From dizziness to pain relief with expert physical therapist Vince Whalen

The room spins when you roll over in bed, then it vanishes, and you start wondering if you should just “wait it out.” That’s where so many people lose weeks of their life to dizziness, falls and fear. Speaking of Women's Health Podcast host Dr. Holly Thacker sits down with Vince Whalen, a physical therapist and co-founder of Wadsworth Family Physical Therapy, to break down what vestibular therapy and evidence-based physical therapy can do when vertigo, imbalance and pain start shrinking your world.

They get specific about benign paroxysmal positional vertigo (BPPV): why “crystals” in the inner ear trigger spinning, how different semicircular canals require different maneuvers and how watching eye movements through goggles helps a PT pinpoint the real problem.

Transcript

Welcome And Guest Background

Dr. \ 0:00

Welcome to the Speaking of Women's Health Podcast. I'm your host, Dr. Holly Thacker, and I am back in the Sunflower House for a new podcast with a terrific guest. I am so happy to be welcoming Vince Whalen. I've known him for a long time and I've sent so many patients to him. And on this podcast episode, we are going to talk with a very seasoned physical therapist who's got a wealth of experience in orthopedic physical therapy, pelvic floor physical therapy, very important for many of our uh female listeners, and vestibular therapy. Um, if you've ever had vestibular problems, uh, believe me, you don't want them and you want it to go away fast. So we're gonna discuss the very important role of physical therapy. So whether you or a loved one is recovering from surgery, managing chronic pain, navigating postpartum changes, physical therapy can really be a game changer. I really wish in retrospect I had seen a physical therapist before and after my three pregnancies. But before we dive into the interview, let me tell you a little bit about Vince Whalen. He is the co-founder of Wadsworth Family Physical Therapy, along with Kathleen Whalen. Vince attended and graduated physical therapy school at Columbia University and then he returned to get his doctorate in physical therapy from Regis University. Vince has been a McKenzie certified uh physical therapist for the last three decades. He also obtained a board certification in orthopedic uh clinical specialty in 1995, and he earned recertification, which is a lot of work, in 2005 and 2015. He also, he's like a hyper overachiever, obtained board certification in neurologic clinical specialties in 2005, and also got recertification 10 years ago in 2015. So I see the physical therapy board is kind of like the medical board, Vince, right? They just make you keep doing things and paying money and re-certifying. It's really um, yeah, that's a little bit of a drag, I have to say, as a physician. Vince takes pride in being a clinical instructor in terms of teaching and giving back to students from several physical therapy schools, including the Ohio State University, Walsh, Regis, Ohio University, Ithaca, Dayton, and CSU. And he's also co-authored a book, How to Treat Your Own Dizziness, Vertigo and Imbalance in the Mature Adult and Beyond. And I have to say, one of the most listened to and downloaded podcasts that I've done on my own is on dizziness and vertigo. I was trying to get Dr. Neil Cheerion, a neurologist who Vince knows and has worked with for years. Um, and he was so busy and it was such a big topic, I just did it on my own as a non-expert. So welcome, Vince. Thank you so much for being here.

SPEAKER_01 3:22

Thank you. I'm very happy to be here and excited to share with the audience all the things that physical therapy can do to improve their lives.

Dr. \ 3:28

Yes. I uh it really touches people's lives on so many levels. And um I think maybe our listeners aren't aware. I think a lot of physicians uh who are listeners too, to the program, uh, and Allied Health and APPs um may not have quite an in-depth uh knowledge or experience with with physical therapy. And I know when I um uh met with you, you said it was really funny. You said thank goodness for neurosurgeons, because you get so many referrals. And I think that is a weakness in medicine that some subspecialties are a lot more embracing of comprehensive care and and physical therapy compared to others. So tell us a bit about your physical therapy services,

What This PT Practice Treats

Dr. \ 4:15

what your team provides, etc.

