March 21, 2023 • 32 mins
I’ve got to admit, pelvic health isn’t an area that I know a lot about. But I have often wondered if I was missing something in my athletes. So I really recommend that you become more aware of pelvic health issues and find someone in your area that you can refer patients to in the future.
In this episode, I’m joined by Amanda Olson, a pelvic health physical therapist, to talk about some of the symptoms of pelvic health issues, signs that we can look out for as sport physical therapists, how to collaborate with specialists in your area, and working with postpartum patients that want to return back to the gym or their sport.
Full show notes: https://mikereinold.com/pelvic-health-in-athletes-with-amanda-olson
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:00):
On this episode of the sportsphysical therapy podcast.
I am joined by Amanda Olson.
Amanda's a pelvic health,physical therapist and president
of the company, intimate rose,where she offers pelvic health,
education and products.
In this episode, we're going totalk about pelvic health issues
and athletes.
Some of the early signs to keepan eye out for and how to best
collaborate with a specialist inyour area.
(00:21):
So that way you can help yourathletes get back in the gym or
back to their sport.
Mike (00:36):
Hey, what's up Amanda?
Welcome to the podcast.
Thanks so much for joining us.
Amanda (00:39):
Thank you so much for having me.
Mike (00:42):
Uh, I've been looking forward to this episode because
you and I started talkingseveral months ago about
potentially getting you on here,and it's a topic that I openly
admit I know just very, verylittle about.
Um, enough that I know that Ineed to be friends with people
like you, um, to help me withthis, to help me and, and people
(01:02):
like me in this.
Um, you know, I, I, I totally.
Realize that we've probablymissed the boat on pelvic
health, um, throughout theyears, especially in athletes a
little bit, I would say.
Um, and I respect that and I, Iwanna learn more and figure out
how, um, people like me thatdeal with, uh, so many athletes
can, can find some early signs,can get'em to the right people,
(01:24):
that sort of thing.
So this should be a really fun.
Amanda (01:28):
absolutely.
Mike (01:29):
Cool.
All right.
Well, why don't we start withthis, because I'm always
interested in hearing this.
Um, I think, you know, you're a,a very niche physical therapist,
which I love.
Um, and I love your niche onpelvic health.
Tell me a little bit about, youknow, how you got involved,
how'd you start specializing inthis, you know, how can somebody
that wants to do the same, likekind of following your footsteps
(01:49):
a little bit.
Amanda (01:51):
It was actually a very adventurous event that happened.
I went, I actually went tophysical therapy school
expressly to specialize inpediatrics and about a year
after I graduated, so I had adoctorate degree in physical
therapy.
So I was smart enough to knowbetter old enough to know
better.
Um, I found myself in asituation where I was out in
(02:15):
nature here in Oregon and I waswith a group of boys who were
cliff jumping into the water at40 feet.
And it was one of those thingswhere it's like a spot in the
river.
It's very deep.
It's very.
Still, people have been jumpingoff at this spot for decades or
something.
And I am not a thrill seeker.
I'm a runner I much prefersteady as she goes, but, um, I
(02:37):
apparently still felt like Ineeded to keep up with the boys.
And when you jump off a cliff at40 feet, apparently you're
supposed to land straight in thewater like a
Mike (02:46):
Right.
Right.
Amanda (02:48):
I landed an L
Mike (02:50):
Oh,
Amanda (02:51):
Bottom first at 40 feet and at 40 feet water behaves
much like concrete.
Um, yes, so I annihilated myself
Mike (03:01):
Oh man.
Bummer.
Amanda (03:03):
yes, it was a big bummer.
had to be like fished outta thewater, and um, I had significant
injury to my tailbone, mypelvic.
Floor, my low back.
It was, it was a really badsituation and I'm so lucky
because, you know, if I had torotated a little bit, um, or hit
a different way, I could begone.
Um, for sure.
So I'm so lucky and I got out.
(03:26):
I was able to walk and ininterestingly enough, but by the
time I got back to my primarycare physician, she recognized
immediately that I.
Significant injury to my pelvicfloor and to my pelvis.
And she knew right away, andthis was very interesting cuz
this was 14 years ago to referme to a pelvic health physical
therapist.
And at the time in, in the USthere was a couple hundred, you
(03:49):
know, we as a.
As a, uh, population of, ofphysical therapists have
actually been around for roughly42 years, but as you mentioned,
it has been very niche.
So people, physical therapistshave been doing this all the
time, but I was so lucky that Ihad a great one there in my city
and she fixed me up.
And, um, it was a long processof rehabilitation, but she said,
(04:12):
you need to quit pediatrics.
You need to do this We, we needto get you trained up cuz
there's not enough in thecountry and you have the right
personality for it.
So I did, I went back andre-certified and now this is my
passion, you know, this is whatI'm here to.
Mike (04:28):
And which, which is amazing too.
And usually I tell people tofollow in the footsteps of their
mentors, but I don't think weshould follow in your footsteps.
Right?
We don't wanna have to jump offa cliff to, to, to find our
niche in this world.
But I think we can, we can learnfrom the importance of all this
from you,
Amanda (04:44):
Yes.
If you do jump land straight
Mike (04:47):
Yes.
Exactly.
Feet first or hands first ordoesn't matter.
They're both the same, right?
It doesn't matter.
you can pencil or dive itdoesn't matter.
But definitely don't go bottomfirst.
Okay.
I like it.
Okay.
All right.
So that's a wrap everybody.
Great episode, Amanda.
We learned a lot this Um, so I,I.
That's amazing.
And I give a lot of credit tonot only your, your physician
(05:10):
that you said, but then thatperson that you found because
they're, they're probably, likeyou said, a trends center to an
extent where they, they said,this is an important thing.
And then I feel like, just likea lot of other niches is once
you see it, you're like, oh, ohmy gosh.
How, how do we miss this?
And why aren't more peoplespecializing?
So for, for me, I think that'slike where I get excited when
(05:31):
people like you say, this iswhat I wanna do.
Um, as a sports pt, I know thisis where I feel like I've, I've,
every now and then I've, I'vehad that little like spidey
sense where you're like, Hmm, Iwonder if I'm missing something
on this person.
Maybe it's not a sport hernia.
Maybe it's.
F a I or a groin strain orwhatever it may be.
Um, tell me a little bit aboutthat.
(05:54):
Like, let's start with that andgoing over, like, what are some
of the most common pelvic floorissues that you see in athletes?
Amanda (06:03):
Yeah, interestingly.
All of those diagnoses that youjust listed actually can be
occurring in the person and theycan as a, as a sequelae or as a
secondary effect, be havingpelvic floor dysfunction.
So, um, for me, because that ismy primary, uh, area of
practice, um, in the athleticpopulation, I tend to see a lot
(06:23):
of incontinence.
With exertion.
So that could be the, what wecall it in Nolo Paris.
So somebody that's not beenpregnant or had a baby, um,
experiencing incontinence.
And so that is actually prettyprevalent.
Um, interestingly enough,there's been several different
studies that show a range fromanywhere from 28% to 82% of
female athletes that have neverhad a baby are experiencing some
(06:46):
degree of incontinence.
And so when you look at thatupper ceiling of like 82%, I
hope that all of my orthopediccolleagues are.
Whoa.
Those people are in my clinic.
Mike (06:57):
That's all of them.
right?
I mean that's a, it,
Amanda (06:59):
At some
Mike (07:00):
all of them.
now is, is that sport specific?
Like, cuz you know, 28 orwhatever it was to 82, I mean
that's a large range.
Was that, was there a sport, um,like is it like different levels
of sports where that's a littlebit more, more prevalent than
others?
Amanda (07:14):
Yeah, they're saying high impact.
So some of the studies lookspecifically at running, but a
lot of them are broadly lookingat high impact.
