Transcription:
Welcome back to the barbell therapy podcast. I am your host, Dr. Brett Scott. And today, I have a old friend and colleague of mine, Dr. Wil Mills with me today. So, so, so a little background on me. And we’ll it’s been quite a few years now that we’ve been friends here since we ever did level up together. So we went through that and then I had started my cache practice a little bit before will had. And so I’ve seen him go from Master meme ologists to take care cash practice business owner, you guys out of network now to
Yeah, yeah, yeah, we’ve been out of network for the past year. So.
So we’ll actually has an interesting background, though. And I’m actually very excited about this podcast today, because well, has gotten some himself into quite a bit with Men’s Health, prostate health and pelvic health. And I really haven’t heard much about this. So I had a lot of questions I want to talk about today. And then just we’ll end that off with some some of the common frustrations we’re having with the movement profession industry as a whole. And what we’re seeing and how it differs from what we might actually need to be doing. So well, give us a little background on yourself and kind of how you got to where you are with the whole pelvic and prostate and Men’s Health, though.
You want the origin story?
Yeah, give me the origin story, because I don’t even know that much about it. Yeah.
So the the thing that the thing that wrote me into it, like it was not on my radar at all, like if you were to told me that I wouldn’t be doing that whenever I was in school, I probably would have laughed at you. Because it was, you know, it was full steam ahead, mindset wise in school for like, my ultimate goal is to work with CrossFitters all day. And I was, I was actually just having this thought, now that I’m now that I’m making my triumphant return to posting on the internet. On Friday, we’re going to be posting about like, my patient that I currently have, his name’s Bob. He’s, you know, he’s given me leeway to, to talk to talk out loud about him. He’s not a prostate patient, but he is like, he’s the epitome of why I got into cash practice and what I wanted to do in the sense of, like, the thing that drew me into the CrossFit and weight or CrossFit community than weightlifting was the fact that anybody can do it. And it’s, it’s scalable across the lifespan. And I saw Bob yesterday. And Bob was like a fall risk. Like for us to the nines, he had all these balance issues. He went as far as to get like a brain stent put in, in the hopes that it would change like his CSF fluid and didn’t didn’t really do shit. He was in hospital balance, vestibular rehab for three months, nothing happened. He was he was such a fall risk that his wife with Parkinson’s couldn’t take care of him. So he moved down to Baton Rouge because that’s where his family is. And he’s, he’s, he’s my gym owners, grandpa. And they were basically like, Could you could you try to help them and then I assessed him and I was like, Look, Bob, you got a lot of shit going on. But if you’re willing to put in the effort, I can get you where you want to go. And he was falling like two or three times a week. And and we’ve gotten them to the point where he’s walking 3000 Plus steps a day with single point cane, and he’s pretty damn independent. All that we said, that’s what got me into the idea of I want to do a cash practice and be in the CrossFit space because I knew I was gonna be able to work with people that want to snatch three wheels and bobs, and the same principles of lifting, insurance, conditioning and all this all this stuff that we know is effective. applied to that so so that was my mindset getting out of school. And it wasn’t until I went to CSM in New Orleans that my other my other friend who’s a gym owner here in Baton Rouge trade out of at Iron tribe wanted me to meet up pelvic therapists that went to his gym so I met with her at CSM you know she she told me about how the the pelvic health side of our profession needs more men men who treat men and you know have the same parts as guys that are having problems. So, so she she basically offered me a job and mentorship. So I started with her when I initially moved back to Baton Rouge. Once I had graduated and did a travel contract in North Carolina just because I was basically delaying the inevitable. So I started working with her and the the mentorship didn’t necessarily go at the speed that I wanted, wanted it to. And she had a lot of different things going on with with her business and having a kid at the time. So I decided to step away and just start my own thing. But I knew that I didn’t want to stop doing pelvic health. So I kept doing it. You know, it was kind of like it kind of started as a word of mouth thing. Like I had a friend who was a dentist and his friend had just had a surgery and he was peeing all over himself.
So, so just kind of background of that guy gets diagnosed prostate cancer, they opt for either a radical prostatectomy, so removal or radiation. So more often than not, surgeries happening at this point, cuz radiation is just not as not as done as much. So so he gets surgery, I start seeing him start having good results, and then it kind of just started to bloom from there slowly, like I didn’t really push it
so you know, in in that space, you’re you’re initially working on urinary incontinence. So the guy is the guy is struggling with, with urination, like pretty consistently. Like, it’s like a dribble, I call it the soaker hose effect, like when they first have surgery and first get their catheter removed. There’s just like no control, right. So when the prostate gets removed, you have a sphincter that’s around your urethra. And that gets removed. And it’s a lot like postpartum in the sense of like there was a trauma to your, to your pelvic floor area. And now you have to retrain the pelvic floor muscles to make up the difference. So so in that space, it’s like, you know, there’s a lot of education, there’s a lot of bowel, bladder and sex habits to talk about. There’s a lot of, you know, structuring somebody’s day helping them structure their day surrounding like when they need to be doing their exercises, how they need to be doing other their exercises, how they’re applying their exercises to their daily life. It’s a pretty common so far is that I get on about, like, if you if you look at the idea of doing a kegel as just doing an exercise that’s going to help you get better, but you don’t actually apply the principle of like, okay, is this an endurance Kegel? Is this a quit what we call a quick flick, like fast turn on, like you’re about to do something quickly in their speed and power? Is this an endurance Kegel? Are you going on a 40 minute walk? Are you going on 100 meter 35 pound farmer’s carry, the endurance side of that Kegel, like 20 plus seconds might be very different if you’re going on a bodyweight walk and it’s like 10% contraction for 40 minutes or trying to maintain that, versus, you know, you’re at 10%. Before you pick up the weight, you got to bump it up to 60%. You got to hold that. You got to be mindful of your breathing. You need to not bear down like a lot of older dudes. This is like 55 to 75 age range. A lot of them have like long history, low back pain, maybe long history of hip and knee pain. They play golf, they play tennis, it turns into like an orthopedic case, on top of a pelvic case. So so you get to use a lot of the same principles. And when it comes to training the pelvic floor, I do very similarly to how I would do most things with like stability training of the pelvis or the low back in the sense of, you know, front and back first, side to side, second, rotational third. And then there’s so many different nuances in between. But it’s mostly helping someone manage their intra abdominal pressure, and be able to match the pressure that they are producing with a lift of the pelvic floor, and then sequencing surrounding that, and then loading it. So it’s, it’s very similar to everything else that people are doing, it’s just a very different flavor, and process, and a pretty specific demographic of who’s having it, like I said, 55 to 75. range.
And, and so let’s just go back for a second because I think there might be a lot of trainers and people out there listening that’s maybe working with this population and don’t really know it, because maybe they haven’t had the conversation or the patient has had it. But talking about intra abdominal pressure and things. So just for people to understand is basically the way the pelvic floor works. And the musculature down there works for us to be able to hold in our urine and such and, and our pills and our balls. When we go to lift anything, or we move, or we go to run, anything that’s kind of a higher level task, even walking is is a low level task. But at these higher level tasks, our core and our abdomen is going to fire up and create pressure within our abdominal cavity there. And that pushes on the bottom floor, or the pelvic floor. And if there’s too much pressure, where those are things like our sphincters, and our pelvic floor musculature isn’t strong enough, or isn’t working properly, we will pee or poop ourselves. And so that’s kind of what Will’s talking about there. As far as that goes, so now we’ll Is there a lot you’re doing is most of it with has to do with prostate cancer in prostatectomies? or is there other things too, that you’re seeing in this field of non oncology type patients or non cancer patients?
Yeah, I see. I see pelvic pain, like pelvic pain is a is another common, but not as common diagnosis. Pelvic pain can, you know, could range from a 15 year old to sky’s the limit past that with age like pelvic pain can affect any male that has hit puberty really. I’ve had, I’ve consulted a guy who’s like 18. And it started when he was 16. The thing about pelvic pain is kind of like it’s one of those it’s one of those diagnoses where they typically get a diagnosis and they’re just sent home and told them and told to like, you know, try these antibiotics, they’re usually given the diagnosis of prostatitis. So like an inflammatory response of the prostate due to an infection. The, the higher end research shows that like as little as three, three between one and 3% if you do the more expensive biopsy test actually have an infection to warrant antibiotics, but most guys because it’s easier, get put on that and it usually makes their symptoms a little better for about a week and then everything gets worse. So a lot of these guys have chronic pain for it’s very unfortunate that like the majority of the guys that I see, it’s like they’ve been dealing with this for 15 to 20 years. And it’s like, I have to pull them out of the seventh ring of Hades to like to get them out of just constant chronic pain and there’s so many things from lifestyle, you know, physiological We’ll changes all these things that, you know, they don’t want to exercise because everything hurts, but the fact that they don’t exercise makes everything worse. But they don’t get that. So you have to like, find these little ends. It’s a lot of education. And it’s usually not necessarily the prostates fault. It’s just something happened at the lumbar spine, something happened at the hip. There’s a lot of different systems feeding into, it hurts when I sit, it hurts when I get an erection, that hurts. You have something to say?
Yeah, I want to, I want to just started to go on it. But yeah, I actually. So I’m lucky, I have a good affiliate down down the road from us. So pelvic pain and rehab centers. So if anyone’s looking for something there, that’s who would we I would refer you guys to but I work a lot with women. So they get to 80%, or this pelvic pain rehab specialist, they’ll get people or patients for about 80%. And then like, if they want to go back to running or anything, they’ll come to me and I kind of finish the job and get them to that 100%. Now, there’s been plenty of cases and I’m seeing it more and more now, the more I’m becoming aware of my own assessment skills, and what’s really learning what’s what. But quite a bit of people have low back pain, hip pain, they’ll, you know, they’ll go to the doctors, they’ll go to an orthopedic. They’re told though, it’s just tendinitis. It’s hip pain, you have tight glutes, whatever. And then they’ll come to me and, and the signs don’t always add up. And we’ll try a couple different things. And then it’s like, two, three sessions. And it’s like you’re not responding. And so when then we’ll start asking these questions. And a lot of times, like, oh, like, I didn’t think that was related. So a lot of people don’t even know that some issues they might be having at home aren’t related at all, or are completely related to their back pain, or their hip pain or their growing pain. Yeah. And I just want to make people more aware of the stuff that it’s it’s becoming more and more common, as we’re seeing it as we’re, we just start to talk about these issues and topics more. But what, you know, from a provider standpoint, for us, it’s like, sometimes they’ll come to us too, and they don’t get better, because we’re not seeing the full picture. It’s like we see the tip of the iceberg of, okay, maybe they have some decreased function here and here, but they just they don’t respond to treatment. And then they end up just leaving treatment and not knowing what’s wrong. And they go on with this pain for years. Where, what things specifically let’s talk more about men, but even women, but what things are, what issues can people have at home, you started to allude to it that could be responsible, or the pelvic floor is responsible for some, you know, lack of action, and it could be causing problems.
