Latest / The Driven Athlete / Pelvic Health & Physical Therapy with Dr. Tori Mallow | Ep 29

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Pelvic Health & Physical Therapy with Dr. Tori Mallow | Ep 29 · The Driven Athlete

• 0:00
  Speaker 1: If you're a driven, active person who wants to reach and pursue a higher quality life with some ambition, then guess what this podcast is for you.
• 0:07
  Speaker 1: This is the Driven Athlete Podcast.
• 0:10
  Speaker 1: What's up?
• 0:13
  Speaker 1: Y'all?
• 0:13
  Speaker 1: It's your man, dr Kyle.
• 0:14
  Speaker 1: Welcome back to the Driven Athlete Podcast.
• 0:15
  Speaker 1: We've got a really cool guest with us again today, dr Tori Mallow.
• 0:19
  Speaker 1: She is a pelvic floor physical therapist, specialist in the field and she has a practice down in South Delray, north Boca.
• 0:28
  Speaker 1: Is that correct?
• 0:28
  Speaker 1: That's correct, but tell us more about what exactly you do and where you're at, about your company.
• 0:35
  Speaker 2: Sure.
• 0:35
  Speaker 2: So I am, like you said, a pelvic floor specialist.
• 0:39
  Speaker 2: So the vast majority of what I help people with is pelvic floor dysfunction.
• 0:43
  Speaker 2: Of what I help people with is pelvic floor dysfunction.
• 0:47
  Speaker 2: What that means is I see people that deal with pelvic pain conditions, bladder dysfunction might be incontinence or difficulty urinating, bowel dysfunction.
• 0:54
  Speaker 2: We also see, you know, low back and hip pain thrown in the mix.
• 0:58
  Speaker 2: Usually there's a lot of overlap.
• 1:00
  Speaker 1: Yeah, a lot of interplay.
• 1:01
  Speaker 2: Definitely.
• 1:02
  Speaker 2: But yeah, I opened Restore in 2020 to give people like a designated um or dedicated space just for pelvic floor um rehab and, like you said, we're we're technically in Delray, we're on the border of Boca, um, and yeah, I love it, so that's my favorite thing, when in 2020, that had to have been rough.
• 1:22
  Speaker 2: Yes, it was December 2020.
• 1:24
  Speaker 1: Okay, all right, so tail end of all the craziness.
• 1:28
  Speaker 2: Yes, it was uh when we all thought that things were going to be squashed, and then they weren't.
• 1:33
  Speaker 2: So, um, we I opened uh in a small space in Boca, within five months, moved to a larger space that's technically now in Delray, and been doing great ever since.
• 1:45
  Speaker 1: That's awesome.
• 1:46
  Speaker 1: Um, what so I understand?
• 1:49
  Speaker 1: I mean, pelvic floor is definitely a unique niche specialty.
• 1:52
  Speaker 1: Um, it's somewhat rare to find it's purely dedicated space just for that.
• 1:57
  Speaker 1: It's getting more popular, more awareness being brought to the table of like oh, I don't have to live like this for the rest of my life.
• 2:02
  Speaker 1: They're like this is a thing that people seek help for, cool Right.
• 2:06
  Speaker 1: Do you hear that a lot from your patients?
• 2:08
  Speaker 2: Absolutely.
• 2:09
  Speaker 1: Like wait, you got you do this.
• 2:10
  Speaker 1: Or like well, I can get helped from this.
• 2:12
  Speaker 2: Oh yeah, people, people are under the misconception that because of age, because of childbirth, because of menopause or whatever, that that this is just normal.
• 2:22
  Speaker 2: Whether it's a bladder, you know issue, pelvic pain issue, um, you know, one common thing is oh, I've had kids so I can't ever jump on a trampoline again.
• 2:32
  Speaker 2: We're like no, um, in fact, I have a trampoline in my office just for that reason.
• 2:35
  Speaker 2: Um, so, yeah, it's dispelling a lot of myths that have been kind of passed down generation to generation, um, and getting awareness out there.
• 2:44
  Speaker 2: Yeah.
• 2:44
  Speaker 1: So that's cool.
• 2:45
  Speaker 1: We'll be like see that trampoline over there, like we're going to be on that in a couple months.
• 2:47
  Speaker 1: We know no way, no, we can't.
• 2:48
  Speaker 1: Yeah, totally.
• 2:49
  Speaker 1: I'm sure they see other people jumping on it Like can I, can that be me?
• 2:54
  Speaker 2: Yeah, when they come in, they're a little skeptical.
• 2:55
  Speaker 2: They're like what's the trampoline?
• 2:57
  Speaker 2: Forite of passage, and you know, as they're making their way through their plan of care and getting ready to exit therapy and be on their own for self-management, I'm like, hey, let's jump on the trampoline.
• 3:12
  Speaker 2: They, they do it.
• 3:12
  Speaker 2: And they're like I can't believe I'm doing this.
• 3:14
  Speaker 2: That's cool, it's a cool graduation send off task.
• 3:18
  Speaker 1: That's a.
• 3:19
  Speaker 1: That's really cool.
• 3:20
  Speaker 1: Um, with all that being said, um to clarify or just bring more awareness to it, what message would you convey to people who are like, basically what you're saying right, um, I thought this was like normal, I had kids, or like, uh, incontinence, menopause, all these things that contribute.
• 3:37
  Speaker 1: What message would you want to convey to people who are contemplating this stuff?
• 3:43
  Speaker 2: Yeah, Just to know that there are people who specialize in this and you don't need to live with these symptoms, whether it is something like bladder leakage, even fecal incontinence, you know these are things that people don't talk about.
• 3:55
  Speaker 2: You're not going to see someone in the grocery store with depends and be like, oh, you pee your pants as well, Like me too Whereas you see someone out there with a knee brace on and you might say, oh, what happened?
• 4:06
  Speaker 2: I just had my ACL, you know, repaired last year.
• 4:08
  Speaker 2: So there are people like myself who specialize in this, who have heard it all.
• 4:14
  Speaker 2: There's no TMI.
• 4:15
  Speaker 2: We talk about pee poop, sex pain, all the things, and you don't have to live with it.
• 4:21
  Speaker 2: So you just need to find someone that knows how to treat this stuff.
• 4:25
  Speaker 1: Right.
• 4:26
  Speaker 1: Interesting Demographic wise, do you find yourself with more women, men equally?
• 4:33
  Speaker 2: So I've seen a big shift, especially over the past year, with more and more men coming into the clinic.
• 4:38
  Speaker 2: Right now our caseload is about 30 percent men More than I would have expected to hear.
• 4:45
  Speaker 2: Yeah, and it's just growing.
• 4:47
  Speaker 2: And I have to say I love working with men, especially, you know, for women.
• 4:53
  Speaker 2: A lot of us are used to seeing the gynecologist.
• 4:55
  Speaker 2: Many women that come see me have maybe had children and so they're kind of of the mindset all right, well, I've had this kind of treatment before, this kind of evaluation before Men, especially younger men who haven't, you know, reached the age of doing routine prostate exams.
• 5:13
  Speaker 2: They're like wait what?
• 5:14
  Speaker 2: But we make such huge differences for them that you know they just they're like tell me what you need me to do and I'm going to do it.
• 5:22
  Speaker 2: They're the most compliant patients ever, cool, and that's why I love working with them and helping to make them feel comfortable.
• 5:29
  Speaker 1: Yeah, I mean as a young man, right?
• 5:31
  Speaker 1: Well, compared to who you're talking with, I would consider myself a young man right.
• 5:34
  Speaker 1: I'm only 35.
• 5:35
  Speaker 1: Just a heads up everybody, I'm a dad right Business owner husband.
• 5:41
  Speaker 1: Usually a dad right Business owner husband.
• 5:42
  Speaker 1: Usually young men are very like this is the problem.
• 5:46
  Speaker 1: Okay, let's fix it.
• 5:50
  Speaker 1: What tasks need to be done to just get this done?
• 5:51
  Speaker 1: Cool, I'll do whatever you want.
• 5:52
  Speaker 1: Right Versus like, but it's just very it can be very simple of like boom, boom, boom, let's just get this thing fixed.
• 5:56
  Speaker 1: Is that what you're saying?
• 5:57
  Speaker 2: Like that's typically their mindset they're like look, I don't want to be here, this is embarrassing, like just tell me what I need to do and I'm gonna get the hell out of here.
