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$#it That Needs To Be Said: Clinical Edition · Pelvic PT Rising

• 0:02
  Speaker 1: In the last 10 years, our field has gone from an unknown specialty to a household name.
• 0:09
  Speaker 1: This brings unprecedented opportunities, but we need to rise up to meet them and give our patients the care that they deserve.
• 0:17
  Speaker 1: In order to help others get better, we need to be better.
• 0:23
  Speaker 1: This podcast will help you to become more confident with your patients, more successful in your practice or business and a leader in pelvic health, and we're going to have some fun along the way.
• 0:36
  Speaker 1: Join us as we rise together.
• 0:39
  Speaker 1: We're Jesse and Nicole Cozine, founders of Pelvic Sanity Physical Therapy and the creators of the Pelvic PT Huddle, and this is Pelvic PT Rising.
• 0:54
  Speaker 2: Hey guys, welcome back to another episode of the Pelvic PT Rising podcast with Jesse and Nicole Cozine.
• 0:58
  Speaker 2: Hey, I'm Nicole.
• 0:59
  Speaker 2: Hello, are you pumped?
• 1:00
  Speaker 2: This is like you're a kid in a candy shop when we do the shit that needs to be said.
• 1:05
  Speaker 2: Episodes yes.
• 1:07
  Speaker 1: I've done like series of this over the years.
• 1:09
  Speaker 1: I used to do fire it up Fridays on Instagram.
• 1:12
  Speaker 1: I get fired up about a lot of shit and sometimes these topics don't really make a great full full episode, and so I just feel like we should fire off a bunch of different things In addition, shit that needs to be said.
• 1:29
  Speaker 2: So we're going to hit that right now.
• 1:30
  Speaker 2: We will.
• 1:31
  Speaker 2: Actually this is something we talked about before this.
• 1:33
  Speaker 2: Nicole, if you guys write in, we will do longer episodes on some of these topics.
• 1:38
  Speaker 2: So we will take probably the top two of these.
• 1:40
  Speaker 2: So send Nicole a DM with your favorite one of these and we will take some of your favorites and maybe turn it into a full scale longer podcast, do a little bit more of a deep dive, but these are mostly, like you said, nicole, topics that don't really necessitate like a huge long discussion.
• 1:56
  Speaker 2: It's kind of shit that needs to be said, that probably doesn't really need to be said or shouldn't need to be said, but it does for some reason.
• 2:02
  Speaker 1: Yeah, that's a long title, so we just want to shit the need to be said Totally, and so when you write me on Instagram, we make sure to tell me either the favorite topic or one that you just feel like you want more information on, you want a deeper dive into, because I have thought about these quite deeply, even though we're going to fire them off pretty quickly in this podcast.
• 2:24
  Speaker 1: So let me know DM on Instagram Nicole Cozine, dpt.
• 2:30
  Speaker 2: All right, Nicole, you ready.
• 2:31
  Speaker 1: I am so ready.
• 2:32
  Speaker 2: Number one don't poke your patient.
• 2:34
  Speaker 1: Y'all.
• 2:34
  Speaker 1: Could we please refrain from poking your patient.
• 2:39
  Speaker 1: What I mean by this is, when we're doing an external evaluation of the pelvic floor muscles, you do not go in with your pointer finger and just push on things, all right.
• 2:52
  Speaker 1: We need to actually be doing an assessment If anything that you're doing resembles poking.
• 2:57
  Speaker 1: This includes abdominal assessments.
• 3:00
  Speaker 1: This includes visceral assessments.
• 3:01
  Speaker 1: If there's anything that resembles poking that a kid would come in and be like why are you poking that person?
• 3:09
  Speaker 1: Then just don't do it.
• 3:10
  Speaker 1: We need to find a different assessment technique.
• 3:12
  Speaker 2: Say no to poking.
• 3:13
  Speaker 2: Leave it for 2004 Facebook.
• 3:15
  Speaker 2: That's where we should leave.
• 3:18
  Speaker 1: Just see just these sole responsibility on these, the shit that needs to be said.
• 3:22
  Speaker 1: Clinician edition is just like dumb jokes, that's it.
• 3:25
  Speaker 1: Yes, poke for Facebook 2004.
• 3:28
  Speaker 2: Good job, hey bringing it back y'all.
• 3:30
  Speaker 2: Some people are like what's Facebook?
• 3:32
  Speaker 2: I was like, man, we have to tell you about Myspace and you're really going to blow your mind.
• 3:35
  Speaker 2: Whatever happened to Tom.
• 3:36
  Speaker 2: Anyway, moving on Skin rolling, nicole.
• 3:39
  Speaker 2: Everyone listening to this, nicole, thinks you're doing skin rolling wrong.
• 3:43
  Speaker 1: I kind of do.
• 3:44
  Speaker 1: Well, here's the thing.