So, so something that I talk with everybody about is water, how much you’re drinking on a daily basis, and fiber. And it’s like, if you if I were to just, you know, preface a conversation with a patient of, okay, you know, with any pelvic floor issue, I’m always talking about the three big buckets. And I want to I want to say this earlier, whenever you’re talking about the intra abdominal pressures, I usually talk about, I usually preface that with, I view it as like the canister or the can affect, or it’s like we have to consider which part of your can is the problematic part. And with a lot of these older dudes, they also have a history of hernias, they have a history of dialysis rep die, I’ve seen huge dialysis rec dies in dudes where they have for for all intensive purposes, a big split down their six pack muscles. And basically when they you know, do a sit up, do something that increases their pressures. They’re basically bulging their organs out. And that is no bueno when it comes to dealing with pressures. But we could get we could go back to that. So with crap, what was the question?
It was what things could men or women be dealing with that are symptoms of a pelvic floor issue that maybe is not completely known to medical providers?
Yeah, or even themselves because that’s that’s something that’s like when we get into those three buckets, bowel function, bladder function, sexual health, and then function function, so there’s like a third but then There’s the fourth of just like how you move on a daily basis. water intake and bladder habits and pooping habits like to like big, heavy hitters in, in dealing with this issue in the sense of, you know, people sometimes don’t even realize that they have an issue with, like, they think it’s normal that they go to pee every hour, or they try to poop five times a day. And they feel like they don’t fully evacuate. But, you know, they just, they just keep doing it, because that’s what their body’s telling them. And it’s it’s very similar to pain where it’s like, just because you have that initial sensation of oh, I need to pee only to poop doesn’t necessarily mean it’s time. And if you continuously do it over a long period of time, you can basically change your body’s ability to understand what these signals or cues mean, or fall down to a reflex, where you’re creating a poor habit. And in the sense of where the symptoms lie, it typically ends up with, you know, you’ve been doing this for five years, you’ve been constipated, you didn’t think you were constipated. On upon further inspection of what your poop looks like, when you actually like, give someone a sheet and set and it’s like six different types of poop. And then, and they’re like, oh, yeah, I’m that one. And it’s like, that’s a sign of chronic constipation. If you’re chronically constipated, your your bowels are having to work harder, you’re having to work harder to evacuate, you’re having to use pressures that you don’t, that you shouldn’t necessarily be using for every single time you poop, to get it out and to initiate. And that typically, you know, it makes your pelvic floor have to work harder. And eventually, there’s going to be some changes to the pelvic floor, it’s not going to, it’s not going to continue to work as well or effectively. And it just, it’s like the traps in like neck pain over the course of a day. Like they just start to get beat up. And then they start talking to you. And but it’s not as evident because it’s in the pelvis. And people don’t typically go there first. It’s usually like a further down the road thing. But from like a subjective screening standpoint, water intake, bowel and bladder habits, like frequency, duration, getting into those conversations, like it’s good conversations to have, as far as screening purposes go for sure.
So, so like some of the things I’ve seen that I unfortunately didn’t catch right off the bat. Because again, these things aren’t all that common, but they’re becoming more common, the more I practice, and the more I see them. But a few of the things I’ve had, I’ve had one, one guy that he was getting up eight times a night to go to the bathroom. I’ve had another guy that told me he couldn’t we these were all back pain cases or hip pain cases. And they just weren’t responding to treatment. And so I started asking more questions, and I went to pelvic floor type things. And I am no expert in pelvic floor, but I at least know to screen for it and call it a red flag and say I need to refer you to someone else. But it was Yeah. Peeing, you know, basically hourly, not feeling like they could empty themselves. I have I’ve had a couple men now young men too. That felt like they couldn’t hold an erection for more than five minutes. And like they didn’t have endurance down there. Yeah, so what other things could we see that like, don’t seem like something related to back pain that could definitely be related to pelvic floor.
You, you hit a lot of common ones actually. Urinary and frequency. You know, sensations of oh, I have to pee. Heavy urgency, like, oh, I need a pee. And if I don’t sprint to the toilet, I’m gonna I feel like I’m gonna pee on myself. Those are all like, those are all things that can be heavily related to habits and like, when those things start to happen, there’s typically a side of Well, I don’t feel like I fully empty therefore I have to push to pee, you should never have to push to pee. If you’re pushing the pee, something’s like something’s happening that shouldn’t be happening. And that can be like a screening tool in and of itself, you ask the question, do you have to push the P ever? There, there could be something that’s, you know, blaringly pelvic floor related. But pushing to pee isn’t necessarily like a thing or like a diagnosis, it’s more of like something that is a outward expression of their symptoms. And it’s something that could elude you to oh, they probably need more help. But then they start to think that it’s normal to have to do that. And that’s like one of those things.
In the weightlifting community, with females peeing on themselves standing up a heavy front squad pulley normally common.
Heavy deadlift, you know, that doesn’t really happen as much in the dude in the dude life. But like squat, farts, squat farts are pretty, pretty common. And that goes in. Okay, so this is a good bridge. This is a good bridge actually is for me to get them up my prostate soapbox, of like, so what I see with prostate guys, right, what we had talked about previously, you got to unpack the demographic, these older dudes typically have history, long history of low back pain, hip pain, knee pain, a lot of them, they want to get back to being able to travel without paying, they don’t necessarily have exercise goals. I’m in South Louisiana, most of them are overweight, cuz you know, Lesiba baltoro lay like a lot the good times roll, and it’s Mardi Gras season. So it’s like, most season like football season, GO TIGERS rolls into Mardi Gras season. So like, most of the years surrounding like, hey, let’s party. And the food’s good down here. So like, most of these guys, kind of overweight, don’t have a good history of nutrition. And they have the diathesis they have, they have these things. They have these history. This this long history of hernias, hernia repairs. So if movement doesn’t matter, and the idea of like the idea that’s getting perpetuated on the internet of just pick the fucking bar up, it doesn’t matter how you do it, like, doesn’t matter how you preset doesn’t matter how you breathe, bracing is good. Push all your innards out, put that belt on just fucking belly breath into it. Don’t use any kind of strategy. Like if we’re, if we’re encouraging that for powerlifting and barbell stuff. I don’t know, I don’t know what’s gonna happen. Like, there’s not a there’s not a long term research study on like, what’s going to happen from that. But I see these dudes that don’t have a history of lifting correctly. And they think that they’ve been doing doing it correctly for the longest time. And I do, you know, an abdominal assessment and a pelvic assessment. And I say, okay, Do a kegel and everything is just bearing down. So I’m like, Oh, so you’ve been lifting like that for the past 30 years, like you go to pick something up and you just bear down. That’s not really good for your abdomen. That’s not really good for your pelvic floor. This is probably why you’ve had hernias. And there’s not there’s not like, I don’t feel the need to like, self assess in the sense of, oh, yeah, you’ve had three hernia repairs? Do you just keep picking up fucking thing? Just, I don’t give a shit.
So this is, this is a great topic. And this, this is a great bridge here into this conversation. So again, a little background on this, that I think has
been a bracing. Oh, it’s an important thing.
It’s been a really frustrating topic to see on the internet, I think for me in will here. And we’ve kind of gone through it together. We graduated school at the same time. And a lot of people now know about pain science and how important pain sciences. And it’s like, I remember coming out of school and being like, What the fuck is what like, we learned all this manual therapy and biomechanics and biomedical model in school. And then you come out and start listening to these other guys that are saying, oh, biomechanics don’t matter. It’s all about pain science, and everything’s in your head and you know, it’s just sensitive XYZ. And nothing really matters. We just need to, you know, calm it down and then build it back up and you It’ll be fine. Yeah. And,
and that was like the I don’t want that to come across as like everybody was saying that. But like, that was the theme, the theme that was the messaging. But yeah, go ahead.
