Hi everyone and welcome back. I have an incredible guest with me here today because, because, and if you’re not watching YouTube, I’m like putting my fingers in the air right now, because of a couple of things. One, she is not just a clinician. Two, she is a she, and I think that’s important when you’re a clinician. And number three, she…is a clinician and an entrepreneur. So three fantastic things. Welcome Dr. Amanda Olson.

Amanda Olson (00:35)

Thank you so much for having me.

Ginger Garner PT, DPT (00:37)

Yeah, yeah, thank you for taking the time out of your crazy schedule because I get your emails and I know you’re like popping around to all these conferences and I know that I’ll see you in a couple of weeks at another conference and then again in March and it’s going to be fantastic. So I am really excited to have you on the show today because you are truly an inspiration for a lot of people.

you know, if it’s not because they’re a patient and, you know, of pelvic health and they know how amazing you are, or you’re an inspiration because you’re an entrepreneur or because you’re doing all this stuff and you’re also a mom and you’re just, you know, forging a path, which is fantastic. So for those of you guys who do not know Dr. Olson, I want to introduce her to you first. She has a doctorate in PT, physical therapy from Regis University.

and certifications, various certifications. My eyebrows go woo in pelvic floor therapy, stop Pilates, running coaching. She’s also president and chief clinical officer of Intimate Rose where she develops pelvic health products and education. She’s very passionate about empowering individuals with pelvic health issues and she specializes in pelvic pain, incontinence, pregnancy and postpartum care. She’s an international lecturer

on pelvic health and has authored articles in the book, Restoring the Pelvic Floor for Women. Welcome, Amanda.

Amanda Olson (02:11)

Thank you so much for having me.

Ginger Garner PT, DPT (02:14)

Yeah, all right. So I want you to take this phrase on and run with it. It’s all in your head.

Everybody take a breath.

Amanda Olson (02:29)

sound.

is all

in your head can often be delivered in other phrases. And that would include imaging’s clear, not really sure what to tell you. Have you tried having a glass of wine? Here’s what other people who have anxiety have benefited from. Have you tried a counselor? And these things, yes, these are so triggering. Perhaps you’ve heard it.

Ginger Garner PT, DPT (02:43)

you

My heart rate’s rising. Yeah.

Amanda Olson (03:02)

My heart rate goes up too. And

Ginger Garner PT, DPT (03:02)

Yeah, yeah.

Amanda Olson (03:04)

additionally, I get that feeling every time a patient comes into my office and says that that’s what they’ve heard because it continues to happen. It is getting better. But to unpack it, imaging’s clear. I’m not sure what to tell you. Well, there’s a lot of things, including musculoskeletal drivers of pain and visceral drivers of pain and inflammatory drivers of pain.

Ginger Garner PT, DPT (03:11)

Yeah.

Amanda Olson (03:32)

that don’t appear on imaging. Whole disease process known as endometriosis is not visible on imaging. There’s certainly some new introductions of different types of technology in AI where there’s hope that might be able to pick some things up coming down the pike and it may not always be this way. And perhaps if we’re listening to this episode in 10 years, that will have changed. But all that’s to say is you can have clean imaging and have a true and legitimate musculoskeletal driver of pain.

Ginger Garner PT, DPT (03:35)

Mm-hmm. Yes. On imaging.

Yeah.

Amanda Olson (04:02)

Additionally, yeah, sure. So you can have clean imaging and have something like a trigger point or a tender point or a muscular imbalance that can be driving pain that is a legitimate musculoskeletal and I’ll add that I didn’t say previously fixable condition that isn’t going to appear on imaging. So

Ginger Garner PT, DPT (04:02)

Can you repeat that again? Just like that bears repeating.

yeah.

Amanda Olson (04:29)

depending on who your care team is, that the fact that we’ve started with a symptom like pain or bloating or other issues, and we image and there’s nothing there, it begs the question, who else should this patient see to be evaluated to determine what’s causing the pain? Because you’re not nuts. You’re experiencing something and it warrants follow up.

And the brain is involved in terms of the pain experience. We have a brain that perceives things from different parts of our body. And the longer we have pain, that can change. Our system can become more sensitive to where maybe something’s not necessarily an actual tissue damage or a tissue injury, but it’s starting to feel that way. But all of that still requires working with

the muscles and the nerves and the tendons and the brain together to retrain certain patterns. So all that’s to say is where it’s not in your head, your brain is involved in the healing process and in rehabilitation world, pelvic health, physical therapy and occupational therapy. We want to work together with your multidisciplinary team to do an actual evaluation on your body and determine if there’s something

happening within the pelvic floor or the hip or the low back that is the driver of the pain. And then we’re going to help work with you to create a plan of care so that you can move on and reach your goals and live a life not encumbered by pain.

Ginger Garner PT, DPT (06:12)

Yeah, I think that’s one of the most hopeful messages. If someone says, you know, what does pelvic floor PT really do before endometriosis excision or in absence of excision? Maybe someone has had ablation or maybe post-op excision when they finally do have that surgery. One of the most hopeful things that the pelvic floor PT brings is that

we’re not going to ignore those unexplained symptoms. And before we started, you we hit the record button, Amanda, you were saying something that I think also needs to be repeated in that unexplained symptoms deserve investigation. And that’s the hope that pelvic floor PT brings because we’re not going to ignore those symptoms. Whereas, you know, the other problem with endometriosis is pain can be very cyclical.

and it may not follow a particular pattern. And that is where I think women are chronically, know, epidemically misdiagnosed with mental health issues, you know. Yes, pain is perceived in our head. So it is in our head, but it’s not a mental health issue in our head unless you end up suffering a mental health issue as a result of the crappy care that you got. No.

Amanda Olson (07:37)

I was just going to say that it becomes a

mental health issue out of fatigue and exhaustion and gaslighting to the point where you no longer trust your own instincts or trust what your own body is trying to tell you.

