Latest / Pelvic PT Rising / Don't Overlook the Ischiorectal Fossa

Transcript

Don't Overlook the Ischiorectal Fossa · 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.
• 0:59
  Speaker 2: Hey, nicole, hello, all right, we're going to be talking about Isiorectal Bossa today.
• 1:04
  Speaker 2: I think that I said that right.
• 1:06
  Speaker 2: Nicole has been making sure that I have been practicing it as we go through.
• 1:10
  Speaker 2: Incredibly important, often overlooked.
• 1:12
  Speaker 2: Before we do a couple of little things here, one thing, nicole we just love getting reviews from you guys.
• 1:20
  Speaker 1: They're so funny.
• 1:21
  Speaker 1: They seriously give me kind of a good ego boost and it's fun.
• 1:26
  Speaker 2: Yeah, it makes our day.
• 1:27
  Speaker 2: I don't know if it helps anybody else find the podcast or anything else, but we love it.
• 1:30
  Speaker 2: I think it does Whatever.
• 1:33
  Speaker 1: I think it does.
• 1:34
  Speaker 1: It makes me feel good.
• 1:35
  Speaker 1: Yeah, man.
• 1:37
  Speaker 2: So our most recent one is from Emily Mason, pelvic Wellness.
• 1:39
  Speaker 2: As my favorite podcast for everything Pelvic Health, I've been listening to Nicole and Jesse's podcast since day one.
• 1:45
  Speaker 2: That's impressive, back in COVID times.
• 1:48
  Speaker 2: You must Emily must have heard some pretty cringe-worthy things.
• 1:52
  Speaker 2: Actually, I'm kind of glad.
• 1:53
  Speaker 2: Total aside, apple podcast starts hiding episodes once you've hit more than 300.
• 1:59
  Speaker 2: So our last 50 are really hard to find.
• 2:02
  Speaker 2: We were our first 50.
• 2:03
  Speaker 2: Our first 50, yes, so which is, all told, probably a blessing.
• 2:08
  Speaker 1: Probably a blessing.
• 2:09
  Speaker 1: I mean, you know how sometimes when you start something new, you don't really know what you're doing, and we looked back at some of those episodes and we were commenting On COVID.
• 2:21
  Speaker 2: Yeah, a little bit of a COVID diaries of public sanity, as we were shutting down the clinic and thinking we were at first going to be closed down for two weeks and then all the rest of the things.
• 2:31
  Speaker 2: But Emily goes.
• 2:32
  Speaker 2: Oh, she says I feel like I must have written a review at some point, but I just keep getting so much value I figured I'd write one in case I never did.
• 2:39
  Speaker 2: I've always been the type of clinician that questions why we do things the way we do and pushes the envelope a bit when it comes to the way we treat.
• 2:46
  Speaker 2: This is a lot of what I resonate with on this podcast.
• 2:49
  Speaker 2: Not only do Nicole and Jesse push our profession forward, but they have given me the confidence I need to continue pushing as well.
• 2:55
  Speaker 2: Podcast has led me to their amazing courses.
• 2:57
  Speaker 2: Pelvicon has me interested in their business mentorship.
• 3:00
  Speaker 2: In the future, emily, we need to talk.
• 3:02
  Speaker 2: Love Nicole and Jesse's dynamic and the humor is right up my alley.
• 3:05
  Speaker 2: She's probably talking about yours.
• 3:07
  Speaker 1: She's probably talking about yours actually, Right, because yours is hard to find.
• 3:12
  Speaker 2: It makes learning and growing fun and leaves you waiting for that next, so I highly recommend the podcast, emily.
• 3:18
  Speaker 2: Thank you so much, thanks so much.
• 3:20
  Speaker 1: That's so nice.
• 3:20
  Speaker 1: We do need to talk.
• 3:21
  Speaker 1: By the way, it was a good summary of all the things that we do.
• 3:23
  Speaker 1: Sometimes we forget about all the things that we do because we're doing so many things.
• 3:28
  Speaker 2: Yes, one of the things.
