The Estrogen Edge: How Women are Changing the Fitness Game

In this episode of Soma Says, Dr. Soma sits down with Dr. Jessie Duppler, a Doctor of Physical Therapy and the founder of Chain Reaction Physical Therapy. Dr. Duppler shares her inspiring journey from working as a surgical technologist to becoming a leader in functional physical therapy.

Together, they explore how women can build strength safely, manage osteoporosis, and stay active through all stages of life. They dive into the physical and emotional impact of menopause, the importance of addressing pain at its source, and why sleep, nutrition, and stress play critical roles in recovery. Dr. Duppler also opens up about her unique approach to personalized care, her work with endurance athletes and retirees, and how technology like AI is shaping the future of physical therapy.

🕒 Episode Breakdown 00:00 – Introduction and Disclaimer 01:13 – Meet Dr. Jessie Duppler 02:12 – Journey to Physical Therapy 03:27 – Challenges Women Face in Fitness 06:22 – Addressing Osteoporosis 15:29 – Menopause and Muscle Mass 18:39 – Holistic Approach to Pain Management 20:30 – Physical Therapy for Retirees 23:10 – Understanding Muscle Tightness and Compensatory Patterns 23:56 – Referral Sources and Insurance Practices 24:55 – Success Stories: Endurance Athletes and Osteoporosis Patients 26:59 – The Role of Technology and AI in Physical Therapy 29:55 – The Future of Strength Training for Women 33:24 – Addressing Female-Specific Health Concerns 37:59 – The Impact of COVID-19 on Physical Therapy 40:10 – Where to Find More Information

 

 

💬 Connect with Jess: Website: https://www.chainreactionpt.com/about-dr-jessie-duppler Instagram: https://www.instagram.com/chainreactionpt/#

 

🎧 Subscribe to Soma Says for more conversations blending Western tools and Eastern wisdom in women’s health, emotional wellness, and whole-person healing.

Episode Transcript

(00:00):
Hi, this is Dr.

(00:01):
Soma.
Just a disclaimer, this podcast is for informational purposes only and isn't intended as medical advice.
Always consult with your doctor before making any changes to your diet, exercise, or health regimen.
Let's go to the show. 6 00:01:06,380.023 --> 00:01:11,600.023 My passion is really making sure that I spread the word about how important strength training is specifically for women. 7 00:01:13,55.193 --> 00:01:13,305.193 Dr. 8 00:01:13,305.193 --> 00:01:19,995.193 Jessie Duppler is a Doctor of Physical Therapy and the founder of Chain Reaction Physical Therapy in Prescott, Arizona. 9 00:01:20,535.193 --> 00:01:31,695.193 With a background as a surgical technologist and a competitive cyclist, she brings a unique perspective to her practice, focusing on addressing the root causes of pain rather than just symptoms. 10 00:01:32,405.193 --> 00:01:32,685.193 Dr. 11 00:01:32,685.193 --> 00:01:43,645.193 Duppler specializes in helping active individuals—particularly cyclists, ultrarunners, and hikers—achieve fearless, pain-free movement through personalized care and expert bike fitting. 12 00:01:44,105.193 --> 00:01:49,685.193 Her approach emphasizes empathy, empowerment, and the belief that movement is medicine. 13 00:01:50,355.193 --> 00:01:53,145.193 So wanted to welcome you to my podcast officially. 14 00:01:53,810.193 --> 00:01:54,575.193 Thanks for Thank you. 15 00:01:54,800.193 --> 00:01:56,150.193 Thank you for being here. 16 00:01:56,570.193 --> 00:02:02,330.193 You work on issues that are very common amongst my patients. 17 00:02:02,380.193 --> 00:02:11,40.193 I wanted to know what inspired you to become a physical therapist and then secondarily work with the type of patients that you work with. 18 00:02:12,180.193 --> 00:02:12,510.193 Yeah. 19 00:02:12,570.193 --> 00:02:16,140.193 So prior to going to PT school, I was actually a surgical tech, so I worked in surgery. 20 00:02:16,140.193 --> 00:02:19,130.193 I started doing in mostly in vascular surgery. 21 00:02:19,130.193 --> 00:02:29,50.193 And in vascular surgery we saw a lot of patients who were diabetic smokers and so we'd be fixing some vessels and then they'd come back and they'd still be a problem and we'd see 'em again and again. 22 00:02:29,300.193 --> 00:02:33,110.193 I realized we were never giving people any sort of chance to address some of the. 23 00:02:33,245.193 --> 00:02:35,285.193 Things that were causing them to see us in the or. 24 00:02:35,285.193 --> 00:02:37,745.193 Lifestyle changes and exercise and quitting smoking. 25 00:02:37,745.193 --> 00:02:41,465.193 then I started working more in ortho and doing, more back surgeries. 26 00:02:41,465.193 --> 00:02:45,845.193 we saw people come in for, a laminectomy and then a fusion, and then they just come, keep coming back. 27 00:02:45,845.193 --> 00:02:48,396.193 And so same thing, we weren't giving people any. 28 00:02:48,655.193 --> 00:02:51,685.193 Tools to try and prevent coming to see us, basically. 29 00:02:51,685.193 --> 00:02:55,855.193 And we were selling surgery as a solution when really it was just treating symptoms. 30 00:02:55,855.193 --> 00:02:57,265.193 We're very robust humans. 31 00:02:57,475.193 --> 00:03:03,595.193 We don't just degenerate our spine well, our spine does generate over time 'cause that's aging, but not to the point where it's pathological. 32 00:03:03,595.193 --> 00:03:05,335.193 And so something is causing that. 33 00:03:05,335.193 --> 00:03:06,385.193 There's a cause and effect. 34 00:03:06,385.193 --> 00:03:10,725.193 And I started, shadowing some PTs and I was like, oh, this is how we change things. 35 00:03:10,725.193 --> 00:03:18,855.193 This is how we give people the o, the opportunity to move better, help their body be healthy and so they don't have to necessarily come see us for surgery. 36 00:03:18,855.193 --> 00:03:25,925.193 So that was the progression to PT going from kind of symptom fixing to actually looking at the root cause and fixing it from that perspective. 37 00:03:27,90.193 --> 00:03:31,350.193 And you primarily work with women I work with everyone. 38 00:03:31,350.193 --> 00:03:39,820.193 You mentioned one of the other podcast you're speaking to someone about just, how important aesthetics always seemed to have been for the female population. 39 00:03:39,820.193 --> 00:03:45,490.193 I grew up mostly in the nineties where like wave culture was very big and being very thin and being a size eight was too big. 40 00:03:45,490.193 --> 00:03:50,90.193 And so a lot of those, paradigms have continued to carry on to today. 41 00:03:50,90.193 --> 00:03:56,60.193 And so now I see women who, constantly were, on South Beach diet and constantly calorie restricting. 42 00:03:56,60.193 --> 00:04:00,470.193 Carbs are bad and cardio cardio and not a lot of strength training for women. 43 00:04:00,470.193 --> 00:04:03,590.193 A lot of women who had hysterectomies early in life. 44 00:04:03,590.193 --> 00:04:06,70.193 When they were having fibroids or bad periods, and they were done having kids. 45 00:04:06,70.193 --> 00:04:10,930.193 if we see a lot of women who had hysterectomies and ectomies or having their ovaries out too. 46 00:04:10,930.193 --> 00:04:14,90.193 And those are really important organs for estrogen production. 47 00:04:14,90.193 --> 00:04:21,20.193 And so when we see these women that had their uterus and ovaries out, 'cause typically in the past too, they just took everything. 48 00:04:21,230.193 --> 00:04:28,330.193 And we see a lot of repercussions from that with lower bone density in our women these days that had that done in their thirties and forties. 49 00:04:29,730.193 --> 00:04:37,740.193 And so I see a lot of women now who unfortunately their DEXA scans aren't any good and they have osteopenia, osteoporosis. 50 00:04:38,25.193 --> 00:04:45,135.193 And then they also haven't been strength training because it's just not something that has been presented to them as either an option or really a necessity. 51 00:04:45,135.193 --> 00:04:50,685.193 And especially where I live, I do see a lot of people who are in their fifties and sixties as well as I have two dichotomies. 52 00:04:50,685.193 --> 00:04:54,665.193 I see fifties and sixties, and then I see a lot of professional cyclists and runners. 53 00:04:54,665.193 --> 00:04:56,855.193 And a lot of my older cyclists as well, cycling is. 54 00:04:56,855.193 --> 00:05:04,850.193 Basically a non-weight bearing sport so we see a lot of older women who have been riding for forever, but also are having issues with bone density. 