Pain with Sex? Leaking During Workouts? Pelvic PT Intro | The Art of Wellness Podcast

What’s up? Art of Wellness podcast. Thank you for listening and subscribing. We have doctor Aissa here with us. Aissa, what’s up?

How’s life? Oh, life’s good. Thank you for having me. Life’s good. Awesome.

Well, two things I wanna accomplish with this podcast are, first is us kinda talking about our early years in PT. Right? And secondly is all things, which is why you’re here, pelvic health. So first, some general questions, some background stuff is where’d you go to school for undergrad? Where’d you go to PT school?

And lastly, what was your first job out of PT school? So kind of a three part question if you could answer that for us. That’s kind of only two part. So I went to University of Hartford. Uh-huh.

So I went to University of Hartford. I did my four years undergrad. And they kind of had it so that as soon as you finish, like, your undergrad, you’re automatically into the graduate program. Oh, yeah. Gotcha.

So I did all seven years through the University of Hartford straight through no breaks. Yeah. And after that, my first job out of PT school was working at Select Physical Therapy. And it’s ironic because that was one of my internships that I did while I was at the University of Hartford. So seven years right into Select Physical Therapy.

And, I mean, we could just kinda talk about our first jobs then. So, like, what was your experience like working at at that first job? So I feel like it started off pretty good because I really didn’t know any better. Like, I had nothing to compare it to. Mhmm.

So the bosses that I had, they were pretty good bosses. The company, like, learning later on, like, I didn’t enjoy working for the company as much, but it’s it it seemed like a pretty good job, especially, like, starting off, especially because I had really nothing to compare it to. Yeah. So a lot of orthopedic patients, neck pain, back pain, shoulder pain, knee pain. Yeah.

And what I really I really did like about the company was that they had a very good continuing education program. So, like, every weekend or every other weekend, I was taking course after course after course after course. And they were they were giving me so much extra education. And that’s that was one of, like, the really, like, big benefits from working for this company that I absolutely enjoyed. And I and I miss it to this day, being able to just get all this free education.

Yeah. Okay. So that’s something you you do miss. Well, mine’s kinda the same story, but I wanna hear about what don’t you miss from working there. So it was the two to three patients per hour.

Mhmm. The back to back to back to back. The documentation not never necessarily having, like, a break throughout the day. Like, yeah, we might, like, get, like, a cancellation here and there. But I feel like it was just, like, you’re just on this go go go state all day.

And where I was working, for sometimes I did, like, my four days a week, but sometimes because I did, like, a Monday through Thursday schedule, I always had my Fridays. But sometimes, like, I’d pick up, like, an extra day. So Mhmm. Within that, I had twelve hour days. So two eights, two twelve hour days, and then sometimes, like, I pick up something and maybe sometimes, like, I had an additional course.

And Mhmm. I guess the main thing about it is, like, I just was so burnt out, and I didn’t even know that I was so burnt out with working with this company because, again, I had nothing to compare it to. Yeah. I think burnt out is a very I mean, it’s a word we hear a lot in health care, and, you know, we can only speak on our, like, our experience as PTs, but, you know, I had a similar experience to where yeah. I mean, if you’re in Illinois, it’s whatever company.

I’m not gonna name the company, but it’s they’re all the same. You know what I mean? It’s it’s very typical seeing you know, I would see three people at a time sometimes, just because I had to get people in, you know, because they wanted us to for for productivity reasons or because this person need an eval, like, now. And, you know, I guess, like you, I I miss the the camaraderie of our team, also the continued ed stuff, you know, like, getting those classes paid for and stuff. That was always cool.

You know? Yeah. But it wasn’t enough for me to to stay because of all the, you know, corporate mumbo jumbo and insurance breathing down our necks all the time. You know, our corporate higher ups telling us to bill a certain way for more reimbursement purposes, things like that. You know, not saying it like that, but, again, you know, I’m not Yeah.

We’re not stupid. We’re like, okay. We know what we’re trying to do. We’re trying to bill more for x amount of for this patient or whatever, and it’s borderline unethical. And that’s where I was like, okay.

Like, I I was there maybe, what, three years, four years? And I was like, alright. I’m good. Like, I I get the idea. Like, I I got what I needed out of that experience, which is, you know, treating a lot of patients in a day, seeing different diagnoses.

It definitely prepares you. Like, it it really prepares you to, like, take things on quickly, think fast on your feet, be very efficient. Like, it it really does prepare you. Yeah. So, like, even though, like, it wasn’t the greatest, like Mhmm.

Part of you, like, it’s like we kinda needed it a little bit. That’s a great point. Yeah. I don’t disagree. I mean, I think everything in life happens for a reason.

I think that for for us, it sounds like and a lot of younger clinicians too. Like, I don’t know. I I I feel like it definitely benefited me to be able to think on my feet, you know, that fast in a day, seeing different people, you know, just like rapid fire style. So Mhmm. In a way, yeah, it definitely did help me for for now, you know, having my own practice and kinda seeing people one on one where, you know, it’s different, but, you know, if needed, I could take on a lot of people in a day, but not that I want that.

But Yeah. You know, it definitely helped me kind of see the bigger picture of I guess, when I do see somebody one on one, I don’t take it for granted type type deal. You know? Absolutely. Does that make sense?

Oh, yeah. Oh, there there’s nothing like treating somebody one on one. Like, having to constantly have, like, your attention divided in between two to three people, you are never able to fully give this person your attention and fully, like, think about their particular situation because you’re juggling two different things, potentially three different things, essentially notes on the side all at the same time. Yeah. And it’s the pace it’s the patient that suffers because your attention is certified you to suffer too.

But the patient, they are the ones that really suffer. Yeah. Oh, yeah. And, you know, we’re in health care. I know I know we all get burnt out too, but really, unfortunately not unfortunately.

Fortunately, because that’s our job is it’s a job of service. Right? Like, they suffer. You know? At the same time, we suffer, but it is about them.

