1
00:00:01,803.7200820899 --> 00:00:12,793.71908209
Welcome to Zebra Talks, where people living with hypermobility syndromes hear their experiences reflected in conversations with guest experts and fellow zebras living their best bendy lives.
2
00:00:13,343.71908209 --> 00:00:14,723.71908209
I'm your host, Dr.
3
00:00:14,723.71908209 --> 00:00:18,803.71908209
Libby Hinesley, physical therapist and author of Yoga for Bendy People.
4
00:00:19,773.71908209 --> 00:00:29,713.72008209
The information and opinions shared on this podcast should not be taken as medical advice and are not a substitute for diagnosis and treatment by a qualified healthcare professional.
5
00:00:30,503.72008209 --> 00:00:33,803.72008209
And now, let's get started with today's Zebra Talk.
6
00:00:35,926.35063074 --> 00:00:41,276.35063074
Today I am really excited to welcome Amy Stein to Zebra Talks podcast, Dr.
7
00:00:41,276.35063074 --> 00:00:49,736.35063074
Amy Stein is at the forefront of treating pelvic floor dysfunction and pelvic pain, specializing in functional manual therapy for people of all ages.
8
00:00:49,832.221755008 --> 00:00:57,32.221755008
She's the founder and owner of Beyond Basics Physical Therapy in New York City with offices in both Midtown and downtown Manhattan.
9
00:00:57,125.213494917 --> 00:00:57,500.213494917
Dr.
10
00:00:57,500.213494917 --> 00:01:21,736.624552992
Stein is an award-winning author, best known for her books, heal Pelvic Pain and Beating Endo, how to Reclaim Your Life From Endometriosis, she is co-editor of Healing in Urology and has contributed to leading medical textbooks including pelvic pain management, female sexual pain disorders, evaluation and management, management of sexual dysfunction in men and women, and the overactive pelvic floor.
11
00:01:22,216.624552992 --> 00:01:29,866.624552992
She served as president of the International Pelvic Pain Society where she now chairs the past President's Committee and sits on the advisory board.
12
00:01:30,301.624552992 --> 00:01:37,884.247877191
She also founded Wellness By Nature, a line of healing CBD products designed to support people on their path to health and healing.
13
00:01:38,33.989443043 --> 00:01:40,253.98944304
So Amy, welcome to Zebra Talks.
14
00:01:40,253.98944304 --> 00:01:41,873.98944304
I'm thrilled to have you on today.
15
00:01:42,138.98944304 --> 00:01:42,778.98944304
And thank you for.
16
00:01:42,978.98944304 --> 00:01:44,978.98944304
Having me, I'm very excited to be here.
17
00:01:45,538.98944304 --> 00:01:50,368.98944304
Well, I think all of the work that you do is highly relevant to the hypermobile population.
18
00:01:50,818.98944304 --> 00:01:57,688.98944304
I think that almost universally Bendy people tend to struggle with pelvic floor symptoms of one sort of another.
19
00:01:57,688.98944304 --> 00:02:00,568.98944304
So I think that we have a lot to talk about on that.
20
00:02:00,690.09051726 --> 00:02:01,170.09051726
Yeah.
21
00:02:01,327.90627247 --> 00:02:03,607.90627247
I definitely agree with that.
22
00:02:03,607.90627247 --> 00:02:16,397.90627247
And I have to say when I started this 25 years ago now, maybe more with just pelvic pain and it's probably been in the last 10 years that I'm like, wow, okay.
23
00:02:16,787.90627247 --> 00:02:25,97.90627247
So there is quite the overlap with Hypermobility and now we know that there's all these different categories and various criteria, whereas.
24
00:02:27,92.90627247 --> 00:02:38,902.90627247
Was like The thumb thing and the touching the floor thing and now they're like 50, 60-year-old people may not be able to touch the floor anymore, but maybe so ask them if they could, when they were teens.
25
00:02:39,69.81664103 --> 00:02:40,149.81664103
So it's been quite.
26
00:02:40,404.81664103 --> 00:02:48,123.46125366
Quite fascinating and wonderful to see the progression of knowledge on Hypermobility spectrum disorder.
27
00:02:48,213.46125366 --> 00:02:55,693.46125366
And then I have to say, like now I'm, we,, hone in on it as pelvic floor PTs and we're like, okay.
28
00:02:56,143.46125366 --> 00:02:58,33.46125366
It's a lot of our population.
29
00:02:58,95.98424357 --> 00:02:58,425.98424357
Yeah.
30
00:02:58,425.98424357 --> 00:03:18,226.40762964
So now, having this new awareness over these last 10 years, about that big overlap between Hypermobility and all the things you do in pelvic pt what would you say the percentage of your patient population is? Who have Hypermobility? So my patient population, I almost feel like all of 'em have some form or other.
31
00:03:18,367.51359221 --> 00:03:22,637.51359221
But maybe not probably like 70% of 'em though.
32
00:03:22,772.51359221 --> 00:03:24,602.51359221
So really heavily, Yeah.
33
00:03:24,602.51359221 --> 00:03:25,682.51359221
heavily represented.
34
00:03:25,967.51359221 --> 00:03:42,767.51359221
And I would have to ask, so that we have both offices, between both offices, there's about 12 PTs, so I would be curious to see what they have to say too, Yeah, because I know we're all seeing it more and we're looking for it.
35
00:03:43,127.51359221 --> 00:03:50,778.45511035
Whereas again, 25 year, even 10 years ago when I was doing pelvic floor pt, I just wasn't looking for it as much.
36
00:03:50,778.45511035 --> 00:03:57,912.27753874
I was using the Bendy finger, the hyper extended knees, the hyperextended elbows, and now it's okay, not everyone has that.
37
00:03:58,197.27753874 --> 00:03:59,457.27753874
Yes, exactly.
38
00:03:59,457.27753874 --> 00:04:10,836.77847461
Can you say a little bit about your own background with Hypermobility too, and how that informs the work that you have come to do, I know you mentioned that you have a Bendy body also to some degree.
39
00:04:11,585.13011849 --> 00:04:11,975.13011849
Yes.
40
00:04:11,975.13011849 --> 00:04:18,286.15591602
So I do, I was able to touch hands to floor and then I was the cheerleader.
41
00:04:18,871.15591602 --> 00:04:20,71.15591602
Yes, I was a cheerleader.
42
00:04:21,721.15591602 --> 00:04:26,11.15591602
I was the cheerleader on the top that was doing like the hyperextended splits.
43
00:04:26,61.15591602 --> 00:04:27,801.15591602
Oh, she bends a lot there.
44
00:04:28,221.15591602 --> 00:04:36,791.15591602
But I don't have the elbow, I don't have the knee, but I do interestingly have the cracking and I've had the popping joints since in my twenties.
45
00:04:37,501.15591602 --> 00:04:46,883.21219043
And I have other things that I found fascinating, and I think I've just learned it from you, like the degenerative gums, the oh, I forgot what they're called in your feet.
46
00:04:46,883.21219043 --> 00:04:53,913.69762337
The pop, the connective Yeah, the epigenic little papules, the fat pads herniating through the superficial fascia.
47
00:04:54,378.69762337 --> 00:04:56,178.69762337
So I look for those now.
48
00:04:56,538.69762337 --> 00:05:04,308.50701238
And yeah, and then with pt,, again, we're more aware of All the various degrees.
49
00:05:04,308.50701238 --> 00:05:08,538.50701238
So we're seeing it more, but I think it's always been there.
50
00:05:08,688.50701238 --> 00:05:17,440.491011
I just think we're diagnosing it more and I think we do see a high population because obviously prolapse, that is one.
51
00:05:17,440.491011 --> 00:05:19,150.491011
And to be transparent.
52
00:05:19,495.491011 --> 00:05:20,635.491011
I have one too.
53
00:05:21,385.491011 --> 00:05:25,195.491011
I also had to have hernia surgery of seven hernias.
54
00:05:25,195.491011 --> 00:05:28,650.491011
So Oh really? yes, seven hernias.
55
00:05:29,25.52583979 --> 00:05:31,335.52583979
Yeah, I definitely fall in the category.
56
00:05:31,785.52583979 --> 00:05:49,291.9853094
And here we also see pelvic wise we do see the patients that are hypermobile in their hips or their SI or their lumbosacral area and their pelvic floor is gripping because they don't have enough stability in the other joints.
57
00:05:49,291.9853094 --> 00:05:54,767.18864089
So they're Overworking the pelvic floor muscles to keep other areas stable.
58
00:05:55,187.18864089 --> 00:05:56,912.61242833
So we are seeing that quite a bit.
59
00:05:56,912.61242833 --> 00:05:57,178.9988419
Yeah.
60
00:05:57,178.9988419 --> 00:06:00,855.49074457
So when I think about what would be the classic hypermobile person.
61
00:06:01,312.60195063 --> 00:06:11,262.60195063
Pelvic presentation, it is that, it's like I imagine that most of those folks are gonna show up with a lot of gripping, a lot of background contraction in their pelvic floor muscles.
62
00:06:11,592.60195063 --> 00:06:13,572.60195063
That's leading to a lot of pain symptoms.
63
00:06:13,682.60195063 --> 00:06:22,351.67458648
Is that kind of the overarching theme, or would you say it's really variable across that population? I'd say there's some consistency.
64
00:06:22,811.67458648 --> 00:06:28,811.67458648
It's not across the board, but there is some consistency with the patients, how they present.
65
00:06:28,904.73582169 --> 00:06:40,164.73582169
And usually to be honest, one side of the, like back is tighter, one side of the hips are tighter, and then the other side of the pelvic floor is tighter.
66
00:06:40,434.73582169 --> 00:06:43,734.73582169
So it's almost like everything's trying to balance itself out.
67
00:06:44,364.73582169 --> 00:06:51,124.52219865
So that pattern I do see, but typically when they first come, it's all the muscles are just not happy.
68
00:06:51,544.52219865 --> 00:06:51,814.52219865
Yeah.
69
00:06:51,814.52219865 --> 00:06:52,204.52219865
Yeah.
70
00:06:53,209.62707739 --> 00:06:56,449.62707739
Then it's that fine line, you know very well.
71
00:06:56,449.62707739 --> 00:07:03,933.50179256
It's that fine line of that, okay, we have to get rid of the tension and the trigger points and the tightness, but yet we need to strengthen.
72
00:07:04,713.50179256 --> 00:07:06,303.50179256
So we don't wanna flare 'em.
73
00:07:06,903.50179256 --> 00:07:09,430.24456356
But we do need to increase stability.
74
00:07:09,441.94519262 --> 00:07:10,521.94519262
Yeah, absolutely.
75
00:07:10,521.94519262 --> 00:07:16,421.94519262
That is the fine line is that muscular engagement that's always going on in the background is, sometimes.
76
00:07:16,561.07188126 --> 00:07:21,481.07188126
It's dysfunctional and it's also functional, right? That people are, they're depending on it to some degree, for some stability.
77
00:07:21,481.07188126 --> 00:07:24,234.33976719
It's just not an optimal type of stability.
78
00:07:24,234.33976719 --> 00:07:26,484.33976719
So gotta do both things at once.
79
00:07:26,611.60152663 --> 00:07:38,111.60152663
So when you think about Hypermobility and pelvic pain what are the most important things that come to your mind that you wanna share with listeners about that? Yeah that's definitely a great question.
80
00:07:38,161.60152663 --> 00:07:46,988.95717849
I wanna start off with, I've also now certified in perimenopause, menopause, and I do see shifts with that too.
81
00:07:47,508.95717849 --> 00:07:57,474.77321853
Along with I know you're familiar with like autoimmune issues being more affecting the symptoms more and like mast cell activation pots, et cetera.
82
00:07:57,542.56598383 --> 00:08:05,907.29644372
I do have to say that a lot of these patients, they have a lot of different symptoms and typically not just pelvic floor.
83
00:08:05,930.97001622 --> 00:08:10,701.92318191
And we have to start with one addressing the musculoskeletal system.
84
00:08:10,701.92318191 --> 00:08:18,396.03796869
So trying to calm, aggravated tissues and muscles and trying to strengthen or stabilize other joints.
85
00:08:18,521.48311843 --> 00:08:25,27.80129512
But at the same time, I do find it super helpful to also down regulate the nervous system.
86
00:08:25,170.69922357 --> 00:08:28,200.69922357
cause I'm just seeing a lot of overlap with that.
87
00:08:28,200.69922357 --> 00:08:30,510.69922357
Again, is it the pots It's scary.
88
00:08:30,579.94258105 --> 00:08:32,79.94258105
The symptoms of pots are scary.
89
00:08:32,79.94258105 --> 00:08:39,763.61811816
The symptoms of chronic, joint pain or having various joint pains throughout their life is also upsetting and scary.
90
00:08:39,763.61811816 --> 00:08:45,41.05199674
So that aspect of downregulating the system, plus just being in pain.
91
00:08:45,134.29886361 --> 00:08:48,286.54516081
Frequently in general up reg up your system.
92
00:08:48,286.54516081 --> 00:08:53,910.17552913
So you have to typically do the pelvic floor PT with, some type of mindfulness practice.
93
00:08:54,171.03313363 --> 00:08:56,758.7721783
Slow and steady also wins the race.
94
00:08:56,808.7721783 --> 00:09:03,610.22115291
It's not a marathon, but I've had patients down and out and I know you have to can't even get outta bed.
95
00:09:03,640.70719621 --> 00:09:13,489.49829321
And now it's been a road with some patients, but now they're running and I am not, whatever exercise they like to do, I try to work with them.
96
00:09:13,847.95370654 --> 00:09:15,155.56762915
So maybe don't run.
