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New Frontiers in Diastasis Recti Treatment: An Interview with Munira Hudani · Pelvic PT Rising

• 0:02
  Speaker 1: In the last 10 years, our field has gone from an unknown specialty to a household name.
• 0:09
  Speaker 1: This brings unprecedented opportunities, but we need to rise up to meet them and give our patients the care that they deserve.
• 0:17
  Speaker 1: In order to help others get better, we need to be better.
• 0:23
  Speaker 1: This podcast will help you to become more confident with your patients, more successful in your practice or business and a leader in pelvic health, and we're going to have some fun along the way.
• 0:36
  Speaker 1: Join us as we rise together.
• 0:39
  Speaker 1: We're Jesse and Nicole Cozine, founders of Pelvic Sanity Physical Therapy and the creators of the Pelvic PT Huddle, and this is Pelvic PT Rising.
• 0:54
  Speaker 2: Hey guys, welcome back to another episode of the Pelvic PT Rising podcast with Jesse and Nicole Cozine.
• 0:58
  Speaker 2: Hey, nicole, hello, I am so excited for this conversation that you have with Manira Hadani.
• 1:03
  Speaker 2: She is a PelvicCon speaker.
• 1:05
  Speaker 2: She has a passion for pregnancy and postpartum, particularly with diastasis, which I feel like is a diagnosis that a lot of people struggle with, frankly.
• 1:16
  Speaker 1: Yes, there's so much misinformation, there's so much differing information, and I think Manira has done such a great job of helping us navigate where we are in terms of where we've been and where we are now and where we need to go with treating people with diastasis, and she has now entered into another subspecialty about treating people before and after abdominal plastic, so she's just a really awesome person.
• 1:40
  Speaker 1: This is a podcast where I fly solo for the first time.
• 1:45
  Speaker 2: Fly, little bird fly yes.
• 1:47
  Speaker 1: So we'll be interested to see what you guys think about my interviewing style, and I'm really excited to dive into some clinical things with Manira Hadani.
• 1:55
  Speaker 2: Perfect and jump into that.
• 1:57
  Speaker 2: Make sure PelvicCon now is less than 50 days away.
• 2:00
  Speaker 2: If you're listening to this on the time it comes out, or if you're listening to it after it comes out, it's still less than 50 days away.
• 2:06
  Speaker 2: That's how time works, everybody.
• 2:08
  Speaker 2: This is why Nicole's flying solo on this.
• 2:10
  Speaker 2: She's like I don't think I need this anchor holding me back on this podcast anymore.
• 2:14
  Speaker 2: But if you are wanting to make sure that you get all of this great information and you're not able to join us in person, there's still time to get that early bird discount $50 off on the recording.
• 2:24
  Speaker 2: You will get the entire PelvicCon recording.
• 2:27
  Speaker 2: You will get two speeches from each of our incredible speakers.
• 2:30
  Speaker 2: You'll get the manual with all of the slides.
• 2:34
  Speaker 2: You get all the information.
• 2:35
  Speaker 2: So just head to PelvicConcom and check that out.
• 2:38
  Speaker 2: If you are going to be joining us, make sure you're paying attention to your email for things like t-shirts and add-ons and all the other things that are going to make this conference incredible.
• 2:47
  Speaker 2: So that's the last announcement I've got.
• 2:49
  Speaker 2: So, with no further ado, here is Nicole's conversation with Manira Houdani.
• 2:59
  Speaker 1: All right folks we have with us today on the PelvicPT Rising podcast, manira Houdani.
• 3:04
  Speaker 1: I am so thankful and grateful that you're sharing your time with us today.
• 3:08
  Speaker 3: Thanks for being here.
• 3:09
  Speaker 3: Oh, absolutely, thank you so much for having me.
• 3:13
  Speaker 1: Someone doesn't know who you are.
• 3:15
  Speaker 1: Give them the rundown of how you became a Pelvic Physio and what specifically got you so interested in treating diastasis.
• 3:27
  Speaker 3: I am, of course, a PelvicPT.
• 3:29
  Speaker 3: I kind of started off, as many do, out of school in mainly orthopedics.
• 3:35
  Speaker 3: But when I was looking for a new place to work, when I was being interviewed, the person who was interviewing me she was wondering if I was interested in doing something along the lines of the Pelvic Health or vestibular rehab, because she was interested in starting some of these programs in her clinic.
• 3:53
  Speaker 3: And I said, absolutely, I will do vestibular, absolutely.
• 3:57
  Speaker 3: Because my understanding of what Pelvic Health was was just based off of an, as I joined, course that I had taken, and me and my friend were listening to the instructor talk about these physios that do internal vaginal work and we just looked at each other like wait, what Right, we kind of fresh out of schools.
• 4:15
  Speaker 3: We were like, are you serious?
• 4:16
  Speaker 3: This is something we do.
• 4:18
  Speaker 3: And we were, yeah, that was my first introduction.
• 4:21
  Speaker 3: We had no idea this existed and so hence I went into that interview like I will do vestibular and I will be happy to do that.
• 4:27
  Speaker 3: But she was like, well, why don't you, before writing it off, why don't you do some shadowing with the lead in Ontario and her name's Carolyn Pendekin, and just see if you are interested or not.
• 4:38
  Speaker 3: I'm like, absolutely.
• 4:39
  Speaker 3: I'm certainly open to the idea.
• 4:41
  Speaker 3: She was about an hour and 20 minutes away, but I ended up going there six times just to shadow her mentor with her.
• 4:49
  Speaker 3: It was just an invaluable experience.
• 4:51
  Speaker 3: She was kind of my entry into the world of Pelvic Health.
• 4:54
  Speaker 1: And then did you know at that time that she was who she was?
• 4:58
  Speaker 1: Because that's like a really big name in pelvic physio.
• 5:01
  Speaker 1: Like, did you know at the time that she was a big deal?
• 5:04
  Speaker 3: Well, she was a big deal in Ontario to begin with because she was kind of setting things up like establishing the educational platforms for all of us other physios to potentially get into it as well.
• 5:18
  Speaker 3: So she was kind of in the beginning of all of that and I think that's also when she started becoming more focused in on the biopsychosocial and the pelvic pain and all of that.
• 5:28
  Speaker 3: So, long story short, it was not a hard sell.
• 5:33
  Speaker 3: I loved what I saw.
• 5:35
  Speaker 3: I loved what I was able to do.
• 5:36
  Speaker 3: I came back to the clinic and I started the Pelvic Health program there.
• 5:40
  Speaker 3: We were adjacent to the hospital, so very quickly it developed into a busy practice.
• 5:47
  Speaker 3: We had more physios that we brought on as well.
• 5:49
  Speaker 3: And then I moved out to another clinic instead, just because it was closer to where I was living, started a Pelvic Health program there and started my own home care.
