Podcast appearances and mentions of alexis morgan

In this episode Mark and Chris speak with Alexis Morgan, Global Water Stewardship Lead for WWF, and Jason Walters, Director at GlobeScan, about a research project they led with 20 companies on the future of the corporate water agenda. Their discussion explores priorities for the water agenda and how those will evolve as water becomes a more central part of corporate sustainability strategies alongside climate and nature as a whole.

Alexis Morgan // #ICEPelvic // www.ptonice.com  In today's episode of the PT on ICE Daily Show, ICE Pelvic division leader Alexis Morgan discusses that when providing care in male pelvic health, many practitioners may feel apprehensive about initiating the evaluation process, particularly when it involves physical examinations. A highly effective way to alleviate these fears and lower barriers to entry is to begin with a subjective exam. This approach allows practitioners to engage with their clients on a deeper level without the immediate pressure of conducting a physical exam. Take a listen to learn how to better serve this population of patients & athletes or check out the full show notes on our blog at www.ptonice.com/blog. If you're looking to learn more about our live pregnancy and postpartum physical therapy courses or our online physical therapy courses, check our entire list of continuing education courses for physical therapy including our physical therapy certifications by checking out our website. Don't forget about all of our FREE eBooks, prebuilt workshops, free CEUs, and other physical therapy continuing education on our Resources tab. Are you looking for more information on how to keep lifting weights while pregnant? Check out the ICE Pelvic bi-weekly newsletter!

Dr. Alexis Morgan // #ICEPelvic // www.ptonice.com  In today's episode of the PT on ICE Daily Show, ICE Pelvic division leader Alexis Morgan discusses diastasis recti, a common issue encountered in clinical practice. Building on previous discussions from earlier this year, she emphasizes the importance of measuring interrectus distance (IRD) versus measuring strength. Alexis highlights new data supporting the idea that ultimately, all roads lead to loading the core for effective treatment. Alexis provides valuable insights for clinicians working with individuals affected by diastasis recti, focusing on practical approaches to loading and strengthening. Take a listen to learn how to better serve this population of patients & athletes or check out the full show notes on our blog at www.ptonice.com/blog. If you're looking to learn more about our live pregnancy and postpartum physical therapy courses or our online physical therapy courses, check our entire list of continuing education courses for physical therapy including our physical therapy certifications by checking out our website. Don't forget about all of our FREE eBooks, prebuilt workshops, free CEUs, and other physical therapy continuing education on our Resources tab. Are you looking for more information on how to keep lifting weights while pregnant? Check out the ICE Pelvic bi-weekly newsletter!

Dr. Alexis Morgan // #ICEPelvic // www.ptonice.com In today's episode of the PT on ICE Daily Show, ICE Pelvic division leader Alexis Morgan discusses passing on the positives of the pregnancy, labor, and delivery process with patients. Take a listen to learn how to better serve this population of patients & athletes or check out the full show notes on our blog at www.ptonice.com/blog. If you're looking to learn more about our live pregnancy and postpartum physical therapy courses or our online physical therapy courses, check our entire list of continuing education courses for physical therapy including our physical therapy certifications by checking out our website. Don't forget about all of our FREE eBooks, prebuilt workshops, free CEUs, and other physical therapy continuing education on our Resources tab. Are you looking for more information on how to keep lifting weights while pregnant? Check out the ICE Pelvic bi-weekly newsletter!

Send us a Text Message.In the exciting season opener, host Alexis Morgan sits down with Dr. Derek Bub, the superintendent of the West Ada School District, the largest district in Idaho, serving nearly 40,000 students. This engaging conversation covers essential topics relevant for parents and staff, providing behind-the-scenes insights into the district's goals for the upcoming year, significant data sharing, and key initiatives aimed at enhancing student success. Listeners can expect to hear Dr. Bub address critical questions, including the district's objectives for students and educators, the challenges of leading such a large district, and the strategies in place to improve academic performance, particularly in reading and math. Additional topics of discussion include bussing expectations for parents, ways for parents to get involved and be heard, how to address rising costs of college fees, and efforts to prepare students for careers in an evolving educational landscape. Join us for this informative episode packed with valuable information for all stakeholders in West Ada and education!Find Alexis on Instagram and JOIN in the conversation: https://www.instagram.com/the_idaho_lady/ Utilize Alexis and her awesome skills. Check out her website: https://www.thealexismorgan.com/

Send us a Text Message.What if you could tap into the minds of three lending powerhouses and transform your land investing game overnight? In this explosive episode of "Lender's Roundtable Discussion," industry mavens Alexis Morgan, Brad DeGraw, and Chris Duff unveil the hidden strategies that are reshaping the real estate landscape. Uncover the shocking truth about creative deal structures that have yielded astronomical returns, and learn why your due diligence process might be leaving money on the table. From hard money secrets to managing eight-figure portfolios, this episode is a goldmine of actionable insights for investors at every level. Don't let your competition get the upper hand – tune in now and arm yourself with the knowledge that separates the players from the spectators in the high-stakes world of land investing! Enjoy the show!Join land investing powerhouses Chris Duff, Brad DeGraw, and Alexis Morgan for a game-changing discussion. Chris, asset manager at Serious Land Capital, brings medical expertise and venture capital experience to his land investment strategies. Brad DeGraw, founder of All Terrain Capital, is the go-to hard money lender for land flips, known for creative financing solutions. Alexis Morgan, a real estate prodigy, has contributed to over $50 million in transactions in just two years and manages eight-figure capital through her fund. Together, they offer unparalleled insights into due diligence, creative deal structuring, and capital management in the dynamic world of land investing. For more information on Chris, Brad, and Alexis, you can check them out here:Alexis Morgan: hoo.be/alexisjmorgannChris Duff's Serious Land Capital (equity funding $50K-$500K): https://seriousland.capital/Chris Duff's "Land Daily Diligence": Free Facebook group for live deal reviewsChris Duff & Brad DeGraw recommend: www.Landfunding.Partners for all your funding needsElevate your land investing with these expert-curated resources!◽️◽️◽️◽️◽️◽️⬇️OnlyLandFans Group⬇️https://www.onlylandfans.com/◽️◽️◽️◽️◽️◽️LET'S CONNECT ON SOCIAL:Website: https://www.Kendall-LeJeune.comInstagram: https://www.instagram.com/kendall_lejeuneTikTok: https://www.tiktok.com/@kendall_lejeune

Dr. Alexis Morgan // #ICEPelvic // www.ptonice.com  In today's episode of the PT on ICE Daily Show, #ICEPelvic division leader Alexis Morgan discusses three myths in pelvic health surrounding pelvic health demographics, urinary incontinence, and sexual intercourse. Take a listen to learn how to better serve this population of patients & athletes or check out the full show notes on our blog at www.ptonice.com/blog. If you're looking to learn more about our live pregnancy and postpartum physical therapy courses or our online physical therapy courses, check our entire list of continuing education courses for physical therapy including our physical therapy certifications by checking out our website. Don't forget about all of our FREE eBooks, prebuilt workshops, free CEUs, and other physical therapy continuing education on our Resources tab. Are you looking for more information on how to keep lifting weights while pregnant? Check out the ICE Pelvic bi-weekly newsletter! EPISODE TRANSCRIPTION ALEXS MORGANGood morning, PT on Ice Daily Show. My name is Dr. Alexis Morgan, and I am so happy to be with you all this morning to talk about some myths and bust them. So there are so many myths in pelvic health. I narrowed it down to three. I might sneak a fourth one in. But there are so many myths that need to be dispelled in this area of pelvic health. And so this morning we are going to talk about a couple of misconceptions in the topic of pelvic health and then what the actual facts are. So thank you all for joining me so much this morning. At the end, we'll talk about some courses upcoming in the pelvic health division if you are interested in joining us. So top three myths. Number one, only women need to worry about pelvic health. Number two, urinary incontinence is a normal part of aging. And number three, pain during sex is normal. Three myths that are pervasive in this space. MYTH #1: ONLY WOMEN NEED TO WORRY ABOUT PELVIC HEALTH So let's start with myth number one. Only women need to worry about pelvic health. This is absolutely not true. All people need to be considerate of pelvic health. All people can have pelvic floor issues, no matter what your anatomy is. So whether there is a penis or a vagina, you may have issues that are because of your pelvic floor. So some common issues that we treat are chronic prostatitis, slash chronic pelvic pain. And that is, um, that is what a topic that we discuss in our level two course, as well as erectile dysfunction and so many more. these issues can absolutely be addressed with a pelvic floor physical therapist, a pelvic floor therapist altogether. And it's really important that people understand that these issues can absolutely be addressed And so often, of course, you'll have to take our course to learn a whole lot more about it, but so often these lifestyle things that we discuss like eating well and exercise and getting blood flow, all of those are so incredibly important for all people. And in particular, issues as we just discussed, like chronic pain and even erectile dysfunction. So of course, big solution being when we kind of shift the gears and talk about how all people may benefit from pelvic health, then all people have an equal opportunity to seek that care. that's a big part of why in the ice certification for pelvic health we go over all anatomy and all diagnoses surrounding any and every pelvic floor issue that can arise here because We want to provide health for all. And if you are ICE certified in pelvic, then you know exactly what I'm talking about. You have the abilities to provide that care to all people. Speaking of, congratulations to our individuals, our very first individuals who are ICE certified in pelvic. We just completed our first level two course and we have several who are now ICE certified in pelvic. So congratulations to you all. MYTH #2 - URINARY CONTINENCE IS A NORMAL PART OF AGING Moving on to myth number two, urinary incontinence is a normal part of aging. It is absolutely not the case that incontinence is inevitable with age. And again, this kind of goes back to myth number one, this occurs in all can occur in all people. So incontinence might occur with, um, males and females, and it does not have to happen just because someone is aging or just because someone had their prostate removed. There's a lot of different types of urinary incontinence, but these can all be addressed. A big one that we talk about a lot in sport and kind of in function is stress urinary incontinence. and this is where there's an increase in intra-abdominal pressure and the pelvic floor musculature either doesn't know how to, can't coordinate enough, or is not strong enough to withstand that pressure up above and the leaking occurs. There could also be urge incontinence where you have the urge to go pee and then it's really difficult to hold it in because of that urge. And we even have functional incontinence as well where it is difficult for an individual to get to the bathroom in time because of some type of physical impairment or cognitive impairment. And because of that, there is incontinence. So for all of these individuals, there are absolutely solutions for them. And because of that, we don't accept the myth, we don't accept the statement that it's normal to Pee your pants as you age. It is absolutely something that can and really should be addressed to improve the quality of life for all people. MYTH #3 - PAIN DURING SEX IS NORMAL Myth number three. Pain during sex is normal. That is a very pervasive and difficult myth that we hear quite a bit. Maybe that is surrounding menopause, maybe that is surrounding postpartum, or just in general. But pain during sex should not be expected. Sex should be pleasurable, should be enjoyable, and should be enjoyed by both or all parties involved. And unwanted pain during sex is something that can and should be addressed to improve pleasure in a very important aspect of life that is sexual health. There's so many reasons why someone might be experiencing pain, and just like in all areas of the musculoskeletal system, when we experience pain, it's not always straightforward. Wouldn't it be nice if it were? But with pain with sex, we talk about in all of our courses, we layer in all of the different aspects of pain with sex and begin to separate these issues out. It is our job, it is our duty, it is our honor to help individuals decrease pain and increase pleasure with sex to improve their quality of life. And we do this from some simple ways like lubrication maybe more complicated ways like can referring someone to counseling to mental health therapy to assist in maybe some prior traumas and we also can do some manual work as well as exercises in order to fully address the full person and address the full picture of the reason why someone is having pain with sex. So again, if you want to learn more about that, we do talk about it in all three of our courses, our live, our online, and level one and level two, but we really take a deep dive in level two. So if this is something that you're interested in, yay, join me. This is one of my more recent more recent interest in pelvic health, and we would love for you to join us in any of our courses. SUMMARY So to recap, pelvic health is absolutely important for all people. Incontinence is treatable. Let's help these individuals get treatment. And lastly, pain with sex should be addressed. Let's have Our job is to get individuals to understand that we are available for them to help them address their pelvic concerns. And let's reduce those barriers as much as we can for them, talking about them, letting people understand that you are a resource for them. And by all means, take this information, create some reels about it, create some posts, but get those myths out there, and most importantly, get the truth out there. Thank you all for joining me this morning. Before I close up, I just wanna let you all know, our Level 1 course, it's about to sell out. There are still a few spots. We have one week left before we officially start, so that's July 8th, if you're listening on the recording. And so sign up for that if you are trying to get that in soon. It will sell out. Same with level two, but that one starts in August. So August 19th. And then our next three courses that we have live are in Ohio, July 20th and 21st. in Wyoming, July 27th and 28th. And then Tennessee, right here in my hometown, Hendersonville, Tennessee, September 7th and 8th. So we hope that you will join us. If you're already signed up, can't wait to see you in person. And thank you all for tuning in this morning. Have a great day, have a great week. OUTRO Hey, thanks for tuning in to the PT on Ice daily show. If you enjoyed this content, head on over to iTunes and leave us a review, and be sure to check us out on Facebook and Instagram at the Institute of Clinical Excellence. If you're interested in getting plugged into more ice content on a weekly basis while earning CEUs from home, check out our virtual ice online mentorship program at ptonice.com. While you're there, sign up for our Hump Day Hustling newsletter for a free email every Wednesday morning with our top five research articles and social media posts that we think are worth reading. Head over to ptonice.com and scroll to the bottom of the page to sign up.

Send us a Text Message.Join host Alexis Morgan as she dives deep into conversation with Haley Regan, the assistant director of Community Schools. Since its inception in Idaho in 2016, the Community Schools strategy has been at the forefront of reimagining educational leadership and school-community integration across the United States. With the United Way of Treasure Valley recently awarded a significant $46 million grant, the model's potential for transformation and growth has never been more exciting. Tune in to hear from Haley about the nuances of the Community Schools model, its impact, and how it might just be the change your community needs. Get ready for a thought-provoking discussion on the future of education!Connect with Alexis via her website at: www.thealexismorgan.comContinue the Conversation on Instagram at: https://www.instagram.com/the.alexis.morgan/Find Alexis on Instagram and JOIN in the conversation: https://www.instagram.com/the.alexis.morgan/ Utilize Alexis and her awesome skills. Check out her website: https://www.thealexismorgan.com/

Please note: As this is a live podcast during the party, the audio quality may not be perfect due to the background noise. It is recommended to watch this on YouTube. We'll be back in the studio next week!PILLOW TALK MANSION PARTY W/ WORLD'S TOP P*RNSTARSLadies and Gentlemen, get ready to celebrate in style with a special live episode of Pillow Talk! We're throwing a massive party to mark hitting 1 million subscribers, and you're invited to join the fun! Host Ryan Pownall will be joined by a star-studded lineup of guests including Meg Banks, Alexis Morgan, Savannah Bond, Viking Barbie, Kira Noir, Kazumi, Celina Powell, Cherie DeVille, Scott Nails, Adam22, and many more!Please note: As this is a live podcast during the party, the audio quality may not be perfect due to the background noise. It is recommended to watch this on YouTube. We'll be back in the studio next week!*RK WITH MATES - FREE $10 PROMO CODE:https://linktr.ee/pillowtalkwithryanGET FREE $10 TO PLAY WITHClaim your FREE MONTH of Bluechew:https://bluechew.com/USE CODE "PILLOWTALK" TO CLAIMJOIN OUR OFFICIAL DISCORD SERVER:https://discord.com/invite/kHXHhVtw23PILLOWTALK UNCENSORED:https://linktr.ee/pillowtalkwithryanSOCIALS:Ryan Pownallhttps://www.instagram.com/itsryanpownall/@itsryanpownall@pillowtalkwithryanEpisode 150- Producer Terry

Dr. Alexis Morgan // #ICEPelvic // www.ptonice.com  In today's episode of the PT on ICE Daily Show, #ICEPelvic Division Leader Alexis Morgan discusses what a pelvic floor exam looks like in light of updated practice patterns & research,. Take a listen to learn how to better serve this population of patients & athletes or check out the full show notes on our blog at www.ptonice.com/blog. If you're looking to learn more about our live pregnancy and postpartum physical therapy courses or our online physical therapy courses, check our entire list of continuing education courses for physical therapy including our physical therapy certifications by checking out our website. Don't forget about all of our FREE eBooks, prebuilt workshops, free CEUs, and other physical therapy continuing education on our Resources tab. Are you looking for more information on how to keep lifting weights while pregnant? Check out the ICE Pelvic bi-weekly newsletter! EPISODE TRANSCRIPTION ALEXIS MORGAN Good morning. Welcome to the PT on Ice daily show. My name is Dr. Alexis Morgan. I am one of the faculty with the pelvic division and happy Monday. I'm excited to be here this morning to talk to you all about the 2024 version of the pelvic floor assessment. We've been through so many iterations as a profession of the pelvic floor assessment. And I want to just take a few minutes today to talk with you all about the 2024 version, the updated version, the modern way to assess the pelvic floor. Thanks for joining me. Let's jump right in. HISTORY OF THE PELVIC FLOOR EXAM So when we think about the history of the pelvic floor exam, this goes way back, all the way to Dr. Kegel. I've actually done some podcast episodes on the history, and if history's not your jam, don't worry, I won't bore you with the history details today. But our pelvic floor exam does go way back decades, closing in on 100 years now. And over the last several decades, of course, we've had a lot more research come out and a lot more evidence, a lot more understanding of these muscles that are at the base of the pelvic floor. And so with, of course, new updates, new pieces of understanding, we're still gathering information, but of course, as we change in the way that we understand a group of muscles, of course we're gonna change in the way that we assess them clinically, right? We see this so frequently when we look at the evidence on strength. So strength is not necessarily indicative of problems or lack thereof problems. Yet we are so often talking about assessing strength and obsessing about what manual muscle test grade is there. And yes, if you're not familiar, we do have a manual muscle testing score for the pelvic floor. but realize that that is such a small piece of the entire picture. And we're starting to see this in the evidence as just described, and there's several studies that are making us go, hmm, maybe it's not all about strength. But how do we then take that into our clinical practice? FOCUS ON RANGE OF MOTION & MUSCLE COORDINATION First and foremost, we ourselves need to back off of obsessing about strength, right? We need to really get a full understanding of the person in front of us and really gather that information and not just talk about strength, but talk about the entire picture. So, here's the updated version of the way that we do our assessments. First, we're going to test their range of motion. I'll dive into each of these details, but I want to give you all the overall picture first. So first, we do a range of motion assessment. Then we go into coordination. And after coordination, then we might go into a strength assessment. We might go into a palpation assessment. or we might go into a prolapse assessment, depending on how that person shows up in front of us. We may take it a few different directions, our assessment, but we're going to start with the range of motion and coordination assessment. Range of motion and coordination are important for all people. No matter what we are assessing, no matter what problem, no matter what genitalia we are looking at, all of the people that we are assessing with the pelvic floor, we need to start with range of motion and coordination. So what is the range of motion of the pelvic floor? What do you mean by coordination? Well, range of motion of the pelvic floor, you've heard us talk about this a lot here at ICE, is squeezing up, we call it squeezing into the attic, going up towards the head, going to baseline, and then going into the basement. So in our A-frame analogy, we've got the attic, the first floor, and the basement. So we need to assess all of these areas. That is the range of motion. There are going to be problems if somebody can't raise it up. There's also gonna be problems if they can't push their pelvic floor down. There's problems when the full range of motion does not exist. So we need to A, assess it, and then B, help them find their full range of motion. That's beyond the scope of this podcast. Come to our live course where we talk more about this. But that is range of motion assessment. Very important as it is first. Then we go into coordination. So coordination is me assessing your pelvic floor with certain coordinated movements or certain movements that you do in the day. And I'm assessing to see what does your pelvic floor do and is it coordinated with the core muscles? How does that function? So we might would look at a cough We would definitely look at a brace, especially if the individual is having issues with some type of bracing mechanic. And you may do it in a lot of other different positions. I have clinically assessed pelvic floor coordination for a yogi who is having difficulty with downward facing dog. Yes, we got into that position to assess the coordination of her pelvic floor. That was where her primary complaints were. That's where we need to do that assessment. It's not a strength assessment at that point. It's a coordination. What is she doing with her core and pelvic floor in the problematic position? That is coordination. With these two important pieces of the assessment, There's a lot of different ways in which you might assess. Range of motion, coordination. That could be assessed just visually. Just externally, I am looking at maybe the rectum, maybe the vagina, male or female. Whatever it is, I might be just looking externally. Or I might do an internal assessment. vaginal or rectal. I might would do it in standing, a standing assessment. There's a lot of ways in which we're going to match the assessment with the problems that the person presents to us with. We're going to match them, but realize that they're going to start with a range of motion assessment and coordination. Then of course we can dive into our other three options, that strength assessment, that palpation assessment, and the pelvic organ prolapse assessment. So it's important for you to know that All of these options that exist, you may not use all of them in a client. You may not use them all in one day. It may take you several months or weeks, depending on the person in front of you, to go through all of these assessment tools. That doesn't matter as much as what matters is that you're testing the problems that they're presenting with, and of course, that you're making progress along the way. So that strength assessment is important. It is a piece of the puzzle. Someone needs to be able to generate enough force in their pelvic floor to squeeze off their holes. That way they do not have problems of a lack of force. That is important. But only when we know that they're coordinated enough to squeeze their pelvic floor. Right? Because if they can squeeze it on their own, but whenever they're bracing, they're not squeezing it, it doesn't really matter to work on strength. It matters to work on coordination. You see where I'm getting at? So once they get that, those first pieces, the range of motion and coordination, then we move on to strength. WHAT NEXT AFTER RANGE OF MOTION & COORDINATION? So with that strength assessment, we might do that in supine, we might do that in standing, testing their strength, their ability to squeeze the pelvic floor. With the palpation assessment, and again, we go into all the details. I'm skimming the surface here. We go into all the details in our live course. When we are doing a palpation assessment, that is purely to reproduce their pain. You hear us at ICE all the time talking about, and no matter which course you're taking, when we are doing a palpation exam, we are trying to reproduce their main complaint that they're coming in to see us for. So, same is true in the pelvic floor muscles, each of the layers, left side and right side. Does this reproduce their problem? Their problem might be urgency. When I gotta go pee or poop, I've got to go. Let's see if pressing on some of these muscles causes that urgency. or round ligament pain or adductor pain or might even look or sound like what the patient may come in with is sciatica, right? Or radicular pain. All of those could be caused by the pelvic floor muscles in which you would find in that palpatory exam. So that palpation exam is important to rule out the pelvic floor as a potential root cause of some of their symptoms that they are experiencing. And then lastly is pelvic organ prolapse. So we may not do this pelvic organ prolapse assessment. There's a lot of podcasts where we're talking about our thoughts on POP or prolapse, and I will have to guide you to those. I'm not gonna take all of your time talking about that this morning either, but it is a piece of the exam that you might would add in. We might would add in the prolapse exam if the person is coming in with their main complaint saying the word prolapse. Saying that I've been diagnosed with prolapse. Discussing some concerns about prolapse. Similar to the obsession about the strength scores, we can also see an obsession about a prolapse grade. Something about these numbers gives us this black and white, this very clear picture in our heads, but it's not exactly the full clinical picture. So really, do the pelvic floor assessment. If you need to do the prolapse assessment, absolutely do that. And again, you can do that in supine. You can also do it in standing and apply that to that individual. But just remember that 50% of individuals assessed objectively are going to have some sign of dissent, aka some sign of prolapse, so we don't need to be freaked out about it. Rather, what we need to do is focus on their range of motion, focus on their coordination. Those two pieces are so incredibly fundamental and important for everyone to be able to utilize their pelvic floor effectively. Whether that is in preparation for birth, whether that is performance under the barbell, or trying to reduce pain with sex, Whatever the topic is that the individual is coming to us for, we're going to start with that range of motion assessment. We're going to go into that coordination and we might hang out there for a while and work on the goals of pulling pelvic floor up, pushing down, feeling all of those differences of the pelvic floor, and then coordinating it. Coordinating it with diaphragmatic breathing, with bracing, with whatever problem they have, matching it to that. That right there added with it the three options of the strength, the palpation, and the prolapse assessment, that is the updated version of the pelvic floor assessment. That is what aligns with how we understand, as of today, the pelvic floor function. It matches what we see in the newest literature all the time, which is maybe it's not all about strength. Maybe there's some other aspect. And when you look at these studies, we recognize that individuals are assessing this, but it's not really been discussed about in this way. This is what we're doing. This is how you create change. This is how you have some organization in your assessment. This is how you get the patient on board. You tell them we're gonna do range of motion. We're gonna do coordination. We're gonna see how you do with each of these. This is gonna look a lot like this problem that you're experiencing. We're gonna match that up and we're gonna talk about what optimal is. Really focusing in on what matters to them helps them stay focused. SUMMARY So use this, let me know what you think, and if you are so excited to see us maybe in Greenville, South Carolina this coming weekend at the live course, we're excited too. Or we've got several courses coming up in Colorado, in Missouri, in Alaska, In New York, we're all over the place this year. So look for a course that's near you or near somewhere that you would like to travel to. We would love to have you at our course. We also are discussing these topics in a little bit different ways in our Online Level 1 and our Online Level 2. Our first cohort of the Level 2 is actually sold out. Our second cohort of the season of the year is in August. It will sell out. If you are interested in joining us, you should go ahead and purchase that ticket. We'll be talking about all of these aspects of what we just discussed today in both of those courses. head on over to PTOnIce.com, check us out, we would love to have you join us in the courses. Have a wonderful day, a wonderful week, and let me know what you think about the new way of doing the pelvic floor assessment. OUTRO Hey, thanks for tuning in to the PT on Ice daily show. If you enjoyed this content, head on over to iTunes and leave us a review, and be sure to check us out on Facebook and Instagram at the Institute of Clinical Excellence. If you're interested in getting plugged into more ice content on a weekly basis while earning CEUs from home, check out our virtual ice online mentorship program at ptonice.com. While you're there, sign up for our Hump Day Hustling newsletter for a free email every Wednesday morning with our top five research articles and social media posts that we think are worth reading. Head over to ptonice.com and scroll to the bottom of the page to sign up.