And so in that they're includinggymnasts, runners, basketball
players, um, like lacrosse.
Um, Jumpers, those kinds ofthings.
So thinking impact.
Um, and then across both gendersor all the genders, um, pelvic
(07:35):
pain, um, which can bemasquerading as a hip pain or a
low back pain, it can beassociated with.
Trauma or other injuries.
And it can also be associatedwith stress and, um, how they
are guarding against that.
And then of course, in yourcyclist population, it can be
due to nerve compression withhow they are seated and, um, the
(07:56):
prolonged time that they're sethey're spent on their seat.
Mike (08:00):
Right.
And, and, and just to clarify,these are things that can happen
to all genders, right?
This isn't, this isn't a femalething.
I know we, we, you know,postpartum makes this a real
issue for, for females,obviously.
But when you said, you know,athletes that were not
postpartum, right?
Not pregnant, no po wellpostpartum, um, that means this
applies to everybody, right?
Amanda (08:21):
Yeah, it certainly.
Mike (08:23):
And is there, do you see that incidence, um, different
between genders?
Like is this more specific tofemales or could it be.
Amanda (08:32):
Um, a lot more of the data is taken on female
athletes.
Um, there's some new emergingdata on the incontinence aspect
on the males.
Um, because of the anatomy, itdoes tend to affect females a
little bit more.
Um, there's a little bit moreopportunity for.
What we call gapping around theurethra are just different
changes in the dynamic dynamicsof their pressure system, um,
(08:55):
that we see in sport that canresult in those symptoms of
urine linkage.
Um, but there is more work beingdone to start collecting data on
males.
And then of course, in the paincategory, we know that it is
affecting both.
Mike (09:10):
Right.
I can see that too, for sure.
And, and, and just to clarify,incontinence in a young athlete
is abnormal, right?
So
Amanda (09:20):
In anyone.
Yeah, it's common in thepostpartum population, but not
normal.
And then in the young athletewho's never had surgery, never
had a baby, we wanna becertainly picking that up and
getting, getting that addressedright away.
Mike (09:34):
Right.
So do you, you know, I knowyou're, you're a niche, but for
me in the sports setting, um, atour clinic, you know, we have
one of our therapists, DaveTilley's, a big gymnastic
specialist.
Um, he's got, you know, almostexclusive, um, young female
athletes that are, that aregymnasts.
Um, when do you start addingthis almost to like your intake
(09:56):
forms or that sort of thing?
Like when do you start addingthis?
To kinda ask some of thesequestions.
They're, they're coming in,you've never seen before.
Maybe their parents brought'emin because they have low back
pain or hip pain or a groinstrain.
Right.
Or whatever.
Like when do you, when do yourecommend that people in the
sports and ortho section startto broach these subjects?
And, and h how do we do that ina way that doesn't make the
(10:17):
athlete uncomfortable?
Amanda (10:19):
I recommend that they do it yesterday, Um, I try to
always educate, especially whenI am, um, around my ortho
friends, um, to advocating toget it.
Put on the intake forms rightaway because, um, a couple of
things in the dynamic,especially between like, say
like a male with a young femaleathlete, it can be difficult to
(10:39):
have those conversations.
But if it's on the writtenintake form and they're filling
it out privately or with theirparent, they can fill in a
bubble or they can circlesomething or they can check.
And then when you receive that,say even if you're seeing them
for their elbow or their knee ortheir foot, and you see that
there, you can, as part of yourtherapeutic alliance when you're
(11:02):
taking their medical history,say something to the effect of,
I see that you've indicated herethat you sometimes leak urine.
That can indicate that theremight be a problem with your
pelvic floor.
And I'd like to recommend, inaddition to our care that we're
doing here, that we get aconsult.
So you're not quarterbackingthat patient outta your clinic,
you're still managing them, andyou're working with a, um, a
(11:24):
very collaborative pelvic healthPT that can be then helping to
manage that person and then you.
It's, it's just an easy way foran orthopedic PT who may not be
comfortable having in-depthconversations to screen.
And so the, there's like four orfive questions that are just
easy, easy to include on thatbasic medical intake form.
(11:44):
And they are, do you experienceloss of urine when you jump,
run, sneeze, cough, or play yoursport?
Um, do you experience pain withbowel movements or issues having
a bowel movement?
Do.
Feel a bulge or a sense ofpressure in your pelvic area or
in your vagina.
And then also do you have anydifficulty having a medical exam
(12:08):
with a gynecologist, becausesometimes they don't even bring
it up there.
So it may be that they're havingissues using a tampon or
tolerating a speculum in theolder population, like if.
Athlete is older, not like yournine year old gymnast sitting in
front of you.
It may be that they have painwith intercourse, and that may
be not a conversation thatyou're interested in having as a
(12:29):
orthopedic pt, but if it's onthere, then you can be, you can
be working collaboratively withyour pelvic PT colleague.
Mike (12:37):
Well, and I, I think the fact that you even put those on
an intake form, um, I, Iwouldn't be surprised if a young
athlete, like in their teens,like they didn't understand that
those things were abnormal.
So they just thought, oh,that's, that's me.
That's what I do.
That's maybe everybody's likethat.
Maybe everybody has.
A little bit of incontinencehere and there.
Right.
So I think just even puttingthem on that, on the form, um,
(13:00):
actually might be helpful justfor them to realize and open up
a conversation that they didn'teven realize was part of it.
Amanda (13:06):
absolutely.
Mike (13:07):
So you, I, so for me, I wanna know some of the early
signs, right?
So incontinence seems like, Idon't wanna say a late sign,
right?
But it's like, um, like that,that, to me, that's an obvious
one.
What are, what are some of the,the more, more subtle things
that we can look for or, ormaybe the nuances of some, some
pain that you mentioned earlier.
(13:28):
What are some of the things thatwe can do when we say, oh, wait
a minute.
They said they had hip pain,they said they had back pain.
I did my full orthopedic screenof their, of their back or their
hip, and it didn't a hundredpercent add up.
What are some of the otherthings that we should look for?
Amanda (13:43):
um, if they have a history of constipation that can
indicate a pelvic floordysfunction, tailbone pain, and
then when it comes to the hip,it's often deep.
Hip pain that they can't reach,they can't stretch.
Like you put'em into a figurefour stretch.
No, that's not quite it.
Internally rotate'em, not quitethere yet.
(14:04):
Getting closer, you know, andthey, they might point through
it through the groin area andsay it's deep in there.
Um, which then you would need tobe screening for the hernia.
And they do tend to happentogether.
PE the floor dysfunction inhernia can happen together.
Or they're like saying deep in.
Not the sciatic nerve, it's notfollowing the porous kind of
thing.
And just if, if you can imagineas you're doing your evaluation,
(14:27):
the pelvic floor is literally onthe other side of that special
plane of the piora.
Um, it is, you know, I thinksometimes, especially in PT
school, I'm thinking about howthe way that my brain.
Created that geography or thatanatomy prior to pelvic health
education.
And you're thinking like, oh,you learn about ator,
internists, but it's deep inthere.
(14:47):
You'll never reach it.
No.
In pelvic health, we palpatethat every day, and we can reach
it, and it is often a driver ofpain.
So it's kind of that, that deephip pain where you're not able
to quite reproduce it on thetable.
Mike (15:00):
And I, I, I think that part is great because I bet you
that happens more than peoplegive a credit.
They come in, it's in your head.
You're like, oh, bam.
This is an f a i patient formore oso tabular impingement,
that this is easy.
I got this right.
And then you bring'em to thetest and you're like, oh, wow.
Nothing produced Pain Right.
Which, so I, and as a sports PTin this conversation, I can tell
(15:23):
you if you're listening, that'sweird, right?
If you have f a i, it is kind ofclear you have f a i, right?
