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It’s true – we all have a pelvis. Unfortunately, most of you probably weren’t taught how to truly know your pelvis. What better reason to write a book except to teach women about their pelvises and to end the shame, stigma, and suffering that women endure with the mysteries that surround caring for conditions of the pelvis?
Sometimes getting to know your pelvis starts in your adult life, after conditions like urinary incontinence, prolapse, or even constipation have developed. While these issues can be terribly frustrating, there is hope. And in this interview, Ginger has the pleasure of interviewing Dr. Maureen Mason PT, DPT, WCS, PYT about her professional experience and knowledge, and how she fit all of it into a book, Pelvic Rehabilitation: The Manual Therapy and Exercise Guide Across the Lifespan.
Our culture and healthcare system often oversimplifies pelvic health therapy to doing Kegel’s. However, the reality of pelvic health physical therapy is astoundingly more complicated, especially as you get to know your pelvic and how its needs change depending on your stage of life.
Just as we learn how interconnected our ecosystems are, our body’s systems are equally interdependent and in order to effectively treat the pelvic floor and surrounding areas, you must also address gut health, stress, sleep, nutrition, and exercise.
For instance, did you know that things like urogynecological surgery, spinal pain, and depression can lead to hypertonicity of the pelvic floor? Or that roughly 50% of women with incontinence are unable to contract their pelvic floor?
It’s no wonder that so many women are struggling with pelvic floor issues and we only hope that this book can help empower women to get the services, care, and healing that they need!
Listen in to learn all the ways in which Dr. Mason makes pelvic health physical therapy compassionate, fun, and effective no matter what your age or your diagnosis. It’s time to get to know your pelvis.
Maureen is an integrative physical therapist with a holistic approach to treatment. She holds two specialty certifications, Professional Yoga Therapy (PYT), and Women’s Health Specialist (WCS), as well as a Doctorate in Physical Therapy (DPT). She is a specialist in interventions for male and female clients in pelvic self–care, regarding bladder, bowel, gastrointestinal, pain management, and sexual health, and is well versed in orthopedic client care and chronic pain treatment. She has a passion for helping women over the perinatal and menopausal transition times.
Maureen is a member of the American Physical Therapy Association (APTA), Professional Yoga Therapy Institute (PYTI), the National Institute for Clinical Application of Behavioral Medicine(NICABM), American Urogynecology Association (AUGS), the Academy of Integrative Health and Medicine(AIHM), and the Global Pelvic Health Alliance (GPHAM). Maureen has served as a research therapist on 2 studies: “Noninvasive Treatment of Postpartum Diastasis Recti Abdominis: A Pilot Study” with SDSU, lead by Dr. Lori Tuttle, published in JWHPT 2018, and “Randomized multicenter clinical trial of Myofascial Physical Therapy in Women with Interstitial Cystitis/Painful Bladder Syndrome”, Journal of Urology 187:6:2012. Maureen is the proud parent of two daughters, and in her spare time practices yoga, organic gardening, chicken wrangling, and home improvement with her husband of 31 years!
00:00 Dr. Ginger Garner: Hello everyone and welcome back. I would like to introduce a very special friend and colleague to you today. She is a specialist in pelvic health and she has a lot of information to share with us today. So before we launch into this, which I am really super excited about, I want to do a little formal introduction. Welcome Dr. Maureen Mason. She is, in addition to just being fantastic all the way around, she is a wonderful integrative PT. She has a very holistic approach to treatment. She does have her doctorate in physical therapy. She is board certified in women’s health. She is also certified in professional yoga therapy. She focuses on male and female clients with pelvic self-care, bladder, bowel, GI, pain management, sexual health.
As a lot of us were, she also was raised in orthopedic health and then made that migration over to pelvic health and to chronic pain management because that is oftentimes what happens when we see people for pelvic health. But she has a big passion for helping women over the perinatal and menopausal transition times. Huge time for women and one or both we all end up going through.
Dr. Mason is a member of APTA, the American PT Association, Professional Yoga Therapy Institute, which is now Living Well Institute, and several other organizations with acronyms that are so long, I’ll let you read those on the bio on the blog. She’s also been involved in research, which is incredibly important in things like postpartum diastasis rectus abdominis, and a randomized clinical trial there. I’ll let her explain that when we get to a little bit of that background in the interview.
Dr. Mason is also a mom of two daughters and in her spare time loves yoga, organic gardening, chicken wrangling. You might have to talk about that a little bit. And home improvement with her husband of more than three decades.
So welcome.
02:24 Dr. Maureen Mason: Thank you, Dr. Ginger. For the opportunity to reach people.