• 6:00
  Speaker 3: And I just knew in working with so many Pelvic Health individuals that I actually had a desire to really learn more about pre and postnatal care.
• 6:10
  Speaker 3: So that's kind of where I was fine, tuning my own passions.
• 6:13
  Speaker 3: And then inside of that was the world of diastasis that sort of emerged and for me when people were coming in to see me for help with their core.
• 6:22
  Speaker 3: I didn't know too much really about diastasis back then, and so I just wanted to learn more about it.
• 6:28
  Speaker 3: It was just a natural passion of mine.
• 6:31
  Speaker 3: I wanted to do the best I could to help these people.
• 6:34
  Speaker 3: So the more I learned, the more I was able to help them.
• 6:38
  Speaker 3: And yet the more I learned and then the more I practiced, the more I realized there's kind of like a mismatch between what I'm learning and what I'm seeing clinically.
• 6:46
  Speaker 3: And so then a lot of questions started coming up in my own head on what's going on here.
• 6:53
  Speaker 3: Is this actually true?
• 6:55
  Speaker 3: Is what I'm teaching, is what I'm educating about?
• 6:58
  Speaker 3: Is it actually true?
• 6:59
  Speaker 3: Am I helping or am I confusing people more?
• 7:03
  Speaker 3: Am I helping or am I actually creating more fear?
• 7:06
  Speaker 3: Am I participating in fear mongering?
• 7:09
  Speaker 3: And so I had a lot of questions about what I was doing.
• 7:12
  Speaker 3: So internally.
• 7:13
  Speaker 3: That drove me to find more answers, and there really wasn't too much out there again in terms of information, except the same sort of regurgitation of the same stuff, and so I just kind of had to revamp how I saw it in my head so I could feel better about what I was saying and how I was approaching it with the people that I saw in front of me.
• 7:34
  Speaker 1: I love that story of just curiosity, right, because I, sometimes a lot of people and in some ways my journey to loving treating interstitial cystitis is very similar.
• 7:44
  Speaker 1: I kept reading things on the internet and I was like that's not what I'm seeing, that's not what I feel like these patients are presenting like, and then so, clinically, we're seeing differences and improvements where that information is like not as quite there is what we assume it should be, and so, but that curiosity of like, well, what if there's a better way?
• 8:09
  Speaker 1: What am I doing?
• 8:10
  Speaker 1: What's my place in this?
• 8:11
  Speaker 1: I think that's really excellent and it drives forward clinical changes in philosophy and what we're doing.
• 8:19
  Speaker 1: But, menera, so what you think?
• 8:22
  Speaker 1: Now, having been there with being curious and doing all of that, can we go back to what is the actual conventional method?
• 8:34
  Speaker 1: What is that conventional stuff?
• 8:37
  Speaker 1: Let's just get it out there and say so, what was it?
• 8:41
  Speaker 1: What is it and how is it different?
• 8:43
  Speaker 1: Now Do you feel like Sure?
• 8:47
  Speaker 3: Conventionally there are approaches to diastasis that involve limiting people in certain movements, limiting certain exercises, limiting based on certain things that we see, such as doming Okay, and then there's also things that sort of came up a little bit more recently and so it's not quite conventional, but when it is still sort of a passing thing and we're kind of going through it right now.
• 9:16
  Speaker 3: So added to that is limiting people based on the feeling of tension or the lack of tension, and if they don't have it, then how we proceed with that.
• 9:28
  Speaker 3: So conventionally there is a lot of restriction around things you can do with diastasis.
• 9:36
  Speaker 3: Conventionally, there's a lot of fear around basically what it means to have diastasis and the prognosis as well.
• 9:45
  Speaker 3: So and conventionally we have to put it out there the goal for diastasis is to close the gap.
• 9:54
  Speaker 3: So these are sort of the premises of how we used to and also still are.
• 10:01
  Speaker 3: But there's a lot of change currently happening in the world of diastasis, so it's not all just changing so quickly.
• 10:09
  Speaker 3: We know it takes time for a lot to change.
• 10:12
  Speaker 3: We know that research what is it Like?
• 10:14
  Speaker 3: It takes eight years for something in research to really make a significant change in clinical practice.
• 10:20
  Speaker 1: Yep.
• 10:21
  Speaker 3: And yet also the opposite is true.
• 10:24
  Speaker 3: Clinically, when we are doing things, we also know that sometimes, clinically, we are far more advanced in what our questions are compared to what they're doing in research.
• 10:33
  Speaker 3: So it like it goes both ways.
• 10:35
  Speaker 3: Yes, but in general, there has been a leg in research as well in diastasis.
• 10:40
  Speaker 3: So conventionally, it's all about how to close the gap.
• 10:44
  Speaker 3: What exercises can we do to close the gap?
• 10:46
  Speaker 3: What are the tools and strategies to reduce intracidistance?
• 10:51
  Speaker 3: And there then in 2016, was a pretty transformative, paradigm shifting research paper that Dianlee produced or published with Paul Hodges.
• 11:04
  Speaker 3: And that's the tension study.
• 11:06
  Speaker 3: So that's the one where they're talking about.
• 11:07
  Speaker 3: Well, maybe we're not so much needing to emphasize the reduction in IRD, intracidistance.
• 11:15
  Speaker 3: However, maybe the more important factor is generating tension within the linear albus.
• 11:22
  Speaker 1: So just through that one paper it kind of swept across the globe and there was a wave of transformation where we started to focus less on IRD and closing the gap and more on generating tension, or we focused on both Got it Right and so, and then just to go back a half a beat for the other conventional stuff, because when I was going through so I've been a public PT for 17 years and when I was learning about, you say diastasis, I say diastasis.
• 11:52
  Speaker 1: Which one is right, Maneera?
• 11:54
  Speaker 1: Let's settle it right here.
• 11:55
  Speaker 3: You will honestly hear me say both of them today Perfect, because here you say diastasis and I normally say diastasis, and then it just kind of, you know, I feel like we're just going to feed off of each other.
• 12:06
  Speaker 3: Great, I think it was a right, the wrong way.
• 12:08
  Speaker 1: I was like when you called on your website the diastasis guru or the diastasis genius, and now you say the word and I'm saying it different than you are like, oh no, I don't think there's a right way.
• 12:18
  Speaker 1: Beautiful, ok, but when I was going through and learning about diastasis, I was learning all of the other things about closing the gap, so the things that you might see or people wreck their brain about wrapping a towel around and doing a transversus and approximating the tissue while you're doing a crunch, and this very much this stepwise fashion of you have to get the transversus abdominis before you do anything else.
• 12:47
  Speaker 1: So it was a lot of isolated transversus activation patterns and then heaven forbid you actually add something else in before the transversus is doing its job, whatever that is, and so then I think what you're also alluding to with Paul Hodges and Diane Lee's study was that they actually isn't that the same study that showed that actually, during a transversus contraction, the interrecti distance actually widened Right, and so now it's like flipping everything on its head.
