The Lack of Postpartum Care: Dr. Amanda Thompson Unlocks the Mysteries of Pelvic Floor Therapy

In episode 71, we sit down with Dr. Amanda Thompson, the dynamic force behind Rooted Physical Therapy. We embark on a transformative journey into the world of pelvic floor therapy, a realm where Amanda's expertise shines brightly, especially when it comes to the nuanced care required for prenatal and postpartum women. Brace yourself for an episode that not only educates but also empowers, as Amanda's vivid storytelling paints a picture of a life free from the silence and discomfort that too many women endure.

Amanda is a physical therapist and the owner of Rooted Physical Therapy. She is originally from Humble, TX. She attended Texas A&M (where she met her husband) and received her Bachelors of Science degree in Kinesiology in 2007. She later received a Doctorate of Physical Therapy degree in 2013 from University of North Texas Health Science Center in Fort Worth. Amanda is proficient in all areas of physical therapy including orthopedics, neurological conditions, sports medicine and pediatrics and gained experience in rural settings working with chronic pain, fibromyalgia, connective tissue disorders and more. 

Amanda is passionate about women’s health, helping women in the perinatal phase with pain management, birth prep, birth trauma and healing postpartum. She received training from Lynn Schulte with the Institute for Birth Healing and Jessica Drummond of the Integrative Women's Health Institute. Her specialty is pelvic floor therapy, treating symptoms of pelvic pain, dyspareunia, vulvodynia, vaginismus, incontinence, urgency/frequency, and bowel dysfunction.

Join the Waitlist for Amanda's Book:

• What your PT wants you to know.. about Post Partum Care

Rooted Physical Therapy Resources:

• Website
• Instagram
• Facebook
• TikTok
• YouTube
• Linktree

Other Resources Mentioned:

• The Vagina Whisperer
• APTA - PT Locator 
• Expecting and Empowered
• Jessica Drummond's Instagram

Connect with USS: United SHE Stands Instagram

This episode was edited by Kevin Tanner. Learn more about him and his services here:

• Website: https://www.kevwyxin.com/
• Instagram: @kevwyxin

If you purchase from any links to resources or products, the show may make a small commission.

Transcript

Amanda: 0:00

The United States is probably, I would say, third world country when it comes to women's health, in my opinion, but they truly don't know any different. How do we make that change? I don't know. I don't know the answer to that, because every state in the, at least in physical therapy, every state mandates their own rules and regulations around physical therapy.

Ashley: 0:30

Welcome back to the United Cheese Stands podcast, the show that brings kindness and women into politics. I'm Ashley.

Sara: 0:36

And I'm Sarah, and we're two women from Ohio who are here to become more educated about American politics and build a community so we can all get involved and make an impact together.

Ashley: 0:46

We hope we'll inspire and empower you along the way. All right, hello and welcome back to another episode of the United Cheese Stands podcast. We have an awesome guest this week, my friend Amanda Thompson. I met Amanda through the pursuing her purpose mastermind I enrolled in last summer.

Ashley: 1:15

Amanda is a physical therapist and the owner of Rooted Physical Therapy. She is originally from Humboldt, texas. She attended Texas A&M where she met her husband and received her bachelor's of science degree in kinesiology in 2007. She later received a doctorate of physical therapy degree in 2013 from University of North Texas Health Science Center in Fort Worth. Amanda is proficient in all areas of physical therapy, including orthopedics, neurological conditions, sports medicine and pediatrics, and gain experience in rural settings working with chronic pain, fibromyalgia and connective tissue disorders and more. Amanda is passionate about women's health, helping women in the prenatal phase with pain management, birth prep, birth trauma and healing postpartum. She received training from Lynn Schult with the Institute for Birth Healing and Jessica Druman of the Integrative Women's Health Institute. So Amanda's specialty is pelvic floor therapy and she treats a lot of symptoms which I'm going to let her talk about in a little bit here, because a lot of them I cannot pronounce.

Amanda: 2:11

But welcome Amanda. Thank you for having me. I'm so excited to be here and really just educate the world as my whole goal with everything, but I really appreciate you having me on, yeah.

Sara: 2:24

Yeah, we're so excited to have you. I first heard about you from Ashley and it's quite a funny story. So, true or false, the first time you two met you were in a vagina costume. I was.

Ashley: 2:40

Yeah, awesome too guys.

Amanda: 2:43

Or maybe it was the poop costume was the first day, because I have to make an entrance. You can't go somewhere in a group of women and not stand out. So my whole goal was to stand out. So the first day I tried to go to the bathroom and put the poop costume on first so that when people came in people would be like, oh my God, who is that? And nobody would forget who I am because I was the girl in the poop costume. And then the second day I went to the bathroom right before we started and I danced in front of everybody in my Volvo costume. So if you follow me on social media, eventually there is lots of poop and Volvo dancing situations happening.

Ashley: 3:23

Yeah, and I love your one liner because I actually got to meet you. So, like I said, me and Amanda and I know each other through the pursuing her purpose, mastermind, and there was an in person event in Madison, wisconsin, like two days, like Thursday, friday. I actually ended up getting a drink with Amanda Wednesday night before the event and I your one liner, like when you introduce me, like this is how I think I'm going to introduce myself, and it was so good. Can you, can you tell everyone?