02:32 Dr. Ginger Garner: I’m glad you’re here. Yeah, I’ve been looking forward to this interview for a while. And this is a story that I’ve not heard you guys, so I’m going to spring this question on her….And that is, what made you choose PT?
02:44 Dr. Maureen Mason: Love of movement and needing to move versus sitting in one room as a physician throughout the day. My dad was a neurosurgeon and he told me I’d make a wonderful physical therapist when I was 13 years old. I was very stubborn. I did not want my dad telling me what I was going to do. And I started off in nursing.
However, I loved anthropology and I love ceramics and I was in dance theater at Boston University. And I got very mixed up and I took a year off and I worked in a chronic hospital to see what medicine was really about. And I saw how people have their last final months from all the chronic diseases. And I saw the physical therapist going in with clipboards, figuring out what to do with people. And I said, I want to be the person with the clipboard, figuring out what to do, coming up with the programs.
03:48 Dr. Ginger Garner: Yeah. Oh, I love that. I love hearing people’s origin stories of how they came into PT because I think it’s a really special, super caring field. We don’t just haphazardly enter into it. We also have some really incredible stories that drew them to it. One more question along those lines because we have a great need for more pelvic PTs in the US and beyond. So what specifically drew you into pelvic PT?
04:14 Dr. Maureen Mason: I wasn’t interested, as an orthopedic and neurological therapist. And I was in a big HMO and the director asked me to take a course on urinary incontinence. Kathy Wallace was just starting. I flew up to Seattle. I took her fun course. She was playing chimes. She was feeding us espresso beans and asking us, did we really need to go to the bathroom? Are we going just in case? She really made it fun. And I realized in my young patients, as well as the elders, I was missing this whole piece of the puzzle.
So the docs at Sharp Healthcare in San Diego, which is a huge organization, began to send me urinary incontinence, pelvic pain, male, female, so many oncology cases. I was not prepared. And it took 10 years of courses to cover all the specialty topics. And I remember thinking, go to the basics, go to the basics. But I think most physical therapists are that way with pelvic. They say, well, you can do that, but not me. So it takes a certain personality and mindset. And then what sealed the deal was becoming a mom and having my own challenges, certainly, and realizing moms are heroes when they make it into the clinic.
05:34 Dr. Ginger Garner: Yeah. Yeah. Goodness gracious. I love that, that you weren’t interested in it. And then you got kind of drawn into that. I have a similar story where we just didn’t have anyone doing pelvic health. And I was the new kid on the block. And they pointed to me and said, you, you go to that incontinence course. I’m like, okay. And the rest is history.
So now you have a book on this topic. So I’d like to talk a little bit about that. But one of the things that because you mentioned becoming a mom, and it did really seal the deal for me to one kid, two kids, three kids. And I thought, how does anyone get better? How does anyone navigate a system where you don’t always feel like someone’s listening?
And at the time when I was having my kids, there were no referrals. And certainly when you’re having your kids, that’s a whole different story, right? I remember talking to my midwife about, yeah, well, I have a pelvic PT and sometimes I refer. I’m not really sure what they do, but they always fix it. So with that experience, I just remember being super thankful that I had the background to heal myself using my skill set. But then that gave me a really great passion to help women who were giving birth and people giving birth that didn’t have that and don’t even have access to it.
So I’d like to just ask this question because it’s about safety. I know I had moments where I didn’t feel seen or heard. And women across the spectrum have moments where they maybe don’t even feel safe. I know that if you’re a woman of color, a person of color, and you go to give birth, your risk of dying is nearly four times higher than for someone like us.
So how do you go about creating that trust and safety for women and people going into that situation? It may not be just birth, for example, right? It can be across the spectrum. But how do you do that? Let me stop there and just ask that question first. How do you do that?
07:58 Dr. Maureen Mason: Right. So the first question I asked someone that shows up in my clinic, if I haven’t really had the interview with them by the phone beforehand and they haven’t looked at my website, Central Station Well, that has a lot of basics on pelvic for them, for their education.
I’ll ask them, do they know why they’re here? Do they know anything about pelvic PT? And those two things really start the ball rolling. Maybe a friend told them that I fixed their episiotomy pain and then they can have intimate relations with their partner again, these sorts of things.
So we really because we’re doing possibly external and internal pelvic work, the convention is women are used to the speculum exam. They may have even had a drape up and they don’t know when it’s going to pinch or hurt. But they’re suddenly stretched and pinched and poked. This is the opposite experience: that I’ll ask permission, explain a procedure, ask permission.
