June 5, 2025 • 56 mins
(00:00:00) Pelvic Floor Therapy for Everyone: Debra Goldman on Healing, Strength & Support
(00:16:57) Types of Therapy (virtual & in-person)
(00:22:40) What does therapy look like?
(00:36:43) What are the limitations?
(00:39:57) Pelvic floor
In this powerful episode of The Body Pod, pelvic floor physical therapist Debra Goldman shines a light on the life-changing benefits of pelvic floor therapy. Whether you're dealing with postpartum recovery, bladder leakage, pelvic organ prolapse, or chronic pelvic pain, this conversation uncovers why pelvic health matters for people of all ages and genders. Debra shares her unique journey from professional dancer to women’s health expert and breaks down the most common myths and conditions around pelvic floor dysfunction. If you’ve ever experienced discomfort, incontinence, or just wondered what the pelvic floor actually does—this is a must-listen.
(00:16:57) Types of Therapy (virtual & in-person)
(00:22:40) What does therapy look like?
(00:36:43) What are the limitations?
(00:39:57) Pelvic floor
In this powerful episode of The Body Pod, pelvic floor physical therapist Debra Goldman shines a light on the life-changing benefits of pelvic floor therapy. Whether you're dealing with postpartum recovery, bladder leakage, pelvic organ prolapse, or chronic pelvic pain, this conversation uncovers why pelvic health matters for people of all ages and genders. Debra shares her unique journey from professional dancer to women’s health expert and breaks down the most common myths and conditions around pelvic floor dysfunction. If you’ve ever experienced discomfort, incontinence, or just wondered what the pelvic floor actually does—this is a must-listen.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:00):
Hey everyone, This is Haley and I'm Lara, and welcome
to the Body Pod.
Speaker 2 (00:11):
What if the.
Speaker 3 (00:11):
Key to unlocking your core strength, easing chronic pain, and
even improving your emotional well being was hidden in your
pelvic floor. Today we're diving deep, literally and figuratively with
pelvic floor therapist Deborah Goldman. As a leading practitioner in
pelvic rehabilitation, Deborah helps people reconnect with the most foundational
(00:33):
part of their bodies. This is a conversation that just
might change the way you think about your body.
Speaker 1 (00:46):
Welcome Deborah Goldman to the Body Pod. We are so
thrilled to have you here. This is a very different
subject and we've had we haven't had an expert on
in this pelvic floor area.
Speaker 2 (00:59):
So welcome, thank you. I'm so excited to be here.
It's truly in honor.
Speaker 1 (01:05):
Can you just give us a little just give us
a little intro about yourself and how you got into
pelvit floor physical therapy, because I don't even know that
every woman knows what that entails. They might have heard
the name, but couldn't tell you exactly you know what
actually happens.
Speaker 2 (01:24):
Okay, Well, I'll start off by saying I'm a late bloomer,
so I didn't go to physical therapy school until I
was thirty three. After a career as a career as
a modern dancer and movement teacher, I taught exercise at
(01:45):
NYU's fitness center. I did body work. I became certified
in something called the Alexander technique, which is all about
posture and breathing. And then and that was, as I said,
I was dancing, and then I realized I needed a career,
and I was attracted to physical therapy because I had
always been very active and physical. And I went to
(02:09):
school after completing my prerequisites, even though I had two
other degrees, because I managed to avoid science and math
for so long that been there. Yeah, and so graduated
from Northwestern University, a fantastic school, with a degree in
(02:32):
physical therapy, and immediately went into moved back to New
York and went into sports medicine and orthopedics for twelve years.
So I worked at a wonderful training and physical therapy
facility in the World Financial Center, and I had a
(02:54):
really great experience reading every type of sports medicine and
orthopedic surgeries, knee surgeries, you know, elbows, backs, lots of
great collaboration too with fantastic orthopedist orthopedists in New York
who loved s tending their patients to physical therapy and
(03:17):
really believed in what we did. But I started to
have an interest in women's health too. And then when
I was there for a few years, then I had
my I was pregnant and at forty and with my
one and only, and I discovered a book called The
(03:40):
Essential the Essential Exercises for the child Bearing Year, which
was written by an Australian physical therapist. I know you
love Australian people, and so and Elizabeth Noble was someone
who had come and moved to the United States, I
think in the late sixties, but wrote this book in
(04:04):
nineteen seventy six. There was nothing else like that, So
and she actually started in my professional organization, the American
Physical Therapy Association, the kind of the groundwork for what
we know as public floor physical therapy specialization. So when
I was pregnant and postpartum, I used her book as
(04:27):
my guide to my postpartum recovery. And it was really
more exercise base at that time, but there was nothing
else like that. So fast forward a couple of years
and I started a practice in New York at a
midwiffery run child bearing center, which was one of the
(04:49):
few of its kind, and I worked closely with the
midwives and the assistance there, and so I started seeing
a lot of pregnant postpartum patients and I knew I
was missing something, but the pelvic floor aspect wasn't really
in my consciousness at that time. That was like nineteen
(05:10):
ninety nine. But in any case, and I a few
years later, in two thousand and two, my family moved
to New Jersey, and I was trying to figure out
what I was going to do because I didn't want
to work for a big practice anymore. And so I
was trying to figure things out, and I had put
(05:31):
myself out there on my professional organization as someone who
was interested in women's health. And I was contacted by
a young physician who was just starting his eurogynecological practice
at a local hospital. So eurodynecology at that time was
a relatively new field too. Eurogynecology is kind of the
(05:53):
marriage of obstetrics, gynecology, and neurology with emphasis, you know,
solely on women's pelvic health. So I met Yeah, so
I met with him, doctor Siegel, and he convinced me
that I should study pelvic floor therapy because he was
(06:14):
looking for someone to refer his patients to. And it
just was kind of serendipitous because I really was looking
for something else and I just kind of dove into
the coursework and immediately loved it and found it incredibly
interesting and realized this was my niche because this was
(06:37):
everything that I kind of wanted to put together that still,
you know, having the orthopedic sports medicine mind, but really
focusing on women's health. So I quickly started my own
private practice. Plus I worked with him at the hospital
one day awake, one day a week for eight years years.
(07:00):
So I learned a lot about your guide, about prolapse,
about eurodynamics. I had residents and medical students shadowing me.
I was able to give grand rounds at the hospital
to the attendings and the residents and this pelvic floor function.
So I had a great education on that and then
(07:21):
I so as I said, I did that for eighty years,
and then I kind of focused more on pelvic pain.
So I really see a wide variety of patients male, female,
you know, all I accept all genders, all sexes, Everyone
has a pelvic floor. I don't see children, but that's
(07:42):
kind of how the trajectory of my career started back
in two thousand and four after my twelve years as
an archpedic sports medicine, physical therapy.
Speaker 1 (07:53):
So let's break down what pelvic floor therapists. If somebody
is coming to you, because I I think I shared
this with you earlier on another podcast or just when
we were chatting, I was I was seeing a physical
therapist for a hamstring issue that was not getting resolved,
and I don't know why, but somehow she was like,
(08:16):
did you have trauma with any birth? And I said, yeah,
my last child, blah blah blah x y Z, and
she said, you need I think you need to see
a pelvic floor therapist. I had no idea that it
was like what it was and what it entailed, meaning
I didn't know it was an internal exam. I thought
(08:36):
I was just like going for physical therapy and I
didn't know what they were going to do. So I know,
I can't be the only one here. What if somebody
were to come to you, Well, first of all, somebody
would ask you to what you do? Can you break
down what a pelvic floor therapist does and then how
a session would go.
Speaker 2 (08:56):
Yeah with you. So, typically the things that people come
to see a pelvic floor physical therapists are bladder symptoms.
So it could be you know, urinary leakage, retention, frequency,
stress in continents, urge in continence, and we can go
into that a little bit more later. Different types of
(09:19):
bowel symptoms constipation, hemorrhoids, fecal incontinence, and perenial trauma which
can cause all of those above, and that's from childbirth injuries.
Sexual dysfunction that includes pain with penetration. The medical term
(09:40):
is dysperunea. So even just very right at the entrance,
there's pain or pain with deeper penetration difficulty or pain
or leakage with orgasm. Then there's kind of the umbrella
term of pelvic pain, which could include people who have endometriosis,
(10:02):
so they have adhesions, they have restrictions, they have they
have their public organs don't move because of those restrictions.
I see patients post hysterectomy, both surgical medical and natural,
or you know, menopausal. I see patients with who have
(10:24):
had post gynecological cancer surgeries. I see people with abdominal surgeries,
so I see patients with tummy tucks because that can
really affect the bladder function as well. You would also
see patients who have coxic or tailbone pain, so it
(10:46):
could be a trauma from falling or even a childhood
fall on the coccic or even from a seat belt
injury from having COCs of pain. And then I see
pregnant patients, So I see pregnant patients who have pelvic
girdle joint pain, you know, pubic synthesis pain, hip pain,
(11:07):
lower back pain, muscle tightness, bladder leakage, or they also
want a program to prepare them for childbirth, and so
we can include that. Then kind of the bread and
butter is postpartum patients, so people who have had childbirth
(11:28):
injuries from non physiological childbirth, you know. So that can
include episiotomy, the use of forceps or a vacuum, or
just some some women are induction. They have inductions, and
it's they're kind of encouraged to push before they're really
(11:49):
ready to push, so that all of those things can
cause a lot of pelvic floor trauma. They also might
come for diastesis recti, which is the separation of the
rectus muscle prolapse, So pelvic organ prolapse can happen during pregnancy,
(12:10):
and it can happen postpartum. And then I see also
a lot of women in perry and menopause right now.