Dr. Alexis Morgan // #ICEPelvic // www.ptonice.com  In today's episode of the PT on ICE Daily Show, #ICEPelvic division leader Alexis Morgan discusses the essential, yet often overlooked as aspect of early postoperative care. Alexis explores the wide range of concerns and adjustments individuals face postoperatively beyond the usual need for return to exercise. From emotional and mental health needs to navigating the logistics of daily life, we share valuable insights on how to care for individuals early postoperatively. Save this podcast and share it with your communities to educate them, and let them know what an early postop visit with you might would look like too! Take a listen to learn how to better serve this population of patients & athletes or check out the full show notes on our blog at www.ptonice.com/blog. If you're looking to learn more about our live pregnancy and postpartum physical therapy courses or our online physical therapy courses, check our entire list of continuing education courses for physical therapy including our physical therapy certifications by checking out our website. Don't forget about all of our FREE eBooks, prebuilt workshops, free CEUs, and other physical therapy continuing education on our Resources tab. Are you looking for more information on how to keep lifting weights while pregnant? Check out the ICE Pelvic bi-weekly newsletter! EPISODE TRANSCRIPTION INTRODUCTION Hey everyone, this is Alan. Chief Operating Officer here at ICE. Before we get started with today's episode, I want to talk to you about VersaLifts. Today's episode is brought to you by VersaLifts. Best known for their heel lift shoe inserts, VersaLifts has been a leading innovator in bringing simple but highly effective rehab tools to the market. If you have clients with stiff ankles, Achilles tendinopathy, or basic skeletal structure limitations keeping them from squatting with proper form and good depth, a little heel lift can make a huge difference. VersaLifts heel lifts are available in three different sizes and all of them add an additional half inch of drop to any training shoe, helping athletes squat deeper with better form. Visit www.vlifts.com/icephysio or click the link in today's show notes to get your VersaLifts today. In today's episode of the PT on ICE Daily Show, #ICEPelvic division leader Alexis Morgan discusses the essential, yet often overlooked as aspect of early postoperative care. Alexis explores the wide range of concerns and adjustments individuals face postoperatively beyond the usual need for return to exercise. From emotional and mental health needs to navigating the logistics of daily life, we share valuable insights on how to care for individuals early postoperatively. Save this podcast and share it with your communities to educate them, and let them know what an early postop visit with you might would look like too! Take a listen to learn how to better serve this population of patients & athletes or check out the full show notes on our blog at www.ptonice.com/blog. If you're looking to learn more about our live pregnancy and postpartum physical therapy courses or our online physical therapy courses, check our entire list of continuing education courses for physical therapy including our physical therapy certifications by checking out our website. Don't forget about all of our FREE eBooks, prebuilt workshops, free CEUs, and other physical therapy continuing education on our Resources tab. Are you looking for more information on how to keep lifting weights while pregnant? Check out the ICE Pelvic bi-weekly newsletter! EPISODE TRANSCRIPTION INTRODUCTION Hey everyone, this is Alan. Chief Operating Officer here at ICE. Before we get started with today's episode, I want to talk to you about VersaLifts. Today's episode is brought to you by VersaLifts. Best known for their heel lift shoe inserts, VersaLifts has been a leading innovator in bringing simple but highly effective rehab tools to the market. If you have clients with stiff ankles, Achilles tendinopathy, or basic skeletal structure limitations keeping them from squatting with proper form and good depth, a little heel lift can make a huge difference. VersaLifts heel lifts are available in three different sizes and all of them add an additional half inch of drop to any training shoe, helping athletes squat deeper with better form. Visit www.vlifts.com/icephysio or click the link in today's show notes to get your VersaLifts today. ALEXIS MORGAN Good morning, YouTube. Get Instagram going here. Good morning. Welcome to the PT on Ice Daily Show. Happy Monday. My name is Dr. Alexis Morgan, and I am one of the faculty with Ice Pelvic. In our pelvic division, we enjoy talking about all things around exercise. And, you know, if you are part of ICE, you know that and understand that. But sometimes our reputation scares people. It might scare our community like, oh, that's the exercise person. They're definitely going to make me exercise immediately. Today's topic is surrounding non-exercise topics for that early post-op care. non-exercise topics for the early post-op care. This is incredibly important, maybe because of the reputation that you have in your community, which if you have that, great, so do I. Awesome reputation to have. However, we need our potential patients, we need our clients, we need them to understand a lot of the things that we can do early post-operatively that don't necessarily involve exercise. And that's not just to get them in the door, but that's also because there's a huge role that we play in early post-op management. Now I'm discussing this with the lens of early post-op post C-section or post-op post hysterectomy or any of these post hernia surgery, any kind of core and or pelvic floor, pelvis type of surgery. That's the lens that I'm going to be discussing this in. However, I will say this is going to be in many of these cases pertaining to really post-op, any surgeries. And we've had a couple of great podcasts on this topic. And Lindsey Hughey has one that comes right to mind on things that we can do to educate to reduce inflammation postoperatively. But I'm going to add a couple other things to that list. So let's go ahead and jump right into those. ASSESSING VITAL SIGNS So number one, we need to be assessing vital signs. This is incredibly important in the postpartum period as maternal death rates are actually increasing in America. And for black women, maternal death rates are three times the rate as white women. Many of these are because of some type of cardiovascular event. We have got to check blood pressures. And in many cases, we as the conservative care providers, those physical therapists or rehab providers, we're some of the only ones that are checking postpartum. Or we might be able to catch something very soon before they might have a six or eight or 12 week follow-up postpartum. we've got to be checking their vital signs and assessing and making certain calls when necessary. That is absolutely important and definitely not exercise related at all. We can get them in and get their blood pressures checked. OWNING SCAR MANAGEMENT Additionally, we, we assess sutures or incision sites or whatever whether that was an abdominoplasty where they have an incision from ASIS to ASIS, whether that is a C-section incision, a little bit smaller, more midline, or that might be smaller little incisions all throughout the belly from some type of laparoscopic surgery. Whatever the case, We, as their rehab providers, assess that incision. We're gonna look for signs of infection and we're also educating about those signs of infection. We're assessing to see how the patient feels about it. Maybe we need to set some expectations surrounding what the C-section scar or what any of these scars are going to look like in a month and in six months. And with that, we can go ahead and begin some scar mobilizations. Now, very early postpartum, we're still in the proliferation phase, inflammation, then proliferation, and then maturation. We're still in that proliferation phase, so we're not gonna be doing scar mobilization on the actual scar, but we can come inches above and below and surrounding. We can teach them how to pull on their skin and press on their skin well away from the scar to go ahead and begin that desensitization. That is incredibly valuable. And just going ahead and painting the picture of what that scar rehab is going to look like over the next three to four months. Many individuals have a lot of fear and concerns surrounding the scar. And we are the best people to be giving them home exercise program, these interventions and helping them understand what it's going to look like. We know we're the rehab providers that have seen this all along the way in several other of our patients. So we can help them understand what to expect and If there's concerns where we need to refer to a mental health provider, then we're absolutely going to do that. That is completely within our realm to assess that and to refer out. And what a great opportunity to help someone. Body image is rather difficult. It always has been, but with social media and the way the world that we live in right now, It is incredibly difficult. And so we need a lot of times mental health providers to help us navigate that. So first we talked about vital signs. Now talking about sutures, we can absolutely discuss fueling. That's the podcast I mentioned with Lindsay Huey, so I won't jump into that necessarily. ASSESSING DAILY FUNCTION But next is ADLs. I was just looking through my messages, some screenshots that I've saved from various, um, various people who have messaged me about, um, pelvic floor related topics. And what I saw was this message from someone who said, I just went to my, uh, follow-up and they told me not to lift any weight. And the person asked, can I lift my baby? And they said, no. Now, obviously this is hopefully a one-off. Hopefully that word is not being said. And who actually, I don't know if the doctor actually said that, but the point is, is that this individual did think that that's what the doctor said. We are here to help them understand how can they be safe? How can they hold their baby? How can they get out of bed? How can they bend over and get the clothes out of the dryer, out of the washer? We can help them navigate these things. This is a great opportunity for occupational therapists as well. We can lean into their expertise here. Helping individuals with these ADLs can be really valuable for these individuals and can help them feel more confident in their body in that early postpartum period. Sometimes they just need to share their story. I think a lot of times we as rehab providers really feel this urge to do, do, do, put hands on, give home exercise program. I need you to do all three of these. We feel like so rushed in order to provide and sometimes The best thing that we can provide is a listening ear, is someone to be someone who can just ask questions about their surgery, about how they felt, about how they felt going into that and how they felt coming out of it. That can be incredibly helpful. ASSESSING READINESS TO EXERCISE While we're talking about non-exercise plans, I said that we wouldn't be doing exercise, but I didn't say that we wouldn't be talking about it. So when we have someone early postpartum, they might be an exerciser and they might be saying, oh, I'm not ready for exercise just yet. Well, that's okay. Let's talk about what does exercise mean to you? What does readiness look like to you? What do you want and what are your timeline expectations? And do they match up with what we have seen or what we expect? Having a conversation about an exercise plan and exercise expectations can be incredibly helpful. Some people may not understand that they can go ahead and start to move now. and they think exercise is any type of movement, and we can kind of break that down. We can discuss different exercises that individuals can do or that this person in front of us can do in this early time, like walking or some basic hip exercises or arm exercises. A lot of times there's several restrictions surrounding surgeries. But just because there's restrictions doesn't mean that there has to be zero exercise. So we can discuss that plan and kind of help them understand what that overarching picture of exercise and health looks like. I already mentioned one referral, but there are several other referrals that we can also make. So in the postpartum realm, referring back to their provider, their OB or their midwife. We can refer to a lactation consultant, to mental health providers. Postpartum doulas are another great referral source, particularly for people who are postpartum and maybe don't have a lot of family nearby. There are so many ways in which we can help people and We don't hold the keys to everything. I can't help with mental health. I can listen, but I don't have all of the tools, but I can absolutely refer to somebody who does. And together we can work to get this person in front of us feeling really good. SUMMARY So vital signs, checking the sutures or those incision sites, discussing fueling, helping them with their activities of daily living, their ADLs, listening to them, listening to their story, figuring out an exercise plan and referring out. The last thing I'll just mention here with pelvic floor and particularly with postpartum, we're gonna discuss with them expectations surrounding those. That's a whole nother podcast for another day, but discussing the expectations surrounding bleeding postpartum, leaking heaviness and pain and giving them what to listen to when we say, listen to your body, giving them a key to understanding what that exactly means. That way, once again, they can be successful. So that's just a little sneak peek into a whole lot of what you're going to learn if you take our online level one course. Our next cohort for our online level one starts March 5 so upcoming in one month at the beginning of March. It is going to sell out, just like this current cohort did so if you're on the fence about it, I recommend going ahead and purchasing that ticket because. If you wait too long, you're not going to get a seat. And we are very strict on keeping our student to faculty ratio at an appropriate level. That way you get your questions answered and you get the care that you need as you're learning from us in the course. So sign up for that. And we also have our first online level two course coming up at the very end of April. And so you're not going to miss that. Once again, that is definitely going to sell out. We are still months away from that, but only a few few seats remain for that. We're going to shut that one down pretty soon. So if you're on the fence about the online level to go ahead and sign up for that one. We are all over the place in twenty twenty four. Our next upcoming cohorts. for our live course. We're going to be in California, North Dakota, South Carolina, and Colorado. Those are our upcoming next courses, all in March and April. So be sure to check us out on the road. And remember, when you do all three of these courses, you are eligible for the ICE certification certified in pelvic. We are here to change the game when it comes to pelvic floor health and pelvic floor rehab. And we need more of you. So please consider hopping on the train, coming to our courses. We know you're going to have a great time. Thanks for being here this morning and listening with me. Have a great rest of your day and we'll catch you next time. OUTRO Hey, thanks for tuning in to the PT on Ice daily show. If you enjoyed this content, head on over to iTunes and leave us a review, and be sure to check us out on Facebook and Instagram at the Institute of Clinical Excellence. If you're interested in getting plugged into more ice content on a weekly basis while earning CEUs from home, check out our virtual ice online mentorship program at ptonice.com. While you're there, sign up for our Hump Day Hustling newsletter for a free email every Wednesday morning with our top five research articles and social media posts that we think are worth reading. Head over to ptonice.com and scroll to the bottom of the page to sign up.

Send us a Text Message.In this episode, host Alexis Morgan is joined by Quinn Perry, Deputy Chief and Government Affairs for the Idaho School Board Association. Alexis and Quinn delve into the pivotal role that school board members play in shaping the Idaho education system. They break down the essential duties of a school board member and provide insight into what stakeholders can expect from their representatives. Further, they shed light on the primary responsibility of board members and elucidate the relationship between school board members and their communities. Also discussed is the importance of balanced board governance and the dispelling of common misconceptions surrounding the role of school board members. A must-listen for parents, school district employees, and patrons, this episode offers a comprehensive understanding of these crucial volunteer roles within our education system.Join the conversation on Instagram: https://www.instagram.com/the.alexis.morgan/Connect with Alexis on her website: https://www.thealexismorgan.com/Find Alexis on Instagram and JOIN in the conversation: https://www.instagram.com/the.alexis.morgan/ Utilize Alexis and her awesome skills. Check out her website: https://www.thealexismorgan.com/

Dr. Alexis Morgan // #ICEPelvic // www.ptonice.com  In today's episode of the PT on ICE Daily Show, #ICEPelvic division leader Alexis Morgan defines interrectus distance and how to measure it, how to functionally measure core strength, and the limitations of focusing on interrectus distance with patients. Take a listen to learn how to better serve this population of patients & athletes or check out the full show notes on our blog at www.ptonice.com/blog. If you're looking to learn more about our live pregnancy and postpartum physical therapy courses or our online physical therapy courses, check our entire list of continuing education courses for physical therapy including our physical therapy certifications by checking out our website. Don't forget about all of our FREE eBooks, prebuilt workshops, free CEUs, and other physical therapy continuing education on our Resources tab. Are you looking for more information on how to keep lifting weights while pregnant? Check out the ICE Pelvic bi-weekly newsletter! EPISODE TRANSCRIPTION INTRODUCTION Hey everyone, this is Alan. Chief Operating Officer here at ICE. Before we get started with today's episode, I want to talk to you about VersaLifts. Today's episode is brought to you by VersaLifts. Best known for their heel lift shoe inserts, VersaLifts has been a leading innovator in bringing simple but highly effective rehab tools to the market. If you have clients with stiff ankles, Achilles tendinopathy, or basic skeletal structure limitations keeping them from squatting with proper form and good depth, a little heel lift can make a huge difference. VersaLifts heel lifts are available in three different sizes and all of them add an additional half inch of drop to any training shoe, helping athletes squat deeper with better form. Visit www.vlifts.com/icephysio or click the link in today's show notes to get your VersaLifts today. ALEXIS MORGAN Good morning, PT on Ice. Getting both our cameras going here. Good morning, PT on Ice Daily Show. My name is Dr. Alexis Morgan, and I am excited to be with you on this morning, this new year. Happy New Year, everyone. And let's talk about measuring IRD or inter rectus distance versus measuring strength. Which one matters more? So to jump right into the topic here, Interrectus distance is a common measurement that individuals are going to be taking in pelvic health. WHAT IS INTERRECTUS DISTANCE (IRD)? So interrectus distance is the distance or the measurement of the linea alba width. It's that linea alba between the rectus abdominis on the left compared to on the right. What is that distance between? That's our interrectus distance. Many people advocate for measuring interrectus distance. Number one, it's measured in a lot of our scientific studies that is looking at diastasis recti. There's a lot of studies that are looking at it. And so if they're looking at it in the studies, well, maybe we should be looking at it in clinic as well. It's also repeatable. We can measure it the exact same way and we can see if there is change. And we like data that we can measure and we can see if there is change. So people are definitely advocating for its use. There are some benefits from measuring change. Obviously, you're here at ICE, you know that we are recommending to be able to test and retest to see those differences in all aspects of care. So, of course, we should be recommending that here, right? Well, we do recommend testing and retesting in this space. MEASURING STRENGTH However, we recommend measuring strength. So, measuring strength entails getting functional with your clients. One of our favorite tests is the sit-up test. We talk about it in our online course, and it is a way in which you can measure how strong an individual's rectus abdominis is. So they're sitting up. How much support do they need from their legs? How much support do they need from their arms? Do they need to whip themselves up or can they control themselves up? Do you need to hold onto their feet or not? This gives you a score. And with that score, we can then track change over time. It's extremely functional. This is what individuals are doing when they're getting out of bed or when they're getting up out of the floor with their little ones. This is also very functional for all populations. So not just the postpartum individual, but this is also helpful for individuals who are post hernia surgery or pre-hernia surgery. This is great for individuals with varying levels of adiposity. You don't have to measure, you don't have to assess something and be distracted or be, oh, I don't really know what I'm looking at because there's adiposity. We're just measuring strength. We're just testing the functionality. LIMITATIONS OF IRD When we think about the limitations of measuring the interrectus distance, Really, I could go on for a long time here. There's actually no known pathological number or centimeter or measurement. There's no known measurement that we all are in agreeance of like, yes, that number is pathological. We don't have that. In 2021, a recent paper came out and actually I believe Rachel did a podcast on this exact paper. So I'm not going to go into all of the details. You can search back to listen to this, but in 2021, a paper came out looking at individuals ages 20 to 90 males and females of all BMI sizes, looking at their CT scans and they measured the interrectus distance. With all of these people, 57% had greater than two centimeters in that interrectus distance. Now for reference, over the last 70 years, much of the data, much of the science that is looking at diastasis is using measurements, oftentimes in centimeters, and they vary. There's no agreeance in these studies. So sometimes there are two, sometimes it's 2.2, sometimes it's 2.5, that that one particular study calls pathological because there's no known pathological. But around that two centimeter mark, Well, now we have this study just in 2021, looking at what is normal. And we see that 57, so over half of the individuals actually had greater than two centimeters. So there's a problem here. We can't call this pathological of more than half of the individuals of all ages, of all BMIs, parity being one risk factor, but BMI and age also being risk factors. We can't use that. Not to mention in all these studies there's a variety of tools that are being used. So measuring with just fingers, measuring with calipers, measuring using a ultrasound machine. There's a lot of different ways to measure and of course those are going to be different between different tools. We don't have any standards. We don't know where exactly should we measure. In all of these studies, sometimes it's a couple centimeters above the belly button, sometimes it's more, sometimes it's less, sometimes it's right at, sometimes they avoid. There is no absolute on where we should measure, nor the type. It's all over the place. And one of the aspects that I think is the most concerning here is that, well, I've just laid out one, the fact that we don't have any agreement on any of this. Why are we doing, why are we measuring? FOCUS ON FUNCTION AND NOT APPEARANCE But number two, when we're measuring, we are perpetuating this focus on the looks. We're focused on what they look like and what that measurement is has nothing to do with their function. We talk a lot in our level one course on diastasis and a big aspect that I'll have to leave for another podcast on another day, or you can join us in our course, but another aspect of this is body image. And many individuals are very concerned and have body image dissatisfaction. If we can help them by shifting the focus to function in our little space, absolutely we recommend referring out to mental health professionals to help with that. But in our little space that is the physical world, If we can help by shifting the focus to physical and to function, then why would we not do that? Especially when there's a lack of evidence for clarity on measuring that inter-rectus distance. Our newest research in this space in the last handful of years, our newest research has shifted in this direction. it shifted in measuring abdominal torque. the rotational torque that is that one can generate power. Why? Because that's functional. Or that sit-up test, like I mentioned, it's functional. Our newest evidence is heading in this direction. Let's not wait 20 years. Let's go ahead and jump on this train and let's start measuring function today, this year, for 2024. Let's measure function and let's focus on what matters. for our clients, and let's follow this research. And when we do that, we know we can absolutely help them increase in their function. We've got no doubt about it. I know for sure if you can't do a full setup, I'm gonna give you the modifications and I'm gonna give you that home exercise program that will allow you to do a full setup in due time. I have no doubt about it. I can sell that so easily and I would hope that you can too. So let's stop focusing on interrectus distance. Let's start focusing on function. Our recommendation is that if somebody comes in and asks for an interrectus distance measurement, if they're asking you to measure, and they fully believe in its importance in their rehab, that would be the only time in which you would use measurement. Other than that, other than they're asking for it and there is a significant belief in its importance, If those two things are not both on the table, then we need to set the measuring IRD aside and focus in on strength. Thank you so much for joining me this morning. I hope it made you think. It's something we've been thinking a lot about, both in reading the evidence and in practicing clinically. And I hope it helps you focus in on what matters this year for your patients. This material and a whole lot more is in our online level one course. Our course starts next week. It's absolutely sold out. We are closing, we will be selling out for the March cohort well before March as well. So if you are wanting to get into this level one course, it's been revamped, all brand new. If you want in, you should go ahead and register for that March cohort. If you've taken our online courses before, online level one before, then you will be interested in our online level two course. And that is a brand new course, which starts April 30th. If you want to catch us live, we're going to be on the road a lot in 2024. All of that's on the website. You can see it. I'll just mention the few that are coming up in January and February. We are going to be in Raleigh, North Carolina, January 13th and 14th, Hendersonville, Tennessee, January 28th and 29th, and Bellingham, Washington, February 3rd and 4th. We are so excited to see you all out on the road in 2024 and can't wait to see you all online as well. Have a great day. Happy New Year. And we'll catch you next time. OUTRO Hey, thanks for tuning in to the PT on Ice daily show. If you enjoyed this content, head on over to iTunes and leave us a review, and be sure to check us out on Facebook and Instagram at the Institute of Clinical Excellence. If you're interested in getting plugged into more ice content on a weekly basis while earning CEUs from home, check out our virtual ice online mentorship program at ptonice.com. While you're there, sign up for our Hump Day Hustling newsletter for a free email every Wednesday morning with our top five research articles and social media posts that we think are worth reading. Head over to ptonice.com and scroll to the bottom of the page to sign up.

Dr. Rachel Moore // #ICEPelvic // www.ptonice.com  In today's episode of the PT on ICE Daily Show, #ICEPelvic faculty member Rachel Moore describes pelvic varicosities & varicoceles. Rachel breaks down the difference in how these present in both male and female pelvic physical therapy patients as well as how to conceptualize treatment in the clinic.  Take a listen to learn how to better serve this population of patients & athletes. If you're looking to learn more about our live pregnancy and postpartum physical therapy courses or our online physical therapy courses, check our entire list of continuing education courses for physical therapy including our physical therapy certifications by checking out our website. Don't forget about all of our FREE eBooks, prebuilt workshops, free CEUs, and other physical therapy continuing education on our Resources tab. Are you looking for more information on how to keep lifting weights while pregnant? Check out the ICE Pelvic bi-weekly newsletter! EPISODE TRANSCRIPTION INTRODUCTION Hey everyone, this is Alan. Chief Operating Officer here at ICE. Before we get started with today's episode, I want to talk to you about VersaLifts. Today's episode is brought to you by VersaLifts. Best known for their heel lift shoe inserts, VersaLifts has been a leading innovator in bringing simple but highly effective rehab tools to the market. If you have clients with stiff ankles, Achilles tendinopathy, or basic skeletal structure limitations keeping them from squatting with proper form and good depth, a little heel lift can make a huge difference. VersaLifts heel lifts are available in three different sizes and all of them add an additional half inch of h drop to any training shoe, helping athletes squat deeper with better form. Visit www.vlifts.com/icephysio or click the link in today's show notes to get your VersaLifts today. RACHEL MOORE All right, good morning PT on ICE Daily Show my name is Dr. Rachel Moore I am here this morning. It is Monday morning. That means it is our pelvic day here on this podcast So I'm here with the pelvic division and I am super excited to talk to you guys this morning We're gonna be kind of diving into varicoceles and varicosities, vulvar varicosities, and the way that those are actually incredibly similar in our treatment approach, whether we realize it or not. Before we dive into that though, if you missed it, we've officially rolled out all of our certifications here at ICE. So we have certifications, we've had them before in the clinical management of the fitness athlete division and an MMOA, but now we have new ones. So we have orthopedic, we've got dry needling, we've got an endurance athlete, and then what we are super excited about in the pelvic division is we have our pelvic cert as well. So this is three courses, two online, a level one and a level two, and then one live course. If you're looking to get in on that certification, our upcoming courses, we actually have one this weekend in Bear, Delaware. That's going to be with myself and Alexis Morgan. So super excited about that. Still, time to hop into that if you want to buy yourself a plane ticket and get out there. And then we also have one on December 2nd. If you are north of the US border in Canada and Halifax, Nova Scotia, Christina is bringing those live courses to Canada. So we're super excited about that. Our next L1 cohort kicks off January 9th, and then our L2 you can already sign up for. So if you want to be in that first cohort of that L2, it kicks off April 30th. So if you're interested in getting that cert, all of the options are out there. Hop into one of those courses. We're excited to see you in them. VARICOSITIES AND VARICOCELES Let's dive into our topic for the day. So a lot of times those of us in the pelvic space if we are maybe majority see women a lot of us tend to maybe start there and then maybe branch off into seeing men but if we are in this kind of blinders-on situation where we're like no no I only see women sometimes we may be uncomfortable or unsure if somebody gives you a call and asks about a certain diagnosis or maybe you have a friend or somebody that you know that is struggling with something and asks for advice on the pelvic space and you're trying to figure out how to get them into your clinic. And so I wanted to draw a parallel this morning between two diagnoses that we see as fairly common that actually are very similar in the way that we treat them. So that is going to be varicoceles and varicosities. So in utero, the reproductive tissues of males and females begin developing similarly. If you guys remember that from PT school, when we were learning about the brief amount that we cover these types of topics, once testosterone starts being released, that's when the reproductive organs shift and either develop into male organs or continue on the path of female organs. And so if the testosterone is there, then the tissue that is becoming the scrotum becomes the scrotum. But if the testosterone is not there, then that tissue continues on to turn into the labia. So when we think about our tissues and our anatomy, we often talk about how male and female anatomy really aren't that different. It is similar parts arranged differently and maybe to different sizes and proportions. But when we look back all the way in utero, we can see that developmentally these things start the same and there's a certain point where things branch, but we have these kind of analogous, um, uh, tissues within males and females. So, We know that the tissues are similar between the scrotum and between labia. When we're talking about varicosities, this is important for us to know because these are two diagnoses that we tend to see come up fairly frequently. VARICOSE VEINS IN THE PELVIS So before we dive into the specifics of varicose veins in the pelvic area, let's talk about what varicose veins are. Varicose veins, if you're not familiar with them, are enlarged twisted veins. So oftentimes this comes from damage to the valves in the veins. So our veins have one-way valves that help push blood up and prevent backflow back down. If there is damage to the inside of the vein and the valves are damaged somehow or maybe are not operating at the capacity that they need to be operating, we can see kind of a backlog of blood and that can lead to this kind of inflamed or swollen look to the veins and that blood just kind of pulls in there. The causes of the damage, quote-unquote, Inside of the vein can be known. So this can be something like high blood pressure or it can be unknown Things that increase your risk for developing varicosities are gonna be things like being female So that's always fun when gender is one of the top things can't control for that genetic predisposition so if you have a family history of varicosities then this might be something that you're really keeping an eye on and older age as we get older maybe those valves within the vein become a little bit less competent increased body mass and then in pregnancy we'll dive into that here in just a second and then also interestingly having a history of blood clot that's really important to kind of keep in mind on our radars not only in our post-surgical patients but we're starting to see blood clots kind of popping up more and more um and so if you have somebody who might be not hitting any of these other risk factors but has a history of blood clots it's still something that we want to kind of keep on our radar varicose veins aren't a medical emergency by any means but they can cause some like uncomfortable unpleasant symptoms like heaviness aching pain and then swelling. VARICOSITIES Let's dive a little bit deeper into varicosities of the pelvic region so in our biologically female counterparts we see vulvar varicosities this is varicosity that develops on the vulva so anywhere along the outside of the vagina so that tissue of the vulva It can happen on labia majora, labia minora. It can be going towards the inner thigh, more into that groin area. Really just kind of depends on the area that is affected. The risk factor for this specifically is pregnancy. So we see this come up in pregnancy for a few different reasons. One reason is that we have an increase in blood volume during pregnancy in order to support the baby. So that increase in blood volume means that our veins have to work harder to push more blood up. we also know that we see relaxin circulating and that does have an effect on all tissues and then we have an increase in pressure so we have increased pressure from both the weight coming down of baby placenta amniotic fluid and all the things but then if we also think about like the anatomy of a pregnant belly as people progress through pregnancy get into this maybe anterior pelvic tilt their belly maybe drops low it can cause some congestion or some backup within that system which then leads to less efficient drainage. This is something that we see pretty often in the clinic really and you might be familiar with this if you're in the pelvic space. but what we tend to not really think about is how this parallels varicose seals. So a lot of times we're pretty confident and comfortable with vulvar varicosities, but then somebody comes in with a little bit different anatomy, and we kind of get thrown for a loop. So a varicose seal is a varicose vein that's located within the scrotal sac. This can actually develop during puberty because blood flow to the genitals increases during puberty. As those tissues are maturing things can just get a little thrown off, but it can also happen as a result of surgeries So think about vasectomies even though those are like minor office procedures surgeries vasectomies or trauma to the scrotum They're surprisingly common, especially in the adolescent puberty side of things. And just because you have a varicocele doesn't necessarily mean you'll even know it, aside from feeling it, potentially. So the biggest way or hallmark of this is called the bag of worms. because within the skirt sack that varicocele feels like a thick ropey worm and so as people are feeling around checking testicles for different things then you might feel that bag of worms type sensation or that that feeling with your fingers and other than that you may not have any idea However if you have a varicose seal that is causing problems We can see swelling pain and heaviness as I talked about earlier and if this is left alone and becomes severe it can actually impact fertility in men because it can lead to decreased sperm in the ejaculate and so it can be something that if it happens in adolescence and somebody is trying to conceive later on in life with their partner and they're struggling, it's an area to look at. Just like vulvar varicosities, we see an increase in symptoms when we're standing for prolonged periods, but uniquely to this population, we can see potential pain with ejaculation. So with vulvar varicosities, we might see pain with intercourse because of the pressure on the outside of the vulva during intercourse. But with this population, it's going to be more so during ejaculation that there is pain. WHAT TO DO ABOUT VARICOSITIES AND VARICOCELES We have our person in front of us, male or female, who comes into your clinic, some varicosity of some sort going on. What are we supposed to do? Jess actually did a really fabulous episode on this topic. It's episode 1198, so if you want to go back and listen to that, she talks specifically about varicosities during pregnancy, and those same concepts can be applied to varicoceles in men. So I highly recommend giving that a listen. We're going to dive in just really briefly touch on some of those topics and then I'll let you guys really dive into justice. External support can be a game changer for these folks, especially those with varicose heels whose anatomy is already putting things in a gravity, um, disadvantageous position for drainage. So giving some type of support, whether that is like when you're getting up and moving using your hand to support or getting some type of support garment. There are specific support garments that are made both for males and females for varicosities. soft tissue massage and when we think about this we're really thinking like mimicking lymphatic drainage I talk about this all the time with breast tissue and engorgement but the same thing we're thinking about this like congestion within the pelvic region and so we want to think about clearing more proximally up Towards the iliac vein so that we can kind of promote that drainage and then work our way down Rather than coming down to the bottom and just shoving everything up and causing more congestion Superiorly, so we're starting closer to the midline Draining quote-unquote that area. So if you're watching on Instagram, we're saying we've got a guy in and he's got varicose heels maybe we're starting here and then we're working lower and then working lower and until we get to that most distal tissue. From an exercise intervention standpoint, the pelvic floor muscles, of their functions are a sump pump. So when they contract and relax, they push fluid out of areas. So teaching our patients how to do pelvic floor contractions, how to lift up and contract into the attic, relax down and go into the basement, get that pumping mechanism going, and then teaching them belly breathing on top of that to help facilitate that as well. Finally, from a positional standpoint, we can have our patients if at the end of the day, they're super symptomatic and they're feeling rough after being on their feet, laying on their back, propping their legs up on the couch, or on a wall to get some passive decrease in gravity pressure on the pelvic region, and we can even take that a step further, have them plant those feet on that surface and do some bridging where they're squeezing their glutes, maybe adding in that pelvic floor contraction, layering that in, so we've got gravity coming down, we've got our muscles contracting and relaxing, really everything helping to push that fluid up and out into the drainage system to go bring that blood back to the heart. So, if you have somebody come in your clinic tomorrow, and you are a pelvic floor PT who traditionally treats females, and a guy walks in and he's like, I have a varicose seal, I don't know what to do. I hope that you can put your cap on, thinking cap on, and realize like, you got this, you know what to do. At the end of the day, we have to remember that our males and our females, although the anatomy is arranged a little bit differently, and proportions are a little bit different, they are similar tissue. So keep that in mind. You guys are rocking it out there. Have a happy Monday. Thanks for having me. Bye. OUTRO Hey, thanks for tuning in to the PT on Ice daily show. If you enjoyed this content, head on over to iTunes and leave us a review, and be sure to check us out on Facebook and Instagram at the Institute of Clinical Excellence. If you're interested in getting plugged into more ice content on a weekly basis while earning CUs from home, check out our virtual ice online mentorship program at ptonice.com. While you're there, sign up for our Hump Day Hustling newsletter for a free email every Wednesday morning with our top five research articles and social media posts that we think are worth reading. Head over to ptonice.com and scroll to the bottom of the page to sign up.