They’ve given consent when they sign in. But people do that in medical clinics and they don’t even really know what they’re consenting to and that we can stop at any time if there’s pain or discomfort.
And I have a nice technique of teaching people to say hello to their pelvic floor and to explain the muscles with charts and diagrams, maybe have them do some self-palpation, maybe use a mirror. There’s so many great techniques and saying hello to, for example, the solar plexus, our energy factory, you know, fun things like that. These are processes of embodiment also where we could just turn our body over to the doctor and some that have had trauma might be numb and be saying, oh, yeah, it’s OK. I don’t care what you do to me. We need to get this over with. I need to get better.
Those are signs of trauma and a disconnect and going out of the body. So I’ve learned from wise Dr. Holly Herman and Kathy Wallace and many other providers to keep checking in, ask permission and explain even to the point of people saying, why do you keep asking? I’m cool. I know what you’re doing. You’re doing great. And I’ll have to explain to those people. Some people have had trauma and we want to make sure that they’re comfortable as we go along and educated as to what’s going on.
Thank you.
10:18 Dr. Ginger Garner: So step one, you know, informed consent, repeated asking, creating that therapeutic landscape where they feel comfortable, where they know what’s happening. And they also have agency so they can say, yeah, I’m not as comfortable as I was or that’s painful and I don’t think I can take the next step.
10:36 Dr. Maureen Mason: One of my first cases was a nurse with urinary incontinence. She said, I don’t want a pelvic exam. Is that okay? And I said, yes. And then I had to figure out how to do all sorts of latter training without knowing if it could act well or not. And in about four sessions, we realized she wasn’t voiding as much as she, as often as she needed to and some other things.
But at the end, she practically bowed to me and thanked me for not doing a pelvic evaluation and that I had helped her. And I didn’t need to ask what happened. You know, it wasn’t appropriate. So these are some scenarios for therapists and patients listening that they need to know that everyone always has choices. Yeah
11:26 Dr. Ginger Garner: Yeah, absolutely. So, you know, if you’re listening and those type of, I don’t know any, any person who looks forward to any internal exam at all, no matter where it is, but know that you have that choice, that you have options, that these are some of the things that your practitioner should do.
And if they don’t, maybe it’s time to find a new practitioner or, you know, take steps to make sure that you feel safer in your environment. But thanks for that answer, because I think it’s really important that people know that they can they have a right to ask for that safe environment and to expect it.
12:03 Dr. Maureen Mason: So, yeah, one final note on that. Therapists may be pressured to get the evaluation information and what’s the manual muscle test, you know, these sorts of things in the big healthcare systems. And that’s evaluation criteria. And to miss out on those points can put the therapist in a little tough situation too, because they might not be able to have any examination techniques to start.
12:37 Dr. Ginger Garner: Yeah. It’s a good point for PTs or PTs, pelvic PTs or PTs on the other side of things, because they need to be able to feel like they have the time and the space to safely cover what they need to. And so if you’re listening and you’re on that side of the coin, proverbial coin, it’s a good idea to just step back and go, is this the therapeutic landscape that I want for my patients or would I want this type of therapeutic landscape as a patient?
And if not, I’m taking some steps to remedy that. So you have written this amazing book that I can’t wait to get my hands on. I haven’t got my hands on it yet. Just in general, what motivated you to write a book like this because it is, you know, pelvic health across the lifespan, which is a large scope. So tell me a little bit about your thought process behind it and what went into it.
13:40 Dr. Maureen Mason: Thank you, Ginger.
What motivated me to write the Pelvic Rehabilitation Guide is first to alleviate suffering and shame for those with pelvic health conditions. I’ve had many patients cry in my office over the years and many of whom suffered in silence and felt shame over their conditions. They didn’t know help was available from skilled providers and skilled providers can be articulate and empathetic in screening questions about pelvic health, bladder, bowel and pain conditions.
So that’s just shame, stigma, suffering.
And another reason, the second prime reason is to educate and empower the world globally about pelvic health. For the public and the healthcare providers, treatments that are based on science with an integrative model of care and do no harm. We know many pelvic health conditions can be improved by lifestyle, habit training, nutrition, therapeutic exercise, manual and visceral therapy.
These are the nuts and bolts of pelvic PT. And the more the public knows about conservative care and that it’s an option, they may choose to seek it.
Pelvic PT is still not typically known about as an option for care. There’s a sense of mystery or a secret world of pelvic PT. And people may certainly know about urology, gynecology, gastroenterology. Those specialists may all see someone with a pelvic health condition and PT may be not considered or left out. Whereas physical therapists that are specialists such as myself and yourself, we have advanced postdoctoral training in all of these fields and from pediatrics to teen to young adults, moms over birth period and elders.