• 6:05
  Speaker 2: Um, so that's why I love working with them.
• 6:07
  Speaker 2: They, they show up and they do the thing.
• 6:09
  Speaker 2: And you know, a lot of times the, the wives or the women, they take on the responsibility oh, the kid's got a fever, or this or that, or you know and I say this from personal experience as a woman a lot of times we put ourselves on the back burner.
• 6:23
  Speaker 2: Um, the men kind of just show up and they're, they do their thing and they're in and out, um, and of course there's variation.
• 6:31
  Speaker 2: But you know, that's one thing that I I didn't really expect or realize going into it when I started working with men, cause I did start off treating only women and now we treat everybody, um, all ages, all genders, everybody.
• 6:45
  Speaker 1: So with that being said, what typical diagnoses or issues do men come in with?
• 6:50
  Speaker 1: Be like hey, can I do you help me with this Right?
• 6:53
  Speaker 1: What, what issues?
• 6:54
  Speaker 2: So I see in general across the board a lot of pelvic pain conditions, but definitely bladder bowel stuff.
• 7:01
  Speaker 2: The interesting thing is, you know, men and women, we both have pelvic floors the same.
• 7:06
  Speaker 2: Some of the structures are oriented a little differently, but it all functions the same.
• 7:10
  Speaker 2: So the symptoms people come in with are pretty much the same.
• 7:15
  Speaker 1: Which is usually pain.
• 7:16
  Speaker 2: A lot of pain in my clinic.
• 7:18
  Speaker 2: Yeah, so a lot of testicular pain, penile pain.
• 7:21
  Speaker 2: I'll also see men that have had a history of hip pain and back pain and maybe they've been through PT and it got better, but not, you know, completely resolved.
• 7:32
  Speaker 2: And then we turn, you know, we find out that there is a pelvic floor component because there are shared structures.
• 7:38
  Speaker 2: Especially with the hip, there's nerves coming from the back to the pelvis, so that kind of fills in that gap a little bit sometimes too.
• 7:46
  Speaker 1: Um, what so, with that being said, with a pelvic floor issue?
• 7:50
  Speaker 1: Is it a muscle recruitment strength problem?
• 7:53
  Speaker 1: Um, is it a a referred pain from the, from the low back, the sacrum SI joint, like what?
• 8:00
  Speaker 1: What's usually the root cause?
• 8:01
  Speaker 2: Yeah, so that's a good question.
• 8:02
  Speaker 2: That's what everyone always asks.
• 8:04
  Speaker 2: We see a wide variety, so we see a big mix.
• 8:07
  Speaker 2: We see people that have had, again, chronic hip impingement, let's say, or labral tears, and they might muscle through and keep doing their sport or their activity and just deal with the pain for a while and eventually that leads to pelvic floor dysfunction.
• 8:23
  Speaker 2: Usually what we're seeing is the pelvic floor muscles become overactive, so they become really tight.
• 8:28
  Speaker 2: It can compress nerves, it can restrict blood flow and oxygen to the tissue, which in turn causes pain.
• 8:36
  Speaker 2: So that's one thing that we see.
• 8:39
  Speaker 2: We do see issues stemming from the back, a couple of the nerves in particular that dive through the abdominal wall.
• 8:47
  Speaker 2: We see people that keep their abdomen sucked in and tight all day long and so they're constantly compressing on these nerves, and a lot of problems with pelvic health, you know, arise over time.
• 8:59
  Speaker 2: It's like a a um cumulative effect as opposed to.
• 9:03
  Speaker 2: I landed wrong playing basketball, heard a pop.
• 9:07
  Speaker 1: Kissed my knee yeah.
• 9:08
  Speaker 2: So it's a lot of that, a lot of looking back at your history, like when did this start?
• 9:13
  Speaker 2: Let's look at how you're moving, what your day is like, all those things.
• 9:17
  Speaker 1: There's a lot of repetitive micro trauma, micro irritation that then leads to like symptoms developing and then all of a sudden it's like man, it's just not going away and it hurts, or like this is an issue.
• 9:26
  Speaker 2: Yeah, exactly, and most of the time it is an overactive issue, I should say, and that pelvic floor muscles that are guarded tense, overly recruited all the time.
• 9:40
  Speaker 2: We see and this is across the board, no matter you know who we're talking about men, women, even kids Um, but a lot of times the glutes and the hip muscles are weak for one reason or another.
• 9:47
  Speaker 2: The pelvic floor takes over, overcompensates.
• 9:50
  Speaker 2: Yeah, so it's.
• 9:51
  Speaker 2: We tend to see that side of things versus oh, your muscles are so weak.
• 9:56
  Speaker 2: Here we need to strengthen, strengthen, strengthen.
• 9:58
  Speaker 2: Usually we're trying to undo some stuff interesting and then work on the recruitment patterns of what muscles you're turning on when what you're using.
• 10:06
  Speaker 1: So if somebody Googles this stuff or like I'm having pelvic floor pain, groin pain, like oh Kegels.
• 10:10
  Speaker 2: Right, just crush Kegels.
• 10:11
  Speaker 2: That's what we see all the time.
• 10:12
  Speaker 1: And that you would say not necessarily, please, no, don't do that anymore.
• 10:16
  Speaker 2: So you know, for some people Kegels aren't going to necessarily hurt you.
• 10:20
  Speaker 2: Um, if you do struggle with some weakness, they're not the most effective or efficient way to strengthen, so they're not going to really get you where you need to be, but you know they're not going to necessarily hurt you.
• 10:32
  Speaker 2: That, I would say, is probably a smaller percentage of the population.
• 10:35
  Speaker 2: The vast majority of people have this overactive pelvic floor and in which case Kegels are going to make things worse.
• 10:41
  Speaker 2: So I tell people, just don't do them.
• 10:44
  Speaker 2: You have to know how to turn on your pelvic floor.
• 10:47
  Speaker 2: You also have to know how to relax it.
• 10:49
  Speaker 2: But it's just not.
• 10:50
  Speaker 2: It doesn't make sense, if you think about it, to sit there and do a thousand kegels a day.
• 10:54
  Speaker 2: It'd be like sitting and doing a thousand bicep curls a day to to help your elbow.
• 10:59
  Speaker 1: Yeah, it's just getting worse.
• 11:02
  Speaker 1: What the heck Right Interesting so for women?
• 11:04
  Speaker 1: Then right a lot of the stuff with men.
• 11:07
  Speaker 1: You were describing similar issues with women on the same board.
• 11:11
  Speaker 2: Yeah, absolutely.
• 11:12
  Speaker 2: We have the added layer of pregnancy, postpartum, for women specifically, and sometimes that's also really fun to treat because it's usually people coming in for happy reasons.
• 11:25
  Speaker 2: They want to prepare to have a successful pregnancy while mitigating any pain and staying strong.
• 11:31
  Speaker 2: They want to learn what do I need to focus on throughout pregnancy?
• 11:34
  Speaker 2: Or birth prep, just preparing for a vaginal delivery All that stuff's pretty fun, it's fun to do, it's usually a happy time.
• 11:44
  Speaker 2: And then we also see people that are coming in, you know, during pregnancy with already back pain, hip pain, si pain, and we can tackle that too.
• 11:54
  Speaker 1: Interesting.
• 11:55
  Speaker 1: So then, postpartum, after birth, um, what's usually the the the thing?
• 12:01
  Speaker 1: People come in with questions and stuff.
• 12:03
  Speaker 2: Usually people want to get back to exercise and activity safely.
• 12:07
  Speaker 2: Um, sometimes they are already feeling, you know, some back pain or pelvic pressure and heaviness.
• 12:14
  Speaker 2: Um, because you're sent home.
• 12:16
  Speaker 2: You're told hey, take it easy, heal and rest, especially if you've had a C-section.
• 12:20
  Speaker 2: But then they hand you this baby that's like eight, 10 pounds, pounds, whatever, and you have to take care of them as well yeah, which is a whole another.
• 12:29
  Speaker 2: I mean it's a ton yeah yeah, and a lot of these people already have, you know, a toddler at home.
• 12:34
  Speaker 2: So you're trying to heal yourself, but you also have to keep these little humans alive, so it's a lot, um.
• 12:40
  Speaker 2: So we go through you know body mechanics and ways to lift and change the baby and feed the baby, just to be easier on your own body and help with healing.
