Latest / Pelvic PT Rising / SUI is a Symptom, Not a Diagnosis: An Interview with Taryn Hallam

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SUI is a Symptom, Not a Diagnosis: An Interview with Taryn Hallam · 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.
• 0:53
  Speaker 2: Hey guys, welcome back to another episode of the Pelvic PT Rising podcast with Jesse and Nicole Cozine.
• 0:58
  Speaker 2: Hey, nicole, hello, I am so excited for your conversation with Teran Hallam.
• 1:03
  Speaker 1: I am excited for everybody else to get excited about this conversation with Teran Hallam.
• 1:08
  Speaker 1: So for those of you who don't know Teran, she is a Australian physio, very awesome and just really excited to share with you some of her unique perspective of how she got started and all of the things.
• 1:23
  Speaker 1: This actually might be one of my most favorite pelvic PT Rising podcast interviews.
• 1:30
  Speaker 1: This is mind blowing.
• 1:31
  Speaker 1: You are going to get your mind blown by what you're about to listen to.
• 1:34
  Speaker 2: And so if you guys are coming to PelvicCon it is in less than six weeks you better have your tickets, you better have your hotel flight, you better have your add-ons and you better be ordering your awesome swag so you can be wearing the PelvicCon t-shirt when you arrive.
• 1:46
  Speaker 2: If you are not able to join us, you are definitely going to want to get the recording.
• 1:51
  Speaker 2: As of right now, you can still get that early bird discount $50 off.
• 1:55
  Speaker 2: Honestly, teran's two talks after you hear her interview are worth that by themselves.
• 2:01
  Speaker 2: Forget about the eight other world-class speakers that are coming in.
• 2:05
  Speaker 2: And you know, nicole, I will say it was a little intimidating putting on the second PelvicCon after the speaker lineup we had at the first one.
• 2:13
  Speaker 2: That was an incredible group of people to have on a stage and it was frankly a little bit challenging to say how are we going to meet that, exceed that in our next one?
• 2:24
  Speaker 2: And I think one of the really cool things that we've done is gone beyond the borders.
• 2:29
  Speaker 2: I mean, we always want to like stretch the breadth of the field.
• 2:32
  Speaker 2: In this case, we're literally doing it with Manira from Canada, michelle from Ireland and Europe and now with Teran from Australia.
• 2:40
  Speaker 2: We're getting the cutting-edge trailblazers from every aspect of the world to come in and be able to impart their knowledge.
• 2:47
  Speaker 2: That's pretty crazy.
• 2:49
  Speaker 1: It really is, and you, jessica, and I certainly have a lot of anxiety about making sure that this PelvicCon is even better than the first and it's going to be.
• 2:59
  Speaker 1: But I'm really excited for you guys to hear, and get to know a little bit more about Teran, what she's all about, what she is special, what she's doing that's so special and how she's going to shape the way that you think about prolapse and incontinence and pestery fitting and all of it.
• 3:20
  Speaker 2: So, guys, with no further ado, here is Nicole's conversation with Teran Hallam.
• 3:28
  Speaker 1: Alrighty folks, we have for you a really wonderful physio from Australia named Teran Hallam, and if you know her, you're going to be super excited to hear us talk today.
• 3:39
  Speaker 1: If you don't know her, you better frickin' listen up, because even just in my little teeny bit that we were talking before this podcast, I'm super excited to bring all of her knowledge to you on the podcast.
• 3:51
  Speaker 1: Teran hi, say hi to everyone.
• 3:54
  Speaker 3: Hi everybody.
• 3:55
  Speaker 3: It's really exciting to be here and to be a part of this.
• 3:58
  Speaker 3: So, yeah, looking forward to meeting you all soon, face to face.
• 4:02
  Speaker 1: Perfect, I know right, I'm also speaking at Pelvicon at 2023 in Atlanta in just over a month.
• 4:10
  Speaker 1: We're going to talk about all of her Pelvicon topics coming up here, but first Teran, can you please?
• 4:16
  Speaker 1: I know that you have a sort of unorthodox way to get into pelvic physio, so can you just bring us up to speed?
• 4:23
  Speaker 1: How long have you been practicing?
• 4:24
  Speaker 1: When did you start?
• 4:25
  Speaker 1: What'd you do in that first part of your career and what are you doing now?
• 4:30
  Speaker 3: Yeah, it was a bit of a crazy start.
• 4:32
  Speaker 3: I think I've had the most unusual start to my pelvic health career compared to any physio in the world.
• 4:37
  Speaker 3: Maybe I was.
• 4:38
  Speaker 3: Look, I was a really privileged physician that I had.
• 4:41
  Speaker 3: So to try and bring it back, how long have I been in the field?
• 4:44
  Speaker 3: Because it's my 24th year in pelvic health.
• 4:46
  Speaker 3: So, yeah, really long time.
• 4:48
  Speaker 3: I've spent my whole physio career in pelvic health.
• 4:51
  Speaker 3: So I trained as a physio at the University of Sydney in Australia.
• 4:55
  Speaker 3: It's a four-year bachelor's degree.
• 4:57
  Speaker 3: As part of that, in your final year, you do an elective clinical placement.
• 5:02
  Speaker 3: So you've got all your standard clinical placements but you get one elective.
• 5:05
  Speaker 3: And I chose it in women's and pelvic health and just loved it and knew that's where I wanted to go.
• 5:11
  Speaker 3: And shortly after that, basically a really unique opportunity came up, and what it was was one of the senior gynecologists at the Big Women's Hospital in Sydney received a grant to pay for a physio to work full-time for one year to help run what ended up being the first ever randomized control trial looking at combining physio with incontinence and prolapse surgery.
• 5:37
  Speaker 3: So basically we were going to have all these women having incontinence and prolapse surgery at the hospital and we were going to do an RCT where half of them just had this surgery but half of them we actually gave prehab to, saw them immediately on the ward afterwards, saw them afterwards and saw whether adding physio gave any benefit to surgery as opposed to just having surgery alone.
• 5:57
  Speaker 3: So the reason that was so, I suppose, influential in my career was I remember turning up to the first day of that job and it was a one-year contract and the gynecologist was explaining to me so you need to be here every day in case a woman comes in who needs to have surgery and if she does, you need to try and see whether she's happy to be randomized to the two groups.
• 6:19
  Speaker 3: And the goal was to basically have 60 patients across the year in this study, and I said 60.
• 6:26
  Speaker 3: I said that means I'm only going to be probably recruiting one to two a week.
• 6:30
  Speaker 3: Why am I here full-time?
• 6:31
  Speaker 3: And they said because, well, we don't know when they're coming into hospital, so you need to always be available in case.
• 6:37
  Speaker 3: And I said right, so I might use half a day a week seeing these women.
• 6:41
  Speaker 3: What do I do the other four and a half days?
• 6:44
  Speaker 3: And he said well, just use this to your best advantage.
• 6:48
  Speaker 3: You are welcome to come to theaters operating theaters like a couple of days a week.
• 6:53
  Speaker 3: You're welcome to come to a urodynamics clinic one day a week.
• 6:55
  Speaker 3: You're welcome to come to our advanced urogyne ecology clinic where we do all the advanced pelvic floor assessments, pop cues and all the advanced management with our urogyne ecologists one or two days a week.
• 7:07
  Speaker 3: So I basically got paid I almost feel embarrassed, to admit.
• 7:12
  Speaker 3: I got paid to basically have one year just observing and learning.
• 7:17
  Speaker 3: I was in theaters watching every surgery under the sun.
• 7:20
  Speaker 3: So I had this whole year, which was sort of a bit funny because we got to end of the year and the staff at the hospital said we've now got a bit of a dilemma because they have this physio who's fully trained in pelvic health as a physio but is also fully trained in medical surgical management and how it works.
• 7:39
  Speaker 3: What do we do with it?
• 7:41
  Speaker 3: And so they kept me on in a supervisory role, mentoring role.
• 7:46
  Speaker 3: I started also getting lecturing at senior university and a range of universities, speaking at conferences and so forth.
• 7:53
  Speaker 3: So my career's been a little bit unusual because I now find myself teaching both at physio level and at medical surgical conferences, which is an amazing role to be in, because I find when I teach physios I can sort of, I suppose, fill the gap of the medical surgical side that they don't know.
• 8:13
  Speaker 3: When I speak at medical surgical conferences they want to know how physio can match in with things, but also in a way that they can understand.
• 8:21
  Speaker 3: So that was my start.
• 8:23
  Speaker 3: I continued working clinically in a public hospital for 10 years.
• 8:26
  Speaker 3: I then went to private practice for eight or nine years, but as I went along, I suppose this long story to try and cut it short so we can get onto the real stuff.
• 8:34
  Speaker 3: The biggest thing is I have a love of research and statistics.
• 8:39
  Speaker 3: I just love research and statistics.
• 8:41
  Speaker 3: I'm an absolute maths nerd.
• 8:43
  Speaker 3: That's my thing.
• 8:44
  Speaker 3: I love statistics.
• 8:45
  Speaker 3: I know most physios hate it, but I love it.
• 8:49
  Speaker 3: And the biggest thing I found, although I started doing my career doing research, was my biggest sadness in health generally was the realization that most clinical practice is about 10 years behind the research, and that is such a shame.