55 00:05:04,850.193 --> 00:05:20,840.193 And then we talk also about just how important strength is for longevity as well So all those things I just, as I see more people in my practice and I see the repercussions of social pressure to be thin and social pressure not to be bulky, God forbid. 56 00:05:20,990.193 --> 00:05:27,880.193 And, just making sure that we get the word out there as to how important strength is, especially for my women. 57 00:05:28,940.193 --> 00:05:30,110.193 you mentioned the nineties. 58 00:05:30,710.193 --> 00:05:38,690.193 It was in the nineties where the Women's Health Initiative came out and doctors and other practitioners stopped. 59 00:05:39,680.193 --> 00:05:42,50.193 Prescribing hormone replacement. 60 00:05:42,410.193 --> 00:05:53,440.193 So we now have a whole generation of women who were without estrogen replacement, and that definitely has affected their bone densities. 61 00:05:53,830.193 --> 00:05:55,840.193 So I think it's multiple. 62 00:05:56,255.193 --> 00:06:13,505.193 Factors plus as you were mentioning the cultural, the aesthetic part where women and it, and as unless women are taking steroids or they have some type of testosterone issue where, or they're getting, exogenous testosterone, they're not going to bulk up. 63 00:06:14,15.193 --> 00:06:15,305.193 They will not bulk up. 64 00:06:15,615.193 --> 00:06:19,815.193 So if you do strength training, yes, you will, obviously tone. 65 00:06:20,55.193 --> 00:06:22,605.193 More, but you will not bulk up. 66 00:06:22,655.193 --> 00:06:37,5.193 Many of your patients who have osteoporosis, what kind of regimen do you go through with them? To number, with osteoporosis, right? There's like a thinning of the bone, osteopenia, osteoporosis. 67 00:06:37,335.193 --> 00:06:45,585.193 So what kind of regimen do you go through them? Because that's like a number one question that patients ask when they're diagnosed with these conditions. 68 00:06:45,595.193 --> 00:06:53,895.193 what can they do, what exercises can they do? And I'm always surprised 'cause they don't often understand what weightbearing exercise means. 69 00:06:54,675.193 --> 00:06:59,795.193 When it comes to exactly how we treat osteopenia, osteoporosis, it's all about load. 70 00:07:00,45.193 --> 00:07:00,675.193 Tolerance. 71 00:07:00,675.193 --> 00:07:02,115.193 So typically there's a progression. 72 00:07:02,115.193 --> 00:07:06,485.193 So you're right in that when we say weight bearing, people are like, oh, a lot of my cyclists say this. 73 00:07:06,485.193 --> 00:07:07,145.193 Oh, I cycle. 74 00:07:07,145.193 --> 00:07:14,715.193 Yes, there is force, but there's not the actual ground reaction force of you hitting the ground that we need for actual bone density growth. 75 00:07:14,745.193 --> 00:07:18,555.193 And so what we typically start with is exactly that is. 76 00:07:18,570.193 --> 00:07:21,990.193 Teaching people how to load their skeleton appropriately. 77 00:07:22,320.193 --> 00:07:33,510.193 Typically that's in sagittal planes, so not a lot of rotation or a lot of lateral movement to start, but really making sure the skeleton can actually accept axial load or load from the, basically the top down. 78 00:07:33,850.193 --> 00:07:38,690.193 A lot of education also has to come with how much weight we need to lift as well. 79 00:07:38,900.193 --> 00:07:49,90.193 Most people are underdosing themselves when it comes to weight, and so we typically want, there's a big range, but for muscle hypertrophy, which is typically, first stage we go through muscle growth. 80 00:07:49,400.193 --> 00:07:54,200.193 We need to be doing somewhere around eight to 15 reps of something with three to five sets. 81 00:07:54,440.193 --> 00:08:02,930.193 And so I typically tend to try and get towards that lower end with a little bit higher weight 'cause it tends to be most productive for muscle growth. 82 00:08:03,320.193 --> 00:08:04,490.193 Most people. 83 00:08:04,490.193 --> 00:08:08,80.193 What we should be seeing is when you're getting to that end of that, set of reps. 84 00:08:08,80.193 --> 00:08:12,550.193 So let's say we're doing eight, that sixth, seventh, eighth rep should feel pretty darn hard. 85 00:08:12,580.193 --> 00:08:16,240.193 You should probably have to be slowing down to simply be able to create that force. 86 00:08:16,570.193 --> 00:08:22,240.193 So really a lot of times it comes down to teaching first what to do, and then appropriate dosage as well. 87 00:08:22,550.193 --> 00:08:23,870.193 From there, there needs to be a progression. 88 00:08:23,870.193 --> 00:08:30,850.193 So there needs to be a progression to if we can tolerate transverse motion now making sure some people who do have really involved. 89 00:08:30,880.193 --> 00:08:31,870.193 Osteoporosis. 90 00:08:32,20.193 --> 00:08:36,610.193 We don't necessarily wanna load a ton of transverse or lateral motion, but so it's patient appropriate. 91 00:08:36,610.193 --> 00:08:42,390.193 But working on teaching them how to move their spine in all directions because our spine takes force in all directions. 92 00:08:42,390.193 --> 00:08:47,460.193 A lot of times when these predominantly women have osteopenia, osteoporosis, I say, oh, don't bend down anymore. 93 00:08:47,460.193 --> 00:08:48,690.193 Don't flex your spine at all. 94 00:08:48,930.193 --> 00:08:52,880.193 And that's a pretty, unreasonable requests for people who have to tie their shoes. 95 00:08:52,930.193 --> 00:08:57,270.193 Making sure that the spine is still robust enough to be able to at least have some sort of force. 96 00:08:57,690.193 --> 00:09:08,30.193 And then there's some interesting research coming out too about velocity and how important velocity can be for bone health the last stage that I typically take my patients through is making sure we have some sort of velocity or speed driven movement. 97 00:09:08,310.193 --> 00:09:09,240.193 They found that. 98 00:09:09,310.193 --> 00:09:17,320.193 Speed, such as jumping, running or plyometrics can be even more beneficial and more productive when it comes to improving bone density. 99 00:09:18,795.193 --> 00:09:35,165.193 I think you know, this is all useful for my listeners to understand because again, there's so much confusion around weightbearing exercise and their regular cardio exercise and from gauging, it doesn't necessarily sound like. 100 00:09:35,585.193 --> 00:09:41,645.193 Most of my patients are getting that true weightbearing exercise that we desire. 101 00:09:41,975.193 --> 00:09:45,975.193 So a lot of people, as we were talking they're afraid of bulking up. 102 00:09:46,135.193 --> 00:09:48,295.193 They're afraid that they might look bigger. 103 00:09:48,525.193 --> 00:10:03,540.193 So how do you overcome that resistance with your women patients and try to convince them obviously you speak with them just as I do, but what do you say to them? That they realize that this is crucial or very important as they get older. 104 00:10:04,795.193 --> 00:10:05,635.193 Yeah, you're right. 105 00:10:05,635.193 --> 00:10:08,935.193 That is, a really cultural mindset that is hard to break through. 106 00:10:08,935.193 --> 00:10:10,315.193 And so it depends on the patient. 107 00:10:10,315.193 --> 00:10:13,765.193 Some of them I can speak to it because yes, you're right, we are gonna gain muscle mass. 108 00:10:13,765.193 --> 00:10:29,895.193 And the hardest part I think is not necessarily just the bulking up but women being unfortunately worried of seeing changes on the scale because muscle weighs more than fat Typically what I ask people too is when they come in and say, I gained, and always it's like I gained three pounds, nothing super substantial, but it can be. 109 00:10:29,895.193 --> 00:10:32,25.193 Emotionally speaking, three pounds can feel substantial. 110 00:10:32,25.193 --> 00:10:36,75.193 And typically my next question is, yeah, but do your pants feel better Typically the answer is yes. 111 00:10:36,285.193 --> 00:10:44,455.193 So the change in our body can result in feeling better in our clothes, even though the, numbers on the scale may look different. 112 00:10:44,935.193 --> 00:10:50,815.193 Secondly, as far as feeling bulky or seeming bulky we do have to have significant load in order for muscle hypertrophy. 