Amanda: 3:44

So I do a quick. Well, a, I was already drinking. So that was, yeah, that was true Whiskey beverages had been in progress, but I introduced myself as I'm Dr Amanda Thompson. I'm a physical therapist. I treat pee poop and sexual dysfunction. Yep, I love it.

Ashley: 4:04

That was like the first time she ever said to me and I was like it's nice to meet you. You grab people's attention all the way.

Amanda: 4:09

It does. And I used to be really nervous when I started doing public for therapy. I would be like I'm a physical therapist and somebody on the airplane would be like, oh, I went to physical therapy for my ankle and I'm like, okay, but any physical therapist can treat an ankle like that Like good, I'm glad you had a good experience. But I treat public floor dysfunction and chronic pain and all the things that nobody wants to talk about and nobody wants to treat, and everybody gets red faced when they do so. Now I'm brave enough that I'm like I treat pee poop and sexual dysfunction. People are like, wait, what, what did she just say? Yeah, especially when I talk about once I get people out of public, public pain, which we'll talk about a little bit more. Then the next line is my patients will come in. They'll be like I was able to have sex without pain. Oh my God, thank you, thank you, thank you. But it was. And I'm like, all right, let's work on that.

Amanda: 5:09

So then it turns. It turns into a let's fix your orgasms. We need pain free and really good orgasms. And so then my patients are like, all right, I'm down. And so when I talk about that on my social media. It's really. It's a funny engagement, but it's a real problem that people face, and so I just try to make fun and light of the situation, but really trying to broaden the horizons of I used to think I'm only one human that is trying to make an impact in the world, but I'm truly just trying to impact one person at a time, and if one person can hear what I'm saying and that their symptoms are not something that they have to live with for the rest of their life, then I've done my job, and so seeking out somebody in your area is going to be key. So I love talking about pelvic floor. I could talk about pelvic floor therapy and what I do for hours on end, for sure.

Ashley: 6:02

That's awesome and we are going to talk about it quite a bit here, but first we're going to talk about what we're drinking. So, sarah, do you want to talk about what we're drinking first? Yeah, we're going to get over to.

Sara: 6:12

Amanda Ashley and I are sharing a juice caboose beer from Westbound Down Brewing.

Amanda: 6:20

This is from.

Sara: 6:20

Ashley's beer fridge. She and her husband have no idea where it came from. It just ended up there, but it's a really cool tie-dye can and it's quite tasty. It's a hazy IPA.

Ashley: 6:30

I feel like one of our friends sent it home with us on purpose, but I can't remember.

Sara: 6:33

Shout out to our friends.

Ashley: 6:34

Yeah, amanda, are you drinking anything with us today?

Amanda: 6:37

I am drinking with you today, so I blame my dad or my mother, whichever one. But I'm a huge whiskey drinker, so I love whiskey, I love the, I love old-fashioneds, I like it to burn, just a little bit going down. But my favorite drink is Jameson and Ginger Ale. So I'm drinking Jameson and Ginger Ale, yum.

Sara: 6:59

Awesome. All right, we're going to dive into it. Yeah, let's do it. We'll start at pretty high level. So what led you to becoming a PT and, specifically, what led you to focus on pelvic floor therapy?

Amanda: 7:09

So this could be a really long conversation, but the short version is I was a gymnast growing up, so I competed my whole life until I graduated high school, and if you do gymnastics you get injured quite a bit. So I was injured a lot. I broke all the things the arms, the legs, the feet, the back, all everything. I never went to physical therapy for two reasons my parents never had insurance on us and so we couldn't afford to go to physical therapy. And then why do physical therapy when I have all the equipment I need in the gym? So even when I was have a cast on, I would still do the bars, I would still learn release moves, I learned aerials. With a broken arm, I learned all kinds of things with casts on different body parts. So when I went to undergrad I was like well, I want to do something in the medical field and physical therapy seemed to be a natural kind of flow for me as an athlete former athlete, I should say. And so as a physical therapist, getting into the world, you have to do different hours in different fields, and so of course, everybody that gets into physical therapy not everybody, but a lot of people say I did sports, so I want to do physical therapy. I did sports, so I want to do physical therapy. So I was like, well, I have to get hours in different areas so that I stand out a little bit different. And so I started investigating different things. Short version I never heard of pelvic floor therapy or women's health therapy until my second year of physical therapy school. So I went to undergrad, got my bachelor's degree, did two or three years of working as a tech, again in the sports medicine field, then I went to PT school. In PT school we had one lecture it was two hours followed by a two hour lab, which was kind of a joke because nobody does anything crazy in PT school. But I was lured literally at the lack of information that was provided. But I still didn't think I'm going to do pelvic floor therapy Not like no idea. So fast forward. I ended up doing my very first job at a very rural hospital, and so we live in Texas, in about an hour from the DFW area, so it's in a rural area, but I worked 30 more miles northwest, which is even further into a rural area. So that, honestly, was the best place to work as a new grad, meaning I learned everything I could to this day because I did my first few years in a rural hospital outpatient, inpatient, neuro kids, everything. I can walk into any facility at any point in time and be proficient at that job, so I'm very thankful for that. But what I started realizing was everybody that came in with chronic back pain or SI joint pain. Everybody would say I would be better for two or three months and then they would end up right back in the same gamut of things.

