Our Clients Are Our Best Teachers: an OTP Evaluation

My guests for this epsiode are: Dana Soloman, Lisa Loveless, Carolinne Bradley and Jessica Ekberg. 
This is part of a 3 part series. Here's a link to the other episodes:

• Episode 1

Resources mentioned in this episode:

• Doug Vestal of Freedom of Practice.  His course to help OTPs start their private pay practice's is called, "Private Pay MBA."
• The first ever Trauma-Informed Pelvic Health Certification by Lindsey + Lara
• Pelvic OTPs United -- Lindsey's new off-line community!
• Get Lindsey's 9 page OTs Map to the World of Pelvic Health.
• Meet Lindsey on the OTs for Pelvic Health Facebook Group!

Bios of my Guests
Jessica Ekberg of the The Pelvic Connection
IG @jessekbergpelvicfloor
Facebook: The Pelvic Connection 

She has been an OT for 23 years, and have worked in almost every setting all over the country. She discovered Pelvic floor therapy through her own issues specifically after her daughter was born trying to get back to running and started getting plantar fasciitis, knee and low back pain. Ironically enough,  she has been peeing her pants since She was in her20’s.  She is now a proud former pants pee’er! However once she started my deep dive, she  fell in love with PFT, it made changes in me that she had not expected and the best part is that it is a whole body approach. She admits the field can be difficult to feel confident in a times but it’s just such a perfect fit for OT. She now has my own business which allows her to take a little more time to evaluate patients. She constantly learning and adapting her evaluations/sessions to meet the needs of her clients. 

 Lisa Loveless of Next Level Therapy 

Where to find her on social media:
Facebook
IG
Email: lisa@nextleveltherapy.net for 1:1 online mentoring.

She is the  cofounder of Next Level Therapy and, outside of our Medicare caseload, she

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Pelvic OTPs United - Lindsey's off-line interactive community for $39 a month!
Inside Pelvic OTPs United you'll find:​

• Weekly group mentoring calls with Lindsey. She's doing this exclusively inside this community. These aren't your boring old Zoom calls where she is a talking head. We interact, we coach, we learn from each other.
  ​
• Highly curated forums. The worst is when you post a question on FB just to have it drowned out with 10 other questions that follow it. So, she's got dedicated forums on different populations, different diagnosis, different topics (including business). Hop it, post your specific question, and get the expert advice you need.

More info here. Lindsey would love support you in this quiet corner off social media!

Transcript

Lindsey Vestal I feel so fortunate to welcome four O.T. practitioners to today's Autism Pelvic health podcast to talk about their evaluation process in their pelvic health practices. I'm joined by Lisa Loveless, Jessica Ekberg, Dana Soloman and Carolinne Bradley to have this conversation. It's part of a three part series. I will link to the other two conversations in the show notes where we also do a deep dive into other OTs evaluation processes. Here's a little bit about my guest today, but you can read their full bio in the show notes. Jessica Ekberg has been an OTA for 23 years and has worked in almost every setting all over the country. She discovered pelvic floor therapy after her own issues after giving birth. She is now a proud former pants peer. She started her deep dive and fell in love with pelvic floor therapy. It made changes in her. She would have never expected it. And the best part is that she loves the whole body approach. She has her own business, which allows her to take a little bit more time to evaluate patients. And she's constantly learning and adapting evaluations and sessions to meet the needs of her clients. Next up, Lisa Loveless. She's the co-founder of Next Level Therapy. And outside of her Medicare caseload, she's primarily a private pay outpatient practice established four and a half years ago with three practice locations. At their clinic, they treat all genders, and her client interventions are strongly manual based, while focusing holistically on every patient. In her free time, you can find her on her bike, lifting weights or training for a marathon, which every time she asks herself, Why am I doing this again? Our third panelist today is Carolinne Bradley, who's a lifelong learner and athletic trainer, a physical therapy assistant and an O.T., along with being a wife, mother and dog mom. She's been working as a health care provider for almost nine years now. Fun fact she ran collegiate track and field for four years and experienced pelvic floor related dysfunction while competing and later on in life having her first child. Pelvic health is not only enabled her to grow professionally, but also personally. And last, I welcome Dana Solomon, who came into Pelvic health after years of specializing in pediatrics. Like many new OTs emerging into Pelvic health, she's an OT pioneers graduate as well as one of the original pre-med graduates and later a Ta. She has found her solid ground in the field after coming across many closed doors and life transitions along the way. Today she's the owner of a private practice called Triangle Pelvic health and the founder of the Pelvic health Clubhouse, a home base for the busy pelvic health professional. She is passionate about elevating Ot's and Pelvic health and raising the standard for ourselves as professionals. Let's get into today's conversation. 

New and seasoned OTs are finding their calling in Pelvic health. After all, what's more ADL than sex, peeing and poop? So here's the question. What does it take to become a successful, fulfilled and thriving OT in Pelvic health? How do you go from beginner to seasons and everything in between? Those are the questions and this podcast will give you the answers. We are inspired, OTs. We are out of the box, OTs. We are Pelvic health OTs. I'm your host, Lindsey Vestal, and welcome to the OTs and Pelvic health Podcast. 