So perimenopausal women are you know, coming to me with
also some of the same same complaints, but it's now
it's kind of being mediated by hormonal changes. So pain
(12:34):
with pain with penetration, the bladder leakage, not able to
have the same kind of core strength they might have
had before strength programs. I mean, it's prolapse, it's it's
really can go on and on with that. I also
see men, not as many because men don't like to
(12:55):
refer themselves quite as much. But you know, I've seen
men who have pelvita from you know, working lifting too
heavy at the gym, or or they are they do
work that requires a lot of lifting and pressure. And
actually that goes for you know women too, like so
women who are women who have jobs where they're may
(13:19):
be nurses or lifting, you know, people in healthcare situations,
teachers because teachers don't get to go to the bathroom,
so they might have retention and bladder issues. It's pretty
it's quite a long list. So that's why someone would come.
Speaker 3 (13:39):
That's what I was just going to say. The list
is so long.
Speaker 1 (13:43):
So pretty much everyone, this is what I'm mad about
because I found out after I started going, I found
out that in France, part of their postpartum care includes
pelvic floor physical therapy.
Speaker 2 (13:58):
Come on, America, Well it's not. It's not only France.
I mean, it's most of the Nordic countries, it's I'm
pretty sure it's Australia. There might even be other places
in you know, the Middle East or India, like there's
we are so behind, we are so behind the times.
(14:19):
And you know, it's I mean, and it's scary because
I think things are just going to get worse for
women's health right now. So and I think that we still,
you know, women are still being gaslighted about their experiences. So,
(14:42):
I mean, when I started back in two thousand and
three or four, and I've had so many women tell
me that they were having leakage. They might have had,
you know, a few pregnancies, and they would complain to
their physician and they were they we literally were told,
what do you expect you you had children, you were pregnant,
(15:06):
or I have other patients who have pelvic pain and
they're still told have a glass of wine, or go
for a walk, or relax, or just go bear through
the pain. So I'm sorry to say that it's still
really bad, that it hasn't changed much. I mean, what
(15:28):
has changed? What has changed? Because menopause is having a
moment finally, So now they're on social media, there are
you know, people can learn from the there's some really
great doctors as you know, you know, Rachel Ruben and
Kelly Casperson, people I've met at conferences in New York,
and so they're on board with pelvic floor therapy, but
(15:51):
they're also on board with just saying it like it
is and helping helping women find their voice to fight
back because for a long time, you know, my profession,
we were in the trenches. I've been seeing her menopause
and menopausal women you know for years and to try
(16:12):
to communicate with their physicians that maybe try some vaginal
estrogen or it was torture. So now there's a little
more opening up, but it's still a very difficult road.
Speaker 1 (16:25):
Okay, So then what does that look like somebody, here's
all of the symptoms that they might have or a
reason to come to you. So they come to your office,
and what does therapy look like? And can they do
some at home? I absolutely did some stuff on Zoom
when we had the pandemic and nobody was seeing anyone
in person. So what does that look like?
Speaker 2 (16:47):
You know? I will tell you during the pandemics, I
had never done virtual therapy before, and my phone was
ringing off the hook and it worked better than I thought.
It was good though, And I'll show you some of
the things that I use to So when someone comes
to see me, you know, I send them a detailed
(17:10):
intake form because I want to know what's going on
and have some background. And I mean, you know, as
I'm saying, I can have such a range of patients.
So there's not one prototype. There's not one. You know,
everyone is individual. But I look at them as a
whole person, and you know, I start with the subjective exam,
(17:32):
and then I do a movement exam, so I look,
you know, with their clothes on, so I look at
their spine, I look how they're moving. I do functional movements.
I have them twist, I have them bend, I go,
I look at a squat. I put them on the
table and I check their hip range of motion. I
check their hip strength. I check their their parts of
(17:55):
their nervous system, what's called neural tensions, to see if
there's any nerve pain. I look at their abdominal wall.
I check for diastesis. I check with them lying face down.
I check all the different el the girdle joints. I
check their spine, I check their ribcage. I see how
they're breathing. And then I invite them for a pelvic
(18:19):
floor exam. SO pelvic floor exam so so and I
explained that a pelvic floor exam is not like going
to the gynecologist. It's a muscular skeletal exam. So, so
I'm looking at I'm looking at the muscles and the
nerves and the ability of the muscles to contract to relax.
(18:44):
Are there trigger points? Are their tender points? How does
it function? Can I? And I will also do an
exam of the what's you know referred to as the perineum. So,
and this is very typical. It's there's a is called
a Q tip test. So you use a medical Q
tip and you check along the peranial body, along the labia,
(19:08):
in the labium, manure and majora. You're really looking to
see is their tenderness, is their inflammation, what nerves are involved,
because there's several different nerves that innervate all different parts
of the pelvic floor. And then I have that objective information.
Then I put on my gloves and we use lubrication
(19:30):
and I explain the popasaf so then I do. So
they are lying on their back with their knees up,
and I use one or two fingers, left fingers, and
I come in and I check the integrity of the
So these are more of the superficial first layer muscles
(19:52):
as I just described it about the paraneum. And then
I go and I checked the deeper muscles. So the
pelvic floor is a sling and a bowl, and so
just like any other floor, it's there to serve as
support for whatever is on top. So I'm looking at
(20:12):
the deep muscles and I'm asking them, you know, I'm
seeing can I do I feel that they can contract?
Do I feel that they can relax? Is there any pain? Tenderness?
Is there? Nerve pain there? And then I'll go to
the other muscle I'll do the same thing. And then
(20:33):
I'll check the muscles that are up in the area
behind the pubic bone, because this is where the urethra
and the bladder live, so I want to check the
integrity of those muscles. I'll check. For a female, I'll
check the integrity of the anterior or front vaginal wall.
I'll actually check on the urethra and see how that feels,
(20:56):
because it should feel firm and not mashey. And then
and then I'm going to check I'm going to check
the muscles that are what we call the fast switch muscles,
So those are the muscles as a where eye on
these behind the urefair because these are the muscles that
(21:16):
have to quickly close the sphinters if there's a bladder issue.
The muscles of the deeper part of the pelvic floor
are those are your endurance muscles, So I'm checking for
a more like endurance or longer rest. And then that's
pretty much the basis for the pelvic floor exam some patients.
(21:41):
Some patients I might do the exam rectally because if
they have so much pain and they're not able to
tolerate any vaginal penetration, I can get very good results
from doing a rectal exam and you get to check
the muscles that are deeper by the tailbone. But I
can even get up to this deep opperator muscle there.
(22:04):
So you really want to find you really want to
find the driver for what's happening in the pelvic floor
in order to have a plan of care.
Speaker 3 (22:14):
Okay, I did not realize how thorough and how much
went in to the exam.
Speaker 2 (22:21):
It's a lot, and sometimes you don't do it all
at once.
Speaker 1 (22:27):
Yeah, if you if okay, so you find something that's
tender or or that you know doesn't feel like it's
up to par, then you know what, what does the
therapy look like?
Speaker 2 (22:39):
You know what? I also what I left out is
you know, for for for females, I can also see
and check if there's a prolapse. So I want to
know is there a bladder prolapse? Is there a rectal prolapse?
I can also check and I can actually go on
try to find the cervix and see if that's moving correctly. So,
(23:00):
so if it was someone who had pain with penetration,
who had what we call non relaxing short type pelvic
floor muscles, that's going to look very different than someone
who has perhaps weakness with overly lengthened pelvic floor muscles.
(23:25):
So for someone with very tight muscles, if we're able
to do an internal vaginal exam and they're able to
tolerate that, then this is one of the tools that
we would use for home, which is called a pelvic
wand so it's a medical grade silicon wand that because
(23:48):
of the way it's designed, it has a smaller end
and a bigger end, So someone can actually initiate their
own therapy using the wand to do some at the
superficial layers, but also I teach them how to view
the stretching and the mobilization of these tissues at the
(24:09):
deeper levels. But it really helps if they're able to
tolerate my manual work doing it, because that way they
will be able to connect more with their breath and
I really integrate it with mindfulness and diaphetic breathing. So
(24:31):
having an exam, having an exammed by a public therapist
can really help you understand what is exactly the problem.
So once I know that, then I can prescribe this
and teach them how to use it, and we might
start with that and it might take a while for
them to even feel comfortable to do this, you know,
(24:53):
and I try to, you know, not put pressure on people,
like keep it by your bedside table, even if you
do for two or three minutes a day, that's a start.
And then once they get comfortable with this, they learn
to relax and really feel what's happening in their body,
(25:13):
because I think that's often the disconnect. It's like, you
know you have pain, you know it's hidden inside of you.
You can't see it like you can see your bicep.
So you know, some people think like, oh, is it
just a hole that's tight. So once you really learn
about your own body and what the model looks like,
(25:36):
becos it becomes a conversation with your nervous system more
than anything else. And so it allows the muscles to
relax around the nerves and that way to diminish the
tightness and to get a more integrated feeling for what's
going on and what happens is So then they might
do that and then all of a sudden, there seeing
(26:00):
their bladder more efficiently, or maybe they're they're they're realizing,
you know, they don't have to stop and start having
a bowel movement four times a day, they can just empty.
So those are some of the things. And then we
also might use vaginal dilators, which I'm gonna show you.
(26:21):
So they this way someone can practice penetration without the
pressure of having a partner. And because you know, I
mean most partners they don't want to, they don't want
to cause pain. They don't want to, they don't want
to you know, it hurt you. But but there's still
(26:43):
this need for intimacy and for sex, and I think
a lot of people feel pressured. So if you start
with I mean, this is a very you know, this
is a teeny leany little vaginal dilator and this is
the same company Intimate rows. So these are all medical
grain silicons. This would be for someone who you know,
really has a hard time having any penetration. They go
(27:04):
up sequentially. Most people will graduate to something like this,
but they come bigger. So this way they have a
home program where they can first use the wand get
that relaxation. Because I think it's important to think of
the public floor three dimensionally, which it is, so it's
(27:27):
that bottom, it's the top, and it's the bowl, and
then you can use your dilator to practice penetration and
breathing and use that to bring you closer to your
goals with your intimacy.