• 9:04
  Speaker 3: We have all these amazing researchers out there doing research and it doesn't get to the clinicians for 10 to 15 years on average.
• 9:11
  Speaker 3: So what I ended up doing was setting up WHCA, which is in Australia.
• 9:17
  Speaker 3: It's Women's Health Training Associates, and I now spend my life basically reading all the research, summarizing the latest research and trying to bring it to clinicians, because the research comes out so thick and fast no one can keep up to it and actually have a clinical load.
• 9:32
  Speaker 3: So what I try to do is read it all, summarize it all so that it gets to the patient care as fast as possible, and I love it and that's, I don't know, that's my career, to get me to here.
• 9:43
  Speaker 1: It's a bit unusual, but yeah Well, super unusual, but it's a foundation that you have then that allows you to, when you are training people in pesteries and training people on how to best treat people with stress-earning incontinence and prolapse, I feel like that has got to be just so cool to have that background on both ends.
• 10:05
  Speaker 1: Now I will say this some of the things that came to me when you were saying that is that I feel like in the physio world we're always so.
• 10:13
  Speaker 1: Why can't doctors just refer to us sooner?
• 10:20
  Speaker 1: Why don't they know about the pelvic floor?
• 10:23
  Speaker 1: Now, having your experience with their training and you know our training?
• 10:29
  Speaker 1: Do you have an answer for that Like why is that?
• 10:32
  Speaker 1: Number one, I guess, is it true?
• 10:34
  Speaker 1: And number two, why do you feel like that is?
• 10:37
  Speaker 1: If it is true, there's?
• 10:39
  Speaker 3: two different things with this and I'm going to say that it applies.
• 10:42
  Speaker 3: I believe it applies in both directions.
• 10:45
  Speaker 3: So the first thing that we need to understand is that patients help professional shop.
• 10:51
  Speaker 3: So what that means is they go to the person who they think is getting them better.
• 10:58
  Speaker 3: If you're not getting them better, that's when they switch to the other person.
• 11:04
  Speaker 3: Now what that means is both camps get a skewed view of the outcomes of the other person.
• 11:12
  Speaker 3: So, as a physio, when I'm working as a physio, if I only looked at the patients who come to see me, I'm going to get a very skewed view that lots of surgeries fail and that lots of surgeries have complications.
• 11:25
  Speaker 3: Because if you have a surgery and it fails, you're then angry.
• 11:30
  Speaker 3: The surgery fail, you're angry at the surgeon, you don't want to see a surgeon, and then you want to come to a physio to say I can't believe this surgeon did this and there's all these complications and it's bad, and that's what we're going to see.
• 11:42
  Speaker 3: All the people who had good surgical outcomes we're not going to see.
• 11:47
  Speaker 3: Now this works in reverse as well.
• 11:49
  Speaker 3: If you have patients who do really well with physio, they're happy.
• 11:55
  Speaker 3: That's it.
• 11:55
  Speaker 3: Their treatment's finished.
• 11:57
  Speaker 3: If they spend six months with physio and it fails.
• 12:00
  Speaker 3: Now they're angry.
• 12:01
  Speaker 3: I spent all this time going to the physio.
• 12:04
  Speaker 3: I paid all this money, I didn't get anywhere.
• 12:06
  Speaker 3: Then they go to the surgeon and the surgeon hears all these patients who wasted their time on pelvic floor muscle training that didn't work and now I get this angry patient when I could have just fixed them in the start.
• 12:19
  Speaker 3: So I think what we need to understand is we both see the other profession in its worst light because patients only go to the other one when they've had a bad outcome.
• 12:30
  Speaker 3: So that means if we use our clinical experience, we are skewed on our outcome view and we have to acknowledge that.
• 12:41
  Speaker 3: Actually, both professions do really really good work a lot of the time and they have some really bad outcomes some of the time.
• 12:49
  Speaker 3: Once you start to have that understanding and you go right, we both accept we have good outcomes.
• 12:56
  Speaker 3: We both expect big understand.
• 12:58
  Speaker 3: We have failures.
• 12:59
  Speaker 3: Now, once we're understanding of that, we start working as a team better.
• 13:05
  Speaker 3: And one of the things that I would say I would say the biggest feedback I get from physiotherapists in Australia and New Zealand which I've taught the most.
• 13:15
  Speaker 3: I've taught physios from Singapore, hong Kong, uk, ireland.
• 13:19
  Speaker 3: I've started teaching some US physios that probably the longest I've had is Australian, new Zealand.
• 13:24
  Speaker 3: The biggest feedback I get is physios experience.
• 13:29
  Speaker 3: What I experienced in my career is when you move towards the surgeon and you understand their side and you understand that there's a role for their side and actually there are some women who it really is the right way to go to go with surgery the surgeons here that you're open to their side and then they naturally say, well, actually there's a role for physio too, and that whole animosity breaks down and everyone starts to take that fight of who's going to get this person better away and says, actually we're going to both have a role for different people.
• 14:04
  Speaker 3: And it's really nice when, I believe, you get to that point with the surgeons that you have such a good mutual respect for each other that they refer to you and they say, look, I can do surgery for this person.
• 14:18
  Speaker 3: But you might think that this is a person who can fix with conservative first.
• 14:22
  Speaker 3: I'm going to send them to you If you think they can work conservatively.
• 14:26
  Speaker 3: You work with them for three to four months and hopefully they'll get better.
• 14:29
  Speaker 3: If they don't send them to me, but if you see them and you immediately that day think conservative is not going to work, then I'm happy for you to send them straight back so they don't send with a.
• 14:38
  Speaker 3: You should do three months off.
• 14:40
  Speaker 3: They send with a.
• 14:41
  Speaker 3: Can you tell me whether you think you can fix this or you can get this better or not?
• 14:47
  Speaker 3: And I have a really honest response and you know, most of the time, 70, 80% of the time I'm going to say to them physio should be a good result, depending on the condition.
• 14:59
  Speaker 3: If I see them, there is that maybe one in 10 or maybe two in 10 where I say I say to the patient first go, this is going to be a hard slog, conservative, to get this year.
• 15:09
  Speaker 3: So you know, let's look at our options, what you want to do, and it becomes a really mutual discussion.
• 15:15
  Speaker 3: But unfortunately I don't think this is the fault of either profession.
• 15:19
  Speaker 3: I think we all spend so much time training in our own area and we get very little opportunity.
• 15:26
  Speaker 3: So that's where I say I was really blessed.
• 15:29
  Speaker 3: I understand how unique my training opportunity was and that actually I don't blame the surgeons because they don't get a chance to learn about the muscles.
• 15:39
  Speaker 3: Physios don't get a chance to really learn about why certain ones need surgery, for what reasons and what are the facial defects that could implicate there.
• 15:49
  Speaker 3: It's not because either profession is bad.
• 15:52
  Speaker 3: They actually just don't get a chance to learn the opposite side to know it.
• 15:58
  Speaker 1: Yeah, yeah, I think that is gosh.
• 16:00
  Speaker 1: That's such a valuable I even feel like at an aha moment in there as well, where it's like when we can be maybe the first people to reach out and start and extend an olive branch first.
• 16:12
  Speaker 1: That might decrease some of that potential animosity and then also they'll extend one back.
• 16:19
  Speaker 1: That's very interesting.
• 16:20
  Speaker 1: Yeah, you know it's interesting.
• 16:22
  Speaker 1: You said too that we have a skewed view and I recently realized that after having a baby.
• 16:27
  Speaker 1: Right, because after I was terrified at the beginning to be like oh crap.
• 16:34
  Speaker 1: And then when I actually thought, why am I feeling that way?
• 16:38
  Speaker 1: My mental health therapist helped me to feel that way.
• 16:41
  Speaker 1: It's like, well, we only see the people that have a problem after this baby.
• 16:47
  Speaker 1: We only see the person that has something with their perineal tear that goes awry or they're having to go back for a revision of their grade three repair or whatever.
• 16:59
  Speaker 1: And my therapist was like you're not seeing the thousands of people that actually do fine.
• 17:07
  Speaker 3: Yeah.
• 17:08
  Speaker 3: So you look at midwifery and physio and then you say, you know, we see all the people who've had the pelvic floor trauma after a vaginal birth and we don't see all the women whose pelvic floors are absolutely fine, Saying that if you're a midwife working in a hospital not seeing them six months later, I would say you're seeing them, then thinking it's fine, we're seeing them when you have problems.
• 17:35
  Speaker 3: So midwives have skewed views to the positive vaginal birth and you know, physios have skewed views to the negative.
• 17:41
  Speaker 3: It had the debate happens between midwives and obstetricians because if you have a midwife working in Australia, we have what's called birth centers.
• 17:49
  Speaker 3: They're like our home birth, like situation.
• 17:52
  Speaker 3: So yeah, you have the same.
• 17:53
  Speaker 3: If you work in a birth center in Australia, you have to be screened to be a low risk woman with no complications and all of these things to be able to have that home birth setting.
• 18:02
  Speaker 3: And you go oh, look, how amazing that is.
• 18:04
  Speaker 3: And poor obstetrician who only gets called at two in the morning if there's a problem, comes in and says, well, I need to intervene.
• 18:14
  Speaker 3: And they're saying, well, you need to intervene in birth or else a baby could die.