There are appropriate interventions for specific pelvic health conditions. And I wanted to promote safety for the patients to do no harm in providing treatment. This is about protection of patients. We’re in a medical system in the US where we may, doctors may utilize medicine and procedures before addressing lifestyle factors that may be the root causes of the pelvic condition. So by educating healthcare providers, we can promote collaborative care, teamwork, and lifestyle factors.
Regarding education and empowerment, we do have direct access in most states in the US where individuals can self-select to see a physical therapist for pelvic evaluation and treatment. So those are the two reasons. Empowerment and yeah, destigmatize.
16:46 Dr. Ginger Garner: You made some really important points. I just want to go back and land on those for a second. And one is if you are going, if you have a stomach issue, if you have a urology issue, if you have a gynecological issue, those are three systems of the body that people often consider separate. I’ve had a lot of people who have had a gynecological issue, they’re not going to separate. I’ve actually had an OB-GYN say to me, oh, pelvic pain has nothing to do with digestion. And I just had to, I had to have a moment over that.
So what, what, you know, to reiterate what you’re saying, it is so important to realize that those systems do overlap. And if you’re going to the GI doc for, you know, stomach ailment, it could have a pelvic pain driver. And it’s important that all of that is screened for. So that’s important.
The second thing that you mentioned that’s important is that oftentimes, you know, people will confuse pelvic health with doing Kegels or something like that. And what, what we want to really drive home is the message that you iterated so wonderfully is that the lifestyle choices that we make, sometimes that are outside our control, but very oftentimes we can help you make shifts that really will greatly improve your condition are often driven by things like the big six pillars, nutrition, stress, relationships, sleep, mindfulness and movement, and also environmental triggers that change the makeup of our hormones, the balance of cortisol levels and things like that.
So that’s another point that I wanted to pull out. That’s super, that’s just super critical that it could be, it’s not particularly the pelvic floor at all, but we will help identify. And this is the whole point of your book is to help identify what some of these other drivers are. That’s what makes us such holistic primary care providers when it comes to, you know, handling your pelvic health.
And then there was one more and I, and I didn’t write it down. So it escapes me. But it was the last thing that you mentioned about, about protection and safety and doing no harm. It’ll come to me in a minute.
But the point of that is to know that if you have these, if you have overlapping issues and mood could be included in that too, that could be impacting pelvic health. Ask for pelvic health because we can help figure that out and then know that there’s all kinds of lifestyle drivers too.
So thank you for making those points because I think oftentimes people see pelvic health through, if they see it at all as an option, they see it through this kind of little microcosm of what we can offer, but there’s just so much more. And, and I know that’s what your book focuses on. Thank you.
To follow up with that, can you describe some conditions? We often call them diagnosis or diagnoses, um, and their options for management that would be really relevant for a large part of the population that you talk about in the book and, you know, how can pelvic PT help?
20:05 Dr. Maureen Mason:
Sure. Uh, conditions or diagnoses that people may benefit from pelvic physical therapy for. In my explanation, I will start with simple solutions. I’ll give profiles, then talk about more complex cases, which is what shows up in my physical therapy practice. So, um, conditions that we might see the conditions that I thread through the pelvic rehab book or, uh, urinary incontinence, constipation, um, and pelvic pain. Those are kind of the three major conditions.
There’s also pelvic organ prolapse, and then there’s sexual health problems. Which are all addressed in the book and each condition can have one or two drivers or causes and have simple solutions. People may get better in one or two visits and say, Oh, I didn’t realize I was doing such and such.
Or these pelvic health conditions may be associated with other problems, comorbidities, um, inflammation in the body, that sort of thing. So I’ll just illustrate a simple case of urinary incontinence, which I’ve seen a lot. We can picture someone who waits too long to use the bathroom.
They feel like, Oh, I need to pee. Nope. I’m on the computer or I’m fixing a meal or I’m gardening and they just wait. No, I’m not going. I’m not going. And all of a sudden, boom, strong urge. Whoa, gotta go. And they have a leak, small leak, medium leak, large leak. This could be urge incontinence and also overflow because they’ve just waited too long. Happens a lot.
People are embarrassed when they discover this with the physical therapist. They were just waiting for hours and they had the venti coffee or maca or something. So that’s simple.
Also people can oftentimes have citrus sensitivity, caffeine, and, nutrition triggers. So if you combine waiting too long and having nutrition triggers, let’s say I have a large glass of orange juice and I’ve also had two cups of coffee and I wait too long because I’m a healthcare provider or mom, those are what we call poor bladder habits and they’re so simple.