And I know for myself, I really like I love manual therapy. I’m a huge believer in it a proponent of it, not not by itself, but even just, you know, being in the performance model of being a weightlifting coach. It’s like form fuckin matters. It just does. You can’t, you can’t have a really good elite level lifter and not worried about technique. So that was one of my my pieces there. And, you know, people that had left ins,
that’s the lens that like, I was a CrossFit and weightlifting coach before I went to PT school. So like, learning open and closed pack shoulder like I was like, okay, so it’s like the snatch. So like, this is close pack position. Like I, I, I view things through the lens of how does this relate to what somebody would expect with hinging to pick up a bar, and either getting in a clean position or deadlift position? And then where does it go from there. And,
and so we go through school, and we learn this. And I definitely changed my tune of understanding pain science, and respecting the laws of it, and our communication skills with people. But it just still didn’t make sense to me. And it still doesn’t cut in, there’s still plenty of people out there on the internet trolling other providers for talking about good form and good technique. And now Now, I have gone through a residency program, and a manual therapist in orthopedic manual therapy resident, a fellow in PNF. So shout out to my boy remez from neuro PDX here has done both. So we’ve seen the neuro he’s seen the ortho he, he’s follow the pain science. And he really taught me that all of this can live together in the same place. And we still need to respect biomechanics, I’ve had so many complex cases come in now, where biomechanics didn’t matter. And so much of this comes down to low back pain. Could be pelvic floor, just breathing, dysfunction, bracing, dysfunction, things that we really need to improve upon that just some of these people out there now it’s just like, Nope, just keep going and loading it and doing whatever and it’ll get better when I think the pelvic floor and these things really shine light on it. Hey, pressure, it’s your
feedback. If you don’t do it, right, you’re gonna piss on yourself. Like, I have very unique view of this because I’m the only one doing it with dudes as a dude, but it’s like, A plus B equals C in this instance, like if you don’t do it, right. You’re gonna have the instant feedback. Oh, I feel myself. Oh, I felt a little dribble. Oh, yep. It was a squirt. Like, I hear dude, say this to me all day. And I said, what happened? Did you not? Did you not fully exhale first? Did you not get all your pressure out first, like, that’s my mantra with building somebody’s back up is like, yes, we have to learn, you’re going to have to learn how to exhale, create a sense, and then breathe into that cinch to support everything, like using your breath, right? But until you’ve learned to lift the pelvic floor to match that pressure of the breath. So it’s like, things, things like, butt up against each other and do that symbiotically rather than you just pushing straight down or pushing straight out. Then we’re training. Let’s let’s try to get as much pressure off of your bladder as we can. And like the process and the sequence of that very much matters. The the science behind like, what is the optimal Kegel for a dude, it’s front to back, it’s retract the penis, lift the testicles, but hold a belly button. Like that’s what I say. Right? And if you do it from back to front, it’s not as effective. So like, that matters. I mean, I could argue all day, like how much biomechanics matter and how they shouldn’t be written off. That’s not say like, I I don’t tell people Oh, we you don’t you have this issue? So you shouldn’t pick stuff up? Like you should never like, lift something off the ground right now. It’s like no, it’s yeah, if you if you don’t, if you don’t manage your pressure Well, right now, you should expect to pee on yourself. You should expect to have some leakage right. If, and you know, whenever I’m not just saying off off the cuff Oh yeah, dude, you’re peeing on yourself. It’s like now like, we have the conversation. Do you want to speak about this in anatomical terms? Do you want me to say incontinence? Or do you want me to just say European on yourself? And they’re like, Yeah, let’s just say, peeing, or pooping, or an erection. Like, do we have to call it the perennial? No, we could just call it the Gooch. Like, you’re right. Yeah. All right, cool. Talk. Huge. Um, and, you know, these these things, there is a there is like, it is as much the habits as the biomechanics. I tell guys on the first visit, when they’re when they’re coming in, to do a pre op. And, and I would say for prostate cancer related things, it is as much habits as it is biomechanics for, for pelvic pain, it’s a little different, still heavily involved with with biomechanics, big, big things related to pelvic pain with you know, where the thoracic spine miss the lumbar spine, the lower lumbar how the pelvis moves, how the pelvis stabilizes. I haven’t had a pelvic pain patient that didn’t have a lot of orthopedic things also going on. And in most of those cases, because pelvic floor therapy is a little bit more invasive, on my initial screens, like, you know, I’m saying, you know, what’s your goal here, like, I still want to be able to play volleyball when, when I have this as I’m having this issue, but I don’t want it to constantly flare up. Alright, well, let’s start with your low back and your hips, because pelvic floor is secondary if you’re trying to play volleyball and not piss everything off. So it’s okay to start with orthopedics and work your way down the chain and pelvic bowl. But it’s it’s just one of those things where you can’t totally write off the biomechanics and biomechanics do matter in that instance.
And, and so do you think well, because I don’t know, but you probably have better insight into this of the population you work with definitely shines light on how much biomechanics can matter, and do do matter, especially for him. And I see it too, as a powerlifting. Coach of if I can teach them and really to lock down and bear down on their core and get things set, right, like, the squat looks better, their their positioning looks way better, and a lot of them feel more powerful. Right, some of it doesn’t take much more, and people should on McGill all the time, and that’s fine. But like, McGill, big three works, like hands down, like I’ve had so many lifters come through an injury and not an injury just for performance. And I have them do McGill, big three for like two months. And all of a sudden that’s like, like, they really just learn to feel where their abdominal pressure should be needs to be. And they learn to lock that in. Yeah, it would you know, it’s a positional isometric. And then all of a sudden, like, their squat goes up 20 pounds, and we didn’t change anything. But do you think so? So there is this whole culture of just load it and do it however, and just pick up the bar however you feel is best. Do you think there is some long term effect this might have on people
of not doing that, like just picking up the bar? All willy nilly?
Yeah, just no regards for position or anything. Just pick it up? How they feel is that Sir, do you think there’s implications to that later on for them as far as not only orthopedics but for pelvic floor type issues? Because it’s a thing in powerlifting, to to blow an O ring?
Well, so so if you have any ideations of wanting to get better at cleaning and snatching, you’re gonna be shit out of luck if you don’t. If you don’t focus on on how you lift it. For powerlifting yeah, I’ve, I have a good working relationship with a strongman gym. And I’ve done a podcast with them talking about like, is it beneficial? Is it is it or is it not beneficial to use a squat plug? Like, no, absolutely not. Like, please never even consider that. Your muscles are supposed to be able to do that on their own volition. And you should have an awareness surrounding that. Um,
was this an actual question? It
was like, it was like a half joke. Okay. But I talked about like, money Mechanical tension curve and like why having a squat plug wouldn’t be beneficial? Just because I’m a nerd and I had to the I mean, yeah, it’s the amount of the amount of hernias that you know, me and me and my business partner Joey have seen in powerlifters. Dude, powerlifters is nuts, the amount of like, the farts is nuts. And that’s, that’s kind of like the young man’s pelvic, pelvic. I guess you could say polo insufficiency issue in the sense of, if we’re considering the canister and you’re farting, whenever you whenever you have heavy weight that you’re moving, then you need to be able to match the pressure that you’re producing in your abdomen with a bud hold a belly button lift, and, and lock it in. Right, it’s not mechanically advantageous to leak pressures, actually leak them out of your B hole while you’re squatting or dead lifting heavy. Because because something is changing, it’s kind of like, I would view that as like if you’re using a if you’re using a Velcro belt, and like you’re in the bottom of the hole and the belt on velcros, like that’s a really shitty feeling. Mm hmm. And it’s like, you there was just an instant print, change in pressure and how you got set. It’s the same thing if you fart, like, the there’s a pressure change. There’s leech, and it’s not I mean it right now. It’s kind of like, oh, yeah, he farted who? Funny, but like, it’s not, it’s surely not optimal. And if you if you unpack that and start talking to the dudes about like, their bowel habits, like, chances are, they might have a hemorrhoid, they might have a history of hernia, they might have some upper groin pain. They might wipe entirely too much, they might have a very strange poop schedule, they might be going to the bathroom to pee way more than they should, like, those aren’t outside of the realm of possibility. Because I’ve had powerlifter dudes that had those issues associated with it. And a lot for them. A lot of it was education. A lot of it was, you know, pelvic floor function independent of what’s happening whenever they whenever they’re lifting. But it’s, it’s one of those things where historically in the medical community, it’s like, well, if I have these problems, and I go to a doctor, they’re just going to tell me to stop lifting. So I just don’t, but I just keep farting or peeing on myself when I do it. Let’s just keep sending it baby, like loaded up. It’s not it’s probably not ideal.
Yeah, absolutely. And so what are some things people can do is kind of a place to start helping themselves. And I know that the issues with this question are, you could be in two different directions to like with the pelvic floor, we could have hypertonicity or we could have hypertonicity. So some people need to learn to be more relaxed, and some need to learn to contract better. So yeah, aside from that, what are some things people should keep in mind? Where should they try to start looking for help? What’s their starting point? And what things can they do for themselves?
If they don’t have a blurring issue right now?
Yeah, if they just if they’re listening, this podcast is like, oh, man, I have this actually sounds like me like, yeah, like I didn’t know it was wasn’t normal to go to the bathroom every hour?
Yeah, I would say. I would say if those things pop up from like a habit standpoint, that would be like a yellow flag, like, maybe further investigation would be helpful. And I would say, if those things are happening currently and have been happening, it would probably be helpful to consult a pelvic for PT. And if and if your goal is to lift, consulting a pelvic floor PT with the intent of I also want to keep lifting at a high level and improving that not just I want to not the I would say that would be the most helpful as like a self assessment just based off of the city objective if those things are happening, that would probably help, it would probably help your performance as well. If you got an assessment, talk to somebody kind of screened it, screened it out, see what happens. And then maybe change a few things surrounding that. It’s not, it’s not one of those things where it’s like, the idea is doom and gloom in the sense of, oh, yeah, you’re probably gonna have hemorrhoids in 10 years, if you don’t work on these things. It’s like, do you really want to not be comfortable when you have to poop every day? Like, do you want to feel like your life surrounds? When’s the next time you’re going to the toilet? I’m, like I had, I had wings for on Sunday for the for the Super Bowl. And yesterday, I was just like, I had to pee every 90 minutes, because I ate a bunch of spicy food. And spicy food can piss off your bowels and your bladder. So I was like, I felt like had these strong urges to pee all day. It was awful. And I was like, you know, if this was my everyday, I would certainly be seeking out help. There’s people that do it for years and don’t even know it’s a problem?
Well, I think it gets progressively worse to over time. And it’s just like that slow change of like, like someone can change weight and either go up or go down a weight and they don’t see it themselves. And all of a sudden, it’s like, Wait, this isn’t normal. So what what would you define as normal? So for for bowel and bladder movements? What? What is the norm for most people? How many times should show be poop a day? And how many times should we pick?
So based off of the so it’s, it’s a weird thing, because it’s like, based off of the GI recommendations, it’s considered normal to, to poop once every two to three days. And I’m like, I don’t know how I would live. I feel like absolute trash if I travel and don’t poop every day.
Well, is that the norm or is that
it’s considered reasonable, it’s considered within within reasonable not often, I wouldn’t say so I would argue the literal and figurative shit out of it’s not optimal. If you’re pooping once every three days. Once a day, at the same time, a day, like where your machine, your machine in the sense of you, your body, you have trained your body to know, if I do X, Y, and Z, I’m going to have the urge, my body’s going to tell me that I’m having the urge. And I go and sit on the toilet. And I don’t have to do much to get it out. And then I go about my business. That’s, that is the most that is the most optimal, in my opinion. Um, sometimes it’s more, it’s optimal for people to poop twice a day. But then if it’s like, if you’re not, if you don’t feel like you’re fully evacuating, or something along those lines, that might be a sign that you potentially have something going on with the pelvic floor, it’s pressurization thing. It’s a reflex thing we’re not, you’re not facing when you go off of the reflex. And then for for urination. You I always say the rule of thumb is, you know, sleep is important. And if and I don’t want to have to wake up to go to pee every single night, it is to it is technically normal to have to wake up to pee once or twice a night. But if you have the capacity to be able to hold your pee for four hours during waking hours, you should be able to hypothetically hold it for eight when you’re sleeping. So it’s like, you know what’s the top end strength of your capacity of your bladder? If you can hold it for four hours, you should be able to sleep throughout the night. What is the average to two and a half every two, two and a half hours? You’re going to pee if it’s less than that you might not be allowing your bladder to fully fill. And then that could cause like a diminishing returns thing which is very common in dudes that are getting older as their prostate starts to get larger with aging. That kind of slippery slope is something that definitely happens and definitely should be taken into account. But yeah, to two and a half hour
Can people just train that though to to like just hold it longer? It’s it’s a muscle. It can be trained, right?