113 00:10:51,85.193 --> 00:10:55,185.193 That is enough for there to be a aesthetic difference too. 114 00:10:55,695.193 --> 00:11:01,755.193 The other way sometimes I talk to patients about this is, people becoming more concerned about longevity and health. 115 00:11:02,115.193 --> 00:11:07,395.193 Speaking to people on the basis of health and how important strength is when it comes to longevity. 116 00:11:07,735.193 --> 00:11:11,475.193 Things like grip strength are a good marker of longevity. 117 00:11:11,475.193 --> 00:11:13,455.193 They found that people have better grip strength, live longer. 118 00:11:13,815.193 --> 00:11:18,105.193 The reason for that is not simply 'cause people are doing hand exercise, the reason is because they're picking up heavy things. 119 00:11:20,370.193 --> 00:11:23,760.193 The mortality rate for people with hip fractures increases exponentially. 120 00:11:23,760.193 --> 00:11:30,260.193 When we get to seventies, eighties, nineties it's something like 90% for 90 year olds that get hip fracture or have a hip fracture within one year. 121 00:11:30,530.193 --> 00:11:37,880.193 You have to be lifting three to four times a week in order to really increase and at a heavy enough dose to increase muscle mass substantially. 122 00:11:38,150.193 --> 00:11:46,900.193 We do increase power and actual strength prior to that too, but in order to really gain a lot of muscle bulk. 123 00:11:47,145.193 --> 00:11:49,635.193 You have to be working for it, which is great if some people do wanna do that. 124 00:11:49,635.193 --> 00:11:50,25.193 I love it. 125 00:11:50,215.193 --> 00:12:01,325.193 But I think also luckily the change in mentality has started to come in which people are thinking, oh, for longevity wise, oh, for strength wise this is really important. 126 00:12:01,375.193 --> 00:12:06,10.193 I and I recognize that and I think it may be a function of just me getting older as well. 127 00:12:06,10.193 --> 00:12:21,970.193 And hanging out with people who are now older as well, where, we're talking about preserving our muscle mass and being able to live a healthier life while whereas I remember when I was much younger, it was all about looking trim and. 128 00:12:22,640.193 --> 00:12:23,390.193 being fit. 129 00:12:23,870.193 --> 00:12:30,815.193 So yeah, it wasn't necessarily about overall longevity, at least, I don't remember at that time. 130 00:12:30,815.193 --> 00:12:33,155.193 But again, it could have just been a function of age. 131 00:12:33,495.193 --> 00:12:49,770.193 How do you gauge increases or even decreases in muscle mass in your patients? There are ways of gauging bone density, obviously, that practitioners use but how do you assess that the muscle mass is increasing appropriately. 132 00:12:50,565.193 --> 00:12:50,775.193 Yeah. 133 00:12:51,145.193 --> 00:12:53,205.193 Part of it is function basically. 134 00:12:53,205.193 --> 00:13:03,615.193 So for my older adults, and there are actually a lot of standardized tests for our 60 seventies or eighties year olds regarding norms for those age groups, for things like a sit to stand test. 135 00:13:03,615.193 --> 00:13:08,345.193 how many sit to stand, how many times can you rise from a chair without using your hands? In 10 seconds. 136 00:13:08,660.193 --> 00:13:14,150.193 There's a six minute walk test in which, how far can you travel in six minutes? So we can use some of those tests. 137 00:13:14,180.193 --> 00:13:19,670.193 Again, because there are standardized norms to gauge where people are as far as what their fitness should be like. 138 00:13:20,60.193 --> 00:13:30,600.193 For me, because I see more active adults, I typically look more at a and because I see people in PT mostly be, if they have some sort of pain what causes their pain and what does that cause some of their movements. 139 00:13:30,600.193 --> 00:13:31,200.193 To look like. 140 00:13:31,500.193 --> 00:13:50,220.193 So seeing how people do a squat or even a bridge or whatever it might be, that's a really good gauge for me to say, okay, what muscle groups may not be working as appropriately as we need them to, and what else do we need to make sure that they can do to increase that to the point where they're working here can match the function of what they need to be able to do. 141 00:13:50,220.193 --> 00:13:52,530.193 So things like, especially so my hikers. 142 00:13:52,675.193 --> 00:14:01,695.193 Step-ups are a really great example of like, how are they stepping up onto a higher surface for my cyclist a single leg squats A really good example of what they're doing. 143 00:14:01,695.193 --> 00:14:12,425.193 So a lot of it is how are they resisting the force of the ground or how are they performing? The movement can give me a really good idea on what their overall strength is, as well as what muscle groups need, the work individually. 144 00:14:14,195.193 --> 00:14:19,75.193 Are there ever any tests? 'cause I know that some people get these fat. 145 00:14:19,465.193 --> 00:14:20,875.193 Muscle. 146 00:14:20,905.193 --> 00:14:34,475.193 It's a, I think it's called like a one, one company that does it, is, I think it's called Body Site or any, something like that where it's like a machine where you step up and it just does a scan of your body to determine the ratios. 147 00:14:34,725.193 --> 00:14:39,410.193 Do you ever use anything like that in your office? I haven't used anything of that. 148 00:14:39,410.193 --> 00:14:42,820.193 I do have a colleague, a doctor in town who has something like that. 149 00:14:42,820.193 --> 00:14:45,790.193 So if I feel like that's appropriate, I can always refer them to them. 150 00:14:46,280.193 --> 00:14:55,20.193 I'm a little less concerned about necessarily body mass percentages as far as muscle versus fat and a little more about just how they use the muscles that they do have. 151 00:14:55,20.193 --> 00:14:57,420.193 But it is a nice parameter to have for sure. 152 00:14:57,720.193 --> 00:14:58,620.193 They do exist. 153 00:14:58,620.193 --> 00:15:02,100.193 I think it's become more available to Yep. 154 00:15:02,340.193 --> 00:15:03,120.193 To people. 155 00:15:03,400.193 --> 00:15:15,430.193 Especially I think you can get 'em done at the gyms, some of the fancier gyms, and it's a good way to gauge, but I tell people not to necessarily get too wrapped up with it. 156 00:15:15,465.193 --> 00:15:18,70.193 I think it's good that you focus more on. 157 00:15:18,340.193 --> 00:15:23,440.193 The function, right? Preserving function, and obviously even increasing function. 158 00:15:23,620.193 --> 00:15:29,270.193 And I think that's a better way of gauging improvement in muscle mass. 159 00:15:29,510.193 --> 00:15:37,620.193 I, you may know that I focus a lot on women who are in their midwives and part of that is menopause. 160 00:15:38,40.193 --> 00:15:53,960.193 So menopause, and we were talking a little bit about estrogen previously when it comes to removal of the ovaries, but with menopause, as and the listeners know that there is a gradual decline in reproductive hormones such as estrogen. 161 00:15:54,500.193 --> 00:15:58,500.193 And you can even see that with testosterone as well during menopause. 162 00:15:58,770.193 --> 00:15:58,830.193 Yeah. 163 00:15:59,130.193 --> 00:16:16,800.193 Do women in their menopausal years seek you out to help them with their health at this stage? Do you find that more often than, let's say maybe five years ago? Yeah, I would say there's definitely a lot more awareness of menopause and just what a huge health impact it is. 164 00:16:17,110.193 --> 00:16:25,160.193 I don't think women necessarily seek me out for that, but I do field a lot of questions from it because what we see a lot of times is, decreases in strength. 165 00:16:25,160.193 --> 00:16:33,410.193 And so I'll have women come in and be like, hey, I'm really having a hard time with maintaining my, lifts at the gym and I've got brain fog and I'm not sleeping very well. 166 00:16:33,410.193 --> 00:16:37,880.193 And all these things affect how our body feels and how we are able to generate force. 167 00:16:37,880.193 --> 00:16:45,840.193 And so a lot of times it's about talking about all of those other extraneous symptoms Feel musculoskeletal related, but impact the musculoskeletal system. 