SPEAKER_01 4:18

Okay. Uh so we have a pretty big team. We have eight therapists and one PTA. Uh we have a lot of subspecialists, but the big categories, we have uh a neurological component to our practice, which does a lot of uh traumatic brain injuries, multiple sclerosis, strokes, things like that. Then we've uh sports medicine, orthopedic wing uh that does both pre pre-surgical, post-surgical, and those trying to avoid surgery. And then we have a very big vestibular program. We're looking at dizziness imbalance, and then we have women's health that is doing mostly post-mastectomy care and then pelvic health issues.

Dr. \ 4:54

Oh, that's right. And uh breast cancer is such a big concern. So I didn't realize that physical therapists were involved with post-mastectomy. I thought it was primarily occupational therapists for massage and lymphatic drainage.

SPEAKER_01 5:07

Yeah, we do mostly we'll get them because they they're coming for something else, and then we found out they had this scar that no one ever worked on, and it's impacting. So we usually see them through shoulder, you get a shoulder referral, and then as you're talking to them, you understand that they had surgery and never got it. Uh the scars stretched back out.

Dr. \ 5:22

That is so interesting. And so scar massage is um and dealing with the scar is something that really an allopathic medicine. I don't remember any of that training when I did general surgery about even other than just infection and making sure the wound healed, but nothing per se about scar massage.

SPEAKER_01 5:41

Yeah, scar tissues, uh without scars, we wouldn't have jobs. That is uh a big component of physical therapy is you know getting scars to LinkedIn back out and letting the tissue return to normal.

Dr. \ 5:51

So um, you know, your legion, an expert in vestibular care. And uh one of our guest podcasters, uh, a good friend of mine, Sylvia Morrison, she sings your praises. She had one of the worst cases of uh vertigo, and uh, you know, she came to see you and um got the care, and I know has also referred a lot of other people. It's so disorienting. I recently saw a patient, and I got exposed to this through being a woman's health doctor, dealing with perimetopause fluctuating hormones, which can trigger migraines, and migraines and vestibular vertigo can go along, obviously, inner ear, um, brain issues. I mean, it can be so many different levels. It's so complex. So just tell us about your role and some of the different types of vertigo and why people want to get physical therapy sooner

Vertigo Crystals And Eye Goggles

Dr. \ 6:45

rather than later.

SPEAKER_01 6:46

There's really three big categories of dizziness that we see. One one is uh benign paroxysmal positional vertigo, which is kind of the sudden onset of severe vertigo often with rolling in bed or bending over. And that's when debris gets into one of those semicircular canals, which is they're designed to help you move through space. But when a crystal breaks off of its calcium carbonate, it goes into one of these canals, then it weights them, and then when you move, the your brain thinks you're you're moving when you're not. Um, so there's an anterior canal, horizontal, and a posterior. And most commonly the debris in the posterior. Next, most commonly is the is the horizontal, and then pretty rarely is the anterior canal. And if it's the posterior canal, then you do that classic Epple maneuver that a lot of people are becoming familiar with. But if it's in the horizontal canal or anterior, then you have to do different maneuvers to get the crystals to move through. I usually tell patients it's like BBs in a tube, and you gotta kind of it's like the game, you gotta move the head around to get them back where they belong. But sometimes these crystals can get stuck, and then that's a different problem. That's called cupulothiasis. If they're floating free in the canal, it's canal thyasis. So if they have cupulothiasis, we can tell because each one of these canals is connected to an eye muscle. So we put goggles on you and we watch your eyes in different positions, that's how we know where the problem is. If the debris is stuck, then the the eye is going to keep jumping. It doesn't fatigue. Or if it's floating free, it'll fatigue within 60 seconds. So if it's stuck, if it's cupulotysis, then we have to give you a series of exercises to break those loose. And those are often the tougher cases. Sometimes we'll even have you use a vibrator against your head to try to shake those loose a little bit. So those cases are a little bit more challenging. But the important thing is really figuring out what canal it is, and the tough cases are um, you know, multiple canals, multiple, multiple ears. Those are always the uh the trickier cases that make us make us work harder. But the goggles really, watching the eyes really helps you sort that out.

Dr. \ 8:41

Interesting. So do you think it's best for someone to find out and get that diagnosis rather than just go on YouTube and Google the Eppley maneuver themselves?

