Listening is Treatment: How Curiosity Transforms Care

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Transcript

Lindsey: Hey everybody, Welcome back to another episode of OTs in Pelvic Health podcast. I am so glad you're here.

Whether you are driving to work, catching up on laundry like I need to, or in between client sessions, I hope that this space gives you a moment to reflect, reconnect, and reimagine what's possible in our work as pelvic health occupational therapists.

Today, we're diving into a topic that comes up in every single evaluation I do, whether the client names it or not, and that's pain. Not just what it is, but how we understand it, talk about it, and help our clients move through it.

 This episode is for anyone who's ever felt stuck when pain doesn't match the injury, for anyone who's wondered if they're doing enough work, just for anyone who's wondering if they're doing enough when things just aren't changing in the client's life, and for every OT who wants to deepen their understanding of what it means to practice from a truly biopsychosocial lens. Here we go.

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

Lindsey: So what is pain, really? I'm gonna start with a client story. I'll call her Hannah. Hannah was 42.

 She came to see me at the functional pelvis for persistent pelvic pain. She was describing things like burning during sex, aching after sitting for about two hours, and a sharpness with bowel movements. She had seen, I think it was two or three gynecologists, at least one urologist, and even had exploratory laparoscopic surgery that actually didn't reveal much.

 Her imaging looked fine, her blood work was normal, but her pain was very real. At her first session, she said something that really struck me. She said, it's like my body is screaming, but no one could hear it.

 I was so taken back by this. No one had ever described it to me like that. It really struck a deep chord in me that caused me to start going down the path of better understanding pain and how to describe and support our clients through their pain experience.

 And I think that's when I shifted our conversation intuitively away from chasing a tissue-based fix and towards understanding pain as more a protective output of the brain. And here's the truth. Pain is not a direct measure of tissue damage, right? It's a message from the brain saying, something, something needs your attention.

It's a warning system. And like any alarm, it's not always accurate. It can be turned up too high or stuck in the on position.

 Inside Pelvic OTPs United, which is my off social media membership. One of my students this week described this beautifully. And what she said was, house alarms are great.

 They definitely let us know when an insurer is there or we need to be on high alert. But what about if it's up too high or too intense and the wind blows and the alarm goes off, right? This is exactly what we're talking about. And I know this can be a hard concept for clients to wrap their heads around, even for us to wrap our heads around, especially when our clients are just so gaslit and misunderstood.

 But I found that when we really show up with compassion and curiosity and lead with curiosity instead of just explanations, that's when the shift starts to happen for everybody. All right, let's keep using this alarm analogy because I find that our clients, it really resonates with them. So again, imagine your house alarm goes off, maybe there's a break in, maybe that wind blew the door open or a cat jumped on the windowsill, but the alarm is real, right? Like the alarm is actually going off, but the cause may not be dangerous.

 And that's what happens in our nervous system. The brain gathers input from the body, from past experiences, from emotions and from beliefs, and it makes a call. Do I need to protect? Because when the brain perceives threat, even if tissue damage isn't happening, it can produce pain.

 Isn't that crazy? It is, I mean, the body really has our best interest and heart. I am thinking now of another client, we'll call her Eli. He was a stay-at-home dad who came in with tailbone pain that every time he sat up to feed his newborn, it went off.

 His MRI was perfect. Pelvic floor tone was definitely overactive, but not too extreme. And what stood out with Eli was his anxiety.

 He was exhausted. He was overwhelmed. He was constantly second-guessing himself as a parent and his nervous system was definitely on edge.

 Sitting, something that should be pretty benign became a trigger. So we didn't just focus on sitting posture or coccyx release. We explored regulation, pacing, self-trust, role shifting, role identity.

 And over time, things started to shift with Eli. And it wasn't because of an amazing manual technique or incredible home exercise program stretch. It's because we started talking about perceived threat.

 So one way I bring this concept to life with clients even more is comparing pain to vision, right? Vision. So your eyes don't actually see, like literally they don't see, they collect information. It's the brain that interprets the input and creates the image that you see, right? It's the exact same thing with pain.

 The nerves collect data and the brain decides to do something with it. Now, when I say it like this, clients often get it, right? It's kind of like, okay, oh yeah, their brain is doing their job maybe a little too well. And so at this point in the conversation, I'll often bring up the pain knowledge quiz by the incredible Laura Moore Moseley.

 And this is a tool that helps to bust myths and open up conversation. Things like, it's a true and false quiz, right? So one of the questions is, pain only occurs when you're injured. True or false? False.

