[00:00:04] Nick: That makes no sense. Like, why can't you have the best of both worlds? So I said, if it doesn't seem which it's not, then you need to say something that your responsibilities healthcare. And she knows that she's just not trying to step on anybody's toes, but I'm done separated by anybody’s toes. It's time to stop stepping back.
[00:00:29] PODCAST INTRO: Welcome to “In The RACK” podcast, where we provide you with the practical framework for breaking PRs in all facets of health and wellness. We are just a couple of bros giving you the simple house in a world of complex wants. No filters, no scripts, no rules, just straight talk, talk tune. Now, let's get into the rack with your hosts, Dr. Chad and Dr. Nick.
[00:00:55] Chad: Alright, everyone. Welcome to another episode of “In The RACK” podcast. I'm your host, Chad. And with me is my co-host and physical therapist, Nick. We also have another fellow physical therapist in the building today. And that is Katie. She's on the show for the second time.
[00:01:12] Nick: Repeat customer.
[00:01:13] Chad: Yeah, repeat customer. It is “Episode 25”. So that's another milestone, which is cool. But it's also another five episodes in which means it's another reckless in the rack series. So every five we try to get another reckless in the rack episode in. The last one we did the mess ups, our mess ups.
[00:01:34] Nick: We were reckless, where we were talking about other people being reckless.
[00:01:38] Chad: So we're probably gonna go along the lines of just talking about overall recklessness. I think Nick might even talk about his own.
[00:01:45] Nick: Yeah, it was my fault.
[00:01:47] Chad: So we'll talk a little bit about that. But for all of you that are new to our reckless in the rack series, this is where, Nick, and I and now Katie will share some stories from our patients. We like to share these stories not only because they are reckless, but some of these stories may sound familiar. It's perfectly okay if they sound familiar, because that, in fact, is the purpose of this episode. So if you are joining us for the first time, in this episode, we are going to be providing you a few quick stories, and then we give our two cents on the story. So this one is going to be a little bit different, because we're going to have Katie's story in here. And, Katie, as you all know, is our pelvic health specialists in the building. So she's going to give us a story that she had recently that she wants to share with all of you, and hopefully some of you can maybe relate to her story, and it might help you. So how should we get started? Nick, you want to go first?
[00:02:42] Nick: I'll kick this off. So last episode, I made a joke. It was a joke that we haven't messed up in a while. So we're gonna go back to talking about how other people are reckless. And within a couple of days of that I was reckless myself. So I'm actually going to kind of go back to the theme of “Episode 20” and talk about how I messed up just because it's so fresh in my mind. So I had an individual will go by, we do alias names here. So this one will be Smart Cuffs. Smart Cuffs are BFR unit. So Smart Cuffs came in with knee pain, and this pain was only occurring at the bottom of the squat. So this individual does CrossFit. And Smart Cuffs was only getting this pain, the bottom of a catch for a clean or snatch and then front squatting and things like that. So it was impacting his performance to an extent but not completely debilitating. So we looked around and everyone knows him Bigfoot guy. So I looked at his feet, and I could have sworn there was some stuff going on with the feet. So I just attacked the feet. And he came in couple weeks in a row. So we're three visits in and still addressing the feet. And still no change, still just takes them right out of the bottom of squat. Like literally, it's like a sharp twinge that just makes him have to bail out. So I was like, “Maybe I need to hit the drawing board again”. So I started talking it over with, Chad, and we talked about more about his pelvis and hips and what's going on up there, which I had just kind of went tunnel vision on it and just disregarded not totally disregarded, but I just went all in on the feet. So then next time we really honed in on the pelvis and the hips, did a couple repositioning exercises and more awareness things first, and what do you know, go figure? No pain at the bottom of the squat, was able to squat was able to load up the squat and everything. So we addressed the pelvis a little bit and then after getting to talking more about the hips and the pelvis, we had actually had a deeper conversation about how he in the past couple months was someone had He told them he has a huge book week and that could be a whole other podcast. So he was overcorrecting to try to not but wink. So he was totally anteriorly tilting, so tipping his pelvis forward for the listeners. And he was basically just putting a ton of tension on the hamstrings to start the movement. So that's how he gets to the bottom. He was trying to fight that natural blank. And then boom, he's getting all these muscles yanking on his knee. And he's getting that that twinge because His body did not want to be there with all that attention. So we talked about how he shouldn't just overcorrect that, but I think is going to happen at some point. And like I said, “We could talk about that on a separate podcast”. But moral the story there is that I don't want to steal your moral story. That's my moral story. That's not the podcast, my Journey. Chad will give the real more moral of the story. But in terms of this case, don't get narrow, narrow vision, don't get tunnel vision. And if you're struggling with a certain case, talk to your colleagues, talk to people or and if it's really significant, and you really can't figure it out, you might need to refer out to someone who will do be able to or might be able to look at other things that you might not be as well versed in.