Dr. Alexis Morgan // #ICEPelvic // www.ptonice.com  In today's episode of the PT on ICE Daily Show, #ICEPelvic lead faculty Alexis Morgan discusses the research & practical approach to helping runners return to running beginning at 4 weeks postpartum. She references research that about 50% of postpartum patients begin reintroducing running at approximately 4 weeks postpartum, with varying degrees of symptoms. Alexis emphasizes utilizing the symptom behavior model to monitor symptoms, educating & encouraging patients that about 85% of all individuals have some sort of symptom(s) with running, and that volume is an important variable to have a successful return to running. Take a listen to learn how to better serve this population of patients & athletes. If you're looking to learn more about our live pregnancy and postpartum physical therapy courses or our online physical therapy courses, check our entire list of continuing education courses for physical therapy including our physical therapy certifications by checking out our website. Don't forget about all of our FREE eBooks, prebuilt workshops, free CEUs, and other physical therapy continuing education on our Resources tab. Are you looking for more information on how to keep lifting weights while pregnant? Check out the ICE Pelvic bi-weekly newsletter! EPISODE TRANSCRIPTION 00:00 - ALEXIS MORGAN Good morning, Instagram. Good morning, fellow ice people. Welcome to the PT on Ice Daily Show. Welcome to Monday. It is the start of another week. And we are so excited to be here. Really as we're wrapping up the end of this year, we still have a lot going on at the end of the year that I want to tell you all about this morning. And then we are really getting already very excited about 2024. And just want to talk to you all about some of the things that are going on. If you are in the ICE Students Facebook group, you've been to an ICE course or you were just recently added in because you just finished a course this weekend, welcome. You've seen some announcements in there as well a while back. And I just want to highlight a couple of things. So let's get started on that before we discuss four weeks returning to running, four weeks postpartum. So number one, we've still got three more chances for a live course, or you've got three more chances to hit us in the pelvic division at a live course. So this, not this weekend, but next weekend, if you're listening live, November 4th and 5th, we will be in Bozeman, Montana, and then a few weeks after that in Bexar, Delaware. And a few weeks after that in Halifax, Nova Scotia, Canada. That is the first weekend in December, December 2nd and 3rd. So those are your three chances to get into seeing this Pelvic Live course, experiencing it, having fun with us, learning so much about pelvic floor health. not just for pregnancy and postpartum, but in general, across the lifespan, men and women, pregnancy, yes, but also all things pelvic health. So those are your three chances, Bozeman, Bexar, Delaware, and Halifax, Nova Scotia, Canada. So if you're on the fence, go ahead and pop onto those. Second, thing that we i want to share with you all is about the pelvic level one course so our name is changing as you all have heard us talking about and we're actually going to be taking a little break through the next few months and our new level one cohort is going to start in january so Be sure, we've already got people signed up for that, gearing up, ready to experience the new content. Very regularly, we are always reading the research on a weekly basis. And once enough of it stacks up, we've got to reframe the way that we're teaching, particularly in the space, because it changes so incredibly rapidly. And so with that, we are updating that material. So that is coming up on, that will be on the website soon. Actually, that is actually already on the website. So that is on there. So a lot of things coming up at the end of this year, the beginning of next year. We've got even more announcements, so stay tuned. And we're gonna be announcing a couple more exciting things in our ice pelvic newsletter. So if you're not already signed up for the pelvic newsletter, go ahead and sign up for that because we've got even more things to discuss and share with you all. 04:31 - RETURNING TO RUNNING 4 WEEKS POSTPARTUM  So all of that aside, let's go ahead and discuss this four week return to running. This is a topic that a handful of years ago really was not discussed. No way are we going to be facilitating someone running one month after giving birth. That's what we thought a handful of years ago. But fast forward, we've got several examples of elite level athletes which then trickles down to our recreational level athletes, we've got several examples of people returning to running. And it's actually even showing up in our literature. And when we are starting to see this, it's kind of interesting in the pelvic world, like we have all of these thoughts and beliefs and oftentimes you're you're gonna run into some strong opinions surrounding those, and a deep connection here. We've gotta have that connection with our beliefs, but also be willing to let that go once the evidence and once the, even the anecdotal evidence that your clients show up to you with, once that narrative begins, and it's maybe opposite of yours, we need to be able to let that go and to explore and ask questions and be curious about, well, what are some other possibilities? And that's exactly what we're seeing in this four-week return to running. So what we've seen is people aren't running. Runners will run, as we always say, in pregnancy and then early postpartum. And what we know is that the longer someone runs in their pregnancy, the sooner they're going to run in that postpartum phase. And in Shefali Christopher's study looking at returning to running and risk factors associated with musculoskeletal pain, she actually saw that it was close to half of those individuals, 46%, reported returning to running at four weeks. And so we've got some information to kind of digest, right, as therapists. And what we know, and again, in her research, what we know is that when runners return to running, we're seeing that musculoskeletal injuries or musculoskeletal pain does occur. And so that's the number one thing that we want to be educating our runners on and we want to be looking out for. But rather than waiting until they've hit certain guidelines, what we are proposing and what we are doing, what I am doing clinically, what a lot of our faculty is doing clinically is we're educating our patients. And we urge you to educate your patients as well. Based on this evidence, this is what we're seeing. We're seeing that when we're returning to running, we're actually, many people are experiencing musculoskeletal pain, about 85% of people. Not just those that are returning at four weeks. The median time returning at 12 weeks. So that's significantly before and significantly afterwards. We educate them. So we can, Educate them. They know that okay. There's a risk of injury. There's a risk of musculoskeletal pain Of course, just like with everything and what we tell them is when you feel something You need to let me know That visit is so much easier to discuss that if it's already been planned. So you schedule your person a couple weeks out. Go ahead and return to running and see how that feels. We're gonna control for the volume. We're not gonna go out and run five miles for the first time in eight weeks. We're gonna control that volume. Build up slowly and see how they feel. If you're experiencing some mild knee pain or some hip pain, we are gonna address that. All the while, absolutely, we're doing our basic hip strengthening, right? I say basic, not just talking about a basic squat, but also your accessory movements like clamshells to work on that rotation. Or better yet, some single leg standing you know, the standing variation of the clamshell or the hip abduction with your foot on the wall. That way you're working both sides. We love that accessory work to decrease the risk of pain. But even while they're working on that strength, they're still, everyone is still at a risk. And so the best thing they can do is talk to you about it as soon as they experience that. And tell them, okay, let's back down on that volume right when they're when they experience that let's say they bumped it up to a two mile total volume of running maybe they were doing one minute of running 30 seconds of walking and they had just bumped all of that volume and those intervals up experience that bit of lateral knee pain let's bump that back down. What were they doing last week? Let's repeat last week's volume. Let's repeat last week's running workouts and let's calm that system down. That's how we'll address it from that pain aspect. And then of course, we're going to be continuing to build that accessory strength training and coaching their running, looking at their running form. We're not afraid of them experiencing that pain. In fact, we know more than likely they're going to experience that. Again, 85% of runners are experiencing some level of pain, typically in the lower extremities, not necessarily their pelvis or pelvic floor. So we know we're gonna bump into that. So we educate them on the factors, and then we schedule a visit to where we're gonna follow back up on that. That's already in their calendar, they already know. That way we can discuss those itty bitty issues that they have, and we can address them before they get bigger. That's exactly the same thing that we want to do with pelvic heaviness, symptoms of heaviness, really fatigue, we've talked a lot about that on the podcast here and of course in our courses, but pelvic floor heaviness or fatigue is another symptom that we're going to address in the exact same way. We're gonna decrease their volume. We're gonna educate them about it first and talk with them when they experience it, but they are going to decrease their volume when that occurs. We're gonna continue to be building that hip accessory work. All the while we're working pelvic floor strength, but pelvic floor and hip accessory movement, that's what builds up strength and endurance for the run. Just like how we expect them to experience pain, what we're realizing is that we expect them to bump into some symptoms of heaviness as well. We, as the rehab providers, are not scared of that. Just like we're not scared of them experiencing pain. We know they bump into that and we get them to back off immediately. We know they're not gonna have an issue there. We know they're gonna meet all of their goals and continue to run. We know this with the symptoms of pelvic floor heaviness as well. Heaviness, in most cases, many cases can come on with a lot of emotional concern. And honestly, in some cases, pain can do that as well. You've all experienced that with your patients. Very similar with pelvic floor heaviness. I see it very, we all see it very heightened in that emotional response. But if we can educate them on this first, if we can tell them, Hey, You're gonna bump into this. This is a symptom of fatigue. What you're gonna do when you bump into it is you're gonna back down. You're gonna back down in that volume. You're gonna wait to return to your next running workout until those symptoms have died down, because your body is telling you that that's too much. But you're gonna return, and we're gonna talk about it on our next visit, and you are absolutely gonna run that 5K at Thanksgiving. or you're absolutely gonna run that New Year's Day 5K, whatever that may be for them. So, educating them about symptoms, whether it's pain, whether it's heaviness, of course, leaking. I feel like we as pelvic floor PTs have educated people so, so much on leaking, but similar conversation here. you're probably going to have leaking with some point of return to running. Again, it's muscle fatigue that often precedes that return or that leaking. So we're going to probably experience it. If that athlete is running to a fatigue level, that's okay. We've gotta understand where their capacity is and where that lies and where that threshold is for leaking or for heaviness or for pain. We figure out where that threshold is, we go down from that. We build capacity and we bump that threshold up. That's the name of the game in all things that we do. That is the name of the game in pelvic floor health, in returning to running, even when they're returning early, like at four weeks. Realize runners are gonna run. Many of them are already going to run at four weeks. So go ahead and have that conversation at your two-week follow-up. Better yet, go ahead and have that conversation in their late pregnancy. Prepare them for what they're going to experience in that return to run. Prepare them for it to decrease fear and to improve education and awareness. Education goes such a long way in this area, but we've also gotta have that follow-up. We've gotta have that action item, okay? When they experience the pain or the heaviness, what you're going to do is X, Y, Z. Decrease that volume, right? Maybe return to some, diaphragmatic breathing and regulate your nervous system if it's someone who's has a heightened level of concern, right? We're going to repeat last week's workouts after symptoms have resolved. Give them several action items that way they feel empowered to make those decisions for themselves. All of that and then have that follow-up appointment with them already scheduled a couple weeks out. And that way, you can address all of these issues that are small, and we ensure that it does not continue to grow. So that's a very different way of guiding someone in this return to running, where someone is starting to run early, we don't have the time to go through all these strength and all of these assessments, but we just say, hey, let's use our symptoms as our guide. Let's start small, 15 seconds of running, 30 seconds of walking. Let's start small and add that in and let's see how you do. That is an example of us coming alongside someone who's already going to be running. This is how we stay in their corner as opposed to, Hey, you're not ready to run. Person's like, I know I'm ready to run. I mentally am so ready to run. I'm not gonna go back to that person. I'm gonna go run. We lose people when we have this black and white yes and no and I am the boss. We gain people, we gain people's trust and confidence and their willingness to work with us if we come alongside them. So that's what we're advocating for this return to run. Absolutely, you're gonna work on strength, overall building capacity, calf. We're gonna work on coaching them and how do they look with running and running form and their cadence. And we're going to be addressing all of these factors. Let's do it by letting them run and coming alongside them. That's a bit different than what you might be doing. That's different than what we used to do several years ago. What do you think? Do you want to try it? Have you recently tried it? Or are you concerned? Think we might be missing something? I'd love to hear your thoughts on this. Have a wonderful Monday. Hope to see you on the road at one of our three courses at the end of this year. And we will talk soon. Thanks for being here, y'all. OUTRO Hey, thanks for tuning in to the PT on Ice daily show. If you enjoyed this content, head on over to iTunes and leave us a review and be sure to check us out on Facebook and Instagram at the Institute of Clinical Excellence. If you're interested in getting plugged into more ice content on a weekly basis while earning CEUs from home, check out our virtual ice online mentorship program at ptonice.com. While you're there, sign up for our Hump Day Hustling newsletter for a free email every Wednesday morning with our top five research articles and social media posts that we think are worth reading. Head over to ptonice.com and scroll to the bottom of the page to sign up.

Are you ready to be inspired by a young entrepreneur who is only 19 but already a real estate sensation ? Hoe does she navigate the competitive real estate industry with such achievement ? Join us in this episode as we dive into the journey of this remarkable young investor . Explore the strategies, the MINDSET, the passion that have driven her to excel in the business. Subscribe now and be part of this extraordinary story! ---------------------------- Connect with us Today: Email: info@mitcapitals.com Website: https://www.mitmultifamilies.com/ Facebook: / mitcapitals Instagram: / mit_capital. . Podcast :https://podcasts.apple.com/tw/podcast... Connect with Alexis on INSTAGRAM: @alexisjmorgann FACEBOOK: Alexis Morgan TIKTOK: @alexisjmorgann YOUTUBE: @alexisjmorgann Powered by Firstory Hosting

Send us a Text Message.Welcome to the momentous first episode of Our Kids, Our Schools, a podcast that promises to challenge, inspire, and reshape your perspective on education. The curious spark that ignited this journey was an article from The Atlantic: "The One Parenting Decision that Really Matters." Alexis Morgan connects the dots between this article (answering that ONE parenting decision that REALLY matters), the importance of school communities, and broader themes of civil rights and civic responsibilities.Brace yourself for an intellectual adventure as Alexis poses thought-provoking questions that will challenge you to rethink the status quo.The episode wraps up with her "2 Key Takeaways" which will leave you pondering long after the episode ends.But the conversation doesn't stop there — join the discourse on Instagram with @the.alexis.morgan and deepen the dialogue.To stay in step with this enlightening journey, hit Follow on your podcast app. Dive in and let Alexis guide you through the intricate landscape of education.Find Alexis on Instagram and JOIN in the conversation: https://www.instagram.com/the.alexis.morgan/ Utilize Alexis and her awesome skills. Check out her website: https://www.thealexismorgan.com/

Dr. Alexis Morgan // #ICEPelvic // www.ptonice.com  In today's episode of the PT on ICE Daily Show, #ICEPelvic division leader Alexis Morgan emphasizes emphasizes the significance of comprehending your own body and the process involved in utilizing the pelvic floor. Without this understanding, it can be challenging to educate and support others in this area. To better understand and utilize your pelvic floor, Alexis suggests a five-step process. The first step is to "tell" the actions of the pelvic floor, which involves becoming familiar with its location and functions. Alexis uses the analogy of an A-frame house to explain the contraction and relaxation of the pelvic floor. The second step is to "demo" the actions of the pelvic floor. This can be done through videos or using a pelvic model to visually demonstrate the movements. The purpose of this step is to help individuals visualize and better comprehend what was explained in the first step. The third step is to "practice" contracting and relaxing the pelvic floor. Alexis encourages listeners to pay attention to any sensations they feel when they contract their pelvic floor. During virtual sessions, she advises being mindful of any additional body movements that may occur during the contraction. The fourth step is to "ensure" that the individual is correctly performing the pelvic floor movements. This step involves confirming if the person felt the intended movements and if they understood the instructions. If there is any uncertainty or confusion, Alexis emphasizes the importance of not progressing to the next phases until both the individual and the instructor are confident in their understanding. Lastly, the fifth step is to "progress" in using the pelvic floor. Alexis mentions that this five-step process may not occur in one session and that it may take time before individuals can confidently progress. However, by understanding their own body and going through these steps, individuals can develop the knowledge and skills necessary to effectively assist others in utilizing their pelvic floor. Overall, the episode highlights the significance of understanding one's own body and the steps involved in using the pelvic floor in order to effectively educate and assist others in this area, as well as provide meaningful care virtually. Take a listen to learn how to better serve this population of patients & athletes. If you're looking to learn more about our live pregnancy and postpartum physical therapy courses or our online physical therapy courses, check our entire list of continuing education courses for physical therapy including our physical therapy certifications by checking out our website. Don't forget about all of our FREE eBooks, prebuilt workshops, free CEUs, and other physical therapy continuing education on our Resources tab. Are you looking for more information on how to keep lifting weights while pregnant? Check out the ICE Pelvic bi-weekly newsletter! EPISODE TRANSCRIPTION 00:00 INTRO Hey everyone, Alan here. Before we get into today's episode, I'd like to take a moment to introduce our show sponsor, Jane. If you don't know about Jane, Jane is an all in one practice management software with features like online booking, scheduling, documentation, and a PCI compliant payment solution. The time that you spend with your patients and clients is very valuable and filling out forms during their appointment time can quickly take away from the time that you all have together. That's why the team at Jane has designed online intake forms, that your patients can complete from the comfort of their own homes. And to help them remember to fill out their forms, Jane has your back with a friendly email reminder sent 24 hours before their appointment. This means they arrive ready to start their appointment and you can arrive ready to help. Jane's online intake forms are fully customizable to ensure you're collecting everything you need ahead of time, whether that's getting a credit card on file, insurance billing details, or a signed consent form. You can build out your intake forms from scratch or use templates from Jane's template library and customize it further to meet your practice needs. If you're interested in learning more, head on over to jane.app slash guide. Use the code IcePT1MO at sign up to receive a one month grace period on your new account. Thanks, everyone. Enjoy today's episode of the PT on Ice daily show. 01:26 ALEXIS MORGAN Good morning, PT on Ice daily show. My name is Dr. Alexis Morgan, and I am here today representing the pelvic division. Happy Monday. I hope you all had a wonderful weekend. Let's discuss a huge topic that is virtual care this morning. Virtual care is something that really grew a lot during COVID. and we all kind of had to pivot, right, and try to figure out, okay, how exactly is this done? One of the areas that I feel like is potentially the most surprising about doing virtual care in is pelvic floor health, pelvic floor assessment, pelvic floor physical therapy. A few weeks ago, I did a PT on ice, about the virtual care and the subjective exam. And did a whole entire podcast on that, did not have time to discuss the objective assessment. So today I'm hopping back on to discuss how we do the virtual objective assessment. If you missed last time's podcast, go ahead and rewind back about a month and look for that. that virtual subjective care, because that's gonna be important and of course it's gonna lay the foundation for this pelvic floor assessment in the objective category. So, let's go ahead and just dive right in to exactly what we teach and what we do for that objective exam. We talked last time, and we talk all the time in pelvic health, that we are educators, that we really teach people how their body works and we teach them the truth about their bodies when in fact they've read unfortunately online and in magazines and on YouTube and in various forms they've heard lies. They've heard myths and they've heard misconceptions. It's very confusing. It's a confusing area of our body. And we get the opportunity to be educators. Part of this objective exam, when we are virtual, is education. So here's how it goes. It's really a five-step process. Number one, tell. Number two, demo. Three, practice, four, ensure, and five is progress. So let's dive into each of those categories. 04:47 ACTIONS OF THE PELVIC FLOOR So with tell, number one, first you're gonna tell them the actions of the pelvic floor. You're gonna essentially get them oriented with where the pelvic floor is and what it does. You're teaching, you're telling. So you're gonna tell them the actions of the pelvic floor, right? So when it contracts, it goes up. We use the analogy attic, first floor, and basement of the A-frame house here at ICE. So tell them that. So when it squeezes, it goes up into the attic. When you're just chilling, you're hanging out at first floor. We're just at rest at that first floor. That's where life is. happens when we're just chilling. Then we go into the basement. And that basement is the downward movement towards the feet. The holes expand, they enlarge. That analogy is helpful for someone to understand, helpful for them to kind of visualize that. But generally, that analogy isn't quite enough. And because in this objective exam, you know you're not gonna get to give them direct feedback, direct visual or tactile feedback, you've gotta go that extra step. So step number two, so step one was tell. Step two is demo. So you're gonna demo with maybe a video or your pelvic model that you have. Help them visualize what it is that you just said with that analogy. So looking at the pelvic floor, when it squeezes, it goes up towards your head. When it relaxes or an effortful relaxation, it opens up and goes away from your body. That's demo. So they can actually see. So tell and demo these two work hand in hand together. Step number three is practice. So you're gonna ask the client, okay, I want you to practice that. Go ahead and contract your pelvic floor. Do you feel anything? When they are contracting, you're looking for on this virtual call, you're looking for any kind of extra little body movements that they may have. If they're holding their breath, if their entire musculoskeletal system rises, they're doing too much. They're putting way too much into that. And so you can cue them and have them, okay, can you, can you do a similar thing? Can you still raise your pelvic floor? But can you do it with your entire body? relaxed. Just move your pelvic floor, even if it's a little bit less of a muscular engagement practice. You also want to have them do the opposite. So you had them go into that attic. Now you want to have them go into that basement. If they had trouble going into the attic, we definitely want to just move on and go to the basement because maybe they'll feel that a little bit better. So we go into the basement and we say, okay, I want you to bear down. I want you to push towards your feet. I want you to open up those holes, whatever language they need, and you wait for them to feel that. So we're talking them through this practice, but that's not really all. We've got to go on to step number four, which is ensure. So, you've got to ensure that they're doing what you both think that they are doing, what you both want them to be doing. You've got to ensure. So you're gonna ask them some questions, like, okay, so we talked about how it contracts, it closes up, and it goes, your pelvic floor, when you squeeze, raises up, like towards your head. Did you feel any of that movement? Are you sure that you felt it go up? Can you feel the difference between up and down, between that attic and that basement? Can you feel a distinct difference? If they can, I'm still reading their answers, and if they're saying, yeah, yeah, I think I felt that, I'm not convinced with that. I'm not convinced with a little question mark sounding. Yeah, I think I felt that. What we want to hear is, yes. Yes, I felt it. It wasn't strong. I didn't feel much, but I definitely felt a difference in that direction. We want to hear that. Because from that, we can then progress them. Number five. progress them to teaching what the pelvic floor should be doing in their problematic movements. Whether that is double unders, squatting heavy, catching a clean, whatever that might be. We want to teach them what their pelvic floor should be doing. That's again beyond the scope of this of this podcast this morning and please come on to our courses where we can really dive into that. But realize that that five-step process does not always occur in one session. So tell, demo, practice, and ensure absolutely will go hand-in-hand together. But it might be a while before you can progress. because if that person who's like, I think so, I think I felt that, or maybe they're saying like, I didn't feel it at all. I really don't know what you're talking about, Alexis. I didn't feel that. If neither one of you are sure that they felt those movements, you can't go on. You can't go on to the next phases because they have no idea. This little area of their pelvis is like a black box. They can't feel it. They can't move it. How are we supposed to rehab it? We've got to give them homework. We've got to give them projects to work on to be able to feel that. Some examples that I use is I'll send them with a mirror. to look at their pelvic floor to see if they see that movement. Or they can use their finger. They can use a finger and insert it vaginally and feel those differences. They can feel that pelvic floor move. Just getting to the point where they can feel that mobility is a really big improvement and can get them to where they can feel that elevation and that depression of the pelvic floor. So a visual tool for them or maybe a tactile tool for them with their finger. That's kind of a double tactile cue, right? They can feel it with their finger. They can also feel it in their pelvic floor. You might go with just a third option, a single tactile cue. So rolling up a washcloth and sitting on top of that. or straddling over the top of a bouncy ball to be able to feel a little bit of the difference. One of my most commonly used ones for the single tactile is actually tell them to sit in a bathtub where it's super, super still and work on feeling those movements. 13:15 USING WATER AS A TACTILE CUE Because of the pressure of the water, and the stillness of the water, they can actually feel any slight movement, particularly if it's still and if it's quiet in there. So that's one of my favorite ways to send them home with Homework, to try to get to where they can feel that movement, they can actually engage their pelvic floor, and they can discern the difference between a contraction and that effortful relaxation, or the attic and the basement. You send them home, you repeat all of this on the next visit in about a week or 10 days. Give them that practice to do and follow up with them soon on this, and you're gonna go through that same thing. tell, demo, practice, ensure, see how their confidence is, and then potentially at that point, then we progress. Then we move on to their positions that challenge them or their movements that challenge them, and we educate accordingly. I hope that was helpful for you all to utilize in your own practice and realize that It is challenging to do this if you don't understand your own body and if you don't understand all of these steps. So if you're listening to me today and you're like, I don't really understand how to use my pelvic floor, then you go through these steps. And I guarantee you that when you flip to the other side and you're talking others through this, you being able to relate to them is really going to be able to help. and you can understand that client so much better. Thank you all so much for joining today. I hope this was helpful. I hope you all have a wonderful week. This weekend, I'm gonna be in Scottsdale, Arizona with a whole lot of you all. We are so excited to join you all for the two-day live course. We're gonna have a blast down in Arizona. We've got several upcoming courses. So be sure to take a look on ptonice.com and be sure to register for our newsletter. Everyone always asks us, how do I find out more information? How do I stay up to date on the research? How, how, how in this fitness forward pelvic health world that is ice pelvic, The way to do it is to register for the newsletter. It comes out every other week, every other Thursday, and we give you all the goods there. So be sure to sign up for that, it's absolutely free. And of course, come on over to our courses, our live courses, and we're rolling out our last online course of the year right now, and we're gonna start fresh in the new year. So we are really looking forward to seeing you all out on the road or online. Thanks for being here. 16:42 OUTRO Hey, thanks for tuning in to the PT on Ice daily show. If you enjoyed this content, head on over to iTunes and leave us a review and be sure to check us out on Facebook and Instagram at the Institute of Clinical Excellence. If you're interested in getting plugged into more ice content on a weekly basis while earning CEUs from home, check out our virtual ice online mentorship program at ptonice.com. While you're there, sign up for our Hump Day Hustling newsletter for a free email every Wednesday morning with our top five research articles and social media posts that we think are worth reading. Head over to ptonice.com and scroll to the bottom of the page to sign up.