• 12:50
  Speaker 2: And then we also transition women back into whatever exercise they're trying to get at.
• 12:55
  Speaker 2: Because that's pretty much the biggest problem I see is when people rush back into things too soon.
• 13:02
  Speaker 2: Maybe they were an athlete beforehand and so they think they can jump right back in, but your body's just been through a huge trauma, essentially, whether it's cesarean or vaginal delivery.
• 13:15
  Speaker 1: Right, and also that I mean a lot of changes happen between the previous nine months.
• 13:20
  Speaker 1: You know, 11 months of time for a month afterwards and it's the whole thing is like a, a big traumatic change.
• 13:26
  Speaker 1: You know, um, interesting um.
• 13:30
  Speaker 1: For incontinence I know postpartum incontinence is a is a very common thing, right?
• 13:35
  Speaker 1: Yep, what's usually the a lot of the common issues you find with that.
• 13:39
  Speaker 2: So a big thing.
• 13:40
  Speaker 1: Yeah.
• 13:41
  Speaker 2: A big thing is pressure management and what that means is kind of relearning how to coordinate your core and you know a lot of muscles make up the core, as you know.
• 13:51
  Speaker 2: But if we're talking specifically your abdominals, how and when to turn those on, coordinating that with your breathing, because your diaphragm, your abdominals and your pelvic floor, those three things all have to work in sync together to keep you continent.
• 14:05
  Speaker 2: So a lot of times you know we're sleep deprived, we're on autopilot, we're just trying to get through the day.
• 14:12
  Speaker 2: When we are lifting the toddler in one hand and we're holding the baby in the other and trying to cook dinner, we start holding our breath.
• 14:19
  Speaker 2: Our posture suffers and that doesn't allow the diaphragm to coordinate with the pelvic floor.
• 14:24
  Speaker 2: So we go through a lot of that kind of stuff to help with bladder leakage and, you know, of course, trying to wake up those muscles again.
• 14:32
  Speaker 2: That just became, if it's a vaginal delivery, really stretched abruptly Even with pregnancy alone.
• 14:39
  Speaker 2: Before you even get to delivery your pelvic floor is having to work to combat all the pressure and the stress downward.
• 14:45
  Speaker 1: Right, totally Interesting.
• 14:47
  Speaker 1: Um, so it's not just pelvic floor, um prevention, it's like strength prevention, still in a situation that could be over, overly guarded and tight, or like just just overly intense.
• 14:59
  Speaker 2: Yeah, we'll definitely see that, especially with, like, a vaginal delivery, when all of a sudden you have to figure out how to lengthen your muscles instead of holding everything in.
• 15:08
  Speaker 2: Those muscles need to move out of the way so that your uterus can push the baby out.
• 15:13
  Speaker 2: So they go through this, you know, pretty abrupt, big stretch and then they can recoil.
• 15:19
  Speaker 2: Especially if it's a traumatic birth and you have tissue tearing and things like that.
• 15:23
  Speaker 2: They can recoil and become super tense and super tight.
• 15:27
  Speaker 2: And you know, a lot of times, if that leads to, let's say, pain, discomfort, it can trigger our nervous system and we can become a little hyper aware, a little anxious about it, and that further promotes muscle tension and guarding.
• 15:42
  Speaker 1: Right, yeah, totally, I know we have two kids right.
• 15:44
  Speaker 1: I know, Um, I mean, we have two kids right.
• 15:46
  Speaker 1: Two top two of a two year old son will be two in a month, and then my daughter's three and a half.
• 15:50
  Speaker 1: And I find myself like holding my son, who's trying to get out of my hands, and I'm like, dude, you can't run in the street.
• 15:55
  Speaker 1: Right now I'm trying to get this bag of groceries for my car, so I'm like bending over in a weird way while wrestling him Right.
• 16:02
  Speaker 1: And then I chased after my daughter like, nope, don't go in the street Right.
• 16:04
  Speaker 1: And I'm like holding her at the same time.
• 16:05
  Speaker 1: All these weird contorted bending over positions and stuff like that, and, as a taller guy, like chronic back pain as a dad makes total sense.
• 16:14
  Speaker 1: All the dad noises make total sense.
• 16:16
  Speaker 1: Now you know the automatic dad noise and you sit down.
• 16:20
  Speaker 1: Oh, it's like fine, I get a chance to rest, um.
• 16:24
  Speaker 1: So do you see a lot of dads with that?
• 16:25
  Speaker 1: Then?
• 16:26
  Speaker 1: Like a lot of, um, similar situations.
• 16:28
  Speaker 2: Yeah, yeah, it really it.
• 16:30
  Speaker 2: It's across the board.
• 16:31
  Speaker 2: We see so many of these different compensations, poor body mechanics, underutilization of their the core or the hip, and it just leads to all the same types of symptoms, no matter who you're talking about.
• 16:43
  Speaker 1: For treatment.
• 16:43
  Speaker 1: What kind of manual therapy stuff do you guys do?
• 16:46
  Speaker 1: I would imagine a lot of manual therapy would be, for a lot of people could be included.
• 16:50
  Speaker 2: Yeah, yeah.
• 16:51
  Speaker 2: So for most people they're having at least some portion of their visit with manual therapy and that can look, you know, different for everybody.
• 17:01
  Speaker 2: So we do a lot of work over the abdomen really trying to get some of those muscles to let go, especially for the chronic sucker inners if you want to say that or the chronic tensors.
• 17:12
  Speaker 2: Um, we work over the back, the hips, even down at the foot and ankle, believe it or not, because of shock absorption with walking, running you know the mechanics there everything translates up the chain to the pelvis.
• 17:23
  Speaker 2: At the pelvic floor.
• 17:25
  Speaker 2: We do have the option to work directly there.
• 17:28
  Speaker 2: Excuse me, I give people in my office always the option.
• 17:34
  Speaker 2: You know, no one's ever required to do a pelvic floor evaluation and internal evaluation.
• 17:39
  Speaker 2: We have different ways to evaluate the pelvic floor and treat it with manual therapy.
• 17:43
  Speaker 2: But one option is to do internal, really get at all the pelvic floor and treat it with manual therapy.
• 17:45
  Speaker 2: But one option is to do internal, really get at all those pelvic floor muscles.
• 17:48
  Speaker 2: We can also work externally around what we call the perineum.
• 17:52
  Speaker 2: You know, so it's.
• 17:54
  Speaker 2: It's it's always modified to what the person needs and what they're comfortable with.
• 17:58
  Speaker 2: But definitely we treat head to toe at our office.
• 18:02
  Speaker 1: So I mean the, the internal um manual therapy, evaluation and treatment.
• 18:06
  Speaker 1: I'm sure it can be very effective, right?
• 18:08
  Speaker 1: Um, we didn't dive into that at all, Like in school um, definitely not my thing, right, but um, I understood that could be a very effective approach to like helping stuff um either settle down right or mobilize some things.
• 18:22
  Speaker 2: Absolutely.
• 18:23
  Speaker 2: I tell people all the time.
• 18:24
  Speaker 2: You know, imagine you're sitting at your computer all day long and you get this knot up in your upper trap, your shoulder, your neck area, and you kind of press on it and you move your head side to side and you're trying to like, oh, that feels good.
• 18:36
  Speaker 2: I can't kind of work it out.
• 18:38
  Speaker 2: We do a similar approach, much more gentle, much more, you know, methodical, but we take the same concept and we can achieve those changes at the pelvic floor really getting tissue to relax, trying to free up nerves, trying to improve blood flow to the area Um.
• 18:55
  Speaker 2: That's the main goal there.
• 18:56
  Speaker 1: Interesting Um.
• 18:57
  Speaker 1: What about dry needling around the back hip pelvic floor?
• 19:01
  Speaker 2: There's even pelvic floor.
• 19:02
  Speaker 2: So I personally have not gone through the training yet.
• 19:04
  Speaker 2: It is on my bucket list to do.
• 19:06
  Speaker 2: But dry needling is a huge um, a huge component that can be really, really helpful.
• 19:11
  Speaker 2: And so you guys know, I've sent you some people to kind of fill in that gap, whether it be the back, the hip.
• 19:18
  Speaker 2: Some people do dry needle at the pelvic floor, the abdomen.