It’s health care. Right? So, you know, it sucks when I I did, you know, have three people at a time, and I’m just, like, telling my aids or assistants, yeah, do this and this with this this patient as I see somebody else. And, yeah, I mean, both parties suffer, you know, the health care provider and the patient. But, yeah, the patient’s the one not getting the appropriate care at that time for their their back pain, their neck pain, you know, whatever they had, you know, post surgical ACL.

What it doesn’t really matter what it is. You know? It’s just they need care, and we can’t give it to them because of certain standards and and things that these companies want out of us that sometimes seem impossible, honestly. But yeah, so I guess in a way, like we said, yeah, it it definitely helped me think or see a better picture of physical therapy, which is, you know, what I’m doing now, thankfully. But, yeah, it was it definitely like you said, I don’t think I was aware of being burnt out until I was, like I think it just hit me all at once, like, one week.

I was, like, super stressed. I was not sleeping well. I was having, like, back pain and stuff, and I was like, oh, okay. Now I’m burnt out. This is what being burnt out feels like.

You know? And and I was like, what? I don’t know how old I was. Maybe, like, 30 at the time or something. Do you remember that point?

Like, when you were like, alright. This is enough for me. Like, this is like, I’m done with this. Do you remember that? Yeah.

Yeah. I was So I got pregnant during COVID. So I was working all throughout my pregnancy. And I was just exhausted. Like, it like it felt like every day I was running a marathon.

Like there was like points in the day where I just like, I just couldn’t. Like it was the weirdest form of exhaustion I’ve ever felt in my life. And there was like nothing I could do about it. And as a result, like, I’m seeing clients, but I’m still, like, exhausted. So it kind of Mhmm.

I guess it kind of reflected in how I was treating my patients. Not that, like, I wasn’t giving them my all, but, like, my all was just, like, not even there. Mhmm. And I told my boss this, and I’m, like, I’m I’m exhausted. And I think what ended up happening was they kind of, like, in in my review, they kind of, like, said that I wasn’t, like, giving my patients my all.

Because I was essentially like exhausted at that point. And granted, there was, I didn’t have maternity leave. So I had to use my, my PTO. So it was just like a combination of, oh, I was exhausted. You put this into like my review.

Oh, I didn’t have, maternity leave. And it was just kind of like all these things on top of each other. And it just made me just like, feel like, why am I putting all of my effort into this company that doesn’t really care about me? Yeah. Care about you or the patient, really.

But Yeah. Yeah. It’s a it’s a weird exhaustion being burnt out because, yeah, physically, you feel tired, but I think mentally, like, I was definitely just on autopilot. You know? Like, it just it felt like I was I guess the word is going through the motions, but or the phrase, but it felt like you were I was in a haze or something.

Like, I wasn’t fully present half the time. Like, I am right now talking to you. Like, I feel like I’m here talking to you, but, like, going along a typical day in those outpatient clinics, you’re just like, you have no time to just, like, I don’t know, be present because you’re always giving yourself to somebody, and then it just, like, chips away at you. Thinking about the next thing. Mhmm.

Which is terrible for the patient again because, you know, you’re thinking about somebody else, but you have this person laying on a table. You know, you maybe even do some manual therapy on them or something, and you’re thinking about the next person coming in who’s post op ACL. You have to get them warmed up on something, and then it’s and I guess that’s good in a way because, again, like, now I could think that rapidly. So in a way, I had to unlearn that sometimes or a little bit because, like, now, again, I’m with people more private and for an hour, that full hour of my undivided attention. So I had to kinda, like, reprogram myself to slow down too.

So it’s good and bad, I guess. I don’t know if you had that experience, but, yeah, that was kinda tough for me. Oh, I love I love the slowness, but I feel like at times it’s like like, there’s times where I’m like, oh, I just love this snow slowness, but sometimes it gets a little bit boring. But I definitely understand, like, having to reprogram yourself because you get so used to just being go go go all the time. Yeah.

Yeah. But it was kind of, like, weird for me. Like, I was used to being, like, in this go go go state all the time. And then, like, as soon as I got, like, pregnant, I, like, I I couldn’t. Mhmm.

I couldn’t. So, like, my body said, alright. Stop. You can’t do all this stuff anymore. Yeah.

Yeah. I mean yeah. I you know, you go from seeing I don’t know how many people would see in a day. Maybe, like, I don’t know, 13 to 15 people in a day and then cutting that in half as a private practice or a little bit over a half sometimes, but it’s it’s a weird change of pace. But Yeah.

It it it helped me see what health care can be, which is truly one on one and helping somebody, again, giving them my undivided attention, which, you know, obviously, they like it more because I’m with them the whole time, showing them exercise and progressions to things, and even just talking with them for longer than I could have in my last job. You know? It’s people just wanna be listened to, especially when they’re in pain. You know? Like Absolutely.

You know, we hear it all the time. They go see their primary care or they see some specialists, and they’re like, oh, well, he saw me for five minutes and then he left. And I’m like, you know, again, I don’t wanna swear, but I’m like, fuck. You know? Like like, that sucks.

You know? Why is that why is it like that? And I’m glad that I could be sitting with them for you know, today, I sat with somebody for, like, twenty minutes just talking to them. And and, again, half of that I mean, that’s also a treatment because in a way, like, they’re kinda just, like, venting to you, and I’m like, you know, yeah. I’m here to listen.

I got I got this time blocked out for us. So you tell me whatever you need to tell me. Like, it’s all good. And I could tell that she was time that okay. Sorry.

Go ahead. I was just gonna say, you know, I could tell that she was, you know, happy about that because nobody else gave her that opportunity. But yeah. Go ahead. And then a lot of the times, that’s such valuable information.

Like being able to talk to our patients, it gives us so much valuable information to be able to direct them to what they’re able to do in their exercise programs and even outside of that. And if you’re just treating or just doing all these things while you have all these other patients, you don’t have that time to actually sit there and talk to them, and you miss so much information that is key in helping our patients heal. Yeah. And that’s what I tell students all the time when I get an intern or something. I’m like, the subjective part, the history part, like, they’re gonna give you clues how to help them.

