Podcast appearances and mentions of Rachel Moore

Dr. Rachel Moore // www.ptonice.com  In today's episode of the PTonICE Podcast, ICE CEO Jeff Moore & Pelvic Division faculty member Rachel Moore engage in a candid conversation about the unique challenges and rewards of balancing motherhood with athletic pursuits. They explore how Rachel's experiences as a mom over the past five to six years have not only tested her resilience but also enhanced her performance in the gym. The discussion delves into the lessons learned from parenting, the obstacles faced, and how these experiences have shaped her as an athlete. Rachel shares insights that can inspire other parents navigating similar paths, emphasizing the strengths gained through the journey of motherhood. Tune in for an inspiring episode that highlights the intersection of parenting and athleticism. 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!

The HappyCast team takes on the Rabid Raccoon 100, an ultra in Pennsylvania that delivered relentless mud, unpredictable storms, and plenty of surprises. Stephanie Leake shares her emotional journey through the race, from navigating steep climbs and descents to finding strength in her crew and pacers. Ultimately conquering her fear of the mud with the help of trekking poles.Rachel Moore joins the conversation to break down her first-place finish and new course record, sharing insights into her pacing strategy, mental approach, and the moment she realized she had won. Jason Hanley and Kathleen Hanley played a huge role in keeping the runners going, with Kathleen stepping in as Stephanie's pacer and teaching her how to use trekking poles effectively in the deep mud. Jason, who was also crewing and pacing, kept a close eye on race standings and played a key role in confirming Rachel's frontrunner status before she crossed the finish line. Their crew experience, patience, and humor helped keep spirits high through long, wet, and grueling miles.From first-time pacers to seasoned runners, the team dives into the camaraderie and perseverance that make 100-milers so special. They reflect on the women's buy-one-get-one entry initiative that brought six Texas women to the event, the seamless crew logistics with an indoor start/finish area, and the small yet fierce competition that kept the field moving. They also discuss frogs, unexpected fan encounters, and the importance of community in the ultrarunning world. Whether you're a seasoned ultrarunner or just love hearing about extreme endurance feats, this episode is packed with inspiration, insights, and plenty of laughs!Be sure to subscribe to the podcast wherever you listen, and we always appreciate you leaving a good rate and review. Join the Facebook Group and follow us on Instagram and check out our website for the more episodes, posts and merchandise coming soon. Have a topic you'd like to hear discussed in depth, or a guest you'd like to nominate? Email us at info@happyendingstc.org

Welcome to another episode of "How I Met Your Data" with your hosts Sandy Estrada and Anjali Basal. Join us in this engaging conversation as we bid Sandy farewell on her new venture and welcome Rachel Moore Best, a renowned negotiation expert and lecturer at MIT. In this episode, Rachel shares her journey from music studies to becoming a negotiation specialist, emphasizing the significance of negotiation beyond the boardroom and into everyday life. Discover the power of negotiation in enhancing communication, collaboration, and influence within teams while navigating complex dynamics and decision-making. Perfect for data practitioners, engineers, or anyone interested in improving their negotiation skills, this episode is packed with insights and strategies that transcend typical negotiation boundaries.

Dr. Rachel Moore // #ICEPelvic // www.ptonice.com  In today's episode of the PT on ICE Daily Show, ICE Pelvic division faculty member Rachel Moore discusses the importance of scaling workouts for pregnant and postpartum women, as well as individuals with pelvic concerns. Rachel highlights a previous episode by Shae Sharbutt, which provided real-world case examples of scaling for different stages of motherhood. Rachel aims to demystify the stigma surrounding scaling workouts, emphasizing its relevance not just for the Open but for everyday classes and boot camps. Tune in for valuable insights on making fitness accessible and safe for all athletes, regardless of their stage in motherhood. 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. Rachel Moore // #ICEPelvic // www.ptonice.com  In today's episode of the PT on ICE Daily Show, ICE Pelvic faculty member Rachel Moore discusses the topic of planned cesarean deliveries, addressing the emotional and social challenges faced by women who choose this option. She shares a recent patient experience where the patient felt judged for opting for a cesarean, highlighting the complexity of birth and the importance of supporting individual choices. Rachel emphasizes the role of pelvic physical therapists in preparing and assisting patients for cesarean deliveries, aiming to create a supportive environment free from shame. The episode underscores the significance of understanding the diverse factors that influence delivery choices and promotes a compassionate approach to maternal care. 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. Rachel Moore // #ICEPelvic // www.ptonice.com  In today's episode of the PT on ICE Daily Show, ICE Pelvic faculty member Rachel Moore unpacks the stigma behind women strength training and gives tips on ways to boost excitement about strength training through education on the benefits and guidance on how to get started. 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! https://youtube.com/live/RoTF2fFW4aE

Rachel Moore // #ICEPelvic // www.ptonice.com  In today's episode of the PT on ICE Daily Show, ICE Pelvic faculty member Rachel Moore delves into a comprehensive and thoughtful gift guide specifically designed for pregnant individuals, postpartum mothers, and those experiencing pelvic pain. Rachel emphasizes the importance of selecting gifts that are not only practical but also considerate of the unique challenges and experiences faced by these individuals. 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. Rachel Moore // #ICEPelvic // www.ptonice.com  In today's episode of the PT on ICE Daily Show, ICE Pelvic lead faculty Rachel Moore delves into the topic of pain during labor, challenging the cultural tendency to avoid discomfort. Drawing inspiration from a thought-provoking Instagram post, she discusses how the discomfort experienced during pregnancy and birth prepares individuals for the challenges of motherhood. As a mother of two with experience in both medicated and unmedicated deliveries, Rachel shares her insights on embracing pain as an integral part of the birthing process. Tune in for a thoughtful exploration of the role of pain in labor and its significance in the journey of motherhood. 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!

Rachel Moore, battling a rough voice yet still bringing the energy, kicks off the Just Trust Me Marketing Podcast with co-hosts Elizabeth Allen and Anh Nguyen. They dive into how the ultimate FOMO marketing strategy was unwittingly (or probably wittingly) employed by Casa Bonita's revival, thanks to South Park creators Trey Parker and Matt Stone. Anh shares juicy secrets about Le Creuset's mystery box events, while Rachel reveals her hilarious yet relatable experience of being wooed by political texts. Anh rounds out the discussion with entertaining stories of being lured by the allure of TikTok shop ads and hot tub experiences. Tune in for a rollicking ride through marketing missteps and victories! Got a marketing topic you want us to tackle in a future episode? Email us at justtrustme@butwaittheresmoore.com.  Support the show to do all the trustworthy, marketing things along the way. https://www.justtrustme.butwaittheresmoore.com Show links: Casa Bonita documentary (NPR) Casa Bonita public reservations sell out within a few hours Le Creuset bakeware   00:00 Cold Open and Intro 06:13 Good Marketing? 27:53 How to Use FOMO in Marketing 41:48 We Got Got

Dr. Rachel Moore // #ICEPelvic // www.ptonice.com  In today's episode of the PT on ICE Daily Show, ICE Pelvic faculty member Rachel Moore unpacks a new way to conceptualize coning or doming in our pregnant and postpartum clients, and if we actually even care that it happens at all 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. Rachel Moore // #ICEPelvic // www.ptonice.com  In today's episode of the PT on ICE Daily Show, ICE Pelvic faculty member Rachel Moore breaks down how purity culture and pelvic floor dysfunction are linked, and ways we can empower and educate women to reduce dyspareunia 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 RACHEL MOOREGood morning, guys. What is up? Happy Monday morning. My name is Dr. Rachel Moore, and I'm hopping on this morning representing our pelvic crew to dive in and talk about a topic that's pretty near and dear to my heart in the area that I live in in Texas. We're going to be diving into purity culture and the pelvic floor. So if you're not familiar with what purity culture is, it is a set of beliefs that really focuses on promoting abstinence for sexual health and well-being and kind of involves a lot of feelings of shame or guilt or even fear focused around sexual functions and sex as a whole. So we know that sexuality in and of itself is biologic and it's instinctual. But there are a lot of overtones and a lot of components of sexuality and the development of sexuality that come from culture. Culturally embedded meanings are just kind of rampant in this space. And we see that one really large cultural component that can lead to issues with the pelvic floor, like dyspernia or vaginismus, is this topic of purity culture. We have studies that have looked at this in a lot of different countries. And what we see is that countries that really emphasize sexual purity hone in on and focus in on male sexual satisfaction over female cultures that emphasize like virgin brides and have a lot of societal contracts or context in place to eliminate or reduce premarital sexual relations have higher rates of vaginismus and dyspareunia. We know that societies that suppress female sexuality have higher rates of pelvic floor dysfunction that are associated with pain with intercourse. In order to understand all of this, we really need to understand purity culture in and of itself and understand kind of the component pieces and things that go into dyspareunia and vaginismus. So we already honed in on what purity culture is just a little bit. A lot of times purity culture is in theory linked with religiosity. And I see that in my area of Texas. I'm in a very conservative part of Texas and I've seen a lot of patients with vaginismus and with dyspareunia that were raised in a very religious household and have a lot of certain feelings and ideals and beliefs around sex and sexuality that are went kind of hand in hand with that is the common thought. However, we actually have a case study that looked at the link between religiosity and dyspareunia and vaginismus. And it was a 2020 case study that sent out a survey to 901 women. 19% of them had pain with intercourse. So dyspareunia or pain with intercourse And what they found is that religiosity was actually not linked with the presence of dyspareunia or vaginismus, whether it was current religiosity or previous religiosity, the way they were raised. But what they found is that the attitudes and connotations around sex and sexuality in and of itself is actually what was linked with that presence of pain with intercourse. So really kind of debunking this idea that religiosity and pain with penetration and intercourse go hand in hand. I think purity culture in and of itself gets linked a lot with the religiosity or that highly conservative group, but it's not necessarily because of the religion aspect. It really boils down to the education that we provide women about their bodies and the attitudes and beliefs about intercourse and sexuality in and of itself. There's actually another study that was done. It was another study that surveyed women that had vaginismus and they asked them, like, what are the reasons or what are the things that kind of led up to this happening? And what they found is that the number two reason for vaginismus was a negative attitude or a negative connotation around sex and sexuality as they were raised. And the number one reason was fear of pain with penetration. So that's pretty powerful that the way that we are taught about our bodies and the way that we are taught about sex and sexuality can have long lasting effects on the rest of our lives as females. It's really interesting because we used to think back in the day before women's health was really studied that vaginismus was just a purely motor response, right? Like with the penetration, these muscles tense up and they spasm and therefore penetration is painful and uncomfortable. and women are not able to have intercourse or are not able to enjoy intercourse. But just like every other realm of physical therapy, we're really diving into all of these different subsets of this diagnosis as a whole. And what we're finding is that the biopsychosocial piece of this is massive. The way that we are taught about our bodies, the way that we are taught about intercourse, the way that we are taught to feel about our natural desires and sexual urges can lead to a physiologic response that is outside of our control. So our pelvic floor has a protective reflexive mechanism when we are stressed or scared, and that protective reflexive mechanism can be maladaptive. But if we're taught from a young age that sex is shameful and that our bodies are something to be ashamed of, or maybe they only serve one purpose and that is only for reproduction and you're not trying to have sex to reproduce, then that can cause this reflexive reaction to kick in, where those muscles tighten and tense up. Even if you do all of the relaxation work in the world, and even if you do all of the things to stop it, that ideal is really deeply ingrained. And so that really leans into a lot more psychological work that needs to be done, not necessarily the physical work. so with that being said kind of segue into how can we help because we can't obviously go back in time and change the way that somebody was raised or change the way that somebody feels about sex and sexuality necessarily from their childhood or from the way that their parents raised them so as pts when we see this diagnosis walk in we see somebody come in who Has pain with intercourse and has or has dyspnea has vaginismus any other sexual condition? That is linked with pain or the inability to have or enjoy intercourse We want to start thinking about this in the back of our mind like this needs to be a way a topic that we come across maybe not necessarily directly asking like how were you raised to view sex and but it's something that we want to kind of keep in our back burner because if this is on board, then it's going to require a lot more collaborative care and it's a great opportunity for us to partner up with a mental health therapist in our area and really refer out and make sure that we're hitting this from all angles. One of the biggest things that we can do as pelvic PTs is educate. It is insane how many people are not educated about their bodies and especially in this purity culture realm, There's a lot of misinformation and miseducation and wrong education that is done that is really kind of focused or driven out of fear. And there's a lot of just lack of education. Women aren't taught about their bodies at all. And if we think about that, if you knew nothing about this area at all and something was going wrong, you would probably start panicking a little bit. It seems silly to reference it to our shoulder because we all obviously see our shoulders and know about our shoulders and For the most part, even if you have no anatomical knowledge, kind of get a sense of like, it does this, it does this, it needs to do all these things. But that's not true about our pelvic floor. Especially in cultures where purity is really honed in on, nobody is talking to women about the proper way to clean their vulvas. people aren't talking to women about the number of holes. Most of these cultures are not, absolutely not teaching about clitoral stimulation and female orgasm. And so keeping that in mind, like not knowing something can lead to a lot of confusion and fear when we do start having sensations of discomfort or pain. So educating in and of itself can be huge. Educating about the anatomy, we have three holes down there in a female pelvis. There are a lot of adult women that do not know that they have three holes. That in and of itself is a large piece of education. Educating them about how our pelvic floor works, what its functions are, how it aids in sex and sexuality, and the ways that we can really kind of lean into that and make sex or make the pelvis in and of itself not even sex, but the pelvis demystified. so that they're not looking at this area as a big black box with a question mark over it. And they have an understanding of the functions and the basic ways and inner workings of their own bodies. The other thing that we can really hone in on is working on parasympathetic drive work. So working on relaxation work, helping them get out of this fight or flight response. This is something that we can start in pelvic floor PT for sure and is a great way to partner with a local therapist or counselor or somebody that is trained in working with people with Sexual dysfunctions because a lot of this comes down to like taking a lot of steps back So we're not even talking about like let's relax while you're about to have intercourse we're talking about like let's lay in bed next to your partner and Hold hands and practice relaxing and then let's talk about maintaining that as your partner touches your leg and just kind of working in on these component pieces and Sometimes it's even like, let's go all the way backwards, just you. Like your partner is not even a piece of this puzzle. Let's talk about ways that you can get comfortable with your own body so that you can go into this partnership and this relationship with a degree of comfort and understanding, and it's not about this other person at all. finding a counselor or a therapist in your area, or maybe not in your area, but virtually, that is somebody that you trust, that can help guide this path. We can absolutely help. We can be a facilitator of that. But the great thing about having that mental health component is they can really kind of go back a little bit farther and more in depth than we can, because they're trained in that, to really break down those beliefs and talk about ways to rebuild that from a psychological level. And then we can go in, with that happening and align that with the physical piece. So kind of bridging those two pieces together so that we're getting this complete rehab component. A lot of the times in this population, the assumption is like, oh, we just need to work on strengthening other areas or whatever. But I think that in the sense of vaginismus, absolutely, we always are promoting strength training our hips and strength training our core and making sure that the muscles around our pelvis are strong and supporting the pelvic floor. So the pelvic floor isn't becoming the hero and becoming super tense and tight in a response to that. But especially when we're thinking about vaginismus, we're really looking at like the attitudes and core beliefs and the situation around the intercourse or the act that is causing that vaginismus to occur in and of itself. So we always can layer those things in. We love that, but really focusing in on that relaxation and finding ways to promote that relaxation paired with education and partnering with a provider that we trust that can help address the psychological component. We know, we have surveys that show that women that are raised in households where the mother had negative views about sex or negative beliefs about sex or talked negatively about it, have higher rates of vaginismus and dyspnea, which is wild to me. It makes sense when we think about it. You know, we always talk about how our kiddos are really mirroring the things that we say and we do in the way that we act. So as adults in and of ourselves, not necessarily even in the PT realm, But making sure that the way we talk about these functions is in a way that is not promoting shame or fear. I think that again purity culture is often linked with religion and so you have kind of these two sides and this can be a really polarized topic. And I think no matter what you believe, the big goal is that at the end of the day, our young women need to understand how their bodies work, they need to understand the functions of their bodies, and then they need to understand what sexuality means. In whatever way it is that we believe that, making sure that sexuality isn't seen as something that is really driven in shame or driven in fear, but it's something that is celebrated because at the end of the day, it is one of our basic biologic functions that we all need in our lives. And so making sure that we are setting our future generations up for not having these pelvic floor dysfunctions down the line. providing education at a community level in any way that you're able to can also be really wonderful. We've set up before like a mom and daughter workshop where we literally just talked about like, this is the pelvic floor, and this is the way the menstrual cycle works, and this is the way the pelvic floor functions, not diving into this is how you have sex, but base knowledge. That base knowledge can be so powerful in a community that doesn't have that knowledge. i hope you guys enjoyed this i hope that this hit a chord with you maybe especially if you're in an area where you're seeing a lot of patients that come in that are raised in cultures where sex is seen as shameful and seen as something that is not to be celebrated and is um maybe fear-based so um SUMMARY If you guys are interested in hopping into one of our courses in the pelvic division we talk a lot about pelvic pain in our l2 cohort which we have seats available for that october cohort coming up we just started our second cohort of the year so that one is kicked off We've got one more cohort of L2 coming up at the end of the year, so if you want to hop into that, look at that online. We've got L1 coming up in two weeks, and then we've got a lot of courses coming up in the end of the year. We are rounding out quarter four with tons of courses. We're on the road a lot. We're all over the United States, so if you are interested in hopping into one of our Pelvic Live courses, go to the website, PTOnIce.com, get into one of those courses. We can't wait to see you on the road. Have a great rest of your Monday, and I'll see you guys around. 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, ICE Pelvic faculty member Rachel Moore highlights the ways the 2024 Paris Olympics are changing the narrative around motherhood for athletes and providing resources and support along the way 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 RACHEL MOOREGuys, good morning. My name is Dr. Rachel Moore. I am here this morning representing the pelvic crew and I am so excited to talk to you guys about the Olympics and some pretty big stuff that's going on in the Olympics this year. The Olympics is huge in my area. Simone Biles actually lives like five minutes away from me, which is like my claim to fame humble brag. My daughter went to her gymnastics gym. And so if you've seen the Simone Biles documentary that's on Netflix, We were like fangirling and fanboying. We were watching it because we're like, oh, that's where Libby does gymnastics. So Olympics are a pretty big thing in our area, in our neck of the woods. And I think the Olympics this year are really interesting. And I wanted to get on this morning to highlight some of the things, especially when it comes to women in sport. that are really kind of setting apart this Olympics from ones in the past. If you didn't catch it, the opening ceremony was on Friday. It was a really interesting one because they were just kind of doing this parade of river boats down the river. And they incorporated all of these architectural pieces of France architecture into the opening ceremony. So it was pretty interesting to watch. And it just kind of set the tone for how different this year's Olympics are from a lot of the other Olympics in the past. So one of the key things that I think is really interesting, and I didn't even realize this until somebody else on faculty had shared a story about this, is that this is the first Olympics that has been almost equal representation as far as genders go. So the IOC set out to have a goal to have 50-50 participation between male athletes and female athletes. for this year's Olympics. And they actually just barely fell short of that goal. So the way it shook out with the amount of athletes that showed up and qualified and came to the Olympics was 51% male, 49% female. But that's pretty wild to see almost equal representation at this competition on a global level. A lot of us in the ice world are involved in CrossFit. We're kind of used to seeing that 50-50 representation. And that's one thing that really makes CrossFit unique compared to a lot of other sporting organizations. And so it's cool to see this transition or start seeing this change in this shift towards women in sport take this like worldwide platform where it's not a male-dominated thing and we're seeing more females represented and within that we're seeing more women that have children represented so motherhood is really starting to take a front row seat to the Olympics. So Allison Felix, who is the most decorated female track and field athlete, she's a US athlete. She actually made headlines a while ago because she lost her sponsorship with Nike when she told them that she was pregnant. And so that was this huge shakeup as far as women athletes and females in sport of, we are not a liability when we're pregnant. We're not less than because we choose to have children. And a lot of women, we see this a lot where People are delaying having children because of this athletic window and this fertility window kind of overlapping And so when athletes decide to start their families and then there's this response where they get dropped in their sponsorships, that sends us a certain message about what a female's role is and what her worth is in sport when she becomes a mother. And so Alice and Felix really spoke out against this and started this really amazing conversation about this overlap and about maternity leave and about just female in sport and how motherhood fits into that role. She took this to the Olympics this year. Um, so she's at athlete representative for the IOC and she actually started an initiative and it did great. And it's a thing now to open a nursery for mothers with young children at the Olympics. So historically the way it's always shook out in the past is that children are not allowed in the athlete village where athletes and coaches stay for the duration of the competition. So if somebody was breastfeeding a baby and also competing at the Olympics, they either had to choose to be separated from their baby for the duration of that competition, or they would have to kind of foot the cost of lodging for themselves. The problem with that is that Olympics is expensive and not everybody has the funds to even go compete at the Olympics. But then if we're thinking that somebody qualifies for the Olympics and now they have to pay for a caregiver maybe for their child and also they have to pay for lodging for their child or they're not going to be able to To be there that could make somebody not go to the Olympics that had qualified and had earned their spot So it's pretty cool to see this shift start happening. The nursery is actually sponsored by Procter & Gamble So Pampers is like branded all over it it's kind of funny if you look at pictures because they literally put Pampers and like every square inch that they possibly could and But it's a really exciting thing. So it's for children that are diaper age and below and their parents and their caregivers can go and kind of get away from the chaos of everything that's happening at the Olympics and have a quiet space to be together to spend time together. to bond. And then really a big thing is to nurse. The Tokyo Olympics, the last summer Olympics that we had, was right in the kind of height of the pandemic, or I guess kind of the downhill trickling of the pandemic, if you guys remember. And there was a lot of restrictions on the athletes. And so the athletes weren't allowed to bring support people, families, people had to stay behind. They were traveling with this like skeleton crew. And IOC The mothers to spend time with their children and to be able to nurse was Honestly pretty laughable. It was pretty wild if you if you just google like tokyo nursing room olympics Um, there's a picture of one of the athletes like two-year-olds laying on the floor And there's like a folding table with two folding chairs next to it And that's where the athletes would go To spend time with their children in between their events when they weren't training or they weren't preparing for the games again, if we're thinking about the message this sends that really tells people like you're here to be an athlete and everything else doesn't matter like we don't care that you also might be a mom oh it's it's okay you need a space well here's this like folding chair in the corner that message is so different this year the message the ioc is sending this year is that we recognize that the maternal timeline and the athletic timeline might overlap and your worth is not only as an athlete and we recognize that your worth also exists in motherhood. Allison Felix had this really cool quote. She said, I think it really tells women that you can choose motherhood and also be at the top of your game and not have to miss a beat. That's amazing. We preach that all the time in our division. We talk a lot, again, about how the fertility window and the athletic window overlap. And what we're starting to see is this trend of women pushing back and saying, yes, we can still be athletic. Yes, we can still be in the top of our sport. and also show up for our families, and also feed our babies, and us be their primary source of nutrition while we're training for the Olympics. So it's really cool to see this take, again, a worldwide platform to acknowledge that these things can exist at the same time. There's a couple other countries and groups that are showing up for their athletes as well. So the French Olympic Committee is actually paying for hotel rooms for their breastfeeding mothers. to stay in so again before athletes would stay in the athlete village with their coaches partners and babies would stay elsewhere they couldn't go spend the night with them they had to be in the athlete village so the french olympic committee this year has started an initiative where they're paying for hotel rooms for nursing mothers where they can go spend the night with their baby their partner can be there as well so kind of minimizing this interruption between this mother-baby bond and what's really cool is that they made a statement that this isn't just because quote-unquote the Olympics are here in our home ground This is something that we want to see carry over into future Olympics. So they're really again just kind of setting this example that motherhood matters and that we can do both. So really exciting to see when we look at the numbers. The US has 338 women on their team, which is the highest amount of women. on an olympic team france has 293 so these top two countries as far as women and female representation are really just showing up for all uh seasons of females lives um from what i could find i was trying to google like exactly how many moms are on the olympic team and um i even asked chat gpt i was like what percentage of olympic athletes are moms And it was like, we don't have that data. But I did see several articles that said that this year the USA team has 16 moms that are representing the US and five of them are on the basketball team. So kind of astounding that out of 338 athletes, if that number truly is 16, that's pretty wild. But again, it's really cool to see that representation and that acknowledgement as a whole. it's really exciting that we're seeing this culture shift that we have believed in and we have seen again in the crossfit world with annie thora's daughter and now tia and all of these top athletes really embracing their motherhood and talking about how motherhood has affected them as an athlete and watching this happen not just in the crossfit world where we all kind of live and spend time but in athletic world as a whole is so exciting and I just can't get over the fact that the Olympics, which is this massive platform that so many people are tuning into, are really highlighting and bringing attention and awareness to the fact that these athletes are also mothers. These athletes are doing these things simultaneously and it can be done. It's a really exciting message We are all about it here at ICE. We are here for it. We're excited to see it continue. And here's hoping that at future Olympics, we only see these accommodations grow between other Olympic committees, other country delegations, and that this nursery just continues to take off and that the athletes really enjoy it. SUMMARY If you guys want to hop in to our pelvic courses, we have a lot of chances to catch us in September. So we've got Hendersonville, September 7th and 8th, Wisconsin, September 14th and 15th, and Connecticut, September 21st and 22nd. So a lot of ways that you can come hang with us on the road in September. Our next L1 cohort starts September 9th, and our next L2 cohort starts August 19th. So if you're interested in an ice course, especially in that pelvic division, Head on over to PT on Ice and sign up for your course. Otherwise, keep an eye on the Olympics. If you guys have a favorite sport, comment it below. Let me know what it is that you're going to be watching. Obviously, I'm going to be all in on gymnastics because Simone Biles is essentially my neighbor, even though she's really not. But trying to get my daughter into horseback riding, so I keep hyping up all these equestrian things. so that she falls in love with horses. It's not working yet. We'll see. You guys have a great week. I hope you guys crush it. Thanks for tuning in. 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 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.