[00:06:13] Chad: And I know who you're talking about. And he's a very good athlete. I've trained with him before and he's a monster. Sometimes when you're trying to see something noticeable and an already good athletes, sometimes it's not so noticeable. Because they can overcompensate and hide some of their sharing.
[00:06:34] Nick: So the best athletes are the best compensated.
[00:06:36] Chad: Without a doubt. So I know, there was a good find there.
[00:06:39] Katie: What was a total waste to be treatment at the fee?
[00:06:43] Nick: No, I wouldn't say it was a total waste, I would just say we, you we probably because I went over emphasize his feet, because he still does have some stuff that we can address at the feet. That is also playing a role up the chin, up into the hips and the pelvis. But targeting the pelvis was giving us a better bang for our buck. So I wouldn't say it was a waste of time. But we definitely could have gotten him back to full range squatting probably a couple weeks sooner. But the fact that he had to curtail his workouts could have been a blessing in disguise because he started working more on single leg stuff. Because the whole time, it was really just the bilateral squat that was hurting. So on both legs is his single leg stuff felt totally fine, full depth, full range everything. And he could do that no problem. So we just shifted his focus. We didn't stop and we didn't shut down. We just shifted his focus to doing more unilateral Single Leg stuff. And it may have been helped form in the long run for shifting gears a bit for a couple weeks.
[00:07:49] Chad: Cool. That was great one.
[00:07:51] Nick: I was a little reckless. I'm back.
[00:07:54] Chad: You know what, at least you learn from your recklessness.
[00:07:57] Nick: You know, you got to test the waters.
[00:07:59] Katie: So now if I were seeing somebody like that, I would have probably not really paid much attention to those feet. And I would have been all about those hips.
[00:08:08] Chad: You probably would have done much, much better than myself. Some people are top down, some people are bottom up. You know what I mean? It just all depends who you’re.
[00:08:18] Nick: And it's true.
[00:08:19] Chad: As long as the common goal is met, it doesn't matter where you start.
[00:08:23] Nick: That's it.
[00:08:25] Chad: Alright, Katie, why don't you tell us your story, because you're bringing in another different element here? Something that, Nick, and I have no idea about. So we want to hear.