Like we can reproduce it withsome of our range of motion and
internal, uh, rotation stuffthat Amanda kind of just
mentioned there.
Um, so again, this is where, youknow, I tell our PT students
this all the time.
Um, I don't like scratching myhead.
When I scratch my head andsomething confuses me, we're
(15:44):
missing something or take, wegotta take a step back and think
outside the box, what are wemissing?
So remember that orthopedically,if you're looking at something
and it doesn't add up, you haveto start thinking, okay, that
should have.
That f a I test, I just did,should have produced some
symptoms and it didn't.
So let, let, let me startworking on that.
So I guess that's my nextquestion now.
(16:05):
Okay.
We found somebody, we have somequestions.
Uh, what do you recommend we dofirst you kind of alluded to
this, that we, that we, youknow, we work in collaboration
with somebody.
How do we find a good person inour area?
Do you guys have like anassociation or something that,
you know, like how can people inour area reach out and find some
people near.
Amanda (16:25):
Absolutely.
So the American Physical TherapyAssociation's Academy of Pelvic
Health has a list served withpelvic providers throughout the
country, and I will say backfrom 14 years ago to now, there
are.
Thousands.
We are in every state.
Um, we are, we, the numbers aregrowing.
There's better awareness.
(16:45):
So, um, that is a reallyreliable place to find them.
Um, I have a listserv as well,so if people are listening and
they, they want to find acolleague in their area, I can
help connect them by zip codetoo.
So, um, yeah.
There's a, and then I alwaysrecommend too, like any, like at
your state conferences, whenyou're there, if you're visiting
(17:06):
for that or csm, try to try tofind those providers and team up
with them.
And a great sports pelvic PT isgoing to be a tremendous asset.
We're very collaborative.
We're not gonna take yourpatient away.
We're gonna be addressing theother side of that special
plane.
And you keep working on whateverit is you're addressing.
Mike (17:24):
I like that.
Amanda (17:25):
We're gonna service that patient and we're gonna help
them reach their goals.
Mike (17:29):
I, I, I think you said it great too before is like, don't
just punt.
Right?
I think you, you kind of alludedto that.
Don't just punt say, oh, thismight be something else.
No, their, their hip and their,their exterior muscles that
we're talking about in their hipand their low back, those might
need some things too.
And that could be somethingwhere it's, it's a collaborative
effort.
So I, I think that's a really,uh, good way of thinking of it.
(17:49):
Um, I, I really think you shouldtake Amanda up on that, by the
way.
Um, so I'll put some info on herwebsite on, in the show notes,
but you should probably checkout the A P T A pelvic floor,
um, uh, academy, uh, or pelvichealth AC academy, I should say.
Um, you should probably checkthat out because I think if
you're working with athletes,you should probably have
(18:10):
somebody just like you have ashoulder specialist, an elbow
specialist, a knee specialist.
Doctors, chiropractors, massage.
I, I feel like you need to haveone of these in your network,
and I bet you a lot of mylisteners don't, Amanda,
unfortunately.
So, um, make these connectionsand, and, and let's, let's do
this, right.
Um, let's, let's shift gears alittle bit.
(18:31):
Similar note here, but I think,um, a lot of my listeners
probably do work with postpartumpatients and, um, a lot of the
people I think that, that listento me are both fitness and.
Professionals.
So I think we, we have lots ofdifferent avenues there, but
they're also helping people getback to some advanced level
things like, like working out inthe gym or, you know, if, if
(18:53):
they're a runner or, or playingwhatever their sport is.
Um, I know this is a broadquestion because this is so
fresh to me, but what are someof the keys to working with
postpartum patients that youstart with?
What are the things you focuson?
Help somebody like myself that'snaive.
Start getting into.
Amanda (19:11):
Absolutely.
Um, so depending on how they'vecome to you, whether they're
just coming in because they arepostpartum and they are looking
for a safe transition back in,or they're coming in with a
driving injury, you know, they aspecific reason.
I always recommend that as aclinician, we realize and we
help educate with this personthat.
Every cell in their body changedwhile they were pregnant.
(19:34):
And their, their body haschanged.
Their, their abdominals havechanged, their feet have
changed.
And so in this way, their brainmap might not quite match the
body that they have at thismoment.
It's almost like AlisonWonderland, where they were
very, they were very tallyesterday and they're very short
today.
Um, you know, they, they hadchanges in their posture and
(19:55):
elongation of certain muscles
Mike (19:57):
whoa, I could touch my toes.
I could never touch my toes.
Amanda (20:00):
Yeah, I can roll over
Mike (20:02):
Yeah.
Right.
Exactly.
Mm-hmm.
Amanda (20:04):
so along those lines, their coordination has changed,
their timing and their speed ofcontraction has changed.
And we have data now thatdemonstrates that, especially in
their abdominal and trunkmuscles, they are highly
fatigable.
are also sleepy fatigable.
So we want to be providing thisjust general, almost like giving
(20:28):
them, like reminding them togive themselves grace.
It's not about like, oh, go easyon yourself.
Cuz certainly an athlete doesnot want to go easy on
themselves.
They wanna be.
Bounce back, you know,yesterday.
Um, but it's just reminding themthat their body has been through
these changes and that their,their motor control, their
ability to control those, uh,these new segments, um, is
(20:49):
different.
And so from that lens, we wantto be doing a complete.
Screen, you know, a, a completeposture movement screen of their
trunk, their hips, looking attheir feet, um, reminding them
that oftentimes they have lostsome intrinsic muscle control or
strength, um, and that they aregonna be wanting to include foot
(21:11):
training in their, in theirretraining, because, That is the
base of their contact.
Um, and then from there,especially, I, I think that this
return to run, uh, runningreadiness screen is really
practical for all types ofathletes.
So just doing an overall screenof their form.
It's a, you know, a single legsquat.
(21:33):
It's a wall squat, looking attheir endurance.
I step up and.
A two foot hop.
So you're looking at theirability to mitigate force.
You're looking at their fatigueability and symmetry, right
versus left, which is oftencrummy especially in their
single egg squat.
And then from there you can goon to design their plan of care
(21:54):
or their exercise program andthen of course screening for the
pelvic floor.
Um, but it's, you know, whenwe're looking at these, what's
the magic?
As to when they're appropriate.
There is no hard and fast date.
It's not six weeks, it's not 12.
It's the person in front of you.
And that's where workingcollaboratively with somebody
that specializes can help youdrive your exercise prescription
(22:18):
and some of that, um, becausethey're going to be helping to
ensure that there's no othercontraindications or, um, like
more like yellow flag typethings to them participating in
exer.
Mike (22:31):
Yeah, for sure.
And, and call me crazy.
It seems like everybody.
Should go through this.
I mean, we're, we're talkingabout athletes, we're talking
about people that maybe, youknow, weren't feeling great
after pregnancy.
Right?
It, I mean, think about whathappens to your body during
pregnancy, right?
There's, you have a lot oforthopedic things you gotta get
back to.
It's crazy that we just saylike, oh yeah, no, it'll come
(22:52):
back, right?
Without, without working withsomebody.
Isn't that crazy?
Amanda (22:57):
Yes, very.
Mike (22:59):
So h how many people in your practice come to you
without any issues?
They just, they give birth andthey say, you know, I, I know
that just, that really changedme.
Um, and I wanna do the best Ican.
How many people do you work withlike that versus people that are
coming because they havepersistent back pain or
something like that?
Amanda (23:18):
I would say roughly 10%.
You know, it's the ones thatalready know what I do, and
they, they just want to be doingthe best they can.
Or they recognize, you know, incountries like France, every
woman gets 12 visits of pelvichealth physiotherapy provided
under their system to, to, theycall it perineal, reeducation,
(23:39):
and
Mike (23:40):
that,
Amanda (23:40):
That's exactly what it
Mike (23:41):
Right?