• 13:18
  Speaker 1: What have we been doing this whole time?
• 13:21
  Speaker 3: Is that correct?
• 13:22
  Speaker 3: Absolutely yes, yeah, that's exactly it and yes, I would say that's definitely part of, again, the conventional, traditional, historical approach to diastasis.
• 13:33
  Speaker 3: But even though I say that, that is still the paradigm that a lot of us are still in and I think it's important just to realize that in the space that we are currently in, there are people at different places in understanding.
• 13:49
  Speaker 3: So it is very easy for someone to potentially learn more about it and take some more updated courses and kind of have a revamp of how they see it.
• 14:01
  Speaker 3: But then when they go back and they hear and see other practitioners talking about diastasis in a way that it has always been taught to be like, well, yeah, no, that's wrong and maybe be a little bit judgmental over it or try to call them out on it, I think we have to kind of back away from that and instead just sort of accept that we're all in different places.
• 14:23
  Speaker 3: But I think a shift is also currently happening, another shift.
• 14:29
  Speaker 3: So we have this tension study that kind of created that paradigm shifting event in diastasis and I feel like there is now and we're on the verge of another one, which will probably take the next several years before yet another one comes out, but I feel like we are now moving towards well and I'm saying this based on even more recent systematic review with meta-analysis where the results of that most recent meta-analysis is that really, in terms of our conservative management of diastasis and the effect on reducing interactive distance, we do not exactly have a great ability to do that In terms of our exercise programs.
• 15:17
  Speaker 3: We are not exactly ending off these programs with a change in interactive distance.
• 15:24
  Speaker 3: It seems like what we've seen in research is maybe the change that we are seeing is about 0.4 centimeters, so 4 millimeters, and really is that clinically significant?
• 15:37
  Speaker 3: How much is that really going to affect, let's say, the appearance of the abdominal wall, the function of the abdominal wall, and so this is brand new.
• 15:46
  Speaker 3: It's a 2023 systematic review paper that was just published, so what I feel like is soon going to happen from that paper in addition to yet another unpublished paper and hopefully it'll be out soon by Diane Lee and Paul Hodges, where she also and this is stuff that she spoke about already in the birth healing summit Right, cool.
• 16:09
  Speaker 3: So she completely gave us a lot of this information in advance, ahead of print, where, in her study, it seems like when you do exercises in a progressive fashion.
• 16:20
  Speaker 3: You progressively load and overload and you do them for a long enough period of time, because it seems like we were cutting people off too soon with exercises, we weren't doing it for an appropriate length of time and we weren't loading long enough to be too gentle.
• 16:34
  Speaker 3: So when we take those two factors into consideration, what we end up seeing is that again interact at a distance and some people increases and some people decreases and some it stays the same, but for all, generally speaking, they all have an improvement in the distortion, so less so, basically an improvement in the tension within the system, an improvement in the potentially the quality of the connective tissue.
• 17:02
  Speaker 3: So now we've got two major studies, one unpublished, one is already out there.
• 17:08
  Speaker 3: I have a feeling we are going to be switching over now to de-emphasizing IRD even more, and we started with that in the 2016, and now I feel like we're going to go into that even more.
• 17:25
  Speaker 3: And this is kind of where we're at, because people are now going to come to us and they're going to come and ask us what can we do to help them in closing their gap?
• 17:34
  Speaker 3: We're going to be forced to have discussions around.
• 17:37
  Speaker 3: Well, this is sort of what we may or may not be able to accomplish with the gap, and if they're a little, maybe if their heart sinks a little bit when they hear well, we may not be able to close that gap, but we might be able to do other things, we have to ask them well, what is that about closing the gap?
• 17:54
  Speaker 3: That is so, what is important to you?
• 17:58
  Speaker 3: What does it mean to you to have a gap close?
• 18:00
  Speaker 3: What is it going to give you?
• 18:01
  Speaker 3: What do you really want?
• 18:03
  Speaker 3: Is it that you want a flat stomach?
• 18:05
  Speaker 3: Is that what you want in closing the gap?
• 18:07
  Speaker 3: Do you think that's what you're going to?
• 18:09
  Speaker 3: Is that really the goal here?
• 18:10
  Speaker 3: Or is it you want to be more comfortable naked, with your partner?
• 18:16
  Speaker 3: You want to rekindle intimacy that you've been pushing off, because you are just not comfortable anymore in your own skin.
• 18:26
  Speaker 3: The thought of anybody touching your belly, seeing your belly, is one of those things where you're just.
• 18:32
  Speaker 3: You are reflexively, instinctively, trying to push people away from.
• 18:35
  Speaker 3: You're trying to hide or disguise it.
• 18:38
  Speaker 3: You're personally not looking, even looking at it in the mirror.
• 18:42
  Speaker 3: You are trying to almost erase it from your consciousness.
• 18:46
  Speaker 3: The goal when going to the store and buying clothes is no longer to buy clothing that you love, that represents you, that you can really be and showcase your best self in.
• 18:58
  Speaker 3: It is now the goal of going and buying whatever can disguise and hide the belly, whether it's your style or not.
• 19:06
  Speaker 3: So is the goal to have a flat stomach, or is it even deeper than that with all of these other things that I'm talking about?
• 19:15
  Speaker 3: So I have a feeling now that we are going to be forced to really dig deeper in what it means to have a gap, what it means to the person in front of us to close the gap, what it's going to do for them in their mind, and I think what that is now making us do is really embrace this bio-psycho-social approach to diastasis, rather than fixating on the bio, such as let's close the gap, let's create tension, let's do these exercises, let's avoid doming, let's involve doming, like all of that stuff which is included in the bio.
• 19:49
  Speaker 3: But now we have to dig a bit deeper on why, and I feel like understanding the why behind it is really going to allow us to connect better with our clients, to relate to them, to have more of a sounding board for what it is they're seeking help with and building that rapport and being able to refer them to whichever practitioner, like a mental health practitioner, if they need it, and so to support them better in their diastasis journey.
• 20:19
  Speaker 1: Yes, so many things to unpack there, but I really want to pull out two things.
• 20:24
  Speaker 1: Number one is that I love that now we're talking about essentially the title of your Pelvicon title, which is DRA Helping the Whole Person and Not Just the Gap, because I feel like that is where our field needs to go with this, with this bio-psycho-social model.
• 20:41
  Speaker 1: But what that does bring up, though, is when we're striving to do that in a way that's non-nosebic, like without noosebic language.
• 20:50
  Speaker 1: How do we then communicate that with the patient with accurate things, because there is an interact-idistance issue.
• 21:00
  Speaker 1: We do know that Now, whether or not that's as important as we used to think, it is that we're.
• 21:05
  Speaker 1: Now we're finding that that's not, probably, but the patient is still, and that's the one thing that they can look at and see and they can feel.
