WEBVTT
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Thanks for joining me on Menopause Unscripted.
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Remember, the change is just another beginning.
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Welcome back to another week of Menopause Unscripted.
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I'm Dr.
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Heidi and I'm joined today by my friend and mentor, Dr.
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Marcy Crouch.
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She is the down there doc for any of you who have seen her on social media, who's just like so cute.
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Oh my god, my glasses and my old age blind now.
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Oh, I told you I had to wash mine before I came on.
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I'm like, give me a minute, I'm washing my glasses.
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I've washed them with soap and water daily.
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Yeah, how can you not?
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They just get so gross.
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I digress.
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She launched her app, the Down There Doc app, yesterday, which I had no idea until this morning, and I was so excited.
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It was actually last night, but it's like, thank you for being on today when life is hectic.
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Oh, yeah.
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And you also have your platform, which is drmarcycrouch.com.
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So thank you for coming on.
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Marcy is an expert and a board-certified expert in pelvic floor physical therapy and does a lot of work with pregnancy and postpartum women.
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She also consults that correct me if I'm wrong with the company Perifit, who I'm a huge fan of.
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And we are on today to talk about how biofeedback, which is what Perifit is, it's an example of it, how that can be used for pelvic floor physical therapy and with patients' home management strategies.
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Yes.
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Did I miss anything?
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No.
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No.
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No, I mean, no.
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It's all true.
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I don't have the so the main website is the downtherdoc.com.
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I don't have like I merge them because my ADD brain, I can't have more than like one website because I'm so like, ah, but um, I used to have both, and now it's just easier to kind of keep it all in one.
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As you know, like as a clinician and a woman and all the things, it's like there's 900 my tab, like my post perimenopausal brain, too many tabs open.
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So I'm like, yeah, just simplify, I think.
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I don't blame you.
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I found you on both last weekend when I was looking to see what ones were still present.
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So yeah, yeah, yeah, it's still up.
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It is up, yeah.
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But I yeah, so to put that back on my to-do list, but yeah, we just use the downker doc one now.
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Compressed.
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Yes.
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Which is like the such a fun name, anyways.
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I just absolutely have always loved that handle.
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Yeah, thanks.
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My sister came up with it for me when I started it like years ago.
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So she has a hand, she has like a big hand in naming the brand, which is great.
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Well, it's worked for you, obviously.
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So tell me about your practice now.
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Who are you treating mostly?
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Because you're in Alabama now.
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Yes.
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Yep, yep, yep.
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So we moved to Alabama.
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We live in Auburn, Alabama.
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We moved here in 2020, the week of COVID.
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And that's I think you and I met a like a year or so after that when I was doing the Thriving Mama um series for clinicians.
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I actually met you when you're at Formosa still.
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Oh yeah.
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Because we were just down the street.
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Oh yeah.
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Okay, we need to talk about this like memory thing.
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I really feel like but you did Thriving Mamas, right?
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I did.
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Okay.
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You're not wrong there.
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But we were up the street.
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I know you took a lot longer, so that's this is very true.
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Okay, great.
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All right.
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So yes, we moved here in 2020 and um it was like right in COVID, like the start of COVID, all the things.
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So I kind of pushed real heavy on the online portion, um, started the online business.
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And then I went back in the clinic.
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I worked for a company um that's kind of like a corporate outpatient PT like whatever franchise.
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I'm not really sure.
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But they have a bunch of offices down here in the south.
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And they hired me to like basically start their pelvic floor program, but kids were still little and it was, you know, a little, it was kind of like weird going back in the clinic after COVID.
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So I did it for a little bit and then um I left there and opened my own here.
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So I have a practice very similar to what I had in Redondo.
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It's the same kind of model, one-on-one, cash-based.
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I rent a very cute space from a good friend of mine, actually, who's an esthetician.
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So she bought this old house and she does like facials and waxing and like all the things next door, and then she had this room available that already had a table that goes up and down, and she's our sons, our friends, and that's how we met.
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And she's like, Oh, yeah, I have this room.
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I was like, Oh, I'll rent it from you.
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So that's kind of how that started.
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So I've been here for about two years now, I want to say two and a half, maybe three.
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Um, I have one other therapist that works here for me on Mondays, and then I just hired a PTA, so she's gonna be helping me with some of my case loo.
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Um, but yeah, very similar.
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We do a lot of pregnancy pelvic floor prep, a lot of postpartum recovery, pregnancy musculoskeletal.
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I have some guys on my schedule, not really like I used to treat.
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I'm really trying to just focus mainly on pelvic floor stuff for women, birth prep, postpartum recovery, bladder, pelvic pain, kind of all the things that that you and I treat together.
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So I've been here long enough.
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I feel like where some of my patients now in this cycle are coming back in after their second, third, um, or I saw them after their last baby, you know, a couple years ago, and now they're getting it transitioning into like the perimenopause kind of menopause side of things.
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So there's so much overlap in our treatments and kind of what we're doing and what we're preparing them for.
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So yeah, so that's kind of the caseload, caseload here.
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And how much would you say are you doing online?
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Are you doing a lot of virtual PT at this point as well?
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No, I don't do any virtual, yeah.
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I don't do any virtual PT.
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I do some online kind of like wellness coaching, I would say, every now and then, but it's really like mainly through the app.
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So the community that we had online, um, we just created an app for that.
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So all of the programs that we have, instead of doing it on your desktop, you can do it on the app.
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It's the same programs.
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Um, and then we do like kind of one-on-one stuff in there if needed, or like discussion boards, kind of interviews like this, that sort of thing.
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Um, I have thought about doing some telehealth here in Alabama for some of my patients that um can't get back into the clinic after they have their babies, like in the early rehab phase, but I haven't like set that up yet.
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But you know how it is with like licenses, and you know, if I I'd have to like get licensed in lots of other states to treat people in those states, but for wellness you can kind of do it all over.
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But here under this business, under this clinic business, it would be um just in Alabama and patients who I've already seen.
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But I love the fact that with the app and with the web in the web stuff as well, you're able to access patients more broadly and help them with programming and whatnot that they couldn't maybe access you otherwise.
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Yeah, yeah, yeah.
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I mean, that was really the genesis behind going online.
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I mean, you see in your practice too, I'm sure, that a lot of times, you know, we lose women after um maternity leave is over, when their kids are still kind of involved in all the things.
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Like we, you know, might get them during pregnancy and right after, but then we really don't see them because it's hard to get in for appointments, it's expensive, insurance doesn't really cover it, you know, there's all these variables.
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So, like, can we just strip away some of these um boundaries and some of these reports that we have in place and offer something that kind of bridges the gap a little bit, you know, and um can we translate what we're doing in the clinic over to this kind of different type of platform and still get very similar results?
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And we found that we can.
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It's just a matter of now of like disseminating it, basically.
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No, I love that, and I think that that's really great is being able to transcend the barriers, yeah, get people the education that they need because women and moms just like to put themselves at the last, right?
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So if we can make it easier for them to access, and I think that translates kind of into the conversation for today is when we're trying to teach women how to do things for themselves and be able to do it at home, you know, can we be using other tools to help them to do it better?
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And that's part of how I use biofeedback in my practice.
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Do you do something similar with yours?
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Yeah, I do.
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I have I I do use biofeedback, yes, and I do like a couple of the options out there.
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Um working mainly with PerryFit, I've really got to understand the technology and how it can help uh when we're talking about how people are understanding and accessing their pelvic floor for sure.
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And I think it's a really great option for people that are doing well with therapy and but need just like a little bit more reinforcement, and we'll kind of talk about that a little bit too.
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Um, so they know that what they're doing at home or if they're doing kind of higher level type activities like getting back into running or doing these kind of dynamic things, um, they have something that gives them a little bit of visual feedback, uh, which I can find, you know, very helpful.
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Um I don't do a lot of surface EMG or surface biofeedback um just because of like time constraints and um, you know, I feel like I get a good result with my fingers, to be honest, like from a manual side.
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And then, you know, if we need to do stuff at home, then Perryfit is usually like kind of where I where I um direct them.
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Okay.
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So in terms of types of biofeedback, can we kind of do a quick review of like the different types of biofeedback for people who might have no idea what we're talking about?
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Yes.
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Yeah.
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So backing it up a little bit.
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Yes, yes, yes.
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So biofeedback is just really a fancy way of giving different sorts of um information back to the patient to understand their body or muscle contraction or movement or whatever the case may be.
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So this could be in the form of um uh verbal, like verbal feedback, talking to them about, okay, move your knee this way or take a breath this way, or or move your shoulder this way.
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It can be tactile, you know, manual palpation to a certain muscle joint, both from an inhibition, which means like, okay, I want you to turn this muscle off and let's try to do this muscle.
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Or um in a way that's like, okay, focus right here, like right where I'm touching it.
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I want you to think about this.
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Um, and then that usually works well for the kind of general orthopedic setting for muscles and movements that we can see, like outwardly, especially for people relearning how to walk or contract a muscle that's been in, you know, gas for an X amount of time and need a little bit more of that.
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Like, okay, yes, it's like I'm connecting to this muscle here.
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For pelvic floor, bladder retraining, pelvic floor stuff, biofeedback has always kind of been around.
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It's been one of the early treatments um studied, kind of the first, I would say, one of the first things that was studied, because we can have objectifiable data, like we're able to look at what the biofeedback machines are telling us, and we can like put that into a study and we can compare it.
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You know, it's not it's not like subjective in any way.
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I think it's like data and actual numbers.
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Yeah, exactly.
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And we can like control that.
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Like we're using this machine and we're using this exercise, and we're using this way to measure, and this person looks like this, and this person looks like this.
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So it's like we can kind of really be able to tell what that's doing.
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It's a way for the pelvic floor, especially since we can't see it, and it's a 3D muscle and goes and lies in this different plane and this transverse plane of our body, it's very hard for our brain sometime to connect to it, um, especially after having a baby, especially after any type of surgery, especially in any type of swelling, trauma, whatever, it makes that connection from our brain to our pelvic floor not as robust as it used to be.
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So just figuring out how to move the pelvic floor, how to contract, what does that look like, what does your baseline look like?
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You know, all of these symptoms that our patients are dealing with.
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Um, this is a way that you can take that activity of the muscle and put it onto a screen on your phone, for example, this particular device, um, and it gives you information of the electrical activity of the muscle.
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So specifically for periphit or devices that are similar to that, it's an internal probe that looks like a tampa and you put it inside your vagina or in the rectum, depending on what you're doing.
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Um, and it picks up activity of the skeletal muscle.
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So it'll tell you on the app if you're contracting, if you're relaxing, if you have kind of like fluttering contraction, if you're squeezing your muscle, but you're not really sure if you know what you're doing it right, then you'll see on the app the line go up a little bit, you know, and they have games kind of keep the bird flying in the sky and like a gamified.
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Yeah, yeah, like put the bird up and then like let the bird come down, and then okay, we're gonna like hit this flower over here.
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Like, there's ways to do it.
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Um, and it can be a very useful tool for somebody that needs a little bit more kind of visual feedback, um, which is always kind of fun.
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Um, it doesn't tell you though, biofeedback does not give you any measurement of strength or any measurement of hypertrophy.
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It'll it just literally t picks up the electrical activity of the muscles so you can see what they're doing.
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Um, oftentimes we'll see that translates over to strength and function, but we can't say that the device is measuring strength directly.
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It's more about activation timing, that sort of thing.
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And there's also um external biofeedback too.
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You can put those little like sticky pads on the perineum or on the belly or wherever, um, and that'll get up too.
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But it's a little bit tricky there because you get more uh feedback and noise from other structures, and it's hard to say, like, okay, which is the perineum and which is this, and what is giving here and what's giving there.
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So with an internal device, you it's a lot more um kind of uh like isolated.
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You'll still get you'll still get noise from other muscles, but it's much more specific to public core.
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So that's like led me into a conversation I had with a patient yesterday.
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One, we this particular individual, we had used surface emg at her first visit.
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And it's because mostly she wasn't comfortable with doing anything internal.
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Yeah, great.
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And she wasn't ready for an internal exam.
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That's completely fine.
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That's where I probably use it the most is people who we need to get polyfluor PT started, but we need some warm-up time for us to become friends before we just go right in there.
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Right, they're not ready for like the full, you know, full Monty day one.
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And so we done that day one, and so yesterday we just did a reassessment because we want to see where she was.
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But to your point about it picking up external noise, when I use that surface EMG, I have to unplug my high-lo table.
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I have to turn off my lights.
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Oh, that's interesting.
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I have to turn off my air conditioning because it will pick up everything in the room.
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And it shows that somebody is hypertonic and cannot relax.
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Huh.
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So, like this is your baseline, it like reads like up here, and so it's like they're just looking like they're contracting 24-7.
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Yeah, yeah, yeah.
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And I feel like that doesn't make a really great candidate for home use, right?
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Because people don't know like what things that they have to turn off, and I now know what I have to turn off in here in order to make it work.
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But that I find is like a really great way for people to understand like where we're starting if we're not doing like an internal examination, just like to get a start.
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But in the same way, we're talking a lot about her use of her home biofeedback unit and how she felt like she had lost strength.
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And we've got a really large conversation about that, like how your symptoms regressed, you know, because we're looking, I'm looking at your symptoms, I'm looking at your function, and her symptoms hadn't regressed, but she was just having some days where she was trying to do it and she was really tired, and she just wasn't making that brain-body connection.
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And so the conversation was okay, don't do this when you're really tired.
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And also, like you're rushing because now you feel like you need to get it done because you haven't done it, and it's like five minutes before bed, you're all ramped up.
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And so she just wasn't making the brain-body connection.
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So we did like five minutes of breath work, kind of relaxed, got her in her body, and then did it, and it was like a completely different experience.
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But I was trying to relate to her that this is more like brain-body neuromuscular versus is not telling you you're getting weaker or it's not telling you that you're getting stronger.
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It's this, you know, this deal.
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Yeah, and I think that's like a really great use for that too, to kind of give a little bit of validation to how these external factors will influence what your muscles are doing, you know, and kind of see that when you're stressed, it's gonna be harder to do XYZ, or when you're sick, it's gonna be harder to do.
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But it doesn't mean that like we lost muscle strength in the 20 minutes that you were stressed.
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It's like, okay, just see how this is, you know, affecting your ability to get the muscles doing what they need to be doing.
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And it's just kind of like, oh, okay.
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And that might lend itself to more data about all right, well, maybe you know, when I have a little bit more anxiety, that could explain these symptoms because I can't do this with my pelvic floor versus like, oh gosh, I don't know what's going on, and and then like it kind of feeds back on the anxiety, and then we have this cycle.
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So even though sometimes like the data might not be exactly like what we want to hear in the beginning, perhaps, I think it could be something that would be very empowering in terms of knowing how your body is responding to external factors, and then using that information in a way to design a program and to make things successful at home.
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And then eventually, you know, we stop using the biofeedback because we don't need it anymore, but we know that these triggers are happening, and then you can actually tell a difference in function and public floor muscle contraction relaxation because like you've already trained with the biofeedback.
00:18:59.599 --> 00:19:11.039
And I do like that kind of like tracking trends over time because people like to see how they're doing, and but I do feel like we get a little fixated sometimes too on like, oh, I didn't reach that same number I did yesterday.
00:19:11.519 --> 00:19:13.440
Yeah, yeah, it's tricky, it's a slippery slope.
00:19:13.519 --> 00:19:15.119
That's why I don't do bladder diaries.
00:19:15.200 --> 00:19:17.119
I'm like, I don't want to do it.
00:19:17.279 --> 00:19:23.920
I'm like, we're already thinking too much about your pelvic floor, about your peeing, about your urge or your frequency.