Join Jessica Marx in this episode of the Millions Were Made Podcast as she sits down with Rachel Moore of Pinteresting Plans, a former Nurse Practitioner turned influential social media figure and real estate mogul. Rachel shares her incredible journey from blogging and flipping furniture to creating multimillion-dollar ventures in both real estate and online influence. Discover the strategic insights behind Rachel's success, including the challenges of becoming an influencer and effective tips for brands seeking fruitful partnerships. Emphasizing authenticity and the power of a supportive team. Rachel also dives into leveraging real estate for financial benefits and her latest venture in education. Whether you're an aspiring entrepreneur or a brand looking to collaborate with influencers, this episode offers invaluable advice on navigating the world of business and influence.Tune in now!Learn more about the Business Performance Audit: https://tailoredpremier.com/business-performance-assessmentHighlights(01:44) Rachel's journey from blog, "Pinteresting Plans," while managing family challenges and seeking financial independence.(03:21) Rachel's transition from furniture flipping to fashion posts on Instagram .(07:41) Strategies for staying ahead in social media and adapting to platform changes like the shift to video content.(09:56) Importance of a team.(16:59) Success factors in business.(18:57) Importance of leveraging real estate investments to manage cash flow and tax strategies effectively.20:12) The launching of Rachel's new venture in education with a personalized school model.21:45) Rachel's challenges and rewards of transitioning from healthcare to entrepreneurship.(26:18) The importance of balancing personal life and professional ambitions.Connect with Jessica:Instagram: @millionsweremade and @thejessicamarx   Website: Million Were MadeWork with Jessica: Tailored PremierConnect with Rachel:Website: pinterestingplans.comInstagram: pinterestingplans

Unpacking the Meltwater Summit: Marketing Insights & New York Tales **No paid endorsements are part of this episode.** Join host Rachel Moore in this lively episode as she shares her insights and takeaways from the recent Meltwater Summit held in New York City. From Ryan Reynolds' marketing gems to practical advice on reaching Gen Z, this episode is packed with actionable wisdom and a few funny anecdotes from Rachel's own New York escapades. Show links: ⁠Meltwater Summit Personify Leadership Training Wheels That Peloton Ad That Aviation Gin Ad 0:00 Opening Apology and Intro 00:47 Meltwater Summit Download 04:10 Joy as the North Star 06:29 Conflict Resolution 09:22 FASTvertising 15:27 Power of Stories - Size Matters Not 19:25 Marketing to GenZ 23:48 Production Quality 25:46 Reddit communities 28:00 Keynotes at marketing conferences 32:01 I Got Got

Unpacking the Meltwater Summit: Marketing Insights & New York Tales **No paid endorsements are part of this episode.** Join host Rachel Moore in this lively episode as she shares her insights and takeaways from the recent Meltwater Summit held in New York City. From Ryan Reynolds' marketing gems to practical advice on reaching Gen Z, this episode is packed with actionable wisdom and a few funny anecdotes from Rachel's own New York escapades. Show links: ⁠Meltwater Summit Personify Leadership Training Wheels That Peloton Ad That Aviation Gin Ad 0:00 Opening Apology and Intro 00:47 Meltwater Summit Download 04:10 Joy as the North Star 06:29 Conflict Resolution 09:22 FASTvertising 15:27 Power of Stories - Size Matters Not 19:25 Marketing to GenZ 23:48 Production Quality 25:46 Reddit communities 28:00 Keynotes at marketing conferences 32:01 I Got Got

Rachel Moore and Tanya Ballard Brown explore the wild world of marketing in this episode of Just Trust Me. From a mic-breaking moment to the spectacular dragon atop the Empire State Building, they chat about the intriguing partnership between Apple and OpenAI, the WWDC, and the futuristic integration of AI into our everyday lives. Tanya considers a tempting pair of Aerosoles shoes while Rachel dives into Denver's legendary Casa Bonita. And we're all looking upward to the massive dragon curled around the top of the Empire State Building to celebrate Season 2 of House of the Dragon! Show Links: Apple vs. Android market share in U.S. and Global Forbes.com: Apple's Deal with OpenAI X post about House of the Dragon atop the Empire State Building Tanya's Aerosole Shoes 00:00 Cold Open 05:14 Apple Gets It On with OpenAI 20:09 Good Marketing? 36:56 We Got Got

Rachel Moore and Tanya Ballard Brown explore the wild world of marketing in this episode of Just Trust Me. From a mic-breaking moment to the spectacular dragon atop the Empire State Building, they chat about the intriguing partnership between Apple and OpenAI, the WWDC, and the futuristic integration of AI into our everyday lives. Tanya considers a tempting pair of Aerosoles shoes while Rachel dives into Denver's legendary Casa Bonita. And we're all looking upward to the massive dragon curled around the top of the Empire State Building to celebrate Season 2 of House of the Dragon! Show Links: Apple vs. Android market share in U.S. and Global Forbes.com: Apple's Deal with OpenAI X post about House of the Dragon atop the Empire State Building Tanya's Aerosole Shoes 00:00 Cold Open 05:14 Apple Gets It On with OpenAI 20:09 Good Marketing? 36:56 We Got Got