Dr. April Dominick // #ICEPelvic // www.ptonice.com  In today's episode of the PT on ICE Daily Show, #ICEPelvic faculty member April Dominick  kicks off part 1 of a series on postpartum depression. In this episode, she discusses the differences between postpartum depression and other PP mood disorders. She then highlights the prevalence of and risk factors for developing postpartum depression. In her next episode, she will focus on screening for and how to communicate with folks who may have postpartum depression. Take a listen to learn how to better serve this population of patients & athletes. If you're looking to learn more about our live pregnancy and postpartum physical therapy courses or our online physical therapy courses, check our entire list of continuing education courses for physical therapy including our physical therapy certifications by checking out our website. Don't forget about all of our FREE eBooks, prebuilt workshops, free CEUs, and other physical therapy continuing education on our Resources tab. Are you looking for more information on how to keep lifting weights while pregnant? Check out the ICE Pelvic bi-weekly newsletter! EPISODE TRANSCRIPTION 00:00 INTRO Hey everyone, Alan here. Before we get into today's episode, I'd like to take a moment to introduce our show sponsor, Jane. If you don't know about Jane, Jane is an all-in-one practice management software with features like online booking, scheduling, documentation, and a PCI-compliant payment solution. The time that you spend with your patients and clients is very valuable, and filling out forms during their appointment time can quickly take away from the time that you all have together. That's why the team at Jane has designed online intake forms, that your patients can complete from the comfort of their own homes. And to help them remember to fill out their forms, Jane has your back with a friendly email reminder sent 24 hours before their appointment. This means they arrive ready to start their appointment and you can arrive ready to help. Jane's online intake forms are fully customizable to ensure you're collecting everything you need ahead of time, whether that's getting a credit card on file, insurance billing details, or a signed consent form. You can build out your intake forms from scratch or use templates from Jane's template library and customize it further to meet your practice needs. If you're interested in learning more, head on over to jane.app.com. Use the code icePT1MO at sign up to receive a one month grace period on your new account. Thanks everyone. Enjoy today's episode of the PT on Ice daily show. 01:26 APRIL DOMINICK Good morning, everyone. Dr. April Dominick here from the Ice Pelvic Division, and today we're gonna talk about postpartum depression. This is a series, so in part one, we will define it, we'll talk about its prevalence, and we'll go through some risk factors for developing this condition. But before we dive in, we have some exciting updates from our division. Drum roll, please, or Harp glissando. So if you didn't catch our big news that dropped on Thursday of last week in our pelvic newsletter, we now have an eight week online level two course that will drop in spring 2024. We are so excited for this course. It is loaded with fun material. So we'll talk about pelvic pain syndromes. We'll go through post-op rehab for the pelvic and abdominal surgery that someone may get. We'll go through some birth prep and talk about all things fertility and infertility. So hop into that course when it becomes available. If the virtual option is not for you or your cup of tea, then I invite you to join us on the road live where we teach all things pelvic health rehab, bridging the gap between the fitness athlete and pelvic health. We're doing internal exams, external exams. We are talking about core rehab, going through labs that go over diastasis recti, return to the barbell, hopping on the rig, endurance, impact. It is so much fun as well. So when can you catch us live? We have some courses coming up September 23rd and 24th in Scottsdale, Arizona, and October 13th and 14th in Milwaukee, Wisconsin. Those classes will be with Dr. Alexis Morgan and Dr. Rachel Moore. Or you can find Dr. Christina Previtt. That's right, I said doctor. She just earned her PhD and we couldn't be more proud of her. So Christina and I will be out in the Pacific Northwest in Corvallis, Oregon on October 21st and 22nd. Tons of opportunities for you all to learn with us head over to PTOnIce.com and check out more. 06:34 POSTPARTUM DEPRESSION All right, postpartum depression, the topic of the day. Let's just cut to the chase. We'll call a spade a spade, pregnancy and parenthood. That is a transformative time. It's filled to the brim with new challenges when it comes to emotional, physical, mental, and lifestyle changes. We'll talk about pregnancy, I mean, that's approximately nine months of physical body alterations that support and nurture the baby. Then we have labor and delivery. That's an incredible feat. It's remarkable in the mental and physical strength that is required to get the baby to come out into the world. And then we have postpartum. Voila, the baby has arrived. Now what? So even though the baby may be all that the birthing person has ever dreamed of, it's gonna come with a lot of emotions, anticipation, joy, maybe even fear. Not to mention the added responsibility of caring for a baby while the birthing individual is functioning on minimal sleep, who knows what's happening with nutrition, and then there's an emotional rollercoaster going on. What up, hormones? and all the while that person is trying to heal and recover themselves. All of that can put a person at risk for postpartum mood disorders. We'll focus on postpartum depression or PPD, but I am going to share other conditions that may look like PPD. There's a side note here. A lot of the research that I did is on the postpartum parent who identifies as pronouns she, her, hers, or mother. So I'll be using that terminology for this podcast just based off of the research that I found. So here are three different postpartum mood disorders to include in a differential diagnosis if someone is coming to you postpartum. Number one, we have baby blues. This is gonna be the mild, most mild form of a depressive mood disorder. Then we have postpartum depression. And then our third type is postpartum psychosis, and that's gonna be the most severe form of depression for postpartum. So let's unpack baby blues. Due to the hormonal changes that happen immediately postpartum, About 50% of new mothers get the baby blues. That's a lot. By definition, the baby blues are mood changes that are mild, transient, and self-limited. And that means it'll resolve on its own and there is minimal medical retreatment required. Someone experiencing baby blues may exhibit signs of tearfulness, sadness, exhaustion, They may be irritable, they may have decreased concentration, mooniness, and decreased sleep. But all of those changes don't affect the person's ability to care for the baby or their own daily function. So from a time standpoint for baby blues, the onset and conclusion is like a bell curve. The symptoms come on within two to five days after childbirth, they peak, and then they generally resolve within two weeks of onset. One of the most common complications though of baby blues is the development of postpartum depression. So what is postpartum depression defined as? The DSM-5 defines it as a moderate to severe depressive episode that starts around four weeks post delivery. And this is typically going to require medical intervention. Compared to the baby blues, The big difference is that with postpartum depression, or PPD, symptoms persist for a longer period of time, so they aren't transient. 09:06 EFFECTS OF POSTPARTUM DEPRESSION If we zoom out, a person with postpartum depression can have changes in feelings, changes in everyday life, and they may even change how they think about their baby. Common symptoms for someone who is experiencing PPD They may have chronic feelings of guilt, feelings of failure as a mother, loss of interest in activities that used to bring them joy, feelings of despair that do interfere with their ADLs, and self-care. They'll also have unreasonable worries about the child's health and possibly infanticide or suicidal thoughts. So I wanted to talk about the effects of postpartum depression on the members in the family. So it's going to put the mother at greater risk for developing depressive episodes in the future. It can also affect the mother and infant bonding, and this has some potential implications if, say, the person is wanting to breastfeed, that may interrupt the success with that just due to the bonding issue. Beyond that, it's gonna affect the co-parent or the spouse and overall family dynamics. And there is some research showing the effects of postpartum depression and how that may negatively affect the behavioral and emotional development of the child. All right, so we went over baby blues, we went over postpartum depression, I can't leave this conversation without talking about postpartum psychosis. This is a psychiatric medical emergency. It's associated with increased suicide and infanticidal risk. It's rare. The global prevalence of it is about one to two and a half in every 1,000 women. It's going to emerge during the first few days or weeks of childbirth. And folks with postpartum psychosis will demonstrate rapid shifts in mood swings that are similar to bipolar tendencies. They'll have a loss of sense of reality. They may experience hallucinations, lack of sleep for several nights, agitation, delusions, and attempts to hurt themselves or the baby. So when you're meeting with a client, two keys for differentiating between baby blues and postpartum depression is the time since childbirth and severity of symptoms. So with baby blues, symptoms are usually present and gone within the first two weeks. Whereas those symptoms that persist beyond the first few weeks are more in the PPD camp. And then with baby blues, the symptoms are more mild and they don't affect the daily function of the individual. Whereas with PPD, it is more moderate in symptom nature and it will affect their daily life. So what is the prevalence of postpartum depression? It is one of the most common complications for someone after they give birth. PPD occurs in 15% or one in seven postpartum women. One in seven. These numbers are just representative of those who actually report it. So according to a study done in 2006 by Beck and colleagues, as many as half of PPD in new mothers goes undiagnosed because the individual is not wanting to share this with their family members or to share it with a research study. They wanna protect their own privacy. There are some effects of race as well in terms of prevalence, at least in when postpartum depression hits folks. So African-American and Hispanic mothers reported the onset of PPD within two weeks of delivery versus white mothers who tended to report the onset of PPD later. Region also matters. So geographical region. The prevalence of PPD varies by country. And what we know is that folks from developing countries have a higher prevalence of postpartum depression. Okay, what are the risk factors for postpartum depression? Y'all, there are so many. There were so many that I'm only gonna highlight the ones that came up over and over again that had the greatest impact in the research. So a 2022 literature review of risk factors of PPD identified the following as those that had the most powerful impact on development of PPD. Previous history of depression or psychiatric illness, depressive symptoms during pregnancy, and decreased social and spousal support. So there has been some research done that suggests, hey, if someone has healthy and supportive relationships, that is going to act as a protective mechanism during the prenatal period, specifically for the development of depression as well. There were some other factors, risk factors for PPD. Low socioeconomic status, stressful life events, and obstetrical specific factors like gestational diabetes, negative birth experiences, preterm deliveries, and low birth weight infants. All of these have a profound effect on the development of PPD. There was another systematic review from 2021 that they identified six major risk factors, which some of those we've gone over. But there were two in their list that I thought were interesting. One was that a risk factor if you were a pregnant woman who gave birth to boys, and then if you had an epidural anesthesia during childbirth. So I felt like those two were interesting, just side effects or side notes, and they were from a systemic review as well. 15:06 THE ROLE OF THE HPA AXIS Another area of emerging evidence looks at the role of the hypothalamus pituitary adrenal axis, or HPA. So we're about to get a little nerdy, but I love the brain, I love neuroscience, and I'm a psychology major, so let's talk about the brain and the endocrine system. So the HPA, or that hypothalamic pituitary adrenal axis, is a known responder during stress because it regulates physiologic processes such as the immune system and the autonomic nervous system. The HPA releases cortisol in trauma and stress. So if the HPA is not functioning correctly, there's a poor stress response. I think we can all agree that pregnancy itself and labor and delivery are some pretty extreme stressful and sometimes traumatic events. So during pregnancy, there are higher levels of estrogen and progesterone. Then during the delivery of the placenta, there's a dramatic fluctuation and drop of estrogen and progesterone. This rapid drop in hormone levels during that immediate postpartum period is a potential stressor and thought to contribute to the onset of depression. There was a 2017 systematic review that found seven out of 21 studies evaluating postpartum blues, and then 15 out of 28 studies evaluating PPD found abnormalities in the HBA axis. And from previous literature, we know that the dysregulation of the HBA axis is present in those with mental illness. So from all that, this is what I want us to think about. A healthy management of stress during pregnancy and postpartum should be a priority. We as rehab providers and medical professionals can have a tremendous impact in offering solutions for stress management like exercise, nutrition, sleep, proper medications. All right, let's recap. 18:39 IDENTIFYING POSTPARTUM DEPRESSION When working with the postpartum population, one of the most common complications is postpartum depression. It affects 15% of women giving birth. It's imperative that we're aware of the different mood disorders that can happen postpartum and the differences between them. We have postpartum blues, very common, affects about 50% of new mothers. It's mild, it's transient, doesn't usually need medical intervention, but we do need to provide some validation and compassion for those individuals. It's usually resolved by week two from childbirth. Then we have postpartum depression. It's moderate and severe in symptom nature. It can arise around four weeks post childbirth. It is going to affect daily functions and be present for up to a year postpartum. It will usually require medical intervention. Then we have postpartum psychosis. This is going to be a medical emergency. It's rare. but the person will present with rapid shifts in emotions, maybe have hallucinations, and the lives of the birthing person and infant are at risk. We as PTs play a tremendous role in identifying postpartum depression and other mood disorders. We can refer them to their physician, their mental health providers, and this can be helpful for someone if we think it's a medical emergency and we're suspecting postpartum psychosis. Understanding risk factors for PBD can be impactful when it comes to managing and treating it. Some of those major risk factors we can ID during pregnancy as well. So, hey, we're treating someone who is pregnant and we notice, oh, they have a lack of social or spousal support. They've told you they have a previous history or are having some depressive episodes during pregnancy. They have a lower SES or increased stressful life events besides pregnancy and delivery. Or they may say, hey, I was diagnosed with gestational diabetes. What I want to point out, these risk factors are modifiable. So in my upcoming podcast in this postpartum depression series, we'll discuss screening for PPD in the clinic, ways to communicate with a client who may be suffering from PPD, Then our final episode will cover resources, support, and the effects of exercise in treating PPD. Cheers, y'all. 19:53 OUTRO Hey, thanks for tuning in to the PT on Ice daily show. If you enjoyed this content, head on over to iTunes and leave us a review and be sure to check us out on Facebook and Instagram at the Institute of Clinical Excellence. If you're interested in getting plugged into more ice content on a weekly basis while earning CEUs from home, check out our virtual ice online mentorship program at ptonice.com. While you're there, sign up for our Hump Day Hustling newsletter for a free email every Wednesday morning with our top five research articles and social media posts that we think are worth reading. Head over to ptonice.com and scroll to the bottom of the page to sign up.  

Christina Prevett, PT, PhD and Alexis Morgan, PT, DPT are pelvic floor physiotherapists who lead the Pelvic Division at the Institute for Clinical Excellence.  Together, they work to help other physiotherapists empower their pregnant and postpartum athletes to safely continue strength training via online and live courses across North America. Christina recently completed her PhD at the Faculty of Health Sciences at McMaster University, and she holds a Masters of Physiotherapy.  She also helps create programming for pregnant and postpartum athletes via The Barbell Mamas.  Christina is a national level weightlifter, who competed in powerlifting and olympic weightlifting meets within 6 months of giving birth to her daughter. She has also completed the CrossFit Open while pregnant twice! Alexis is a clinical practitioner and co-owner of Onward Physical Therapy in Hendersonville, TN with her husband.  In her practice, she works with individuals interested in improving their pelvic health, utilizing and applying the latest research. As a CrossFit Level 2 trainer, Alexis is dedicated to fitness; you can find her exercising at the 4pm class at CrossFit Hendersonville. You can connect with Alexis & Christina via Instagram. @alexismorganpt, @christina_prevett, & @icephysio Related Episodes: Ep 83 - Pelvic Floor Health for Athletes with Dr. Julie Wiebe Ep 179 - Half His Size: Physical Therapist Alan Fredendall on Losing 200 Pounds and Introducing Patients to CrossFit If you like this episode, please subscribe to Pursuing Health on iTunes and give it a rating or share your feedback on social media using the hashtag #PursuingHealth. I look forward to bringing you future episodes with inspiring individuals and ideas about health. Disclaimer: This podcast is for general information only, and does not provide medical advice.  I recommend that you seek assistance from your personal physician for any health conditions or concerns.

Dr. Rachel Moore // #ICEPelvic // www.ptonice.com  In today's episode of the PT on ICE Daily Show, #ICEPelvic Division Leader Rachel Moore discusses reintroducing exercise early to the postpartum athlete, including modified CrossFit workouts, gymnastics, core training, and impact training. Take a listen to learn how to better serve this population of patients & athletes. If you're looking to learn more about our live pregnancy and postpartum physical therapy courses or our online physical therapy courses, check our entire list of continuing education courses for physical therapy including our physical therapy certifications by checking out our website. Don't forget about all of our FREE eBooks, prebuilt workshops, free CEUs, and other physical therapy continuing education on our Resources tab. Are you looking for more information on how to keep lifting weights while pregnant? Check out the ICE Pelvic bi-weekly newsletter! EPISODE TRANSCRIPTION 00:00 INTRO Hey everyone, Alan here. Before we get into today's episode, I'd like to take a moment to introduce our show sponsor Jane. If you don't know about Jane, Jane is an all-in-one practice management software with features like online booking, scheduling, documentation, and a PCI-compliant payment solution. The time that you spend with your patients and clients is very valuable, and filling out forms during their appointment time can quickly take away from the time that you all have together. That's why the team at Jane has designed online intake forms that your patients can complete from the comfort of their own homes. And to help them remember to fill out their forms, Jane has your back with a friendly email reminder sent 24 hours before their appointment. This means they arrive ready to start their appointment, and you can arrive ready to help. Jane's online intake forms are fully customizable to ensure you're collecting everything you need ahead of time, whether that's getting a credit card on file, insurance billing details, or a signed consent form. You can build out your intake forms from scratch or use templates from Jane's template library and customize it further to meet your practice needs. If you're interested in learning more, head on over to jane.app slash guide. Use the code ICEPT1MO at sign up to receive a one-month grace period on your new account. Thanks everyone. Enjoy today's episode of the PT on ICE Daily Show. 01:22 RACHEL MOORE Good morning PT on ICE Daily Show. My name is Dr. Rachel Moore. I am on faculty with the pelvic division here at ICE, and I am coming at you live from a different space than I normally am today. I was in San Antonio this weekend with Christina Prevot at a pelvic course, and it was a blast. It was so much fun. We met so many amazing people. We always love our weekends out on the road. So if you are interested in jumping into one of our upcoming live cohorts, we've got Scottsdale, Arizona coming up September 23rd and 24th. That is our live course. It'll be myself and Alexis Morgan. And then September 30th and October 1st, we actually have a course in Canada. Christina Prevot will be leading that one. So if you are north of the border and you're interested in jumping into one of our live pelvic courses, great opportunity to do that coming up. We also have our pregnancy and postpartum newsletter. If you're interested in learning about all things pelvic, staying up to date on everything pelvic, it's a great way to get resources sent directly to your inbox. And you can find that link on the website. So you might hear my baby screaming in the background because he's eating. My mother-in-law is feeding him, so just ignore the baby. 02:46 MODIFYING CROSSFIT WORKOUTS I'm here to talk to you guys this morning about modifying workouts for the postpartum athlete, particularly in that early stage. So what I wanted to do is kind of break down one workout and talk about how somebody at four weeks, eight weeks or 12 weeks for the same athlete, maybe we would modify that workout. Modifying workouts can be confusing because there's no set standard of at this point you do this, at this point you do this. So kind of across the board, it's going to be very individualized depending on the athlete in front of you. This is something we dive into a ton in our online cohort and we have an entire assignment where we break down different types or the programming and talk about ways to modify it for a particular athlete. But just to kind of give you a little glimpse of what that looks like and just chit chat about it this morning, there are a few factors that we're going to really heavily consider when we're trying to decide what we want to do for a postpartum athlete. And before we dive into those, I want to talk about why. 04:09 GETTING ATHLETES BACK INTO THE GYM Why do we care about getting an athlete back in the gym, maybe at that three to four week mark rather than waiting until six weeks or even later? Why are we really emphasizing and why do we promote here at ICE getting our athletes back? For a lot of women, the gym is their community and it is their mental health support system. And so postpartum in and of itself can be an incredibly lonely time, especially if you don't have a village around you and especially if you feel like you're isolated from a village that you maybe have. So if we can find ways to get these women into their boxes back at the gym, maybe bringing baby along in their car seat or stroller or if there's child care, great. But bringing baby along, finding ways to modify the stimulus appropriate for somebody that's at that three, four week postpartum mark, we feel that that is incredibly advantageous for mom from both a physical health standpoint. So what are the factors we're going to look at when we're deciding what workouts need to be modified and how to modify them? For one, we want to know what mom did before she was postpartum. So did she work out in pregnancy? What did she do prior to getting pregnant? Had she been a CrossFitter for years when she found out she was pregnant? What was her previous level of strength and did that maintain throughout pregnancy or did she take a long time off and see this big deconditioning response? Method of delivery is another thing that matters really heavily. Some issues with their anterior core wall, but we typically expect to see that somebody who's had a vaginal delivery is going to have potentially more struggles with pelvic floor dysfunction with things like heavy lifting and running and that are going to challenge that anterior core wall. Again, that's not a hard and fast rule. That's not saying it's the only way. We see that overlap, but that's kind of the things that we can expect to see based on the type of delivery. We also need to know about the type of delivery that we expect to see. Especially if they're breastfeeding, we need to make sure we're having the discussion with them about making sure that they're getting enough calories in to support their body and help that not only postpartum healing that is occurring naturally, but also that recovery from being in the gym. We also really want to think about mirroring the stimulus of the workout. So we're not going to do the same things that somebody who is not postpartum, four weeks postpartum is doing, but we want to think about what the intended stimulus of that workout is and try to find ways that we can match that intended stimulus, whether that's muscle groups that are being hit, whether it's cardiovascular versus more muscular strength or what kind of factors we're shooting for and prioritizing in that workout. We want to preserve that with our modifications. So let's break down an athlete and a workout and let's talk about how we would how I would scale this athlete at four weeks postpartum, eight weeks postpartum and 12 weeks postpartum. So our athlete, we're going to call her Suzy. Suzy is a CrossFitter. She's been doing CrossFit for seven years. She just had her first baby. She exercised during her pregnancy until 38 weeks and then she just kind of felt like she wanted to rush. She was feeling like, meh, I'm not really wanting to push fitness right now. I'm just going to kind of take it easy. Her previous lifts, her one rep max back squat was 215 pounds pre-pregnancy. Her one rep max deadlift was 275 pounds pre-pregnancy. Her strict press pre-pregnancy was 95 pounds. And from a gymnastics standpoint, she was able to do kipping pull-ups, bar muscle-ups, chest to bars, and she was able to do double-enders and workouts. So an athlete that has pretty decent experience in CrossFit. It isn't brand new to this and continued to exercise during her pregnancy, had a vaginal delivery. How would we modify a workout for her at four weeks? So we're going to take a workout. It's going to be the same throughout just for the sake of not being confusing. And it's hard to kind of conceptualize and listen. So our workout, the RX version of this workout is five rounds for time, 40 double-enders, three wall walks, 15 toes to bar, and 20 double kettlebell deadlifts. At four weeks postpartum, how are we going to modify for Suzy? So we're going to maybe keep that same stimulus of five rounds. We could also decrease that, but for this exercise, we'll keep that same stimulus of five rounds for time. Instead of 40 double-enders, four weeks postpartum is pretty dang early to start doing that impact. So instead of just doing something like calf raises that would work her calves, but maybe not tax her cardiovascular system, I'm going to have Suzy do a 30 second either bike, row or ski, whatever feels the most comfortable at a comfortable pace. So she's not going breakneck. She's not going to like an eight, nine out of 10 RPE. She's just moving and getting her heart rate up for 30 seconds. Instead of wall walks, we're going to do a 30 second, 30 second, 30 second workout. So swapping the three wall walks out for 12 elevated plank shoulder taps, really focusing on that core connection piece. So focusing on that hollow body, maintaining that core brace, making sure that she's not pushing down into the basement and doing plank shoulder taps to an elevated surface that is challenging for her, but does not feel uncomfortable in any way. Instead of toes to bar, thinking about what the components of that toes to bar are with that lap pressed down and core component piece. I'm going to have her hook a band up to the rig and face away from it. She's going to hold a isometric lap pressed down. So she's going to engage her lats. If you're watching, you can see, but facing away from the rig, hands are in the van, pressing down, standing in that hollow body position, focusing on maintaining that core brace. Focusing on maintaining that core engagement. And I'm going to have her do knee marches. So we're going to swap out those 15 toes to bar for 15 standing knee marches with isometric lap pressed down to mimic that pressing with the knee raise. We could also, if we're thinking about flipping this, preserving grip or reintroducing grip, have her hold an active hang for 30 seconds as well. Those are two options for the same athlete. And you could also alternate from round to round. So maybe one round, we're doing that lap pressed down knee raise. And then that second round, we're doing that active hang and we're alternating between those two. And then finally, instead of the 20 double kettlebell deadlifts, we can even just take bodyweight good mornings. These get sneaky on you if you haven't worked your hammies in a while. So putting hands behind the neck, nice flat neutral spine, hinging forward and coming back up. So her workout again, five rounds for time, 30 seconds on a cardio machine bike rower ski, 12 elevated plank shoulder taps focusing on maintaining that core engagement, either 15 standing marches with isometric lap press downs or 30 seconds of an active hang or whatever amount of time she was able to maintain. And then 20 bodyweight good mornings. That would be the workout for somebody who is four weeks postpartum. She's showing up to the gym. She's hitting a similar intended stimulus. She's moving. She's in class with her friends and she's getting a workout in. Let's take this same athlete, same workout and pretend we have fast forwarded for whatever reason she's now eight weeks postpartum. At eight weeks post, five rounds for time, 40 toe taps or line hops. So we are introducing impact at this point. We can absolutely have maybe began this earlier at about that six week point. So introducing that impact 45 times is a high volume. So if this was something where we wanted to work on single unders, we could maybe cut that rep scheme to 15 or 20 and then still have her do those five rounds focusing on that less volume as we're introducing impact. So two options there from that impact standpoint instead of three full wall walks, maybe we're having her do three modified wall walks. So if you've done the crossfit open and you did a scale division with the wall walk, you start out on the floor, press up on your hands, feet go on the wall and you go hand behind, hand behind, hand forward, hand forward, come all the way back down. The chest hits the floor again. to start working on that core engagement, that active shoulder and getting up on the wall. Alternatively, she can work on a wall walk as high as she can go. So two options there as well. Instead of toes to bar, we're going to say that she's been working on her hangs, she's building that grip strength, she's got that hip swing down. We're going to swap that out for hanging knee raises and maybe 15 is too high volume so we can do 10 hanging knee raises, working on that good kip swing, pressing down as she brings her knees up and really pulling through the bar to get into that arch position. And then finally for the double kettlebell deadlift, we're going to let her send that and she's just going to choose a weight that she's able to hang on to that is an appropriate stimulus for her that she's not feeling any heaviness, pain or leakage. So for this athlete at eight weeks postpartum, five rounds for time, either 40 toe taps or line hops or decreasing that rep scheme and adding in single unders to work on that impact with the rope swing. Three modified wall walks or walking up as high as she can. Ten hanging knee raises and 20 double kettlebell deadlifts at a lighter weight. Let's take this athlete, hit the fast forward button and now we're 12 weeks postpartum. Same workout, same athlete. Five rounds for time. We're going to let her play with double unders. 12:27 INTRODUCING IMPACT So these 12 weeks postpartum, let's say we've been working on impact. Eight weeks we did some single unders or some line hops. That's four weeks of time to have built up the stimulus of maintaining or responding to that impact. So instead of setting a set number for her, I'm going to give her a time domain. I want you to spend about 30 seconds of effort working on your double under. Doesn't mean it has to be breakneck speed. Maybe she's getting two to three, getting into that pelvic recovery position, resting and then picking the rope back up. This is giving her time within that workout to work on the skills that we are hoping to get back to while progressing along in that impact. We're going to swap out wall walks. Maybe not three wall walks, maybe just two. She may be able to do three, but if not, then we are going to drop that number down to two. We can always scale volume with movements. Same thing for toes to bar. So maybe she's back to toes to bar. She's able to hang on to four or five and then she starts feeling some fatigue, hops down from the bar, jumps back up for that second set. Again, this is five rounds, so that cumulative volume does add up. So instead of 15 toes to bar, maybe we're dropping her down to eight toes to bar instead. And then finally, that double kettlebell deadlift, we're going to let her send it and we're going to think, okay, at eight weeks she may have done a certain weight. She's probably at a little bit heavier weight at this point. Maintaining able to breathe, not having leakage, not having heaviness, not having pain, but choosing a weight that feels great for her. Double kettlebell deadlifts are an incredibly functional thing if you're a mom, constantly picking up diaper bags and car seats and kiddos and all the things. So one workout, one person, three different timelines. There are options even within each timeline for this athlete. There is no one right answer when it comes to modifying a workout for an athlete. We need to consider the stimulus of the workout. We need to consider this athlete's history. We need to consider this athlete's recovery and we need to consider the athlete's goals. So when we take all of these things into account, this is kind of a day by day process starting out, but eventually we want to get to the point where our athletes understand how to make these modifications themselves and they feel comfortable. Okay, I can press the gas on this or maybe I need to take a step back on this. At the end of the day, our job is to help them figure this out as we are actively working towards getting back to doing all the things that it is that they want to do. I hope that makes sense. I know it's kind of hard without like, I'm a whiteboard person. So I hope you guys learned something this morning. This is an area that we cover in our online cohort. So if you are looking to learn more about modifying workouts for the postpartum athletes from a programming standpoint especially, hop into our online cohorts, come hang out with us live on the road. We've got tons of courses coming up between September to December and hopefully we'll see you guys soon. Bye! 18:02 OUTRO   Hey, thanks for tuning in to the PT on Ice Daily Show. If you enjoyed this content, head on over to iTunes and leave us a review and be sure to check us out on Facebook and Instagram at the Institute of Clinical Excellence. If you're interested in getting plugged into more ICE content on a weekly basis while earning CUs from home, check out our virtual ICE online mentorship program at ptonice.com. While you're there, sign up for our hump day hustling newsletter for a free email every Wednesday morning with our top five research articles and social media posts that we think are worth reading. Head over to ptonice.com and scroll to the bottom of the page to sign up.