97
00:09:15,665.56762915 --> 00:09:22,185.56762915
Marathons and maybe just run a little bit and then walk and run a little bit, walk or vary.
98
00:09:22,185.56762915 --> 00:09:23,895.56762915
Your exercise is important.
99
00:09:24,135.56762915 --> 00:09:29,809.26078756
And we work also on stability exercises while trying to work on pelvic pain.
100
00:09:29,809.26078756 --> 00:09:34,433.36670141
So definitely multimodal approach with our Bendy people.
101
00:09:34,918.36670141 --> 00:09:41,668.36670141
I really think it's a common theme across all the practitioners that I talk to who treat Bendy populations.
102
00:09:41,718.36670141 --> 00:09:46,964.22933162
That is the importance of nervous system regulation as a really central part of the approach.
103
00:09:47,24.22933162 --> 00:09:47,362.90344458
Yeah.
104
00:09:47,362.90344458 --> 00:09:50,9.07287817
So pelvic floor is the bottom of your core.
105
00:09:50,9.07287817 --> 00:09:54,184.57117694
It connects the sits bones with the tailbone, with the pubic bone.
106
00:09:54,184.57117694 --> 00:09:58,562.99325483
So it makes a bowl at the bottom of your core, at the bottom of your pelvis.
107
00:09:58,562.99325483 --> 00:10:03,431.27777111
It helps with bladder bowel continence, it helps with core stability.
108
00:10:03,437.30758644 --> 00:10:05,957.30758644
It helps with sexual arousal and performance.
109
00:10:06,53.35067726 --> 00:10:15,737.77507006
And the organs the urethra bladder, they do go through the muscles and the anal rectal area goes through the muscles.
110
00:10:15,749.13483923 --> 00:10:24,232.42504106
So if you think about it, you can't fully relax those muscles in the sense that you can't just take a break and lie.
111
00:10:24,262.42504106 --> 00:10:26,2.42504106
You, you have to go to the bathroom.
112
00:10:26,52.42504106 --> 00:10:28,572.42504106
It's hard in that sense too, 'cause you can't.
113
00:10:29,172.42504106 --> 00:10:33,42.42504106
Just turn it off and not use 'em for a couple days.
114
00:10:33,672.42504106 --> 00:10:37,212.42504106
It's A very unique and special part of the muscular system.
115
00:10:37,262.42504106 --> 00:10:47,644.48975867
And then sexual arousal, you want it to be pleasurable, but if it's an area of discomfort, it's confusing and that obviously affects the nervous system quite a bit too.
116
00:10:47,644.48975867 --> 00:10:51,273.33412096
So, it's multifaceted because you do have to.
117
00:10:51,483.33412096 --> 00:10:56,13.33412096
Try to also downregulate the bladder if there's a lot of overactivity.
118
00:10:56,73.33412096 --> 00:10:57,963.33412096
Frequency, urgency, retention.
119
00:10:58,413.33412096 --> 00:11:08,39.20651886
Those are all signs of muscle dysfunction, meaning obviously you get the organs checked out, make sure there's no infections et cetera.
120
00:11:08,68.98343329 --> 00:11:08,458.98343329
But.
121
00:11:08,639.99051337 --> 00:11:20,255.57533189
Once you get everything cleared and everything's negative, most likely if you're having bladder, bowel or sexual dysfunction, any type of symptoms, there is a pelvic floor component to it.
122
00:11:20,437.14373196 --> 00:11:22,627.14373196
And this could be all genders.
123
00:11:22,627.14373196 --> 00:11:23,737.14373196
It's all genders.
124
00:11:23,837.14373196 --> 00:11:24,752.5693757
Not just.
125
00:11:24,752.5693757 --> 00:11:34,996.2268161
People with female anatomy, it's all genders 'cause we all have a pelvic floor and they all surround the same urethra, bladder, rectal area and genital region.
126
00:11:35,53.20822072 --> 00:11:38,803.20822072
So it's complex because again, you can't fully relax.
127
00:11:38,810.19984839 --> 00:11:43,869.9968276
I mean we do teach patients how to relax the muscles, which is key, but.
128
00:11:43,869.9968276 --> 00:11:47,429.04079077
It's not something you could just turn off for a day or give a cast.
129
00:11:47,519.04079077 --> 00:11:48,359.04079077
Put a cast on.
130
00:11:48,714.04079077 --> 00:11:49,314.04079077
Exactly.
131
00:11:49,394.04079077 --> 00:12:02,907.23028458
So that, maybe part of why it's such a slow road for a lot of folks as far as changing those patterns that are, in play between the brain and the pelvic floor and Come up with some more functional stability for the whole region.
132
00:12:03,237.23028458 --> 00:12:05,577.23028458
So when you're thinking about that aspect..
133
00:12:05,669.58566725 --> 00:12:15,220.39840743
What are some of your go-tos on that front? so we've been recognizing that prolotherapy especially for hypermobile patients can be helpful.
134
00:12:15,268.10389245 --> 00:12:21,596.6205347
And as pelvic floor PTs we are seeing that like into the SI area, into the hip.
135
00:12:22,176.6205347 --> 00:12:28,530.7192489
Area into certain ligaments can be helpful if the lumbosacral area is hypermobile.
136
00:12:29,315.6113184 --> 00:12:41,671.44688968
Wherever we're finding Hypermobility, we are saying that is an option for patients to help with the stability of the joints, of the ligaments, and then when it comes from a PT perspective.
137
00:12:41,697.34746272 --> 00:12:45,160.87132816
So if they do you have symptoms of POTS or any type of.
138
00:12:45,500.87132816 --> 00:12:53,690.87132816
Dizziness with exercise, we will start them supine if they're in a lot of pain, even if they don't have the dizziness.
139
00:12:53,690.87132816 --> 00:12:58,104.74400882
Typically we also start them in supine, meaning like lying on their back, or.
140
00:12:58,830.7443695 --> 00:13:08,139.9871322
Prone lying on their stomach and starting isometric exercises for the deep abdominal muscles, the deep back muscles, the hip rotators.
141
00:13:08,227.61239405 --> 00:13:12,787.61239405
But starting flow, 'cause again, we don't wanna aggravate symptoms.
142
00:13:12,787.61239405 --> 00:13:19,714.97242009
So with some of my more symptomatic patients, meaning they had just a lot of symptoms when they first came in.
143
00:13:20,14.97242009 --> 00:13:29,997.49098495
It was more about the breathing, and I did use to give stretches a lot in the past and now I'm like, okay, with this patient population.
144
00:13:29,997.49098495 --> 00:13:36,811.58990883
It's not so much about the stretch, it's more about just trying to relax the tissues and breathe into the.
145
00:13:36,811.58990883 --> 00:13:39,215.20389593
The joints versus stretching them.
146
00:13:39,755.20389593 --> 00:13:40,45.20389593
Yeah.
147
00:13:40,492.76494215 --> 00:13:51,746.11284573
So For the more extreme pain we do start really slow and more breathing, more mindfulness practices, then making sure they know how to relax the pelvic floor.
148
00:13:51,746.11284573 --> 00:13:55,458.99162285
Pelvic floor coordination can be challenging for a lot of people.
149
00:13:55,458.99162285 --> 00:13:58,278.99162285
All populations, not just Hypermobility.
150
00:13:58,337.77743014 --> 00:14:09,754.17371106
So really trying to teach them how to engage the pelvic floor correctly, relax the pelvic floor correctly, do the exercises without engaging the pelvic floor if there's too much tone.
151
00:14:09,831.68871554 --> 00:14:11,509.35277866
So that's how we start.
152
00:14:11,509.35277866 --> 00:14:16,152.33060193
And then we slowly progressed into, okay, let's try a TA or Transverse.
153
00:14:16,152.33060193 --> 00:14:17,452.94677052
Abdo one of the deep.
154
00:14:17,657.94677052 --> 00:14:18,737.94677052
Abdominal muscles.
155
00:14:18,737.94677052 --> 00:14:22,447.2938978
Let's try that and try to isolate it from the pelvic floor.
156
00:14:22,657.2938978 --> 00:14:26,262.36545564
Okay, we could do that now let's add the deep back muscles.
157
00:14:26,542.36545564 --> 00:14:28,132.36545564
So that's how we progress.
158
00:14:28,179.66005365 --> 00:14:42,701.22186026
It is a bit slow, so depending on where they're at, we'll also meet them there so if they're already doing exercises, if they're already lifting weights, we will modify it, but we don't want to discourage them from doing them.
159
00:14:43,41.22186026 --> 00:14:45,861.22186026
But we will modify, if any, are painful.
160
00:14:45,911.22186026 --> 00:14:52,156.22186026
There's so many exercises to do, so I always say we'll find a half hour if you want, for sure.
161
00:14:52,231.22186026 --> 00:14:54,721.22186026
but it doesn't have to be painful.
162
00:14:55,36.22186026 --> 00:14:55,606.22186026
Yes.
163
00:14:55,656.22186026 --> 00:15:08,756.22186026
And I think sometimes for patients, that's one of the hardest things is slowing down and being patient with those more subtle connections that the brain's trying to make with these key deep muscles that can feel tedious.
164
00:15:08,773.08831534 --> 00:15:12,820.97019197
requires a lot of concentration and it feels hard, until it doesn't.
165
00:15:12,820.97019197 --> 00:15:15,818.11038488
But I think that can be tough for folks when they're starting out.
166
00:15:15,858.11038488 --> 00:15:16,338.11038488
Yeah.
167
00:15:16,368.11038488 --> 00:15:20,118.11038488
It is tough to go backwards, so I try not to go.
168
00:15:20,122.8535625 --> 00:15:24,454.13170649
Too far back because I don't wanna stop them from what they're already doing.
169
00:15:24,454.13170649 --> 00:15:35,286.75033099
I just try to modify but the key is in the beginning, is to make sure they can isolate the pelvic floor and then they're not gripping the gripping part can be the more challenging part.
170
00:15:35,366.75033099 --> 00:15:57,207.76429004
And then another thing I did wanna mention, you were asking about patterns before, and this is really big to bring up, is that we do see a lot of irritable bowel symptoms and constipation because the tissue is more flexible and stretchy, we do end up seeing more patients that their bowel has been stretched more Yeah.
171
00:15:57,207.76429004 --> 00:16:00,377.76429004
And then also the vascular system.
172
00:16:00,407.76429004 --> 00:16:07,50.12431608
So we may see a bit more pelvic congestion that type of thing because of the connective tissue.
173
00:16:07,50.12431608 --> 00:16:19,519.91048958
Do you see that the pelvic floor dysfunctions that you're treating are contributing to some of those IBS symptoms, or can they even contribute to some of the pelvic congestion I feel like it could be both ways.
174
00:16:19,651.73371143 --> 00:16:22,621.73371143
They could have had constipation since they were little.
175
00:16:23,171.73371143 --> 00:16:26,278.74171478
But was it the constipation that.
176
00:16:26,278.74171478 --> 00:16:37,240.37440763
Aggravated things and resulted in irritable bowel type symptoms, or was it 'cause they have more flexible connective tissue and they would just get more constipated from that.
177
00:16:37,240.37440763 --> 00:16:42,140.3744076
But also another thing is like prolapse and you don't see that as much in young kids and teens.
178
00:16:42,140.3744076 --> 00:16:44,90.3744076
So that could be an issue.
179
00:16:44,127.2031261 --> 00:16:46,362.5800147
Contributing to bowel dysfunction.
180
00:16:46,835.7681353 --> 00:16:58,995.0146583
We could have the gripping around the anal recal opening the tightening, and they just can't relax it and they can't empty fully, or they relax and it tightens too quickly.
181
00:16:59,27.2177202 --> 00:17:06,738.9216183
So they're not emptying fully or they're just, we have patients that they only go to the bathroom once a week or twice a week.
182
00:17:06,738.9216183 --> 00:17:09,708.9216183
So definitely working on that with them.
183
00:17:09,780.9925523 --> 00:17:13,500.9925523
Giving 'em behavioral modifications is key.
184
00:17:13,500.9925523 --> 00:17:23,430.9925523
So that's a big thing that we work with patients on, like learning how not to strain using the squatty potty positioning, doing the ILU massage.
185
00:17:24,30.9925523 --> 00:17:29,760.9925523
Then if the bladder's affected, that definitely can affect the bowel and vice versa.
186
00:17:30,0.9925523 --> 00:17:41,674.0732
If there's a lot of stool pressing on the bladder, the bladders can't hold as much, so they may have more frequency or discomfort because of the pressure onto the bladder or pelvic area.
187
00:17:41,769.140675 --> 00:17:46,745.702737
Definitely a lot of different things that we see, but we can help a lot.
188
00:17:46,895.702737 --> 00:17:48,915.702737
We've helped many patients.
189
00:17:48,915.702737 --> 00:17:51,975.702737
We do find that it just, it takes time.
190
00:17:51,975.702737 --> 00:17:52,965.702737
It does take time.
191
00:17:53,275.702737 --> 00:18:03,951.8007594
I think it's really good to put that on people's radar that some of the more GI adjacent symptoms that they're having might also be some overlap with pelvic floor dysfunction and.
192
00:18:04,661.8007594 --> 00:18:15,891.8007594
I do in my mind, generally think, hey, pelvic PT is something that the vast majority of hypermobile people are probably gonna be able to benefit from at some point along their pathway.
193
00:18:15,971.8007594 --> 00:18:18,470.8065303
So yeah, I always recommend it.
194
00:18:18,620.8065303 --> 00:18:22,760.8065303
I'm interested in going back to the menopause and perimenopause.
195
00:18:23,135.8065303 --> 00:18:25,415.8065303
Kind of new focus that you've brought into your practice.