Dr. Christina Prevett // #GeriOnICE // www.ptonice.com  In today's episode of the PT on ICE Daily Show, join Modern Management of the Older Adult division leader Christina Prevett as she discusses experiencing loss, processing grief, and its impact on being a geriatric clinician. 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 live courses designed to better serve older adults in physical therapy 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 INTRODUCTIONHey everyone, Alan here, Chief Operating Officer here at ICE. Before we get into today's episode, I'd like to introduce our sponsor, Jane, a clinic management software and EMR with a human touch. Whether you're switching your software or going paperless for the first time ever, the Jane team knows that the onboarding process can feel a little overwhelming. That's why with Jane, you don't just get software, you get a whole team. Including in every Jane subscription is their new award-winning customer support available by phone, email, or chat whenever you need it, even on Saturdays. You can also book a free account setup consultation to review your account and ensure that you feel confident about going live with your switch. And if you'd like some extra advice along the way, you can tap into a lovely community of practitioners, clinic owners, and front desk staff through Jane's community Facebook group. If you're interested in making the switch to Jane, head on over to jane.app.switch to book a one-on-one demo with a member of Jane's support team. Don't forget to mention code IcePT1MO at the time of sign up for a one month free grace period on your new Jane account. CHRISTINA PREVETT Hello everyone and welcome to the PT on ICE Daily Show. My name is Christina Prevett. I am one of the lead faculty within our geriatric division and today I want to talk a little bit about grief. This is kind of a personal conversation, but it's also one that I think is really important when we are working with older adults. So personally, I've kind of been speaking a little bit on my social media. I lost somebody very close to me very recently. So I lost my godmother. She was my aunt. She was in my top 10 list of favorite people and she was somebody who had battled cancer a long time ago. They found out a couple of weeks ago that she had a metastasis in her brain and her first radiation she didn't do very well and she passed away like very very suddenly. And to say that this rocked me, like, I don't know if I'm going to keep it together on this podcast. I'm going to try. But to say that this rocked me was like an understatement of the world. And it was devastating. I'm still not OK. And it made me think a lot about grief. So I am 34 years old. And over the last two and a half years, I have lost three people that are really close to me. I lost an uncle that was my dad's best friend, my aunt who was my mom's best friend, which means that they were around us all the time, and I lost my grandmother who I was really close to. And as I was reflecting on this most recent loss, which my aunt was probably the closest person that I have ever lost, I reflected a lot on the process of grief and I thought a lot about how my older adults must feel. And so it reminded me of a conversation that I had with my grandmother. So my grandmother passed away just shy, a month shy of her 98th birthday. She lived a very long life. Her husband was alive until he was 93. And she was just this incredible role model of successful aging. somebody who was able to keep cognitive capacities, physical capacities in the realm of what she wanted for a very long time. And I was having a heart-to-heart with her one time, and I'm sure many of you have had similar conversations with loved ones that have lived a long life. And I said, you know, Grandma, I want to be like you and live to 100, because at that time I was certain she was going to be a centurion. And she turned to me and she said, you don't really want to live to 100. And I asked her why, and she's like, because everybody around you is dead. And to be somebody at, I'm 34 years old, to have had this feeling of accumulated loss, I'm only starting to potentially scratch the surface of what she could possibly mean and what all of our or so many of our older adults may be experiencing in their life. And so while I feel the acute sting of losing somebody really close to me, what I'm also like really recognizing is that there's also a accumulation effect that weighs heavily on my heart around having multiple people that I've been really close to that have passed away. And if I am feeling that at 34, I can only imagine how many of my older adults are feeling when it comes to, you know, they've lost parents, all parents, both parents, their in-laws' parents. They may have lost siblings or, God forbid, kids. Like there's friends and family, like you know, there's jokes around how our older adults are one of their social calls is going to funerals because they experience loss around them so frequently. And I never truly appreciated, I think, how much of a toll that would take on an individual's soul and their experience in some of their zest for life until I felt like some of the accumulated effects over a relatively short amount of time of experiencing a significant amount of loss. what this got me to think about is the way that we interact with grief with our older adults. And when we, really as a culture, how we interact with grief. And so I had one of our TAs, Rachel Moore, she's one of our lead faculty for Pelvic. We were having conversations about this and she said, you know, it's so interesting because everything else just keeps going and you feel like you're stuck in this loop of, oh my gosh, this person has left. And it's true, right? We are with individuals in that short amount of time where we're doing funeral preparations and all those types of things, but that grief weighs heavily on a person's soul and on a person's mind. And we don't really teach individuals how to deal with grief. And when it comes to older adults, we oftentimes think that this is such a normal part of the aging process that I don't think we ever truly hold space for individuals when they are dealing with grief. And so when I was reading a book called Breaking the Age Code, this really came front of mind. So we talk at an MMOA about the psychosocial considerations of working with older adults, about how it can be so great for us to put a heavy deadlift in their hand or get them getting up off the floor for the first time in a decade. And all of those things are really wonderful. But if there are other buckets that are just leaking because they do not have the financial resources, the mental resources, or the skills in order to help with these big buckets that are truly just hemorrhaging, then we're not really gonna give them the best type of care. And when I was reading a book called Breaking the Age Code, it really came front of mind for me about this. where when we look at mental health disorders, and not to say that grief is not a very healthy expression of sadness, but Becca Levy, who wrote The Code Breaking the Age Code, she's the one that we talk about with all of our ageism literature. She wrote a section in this book, her book on mental health, and she talks a lot about how the knee-jerk reaction with our older adults is to give them anxiolytics and antidepressants, without truly leaning into grief and leaning into talk therapies and conservative cognitive behavioral therapies that can just be so, so beneficial when we're working with our older adults. And she described some literature where she actually said, you know, many of our older adults may do even better with talk therapies than some of our younger individuals do because they're creating that connection so intensely. are craving those skill sets that they need in order to make it through their day because their grief is so heavy and your grief doesn't just last for two weeks. And so I was reading, kind of thinking about all this and the weight of grief and the thoughts around grief and how this relates to our older adults and how personally this is relating to me. I started reading a book called The Collected Regrets of Clover and there was a couple of things that they really talked about that I think is helpful for the way that I'm approaching now or thinking about approaching conversations with some of my older adults that I am working with who are experiencing loss or who have disclosed to me that they have lost a lot of people that are close to them. This book is it's fiction. It is so beautiful. It talks about a woman who is a death doula who basically comes and supports individuals through the end of their life. Similar to how a postpartum doula would help a new baby come into the world or a pregnancy postpartum doula, a death doula helps people end their life and end their life on their terms. And they talk about how when we're thinking about grief, First, it's this large weight that is on their frame. And as time passes, that big backpack turns into a purse. And what she's saying is that your grief is always carried with you, but the weight of it becomes easier to carry with time. It never goes away, but we start to be able to function in some ways with it. And I think that's really such a powerful thing to speak to. And when we are working with our older adults, they may be holding a lot of purses. They may be carrying a lot of bags of loss in the non-literal sense that can create this expression of apathy or a lack of engagement, which can sometimes create this space where it may be hard for individuals to engage with us in rehab. sometimes being able to dig deep into some of those considerations and create resources for them can be one of the best things that we can do. And so in this book, she had this quote and I read it on my Instagram a couple of weeks ago, but I'm going to read it to you now. And then we're going to finish off this podcast with a couple of things that I'm thinking about as a geriatric clinician to recognize that there is a lot of grief with our people that we are working with that we cannot see that are influencing who they are and how they show up in the world. And so in this book, this was literally the fifth page in. So if you're a fiction reader, this is such a beautiful book, but they said the most important thing is never to look away from someone's pain, not just the physical pain of their body shutting down, which we see all the time in rehab, right? But the emotional pain of watching their life end while knowing they could have lived it better. Giving someone the chance to be seen at their most vulnerable is much more healing than any words. And it was my honor to do that, to look them in the eye and acknowledge their hurt, to let it exist undiluted, even when the sadness was overwhelming. And so to put this into the context of rehab, I think there's a couple of things that I can think of as a clinician. And the first is that physical vulnerability and emotional grief, they are challenging to navigate. And we want to recognize that not only are we working with individuals who have low physical reserve, but there is an emotional piece of recognizing the loss of physical capacities and the emotional load of the loss of people that love them and they loved. as they get older. So my dad is 67. He has lost his mom, his brother, his best friend, and another friend from school in the last two years. And he's like, this might be it for me. All these people that I planned my retirement with are no longer with me. And I don't want to go to the golf courses anymore. I don't want to engage in physical activity because the people that I wanted to engage in physical activity with are no longer there. diving deep into some of those conversations, we say at MMOA to get truly curious, but not only physically curious about the things that drive individuals, but emotionally curious about maybe some of the things that are holding them back. And I think that can be a really, really wonderful way to get into some of the barriers and recognize that it's a little bit more complicated than them just not wanting to engage in doing squats with us, right? And so that's kind of number one. Number two is it's heavy for us to be able to listen to things that are really sad, but we can have a very big role in trying to mend and heal some individuals who do not have somebody to talk to. We have a loneliness epidemic in our older adult spaces, really all over our generations, but that is compounded, that loneliness is compounded when the people that you are not lonely with have passed away. And so recognizing trying to create resources, whether that is resources within the community like seniors associations or gyms where individuals can connect and have new kinships, especially in the face of loss when they are ready to. is one way for us to create resources and networks. But additionally, having a person that you can refer that is a psychologist, a talk therapist, a psychiatrist too, but where the knee-jerk reaction isn't just prescribing medications. And I am not anti-medication, do not mishear me, but I think that the addition of, you know, our conservative side, we talk about how we are not anti-surgery, we are conservative management forward. Why are we not applying this same mindset when we are working with our older adults who are dealing with really heavy emotions and maybe have never been taught how to deal with grief? I am a parent who is trying to not hide, but make appropriate the work that, you know, of grief and grief processing with my five-year-old. And I am acutely aware of trying to teach her skills to manage sad emotions. But so many of our older adults don't, they don't have those skills. And so it's important for us to recognize some of those resources. And so where I'm going to challenge you all today is one, to lean into these conversations if you have them with some of your older adults. But two, is to do a quick Google search to see if you can find a talk therapist in your area that you could have in your referral network when these conversations do come up. And inevitably, if you're working in geriatrics, the concept of grief and loss will come up. I recognize that in the United States and in Canada, one of the hardest things is finding someone who's in network or taking Medicare and finding somebody who doesn't have a super long wait list. I totally recognize that. It may require a little bit of digging deeper and that can oftentimes be one of the biggest barriers for individuals seeking care through talk therapy and why our primary care physicians are leaning into med management. But sometimes, you know, the best thing we can do is try and find some providers, find individuals who work with older adults on the regular, and try and create those bridges and those connections when appropriate. All right, I hope you found that helpful. I kept it together pretty good, I think, considering all things considered. If you are looking to get into some of our older adult live courses for the summer, we have a couple of opportunities coming up. Our last opportunity in June is in Charlotte, North Carolina with Julie. That is June 22nd and 23rd. In July, we have three courses going. We have Virginia Beach, July 13th, 14th. Jeff Musgrave is up in Victor, New York, July 20th and 21st. And if you truly want the full experience of all of our MMOA faculty and staff, we have our MMOA Summit where Dustin and I are going to be teaching the course, but all of our teaching assistants and other lead faculty are going to be there. That is going to be in Littleton, Colorado, July 27th, 28th. That is going to be a super fun time if you are interested in hanging out with all of us and geeking out about older adult care, like that is the time to take MMOA Live. So if you have any other thoughts, questions, concerns, let me know. If you want to share some of your grief journey, I am all ears because It has been quite the couple weeks that I know that I'm just at the front end of this journey and I'm not gonna shy away from it. And it's definitely given me some new perspective as a geriatric clinician. Even when I thought I kind of had done my research and I've been in a lot of experiences talking about grief, it is so different when you're experiencing it yourself. All right, hope you all have a wonderful week. Signing off now, 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. Rachel Moore // #ICEPelvic // www.ptonice.com  In today's episode of the PT on ICE Daily Show, #ICEPelvic faculty member Rachel Moore discusses the CrossFit hero workout "Murph", including modifications & considerations for pregnant & postpartum athletes. 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 everybody, Alan here, Chief Operating Officer at ICE. Thanks for listening to the P-10 ICE Daily Show. Before we jump into today's episode, let's give a big shout out to our show sponsor, Jane. in online clinic management software and EMR. The Jane team understands that getting started with new software can be overwhelming, but they want you to know that you're not alone. To ensure the onboarding process goes smoothly, Jane offers free data imports, personalized calls to set up your account, and unlimited phone, email, and chat support. With a transparent monthly subscription, you'll never be locked into a contract with Jane. If you're interested in learning more about Jane, or you want to book a personalized demo, head on over to jane.app.switch. And if you do decide to make the switch, don't forget to use our code ICEPT1MO at signup to receive a one month free grace period on your new Jane account. RACHEL MOORE My name is Dr. Rachel Moore. I am here this morning on Memorial Day to chat with you guys about the MRF workout and reflections for the MRF workout as a prenatal or maybe postpartum athlete. So whether you yourself have been that athlete and been prenatal or postpartum while doing MRF, or maybe the population of patients that you see is this prenatal space. I want to dive in to some reflections on that today. So first of all, we're going to kick it off. If you are not familiar with the CrossFit space, you're not in the CrossFit space. What is the Murph workout? So Murph is a workout. It's called a hero workout. it's done typically on or around a memorial day so whether memorial day weekend or memorial day itself it is a hero workout which is a named workout in the crossfit space for somebody that has given the ultimate sacrifice and paid their life for whatever the reason so michael murphy Um is who this workout is honoring he was a navy seal and he died in the line of duty So the workout itself is a one mile run 100 push-ups or sorry 100 pull-ups 200 push-ups 300 air squats and then you cap it all off with a mile run and the rx version of this workout is wearing a weight vest 20 pounds for guys 14 pounds for ladies If you have never done this workout, it's a long one. Most people kind of fluctuate like earlier times or fast times or sub one hour, but a lot of people tend to hover around that one hour a little bit more mark if they're doing a quote unquote full Murph. We also can do a half Murph, which is where we take that workout. and cut that volume in half. So the Murph itself is one of those workouts that is a really powerful symbol within the CrossFit community. Typically, most gyms are getting together, whether it's on that Saturday or on that Monday. It's a large community event. It's a really exciting thing to be a part of and a really exciting thing to come together. A lot of people really look forward to this workout every year. not only for the reason of what it represents and the fact that we're paying honor and tribute to people that have given that ultimate sacrifice of their lives so all of us have the freedoms that we have. but also because it is a pretty big test of fitness. And depending on what season of life we're in, sometimes those tests of fitness can be hard. Whether it is physically hard or emotionally hard, regardless, it can be tough. And in one of the largest seasons where we see that is in the perinatal space. So when somebody is pregnant or when somebody is maybe newly postpartum, and they're trying to figure out how to tackle Merv. it can be tough to set aside that athlete brain. It can be really hard to turn that off, especially if you're somebody that's done Murph maybe in the past, and you want to know where you shake out. Or if you're brand new to CrossFit, maybe you started doing CrossFit, found out you were pregnant shortly after, and you're seeing everybody in your gym get super excited about testing their fitness and seeing where they're at, seeing how they compare, maybe doing it for the first time, and knowing that you can't do it the way that you would quote unquote like to. So let's unpack that a little bit. For one, we at Ice really preach that we don't modify unless we need to modify. Just because we're pregnant, quote-unquote, is not a reason to modify MRF. If you're somebody that this workout is in your wheelhouse, maybe you are doing pull-ups and have been doing pull-ups in the gym. maybe push-ups are not bothersome to you, you're early enough on in pregnancy that your bum's not getting in the way, you feel good doing all those push-up volume, air squats feel great, running hasn't gotten to a point where it's bothersome at all, then there's no reason to modify the workout. We don't modify the workout because of pregnancy. We may be able to tweak it slightly, so maybe you partition instead of doing all of the reps in a row to save some of your core fatigue, So instead of doing 100, 200, 300, you do 5, 10, 15, and just give yourself some breaks in between. But if none of those movements are problematic for you and the volume isn't problematic for you, then it's okay to just do the workout, maybe a little bit slower than you otherwise would have, but it's okay to send it. If you're somebody who has issues with one of those movements, whether it is the pull-ups. You don't have that midline strength and stamina anymore and you're seeing a lot of that coning repeatedly over time and it's something that's bothersome to you or maybe the push-up volume is way too high for you or squatting below parallel triggers some pain. It's also okay to modify the workout. Modifying a Murph is not a sign of shame. Doing the Murph in and of itself is huge. modifying the MRF, whether that is because of pregnancy, whether that is in the postpartum season, or whether it's because of an injury, or you're a new CrossFitter, it's okay to modify when we have a reason to modify. It's still exciting to show up. It's still exciting to be a part of your community and do that workout. I have done this workout myself. This was my sixth MRF this year and I did it as a new postpartum. So it was three months postpartum and I was a newer crossfitter. I've done it as a, I think 18 week pregnant crossfitter. I've done it as a year-ish postpartum crossfitter, and then I've done it Rx twice. And in each of those seasons, the challenges were different. When I was a pregnant athlete, I wanted so badly to send it. I wanted to do a full MRF. I wanted to do the entire volume. But my body didn't feel great with that. And so that year, my husband and I ended up splitting the MRF. So we ran the mile together. It was a little bit slower than I otherwise would have ran. and we did you go, I go rounds and we took turns so that I had some built-in rest breaks because for me at that stage in my pregnancy, my heart rate was skyrocketing and I was having a really hard time managing that much volume with that high of a heart rate for that long a period of time. That was a challenging year for me. It has nothing to do with the physical side. Honestly, when we finished our MRF that we split, I was just like, okay, like that was fine, I guess. I'm excited I was here. But physically, it didn't feel like that much of a challenge. But that was the most mentally challenging year. On the flip side, the very first time I did MRF, I did a similar thing. I split a Murph, quote unquote, with a friend. We did you go, I go rounds. I was a newer CrossFitter and I was postpartum. So I scaled the pull-ups for ring rows. I did push-ups for my knees and I did air squats, but I did it all with a vest because I wanted to know if I could. So half a Murph shared with somebody, quote unquote, with a weight vest on, so reduced volume and scaled movements. And I have never felt so powerful than when I finished that workout at three months postpartum. It was awesome. So those are two very different seasons, two very different iterations of the workout from the standpoint of RX movements versus scaled movements, weight vest versus non-weight vest. And the outcome was different. One, I felt physically strong, mentally strong, felt super empowered. And one, honestly, was a really hard mental load for me because I wanted to do what all of my friends were doing in the gym and I wanted to be able to push myself. that athlete brain is tough to turn off. So if you are one of these patients, or one of these people that is doing MRF this year, or has done MRF by this point at 9.20 on a Monday Memorial Day morning, and you struggled with that, it's okay. If you have patients coming in in the future, and they're talking to you about, I wanna do MRF this year, but I just don't really know what to do, it's okay to tell them to modify. It's also okay if they wanna send it. At the end of the day, we're not modifying just for the sake of modifying. We had a gal in our gym last year who was in her 30th week of pregnancy. She's a former CrossFit Games athlete. She crushed it. She swapped out the pull-ups for ring rows, but otherwise did everything else RX and did fantastic and felt fantastic for her body. that challenge and that load was appropriate. We've also had people like myself who at 18 weeks pregnant decide that I need to modify. I'm not going to do a full Merv and I'm going to scale the movements. All of these options are okay. The beautiful thing about this workout is there are so many ways to modify it. There are so many ways to modify the movements themselves. There are so many ways to break up the volume. There are so many ways to cut the volume down. And at the end of the day, showing up and being a part of the community is what is really key this weekend. Being there, paying that tribute, showing that respect, and getting to be a part of your community is huge. If you're somebody that's been in this season and wants to chat more, shoot me a message. I would love to talk with you more. This is a topic that I'm super passionate about because I've been there. I've been in those shoes. And sometimes, you know, we just need to commiserate together about how hard something was. SUMMARY If you are looking to join any of our pelvic courses, we have got, we're about halfway through our L1 and our L2 cohorts. So we've got another L1 cohort kicking off. Our next L2 cohort is not until the fall. If you're interested in that, hop into it because it's going to fill out. Catch us on the road this summer. We've got a lot of opportunities to get to the live course where you can sit for that cert test and become ice pelvic certified. I hope you guys have a great rest of your day. If you did MRF today or at any point this weekend, make sure you take care of yourselves. Hydrate get your electrolytes in make sure you're getting protein in take care of your bodies And I know I'm feeling a little bit sore from my Saturday Murph So just know that in the next couple days you may be feeling some type of way, but it's temporary and it'll pass See you guys around 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.