Yeah. So. So we we talk in the clinic about want versus need. The reflex of the initial sensation of oh I need to pee might not mean that you actually need to pee, it might just mean that you’ve trained yourself to want to go immediately off the cuff of experiencing the sensation. So for bladder retraining, we say, okay, you feel the sensation that you need to pee, you’re going to do a 10 second max contraction, Max Kegel. For dudes, I say nuts to guts, because that’s the easiest one. Hold that for 10 seconds maximally. Relax, and then check in with yourself, do you feel like it’s equally as strong? Do you feel like it’s still there at the same rate, if if it’s still there, and nothing’s changed, you probably need to pee. If it’s decreased sensation, then you should probably just wait try to wait another 30 minutes and see what happens. For for bowel function, the muscles are different. So if if someone is having issues with frequency, like I’ve seen, I’ve seen people that you know, feel like they need to poop, they go to poop, they don’t feel they don’t feel like they fully empty. And so they either stay on the toilet for way too long. Like you shouldn’t really be spending more than 15 minutes on the toilet. Because over time, like it is a stretch of the pelvic floor, it’s probably one of the better stretches of the pelvic floor, if you have like a tightness issue. But that’s a whole other conversation. But if if you are having a if you’re trying to retrain the habit of needing to poop going down the want versus need continuum, you would have to do a 62nd sub Max contraction. And a lot of times, people don’t know what a sub Max contraction is, because it’s either it’s like, it’s like Spongebob. But Driver’s Ed, it’s like, just a bit just a big dumb, not the like, not the frickin full gas it right? Because most people just do that. Whenever you tell them to contract their pelvic floor, it’s like, no, it’s just like 30 to 50%, lift air and hold that for 60 seconds. So with the bounce stuff, it’s a little bit harder to train because you have to teach the person. Alright, this is what submaximal is. And then if they can’t hold the submaximal for more than 15 seconds, then you need to do endurance training on top of that, to get to the point where you can start to train the reflex. The bowel stuff about bowel habits stuff, chronic constipation. It’s something that is a little bit newer to me. I just took another Herman and Wallace class on learning about that stuff. Very interesting. A lot of like a lot of psychosocial, you know, habitual stuff plays into those things. And it’s usually as the therapist, you’re like, trying to reorganize how they do things to optimize those systems. And then that’s where you’re getting into the hydration fiber conversation with people.
Well, yeah, and you still got a few more minutes here. Yeah, so that’s one thing. So just even hearing you talk. So I actually for the past two years now was dealing with some issues of my own, and we’ll just call them digestive. And my, I didn’t even realize it either at the time, but I went to a functional medicine doctor. And they gave me the diagnosis of IBS. And I was like, what? And then just based on my subjective report and going back and look and things like oh, like, Yeah, I had urgency to go all the time I had this turns out I had a parasitic infection. And they’re still testing me for SIBO small intestinal bacterial overgrowth. But we have recently cleared up the parasitic infection, which has made a big difference in my urgency to go to the bathroom. My frequency of going to the bathroom, my stools, and what I’m noticing too, is Yeah, I had the squat farts far more frequently before and I don’t anymore. Yeah, and my squats hurt a lot less now than they used to because I was having like, you know, anterior pelvic pain. I have FAI and or impingement syndrome, both my hips. I have bony overgrowth, but you know, I didn’t realize any of these things in till they’re gone, and it’s like, oh, that was a big issue. And even so just digestive health. And so if someone’s having issues and food sensitivities, bloating, constipation, because I got into this because I had a patient that was kind of in a similar boat and came in, she had had SIBO, which basically wrecked her utilization of nutrients. She broke both through stress fractures, and both are femurs, and she had so much swelling in her abdomen by the end of the day, and she like would look pregnant by the end of the day, and like kind of skinny in the morning, she had a bunch of pelvic floor issues that we she had addressed with another therapist and come to me, we still work on the men’s of clearing up. But also I don’t think people realize how much like digestive health and things matter to so not only fiber, but like. And for me, it was like for me right now figuring out like my diet, like, not all fiber is optimal for you either, like I’m on a low FODMAP diet, because certain fibers and sugars from carbohydrates will piss you off even more.
Yeah, yes, SIBO is SIBO is an interesting beast. Things that make people gassy is it’s kind of like, what, what kind of testing have you had in the past. If these things check off, then we can then assume this. And for a lot of those people, it’s like ball breathing, and guts smashing, like getting on a get on a deflated ball, and doing a self Bal massage, just to keep things moving, because it’s too difficult for your body to be able to do it on its own right now. And you just need to give it some extra help, or going on a walk like intermittently throughout the day. So your stuffs moving, grat, you’re like getting gravity into the picture, you’re not just sitting. Those things help manage those symptoms, while you’re also having like a team management strategy. And, you know, when it comes to digestive stuff, that’s typically my kind of my triage is like, alright, what what have you been told in the past? Has this been managed by another medical provider? And and where are you at right now? If if those things haven’t been answered, it’s like, well, we should probably do that first. But we can also talk about your pelvic floor, because that’s like, it’s kind of like the end of the pipeline. Right? So
literally, yeah.
Literally. All all super important things for sure. Yeah, absolutely. But the reintroduction of those fibers would probably be helpful for you to have like a sense of normalcy with you being able to eat things and not really worry about it. That’s, that’s the side of it that I’m less clear on like, what are the time frames cuz I have a lot of people on FODMAP, where it’s just like, they eat crackers and toast and I’m like, that sounds so awful for for like long term use, but they haven’t really gotten an answer of like, okay, well, then we’re going to start to do more inclusion of things. Have you gotten into that?
Starting to so I’ve been so I started with my functional medicine doctor in October and so I currently have been, I didn’t realize I had like a pretty bad dairy allergy. So I eliminated that notice a big difference in my mind. My just like less negative thoughts less anxious. It was weird night, I never considered myself anxious. So I eliminated that we did some food sensitivity testing. And we did a stool sample. And I am in like, complete dysbiosis. So my bacterias are way off and I had the parasite. And with the food sensitivities, it was I’m allergic to, or sensitive to all dairy eggs included. I am good with all meats. I’m gluten free. I am sensitive to yeast as well, apples, bananas, some other things. So and then I had found even before that, that the low FODMAP thing was definitely making me better and less symptomatic. So it’s been this ride of well, these things are working for me like a bland diet is the best thing for me, which is no vegetables. But it’s hard because you also want nutrients. And so it’s this slow. So I’ve been doing that the low FODMAP thing and then the thing about the SIBO is there are certain so FODMAP is kind of highly suggested for a lot of these people. and it works for a lot of people. But there’s also dependent there’s two different types of SIBO. So there’s methane and hydrogen. And so certain different foods will piss off the one respective type of SIBO and not the other. So it’s, we’re doing the testing now to find out which type of SIBO I probably have. But then it’s just slowly reintroducing foods and seeing what works, because there’s a lot of foods that are high FODMAP that are good for SIBO for some types of SIBO and not for others. So yeah, it really is a mix of like doing this, but I found myself like last week, we had had a meal. And I was like spinach, and there’s some garlic in it. And it was I did not have a good day, the next two days. I was like, what was it the spinach? Or was it the garlic? And it’s like, I don’t want to eat either of them now. So you get this like you there is this like, psychosocial component to fear avoidance of food? Because you don’t want to have to deal with that, that for the next few days.
Yeah. But I can’t, I can’t not tell the SIBO story that I have. Because you brought it up. I had this guy that I was consulting with who hadn’t hadn’t received his diagnosis of SIBO when he took it into his own hands to try to self treat. And he had read on the internet that SIBO doesn’t like carrots. And so he ate a bag of carrots. And in the night that he ate the bag of carrots, he had extreme gas for like eight hours straight. And he said that he probably farted, like 600 times he spent the whole night on the toilet because he just felt like he was gonna defecate at any time he couldn’t go to sleep. It was like one of the worst nights of his life. So the ramification of that was like anytime he was doing something functional, he felt like he had the urge to go poop. And my my hypothesis there was he farted so many times during the night of what we called carrot gate that he created like a mechanical insufficiency of His external anal sphincter. So like he needed to do a butthole the belly button like low grade butthole, the belly button contraction, when to re educate those muscles to like work in a neutral range. Because he it, it felt like he had like a sagging type of sensation. Like he would describe it as like, it feels like my butthole is hanging out. But he never had any rectal prolapse. He just he would feel this heaviness there. So so the treatment there was okay, well, let’s talk about endurance, let’s talk about utilization of that of that muscle. And then Then we just need to apply, it’s going to feel weird at first. But we just need to apply that that gentle lift to match what you’re doing, based off the task, going walk around the park with your kid is different than doing to 25 RDLs. Right. But you need to be able to apply that contraction to based off what you’re doing. But all of that happened, because of SIBO and the night where he ate the carrots. So it’s, it’s always, these stories are always interesting, as far as like what happens to people and how the pelvic floor can turn into the symptom, not necessarily the source cause of what’s happening. But like, it’s something that’s now affecting their daily life and health and they want to figure it out. So it’s kind of like one of those things where it’s, you have to have both, you can’t you can’t totally separate out the buckets or it’s not going to be successful. You have to take into consideration, nutrition, how that affects the bowel health, how that affects your timing, how that affects what you’re doing whenever you’re lifting. I would say it’s much easier in the cases of a like a guy like him where he won’t he’s already training and he hasn’t stopped training because of this. But training is now problematic. Usually it’s they haven’t been they don’t even consider themselves to be training or trained because they’ve completely avoided all kinds of physical activity because they feel like that. That’s a whole other type of beast. So
Yeah, there’s so much there’s so many different rabbit holes we could go down here for sure. But I do have to wrap up here because I have to get to the clinic treat a patient I think you do too. Yeah. So um, well where can people find you?
So I’m on Instagram and Facebook as Doc Mills dot DPT you can also find me on my clinic website Alinea performance. It’s also a linear performance on Instagram and Facebook. If you need to contact me, you can shoot me a DM or if you go through a website, my emails on there my emails in my bio on Instagram. But yeah, Doc Mills dot, DPT and then Alinea performance.