Lindsey Vestal Thank you so incredibly much. Jessica, Carolinne, Dana and Lisa for being a guest on the OTs for Pelvic health podcast. This is round two where we are talking about what our Pelvic health evaluation is like. So everyone is always super curious to kind of hear the tips and tricks and just really, quite frankly, the experience that we all have had in our treatment rooms to make the evaluation just an incredible process for our clients. So thank you so much for volunteering and raising your hands to be a part of this special second round of what a Pelvic health evaluation is like. I would love to kick it off with just kind of like a simple question where we all can get a better sense of each of you. So when you answer the questions, we kind of have a little bit of frame of reference of where you're coming from. So it's kind of a three parter and we'll kick it off with you, Jessica. And the question is, I'm just wondering how long you've been in Pelvic health, what setting you're in and what community makes up like 70% or more of your clientele. 

Jessica Ekberg First. Thank you for having me. I'm a little bit nervous, so. Okay. So I have been in Pelvic health for about three years. I have owned my own business. I started my own business about a little over a year ago, actually. Actually, this month was a year, but I was treating in a clinic for about a year before that. I. Most of my clientele is right now trending towards males and athletes. And I think that's just because of the groups that I've sort of been able to get into and I do and do not do insurance. So it's a little bit harder to market and get out there. But there was one more question in there. My location I do, though. I work in a I actually I work out of two locations. One is the office of I've worked here at a physical therapy office and I rent space. And then the other is more of a holistic type place. And I also have a spot, an office there. 

Lindsey Vestal I love that Jessica and I have got to do a quick shameless plug because you talked about being private pay. I was I was private pay for years in both New York City and Paris. And it's one of my favorite models I think we can show up the most authentically and really serve our clients. And I have to do a quick plug for my husband because he now 100% supports OTs, who do this. And his company's name is Freedom of Practice and his course is private pay.com excuse me, private pay MBA. And it is truly, truly the best move I've ever made as an entrepreneur, as a family. Jessica, thank you so much for being here. Carolinne, how long have you been in Pelvic health? What setting are you in and what communities make up? About 70% or more of your clientele. 

Carolinne Bradley Hello. So I have been in public health as an O.T. for a year, but I also worked more in the exercise portion of Pelvic health six months prior to that, and also kind of shadowing if it was an area that I wanted to dive into. Given my background, I kind of hopped around, but I've always worked outpatient settings. So I work outpatient. We're under the hospital system. And we're kind of our own entity, but we function under the umbrella of the hospital. I would say my the populations I see varies because we see anything and everyone. I would say currently 70% or more of my caseload have been more of those with bowel dysfunction. So but it can vary again, almost just time of year. And so it just depends honestly. But for the majority right now, I've seen more of those without this dysfunction. 

Lindsey Vestal I love that near and dear to my heart. My first job was also supporting colorectal and bowel issues. So thank you so much for being here. Excited to learn more. Dana, you're up. 

Dana Soloman Hi. So I've been in Pelvic health for about three and a half years and my journey is very diverse. I've done outpatient clinic in network. I've worked for somebody else's private practice and I have my own private practice. And I actually just recently relocated my private practice. So I'm a little unique in that way. And I actually see people virtually in office and in their home. So I have a little bit of some variety and to my practice and I find. So I've seen a little bit of everything. And I really love General Pelvic health, but I find before I left my new town, I was seeing pregnant a lot of pregnant and postpartum people as well as pain and chronic pain. And I'd say that those were like two big areas that I would see frequently here in my new town of Raleigh. I've been getting a lot of very, very new postpartum moms, like a week, two weeks postpartum, which is really cool and exciting. 

Lindsey Vestal Shout out to Riley. I went to undergrad there. I love that you're there, Dana. And I'm so glad you're here. Young Bring quite a quite a diverse perspective to our conversation today. Lisa Loveless, I'd love to hear from you. 

Lisa Loveless Hello. Thank you for having me. It's very exciting. I have been in Pelvic health for, I think well, three and a half years approaching my fourth year now. Pretty exciting. I do own private practice and we've been in business for four years. I have a coach I'm co-founding that. I have a business partner and what do I primarily serve? I would say I'm actually pretty evenly split between my male population, my pre and postpartum, and then my Perry and menopausal and someone. I think in your other podcast I said you kind of. Bring it, People come to you where you're at. And so I sort of I see a lot of that happening lately. So which tends to leads me toward that sort of menopausal population. So and then pain. I see lOTs of people with pain. So I'm also a cash based practice. Besides Medicare, we take Medicare. So yeah. 

Lindsey Vestal Awesome. I just a big thank you to all four of you. Thank you. Thank you for being here. We're excited about the conversation. So I know you all see if least you know of your 70% clientele, you're all seeing at least two different groups, which is awesome. So this next question, just kind of think about one of one of those groups, which I know can be hard, but we'll do our best. I'd love to know what is one topic that you hope to cover in your evaluation session with your clients? Like what is one burning, indispensable topic that you're like, I have got to get to this. This is this is quintessential for me. 

Jessica Ekberg For me, it is breathing. Intergovernmental pressure and the impact it has on the pelvic floor and just the location within the sort of piston know the container that is priority for me. 

Lindsey Vestal Thank you, Jessica. That's great. Carolinne, what about you? 

Carolinne Bradley I would say one area I always tend to want to address and I usually comes on an intake too, is just their emotional and mental health. It's one area I think, that opens up a lot of doors of conversation and even can lead into. Say what brought them to pelvic floor rehab. So I usually they might sit on intake that kind of warms them up for Okay interesting And then we kind of dig into that a little bit more. And it can also open up to, you know, what are some of their social supports, what's their environment? Usually if I bring up, where would you say you're at as far as stress levels go? It starts one way and then it kind of leads into, well, how do you manage that? And usually it starts to open up the door is more conversation of what's going on in their lives and and how we can work with them best and just build rapport. 