[00:08:33] Katie: Okay, here we go. So this was really challenging for me to narrow down because pretty much every person that comes in, for me when we're talking about gynecological issues, bladder issues, those types of things or postpartum issues. Everybody has a story that I'm just jaw dropped and don't understand how they got here. And we're not addressed, or their concerns were not validated and addressed prior to coming in to see me, but that's why I'm here. So this person was posted up about six weeks. I know, when she came to see me she was closer to nine weeks, but she had her six week post op visit with her OBGYN and this patient had a vaginal delivery. Big Baby like 10 pound baby. And as a result, had a little bit of tearing nothing crazy. It was just great one. So just in the skin. But she had concerns to her doctor that she felt fullness in her bottom and her vagina her bowel and bladder functioning was not the same. She was dribbling a little bit. She was having trouble going, like urinating all the way so you go pee and then you get up and couple minutes later, you're still feeling like you're dribbling. So we're not getting it all out when we want to go. So she told me this, and she said that her doctor told her that things will return to normal. And let's just see how it goes, and that was it. So she was talking to friends and our friends were saying, “Hey, here's this thing called Pelvic PT. And maybe you could benefit from it”. So that's when she came to see me and I got her whole story. And sometimes it's really hard for me to get just that hour with somebody, because there's a lot to talk about when you're talking when you're dealing with pelvic related issues, because there's a lot of things that play a factor. So we did spend the time to do that. My first question was, “Did the doctor do an internal exam?” And they do that six week post up our postpartum check. And I think they might have even done a path or something. But I said, “I explained what I assess when I do my internal exam”. And my thoughts were going towards in organ prolapse, and I explained what the pelvic organ prolapse test is like, and what I do. And she said, “No, no, no, it was in and out real quick, there was nothing like that”. So she was game for an internal assessment. And sure enough, when we did that, we had lots of let's say, “It was an anterior vaginal vault laxity”. So she had a sister seal, and it was a grade two seal. So I don't want to get too technical. But there's different grades for different grades for an organ prolapse. And your prolapse can happen where the anterior wall of the vagina falls back into the vagina. And that would be your bladder falling back into the vaginal wall or it could be coming from the posterior wall, and that would be erected seal, so the rectum would fall forward into the vaginal vault. And we can test for those things and kind of determine what we're dealing with and how severe it could be. And so we did that. And that kind of supports the idea that when she was urinating, she wasn't getting it all out. And that's because the bladder was kind of falling back into the vaginal vault. So we were getting some retained urine in there. And that's not a good thing, because then we can get UTIs when that happens, but I guess, my moral of the story,
[00:12:34] Nick: Everyone's still in it today.
[00:12:36] Chad: I don’t want to do it anymore, not even do it anymore.
[00:12:40] Katie: So it was, I don't want to make doctors the bad guy. But patients are coming with valid concerns. And I just feel like if we just listen and validate their concerns, and then maybe do something, just test for it, then we're going to meet them where they need to be met. And we're going to potentially find the why of what's going on, because she had all these symptoms and things that were going on. And just to say, “Let's see what happens, you had a big baby, and you're six weeks post-partum. So let's just see what happens” but I don't know. I just feel like we can prevent things from getting worse and, and stop things before they even happen. Because there can be a cascade effect of other things that can happen down there.
[00:13:39] Nick: Do you think that was more so because the doctor or provider didn't know enough about that particular thing, or is because they didn't have time?
[00:13:48] Katie: And it could be a combination of both, I know. So when I have people come in, and they say, “Well, I'm going to see my gynecologist in a couple of weeks, and it's our first initial evaluation and I have certain questions” and I'm like, “I don't really know what's going on until I get in there”. And I do like a look, we can do like a quick internal and I just need to know if you're able to squeeze and what's going on so in and so my response to them when they say I have like an appointment in a couple of weeks, so when you've gone in the past, have they done this? And I and then I explained my exam and they say no, and they've never done that, and I said, “Well, I've never had that, but I'm only one person and I just know my experiences when I go to these appointments and I've never had a formal assessment by my OB or my gynecologist as to the integrity of my pelvic floor”. If it's symmetrical, if it's contracted and tight and spastic, I don't really know what they're doing. I think they're assessing for organ location because they're doing a finger in and they're pushing down from the top. So it's like assessing that but the musculoskeletal component and checking on the muscle integrity. They just don't do it. So maybe they don't incorporate it into their practice. I don't know that they would do it, if they were asked to do it too. Like, if I went to my gynecologist said, “Hey, could you check the integrity of my anterior pelvic floor? Because I've been leaking or something like that?” And I don't know, what kind of a response I would get? That's a good question.
[00:15:28] Chad: She tried to test it out.
[00:15:30] Nick: Go and have a bunch of question ready to go to see put on the spot. It’s interesting. I think the time is a concern, though, for a lot of that's part of the reason we broke away from insurance companies, because we weren't allowed to have adequate time with our patients, and clients. And unfortunately, these other providers are dealing with the same thing. So they very well may have been like, “I wish I could do this, but I just can't have, my schedule is so full, I need to get to the next patient”. I don't have time for this, hopefully, this will resolve itself. So they're torn. And it's unfortunate that it has to be that way, but that's a system issue more than that, that individual provider totally.