In the final edition of the NAIA SIDA Spotlight Series for 2023-24, Rachel Moore visited with NAIA SIDA President and CSC College Division Representative, Donnie Smith, on his background and current work at Southeastern University and what attendees can expect at #CSCUnite24 this coming June in Las Vegas.

I truly have not found a Staging CEO in either of the 3 phases of business with no challenge. It could be worries about a slow season, the demands of your clients, or even the general volatility of the real estate market.  If you have ever had to forfeit a good night's sleep for any of these, know that you are not alone. At least, Racheal Moore who has struggled with that and overcame it, will share what mindset and strategies helped turn the situation around, yielding rewards for future business growth. Come hear what mindset adoptions have worked for the Lead Designer at LA's Top Home Staging Company.   WHAT YOU'LL LEARN FROM THIS EPISODE: How Rachel Moore uses guided meditation to ease her business worries. What Rachel Moore does at MadMod Home financially and mindset-wise to get through the expenses of a slow season. How to get more out of the experience of being a business owner. Goal setting strategies for success and fun in your staging business.   RESOURCES:   Listen to Rachel Moore's Business Lessons Learned Madmod Home's Website: https://www.madmodhome.com Madmod Home's Instagram: https://www.instagram.com/madmod_home Join the Staging Business School Growth Track Waitlist: www.rethinkhomeinteriors.com/growth Enroll in Staging Business School Accelerate Track: www.rethinkhomeinteriors.com/accelerate Follow Lori on Instagram: www.instagram.com/rethinkhome Follow the Staging Business School on Instagram: www.instagram.com/stagingbusinessschool/   If you want to learn how to market and grow your staging business, enrollment is open for Rethink You Accelerate. This is a year-long mentorship program, where I help you and other staging business owners plan, grow, flow, and thrive with the results that you've always wanted. The doors are open and I would love to see you in the classroom!   ENJOY THE SHOW? Leave a 5-star review on Apple Podcasts so that more Staging CEOs find it. Also, include links to your socials so that more Staging CEOs can find you. Follow over on Spotify, Stitcher, Amazon Music, or Audible.

Dr. Rachel Moore // #ICEPelvic // www.ptonice.com  In today's episode of the PT on ICE Daily Show, #ICEPelvic faculty member Rachel Moore discusses pelvic floor screens such as the PFD-SENTINEL and introduces a new pelvic floor screening resource coming soon to the ICE Physio App! 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 INTROHey everybody, Alan here. Currently I have the pleasure of serving as their Chief Operating Officer here at ICE. Before we jump into today's episode of the PTI Nice Daily Show, let's give a shout out to our sponsor Jane, a clinic management software and EMR. Whether you're just starting to do your research or you've been contemplating switching your software for a while now, the Jane team understands that this process can feel intimidating. That's why their goal is to provide you with the onboarding resources you need to make your switch as smooth as possible. Jane offers personalized calls to set up your account, a free date import, and a variety of online resources to get you up and running quickly once you switch. And if you need a helping hand along the way, you'll have access to unlimited phone, email, and chat support included in your Jane subscription. If you're interested in learning more, you want to book a one-on-one demo, you can head on over to jane.app.switch. And if you decide to make the switch, don't forget to use the code ICEPT1MO at signup to receive a one-month free grace period on your new Jane account. RACHEL MOOREGood morning, PT on ICE Daily Show. I am getting lunched on YouTube and Instagram and we are good to go. All right, what's up? My name is Dr. Rachel Moore. I am here this morning to talk to you guys about screening for pelvic floor dysfunction especially if you are somebody who is maybe not familiar with the pelvic floor space or this is an entirely new space for you or you're somebody who is like identifying or classifying as a orthopedic PT and you're like I don't know anything about the pelvis. I want to clear things up with you guys and put together or we did put together a resource for you guys that is a pelvic floor screen that you're going to be able to access through the Ice Physio app under the resources section. So you'll be able to get that off of the app, download it, either have it in your intake forms, in your paperwork so that you can use that as people are coming in and kind of have an indicator of if this would be a person who would benefit from a referral for pelvic floor PT. Where this all came from, we've been asked at our courses before for just kind of an easy, quick, general screen. A lot of us use kind of a different option. So there was some people had a couple options that they were using. Other people were using different things. So what we did is we took all of these resources. We compiled them together and we really leaned into the research and what we have out there for pelvic floor screening. So we're going to chat a little bit about what that screen is and how we kind of adapted it or modified it for this really quick, easy, downloadable version that you can pull up and have as an 11 question fast screen for your patients. So This whole screen kind of is based around or adapted from a study that was published in the British Journal of Sports Medicine in December 2022. So the screen is called the PFD Sentinel Screen, S-E-N-T-I-N-E-L. What this was was a Delphi study and they basically polled professionals that are experts in this space. So they had PTs, they had urogynecologists, they had just different healthcare providers, physical medicine and rehab providers that all had either been in this space seeing patients or been in this space researching these topics. And what they did is they polled these providers to kind of come up with a consensus. Because prior to this, there really wasn't a validated published screen in any evidence. that we could really lean into for patients that would benefit from pelvic floor physical therapy. And so they created this screen kind of as a way to have a resource specifically for sports medicine providers, and this was really kind of leaning into sports medicine PTs, like orthopedic PTs, or sports medicine doctors that were already seeing female athletes, and they're kind of range or definition of female athletes was like super broad. So across all ages, across all sports, across all profession levels, whether it was amateur athletes or professional athletes, they came up with this screen based on this Delphi questionnaire, not questionnaire, but survey. And so what they landed on were five main pelvic floor dysfunction symptoms, and then 28 risk factors for pelvic floor dysfunction. So with that, in order to be included on this screen, they had to have over 67% of the consensus of the group. And this went through two rounds. So it was like 43 and 37 were the two rounds of number of professionals. So of those two rounds, 67% or higher had to agree that they felt that these were indicators for potential pelvic floor dysfunction screens. So with this screen, there was this top section of score A, which was five main pelvic floor dysfunction symptoms. So this was things like leaking urine, urinary urgency, leaking gas and stool. And with these five, if they answered yes to any one of these, then they recommend an automatic referral to a pelvic floor specialist. Doesn't necessarily specify PT, but could be a urogynecologist or somebody that specializes in treating the pelvic floor. From there, there was 28 risk factors that they delineated. With these 28 risk factors, they either landed in the categories of score B or score C. If they were score B, that means that they had greater than 14 of these risk factors. These risk factors were pretty broad. I actually really loved the things that they included. So this was things like whether or not somebody's in menopause, if they've been diagnosed with hypermobility or connective tissue disorder, if they have a family history of urinary incontinence or a family history of pelvic organ prolapse, their BMI being under or over a certain range. So they really took a lot into account here under the risk factors. And if they had a score of greater than 14 for those risk factors, then they fell under a score B, and that would be a recommended referral to a pelvic floor PT or pelvic floor specialist. So score A, for sure, send them. Score B, we recommend you get this checked out. And then score C was less than 14. So if they didn't have more than 14 of these risk factors, Then it was just monitor, kind of keep an eye on them and see how they do. And when they made this screen, they made it as a kind of touch point to repeat. So maybe you start this at the beginning of the season, and then as they begin off season, you start or you re-screen this. So this is kind of an easy ongoing screen to see how things are changing as these athletes are evolving potentially, whether they're in off season or in season. Or if, again, we're thinking about just our general population, maybe once a year when they're coming in or once every six months when they're coming in, we're doing this really quick and easy screen to determine if they would benefit from a referral for pelvic floor PT. One thing to kind of note about this is it was specifically created for female athletes. Again, broad term for athletes here, but specifically created for females. So no males were included in this when they were breaking down the rationale for when somebody would benefit for a referral for PT. And so we don't really have a good resource of when our males need to be referred to PT just yet. Maybe that's something that'll be coming out in the research soon. And then also just note that this hasn't been like validated by any further research yet. This is kind of the kickstart point of, Hey, we've got this group of experts that have come together. We don't really have a lot of information in this space. Let's come up with something so that we can then push this out there and see how it flows. So, Love it. It's really awesome. PFT Sentinel is really in-depth. It has a lot of really great risk factors on there. When we were putting together our screen, our thought process was a little bit different. It was a little bit more leaning in towards something quick and easy that, like I said, we can put in our intake forms and just have people check things off. You could really even use this as marketing. So I actually do use a pelvic floor screen on the backside of my flyers. So on the front side, I have all of my business information. I've got a QR code for people to book a session pretty easily. And then on the back is the pelvic floor screen printed on it. So as people are setting these out, it's got our business logo on the top, set it on a counter at the chiropractor's office or at the gym or whatever, and they can pick up the screen and read through it. and it says at the top if you say yes to one of these following questions, you might benefit from Pelvic Floor PT. So, great option for marketing, great option just to have as part of your intake form in your paperwork. If you are not a Pelvic Floor PT and you're not really sure who you should be sending to Pelvic Floor PT, it's also a really great resource to have on hand. So, diving into our specific screen, what we really focused in on were what we felt were kind of the heavy hitters for recommendations for pelvic floor PT, and then maybe some of the things that doesn't necessarily jump out at somebody that's not in this space. So, some of the more obvious ones would be like experienced urinary leakage, urinary urgency or frequency, issues with remaining continent or holding in gas or stool, sensations or feelings of heaviness or seeing something bulging at vaginal opening and then really leaning into the pain side pain or discomfort and we really kept this grog because we've seen pelvic floor dysfunction show up as hip pain, we've seen it show up as low back pain, we've seen it show up as groin pain, and so we really wanted to kind of catch a broad range here, especially if you are the orthopedic PT who's maybe been seeing somebody for their hip and you're doing all the right things and you're like, I'm crushing this, but they're just not 100% better, maybe that would be the time to kick them over to a pelvic floor PT if you're not doing pelvic floor. and see if there's some contribution from the pelvic floor to that issue. Childbirth, whether it is a vaginal or a cesarean delivery, both of these situations we feel weren't a referral to pelvic floor PT, just to really kind of recalibrate and get things on the same page again. Being in menopause or perimenopause, A, from the education standpoint, there is so much education that we can provide to this population. but also just kind of staying ahead of any problems or symptoms that may arise as they're progressing into this low estrogen state. And then having a history of relative energy deficiency in sport. And this is something where we might need to lean into our providers to do some education. If somebody doesn't know what that is, really knowing if somebody's had irregular cycles, if they have these chronic injuries, or one week you're seeing them for their knee, the next month it's for their shoulder, the next month it's for their back, these signs of these chronic kind of nagging injuries would be a thing to hone in on that maybe they're potentially in this relative energy deficiency in sport state. We've got a lot of really great information out there, lots of podcast episodes about reds that we've done as the pelvic division. So if you're unsure about that, definitely go to YouTube and type that in the search bar and pull that up so you can learn a little bit more about that topic and really be able to screen that a little bit better. But again, we came up with this resource. I hope you guys love it. I hope it's helpful. We've been asked for it at our pelvic courses. I've been asked for it at our other courses that I've attended just as a participant. OrthoPTs that are like, I'm not really sure what I'm supposed to do. Can you please come up with a resource that we know how to screen? So we're really excited about this resource. It's going to be on the ICE app. So keep an eye out. In the app, we'll also blast it out on the pelvic newsletter. So if you're not signed up for the pelvic newsletter, go ahead and get signed up for that. And same thing with hump day hustling as well. Sign up for that. That way you know exactly when it gets posted, exactly when it goes live, and when you can download it to have it as part of your screens. SUMMARY If you are somebody who wants to be in the pelvic floor space but maybe isn't in the pelvic floor space yet or you want to learn more about pelvic floor pt then jump into one of our courses We've got so many live courses coming up. Christina and I are actually teaching in Spring, Texas this weekend at my home gym. I'm so excited. We still have openings there if you want to come hang with us. But lots of offerings for our live course coming up, as well as our L1 coming up again. And then our L2 is sold out for this upcoming cohort, but we do still have spots open. in our fall cohort so head to the website figure out where you can jump into a pelvic course if you're interested in learning more about pelvic floor pt and how to treat these women If you're not really sure how to treat these women or who should be referred out, head to the resources link. You're going to see this resource posted in just a bit. And then we are excited for you guys to have it out there. Use it for marketing if you are a pelvic PT and let us know how it goes. Thanks for joining in. I appreciate it. I hope you guys have a great day. 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.

In today's episode, Tom visits the Tenement Museum on the Lower East Side to walk through the reconstructed two-room apartment of an African-American couple, Joseph and Rachel Moore, who lived in 1870 on Laurens Street in today's Soho neighborhood.Both Joseph and Rachel moved to New York when they were about 20 years old, in the late 1840s and 1850s. They married, worked, raised a family – and they shared their small apartment with another family to help cover costs. Their home has been recreated in the Tenement Museum's newest exhibit, “A Union of Hope: 1869.” The exhibit reimagines what their apartment may have looked like – and it also explores life in the Eighth Ward of Manhattan, and, specifically, within the black community of the turbulent and dangerous decades of the 1850s and 60s.This is the first time the museum has recreated the apartment of a black family – although, as you'll hear, the museum's founders had long planned for it. And the exhibit is also the first time the museum has recreated an apartment that wasn't housed in one of their buildings on the Lower East Side, but in another neighborhood. So, just who were Joseph and Rachel Moore? And how and why did the Tenement Museum choose to put them at the center of their new exhibit?  FURTHER LISTENING:Tales from a Tenement: Three Families Under One Roof (episode #246)Nuyorican: The Great Puerto Rican Migration to New York (episode #384)The Deadly Draft Riots of 1863 Seneca Village and New York's Forgotten Black Communities

On this week's PreserveCast, join us as we talk with Annie Polland, President of the Tenement Museum, about their new exhibit A Union of Hope. Annie will take us through how they discovered the story of Joseph and Rachel Moore, Black New Yorkers who lived in the tenement in the 1860s – 1870s, and how they recreated their apartment in the Tenement Museum while navigating historic preservation and interpretation.  