They’re kind of silly, but this can get people off pads. People say, well, I need to wear a pad. I’m going to flood my bladder, my pants.
So this is what we call paying attention and we can teach people to put their hand over their pubic bone at the region of the bladder, say hello to their bladder, ask for signals throughout the day. Those are simple.
The other thing with constipation, it’s oftentimes insufficient fluid and fiber. So correcting fluid, correcting fiber, hydration, some with constipation, wait to go, and then their body, the body stores a stool and the stool gets larger inside. So chronic constipation can just develop from not going from not going. Some people need more of a movement program too, to help them poop, they need a daily 15 minute walking program, relaxes the nervous system, pistons on the diaphragms, that sort of thing.
So those are simple things, but, also some people, may have a problem in their coordination of their pelvic floor muscles, which Ginger, I know you teach and educate on a lot with the diaphragms of the body. But sometimes people are rushing, they’ll rush into urinate, they’ll squat above the toilet, they’ll push. And then as they walk away, they think they’re done, they’ll leak. So they’re not allowing the pelvic floor to relax.
That’s post-micturation or post-urination leakage. Where does that come from? Sometimes they’re just not relaxing, other times they may be pushing and tightening the muscles the whole time and have insufficient emptying. Same thing with bowel emptying. People will, perhaps its painful stool, hard stools, hemorrhoids, these sorts of things. And they’ll sit there and they’ll kind of clench and they’ll push. And they’re actually really tightening their anal sphincter.
This is dyssynergia where they’re supposed to relax their bottom, relax their pelvic floor muscles, generate intra-abdominal pressure, bear down. This is pelvic dyssynergia instead of synergy, all the systems working together, they’re having dyssynergia. And that can take some time to retrain.
People can feel so foolish. You can have someone with a PhD or an MD and have trouble eliminating and they don’t realize they’re clenching. So there’s lots of training techniques for that on synergy training. Pelvic health providers make sure people realize it’s okay, these things just happen. Thank you for coming in. We want to get your whole GI system working better and your bladder working better. Those are some conditions.
Then more complex…someone may have diabetes, have blood sugar dysregulation and be insufficient in their vitamin D storage. Vitamin D is essential for the urethra as well as estrogen and the female for the thickness of the cells. High blood sugar causes bladder irritation. So someone may come in with their first sign of incipient diabetes is frequent urination, thirst, and hunger.
So these are things we all need to be aware of. Why is the bladder doing this? Is there a systemic infection? People can have toxemia and have balance problems and they could really have a urinary tract infection that’s gone to their kidneys and becomes systemic. So sometimes it’s not simple. That’s where medical screening is critical on not just throwing techniques at someone, but finding out what’s going on with their body systems.
26:10 Dr. Ginger Garner: Yeah, that’s such an important point because, I know historically, if we go back to the origin of PTs, we were rehab aides, quote, end of quote, during the world war, or the world wars and that kind of attitude towards therapists as techs or aides or something that you only throw a simple treatment, you know, at it can be pervasive and persistent. And some of the, some of the things that you have mentioned, um, again, really underscore how important it is that we are kind of primary care providers across the lifespan.
So your, your book is very aptly named, in terms of its title, because, we do have to do those, systemic screenings to make sure there are no other issues when someone comes in. So if you’re going to see a pelvic PT or if you’re a pelvic PT or practitioner, those screens should be done, but you should expect to have those done. And if they’re not looking at all the bases that, you know, that can be, um, a red flag, but if they are, that’s a lovely green flag for the, for the pelvic PT that, that you are, or OT or other practitioner that you’re seeking out.
Can you tell us a little bit about, because for everything that you mentioned, bowel and bladder incontinence, pelvic organ prolapse, urgency, frequency, getting up in the middle of the night, nocturia. I just had a long conversation with someone about this the other day, um, and identifying the other problems that we may have with that.
There are so many myths that surround pelvic therapy too, and misunderstandings, um, and things that both healthcare providers should know, but also everyone should know, because if you’ve got a pelvis, you should be concerned about getting the right type of therapy. So can you talk a little bit about what some of those myths are so people can understand what the red flags and green flags are in seeking out good care?
28:18 Dr. Maureen Mason: Right. So, um, I just want to touch on an example you gave of nocturia, people that need to get up a lot at night, just to illustrate what pelvic PT can do. And then we’re going to go into the myths and misunderstandings, but sometimes people have a sleep disorder, anxiety disorder, disrupted sleep. And what happens is they wake up and then they say, Oh, I need to go.
