Building Trust With Our Clients

• OT Pioneers: Intro to Pelvic Floor Therapy  opens Sept 16-20, 2024
• Introducing the Functional Pelvic Practitioner Levels and Certification - for OTPs Craving a Structured and Recognized Path to Specialize in Pelvic Health

More about my guest:
Brianna  Murosky was drawn to pelvic heath when she experienced her own symptoms of pelvic floor dysfunction while in collage. She holds a certification as a Pre and Postpartum Corrective Exercise Specialist (PCES) and Trauma Inform Pelvic Health (TIPH)  in addition to  completing a divers variety of pelvic health courses. Brianna is especially passionate about getting to the root cause of each individual's pelvic floor dysfunction which involves assessing nervous system regulation, biomechanics, lifestyle habits and more. She believes it is her job to empower her clients to better understand what's going on with their own bodies, and walk alongside them in their journey to recovery. In her free time she enjoys spending time with family and friends while cooking a homemade meal. She is always down for an outdoor adventure including water and snow sports. After work you can find her at the gym weight lifting or elevating her yoga practice. 

Where to find her: @ bri_pelvic_ot 

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Transcript

Lindsey Vestal Brianna. My guest today was drawn to Pelvic health when she experienced her own symptoms of pelvic floor dysfunction while in college. She holds a certification as a pre and postpartum corrective exercise specialist, and she recently received the trauma informed Pelvic health certification through Laura Desrosiers and I. Brianna is especially passionate about getting to the root cause of each individual's pelvic floor dysfunction. 

Lindsey Vestal Which involves assessing nervous system regulation, biomechanics, lifestyle habits and more. 

Lindsey Vestal She believes it's her job to empower her clients to better understand what's going on with their own bodies and walk alongside them in their journey to recovery. In her free time. 

Lindsey Vestal She enjoys spending time with family and friends while cooking a homemade meal. She is always down for outdoor adventures, including water and snow sports. After work, you can find her in the gym, lifting weights or elevating her yoga practice. Let's get into today's conversation. New and seasoned OTs are finding their calling in Pelvic health. After all, what's more adult than sex, peeing and poop? But here's the question What does it take to become a successful, fulfilled and thriving O.T. in Pelvic health? How do you go from beginner to seasons and everything in between? Those are the questions and this podcast will give you the answers. We are inspired, OTs. We are out of the box, OTs. We are Pelvic health OTs. I'm your host, Lindsey Vestal, and welcome to the OTs and Pelvic health Podcast. 

Lindsey Vestal Brianna, it is such an honor to have you on the OTs Pelvic health podcast today. Thank you so much for being a guest. 

Brianna Murosky Thank you for inviting me on here. 

Lindsey Vestal I had the pleasure of supporting you in the inaugural cohort for the trauma informed Pelvic health certification. Got to hang out in Sedona together a little bit over a month ago. And I just have to tell you how much I really appreciate it. Your thoughtfulness, your perspective, just how much you're integrating trauma informed work into your practice with your clients. You're a wealth of knowledge and it was such an honor to get to know you. 

Brianna Murosky Thank you. It's it has been an amazing experience to go through the certification and see and meet everyone in person and really just get to apply all the knowledge that I learned over the course of those few months. 

Lindsey Vestal So I'd love to kick it off with, I think, something that you have deeply integrated into your practice, which is as pelvic floor therapists, how can we recognize signs of nervous system dysfunction within our clients? 

Brianna Murosky So the first thing that comes to mind is using our observation and analytical skills from the very first evaluation with the client and noticing their nonverbal cues. So how are they sitting in the chair or are they kind of upright on the edge or are they more slouched? What's their tone like? How fast are they talking? Are they fidgeting a lot? Are they calm? And then how are they explaining kind of their story and their health history? A lot of times people who have a lot of medical trauma have been to a lot of different practitioners. They're in search of answers and they really have never felt that support that they are looking for from other practitioners. So being able to really listen and hear what they're saying and then give them affirmation that, yeah, what you're saying, you've been through a lot and this is what I'm noticing as we're talking. 

Lindsey Vestal And do you find bringing that up as, as something you had a kind of work towards feeling more comfortable with or do you kind of have kind of stepped into it pretty early on in your journey? 

Brianna Murosky I would say a combination of both. Especially getting into Pelvic health as a fairly new grad when I did. There's definitely a lot of emotions and a lot of stress just to know what to say. So when also when you kind of get caught up in that, sometimes you forget to take a breath. Really focus and listen and you're just on to, okay, what do I need to ask them next? Like, what do they expect me to say? Am I going to be able to answer their questions to the best of my abilities? And then as I just got more comfortable and more practice with treatments, I that's when I think I really saw myself picking up on those little subtleties that I didn't necessarily get in the very beginning. 