Yeah, that's, that's, that'sgreat.
Amanda (23:43):
Yes.
So there's people that arerecognizing that and that are,
you know, wanting it, um, sothat they can either mitigate
any forces or really address anysmaller things that they're,
they're feeling.
Mike (23:56):
It just seems like a no-brainer and we haven't even
talked about a C-section and Ican't even imagine.
You take all that plus then you.
Disrupt your abdominal wall.
I mean, like the, I I can, I canonly imagine.
Um, so, uh, yeah.
Uh, so it sounds like we needmore awareness.
We need more awareness in thiscountry.
But why aren't doctors liketelling their, their patients to
(24:18):
do this?
Why aren't primary cares or obGYNs, why aren't they saying
like, Hey, you know, by the way,after you give pregnancy, like
you should go see this personand, and, and help you get back
on your feet faster.
Why isn't that a thing in theUnited.
Amanda (24:31):
You know, we are working on it.
I have seen a vast improvementin the last 14 years, and I will
say this younger generation ofphysicians are doing it.
They are.
I.
You know, when I go to nationalconferences where physicians are
present, it's, it's thatyounger, newer generation, uh,
fresh outta residency toroughly, you know, five, 10
years out that are saying, ohyeah, we, we have a whole team
(24:54):
of public health physicaltherapists.
We send our patients there.
Um, and I think from theirperspective too, they are
looking at it from theirparticular lens.
And if they're not aware, it's,it's like we see what we look.
We look for what we know.
If they're not aware yet, that'sour fault.
As physical therapists and weare working on it, you know, we
(25:14):
are working to raise awarenessand I think that it, it has
worked in that youngergeneration changing practice
patterns of some of the set intheir ways.
Physicians can be morechallenging, but it's when we
get one or two in and they seethe differe.
It's, it's like anything, youknow, when you're new in town as
a physical therapist and you'rehaving to prove yourself, it's,
you know, send me, send me theone that is struggling, send me
(25:36):
the one that's in incontinent orhaving pain and can't sit.
Send me them and I will helpthem.
And then they see the resultsand that, that's ingrained in
their head when, when we'rehelping their patients.
That makes a difference.
Mike (25:48):
Yeah, may I, I can see that making a lasting
impression.
And then that'll probably changetheir practice for forever once
they go through a tough one.
Um, you know, so well, hopefullyat least, so um, awesome.
So, all right, so we need moreawareness.
We know that you need to find aspecialist in your ear.
You need to, I, I would at leastjust say for people listening,
you need to have this on yourradar.
And I think that's the mostimportant thing cuz this wasn't
(26:10):
something that I thought ofearlier in my career, but I
definitely, I, I had severalpatients, you know, and, uh, I
think CrossFit, um, as thatgained popularity like 10 years
ago or so, and it got really,really popular.
I think we started seeing more.
More people in our, our clinicswith this because, uh, it became
more obvious, maybe because theywere doing so much more
activities.
(26:30):
Um, but I definitely realizedthat this is something that I
wanted to get better at or atleast understand so I can
collaborate.
And that's really why I wantedyou to, to come share this with
us, Amanda.
So I.
Thank you so much for takingtime out to do this.
This was awesome.
Um, before I let you go, wegotta have our high five segment
at the end where five quickquestions, five quick answers.
(26:51):
Um, very curious here, but Ilike hearing it.
I like hearing how people think.
I like their brains.
Right.
And, and obviously you're,you're, you're smart.
So I want to hear a little bit,but first question, what are you
currently working on for yourown professional development?
I know you educate a lot ofothers.
What are you.
Amanda (27:07):
I am brushing up on some of the newer data.
So over the pandemic, all of ouramazing colleagues that we're
looking at how the Calvinrunning, produced a ton of new
literature.
Um, so I am going through andbrushing up on that.
We published a paper in April onthat subject and are looking at
doing another delphy, um,shortly that is international.
(27:29):
So it's a lot of data there, butanother one that I am having to
re.
Integrate into my practices,this change in IT band from
friction syndrome to, we'recalling it compression now, is
Mike (27:42):
Yeah.
Yep, yep.
Exactly.
Yeah.
Amanda (27:45):
yes.
Mike (27:45):
friction.
I mean, we'll
Amanda (27:46):
Yeah.
Mike (27:46):
it again in 10 years.
It is what it is, but sure.
Amanda (27:49):
Yes.
So I'm pouring back through thatliterature as well and changing,
you know, cause I teach a twoday course on, uh, pelvic floor
dysfunction and runners, andit's pertinent because of the
role of the hip.
So I'm, I'm having to reacquaintmy brain with some different,
some changes in understanding ofthe mechanics.
Mike (28:06):
exactly.
Well said.
I like that.
Um, what's one thing that you'verecently changed your mind?
Amanda (28:13):
Oh, um, I would say two minute plank test.
I still, I still like it, um,because I do like pushing
patients into fatigable statesin service of especially
running, um, but less as adiagnostic tool, more as a, uh,
training tool that they can dowhile they're.
You know, maybe having to doother things with their brain,
(28:33):
especially in the postpartumpopulation, they're oftentimes
having to multitask.
So I feel like that's kind of aneasy one, but not using it to
let necessarily like diagnose,but more as just a training
tool.
Mike (28:45):
I like that.
That's a good one.
What is your favorite piece ofadvice that you love to give
your student?
Amanda (28:50):
Okay.
Oh, um, well, I think the, themost pertinent is that what you
are learning currently is notgonna be how you practice in
three years.
It's, I mean, it's not even fiveanymore.
It's like
Mike (29:03):
right?
Yeah.
Amanda (29:04):
turn and burn.
Mike (29:06):
Right, exactly.
That's great.
So keep an open mind and, andyou know, I I, you know, it's
funny you say that cause that isone of the areas I see so many
young professionals like dig inon their opinions, like really
hard, really fast.
And, and, you know, people likeus, we just watch on Instagram
and you're like, they're gonnaregret that post in three years.
you know, they, that was alittle aggressive.
(29:29):
Uh, but nice.
I like it.
What's, uh, what's coming upnext for.
Amanda (29:33):
Um, working on the Delphy with Shali, Christopher
and Rita Dearing, and aninternational team of amazing,
um, physios in the running andpelvic health space.
So we're working on creatingsome recommendations for
postpartum return to fitness andrunning.
Um, and CSM CSMs coming up inlike, what, five weeks?
(29:55):
Six.
Mike (29:56):
Yeah, it's so close that I'll probably publish this
podcast well after, but yes, Ilike that.
Maybe it'll be next CSM thatyou're talking about in Boston.
I like that
Amanda (30:05):
Are we coming your way?
Mike (30:06):
We're coming to Boston in February.
It makes perfect sense.
Like I don't even, I don't evenwanna be in Boston in February,
but yes, it should be good.
Hopefully we'll have a goodturnout
Amanda (30:15):
And we're all gonna be stuck there cause no flights
come and go outta Boston inFebruary.
Mike (30:20):
There's a solid chance I'll leave it at that, that
there's a solid chance you don'tget home or to the meeting on
time, but we'll just leave it atthat That's awesome.
Well, Amanda, how can peoplefind out more about you?
Um, te tell me like where, whereyou like to, to collaborate with
people.
Is it Twitter, Instagram, yourwebsite?
What, what's the best place tofind more info from you?
Amanda (30:39):
I'm on all those places.
I love Instagram, so I'm aOlsen, d p t and Intimate Rose,
which is my company.
And um, for website, theIntimate Rose website, I have
hundreds of videos and blogarticles and free education for
patients and providers alike onevery subject in Pelvic Cal
(31:00):
under the sun.
Mike (31:01):
Awesome.