• 3:30
  Speaker 2: This is a total other non sequitur, but I don't know if you guys noticed, but we do not do ads on this podcast Because they make me so enraged in some of my favorite ones.
• 3:42
  Speaker 2: I don't know.
• 3:43
  Speaker 2: Nicole and I talked about this.
• 3:44
  Speaker 2: We've been approached by quite a few people to do those and I feel kind of safe saying Nicole's like are we allowed to say this on air?
• 3:51
  Speaker 2: What if we do a podcast sponsor at some point and say I don't think that that's going to happen?
• 3:55
  Speaker 2: I'm saying it, we're not doing it.
• 3:58
  Speaker 1: Okay, jesse's putting the hammer down as if he has any say in a lot of things.
• 4:02
  Speaker 2: Totally do.
• 4:03
  Speaker 2: I know right, but I don't know.
• 4:05
  Speaker 2: I bet you guys, but that always just drives me nuts.
• 4:09
  Speaker 2: And then you're trying to skip forward through it, and then you're having to skip forward too far and you have to reverse past.
• 4:15
  Speaker 1: Which is actually kind of dumb, like the whole point of it being an ad is that you shouldn't be able to skip through it Right, like if you're going to have it in there, you might as well have to listen to whatever the hell they have to say.
• 4:25
  Speaker 2: And I do it.
• 4:25
  Speaker 2: I mean, there's a couple of places that do it really well and like actually introduce their person and I feel like kind of the way we do at PelvicCon is usually the people that we have working at PelvicCon and sponsoring PelvicCon are people who are passionate about Pelvic Health and we really have something to bring to the community.
• 4:40
  Speaker 2: Some places do that pretty well and other ads are just like wait what?
• 4:44
  Speaker 2: Why am I getting pitched this random thing for erectile dysfunction when I'm in the middle of a marketing podcast and it's like I feel called out.
• 4:54
  Speaker 1: AI.
• 4:54
  Speaker 1: Good thing you're at PelvicCon.
• 4:58
  Speaker 2: It's right, jake, I'll be calling Public Floor, jake, if I need help with that.
• 5:03
  Speaker 2: Guys, I don't need your pills.
• 5:04
  Speaker 2: See, I'll just get off of me.
• 5:05
  Speaker 2: So that took a turn.
• 5:10
  Speaker 1: I can't.
• 5:10
  Speaker 1: I just snorted.
• 5:11
  Speaker 1: I can't believe that we just started talking about that.
• 5:15
  Speaker 1: You don't actually have erectile dysfunction.
• 5:17
  Speaker 1: Let's just be clear.
• 5:19
  Speaker 2: But I could, nicole, and if I did Public Floor, jake, I see what I'd be calling Okay.
• 5:24
  Speaker 2: So, with that transition, though, if I did have erectile dysfunction, one of the things, nicole, you would be looking at is my ischio recto fascia FASA, fasa, f-o-s-a.
• 5:38
  Speaker 1: Yes.
• 5:39
  Speaker 2: Okay, okay.
• 5:39
  Speaker 2: So why are you so down?
• 5:41
  Speaker 2: Can I call it IRF?
• 5:43
  Speaker 1: Yeah, you can call it the IRF Cool.
• 5:46
  Speaker 2: Why are you so down with the IRF?
• 5:48
  Speaker 1: I freaking love the ischio recto fascia.
• 5:50
  Speaker 1: So first of all, I love the external anal sphincter.
• 5:53
  Speaker 1: It is one of my favorite muscles.
• 5:55
  Speaker 1: I also love the perineal body and it's one of the big reasons why I think that rectal treatment is so important.
• 6:02
  Speaker 1: But one but.
• 6:04
  Speaker 1: But one of the other really important things that I think it's missed so often is true targeted treatment of the issue of rectal fossa.
• 6:16
  Speaker 2: Cool, I just looked this up.
• 6:17
  Speaker 2: Do you know what fossa means?
• 6:19
  Speaker 1: It's like a hole.
• 6:22
  Speaker 2: Yeah, a shallow depression, or hollow.
• 6:24
  Speaker 1: Yeah.