168 00:16:46,170.193 --> 00:16:57,370.193 And so one of the things I talk a lot to my women about, and even actually starting in our thirties again, if we talk about menopause and how we can at least from, a me musculoskeletal perspective, try and mitigate some of the symptoms of that. 169 00:16:57,680.193 --> 00:17:06,130.193 This is why strength training becomes so important before we hit menopause two, because the more muscle mass we have prior to the easier it is for us to. 170 00:17:06,465.193 --> 00:17:13,575.193 I shouldn't say easier, but it gives us a step up for maintaining some of that as we start to go through a lot of these symptoms and we see all these drops in hormones. 171 00:17:13,575.193 --> 00:17:17,15.193 'cause you're right, testosterone's also one of the ones that start to drop for us too. 172 00:17:17,105.193 --> 00:17:24,505.193 So the big thing is making sure that I do, and I have a lot of great practitioners here that also treat a lot of women with menopause too. 173 00:17:24,505.193 --> 00:17:35,945.193 having that network of being able to make sure I can, when I see something, especially for women that maybe are appropriate for hormone replacement but don't have anything or are really not sure where to go next or how to manage symptoms. 174 00:17:35,995.193 --> 00:17:45,565.193 I have a lot of providers that I can refer to as well, so we can make sure that we're looking at it from a holistic, comprehensive point of view and not just necessarily from more of a musculoskeletal point of view. 175 00:17:46,495.193 --> 00:17:47,785.193 So tell me about your practice. 176 00:17:47,785.193 --> 00:17:53,995.193 Do you work with other physical therapists or do you work within a multi-specialty group? Yep. 177 00:17:53,995.193 --> 00:17:55,45.193 So it's just me right now. 178 00:17:55,45.193 --> 00:17:56,185.193 So I've been in business. 179 00:17:56,590.193 --> 00:17:57,520.193 Three years now. 180 00:17:57,550.193 --> 00:17:58,690.193 Time flies when you're having fun. 181 00:17:58,940.193 --> 00:18:00,440.193 And I'm sure you've seen this as well too. 182 00:18:00,440.193 --> 00:18:03,20.193 I opened my practice so that I could treat the way I wanted to treat. 183 00:18:03,20.193 --> 00:18:11,190.193 We see that a lot of people's experience with physical therapy is going to what we call the PT mills, the ones with a ton of practitioners, and they see it for 20 minutes and they move on. 184 00:18:11,490.193 --> 00:18:15,510.193 And we found that people don't necessarily get the best results from that either. 185 00:18:15,510.193 --> 00:18:24,400.193 And so my goal was to really make sure that I could have treat patients one-to-one for an entire hour for as long as they need, and really make sure that we can dive into some of these root causes. 186 00:18:24,400.193 --> 00:18:28,630.193 Because it turns out solving 30 years of back pain in 15 minutes is a pretty tough ask. 187 00:18:28,630.193 --> 00:18:38,410.193 Allows me the time to talk to my patients about menopause symptoms and other things that might be going on with their lives and all the other factors that are contributing to why they might be landing in my office because they have some sort of pain. 188 00:18:39,580.193 --> 00:18:52,640.193 What other factors, we've touched a lot on menopause, but what other, conditions do you see that lead to lower back pain and, just deterioration in general? Yeah. 189 00:18:52,640.193 --> 00:19:00,500.193 Interestingly enough, if we talk about, again, from other aspects that contribute to when I see people with pain, with low back pain or whatever, they're not dissimilar. 190 00:19:00,500.193 --> 00:19:02,570.193 A lot of the things we see an increase in menopause. 191 00:19:02,570.193 --> 00:19:04,40.193 Stress is a huge one. 192 00:19:04,40.193 --> 00:19:06,470.193 Stress can really honestly increase pain symptoms. 193 00:19:06,520.193 --> 00:19:11,360.193 Because our body how I tell people is our body only has so many matches to burn a day. 194 00:19:11,360.193 --> 00:19:17,890.193 And so if some of those batches are going to stress, we have less for our body to actually burn, to treat pain or void. 195 00:19:17,940.193 --> 00:19:19,380.193 Pain or ignore their pain. 196 00:19:19,590.193 --> 00:19:24,870.193 And sometimes those inflammatory signals or those nervous system signals will actually elevate when we're in pain. 197 00:19:25,180.193 --> 00:19:26,380.193 Sleep's another big one. 198 00:19:26,380.193 --> 00:19:29,230.193 More and more research shows just how important sleep is for our body. 199 00:19:29,230.193 --> 00:19:30,310.193 For recovery too. 200 00:19:30,610.193 --> 00:19:34,370.193 When we lack sleep there's research that shows that less sleep will actually put. 201 00:19:34,385.193 --> 00:19:36,995.193 Athletes at a significantly higher risk for injury. 202 00:19:36,995.193 --> 00:19:39,635.193 So our muscles and our body really need sleep as well. 203 00:19:39,965.193 --> 00:19:41,135.193 Nutrition's another one. 204 00:19:41,135.193 --> 00:19:53,325.193 Making sure that we aren't taking in a bunch of stuff that may be more harmful to the body and whether that is alcohol or lots of sugar or just things that maybe our body doesn't love quite as much that can really affect pain as well. 205 00:19:53,575.193 --> 00:19:56,455.193 Emotions and just social obligations too. 206 00:19:56,455.193 --> 00:20:01,765.193 I see a lot of, unfortunately, with these mothers who are busy taking care of their kids and having to get the family in order. 207 00:20:01,765.193 --> 00:20:05,295.193 And still are responsible for a lot of the in-house responsibilities. 208 00:20:05,295.193 --> 00:20:13,725.193 And so it doesn't leave 'em a lot of time to be able to a, simply exercise to keep themselves moving, and b, if they do have pain, get their PT in as well. 209 00:20:13,975.193 --> 00:20:23,515.193 And so a lot of what I do too is making sure that we address all of those psychosocial factors as well, because they all have significant implications when it comes to pain. 210 00:20:25,365.193 --> 00:20:29,745.193 You also have patients who are retired. 211 00:20:29,775.193 --> 00:20:30,495.193 Yes. 212 00:20:30,545.193 --> 00:20:44,355.193 And so what do you frequently see amongst this population in terms of injuries and what do you focus on to help them? I see a lot of low back pain, which is pretty common as we get older. 213 00:20:44,485.193 --> 00:20:49,345.193 Our spine's done a lot of work for us by the time we hit 65, and I see a lot of that. 214 00:20:49,345.193 --> 00:20:53,245.193 a lot of times my progression for people is I'm lucky in that. 215 00:20:53,270.193 --> 00:20:55,730.193 Where I live in Prescott actually is a fairly big retirement community. 216 00:20:55,730.193 --> 00:20:59,660.193 We have a lot of retirees and then we have a lot of active cyclists and ultra runners actually. 217 00:20:59,660.193 --> 00:21:01,100.193 I'm lucky that I get to see both. 218 00:21:01,100.193 --> 00:21:09,740.193 And so the other lucky part about that is a lot of my retirees, this is a very out big outdoor community, so a lot of them are hikers or cyclists, so they are still active. 219 00:21:09,740.193 --> 00:21:17,10.193 So it's a little bit of a, departure from, unfortunately some of the more common aging population, but we still see a lot of the same pain points. 220 00:21:17,10.193 --> 00:21:20,335.193 So again, low back pain, neck pain's, also really impor I see a lot of that. 221 00:21:20,695.193 --> 00:21:24,745.193 But with the low back pain typically what I do is I take people through a progression. 222 00:21:24,745.193 --> 00:21:29,65.193 So I always explain it to my patients, like I have four phases of physical therapy. 223 00:21:29,675.193 --> 00:21:34,385.193 Typically what happens over time is our body will always choose the path of least resistance for most things. 224 00:21:34,655.193 --> 00:21:41,815.193 And so it gets really good at using our bigger muscles, our quads, our hamstrings, our especially our paraspinals and our low backs, the big low back muscles. 225 00:21:42,185.193 --> 00:21:46,145.193 My hunters call 'em the backstrap muscles, and we tend to overuse those over time. 226 00:21:46,175.193 --> 00:21:48,995.193 And what happens is our body goes, oh, I can just use these for everything. 227 00:21:49,265.193 --> 00:21:51,425.193 I don't need to use those small stabilizing muscles. 