• 21:14
  Speaker 1: So, when we're talking about that, how do we speak to patients in a way that they can understand?
• 21:21
  Speaker 1: That's not dismissive of what they're feeling and reading and seeing, but that's still accurate from what's going on?
• 21:29
  Speaker 1: So what were your recommendations on?
• 21:31
  Speaker 1: How are we supposed to navigate those conversations?
• 21:35
  Speaker 3: Yes, oh, my goodness, you brought up exactly what we're probably all kind of managing and dealing with right now, but also we'll have to do a lot more of as we go through the second shift in diastasis.
• 21:49
  Speaker 3: So we absolutely need to be in a position of educating, of empowering, and we can only do that once we ourselves know more of the story.
• 22:00
  Speaker 3: So we do have to be up to date in what we know about diastasis, current research, current practices around it, and then we can confidently communicate that and have discussions about those things with our patients and our clients.
• 22:16
  Speaker 3: So really, when they're coming to us and yes, it's so convenient to be able to use your fingers and assess and that's a blessing and a curse, because the curse side of it is it's so convenient that they do it all the time they want to see it how am I today?
• 22:34
  Speaker 3: So they'll start checking it every day.
• 22:36
  Speaker 3: From day to day.
• 22:37
  Speaker 3: Things are going to change depending on muscle activity, depending on also bloating and depending on technique and just how much you've lifted your head or not lifted your head.
• 22:48
  Speaker 3: It's just not a super reliable test to do regardless, but yet it is super convenient for them to do and it's what is out there on the internet.
• 22:56
  Speaker 3: That's what they.
• 22:58
  Speaker 3: How do we assess it?
• 22:58
  Speaker 3: You just check online and there are a million videos on it and it's also a way for them to compare themselves to other people.
• 23:07
  Speaker 3: Okay, like relatively speaking.
• 23:09
  Speaker 3: So I've got a three finger and she had a five finger, so I must not be as severe as that person, et cetera.
• 23:15
  Speaker 3: So they'll come up with their own, I guess, stories around that.
• 23:19
  Speaker 3: So for us, what we need to do is absolutely hold the space for them to bring in whatever notions and preconceived notions that they have about diastasis and us just kind of.
• 23:32
  Speaker 3: Well, my approach I mean, everybody has their own approach but my approach is to gently go in and sort of discuss and maybe dismantle one false belief about diastasis at a time.
• 23:44
  Speaker 3: And I typically start off with explaining that in pregnancy, yes, we definitely have widening of the midline, vertical midline, and that's there as a natural adaptation for pregnancy to continue, because the baby is growing.
• 23:59
  Speaker 3: We need that extra space.
• 24:00
  Speaker 3: But we also should keep in mind that actually even the sides are expanding as well.
• 24:07
  Speaker 3: It's not just the center, it's the whole abdomen, from the sides to the front and so.
• 24:14
  Speaker 3: But we're not really measuring those distances, so we don't necessarily have to focus too much on what's happening in the center, because everything is expanding and actually from front to back, when you're looking at the side profile, from the spine to the front of the abdomen, there's much more lengthening happening in that plane than when you're looking at them just face on in that horizontal plane in the front.
• 24:39
  Speaker 3: So I just try to go in and talk to them a little bit about how the gap itself is only one part of the whole picture.
• 24:47
  Speaker 3: And then for postpartum, I certainly talk about how, in terms of closing the gap, it may or may not happen.
• 24:57
  Speaker 3: But what we can do is what we know.
• 25:00
  Speaker 3: What we can do is we can start to walk on a great set of exercises, a great exercise program that will be progressive, that will involve all of the abdominal muscles, that will sort of meet you where you're at and kind of take you to the next level.
• 25:13
  Speaker 3: And if we do that through a long enough period of time and we continue with that, we will potentially see changes in the abdomen and we may see changes in the gap size, or we may see changes with the tissue, what it feels like within the gap, or we may see changes in abdominal circumference, where things start to sort of pull in from the sides or pull in through the front a change in the tone and the definition of the muscles that are there.
• 25:40
  Speaker 3: You may feel more stable Stable is a word that they use, not a word that I use so you may go from a feeling of being unstable to a feeling of being more stable within your core.
• 25:52
  Speaker 3: You may feel a cough better like, have a more forceful cough and like so all of these things.
• 25:57
  Speaker 3: So I give them the picture.
• 25:59
  Speaker 3: I know that, whatever their goal is, I tell them that's actually what we're going to be working towards and the only thing especially when it comes to aesthetics and how things will appear afterwards that's the only thing we cannot guarantee from the beginning.
• 26:14
  Speaker 3: I can't say to you right now that this is what you're going to look like.
• 26:18
  Speaker 3: You're going to have the flat stomach that you want, that your abs are going to look like this, because everybody is different and everybody is different in how it responds to the things that we're going to do.
• 26:29
  Speaker 3: So we can't guarantee that.
• 26:31
  Speaker 3: In terms of conservative management, this is the best we have to offer.
• 26:35
  Speaker 3: We're going to do a great exercise program and then we're also going to talk about other things, such as stress management, sleep and nutrition and other parts of your life that are either stressed or providing joy and connection.
• 26:49
  Speaker 3: We're going to tackle those and sort of tap into that as well for a more holistic view of this whole thing.
• 26:57
  Speaker 3: And so if you're really here to have your gap closed because you think that's going to give you a flat stomach, what I can say is that the gap itself is not actually creating the stomach that you see right now and it's also not going to be, if it closes, the thing that's going to give you the stomach that you want.
• 27:17
  Speaker 3: So strengthening is going to be more holistic.
• 27:20
  Speaker 3: In effect, the whole abdominal wall and what we're going to see is through a change in the whole abdominal wall that will lead you towards those things rather than a focus on closing up the gap.
• 27:31
  Speaker 3: So it is a very long winded thing, but I think it's important to just have some kind of discussion around that so that they know and what to expect from the beginning.
• 27:42
  Speaker 1: Yes, thank you.
• 27:42
  Speaker 1: I think there's a point to be made that it's okay that it's long-winded, because you're probably not telling that person that all in one session this might take a long time to dismantle what they've got going on with the construct in their brain about what they thought it was going to be, because they're working under false assumptions a lot of the time.
• 28:03
  Speaker 1: So I love when you talked about sort of dismantling that one step at a time and then to summarize.
• 28:08
  Speaker 1: I think if I were to summarize what you just said and you can add to this if I get it wrong.
• 28:13
  Speaker 1: But I feel like it's helping the person to see that there's multiple avenues to the end goal that they want, versus focusing on one thing that actually isn't completely accurate to begin with.
• 28:28
  Speaker 1: Exactly.
• 28:30
  Speaker 3: Yes, yes, exactly, and I think it also helps to just for us as practitioners to sort of check our own biases about it and just be super mindful of what we are saying, how we are saying it, how it could be perceived.
