From Clinic to Research: Bridging the Gap in Pelvic Health

• Learn more about Level 1 Functional Pelvic Health Practitioner program
• Get certified in pelvic health from the OT lens here
• Grab your free AOTA approved Pelvic Health CEU course here.

Learn More About My Guest Here:

https://totalpelvichealth.ca/

____________________________________________________________________________________________
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: New and seasoned OTs are finding their calling in pelvic health. After all, what's more ADL than sex, peeing, and poop? But 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 seasoned 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, Lindsay Vestal, and welcome to the OTs in Pelvic Health podcast. 

My guest today is the amazing MJ Forge. You may know her because she is the brilliant artist behind the anatomical pelvic models that are laminated and foldable and have velcro on it. She is the owner of Total Pelvic Health and I have been using her portable laminated pelvises since 2016, maybe even 2015.The moment I found them, it was a game changer for my concierge travel private practice in New York City. By the way, I will link to her company in the show notes. MJ has graciously given us a 10% discount if you buy the pelvis and use the code OTpioneer. Now, MJ doesn't just create beautiful pelvises. She also graduated from the University of Ottawa in 1995 and began taking pelvic health courses in 1997. She opened a private practice in Northern Ontario in 1997 that offered both orthopedic and pelvic health services back when there was very little pelvic health services being provided.She started teaching for Pelvic Health Solutions in 2012 and she teaches a continence prolapse and pelvic pain conditions course as well as a pregnancy PGP course. Now, the world of pelvic health therapy is quite small and she was asked if she was interested in participating in a pelvic health research through some colleagues, none other than Carolyn Van Dyken and Shanae Dufour. She then went on to get involved in two different projects and we're going to talk about them both today. MJ is just incredibly warm and incredibly generous and I cannot wait for you to hear today's conversation.

Lindsey:
MJ, I am definitely fangirling right now. I have been dying to get you on the OTs for Pelvic Health podcast for so many reasons. So without further ado, I just want to thank you so much for setting aside this time with me today to chat about your role as a clinician in research, the impact you've had on our field in general, and this conversation is going to be amazing. So thank you so much for making the time. 

MJ:

Well, thank you for having me. I'm always happy to chat about all things pelvic health, and who knew that I'd be chatting about a topic like research? If you would have asked me that 30 years ago, I probably would have said, no, I'm not going to do anything research, and yet here we are talking about research.

Lindsey:
Well, I think research is an incredibly important topic in our field, and I'm excited because from what I know about your contribution, you describe yourself as just a regular physio. You do not have a PhD. I think you told me before we started recording that statistics hasn't really been a thing for you, if I'm not mistaken, right?

MJ:
Not my first love, not my strength, and probably the main reason why maybe I never would have entertained the thought of doing a PhD is a bit of that daunting of all things statistics.

Lindsey:
That's why I'm really excited because we know there's such a gap between research and clinicians, but yet we really could be each other's best friends and move so many things forward that we're all passionate about. So I'm excited to get into that. I also do want to just thank you for creating the portable laminated pelvic health models that you have. I personally have been using them since 2014, 2015. When you first came out with them, they were a game changer for my practice because I did house calls in New York City, and so I always had my big book bag with my very large clunky pelvis in it, and when I knew I could present such beautiful portable artwork that still helped our clients understand their pelvic floor, it blew me away. So on behalf of clinicians everywhere, you've saved our back, you've made the topic so much more accessible, and it's something I can't tout enough. So I need to give a nod to you on that before we get started with our conversation today. 

MJ:
Thank you.I'm so grateful to all of you, all of you that have highlighted my pelvic models all over the world. I'm immensely grateful because, again, it's a labor of love. Anatomy drawings was basically my way of learning, and because I'm a visual learner, so I was that PT student that drew all her images in school, and to think that it's being used all over the world to help educate not only PTs, OTs, but also our clients, our patients, really is mind-boggling to me.I'm very, very grateful to all of you and to you as well for highlighting my models and making them the success that they are today. Thank you so much. That's so cool.