196
00:18:25,475.8065303 --> 00:18:37,414.1927608
I would love to hear a little bit more about that and some of the changes that you see with the perimenopause transition, and especially with regard to Hypermobility.
197
00:18:37,464.1927608 --> 00:18:43,635.1192745
Yeah, with the Hypermobile patients, we definitely see, they are.
198
00:18:43,779.2198197 --> 00:18:59,377.8135697
More susceptible to symptoms than other patients, even during pregnancy and postpartum and breastfeeding, just because of those hormonal changes as well as the ligament of laity during pregnancy, just as an example.
199
00:18:59,383.6167259 --> 00:19:11,376.3741843
But the hormonal changes that all women go through again, because of the Hypermobility, they may need to be just more sensitive to doing more stability exercises during that period of time.
200
00:19:11,416.3741843 --> 00:19:13,966.3741843
The hormonal changes are similar with menopause.
201
00:19:13,966.3741843 --> 00:19:16,96.3741843
So the menopause, it's different.
202
00:19:16,126.3741843 --> 00:19:22,733.4390247
It's definitely different, but it's the same idea in the estrogens are dropping a lot.
203
00:19:22,793.4390247 --> 00:19:24,743.4390247
Estrogen helps with bone health.
204
00:19:24,743.4390247 --> 00:19:30,583.4390247
It helps with brain health, it helps with heart health, and then estrogen and testosterone also helps with muscle health.
205
00:19:30,609.3101694 --> 00:19:40,119.3101694
We're just seeing oh, we have to also be on top of this for our Hypermobility patients with female anatomy that are going through perimenopause and menopause.
206
00:19:40,183.4200733 --> 00:19:43,353.4200733
Because again, it can affect the cardiovascular system.
207
00:19:43,353.4200733 --> 00:19:46,447.194284
Okay, our POTS patients, we have to be more mindful.
208
00:19:46,447.194284 --> 00:20:02,752.9626817
The decrease in testosterone, which It definitely decreases but that can decrease muscle health and it's really important to have enough muscle health to keep the bone health and to decrease in estrogen can affect the bone health as well.
209
00:20:02,767.1682662 --> 00:20:07,978.53806
Definitely addressing the hormone therapy is important.
210
00:20:08,51.4339346 --> 00:20:13,306.4925685
It starts 10 to 15 years prior to menopause, so I just wanna say that one more time.
211
00:20:14,476.4925685 --> 00:20:16,966.4925685
Perimenopause starts 10 to 15.
212
00:20:17,467.0901026 --> 00:20:22,147.0901026
Prior to menopause and your numbers start to drop then.
213
00:20:22,166.422178 --> 00:20:33,66.3686706
I just saw a great influencer, urologist, Rachel Rubin, and she just said, I don't understand why every system of the body we address it.
214
00:20:33,554.8035257 --> 00:20:43,868.6104919
Before it gets totally depleted, but our patient population of perimenopause, menopause, we're waiting till it's completely depleted before we start to address it.
215
00:20:44,78.6104919 --> 00:20:50,52.0225605
There's no other system in the body that we wait until it's on zero And then start to address it.
216
00:20:50,867.0225605 --> 00:20:51,407.0225605
yeah.
217
00:20:51,677.0225605 --> 00:20:52,197.1593004
Oh.
218
00:20:52,272.2794677 --> 00:20:57,660.7741373
I am telling all my patients down okay, you're 35, 40.
219
00:20:58,30.7741373 --> 00:21:04,810.7741373
Ideally knowing when like a mother or sister went through menopause, not necessary.
220
00:21:04,840.7741373 --> 00:21:08,63.8378073
'cause a lot of what they treat is symptomatic.
221
00:21:08,150.4393086 --> 00:21:12,260.4393086
It's hard to test the estrogen because it regulates.
222
00:21:12,355.4393086 --> 00:21:15,792.6918242
Throughout the day, let alone throughout the week, let alone throughout the month.
223
00:21:15,875.2818379 --> 00:21:18,375.2818379
But we all know it's going down.
224
00:21:19,125.2818379 --> 00:21:20,445.2818379
So it is by symptoms.
225
00:21:20,445.2818379 --> 00:21:27,255.2818379
Testosterone you can test and that is important to test But And I think in the bente population.
226
00:21:27,565.2818379 --> 00:21:44,901.7729431
It's really tricky to tease apart, okay, are my symptoms possibly related to pre menopause or are they symptoms that are related to my pots that are related to, my connective tissue disorder as the background reality? that complicates things for folks a little bit.
227
00:21:45,21.8988187 --> 00:21:46,190.0953918
Yeah, it definitely does.
228
00:21:46,880.0953918 --> 00:21:53,15.0953918
And you mentioned earlier what have my symptoms been? I definitely just wanna throw it out there that my.
229
00:21:53,552.7353658 --> 00:21:58,332.7353658
Joint pain has definitely gotten worse with this I am 52.
230
00:21:58,332.7353658 --> 00:22:00,282.7353658
I just turned 52 yesterday.
231
00:22:00,507.7353658 --> 00:22:01,257.7353658
Happy birthday.
232
00:22:01,542.7353658 --> 00:22:01,722.7353658
Thank you.
233
00:22:02,892.7353658 --> 00:22:13,394.7720356
And yeah, I am seeing it more and i'm actually also lifting more weights, which I wasn't doing as much because I would get injured so easily.
234
00:22:13,436.9184386 --> 00:22:20,83.8154112
But I am trying to lift more weights and I honestly don't think that's the cause of the increased symptoms.
235
00:22:20,83.8154112 --> 00:22:28,363.6360218
I think It's the HRT and one thing that I unfortunately do have, which I'm still working on, is sleep issues.
236
00:22:28,363.6360218 --> 00:22:35,278.5001169
And sleep is huge with healing and you may need progesterone 'cause progesterone drops too.
237
00:22:35,314.9096221 --> 00:22:37,980.3660239
You may need progesterone to help with sleep.
238
00:22:37,980.3660239 --> 00:22:42,164.1383412
Progesterone also helps with anxiety and mood differences.
239
00:22:42,214.1383412 --> 00:22:46,649.1383412
Yeah, you need to look at the full picture with perimenopause, menopause as well.
240
00:22:47,39.7680205 --> 00:22:48,289.7680205
Yeah, that makes a lot of sense.
241
00:22:48,329.7680205 --> 00:23:19,642.8918943
What are the main changes that we see in connective tissue when these hormonal levels start to drop? Specifically the estrogen and the progesterone along with it? How would you describe the changes to tissues, not only connective tissues, but also the muscle tissue? So definitely I mean from a pelvic PPT perspective, we were taught even before I've learned about Hypermobility and menopause, that the elasticity in the tissues, it just changed and the muscle bulk in the pelvic floor changes.
242
00:23:19,642.8918943 --> 00:23:22,228.7581866
That's why more people have incontinence.
243
00:23:22,606.6378253 --> 00:23:27,754.6147133
Yes, you should make sure the muscles are strong, but the actual tissues are changing too.
244
00:23:27,754.6147133 --> 00:23:34,984.6147133
So it's the elasticity in the tissues and it's the elasticity in all the tissues that are changing.
245
00:23:35,164.6147133 --> 00:23:36,904.6147133
It's not just the pelvic floor.
246
00:23:37,84.6147133 --> 00:23:42,193.4798663
There are creams specific to the pelvic floor that can be very helpful.
247
00:23:42,193.4798663 --> 00:23:43,363.4798663
There's an estrogen.
248
00:23:43,389.3137546 --> 00:23:50,358.1816078
Testosterone is off-label, but there's an estrogen testosterone cream that can really help with the vaginal tissues.
249
00:23:50,358.1816078 --> 00:23:53,910.6358315
And if you're feeling any dryness, it can help with all of that.
250
00:23:54,10.6358315 --> 00:23:58,274.4934568
It doesn't replace any strengthening or if there's increase tone.
251
00:23:58,274.4934568 --> 00:24:03,434.4934568
It doesn't fix it, but it helps with the overall health of the tissues.
252
00:24:03,524.4934568 --> 00:24:03,944.4934568
Yeah.
253
00:24:03,944.4934568 --> 00:24:07,684.3566363
So that loss of elasticity is like a double whammy for the Bendy person.
254
00:24:07,684.3566363 --> 00:24:16,714.3566363
'cause we already don't have as much elasticity, Our tissues are less like a trampoline, there's not as much bounce back, I guess is a, is one way to describe it.
255
00:24:16,764.3566363 --> 00:24:18,54.3566363
That's all good to know about.
256
00:24:18,84.3566363 --> 00:24:36,135.758362
Speaking of creams, I'd love to hear a little bit more about your CBD products and how you use CBD in your practice, but also how you learned about it So it was a bit of a COVID project When everything was going south in New York City and just zero patients were coming in.
257
00:24:36,179.8753438 --> 00:24:39,656.7344927
I had met a group upstate New York.
258
00:24:39,687.0305381 --> 00:24:45,808.3674114
And I was really fascinated by their whole operations of clean products.
259
00:24:45,858.3674114 --> 00:24:55,481.3947552
And I had already started to look into CBD and CBD has been researched, not as much in the US unfortunately because of the FDA regulations and trying to manage that.
260
00:24:55,481.3947552 --> 00:25:06,650.5586953
But I know in a lot of the European countries, I'm not sure about Australia, but they're studying that CBD helps with pain, inflammation, it helps increase blood flow.
261
00:25:06,650.5586953 --> 00:25:12,882.1884357
And some studies in Europe showed increased blood flow into the genital region specifically.
262
00:25:12,955.1621364 --> 00:25:16,435.1621364
To help with arousal performance, but also if they're in pain.
263
00:25:16,435.1621364 --> 00:25:23,875.3643153
So the CBD that I created, I have a sve, which is basically like a cream that you can put on any joints.
264
00:25:23,935.3643153 --> 00:25:26,690.3643153
And trust me, I put it all over these days.
265
00:25:27,830.3643153 --> 00:25:28,330.3643153
And then.
266
00:25:29,21.1612407 --> 00:25:41,404.117774
I do have patients with male or female anatomy or any transgender as well, that I do tell them they could even use the sav on the external genital region to help with blood flow.
267
00:25:41,451.245663 --> 00:25:46,751.245663
I did add botanicals to it, so I added Solomon Seal, calendula, and Arnica.
268
00:25:47,496.9371913 --> 00:25:52,276.9371913
To the SVE Again, those are all anti-inflammatory pain relieving.
269
00:25:52,323.5125087 --> 00:25:57,383.5125087
Then my goal was to also create an intimacy oil.
270
00:25:58,223.5125087 --> 00:26:07,343.5125087
So the intimacy oil, it is an oil base, so you have to be mindful of that when using it internally, but a lot of patients use coconut oil.
271
00:26:07,343.5125087 --> 00:26:10,711.0434332
So I was like why can't we create something that has even more.
272
00:26:11,55.8397695 --> 00:26:13,332.0268881
Health benefits than just coconut oil.
273
00:26:13,332.0268881 --> 00:26:22,703.4842194
So it has CB, D, and then with the intimacy oil, I did add a willow bark and cava, which both help with nerve sensitivity or nerve pain.
274
00:26:23,59.4938903 --> 00:26:31,394.215707
So I had patients use it if they're having genital pain pain in the perineum, the vestibular area for patients with female anatomy.
275
00:26:31,458.8008714 --> 00:26:35,138.8008714
Or I just have 'em use it to help, with sexual arousal too.
276
00:26:35,138.8008714 --> 00:26:35,920.7549252
I think that.
277
00:26:35,946.890717 --> 00:26:39,96.890717
A lot of people with Hypermobility really struggle with that.
278
00:26:39,126.890717 --> 00:26:46,636.890717
Pain with intercourse, pelvic pain across the board So that's a, an interesting product for people to know about Yeah.
279
00:26:46,756.890717 --> 00:26:47,236.890717
Yeah.
280
00:26:47,296.890717 --> 00:26:48,316.890717
Take it for a spin.
281
00:26:48,676.890717 --> 00:26:50,866.890717
Yes, definitely take it for a spin.
282
00:26:50,936.890717 --> 00:26:57,46.4479782
I've gotten tons of positive feedback I also did create a tonic that you take orally.
283
00:26:57,46.4479782 --> 00:27:02,856.4479782
So I had my office crew test it out first, and the SAV helped with headaches right away.
284
00:27:02,921.4479782 --> 00:27:10,794.1479147
The tonic helped with some it doesn't replace medication, but it eased some anxiety and it did help some people with sleep.
285
00:27:10,794.1479147 --> 00:27:20,994.1479147
Some people said they didn't feel it as much, but and then the intimacy oil, I use it actually during my sessions too with the patients if they're okay with it.
286
00:27:21,364.1479147 --> 00:27:22,984.1479147
Yeah, it doesn't burn.
287
00:27:22,984.1479147 --> 00:27:24,244.1479147
It's soothing too.
288
00:27:24,354.1479147 --> 00:27:25,614.1479147
And you don't need a lot.
289
00:27:25,644.1479147 --> 00:27:26,334.1479147
That's key.
290
00:27:26,334.1479147 --> 00:27:29,240.0742249
You don't need, you just need like a small amount.
291
00:27:29,607.2519593 --> 00:27:30,687.2519593
it lasts a long time.
292
00:27:31,292.2519593 --> 00:27:31,532.2519593
Cool.
293
00:27:31,532.2519593 --> 00:27:31,892.2519593
Okay.
294
00:27:31,942.2519593 --> 00:27:32,392.2519593
Yeah.
295
00:27:32,539.8044496 --> 00:27:35,529.8044496
You can't use it with condoms though 'cause there isn't oil.
296
00:27:35,538.3171155 --> 00:27:35,870.6247621
Gotcha.