SPEAKER_01 8:51

I have people try that, and I think you know, we're we're seeing less simple BPV. You know, I first started doing this, it was I was a genius because I could do an Eppley maneuver. And now a lot of those people I think are self-training and doing well. So I think if you have someone with you and really make you got to really make sure you do all the maneuvers correctly, because if you turn your head too far or not enough, then you're just gonna throw the debris all over the place. All these canals meet in a common area. So if you don't do a good technique, often you dump it in a another canal, and you got it in multiple canals. So if you're doing, just have someone really pay attention that they're moving your head exactly like uh like you're taught by the videos. And then if it doesn't work, you know, I say then make an appointment and come in.

Dr. \ 9:31

You know, that it's been my own personal experience that having someone else look at you objectively, you know, as opposed to you trying to figure it out yourself, is is so helpful and like things I didn't even know about my own body, and it's my own body in terms of like muscle imbalance or other things that a physical therapist was able to pick up on. And I think treatment sooner rather than later is so important. Uh, one of my mentors at the field of women's health and menopause, and I know he listens to all these podcasts, uh, got a bad episode of dizziness and vertigo after um having uh a procedure done on his scalp where his head was in an unusual position. And I'm like, you've got to go to this physical therapist, you know, it's right down the road. This will fix you up. No, no, I want to keep waiting. And I think in any person, but especially somebody who's, you know, a senior person, um, you don't want them to fall or not be able to socialize or interact or drive or do activities

Fall Risk And Balance Training

Dr. \ 10:30

of daily living.

unknown 10:32

Right.

SPEAKER_01 10:32

The fall risk is a big issue. It's interesting as people get into like their 80s and 90s, often they don't feel this vertigo, but we'll put their goggles on them, their eyes flying. They more have the sense of imbalance. So I think in that older population, that late 80s, 90s, which we see a lot of, um, it's impacting their balance, but their brains kind of desensitized to feel the swirl. And then you'll reposition them, and then immediately they can feel an improvement in their balance. So I think that population is really, really underserved. So I think if someone's all of a sudden noticing their balance is not good, it kind of came on quickly and they have no other neurological signs, then they really should think about uh being checked for a crystal.

Dr. \ 11:09

Oh boy, that is like such a great tip. I I don't do very much geriatric medicine because I'm in the midlife sphere trying to improve aging for women. So as they get to that phase. So do a lot of geriatricians refer to you or know about your services?

SPEAKER_01 11:26

Yeah, most the local neurologists do, I think, but I think it's still a way underserved uh area. I think there's a lot of people in nursing homes that are there because they're falling and they could probably have gotten help. It's pretty surprising how often people come for balance, we'll check them and then they have BPV, and sometimes it even surprises us.

Dr. \ 11:42

Interesting. Wow, what a great tip. And um on this podcast, we focus so much on anti-aging and nutrition and physical therapy. And obviously, if someone is um in most everyone that I ever see always wants to avoid nursing home placement. And if you fall or if you have muscle weakness or imbalance, that's going to make you a lot more likely to head to a nursing home.

unknown 12:09

Right.

SPEAKER_01 12:09

There's some simple tests. There's it's called the dynamic gain index. There's a brief one, it just takes a couple minutes. You have the patient walk, you have them walk and turn their head, walk, look up and down, walk and change their speed. And we score that. And if you try if you're nine or under, then we know you're at fall risk, and that's someone who'd really benefit from physical therapy. So we do see a lot of people, you know, everyone wants to age in place, and uh fall prevention is a big part of what we're doing. And as they get older, you know, they get other issues, lumbar stenosis and neuropathies and other things that feed into the problem as well.

Dr. \ 12:39

Yes, absolutely. So you were telling me about um a new tool that you are uh using in your practice for people over 65 for fall prevention or assessment of fall risk. Is that the same thing or similar?