• 19:21
  Speaker 2: It can be super, super helpful in conjunction.
• 19:24
  Speaker 1: We've had some good, you know, success with it.
• 19:26
  Speaker 1: We definitely don't needle everybody.
• 19:27
  Speaker 1: It's the same thing, you know.
• 19:28
  Speaker 1: Like number one, step number one.
• 19:30
  Speaker 1: Are you cool with this?
• 19:31
  Speaker 1: Are you like, let me educate you on what it is?
• 19:33
  Speaker 1: Are you afraid of needles?
• 19:34
  Speaker 1: Like you don't not want it?
• 19:35
  Speaker 1: And then if you're like, yeah, I think it would be fine, let's try it, explain what we're going to do.
• 19:40
  Speaker 1: But it can be really effective.
• 19:42
  Speaker 1: I would say the only thing closest to the pelvic floor, the abdomen.
• 19:45
  Speaker 1: Needling a psoas can be very effective for some stuff, but other than that, maybe upper quad, you know, glutes and hips, but yeah, that's not the pelvic floor, stuff's not our thing.
• 19:56
  Speaker 1: That's what we send you people, you know, for that Interesting Cool.
• 20:00
  Speaker 1: So what originally got you into pelvic floor as an interest, like what was that direction?
• 20:10
  Speaker 2: Yeah, so I I was very fortunate I got my doctorate at Wash U out in St Louis, where a lot of the PT research in general comes out of that place.
• 20:13
  Speaker 2: So we got a little bit more exposure to pelvic floor than I think most programs offer.
• 20:18
  Speaker 2: Pelvic floor is really the only specialty within PT that you can't really do just coming out of school.
• 20:24
  Speaker 2: You have to go through some additional training.
• 20:26
  Speaker 2: So we got a little bit you know exposure to that.
• 20:31
  Speaker 2: I thought it was pretty cool to see things that you never thought you could help Right, and so it did spark my interest.
• 20:38
  Speaker 2: When I graduated, though, I went right into acute care, and I did some acute care and orthopedics In St Louis.
• 20:44
  Speaker 2: Well, we actually my family moved after graduation, so I was practicing in Baltimore, maryland.
• 20:50
  Speaker 2: I did acute care there, I did some orthopedic and sports med, and when I was in that role, my boss at the time wanted to hire a pelvic floor therapist.
• 21:00
  Speaker 2: I said you know I have some interest in it.
• 21:03
  Speaker 2: Why don't you send me for the training, and if I can tolerate it, I'll do it for you?
• 21:07
  Speaker 2: So I went to my very first course.
• 21:09
  Speaker 2: It was a full weekend, and I just fell in love and I said this is all I want to do from now on.
• 21:14
  Speaker 2: Um, and it just kind of went from there.
• 21:16
  Speaker 1: That's interesting and that was in Baltimore.
• 21:18
  Speaker 1: That was in Baltimore and then when did you move down to South Florida?
• 21:21
  Speaker 2: Uh, August of 2019, my family relocated down here and I was working for, you know, for some other people with the intention of starting their pelvic floor program for them.
• 21:33
  Speaker 1: This was in Delray or.
• 21:35
  Speaker 2: Boca.
• 21:35
  Speaker 2: The office was actually up in Boynton so we relocated to Boca as a family.
• 21:43
  Speaker 2: But I was working for a practice up in Boynton.
• 21:46
  Speaker 2: I was going to start their pelvic floor program and then COVID hit.
• 21:49
  Speaker 2: So when the pandemic hit and we all got furloughed and sent home, and that would have been six months after you were hired.
• 21:56
  Speaker 2: Yes, august.
• 21:57
  Speaker 1: Exactly March.
• 21:58
  Speaker 1: Yeah, seven months.
• 22:00
  Speaker 2: Yeah, yeah.
• 22:01
  Speaker 2: So it was March that you know.
• 22:03
  Speaker 2: I found myself sitting at home with two kids.
• 22:06
  Speaker 2: Week after week.
• 22:07
  Speaker 2: I was like I'm going crazy.
• 22:09
  Speaker 1: WTF.
• 22:09
  Speaker 1: What the heck am I going to do?
• 22:11
  Speaker 1: Yeah?
• 22:15
  Speaker 2: How old are your kids?
• 22:16
  Speaker 2: Now they're nine and five, but at the time I had a four year old and or a five year old, and my daughter was turning one.
• 22:20
  Speaker 2: So, I was in the thick of it you know, isolated at home with them, and but it left me a lot of time to think about what I really wanted to be able to provide people in terms of, you know, the experience as a patient and the and the level of treatment I wanted to provide, and I just knew I couldn't provide that working for someone else, especially in a clinic.
• 22:39
  Speaker 2: That was a mixed bag we had older people on walkers, we had people rehabbing ACLs and rotator cuffs and a tiny little room dedicated to pelvic floor.
• 22:50
  Speaker 2: So I spent my time researching what I needed to do, listening to every podcast I could get my hands on, what were you listening to?
• 22:59
  Speaker 2: So Jesse and Nicole Cozine which is the Pelvic PT Rising podcast out in California.
• 23:03
  Speaker 2: That was a big one for me.
• 23:04
  Speaker 2: Cool Also some of the big people in ortho, danny Matta.
• 23:11
  Speaker 1: Danny, matte, matte, thank you.
• 23:13
  Speaker 2: A couple other people I was listening to, and so I basically created my idea of what I wanted to be able to provide someone and created restore from there, and I decided then I was never going to work for someone else.
• 23:26
  Speaker 1: Yeah, so that you jumped on board doing that officially December.
• 23:30
  Speaker 2: December 2020.
• 23:32
  Speaker 1: So from March to December is when you were gathering all this information and speculating what you wanted to do Exactly, cool.
• 23:36
  Speaker 1: So from March to December is when you were gathering all this information and speculating what you wanted to do Exactly Cool.
• 23:39
  Speaker 1: So you started seeing your first people solo in December.
• 23:42
  Speaker 1: Yes, okay, cool.
• 23:43
  Speaker 1: Yeah, that's a long time then, like you know, to be with the kiddos and be locked in because of the pandemic man that's crazy.
• 23:52
  Speaker 1: So it was forced, that your hand was forced.
• 23:54
  Speaker 1: Yes, I mean, I'm all about that.
• 23:56
  Speaker 1: I'm super entrepreneurial and like visionary, um and my I've always been like man F the ladder dude.
• 24:02
  Speaker 1: I'm gonna make my own ladder.
• 24:02
  Speaker 1: You know, f this F that, like, I'm not gonna do that, I'm gonna do my own thing.
• 24:06
  Speaker 1: You know, don't tell me what to do, um, but that's cool.
• 24:09
  Speaker 1: So that was December of 2020.
• 24:13
  Speaker 1: You had a small space and then you moved to a bigger space five months later.
• 24:16
  Speaker 2: Yep.
• 24:16
  Speaker 1: Okay, and now you find yourself in South Delray.
• 24:19
  Speaker 1: How big is your clinic?
• 24:21
  Speaker 2: It's about 1,500 square feet, so we have three private treatment rooms.
• 24:25
  Speaker 2: We have a larger area for exercise.
• 24:28
  Speaker 2: There's a waiting area, so at the moment it's myself.
• 24:33
  Speaker 2: I'm desperately looking for someone to come on board and help me out.
• 24:35
  Speaker 2: But we're cranking away and seeing people you know all week long and, fingers crossed, we're hoping to be getting mental health in our space as well.
• 24:46
  Speaker 1: It's a great.
• 24:47
  Speaker 1: It's a great idea.
• 24:48
  Speaker 2: Yeah, it's a big collaboration in the world of pelvic health, and so you know things are in the works for that too.
• 24:55
  Speaker 1: Cool, that's awesome.
• 24:56
  Speaker 1: We can chat, have some contact, maybe some potential synergy.
• 24:59
  Speaker 1: Um, that's really cool, awesome.
• 25:02
  Speaker 1: Um, you mentioned males and females 30% male, 70, majority female, for sure and you, a lot of them want to get back to exercising, right, fitness of some sort, regaining their life again, right, yeah, and there's a big blend, right, I would imagine, of sports rehab, sports performance and then pelvic health.
• 25:23
  Speaker 1: Is that accurate, 100%?
• 25:25
  Speaker 1: What do you find with that?
