said, they come to us, and they’re like, oh, like, we’re actually assessing them, and we’re with them for the full time Yeah. And looking at all these different things.

Whereas those PT places like, I worked in those environments, and I had no time to and I hated it, you know. I was like, I I couldn’t look at their internal rotation for anything because I was like, you know, I was so stressed that somebody else walked in as I was eval ing this person, right now. And I was like, well, now what do I do? Like, I have, like, no time to even assess somebody. And, you know, there’s different layers to the the health care problem we have these days.

And yeah. I mean, I wish every PT can, like, hone in on their skills more and actually evaluate the person like we do, but, hey, that’s health care for you, I guess. You know? It sucks. But, thankfully, we disconnected from that, I guess, because, man, was it tough.

But, anyways, let’s go back to the so we did erectile dysfunction. So, like, let’s go down the list here. So even, like, with premature ejaculation issues, again, like, would you say it’s more so, like, a tightness type thing? Or, like, what would you say the symptoms that people have with that in their pelvic floor? A lot of time generally, that one is also, like a more tone problem, but there there is a possibility because the job is for the muscles to maintain erection.

There is a possibility that there is a weakness component. Mhmm. That being said, premature ejaculation is different than losing an erection. Right? So you there is also, like, a sensory, like, a nerve component or potentially, like, an increased sensitivity, in the small nerves of the penis, which could come from some kind of, like, compression of the nerves a little bit further up, or even, like, farther farther up.

A lot of the, a lot of the innervation to the pelvic region comes from the, like, mid spine, thoracolumbar region. So sometimes even issues, like, way away from the pelvis can have a contribution. So a lot of times, you have to kinda, like, think. If you’re not really finding anything in the pelvis and you kind of ruled out other non musculoskeletal things, you sometimes have to kind of think higher Yeah. To get to it.

And, again, we’re speaking in in generalities here. So I think it’s important to say, like, we as we always say, me and you, we say this all the time, you know, like, people need to get a thorough assessment from a pelvic floor PT. Medical advice. Yeah. Sure.

Yeah. Yeah. But, like, you know, a thorough examination and assessment from a PT or or if it’s a pelvic, type issues from a pelvic floor PT, is always best. And I will you know, we’re giving general advice here in a way, but, like, go see a PT for a thorough examination. That’s always best.

We do virtuals. I’m just saying. Yeah. Yeah. We do that too.

Okay. So we ED premature ejaculation. I also have down here, pain with ejaculation and and orgasming. What’s the story with this as it relates to the pelvic floor? Yeah.

So a lot of time so that can be a muscular tension issue. Usually, pain symptoms are more of like a high tone Mhmm. Mhmm. Issue, generally Yeah. In the pelvic floor.

With that one specifically, though, I have seen in my this is like there’s no study that says this. Yeah. But in my clinical experience, when I hear that, I get suspicious of a hernia because I’ve seen it happen enough times where those things have happened side by side, that, like, if if I’m doing all the things and that person is not getting better, I’m gonna be like, you need to go be evaluated and see if this is part of the problem. I have a client right now who has pain with ejaculation and had, had hernia inguinal hernia repairs and then still was having symptoms and then went back, and then they found a sports hernia. And then had had, like, a diagnostic injection done in that region, and his symptoms were gone for, like, a couple of like, gone gone for a couple of weeks after he had that.

And he was like, great. Now I’m gonna have to have the surgery. And I was like, listen. At least we found the issue. So Yeah.

He ended up having PRP injections and is doing better Okay. With that, but it’s he knows it’s just like a it’s just like a stepping stone to ultimately probably having to have that repaired. Yeah. Always tough tough cases, with this stuff. So I wrote down as well, like, surgeries, like, pain with in that area after surgeries.

What types of surgeries, contribute to, like, chronic pelvic pain, would you say? Hernia. Okay. Because the reason is that, in the inguinal canal, you have, the you have nerves basically that go and supply sensory, innervation Mhmm. To the penis and testicles.

So if something happens and there’s, like, compression on the nerves in that area or, like, poor neural mobility of those nerves, then you might have some painful symptoms. Usually, I’ve seen it go the opposite way of, like, the hernia was there, and so there was pressure pushing into the canal. And then once the pressure was alleviated, things got better. Yeah. But in some rare cases, I’ve seen people have post op discomfort.

It usually goes away. Okay. I mean, it’s But I’ve had some some of those. Prostate surgeries, people can have pain, but, usually, it’s more what what the known risks are of a prostate surgery is urinary incontinence. So that is one where there is a very there’s, like, a probably a guarantee, basically, that you’re gonna have urinary incontinence after that surgery, and then also lack of erectile function.