Ginger Garner PT, DPT (07:40)

Yeah. Right.

Right.

Yeah, you’ve been medically gaslit to the point where the system has traumatized you, basically. And still, then, even if you have that mental health issue,

Dang it, it’s the system’s fault. It’s like an institutional betrayal that they didn’t take care of you and then they just kept gaslighting you until you had that issue. But talk to me a little bit more about the unexplained symptoms because there’s such a wide range in endometriosis that can be cyclical, that can follow no particular pattern, et cetera.

Amanda Olson (08:23)

Absolutely, goodness, where to begin. I think about digestive issues and how it’s often the first presenting feature before one even starts their period. I lived that as a person with endometriosis, gastrointestinal issues are my earliest medical memory. then, yeah, yeah. I think I read something like that is

Ginger Garner PT, DPT (08:44)

Yeah, yeah, me too. Mm-hmm, yeah.

Amanda Olson (08:51)

the primary for most people once they understand it better. I think about pain radiating down the thighs and up and into the abdomen, tailbone pain, which we’ll talk more about. Deep pain that can’t reach it, can’t stretch it, which we on the pelvic health physical therapy side know can be driven by restrictions in deep pelvic floor musculature that we can reach internally in a very gentle manner.

Ginger Garner PT, DPT (08:58)

Mm-hmm.

Yeah.

Amanda Olson (09:19)

And then, you know, different issues cognitively with cognitive fog and certain headache type related issues that can be associated with hormones and inflammatory responses as a byproduct of living with the disease.

Ginger Garner PT, DPT (09:31)

Yeah.

I have a lot of patients and when I remember when I woke up from my excision surgery, my hands were already on my body doing orophacial release, like involuntarily. When I woke up, I was already doing that, you know, that manual therapy. But to get to the point, I have a lot of patients who have orophacial pain because you mentioned headaches. And I think that

with the disease being, you know, estrogen mitigated or mediated or driven, whatever word you want to choose, that you could validly have those headaches. But I think a lot of it, can genuinely be, or a facial pain from, maybe it’s from the medical gaslighting, like where are you holding stress, right?

Do you clench, do you grind? Are you having nightmares about it? Are you waking up in the middle of the night, you know, in some weird protective trauma posture, in addition to the things that the estrogen inflammation can drive?

Amanda Olson (10:41)

Absolutely.

Ginger Garner PT, DPT (10:42)

Yeah. So what are some other red flags? We mentioned the gastrointestinal, and for you and me both, that was a red flag in the beginning that was entirely ignored. I was handily gaslit over that for a lot, a lot of years.

with gastroenterologists, gynecologists, all of everybody, essentially, even well-meaning colleagues that didn’t understand. But what are some other red flags? Do we leave any other red flags out in patient history that often point to undiagnosed endometriosis or make it such that endo should be on the list of things to rule out?

Amanda Olson (11:31)

say pain with tampon, speculum, or penetrative intercourse or pain with climax during intimacy. Oftentimes that tampon feature can be early and presenting, you know, first onset of menses or sometimes it’s later on in life, but just pain, pelvic pain associated with something coming inside and that can be due to adhesions in the viscera and muscles themselves.

And it can be because of that guarding reflex that you just spoke about with the headache and the clenching and the jaw, but the pelvic floor muscles providing that guarding response to try to be involuntarily protective, but that leads the muscles really tight just the same way as clenching and elevating the shoulders does.

Ginger Garner PT, DPT (12:17)

Mm-hmm. Yeah, I’ve actually seen, had a really good example lately on imaging, where I was imaging someone, their pelvic floor, ultrasound imaging, and we started to talk about a stressful, a rather large stressful event that was about to happen. And her pelvic floor, she had no idea it was happening. That was a turning point in rehab for her.

pelvic floor immediately when she began to talk about it, it just kept coming up. The bottom base just kept coming up, coming up, so the tension in the pelvic floor, you know, it just kept rising. And it wasn’t just a little, it wasn’t a few millimeters, it was like 12 to 14 millimeters. It was like a pelvic floor full contraction. And

I stopped and I said, did you just feel that? was kind of like if an earthquake just happened, you know, I stopped and said, did you feel that just happened? She was like, what? I have some pelvic pain. What’s, what’s, you what’s happening? I said, okay, let’s do some breathing. Let’s talk it back down. And then, you know, in the image, the pelvic floor came back down again, but

A few minutes later, I was like, let’s just make sure that’s not a fluke. Let’s see if this is truly a driver. If this trauma that you are about to experience that you cannot get out of that you don’t want to have happen is, but it’s going to happen. Just start talking about it again. And it went right back up again. And it was just a consistent trigger for her. And it was just verbalizing that stressor. That’s all it took. And the pelvic floor was like, fine, we’re out. We’re doing what we, what we want. And it kind of went offline and she had no control over it.

Amanda Olson (13:56)

I have had that experience with the patient as well. It’s so incredibly interesting. I had just placed my index finger in for assessment. wasn’t first eval, but it was just, you know, I had literally just gotten in there and she recounted the death of her husband. in, in 16 years of being a pelvic health PT, I’ve not had this, the situation where my, my circulation was cut off on my finger. She went from normal baseline neutral.

pelvic floor tone to clenching so hard that I wasn’t worried about myself, but I was in pain. It was cutting off my circulation on my finger and I’m listening to this poor woman recount the death of her husband and seeing this very clear trauma response of her pelvic floor. And it was the exact same thing. She had no, I said, are you able to feel the tension in your pelvic floor right now? And no, no cognitive,

Ginger Garner PT, DPT (14:33)

Yeah.

Wow. Yeah.

Yeah.

couldn’t feel it.

Amanda Olson (14:56)

knowledge of this motor behavior of her body.

Ginger Garner PT, DPT (14:57)

Yeah.

