Pelvic Floor Physical Therapy: 5 Things You Need to Know wit…

Brett Scott  00:00

All right. Welcome back to the barbell therapy podcast. I am your host, Dr. Brett Scott. And with me here today is Dr. Kim blown Mo. And she is a doctor Kimble, almost slash to be Dr. Norton, just getting married in a few weeks. So she is here today to talk all about pelvic pain, pelvic dysfunction, and all things related to pelvic floor. So I’ve had the pleasure of working with Kim for quite, maybe three or four years now. Yeah, because I had a powerlifter weightlifter referred, that was dealing with some back pain, also some pelvic issues. And we’ve met a great referral source for one another back and forth and kind of complemented each other in the rehab process. And so to me, the pelvic floor space is something that is not completely unknown to me. But it’s not something I treat on a regular basis, or really know all that much about how to treat, sometimes we will see these things in our email, can we be like, Hey, I have this could this be related? Could this be something to do with pelvic floor, and then I get these emails with all kinds of information, and then where I learned plenty, but then you get my assays back.

Brett Scott  01:18

But there’s a lot that we see on our end is orthopedic PTS that people present symptoms with, where they could have groin pain, they could have low back pain. And sometimes these are the common things we see. And if you’re someone out there that has these things in they’re not making sense, and they’re not getting better. They’re not responding to PT, there’s a potential that you could have something else and when we have these conversations with patients about is there something else going on? Do you have issues with constipation, diarrhea, completely emptying yourself? Peeing yourself? Problems with erections for men out there? You know, incontinence? There’s so many different things. It’s like, oh, yeah, actually, I have been dealing with these things that didn’t want to tell us. But these are all things that could be related to pelvic floor. And there’s a host of other things, too. I’m sure I’m not thinking of so my guest here. Kim is on to present some of those things for us. So, Kim, thanks for coming on. And tell us a little bit about yourself and your background in the pelvic floor space.

02:26

Yeah, thanks for having me. Um, so I’ve been a PT for six years. And I’ve been at the Pelvic Health and Rehabilitation Center in Lexington for the last four and that’s 2018 Four years ago is when I decided to specialize in pelvic health. So I’ve been a pelvic health specialist since then. So I really really love the education sphere of pelvic floor physical therapy. And so since 2018, I’ve been a guest lecturer at UMass Lowell as and I did prior to COVID at Mass College of Pharmacy and health sciences as well give their pelvic health lectures to their PT students. I am a clinical mentor. So I lead weekly discussion groups and answer you know, when some of the newer staff have questions about their cases, you know, I help kind of walk them through some of the complexities. I’ve been teaching assistant at a complex pelvic pain syndromes course. And neck two months from now, shortly after my wedding, I am going to Kenya with my company, as well as the Jackson Clinic Foundation and we are going to teach Kenyan physical therapists how to specialize in pelvic floor. So I’ve been keeping myself busy.

Brett Scott  03:51

Yeah, sounds it so for everyone that doesn’t know Kim, she knows her stuff. And she’s someone that I trust all my patients within we’ve sent plenty of patients back and forth. So you know, there’s a whole host of things I have to ask myself today and things I want to learn from this talk. So the first thing I think people need to know is what are like the big common misconceptions that are around pelvic PT so for me, the big ones are pelvic PT isn’t for men. I it only has to do with post pregnancy issues or peeing yourself. And, you know, I’ll just go there and they’re gonna have me Duke eagles.

04:31

Yeah, so those are definitely three of the big ones. And unfortunately, you know, they’re these misconceptions are very common, but they are just that they are misconceptions. And so, you know, talking about pelvic floor PT isn’t for men at our company. So we have two locations on the East Coast. We have one in Merrimack New Hampshire and one in Lexington mass, and we have eight in California. And we really specialize in the treatment of pelvic pain more. So the on pregnancy, postpartum are more you know any other of these subsets of pelvic floor PT. Now we see a lot of that stuff as well. But you know pelvic floor PT being for men company wide, we see about a 6040 split. So we do see a little bit more female patients than male patients at this point. But we see, almost half of my caseload is people who are born with a penis, and you know, absolutely also we see people, you know, transgender individuals, we see people you know, of all genders. And my big thing that I always say anyone with a pelvis can have pelvic floor dysfunction, right? Anyone who has a pelvic floor that functions can have pelvic floor dysfunction. So absolutely, it’s not just for men. You know, thinking about pregnancy and postpartum you know, very personally speaking, this isn’t a company wide statistic, but probably 20, maybe 30% of my patient caseload is pregnant or within the first year of postpartum. So again, it’s absolutely a thing that can happen to your pelvic floor, it’s a thing that can cause pelvic floor dysfunction, but it’s not all I see. And then they’re just going to have me do key goals. I think we’re going to get into a lot more depth on this later in our chat. But know who you know, key goals are great key goals are really important in a very particular subset of folks with pelvic floor dysfunction. And so, you know, when you broaden that definition of you know, considering all my patients with chronic pain, considering my patients who are post op, considering my patients who have endometriosis or other you know, pelvic pain conditions, constipation, if you’re having an issue where your pelvic floor muscles aren’t relaxing effectively, to let something happen. And, you know, in my world that could be constipation, like not relaxing effectively to poop, or not relaxing effectively to allow for comfortable sexual penetration or a comfortable gynecological exam. key goals are the last thing you want to do in a patient like that, because it’s going to take a tight muscle and make it tighter. And the other big misconception regarding key goals that I often see is in that patient subset who might benefit from key goals, right? If you’re, you know, it’s not exclusively to postpartum women, but or we’re, you know, postpartum people, but in the patients who do benefit from key goals, there is so much more to my job than saying, Great, go do key goals, right? You know, that’s, you know, in the Ortho world, like saying, you sprained your ankle great, go strengthen your ankle. Like, no, you know, as a PT, okay, well, are we talking about strength, endurance, coordination, motor control? You know, are we looking at you, if you sprained your ankle? How would you run now? You know, it’s so much of a bigger picture, when we talk about key goals. You know, are you leaking under a lot of pressure over a short time, like a cough or sneeze? Are you leaking when you’ve been walking for half an hour, and now your pelvic floor endurance is poor, and your muscles can’t keep up with that demand? Are you leaking when you start adding a complex activity to that or you leaking in the middle of the night? You know, so, it really there is, is so much science and so much more specialization to this man. You know, if I just saw postpartum people who leaked, I’d probably be out of a job, I would see a much smaller client all than I’m really seeing. Yeah,

Brett Scott  08:45

I think the other big thing that needs to be known by just about everyone, especially when I think it’s 80 million of people, or more now have back pain. And this is why I sent my patient to you of, I had a patient that had some back pain had some groin pain and some hip pain. And mechanically, I didn’t find anything that really was reproducing her back pain symptoms, but she had this pain that was going and then she told me she had some issues with some endometriosis. And they went in and did a procedure to scan and look for things and they didn’t find anything. And then the next answer she got from the doctor was, well, we’re just gonna do a surgery. And I was like, hold on, let’s let’s not do surgery, just because we did it because we didn’t find anything. Let’s just take it out. Maybe sometimes it is the answer, but I think people should look at well, let’s not just look at structures but let’s look at function to have is there just something I’m doing not as optimally as I could be in prevent something completely unnecessary and potentially that has a dangerous effects to it as well.