• 28:46
  Speaker 3: It can be exhausting sometimes to really filter out words and sometimes you just want to say what you want to say.
• 28:53
  Speaker 3: But no, I think, especially in this case, there is so much inside of the words diastasis.
• 29:00
  Speaker 3: There's so much meaning in there that, based on what society has told them is what diastasis is, and also we are part of that society, we have contributed to that and hopefully we can, as society, change some of that.
• 29:16
  Speaker 3: But yes, we have to be very mindful of what we are saying and how it's coming across, but also to know that we, from the beginning, we should not really be promising things, promising that your gap is going to close, promising that you're going to have like a flat stomach.
• 29:34
  Speaker 3: So it's very easy to go down the marketing route and when you see diastasis programs out there online and how they're marketing it as well not all of them, but there are some not so great ones and there are some really good ones.
• 29:48
  Speaker 3: That some of the not so great ones.
• 29:51
  Speaker 3: In terms of marketing.
• 29:52
  Speaker 3: We're seeing words like or phrases like get rid of your wobbly, mushy mummy tummy with these three exercises in five minutes a day, and it's that kind of like preying on the vulnerabilities of people who just they're already unhappy with it.
• 30:10
  Speaker 3: But we also know that there's going to be a subset of these people who, unfortunately, are going to go through all these programs and still not be where they want to be, and yet they were promised all these things, either through the programs or through us.
• 30:23
  Speaker 3: You know our one-on-one interactions with them.
• 30:25
  Speaker 3: So let us not promise these things because we don't know at this point what exactly is going to get them to where they want to be, and we have to absolutely take into account the role of genetics.
• 30:36
  Speaker 3: So we can't make those promises.
• 30:39
  Speaker 3: But we can say this is what we have to offer and let's try this out, let's see how your body responds, and see if you're after every few months or so.
• 30:49
  Speaker 1: Super interesting, you know when you're talking.
• 30:51
  Speaker 1: It reminds me a little bit of you know things that we go over with people in business, where it's like the difference between a results-driven goal and a process-driven goal is and a lot of times the process-driven goal is a lot more effective at seeing change and being able to do bite-sized pieces because, right.
• 31:09
  Speaker 1: So, if the results-driven goal is closed the gap, but the process-driven goal is strengthening the entire abdominal wall in the system, then it's all about getting that going on and then we'll see what the end result is.
• 31:23
  Speaker 1: After we have created this.
• 31:26
  Speaker 1: Stronger, better dealing with load, all of that.
• 31:31
  Speaker 1: Better able to manage pressure system.
• 31:33
  Speaker 1: Beautiful, Exactly, Exactly, yeah, Cool.
• 31:37
  Speaker 1: Well, that's super helpful.
• 31:39
  Speaker 1: Now I have one other question.
• 31:40
  Speaker 1: There was something that you said about the way that we're conventionally taught to measure the interrexidistance, and we've all I still do it this way where it's check the gap and the gap in air quotes and use your finger with the distance, which we know is not super accurate, but it does give broad strokes, Sort of what are we working with?
• 32:04
  Speaker 1: How long is it?
• 32:05
  Speaker 1: How wide actually is it?
• 32:06
  Speaker 1: Is it small, medium, large?
• 32:09
  Speaker 1: What's going on?
• 32:09
  Speaker 1: What do you recommend that we do now, given the, in light of the current research and current practice, that we know that the gap is not the only thing.
• 32:20
  Speaker 3: I would say to exactly that the gap is not the only thing that we're going to be looking at.
• 32:26
  Speaker 3: So let's look at the gap but not stop there, not end there.
• 32:30
  Speaker 3: It's fine.
• 32:30
  Speaker 3: It is still current practice to measure interrexidistance and I wouldn't say to just throw it out the window because it can change.
• 32:41
  Speaker 3: It's just that we're seeing in research that it may not change that much, it may not be very perceptible even in our finger measurements, and that for some people I'm sure you've seen it too and I've seen it where it changes significantly.
• 32:57
  Speaker 3: We need to also consider that possibly research isn't looking at the more significant, severe cases where maybe there's more potential for change to occur and maybe there are in the more moderate category.
• 33:07
  Speaker 3: So let's not just throw out the interrexidistance but let's just keep it as one piece of the whole puzzle or person meaning.
• 33:17
  Speaker 3: Ok, interrexidistance, let's take a look at that.
• 33:19
  Speaker 3: Let's take a look at depth or tension, so some sort of way to assess the tissue quality and tensioning ability, because we know tension is important for being able to sort of transfer loads through it, to then create some physiological change within it.
• 33:36
  Speaker 3: So we need some kind of tension there.
• 33:39
  Speaker 1: Yeah.
• 33:40
  Speaker 3: But then let's take a look at function.
• 33:41
  Speaker 3: Let's take a look at OK, how strong is your rectus?
• 33:44
  Speaker 3: How strong?
• 33:44
  Speaker 3: What is your rotation ability like?
• 33:47
  Speaker 3: Are you able to draw in your abdomen as a means of assessing transverse abdominis?
• 33:53
  Speaker 3: That is one of the things it does.
• 33:54
  Speaker 3: So, in an upright position, relax your abdomen and see how far you can pull it back in.
• 33:59
  Speaker 3: That's a TA assessment right Then there.
• 34:02
  Speaker 3: So let's assess all the muscles.
• 34:04
  Speaker 3: Let's assess you doing some simple exercises, core exercises, and some harder ones in different positions.
• 34:11
  Speaker 3: Where are you doming?
• 34:13
  Speaker 3: How much are you doming?
• 34:15
  Speaker 3: What are you having a difficult time with in terms of being able to contain your abdominal wall and not let it sort of bulge out inside of an exercise?
• 34:27
  Speaker 3: Your control over it.
• 34:28
  Speaker 3: So your core strategy Are there certain exercises you're having a hard time in having that control in?
• 34:34
  Speaker 3: And let's see where you're at.
• 34:37
  Speaker 3: In addition, when we're talking about treating the whole person, not just the gap, what are the things that you are avoiding because you're worried that doing that's going to make it worse?
• 34:48
  Speaker 3: What are the movements that you are afraid to do?
• 34:52
  Speaker 3: What are the movements you're nervous about?
• 34:55
  Speaker 3: Let's go into those.
• 34:56
  Speaker 3: So we just sort of we enter those progressively, step by step, one little thing at a time, and also again, going even beyond that, from the bio into the psychosocial.
• 35:09
  Speaker 3: Why do you want this to change?
• 35:11
  Speaker 3: What is it that you want out of all of this?
• 35:13
  Speaker 3: So the end goal and we really shouldn't kid ourselves, most people are not there to get stronger, they're getting there to get.
• 35:22
  Speaker 3: So the process versus the end result, like you were talking, will get stronger, but with the end result hoping to be a flat stomach or flatter, or a change in the stomach, the appearance of the abdomen.