He does have some great names on his doc Mills page so you can check those out. But well, thanks for so much for coming on, I think very insightful to a lot of people. And I’ll put those some resources there in the show notes for people as well. So thanks for listening in everybody. See you next time. I’m the worst that sign us
Yeah, yeah, yeah, we’ve been out of network for the past year. So.
So we’ll actually has an interesting background, though. And I’m actually very excited about this podcast today, because well, has gotten some himself into quite a bit with Men’s Health, prostate health and pelvic health. And I really haven’t heard much about this. So I had a lot of questions I want to talk about today. And then just we’ll end that off with some some of the common frustrations we’re having with the movement profession industry as a whole. And what we’re seeing and how it differs from what we might actually need to be doing. So well, give us a little background on yourself and kind of how you got to where you are with the whole pelvic and prostate and Men’s Health, though.
You want the origin story?
Yeah, give me the origin story, because I don’t even know that much about it. Yeah.
So the the thing that the thing that wrote me into it, like it was not on my radar at all, like if you were to told me that I wouldn’t be doing that whenever I was in school, I probably would have laughed at you. Because it was, you know, it was full steam ahead, mindset wise in school for like, my ultimate goal is to work with CrossFitters all day. And I was, I was actually just having this thought, now that I’m now that I’m making my triumphant return to posting on the internet. On Friday, we’re going to be posting about like, my patient that I currently have, his name’s Bob. He’s, you know, he’s given me leeway to, to talk to talk out loud about him. He’s not a prostate patient, but he is like, he’s the epitome of why I got into cash practice and what I wanted to do in the sense of, like, the thing that drew me into the CrossFit and weight or CrossFit community than weightlifting was the fact that anybody can do it. And it’s, it’s scalable across the lifespan. And I saw Bob yesterday. And Bob was like a fall risk. Like for us to the nines, he had all these balance issues. He went as far as to get like a brain stent put in, in the hopes that it would change like his CSF fluid and didn’t didn’t really do shit. He was in hospital balance, vestibular rehab for three months, nothing happened. He was he was such a fall risk that his wife with Parkinson’s couldn’t take care of him. So he moved down to Baton Rouge because that’s where his family is. And he’s, he’s, he’s my gym owners, grandpa. And they were basically like, Could you could you try to help them and then I assessed him and I was like, Look, Bob, you got a lot of shit going on. But if you’re willing to put in the effort, I can get you where you want to go. And he was falling like two or three times a week. And and we’ve gotten them to the point where he’s walking 3000 Plus steps a day with single point cane, and he’s pretty damn independent. All that we said, that’s what got me into the idea of I want to do a cash practice and be in the CrossFit space because I knew I was gonna be able to work with people that want to snatch three wheels and bobs, and the same principles of lifting, insurance, conditioning and all this all this stuff that we know is effective. applied to that so so that was my mindset getting out of school. And it wasn’t until I went to CSM in New Orleans that my other my other friend who’s a gym owner here in Baton Rouge trade out of at Iron tribe wanted me to meet up pelvic therapists that went to his gym so I met with her at CSM you know she she told me about how the the pelvic health side of our profession needs more men men who treat men and you know have the same parts as guys that are having problems. So, so she she basically offered me a job and mentorship. So I started with her when I initially moved back to Baton Rouge. Once I had graduated and did a travel contract in North Carolina just because I was basically delaying the inevitable. So I started working with her and the the mentorship didn’t necessarily go at the speed that I wanted, wanted it to. And she had a lot of different things going on with with her business and having a kid at the time. So I decided to step away and just start my own thing. But I knew that I didn’t want to stop doing pelvic health. So I kept doing it. You know, it was kind of like it kind of started as a word of mouth thing. Like I had a friend who was a dentist and his friend had just had a surgery and he was peeing all over himself.
So, so just kind of background of that guy gets diagnosed prostate cancer, they opt for either a radical prostatectomy, so removal or radiation. So more often than not, surgeries happening at this point, cuz radiation is just not as not as done as much. So so he gets surgery, I start seeing him start having good results, and then it kind of just started to bloom from there slowly, like I didn’t really push it
so you know, in in that space, you’re you’re initially working on urinary incontinence. So the guy is the guy is struggling with, with urination, like pretty consistently. Like, it’s like a dribble, I call it the soaker hose effect, like when they first have surgery and first get their catheter removed. There’s just like no control, right. So when the prostate gets removed, you have a sphincter that’s around your urethra. And that gets removed. And it’s a lot like postpartum in the sense of like there was a trauma to your, to your pelvic floor area. And now you have to retrain the pelvic floor muscles to make up the difference. So so in that space, it’s like, you know, there’s a lot of education, there’s a lot of bowel, bladder and sex habits to talk about. There’s a lot of, you know, structuring somebody’s day helping them structure their day surrounding like when they need to be doing their exercises, how they need to be doing other their exercises, how they’re applying their exercises to their daily life. It’s a pretty common so far is that I get on about, like, if you if you look at the idea of doing a kegel as just doing an exercise that’s going to help you get better, but you don’t actually apply the principle of like, okay, is this an endurance Kegel? Is this a quit what we call a quick flick, like fast turn on, like you’re about to do something quickly in their speed and power? Is this an endurance Kegel? Are you going on a 40 minute walk? Are you going on 100 meter 35 pound farmer’s carry, the endurance side of that Kegel, like 20 plus seconds might be very different if you’re going on a bodyweight walk and it’s like 10% contraction for 40 minutes or trying to maintain that, versus, you know, you’re at 10%. Before you pick up the weight, you got to bump it up to 60%. You got to hold that. You got to be mindful of your breathing. You need to not bear down like a lot of older dudes. This is like 55 to 75 age range. A lot of them have like long history, low back pain, maybe long history of hip and knee pain. They play golf, they play tennis, it turns into like an orthopedic case, on top of a pelvic case. So so you get to use a lot of the same principles. And when it comes to training the pelvic floor, I do very similarly to how I would do most things with like stability training of the pelvis or the low back in the sense of, you know, front and back first, side to side, second, rotational third. And then there’s so many different nuances in between. But it’s mostly helping someone manage their intra abdominal pressure, and be able to match the pressure that they are producing with a lift of the pelvic floor, and then sequencing surrounding that, and then loading it. So it’s, it’s very similar to everything else that people are doing, it’s just a very different flavor, and process, and a pretty specific demographic of who’s having it, like I said, 55 to 75. range.
And, and so let’s just go back for a second because I think there might be a lot of trainers and people out there listening that’s maybe working with this population and don’t really know it, because maybe they haven’t had the conversation or the patient has had it. But talking about intra abdominal pressure and things. So just for people to understand is basically the way the pelvic floor works. And the musculature down there works for us to be able to hold in our urine and such and, and our pills and our balls. When we go to lift anything, or we move, or we go to run, anything that’s kind of a higher level task, even walking is is a low level task. But at these higher level tasks, our core and our abdomen is going to fire up and create pressure within our abdominal cavity there. And that pushes on the bottom floor, or the pelvic floor. And if there’s too much pressure, where those are things like our sphincters, and our pelvic floor musculature isn’t strong enough, or isn’t working properly, we will pee or poop ourselves. And so that’s kind of what Will’s talking about there. As far as that goes, so now we’ll Is there a lot you’re doing is most of it with has to do with prostate cancer in prostatectomies? or is there other things too, that you’re seeing in this field of non oncology type patients or non cancer patients?
Yeah, I see. I see pelvic pain, like pelvic pain is a is another common, but not as common diagnosis. Pelvic pain can, you know, could range from a 15 year old to sky’s the limit past that with age like pelvic pain can affect any male that has hit puberty really. I’ve had, I’ve consulted a guy who’s like 18. And it started when he was 16. The thing about pelvic pain is kind of like it’s one of those it’s one of those diagnoses where they typically get a diagnosis and they’re just sent home and told them and told to like, you know, try these antibiotics, they’re usually given the diagnosis of prostatitis. So like an inflammatory response of the prostate due to an infection. The, the higher end research shows that like as little as three, three between one and 3% if you do the more expensive biopsy test actually have an infection to warrant antibiotics, but most guys because it’s easier, get put on that and it usually makes their symptoms a little better for about a week and then everything gets worse. So a lot of these guys have chronic pain for it’s very unfortunate that like the majority of the guys that I see, it’s like they’ve been dealing with this for 15 to 20 years. And it’s like, I have to pull them out of the seventh ring of Hades to like to get them out of just constant chronic pain and there’s so many things from lifestyle, you know, physiological We’ll changes all these things that, you know, they don’t want to exercise because everything hurts, but the fact that they don’t exercise makes everything worse. But they don’t get that. So you have to like, find these little ends. It’s a lot of education. And it’s usually not necessarily the prostates fault. It’s just something happened at the lumbar spine, something happened at the hip. There’s a lot of different systems feeding into, it hurts when I sit, it hurts when I get an erection, that hurts. You have something to say?
Yeah, I want to, I want to just started to go on it. But yeah, I actually. So I’m lucky, I have a good affiliate down down the road from us. So pelvic pain and rehab centers. So if anyone’s looking for something there, that’s who would we I would refer you guys to but I work a lot with women. So they get to 80%, or this pelvic pain rehab specialist, they’ll get people or patients for about 80%. And then like, if they want to go back to running or anything, they’ll come to me and I kind of finish the job and get them to that 100%. Now, there’s been plenty of cases and I’m seeing it more and more now, the more I’m becoming aware of my own assessment skills, and what’s really learning what’s what. But quite a bit of people have low back pain, hip pain, they’ll, you know, they’ll go to the doctors, they’ll go to an orthopedic. They’re told though, it’s just tendinitis. It’s hip pain, you have tight glutes, whatever. And then they’ll come to me and, and the signs don’t always add up. And we’ll try a couple different things. And then it’s like, two, three sessions. And it’s like you’re not responding. And so when then we’ll start asking these questions. And a lot of times, like, oh, like, I didn’t think that was related. So a lot of people don’t even know that some issues they might be having at home aren’t related at all, or are completely related to their back pain, or their hip pain or their growing pain. Yeah. And I just want to make people more aware of the stuff that it’s it’s becoming more and more common, as we’re seeing it as we’re, we just start to talk about these issues and topics more. But what, you know, from a provider standpoint, for us, it’s like, sometimes they’ll come to us too, and they don’t get better, because we’re not seeing the full picture. It’s like we see the tip of the iceberg of, okay, maybe they have some decreased function here and here, but they just they don’t respond to treatment. And then they end up just leaving treatment and not knowing what’s wrong. And they go on with this pain for years. Where, what things specifically let’s talk more about men, but even women, but what things are, what issues can people have at home, you started to allude to it that could be responsible, or the pelvic floor is responsible for some, you know, lack of action, and it could be causing problems.