Lindsey Vestal Yeah. And, you know, it's, it's a, it's a practice, right? Like it's, it's one of those things where I think the more we start to trust our intuition, the more we're able to and lean into. So some of those, you know, intuitive hits that we're getting some of those observations. I think that the more confident we we get and it's not always practiced, you know, I think that a lot of our mentors and a lot of, you know, a lot of the past of Pelvic health therapy hasn't hasn't always kind of leaned into this trauma informed lens or or in the course of the last 30 years. Right? We've been developing our understanding of what that could look like and putting concreteness around it. And so I am just I'm so appreciative of you taking the time to kind of share some of that journey with us so that more and more of us can feel good about kind of stepping into what I think most of us know is just really the foundation of pelvic health. 

Brianna Murosky Absolutely. And to go along with that, it's understanding that we're all human and we don't know everything. And you need to give yourself grace, because at the end of the day, you are just trying to do what's best for your client. And they when you show them that trust and build that good foundation in that relationship, they're going to respect you so much more, I think, and continue to come and want to work with you. 

Lindsey Vestal Well, I love that. I love that. I think, you know, most of us occupational therapy practitioners have a sense of the importance of the nervous system approach. To our work. Right that that you know, even the best hands on skills, the most incredible manual therapy techniques you know have their place and are incredibly important in the healing journey but that you know that nervous system approach first feeling safe in the body feeling embodied. So madekwe, I think is that foundation that then all the other incredible skills that we have developed kind of stack up with and alongside of in your opinion, Brianna, how do you think we as occupational therapy practitioners can effectively integrate nervous system education into our sessions with clients, especially if we're just kind of getting started? 

Brianna Murosky Yeah. I loved him. Naturally. Integrate it from day one of my visit. And how I do that is I explain to them actually the five functions of the pelvic floor. Right? I call it the five S's. So support stability, seven terek, sexual and sub pump. And when I go into the sub pump category, I talk about how 316 breathing or diaphragm breathing is really essential for the coordination of the pelvic floor. And then I go into how breathing relates into the nervous system and the vagus nerve and how these things can affect heart rate variability. Digestion are holding in tension stressors and all of that. And usually that's really what ties them in of like, my gosh, like I'm connecting with something that you're saying, and maybe I even bring in something we've talked about earlier in that session of a stressor they've experience and how it can relate to the nervous system and their pelvic floor symptoms. And that really gets them, gets their attention and gets them wanting to know more. So I kind of just give them a little bit of a taste, that first visit. And then from there, it really depends on the client and kind of their response because some are a little bit more hesitant. So I'm going to ease into it a little bit more versus others are like, No, I really want to learn more. Like, let's start to do this in future sessions. So we'll jump right in. 

Lindsey Vestal That's so, that's so incredible. I love this this guidance that you're that you're suggesting here of like, you know, it's there from the beginning, but it's just sort of like weaving it in as appropriate and then recognizing, you know, how to add on to that based on the questions the client is asking, based on their experiences, why they're there to see you to begin with. And just kind of like playing on that, that sense of curiosity to to bring them more into this this nervous system based approach. That's that's fantastic. Brianna. 

Brianna Murosky Thank you. 

Lindsey Vestal What are I'm so curious, what are some of your go to use for grounding techniques with clients? 

Brianna Murosky So my favorite way to start, especially if someone is a little bit more hesitant to nervous system techniques, is starting with manual therapy. And a lot of times I actually start with the abdominals because so many people are abdominal grippers and they have a lot of tension in that area. And that's one of the places that people don't really think to treat or address right away. So I usually will do more visceral techniques, but while I'm doing that, I'll start to really have them tune into their breath and the expansion and what area they're breathing into, and then through their own kind of create this imagery of maybe of a place that they find really safe and relaxing. And sometimes I give them the option. I'll say, Okay, what one resonates best with you? Is it somewhere on an ocean beach side? Is it in the mountains? Is it a field of flowers, or is there one that I haven't said that you want to pick? And then from there I'll just create this imagery of them kind of laying down in this beautiful scenery. And then I'll tap into maybe some auditory cues, some tactile cues and or factory cues and really paint this picture while I'm still doing the manual work on them. And that's usually where they start to feel their body really release and I like to say, melts into the table and they can truly feel how their body is responding to the this, I don't know even like this illusion that I'm creating with them. 