So I always ask people if they’re up a lot at night, how many times is acceptable? Once is okay, twice – all right. But if it’s three times or more, they’re not replenishing their brain cells, because they’re not getting restorative sleep. So a whole nother topic, you and Joe address that in your book, et cetera. but I just want to give an example that there’s no, no quick fix on some of these things.
Some people are just drinking way too much late at night. And that’s their problem. Um, so the most common myth is that physical therapists teach Kegel’s and everyone needs Kegel’s. And you have to be an expert in super strong, even lifting bricks with your pelvic floor. We have seen that ridiculous, crazy thing.
29:33 Dr. Ginger Garner: Yeah. Y’all probably have seen that.
29:35 Dr. Maureen Mason: So, yeah, so some people have a short pelvic floor. That’s so tight. It’d be like my trapezius way up here. And you asked me to do a shoulder shrug and there’s no place to go. So all of our muscles with the myofascial system and biotensegrity, everything’s connected and we want elasticity, contraction, shortening, lengthening, releasing, and all the muscle groups.
So in terms of Kegel’s. Dr. Kegel in the 1940s was an obstetrician that taught women to tighten their pelvic floor muscles around an inflated condom for a pressure sensor to teach them how to tighten the vaginal muscles to help their urinary incontinence, and also to enhance their intimate or sexual functions. At the time that was out of favor to even use a discussion of intimate sexual functions, but he was the one that started it. So now all these exercises are named after one doctor.
I prefer to say pelvic floor muscle tightening and relaxing, but 40% of people do not have the ability to correctly contract the vaginal sphincter and the anal sphincter such that it contracts and actually lifts up and in. People have an incorrect habit where they’ll flinch and sometimes bear down and push down and on the inside, the bladder’s being pushed down, the bowel’s being pushed down, there might be pressure generated on the prostate and to the testicles or labia.
So correction of effort and we have a muscle testing scale that elucidates whether or not someone needs to contract or relax. And if there’s scar tissue present, sometimes people just can’t contract because of the scar tissue. And in one physical therapy session of a myofascial release and tapping and training and having people say hello to their pelvic floor, sometimes someone might start as a zero unable to contract. And then by the end of a session, they’re doing two and three second holds and relaxing. So the myth about pelvic understanding about pelvic PT is that it’s a cookbook approach to Kegel’s.
I was told postpartum with a very large first birth with an episiotomy and vacuum extraction to just do my Kegel’s. I was a young PT and I ended up doing pelvic tilts and kind of squeezing my glutes, my adductors, everything. And I was clueless when I had my first pelvic examination and Kathy Wallace’s course, I was a zero and I was sure I was tightening things correctly.
So there’s a lot to do with the whole top and I laugh about it now, but I do share that with patients that I was unable to contract and it took me a lot of work about six weeks to be able to contract and relax. And I probably had some compression irritation of my nerve supplying the pelvic floor muscles, my pudendal nerve. Lots of times it might get a traction neuralgia and just not, it can be asleep for a while. It can be two years, even if someone has a compression injury, it can take two years for the nerve fibers to fully regenerate. So don’t give up hope. People are listening if you’re kind of numb and you can’t…
33:00 Dr. Ginger Garner: All the things that you mentioned, it’s so similar. I think I spent that whole last segment just nodding my head. A lovely thing that we have, you know, available to us now for some clinics, we have it in, in the clinic that I founded here in Greensboro is lumbopelvic rehab, ultrasound imaging. That’s another wonderful, great biofeedback tool because in a non-invasive, very trauma informed way, we can show if someone has, dysynergia. We can show a paradoxical pelvic floor, if you will, where it’s doing the opposite of what we want to do.
And I would say 99.9% of people that come through my door have it backwards. They’re clenching or bearing down. It doesn’t matter what your education level is. Like you said, Maureen, um, when you first started doing them, you were already a PT, you know, and had them backwards. So we just want to kind of, um, bust that myth that you should already know how to do this or that you should naturally just kind of fall into it or that things are going to fix themselves or that you’re going to quote bounce back.
It’s not your fault if you didn’t get access to that care. It’s not, and it’s not an organic thing that you’re just going to spring into this and go, ah, pelvic floor is back. If only it were that easy. Right. Um, so I just want to encourage people that, you know, to not, not feel ashamed about that, to not beat themselves up and just to tell yourself it’s not your fault. There’s a lot of reasons that, um, you might be listening to this because you didn’t get the care you need, but, um, you know, that’s what this podcast and others are about is to lead you and get you pointed in the right direction.
34:54 Dr. Maureen Mason: That’s for sure. That’s right.