And the that’s because there are a lot of different techniques for we could do a whole podcast on prostate surgeries. But, essentially, what they’re doing, right, is they’re removing the prostate because of prostate cancer, and there are a lot of nerves surrounding the prostate. So to the extent that it’s possible, they try to spare the nerves when they do that surgery. But there is going to be some damage to those nerves. And so there are a lot of things that we can do to improve urinary incontinence.

Sometimes we can help people regain erectile function, but there’s also surgical interventions to help people. Like, there are penis pumps now that are, like, very they’re kind of they’re pretty cool, actually. Like, the Pretty cool. Pump is they’re super cool. Like, the pump is hidden in the scrotum, so you can actually pump it up Yeah.

Without but there’s, like, no visible thing on you. So that’s pretty cool. Mhmm. There are clamps, that are used that people can wear. So, basically, you’re, like, clamping off the urethra.

So you can basically be continent and not have to wear, any kind of, like, adult diapers or any kind of, like, padding or anything like that Yeah. Which is very liberating for a lot of people. So there is a there is a sort of, like, a lifestyle change piece of managing that, but there is also very good evidence for improved results on urinary function and sexual function if you do PT beforehand. Mhmm. Prehab is, like, super important.

Love prehab. And post. And a lot of people having these surgeries never even hear about pelvic PT. It’s very sad. Yeah.

And that’s something that, like, really, I think it’s on us, the pelvic PT community, to continue to educate urologists and people who are doing these surgeries about because, truly, like, the outcomes are significantly better when people have pre and post op care. Yeah. And I think, you know, we’re narrowing down for just, like, pelvic floor and pelvic PT, but I think in general, PTs and prehab for, like, ACL injuries, other surgeries like that in the musculoskeletal system is extremely important. And, you know, I think, again, like you said, pelvic PTs I always say PTs in general, we need to speak up about all this stuff because I still think nobody really, like, knows about us, and we’re a huge part of health care. Like you said, the conservative part, we get people better without pills and surgeries and things like that.

So it’s you know, I try to, like, generalize as much as I can because, you know, prehab in general is very important as well as, obviously, for pelvic PT stuff. But Yeah. Oh, Oh, I wanna bring up one other surgery. Please. Hip labral repairs.

Okay. Because there is such a such a strong connection between your pelvic floor musculature and your hip musculature. Mhmm. And sometimes or even just, like, people who have hip like, persistent hip issues. Yeah.

So regardless of whether you even have the repair. But especially after the repair, like, somebody on your care team should be asking you if you’re having pelvic floor symptoms because I have seen that happen many times. Okay. Groin injuries, groin strains. Yep.

Those kinds of things. Yeah. Yeah. It’s important that, again, these patients get, you know, asked about these things. But oftentimes, like you said, they’re just overlooked, and it’s Mhmm.

It’s it’s not fun when that happens. Let’s see. So we talked about did we touch on, like, changes in orgasm too a little bit, or did you wanna expand on that a little bit more? We talked about pain with orgasm. Okay.

What about just changes? Changes in orgasm. Orgasm is an interesting thing. Like, men can’t ejaculate without orgasming. And so there is, that’s also a super multifactorial thing.

There’s a psychological piece. There’s a sensory piece. There’s, like, a safety emotional safety in the environment Yep. Piece. But I think from, like, a pelvic floor perspective, part of what is happening aside from, like, ejaculation aside, part of what is happening during an orgasm is that the pelvic floor musculature is, like, contracting and relaxing.

It’s part of those sensory experience. So, again, it’s like, is it weak? Is it tight? We don’t really know because it could be both. Like, it could just be that there’s not a very strong contraction and because of that, there’s, like, a decreased sensory experience.

It could be that the muscles are really tight, and so they aren’t contracting as successfully, and there’s less of a positive sensory experience. It could be that for some there’s some kind of nerve, decreased neural input Mhmm. To the area coming either from within the pelvis or from before the pelvis somewhere in the body. That’s contributing to a change in sensation in the area. I’ve heard people tell me that their penis feels kind of numb.

Like, it’s not numb, but it doesn’t feel as sensitive as Okay. Nor as it normally does to them. So that’s kind of like, if that’s happening, clearly, it’s gonna be more difficult for you to feel as powerful, or maybe it’s gonna take longer for you to achieve an orgasm because it’s, like, harder to get yourself to a heightened sensory Yeah. Yeah. Experience.

I’m gonna go down that list again of what I think is important with, like, erections and, you know, with guys and stuff is, like, we talked about, like, hormones, blood flow. You mentioned the psychological component. We can’t ignore that as well. And, you know, we’re not the experts on that. I don’t claim to be the expert on that, but it would be cool in the future to have someone who’s an expert on the whole psychology of it to have on this podcast.