00:19:24.000 --> 00:19:29.759
Like, we don't need to be like charting it, like it doesn't matter because sometimes it's just too much.
00:19:29.839 --> 00:19:34.559
Like we we have to do the opposite, you know, and I mean it's just like too much of a good thing, right?
00:19:34.640 --> 00:19:35.279
It's the same.
00:19:36.240 --> 00:19:52.160
It's like for me when I was pregnant and I had all this anxiety about my kids like be like being pregnant, and I'd get like a handheld Doppler, you know, and I was like Doppler, I'm like, oh, and then I'm like Googling heart rate, I'm like, and that's just like okay, easy.
00:19:52.240 --> 00:19:53.200
Like it's fine, you know.
00:19:53.279 --> 00:19:56.319
If you didn't have this, you wouldn't even be worried about it.
00:19:56.559 --> 00:20:02.640
It's like so you have to, is this like you know, within medicine knowing too much?
00:20:02.799 --> 00:20:04.000
Yeah, yeah.
00:20:05.759 --> 00:20:09.279
So aside from like what what other types of biofeedback do you use?
00:20:09.359 --> 00:20:12.799
I mean, you mentioned earlier, like you being able to feel, and that's a good point.
00:20:12.880 --> 00:20:17.920
Is like when people come into a pelvic floor exam or they're coming into someone like you and I, we're doing a vaginal exam.
00:20:18.799 --> 00:20:28.880
I think that that is something that people don't understand sometimes, like why we are doing a finger internal exam, but that is another type of biofeedback for people.
00:20:29.839 --> 00:20:34.000
So could you tell me a little bit about like your initial exam when you see people?
00:20:34.319 --> 00:20:44.960
Yeah, so I mean, it varies a lot kind of depending on what they're coming in for and what their goals are, and you know, kind of all of those things where they are in their postpartum.
00:20:45.119 --> 00:20:52.319
Like sometimes if I see somebody for the first time postpartum and you know they haven't been cleared yet, I won't do internal, like we'll just do external sort of thing.
00:20:52.400 --> 00:20:56.240
But yeah, I mean, my initial appointment is about an hour.
00:20:56.480 --> 00:21:08.640
We do like good history taking, and then I'll just do some very basic, easy tests to just kind of see like where I need to focus our first couple appointments on.
00:21:08.720 --> 00:21:10.319
You know, like are we looking at the SI?
00:21:10.400 --> 00:21:12.720
Are we gonna work on belly stuff?
00:21:12.799 --> 00:21:16.240
Are there is there like a big C-sex and a scar that's like bothering us?
00:21:16.400 --> 00:21:19.039
Is there something going on in the glutes?
00:21:19.279 --> 00:21:20.799
Or like, is there chronic hip pain?
00:21:20.880 --> 00:21:21.440
Like, what's happening?
00:21:21.519 --> 00:21:24.079
So I'll kind of like get a you know, lay in the land a bit.
00:21:24.319 --> 00:21:29.440
And then with consent, we do the internal exam and kind of just depends on what we're looking for.
00:21:29.599 --> 00:21:46.559
For some of my patients that have pain, chronic yeast infections, difficulty with penetration, had a baby and a big tear, and now they're having like a lot of nerve pain or scar pain or delayed healing, granulation tissue, and silver nitrate, and now they're coming to me after all that's done.
00:21:46.799 --> 00:21:51.119
Sometimes I don't need to do a full internal exam, all the layers.
00:21:51.200 --> 00:21:53.119
Like I'll do what they can tolerate.
00:21:53.200 --> 00:21:54.799
I have enough information.
00:21:55.359 --> 00:21:58.240
Um, and then we kind of design a plan from there.
00:21:58.400 --> 00:22:07.920
But one big piece that I Do that, I think is very, very important, and I don't think a lot of people do is like a skin, like a full skin assessment.
00:22:08.640 --> 00:22:22.720
Because like you need to make sure you need to be looking at the skin and the tissue and not just like the function of the muscles, but what is happening on the outside, especially if there's like superficial pain, bulbodenia, yeast.
00:22:22.799 --> 00:22:31.119
Like I have caught so many chronic yeast infections that have been untreated for years, and yeast is just like hanging out.
00:22:31.279 --> 00:22:35.839
It's not like traditional, you know, clumpy yeast coming out of the vaginal canal.
00:22:35.920 --> 00:22:40.640
It's just like in the labia, just hanging out in the labia, and it's just in there for so long.
00:22:40.720 --> 00:22:48.880
And that skin is so fragile and so friable, and you're just like micro trauma, micro trauma, micro trauma for years and years and years.
00:22:49.039 --> 00:22:51.200
And like the pelvic floor is kind of secondary.
00:22:51.359 --> 00:22:58.400
Like a lot of times, once you get past that first layer, you're in the deeper layer, and then the pelvic floor is fine, but it's like that first layer is all screwy.
00:22:58.640 --> 00:23:02.799
So, like, I don't need to go back in there, like I know what the problem is, you know.
00:23:02.880 --> 00:23:04.720
So I think it kind of depends.
00:23:05.039 --> 00:23:11.839
But um, I do a big skin exam, move the clitoral hood, look at heart's line.
00:23:12.000 --> 00:23:15.119
Is there demarcation of labia menorah majora?
00:23:15.680 --> 00:23:18.240
Does the anatomy look like it's supposed to look?
00:23:18.400 --> 00:23:20.240
Where is the urethra sitting?
00:23:20.400 --> 00:23:22.640
Do I see a prolapse right at the opening?
00:23:22.799 --> 00:23:24.559
Is there yeast and redness?
00:23:24.720 --> 00:23:25.599
What's going on?
00:23:25.839 --> 00:23:28.799
Like just what what does it look like basically, you know?
00:23:28.960 --> 00:23:32.319
Um, I've got a look, I've got a girl in here now who's in college.
00:23:32.480 --> 00:23:35.119
She had sex for the first time when she was in high school.
00:23:35.359 --> 00:23:52.079
She was um ashamed about it, and she had like a tear or something down there in her pernium from that experience, um, but didn't tell anybody about it because she was embarrassed that she had sex, so it healed all kind of funky.
00:23:52.160 --> 00:23:54.559
She had sex again, tore again.
00:23:54.720 --> 00:23:57.839
She had to go into like the ER and they had to like repair it.
00:23:57.920 --> 00:24:28.400
So the ER doctor is doing like I don't, it's just so now, years later, she's got this just like really her skin is just very bound up there at the scar, plus she has chronic yeast, so it's like nobody was looking at like what the skin was doing, they were just like really focused on this one area, which is a big problem because she's like bleeding every time she puts anything into her vagina, but also she shouldn't be bleeding, like even with a big scar.
00:24:28.720 --> 00:24:32.720
Like we see grade four tears, and people aren't bleeding, it's painful.
00:24:32.799 --> 00:24:35.839
But so it's like you have to kind of look at all of that other stuff.
00:24:35.920 --> 00:24:47.759
So I do a big big kind of exam, like skin exam, all that stuff, like I said, and then um then we'll you know decide what the what the plan is, but no stirrups, no speculum, one finger, lots of lube.
00:24:47.920 --> 00:24:52.000
I have a light that I have to like put in now because I'm blind.
00:24:52.240 --> 00:25:02.319
Um and then other than that, we just kind of we figure out what we need to get done and what the goals are and what is reasonable prognosis-wise and kind of go from there.
00:25:03.119 --> 00:25:06.079
I was grilling last night and realized I need a grill light.
00:25:06.559 --> 00:25:07.920
Because I can't I can't see.
00:25:08.160 --> 00:25:11.440
And I just when you said that I was like, that's exactly what I did with my grill light.
00:25:11.519 --> 00:25:13.200
I'm like, do I need to get one of those for my table?
00:25:13.359 --> 00:25:15.519
Like, yeah, look, there it is.
00:25:15.759 --> 00:25:20.240
It's got like a bendy neck, and I just like put that right there.
00:25:20.480 --> 00:25:21.119
I can't see.
00:25:21.359 --> 00:25:21.920
Yeah.
00:25:22.319 --> 00:25:26.240
That looks a lot less intense than the grill light that I just used last night.
00:25:26.400 --> 00:25:28.000
I need to find a pretty one like that.
00:25:28.160 --> 00:25:30.240
Yeah, it looks like it's gold.
00:25:30.480 --> 00:25:30.799
Perfect.
00:25:30.880 --> 00:25:32.880
We we love Amazon for everything.
00:25:33.039 --> 00:25:33.440
Yeah.
00:25:35.039 --> 00:25:44.000
With that skin exam, and back to the patient you mentioned, is it fragility, the tissue that's just formed over time, where she's like fissuring then when she has insertion?
00:25:44.319 --> 00:25:46.799
Yes, and it's from the chronic yeast.
00:25:47.200 --> 00:25:47.519
Okay.
00:25:48.400 --> 00:25:53.519
And that's just and with the chronic yeast, is that something that she's been able to is now getting under control at all?
00:25:53.759 --> 00:25:55.119
Yeah, just starting now, yeah.
00:25:55.279 --> 00:25:59.200
So like I have her go back in and ask for like two courts of diflucan.
00:25:59.279 --> 00:26:00.400
We're doing boric acid.
00:26:00.480 --> 00:26:05.920
I'm having her blow dry with a cool, cool blow-dry setting after she gets out of the shower.
00:26:06.720 --> 00:26:12.480
We're cleaning like clean underwear, always in her purse, a couple pairs of cotton underwear, so she's like dry.
00:26:12.559 --> 00:26:14.160
And here in the south, it's hot.
00:26:14.319 --> 00:26:19.119
Like we not yet, but like soon, it will be like very hot and very muggy.
00:26:19.200 --> 00:26:20.319
So you're just like always sweating.
00:26:20.400 --> 00:26:23.680
And then if you're at the pool all day, you're always in like a wet bathing suit.
00:26:23.839 --> 00:26:28.559
So it's like you're constantly in an environment that like breathes yeast.
00:26:28.960 --> 00:26:31.920
Um, so we're getting that taken care of.
00:26:32.079 --> 00:26:38.400
I'm working scar mobilization and some like laser, red light laser, red light therapy.
00:26:38.559 --> 00:26:42.319
I'm gonna need all it a little bit if she lets me, like at her perennium.
00:26:42.480 --> 00:26:43.359
I'm not sure yet.
00:26:43.519 --> 00:26:49.039
Um, and then I'm sending her up to a surgeon that I know up outside of Atlanta.
00:26:49.200 --> 00:26:50.960
He's a public reconstruction guy.
00:26:51.200 --> 00:26:53.680
She's got an appointment with him at the end of the summer.
00:26:53.839 --> 00:27:00.960
We might not need it, but I want him to look at it to see if we can like if that spot is like needs to be removed.
00:27:01.039 --> 00:27:04.319
You know, can he do like almost like a hymenctomy?
00:27:04.559 --> 00:27:06.799
I mean, but it's not like um you know what I mean?
00:27:06.880 --> 00:27:10.720
But like just if there's that one spot, because that's really the only spot that's problematic.
00:27:10.880 --> 00:27:15.119
But I really think if we get this yeast under control, then it's not gonna be a problem anymore.
00:27:15.200 --> 00:27:19.920
But I've caught so many of it just like hanging out in there, yeah.
00:27:20.160 --> 00:27:27.440
Especially menopause and perimenopause women, because we have a higher, it's easier for us to get yeast infections at this time in life.
00:27:27.759 --> 00:27:38.640
And a lot of times, like the dysprunia, painful penetration will be due to the skin changes and yeast, and pelvic floor dysfunction, and untreated trauma from babies.
00:27:38.720 --> 00:27:53.759
So it's like all of it, it's like it's so multifactoral hormonal component, tissue fragility changes because of hor because of those hormones, yeast that might be hanging around all the time, scar tissue, tightness in the pelvic floor.
00:27:53.839 --> 00:28:16.160
Like I just had a woman today who um had four C-sections, four C-sections, never had any problems with her pelvic floor afterwards, and then just in the last year, she started getting like frequency urgency UTI-like symptoms, no culture-positive UTI, can't release her pelvic floor, and she's like super hypertonic.
00:28:16.559 --> 00:28:40.400
And um, you know, it's like it kind of happens sometimes like randomly, and it's not, you know, she's like her parents went her mom and sister went through menopause early, and you know, maybe she's having some skin changes also that's contributing to some fragility and some like true infection, but most of it I think is more of like a muscle thing.
00:28:41.279 --> 00:28:44.000
Have you tried blue light therapy with that patient yet?
00:28:44.319 --> 00:28:46.720
Um, I have blue light, uh, but I haven't.
00:28:46.880 --> 00:28:47.200
Nope.
00:28:47.279 --> 00:28:50.160
I just did laser on her for the first I've only seen her twice.
00:28:50.319 --> 00:28:52.400
So I just did laser on her the last time.
00:28:52.720 --> 00:28:53.200
Got it.
00:28:53.359 --> 00:28:57.039
I was just wondering if that would help with some of the like the you know, the yeast and stuff as well.
00:28:57.359 --> 00:29:03.279
Yeah, and there are some studies coming out, I think, about like red light for yeast during pregnancy.
00:29:03.599 --> 00:29:03.920
Okay.
00:29:04.240 --> 00:29:05.839
Because that being safe.
00:29:06.079 --> 00:29:12.960
Yeah, is that like safer potentially than you know taking oral diflucan or something like that?
00:29:13.279 --> 00:29:13.599
I don't know.
00:29:13.759 --> 00:29:14.480
So I'd be interested.
00:29:14.559 --> 00:29:16.079
I mean have you had success?
00:29:17.119 --> 00:29:18.079
Oh, sorry, what was that?
00:29:18.319 --> 00:29:24.400
No, I was gonna be interested to see, yeah, how that goes because that would be like a really great treatment option.
00:29:24.799 --> 00:29:25.759
Definitely.
00:29:26.000 --> 00:29:31.440
Do you try um use have or have people get topical vaginal estrogen for these problems as well?
00:29:32.160 --> 00:29:35.839
Oh pretty pretty pretty early after pregnancy, too.
00:29:36.160 --> 00:29:36.640
For sure.
00:29:36.880 --> 00:29:58.720
And like if they're doing boric acid for chronic yeast, if they're doing boric positive, one of the OBs that I work with down here, she's a big fan of vaginal estrogen when there's like a boric acid going in there because boric acid can be very irritating to the mucosa, and the vaginal estrogen after that can like help just kind of build it up a little bit more.
00:29:59.359 --> 00:30:01.359
Using the two things in in combination?
00:30:02.000 --> 00:30:02.640
After.
00:30:03.279 --> 00:30:04.880
Okay, so one and then the other.
00:30:05.119 --> 00:30:05.599
Okay, forgot.
00:30:05.680 --> 00:30:08.720
I was like, you see my brain working, like what?
00:30:08.960 --> 00:30:11.279
Yeah, otherwise too messy.
00:30:11.920 --> 00:30:12.319
Yeah.
00:30:12.640 --> 00:30:16.559
Well, so you mentioned hypertonicity and like having that pelvic floor being too tight.
00:30:16.640 --> 00:30:25.519
And so circling back to like our original topic, do you use any sort of biofeedback to help women with hypertonicity issues at all?
00:30:25.839 --> 00:30:28.480
Like helping them to learn how to relax.
00:30:28.960 --> 00:30:30.079
I have in the past.
00:30:30.240 --> 00:30:40.240
I don't a ton just because um I haven't really needed to with like just I think it's just like kind of like luck of the draw.
00:30:40.400 --> 00:30:42.160
Um, but I have for sure.
00:30:42.319 --> 00:30:47.920
Like if what I'm doing isn't working and I feel that you know it should, then for sure.
00:30:48.079 --> 00:30:52.880
And I really like using that for high tone and disinertia together.
