Latest / Pelvic PT Rising / The 'Rule of 3' with HEP

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The 'Rule of 3' with HEP · 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: Hello, my favorite time of the year it's coming up here with our CEO and rising retreats.
• 1:05
  Speaker 2: Nicole, our CEO retreat.
• 1:06
  Speaker 2: This week we've got a rising retreat.
• 1:08
  Speaker 2: In two weeks when this drops, it's go time and this is so much fun.
• 1:12
  Speaker 2: This is literally my favorite week of the year.
• 1:14
  Speaker 1: Dude.
• 1:14
  Speaker 1: For people that have been in our programs for a while sometimes, we're going to be seeing them again, but for many folks we're going to be seeing them for the first time in person, even though we've been working with them for a long time, and so I'm just really excited.
• 1:27
  Speaker 1: This coming up week is 17 bad ass female business owners doing the Pelvic Health thing.
• 1:35
  Speaker 1: It is going to be so rad.
• 1:36
  Speaker 1: And this group is extra bad ass because they're all make over $250,000 in their business, or more, which sometimes you know we don't feel like talking about the revenue part of owning a business, but it's freaking real and we shouldn't be ashamed of it, because when you kick ass then you should be able to like say that proudly.
• 1:54
  Speaker 2: Yeah, say that and then get on a plane to come out in San Clemente and have a great time, learn some business stuff.
• 1:59
  Speaker 2: So could not be more excited.
• 2:01
  Speaker 2: It honestly is at least for me to call my favorite time of the year.
• 2:05
  Speaker 2: Pelvicon is a very, very close second, but, man, this is like so much more intimate.
• 2:11
  Speaker 2: We get to actually sit down and talk.
• 2:12
  Speaker 2: It's so focused on business.
• 2:14
  Speaker 2: We get to show them our hometown.
• 2:16
  Speaker 2: Pelvicon is like a New Year's party and this is like a soiree with your closest friends.
• 2:20
  Speaker 2: So we are really pumped.
• 2:24
  Speaker 2: Nicole, here we go talking about the rule of three with HEP, and this is because it comes actually really great on the heels of Susan Clinton's talk about simplicity and about how we give people too much stuff and this is something you've been saying for a long, long time that we are overloading our people with home exercise things and we need to simplify, and so we wanted to do a whole episode.
• 2:49
  Speaker 2: It was actually kind of surprised we haven't really talked about this on the podcast that much.
• 2:52
  Speaker 2: We talk about it a lot in the accelerator program and people are always shocked when you say things about and you should be giving people three things max in their HEP program.
• 3:04
  Speaker 1: I know people like don't believe me when I say that, but you know, I just want to give a shout out to Susan Clinton.
• 3:07
  Speaker 1: If you haven't listened to that podcast yet, go back and listen to our interview with her.
• 3:11
  Speaker 1: You know it's always really cool for me when I get to interview really leaders in our field, people that have been at the forefront of pushing our field forward, and there's a bit of realization of this like convergent evolution, so like she'll say something and I'll be like oh my gosh, like yes, yes, like almost a little bit of confirmation bias a little bit, and for me it was like oh yeah, like I think that too, this is so cool.
• 3:39
  Speaker 1: We'd see that a lot when we talk about with folks.
• 3:42
  Speaker 1: We have the gift of time with people.
• 3:44
  Speaker 1: A lot of the leaders of the field are cash based business owners, and so we could see some of these through lines.
• 3:49
  Speaker 1: But one of the through lines from that came out of Susan Clinton's podcast was about keep it simple.
• 3:54
  Speaker 1: Simple in terms of education, simple of terms of giving them things to do, and I've been saying for years about how to keep it simple with giving people their quote unquote home exercise program.
• 4:09
  Speaker 2: And I very much identify with the patient on this side.
• 4:12
  Speaker 2: So I'm going to be kind of the patient doubles advocate through all of this stuff, Nicole.
• 4:15
  Speaker 2: But I think one of the things that's most helpful that you talk about is you give this hypothetical and say it's really difficult.
• 4:21
  Speaker 2: You just met somebody.
• 4:23
  Speaker 2: You don't know anything about their personality, what they're actually going to do, so if you say that it's almost impossible to give them the perfect amount of HEP on day one, then you really have two options You're going to give them too little or you're going to give them too much.
• 4:36
  Speaker 2: So which of those would you rather do?
• 4:39
  Speaker 2: So, Nicole, like what happens if you give a patient too few things to do after their initial evaluation or early in their plan of care.
• 4:45
  Speaker 1: Yeah, I mean, if you give them too few things to do, like nothing bad happens.