Dr. Rachel Moore // #ICEPelvic // www.ptonice.com  In today's episode of the PT on ICE Daily Show, #ICEPelvic faculty member Rachel Moore discusses a story of usual patient care when experiencing menopause in the American healthcare system. 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 RACHEL MOOREAlright up and running on Instagram and YouTube. What is up guys? My name is Dr. Rachel Moore I am on faculty with the pelvic division here at ice Pollen has been wild in my area of Houston and I have a sinus infection. So I Sorry about the congestion that you're likely going to hear throughout this episode. This morning we are here to talk about menopausal women and how they deserve better and how they have been kind of set aside and really isolated in the type of pelvic care that we are starting to see normalized. I really want to kick this off this morning with a story that inspired me to even pick this topic. So Last weekend I was teaching in California with Alexis for our pelvic live course and on the plane I ended up sitting next to this older couple. It was a husband and a wife and they were having a hard time like connecting to the Wi-Fi. I didn't really know how to get the United app up and running so I leaned over and I helped him kind of figure that out and I had my iPad with all my slides next to it because I was going to prep for my lectures on the plane. So I always like to work on the plane on the way there. And the lady leaned over and she was like, oh, like, thanks so much for your help. And just kind of started making small talk. Asked what I was traveling to California for. And I told her that I was actually going to work. I was going to go teach other physical therapists because I was a physical therapist. And so this kind of kick started a whole conversation where she was telling me she was flying out to California to run a marathon and she had been rehabbing a hamstring injury for like two years and she had gone to in-network PT and then she had gone to out-of-network PT and all along the way like her hamstring would get better and then it would come back and it would get better and it would come back and so we kind of chit-chatted about that a little bit talked about her running volume and things like that and then I kind of alluded or something I said I don't even remember exactly what it was but told her like I'm actually a pelvic floor PT and that's a big part of what I treat And she was like, oh my goodness, I can't believe this. Like I just had a pelvic floor evaluation and her husband leaned over and he was like, oh boy, you have no idea the can of worms you just opened. And we, she really just dove into her story. And so she had had surgery or not surgery. She'd had a bladder pacemaker put in because she was struggling with urgency and frequency of urination. So she had been at this point to a gynecologist, to a urogynecologist, to an orthopedic doctor for her hamstring, and on the MRI that was done for her hamstring, the report also said that she'd had some issues with her bladder, and she asked her ortho doctor about it, and he was like, I don't know, all I know is about the hamstring, I'm not here to treat your bladder. and she was really feeling hopeless about her pelvic floor and about whether or not she could get help for her pelvic floor. She'd gone to a pelvic floor evaluation and she said it was really helpful and she learned a lot but it was an out-of-network provider and she'd already spent a lot of money on out-of-network care for her hamstring and she didn't want to dive into this area at that point. And so in this conversation we really kind of got into the weeds a little bit. So through this conversation, it's like those conversations on the plane, you never know where they're gonna go. We ended up chatting about cycles and menopause, and she was menopausal at this point. And ever since she had been in menopause, that's when her hamstring symptoms started. That's when she started noticing issues with the pain in her hamstring, and we started talking about fueling especially with her running volume and we started talking about how there's estrogen receptors in other parts of your body aside from in your ovaries and all of the ways that being in menopause can potentially set you up for issues with your musculoskeletal system And in this conversation, she was shocked because nobody had ever really talked to her about what menopause consists of, all of the different ways that menopause can cause issues aside from just you don't have a period anymore, you may have hot flashes, and it was really upsetting to her. And we kind of continued talking over the course of the flight, it was a four, three and a half, four hour flight, and it kind of dawned on me in that in this moment in this conversation because she had a son and we were talking about how when she had her son pelvic floor pt was not done nobody talked about it nobody uh it was just normal that you pee on yourself and i know these days we like to feel like that is still a thing but if we think about perspective shifts like 20 30 years ago It was even less common than it is now, right? Like it was not a thing that was really prescribed at all. So many women were getting surgeries right out the gate after having had their kids. And so this group of women that are now going through menopause were really kind of, I don't want to say shafted, but shafted in their prenatal and postpartum pelvic floor care. And I think that that means that we as pelvic floor PTs need to put it out there that we can help them because they have lived their entire lives up until this point, believing that it's normal to pee when they sneeze, believing that it's normal to leak when they exercise, maybe not exercising at all because this has been something that they've dealt with since they delivered their kids 20 or 30 years ago. And now is the time that their symptoms are potentially flaring back up. We see an increase in pelvic symptoms as we transition into this stage of life. And so if we are not addressing these issues and we're not putting it out there that we can address these issues, women aren't getting the care that they deserve. And not only did they not get the care that they deserve initially, when they first got into this pelvic floor space after having had a baby, they're not getting it now. I think as pelvic floor PTs some of us may really lean into the prenatal and postpartum space and it makes sense because a lot of us are maybe in that time stage of life where either we are having kiddos or people that we know are having kiddos or maybe thinking about it in the future. And so it really feels like this easy transition as we're entering into the pelvic space to lean into the prenatal and postpartum space. And it is needed. I'm not saying we shouldn't do that, but I think as pelvic PTs, we really need to get comfortable with explaining menopause and explaining the changes that happen in menopause. And more importantly, talking to women and talking to providers like, gynecologists like urogynecologists getting together with these people and letting them know like we can help mitigate these symptoms. We can help be an adjunct to care on top of things like HRT or hormone replacement therapy which absolutely should be talked about especially now that we're seeing the shift away from like absolutely don't do HRT because it can increase your breast cancer risk We're seeing that language changing. And so it's exciting to see these women start getting the care that they need in the realm of HRT. But as pelvic PTs, we can step up to the plate and help layer on even more in terms of helping them manage their pelvic floor symptoms, the genitourinary syndromes that they're experiencing. We can really talk to them about building up strength and building up muscular support for their bones as everything changes with their bone mineral density. We can maybe teach them how to exercise for the first time if they're people that have been avoiding exercise for the majority of their life because of symptoms that they have been experiencing since they first had their babies. So really, my whole point of this episode this morning is if you are not in this menopausal space, If you're a pelvic PT and you're not comfortable talking to people about menopause, or you really don't feel like you know enough about menopause to really truly serve this population, I truly feel like it's time for us to step up to the plate and get comfortable with it. We have a lot of resources out there. A few resources, I'm just going to list a couple because otherwise it kind of sounds like a rambly list. The North American Menopause Society actually has like a provider list that you can go in and search for menopause-informed urogynecologists and providers. Letstalkmenopause.org is a website that you can take a peek at, you can also direct your patients to, has resources for patients, really kind of breaks things down into patient-friendly language. The Menopause Manifesto by Dr. Jen Gunter. And then in our live course, we actually dive into menopause in week five. And we talk in more depth about how, sorry, our online course, not live course. We talk in depth about how we can help as PTs serve this group of women. I really feel like it is time for us to do this y'all. I think that this group of women and maybe it's my heart going out because I'm thinking about like moms and grandmothers and all of all of these women in our lives that have just been told that this is something they have to deal with. And now they're being told this again. It's time for us to help change this. It's time for us to bring fitness forward PT to this group of women, especially this group of women. They deserve it. I don't want to say more than anybody else because absolutely we all deserve it, but they deserve to get this quality of care. SUMMARY If you're interested in jumping into our online course to learn about menopause in that week five, our next cohort opens up April 29th. We have two live courses coming up, April 6th and 7th in Windsor, Colorado, April 13th and 14th in Spring, Texas. That's where you can catch us on the road in April. We've got some more courses coming up in May as well, so if you're looking into summer, hop on the website, sign up for a live course, and catch us on the road. Thanks for tuning in this morning. If you guys have any questions about menopause, reach out to all of us on the ice pelvic faculty and we'd be happy to answer. Thanks. Have a great Monday. 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.

A quick note from show producer Rachel Moore. Follow Just Trust Me podcast on TikTok, Instagram, and now on Threads @justtrustmepodcast

A quick note from show producer Rachel Moore. Follow Just Trust Me podcast on TikTok, Instagram, and now on Threads @justtrustmepodcast

FIRST EPISODE DROP of the Just Trust Me Podcast. Hosted by Elizabeth Allen, Rachel Moore, and Tanya Ballard Brown. From cowboy hats to friendship bracelets, what are Bey and Tay up to? Is Valentine's Day for all brands? Is Elmo our new therapist? And is Charlotte Tilbury just messing with us? Join Rachel, Tanya, and Elizabeth as they discuss the wide world of marketing and how it drives the culture! 

FIRST EPISODE DROP of the Just Trust Me Podcast. Hosted by Elizabeth Allen, Rachel Moore, and Tanya Ballard Brown. From cowboy hats to friendship bracelets, what are Bey and Tay up to? Is Valentine's Day for all brands? Is Elmo our new therapist? And is Charlotte Tilbury just messing with us? Join Rachel, Tanya, and Elizabeth as they discuss the wide world of marketing and how it drives the culture! 

In this February edition of our NAIA-SIDA Spotlight series, Rachel Moore visited with Jeff Braun, Assistant AD/Sports Information Director of Midland University in Fremont, Nebraska. The duo visited about Jeff's time in high school athletics early in his career and how he oversees one of the largest athletic departments in the country. This content is produced/provided by NAIA-SIDA.

Dr. Rachel Moore // #ICEPelvic // www.ptonice.com  In today's episode of the PT on ICE Daily Show, #ICEPelvic faculty member Rachel Moore discusses the ins and outs of bracing and how to engage in conversations with fitness professionals to make sure we are all speaking the same language. 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. RACHEL MOORE Good morning, PT on ICE Daily Show. What is up? It is Monday morning. My name is Dr. Rachel Moore. I am here representing our pelvic division, hanging out today to chat with you guys about bracing. So really breaking down the brace, understanding this concept a little bit more, understanding maybe where some pitfalls are in our communication with our fitness professionals that we are working with. So diving into that, let's just get started. IS ALL BRACING INSTRUCTION THE SAME?The brace as a term is kind of like poorly defined. There's really an understanding maybe in the PT world of what the brace is and then maybe in the strength world of what the brace is. And oftentimes what we're seeing or what we're getting feedback from is maybe there's a disconnect between what we're teaching as PTs or being taught as PTs and what the fitness professionals in our communities are being taught. And we wanted to kind of break down where this comes from. So for one, a lot of times fitness professionals aren't necessarily ever truly like taught how to do a brace. The most common cue we hear in like the fitness professional space is brace like somebody is going to punch you in the belly or like somebody is going to hit you in the stomach. And a lot of times that kind of brings about, or people think that this means this push out and this push out. on the PT side of things is actually what we're trying to avoid. And so we get some feedback from students in our courses and that's actually kind of what inspired the topic today is we got an email from one of the students who had taken our courses who said that she was kind of hearing from fitness professionals in her community that the way she was teaching the brace wasn't correct. So what do we do with that conversation? How do we navigate that conversation with those fitness professionals? And how do we kind of get across that we're probably saying the same thing, but it's not coming across the same way. WHAT DOES IT MEAN TO BRACE? So first thing I want to do is really define what the brace is. And in order to define what the brace is, we have to define the component pieces of the core canister, which is what's involved in the brace. So when we're talking about our core canister, we're talking about a 360 degree canister that has a top and a bottom. The top of that is going to be our diaphragm. The bottom of that is going to be our pelvic floor. The front insides are our anterior abdominal wall. A lot of times people just say, oh, that's the transverse abdominal muscles. But in reality, we have to understand that that is more than just the transverse abs. That's actually all of the layers of the abdominal wall. and then the back is the spine and the muscles of the spine. When we talk about this brace, we want the canister to have equal pressure distributed around it and dissipate forces in an equalized manner, rather than maybe one side of the canister getting too much force, which then causes a leakage of pressure into a different direction. So when we're explaining the brace, or we're teaching the brace, We oftentimes teach it as tense your abs, or think about pulling your pelvic bones together. A cue that we use a ton over in the pelvic division with our pregnant athletes is if you have a baby, hug your baby, or if you can remember what it felt like to recently be pregnant, hug baby, that pull together of the abs. We are never queuing a push out because if we think about this canister, a push outwards is going to cause a mismatch of pressure within the inside of that canister. That's then going to come downwards through the pelvic floor. And oftentimes in the pelvic space can elicit pelvic floor symptoms like leakage, heaviness, or farting in the bottom of a squat or when we're lifting. so we expect that the pelvic floor is going to match the degree of abdominal brace we don't necessarily cue an intentional pelvic floor contraction when we're saying brace we might in our populations that are having issues with symptoms cue almost like an over correction because especially if there's somebody that's actually bearing down or pushing when they're bracing and not understanding that they're lengthening their pelvic floor rather than either staying at the same level or allowing their pelvic floor to match the demand of everything that's on top of it. So when we're cuing our brace, it is tense your abs, pelvic floor either stays the same or we slightly lift pelvic floor to match that pressure. That's how we teach that brace. THE CONFUSING NATURE OF THE WEIGHTLIFTING BELT The confusion I think comes in especially when we start talking about layering in a belt. So oftentimes in the strength training world, we see athletes busting out a belt and maybe they're using it all the time for every However, whatever the weight is on the bar, it's not necessarily just that they're heavier lifts or maybe they're reserving it for their heavier lifts. The key thing with the belt is that when we layer in the belt, the brace doesn't change. And that's something that I think we need to make sure our athletes and our coaches are understanding is that the belt is there to give us this extra support and really proprioceptive input to allow that increase in spinal stiffness to happen, but it is not a mechanism to push into. and I have my husband's belt. I left mine at the gym, so this isn't gonna fit me exactly right, but I wanna walk through the fit of the belt and where I think this confusion maybe comes from when we start talking about fitness professionals queuing a push-out. So with the belt, when we're talking about using a weightlifting belt, we want to think about, if you have YouTube or Instagram live up, I've got the belt here, and I'm just gonna kinda walk through the fit of the belt and what we're looking for. So when we are putting a weightlifting belt on, we're looking to fill that space in between our pelvis and our ribcage. If there's a little bit of overlap, that's totally fine, but we're kind of going like the top of the pelvis and that's my marker for where this belt is going to go. When I put my belt on, I'm going to put my belt on and as I tighten it, I want to fully exhale. I'm not like sucking in and shrinking and shriveling up as tiny as I can. I'm just doing a comfortable exhale. And then from there, I'm tightening. And in this tightening, I can breathe. I can talk. I can put a finger in between me and my belt, and I'm not uncomfortable. It's not squeezing me. If we have the fit of the belt correct, then that approximation that comes from inhaling i think is maybe what the confusion is coming from so if i have my belt on right i tightened it on my exhale as i do an inhale and i think about inhaling into my belly and into my spine that good solid 360 breath i feel my tissues push into that belt that is different than me intentionally pushing into the belt, that push your belly out sensation. If you're watching this live or listening to this later, put your hands on your belly and feel what happens when you push your stomach out. What do you feel at your pelvic floor? More than likely, it's a dropdown. If we think about tensing our core, Usually we don't feel much there. Maybe we feel a slight lift. And if we do feel a drop down, then we over correct and think about going up towards the basement to mitigate that. But the key here is the fit of the belt and understanding how to do that brace. So where does the confusion come in? When we're talking about our fitness professionals or maybe people who have never been trained in how to use a belt, the thought is to push out into the belt to create that contact with the belt. But if we have the belt fitting correctly, we don't need to do that push up. That's the biggest thing that I want you guys to understand and take away is it all comes back to the fit and making sure that we're using that belt correctly. Even without the belt, our brace stays the same, right? We're thinking inhale into belly, tense abs. It's never push out as if we're pushing our abdominal wall away. WORKING ALONGSIDE FITNESS PROFESSIONALS So when we're having these conversations with Fitness professionals or other coaches in our community who are maybe pushing back and saying like that's not how we teach our brace Really breaking this down and explaining to them where we're coming from and why. I think a lot of the time like we assume that everybody is just saying the opposite just for the sake of saying the opposite or maybe like they're just digging their heels in and there's no sense in educating them. But in reality like we have a lot of opportunity here to create bridges with these fitness professionals and create positive relationships. And we're not gonna do that by saying, well, you're wrong, or telling the athletes, well, your coach is wrong, just do it how I teach you. So using this as an opportunity to get in front of those coaches and those fitness professionals, and as a way to kind of bridge this relationship of, hey, you guys are coaching, I'm teaching your athletes, I would love to get on the same page, this is how I teach a brace, this is why. The goal here is to create equalized pressure across this core canister, If we push out in one direction or another, we put ourselves at risk of potentially having pressure leakage, quote unquote, out through that wall. It's also just not as strong. And at the end of the day, all of us are here to help people get stronger and move better. So if we think about this and conceptualize all of these walls of this castle being strong rather than one being broken or pushed out, then we can kind of understand that that applies into better, more efficient bracing mechanic, which then leads into better lifting and higher strength with our sets that we're working on, increasing our strength and capacity there. If this is confusing to you, I've got another podcast episode, episode 1577 of PT on Ice Daily Show that's all about the Valsalva, kind of breaks down a little bit more of the specifics of the Valsalva, which is that breath hold with the brace. The Valsalva can also have the belt, so we can have this spectrum of breathing. SUMMARY We really break down the spectrum of breathing in our live courses. Our live course is coming up in March. There are so many opportunities to catch the live course out on the road in March, y'all. March 2nd and 3rd in California, 9th and 10th in North Dakota, 23rd and 24th in South Carolina. So holy cow, so many opportunities to come hang out with us. Be on the lookout. Christina Prevett and I also did a clinical commentary that will be coming out in the spring 2024 edition. of the Journal of Pelvic Obstetric and Gynecologic Physiotherapy, so that should be coming out here pretty soon. We'll be blasting that all over the place when it does come out, but be on the lookout. Sign up for our pelvic newsletter, because that's gonna be one of the first places that drops, as well as on our hump day hustling. Thanks for joining me this morning, guys. I hope that cleared up some confusion. If you have any questions about bracing, or you're not sure how to explain it, or anything along those lines, please reach out, shoot me a message. I'm happy to chat with you more. 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 discusses how to get patients performing more fitness in their plan of care, as well as suggestions on how to help patients transition to becoming "everyday athletes" with a wide variety of home & community fitness programs. 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.RACHEL MOORE Good morning, PT on Ice Daily Show. It is 8 a.m. on a Monday morning, which means we are here tuning in for our ice pelvic. We are hanging out here today. We are gonna be talking about building the bridge to fitness in the pelvic floor PT space. So we talk a lot at Ice about being fitness forward. We've had Jeff Moore on the podcast a few weeks ago talking about what fitness forward means. and we really pride ourselves on being fitness forward right sometimes that can create this like mindset of if i'm not seeing athletes quote unquote how can i bring this fitness forward um style of therapy into pelvic floor pt WHAT DOES BEING AN ATHLETE MEAN? And first I want to talk about what athlete means, like define what that means in this space and kind of dive in from there. So when we talk about like athletes, quote unquote, in our space, that's anybody that's like intentionally moving their body for exercise. That doesn't mean that they're CrossFit Games athletes. That doesn't mean that they're super competitive. It just means that they are moving their body intentionally to get some effect. I would argue that every parent that is chasing after kiddos is an athlete in that case. And so if we take this term of athlete and broaden it out, we can apply that concept to everybody that walks into our clinic. This is a really huge key point in the pelvic space because there are so many people that are coming into pelvic floor PT that maybe have not ever exercised before or maybe exercise like back in high school played sports and since they graduated high school haven't done anything in the gym intentionally or haven't done any sport. So this season of life of pregnancy and even postpartum is a fabulous reintroduction into potentially the world of exercise. And that's where we come in. So when we have people coming in that are pregnant that want to get out of pain, maybe their goal isn't even anything to do with staying in the gym or getting back into the gym and their entire goal is to get rid of their back pain in pregnancy or get rid of their pelvic girdle pain in pregnancy. We can help not only accomplish that, like we know that. We talk about it in all of our courses, in our live course and in our online course, how we can use resistance training to mitigate pain and get rid of pain in these populations. But we have a fabulous opportunity here to literally change somebody's life. We can help them fall in love with fitness and fall in love with that feeling of being strong. a lot of times people are coming in and again maybe they haven't resistance trained ever and we put a barbell or a dumbbell in their hands and they kind of look at you like I'm not really sure who you think I am but there's no chance I can do this and so having conversations with them about like look this is a 20 pound dumbbell and your toddler weighs 30 so yeah you can and I know this looks scary because it is this little metal handle with two big old heads on the side But in reality, you're already lifting more than this. Let's just build your capacity by doing it intentionally at a higher volume. And then they start feeling those effects of that. We can have so many downstream effects from resistance training, not just getting them out of pain, not just giving them a new hobby. We can shift the trajectory of their life and impact things like metabolic diseases in their future. So this really is a powerful thing that we can do. And we have to recognize that every time somebody comes into our clinic, whether or not they've exercised before, we have a lot of opportunity to help build this capacity for them, not only physically, but also emotionally and mentally. In our PT sessions, we do a lot to help build confidence and rapport, right? Like we're in there with them. We're going over form. We're talking to them about like, okay, this is how you do a deadlift. This is how I want you to brace. This is what a brace means. Now we're going to practice it. Let's go apply it. Like let's actually lift heavy things while bracing. And when they're in the clinic with us, that can be incredibly empowering and amazing. And we love that, but sometimes that doesn't translate over into the next step. So great. WHAT TO DO AFTER FORMAL PT HAS ENDED? When I'm in the clinic and you're watching me do the things, I feel awesome and I feel like I can knock that out of the park, but I'm just not really sure what to do when I leave here. A lot of the times the way that I'll program HEPs is I'll do like our rehab EMOM style and I'll give them two or three workouts, if you will, and they cycle through them. But I think we all can agree that if you're just doing the same thing like three times in a week, so like A day, B day, C day, and do that for a few weeks, it can kind of start getting stale. And we kind of like crave that variety, right? Especially as people are starting to get a little bit more confident. So there's kind of this like gap between I'm done with PT, informal PT sessions. A lot of clinics are now coming out with like once a month or like once every other month kind of like check-in style appointments where you come in, you get a progression of your exercises, you get maybe some updated programming, and then you go off for another month or so on your own again. And those are really the two big things that we see. And then the third option is like, okay, you discharge and you're done. I'm here to talk today about another option, right? So when we have our person who's coming in and they've been coming to us for several weeks, they're feeling really great or maybe a couple months and they want to continue working out, but they want something a little bit more than once a month. and they don't really want to do like a full blown PT session. Like they just want to come in and work hard. We've got two options. We can create a program within ourselves and within our clinics, or we can get really, really good at helping find a home gym or a home space for them. If we're talking about the creating a program route, this is something we're about to roll out in my clinic. We're calling it like the bridge. Feel free to take that same concept. But the whole idea is when you're done with PT, quote unquote, like you're not in pain anymore, all your symptoms are gone. You're feeling really solid. You want to work out, but you're just not sure where to go and you're not sure if you feel like you can confidently take the things that we've done in our sessions. and apply them across the board, this is the spot for you. So we're doing it as a couple times a week and obviously this depends on what the capacity is within your clinics. We're rolling it out starting out two times a week and these are group HIIT style classes, where we're going to have a cardio component, we're going to have a strength component, we're going to take them through different movements, and so there will be a variety of movements that they can increase their comfort and their confidence in while they're in our classes. They're also building community here. They're meeting other people that are in a similar stage of life as they are. Not only are they maybe pregnant or postpartum just like they are, but they're people that are wanting to get into exercise and wanting a little bit more, but maybe haven't really known how to do that up until this point. So we're taking these people and we're bringing them together and then we're lifting heavy things together. So powerful. If you've ever set foot in a CrossFit gym or any type of like group fitness setting, you know how powerful these connections are that get built in under like shared suffering, if you will. This class, though, isn't meant to be forever. Like, its whole goal or the whole purpose is to build capacity, increase confidence, so that these people can go from working out a couple times a week, doing their PT exercises, and then coming to these bridge classes. But I want you getting to the point where you're like, let's send it five days a week, or whatever that looks like in your schedule. And truthfully, I want you to have more variety. Like I want you to get out and do different things and try new sports. BUILDING A NETWORK OF FITNESS PROFESSIONALS And so that's where option two comes in, where we as professionals need to have a really reliable, strong network of fitness providers. So we need to know not only the CrossFit gyms in our area, Because truthfully, not everybody vibes with CrossFit. That's OK. There's the whole phrase, like, CrossFit is for everybody, but it's not for everybody. So CrossFit gyms in your area, knowing those coaches, being comfortable with, like, if I send you there as a newbie, I know that you're going to be in really solid hands and be taken care of. But also the other types of workout spaces, too. So we're thinking things like F45 or burn boot camp, maybe having some options for, like, Pilates studios, where you've taken some classes there you understand how they teach the bracing piece of it and if it isn't maybe what the way that you've taught them you kind of have that conversation beforehand or you have an opportunity to educate those Pilates instructors on like hey this is how we do things from a pelvic floor PT side you've got somebody coming in that's postpartum or pregnant So this is kind of the messaging that we have. We also really love things like PureBar. We've got actually evidence for PureBar helping reduce stress urinary incontinence, not even full-blown pelvic floor PT, but just going to PureBar classes. So having a variety, knowing who these people are, knowing what these spaces are like, and knowing what the environment is like. It is powerful to be able to have your hands directly on give the people the thing that they need as far as improving their fitness and improving their form. But it's also powerful to then watch them take that and go off into the world and utilize it. And then you're seeing them maybe on Instagram months later, or you run into them at a workshop, and they've been going to these gym classes for like a year. And now maybe they're competing at different things that they're in CrossFit. And you can see this like spark ignite. And we have the opportunity to start that spark at our very first visit, our very first appointment when somebody comes waddling into our office because they're in so much pain, they can't even take a full length step because their pubic bone pain is so bad. We can be the ones that not only knock that pain out, because I know we can, but also create this bridge into a completely different life for this person. Increasing their capacity, increasing their confidence, helping them find community and support, and having that far reach outside of the realm of what our typical plan of care is. This is huge. This is a massive piece of the puzzle in the pelvic floor PT space. So if you are not somebody who has the ability or desire, totally understand, to create a group class within your own setting, whether it's in your clinic or your gym or whatever, start reaching out and start making those connections with providers, fitness providers in your area. Meet those gyms, take those classes, get out there and build that network. Have some cards on hand when your patients are talking about, hey, I just really think I'm ready to get out there and do more. Lay them all out. Here's everything we know about all the gyms in the area. Let's talk about all your options and help you find the perfect home for you. I hope that kind of lights a fire under you guys if you have an eval coming in this afternoon on the ways that you can really implement all of these strength training principles to change their lives and also to get out there and make some connections in your community. SUMMARY If you are looking to join any of our pelvic classes, we've got our live courses. We actually have a ton coming up in the next couple months. We've got one in February, February 3rd and 4th in Bellingham, Washington. And then we've got three rolling out in March. Our first two are gonna be March 2nd and 3rd in Newark, California, and March 9th and 10th in Bismarck, North Dakota. Our next online cohort comes on March 5th. If you're interested in that L1 online cohort, hop into it, because we are, man, we're getting full. So grab your spot before there's not one, because if so, you've gotta wait another nine weeks after that March 5th cohort to hop into the next one. I hope you guys have a great Monday morning. Absolutely crush it. Thanks for joining. 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.