Amanda: 10:10

Fast forward a little bit more. I had my own journey of infertility and so I was seeking out holistic things to get treated. Nobody could figure out why we had infertility. We tried for four years, couldn't get pregnant. I did all the things. I even went to a pelvic floor therapist. I drove an hour and a half because that's the closest one to me, hour and a half to a pelvic floor therapist back in. It would have been 2014 at the time and she basically told me to breathe and told me to relax, and I was so distraught with the amount of information I was provided, which was nothing, but I started seeking out things. So I had IVF with both my kids. So both my kids are my little Petri dish babies science projects, and I had a horrible traumatic delivery for my son.

Amanda: 11:03

It was a three hours of active pushing after my water broke at 37 weeks I had to be put on Potosin because my water broke so early, I wasn't dilated nothing, so I had to go from zero to 60 really quickly. Three hours of active pushing, with heartburn, by the way. If anybody's pushed with heartburn, that was horrible, so I did not tear, thankfully. But the amount of information I was provided afterwards was so limited I didn't get any postpartum information other than the ice pack myself and drink and have stool softeners. So I myself dealt with urinary leakage. I even had fecal leakage right after I had a baby, just from the amount of pressure that was down there, and I realized that nobody was talking about it.

Amanda: 11:51

So I started going to courses to fix myself. Then I would ask more questions to my clients, find out more information, and it turned into this catapult of realizing that all of these patients had similar issues and that I could actually fix them. So it's a really long story how I actually got there, but really it was a trial and error for myself and I didn't realize that I was also seeking out information that other providers were seeking out. So I'm also part of another mastermind group, which is all pelvic floor therapists, and once I met them I was like wow, I didn't know that what I was doing everybody else was doing as well, and the pelvic floor world is truly just trying to educate the community.

Amanda: 12:42

In a way. That's funny, but we're also very serious about it because it's a problem that I would say most people experience at some point in their life. They just think it's normal or they just don't want to conversate about it. I didn't get brave enough to jump and talk about a lot of this stuff until well. I didn't get brave enough to do it on my own until my best friend, taryn, actually pushed me off the edge and told me I could do it on my own. So I thought I was being at the hospital setting forever. That didn't work out.

Amanda: 13:12

That could be a whole nother beverage conversation of why hospital-based outpatients for physical therapists is just not good, and I was worn out. So COVID really pushed me over the edge as far as burnout. So I had been in practice for several years winding and grinding, going into work at 7 am, leaving at 5.30, going to pick up my kids at daycare. I was blessed to have a daycare that stayed open during COVID.

Amanda: 13:38

But because I was a salaried employee in the healthcare world, I was worked to death and so, although other people were furloughed, when people at the end of the summer of 2020, when people were starting to cut it well, in Texas at least everybody was like fuck, covid, we don't really care anymore. So things started opening back up and people were like, oh, we spent so much time with our kids and we were so blessed with the time, although it was really tough. And then I had the realization like, oh shit, I worked 60 hour work week since March. I didn't have a vacation, we weren't allowed to take off, I worked weekends. I did not experience COVID like everybody else did, and so once I kind of realized that it did take me another year and a half or so to leave, but it was a big eye opener that I did not experience that timeframe like everybody else, and the burnout got worse after that.

Ashley: 14:33

Yeah, yeah, that all makes sense. Long journey, but it got you to pelvic floor therapy. So you had even said you had never really heard of it. For anybody listening who doesn't know, can you explain what is a pelvic floor and what is pelvic floor therapy?

Amanda: 14:46

So everybody has a pelvic floor, even men. So the pelvic floor is the muscles underneath your pelvis, and so we're going to make this interactive for anybody that's not currently driving listening to podcasts. What you're going to do is you're going to take your hands and you're going to find your sit bones. Your sit bones are what you sit on, so the bony pony pieces under your butt, and you find those with your fingers, and then you go inwards just a smidgen towards your butthole, and that's your pelvic floor, bound it no-transcript.

Amanda: 15:18

You can practice a few things which will go over breathing and a few things here, but your pelvic floor sits underneath your pelvis. The muscles from the front to the back go from your pubic bone to your tailbone and then they go from sit bone to sit bone. They have five functions. The five functions are the five Ss, but the main three are what everybody cares about. They are supportive, so they help support everything, above all the organs, everything connected above it. They are stabilizers. They are also connected to your hip and your sacrum or your butt bone, your tailbone, your pubic bone. They help stabilize that whole area. They are spinked teric, meaning they control all the ins and outs going in and out of there. They are also sexual in nature shocking. Then there's something called the sump pump which, just as a fancy way of saying it, helps with lymphatic drainage. There's some diagnoses like pelvic congestion syndrome, endometriosis, things that increase inflammation in a very selected area. The sump pump can get really clogged and so the lymphatic drainage in that area is really, really important to get rid of Five functions of the pelvic floor. But the most important thing about the pelvic floor is that everybody has one, if you leak or you have any pain, including back pain, then you might have some sort of pelvic floor dysfunction. Constipation is a big one Everybody just takes drugs for. So the pelvic floor is the.

Amanda: 16:51

I tell people the pelvic floor doesn't lie. So the pelvic floor houses all of our trauma, all of our past, all of our secrets. It literally you can go really woo-woo on it or you can go very anatomical and the muscles themselves get very, very tight, just like any muscle in the body. So if your upper trap muscle or your neck muscle gets really tight after you sleep weird or you're on your phone a lot and you're looking down, you would naturally just rub it out and be like, oh, I have a knot right there. Well, in the same context those knots can get downstairs. So when there's knots down there, they can cause a slew of issues.