• 3:45
  Speaker 1: I don't know if you're doing it wrong You're the new person listening to this podcast but I certainly know that people coming into pelvic sanity, the people that I've trained, the people that I've mentored when I was teaching in the interstitial cystitis course that I used to teach live, before COVID happened and before I even had pelvic PT rising, I had to do an impromptu lab on skin rolling because I assumed everybody knew what that was and we were doing a specific adductor technique with a concurrent bladder visceral mobilization.
• 4:19
  Speaker 1: I was like, oh my God, everybody is not picking up what I'm putting down with the skin rolling situation.
• 4:24
  Speaker 1: We had to do an impromptu addition to the lab because I was like no one's doing it right.
• 4:30
  Speaker 1: Literally no one that's ever walked into pelvic sanity has been doing it the correct way.
• 4:35
  Speaker 2: So check yourself on the skin rolling.
• 4:38
  Speaker 1: It should not be crazy painful.
• 4:40
  Speaker 1: That's like way back in the day when we used to think that we just had to plow through all the fascia and we weren't thinking about the nervous system and it's also not tickling your patient.
• 4:49
  Speaker 1: So along with poking, it's don't tickle, it's not just like this very like spidery type feeling thing, looking thing on the very superficial part of their abdomen, Like no.
• 5:02
  Speaker 2: Nicole is part of the no funly no tickling, no poking.
• 5:05
  Speaker 2: What's next, nicole?
• 5:06
  Speaker 2: No laughing, no joy, no Christmas.
• 5:08
  Speaker 2: Okay, thank you, jesse for that.
• 5:10
  Speaker 2: See guys, this is my favorite part too.
• 5:12
  Speaker 2: I don't have to know anything.
• 5:14
  Speaker 2: Okay, this one seems like I shouldn't have to say it, but it's on my paper so I'm going to read it.
• 5:17
  Speaker 2: Courses should have instructors.
• 5:20
  Speaker 1: I mean, if we're learning how to palpate and assess internal pelvic floor muscle structures trans vaginally and trans erectile, I would say that like there should be someone in the room that like knows how to do that Well, like I just can't get over it.
• 5:38
  Speaker 1: This is actually turned into a question that we have to ask folks that have gotten trained in pelvic floor relatively recently, because not that we're not going to hire them.
• 5:49
  Speaker 1: I mean, we'll still hire a new grad that doesn't have a ton of pelvic health experience but that is super passionate about the field.
• 5:55
  Speaker 1: But if they've been gone to a course and there wasn't an actual instructor, I just need to know that, for the reason that I need to like spend way more time in the onboarding and training section, Like I can't believe I'm actually have to say that, but like that's what I think.
• 6:12
  Speaker 2: And this is I know, before we get the hate mail coming in.
• 6:14
  Speaker 2: We know that there are great TAs out there.
• 6:16
  Speaker 2: Some of our staff are amazing TAs and do that.
• 6:19
  Speaker 2: But you're also placing a lot of reliance on a completely unpaid volunteer type person whose sole requirement is that they took a course once themselves to teach other people how to do that with very limited training or an oversight with, like a really experienced person that's still doing it all the time.
• 6:38
  Speaker 1: I can't.
• 6:39
  Speaker 2: So not that there aren't good TAs out there, but I mean, at the end of the day, like that's why you want to take a course that has an instructor.
• 6:45
  Speaker 1: Right and to your point.
• 6:46
  Speaker 1: Then it's like if the course is that reliant and variable, like the quality of the course, is that variable on the TA that you have, like that's a problem.
• 6:55
  Speaker 2: Right, you shouldn't be rolling the dice to see if you're going to have a good or a bad course.
• 6:59
  Speaker 1: Yeah, anyways.
• 7:00
  Speaker 2: Okay, so after that, nicole, I've got get your patient off the table.
• 7:04
  Speaker 2: People who know you are not surprised by this one, I am presuming, but talk to me.
• 7:10
  Speaker 1: Yeah, just get your patient off the fucking table Like it's.
• 7:13
  Speaker 1: This is not a trick.
• 7:15
  Speaker 1: Pelvic floor issues come when people are upright, when they're.
• 7:23
  Speaker 1: We are walking biped human beings, biped is that a word?
• 7:27
  Speaker 1: Bipedal?
• 7:28
  Speaker 1: But we walk on two legs.
• 7:30
  Speaker 1: It's just the needs of you, said Nicole, handle your shit with these words.
• 7:35
  Speaker 1: But whatever we are, we're not.
• 7:38
  Speaker 1: Yeah, okay, we're not walking around in quadruped right, we're bipeds.
• 7:43
  Speaker 1: Yes, is this the right word?
• 7:45
  Speaker 1: Write me in and tell me is this?
• 7:48
  Speaker 2: the right word.
• 7:48
  Speaker 2: It recently occurred to me, Nicole, that the dog is eternally in the push-up position.
• 7:52
  Speaker 1: Okay, Jesse.
• 7:54
  Speaker 2: I love that joke.
• 7:55
  Speaker 2: Okay, do you, I do.