297
00:27:36,65.6247621 --> 00:27:36,245.6247621
Okay.
298
00:27:36,245.6247621 --> 00:27:36,815.6247621
Good to know.
299
00:27:36,845.6247621 --> 00:27:37,355.6247621
Good to know.
300
00:27:37,460.4246595 --> 00:27:44,655.7246563
So Amy, when you're thinking about the work you do, public pain and Hypermobility, are there any other.
301
00:27:44,689.7977357 --> 00:27:46,604.7977357
Topics that come up that you wanna cover.
302
00:27:47,0.6225545 --> 00:27:55,659.9078329
I know we both talk about the importance of cardiovascular health too, so I do coach patients on that as well.
303
00:27:55,659.9078329 --> 00:27:59,649.9078329
And but also for the pelvic floor, like we need blood flow to that area.
304
00:27:59,919.9078329 --> 00:28:08,894.8964393
Nerves also love blood flow and if tissues are restricting the nerves or if you're sitting all day you're decreasing the blood flow to that area.
305
00:28:09,54.8964393 --> 00:28:14,328.448064
Plus, if you have a tight pelvic floor, it's a double whammy because you're decreasing the blood flow.
306
00:28:14,762.4036002 --> 00:28:20,455.1578621
With sitting in general, and then if the muscles are tight, you're also decreasing the blood flow.
307
00:28:20,455.1578621 --> 00:28:24,866.2101082
So importance of movement, but within their comfort.
308
00:28:25,56.3458097 --> 00:28:33,430.1584725
So again, starting 'em slow, if they can only take a five minute walk or if they can only start with exercises lying down, it's great.
309
00:28:33,460.1584725 --> 00:28:35,740.1584725
We just need to, we need to move though.
310
00:28:35,980.1584725 --> 00:28:36,250.1584725
Yeah.
311
00:28:37,180.1584725 --> 00:28:38,560.1584725
Yeah, so I talk about that.
312
00:28:38,560.1584725 --> 00:29:01,358.7582409
I do talk quite a bit about the mental health part, just because, again, most of our patient population there has been a lot of suffering there's also been a lot of gaslighting and trauma with our patients, so really that does affect your nervous system, plus Experiencing pain on a daily basis can affect the nervous system, so making sure they're addressing that as well.
313
00:29:01,503.7939783 --> 00:29:03,693.7939783
And then just general dietary.
314
00:29:03,995.8665796 --> 00:29:08,500.7158228
Changes to, especially with our patients with bladder symptoms, frequency, urgency.
315
00:29:08,500.7158228 --> 00:29:20,184.4300155
We wanna make sure we take any irritants away, but people ask can I have my coffee? Okay, one, does your coffee affect your nervous system? Does it make you any more anxious? But also.
316
00:29:20,316.229909 --> 00:29:25,921.0348332
Does it cause you to have increased frequency? If it doesn't, then one cup of coffee.
317
00:29:26,6.6103075 --> 00:29:30,96.6103075
Some of these patients are, so deprived because they're taking everything away.
318
00:29:30,96.6103075 --> 00:29:32,586.6103075
Then I'm like, no, let's not start with the coffee.
319
00:29:32,796.6103075 --> 00:29:36,841.6103075
Let's start with, let's start with what's most irritating you.
320
00:29:37,276.6103075 --> 00:29:42,346.6103075
Is it the wine or is it dairy I listen a lot to Jessica Drummond too.
321
00:29:42,506.6103075 --> 00:29:48,812.6523811
She's the person I took my perimenopause menopause certification and she's done a lot on.
322
00:29:48,891.9256973 --> 00:29:49,652.4884
Pelvic pain.
323
00:29:49,652.4884 --> 00:30:01,360.3978441
She's a pelvic floor pt, but about 15 years ago, switched to nutrition and dietary and listening to her, but also listening to a lot of other nutritionists.
324
00:30:01,360.3978441 --> 00:30:08,619.6033699
Now everyone's talking about adding things back into diets and not taking them away, adding healthy fats.
325
00:30:08,679.6033699 --> 00:30:12,937.245925
And for our group, the anti-inflammatory foods.
326
00:30:12,968.414405 --> 00:30:25,70.6749437
So definitely trying to address the full body is key with our patient population, it makes a lot of sense and so many of 'em are unfortunately limited by all sorts of GI issues and food sensitivities.
327
00:30:25,151.6281094 --> 00:30:28,301.6281094
That impair their ability to take in adequate nutrition.
328
00:30:28,551.6281094 --> 00:30:33,835.4124417
That gets us into a really tricky spot, especially when you're talking about taking foods away.
329
00:30:33,985.4124417 --> 00:30:37,822.489458
So I like the idea of adding foods back, Yeah, protein's huge.
330
00:30:37,912.489458 --> 00:30:40,852.489458
Especially also during perimenopause and menopause.
331
00:30:41,157.3237476 --> 00:30:42,447.3237476
You make a lot of good points.
332
00:30:42,447.3237476 --> 00:30:46,797.3237476
I like the emphasis on getting that mental health support.
333
00:30:46,797.3237476 --> 00:30:50,697.3237476
I think it's universally important as a human living in this world at this time.
334
00:30:50,697.3237476 --> 00:31:01,876.1111825
It's important and add to that a chronic health condition and like you mentioned, a lot of medical gaslighting and trauma that people have experienced and it really does take a toll on the mental health.
335
00:31:01,876.1111825 --> 00:31:03,316.1111825
And then movement.
336
00:31:03,500.7728811 --> 00:31:09,120.7728811
It's just amazing how every system of our body, depends on movement for its health.
337
00:31:09,430.7728811 --> 00:31:15,685.530049
Not just for the strength of your muscles and your bones, but the way that all of our body functions.
338
00:31:16,195.530049 --> 00:31:17,575.530049
Depends on movement.
339
00:31:17,725.530049 --> 00:31:22,664.2088099
So whatever it is, you know, low and slow doesn't have to be uncomfortable.
340
00:31:22,664.2088099 --> 00:31:24,89.2591037
But we gotta find some way.
341
00:31:24,89.2591037 --> 00:31:25,72.6265752
To To move.
342
00:31:25,72.6265752 --> 00:31:25,522.6265752
Yeah.
343
00:31:25,852.6265752 --> 00:31:26,272.6265752
Yep.
344
00:31:26,682.6265752 --> 00:31:26,972.6265752
Yeah.
345
00:31:27,232.6265752 --> 00:31:37,346.6091191
And then I do wanna mention too, just for the listeners there is quite a range, and I know it's the same with PTs that specialize in Hypermobility.
346
00:31:37,346.6091191 --> 00:31:42,261.9330124
There is quite a range of, expertise in pelvic floor PTs.
347
00:31:42,329.753004 --> 00:31:56,640.0608607
Unfortunately, right now in New York City, we are being overtaken by privately funded practices that are doing, the mill work of every 20 minutes with patients and they are saying they do pelvic pt.
348
00:31:56,805.0608607 --> 00:31:59,565.0608607
But they don't have private treatment rooms.
349
00:31:59,595.0608607 --> 00:32:12,563.832223
They tell 'em to do Kegels or to do bridging or, so I do wanna mention that there is quite a range of expertise in pelvic floor pt and what you should look for is that they're really looking at the whole body.
350
00:32:12,597.1759475 --> 00:32:15,543.3399744
They are addressing the pelvic floor and that.
351
00:32:15,557.1736853 --> 00:32:18,565.064966
Most of the time means an internal assessment.
352
00:32:18,605.064966 --> 00:32:32,825.778823
And then I tell my physicians too, like sometimes I'll assess vaginally for patients with female anatomy and it feels okay, and then I go and assess rectally and they're just gripping there and I see that quite a bit.
353
00:32:32,825.778823 --> 00:32:43,399.3245587
Interestingly, with the Hypermobility patients, it's almost like they're gripping posteriorly, and there's not a ton going on in the anterior muscles, more posterior.
354
00:32:43,399.3245587 --> 00:32:49,239.3245587
Really finding the PT that has experience in pelvic floor PT is important.
355
00:32:49,699.3245587 --> 00:32:55,410.0217435
If they have minimal experience and you don't have anyone around, that's okay too.
356
00:32:55,453.7500144 --> 00:33:06,930.307388
Maybe doing some pelvic health coaching with other PTs so that they could progress you more than just doing bridging or just doing breathing exercises or yeah.
357
00:33:06,960.307388 --> 00:33:10,620.307388
It's an important point too, it is true in any discipline, but.
358
00:33:10,750.0823718 --> 00:33:17,340.0823718
Word of mouth is a great way to find good people, right? And if you land with someone and you're not getting results, move on too.
359
00:33:17,390.0823718 --> 00:33:20,360.0823718
Like you don't have to stay at a place that's not a good fit.
360
00:33:20,460.0823718 --> 00:33:31,330.0823718
But yeah, that very individualized, usually internal assessment to figure out exactly what is going on in your particular body, in your particular pelvic floor is so important.
361
00:33:31,330.0823718 --> 00:33:33,190.0823718
And that's really the work of a very skilled.
362
00:33:33,204.291579 --> 00:33:37,884.1448718
Pelvic PT who doesn't have to get to the next patient in 15 minutes or whatever.
363
00:33:38,364.1448718 --> 00:33:40,233.0991222
It takes time to do those things well.
364
00:33:40,233.0991222 --> 00:33:42,963.0991222
Amy, thanks so much for the work you're doing out there in the world.
365
00:33:42,963.0991222 --> 00:33:48,545.2968456
You're doing so much that educates others and supports the hypermobile, community and beyond.
366
00:33:48,605.2968456 --> 00:33:50,885.2968456
So thank you so much and keep it up.
367
00:33:50,955.4797476 --> 00:33:51,255.4797476
Yeah.
368
00:33:51,255.4797476 --> 00:33:51,825.4797476
Thank you.
369
00:33:51,825.4797476 --> 00:33:55,35.4797476
And thank you for your podcast and for all that you do too.
370
00:33:55,121.218273 --> 00:34:01,451.218273
I'm glad we now have officially met, 'cause I've heard so many wonderful things about you and your podcast.
371
00:34:02,96.218273 --> 00:34:02,976.218273
Huh, Likewise.
372
00:34:02,976.218273 --> 00:34:04,386.218273
I'm really glad that we could do this.
373
00:34:04,386.218273 --> 00:34:06,995.097871
I really appreciate your time and sharing with listeners.
374
00:34:06,995.097871 --> 00:34:09,125.097871
I know they'll find it highly relevant as well.
375
00:34:10,365.097871 --> 00:34:25,43.3918083
Before we sign off Amy, will you tell listeners where they can find out more about your work? Yes, we have a pretty extensive website Beyond Basics, physical Therapy or Beyond Basics pt, and we're also very active on social media.
376
00:34:25,43.3918083 --> 00:34:27,143.3918083
So at Beyond Basics pt.
377
00:34:27,503.3918083 --> 00:34:30,758.5220166
And then YouTube Instagram, all the things.
378
00:34:31,727.7486569 --> 00:34:42,647.7486569
We do have a newsletter if you're interested because for instance, tonight we're doing a complex pelvic pain webinar with some physicians that specialize in pelvic pain.
379
00:34:42,647.7486569 --> 00:34:49,717.7486569
So we do quite a bit of free Pelvic health 1 0 1 in May for May is pelvic pain awareness month.
380
00:34:49,728.1717323 --> 00:34:53,648.1717323
So we do quite a bit of information for the community.
381
00:34:53,720.7498573 --> 00:34:54,230.7498573
Awesome.
382
00:34:54,230.7498573 --> 00:34:55,340.7498573
That's great to know about.
383
00:34:55,700.7498573 --> 00:34:58,875.3236284
Do you want to talk about the 20% off code.
384
00:34:59,340.5880788 --> 00:34:59,847.8639116
Yeah.
385
00:34:59,877.8639116 --> 00:35:04,560.3651043
For the CBD, the website is Wellness X Nature.
386
00:35:04,560.3651043 --> 00:35:07,8.8278249
I do have some social media on that.
387
00:35:07,8.8278249 --> 00:35:08,208.8278249
I do have a website.
388
00:35:08,458.8278249 --> 00:35:09,628.8278249
It's not quite as extensive.
389
00:35:09,958.8278249 --> 00:35:13,238.8278249
It's beyond basics because it is just me.
390
00:35:13,238.8278249 --> 00:35:21,828.8278249
But, yeah, it's great products and yeah, and if you need more information about pelvic health, My Book heal Pelvic Pain.
391
00:35:22,278.8278249 --> 00:35:29,201.3884006
Or if you do have endometriosis beating endo they're both very inexpensive on Amazon, Awesome.
392
00:35:29,231.3884006 --> 00:35:34,741.3884006
Okay, listeners you can get 20% off using the code BBPT.
393
00:35:35,221.3884006 --> 00:35:45,552.7094048
That's on the Wellness By Nature products when you sign up for a 15 minute phone consultation with one of the Beyond Basics physical therapists.
394
00:35:46,542.7094048 --> 00:35:46,962.7094048
Okay.
395
00:35:47,52.7094048 --> 00:35:47,412.7094048
Cool.
396
00:35:47,662.7094048 --> 00:35:50,602.7094048
Thank you again, Amy, and thank you again, listeners.
397
00:35:50,932.7094048 --> 00:35:51,892.7094048
That's it for now.
398
00:35:51,892.7094048 --> 00:35:53,422.7094048
I'll catch you in the next episode.
399
00:35:53,637.3999566 --> 00:35:54,197.3999566
Thank you.
400
00:35:54,197.3999566 --> 00:35:54,887.3999566
Take care.
401
00:35:56,83.5998739 --> 00:35:59,263.4998739
Um, uh, Um, Uh, transcript.