Amanda: 17:30

The fancy words that you were talking about in the bio, they're just Googleable words. So if you Google pelvic pain something like volvedenia or vaginismus or dysperaunia in reality it's just a different way to phrase pelvic pain, but they're coded a certain way based on what the physician's preferences, which is kind of sad. There's incontinence, constipation and a slew of other things. Urinary interstitial stitis is a diagnosis that I treat. I treat the whole body, so it's not just the pelvic floor, because the pelvic floor is connected to the hip and the back and all the things.

Ashley: 18:12

Yeah, Thanks, that's a really good explanation. I feel like I understand it because I'm even talking to you last time or like I mean, we didn't get into the details or I knew what you did, but even like some googling, I didn't fully feel like I understood exactly what the pelvic floor was. So that was really good.

Amanda: 18:27

If we have this on visual at some point or when, at the bottom we'll talk about my YouTube channel. I have a model that I described.

Ashley: 18:34

Oh yeah, amazing, yeah, yes, we'll have all your stuff linked for sure in the show notes.

Sara: 18:40

That's awesome. Yeah, I love the emphasis on even men have pelvic floors, so that's great, I do.

Amanda: 18:47

So men are not subject to not having pelvic floor therapies. So there's very few pelvic floor therapists out there period, and then there's even fewer that treat men. So men are just as susceptible to pelvic pain. They can have pain with erection, pain with ejaculation, they can have sacral pain or deep tailbone pain, constipation. So even a population that I see a lot of where I live is people that sit a lot. So I live in a rural area of Texas. So most of the men that come to see me are older men. They are at their width ends and most of them have either deep peritoneal pain or they have constipation. But I do get some younger men with pain with erection ejaculation. I have a few men that have deep sacral pain like where they sit. Sometimes it's related to the whole body. So we're looking at the way they stand, the way they sit, the way they move, the way they squat, get up and off the ground, what they do for a living.

Amanda: 19:55

There's a whole another area of pelvic floor therapy that works with men and women in the transgender population. There is one specific therapist who isn't that I know of there's more, but he is very outspoken about gay men and he is an Atlanta. He only treats gay men. That's his niche, that's what he treats. There's a whole other world of physical therapy that I don't have that patient population just from where I live. But I do have men. It's not on my website because that's not what I niche for, but the men that find me are pretty desperate for help. They're the most compliant patients and they get better very quickly.

Sara: 20:39

I love that let's switch to women, though. Can you talk us through how public floor therapy relates to postpartum care?

Amanda: 20:48

I think one of the biggest things that I want broadcasted out is something called the open birth position. If you've ever been pregnant, whether you had a full-term baby or not, whether you had a vaginal delivery or a C-section, you're likely still in the open birth position. Unless somebody's explained this On my YouTube channel, there is a video of it, but for those of you that are on this Zoom call, we will go over it. So when the baby's head descends into the pelvis, the effacement, dilation stages all the things that the nurse is checking for are midwife or whoever all the things they're checking for are happening at the same time. You don't do effacement and then dilation and then drop with the stages. Everything's happening at once. When that happens, your pelvis is moving from a position where the baby's head is a little bit more up at the top of your pelvis to where the baby's head is descending or going down into the pelvis. The pelvis has to move. There are physical therapists and other providers out there that say the pelvis in the sacrum and the SI joint do not move. It physiologically has to move in order for baby to get out. So if you watch a YouTube video of a mom delivering a baby, or if you've ever seen another person deliver a baby on all fours, specifically, you will see the sacrum or that butt bone actually protrude or push out a good quarter of an inch to half an inch, and I've seen it even more. So the bone in the back actually comes outwards this way. Why that's happening is because the baby's head in the inside is pushing downwards. Then baby has to come out. In order for that to happen, the bones on the sit bones that you just felt when you sat down those have to move out to the side. At the same time the tailbone has to kick out and push backwards. So after you deliver a baby, your pelvis never goes back to the position it was, unless someone puts it back.

Amanda: 22:56

I did not know this until like five or six years ago when I learned this technique. Then I started teaching or practicing on other women that weren't coming in for pelvic floor. They were coming in for back pain or hip pain or piriformis syndrome or very orthopedic related issues that have been in and out of physical therapy, and nobody's asked all the questions. So I would just ask them hey, can I try this technique on you? Can I do this? And they would let me, and then their pain would magically go away forever, which is phenomenal. So closing them, getting those bones back where they're supposed to be, is key.

Amanda: 23:35

Now my C-section. Mamas are like oh, I have C-section, I don't have any pelvic floor issues. Well, let me tell you, when, babies, at some point your labor was interrupted which means you are still wide open in the open birth position Baby's head was coming down. Some traumatic event happened the first time usually, and baby's head is ripped out, not literally, but when they have her second anybody's had a second or third pregnancy and they're like, oh my gosh, I guess I'm just older.