• 7:56
  Speaker 2: Okay, it lights me up.
• 7:58
  Speaker 1: Great.
• 7:58
  Speaker 1: Anyways, we walk around, folks.
• 8:01
  Speaker 1: Gravity is on our body when we're on our two feet, when we're walking around, when we are in asymmetrical positions, when we're in lunging positions, when we're in squatting positions, when we're bending, when we're twisting, when we don't have perfect body mechanics and there's no such thing as perfect posture so guess what?
• 8:17
  Speaker 1: Our assessment and our training and our treating needs to be in those positions, and it also needs to be in a position where you can control a lot of those variables.
• 8:30
  Speaker 1: It needs to do, you need to do both.
• 8:32
  Speaker 1: But freaking, get your patient off the table, and if you don't have time, you need to make time.
• 8:36
  Speaker 1: And if you don't have time, you might need to switch your job so that you can actually treat patients with public floor issues for a full hour period.
• 8:45
  Speaker 2: And if you want to know more about that.
• 8:47
  Speaker 2: That's all in your strengthening course, where you go into a much, much longer rant on that with some actual practical things 12 hours 12 hours of that, get your patients up there by pedal.
• 8:58
  Speaker 2: Okay, nicole, stress management does not equal down training.
• 9:03
  Speaker 1: This is just word of like, a allow me to get blow off all my steam on this podcast.
• 9:09
  Speaker 1: I feel like we have so much overlap and we use these words, these three phrases, as synonyms when they're freaking not.
• 9:20
  Speaker 1: So.
• 9:21
  Speaker 1: Helping your patient with stress management is different than helping your patient with nervous system down training is different than helping your patient with pelvic floor muscle down training Two of those things I've already done in down training master class on, because I got irritated with this before, and I feel like we made a decent change with that.
• 9:39
  Speaker 1: We're really asking the question why is the pelvic floor like that?
• 9:41
  Speaker 1: There's three forms of down training, but that does not equal stress management.
• 9:48
  Speaker 1: I believe that stress management is a foundational principle for a strong pelvic health foundation.
• 9:54
  Speaker 1: We all know that it's in the pelvic floor.
• 9:56
  Speaker 1: Muscles are very much innervated and influenced by the autonomic nervous system and when somebody has a dysregulated stress response, then we know that their pelvic floor muscle function is going to be affected.
• 10:08
  Speaker 1: But where my rant comes in here and with the shit that needs to be said, is that it's.
• 10:14
  Speaker 1: We cannot just say you need to manage your stress better to patients and expect that to just magically hit home with them.
• 10:21
  Speaker 1: We can't expect our patients to magically understand what we mean.
• 10:25
  Speaker 1: We can't even expect patients to be self aware enough to know what that actually means and that they actually are stressed and anxious.
• 10:32
  Speaker 1: That's basically telling somebody with years of trauma the way that they were brought up, like all kinds of stuff to be like, yeah, go ahead and just fix that and then your pelvic floor muscle will be better.
• 10:45
  Speaker 1: And it's like that's just ridiculous that we are using these terms as synonyms.
• 10:50
  Speaker 1: They're not, and we need to be with you to take ownership of being able to help people in each of those different aspects.
• 10:56
  Speaker 1: Now you might be thinking like well, stress management, but I just need to send them to a psychologist.
• 11:02
  Speaker 1: And no, that's not necessarily the case either.
• 11:05
  Speaker 1: That might be a very appropriate referral, but you also have to assess the patient, for is that the right time for them?
• 11:10
  Speaker 1: Are they capable of that?
• 11:11
  Speaker 1: Do they have capacity for that?
• 11:12
  Speaker 1: Do they want to go?
• 11:13
  Speaker 1: And we still have a very big role in helping patients understand how to manage their stress.
• 11:20
  Speaker 1: But those are different terms that require different plans of care and different car bouts in their treatment Period.
• 11:30
  Speaker 2: That's like when you're mad at me or we're in a fight and I just tell you to chill out, because that goes super good for me.
• 11:37
  Speaker 2: Yes, nicole, you need to stress management.
• 11:40
  Speaker 2: You seem to chill out.
• 11:41
  Speaker 1: You seem to chill out Take a deep breath, just take a breath, just do a deep, big, deep belly breath.
• 11:46
  Speaker 1: I'm like want to freaking bite your motherfucking head off.
• 11:49
  Speaker 2: Yikes.
• 11:49
  Speaker 1: Even more.
• 11:50
  Speaker 1: Yikes, folks.
• 11:50
  Speaker 1: That's what your patients are doing to you, and they don't have the ability to just say things like that to you.
• 11:55
  Speaker 1: So you're actually aiding to their stress when you tell them to manage their stress.
• 12:00
  Speaker 2: Got it Okay.
• 12:00
  Speaker 2: This also goes into that, nicole, with behavior change, with how everything goes.
• 12:04
  Speaker 2: We are discharging as a field too early.