10:01

Absolutely. And specifically with endometriosis now, endometriosis, we believe affects one in 10 people who were born with vaginas, right? So we are learning so much more about it. But at the moment, the only gold standard way to effectively diagnose endometriosis is actually with surgery. So sometimes if you you know, want that diagnosis or that’s, you know, important to your treatment plan or in order to effectively remove the Endometriotic lesions. Sometimes, yes, surgery is absolutely necessary, but I definitely would the reason I say we believe it’s one in 10, the actual rate might be much higher, because we’re not giving a laparoscopic surgery to any person who has the symptoms of endometriosis. You know, we it, it’s something that we’re kind of working through, you know, very often these patients are treated with oral contraceptives to suppress the hormones that cause the pain associated with Endo, but we

Brett Scott  11:06

Yeah, we we think the number is realistically much higher, but I often see patients who have unnecessary surgeries for so many other reasons. And yeah, this particular patient that we saw together, you know, there was a lot of other stuff going on. And even actually, without doing a pelvic floor exam, I was able to help you and a few other ways, in part thinking functionally but apart looking more closely at the groin, even externally, you know, there was a lot of other contributing factors there.

Brett Scott  11:42

What other unnecessary surgeries or procedures do you see that people are potentially having done that might not need done?

11:51

Well, again, you know, endometriosis, laparoscopy is not an unnecessary surgery. That’s the gold standard for diagnosing endometriosis. So that is a really important distinction to make. But, you know, I very often I don’t know how much I would say, unnecessary surgeries I see. But I would say that I see surgeries that I kind of wish the person had been to PT prior to surgery, rather than seeing me post op. A lot of times, this has to do with pelvic organ prolapse repair. Also inguinal hernia surgery. So someone who has an inguinal hernia, you know, very well may ultimately end up needing surgery. But if you can strengthen and support their pelvic floor, if you can support their transverse abdominus, they may be able to use their muscles effectively enough to reduce the urgency of a need for that surgery. You know, because very often I feel like patients are like, I’m in so much pain, I just need this surgery to make me feel better. And I think there’s so much conservatively, you know, both on the pelvic specific side and on just the general orthopedic side, that we can do. And you know, it’s also fairly common to have complications post operatively, that can result in pelvic pain as an example, post hernia surgery is common to have an injury to the elbow, inguinal nerve, which can result in groin pain. So we absolutely, you know, I want people to not undergo surgery, when there’s stuff we maybe could do prior to surgery to help. And if we go through PT, and the patient isn’t meeting their goals, and we know that there’s this underlying structural thing, we say, Hey, okay, you know, maybe it is time for surgery, maybe you know, we’ve done what we can and PT, maybe you should go and explore that Avenue, and then come back to us for post op rehab. Another example of which is surgery for pelvic organ prolapse. So you know, when someone has either a bladder sling or trans obturator, taped kind of support in Oregon, that’s descending in a way that it shouldn’t be. PT has been shown and pelvic floor PT to rehab prolapse up to one grade. And so we can do a lot to support a patient to improve their function, and to help their quality of life without having pain or discomfort associated with these conditions. And so I wish that a lot of people knew that this existed as an option because I can’t tell you how many times a patient of mine is like I’ve seen six other doctors. I’ve been in pain for five years, and you’re the first person who’s had any idea what I’m talking about. And I really, that’s what’s important to me is getting help for these people. And in a conservative way where hey, listen if surgery is down the road for you, okay? But I want to know that we’ve explored all other conservative options because PT we’re not doing we’re changing your tissues. We’re helping your A brain communicates your body better, we’re strengthening we’re supporting. But we’re not cutting, you know. And in that regard, I don’t feel like we’re doing anything that we can’t come back from, right? Like, if you do a surgery and you have scar tissue, you just have that scar tissue now, and There absolutely are interventions to minimize it. But we’re not changing the basic structure of those tissues, you know, we’re helping them function better.

Brett Scott  15:25

Yep. One thing we see on on the orthopedic side a lot, then this can very well relate to pelvic floor dysfunction is herniated discs. Right. So it’s like people people’s first thought is, well, I have a bad I have a bad back, I have a herniated disc. And I need surgery to fix this. Because I’m in pain, because it’s structural. And that’s just not the case. So when you come into PT, it’s like, well, how did you end up with a herniated disc? It’s not that you just have a bad back, there’s been something going on that led up to this. And for us, it’s like, one of the biggest things is, well, how well do you know how to brace your core? Can you stabilize it under different contexts or conditions, and most of them can’t, or they don’t do it as well as they need to for whatever activity or demand they’re putting on themselves. So I teach my power lifters to brace much, much different than I teach a runner, but the same fundamentals come down to, we need the pelvic floor to work. And if it doesn’t, and you go have a surgery, and you go back, well, more discs can just further herniate. So let’s fix the source of it first. And most of the time with herniations, even though they’re structural, they can heal, they can resolve it, we can go back to a completely 100% pain free life without any surgery, and then get in go back to normal living. So

17:00

and, and speaking of that, too, so patients who so there was a study that showed 95% of patients that had lumbo pelvic pain, had pelvic floor dysfunction on exam and 83% had one or more pelvic floor conditions. So we really I think as an a whole need to be screening our orthopedic back pain cases for potential pelvic floor involvement, because it’s incredibly common. And you’re right, if you’re not fixing the functional issue, you know, throughout the abdominal canister. So including, you know, I always with every patient, you know, if I just looked at the pelvic floor and didn’t think about, you know, the back the MultiFit eye, the transverse abdominus, the diaphragm, the posture, the movement strategies, I’d be missing a large part of that picture. And so I always assessing all of those things with, you know, every patient.

Brett Scott  17:57

Yeah, and so for those out there that don’t have a full understanding of the pelvic floor, can you just touch upon how the pelvic floor can affect backpay?