• 6:25
  Speaker 2: Okay, I mean, you learn something new every day Fossa.
• 6:28
  Speaker 2: It is like when have you ever used the word fossa?
• 6:30
  Speaker 2: We have.
• 6:31
  Speaker 1: That's like anatomy dude we have like in all of our things, like the Lecrenon fossa.
• 6:36
  Speaker 1: There's like a ton of different types of fossas in our skeleton.
• 6:39
  Speaker 2: Yeah, but I feel like we should use that more though, because it doesn't just mean an anatomical thing.
• 6:44
  Speaker 2: Like you can use that in casual conversation.
• 6:46
  Speaker 2: I want you to bring that back.
• 6:47
  Speaker 2: We are making fossa popular again.
• 6:49
  Speaker 2: You go up a hill and then down into the fossa on the other side.
• 6:52
  Speaker 1: Why don't you go ahead and make it popular again Jesse and Terry?
• 6:56
  Speaker 2: Done, Done Okay perfect.
• 6:58
  Speaker 1: So now I kind of understand what the definition is.
• 7:02
  Speaker 2: What is it?
• 7:02
  Speaker 2: What is the IRF?
• 7:04
  Speaker 1: Okay, so the ishire rectal fossa is actually part of the anal triangle, which is a really important region of our bodies which I feel like we forget.
• 7:12
  Speaker 1: That like, oh, the posterior pelvic floor is in part in the anal triangle, so a lot of important structures in there, one of which is the ishire rectal fossa.
• 7:21
  Speaker 1: So basically, it is a fatty tissue in this region that's medial to the ischial tuberosity, that which has numerous fibrous bands that allow for distention of the anal canal During defecation.
• 7:33
  Speaker 1: It contains and this is important folks it contains the penile nerve artery, penile vein, the inferior rectal artery nerve and vein.
• 7:44
  Speaker 1: If you know anything about how the pelvic floor is innervated, what happens with the bladder, how the bladder is innervated, anything at all about the penile nerve, autonomic inputs like this is where that nerve, one of the areas where that nerve runs, and it's one of the most easily accessible areas where that nerve runs, and so it's like it's so important to be able to assess this and to treat it well in patients, and I will tell you that it's one of the areas that I can pretty much guarantee has not been assessed.
• 8:17
  Speaker 1: When we see patients from all over the world at pelvic sanity, we've seen what we're up to probably 150 now people that have come for our out of town program and I can probably safely say that not one person has had this area thoroughly checked out, looked at, treated well in especially with pelvic pain diagnoses, but it's implicated in almost every other diagnosis that we see.
• 8:41
  Speaker 2: So when you said and I know you go over all of this in your rectal course but if you had to pick one area, site unseen and said, hey, this is what you need to treat for the biggest bang for your buck, irf is in that conversation.
• 8:55
  Speaker 2: Irf wins, like, where are we at?
• 8:57
  Speaker 2: I think IRF wins.
• 8:59
  Speaker 1: I mean, if somebody came to me and said this person has these symptoms and you have to treat one thing without actually like seeing the person reading anymore about their symptoms doing anything, I would be like, let me pick the IRF because it's also accessible externally, and so that's the other thing.
• 9:16
  Speaker 1: It's like I would pick probably some pelvic floor stuff.
• 9:19
  Speaker 1: If that were guaranteed that I could do that.
• 9:21
  Speaker 1: But the issue of rectal fossa is always guaranteed that we can assess it, even if somebody does not want to do internal or an internal exam is not appropriate.
• 9:30
  Speaker 2: So if it's, so important, why are we missing it?
• 9:33
  Speaker 1: I literally don't know.
• 9:33
  Speaker 1: I seriously don't understand.
• 9:36
  Speaker 1: I don't know.
• 9:36
  Speaker 1: That's one of the reasons why I put it in the rectal course.
• 9:38
  Speaker 1: I literally put it in every single course that I do because it's like it's in my IC course, because it's important for people with an interstitial cystitis.
• 9:46
  Speaker 1: Do an rectal course, we do it for the strengthening course like it's super important.