• 12:07
  Speaker 1: Way too early.
• 12:08
  Speaker 1: I am so sick of this and people might come at me in the DMs about like, oh, we can't create a dependent patient and all the things we're not.
• 12:20
  Speaker 1: We are as a field discharging patients like so freaking soon, it's borderline malpractice.
• 12:29
  Speaker 1: Honestly, it's so unethical Sometimes how quickly we assume patients can quote get better.
• 12:37
  Speaker 1: It's ridiculous.
• 12:39
  Speaker 1: I don't know where it comes from.
• 12:40
  Speaker 1: Actually, I probably do know where it comes from.
• 12:42
  Speaker 1: It comes from insurance companies.
• 12:43
  Speaker 1: It comes from fucking stupid ass PT school people that are educators that haven't been in the goddamn field for 20 years telling us how to treat patients.
• 12:53
  Speaker 2: But it's interesting because people accept that a ACL repair is going to be a nine month process.
• 12:59
  Speaker 2: It's not like and that's uncovered by insurance, so it's not like.
• 13:02
  Speaker 2: It's so interesting, the double standard with some of that stuff.
• 13:05
  Speaker 1: I don't even understand.
• 13:06
  Speaker 1: I literally cannot understand why it's such.
• 13:10
  Speaker 1: We're villainizing seeing patients for longer.
• 13:13
  Speaker 1: I just don't understand it.
• 13:15
  Speaker 1: I feel like the pelvic floor muscles are complex, the pelvis is complex.
• 13:19
  Speaker 1: Locomotion at the pelvis is complex.
• 13:21
  Speaker 1: The fact that it's innervated by, directly innervated by the autonomic nervous system that's complex.
• 13:27
  Speaker 1: The fact that we have bodily functions that it controls is complex.
• 13:31
  Speaker 1: Patients are complex, people are complex.
• 13:34
  Speaker 1: Behavior change is complex.
• 13:35
  Speaker 1: There are so many complexities.
• 13:37
  Speaker 1: Trauma is complex big T and little T.
• 13:41
  Speaker 1: Trauma is complex.
• 13:42
  Speaker 1: There are so many complexities that go on with pelvic floor conditions.
• 13:47
  Speaker 1: Childbirth is one of the most crazy, complex things that can happen and the most miraculous things that happen.
• 13:55
  Speaker 1: We just think that it should be easy, that we should get people out in four to six visits, eight visits.
• 14:00
  Speaker 1: Are you fucking kidding?
• 14:01
  Speaker 1: Are you seriously kidding me?
• 14:03
  Speaker 1: I can't handle it.
• 14:04
  Speaker 1: This is just the more that we can just throw out.
• 14:08
  Speaker 1: That notion that we should just be getting people better faster is better for pelvic floor conditions, like the better that our whole field is going to be.
• 14:17
  Speaker 1: It's not.
• 14:18
  Speaker 2: One of the cool things about doing those interviews with the Pelvicon speakers and some of the great folks we've had on this podcast is seeing that kind of convergent evolution.
• 14:25
  Speaker 2: It was almost eerie.
• 14:27
  Speaker 2: I think it was Michelle Lyons and Yenny we're both talking about them with hormones and how they track cycles and all of that stuff they're like yeah, we do that for three or four cycles, just offhand, like we're going to be seeing somebody for a minimum of three to four months.
• 14:41
  Speaker 1: Just to be able to scratch the surface and see patterns of what we think is going on.
• 14:44
  Speaker 1: That's not even to mention all of the other complexities that I just mentioned.
• 14:48
  Speaker 1: The menstrual cycle is complex.
• 14:51
  Speaker 1: Male hormones are complex.
• 14:54
  Speaker 2: I want to know more about that.
• 14:54
  Speaker 2: That sounds cool.
• 14:56
  Speaker 1: Yes, they are Jesse.
• 14:57
  Speaker 2: Awesome.
• 14:58
  Speaker 1: You're a complex human, yes, anyways.
• 15:00
  Speaker 1: But like, just stop.
• 15:02
  Speaker 1: Like I don't understand why six to eight visits is acting like.
• 15:06
  Speaker 1: This is like the longest plan of care you've ever fucking seen.
• 15:08
  Speaker 1: Like get over yourselves and stop it, because we are doing our patients' disservice by getting them just to symptom decrease or just to symptom resolution and not helping them to live better lives past that and going into wellness and better goals and helping them to navigate life through going back up to stress management, stressful situations.
• 15:35
  Speaker 1: If you have a patient whose incontinence is because of overactivity of the pelvic floor muscles post childbirth, do you think things get easier as the kid gets older?
• 15:45
  Speaker 1: Like are you kidding?
• 15:46
  Speaker 1: There's just so many things that need time for us to truly see patterns and to help patients that just six to eight visits is like the absolute minimum, not the max.
• 16:01
  Speaker 2: Right Next on our list.