• 18:18
  Speaker 3: You know, because they get called at the last minute for that and the midwives go no, no, no, but most births are fine.
• 18:24
  Speaker 3: So I think when we are caring to all the professions and understand you know, everyone went into health because we wanted to help people.
• 18:32
  Speaker 3: So there's no one out there going.
• 18:34
  Speaker 3: I'm a health practitioner and I want to do the worst I can by my patient, Like that's not what's happening and we understand, we all know a part and we all have a role and it's like, okay, where can I fit, when am I going to be able to help people and when do I get a limitation and when do we jump between each other and the more.
• 18:55
  Speaker 3: And that's where I suppose I really value the start that I had, because if I hadn't had that start, I don't think I would have seen that.
• 19:03
  Speaker 3: It gave me the ability to see both and it's given me such a unique chance.
• 19:08
  Speaker 3: So I find it amazing, Like a few years ago I had one of the surgical societies contact me and say, Terrin, we want you to talk on if we have a patient who wants to do crossfit after their prolapse surgery, how to that impact which surgery we choose?
• 19:26
  Speaker 3: And I literally did a talk to 400 surgeons saying, well, if the elevator hiatus is like this and this, then you probably will get away with an anterior native tissue repair.
• 19:36
  Speaker 3: But if the elevator hiatus is like this, there is no way it's going to hold.
• 19:39
  Speaker 3: It's going to come down within six or eight weeks.
• 19:41
  Speaker 3: You really need to think of the sake of culpaplexi for that reinforcement and they absolutely would take on if the pelvic floor muscles like this you may want to consider this for your surgical approach the pelvic floor muscles like this will then dispute surgical approach and then like that's so helpful for us to consider that and it's a very I can't do the surgery and I say you've then got to decide if that surgery is appropriate.
• 20:02
  Speaker 3: But that's what I would be thinking from a muscular approach, when you've got a choice between those surgeries, what you would consider.
• 20:10
  Speaker 3: And it was very mutual respect, very mutual respect.
• 20:14
  Speaker 1: Yeah, that is really awesome and really just so thankful for someone like you that is able to do that and then also shares that experience with us all, because I think we have so much to learn from that.
• 20:27
  Speaker 1: Now, Terrin, I know that many people, when they heard you sort of spout off the things with like, oh, a surgeon brings patient to you and says, what do you think?
• 20:37
  Speaker 1: Do you think this person is going to be benefited by conservative care first, or just go right to surgery?
• 20:43
  Speaker 1: And then you say, great, I can go ahead and predict who's going to do.
• 20:48
  Speaker 1: Well, so I'm sure everyone's listening is like well, do you have a checklist?
• 20:52
  Speaker 1: Like what do you look at?
• 20:53
  Speaker 1: How do you evaluate the facial connections?
• 20:55
  Speaker 1: What do you say?
• 20:56
  Speaker 1: Is that in your course?
• 20:58
  Speaker 1: Is that like what's happening there?
• 21:00
  Speaker 1: Like what's your method?
• 21:03
  Speaker 3: So there's a lot more predictors out there than people think and it's really amazing, and I am going to be at pelvic, I'm going to be talking about predictors for that.
• 21:14
  Speaker 3: So at pelvic I am going to be talking about predictors, but you know, so I don't know how much you want me to give away before we do this to you know, to give the upshots there.
• 21:23
  Speaker 3: But so let me take stress incontinence for a minute.
• 21:28
  Speaker 3: Okay, so if we look at stress urine ring continents, one of the things that I most commonly talk about is I think there's a real trap with stress urine ring continents, and the trap is that stress urine ring continents is a really, really easy diagnosis.
• 21:43
  Speaker 3: So because if you say, okay, they leak when they cough, they sneeze, they laugh, you can say they have stress incontinence.
• 21:49
  Speaker 3: But that's sort of a bit of a cheat, because I don't believe stress incontinence is a diagnosis.
• 21:54
  Speaker 3: Stress incontinence is a symptom.
• 21:57
  Speaker 3: All right, we talk about it as a diagnosis, but it's just, that's a symptom.
• 22:03
  Speaker 3: If I cough and I leak, it's something that, or it's a sign, it's something there.
• 22:07
  Speaker 3: What you then have to say is well, why is the person leaking?
• 22:11
  Speaker 3: Like if someone turned up to me and said oh, my head is just throbbing and I said well, my diagnosis is you have a headache Like.
• 22:17
  Speaker 3: That's not a diagnosis.
• 22:19
  Speaker 3: I mean it's a term but it's not a diagnosis.
• 22:22
  Speaker 3: So you take stress incontinence.
• 22:24
  Speaker 3: When you go under stress incontinence you say well, we've always known there's been two broad types of stress incontinence.
• 22:31
  Speaker 3: One is from urethral hypermobility.
• 22:34
  Speaker 3: And if it's urethral hypermobility we assume the baseline urethral pressure from the urethral sphincters is fairly good.
• 22:41
  Speaker 3: But when you cough or sneeze and your urethral pressure is meant to be augmented by abdominal pressure coming down and compressing the urethra, it can't do that.
• 22:50
  Speaker 3: The second one is intrinsic sphincter deficiency.
• 22:53
  Speaker 3: We're actually no, it's not the augmentation.
• 22:57
  Speaker 3: Your base urethral closure pressure from your urethral sphincters is low.
• 23:00
  Speaker 3: Both of them can cause stress, urinary incontinence.
• 23:04
  Speaker 3: Now, if you take urethral hypermobility, we have suddenly a dichotomy again, because under urethral hypermobility you can be hypermobile because your levator arty muscle can't pull and brace the fascia to hold the urethra.
• 23:20
  Speaker 3: Still, that would be responsive to physiotherapy.
• 23:24
  Speaker 3: You could have urethral hypermobility because the pubosovical fascia is torn behind the urethra.
• 23:30
  Speaker 3: Now the only way that levator is going to brace that urethra is if the pubosovical fascia is intact.
• 23:36
  Speaker 3: So if you have a torn pubosovical fascia, it doesn't matter how much you pull that levator, you won't brace that urethra.
• 23:44
  Speaker 3: So you can pull it for six months you can get a grade five pelvic floor contraction that is functional with endurance, it has timing, it can pull and you can palpate it and you can feel that it's got all of the every sort of component of function that physio was talking about.
• 24:02
  Speaker 3: And you don't have a transab ultrasound.
• 24:04
  Speaker 3: The bladder base doesn't lift and you go.
• 24:06
  Speaker 3: Well, why isn't it lifting?
• 24:08
  Speaker 3: Because I can feel it lifting when I palpate it, but on ultrasound it's not lifting the bladder, because what we view on an ultrasound is the bladder, and if the bladder is not lifting by the muscle lifting, then you have to say, well, the fascia must be damaged.
• 24:22
  Speaker 3: So there's a way you can put your clinical reasoning together and say, well, I'm going to be limited here, because that muscle can't functionally pull, no matter how strong it gets Right.
• 24:35
  Speaker 1: And here are things we can do.
• 24:37
  Speaker 1: That's one example.
• 24:37
  Speaker 1: That's one example.
• 24:38
  Speaker 1: That's one example, perfect.
• 24:39
  Speaker 1: So that's one example I take an approach to, which is interesting, because then I tend to look at the demand as well.
• 24:50
  Speaker 1: It's the demand of the system.
• 24:53
  Speaker 1: So, because a cough is one type of demand, it's a high amplitude, high load demand, but it's a short duration, and then we can also change from a physio perspective, change the demand of the pelvic floor, but again, some of the fascial things that you're just talking about might stay the exact same.
• 25:11
  Speaker 1: So you can affect incontinence from a different angle that way as well.
• 25:16
  Speaker 1: But yeah, can you speak a little bit on that?
• 25:18
  Speaker 1: Do you agree with that as well?
• 25:20
  Speaker 1: Yeah, Absolutely.
• 25:22
  Speaker 3: And that's where I would say to you there is a difference between a study that says, does physiotherapy improve incontinence and a study that says does pelvic floor muscle training improve incontinence?
• 25:34
  Speaker 3: So you might have someone who the fascia is not torn, but it's a little bit more lax than it should be Now.
• 25:43
  Speaker 3: What that means is if you could do this in newtons, maybe that fascia can withstand three newtons, but it can't withstand eight newtons coming down on it Now.
• 25:54
  Speaker 3: But then you say, okay, it's one of those things that the pelvic floor can't change.
• 25:59
  Speaker 3: That laxity in the fascia it can't change that.
• 26:02
  Speaker 3: The pelvic floor sorry, the pelvic floor muscles can't change that laxity.
• 26:06
  Speaker 3: However, if you have someone who can't lose weight we know there are studies someone could be morbidly obese and they don't need to get back to ideal weight.
• 26:17
  Speaker 3: If they lose 5% of their body weight, even if they're 20% over there, then they will have their incontinence.
• 26:25
  Speaker 3: But that becomes an important discussion for patients as well.
• 26:30
  Speaker 3: Because if you have a patient who turns up the first day to your appointment and they say I've been told I need to do pelvic floor muscle training and you assess them and you say, okay, but they're strong, they're coordinated, they have good endurance.
• 26:44
  Speaker 3: Everything's fine there.
• 26:45
  Speaker 3: The fascia is not great, but they are overweight.