• 4:51
  Speaker 1: The worst thing that can happen is that they come back and they're like hey, doc, I need more stuff.
• 4:58
  Speaker 1: That was super easy for me, please load me up with more things to do.
• 5:04
  Speaker 1: That, I think, would be a good thing if you actually have people coming back to you saying like, hey, I actually need more things.
• 5:11
  Speaker 1: I love doing this, I want more.
• 5:14
  Speaker 1: I had more time than I thought.
• 5:16
  Speaker 1: All of that would be freaking great.
• 5:19
  Speaker 1: I cannot see a downside of giving too little stuff, and I think here we're going to talk a little bit as we go through the podcast about if we give somebody too little of things to do.
• 5:31
  Speaker 1: We may not make as big of changes as we think we should be making, but the reality is that making changes in someone's symptoms is a longer period of time, and so that's fine.
• 5:44
  Speaker 1: We need to get to know them a little bit more and we need to just get them less.
• 5:50
  Speaker 2: Okay, so conversely, then what happens if you give somebody too much stuff?
• 5:54
  Speaker 2: And I've been on the patient end of this, so I know the answer but what happens if you give somebody too much on early in the plan of care on day one?
• 6:01
  Speaker 1: I mean they're going to come back.
• 6:02
  Speaker 1: They may lie to you saying that they actually did it when they didn't.
• 6:05
  Speaker 1: They're going to be maybe, conversely be frustrated because they tried to get it all in and they couldn't, so they feel like a failure.
• 6:11
  Speaker 1: There's a lot of negative things that can happen from giving somebody too much stuff to do.
• 6:16
  Speaker 1: Big time thing for somebody in pelvic pain.
• 6:19
  Speaker 1: You could flare them.
• 6:21
  Speaker 1: They could actually come in with their symptoms being worse because you can do too much of a good thing with people in pelvic pain especially.
• 6:29
  Speaker 2: And I've been as a patient.
• 6:30
  Speaker 2: I've just stopped coming back because I knew that.
• 6:33
  Speaker 2: I mean, I literally went to somebody who I know is a brilliant ortho person.
• 6:38
  Speaker 2: You know, nicole, like you recommended and said, this person is like absolutely like the top of the line.
• 6:44
  Speaker 2: They're trained at all these crazy techniques.
• 6:45
  Speaker 2: Go see this person.
• 6:48
  Speaker 2: I literally I walked out and I had 22 things to either read, watch on YouTube or do and I didn't go back.
• 6:57
  Speaker 2: I did not want to sit there and talk about why didn't you do these things.
• 7:02
  Speaker 2: I was like because I have a fucking job, because I have things to do, because I don't want to sit there on YouTube and watch this thing that you sent me.
• 7:12
  Speaker 2: I mean, like I didn't want to go back.
• 7:14
  Speaker 2: I was that much of a and not because the person was super nice and I know the guy personally and all the things, but it was like man, that was a lot, and it doesn't feel great to go back and say like, wow, I didn't do any of the things that you told me.
• 7:26
  Speaker 2: It takes like somebody who's got a lot of I don't know confidence, something that I don't have to want to go back and do that.
• 7:32
  Speaker 1: Yeah well, I just want to also point out, too, that the scenario from the patient end if you give them too many things, what other things can you be communicating without realizing it?
• 7:46
  Speaker 1: It's inadvertently communicating to them that I don't really need to see you again until you do all these things, even though we all know that's not actually true and we can sit here until we're blue in the facing, like, oh, I'll meet patients where they are and it's okay, it's just a starting point and it's okay to fail and all that stuff, but don't set them up to fail.
• 8:07
  Speaker 2: Yeah, because it's not okay to fail, like I don't care if somebody tells me it's okay to fail.
• 8:11
  Speaker 2: That actually makes me feel worse about failing, like that's human.
• 8:15
  Speaker 2: Yeah.
• 8:16
  Speaker 2: So the point, I think the point is with all of this.
• 8:19
  Speaker 1: Right is that there is no Goldilocks number for each patient of how many things they're gonna be for an HEP, and so you're going to give them either too little or too much, and so we want to err on the side that's going to be less problematic.
• 8:36
  Speaker 2: Yes, and that, colin, just so I know you've had a long, 20-year almost career in pelvic health.
• 8:42
  Speaker 2: How many times have you had a patient come back and be like mad or frustrated that you didn't give them enough stuff to do at home?
• 8:50
  Speaker 1: I mean literally never.
• 8:52
  Speaker 2: I mean seriously like never.
• 8:54
  Speaker 1: Like literally never.