• 35:33
  Speaker 3: So if that's the end goal, and also for us knowing that not everybody is going to achieve that and some do actually, so again, it's kind of this mixed bag of results at the end, but some are not going to get where they want to be, and so not closing the door or scaring them into what abdominal plastic looks like, what it can offer them, and not shutting the door or talking about it in such a way that again it scares them away from it, and so keeping that line of communication open as well.
• 36:07
  Speaker 1: That is such a good thing to remember and that leads us right into sort of the two topics that we have.
• 36:14
  Speaker 1: Then there's a method to our madness.
• 36:16
  Speaker 1: This is why we wanted to have you here.
• 36:18
  Speaker 1: So for the Pelvicon you're speaking of Pelvicon, it's in Atlanta, it's in September and your topics are exactly this.
• 36:24
  Speaker 1: It's DRA helping the whole person and not the gap, like we mentioned before but it's also abdominal plastic, navigating the mommy makeover.
• 36:34
  Speaker 1: And when Jessica and I were talking briefly about this podcast recording today and things that we wanted to make sure that we went over with you, one of the things that came to our minds was there's so many times when physios, pelvic PT's, pelvic OT's will villainize the surgical route.
• 36:55
  Speaker 1: Same thing for prolapse we villainize that it's a failure if you have to end up having surgery, and especially with things like DRA and even prolapse, where there is a connective tissue piece to the puzzle, there is an aesthetic or a feeling to that that we can't ignore.
• 37:18
  Speaker 1: That I feel like as a group, we're not doing our patients a huge service to villainize something that might be an end result that we can still help them through and prepare for and all of that.
• 37:34
  Speaker 1: So can you speak a little bit to that, because I know that you have a lot of.
• 37:39
  Speaker 1: You have a program, you have a whole other Instagram account all about Tummy Tuck rehab, so can you just speak a little bit to that?
• 37:47
  Speaker 1: This is a whole potentially villainizing something that might actually be helpful for somebody, especially if it helps to achieve their own goals.
• 37:55
  Speaker 3: Oh my gosh, I'm so glad you are asking this question and the reason is because I think, as pelvic rehab providers, I mean part of the reason, I think in sort of behind.
• 38:08
  Speaker 3: I guess the premise of that question is that we are very confident and very excited about what we can offer to our clients or patients and we love getting them there and we love helping them there, and it's like our mission too to get them to where they want to be.
• 38:24
  Speaker 3: So there's like it ties into what we want for them as well, and so potentially there are some people who might feel like, if their patients have not gotten to the point of aesthetically getting them where they want to be, that they themselves as practitioners have failed, that there's there's something that they're not doing, that they're missing something, that they should be doing something different or adding in this or that.
• 38:51
  Speaker 3: So there's potentially the feeling of we are failing if we really talk about surgery, that we are doing something wrong.
• 38:59
  Speaker 3: We could, we just need to go find out what it is and do that, and this person's not going to eat surgery anymore.
• 39:04
  Speaker 3: It's that missing piece.
• 39:06
  Speaker 3: And yet a lot of times it's not like.
• 39:10
  Speaker 3: A lot of times it actually there's not a missing piece here.
• 39:13
  Speaker 3: It's just a person has done everything they possibly can and their body, their genetics are such that they needed the surgery to get them to where they wanted to be.
• 39:26
  Speaker 3: And I think another part of this villainizing surgery is possibly because we are not comfortable with it.
• 39:34
  Speaker 3: You know, when we're not really sure about something, we may not really talk about it in, like you know, the most confident manner.
• 39:41
  Speaker 3: So we, if we haven't worked with a lot of people who've had a dominant plasticity, we don't know kind of the ins and outs of it, then we're not really going to promote it that much and we're not going to talk that well about it.
• 39:52
  Speaker 3: So there could be that piece of it as well.
• 39:54
  Speaker 3: But I think what's really important is that we still remain confident in what we can offer, but without being anti-surgery.
• 40:06
  Speaker 3: And there is absolutely a place for surgery for the abdominal wall, just as there is a place for surgery for a shoulder or a knee or a hip, if things in the conservative part of the program, you know, didn't get those people to where they wanted to be or needed to be for, whether that's their job or for them to function as a mom or dad, or for work or for you know whatever it means in their life.
• 40:34
  Speaker 3: There's a piece to that and it's part of the continuum of care.
• 40:36
  Speaker 3: So for us to just kind of take plastic surgery and the word plastic surgery is also part of it what I think is part of the reason why we are staring people away from it there are societal assumptions around what plastic surgery is and the aesthetics, so there's a whole bag of things to unpack there as well.
• 40:57
  Speaker 3: But I think we just have to remember that it's part of the continuum of care and it doesn't mean that you've done anything wrong or that the patient has done anything wrong, and it's just sometimes that that's where the results need to go.
• 41:10
  Speaker 3: Be neutral about it I actually not even neutral, but just carry a positive attitude around it because it's part of the continuum of care.
• 41:19
  Speaker 3: And on top of that, yes, we can offer so much in diastasis, rehab, conservative, but oh my goodness, can we offer so much for post-op as well?
• 41:30
  Speaker 3: Yes, and pre-habbing Part of what we can do.
• 41:33
  Speaker 3: It's what we do Exactly, and there's so much we can do to help them.
• 41:37
  Speaker 3: It's part of our knowledge, it's part of our specialty, it's part of our scope of practice.
• 41:41
  Speaker 3: And yet there are these people who have so much, have so many resources, an abundance of information about what they can do for their diastasis, and it just kind of falls off a cliff after they get the surgery and they're left hanging on like how do I get back to using my core afterwards?
• 41:57
  Speaker 3: And there's so much fear around that after the surgery.
• 42:01
  Speaker 3: So like we can do everything that we do so well for diastasis and also we can do it for post-op, and we can help them regardless of where they happen to be.
• 42:11
  Speaker 1: Yes, I know this is so great.
• 42:14
  Speaker 1: This is why I'm so excited to have you speak on this and I'm just so excited that you have resources now for clinicians and for patients, quite frankly, around both of these areas, because I think it's something that we can get really judgy as practitioners around that.
• 42:31
  Speaker 1: And I love what they used to focus at the beginning about meeting people where they are, like if a goal for that person is to have a flatter stomach and what we're doing can offer the most strong abdominal wall, but that doesn't look like it's that strong, or they can't fit into pants, or their partner doesn't like how they look or whatever Like that's not for us to judge.
• 42:55
  Speaker 1: That is for us to be a part of their healing process, whatever they choose, and to be a support for them through the whole thing.
• 43:02
  Speaker 1: And I feel like one of the.
• 43:04
  Speaker 1: I was talking to a practitioner online a little bit about this and they were adamant about trying to avoid this surgery and I was like, well, I was like it's so easy for us to say that when I mean, I just was pregnant, I didn't have a diastasis.