I interviewed LA's Top Home Staging Company Lead Designer. A part of a trio renowned for their love of architecture, good design and great lines, Rachel Moore can walk into a room and know exactly what it needs with a glance.  Nestled in LA's much-hyped Northeast neighborhood, Madison Modern Home is a staging company that averages 100 homes each year, staging more than $100 million worth of real estate in 2022 alone. All beginning from leasing a 7,000-square-foot warehouse. Sitting with Rachel to talk about their origin story, lessons learned, struggles, and the systems they've implemented to improve their business was a session I did not want to end.  Whether you're in the growth phase or looking to accelerate or leverage your staging business, there's valuable information for you in this conversation.   WHAT YOU'LL LEARN FROM THIS EPISODE: How Madison Modern Home came to be and its beginning low days. How Madison Modern Home appeals to its customers. What the inventory system at Madison Modern Home is like. How Rachel has improved at handling "not so great" feedback or change requests. The mindset shift that brought a new perspective on what clients to work with.   RESOURCES: Join Rethink You Accelerate Follow Lori on Instagram  Follow the Staging Business School on Instagram   Madmod Home's Website Madmod Home's Instagram Robin DeCapua's PR Course: Five Steps To Getting Media Coverage For Your Home Staging Business The E Myth Revisited on Amazon  If you want to learn how to market and grow your staging business, enrollment is open for Rethink You Accelerate. This is a year-long mentorship program, where I help you and other staging business owners plan, grow, flow, and thrive with the results that you've always wanted. The doors are open and I would love to see you in the classroom!   ENJOY THE SHOW? Leave a 5-star review on Apple Podcasts so that more Staging CEOs find it. Also, include links to your socials so that more Staging CEOs can find you. Follow over on Spotify, Stitcher, Amazon Music, or Audible.  

In the January edition of NAIA SIDA spotlight series, Rachel Moore, Assistant AD/Director of Athletic Communications at Central Methodist University, visited with veteran SID Ryan Wronkowicz of Lourdes University on his time at both the NCAA Division I and NAIA levels. Ryan gives us an insight look into the inner workings of SIDs at the NAIA level and additional responsibilities as an Assistant Athletic Director. This content is produced/provided by NAIA-SIDA.

This  week we talked to Rachel Moore DPT who work with Christina at the institute of clinical excellence in there pelvic and postpartum division.She opens up about her own experience with preeclampsia during her birth stories and especiallly postpartum.Rachel is joining us as a coach with TBM to take on 1 on 1 patients with either programming or ___________________________________________________________________________Don't miss out on any of the TEA coming out of the Barbell Mamas by subscribing to our newsletter You can also follow us on Instagram and YouTube for all the up-to-date information you need about pelvic health and female athletes. Interested in our programs? Check us out here!

