What I Wish Someone Told Me At The Start Of My Pelvic Health Journey

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Transcript

Lindsey: Welcome back to the OTs in Pelvic Health podcast. Today, I want to have a conversation that's part reflection, part provocation, and all heart. This episode isn't about a new technique or protocol, although I love talking about that stuff.

It's about who you are becoming as a pelvic health OT and who we as a profession are being called to become. I want to unpack six values today that I believe are reshaping the future of pelvic floor therapy through the lens of occupational therapy. But rather than listing them off one by one, I want to live them out loud with you through stories, questions, and really moments that shaped how I practice today.

If you ever feel like your voice is too quiet in this PT-dominated field, or like your sessions are missing something that you can't quite name, this episode is for you.

Intro: 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, Lindsey Vestal, and welcome to the OTs in Pelvic Health podcast.

Lindsey: Okay, when I first entered Pelvic Health, I did what most of us do. I followed the previous roadmap that others drew for me, right? I took the courses. I studied biomechanics. I memorized manual techniques. I did what was expected, but something felt off. I couldn't quite name it at first, right? I felt like I was borrowing someone else's voice. I was performing a role that didn't quite fit.

I admired these people I studied with. I, to this day, I'm very close to these original mentors, and at the time, I wasn't able to share with them that something felt off. Since then, we've had lots of conversations, and really, it has shaped the practitioner I am today, but I couldn't help but wonder back then, is this what I signed up for? What I really wanted was to hold space for transformation, not just in the pelvic floor muscles, but in how my clients felt in their bodies and how they moved through their lives and really how they reclaimed power after disconnection, and that, that is OT.

So fast forward, I wanna share six principles that got me through those days that now shape the heart of my practice. It's not a checklist, but it's a living, breathing framework that helps me stay grounded and grow to this day. 

Number one, being nervous system informed, not just trauma-informed.

Now, we know trauma-informed care is more than checkboxes. It's about how we orient really our entire presence, our tone, our pace, our posture, our eye contact. It's about asking, what helps my client feel safe in their body again? And sometimes this means skipping internal work.

Sometimes it means walking them through every step of the way through what we call explicit consent. And sometimes it means silence as a client is sitting there processing their experience, something like their birth story, something like a fall they had when they were young, but what it always means is that it always means permission. We can stop at any time asking a client, do you have questions before we move forward? Asking them what would help you feel more in control right now? These are nervous system tools and they are sacred.

Number two is being a facilitator more than a fixer. Now, this one was hard for me because like most of you, I love helping people. I love results, but I realized that every time I rushed to fix, I was unintentionally reinforcing the idea that healing comes from the outside in, it doesn't.

Healing is internal work and our job is to walk beside, not drag someone forward. Honestly, that doesn't even sound fun. So now I ask questions like, what do you think is going on? What's worked for you before? When do you feel most connected to your body? Because here's the thing, facilitators ask, fixers tell, and I choose to ask.

Number three, occupational-centered everything. If what we do in this session doesn't translate into our client's real life, what's the point? Like really, I'm asking this a really sincere question to our entire profession right now. If what we do in session doesn't translate into real life, what's the point? So I stopped giving generic home exercise programs.

I started recording audio guides, asking them about their routines and building therapy around their actual environment. So I would say things like, can you try this while unloading the dishwasher next time? Or what time of day do you see yourself doing this exercise? Or where could this fit into your existing habits? That is occupation-based pelvic floor therapy. And honestly, it's magic.

Number four is education as empowerment. I used to think education was handing someone a diagram or explaining anatomy. Now I know it's about giving people the language to describe what they're experiencing.

It's about putting their symptoms in context. And it's about saying, this isn't just happening to you. This is something we can understand with you.

Pain neuroscience education, giving your client the central sensitization inventory, which is my go-to source for helping triage if a client, you know, if we need to start with nervous system first or more traditional pelvic floor therapy first, how they score on that makes that crystal clear. We talk about this all the time inside Pelvic OTPs United, which is my off social media membership community for $39 a month. The link is in the show notes if you wanna join us.

I also think eloquently and simply breaking down pain neuroscience education is a big part of this education as empowerment. These are literally tools of liberation because it helps the client make sense of what just can feel like detachment and misunderstanding. For instance, the central sensitization inventory goes into things like, I have skin issues.

I have headaches multiple times when I wake up, when I go to bed at night. It's all these seemingly unrelated symptoms that a client actually checks off on. And when they see that in context of some pelvic floor questions, which also exist on the central sensitization inventory, they start to see their body as that symphony of symptoms trying to get their attention. And it all starts to make sense why we're addressing the nervous system. 

Of course, I'd like us to be very explicit in telling them we address the nervous system, but then also these tools and our pain science, neuroscience education, all helps to form a story for the client and to start to see the type of practitioner that we actually practice through the lens of, which is really exciting and a fun moment for them to see they're in the right place. They're with someone that cares about their entire being.

Number five is listening through the nervous system lens. So when someone says, I feel tight, I don't just think muscles anymore. I think survival strategies.

When someone says, I can't relax, I think what does relaxation mean to them? So I started incorporating sensory-based strategies to improve interoception because I do think that's what it comes back to. So I started asking things like, where do you feel safest in your body? Or what's one area of resilience you notice? Or what's something your body does well? This is nervous system work and it's foundational. 

The last, number six, is psychosocial integration. Pelvic floor dysfunction is rarely just physical. It's a ripple effect of stress, roles, expectations, relationships, and routines. When a client comes in for painful intimacy, but it was actually about her graduate school stress and her gut health and her perfectionism, her disconnected routines told the real story.