Speaker 3 (27:40):
So is titless one of the most common issues you see.
Speaker 2 (27:44):
It's a very big issue. Yes, and I will tell
you that I see a lot of young women who
have that. So they are you know, they're pre p perimenopause.
I'm talking about you know, young women in their twenties
or you know, early thirties. They have a lot of tightness.
They might have undiagnosed endometriosis. So that's something that you know,
(28:11):
I will take a more of a history. You know,
they do they have very heavy periods where the period's
so bad that they had to miss school and or
work or were they never able to put a tampon in,
Because that's a big clue, So that there's millions of
young women who have those issues. I mean, I have
(28:33):
a young woman who had a hysterectomy. She's thirty one,
and because she had cervical cancer. So you know, after hysterectomy,
your muscles can tighten up and it's very painful, especially
someone who can't take any type of hormone, including including
(28:54):
topical hormones, so that is a very very large component,
and it can happen after a C section two.
Speaker 1 (29:02):
So I assume you're a fan of vaginal estrogen very
much because I think, well, you tell me, but I
would imagine that some of these symptoms maybe present later
on in life around perry and postmenopause, with bladder leakage
(29:24):
and vaginal dryness and pain with intercourse and all of this.
So I mean, yes, does not get worse as we age.
Speaker 2 (29:34):
Well, it can because all of the tissues of this
first layer, the vulvar, the vestibule, which is the deep
layer right above the vaginal opening, these are all hormonally dependent.
So as you start going through perimenopause and you start
(29:57):
feeling some irritation there, there might be some you know,
some redness or some some irritation. The extra estrogen will
help that because it will plump up the tissue and
and add collagen to that area. It's referred to as
(30:18):
the genito urinary symptoms of menopause. So that's that's a
you know, a collection of symptoms that includes all of
these things I described, which used to be described solely
as vaginal atrophy. Now it has a broader, broader, A
(30:40):
horrible men, you know, I just I mean back in
the you know, twenty tens, like I had choked saying
that word because it was we didn't have that estrogen supplies,
you know, all of these tissues. But it also it
also affects the urethra, So the urethra and the bladders.
(31:01):
So as we go through perimenopause and start to have
those changes, the stiffness of the urethra decreases, which is
also an aging issue, because I mean, here's a fun fact.
So after around age twenty, the strength of the urethral
(31:22):
sphincters those are the muscles, the internal external sphincters that
close off the flow of urine. They decrease strength by
two percent every year.
Speaker 1 (31:34):
So this is like any other muscle. It starts, yeah,
to lose strength towards Okay, yes, no difference in the pelvis.
Speaker 2 (31:45):
No. But and interesting enough, just this past year, a
group I think their residents or interns of that work
with doctor Rachel Ruben and Sexual Medicine in Washington, they
propose and now we're using the term the genito urinary
symptoms of lactation because the same issues happen if you
(32:09):
are breastfeeding and your postpartum because when you're when you're breastfeeding,
the hormone trolactin is in abundance to encourage milk production,
and it's decreasing estrogen, so now you have ice. So
so many of the patients that I see, they also
(32:31):
need vaginal estrogen and it's you know, perfectly safe as
your if you're breastfeeding, but they are trying to recover
as well, all of these tissues and with the same
issues as perimenopause, you know, trying to have sex, having
painful sex, having some bladder leakage, having muscles that are weak.
So it starts in a way, it starts in postpartum.
(32:56):
And then if if you don't get any treatment and
then wait, you know, say ten or fifteen years to
start getting treatment, you can still get better, but it's
kind of laid the groundwork for you know, maybe there
is maybe there is a little more prolapse, maybe there
is now there is pelvic floor muscle, true atrophy in
(33:20):
the muscle, and that's something that a pelvic floor therapist
can feel like one side just might feel really thin,
the other side might have good bulk. It could be
because of the way the baby was sitting, and you know,
towards the end of the pregnancy, it could be from
the you know, just the pressure. But they're related, and
they're very much you know, it's very much a continuum
(33:42):
of the same issues that happened and that we treat for.
Speaker 3 (33:46):
So bladder control can affect women that have had children
or someone who hasn't had children, just with age, like
you were saying, with a two percent decrease.
Speaker 2 (33:59):
Correct, yes, yes, but there's a high number of young
elite athletes, female athletes who leak and is not because
of movement, that's because of tightness. So it might be
so if they are if they have if they're super
you know, they're strong, they're doing their sport, they might
(34:22):
have so much tension in their pelvic floor that at
certain points in their you know, maybe in their lift
or maybe in their you know, if they are volleyball players,
in their in their whatever it's called push, that's where
they're leaking. So that's also a thing. And children, i
mean children can it can also start in childhood because
(34:46):
children who are chronically constipated and don't want to go
to the bathroom at school, they develop these bad habits
and then they have type pelvic floors also, so it's
really a continuum from childhood to adulthood. But it's all treatable.
I mean, that's the good news. There are there are
options for treatment. But with exercise, you know, that's a
(35:10):
whole other thing. And and I see that in my patients,
and I see that in the you know, general community
of women who lift and exercise, and I think that's
also really important to talk about because there is treatment
and that can change, but we need to be really
(35:32):
specific about figuring out what it is that's causing that leakage.
Because for one person, it could be you know, as
soon as they do a lift. For someone else, it
could be jumping on the trampoline. For someone else, it
could be you know, even just taking a walk. So
(35:54):
I think that's a you know, for perimenopause and menopause
of women. This is a really good place to have
a discussion because there's forty percent at least of women
in this country leak, and they leak with exercise.
Speaker 1 (36:11):
All right, let's take a quick break to hear from
some of the body pod sponsors. We'll be right back. Well, okay,
let's maybe look at like, if somebody were to come
in with prolapse, well, prolapse number one, but then also
just like, I want to know the limitations for somebody
(36:33):
that because I get this question all the time. I
have prolaps, you know, do you think I can lift heavy?
And first of all, I'm like, I'm not your physician.
Number one, wrong person to ask, and I'm always going
to say ask your physician, but for like, what are
the limitations for someone with prolapse specifically?
Speaker 2 (36:59):
What is that look like?
Speaker 1 (37:00):
Would you say don't lift heavy? You know, there's a
lot of mixed conversations here.
Speaker 2 (37:06):
Yeah, well, I think I think first of all, it
depends on it. It depends on their symptoms and when
they feel the prolapse. So if they only feel the prolapse,
if they only feel that vaginal pressure and prolapse when
they're doing you know, lift X at so many reps
(37:27):
in this range, then bring it down. So let's try
to train the pelvic floor with that in that exercise,
because you know, maybe it's their breathing pattern. Maybe they
just are not coordinating their pelvic floor with their you know,
the stiffness and the abdominal wall. Maybe they're they're have
(37:49):
too much of a forward posture when they're lifting, So
it really has there's a lot of nuance that we
can break down and I would never tell anyone just
stop lifting, So I think that's really important. I also
think that there are things women can use for prolapse
to try to see you know, sometimes sometimes a Pessori
(38:13):
is a good option. So a pessori is a hard
plastic object that you would get from a eurogonecologist or
now in our country, some public dutias are being trained
in pessor reinsertion, which is fantastic, but because it might
be that just getting that bladder or bladderneck up a
(38:36):
little bit higher in the pelvis allows the muscles to
contract more more robustly, and then it eliminates that feeling
of something coming out of the vagina. So we really
need to look specifically at each person. But there's no
hard no in having prolapse. But you would want to
(39:00):
keep going on that same path where you're doing that lift,
where you're you know every time you're reinforcing that you're
feeling that pressure because you know that that you're you're
you're going to be you're not going to feel good
and you're going to limit. Ultimately, you know the pressure
dynamic in your trunk and you know, so there are solutions.
(39:25):
There's definitely solutions. It's very specific.
Speaker 1 (39:28):
Also, I mean that the breathing comes into play too,
because I've had people that when I talk about bracing
for lifting to protect the spine, they almost are down
where then they because they're pushing pressure down when you
know you shouldn't be pushing pressure down exactly.
Speaker 2 (39:49):
Well, that's why I mean, one of the things that
I think can really help with lifting and if someone
has a weak palplic chlore has proaps is to use
the to use these vaginal weights because this is something
these are different different weights that time in six sizes,
(40:12):
and I think that it can give someone the feedback
to that they're actually lifting and pulling in their palvot
floor as they're recruiting their their abdominals and then going
into the lift. So you know, it's it's again it's
if you don't if you're not aware of what's what
(40:34):
you're feeling and what the feedback is, it's really hard
to get better. But you you can. You you can
have these options for improving with with weights, with coaching.
You know there there's just there's no reason now to
not have those options in order to continue your your
(40:57):
fittest journey.
Speaker 1 (40:59):
Okay, I love the ways I ordered them. They still
haven't come to my house. It's been like a month.
Speaker 2 (41:05):
Back.
Speaker 1 (41:06):
And look, maybe you know how sometimes you think you
pross that that there actually purchased. So I got to
look at that. But the weights they come in obviously
different weights. They look like little mice to me.
Speaker 2 (41:22):
I don't know. They tell yeah, there's there's you know.