18:09

Sure. So if you think about your abdomen as though it’s a canister, or a can of soda, at the top of that can is your diaphragm, and at the bottom, and that can is your pelvic floor, wrapping around the walls is your transverse abdominus. And in the back is the MultiFit i in the back supporting musculature. So, you know, I’ll give a different example. And then I’ll kind of lead in, if I were to cut a hole in the sight of that can of soda. And then I shook up the can it would leak, right, if I were to pop a hole in the bottom or pop the top open and shake it up, it would leak. So that’s an easy way to understand how a certain type of pelvic floor dysfunction again, it gets much more nuanced than that, but can contribute to pelvic floor dysfunction, right? So now imagine if I had a can of soda and I were trying it were sealed and intact and everything was working beautifully and I can’t have soda and I were to crush the sides of the can, I really wouldn’t be able to deform that can it would keep its integrity because it has even pressure on all sides and it has appropriate support throughout. Now if I were to warp the can in different ways, right? So if you think about you know, a typical posture as pretty straight pretty upright. Now think about you know, either your, you know, 80 year old grandmother who’s really hunched forward and now your pelvis is tucked under your butt. Or think about you know, someone who has a significant arch in their back and they’re sticking their booty out a little bit. Now you’ve taken that can of soda and you’ve twisted it or you’ve angled it. Okay, that a makes the pelvic floor muscles have to work harder to To support you, because you’ve changed the way that you maintain pressure throughout the rest of the can be as we as PTS know, muscles have an appropriate length tension relationship. So when a muscle is overstretched or over compressed, it doesn’t function as well as when it’s at its appropriate resting state. So you’ve changed some of that length tension relationship. Okay? So you’ve basically put this can in its worst possible position, but it’s holding everything together. Now something happens, you know, and you cough or you sneeze, or you know that one time I lifted that thing wrong. And now you have a back issue. It’s has a lot to do with how your pelvic floor muscles are supporting your pelvic organs and that abdominal canister, but it also has to do with your core with your back muscles with everything along the way. Does that answer your question? Well, yeah, I think that’s a bit of a tangent. That’s

Brett Scott  20:57

okay. We like tangents here. And then I think the other thing is the snowball effect that can have down the line of the other things that start to go wrong from that. So like, when I see patients, and they have these, like giant knots and trigger points in their glutes, and doctors and things like that. I’m like, whoo, okay, what, why is this here, so what’s going on there?

21:23

Yeah, that’s actually something else that I realized I, I should have included. So a really important way that a little more directly pelvic floor muscles contribute to back pain is referral patterns of trigger points. And so we can actually palpate and access, you know, hip muscles in the pelvic floor, piriformis and obturator internus. Or you can palpate, the proximal attachment internally, and trigger points, often in the pelvic floor, you know, in all of the muscles of the pelvic floor, almost all the muscles of the pelvic floor can refer pain to the back to the tailbone, to the hip to the groin, to these other external areas. So when a overworked muscle has now become tight and dysfunctional, and has these knots and these trigger points, you know, I very often can touch someone’s pelvic floor muscle internally and have them go like, Oh, my gosh, what was that you just cause my normal back pain? And that’s how we know really directly that the pelvic floor muscles are involved in that way, too.

Brett Scott  22:29

And so when you say internally, what are you talking about, because I think I’ve sent some patients your way. And I think they went to one went to the Merrimack office because it was a little bit closer. But he came back. And he was not happy with me on the type of massage he got.

22:45

It’s not massage, it’s manual therapy, right. So you know, as PTS we’re really not massaging patients. For the purposes you’d go to, like, you know, a Massage Envy for right. But we do absolutely use our hands to make changes to muscles. And the only real way that we can access the deeper muscles of the pelvic floor is internally. And so we also do provide a handout to all of our patients that says, hey, this is what to expect when you’re coming in to a pelvic floor PT session. So we look externally, we look at, you know, core, you know, back, hips, everything externally. But yeah, when I say an internal exam, I’m assessing the muscles that live from your pubic bone to your tailbone, that support your bladder, your if you’re born with prostate, your prostate, if you’re born with the uterus, your uterus, and your anus. And so when people have vaginas, it means I’m putting a finger in their vagina. People have rectums means a button, a finger in the rectum. And first and foremost, we don’t do anything you’re not comfortable with. And definitely actually that patient who we shared. I never did an internal exam cuz she said, I don’t want that. And I said, Okay, that is absolutely your right and your bodily autonomy. But in order for me to feel what’s happening at that group of muscles, I have to feel them and they live internally. So I have to work internally.

Brett Scott  24:11

Yeah, so something I think a lot of people don’t realize that they can get up there and do different things in there. And I’m not sure if this is true, but do you guys dry needle internally as well? Or some people can we can?

24:23

We can Yeah, and I do. I don’t do it often. Frankly. I’m more when I’m dry needling. I’m doing like hips adductors you know, external but pelvic girdle musculature. But absolutely, and I am trained in internal needling, I just I don’t use it very often. I feel like it’s I feel more confident with my hands and my finger working internally and knowing where I am than a needle that I don’t have sensation through or perception through.

Brett Scott  24:52

Sounds just sounds not not fun either to have a needle anywhere.

24:57

And that’s more you know, when you start to have that conversation with Patient you’re like, so here’s what I want to do. Yeah. Usually the the question is like, Is that necessary? Yeah, the answer is no, no, we’ll, we’ll do something else. Yeah.

Brett Scott  25:09

And so what, what typically brings patients to this point of having pelvic floor dysfunction. So like, you know, for me, I know that pregnancy like a natural delivery and childbirth, we’ll do some significant stretching of the muscles and structures of the pelvic floor. But for, you know, men that don’t have children and go through that, what are some contributing factors we see in kind of everyone across the board that can lead to pelvic floor dysfunction?

25:43

Right, so, when we’re talking about pelvic floor dysfunction in general, it could be you know, any number of really pelvic floor Yeah, it could be any anything really, more often than not my patients are of the it’s the straw that broke the camel’s back variety, rather than you know, I fell off my bike and I landed on my tailbone and it was never the same or you know, I had a baby and I had no other risk factors and I didn’t heal effectively, much more often, you know, as I’m kind of diving through my history and when I’m talking to any patient, I’m always asking about their urinary bowel sexual function. I’m always asking about pain. I’m always asking about you know, if they were pregnant, their pregnancy history if they’re a man if they have any issues with their prostate, but you know, diving through each of those categories, some usually it’s you know, history of yeast infections or UTIs. Constipation straining history of birth control us for prolonged periods of time can absolutely contribute to pelvic pain, surgeries. trauma. In men, prostatectomy surgery can absolutely cause pelvic floor dysfunction. menopause can be very often associated with pelvic floor dysfunction.

Brett Scott  27:10

The list goes on. How does oral birth control cause pelvic floor dysfunction on females?