• 8:55
  Speaker 1: I cannot remember a time when somebody was like irritated at that, if anything.
• 8:59
  Speaker 1: They come back like super proud and they want, they're like almost gloating, like oh, I did all these things.
• 9:07
  Speaker 1: I did it 15 times actually.
• 9:09
  Speaker 1: I had way more time to do it.
• 9:09
  Speaker 1: In fact, I did all of these other things too.
• 9:12
  Speaker 1: So give it to me.
• 9:14
  Speaker 1: I want to get better, faster, that kind of stuff.
• 9:17
  Speaker 2: So I think begs the question then, like if that's really our setup there, if you're going to give either too few or too many and too few is much better than giving too many I feel like we get this all the time, Like I see this in the mentorship groups, I see it all things.
• 9:32
  Speaker 2: Why is it?
• 9:33
  Speaker 2: Our bias is always to do too much.
• 9:35
  Speaker 2: It always is.
• 9:37
  Speaker 2: We've never worked with anybody, either clinically or in business mentorship, and said wow, you really need to step up your HEP game.
• 9:45
  Speaker 2: That was pretty shy.
• 9:47
  Speaker 1: That's certainly why you're having people not come back.
• 9:49
  Speaker 1: That's why you're having drop offs is that they didn't give them enough things to do at home.
• 9:54
  Speaker 1: That just doesn't happen.
• 9:55
  Speaker 1: So why do we do this?
• 9:57
  Speaker 1: Why do we try to do the most all the time, even when we know deep down that that patient probably isn't going to do it and might not do it great and it might cause an issue?
• 10:11
  Speaker 1: I really think that it has something to do with us wanting to provide so much value, like someone's going to great our PT appointment by how many things they left with on a piece of paper, and we just know that's not true.
• 10:28
  Speaker 1: But I feel like we do that because we're trying to provide more value.
• 10:33
  Speaker 1: If you're in a cash base setting, you might do this because you are uncomfortable with your price and, honestly, if you do this in an insurance space setting, you might just still try to over deliver or make up for the fact that you work in a shitty system or that your patient won't be able to see you for a couple of weeks or something like that.
• 10:50
  Speaker 1: You're basically trying to do too much because you're trying to add value for the patient, which isn't inherently a bad trait that you're having.
• 11:00
  Speaker 2: You're trying to do a good thing, but I want this podcast to bring you what that might be doing inadvertently, I think that also gets back to something that I think permeates the whole field, and maybe this is an insurance based thing or something coming from physical therapy school.
• 11:17
  Speaker 2: But you want to fix people fast.
• 11:20
  Speaker 2: You want to get them out of your office.
• 11:21
  Speaker 2: There's an unwritten soundtrack that's underneath that undergirds almost all of the pelvic rehab community that the better you are, the faster you get people.
• 11:31
  Speaker 2: Better that you got to get them out of your office to get to work yourself out of a job.
• 11:35
  Speaker 2: You don't want to over utilize services.
• 11:36
  Speaker 2: It's so expensive.
• 11:38
  Speaker 2: You don't want to get dependent patient.
• 11:39
  Speaker 2: All of that stuff.
• 11:40
  Speaker 1: Yeah, you don't want to create a dependent patient, you want to make them independent as possible all the time.
• 11:45
  Speaker 1: You know, we're actually I think OTs actually have a decent view about this right, because they're typically seeing people in like neuro settings for a lot of times and they know that like well, that might not be the end game, so they have a different view of the whole patient experience in some ways.
• 12:04
  Speaker 1: That I have noticed.
• 12:05
  Speaker 1: But you know, I feel like, especially in the PT world, it is kind of that orthobromentality, like let's get you back on the pitch, man, like let's go, let's do all the things as fast as we can so you don't have to be in here.
• 12:19
  Speaker 1: And really also from a insurance perspective, it's like you might only have a certain amount of visits, so we might as well pack it all in so that you don't have to come back and see me ever.
• 12:29
  Speaker 2: And I think this last reason, Nicole, is one that might cause a little bit of maybe, introspection, a little bit of push back, a little bit of yeah, but, but some of this is just your own lack of wanting to prioritize or really to commit the mental energy to really think about what's most important for that person.
• 12:51
  Speaker 1: Yeah, you know, we have on our notes here written like your own, lack of prioritization, and I'm gonna ruffle a little bit of feathers here saying that giving a lot of exercises or too many things for somebody to do is actually can in certain instances actually be a form of laziness, because we're not being discerning about what we give people at that period of time in their plan of care and it takes mental bandwidth to do that.