In today's episode of the PT on ICE Daily Show, #ICEPelvic faculty member April Dominick discusses three postpartum physical scars that are often invisible to rehab providers. She explores how these scars can impact exercise prescription for clients in the early postpartum period. Take a listen to learn how to better serve this population of patients & athletes. If you're looking to learn more about our live pregnancy and postpartum physical therapy courses or our online physical therapy courses, check our entire list of continuing education courses for physical therapy including our physical therapy certifications by checking out our website. Don't forget about all of our FREE eBooks, prebuilt workshops, free CEUs, and other physical therapy continuing education on our Resources tab. EPISODE TRANSCRIPTION 00:00 INTRO What's up everybody, we are back with another episode of the PT on Ice Daily Show. Before we jump in, let's chat about Jane for a moment as they are our sure sponsor and they make this thing possible. The team at Jane understands that payment processing can be complex, so they built in an integrated payment solution called Jane Payments to help make things as simple as possible so you can get paid. If you're looking for an easy way to navigate payments, here's what we recommend. Head over to jane.app slash payments, book a one on one demo with a member of Jane support team. This can give you a better sense of how Jane Payments can integrate with your practice several other popular features that Jane Payments supports like memberships with the option to automatically invoice and process your membership payments online. If you know you're ready to get started, you can sign up for Jane and make sure when you do, you use the code ICEPT1MO as that gives you a one month grace period while you settle in. Once you're in your new Jane account, you can flip the switch for Jane Payments at any time. Let the Jane team know if you need a hand with anything, they offer unlimited support and are always happy to jump in. Thanks, everybody. Enjoy today's show. 01:27 APRIL DOMINICK   Welcome to the PT on ICE Daily Show. Dr. April Dominic here. I am your host representing the ICE Pelvic Division. Today we'll focus on three postpartum physical scars that are often invisible to the rehab provider. We'll talk about how these scars can affect exercise prescription when it comes to working with a client who is early postpartum. But before we dive into that, let's chat about all things, updates and course offerings for the ICE Pelvic Division. If you're looking for a virtual option to learn all things fitness, athlete, pregnancy Our next Level 1 online cohorts starts September 5th. Otherwise, you can catch us on the road. We've got tons of courses coming up for this fall. And our next one is September 23rd and 24th in Scottsdale, Arizona. This is going to be with the lovely Dr. Alexis Morgan and Dr. Rachel Moore. This course is chock full of literature outlining the ins and outs of pelvic floor basics, pelvic floor dysfunction, the assessment for the pregnant or postpartum fitness athlete that includes an external exam or an internal exam option. We also have a lot of super fun labs that are going to cover core and c-section management. We also have tons of labs on reintroducing or continuing to use the barbell, do rig work and endurance exercise. Please go hop on PTONICE.com. Get yourself in one of our courses. We would love to see you there virtually or in person. 03:23 PHYSICAL SCARS POSTPARTUM Today I wanted to hop on and shed some light on physical scars that a postpartum body endures early on. These scars aren't always visible or front of mind for the rehab provider. So think about it like this. You may have someone who is coming in very early postpartum due to some sort of orthopedic injury like for their hip, their shoulder, maybe their back, or they may be coming in for core and pelvic floor work. So it's important for all of us to be aware of these scars as they heal and the role that they play early postpartum with movement and exercise prescription. So when someone is pregnant, there is usually some sort of baby bump or something that is a visible reminder to others of their condition that they are pregnant. Enter the postpartum period. For many postpartum folks, those visible reminders of pregnancy fade and the physical impact the labor and delivery on the body are invisible to others. When someone is postpartum, there's no physical sign that they and their body have gone through this incredibly challenging feat. There's no cast for like when we have for a broken bone. There's no crutches for that ankle sprain. There's no sling to support the wounds. Unless maybe they have their newborn with them, there's really no obvious physical sign that someone is recovering postpartum. So three invisible scars that we'll chat about today are the uterine scar, the perineal scar, and the lower abdominal scar from a cesarean section. Let's circle back to wound care from school. Remember for our healing stages, our tissue healing goes through four major stages. Starting with the first couple, the hemostasis and inflammatory stages. This is going to be a period of local swelling. Next, the proliferative stage. And that's going to be the stage focusing on covering and filling the wound. And then the remodeling stage is characterized by scar tissue formation, which this can last for a year or two, if not. So let's unpack those three major postpartum scars. The first, the uterine scar. I feel like this is the most invisible. It's as the name indicates, a wound on the uterus. And in terms of time to heal, the uterus typically involutes or returns back to its pre-pregnancy size that's smaller by six weeks. And muscles that may be impacted by this scar, by this wound on the uterus, would be indirectly the pelvic floor and the abdominals. In terms of considerations to return to movement when we're thinking about uterine healing, if someone does some physical activity and there is an increase in vaginal bleeding, then that is going to be a sign for regression that the uterus and body may not be ready for that specific intensity level of physical activity or the duration of physical activity. 07:33 PERINEAL SCARRING Our second scar is the perineal scar. In terms of where it is, it is on the perineum. And the perineum is the tissue that's between the vaginal opening and the anal opening. A perineal scar or injury may occur due to a large stretch on the tissue at the vaginal canal as the baby exits through that vaginal canal. In terms of time to heal, a majority of the stitches are dissolved by about two to four weeks. So there are two ways to tear the perineum. And that's either naturally or via an episiotomy. And that's going to be when the provider actually makes a cut in that perineal tissue. In terms of levels of severity of the perineal tear, there are four. The first degree is the licevier. It's small, skin deep. The second degree is going to involve the muscles of the perineum. The third degree is going to be a tear of the external anal sphincter. And that is what we use to keep poo in or keep poop out, like allow for defecation. And then the fourth degree tear is going to be the most severe. And that's going to be a tear that likely involves the internal anal sphincter, the external anal sphincter, and the rectal mucosa. One time I was talking to a group of OBs and one of them said, you know, we were talking about perineal tears. And one of them said, you know, the vagina is just simply remarkable. It gets to heal in real quick and nobody F's with that vaginal tissue. So that is the one good thing about perineal tears is that the vagina takes care of business. So muscles that are impacted by the perineal tear, the pelvic floor. And then when we're thinking about return to movement with someone with a perineal scar, movements that are wide-legged, like maybe a sumo squat or lateral lunge or really deep squat, there may be some discomfort at that perineum due to that stretch on the tissue in those wide positions. 09:01 C-SECTION SCARRING And then we have our C-section scar. So where is it? I'll talk about the most common cut that is done is called the bikini cut. And then it's about four to five inches long and it's stretched across the lower abdominals. In terms of time to heal, that's going to depend on various factors. But some scars start to close at the skin level as early as two weeks. And then we know by six weeks, generally speaking, the scar is fully healed if there are no complications. And that's about the same timeline that someone is likely returning back to their provider. Some complications with scarring may be hypertrophic scarring or keloid scarring. And the keloid scar is going to be when the body over heals and the scar tissue extends beyond the original boundaries of the wound. So we want to make sure that we are referring them back to their provider if that is the case, if we happen to see that scar on the client. We know that around six weeks, abdominal tissue has only regained about 50 percent of its tensile strength. And by six to seven months, it's approximately in the 75 percent range of its tensile strength pre-incision. And muscles that are impacted by this scar, the C-section scar, are going to be our abdominal group. So the rectus abdominis, internal-external obliques, and the transverse abdominis. 14:01 CORE-CENTRIC MOVEMENTS & EXERCISE In terms of considerations for return back to exercise specifically for a C-section scar, we're thinking we got to watch for that core heavy work, any sort of rig or gymnastics-based movements, or any lifting that may involve some sort of contact at the lower abdomen. So those are the scars. Now let's talk about two movement categories more in depth that may be affected by those scars. We have the return to exercise and then return to intimacy, which we'll dive into. So in terms of movement early postpartum, when dosed appropriately, it can assist in so many areas of recovery. We're talking reduction in postpartum depression risk or reduction in risk of blood clot, promoting tissue healing, promoting getting better sleep. That's just to name a few of why movement is important early postpartum. But when it comes to exercise, variables such as sleep and fuel not only influence the risk of injury and recovery, but they also directly relate to the energy status needed to participate in exercise. So sleep, we should be getting nosy and ask about sleep status. Be realistic and recognize that you're talking to a person with a newborn. So their sleep is going to look a little different given the newborn schedule. But we do want to make sure that the client in front of us is optimizing their sleep. Are they creating the best environment? Is it a cool environment? Can they make everything dark? Can they talk with our partner and be like, hey, I need this chunk of time for sleeping. Can you handle the baby while I do this? And then maybe they switch. In terms of fueling, are they able to nourish themselves with nutrient dense packed meals that are full of protein, packed with plants, reduced processed sugars that have sufficient calories, especially caloric intake is important, especially if someone is breastfeeding. They'll need about 400 to 500 extra calories. Okay, let's talk about return to exercise. Generally speaking, when we're talking about return to exercise for someone who's early postpartum, it's a great idea to start somewhere close to where they left off at the end of pregnancy and then build tolerance from there. Early postpartum, that's a time to determine the body's capacity for tolerating exercise. As a provider, it's helpful to have a conversation with our clients about ways we can manipulate exercise dosage to meet their current needs of their current physical status. These modifications are temporary. This is something that we want to communicate with them. We want to educate them on signs for regression with, hey, they did a certain workout or did certain exercise and then, hey, they experienced some leakage of urine or fecal matter. They had some pain or increased abdominal discomfort or vaginal heaviness. So we want them to communicate this to us so that we can then show them how we can alter a workout if needed through load, through adding rest intervals, maybe modifying the intensity or changing the volume and duration. That way they can still continue exercise without symptoms. So now let's talk about scar types and different types of exercise such as core, impact, or lifting. So during the early days and weeks postpartum, walking, reconnection with the core, the pelvic floor, and breathing is a really great place to start. This is going to be when we are starting to add in a little bit more after the first early days or a couple weeks. So with core-centric movements, as we move towards adding more intensity or load, we want to ensure that that abdominal incision is healed to avoid dehiscence. We can begin to experiment with its tolerance, with the anterior abdominal core walls tolerance to stretch in all planes, specifically going into extension, flexion, side bending both ways, rotation, a combination of all those movements. We want to be mindful of tolerance to pressure on the scar, whether that's pressure from simply just the workout clothes, or maybe they are baby wearing while they work out and they have some irritation there at the abdomen. Or maybe it's increased pressure at the abdomen from a set of dumbbells when they're doing a hip thruster, or when they slam down onto the floor with a burpee, or the rig or barbell making contact with the abdomen during gymnastics movements or lifts. With return to impact exercise, such as walking, running, or jumping, we want to be mindful that someone with a vaginal delivery and significant perineal tearing could experience an increase in their pelvic floor symptoms. Remember symptoms reported may be heaviness, vaginal bleeding from the uterine scar, or irritation of their perineum. And someone with a C-section could also experience these as well, but we're thinking that it may be more common with someone with a vaginal delivery or more likely to happen. So with return to impact, we're going to find their guidepost in terms of how much impact their body can tolerate, whether it's starting with a walk around the block, then adding a few more blocks each day, or if it is explosive calf raises, single unders, or step ups. And then for return to lifting, maybe we start with a PVC pipe, or a light kettlebell, or a barbell only movement. This is going to allow the client to re-familiarize themselves with the movement pattern, say of a clean or any sort of overhead press, and then they will be simultaneously building tolerance and in ranges of motion and load at their perineum and abdomen, where some of their scars may be. So return to any exercise will be person dependent, but knowing their history, mode of delivery, current symptoms, and scar status can help you guide them. And bonus, maybe this is a time that they slow down and dial in on foundational pieces of complex lifts or impact training. 18:07 PAIN WITH INTERCOURSE Besides return to exercise, we also have a different return to movement, and that is return to intimacy, specifically penetrative intercourse. Once cleared by their providers, return to penetrative intercourse, the postpartum person may run into difficulty tolerating that vaginal penetration. This could be from a finger, a toy, or a partner student, Natalia. So it's estimated that 43% of women report pain with intercourse in that first six months early postpartum. And this is something major that we should be thinking about when someone is maybe sharing with us things that are going on with penetrative intercourse for them. A C-section or perineal tear can contribute to painful intercourse. There's a greater risk associated with pain with intercourse with an episiotomy versus a natural perineal tear. Just as we would practice scar desensitization in any other part of the body, we're going to do the same here at the vagina. And a pelvic PT is going to be really great in assisting and making recommendations for internal massage, stretching, or using a dilator set. So let's recap. Today we talked about three main scars that a postpartum person may have. A uterine scar, a perineal scar, or an abdominal scar from a C-section. Remember to respect these healing timelines. They will be unique to each person. The next time you have a client who's early postpartum on your schedule, encourage them to start small. Go slow for returning to exercise and intimacy. Educate them on progressive overload and how that may not be a straight line for them. Maybe a series of peaks and valleys that are impacted by external factors such as sleep, fuel their body's current physical capacity. Communicate with them. Get curious about their invisible physical scars as they may not feel comfortable telling you and offering you that information that, Oh, they have pain at their vagina at the bottom of a deep squat or their abdominal incision site is really bothering them when they're doing a hollow hold or hanging from the bar. So they will no doubt be thankful if their provider considers these scars, asks about them, and because they're not often discussed. So thanks for tuning in, everyone. I hope you gain some awareness of these physical invisible scars that a postpartum person may be dealing with. Next episode, I'll be discussing the emotional invisible scars in the postpartum period. Cheers y'all. 20:28 OUTRO Hey, thanks for tuning in to the PT on Ice Daily Show. If you enjoyed this content, head on over to iTunes and leave us a review. And be sure to check us out on Facebook and Instagram at the Institute of Clinical Excellence. If you're interested in getting plugged into more ICE content on a weekly basis while earning CU's from home, check out our virtual ICE online mentorship program at ptonice.com. While you're there, sign up for our Hump Day Hustling newsletter for a free email every Wednesday morning with our top five research articles and social media posts that we think are worth reading. Head over to ptonice.com and scroll to the bottom of the page to sign up.

Dr. Alexis Morgan // #ICEPelvic // www.ptonice.com  In today's episode of the PT on ICE Daily Show, #ICEPelvic Division Leader Alexis Morgan discusses how virtual pelvic floor care can prove beneficial for physical therapists in both virtual and in-person settings. Alexis shares that engaging in virtual pelvic floor care has significantly improved her overall abilities as a physical therapist, particularly in asking questions and gathering necessary information. She also notes that virtual care seamlessly integrates into both virtual and in-person worlds. Alexis highly recommends physical therapists to explore virtual pelvic floor care as it can be incredibly helpful. Furthermore, she mentions that a future podcast episode will delve into objective exams for pelvic floor virtual PT, indicating the importance of further exploring virtual care. Take a listen to learn how to better serve this population of patients & athletes. If you're looking to learn more about our live pregnancy and postpartum physical therapy courses or our online physical therapy courses, check our entire list of continuing education courses for physical therapy including our physical therapy certifications by checking out our website. Don't forget about all of our FREE eBooks, prebuilt workshops, free CEUs, and other physical therapy continuing education on our Resources tab. EPISODE TRANSCRIPTION 00:00 INTRO What's up everybody? We are back with another episode of the PT on Ice Daily Show. Before we jump in, let's chat about Jane for a moment as they are our sure sponsor and they make this thing possible. The team at Jane understands that payment processing can be complex, so they built in an integrated payment solution called Jane Payments to help make things as simple as possible so you can get paid. If you're looking for an easy way to navigate payments, here's what we recommend. Head over to jane.app slash payments, book a one-on-one demo with a member of Jane's support team. This can give you a better sense of how Jane Payments can integrate with your practice several other popular features that Jane Payments supports, like memberships with the option to automatically invoice and process your membership payments online. If you know you're ready to get started, you can sign up for Jane and make sure when you do, you use the code ICEPT1MO as that gives you a one-month grace period while you settle in. Once you're in your new Jane account, you can flip the switch for Jane Payments at any time. Let the Jane team know if you need a hand with anything. They offer unlimited support and are always happy to jump in. Thanks everybody. Enjoy today's PT on ICE Daily Show 01:27 ALEXIS MORGANGood morning, Instagram. Good morning, PT on ICE Daily Show. My name is Dr. Alexis Morgan. I am one of the faculty with the Ice Pelvic Division. Really happy to have you all here joining me this Monday morning. My voice is a little raw from the weekend. We were just in Denver, Colorado, right outside of Denver at Onward Denver in Parker. This whole weekend, April and I spent with an awesome, awesome group of individuals and we were going through all of our material in our live course. We did our internal exams, supine and standing, and dove into all issues of pelvic floor dysfunction. We of course didn't stop there. We progressed through everything that our athletes are doing at the gym. So talking about how pelvic floor dysfunction fits into weightlifting and Valsalva and using a weightlifting belt and jumping and running and doing gymnastics. We had an absolute blast with this last weekend and we hope that you all will join us in the future for not only our live course but also our online course. I want to talk with you all today about virtual pelvic floor PT. We get a lot of questions asked over Instagram and on our Ice Students Facebook page. Sometimes we answer you all directly with some help. A lot of times we like to use your questions to teach everyone else about the topic that you asked. 03:10 VIRTUAL PELVIC FLOOR PT This particular topic actually came from an Ice student who was wanting to know some more information about how to really apply what we talk about in our live and online courses into the virtual setting. And so that's exactly what I want to dive into today. Kind of similar to what we talk about really in all of our courses is that our subjective exam should be very detailed. It should be specific and we should be taking a while to do our subjective exams. I will say that when it comes to doing an assessment virtually, the subjective becomes huge. Not everything but a vast majority of especially that initial assessment. I'll talk through some ways that we do some objective exams but I want to before we even get there really emphasize to you all the importance of that subjective exam particularly in the virtual setting. So when I say be specific, there's a couple of things I mean with this. Depending on the issue that they may be coming to you for, whether that's leaking urine, whether that's pelvic organ prolapse or feelings of heaviness or vaginal bulge, that might be leaking bowels, whether that's anal incontinence with stool or potentially with flatulence. Maybe it's constipation. Whatever that may be, we want to get very specific on their problem. Again, this is true in person and in virtual but it really does become extremely important in this setting because all you've got to track changes are your words. By you having conversations and by asking questions, that's how you track the person's change. So it's not in session, which sometimes we can gather on that first virtual, but definitely between sessions. It's really, really important. So maybe you use the patient specific functional scale where they fill this out ahead of time or maybe you help them out and ask them further questions when they tell you they leak with double unders. 06:26 LEAKING WITH DOUBLE UNDERS When I hear I'm leaking with double unders, that is not enough information for me to help you just yet. I've got a lot more questions and you should too because depending on how they answer, it could really change how you're going to treat them for that leaking. Not all leaking with jump rope is treated in the same way. And we've talked about this so much yesterday in our live course as we were going through jumping rope. But what we need to do is ask questions. So when does the leaking occur? When in that workout? And tell me what jumping rope looks like to you. Is it single unders? Is it double unders? If it's double unders, is it always doubles? Did you just gain that skill or is that an old skill for you? At what point during the workout? If it's early on, that's going to be different than if it's later on, right? I'm starting to think fatigue plays a role in their leaking. If it's later on in a workout, does it matter about which exact workout it is? What is the volume with that? That's going to be different, right? If it's 50 double unders versus 500 double unders, that's going to be different. And so we need to figure that out and we need to ask those questions. So you can use the patient specific functional scale and make that work for you. You can also use the PFDI, a specific to pelvic floor questionnaire. Now that is not an open box. That is marking, marking symptoms on a questionnaire. But what we've got to do is we've got to get information about their specific number one problem that they have. And moving forward, we need to understand what is their entire pelvic floor environment like. So we're going to ask questions and see if they have issues in other pelvic floor realms. Realizing we understand the number one reason why you came to me and I promise you I'm going to help you with that. But sometimes some of these other issues kind of play into your main leaking problem. Or as we're addressing your leaking, we can also address these other issues and together everything within your pelvic floor is going to function better. So a couple of those questions, again, depending on what they're coming in for, whether that's vaginal or bowel issues, you're going to ask, are you experiencing any leaking with maybe coughing or laughing, sneezing? And even with that, sometimes people are like, no, I don't leak with sneezing, but I do have to cross my legs together aggressively in order not to pee. OK, that's a problem, right? We're going to add that to our list. Do you feel like you can fully void? How frequently are you peeing? This one's a hard question for people to answer, but I generally want to know like, is it every 5, 10, 15 minutes or is it more like every hour or two? If it's very frequent, like every 15 minutes, that's going to be something that we note down and address early on. If it's every hour or two, we're going to lower that on our list. We may get to that if it's every hour and bothersome, we may not get to that. If there is high frequency, we're going to send them with a bladder diary and that's going to be one of our first trial treatments that we do with them. 12:00 STRAINING TO POOP We want to actually pull up the Bristol stool chart. I always laugh when I pull this up. I'm like, OK, listen, I'm going to ask you a weird question. I promise it's relevant. And then I pull up the Bristol stool chart and I say, give me a range like where do your poops normally fall within this Bristol stool chart? Looking at that to see, we want to see around that three or four that are relatively normal. But if it's above or below that, we're thinking, what does diet and hydration look like? And that may lead us into more questions. How frequently are we having a bowel movement? Is it every one to three days? Because that's normal. Or is it six times a day or every six days? Those are not normal. And so we can dive into that. Do you feel like you have to strain really hard in order to have your bowel movement? We have evidence and plenty of it on straining to poop. And we need to be teaching people not to do that for their pelvic floor health. It's a very simple and effective intervention. Do you use a squatty potty or do you use something under your feet to bring your knees up higher than your hips? For most cases, that's going to dramatically improve the ability to go have a bowel movement. And that's really, really helpful. And again, is there any leaking, any anal incontinence that is, again, flatulence or potentially stool? All of these, again, are good questions to ask, even if they're not coming in with bowel problems for you to resolve. We want to go through this with them. And then vaginally, we're going to ask some questions as well. Do you have any pain with insertion? So that insertion could be anything from a tampon to a penis, sex toy, or speculum exams. Do you have any pain with that insertion? And asking, do you have any loss of air, especially with our active individuals who might be going upside down, whether that's in yoga, Pilates, CrossFit? Sometimes people can have loss of air or queefing. And we want to know about that because all of these things really paint a picture for us. Now, usually, this takes up quite a bit of time. I mean, I've been talking about what questions to ask for the last 10 minutes with absolutely no answers behind them. So this typically is a really good starting point and often is the vast majority of my first virtual pelvic floor assessment. However, I like to leave time for a few more questions and then getting into education as my trial treatment. So the few other questions that we always want to know is what is exercise or movement look like, how is sleep, and what do you do for stress management? Some of these questions you can ask in your intake paperwork. You may want to go over that with them as well. But looking at them as a whole person and looking at their pelvic floor issues as a whole. And then from here, we do trial treatments as education. So depending on how they answer any of these questions, typically, and it's beyond the scope of this podcast to really talk about various education pieces for each of those questions, but I'm going to educate and I'm going to intervene. So maybe that is let's start hydrating. Get yourself a favorite water bottle and I actually want you to hydrate. Or potentially it's the opposite if they're over hydrating. Maybe it's can we decrease that intake throughout the day or right before bed? Maybe it's get a squatty potty or get your toddler's stool that's right in front of the sink and slide that under your feet for when you need to have bowel movement. Going back to our initial example of the leaking with double unders, perhaps it is I want you to video yourself doing double unders from the side view and the front view and send it back to me. But between now and then, I want you to make sure that we are videoing it at the end of you're having that leaking. And after we get that, I'm going to have you take more rest breaks if that's what they need. Or maybe it's go into your single unders since double unders are always causing leaking and throughout our plan of care, we are going to dive into that. I try to find some piece of education and something that we know will help them resolve a little bit of their issue and get us rolling with this. We talk about it in our live course, but we have good evidence for education actually improving pelvic floor symptoms. And I think there's no better place to really feel that as a practitioner to feel the difference in the amount of education that you can provide and the amount of change that can occur. There's no better place than in this virtual care where truly we are guides. I can do nothing with my hands. I can do nothing with my body to change how that individual is functioning. I purely have to use my voice and teach and ask questions. If you have not done virtual pelvic floor care, I would highly recommend it. It has made me a much better physical therapist altogether, much better at asking these questions and getting the information that I need. And it blends into both worlds, both virtual and in person. So if you haven't done it, I highly recommend getting some patients in that virtual care because it can be really helpful. That needs to be all for today. I have a lot more that I could say, especially if we dive into the objective exam and how to do that. But I think that's going to need to be a podcast part two for virtual care. So I will do that the next time I hop on to the daily show and talk with you all about how we do objective exams for pelvic floor virtual PT. Thank you all so much for joining me and listening in this Monday morning. Or if you're listening later on the podcast, thank you for listening. One quick note, it is CrossFit Games Week and we are so, so excited to be cheering on our very own Kelly Bimpy at the Games with her team this year. So tune in to the Games. If you're going to be there, let us know. There's several of us ICE faculty that are going to be at the Games. We would love to see you and say hello. And I don't know, maybe we can snag a workout in or something. But we are so excited. It is Games Week. Have an awesome week. Hopefully we'll see you up north. If not, catch you later. Have a good one. 19:26 OUTRO Hey, thanks for tuning in to the PT on ICE Daily Show. If you enjoyed this content, head on over to iTunes and leave us a review and be sure to check us out on Facebook and Instagram at the Institute of Clinical Excellence. If you're interested in getting plugged into more ICE content on a weekly basis while earning CUs from home, check out our virtual ICE online mentorship program at ptonice.com. While you're there, sign up for our Hump Day Hustling newsletter for a free email every Wednesday morning with our top five research articles and social media posts that we think are worth reading. Head over to ptonice.com and scroll to the bottom of the page to sign up.    