• 26:49
  Speaker 3: We can actually say at the beginning actually pelvic floor muscle training is not how you're going to get better, that's not the thing.
• 26:56
  Speaker 3: That that's not where the dysfunction is, it's not on the muscles.
• 27:00
  Speaker 3: That doesn't mean we can't get you better without surgery, but we need to look at the other factors.
• 27:05
  Speaker 3: And so for me, when I read a research paper, one of the things I always say to clinicians is make sure you're really clear on what the paper is saying.
• 27:15
  Speaker 3: So if the paper does pelvic floor muscle training make a difference, you might have a control group that's doing weight management, managing constipation, heavy lifting, all of these things, and then you have a treatment group that's doing all of those plus pelvic floor muscle training.
• 27:31
  Speaker 3: You're actually finding out does the addition of pelvic floor muscle training make any difference?
• 27:37
  Speaker 3: That's very different to a lot of studies where what they will do is the control group gets nothing and the treatment group gets pelvic floor muscle training, weight management, management of constipation and straining and so forth, and the treatment group gets better and I go.
• 27:51
  Speaker 3: Well, that's all willing, good, but I don't know which bit got them better.
• 27:56
  Speaker 3: You're all assuming, because the methodology spent a whole column describing the pelvic floor muscle training program and then wrote two lines saying we managed constipation, straining and weight and all of these things.
• 28:09
  Speaker 3: And I go, but you did both, so I don't know which thing Now.
• 28:12
  Speaker 3: The good thing is it means physio management holistically work, but it does make a difference for patients.
• 28:20
  Speaker 3: And one of the things I would say to clinicians is I think we can get really easy to say that there's no risk factors associated with pelvic floor muscle training, so there's no problem just giving it to everybody.
• 28:33
  Speaker 3: I don't think that's actually true when you have a new mother who's already mental health, wise, feeling like she's dropping the ball everywhere and she says I'm barely getting dressed in the afternoon.
• 28:46
  Speaker 3: I'm not getting that baby to sleep.
• 28:47
  Speaker 3: I haven't done my home reader with my five year old who's in school, and I say to add a demand that she is not going to make a difference, that she then has to feel another failure if she forgets to do, I think is a risk.
• 29:01
  Speaker 3: It's a risk to her self well being, her thoughts on herself, and to be able to only put demands on people that are going to make a difference is really important in this fast paced world where people are struggling to keep all the balls in the air all the time.
• 29:20
  Speaker 3: And I have a lot of women who you can see the relief on their face where I say you know what?
• 29:25
  Speaker 3: Your pelvic floor muscles are already fine.
• 29:27
  Speaker 3: You are absolutely fine there.
• 29:29
  Speaker 3: If you don't do your pelvic floor muscle training every day, that's not what's going to make the difference.
• 29:33
  Speaker 3: But there are other women who I say look, I really think the pelvic floor muscle function for you is one of the big boulders, of all the boulders I'm looking at that I have to manage.
• 29:43
  Speaker 3: It's one of the big ones that we have to address.
• 29:46
  Speaker 3: But it means that I don't have to give pelvic floor muscle training to everybody.
• 29:50
  Speaker 3: I give it to the ones that work in Right, that it will work in.
• 29:56
  Speaker 1: Yeah, yeah, and you know, I feel like, for those who have listened to a couple of our speakers so far, I feel like one of the through lines has been that we need more time with people.
• 30:05
  Speaker 1: This through line, I feel like that we just spoke on, is this bio-psycho-social approach where we are, because we talked about it with Michelle Lines, we talked about it with Manira, with, like, actually taking the person in front of you and being very mindful and deliberate and thoughtful about what we say and how we present material, because I feel like so often we get over excited as physios and OTs in this space and we're just like, boom, I think I'm going to do all of the things, not understanding that that can be actually detrimental to some people and some folks not only just even if it was going to help just the sheer amount of information.
• 30:46
  Speaker 1: But now what you're saying is that sometimes we might be having somebody do something that actually isn't might not be the thing to really be mindful about how we present information and what we say about what's most important for that person to spend time on.
• 31:06
  Speaker 3: What's really interesting about this send is that I think as physios, when we give a multi-modal treatment pelvic floor muscle training, lifestyle and so forth and someone gets better by eight to 10 weeks later, I think we naturally put a lot of weight of that onto the pelvic floor muscle training.
• 31:23
  Speaker 3: There's a study that's come out this year and I still have to look at all the data in detail on it, but it's going to throw the physio world into a bit of chaos because it's the first time that what they've actually done is they've looked at stress and caution.
• 31:41
  Speaker 3: They've taken a group of women, they've given pelvic floor muscle training and, like most studies, their numbers have come out that about 50% completely cured, 75% significantly improved.
• 31:54
  Speaker 3: But then they did something really interesting At the end of the study they took the people who improved, they took the people who didn't improve and they looked at the change in their pelvic floor muscle function over the study.
• 32:06
  Speaker 3: Change in pelvic floor muscle function levator irony function particularly did not predict who got better, and so it's a really interesting thing that we say, okay, how much of this is actually changing levator irony function?
• 32:22
  Speaker 3: And it probably is in some people, but in some people.
• 32:26
  Speaker 3: That's not why we're getting them better and pelvic floor muscle training could be working.
• 32:32
  Speaker 3: But then we have all the debates of maybe it's working though, and all the research saying now, maybe when we do pelvic floor muscle training, the bigger change that we're getting is on the urethral sphincter, and actually that it's not the levator irony, and so your assessment that you're doing on levator irony may be irrelevant.
• 32:47
  Speaker 3: It may be the change on the urethral sphincter.
• 32:50
  Speaker 3: And then you say, okay, so some SUI women, it's their levator irony muscle function to brace the urethra for urethral hypermobility.
• 32:57
  Speaker 3: Some people is because we manage their weight and it fix them.
• 33:02
  Speaker 3: Some people, actually it's a urethral sphincter.
• 33:06
  Speaker 3: So we did pelvic floor muscle training.
• 33:07
  Speaker 3: But even if you have a significant bilateral levator of all, it's still worked because you improve the urethral sphincter.
• 33:15
  Speaker 3: Some people okay, this is the big one that everyone's going to.
• 33:21
  Speaker 3: It always gets people the debate about high tone pelvic floor and stressing continents.
• 33:27
  Speaker 3: Ignoring the tone of the levator is not directly why you improve stress incontinence and everyone wants to say it's so you get more movement.
• 33:38
  Speaker 3: You don't need more movement because your internal hypermobility is the problem.
• 33:42
  Speaker 3: You don't wanna give more movement to that.
• 33:45
  Speaker 3: But a very large part of the insertion of levator arne is into the arcus tendonis, levator arne directly to operator internus.
• 33:54
  Speaker 3: If you are hypotonic through your levator arne and you're constantly pulling on arcus tendonias, operator internus has to brace.
• 34:03
  Speaker 3: It has to because it's the origin, so it's gonna brace.
• 34:06
  Speaker 3: So that's why whenever you see someone with an overactive levator arne you nearly always find an overactive operator.
• 34:12
  Speaker 3: The problem is operator internus has operator fashion.
• 34:16
  Speaker 3: At the base of the operator fashion is alcox canal.
• 34:19
  Speaker 3: Pudendol nerve runs through alcox canal to get to the urethra sphincter.
• 34:22
  Speaker 3: So if you are overactive in operator you're clamping on the pudendol nerve.
• 34:27
  Speaker 3: The pudendol nerve means you can't activate the urethra sphincter.
• 34:30
  Speaker 3: If you let go of levators, you'll let go of obtrader, you'll take the tension of the pudendol nerve and the urethra sphincter will activate and you'll improve your urethra sphincter function.
• 34:38
  Speaker 3: But it's not because you just lowered the tone of levators, which is a good thing.
• 34:43
  Speaker 3: That's not where it's from and so it changes.
• 34:47
  Speaker 3: Either the urethra sphincter issue that's secondary to an overactive pelvic floor and obtrader or is this an elevator issue.
• 34:54
  Speaker 3: What is the issue?
• 34:55
  Speaker 1: What is the issue.
• 34:57
  Speaker 3: And so we can subdivide.
• 34:59
  Speaker 3: And I think you know if physios are such I mean pelvic health physios I think my experience is they're so curious, highly intelligent.
• 35:08
  Speaker 3: We love analyzing what's going on, and what I love about pelvic health and I think what all of us love about pelvic health is that, of all the areas of physio, when we get symptoms coming in we can use all our anatomy knowledge to go for this patient what is going on.
• 35:25
  Speaker 3: And so we no longer have stress here in reincontinence.
• 35:29
  Speaker 3: We have stress here in reincontinence sub-plot one, sub-plot two, sub-plot three, sub-plot four, sub-plot five, sub-plot six.
• 35:35
  Speaker 3: And the better you can differentiate those.
• 35:37
  Speaker 3: You don't then have to give everybody everything, which is nice.
• 35:42
  Speaker 1: Yes, that's just so great, and I mean, we all got into this.
• 35:45
  Speaker 1: This is where I get on my own soapbox about having like an actual differential diagnosis from a musculoskeletal, neuromuscular, fascial standpoint, because I feel like we do that in ortho, or musculoskeletal as you call it.
• 35:59
  Speaker 1: We do that in ortho physio, where, if someone comes in with low back pain and we also will be like, well, what is it?