Amanda: 24:08

And then they realize I have so much more pubic bone pain, my back hurts so much more with this pregnancy compared to the second or the first one. That's because they're still in the open birth position. They're still in the open birth position, so their pubic bone is shifted, their sacrum or their butt bone is shifted and rotated. Their tailbone is not happy. Everybody's still here Now. Remember I told you that the whole point of the pelvic floor is the five functions, the five Ss. So if my function of my pelvic floor is to support everything above it and my bones are no longer where they were, then my support system is now a very slumpy hammock and so all the organs above are just going to protrude or push downwards. The other big thing that happens besides the open birth position is, as my baby grows, my uterus grows, my abdominal wall pushes outwards. So when my abdominal wall pushes outwards, you can develop something called diastasis recti or abdominal separation. When that happens, my core muscles are no longer working very well. Also, if anybody can remember when they're pregnant, or if you're currently pregnant, when you're pregnant your uterus is shoved up into your diaphragm, so your diaphragm it's hard to breathe, so you become an upper chest breather. You're breathing really hard with your upper chest and your diaphragm is actually inhibited or it stops working appropriately because your uterus is shoved up in it. I always remember joking when I was pregnant. I would be documenting on my computer and I would lean forward and my son would give me a swift diaphragm kick. He would just kick me right in the ribs and I would joke because he was like squished that he would just shove it up. But really, if you think about how big your uterus was and you sit down, your diaphragm is no longer working. So then our entire canister pressure is now gone. So when I cough or sneeze or I laugh or I pick up something heavy, now I don't have this nice closed canister anymore. I now have an open can, which means I have urinary leakage. I will have diastasis, recti will protrude outwards, which means I could have a hernia. I can have the mommy pooch especially my C-section moments complain about that a lot.

Amanda: 26:30

And girls, your C-section, your muscles were cut all the way down to your uterus, like all the way down. It's not just like a scratch, like it's all the way down. So not only was your diaphragm inhibited from being pregnant, you have an abdominal separation from being pregnant Now. You have every muscle cut, sliced. You absolutely need physical therapy after C-section or vaginal delivery and I love comparing, which I'm jumping ahead a little bit. I love comparing the C-sections especially, but any surgery which I'll explain peritoneal tears to. If you were to have a knee replacement, would you go get physical therapy? Yeah, yes, if you were to have shoulder surgery, would you have this? You would have therapy? Yep. So if I cut every abdominal muscle open with a C-section scar or even any abdominal surgery, hernia repair, plastic surgery, where they go in and close the abdominal If there's muscle cut or if there's skin opened, the muscles underneath can be inhibited. So we need to recover that. Yeah, that makes sense.

Sara: 27:43

That makes a lot of sense. I'm fascinated by the birth pose or the birth position, yeah.

Ashley: 27:50

Yeah, which I never heard of either.

Amanda: 27:51

in telling Amanda, so, oh my gosh, that I learned from Lyn Shultz. Lyn Shultz is in Colorado, she's in Longmont, colorado, and I learned that from her and she's taken it. There's still only people that have taken her coursework even know what that is. That's crazy. It's even a smaller niche than pelvic floor.

Sara: 28:12

Yeah, oh, my goodness, it just sounds like everyone should know If that's a for sure thing that happens. Wow, that's crazy. I can't imagine just the uncomfort that can bring.

Ashley: 28:24

Yeah, I don't want to say it. It's not surprising. It's disappointing to know that we as women in the United States especially, don't have a lot of care around this. But based on the other health things we've learned around women's health in the last year or so, I'm not super surprised. So, amanda, can you compare postpartum pelvic floor therapy care in the United States here with what is done in other countries?

Amanda: 28:50

So I love talking about a study and I cannot. I don't know, I've quoted this study for so many years that I don't remember when it was, but it was definitely a while ago. But if you just even consider the maternity leave concept, I think in Canada it's 18 months of paid maternity leave and in Europe they have really good maternity leave where it's anywhere from a year to two years of paid maternity leave. As a business owner I can't imagine doing that. I think I would not survive if I had an employee that needed to take off two years, because then you have to pay for two employees, and I don't.

Amanda: 29:29

I think it also has to do with the healthcare world in general for the United States, but in France, at least when this study was done when I read it, probably at least 10 years ago in France they get a standard 12 weeks of it's called physiotherapy. Over there they get a standard 12 weeks of physiotherapy. It's been, they've been doing it for a while, long enough to do a long-term study to where they are seeing a decrease in hysterectomies, decrease in prolapse surgeries, decrease in reported urinary incontinence and an improvement in sexual health in general after a 12-week stent of physical therapy At the initial component of having a child. So you get 12 weeks standard physical therapy or physiotherapy over there and then long term you actually are preventing a lot of issues in your future. And I think that's where preventative medicine, which is kind of turning a little bit of a course in United States, but it's still not standard of practice.

Amanda: 30:38

So let's consider how many times we go to the doctor when we're pregnant. A ton you start. You know, I had infertility, so I went every week until I was nine weeks and then I'll shift it over to my OBGYN and then you go once a month and then you go every other week and then you go every week. And then how many times do you go after you have a baby?

Ashley: 31:00

Once after six weeks, one time, one time. That's insane. Yeah, it is insane.

Amanda: 31:09

And in some regard that's the way that physicians were taught, and so you have to backtrack a lot of things to when surgery started. So if you know somebody that's had a hip replacement, for example the way I would teach my students when I would have students in the orthopedic world they would be like why does this doctor do it this way and this doctor does it different, this way? So there's in a hip replacement world there's three different directions. They can do a hip replacement Front side and back. Do you know how? They learned to do it? From whoever they learned from. They learned it from whoever they learned it from and they learned it from whoever they learned it from.