00:30:53.200 --> 00:31:28.799
So somebody is having a hard time like pooping, for example, or bearing down and they're contracting instead, but they don't know, like I'll have them put in the biofeedback vaginally or regularly, depending, and like do it, actually do the motion, like sitting on the edge of the table or sitting, you know, on the chair that's kind of similar to a toilet, and be like, okay, I want you to like let's do it, let's do the action, and then they can see on the biofeedback that oh, I'm actually not bearing down, I'm contracting instead.
00:31:28.960 --> 00:31:39.200
And that can be helpful too for people that have, like I said, outlet constipation, or even um some difficulty with like bladder emptying afterwards, okay.
00:31:39.359 --> 00:31:46.880
After baby two, or just bladder emptying in general after like a UTI or yeast infection because they have high tone dysnergia, the nerves are going crazy.
00:31:47.119 --> 00:32:01.759
Um also, I have used it before for somebody that had retention after they had a baby from like the epidural, and they just were self-cathing at home, like they just could not like reconnect to their pelvic floor.
00:32:01.839 --> 00:32:05.680
And so we did that a couple of sessions, and that was really helpful.
00:32:06.160 --> 00:32:09.759
What about with just like fingers and like tactile biofeedback in the clinic?
00:32:09.839 --> 00:32:13.519
Like, do you do you do that a fair amount with oh that's yeah, yeah, yeah.
00:32:13.680 --> 00:32:14.240
Okay, yeah.
00:32:14.400 --> 00:32:15.759
As we say, lots of that.
00:32:16.079 --> 00:32:16.799
Yeah, yeah, yeah.
00:32:16.880 --> 00:32:17.839
Lots of manual feedback.
00:32:17.920 --> 00:32:18.319
Yeah, yeah.
00:32:18.400 --> 00:32:23.039
That's basically like what I do for biofeedback is like my fingers in the clinic.
00:32:23.200 --> 00:32:33.519
Um, and I like mirrors, so I'll have patients like look a lot in the mirror, kind of what when I'm working on them, and so they can kind of see what I'm talking about.
00:32:33.759 --> 00:32:41.119
Um, and then I'm like a big fan of um like for our birth prep biofeedback.
00:32:41.279 --> 00:32:52.079
I have people like push out, like when I'm teaching bearing down and pushing, I have people push out the dilator or push out the wand in the different positions.
00:32:52.240 --> 00:32:56.319
So they get the feedback of like, okay, this is what has to happen.
00:32:56.480 --> 00:33:03.039
Instead of just practicing bearing down, they're actually feeling the wand like slide out of their vagina.
00:33:03.119 --> 00:33:13.279
So it's kind of like, oh, okay, this is like even if I have an epidural, I know that if I keep practicing this motion, this will happen down there, down the road.
00:33:13.440 --> 00:33:15.440
So like I have more success.
00:33:15.599 --> 00:33:16.079
You know what I mean?
00:33:16.480 --> 00:33:20.319
Because like with epidural, it's hard to feel sometimes, depending on the level of the epidural.
00:33:20.480 --> 00:33:31.279
So you need to have that motor program kind of in there habitually, so you can do what you can do and then trust that the bottom is gonna follow because you've been training that.
00:33:31.680 --> 00:33:32.720
That makes so much sense.
00:33:32.799 --> 00:33:38.720
I've actually never heard someone say that they use biofeedback that way, and I think that that is an epic use of it.
00:33:39.119 --> 00:33:40.400
That's my whole app.
00:33:40.559 --> 00:33:44.000
That's like the whole program is the push prep.
00:33:45.279 --> 00:33:57.839
So you mentioned the the um mentioned using mirrors earlier, and this is something that I don't know how much you see this, but I see often people being resistant to watching and to looking at what it's happening.
00:33:58.160 --> 00:34:03.359
Do you have suggestions for people who just are not comfortable looking at their own anatomy?
00:34:03.599 --> 00:34:06.799
Do you have suggestions for how they might overcome that fear?
00:34:08.159 --> 00:34:12.559
I mean, I think I mean, I have a lot, I see a lot of that too.
00:34:12.719 --> 00:34:19.760
And I think the biggest thing is providers is like we don't like force anything on them, obviously.
00:34:20.079 --> 00:34:39.280
And the more educated they feel about their anatomy, and if they don't want to look in the mirror, like I pull out the books, I pull out my diagrams, I draw all over them with right erase marker, um, I use analogies that are very non-medical, you know?
00:34:39.920 --> 00:34:51.760
Um, I don't have anything in my office that's like pain scale one to ten with those like scary faces, or like I don't have any medical illustrations up here that like look very clinical.
00:34:51.920 --> 00:35:00.079
It's it's very much like this is a safe space, we can talk about your body in a way that is safe and comfortable and different for everyone.
00:35:00.239 --> 00:35:03.280
And you have to just be able to kind of read those cues.
00:35:03.679 --> 00:35:06.960
And sometimes they're never gonna want to look, and that's perfectly fine.
00:35:07.199 --> 00:35:25.679
But I have found that the more you talk about it during your appointments without the threat of the mirror or without like the threat of them being judged or thinking it's a stupid question or whatever, the more willing they are to kind of keep going down that route.
00:35:26.320 --> 00:35:33.119
Um, and once they do look or once they do start exploring, then it's like they're pleasantly surprised.
00:35:33.440 --> 00:35:33.679
Yeah.
00:35:34.000 --> 00:35:36.079
Like, oh, it's not gross, it's not dirty.
00:35:36.320 --> 00:35:37.199
Like, I know what this is.
00:35:37.280 --> 00:35:39.039
I saw this in the picture, and it's like, yeah.
00:35:39.599 --> 00:35:42.800
I mean, I say all the time, like, vaginas are like elbows, like to me.
00:35:43.039 --> 00:35:46.400
So I'm like, I'll talk about your vagina like it's your elbow.
00:35:46.559 --> 00:35:49.760
And so, like, nothing weird about it for me at all.
00:35:50.000 --> 00:35:52.559
So, like, what do you want me to, you know?
00:35:52.639 --> 00:35:55.280
I'm like, ask me to get whatever you want.
00:35:55.440 --> 00:35:57.280
Like, I don't care, you know, it's perfectly fine.
00:35:57.519 --> 00:36:00.880
This is another body part, it's your body part, it's a body part, it's fine.
00:36:00.960 --> 00:36:02.719
There's nothing wrong with it.
00:36:03.519 --> 00:36:04.159
Yeah.
00:36:04.559 --> 00:36:07.440
And yeah, like an elbow.
00:36:07.599 --> 00:36:08.880
Yeah, vaginas are elbow.
00:36:12.239 --> 00:36:13.760
I use neck, I use necks all the time.
00:36:14.000 --> 00:36:15.440
Like, to me, this is no different than your neck.
00:36:15.679 --> 00:36:17.840
Like, I'm looking at your neck and palpating your neck.
00:36:17.920 --> 00:36:20.400
It's like your neck's your neck, it's like your vagina's your vagina.
00:36:21.280 --> 00:36:23.360
Um, so last question for you.
00:36:23.519 --> 00:36:25.119
Well, I guess two more questions.
00:36:25.599 --> 00:36:30.079
One, when do you teach people to kegel?
00:36:30.400 --> 00:36:33.440
And when do you tell them that that is detrimental?
00:36:34.639 --> 00:36:35.760
I mean, depends.
00:36:36.079 --> 00:36:37.119
Depends, right?
00:36:37.440 --> 00:36:37.840
Depends.
00:36:38.079 --> 00:36:38.880
Always it depends.
00:36:39.039 --> 00:36:40.159
But like, what would you say?
00:36:40.239 --> 00:36:44.960
Like, when you set have someone come in and say, I've done, you know, been doing kegels, it's not fixing my problem.
00:36:45.199 --> 00:36:52.000
When would you say, hey, listen, like that might not be the right strategy versus like, okay, we need to figure out how to do that better?
00:36:52.400 --> 00:37:05.760
Well, you I don't think you can so my school of thought is that I don't like to prescribe or make any sort of claim about what they should or should not be doing until I'm until I've put my hands on them and I assess them.
00:37:05.920 --> 00:37:06.159
Right.
00:37:06.719 --> 00:37:16.559
Because like somebody coming in with the same diagnosis prolapse, let's say, or stress incontinent, immediately we think that's like low-tone supportive dysfunction.
00:37:16.800 --> 00:37:22.639
But we know a lot of times it could not be a strength or low-tone problem, it's a high tone problem.
00:37:22.960 --> 00:37:27.440
So both of those people, same diagnosis, might need completely different treatments.
00:37:27.519 --> 00:37:29.679
One would be up training, one would be down training.
00:37:30.000 --> 00:37:42.960
So I I would say it's appropriate to start to do key goals and up training when it's appropriate to do key goals and up training based on their symptoms, their goals, what their motor control is like, and their timing.
00:37:43.440 --> 00:37:51.920
Even if they are weak, for sure weak, low tone, I felt every time I keep going, like there's no high tone, no spasm.
00:37:52.159 --> 00:38:00.320
I won't give isolated strengthening of the pelvic floor until they can show me that their muscles are able to go through the full range of motion.
00:38:00.559 --> 00:38:03.280
Otherwise, I just feel like it's not gonna do anything.
00:38:03.840 --> 00:38:12.239
The other piece that I've changed in the last couple years of my practice is that I've done I've overloaded a lot more than I have in the past.
00:38:12.480 --> 00:38:20.480
I've I've overloaded the pelvic floor to the point of fatigue much heavier than I have before.
00:38:20.800 --> 00:38:25.119
I don't think we were loading enough before, especially for our dynamic runners.
00:38:25.199 --> 00:38:37.519
Like we were not straining and stressing the pelvic floor as much as we should, especially in a like a progressive resisted type of model.
00:38:38.559 --> 00:38:43.440
So I want their pelvic floor to go to fatigue with the reps that I give them.
00:38:43.599 --> 00:38:48.239
I want them to feel like the last one they can't do, and I want them to have symptoms the next day.
00:38:48.400 --> 00:38:52.239
Like I want there to be soreness and I want them to feel like they're leaking a little bit more.
00:38:53.119 --> 00:38:57.920
Just like we're in the gym and working out our biceps, delayed onset muscle soreness, exactly right.
00:38:58.079 --> 00:39:00.000
Like I want that to happen the next day.
00:39:00.159 --> 00:39:01.199
Do I want it to continue?
00:39:01.360 --> 00:39:02.159
No, of course not.
00:39:02.239 --> 00:39:18.880
But I want that to be like 24, 48 hours, and then knowing it's because they fatigued out their muscles, and then the third or second day, oh look, I feel a little bit like better, you know, or we go back to baseline because obviously we're not gonna see stress changes in two days, but like just hypothetically.
00:39:19.360 --> 00:39:46.960
Um so in people that are having traditional low-tone type problems and weakness and hypermobility and and difficulty with like endurance and sustaining posture and functional activities, like lifting kids and you know, all the things because they have prolapse and they have weakness and their control is off, then we'll up train, but not until like the building blocks are in place.
00:39:47.199 --> 00:39:52.880
Functional first, um, timing needs to be on, and then we can start to progress up.
00:39:53.039 --> 00:40:01.280
Sometimes I'll get people in compression, I'll put them in, I'll tape them, we'll kind of get everything like where we need it to be, and then we start to strengthen.
00:40:02.159 --> 00:40:12.480
On the other side of the spectrum, if somebody's coming in with those same symptoms, but their pelvic floor is contracted and they can't let it go, I'm not gonna give them a concentric shortening contraction.
00:40:12.719 --> 00:40:16.320
It's not a strength problem for them, it's a timing issue, it's a relaxation.
00:40:16.639 --> 00:40:23.360
Maybe there's a strength problem, but the you can't assess that uh if their muscles are so tight that they can't go through the range of motion.
00:40:23.760 --> 00:40:24.239
You can't.
00:40:24.639 --> 00:40:28.320
So, like what harm is it gonna do?
00:40:28.559 --> 00:40:35.519
Yeah, like how like how is that gonna hurt them if you do down training for three weeks before strengthening?
00:40:35.599 --> 00:40:36.159
You know what I mean?
00:40:36.239 --> 00:40:51.119
It's not, it's gonna like if you're wrong, then you just keep you go the other direction, but but I I think it's like you can't say that somebody needs strength because like because they're tight.
00:40:51.440 --> 00:40:55.519
We want long and strong, we don't want short and weak.
00:40:56.159 --> 00:40:58.320
And should everybody be doing keegels?
00:40:58.480 --> 00:40:59.119
I don't know, maybe.
00:40:59.199 --> 00:40:59.920
I have no idea.
00:41:00.079 --> 00:41:00.880
I don't think so.
00:41:01.039 --> 00:41:03.920
I think it's like it's more functional.
00:41:04.079 --> 00:41:11.440
We need more functional, like coordination of the pelvic floor with the core and the breath and your transverse and lifting and that sort of thing.
00:41:11.679 --> 00:41:14.639
Should everybody be standing around, you know, squeezing their vagina?
00:41:14.800 --> 00:41:15.840
You know, what are you waiting for?
00:41:16.000 --> 00:41:16.639
An elevator?
00:41:16.880 --> 00:41:17.199
No.
00:41:17.519 --> 00:41:18.480
I don't think so.
00:41:18.639 --> 00:41:20.320
Do you need to do that sometimes?
00:41:20.559 --> 00:41:21.119
Sure.
00:41:21.360 --> 00:41:23.440
But is that like the treatment program?
00:41:23.679 --> 00:41:24.000
No.
00:41:24.320 --> 00:41:25.679
I mean, like, who would do that?
00:41:25.840 --> 00:41:34.559
Like, what professional would be like, okay, so your exercise, your homework for PT is, you know, three sets of 10, 10 seconds, every time you're sitting at a red light.
00:41:34.719 --> 00:41:35.679
Like, that's ridiculous.
00:41:35.760 --> 00:41:36.639
It's not skilled.
00:41:36.719 --> 00:41:37.920
So, like, why are we doing that?
00:41:38.079 --> 00:41:40.880
First of all, they're not having symptoms sitting in a red light.
00:41:41.039 --> 00:41:44.320
And second of all, everybody can squeeze their vagina at a red light.
00:41:44.400 --> 00:41:47.440
So of course it's not working, you know?
00:41:47.679 --> 00:41:50.000
Like, of course it's not working.
00:41:50.239 --> 00:41:57.519
That would be like telling a soccer player after an ACL reconstruction to do quad sets while they're sitting in the car.
00:41:57.760 --> 00:42:00.480
And then they go into a soccer field and they're like, well, I can't balance.
00:42:00.639 --> 00:42:07.119
And it's like, well, I don't know, you've been doing your strengthing exercises, but it's like you haven't though.
00:42:07.360 --> 00:42:09.920
So why you know what I'm saying?
00:42:10.000 --> 00:42:12.320
Like, I don't know if this can put into function.
00:42:12.480 --> 00:42:19.440
Yeah, it's like I don't know if it's making any sense, but it's like Kegels aren't the worst thing in the world, but like, let's be smarter about them, you know?
00:42:19.599 --> 00:42:29.760
And like, I don't know how many videos you see online that it's like Kegel programs, but there's no explanation for like when this might be detrimental versus when this might actually help you.
00:42:29.840 --> 00:42:47.920
And it's like you're watching this like just like on some random, you know, YouTuber or like you know, TikTok channel of like doing like 500 kegels a day, and that I have so many patients who come in who think that they've been doing pelvic floor strengthening, but all they've been doing is squeezing their butt and like they're not even getting the right muscles.
00:42:48.320 --> 00:42:51.039
No, a hundred percent, a hundred percent.