• 36:07
  Speaker 1: Is it the disc, is it the set?
• 36:08
  Speaker 1: Is it the nerve?
• 36:09
  Speaker 1: Is it the musculature?
• 36:10
  Speaker 1: Is it?
• 36:11
  Speaker 1: We don't settle for it in ortho, so why do we settle for it in pelvic health?
• 36:16
  Speaker 1: And I think that you're saying exactly what we need to all be thinking about is that we need to dig deeper, using our own area of expertise and knowledge of anatomy, physiology, fascial connections and all of those predictors that you talked about, in order to best help the patient in an individualized manner.
• 36:35
  Speaker 3: And I think that that's just really, really cool and what my experience is is that actually for surgeons, most of the surgeons I work with are so open to saying do you know what?
• 36:49
  Speaker 3: We're not great at differentiating that because we get no training in assessing the muscles or anything else.
• 36:55
  Speaker 3: So what I like being able to do as a surgeon is send to a physio and say can you tell me if it's one of these four or five things that you can work with, can you assess that and tell me?
• 37:07
  Speaker 3: And if you send back I can say on all those factors they're good, then okay, now I know it must be the ones that are related to what I do and I'll do that.
• 37:16
  Speaker 3: But if you tell me actually no, yeah, they are problematic, we can work with that first, great, do that, do that first.
• 37:23
  Speaker 3: And so my experience is surgeons are very open to saying we're not good at muscles.
• 37:30
  Speaker 3: I mean I had the funniest lecture once where I was speaking to a group of surgeons at a medical conference and they wanted me to speak on musculoskeletal causes of chronic pelvic pain in intermutrosis and that's like and I was talking about that we know so many of these women have overactivity in obturated internals and where it's located it can present like that low abdominal, almost like ovarian pain At least we have a mistake in this that and I put up cadaver images and I had my model there and I was talking about as palpating obturated internals to say, is that reproducing her pain?
• 38:12
  Speaker 3: Is it from there?
• 38:13
  Speaker 3: Anyway, I was the last speaker of the session and then we did a panel and then we went to morning tea.
• 38:21
  Speaker 3: Now I could not get out of the conference room.
• 38:25
  Speaker 3: I could not get out.
• 38:26
  Speaker 3: I was swarmed by that 150 gynecologist saying so can you tell me how to palpate obturated internals so I can check it in my clinic.
• 38:35
  Speaker 3: And I'll admit and I want you to understand this, with care of the surgeons, they was a part of me saying this was back a few years ago when they were still doing transobterated tapes and I wanted to say you know that thing, you stick a Wackengrae hook through in a transobterated tape.
• 38:50
  Speaker 3: It's that one, that one, it's that one.
• 38:53
  Speaker 3: And I'm like how do you not know?
• 38:55
  Speaker 3: And they honestly were like show me on the model.
• 38:58
  Speaker 3: So where do I put my finger and how do I do this?
• 39:00
  Speaker 3: And so forth.
• 39:01
  Speaker 3: I had a fully trained.
• 39:05
  Speaker 3: What you say OBGYN, we say obginy from there.
• 39:08
  Speaker 3: So OBGYN, who I worked with for years and we were talking about DRAM and all of a sudden I realized one day she'd never been taught how to assess a DRAM.
• 39:16
  Speaker 3: So I actually had a patient and I said put your finger in here, lift the head.
• 39:20
  Speaker 3: And she went oh, that's the DRAM.
• 39:22
  Speaker 3: And as a physio we say how can you not know that?
• 39:28
  Speaker 3: And they say because I spent my PD this year working out how to manage a postpartum hemorrhage or what's the new suture material for a CESA, or what's the latest machine that's coming out to do a CTG in birth, or what's the latest way for someone with cervical cancer to do that, you know, biopsy.
• 39:45
  Speaker 3: And I've only got a certain number of PD hours in the year.
• 39:48
  Speaker 3: So I didn't get to muscles.
• 39:50
  Speaker 3: I didn't get to muscle.
• 39:52
  Speaker 3: I haven't got to that.
• 39:53
  Speaker 3: And so I have a really caring approach to my gynees when we talk about pestries.
• 39:59
  Speaker 3: None of them are trained in pestries.
• 40:01
  Speaker 3: They will say to you, my biggest training in pestries was I was a third year registrar.
• 40:08
  Speaker 3: I was in a gyne clinic and a person needed a pestry and my senior said to me just sort of separate your fingers in the top of the vagina and estimate the size.
• 40:16
  Speaker 3: Walk up to the wall and pick one that looks about that size and just like run it on some water and just push it in and they go.
• 40:22
  Speaker 3: It was a hallway conversation for two minutes and then I just had to do it and I've had no other training in pestries.
• 40:29
  Speaker 3: So you start speaking to them about cubes and galhons, they go.
• 40:32
  Speaker 3: I've never been taught how to fit this.
• 40:34
  Speaker 3: I don't know and I think I would hate to be a doctor because you know, every other health professional says but you're the doctor, so you should know, and internally they're thinking but I don't, but I meant to, so I can't say I don't and I want someone to go.
• 40:51
  Speaker 3: Do you want me to show you that?
• 40:52
  Speaker 3: Would you like me to show you how we assess draft and then you show me what you do when you do this surgery and we'll just share the knowledge and it just changes the dynamic.
• 41:03
  Speaker 3: Yeah, that'd be so interesting.
• 41:04
  Speaker 1: You know, I was giving a talk to about pelvic health physio for prolapse and we talked about pestries and I was sitting there, it was a two group of physicians, assistants, and they were getting taught in front of my eyes that the only people that were appropriate for pestries were people that were post-menopausal, that did not have any desire to have any sexual activity.
• 41:28
  Speaker 1: And it was put me in a really weird space because I was like going to be the one like coming up right after that and I was like, yeah, so I know that's what you just heard, but I'm going to share a different approach and a different experience in our clinic.
• 41:45
  Speaker 1: And all of them and the professor came up to me afterwards and was like you know what, thank you so much for saying that.
• 41:52
  Speaker 1: I just didn't come across that in my research for this class.
• 41:57
  Speaker 1: And to me in my head I was like, wow, why not?
• 42:01
  Speaker 1: But at that point I was just like, wow, well, how cool that she said like I just didn't come across it.
• 42:07
  Speaker 1: Thank you for sharing a different approach.
• 42:10
  Speaker 3: For that, you know, it was great and one of the difficult things there is the old pestries that were made out of PVC.
• 42:17
  Speaker 3: When you swash them, they just don't bend at all.
• 42:21
  Speaker 3: I mean they're solid and most of the GPs, the gynees, when they trained they were the only pestries available, which means that because they were so large, they were so solid, they didn't bend.
• 42:36
  Speaker 3: No one could put them in and out themselves.
• 42:38
  Speaker 3: I can understand.
• 42:39
  Speaker 3: If they were the only pestries I'd ever see, I would say why would I put that in a 34-year-old?
• 42:45
  Speaker 3: And you probably have this same thing when you did your talk.
• 42:48
  Speaker 3: You stand up and you hold up a PVC and you try and squash it and it just doesn't bend at all.
• 42:52
  Speaker 3: And then you pick up a new silicon pestry that's really, really solid and you go so they can just squash it, put it in and out.
• 42:58
  Speaker 3: And for years I haven't said to GPs but for years you guys taught women to put a diaphragm in and out, so why wouldn't they be able to do this Cool?
• 43:10
  Speaker 1: but yeah, but that's.
• 43:11
  Speaker 1: I 100% agree with this approach of just talking to people like they're real people.
• 43:20
  Speaker 1: They want to do the good for their patients.
• 43:23
  Speaker 1: They might just have a knowledge gap in something that we happened to know about and, conversely, we have knowledge gaps that they can fill for us.
• 43:34
  Speaker 1: I love that and, terrin, I want to.
• 43:36
  Speaker 1: So we've already talked quite a bit now about one of your topics, which is stress, urinary incontinence, pelvic floor and urethral considerations in rehab.
• 43:44
  Speaker 1: And then we are just now getting into pestries 101, what you need to know, which are your two pelvic contacts.
• 43:51
  Speaker 1: So real quickly, for those of you who you said because you've been fitting pestries for a long time, I mean, and I've been, everywhere about the US everywhere.
• 44:01
  Speaker 1: About the US like Canada, you can do it, Australia, you can do it, uk, ireland, you can do that.
• 44:06
  Speaker 1: So how has it been bringing that to the United States?
• 44:11
  Speaker 1: We're super excited, but we have not had that experience.
• 44:15
  Speaker 1: How has it been your experience teaching us?
• 44:18
  Speaker 3: I suppose the thing is is that when I started, I've been doing histories for just over a year.
• 44:24
  Speaker 3: So I've been doing histories myself probably about 12 years and I've been teaching them about 10.
• 44:28
  Speaker 3: So when I first started teaching in Australia and New Zealand, it was also people doing them the first time.
• 44:35
  Speaker 3: So to me, actually, it's no different to teaching the physios 10 years ago, because it was the start of physios doing them, and so it's the same there.
• 44:45
  Speaker 3: Every country is still in the process of working out how this gradually incorporates into physio practice, so I don't think anyone's got that completely certain yet and there's still a lot of discussion.
