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Pelvic OTPs United -- Lindsey's off-line interactive community for $39 a month!
Inside Pelvic OTPs United you'll find:
...
____________________________________________________________________________________________
Pelvic OTPs United -- Lindsey's off-line interactive community for $39 a month!
Inside Pelvic OTPs United you'll find:
...
When I was seeing clients in New York City with my company, the Functional Pelvis, I was the first occupational therapist to have a private practice in the city. And I didn't take this lightly. And when I started the practice, I was beginning to formulate ideas around what made OT different, how was the experience different for the client when they saw me versus when they saw someone else. And to be completely honest, I don't know that I always had a clear vision of that in the beginning. I saw things through the lens that my bio psychosocial approach gave me from schooling and from synthesis of experience that I had, why I wanted healthcare, how I wanted healthcare to be different, what I envisioned for my client. But honestly, it wasn't until I went through the trial and error of seeing clients that this became clearer and clearer for me because the patterns that emerged enabled me to create with better clarity and almost gave me the ethics or the, the tenants in which I envisioned with real clarity how OT was different.
(02:05)
And I'm gonna share with you a story today and how I changed things based on the stories that I saw over and over again. So very often I would have clients come to me, especially in the postnatal period. I saw mainly postnatal people in my private practice who would say, you know, I am coming to you because I've been to another therapist and you know, this pain is layering, lingering, the discomfort is happening. I'm leaking urine. And the work I did with them didn't change that. And so I'm coming here because I want an internal exam. I wanna find out the missing piece. And what I saw over and over again is that when I would would say to them whether or not they told me right away that they wanted that internal exam, I would say to them, okay, so you know, after I did my education and we talked about the role of the pelvic floor, I would say, okay, we're at the point in the session now where we can do an internal exam or we don't have to do that today.
(03:21)
There's so many other ways that we can get information. And most of my clients were a bit on the type A side of things. They were very, very driven, ambitious people. And they're like, Nope, internal exam. Like that's what either I was told, that's what I need by my last practitioner. Or if they hadn't been to anyone else for this, they would immediately interpret that the internal exam was the gold standard. And I think it had to do with the way that I set it up, the way that I said, well, we can do an internal exam, but we, there's so many other ways we can get information. And so I started to change my language because I wanted to see my client's response to this. Was I actually setting it up for them that there was a better option and an okay option? And they were almost being forced into the internal exam option because of course they wanted to get the option that gave them the most information or that helped them the best.
(04:25)
So I started experimenting, right? I didn't have any other OT to turn to, uh, you know, all my pt, all my mentors were PTs at this point. And you know, this was over a decade ago, so there just wasn't a lot of talk about consent and trauma informed care. And so I started experimenting and I'm gonna share with you now what I started doing. And I started asking more often if it was okay that I did something. And I told them right off the bat, by the way, this is gonna be really redundant. You're gonna hear me about a billion times today, ask you if things are okay. And that's because I wanna make sure that they are. So then I would say, is it okay if I give you the options now about what the exam could look like? And I never say, this is what I typically do, or this is what I normally do.
(05:22)
I wondered if I had presented it like something was typical or normal. It unconsciously pressured the client to feel like, well, I wanna do what's typical. I wanna do what's normal. And so if I didn't present it that any one of these options were better than the other, I felt like I was giving a client a true chance to choose what their nervous system needed at that time. So how did I do that? Well, I simply said, you know, after saying, is it okay if I, if we chat now about what an exam could possibly look like, I then would explain to them that we have a couple of options forgetting the information about what your muscles are doing and here's what they are. Number one is an internal exam. In this exam, I'm gonna look at your breathing. We've already chatted about the fact that breathing is such an instrumental part of your core and pelvic floor.