• 9:52
  Speaker 1: I literally don't understand why.
• 9:54
  Speaker 1: I think that we learn about it as a structure and then we don't realize we don't ever get taught how much it's implicated in other areas.
• 10:04
  Speaker 2: That's an interesting point, though One of the things that we kind of always go back to us is you know, a lot of times when Nicole this is a little behind the scenes peek of stuff, but a lot of times when Nicole is talking about stuff like this, she just feels like, oh, of course somebody should look at that.
• 10:19
  Speaker 2: It's so obvious, and maybe it is when you've been doing this for 17 years and all of that, but it's not really taught, right.
• 10:28
  Speaker 1: No, but see, this is what I don't understand.
• 10:29
  Speaker 1: Like this is where I always go back to anatomy as evidence.
• 10:32
  Speaker 1: Like anatomy, if you just look at a mother freaking anatomy book, that's some important shit that goes right there and people point there all the time as this hurts.
• 10:44
  Speaker 1: It's like patients are literally pointing there.
• 10:48
  Speaker 1: They're having things like pain with sitting.
• 10:50
  Speaker 1: What are we sitting on?
• 10:52
  Speaker 1: Ischial tuberosity, Ischio rectal fossa Like that's what we're sitting on.
• 10:57
  Speaker 1: I literally don't understand sometimes why we would ever just skip over that.
• 11:04
  Speaker 1: It's just like looking at an anatomy book and then it's like, wow, there's a bunch of important shit in there.
• 11:09
  Speaker 1: How can I access it?
• 11:10
  Speaker 1: Well, weird, it's like super easy actually.
• 11:14
  Speaker 1: Maybe also the ischial tuberosity, Like we learned how to palpate the ischial tuberosity.
• 11:17
  Speaker 1: We learned how to palpate posterior pelvic floor in the ischial rectal fascia.
• 11:22
  Speaker 1: You have to push a little bit harder, but but if that's tender in your patient, then the stuff that you have to push through in order to get to things like the levator anion externally that is also can be a pain generating tissue.
• 11:37
  Speaker 1: To me it's like so obvious Like I just don't understand why we're not all doing it.
• 11:42
  Speaker 2: Okay, and so then talk to me then, because clearly nobody, or not enough people, are talking about, or training, this and initial courses or whatever else.
• 11:51
  Speaker 2: Like, how do you treat it?
• 11:52
  Speaker 2: And is this a dumb question?
• 11:54
  Speaker 2: But like, what position do you have to be in to do that?
• 11:57
  Speaker 1: This is why this is why it's so cool, because it can be accessed from literally any position.
• 12:02
  Speaker 1: You can treat it in supine, you can treat it in prone.
• 12:04
  Speaker 1: You can treat it in sideline.
• 12:05
  Speaker 1: You can treat the ischial rectal fossa of the sideline position that's down, so like if you're there in left sideline.
• 12:12
  Speaker 1: You can treat the left ischial rectal fossa.
• 12:14
  Speaker 1: You can also, in left sideline, treat the right ischial rectal fossa.
• 12:18
  Speaker 1: It puts everything on slack and sideline.
• 12:20
  Speaker 1: You can just access it from anywhere.
• 12:22
  Speaker 1: You could do it in sitting.
• 12:24
  Speaker 1: You can do mobilization with movement in sitting.
• 12:27
  Speaker 1: You can do it in quadruped.
• 12:28
  Speaker 1: You can do it in child's pose.
• 12:31
  Speaker 1: You can both assess and treat it in any of those positions.
• 12:35
  Speaker 1: It is so cool that way and it's accessible externally, which is even cooler, and you know how much I believe that internal assessment and treatment is integral to our specialty.
• 12:47
  Speaker 1: It's literally why we have a specialty is the ability to do internal exams and treatments, but this structure and this region is seriously just as important.
• 12:59
  Speaker 2: So when you're doing this, you mentioned that this was really important for pelvic pain folks.
• 13:05
  Speaker 2: Is that all pelvic pain diagnoses, is that some more than others, and then talk about things that aren't pelvic pain?