• 25:26
  Speaker 1: Sports performance, sports rehab?
• 25:28
  Speaker 2: So I find that a lot of people who have been athletes their whole life I've treated professional athletes as well as people who have.
• 25:36
  Speaker 2: Maybe that's not their career, but they compete regularly.
• 25:40
  Speaker 2: A lot of times along the way they've been told some misinformation and that can lead to again compensation, over-recruiting, all those things.
• 25:49
  Speaker 2: So a lot of what we see is trying to undo some of those poor habits that are contributing to symptoms, but a lot of old hip injuries, ankle injuries, things like that.
• 26:01
  Speaker 2: So that's why I love you know, especially working with your team, I think, collaborating with someone who really knows the sports and ortho world, you know to deal with high level athletes along with pelvic floor therapy.
• 26:16
  Speaker 2: We do that collaboration and we see a lot of amazing results for people.
• 26:20
  Speaker 1: Cool, that's awesome.
• 26:22
  Speaker 1: Um, with any any cool, um specific cases that you've had recently where someone was like unable to do the trampoline jump right and they're like no chance.
• 26:32
  Speaker 1: And then now they're competing in some kind of crossfit deck of fit or um tennis pickleball, pickleballs blown up.
• 26:40
  Speaker 1: You know your area probably even more than up here.
• 26:43
  Speaker 1: Um, and Palm Beach gardens they have like this this they converted the soccer field to 24, um pickleball courts.
• 26:51
  Speaker 1: It's awesome, you know it's packed.
• 26:53
  Speaker 1: We go to this, this playground that's right next to it, and gardens, and like I was like I had no idea, I was like, oh my gosh, but anyway.
• 26:59
  Speaker 1: So any cool cases, like any specific triumphs that you uh yeah, definitely.
• 27:04
  Speaker 2: I mean people who are doing weightlifting competitions.
• 27:07
  Speaker 2: You know, we've gotten people to where they can lift the heaviest they've ever lifted and they're not having any leakage or they're not having any hip pinching and pelvic pain as a result.
• 27:16
  Speaker 2: Um, we do.
• 27:18
  Speaker 2: We see a lot of people that are into CrossFit and F45 and just being able to get people back to doing what they love to do.
• 27:24
  Speaker 2: We see, I mean, I see it, you know, on the regular.
• 27:27
  Speaker 2: So a lot of, a lot of cool cases.
• 27:29
  Speaker 1: That's really cool, that's awesome.
• 27:37
  Speaker 1: Um, with somebody who's listening to this right now and they're sitting in their car or at their desk or whatever and they're like I feel I know exactly what you're talking about.
• 27:40
  Speaker 1: I feel this right now, right, the kink in my shoulder, my upper trap, like pelvic floor groin hip.
• 27:43
  Speaker 1: That's totally me.
• 27:44
  Speaker 1: What suggestions would you have for them?
• 27:47
  Speaker 2: definitely don't live with it.
• 27:49
  Speaker 2: I mean reach out and find there is a solution.
• 27:51
  Speaker 1: Yeah, there's.
• 27:52
  Speaker 2: There's.
• 27:52
  Speaker 2: There's people again, like myself, who, who know, see this every day, know exactly how to tackle it and you know again, if there's a missing link, like potentially the need for dry needling or the need for higher level sports performance work, like dealing with someone who not only can help the pelvic floor but is willing and able to collaborate with other people like yourself and your, your team, um, to get people what they need.
• 28:19
  Speaker 2: I mean we, we have a mutual patient that I've been working with for quite a while, a male patient, and I could just tell like there was a lot of involvement of the hip and you know we were just doing so much in the time that we had in our session, so I sent him your way and with the two of us together, I mean he's doing fantastic.
• 28:38
  Speaker 2: So yeah.
• 28:40
  Speaker 2: So you know, reach out to people because you don't.
• 28:43
  Speaker 2: You certainly don't need to live with these symptoms.
• 28:45
  Speaker 2: And again, pelvic floor.
• 28:47
  Speaker 2: There's no such thing as TMI.
• 28:48
  Speaker 2: We've heard it all.
• 28:49
  Speaker 1: Yeah, I imagine for sure.
• 28:50
  Speaker 1: Um, and I've met people feel self-conscious or intimidated or like nervous and stuff.
• 28:55
  Speaker 1: Um, that's good though Warming, a warm, inviting environment.
• 28:59
  Speaker 1: Like you know, professionals like I guarantee you can't like surprise me or like we've we've heard this.
• 29:04
  Speaker 2: Yeah, and anybody who's in there.
• 29:05
  Speaker 2: You know anyone who's in the waiting room when you come in.
• 29:08
  Speaker 2: They're there for the same kind of reason.
• 29:09
  Speaker 1: Yeah, and that's that's why I think having a designated space is so important.
• 29:18
  Speaker 1: Oh, totally yeah, it's awesome and a great, it's a huge needed niche for sure.
• 29:20
  Speaker 1: Walk us through.
• 29:20
  Speaker 1: So somebody let's say they're like all right, cool, I'm going to call Dr Tori, let's get this thing figured out.
• 29:23
  Speaker 1: What would they expect like sessions to be like you mentioned manual therapy component, corrective exercise component.
• 29:31
  Speaker 2: Yeah, and a lot, of, a lot of times we're working on your day-to-day habits.
• 29:35
  Speaker 2: You know, maybe, how you're sitting at work, how often you're getting up and moving around, how much you're drinking and using the toilet, how you're using the toilet.
• 29:44
  Speaker 2: That's definitely a big piece of it.
• 29:45
  Speaker 2: The manual therapy is another portion, and then exercises to be working on outside of the clinic, whether it's, you know, I'm I'm a big fan of tailoring it to what fits in someone's lifestyle.
• 30:04
  Speaker 2: So if someone's in the gym, you know, four or five times a week and they want a routine to go through, perfect.
• 30:10
  Speaker 2: If someone is, you know, a busy parent between work and childcare and they're like, look, I don't have time to do 30 minutes of exercise, I might give them one to two things that they can weave in during the course of their day.
• 30:22
  Speaker 2: Already that's going to help make some improvements.
• 30:25
  Speaker 2: So I really try to balance it out and tailor it to the person in front of me.
• 30:30
  Speaker 2: The initial visit.
• 30:33
  Speaker 2: We do a lot of talking in the beginning.
• 30:34
  Speaker 2: We go through their history.
• 30:36
  Speaker 2: Education I ton of education.
• 30:38
  Speaker 2: I have pelvic models to really show them.
• 30:41
  Speaker 2: Like you know why it is that we would potentially, you know, discuss a pelvic exam and things like that.
• 30:46
  Speaker 2: We'll go through some some type of an evaluation that always incorporates ortho, you know, your your typical orthopedic.
• 30:54
  Speaker 2: So we look at someone head to toe, not just at the pelvic floor.
• 30:57
  Speaker 2: We start treatment.
• 30:58
  Speaker 2: We give people a folder to go home with after the first visit where we write down specific things that we think would be helpful.
• 31:05
  Speaker 2: Sometimes it's as simple as hey.
• 31:07
  Speaker 2: Stop squeezing your glutes every time you're going into a squat or a bridge.
• 31:11
  Speaker 2: Stop holding your stomach sucked in all day when you're sitting in meetings.
• 31:15
  Speaker 1: Yeah.
• 31:16
  Speaker 2: So that's, you know basically what the first visit looks like and then any follow-up visits.
• 31:21
  Speaker 2: We're working together on the treatment plan that you know.
• 31:24
  Speaker 2: The patient and I discuss ahead of time, updating anything they're doing at home.
• 31:29
  Speaker 1: The?
• 31:29
  Speaker 1: What kind of?
• 31:30
  Speaker 1: For exercise prescription?
• 31:32
  Speaker 1: Right, exercise is definitely a component, right?
• 31:35
  Speaker 1: Um, what is it like?
• 31:37
  Speaker 1: What things do you find yourself working on the most like in your, in your clinic, with the people then?
• 31:41
  Speaker 1: Um, it might be glutes.
• 31:43
  Speaker 1: It might be something else, right?
• 31:44
  Speaker 1: Diaphragmatic breathing, potentially diaphragm?
• 31:46
  Speaker 1: Um, what people expect to like work out when they're with you?
• 31:49
  Speaker 1: Or is it not quite as intense at the beginning and you ramp it up?