That's great.
Yeah, really appreciate youtaking some time out today and
just appreciate all you do forthis niche and combining it with
sports because I think that'swhat's really neat about what,
what you're doing right now.
So appreciate that and all yourinsight and um, thank you so
much for coming on the podcasttoday.
Amanda (31:18):
Thank you so much for having me.
On this episode of the sportsphysical therapy podcast.
I am joined by Amanda Olson.
Amanda's a pelvic health,physical therapist and president
of the company, intimate rose,where she offers pelvic health,
education and products.
In this episode, we're going totalk about pelvic health issues
and athletes.
Some of the early signs to keepan eye out for and how to best
collaborate with a specialist inyour area.
(00:21):
So that way you can help yourathletes get back in the gym or
back to their sport.
Mike (00:36):
Hey, what's up Amanda?
Welcome to the podcast.
Thanks so much for joining us.
Amanda (00:39):
Thank you so much for having me.
Mike (00:42):
Uh, I've been looking forward to this episode because
you and I started talkingseveral months ago about
potentially getting you on here,and it's a topic that I openly
admit I know just very, verylittle about.
Um, enough that I know that Ineed to be friends with people
like you, um, to help me withthis, to help me and, and people
(01:02):
like me in this.
Um, you know, I, I, I totally.
Realize that we've probablymissed the boat on pelvic
health, um, throughout theyears, especially in athletes a
little bit, I would say.
Um, and I respect that and I, Iwanna learn more and figure out
how, um, people like me thatdeal with, uh, so many athletes
can, can find some early signs,can get'em to the right people,
(01:24):
that sort of thing.
So this should be a really fun.
Amanda (01:28):
absolutely.
Mike (01:29):
Cool.
All right.
Well, why don't we start withthis, because I'm always
interested in hearing this.
Um, I think, you know, you're a,a very niche physical therapist,
which I love.
Um, and I love your niche onpelvic health.
Tell me a little bit about, youknow, how you got involved,
how'd you start specializing inthis, you know, how can somebody
that wants to do the same, likekind of following your footsteps
(01:49):
a little bit.
Amanda (01:51):
It was actually a very adventurous event that happened.
I went, I actually went tophysical therapy school
expressly to specialize inpediatrics and about a year
after I graduated, so I had adoctorate degree in physical
therapy.
So I was smart enough to knowbetter old enough to know
better.
Um, I found myself in asituation where I was out in
(02:15):
nature here in Oregon and I waswith a group of boys who were
cliff jumping into the water at40 feet.
And it was one of those thingswhere it's like a spot in the
river.
It's very deep.
It's very.
Still, people have been jumpingoff at this spot for decades or
something.
And I am not a thrill seeker.
I'm a runner I much prefersteady as she goes, but, um, I
(02:37):
apparently still felt like Ineeded to keep up with the boys.
And when you jump off a cliff at40 feet, apparently you're
supposed to land straight in thewater like a
Mike (02:46):
Right.
Right.
Amanda (02:48):
I landed an L
Mike (02:50):
Oh,
Amanda (02:51):
Bottom first at 40 feet and at 40 feet water behaves
much like concrete.
Um, yes, so I annihilated myself
Mike (03:01):
Oh man.
Bummer.
Amanda (03:03):
yes, it was a big bummer.
had to be like fished outta thewater, and um, I had significant
injury to my tailbone, mypelvic.
Floor, my low back.
It was, it was a really badsituation and I'm so lucky
because, you know, if I had torotated a little bit, um, or hit
a different way, I could begone.
Um, for sure.
So I'm so lucky and I got out.
(03:26):
I was able to walk and ininterestingly enough, but by the
time I got back to my primarycare physician, she recognized
immediately that I.
Significant injury to my pelvicfloor and to my pelvis.
And she knew right away, andthis was very interesting cuz
this was 14 years ago to referme to a pelvic health physical
therapist.
And at the time in, in the USthere was a couple hundred, you
(03:49):
know, we as a.
As a, uh, population of, ofphysical therapists have
actually been around for roughly42 years, but as you mentioned,
it has been very niche.
So people, physical therapistshave been doing this all the
time, but I was so lucky that Ihad a great one there in my city
and she fixed me up.
And, um, it was a long processof rehabilitation, but she said,
(04:12):
you need to quit pediatrics.
You need to do this We, we needto get you trained up cuz
there's not enough in thecountry and you have the right
personality for it.
So I did, I went back andre-certified and now this is my
passion, you know, this is whatI'm here to.
Mike (04:28):
And which, which is amazing too.
And usually I tell people tofollow in the footsteps of their
mentors, but I don't think weshould follow in your footsteps.
Right?
We don't wanna have to jump offa cliff to, to, to find our
niche in this world.
But I think we can, we can learnfrom the importance of all this
from you,
Amanda (04:44):
Yes.
If you do jump land straight
Mike (04:47):
Yes.
Exactly.
Feet first or hands first ordoesn't matter.
They're both the same, right?
It doesn't matter.
you can pencil or dive itdoesn't matter.
But definitely don't go bottomfirst.
Okay.
I like it.
Okay.
All right.
So that's a wrap everybody.
Great episode, Amanda.
We learned a lot this Um, so I,I.
That's amazing.
And I give a lot of credit tonot only your, your physician
(05:10):
that you said, but then thatperson that you found because
they're, they're probably, likeyou said, a trends center to an
extent where they, they said,this is an important thing.
And then I feel like, just likea lot of other niches is once
you see it, you're like, oh, ohmy gosh.
How, how do we miss this?
And why aren't more peoplespecializing?
So for, for me, I think that'slike where I get excited when
(05:31):
people like you say, this iswhat I wanna do.
Um, as a sports pt, I know thisis where I feel like I've, I've,
every now and then I've, I'vehad that little like spidey
sense where you're like, Hmm, Iwonder if I'm missing something
on this person.
Maybe it's not a sport hernia.
Maybe it's.
F a I or a groin strain orwhatever it may be.
Um, tell me a little bit aboutthat.
(05:54):
Like, let's start with that andgoing over, like, what are some
of the most common pelvic floorissues that you see in athletes?
Amanda (06:03):
Yeah, interestingly.
All of those diagnoses that youjust listed actually can be
occurring in the person and theycan as a, as a sequelae or as a
secondary effect, be havingpelvic floor dysfunction.
So, um, for me, because that ismy primary, uh, area of
practice, um, in the athleticpopulation, I tend to see a lot
(06:23):
of incontinence.
With exertion.
So that could be the, what wecall it in Nolo Paris.
So somebody that's not beenpregnant or had a baby, um,
experiencing incontinence.
And so that is actually prettyprevalent.
Um, interestingly enough,there's been several different
studies that show a range fromanywhere from 28% to 82% of
female athletes that have neverhad a baby are experiencing some
(06:46):
degree of incontinence.
And so when you look at thatupper ceiling of like 82%, I
hope that all of my orthopediccolleagues are.
Whoa.
Those people are in my clinic.
Mike (06:57):
That's all of them.
right?
I mean that's a, it,
Amanda (06:59):
At some
Mike (07:00):
all of them.
now is, is that sport specific?
Like, cuz you know, 28 orwhatever it was to 82, I mean
that's a large range.
Was that, was there a sport, um,like is it like different levels
of sports where that's a littlebit more, more prevalent than
others?
Amanda (07:14):
Yeah, they're saying high impact.
So some of the studies lookspecifically at running, but a
lot of them are broadly lookingat high impact.
And so in that they're includinggymnasts, runners, basketball
players, um, like lacrosse.
Um, Jumpers, those kinds ofthings.
So thinking impact.
Um, and then across both gendersor all the genders, um, pelvic
(07:35):
pain, um, which can bemasquerading as a hip pain or a
low back pain, it can beassociated with.