If we're not integrating the psychosocial aspects and understanding the client's full story and full experience, we're missing the point. It was nothing about painful intimacy and everything else about her stress that was the real story. So I wanna share a moment with you that changed everything for me.

I was working with a client who quite frankly just wasn't improving. I had seen her, gosh, honestly, it was probably six or seven times and literally nothing was changing. We tried everything I knew and I, I was at my wits end.

Honestly, you guys, like I was scared. I was like, I don't think I know what I'm doing. And something dawned on me and I just turned to her and I asked, what do you think would help? Honestly, it was kind of a cry of desperation. I just didn't know what else to do. 

Well, fast forward, this is now my go-to question with every single client. Even when I have some ideas and I wasn't in a place of like, I have no idea what I'm doing.

So what happened when I asked my client, what do you think would help? She was quiet, honestly. She was quiet and pretty awkward, but I just sat there cause like I said, I didn't know what else to do. It was the best moment I ever had because the answer she came up with was exactly what we needed.

And I needed to hold space for that awkward middle. I actually needed her to generate her own answer. Our clients literally have the roadmap to exactly what they need.

Again, coming back to this fixer versus facilitator mindset, believe in your clients. They are experts of their own body. We're helping them be that detective to remember that.

So this moment was the beginning of the end of my fixer identity. It was the beginning of co-creation with my client. 

All right, let's take a moment to talk about language because language is really important.

How often do we say, or how often have you heard a practitioner say to you, your pelvis is unstable, or your core is weak, or you need to activate your posterior chain more. Now, imagine hearing all of that in a vulnerable state. 

That's what we call a nocebo. It's a negative suggestion that actually is proven to worsen outcomes. And that is the last thing that we want for our clients. So instead, I started reframing those kind of those statements that I heard throughout my own health journey and even with studying with some of my very early mentors.

And I started saying things like, what do you feel when you do that? Or what do you think your body's trying to tell you? Or even let's explore that together. Remember that telling someone their pelvis is unstable. I'm not too sure what we're getting at when we say that.

Like, do we actually think we're helping someone? What do we expect them to do with that information? Remember, words can wound or they can welcome. So choose wisely. 

Now, the next thing I wanna chat about is what if we treat it emptying the dishwasher like a nervous system reset? I know that sounds crazy, but how many times a day do we empty the dishwasher? What if that was a built-in nervous system reset? Or if you're working with a postpartum client or you yourself have a child, what if we used lifting the baby as an assessment of breath, pressure, and presence? What if we turned daily life into the therapy? Because here's the truth, healing, it doesn't live on a handout.

It lives in daily rituals. When we can help clients feel empowered in the mundane, in the thing they're doing time in and time out, we have done something extraordinary and we haven't added something to their to-do list. We've integrated their life into their goals of healing.

And when I started doing all of these things, here's a shift that I saw. When I leaned into the nervous system, I needed fewer orthopedic techniques. And honestly, I didn't really enjoy those orthopedic techniques.

So for me, this was a win-win. When I started offering clients a menu of choices for their internal exam, everything from starting with their clothes fully on, building all the way to the quintessential classic internal exam, outcomes vastly improved. I actually created an alliance and a relationship with the client, meaning when I finally did my pelvic floor assessment, whether clothes were on or off, I actually saw what was authentically happening.

Because imagine, you don't know this therapist, it's the first time you met them, the room is cold, you've got fluorescent lights above you as you're squinting, and probably you're facing the door that opens because someone didn't think to change the table's orientation. So you're just wondering if anyone's gonna walk in that door when your legs are open like that. Do you really think you're going to see the pelvic floor accurately? Are you gonna assess it in a way that actually gives you the valid information that you need? I strongly don't think so.

And this is where waiting to build therapeutic rapport a couple sessions in and offering them agency by giving them a menu of options is how outcomes improve, and it's how you're accurately assessing your client. I am the only one to date who actually teaches a menu of options in pelvic floor therapy. Come study with me through either OT Pioneers or the Level 1 Functional Pelvic Health Practitioner Program and I will teach you exactly how to do this.

The other thing that shifted is that when I co-created CARE, clients felt more empowered and engaged. Every step of the way, not just internal work, I'm talking about the home exercise program, what it included, where they did it, what time of day they did it. I left no stone unturned.

I made sure the client could vividly picture exactly what they were doing, how they were doing it, and when they were doing it. And guess what? That meant they did it. And then lastly, when I led with curiosity instead of certainty, I definitely became a better therapist and it all started with one question.

What if pelvic floor therapy could be more OT? If you ever felt like the OT voice in pelvic health is too quiet, let me tell you, it's not. It's just getting started. You don't have to throw away your ortho knowledge, but you do have to lead with your values.

So ask yourself, what's most authentic to you? Where do you feel most lit up? And what kind of therapist do you want to be? There's no one right way to practice. There's your way. And your clients are waiting for you to show up.

Outro: Thanks for listening to another episode of OTs in Pelvic Health. If you haven't already, hop onto Facebook and join my group, OTs for Pelvic Health, where we have thousands of OTs at all stages of their pelvic health career journey. This is such an incredibly supportive community where I go live each and every week.

If you love this episode, please take a screenshot of this episode on your phone and post it to IG, Facebook, wherever you post your stuff. And be sure to tag me and let me know why you like this episode. This will help me to create in the future what you want to hear more of.

Thanks again for listening to the OTs in Pelvic Health podcast.