 Chronic pain means the injury hasn't healed properly. True or false? False. The intensity of pain matches the severity of injury.

 Also false. So when clients go through this quiz, they start to put together that pain is shaped by context, memory, emotion, not just tissue. And when they take this quiz combined with our conversation, you can almost see the light bulb go off.

 So here's where things get a little bit deeper because pain isn't just about the physical input, it's also about the stories we carry. So I had a client, Denise, who came to me after a traumatic birth. She had, I think it was second, two and a half degree tearing.

 She was leaking urine and she had pain with intimacy. But what actually bothered her the most was the belief that her body had failed, right? It reminded me a lot of that first client that I started this episode with. She said she wasn't herself anymore.

 So I asked her a simple question. Is there something your brain keeps repeating about this pain? She paused for a while. She was looking down the entire time.

 And then she looked up and she said, yeah, I think I'm broken. And I think I'll never be the same after having my baby. That story in that moment became part of our work because healing isn't just mechanical, it's emotional.

 Our brains remember trauma. They hold on to fear. And sometimes pain is the only language our bodies have to say, I'm still hurting. And this is why trauma-informed care is foundational in pelvic health work.

 Again, we are not just treating muscles. We are holding space for grief, shame, identity shifts, and honestly, the invisible weight of expectations. And this is where I believe occupational therapy practitioners shine, really.

 Because we are trained to look at the whole person, not just symptoms, but roles, routines, values, and their context. We're not just asking, where does it hurt? We're asking, how is the pain affecting your ability to be a parent? How does it impact your relationship with your partner? What's changed in the way you see your body? And even things like, what does healing enable you to do when you see yourself on the other side of therapy with me? What do you envision yourself doing? Right? And we have the time and the training to build rapport, to notice patterns, and to help clients reconnect with the parts of themselves that pain has silenced. This is why I always say pelvic floor therapy is not just about the pelvic floor.

It's about the stories that the person and the pelvic floor are sharing. So, what can we do when we suspect central sensitization or nervous system activation, right? Here are a couple of the steps I often take. I go into so much more depth in my Trauma-Informed Pelvic Health Certification course.

 It's my level two course. It is the only prerequisite to taking the Certified Functional Pelvic Health Practitioner exam, which is based on over 200 core competencies linked to our OT practice framework. But I'm gonna share four with you today, but just please know there's so much more to go into, and I'd love to support you in my trauma course.

 Number one, normalize the experience. Pain is real, always, but it's not always a sign of damage. Remind our clients that their bodies aren't betraying them.

 They're trying to protect them, and that's beautiful. Number two, screen for psychosocial contributions. So, I use tools like a central sensitization inventory, the fear avoidance beliefs questionnaire, and the low positive affect scale.

 These guide my intervention, help me know when a nervous system approach is first versus a hands-on manual-based approach, and these questionnaires validate the client's experience, which is huge.

 Number three, start with regulation. Before strengthening or manual therapy, I begin with grounding, breath work, and gentle movement. We build trust with the body first.

 Lastly, collaborate. If trauma, anxiety, or mood are playing a major role, work with trauma-informed mental health providers in your area.

 That bridge is huge because we are a community. Don't put the pressure on yourself to do it all, right? You are a huge part as a pelvic floor therapist, but you are not the only collaborator that our clients need, right? Sometimes they need shifts in hormones. Sometimes they need a dedicated mental health provider, despite our mental health background.

 Think about it as helping the client build their village. If you take nothing else from this episode, take this. Listening is treatment.

 I've had clients say to me, you are literally the first person who asked me about my stress. That moment of being seen, of being believed, is often what opens the door to healing. We don't have to have all the answers.

We just need to stay curious, compassionate, and grounded in the belief that healing is possible. So if you're feeling fired up or a little bit overwhelmed, that's okay. This work is layered, it's emotional, and it's worth doing well.

But please remember that our clients deserve more than protocols. They deserve practitioners who see them as whole human beings. So keep asking the deeper questions, keep listening, keep learning.

And if you wanna dive deeper into pain science and psychologically informed care, check out the Trauma-Informed Pelvic Health Certification. The link is in my show notes. And if you haven't already, join us in the OTs for Pelvic Health Facebook group.

 We have over 8,000 practitioners to date. It's a space where we get to reflect, share, and grow together. There is also the off social media community that I run called Pelvic OTPs United.

 It's $39 month to month. I would love to support you there as well. Thanks for spending this time with me today. Until next time, take care of yourself so you can continue to take care of others.

Lindsey: Thanks for listening to another episode of OTs and 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 and Pelvic Health podcast.