Lindsey Vestal I think the intake form is such a overlooked tool in terms of being able to communicate so much about our approach. You know, like on on our intake forms, it says like we take a whole person approach. So you know. I would apologize ahead of time for the lengthy, you know, questionnaires, but it really starts to let them know, you know, we think a little bit differently. These are the things that we prioritize. And it sounds like you're doing that with that mental wellness perspective. Carolinne That's awesome. Dana We'd love to hear from you. 

Dana Soloman I tend to overeducated. I get really excited about sharing all the topics with people, but I think that it when it comes to one thing, I really like to try to convey how connected everything is and that their symptoms may be in the pelvis, but there's typically a bigger lens. So I'm trying to introduce the idea that that we're trying to look bigger beyond this symptom and doing that and trying to create a sense of safety in the body. That's beautiful. Lisa I love that answer. And I, I concur with you. I my main thing is always to explain in a very manual based therapist. So I'm really trying to explain how one part is very much affected by the other and how our entire body we have to look holistically because like you said, Dana, it's not you may be seeing me because of pressure in your pelvis or bladder problems, but that's not where it starts. And we need to look at what your posture is doing and what's your neck doing and what's your abdomen doing. And so we want to start there. So trying to explain to them and kind of show them why what I'm trying to say visually so that that can make sense is something for them to take home and kind of think through and feel in their body. 

Lindsey Vestal That's amazing. So my next question is if you would do internal exams, what verbiage do you use to introduce it to your clients? 

Jessica Ekberg So into a, do you do internal work? And generally, based on how the feeling I get in the room with someone. Maybe 1% of the time. 2% of the time I do an intern on the first is a lot of people will come in thinking that they're going to get internal. And that's where that that big block is, I think. So I sort of get that out of the way in the beginning. And I just say, you know, because also when they signed my consent form, they signed consent for me to do internal work, maybe part of this. I also do a separate consent prior to doing any of it, but I sort of bring it up first and get it out of the way and just explain that internal is not necessary. There's so many techniques we can do and that you know. And we could we could pursue it. And most people would be like, okay, that's great. You know, Then you can sort of see that whole demeanor relax a little. And then what I've also found is that most people are very open to it, much quicker than they thought they would be afterwards. After you build that rapport and after you start talking and they get comfortable with you, that's the month that. That's for me. 

Lindsey Vestal Yeah, yeah, yeah. That's wonderful. Carolinne, what about you? What verbiage do you use to introduce it to your clients? 

Carolinne Bradley So typically I usually wait probably 10 or 15 minutes of the evaluation. Hours usually last about 45 minutes. But I like to lead in with initially, you know, have you had pelvic floor rehab before? Are you familiar with it? Sometimes it comes up right away in the beginning and they say, well, I know a little bit. And then I'm curious to know what they know about it. So I might address what the internal assessment involves then. But usually if it doesn't come up in any way earlier on, I'll usually bring up the consent form of the waiver that we have. And I explain this is for an internal pelvic floor assessment and I will use the pelvic model, kind of demonstrate how things would be set up. But I also say if knowing that they have choices when it comes, then the assessment itself. So I usually say you have the option to do an internal assessment and again, it can vary between populations of how we would address it badly or rectally. But I also give the option of despite, you know, you signing this consent form today, I will always ask visit after visit. And I also make it clear that we're not necessarily going to do an internal assessment or internal pelvic floor work every visit because I have found that with some clients that they think that's going to happen every time and they come in anxious. So I like to get that out of the way right at the start as far as how things typically go. But I try to be upfront with them as far as how it works, positioning the use of gloves and lubricant and all those types of things just so that they're fully aware. And I also say to throughout the process, I ask for constant feedback and I'll guide them through it. And I like the analogy I've heard where, you know, as far as assessing the pelvic floor, so say internal pelvic assessment is not right for them at that moment. Usually again, I'll talk about how we can do things externally and then I give them that choice and sometimes it comes up with, well, they'll say, what do you advise? What would be best for me? And then I'll say, Well, this could be helpful. But again, it's what you're comfortable with. So that's usually how I go about it. 

Lindsey Vestal So incredibly trauma informed. Carolinne I love that. I love that you ask, what do you know about it? You know, kind of coming in. We sometimes come in with a lot of preconceived notions and you're already like meeting them where they are and hopefully helping to let them know with a little bit more clarity, with the experience with you, it's going to be like, I'm a big fan of choices and giving a menu of choices. I love that you're doing that. I love the continual checking in and consent process because one time is not enough and certainly not on a form. And then lastly, I really love the way you're taking away the mystery of talking about the gloves and the lube and just really letting them. So I'm a big fan of informed consent versus just consent. So informed consent is more of that. Let's kind of break down in specifics what that experience is going to be like and have, you know, and actually visualize it. So you're doing that. I love that so much. Dana, what about you? If you do internal work, what verbiage do you use to introduce. 