• 16:03
  Speaker 2: Here is another one I don't really understand, but it seems like it needs to be said is that it is okay to say physical therapist and occupational therapist, and I don't know.
• 16:11
  Speaker 2: This is seems like there's a group out there that feels like it's somehow exclusionary to use those terms.
• 16:17
  Speaker 2: That I don't think could be further from the truth.
• 16:20
  Speaker 2: Jesse's like genuinely confused, but it's like it's your degree it's.
• 16:23
  Speaker 2: It would be like a chiropractor getting mad that somebody else called themselves an acupuncturist.
• 16:29
  Speaker 1: Literally.
• 16:29
  Speaker 1: Yes, this is how dumb it is.
• 16:31
  Speaker 1: This is why this is on the shit.
• 16:33
  Speaker 1: That needs to be said thing.
• 16:34
  Speaker 1: If you're a pelvic floor physical therapist, you should be able to say, without someone barking at you, that I am a pelvic floor physical therapist and I do pelvic floor physical therapy.
• 16:45
  Speaker 1: If you're an occupational therapist and you do pelvic floor, then you can say I'm a pelvic floor occupational therapist and no one should bark at you for that.
• 16:54
  Speaker 1: Like we're different disciplines with different training, that's okay.
• 17:02
  Speaker 2: And there's overlap in your training.
• 17:03
  Speaker 2: Of course you're both rehab providers right.
• 17:05
  Speaker 2: So it's under that umbrella term, which is why we use that for Pelvicon and when we're talking to both groups.
• 17:10
  Speaker 2: But there are differences and to try to like whitewash over that, that was one of the coolest things, nicole, I thought when you were training the OT who works at Pelvic Sanity is you told her like I don't want to make you into a physical therapist, that's not my job.
• 17:22
  Speaker 2: My job is to use your OT training and lens in mind to get people great results.
• 17:28
  Speaker 2: It's not to try to blend those two things into one.
• 17:31
  Speaker 2: You know, like there's one kind of perfect pelvic rehab provider or something.
• 17:34
  Speaker 1: Yeah, absolutely not.
• 17:35
  Speaker 1: So I mean and I think this goes the reason why this isn't the shit that needs to be said it's like, stop saying that to other people.
• 17:42
  Speaker 1: Like, if you see a post or you see someone using that term, the only thing you should be checking, if you really care, is do they actually have that degree?
• 17:50
  Speaker 1: And if they do, then shut the fuck up and don't say anything or comment nicely on the amazing pelvic floor content that they have.
• 18:00
  Speaker 1: Right, we don't need to be getting into this back and forth about who's better, who's not.
• 18:05
  Speaker 1: That's all the same Same thing with, like, if you're quoting research articles like, for instance, the interstitial cystitis AUA guidelines say pelvic floor physical therapy is great evidence for it.
• 18:17
  Speaker 1: Like, that's what the research was done on.
• 18:20
  Speaker 1: It's not me being like exclusionary to say that that is literally evidence based.
• 18:26
  Speaker 1: So, and that is that unfortunate Sure, do I believe that pelvic rehab providers, like are under one thing.
• 18:33
  Speaker 1: Do I think that a urologist should send to pelvic floor rehab, which can either be PT or OT, even though the research says pelvic floor PT?
• 18:42
  Speaker 1: Sure, like, yes, all of that is true, and it's also really fucking annoying, even in this conversation, when we should all be focusing on getting the information out on how pelvic floor physical therapy and occupational therapy can help patients.
• 19:00
  Speaker 1: That's what we should all be focusing on is patient education and how we can help them uniquely within our own awesome specialties.
• 19:08
  Speaker 2: Yeah, going back to some podcasts we did way back in the day, but it's, don't attack colleagues.
• 19:13
  Speaker 1: Like just don't be a dick.
• 19:14
  Speaker 2: Yeah, that's kind of how it goes.
• 19:16
  Speaker 1: It's like a low bar people.
• 19:17
  Speaker 1: It's a low bar.
• 19:19
  Speaker 2: Next one on here which kind of flows into that, nicole is that pelvic floor therapy is not a protected term.
• 19:24
  Speaker 2: So we do lose something when we start getting so vague and you know other folks are being now invited to, I think you know we get so fired up you see that in the huddle when a physician's office or a nurse practitioner is doing pelvic floor therapy quote, unquote.
• 19:40
  Speaker 2: But that's, we can't be so vague as to have everything lose its meaning.
• 19:44
  Speaker 1: Totally, and we can't have it both ways.
• 19:45
  Speaker 1: We can't be pissed off at that and also being like we need to have one term that encompasses us all.
• 19:52
  Speaker 1: It's like no, we actually don't, and in my opinion we shouldn't, because otherwise that shit happens and we get people that are not trained at all doing quote unquote pelvic floor work and confusing the fuck out of patients, and I'm so not here for that.
• 20:08
  Speaker 1: So pelvic floor therapy is not a protected term and we need to be careful.