• 13:19
  Speaker 1: So if you're in a high-paced environment, if you're in an insurance setting, if you are seeing multiple people an hour like I do understand why you might click five boxes on this robust HEP system or here's 10 things or if you can't see your patient again until for six weeks, then I understand the impetus to do that.
• 13:46
  Speaker 1: But I do think it is a lack of prioritization for whatever reason that may be for you, if it's just like a lack of focus, if it's a overwhelm in other areas of your life or your job, or if you just freaking, don't know.
• 14:03
  Speaker 1: I see this a lot with newer clinicians as well.
• 14:07
  Speaker 1: They're just like you know, in my handout of that Herman Wallace gave me, it's like these four things for quote unquote pelvic floor down training.
• 14:15
  Speaker 1: So do happy baby deep squat, child's pose and breathing and it's like right.
• 14:21
  Speaker 1: But which one of those things is most important for that patient right now?
• 14:26
  Speaker 1: And if they can only do one thing, which one would be the most appropriate?
• 14:30
  Speaker 2: And this always goes back I love this phrase that your dad uses that we're totally stealing.
• 14:36
  Speaker 2: But everybody knows, nobody does.
• 14:38
  Speaker 2: I feel like all of us know and have enough knowledge, like there is so many things that we could all do to be better with our health.
• 14:48
  Speaker 2: Right, we can eat more broccoli, we can be having supplements, we could lift weights or do aerobic exercise or lose weight or sleep better or drink less or stop smoking or all of those different things, or drive the speed limit, nicole.
• 15:03
  Speaker 1: I do have a bit of a lead foot.
• 15:04
  Speaker 2: Right.
• 15:05
  Speaker 2: So, but we all know that those things are like objectively, like there's ways that we can, but where's the priority?
• 15:12
  Speaker 2: Like we all know all of that stuff and we never do any of it.
• 15:15
  Speaker 2: Right, where I'm having a pizza tonight instead of the broccoli?
• 15:18
  Speaker 2: Right, because it's not the priority.
• 15:21
  Speaker 2: And so I think that's a really interesting point to that, and whether it's because you're not really sure or because you don't have the time with the person to sit there and like really think about the priorities, I think that's just an interesting thing of like, oh, here's like the smorgasbord of all the things you could do to get better, but we don't, as humans, do well with that.
• 15:42
  Speaker 1: Never.
• 15:42
  Speaker 1: We never do well with that and, honestly, like you can think of like a postpartum mom, like coming back with 15 things to do, I would be like buy like never coming back, see, yeah, especially if you don't have kids yourself and you're giving me stuff to do.
• 15:58
  Speaker 1: I cringe at when before I got really good at this when I was like 25 and being like you should totally do this and also be on time to your appointment, and all of the unrealistic things that we ask of our postpartum moms that are just barely able to like get out of the damn shower that day within a wake window, to like hurry up and feed and pump and get back home and all the things like this is not the time to be bombarding anybody and you're not doing anybody any favors by doing that, and so I really want you to reflect on.
• 16:31
  Speaker 1: If it's not any of those things that we said before, if it's not because you think we need to fix people fast, if it's not because you're feeling like you need to provide value, if it's not any of those things I really want you to reflect on, maybe it is this lack of being able to, for whatever reason, prioritize things in a meaningful way to your patient.
• 16:54
  Speaker 2: You know, and I wonder, nicole and this is just kind of a total supposition here but I feel like, with the orthopedic background, do you feel like this comes it trickles in from like ortho bro culture where, if you really think about like the majority of your guys's patient population, it's either postpartum moms or people in chronic pelvic pain?
• 17:14
  Speaker 2: This is not the young athlete who's got a sprained ankle who you can say like, hey, here's all the different things like you do want to get like.
• 17:23
  Speaker 2: I remember when I was an athlete and that's like forever ago, and I wanted to get back playing basketball, I was like, yeah, I would have fricking spent four hours a day.
• 17:30
  Speaker 2: I had nothing else to do.
• 17:31
  Speaker 2: I didn't have a girlfriend, clearly.
• 17:33
  Speaker 2: I mean, look at me like I had enough, no better things to do.
• 17:36
  Speaker 2: Do you feel like it trickles in from ortho or do you feel like it's a like an industry, public, pt wide thing?
• 17:43
  Speaker 1: I don't know.
• 17:43
  Speaker 1: I think it might be a combination that we are like people pleaser over.
• 17:47
  Speaker 1: I really do feel like it has to do with like wanting to just over deliver and wanting and almost to being like so excited about all the things we have to offer somebody.