So, so something that I talk with everybody about is water, how much you’re drinking on a daily basis, and fiber. And it’s like, if you if I were to just, you know, preface a conversation with a patient of, okay, you know, with any pelvic floor issue, I’m always talking about the three big buckets. And I want to I want to say this earlier, whenever you’re talking about the intra abdominal pressures, I usually talk about, I usually preface that with, I view it as like the canister or the can affect, or it’s like we have to consider which part of your can is the problematic part. And with a lot of these older dudes, they also have a history of hernias, they have a history of dialysis rep die, I’ve seen huge dialysis rec dies in dudes where they have for for all intensive purposes, a big split down their six pack muscles. And basically when they you know, do a sit up, do something that increases their pressures. They’re basically bulging their organs out. And that is no bueno when it comes to dealing with pressures. But we could get we could go back to that. So with crap, what was the question?
It was what things could men or women be dealing with that are symptoms of a pelvic floor issue that maybe is not completely known to medical providers?
Yeah, or even themselves because that’s that’s something that’s like when we get into those three buckets, bowel function, bladder function, sexual health, and then function function, so there’s like a third but then There’s the fourth of just like how you move on a daily basis. water intake and bladder habits and pooping habits like to like big, heavy hitters in, in dealing with this issue in the sense of, you know, people sometimes don’t even realize that they have an issue with, like, they think it’s normal that they go to pee every hour, or they try to poop five times a day. And they feel like they don’t fully evacuate. But, you know, they just, they just keep doing it, because that’s what their body’s telling them. And it’s it’s very similar to pain where it’s like, just because you have that initial sensation of oh, I need to pee only to poop doesn’t necessarily mean it’s time. And if you continuously do it over a long period of time, you can basically change your body’s ability to understand what these signals or cues mean, or fall down to a reflex, where you’re creating a poor habit. And in the sense of where the symptoms lie, it typically ends up with, you know, you’ve been doing this for five years, you’ve been constipated, you didn’t think you were constipated. On upon further inspection of what your poop looks like, when you actually like, give someone a sheet and set and it’s like six different types of poop. And then, and they’re like, oh, yeah, I’m that one. And it’s like, that’s a sign of chronic constipation. If you’re chronically constipated, your your bowels are having to work harder, you’re having to work harder to evacuate, you’re having to use pressures that you don’t, that you shouldn’t necessarily be using for every single time you poop, to get it out and to initiate. And that typically, you know, it makes your pelvic floor have to work harder. And eventually, there’s going to be some changes to the pelvic floor, it’s not going to, it’s not going to continue to work as well or effectively. And it just, it’s like the traps in like neck pain over the course of a day. Like they just start to get beat up. And then they start talking to you. And but it’s not as evident because it’s in the pelvis. And people don’t typically go there first. It’s usually like a further down the road thing. But from like a subjective screening standpoint, water intake, bowel and bladder habits, like frequency, duration, getting into those conversations, like it’s good conversations to have, as far as screening purposes go for sure.
So, so like some of the things I’ve seen that I unfortunately didn’t catch right off the bat. Because again, these things aren’t all that common, but they’re becoming more common, the more I practice, and the more I see them. But a few of the things I’ve had, I’ve had one, one guy that he was getting up eight times a night to go to the bathroom. I’ve had another guy that told me he couldn’t we these were all back pain cases or hip pain cases. And they just weren’t responding to treatment. And so I started asking more questions, and I went to pelvic floor type things. And I am no expert in pelvic floor, but I at least know to screen for it and call it a red flag and say I need to refer you to someone else. But it was Yeah. Peeing, you know, basically hourly, not feeling like they could empty themselves. I have I’ve had a couple men now young men too. That felt like they couldn’t hold an erection for more than five minutes. And like they didn’t have endurance down there. Yeah, so what other things could we see that like, don’t seem like something related to back pain that could definitely be related to pelvic floor.
You, you hit a lot of common ones actually. Urinary and frequency. You know, sensations of oh, I have to pee. Heavy urgency, like, oh, I need a pee. And if I don’t sprint to the toilet, I’m gonna I feel like I’m gonna pee on myself. Those are all like, those are all things that can be heavily related to habits and like, when those things start to happen, there’s typically a side of Well, I don’t feel like I fully empty therefore I have to push to pee, you should never have to push to pee. If you’re pushing the pee, something’s like something’s happening that shouldn’t be happening. And that can be like a screening tool in and of itself, you ask the question, do you have to push the P ever? There, there could be something that’s, you know, blaringly pelvic floor related. But pushing to pee isn’t necessarily like a thing or like a diagnosis, it’s more of like something that is a outward expression of their symptoms. And it’s something that could elude you to oh, they probably need more help. But then they start to think that it’s normal to have to do that. And that’s like one of those things.
In the weightlifting community, with females peeing on themselves standing up a heavy front squad pulley normally common.
Heavy deadlift, you know, that doesn’t really happen as much in the dude in the dude life. But like squat, farts, squat farts are pretty, pretty common. And that goes in. Okay, so this is a good bridge. This is a good bridge actually is for me to get them up my prostate soapbox, of like, so what I see with prostate guys, right, what we had talked about previously, you got to unpack the demographic, these older dudes typically have history, long history of low back pain, hip pain, knee pain, a lot of them, they want to get back to being able to travel without paying, they don’t necessarily have exercise goals. I’m in South Louisiana, most of them are overweight, cuz you know, Lesiba baltoro lay like a lot the good times roll, and it’s Mardi Gras season. So it’s like, most season like football season, GO TIGERS rolls into Mardi Gras season. So like, most of the years surrounding like, hey, let’s party. And the food’s good down here. So like, most of these guys, kind of overweight, don’t have a good history of nutrition. And they have the diathesis they have, they have these things. They have these history. This this long history of hernias, hernia repairs. So if movement doesn’t matter, and the idea of like the idea that’s getting perpetuated on the internet of just pick the fucking bar up, it doesn’t matter how you do it, like, doesn’t matter how you preset doesn’t matter how you breathe, bracing is good. Push all your innards out, put that belt on just fucking belly breath into it. Don’t use any kind of strategy. Like if we’re, if we’re encouraging that for powerlifting and barbell stuff. I don’t know, I don’t know what’s gonna happen. Like, there’s not a there’s not a long term research study on like, what’s going to happen from that. But I see these dudes that don’t have a history of lifting correctly. And they think that they’ve been doing doing it correctly for the longest time. And I do, you know, an abdominal assessment and a pelvic assessment. And I say, okay, Do a kegel and everything is just bearing down. So I’m like, Oh, so you’ve been lifting like that for the past 30 years, like you go to pick something up and you just bear down. That’s not really good for your abdomen. That’s not really good for your pelvic floor. This is probably why you’ve had hernias. And there’s not there’s not like, I don’t feel the need to like, self assess in the sense of, oh, yeah, you’ve had three hernia repairs? Do you just keep picking up fucking thing? Just, I don’t give a shit.
So this is, this is a great topic. And this, this is a great bridge here into this conversation. So again, a little background on this, that I think has
been a bracing. Oh, it’s an important thing.
It’s been a really frustrating topic to see on the internet, I think for me in will here. And we’ve kind of gone through it together. We graduated school at the same time. And a lot of people now know about pain science and how important pain sciences. And it’s like, I remember coming out of school and being like, What the fuck is what like, we learned all this manual therapy and biomechanics and biomedical model in school. And then you come out and start listening to these other guys that are saying, oh, biomechanics don’t matter. It’s all about pain science, and everything’s in your head and you know, it’s just sensitive XYZ. And nothing really matters. We just need to, you know, calm it down and then build it back up and you It’ll be fine. Yeah. And,
and that was like the I don’t want that to come across as like everybody was saying that. But like, that was the theme, the theme that was the messaging. But yeah, go ahead.