• 44:59
  Speaker 3: The interesting thing about pestries is that because they have changed, you know you've now got probably 15 different shapes and then for every shape you've got 10 different sizes.
• 45:10
  Speaker 3: The ability to prescribe a pestry and to know which one is going to be right has become more complex.
• 45:18
  Speaker 3: I mean, it used to be you had a ring.
• 45:19
  Speaker 3: You put a ring in.
• 45:21
  Speaker 3: If it stayed in, good, it worked.
• 45:23
  Speaker 3: If it fell out, it didn't.
• 45:25
  Speaker 3: That was it.
• 45:26
  Speaker 3: Now we say do we want a soft ring?
• 45:29
  Speaker 3: Do we want a hard ring?
• 45:29
  Speaker 3: Do we want to ring with a support in it?
• 45:31
  Speaker 3: Do we want a gell horn?
• 45:32
  Speaker 3: Do we want a dish?
• 45:32
  Speaker 3: Do we want a cube?
• 45:33
  Speaker 3: Do we want a donut?
• 45:34
  Speaker 3: Do we want?
• 45:34
  Speaker 3: What do we want and what size do we need?
• 45:37
  Speaker 3: And so what I say to people is, first thing, pestries are just the splint, that's all they are.
• 45:44
  Speaker 3: They're a splint, and physios do splints everywhere else all the time.
• 45:48
  Speaker 3: So from our point of view a splint is sort of our bread and butter work, like we know that all casting you know you have to think about is there going to be a precious for when you put a cast on?
• 46:01
  Speaker 3: If you have a splint, that's there, and how does it fit?
• 46:04
  Speaker 3: And how much do we want to restrict mobility versus allow mobility?
• 46:08
  Speaker 3: How much you know all of those things we're used to thinking about.
• 46:11
  Speaker 3: So I think it's a natural fit for physio.
• 46:16
  Speaker 3: I think you know half when you think of pestries pestries for those of you who it's new to you, while there's lots of shapes, we can broadly split them up into two categories.
• 46:27
  Speaker 3: One are called support pestries, which is such a bad name, and because pestries, you think, are all support pestries.
• 46:35
  Speaker 3: So if we think of them as pelvic organ prolapse, pestries say that the overarching name, and under that there's support pelvic organ prolapse pestries and then there's space occupying pelvic organ prolapse pestries.
• 46:48
  Speaker 3: Okay, now, the reason they're called support is the ones that are support pestries need something to support them in, so they can't hold themselves in, so they have no suction on them.
• 47:01
  Speaker 3: So the space occupying ones don't do that.
• 47:06
  Speaker 3: What they do is they fill into space and they usually have suction, which means they sort of just use up the whole vaginal space and suction to the wall so they can semi hold themselves in.
• 47:17
  Speaker 3: So basically, the support pestries are gentler, because they're not they're not so big, they're not so space occupying and because they don't suction, they don't have as much tension on the walls.
• 47:29
  Speaker 3: When you remove them they're not going to fall on the walls.
• 47:31
  Speaker 3: So you would always choose a support pestry if you could, over a space occupying.
• 47:37
  Speaker 3: You go to a space occupying when you can't hold in a support pestry.
• 47:41
  Speaker 3: The thing is, the main thing that holds in a support pestry is the levator arning.
• 47:45
  Speaker 3: So this makes videos the ideal person to decide.
• 47:50
  Speaker 3: Because if you have a small levator hiatus with an intact levator arning and good tone of your levator arning, a support pestry is probably going to hold.
• 47:59
  Speaker 3: If you have a really wide levator hiatus and bilateral evulsion and nothing for it to sit on, it's probably going to fall out.
• 48:06
  Speaker 3: So you're better with a space occupying pestry.
• 48:09
  Speaker 3: So videos aren't just good at this because we are used to prescribing splints.
• 48:14
  Speaker 3: We're also good at this because we can assess the muscle, decide how much muscle function is there to hold a support pestry in, and if it's not go to a space occupying, then you've got the thing of pestries are a bit like I say, they're a bit like glasses.
• 48:29
  Speaker 3: When people go to an optometrist they get their eyes checked and they know, okay, they need glasses.
• 48:35
  Speaker 3: But part of getting glasses is then going out to the main part of the optometry practice and deciding what frames you want.
• 48:41
  Speaker 3: And you think you like those frames, but until you put them on you don't know how they're going to fit on the bridge of your nose, how they're going to fit on the side of your head and so forth.
• 48:49
  Speaker 3: So part of this is about trialling a pestry standing up, seeing how it fits.
• 48:53
  Speaker 3: Is it comfortable?
• 48:54
  Speaker 3: Can you jump up and down?
• 48:55
  Speaker 3: Can you pass urine?
• 48:56
  Speaker 3: Come back.
• 48:57
  Speaker 3: If you don't feel comfortable, take it out, try a different one, like trying on different pairs of glasses till you find the one that's perfect for that woman.
• 49:05
  Speaker 3: Physios often have an hour.
• 49:06
  Speaker 3: You know half an hour an hour consult that they'll allow for this.
• 49:09
  Speaker 3: Paul Guineve are often in a hospital on 10 minute consults all day and they just don't have the time.
• 49:16
  Speaker 3: No, yeah, the most, yeah, the most common time a pestry will fall out is if you're passing a bowel motion on the toilet.
• 49:23
  Speaker 3: Physios will be able to talk about perineal support and how to minimize strain down when passing a bowel motion All the lifestyle stuff that goes to make a pestry work better.
• 49:32
  Speaker 3: So I think physios are just really good at pestries.
• 49:36
  Speaker 3: I think they're really really good at them and I think, as you do them, then what happens is the Guinevans go.
• 49:41
  Speaker 3: You're way better at this than us.
• 49:43
  Speaker 3: Can I just send to you?
• 49:45
  Speaker 3: And, to be honest, if I was a Guinevans, you don't get much money for fitting a pestry compared to doing a surgery.
• 49:51
  Speaker 3: So if I was going to spend my Wednesday morning in theaters or fitting pestries as a Guinevans, free them up to do the surgeries for the people who need surgery.
• 50:01
  Speaker 3: We'll cover the pestries and it sort of just works Very symbiotic, right, it's perfect it just works.
• 50:08
  Speaker 1: That's awesome, and I feel like we're also uniquely educated to be able to look at tissue breakdown and what is the estrogen status of the tissue and all of that stuff, just like we would if someone was wearing an AFO and it was rubbing on their calf weird, I love it.
• 50:23
  Speaker 1: I love it.
• 50:23
  Speaker 1: I'm so excited that we're now able to do this in the United States.
• 50:26
  Speaker 1: I'm so excited that you're coming to Pelvicon and, for those of you who don't know where to find Taryn, she is mostly at whtacomau right.
• 50:41
  Speaker 1: That is the website where people can find your courses.
• 50:45
  Speaker 1: I know you have a wide variety of courses.
• 50:48
  Speaker 1: I'm going to actually take your Pestri or your Pop, advanced, pop and SUI course and do the Prack with everybody at Pelvicon, so that's really exciting that we're able to have you do that.
• 51:01
  Speaker 1: The one of the other big projects that you do is the research update in 2023.
• 51:05
  Speaker 1: Taryn, can you talk a little bit about that and what that is, because I know I think, if I'm right, you alternate between pregnancy, postpartum stuff and what's the other category.
• 51:17
  Speaker 3: Yeah, so the research update is our I suppose it's our hallmark event each year.
• 51:23
  Speaker 3: Okay, and the basis for this is research comes out so fast that if every clinician had to read every paper that came out, they would never see any patient.
• 51:35
  Speaker 3: So it's much more climate efficient for one person to read it all, summarize it and then just give it across two to three days.
• 51:43
  Speaker 3: So that's what I do Basically.
• 51:45
  Speaker 3: I spend a few months every year.
• 51:47
  Speaker 3: People will laugh when you see me present, australians will say you're meeting Penny.
• 51:54
  Speaker 3: So what I've done is I've created this alter ego.
• 51:56
  Speaker 3: So Penny is my presenting persona.
• 51:58
  Speaker 3: That's who's talking right now.
• 52:00
  Speaker 3: It's Penny and I put her on to present because I'm actually super introvert.
• 52:05
  Speaker 3: My natural state is really introvert.
• 52:07
  Speaker 3: So I create this persona that gets dressed up and stands on stage and that's Penny who presents.
• 52:12
  Speaker 3: But I actually am very introvert.
• 52:15
  Speaker 3: So I'm really happy to spend three months each year literally sitting behind my computer on my own and I read.
• 52:21
  Speaker 3: It usually is about two to three thousand pages of research.
• 52:25
  Speaker 3: That's usually the summary, is about that many and I'll read two to three thousand pages of research that's come out in the last two years.
• 52:33
  Speaker 3: It has to be in the last two years and I summarize it all and I then present the summary of it all so videos can say OK, the paper came out and it said this.
• 52:43
  Speaker 3: This paper came out and said this, this paper came out and it said this.
• 52:46
  Speaker 3: So that's the research update.
• 52:48
  Speaker 3: But it does alternate.
• 52:49
  Speaker 3: So this year we're pelvic floor, this year it will be pelvic floor.
• 52:53
  Speaker 3: There's half a day on prolapse, half a day on stress and condense, half a day on OAB, half a day on chain, half a day on bowel, half a day on miscellaneous topics.
