Episode 1652 - Building the bridge to fitness in pelvic PT

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. 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