• 13:14
  Speaker 2: Is this like a stress, urinary and condiments thing you're looking at, or is it not a big player in that?
• 13:19
  Speaker 1: It's literally any diagnosis, and here's the reason why.
• 13:22
  Speaker 1: So here's just a couple of really important facts about the ischial rectal fossa.
• 13:27
  Speaker 1: It actually it's assisting in support of the rectum itself.
• 13:32
  Speaker 1: So for people with recticeal prolapse anything where the perineum is implicated or even not supported or bulging or something like.
• 13:42
  Speaker 1: the ischial rectal fossa helps support the rectum, so it also is 10 to 15% responsible for fecal continents.
• 13:51
  Speaker 1: So anybody that has any sort of gas leakage, fecal leakage, anything like that, the ischial rectal fossa is responsible for that.
• 14:00
  Speaker 1: If it's not a healthy tissue area, it's not it.
• 14:04
  Speaker 1: You literally have less, 15% less control of fecal continents.
• 14:09
  Speaker 1: It's also implicated in constipation.
• 14:11
  Speaker 1: If it needs to have expansion capabilities with those fibrous like bands that are part of it, it has to have blood flow.
• 14:23
  Speaker 1: It has to be nice and cushy when you're sitting.
• 14:27
  Speaker 1: So it can be a painful.
• 14:27
  Speaker 1: If it's not healthy tissue, it can be painful with sitting and that can be the pain generating tissue.
• 14:34
  Speaker 1: So a lot of people will say, oh, my gosh, I have pain with sitting and painful sex and whatever.
• 14:39
  Speaker 1: And everyone's like, oh, it must be penicillin nerve and it's like, well, maybe, but it also can be actually the ischial rectal fossa.
• 14:45
  Speaker 1: Now the penicillin nerve happens to run through the ischial rectal fossa and it's one of the areas we can actually access it and do penile nerve lines through there, which is really cool as well.
• 14:55
  Speaker 1: But that tissue is so important for it to be healthy, for it to have good blood flow, for it to have good mobility, for it to have good excursion, for it to be able to be compressed during sitting.
• 15:06
  Speaker 1: All of those things matter for that structure.
• 15:12
  Speaker 2: So what are you actually doing, then to treat this?
• 15:15
  Speaker 2: Is this anything different than you would do to treat, you know, your elbow fossa?
• 15:21
  Speaker 1: Elbow, jesse.
• 15:23
  Speaker 1: It doesn't even make any sense, I feel like I've got a depression in my elbow.
• 15:26
  Speaker 2: I feel like that's.
• 15:28
  Speaker 1: Reason number 752.
• 15:30
  Speaker 1: Why Jesse is not a clinician?
• 15:33
  Speaker 2: Bringing back fossa.
• 15:33
  Speaker 2: There is a depression around my elbow, Ergo I have an elbow fossa.
• 15:38
  Speaker 1: Great.
• 15:38
  Speaker 1: What's the question?
• 15:41
  Speaker 2: How do you treat this area?
• 15:42
  Speaker 2: Do you treat it differently than any other part of the body, or is it like literally the same work, the same techniques, the same everything else that you use anywhere else?
• 15:51
  Speaker 1: Okay.
• 15:51
  Speaker 1: So sometimes when I am mentoring people, this is where I also get really frustrated at how it's taught, because so if it is taught at all, then you're taught to assess it by just poking in that region.
• 16:04
  Speaker 1: Oh, I want to just push into the area and one of my mantras is like don't poke your patient, don't press on their external structures.
• 16:15
  Speaker 1: Like you learn and freaking all those courses, you don't just poke your patient, can I?
• 16:21
  Speaker 2: wait 20 second time out here because as a patient myself, I identify on that side of the spectrum here.
• 16:26
  Speaker 2: Is it literally taught like I'm thinking, like an actual poke, like like a one, like a finger is just like jab you don't.
• 16:35
  Speaker 1: it's technically not taught jabbing, but they are given this diagram of the perineum, and then there's all these like positions, and it's how you're supposed to like learn the musculature, right?