Like, that’s they’re gonna give you all the pieces to the puzzle. And if you don’t have enough time for that because you’re working at this company that all they care about is money, then you’re like, you know, you’re not giving them the best assessment or the best treatment plan because you don’t get all that information they could give you when they talk to you for twenty minutes or or fifteen minutes even that. You know what I mean? So yeah. It sucks.

Those companies suck. And, you know, I’m more than happy to tell them that they suck. So, anyway, let’s get more positive here. What’s your before we get to pelvic health stuff, like, what’s what’s your favorite thing about working as a as a physical therapist? I feel like the the profession as a physical therapist, I feel like we’ve been able to understand the body on so many different levels.

And I feel like just because we’re able to kind of understand all these different levels, we’re really able to help people, like, really with their body in, like, helping them recover from something, but also in a preventative focus as well. So I’ve I feel like we’re so blessed to have been put in this into this profession just because of, like, all the things that we’ve learned and to be able to take care of my own body as a result of this and then be able to help other people as well. Right. Yeah. I mean, I think just seeing somebody when, you know, the whole progression of their pain journey is, you know, if someone comes in with me with crippling back pain and, you know, the first session, they’re, like, crying with me and they can’t even, like, walk.

You know, walking hurts or sitting hurts or any of those functional activities hurt. And then working with them for x amount of weeks, however long it takes, seeing them get happier and more functional, that’s my favorite part is seeing that that journey of getting better. And then I’m like, you know, it’s hard because that that first day, it’s like they it seems like they have no hope sometimes, and then we’re there to give them hope. You know? Sometimes that’s all they need, and then, you know, we’re there to guide them through it.

And it’s it’s up and down. It’s never just a linear progression like I always say. You know? It it it’s a journey, and it’s never just you just get better week after week. You know, I have seen it where people do get better week after week.

You know, it’s not, like, abnormal. But most of the time, it’s like people have their good days and bad days, good weeks and bad weeks. But I think just seeing that person, whoever it is, you know, with back pain or they had surgery or, whatever, neck pain, they sprained their ankle, whatever it is, and then you see them kinda gradually get back to themselves. That’s my favorite part about working as a PT. But Give people life back?

Yes. And, you know, people love it when they can get back to their sport or get back to just sitting with no pain or, you know, simple things like that that we take for granted. But and we do without any medications or, you know, surgeries or things like that. So it’s a very powerful job, and, that’s what I love about it. But, anyways, pelvic health stuff, pelvic floor stuff.

Do you have your model? I do. You ready to I got two. To educate us on the anatomy of the pelvic floor? Oh, yeah.

Yeah. Wanna hear about it? Please. Okay. So, guys, this is your pelvic floor.

If you are a male, you have a pelvic floor. If you’re a female, you have a pelvic floor. If you’re a male, you don’t have you have these muscles, but they look a little bit different because your external genitalia is a little bit differently, but we all have a pelvic floor. So your pelvic floor is a sling of muscles that rest at the base of your pelvis. So you can see these muscles right here.

So there’s a deeper layer. So this is like the layer that’s on the inside of you the most. And there’s a layer that’s kind of like in between and then there’s more of like a layer that’s kind of like on the outside. So like I said, men have these muscles too. Most of these muscles as most of these, outside muscles as well.

They just look a little bit different because their parts are a little bit different. And these muscles are so vital and not talked about enough. And when we do talk about them, we talk about them in terms of when we’re peeing our pants, postpartum. Maybe you’ll hear it with like a DRA when you’re experiencing pain with sex, things of that sort. But these muscles are vital in everything that we do.

But the main focuses of this pelvic floor, these pelvic floor muscles is bowel, which is holding your poop in, letting it go, bladder holding your pee and letting it go. All of your organs, everything sits on top of your pelvic floor muscles. So if these muscles don’t function well, what is happening to all of these organs on top? It’s important for sexual function. So these muscles are important in arousal and allowing you to orgasm.

So if you’re having issues with sex, your pelvic floor plays a big role of it and role in it and movement. So the biggest thing is that these muscles help you move. And that’s what often gets neglected. Like we think of these pelvic floor muscles when it comes to like any of these diagnoses, but these muscles help us move, which is vital in walking, sitting, moving around the day, doing stairs, exercising. These pelvic floor muscles play a vital role in all of that.

Super cool. So yeah. What, so, like, common conditions that you treat? Like, what what do you see patients for the most when it they do come to you for pelvic stuff? The biggest thing I think I see is incontinence.

So that is when you pee your pants at all. So it could be a little bit, not normal. Could be a lot, not normal. And that’s commonly what I see. And this could happen for a number of reasons.

And like through social media, you’re gonna find, if you have pelvic floor issues, you just do key goals to prevent yourself from peeing your pants. And that is it could be part of the truth, but it’s far from the entire truth. So what it’s really important for people to understand is that these muscles, they just need better function. So whether you’re dealing with incontinence, which is peeing your pants, whether you’re dealing with pain with sex, which is something that I see often a lot, a lot of times just restoring the movement of your pelvic floor with the the other muscles in your body that it works with because your pelvic floor is not working by itself. Mhmm.

It’s working with the muscles deep within your back. It’s working with your deep ab muscles, and it’s working with your diaphragm, which is your primary breathing muscle. So we need to allow these pelvic floor muscles to function with these deep core muscles and our entire system. And that helps with the specific issues that you’re experiencing in terms of like the incontinence, potentially even prolapse. Prolapse is something that I see, which is kind of like this heaviness or, like, your your organs are kind of moving into, like, the vaginal canal.

Mhmm. So when we have better movement, better function of all these muscles together, This is what can resolve our pelvic floor issues. But the thing is, when I see people for pelvic floor issues, they’re not just dealing with pelvic floor issues. Usually there’s other problems going on. Usually it’s their hip, their back, their neck, maybe their foot.

So, again, this is why it’s important to restore the function of our pelvic floor with our deep or in our entire system. So what does what does that look like? Let’s say I know it depends. Just like with any any pain people come in to see us with, but, like, let’s say you said, like, restore function. Like, how do you even start doing that with someone, like, with incontinence, for example?