Amanda: 31:49

So everything that is done is done the way it was done before, and that's an every aspect of medicine, unless something new pops up. So something new that popped up in the 90s ish was more opioids in the pharmaceutical companies and a lot of the money makers that are just trying to treat a symptom that could potentially help prevent something, but it's also going to cause more issues, so nobody's actually fixing the root cause of the problem. So in the orthopedic world that's just what it is, but it's the same in the women's health world. They don't know. They truly don't know my providers. I love my providers. There's four in my area. They speak highly of me, they know all my clients get better, but they still tell their patients to do kegels after, during pregnancy, to prep for a baby, and that's literally the opposite thing you need to do. There is a time and a place for pelvic floor contraction or kegel contraction, but during pregnancy is definitely not the time. It's not going to fix your incontinence and it's not going to fix your pelvic pain. If anything, it's going to make it worse.

Amanda: 32:59

So the United States is probably, I would say, third world country when it comes to women's health, in my opinion, but they truly don't know any different. How do we make that change? I don't know. I don't know the answer to that because every state in the physical, at least in physical therapy every state mandates their own rules and regulations around physical therapy. So in Texas I, until two years ago or four years ago, whenever the two legislations ago, I could only evaluate a patient without a prescription and I could not treat them at all. Now I can evaluate without a prescription and I can treat for 10 business days without a prescription, but I can't treat beyond that without a prescription from a physician. Every state has their own rules and regulations and that's called direct access. What limits Texas, specifically, is the AMA, the American Medical Association, specifically the orthopedics and the primary care physicians. I think they're scared. My personal opinion they're scared we're going to take over their business. We're not. I don't really. They're going to make more money than me. It's fine.

Amanda: 34:09

My goal is to access patients quicker, get patients in quicker and I can tell them if they need more services or imaging. I can tell you I have caught uterine cancer by feeling the uterus and feeling a baby's head when there shouldn't be a baby's head in there, automatically calling the physician and being like, hey, you need to get this patient in ASAP, like tomorrow, and they do because they trust my opinion. Yeah, I can't tell you how many MRIs I've sent for laboral tears that need surgery and all the orthopedic things that need to happen. I'm not here to truly think I can fix everything that walks in my door, but I can tell you if it walks like a duck, talks like a duck and acts like a duck, I know I can fix it, but if it looks like a horse, then I'm going to send it the direction it needs to go.

Amanda: 35:03

You know what I mean? Yeah, but each state has their own rules and regulations. So on a national level, I think the only thing that helped the public health world so far is patient report, patients and clients pushing their own providers and asking their own providers for referrals or access, or seeking it out themselves. My best referral sources are my patients and they broadcast it out. I can count on one hand how many referrals I've gotten in the last year directly from a physician, and that's pathetic. My patients come from social media and word of mouth Wow, yeah.

Sara: 35:51

I feel like the advocating for yourself and seeking the care out yourself and what you think you need has been a common thread or a common theme from these conversations Ashley and I have had with other women in women's health care. It is crazy the amount of self-advocacy work you have to do for your own health. Yeah, to get proper care really.

Ashley: 36:13

I mean, it's what it comes down to.

Sara: 36:15

Yeah, for sure.

Amanda: 36:16

I hope eventually enough people start, the young people that are in high school, because I speak at high schools too and it's really entertaining to talk at high schools. Oh, I bet yeah. On my social media I'm like, hey, if anybody has a student at blah, blah, blah high school, you're welcome. I do a lot of demonstration and I definitely change the way I talk to the kids. They're not kids, they're teenagers. But I make it fun, lighthearted, but at the end of the day they're going to go home and tell their mom and their grandma about me. They're also going to. So I ended up having a few moms or grandmothers come in. My daughter said the one thing she got out of it was when she was pregnant, she was immediately going to contact you or a pelvic floor therapist in wherever she's at. And this girl's 16 and knowing that she needs to at least know something about it beforehand, yeah, yeah, the more we know, the better and the more we can self advocate for ourselves, but also just broadcasting the information, sharing the information, then eventually it's going to come into play where these kids that are learning about it through social media are going to be interested and enticed to seek out that profession to change the world in the way that they can. So I think it's coming. It's just not in my generation for that, not my generation it's just not going to happen in a very timely manner, just like anything else in government.

Amanda: 37:50

But in my opinion, everyone should get standard of care. Pregnancy, pre baby therapy they should get a standard. My patients, if they see them while they're pregnant, I see them between two and four weeks postpartum regardless, and then ideally everybody gets 12 weeks of therapy to prevent any issues in the future. Why not? Yeah, the catch 22 is access cost insurance. Insurance is a whole nother beverage conversation. We can have Medicare. That's a whole nother conversation too. It's unfortunate Medicare doesn't care. If you have pelvic pain, I would have to document my things regarding pelvic pain or pain with sex, and I would have to just make up words, and so I would document pain with recreational activities, but then they don't consider recreational activities as a medical necessity. So then I would have to say ADLs, which is activities of daily living. So I would basically lie in my documentation that it was ADLs. It's not, it's sex, but that's quality of life. So yeah, it's technically accounts.