Lindsey: 

I love imagining you drawing in PT school. So, MJ, can you tell us a little bit—I've already read your bio, so we have a little bit of sense of your background, but give us what we're not reading in the bio. Tell us a little bit more about your background and how you first got involved in pelvic health research as a clinician.

MJ:

So I've been a PT now for 30 years and doing pelvic health for about 27 of that. When I started teaching with Pelvic Health Solutions, that was about 2012. We're a teaching company in Canada that teaches pelvic health courses to PTs, and that's kind of when the world of research kind of opened up because we had some students who were PhDs who got into the world of pelvic health. There are people who've done PhDs in other subjects who took our courses and said, oh, there's a lot of value to doing more research in pelvic health because, again, it's lacking. And so as one of the instructors with Pelvic Health Solutions, we were asked to participate in that first kind of research, the one about low back pain and pelvic floor dysfunction. So that's kind of how it started. So it was just kind of, you know, are you interested in helping? So Sinead DeFore was the lead for that research. She has a PhD here in Canada, very well known for a lot of her research in pelvic vertebral pain and pregnancy. So she reached out to Carolyn Van Dyken, myself, and Allie Fegani to participate in low back pain research. So that was the beginning, and it was my first kind of foray into research as a clinician, which was fantastic.

Lindsey:
Thank you. I'm blown away with that. I mean, these are the work that both Carolyn Van Dyken and Sinead DeFore are doing. I mean, you guys are changing the landscape of pelvic health. You're really highlighting incredibly important topics and finally giving us a chance to practice in an evidence-based way that perhaps we've all kind of come to intuitively. So that's phenomenal.

Tell us a little bit about your role in the research process. As we said, you don't have a Ph.D. Obviously, you're in great company there in Canada with some of these people that you've mentioned. MJ, what kind of input are you offering as a practicing clinician that makes this project have the life that it does have?

MJ:
So the first two research projects, the ones that were led by Sinead, the low back pain and pelvic floor dysfunction, my main role there was really as a clinician. So I was one of the sites, one of the clinics that actually did the assessments, which was really great. And so people would come into the clinic with low back pain, low pelvic pain. They were seen by one of my partner, my business partner, who was a physio. Do you want to participate in this research project? Explaining the project. And I would do the assessment. So I was one of the sites for both of those research. So I was really the clinician doing the evaluations. I did help a little bit with the discussion in the first research project, which is a lot of work. I'm going to tell you, these researchers do a tremendous amount of work to write these research papers. It's mind boggling the amount of time, effort, research that they have to do. So that was the first two research projects. More the clinician, the doing the assessments, the evaluating of the patients that were participants in the studies for both of those. The newer study that I'm helping with, with Linda McLean at the lab here at the University of Ottawa. And Linda is one of our prolific researchers in Canada. And a lot of people come to do their master's, PhD postdoc with her. They are now conducting research on provoked vestibulodynia, which again is not very well studied, as is most chronic pelvic pain. And she invited me to help them basically set up one of the arms of their research. And I was immensely grateful to be asked for that and honoured to be asked to participate as a kind of person to input. Because again, as clinicians, we're the boots on the ground. We are the ones that kind of are the ones that are directly treating people. And so we kind of know or suspect, OK, I wonder if this is working. I wonder if this intervention is really helping. I'd be curious to see why this is helping and why this is particularly meaningful to the patient. So we kind of are the ones that are curious about our intervention, the impact of our intervention. But a lot of our interventions are not studied, including taking a biopsychosocial approach. Right. And so when Linda reached out to me, it's because her research is going to have four arms. And one of the arms is multimodal physical therapy. And in that multimodal, it really reflects how most of us are currently practicing. Because, again, what needs to be studied is what some of us are actually doing so that we can see that what we do makes a difference. Right. And so most of us in the world of chronic pelvic pain, we work in a biopsychosocial approach, which means we're doing pain education, which means we're doing some CBT based care, which means we're developing a therapeutic alliance, which means we're not causing pain or discomfort with our hands on manual therapies. And so that needs to be studied. And there's not a lot of good research in the world of pain, pelvic pain, that really looks at that format of multimodal physical therapy. And so she's doing that. And so she wanted to make sure that their proposed arm of multimodal physical therapy really reflected what most of us are doing clinically. And that's important. Right. We don't want things that are being studied that are not relevant to how we practice. And unfortunately, a lot of things do get studied that we go when we're not using that anymore. We don't do that anymore. So I was really honored to be asked to participate and to give my input on that. So that was kind of like part one sitting in on the meetings. They had done a proposal of this is what multimodal physical therapy is going to look in our study. You know, do you agree with that, MJ? What's your input on that? And I would make, you know, my commentary. And then the second bit of that, which was a lot of work, but really fantastic, is that they asked me to do videos on pain neuroscience education for people who provoke vestibulodymia. Borrowing on concepts from, you know, our NOI group in Australia, Little or More Mosleys of the World, Carolyn Van Dyken and Sandy Hilton, who wrote Why Pelvic Pain Hurts, you know, using a lot of the key constants of pain neuroscience for pelvic pain. And we did 10 videos. So as part of that multimodal group, part of it is pain science education targeted to people with vulvar pain. So they asked me to do that. So it was, you know, making a PowerPoint and then doing 10 videos. And each video is a topic around pain neuroscience. So I was really happy to do that and do it in both official languages of Canada because people in the Ottawa area are bilingual. So we did it in French and we had to do it in English. So definitely more involved in this project than maybe, a different involvement in this project than the one with Sinead on the low back pain, because it was a bit more of input and making sure that they're studying things that a lot of us are actually doing clinically. That was a really long answer.