Dana Soloman It to clients? Much of what Jessica and Caroline have talked about. So I do internal interactional and interact all work. I really start talking about it even in my discovery calls is if it's appropriate, I'll talk about the different intervention strategies that are options and possible. So and then it's also in my consent forms as well. And then in the actual evaluation, when someone comes in and talks when they first enter, I also will say, what brings you here today or what? I appreciate you filling out my paperwork but I'd love to hearing your own words. You know what brings you here today? And have you ever been to pelvic floor therapy before is something that I also ask. And then I kind of walk them through the rest of the process where I say we're going to spend a lot of time talking. We're going to get started on our hands on assessment. These are some of the things that our hands on assessment can look like. It can look like looking at your posture, at your breathing, at your abdomen. We may do a pelvic floor assessment today. We may not. And then I give them options into what a pelvic floor assessment may possibly look like. And I tell them that there's options. Or ways to doing it with wearing clothing to what an external assessment may look like, to what an internal assessment may look like, and that these are all options to opt in and not a requirement. So by the time that that happens that they you know, they say, okay, like by the time we're moving through the evaluation process and maybe it's even in the second session that we do discuss an internal or they consent to an internal, they really know what to expect. So I also go through the process of what what does an external assessment look like? What are we looking for? What what are my hands doing? What are they doing? Same thing with an internal assessment. I also talk about how there's no speculum, there's no tools. So I really try to walk them through step by step so that they know if they choose to go to to do that, that. They know what's happening. And then if they do choose to do an internal assessment, I make sure that it's very clear that, hey, you may say that you want this and that, but at any time, at any point, if you find that you are zoning out, that you are not really able to be present, that your body is telling you like, I'm really done with this. You don't even have to tell me why. You just have to say you're done. And we're we're complete with this because it's an option. So I just like to offer ways to opt out at any point in time. 

Lindsey Vestal Fantastic. Isn't it incredible how so much of this starts in the Discovery call? You know, really sort of already letting them know the perhaps the amount of education are going to be going into that They have options really empowering them. And I really have found, even in my own private practice, how much that tool alone of that discovery call can help you find that ideal client that is not only a fit for you, but really that you're a fit for them. And so you're definitely utilizing that. Dana Which sounds amazing, and I love the question, Have you been to it before? Because it really gives us a chance to also, you know, find out what preconceived notions or experiences they've had and give us a chance to kind of talk about potentially, potentially how it could be different, such as you letting them know that it's not a requirement and all of the other amazing trauma informed tools you're using there. Awesome. Awesome. Lisa, you're up with it. What's it like when the evaluation fragment regarding internal exam?

Lisa Loveless  So, you know, it starts really with the the intake form again and then me reading that and kind of seeing if I can get a really good feel of that person before they walk into my office. And I really want to know those details because just to get an idea, am I do I have somebody who is is very nervous to be here is does struggle with anxiety and depression. What are they struggling with? What did it take to get out of the house, to come into the into my office. And then reading when I see them, the reactions on the face, the tension that maybe they're holding in the body just kind of might change my approach, because you do have all sorts of people who are ready, like I want to do, do everything, do everything, you know, and then I have others that we have to take a completely different approach. And that's that's more often, right? It's a it's a scary place to be. So I'm acknowledging that it's a scary place to be here in this office. And so we're going to sit and we're going to talk. We're starting with just talking. And I want them to know that I've read their information by just kind of dropping some of that information here and there so that they understand that I'm I'm listening to them and I'm ready to listen. And so after going through and explaining how I feel the body works and I'm showing my anatomy app to kind of show the connection of the body. And depending what they're there for, there are some people and I have 90 minutes, I'm private practice, so I have 90 minutes with all of my my first assessments. And so I have the time. And if I feel that they would benefit, I'm I'm probably more often than not am doing an internal on that first visit. But I'm talking them through every step of the way. So I will say. So I think you would benefit from an internal assessment if you're comfortable with that. And let me explain to you what that is. And then we go through it and I say, and you do not have to this this is completely up to you. There are other ways we do not have to do this today. But in general, what I like to do with the internal assessment is I like to get a baseline of where you are and what is going on with your muscles and really with with your pelvic organs. And then we can use that. I can almost use it as a test in a retest so that I'm not it's not we're not going to spend our entire visit there. But it gives me an idea of where you're starting. But again, I'm going to talk you through every step of the way. And hopefully by that point we've built a rapport so that they're there. They're feeling safe in my space, and most often they're there. They're okay with that. And again, it's not that's perfectly fine. We we take our time and that's what we won't do today. 

Lindsey Vestal It's very clear, Lisa, just how important listening is to you and for your practice and you know how rare that is and many health care visits. And so I think that's another thing that you all are demonstrating so beautifully is like you're in a so a different place with me. I'm actually going to be listening to you. And in various ways you all have demonstrated the importance of that. And you know, what I love about that is the fact that when we give our client an experience of what listening can be like in health care, it gives them an opportunity to say, No thank you when they're not listened to, whether that's pelvic health and a future visit or that's with their primary care physician. You know, I think I said this in our in our last episode, but the average physician interrupts after. 11 seconds. And that doesn't leave a whole lot of time for listening, does it? Okay. This next one is kind of a quick one. I'd love to know approximately approximately what percentage of work are you doing that's education based versus hands on? 

Dana Soloman Can I ask one more thing about the other question? I just feel like it's really important to talk about some of the virtual work that I do that I actually lead people through their own internals if they want. And I have found that that is been incredibly like a game changer for some people to feel safe in their own bodies, that no one else is doing something to them, that they get to explore this on their terms has been such an amazing experience as they. And there's obviously boundaries that are created through like turning the camera off and turning the camera away. And they like, I can walk them through it through a session. But to have someone feel safe in their own bodies, to use their own hands to, to explore like what? What does tension feel like in my body has been such an incredible experience for my clients too. 

Lindsey Vestal Thank you for bringing that up. You know, I don't know that virtual work is talked about nearly enough, but you know, there's such a deficit of trained pelvic floor practitioners across the country that, you know, very often many of us were doing it before Covid, but certainly with Covid, that really picked up as much more of a standard practice. So I love, love hearing that, Dana. And I am curious, how much what percentage do you think of the clientele you're seeing is virtual versus that office or in-home structure that you talked about? 