But that’s another huge component of it is, like, the stress to perform or the stress to, you know Totally. That gets in somebody’s head. So we can’t ignore that as well. I’m not a I’m not a sex therapist, but I do have, I have a certificate in sex counseling. And a big part of that I mean, there’s so many things that we could talk about with that.

That it’s a huge topic. But just on, like, a kind of on a sort of basic level Mhmm. We all live in these, like, narratives of what it is to be ourselves in our bodies in a sexual context. And those things are influenced by our race, where we grew up, our social environment, our relationship history, like, our parents. You know, there are so many things that influence our sexual narratives, that are things that a lot of people never acknowledge.

And, you know, I’m a bit I’m like I’m the kind of person who’s like, everybody should be in therapy. Like, every single person should be in therapy. And and I think a lot of it is that, like, if we are not sort of, like, asked to reflect on these things within ourselves, we we never will. It’s just, like, uncomfortable. So why are we gonna do that?

You know? So so, yeah, I think when it comes to, like, sexuality and, like, what it means to be a sexual being for oneself, there’s just, like, so much to delve into. Yeah. There is. We could probably do a whole podcast on that.

Interesting stuff. Yeah. There’s a lot of stuff that goes into all the all these things, like we say. But, let’s get back to, like, the loss of sensation and changes again. But I wrote down here cyclists and heavy lifters, as well as, like you said, the surgical component of it after surgery.

People have issues with that stuff as well. But, like, heavy lifters and cyclists also have these issues, would you say? So cyclers, the reason that cyclers commonly have this issue is that, typically, the male pelvis is narrower than the female pelvis just, like, on an anatomical level Mhmm. Statistically. And so part of what happens is that, like, because of that narrower shape, the bike seat sits.

Like, you can both of the sit bones are, like, hugging the bike seat. This can happen in people with female pelvises too, but Yeah. This is why it’s, like, common in people with male pelvises. So the pudendal nerve, which is, like, a major component of the sensory and motor function in the genital area, goes right along the inside of the sit bone. So you’re basically, like, compressing it over long periods of time on the bike seat, which is why oftentimes cyclists will have this issue.

When it comes to heavy lifting, that one is a little bit more it could be a couple of different reasons. It could be there is, like, a major glute gripping strategy going on and just, like, a lot of posterior pelvic floor tension as part of the lifting strategy. Yeah. So that’s one possibility. Another possibility is, especially for people who are lifting in a belt, and maybe haven’t learned how to, like, successfully use the belt and instead are using it to just create a whole lot of downward pressure.

You can do that with with or without a belt. Yeah. Yeah. But the belt sometimes makes it worse. Yeah.

Yeah. Sometimes it makes it better. You just have to learn how to use the belt. But, anyway, the reason is that, because your pelvic floor is part of that pressure system that we were describing, there’s, like, all of this downward pressure onto the muscles, and then the muscles have to withstand that. So they’re working against all of this Yeah.

Pressure that’s coming down. And, you know, because because men have a different urethral path than women, they don’t really have as many issues with leaking on the platform, but that’s the same reason women leak on the platform. Right? It’s like a a man a pressure management issue of, like, there’s so much downward pressure from this effort that the pelvic floor may not be able to withstand it. And so it might show up different in, like, a man that’s lifting heavy versus, like, a female heavy lifter.

Gotcha. Yeah. Cool stuff. Is a big one that I hear. Constipation?

Group. Constipation. Okay. Because they can’t, not to be crass, but, like, they just can’t get their butthole to relax. They just, like, cannot do it.

Yeah. So That’s never fun. Nothing’s coming out. You know? Just stuck there.

Alright. I put down vasectomies too. What types of issues have you seen with this, in terms of the pelvic someone’s pelvic health? Yeah. I think, honestly, like, anytime you’re doing anything procedural in the pelvic cavity, your body can have a response.

Like, I don’t have a solid reason for you why, aside to from to say, like, somebody went in the pelvis and, you know, maneuvered some stuff. There can be there are often, like, there can be, like, scars inside the eye that you see. Yep. You know, there’s there’s it’s like the way that I usually describe it to people is, like, our container of what we see on the outside and our contents are in constant conversation with each other. And so if something if the contents are, like, mad for some reason, we might experience that in the container because we don’t really have the same experience of the content of of, like, the contents.

You know? Yeah. Yeah. Man. Yeah.

Again, like, I say that about most surgeries. I mean, when someone’s saying, like, why is this still hurt or why am I still having issues with this? You know? Post surgical, everything’s a process. You know?

Someone went in there and rearranged stuff, and sometimes your body is like, hey. What just happened to me? What happened? What’s going on? It’s a form of it’s honestly trauma.