Dr. Rachel Moore // #ICEPelvic // www.ptonice.com  In today's episode of the PT on ICE Daily Show, #ICEPelvic faculty member Rachel Moore discusses that PTs need to be aware of the signs and symptoms of preeclampsia in pregnant women. Preeclampsia is a high blood pressure-related condition that typically occurs after the 20th week of pregnancy. It can also manifest during delivery and postpartum, although it is less common in the postpartum period. The three main symptoms of preeclampsia are swelling of the face and hands, persistent headaches, and pain in the upper right abdomen or right shoulder. PTs should be familiar with these symptoms and know when to refer their patients for further evaluation or treatment. It is crucial for PTs to monitor vital signs, especially in the postpartum period, as they may be the first healthcare professionals to detect an increase in blood pressure. Preeclampsia is the leading cause of mortality in pregnant women, so early detection and management are essential to prevent it from progressing into a life-threatening condition. While PTs may not be responsible for ordering tests or directly managing preeclampsia, they should be aware of the condition and its potential impact on their patients. Take a listen to learn how to better serve this population of patients & athletes. If you're looking to learn more about our live pregnancy and postpartum physical therapy courses or our online physical therapy courses, check our entire list of continuing education courses for physical therapy including our physical therapy certifications by checking out our website. Don't forget about all of our FREE eBooks, prebuilt workshops, free CEUs, and other physical therapy continuing education on our Resources tab. EPISODE TRANSCRIPTION 00:00 INTRO What's up everybody? We are back with another episode of the PT on Ice Daily Show. Before we jump in, let's chat about Jane for a moment as they are our sure sponsor and they make this thing possible. The team at Jane understands that payment processing can be complex, so they built in an integrated payment solution called Jane Payments to help make things as simple as possible so you can get paid. If you're looking for an easy way to navigate payments, here's what we recommend. Head over to jane.app slash payments, book a one-on-one demo with a member of Jane's support team. This can give you a better sense of how Jane Payments can integrate with your practice several other popular features that Jane Payments supports, like memberships with the option to automatically invoice and process your membership payments online. If you know you're ready to get started, you can sign up for Jane and make sure when you do, you use the code ICEPT1MO as that gives you a one-month grace period while you settle in. Once you're in your new Jane account, you can flip the switch for Jane Payments at any time. Let the Jane team know if you need a hand with anything. They offer unlimited support and are always happy to jump in. Thanks everybody. Enjoy today's PT on ICE Daily Show. 01:27 RACHEL MOORE All right. Good morning, PT on ICE Daily Show. It is Monday morning. I am here with the ICE Pelvic Division here to chat with you guys this morning about preeclampsia. This is a topic that is actually really near and dear to my own heart because I had preeclampsia with both of my pregnancies. So it's a really interesting topic. There's been a lot of kind of conversation about this topic in the prenatal space lately because there's a new test that just came out recently. We're going to chat about that here in a bit. Before we dive in, I want to kick this off going over our upcoming courses for the pelvic division. We've got two live courses coming up soon. We've got Denver, Colorado this upcoming weekend with Alexis Morgan and April Dominic. That is the 29th, 30th, and 31st, Friday to Sunday, this upcoming weekend. And then we also have in September in Scottsdale, Arizona, a live course coming up as well. Our live courses are two-day courses. We talk about all kinds of stuff from pregnancy to postpartum. We are in lab a majority of the time. We're practicing skills. We're going over these movements. We're talking about scaling and modifying. We also do the internal assessment and we do the internal assessment not only in supine but also in standing. So it's a really great way to dive into the internal side of pelvic floor if that's not something you're already doing or maybe learn a new way to do pelvic floor assessments if you are already a pelvic floor PT. It's a super fun course. Hop in one of those courses coming up. We've got several other ones listed online on the website. We've got at least one a month until the end of the year. So we're going to be cruising through. Hope to see you guys on the road. Let's talk about preeclampsia. So what is preeclampsia first? That's kind of the first thing we need to talk about. Preeclampsia is a high blood pressure related condition that typically begins any time after the 20th week of pregnancy. It can happen in pregnancy. It can happen during delivery and it can also happen postpartum. It is less common to happen postpartum, but just because it is less common does not mean that it doesn't happen and that is something we need to be aware of, especially if you're in the prenatal space seeing postpartum women. Personally, before we dive in, my story, I had postpartum preeclampsia with my daughter and it wasn't caught until I was two weeks postpartum and I say wasn't caught until I was really fortunate that it even was because I went to a midwife for my delivery and I had a two week postpartum visit and when I went in my blood pressure was like 198 over 110 and she immediately sent me downstairs to the emergency room and I had no idea that there was even anything wrong. I didn't know that I was feeling bad. I thought that it was just kind of the norm for being postpartum and so that's how we caught it in the first pregnancy. And then my second kiddo, we knew that it was something to be on the lookout for and sure enough within 72 hours of my delivery, I was fine and then it was like a truck hit and I had high blood pressure. So something to keep on your radar. It can develop into a life threatening condition. So preeclampsia itself is not necessarily life threatening. What is life threatening is eclampsia, which is the progression of preeclampsia and that is a condition that is characterized by seizures and strokes and it can also progress into help syndrome, which means the abbreviation is hemolysis, elevated liver enzymes and low platelet count. Essentially this is a condition where your red blood cells are damaged and interferes with blood clotting and typically your liver is involved as well. So your liver starts kind of going into failure essentially. Eclampsia and help are both medical emergencies. So we want to be catching preeclampsia when we can so that we can prevent that sequelae into these life threatening conditions. The way that preeclampsia is diagnosed is typically with repeat high blood pressure readings and there's also a urine test that can be done to check for protein in the urine. However, you don't have to have protein in the urine in order to be diagnosed. So this is something that used to be kind of together that you had to have both, but what things have kind of shaken out over the years is that you can have preeclampsia, you can have the high blood pressures, but not necessarily progress to the high protein in the urine. So it's not necessarily something that is utilized as a gold standard. You have to have this thing in order to be diagnosed anymore. Typically if somebody is diagnosed with preeclampsia or they're in their second pregnancy or subsequent pregnancies and they know that they had preeclampsia earlier on, a lot of OBs will prescribe taking baby aspirin during pregnancy. That's not obviously within our scope to suggest, but just something to kind of keep in mind that there are things that can be done quote unquote. Statistically this preeclampsia affects one in 25 pregnancies. It is the leading cause of maternal mortality worldwide and along with a lot of other prenatal health conditions. This affects women of color, particularly black women, significantly more than white women, 60% more likely to develop preeclampsia and that is largely due to the disparities in healthcare for women of color. It's really unclear who gets preeclampsia. So there's a long list of risk factors which we'll chat through, but you can have none of these and you can still get preeclampsia. You can have all of these and not get preeclampsia. You can do all the right things and still get preeclampsia and that's something that can be really tough, particularly if you're treating athletes or people who are in a more healthy lifestyle who are saying like, well I exercised, I ate healthy, I did all of these things and then I still got it, can feel like I did something wrong or like a failure almost. But preeclampsia is a condition that's really not well understood. We're learning a lot more about it as time has gone on. However, there's just not a lot of like real true understanding about what is the cause of preeclampsia. So some of the things that put you in the higher risk category would be having a previous pregnancy with preeclampsia, carrying multiples, so twins, triplets, so on and so forth, chronic hypertension prior to pregnancy, having kidney disease or diabetes, and then any autoimmune condition. All of those are going to put you in the higher risk category for developing preeclampsia, not to say that yes, you are going to get it, but a higher risk. Moderate risk for developing preeclampsia would be a first time pregnancy. So either first time pregnancy puts you moderate risk, previous pregnancy with preeclampsia puts you high risk. BMI over 30, family history of preeclampsia, maternal age advanced quote unquote, so above 35 years of age. IVF can also increase the risk of preeclampsia development and then complications in previous pregnancies. Not even necessarily just preeclampsia, but just complications in general. There's a lot of discussion about what is the reason people get preeclampsia and what it's really boiled down to based on what we know and what we've learned about preeclampsia over the years is that it's most likely related to the structure of the placenta and the creation of blood vessels in early pregnancy. So there's not a lot that quote unquote can be done later in pregnancy necessarily. It's something that is kind of determined and laid out earlier on and then presents itself later in pregnancy. There's really no great way to prevent it. Like I said, you can do all the right things. You can check all the boxes and it can still come up at that later or at those later stages of pregnancy. We really advocate at ICE for getting our postpartum patients in early postpartum for that first visit. So within like two weeks of delivery, kind of touching base, being that healthcare checkpoint because a lot of women aren't getting that from their healthcare providers potentially. And this is a really important thing for us to keep in mind when we're screening our patients postpartum. Typically blood pressure is going to peak within three to six days after delivery. So if you're seeing your patient within the first week, that would be fantastic. It is so important to take vitals. It's always important to take vitals, but especially in the postpartum client, they may have no idea that they're feeling bad or that their blood pressure is high. You might be the first person that watches or sees this upwards trend of blood pressure. So something that's really important. We can be the first touch point within the healthcare system of picking this up if they're not going to a physician earlier on or a birth care provider earlier on in that postpartum period. So what are the biggest signs and symptoms of preeclampsia and how does it relate to our job as PTs? There's three big symptoms that I see with preeclampsia that really kind of like light up. So that could be something musculoskeletal or it could be something that we could have our hands on the pot and correcting or it could not. The top three that I'm thinking are going to be swelling of face and hands or swelling in general. A lot of times we see it in the lower legs in pregnancy, a headache that won't go away and then pain in the upper right abdomen or in the upper or the right shoulder. So that's going to be up in this area here. If you're not, if you're listening, it's kind of the bottom side under part of rib cage, right upper quadrant pain and referring up into the shoulder. The other three symptoms that are really larger for symptoms are going to be nausea and vomiting, especially in later pregnancy. So if there's somebody that didn't have nausea and vomiting and then all of a sudden they're developing it, that would be kind of a red flag. A sudden weight gain. Same thing we know in the third trimester, baby is growing rapidly and as such mom is going to be gaining weight, but a significant sudden weight gain would be a big red flag there. Difficulty breathing is always going to be something that we want to kick our moms over to their healthcare providers for sure. If it's just like I'm out of breath when I stand up and then it goes away, that's one thing. But if it's like a significant shortness of breath, that's a problem. And then vision changes. Vision changes are going to be one of the biggest things to help differentiate for sure. Are these quote unquote normal pregnancy changes or is this something different? Because typically we don't see people seeing floaters or seeing spots or having major vision changes in any other situation in pregnancy. Whereas we could maybe see them having some discomfort in their abdomen or maybe see them having headaches. That's one factor that is really going to point us towards like, okay, you have this thing and vision changes, it's time to go to your doctor and get looked at. So let's talk about those big three things that I said at the beginning. Swelling, headaches and upper abdomen pain. Our job as PTs, right, is to help with musculoskeletal problems. We see people with swelling. We help people manage inflammation and swelling. Even in the pregnancy space when we have patients coming in with a lot of like leg swelling and things like that or varicosities, we help a lot with that. We talk to people about that muscle pumping action and utilizing the muscles around their cardio or their venous system to help facilitate that upwards flow of blood and fluid. And so we know that we can impact this. However, if we're seeing this progress into like hands and face, that would be a sign that that might not be your typical prenatal swelling. And that's something that needs to be referred out. That upper abdominal pain, if you have somebody come in and tell you like, oh, I have, like baby's just growing a lot. I've had, I have pain in my upper abdomen. Typically they're not going to tell you I have right upper quadrant pain. A lot of the times they think it's a rib. So they'll say like, oh yeah, my rib hurts really bad or oh, it's my like my ligaments or my abs are hurting really bad. We want to follow that up with a lot of questions. Some of the biggest questions that we want to know, is it both sides or is it just the right side? So if it's both sides, that doesn't necessarily mean that there might not be something going on, but it's less likely if it versus if it's purely just that right side consistently. We want to know if it's related to anything timing wise. So is it worse after you eat? Is it worse or better after you exercise? Is it relieved by exercise or stretching? So maybe you're a little uncomfortable and then you start moving and your tissues start warming up and then you feel better versus I work out and nothing changes at all. I stretch and nothing changes at all. No position that I get into makes this better or worse. True musculoskeletal pain is going to behave differently than pain that is created by a referred pain from an organ, which is what that right upper quadrant pain in preeclampsia is. So those are some big follow up questions we need to be asking. A lot of pregnant women, especially later in pregnancy, just assume that aches and pains and stretching discomfort and things like that are normal. And to an extent we expect it, but if we hear that right upper quadrant or like my shoulder, my right shoulder, my right neck area, that should be a sign for us to start looking at these other factors as well and just make sure that nothing is being missed. On the flip side of pregnancy, in the postpartum timeline, a lot of the signs of preeclampsia can be brushed aside because of that like fatigue and exhaustion, lack of sleep, all of the things that come along with having a newborn. So I see this a lot, especially in first time moms where any type of symptom for maybe not necessarily even just preeclampsia, but symptoms of anything are just brushed under the rug as normal because they know like, well, I know I'm not going to feel 100%. And so it's probably fine or it's probably normal. We want to make sure that we're educating our patients of red flags to look for when we're seeing them prenatally so that when they're in their early postpartum period, they know what to look for and what they need to be calling their doctors about or following up on to make sure that things don't progress into more serious situations and conditions. Things like blurred vision or maybe not seeing spots, but just like feeling a little foggy headaches or just like that general feeling of like unwell can really be brushed aside. And so we want to make sure we're telling them if you're seeing vision changes, call your doctor. If your headache is there and it's just not going away, no matter how much water you drink, if you take a nap, if you stretch, none of that's helping it. Just go ahead and check in and see how that's going. The education that we can provide prenatally to make sure that our patients are empowered in the postpartum period can be incredibly important in making sure that things are caught, especially in that timeline because we know in pregnancy, especially later pregnancy, mom is going to be going in for frequent visits to their birth care provider, especially like 35, 36 weeks on those are weekly visits. It's pretty easy, quote unquote, to catch things that are changing. In this case, a lot of women are only seeing their physicians or their OBs or their midwives at that six week point. Maybe they have a telehealth visit touch point in there in the middle, but most cases people are not going to their doctor until after that six week point. And we need to make sure that they know what the red flags are, not just for preeclampsia, really for all of the things, but especially for this episode for preeclampsia so that they know if they need to go in and be seen for sure. Most women are not taking their blood pressure at home every day. And so that's something that we can really talk to them about ahead of time. Like, hey, just in the morning when you wake up, take your blood pressure, throw a cuff on and just track it for the first couple of weeks and see if there's any changes. That information can be really valuable if she is also feeling kind of crummy. There's a new test that just came out. The FDA just approved it recently. It's been pretty highly talked about for some pluses and minuses. It's a blood test that measures protein, two proteins that are put out in the case of preeclampsia. And it's essentially a predictive test. So this test is done between 25 to 23 to 35 weeks pregnancy. And it's job is 96% validity of predicting if somebody is going to develop into severe preeclampsia. So the test that was done in order for this test to get preapproval was taking women that already had hypertension or had low severity, quote unquote, preeclampsia, and they followed them and the test could predict within two weeks if they were going to progress into severe preeclampsia. There's some discussion about this test because on one hand, people that are criticizing it are saying it's just another test that costs money, right? That could be fear inducing in people potentially. It's not 100% guarantee that you're going to get severe preeclampsia. And the biggest discussion about this is what are you going to change clinically that you weren't already doing? So if you have somebody who's coming in, they have high blood pressure already, which would be an indication that they could benefit from this test to know, you're probably already keeping an eye and managing that patient a certain way and knowing whether or not they're going to progress to severe preeclampsia within two weeks isn't necessarily going to change the protocols that you're already doing for that hypertension. Same thing with a low severity preeclampsia. If you know somebody has low severity preeclampsia, it's likely not going to change anything other than you're going to be on the lookout regardless, which you would have been anyway. On the flip side, people that are really excited about this test are really talking a lot about the benefits of it clinically, especially in areas with disparities in healthcare. So again, we talked earlier about black women being 60% more likely to develop preeclampsia and a lot of times that comes from poor care and not being believed when they're talking about their symptoms. And so this test gives the opportunity to show like, this is a real pain, this is a real thing and it could be developing into a life threatening condition and it needs to be addressed. So that's one benefit. Another benefit is if you are somebody that's in like a rural area or an area that doesn't have great access to resources that maybe could be life saving for mom or baby, it's an opportunity to transfer somebody to a hospital system that is better equipped to handle a more severe preeclampsia patient rather than a smaller hospital that maybe doesn't have like a NICU or maybe doesn't have the type of care level that somebody with a more severe medical condition would potentially need. The other thing in the prenatal space is women that are coming in with some symptoms or discomfort potentially shortening their hospital stay. If the physicians know, okay, they have low severity preeclampsia, we did this test, they're not likely to progress into severe preeclampsia. They don't need high doses of steroids for baby's lungs to be developed in order for an early delivery. They're probably going to be fine just continuing on their pregnancy with close monitoring. And so that's something that hopefully could impact shorter hospital stays, allowing mom to get moving going from there as far as the impact on their health and their outcomes in the hospital. So there's some pluses and minuses. It's a new test. It was just approved by the FDA recently. So it's something that we're going to see kind of shake out across the prenatal and postpartum space. It'll be interesting to see how much it is offered and if it becomes kind of like a standard of care versus if it is something that people just pay extra and go above and beyond for. It'll be really interesting. Doesn't necessarily affect our role as PTs in the sense that we're not the ones that are going to be ordering that test clearly. But it's just something that we need to keep an eye on and be aware of as something that can be potentially done for our patients or something that our patients may be having. To wrap things up, preeclampsia, number one mortality or highest cause of mortality in pregnant women, high blood pressure condition that can progress into a life threatening condition if not addressed and caught early or addressed and caught whether or not that is through delivery or whatever other ways that they manage it. As PTs, our job is going to be to know what the signs and symptoms are and know when it is a time to send out to be done a more close workup on those symptoms. Those are going to be things like swelling of the hands and face, right upper quadrant pain, a headache that won't go away with any type of our typical quote unquote management of those symptoms, nausea and vomiting that comes out of nowhere in that third trimester, sudden weight gain, difficulty breathing and seeing spots. If your patients are talking to you about these symptoms, tell them to go follow up with their provider. And on the flip side of that, you talk to your patients about those symptoms if you're seeing them prenatally so they know what the red flags are for postpartum, they know what to look for so that in that six weeks that they are potentially not having a visit with a healthcare provider, they're not alone on an island, give them that buoy of information so that they know if they need to address it. That's all I have for you guys today on the postpartum and prenatal preeclampsia episode of Ice Pelvic. This is a topic that we do talk a little bit about in our courses. So if you want to learn more, dive into our courses, we talk about when maybe exercise is indicated or contraindicated. There's a lot of new information about that where some of the old school things that we thought maybe are not actually accurate or don't benefit our patients to put them on restrictions. We can absolutely dive into that more in our courses. So sign up for our online course, sign up for our live course, come hang out with us on the road. I hope you guys have a fantastic Monday and I will see you guys around. 25:08 OUTRO Hey, thanks for tuning into the PT on Ice Daily Show. If you enjoyed this content, head on over to iTunes and leave us a review and be sure to check us out on Facebook and Instagram at the Institute of Clinical Excellence. If you're interested in getting plugged into more ice content on a weekly basis while earning CU's from home, check out our virtual ice online mentorship program at ptonice.com. While you're there, sign up for our hump day hustling newsletter for a free email every Wednesday morning with our top five research articles and social media posts that we think are worth reading. Head over to ptonice.com and scroll to the bottom of the page to sign up.

Dr. April Dominick // #ICEPelvic // www.ptonice.com  In today's episode of the PT on ICE Daily Show, #ICEPelvic faculty member April Dominick discusses the obturator internus muscle and its role in pelvic floor and hip conditions. She highlights the importance of understanding and addressing this muscle for effective treatment. Take a listen to learn how to better serve this population of patients & athletes. If you're looking to learn more about our live pregnancy and postpartum physical therapy courses or our online physical therapy courses, check our entire list of continuing education courses for physical therapy including our physical therapy certifications by checking out our website. Don't forget about all of our FREE eBooks, prebuilt workshops, free CEUs, and other physical therapy continuing education on our Resources tab. EPISODE TRANSCRIPTION 00:00 INTRO What's up everybody? We are back with another episode of the PT on Ice Daily Show. Before we jump in, let's chat about Jane for a moment as they are our sure sponsor and they make this thing possible. The team at Jane understands that payment processing can be complex, so they built in an integrated payment solution called Jane Payments to help make things as simple as possible so you can get paid. If you're looking for an easy way to navigate payments, here's what we recommend. Head over to jane.app slash payments, book a one-on-one demo with a member of Jane's support team. This can give you a better sense of how Jane Payments can integrate with your practice several other popular features that Jane Payments supports, like memberships with the option to automatically invoice and process your membership payments online. If you know you're ready to get started, you can sign up for Jane and make sure when you do, you use the code ICEPT1MO as that gives you a one-month grace period while you settle in. Once you're in your new Jane account, you can flip the switch for Jane Payments at any time. Let the Jane team know if you need a hand with anything. They offer unlimited support and are always happy to jump in. Thanks everybody. Enjoy today's PT on ICE Daily Show. 01:29 APRIL DOMINICK Good morning PT on ICE Daily Show. Dr. April Dominick here. I am your host and I will be continuing our conversation on pain in the butt, this time with a spotlight on the obturator internus muscle. The obturator internus is a persnickety hip muscle that is housed inside the pelvis and it contributes to quite a few pelvic floor and hip conditions. So before we dive into that, I just want to give you all some updates from our ICE Pelvic Division. If you didn't catch our big news from our newsletter that we sent out last week, we week online course that is going to cover advanced pelvic health concepts and it's coming January 2024. So make sure you hop onto pdniice.com, check the resources page and get yourself signed up for our pelvic health newsletter for all things research oriented. And our next level one online cohort starts September 5th. So be sure and hop on to that course. And then you can catch us live for our two day course on the road next week and actually we will be here in Denver, Colorado. That's July 29th and 30th with Dr. Alexis Morgan and myself. We'll have a jam packed course for you. Our lecture will focus on all things pregnancy and postpartum. For the fitness athlete, labs will go over all internal external assessment of the pelvic floor with a option for video learning if that assessment does not sound like it is for you in terms of the internal piece. Other labs will cover management of C-section scar, diastasis recti, core work on and off functional barbell lifting, endurance including running, all sorts of fun fun stuff. So there are still a few seats available for that course if you want to come hang out with us and if you aren't able to make it to the Denver course we'll be in Sedona, Arizona and that's going to be September 23rd and 24th with Christina Prevot and Dr. Rachel Moore. So if you missed it two weeks ago we chatted about another kind of pain in the butt, one that was focusing on a bony structure, the tailbone. It's episode 1505 if you want to slide back and catch that. But today we're going to focus on the soft tissue muscle or cause of the pain in the butt, specifically the obturator internus or I love abbreviations so I may call it the OI during today's episode. So if you, the listener or if you have a client who has some sort of hip pain that seems difficult to pinpoint, they're having trouble telling you where it's at maybe because of where it's at they may be kind of pointing in the nether regions or they might be headed up near the and you're like, oh I don't deal with that stuff or they may point just at the ischial tuberosa and you're like, oh thank goodness, hamstring strains, I can deal with that for sure. But maybe you throw everything you have at it, your hip mobility exercises, your strengthening exercises and it's just not getting any better. Well I encourage you to consider my friend the mysterious obturator internus muscle as that may be influencing some of that hip pain that you or the client has. So we'll chat about the obturator internus' unique anatomy, its functions, other competing soft tissue contributors as well as certain conditions or maybe client reports to be on the lookout for that may be influenced by this muscle. I love history so the word obturator actually originates from the Latin word obturo which means to stop or block up. This lines up given that the obturator muscle actually covers the opening of the obturator for Raymond. So this, the location of the obturator, it's a big old hunk of hip muscle that lives on the front and side of the hip. So for those listening, I'm holding up my pelvic model, we're looking at the pubic bone and going just lateral to it and there's a, I like to think of it like they're two skull eyeballs, but anyways, there's a big old hunk of muscle that's in red here and that is the belly of the obturator internus. And then it has this really cool tail that actually whips out and takes a 90 degree turn to then connect onto the top of the femur or the top of the leg. Due to this unique deep parking spot within the pelvis, it can affect both the function of the pelvis and, or pelvic floor and the hips. So in terms of function, we'll go over three major functions of the obturator internus. Number one is it can externally rotate the hip when the hip is extended. So like when you're standing, it can abduct the hip when the hip is flexed or when your leg is raised up like you're marching. And then it also has a key role in stabilization of the femoral head or the leg into the acetabulum. So especially during weight bearing and propulsion. Based on a study in 2017 that looked at female cadavers, the, they, I love the phrase that they used in this article, they called it the architectural design of the obturator internus is affected by aging. In that, in their study, they found after the age of 60, both the force generation capacity and the fibrotic nature of the OI muscle is reduced. That's so interesting. And what they suggested in that article was maybe we should be focusing a little bit more on functional upright movements that have the leg and weight bearing as that tends to be when the obturator internus is more in a shortened position. So maybe we can generate some greater functional capacity and strength in that position versus our typical non-weight bearing exercises like maybe a clam. In terms of impairments, the OI will often step up to the plate and compensate to stabilize the pelvis when other muscles like the glutes or abdominals are a little on the weak side. You can also develop just like any other muscle, any sort of muscle banding, knots, and it rare if it's rarely lengthening or relaxing. And so all of that is definitely going to result also in some reduced range of motion and then reduce blood flow to this muscle, to this area and its surrounding nerves will definitely contribute to a cranky OI, which then may lead or lend towards hypersensitivity when that OI muscle is palpated. And we can palpate it externally near the ischial tuberosity as the obturator internus actually lies just on top of the ischial tuberosity, similarly to how the subscapularis lies on the underside of the scapula. So it has that similar kind of bony muscle contact. Or you can palpate this muscle intra-vaginally or interactively. And there are so many times during my sessions, if I'm doing a pelvic floor assessment and I roll over to the obturator internus that the shock and maybe relief of the person on the table is paramount. They're like, oh my goodness, that's the pain that I have during deep penetration. Or that actually just brought on some urgency for me, some urinary urgency. That's the feeling that I get randomly. Or that's the pain that I have when I'm sitting and it's been hard for me to describe it to you. So it's super powerful being able to palpate this muscle and just help bring some validation to your client who's like, I just don't know where this pain is coming from. And then due to its many functions and that unique anatomical location, the OI is capable of referring to lots of areas. So sometimes it'll kind of act like a chameleon. One day, you know, it's referring pain to the hip. Maybe one pain is referring pain if someone's pregnant to the round ligaments. So other soft tissue areas that you should be screening if you're looking at the obturator internus muscle would be the hamstrings like we talked about, the adductors, big, big relationship between obturator internus dysfunction and then the pelvic floor, specifically the levator anion muscle group, as well as the coccygeus. And then not to mention just muscle structures, but another nerve structure that would be super helpful to have on your hypothesis list that may be affected if the OI is cranky is one of its best mates, the pudendal nerve. So the pudendal nerves is going to support sensation in your urethral and anal sphincter function. So along its path, the pudendal nerve is actually surrounded by some obturator internus fascia. And that goes along alcox canal, which is on the border of the obturator internus. And it provides a really large opportunity for entrapment of that pudendal nerve, which then could lead to some possible pain and dysfunction. So the obturator internus, I like to think about it like a nosy aunt who has her nose in everybody's business and the family, all the hot goss. So because of that, it is involved in so many different conditions. And these are a few things that you may hear from your clients in terms of aggravating factors. So they may talk about, hey, I just have this ton of discomfort when I sit for a long time. Or I just got my peloton and I actually have a lot more discomfort now because I've been cycling quite a bit. And we're saying this, but maybe you will have already screened out the tailbone. deep penetration or sexual play like I chatted about. And painful or tight hips, urinary urgency, frequency leakage, SI joint tenderness, difficulty or difficulty with description or pinpointing some sort of pain or pressure that's deep within the pelvis, deep within the vagina. Or sometimes people will often say, I have pain that is, it just feels like I have a golf ball in my rectum. So these are all things that I want you to keep in your mind when maybe thinking about could this be the obturator internus muscle. From a trauma standpoint, the OI can be injured in posterior hip dislocations, again, just because of where it's at with from an anatomy standpoint. It can also be involved in acute or overuse strains from sports like kicking, tackling or falling. Falling, usually this is in young males. And then sometimes the obturator internus can be strained in conjunction with adductor longus strains. So in summary, if you have clients that are coming to you that are describing some pain up in that region where you may not be used to screening or palpating for in the nether regions and they point towards this yield tuberosity and you're like, just stay there, don't go higher. I want you to think about thinking outside of the hamstring adductor strain box and be sure to include the obturator internus in your hypothesis list. Due to its unique anatomy of living inside the pelvic bowl, but shooting a little leg out to the side or a little tail out to the side to attach to the femoral head, the obturator internus muscle is sneaky. It's involved in so many different pelvic and pelvic floor and hip conditions. We talked about pain with intimacy, prolonged sitting, bladder urgency, frequency, just to name a few. And if this is describing your hip pain or if you're dealing with a client who isn't responding to traditional PT, consider reaching out to your local pelvic health PT to help screen for pelvic floor dysfunction. I actually have a really close relationship with a lot of the ortho-PTs in my area who don't have an interest in treating the OI, but they've learned how to screen for it from me and they now refer out to me and nine times out of 10, they are spot on with calling that obturator internus as being a contributor to their client's pain. And then better yet, for the PTs out there, come on out to our live course so that you can learn how to palpate and master and learn techniques for external and internal palpation and treatment of the muscle. So learning how to screen for this muscle will be such a game changer for successfully your clients with this hip and pelvic pain without you needing to refer out. Thank you all so much for being here. We appreciate you. Hopefully you don't have any pain in the butts on the schedule, but if you do, at least you're armed now with which other sneaky muscle that could be contributing. Happy Monday and I'll see you next time.  17:02 OUTRO Hey, thanks for tuning in to the PT on Ice Daily Show. If you enjoyed this content, head on over to iTunes and leave us a review and be sure to check us out on Facebook and Instagram at the Institute of Clinical Excellence. If you're interested in getting plugged into more ICE content on a weekly basis while earning CUs from home, check out our virtual ICE online mentorship program at ptonice.com. While you're there, sign up for our hump day hustling newsletter for a free email every Wednesday morning with our top five research articles and social media posts that we think are worth reading. Head over to ptonice.com and scroll to the bottom of the page to sign up.