SPEAKER_01 12:53

No, so this would be this is actually the treatment end. So it's called a slip trainer. Uh, it's been around since about 2014. So it's it's a device on wheels, uh, so the platform moves, and we strap the patient in and have them in a harness so they can't fall. And then you move the platform underneath them, and you basically are trying to make them get that feeling of falling, and that's called a perturbation. And there's a big study that first came out on healthy people over 65 that were community ambulators, and they did this slip train where they got them to have 24 perturbations, and that decreased their fall risk for 50 by 50% for a whole year just with one treatment. And there's been a lot more studies on this in different populations with MS and strokes. Um, but there seems to be something about that, you know, that feeling that we all get when we almost fall, that keeping that pathway awake um is really helpful in preventing falls.

Dr. \ 13:44

Wow. That almost sounds like uh going to like an amusement park ride.

SPEAKER_01 13:50

It kind of is, yes.

Dr. \ 13:52

And and and getting back to vertigo, you know, it's interesting, like some people who really don't like amusement park rides or are more likely to get motion sick or car sick. Does that does that play into the vertigo dizziness um aspects at all?

SPEAKER_01 14:07

I think in some cases, but I think also there's some people who just have a sensitized brain with motion sickness. That's almost uh like a central thing, I think, in a lot of people, uh, maybe with migraine. Uh certainly if you have if you have a crystal in your ear, you're gonna know it if you uh get flipped upside down. And that's definitely a risk factor for BPV. Uh we see patients that are big Cedar Point fans where they go to amusement parks a lot. Uh I have one person, she kept coming back a couple times a year. She was a physician, and then I found out she goes to Orlando and Disney World, does all the rides, and then sure enough, a few weeks later she'd have uh the vertigo. So I think you know, those rides, obviously, if you're prone to this, they they do make the crystals loosen up, I think. Any trauma does.

Dr. \ 14:47

So head trauma, I would think, with like certain sports injuries, you would see it. What about with age? I mean, as people get older, are the crystals just older and more likely to get stuck? So, like, should older people maybe not should they try to avoid rapid head movements or well, um, yes.

SPEAKER_01 15:07

So I c I explained kind of like the hairs sit on on velcro, and as we get older, the velcro ages. So age is the biggest risk risk factor for crystals. But moving your head is really important for your vestibular system. That's what makes your vestibular nerve work. So the people that don't move their heads um when they're moving, then they're not training their vestibular nerve. So every time you move your head, that's your vestibular nerve working, and you want to keep that tuned up. As we age, that nerve um becomes becomes weaker like everything else. And it's pretty simple to train that nerve. It's really there's there's three branches there's a vertical branch, a horizontal, and then diagonal branches. And if you just have your head, your thumb still, and would look at a target moving your head, that's works your vestibular nerve. So people that have problems with that, that's uh how we rehab that, depending on what branch of the nerve we have them go up or down or different angles. And that's called uh vestibular ocular reflex, which is the second biggest reason people come to our office for um dizziness is damage to that balance nerve.

Dr. \ 16:11

Wow. Um, so I'm just thinking about children playing video games. Is that is that a benefit to their vestibular system or as long as their head's moving.

SPEAKER_01 16:21

So if your head's still, it's really your brain doing it. As soon as you move your head, okay, then it's your vestibular system. That's how we can kind of check them out. So if you have someone move their head and then stop real quick, you'll see them have a little nystagmus jump back if they have damage in one of the branches of the balance nerve.

Dr. \ 16:37

Uh-huh. Wow, that is like so uh so interesting and complicated. And you have been listening to the Speaking of Women's Health podcast. I'm your host, Dr. Holly Thacker, the executive director of our nonprofit Speaking of Women's Health. And I am talking with very seasoned physical therapist Vince Whalen. And so we've been talking about just physical therapy in general and have gone quite a bit in depth uh with vertigo, benign, um, positional vertigo, um, and crystals in the ears and diagnosis of that and the importance of kind of getting in early and getting things situated and figuring out which of the three semicircular canals are affected. We've talked a little bit about balance and um reducing fall risk. Um before we dive into the the female realm, um any other things that you want to tell us about the geriatric population in terms of advances, we did talk about um assessing and dynamically treating people to stimulate

Lumbar Stenosis Sneaks Up

Dr. \ 17:40

their their balance system to reduce falls.