00:42:51.679 --> 00:42:57.599
So, can I ask you back to the when you're doing the progressive overload, what are you using to do that for yourself?
00:42:57.760 --> 00:42:59.840
Are you using vaginal content weights?
00:43:00.000 --> 00:43:02.559
Are you having people up on their feet weightlifting?
00:43:02.639 --> 00:43:04.800
Like, what does your progressive overload look like?
00:43:05.039 --> 00:43:05.840
Yeah, all of it.
00:43:06.000 --> 00:43:12.079
Depending on what they need to do, yes, and depending on what they're showing me, like objectively, what that what their pelvic floor can do.
00:43:12.159 --> 00:43:19.280
So, yeah, when I get to the point where we're like really overloading, I love vaginal weights, big fan.
00:43:19.840 --> 00:43:22.159
Used to not be, but I am now.
00:43:22.639 --> 00:43:24.159
Big fan of vaginal weights.
00:43:24.320 --> 00:43:28.880
Um, I like a lot of eccentric training of the lower extremity with the weights in.
00:43:29.119 --> 00:43:45.920
I do um if I have like weightlifters or crossfitters, or people that like a lot of people here do those like circuit like hit training, like true 40 or orange theory or whatever, kind of like the those types, like I'll have them use the weights at home with bands.
00:43:46.000 --> 00:43:52.400
And I do a lot of stuff like squat, donkey kicks, monster walks, multiplaner.
00:43:52.480 --> 00:43:56.719
I'm a big like cross midline person, so I want all degrees of freedom.
00:43:56.800 --> 00:43:58.400
I don't want just sagittal planner.
00:43:58.960 --> 00:44:01.760
Um if They're doing arms at the gym.
00:44:01.840 --> 00:44:03.679
I have them put a small weight in.
00:44:04.559 --> 00:44:06.159
And practicing arms with it in.
00:44:06.239 --> 00:44:06.480
Mm-hmm.
00:44:06.559 --> 00:44:06.800
Yeah.
00:44:06.880 --> 00:44:07.039
Yeah.
00:44:07.119 --> 00:44:13.039
I mean, if today's like arm and chest day and you're bench pressing, you're using your public floor when you're doing that.
00:44:13.119 --> 00:44:14.880
So let's put a little weight in.
00:44:15.679 --> 00:44:17.920
Oh, and see if you can keep that baby in while you do it.
00:44:18.400 --> 00:44:19.119
Yeah, 100%.
00:44:19.599 --> 00:44:25.440
And then if you're vacuuming, you know, if you're out doing yard work, yeah, that's an endurance thing.
00:44:25.599 --> 00:44:26.159
Let's say you can.
00:44:28.000 --> 00:44:30.639
You're going in every freaking direction when you do that.
00:44:30.800 --> 00:44:31.119
Yeah.
00:44:31.360 --> 00:44:34.400
And like lunge with it and like walk the dog with it.
00:44:34.559 --> 00:44:38.480
And like, you know, do I want you walking around all day with your, you know, vagina clenched?
00:44:38.639 --> 00:44:39.199
No, I don't.
00:44:39.360 --> 00:44:42.719
But like, can you ru like lift up the weight and let go?
00:44:42.880 --> 00:44:46.079
Can you keep the weight in when you bend down and lift up a laundry basket?
00:44:46.320 --> 00:44:49.840
Can you keep the weight in when you're doing you know leg press?
00:44:51.119 --> 00:44:52.400
That would be good.
00:44:52.960 --> 00:44:53.599
Yeah.
00:44:55.119 --> 00:44:57.440
You're using your pelvic flow and your breath for all those things.
00:44:57.519 --> 00:45:05.280
Like, I mean, that's the thing I think probably think about the most when I train bench press is am I keeping my pelvic floor and my breath coordinated?
00:45:05.679 --> 00:45:06.800
Because if I don't, guess what?
00:45:06.880 --> 00:45:07.840
I'm getting pinned.
00:45:08.079 --> 00:45:08.320
Yeah.
00:45:08.559 --> 00:45:09.280
Like, right.
00:45:09.440 --> 00:45:12.639
And it it happens at least once a week where I lose my breath.
00:45:12.719 --> 00:45:19.760
And like my trainer's like, I saw you lose your breath, and then like here and like can't get the bar back off of me.
00:45:19.920 --> 00:45:24.800
So and you'll just shoot the vaginal weight right out of your vagina if you're val salving.
00:45:25.039 --> 00:45:26.400
So yeah.
00:45:27.199 --> 00:45:29.039
But that's what's happening to your bladder, right?
00:45:29.119 --> 00:45:30.320
That's what's happening with prolapse.
00:45:30.480 --> 00:45:33.599
That's why you're leaking because you're moving down, right?
00:45:33.679 --> 00:45:37.760
And the pelvic floor can't contract, can't like contract against that pressure.
00:45:38.079 --> 00:45:43.679
So let's do that with a weight in to like get some hypertrophy and feedback.
00:45:43.840 --> 00:45:46.960
I mean, now you could do it with a perifit, I would think, too.
00:45:47.199 --> 00:45:48.880
And like I would think so, you know.
00:45:48.960 --> 00:45:51.280
And what are you doing when you're bench pressing with a perifit?
00:45:51.360 --> 00:45:57.840
What are you doing in there when you're doing your rows or your, you know, like sumo squats?
00:45:58.320 --> 00:45:58.719
Yeah.
00:45:58.960 --> 00:46:01.519
Oh god, he's gonna love when I show up to my next session.
00:46:01.599 --> 00:46:03.679
I'm like, so give me a minute.
00:46:04.400 --> 00:46:06.320
Gotta stick this in and get the app up.
00:46:06.880 --> 00:46:11.039
I was gonna say, well, I mean, I just bring like a vaginal cone, but like we haven't done that yet.
00:46:11.280 --> 00:46:13.840
He's gonna he's gonna love when I show up with that part.
00:46:14.159 --> 00:46:15.119
Why not?
00:46:17.840 --> 00:46:19.199
Absolutely love it.
00:46:20.559 --> 00:46:23.360
Well, I think we've kind of canvassed everything that I can think of.
00:46:23.440 --> 00:46:30.000
Is there anything else that you think like listeners should know about feedback, vaginal training, weights?
00:46:30.320 --> 00:46:31.840
Any of these campuses?
00:46:32.159 --> 00:46:49.679
I mean, I think the main thing is that like there's not one answer, and there's not like one thing, and oftentimes it's a combination of things that help the most, and we have to kind of like figure that out, and everybody's a little bit different.
00:46:49.920 --> 00:47:09.119
And as we go through perimenopause, as we go through menopause, as we go through you know, all of the things, those needs are gonna change, and like that's okay, you know, and like maybe for a while biofeedback works, and then maybe it doesn't really work anymore for you, or maybe for a while weights work, and then you need a break from that, and then you go back to them, and that's fine.
00:47:09.440 --> 00:47:15.840
But just know that like nothing that not one thing is gonna do it.
00:47:16.159 --> 00:47:24.639
And I think with the weights and with Perifit and with uh or other type, I mean, this is not sponsored by Perifit in any other way.
00:47:24.719 --> 00:47:39.519
We just happen to be talking about this one, um or any other sort of device, like, you know, it's okay to ask for some guidance and some parameters, you know, from a PT or from their, you know, whoever their medical staff is or whatever.
00:47:39.599 --> 00:47:43.039
Um, because you want a little bit, you don't want to just go in there blinded.
00:47:43.280 --> 00:47:49.360
Oh, well, I so appreciate you taking the time in the busy clinic schedule today and the day after your app launched.
00:47:49.440 --> 00:47:50.960
I'm so excited for you for that.
00:47:51.199 --> 00:47:51.599
Thank you.
00:47:51.760 --> 00:47:54.800
And I'd like to just ask you one final question, if you don't mind.
00:47:55.119 --> 00:47:55.840
Tell me.
00:47:56.880 --> 00:48:00.960
What is your personal one daily health non-negotiable?
00:48:01.039 --> 00:48:03.840
What is it that you for yourself have to do every day?
00:48:05.760 --> 00:48:07.280
That's a great question.
00:48:07.519 --> 00:48:10.400
Um, does it have to be healthy?
00:48:11.119 --> 00:48:13.119
No, it doesn't have to be healthy.
00:48:13.199 --> 00:48:15.039
If it's still for your health, it doesn't have to be healthy.
00:48:15.280 --> 00:48:16.320
Okay, love that.
00:48:16.639 --> 00:48:27.280
Um I like my morning ritual, like I really like my morning ritual, which is like I stopped putting my phone next to my bed.
00:48:27.440 --> 00:48:29.599
So I have my phone like across the room.
00:48:29.760 --> 00:48:32.559
So when my alarm goes off, I actually have to like get my ass out of bed.
00:48:32.639 --> 00:48:38.159
Although I have circumvented and start, I like scream at Siri to snooze.
00:48:39.599 --> 00:48:40.800
So I'm like, damn it.
00:48:40.960 --> 00:48:45.519
So I actually think I'm gonna go back and get like an analog alarm clock, like a legit one.
00:48:45.679 --> 00:48:49.119
But I you have to like get up and walk, turn it off.
00:48:49.360 --> 00:49:04.719
Um so I've been like I've been doing that, which is nice because I won't stay in bed like scrolling on my phone, which I don't need to be doing, and I get up and I have a cup of coffee and I let the dogs out, and now it's like spring here, so things are blooming, and I've got little baby birds outside.
00:49:04.880 --> 00:49:07.199
Um I know it's so cute.
00:49:07.360 --> 00:49:14.639
So and like I just kind of like have this moment to myself in the morning before like the craziness of the day.
00:49:14.800 --> 00:49:26.320
Um, and my I mean, ideally I would like to be at the barn with my horse every day for like my exercise and mental health, but I can't do that because of work and life and all the things.
00:49:26.480 --> 00:49:32.480
And so that's I get that twice a week, sometimes three times, and that is like a non-negotiable.
00:49:33.280 --> 00:49:35.760
That's lovely, and that's perfect.
00:49:37.119 --> 00:49:38.880
Well, thank you again for being here today.
00:49:38.960 --> 00:49:43.039
Yeah, I make sure that everywhere everyone can find you is in the show notes.
00:49:43.199 --> 00:49:47.599
So you can I'll have your people send that over so I can make sure it's all in there.
00:49:47.760 --> 00:49:48.239
Yeah, yeah, yeah.
00:49:50.480 --> 00:49:54.400
And thank you all again for being here for another week of Metopause Unscripted.
00:49:54.559 --> 00:49:56.239
If you enjoyed this conversation with Dr.
00:49:56.400 --> 00:50:02.000
Marcy, please come back last next week and like, follow, and subscribe everywhere you like to follow your podcasts.
00:50:02.079 --> 00:50:04.079
And we'll see you again next week.
00:50:04.639 --> 00:50:06.559
Now I have to end with the boring stuff.
00:50:06.800 --> 00:50:09.920
While I am a doctor, I am not your doctor.
00:50:10.480 --> 00:50:15.119
This podcast is for entertainment and educational purposes only.
00:50:15.440 --> 00:50:23.039
If something in today's episode resonated with you, please bring this to your own healthcare team and self advocate.
00:50:23.280 --> 00:50:24.960
You always are promoting that.
00:50:25.199 --> 00:50:33.199
I cannot wait for you to join me on next week's episode of MetaPause Unscripted for another hot topic.
00:00:02.640 --> 00:00:05.519
Thanks for joining me on Menopause Unscripted.
00:00:05.679 --> 00:00:08.960
Remember, the change is just another beginning.
00:00:11.759 --> 00:00:14.160
Welcome back to another week of Menopause Unscripted.
00:00:14.240 --> 00:00:14.560
I'm Dr.
00:00:14.640 --> 00:00:17.440
Heidi and I'm joined today by my friend and mentor, Dr.
00:00:17.600 --> 00:00:18.559
Marcy Crouch.
00:00:18.800 --> 00:00:25.039
She is the down there doc for any of you who have seen her on social media, who's just like so cute.
00:00:25.440 --> 00:00:29.039
Oh my god, my glasses and my old age blind now.
00:00:29.359 --> 00:00:31.519
Oh, I told you I had to wash mine before I came on.
00:00:31.600 --> 00:00:33.359
I'm like, give me a minute, I'm washing my glasses.
00:00:33.600 --> 00:00:36.560
I've washed them with soap and water daily.
00:00:36.880 --> 00:00:38.000
Yeah, how can you not?
00:00:38.079 --> 00:00:38.960
They just get so gross.
00:00:40.399 --> 00:00:41.359
I digress.
00:00:41.759 --> 00:00:48.320
She launched her app, the Down There Doc app, yesterday, which I had no idea until this morning, and I was so excited.
00:00:48.399 --> 00:00:52.640
It was actually last night, but it's like, thank you for being on today when life is hectic.
00:00:52.799 --> 00:00:53.119
Oh, yeah.
00:00:53.600 --> 00:00:58.640
And you also have your platform, which is drmarcycrouch.com.
00:00:58.960 --> 00:01:01.280
So thank you for coming on.
00:01:01.679 --> 00:01:09.840
Marcy is an expert and a board-certified expert in pelvic floor physical therapy and does a lot of work with pregnancy and postpartum women.
00:01:10.079 --> 00:01:16.799
She also consults that correct me if I'm wrong with the company Perifit, who I'm a huge fan of.
00:01:16.879 --> 00:01:27.519
And we are on today to talk about how biofeedback, which is what Perifit is, it's an example of it, how that can be used for pelvic floor physical therapy and with patients' home management strategies.
00:01:28.239 --> 00:01:28.560
Yes.
00:01:28.799 --> 00:01:30.079
Did I miss anything?
00:01:30.400 --> 00:01:30.719
No.
00:01:31.280 --> 00:01:31.599
No.
00:01:33.439 --> 00:01:35.439
No, I mean, no.
00:01:35.680 --> 00:01:36.480
It's all true.
00:01:38.959 --> 00:01:42.719
I don't have the so the main website is the downtherdoc.com.
00:01:43.120 --> 00:01:56.159
I don't have like I merge them because my ADD brain, I can't have more than like one website because I'm so like, ah, but um, I used to have both, and now it's just easier to kind of keep it all in one.
00:01:56.239 --> 00:02:05.359
As you know, like as a clinician and a woman and all the things, it's like there's 900 my tab, like my post perimenopausal brain, too many tabs open.
00:02:05.439 --> 00:02:08.319
So I'm like, yeah, just simplify, I think.
00:02:09.039 --> 00:02:10.159
I don't blame you.
00:02:10.240 --> 00:02:14.639
I found you on both last weekend when I was looking to see what ones were still present.
00:02:14.879 --> 00:02:17.039
So yeah, yeah, yeah, it's still up.
00:02:17.360 --> 00:02:18.400
It is up, yeah.
00:02:18.479 --> 00:02:24.000
But I yeah, so to put that back on my to-do list, but yeah, we just use the downker doc one now.
00:02:24.240 --> 00:02:24.879
Compressed.
00:02:25.919 --> 00:02:26.400
Yes.
00:02:26.960 --> 00:02:29.120
Which is like the such a fun name, anyways.
00:02:29.199 --> 00:02:31.120
I just absolutely have always loved that handle.
00:02:31.280 --> 00:02:31.919
Yeah, thanks.
00:02:32.000 --> 00:02:35.520
My sister came up with it for me when I started it like years ago.
00:02:35.759 --> 00:02:41.680
So she has a hand, she has like a big hand in naming the brand, which is great.
00:02:42.240 --> 00:02:44.319
Well, it's worked for you, obviously.
00:02:45.199 --> 00:02:47.759
So tell me about your practice now.
00:02:47.919 --> 00:02:49.199
Who are you treating mostly?