• 20:13
  Speaker 1: What we wish for in terms of are we going to be using that ubiquitously, because a lot of other disciplines can use that too.
• 20:21
  Speaker 1: A chiropractor could use that term.
• 20:23
  Speaker 1: If a chiropractor was using that term, we'd get super pissed off right, but there's a lot of overlap between some of your training.
• 20:29
  Speaker 1: Yeah, there is.
• 20:30
  Speaker 1: And shouldn't we then just be saying this is why chiropractic care is great, this is why occupational therapy is great, this is why pelvic floor PT is great, and we can all help patients with our own training and our own discipline and, for us, our own doctorate level care right, doctor of occupational therapy, doctor of PT, that's it Okay, so this also gets into confusing things, but the thing that separates pelvic floor rehab providers is the ability to do an internal exam.
• 20:57
  Speaker 1: Yeah, I, don't know if I'm going to get a lot of pushback on this, but this is why we do these shit.
• 21:01
  Speaker 2: That needs to be said.
• 21:02
  Speaker 2: Ones yeah, we anticipate a little bit of that, but I mean to head off some of that.
• 21:06
  Speaker 2: Can you get people better, nicole?
• 21:09
  Speaker 2: If you don't do an internal exam, if you're not trained in it, you're not comfortable with it, you just don't want to.
• 21:14
  Speaker 2: Can you get patients better?
• 21:16
  Speaker 1: Yes.
• 21:16
  Speaker 1: Is that the gold standard of what our specialty is?
• 21:20
  Speaker 1: No.
• 21:20
  Speaker 2: Exactly I feel like that's the.
• 21:22
  Speaker 2: When you get that pushback, it's like, well, people get better without it.
• 21:25
  Speaker 2: It's like, yeah, but that's not the criteria.
• 21:28
  Speaker 2: Is it the gold standard?
• 21:29
  Speaker 1: And you're just fucking guessing, then you're just fucking guessing.
• 21:32
  Speaker 1: And even if you're saying like, oh, I can use real time ultrasound and I can do all these other things, it's like, yes, and also like when we're pelvic rehab providers our hands are our eyes, our hands are our movement analysis, our hands are, we can feel what's going on.
• 21:51
  Speaker 1: Like the fact that we have extra specialized training in the internal examination, trans rectal layer, trans vaginally, like that is what makes us special.
• 22:01
  Speaker 1: Physicians don't get that, chiropractors don't get that.
• 22:04
  Speaker 1: We get that.
• 22:06
  Speaker 1: Regular physical therapy school and occupational therapy school doesn't get that.
• 22:09
  Speaker 1: We have to go to extra special training for that and then, if we're not, then using that tool of exactly the specialty that we're claiming to be.
• 22:19
  Speaker 1: That's where I have a problem.
• 22:21
  Speaker 2: And confusing.
• 22:22
  Speaker 2: Going back that's this whole sequence in the middle of this podcast is all about confusing patients.
• 22:26
  Speaker 2: Who people?
• 22:26
  Speaker 2: Somebody says I've been to pelvic floor therapy and you're like, well, what happened?
• 22:32
  Speaker 2: And you're like, oh, that was nothing like what you would experience, do you?
• 22:35
  Speaker 1: know how many people that I have talked to with remote consultations across the motherfucking world, folks world that they come to me.
• 22:44
  Speaker 1: They say I tried pelvic floor physio, I tried pelvic floor therapy, I tried all these things for a long time, years.
• 22:49
  Speaker 1: And I say, cool, talk to me about what they did.
• 22:53
  Speaker 1: Did they do?
• 22:53
  Speaker 1: Why should I have to ask the question?
• 22:55
  Speaker 1: I have to ask the question what did they do externally?
• 22:59
  Speaker 1: What did they do internally?
• 23:01
  Speaker 1: Do they actually assess the pelvic floor muscles internally through the vaginal canal, through the rectal canal?
• 23:06
  Speaker 1: What did they do?
• 23:07
  Speaker 1: How long did they do that for?
• 23:09
  Speaker 1: How often did they do it for?
• 23:10
  Speaker 1: Because this is a whole other situation.
• 23:12
  Speaker 1: But now you can't just do it one time and be like, oh, I get it, it's like things fucking change.
• 23:17
  Speaker 1: We do reassessments all the time in other areas and we have to continuously go back and assess and reassess internally.
• 23:23
  Speaker 1: That's our specialty area.
• 23:25
  Speaker 2: Gold standard Cool, so I'm going to do one.
• 23:28
  Speaker 2: Nicole, do I get to do one?
• 23:29
  Speaker 1: You get one.
• 23:30
  Speaker 2: I get one.
• 23:30
  Speaker 2: This goes into language that y'all don't have direct access.
• 23:34
  Speaker 2: Stop saying that.
• 23:35
  Speaker 2: That's not what that word means.
• 23:37
  Speaker 2: True Right Physicians have direct access because they don't have to ask anybody for shit to see a patient.