Sara: 38:57

Yeah, well, that's really crazy. So I know you mentioned you think, with this next generation coming up and just the awareness that we can get from social media and just the internet, hopefully things will start to be better in the arena, right, there'll be more awareness. But do you think there's anything else we can help fix the issue of the lack of pelvic floor therapy and postpartum care today, like, are there any bills or initiatives, grassroots efforts that you're aware of, maybe like Texas specific I know we're in Ohio, but just anything that you're currently aware of.

Amanda: 39:31

So the only thing I know, that is that I'm aware of, is there is, if anybody follows the vagina whisperer, her name is Sarah Reardon. She's a part of a big organization that is global. I don't know what the the the point of it is is getting access to physical therapy for pelvic floor and pregnant and postpartum women from early on, and so they're trying to do funds, they're trying to advocate A lot of it is. It's global. So there are people all over the world in this global initiative, but it's definitely in the infant stages, like newborn stages, gotcha. But Sarah Reardon is part of a group. I don't know who else is part of this group, but I do know she's part of it and I can get more information on what that's called. But it's a global initiative that she's part of. That's about it.

Amanda: 40:29

United States wise, not so much, texas wise, not so much. There is nothing out there really caring about it. What we can do is broadcast that each person should seek out a public floor therapist. If they can Contact one, start following people. Once you follow one public floor therapist, it's really fun, because the more the public floor therapist start popping up in a, you may also know or you may also be interested in, and most of us also have TikTok, instagram, facebook, youtube. My YouTube is very minimal. There's people out there that have way more out there than I have. People are trying to hit different avenues. Honestly, we are all trying to share the same information. So if you're following a few worst, we're telling you the same information. It's just our target audience may be a little different, but if you're following one follow another, the more you might actually see that you might need somebody, at least in your near future or far future, or somebody you know may need one.

Ashley: 41:36

Yeah, yeah, we thank you for all that information. Like we've kind of mentioned, we've talked to just different women on the podcast that do something in the way of women's health, and so I hope, I'm optimistic that this area just like you know, women being in studies and research like you know, there was such a lack of that and that's that's moving the right direction. So with your effort and everybody else who helps with this, like hopefully we can move this in the right direction as well. Before we kind of start to wrap up, one more question, but it's going to be a little bit different. So earlier you just kind of mentioned, like the stigma around working in the space and just how, like you could be scared to kind of talk about it or say some of the things. So can you talk a little bit more about that? Like, what is the stigma around pelvic floor therapy? Why should our listeners not feel ashamed or scared or nervous to kind of seek out this type of help or this type of therapy?

Amanda: 42:28

So I think the stigma originates from people generationally. Let's let's go back to like my grandmother's generation. If you talked about sex to my grandmother not I mean, she's past now, but at the end it was like a running joke. But my mom would be like we never talked about any of that. All of that was very private. Even if you go back to like the I love Lucy show, when they had two separate twin beds, like nobody talked about sex at all. Nobody talked about their husband spending 45 minutes pooping on the bathroom. Now they're on their phone for 45 minutes and it's always just a running joke. Nobody talks about the fact it's a fact that men produce 60% more gas than women Shocking Is anybody shocked with that? No, nobody talks about it, but it's a funny thing that people talk about in general. So when you think about generally, generationally even my older ladies they have a hard time talking about some of these things because they're like you just don't understand. We do not talk about this, and so it's become. I think the hippie generation was very open and free about it, but then there was back to this 80s generation where we talk about what's necessary but we don't really talk about it. Go back to like.

Amanda: 43:58

Now I have school aged kids, so I'm very educational and normal about talking about pee and poop. Like we have to poop every day, twice a day. We have gas. Okay, we're tooting up a storm. Let's go sit on the potty. My kids are five and eight, so it's funny. But I want them to be comfortable pooping in public. I want them to know how to poop in public and, if they pass gas, how to not be ashamed of it. It's a very shameful thing and we start shaming ourselves as a very young age. Two year olds don't get shameful about it, but once they hit kindergarten and then once we hit puberty, puberty throws a whole another wrench in things.

Amanda: 44:44

Nobody talks about tampon use. Nobody talks about pelvic pain with tampons. People limit themselves to only wearing certain types of feminine hygiene because of pain. Nobody talks about it and it's simply because I think a lot of it. People don't know about it. People don't know it's any different. But you also don't know what's abnormal if it's not talked about. So if you had pain with tampon, wearing tampons, as a teenager and you're like well, I just chose to wear pads, but then you go to have sex later on, you're like what the heck is this? Why did I want to wait so long to have sex? If it's so painful, why is everybody having sex all the time? Then you think you're weird and abnormal. You think something's wrong with you. What does the physician say? Drink more wine. That's what they say. Drink more wine, it'll get better. It'll get better with time, but for some people it doesn't and it turns into a PTSD thing and then the whole shame game, blame world.

Amanda: 45:43

So I love working with mental health therapists. I have a lot in my area that I reach out to, that do in person and virtual stuff, and so I have my specific personalities that I reach to. But the stigma really is simply that nobody wants to talk about pee poop, sex and orgasm, unless you're around. A bunch of girlfriends have a wine and then bachelor parties. People are talking about sex and orgasm. Then there's going to be one person that's heard of physical therapy for pelvic floor and one person is going to start the conversation and that's really where it's going to end up being. But if we can talk about it in normal conversation which is why when I get on an airplane and I introduce myself as I'm Dr Amanda, I'm a pelvic floor therapist and I treat pee poop and sexual dysfunction. People are like what did you just say?