Dr. Christina Prevett // #ICEPelvic // www.ptonice.com  In today's episode of the PT on ICE Daily Show, #ICEPelvic division leader Christina Prevett discusses the role of estrogen in the body, the important role estrogen (or lack thereof) may play in rehab outcomes, assessing menopause in the clinic, and hormone replacement therapy. 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 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. CHRISTINA PREVETT Hello, everybody, and welcome to the PT on Ice Daily Show. My name is Christina Prevett. I am one of the lead faculty within our pelvic division. And y'all, the pelvic division has been just really busy over the last couple of weeks, couple of months, heck, the entire year. But if you did not see, we actually just sold out our first online cohort for 2024. And so that is sold out. So our next cohort for our online level one is March 5th. Our brand new inaugural cohort for level two, if you've taken level one, is April 30th. And in 2024, I am going to be in Raleigh, North Carolina with Rachel Moore, January 13th, 14th. And Alexis is going to be teaching in Hendersonville, 27th, 28th of January. And then we're heading over to Bellingham, Washington, February 3rd and 4th. Those are the first three courses of 2024 if you guys are interested in coming to our live course and doing some of our skills check for cert. ESTROGEN & REHAB Okay, so I kind of want to talk about estrogen and specifically estrogen in later life and lack of estrogen and how it influences rehab. So this has been something that I've been really kind of geeking out about over the last little while around, you know, not just as pelvic therapists, but as anybody working with a person going through menopause, if you are working with anybody over the age of 50, a female over the age of 50, you are interacting with a person who is going through estrogen depletion in their body. And As I've learned more about the influence of estrogen on our bodies, the more I am recognizing even outside or maybe even especially outside of the context of pelvic health when I'm seeing people who are postmenopausal, but in my orthopedic rehab, how much it is influencing our outcomes. and just a person, a person who is a female in an aging body, what the lack of estrogen may do for the way that we experience aging. And then I kind of want to cap this podcast off talking a bit about some of the myths and misconceptions around estrogen replacement therapy. or menopause replacement therapy. And we'll talk a little bit about the change in the labeling of these types of treatments and where some of the thoughts around risk for things like sex-related cancers has come up. So to start this off, I want to start with a story. So I was working with a woman who was coming in. She was in her early 60s and dealing with shoulder pain. She had a history about 10 years ago of frozen shoulder. So when it comes to adhesive capsulitis, we know that being a female and being kind of in middle age is a risk factor. And I never really thought about that risk factor being linked to estrogen status or like the beginning of perimenopause. Still wasn't really thinking about it. But she said, you know, that was a really long journey when her shoulder froze. And but it got better, got better over time. She realized that she was going through hormone replacement therapy or she was going through menopause. She got put on hormone replacement therapy. She was on it for 10 years. And then her doctor on a follow up where she was trying to get a renewal said, actually, you've been on it for too long. I'm going to take you off of it, which that That's a whole other ethical scenario, especially because we should be weaning off estrogen replacement therapies, not just going cold turkey. But however, took her off and within a couple of months of that weaning process, her other shoulder started to freeze. I've obviously been in the weeds of this research right now around the influence of estrogen on our body, but I was thinking about and reflecting on how many women I have worked with over my career. THE INFLUENCE OF ESTROGEN ON OUTCOMES I've been a PT for 10 years, so very still early on in my career, but how many have I not recognized the influence of a person's estrogen status on our outcomes? And so when we think about estrogen, we think about fertility, rightfully so. We think about pelvic floor physical therapists kind of specializing in the fertility space, granted, but estrogen, when we have a depletion in estrogen as women go through menopause, it affects every part of our body where there is an estrogen receptor. And I don't think that many orthopedic therapists or people who kind of aren't niching into this space, myself included until I got into this arena, recognize just how widespread that is. And in pelvic health, we've done an incredible job of advocating for individuals in the perinatal space. We still have, of course, ways to go. However, you know, there's this rise of individuals going through menopause who are starting to advocate that we need that same type of education. And too frequently now that I've been asking are my patients saying to me, oh, well, my doctor said it was just part of aging and I shouldn't be on hormone replacement for this long or like have just been dismissed about their symptoms and have not linked some of these other body systems and the experiences that they're having in these other body systems with their estrogen depletion. I have a client seeing me for ankle pain and she's kind of in that postmenopausal window and she said, I am trying to learn a new body that I do not understand. And I think that was such a profound statement because so many individuals are feeling this way and we have a huge role to play in rehab. And I'm not talking pelvic, I'm talking generally. THE ROLE OF ESTROGEN IN THE BODY And so when we think about estrogen, estrogen has receptors in our brain. It has receptors in our joints and muscles. It has receptors in our heart, and it influences our bone, right? Bone is probably the easiest one. We know that individuals who are postmenopausal are at increased risk for osteoporosis osteopenia, that there is an accelerated rate of decline in bone mineral density loss with estrogen as rates of, estrogen helps rates of bone build up. And with estrogen depletion, we see a switch in the slope of the line where bone breakdown exceeds rate of bone growth. And so rates of osteoporosis go up postmenopausally. We also see that individuals who are in an estrogen depleted state have higher rates of joint pain. So kind of an umbrella term of joint arthralgia. and we see links to risk factors around things like adhesive capsulitis in individuals going through perimenopause, but very little research has actually looked at individuals' experiences of musculoskeletal pain in the postmenopausal window. So we could have individuals who are not responding as quickly to rehab, even though we're throwing everything at them that is evidence-based and evidence-informed, because they are going through menopause and it's the influence of their hormones is changing the way that their body is responding to some of our rehab interventions and we don't know about it. Our body also has estrogen receptors in the heart. And so we see that men tend to have a higher rate of cardiovascular disease and heart disease than women, but that change in rate between men and women starts to change in that postmenopausal window. So rates of heart disease start to go up postmenopausally because of the protective effect of estrogen on the heart. What we also see from a metabolism perspective is that there is a change to the way that fat is laid down when individuals are postmenopausal. So where we have the protective subcutaneous fat that tends to be something that is kind of a net, potentially neutral way of laying down fat, the more dangerous fat is visceral fat lay down, and that tends to accelerate in a postmenopausal female because of estrogen deficiency. which then increases risk for a whole bunch of different metabolic diseases, including, you know, heart disease, stroke, Alzheimer's disease, like all these diabetes, all of these things that we know are linked to pro-inflammatory cascades. It accelerates for individuals as they go through menopause. And then finally, from a cognition perspective, we have systematic review evidence that Individuals who go through premature ovarian insufficiency. So individuals who go into menopause before the age of 40 are at an increased risk for cognitive decline. So rates of Alzheimer's are higher in individuals who go through early menopause. And we see that there may be a protective effect, preventative effect of the development of cognitive decline for these individuals who are going through menopause early if they are on hormonal contraception. Which gives a very strong argument for the link between estrogen status and cognition. And when we think about symptoms of menopause, we kind of put them into different buckets. We talk about, you know, vasomotor symptoms, which are night sweats, issues with sleep, sleep disturbances are very high around the postmenopausal or menopausal transition, and hot flashes. Right? And there's kind of like this immediate withdrawal effect of estrogen. Like you could almost think about it as like a drug withdrawal. Like when we get withdrawn from estrogen, those vasomotor symptoms kick up. And then eventually our body gets used to being in that state of estrogen deficiency and those withdrawal symptoms kind of go away. But genitourinary syndrome of menopause is really focused on the aging of the pelvis and its influences. And so when we're in pelvic health and we're talking about estrogen deficiency, we see, you know, adhesions in the labia minora to the labia majora. We see an increase in friability of tissues. We see an increase or a changes to the pH of the vaginal microbiome. And so these all have influences, but the genital urinary syndrome very much focuses on the pelvis. ASKING ABOUT MENOPAUSE And so if you are not in pelvic health, you may not be really considering it a reason to be asking about symptoms of menopause and when you went in through menopause. But if you are an individual who is working with anybody who is a female over the age of 50, you should be asking, are you in menopause? Have you gone through menopause? When did you go through menopause? And menopause is diagnosed as the 12 month mark of not having a period. So when you have not had a period for 12 months consecutively, that is considering being in menopause. Average age is 50 to 51 in the United States. asking around changes in symptoms around the menopausal transition. Did you notice a change to your mood? Did you see a change to your sleep? Did you see a change to your cognition? Did you see a change to all these other things? Because we know that if you're depressed and not sleeping and your joint pain is up, we're probably gonna have a lot of conversations that we need to have around recovery. It's gonna influence the way that our treatment is going to go. And then we can be an advocate for ways to manage. Too often, and there is nothing that makes me more mad. Like when I see individuals who have gone to their doctor and they say, I am suffering with vasomotor symptoms. I am suffering with all of these things. And they say, I have no libido. And they say, well, you are going through menopause. And that's kind of the way it is. Men will get Cialis or other types of hormone replacement for their sexual dysfunctions very readily. And it is met with hesitation when we are talking about female reproductive aging. And I was just at a course where it has some individuals who are part of the military and the military nurse practitioners were there, which is really cool. But they said, you know, we are so willing to prescribe Cialis but we are very hesitant as a division to give hormone replacement therapy. HORMONE REPLACEMENT THERAPY And so the next part of this conversation, one, estrogen affects everything. It's absolutely gonna influence our pelvic floor. It's absolutely gonna influence our pelvic health. But then the next thing that people are asking is around estrogen replacement therapy, sex hormone replacement therapy, and its safety and efficacy. So I wanna do a little bit of a history lesson here around where this risk is coming from. So there is a large longitudinal study called the Women's Health Initiative that has been collecting data on women for a very, very long time. And early, early on in about 2001, a study was released from the Women's Health Initiative that said that there was a 25% increased risk of sex-related cancers for individuals who are on hormone therapy than individuals who are not. This was, potent, like kind of true, but it missed the forest for the trees. And so when we kind of zoom out and we look at relative risk of sex-related cancers, that, well, that translated into, instead of it being three in 1,000, and these are not perfect numbers, I don't remember off the top of my head, it changed to a four in 1,000 rate or incidence of sex-related cancers. When if you think about it like that, that is not the biggest difference. However, that one study came out and it changed everything. It was largely disseminated, many media outlets put it up, and it made everybody very, very fearful of prescribing hormones. So there's a couple things nuanced to this. When we are taking any type of medication and our sex hormones are not anything different, there is always going to be potential risks. Those have to be balanced by the benefits. We see, for example, that individuals who are on replacement therapy have a lower risk of Alzheimer's, dementia, especially if individuals are going through a menopause early. We see sexual health, sexual, satisfaction increases on hormone replacement therapy. We see an increase or rather a decrease in rates of urinary tract infections. And if you are working in the geriatric space, move this into Wednesday. It makes a huge difference. A urinary tract infection can change a person's life. A person can die of a UTI because it can end up, they get in hospital, UTI becomes sepsis, sepsis becomes a full blown, you know, it's now a full blown infection and individuals don't get out of hospital or they see a consistent change in function. All of these benefits for many are going to outweigh that slight increase in risk. Now, we have evidence since then that that risk percentage may have actually been when we replicate a study, which is super important before we're making very broad sweeping statements. There is a range of that relative risk and it actually might be lower. And because of that, we now have good evidence for individuals who are going through chemo to be able to have, because it can irradiate and bring you into a low estrogen state, where they may use topical estrogens. We have more evidence for individuals who are on estrogen receptor blockers, like tamoxifen, to, again, have topical estrogens. Because, obviously, we're not gonna wanna ingest estrogen when we're trying to block it so that cancer doesn't regrow, but to put it on the external genitalia, that would allow us to remove some of those pelvic-related symptoms for individuals being in low estrogen as a consequence of cancer treatment. And this evidence is continuing to grow. NO EVIDENCE FOR AN OPTIMAL HORMONE REPLACEMENT WINDOW The other question, when I go back to my patient that I talked about, is that he said, well, you've been on it for enough, this physician, and I'm gonna take you off. We actually, again, don't really have any evidence around where that window is. Like how long you can be on it before the risks start to outweigh the benefits. And because we don't know, individuals are just creating a risk tolerance zone for themselves and then unilaterally kind of applying it in their practice. And so we still have so much work to do in this space. We are starting to see a change in our language around hormone replacement therapy, and it's being changed to MHT, menopausal hormone therapy. And it is actually encompassing a variety of different treatments. It is not just a systemic pill that you can take that is a natural replacement, there is those. There are progesterone replacements. There are estrogen and progesterone combos. There is evidence for testosterone replacement and testosterone replacement helping individuals with hyposexual disorders. And then there are topical estrogen therapies where individuals who are experiencing recurrent UTI, individuals with issues with labial adhesions, individuals with clitoral adhesions, all these different things can see a huge benefit to this type of hormone replacement. And so, The role that we have to play here, if you were a pelvic clinician listening to this, we have a ton of advocacy to work on. Staying up to date with the evidence, referring back for potential counseling on hormone replacement, and continuing to have those conversations with our physicians is gonna be super important. If you are a person who's an orthopedic specialist, you need to be asking about estrogen status. Have you lost your menstrual cycle? That puts you in low estrogen. Have you recently had a baby? If you're a postpartum and you're dealing with a wrist injury, that low estrogen is gonna impact your ligaments. It's going to make it so that you may be more likely to have things like mom wrist decorvains tendosynovitis. And then if you're working with individuals who are older, then again, we're gonna be asking about when you went through that menopausal transition and how you're feeling. A lot of people feel like, oh, well, I'm going okay through my menopause right now. I don't really need it. The thing is estrogen deficiency is accumulative. So it is also a discussion around the preventative aspect of continuing to have individuals on hormone replacement. I don't know the answer to this, but it is a continual conversation. It is one that is happening in lots of spheres and one where there is a role for rehab. And this has been such an important part of the development of our research base in pelvic and a huge portion of the proportion of individuals that we are seeing in our practice that we have put it into our level one. So we have an entire week on the influence of menopause on the female body and an entire module on the way that we would work towards treating individuals and advocating for individuals who are going through menopause, who are subsequently feeling issues with pelvic health. So if you are interested, get into our March cohort. I could rant about this all day. I'm already 20 minutes in. I'm gonna get off here, but it's important. And it is not just important to our pelvic health clinicians. It is important for everybody who is working with a female body over the age of 50. And we're not even going to go into the perimenopause part because perimenopause could be 10 years before. So if you're working with anyone over the age of 40, this is relevant and it influences our rehab outcomes. All right. I hope you all have a wonderful week. Merry Christmas. If you are off, happy holidays. Whatever denomination you are, please hopefully have some time to spend with loved ones. And I hope that you get some of the rest and relaxation that is just something that you are looking for. I have two little ones, four and two, and the magic of Christmas and the holiday season is so alive and well in our house, and it is such a beautiful thing. So I hope you all get that. You are so welcome for me talking about this. I promise you, I will be diving more into this onto my personal Instagram, and it's definitely gonna come onto ICE because I think it's really important, and I think it's a huge miss that we have. So thank you for listening, and I am so excited to continue these conversations. Merry Christmas, happy holidays, and hopefully you get all of that rest and relaxation for the end of 2023. 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 discusses how to better educate patients on prolapse, including a three-step framework focusing on education, risk factors, healing timelines, and empowerment. 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 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 Good morning, PT on ICE Daily Show. My name is Dr. Rachel Moore. It is Monday morning, which means it is pelvic day on our podcast here. So, we are going to dive in today. Our topic is using words that heal to talk to our patients about prolapse. So we want to make sure that when we are talking about our patients that have prolapse or maybe have been given this diagnosis of prolapse, that we're using words that are going to empower them. So we're going to dive into that today. Before we do that, a couple of housekeeping things, just letting you guys know the courses that we have coming up within our pelvic division. So we are done for December, nothing left in 2023, but we are kicking off 2024 strong. We've got two courses on our live docket in January. So we've got one January 13th and 14th in North Carolina. We've got one January 27th and 28th in Hendersonville, Tennessee. And then February 3rd in Bellingham, Washington. So we've got three chances within the first like month-ish of 2024 to catch us on the road. um on the those live courses that's where you'll be taking your certification test if you're interested in having that pelvic certification which includes taking all three we now have three of our pelvic courses our next online level one cohort starts january 9th and the sign up for our level two is now officially open so if you want to hop into that cohort it starts april 30th and that will be the first cohort of our level two so Really excited to kick that off and just kind of get that rolling. TALKING PROLAPSE So without further ado, let's dive into our topic of the day. We talk a lot about ICE or talk a lot at ICE about using words that heal, not harm. We preach it a lot and sometimes it can be really tough to figure out how to explain like difficult diagnoses. Especially things that are maybe controversial when it comes to the postpartum space and we're gonna see that with things like diastasis or prolapse and a lot of times our patients are coming in and maybe they've been given this diagnosis by another provider and it's not really explained very well and so they go down this scary Google rabbit hole and they come in and with all of these preconceived notions um oftentimes mostly negative preconceived notions from all of this research that they've done and they feel like they're empowering themselves with knowledge but in reality there's a ton of negativity and fear-based messaging about these topics so today we're going to talk about prolapse later on in a future episode we're going to talk about diastasis and i really just wanted to talk about some actual quotes that i use with my patients or kind of an outline or a framework of how we can break these scary diagnoses down, especially if you're newer to the pelvic population, you haven't had a lot of reps practicing talking about this, so that we can make sure that all of our patients are leaving their sessions feeling very empowered and excited to be working with you. EDUCATE So the first step of our three-step framework is going to be educate. I can't tell you how many times I have people come into the office and they're sitting there and they're squeezing their legs together because they are so terrified that if they aren't constantly contracting their pelvic floor and squeezing their legs together that their bladder is going to fall out of their vagina because they've been told that they have a bladder prolapse. with no other explanation this happens so often people will go to a provider the provider maybe will be doing a well women's exam or a check for whatever reason postpartum follow-up whatever and they tell them you have a bladder prolapse or you have a rectal prolapse and then that's it and they don't really tell them anything else and maybe they don't even really prescribe them physical therapy and they just wander into your clinic um on their own but there's not a lot of follow-up in most cases. So the very first thing that I'm doing when I'm sitting down with patients is breaking down. Okay, you were told you have a prolapse. Did anybody explain to you what that is? And usually that's followed with no, I went on Google and I saw a bunch of scary things. I'm like, okay, great. Like we're going to undo all of that. And even sometimes if they were explained, it maybe was using a very medicalized definition that can be, again, terrifying if you don't really know what's going on. So I'll bust out a whiteboard and I will draw out the pelvic organ. So if you're watching on Instagram or YouTube, you can kind of see with my hands, but if you're not listening, just visualize. I'll draw out, like, here's our bladder, here's our uterus, here's our vaginal canal, and here's our rectum. All of these organs sit within our pelvic bowl. When we have pelvic organ prolapse, essentially what that means is there is a descent of one of these organs or a drop down that pushes onto the walls of the vagina. at this point usually i'll take a minute to explain to people that the vagina is not a hollow tube it does not look like this it actually looks more like sides of soft tissue coming together most people don't realize that because every picture we've ever seen of a vagina in a textbook in anatomy books anything Looks like a hollow rigid tube. So a lot of times even letting them know like hey your vagina is not like this It's like this you'll see a light bulb moment where they're like, oh Okay, so maybe that's not a prolapse that I'm seeing maybe that's actually just my vagina. So that alone can be really helpful We'll talk about the fact that the vagina is not a hollow tube and that it is soft tissue and with that it is influenced by other things around it and so then we'll kind of break down here's your bladder maybe you have a descent of your pelvic organs and we see this kind of drop down if vaginal canal is here and our bladder is dropping down slightly and pushing onto that vaginal wall what we may see is a slight drop down of that vaginal wall oftentimes we're doing this test on our backs Oftentimes gravity is pulling everything down a little bit more and so when we take this person who's upright like this and put her on her back, our bladder drops down and we can kind of see and maybe feel that drop down sensation. When we layer in gravity with standing, we're upright, we drop down, we can sometimes feel that heaviness sensation from the vaginal wall not necessarily supporting that drop down quite as well. It is really important to highlight and differentiate an organ falling physically out of the vagina which can happen if we have a uterine prolapse where the uterus is dropping down into the vaginal canal versus an anterior wall or a bladder or a posterior wall or rectal prolapse where it is not the physical organ dropping down, it is just the wall of the vaginal canal dropping inwards. That education is huge. You will see people have this like weight lifted off of their shoulders knowing that their organs are not actually falling out of their bodies. Education is important. DISCUSSING RISK FACTORS Talking about risk factors is also incredibly important. Letting them know what the top risk factors are. Genetics and connective tissue immobility, BMI, chronic constipation, which comes along with that straining, that consistent straining mechanism where we're bearing down repeatedly over time, pregnancy or parity, and vaginal delivery. A lot of those aren't things we can necessarily control for, but what's important to let them know is that exercise is not one of those factors. We want to make sure that our patients know that they didn't cause their prolapse by doing too much too early, especially if they're in the postpartum space or if they have this like shame associated with, I have a prolapse and I did it to myself. That's not the case. More often than not, if a prolapse or a pelvic organ position change is going to happen, it's going to happen in a vaginal delivery after a pregnancy. And it's not necessarily something that they're causing by doing activities later on. Letting them know that they didn't cause this thing to happen, again, can be huge for somebody's mental state. If they're feeling like, oh, I did too much and I caused this, that can kind of cause this negative spiral of fear for movement in the future. DISCUSSING TIMELINES Finally, we want to talk about, on the education standpoint, timelines. It doesn't make sense to have somebody at six weeks postpartum come in and say, yep, you got a grade three prolapse. Your bladder is dropped down and your anterior wall is coming out of your vagina. We expect there to be changes. we expect that after a vaginal delivery, those tissues aren't just going to pop back and get to their original position or even a new baseline for a longer timeline. So talking about the fact that early postpartum is not the time to be diagnosed, quote unquote, with a prolapse or to even really be concerned about where things are. Instead, we want to talk about ways to talk to them about um body mechanics and um their strategies for bracing we want to talk about bowel health and making sure that they're not continuously straining and bearing down and let them know that when we layer these two things in And then we allow time as a factor. Where they're at at six weeks postpartum is going to look different than where they're at at six months postpartum, even if that was the only things that they did. So education is huge. Educate them about what prolapse even is, educate them about what the risk factors are, and more importantly, are not, and talk to them about the timelines for healing. The next step in our little three-piece framework is going to be normalize. there is so much conversation happening in the pelvic floor PT world that a prolapse or a like a grade one prolapse which is just a slight descent of pelvic organs might be normal in the postpartum population. Just like we don't expect our breast tissue to look exactly the same after breastfeeding, we can't expect our pelvic organs to be in the exact same position after they've undergone nine to 10 months of low load, long duration stretch that creep has set into those tissues. And then we also potentially layer in a vaginal delivery. A grade one might not be a big deal at all. That might just be a typical postpartum change. On top of that a grade two might even be somewhat of a normal finding I have not yet seen a grade zero quote-unquote after a vaginal delivery I think it's a unicorn that actually doesn't really exist and we've had a lot of conversation about this within our pelvic crew of has anybody ever seen that The consensus so far is no. And so if you guys have, drop it in the comments. I'm curious. But we want to talk about normalizing this change. We expect physical changes in our body after pregnancy. We expect physical changes in our body after vaginal delivery. It's OK to look like you've had a baby. It's OK for your body to show those signs. this can be a big thing for people to wrap their heads around because there's a lot of talk within our culture about bouncing back to what your body was before and Switching up that conversation to we're not worried about what it was before We're getting to a new baseline and that might show changes that have happened and that's okay Normalizing the fact that our bodies are going to change during pregnancy after a delivery is important The other part that we want to normalize is that in the early postpartum timeline, those muscles are recovering, especially following a vaginal delivery where they've had a stretch injury, they've been stretched out, elongated, they're returning back to their resting state. We expect those muscles to have a lower threshold for activity than they did before. as pts this makes sense as patients it not it doesn't necessarily um come to the forefront of the mind so reminding them these are muscles think about any other muscle in your body maybe you've pulled a hamstring maybe you've pulled your quad maybe you've overstretched your shoulder those few days maybe weeks afterwards it took less activity for you to feel something in that area in this case specifically what I'm really kind of preaching to people is that if you get up and you're feeling good one day and you go for a walk with your kiddo around the block and that's the farthest you've walked and then later in the day you start feeling some heaviness you didn't cause a prolapse likely those muscles are just tired. They worked harder than they have all this timeline leading up to this. And so they're fatigued. And just like every other muscle that fatigues when it fatigues, it doesn't work quite as well. And so we feel that heaviness sensation. normalizing that heaviness sensation. I love to do this when people are pregnant, set that expectation. Hey, look, as you start moving more, you might notice that you feel a little bit of heaviness. It's not a big deal. That's kind of our buoy lets us know where we're at. You're not causing any damage. It's going to be okay. That heaviness will resolve and over time you're going to build up your capacity where that heaviness sensation comes on later and later and later normalizing what a prolapse is, normalizing what the grades are, normalizing the changes of our body that happened during pregnancy and postpartum and normalizing recovery of those muscles and potentially having an onset of symptoms. FINISH WITH EMPOWERMENT Finally, we want to empower our patients. This is where our bread and butter lies. This is what we are here for. We are all about empowering women in this pelvic space. we have evidence that we can reverse a prolapse up to one grade. So that means if somebody comes into the grade two, then potentially we can get them to a grade one. Realistically though, at the end of the day, I don't even really care about that. What I'm really harping on more, really focusing on more with my patients is that We know that the degree of prolapse or the descent of those pelvic organs and how much they are descended has no correlation with your symptoms. You can have a grade three and be highly sensitized and feel everything. You can have a grade three and have no idea that you even have a change on the flip side. You can have a grade one and feel like things are falling out. so talking about the ways that we can directly impact that by calming down the system giving them tools like laying on their back with their feet elevated adding in some bridges to get some muscle activation kind of taking the pressure off of the pelvic floor so that they can decrease that symptom of heaviness discussing things like bowel health, like we chatted about earlier, avoiding straining, using a squatty potty, making sure that they're drinking enough so that they're not falling into this chronic constipation camp, and then talking about body mechanics. That's one of the biggest things that we really want to focus on. We have to know what they're doing when they brace. We have to know what they're doing when they bear down. We have to know what they're doing when they do a pelvic floor contraction. we need to collect that data. We need to calibrate to make sure that they're not dropping down with their pelvic floor and increasing that heaviness sensation with their daily tasks. That is a huge piece of the puzzle. So our three-step framework, when we're talking about somebody coming into the clinic day one terrified that they have a prolapse. The first thing we're going to do is educate them. We're going to talk to them about what a prolapse is. We're going to talk to them about the risk factors and what potentially caused it and what definitely did not cause it. And we're going to talk to them about timelines. We're going to normalize. We want to make sure that they leave feeling like their body, their vagina, their pelvic floor are normal. And even if you have somebody come in with a grade four, We're still normalizing. We're still talking about all of the ways that we can help. We can work on prehab. We can take those same tools and improve things so that going into a potential surgery, they have better outcomes. And anything less than a grade four, you better believe I'm normalizing. You might have a change in your pelvic organ position, but you know what? That's totally normal after having had a baby and a vaginal delivery. The third step is we're going to empower. We're going to make sure that our patients feel confident in movement, feel confident in that bracing strategy, feel confident in what they're doing in their daily lives so that we can build a stronger and more resilient human being who can tolerate more things before symptoms come on. I hope you guys enjoyed this. I hope it helped clear some things up, especially if you're newer in the pelvic space and you really understand what prolapse is, but you're just not quite sure how to talk to patients about it. It can be intimidating, but I trust that you guys have got this. If you're not confident in treating heaviness and pelvic organ descent, um, and that sensation of heaviness hop into our live course, we spend a ton of time going over bracing. We talk a lot about what prolapse is, We have a whole matrix and kind of framework about treatment approaches for each of these little camps, whether they have symptoms objectively or subjectively and what the combinations are. I hope you guys have a great Monday. Get out there and crush it. Thanks. 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.