228 00:21:51,785.193 --> 00:21:57,905.193 So what I've seen a lot of my patients is that over time we've stopped using the smaller muscles that help stabilize the spine and the hips more. 229 00:21:58,235.193 --> 00:22:01,385.193 Those muscles rotate us, and as we get older, we rotate less. 230 00:22:01,385.193 --> 00:22:05,465.193 We're not playing on the playground, we're not playing sports, and so we tend to use them less. 231 00:22:05,825.193 --> 00:22:12,515.193 So a lot of times where we have to start is figuring out how to get some of those muscles to work in conjunction with some of the bigger muscles. 232 00:22:13,0.193 --> 00:22:18,100.193 Second step from that actually is then coordinating once we get those isolated muscles to work a little better for us. 233 00:22:18,100.193 --> 00:22:20,410.193 And then from there we have to strengthen into those patterns. 234 00:22:20,410.193 --> 00:22:21,880.193 A lot of it comes down to muscle memory. 235 00:22:21,880.193 --> 00:22:25,720.193 the stronger we are, the more the body can remember the patterns it needs to use. 236 00:22:26,60.193 --> 00:22:28,340.193 And then the fourth step there is what I call performance. 237 00:22:28,340.193 --> 00:22:29,300.193 So endurance. 238 00:22:29,315.193 --> 00:22:36,135.193 Velocity, making sure my patients can get back to hiking the hikes they wanna do ride the rides they wanna do, making sure they're back to full strength. 239 00:22:37,555.193 --> 00:22:50,335.193 I didn't realize that, it's those muscles that I guess it sounds like they take over and then the rotator kind of muscles, the small ones, smaller ones, at least we're not utilizing them as well. 240 00:22:50,545.193 --> 00:22:53,615.193 And so that effects are. 241 00:22:54,90.193 --> 00:22:58,410.193 Ability to move, obviously, and have that flexibility. 242 00:22:58,740.193 --> 00:23:09,780.193 And as we all get older there's a level of stiffness that happens and for those of us who are not as active, I guess it's more pronounced. 243 00:23:09,840.193 --> 00:23:10,965.193 Is that correct? Okay. 244 00:23:10,965.193 --> 00:23:11,485.193 That is correct. 245 00:23:11,560.193 --> 00:23:13,300.193 tightness is a symptom, not a cause. 246 00:23:13,660.193 --> 00:23:17,20.193 Something is tight because something else is not working appropriately, typically. 247 00:23:17,20.193 --> 00:23:18,820.193 our body's really good at moving us forward no matter what. 248 00:23:18,820.193 --> 00:23:21,520.193 We're all still standing up and walking for the most part, or still moving. 249 00:23:21,880.193 --> 00:23:24,790.193 And so what happens is we figure out some. 250 00:23:25,180.193 --> 00:23:27,640.193 I don't particularly love this word, but compensatory patterns. 251 00:23:27,640.193 --> 00:23:29,110.193 So we figure out other ways to move. 252 00:23:29,110.193 --> 00:23:33,160.193 And what happens though is our body eventually goes, this is not the most efficient way for me to do this. 253 00:23:33,160.193 --> 00:23:37,840.193 And so it'll tighten up other muscles in the attempt to try and keep getting us moving in the same way. 254 00:23:37,840.193 --> 00:23:42,375.193 A lot of times that's where that stiffness or tightness or like the, people will come to me like I'm stretching my hamstrings forever. 255 00:23:42,520.193 --> 00:23:44,380.193 They always feel good for a little bit and then they get tired. 256 00:23:44,775.193 --> 00:23:48,255.193 Typically hamstrings may be tight because of something that's going on in the low back. 257 00:23:48,255.193 --> 00:23:52,335.193 And so until we change how those muscles are working, the hamstrings are continue to be tight for you. 258 00:23:52,385.193 --> 00:23:56,635.193 And then if we just don't change those patterns and we are less mobile we have no ability to change them. 259 00:23:56,635.193 --> 00:24:07,430.193 How do you get most of your referrals? Is it through doctors? Is it through patients who are referring themselves to you? Yeah, it's almost all actually word of mouth from other patients. 260 00:24:07,430.193 --> 00:24:13,640.193 I do have a couple of doctors that do refer to me and vice versa, but mostly it is actually just other patients spreading the word. 261 00:24:14,420.193 --> 00:24:14,960.193 Awesome. 262 00:24:15,440.193 --> 00:24:23,490.193 And the three years that you've been in practice for, do you take insurance or are you a cash based practice? I am an out of network practice. 263 00:24:23,490.193 --> 00:24:23,520.193 Okay. 264 00:24:23,520.193 --> 00:24:25,350.193 Which means that I don't bill insurance directly. 265 00:24:25,350.193 --> 00:24:31,775.193 So I do what patients typically do is they do something called super bills, which is I can give them the coding, the insurance needs. 266 00:24:31,805.193 --> 00:24:34,645.193 And then they can get reimbursed for it if they have out of network benefits. 267 00:24:34,645.193 --> 00:24:39,815.193 That allows me to, and I'm sure you feel the same way, in that if we take insurance gets to dictate how we treat. 268 00:24:39,815.193 --> 00:24:41,135.193 And what I found is. 269 00:24:41,485.193 --> 00:24:44,35.193 Insurance is not really interested in people getting better. 270 00:24:44,35.193 --> 00:24:46,985.193 They don't really care, what the clinical reasoning is behind it. 271 00:24:46,985.193 --> 00:24:54,65.193 And so again, when I started my practice, my goal was to make sure that I could treat in a way that actually made people get better instead of just taking their copay. 272 00:24:55,85.193 --> 00:25:03,715.193 So you shared a lot of information with us about osteoporosis and increasing muscle mass and increasing or improving flexibility. 273 00:25:03,955.193 --> 00:25:10,215.193 give us some success stories of patients that you've treated with each group of people that we've talked about. 274 00:25:10,215.193 --> 00:25:23,595.193 We've talked about endurance athletes, we've talked about women who have osteoporosis, but if you can give us some examples, I think my listeners will have an easier idea of understanding how this might benefit them. 275 00:25:24,705.193 --> 00:25:32,395.193 Yeah, so if we start with some of my endurance athletes I have a professional cyclist right now actually that she came in with low back and neck pain. 276 00:25:32,395.193 --> 00:25:37,995.193 And so the cool thing that I always tell people too, When we fix their pain, we typically improve their performance as well. 277 00:25:37,995.193 --> 00:25:45,255.193 So like with cycling, a lot of people have what's called a power meter, so it shows how much their right foot's putting in versus how much their left foot's putting in. 278 00:25:45,645.193 --> 00:25:49,405.193 And for her she had a really significant power discrepancy between right and left foot. 279 00:25:49,735.193 --> 00:25:52,675.193 And so what that does is it creates fatigue on one side. 280 00:25:52,675.193 --> 00:25:53,575.193 They can create back pain. 281 00:25:53,575.193 --> 00:25:54,85.193 It also. 282 00:25:54,375.193 --> 00:25:56,565.193 SAPs your power on the bike and makes you less efficient. 283 00:25:56,565.193 --> 00:26:02,55.193 Once we fixed her back pain and neck pain, what we also saw was her power evened out to 50 50. 284 00:26:02,55.193 --> 00:26:07,425.193 And so now she's able to be more efficient and more powerful on the bike, on top of not having to deal with pain. 285 00:26:07,425.193 --> 00:26:10,335.193 So that's cool when we see these performance changes that really help with people too. 286 00:26:10,405.193 --> 00:26:14,400.193 And then I have another patient who came, she's 60, I think she's 65. 287 00:26:14,845.193 --> 00:26:20,285.193 And so she's always been active her whole life, but in the last couple years, less and she was having knee pain. 288 00:26:20,285.193 --> 00:26:23,645.193 And the other thing that happens a lot with my patients, they go into the doctor, they get an x-ray. 289 00:26:23,895.193 --> 00:26:25,725.193 The doctor says, oh, it's bone on bone. 290 00:26:26,55.193 --> 00:26:27,525.193 And so that's exactly what they told her. 291 00:26:27,525.193 --> 00:26:29,235.193 And she said I don't want a total knee. 292 00:26:29,235.193 --> 00:26:31,5.193 I still wanna try and see if I can hike. 293 00:26:31,5.193 --> 00:26:42,475.193 And she went from not being able to hike at all to now she's planning on going to the Grand Canyon because what we do is, again, we change how the muscles are affecting the joints and we're able to support the body. 294 00:26:42,475.193 --> 00:26:47,455.193 So even though, maybe her x-ray doesn't look a hundred percent, but again, she's 65, your X-rays not gonna. 