• 43:20
  Speaker 1: My stomach actually returned pretty good.
• 43:22
  Speaker 1: Thank you, mom.
• 43:23
  Speaker 1: I didn't have any of that I might be singing a different tune with oh my gosh, talk to me about plastic surgery to fix this business, if it was me.
• 43:32
  Speaker 1: Like I feel like we're not putting ourselves in the patient's shoes and it's easy for us to say like, oh, that's a goal that you shouldn't have to have, you shouldn't have to go down that road, except for if you're not the one that has a past history of body image issues and this is bringing up a lot of things for them.
• 43:51
  Speaker 1: It's like maybe for their mental health, they actually need to go through the surgery so that they can heal in other ways as well, and so I feel like sometimes we just need to remember that a little bit when our patient's in front of us.
• 44:07
  Speaker 3: Yes, absolutely A thousand percent everything you just said.
• 44:11
  Speaker 1: Beautiful.
• 44:12
  Speaker 1: This is so great.
• 44:13
  Speaker 1: So here's the deal.
• 44:15
  Speaker 1: So you're speaking about this at Pelvicon.
• 44:18
  Speaker 1: In my podcast, we usually go through what's a missing piece and I feel like I might know what you're going to say.
• 44:25
  Speaker 1: But if, maniera, if you were to say what a missing piece is when we are helping people rehab either from DRA or abdominal plasticity, what do you think as a group we're missing that we need to pay a little bit more attention to and a little bit more take a little bit more notice on during the treatments?
• 44:46
  Speaker 3: It is sort of like what we've just talked about, this kind of this entire podcast episode.
• 44:51
  Speaker 3: It's really trying to understand what having the gap means to the person, taking us out of the picture.
• 44:59
  Speaker 3: Whatever we think needs to be done or whatever we think we can do, is just understanding what it means to the person, why they want to close their gap.
• 45:07
  Speaker 3: What do they hope to achieve in getting a smaller, narrow gap and then being able to navigate the rehabilitation, the journey of conservative management with them, knowing what their goals are, and we will then be able to help them better.
• 45:28
  Speaker 3: You touched on body dysmorphia or eating disorders, and you touched on how it can be almost a slippery line between wanting to change the way your stomach looks because you just want to feel better, but then there's a slippery line between you know, is there a preexisting history of eating disorders and body dysmorphia, or something more in the realm of mental health?
• 45:52
  Speaker 3: So the missing piece here, in my opinion, is let's look at the whole person and dig deeper and not just focus on the gap.
• 46:01
  Speaker 3: Let's move into a wider picture.
• 46:05
  Speaker 1: Beautiful, wonderful, and I will say too, just to throw in a little personal thing about me being postpartum.
• 46:12
  Speaker 1: The thing is, it's like it changes your whole perspective on everything about around your body and what it's going through.
• 46:21
  Speaker 1: There's so many things that are happening and so, you know, I encourage all of us that have had kids to remember what that's like in that immediate postpartum phase.
• 46:31
  Speaker 1: And if you haven't had children and don't plan to, and all of that, then I really want you to have that empathy, to like to put yourself in that person's shoes, that literally everything for the past year has been changing, literally out of your control.
• 46:48
  Speaker 1: You go through this major event, physical event, to get this baby out whether that's a C-section, whether that's a vaginal delivery and then we have this whole thing postpartum that you're still out of control.
• 47:02
  Speaker 1: Your whole life is changing, it's in upheaval, and All you do every day is look at yourself in the mirror and you see evidence of that lack of control, and that is whether that's a flappy arm or a weird breast pocket in your armpit where your bras are like now why can't wear this shirt anymore?
• 47:25
  Speaker 1: Because this is a weird thing that's popping out, it's happening all the time, everywhere and I feel like we can provide such a key place in this person's life if we can just be there for them during that whole time.
• 47:39
  Speaker 3: Oh, absolutely Just simply, like you said, if we have had children, to kind of maybe reflect on what it was like for us in pregnancy and postpartum or is still like, or if we haven't to step in their shoes.
• 47:56
  Speaker 3: But I think one thing that's just sort of it just came into my mind and I just thought it would be important to share is that, beyond the lack of control that what has happened to our body, what the body is doing, is sort of beyond what we can consciously and voluntarily change or will itself to do something different, and for that reason it makes it even more difficult for some of these people, because there is no control over that in many regards.
• 48:23
  Speaker 3: But also it's like what they see in the mirror is just something so different, and so there's like this piece of their identity that is almost in their mind, they feel like has been taken away from them, and so they're striving not just to get their flat stomach back or their body back, but to get a part of their identity back, because a lot has changed in being postpartum, including their body.
• 48:50
  Speaker 1: So, yes, tying all of that in, yes, though that is something to remember, a huge missing piece.
• 48:57
  Speaker 1: All right, manira, we do this with everybody.
• 49:00
  Speaker 1: We do a little lightning round where there's four questions with all of our Pelvicon speakers.
• 49:04
  Speaker 1: We're asking you guys the same questions Are you ready for the lightning round?
• 49:10
  Speaker 3: Ready.
• 49:10
  Speaker 1: Okay, what is the most Canadian thing about you?
• 49:14
  Speaker 3: I do love Tim Hortons and I do love Kraft peanut butter.
• 49:17
  Speaker 3: Okay.
• 49:19
  Speaker 1: Okay, Wonderful.
• 49:21
  Speaker 1: Do you have any pets?
• 49:22
  Speaker 1: Manira Animals.
• 49:23
  Speaker 1: I have a dog, okay, what kind?
• 49:25
  Speaker 3: The rest of the dogs from South Korea, so we don't know, but she's likely a mix of Maltese and something else.
• 49:34
  Speaker 3: So she started with a small, medium sized white dog.
• 49:38
  Speaker 1: Cute.
• 49:39
  Speaker 1: That's awesome.
• 49:39
  Speaker 1: They're so fun, those pets.
• 49:41
  Speaker 1: What are you most excited about in our field of pelvic rehab?
• 49:46
  Speaker 3: I'm really excited at the fact that more of us in our field are embracing social media.
• 49:55
  Speaker 1: Yes.
• 49:56
  Speaker 3: Including ourselves out there and really allowing us to be at the forefront of many of these conditions, because we are often the people that spend the most time with these individuals of whatever conditions is, and I want us to be there.
• 50:12
  Speaker 3: Yes, I love our allied health professionals also in this space, but I really don't want us to fall behind and stay in behind the scenes when you know other professions are doing a great job marketing and selling their services.
• 50:26
  Speaker 3: I want us to do that because we are evidence based.
• 50:29
  Speaker 3: We offer so much and it's an untapped potential of how many people we can help you reach people.
• 50:38
  Speaker 1: Absolutely.