It’s trauma. You’re not I say it all the time. I say it all the time. And, again, that’s I have to explain it to them, which is which is fine. You know, some people just you know, it takes a while for them to kinda wrap their head around that that someone went in there, move things around, and your body reacts sometimes negatively.

And it’s like, hey. Like, what’s scar tissue, more pain, nerve sensitivity can all shoot up, and your body is like, hey. I don’t like this right now. Let me give you a ton of pain and stiffness and all this other stuff. Whatever joint it is, shoulders, knees, whatever.

So it it’s good to kinda, like, reinforce that that, like, you had a a surgery, and it’s trauma. It’s a major event. It’s a major event, and your body’s gonna be like, hey. What just happened? Here’s some pain and tension.

Yeah. I mean, mastectomies are, in the scheme of, like, surgeries that a person might have. It’s like a pretty Yes. Low low threshold intervention. Sure.

But Still. You know, your body might still not like that. Different. Yeah. So yeah.

Everybody’s different. Somebody might just not, like, not like it a lot at all. And they’re like, hey. Like, what’s going on down there? Yeah.

I have down here chronic pelvic pain syndrome, nonbacterial prostatitis. Yeah. Do you wanna expand on this? Is like this one drives people completely insane. Okay.

They go to the urologist. They’re probably having some constellation of symptoms, like urinary frequency, issues with erection, arousal. You could it could be anything. Post void dribbling, that one’s very common too. I’m not sure if I explained what that is, but it’s basically like normally, when men pee standing up, it’s like you pee, and then maybe you have to, like, do a little bit of a squeeze to get the last of it out, and then it’s done.

Mhmm. And you just to pee, you just kinda, like, stand there and, like, let go. Yeah. But what people who are having, like, a lot of pelvic floor muscle tension might have to, like, push to pee. Mhmm.

Or maybe they pee, and it’s, like, immediately, they feel like they have to go again and they try to go and, like, a little bit more comes out. But they just, like, can’t feel like they’ve totally emptied. Or they pee, and then they’re, like, walking away from the bathroom and there’s, like, little dribble comes out and they’re like, the hell was that? You know? Like, there’s a lot of ways this could show up for a variety of reasons of, like, specifically what’s going on in your pelvic floor that we don’t have to get into.

But all of them sometimes there’s genuinely, bacterial infection. Un unlikely. That’s rare. That’s, like, the least likely form of prostatitis. Okay.

Usually, people are diagnosed with prostatitis in the absence of anything being wrong with their prostate. There’s just like, well, there’s, like, this weird constellation of symptoms, and we’re gonna call it this. And then they get put on an antibiotic. And then they feel pretty good when they’re on the antibiotic because the antibiotic is usually Cipro, and Cipro has an anti inflammatory component. And so they feel pretty good when it’s like taking Advil, you know Yeah.

When they’re when they’re on it, and then they go off of it, and then immediately all of their symptoms cut back. And then they’re like, what happened? Right. So, obviously, I’m, like, a little spicy about this one because what ends up happening is that they go back, and they’re just, like, in this, like, endless Yeah. Loop of, like and then I went to this urologist, and then he made me do this test and, like, all of this stuff.

And I’m like, just send them to PT. Please. They might you know? They could have anything. Any of the symptoms we mentioned, they could have.

But, definitely, the urinary ones are, like, very common. A lot of those people will come from urology. Yeah. And, you know, in PT, we get a lot of these umbrella terms for a bunch of different things going on with patients. I’m here to try to, like, generalize it for people.

Like, you know, let’s say someone has back pain and, you know, ninety percent of back pain is nonspecific back pain. Like, there’s nothing really structurally going wrong. It’s just like, hey, he’s got back pain, MRI. It looks pretty much clean. I’m not gonna do surgery on it.

The umbrella term is just, and they just have back pain. Mhmm. When they should’ve just came to us in the first place instead of, like, going through this rabbit hole of, you know, MRIs, x rays, all these other things. And we could explain to them. It it’s also scary.

Right? Yeah. So, like, you’re going to this doctor, you know, imaging, the readout if you ever read the actual words on imaging, it’s, like, very threatening, very scary. You know? You’re going for all these tests, like, in the example of back pain, the imaging stuff.

But, like, even in the example of prostatitis or chronic prostatitis, you’re going for all these tests. You start to get worried that something is, like, very medically wrong with you. It’s very scary, and it just plays into the stress of it all. And we haven’t even talked about it, but, like, your nervous system can wreak absolute havoc on your pelvic floor. You know?

There was actually so Bloomberg just published this article. I forget exactly what it was called. I feel like I wrote it down. It was called, it was called the stress of Wall Street is sending men to pelvic floor Therapy. And then the subtitle was, physical therapists in New York are seeing an uptick in younger male patients with penile and bladder issues.