34:58 Dr. Ginger Garner: So do you have any, um, you know, tips for the listener? The listener could be a practitioner, could be a person that needs pelvic health that are just important, critical pieces in your current area of work.
35:12 Dr. Maureen Mason: Right. I would say for someone seeking care, look around your neighborhood and there’s websites. I know you have links for your providers that are trained in integrative medicine. Right? And in the pelvic world, we have the Herman and Wallace Pelvic Rehab Institute where people can find providers that have taken their courses and we can also look at American Physical Therapy Association sources for links for providers in your neighborhood and also Pelvic Guru with Tracy Sher.
Then Jessica Drummond Integrative Women’s Health Institute, there are, health coaches and integrative providers that people can use as an adjunct to the pelvic therapy, because if someone has IBS (irritable bowel syndrome) and diarrhea, they’re bloated a lot.
This is something that would take a long time, potentially months or over a year, maybe even longer to really improve the digestion, because if someone’s all bloaty and lots of gas and this sort of thing, that can be causing not only, the stool problems, but irritating the bladder and causing pelvic pain too.
So I would say for people to look in their neighborhood, look at resources online and then call a clinic. If you’re interested and asked to speak to a provider, lots of times there’s that complimentary call, but more often than not, providers will have their website with lots of resources on the topic too. And that lets you know. There is a little trend now for pelvic PT and people may have had one course or two and not be quite comfortable with some of the more complex presentations. So you might consider what type of therapy you could need and, and just look around and ask for recommendations from friends too. Um, and Ginger, I would say your book.
37:25 Dr. Ginger Garner: Oh, go ahead. I’ll, I’ll keep my thought on tap.
37:30 Dr. Maureen Mason: So you have just written a fantastic book with Joe Tatta. It’s available on Orthopedic Physical Therapy Practice (OPTP) and, uh, providers and it’s Integrative Lifestyle Medicine in Physical Therapy. And it’s really a primary care book and it addresses all the socioeconomic barriers to care, trauma informed care, motivational interviewing, things that most PTs, don’t have a health coaching background nor do primary care providers.
If you’re in a hospital system where your therapist has 20 or 30 minutes with you or your doctor has seven minutes, maybe you’re not being respected and asked, what would you like to start with first? So, I really highly suggest that providers read your book and gain some,, motivational interviewing skills and techniques to put the patient first. Because if we want compliance, if we want people to do the, some of the best programs we know about that can really help them heal, can help them feel vitality, we’ve got to start with what are they most interested in? What are they most curious about? What do they think they most need rather than throwing a pelvic muscle exercise at them or having them lie in their back and use the ultrasound training. We have lovely pelvic health equipment too.
For example, the Intimate Rose site developed by Amanda Olson is absolutely wonderful with informative videos for patients on all of their equipment, as well as, FDA approved products. So, people can really look around now. I think with the younger generation, it’s easy. They can look around on the internet and talk with people.
I think not to put people in a box that are over 50, which I’m over 50, but a lot of people aren’t computer savvy. So they just, well, ‘my doctor told me to go here, you know, and I need to do Kegel’s. So I looked on the internet and I’m doing Kegel’s. Why am I here?’ You know, these sorts of things. So, yeah.
39:38 Dr. Ginger Garner: Yeah. So all these resources, that Maureen just mentioned with pelvicguru.com, Herman and Wallace, um, Living Well Institute, Jessica Drummond, Academy of Pelvic Health. We’ll make sure all those are in our liner notes, um, so that you can easily access those because that is how you find a good reputable, reputable pelvic practitioner.
The other piece of that is you would think that pelvic PT is a subspecialty and then that’s kind of the end of it. However, um, there’s a really important point to make, which is there are subspecialties in pelvic PT. So a pelvic PT may just cater to the transgender community or only men’s health post-prostatectomy, or maybe it’s just endometriosis.
So if you look on these provider websites, you’ll be able to see where your pelvic practitioner really specializes and that can help kind of narrow down where you need to go. And most therapists are happy to speak to you over the phone. I know at my practice, I do a free first consult. It’s a phone call to really just kind of triage and say, well, I think you could benefit or maybe there’s someone closer to you for that, or there’s a better practitioner, you know, that you could go to. So it’s not about getting you in the door as much as it is about getting you in someone’s door that is a best fit for you.
Even if it’s not the pelvic PT or a practitioner that you’re talking to at the moment. I can say that with confidence that everyone in this field is here because they are passionate about helping people. So, um, we’ll have those resources for you.