Yeah. So, usually, what I do is I assess their movement. A big component of this is a lot of people are generally tight. So they have tight muscles in various areas of our body. So part of the tightness could be kind of like in this pelvic floor region, but we also have this tightness in our back, some muscles in our abs, like that six pack ab muscle that we train so hard in the gym, our neck, our rib cage, and what that ends up doing is it ends up putting more pressure downward onto our pelvic floor muscles.

So these pelvic floor muscles have to fight for dear life to do the job that they’re supposed to do. So oftentimes what I’m doing is I’m assessing mobility of their hips, seeing how their hips move, which gives me a good indication of how their back is moving, how their pelvic floor is moving, as well as how their upper body is moving as well. Because the upper body, I feel like this doesn’t get enough, exposure. The upper body plays a vital role in your pelvic floor issues. And even if we’re just addressing like this core, this, the pelvic floor muscles like in their strength, if you don’t address the upper body component, you’re missing out on a huge component.

So we wanna make sure that we’re assessing how we move based off of how we move. A lot of the times it’s just getting things to move better. So it could be stretches that kind of help things calm down. It could be kind of like manual work such as dry needling. It could be like massage balls.

It could be foam rolling. It could be internal work because that’s something that I do and often be very helpful. But allowing these muscles to start to let go is really important. Because if these muscles can’t lengthen and let go, they can’t contract. So they can’t lengthen and let go.

So they can’t contract to do what they’re supposed to do. So one of the biggest ways that I’m able to kind of one, allow these muscles to lengthen and then contract is coordinating all this stuff with your breath. So we do often a lot of times, breathing exercises that incorporate your breath to allow all of these muscles to lengthen and relax. And then that same breath to strengthen these muscles at the same time because when we exhale, we get these pelvic floor muscles to contract, which is to strengthen them. We get our core muscles to contract, which is to strengthen those core muscles at the same time, and we get our deep back muscles to contract to strengthen them all at the same time.

Yeah. And depending on who the person is, they might need specific exercises. Somebody might need lighter exercises where you’re not doing much at all. And then somebody who’s higher level, they might need something that’s a little bit more advanced. Or a lot of the times I work with people who are gym goers and what I find for people who are squatting, dead lifting, lunging, running, doing all these different things.

A lot of us have so much tension in our body. Yep. And some of us are stretching and it helps, but it doesn’t help enough. So a lot of the times like manual work can be really, really helpful, especially in like the athletic population to allow in these tight areas in your neck, in your back, in your hips to let go so that you’re able to do a little bit more advanced exercises and then be able to apply it to what you’re doing in your workout as well. Yeah.

Yeah. Makes perfect sense. You mentioned internal work, external work. So, like, meaning, like, manual therapy. Right?

I would assume. Yeah. Mhmm. Can you give us an example of each one and how you would perform internal work? So internal work, I’m gonna remove the outer layer.

So I’m gonna speak in terms of women. So internal work, it’s done with just one gloved finger. So we put a glove on, we lube it up. It’s not like the I can’t even remember the the scary thing that OB GYNs use. I don’t I don’t like that thing.

But it’s just it’s just one finger. You put it in the vaginal canal. So we’re able to kind of assess, depending on how far our finger goes in to assess kind of like the tone of the muscles if they hurt, if they’re able to contract well, and then be able to kind of like treat them from there. So internal work literally is just finger goes in. So we could either just kind of apply pressure to kind of like someone like the superficial muscles.

It’s literally looks like this. Yeah. Or if you’re going in a little bit deeper, it’s kind of like you hook in and potentially go on some of, like, the muscles, like, in the bowl. Mhmm. So that’s kind of like what manual therapy could look like if you’re doing, like, internal work.

For men, we go in through the butt and it looks similar, but you’re just accessing it from a different whole. Yeah. Yeah, but either way, it’s just like you’re applying pressure to these muscles. It’s kind of like a trigger point release. Yeah.

Just applying the pressure. The pressure, should start or the, the pain should start to subside a little bit as you apply the pressure, and that helps to kind of allow the muscles to relax. Right. I mean, it’s just like any muscle. Right?

I mean, you’re assessing the tone first, and then you could apply whatever manual technique that you feel is necessary for that skeletal muscle. Like you said, it’s it’s muscle. So same thing except it to go inside a hole, like you said. Yeah. But yeah.

Yeah. Cool stuff. Just a little bit more intimate. Yes. So what what surprised you the most when starting to treat this population?

Like, I guess, what what what was the one thing that you’re like, oh, this is different besides treating the normal orthopedic person? You know what I mean? Even though it’s all connected, I know, but, like, what do you think surprised you the most when you first started treating a a pelvic floor person, health person? I think, usually, when I see people for pelvic floor issues, usually, they’re a little bit more difficult as a patient. Mhmm.

Not in, like, they’re difficult, just that their symptoms might be a little bit more complex. Because usually when I see somebody for pelvic floor issues, it’s usually not just their pelvic floor that is bothering them. Yep. And if it did, and if it is, it probably just got to a point where their pelvic floor has gotten so bad that they finally come in to see you. So it’s just that these patients are a little bit more I I don’t I don’t even wanna use the word difficult.

Like, they’re just a little bit more complex in terms of they might be dealing with potential hormonal issues, other, maybe autoimmune issues, maybe other aches and pains. Yep. So it’s just it’s I’m just a little bit more cautious in dealing with, specific people. But granted, there are some people that, they’re they’re not as complex. It could be a little bit more straightforward.

But usually, what I find is the pelvic floor patients are a little bit more complex. Okay. What so, like, a pelvic what are, like, some symptoms some symptoms that people exhibit when they are coming in for like, what what do they tell you first when you do get a patient who’s referred to you for pelvic floor things? What do they say is, like, some common symptoms they’re having around that area? Yeah.

So, usually, it’s, like, they leak a little bit. They might feel like a dragging or like a pressure in that area. Mhmm. They might have like a bloated belly or like they have like a DRA or like a DRA that’s persistent even like years after they’ve had childbirth. DRA meaning?