• 53:00
  Speaker 3: And I just summarize any relevant research for physios that's come out in the last two years on those topics.
• 53:06
  Speaker 3: Next year we'll be back to childbearing year.
• 53:10
  Speaker 3: So childbearing year is where we do things like dram, pregnancy related back pain, exercising pregnancy, but we also do pelvic floor specifically during pregnancy, early postpartum.
• 53:21
  Speaker 3: So it would be management of OAC, early OAC.
• 53:25
  Speaker 3: That would be in the childbearing year.
• 53:26
  Speaker 3: I don't do that this year and then the next year we'll go back to pelvic floor again and then we'll do a childbearing year, and just every year.
• 53:33
  Speaker 3: So it means that every year we alternate and that's why I do two years worth of research, because we do that topic every second year and it means we don't miss any research coming out.
• 53:43
  Speaker 3: So, yeah, so I sort of then just sit there doing paper after paper after paper and going here's all the research that's come out, everybody yeah.
• 53:50
  Speaker 1: That's really amazing.
• 53:50
  Speaker 1: That's my biggest and I really love that.
• 53:52
  Speaker 1: The goal of that right is to bring that clinical application gap to research, like to make it shorter, because I feel like that is a knock, especially and people like me who, like I, get why research is important, but that really doesn't do it for me to sit down and read those papers.
• 54:08
  Speaker 1: I'm just like whatever.
• 54:09
  Speaker 1: I'd much rather like try some shit in the clinic and be like that works.
• 54:15
  Speaker 1: That's awesome.
• 54:15
  Speaker 1: What's the what's the plausibility for that?
• 54:17
  Speaker 1: So I really believe that there's a place for both people right.
• 54:21
  Speaker 1: There is a place for the clinical people pushing things forward to inform research.
• 54:25
  Speaker 1: And then you know, manira and I talked a lot about on Diasis at rehab, how a lot of times, especially in that field, the research is now changing clinical practice that way versus clinical practice informing what we're trying to do with research.
• 54:40
  Speaker 1: So I love that it goes both ways and I think that it's really cool that you're doing a service to us all honestly to like help make that timeframe a little bit shorter.
• 54:49
  Speaker 3: It's great Well well, the thing that's really interesting about this is that there was I see this now three parts to the profession functioning and they all need each other.
• 55:00
  Speaker 3: So I think historically we've put researchers on a pedestal.
• 55:05
  Speaker 3: Now I don't believe that they shouldn't be on a pedestal, it's just I don't think the pedestal is any higher than the other two areas of that.
• 55:12
  Speaker 3: So the thing is is that I mean I started in research.
• 55:15
  Speaker 3: My first role was doing a randomized control trial.
• 55:18
  Speaker 3: So the thing is is that if you do a research paper and you dedicate your life for two years doing a research paper and then it's blocked behind a firewall, so for 10 years it never gets to anyone, what was the point of your life's work if no clinician uses it with a patient?
• 55:37
  Speaker 3: So one of the things of the research update, if I say to research, is I am going to bring your research to the clinician.
• 55:45
  Speaker 3: And the biggest example that I can have of this was again, it was actually a medical surgical conference.
• 55:50
  Speaker 3: It wasn't a physio conference.
• 55:51
  Speaker 3: I stood up and I was talking about how physios would be look at risk of recurrence of prolapse after surgery and I said we're going to look at levator hiatus, which traditionally has been done by transpironial ultrasound, 3d transpironial ultrasound but we had this amazing research done that showed there's an enormous correlation between measuring externally, gh plus PB and the ultrasound assessment of that.
• 56:16
  Speaker 3: And I said this has become probably one of the biggest assessments that physios in Australia will add to their clinical practice is doing GH plus PB to look at levator hiatus.
• 56:28
  Speaker 3: I went out to morning tea.
• 56:30
  Speaker 3: The author of that paper came up to me and said, oh my goodness, I didn't think anyone read my research on that.
• 56:37
  Speaker 3: I thought I'd published it and it was nothing.
• 56:39
  Speaker 3: And I said, look, it may not be anything for the surgeons, but I can tell you that 95% of physios across Australia and New Zealand are now implementing that as a main assessment because of your research paper.
• 56:51
  Speaker 3: And like, honestly, his grin was from ear to ear because it was like so my research made a difference.
• 56:57
  Speaker 3: I said you have not.
• 56:58
  Speaker 3: It was probably one of the most profound changes to our assessment in the last 10 years.
• 57:03
  Speaker 3: And he was just in shock that I've made a difference.
• 57:06
  Speaker 3: And I was like, yeah, because I got it to the clinician.
• 57:09
  Speaker 3: Yes, there, and so excited, you know, and that was great.
• 57:13
  Speaker 3: And I'm like there's no point doing research if we don't get it to the clinician.
• 57:17
  Speaker 3: However, if you don't have clinicians trying things in clinic, it's a clinician trying them.
• 57:23
  Speaker 3: Everyone always says to me oh, but if you did a PhD, how do you think of a topic?
• 57:27
  Speaker 3: I say just working clinical practice for two years, because what happens is, as you're seeing patients, you observe something happen and you go oh, we need to know more about that.
• 57:37
  Speaker 3: Every good research trial came from a clinician seeing something and going we need to know more on that, or why that didn't work, or why that did work.
• 57:47
  Speaker 3: So without clinicians, there are no research projects to do, because you can't sync them up in air.
• 57:53
  Speaker 3: You have to observe something, know that you don't know much about it and want to explore it more.
• 57:59
  Speaker 3: So researchers need clinicians, clinicians need researchers, but the silly firewalls in between and workloads mean that you need someone in the middle to then actually join them together, because otherwise there's no point.
• 58:13
  Speaker 3: Yes, yeah, so they're all important.
• 58:15
  Speaker 1: They're all important, everyone's important.
• 58:17
  Speaker 1: It's so awesome, it's so great.
• 58:20
  Speaker 1: Terrin, I have just thoroughly enjoyed this.
• 58:21
  Speaker 1: Man, if you don't get excited about this conversation, I don't know what's wrong with you people listening.
• 58:29
  Speaker 1: So if you want to hear more from Terrin, she's going to be at Palvacan speaking on those amazing topics, and thank you so much for your time.
• 58:38
  Speaker 1: We do have the lightning round, terrin, we start.
• 58:42
  Speaker 1: What questions for you?
• 58:43
  Speaker 1: Lightning round here we go.
• 58:46
  Speaker 3: This is when my introvert side is going to creep into this.
• 58:48
  Speaker 3: I know, penny, stay with me, penny.
• 58:50
  Speaker 3: It's Penny right, oh, yeah, yeah.
• 58:54
  Speaker 1: All right.
• 58:54
  Speaker 1: What is the most Australian thing about you?
• 58:57
  Speaker 1: Oh gosh.
• 58:59
  Speaker 3: Look, probably at the moment it's actually temporary.
• 59:02
  Speaker 3: At the moment where I'm living, I'm actually knocking down my main house to rebuild it and I'm renting.
• 59:07
  Speaker 3: And the thing is, I mean this is a lovely position, that what the rest of the world would see is Sydney is out my window.
• 59:13
  Speaker 3: So when I look out the window at the moment, I'm looking at the Harbour Bridge and Opera House of Sydney Harbour, which is very privileged position to be.
• 59:20
  Speaker 3: It's beautiful, I'll take a photo of it, but I'm right on Sydney Harbour.
• 59:23
  Speaker 3: So when you picture Sydney, yeah, that's where I literally am talking from right now.
• 59:26
  Speaker 3: It's there, that is.
• 59:27
  Speaker 3: Yeah, that's awesome.
• 59:28
  Speaker 1: That's awesome.
• 59:29
  Speaker 1: That's amazing.
• 59:29
  Speaker 1: Jessie and I were there.
• 59:33
  Speaker 1: I taught in Australia and we stayed right around where you are right now.
• 59:36
  Speaker 1: That's so cool.
• 59:37
  Speaker 1: Yeah, okay, karen, do you have?
• 59:38
  Speaker 3: any pets I do.
• 59:40
  Speaker 3: I call them my little jetsy girls.
• 59:42
  Speaker 3: She's a black cavoodle.
• 59:44
  Speaker 3: Oh, my goodness, she's a lot of my last, and so she's almost 14 and she's a little black cavoodle.
• 59:52
  Speaker 1: Yeah, she's so cute.
• 59:53
  Speaker 3: She's awesome.
• 59:53
  Speaker 3: First she's like in the human years, she's like 95 or something.
• 59:57
  Speaker 1: Yeah, little lady, all right.
• 59:59
  Speaker 1: What are you most excited about if you look forward in the future of pelvic health, pelvic physio, pelvic rehab what are you most excited about?
• 1:00:10
  Speaker 3: Is the expansion of linking to get this.
• 1:00:13
  Speaker 3: Oh gosh, there's probably a few things linking together the history with pelvic floor muscle training but very, very specifically early postpartum that we have like one case study on.
• 1:00:27
  Speaker 3: We have no RCTs on On if you can support the fascia early postnatal and do pelvic floor muscle training do.
• 1:00:36
  Speaker 3: We get preventatively way better outcomes to restore that.
• 1:00:41
  Speaker 3: So I think that's where we're going to head with.