Ashley: 46:38

I would love to sit by you on an airplane, if I never met you. I would love to sit by you on an airplane, oh my gosh, I would learn so much.

Sara: 46:44

Oh man, okay, so we're going to start to wrap it up here. I know you mentioned a few resources throughout this, but any other resources off the top of your head that you can recommend to our audience to learn more about this or to seek care themselves?

Amanda: 47:00

Yeah, so I share on my Instagram. Personally, I share a lot of other people's content as well, but if you're looking for a pelvic floor physical therapist in your area, just Google pelvic floor physical therapist and there's several different resources out there. Herman and Wallace is a pelvic floor PT courses group. They have one. It's called PT locator, I think, but you just Google women's health PT locator and you'll find a pelvic floor therapist in your area. Just type in your zip code. Also, the APTA, which is the American Physical Therapy Association, has a PT locator and you just have to toggle the dropdown arrow to be women's health, or I think they changed the name to pelvic health because we do treat men as well and transgender and all the things. So those are the two big ones to seek out.

Amanda: 47:53

There's some other smaller resources out there, some big accounts to follow. I always tell people to follow the vagina whisper. Hers are hilarious. Most of us follow her stuff, expecting an empowered. I've been following them for years. Then mine is just rooted physical therapy. I have a small account but I'm just trying to get more information out there. I really tried to keep my name the same for rooted physical therapy for my Instagram, my TikTok and my Facebook page, so we'll see how well I did with that.

Ashley: 48:27

I think you did good. I wouldn't say don't, don't tell me it. Yours isn't a small account. You have a good amount of followers, like a thousand.

Amanda: 48:33

I wanted five thousand by the end of the year. That was a lot.

Ashley: 48:37

That's a good 2024 goal you can make. I believe in you. Just your vagina costumes. One of those is going to go viral. Oh, they have to, I mean okay, yeah, we will link all of your contact info, all of the sources you gave us in the show notes before we wrap up. Is there anything else? You want to leave our listeners with Amanda?

Amanda: 48:56

No, I think I mean as far as getting more information, honestly, following as many people as you can. The more information you have, the better. The more you see it, the more you realize that you might actually need public floor therapy. I'd say the majority of the people I know that treat public floor treat virtually and in person, and it's pretty fascinating the things that we can do virtually. One really cool thing that I didn't mention earlier is most public floor therapists not all. There's good and bad and ugly of every profession, right? Not not all things are great, but most of us look at the body from the head to the toe.

Amanda: 49:36

So I'm looking at somebody in sitting lying down. I'm looking at their belly, how their belly moves. I'm asking very much details about their bladder and their bowel health, but I'm also watching them stand up, squat, stand on one leg, single leg squat If they have trouble jumping. I want to see how their body moves with everything that they do. I spend a lot of time going over how to get in and out of a car, in and out of bed on enough a chair in a manner that is functional for them.

Amanda: 50:07

If your pelvic floor therapist is having you do kegels nothing but kegels, I would seek out another pelvic floor therapist If your pelvic floor therapist is doing nothing but breathwork exercises and hasn't moved into the functional movement standing, squatting, lunging. You have to be able to learn to get on and off the floor carrying a baby. You have to be able to learn to carry and pick up a 40 pound bag of dog food or a case of water they have to shove underneath a grocery cart. You have to be able to reproduce that without symptoms. So when pelvic floor therapists are looking at you, they're looking at more than just your pelvic floor.

Amanda: 50:49

I love working with people with nutrition components too, so I dive heavily into foods, irritants, bowel and bladder irritants, stimulants and true nutrition. I learned a lot of things from Jessica Drummond. If you're not following her, she's the Integrative Women's Health Institute. She is a guru when it comes to nutrition and gut health, nutrition and endos, so I love talking about every single aspect of your life. That way, long term, we're giving as many tools in your toolbox to be successful in whatever you're wanting to be successful in.

Ashley: 51:26

Yeah Well, thank you so much. Your passion is just amazing. It makes talking about pee poop and sex just so great. Yes, so we appreciate you so much for coming on. We learned so much. I know our listeners are going to learn so much.

Amanda: 51:40

Yes, thank you for having me. Cheers, cheers.

Ashley: 51:43

Have another beverage and thanks everyone for tuning in. We will catch you guys next week.

Sara: 51:55

Thanks for joining us for today's episode. We really appreciate the support.

Ashley: 51:59

We would also really appreciate it if you hit the follow button and share this episode with anyone you think would enjoy it.

Sara: 52:04

And we'd like to thank Kevin Tanner, who edited this episode. If you're interested in learning more about him and his services, his website and Instagram are in the show notes.

Ashley: 52:13

With that, we'll see you next week. Did I say all that?

Amanda: 52:26

right, it's fine Well no, did I say anything wrong? Well, no, because I'm from Houston, so it's umbil, um, but everything else is fine.

Sara: 52:37

Okay, I'm gonna never get. Yeah, I wouldn't guess that either Okay.

Amanda: 52:43

I got a pause for a second. My husband's texting me or calling me, but um.