So the white is this the lightest, then it goes
to pale, pink, a little darker pink, a few shack
and then I always when I show patients this one
is if you're like a serious cross trainer or a
more Olympic lifter. Okay, because this one's pretty heavy, But
(41:45):
I think there it's a great tool, you know. And
it doesn't mean that doing keegels alone is the is
the answer to the problem. But you have to use
the pelvic floor to understand what it is and to
integrate it into the exercise and the activity and the breathing,
because one of the main tenets of breathing awareness and
(42:11):
diatramatic breathing is understanding that every time we breathe, we
take a breath in thee our breathing diaphragm, which is
three hundred and sixty degrees around and the pelvic floor
are always moving in the same direction. So you take
a breath in the pelvic floor and the diaphragm push
down and create that pressure. And then when you breathe
(42:32):
out and if you brace your abdominals, everything comes back
to its resting position or you get a contraction. So
learning how the breathing is with the pelvic floor integration,
I think is critical for anyone who wants to lift
heavy or just lift or do you know, high intensity exercise.
It's really an important part of that rehab journey.
Speaker 3 (42:56):
So a lot of this therapy is probably creating awareness
body awareness, even because I'm exactly, if you tell someone, okay,
tighten this part of your pelvic floor, they I don't
even know if I would know specifically how to do
(43:19):
certain exercises. So is that part of the beginning of
the therapy is breathing or like contracting certain aspects of
your body.
Speaker 2 (43:29):
Yeah, it's exactly because there are you know, over the years,
I've had many patients who I might be doing the
exam and asking them to contract. And there's different specific
cues I might use, So I might say contract like
you're stopping key and or construct contract like you're stopping gas,
(43:51):
because then we're you were accessing the deeper levt or
Ani muscles. But some patients do something the op so
they might be they might bear down when they think
they're contracting, and then they're contracting when they think they're
barren down. So and that technically is called disenergia. It's
(44:12):
like a complete mix up of what you actually want
to do. So so getting someone to be able to
feel that and understand that and not and to be
able to do it without engaging their glutes or pulling
their ad doctors together or sometimes they do this is
like it's it's a tremendous shift in their awareness. And
(44:36):
to me, that's foundational, Like that's the foundation of how
you heal of the floor dysfunction. It has to start
with this inner awareness. And I think you know, it's
the hands on therapy, it's the breathing, it's using these
tools that help give someone, you know, the their toolbox
(44:58):
to be able to to go on with this. So yeah,
one hundred percent the breathing and and you know, I
always ask people, you know, are you doing any kind
of mindfulness program? Are you taking any time to like
just use maybe use an app, Like I'm a big
fan of Headspace, the Headspace app because you can open
(45:21):
the app and they have a one minute breathing exercise
with a visualization. Like even if you just do that,
that's a lot. Like now you've also you've you've calmed
your nervous system, you've relaxed your public floor, You've had
that integration of the central and peripheral nervous system. Like
(45:43):
that's priceless, and that's foundational for all this work. So
you know, it's kind of the same way I approach.
Once I get someone to do more exercise, like I
give them some foundational strengthening if they need it. So
maybe just you know, lambshells or or bridging or something
(46:07):
to just feel the muscles and then progress too more
to standing, to different positions, to waits, Like you have
to have the foundation, I think in order to go further.
Speaker 1 (46:21):
So if somebody were to come to you, I know
this could be a huge range, but how many visits
on average would somebody come? Is it like twenty five?
Speaker 2 (46:35):
Is it ten? Is it?
Speaker 1 (46:38):
What does that look like?
Speaker 2 (46:39):
People do ask that and it's and it's a hard question,
but I mean there's I can give them certain guidelines.
So because I don't when they asked that before I've
met them and evaluated them, I don't know, you know,
I don't. I don't even know you like, so that
I have to, you know, I tell them, let's have
(47:01):
the exam. Because after the exam, we sit down, I
talk about what the findings are, what I think, in
my best professional opinion is the best plan of care,
and then we go from there. And you know, I
know people have expectations and financial considerations too, so I
want it to be I wanted to be work best
(47:22):
for you, But you also have to commit to doing
the homework that I'm telling you to do so because
you'll get the best results if we really collaborate together
on this. So we know that basically with muscle strengthening,
it takes eight to twelve weeks for muscle to change.
So if someone was really working on prolapse and strength,
(47:45):
I would say it's probably going to be you know,
eight to twelve visits. If someone If someone comes to
me with pain, plot pain that they've had for five years.
I'm going to I might say it's going to take
a minimum of twelve visits and you know, and then
we'll re reevaluate and see from there.
Speaker 3 (48:05):
What about bladder control?
Speaker 2 (48:08):
Bladder control? You know, So with stress and continents, we
have the best We actually have the evidence based studies
on palvit floor physical therapy for stress and continents. So
a typical program could be twelve weeks, but that doesn't
mean that they're coming to see me for twelve weeks.
They might come for six visits and then they might
(48:30):
do the rest at home, and then they might come
back and check in. So because we have very good,
good stats on that, we know that and this is
over many years in several countries that at least around
fifty percent of women who do pelvic floor therapy for
stress and continents have one hundred percent recovery, which is really.
Speaker 3 (48:54):
Good, great news.
Speaker 2 (48:57):
Yeah, seventy five percent might have have most issues, you know,
improved or full recovery. So there's still some that it
might not work for. And if it doesn't work, then
we have to look at you know, maybe you have
maybe you have a bladder and bladderneck that are sitting
(49:19):
too low. Maybe you have intrinsic sphincter weakness, and you know,
maybe like we can still do the therapy, but maybe
going to the urologist and having collagen injections might help
to you know, it really depends because if they have
those other issues where the bladder is sitting too low
(49:40):
in the pelvis, you're not They're just not going to
get that closure of the from the back wall of
the pelvic floor where the the so you create a
backstop and a front stop, and so we might need
to look at other things, but I think overall those
are pretty good statistics. So you know, I have some
(50:00):
patients who come to me during their the later part
of their pregnancy, and it might be because they have
those pelvic pelvic joint pain they might have, they might
have some and I'm able to do some internal pelvic
work with pregnant patients as long as their doctors sign
off on it and they don't have any type of
(50:21):
placental issues. And then at thirty four weeks we can
start doing perineal massage. And again for that there is
good evidence based studies that that decreases the incidence of
third and fourth degree paranial tears, which can lead to
fecal and urinarian continence and chronic pain. So we have
(50:42):
studies on things, you know, and so I'll always try
to impart as much information as I know. But sometimes
it's like, let's try this, let's see how you are
for you know, let's see if in a couple of
weeks you start to feel improvement. But I do feel
when for the most part, I will always tell someone
(51:03):
you can be much better, because they probably can't. I
know they can and they will. They will because they're
already starting something. So you know, I try not to
set expectations like you're going to be better in six
visits because probably you're not, because most people take seven
to ten years to come for treatment or they've seen
(51:24):
seven to ten doctors who didn't give them the right informission.
So it's really a different journey for you know, for
different people, but it's it can be really transformative for people.
It can really be it can you know, when someone
tells me that the work has changed their life, Like,
(51:49):
you know, I don't want to ever retire because that's.
Speaker 4 (51:52):
Like amazing, very rewarding, very rewarding, Okay, before we before
we go, I want to know, do you have a
tip that you can give our listeners of an exercise
that just strengths strengthens the pelvic floor, like whether they're
driving in their car, or they're sitting or there whatever,
(52:14):
is there an easy tip or exercise that people can
do that just strengthens the pelvic floor overall.
Speaker 2 (52:23):
Sitting is a great place to start because it's functional
and we all have to sit, so sitting in the
car or first on a flat chair, and I'm going
to just use the you know, finding finding a neutral
pelvic position meaning the same as if you were standing
up straight and you were not arching or slouching, but
(52:43):
just a relaxed neutral position because that way you have
the whole sling part of the pelvic floor in contact
with the seat. And first breathe and see if you
can feel that when you breathe in you can sense
that there's some sense of dropping or relaxing the pelvic floor.
(53:06):
And then once you do that, exhale and see, you know,
if you can contract it, give yourself the queue, stop
the gas. See if you feel the anal sphincter tightening
and pulling up, and if you do. If you can
feel that, then you already are winning because you have
some awareness of that. If you're having leakage, do the
(53:29):
same thing, but give yourself the queue, stop the flow
of urine, because then you're going to work more on
the area where those sphincters are. You're still going to
get those deep muscles, but if there's a sphincter deficiency,
you're going to start to get that as well. So
start with something really basic, see if you feel it,
(53:51):
and keep practicing that and then you know not everyone
needs to strengthen because we talked about people with the
high tone, non relaxing. But if you can feel that
you can relax and contract, then you know that you
have some good mobility there, and good mobility is like
the best place to start.
Speaker 3 (54:11):
Yeah, thank you so much for joining us.
Speaker 1 (54:15):
This is such a great conversation and so needed.
Speaker 2 (54:19):
So bad. It's my pleasure.
Speaker 1 (54:22):
How do people can? Can you work with people via zoom?
So how how do people find you?
Speaker 2 (54:28):
Well, they can find me on my website for Corners
Physical Therapy. They can also find me on my Google profile.
I actually have a lot of more information. So if
you just google four Corners Physical Therapy and SLORM I
mean Montclair, New Jersey. You'll come to my Google profile
(54:48):
and I have a Facebook business page, so four Corners
Physical Therapy. I'm on LinkedIn. I have a Instagram am
it's at four Corners PT but it's not great and
I have to work on that. I tend to put
(55:09):
more other things and those are the best ways to
get in touch with me. My email Debra at four
Corners Physical Therapy dot com and it's all spelled out
f O U R Corners Physical Therapy. So yeah, I'm
I'm excited. I'm so excited to share the information because
(55:31):
as much as as much as I think and my
colleagues and people who are already doing it think that
everyone knows, we don't know. We don't know, so and
you know, we could we could talk so much more
about the more specific things, but this is a This
was great and I think that I'm very grateful that
(55:54):
you gave me this opportunity. I feel like I'm sitting
on the shoulders of some really amazing people that you
too have interviews.