And that’s how, that is such an important point because if you are

no one has the exact skill set that a pelvic floor PT or OT is going to have, like no one. And so no one can evaluate you. If you’re listening, no one can evaluate you and then just tell you that, you absolutely 100 % need pelvic floor PT because we’re the ones that evaluate and determine whether or not you need it. And it’s why I feel so strongly, I think that everyone with a diagnosis of endometriosis because of the trauma and everything, even if you haven’t had surgery or if

If surgery, you can’t do it or can’t access it. I think 100 % of women need to be evaluated because of things like this.

So that.

Just, it’s, I just have to take it like a full breath, you know, thinking about these women, these cases that we’re talking about that are real people that have been in our recent, you know, clinical practice history. It affects, I know it affects me. I know it affects you personally. It’s not just another case. So I think it, if we can just like impress upon you as a listener that

That’s the degree of passion and how strongly we feel about women having access to this care. And I think that, and I believe that, and knowing you Amanda, and knowing what I know about you as a colleague and as a friend is that deep passion is what drove you to create what you did with Intimate Rose. And…

that is all about innovation. It’s passion, but then it’s a lot of blood, sweat, and tears. It’s probably, you know, it’s a lot of loving what you do and then hating the tedium of what happens on the other side of it. It’s so hard as a female to be an entrepreneur anyway, and then to do that as a mom and to do it with all of the barriers that we have is just incredible. So first, like thank you for doing

what you did with creating Intimate Rose and all of these pelvic health tools. And I have a little toy box at work and it’s on roll. Everything I like to be on like wheels and roll around. So I have my rolling pelvic health toy box and it’s full of your stuff. And so I just want to talk for a minute about

that little bit of the back that backstory. Now Amanda’s been on the show before so if you haven’t heard her story you’ve got to go listen to it. So go and look it up. It’s in a previous season and listen to that so you can hear her backstory and history. But I’d like to hear you talk about those pelvic health tools and your you know passion for doing this as a

a catalyst for and reason for empowerment, you know, for women. And I think that word gets overused a lot, but maybe it’s because we’re not truly, like, I don’t think we’ve reached the level of empowerment in women’s health that we can aspire to yet. So tell me where that comes from, from you in creating, you know, the line of tools and supplies and all that and how it fits into empowerment.

Amanda Olson (18:31)

Absolutely. I think at its core, I wanted to make things that looked pretty and hopeful and cheerful and thank you. They’re bright and they’re cheerful and destigmatized and recognizing, and I think all of us in pelvic health therapy feel this way is that we want to help you feel better as fast as possible.

Ginger Garner PT, DPT (18:42)

Y’all they are. They’re very pretty.

Amanda Olson (19:00)

but a lot of these things require new habits and new changes that do take time and they take a lot of practice. And our sessions, we’re always bringing as much education and manual therapy and care and love into our sessions as possible, but it’s not enough. And it has to carry over into the lifestyle. I know you’ve heard it, Ginger, and I hear it all the time is,

it feels so good when you relieve that tender point. Can I just carry around in my pocket? Can you come fix my constipation at home every day because I feel great after our sessions and then I go home and I go back to life and things go back. And so the tools are all intended for home use, for people to take control of their symptoms and be making gains towards their goals and also managing their pain and their symptoms independently.

Ginger Garner PT, DPT (19:31)

Yeah.

Amanda Olson (19:56)

so that they can feel better faster, reach those goals faster, and because at some point you’re gonna graduate and you are going to live a life without appointments, which is the whole point, is not that we never wanna see you again, but we want you to go live your life. And flare-ups can sometimes happen when we experience a change in our health status or something stressful happens, and it’s meant as a means for you to say, okay, it’s another one of those.

Ginger Garner PT, DPT (20:10)

Yeah.

Amanda Olson (20:23)

I know what to do. I’m going to use my wand. This will all be better in a few days or this will all be better in 20 minutes when I just get the wand in there and get it done. So yes, there is a means to empower people to have the knowledge that we’re giving them and also to be able to reach and really truly make changes in their body to feel better.

Ginger Garner PT, DPT (20:29)

Sometimes it can be.

Yeah, so tell me about, you know, pick one or two tools, pick the ones that you think are the most beneficial for women with endometriosis, you know, across the spectrum. Now, we’re both, you know, women with endometriosis, so we have all kinds of stories, but share a little bit with me about that because I think that, you know, the listener may have never even picked up or seen.

one of the tools before. So yay! If you’re watching, yeah, if you’re watching YouTube then here they are.

Amanda Olson (21:15)

Yeah. I’ll bring them up for those that are watching on the YouTube.

yes.

Ginger Garner PT, DPT (21:23)

And dilators? Yeah. So explain a little

bit about those because even now, like, I’ll have a patient come in, sit down, and we’ll talk about, you know, therapy tools and ways they can take this at home. And of course, I pull things out. And if you’ve had endo with, like, painful penetration or painful bladder or any of those things, I can visibly see women go, where am going to put that? Like,

they’re so afraid of touch and being touched and maybe they’ve not had that experience of someone compassionately talking them through how that touch looks and when they’re doing it themselves. Take the listener through that and that experience, you know, for just pick an issue with endometriosis.

Amanda Olson (22:06)

sure, and predominantly overarching sensation of pain coming into the pelvic floor that may be prohibiting penetration, whether it’s using a tampon or the speculum or intercourse. And that’s where the dilators are helpful. And then myofascial pain that feels like you mentioned, pain in the face or the headache sensation or shoulders, and that’s where a wand is helpful. So they do go inside the body.

but we warm up into it. So starting first, we’ll start with the wand. It’s the same thing as those nice little canes where if you have a knot in your neck or your back and you push on it and it’s like, there’s a knot there and it’s zinging up and over your head and driving that headache type sensation and you reach back there, you use one of those handy little canes and you kind of rub it and you kind of knead it.

Ginger Garner PT, DPT (22:45)

Just, yeah.