TIME STAMPS: 00:55 “Strength and honor are her clothing.” Proverbs 31:25 01:30 Getting SOBER, learning to MEAL PREP, and falling in love with the process of COMPETITION PREP. 08:02 How Rachel REVERSE DIETED and CUT CARDIO to fill out into her BEST PHYSIQUE of her entire FIGURE career! 11:35 How to identify the best MENS BODYBUILDING TRUNKS for your physique. 14:50 MALE BODYBUILDERS: Adjust your trunks to best show your GLUTES and HIP FLEXORS. 19:02 EXCITING!!! Sponsored logos on MENS CLASSIC PHYSIQUE trunks! 20:11 What are the differences between BIKINI/WELLNESS, FIGURE, and WOMENS BODYBUILDING suits? 22:08 “SCRUNCH-BUTT:” The key to displaying long, developed glutes. 25:55 Tactical badges, flannel jackets, and motivational “COMPETITOR” tank-tops! 30:03 How to PLAN AHEAD STRATEGICALLY as a SELF-EMPLOYED fitness entrepreneur! 36:41 Be a “GO-GIVER!”  Rachel Moore: FIGURE athlete and featured guest of the day! Owner of RADIANT PHYSIQUE WEAR Custom Competition Bikinis & Posing Suits Men's Bodybuilding & Classic Physique Trunks Known for having the HIGHEST QUALITY & PERFECT FIT

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.

In the words of Julia Cameron, “if you want to work on your art, work on your life.” In this episode, Dr. Graham Taylor speaks with Rachel Moore, LMFT. Prior to Rachel's career as a Marriage and Family Therapist, Rachel earned a bachelor's degree in creative writing and enjoyed a 14-year career as a newspaper copy editor, winning a Pulitzer Prize in 2006 along with the staff of the San Diego Union-Tribune. She left newspapers in 2010 to study for her master's degree in Marriage and Family Therapy. During that time, she started a creativity coaching business and facilitated workshops based on the book “The Artist's Way” by Julia Cameron.Currently, she sees therapy clients at her private practice in San Diego, where her focus is on helping writers, artists, singers, and musicians. Rachel is an active singer and has performed on several stages around San Diego. She is currently a member of the San Diego Master Chorale. And she is the creative force behind her podcast, Beyond the Artist's Block, which explores mental health and creativity, bringing interviews and insights to working with creative people. We're excited to have Rachel with us today as we lean into her creativity and the art of working with creative clients.   For more information about Rachel Moore, LMFT, please visit: https://www.rachelmoorecounseling.com/ For more information about Rachel's podcast Beyond The Artists Block, please visit: https://www.beyondartistsblock.com/ For more information about the San Diego Master Chorale and their upcoming events, please visit: https://www.sdmasterchorale.org

Dr. Rachel Moore // #ICEPelvic // www.ptonice.com  In today's episode of the PT on ICE Daily Show, #ICEPelvic faculty member Rachel Moore takes a deep dive into the Valsalva Maneuver from 3 different lenses: the scholarly research, the pregnancy & postpartum patient, and the strength & conditioning world. 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 TRANSCRIPTION00:00 - RACHEL MOORE Good morning PT on ice daily show. My name is dr. Rachel Moore. I am here with Representing the ice pelvic division. I'm on faculty with ice pelvic division. Whoo. Sorry. I need to drink my coffee um i just got back in last night super late night flying from a course this weekend our pelvic live course in um wisconsin it was so much fun we got to see some leaves change which is exciting for me because in houston we don't really have that happen um so really awesome super great weekend awesome and engaged group that we had. If you are looking to join us on the road to catch our live course, our live pelvic course, there are still so many opportunities this year. In that course, we are doing so many things. We are talking about pelvic floor considerations. We're talking about the internal assessment and actually going over and practicing it on your back and in standing. We're talking about pelvic girdle pain which is such a huge topic in the pregnancy and postpartum and just pelvic world in general and then day two we're diving into the actual fitness side of things where we're doing squats and we're learning how to brace and we're using weightlifting belts and we're getting up on the rig and doing gymnastics moves it is a blast every time I come home from a course I'm hyped and there are four more chances of in 2023 to catch this course on the road. So October 21st, we've got a course in Corvallis, Oregon. November 4th, we've got one coming up in Bozeman, Montana. November 18th, we've got one coming up in Bear, Delaware. And then December 2nd, we've got one in Nova Scotia, Canada. So tons of opportunities to catch this course live on the road. Our online course will pick up again in January. So if you're interested in joining us in the ice pelvic division, that's what we got coming up. 02:08 - THE HISTORY OF VALSALVA This morning we are here to talk about Valsalva. So the word Valsalva is kind of a term that nobody really knows what it means or everybody thinks they know what it means and they all have their own separate camps of what it could mean because it's described so many different ways in the literature. So what we're going to do this morning is clarify what the different definitions of this one word are, talk about the history of it a little bit more, where this term really even came from in the first place. So this topic is really near and dear to my heart. Recently, Christina Prevett and I recently just wrote a clinical commentary on Valsalva and on the nuances of Valsalva. and how as clinicians we can take this term and how we need to take this term and understand the lens, especially when we're looking at research, but when we're talking to patients about what this term even means and what we're actually looking for in our strength training fitness world when we say the word Valsalva. So let's kick it off with the history of Valsalva. The term Valsalva is actually named after a physician from the 18th century. So he was an otolaryngologist. Anyway, he worked in ears and throat, ear, nose and throat doctor. And he created this maneuver essentially as a way to push infection out of the ears. So, the maneuver that Dr. Valsalva described actually doesn't even look like the Valsalva that a lot of people talk about today. His maneuver was plugging your nose and blowing out, but not against a closed glottis. And when he created this maneuver, the purpose of it was to flush infection out of the ear by having that tympanic membrane push outwards to, in theory, push pus out of the ear. That is where this term was created. So when we look at Valsalva in the research lens, when we talk about diving into the specifics of research on this topic, if we're looking in the ENT world, autolaryngological world, we're thinking about this maneuver as a plugged nose, closed glottis, now push out in order to push that tympanic membrane out. When we're looking at this word in the urogynecologic world, it has a very different emphasis or purpose. So when we think about pelvic organ prolapse and the diagnosis of pelvic organ prolapse, that's where we see the Valsalva, quote unquote, being useful, I would say. So the Valsalva in a urogynecologic world is an intentional bear down and strain with a closed glottis. in order to measure the descent of the pelvic organs, particularly during that POPQ or that assessment for pelvic organ prolapse. So on the ENT side, we have the focus of plugging nose, blowing out, pushing tympanic membranes out. In the urogynecologic world, we've got this strain down through the pelvic floor in order to descend the pelvic organs and measure what that descent is. 06:04 - VALSALVA IN STRENGTH TRAINING In the strength and conditioning world, the term Valsalva means something completely different. In the strength and conditioning world, the Valsalva is a maneuver that is advantageous, particularly if you're a competing athlete in the strength training world, where we need a little bit extra spinal stiffness in order to hit a lift to PR. so in the strength training world this is an inhale into the belly and then a brace of those core muscles that anterior abdominal wall and all of those muscles within the core in general in order to increase that intra-abdominal pressure and spinal stiffness to be able to lift heavier. So when we do the Valsalva, we have a 10% increase in that spinal stiffness and that carries over or translates into pounds on the barbell. So when we're again thinking about our competitive athletes who are maybe trying to like edge somebody out, the Valsalva is an incredibly useful and productive maneuver. Even if we're not a competing athlete, if we're talking about just getting stronger and we're pushing ourselves to the capacity that we want to push ourselves to in order to make those strength gains, the Valsalva is likely utilized in order to increase that capacity to lift heavier. The confusion here comes from that one word having many different definitions. And when we look at the urogynecologic world versus the strength training world, they really are truly opposite. When we're thinking about straining and bearing down, we're pushing down with our abdominal wall muscles, we're pushing down with our pelvic floor, and we expect to see that descent. I 100% agree that we shouldn't put a heavy barbell on our back and then strain and push down through our pelvic floor. That is not beneficial and it is going to put a lot of strain through the pelvic floor. Absolutely. However, when we talk about Valsalva in a strength training capacity, that's not what the Valsalva is. The Valsalva in a strength and conditioning world is that intentional inhale into the belly and brace of that anterior abdominal wall muscles. When we do that brace of those anterior abdominal wall muscles, we don't want to see a descent of the pelvic floor. That would be an improper brace that would need training to improve that coordination. What we expect to see with a valsalva in the pelvic floor world is a matched degree of contraction for the demand that's placed on that system. So if we're thinking about somebody who's lifting a heavy lift, a one rep max, We expect that pelvic floor to kick on, but we're not necessarily volitionally thinking about lifting pelvic floor and doing that pelvic floor contraction. As that core canister is engaged and we engage that proper brace, the entire core canister should kick on to a relatively equal degree. So in the strength and conditioning world, that Valsalva is advantageous. In the urogynecologic world, if we're taking that concept and applying it to lifting, it is the opposite of advantageous. So when we're looking at recommendations for our strength training athletes and our patients, we need to understand the language that is being used and what the definition of that language is. So from the standpoint of our OBs who are telling our patients, don't ever do a Valsalva, in their mind, they're saying, don't ever strain and push your pelvic floor down when you're lifting. Totally. We agree. 100%. Don't do that. It's not going to be great. But the disconnect is that this one word has so many different definitions. So we really have to dive in and break down what was that recommendation specifically. So when we're with our patients, that looks like breaking down the definition for them. 09:01 - VALSALVA MANUVEUR IN THE LITERATURE But if we're looking in the research world and we're trying to read literature, read the newest evidence about what recommendations are for our pregnant and postpartum athletes, we need to go into the article itself and look at how they define Valsalva. Because we can easily read the abstract and the conclusion of an article that says Valsalva is not recommended, but if we're, looking at this article and it's actually meaning the bearing down, then we're not getting, we're not able to extrapolate that to the strength and conditioning side. So really with this term, it's one word named after a man who the original maneuver isn't even what we're talking about anymore anyway. Across the board, we have to either figure out different words or different ways to describe this, or it really falls on us as providers to break down what it is we're talking about. So rather than just telling your patients, do a Valsalva, maybe we don't use that language at all, and we just talk about bracing. When we do a brace, we can manipulate breath. If we're gonna take that intentional inhale and then brace, that is a Valsalva, But in order to eliminate the confusion across the board, we can just call it a brace. This makes a lot more sense to patients than being told by one person to never valsalva and then by another person to valsalva. And when we lay it all out and explain what all of these differences are and how it's all one term, but it has different meanings, and none of these meanings necessarily are the same. And in fact, in the urogynecologic world, in the strength and conditioning world, they're literally the opposite. It starts to click with patients, why it's okay that my physician told me not to do this Valsalva, but you're telling me that I can, because I understand that these are two very different physiologic mechanisms. Our clinical commentary over this that dives into all of this and so much more comes out in the spring. So keep an eye out. We'll be sending it out in the ice pelvic newsletter. So if you are not signed up for that newsletter, head to PT on ice.com, go to the resources tab, sign up for that newsletter, not only for our clinical commentary in the spring, but for all kinds of resources. in the pelvic floor world. Stay up to date on the newest evidence and also just check out some cool stuff that we find along the way. I hope you guys have an awesome Monday and I hope we see you on the road soon. 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.  

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.

In today's show, Eric is joined by Rachel Moore, a licensed psychotherapist and marriage and family therapist, based in San Diego, California!  Rachel is also certified in EMDR and Brainspotting (BSP)!  She works primarily with creative clients, such as artists, writers, and musicians.  Before becoming a therapist, Rachel earned her bachelor's degree in creative writing and was a newspaper copy editor for 14 years.  She is also a musician, a singer, and a proud member of the ADHD community!   You'll hear about relational-based therapy, trauma and overwhelm, discussions on EMDR and brainspotting, and the importance of finding a therapist who understands your creative needs.  You will also be along for the ride as Rachel guides Eric through the Flash technique!   Find Rachel on Instagram @rachelmoorecounseling Learn more about Rachel at RachelMooreCounseling.com Check out The Artist's Way Workshop on her website Listen to Rachel's podcast: Beyond Artist's Block   Questions/Topics:  [00:01:10] Introducing Rachel [00:01:58] What is EMDR? What is Brainspotting? Are the two types of therapy connected?  [00:05:30] Discussing relational-based therapy   [00:07:18] How do you distinguish the difference between a general state of overwhelm and a trauma response?  [00:16:58] What is the Flash technique?  [00:19:14] A demonstration of the Flash technique  [00:27:25] Eric shares his experiences with the Flash technique  [00:31:40] “The brain and the eyes are made of the same stuff” and the theories of Brainspotting [00:37:35] A demonstration of grounding techniques  [00:41:18] EMDR and BSP: How are these modalities helpful for ADHD brains and creatives?  [00:45:30] Finding someone who understands the experience and depth of what creativity means for you [00:49:14] Closing Thoughts Resources & Honorable Mentions: Book: The Artist's Way by Julia Cameron Article:  on Brainspotting.com - What is Brainspotting?   Article: on EMDRIA - About EMDR Therapy

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. Moore of Disrupt Physiotherapy joins The Perinatal Podcast this week to discuss the importance of restoring functional movement and how her practice provides help for the entire family.We chat about how insurance restrictions can (but don't always!) impact client motivation if treatment is dictated by payment more than client goals, how our education system needs to do a better job of teaching us about our bodies, and how we can benefit from knowing more about what's happening to our bodies in the perinatal season.Dr. Moore share about her specific evidence-informed practice with a goal of seeing her clients feel empowered through working on their pelvic and other health, discussing fueling your body for the rigors of parenting, which is absolutely an athletic endeavor, and I loved it so much I named the episode after her quote - "Maybe I don't have to pee my pants?" Tune in for this and more with Dr. Rachel Moore on The Perinatal Podcast! Find Dr. Moore! Instagram: https://www.instagram.com/disruptphysiotherapy/ Website: https://www.disruptphysio.com/ Thanks so much for joining me for this episode of The Perinatal Podcast. I'd love for you to write a review of my show on your app, and don't forget to subscribe so you get a notification when new content is posted. Take a moment to leave a 5-star rating, too! You can also support this podcast by purchasing a monthly subscription for the amount of your choosing at https://podcasters.spotify.com/pod/show/theperinatalpodcast/support. Follow me at @TherapyByMeg on Instagram and find Meg Duke LCSW on Facebook. You can also look for Let's Discuss… content by searching the hashtag, #LetsDiscussWithMeg. The Perinatal Podcast with Meg Duke is executive produced by David Presley and produced by Meg Duke. Our theme song was written and performed by Antwone McDuffie.

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. 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