• 17:58
  Speaker 1: We honestly I think sometimes to our detriment get overly stoked on the pelvic floor in front of our patient and they're like Wow, these people are like really into this and I just like want to not leak I don't necessarily want to know about my poop right now and like how I need to also use a squatty potty and how I also need to eat more broccoli Sorry, Michelle lions and like all of this stuff.
• 18:23
  Speaker 1: Right, it's just like and this is the other question that I ask, and I make all my PTs do this too but like if you never saw this person again, what would you want them to leave with?
• 18:35
  Speaker 1: What would you want them to do every single day for the rest of their life?
• 18:40
  Speaker 1: That's the kind of prioritization that I want you to think about when you're prescribing this stuff, and a prescription is exactly that.
• 18:48
  Speaker 1: It's like why we have a doctor.
• 18:51
  Speaker 1: It's you're prescribing a certain dosage and type of essentially movement medicine, and that's important, and it's not something that we should just be like, because if we went to the doctor and we got 17 pills, Then we would also be like, wow, I don't know if I want to take all these things right.
• 19:11
  Speaker 1: We would be like, let me go look these things up, I'm not sure what I'm putting in my body, and we would make an excuse to not do that.
• 19:18
  Speaker 1: And so what are we really doing when we're prescribing, over prescribing movement medicine in this scenario?
• 19:26
  Speaker 1: Well, we're making our people think about what they're doing and feel like a failure and then making decisions that they don't know as much about because we've not done a good job of discerning it for them.
• 19:39
  Speaker 2: Yes, you are forcing them to be the one who prioritizes because you don't have as a patient, speaking as a patient, you don't have the ability or time or motivation or whatever it is to do all of those things.
• 19:51
  Speaker 2: Well, guess who now is making the prioritization choice?
• 19:54
  Speaker 2: I'm going to do this because I like that exercise.
• 19:56
  Speaker 2: Or I'm not going to do that one because it makes me sit on the floor and I don't like doing that.
• 20:01
  Speaker 2: Or you gave me this one and it requires a band.
• 20:04
  Speaker 2: Well where am I going to get a fucking band?
• 20:06
  Speaker 2: I don't know.
• 20:06
  Speaker 1: That seems like a pain and she gave it to me and now it's in the car and I don't know where it is and all the things you guys Like.
• 20:12
  Speaker 1: I really want you to take a deep introspective look about that last piece that we're just talking about that prioritization part.
• 20:21
  Speaker 2: So the rule of three, nicole, three things Max.
• 20:25
  Speaker 1: Yes, this is the first of the three rule of threes.
• 20:28
  Speaker 1: It's three exercises, things to do, max, and note that it's not all exercises, it's not all stretches, it's three things total to do.
• 20:43
  Speaker 2: So if a bladder diary is in there that's one, that's one thing.
• 20:46
  Speaker 2: If a bladder and bowel diary is in there, is that two?
• 20:48
  Speaker 2: Well, that's a whole other conversation.
• 20:51
  Speaker 1: I never give somebody.
• 20:52
  Speaker 1: This is actually going to be a hold on their podcast, if you'll.
• 20:54
  Speaker 1: I never give just a bladder diary.
• 20:56
  Speaker 1: It's like if I'm going to make somebody do that, they need to do all of it.
• 21:00
  Speaker 1: I want to know what's going in, what's coming out.
• 21:01
  Speaker 1: What are you drinking, what are you eating, what are you pooping?
• 21:05
  Speaker 1: What are you peeing?
• 21:06
  Speaker 1: What are you doing like literally activity-wise, like I'm doing all of it.
• 21:10
  Speaker 2: So that might be the only thing yeah, then at that point it's three max, it's not three minimum people.
• 21:17
  Speaker 1: I'm saying three things Max.
• 21:21
  Speaker 2: And now, as you progress, somebody.
• 21:22
  Speaker 2: So just so I understand that a little bit, so like you might finish initial evaluation and make it a little bit more.
• 21:26
  Speaker 2: Maybe this is visit two and you send me home with three things to do.
• 21:31
  Speaker 2: What happens when I come back at visit three and then visit four?
• 21:35
  Speaker 2: Is it escalating three things?
• 21:38
  Speaker 2: So at visit two I got three, and then at visit three I get three more, so that's six, and then at visit four I get three more, so that's nine, and we're talking about this like logarithmic growth of things to do.
• 21:51
  Speaker 2: Is it just that you need to see people long enough so you can give them the 28 things you want to do?
• 21:55
  Speaker 1: No, no, it is never that I'm like looking at it, I just like got so mad when it's like no, it's not that either.
• 22:04
  Speaker 1: It's literally what are the three main things for you to focus on at this point in your plan of care Period?