00:02:49.280 --> 00:02:50.639
Because you're in Alabama now.
00:02:50.879 --> 00:02:51.120
Yes.
00:02:51.280 --> 00:02:52.159
Yep, yep, yep.
00:02:52.240 --> 00:02:54.960
So we moved to Alabama.
00:02:55.199 --> 00:02:57.280
We live in Auburn, Alabama.
00:02:57.360 --> 00:02:59.759
We moved here in 2020, the week of COVID.
00:02:59.840 --> 00:03:06.719
And that's I think you and I met a like a year or so after that when I was doing the Thriving Mama um series for clinicians.
00:03:07.120 --> 00:03:09.759
I actually met you when you're at Formosa still.
00:03:10.000 --> 00:03:10.800
Oh yeah.
00:03:11.199 --> 00:03:12.960
Because we were just down the street.
00:03:13.280 --> 00:03:14.479
Oh yeah.
00:03:16.800 --> 00:03:19.759
Okay, we need to talk about this like memory thing.
00:03:19.919 --> 00:03:23.759
I really feel like but you did Thriving Mamas, right?
00:03:24.159 --> 00:03:24.560
I did.
00:03:24.800 --> 00:03:25.120
Okay.
00:03:26.319 --> 00:03:26.960
You're not wrong there.
00:03:27.199 --> 00:03:28.240
But we were up the street.
00:03:28.479 --> 00:03:31.120
I know you took a lot longer, so that's this is very true.
00:03:31.360 --> 00:03:32.000
Okay, great.
00:03:32.240 --> 00:03:32.560
All right.
00:03:32.800 --> 00:03:39.439
So yes, we moved here in 2020 and um it was like right in COVID, like the start of COVID, all the things.
00:03:39.520 --> 00:03:44.319
So I kind of pushed real heavy on the online portion, um, started the online business.
00:03:44.560 --> 00:03:46.639
And then I went back in the clinic.
00:03:46.800 --> 00:03:55.759
I worked for a company um that's kind of like a corporate outpatient PT like whatever franchise.
00:03:55.840 --> 00:03:56.400
I'm not really sure.
00:03:56.479 --> 00:03:58.159
But they have a bunch of offices down here in the south.
00:03:58.319 --> 00:04:07.439
And they hired me to like basically start their pelvic floor program, but kids were still little and it was, you know, a little, it was kind of like weird going back in the clinic after COVID.
00:04:07.520 --> 00:04:13.680
So I did it for a little bit and then um I left there and opened my own here.
00:04:14.000 --> 00:04:16.959
So I have a practice very similar to what I had in Redondo.
00:04:17.040 --> 00:04:20.879
It's the same kind of model, one-on-one, cash-based.
00:04:20.959 --> 00:04:26.560
I rent a very cute space from a good friend of mine, actually, who's an esthetician.
00:04:26.879 --> 00:04:40.000
So she bought this old house and she does like facials and waxing and like all the things next door, and then she had this room available that already had a table that goes up and down, and she's our sons, our friends, and that's how we met.
00:04:40.079 --> 00:04:41.680
And she's like, Oh, yeah, I have this room.
00:04:41.920 --> 00:04:43.439
I was like, Oh, I'll rent it from you.
00:04:43.600 --> 00:04:45.759
So that's kind of how that started.
00:04:46.000 --> 00:04:51.759
So I've been here for about two years now, I want to say two and a half, maybe three.
00:04:52.000 --> 00:05:02.079
Um, I have one other therapist that works here for me on Mondays, and then I just hired a PTA, so she's gonna be helping me with some of my case loo.
00:05:02.160 --> 00:05:04.079
Um, but yeah, very similar.
00:05:04.160 --> 00:05:10.879
We do a lot of pregnancy pelvic floor prep, a lot of postpartum recovery, pregnancy musculoskeletal.
00:05:11.120 --> 00:05:15.920
I have some guys on my schedule, not really like I used to treat.
00:05:16.000 --> 00:05:28.639
I'm really trying to just focus mainly on pelvic floor stuff for women, birth prep, postpartum recovery, bladder, pelvic pain, kind of all the things that that you and I treat together.
00:05:28.879 --> 00:05:30.240
So I've been here long enough.
00:05:30.319 --> 00:05:46.800
I feel like where some of my patients now in this cycle are coming back in after their second, third, um, or I saw them after their last baby, you know, a couple years ago, and now they're getting it transitioning into like the perimenopause kind of menopause side of things.
00:05:46.959 --> 00:05:53.040
So there's so much overlap in our treatments and kind of what we're doing and what we're preparing them for.
00:05:53.279 --> 00:05:56.879
So yeah, so that's kind of the caseload, caseload here.
00:05:57.759 --> 00:06:00.079
And how much would you say are you doing online?
00:06:00.160 --> 00:06:02.720
Are you doing a lot of virtual PT at this point as well?
00:06:02.959 --> 00:06:05.120
No, I don't do any virtual, yeah.
00:06:05.199 --> 00:06:06.560
I don't do any virtual PT.
00:06:06.639 --> 00:06:11.920
I do some online kind of like wellness coaching, I would say, every now and then, but it's really like mainly through the app.
00:06:12.079 --> 00:06:19.279
So the community that we had online, um, we just created an app for that.
00:06:19.519 --> 00:06:24.160
So all of the programs that we have, instead of doing it on your desktop, you can do it on the app.
00:06:24.240 --> 00:06:25.439
It's the same programs.
00:06:25.600 --> 00:06:32.959
Um, and then we do like kind of one-on-one stuff in there if needed, or like discussion boards, kind of interviews like this, that sort of thing.
00:06:33.120 --> 00:06:48.639
Um, I have thought about doing some telehealth here in Alabama for some of my patients that um can't get back into the clinic after they have their babies, like in the early rehab phase, but I haven't like set that up yet.
00:06:48.720 --> 00:06:57.680
But you know how it is with like licenses, and you know, if I I'd have to like get licensed in lots of other states to treat people in those states, but for wellness you can kind of do it all over.
00:06:57.839 --> 00:07:06.000
But here under this business, under this clinic business, it would be um just in Alabama and patients who I've already seen.
00:07:06.560 --> 00:07:17.519
But I love the fact that with the app and with the web in the web stuff as well, you're able to access patients more broadly and help them with programming and whatnot that they couldn't maybe access you otherwise.
00:07:17.759 --> 00:07:18.399
Yeah, yeah, yeah.
00:07:18.480 --> 00:07:20.879
I mean, that was really the genesis behind going online.
00:07:21.120 --> 00:07:32.319
I mean, you see in your practice too, I'm sure, that a lot of times, you know, we lose women after um maternity leave is over, when their kids are still kind of involved in all the things.
00:07:32.480 --> 00:07:43.199
Like we, you know, might get them during pregnancy and right after, but then we really don't see them because it's hard to get in for appointments, it's expensive, insurance doesn't really cover it, you know, there's all these variables.
00:07:43.279 --> 00:08:02.800
So, like, can we just strip away some of these um boundaries and some of these reports that we have in place and offer something that kind of bridges the gap a little bit, you know, and um can we translate what we're doing in the clinic over to this kind of different type of platform and still get very similar results?
00:08:02.959 --> 00:08:04.000
And we found that we can.
00:08:04.079 --> 00:08:08.720
It's just a matter of now of like disseminating it, basically.
00:08:09.600 --> 00:08:20.160
No, I love that, and I think that that's really great is being able to transcend the barriers, yeah, get people the education that they need because women and moms just like to put themselves at the last, right?
00:08:20.240 --> 00:08:35.039
So if we can make it easier for them to access, and I think that translates kind of into the conversation for today is when we're trying to teach women how to do things for themselves and be able to do it at home, you know, can we be using other tools to help them to do it better?
00:08:36.720 --> 00:08:40.240
And that's part of how I use biofeedback in my practice.
00:08:40.320 --> 00:08:42.159
Do you do something similar with yours?
00:08:42.399 --> 00:08:43.120
Yeah, I do.
00:08:43.279 --> 00:08:50.879
I have I I do use biofeedback, yes, and I do like a couple of the options out there.
00:08:51.120 --> 00:09:05.360
Um working mainly with PerryFit, I've really got to understand the technology and how it can help uh when we're talking about how people are understanding and accessing their pelvic floor for sure.
00:09:05.600 --> 00:09:17.120
And I think it's a really great option for people that are doing well with therapy and but need just like a little bit more reinforcement, and we'll kind of talk about that a little bit too.
00:09:17.279 --> 00:09:32.639
Um, so they know that what they're doing at home or if they're doing kind of higher level type activities like getting back into running or doing these kind of dynamic things, um, they have something that gives them a little bit of visual feedback, uh, which I can find, you know, very helpful.
00:09:32.799 --> 00:09:51.120
Um I don't do a lot of surface EMG or surface biofeedback um just because of like time constraints and um, you know, I feel like I get a good result with my fingers, to be honest, like from a manual side.
00:09:51.440 --> 00:09:58.960
And then, you know, if we need to do stuff at home, then Perryfit is usually like kind of where I where I um direct them.
00:09:59.440 --> 00:09:59.759
Okay.
00:10:00.000 --> 00:10:08.159
So in terms of types of biofeedback, can we kind of do a quick review of like the different types of biofeedback for people who might have no idea what we're talking about?
00:10:08.480 --> 00:10:09.120
Yes.
00:10:09.919 --> 00:10:10.320
Yeah.
00:10:10.399 --> 00:10:12.240
So backing it up a little bit.
00:10:12.480 --> 00:10:13.360
Yes, yes, yes.
00:10:13.600 --> 00:10:32.159
So biofeedback is just really a fancy way of giving different sorts of um information back to the patient to understand their body or muscle contraction or movement or whatever the case may be.
00:10:32.240 --> 00:10:44.639
So this could be in the form of um uh verbal, like verbal feedback, talking to them about, okay, move your knee this way or take a breath this way, or or move your shoulder this way.
00:10:44.879 --> 00:10:55.759
It can be tactile, you know, manual palpation to a certain muscle joint, both from an inhibition, which means like, okay, I want you to turn this muscle off and let's try to do this muscle.
00:10:56.080 --> 00:11:00.639
Or um in a way that's like, okay, focus right here, like right where I'm touching it.
00:11:00.720 --> 00:11:02.080
I want you to think about this.
00:11:02.559 --> 00:11:23.039
Um, and then that usually works well for the kind of general orthopedic setting for muscles and movements that we can see, like outwardly, especially for people relearning how to walk or contract a muscle that's been in, you know, gas for an X amount of time and need a little bit more of that.
00:11:23.120 --> 00:11:27.039
Like, okay, yes, it's like I'm connecting to this muscle here.
00:11:27.919 --> 00:11:33.600
For pelvic floor, bladder retraining, pelvic floor stuff, biofeedback has always kind of been around.
00:11:33.679 --> 00:11:50.159
It's been one of the early treatments um studied, kind of the first, I would say, one of the first things that was studied, because we can have objectifiable data, like we're able to look at what the biofeedback machines are telling us, and we can like put that into a study and we can compare it.
00:11:50.240 --> 00:11:54.320
You know, it's not it's not like subjective in any way.
00:11:54.720 --> 00:11:56.799
I think it's like data and actual numbers.
00:11:57.120 --> 00:11:57.600
Yeah, exactly.
00:11:57.679 --> 00:11:58.879
And we can like control that.
00:11:58.960 --> 00:12:06.000
Like we're using this machine and we're using this exercise, and we're using this way to measure, and this person looks like this, and this person looks like this.
00:12:06.080 --> 00:12:10.399
So it's like we can kind of really be able to tell what that's doing.
00:12:10.799 --> 00:12:38.879
It's a way for the pelvic floor, especially since we can't see it, and it's a 3D muscle and goes and lies in this different plane and this transverse plane of our body, it's very hard for our brain sometime to connect to it, um, especially after having a baby, especially after any type of surgery, especially in any type of swelling, trauma, whatever, it makes that connection from our brain to our pelvic floor not as robust as it used to be.
00:12:39.039 --> 00:12:44.960
So just figuring out how to move the pelvic floor, how to contract, what does that look like, what does your baseline look like?
00:12:45.039 --> 00:12:47.840
You know, all of these symptoms that our patients are dealing with.
00:12:47.919 --> 00:13:03.679
Um, this is a way that you can take that activity of the muscle and put it onto a screen on your phone, for example, this particular device, um, and it gives you information of the electrical activity of the muscle.
00:13:03.840 --> 00:13:14.240
So specifically for periphit or devices that are similar to that, it's an internal probe that looks like a tampa and you put it inside your vagina or in the rectum, depending on what you're doing.
00:13:14.559 --> 00:13:20.000
Um, and it picks up activity of the skeletal muscle.
00:13:20.080 --> 00:13:39.840
So it'll tell you on the app if you're contracting, if you're relaxing, if you have kind of like fluttering contraction, if you're squeezing your muscle, but you're not really sure if you know what you're doing it right, then you'll see on the app the line go up a little bit, you know, and they have games kind of keep the bird flying in the sky and like a gamified.
00:13:40.240 --> 00:13:45.759
Yeah, yeah, like put the bird up and then like let the bird come down, and then okay, we're gonna like hit this flower over here.
00:13:45.840 --> 00:13:47.440
Like, there's ways to do it.
00:13:47.679 --> 00:13:55.919
Um, and it can be a very useful tool for somebody that needs a little bit more kind of visual feedback, um, which is always kind of fun.
00:13:56.080 --> 00:14:03.440
Um, it doesn't tell you though, biofeedback does not give you any measurement of strength or any measurement of hypertrophy.
00:14:03.519 --> 00:14:11.840
It'll it just literally t picks up the electrical activity of the muscles so you can see what they're doing.
00:14:12.320 --> 00:14:21.679
Um, oftentimes we'll see that translates over to strength and function, but we can't say that the device is measuring strength directly.
00:14:22.000 --> 00:14:24.720
It's more about activation timing, that sort of thing.
00:14:24.799 --> 00:14:27.440
And there's also um external biofeedback too.
00:14:27.519 --> 00:14:33.039
You can put those little like sticky pads on the perineum or on the belly or wherever, um, and that'll get up too.
00:14:33.120 --> 00:14:45.440
But it's a little bit tricky there because you get more uh feedback and noise from other structures, and it's hard to say, like, okay, which is the perineum and which is this, and what is giving here and what's giving there.
00:14:45.519 --> 00:14:51.120
So with an internal device, you it's a lot more um kind of uh like isolated.
00:14:51.200 --> 00:14:56.720
You'll still get you'll still get noise from other muscles, but it's much more specific to public core.
00:14:57.919 --> 00:15:01.840
So that's like led me into a conversation I had with a patient yesterday.
00:15:02.159 --> 00:15:08.320
One, we this particular individual, we had used surface emg at her first visit.
00:15:08.399 --> 00:15:11.519
And it's because mostly she wasn't comfortable with doing anything internal.
00:15:11.679 --> 00:15:12.159
Yeah, great.
00:15:12.399 --> 00:15:14.720
And she wasn't ready for an internal exam.
00:15:14.799 --> 00:15:16.159
That's completely fine.
00:15:16.399 --> 00:15:26.399
That's where I probably use it the most is people who we need to get polyfluor PT started, but we need some warm-up time for us to become friends before we just go right in there.
00:15:26.720 --> 00:15:30.399
Right, they're not ready for like the full, you know, full Monty day one.
00:15:30.559 --> 00:15:35.759
And so we done that day one, and so yesterday we just did a reassessment because we want to see where she was.
00:15:36.080 --> 00:15:43.759
But to your point about it picking up external noise, when I use that surface EMG, I have to unplug my high-lo table.
00:15:44.240 --> 00:15:45.679
I have to turn off my lights.