Diastasis rectus abdominis. So a separation of the rectus abdominis muscle. Okay. Got it. Back pain.

It’s it’s back pain is almost always there. Yep. Hip pain, a lot of neck pain. Because, like, again, all of these things are kind of going on at the same time. But the major issue that people will come to see me with is usually incontinence or peeing their pants, or even just like the pressure in that, pelvic region.

Or, then sometimes this doesn’t even come out till way later that sex hurts. Like they kind of like brush it off in the beginning. Eventually they say, oh, yeah. This is a it’s a little uncomfortable. Is this men and women or just women?

The women. I see right. Yes. I mostly see women. Yeah.

Okay. What about when a guy have you had many male patients, and what do they tell you when they do? I had a few. I had a few. Okay.

And what do they say symptom wise? So erectile dysfunction, potentially constipation, pain in, like, their groin, back pain. I’ve seen a couple, like, hernias. That’s a big one. Yep.

And men can pee their pants too. It’s not isolated. Damn right. We can. Yeah.

Yeah. Okay. Yeah. I mean, very yeah. Again, like, sometimes we make light of this stuff, but it’s you know, why do you think there’s still such a stigma when talking about this stuff?

Like, I guess we could you know, between health care providers, we kinda, like, joke a little bit about it. But it’s a very serious topic, though. You know? Like but it’s also a very private area, I guess. But why do you think there’s still such a sig a stigma with these, I guess, talking about these topics when it comes to males or females?

You know, pain with sex, erectile dysfunction, premature ejaculation, whatever it is. Like, I don’t think we should be afraid to talk about these things because, you know, again, especially us as PTs, like I always say, like, say somebody goes see their provider, whatever, and they’re like, oh, yeah. I mean, you’re fine. Here’s a pill maybe. Here’s this.

They don’t really assess, like, their tone of their muscles or anything, and they’re like, yeah. Maybe go see a pelvic health PT or something. You know what I mean? Again, I always say we’re that gap in between somebody not needing a surgery, a pill, anything too crazy. You know, they should come see us for whatever, you know, condition they have or symptoms they’re having.

So I think, you know, in this YouTube space or, podcast space, we kinda forget to talk about that huge space in between where they where someone, again, doesn’t need a surgery or a pill or a medication or something like that, but they need help still. They’re like, okay. Like, they walked out of there seeing their MD or specialist, urologist, or whatever, and they’re like, alright. Now what do I do? And that’s where we come in.

You know what I mean? Where a a pelvic, specialized person in pelvic floor comes in. And I don’t think people I don’t know if they’re just not aware of it or it doesn’t get talked about enough. Like, why do you think it’s still not hasn’t caught on yet? Like, we’re it’s a huge part in health care that people are just missing, at least to me, it seems like.

You know? I don’t I feel like our parents and just, like, even, like, older generations, like, this was something that, like, you do this like, you don’t talk about this stuff. Yeah. Like, if if you like, even like our, like, our grandmother or mom, like, I’m sure they’ve dealt with stuff like this for years, but they never actually talked about it. Mhmm.

And now, like, there’s becoming more and more, like, pelvic floor PTs, more people talking about this stuff. And I think it’s slowly becoming a little bit more normalized. But there’s still kind of like this gap, like, this gap in that, like, we didn’t talk about this stuff for so long. And I feel like we just need some time to catch up. And I think the more and more we talk about it, the more and more like people understand like, hey, this happens.

Hey, I’m not alone. Hey, I can actually do something about it. Because before we were just suffering in silence thinking like, oh, I’m all by myself. This is I can’t talk I can’t talk about this because it’s bad to talk about. And there’s nothing that I could do about it.

But now, like, we are able to talk about it a little bit more and actually do something about it. Yeah. Yeah. I mean, how do you think we could get we can improve an understanding of these things? Like, I guess, talking about it on podcast like this and stuff, but, like, I mean, what else can we do to talk about stuff like this I guess.

As we get a special guest in here? Yeah. But, like, how how how can we improve the public understanding of what we’re trying to convey in this podcast of pelvic health? Later. Later.

Go ahead. Alright. Go later. I think what we’re doing right now is one of the best ways to do it. Like, I I I don’t like social media sometimes, but I feel like it does help to get information out there that we would have not known otherwise.

So social media can be great to educate us on, hey, I’m not alone. Like, other people are suffering with this. And then there are other people out there providing this education so people know that what they can actually do about it. So it’s just the more and more we talk about it, norm not normalize these symptoms, but help people know that they’re not alone because I I also don’t want people to think like, oh, I pee my pants. This is this is just what everybody does.

Yeah. Like, I want people to understand, like, yes, you are absolutely not alone, but there is something that you could do about it. And the best way that we could do that is just continuing to talk about it more and more and educating ourself on what our own body is doing, what our own body is supposed to be doing, and then, again, doing what we can do to resolve these symptoms. Yeah. And, you know, on social media, I mean, gym stuff, exercise stuff, it’s pretty big on social media, you know, I would say.

Maybe it’s just my algorithm. But, you know, to me, the the physical therapy profession in general like, I don’t know if it’s actually caught on to, like, mainstream social media, if you wanna call it that. You know what I mean? Like, we’re we’re such a it still feels like we’re such a niche group, but, like, our main weapon is movement and exercise when treating symptoms and, like, catching these, dysfunctions and and helping people move better through exercise and movement. Maybe some hands on stuff too.

But, like, to me, it just seems like a layup in terms of being especially nowadays, being something more popular. And, you know, especially on social media, a lot of physical therapists complain about, like, we just in the beginning about their jobs being burnt out, all these things. And I feel like we shouldn’t be afraid to talk about this stuff, anything within PT, whether it is pelvic health, those companies that suck. You know what I mean? Like, I don’t know why we just aren’t more vocal about it, but about anything of those, you know, that stuff.

So, like, to me, there’s, like, too many people complaining in the PT profession when we should be just educating and getting our our stuff out there. You know what I mean? And, you know, hopefully, we can do our part in educating the public, whether it’s through social media or I’ve seen you on TV. That was kinda cool, that one time. What was that for anyway?