Amanda Olson (22:59)

and you move around and after a few minutes, oh, that’s feeling much better. I can move, you know, maybe I’m hearing better, all of these interesting sensations that come through. The pelvic wand is intended to allow people to do that same thing with tender points or trigger points as they were formerly known as, or mild fascial restrictions in scar tissue in the pelvic floor muscles that can be reached.

through the vaginal opening or the rectal opening, which sounds very scary. That can be a method used after you’ve been seeing a pelvic health PT and had some more education or pelvic health OT. But essentially what it is is there’s these two little ends and they have different curvatures that just allow you to come inside and gently massage the muscles. And if you find a little tender point, you can just hold this pressure. I liken it to a tomato, whereas

If you’re going to check a tomato for ripeness, you’re going to give it a little squeeze and see if it’s ripe and see if it’s ready to use. You’re not squishing it. You’re not going to squash your tomato. Likewise with your muscles. It’s just nice and gentle. And you can massage them out. And that oftentimes releases those strange deep, can’t reach it, can’t stretch it, tailbone, sometimes even bladder type pain because of those restrictions coming around the muscles.

Ginger Garner PT, DPT (24:14)

So.

Amanda Olson (24:20)

oftentimes referral of these tender points can be up to a foot away in different directions. So sometimes you find just by relieving one little tender point, suddenly that front thigh pain that was going all the way down to your knee is suddenly significantly reduced or gone. So that’s the role of the wand. I’ve made different types of wands. They’re all the same shape and size, but they have different functionality. So the vibrating wand has been really helpful for people with endo.

It’s very soothing. There’s 10 frequencies of vibration. People can select and use that to help soothe the muscles, get some good blood flow to the area and make the muscles more relaxed, more flexible, which just makes us move easier and often reduces that chronic pain sensation. The vibrating wand’s been a game changer for a lot of those people.

Ginger Garner PT, DPT (25:10)

Yeah, huge fan. I’m a huge fan of the

vibrating wand. And just as a side note for my patients who have orofacial pain that is connected to the pelvic floor, like you and I were describing, I will use the vibration on particular muscles in the orofacial area. So thanks for making that because it works from the voice to the pelvic floor.

Amanda Olson (25:31)

Absolutely.

It’s so interesting. In one of my previous clinical settings, I worked with some really renowned TMJ specialists. So we had like me doing pelvic floor and these people attending dental conferences. And I was at a big conference one time that was open to all the different types of providers. And a very well-known TMJ specialist came up and told me, I know that I know what you invented this for, but I’m having people do it in the mouth and on the jaw and making a big change for them. So thank you.

Ginger Garner PT, DPT (25:37)

Mm-hmm. Yeah.

Yeah.

Yeah, yeah.

Yeah,

Amanda Olson (26:01)

I think that’s fantastic. That’s great.

Ginger Garner PT, DPT (26:03)

yeah, yeah, it is, it is, it is. So, I interrupted you right in the middle of your going over the different types of one. So I know you also have a new one that’s the longer one.

Amanda Olson (26:17)

Yeah. It is, for those who are not able to see, it features the same different types of points on either end, but it’s extra long and it’s bendable. So that allows people to change it to accommodate their own different unique needs. For people who need a little extra reach or a little extra help, you know, making it form to their unique body, the bendable wand has been.

Ginger Garner PT, DPT (26:20)

Yeah!

Amanda Olson (26:45)

a really big crowd pleaser for that.

Ginger Garner PT, DPT (26:49)

Yeah, that’s, love showing people that one. It is cheerful. It’s orange. And because I have had patients where they’re trying to use that internally and they’re getting like, it’s almost like they need a little bit, they need a half inch more, you know, length or shape and a different. And so if they need it, now they have it. So I think that one’s great.

Amanda Olson (26:51)

It’s cheerful. It’s orange.

Yeah.

Perfect. Love that.

Ginger Garner PT, DPT (27:15)

Yeah, and then you’ve got one that you can heat. Yeah.

Amanda Olson (27:18)

Yes, the temperature

therapy one is actually an endometriosis yellow in homage to endo. It can be placed in the freezer, which sounds to some really jarring, but there’s a lot of people that have this just burning sensation associated with their inflammatory cycles to where that cold feels really good to them. So they can place it in the freezer. It will retain cold and they can do their myofascial release that way, or they can place it in hot water and it will retain warmth and they can do

myofascial release with it warm. I’m a warm person, but I have many patients that are telling me they’re freezing a glove, they’re freezing a spoon and sticking that in there. So in lieu of those items, may I suggest a

Ginger Garner PT, DPT (27:50)

Yeah. Oh gosh.

Yeah. On the

end, yellow, therawand. Fantastic. That’s good. It just goes to show you and underscore that.

Amanda Olson (28:04)

Yes, yes.

Ginger Garner PT, DPT (28:15)

there’s so many, I mean, if there’s so many different types of wands, and there’s so many different types of uses that you get the best result out of it. You can certainly just order them direct, but if you had some visits, you know, the pelvic floor, PT or OT, they would be able to really specifically show you where it is. Cause we have models and, 3d models and one dimensional models. And if you use imaging,

then you’re able to get biofeedback in real time of what’s going on. So just so many different tools. And I say that because it’s hope that there are so many different things that can be done. And that’s just talking about releasing tender points in the pelvic floor, right? Or maybe some around the orophacial area. And there’s so much more that encompasses the multidisciplinary care.

you know, that really treating endometriosis is kind of requires. It’s not really optional just to see your excision surgeon in a pelvic floor PT. I think that

there’s more people you know that you could have on your team if you have access to it. So I mean let’s talk about that a little bit because there’s such a massive psychological impact of endo. Where do you find it’s been helpful along the way? Like what other team members do you find as a clinician? You know as a person that cares about others with endo and you know as a person with endo.