00:15:45.840 --> 00:15:46.559
Oh, that's interesting.
00:15:46.720 --> 00:15:50.960
I have to turn off my air conditioning because it will pick up everything in the room.
00:15:51.360 --> 00:15:55.840
And it shows that somebody is hypertonic and cannot relax.
00:15:56.000 --> 00:15:56.320
Huh.
00:15:56.480 --> 00:16:02.000
So, like this is your baseline, it like reads like up here, and so it's like they're just looking like they're contracting 24-7.
00:16:02.240 --> 00:16:02.720
Yeah, yeah, yeah.
00:16:03.919 --> 00:16:07.279
And I feel like that doesn't make a really great candidate for home use, right?
00:16:07.519 --> 00:16:14.720
Because people don't know like what things that they have to turn off, and I now know what I have to turn off in here in order to make it work.
00:16:15.200 --> 00:16:23.600
But that I find is like a really great way for people to understand like where we're starting if we're not doing like an internal examination, just like to get a start.
00:16:24.159 --> 00:16:33.519
But in the same way, we're talking a lot about her use of her home biofeedback unit and how she felt like she had lost strength.
00:16:33.919 --> 00:16:52.159
And we've got a really large conversation about that, like how your symptoms regressed, you know, because we're looking, I'm looking at your symptoms, I'm looking at your function, and her symptoms hadn't regressed, but she was just having some days where she was trying to do it and she was really tired, and she just wasn't making that brain-body connection.
00:16:52.480 --> 00:16:56.080
And so the conversation was okay, don't do this when you're really tired.
00:16:56.639 --> 00:17:05.119
And also, like you're rushing because now you feel like you need to get it done because you haven't done it, and it's like five minutes before bed, you're all ramped up.
00:17:05.440 --> 00:17:08.079
And so she just wasn't making the brain-body connection.
00:17:08.160 --> 00:17:16.400
So we did like five minutes of breath work, kind of relaxed, got her in her body, and then did it, and it was like a completely different experience.
00:17:16.559 --> 00:17:26.319
But I was trying to relate to her that this is more like brain-body neuromuscular versus is not telling you you're getting weaker or it's not telling you that you're getting stronger.
00:17:26.400 --> 00:17:28.240
It's this, you know, this deal.
00:17:28.559 --> 00:17:47.519
Yeah, and I think that's like a really great use for that too, to kind of give a little bit of validation to how these external factors will influence what your muscles are doing, you know, and kind of see that when you're stressed, it's gonna be harder to do XYZ, or when you're sick, it's gonna be harder to do.
00:17:47.759 --> 00:17:54.319
But it doesn't mean that like we lost muscle strength in the 20 minutes that you were stressed.
00:17:54.480 --> 00:18:02.000
It's like, okay, just see how this is, you know, affecting your ability to get the muscles doing what they need to be doing.
00:18:02.079 --> 00:18:03.359
And it's just kind of like, oh, okay.
00:18:03.599 --> 00:18:20.079
And that might lend itself to more data about all right, well, maybe you know, when I have a little bit more anxiety, that could explain these symptoms because I can't do this with my pelvic floor versus like, oh gosh, I don't know what's going on, and and then like it kind of feeds back on the anxiety, and then we have this cycle.
00:18:20.240 --> 00:18:42.640
So even though sometimes like the data might not be exactly like what we want to hear in the beginning, perhaps, I think it could be something that would be very empowering in terms of knowing how your body is responding to external factors, and then using that information in a way to design a program and to make things successful at home.
00:18:42.799 --> 00:18:58.319
And then eventually, you know, we stop using the biofeedback because we don't need it anymore, but we know that these triggers are happening, and then you can actually tell a difference in function and public floor muscle contraction relaxation because like you've already trained with the biofeedback.
00:18:59.599 --> 00:19:11.039
And I do like that kind of like tracking trends over time because people like to see how they're doing, and but I do feel like we get a little fixated sometimes too on like, oh, I didn't reach that same number I did yesterday.
00:19:11.519 --> 00:19:13.440
Yeah, yeah, it's tricky, it's a slippery slope.
00:19:13.519 --> 00:19:15.119
That's why I don't do bladder diaries.
00:19:15.200 --> 00:19:17.119
I'm like, I don't want to do it.
00:19:17.279 --> 00:19:23.920
I'm like, we're already thinking too much about your pelvic floor, about your peeing, about your urge or your frequency.
00:19:24.000 --> 00:19:29.759
Like, we don't need to be like charting it, like it doesn't matter because sometimes it's just too much.
00:19:29.839 --> 00:19:34.559
Like we we have to do the opposite, you know, and I mean it's just like too much of a good thing, right?
00:19:34.640 --> 00:19:35.279
It's the same.
00:19:36.240 --> 00:19:52.160
It's like for me when I was pregnant and I had all this anxiety about my kids like be like being pregnant, and I'd get like a handheld Doppler, you know, and I was like Doppler, I'm like, oh, and then I'm like Googling heart rate, I'm like, and that's just like okay, easy.
00:19:52.240 --> 00:19:53.200
Like it's fine, you know.
00:19:53.279 --> 00:19:56.319
If you didn't have this, you wouldn't even be worried about it.
00:19:56.559 --> 00:20:02.640
It's like so you have to, is this like you know, within medicine knowing too much?
00:20:02.799 --> 00:20:04.000
Yeah, yeah.
00:20:05.759 --> 00:20:09.279
So aside from like what what other types of biofeedback do you use?
00:20:09.359 --> 00:20:12.799
I mean, you mentioned earlier, like you being able to feel, and that's a good point.
00:20:12.880 --> 00:20:17.920
Is like when people come into a pelvic floor exam or they're coming into someone like you and I, we're doing a vaginal exam.
00:20:18.799 --> 00:20:28.880
I think that that is something that people don't understand sometimes, like why we are doing a finger internal exam, but that is another type of biofeedback for people.
00:20:29.839 --> 00:20:34.000
So could you tell me a little bit about like your initial exam when you see people?
00:20:34.319 --> 00:20:44.960
Yeah, so I mean, it varies a lot kind of depending on what they're coming in for and what their goals are, and you know, kind of all of those things where they are in their postpartum.
00:20:45.119 --> 00:20:52.319
Like sometimes if I see somebody for the first time postpartum and you know they haven't been cleared yet, I won't do internal, like we'll just do external sort of thing.
00:20:52.400 --> 00:20:56.240
But yeah, I mean, my initial appointment is about an hour.
00:20:56.480 --> 00:21:08.640
We do like good history taking, and then I'll just do some very basic, easy tests to just kind of see like where I need to focus our first couple appointments on.
00:21:08.720 --> 00:21:10.319
You know, like are we looking at the SI?
00:21:10.400 --> 00:21:12.720
Are we gonna work on belly stuff?
00:21:12.799 --> 00:21:16.240
Are there is there like a big C-sex and a scar that's like bothering us?
00:21:16.400 --> 00:21:19.039
Is there something going on in the glutes?
00:21:19.279 --> 00:21:20.799
Or like, is there chronic hip pain?
00:21:20.880 --> 00:21:21.440
Like, what's happening?
00:21:21.519 --> 00:21:24.079
So I'll kind of like get a you know, lay in the land a bit.
00:21:24.319 --> 00:21:29.440
And then with consent, we do the internal exam and kind of just depends on what we're looking for.
00:21:29.599 --> 00:21:46.559
For some of my patients that have pain, chronic yeast infections, difficulty with penetration, had a baby and a big tear, and now they're having like a lot of nerve pain or scar pain or delayed healing, granulation tissue, and silver nitrate, and now they're coming to me after all that's done.
00:21:46.799 --> 00:21:51.119
Sometimes I don't need to do a full internal exam, all the layers.
00:21:51.200 --> 00:21:53.119
Like I'll do what they can tolerate.
00:21:53.200 --> 00:21:54.799
I have enough information.
00:21:55.359 --> 00:21:58.240
Um, and then we kind of design a plan from there.
00:21:58.400 --> 00:22:07.920
But one big piece that I Do that, I think is very, very important, and I don't think a lot of people do is like a skin, like a full skin assessment.
00:22:08.640 --> 00:22:22.720
Because like you need to make sure you need to be looking at the skin and the tissue and not just like the function of the muscles, but what is happening on the outside, especially if there's like superficial pain, bulbodenia, yeast.
00:22:22.799 --> 00:22:31.119
Like I have caught so many chronic yeast infections that have been untreated for years, and yeast is just like hanging out.
00:22:31.279 --> 00:22:35.839
It's not like traditional, you know, clumpy yeast coming out of the vaginal canal.
00:22:35.920 --> 00:22:40.640
It's just like in the labia, just hanging out in the labia, and it's just in there for so long.
00:22:40.720 --> 00:22:48.880
And that skin is so fragile and so friable, and you're just like micro trauma, micro trauma, micro trauma for years and years and years.
00:22:49.039 --> 00:22:51.200
And like the pelvic floor is kind of secondary.
00:22:51.359 --> 00:22:58.400
Like a lot of times, once you get past that first layer, you're in the deeper layer, and then the pelvic floor is fine, but it's like that first layer is all screwy.
00:22:58.640 --> 00:23:02.799
So, like, I don't need to go back in there, like I know what the problem is, you know.
00:23:02.880 --> 00:23:04.720
So I think it kind of depends.
00:23:05.039 --> 00:23:11.839
But um, I do a big skin exam, move the clitoral hood, look at heart's line.
00:23:12.000 --> 00:23:15.119
Is there demarcation of labia menorah majora?
00:23:15.680 --> 00:23:18.240
Does the anatomy look like it's supposed to look?
00:23:18.400 --> 00:23:20.240
Where is the urethra sitting?
00:23:20.400 --> 00:23:22.640
Do I see a prolapse right at the opening?
00:23:22.799 --> 00:23:24.559
Is there yeast and redness?
00:23:24.720 --> 00:23:25.599
What's going on?
00:23:25.839 --> 00:23:28.799
Like just what what does it look like basically, you know?
00:23:28.960 --> 00:23:32.319
Um, I've got a look, I've got a girl in here now who's in college.
00:23:32.480 --> 00:23:35.119
She had sex for the first time when she was in high school.
00:23:35.359 --> 00:23:52.079
She was um ashamed about it, and she had like a tear or something down there in her pernium from that experience, um, but didn't tell anybody about it because she was embarrassed that she had sex, so it healed all kind of funky.
00:23:52.160 --> 00:23:54.559
She had sex again, tore again.
00:23:54.720 --> 00:23:57.839
She had to go into like the ER and they had to like repair it.
00:23:57.920 --> 00:24:28.400
So the ER doctor is doing like I don't, it's just so now, years later, she's got this just like really her skin is just very bound up there at the scar, plus she has chronic yeast, so it's like nobody was looking at like what the skin was doing, they were just like really focused on this one area, which is a big problem because she's like bleeding every time she puts anything into her vagina, but also she shouldn't be bleeding, like even with a big scar.
00:24:28.720 --> 00:24:32.720
Like we see grade four tears, and people aren't bleeding, it's painful.
00:24:32.799 --> 00:24:35.839
But so it's like you have to kind of look at all of that other stuff.
00:24:35.920 --> 00:24:47.759
So I do a big big kind of exam, like skin exam, all that stuff, like I said, and then um then we'll you know decide what the what the plan is, but no stirrups, no speculum, one finger, lots of lube.
00:24:47.920 --> 00:24:52.000
I have a light that I have to like put in now because I'm blind.
00:24:52.240 --> 00:25:02.319
Um and then other than that, we just kind of we figure out what we need to get done and what the goals are and what is reasonable prognosis-wise and kind of go from there.
00:25:03.119 --> 00:25:06.079
I was grilling last night and realized I need a grill light.
00:25:06.559 --> 00:25:07.920
Because I can't I can't see.
00:25:08.160 --> 00:25:11.440
And I just when you said that I was like, that's exactly what I did with my grill light.
00:25:11.519 --> 00:25:13.200
I'm like, do I need to get one of those for my table?
00:25:13.359 --> 00:25:15.519
Like, yeah, look, there it is.
00:25:15.759 --> 00:25:20.240
It's got like a bendy neck, and I just like put that right there.
00:25:20.480 --> 00:25:21.119
I can't see.
00:25:21.359 --> 00:25:21.920
Yeah.
00:25:22.319 --> 00:25:26.240
That looks a lot less intense than the grill light that I just used last night.
00:25:26.400 --> 00:25:28.000
I need to find a pretty one like that.
00:25:28.160 --> 00:25:30.240
Yeah, it looks like it's gold.
00:25:30.480 --> 00:25:30.799
Perfect.
00:25:30.880 --> 00:25:32.880
We we love Amazon for everything.
00:25:33.039 --> 00:25:33.440
Yeah.
00:25:35.039 --> 00:25:44.000
With that skin exam, and back to the patient you mentioned, is it fragility, the tissue that's just formed over time, where she's like fissuring then when she has insertion?
00:25:44.319 --> 00:25:46.799
Yes, and it's from the chronic yeast.
00:25:47.200 --> 00:25:47.519
Okay.
00:25:48.400 --> 00:25:53.519
And that's just and with the chronic yeast, is that something that she's been able to is now getting under control at all?
00:25:53.759 --> 00:25:55.119
Yeah, just starting now, yeah.
00:25:55.279 --> 00:25:59.200
So like I have her go back in and ask for like two courts of diflucan.
00:25:59.279 --> 00:26:00.400
We're doing boric acid.
00:26:00.480 --> 00:26:05.920
I'm having her blow dry with a cool, cool blow-dry setting after she gets out of the shower.
00:26:06.720 --> 00:26:12.480
We're cleaning like clean underwear, always in her purse, a couple pairs of cotton underwear, so she's like dry.
00:26:12.559 --> 00:26:14.160
And here in the south, it's hot.
00:26:14.319 --> 00:26:19.119
Like we not yet, but like soon, it will be like very hot and very muggy.
00:26:19.200 --> 00:26:20.319
So you're just like always sweating.
00:26:20.400 --> 00:26:23.680
And then if you're at the pool all day, you're always in like a wet bathing suit.
00:26:23.839 --> 00:26:28.559
So it's like you're constantly in an environment that like breathes yeast.
00:26:28.960 --> 00:26:31.920
Um, so we're getting that taken care of.
00:26:32.079 --> 00:26:38.400
I'm working scar mobilization and some like laser, red light laser, red light therapy.
00:26:38.559 --> 00:26:42.319
I'm gonna need all it a little bit if she lets me, like at her perennium.
00:26:42.480 --> 00:26:43.359
I'm not sure yet.
00:26:43.519 --> 00:26:49.039
Um, and then I'm sending her up to a surgeon that I know up outside of Atlanta.
00:26:49.200 --> 00:26:50.960
He's a public reconstruction guy.
00:26:51.200 --> 00:26:53.680
She's got an appointment with him at the end of the summer.
00:26:53.839 --> 00:27:00.960
We might not need it, but I want him to look at it to see if we can like if that spot is like needs to be removed.
00:27:01.039 --> 00:27:04.319
You know, can he do like almost like a hymenctomy?
00:27:04.559 --> 00:27:06.799
I mean, but it's not like um you know what I mean?
00:27:06.880 --> 00:27:10.720
But like just if there's that one spot, because that's really the only spot that's problematic.
00:27:10.880 --> 00:27:15.119
But I really think if we get this yeast under control, then it's not gonna be a problem anymore.
00:27:15.200 --> 00:27:19.920
But I've caught so many of it just like hanging out in there, yeah.
00:27:20.160 --> 00:27:27.440
Especially menopause and perimenopause women, because we have a higher, it's easier for us to get yeast infections at this time in life.