295 00:26:49,705.193 --> 00:26:55,15.193 When we change how you move, we change what you feel and we're able to get you back to doing the things you love. 296 00:26:55,15.193 --> 00:26:56,995.193 So that's always a really fun story for me too. 297 00:26:56,995.193 --> 00:26:59,155.193 And then she came in one time, she's I signed up to go to the Grand Canyon. 298 00:26:59,205.193 --> 00:27:21,250.193 Are there any cool apps that you recommend to patients or even other tools or anything that they can use to help them track themselves? And how do you see AI potentially helping patients with physical therapy? And do you use anything like that in your practice right now? I. 299 00:27:21,805.193 --> 00:27:25,945.193 Great I don't currently, and I'm trying to think of, I don't utilize a lot of apps either. 300 00:27:25,945.193 --> 00:27:28,945.193 I know there are a lot of apps out there as far as like accountability goes. 301 00:27:28,945.193 --> 00:27:33,55.193 I'm sure you see this too, right? Like lifestyle changes require accountability and sometimes that's hard. 302 00:27:33,55.193 --> 00:27:35,305.193 we like to gamify stuff, so we like to track things. 303 00:27:35,355.193 --> 00:27:42,615.193 I don't off the top of my head though, necessarily know any apps that are helpful with that, and that's a great question that I probably should be able to have some ideas on. 304 00:27:42,645.193 --> 00:27:45,505.193 But as far as AI goes, I haven't used a lot. 305 00:27:45,505.193 --> 00:27:47,335.193 I don't know what use for an EMR, but I use Jane. 306 00:27:47,665.193 --> 00:27:50,935.193 They just recently came out with a talk to text. 307 00:27:51,45.193 --> 00:28:00,455.193 Ability to have your notes basically populated with you talking instead of having to type it out because we all know that, notes and charting are the bane of any practitioner's existence. 308 00:28:00,505.193 --> 00:28:07,695.193 I haven't used it yet, but I've heard some good reports on that to be able to, at least cut down some of your time on charting. 309 00:28:07,725.193 --> 00:28:13,755.193 'cause I know that takes a significant amount of time for us and SAPs our energy to be used towards our patients too. 310 00:28:13,785.193 --> 00:28:20,165.193 But as far as AI is concerned with physical therapy I think all of us practitioners, to be honest, I think we all have. 311 00:28:20,165.193 --> 00:28:20,225.193 I. 312 00:28:20,600.193 --> 00:28:24,920.193 And I think rightly we have some hubris that says there's no way anyone, any computer could do our job. 313 00:28:25,160.193 --> 00:28:39,20.193 But I am sure there are honestly probably some technological advances that could be helpful for people, especially when it comes to possibly helping with accountability or, helping with describing pathologies to patients in a way that might be able to help them more. 314 00:28:39,20.193 --> 00:28:41,730.193 I'm, the future's out there and it's gonna go no matter what. 315 00:28:41,730.193 --> 00:28:44,995.193 It'll be interesting to see what will be helpful and what won't. 316 00:28:45,415.193 --> 00:28:58,645.193 And I think it's gonna come down to us sifting and winnowing through a lot of information to make sure AI and its evolution, continues to be helpful for our patients and not, taking everything from the internet and summarizing it into something that may or may not be super helpful. 317 00:29:01,40.193 --> 00:29:07,700.193 I think, as it is now, a lot of my patients wear the AA rings, to help them track their sleep. 318 00:29:07,700.193 --> 00:29:10,140.193 And I think it tracks a lot of things. 319 00:29:10,140.193 --> 00:29:13,500.193 I don't necessarily know if there's anything that corresponds. 320 00:29:13,765.193 --> 00:29:22,205.193 To the physical therapy world in my, I think it tracks your exercise, your fitness, right? All sorts of other things. 321 00:29:22,475.193 --> 00:29:27,965.193 But I think more and more people are getting interested in those kind of things. 322 00:29:28,180.193 --> 00:29:30,940.193 I think it does help in a certain way. 323 00:29:31,270.193 --> 00:29:49,520.193 The end result though is is there, because I think you might be getting a demographic who's already into fitness and tracking and and obviously not everyone can afford those kind of things So it'll be interesting to see how that also evolves. 324 00:29:49,520.193 --> 00:29:51,670.193 So health tech is also a big sector. 325 00:29:51,700.193 --> 00:29:54,660.193 I think That may affect, our worlds as well. 326 00:29:54,660.193 --> 00:29:54,720.193 Yeah. 327 00:29:55,170.193 --> 00:30:07,485.193 So where do you see, like what exciting developments do you see in the future of strength training, especially when it comes to women? what do you hope for as well? And just real quick, I could address something else you just said there too. 328 00:30:09,445.193 --> 00:30:09,985.193 Parameters. 329 00:30:09,985.193 --> 00:30:12,955.193 'cause you're right, those AA rings are great and they give people a lot of data. 330 00:30:12,955.193 --> 00:30:17,545.193 But I think part of what our job is as practitioners too, is the interpretation of that data. 331 00:30:17,605.193 --> 00:30:21,735.193 A good example of that is I have a master's runner who's in his late seventies Crushing it. 332 00:30:21,735.193 --> 00:30:27,345.193 But he has, a smartwatch that can track all sorts of stuff, even his VO two max and his heart rate and everything. 333 00:30:27,645.193 --> 00:30:29,715.193 And so he came in and actually showed me all the data. 334 00:30:29,715.193 --> 00:30:36,340.193 He was like, Hey my times aren't changing at all for my 5K but my VO two max keeps going up. 335 00:30:36,340.193 --> 00:30:37,650.193 And concerned about his time's. 336 00:30:37,650.193 --> 00:30:44,910.193 Not necessarily changing in the short term, but what we saw is, okay, so you're actually keeping, 'cause research shows we may get a little slower as we get older. 337 00:30:44,910.193 --> 00:30:52,740.193 Not always, but if your VO two max can actually increase, we know you're getting fitter because that is something that traditionally will decline over time. 338 00:30:52,740.193 --> 00:30:59,220.193 So again, being able to spot those differences and inter interpret that data, I think is something that can be super helpful for patients too. 339 00:30:59,220.193 --> 00:31:02,850.193 'cause sometimes numbers are just numbers until we understand what that context. 340 00:31:02,860.193 --> 00:31:15,670.193 But in response to your current question about kinda what is coming down the pipeline, I think the tide is turning with in response to what, how women perceive strength and how they perceive the benefits of it and how they perceive the importance of strength training. 341 00:31:15,670.193 --> 00:31:19,660.193 So I see more women coming in saying, Hey, I want to gain muscle mass. 342 00:31:19,660.193 --> 00:31:21,310.193 I want to make sure that I am strong. 343 00:31:21,580.193 --> 00:31:33,240.193 And again, I think with a higher emphasis or attention paid to longevity these days too, with Peter Atia and all the stuff that we have out there, I think a lot of people really are, and a lot of women are switching their minds. 344 00:31:33,610.193 --> 00:31:36,100.193 Hey, I need to be in this for the long haul. 345 00:31:36,400.193 --> 00:31:42,250.193 I think some of my women, they're getting into their fifties and sixties and they're getting their DEXA scans back and they're saying, woo, there's a problem here. 346 00:31:42,550.193 --> 00:31:54,455.193 And those women are saying, Hey, what can I do now to prevent further degradation or problems with bone density? And then I have my women in my thirties and forties Especially the demographic that's saying, Hey, I want more muscle mass. 347 00:31:54,455.193 --> 00:31:57,665.193 And not oh, I wanna get toned, but Hey, I wanna be stronger here. 348 00:31:57,995.193 --> 00:32:00,665.193 They're even seeing things like, Hey, when I pick up my kids, it seems hard. 349 00:32:00,665.193 --> 00:32:02,525.193 It feels like I shouldn't see this seem this hard. 350 00:32:02,575.193 --> 00:32:05,515.193 Or Hey, I want my kids to see me exercising, but if. 351 00:32:05,615.193 --> 00:32:07,145.193 I can't run 'cause it hurts. 