27:19

Yeah, so when the sorry, let me formulate my answer effectively. When we are on birth control, it affects our hormones, we’re flooded with synthetic hormones that mimic the job that our real hormones are supposed to do. And as a result, it increases something called sh PG, which is sex hormone binding globulin, which results in a decrease in free testosterone in our body. So humans, you know, cisgender women need to stop your own men need estrogen. It’s not exclusive to one gender. And so when there’s an increase in sh, PG, and some people are more prone to it than others, and there’s, I believe it’s a genetic coding, I could be mistaken there, that predisposes someone to develop what we call vestibular Edenia. But pain of the vestibule or the opening of the pelvic floor, kind of where the internal vagina meets the external vulva. When you’re not getting the hormones that you need in that area, you can end up with pain, dysfunction, you know, all kinds of stuff. We have a great blog series on my company’s blog, which is pelvic pain rehab.com. All about the influence that birth control pills can have on pelvic floor function and pelvic pain and pain with sex specifically,

Brett Scott  28:49

I did not know that was a risk factor for increasing pelvic floor dysfunction. So that’s an interesting one.

28:57

And it’s the research is well accepted. Like it’s definitely it’s been around for a while, but it’s still kind of making its way to the gynecologist of the world. So seeing a gynecologist who really is well versed in the pelvic pain sphere, and is up to date on this research is really important for patients of mine because they want to, you know, the, I think for so long, the birth control pill was just so widely prescribed because it was easy and accessible. We really wanted there’s a risk of stroke, there’s a risk of all kinds of health complications. And with any medication, you want the benefits to outweigh the risks. And so you always want to see a provider that’s really well informed and who can have those conversations with you in understanding you know, what the right choice for any individual and their medical health is?

Brett Scott  29:44

Yeah, certainly. And it’s interesting you say that because now I’m starting to see and hear, especially where I own a gym too. And we have a fair amount of younger to middle aged women now all coming off of birth control, not because they’re are trying to get pregnant because just the side effects and what we’re kind of starting to see birth control is doing to people from all kinds of different perspectives. And absolutely, I should probably have someone on my podcast at some point to discuss all those risk rewards, too, that

30:18

I have some great names I can I can send you some. Yeah, that’d be great. I work with a lot of great professionals in this arena. Yeah,

Brett Scott  30:25

for sure. That’d be awesome. And so what are some ways are is do you have a stat at all of how many people encounter pelvic dysfunction at some point in their lives?

30:41

Yeah. So I want to disclaimer all of these stats by saying I think it’s very underreported. I think for a lot of reasons. I think that people don’t like to talk about their pelvises, I think that it’s hard to get access to health care and access to a health care professional who’s going to, you know, hear you and help you effectively and be in the know enough again, about the pelvic pain sphere that they can really treat you comprehensively and do something about it. I can’t tell you how many patients who have told me that their gynecologist told them to just relax and have a glass of wine. And that’s not a comprehensive medical treatment. But you know, the the commonly current accepted numbers are about 20 to 25% of people who are assigned female at birth or you know, women have pelvic pain, and two to 16% of men, but we actually suspect that that number is a lot higher because of, you know, this whole thing called chronic pelvic pain syndrome, which very often gets misdiagnosed. Just prostatitis. So I can talk about that a little more, if that’s okay.

Brett Scott  31:50

Yeah, that’d be interesting. I want to hear more about that. Yeah.

31:53

So prostatitis. You know, itis is your inflammation of the, you know, so inflammation or irritation of the prostate is the most common reason that men go to a urologist. And there’s true prostatitis bacterial prostatitis is when there’s an infection in the prostate that is bacterial and it’s causing these irritated symptoms of the prostate. But it’s so there’s a subset that’s called nonbacterial prostatitis, which we call chronic pelvic pain syndrome. And it’s estimated that 90% of prostatitis cases that go to a urologist are actually this chronic pelvic pain syndrome, which does not have a bacterial component. So leaves people go to their doctor, they say, I’m having prostate pain, there are pain with urination or, you know, urgency, hesitancy, you know, all kinds of symptoms. Their urologist, you know, doesn’t necessarily do a bacterial culture and they just say, oh, prostatitis go take antibiotics. They take the SPX and don’t really help, they go back and they see the infections back and they say, Oh, it must have come back and we go on these multiple multiple rounds of antibiotics that were for an infection that isn’t actually bacterial. It isn’t actually there. So the, the statistic is it takes about seven years for a man with chronic pelvic pain syndrome to get a proper diagnosis. And then treatment starts. So you know, he caught out call that 16% of men. That’s not considering these all these people who are getting diagnosed with chronic bacterial prostatitis when they actually have nonbacterial prostatitis and associated pelvic floor dysfunction.

Brett Scott  33:34

No, where should a man so if a man has pelvic pain down there, and they suspect something like, where do they start their their treatment journey? Where did they go first?

33:47

urologist can be wonderful. But again, seeing a urologist who really knows about pelvic pain because many of them don’t. Absolutely, I think a multidisciplinary approach is the right answer. So absolutely go see your urologist get ruled out for anything medical get ruled out for bacteria, but also see a pelvic floor PT, you know, I think that that is a really important associate associated provider and you know, I’m biased I am one but, you know, you just like you, you know, you want to see the right specialist for the right body system, right. You know, I can’t rule in or out a bacterial infection you you absolutely need a urologist to do that. Your ra ologists may not be as effective as a PT or I’d say aren’t as effective as a trained pelvic floor. Physical Therapists are ruling in a row pelvic floor muscle dysfunction, and you can have both happen at the same time.

Brett Scott  34:44

And how does a non How does nonbacterial prostatitis occur like What are some common occurrences that happen that, you know, precede the onset of that

34:59

so When I see a patient who is presenting with that, they’re usually telling me, you know, it’s that same straw that broke the camel’s back, they usually have a long standing history of constipation, maybe they’re a powerlifter. Maybe they, you know, sit on the bike seat, maybe a triathlete who’s doing a lot of cycling. And basically, through, you know, they, maybe they’re stressed, and they’re clenching and guarding their pelvic floor muscles. But through kind of, you know, a long series of associated pelvic floor triggers, they end up with a pelvic floor that is too tight and isn’t relaxing effectively. Okay? When your pelvic floor muscles, especially what we call the Euro general triangle, so the muscles that support the base of the penis and men, the same muscle group in women surrounds the opening of the vagina, these muscles, if they’re really tight, and they can’t relax, they can irritate the urethra by just mechanical compression, you know, they’re causing an inflammation irritation locally, they can also have trigger points or knots in the muscles that are referring pain to the bladder, or referring pain to the urethra, they may not be able to relax those muscles effectively to get the pee out. And now they’re saying they have hesitancy when they pee is that like, I stand at the toilet and nothing happens, you know. So all of these symptoms can mimic a true UTI.