• 31:53
  Speaker 2: It's honestly different for everybody.
• 31:55
  Speaker 2: So I have people that we go right out to the.
• 31:58
  Speaker 2: You know the we call the big gym area where we have a mat, we have weights, we have bands, all the things, and we might be out there day one.
• 32:05
  Speaker 2: Um other people we might be more in the treatment room working on calming the nervous system and working on realizing that they can move without causing pain or injury and really calming things down.
• 32:18
  Speaker 2: So we see, you know, across the board a lot of variety, but we definitely try to meet people where they're at and not not only based on what their symptoms and concerns are, but where they want to go.
• 32:31
  Speaker 2: With that, if someone hates exercise, I'm not going to have them get out there and try all different types of squats and things like that.
• 32:37
  Speaker 1: Well, guess what?
• 32:38
  Speaker 1: We're doing it anyway.
• 32:39
  Speaker 1: This is not what I came for.
• 32:41
  Speaker 2: I don't care, we just.
• 32:42
  Speaker 2: I try to make it all functional.
• 32:43
  Speaker 1: Yeah, totally, and meet them where they're at course, correct as necessary what they're interested in, what they want, their goals and stuff like that.
• 32:48
  Speaker 1: Yeah, I think it's interesting.
• 32:50
  Speaker 1: You mentioned, like the nervous system, right Um, we had a, uh, I mean, pain science is a very interesting conversation, different realm of some stuff, but we can't neglect that there's a psychological component and a ton of interplay, because you can't separate the mind from the body.
• 33:06
  Speaker 1: We had a really cool, uh, mental health professional in here.
• 33:10
  Speaker 1: I'm talking about that stuff too and just valid, like validating the link, the link, you know um, the, the mind body connection, you know um, over time that stuff can definitely get amplified, right Um, and the hypervigilance, like you were describing, totally is a very common thing.
• 33:29
  Speaker 1: And I had somebody recently asked me, um, I think I was doing mentorship of some sort of like clinical, and they were like what do you find yourself getting into, what have you found yourself weaning into more as like a practitioner, and I'm like dude, the psychological component, like there is a psychological for like almost everything, and I feel like not enough weight is placed on that component for getting people better educating, actually improving symptoms right and improving functionality, getting people better educating, actually improving symptoms, right, and improving functionality.
• 33:57
  Speaker 1: Um, anyway, just the mind body interplay and how it can amplify some stuff.
• 34:00
  Speaker 1: You know what I mean.
• 34:02
  Speaker 1: Um, and you mentioned, you talked to people a lot about that stuff.
• 34:04
  Speaker 1: Right, different levels for different people.
• 34:06
  Speaker 1: Um, what do you find yourself educating people on on that subject?
• 34:12
  Speaker 2: as it relates to pelvic floor and, like what you do, yeah, a big one is um kind of highlighting how someone's trauma in the past whether it be physical trauma, emotional trauma, abuse, whatever, um, whatever you know, fits into that category, how that can really impact physical symptoms and to let people know that it's not in your head.
• 34:34
  Speaker 2: Sometimes people hear that there's a psychological component.
• 34:38
  Speaker 2: They think, oh well, it's not real.
• 34:39
  Speaker 1: So I'm making it up Crazy, yeah, so you're saying I'm crazy, right?
• 34:42
  Speaker 1: Whoa, whoa, whoa.
• 34:42
  Speaker 1: Let me backstroke on this, right I?
• 34:45
  Speaker 2: mean, and not at all.
• 34:46
  Speaker 2: I mean the nervous system is the brain, the nerves that come from the spinal cord all communicate to your tissues.
• 34:53
  Speaker 2: So that's explaining that to someone and understanding how there's.
• 34:56
  Speaker 2: There's feedback loops, just like a thermostat, and you know you get apprehensive and anxious cause you're going on a long car ride and you're not going to have a bathroom to stop at.
• 35:06
  Speaker 2: Well, it's going to, you know, rev up the nervous system.
• 35:09
  Speaker 2: It's going to make the muscles tense more.
• 35:10
  Speaker 2: It's going to irritate the bladder.
• 35:12
  Speaker 2: Potentially it's going to flare your symptoms.
• 35:14
  Speaker 2: When you start to feel like you're going to have to pee, you freak out and it's this whole cycle.
• 35:19
  Speaker 2: So, yeah, so explaining to people how you know how all of that works really also helps them take control of their symptoms.
• 35:26
  Speaker 2: Um, because stress is a huge player, especially in the pelvic pain world.
• 35:31
  Speaker 2: Um, I had a patient just over the weekend email me.
• 35:35
  Speaker 2: They had a super stressful day and night at work.
• 35:38
  Speaker 2: They're in law enforcement on Friday night and they're saying I'm starting to feel that can be stressful, yeah, intense.
• 35:47
  Speaker 2: And they were starting to feel some symptoms.
• 35:48
  Speaker 2: So I emailed them reminding them of all the tools they have in their toolbox now and, sure enough, they're starting to take, you know, control of it.
• 35:58
  Speaker 2: But we can see some amazing things, like you know, things that would typically send someone into a pain flare for a week.
• 36:05
  Speaker 2: All of a sudden they can catch it and they can address it, and maybe they have, you know, a bad day, and then things improve.
• 36:11
  Speaker 1: Yeah, that's really interesting.
• 36:13
  Speaker 1: Um, I think, also a good validation for some people that who might not be on that page yet or be like no, there's no way.
• 36:23
  Speaker 1: You know, like dude, stress can play a factor in contributing to symptoms.
• 36:26
  Speaker 1: There's a lot of like studies that have demonstrated the link to that and the exacerbation of some things and the prolonged nature of some stuff.
• 36:35
  Speaker 1: That's really interesting.
• 36:36
  Speaker 1: So police officer intense weekend, a lot of more stress and anxiety, I think, and then increased symptoms or just noticing some stuff I think really interesting.
• 36:46
  Speaker 1: Like step one.
• 36:47
  Speaker 1: You're like, I feel, stressed right now.
• 36:50
  Speaker 1: You know, I think and I've gotten a little more self aware, I've tried to at least myself personally Like why am I so tightened up right now and just tensed right?
• 37:00
  Speaker 1: Step one, I am stressed.
• 37:02
  Speaker 1: Okay, you're allowed to be right.
• 37:05
  Speaker 1: You're allowed to be stressed.
• 37:06
  Speaker 1: Things happen.
• 37:06
  Speaker 1: We're human beings, like welcome to the human condition.
• 37:08
  Speaker 1: And then at least step two, being like why, what things maybe have?
• 37:17
  Speaker 1: Let me reflect on the past 24 hours and then, at least for me, it's just helpful.
• 37:19
  Speaker 1: I can identify some stuff.
• 37:20
  Speaker 1: I'm like that's understandable, but that's not that bad, you know, like it's fine.
• 37:23
  Speaker 1: You know what?
• 37:24
  Speaker 1: Okay, interesting.
• 37:26
  Speaker 1: Uh, that's a really interesting case.
• 37:27
  Speaker 1: What for education?
• 37:29
  Speaker 1: Or on that stuff, um, or tools in a toolbox taking control, like you mentioned, um, what are the things do you find educating your patients on that of?
• 37:38
  Speaker 1: Like, here's some tools.
• 37:40
  Speaker 2: Yeah, so we do a lot of diaphragmatic breathing.
• 37:43
  Speaker 2: What that does is when you move your diaphragm with breathing, as opposed to the normal shallow breathing you're doing sitting at your desk.
• 37:51
  Speaker 2: It stimulates the vagus nerve which takes you out of that fight or flight mode of your nervous system.
• 37:57
  Speaker 2: It helps calm things down, you kind of when you learn and practice that it really you can feel the effects.
• 38:04
  Speaker 2: You're like, oh, my whole body just kind of let go a little bit.
• 38:07
  Speaker 1: It's a game changer.
• 38:07
  Speaker 1: Yeah, totally.
• 38:08
  Speaker 2: So that's one piece.
• 38:10
  Speaker 2: There's ways to stimulate the vagus nerve you know over the neck, and we TMJ dysfunction, pelvic floor dysfunction.
• 38:22
  Speaker 2: Really, let's talk about that next Keep going All right and the vagus nerve runs right through that region.