00:00:01,803.7200820899 --> 00:00:12,793.71908209
Welcome to Zebra Talks, where people living with hypermobility syndromes hear their experiences reflected in conversations with guest experts and fellow zebras living their best bendy lives.
2
00:00:13,343.71908209 --> 00:00:14,723.71908209
I'm your host, Dr.
3
00:00:14,723.71908209 --> 00:00:18,803.71908209
Libby Hinesley, physical therapist and author of Yoga for Bendy People.
4
00:00:19,773.71908209 --> 00:00:29,713.72008209
The information and opinions shared on this podcast should not be taken as medical advice and are not a substitute for diagnosis and treatment by a qualified healthcare professional.
5
00:00:30,503.72008209 --> 00:00:33,803.72008209
And now, let's get started with today's Zebra Talk.
6
00:00:35,926.35063074 --> 00:00:41,276.35063074
Today I am really excited to welcome Amy Stein to Zebra Talks podcast, Dr.
7
00:00:41,276.35063074 --> 00:00:49,736.35063074
Amy Stein is at the forefront of treating pelvic floor dysfunction and pelvic pain, specializing in functional manual therapy for people of all ages.
8
00:00:49,832.221755008 --> 00:00:57,32.221755008
She's the founder and owner of Beyond Basics Physical Therapy in New York City with offices in both Midtown and downtown Manhattan.
9
00:00:57,125.213494917 --> 00:00:57,500.213494917
Dr.
10
00:00:57,500.213494917 --> 00:01:21,736.624552992
Stein is an award-winning author, best known for her books, heal Pelvic Pain and Beating Endo, how to Reclaim Your Life From Endometriosis, she is co-editor of Healing in Urology and has contributed to leading medical textbooks including pelvic pain management, female sexual pain disorders, evaluation and management, management of sexual dysfunction in men and women, and the overactive pelvic floor.
11
00:01:22,216.624552992 --> 00:01:29,866.624552992
She served as president of the International Pelvic Pain Society where she now chairs the past President's Committee and sits on the advisory board.
12
00:01:30,301.624552992 --> 00:01:37,884.247877191
She also founded Wellness By Nature, a line of healing CBD products designed to support people on their path to health and healing.
13
00:01:38,33.989443043 --> 00:01:40,253.98944304
So Amy, welcome to Zebra Talks.
14
00:01:40,253.98944304 --> 00:01:41,873.98944304
I'm thrilled to have you on today.
15
00:01:42,138.98944304 --> 00:01:42,778.98944304
And thank you for.
16
00:01:42,978.98944304 --> 00:01:44,978.98944304
Having me, I'm very excited to be here.
17
00:01:45,538.98944304 --> 00:01:50,368.98944304
Well, I think all of the work that you do is highly relevant to the hypermobile population.
18
00:01:50,818.98944304 --> 00:01:57,688.98944304
I think that almost universally Bendy people tend to struggle with pelvic floor symptoms of one sort of another.
19
00:01:57,688.98944304 --> 00:02:00,568.98944304
So I think that we have a lot to talk about on that.
20
00:02:00,690.09051726 --> 00:02:01,170.09051726
Yeah.
21
00:02:01,327.90627247 --> 00:02:03,607.90627247
I definitely agree with that.
22
00:02:03,607.90627247 --> 00:02:16,397.90627247
And I have to say when I started this 25 years ago now, maybe more with just pelvic pain and it's probably been in the last 10 years that I'm like, wow, okay.
23
00:02:16,787.90627247 --> 00:02:25,97.90627247
So there is quite the overlap with Hypermobility and now we know that there's all these different categories and various criteria, whereas.
24
00:02:27,92.90627247 --> 00:02:38,902.90627247
Was like The thumb thing and the touching the floor thing and now they're like 50, 60-year-old people may not be able to touch the floor anymore, but maybe so ask them if they could, when they were teens.
25
00:02:39,69.81664103 --> 00:02:40,149.81664103
So it's been quite.
26
00:02:40,404.81664103 --> 00:02:48,123.46125366
Quite fascinating and wonderful to see the progression of knowledge on Hypermobility spectrum disorder.
27
00:02:48,213.46125366 --> 00:02:55,693.46125366
And then I have to say, like now I'm, we,, hone in on it as pelvic floor PTs and we're like, okay.
28
00:02:56,143.46125366 --> 00:02:58,33.46125366
It's a lot of our population.
29
00:02:58,95.98424357 --> 00:02:58,425.98424357
Yeah.
30
00:02:58,425.98424357 --> 00:03:18,226.40762964
So now, having this new awareness over these last 10 years, about that big overlap between Hypermobility and all the things you do in pelvic pt what would you say the percentage of your patient population is? Who have Hypermobility? So my patient population, I almost feel like all of 'em have some form or other.
31
00:03:18,367.51359221 --> 00:03:22,637.51359221
But maybe not probably like 70% of 'em though.
32
00:03:22,772.51359221 --> 00:03:24,602.51359221
So really heavily, Yeah.
33
00:03:24,602.51359221 --> 00:03:25,682.51359221
heavily represented.
34
00:03:25,967.51359221 --> 00:03:42,767.51359221
And I would have to ask, so that we have both offices, between both offices, there's about 12 PTs, so I would be curious to see what they have to say too, Yeah, because I know we're all seeing it more and we're looking for it.
35
00:03:43,127.51359221 --> 00:03:50,778.45511035
Whereas again, 25 year, even 10 years ago when I was doing pelvic floor pt, I just wasn't looking for it as much.
36
00:03:50,778.45511035 --> 00:03:57,912.27753874
I was using the Bendy finger, the hyper extended knees, the hyperextended elbows, and now it's okay, not everyone has that.
37
00:03:58,197.27753874 --> 00:03:59,457.27753874
Yes, exactly.
38
00:03:59,457.27753874 --> 00:04:10,836.77847461
Can you say a little bit about your own background with Hypermobility too, and how that informs the work that you have come to do, I know you mentioned that you have a Bendy body also to some degree.
39
00:04:11,585.13011849 --> 00:04:11,975.13011849
Yes.
40
00:04:11,975.13011849 --> 00:04:18,286.15591602
So I do, I was able to touch hands to floor and then I was the cheerleader.
41
00:04:18,871.15591602 --> 00:04:20,71.15591602
Yes, I was a cheerleader.
42
00:04:21,721.15591602 --> 00:04:26,11.15591602
I was the cheerleader on the top that was doing like the hyperextended splits.
43
00:04:26,61.15591602 --> 00:04:27,801.15591602
Oh, she bends a lot there.
44
00:04:28,221.15591602 --> 00:04:36,791.15591602
But I don't have the elbow, I don't have the knee, but I do interestingly have the cracking and I've had the popping joints since in my twenties.
45
00:04:37,501.15591602 --> 00:04:46,883.21219043
And I have other things that I found fascinating, and I think I've just learned it from you, like the degenerative gums, the oh, I forgot what they're called in your feet.
46
00:04:46,883.21219043 --> 00:04:53,913.69762337
The pop, the connective Yeah, the epigenic little papules, the fat pads herniating through the superficial fascia.
47
00:04:54,378.69762337 --> 00:04:56,178.69762337
So I look for those now.
48
00:04:56,538.69762337 --> 00:05:04,308.50701238
And yeah, and then with pt,, again, we're more aware of All the various degrees.
49
00:05:04,308.50701238 --> 00:05:08,538.50701238
So we're seeing it more, but I think it's always been there.
50
00:05:08,688.50701238 --> 00:05:17,440.491011
I just think we're diagnosing it more and I think we do see a high population because obviously prolapse, that is one.
51
00:05:17,440.491011 --> 00:05:19,150.491011
And to be transparent.
52
00:05:19,495.491011 --> 00:05:20,635.491011
I have one too.
53
00:05:21,385.491011 --> 00:05:25,195.491011
I also had to have hernia surgery of seven hernias.
54
00:05:25,195.491011 --> 00:05:28,650.491011
So Oh really? yes, seven hernias.
55
00:05:29,25.52583979 --> 00:05:31,335.52583979
Yeah, I definitely fall in the category.
56
00:05:31,785.52583979 --> 00:05:49,291.9853094
And here we also see pelvic wise we do see the patients that are hypermobile in their hips or their SI or their lumbosacral area and their pelvic floor is gripping because they don't have enough stability in the other joints.
57
00:05:49,291.9853094 --> 00:05:54,767.18864089
So they're Overworking the pelvic floor muscles to keep other areas stable.
58
00:05:55,187.18864089 --> 00:05:56,912.61242833
So we are seeing that quite a bit.
59
00:05:56,912.61242833 --> 00:05:57,178.9988419
Yeah.
60
00:05:57,178.9988419 --> 00:06:00,855.49074457
So when I think about what would be the classic hypermobile person.
61
00:06:01,312.60195063 --> 00:06:11,262.60195063
Pelvic presentation, it is that, it's like I imagine that most of those folks are gonna show up with a lot of gripping, a lot of background contraction in their pelvic floor muscles.
62
00:06:11,592.60195063 --> 00:06:13,572.60195063
That's leading to a lot of pain symptoms.
63
00:06:13,682.60195063 --> 00:06:22,351.67458648
Is that kind of the overarching theme, or would you say it's really variable across that population? I'd say there's some consistency.
64
00:06:22,811.67458648 --> 00:06:28,811.67458648
It's not across the board, but there is some consistency with the patients, how they present.
65
00:06:28,904.73582169 --> 00:06:40,164.73582169
And usually to be honest, one side of the, like back is tighter, one side of the hips are tighter, and then the other side of the pelvic floor is tighter.
66
00:06:40,434.73582169 --> 00:06:43,734.73582169
So it's almost like everything's trying to balance itself out.
67
00:06:44,364.73582169 --> 00:06:51,124.52219865
So that pattern I do see, but typically when they first come, it's all the muscles are just not happy.
68
00:06:51,544.52219865 --> 00:06:51,814.52219865
Yeah.
69
00:06:51,814.52219865 --> 00:06:52,204.52219865
Yeah.
70
00:06:53,209.62707739 --> 00:06:56,449.62707739
Then it's that fine line, you know very well.
71
00:06:56,449.62707739 --> 00:07:03,933.50179256
It's that fine line of that, okay, we have to get rid of the tension and the trigger points and the tightness, but yet we need to strengthen.
72
00:07:04,713.50179256 --> 00:07:06,303.50179256
So we don't wanna flare 'em.
73
00:07:06,903.50179256 --> 00:07:09,430.24456356
But we do need to increase stability.
74
00:07:09,441.94519262 --> 00:07:10,521.94519262
Yeah, absolutely.
75
00:07:10,521.94519262 --> 00:07:16,421.94519262
That is the fine line is that muscular engagement that's always going on in the background is, sometimes.
76
00:07:16,561.07188126 --> 00:07:21,481.07188126
It's dysfunctional and it's also functional, right? That people are, they're depending on it to some degree, for some stability.
77
00:07:21,481.07188126 --> 00:07:24,234.33976719
It's just not an optimal type of stability.
78
00:07:24,234.33976719 --> 00:07:26,484.33976719
So gotta do both things at once.
79
00:07:26,611.60152663 --> 00:07:38,111.60152663
So when you think about Hypermobility and pelvic pain what are the most important things that come to your mind that you wanna share with listeners about that? Yeah that's definitely a great question.
80
00:07:38,161.60152663 --> 00:07:46,988.95717849
I wanna start off with, I've also now certified in perimenopause, menopause, and I do see shifts with that too.
81
00:07:47,508.95717849 --> 00:07:57,474.77321853
Along with I know you're familiar with like autoimmune issues being more affecting the symptoms more and like mast cell activation pots, et cetera.
82
00:07:57,542.56598383 --> 00:08:05,907.29644372
I do have to say that a lot of these patients, they have a lot of different symptoms and typically not just pelvic floor.
83
00:08:05,930.97001622 --> 00:08:10,701.92318191
And we have to start with one addressing the musculoskeletal system.
84
00:08:10,701.92318191 --> 00:08:18,396.03796869
So trying to calm, aggravated tissues and muscles and trying to strengthen or stabilize other joints.
85
00:08:18,521.48311843 --> 00:08:25,27.80129512
But at the same time, I do find it super helpful to also down regulate the nervous system.
86
00:08:25,170.69922357 --> 00:08:28,200.69922357
cause I'm just seeing a lot of overlap with that.
87
00:08:28,200.69922357 --> 00:08:30,510.69922357
Again, is it the pots It's scary.
88
00:08:30,579.94258105 --> 00:08:32,79.94258105
The symptoms of pots are scary.
89
00:08:32,79.94258105 --> 00:08:39,763.61811816
The symptoms of chronic, joint pain or having various joint pains throughout their life is also upsetting and scary.
90
00:08:39,763.61811816 --> 00:08:45,41.05199674
So that aspect of downregulating the system, plus just being in pain.
91
00:08:45,134.29886361 --> 00:08:48,286.54516081
Frequently in general up reg up your system.
92
00:08:48,286.54516081 --> 00:08:53,910.17552913
So you have to typically do the pelvic floor PT with, some type of mindfulness practice.
93
00:08:54,171.03313363 --> 00:08:56,758.7721783
Slow and steady also wins the race.
94
00:08:56,808.7721783 --> 00:09:03,610.22115291
It's not a marathon, but I've had patients down and out and I know you have to can't even get outta bed.
95
00:09:03,640.70719621 --> 00:09:13,489.49829321
And now it's been a road with some patients, but now they're running and I am not, whatever exercise they like to do, I try to work with them.
96
00:09:13,847.95370654 --> 00:09:15,155.56762915
So maybe don't run.