Brett Scott  36:26

Very interesting. And so we touched on to have people think just how or have this assumption that doing key goals can make them better when it actually sounds like what I’ve heard before too, is sometimes key goals can make certain people’s people worse. And you need to be really careful about choosing that as the exercise prescription for yourself. Or if you’re working with someone and you don’t know much of as much about the pelvic floor. So are there ways to like classify and group people so like, what what, from what I know from talking to you a lot is we have people that can be hypertonic. So very much an increased tension on the muscles, they’re not going to be muscles that can relax, they don’t want to be stretched, or we can be the other way of we can be hype, oh, we’re low. So low tone where they want to, they can’t contract a very relaxed, they’re almost too relaxed to function properly. So up there. And this is more of one of the questions that I wanted to know more about is, how do we classify those things? And what did we see presented to us?

37:40

Yeah, so when I’m, if I’m narrowing into just the pelvic floor, you know, and again, my job, I’m looking so much externally as well. And functionally as well. When I’m talking about the hammock of actual pelvic floor musculature, it can I narrow down to one of three things and they can all you can have more than one at the same time. So it’s either low tone, which is a weak pelvic floor, that is your, what everyone assumes is the postpartum need to do key goals. thing, you know, there’s no one diagnosed knowing a diagnosis is actually there’s no way if you just say someone is leaking urine when they cough or sneeze, they must have a blank, high tone, low tone, pelvic floor, you can have whatever symptom or diagnosis with either a high tone or low tone condition. But sorry, that was beside so low tone pelvic floor needs to be strengthened, that is a muscle that’s too weak to function. high tone pelvic floor is a muscle that’s too tight or too guarded, okay, so you can kind of have one or the other or you can even have may see very often, patients with high tone, like hip stabilizers, like patients with a trigger point in their obturator or patients with a trigger point in their performance or in their glutes, but who aren’t utilizing the superficial muscles that hold in their urine effectively, right? So you can have pain with running because your hip stabilizer has a trigger point, but also leakage of urine because your your general triangle is not working. Right? Right. So you can have kind of high tone, low tone or both. And then you have what I call motor control dysfunction. You can, you can engage, you can relax, but you’re not doing the right thing at the right time. So more often I’ll see someone whose primary high tone or primary low tone, who also has motor control deficit and we have to really, you know, I like shoulders is an analogy and I noticed as a podcast with audio not that not as many people are going to be watching the recording. But when we think about high tone, I think about that person has their shoulders height to their ears all the time. Right. And so if I’m that person I have my shoulders hiked up in my ears all the time and someone says shrug your shoulders. And I try and it goes nowhere, right? It looks like it’s weak, it looks like I can’t execute the movement you asked me to do. And so if you go and put your hand on that person’s shoulder and you’re like, Wow, your upper traps are lit, like you need to bring your shoulders down and relax. That is a really common presentation, I see in the pelvic floor where the muscles are so high tone and guarded and tight, that it almost looks like a weak pelvic floor, if you don’t actually ask them to try and relax or to downgrade, or to kind of assess the other side of that scale.

Brett Scott  40:38

Interesting. So just so I can double clarify here to someone. So like the presentation we see. So as we talk with patients a lot is like the mobility, stability continuum, and kind of phenomenon of this interchange. So yeah, for people out there that have been patients of ours, in our clinic, we talk a lot about proximal stability gives you distal mobility, right. So if our core that’s supposed to be stable, is then we can be mobile at our hip, however. So basically, what we’re saying is the pelvic floor is still part of the core. And if we don’t have the right tone there, so if we’re, if we’re high tone, or dysfunctioning, with high tone in the pelvic floor, we’ll see a lot of trigger points and stiffness through the hip the the internal external rotators of the hip. And in all those pieces. Yeah,

41:37

I was gonna say how much more proximal can you get than the pelvis? Right? That’s where all of our load is transferred from, that’s where all of our stability comes from. That’s such a major orthop orthopedic sight.

Brett Scott  41:51

Now, will you see? Could someone with low tone through the pelvic floor also still have these trigger points and everything in like the hips and adductors and such?

42:03

Yes, generally less common. However, you know, somewhat often, we’ll see patients whose basically, you know, the cookie, we all say it is your pelvic floor is not holding up its end of the bargain, right. So if your pelvic floor muscles aren’t supporting you, and they’re too weak, now, you’re over engaging your hip stabilizers, you’re over squeezing your adductors. And your your core is not working effectively, you might be kind of all clench through the mid back and the low back, or if you’re not breathing effectively. So you’re gonna see trigger points in associated muscles of the dysfunction. And so, you know, this is why it’s, I’m a manual therapist, you know, I really, I like working with my hands. And it’s really important to what I do, but you know, I call it zoom in, zoom out, I zoom in, I look at the pelvic floor, I see what the dysfunction is there. But then I zoom out and look at your posture, how you move how you walk, because what’s going on in the neighborhood, like what’s going on in all of these other, you know, more distal muscle groups, because it’s going to be the day is going to affect b and b is going to affect a

Brett Scott  43:11

for sure. And I think the hardest part of this for anyone. So there’s, there’s really because as you said earlier, there’s no way for someone to truly like self diagnose or get an idea of what they’re doing. Because you really need to kind of put your hands in there and figure out if it’s high or low tone Correct.

43:31

Among other things,

Brett Scott  43:32

depth in depth history taking and everything else. Yeah. Okay. And is there a point where people should start searching out treatment or when certain things happen? Because I definitely, as you said, I think things are much underreported. And there’s been a multitude of cases I’ve had where it’s like, okay, things aren’t adding up. Let’s ask her questions. And in especially men, more women more I have, especially all the women you’ve sent me. We talk about, you know, urine, peeing pooping issues, they have pain in what they have with no problem where men are like, Why are you asking me this question? They’re very defensive about it. Sometimes it’s like, it’s okay. Yeah, I’m a medical provider. This is a safe space. But But this affects your care. So you need to tell me what’s going on down there. So

44:28

and like, Thank you, thank you for having these conversations. Thank you for normalizing these conversations. Because so often men, anyone, anyone of any gender, I can’t tell you, even women, how many people I’ve seen, I was like, I’m so embarrassed. Like, I don’t want to talk to you about this. And, you know, I think if you come to my office, you know that that’s what you’re in for, you know, pelvic is in the name, you know, we’re going to talk about your pelvic function. But I think I really want to see us as a society come a long way in normalizing talking About pee and poop and sacks and our our pelvises, you know, it’s it’s important to everything we do, and it can be a symptom of something bigger. So, you know, when should someone kind of start? I think we even having a conversation surrounding what normal function is, I think is a really important place to start, because so many people to come in and I’m like, Do you have any, that one of our, our intake form? Right, it’s do you have any concerns about your urinary function? Do you have any concerns about your bowel function? Do you have any concerns about your sexual function? I still with every patient will say, Okay, I know you said you have no concerns about your bowel function. I’m just going to run through what’s normal. And you tell me if if this matches you? Great, awesome. See you later, we won’t talk about your bowel function anymore. But more often than not, I start diving into the more of the specifics. And like, Oh, that’s not normal. Like no, you know, this is this is an associated symptom of pelvic floor dysfunction. If you send

Brett Scott  46:02

me that you’ll probably get patients. What they’ll question your level seamless. Oh, gosh.