Dana Soloman Well, because I recently moved, I would say probably 50% of the people that I see right now are virtual because so many people from my old town have wanted to come and continue working with me because they're already comfortable with me. And other people have found me through like other friends that understand that they're working virtually with me. So I'd say 50% of my caseload. 

Lindsey Vestal Fantastic. That's awesome. Great. Thank you so much for bringing that up. All right, Jessica, let's hear about the percentage of education versus hands on work in your sessions, approximately in the email. 

Jessica Ekberg I think everybody kind of touched upon I'm a total nerd when it comes to this. And I provide a lot of education. And I continually tell people I know this is an immense amount of education, and I don't expect that you'll remember it all. But I want I kind of want to connect the dots. And so I want to get through a few things so that you have a better understanding and always bringing it back to why they're there. But I think it's important that they understand all the other than connect the dots. So I would say I also am lucky enough to go to do 90 minute evaluations. So I would say four I would say is probably 5050. I think it's about 45 minutes, 30 minutes that they we do a lot of talking and I just pick up on how they're feeling. And you can think if you really listen, they tell you a lot of what they need, right? So you can tell if people really are open to hands on or that type of thing, or if more if they're just getting a more out of just talking and telling their story and being able to finally have somebody listen. So it's hard to say, but I would say 5050 and I because I like to do a lot of manual work, too. I think you get a lot back because I want them to leave. I guess my goal is always I want them to leave feeling a little lighter. Whether that means they were able to shed some of the stress or I was able to, you know, make their breathing a little easier or something like that. So probably 5050. 

Lindsey Vestal Beautiful. Caroline, what about you? 

Carolinne Bradley So I would say it varies from evaluation to the second visit. So evaluation, I would say 85% of it is purely education. And I want to get as much information from them. And I love handouts, so I might give them quite a few handouts to take home, read over and then come and visit. We can talk more about it if they have any more questions and kind of expand on. And usually that sparks some more conversation of, you know, you mentioned this and I wanted to bring this up so I can add to just the rapport that we build and what we're looking to to gain overall. And then I'd say following the evaluation, it varies by patient. Some, I will say are more inquisitive, they'll ask more questions. And so I might know that one individual I might spend 15 to 20 minutes of a 45 minute treatment session discussing things and then some others. There might be more of a hands on. So I would say at least 50% is probably education. And then it can just vary again by person to. 

Lindsey Vestal I love that. Dana, what about you? 

Dana Soloman I'd say between 50 to 60% of my evaluation is education and rapport developing. And then that other 40% percent that I'm assessing, I'm also trying to sneak in that like teaching how to be the detective of like, did you notice this or this is what I'm seeing. What does that feel like for you? So even though it's it's hands on, I'm still trying to create moments of education, even throughout the hands on assessment. I've also found that over time I do emphasize education of pelvic health, but I want to try to make it clear and concise so that someone just doesn't leave. Just being like, what happened in that last hour? I have no idea. So I like to try to keep things, you know, I'll listen to them and then I'll pick a couple topics that I feel like, okay, what can they take away? And then I also try to I also do hand out, so I'll always send out either 2 or 3 handouts or a couple of little like short videos that they can then watch on their own because people learn in different ways. And I know that if I was told to take all that information in, in 60 minutes, that I would leave being really overwhelmed. Yeah. 

Lindsey Vestal Yeah. Excellent points. Excellent points. Lisa, what about you? 

Lisa Loveless I would say honestly, I think it's 5050 because I, I, I do a lot of manual work. And like Jessica said, I do, I want them to feel better when they walk out something. And also with the visceral work or factual work, you want that to build up over time. You want, you know, we're going to get better benefits and then second session in the third session. So I do want to get something started. And so I've also learned I have to rein myself in because I could get I get so excited about the body. I just get so for real. But, you know, they all get to start out this mean maybe, you know, or they laugh at me. But you know I can't give them everything, right? Because they're going to walk away. my gosh. She's Grace. So yeah. So I try to rein myself in a bend a bit. And I do. I want them to walk out feeling better, or at least than feeling that I get this. And I know the next time I come, I'm going to feel even better and I want to get there by it, I guess. 

Jessica Ekberg And Lindsay, one other thing I just wanted to add. I think that helps people. I make a video for everybody after they're done, so I do a specific one to them. It goes over everything we went over. It's I mean, and for the most part, it ends up being sort of the same video for everybody, but with tweaks to make it a little bit more personal. And I think when I tell them, I don't want you to worry, I'm going to send you a video of all this stuff and it's going to sort of put it all together a little more concise. And I think I often see people go, okay. And then you can see their brain relax a little. So I think that's helpful 100%. 

Dana Soloman I did I think I wanted to say I have a whiteboard in my in my office space there and as because I do some videos that I'll send or I'll take videos of them. But what I found is that sometimes even I can't remember what we've gone over, you know. And so and then I go right into the next patient. So I have this whiteboard and I'll jot things down for them and me as we're in there, whether it's their homework assignments, whether it's some education pieces, they can take a picture of it and walk right out. I can take a picture of it. And then when I go to write it all down later, I've got it as a reference. I found it to be my most useful tool lately because my brain was running out of space. 