Dr. April Dominick // #ICEPelvic // www.ptonice.com  In today's episode of the PT on ICE Daily Show, #ICEPelvic faculty member April Dominick discusses when and how the tailbone/coccyx may be a contributor to a patient's symptom behavior, as well as how to begin to assess & treat the region if appropriate. Take a listen to learn how to better serve this population of patients & athletes. If you're looking to learn more about our live pregnancy and postpartum physical therapy courses or our online physical therapy courses, check our entire list of continuing education courses for physical therapy including our physical therapy certifications by checking out our website. Don't forget about all of our FREE eBooks, prebuilt workshops, free CEUs, and other physical therapy continuing education on our Resources tab. EPISODE TRANSCRIPTION 00:00 INTRO What's up everybody? We are back with another episode of the PT on Ice Daily Show. Before we jump in, let's chat about Jane for a moment as they are our sure sponsor and they make this thing possible. The team at Jane understands that payment processing can be complex, so they built in an integrated payment solution called Jane Payments to help make things as simple as possible so you can get paid. If you're looking for an easy way to navigate payments, here's what we recommend. Head over to jane.app slash payments, book a one-on-one demo with a member of Jane's support team. This can give you a better sense of how Jane Payments can integrate with your practice several other popular features that Jane Payments supports, like memberships with the option to automatically invoice and process your membership payments online. If you know you're ready to get started, you can sign up for Jane and make sure when you do, you use the code ICEPT1MO as that gives you a one-month grace period while you settle in. Once you're in your new Jane account, you can flip the switch for Jane Payments at any time. Let the Jane team know if you need a hand with anything. They offer unlimited support and are always happy to jump in. Thanks everybody. Enjoy today's PT on ICE Daily Show. 01:27 DR. APRIL DOMINICK, PT, DPTWhat is up PT on ICE fam? Dr. April Dominic here. Today we are starting our two-part series on pain in the butt. And today you will learn how you as a clinician can screen for tailbone pain, some general assessment and treatment strategies, as well as in part two, next in two weeks we'll cover soft tissue structures that may contribute to pain in the butt. Before we dive into tailbone pain today, let's talk about some course offerings from the ICE Pelvic Division. So we have our eight-week online cohort that starts July 10th and we still have some spots left. So please hop on in and join us for all of that fun. And then we have our live course and this course is going to give folks the ability to learn pelvic floor basics and about the pregnancy and postpartum changes of the body. We'll definitely dive into the internal exam in supine and standing with an option to learn another way if an internal exam is not for you. Then in day two, we are in the gym and we're applying what we learned day one into all activity types such as impact work, rig work, barbell and more. And we learn how to coach and come alongside and offer modifications for this population and keep them in the gym during pregnancy if that's what they desire, as well as help them feel confident returning back to the gym during postpartum. So our next course is actually going to be with myself and Dr. Alexis Morgan. It'll be here in Denver, Colorado. That's going to be July 29th and 30th. And then you can hop into our next course offering, which is in September 23rd and 24th, I believe, and that's going to be in Scottsdale, Arizona. So tailbone pain. We've got people with pain in the butt and we're thinking, hey, it may be coming from the tailbone. So what do we know about tailbone pain right now? Well, true to the pelvic health research world form, we are still learning and growing. We don't know a lot about incidence rates for tailbone pain. It is under reported. It is multifactorial in nature. There are a lot of psychological and physiologic factors that are involved in tailbone pain. So with that, it is just a trickier diagnosis to treat. But I wanted to share about all of the things that you can do from a general assessment and treatment strategy today. So one study did find that comparing female to males, females tend to be affected by tailbone pain about five times more than male counterparts. We also know that typically speaking, tailbone pain can resolve within weeks or months with time. However, we do know that conservative treatment strategies are welcome and definitely help reduce that duration for some. So what is the tailbone? Or I'll sometimes call it the coccyx. The word coccyx actually originates from the Greek word for the beak of a cuckoo bird. So like a tailbone, the beak and the tailbone have a triangular shape. The tailbone is three to five fused bones that articulate to the bottom of the sacrum. So everyone listening right now, let's go ahead and orient ourselves to where the tailbone actually is. With your fingertips, I want you to try right now, locate the edges of your sacrum, which is going to be that bone that kind of sits inside of the center of the buttock. And I want you to head inferiorly or towards the toes and towards midline. You're going to follow that bone until it ends. You'll bump into a small bone and that is the coccyx. You might be like, whoa, April, I'm like right near the anus. Well, then you're in the right spot because the coccyx is just superior to that anal opening. So the coccyx may be tiny, but it is mighty and it is not insignificant. I like to think about the coccyx as a leg of a tripod. And that tripod is going to consist of a sit bone on one side, a sit bone on the other, and then the tailbone in the center. It is the anchor for the posterior pelvic floor muscles. So there are all kinds of muscles that attach to the coccyx itself all around. Specifically, the coccygeus muscle is going to attach on either side of the coccyx. But wait, there are more. So what is really important and why I wanted to come on here today to talk about tailbone is that there are other structures that are not actually pelvic floor specific that are attaching directly to the tailbone. Those are the glute max. So we have hip insertions as well as the sacro tuberous and sacrospina ligaments. So if you've got someone coming in for tailbone pain, it is important to assess above the joint and below, of course, but assessing above the joint, like at the hip and the low back due to these attachments. Functionally speaking, the tailbone is dynamic. It's going to move as we move throughout our day doing our activities of daily living. So when the pelvic floor contracts, the tailbone is going to draw in and come forward or come anteriorly. So let's chat about actual functions that the coccyx is involved in. More specifically, the coccyx is involved in sitting, bowel health, so it helps to keep poop in or get out of the way to get poop out. It is involved in childbirth, sexual play, and transfers such as sit to stands. So let's put ourselves in the subjective exam. You've got someone that came in and they've got some kind of hip pain or tailbone pain. So what are we going to hear from a traumatic mechanism of injury or a non-traumatic mechanism of injury? I'm also going to talk about aggravating factors here. So what are some things that you might hear during your subjective or things that you might want to dive deeper into in order to maybe put coccidemia or tailbone pain onto your hypothesis list? So from a traumatic mechanism of injury standpoint, we most commonly hear of tailbone injuries during labor and delivery. The tailbone should move out of the way to allow for the fetus to slide on down the birth canal as if it was that easy, right? And simple. But sometimes that birth doesn't go according to plan and someone may need to have an instrument assisted delivery with the use of forceps or a vacuum. And that is going to put someone at a higher risk for a tailbone injury. Another traumatic mechanism of injury would be a fall. And that can be a fall during your sport, during an activity, or from a horse, which we hear often. So now I'm going to dive into eight common non-traumatic aggravating factors or contributors to tailbone pain. We have pregnancy. So during pregnancy, things are a-growing and that's going to put a lot more force down into the sacrum, onto the tailbone. So some of those folks may start to say, hey, I've actually got a lot more pain when I sit during pregnancy. But you don't have to be pregnant to have pain with sitting. So one of the biggest, biggest complaints of, or aggravating factors for tailbone pain is going to be pain with sitting. So especially for a prolonged time. The tailbone assists with weight-bearing support, especially in sitting. So let's bring it to real life. In real life, we're thinking truck drivers or maybe people who have jobs who you are sitting without any brakes or with minimal brakes. So just constant pressure and force down onto that tailbone. And then I also want us to take a minute and think about the social implications of someone who has pain, severe pain with sitting. So what is that going to prevent us from doing? Hey, maybe going on a dinner date, right? Or comfortably going to a movie with your grandkids or any sort of event at work or your job duties itself. So people who have tailbone pain and it is severe, just have some grace for them because we do a lot of sitting in our daily lives. Think about like even transportation, we're sitting in a car, right? Not everybody has subways in their region of the United States. So just extend some grace to these folks because they, this is definitely interrupting their life quite a bit. Other reasons, or contributors to tailbone pain, rapid weight loss, increased stress might increase some overactivity of the pelvic floor muscles that surround the coccyx. We also have some sometimes tailbone pain after spinal injury. If someone has hypermobility, that is going to play into the mechanics of ligaments and of the tailbone, as well as oftentimes people will complain of pain in the tailbone with sexual play due to certain positions causing a little bit more force down into the tailbone. And then finally, exercise. You know, you've got those folks who are like, oh, it's summertime, I'm going to get my hot girl summer on or whatever kind of summer they're wanting. And they are recently starting some sort of exercise routine, whether that is doing a lot of orange theory or 45 where they have or CrossFit where they have a lot of biking or cycling or rowing that they didn't used to have. And that's a little bit more pressure on the tailbone or maybe the Pilates person who is doing like a hundred boat poses, right? So exercise can play a big role in a new onset of tailbone pain. And then from a medical perspective, bone spurs, infections and cysts can also contribute. So what are some easing factors? What are these people are going to say that may lead you to be like, oh, maybe if this is what's relieving their pain, maybe I should be considering tailbone pain. They are going to say, you know, if I change positions or they might report being on their belly or standing or sideline, those are the positions of comfort. And that's because we are not weight bearing onto the tailbone. So from an objective standpoint, let's run through what are some bony structures we should be looking at. So hip and low back. Hopefully I've made that clear to you that those need to be screened out. Pelvic specific structures. We're looking at the sacroiliac joint as well as the tailbone itself. And in our live courses for our pelvic class, we dive deep into assessment and treatment and help you just dial in those skills. So hop on into our live course for that. I'll walk us through verbally how we would palpate the tailbone itself. So first, first, first, first, make sure it is actually the tailbone. I had a patient one time who is a health care provider and they were all through other subjective exam. They're saying, yeah, you know, tailbone this, tailbone that, blah, blah, blah. I get to the objective exam. I'm doing my P.A. mobs on the spine. I get down to L3 through five. Boom. That is their pain. Tenderness. Ah, that's it. That's it. And so I'm like, OK, noting for later. And then we continue on into some tailbone palpation and nothing. Any sort of tailbone pressing or mobilizations does not reproduce the pain that they came in for. So just make sure that we're all on the same page about what the tailbone is. Now, let's just call it what it is. Palpating the tailbone is awkward. It can be uncomfortable for the client, but to quote Finding Nemo, just touch the butt. OK, touch the tailbone. You wouldn't avoid palpation or assessment of the hip if someone came in with hip pain. Right. So we shouldn't think any different about externally palpating the tailbone. So let me give you some options for how to do that. When we are palpating the tailbone, we are looking for reproduction of pain. And sometimes after you get a feel for a few tailbones, you can appreciate that some positions, some tailbone positions are a little more flexed or some are a little more vertical. And that usually comes with a little time after palpating a bunch of them. But the tailbone palpation, we've got three recommendations. So number one is externally, you can palpate as a clinician, you can palpate the client's tailbone in prone, side lying or sitting. And in prone or side lying, it's going to be the same way that I just walked us through how to palpate your own tailbone, except you'll have as a clinician, a pincers grasp on that tailbone and you'll be able to do some mobilizations and manipulations there. So these do make it difficult for getting a solid grasp on the bone. And then in sitting, I love this because this is a little more functional for the person. So you can have your fingertips on their tailbone in sitting and ask them to sit upright and then also slump. And that's going to give you a good appreciation of the movement of the coccyx itself. And then another way to palpate the tailbone is they may be like, uh-uh, you are not getting anywhere near my tailbone. That is my tailbone. So that is okay. You can come alongside them and you can just walk them through how to palpate their own tailbone again in sitting or side lying. And you can ask them some subjective questions about what it is that they're feeling and make sure they're in the right spot. And then the final way to palpate the tailbone would be internally or interactively. And those with pelvic floor specialty, especially trained in inter rectal examinations, will be able to do that. So from a general conservative treatment strategy standpoint, let's talk through some of those things. You've got someone that came in, you're like, yes, they definitely have tailbone pain. Now what do you do? We'll talk through manual therapy, exercise and education. So from a manual therapy side of things, you can do some direct coccyx mobilizations, whether that's externally or interactively. So you've got your pins or grass and you are applying some mobilizations to that structure. You can also do it indirectly where your pins or grass stays on that tailbone. And then you ask them, maybe they're in side lying, hey, can you do some posterior pelvic tilts, anterior pelvic tilts of the hips or can you move your hips while we are stabilizing the tailbone? That is obviously a more active way to get some manual mobilizations in there. We can also supplement with dry needling, cupping, e-stim. We definitely want to hit the glute max, the lumbar spine. And if you're trained in it, the pelvic floor as well, especially those coccidius muscles that attach nearby, that touch directly to the coccyx. And then from an exercise standpoint, I'll talk through some stretches, strengthening and aerobic activity. So my three favorite stretches for promoting down regulation of the nervous system for the tailbone pain is going to be throwing some diaphragmatic breathing in with these three exercises. So the first, I like my clients to be on hands and knees doing some rock backs. The second is happy baby. You can be in happy baby, maybe do some lateral movement side to side, but I love a good modified happy baby where the feet are actually on the wall that frees the client's hands to actually spread the cheeks. It is okay to touch your butt. It's your own butt, right? So spreading those cheeks is actually going to put a stretch onto the tailbone itself and for some people relieve some of that pain. And then a deep supported squat against the wall is going to be wonderful for those pelvic floor muscles that may be, again, a little overactive and pulling on that coccyx bone. Of course, in the long term, we'll want to do some general loading, whatever that patient can tolerate and especially if hyper mobility is on board, loading of the hips and back and pelvic floor can be wonderful for these humans. And then finally, let's blast them with some high intensity interval training of whatever they can tolerate. So bike and rower are probably going to be out the window, but they may be able to do some standing, arm bike intervals, brisk walking, treadmill incline, pull walking, anything to really hit the system to address that increased inflammatory state and promote some blood flow and healing. And then finally, education. Education is huge for these humans. So we're going to talk about positioning, positioning in sitting. Let's encourage a neutral or anterior pelvic tilt because that's going to put a lot less pressure down onto the sacrum and the tailbone. Let's identify the threshold that the patient is able to tolerate in sitting. So if they're like during the subjective, they say, yeah, you know, around 30 minutes is when I start to feel my tailbone pain. Great. We've identified a threshold. below that and say, if you wouldn't mind, let's do some, some standing breaks or movement snacks around 20, 25 minutes of sitting just so that we don't keep hitting that threshold of pain and continuing that ripping the bandaid off cycle of I sit for hours and hours and I have pain and then it starts all over again. So let's do something about it. And then cushions. I love recommending a lumbar support cushion like a half McKinsey slimline roll. They can tuck that below the low back and that's going to give them a little more anterior pelvic tilt and then also tailbone for the cushions for the tailbone itself. So some of my favorite models are the cushion your assets, tailbone support, the kabootie or a donut. And then during intimacy. So using pillows for support or maybe opting for positions with decreased tailbone compression like hands and knees or legs up or side laying. Those may feel better for that human. And then it wouldn't be an ice podcast without talking about lifestyle factors. We want you to be talking with them about nutrition, reducing processed sugar intake, and especially for this population, stress management, increased stress with job, family, whatever can be a huge factor for keeping this tailbone pain around. So we want to make sure that we get them hooked up with someone or using some sort of stress management techniques to address that part of this diagnosis. And then finally, remind these people that it takes time. Tailbone bruises, tailbone pain, all of that. It just takes a really long time. And so it will get better, especially if they can implement some of these strategies. But unfortunately, they are going to have to be a little patient. So let's review what it is that we talked about. Tailbone pain is tricky. It's tricky to treat. It's understudied and it's underreported. But it is involved in so many life functions, including weight bearing support, especially pain sitting, bowel sexual function, labor and delivery. Due to the attachment sites to the tailbone, it should be part of your hypothesis list for folks coming in with back and hip pain. Actually touch the butt, but really touch the tailbone. Make sure that it is the tailbone that is possibly a structure that is involved. If you feel that the tailbone is involved, give it some manual therapy with some mobilizations, soft tissue love, and then supplement that with whatever kind of modalities you prefer. Cupping, dry needling, some supportive stretches like happy baby, quadruped rocking, getting some gentle loading in, and then offering some cushions for solutions for positioning. And finally, refer to a pelvic floor PT in your area or get yourself to one of our live courses because we dive deep into pelvic pain assessment and dialing in those skills so that you feel confident when you have someone like this in front of you. So happy Monday, everyone. Happy Fourth of July. And I will see you all in two weeks to discuss the soft tissue structures that may contribute 24:37 SPEAKER_02 to some pains in the butt. Hey, thanks for tuning in to the PT on Ice Daily Show. If you enjoyed this content, head on over to iTunes and leave us a review and be sure to check us out on Facebook and Instagram at the Institute of Clinical Excellence. If you're interested in getting plugged into more ice content on a weekly basis while earning CUs from home, check out our virtual ice online mentorship program at PT on ice.com. While you're there, sign up for our hump day hustling newsletter for a free email every Wednesday morning with our top five research articles and social media posts that we think are worth reading. Head over to PT on Ice dot com and scroll to the bottom of the page to sign up.

Dr. Rachel Moore // #ICEPelvic // www.ptonice.com  In today's episode of the PT on ICE Daily Show, #ICEPelvic faculty member Rachel Moore discusses how physical therapists don't need to be the masters of movements in order to teach them to others, or help others begin their progression towards achieving them. Take a listen to learn how to better serve this population of patients & athletes. If you're looking to learn more about our live pregnancy and postpartum physical therapy courses or our online physical therapy courses, check our entire list of continuing education courses for physical therapy including our physical therapy certifications by checking out our website. Don't forget about all of our FREE eBooks, prebuilt workshops, free CEUs, and other physical therapy continuing education on our Resources tab. EPISODE TRANSCRIPTION 00:00 INTRO What's up everybody, we are back with another episode of the PT on Ice Daily Show. Before we jump in, let's chat about Jane for a moment as they are our sure sponsor and they make this thing possible. The team at Jane understands that payment processing can be complex, so they built in an integrated payment solution called Jane Payments to help make things as simple as possible so you can get paid. If you're looking for an easy way to navigate payments, here's what we recommend. Head over to jane.app slash payments, book a one on one demo with a member of Jane support team. This can give you a better sense of how Jane Payments can integrate with your practice several other popular features that Jane Payments supports like memberships with the option to automatically invoice and process your membership payments online. If you know you're ready to get started, you can sign up for Jane and make sure when you do, you use the code ICEPT1MO as that gives you a one month grace period while you settle in. Once you're in your new Jane account, you can flip the switch for Jane Payments at any time. Let the Jane team know if you need a hand with anything, they offer unlimited support and are always happy to jump in. Thanks, everybody. Enjoy today's PT on ICE Daily Show. 01:27 DR. RACHEL MOORE, PT, DPT All right. Good morning, PT on ICE Daily Show. Welcome to our 1500th episode of PT on ICE. We are incredibly honored that you guys tune in and listen to our crew rap about everything from pregnancy and postpartum to fitness athlete management, from pushing the envelope on Geri Care to evidence based orthopedic care, whether that's from our spine division or our extremity crew and the latest and greatest about dry needling and then gaining some leadership insights. We are so honored that you guys choose us to listen to for all of the information. ICE wouldn't be what it is without you guys. So thank you so much for hanging with us on Instagram, on YouTube, on your podcast apps and in our courses. We love connecting with you all and working together to push our profession towards PT 2.0. Today, I want to ring in our 1500th episode with a topic that honestly might seem a bit random, but don't worry, I'm going to explain where it came from. Today, we're going to be talking about lessons we can all learn from the man, Ted Lasso himself, both as physical therapist and honestly, just in life too. Before we do that, I'm going to dive into our upcoming courses in the Ice Pelvic Division. Our next online cohort starts July 10th. This is our eight week course where we dive into everything from preconception and relative energy deficiency in sport to pregnancy, making modifications for pregnant athletes. We talk about birth, we talk about the fourth trimester, we talk about postpartum, we go over how to get athletes back to the barbell, back to the gymnastics rig. It is a lot of really great information and that cohort starts July 10th is when our next one kicks off. Our next in-person courses, we've got three coming up in the next few months. July 29th and 30th, we've got a team going out to Parker, Colorado. That's going to be with Alexis Morgan and April Dominic. September 23rd and 24th in Scottsdale, Arizona. That'll be with Alexis Morgan and myself. And then September 30th and October 1st, Christina Prevot is going to be hanging out in Ontario. So if you've been looking for a course north of the border for the pelvic division, check that one out. Head to the website, sign up for those courses. While you're there, head to the resources tab, sign up for our newsletter to stay up to date on all of the latest pelvic and pregnancy and postpartum information and research. All right, guys, here we go. We're kicking it off. Why are my here on Pelvic Monday talking about Ted Lasso? In our online cohort, we cover a lot of different topics like I just said. In week six, we talk about gymnastics and we are talking about helping our patients get back to the pull-up bar, working on pull-ups and chest to bars and bar muscle ups and ring muscle ups and all of these like advanced gymnastics skills that we learn how to do in CrossFit that are all super fun. We always ask the crew in the class kind of towards the end of our meetup, what is the biggest barrier that you perceive in helping patients get back to these skills? In every single cohort, we always get the same answer across the board and it's that I can't do this skill so I don't feel like I can teach it. I'm not confident in the ability to be able to teach it. While we do encourage people to be about it and we want them to get themselves into whatever area of fitness they love and we always encourage them towards the CrossFit side in particular, we also always have a conversation that you don't have to be able to teach things in order to be able to do things in order to teach them. So in past cohorts, I always make the reference of like a coach and a sport team. I admittedly do not watch sports at all so I'm always trying to like pull a random name out and it never really works out very well. I'm like, oh yeah, like you know the football coach on the sidelines, he's probably like scrawny but then the football players are over there. And last cohort, in the middle of trying to explain this with my very poor background in sports, it hit me that Ted Lasso is the perfect example of this. This leads us beautifully into lesson number one. And don't worry, I went through all of these examples with a fine tooth comb to make sure that I don't spoil it if you are still finishing up Ted Lasso or maybe you haven't watched it. So lesson number one, you don't have to be able to do the thing in order to coach it. We all know this is a prime example from Ted Lasso because he has never played soccer and has never coached soccer and he moves to London to coach a soccer team after having a background working with college football, athletics. So that kind of resonates with me personally, I coach CrossFit and I've never done a ring muscle up for example. However, I understand the component pieces of a ring muscle up. I know what the points of performance are. I can record somebody doing a ring muscle up and I can break down where in the movement maybe we need to tweak something or the mechanics are changing. Being able to take a step back and watch a movement and help an athlete clean up the pieces of the movement matters. Being able to jump up on the rings and do it yourself doesn't. Your patients are seeing you for a reason. They're not there to watch you just bang out a bunch of reps. They're there to get your expertise in the physical therapy realm and help connect to the dots of fitness and rehab. And again, we absolutely want you guys being about it and pushing yourselves in your own fitness domains. So spending the time to learn these movements both by like watching videos of people doing these things, pulling up YouTube, following athletes on Instagram, getting comfortable with seeing movement variability and what some of those common faults are, but also by working on them yourself. You don't have to be the best athlete out there. We actually had a whole conversation in that most recent cohort about how sometimes the best athletes do not make the best coaches because they can just jump up and do the thing. They don't really understand how to break down those component pieces. They're like, yeah, you just do it like this. So sometimes it can make you an even better coach if you don't know how to do the movement or you're not proficient in it, but you've taken the time to kind of break that down and work on it in and of yourself. Put the time in to work through it yourself and that's going to help you troubleshoot what you're going to be eventually teaching. You want to get to know the things your patient's wanting to do, understand them well, and then understand how to break that down to the key points of performance. If that is in the fitness realm or realistically the functional movement realm, we really encourage you guys to hop into our CMFA courses to learn what those points of performance are with a physical therapist kind of scope on them or hop into a CrossFit level one course or take a CrossFit specialty course. If you know you want to hone in on your gymnastics coaching specifically or maybe your weightlifting specifically, there's specialty courses that break that down seeking out the knowledge along the way, but that doesn't have to be a barrier to getting into the thing. You can start it. You can learn it. We want to make sure that we understand the component pieces, but you don't have to be able to be a master of it on your own physically in order to be able to teach it. We're going to head into lesson two. This is my favorite lesson. Be unashamedly enthusiastic in celebrating your patient's victories. Within the very first few minutes of the first episode of Ted Lasso, there is a video of Ted dancing in the locker room with a college football team that he led to victory in his first year of coaching after they won the division two national title. This is what Ted is known for before he becomes the coach for AFC Richmond and moves to London. This is his reputation. If that's not what I hope every single one of us is doing in clinic when our patients tell us some positive progress, I don't know what it is. Maybe we're not busting out fully into a dance, but we need to be enthusiastically celebrating the wins with our patients. Vision this. You have a patient named Sally. She's coming in to see you. You're chatting with her. You're catching up on your asterisk signs. You ask her how things have been since the last visit, asking how her leakage has been because that was her worst symptom at your first visit. She tells you, like, yeah, things are okay, I guess. I'm still leaking when I work out though. So naturally, you follow this up by asking her more details. What was the workout? What movements were in the workout? When did the leakage happen within that workout? She tells you it was in her third round of a METCON that had 200 meters running and 50 double unders. And you're looking at her chart and you're scrolling through and you look at her last asterisk sign and you see that previously she was leaking at 10 double unders, but she just made it all the way to the third round of a workout that had running and double unders in it. You're going to freak out, maybe not freak out, but you're going to tell her, girl, that is amazing. You're doing fantastic. Look at all of this volume that you just did. We used to be here and this was our buoy. And now your buoys all the way up here. What we're doing is increasing your functional capacity. It's increasing the amount of work that you can do before your symptoms kick on. And that is fantastic. You are crushing it. That is what we want to be doing. We want to be celebrating our patients. Another example, maybe you have Lucy on your schedule and Lucy used to have three out of 10 pain with her sit to stands every single time when she was getting off the couch with her newborn. And the other day she sent you a text message because she back squatted 70% of her one rep max pain free at three months postpartum. And she wants you to know maybe you're not seeing her in the clinic. Maybe she's just excited to tell you in between sessions. We are going to respond to that text message with all of the party emojis. We're going to tell her great job. You are crushing it. You are doing so awesome. We want to pump her up and make sure that she knows that she is doing fantastic. We can take this concept and we can apply it across so many different realms in the physical therapy world, not just in the pelvic space. Our job is to guide our patients. Our job, particularly in the PT 2.0 realm, is to load our patients and make them stronger and more resilient humans. And dang it, our job is to celebrate with them when they are crushing it. And if they are struggling to find those victories, our job is to help point them out and again, celebrate all of these victories with them. This leads us into our third lesson of the day. Our final lesson of the day from Ted Lasso is to not be afraid to pivot. If plan A isn't working, plan B is there. This is another topic we talk about a lot in the pelvic space because there's kind of a dichotomy between high tone versus low tone and how you address the presentation. This is another topic that does come up a lot in our online cohort. We typically ask students, like, if you're new to pelvic, what are you worried about or what is a barrier? What kind of things are you nervous about with getting into this space? And a lot of times people say that they're nervous about doing the wrong thing or giving the patients the wrong exercises. So for example, if there's somebody that the therapist sees and they're like, we're going to do down regulation and really work on calming that tone down and you see the patient the next time and nothing has changed, it's okay to pivot. It's okay to say, okay, great, we tried to downtrain, we did that and that was fantastic, but that wasn't really exactly what landed for us. So now we're going to switch gears and we're going to focus on loading. The downtraining stuff is okay and we can still continue it, but now I want to see what happens when we introduce some load to the system. As PTs, our job is to test, treat and retest within session is great, but also between sessions, right? So if we give a patient intervention and they take that home, they work on it for homework and it doesn't quite do exactly what we were hoping, it's okay to change gears and do something different at your next session. It doesn't make you a bad therapist, it makes you somebody who is consistently creating hypotheses, testing them, retesting them and pivoting for the best interest of your patient. So there we have it, lessons from Ted Lasso. I hope you guys enjoyed this topic. If you haven't watched Ted Lasso, I highly recommend adding it to your list. If you have watched Ted Lasso, feel free to drop a comment of your favorite Ted Lasso in the comments below and you guys get out there and crush your Monday. Bye!  14:16 OUTRO Hey, thanks for tuning in to the PT on Ice Daily Show. If you enjoyed this content, head on over to iTunes and leave us a review and be sure to check us out on Facebook and Instagram at the Institute of Clinical Excellence. If you're interested in getting plugged into more ice content on a weekly basis while earning Check out our virtual Ice Online Mentorship Program at PTOnIce.com. While you're there, sign up for our Hump Day Hustling Newsletter for a free email every Wednesday morning with our top 5 research articles and social media posts that we think are worth reading. Head over to PTOnIce.com and scroll to the bottom of the page to sign up.

In this episode, Dillon sits down with Dr. Alexis Morgan and Dr. Christina Prevett to discuss strategies to return back to the gym postpartum. We look to answer questions: What is pelvic organ prolapse? Can you exercise with pelvic organ prolapse? How do you overcome the fear of lifting heavy after delivery? What should you do about leakage or urinary incontinence postpartum? All of this and more are answered in this episode. Hope you enjoy! -Team [P]Rehab The [P]rehab Membership: Trial 7-days for Free! Guest Bio: Dr. Christina Prevett MScPT, PhD (c)  teaches five courses at the Institute of Clinical Excellence, including Clinical Management of the Fitness Athlete: Pregnancy and Postpartum. She speaks internationally on topics such as Lifting in Pregnancy and Postpartum and Pelvic Health for the Female Athlete. Christina is a national-level weightlifter, who competed in powerlifting and Olympic weightlifting meets within 6 months of giving birth to her daughter Mya. Dr. Alexis Morgan, PT, DPT is a women's health physical therapist, internally trained pelvic floor clinician, and CrossFit-L1 trainer located in Hendersonville, TN. She specializes in treating pregnant and postpartum athletes. This is the ultimate anti-barrier solution to keeping your body healthy. Access state-of-the-art physical therapy, fitness programs, and workouts online in the comforts of your own home or gym. Follow [P]rehab: Website Instagram LinkedIn Twitter Facebook TikTok [P]Rehabbers thank you for listening and let us know what to talk about next. We hope to help you take control of your health through education! Did you enjoy this? Please rate, review, share, and subscribe. Every bit of feedback, comments, subscriptions, and sharing helps others to discover this content and find available solutions! 

How do we handle difficult conversations when opinions differ? It's been clear for a while that Idaho, and the rest of the United States, have struggled to come to the table on divisive topics. Whether it's in political debates, or around the kitchen table. In this episode, we talk with local Alexis Morgan, an Organizational Culture Consultant about this disconnect. Alexis and Shane come with their extensive backgrounds in Organizational Development and Natalie with 15 years of working in social media. We pull many ideas from the book “Crucial Conversations” Tools for Talking When Stakes Are High. Dropping just in time for your Thanksgiving dinner conversations.

In this episode, Dillon sits down with Dr. Alexis Morgan and Dr. Christina Prevett to discuss exercise and pregnancy. We look to answer: How can women best Prehab their body to get ready for pregnancy physically? What is relative energy deficiency syndrome? How can women best take care of their mental health during pregnancy? Is it safe to exercise while pregnant? What modifications if any need to be changed? All of this and more are answered in this episode. Hope you enjoy! -Team [P]Rehab The [P]rehab Membership: Trial 7-days for Free! Guest Bio: Dr. Christina Prevett MScPT, PhD (c)  teaches five courses at the Institute of Clinical Excellence, including Clinical Management of the Fitness Athlete: Pregnancy and Postpartum. She speaks internationally on topics such as Lifting in Pregnancy and Postpartum and Pelvic Health for the Female Athlete. Christina is a national-level weightlifter, who competed in powerlifting and Olympic weightlifting meets within 6 months of giving birth to her daughter Mya. Dr. Alexis Morgan, PT, DPT is a women's health physical therapist, internally trained pelvic floor clinician, and CrossFit-L1 trainer located in Hendersonville, TN. She specializes in treating pregnant and postpartum athletes. This is the ultimate anti-barrier solution to keeping your body healthy. Access state-of-the-art physical therapy, fitness programs, and workouts online in the comforts of your own home or gym. Follow [P]rehab: Website Instagram LinkedIn Twitter Facebook TikTok [P]Rehabbers thank you for listening and let us know what to talk about next. We hope to help you take control of your health through education! Did you enjoy this? Please rate, review, share, and subscribe. Every bit of feedback, comments, subscriptions, and sharing helps others to discover this content and find available solutions! 