00:27:27.759 --> 00:27:38.640
And a lot of times, like the dysprunia, painful penetration will be due to the skin changes and yeast, and pelvic floor dysfunction, and untreated trauma from babies.
00:27:38.720 --> 00:27:53.759
So it's like all of it, it's like it's so multifactoral hormonal component, tissue fragility changes because of hor because of those hormones, yeast that might be hanging around all the time, scar tissue, tightness in the pelvic floor.
00:27:53.839 --> 00:28:16.160
Like I just had a woman today who um had four C-sections, four C-sections, never had any problems with her pelvic floor afterwards, and then just in the last year, she started getting like frequency urgency UTI-like symptoms, no culture-positive UTI, can't release her pelvic floor, and she's like super hypertonic.
00:28:16.559 --> 00:28:40.400
And um, you know, it's like it kind of happens sometimes like randomly, and it's not, you know, she's like her parents went her mom and sister went through menopause early, and you know, maybe she's having some skin changes also that's contributing to some fragility and some like true infection, but most of it I think is more of like a muscle thing.
00:28:41.279 --> 00:28:44.000
Have you tried blue light therapy with that patient yet?
00:28:44.319 --> 00:28:46.720
Um, I have blue light, uh, but I haven't.
00:28:46.880 --> 00:28:47.200
Nope.
00:28:47.279 --> 00:28:50.160
I just did laser on her for the first I've only seen her twice.
00:28:50.319 --> 00:28:52.400
So I just did laser on her the last time.
00:28:52.720 --> 00:28:53.200
Got it.
00:28:53.359 --> 00:28:57.039
I was just wondering if that would help with some of the like the you know, the yeast and stuff as well.
00:28:57.359 --> 00:29:03.279
Yeah, and there are some studies coming out, I think, about like red light for yeast during pregnancy.
00:29:03.599 --> 00:29:03.920
Okay.
00:29:04.240 --> 00:29:05.839
Because that being safe.
00:29:06.079 --> 00:29:12.960
Yeah, is that like safer potentially than you know taking oral diflucan or something like that?
00:29:13.279 --> 00:29:13.599
I don't know.
00:29:13.759 --> 00:29:14.480
So I'd be interested.
00:29:14.559 --> 00:29:16.079
I mean have you had success?
00:29:17.119 --> 00:29:18.079
Oh, sorry, what was that?
00:29:18.319 --> 00:29:24.400
No, I was gonna be interested to see, yeah, how that goes because that would be like a really great treatment option.
00:29:24.799 --> 00:29:25.759
Definitely.
00:29:26.000 --> 00:29:31.440
Do you try um use have or have people get topical vaginal estrogen for these problems as well?
00:29:32.160 --> 00:29:35.839
Oh pretty pretty pretty early after pregnancy, too.
00:29:36.160 --> 00:29:36.640
For sure.
00:29:36.880 --> 00:29:58.720
And like if they're doing boric acid for chronic yeast, if they're doing boric positive, one of the OBs that I work with down here, she's a big fan of vaginal estrogen when there's like a boric acid going in there because boric acid can be very irritating to the mucosa, and the vaginal estrogen after that can like help just kind of build it up a little bit more.
00:29:59.359 --> 00:30:01.359
Using the two things in in combination?
00:30:02.000 --> 00:30:02.640
After.
00:30:03.279 --> 00:30:04.880
Okay, so one and then the other.
00:30:05.119 --> 00:30:05.599
Okay, forgot.
00:30:05.680 --> 00:30:08.720
I was like, you see my brain working, like what?
00:30:08.960 --> 00:30:11.279
Yeah, otherwise too messy.
00:30:11.920 --> 00:30:12.319
Yeah.
00:30:12.640 --> 00:30:16.559
Well, so you mentioned hypertonicity and like having that pelvic floor being too tight.
00:30:16.640 --> 00:30:25.519
And so circling back to like our original topic, do you use any sort of biofeedback to help women with hypertonicity issues at all?
00:30:25.839 --> 00:30:28.480
Like helping them to learn how to relax.
00:30:28.960 --> 00:30:30.079
I have in the past.
00:30:30.240 --> 00:30:40.240
I don't a ton just because um I haven't really needed to with like just I think it's just like kind of like luck of the draw.
00:30:40.400 --> 00:30:42.160
Um, but I have for sure.
00:30:42.319 --> 00:30:47.920
Like if what I'm doing isn't working and I feel that you know it should, then for sure.
00:30:48.079 --> 00:30:52.880
And I really like using that for high tone and disinertia together.
00:30:53.200 --> 00:31:28.799
So somebody is having a hard time like pooping, for example, or bearing down and they're contracting instead, but they don't know, like I'll have them put in the biofeedback vaginally or regularly, depending, and like do it, actually do the motion, like sitting on the edge of the table or sitting, you know, on the chair that's kind of similar to a toilet, and be like, okay, I want you to like let's do it, let's do the action, and then they can see on the biofeedback that oh, I'm actually not bearing down, I'm contracting instead.
00:31:28.960 --> 00:31:39.200
And that can be helpful too for people that have, like I said, outlet constipation, or even um some difficulty with like bladder emptying afterwards, okay.
00:31:39.359 --> 00:31:46.880
After baby two, or just bladder emptying in general after like a UTI or yeast infection because they have high tone dysnergia, the nerves are going crazy.
00:31:47.119 --> 00:32:01.759
Um also, I have used it before for somebody that had retention after they had a baby from like the epidural, and they just were self-cathing at home, like they just could not like reconnect to their pelvic floor.
00:32:01.839 --> 00:32:05.680
And so we did that a couple of sessions, and that was really helpful.
00:32:06.160 --> 00:32:09.759
What about with just like fingers and like tactile biofeedback in the clinic?
00:32:09.839 --> 00:32:13.519
Like, do you do you do that a fair amount with oh that's yeah, yeah, yeah.
00:32:13.680 --> 00:32:14.240
Okay, yeah.
00:32:14.400 --> 00:32:15.759
As we say, lots of that.
00:32:16.079 --> 00:32:16.799
Yeah, yeah, yeah.
00:32:16.880 --> 00:32:17.839
Lots of manual feedback.
00:32:17.920 --> 00:32:18.319
Yeah, yeah.
00:32:18.400 --> 00:32:23.039
That's basically like what I do for biofeedback is like my fingers in the clinic.
00:32:23.200 --> 00:32:33.519
Um, and I like mirrors, so I'll have patients like look a lot in the mirror, kind of what when I'm working on them, and so they can kind of see what I'm talking about.
00:32:33.759 --> 00:32:41.119
Um, and then I'm like a big fan of um like for our birth prep biofeedback.
00:32:41.279 --> 00:32:52.079
I have people like push out, like when I'm teaching bearing down and pushing, I have people push out the dilator or push out the wand in the different positions.
00:32:52.240 --> 00:32:56.319
So they get the feedback of like, okay, this is what has to happen.
00:32:56.480 --> 00:33:03.039
Instead of just practicing bearing down, they're actually feeling the wand like slide out of their vagina.
00:33:03.119 --> 00:33:13.279
So it's kind of like, oh, okay, this is like even if I have an epidural, I know that if I keep practicing this motion, this will happen down there, down the road.
00:33:13.440 --> 00:33:15.440
So like I have more success.
00:33:15.599 --> 00:33:16.079
You know what I mean?
00:33:16.480 --> 00:33:20.319
Because like with epidural, it's hard to feel sometimes, depending on the level of the epidural.
00:33:20.480 --> 00:33:31.279
So you need to have that motor program kind of in there habitually, so you can do what you can do and then trust that the bottom is gonna follow because you've been training that.
00:33:31.680 --> 00:33:32.720
That makes so much sense.
00:33:32.799 --> 00:33:38.720
I've actually never heard someone say that they use biofeedback that way, and I think that that is an epic use of it.
00:33:39.119 --> 00:33:40.400
That's my whole app.
00:33:40.559 --> 00:33:44.000
That's like the whole program is the push prep.
00:33:45.279 --> 00:33:57.839
So you mentioned the the um mentioned using mirrors earlier, and this is something that I don't know how much you see this, but I see often people being resistant to watching and to looking at what it's happening.
00:33:58.160 --> 00:34:03.359
Do you have suggestions for people who just are not comfortable looking at their own anatomy?
00:34:03.599 --> 00:34:06.799
Do you have suggestions for how they might overcome that fear?
00:34:08.159 --> 00:34:12.559
I mean, I think I mean, I have a lot, I see a lot of that too.
00:34:12.719 --> 00:34:19.760
And I think the biggest thing is providers is like we don't like force anything on them, obviously.
00:34:20.079 --> 00:34:39.280
And the more educated they feel about their anatomy, and if they don't want to look in the mirror, like I pull out the books, I pull out my diagrams, I draw all over them with right erase marker, um, I use analogies that are very non-medical, you know?
00:34:39.920 --> 00:34:51.760
Um, I don't have anything in my office that's like pain scale one to ten with those like scary faces, or like I don't have any medical illustrations up here that like look very clinical.
00:34:51.920 --> 00:35:00.079
It's it's very much like this is a safe space, we can talk about your body in a way that is safe and comfortable and different for everyone.
00:35:00.239 --> 00:35:03.280
And you have to just be able to kind of read those cues.
00:35:03.679 --> 00:35:06.960
And sometimes they're never gonna want to look, and that's perfectly fine.
00:35:07.199 --> 00:35:25.679
But I have found that the more you talk about it during your appointments without the threat of the mirror or without like the threat of them being judged or thinking it's a stupid question or whatever, the more willing they are to kind of keep going down that route.
00:35:26.320 --> 00:35:33.119
Um, and once they do look or once they do start exploring, then it's like they're pleasantly surprised.
00:35:33.440 --> 00:35:33.679
Yeah.
00:35:34.000 --> 00:35:36.079
Like, oh, it's not gross, it's not dirty.
00:35:36.320 --> 00:35:37.199
Like, I know what this is.
00:35:37.280 --> 00:35:39.039
I saw this in the picture, and it's like, yeah.
00:35:39.599 --> 00:35:42.800
I mean, I say all the time, like, vaginas are like elbows, like to me.
00:35:43.039 --> 00:35:46.400
So I'm like, I'll talk about your vagina like it's your elbow.
00:35:46.559 --> 00:35:49.760
And so, like, nothing weird about it for me at all.
00:35:50.000 --> 00:35:52.559
So, like, what do you want me to, you know?
00:35:52.639 --> 00:35:55.280
I'm like, ask me to get whatever you want.
00:35:55.440 --> 00:35:57.280
Like, I don't care, you know, it's perfectly fine.
00:35:57.519 --> 00:36:00.880
This is another body part, it's your body part, it's a body part, it's fine.
00:36:00.960 --> 00:36:02.719
There's nothing wrong with it.
00:36:03.519 --> 00:36:04.159
Yeah.
00:36:04.559 --> 00:36:07.440
And yeah, like an elbow.
00:36:07.599 --> 00:36:08.880
Yeah, vaginas are elbow.
00:36:12.239 --> 00:36:13.760
I use neck, I use necks all the time.
00:36:14.000 --> 00:36:15.440
Like, to me, this is no different than your neck.
00:36:15.679 --> 00:36:17.840
Like, I'm looking at your neck and palpating your neck.
00:36:17.920 --> 00:36:20.400
It's like your neck's your neck, it's like your vagina's your vagina.
00:36:21.280 --> 00:36:23.360
Um, so last question for you.
00:36:23.519 --> 00:36:25.119
Well, I guess two more questions.
00:36:25.599 --> 00:36:30.079
One, when do you teach people to kegel?
00:36:30.400 --> 00:36:33.440
And when do you tell them that that is detrimental?
00:36:34.639 --> 00:36:35.760
I mean, depends.
00:36:36.079 --> 00:36:37.119
Depends, right?
00:36:37.440 --> 00:36:37.840
Depends.
00:36:38.079 --> 00:36:38.880
Always it depends.
00:36:39.039 --> 00:36:40.159
But like, what would you say?
00:36:40.239 --> 00:36:44.960
Like, when you set have someone come in and say, I've done, you know, been doing kegels, it's not fixing my problem.
00:36:45.199 --> 00:36:52.000
When would you say, hey, listen, like that might not be the right strategy versus like, okay, we need to figure out how to do that better?
00:36:52.400 --> 00:37:05.760
Well, you I don't think you can so my school of thought is that I don't like to prescribe or make any sort of claim about what they should or should not be doing until I'm until I've put my hands on them and I assess them.
00:37:05.920 --> 00:37:06.159
Right.
00:37:06.719 --> 00:37:16.559
Because like somebody coming in with the same diagnosis prolapse, let's say, or stress incontinent, immediately we think that's like low-tone supportive dysfunction.
00:37:16.800 --> 00:37:22.639
But we know a lot of times it could not be a strength or low-tone problem, it's a high tone problem.
00:37:22.960 --> 00:37:27.440
So both of those people, same diagnosis, might need completely different treatments.
00:37:27.519 --> 00:37:29.679
One would be up training, one would be down training.
00:37:30.000 --> 00:37:42.960
So I I would say it's appropriate to start to do key goals and up training when it's appropriate to do key goals and up training based on their symptoms, their goals, what their motor control is like, and their timing.
00:37:43.440 --> 00:37:51.920
Even if they are weak, for sure weak, low tone, I felt every time I keep going, like there's no high tone, no spasm.
00:37:52.159 --> 00:38:00.320
I won't give isolated strengthening of the pelvic floor until they can show me that their muscles are able to go through the full range of motion.
00:38:00.559 --> 00:38:03.280
Otherwise, I just feel like it's not gonna do anything.
00:38:03.840 --> 00:38:12.239
The other piece that I've changed in the last couple years of my practice is that I've done I've overloaded a lot more than I have in the past.
00:38:12.480 --> 00:38:20.480
I've I've overloaded the pelvic floor to the point of fatigue much heavier than I have before.
00:38:20.800 --> 00:38:25.119
I don't think we were loading enough before, especially for our dynamic runners.
00:38:25.199 --> 00:38:37.519
Like we were not straining and stressing the pelvic floor as much as we should, especially in a like a progressive resisted type of model.
00:38:38.559 --> 00:38:43.440
So I want their pelvic floor to go to fatigue with the reps that I give them.
00:38:43.599 --> 00:38:48.239
I want them to feel like the last one they can't do, and I want them to have symptoms the next day.
00:38:48.400 --> 00:38:52.239
Like I want there to be soreness and I want them to feel like they're leaking a little bit more.
00:38:53.119 --> 00:38:57.920
Just like we're in the gym and working out our biceps, delayed onset muscle soreness, exactly right.
00:38:58.079 --> 00:39:00.000
Like I want that to happen the next day.
00:39:00.159 --> 00:39:01.199
Do I want it to continue?
00:39:01.360 --> 00:39:02.159
No, of course not.
00:39:02.239 --> 00:39:18.880
But I want that to be like 24, 48 hours, and then knowing it's because they fatigued out their muscles, and then the third or second day, oh look, I feel a little bit like better, you know, or we go back to baseline because obviously we're not gonna see stress changes in two days, but like just hypothetically.
00:39:19.360 --> 00:39:46.960
Um so in people that are having traditional low-tone type problems and weakness and hypermobility and and difficulty with like endurance and sustaining posture and functional activities, like lifting kids and you know, all the things because they have prolapse and they have weakness and their control is off, then we'll up train, but not until like the building blocks are in place.
00:39:47.199 --> 00:39:52.880
Functional first, um, timing needs to be on, and then we can start to progress up.
00:39:53.039 --> 00:40:01.280
Sometimes I'll get people in compression, I'll put them in, I'll tape them, we'll kind of get everything like where we need it to be, and then we start to strengthen.