(06:21)
It's kind of the top part of that canister. Uh, you know, they're, they're the pelvic floor and the diaphragm look like parenthesis of one another and they move together. So by doing an internal exam where I look at your breathing, I'll have a chance to see how your muscles are contracting, how they're relaxing. And this can totally be done with your clothes on or off. Another option is that you can disrobe from the waist down. I can take a look at the muscles right around your vaginal opening. And we're gonna look at what happens when you breathe, when you bear down, what happens, what, what does it look like when you do a Kegel? And I'm gonna check to make sure that you're coordinated not only within the muscle movement itself, but with the, within the larger system of your core, your abdominal muscles, your respiratory diaphragm, all that stuff that we talked about when you first walked into my office.
(07:21)
Now yet another option would be to do an internal exam. Now I don't use a speculum. Uh, it's not like your, your typical gynecology exam. I'm just going to use a gloved finger and you're gonna feel my finger at your vaginal opening. I'm going to check with the strength of your muscles are, I'm gonna check the coordination. I'm going to check your ability to relax, right? I'm gonna check your endurance. And in all three of these exams, we're going to get the information that's go, we're gonna be able to put together so that you can meet the goals that you came to see me for. Do any of these sound like an exam that you are open to today? And then they would reply, they would often ask me some questions. They would say, you know what I, I'm really thinking this one. Right? Then I say to them, is there any part of the of this exam that's not gonna work for you today?
(08:18)
Right? So then we're starting to personalize the experience. So I gave them the options, but then we have the ability to customize it even more for that client. What is gonna put them at ease? What are they the most comfortable with? People in general are not used to being asked what they prefer. I feel like we're socialized to basically put up with, especially in medical situations, with whatever the authority figure is presenting, right? And my hope with letting this client know and empowering them with agency over what felt right for their body, that they would start to expect more of this in other aspects of their life. This could be with their partner, this could be with their children, with their friends, with other medical providers. So that was my approach. And as I started to do this more and more, I found that opening up the conversation and reminding the client that they had a choice was the singular most powerful thing that I could do in their pelvic floor exam.
(09:36)
And in their evaluation they realized that there wasn't one right way. And this also set the stage for the continuity of care, right? That there was never one right answer or one right solution. There was only their right solution and their right approach. Over the years, the longer that I practiced this, I really started to see that you could give the best evidence-based care. You could do things exactly like you were taught, right? But if we're missing the relationship side of things or the trauma informed side of things, we're missing a huge opportunity to empower our clients. Not only right there in the moment in that session, but in their life. The ripple effect to feeling this agency, to being able to speak up for what you really need is incredibly powerful. And it's my innate belief that as occupational therapists, when we start to practice this way and when we start to enable our clients to see how they can truly be an agent in their own life, the nervous system really starts to take a pause and to actually start breathing for the first time.
(11:03)
Because so many of the clients I saw, I felt like they were navigating a world of things being done to them and that they didn't have a choice in that. And so this ripple effect is incredibly powerful and soothing. And I started to see that by providing an ability to have an agency in their own life, starting with healthcare and and rippling on that I was actually affecting and impacting their pelvic floor without even putting a hand on them. And this really set me down a path of discovering alternate ways to treat pelvic floor clients that didn't always involve a hands-on approach. Now this is the start of a much deeper conversation. This is a short podcast because I wanted to have it to be around specifically how we're talking about the exam portion of the part of our work with clients. But you're going to hear a lot more from me on this topic cuz it's one I'm incredibly passionate about. And I'm so passionate about it that my good colleague and friend and fellow OT Laura DeRosier and I are creating the very first trauma informed pelvic health practitioner certificate. And this is going to be available this year in 2023. And if you'd like to learn more about this incredibly supportive six month long process that does culminate in an in-person experience in the show notes, you will see information on how to get on the communication list to learn more about this approach and this very OT lens to pelvic floor therapy.
Lindsey (12:52):
Thanks for listening to another episode of OTs in Pelvic Health. If you haven't already, hop onto Facebook and join my group OTs for Pelvic Health, where we have thousands of OTs at all stages of their pelvic health career journey. This is such an incredibly supportive community where I go live each and every week. If you love this episode, please take a screenshot of this episode on your phone and post it to ig, Facebook, wherever you post your stuff. And be sure to tag me and let me know why you like this episode. This will help me to create in the future what you wanna hear more of. Thanks again for listening to the OTs and PE Health podcast.