Lindsey Vestal I love that. And so these are like exactly those gems that are so indispensable that we get for pelvic floor of the Ottps in the room and we can just like go, Right, okay. All right. Whiteboard. Like I'm on that. I was recently talking with Meghan Casper, who was on the first the first eval podcast that we had, and she shared with me offline that she will take a video of her client doing the exercise on their phone. So it really does cut back on time for her. And the client leaves hearing her cuz watching their own body, seeing her hands shift, you know, the rib cage. So it's like already like I love these efficient means of transfer that the client knows they're walking out with it because I can't tell you how many clients who have gone to previous pelvic floor therapist who will say, Yeah, I never got my homework or, you know, they didn't follow up with this. It's like, well, this is guaranteed. And just like Jessica said, like the amount of pressure that's relieved because they know they're walking away. They want to be good students. They want to know what that homework is. And with that picture on the whiteboard or what Megan Casper is doing, we've got him covered. So how beautiful is that? All right. I'd love to know. Next, like what assessments or tests are you doing in your evaluations? 

Jessica Ekberg This is a tough one. I listen to the podcast from from the other day and I was trying to think of I think it's just so different because I see such a wide variety of people and I always do a sort of basic movement screen seeing, you know, single leg stands, toe touch, squats, those type of thing. Just just to get an idea of how they move. Also, if they're aware of how their body moves, you know, how they pick something up from the floor. Other assessments. Goodness. You might have to come back to me on that one, I think. I mean, I don't do a lot of formal assessments. I just kind of take everything in. I do a lot of put on, I think, emotional psychological type questions. But they're more I think Dana made a reference to just sort of sneaking them in there. You know, it's kind of like letting them go and then kind of asking them to elaborate on things or I sort of have a reason for asking. There's a method to my madness. So and I I'm really good at or it's how I've learned is just going with the flow. As when I first started, I tried to make a plan and it never went according to plan and my brain got confused. So I now sort of implement little pieces and I try to do at least 2 or 3 like test retest things like what possession causes pain and then retested at the end or something like that. But it's one of the great things about having to deal with insurance and have to do tests. So that's my best answer. 

Lindsey Vestal I was going to say, Jessica, all the best answer is your answer on this. This is not meant to be a trick question. And honestly, what I love about this conversation is, you know, I support new O.T. so I have O.T. pioneers, which is that foundational introductory course. And a lot of my students leave that course really wanting to have the playbook on the precision of what assessments, what you know, what order them. And we all crave that when we're new at something. And so what I love about this conversation is, you know, here you are owning your own business, private practice, and you are you know, you have this is not a formal process for you. And that's beautiful. I want I want our listeners to see the gamut of what's possible and what we're all doing, and it's fantastic. So thank you for that. That was that was a great answer. Carolinne, what about you? 

Carolinne Bradley So I would say it's, you know, patient dependent depending on what they're coming in for. So if they're postpartum versus post-surgical, whether it be, you know, bowel dysfunction, bladder dysfunction. But typically, I always do a kind of a functional movement screen that could be doing a squat, single leg squat, and then going through just lumbar active range of motion. Can they touch their toes? Can they rotate, Can they extend? Can they side bend? And then I might do the start test or assess Hauser as I joint moving or how is it not how are they able to weight shift be between left and right side and vice versa and how they load their pelvis. So usually I try to get to those. And again, if, say, there's someone postpartum, I might do like a dry assessment or, you know, doing different movements specific to where they're at in their journey. So those are usually my baseline. I try to get to same with, say, assessing their rib mobility and things like that. And while they're doing these, I'll also kind of look at their breathing typically, too, in their posture. So yeah, kind of looping everything in. But like Jessica said, it's almost like improv. So when you're there in the moment saying, you know what, now that you say this, I probably should assess this as well. Or if they had like a prior diagnosis of something or say they had a total knee replacement, you know, five years ago and just I might look at something a little bit closer because of that. So it just depends on, you know, what they come in with, what they report and then kind of going from there. 

Jessica Ekberg I just want to add real quick to I think that's part of where that imposter syndrome comes from, at least for me. You're you're I think for so long we've to do like an essay. Join us. And it sounds so scary right S.I. joints and and the lumbar spine and because for me I can oftentimes and most of us we can see what's wrong but putting a name in the medical terminology, you know, I think is very scary as a know because we don't have we're we're told off and we don't have that background. And I think we have a lot more than we think. But we overthink because we can't put the names and the insertions and the muscle origin, all these things. Again, I have really just learned and made my own assessments. And the more people I see, the more it's like, now I see. Because you're looking, you know, an S.I. joint moves, but it's not doesn't move a lot like an arm. You know, it's like you're looking for these little things that you don't get trained on. So just in Carolinne talking, I just I could almost feel it, too, in my in my chest being like, like because those are scary concepts. So I would just offer that. Don't be scared of those things. Yeah. As an O.T. because you can do well. 

Lindsey Vestal And that's beautiful. Jessica And I really appreciate you saying that. And I think what I also hear you saying is that our clients are our best teachers. You have really developed your protocol or what you do in that evaluation in terms of the assessments and tests based on the person that's in front of you. And guess what? It's working. It's working. Awesome. Dana, we'd love to hear from you. 