I have one more question, but I didn’t know if you have any other final thoughts to add, cause this is a kind of a good stopping point for us. How do you see that we can make healthcare safer for women overall? And I say women because, I know that’s one of your subspecialties in pelvic health, but also a lot of trauma inside the medical system for women. There’s a lot of medical gaslighting that happens to women where women are ignored, their critical diagnoses are delayed because they’re simply not believed or listened to.
So if you had a magic wand, what would you say would be one of the many solutions for just helping women navigate the healthcare system more safely, or do you have any tips for women on how to navigate the system more safely?
42:30
Dr. Maureen Mason: Right. So I’d say the main thing is with, for example, a pap, which they’re not doing as much as they used to, but people have the right to say, ‘stop’. Or I’ve had patients tell their doctor, ‘please. I have vaginismus. I have vaginal spasm. You need to use a pediatric speculum. You will cause pain otherwise. I’m in pelvic therapy and the pelvic therapist taught me to not let myself be forced to be in pain during the office visit.’ So stop the provider and choices.
And, I think that that’s one of the main empowerment things that I’ve taught people is if they’re going for an annual gynecologic exam, sometimes they’re rough. The doctors are rushed and there’s pain and there’s a lot of fear. So the patient’s saying, ‘I have pelvic pain. I need you to be gentle. I need to know what’s happening. I need you to ask permission.’
And this stops a lot of providers in their tracks because they’re moving so fast with such a high patient volume that they’re not considering that they’re creating trauma in an individual. So patients can find trauma-informed therapists, perhaps by looking, looking at their website and asking around.
And sometimes someone might come through a friend that has told them that the provider is very sweet and safe. And one of my most recent patients was someone I worked with 20 years ago. She said, I know you won’t hurt me. I feel safe with you. And that was so important to me. So I will say I’m going to ask for permission. So the person has to practice that.
The authority figure of the medical provider can be overpowering and people just succumb to it and expect to have trauma and that’s very unfortunate. And there are providers out there that will treat you with respect and compassion and it’s your choice whether or not you have procedures done.
44:42 Dr. Ginger Garner: Yeah. That’s a really good point to end on is that you’re in control of your health care. You are in control of whether or not you allow any procedures to happen at all. And to, um, just take that first step, although it might be scary and feel a little bit terrifying to set that boundary with your provider. It’s absolutely within your right to do that.
And just that simple question of, or statement of what, Maureen mentioned can make all the difference. Just makes them stop and realize this is a person in front of me. This is not another patient file or number. This is a person that is coming into the system, into the healthcare system for help, the last place that someone should experience trauma is inside the healthcare system. And so I think Maureen and I are both very passionate about seeing that end.
And until it does, we will continue to need trauma-informed care and for, for women and people who’ve experienced trauma outside of the system. But it’s just a real shame that trauma has to happen in offices, in systems, just because they’re not delivering care, compassionately or in a mindful manner. And you have every right to ask for that. So may the force be with you with asking for that you’re empowered to do it and you have a right to do it. And you have a right to also fire your healthcare provider when they are not providing compassionate care to you. So that power rests with you.
Yeah. Well, thank you Dr. Mason, um, for joining us here today. You’ve provided so much amazing information. The two books, the two books that were mentioned, of course, I want you to tell them your book title exactly where they can get it and you mentioned, I did have a book that I have co-edited with Dr. Joe Tatta that just came out. That’s on OPTP.com. It’s called integrative and lifestyle medicine and physical therapy. And now Mo, where can they find your book, its title and other resources that you have?
46:58 Dr. Maureen Mason So major publishers have the book. It’s on Amazon. A recent patient just wrote a review and it’s called Pelvic Rehabilitation, The Manual Therapy and Exercise Guide Across the Lifespan. And again, it’s on Amazon. Oh, so you have a copy of it. Rehabilitation. Pelvic rehabilitation.
Yeah. You, you wrote my foreword because you had the understanding through our yoga work together with your Institute on me being a pelvic therapist and how this all blends in together, the control of the breath and embodiment and feeling safe and feeling good and making healthy choices to how do we make healthy choices and what, what can we learn about, um, to improve our health globally? Yeah.
47:52 Dr. Ginger Garner: It was an honor and a privilege to be able to pen a forward for the book. And I can’t wait to get my hands on the final copy. You guys, I have seen in the advanced copy, of course, but I can’t wait to get my hands on a final copy and I would recommend that to anyone who’s looking to hone and improve and broaden their skills or anyone who just wants to know what good pelvic therapy should look like across the lifespan. Thank you so much for joining us. And I look forward to talking to you in the future.
48:25 Dr. Maureen Mason: Thank you for the opportunity, Ginger.
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