Speaker 1 (56:02):
This is fantastic. So we're so grateful for your knowledge,
your education, time to share this.
Speaker 2 (56:09):
Thank you.
Speaker 1 (56:09):
But it's a very important subject, So thank you so much, Deborah.
Speaker 2 (56:13):
My pleasure anytime, thanks for listening.
Speaker 3 (56:18):
If you enjoyed this episode, please consider giving us a
five star review and sharing the body Pod with your friends.
Speaker 1 (56:25):
Until next time,
Hey everyone, This is Haley and I'm Lara, and welcome
to the Body Pod.
Speaker 2 (00:11):
What if the.
Speaker 3 (00:11):
Key to unlocking your core strength, easing chronic pain, and
even improving your emotional well being was hidden in your
pelvic floor. Today we're diving deep, literally and figuratively with
pelvic floor therapist Deborah Goldman. As a leading practitioner in
pelvic rehabilitation, Deborah helps people reconnect with the most foundational
(00:33):
part of their bodies. This is a conversation that just
might change the way you think about your body.
Speaker 1 (00:46):
Welcome Deborah Goldman to the Body Pod. We are so
thrilled to have you here. This is a very different
subject and we've had we haven't had an expert on
in this pelvic floor area.
Speaker 2 (00:59):
So welcome, thank you. I'm so excited to be here.
It's truly in honor.
Speaker 1 (01:05):
Can you just give us a little just give us
a little intro about yourself and how you got into
pelvit floor physical therapy, because I don't even know that
every woman knows what that entails. They might have heard
the name, but couldn't tell you exactly you know what
actually happens.
Speaker 2 (01:24):
Okay, Well, I'll start off by saying I'm a late bloomer,
so I didn't go to physical therapy school until I
was thirty three. After a career as a career as
a modern dancer and movement teacher, I taught exercise at
(01:45):
NYU's fitness center. I did body work. I became certified
in something called the Alexander technique, which is all about
posture and breathing. And then and that was, as I said,
I was dancing, and then I realized I needed a career,
and I was attracted to physical therapy because I had
always been very active and physical. And I went to
(02:09):
school after completing my prerequisites, even though I had two
other degrees, because I managed to avoid science and math
for so long that been there. Yeah, and so graduated
from Northwestern University, a fantastic school, with a degree in
(02:32):
physical therapy, and immediately went into moved back to New
York and went into sports medicine and orthopedics for twelve years.
So I worked at a wonderful training and physical therapy
facility in the World Financial Center, and I had a
(02:54):
really great experience reading every type of sports medicine and
orthopedic surgeries, knee surgeries, you know, elbows, backs, lots of
great collaboration too with fantastic orthopedist orthopedists in New York
who loved s tending their patients to physical therapy and
(03:17):
really believed in what we did. But I started to
have an interest in women's health too. And then when
I was there for a few years, then I had
my I was pregnant and at forty and with my
one and only, and I discovered a book called The
(03:40):
Essential the Essential Exercises for the child Bearing Year, which
was written by an Australian physical therapist. I know you
love Australian people, and so and Elizabeth Noble was someone
who had come and moved to the United States, I
think in the late sixties, but wrote this book in
(04:04):
nineteen seventy six. There was nothing else like that, So
and she actually started in my professional organization, the American
Physical Therapy Association, the kind of the groundwork for what
we know as public floor physical therapy specialization. So when
I was pregnant and postpartum, I used her book as
(04:27):
my guide to my postpartum recovery. And it was really
more exercise base at that time, but there was nothing
else like that. So fast forward a couple of years
and I started a practice in New York at a
midwiffery run child bearing center, which was one of the
(04:49):
few of its kind, and I worked closely with the
midwives and the assistance there, and so I started seeing
a lot of pregnant postpartum patients and I knew I
was missing something, but the pelvic floor aspect wasn't really
in my consciousness at that time. That was like nineteen
(05:10):
ninety nine. But in any case, and I a few
years later, in two thousand and two, my family moved
to New Jersey, and I was trying to figure out
what I was going to do because I didn't want
to work for a big practice anymore. And so I
was trying to figure things out, and I had put
(05:31):
myself out there on my professional organization as someone who
was interested in women's health. And I was contacted by
a young physician who was just starting his eurogynecological practice
at a local hospital. So eurodynecology at that time was
a relatively new field too. Eurogynecology is kind of the
(05:53):
marriage of obstetrics, gynecology, and neurology with emphasis, you know,
solely on women's pelvic health. So I met Yeah, so
I met with him, doctor Siegel, and he convinced me
that I should study pelvic floor therapy because he was
(06:14):
looking for someone to refer his patients to. And it
just was kind of serendipitous because I really was looking
for something else and I just kind of dove into
the coursework and immediately loved it and found it incredibly
interesting and realized this was my niche because this was
(06:37):
everything that I kind of wanted to put together that still,
you know, having the orthopedic sports medicine mind, but really
focusing on women's health. So I quickly started my own
private practice. Plus I worked with him at the hospital
one day awake, one day a week for eight years years.
(07:00):
So I learned a lot about your guide, about prolapse,
about eurodynamics. I had residents and medical students shadowing me.
I was able to give grand rounds at the hospital
to the attendings and the residents and this pelvic floor function.
So I had a great education on that and then
(07:21):
I so as I said, I did that for eighty years,
and then I kind of focused more on pelvic pain.
So I really see a wide variety of patients male, female,
you know, all I accept all genders, all sexes, Everyone
has a pelvic floor. I don't see children, but that's
(07:42):
kind of how the trajectory of my career started back
in two thousand and four after my twelve years as
an archpedic sports medicine, physical therapy.
Speaker 1 (07:53):
So let's break down what pelvic floor therapists. If somebody
is coming to you, because I I think I shared
this with you earlier on another podcast or just when
we were chatting, I was I was seeing a physical
therapist for a hamstring issue that was not getting resolved,
and I don't know why, but somehow she was like,
(08:16):
did you have trauma with any birth? And I said, yeah,
my last child, blah blah blah x y Z, and
she said, you need I think you need to see
a pelvic floor therapist. I had no idea that it
was like what it was and what it entailed, meaning
I didn't know it was an internal exam. I thought
(08:36):
I was just like going for physical therapy and I
didn't know what they were going to do. So I know,
I can't be the only one here. What if somebody
were to come to you, Well, first of all, somebody
would ask you to what you do? Can you break
down what a pelvic floor therapist does and then how
a session would go.
Speaker 2 (08:56):
Yeah with you. So, typically the things that people come
to see a pelvic floor physical therapists are bladder symptoms.
So it could be you know, urinary leakage, retention, frequency,
stress in continents, urge in continence, and we can go
into that a little bit more later. Different types of
(09:19):
bowel symptoms constipation, hemorrhoids, fecal incontinence, and perenial trauma which
can cause all of those above, and that's from childbirth injuries.
Sexual dysfunction that includes pain with penetration. The medical term
(09:40):
is dysperunea. So even just very right at the entrance,
there's pain or pain with deeper penetration difficulty or pain
or leakage with orgasm. Then there's kind of the umbrella
term of pelvic pain, which could include people who have endometriosis,
(10:02):
so they have adhesions, they have restrictions, they have they
have their public organs don't move because of those restrictions.
I see patients post hysterectomy, both surgical medical and natural,
or you know, menopausal. I see patients with who have
(10:24):
had post gynecological cancer surgeries. I see people with abdominal surgeries,
so I see patients with tummy tucks because that can
really affect the bladder function as well. You would also
see patients who have coxic or tailbone pain, so it
(10:46):
could be a trauma from falling or even a childhood
fall on the coccic or even from a seat belt
injury from having COCs of pain. And then I see
pregnant patients, So I see pregnant patients who have pelvic
girdle joint pain, you know, pubic synthesis pain, hip pain,
(11:07):
lower back pain, muscle tightness, bladder leakage, or they also
want a program to prepare them for childbirth, and so
we can include that. Then kind of the bread and
butter is postpartum patients, so people who have had childbirth
(11:28):
injuries from non physiological childbirth, you know. So that can
include episiotomy, the use of forceps or a vacuum, or
just some some women are induction. They have inductions, and
it's they're kind of encouraged to push before they're really
(11:49):
ready to push, so that all of those things can
cause a lot of pelvic floor trauma. They also might
come for diastesis recti, which is the separation of the
rectus muscle prolapse, So pelvic organ prolapse can happen during pregnancy,
(12:10):
and it can happen postpartum. And then I see also
a lot of women in perry and menopause right now.
So perimenopausal women are you know, coming to me with
also some of the same same complaints, but it's now
it's kind of being mediated by hormonal changes. So pain
(12:34):
with pain with penetration, the bladder leakage, not able to
have the same kind of core strength they might have
had before strength programs. I mean, it's prolapse, it's it's
really can go on and on with that. I also
see men, not as many because men don't like to
(12:55):
refer themselves quite as much. But you know, I've seen
men who have pelvita from you know, working lifting too
heavy at the gym, or or they are they do
work that requires a lot of lifting and pressure. And
actually that goes for you know women too, like so
women who are women who have jobs where they're may
(13:19):
be nurses or lifting, you know, people in healthcare situations,
teachers because teachers don't get to go to the bathroom,
so they might have retention and bladder issues. It's pretty
it's quite a long list. So that's why someone would come.
Speaker 3 (13:39):
That's what I was just going to say. The list
is so long.