352 00:32:07,145.193 --> 00:32:15,115.193 What am I gonna do about that? So I think really the cultural shift is the biggest thing I've seen, which is just it's really fascinating. 353 00:32:15,115.193 --> 00:32:17,15.193 It's really encouraging to see. 354 00:32:17,45.193 --> 00:32:25,265.193 'cause again, we talk about just how much the culture was not like that for so long and how it's ingrained in most of us to be smaller, be fitter. 355 00:32:25,595.193 --> 00:32:36,295.193 So I think the change of the mentality of coming at it from a health perspective has been huge, and I can't attribute that other than for the longevity just becoming more on the forefront. 356 00:32:36,595.193 --> 00:32:39,25.193 I can't attribute that to any one thing, but I'm thrilled to see it. 357 00:32:40,60.193 --> 00:32:41,170.193 Yes, I am too. 358 00:32:41,170.193 --> 00:33:08,920.193 And I'm glad that, we are shifting away from just, the aesthetic point where, it's not just about how we look and obviously it's like if you wanna call it inner beauty, right? How fit we are and how we're able to function, especially as we get older and for women, we go through major transitions all through our life, so the ability to adapt to that is crucial in order to stay healthy. 359 00:33:09,610.193 --> 00:33:14,510.193 I've asked you, I've thrown a lot of different questions at you, I love it. 360 00:33:14,610.193 --> 00:33:25,245.193 Are there any topics that you'd like to talk about or anything that you are interested in that I haven't asked you about that we can include in this podcast? That's a great question. 361 00:33:25,245.193 --> 00:33:29,85.193 I do see all populations, but as a female myself, I think I'm protective of my women. 362 00:33:29,85.193 --> 00:33:32,270.193 I think that we do have a very different, we have other needs. 363 00:33:32,270.193 --> 00:33:33,470.193 I think that's important. 364 00:33:33,470.193 --> 00:33:42,260.193 And I think one of the things I also see that I think might be important to point out to the female population is the unfortunately the kind of brushing off of female symptoms as well. 365 00:33:42,260.193 --> 00:33:47,870.193 So I see a lot of patients who have had pain for a long time and I'm typically not their first stop. 366 00:33:47,870.193 --> 00:33:50,210.193 I'm typically someone they see later down the line. 367 00:33:50,210.193 --> 00:33:53,110.193 So I've seen a lot of patients who come to me and they were like my doc said. 368 00:33:53,305.193 --> 00:33:56,395.193 That nothing was really all that wrong with me, but I've been having this pain forever. 369 00:33:56,395.193 --> 00:34:00,685.193 Or my doc said my tests were fine and my x-ray looked good, but everything really hurts. 370 00:34:00,685.193 --> 00:34:03,945.193 And or they went to another PT and their PT said, ah, you're just not strong. 371 00:34:03,945.193 --> 00:34:07,35.193 And, maybe that's part of it, but it's typically not the whole story. 372 00:34:07,35.193 --> 00:34:15,405.193 A lot of women I see come to me after they've gone several other places and been told that their pain can't be changed or it can't be helped or whatever it might be. 373 00:34:15,405.193 --> 00:34:16,695.193 I had a patient yesterday actually that. 374 00:34:17,155.193 --> 00:34:19,525.193 Her x-ray, you can see her pelvis is rotated. 375 00:34:19,525.193 --> 00:34:22,705.193 And typically that'll happen if some muscles are pulling unevenly on your pelvis. 376 00:34:22,705.193 --> 00:34:25,45.193 And she's been told by several practitioners, oh, that can't change. 377 00:34:25,45.193 --> 00:34:25,975.193 That's just the way you are. 378 00:34:26,305.193 --> 00:34:30,185.193 And so then these thoughts get in your head of I'm unchangeable, I'm unfixable. 379 00:34:30,425.193 --> 00:34:32,255.193 And so we hear that a lot of I can't get, I. 380 00:34:32,255.193 --> 00:34:39,570.193 Fixed because this doctor told me and and really what we can do is change the tension on those muscles to change what your pelvis may or may not look like. 381 00:34:39,570.193 --> 00:34:48,480.193 Some, things with like scoliosis, yes, we may not change the position of your pelvis, but if we just have a muscle imbalance, a lot of times we can change where your pelvis sit to the space basically. 382 00:34:48,480.193 --> 00:34:53,390.193 And small things like that are really important I think, to make sure we dedicate our patients on. 383 00:34:53,390.193 --> 00:34:55,880.193 There are things we can do to change the things that are bothering you. 384 00:34:55,880.193 --> 00:35:06,350.193 There are things we can do to address what you might be feeling and what I always tell my patients, and I'm sure you're the same way as, even if I don't know why we're gonna figure it out, The answer is, okay, so this wasn't the right thing. 385 00:35:06,560.193 --> 00:35:08,600.193 Let's figure out why you're feeling the way you're feeling. 386 00:35:08,600.193 --> 00:35:09,920.193 And I think that's an important part about this. 387 00:35:09,970.193 --> 00:35:15,640.193 And I know this is not exclusive just to women, but I tend to see a lot of this in my female population. 388 00:35:16,480.193 --> 00:35:18,100.193 I do too, unfortunately. 389 00:35:18,155.193 --> 00:35:19,685.193 It's almost on a daily basis. 390 00:35:19,835.193 --> 00:35:30,415.193 And not to say I'm that perfect doctor that has always been able to figure things out and that everyone comes to me at times I can be, but there are times when I can't figure it out. 391 00:35:30,755.193 --> 00:35:35,345.193 I do see more women than men with this. 392 00:35:35,345.193 --> 00:35:38,465.193 but again, as you said, this can happen to men as well. 393 00:35:38,545.193 --> 00:35:41,915.193 But I think it's more frequent in women, to be honest with you. 394 00:35:41,980.193 --> 00:35:42,280.193 Yeah. 395 00:35:42,460.193 --> 00:35:44,380.193 And sometimes the answer isn't I can fix you. 396 00:35:44,380.193 --> 00:35:46,450.193 The answer is knowing who to refer to as well. 397 00:35:46,450.193 --> 00:35:46,540.193 Yes. 398 00:35:46,600.193 --> 00:35:52,260.193 But making sure though, that it's, Hey, I'm gonna communicate with this next practitioner and tell him what I'm finding so we can figure it out. 399 00:35:52,270.193 --> 00:35:57,190.193 I'm just gonna send you to someone else, and that's why I think it's important too, and why I'm thrilled to be able to talk to you. 400 00:35:57,190.193 --> 00:36:01,330.193 'cause you'd think our world may or may not overlap that much, but really it's important to have a really good. 401 00:36:01,370.193 --> 00:36:09,420.193 A robust network of being able to call on the people you need to make sure that you can find the resources you need for that patient. 402 00:36:09,420.193 --> 00:36:12,220.193 And I think that's healthcare's a little too siloed, I think. 403 00:36:12,220.193 --> 00:36:20,590.193 And our ability to reach across lines and make sure that we can do the best for our patients, is something that's super important and can sometimes get lost in the shuffle. 404 00:36:21,315.193 --> 00:36:23,745.193 Maybe AI can help us with that in the future. 405 00:36:23,865.193 --> 00:36:28,215.193 Where Yeah, it could, there might be something where it says, no, Dr. 406 00:36:28,215.193 --> 00:36:35,885.193 Mandel, you need to still think about sending this patient to physical therapy and maybe a physiatrist and, yeah. 407 00:36:37,390.193 --> 00:36:42,310.193 because you know how we get, sometimes we get so myopic too about like how we're gonna fix the problem. 408 00:36:42,500.193 --> 00:36:44,870.193 maybe we need a computer to be like, Hey, here's some other options. 409 00:36:47,700.193 --> 00:36:51,885.193 I know we're joking about it, but I honestly foresee that happening, yeah. 410 00:36:51,905.193 --> 00:36:58,560.193 And at least if you can, I don't know about new Jersey's bigger than some of the, I'm in actually more of a, not rural Arizona, but I'm not in Phoenix. 411 00:36:58,780.193 --> 00:37:05,900.193 having the ability to find other practitioners, a lot of times I do have to refer down to Phoenix, and sometimes it's the of having too many options. 412 00:37:05,900.193 --> 00:37:06,680.193 Then down there. 413 00:37:08,850.193 --> 00:37:12,600.193 I think healthcare right now it's in a fragile state. 