Oh, okay. So funny because when this article came out, like, there were I was getting, like, two very, like, specific versions of people’s reactions to it. Some people were like, wow. This is so wild. Who would have known?

And every pelvic PT that I know posted it and was like, duh. Yeah. You know? Like, we know. But, you know, I think it’s good for, like, these larger news sources to be like, hey.

Like, this is a problem. Yeah. This is a great example of, like, hey. Look. There’s this, like, PT thing that can actually help you with this stuff.

But What is this? That’s like but it’s like a it’s, like, so true. Like, if you are it like, stress and when when I say stress, I mean any form of stress. So, obviously, like, Wall Street stress is a very specific form of stress. Yeah.

But, like, not sleeping enough, not getting enough nutrients Yeah. Not having enough water, poor blood sugar regulation, not pooping every day, you know, like, digestive unrest. All of these things are things that are, like, physiological stressors on the system, and any constellation of those things Yeah. Could affect your nervous system. And so, you know, we live I live in New York City, so there’s this very kinda, like, go go go mentality all the time.

Right? Like, you know, a lot of people really fall victim to that. Yeah. I I always tell people, I’m like, you know, for for most people, a mindfulness practice is, like, a nice to have. If you live in New York City, it’s a requirement.

Like, you have to have something that pulls you back into yourself. And so, you know, there that’s a very real part of managing a lot of these, like, high tone pelvic floor issues, but it’s not just pelvic floor issues. That’s right. It’s back pain. It’s pain.

It’s everything. Yeah. Pain, it plays that nervous system dysregulation plays right into all of our body’s pain experience and, like, increases the threat level of everything we experience as humans. That fight or flight system, people are always ready to fight in this modern age of, like you said, go go go, working all the time, getting money all the time, relationship stress, family stress, you name it, can contribute to anything, back pain, pelvic pain, shoulder pain, neck pain. Yeah.

And, you know, thankfully amount though. I think sometimes people hear, like, oh, your stress is contributing to this. And then what they hear is, like, okay. So you’re telling me that you’re just telling me to calm down. Yeah.

Basically. It’s like, no. No. No. No.

I know that as a 30 or whatever year old man working in consulting in New York City, we can’t change those factors. Yeah. What we can do is, like, take a step back and be like, okay. Here’s the like, where can we intervene? Like, what can we do Right.

To try to decrease that over like, what are the behaviors we can maybe add to your lifestyle when there’s not really anything we can take away? Right. You know? Right. And we’re not saying that it’s just all in your head.

You know? That’s also not what we’re saying. I we’re just saying to be aware of these things that they contribute to, I mean, any pain really. So, you know, people kinda just, you know and we’re the biomechanics people. We’re the anatomy people.

So it’s hard for them to hear it from us that, like, hey. Stress contributes to this. What’s going on here at your job contributes to this as well. So it sometimes it just helps the the client to be aware of, like, hey, I mean, this stuff also contributes to pain. Don’t just completely ignore it, and we could try to give them some strategies or whatever.

We’re not the experts on that, but at least sometimes even just kinda throwing it out there and being aware of that, can help a little bit. In some ways actually that we are the experts. Okay. Yeah. Sure.

I think that we I mean, hopefully hopefully, at this point in time, with everything we know about how pain and our nervous systems interact, physical therapists are, like, taking ownership of that and learning more tools to teach people. Sure. Sure. Sure. Yeah.

Yeah. There are plenty of other, like, you know, mental health therapists, even some dietitians that I work with in my in my private life and then also in my, like, clinical network. Like, there’s a lot of places where you can get that, but I think that we need to take ownership of that because Yeah. I was speaking more towards, like, let’s say, in PT school, like, we’re all, like, anatomy. Not most all schools.

Thankfully, we’re getting a little bit more biopsychosocial, like I said. But, like, most of the curriculum is still geared towards that stuff. But yeah. I mean, it it’s within our scope, but we also can’t, like, go over the boundaries with that stuff either. But, being a holistic provider, we can, you know, definitely touch on those things and give them strategies for, you know, exercise in general is good for all that stuff regardless.

So educating on that helps a lot too. So but yeah. I mean, as always, pain is multifactorial. So many things going on. It’s hard sometimes to just, like, sit down with somebody and explain all these things.

There’s only so much time we have with somebody. Again, thankfully, we could do have more time that we’re, you know, working for ourselves and all that. So that’s always a good thing. Let’s see. What else we got here?

There’s I mean, there’s so many things to touch on with with pelvic health. Besides assessing tension, I put down, like, pressure systems, coordination with your breath. Can you expand on those things a little bit? Yeah. So the the explanation of the evaluation that I gave is, like, just the pelvic floor piece of it.