Trauma or other injuries.
And it can also be associatedwith stress and, um, how they
are guarding against that.
And then of course, in yourcyclist population, it can be
due to nerve compression withhow they are seated and, um, the
(07:56):
prolonged time that they're sethey're spent on their seat.
Mike (08:00):
Right.
And, and, and just to clarify,these are things that can happen
to all genders, right?
This isn't, this isn't a femalething.
I know we, we, you know,postpartum makes this a real
issue for, for females,obviously.
But when you said, you know,athletes that were not
postpartum, right?
Not pregnant, no po wellpostpartum, um, that means this
applies to everybody, right?
Amanda (08:21):
Yeah, it certainly.
Mike (08:23):
And is there, do you see that incidence, um, different
between genders?
Like is this more specific tofemales or could it be.
Amanda (08:32):
Um, a lot more of the data is taken on female
athletes.
Um, there's some new emergingdata on the incontinence aspect
on the males.
Um, because of the anatomy, itdoes tend to affect females a
little bit more.
Um, there's a little bit moreopportunity for.
What we call gapping around theurethra are just different
changes in the dynamic dynamicsof their pressure system, um,
(08:55):
that we see in sport that canresult in those symptoms of
urine linkage.
Um, but there is more work beingdone to start collecting data on
males.
And then of course, in the paincategory, we know that it is
affecting both.
Mike (09:10):
Right.
I can see that too, for sure.
And, and, and just to clarify,incontinence in a young athlete
is abnormal, right?
So
Amanda (09:20):
In anyone.
Yeah, it's common in thepostpartum population, but not
normal.
And then in the young athletewho's never had surgery, never
had a baby, we wanna becertainly picking that up and
getting, getting that addressedright away.
Mike (09:34):
Right.
So do you, you know, I knowyou're, you're a niche, but for
me in the sports setting, um, atour clinic, you know, we have
one of our therapists, DaveTilley's, a big gymnastic
specialist.
Um, he's got, you know, almostexclusive, um, young female
athletes that are, that aregymnasts.
Um, when do you start addingthis almost to like your intake
(09:56):
forms or that sort of thing?
Like when do you start addingthis?
To kinda ask some of thesequestions.
They're, they're coming in,you've never seen before.
Maybe their parents brought'emin because they have low back
pain or hip pain or a groinstrain.
Right.
Or whatever.
Like when do you, when do yourecommend that people in the
sports and ortho section startto broach these subjects?
And, and h how do we do that ina way that doesn't make the
(10:17):
athlete uncomfortable?
Amanda (10:19):
I recommend that they do it yesterday, Um, I try to
always educate, especially whenI am, um, around my ortho
friends, um, to advocating toget it.
Put on the intake forms rightaway because, um, a couple of
things in the dynamic,especially between like, say
like a male with a young femaleathlete, it can be difficult to
(10:39):
have those conversations.
But if it's on the writtenintake form and they're filling
it out privately or with theirparent, they can fill in a
bubble or they can circlesomething or they can check.
And then when you receive that,say even if you're seeing them
for their elbow or their knee ortheir foot, and you see that
there, you can, as part of yourtherapeutic alliance when you're
(11:02):
taking their medical history,say something to the effect of,
I see that you've indicated herethat you sometimes leak urine.
That can indicate that theremight be a problem with your
pelvic floor.
And I'd like to recommend, inaddition to our care that we're
doing here, that we get aconsult.
So you're not quarterbackingthat patient outta your clinic,
you're still managing them, andyou're working with a, um, a
(11:24):
very collaborative pelvic healthPT that can be then helping to
manage that person and then you.
It's, it's just an easy way foran orthopedic PT who may not be
comfortable having in-depthconversations to screen.
And so the, there's like four orfive questions that are just
easy, easy to include on thatbasic medical intake form.
(11:44):
And they are, do you experienceloss of urine when you jump,
run, sneeze, cough, or play yoursport?
Um, do you experience pain withbowel movements or issues having
a bowel movement?
Do.
Feel a bulge or a sense ofpressure in your pelvic area or
in your vagina.
And then also do you have anydifficulty having a medical exam
(12:08):
with a gynecologist, becausesometimes they don't even bring
it up there.
So it may be that they're havingissues using a tampon or
tolerating a speculum in theolder population, like if.
Athlete is older, not like yournine year old gymnast sitting in
front of you.
It may be that they have painwith intercourse, and that may
be not a conversation thatyou're interested in having as a
(12:29):
orthopedic pt, but if it's onthere, then you can be, you can
be working collaboratively withyour pelvic PT colleague.
Mike (12:37):
Well, and I, I think the fact that you even put those on
an intake form, um, I, Iwouldn't be surprised if a young
athlete, like in their teens,like they didn't understand that
those things were abnormal.
So they just thought, oh,that's, that's me.
That's what I do.
That's maybe everybody's likethat.
Maybe everybody has.
A little bit of incontinencehere and there.
Right.
So I think just even puttingthem on that, on the form, um,
(13:00):
actually might be helpful justfor them to realize and open up
a conversation that they didn'teven realize was part of it.
Amanda (13:06):
absolutely.
Mike (13:07):
So you, I, so for me, I wanna know some of the early
signs, right?
So incontinence seems like, Idon't wanna say a late sign,
right?
But it's like, um, like that,that, to me, that's an obvious
one.
What are, what are some of the,the more, more subtle things
that we can look for or, ormaybe the nuances of some, some
pain that you mentioned earlier.
(13:28):
What are some of the things thatwe can do when we say, oh, wait
a minute.
They said they had hip pain,they said they had back pain.
I did my full orthopedic screenof their, of their back or their
hip, and it didn't a hundredpercent add up.
What are some of the otherthings that we should look for?
Amanda (13:43):
um, if they have a history of constipation that can
indicate a pelvic floordysfunction, tailbone pain, and
then when it comes to the hip,it's often deep.
Hip pain that they can't reach,they can't stretch.
Like you put'em into a figurefour stretch.
No, that's not quite it.
Internally rotate'em, not quitethere yet.
(14:04):
Getting closer, you know, andthey, they might point through
it through the groin area andsay it's deep in there.
Um, which then you would need tobe screening for the hernia.
And they do tend to happentogether.
PE the floor dysfunction inhernia can happen together.
Or they're like saying deep in.
Not the sciatic nerve, it's notfollowing the porous kind of
thing.
And just if, if you can imagineas you're doing your evaluation,
(14:27):
the pelvic floor is literally onthe other side of that special
plane of the piora.
Um, it is, you know, I thinksometimes, especially in PT
school, I'm thinking about howthe way that my brain.
Created that geography or thatanatomy prior to pelvic health
education.
And you're thinking like, oh,you learn about ator,
internists, but it's deep inthere.
(14:47):
You'll never reach it.
No.
In pelvic health, we palpatethat every day, and we can reach
it, and it is often a driver ofpain.
So it's kind of that, that deephip pain where you're not able
to quite reproduce it on thetable.
Mike (15:00):
And I, I, I think that part is great because I bet you
that happens more than peoplegive a credit.
They come in, it's in your head.
You're like, oh, bam.
This is an f a i patient formore oso tabular impingement,
that this is easy.
I got this right.
And then you bring'em to thetest and you're like, oh, wow.
Nothing produced Pain Right.
Which, so I, and as a sports PTin this conversation, I can tell
(15:23):
you if you're listening, that'sweird, right?
If you have f a i, it is kind ofclear you have f a i, right?
Like we can reproduce it withsome of our range of motion and
internal, uh, rotation stuffthat Amanda kind of just
mentioned there.
Um, so again, this is where, youknow, I tell our PT students
this all the time.
Um, I don't like scratching myhead.
When I scratch my head andsomething confuses me, we're
(15:44):
missing something or take, wegotta take a step back and think
outside the box, what are wemissing?