Speaker 1 (13:43):
So pretty much everyone, this is what I'm mad about
because I found out after I started going, I found
out that in France, part of their postpartum care includes
pelvic floor physical therapy.
Speaker 2 (13:58):
Come on, America, Well it's not. It's not only France.
I mean, it's most of the Nordic countries, it's I'm
pretty sure it's Australia. There might even be other places
in you know, the Middle East or India, like there's
we are so behind, we are so behind the times.
(14:19):
And you know, it's I mean, and it's scary because
I think things are just going to get worse for
women's health right now. So and I think that we still,
you know, women are still being gaslighted about their experiences. So,
(14:42):
I mean, when I started back in two thousand and
three or four, and I've had so many women tell
me that they were having leakage. They might have had,
you know, a few pregnancies, and they would complain to
their physician and they were they we literally were told,
what do you expect you you had children, you were pregnant,
(15:06):
or I have other patients who have pelvic pain and
they're still told have a glass of wine, or go
for a walk, or relax, or just go bear through
the pain. So I'm sorry to say that it's still
really bad, that it hasn't changed much. I mean, what
(15:28):
has changed? What has changed? Because menopause is having a
moment finally, So now they're on social media, there are
you know, people can learn from the there's some really
great doctors as you know, you know, Rachel Ruben and
Kelly Casperson, people I've met at conferences in New York,
and so they're on board with pelvic floor therapy, but
(15:51):
they're also on board with just saying it like it
is and helping helping women find their voice to fight
back because for a long time, you know, my profession,
we were in the trenches. I've been seeing her menopause
and menopausal women you know for years and to try
(16:12):
to communicate with their physicians that maybe try some vaginal
estrogen or it was torture. So now there's a little
more opening up, but it's still a very difficult road.
Speaker 1 (16:25):
Okay, So then what does that look like somebody, here's
all of the symptoms that they might have or a
reason to come to you. So they come to your office,
and what does therapy look like? And can they do
some at home? I absolutely did some stuff on Zoom
when we had the pandemic and nobody was seeing anyone
in person. So what does that look like?
Speaker 2 (16:47):
You know? I will tell you during the pandemics, I
had never done virtual therapy before, and my phone was
ringing off the hook and it worked better than I thought.
It was good though, And I'll show you some of
the things that I use to So when someone comes
to see me, you know, I send them a detailed
(17:10):
intake form because I want to know what's going on
and have some background. And I mean, you know, as
I'm saying, I can have such a range of patients.
So there's not one prototype. There's not one. You know,
everyone is individual. But I look at them as a
whole person, and you know, I start with the subjective exam,
(17:32):
and then I do a movement exam, so I look,
you know, with their clothes on, so I look at
their spine, I look how they're moving. I do functional movements.
I have them twist, I have them bend, I go,
I look at a squat. I put them on the
table and I check their hip range of motion. I
check their hip strength. I check their their parts of
(17:55):
their nervous system, what's called neural tensions, to see if
there's any nerve pain. I look at their abdominal wall.
I check for diastesis. I check with them lying face down.
I check all the different el the girdle joints. I
check their spine, I check their ribcage. I see how
they're breathing. And then I invite them for a pelvic
(18:19):
floor exam. SO pelvic floor exam so so and I
explained that a pelvic floor exam is not like going
to the gynecologist. It's a muscular skeletal exam. So, so
I'm looking at I'm looking at the muscles and the
nerves and the ability of the muscles to contract to relax.
(18:44):
Are there trigger points? Are their tender points? How does
it function? Can I? And I will also do an
exam of the what's you know referred to as the perineum. So,
and this is very typical. It's there's a is called
a Q tip test. So you use a medical Q
tip and you check along the peranial body, along the labia,
(19:08):
in the labium, manure and majora. You're really looking to
see is their tenderness, is their inflammation, what nerves are involved,
because there's several different nerves that innervate all different parts
of the pelvic floor. And then I have that objective information.
Then I put on my gloves and we use lubrication
(19:30):
and I explain the popasaf so then I do. So
they are lying on their back with their knees up,
and I use one or two fingers, left fingers, and
I come in and I check the integrity of the
So these are more of the superficial first layer muscles
(19:52):
as I just described it about the paraneum. And then
I go and I checked the deeper muscles. So the
pelvic floor is a sling and a bowl, and so
just like any other floor, it's there to serve as
support for whatever is on top. So I'm looking at
(20:12):
the deep muscles and I'm asking them, you know, I'm
seeing can I do I feel that they can contract?
Do I feel that they can relax? Is there any pain? Tenderness?
Is there? Nerve pain there? And then I'll go to
the other muscle I'll do the same thing. And then
(20:33):
I'll check the muscles that are up in the area
behind the pubic bone, because this is where the urethra
and the bladder live, so I want to check the
integrity of those muscles. I'll check. For a female, I'll
check the integrity of the anterior or front vaginal wall.
I'll actually check on the urethra and see how that feels,
(20:56):
because it should feel firm and not mashey. And then
and then I'm going to check I'm going to check
the muscles that are what we call the fast switch muscles,
So those are the muscles as a where eye on
these behind the urefair because these are the muscles that
(21:16):
have to quickly close the sphinters if there's a bladder issue.
The muscles of the deeper part of the pelvic floor
are those are your endurance muscles, So I'm checking for
a more like endurance or longer rest. And then that's
pretty much the basis for the pelvic floor exam some patients.
(21:41):
Some patients I might do the exam rectally because if
they have so much pain and they're not able to
tolerate any vaginal penetration, I can get very good results
from doing a rectal exam and you get to check
the muscles that are deeper by the tailbone. But I
can even get up to this deep opperator muscle there.
(22:04):
So you really want to find you really want to
find the driver for what's happening in the pelvic floor
in order to have a plan of care.
Speaker 3 (22:14):
Okay, I did not realize how thorough and how much
went in to the exam.
Speaker 2 (22:21):
It's a lot, and sometimes you don't do it all
at once.
Speaker 1 (22:27):
Yeah, if you if okay, so you find something that's
tender or or that you know doesn't feel like it's
up to par, then you know what, what does the
therapy look like?
Speaker 2 (22:39):
You know what? I also what I left out is
you know, for for for females, I can also see
and check if there's a prolapse. So I want to
know is there a bladder prolapse? Is there a rectal prolapse?
I can also check and I can actually go on
try to find the cervix and see if that's moving correctly. So,
(23:00):
so if it was someone who had pain with penetration,
who had what we call non relaxing short type pelvic
floor muscles, that's going to look very different than someone
who has perhaps weakness with overly lengthened pelvic floor muscles.
(23:25):
So for someone with very tight muscles, if we're able
to do an internal vaginal exam and they're able to
tolerate that, then this is one of the tools that
we would use for home, which is called a pelvic
wand so it's a medical grade silicon wand that because
(23:48):
of the way it's designed, it has a smaller end
and a bigger end, So someone can actually initiate their
own therapy using the wand to do some at the
superficial layers, but also I teach them how to view
the stretching and the mobilization of these tissues at the
(24:09):
deeper levels. But it really helps if they're able to
tolerate my manual work doing it, because that way they
will be able to connect more with their breath and
I really integrate it with mindfulness and diaphetic breathing. So
(24:31):
having an exam, having an exammed by a public therapist
can really help you understand what is exactly the problem.
So once I know that, then I can prescribe this
and teach them how to use it, and we might
start with that and it might take a while for
them to even feel comfortable to do this, you know,
(24:53):
and I try to, you know, not put pressure on people,
like keep it by your bedside table, even if you
do for two or three minutes a day, that's a start.
And then once they get comfortable with this, they learn
to relax and really feel what's happening in their body,
(25:13):
because I think that's often the disconnect. It's like, you
know you have pain, you know it's hidden inside of you.
You can't see it like you can see your bicep.
So you know, some people think like, oh, is it
just a hole that's tight. So once you really learn
about your own body and what the model looks like,
(25:36):
becos it becomes a conversation with your nervous system more
than anything else. And so it allows the muscles to
relax around the nerves and that way to diminish the
tightness and to get a more integrated feeling for what's
going on and what happens is So then they might
do that and then all of a sudden, there seeing
(26:00):
their bladder more efficiently, or maybe they're they're they're realizing,
you know, they don't have to stop and start having
a bowel movement four times a day, they can just empty.
So those are some of the things. And then we
also might use vaginal dilators, which I'm gonna show you.
(26:21):
So they this way someone can practice penetration without the
pressure of having a partner. And because you know, I
mean most partners they don't want to, they don't want
to cause pain. They don't want to, they don't want
to you know, it hurt you. But but there's still
(26:43):
this need for intimacy and for sex, and I think
a lot of people feel pressured. So if you start
with I mean, this is a very you know, this
is a teeny leany little vaginal dilator and this is
the same company Intimate rows. So these are all medical
grain silicons. This would be for someone who you know,
really has a hard time having any penetration. They go
(27:04):
up sequentially. Most people will graduate to something like this,
but they come bigger. So this way they have a
home program where they can first use the wand get
that relaxation. Because I think it's important to think of
the public floor three dimensionally, which it is, so it's
(27:27):
that bottom, it's the top, and it's the bowl, and
then you can use your dilator to practice penetration and
breathing and use that to bring you closer to your
goals with your intimacy.
Speaker 3 (27:40):
So is titless one of the most common issues you see.
Speaker 2 (27:44):
It's a very big issue. Yes, and I will tell
you that I see a lot of young women who
have that. So they are you know, they're pre p perimenopause.
I'm talking about you know, young women in their twenties
or you know, early thirties. They have a lot of tightness.