Lindsey:
Brilliant. My mind is just reeling. And I appreciate so much of what you said, everything from the nod to researchers and just how incredibly in depth, so much work, I was wondering if there was any other unique perspectives that clinicians bring to research that perhaps academics or PhDs don't, because one of the things you mentioned was making sure we're studying something that's relevant, that we're actually using in clinic. Was there anything else with these studies that can highlight that as well to us?

MJ:
So definitely being clinically relevant, I think we kind of made a point of that is really important. Let's study the things that we are doing that we find are clinically meaningful. I think the big one with the vestibulodynia is I really wanted to highlight to the researchers two things. I wanted to highlight that having a good therapeutic alliance is key and important and that we shouldn't discount that. And it's hard in research, you know, for the vestibulodynia study, they're going to do this in 12 weeks. But in 12 weeks, you can still develop a therapeutic alliance. So I wanted that multimodal physical therapy to kind of embrace a little bit of that, you know, importance of developing a therapeutic alliance. And that's important to study as well. And also non-nociceptive, you know, this idea of, you know, can we please study interventions that don't cause pain, that don't, you know, again, because, you know, again, we need to study that because it's what we do, especially with people that have a very sensitive nervous system. We do not want to be the threat to their nervous system. And I think in the world of research, that bit isn't always understood because, again, they're not clinicians, but those of us who work clinically really get that bit, really understand how powerful the relationship is between therapist and patient, how valuable that is, how significant, maybe more significant than we realize that is, that that's not been studied. And that we don't want to cause people pain. Like that's another big, big one as well with our intervention, with our manual therapies. So I would say those are the two, you know, main points that I definitely wanted to highlight. And then also the education bit is key because it also has to be individualized. I think that was the other point too is that when you're doing any type of education, it can't be formulaic. It has to be individual to the person in front of you. And so the physios that are going to do the actual research, we did a day together, which was really fun. They came and actually spent time with me, and we took turns being each other's patient, and I demonstrated a lot of the manual techniques with the lens of communication, education, non-nociceptive, therapeutic alliance, you know, so to make sure that they're doing that when they're doing their research as well. And that education is individual, right, to the person in front of you who has their own lived experience, right? They may all have provost vestibulodynia, but they all have a different lived experience. And our job is to recognize that and to know that that's powerful in research. And again, it's part of that multimodal. So, of course, the multimodal isn't going to tease out the manual therapy versus the therapeutic alliance versus education. It's all going to be in one. But that's what we do. That's what we do. That's how we practice. So I definitely kind of highlighted that quite a bit with this group, and I'm happy that they're kind of embracing that as well.