It’s a local news. I I think it’s I think it’s the CW, but they have, like, a local station, and they do, like, little health segments. It’s called Bloom TV. So I’ve been on there. This is the third third time.

Oh, wow. Yeah. Yeah. What was your your topics for that? What like, what did you talk about for those?

The first one was pelvic health. The second one was, period issues. Okay. And then the last one was exercises that you could do for infertility. Man.

Do we have I wanna get into that stuff now that you mentioned that. Oh, no. Ask me. Ask away. The second one was period issues, you said?

Yeah. Can you dive into that a little bit? Yeah. So a lot of the period issues that I believe that we have, it’s so there’s there’s, like, yes, there’s the pelvic floor component, the muscles, the fascia, all of that stuff in that area. But I think a big problem with like the period issues that I feel like a lot of people are having is a big part of that is their hormones.

And a big part of that is their diet, exercise and their lifestyle. I don’t remember specifically. Oh, I was talking about more of like, what is a normal period? And then what is normal period? That was my explanation.

Yeah. Yeah. So a normal period should last, like, about I think it’s like three three to five days. We should lose anywhere from 25 to 80 milliliters of blood. Mhmm.

Should be a bright red to a deep burgundy. Mhmm. And mild to no PMS symptoms are normal. So if we’re experiencing moderate to severe PMS symptom, that is a sign that our body is telling us that something is off. Okay.

And we can experience these symptoms. A lot of us experience them, like, kind of like the week before period. That’s our luteal phase. Like, we can experience something, like, during our period. But it’s not just our period and our luteal phase that we have to be concerned about because we have specific hormones that are going up and down at specific ratios, within our cycle.

And if our lifestyle is impacting these hormones, a lot of the times it shows up as symptoms during our period where our energy is a little bit less, we’re a little bit tighter, a little bit more bloaty, have a little bit more inflammation going on. And that could result in some symptoms and even, underlying conditions such as like endometriosis, PCOS, fibroids, things of that sort. So I I love as a PT, one, we’re able to teach people to be able to move better because this absolutely has an influence on kind of like all the things that are going on in that area. But being able to move better and then specifically building muscle has a big impact on any of these conditions just due to kind of like the metabolic effect, the effect on our nervous system, the effect on our brain, the effect on our cardiovascular function, like all of these things. So it’s it’s a great way, like, as a PT to be able to kind of get in there and talk about something that is so prevalent.

Like, I feel like we’ve normalized, like, oh, my period. I gotta lay down for a week. Like, what? No. That’s not normal.

That’s not normal. That’s yeah. That’s a cool topic to talk about. Yeah. I mean, yeah.

Period stuff, I mean, you probably know more about I mean, in general, like, I I you know, I’ve come across that on my algorithm sometimes on Instagram because I I follow gym people or whatever, and I see that. Yeah. Like, people are like, well, I’m on my period. I can’t do this or something and or I feel like crap this week or something. Like so, like, you’re saying, like, no that’s not a normal that that’s not that means something else is going on.

Correct? Yes. If you if you’re, like, laid out from your period, like, you can’t get up, you’re you have to take, like, days off, that’s a sign that your body’s telling you something. Like, it doesn’t mean, like, you’re dying, but it’s it’s your body saying something is off, and it’s your body saying you need to change something up, whether it is or all the above your lifestyle, absolutely your nutrition Okay. And your exercise.

Those are all vital in regulating your period. Are those the main things you found when talking to these people to modify, like, their nutrition, exercise, regimen? Are those the the main things, the main culprits, would you say? Oh, yeah. Yeah.

So if if somebody has, like, period issues, it’s definitely best to go see, like, a functional medicine doctor or functional nutritionist so that they’re able to, like, specifically test, like, your specific hormone levels because everybody is gonna be a little bit different. But just by having better eating habits, which is getting high quality animal protein, getting in a bunch of plants, staying hydrated, eating frequently throughout the day, making sure that you’re eating enough food. Those are, those can be game changers in helping your hormones function better to help to reduce these symptoms. And if you’re experiencing period symptoms, there’s probably other things that you’re experiencing as well, especially. So yesterday, I heard this, video talking about cycle syncing.

You heard of cycle syncing? That was that was my next question. Yeah. What’s your take on that? I like cycle awareness because cycles, when they say cycle thinking, a lot of the times people see it as, and this could just be my definition, people see it as during your period or like the week before your period, you’re supposed to just do yoga, Pilates, just take it easy.

And that might work for somebody. For somebody who gets like very bad period pain, they’re not like an avid fitness goer or like they’re just getting started. They might have to take it easy during like their luteal phase slash period. But that also doesn’t mean like somebody who’s highly trained that they don’t have to work out or they can’t train hard during your period. It just means that you might have to be a little bit more aware of like how your body’s feeling in terms of of your energy.

Maybe warming up a little bit more, maybe reducing the load just because you’re again, you’re not gonna have as much energy. Things might feel a little bit tighter. You might be a little bit achier. So just having some degree of awareness of your body during this timeframe to make the reasonable adjustments so that you aren’t in debilitating pain afterwards. So like your back hurts, you have these severe cramps, you don’t have this neck pain or this headache, because all of those can be absolutely influenced by your workout.

And if we are not, like if we don’t have some level of awareness, like during our cycle, A lot of the times women just, they get like these headaches during their period. And they wonder why, like, like, but why am I getting this during my period? It just must be my period. But a big component of this is how we’re doing our workouts, potentially the mobility component. Maybe we’re doing too much at that time, maybe we’re overstressed, maybe we’re not feeling enough.

All of these are involved and we just need to have some level of awareness. Maybe where we are in our cycle, how our body is feeling, just so we can make adjustments. And these adjustments are gonna look different from person to person. Do you get that a lot? Because I I’ve had female athletes to ask me about that stuff, and I’m gonna use that now.

Yeah. Cycle awareness. I like that. But, you know, they ask me because I’m just their provider, but, so I’ll do my best to convey that information. But do you do female athletes ask you about that a lot?