But, you know, the evaluation also includes looking at the whole musculoskeletal system. So two part. There’s two things that are, like, there’s a lot of different things we can look at, but on a sort of base level, we have to look at how does the body absorb and produce force. So is there in the places where the body needs to absorb force, can it do that? So at the foot, for example, the foot has to be able to pronate.

It has to be able to flatten enough through the gait cycle. At the hip, the hip has to be able to internally rotate enough. That’s a force absorption pattern at the hip. The trunk has to be able to stiffen. Like, can you successfully use your abdominal wall?

Your what is your diaphragm doing? Can it move, or are you stuck in this kind of, like, inhaled position or exhaled position? Are you able to breathe into the entirety of your rib cage? Yeah. And, you know, there are other pieces of that, but those are sort of, like, key hallmarks of that.

And the reason that I care about those thing I mean, I care about other ranges of motion too, but those things, the pelvis is a load transfer zone in the body. When you when your foot hits the ground, forces are traveling from your foot through the leg via the pelvis to the upper body, and most of the things that we do are rotational. So we have to be able to transmit those forces up and down. And if we’re not absorbing force well somewhere, sometimes the pelvic floor is the thing that’s, like, taking over. Yeah.

And so and that’s, like, that’s, like, on a sort for a person who is maybe a runner, or somebody where they’re doing, like, some kind of reciprocal thing like that, that is, like, really important. From a pressure standpoint, the pelvic floor is the bottom of a pressure system. So you have your pelvic floor on the bottom. You have your abdominal wall around the trunk. You have the diaphragm on top of that.

And then even on top of that, you have the glottis, which is what, like, closes off your throat when you’re trying not to when you’re trying to hold your breath or when you’re after you swallow, that kind of thing. Yep. And so pressure is gonna go somewhere in that system, and we want it to be able to be distributed as evenly as possible. And so there needs to be successful expansion and compression of that system, both in the rib cage and in the abdominal cavity. And so we’re looking at that in various different ways, and and, also, we’re looking at it, in the context of, like, different breathing conditions, like what happens when you inhale, what happens when you exhale, what happens when you hold your breath.

How are you doing those things under the demands of whatever your exercise is, like heavy lifting or, you know, whatever. I’ve I’ve worked with singers who have issues with their pelvic floors because they are using this very kinda, like, bottoms up tension strategy and are struggling to engage with other parts of the canister to produce enough, exhale force, basically, to hit a high note. So they’re, like, doing it by creating this tension down below. And so, you know, there’s a lot of reasons why we care about that stuff, but from, like, a zoomed out standpoint of what we’re looking at in the pelvic floor assessment, that’s those two things are a big part of it. Okay.

Gotcha. Let’s try to go back again more. Like you said, just zoomed out. We just mentioned that. But, like, in conjunction with, like, low back pain, hip, SI joint pain, like, how do you start piecing everything together when it comes to evaluating somebody with back pain?

Like, where do you start with that? Do you also assess the pelvic floor? Do you always assess the pelvic floor with these types of pains? How do you start with that? I feel like it depends.

Always. My favorite answer. Yeah. If a person is just, like, newly coming to me with back pain, and was referred to me for back pain or, like, that’s their chief complaint, I I’m a pelvic floor therapist, so I’m always thinking about it a little bit. Mhmm.

But I will probably manage it. I might ask them if they’re having any symptoms. Everybody who comes into my office gets the same intake. What do you ask them? What’s your general way of screening for that?

I’m I’m asking them, like, I’m asking them a lot of the things I’ve already mentioned that are symptoms. Do you feel like you have to go to the bathroom all the time? Do you feel like you have to push out your pee? Do you have a bowel movement every day? Have you ever, in the last year, experienced issues maintaining or achieving erection?

Do you have pain with arousal? You know, like, those kinds of things. Yeah. Important stuff. But my intake paperwork has all of that stuff in it Mhmm.

And everyone gets the same thing. I don’t care if you’re coming in for knee pain or, you know, penile pain. You’re getting the same form because I’m giving everybody the opportunity to be like, oh. Yeah. Maybe I should tell somebody about that.

Yeah. You know? Right. You could help me with that? Tell me more.

You know? So so I usually will read the eval form. And if they haven’t if they haven’t ticked off any of those symptoms, I usually assume that they aren’t there unless, I like, on the first day. And then I’ll kinda come back to it later. But there’s so much like I was just saying, right, with, like, the foot and the hip and the pelvic girdle and, like, all of this external stuff.