• 1:00:44
  Speaker 3: That is is early postpartum that we're not trying to manage prolapse five years down the track.
• 1:00:49
  Speaker 3: We're preventing it from that case early postpartum.
• 1:00:52
  Speaker 3: That's probably what I'm most excited to see where the research goes.
• 1:00:56
  Speaker 1: That's really cool, that's awesome.
• 1:00:57
  Speaker 1: And then, Karen, last question if you were not a pelvic physio, what would you be doing if you had to pick something completely outside of the field?
• 1:01:07
  Speaker 3: Well, it's probably not completely outside.
• 1:01:09
  Speaker 3: Okay, I'm going to give two answers.
• 1:01:11
  Speaker 3: One isn't completely outside, it's very linked.
• 1:01:13
  Speaker 3: If I was to go back to university, I would probably do a biostatistics degree.
• 1:01:17
  Speaker 3: I'm absolutely a maths nerd.
• 1:01:19
  Speaker 3: My sons are maths nerds as well.
• 1:01:21
  Speaker 3: We love talking maths, complex numbers.
• 1:01:24
  Speaker 3: My son told me the other day this cool equation e to the I, prime minus something, equals zero and it all balances out.
• 1:01:32
  Speaker 3: We're like that's so beautiful, it just balances and so we're complete maths nerds.
• 1:01:37
  Speaker 3: I'd probably go back and do biostatistics as a degree there.
• 1:01:40
  Speaker 3: Or if I wasn't doing that, I'd go back and do a degree and finish my fluency in Japanese.
• 1:01:46
  Speaker 3: Actually, I'd to get my fluency in Japanese.
• 1:01:49
  Speaker 3: I used to be pretty good.
• 1:01:50
  Speaker 3: I'm not as good now, but I would do that and then maybe do more teaching Japan, that sort of thing.
• 1:01:57
  Speaker 3: Yeah, so I'd probably do my degree in Japanese to get my fluency out there.
• 1:02:01
  Speaker 3: That is wonderful, cool.
• 1:02:04
  Speaker 1: Oh my gosh, I'm so excited.
• 1:02:05
  Speaker 1: I love this conversation, thank you, thank you.
• 1:02:08
  Speaker 1: Thank you so much for your time.
• 1:02:09
  Speaker 1: I'm so excited to see you in Atlanta.
• 1:02:11
  Speaker 1: For those of you who aren't following Taryn, you need to follow her.
• 1:02:15
  Speaker 1: Probably You're not on Instagram, right?
• 1:02:17
  Speaker 1: Is that?
• 1:02:18
  Speaker 1: Penny Does not work on Instagram.
• 1:02:21
  Speaker 3: This is the terrible thing.
• 1:02:22
  Speaker 3: I don't advertise at all.
• 1:02:24
  Speaker 3: I mean, I have my personal social media accounts, but it's just not my thing.
• 1:02:30
  Speaker 3: Yeah, so I have a main website and outside of that I'm like oh, Instagram, Twitter, Mm.
• 1:02:36
  Speaker 1: That's just all of you.
• 1:02:37
  Speaker 1: Yes, right, but your website is whgacomau, correct.
• 1:02:43
  Speaker 1: Yes, it is Beautiful.
• 1:02:44
  Speaker 1: So you can reach out to Taryn on there.
• 1:02:46
  Speaker 1: Make sure you check out all of her courses and we will see you in Atlanta at Polycon, right.
• 1:02:51
  Speaker 3: Call away.
• 1:02:51
  Speaker 3: Thanks so much for having me Perfect.
• 1:02:57
  Speaker 2: Nicole, first of all, what a great interview.
• 1:03:00
  Speaker 2: Holy cow, just being able to listen back to that.
• 1:03:02
  Speaker 2: That was amazing, and I think it was really neat to see that it started with Taryn's unique training.
• 1:03:09
  Speaker 2: Who else gets to work that closely on the medical side?
• 1:03:13
  Speaker 2: She probably knows more about the medical side of all of these conditions than any other PT or physio or OT ever.
• 1:03:21
  Speaker 2: Right, I mean that's crazy.
• 1:03:23
  Speaker 1: I think honestly, some of her perspective of getting to do that in the first part of her career, like right out of the chute, like she mentioned in the podcast, it really shapes her understanding of what our role is as rehab providers.
• 1:03:39
  Speaker 1: Because I was asking her a little bit offline, based on that story, would you want to be a surgeon?
• 1:03:44
  Speaker 1: And she goes well, no, I mean, I didn't.
• 1:03:47
  Speaker 1: I still a physio, I love being a physio and so what's really cool about this is that, even with all of that knowledge, she still has such a reverence for what we know and do and our ability to have a say in the musculoskeletal and neuromuscular diagnoses of things and not just stopping at what would be considered a simple diagnosis like prolapse or stress, hearing and hearing incontinence, but actually saying no, what is the actual problem?
• 1:04:20
  Speaker 1: Is it urethral hypermobility?
• 1:04:22
  Speaker 1: Is it a fascial defect?
• 1:04:23
  Speaker 1: Is it truly a muscle function problem?
• 1:04:26
  Speaker 1: Is it a strength problem?
• 1:04:27
  Speaker 1: Is it a recruitment problem?
• 1:04:28
  Speaker 1: Is it a timing problem?
• 1:04:30
  Speaker 1: Like all of it, like we have such a say in that.
• 1:04:33
  Speaker 2: And it actually matters, and it matters.
• 1:04:35
  Speaker 1: It matters for how you treat it.
• 1:04:36
  Speaker 1: It matters for the patient on whether or not you can predict whether some conservative care is actually going to work.
• 1:04:42
  Speaker 1: I thought her perspective on why there is such friction between surgeons and physios was really, really insightful.
• 1:04:51
  Speaker 1: Us having both of that skewed view of each other's practice I mean that alone is a game changer to have your mindset shifted, Because I think we get so frustrated with physicians and it's easy to scapegoat them as a big, huge problem.
• 1:05:08
  Speaker 1: But her perspective on actually we both have skewed views of our patient populations and what the other person is doing I mean this conversation was really cool.
• 1:05:17
  Speaker 1: You guys are going to have to go back and listen to it a million times over.
• 1:05:20
  Speaker 2: It is going to be great and for those of you guys who are on the fence about the recording, make sure you grab that.
• 1:05:26
  Speaker 2: Talking about pest refitting, I mean Taren has fitted so many pestries, trained so many people in doing that, from a time when it wasn't even thought of or allowed here in the United States.
• 1:05:35
  Speaker 2: It's one of the benefits of bringing in someone who is a totally different perspective, a totally different country, a totally different continent of experience to offer and her thoughts on pest refitting, on prolapse, on stress, here in incontinence If you guys are seeing those or treating those, it's so important.
• 1:05:50
  Speaker 2: I also loved hearing Nicole, because you and I talk a lot about research and hearing Somebody who is dove into the research, so much have that same perspective of sometimes, actually most of the time, the abstract doesn't convey what the paper says, the conclusion certainly doesn't.
• 1:06:06
  Speaker 2: The discussion might get a little bit closer, but the juice is in the methods and sometimes the paper isn't even saying what the people think it's saying.
• 1:06:13
  Speaker 2: I thought that was so cool conversion, evolution, something that you said, that you and I have talked about on here.
• 1:06:19
  Speaker 2: But it's so true.
• 1:06:20
  Speaker 2: You can't just read that 450 character abstract and think that you've gotten anything from a paper.
• 1:06:28
  Speaker 1: Yeah, absolutely.
• 1:06:29
  Speaker 1: And you know, Jesse, I know you have influenced my thinking in that quite a bit with your research background, but hearing it from somebody who's started in the field doing research in RCTs and everything like that, it's very enlightening and it really makes you wonder about how we're even gleaning anything from any research if it's that complicated and complex and also sometimes it's just not saying what, like you said, the researchers think it's saying or what it sought out to say.
• 1:06:58
  Speaker 1: And so I think that doing something like her research symposium that she does, where she loves that stuff, she goes through it.
• 1:07:05
  Speaker 1: Thank God for her, because I sure don't want to do that, and that's awesome that we have somebody in our field that we can look up to that is summarizing the research like that every couple of years.
• 1:07:15
  Speaker 1: I just thought that is fascinating as well.
• 1:07:18
  Speaker 2: So, guys, hope you enjoyed that conversation with Teran Hallam.
• 1:07:21
  Speaker 2: If you are coming to Public Con, we cannot wait to see you.
• 1:07:24
  Speaker 2: It is going to be so much fun.
• 1:07:25
  Speaker 2: As we take over that hotel, make sure you've got your add-ons, your swag, all the stuff you need, and bring the noise, bring the funk.
• 1:07:32
  Speaker 2: It is going to be so much fun.
• 1:07:34
  Speaker 2: If you want to be there in spirit, make sure you pre-order those recordings.
• 1:07:38
  Speaker 2: Get that $50 off.
• 1:07:39
  Speaker 2: You can find all the information at Pelviconcom.
• 1:07:43
  Speaker 2: So, as always, guys, thank you for listening.
• 1:07:45
  Speaker 2: Hope you enjoyed this.
• 1:07:46
  Speaker 2: We want to keep this conversation going.
• 1:07:48
  Speaker 1: And let's continue to rise.