[00:16:11] Chad: And I know a lot of these doctors are, or they have 20, 30, and 40 emails a day, there's lazy tons of how can you catch everything, you can't. So you just go with your gut, save a monitor as much monitoring as you can try to be efficient, and you get to the next patient, and then the next patient. And it's nice that we have direct access in this state that allows people to skip that step, and see you directly, and they get the full hour so that hopefully nothing can be missed. Like it would normally in a really, really fast situation. Not like every doctor's like that. But that's the standard, let's be honest, that's what it is.
[00:16:51] Nick: It's too bad.
[00:16:52] Chad: It is too bad.
[00:16:53] Katie: I just wish more people would know that this is an option for them, so that they can be advocates for themselves.
[00:17:02] Chad: That's the whole purpose of this podcast just to bring more awareness as to exactly what your options are. Because you’re right and they need to be more aware, how else do we do that? We create awareness through a podcast through content as much as we can spread the good word, and just hopefully people get it over time, it will happen over time, it's gonna take time.
[00:17:24] Katie: It's just so rewarding when you're in there with somebody, and you've got this amount of time to spend with them. So you're actually able to listen to them, you're validating their concerns. And then we get to talking while I'm doing my exam. We're also talking, and I'm continuing to learn information. And it's just so rewarding for me to hear that aha moment, like almost every single one of my patients has this aha moment, where they just get it and they understand because we were able to talk and I was able to explain to them. Because I really like to spend time educating them on their body, because they should know what's going on. And they should know why we're doing something. And I feel like that promotes patient compliance with an exercise like that, if I'm going to show you to do , X, Y, and Z, like I want you to know why. Because you're going to be more inclined to do it, because you're gonna understand what the potential benefit is and why we're trying to do it. So it's really awesome to see people who are just like, “Oh, my God, this makes so much sense. Thank you so much for explaining that to me”. Like, that's super rewarding.
[00:18:28] Chad: The ultimate goal is to get them to be able to take care of themselves. They don't want to be dependent on you to have to help them all the time and being you want to get them to be educated enough so that they know how to deal with it and continue to take care of it over time when they're done with you. That's the ultimate goal for sure.
[00:18:45] Nick: Cool. That was good story.
[00:18:47] Katie: You're welcome.
[00:18:49] Chad: Thanks. I'll go next. So my story's a little bit different. It's actually from a trainer that I met out in Michigan. And this was a few months ago, I was at the gray Institute out there. And she is not only a trainer, she's also a nurse in an Ed department. So she's got some pretty good background in medical as well as health and wellness. So she hit me up because she's an avid listener of the podcast. So go you know who you are, who you are. So if you're listening to this, which I hope you are, then you'll know that this was for you, because she listens to this all the time, but her story is actually quite interesting as well. And it fits really, really well with reckless in the rack series. So she hit me up not too long ago, and she said she had a 65 year old patient who was a female. She was somewhat sedentary. She started training with her like a month or two previously. So she wanted to like feel healthier have this new training routine, and she ended up falling during a yoga class that she was taking not with her. It was another class that she was taking in addition to her training, and then she ended up seeing the doctor the doctor diagnosed her with the medial meniscus tear, which they ended up doing a repair on. So if anybody knows there is a difference between a mastectomy where they're like just taking some of that meniscus out, and then the repair where they're actually trying to fix what's already there. So it's a different surgery altogether. The major difference is that with the repair, you have to be a little bit careful with like weight bearing precautions for the first couple weeks or so, and then they usually start like partial weight bearing and then you get them to full weight bearing when they can tolerate it all depending on the surgeons protocol. There's so many different ones out there. But so the how the story went here, she ended up having that surgery, and this was 10 days ago prior to her sending me this email. And her surgeon said, “Yep, I just want you on bed rest, and she said bed rest all the time”. So you can't get out of bed. No movement, no movement whatsoever. So her having this nursing background was like doesn't really sound right. I think I'm going to hit up chat on this one. Just make sure because she knows that we deal with a lot of this stuff and she likes our podcast. She knows that like I'll tell her like her client ended up seeing her PA the other day and her PA said, “Yep, looking great. I still want you no weight bearing this is two weeks after she had the surgery”. Still no weight bearing and remain stationary, by the way. So and I don't want you to start PT for another two weeks. So she's going to be on bed rest not stationary. She's not moving. She's non weight bearing. And she doesn't see the PT for a solid four weeks until after the surgery.