There is so much that you can do without ever doing, like, a hands on, like, palpation pelvic floor assessment that Mhmm. A lot of times I, it’s always in the back of my mind. Maybe I’m giving them exercises where I’m targeting it, and I’m just kinda, like, seeing, like, even if I think it’s there, can I resolve it without ever actually doing the internal part? Not that I’m not I will tell them that that is what I’m doing. Yeah.

But, you know, because I want them to be aware and then maybe tell their friends that this is a thing that people can get help with. Yeah. But, you know, I don’t really ever I don’t really have to do the internal part of the exam a lot of the time. I feel like it honestly, I think it has been overused sometimes in, pelvic PT, and I think sometimes we forget that we’re also, like, orthopedic therapists who can manage a lot of this stuff in a more, holistic Yeah. Oh, yeah.

Way. Yeah. Yeah. And I’m I’m gonna zoom out again. And I think a lot of in in general, PT people overuse hands on stuff or that’s people you know, again, people think we just do massage or something.

And I’m like, no. Not at all. I mean I literally had a patient come in. It was her first it was, it was their first session today, and they were like, you know, you can do whatever you want, but please don’t poke my psoas muscle. I’ve had so many Yeah.

Physical therapist do that, and it just, like, doesn’t help me. And I was like, I was literally not even gonna put you on the table. You know? Yeah. Like, it’s just crazy.

And it’s like it’s like this person now feels, like, scared to go to physical therapy because they’re afraid that they’re gonna get poked. I’m just like, come on, guys. Do better. Poke yeah. Poking already painful and tight muscles, possibly sensitizing it even more and just creating creating this vicious cycle of more sensitization of that muscle, especially when I do it super hard.

I’m not saying that always happens, but, you know, the possibility is there. Yeah. I mean, with the pelvic floor stuff, like, there again, I’m not saying that there is never a reason to do internal exams, to do internal treatment. I do those things every day. Mhmm.

But I do think that there sometimes are times where, like, if you just think one step further, you can maybe give somebody something that they will actually do at home so that then, you know, you’re, like, accelerating their progress. A lot of people, honestly, especially men, are not gonna do internal self releases at home. They’re gonna come in. They’ll they’ll be totally game to do it in the office. They don’t wanna do that at home.

You know? So Hot take. They don’t. At least the guys who have been here to see me. So Yeah.

And it makes sense, though. But yeah. Going along with that again, like, I think I had was this last week? I had one guy with, like, hip flexor tendonitis. And like you said, the PT before at name whatever outpatient mill PT place, all they would do is just try to release it, poke on it, try to release it.

I’m like, what stuff did they have you doing at home? Like, one general hip flexor stretch. I was like, oh, god. Did they try to strengthen it at all? And they’re like, yeah.

Isn’t this a strengthening exercise? It was a stretch, of course. I was like, no. It’s not. And so I I again, I gave him a a lot of homework to strengthen it, to get better, and he’s good now.

And he was like, oh, that’s PT. I was like, yeah. Yeah. It is. Yeah.

And I’m glad I got you stronger, more resilient, and self efficient, you know, at home Because a good PT, they’re not gonna need us all the time. If we give them the right tools to do at home, without us working on them all the time, that’s the best case scenario. You know? Yeah. I think I think too, like, the more we this again, I’m gonna give, like, a pelvic example because that’s what I’m here to talk about.

But, like, the more that we are out here talking about that, the more I think the message comes across. I will say, like, usually, I’m not a fan of, people googling their symptoms because I’m like, the Internet is gonna, like, tell you you have anal cancer or something. Just like Yeah. Don’t do that. But I will say that, like, a lot of men find out about pelvic PT on Reddit, and they are actually going and getting help.

And not only that, they’re finding pelvic PTs on Reddit, and then they’re going to a pelvic PT. And the pelvic PT is just, like, doing a bunch of internal stuff. And they’re like, you know what? I read on Reddit that there is a connection between my hips and my pelvic floor. So I’m gonna go like, these are the people who are then coming to me being, like, try that person.

They didn’t give me any hip stuff, and now I’m here. And I’m like, honestly, great. Fine. Like, I love that you took that level of initiative to do this for yourself. But, like, we shouldn’t need people to do I know.

You know? I know. It’s But, anyway, my point is just that, like, I think that that, like, all we can do really is just, like, do this and tell people that there’s another way and, like, also thank the people on Reddit for for spreading. Do you scour Reddit to, like, you know I do, actually. Nice.

And now that I learned that, I’m like, let me just see what people are talking about. About it. Yeah. There’s a whole, like, community there of PT and stuff that Oh, I joined, like, multiple, like, men’s health Okay. Channels just to be like, what are people even asking?

I wanna know. Have you commented and talked to them? I’m a lurker, to be honest. I’m definitely lurking. But it’s it helps me, like, understand what kinds of questions people have.