46:13

I mean, I, I’m happy to talk about it. Right. Yeah, go

Brett Scott  46:15

ahead. We should, we should, because I think a lot of people, and I, myself, I didn’t realize it. So I had, for two years, I was dealing with a parasitic infection. And I have all kinds of digestive issues. And as we’ve talked about, on another podcast that I did with Wil Mills, a few months back, the like, you get the squat farts. And I knew something was wrong, but it was more food and digestive related than it was like pelvic floor, because if I ate like a very bland diet, it would all go away.

46:49

So SIBO. Also, SIBO is a fairly common small intestinal bacterial overgrowth, I have anything that affects our gut microbiome is going to affect our pain. I had a mild

Brett Scott  46:58

form of SIBO as well. So that wasn’t fun. But once I got over that, I like it, because it happened so slowly. And gradually that symptoms came on that I kind of forgot what normal was. And once I got treated the right way for all these things, I was like, oh, yeah, that’s that’s how it was supposed to be. So go ahead and go through some of these things of what normal is. Yeah.

47:19

And that that’s a super common thing I hear a lot to have, like, once patients see me and they start to feel better. They’re like, I forgot, like pooping was supposed to be easy. I’m like, Yeah, because they’ve been dealing with this dysfunction for so long. So you know, the way that I usually kind of phrase it to patient, I’m like, urinary function. Alright, so tell me if this is you tell me if this isn’t. You go into the bathroom every two to four hours when you’re awake. Generally, you get an urge that comes on fairly appropriately, like, Hey, I’m gonna have to pee soon. All right, it’s time for me to pee. You can hold your pee until that point in time that you can get to a bathroom. When you’re in the bathroom, you sit down, you pull your pants down, up, starts right away, comes out all at once. There’s no pain, there’s no leakage. You feel like you’re totally empty. Your urine stream quality is normal, and you’re not power peeing or drip, drip dripping. You wipe you get up you leave. That’s what should happen. And usually it’s every two to four hours when you’re awake. Obviously, it depends on how much water you’re drinking, it depends on you know how much you’re sweating, you’re exercising a lot of other factors. And under the age of 65, if you’re waking up zero or once per night, that’s normal. If you’re over 65, we lose some bladder elasticity. So you might be waking up twice a night. And your bladder generally shouldn’t wake you to pee you if you’re waking besides maybe once a night, if you’re waking up four times a night to pee but you’re waking up because the cat jumped on the bed you’re waking up because your partner snore, you’re waking up you know for some other reason besides your bladder, it’s less indicative of a pelvic floor issue. So that’s kind of normal urinary function. normal bowel function follows a similar what happens when you’re in the bathroom, you know, you go to the bathroom when you get nervous. The urge comes on fairly appropriately, I’ll say you know, well, I’m gonna have to poop soon. Okay, time to boot. You can make it to the bathroom a time you’re not having trouble holding in your gas or holding in your bowel movements. bowel movements are soft and formed, generally happening once a day, but normal values it could be once every three days. It could be three times a day. And that’s just different per human. You’re not pushing you’re straining me set. It comes out you get up you leave. You’re good until the next time you have to go to work to write Yes, you wait, you said you’ve already wipe you get up. You shouldn’t excessively wipe you shouldn’t feel like you know you have to wipe and wipe and wipe forever. In order to be clean, you should feel relatively clean, no bleeding, no hemorrhoids, no filters, and then normal sexual function. You know I leave it a lot more general I just say you can have sex in whatever way you want to without pain. and do so effectively, you know, and because that sex looks so different per human. And, and kind of we go from there,

Brett Scott  50:09

um, anything else there for normalcy

50:17

that’s the majority of if I’m forgetting something, I might be forgetting something, but that’s the majority of it. And you shouldn’t have groin pain or, you know, you should. Pain is a really big

Brett Scott  50:28

one to know, I want to go back for a second to what you just mentioned. So in the powerlifting world that I live in, I’ve seen plenty of people get hemorrhoids. And I’ve heard a couple of people getting fissures. And, and there’s this term of people, as they call it, blow in an O ring on squats. So that and I think the hemorrhoids thing, and the fissures thing is something that people just kind of accept as like, Oh, I just have this thing like I genetically, I’m getting hemorrhoids for, you know, some random reason. I’m just bad luck. Like I got the short end of the stick. But there could be reason to it to correct.

51:14

Oh, God. Yes. Yes. I think it’s, it’s, I’d say the the opposite of like, oh, yeah, sometimes it just happens. But there could be a reason I’d be like, there’s a reason like, there’s almost always a reason. And, you know, people might have like an underlying this is, again, a multidisciplinary treatment. If you have a SIBO, or a parasite, that’s going to affect your stool consistency. And that’s going to affect how you wipe how you strain how you push, and that can cause a fissure, right? But absolutely, like there’s either if we’re talking about squats and lifting you if you’re lifting with bad form, if you’re holding your breath, and you’re really Val salving, you’re asking your pelvic floor to support you more than it’s capable of doing. And that’s when you, you know, blow an O ring, that’s when you lose support and your pelvic floor is because your muscles tried as hard as they could to hold everything together, and you just asked way too much of them and you lost you compromise that pressure in your abdomen now. And that’s what a hemorrhoid is a hammer. It is a prolapsed blood vessel. So you’re straining so hard that you’re causing a blood vessel to kind of descend into the rectal cavity where it’s not meant to be it’s meant to be in the walls of the rectum?

Brett Scott  52:33

Yeah. And so are, are you saying that just by powerlifting, and doing some of these strength type sports, we’re likely to get them or

52:47

it’s a risk factor. But if you are lifting safely and with good form, you can absolutely lift, you know, very effectively, very safely at very high weights and not have any of these issues. But, you know, I think, you know, in in your world, you know, this form is so critical. And I see patients who are power lifters fairly often, but I see them, you know, when they’re not supporting their bodies, you know, when they’re not training, when they’re not training appropriately, or if they’re, you know, progressing their weights very quickly, and, you know, holding their breath and straining, and, you know, not doing it effective. So

Brett Scott  53:26

you’re not saying that just because some because Valsalva is a technique we use in powerlifting. So are you saying that doing a Valsalva will cause it or just if we’re not supported in the right way that it could potentially cause it?