They might have undiagnosed endometriosis. So that's something that you know,
(28:11):
I will take a more of a history. You know,
they do they have very heavy periods where the period's
so bad that they had to miss school and or
work or were they never able to put a tampon in,
Because that's a big clue, So that there's millions of
young women who have those issues. I mean, I have
(28:33):
a young woman who had a hysterectomy. She's thirty one,
and because she had cervical cancer. So you know, after hysterectomy,
your muscles can tighten up and it's very painful, especially
someone who can't take any type of hormone, including including
(28:54):
topical hormones, so that is a very very large component,
and it can happen after a C section two.
Speaker 1 (29:02):
So I assume you're a fan of vaginal estrogen very
much because I think, well, you tell me, but I
would imagine that some of these symptoms maybe present later
on in life around perry and postmenopause, with bladder leakage
(29:24):
and vaginal dryness and pain with intercourse and all of this.
So I mean, yes, does not get worse as we age.
Speaker 2 (29:34):
Well, it can because all of the tissues of this
first layer, the vulvar, the vestibule, which is the deep
layer right above the vaginal opening, these are all hormonally dependent.
So as you start going through perimenopause and you start
(29:57):
feeling some irritation there, there might be some you know,
some redness or some some irritation. The extra estrogen will
help that because it will plump up the tissue and
and add collagen to that area. It's referred to as
(30:18):
the genito urinary symptoms of menopause. So that's that's a
you know, a collection of symptoms that includes all of
these things I described, which used to be described solely
as vaginal atrophy. Now it has a broader, broader, A
(30:40):
horrible men, you know, I just I mean back in
the you know, twenty tens, like I had choked saying
that word because it was we didn't have that estrogen supplies,
you know, all of these tissues. But it also it
also affects the urethra, So the urethra and the bladders.
(31:01):
So as we go through perimenopause and start to have
those changes, the stiffness of the urethra decreases, which is
also an aging issue, because I mean, here's a fun fact.
So after around age twenty, the strength of the urethral
(31:22):
sphincters those are the muscles, the internal external sphincters that
close off the flow of urine. They decrease strength by
two percent every year.
Speaker 1 (31:34):
So this is like any other muscle. It starts, yeah,
to lose strength towards Okay, yes, no difference in the pelvis.
Speaker 2 (31:45):
No. But and interesting enough, just this past year, a
group I think their residents or interns of that work
with doctor Rachel Ruben and Sexual Medicine in Washington, they
propose and now we're using the term the genito urinary
symptoms of lactation because the same issues happen if you
(32:09):
are breastfeeding and your postpartum because when you're when you're breastfeeding,
the hormone trolactin is in abundance to encourage milk production,
and it's decreasing estrogen, so now you have ice. So
so many of the patients that I see, they also
(32:31):
need vaginal estrogen and it's you know, perfectly safe as
your if you're breastfeeding, but they are trying to recover
as well, all of these tissues and with the same
issues as perimenopause, you know, trying to have sex, having
painful sex, having some bladder leakage, having muscles that are weak.
So it starts in a way, it starts in postpartum.
(32:56):
And then if if you don't get any treatment and
then wait, you know, say ten or fifteen years to
start getting treatment, you can still get better, but it's
kind of laid the groundwork for you know, maybe there
is maybe there is a little more prolapse, maybe there
is now there is pelvic floor muscle, true atrophy in
(33:20):
the muscle, and that's something that a pelvic floor therapist
can feel like one side just might feel really thin,
the other side might have good bulk. It could be
because of the way the baby was sitting, and you know,
towards the end of the pregnancy, it could be from
the you know, just the pressure. But they're related, and
they're very much you know, it's very much a continuum
(33:42):
of the same issues that happened and that we treat for.
Speaker 3 (33:46):
So bladder control can affect women that have had children
or someone who hasn't had children, just with age, like
you were saying, with a two percent decrease.
Speaker 2 (33:59):
Correct, yes, yes, but there's a high number of young
elite athletes, female athletes who leak and is not because
of movement, that's because of tightness. So it might be
so if they are if they have if they're super
you know, they're strong, they're doing their sport, they might
(34:22):
have so much tension in their pelvic floor that at
certain points in their you know, maybe in their lift
or maybe in their you know, if they are volleyball players,
in their in their whatever it's called push, that's where
they're leaking. So that's also a thing. And children, i
mean children can it can also start in childhood because
(34:46):
children who are chronically constipated and don't want to go
to the bathroom at school, they develop these bad habits
and then they have type pelvic floors also, so it's
really a continuum from childhood to adulthood. But it's all treatable.
I mean, that's the good news. There are there are
options for treatment. But with exercise, you know, that's a
(35:10):
whole other thing. And and I see that in my patients,
and I see that in the you know, general community
of women who lift and exercise, and I think that's
also really important to talk about because there is treatment
and that can change, but we need to be really
(35:32):
specific about figuring out what it is that's causing that leakage.
Because for one person, it could be you know, as
soon as they do a lift. For someone else, it
could be jumping on the trampoline. For someone else, it
could be you know, even just taking a walk. So
(35:54):
I think that's a you know, for perimenopause and menopause
of women. This is a really good place to have
a discussion because there's forty percent at least of women
in this country leak, and they leak with exercise.
Speaker 1 (36:11):
All right, let's take a quick break to hear from
some of the body pod sponsors. We'll be right back. Well, okay,
let's maybe look at like, if somebody were to come
in with prolapse, well, prolapse number one, but then also
just like, I want to know the limitations for somebody
(36:33):
that because I get this question all the time. I
have prolaps, you know, do you think I can lift heavy?
And first of all, I'm like, I'm not your physician.
Number one, wrong person to ask, and I'm always going
to say ask your physician, but for like, what are
the limitations for someone with prolapse specifically?
Speaker 2 (36:59):
What is that look like?
Speaker 1 (37:00):
Would you say don't lift heavy? You know, there's a
lot of mixed conversations here.
Speaker 2 (37:06):
Yeah, well, I think I think first of all, it
depends on it. It depends on their symptoms and when
they feel the prolapse. So if they only feel the prolapse,
if they only feel that vaginal pressure and prolapse when
they're doing you know, lift X at so many reps
(37:27):
in this range, then bring it down. So let's try
to train the pelvic floor with that in that exercise,
because you know, maybe it's their breathing pattern. Maybe they
just are not coordinating their pelvic floor with their you know,
the stiffness and the abdominal wall. Maybe they're they're have
(37:49):
too much of a forward posture when they're lifting, So
it really has there's a lot of nuance that we
can break down and I would never tell anyone just
stop lifting, So I think that's really important. I also
think that there are things women can use for prolapse
to try to see you know, sometimes sometimes a Pessori
(38:13):
is a good option. So a pessori is a hard
plastic object that you would get from a eurogonecologist or
now in our country, some public dutias are being trained
in pessor reinsertion, which is fantastic, but because it might
be that just getting that bladder or bladderneck up a
(38:36):
little bit higher in the pelvis allows the muscles to
contract more more robustly, and then it eliminates that feeling
of something coming out of the vagina. So we really
need to look specifically at each person. But there's no
hard no in having prolapse. But you would want to
(39:00):
keep going on that same path where you're doing that lift,
where you're you know every time you're reinforcing that you're
feeling that pressure because you know that that you're you're
you're going to be you're not going to feel good
and you're going to limit. Ultimately, you know the pressure
dynamic in your trunk and you know, so there are solutions.
(39:25):
There's definitely solutions. It's very specific.
Speaker 1 (39:28):
Also, I mean that the breathing comes into play too,
because I've had people that when I talk about bracing
for lifting to protect the spine, they almost are down
where then they because they're pushing pressure down when you
know you shouldn't be pushing pressure down exactly.
Speaker 2 (39:49):
Well, that's why I mean, one of the things that
I think can really help with lifting and if someone
has a weak palplic chlore has proaps is to use
the to use these vaginal weights because this is something
these are different different weights that time in six sizes,
(40:12):
and I think that it can give someone the feedback
to that they're actually lifting and pulling in their palvot
floor as they're recruiting their their abdominals and then going
into the lift. So you know, it's it's again it's
if you don't if you're not aware of what's what
(40:34):
you're feeling and what the feedback is, it's really hard
to get better. But you you can. You you can
have these options for improving with with weights, with coaching.
You know there there's just there's no reason now to
not have those options in order to continue your your
(40:57):
fittest journey.
Speaker 1 (40:59):
Okay, I love the ways I ordered them. They still
haven't come to my house. It's been like a month.
Speaker 2 (41:05):
Back.
Speaker 1 (41:06):
And look, maybe you know how sometimes you think you
pross that that there actually purchased. So I got to
look at that. But the weights they come in obviously
different weights. They look like little mice to me.
Speaker 2 (41:22):
I don't know. They tell yeah, there's there's you know.
So the white is this the lightest, then it goes
to pale, pink, a little darker pink, a few shack
and then I always when I show patients this one
is if you're like a serious cross trainer or a
more Olympic lifter. Okay, because this one's pretty heavy, But
(41:45):
I think there it's a great tool, you know. And
it doesn't mean that doing keegels alone is the is
the answer to the problem. But you have to use
the pelvic floor to understand what it is and to
integrate it into the exercise and the activity and the breathing,
because one of the main tenets of breathing awareness and
(42:11):
diatramatic breathing is understanding that every time we breathe, we
take a breath in thee our breathing diaphragm, which is
three hundred and sixty degrees around and the pelvic floor
are always moving in the same direction. So you take
a breath in the pelvic floor and the diaphragm push
down and create that pressure. And then when you breathe
(42:32):
out and if you brace your abdominals, everything comes back
to its resting position or you get a contraction. So
learning how the breathing is with the pelvic floor integration,
I think is critical for anyone who wants to lift
heavy or just lift or do you know, high intensity exercise.