Lindsey Vestal I love that Here we are talking about a trauma informed, nervous system centric approach. And I really love how you just shared with us. Like actually I start with manual therapy and I love that because there is not one right way. And I think that when we take our own set of unique skills, our background, our training, our therapeutic use of self, all of the things that as human beings we have kind of like, you know, brought to this moment, brought to what we can bring into the clinic and to support our our clients. You know, it's it ends up being you take a little bit from. Here, right? You take a little bit from there and it's this beautiful combination that we then have this unique ability to prepare this recipe that is authentically us. It's not cookie cutter. It's not it's not straightforward. And I know that a lot of new therapists probably really crave that. And I know I did, too. But I will say that for anyone listening to this episode who, you know is thinking about getting into Pelvic health, it is probably the reason you'll stay, even though it can be a little intimidating in the beginning to not have, you know, a complete protocol to follow, It ends up being one of the most liberating aspects and most fulfilling aspects of our job. 

Brianna Murosky Absolutely. And it's is just amazing how you can tie that in in so many different ways. And the patient might not even connect the dots at first, but then you might add in little tidbits here and there and then all of a sudden kind of a light bulb goes off of, my gosh, wow. I didn't realize this at first, but I made this connection. And sometimes it's at home when you give them something to do outside of your session and they're there taking time to be intentional about it and something just clicks and then that's when it's really exciting for you as a practitioner when they come back to their next session and they share with you what they that little glimmer of what they learned that leave without you and what more. 

Lindsey Vestal Fantastic. I love that and thank you for bringing that up. Regarding like stuff that happens outside of the session, I think that's a huge point of integration for our clients. It's like, you know that time between sessions when they're kind of sitting and still processing what's actually very, very novel information for them, everything from education of the pelvic floor to how the nervous system is involved and all of the myriad of topics in between. I think sometimes it does take them kind of stepping away and processing and reflecting to have those moments. 

Brianna Murosky Yes. And sometimes I even have to remind myself, okay, I teach this to X amount of patients a week. So to me, it's second nature. But to someone who's never heard it before, it's brand new and it might take a couple sessions to really sink in. So just being patient and it's okay to repeat something that you've said before because we we need repetition and we need to learn something in multiple different ways to get the best benefit from it. 

Lindsey Vestal Thank you. Thank you so much for saying that. I think you're so right. I mean, just reiterating the two jams you just said, we go through this information X number of times per day per week, but this is the first time they're hearing it. And then I'm a big fan of repetition. I personally even going through grad school even now and pursuing more education and pelvic health, I am definitely a learner who needs that repetition and needs to kind of go over the material again and again to see it in new ways and sometimes to even really deeply integrate it and understand it. And I think it's the same thing for our clients. And so for anyone listening who might think, well, gosh, like I already explained the roller breathing or I already talked about the three function, you know, the functions of the pelvic floor, it is an ongoing process that they're going to be able to hear in different ways throughout their healing experience with you because of just sort of the ebbs and flows of really not only intellectually, but cinematically understanding the material you're presenting. 

Brianna Murosky Right? And also knowing if the patient isn't getting it. Sometimes it's okay to put whatever you're trying to teach them on the back burner going to something else. And then if in a few more sessions, going back to whatever that was, because there is times where that person isn't ready to hear what you're telling them and you just trying to continue to force it. It's not going to work and you're both going to end up frustrated and your your client's going to lose your trust. And sometimes that's hard to do. And it's especially hard to keep everything in your brain of what you're doing with them, why you're doing it, and then putting that in late term. So they're really understanding it. 

Lindsey Vestal Awesome points. Yeah, I completely agree with you, Brianna. Do you mind sharing a case study that kind of illustrates your work through a nervous system approach? 