97
00:09:15,665.56762915 --> 00:09:22,185.56762915
Marathons and maybe just run a little bit and then walk and run a little bit, walk or vary.
98
00:09:22,185.56762915 --> 00:09:23,895.56762915
Your exercise is important.
99
00:09:24,135.56762915 --> 00:09:29,809.26078756
And we work also on stability exercises while trying to work on pelvic pain.
100
00:09:29,809.26078756 --> 00:09:34,433.36670141
So definitely multimodal approach with our Bendy people.
101
00:09:34,918.36670141 --> 00:09:41,668.36670141
I really think it's a common theme across all the practitioners that I talk to who treat Bendy populations.
102
00:09:41,718.36670141 --> 00:09:46,964.22933162
That is the importance of nervous system regulation as a really central part of the approach.
103
00:09:47,24.22933162 --> 00:09:47,362.90344458
Yeah.
104
00:09:47,362.90344458 --> 00:09:50,9.07287817
So pelvic floor is the bottom of your core.
105
00:09:50,9.07287817 --> 00:09:54,184.57117694
It connects the sits bones with the tailbone, with the pubic bone.
106
00:09:54,184.57117694 --> 00:09:58,562.99325483
So it makes a bowl at the bottom of your core, at the bottom of your pelvis.
107
00:09:58,562.99325483 --> 00:10:03,431.27777111
It helps with bladder bowel continence, it helps with core stability.
108
00:10:03,437.30758644 --> 00:10:05,957.30758644
It helps with sexual arousal and performance.
109
00:10:06,53.35067726 --> 00:10:15,737.77507006
And the organs the urethra bladder, they do go through the muscles and the anal rectal area goes through the muscles.
110
00:10:15,749.13483923 --> 00:10:24,232.42504106
So if you think about it, you can't fully relax those muscles in the sense that you can't just take a break and lie.
111
00:10:24,262.42504106 --> 00:10:26,2.42504106
You, you have to go to the bathroom.
112
00:10:26,52.42504106 --> 00:10:28,572.42504106
It's hard in that sense too, 'cause you can't.
113
00:10:29,172.42504106 --> 00:10:33,42.42504106
Just turn it off and not use 'em for a couple days.
114
00:10:33,672.42504106 --> 00:10:37,212.42504106
It's A very unique and special part of the muscular system.
115
00:10:37,262.42504106 --> 00:10:47,644.48975867
And then sexual arousal, you want it to be pleasurable, but if it's an area of discomfort, it's confusing and that obviously affects the nervous system quite a bit too.
116
00:10:47,644.48975867 --> 00:10:51,273.33412096
So, it's multifaceted because you do have to.
117
00:10:51,483.33412096 --> 00:10:56,13.33412096
Try to also downregulate the bladder if there's a lot of overactivity.
118
00:10:56,73.33412096 --> 00:10:57,963.33412096
Frequency, urgency, retention.
119
00:10:58,413.33412096 --> 00:11:08,39.20651886
Those are all signs of muscle dysfunction, meaning obviously you get the organs checked out, make sure there's no infections et cetera.
120
00:11:08,68.98343329 --> 00:11:08,458.98343329
But.
121
00:11:08,639.99051337 --> 00:11:20,255.57533189
Once you get everything cleared and everything's negative, most likely if you're having bladder, bowel or sexual dysfunction, any type of symptoms, there is a pelvic floor component to it.
122
00:11:20,437.14373196 --> 00:11:22,627.14373196
And this could be all genders.
123
00:11:22,627.14373196 --> 00:11:23,737.14373196
It's all genders.
124
00:11:23,837.14373196 --> 00:11:24,752.5693757
Not just.
125
00:11:24,752.5693757 --> 00:11:34,996.2268161
People with female anatomy, it's all genders 'cause we all have a pelvic floor and they all surround the same urethra, bladder, rectal area and genital region.
126
00:11:35,53.20822072 --> 00:11:38,803.20822072
So it's complex because again, you can't fully relax.
127
00:11:38,810.19984839 --> 00:11:43,869.9968276
I mean we do teach patients how to relax the muscles, which is key, but.
128
00:11:43,869.9968276 --> 00:11:47,429.04079077
It's not something you could just turn off for a day or give a cast.
129
00:11:47,519.04079077 --> 00:11:48,359.04079077
Put a cast on.
130
00:11:48,714.04079077 --> 00:11:49,314.04079077
Exactly.
131
00:11:49,394.04079077 --> 00:12:02,907.23028458
So that, maybe part of why it's such a slow road for a lot of folks as far as changing those patterns that are, in play between the brain and the pelvic floor and Come up with some more functional stability for the whole region.
132
00:12:03,237.23028458 --> 00:12:05,577.23028458
So when you're thinking about that aspect..
133
00:12:05,669.58566725 --> 00:12:15,220.39840743
What are some of your go-tos on that front? so we've been recognizing that prolotherapy especially for hypermobile patients can be helpful.
134
00:12:15,268.10389245 --> 00:12:21,596.6205347
And as pelvic floor PTs we are seeing that like into the SI area, into the hip.
135
00:12:22,176.6205347 --> 00:12:28,530.7192489
Area into certain ligaments can be helpful if the lumbosacral area is hypermobile.
136
00:12:29,315.6113184 --> 00:12:41,671.44688968
Wherever we're finding Hypermobility, we are saying that is an option for patients to help with the stability of the joints, of the ligaments, and then when it comes from a PT perspective.
137
00:12:41,697.34746272 --> 00:12:45,160.87132816
So if they do you have symptoms of POTS or any type of.
138
00:12:45,500.87132816 --> 00:12:53,690.87132816
Dizziness with exercise, we will start them supine if they're in a lot of pain, even if they don't have the dizziness.
139
00:12:53,690.87132816 --> 00:12:58,104.74400882
Typically we also start them in supine, meaning like lying on their back, or.
140
00:12:58,830.7443695 --> 00:13:08,139.9871322
Prone lying on their stomach and starting isometric exercises for the deep abdominal muscles, the deep back muscles, the hip rotators.
141
00:13:08,227.61239405 --> 00:13:12,787.61239405
But starting flow, 'cause again, we don't wanna aggravate symptoms.
142
00:13:12,787.61239405 --> 00:13:19,714.97242009
So with some of my more symptomatic patients, meaning they had just a lot of symptoms when they first came in.
143
00:13:20,14.97242009 --> 00:13:29,997.49098495
It was more about the breathing, and I did use to give stretches a lot in the past and now I'm like, okay, with this patient population.
144
00:13:29,997.49098495 --> 00:13:36,811.58990883
It's not so much about the stretch, it's more about just trying to relax the tissues and breathe into the.
145
00:13:36,811.58990883 --> 00:13:39,215.20389593
The joints versus stretching them.
146
00:13:39,755.20389593 --> 00:13:40,45.20389593
Yeah.
147
00:13:40,492.76494215 --> 00:13:51,746.11284573
So For the more extreme pain we do start really slow and more breathing, more mindfulness practices, then making sure they know how to relax the pelvic floor.
148
00:13:51,746.11284573 --> 00:13:55,458.99162285
Pelvic floor coordination can be challenging for a lot of people.
149
00:13:55,458.99162285 --> 00:13:58,278.99162285
All populations, not just Hypermobility.
150
00:13:58,337.77743014 --> 00:14:09,754.17371106
So really trying to teach them how to engage the pelvic floor correctly, relax the pelvic floor correctly, do the exercises without engaging the pelvic floor if there's too much tone.
151
00:14:09,831.68871554 --> 00:14:11,509.35277866
So that's how we start.
152
00:14:11,509.35277866 --> 00:14:16,152.33060193
And then we slowly progressed into, okay, let's try a TA or Transverse.
153
00:14:16,152.33060193 --> 00:14:17,452.94677052
Abdo one of the deep.
154
00:14:17,657.94677052 --> 00:14:18,737.94677052
Abdominal muscles.
155
00:14:18,737.94677052 --> 00:14:22,447.2938978
Let's try that and try to isolate it from the pelvic floor.
156
00:14:22,657.2938978 --> 00:14:26,262.36545564
Okay, we could do that now let's add the deep back muscles.
157
00:14:26,542.36545564 --> 00:14:28,132.36545564
So that's how we progress.
158
00:14:28,179.66005365 --> 00:14:42,701.22186026
It is a bit slow, so depending on where they're at, we'll also meet them there so if they're already doing exercises, if they're already lifting weights, we will modify it, but we don't want to discourage them from doing them.
159
00:14:43,41.22186026 --> 00:14:45,861.22186026
But we will modify, if any, are painful.
160
00:14:45,911.22186026 --> 00:14:52,156.22186026
There's so many exercises to do, so I always say we'll find a half hour if you want, for sure.
161
00:14:52,231.22186026 --> 00:14:54,721.22186026
but it doesn't have to be painful.
162
00:14:55,36.22186026 --> 00:14:55,606.22186026
Yes.
163
00:14:55,656.22186026 --> 00:15:08,756.22186026
And I think sometimes for patients, that's one of the hardest things is slowing down and being patient with those more subtle connections that the brain's trying to make with these key deep muscles that can feel tedious.
164
00:15:08,773.08831534 --> 00:15:12,820.97019197
requires a lot of concentration and it feels hard, until it doesn't.
165
00:15:12,820.97019197 --> 00:15:15,818.11038488
But I think that can be tough for folks when they're starting out.
166
00:15:15,858.11038488 --> 00:15:16,338.11038488
Yeah.
167
00:15:16,368.11038488 --> 00:15:20,118.11038488
It is tough to go backwards, so I try not to go.
168
00:15:20,122.8535625 --> 00:15:24,454.13170649
Too far back because I don't wanna stop them from what they're already doing.
169
00:15:24,454.13170649 --> 00:15:35,286.75033099
I just try to modify but the key is in the beginning, is to make sure they can isolate the pelvic floor and then they're not gripping the gripping part can be the more challenging part.
170
00:15:35,366.75033099 --> 00:15:57,207.76429004
And then another thing I did wanna mention, you were asking about patterns before, and this is really big to bring up, is that we do see a lot of irritable bowel symptoms and constipation because the tissue is more flexible and stretchy, we do end up seeing more patients that their bowel has been stretched more Yeah.
171
00:15:57,207.76429004 --> 00:16:00,377.76429004
And then also the vascular system.
172
00:16:00,407.76429004 --> 00:16:07,50.12431608
So we may see a bit more pelvic congestion that type of thing because of the connective tissue.
173
00:16:07,50.12431608 --> 00:16:19,519.91048958
Do you see that the pelvic floor dysfunctions that you're treating are contributing to some of those IBS symptoms, or can they even contribute to some of the pelvic congestion I feel like it could be both ways.
174
00:16:19,651.73371143 --> 00:16:22,621.73371143
They could have had constipation since they were little.
175
00:16:23,171.73371143 --> 00:16:26,278.74171478
But was it the constipation that.
176
00:16:26,278.74171478 --> 00:16:37,240.37440763
Aggravated things and resulted in irritable bowel type symptoms, or was it 'cause they have more flexible connective tissue and they would just get more constipated from that.
177
00:16:37,240.37440763 --> 00:16:42,140.3744076
But also another thing is like prolapse and you don't see that as much in young kids and teens.
178
00:16:42,140.3744076 --> 00:16:44,90.3744076
So that could be an issue.
179
00:16:44,127.2031261 --> 00:16:46,362.5800147
Contributing to bowel dysfunction.
180
00:16:46,835.7681353 --> 00:16:58,995.0146583
We could have the gripping around the anal recal opening the tightening, and they just can't relax it and they can't empty fully, or they relax and it tightens too quickly.
181
00:16:59,27.2177202 --> 00:17:06,738.9216183
So they're not emptying fully or they're just, we have patients that they only go to the bathroom once a week or twice a week.
182
00:17:06,738.9216183 --> 00:17:09,708.9216183
So definitely working on that with them.
183
00:17:09,780.9925523 --> 00:17:13,500.9925523
Giving 'em behavioral modifications is key.
184
00:17:13,500.9925523 --> 00:17:23,430.9925523
So that's a big thing that we work with patients on, like learning how not to strain using the squatty potty positioning, doing the ILU massage.
185
00:17:24,30.9925523 --> 00:17:29,760.9925523
Then if the bladder's affected, that definitely can affect the bowel and vice versa.
186
00:17:30,0.9925523 --> 00:17:41,674.0732
If there's a lot of stool pressing on the bladder, the bladders can't hold as much, so they may have more frequency or discomfort because of the pressure onto the bladder or pelvic area.
187
00:17:41,769.140675 --> 00:17:46,745.702737
Definitely a lot of different things that we see, but we can help a lot.
188
00:17:46,895.702737 --> 00:17:48,915.702737
We've helped many patients.
189
00:17:48,915.702737 --> 00:17:51,975.702737
We do find that it just, it takes time.
190
00:17:51,975.702737 --> 00:17:52,965.702737
It does take time.
191
00:17:53,275.702737 --> 00:18:03,951.8007594
I think it's really good to put that on people's radar that some of the more GI adjacent symptoms that they're having might also be some overlap with pelvic floor dysfunction and.
192
00:18:04,661.8007594 --> 00:18:15,891.8007594
I do in my mind, generally think, hey, pelvic PT is something that the vast majority of hypermobile people are probably gonna be able to benefit from at some point along their pathway.
193
00:18:15,971.8007594 --> 00:18:18,470.8065303
So yeah, I always recommend it.
194
00:18:18,620.8065303 --> 00:18:22,760.8065303
I'm interested in going back to the menopause and perimenopause.
195
00:18:23,135.8065303 --> 00:18:25,415.8065303
Kind of new focus that you've brought into your practice.