It's really an important part of that rehab journey.
Speaker 3 (42:56):
So a lot of this therapy is probably creating awareness
body awareness, even because I'm exactly, if you tell someone, okay,
tighten this part of your pelvic floor, they I don't
even know if I would know specifically how to do
(43:19):
certain exercises. So is that part of the beginning of
the therapy is breathing or like contracting certain aspects of
your body.
Speaker 2 (43:29):
Yeah, it's exactly because there are you know, over the years,
I've had many patients who I might be doing the
exam and asking them to contract. And there's different specific
cues I might use, So I might say contract like
you're stopping key and or construct contract like you're stopping gas,
(43:51):
because then we're you were accessing the deeper levt or
Ani muscles. But some patients do something the op so
they might be they might bear down when they think
they're contracting, and then they're contracting when they think they're
barren down. So and that technically is called disenergia. It's
(44:12):
like a complete mix up of what you actually want
to do. So so getting someone to be able to
feel that and understand that and not and to be
able to do it without engaging their glutes or pulling
their ad doctors together or sometimes they do this is
like it's it's a tremendous shift in their awareness. And
(44:36):
to me, that's foundational, Like that's the foundation of how
you heal of the floor dysfunction. It has to start
with this inner awareness. And I think you know, it's
the hands on therapy, it's the breathing, it's using these
tools that help give someone, you know, the their toolbox
(44:58):
to be able to to go on with this. So yeah,
one hundred percent the breathing and and you know, I
always ask people, you know, are you doing any kind
of mindfulness program? Are you taking any time to like
just use maybe use an app, Like I'm a big
fan of Headspace, the Headspace app because you can open
(45:21):
the app and they have a one minute breathing exercise
with a visualization. Like even if you just do that,
that's a lot. Like now you've also you've you've calmed
your nervous system, you've relaxed your public floor, You've had
that integration of the central and peripheral nervous system. Like
(45:43):
that's priceless, and that's foundational for all this work. So
you know, it's kind of the same way I approach.
Once I get someone to do more exercise, like I
give them some foundational strengthening if they need it. So
maybe just you know, lambshells or or bridging or something
(46:07):
to just feel the muscles and then progress too more
to standing, to different positions, to waits, Like you have
to have the foundation, I think in order to go further.
Speaker 1 (46:21):
So if somebody were to come to you, I know
this could be a huge range, but how many visits
on average would somebody come? Is it like twenty five?
Speaker 2 (46:35):
Is it ten? Is it?
Speaker 1 (46:38):
What does that look like?
Speaker 2 (46:39):
People do ask that and it's and it's a hard question,
but I mean there's I can give them certain guidelines.
So because I don't when they asked that before I've
met them and evaluated them, I don't know, you know,
I don't. I don't even know you like, so that
I have to, you know, I tell them, let's have
(47:01):
the exam. Because after the exam, we sit down, I
talk about what the findings are, what I think, in
my best professional opinion is the best plan of care,
and then we go from there. And you know, I
know people have expectations and financial considerations too, so I
want it to be I wanted to be work best
(47:22):
for you, But you also have to commit to doing
the homework that I'm telling you to do so because
you'll get the best results if we really collaborate together
on this. So we know that basically with muscle strengthening,
it takes eight to twelve weeks for muscle to change.
So if someone was really working on prolapse and strength,
(47:45):
I would say it's probably going to be you know,
eight to twelve visits. If someone If someone comes to
me with pain, plot pain that they've had for five years.
I'm going to I might say it's going to take
a minimum of twelve visits and you know, and then
we'll re reevaluate and see from there.
Speaker 3 (48:05):
What about bladder control?
Speaker 2 (48:08):
Bladder control? You know, So with stress and continents, we
have the best We actually have the evidence based studies
on palvit floor physical therapy for stress and continents. So
a typical program could be twelve weeks, but that doesn't
mean that they're coming to see me for twelve weeks.
They might come for six visits and then they might
(48:30):
do the rest at home, and then they might come
back and check in. So because we have very good,
good stats on that, we know that and this is
over many years in several countries that at least around
fifty percent of women who do pelvic floor therapy for
stress and continents have one hundred percent recovery, which is really.
Speaker 3 (48:54):
Good, great news.
Speaker 2 (48:57):
Yeah, seventy five percent might have have most issues, you know,
improved or full recovery. So there's still some that it
might not work for. And if it doesn't work, then
we have to look at you know, maybe you have
maybe you have a bladder and bladderneck that are sitting
(49:19):
too low. Maybe you have intrinsic sphincter weakness, and you know,
maybe like we can still do the therapy, but maybe
going to the urologist and having collagen injections might help
to you know, it really depends because if they have
those other issues where the bladder is sitting too low
(49:40):
in the pelvis, you're not They're just not going to
get that closure of the from the back wall of
the pelvic floor where the the so you create a
backstop and a front stop, and so we might need
to look at other things, but I think overall those
are pretty good statistics. So you know, I have some
(50:00):
patients who come to me during their the later part
of their pregnancy, and it might be because they have
those pelvic pelvic joint pain they might have, they might
have some and I'm able to do some internal pelvic
work with pregnant patients as long as their doctors sign
off on it and they don't have any type of
(50:21):
placental issues. And then at thirty four weeks we can
start doing perineal massage. And again for that there is
good evidence based studies that that decreases the incidence of
third and fourth degree paranial tears, which can lead to
fecal and urinarian continence and chronic pain. So we have
(50:42):
studies on things, you know, and so I'll always try
to impart as much information as I know. But sometimes
it's like, let's try this, let's see how you are
for you know, let's see if in a couple of
weeks you start to feel improvement. But I do feel
when for the most part, I will always tell someone
(51:03):
you can be much better, because they probably can't. I
know they can and they will. They will because they're
already starting something. So you know, I try not to
set expectations like you're going to be better in six
visits because probably you're not, because most people take seven
to ten years to come for treatment or they've seen
(51:24):
seven to ten doctors who didn't give them the right informission.
So it's really a different journey for you know, for
different people, but it's it can be really transformative for people.
It can really be it can you know, when someone
tells me that the work has changed their life, Like,
(51:49):
you know, I don't want to ever retire because that's.
Speaker 4 (51:52):
Like amazing, very rewarding, very rewarding, Okay, before we before
we go, I want to know, do you have a
tip that you can give our listeners of an exercise
that just strengths strengthens the pelvic floor, like whether they're
driving in their car, or they're sitting or there whatever,
(52:14):
is there an easy tip or exercise that people can
do that just strengthens the pelvic floor overall.
Speaker 2 (52:23):
Sitting is a great place to start because it's functional
and we all have to sit, so sitting in the
car or first on a flat chair, and I'm going
to just use the you know, finding finding a neutral
pelvic position meaning the same as if you were standing
up straight and you were not arching or slouching, but
(52:43):
just a relaxed neutral position because that way you have
the whole sling part of the pelvic floor in contact
with the seat. And first breathe and see if you
can feel that when you breathe in you can sense
that there's some sense of dropping or relaxing the pelvic floor.
(53:06):
And then once you do that, exhale and see, you know,
if you can contract it, give yourself the queue, stop
the gas. See if you feel the anal sphincter tightening
and pulling up, and if you do. If you can
feel that, then you already are winning because you have
some awareness of that. If you're having leakage, do the
(53:29):
same thing, but give yourself the queue, stop the flow
of urine, because then you're going to work more on
the area where those sphincters are. You're still going to
get those deep muscles, but if there's a sphincter deficiency,
you're going to start to get that as well. So
start with something really basic, see if you feel it,
(53:51):
and keep practicing that and then you know not everyone
needs to strengthen because we talked about people with the
high tone, non relaxing. But if you can feel that
you can relax and contract, then you know that you
have some good mobility there, and good mobility is like
the best place to start.
Speaker 3 (54:11):
Yeah, thank you so much for joining us.
Speaker 1 (54:15):
This is such a great conversation and so needed.
Speaker 2 (54:19):
So bad. It's my pleasure.
Speaker 1 (54:22):
How do people can? Can you work with people via zoom?
So how how do people find you?
Speaker 2 (54:28):
Well, they can find me on my website for Corners
Physical Therapy. They can also find me on my Google profile.
I actually have a lot of more information. So if
you just google four Corners Physical Therapy and SLORM I
mean Montclair, New Jersey. You'll come to my Google profile
(54:48):
and I have a Facebook business page, so four Corners
Physical Therapy. I'm on LinkedIn. I have a Instagram am
it's at four Corners PT but it's not great and
I have to work on that. I tend to put
(55:09):
more other things and those are the best ways to
get in touch with me. My email Debra at four
Corners Physical Therapy dot com and it's all spelled out
f O U R Corners Physical Therapy. So yeah, I'm
I'm excited. I'm so excited to share the information because
(55:31):
as much as as much as I think and my
colleagues and people who are already doing it think that
everyone knows, we don't know. We don't know, so and
you know, we could we could talk so much more
about the more specific things, but this is a This
was great and I think that I'm very grateful that
(55:54):
you gave me this opportunity. I feel like I'm sitting
on the shoulders of some really amazing people that you
too have interviews.
Speaker 1 (56:02):
This is fantastic. So we're so grateful for your knowledge,
your education, time to share this.
Speaker 2 (56:09):
Thank you.
Speaker 1 (56:09):
But it's a very important subject, So thank you so much, Deborah.
Speaker 2 (56:13):
My pleasure anytime, thanks for listening.
Speaker 3 (56:18):
If you enjoyed this episode, please consider giving us a
five star review and sharing the body Pod with your friends.
Speaker 1 (56:25):
Until next time,
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