• 38:28
  Speaker 2: So, teaching them how to stimulate the vagus nerve there and other things are just helping people find ways that they can manage their stress, whether it be a meditation or mindfulness app, practicing yoga for 10 minutes a day, even journaling, you know.
• 38:47
  Speaker 2: Because the big thing is you're not going to tell someone don't be stressed.
• 38:51
  Speaker 2: You're not going to say like, oh, you shouldn't be stressed, or let's remove stress, Like you can't do that.
• 38:56
  Speaker 1: Like I know you're really mad right now, but just calm down.
• 38:58
  Speaker 1: Right Problem solved.
• 38:59
  Speaker 1: Why didn't I think of that?
• 39:00
  Speaker 1: You know everybody's more bad right, at least for me.
• 39:04
  Speaker 2: Yeah, and it's just unreasonable.
• 39:06
  Speaker 2: Everyone's going to have stress, but it's.
• 39:13
  Speaker 2: It's teaching people how to interfere, to block the physical manifestations of that.
• 39:14
  Speaker 2: That's you know where we come in, basically, yeah.
• 39:18
  Speaker 1: Um, I definitely, uh, I know, even for um you you'd like, do you know Jocko Willink?
• 39:22
  Speaker 1: He's a Navy SEAL, he's written some books on some stuff.
• 39:30
  Speaker 1: He's a very I mean, he's a military Navy SEAL dude, um, so you would imagine that kind of personality, you know, can be gruff and just like matter of fact, just get after it, um, but a lot of the stuff he's talked about very similar, is like how did Navy SEALs control their emotions and stuff Like a big component out, when I remember hearing is just controlling their breathing?
• 39:45
  Speaker 1: That's one major thing that you can actually control 100%.
• 39:48
  Speaker 1: Right, you can focus and control your breathing, um, and the diaphragmatic breathing and we'll talk about like shallow breathing, what you mentioned, um, with the vagus nerve and parasympathetic activation and involvement.
• 40:00
  Speaker 1: It's going to help deregulate your sympathetic, which is the fight or flight intensity, and like anxiousness, um, and then the the professional is talking about the mental health one.
• 40:10
  Speaker 1: If you link that stuff together, um, emotions really, when you break it down, are just neurotransmitters in your brain that can get flooded flooded right now, right, or I'm um just feeling a certain way Cool.
• 40:21
  Speaker 1: It takes like 14 to 17 minutes for those neurotransmitters to get flushed out if you're feeling a heightened emotional state.
• 40:28
  Speaker 1: So cool exercise, right, or intervention that you can a person can intervene with diaphragmatic breathing and focus for like a couple of minutes on your diaphragmatic breathing.
• 40:38
  Speaker 1: It's going to help re-regulate your parasympathetic, deregulate your sympathetic.
• 40:43
  Speaker 1: It also allows some time that you're not focusing on where the stressor was to get those flooded neurotransmitters to begin the process of getting flushed out, so that heightened emotional sense can also decrease.
• 40:54
  Speaker 1: So I'm like that's a cool intervention, right, like a couple of minutes, and it's like you're de-regulating this nervous system.
• 41:00
  Speaker 1: Neurotransmitters are also getting flushed out.
• 41:02
  Speaker 1: Cool, it's like it's an avenue to help lower that heightened state and I, for me, it's can be pretty effective.
• 41:08
  Speaker 1: You know, um, but that's why I think that's really cool, yeah.
• 41:12
  Speaker 2: Yeah, I mean, it's all about balance, right.
• 41:14
  Speaker 2: You don't want to be in that sympathetic state all day long and it's unrealistic to be always calm, chill and whatever but just having that balance and being able to tap into it when you need it.
• 41:24
  Speaker 2: That's the key.
• 41:26
  Speaker 1: Let's talk about.
• 41:27
  Speaker 1: You mentioned shallow breathing.
• 41:28
  Speaker 1: What's that mean?
• 41:29
  Speaker 2: So shallow breathing is just.
• 41:30
  Speaker 2: You know you're breathing at rest, at rest, I'm sorry.
• 41:34
  Speaker 2: So.
• 41:34
  Speaker 2: Sitting at your desk doing work, you know you might be feeling your chest rise a little bit, but it's very shallow.
• 41:40
  Speaker 2: You're not talking about taking deep, intentional breaths there, so your diaphragm is not going to be moving quite as much and that's what's just different about that compared to tapping into some diaphragmatic breathing.
• 41:52
  Speaker 2: So I tell people, you know you don't have to wait until you're in fight or flight mode to do it.
• 41:57
  Speaker 2: You know, throughout the day I tell people, if you leave my office you get stuck at a red light take two or three deep breaths in and out.
• 42:04
  Speaker 2: you know, teaching them how to breathe in using their diaphragm, which means your abdomen, your back, your ribs all of that should expand.
• 42:11
  Speaker 2: Your chest should not lift up, you shouldn't have your shoulders lifting, um, but being able to tap into that to take some slow, deep breaths in and out, that's.
• 42:20
  Speaker 2: That's what's different there.
• 42:22
  Speaker 1: Um's awesome and you mentioned before like weaving in some exercises throughout the day.
• 42:27
  Speaker 1: Something else I've found myself, and us doing too, is suggesting to people these exercises.
• 42:33
  Speaker 1: We're showing you three of them.
• 42:34
  Speaker 1: Let's say, today your homework for this next week is do boom, boom, boom, a, b, c.
• 42:38
  Speaker 1: The recommendation we usually give is like do it just randomly all the time during the day.
• 42:44
  Speaker 1: Do one exercise, commercial break, do one more exercise.
• 42:47
  Speaker 1: I said a 10, eight, 12, like whatever reps, really don't matter, just do it.
• 42:50
  Speaker 1: Um, after lunch, knock out one more set of 10 of each or one more set of 12, whatever.
• 42:55
  Speaker 1: Before bed, when you like in um, when you're in bed, right, knock out some diaphragm breathing versus like, all right, guys, it's one o'clock, I'm going to, I'll be back in an hour.
• 43:04
  Speaker 1: I'm going to do all my PT exercises way back Right, doing it randomly all the time and just weaving it in is a good adjective.
• 43:12
  Speaker 1: Um, you're going to get more reps that way.
• 43:14
  Speaker 1: Anyway, you're going to get more blood flow, motions, lotion and just re um, enforcing those neuromuscular um recruitment patterns of the things we're trying to activate.
• 43:23
  Speaker 1: So diaphragmatic breathing.
• 43:25
  Speaker 1: The reason why we're talking about diaphragmatic breathing and you tell me more for sure read a lot of links and correlation to chronic low back pain and chronic neck pain.
• 43:34
  Speaker 1: Tmj is a component.
• 43:35
  Speaker 1: There's a lot of issues with a lack of diaphragmatic breathing and activation, so there's a component of that.
• 43:40
  Speaker 1: So we can link that in as one thing.
• 43:42
  Speaker 1: Cool, practice it all the time.
• 43:45
  Speaker 1: Red light, knock out 10, eight, right or five You're at your desk.
• 43:48
  Speaker 1: What we've recommended to people is like put a little sticky note on your computer monitor that says diaphragm question mark.
• 43:54
  Speaker 1: So every once in a while you're getting the groove and knocking things out your deep work and like, oh yeah, diaphragm, but anyway, incorporating that randomly all the time is going to help with that neuromuscular firing and it just normalizes that pattern, that movement pattern, that recruitment pattern.
• 44:09
  Speaker 1: So it just makes it more normalized throughout the day.
• 44:11
  Speaker 1: So when you're not thinking about it the root default might just be that instead, cool, problem solved.
• 44:17
  Speaker 1: So sitting, like you're saying, in shallow breathing, chest breathing, shoulder breathing, using a lot of those neck accessory muscles, chest breathing, shoulder breathing, using a lot of those neck accessory muscles it's a great setup for um things getting involved in the neck, shoulder and TMJ.
• 44:31
  Speaker 1: People at the desk hunched over a little bit forward head posture and then like that for hours, right, and I get in the zone and I'll be banging stuff out for hours and then just shallow breathing the whole time.
• 44:41
  Speaker 1: So things chronically do that.
• 44:43
  Speaker 1: Um, and you mentioned TMJ linked to pelvic floor, right, that's just a great setup for TMJ neck, shoulder.
• 44:50
  Speaker 1: Things just get irritated.
• 44:51
  Speaker 1: Um, and TMJ, for sure.