• 22:12
  Speaker 1: It's not three extra things on top of the three things that you're already doing.
• 22:16
  Speaker 2: So a new idea you take away something else.
• 22:19
  Speaker 1: Yeah, a lot of times, unless someone really comes back to me, and I'm really sure and this only happens after like months if they've really loved something that I've given them and they have adopted it into their daily routine without me even having to say anything If somebody has adopted that into their like.
• 22:40
  Speaker 1: So a good example of this is if someone has picked up what I am putting down about meditation and I've taken the time to figure out what they like about it, helped them pick the app that they want to do it.
• 22:53
  Speaker 1: I've given them five minutes a day.
• 22:55
  Speaker 1: Do that.
• 22:56
  Speaker 1: They come back and they're like oh my gosh, you know what?
• 22:58
  Speaker 1: I searched around and I did a five minute one, and then I did a 10 minute one, then I did a 30 minute one and, oh my gosh, this is so amazing.
• 23:04
  Speaker 1: It's helping my symptoms and everything, and now I don't even have to ask if they're doing it.
• 23:09
  Speaker 1: I know that they have now made meditation a part of their daily routine.
• 23:13
  Speaker 1: That I feel like can graduate off of my three list of things to do, and then we go to a different thing.
• 23:21
  Speaker 2: Because it's just assumed at that point that they're doing it.
• 23:24
  Speaker 2: But generally speaking, again, that's only after months.
• 23:27
  Speaker 2: So if something comes onto the list of three, then something has to go off.
• 23:31
  Speaker 1: Yeah, because they're progressing in some way, like yes, yes, it's like we're progressing.
• 23:37
  Speaker 1: Their list of three, as they're progressing or regressing, if in the case of a flare, right, if it's something that you know, I had bridges, single limb bridges on there one time and it's like now they're in a flare state.
• 23:50
  Speaker 1: Well, that week, guess what they're not going to do?
• 23:53
  Speaker 1: That that week they're going to focus on three things of their flare busting plan, like you don't just get to add on.
• 24:00
  Speaker 2: Yes, so rule of three is three things max.
• 24:03
  Speaker 2: Second thing we want to talk about also has three things in it.
• 24:06
  Speaker 2: Those each of those three should be DMR doable, manageable and relatable.
• 24:12
  Speaker 2: Nicole, what do you mean by that?
• 24:13
  Speaker 1: Okay.
• 24:13
  Speaker 1: So they should be doable and this should go without saying, but I'm going to say it anyways.
• 24:18
  Speaker 1: You cannot ask your patient to do something that they're physically incapable of doing, Right.
• 24:24
  Speaker 1: So, for instance, if you give or giving somebody nerve glides and they don't have that range of motion in their nerve because you haven't been able to take the time to give them that range of motion, then you can't give them nerve glides Right.
• 24:39
  Speaker 1: It's not like oh, you have sciatic nerve irritation and hamstring tightness here, Do these nerve glides?
• 24:45
  Speaker 1: It's like no, that's a relatively advanced thing to do.
• 24:48
  Speaker 1: So you have to make sure that they have the physical capability to do what you're asking them to do.
• 24:54
  Speaker 1: This also goes in this doable category.
• 24:58
  Speaker 1: You have to make sure that they have the equipment, like the physical equipment space you're having them do.
• 25:04
  Speaker 1: So if you're showing them in your session to do something on a yoga mat, then you need to also ask them A, do you have a yoga mat?
• 25:14
  Speaker 1: Or?
• 25:14
  Speaker 1: B, do you have a place to do yoga, A place in your house where you feel like you could do this comfortably?
• 25:18
  Speaker 1: And if they say sure, I can do it on my bed, is a bed an appropriate place to do pelvic tilts, for instance?
• 25:26
  Speaker 1: No, it's too soft, Like whatever it is like.
• 25:29
  Speaker 1: You need to just make sure that you're breaking it down into the doable part and making sure that they're able to replicate what you want them to replicate Well at home and now manageable.
• 25:42
  Speaker 2: So that's the, d is doable, m is for manageable and that's really mostly Nicole, related to time Right.
• 25:47
  Speaker 1: Yes.
• 25:48
  Speaker 1: So I want you all to be asking your people the next question of when do you think you're gonna be able to implement this Right?
• 25:58
  Speaker 1: I'm gonna give you three things.
• 26:00
  Speaker 1: Let's talk about your daily routine.
• 26:02
  Speaker 1: When are you gonna do this meditation?
• 26:05
  Speaker 1: When are you gonna do this happy baby stretch?