• 16:47
  Speaker 1: You guys all know what I'm talking about, right?
• 16:49
  Speaker 1: It's like this picture, it's like the the lithotomy position picture, and it's of the perineum, and it's like oh, at number one is the ischial cavernosis.
• 17:00
  Speaker 1: And then how you learn to assess, it is like put that picture up right near your patient and then your real patient.
• 17:06
  Speaker 1: Then you like put your finger and press into that muscle, and but what happens, though, is that you're taught just to identify.
• 17:15
  Speaker 1: So what I think ends up happening is that you guys just go through the numbers and you pressed into the numbers, but you're not actually assessing the tissue.
• 17:26
  Speaker 1: And if you were actually assessing the tissue, you would place your finger on the area, you would then press in lightly.
• 17:31
  Speaker 1: You would see if it moves around at all.
• 17:34
  Speaker 1: Then it's not just one thing to see how much tissue depresses in when you poke it, you also have to see, like, what direction does it move and can it come away from the bone.
• 17:46
  Speaker 1: So, long story short is that I hate assessing that way, and, in fact, when we train people at public sanatorium, like right, so I understand that, like that's how they taught you and also you're never going to do that to a patient ever.
• 17:59
  Speaker 1: But the issue of rectal fossa, you can actually, I think the best way to assess it is to and I'll put this on Instagram mark my words, I'm going to put a picture on Instagram of how you do this.
• 18:10
  Speaker 1: But you put your your hand almost like in a C and in the shape of the letter C and you have your fourth other fingers kind of near where the glute would be and you can press your thumb.
• 18:25
  Speaker 1: You can find the ischial tuberosity.
• 18:27
  Speaker 1: You go just medial to that and then you gently press into the tissue.
• 18:32
  Speaker 1: But the real assessment piece to me is actually pulling it away from the ischial tuberosity, like towards you, and then seeing in which direction it moves the best, because you want that tissue to have, give an umphum, be able to compress back in and also move back out, because it has to expand and bulge when you're, for instance, pooing and stuff like that, so that tissue has to be mobile in all directions.
• 19:04
  Speaker 2: So one of the big things is that kind of facial distraction technique that you just described.
• 19:08
  Speaker 1: Yes, so facial distraction.
• 19:10
  Speaker 2: hey, jesse, good job I got so excited that that term, like, was even remotely applicable.
• 19:17
  Speaker 1: It is a facial distraction there's.
• 19:20
  Speaker 1: You can also treat there with skin rolling techniques.
• 19:23
  Speaker 1: But all y'all do skin rolling wrong as well.
• 19:26
  Speaker 1: I need to do like a master class on skin rolling.
• 19:28
  Speaker 1: I've seriously never had a clinician come in and do skin rolling the way that I think it should be done.
• 19:34
  Speaker 1: So you can do a form of skin rolling in there, you can do facial elongation, you can do tack and stretch with you when you're moving your hip, you can do penile nerve glides through there.
• 19:44
  Speaker 1: You can do all kinds of cool stuff.
• 19:46
  Speaker 1: All to help to increase blood flow, circulation, facial mobility, the ability for the tissue to tolerate compression because that's what you're sitting on and in that way the area of the ischial rectal fossa then gets more.
• 20:04
  Speaker 1: I call it kind of like more plump, more squishy.
• 20:07
  Speaker 1: It needs to be squishy when you are pressing in that region or you are assessing that tissue.
• 20:13
  Speaker 1: If it feels like it's really stuck onto the ischial tuberosity, that is not a healthy ischial rectal fossa.
• 20:22
  Speaker 2: So let me ask you this how many times have you actually evaluated somebody's IRF and it was great, it was perfect, it's rare, that is perfect so it doesn't happen that often.
• 20:34
  Speaker 2: If it did, that's what would be.
• 20:36
  Speaker 2: What you're looking for is that kind of spongy squishy not painful, totally moves, like everyone's.
• 20:42
  Speaker 1: Like what are you even doing like that kind of thing?