00:40:02.159 --> 00:40:12.480
On the other side of the spectrum, if somebody's coming in with those same symptoms, but their pelvic floor is contracted and they can't let it go, I'm not gonna give them a concentric shortening contraction.
00:40:12.719 --> 00:40:16.320
It's not a strength problem for them, it's a timing issue, it's a relaxation.
00:40:16.639 --> 00:40:23.360
Maybe there's a strength problem, but the you can't assess that uh if their muscles are so tight that they can't go through the range of motion.
00:40:23.760 --> 00:40:24.239
You can't.
00:40:24.639 --> 00:40:28.320
So, like what harm is it gonna do?
00:40:28.559 --> 00:40:35.519
Yeah, like how like how is that gonna hurt them if you do down training for three weeks before strengthening?
00:40:35.599 --> 00:40:36.159
You know what I mean?
00:40:36.239 --> 00:40:51.119
It's not, it's gonna like if you're wrong, then you just keep you go the other direction, but but I I think it's like you can't say that somebody needs strength because like because they're tight.
00:40:51.440 --> 00:40:55.519
We want long and strong, we don't want short and weak.
00:40:56.159 --> 00:40:58.320
And should everybody be doing keegels?
00:40:58.480 --> 00:40:59.119
I don't know, maybe.
00:40:59.199 --> 00:40:59.920
I have no idea.
00:41:00.079 --> 00:41:00.880
I don't think so.
00:41:01.039 --> 00:41:03.920
I think it's like it's more functional.
00:41:04.079 --> 00:41:11.440
We need more functional, like coordination of the pelvic floor with the core and the breath and your transverse and lifting and that sort of thing.
00:41:11.679 --> 00:41:14.639
Should everybody be standing around, you know, squeezing their vagina?
00:41:14.800 --> 00:41:15.840
You know, what are you waiting for?
00:41:16.000 --> 00:41:16.639
An elevator?
00:41:16.880 --> 00:41:17.199
No.
00:41:17.519 --> 00:41:18.480
I don't think so.
00:41:18.639 --> 00:41:20.320
Do you need to do that sometimes?
00:41:20.559 --> 00:41:21.119
Sure.
00:41:21.360 --> 00:41:23.440
But is that like the treatment program?
00:41:23.679 --> 00:41:24.000
No.
00:41:24.320 --> 00:41:25.679
I mean, like, who would do that?
00:41:25.840 --> 00:41:34.559
Like, what professional would be like, okay, so your exercise, your homework for PT is, you know, three sets of 10, 10 seconds, every time you're sitting at a red light.
00:41:34.719 --> 00:41:35.679
Like, that's ridiculous.
00:41:35.760 --> 00:41:36.639
It's not skilled.
00:41:36.719 --> 00:41:37.920
So, like, why are we doing that?
00:41:38.079 --> 00:41:40.880
First of all, they're not having symptoms sitting in a red light.
00:41:41.039 --> 00:41:44.320
And second of all, everybody can squeeze their vagina at a red light.
00:41:44.400 --> 00:41:47.440
So of course it's not working, you know?
00:41:47.679 --> 00:41:50.000
Like, of course it's not working.
00:41:50.239 --> 00:41:57.519
That would be like telling a soccer player after an ACL reconstruction to do quad sets while they're sitting in the car.
00:41:57.760 --> 00:42:00.480
And then they go into a soccer field and they're like, well, I can't balance.
00:42:00.639 --> 00:42:07.119
And it's like, well, I don't know, you've been doing your strengthing exercises, but it's like you haven't though.
00:42:07.360 --> 00:42:09.920
So why you know what I'm saying?
00:42:10.000 --> 00:42:12.320
Like, I don't know if this can put into function.
00:42:12.480 --> 00:42:19.440
Yeah, it's like I don't know if it's making any sense, but it's like Kegels aren't the worst thing in the world, but like, let's be smarter about them, you know?
00:42:19.599 --> 00:42:29.760
And like, I don't know how many videos you see online that it's like Kegel programs, but there's no explanation for like when this might be detrimental versus when this might actually help you.
00:42:29.840 --> 00:42:47.920
And it's like you're watching this like just like on some random, you know, YouTuber or like you know, TikTok channel of like doing like 500 kegels a day, and that I have so many patients who come in who think that they've been doing pelvic floor strengthening, but all they've been doing is squeezing their butt and like they're not even getting the right muscles.
00:42:48.320 --> 00:42:51.039
No, a hundred percent, a hundred percent.
00:42:51.679 --> 00:42:57.599
So, can I ask you back to the when you're doing the progressive overload, what are you using to do that for yourself?
00:42:57.760 --> 00:42:59.840
Are you using vaginal content weights?
00:43:00.000 --> 00:43:02.559
Are you having people up on their feet weightlifting?
00:43:02.639 --> 00:43:04.800
Like, what does your progressive overload look like?
00:43:05.039 --> 00:43:05.840
Yeah, all of it.
00:43:06.000 --> 00:43:12.079
Depending on what they need to do, yes, and depending on what they're showing me, like objectively, what that what their pelvic floor can do.
00:43:12.159 --> 00:43:19.280
So, yeah, when I get to the point where we're like really overloading, I love vaginal weights, big fan.
00:43:19.840 --> 00:43:22.159
Used to not be, but I am now.
00:43:22.639 --> 00:43:24.159
Big fan of vaginal weights.
00:43:24.320 --> 00:43:28.880
Um, I like a lot of eccentric training of the lower extremity with the weights in.
00:43:29.119 --> 00:43:45.920
I do um if I have like weightlifters or crossfitters, or people that like a lot of people here do those like circuit like hit training, like true 40 or orange theory or whatever, kind of like the those types, like I'll have them use the weights at home with bands.
00:43:46.000 --> 00:43:52.400
And I do a lot of stuff like squat, donkey kicks, monster walks, multiplaner.
00:43:52.480 --> 00:43:56.719
I'm a big like cross midline person, so I want all degrees of freedom.
00:43:56.800 --> 00:43:58.400
I don't want just sagittal planner.
00:43:58.960 --> 00:44:01.760
Um if They're doing arms at the gym.
00:44:01.840 --> 00:44:03.679
I have them put a small weight in.
00:44:04.559 --> 00:44:06.159
And practicing arms with it in.
00:44:06.239 --> 00:44:06.480
Mm-hmm.
00:44:06.559 --> 00:44:06.800
Yeah.
00:44:06.880 --> 00:44:07.039
Yeah.
00:44:07.119 --> 00:44:13.039
I mean, if today's like arm and chest day and you're bench pressing, you're using your public floor when you're doing that.
00:44:13.119 --> 00:44:14.880
So let's put a little weight in.
00:44:15.679 --> 00:44:17.920
Oh, and see if you can keep that baby in while you do it.
00:44:18.400 --> 00:44:19.119
Yeah, 100%.
00:44:19.599 --> 00:44:25.440
And then if you're vacuuming, you know, if you're out doing yard work, yeah, that's an endurance thing.
00:44:25.599 --> 00:44:26.159
Let's say you can.
00:44:28.000 --> 00:44:30.639
You're going in every freaking direction when you do that.
00:44:30.800 --> 00:44:31.119
Yeah.
00:44:31.360 --> 00:44:34.400
And like lunge with it and like walk the dog with it.
00:44:34.559 --> 00:44:38.480
And like, you know, do I want you walking around all day with your, you know, vagina clenched?
00:44:38.639 --> 00:44:39.199
No, I don't.
00:44:39.360 --> 00:44:42.719
But like, can you ru like lift up the weight and let go?
00:44:42.880 --> 00:44:46.079
Can you keep the weight in when you bend down and lift up a laundry basket?
00:44:46.320 --> 00:44:49.840
Can you keep the weight in when you're doing you know leg press?
00:44:51.119 --> 00:44:52.400
That would be good.
00:44:52.960 --> 00:44:53.599
Yeah.
00:44:55.119 --> 00:44:57.440
You're using your pelvic flow and your breath for all those things.
00:44:57.519 --> 00:45:05.280
Like, I mean, that's the thing I think probably think about the most when I train bench press is am I keeping my pelvic floor and my breath coordinated?
00:45:05.679 --> 00:45:06.800
Because if I don't, guess what?
00:45:06.880 --> 00:45:07.840
I'm getting pinned.
00:45:08.079 --> 00:45:08.320
Yeah.
00:45:08.559 --> 00:45:09.280
Like, right.
00:45:09.440 --> 00:45:12.639
And it it happens at least once a week where I lose my breath.
00:45:12.719 --> 00:45:19.760
And like my trainer's like, I saw you lose your breath, and then like here and like can't get the bar back off of me.
00:45:19.920 --> 00:45:24.800
So and you'll just shoot the vaginal weight right out of your vagina if you're val salving.
00:45:25.039 --> 00:45:26.400
So yeah.
00:45:27.199 --> 00:45:29.039
But that's what's happening to your bladder, right?
00:45:29.119 --> 00:45:30.320
That's what's happening with prolapse.
00:45:30.480 --> 00:45:33.599
That's why you're leaking because you're moving down, right?
00:45:33.679 --> 00:45:37.760
And the pelvic floor can't contract, can't like contract against that pressure.
00:45:38.079 --> 00:45:43.679
So let's do that with a weight in to like get some hypertrophy and feedback.
00:45:43.840 --> 00:45:46.960
I mean, now you could do it with a perifit, I would think, too.
00:45:47.199 --> 00:45:48.880
And like I would think so, you know.
00:45:48.960 --> 00:45:51.280
And what are you doing when you're bench pressing with a perifit?
00:45:51.360 --> 00:45:57.840
What are you doing in there when you're doing your rows or your, you know, like sumo squats?
00:45:58.320 --> 00:45:58.719
Yeah.
00:45:58.960 --> 00:46:01.519
Oh god, he's gonna love when I show up to my next session.
00:46:01.599 --> 00:46:03.679
I'm like, so give me a minute.
00:46:04.400 --> 00:46:06.320
Gotta stick this in and get the app up.
00:46:06.880 --> 00:46:11.039
I was gonna say, well, I mean, I just bring like a vaginal cone, but like we haven't done that yet.
00:46:11.280 --> 00:46:13.840
He's gonna he's gonna love when I show up with that part.
00:46:14.159 --> 00:46:15.119
Why not?
00:46:17.840 --> 00:46:19.199
Absolutely love it.
00:46:20.559 --> 00:46:23.360
Well, I think we've kind of canvassed everything that I can think of.
00:46:23.440 --> 00:46:30.000
Is there anything else that you think like listeners should know about feedback, vaginal training, weights?
00:46:30.320 --> 00:46:31.840
Any of these campuses?
00:46:32.159 --> 00:46:49.679
I mean, I think the main thing is that like there's not one answer, and there's not like one thing, and oftentimes it's a combination of things that help the most, and we have to kind of like figure that out, and everybody's a little bit different.
00:46:49.920 --> 00:47:09.119
And as we go through perimenopause, as we go through menopause, as we go through you know, all of the things, those needs are gonna change, and like that's okay, you know, and like maybe for a while biofeedback works, and then maybe it doesn't really work anymore for you, or maybe for a while weights work, and then you need a break from that, and then you go back to them, and that's fine.
00:47:09.440 --> 00:47:15.840
But just know that like nothing that not one thing is gonna do it.
00:47:16.159 --> 00:47:24.639
And I think with the weights and with Perifit and with uh or other type, I mean, this is not sponsored by Perifit in any other way.
00:47:24.719 --> 00:47:39.519
We just happen to be talking about this one, um or any other sort of device, like, you know, it's okay to ask for some guidance and some parameters, you know, from a PT or from their, you know, whoever their medical staff is or whatever.
00:47:39.599 --> 00:47:43.039
Um, because you want a little bit, you don't want to just go in there blinded.
00:47:43.280 --> 00:47:49.360
Oh, well, I so appreciate you taking the time in the busy clinic schedule today and the day after your app launched.
00:47:49.440 --> 00:47:50.960
I'm so excited for you for that.
00:47:51.199 --> 00:47:51.599
Thank you.
00:47:51.760 --> 00:47:54.800
And I'd like to just ask you one final question, if you don't mind.
00:47:55.119 --> 00:47:55.840
Tell me.
00:47:56.880 --> 00:48:00.960
What is your personal one daily health non-negotiable?
00:48:01.039 --> 00:48:03.840
What is it that you for yourself have to do every day?
00:48:05.760 --> 00:48:07.280
That's a great question.
00:48:07.519 --> 00:48:10.400
Um, does it have to be healthy?
00:48:11.119 --> 00:48:13.119
No, it doesn't have to be healthy.
00:48:13.199 --> 00:48:15.039
If it's still for your health, it doesn't have to be healthy.
00:48:15.280 --> 00:48:16.320
Okay, love that.
00:48:16.639 --> 00:48:27.280
Um I like my morning ritual, like I really like my morning ritual, which is like I stopped putting my phone next to my bed.
00:48:27.440 --> 00:48:29.599
So I have my phone like across the room.
00:48:29.760 --> 00:48:32.559
So when my alarm goes off, I actually have to like get my ass out of bed.
00:48:32.639 --> 00:48:38.159
Although I have circumvented and start, I like scream at Siri to snooze.
00:48:39.599 --> 00:48:40.800
So I'm like, damn it.
00:48:40.960 --> 00:48:45.519
So I actually think I'm gonna go back and get like an analog alarm clock, like a legit one.
00:48:45.679 --> 00:48:49.119
But I you have to like get up and walk, turn it off.
00:48:49.360 --> 00:49:04.719
Um so I've been like I've been doing that, which is nice because I won't stay in bed like scrolling on my phone, which I don't need to be doing, and I get up and I have a cup of coffee and I let the dogs out, and now it's like spring here, so things are blooming, and I've got little baby birds outside.
00:49:04.880 --> 00:49:07.199
Um I know it's so cute.
00:49:07.360 --> 00:49:14.639
So and like I just kind of like have this moment to myself in the morning before like the craziness of the day.
00:49:14.800 --> 00:49:26.320
Um, and my I mean, ideally I would like to be at the barn with my horse every day for like my exercise and mental health, but I can't do that because of work and life and all the things.
00:49:26.480 --> 00:49:32.480
And so that's I get that twice a week, sometimes three times, and that is like a non-negotiable.
00:49:33.280 --> 00:49:35.760
That's lovely, and that's perfect.
00:49:37.119 --> 00:49:38.880
Well, thank you again for being here today.
00:49:38.960 --> 00:49:43.039
Yeah, I make sure that everywhere everyone can find you is in the show notes.
00:49:43.199 --> 00:49:47.599
So you can I'll have your people send that over so I can make sure it's all in there.
00:49:47.760 --> 00:49:48.239
Yeah, yeah, yeah.
00:49:50.480 --> 00:49:54.400
And thank you all again for being here for another week of Metopause Unscripted.
00:49:54.559 --> 00:49:56.239
If you enjoyed this conversation with Dr.
00:49:56.400 --> 00:50:02.000
Marcy, please come back last next week and like, follow, and subscribe everywhere you like to follow your podcasts.
00:50:02.079 --> 00:50:04.079
And we'll see you again next week.
00:50:04.639 --> 00:50:06.559
Now I have to end with the boring stuff.
00:50:06.800 --> 00:50:09.920
While I am a doctor, I am not your doctor.
00:50:10.480 --> 00:50:15.119
This podcast is for entertainment and educational purposes only.
00:50:15.440 --> 00:50:23.039
If something in today's episode resonated with you, please bring this to your own healthcare team and self advocate.
00:50:23.280 --> 00:50:24.960
You always are promoting that.
00:50:25.199 --> 00:50:33.199
I cannot wait for you to join me on next week's episode of MetaPause Unscripted for another hot topic.