• 26:07
  Speaker 1: When are you gonna do the bladder diary?
• 26:10
  Speaker 1: Are you going to take it with you to work?
• 26:12
  Speaker 1: What?
• 26:13
  Speaker 1: Where do you work?
• 26:14
  Speaker 1: To you, you know, is this gonna make you feel uncomfortable if you have to do it in a public bathroom?
• 26:18
  Speaker 1: All of the stuff, like.
• 26:21
  Speaker 1: I want you to make sure that it's manageable with Time, and so sometimes that means this is where the three maximum comes in.
• 26:29
  Speaker 1: If one thing is going to take up a lot of time, or you want to spend a lot of time on one thing, then they only get one or two, and that's totally fine.
• 26:40
  Speaker 1: Guess why?
• 26:41
  Speaker 1: Because it's targeted and it's discerned by you to be Important for them to be doing this at this time.
• 26:49
  Speaker 2: So doable, manageable, and then the R is for relatable Nicole.
• 26:54
  Speaker 2: What does this mean?
• 26:55
  Speaker 1: We have to make it relatable to their symptoms.
• 26:57
  Speaker 1: So if I'm giving somebody a figure four stretch for their glute, I Need them to understand what my thought process is in layman's terms, in simple One or two sentences.
• 27:16
  Speaker 1: Why do we care about this muscle that we're stretching as it relates to their insert, blank incontinence, prolapse, pelvic pain, like we have to make it relatable to the symptoms.
• 27:32
  Speaker 1: And so Another really great example of this is when I'm doing internal on somebody and I'm doing my bimanual techniques and I'm like slacking an area and I feel a release in the pelvic floor and I'm like, oh, my gosh, okay, cool, I like make a big deal about it to the patient.
• 27:47
  Speaker 1: I was like, when I have you Do an inner thigh stretch or that's what we're gonna do here, right, as soon as we're done with this internal portion, I want you to remember this right here.
• 27:58
  Speaker 1: I want you to remember then, when I press here without slacking me the inner thigh muscle, it feels like this Tell me what it feels like.
• 28:07
  Speaker 1: Oh, it makes me feel like I have urgency.
• 28:09
  Speaker 1: It makes me feel like I'm that bladder symptom.
• 28:12
  Speaker 1: I'm like, cool, if I slack your adductor or your inner thigh muscle and now I do that same exact thing.
• 28:18
  Speaker 1: What happens?
• 28:18
  Speaker 1: It goes away.
• 28:19
  Speaker 1: I can't even see it.
• 28:20
  Speaker 1: Feel your finger in there.
• 28:21
  Speaker 1: I'm like great, that is what I want you to remember when you're doing this inner thigh stretch that I'm gonna give you when we get off the table here.
• 28:30
  Speaker 1: Right, you make it relatable to their bladder symptom so that when they're doing their inner thigh stretch, they're actively thinking about reducing their urgency and I would say, as a patient, simplifying that you guys have the curse of expertise Right.
• 28:46
  Speaker 2: You guys all have, for the most part, doctorates.
• 28:48
  Speaker 2: You guys been doing this for a long time.
• 28:49
  Speaker 2: You guys are smart, brilliant people and us as patients are not smart and brilliant when it comes to the body and the Relationships among the body.
• 28:58
  Speaker 2: So we actually had an experience where I had a ortho PT.
• 29:02
  Speaker 2: I was trying to get some help with some headaches and some stuff in my upper neck and traps and she had me.
• 29:09
  Speaker 2: Her HEP was to do like planks and practice my breathing and I was like lady, you're looking at the wrong part of the body.
• 29:17
  Speaker 2: I asked you, it's in the back top and you you're looking at like the front middle, like we're real off here.
• 29:25
  Speaker 1: She's not listening to me, right.
• 29:27
  Speaker 2: She doesn't know, like why the hell am I doing all this like ab work?
• 29:30
  Speaker 2: I've got neck and shoulders stuff going on and I tell Nicole that and she starts laughing.
• 29:36
  Speaker 2: She's like oh yeah, that's totally related.
• 29:37
  Speaker 2: It's all about how you hold your breath, you idiot all the things say idiot.
• 29:41
  Speaker 2: You might.
• 29:42
  Speaker 1: I maybe it did.
• 29:44
  Speaker 2: It very certainly was, at least implied, right, but I had no idea.
• 29:48
  Speaker 2: I literally was given this HEP and I had no idea why I was doing it, even though she was Totally right.
• 29:55
  Speaker 1: Totally, I want you guys to practice this, right, like I want you to practice.
• 30:00
  Speaker 1: Why would you give someone an inner thigh stretch for urgency, right?