Amanda Olson (29:45)

Absolutely. I love having a dietician available to help patients understand what their unique true allergies and sensitivities are. There’s some commonalities that I think a lot of us share. But it’s really nice to have somebody that can take a really solid look at you and your life and your day to day. Because sometimes I think we look at maybe like an influencer person on

on Instagram that’s saying like these very broad statements that do encompass a lot of people, but maybe not for one particular person. And if they’re latching onto these ideas of sensitivities and they don’t know how to prepare food that does work, it can feel very overwhelming to look at all of these different sensitivities and say, well, what am I supposed to eat? And how am I supposed to feed the other people in my house? You know, based off of these, you know,

Ginger Garner PT, DPT (30:27)

Yeah.

Yeah, that’s a real problem.

Amanda Olson (30:39)

That can be really helpful. And then under the category of like mental health, there’s so many different types of counselors and therapists with different backgrounds. So for example, like there are licensed clinical social workers who also specialize in counseling that have really extensive trauma therapy backgrounds. I love that. And I’ve talked to a lot of them and they’re so passionate about what they do. And they do a really good job of looking at the whole environment of the person.

from their work environment to their family and how they were raised and all of those things that’s just really incredible. And then there’s counselors and therapists who specialize in cognitive behavioral therapy where they’re like really trying to help the person rewire their behavior. EMDR, it’s eye movement therapy. I will say I have done a lot of EMDR.

Ginger Garner PT, DPT (31:33)

Me too.

Amanda Olson (31:33)

And it really

was profoundly game changing for me to overcome some really big barriers. It was originally incepted for Vietnam war veterans who had PTSD. And what it involves is there’s different ways of doing it. the way that a lot of people do it is there’s a little bar and your eyes are following this light bar. So they’re moving back and forth. And what it does is it stimulates both sides of your brain.

Ginger Garner PT, DPT (31:36)

It is.

Mm-hmm.

Amanda Olson (32:02)

frees you up to have a conversation with your therapist. So you’re not just sitting there watching lights all day long and different therapists do it different ways, but it can calm your nervous system. And I know there’s a lot of fantastic vagal nerve specialists out there now that talk about using both sides of your brain and calming your nervous system so that you can actually get to the root of what’s in your way. And that’s what that does. So it’s just one type, but

I know a lot of pelvic health PTs that are working closely with EMDR therapists and getting a lot of great results for their patients as well. And then there’s sex therapists who do a fantastic job of bringing intimacy back into people’s lives and faith-based therapists, if that’s really what you’re leaning into that can be assistive for people. There’s just so many different types. There’s just so many different types of people.

having a wide scope of different types of practitioners is really helpful.

Ginger Garner PT, DPT (33:04)

Yeah, I do recommend a lot of different types of mental health therapies for patients depending on kind of how they present. I know that the one patient that when we identified with the imaging example, to go back to her for just a second,

we started to immediately talk about what that would mean to identify the root cause of where that was coming from. Because for her, it wasn’t like an adverse childhood experience or anything like that, but it came from, turns out, after working with a mental health therapist, she found out pretty quickly it came from unresolved birth trauma.

And for her, didn’t have access to, this person didn’t have access to EMDR, but she had been working with and had a really strong therapeutic relationship with someone who did hypnosis, which I would think you’d have to have a very strong trust, strong therapeutic relationship with them. And in that, it allowed her to, and I think that’s the concept of EMDR too, is it just allowed her to finish processing using the full faculties of her mind.

finish discussing and talking through the stuck points that it’s kind of like when we try to carry someone through the tendonitis or tendinosis process and we want to carry them through all the way to healing instead of partial trauma of the tendon, right? And then not finishing the healing process. And so for her, that was a major breakthrough. And I think that…

if we can, I mean, what we’re really talking about is ditching the stigma attached to getting therapy, any type of therapy, but it still exists for mental health, you know, therapy, if we’re honest about it. And just straight up saying, gosh, you know, I don’t know any woman that could walk through the journey of endometriosis and not need therapy for.

just what happens as you go through that, mostly because of the delay in diagnosis of seven to 10 years and much, much longer for other patients.

Everybody needs help sometimes. Yeah, yeah, there’s such a heavy psychological impact, you know, of endo. So I think that the way that you see it, just to recap, is just women talking about a tough experience can create pelvic floor tension. What are some of the other patterns that

Amanda Olson (35:27)

That’s exactly right.

Ginger Garner PT, DPT (35:55)

you have seen that either made you stop and take therapy in a different direction for a minute, maybe it’s like a mindfulness practice or some other lifestyle practice, that or say well and I think you know a mental health therapist might be a good idea. What are some of the things that you see that are like yellow flags and you could talk about green flags too but I think sometimes it’s helpful helpful to hear about those yellow flags.

Amanda Olson (36:23)

think looking at day-to-day behaviors and comparing it and matching with the patient’s presentation on any given day, and I think that speaks to our relationship over time. Sometimes it’s apparent right when you do the eval and you meet them as to like, let’s take exercise for example. Somebody might be quite sedentary.

and you start exploring what different types of body movements sound intriguing to them or that they might be curious about or which ones they have fear about and how they’re responding to that. And some come in and they’re exercising a ton and we start to see some sort of pattern of flare-up surrounding the intensity of their exercise. And we don’t necessarily wanna take exercise away and bench them, you know, to use that phrase.

Ginger Garner PT, DPT (37:15)

Mm-hmm. Yeah.

Amanda Olson (37:19)

but just starting to maybe find some, find a mode of exercise and movement that is suitable to the place that they are in now and then taking into consideration their goals. know, taking an example of an avid runner where they come in and they’re running a lot and we’re starting to see flare ups associated with certain intensities of run or durations of run.

And just looking at what would happen if over the next six weeks while we’re working in therapy together and we’re addressing these other factors, we stick with the lower intensity run. So you’re still getting what brings you joy and you’re still feeling healthy and making, you know, your, good daily activities that bring you psychological wellbeing and physical wellbeing. But we’re not going to do that high intensity or taking somebody again, who’s

sedentary because they are in a lot of pain and really crunched up and exploring what works well for them. And along those lines, interesting flags that might come up. I had a patient who had a lot of pain and she knew from listening to other people that perhaps yoga was recommended. And she went to the yoga class and she said, being quiet and in a quiet room and going through that hour really made me feel anxious.