What’s even more fascinating and it’s fascinating sometimes is, like, the answers that people get. But if I see something egregious, I will comment. Is that a compliment to just on some stuff. Yeah. Yeah.

I mostly just, like, lurk in the shadows and be like, oh, that’s what people are talking about. Interesting. Interesting. Well, I lurk the what is it? I think it’s just called the physical therapy subreddit or something.

I’m not familiar with any of this stuff, but, like, a lot of these, you know and we could get into this different podcast, but, like, different gripes with health care and the the profession itself. And I’ve commented, sub Reddit. No one said anything one time. I was like, alright. Well, I’m lurking too now, but maybe I should be more, you know, engaging with it.

But I know. If you guys are just spend your time doing that. What’s up? You guys could you know, my stuff is on the YouTube channel if you wanna Right. You know, message me.

Like and subscribe. I’m trying to help you guys here. You know what I mean? We’re all in it together to help educate about PT. So Yeah.

Yeah. Let’s get into more, like, actionable items. I know, again, everybody’s different, and it’s hard to without a thorough assessment, it’s hard to give basic, pelvic PT advice. But, like, what are good habits for men specifically, that can maybe help them avoid these symptoms with, you know, erectile dysfunction, premature ejaculation, the big ones, let’s say? Yeah.

I think that, this is, like, this is, like, for desk workers. Right? And I think this kinda goes for a lot of different things. But a lot of people just are in the same position all day Yeah. Every day.

Me right now sitting here, I’m like, ugh. Right. I might not use the city for that long. Yeah. Me either.

But the more variability you can introduce into your day Yeah. In positions, postures, like, we don’t rotate that much as humans, and a lot of, like it’s like our nervous systems really like that. It’s like a massage for your guts and for your nerves. So, like, anything that you can do that’s, like, a more twisty motion. Even if you just, like, take a break and, like, lay on your back and windshield wipe your knees from side to side, something, to move across midline.

I think, a lot of times, like, standard strength training programs have a lot of, like, two feet or two arm lifts, like, the basic convention basic, like, compound lifts. Yep. And so if you are a person who’s lifting, you know, introduce some variability there. Do things on one leg. Do things that are rotational.

One leg exercises are pretty much pelvic floor exercises because your pelvic floor muscles are working with your hip musculature to stabilize you on one foot. So Yep. Introduce some new patterns to your straight your training program. K. Nervous system regulation.

It’s so hard, but, like, you know, there needs to be at the very least, if you’re working, like, a very stressful job or something like that, there needs to be a wind down period. Like, you need to have a time where it’s like you don’t just, like, get home and make dinner and go to bed. Like, you need to have a time that’s maybe not watching TV because that’s not always, like, a wind down, but, like Yeah. Something that you it doesn’t have to be, like, meditation. It could be, like, a short walk with, like, like, paying attention to your surroundings.

Yeah. Yeah. Something that kind of, like, puts you in your body and in your environment to help quiet your nervous system. Use a squatty potty for your bowel movements. Get your feet up on something higher than your knees.

It will help the it will help things come through for reasons that we didn’t really get into. But, basically, it, like, makes a straighter line from, like, the end of your colon to the end, like, to the anal sphincter, easier pathway. Yep. Drink enough water. Get enough food.

You know? Stressless. Basic. I think you got me on the the Squatty Potty, like, two, three years ago. I still have it, and I use it.

That thing I tell people this all the time. Like, so I live with my husband, and I bought a Squatty Potty for our bathroom. And he was like, what is that? And I was like, use that thing one time. It will change your life.

Yeah. That’s great. Was like, next day, he was like, you were right. Yeah. So I was like comes right out.

Love it. I know. I know I was right. Right out. Alright.

Where can people find you, social media stuff, website? Yeah. Go ahead and tell us about it. I I am in Brooklyn. So, if you are in New York City, I’m located in Dumbo.

But you can find me on social media. My clinic’s Instagram is at empower p t n y c, and my personal Instagram is at doctor Julia Rosenthal. Your our website is www.empowerpt.nyc, and those are probably the best best few places to find us. Cool. Awesome.

Yeah. And you guys could find me, as always, on Instagram at a p t doctor g. Website, artofpt.com. I have my newsletter, the PT Handbook, which you could subscribe through my Instagram website. It’s everywhere.

It should be on the YouTube, description as well. I do have an ebook coming out about back pain, which will be, out maybe in a couple weeks, and I’m gonna try to record myself doing the audiobook as well. So be on the lookout for that. And thanks, Julia. I appreciate it.

Yeah. Thank you. Thanks for having me. Yeah. We’ll see you guys next time.

Peace.