[00:21:40] Katie: So wait a minute, what about going party? I might be the only one who's wondering like, can we go, I think we get up and go party.
[00:21:47] Chad: I'm the severity of it, I think was pretty much like I don't want you moving unless you have to. You know what I mean?
[00:21:53] Katie: Like she couldn't do any like movements with her leg in bed.
[00:21:56] Chad: She was not instructed do any exercise did not have any Home Health. She didn't want the trainer her working with her because the doctor said bed rest stationary only. So when patients hear this stuff from their doctors, they take it seriously. They're like, “Okay.”
[00:22:12] Nick: This is where advocacy comes into play. If you have a provider, it could be doctor, anybody, it could be anybody if they tell you stationary, there's very few instances, if any, where you should actually be stationary. And the ones that are those instances are emergent. They should be taken care of right away in the ER, whatever. So if someone's telling you to be stationary for a period of time, you need to ask questions, and a lot of them.
[00:22:37] Chad: So she goes on to say that, I'm really just worried because as with my nursing background, I'm worried that she's gonna get a DVT. And don't you know a couple days later, she let me know that they were starting to work her up for DVT no shit, she has probably a high risk for DVT. She's been on weight bearing, and she hasn't moved for three to four weeks now.
[00:23:00] Katie: You want to explain what a DVT is to sounds good for average person?
[00:23:03] Chad: So it’s of a blood clot that typically starts in your lower leg and then work itself up. So if she does move now, now it's even worse, because if it travels, it makes its way to the heart which it could then it could be deadly.
[00:23:18] Katie: And the lungs?
[00:23:19] Chad: Yeah, lungs, totally.
[00:23:20] Nick: She's gonna have to be on blood thinners for numerous weeks, if not months. And that's probably going to impact PT once they're permitted to DVT.
[00:23:32] Chad: So my response to her was, this is absurd. And you need to get her up and eat him over. And if she's non weight bearing on that side, then you can respect that. But you can do upper body, you can have her move in bed, you can have her do, you can do crutch training with her. You're not to do all that. So get her up and move her. The worst thing that she can do is be in bed, that's only going to prolong your progress. So she ended up reaching back out to me a couple days later. And she's like, “You know what, we started doing some upper body movements, I got her up out of bed”. She texted me the next day, and told me that she was actually feeling better now that she was moving. Shocking. And she also sent her our number seven podcast which episode seven was all about our PT misconceptions, which we talk about movement quite a bit there and the myth between not moving after injury and I hope that helped her.
[00:24:26] Nick: So for listeners out there who might be considering an orthopedic surgery like that. Think about it from the surgeon’s perspective that what they do inside your knee, shoulder, whatever is there, it's their product, and they’re not willing to do whatever they got to do to protect their product. So they're going to ERR on the side of significant caution. So you need to ask more questions when you're in those situations because they'll tell you the safest possible option because they don't want you hurting their product and obviously not hurt yourself in, they're doing the same thing. But their product is the primary concern. They don't want anything to go wrong with that. And that's not necessarily a bad thing that they're thinking that way, they're still thinking about you. They're not thinking of you as a product but you have to think of it from that perspective. Like, that's why the surgeon is saying what they're saying. So ask more questions and investigate that a little bit more and get specifics, what can I do or what they don't want you to do? And if it still sounds a little crazy in your head, that'd be like, “Okay, I'm gonna get another opinion on this”.
[00:25:32] Chad: And I kind of told her too was like, “I don't want you to think of this”. Like, as you being a trainer, don't forget that you have this nursing background, and you're a nurse and an emergency department, you deal with this stuff all the time, put on your nursing hat and say, “This isn't right”. Like you can do that. That's within your scope of practice. Just because you're training somebody doesn't mean that you can't be a nurse that's like us. We can't be a PT when we're training that makes no sense. Like, why can't you have the best of both worlds? So I said, “If it doesn't seem right which it's not, then you need to say something, that's your responsibility as a healthcare provider.” You know what I mean? And she knows that she just not trying to step on anybody's toes, but I'm done not step anybody's toes, it's just time to stop stepping.