Ginger Garner PT, DPT (38:41)

Hmm.

Amanda Olson (38:41)

and worse

because that environment just isn’t suitable to my personality type. So I need to do something different. just gauging it based off of what you’re hearing and what maybe they have preconceived fears about.

Ginger Garner PT, DPT (38:47)

Yeah.

Mm-hmm. Yeah. I mean, I had a patient recently who had a pretty major bowel resection. And so they were going to do a reversal of the colostomy. And

That brings up a lot. So if you’re out there, you’re listening, and you’ve, you know, had bowel endometriosis, which a lot of women end up with bowel endometriosis, you feel like you’re starting over with all your lifestyle choices, with everything that you can. I eat this now, right? If they couldn’t eat it before and it was a huge trigger, you might be able to go back and eat those things now, right? Or how, you know, how much activity am I going to be able to do? When am I going to be able to do it? All those things can be worked out.

in the context of a pelvic floor PT who really specializes in, you know, the orthopedics, the lifestyle, and of course, obviously the pelvic piece. But I’m sure Amanda, you see too a lot of orthopedic overlap where it’s super helpful to have the ortho and the pelvic piece of those puzzles together so that, you know, you don’t have to have redundancy, you know, in PT.

Amanda Olson (40:13)

Absolutely. I lean into my orthopedic skills daily and with every patient. I check feet on every patient because of the relationship between the foot and the pelvic floor, both with common nerve origins and in how we walk. yeah, every patients are interested when I’m assessing feet. Did you roll this ankle? Did you ever have a fracture here? Yes. How do you know? I can tell. And it can change the way they move.

Ginger Garner PT, DPT (40:28)

Mm-hmm.

Yeah. Yeah.

Amanda Olson (40:42)

really important.

Ginger Garner PT, DPT (40:44)

It is. I think that it’s probably, it might be important for, you know, you as the listener to hear that what does a good Endo expert in PT look like? And I think this is where we start to lean into the physical therapist side.

because ortho-PTs are pretty uniquely situated when you’ve done ortho first and then you came into pelvic PT because you have both of those things. And I do think that’s part of a well-rounded program. Not that someone couldn’t get away with just, you know, like pelvic OT or pelvic PT who doesn’t have any ortho experience, but it does make it harder. I think that that

person would need to know their limitations that, well, I’m not well versed in evaluating feet and knees and shoulders and the cervical spine. But hopefully they know someone who is and can fill that gap.

Yeah, so let’s talk a little bit about, you know, advocacy about education. If you know anything about endo, you guys, you’ll know that it’s the diagnosis is plagued with late diagnoses and a bunch of boatload, a ton, a crap ton of medical gas lighting.

And throughout this entire season, we have talked to advocates and surgeons and other therapists who have talked about how they empower patients to advocate for themselves. If you haven’t listened to some of the surgeons, you know, episodes, go back and listen to some of the surgical episodes because they have unique challenges like

What if when they do surgery, you know, we’re talking expert excision surgery, that the patient goes back to their home state or their home practice or whatever and their GYN no longer wants to see them?

They refuse to see them because they’ve seen someone else, right? Which is, I’m just holding my head, you know, right now going, how could someone refuse care because they went out of state to get expert care somewhere else. That’s a special kind of closed-minded person who will not see them, but it’s happening, right?

So Amanda, and you know, from what you have seen, what are some of those stories and experiences that you’ve heard patients have and what have you done to kind of get them past that? I know sometimes it’s just, it’s a matter of talking to the patient and saying, well, you know, maybe, maybe a quiet quit is an order of that provider if they’re not willing to listen. But what are some of the things that

that you’ve been faced with, how have you handled those?

Amanda Olson (43:42)

biggest concern at this moment is the gap in time it takes to get the diagnosis and the amount of advocacy, the self advocacy and searching for solutions that happens to get the diagnosis. And then the continued advocacy and emotional load and time load that it takes in the living with post diagnosis and post operatively, because I do I think there’s a relief.

in the determination and the label and the diagnosis. And then it’s the not all surgeons are created equal. Like you just said, we have expert excisions and we’ve got 20 ablations a day providers.

Ginger Garner PT, DPT (44:18)

Yeah.

Mm-hmm.

Right, you’ve got people that hang their shingle without, I mean they, anyone can hang a shingle and say they’re an endo expert.

Amanda Olson (44:31)

Yep. Yeah, which is, which is I think our current hill that we’re all on and you know, forming these lists and I think I love the concept of providers lists that have been screened by people not in the medical community. So the advocacy driven lists of where people have gone and gotten good care, good care, both on the actual surgical side and the humanistic side and

Ginger Garner PT, DPT (44:35)

Yeah.

Mm-hmm.

Amanda Olson (45:00)

There’s a lot of fantastic providers out there that have both, and there’s some that have one and not the other, unfortunately. And then it’s the living with it, as you mentioned, and the egotistical response to not providing care for a patient. mean, so let’s put it into cancer. If a patient were to go from, say, state and go to Mayo Clinic and receive some diagnostic workup and some care at a Mayo Clinic and come back,

Ginger Garner PT, DPT (45:25)

Mm-hmm.

Amanda Olson (45:30)

I’ve not yet been made aware of a primary care provider or a oncological provider that would not care for that patient because they went to Mayo. And Mayo is one of the gold standards of oncological care in this country. We need to get there with endo. And endo is a similar disease that requires additional education and care. And I would say if you’re in that position, if you’ve been let go or released by your provider,

Ginger Garner PT, DPT (45:39)

Right.

Yeah.