53:42

If you’re not supported in the right way, it could absolutely potentially cause

Brett Scott  53:46

Okay, and so this brings up another thing that kind of blends us back into the orthopedic world where my my colleague will Mel’s there had brought this up, and it was an interesting concept to hear from a pelvic therapist, and I want to go through it with you. Because you mentioned bad form, and something that I don’t know how much pain science you guys do in your worlds of dealing with things but on our side of communicating with patients that thing it’s like we don’t want to say it’s bad because we we don’t really have anything that says one is better than the other or that if you do this, you’re gonna get hurt because a lot of the research is coming out now saying, well, people aren’t herniated discs if their volume and load is good, and we can flex our spine up to 80% and be fine. But but we still don’t have any evidence that says it’s good for you. Right and there’s this whole thing out here now have formed doesn’t matter technique and biomechanics don’t matter. And a lot of strength coaches and even PTS are getting on this. This train of just keep loading it you loaded. If it’s, even if it’s painful, we can keep loading it. And it’s like, whoa, whoa, whoa. And I’m fair fairly much a stickler for technique and form. Because there’s a huge technical aspect to a lot of these things that we want to do good. And for us we are, I know from what I do know and think that’s, well, if we could do it better, let’s just do it better. Let’s not just do whatever we feel comfortable with. Even though we say might not be bad, we don’t know if it’s good yet. So when we’re talking about that, I just want to hear your perspective on that as far as like, technique and inform and certain ways to do things with training. Yeah, so that was a rant?

55:47

I’ll, no, that’s great. I mean, I’ll be honest, that this isn’t as much of my area of specialization, and this is why we share patients, because I’m like, Great, now your pelvic floor dysfunctions largely resolved, you should go see Brett to get back into powerlifting. Because, you know, I know, this is the area of you’ve chosen to specialize in my, we do a lot of pain science. But I haven’t heard as much about, you know, that. And I guess I’ll clarify, when I, when I guess when I said bad form, I was thinking sub optimal for the individual form, you know, and that doesn’t inherently mean that if they are hinging at the hips, or aren’t hinging at the hips, or are using your, you know, more of your torso versus whatever, you know, I think every human might have a different variation of where they’re going to have their optimal body mechanics. So I’m not trying to make everyone fit this mold of like, perfect technique, or perfect form. But I am trying in my thought process. And again, if there is new science out there, I’m sorry, if I’m not as aware of it, but I’m optimizing how one goes about the tasks that they’re trying to go about, in order to make their function. And that may look different for each person.

Brett Scott  57:07

But I don’t hate that you said bad form, because as Will said, you know, there’s all these coaches saying, oh, and I do believe everyone has different, different things that are wrong with them. And we need to kind of support and facilitate those things. However, there’s this crowd that like, you can’t say bad, you can’t say this, like, everything has to be positive, and anyone can do whatever they want, and we’re just gonna allow them to get better. Or it’s like talking to will, and you it’s like, if you do it wrong, you could pee yourself, you could poop, you could do any of these things. So there is this comes back to like, getting out of pain science, and into biomechanics, and bracing, and all these things still do matter.

57:53

Ya know, and, you know, it’s, it’s a really immediate, like, something like being yourself or pooping yourself or blown and Oh, right. Like, it’s a really immediate form of feedback that, hey, you’re, you did this and something bad happened? You know, it’s like, I imagine a similar equivalent, and in your world, it’s like, well, yeah, you’re, you can like, roll your ankle as you run. And let’s just keep loading that ankle, like, you know, yes, you do want to keep running it, but like, that’s not running and rolling on your ankle is an optimal form of running. Right, you’re, you’re going to injure yourself that way. So, you know, I I’d have to, you know, again, certainly dig into the literature. You know, I understand I’m, I’m not informed on that. But no, I definitely everything I’ve been aware of so far. You know, if you’re leaking when you’re doing something, you’re putting your pelvic floor under more pressure than it’s comfortable here. And there, there is something that, you know, and I’ve very recently heard about this, and something I’m continuing to look into myself, but it’s the thought process of so diathesis RekSai. It’s a separation of your abdominal muscles. So you think of your six pack and you have like two halves of your six pack. There’s a connective tissue that holds those two halves together. So what we used to believe was that if you have a separation of that muscle, you can’t do a sit up ever again for the rest of your life, like Nope, you can’t load that muscle, you can’t live that tissue that’s bad for it, that’s going to hurt you. What we’re learning so much more of is you absolutely can and should load that tissue. If there’s no pain, if there’s no leakage, if you can support with the rest of the supporting musculature, effectively, we don’t want to promote fear avoidance. We don’t want to promote someone not doing so. And this ties back into the pain science. We don’t want to tell people they can’t or shouldn’t or will hurt themselves if they do X activity. But I also think that we shouldn’t be to teaching people you know, to run on the sides of our ankles, rather than on the soles of our feet, you know, like,

Brett Scott  1:00:05

it just it all goes back to, it’s like, there’s all this stuff that’s accepting. There’s this whole side of pain sides, just like keep loading it biomechanics don’t really matter that much unless you’re loading at complete end range. But then it’s like, well, if we’re doing this and putting the pelvic floor in the abdomen in a position that just doesn’t flow with the, you know, the way the body wants to work in a position that’s optimal for it. And then some of what I’ve started with the DNS system in dynamic, or what we call dynamic neuromuscular stabilization, there’s a way the body will perform better when it’s in certain positions. And when it feels stable, it can be mobile, and but if we just start going into like all these, like, you know, big extended type positions there’s a lot of athletes already do. And we keep perpetuating that we could be creating a pelvic floor dysfunction, which could lead to a whole host of other issues. And I just think in the world of biomechanics, versus pain, science, pain, science hasn’t caught on to that with biomechanics, yet of oops, we forgot about this. So it’s just an interesting paradox we’re kind of in right now of because pelvic floor is still fairly new to the world to have people don’t don’t know you guys exist. I talk about you guys all the time. Like, what? They see what they put needles up there. So it’s just,

1:01:35

yeah, I mean, I can’t tell you how many patients I’m like, I’ve been in pain for for 30 years. And no one mentioned this. I’m like, because 30 years ago, we were just figuring it out, you know, just,

Brett Scott  1:01:45

it’s very interesting. And so anyway, anything else you’d have to add on? Like, the powerlifting? Mechanics, stuff like that? Or weightlifting? And? Yeah, I don’t know.

1:02:01

My facetious answer is, that’s what I send them to you for. But no, seriously, I mean, the pelvic floor is, you know, the, the crux of our stability, it’s, it’s where all of our load is transferred from, you know, so taking care of your pelvic floor, especially if there’s an underlying dysfunction, we’ll help you get more out of your powerlifting. You can gentle with, you know, and this is more of a study, I’m going to quote that was about posture. But with better posture, you can get in more effective pelvic floor contraction, you have reduced leakage, you have better strength, you have better ability to lift. And so you know, looking at the whole pelvic girdle, and the pelvic floor is part of that is going to help you in all areas of your life, especially something that’s as physically demanding as Yeah, for

Brett Scott  1:02:47

sure. So that’s good to know. And so for people thinking about this, and maybe hearing this episode now, are there certain credentials people should look for in a pelvic floor? PT?