So remember that orthopedically,if you're looking at something
and it doesn't add up, you haveto start thinking, okay, that
should have.
That f a I test, I just did,should have produced some
symptoms and it didn't.
So let, let, let me startworking on that.
So I guess that's my nextquestion now.
(16:05):
Okay.
We found somebody, we have somequestions.
Uh, what do you recommend we dofirst you kind of alluded to
this, that we, that we, youknow, we work in collaboration
with somebody.
How do we find a good person inour area?
Do you guys have like anassociation or something that,
you know, like how can people inour area reach out and find some
people near.
Amanda (16:25):
Absolutely.
So the American Physical TherapyAssociation's Academy of Pelvic
Health has a list served withpelvic providers throughout the
country, and I will say backfrom 14 years ago to now, there
are.
Thousands.
We are in every state.
Um, we are, we, the numbers aregrowing.
There's better awareness.
(16:45):
So, um, that is a reallyreliable place to find them.
Um, I have a listserv as well,so if people are listening and
they, they want to find acolleague in their area, I can
help connect them by zip codetoo.
So, um, yeah.
There's a, and then I alwaysrecommend too, like any, like at
your state conferences, whenyou're there, if you're visiting
(17:06):
for that or csm, try to try tofind those providers and team up
with them.
And a great sports pelvic PT isgoing to be a tremendous asset.
We're very collaborative.
We're not gonna take yourpatient away.
We're gonna be addressing theother side of that special
plane.
And you keep working on whateverit is you're addressing.
Mike (17:24):
I like that.
Amanda (17:25):
We're gonna service that patient and we're gonna help
them reach their goals.
Mike (17:29):
I, I, I think you said it great too before is like, don't
just punt.
Right?
I think you, you kind of alludedto that.
Don't just punt say, oh, thismight be something else.
No, their, their hip and their,their exterior muscles that
we're talking about in their hipand their low back, those might
need some things too.
And that could be somethingwhere it's, it's a collaborative
effort.
So I, I think that's a really,uh, good way of thinking of it.
(17:49):
Um, I, I really think you shouldtake Amanda up on that, by the
way.
Um, so I'll put some info on herwebsite on, in the show notes,
but you should probably checkout the A P T A pelvic floor,
um, uh, academy, uh, or pelvichealth AC academy, I should say.
Um, you should probably checkthat out because I think if
you're working with athletes,you should probably have
(18:10):
somebody just like you have ashoulder specialist, an elbow
specialist, a knee specialist.
Doctors, chiropractors, massage.
I, I feel like you need to haveone of these in your network,
and I bet you a lot of mylisteners don't, Amanda,
unfortunately.
So, um, make these connectionsand, and, and let's, let's do
this, right.
Um, let's, let's shift gears alittle bit.
(18:31):
Similar note here, but I think,um, a lot of my listeners
probably do work with postpartumpatients and, um, a lot of the
people I think that, that listento me are both fitness and.
Professionals.
So I think we, we have lots ofdifferent avenues there, but
they're also helping people getback to some advanced level
things like, like working out inthe gym or, you know, if, if
(18:53):
they're a runner or, or playingwhatever their sport is.
Um, I know this is a broadquestion because this is so
fresh to me, but what are someof the keys to working with
postpartum patients that youstart with?
What are the things you focuson?
Help somebody like myself that'snaive.
Start getting into.
Amanda (19:11):
Absolutely.
Um, so depending on how they'vecome to you, whether they're
just coming in because they arepostpartum and they are looking
for a safe transition back in,or they're coming in with a
driving injury, you know, they aspecific reason.
I always recommend that as aclinician, we realize and we
help educate with this personthat.
Every cell in their body changedwhile they were pregnant.
(19:34):
And their, their body haschanged.
Their, their abdominals havechanged, their feet have
changed.
And so in this way, their brainmap might not quite match the
body that they have at thismoment.
It's almost like AlisonWonderland, where they were
very, they were very tallyesterday and they're very short
today.
Um, you know, they, they hadchanges in their posture and
(19:55):
elongation of certain muscles
Mike (19:57):
whoa, I could touch my toes.
I could never touch my toes.
Amanda (20:00):
Yeah, I can roll over
Mike (20:02):
Yeah.
Right.
Exactly.
Mm-hmm.
Amanda (20:04):
so along those lines, their coordination has changed,
their timing and their speed ofcontraction has changed.
And we have data now thatdemonstrates that, especially in
their abdominal and trunkmuscles, they are highly
fatigable.
are also sleepy fatigable.
So we want to be providing thisjust general, almost like giving
(20:28):
them, like reminding them togive themselves grace.
It's not about like, oh, go easyon yourself.
Cuz certainly an athlete doesnot want to go easy on
themselves.
They wanna be.
Bounce back, you know,yesterday.
Um, but it's just reminding themthat their body has been through
these changes and that their,their motor control, their
ability to control those, uh,these new segments, um, is
(20:49):
different.
And so from that lens, we wantto be doing a complete.
Screen, you know, a, a completeposture movement screen of their
trunk, their hips, looking attheir feet, um, reminding them
that oftentimes they have lostsome intrinsic muscle control or
strength, um, and that they aregonna be wanting to include foot
(21:11):
training in their, in theirretraining, because, That is the
base of their contact.
Um, and then from there,especially, I, I think that this
return to run, uh, runningreadiness screen is really
practical for all types ofathletes.
So just doing an overall screenof their form.
It's a, you know, a single legsquat.
(21:33):
It's a wall squat, looking attheir endurance.
I step up and.
A two foot hop.
So you're looking at theirability to mitigate force.
You're looking at their fatigueability and symmetry, right
versus left, which is oftencrummy especially in their
single egg squat.
And then from there you can goon to design their plan of care
(21:54):
or their exercise program andthen of course screening for the
pelvic floor.
Um, but it's, you know, whenwe're looking at these, what's
the magic?
As to when they're appropriate.
There is no hard and fast date.
It's not six weeks, it's not 12.
It's the person in front of you.
And that's where workingcollaboratively with somebody
that specializes can help youdrive your exercise prescription
(22:18):
and some of that, um, becausethey're going to be helping to
ensure that there's no othercontraindications or, um, like
more like yellow flag typethings to them participating in
exer.
Mike (22:31):
Yeah, for sure.
And, and call me crazy.
It seems like everybody.
Should go through this.
I mean, we're, we're talkingabout athletes, we're talking
about people that maybe, youknow, weren't feeling great
after pregnancy.
Right?
It, I mean, think about whathappens to your body during
pregnancy, right?
There's, you have a lot oforthopedic things you gotta get
back to.
It's crazy that we just saylike, oh yeah, no, it'll come
(22:52):
back, right?
Without, without working withsomebody.
Isn't that crazy?
Amanda (22:57):
Yes, very.
Mike (22:59):
So h how many people in your practice come to you
without any issues?
They just, they give birth andthey say, you know, I, I know
that just, that really changedme.
Um, and I wanna do the best Ican.
How many people do you work withlike that versus people that are
coming because they havepersistent back pain or
something like that?
Amanda (23:18):
I would say roughly 10%.
You know, it's the ones thatalready know what I do, and
they, they just want to be doingthe best they can.
Or they recognize, you know, incountries like France, every
woman gets 12 visits of pelvichealth physiotherapy provided
under their system to, to, theycall it perineal, reeducation,
(23:39):
and
Mike (23:40):
that,
Amanda (23:40):
That's exactly what it
Mike (23:41):
Right?
Yeah, that's, that's, that'sgreat.
Amanda (23:43):
Yes.
So there's people that arerecognizing that and that are,
you know, wanting it, um, sothat they can either mitigate
any forces or really address anysmaller things that they're,
they're feeling.