• 50:39
  Speaker 1: At Pelvicon we're actually having a panel discussion, with Sarah Reardon leading it, on how to reach people some through social media and then some other places but we do need to be at that table.
• 50:49
  Speaker 1: I 100% agree with you, and there's people in our field that think that social media is not the way to educate folks, and I just frankly disagree.
• 50:58
  Speaker 1: So I'm really glad that you said that.
• 51:00
  Speaker 1: It's so great.
• 51:01
  Speaker 3: I have to disagree as well, and I just recently discovered one major researcher in the world of Diastasis that she was on Instagram as well.
• 51:09
  Speaker 3: And so this is what I mean Educators, researchers, clinicians, like all of us just let us just get out there and even if you're not selling a program, even if you're not trying to educate, you know about certain topics, you're just there, you know, just to proudly showcase.
• 51:27
  Speaker 3: This is the research that I'm doing.
• 51:28
  Speaker 3: This is my day at the clinic.
• 51:30
  Speaker 3: Like we can connect with each other, we can have, and then there will be some people because they love it.
• 51:35
  Speaker 3: They will find their voice and do more and, you know, reach more people when it comes to patients or it might be more practitioner focused.
• 51:44
  Speaker 3: But, yes, like let's just keep going out there and doing it.
• 51:47
  Speaker 1: Absolutely All right, Meneer.
• 51:49
  Speaker 1: Last question If you weren't a physio, what would you be doing?
• 51:53
  Speaker 3: That's easy.
• 51:53
  Speaker 3: I would be probably some kind of artist kind of person, something in the arts field, in addition to something in the baking field, because I love both.
• 52:07
  Speaker 1: Oh, like baking, like eating baking, like cookies.
• 52:10
  Speaker 3: Okay, yeah, exactly.
• 52:11
  Speaker 3: So whether it's like a bakery with some really gorgeous cakes or cookies with like beautiful designs on top, or something colorful and bright, like so color, design and baking and just mashing the two together and whatever that creates, I would do that.
• 52:30
  Speaker 1: My gosh, I'm going to wait for your next project to be that.
• 52:34
  Speaker 1: Yes, speaking of everything else that Meneer is doing, you can check her out at MeneerHoudaniPTcom.
• 52:40
  Speaker 1: She also has another website called tummytechrehabcom and then the corresponding Instagram handles Meneer HoudaniPT and at tummytechrehab she's got things for patients and clients.
• 52:53
  Speaker 1: She has things for health, fitness and rehab professionals.
• 52:57
  Speaker 1: Meneer, you are the diastasis guru and genius.
• 53:01
  Speaker 1: Thank you so much for your time today and I really am excited for everybody to hear from you more at PelvicCon.
• 53:08
  Speaker 3: Oh, first, again, thank you so much for having me.
• 53:12
  Speaker 3: I have the most honored feeling when you asked me to come and speak at Palo Con.
• 53:18
  Speaker 3: I am so excited for it.
• 53:20
  Speaker 3: I feel humbled by it and it's just amazing to be a part of such an incredible event.
• 53:27
  Speaker 3: Thank you for organizing it.
• 53:29
  Speaker 3: Thank you for everything you are doing.
• 53:32
  Speaker 1: Oh, thanks, munira, we will see you in Atlanta.
• 53:35
  Speaker 1: Everybody, talk to you soon.
• 53:40
  Speaker 2: Well, Nicole, such a great conversation with Munira and frankly, I don't know what I've been doing on this podcast the whole time.
• 53:45
  Speaker 2: You clearly don't need me.
• 53:47
  Speaker 1: I do.
• 53:47
  Speaker 1: It was a little shaky at the beginning but we got it.
• 53:50
  Speaker 1: We got it figured out.
• 53:51
  Speaker 1: I loved actually really loved the history lesson where Munira took us back through like where we've been and what shift of thinking we're in now.
• 54:01
  Speaker 1: I loved hearing the first shift.
• 54:02
  Speaker 1: After that, diane Leap and Paul Hodges' paper came out.
• 54:05
  Speaker 1: Now the second shift and it's a really good example of how you know, a lot of times we say clinical practice is preceding research, but this is a good example of a condition and something that we treat that actually needs better research so that we can change what we do in practice and help treat our patients better.
• 54:24
  Speaker 2: It's absolutely incredible and you know, talk about the growth of the field and what she was saying about.
• 54:29
  Speaker 2: You know helping people before and after abdominal plastic man.
• 54:32
  Speaker 2: Again, we talk about how many people need our help who aren't getting it.
• 54:34
  Speaker 2: What if we were able to help every single person who is going to undergo that surgery?
• 54:39
  Speaker 1: You know, sometimes I feel like helping patients prehab and post-surgical rehabilitation and pelvic health is sort of a forgotten thing and every once in a while we'll say something on Instagram about it like, oh, we should prehab all these conditions.
• 54:50
  Speaker 1: But, man, we really need to sort of embrace is the fact that we can't villainize surgeries, like if people are having them prolap surgery is another good example, right Abdominal plasticities like people are having these things and for good reason, and it's not our job to judge whether or not the reasons why someone's doing that and I thought Manera did a really great job in the podcast of talking about that and what's important to the person and us being there and meeting people where they are.
• 55:18
  Speaker 1: And we can go back to our roots about what we all got into physio for.
• 55:22
  Speaker 1: Right, we got into rehab to rehab people prevent surgeries when we can, but then also be with them afterwards to make sure that they return to function better than they were before.
• 55:34
  Speaker 1: And that's what we can do in the diastasis and abdominal plastic world as well.
• 55:38
  Speaker 2: I cannot wait to hear her full conversations at Pelvicon.
• 55:40
  Speaker 2: Those of you who have tickets, I cannot wait.
• 55:42
  Speaker 2: We're going to be taking over an entire hotel, 600 plus of you descending on Atlanta in just under 50 days.
• 55:50
  Speaker 2: Make sure, if you are coming, that you have got your t-shirts, that you've got your add-ons, that you are ready to bring the energy and have an incredible time.
• 55:58
  Speaker 2: If you are listening to some of these podcasts and if you've missed any of these podcasts here, go back.
• 56:02
  Speaker 2: Check out Yenny's interview, check out Jake's interview.
• 56:05
  Speaker 2: You guys need to hear both of those.
• 56:06
  Speaker 2: But if you can't imagine missing out on these conversations that really highlight and showcase the breadth of everything that pelvic rehab can do, make sure you are grabbing the recording.
• 56:17
  Speaker 2: You get an early bird discount of $50 off If you grab that now.
• 56:20
  Speaker 2: Head to Pelviconcom for all of that.
• 56:23
  Speaker 2: So thank you guys.
• 56:24
  Speaker 2: So much for tuning in.
• 56:25
  Speaker 2: I know you enjoyed that interview.
• 56:27
  Speaker 2: As always, reach out, keep this conversation going.
• 56:30
  Speaker 1: And let's continue to rise.