196
00:18:25,475.8065303 --> 00:18:37,414.1927608
I would love to hear a little bit more about that and some of the changes that you see with the perimenopause transition, and especially with regard to Hypermobility.
197
00:18:37,464.1927608 --> 00:18:43,635.1192745
Yeah, with the Hypermobile patients, we definitely see, they are.
198
00:18:43,779.2198197 --> 00:18:59,377.8135697
More susceptible to symptoms than other patients, even during pregnancy and postpartum and breastfeeding, just because of those hormonal changes as well as the ligament of laity during pregnancy, just as an example.
199
00:18:59,383.6167259 --> 00:19:11,376.3741843
But the hormonal changes that all women go through again, because of the Hypermobility, they may need to be just more sensitive to doing more stability exercises during that period of time.
200
00:19:11,416.3741843 --> 00:19:13,966.3741843
The hormonal changes are similar with menopause.
201
00:19:13,966.3741843 --> 00:19:16,96.3741843
So the menopause, it's different.
202
00:19:16,126.3741843 --> 00:19:22,733.4390247
It's definitely different, but it's the same idea in the estrogens are dropping a lot.
203
00:19:22,793.4390247 --> 00:19:24,743.4390247
Estrogen helps with bone health.
204
00:19:24,743.4390247 --> 00:19:30,583.4390247
It helps with brain health, it helps with heart health, and then estrogen and testosterone also helps with muscle health.
205
00:19:30,609.3101694 --> 00:19:40,119.3101694
We're just seeing oh, we have to also be on top of this for our Hypermobility patients with female anatomy that are going through perimenopause and menopause.
206
00:19:40,183.4200733 --> 00:19:43,353.4200733
Because again, it can affect the cardiovascular system.
207
00:19:43,353.4200733 --> 00:19:46,447.194284
Okay, our POTS patients, we have to be more mindful.
208
00:19:46,447.194284 --> 00:20:02,752.9626817
The decrease in testosterone, which It definitely decreases but that can decrease muscle health and it's really important to have enough muscle health to keep the bone health and to decrease in estrogen can affect the bone health as well.
209
00:20:02,767.1682662 --> 00:20:07,978.53806
Definitely addressing the hormone therapy is important.
210
00:20:08,51.4339346 --> 00:20:13,306.4925685
It starts 10 to 15 years prior to menopause, so I just wanna say that one more time.
211
00:20:14,476.4925685 --> 00:20:16,966.4925685
Perimenopause starts 10 to 15.
212
00:20:17,467.0901026 --> 00:20:22,147.0901026
Prior to menopause and your numbers start to drop then.
213
00:20:22,166.422178 --> 00:20:33,66.3686706
I just saw a great influencer, urologist, Rachel Rubin, and she just said, I don't understand why every system of the body we address it.
214
00:20:33,554.8035257 --> 00:20:43,868.6104919
Before it gets totally depleted, but our patient population of perimenopause, menopause, we're waiting till it's completely depleted before we start to address it.
215
00:20:44,78.6104919 --> 00:20:50,52.0225605
There's no other system in the body that we wait until it's on zero And then start to address it.
216
00:20:50,867.0225605 --> 00:20:51,407.0225605
yeah.
217
00:20:51,677.0225605 --> 00:20:52,197.1593004
Oh.
218
00:20:52,272.2794677 --> 00:20:57,660.7741373
I am telling all my patients down okay, you're 35, 40.
219
00:20:58,30.7741373 --> 00:21:04,810.7741373
Ideally knowing when like a mother or sister went through menopause, not necessary.
220
00:21:04,840.7741373 --> 00:21:08,63.8378073
'cause a lot of what they treat is symptomatic.
221
00:21:08,150.4393086 --> 00:21:12,260.4393086
It's hard to test the estrogen because it regulates.
222
00:21:12,355.4393086 --> 00:21:15,792.6918242
Throughout the day, let alone throughout the week, let alone throughout the month.
223
00:21:15,875.2818379 --> 00:21:18,375.2818379
But we all know it's going down.
224
00:21:19,125.2818379 --> 00:21:20,445.2818379
So it is by symptoms.
225
00:21:20,445.2818379 --> 00:21:27,255.2818379
Testosterone you can test and that is important to test But And I think in the bente population.
226
00:21:27,565.2818379 --> 00:21:44,901.7729431
It's really tricky to tease apart, okay, are my symptoms possibly related to pre menopause or are they symptoms that are related to my pots that are related to, my connective tissue disorder as the background reality? that complicates things for folks a little bit.
227
00:21:45,21.8988187 --> 00:21:46,190.0953918
Yeah, it definitely does.
228
00:21:46,880.0953918 --> 00:21:53,15.0953918
And you mentioned earlier what have my symptoms been? I definitely just wanna throw it out there that my.
229
00:21:53,552.7353658 --> 00:21:58,332.7353658
Joint pain has definitely gotten worse with this I am 52.
230
00:21:58,332.7353658 --> 00:22:00,282.7353658
I just turned 52 yesterday.
231
00:22:00,507.7353658 --> 00:22:01,257.7353658
Happy birthday.
232
00:22:01,542.7353658 --> 00:22:01,722.7353658
Thank you.
233
00:22:02,892.7353658 --> 00:22:13,394.7720356
And yeah, I am seeing it more and i'm actually also lifting more weights, which I wasn't doing as much because I would get injured so easily.
234
00:22:13,436.9184386 --> 00:22:20,83.8154112
But I am trying to lift more weights and I honestly don't think that's the cause of the increased symptoms.
235
00:22:20,83.8154112 --> 00:22:28,363.6360218
I think It's the HRT and one thing that I unfortunately do have, which I'm still working on, is sleep issues.
236
00:22:28,363.6360218 --> 00:22:35,278.5001169
And sleep is huge with healing and you may need progesterone 'cause progesterone drops too.
237
00:22:35,314.9096221 --> 00:22:37,980.3660239
You may need progesterone to help with sleep.
238
00:22:37,980.3660239 --> 00:22:42,164.1383412
Progesterone also helps with anxiety and mood differences.
239
00:22:42,214.1383412 --> 00:22:46,649.1383412
Yeah, you need to look at the full picture with perimenopause, menopause as well.
240
00:22:47,39.7680205 --> 00:22:48,289.7680205
Yeah, that makes a lot of sense.
241
00:22:48,329.7680205 --> 00:23:19,642.8918943
What are the main changes that we see in connective tissue when these hormonal levels start to drop? Specifically the estrogen and the progesterone along with it? How would you describe the changes to tissues, not only connective tissues, but also the muscle tissue? So definitely I mean from a pelvic PPT perspective, we were taught even before I've learned about Hypermobility and menopause, that the elasticity in the tissues, it just changed and the muscle bulk in the pelvic floor changes.
242
00:23:19,642.8918943 --> 00:23:22,228.7581866
That's why more people have incontinence.
243
00:23:22,606.6378253 --> 00:23:27,754.6147133
Yes, you should make sure the muscles are strong, but the actual tissues are changing too.
244
00:23:27,754.6147133 --> 00:23:34,984.6147133
So it's the elasticity in the tissues and it's the elasticity in all the tissues that are changing.
245
00:23:35,164.6147133 --> 00:23:36,904.6147133
It's not just the pelvic floor.
246
00:23:37,84.6147133 --> 00:23:42,193.4798663
There are creams specific to the pelvic floor that can be very helpful.
247
00:23:42,193.4798663 --> 00:23:43,363.4798663
There's an estrogen.
248
00:23:43,389.3137546 --> 00:23:50,358.1816078
Testosterone is off-label, but there's an estrogen testosterone cream that can really help with the vaginal tissues.
249
00:23:50,358.1816078 --> 00:23:53,910.6358315
And if you're feeling any dryness, it can help with all of that.
250
00:23:54,10.6358315 --> 00:23:58,274.4934568
It doesn't replace any strengthening or if there's increase tone.
251
00:23:58,274.4934568 --> 00:24:03,434.4934568
It doesn't fix it, but it helps with the overall health of the tissues.
252
00:24:03,524.4934568 --> 00:24:03,944.4934568
Yeah.
253
00:24:03,944.4934568 --> 00:24:07,684.3566363
So that loss of elasticity is like a double whammy for the Bendy person.
254
00:24:07,684.3566363 --> 00:24:16,714.3566363
'cause we already don't have as much elasticity, Our tissues are less like a trampoline, there's not as much bounce back, I guess is a, is one way to describe it.
255
00:24:16,764.3566363 --> 00:24:18,54.3566363
That's all good to know about.
256
00:24:18,84.3566363 --> 00:24:36,135.758362
Speaking of creams, I'd love to hear a little bit more about your CBD products and how you use CBD in your practice, but also how you learned about it So it was a bit of a COVID project When everything was going south in New York City and just zero patients were coming in.
257
00:24:36,179.8753438 --> 00:24:39,656.7344927
I had met a group upstate New York.
258
00:24:39,687.0305381 --> 00:24:45,808.3674114
And I was really fascinated by their whole operations of clean products.
259
00:24:45,858.3674114 --> 00:24:55,481.3947552
And I had already started to look into CBD and CBD has been researched, not as much in the US unfortunately because of the FDA regulations and trying to manage that.
260
00:24:55,481.3947552 --> 00:25:06,650.5586953
But I know in a lot of the European countries, I'm not sure about Australia, but they're studying that CBD helps with pain, inflammation, it helps increase blood flow.
261
00:25:06,650.5586953 --> 00:25:12,882.1884357
And some studies in Europe showed increased blood flow into the genital region specifically.
262
00:25:12,955.1621364 --> 00:25:16,435.1621364
To help with arousal performance, but also if they're in pain.
263
00:25:16,435.1621364 --> 00:25:23,875.3643153
So the CBD that I created, I have a sve, which is basically like a cream that you can put on any joints.
264
00:25:23,935.3643153 --> 00:25:26,690.3643153
And trust me, I put it all over these days.
265
00:25:27,830.3643153 --> 00:25:28,330.3643153
And then.
266
00:25:29,21.1612407 --> 00:25:41,404.117774
I do have patients with male or female anatomy or any transgender as well, that I do tell them they could even use the sav on the external genital region to help with blood flow.
267
00:25:41,451.245663 --> 00:25:46,751.245663
I did add botanicals to it, so I added Solomon Seal, calendula, and Arnica.
268
00:25:47,496.9371913 --> 00:25:52,276.9371913
To the SVE Again, those are all anti-inflammatory pain relieving.
269
00:25:52,323.5125087 --> 00:25:57,383.5125087
Then my goal was to also create an intimacy oil.
270
00:25:58,223.5125087 --> 00:26:07,343.5125087
So the intimacy oil, it is an oil base, so you have to be mindful of that when using it internally, but a lot of patients use coconut oil.
271
00:26:07,343.5125087 --> 00:26:10,711.0434332
So I was like why can't we create something that has even more.
272
00:26:11,55.8397695 --> 00:26:13,332.0268881
Health benefits than just coconut oil.
273
00:26:13,332.0268881 --> 00:26:22,703.4842194
So it has CB, D, and then with the intimacy oil, I did add a willow bark and cava, which both help with nerve sensitivity or nerve pain.
274
00:26:23,59.4938903 --> 00:26:31,394.215707
So I had patients use it if they're having genital pain pain in the perineum, the vestibular area for patients with female anatomy.
275
00:26:31,458.8008714 --> 00:26:35,138.8008714
Or I just have 'em use it to help, with sexual arousal too.
276
00:26:35,138.8008714 --> 00:26:35,920.7549252
I think that.
277
00:26:35,946.890717 --> 00:26:39,96.890717
A lot of people with Hypermobility really struggle with that.
278
00:26:39,126.890717 --> 00:26:46,636.890717
Pain with intercourse, pelvic pain across the board So that's a, an interesting product for people to know about Yeah.
279
00:26:46,756.890717 --> 00:26:47,236.890717
Yeah.
280
00:26:47,296.890717 --> 00:26:48,316.890717
Take it for a spin.
281
00:26:48,676.890717 --> 00:26:50,866.890717
Yes, definitely take it for a spin.
282
00:26:50,936.890717 --> 00:26:57,46.4479782
I've gotten tons of positive feedback I also did create a tonic that you take orally.
283
00:26:57,46.4479782 --> 00:27:02,856.4479782
So I had my office crew test it out first, and the SAV helped with headaches right away.
284
00:27:02,921.4479782 --> 00:27:10,794.1479147
The tonic helped with some it doesn't replace medication, but it eased some anxiety and it did help some people with sleep.
285
00:27:10,794.1479147 --> 00:27:20,994.1479147
Some people said they didn't feel it as much, but and then the intimacy oil, I use it actually during my sessions too with the patients if they're okay with it.
286
00:27:21,364.1479147 --> 00:27:22,984.1479147
Yeah, it doesn't burn.
287
00:27:22,984.1479147 --> 00:27:24,244.1479147
It's soothing too.
288
00:27:24,354.1479147 --> 00:27:25,614.1479147
And you don't need a lot.
289
00:27:25,644.1479147 --> 00:27:26,334.1479147
That's key.
290
00:27:26,334.1479147 --> 00:27:29,240.0742249
You don't need, you just need like a small amount.
291
00:27:29,607.2519593 --> 00:27:30,687.2519593
it lasts a long time.
292
00:27:31,292.2519593 --> 00:27:31,532.2519593
Cool.
293
00:27:31,532.2519593 --> 00:27:31,892.2519593
Okay.
294
00:27:31,942.2519593 --> 00:27:32,392.2519593
Yeah.
295
00:27:32,539.8044496 --> 00:27:35,529.8044496
You can't use it with condoms though 'cause there isn't oil.
296
00:27:35,538.3171155 --> 00:27:35,870.6247621
Gotcha.