Lindsey:
That's incredible. And I couldn't agree with you more with all of that that you so eloquently described as equal parts importance with our clients. MJ, how do you, and I'm so excited to learn more about the study as more comes out. But just with your involvement and what you know of it so far, how do you think that this research might impact how we end up treating clients with vestibulodynia?

MJ:
So I think, again, because there's lack of research. When Linda was doing her proposal, and as I was reviewing her proposal, I was actually really surprised at how little there is that really studied, you know, beyond medication. You know, in the world of vestibulodynia, there was a lot done with lidocaine. Okay, well, lidocaine is not how we practice. So this whole idea of multimodal, what does that mean? There was very, very little studies. Really, there was only, or actually we only really have just a couple of studies. One came out, I think, in 2021 with Melanie Murray, who's also a researcher here in Canada, looked at multimodal physio versus lidocaine. So that was kind of like the first research. And that came out very much in favor of multimodal physio. And what did they do? Well, they did the same thing. They did education. They did some relaxation of the pelvic floor in different ways. So they did some manual therapies. They used vaginal accommodators, vaginal trainers. So that was great because, again, that was highlighting, okay, that's kind of how we work and how we practice clinically. So that was fantastic in 2021. So that was a little, you know, an RCT at that time. So then, Linda, you know, a lot of gadgets are out there. I mean, that's the other thing, too, in the world. You know, and I'll speak to physical therapy because we're definitely kind of more the we have more gadgets, right? We have electrotherapies. We have all sorts of things that get marketed to us and that people want to sell to us to use in clinic. And a lot of these devices can be very costly. And so as a practitioner and a past clinic owner, I want to know, well, does that does that work? Right. If you're going to tell me to buy a laser or to buy this or to buy that, you know, does it actually work clinically? And so when Linda looked at doing this research, she had done like a little pilot on photobiomodulation, which is a laser that is proposed to help with with skin issues and pains and was studied, I think, in dentistry quite a bit. And so then she did a little kind of pilot study that looked at it versus sham. And for people with Provo vestibulodynia and kind of went, OK, well, this is actually showing some positive outcomes in pain and sexual function that warranted a full scale, you know, randomized control trial, which is the one she's doing right now. And then really the only other study we had just just came out at ICS Madrid and I was at it. And that was Malgorza Starzek Prosperio study. That was the effectiveness of non pharmacological conservative therapies for chronic pelvic pain. It was a systematic review in a meta analysis. And it was wonderful. It just published in twenty twenty five in January. And they also looked multimodal physio compared to a lot of interventions. And in that systematic review, they had, you know, I see bladder pain, but they had a lot of the studies on Provo vestibulodynia, including Menini-Marin study. And again, the multimodal was education, more pain education, which is great. Self-management skills, which is really great. We love good self-management, good self-efficacy. Again, that's how most of us practice pain neuroscience and CBT based approaches. Again, a lot of how we practice and a very much piece patient centered framework, because, again, every person with pain is an individual. And so their systematic review came out saying that the multimodal physical therapy was the most effective at reducing pain and intensity at high high certainty evidence, which is really great compared to mono therapies, which is like using our electrical device. Like if you think tens and muscle stem acupuncture individually, that individual mono therapies were not helpful. But this whole multimodal, which was a biopsychosocial approach, really helps. So that was a recent study, systematic review and meta analysis, which was great. So that's going to really complement Linda's study because she's, again, looking at an intervention, the laser versus multimodal physical therapy and doing it in a really rigorous fashion because she's got four arms to her study. So when you look at the background, we really didn't have a lot of studies that looked at how most of us practice clinically when it comes to pain. So hopefully Linda's study and the results of her studies will, my biases, hopefully will favor the multimodal physical therapy. Throwing the laser in there is going to be fun because, again, who knows, maybe, maybe it helps. So we can talk about those four arms if you did you want to know a little bit more about. Yeah. Yeah, so what's really cool and again you know being a clinician and not kind of really knowing the world of research I really do appreciate things that are well designed so she's going to have a sham laser group. She's going to have a group that has the laser. She's going to have the group that only has the multimodal physical therapy, and then she's going to have the group that has multimodal physical therapy and real, real laser which is really amazing right because then we'll really know, does it help. And so it's blinded meaning that the physios doing the laser sham and or real are going to be blinded somebody else is actually going to turn on or off the machine so it's so truly blinded which is great you can't blind multimodal so that's not going to work. But it's great because maybe, maybe, again my bias, maybe, and I'm hoping that the multimodal group really comes out shining and but if the multimodal group, and the laser comes out shining fine. If the laser comes out shining well you know what, as, as practitioners and we say okay well then maybe there is value to adding some laser to the vulva. But again, before I go spend money on a laser I would like to know that it's going to work. And that it does what it says it's going to do. So that's kind of the, the basic of her of her study and how she is laying it out which is really really a great rigorous study I really do appreciate it. Right.