• 23:42
  Speaker 2: Chiropractors have direct access because they don't have to ask anybody for anything to see a patient.
• 23:47
  Speaker 2: Acupuncturists, right Massage therapists, personal trainers, some random dude on the street who wants to give you a back massage.
• 23:55
  Speaker 1: They all don't have to ask.
• 23:56
  Speaker 1: Guess what we have to ask.
• 23:57
  Speaker 2: Right.
• 23:58
  Speaker 2: So just because it's not as restrictive as it used to be does not mean that you have direct access.
• 24:03
  Speaker 2: So that just is a term thing that drives me nuts that we talk about that.
• 24:07
  Speaker 2: You've been like anointed with this direct access because you can wait for 10 days before you get a prescription, or you can wait for 45 days or 12 visits or whatever it is in your state.
• 24:17
  Speaker 2: Now there are a couple out there who really do have true direct access, but those are few and far between.
• 24:23
  Speaker 2: That is not what you guys have.
• 24:25
  Speaker 2: You guys have limited access.
• 24:26
  Speaker 2: It's literally the exact opposite of the word direct.
• 24:29
  Speaker 1: Yes, 100%, I'm with you.
• 24:30
  Speaker 1: Good job Desi All right.
• 24:32
  Speaker 2: Here's another one, nicole.
• 24:33
  Speaker 2: That's just kind of on the annoyance category.
• 24:35
  Speaker 2: I think we can just tag and move on.
• 24:37
  Speaker 2: If someone is posting a question about a patient or posting something on social media talking about treatment or whatever it is, it's not clever or a gotcha moment or like a Sherlock Holmesian thing to be like.
• 24:51
  Speaker 2: Did you get consent?
• 24:53
  Speaker 1: Yeah, jesse loves to use the word pedantic.
• 24:56
  Speaker 1: Can you please give the definition of pedantic inside to look this up.
• 24:59
  Speaker 2: Yeah, it's just like needlessly technical on something that clearly is implied, right?
• 25:03
  Speaker 2: So if somebody's asking a question about what they're doing with this patient, you guys are all trained rehab professionals Like.
• 25:10
  Speaker 2: You guys clearly care about this.
• 25:12
  Speaker 2: You're getting informed consent, you're doing all of the things.
• 25:14
  Speaker 2: And then somebody comes in and the first comment on some posts is always like well, did you get conformed consent?
• 25:20
  Speaker 2: Or well, what about children?
• 25:22
  Speaker 2: And it's like what about cats?
• 25:24
  Speaker 2: Did we really need to specify we're talking about humans in this fucking post.
• 25:28
  Speaker 1: Like it's like can we all just agree that we have the utmost reverence for getting not only initial informed consent but ongoing consent if we're doing internal treatments?
• 25:42
  Speaker 1: We understand that those things can change.
• 25:44
  Speaker 1: We understand that it's a big deal for people.
• 25:47
  Speaker 1: We understand that it's just saying it once is not always saying it again.
• 25:51
  Speaker 1: We understand that there's verbal and nonverbal forms of that.
• 25:54
  Speaker 1: We understand all of that.
• 25:56
  Speaker 1: Can we just all agree that we have that implied in everything that we do for the end of time?
• 26:04
  Speaker 2: Yes, let's just call that the implication.
• 26:06
  Speaker 2: And it's not like you are somehow stopping nonconsensual exams by putting a comment in somebody's Instagram post by the way, like you're not saving the world with that where somebody who was doing that and is that terrible of a human being is being like, oh my gosh, somebody asked me about that and I really need to change my ways.
• 26:24
  Speaker 2: Like what?
• 26:26
  Speaker 1: Like not, that's crazy so pedantic is what that is.
• 26:30
  Speaker 2: Here's another one, Nicole, I feel like it took you a little while to come around to, but physicians are not the bad guys.
• 26:35
  Speaker 1: Physicians are not the bad guys.
• 26:37
  Speaker 1: I think I'm going to credit a lot of Terran Hallam actually Physio, amazing Physio from Australia about this.
• 26:45
  Speaker 1: She talked about this at Pelvicon and also in her courses, but that you know.
• 26:52
  Speaker 1: I think it's very easy to make physicians the villains.
• 26:55
  Speaker 1: They should be sending all their patients to us and they don't do pelvic floor exams and they don't get trained in this and they didn't refer patients when they should have, and all of that is true a lot of the times for a lot of folks.
• 27:08
  Speaker 1: But they also do a shit ton of stuff that we don't do.
• 27:13
  Speaker 1: Their lens is different, their training is different, their responsibility to their patients is different than ours, and we can both coexist.
• 27:24
  Speaker 1: We both need to do better at respecting each other's field and remember that we see a subset of patients that have had negative physician experiences, and this is what Terran very much brought home in one of her pelvic con talks.
• 27:39
  Speaker 1: Physicians have a subset of people that they see more often that have failed pelvic floor physical therapy or pelvic floor therapy.