• 44:54
  Speaker 1: What have you found then with TMJ and the link with pelvic floor?
• 44:59
  Speaker 1: Like, tell us more what you, what you found with that.
• 45:01
  Speaker 2: Yeah, so in in the pelvic world it's pretty.
• 45:04
  Speaker 2: I think it's becoming pretty well known now that there is definitely a link between the TMJ and pelvic tension.
• 45:13
  Speaker 2: So we tend to see people that are teeth grinders, clenchers of the jaw, having chronic jaw pain, needing their TMJ addressed manually, just like their pelvic floor.
• 45:25
  Speaker 2: And in fact I've seen really, really cool things in the clinic.
• 45:28
  Speaker 2: Um, one person coming to mind in particular we start every session just working on her TMJ and we're talking five minutes each side, where I actually have one finger in her mouth and we're addressing the tension right around that joint, uh, right around that joint.
• 45:46
  Speaker 2: And as soon as I feel those muscles like let go, she tells me oh, my God, my whole body just relaxed.
• 45:52
  Speaker 2: Or I just felt my, my pelvis like let go.
• 45:55
  Speaker 2: Um, you know, it sounds so woo woo at first when you talk to people about it, but the body's all connected.
• 46:01
  Speaker 2: So, you know, when you think about it that way, it it makes sense that there's connections there.
• 46:06
  Speaker 2: One of the underlying theories is that during embryology, when you're just, you know, a bunch of cells, and before you've really, you know, differentiated into different parts, those two areas were one.
• 46:18
  Speaker 2: They're made of the same.
• 46:19
  Speaker 2: You know cellular structures, the same tissue way back when.
• 46:23
  Speaker 2: You know cellular structures, the same tissue way back when.
• 46:27
  Speaker 2: And then you know, as your body grows and develops, um becomes the inlet through the mouth and the outlet through the pelvic floor.
• 46:30
  Speaker 2: So that's one theory as to why we see this happening.
• 46:35
  Speaker 2: But we do.
• 46:35
  Speaker 2: And and if you just think about it when people are stressed, what do they do?
• 46:39
  Speaker 2: yeah, they probably shrug their shoulders, clench their jaw, maybe grind their teeth.
• 46:43
  Speaker 2: So yeah, interesting, yeah, just one maybe grind their teeth.
• 46:44
  Speaker 1: So, yeah, interesting Just one component of the whole pain experience.
• 46:47
  Speaker 1: Yeah, and that makes sense.
• 46:49
  Speaker 1: You know you mentioned the vagus nerve link with TMJ as well.
• 46:53
  Speaker 2: Yep.
• 46:53
  Speaker 2: So a lot of times when we treat the TMJ area, I'll also go into like their neck and I'll start treating like the muscles there will stimulate the nerve as it runs down, you know, behind the ear, and that can also help calm things down, teach people how to do it themselves at home.
• 47:10
  Speaker 1: Interesting.
• 47:10
  Speaker 1: That's cool, I know, for, like, we help people with TMJ stuff too, dr Peter, dr Hunter, dr Stephanie, needling can be a really good component, a good, advantageous thing to intervene with.
• 47:23
  Speaker 1: But the TMJ, the trigeminal nerve, is pretty close to that and as it links the trigeminal nucleus at C3, c2, upper cervical right, again like it's woo-woo right you think, but it's like yo, it makes sense, right.
• 47:39
  Speaker 1: All the muscles of mastication, of chewing, is innervated by trigeminal nerve, right, super close length, of course, to the TMJ.
• 47:51
  Speaker 1: Trigeminal nuclei is actually located at the C2, c3, right, so we can influence upper cervical things to help with TMJ things, right.
• 47:56
  Speaker 1: And then the vagus component with diaphragmatic breathing, right For a sympathetic response.
• 48:01
  Speaker 1: Diaphragm as it connects to the low back and the abdomen, psoas, everything, pelvic floor, boom, huge connection.
• 48:07
  Speaker 1: It just makes sense, right, if you can link and at least educating that to people to be like why are you doing this?
• 48:12
  Speaker 1: I have this.
• 48:13
  Speaker 1: It's like well, here's this right Sympathetic trigeminal nerve like oh, totally forgot about that, you know, just lost, Didn't consider that today.
• 48:25
  Speaker 2: Yeah, that's where bringing out the models, bringing out, you know, my anatomy book, really showing people so they understand.
• 48:28
  Speaker 2: You know, you don't have to have a science background or like a deep understanding of this stuff for it to make sense to somebody.
• 48:33
  Speaker 2: You just say, hey, this is connected to this, this nerve runs right through this area.
• 48:37
  Speaker 1: That's why it's messed up.
• 48:38
  Speaker 1: Yeah, it's linked.
• 48:39
  Speaker 1: Yeah, something we should probably.
• 48:40
  Speaker 1: That I've considered doing, I haven't done yet for more anatomy stuff is on the 3D apps like iPad.
• 48:46
  Speaker 1: Do you guys do that?
• 48:47
  Speaker 2: I haven't.
• 48:48
  Speaker 2: I have a colleague that does it and he showed me what it looks like.
• 48:51
  Speaker 2: It looks amazing.
• 48:52
  Speaker 1: I wish I would have that when we were in school.
• 48:53
  Speaker 2: Yeah.
• 48:54
  Speaker 1: It would have helped a lot, even undergrad, you know, like that's what that I got it.
• 49:00
  Speaker 2: I'm still old school.
• 49:01
  Speaker 2: I pull out the book or I pull up a Google just to show people.
• 49:05
  Speaker 2: You know where things are located.
• 49:06
  Speaker 2: The relationship, but yeah, that can definitely be helpful.
• 49:08
  Speaker 1: It's really interesting because people we're working with don't know it.
• 49:10
  Speaker 1: There's just, there's not what they do, you know.
• 49:12
  Speaker 2: Right, right.
• 49:13
  Speaker 1: Police officers aren't going to dive into like biggest nerve, innovation and pathway.
• 49:17
  Speaker 1: Um, that's really cool.
• 49:19
  Speaker 1: Well, I appreciate you coming in.
• 49:21
  Speaker 2: Thank, you for having me.
• 49:22
  Speaker 1: We'll have to deep dive more into like just sports performance exercise, exercise prescription for some stuff, like specific things.
• 49:31
  Speaker 1: But if people want to reach out to you, questions, want to work with you, what's the best way for them to reach you?
• 49:40
  Speaker 2: So they can definitely reach us through our website.
• 49:41
  Speaker 2: We have you know our phone number.
• 49:41
  Speaker 2: We have a form that they can fill out to get a call back from our front desk.
• 49:45
  Speaker 2: Um our websites um restore pelvic rehabcom um pelvic rehabcom restore pelvic rehabcom.
• 49:54
  Speaker 2: Yeah, we're.
• 49:54
  Speaker 2: We're also on.
• 49:55
  Speaker 2: You know we're on social media at restore pelvic rehab, underscore Boca, and I always tell people.
• 50:02
  Speaker 2: If you aren't sure it's for you, if you have questions, if you're skeptical, give me a call.
• 50:06
  Speaker 2: I talk to people all the time on the phone, Just answer their questions, you know, feel them out if it's a good fit for both of us.
• 50:13
  Speaker 2: It's a very noncommittal thing.
• 50:16
  Speaker 2: I mean, it's health care.
• 50:17
  Speaker 2: You need to jive with the person that's going to be helping you and know that you're in the right place.
• 50:22
  Speaker 1: Yeah, for sure, awesome.
• 50:23
  Speaker 1: Well, again, thanks for coming in.
• 50:25
  Speaker 1: I know you're a busy professional, so you got patients waiting for you, I'm sure, on the way back.
• 50:29
  Speaker 1: But thanks for coming in.
• 50:31
  Speaker 1: We'll have you on again, for sure.
• 50:32
  Speaker 1: We're always open to questions and suggestions, comments, conflicting opinions for sure, so definitely reach out.
• 50:38
  Speaker 1: If you have any of those thoughts, the best way to reach us is our phone number at 561-899-8725 or our website, athleterestorationcompanycom.
• 50:47
  Speaker 1: We always love answering questions.
• 50:48
  Speaker 1: Or, if you feel like you want to work with us, have questions for sports rehab things, definitely reach out to us too, and we'll catch you all next time.