Amanda Olson (45:58)

initial steps would be to maybe get somebody on telehealth in your state. So somebody that can provide telehealth services to maintain you or provide your care. And then finding somebody in your town who can at least do your ongoing pap smear care. Because we have two different things. We have what needs to happen annually to continue to screen just as a byproduct of being a woman. And then we have…

Ginger Garner PT, DPT (46:23)

Mm-hmm.

Amanda Olson (46:26)

the person that’s going to be providing management with prescriptions and whatnot too. So there’s a lot of different ways now to wrap that present that just can require some creativity, but you are worth it and you deserve it. And I don’t have the answer of how it gets better right in this moment, but I would say it’s just, you just gotta make it work for the position that you’re in at this moment.

Ginger Garner PT, DPT (46:35)

Yeah.

Yeah, I think realizing that it will have to happen, that you’re going to probably experience these roadblocks because your example was brilliant, you know, that cancer example of if someone went to MD Anderson or Mayo, okay, no one is turning them, Duke is not turning them away when they come home. I’m in North Carolina, so I’m just using Duke University as an example, but they’re not turning them away and yet it’s happening because it’s women’s health and there’s not enough awareness with endo. It’s

It’s absolutely insane, it’s wrong and it shouldn’t be happening, but instead of saying, well I guess there’s nothing we can do about it then, well there is, there is, there is the solidarity that you know, that you have now just in listening to the podcast, right? And knowing that you can reach out and there are providers across the country.

that we can help put you in touch with. There are multiple lists that can be helpful in seeking out that care. A lot of providers actually are licensed in other states and so they can provide care across state lines. You’d be amazed at what can be done on telehealth, right? You would think pelvic health PT on telehealth? Yes.

Amanda Olson (48:07)

Yep.

Ginger Garner PT, DPT (48:08)

Thanks to Intimate Rose a lot of the tools too, it makes it possible because you can explain concepts and then as a patient you go away, you try those concepts, you come back and you go, okay, that worked or was that right? Because it felt a little weird when I went in this direction, you know, with the bond or something like that. So there’s a lot of stuff that can be done. It is not going to be made right immediately and…

I wish we could predict, but looking ahead, it could be five, 10, 15, 20 years, given the current political climate that we’re living in right now, to kind of see women’s health finally come around to being a fully respected part of living as a human being on this planet. And I think that

all the discussion too about you know gynecology can get really negative really quickly because of the burden that they’re placed under. Like if you have a heart problem you’re going to see a cardiologist but then the cardiothoracic surgeon is going to take over and do surgery. Not with women’s health. It could be a pediatric problem, gynecology problem, it could be a pediatric oncology, it could be menopause, it could be

prenatal, postpartum, infertility. Our health care system doesn’t value women’s health enough because if it did, we would have separate specialties for all of these things. We would have GYN, that would be, you menopause. We would have a separate surgeon for it, but they’re heaping all this onto, you know, OB-GYN’s heads and expecting them to just be

Amanda Olson (49:58)

Be all the things.

Ginger Garner PT, DPT (49:59)

Yeah, be all the things to all the women, which is absolutely impossible. And I think that if we begin to shift our mindset about it, you know, I know you and I already have, so we’re kind of preaching to the choir, talking back and forth, but to the listener, you know, if we can shift our mindset about it and realize that, yep, your GYN is probably not going to know unless they’re on the NAMS list, the North American Menopause Society list. If you’re going through Endo and Meno

they’re probably not going to know anything about endometriosis or menopause. Hate to write it to you. So you’d have to go to North American Menopause Society and look up that list, but then you’re also going to have to look up some of the endo lists, and they’re usually not going to overlap. People that know about endo are not going to know about meno and so that is where, you know,

That’s why I’m doing a whole season on endometriosis. It’s why we keep talking about it. It’s why I also want to impress upon the listener that pelvic floor PT can do a lot for both for helping you manage perimenopause, menopause and endometriosis. So that kind of pushes us into the looking ahead. Like if we’re looking ahead.

Like what breakthroughs, changes, like what do you see Amanda that can be in the field of just pelvic health and endo, know, like within the next five or 10 years, what are you hopeful for?

Amanda Olson (51:25)

It’s going to sound bananas. And I understand this. I’ve taken multiple meetings in the last few months with different medical tech provider driven uses of AI and imaging together to start to get perhaps some earlier diagnostic capabilities in the endospace specific to endometriosis. And the fact that there’s multiple, you know, me, me being a

Ginger Garner PT, DPT (51:50)

That would be amazing. Yeah.

Amanda Olson (51:54)

a pelvic health physical therapist and really operating at tissue level, musculoskeletal tissue level with growing knowledge of technology and AI, but certainly not. I’m not an expert, but when I’m looking at these new entities and I’m listening and they are driven by patients, these tech people and these providers have endo, their daughters have endo, like they are pushing in the right direction. What I feel is the right direction.

I’m very excited about that. And I do think that this landscape and this conversation is going to look really different in 10 years because I do think something has lit fire in the last four years or so. The other side of it is lobbying and looking at policy change around financing research.

Ginger Garner PT, DPT (52:42)

Mm-hmm.

Amanda Olson (52:46)

in all those different avenues that you just said. So ensuring that there’s adequate funding for research in what happens to a person with endo when they go through menopause, how do those things change? Because this is an expensive problem and it’s pulling people out of school, it’s pulling people out of education and their work, it’s affecting their home lives, it’s affecting relationships and it’s affecting fertility. So my hope and my dream would be that

there would be changes in how allocation of funds is made in women’s health and to getting better at supporting this population for all of the reasons that we just described. So those aren’t necessarily specific. And I feel like as pelvic PTs, we’re always just gonna be the ones that are in the canoe paddling with the patient anyway. So it’s like, yay, new AI diagnostic. We’re gonna get you in faster. You have pain. This is what it sounds like. Boom, quarterback them in instead of.

Ginger Garner PT, DPT (53:28)

Yeah, yeah.