• 30:04
  Speaker 1: How would you explain that to somebody?
• 30:05
  Speaker 1: Your bladder talks to your inner thighs, your inner thighs talks to your bladder.
• 30:09
  Speaker 1: When your inner thighs are happy, your bladder is happy, right?
• 30:14
  Speaker 1: So, like that's it, like it's that, and is that oversimplified?
• 30:17
  Speaker 1: Sure, do patients give a shit?
• 30:19
  Speaker 1: No, they don't.
• 30:21
  Speaker 1: They just need, I just need them to know that they're not doing the inner thigh stretch.
• 30:26
  Speaker 1: Just because I need them to know that, it's because I really feel like this is connected to their urgency and that is why we're having them do it.
• 30:35
  Speaker 1: So it's relatable.
• 30:36
  Speaker 1: So it's doable, it's manageable with time and it's relatable to their symptoms.
• 30:41
  Speaker 1: Dmr.
• 30:42
  Speaker 2: All right.
• 30:42
  Speaker 2: So last thing here, Nicole and we get this question a ton often in the entrepreneur group is what HEP system are you using?
• 30:52
  Speaker 2: What library, what batch of videos?
• 30:55
  Speaker 2: And this drives you batch I just batch it crazy.
• 30:58
  Speaker 1: I am such an absolute psycho and these questions come up in whatever group I'm listening to, because I'm like it's literally nothing.
• 31:07
  Speaker 1: It's like a fucking post-it note or a piece of paper or a video on the phone or a handout.
• 31:14
  Speaker 1: That's simplified.
• 31:15
  Speaker 1: We could just circle something like you don't need something that is so Complex and or even exhaustive.
• 31:24
  Speaker 1: It's like it's you're picking three things at a time.
• 31:27
  Speaker 1: They should go on a half a sheet of paper.
• 31:30
  Speaker 1: We actually created at pelvic sanity a you know decent-sized post-it note thing that literally has three boxes, that it numbered one, two, three, that's it.
• 31:40
  Speaker 1: I just write what they need to do for the week of whatever it is and it's like number one blank.
• 31:47
  Speaker 1: Number two blank, number three.
• 31:49
  Speaker 1: Sometimes I'm writing an X in that section like, oh cool, we made it to the time.
• 31:53
  Speaker 2: We only have to do two things this week but, nicole, what happens if you finish the first three and then you've got one of the One to add?
• 32:00
  Speaker 1: you don't add it, you freaking prior, or you decide if it's like that fourth thing You're really toying with it, then this is the thing it helps you to prioritize.
• 32:09
  Speaker 1: If, number four you're really having a hard time, then Do an experiment and be like do I have that same feeling with number one?
• 32:19
  Speaker 1: And if you don't, then swap number one for number four and you have equals three again.
• 32:25
  Speaker 2: That's it, guys.
• 32:26
  Speaker 2: That is the rule of three.
• 32:28
  Speaker 2: So you don't need a super complex system, you don't need to pay a whole bunch of money, you definitely don't need to spend hours and hours recording videos that you're gonna create in a library for your people.
• 32:40
  Speaker 2: I can tell you, as patients, we do not care, we are not going to watch it, we have no interest in that at all.
• 32:47
  Speaker 2: And getting back to that rule of three, three things max.
• 32:51
  Speaker 2: That can evolve, that can change and it should evolve and change, right, nicole?
• 32:56
  Speaker 1: Thousand percent.
• 32:57
  Speaker 1: It should evolve and change.
• 32:58
  Speaker 1: It's the same three things through the whole plan of care.
• 33:00
  Speaker 1: We have another problem for another podcast, right?
• 33:02
  Speaker 2: but that's it, guys.
• 33:04
  Speaker 2: So the rule of three for HEP.
• 33:06
  Speaker 2: I hope this simplifies things for you.
• 33:08
  Speaker 2: If you have any questions about this, please reach out.
• 33:10
  Speaker 2: We are so appreciative of you guys.
• 33:12
  Speaker 2: Would love if you guys have a minute to drop a review.
• 33:15
  Speaker 2: Let us hear how you guys are enjoying the podcast.
• 33:17
  Speaker 2: It makes us feel good.
• 33:18
  Speaker 2: It helps other people find the podcast.
• 33:20
  Speaker 2: We will probably read it on air all of the good things.
• 33:24
  Speaker 2: So appreciate every single one of you guys who's listening.
• 33:26
  Speaker 2: Please reach out.
• 33:27
  Speaker 2: Let us know we always want to keep this conversation going and let's continue to rise.