Mike (23:56):
It just seems like a no-brainer and we haven't even
talked about a C-section and Ican't even imagine.
You take all that plus then you.
Disrupt your abdominal wall.
I mean, like the, I I can, I canonly imagine.
Um, so, uh, yeah.
Uh, so it sounds like we needmore awareness.
We need more awareness in thiscountry.
But why aren't doctors liketelling their, their patients to
(24:18):
do this?
Why aren't primary cares or obGYNs, why aren't they saying
like, Hey, you know, by the way,after you give pregnancy, like
you should go see this personand, and, and help you get back
on your feet faster.
Why isn't that a thing in theUnited.
Amanda (24:31):
You know, we are working on it.
I have seen a vast improvementin the last 14 years, and I will
say this younger generation ofphysicians are doing it.
They are.
I.
You know, when I go to nationalconferences where physicians are
present, it's, it's thatyounger, newer generation, uh,
fresh outta residency toroughly, you know, five, 10
years out that are saying, ohyeah, we, we have a whole team
(24:54):
of public health physicaltherapists.
We send our patients there.
Um, and I think from theirperspective too, they are
looking at it from theirparticular lens.
And if they're not aware, it's,it's like we see what we look.
We look for what we know.
If they're not aware yet, that'sour fault.
As physical therapists and weare working on it, you know, we
(25:14):
are working to raise awarenessand I think that it, it has
worked in that youngergeneration changing practice
patterns of some of the set intheir ways.
Physicians can be morechallenging, but it's when we
get one or two in and they seethe differe.
It's, it's like anything, youknow, when you're new in town as
a physical therapist and you'rehaving to prove yourself, it's,
you know, send me, send me theone that is struggling, send me
(25:36):
the one that's in incontinent orhaving pain and can't sit.
Send me them and I will helpthem.
And then they see the resultsand that, that's ingrained in
their head when, when we'rehelping their patients.
That makes a difference.
Mike (25:48):
Yeah, may I, I can see that making a lasting
impression.
And then that'll probably changetheir practice for forever once
they go through a tough one.
Um, you know, so well, hopefullyat least, so um, awesome.
So, all right, so we need moreawareness.
We know that you need to find aspecialist in your ear.
You need to, I, I would at leastjust say for people listening,
you need to have this on yourradar.
And I think that's the mostimportant thing cuz this wasn't
(26:10):
something that I thought ofearlier in my career, but I
definitely, I, I had severalpatients, you know, and, uh, I
think CrossFit, um, as thatgained popularity like 10 years
ago or so, and it got really,really popular.
I think we started seeing more.
More people in our, our clinicswith this because, uh, it became
more obvious, maybe because theywere doing so much more
activities.
(26:30):
Um, but I definitely realizedthat this is something that I
wanted to get better at or atleast understand so I can
collaborate.
And that's really why I wantedyou to, to come share this with
us, Amanda.
So I.
Thank you so much for takingtime out to do this.
This was awesome.
Um, before I let you go, wegotta have our high five segment
at the end where five quickquestions, five quick answers.
(26:51):
Um, very curious here, but Ilike hearing it.
I like hearing how people think.
I like their brains.
Right.
And, and obviously you're,you're, you're smart.
So I want to hear a little bit,but first question, what are you
currently working on for yourown professional development?
I know you educate a lot ofothers.
What are you.
Amanda (27:07):
I am brushing up on some of the newer data.
So over the pandemic, all of ouramazing colleagues that we're
looking at how the Calvinrunning, produced a ton of new
literature.
Um, so I am going through andbrushing up on that.
We published a paper in April onthat subject and are looking at
doing another delphy, um,shortly that is international.
(27:29):
So it's a lot of data there, butanother one that I am having to
re.
Integrate into my practices,this change in IT band from
friction syndrome to, we'recalling it compression now, is
Mike (27:42):
Yeah.
Yep, yep.
Exactly.
Yeah.
Amanda (27:45):
yes.
Mike (27:45):
friction.
I mean, we'll
Amanda (27:46):
Yeah.
Mike (27:46):
it again in 10 years.
It is what it is, but sure.
Amanda (27:49):
Yes.
So I'm pouring back through thatliterature as well and changing,
you know, cause I teach a twoday course on, uh, pelvic floor
dysfunction and runners, andit's pertinent because of the
role of the hip.
So I'm, I'm having to reacquaintmy brain with some different,
some changes in understanding ofthe mechanics.
Mike (28:06):
exactly.
Well said.
I like that.
Um, what's one thing that you'verecently changed your mind?
Amanda (28:13):
Oh, um, I would say two minute plank test.
I still, I still like it, um,because I do like pushing
patients into fatigable statesin service of especially
running, um, but less as adiagnostic tool, more as a, uh,
training tool that they can dowhile they're.
You know, maybe having to doother things with their brain,
(28:33):
especially in the postpartumpopulation, they're oftentimes
having to multitask.
So I feel like that's kind of aneasy one, but not using it to
let necessarily like diagnose,but more as just a training
tool.
Mike (28:45):
I like that.
That's a good one.
What is your favorite piece ofadvice that you love to give
your student?
Amanda (28:50):
Okay.
Oh, um, well, I think the, themost pertinent is that what you
are learning currently is notgonna be how you practice in
three years.
It's, I mean, it's not even fiveanymore.
It's like
Mike (29:03):
right?
Yeah.
Amanda (29:04):
turn and burn.
Mike (29:06):
Right, exactly.
That's great.
So keep an open mind and, andyou know, I I, you know, it's
funny you say that cause that isone of the areas I see so many
young professionals like dig inon their opinions, like really
hard, really fast.
And, and, you know, people likeus, we just watch on Instagram
and you're like, they're gonnaregret that post in three years.
you know, they, that was alittle aggressive.
(29:29):
Uh, but nice.
I like it.
What's, uh, what's coming upnext for.
Amanda (29:33):
Um, working on the Delphy with Shali, Christopher
and Rita Dearing, and aninternational team of amazing,
um, physios in the running andpelvic health space.
So we're working on creatingsome recommendations for
postpartum return to fitness andrunning.
Um, and CSM CSMs coming up inlike, what, five weeks?
(29:55):
Six.
Mike (29:56):
Yeah, it's so close that I'll probably publish this
podcast well after, but yes, Ilike that.
Maybe it'll be next CSM thatyou're talking about in Boston.
I like that
Amanda (30:05):
Are we coming your way?
Mike (30:06):
We're coming to Boston in February.
It makes perfect sense.
Like I don't even, I don't evenwanna be in Boston in February,
but yes, it should be good.
Hopefully we'll have a goodturnout
Amanda (30:15):
And we're all gonna be stuck there cause no flights
come and go outta Boston inFebruary.
Mike (30:20):
There's a solid chance I'll leave it at that, that
there's a solid chance you don'tget home or to the meeting on
time, but we'll just leave it atthat That's awesome.
Well, Amanda, how can peoplefind out more about you?
Um, te tell me like where, whereyou like to, to collaborate with
people.
Is it Twitter, Instagram, yourwebsite?
What, what's the best place tofind more info from you?
Amanda (30:39):
I'm on all those places.
I love Instagram, so I'm aOlsen, d p t and Intimate Rose,
which is my company.
And um, for website, theIntimate Rose website, I have
hundreds of videos and blogarticles and free education for
patients and providers alike onevery subject in Pelvic Cal
(31:00):
under the sun.
Mike (31:01):
Awesome.
That's great.
Yeah, really appreciate youtaking some time out today and
just appreciate all you do forthis niche and combining it with
sports because I think that'swhat's really neat about what,
what you're doing right now.
So appreciate that and all yourinsight and um, thank you so
much for coming on the podcasttoday.
Amanda (31:18):
Thank you so much for having me.
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