Hahaha

Mm-hmm.

Amanda Olson (53:46)

you know, instead of what it is.

Ginger Garner PT, DPT (53:49)

Yeah, because right now, know, Endo is essentially, the way you’re describing it, the words that came into my mind was, gosh, you know, Endo is a real home wrecker, you know.

Amanda Olson (54:01)

Yeah.

Ginger Garner PT, DPT (54:02)

It’s a job wrecker, it’s a life wrecker, but you know, a home wrecker, when you think of your home being your place of sanctuary and quiet and peace and tranquility, when you have endo, you don’t have a sanctuary. Like your own body has felt, feels like it has betrayed you. And…

I mean, that’s worth a pause because it does invade every area of your life. And I think that, you know, as women, you can easily gaslight yourself and say, suck it up, buck up, get over it, push through, because, you know, essentially that’s what you were told, especially if you started out and your very first period was painful or awful or whatever, you are always told that because it was overlooked. And if you think about a similar statistic, if I think it’s probably

underdiagnosed at one out of every 10, you know, one out of every 10 women. Well, if it takes a decade to be diagnosed, approximately, you know, seven to 10 years or so, we probably have a lot more cases than just one out of 10. But if you look at men, one out of 10 men are going to have diabetes and look at the body of research done on diabetes or the amount of money that’s given to Crohn’s disease, which I think is like a buck 30 a patient.

Amanda Olson (54:56)

Yeah.

Ginger Garner PT, DPT (55:22)

a 130 dollars a patient versus two dollars for endo right that what you’re saying amanda is so important and so true that we have to have more funding and we have to have the policy to support it and when you compare it against diseases that men processes that men would have you know

Amanda Olson (55:27)

for Endome.

Ginger Garner PT, DPT (55:47)

there’s no comparison. Like it’s virtually ignored. So we want to end on the uplifting positive, you know, we’ve dispelled a lot of misconceptions and myths. We have talked about the multidisciplinary aspect of care. We have talked about where care needs to go. We’ve talked about the different aspects of what pelvic PT

can do which is more than just you know your internal you know check of pelvic floor because if you really think about pelvic floor PT is kind of across the lifespan of having endo provider you’ll see a pelvic PT at at every new change new era right of your life and they should be able to I love your phrase of a kind of being in the canoe with the you know within the hallway that person should

travel with you, you know, through that journey because we don’t just magically get rid of endo, although excision surgery can do a darn good job, you know, these days. It’s only part of it, it’s not all of it. Yeah. So what would you, what suggestions would you have for women with endo who are experiencing, you know, just the frustration?

Amanda Olson (56:56)

That’s right.

Ginger Garner PT, DPT (57:11)

the fatigue at finding the providers that they want or feeling like they’re not being listened to. What advice do you have for them?

Amanda Olson (57:23)

Don’t give up first and foremost. What you deserve and what you need exists. And be checking, you know, if I can say them, Nancy’s Nook and some of the other end of endo project that has these lists of bedded providers who have given solid care to other people who are.

Ginger Garner PT, DPT (57:35)

Yeah, say them.

Amanda Olson (57:45)

very much like you were all unique in our presentation and in our needs from life and from our bodies. But there are providers who are going to listen and there are there’s already been so much work done to organize them. And then, you know, the Endometriosis Summit has phenomenal providers as well and education to empower you as well. And then getting keeping track of

different factors of flares and on a calendar, just trying to be as organized as possible with your personal data so that when you do get to that person, they can easily look at it. And what that might look like is I’ve noticed these foods seem to flare me up. I have noticed that in these days after my period, these are my pain symptoms, those kinds of things, so that it’s really easy to communicate with your provider because it is exhausting. So just trying to be as organized as possible with that.

Ginger Garner PT, DPT (58:40)

Yeah, I think that’s really good advice. And we will put those links that you mentioned, Amanda, in the show notes so that it’s easier for you to access them. I never want to forget at the end, speaking of links and resources and things like that, where can everyone find you and your products? I know you’re on Instagram, so kind of give us a rundown of where they can find you.

Amanda Olson (59:06)

Absolutely. On our website, IntimateRose.com, you will see the products and the tools, but also what I want to highlight is that under the resources tab, each product has its own guide with lots of different videos to help you. And on our blog, we have now hundreds of different topics and articles to help provide free education, step-by-step, how to use the wand, how to use the dilators. So our website is a really phenomenal resource.

On Instagram, I am at A. Olson, DPT, and then at Intimate Rose. And I have Substack now, which is Dr. Amanda Olson, DPT, PRPC. Yeah, I’ve been loving that actually. And then X, I don’t do as much on X, but I am there.

Ginger Garner PT, DPT (59:46)

Awesome.

Fantastic.

I actually

deleted my account. I did, I did. Yeah, so put it out there. Yeah, sometimes I think about narrowing down, you know, what I do more because then you can actually focus on your messaging where you are, you know, instead of feeling like you have to cover all the bases and…

Amanda Olson (1:00:01)

Did you? I would like to do that. That’s a goal I have someday. Yeah.

Ginger Garner PT, DPT (1:00:21)

Of course, we’re referring to platforms that don’t necessarily vibe with our core values. Obviously, if it doesn’t vibe with our core values, we’re not going to be on that platform. So fortunately, there are many different places that you can find Dr. Amanda Olson and all of her amazing stuff. And I love that you have all the resource, the guides, the blog, the videos.

Amanda Olson (1:00:32)

Right.

Yeah.

Ginger Garner PT, DPT (1:00:51)

It’s just amazing. And when I think back to 20 years ago, I’m like, wow, you know, we have come a long way, you know, even though 20 years seems like five minutes ago, lots has improved and lots has changed. And so we’re just so glad that you’re here today and doing what you do and persisting and sharing your story. So thank you so much.

Amanda Olson (1:01:14)

Thank you so much. appreciate everything that you do.