SPEAKER_01 17:43

The other thing I would say is um in that population, lumbar stenosis, which is you know, the the nerves go through a hole, and as we age, arthritis fills those holes in, and that becomes they become stenotic, and the messages from the spine uh don't get to the feet and legs very well. So those people often feel they feel better sitting, worse walking, and their legs fatigued, they get numb, they feel better holding on their gursor car because they're leaned over, which opens up that canal. So those people, there's a lot of lumbar stenosis when we get into our later years, and that sets them up for fall risk also. And physical therapy, I think, is really helpful for those people. We usually get them on a flexion program to stretch that out and try to give them just a lot of times, just a little bit of room there makes a big difference in how they function. So that's probably the two big things we look at, really the vestibular system and then um the lumbar stenosis, and then if there's anything in the legs in terms of numbness and weakness, obviously that that would be addressed as well. But lumbar stenosis easily missed, it kind of sneaks up on people, and all of a sudden they don't they just have weakness up and down the stairs. Um, so that's an important thing, I think, to get checked out on the elderly people.

Dr. \ 18:51

And um, you know, there's increasing minimally invasive procedures that some of the spine surgeons and neurosurgeons are doing, and some pretty major surgeries as well. But anytime something is fixed from an orthopedic standpoint, they don't do anything for the muscles or the tendons at all. So or for any of the rehab. And so I really think that that's important in people, um, you know, if they can to be assessed pre-operatively and post-operatively. And we've had several podcasts on joint replacement, on um preparing just in general for general surgery, because we really want to empower people to be strong, be healthy, be in charge, and uh be as involved in their own care and health as possible, um, and looking at things from kind of a holistic uh standpoint. Tacking on the same um, you know, aging, you know, after age 30, everything seems to go downhill. Shoulder issues are a big thing. And I was just reading the other day that pretty much anybody over a certain age, if they have a shoulder MRI, are gonna see rotator cuff problems. And um I was having some shoulder problems, and my orthopedic surgeon was asking me, like, what kind of activities are I'm doing? He's like, Well, if you're over 50, you can't

Shoulder Pain And Frozen Shoulder

Dr. \ 20:05

be doing that. I'm like, wait a minute, why not? So you wanna delve into that shoulder.

SPEAKER_01 20:11

Okay, so really between age 40 and 60 in women, that's when frozen shoulders are most common.

Dr. \ 20:17

Yes. Oh, you see that with low estrogen. And I see a lot of women come to me because shoulder pain, that's actually there's a Japanese term and it's associated with menopause. They don't really complain of hot flashes, they could complain of shoulder pain.

SPEAKER_01 20:30

Right. That that's and frozen shoulders kind of sneaks up on people because all of a sudden you you don't raise your arm, you raise a little less because it hurts, and then you slowly notice all of a sudden you're only raising it here. So if you're noticing your shoulders slowly getting stiffer, the sooner you get that looked at, the better, because frozen shoulders can really be tough. Uh but in general, with shoulders, you know, the rotator cuff does the internal in and out motions, the rotation movements of your arm. And, you know, everyone goes to the gym and does pulling and pushing, but really very few people know to do the rotation movements. So if you're on your side, you know, rotating your arm in and out is internal and external rotation. And if you just get a band, that's really the muscle, especially rotating out, that has to be strengthened. And the shoulders you age, the blood supply goes down. So that makes it, you know, net wrist tendon for sure. When you're moving your arm out to the side, like a jumping jack motion, between like 70 degrees and 120, that's kind of your impingement zone. And you want to try not to work out with weights. You want to keep your shoulders out of that position because that's where you start impinging the tendons against the bones. And as you get older, even young, it's not great, but especially as we age, we want to stay out of that impingement. Most people hurt themselves on those lap pull downs when their arms are really wide and they're pulling heavy weights through that impingement zone. So you want to kind of keep your arms close to your body and just try to remember to work your your rotators, the the in and out motions of the shoulder.

Dr. \ 21:56

Can you still do those motions, just not increase the weight? Because that's The problem I've gotten into when I increase the weight is the problem.