Do you even lift?Yeah, & I can help you too!I had the pleasure of catching up with the dynamic duo of PT's @alexismorganpt & @christina_prevettBoth are physios who work with postpartum women & female athletes. Both women are barbell athletes themselves. Christina helps female athletes maximize fitness potential with online programming for pregnant & postpartum CrossFitters & weightlifters via @thebarbellmamas & Alexis practices within @onwardtnptThese postpartum education rockstars also teach other rehab pros to do the same via @icephysio courses. Christina & Alexis are leading the charge to teach and inform moms & pros alike, that women can come back to the barbell postpartum & be even stronger! We talk about using the research to inform our practice instead of letting the research limit what we do, and why the line is so fine. We dispel common myths and set the record straight on the what is really possible for female athletes postpartum!We talk about: 

This episode Morgan talks about her newest weight loss journey and her struggles with weight loss and trauma. Follow Morgan: @themorganalexis Follow the podcast: @uncutpodcast Facebook: Facebook.com/uncutpod Email: uncutpod@gmail.com This episodes video: https://youtu.be/h-KOoTCttCg

In this Come Home and Talk Series conversation, Alexis takes Kirsten through the part of a conversation where she can learn to observe is she feels safe or not. Knowing if you feel safe in the conversation means...do I feel comfortable being honest, why or why not? Does the other person feel safe to share? This skill is called Learning to Look. It's one that often overlooked, but it's ESSENTIAL if you want to learn HOW to have hard conversations. (And from our experience, life is learning about HOW to have conversations---the easy, the hard, and all parts inbetween). Learning to notice body cues, emotions, physical responses in ourselves is a key part in determining HOW to proceed when we've entered a hard conversation. The other part of this process is learning to understand the other person's behavior. What does it mean when my teen goes silent?  What does it mean when my co-worker starts trying to control the conversation or collaboration experience? How do I proceed when my spouse is clearly upset? What can I say to help? We hop you come join the conversation. AND...we have some amazing upcoming events. Go to our private FB group to sign up for them. Fun fact--nearly ALL events are free. Find Sharing Her Journey at: sharingherjourney.com Instagram Facebook _______________________________________ Alexis Morgan is a communication consultant focusing on individuals and organizations. She helps both work through communication patterns and issues, leadership development needs, and creating couragous cultures. Find her at: Alexis on Instagram. (send her a DM) Alexis on Facebook website coming soon: www.thealexismorgan.com

Dr. Alexis Morgan joins Niki to discuss Pelvic Floor training in our fourth episode in the "Focus on Female" series...

Come Home & Talk Series featuring Alexis Have you ever walked away from a conversation and thought, what happened? Or maybe you thought, I nailed that. I got exactly what I wanted. Either way, chances are you utilized a method during that conversation that did not help your overall goal. In this conversation, Alexis and Kirsten dive into strategies/maneuvers/moves/methods that people employ on a regular basis because they think it will get them what they want, but it's actually not serving them at all.  We invite you to come and listen, get honest in your reflection, and then...grow. Send us a message and let's continue the conversation. Let us know what you think about the episode. What did you find helpful? We invite you to leave us a review on your podcast platform. For more communication insights find Alexis Morgan on Instagram Follow Sharing Her Journey ______________________________________ Below are two resources referenced during the episode. Terry Real's Book: The New Rules of Marriage: What you need to know to make marriage work. Dr. Jennifer Finlayson-Fife: www.finlayson-fife.com    

Welcome to the first episode of our new series called "Come Home & Talk". We explain in more detail what this is all about in this episode. We are very excited to be sharing more of our very own personal "specific skill set" with you all! Don't all women need better communication skills and home design tips?! YES, please. We jump right in with Alexis talking about the power of the word YET. When you find yourself in a situation where you don't know how to do something, or you haven't accomplished what you desire…it's: I don't know how to do that YET. I haven't accomplished that YET. It is possible. You can get there! Remember some things take time to learn and are worth waiting and working towards. The word YET makes something achievable. It puts the you back in the driver seat of your life. Alexis shares some personal examples where she has applied this concept. It is so helpful to start expanding our thinking. She helps us think about how to change our thinking from can't to can. This concept can sometimes be hard for adults set in their ways **Challenge this week to add the word 'yet' and see how it deeply impacts your life! You can find more of Alexis on social media: @realtalk.alexis

Sharing Her Journey is so excited to introduce to you our new co-host...Alexis Morgan! In this episode Kirsten talks about how she met Alexis and knew she was an amazing fit for the podcast. We cannot wait for you to get to know her better in her very first episode. Alexis is an all around wonderful woman who is passionate about all that she does. She enjoys volunteering in the community and writing articles for websites. She is fun, playful, kind, and very smart. Alexis recently completed a master's in Adult/Organizational Learning and Leadership from the University of Idaho. She is also a communication and personal development coach. Her husband, Clinton, and their four children enjoy spending time outdoors, traveling, and cooking and eating delicious food...especially during the holidays.  For more Alexis follow her on instagram at @alexismorganjourney

If anyone had a reason to give up, it was Ty and Alexis Morgan. First, their seemingly normal pregnancy went very wrong at 18 weeks when their son was diagnosed in utero with a fatal condition for which there were two options: abortion or carry to term with stillbirth. Yet before even knowing the actual diagnosis their answer was on the way. Then, in the midst of this, Ty made the decision to leave his well-paying job and start his own company. With all of this happening at once, it would have been easy to just lay down and give up. But Ty and his wife didn't give up and God miraculously met their needs every step of the way. Meet Ty: https://www.realfaithstories.com/guests/tymorgan Ty's Website: https://infiniteplanning.org/ Find Out More About The Real Faith Stories Podcast: http://www.RealFaithStories.com Meet The Host Of Real Faith Stories: http://www.BrianRobinson.co Special Guest: Ty Morgan.

This episode of Cozy Ink Podcast features an interview with cozy mystery author Alexis Morgan. We discuss her Abby McCree Mystery series.For more information and links to Alexis Morgan's books and social media accounts, click here.Support the show (https://paypal.me/cozyinkpodcast?locale.x=en_US)

Our medical panel breaks down exactly what COVID-19 is and answers your questions from social media. Panelists include Alexis Morgan, MSW, LSW, social worker and therapist; Kimberly Powell, RN, JD and military veteran; and Joshua Scantland, MD, Physician, Vascular and Interventional Radiology Resident, Medical Officer in Indiana Medical Detachment of the Indiana Army Reserve National Guard.

Listen to ICE faculty members Mitch Babcock, Alexis Morgan, Dustin Jones, Zac Morgan, and Alan Fredendall discuss CrossFit Open Workout 20.5!

On today’s show: 1. We're all having a tough time in Vegas and it doesn't matter what we play (1:00). 2. Grizzlies Head Coach Taylor Jenkins joins the show to talk about his Summer League squad, Jonas Valanciunas, the front office moves, Tyus Jones and more (19:05). 3. Sports Illustrated's and DAZN's Chris Mannix joins the show to talk about Anthony Joshua, Deontay Wilder, Andy Ruiz, the future of boxing, upcoming fights worth watching, Jayson Tatum's potential, Kyrie's departure, Kemba's arrival and more (39:40). 4. Alexis Morgan joins the show to chop it up on working with NBA2K, talk some entertainment, listen to some music, and the return of Vegan Corner (1:16:55).- Watch LIVE at Noon, Weekdays on the Grizzlies App: bit.ly/MemGrizzApp - Watch today's full show at: youtube.com/grindcitymedia

On today's show: Y'all Know What Time It Is? Dame Time Edition! Damian Lillard's shot heard round the world and 2nd round matchups (7:00). NFL Draft, who will go #1, who's trading up and who's trading back? (42:29) Alexis Morgan joins the show in-studio for her final appearance as a member of the Grind City Media team. It's her last Vegan Corner and Entertainment Report. Find out where she's going. (57:20) - Watch LIVE at Noon, Weekdays on the Grizzlies App: bit.ly/MemGrizzApp - Watch today's full show at: https://youtu.be/YGbAU3qbNjE

On today’s show: 1. Ish Smith owns the Grizz (2:30) 2. Antwaan Jones transferring from Memphis (21:05) 3. Wade and Dirk have their last games in Miami and Dallas and Magic Johnson quits on the Lakers (25:20) 4. Some news involving Brooks Koepka and The Masters (33:50) 5. Grizzlies Game Day Live Presented by Uber (41:58) 6. Alexis Morgan joins in-studio for Vegan Corner and our Entertainment Report (51:10)- Watch LIVE at Noon, Weekdays on the Grizzlies App: bit.ly/MemGrizzApp - Watch today's full show at: https://youtu.be/G8prMNv-ebI

On today’s show: 1. Hustle clinch a playoff spot (3:00) 2. First 4 (11:50) 3. Memphis beats San Diego but game ops is lacking (14:15) 4. College Basketball Wiseguy Alan Boston joins the show to talk about Thursday's NCAA Tournament Games (19:15) 5. Alexis Morgan joins the show in-studio for Vegan Corner and our Entertainment Report (54:08) 6. Grizzlies Game Day Live Presented by Uber (1:42:24)- Watch LIVE at Noon, Weekdays on the Grizzlies App: bit.ly/MemGrizzApp - Watch today's full show at: https://youtu.be/683oyI0D06Y

On today's show: Mike Norvell speaks before the Tigers open spring practice plus the draft prospects of Darrell Henderson and Tony Pollard (7:30), Conference Tournaments and a team Verno thinks can pull a 1st round upset (15:50), plus Odell Beckham, Le'Veon Bell, Earl Thomas and Mark Ingram all have new teams (28:00). Alexis Morgan joins the show in-studio for Vegan Corner and our Entertainment Report (46:25).- Watch LIVE at Noon on Monday on the Grizzlies App: bit.ly/MemGrizzApp - Watch today's full show at: https://youtu.be/quVtZ_pzXEs

On today's show: Mike Conley drops a career-high 40, Delon Wright drops a career-high 25 and the Grizzlies beat the Blazers (5:00). Can you name the guys in Grizzlies franchise history (VAN/MEM) that have scored 40pts in a game? (39:48). News of the day featuring Antonio Brown and the NFL Draft (52:40). Alexis Morgan joins the show in-studio to talk about what she's doing with NBA 2KTV and we'll have Vegan Corner and our Entertainment Report (1:10:00).- Watch LIVE at Noon on Monday on the Grizzlies App: bit.ly/MemGrizzApp - Watch today's full show at: https://youtu.be/crSHEyEp-ns

On today's show: Grizz lose to the Spurs, Avery Bradley's performance, Jonas debut, and referees (2:00). Lakers struggles, Joe Flacco to the Broncos, NFL Draft notes, Duke's comeback win over Louisville, LSU beats Kentucky at the buzzer and the Tigers at ECU (38:00). Alexis Morgan joins the show in-studio for our Entertainment Report and Roser cooked for this week's edition of Vegan Corner (51:20).- Watch LIVE at noon on the Grizzlies App: bit.ly/MemGrizzApp - Miss the Livestream? Watch today's full show at: https://youtu.be/e_1tFlFehEM

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On today's show: Grizzlies win last night, Marc Gasol gets a big ovation from the crowd, Mike Conley, JJJ, Ivan Rabb and Justin Holiday rise to the occasion, and trade rumors (8:35). A Memphis legend passed away yesterday (47:25) and Alexis Morgan joins the show in-studio for Vegan Corner and our Entertainment Report (55:15).- Watch LIVE at noon on the Grizzlies App: bit.ly/MemGrizzApp - Miss the Livestream? Watch today's full show at: https://youtu.be/1CTIc4w88TI

On today's show: Tony Allen joins the show at the top! Recap of KG/TA (7:05) TA gives his thoughts on the Marc/Mike trade rumors (11:20) Tony Allen on Chandler Parsons (15:55) How TA dealt with trade rumors (17:40) TA on how Mike/Marc feel (19:20) TA tells a Lance Stephenson story (35:05) 3 worst card players (28:05) TA breaks down the remaining Grizz schedule before all-star break (45:00) Alexis Morgan joins for Vegan Corner alongside Tony Allen (57:40). - Watch LIVE at noon on the Grizzlies App: bit.ly/MemGrizzApp - Miss the Livestream? Watch today's full show at: https://youtube.com/grindcitymedia

On today's show: Chris addresses the Woj report that the Grizzlies are looking into trading Mike Conley and Marc Gasol. Where does the team go from here? Who is to blame? (2:30). Chris also touches on the Shams report that the Grizzlies have talked to the Atlanta Hawks about a potential Chandler Parsons deal (37:05). Grizzlies Game Day Live Presented by Uber (45:43) and Alexis Morgan joins the show in-studio for Vegan Corner and our Entertainment Report (57:20). - Watch LIVE at noon on the Grizzlies App: bit.ly/MemGrizzApp - Miss the Livestream? Watch today's full show at: https://youtu.be/v1t84IhmoEg

On today's show: Giannis and his growing popularity (3:00), Hustle lose (25:00), Ole Miss falls to LSU and Tennessee destroys Arkansas (28:00), Warriors score 51pts in the first quarter (34:11), Penny Hardaway was on GET UP! and Tiger Woods is playing next week at Torrey Pines (38:40). Grizzlies Game Day Live Presented by Uber (41:19) and Alexis Morgan joins the show in-studio for Vegan Corner and our Entertainment Report (49:40). - Watch LIVE at noon on the Grizzlies App: bit.ly/MemGrizzApp - Miss the Livestream? Watch today's full show at: https://youtu.be/mIxCsKgv-b0

On today's show: Dillon Brooks received some bad news (13:11), Grizzlies Game Day Live Presented by Uber (36:30) and Alexis Morgan joins the show in-studio for Vegan Corner and our Entertainment Report (39:15). - Watch LIVE at noon on the Grizzlies App: bit.ly/MemGrizzApp - Miss the Livestream? Watch today's full show at: https://youtube.com/grindcitymedia

On today's show: Bevo vs UGA (3:00), Grizz weekend, James Harden got fouled again, Chandler Parsons (11:45), Bowl Games and NFL Playoffs (30:15), Game Day Live Presented by Uber (42:30) and Alexis Morgan joins in-studio with our Entertainment Report (50:58). Watch LIVE at noon on the Grizzlies App: bit.ly/MemGrizzApp Miss the Livestream? Watch today's full show at: https://youtube.com/grindcitymedia

On today's show: Christmas gifts, stories from the holidays and how the Grizzlies fared (4:00). Grizzlies Game Day Live Presented by Uber (40:53). Alexis Morgan joins in-studio for our Entertainment Report (44:27) Watch LIVE at noon on the Grizzlies App: bit.ly/MemGrizzApp Miss the Livestream? Watch today's full show at: https://youtu.be/3ROY9lcAv-Y

On today's show: Chris watched a Christmas movie and played his son in NBA2K (4:00), Austin Rivers (10:39), Penny Hardaway vs Rick Barnes (22:57), NFL Pro Bowl and Mock Draft (40:00), and LeBron James wants Anthony Davis on the Lakers (44:00). Alexis Morgan joins the show in-studio for Vegan Corner and our Entertainment Report. Ed Cabigao, owner of South of Beale, Zaka Bowl and Interim, joins in-studio for Vegan Corner (51:50). Watch LIVE at noon on the Grizzlies App: http://bit.ly/MemGrizzApp Miss the Livestream? Watch full length shows at: https://youtube.com/grindcitymedia

On today's show: Mike Tyson vs Buster Douglas 30 For 30 (3:50), Blazers/Rockets and Marc Gasol's ankle (11:07), 8 Team Playoff Coming? (25:48). Are the Phoenix Suns moving (32:49)? Grizzlies Game Day Live Presented by Uber (40:56). Alexis Morgan joins us for Vegan Corner (48:50) and our Entertainment Report (1:15:15). Miss the Livestream? Watch full shows at: https://youtube.com/grindcitymedia

On today's show: Chris returned to play his son in Madden (6:55), Tigers got an impressive win over SDSU (15:40), DeAndre Ayton basically admitted he stopped trying last night and Markelle Fultz's shoulder "injury" has us rolling our eyes (28:16). Grizzlies Game Day Live Presented by Uber (44:12). Alexis Morgan returns with Vegan Corner and our Entertainment Report (53:52). Miss the Livestream? Watch today's full show at: https://youtu.be/HzIeJMMoDBc

On today's show: Verno recaps last night's Grizz/Raptors match-up. Kawhi Leonard has a new shoe deal (30:05) AAF notable coaches (40:02) Alexis Morgan joins for Vegan Corner & entertainment (45:35). Miss the Livestream? Watch today's full show at: https://youtu.be/0ETu1mk9_xw

On today's show: Grizz vs Spurs and the weekend ahead in sports (3:00). Alexis Morgan joins the show in-studio for Vegan Corner and our Entertainment Report....and she brings along a special guest this week....her mom!!! (48:09) Miss the Livestream? Watch today's full show at: https://youtu.be/BJ7-orqtcWU

On today's show: Penny's Tigers played hard but fell short against LSU (3:30), Verno's son, William, lost his glasses on Walnut Grove (23:17), and Grizzlies/Bucks (35:17). Alexis Morgan joins the show in-studio and brings along Chef Ryan Trimm from Sweet Grass, 117 Prime, and Sunrise for Vegan Corner (46:10). Miss the Livestream? Watch today's full show at: https://youtu.be/jhILIGOQSV8

On today's show: Election Night, Zion Williamson, Penny's regular season debut, Devin's failure last night, and Dez signs with the Saints (3:30). Chris and Roser bring you Grizzlies Game Day Live Presented by Uber (38:51) and Alexis Morgan joins the show in-studio for Vegan Corner and our Entertainment Report (48:25). Miss the Livestream? Watch today's full show at: https://youtu.be/dtV_lYzNZrM

On today's show: John Wall and Bradley Beal's relationship, Shelvin Mack/Mike Conley playing together and more on the Grizzlies win over the Wizards (5:00). Memphis Hustle G Dusty Hannah's joins the show in-studio to talk about the upcoming season, his dad, playing at Arkansas and more (29:32). Alexis Morgan joins the show in-studio and Dusty Hannahs sticks around for Vegan Corner (1:01:04). Miss the Livestream? Watch today's full show at: https://youtu.be/u-_P5O_5KdQ

On today's track: World Series, Pistons/Sixers and Blake Griffin's monster game, Kings/Nuggets (4:00), Devin Walker burned a waffle (15:30), Chandler Parsons knee (26:49). Alexis Morgan joins the show in-studio for Vegan Corner and our Entertainment Report (52:15). Miss the Livestream? Watch today's full length episode at: https://youtu.be/F_O_09JvbbQ

On today's show: Grizzlies Season Opener (2:50). Chris has 10 Things about this Grizzlies season (23:12). Alexis Morgan joins the show for Vegan Corner (52:45) and then she'll have our entertainment segment (1:16:00). Miss the Livestream? Watch today's full episode at: https://youtu.be/ofYJMWH6uco

On today's show: Hurricane Michael (3:00), Yankees/Red Sox (7:00), Bucks/Thunder (19:20) and then ESPN.com's Bill Barnwell joins to talk NFL including the leagues offensive explosion, the success of Jared Goff and Patrick Mahomes, why Dez Bryant doesn't have a job, and the NFC North (26:30). Alexis Morgan joins the show in-studio next for Vegan Corner and our Entertainment Segment. Miss the Livestream? Watch the full episode on YouTube at: https://youtu.be/BpuEr4L647M?t=166

On today's show: Grizz vs Rockets (6:26), our thoughts on each Grizzlies player after one preseason game (12:24), Verno's first Top Golf experience (33:36), Roser's ridiculous gas station purchase (35:28). Alexis Morgan joins in-studio for Vegan Corner (50:06) and to talk about the NBA.com GM Survey (1:12:26) and she gives us our Entertainment Report (1:19:58). Miss the Livestream? Watch full show now on YouTube at: https://youtu.be/qemhTf6tcrc

On today's show: Is SPORTSBYBROOKS back? (3:45), Roser's morning from hell (10:00), Verno's night from hell watching the Cardinals (19:45), Chandler Parsons is an author (22:08), Jimmy Butler possibly going to Miami (34:09), and Kelly Bryant is transferring from Clemson (38:30). Alexis Morgan joins us in-studio for Vegan Corner and our Entertainment Report (45:23). Miss the Livestream? Watch today's show on YouTube at: http://bit.ly/2NWeEdD

On today's show: Grizz Training Camp starting soon and the building of the roster, Josh Gordon and teams holding players accountable (10:30). Alexis Morgan joins the show in-studio and brings Don Gaines (IG: @thatvegandude) from Fuel Cafe with her for Vegan Corner (45:00). After that, we'll have the rest of our entertainment report on Maroon 5, Jimmy Butler and more (1:31:22).

On today's show: Chris has some notes on Tiger Basketball (5:30). Spencer Hall from EDSBS and SB Nation joins the show to talk about Dan Mullen, Auburn/LSU, TCU/Ohio State, Alabama/Ole Miss, and who in the SEC East matches up the best with Georgia (27:43). Alexis Morgan joins the show in-studio for Vegan Corner and our Entertainment Report (48:30).

On today's show: Devin has an update on Memphis WR Sam Craft (4:00), Chris talks WNBA Playoffs and the final episode of HBO's Hard Knocks (7:50). Memphis Hustle Head Coach Brad Jones joins the show in-studio to talk about how he got into coaching, got out of coaching and returned, life in the G-League, and how he got the Hustle job (22:24). Alexis Morgan joins the show in-studio next for Vegan Corner and our Entertainment Report (57:09).

On today's show: Updates on the new Tiger Football indoor practice facility and new locker rooms at the Liberty Bowl (3:40), Grizzlies waive Kobi Simmons (6:00), USL/Tiger Football attendance (12:03), Hard Knocks (18:30), and reactions to LeBron's new show on HBO (26:10). Alexis Morgan joins the show in-studio and she has The Vegan Mom with her for this week's Vegan Corner. This one does not disappoint (58:00). Alexis has our entertainment report after (1:43:55).

On today's show: Hustle have a new coach (5:00), White wide receivers (18:00), HBO Hard Knocks including Bob Wylie hating stretching (23:00), and Penny Hardaway announces a date for Memphis Madness (30:44). Restaurant Iris reopens tonight and Kelly English joins the show in-studio with Alexis Morgan for a special edition of Vegan Corner (40:40). Alexis stays and has our Entertainment Report on Lamar Odom, Post Malone and Nicki Minaj (1:17:08).

On today's show: Devin gives us a report from this morning's Tiger Football practice (8:00), Chris and Roser are loving HBO's Hard Knocks (27:11), Puppy update (39:06), and Roser has a stat that will make you feel good about the upcoming season (49:00). Alexis Morgan joins the show in-studio for Vegan Corner where the guys will try quinoa burgers, gouda mac and cheese, and pan seared cauliflower. Alexis also has a few entertainment stories and the top 5 songs and movies in the world (50:38).

On today's show: Grizzlies Assistant Chad Forcier joins the show in-studio to discuss how he got to Memphis (2:20), interning with the Seattle Sonics (4:30), coaching high school basketball (11:50), coaching under Rick Carlisle and Gregg Popovich (17:45), why coaching with the Spurs is different from every other organization (20:22), coaching Kawhi Leonard (26:00), the Grizzlies roster (29:13), Jaren Jackson Jr (29:52), and Kyle Anderson (30:10). Alexis Morgan then joins the show in-studio for Vegan Corner and the Entertainment Report (40:47).

On today's show: Everything in the Vernon household is fixed (6:47), the Cardinals make Chris miserable (14:20), Netflix's business model (19:10), sports gambling opens in Mississippi and the NBA's partnership with MGM Resorts (21:08). Alexis Morgan joins the show in-studio for Vegan Corner, Entertainment news on Faith Evans, Kim Kardashian and more. Then, we'll have the Top 5 songs and Top 5 movies in the world (46:12).

On today's show: Grizzlies VP of Basketball Ops John Hollinger joins the show in-studio to talk about Jaren Jackson Jr., Jevon Carter, Yuta Watanabe's 2-way deal, signing Kyle Anderson, trading for Garrett Temple, Omri Casspi's deal, trading Jarell Martin and more (2:20). Alexis Morgan then joins in-studio for Vegan Corner (Hollinger sticks around for this) and our entertainment segment (57:00).

Alexis Morgan discusses her career path from hedge funds to NBA digital, building a personal brand, and what's next for NBA Twitter. Meanwhile, Shahbaz and Amara discuss IG TV, PUMA sponsorships, The NBA Draft, & more.

Alexis Morgan discusses her career path from hedge funds to NBA digital, building a personal brand, and what's next for NBA Twitter. Meanwhile, Shahbaz and Amara discuss IG TV, PUMA sponsorships, The NBA Draft, & more.

On today's show: Chris talks about his conversation with Tony Allen last night (8:00). Next, The Ringer's Jonathan Tjarks joins the show to talk about about the NBA Draft including Trevon Duval, Luka Doncic, Michael Porter Jr., Miles Bridges, Trae Young, and Donte DiVincenzo (12:20). Grind City Media's Mike Wallace also joins the show from Cleveland to talk about Game 3 of the NBA Finals and Michael Porter Jr's workout on Friday for NBA teams (43:00). Alexis Morgan is then in-studio for Vegan Corner and to talk about the Pusha T/Drake beef (1:03:00).

EPISODE 119 ON JERRY ROYCE LIVE!BOOK - What He Wanted - 5 STARS (AMAZON) REVIEWER - 5.0 out of 5 stars Love! Love! Love This Book!, July 9, 2014. This book was an amazing read. It captivated me from the beginning and I was all in. Sean was a sick and crazy human being. Stalking is definitely something you take seriously. Will be reading more from this author!ABOUT BOOK - After her father is murdered, Alexis Morgan is slowly starting to piece her life back together. She eventually returns to what has always brought her joy―dancing. But before she can get too comfortable, the cat and mouse games begin, all over again.Sean Edwards had waited a long time to make Alexis his wife, and now he feels the timing is perfect. Although a married man, Alexis has always been the apple of his eye. That’s why he refuses to allow anyone to stand in between their union, including his wife, her boyfriend, and the police.Will Alexis finally find the courage to stop running and fight for her life, or will she die at the hands of her stalker? BiographyEntwining old school romance and erotica, Nicola Motley (Jada Pearl) is set to bring you a stand out reading experience from the normal approach on contemporary fiction. Born and raised in Detroit, Michigan, Jada Pearl started writing when she was 13 years old. She always had a strong passion for stories. So much so that she began working in the Detroit Public Library and soaked in all the books she read. Her love for writing was reinforced when her job hosted a Romantic Readers of Michigan meeting. Being around other authors and learning how they developed their craft, Jada knew there was nothing more that she wanted to do. She wanted to make sure that everyone who read her stories were able to put themselves in the place of the main character.When she isn't penning, Jada Peal spends her time with family and friends, setting up workshops for the community to learn computer skills and working as a Payroll Specialist for a nonprofit. She currently resides in Southfield, MI with her sons.

EPISODE 119 ON JERRY ROYCE LIVE!BOOK - What He Wanted - 5 STARS (AMAZON) REVIEWER - 5.0 out of 5 stars Love! Love! Love This Book!, July 9, 2014. This book was an amazing read. It captivated me from the beginning and I was all in. Sean was a sick and crazy human being. Stalking is definitely something you take seriously. Will be reading more from this author!ABOUT BOOK - After her father is murdered, Alexis Morgan is slowly starting to piece her life back together. She eventually returns to what has always brought her joy―dancing. But before she can get too comfortable, the cat and mouse games begin, all over again.Sean Edwards had waited a long time to make Alexis his wife, and now he feels the timing is perfect. Although a married man, Alexis has always been the apple of his eye. That’s why he refuses to allow anyone to stand in between their union, including his wife, her boyfriend, and the police.Will Alexis finally find the courage to stop running and fight for her life, or will she die at the hands of her stalker? BiographyEntwining old school romance and erotica, Nicola Motley (Jada Pearl) is set to bring you a stand out reading experience from the normal approach on contemporary fiction. Born and raised in Detroit, Michigan, Jada Pearl started writing when she was 13 years old. She always had a strong passion for stories. So much so that she began working in the Detroit Public Library and soaked in all the books she read. Her love for writing was reinforced when her job hosted a Romantic Readers of Michigan meeting. Being around other authors and learning how they developed their craft, Jada knew there was nothing more that she wanted to do. She wanted to make sure that everyone who read her stories were able to put themselves in the place of the main character.When she isn't penning, Jada Peal spends her time with family and friends, setting up workshops for the community to learn computer skills and working as a Payroll Specialist for a nonprofit. She currently resides in Southfield, MI with her sons.

BOUND BY DARKNESS Caught between two worlds, a powerful warrior must choose between impossible destinies when he meets a woman whose love will either make or break him. . . . Originally from St. Louis, Alexis Morgan and her husband live in a small town near Seattle. An avid reader, she grew up reading gothic romances and westerns and developed a love for flawed heroes who hold to their own code of honor--whether fighting rustlers at gunpoint, or standing shoulder-to-shoulder with their fellow warriors, swords at the ready. Come talk with Alexis tonight & discuss the newest edition to her Paladins series. If you think it this series couldn't possibly get much hotter, you're wrong!

Alexis Morgan grew up near St. Louis and received a B.A. in English from the University of Missouri-St. Louis. She and her husband have made the Pacific Northwest their home for more than thirty years, where she launched her career as a writer. She is published in contemporary romance, American West historicals, and currently writes paranormal romances for Pocket Star and Silhouette Nocturne. Her book, Darkness Unknown, is a finalist in the RITA's, the top award in the romance genre. Adrian Phoenix a writer, a person, and a mother, I've always believed in following your dreams, following your heart. It's also important to keep your heart, so I also believe in being prepared for zombie attacks and can't stress enough the importance of having regular family drills so every member of the household is zombie-ready. One never knows.Make sure the sofa is ready to push in front of the door. be clear that if a member of the family is on the wrong side of the door when the zombie action goes down. They remain on the wrong side of the door. The greater good, etc. I live in Springfield, Oregon in a zombie-free home (except when meeting deadlines) with three cats, Amiga, Diabla, and Ember and have two sons and three grandchildren and two granddogs. I hope one day to write a masterpiece like my father's parody of Jaws, a work written on yellow legal paper entitled Beak, the story of a rogue twenty thousand pound Cornish game hen and the men who seek to end its deadly rampage. If i write anything half as funny (and this involved tears and gasping for air), I'll be happy.