• 20:44
  Speaker 1: I would say this that if somebody came to me with like less than a couple of years of experience in pelvic health and said I assess their ischial rectal fossa and it's fine, I would be like let me, I need to see it.
• 20:56
  Speaker 1: I don't believe you.
• 20:57
  Speaker 1: I like literally don't believe you, because the thing is, is it's so implicated in so many diagnoses because that's where a lot of the pelvic floor is.
• 21:07
  Speaker 1: If anybody's had a perineal tear or laceration like the perineal body can be implicated with a grade two or three tear there.
• 21:15
  Speaker 1: The fact that all of your hamstrings, some of your adductors and to also attach to the ischial rectal fossa that can influence excuse me the ischial tuberosity, so that can influence the ischial rectal fossa fascia, like there are just so many things that influence that region that are implicated with other pelvic girdle issues that it's almost impossible for it to be fine if your patient has symptoms.
• 21:40
  Speaker 2: Cool.
• 21:40
  Speaker 2: So I think that is your guys' reminder to pay attention, yeah, to freaking pay attention to it, look at it, actually assess it, don't poke it.
• 21:50
  Speaker 1: And the really cool thing is that it is a great way to be able to treat the pelvic floor indirectly and it's a great way to be able to treat the pedendal nerve region also directly as well.
• 22:04
  Speaker 1: So anybody that has a pedendal nerve issues symptoms, pain with sitting, any problem with pooping and then, by extension, any problem with perineal body needing to have mobility there as well.
• 22:19
  Speaker 1: So anybody that has painful insertion on intercourse or insertibles, anything like, please assess it, look for it.
• 22:28
  Speaker 1: Anybody with hamstring dysfunction, anybody with tight inner thighs, I mean, the list goes on and on.
• 22:33
  Speaker 1: So please put this as a top priority in your assessment.
• 22:37
  Speaker 1: If I am running late with a patient and I am like biggest bang for my buck, what do I want to treat today?
• 22:45
  Speaker 1: It's the IRF.
• 22:47
  Speaker 2: So what's the challenge for everybody tomorrow?
• 22:49
  Speaker 2: You've talked about the IRF.
• 22:51
  Speaker 2: You've talked about the importance of it.
• 22:52
  Speaker 2: What do you want people to actually go and do?
• 22:55
  Speaker 2: If you're sitting there saying, ooh, that sounds a little bit like me, I might blow past that, or that's not something I routinely evaluate and treat.
• 23:01
  Speaker 1: I don't care what your patient is coming in for.
• 23:03
  Speaker 1: I want every single person on every single patient that they see the day you listen to this podcast or the next day to assess the fascial mobility, especially fascial distraction, of the IRF in multiple positions.
• 23:20
  Speaker 2: For every patient.
• 23:21
  Speaker 1: Yes, I do not care what they're coming in for.
• 23:24
  Speaker 2: Guys, there you have it.
• 23:25
  Speaker 2: That's your challenge.
• 23:26
  Speaker 2: So if you're listening to this on the day it drops, this Monday or the next day, tuesday, go through your patients, check it out.
• 23:33
  Speaker 1: And remember that healthy tissue should not be tender to palpation.
• 23:36
  Speaker 1: This is a mantra that one of my most favorite orthopedic professors when I was in PT school used to tell us, and it's holds true today healthy tissue should not be tender to palpation.
• 23:46
  Speaker 1: So, even if it doesn't directly reproduce symptoms and it's tender to palpation, it means it's not healthy tissue, which means it's not a healthy part of the pelvic floor system, and you've gotta address it.
• 24:01
  Speaker 2: So there it is.
• 24:01
  Speaker 2: There is your challenge the next day when you're doing this.
• 24:04
  Speaker 2: Take a look at that and then let us know how it goes.
• 24:06
  Speaker 2: Did you find anything surprising?
• 24:08
  Speaker 2: Did you find anything interesting?
• 24:10
  Speaker 2: We always love hearing your feedback.
• 24:12
  Speaker 2: We always wanna keep this conversation going.
• 24:14
  Speaker 1: And let's continue to rise.
• 24:16
  Speaker 1: We'll see you next time.