1:03:07

Yeah, so there are two kind of special T credentials out there. And one of them is P R. P. C, pelvic rehab. Pa, PC, pelvic rehab, certified practitioner,

Brett Scott  1:03:28

we’ll double check it and then we’ll put it in the show notes. Yeah,

1:03:31

I’ll double check it and I’ll add it. Yeah, we’ll put it in post. But um, the other one is the WCS, the Women’s Health certified specialists, which I believe they’re changing because the APTA the American Physical Therapy Association, Chapter used to be the Women’s Health Division, and I’m actually really happy that they’ve changed it to the Academy of pelvic health. So those are two kind of credentials that one might have. But you know, really working on a PT who specializes in pain. So I’m not sure if you guys have talked about this in other episodes or in your world, but as much as credentials are great, you know, the, there’s no, there’s i The main incentive to go get a certification or specialization is your own professional development and education. We don’t get paid more money for having those credentials or, you know, have any other professional recognition besides by people who know what those credentials are. So I’ll say those. One thing I hope that pelvic health providers will move towards is more standardization of training. Because you can be call yourself a pelvic floor PT if you take pelvic floor one on one. You can call yourself a pelvic floor PT if you know like, my bosses have been leading experts in the field for 20 years and unless you go get one of these specific certifications, which doesn’t necessary really indicate your ability to treat pain versus, you know, incontinence versus whatever. It’s, it’s more of kind of a well rounded specialization. You know, there, it’s hard to find a really good provider who’s well versed in your condition. So, you know, reading reviews, calling people and saying, Hey, do you treat men? Do you? Do you see, you know, this kind of world is actually, you know, as kind of annoying as that is, I think that that’s a really good way to kind of that your pelvic floor PT. More, in addition to those certifications that exist,

Brett Scott  1:05:37

and so what about the practice you work out? Is there a difference between going to pelvic pain and rehab versus, like, traditional PT clinic or like in network clinic, even if they do do pelvic rehab?

1:05:56

Yeah, so we at the Pelvic Health and Rehabilitation Center, really, we specialize in chronic pelvic pain, that’s what we do. And so insurance is really tough for any pelvic health provider. Because of the way that reimbursement is structured, you know, things that tend to help our patients specifically in the pelvic floor will get better is one on one hands on care, you know, it’s harder for me to assess someone’s pelvic floor and have them on the other side of a gym. So we really can’t treat two people at the same time, or I wouldn’t want to be treated by a pelvic floor PT at the same time, as they’re treating someone else, I really want them in the room with me, giving me their full attention. And because of in large part, the way that we structure, you know, we’re we don’t take insurance, we are cash based, it gives us the freedom a to not worry about what insurance companies are going to dictate that we can do with our treatments, right? We don’t have to say, well, I get 12 sessions with you, and then your insurance is gonna kick you out. So if you’re not better in that time, good luck, you know. And in part, it gives us the freedom over like the duration of visits to say, what do I really think is going to help this patient most effectively. So sometimes, that means I only want to see you for half an hour, sometimes that means I’m seeing you for an hour, because I have a lot that I want to teach you and do with you. In addition, just my company and presents insurance versus non insurance of pelvic floor PT, my company in particular, you know, met many people in my company, Stephanie Prendergast, one of the CO owners and co founders was, you know, the president of the International pelvic pain society. You know, both of my bosses was a controller, and also Steph Prendergast have lectured internationally, they are leading experts in the pelvic pain field, and they really work with all of us as employees to develop our skills in this area, we have continuing education all the time. We’re writing weekly blog articles, I definitely encourage if anyone is interested in learning more about pelvic health, our blog is a really great resource. And it’s pelvic pain rehab.com/blog. We write articles about all of it, you know, so we always are having various guest lectures, you know, you heard at the beginning, I give lots of lectures. So we keep really up to date on the current evidence. And we’re really tapped into the network, especially of pain providers.

Brett Scott  1:08:28

And as, as you guys all heard, so if you if you’re listening to my podcast, you’re probably interested in barbells, and weightlifting, and everything else. And after hearing this, Kim’s the go to girl, and, you know, me and her have been able to coach her in a lot of cases, and we’re coming out and looking from different scopes. But it’s been very fun to kind of go back and forth in CO treat, and some sense of, we’re working towards the same goal for these people. We’re just focusing on different different parts of them. So if anyone doesn’t like me and doesn’t want to start with me, go see him. And So Kim, if anyone has questions for you, where can they find you?

1:09:12

So me specifically, I’m at the Pelvic Health and Rehab Center in Lexington. You know, our social media handle is at pelvic health. So that’s on like Instagram, and you know, all of the resources. We do a ton of stuff on YouTube. You know, it’s at pelvic health, we have tick tock at pelvic health. So you know, all those areas.

Brett Scott  1:09:32

Thanks for coming on. And anything else you’d like to add before we end the show here.

1:09:40

Thank you for having me. And this has been great and I really appreciate co treating with you and also the opportunity to come on the podcast. And you know, if you have pelvic floor dysfunction, you’re not alone. Or if you think you have pelvic floor dysfunction. Go get it checked. You know, if there’s nothing going on, we’ll tell you great. You have a happy healthy pelvis. And if there is we’ll fix it so we can get you back to the lab.

Brett Scott  1:10:03

So just to add to that a little bit, I’d like to say, more more and more PTS are becoming more and more aware of how much pelvic PT can help individuals and having these pre screening conversations of what is your pee? Like, what is your poop? Like? How are your erections? All these are just normal conversations with us. So don’t feel like you can’t have them or you’re going to be embarrassed by them. Because we are medical providers. And as much as I like to joke around and have fun in the clinic, I can put my serious face on and have these conversations about how are we going to help you get out of this and get better? So

1:10:40

absolutely, yeah. Don’t you know, don’t don’t let embarrassment about talking about some of these things limit you from getting treatment, because it can get better. You know, and absolutely, you know, there’s a lot we can do. But we can’t do anything if you don’t ask or if you don’t show up at our office.

Brett Scott  1:10:57

So anyways, thanks everyone for listening in and the next couple of weeks would have a few more guests coming on. So I have stuff out and coming on for ACL tears and return to sport. In the next few weeks. I have Dr. Ron McLean coming on. Who’s been on mind pump radio, about hormone optimization for men and for males and females. And I also have Dr. Scott Sigmund coming on about laser treatment and some shoulder in knee surgeries. He’s a surgeon at Lowell general. So thanks for listening to everyone and hope to have you back next time.