Lindsey:
Wow that’s incredible you know, of course, as you're going through I have the options that I prefer, you know, come, come out on top but at the end of the day what we know especially given such a well thought out and rigorous study is that what we find out, at least we know now there's validity in right like we can really, we can really start to feel more confident in our clinical choices when we're with our with our patients because this is exactly what we need to be able to contrast those four arms just, it sounds brilliant.

MJ:

It does. Yeah, and people are always asking us because if you think about social media right now, how many gadgets are being advertised and marketed to our patients and how many times do we have patients coming in, who say, I saw an Instagram I saw on Tick Tock. This this this you know and I and it's really hard because, you know, instinctively your bias is going to kick in as a therapist we have our bias. So we, we do rely on good research to really tell our clients Listen, this has not been researched. And, and if it is been research and it's gotten a good and release we have the data say well this was research and it's shown to be not effective to you want to spend your money on that service or that product, or do you want to spend your money on a intervention that we know has been well researched that has grade a level one evidence I don't use those terms with my patients but you know that that has the highest you know level of evidence that is often less costly versus gadgets because we're bombarded every day. So lasers are one of them, and it could be that is that it is a value, but I'm like, show me show me the proof, like show me the proof before especially because a lot of these are so expensive. Show me meaningful good well done research compared to sham, because again a lot of research is not compared to placebo and compared to interventions that we know are helpful, which now we have two studies that say that multimodal physical therapy in that bio psychosocial lens with education, you know patient centered care seems to be of the highest evidence so let's compare it to that, because that's meaningful. And then we make the best decisions as clinicians as to what we're going to go by, or not. And how best to navigate questions people have when they reach out to us because you know as well as I do how many people reach out to us all the time about things they saw online. And we're always having to navigate that and we don't always have good research to help them make those decisions.

Lindsey:
Exactly, exactly. And so much of what you're highlighting in that multimodal approach MJ is is really sort of like the bread and butter of our work as and, you know, just being very transparent, the world of occupational therapy, we need, we need more research, we just do. And so I'm really hoping and you know was was quite excited about having you on here for that reason alone because, you know, our audience is so passionate about what we do but I think the process of getting involved in some of these things can be intimidating. So I'm wondering what advice do you have for any therapists listening to our chat today who may want to contribute to research, but just aren't too sure where to start.