Because I’ve been getting that more myself just in practice when I get people. Yeah. I’ve had a few people ask me, but I don’t think it’s anything different from what you’ve what any of us have already been doing. Yep. But it’s just having an understanding of kind of like where we are in our cycle, because this is gonna happen every month.

So we might, we’re gonna have these fluctuations every month. So like obviously, if you’re sick, you’re not gonna, hopefully, if you’re sick, you’re not gonna do a super hard workout. You might take it a little bit easy. That was really easy. Yeah.

If your body’s a little bit sore, maybe you just had a hard workout, you’re not gonna push it as hard the next workout. Right. So it’s kind of just having and this goes for everything that goes on in life. We just need to have some awareness of how our body is feeling. Right.

And this cycle awareness, it just puts a term to just being aware of like where we are in our cycle, as opposed to just saying, oh, I’m on my cycle. I can’t work out. Because that’s that’s not what should happen. Yeah. Yeah.

I mean, yeah, like you said, just like with anything in life, you know, like, I was sick last week. This week, I’m kinda feeling better, but I’m not gonna just start going super heavy. And plus, I’m old now, so it’s like I’m always achy and you know? It’s only old if you say you’re old. Yes.

But, yeah. I mean, just like with anything in life, I mean, if you’re super stressed with work for a week or something and you feel like crap all the time, well, then don’t do a super high intense, you know, four zero five deadlift or something. Just, you know, deload that week or take it easy or modify workouts. But I think, you know, a big part of that too is that the general population doesn’t know how to do that either. And that’s why we’re here too is, like, hope you know, thankfully, we’re educated in exercise and, you know, stuff like that that we could kind of help them modify their workouts.

I do that all the time is you know, I did that, like, three times today with someone with shoulder pain, back pain, neck pain. Pain. I’m like, alright. Let’s cut this stuff out. We’ll come back to that.

Let’s rehab this stuff. Get this under control first. We’ll come back to that later. There’s so much modifications going on, and I think Mhmm. You know, that’s also, again, an art form, also a science, but, like, everybody’s different.

So, like, what somebody what works for somebody may not work for this person. You know what I mean? So you have to kinda, like, again thankfully, again, I have more time with people so I could really kinda hone in on what they like and what they don’t like, what they respond to, what they don’t respond to, and adjust as needed that way. So, yeah, it’s a it’s a cool topic. I’ve heard it a lot.

I mean, I’ve had people ask me about it, and I’m gonna steal your answers. So, man, thanks for that. Appreciate it. Of course. What was that third, because you were on on the TV that channel three times, you said.

What was that third topic you said? Infertility. Can we dive into that for, like, crash course in five minutes? Yeah. Yeah.

So I kind of already went over it in terms of, like, your period. So if your period is off, that’s the sign that your body is off. So in order to get pregnant, we need to ovulate. In order to ovulate, we need our hormones to go up and down at specific points at specific times during our cycle. And one, if we’re too stressed, we might not ovulate.

If one of our hormones are too high or something is too low, it might kind of delay kind of like some of the other hormones that are gonna kind of come up in our cycle. So that plays a big role in potentially like this infertility component is like the hormones. And again, if if I’m not the expert in the the hormone stuff, but if you’re experiencing issues in this area, you do wanna get your hormone checked because there are so many things that you could do, especially in terms of like your lifestyle to kind of influence these hormones to come back to a kind of like a baseline rate of like what they’re supposed to be. So hormones play a key role in this. Stress is a big factor in this.

Like if your body is constantly under stress, you’re go, go, go all the time. Like I wasn’t like, we both were at our job. Like we’re in this constantly go go go state. You’re constantly worried about what you have to do. I’m doing this with the pelvic floor in my hand.

And you’re constantly worrying about what you have to do next. Your workouts are super hard. You don’t sleep enough. You’re not recovering enough. Your body is under a constant state of stress.

If your body’s under a constant state of stress, it is not going to, it may not ovulate or your body’s not gonna be in the appropriate condition for you to be able to handle carrying a child to term. So we need to start to reduce or manage our stress load. And to a degree, like a lot of the things we, some things we can’t take off of our plate, but there are some things that we might be able to modify in terms of maybe like how we think about things, maybe saying no to some things, maybe like just prioritizing different things so that we’re able to have a little bit more time to ourselves. And then like additionally, movement, tapping into our movement to allow our bodies to tap into this parasympathetic nervous system. So the exercises that I showed specifically on there, one, they’re helping to kind of alleviate this pressure on this pelvic region because if there’s so much pressure downward, our organs can’t pump and function like they’re supposed to.

And it’s like constantly being squished all day, so they can’t work like they’re supposed to. So the exercise that I showed specifically, they were kind of reducing that pressure on that area. It allows us to rotate a little bit more and it allows us to tap into our parasympathetic nervous system when we’re focused on this breathing component. So our breath is pretty much the way that we are able to tap into our nervous system and when we incorporate this breath in these exercises that I showed and they’re just general like mobility exercises. Honey, you gotta go for a second, okay?

I have some more magic. Yes, just give me a second. Yeah. So when we just incorporate this breath into these exercises, because a lot of the times the exercises that we do do as like stretches and stuff, like even like our hip flexor stretch or like our trunk rotations, Those are great exercises, especially if you’re just starting off. Thank you.

You’re welcome, Jeac. I’ll read it. Sorry. You’re good. So those are great exercises, especially if you’re just starting off.

But when you are able to kind of like add in this breathing component, it allows us to one, stretch us from the inside out. Because like a lot of times we’re just doing stretches, we’re just cranking on these muscles. But we’re missing a vital component when we don’t incorporate this breath because we need to be able to stretch everything from the inside out so that we’re getting this expansion coming from our rib cage or pelvis, not just kind of like the muscles that we’re pulling on. But, again, it also helps us tap into this parasympathetic nervous system to allow our body to be able to feel safe and heal. Can you explain that?

I know I mean, I know we know, but, like, what do you mean by tapping into our parasympathetic nervous system? So we have two branches of our autonomic nervous system. We have our sympathetic, which is this fight, flight fight or flight state. This is this constant state of go, go, go. This is pushing.