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Brianna Murosky Yes. So I had a recent patient that I was treating for it was a male for erectile dysfunction. And as soon as he walked in the room, I knew he was a nervous system client. He was talking really fast. He was kind of rocking back and forth, fidgeting with his fingers, trying to get out all the information he possibly could about his medical history and all the different doctors he's been to and what he's been told and how he just wants to get answers. And I was sitting there taking it all in, and I'm like, okay, I need to take a breath because now I'm a little bit overwhelmed. Ahem. And that session, I kind of just did. I kind of. Recapped what he what he told me. And I was like, okay, we're going to start somewhere. So after I got this client's history, we jumped right into breathing and breath breathwork and then doing an external assessment so I could already tell he was more rigid. Poor mobility, had more of a forward head posture, flared rib cage. And he was a very shallow chest breather with what I call an inhalation pattern. So he, when he inhaled, instead of breathing down, he would get stuck in his chest. And it was really hard for him to figure out how to get his air down. And he felt like very restricted. So that was that first session. And then a couple sessions after that is when I started to ease him into some grounding activities. There was one specific session where he was five minutes late and he came up. He came in specifically amped up and I could really see it. And I knew like, okay, we need to do something because he's just all over the place. So I started with more of a progressive muscle relaxation practice. It was actually recording and I did it with him. And in the specific recording it asked for your thoughts from 0 to 10, from like slow to racing thoughts, and then also asked about your energy level. So from really high up to relaxed and he was pretty high. He was definitely a ten out of ten on racing thoughts and about an eight out of ten in his energy level. So I took him through this practice and afterwards we debriefed and his racing thoughts and energy level definitely came down and he was able to realize that he had very poor awareness of his body. It was really hard for him to feel his sit bones into the chair. He did find out, though, by tapping his legs and arms that helped increase his sensation and bring more awareness to it. So that that practice, I would say, really kind of kick started us into that nervous system route because by the end of the session, he's like, my gosh, that was so helpful. Can we do this again next session? And I was like, Absolutely. Well, we'll continue to try different grounding practices. And from there, one session he came back to me and I was shocked by how much his nervous system had changed. He was sitting in the chair, relaxed. He was talking slow. And he. Jess felt so much calmer and I was like, How did this change in just a couple of sessions? And he he was all of at it. And then another one of the next sessions, he came back and he actually told me this story. And I thought, wow, this this shows how much your nervous system has changed. And he he rented a U-Haul actually to move his his daughter out of an apartment. And there was a rainstorm that happened. And he already didn't like driving new house. So he's white knuckling it. And he he was like I could barely breathe. I was holding my breath. And then he's like, I thought of you. And I was like, I need to breathe. And he just took his nice deep diaphragm breaths and his wife was in the passenger seat just watching this whole thing. And she was shocked because she could not believe how well he was able to regulate himself in that very stressful moment. And it it started to correlate into his relationship with his wife and their intimacy. And he he was able to have pleasurable moments with his wife again, that he had been missing for years. So, yeah, I, I just love telling that story because it it's so exciting to see how he was able to change through a simple like breathwork and body awareness practice. 

Lindsey Vestal That is so beautiful. And I really appreciate that it was a penis owner that you shared the story with. You know, I think so often in public health are often thinking about people with female anatomy. And, you know, this was just such a great illustration of your patients and you just really being present with this client to be able to help help them, help him through, you know, all all of the things he was struggling with. And I really love the story of his partner, you know, driving and sort of noticing that that change that that your work together had had evoked. 

Brianna Murosky Yes. 

Lindsey Vestal Is there anything else that you can think of that you want to share regarding your nervous system work regarding anyone who you know is is curious and kind of like learning more about this, integrating this approach into their work. 

Brianna Murosky I would say always keep an open mind and be okay with a lot of gray right? Pelvic health There's no black or white answer. And a lot of times when treating the nervous system, it's a windy road and you have to walk along side your client and really just listen to what they're saying. And they most often have the knowledge within them. You are just helping them get to where that knowledge is. And I think that's actually a quote that you said once that really resonated with me. And I love it. 

Lindsey Vestal That was amazing. I really appreciate that that that gray area can be really uncomfortable for us. But I do think it's really where the magic can happen. So, Brianna, thank you so much for your time today. And, you know, just for sharing all of your incredible wisdom with us and just for yeah, for for being a part of this really special inaugural cohort for the trauma informed Pelvic health certification. 

Brianna Murosky You're welcome. And for any of you listening, if you're wondering whether or not to take Lenz's certification, please do, because it definitely changed the way I practice and gave me more confidence and I'm glad I did it. 

Lindsey Vestal Well, thank you so much. Have an awesome, awesome rest of your day. Brianna, I have a feeling you're going to be back on the podcast in the future, so I'm looking forward to that already. 

Brianna Murosky Yeah, thanks for having me. 

Lindsey Vestal Thanks for listening to another episode of OTs and Pelvic health. If you haven't already, hop on to Facebook and join my group OTs for Pelvic health, where we have thousands of OTs at all stages of their Pelvic health career journey. This is such an incredibly supportive community where I go live each and every week. If you love this episode, please take a screenshot of this episode on your phone and posted to IG Facebook or wherever you post your stuff and be sure to tag me and let me know why you like this episode. This will help me to create in the future what you want to hear more of. Thanks again for listening to the OTs and Pelvic health podcast.