414 00:37:12,660.193 --> 00:37:15,720.193 There's a lot happening all at the same time. 415 00:37:15,720.193 --> 00:37:16,890.193 Covid did not help. 416 00:37:16,890.193 --> 00:37:24,620.193 I think we're still reeling from, whatever Covid did to all of us and the healthcare system. 417 00:37:24,620.193 --> 00:37:27,470.193 I don't think Covid in that way is over. 418 00:37:27,520.193 --> 00:37:33,390.193 It opened certain doors not in a good way where, you know. 419 00:37:33,440.193 --> 00:37:39,120.193 It was already in a very tenuous state, like for example, mental health and other things. 420 00:37:39,120.193 --> 00:37:39,540.193 And it. 421 00:37:39,855.193 --> 00:37:45,55.193 Basically really showed us, where the deficiencies are. 422 00:37:45,415.193 --> 00:37:48,805.193 So it'll be interesting to see for those of us who stick it out. 423 00:37:52,25.193 --> 00:37:53,15.193 You make an interesting point about that. 424 00:37:53,75.193 --> 00:37:53,585.193 'cause you're right. 425 00:37:53,585.193 --> 00:37:59,135.193 It really kinda unveiled some of the shortfalls that we have of the people that get slipped through the cracks. 426 00:37:59,185.193 --> 00:38:07,25.193 The one interesting thing that happened in my profession with Covid was the evolution of online pt because we were a essential service. 427 00:38:07,25.193 --> 00:38:10,775.193 So we were always open, but a lot of patients weren't comfortable coming in to see us. 428 00:38:10,775.193 --> 00:38:25,265.193 So at the time, I was working at another place with another practitioner, so we did pivot to online pt and at the time I was like, is this actually gonna work? I'm not sure about this, but I actually, I really love doing virtual PT now because the clinical reasoning doesn't change. 429 00:38:25,475.193 --> 00:38:27,245.193 The problem solving doesn't change. 430 00:38:27,425.193 --> 00:38:31,595.193 You get to see the people in their environment, which sometimes can actually be very helpful. 431 00:38:31,895.193 --> 00:38:36,995.193 And so it allowed us to reach more people especially people that were in more rural areas. 432 00:38:37,55.193 --> 00:38:45,185.193 So that was the, one good thing that came out of COVID for us from a PT perspective is that it did actually allow us to be more accessible to more people. 433 00:38:45,235.193 --> 00:38:50,905.193 Isn't that interesting that, we had to go through that? Or you have to go through that to, to discover that. 434 00:38:50,905.193 --> 00:38:53,720.193 I personally I don't like online visits. 435 00:38:53,725.193 --> 00:38:56,655.193 I just still use it for as long as it, it's covered. 436 00:38:56,925.193 --> 00:38:57,526.193 But I. 437 00:38:57,530.193 --> 00:39:01,130.193 Tend to prefer seeing patients face to face than virtually. 438 00:39:01,180.193 --> 00:39:08,590.193 But I still utilize it for a lot of particularly, if it's where I don't necessarily need to examine you, it's for a medication check follow up. 439 00:39:08,780.193 --> 00:39:10,430.193 It's very useful in that way. 440 00:39:10,730.193 --> 00:39:13,10.193 But that's something also just similar to you. 441 00:39:13,10.193 --> 00:39:16,560.193 I wouldn't have figured out until I had been through that. 442 00:39:16,810.193 --> 00:39:16,870.193 Yeah. 443 00:39:16,870.193 --> 00:39:20,15.193 And I think in my own practice it's allowed more. 444 00:39:20,605.193 --> 00:39:32,245.193 Patients who are extremely busy to be, to still be able to see me in that way, whereas they might not have otherwise seen me because it would be too difficult for them. 445 00:39:32,295.193 --> 00:39:35,175.193 I find to be really just as effective as infra species. 446 00:39:35,175.193 --> 00:39:35,835.193 I think you're right. 447 00:39:35,835.193 --> 00:39:39,105.193 There's definitely some value in having people in there and face to face as well. 448 00:39:39,325.193 --> 00:39:42,415.193 But I found it, like I said, to have just as good results. 449 00:39:42,475.193 --> 00:39:46,15.193 And that's interesting too about, being busy, right? I had a couple of people who. 450 00:39:46,520.193 --> 00:39:52,10.193 Worked full-time jobs and then a couple of moms who were like, Hey, I'm gonna stay online 'cause this is so much more helpful for me. 451 00:39:52,10.193 --> 00:39:53,210.193 I don't have to find childcare. 452 00:39:53,390.193 --> 00:39:56,450.193 I don't have to drive, 20 minutes to your clinic, 40 minutes total. 453 00:39:56,580.193 --> 00:39:58,800.193 This has been a really helpful thing for me you're right. 454 00:39:58,800.193 --> 00:40:04,860.193 It would've been nice to not have a pandemic to have forced our hand to figure that out, but at least we did have, again, some utility come out of it, which is neat. 455 00:40:04,860.193 --> 00:40:09,150.193 But there's definitely a lot to be said still for the value of having someone in your office and in your clinic too. 456 00:40:10,330.193 --> 00:40:12,610.193 Jesse, this has been a great conversation. 457 00:40:12,940.193 --> 00:40:23,260.193 Where can my patients find you if they want to look you up? Yeah, my Instagram, which I'm actually very active on, I put a ton of information out there, is just Chain Reaction pt. 458 00:40:23,570.193 --> 00:40:30,200.193 I also have a newsletter that you can get to either on my link, on my Instagram, or if you go to chain reaction pt.com, 459 00:40:30,200.193 --> 00:40:31,130.193 which is my website. 460 00:40:31,455.193 --> 00:40:33,285.193 Chain Reaction, pt.com/newsletter 461 00:40:33,285.193 --> 00:40:34,215.193 if you wanna get right there. 462 00:40:34,375.193 --> 00:40:40,595.193 It's a two times a month newsletter that I also put a ton of information out about PT exercises your body, just all this stuff. 463 00:40:40,905.193 --> 00:40:44,590.193 I do put out workouts as well, like easy and they're all 20 minute workouts. 464 00:40:44,655.193 --> 00:40:45,855.193 'cause again, we don't have a lot of. 465 00:40:45,875.193 --> 00:40:48,545.193 The resistance I see also for strength training is time. 466 00:40:48,545.193 --> 00:40:59,175.193 And 20 minutes is enough to create change and so if we can at least give people 20 minutes to work out and give them tools and the information what they need I have all of those on my Instagram and I also include one of my newsletters. 467 00:40:59,175.193 --> 00:41:01,955.193 So those are some really good ways to, get some information. 468 00:41:02,255.193 --> 00:41:05,375.193 I do have a strength training program also available on my website. 469 00:41:05,435.193 --> 00:41:07,895.193 That's a 12 week self-paced strength training program. 470 00:41:07,895.193 --> 00:41:12,365.193 I created it for my cyclist because they in particular are resistant to strength training. 471 00:41:12,365.193 --> 00:41:13,565.193 'cause cycling's a long sport. 472 00:41:13,565.193 --> 00:41:15,995.193 You're out there for three hours, you don't have a lot of time to strength train. 473 00:41:16,325.193 --> 00:41:16,895.193 So same thing. 474 00:41:16,895.193 --> 00:41:19,655.193 The exercises are, the workouts are all 20 to 40 minutes. 475 00:41:19,695.193 --> 00:41:23,835.193 And it gives people step by step instructions on how to strength train, what to do. 476 00:41:24,215.193 --> 00:41:25,115.193 Here are the workouts. 477 00:41:25,185.193 --> 00:41:27,435.193 I'm really happy with how that's turned out too for people. 478 00:41:27,435.193 --> 00:41:32,260.193 And it turns out I had a lot of non cyclists buy it too, and they've been really successful in it. 479 00:41:32,260.193 --> 00:41:35,390.193 So really it's just a great strength training program for anyone that wants some direction. 480 00:41:35,440.193 --> 00:41:39,290.193 But the biggest thing really is my newsletter and my Instagram are the two places you can find me. 481 00:41:39,290.193 --> 00:41:41,120.193 So chain reaction pt.com, 482 00:41:41,120.193 --> 00:41:43,160.193 and Chain Reaction PT on Instagram. 483 00:41:44,105.193 --> 00:41:47,525.193 I will make sure to include that in my show notes so that people can thank you. 484 00:41:48,185.193 --> 00:41:55,785.193 Easily click that on the podcast as well as YouTube to look at all the fascinating information that you've shared with us. 485 00:41:55,785.193 --> 00:41:59,885.193 And don't forget to like, share and review my podcast. 486 00:42:00,435.193 --> 00:42:04,225.193 Remember, it's always ladies first on Soma Says. 487 00:42:04,525.193 --> 00:42:08,185.193 Let's make a difference one conversation at a time.