MJ:
So I think the first thing you do is just who's in your area, like I will, I was lucky to just move to Ottawa that's how I connected with Linda moved to Ottawa just two years ago. And then I wanted to connect with local therapists, you know, get to know people in my new community and reached out to her lab, and, and that's how that conversation kind of started. So, most of us live in bigger centers where there's likely a university or college, who has likely somebody they're running some research in pelvic health, whether it's OT or PT. And I would say reach out, reach out because I think they need a lot of help. And, you know, it's really difficult to run research, I think it's really difficult to run research and rehab. And so I think they are more than happy to have people reach out to them and say, how can I help you. Do you need Ashley any help and and help can be many things like I was asking Linda I was telling her I was doing this podcast and I'm kind of getting a sense like, you know, what do you, you know, what do researchers need well, they need collaboration with clinicians who have again boots on the ground and who have the questions and curiosity. And that would be my other thing be curious. So if you meet those researchers maybe ask them, what are you studying. Have you thought about studying this or I'm curious, I see this clinically. Is that something that's worth studying, you know, is that something that could be studied maybe give them ideas, because they get students from all over the world, who have to think of a thesis, a study. So if we give them ideas based on our clinical experience, I wonder if this is something that's worth studying and if it is, how would we do that, how would that be done to give them ideas. But then it's also helping as clinicians, you know when they are ready to run research, they need help with recruiting. Right and recruiting is really hard. And so, again, for those of us that are in clinical practice who see you know x many patients a day. It's really helping them find, you know, research participants and highlighting that the research is being done and then they need people and encouraging some of our patients to participate in research as well. So I'd say reach out, connect, go have lunch, do a zoom, I did a zoom meeting with Linda at first. You know, and be curious about maybe questions you have, research projects they have going on and just ask them how, you know, how can I help you. And I bet you they'll find different ways for you to help them and, and it looks a lot different depending on probably the type of research they're doing so whether you do like I did where you're one of the people who hosts and does the assessments or you're providing input. So you're at the table when they're having meetings or you're developing, you know, some of the protocols are just helping recruit as simply as that if they make a poster and they, you know, want you to disseminate that information in your clinic and have you openly talk to your patients like I had three vulvodynia and vestibulodynia patients that I said I think you guys would be, you'd be a good participant or a good person for the study. You know, are you interested in participating. And it's okay to put physio with MJ on hold to participate instead it's really really important. And so again, we are also kind of well set up to have these conversations with our, with our patients and say this is why it's important you know so you know if you're willing to participate for 12 weeks, absolutely go for it, you know, and you may not know, you know, you may be in the sham versus the real laser arm but that's part of research and that's kind of that's kind of fun that you get to participate in that and we can start back up therapy. Once you're done the research as well. So that would be kind of my, my advice to to kind of get involved in if maybe the university has an open house where they open up their lab Linda does a lot of that there's a lot of education evenings go mingle,meet with them, meet with the researchers, and, you know, and ask them how you can best help.

Lindsey: 
Absolutely amazing. It can be that simple.

MJ:
It can be that simple, really.

Lindsey:
Yeah, yeah.

MJ:
And it really was that simple, right? You know, Linda found out I moved to Ottawa. I had reached out. We connected, and she asked me to be involved, and I was happy to do that.

Lindsey:
You know, MJ, it's really clear speaking with you, you know, just how invested you are in this and quite passionate about connecting these two worlds that can really be mutually beneficial. Is there anything else that you're kind of reflecting on as we're having this conversation that you have personally gained, and I should say professionally or personally gained, by participating in this kind of research work?