And I know for myself, I really like I love manual therapy. I’m a huge believer in it a proponent of it, not not by itself, but even just, you know, being in the performance model of being a weightlifting coach. It’s like form fuckin matters. It just does. You can’t, you can’t have a really good elite level lifter and not worried about technique. So that was one of my my pieces there. And, you know, people that had left ins,
that’s the lens that like, I was a CrossFit and weightlifting coach before I went to PT school. So like, learning open and closed pack shoulder like I was like, okay, so it’s like the snatch. So like, this is close pack position. Like I, I, I view things through the lens of how does this relate to what somebody would expect with hinging to pick up a bar, and either getting in a clean position or deadlift position? And then where does it go from there. And,
and so we go through school, and we learn this. And I definitely changed my tune of understanding pain science, and respecting the laws of it, and our communication skills with people. But it just still didn’t make sense to me. And it still doesn’t cut in, there’s still plenty of people out there on the internet trolling other providers for talking about good form and good technique. And now Now, I have gone through a residency program, and a manual therapist in orthopedic manual therapy resident, a fellow in PNF. So shout out to my boy remez from neuro PDX here has done both. So we’ve seen the neuro he’s seen the ortho he, he’s follow the pain science. And he really taught me that all of this can live together in the same place. And we still need to respect biomechanics, I’ve had so many complex cases come in now, where biomechanics didn’t matter. And so much of this comes down to low back pain. Could be pelvic floor, just breathing, dysfunction, bracing, dysfunction, things that we really need to improve upon that just some of these people out there now it’s just like, Nope, just keep going and loading it and doing whatever and it’ll get better when I think the pelvic floor and these things really shine light on it. Hey, pressure, it’s your
feedback. If you don’t do it, right, you’re gonna piss on yourself. Like, I have very unique view of this because I’m the only one doing it with dudes as a dude, but it’s like, A plus B equals C in this instance, like if you don’t do it, right. You’re gonna have the instant feedback. Oh, I feel myself. Oh, I felt a little dribble. Oh, yep. It was a squirt. Like, I hear dude, say this to me all day. And I said, what happened? Did you not? Did you not fully exhale first? Did you not get all your pressure out first, like, that’s my mantra with building somebody’s back up is like, yes, we have to learn, you’re going to have to learn how to exhale, create a sense, and then breathe into that cinch to support everything, like using your breath, right? But until you’ve learned to lift the pelvic floor to match that pressure of the breath. So it’s like, things, things like, butt up against each other and do that symbiotically rather than you just pushing straight down or pushing straight out. Then we’re training. Let’s let’s try to get as much pressure off of your bladder as we can. And like the process and the sequence of that very much matters. The the science behind like, what is the optimal Kegel for a dude, it’s front to back, it’s retract the penis, lift the testicles, but hold a belly button. Like that’s what I say. Right? And if you do it from back to front, it’s not as effective. So like, that matters. I mean, I could argue all day, like how much biomechanics matter and how they shouldn’t be written off. That’s not say like, I I don’t tell people Oh, we you don’t you have this issue? So you shouldn’t pick stuff up? Like you should never like, lift something off the ground right now. It’s like no, it’s yeah, if you if you don’t, if you don’t manage your pressure Well, right now, you should expect to pee on yourself. You should expect to have some leakage right. If, and you know, whenever I’m not just saying off off the cuff Oh yeah, dude, you’re peeing on yourself. It’s like now like, we have the conversation. Do you want to speak about this in anatomical terms? Do you want me to say incontinence? Or do you want me to just say European on yourself? And they’re like, Yeah, let’s just say, peeing, or pooping, or an erection. Like, do we have to call it the perennial? No, we could just call it the Gooch. Like, you’re right. Yeah. All right, cool. Talk. Huge. Um, and, you know, these these things, there is a there is like, it is as much the habits as the biomechanics. I tell guys on the first visit, when they’re when they’re coming in, to do a pre op. And, and I would say for prostate cancer related things, it is as much habits as it is biomechanics for, for pelvic pain, it’s a little different, still heavily involved with with biomechanics, big, big things related to pelvic pain with you know, where the thoracic spine miss the lumbar spine, the lower lumbar how the pelvis moves, how the pelvis stabilizes. I haven’t had a pelvic pain patient that didn’t have a lot of orthopedic things also going on. And in most of those cases, because pelvic floor therapy is a little bit more invasive, on my initial screens, like, you know, I’m saying, you know, what’s your goal here, like, I still want to be able to play volleyball when, when I have this as I’m having this issue, but I don’t want it to constantly flare up. Alright, well, let’s start with your low back and your hips, because pelvic floor is secondary if you’re trying to play volleyball and not piss everything off. So it’s okay to start with orthopedics and work your way down the chain and pelvic bowl. But it’s it’s just one of those things where you can’t totally write off the biomechanics and biomechanics do matter in that instance.
And, and so do you think well, because I don’t know, but you probably have better insight into this of the population you work with definitely shines light on how much biomechanics can matter, and do do matter, especially for him. And I see it too, as a powerlifting. Coach of if I can teach them and really to lock down and bear down on their core and get things set, right, like, the squat looks better, their their positioning looks way better, and a lot of them feel more powerful. Right, some of it doesn’t take much more, and people should on McGill all the time, and that’s fine. But like, McGill, big three works, like hands down, like I’ve had so many lifters come through an injury and not an injury just for performance. And I have them do McGill, big three for like two months. And all of a sudden that’s like, like, they really just learn to feel where their abdominal pressure should be needs to be. And they learn to lock that in. Yeah, it would you know, it’s a positional isometric. And then all of a sudden, like, their squat goes up 20 pounds, and we didn’t change anything. But do you think so? So there is this whole culture of just load it and do it however, and just pick up the bar however you feel is best. Do you think there is some long term effect this might have on people
of not doing that, like just picking up the bar? All willy nilly?
Yeah, just no regards for position or anything. Just pick it up? How they feel is that Sir, do you think there’s implications to that later on for them as far as not only orthopedics but for pelvic floor type issues? Because it’s a thing in powerlifting, to to blow an O ring?
Well, so so if you have any ideations of wanting to get better at cleaning and snatching, you’re gonna be shit out of luck if you don’t. If you don’t focus on on how you lift it. For powerlifting yeah, I’ve, I have a good working relationship with a strongman gym. And I’ve done a podcast with them talking about like, is it beneficial? Is it is it or is it not beneficial to use a squat plug? Like, no, absolutely not. Like, please never even consider that. Your muscles are supposed to be able to do that on their own volition. And you should have an awareness surrounding that. Um,
was this an actual question? It
was like, it was like a half joke. Okay. But I talked about like, money Mechanical tension curve and like why having a squat plug wouldn’t be beneficial? Just because I’m a nerd and I had to the I mean, yeah, it’s the amount of the amount of hernias that you know, me and me and my business partner Joey have seen in powerlifters. Dude, powerlifters is nuts, the amount of like, the farts is nuts. And that’s, that’s kind of like the young man’s pelvic, pelvic. I guess you could say polo insufficiency issue in the sense of, if we’re considering the canister and you’re farting, whenever you whenever you have heavy weight that you’re moving, then you need to be able to match the pressure that you’re producing in your abdomen with a bud hold a belly button lift, and, and lock it in. Right, it’s not mechanically advantageous to leak pressures, actually leak them out of your B hole while you’re squatting or dead lifting heavy. Because because something is changing, it’s kind of like, I would view that as like if you’re using a if you’re using a Velcro belt, and like you’re in the bottom of the hole and the belt on velcros, like that’s a really shitty feeling. Mm hmm. And it’s like, you there was just an instant print, change in pressure and how you got set. It’s the same thing if you fart, like, the there’s a pressure change. There’s leech, and it’s not I mean it right now. It’s kind of like, oh, yeah, he farted who? Funny, but like, it’s not, it’s surely not optimal. And if you if you unpack that and start talking to the dudes about like, their bowel habits, like, chances are, they might have a hemorrhoid, they might have a history of hernia, they might have some upper groin pain. They might wipe entirely too much, they might have a very strange poop schedule, they might be going to the bathroom to pee way more than they should, like, those aren’t outside of the realm of possibility. Because I’ve had powerlifter dudes that had those issues associated with it. And a lot for them. A lot of it was education. A lot of it was, you know, pelvic floor function independent of what’s happening whenever they whenever they’re lifting. But it’s, it’s one of those things where historically in the medical community, it’s like, well, if I have these problems, and I go to a doctor, they’re just going to tell me to stop lifting. So I just don’t, but I just keep farting or peeing on myself when I do it. Let’s just keep sending it baby, like loaded up. It’s not it’s probably not ideal.
Yeah, absolutely. And so what are some things people can do is kind of a place to start helping themselves. And I know that the issues with this question are, you could be in two different directions to like with the pelvic floor, we could have hypertonicity or we could have hypertonicity. So some people need to learn to be more relaxed, and some need to learn to contract better. So yeah, aside from that, what are some things people should keep in mind? Where should they try to start looking for help? What’s their starting point? And what things can they do for themselves?
If they don’t have a blurring issue right now?
Yeah, if they just if they’re listening, this podcast is like, oh, man, I have this actually sounds like me like, yeah, like I didn’t know it was wasn’t normal to go to the bathroom every hour?
Yeah, I would say. I would say if those things pop up from like a habit standpoint, that would be like a yellow flag, like, maybe further investigation would be helpful. And I would say, if those things are happening currently and have been happening, it would probably be helpful to consult a pelvic for PT. And if and if your goal is to lift, consulting a pelvic floor PT with the intent of I also want to keep lifting at a high level and improving that not just I want to not the I would say that would be the most helpful as like a self assessment just based off of the city objective if those things are happening, that would probably help, it would probably help your performance as well. If you got an assessment, talk to somebody kind of screened it, screened it out, see what happens. And then maybe change a few things surrounding that. It’s not, it’s not one of those things where it’s like, the idea is doom and gloom in the sense of, oh, yeah, you’re probably gonna have hemorrhoids in 10 years, if you don’t work on these things. It’s like, do you really want to not be comfortable when you have to poop every day? Like, do you want to feel like your life surrounds? When’s the next time you’re going to the toilet? I’m, like I had, I had wings for on Sunday for the for the Super Bowl. And yesterday, I was just like, I had to pee every 90 minutes, because I ate a bunch of spicy food. And spicy food can piss off your bowels and your bladder. So I was like, I felt like had these strong urges to pee all day. It was awful. And I was like, you know, if this was my everyday, I would certainly be seeking out help. There’s people that do it for years and don’t even know it’s a problem?
Well, I think it gets progressively worse to over time. And it’s just like that slow change of like, like someone can change weight and either go up or go down a weight and they don’t see it themselves. And all of a sudden, it’s like, Wait, this isn’t normal. So what what would you define as normal? So for for bowel and bladder movements? What? What is the norm for most people? How many times should show be poop a day? And how many times should we pick?
So based off of the so it’s, it’s a weird thing, because it’s like, based off of the GI recommendations, it’s considered normal to, to poop once every two to three days. And I’m like, I don’t know how I would live. I feel like absolute trash if I travel and don’t poop every day.
Well, is that the norm or is that
it’s considered reasonable, it’s considered within within reasonable not often, I wouldn’t say so I would argue the literal and figurative shit out of it’s not optimal. If you’re pooping once every three days. Once a day, at the same time, a day, like where your machine, your machine in the sense of you, your body, you have trained your body to know, if I do X, Y, and Z, I’m going to have the urge, my body’s going to tell me that I’m having the urge. And I go and sit on the toilet. And I don’t have to do much to get it out. And then I go about my business. That’s, that is the most that is the most optimal, in my opinion. Um, sometimes it’s more, it’s optimal for people to poop twice a day. But then if it’s like, if you’re not, if you don’t feel like you’re fully evacuating, or something along those lines, that might be a sign that you potentially have something going on with the pelvic floor, it’s pressurization thing. It’s a reflex thing we’re not, you’re not facing when you go off of the reflex. And then for for urination. You I always say the rule of thumb is, you know, sleep is important. And if and I don’t want to have to wake up to go to pee every single night, it is to it is technically normal to have to wake up to pee once or twice a night. But if you have the capacity to be able to hold your pee for four hours during waking hours, you should be able to hypothetically hold it for eight when you’re sleeping. So it’s like, you know what’s the top end strength of your capacity of your bladder? If you can hold it for four hours, you should be able to sleep throughout the night. What is the average to two and a half every two, two and a half hours? You’re going to pee if it’s less than that you might not be allowing your bladder to fully fill. And then that could cause like a diminishing returns thing which is very common in dudes that are getting older as their prostate starts to get larger with aging. That kind of slippery slope is something that definitely happens and definitely should be taken into account. But yeah, to two and a half hour
Can people just train that though to to like just hold it longer? It’s it’s a muscle. It can be trained, right?