• 27:48
  Speaker 1: We're each seeing the failures of the other people's specialties at a higher percentage than the just average population.
• 27:57
  Speaker 2: Right.
• 27:57
  Speaker 2: Just to flesh that out if you're treating somebody for interstitial cystitis and they're doing really really well, they're not going to be going back to their urology office every two weeks.
• 28:05
  Speaker 2: If they're not doing really well, they're going to be going in and telling them that physical therapy, occupational therapy, didn't work.
• 28:11
  Speaker 2: So yes, you're seeing a biased subset of folks there.
• 28:17
  Speaker 2: We're on to our last two here, nicole.
• 28:19
  Speaker 2: One is that overactive pelvic floor muscles is not a diagnosis.
• 28:24
  Speaker 1: Yes, I've said this before, I'm going to say it again.
• 28:27
  Speaker 1: It made the list again that our musculoskeletal and neuromuscular assessment of the pelvic floor cannot stop at.
• 28:35
  Speaker 1: Your pelvic floor is overactive, it's tight, it's we're not using the phrase hypertonic anymore, but some people might still think that.
• 28:43
  Speaker 1: So we need to figure out why.
• 28:45
  Speaker 1: Why is it?
• 28:46
  Speaker 1: And I am proposing essentially four layers of why the pelvic floor is something.
• 28:52
  Speaker 1: Why is that from orthopedic standpoint?
• 28:55
  Speaker 1: Why is that from a nervous system standpoint?
• 28:57
  Speaker 1: Why is that happening now?
• 28:59
  Speaker 1: Why is that happening to this person?
• 29:01
  Speaker 1: Why is it creating the symptoms that it's creating?
• 29:04
  Speaker 1: And that's our true assessment.
• 29:09
  Speaker 1: It's lazy to just say patient presents with overactive pelvic floor muscles and expect that to be taken seriously by any other doctor at level profession.
• 29:19
  Speaker 1: Like we can't just write that in our assessments and send it to a physician and then be like oh, that's overactive, I get it now.
• 29:26
  Speaker 1: It's like no, why is it like that?
• 29:28
  Speaker 1: It's a whole fucking job.
• 29:31
  Speaker 2: Love it Cool.
• 29:32
  Speaker 2: So, moving on from that, last one we have here is kind of a more global one, nicole, but it's take ownership of what you know.
• 29:39
  Speaker 1: Yeah, I guess that's a little bit of a piggyback here on the second to last one, but you guys, we have such an amazing specialty area with so much knowledge about the body, the movement systems, the physiological systems, the nervous system, the social system of our patients.
• 30:00
  Speaker 1: We have so much knowledge about stuff and we have the luxury of time for the most part or we should be advocating for the luxury of time with our patients.
• 30:09
  Speaker 1: We might be the asset on their medical team that cares the most, that knows them the best, that is seeing them the most often, and we have to take ownership of that.
• 30:22
  Speaker 1: I think a little bit more in 2024.
• 30:26
  Speaker 2: Where you don't know I like how you frayed this, nicole where you don't know everything about all things, but you sure know a hell of a lot about most things.
• 30:32
  Speaker 1: Yeah, and we just have such a really cool knowledge base and I will die on the hill saying that physical therapy school prepared me to be the best pelvic floor physical therapist ever.
• 30:44
  Speaker 1: We have so much knowledge about the intangible memory system, the nervous system, the cardiovascular system, the pulmonary system, all of it the social, emotional system we learn about, like so many different systems, that we know that, we can assess for that we can screen, for that we might be the only person that is able to truly see that person for long enough to really give them the best referral if, even if it's outside of our direct knowledge, because we know the most about the most stuff, it really is awesome that way.
• 31:19
  Speaker 2: And that's why you get frustrated when you see people just referring patients out or saying, hey, you need to go and do this.
• 31:25
  Speaker 2: I can't help you until that, when you feel like you are the quarterback of your person's care.
• 31:32
  Speaker 1: We really are and like I want you to own that.
• 31:34
  Speaker 1: I want us to love that we're in that position and not be afraid of it.
• 31:39
  Speaker 1: I want us to, yeah, just like freaking, take that bull by its horns and be like listen, I know this shit.
• 31:46
  Speaker 1: And like have confidence in how much we know and how confident and how much we can help people and then be that person for them.
• 31:54
  Speaker 2: Love it.
• 31:54
  Speaker 2: So, guys, this was the clinical edition of shit that needs to be said.
• 31:58
  Speaker 2: Hope you guys enjoyed.
• 32:00
  Speaker 2: Like we mentioned at the beginning, make sure to reach out to Nicole.
• 32:02
  Speaker 2: Let her know which of these you like the most.
• 32:05
  Speaker 2: If there's one that you disagreed with, if there's one that you want to hear us expand on a little bit more and open up into a full episode, we would love to hear back from you.
• 32:13
  Speaker 1: Keep this conversation going and let's continue to rise.