Dana Soloman It it resonates with me to hear you talk about how new coaches in Pelvic health want a playbook. Because when I first started, I desperately just wanted first do this and then do this, then do this. But definitely don't do this. Right. We all want that like very strict guideline and there is none. It's very much an art that you pick up nuances as you go. And when you go to these new courses, you pick up these new tools and then you lean into them for a little while and then it starts to just get integrated into your stuff and you use things that you find that you use a lot and then it becomes part of your practice. So I guess like I want to talk about what I do, but I feel like it's worth saying that. The more you learn, the more you're going to use and pick up in the things that you lean into. You'll feel more confident doing. So that's why just practicing assessments and practicing is so important, so that you feel good being able to say, I know I see this happening and I want to test for this. When I work with people, I'll always look at breathing and posture. I would say that those are the two go to is no matter what. If I can get to a hip assessment, great. If I don't on that first session, I'm leaving it alone. I'm not like I used to stress out about trying to like get to everything. And there's I'm assessing for probably three sessions. I don't care if I have a 90 minute evaluation or a 60 minute evaluation or a 40 minute evaluation. It takes me three sessions to really assess everything. So letting go of needing to do it all in the first session and just taking your time with even just a couple things is so much better and allow someone to feel so much calmer and safer than trying to do it all at once. So if you can get to posture and breathing, you're good. Beyond that in a while I'm looking at posture. Sure, I'll have them do a standing leg assessment. I'll have them bend over and try to touch their toes because that's something you can kind of do really quickly. I'm also looking at the way they're sitting. So posture isn't just when you're standing up, you're looking at them when they're sitting and they're talking to you. Do you like how And it's actually nicer when they don't think they're being assessed because then you really see how they're sitting and when they're standing just by walking up from when they're greeting you at the door, then you're really seeing how they're standing versus when you're like, okay, let's do a standing assessment. So those are just little things that I'll pick up and they're not overly formal. And then from those things, then that guides my next. So then I wonder, okay, I wonder. I'm watching the shallow breathing pattern. I really want to look at their rib mobility. I like to do abdominal assessments. I do a lot of listening at the abdomen as well. And that's where some but that's when you can kind of play into like, am I assessing in my treating? So it really starts to guide and inform and it becomes more of a listening to your inner guide. Then following this very rigid playbook. 

Lindsey Vestal That was beautiful. Dana I think my neck hurts from how much I was looking enthusiasticly nodding. And I think what you said about the assessment, you know, not being formal, I think that's one of the things I love the most about my house calls in New York City was, you know, really seeing them in their own environment was such a spectacular way to get an insight to their roles, habits and routines because you're witnessing them there. They're not they're not in a new space. Right. With with a different chair and fluorescent lighting. Lighting. And also kudos to you for doing it for three sessions would probably take closer to five. I mean, it's like you know, it's this evolving process. And I, I think all that to say, is it five? Is it three? The point is, is like this expectation that the email is supposed to be done in the first session is like such. It's such a myth that I just want to bust right now. It's it's all evaluation, it's all treatment, it's all continuous. The more we get to know them, the more the more we learn. So that's wonderful. All right, Lisa, we'd love to hear from you. 

Lisa Loveless I was just going to add, I was going to bounce off of what you were saying, Lindsay, where like, I think that telling the client to that we're putting on our detectives hats for the next few sessions and we're really going to find what's going on here so that they don't feel like, we're supposed to have everything figured out in one session, that there's there's a process to this. And I'm being guided and I get to be a part of this process, too. 

Lindsey Vestal Yeah. Excellent points bringing them along for the ride. Right? So we may know that in our head, but taking a moment to communicate that to the client makes makes all the difference. All right, Lisa. 

Dana Soloman Okay. Jump ahead for a second because just to piggyback off, what you guys said is every session is an assessment. It will every session, even the last one, the middle one, because we are going to make changes in the body and they're going to go home and they may come back. And now we have something new that needs to be addressed because it's the body, again, as we know, is connected. So I may be working around your bladder or your cecum and you're going to come in and now I got to be looking around your ribs and your liver. So it's it's all connected. And so you're right. Every session is an assessment. So to back up now, my intake form the only formal assessment. So all those awesome theory based OTs who are fantastic. All I have that's formal is the pelvic floor disability index in my intake form and I don't even go back to it at the end. I but I use it to base kind of where they're starting. It's just a great place for me to start my questions. What I did learned and I, I feel you, Jessica when I started into pelvic health and my business, my copartner, my business partner is a p t and I and I sure we had this discussion back in the day. Lindsay was I'm trying to learn how to do this and I'm watching this party and she's here's how are you? Here's how you assess. And I couldn't grasp and I couldn't get it if you really drove me a little movie like, I can't this isn't making sense to me. And so as I treated more bodies and saw more bodies, I became me and they and and and so I'm going to tell you what me what me looks like because maybe it will help somebody else. But and so when they walk in my door and and when we start our movement assessment, when I'm looking at the ribs, I'm asking them to breathe into the front, into the side, into the back. And we do that a couple of times so they understand what I'm saying and then all together. And that leads me to, okay, maybe there isn't a restriction around the liver or what's going on in the back that we can't extend posteriorly, right? So that's my start. Now when they bend over that, that's a that's a pretty basic kind of movement assessment. But now I'm going to have them sit and I'm going to look at thoracic mobility and that hip is rising. Well, that's interesting. I should go there a little bit more. And I don't have the right terminology and I'm not going to even document it beautifully. I'm just going to say that your height, when you know it doesn't have to be perfect in my world with cash base. And then I'm going to look at how let's raise your arm up. Right. And and what happened with the ribs. There are turn your head and my hair are shoulder height. So something's going on here. I need to look around the PEC or the scapula. So I'm just I'm. I'm a detective inspecting the body and just watching it move. And it has. It can be as simple as that. It doesn't have to be scary, right, when you watch them walk. Well, that's interesting that that foot's pointed inward. That's another area for me to look at what's going on with that hip in the performance. So I'm just I just kind of just made it down to my own simple self that works, you know, And every patient is different and everybody's different. So then it leads you to different, different places to look. Does that make sense? 