This is our workouts. This is running. This is stress. Then there’s our parasympathetic. This is our rest and digest.

This is our recovery mode. So when we’re on the go all day, we’re working out super hard when we’re doing all these different things, our body is more tapped into this sympathetic state. And a lot of the times we neglect this parasympathetic component. So we do need stress. We do want our hard workouts.

We do wanna push us sometimes, but we wanna have a little bit more balance. And that’s what I find. We have no type of balance. Yeah. We are all or nothing.

I’ve been this all or nothing. We are just go, go, go, go, go. Yep. And we need to be able to tap into this parasympathetic nervous system to allow our body to feel safe, to be able to heal. So this allows us to heal in terms of our hormonal conditions, allows us to heal in terms of our aches and pains, but also our body needs to be able to feel safe to be again, to be able to carry a baby to full term.

And I feel like that’s a big component that is often missed. I mean, there’s so many things we could talk about with that. I mean, just modern life being so go go go. I mean, people trying to regulate their their stress levels, in this modern age, quote, unquote. It’s just, you know, it’s tough because everybody is always working, always stressed, always, up to something, and we can’t just kinda take a step back and, like you said, just breathe.

Yeah. But yeah. I mean, I always tell people focus on their stress levels, their nutrition, their hydration, and their sleep, you know, for recovery purposes. Right? And, again, it’s easier said than done.

Like, I you know, I just point it out to them. I’m not gonna you know, we don’t have all the time to just kinda talk about those things, but, yeah, it’s something that should be talked about more, I think. And, again, we’re the kinda we’re the PTs, so we definitely kinda work with more on the exercise and movement size but side. But I I point that out to them, in general. So, alright.

Rapid fire things, We’ll get you out of here quick. But, like, what, what are some actionable things that people could take away from this podcast? Like, in terms of pelvic health things, like, what are some things that most people should be doing? Again, it’s a very general question, I know, but, like, what are some thing some things that you kinda, like some some patterns that you find within people that you can kinda give some actual advice to people listening to this right now, like, pelvic health, type stuff? Yeah.

I think one of the best things that they could do is, one, just learn to just tap into, like, what your body is feeling throughout the day. Like I said, one of the biggest things that I find is people have so much extra tension in their body, and you might find, like, you’re just sitting there just scrunching up, just holding all this excess tension. Yep. Like this. So just yeah.

Yeah. So just just be aware of, like, how your body is feeling. Mhmm. And then once you are aware, like, you’re able to say, oh, hey, my neck is tensed up. Oh, I’m squeezing my belly muscles all the time.

Yeah. Oh, I’m clenching my booty all the time. Like once you’re able to like kind of realize it, you’re able to kind of just like correct some of these things. And these things don’t happen overnight. Like you’re gonna catch yourself doing it all the time.

But the point is like you catch yourself when you’re doing it and you correct yourself and you correct yourself over and over again. And like I said, this breathing component, if you’re able to just tap into your breath throughout the day, when you breathe in, you’re gonna feel this three sixty expansion. So everywhere gets bigger. So ribs, side of your rib cage, belly, back, pelvic floor. And then when you exhale, you’re gonna get this compression through your pelvic floor, lower belly, middle belly, and your rib cage.

And this breath could be applied to so many Here I go again. So so many of these, like, mobility exercises that we’re doing Mhmm. As well as core work. So we can use this breath in our core work as well. And then I think one of the biggest things that you’re able to do is just reflect on how much you’re doing throughout your life.

Like, are there some things that you are able to say no to just to free up some mental space, to literally free up some physical space in your body? Because that could be a big part in pelvic floor symptoms that you’re experiencing. But Yeah. The biggest thing is the awareness and this breath. The breath.

Yes. Gotta be stay present, take some nice deep breaths, and chill for a bit. Everybody’s always so, like you said, go go go. What about for one more question about somewhat PT related, but, like, for PT students, what are some, I guess, some general advice to them? Let’s say some new grads are watching this, and they wanna know about what it’s like actually working in physical therapy.

What are some tips or some advice you could give them? I’d give them the advice to say, take as many courses as you can. Learn, learn, learn, learn, learn, and apply, apply, apply, apply. Because even as a new grad, like, there’s there’s still so many things that you don’t know and just getting out there and getting into the fields, I feel like it’s so valuable no matter where you plan on going with your journey. So I would say education is power and just continue to apply all the things that you’re learning.

And don’t let these companies break your back. They literally broke my back. I don’t know if you’ve heard my last podcast, but they yeah. My whole, like, twisting episode, and I couldn’t bend over for, like, two weeks or whatever. Yeah.

That was not fun. And lo and behold, I haven’t had that back pain in in, well, I don’t know, years now. I wonder why. I’m not stressed all the time because of, you know, working for these crazy companies. But, so where can people find you?

Instagram, website? You wanna plug all that stuff? Yeah. So my Instagram is doctor period a I s s a underscore doctor isa. My website is connectthebodydots.com.

You could also find me on YouTube at connectthebodydots.com. Yeah. So I post a whole bunch of content on this stuff, YouTube videos on this stuff, all this stuff, health and wellness related. And yeah. Yeah.

Awesome. As always, you guys can find me on Instagram at a p t doctor g. Ask me whatever questions about pain you’re having, all that good stuff. And my website is artofpt.com. Send me, you could contact me on there.

Again, if you have questions about pain, stuff like that, if you’re an athlete with back pain, knee pain, post surgical, I I’ll help you guys out. I also have a free newsletter called the the PT Handbook that I send out biweekly. And I think mine comes out tomorrow, the new one, I believe. It’s on, I forgot what it’s on, but it’s a good one. I promise.

It’s, you know, practical PT tips that I could you know, that I share with you guys and also research that I find fun. But, subscribe to the YouTube if you haven’t. Subscribe to the newsletter if you haven’t. And oh, there she is. Hi, G.

Hi. We’re both G. Right? Yeah. But that’s it.

That’s all I got. So we’re signing off. We’ll catch you guys next time. Alright. Bye.

Adios.