297
00:27:36,65.6247621 --> 00:27:36,245.6247621
Okay.
298
00:27:36,245.6247621 --> 00:27:36,815.6247621
Good to know.
299
00:27:36,845.6247621 --> 00:27:37,355.6247621
Good to know.
300
00:27:37,460.4246595 --> 00:27:44,655.7246563
So Amy, when you're thinking about the work you do, public pain and Hypermobility, are there any other.
301
00:27:44,689.7977357 --> 00:27:46,604.7977357
Topics that come up that you wanna cover.
302
00:27:47,0.6225545 --> 00:27:55,659.9078329
I know we both talk about the importance of cardiovascular health too, so I do coach patients on that as well.
303
00:27:55,659.9078329 --> 00:27:59,649.9078329
And but also for the pelvic floor, like we need blood flow to that area.
304
00:27:59,919.9078329 --> 00:28:08,894.8964393
Nerves also love blood flow and if tissues are restricting the nerves or if you're sitting all day you're decreasing the blood flow to that area.
305
00:28:09,54.8964393 --> 00:28:14,328.448064
Plus, if you have a tight pelvic floor, it's a double whammy because you're decreasing the blood flow.
306
00:28:14,762.4036002 --> 00:28:20,455.1578621
With sitting in general, and then if the muscles are tight, you're also decreasing the blood flow.
307
00:28:20,455.1578621 --> 00:28:24,866.2101082
So importance of movement, but within their comfort.
308
00:28:25,56.3458097 --> 00:28:33,430.1584725
So again, starting 'em slow, if they can only take a five minute walk or if they can only start with exercises lying down, it's great.
309
00:28:33,460.1584725 --> 00:28:35,740.1584725
We just need to, we need to move though.
310
00:28:35,980.1584725 --> 00:28:36,250.1584725
Yeah.
311
00:28:37,180.1584725 --> 00:28:38,560.1584725
Yeah, so I talk about that.
312
00:28:38,560.1584725 --> 00:29:01,358.7582409
I do talk quite a bit about the mental health part, just because, again, most of our patient population there has been a lot of suffering there's also been a lot of gaslighting and trauma with our patients, so really that does affect your nervous system, plus Experiencing pain on a daily basis can affect the nervous system, so making sure they're addressing that as well.
313
00:29:01,503.7939783 --> 00:29:03,693.7939783
And then just general dietary.
314
00:29:03,995.8665796 --> 00:29:08,500.7158228
Changes to, especially with our patients with bladder symptoms, frequency, urgency.
315
00:29:08,500.7158228 --> 00:29:20,184.4300155
We wanna make sure we take any irritants away, but people ask can I have my coffee? Okay, one, does your coffee affect your nervous system? Does it make you any more anxious? But also.
316
00:29:20,316.229909 --> 00:29:25,921.0348332
Does it cause you to have increased frequency? If it doesn't, then one cup of coffee.
317
00:29:26,6.6103075 --> 00:29:30,96.6103075
Some of these patients are, so deprived because they're taking everything away.
318
00:29:30,96.6103075 --> 00:29:32,586.6103075
Then I'm like, no, let's not start with the coffee.
319
00:29:32,796.6103075 --> 00:29:36,841.6103075
Let's start with, let's start with what's most irritating you.
320
00:29:37,276.6103075 --> 00:29:42,346.6103075
Is it the wine or is it dairy I listen a lot to Jessica Drummond too.
321
00:29:42,506.6103075 --> 00:29:48,812.6523811
She's the person I took my perimenopause menopause certification and she's done a lot on.
322
00:29:48,891.9256973 --> 00:29:49,652.4884
Pelvic pain.
323
00:29:49,652.4884 --> 00:30:01,360.3978441
She's a pelvic floor pt, but about 15 years ago, switched to nutrition and dietary and listening to her, but also listening to a lot of other nutritionists.
324
00:30:01,360.3978441 --> 00:30:08,619.6033699
Now everyone's talking about adding things back into diets and not taking them away, adding healthy fats.
325
00:30:08,679.6033699 --> 00:30:12,937.245925
And for our group, the anti-inflammatory foods.
326
00:30:12,968.414405 --> 00:30:25,70.6749437
So definitely trying to address the full body is key with our patient population, it makes a lot of sense and so many of 'em are unfortunately limited by all sorts of GI issues and food sensitivities.
327
00:30:25,151.6281094 --> 00:30:28,301.6281094
That impair their ability to take in adequate nutrition.
328
00:30:28,551.6281094 --> 00:30:33,835.4124417
That gets us into a really tricky spot, especially when you're talking about taking foods away.
329
00:30:33,985.4124417 --> 00:30:37,822.489458
So I like the idea of adding foods back, Yeah, protein's huge.
330
00:30:37,912.489458 --> 00:30:40,852.489458
Especially also during perimenopause and menopause.
331
00:30:41,157.3237476 --> 00:30:42,447.3237476
You make a lot of good points.
332
00:30:42,447.3237476 --> 00:30:46,797.3237476
I like the emphasis on getting that mental health support.
333
00:30:46,797.3237476 --> 00:30:50,697.3237476
I think it's universally important as a human living in this world at this time.
334
00:30:50,697.3237476 --> 00:31:01,876.1111825
It's important and add to that a chronic health condition and like you mentioned, a lot of medical gaslighting and trauma that people have experienced and it really does take a toll on the mental health.
335
00:31:01,876.1111825 --> 00:31:03,316.1111825
And then movement.
336
00:31:03,500.7728811 --> 00:31:09,120.7728811
It's just amazing how every system of our body, depends on movement for its health.
337
00:31:09,430.7728811 --> 00:31:15,685.530049
Not just for the strength of your muscles and your bones, but the way that all of our body functions.
338
00:31:16,195.530049 --> 00:31:17,575.530049
Depends on movement.
339
00:31:17,725.530049 --> 00:31:22,664.2088099
So whatever it is, you know, low and slow doesn't have to be uncomfortable.
340
00:31:22,664.2088099 --> 00:31:24,89.2591037
But we gotta find some way.
341
00:31:24,89.2591037 --> 00:31:25,72.6265752
To To move.
342
00:31:25,72.6265752 --> 00:31:25,522.6265752
Yeah.
343
00:31:25,852.6265752 --> 00:31:26,272.6265752
Yep.
344
00:31:26,682.6265752 --> 00:31:26,972.6265752
Yeah.
345
00:31:27,232.6265752 --> 00:31:37,346.6091191
And then I do wanna mention too, just for the listeners there is quite a range, and I know it's the same with PTs that specialize in Hypermobility.
346
00:31:37,346.6091191 --> 00:31:42,261.9330124
There is quite a range of, expertise in pelvic floor PTs.
347
00:31:42,329.753004 --> 00:31:56,640.0608607
Unfortunately, right now in New York City, we are being overtaken by privately funded practices that are doing, the mill work of every 20 minutes with patients and they are saying they do pelvic pt.
348
00:31:56,805.0608607 --> 00:31:59,565.0608607
But they don't have private treatment rooms.
349
00:31:59,595.0608607 --> 00:32:12,563.832223
They tell 'em to do Kegels or to do bridging or, so I do wanna mention that there is quite a range of expertise in pelvic floor pt and what you should look for is that they're really looking at the whole body.
350
00:32:12,597.1759475 --> 00:32:15,543.3399744
They are addressing the pelvic floor and that.
351
00:32:15,557.1736853 --> 00:32:18,565.064966
Most of the time means an internal assessment.
352
00:32:18,605.064966 --> 00:32:32,825.778823
And then I tell my physicians too, like sometimes I'll assess vaginally for patients with female anatomy and it feels okay, and then I go and assess rectally and they're just gripping there and I see that quite a bit.
353
00:32:32,825.778823 --> 00:32:43,399.3245587
Interestingly, with the Hypermobility patients, it's almost like they're gripping posteriorly, and there's not a ton going on in the anterior muscles, more posterior.
354
00:32:43,399.3245587 --> 00:32:49,239.3245587
Really finding the PT that has experience in pelvic floor PT is important.
355
00:32:49,699.3245587 --> 00:32:55,410.0217435
If they have minimal experience and you don't have anyone around, that's okay too.
356
00:32:55,453.7500144 --> 00:33:06,930.307388
Maybe doing some pelvic health coaching with other PTs so that they could progress you more than just doing bridging or just doing breathing exercises or yeah.
357
00:33:06,960.307388 --> 00:33:10,620.307388
It's an important point too, it is true in any discipline, but.
358
00:33:10,750.0823718 --> 00:33:17,340.0823718
Word of mouth is a great way to find good people, right? And if you land with someone and you're not getting results, move on too.
359
00:33:17,390.0823718 --> 00:33:20,360.0823718
Like you don't have to stay at a place that's not a good fit.
360
00:33:20,460.0823718 --> 00:33:31,330.0823718
But yeah, that very individualized, usually internal assessment to figure out exactly what is going on in your particular body, in your particular pelvic floor is so important.
361
00:33:31,330.0823718 --> 00:33:33,190.0823718
And that's really the work of a very skilled.
362
00:33:33,204.291579 --> 00:33:37,884.1448718
Pelvic PT who doesn't have to get to the next patient in 15 minutes or whatever.
363
00:33:38,364.1448718 --> 00:33:40,233.0991222
It takes time to do those things well.
364
00:33:40,233.0991222 --> 00:33:42,963.0991222
Amy, thanks so much for the work you're doing out there in the world.
365
00:33:42,963.0991222 --> 00:33:48,545.2968456
You're doing so much that educates others and supports the hypermobile, community and beyond.
366
00:33:48,605.2968456 --> 00:33:50,885.2968456
So thank you so much and keep it up.
367
00:33:50,955.4797476 --> 00:33:51,255.4797476
Yeah.
368
00:33:51,255.4797476 --> 00:33:51,825.4797476
Thank you.
369
00:33:51,825.4797476 --> 00:33:55,35.4797476
And thank you for your podcast and for all that you do too.
370
00:33:55,121.218273 --> 00:34:01,451.218273
I'm glad we now have officially met, 'cause I've heard so many wonderful things about you and your podcast.
371
00:34:02,96.218273 --> 00:34:02,976.218273
Huh, Likewise.
372
00:34:02,976.218273 --> 00:34:04,386.218273
I'm really glad that we could do this.
373
00:34:04,386.218273 --> 00:34:06,995.097871
I really appreciate your time and sharing with listeners.
374
00:34:06,995.097871 --> 00:34:09,125.097871
I know they'll find it highly relevant as well.
375
00:34:10,365.097871 --> 00:34:25,43.3918083
Before we sign off Amy, will you tell listeners where they can find out more about your work? Yes, we have a pretty extensive website Beyond Basics, physical Therapy or Beyond Basics pt, and we're also very active on social media.
376
00:34:25,43.3918083 --> 00:34:27,143.3918083
So at Beyond Basics pt.
377
00:34:27,503.3918083 --> 00:34:30,758.5220166
And then YouTube Instagram, all the things.
378
00:34:31,727.7486569 --> 00:34:42,647.7486569
We do have a newsletter if you're interested because for instance, tonight we're doing a complex pelvic pain webinar with some physicians that specialize in pelvic pain.
379
00:34:42,647.7486569 --> 00:34:49,717.7486569
So we do quite a bit of free Pelvic health 1 0 1 in May for May is pelvic pain awareness month.
380
00:34:49,728.1717323 --> 00:34:53,648.1717323
So we do quite a bit of information for the community.
381
00:34:53,720.7498573 --> 00:34:54,230.7498573
Awesome.
382
00:34:54,230.7498573 --> 00:34:55,340.7498573
That's great to know about.
383
00:34:55,700.7498573 --> 00:34:58,875.3236284
Do you want to talk about the 20% off code.
384
00:34:59,340.5880788 --> 00:34:59,847.8639116
Yeah.
385
00:34:59,877.8639116 --> 00:35:04,560.3651043
For the CBD, the website is Wellness X Nature.
386
00:35:04,560.3651043 --> 00:35:07,8.8278249
I do have some social media on that.
387
00:35:07,8.8278249 --> 00:35:08,208.8278249
I do have a website.
388
00:35:08,458.8278249 --> 00:35:09,628.8278249
It's not quite as extensive.
389
00:35:09,958.8278249 --> 00:35:13,238.8278249
It's beyond basics because it is just me.
390
00:35:13,238.8278249 --> 00:35:21,828.8278249
But, yeah, it's great products and yeah, and if you need more information about pelvic health, My Book heal Pelvic Pain.
391
00:35:22,278.8278249 --> 00:35:29,201.3884006
Or if you do have endometriosis beating endo they're both very inexpensive on Amazon, Awesome.
392
00:35:29,231.3884006 --> 00:35:34,741.3884006
Okay, listeners you can get 20% off using the code BBPT.
393
00:35:35,221.3884006 --> 00:35:45,552.7094048
That's on the Wellness By Nature products when you sign up for a 15 minute phone consultation with one of the Beyond Basics physical therapists.
394
00:35:46,542.7094048 --> 00:35:46,962.7094048
Okay.
395
00:35:47,52.7094048 --> 00:35:47,412.7094048
Cool.
396
00:35:47,662.7094048 --> 00:35:50,602.7094048
Thank you again, Amy, and thank you again, listeners.
397
00:35:50,932.7094048 --> 00:35:51,892.7094048
That's it for now.
398
00:35:51,892.7094048 --> 00:35:53,422.7094048
I'll catch you in the next episode.
399
00:35:53,637.3999566 --> 00:35:54,197.3999566
Thank you.
400
00:35:54,197.3999566 --> 00:35:54,887.3999566
Take care.
401
00:35:56,83.5998739 --> 00:35:59,263.4998739
Um, uh, Um, Uh, transcript.