Lindsey Vestal It absolutely does. And that is just so liberating and empowering. And we really appreciate you taking us on that journey when you are just like, I'm banging my head against the wall. I'm not sure what I'm supposed to do and I'm not getting it. And what I heard from your story, Lisa, is that through working with clients, you were really able to develop a rhythm that was unique for you, that gave you confidence and that you now can replicate into the client in front of you. And so that's just such a beautiful reminder, especially for any new therapist out there listening to us, you know, just keep seeing clients because that is really how we learn best and are able to to develop the skills that we're so craving, which we wish we could have. Is there anything else that any one of you would like to mention before we conclude our podcast today? Any any information about the evaluation that either other people's comments or my questions prompted you to speak about? Or just like anything else, when you think about your evaluation, like, I really want this person to know this.

Carolinne Bradley I will. I will say I just had a quick comment to just the last discussion. So being newer to the public health field, there is this feeling of having to get through so much. Part of it is insurance reasons. So like authorization forms, you have to list, you know, what assessment what they score looking at their pelvis is. Her pelvic floor contracting, is it unable to relax? So I feel I start to realize early on that I can't get through all of these things in the beginning, as much as I'd like to, you know, I cannot. And it is over multiple sessions and I think that's something I learned within the first few weeks. I'm like, okay, this is not realistic for me to try to get through X, Y, and Z. And and it also depends on the patient. Some that have a lot to share. And you want to hear everything they have to say. And you're actively listening. You're not trying to disrupt them. You're not trying to cut them off. You want to build that report and especially first visit. And so I start to realize that evaluation can look different between each person. Some are very, you know, to the point give you a single answers, and then some have a good amount to share. And it's great because it gives you a lot of background and sometimes you don't have to ask certain questions. So I will say I think that was a big learning point for myself is not feeling the pressure to try to do everything and and give everything because it's not possible in 45 minutes. So and especially if they're still doing paperwork or they come late. And so you're trying to accommodate and do everything you can. And I usually will say up front, All right, So we have such amount of time. I want to get to know as much from you as I can. And then I just tell myself that I don't need to add any extra pressure of the time limitations and trying to fit so much like, yes, insurance is going to ask for X, Y and Z, but you kind of can assess that while you go. And as Dana said, with posture, right, as they're sitting or when they stand up or things like that, you can kind of gauge and understand in that way, too, so. 

Lindsey Vestal One of the things that I love the best about this particular panel is we're really a mix between taking insurance and not so really getting the smorgasbord of the perspectives is that has been awesome. Does anyone have anything else that they want to mention? 

Jessica Ekberg I just wanted to add that always remember the patient has no idea what you don't know. Right? And I think one of the amazing things for us as OTs is we're pretty good chameleons and we think we're really good. You know, we have a big heavy psych background, right? And anybody that's coming in and it doesn't have to be traumatic, but anybody that's coming in is coming in because they can't do something that they really love to do. Right? Generally because for most people, they they don't realize what their pelvic floor kind of does or leads to. So they've waited a long time. And so by the time they come to you, they're really upset because they're something they can't do and they kind of get it off their chest and we just sort of adapt and go with it. And I think that, like Dana said, the breathing and the posture. Yeah, like it opens people's eyes when you just can get them going there. And almost I've found in my evaluations, the more I say I'm proud of myself because I recognize it. And I'm like, Well, I recognize that. But they're just kind of look at you like, like they don't care, right? They want to feel something different. They want to feel your energy and getting them to buy in. I mean, you can go look anything up, right? So really be present. I would recommend get, you know, get them to feel their body to understand what you're trying in 1 or 2 things they feel in their body. That's their moment. And then you have time after to pull it all together. But I think it's really important that when you're talking about bowel bladder, sexual habits, I mean, these aren't things people talk about, so usually they don't want to look in the eye, usually don't want to say the word penis or the vagina very much, right? So once you kind of have them in, they're going to come back because they don't want to have to retell the story over and over. And so let them let them talk. And they're going to be like, walk. They're already going to walk out. Most of my clients walk out 20% better just after having talked right there. They feel like somebody believes in them. Somebody wants to help and is going to. And then you can after that, you can go figure things out. But don't don't be stressed. And you know, way more than you think you do. I promise. 

Lindsey Vestal I love that spot on. Spot on. Anyone else have anything they want to mention about their email process?

Lisa Loveless I just. Sorry. Yeah. To think two things I wanted to say. Number one is keeping yourself grounded. When? Because they're. They're bringing everything to you. A lot of heaviness or their stress or their anxieties. And you've got one after another. You have to keep yourself grounded so that you can be present for them and then the next person. And so finding ways to do that, whether you're tying yourself to the ground or protecting yourself with the bubble or some way or cleansing yourself between just you have to find ways to do that so that you can be your best again and again. And then the other thing is remembering to meet your patient where they are. Because if you find out where they are, because you send them out the door with too much homework to do or too much exercise, too much studying to do, it sets them up for maybe another failure to them to what feels like a failure. So find out where they are and if it is just to go home and breathe. That is your homework. Great. And they they feel success and there's benefit to it. So just making sure because that's, I think another way to create success and then get them back to you so that you can continue to help them. 

Lindsey Vestal Excellent points. You're right, because we do we want them to come back. Right. So it is about that continuity of care. So excellent excellent points there, Lisa. Well, my goodness. Thank you so much, all four of you, for taking the time. You dropped so many wisdom bombs on all of us that we're just going to continue to think about and implement in our own practices. So really, really grateful for all of your time. 

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