[00:26:14] Nick: And also, if a doctor or a surgeon says no PT for the first six weeks, that doesn't mean you can't go to PT that, that PT should know what they should and shouldn't do in that situation. They've seen it before. And hopefully they've worked, very effectively with those types of post op patients in the past. So the PT should be well aware of what they should and shouldn't be doing. So you can absolutely go to PT, even if your surgeon said to wait six weeks that is totally fine. And hopefully your PT will say, “We're going to do this, this and this time.”
[00:26:51] Katie: But don't you think that like most people, the average person is really, they're gonna listen to their doctor before having their own, I don't want to say the mind of their own. I feel like that's kind of rude, but to think for themselves and to get to that point where they do go to a PT and have faith that that PT is going to have them do what's okay to do? And I don't know, I just think it's hard. Because we were in a society where the doctors up on a pedestal and everybody listens to everything that they say.
[00:27:33] Chad: We're not saying that the doctors are wrong. But we also know that words are misconstrued. So when the doctor says, I want you to go easy, who knows what the doctor said, he could have said, “Hey, take it easy. I don't want you to do too much movement, or I don't want you on the leg. That doesn't mean you can't move, it just means you can't be on the leg”. So I think that there just needs to be better communication from that.
[00:27:54] Katie: Ask more question.
[00:27:55] Nick: Ask more questions from multiple sources. What do you do when you look something up on the internet? Usually you'll look at one, you'll click on one length, read it and click on the next one will be like, these are opposite. Now I have to look at more same idea with something like this. It's like ask around who's has this? Has someone been through this that I know? Can that do I know a physical therapist already that I can reach out to? Do I have someone in the family I can ask that's been through this? So ask multiple people questions, gather all the data for yourself, and then you can start to make decisions. Just taking the first answer, especially nowadays probably isn't good.
[00:28:30] Chad: I think people are getting to be better consumers of their own health, I think because of all the resources that are available now, the World Wide Web and smartphones and stuff.
[00:28:42] Nick: It's a blessing and a curse.
[00:28:44] Katie: Totally, that’s a whole another talk.
[00:28:46] Chad: Totally. But I don't think. I think in that respect, it can be helpful if they need to gain a little bit more knowledge as to what's next in their plan of care will that always be? Maybe not, but they get a direction at least. So it's better than be in bed rest. So, that's vicious, did you want to add anything new, Nick?
[00:29:06] Nick: No, I'll save my other story for next time.
[00:29:09] Chad: You get a little gung ho on story. So I just wanted to do it now.
[00:29:11] Nick: I'll save this one for next time.
[00:29:14] Chad: You want to get the moral story, you're gonna take that away?
[00:28:42] Nick: You got to do this is your thing. I don't want to take this my chances, this is your thing.
[00:29:19] Chad: Alright, everybody. Moral of the story. We obviously have a long ways to go with progression in the field of physical therapy and other fields in the medical profession. We do understand the healthcare system will never be perfect. But it seems that we hear stories like this all too often. The best thing we can do is just bring awareness like we talked about. And that is the intention of the podcast. So listen, if you're a healthcare provider, and you're listening this we just ask that you don't be reckless with other people's health. And for all those patients that are listening, you shouldn't put up with people that are reckless with yours now, I'm gonna throw a little ending here. That was how I normally drop it. I might drop right after that, but I can't. I gotta hit this since you. You mentioned something pretty important which I think we should make a podcast on. So I'm gonna leave with this. Butt wink is actually a normal physiological movement. Look the squat me, I just give it a butt week.
[00:30:15] PODCAST OUTRO: Thank you for joining us “In The RACK” this week. Make sure to subscribe so you don't miss out on any future episodes. You can also find us online at proformptma.com, or on social media at ProForm PTMA. And remember;
“If you train inside the rack, you better be thinking outside the rack”.