Yeah. So. So we we talk in the clinic about want versus need. The reflex of the initial sensation of oh I need to pee might not mean that you actually need to pee, it might just mean that you’ve trained yourself to want to go immediately off the cuff of experiencing the sensation. So for bladder retraining, we say, okay, you feel the sensation that you need to pee, you’re going to do a 10 second max contraction, Max Kegel. For dudes, I say nuts to guts, because that’s the easiest one. Hold that for 10 seconds maximally. Relax, and then check in with yourself, do you feel like it’s equally as strong? Do you feel like it’s still there at the same rate, if if it’s still there, and nothing’s changed, you probably need to pee. If it’s decreased sensation, then you should probably just wait try to wait another 30 minutes and see what happens. For for bowel function, the muscles are different. So if if someone is having issues with frequency, like I’ve seen, I’ve seen people that you know, feel like they need to poop, they go to poop, they don’t feel they don’t feel like they fully empty. And so they either stay on the toilet for way too long. Like you shouldn’t really be spending more than 15 minutes on the toilet. Because over time, like it is a stretch of the pelvic floor, it’s probably one of the better stretches of the pelvic floor, if you have like a tightness issue. But that’s a whole other conversation. But if if you are having a if you’re trying to retrain the habit of needing to poop going down the want versus need continuum, you would have to do a 62nd sub Max contraction. And a lot of times, people don’t know what a sub Max contraction is, because it’s either it’s like, it’s like Spongebob. But Driver’s Ed, it’s like, just a bit just a big dumb, not the like, not the frickin full gas it right? Because most people just do that. Whenever you tell them to contract their pelvic floor, it’s like, no, it’s just like 30 to 50%, lift air and hold that for 60 seconds. So with the bounce stuff, it’s a little bit harder to train because you have to teach the person. Alright, this is what submaximal is. And then if they can’t hold the submaximal for more than 15 seconds, then you need to do endurance training on top of that, to get to the point where you can start to train the reflex. The bowel stuff about bowel habits stuff, chronic constipation. It’s something that is a little bit newer to me. I just took another Herman and Wallace class on learning about that stuff. Very interesting. A lot of like a lot of psychosocial, you know, habitual stuff plays into those things. And it’s usually as the therapist, you’re like, trying to reorganize how they do things to optimize those systems. And then that’s where you’re getting into the hydration fiber conversation with people.
Well, yeah, and you still got a few more minutes here. Yeah, so that’s one thing. So just even hearing you talk. So I actually for the past two years now was dealing with some issues of my own, and we’ll just call them digestive. And my, I didn’t even realize it either at the time, but I went to a functional medicine doctor. And they gave me the diagnosis of IBS. And I was like, what? And then just based on my subjective report and going back and look and things like oh, like, Yeah, I had urgency to go all the time I had this turns out I had a parasitic infection. And they’re still testing me for SIBO small intestinal bacterial overgrowth. But we have recently cleared up the parasitic infection, which has made a big difference in my urgency to go to the bathroom. My frequency of going to the bathroom, my stools, and what I’m noticing too, is Yeah, I had the squat farts far more frequently before and I don’t anymore. Yeah, and my squats hurt a lot less now than they used to because I was having like, you know, anterior pelvic pain. I have FAI and or impingement syndrome, both my hips. I have bony overgrowth, but you know, I didn’t realize any of these things in till they’re gone, and it’s like, oh, that was a big issue. And even so just digestive health. And so if someone’s having issues and food sensitivities, bloating, constipation, because I got into this because I had a patient that was kind of in a similar boat and came in, she had had SIBO, which basically wrecked her utilization of nutrients. She broke both through stress fractures, and both are femurs, and she had so much swelling in her abdomen by the end of the day, and she like would look pregnant by the end of the day, and like kind of skinny in the morning, she had a bunch of pelvic floor issues that we she had addressed with another therapist and come to me, we still work on the men’s of clearing up. But also I don’t think people realize how much like digestive health and things matter to so not only fiber, but like. And for me, it was like for me right now figuring out like my diet, like, not all fiber is optimal for you either, like I’m on a low FODMAP diet, because certain fibers and sugars from carbohydrates will piss you off even more.
Yeah, yes, SIBO is SIBO is an interesting beast. Things that make people gassy is it’s kind of like, what, what kind of testing have you had in the past. If these things check off, then we can then assume this. And for a lot of those people, it’s like ball breathing, and guts smashing, like getting on a get on a deflated ball, and doing a self Bal massage, just to keep things moving, because it’s too difficult for your body to be able to do it on its own right now. And you just need to give it some extra help, or going on a walk like intermittently throughout the day. So your stuffs moving, grat, you’re like getting gravity into the picture, you’re not just sitting. Those things help manage those symptoms, while you’re also having like a team management strategy. And, you know, when it comes to digestive stuff, that’s typically my kind of my triage is like, alright, what what have you been told in the past? Has this been managed by another medical provider? And and where are you at right now? If if those things haven’t been answered, it’s like, well, we should probably do that first. But we can also talk about your pelvic floor, because that’s like, it’s kind of like the end of the pipeline. Right? So
literally, yeah.
Literally. All all super important things for sure. Yeah, absolutely. But the reintroduction of those fibers would probably be helpful for you to have like a sense of normalcy with you being able to eat things and not really worry about it. That’s, that’s the side of it that I’m less clear on like, what are the time frames cuz I have a lot of people on FODMAP, where it’s just like, they eat crackers and toast and I’m like, that sounds so awful for for like long term use, but they haven’t really gotten an answer of like, okay, well, then we’re going to start to do more inclusion of things. Have you gotten into that?
Starting to so I’ve been so I started with my functional medicine doctor in October and so I currently have been, I didn’t realize I had like a pretty bad dairy allergy. So I eliminated that notice a big difference in my mind. My just like less negative thoughts less anxious. It was weird night, I never considered myself anxious. So I eliminated that we did some food sensitivity testing. And we did a stool sample. And I am in like, complete dysbiosis. So my bacterias are way off and I had the parasite. And with the food sensitivities, it was I’m allergic to, or sensitive to all dairy eggs included. I am good with all meats. I’m gluten free. I am sensitive to yeast as well, apples, bananas, some other things. So and then I had found even before that, that the low FODMAP thing was definitely making me better and less symptomatic. So it’s been this ride of well, these things are working for me like a bland diet is the best thing for me, which is no vegetables. But it’s hard because you also want nutrients. And so it’s this slow. So I’ve been doing that the low FODMAP thing and then the thing about the SIBO is there are certain so FODMAP is kind of highly suggested for a lot of these people. and it works for a lot of people. But there’s also dependent there’s two different types of SIBO. So there’s methane and hydrogen. And so certain different foods will piss off the one respective type of SIBO and not the other. So it’s, we’re doing the testing now to find out which type of SIBO I probably have. But then it’s just slowly reintroducing foods and seeing what works, because there’s a lot of foods that are high FODMAP that are good for SIBO for some types of SIBO and not for others. So yeah, it really is a mix of like doing this, but I found myself like last week, we had had a meal. And I was like spinach, and there’s some garlic in it. And it was I did not have a good day, the next two days. I was like, what was it the spinach? Or was it the garlic? And it’s like, I don’t want to eat either of them now. So you get this like you there is this like, psychosocial component to fear avoidance of food? Because you don’t want to have to deal with that, that for the next few days.
Yeah. But I can’t, I can’t not tell the SIBO story that I have. Because you brought it up. I had this guy that I was consulting with who hadn’t hadn’t received his diagnosis of SIBO when he took it into his own hands to try to self treat. And he had read on the internet that SIBO doesn’t like carrots. And so he ate a bag of carrots. And in the night that he ate the bag of carrots, he had extreme gas for like eight hours straight. And he said that he probably farted, like 600 times he spent the whole night on the toilet because he just felt like he was gonna defecate at any time he couldn’t go to sleep. It was like one of the worst nights of his life. So the ramification of that was like anytime he was doing something functional, he felt like he had the urge to go poop. And my my hypothesis there was he farted so many times during the night of what we called carrot gate that he created like a mechanical insufficiency of His external anal sphincter. So like he needed to do a butthole the belly button like low grade butthole, the belly button contraction, when to re educate those muscles to like work in a neutral range. Because he it, it felt like he had like a sagging type of sensation. Like he would describe it as like, it feels like my butthole is hanging out. But he never had any rectal prolapse. He just he would feel this heaviness there. So so the treatment there was okay, well, let’s talk about endurance, let’s talk about utilization of that of that muscle. And then Then we just need to apply, it’s going to feel weird at first. But we just need to apply that that gentle lift to match what you’re doing, based off the task, going walk around the park with your kid is different than doing to 25 RDLs. Right. But you need to be able to apply that contraction to based off what you’re doing. But all of that happened, because of SIBO and the night where he ate the carrots. So it’s, it’s always, these stories are always interesting, as far as like what happens to people and how the pelvic floor can turn into the symptom, not necessarily the source cause of what’s happening. But like, it’s something that’s now affecting their daily life and health and they want to figure it out. So it’s kind of like one of those things where it’s, you have to have both, you can’t you can’t totally separate out the buckets or it’s not going to be successful. You have to take into consideration, nutrition, how that affects the bowel health, how that affects your timing, how that affects what you’re doing whenever you’re lifting. I would say it’s much easier in the cases of a like a guy like him where he won’t he’s already training and he hasn’t stopped training because of this. But training is now problematic. Usually it’s they haven’t been they don’t even consider themselves to be training or trained because they’ve completely avoided all kinds of physical activity because they feel like that. That’s a whole other type of beast. So
Yeah, there’s so much there’s so many different rabbit holes we could go down here for sure. But I do have to wrap up here because I have to get to the clinic treat a patient I think you do too. Yeah. So um, well where can people find you?
So I’m on Instagram and Facebook as Doc Mills dot DPT you can also find me on my clinic website Alinea performance. It’s also a linear performance on Instagram and Facebook. If you need to contact me, you can shoot me a DM or if you go through a website, my emails on there my emails in my bio on Instagram. But yeah, Doc Mills dot, DPT and then Alinea performance.
He does have some great names on his doc Mills page so you can check those out. But well, thanks for so much for coming on, I think very insightful to a lot of people. And I’ll put those some resources there in the show notes for people as well. So thanks for listening in everybody. See you next time. I’m the worst that sign us