MJ:
I think a few things. I mean, it opened up my eyes to how much work they do and how much I appreciate them even more. Not that I did not appreciate them before, but how I really do appreciate them and kind of getting a bit of a glimpse in the eye of the amount of work that goes into doing research was really, really important because, you know, by the time, you know, they got to do grant applications, you know, they got to justify why they're doing the research, the importance it's going to do, the benefits it's going to show. I mean, just the grant writing, I think, takes them so much of their time. And, you know, all fighting for a little bit of that piece of the funding pie, you know, then you got to get funding. That's not easy to do. And so getting the funding, then you have to have the students that are doing their PhDs and post-grads and post-docs coming in, attracting those people to your facility and, you know, getting them interested in doing research that's clinically relevant. Well, then you have to do the research. You got to do the research. Then you got to recruit all those people to have enough people in your research that it has a statistical significance at the end. That's not easy. Then even the analysis of everything, putting all that data together and just writing the research. Like I said, the first, first research project with Sinead, I did a bit of the discussion, like a bit of it. And the amount of time that took me was unbelievable. And I kept thinking, my goodness, like some of these, you know, researchers do large RCTs where they're really having to dig into the research. The discussion is very lengthy. And I was like, wow, that's so much work. I did a tiny bit and I was mind boggled, you know, so putting all that together, then it has to get approved. Like, and it's not even approved yet. Then our journal has to look at your research, say, yeah, this is great. Then you got to do all the changes and the rewrites. And then hopefully you get into a journal and then you got to present. Then you got to go out and you got to get your abstract, you know, approved to go to International Cotton Society or IPPS, International Pelvic Pain, and you got to go present. I mean, it's an unbelievable world and it's so time consuming. And so I think for me as a clinician, when I read an article now, when I read research, I always take a moment to be grateful to the people who did it because I know how much work goes into it. When I go to conferences and I do go to a lot of conferences, I always, you know, as they get up there and they're presenting and they're nervous and maybe it's not, they're not presenting in their first language. And, you know, you can tell they're proud, you know, giving them a good clap of the hands and, and, and even one-on-one saying great work. Like that was really a good research project because I don't know that they get thanked a lot for doing the work, but taking a moment, you know, after they're done presenting to go say, thank you. That was really fantastic because it's such an immense amount of work just to get published, like just to get published and then to present all of this data to everyone. So I, you know, so that for me was, was really quite big. And also it makes me appreciate good versus bad research a little bit more, which, you know, again is something important to understand. And I think that being involved with people in the research world makes me now a little bit more, you know, in tune with, yeah, the study not fantastic, you know you know, not very rigorous, you know, so I'm definitely a little bit more in tune to that than I probably was before. And it's been fantastic in terms of just contacts really. Now that I have people that I know that are in the research world, you know, if I read a research paper and I'm like, I'm really not sure about this. I've got somebody who can say to me, yeah, no, that was, that was, that's well done or no, that was not well done. So having kind of good contacts in the research world has been really fantastic. And you know what? And I'm happy to give back. I think I'm at that point in my career where I I've been, I've been doing this for close to 30 years. And for me, it brings me such joy to give back. It really does to my community, to my profession. I'm really, I love what I do so much. I'm proud of us. Rehab people, OTs, NPTs in the world of pelvic health. I see how far we've come in 27 years. Like it's unbelievable how things have changed so much since I started practicing. And I'm really, really, really grateful for people doing this type of work because I don't know that we could sit here and really tap ourselves on the back and say, we have fantastic research to support where we do, but we really do now. We didn't 10 years ago. We didn't 15 years ago, but we do now where we can stand up to our colleagues or gynecologists and obstetrics and gynecologists and GI specialists and, and urologists and say, you know, multimodal PT. I say PT because they're calling it physical therapies, but we understand that it's as much in the OT world as you know, this whole multimodal, like you said, is very much OT as well. Biopsychosocial therapeutic alliance, CBT, self-efficacy. I mean, that's the world you all live in is really what helps. It really is what helps. And we should be first line as inter for interventions for a lot of these complex pain conditions that we see. We finally have really good research to, to kind of really be proud of. And that's because of the work these people do.So I'm immensely grateful and, and also in awe of all the work they do. I'm in awe of the work they do and the grind, the daily grind of doing all of these things is you really, you know, have to be passionate about your topic, your career to do this day in and day out. Right.

Lindsey: 
So MJ the two research articles that you've written, the research projects that you've been talking with us about. I double checked and they are open access. Is it okay with you if I include those links into the show notes for our listeners so they can check out this amazing work that's been done?

MJ:
No, I think it's fantastic. And again, they're great research that's clinically relevant. So the more we share, you know, it would be wonderful that things can always be shared openly because I think the more we have information at our disposal, the better it is. So yes, go ahead and do that. Yeah. Because a lot of people didn't realize the link between, you know, pelvic floor dysfunctions and low back pain. And that changed the narrative a lot around how we were treating lumbopelvic pain. And again, that's, what's fun about research. And I think that's what's important as clinicians is that we get taught certain things. We think certain things are said truth. We build a belief around and then research comes out and kind of turns it all upside down. And then we have to be willing to say, ha, okay, I'm going to change how I clinically practice now. I'm not going to do this intervention anymore. I'm going to change it, which is not easy for a lot of people to do. So research like the lumbopelvic pain was one of those research papers that did kind of change a bit of the narrative, which is not easy for people sometimes to change how they practice. So I think the more we share, the more that information is out there. And then the more we are treating in such a way that is actually clinically relevant and clinically important.

Lindsey:
The two just cycle off of one another, you know, they really do. They get into that and it just strengthens our profession so incredibly much.

MJ:
Yeah. Cause don't you think sometimes, you know, and I remember with that with that lumbopelvic pain for years before we did that study, I would treat people and go, huh, things are happening that I didn't think would happen. And it went against the narrative. And that's not easy because when 90% of people are doing things a certain way and you're part of that 10% that says, I'm not seeing that. And then you tell people, well, let's do this a little differently, but it goes against the narrative. That's not easy. So when you finally have a paper that comes out, that validates that kind of gut instinct you had, that maybe this is not what we thought it was. That's really empowering as well. And, and again, we all have to be very open-minded to, to research findings and be willing to change our, our practice habits because of it. And this was one of them. Cause in the world of orthopedics, there was a very strong belief system around, you know, strengthen the core and everybody had to engage their pelvic floor. And what we saw was actually the opposite, you know? And so that's important, you know, to have that discussion and debate. And also if anybody disagreed with it, well, then you could do a study again and go ahead, you know, see what you find and let's have that open debate. But at least this kind of opened the door and said, huh. And it also gave also an opportunity to those two studies to give us some very, again, key clinical tidbits that we can quickly do, right? Because again, it has to be doable for those of us who are in clinical practice. Our days are busy. Our appointments can be very long and very involved. And so we need clear, concise, precise, easy to do interventions. And so what was really great about that second study is that, you know, for those that are not even doing internal pelvic exams, cause not everybody does internals. How do you know if somebody has increased tone in their pelvic floor? And so the second part of Sinead's study was really good because it looked at that. It said, huh, if you have a CSI score, a central sensitization index score higher than 40, the odds ratio of having pelvic floor tenderness was really high. So just giving the CSI, how easy is that? And if they had strong uncontrollable urgency, that was highly predictive of having increased tone in your pelvic floor. So that's giving a CSI and asking a question that anybody that even doesn't do pelvic health can do. And that somebody who's not an internal practicing therapist can do. And how fantastic is that as research? That's what we want. We want those like little clinical tidbits that goes, that's all I have to do. Give a CSI and ask a couple of questions. And I already have a lot of information now to help manage and help this person in front of me with pain. So, yeah, so that was, you know, kind of some of the great things that come out of research is the fact that we can kind of find these little clinical pearls that help us be as efficient as possible in our very busy days. Right. So it has to make sense to us as clinicians. Right. And it can't be complicated.I don't like complicated things. Simple, simple is good.

Lindsey:
Well, I think the future is so bright and I appreciate so much your perspective regarding, you know, the quality of research we've been getting the last 10 years. And I just think that when people like you are open-minded and show us, show us the benefits of getting involved in our own local areas with this, our professions over the next 10 plus years are going to continue to grow so much more. And that that's what we need. That's what makes it so incredibly exciting because now we're optimizing outcomes for our clients and we're practicing in a way that we feel really, really solid and excited about. And so I can't thank you enough for being a guest with me today and giving us this insight, this, this really like, you know, candid like boots on the ground perspective on why this is important. And I really hope that it helps a lot more clinicians listening to this, get involved and see how much we can give back by, by getting involved in these studies. So can't thank you enough. MJ really appreciate you being a guest today.

MJ:
Oh, thanks so much. That was a lot of fun and I really hope it encourages all, you know, clinicians out there to get more involved with research, that it doesn't have to be complicated. It doesn't, you know, you don't need to do a PhD and still be involved and give back. And it's a lot of fun. It's actually a lot of fun. And how much of the appreciate our help I think is also important to highlight. And I think if we don't support them, then how is research going to continue on, right? If they don't get the recruitment for research, if they don't get ideas of what to research, then we're not going to move forward as a, as a profession. And we have so much to offer as OTs and PTs and pelvic and pelvic pain. And so we really need good, solid research to, to, again, you know, we know instinctively what we do makes a difference. We know it, we live it every day, but again, our colleagues want good evidence to support referring to an OT or to a PT. And so we do need good research that again, is clinically important to us as clinicians and also clinically important for our patients as well. So thank you very much for having me on. It was a lot of fun.