SPEAKER_01 22:04

Well, that impingement zone, I think you you probably want to you can work below it and above it, but working through it is gonna probably get you in trouble eventually. Yeah. So I would encourage people not to do that.

Dr. \ 22:15

Really? And is it true that if you go have an MRI? I mean, I know with imaging, like people can have imaging of their back and it look horrible, but they don't have any problems. And other people have a lot of problems and their x-rays aren't that bad. Is it the same thing with the shoulder that it's not always correlated?

SPEAKER_01 22:31

Yes. When I first started working, everybody, they would do an MRI, they'd see a tear, they'd fix them, they'd be in slings forever. It took forever to get them better, and it was miserable. And now, you know, just really in the last 10 years, even in this in our area, some of the younger guys have come to town and said, hey, you know, a lot of these don't need to be operated on at all, they'll do fine. Just get it, get them stretched out and strengthened. And and that's really the case. Um, getting them a shoulder that's even a little bit stiff is painful. So one of the really important things is getting all your motion of your shoulder back. You know, it's easy, easy to have get let that be a little bit stiff, and other joints you can get away with a little bit of stiffness, but the shoulder mechanics are so precise when it's stiff in one direction, it throws off how the how the shoulder works, and then you get you get problems and the tendons overworking and things like that. So uh the stretching for the shoulder is really important.

Dr. \ 23:20

Yeah, you gotta really take care of every part of your body and keep it all balanced, especially after age 50. Uh my older sister was a college rower, and she's participated in um events all around the country with gold medalists. You know, she wait does weightlifting, and she was really having a lot of trouble with her shoulder. And I'm like, at some point, like, what are you doing? I'm telling her, like, you're just you're really just overworking your shoulders. And she ended up having to have PRP plasma rich um uh injected in. And I guess I had a lot of athletes do that stuff, but she's like wants to get back to rowing. It's just like the people who have joint replacements because they've been excessive runners or very athletic, and then they just want to keep on on doing it. So I'm sure you have so many patients of varying backgrounds and interests, but some of these people with that exercise high and they've done that, they just want to keep doing it.

SPEAKER_01 24:13

I'm guilty myself. I've played soccer my whole life. I finally retired in 60s, so I'm as guilty as everybody else.

Dr. \ 24:19

Yeah, and it's like, you know, the body can only take so much of a beating. But when I see women with uh frozen shoulder, of course, I always assess them for estrogen, and estrogen helps the bones. Um you know, there's estrogen receptors in cartilage. Women on estrogen replacement therapy, they have a slower progression for knee arthritis, even though it's not going to prevent it. But that may be later on that they might need a knee replacement, which is about 10% of the female population, so it's a lot. Um, diabetes is another thing that's associated with frozen shoulder. But I've seen some patients who've let it go so long that they have to go under anesthesia and have like, is it the adhesions broken up? Is that what's done?

SPEAKER_01 25:00

Yeah, and there's a um they're starting to actually also go in and cut the little adhesions. Um, there's a couple surgeons in our area that do that. They they put them to sleep, cut the cut them, manipulate them, then they send them to therapy while the arm is still numb. And you can move that arm any which way. You can just hear these adhesions breaking. Ooh. But um, some people they have other medical issues, you know, MS or complications where they really can't ever get the thing stretched out. Um,

Tendon Healing Through Smart Loading

SPEAKER_01 25:30

those that's a really good option for people. And I've seen those, I've not seen one not do well so far.

Dr. \ 25:34

Interesting. Now, uh, I did a podcast on red light therapy, which is kind of all the rage. Are are you u using that as junctively with physical therapy, telling people to get that for the increased blood flow? Because obviously tendons and ligaments don't have direct blood vessels. So obviously, movement of the muscle gets the blood going, and obviously good nutrition, et cetera, and taking care of other underlying medical problems. But I'm wondering, tendons are so slow to heal. I mean, it can just be such a bite.

SPEAKER_01 26:06

Yeah, tendons there's been a lot of increased understanding on tendons. The the paradigm now is really saying if you load it too much, you blow it up. If you don't load at all, it never remodels and becomes normal tendons again. So a tendon out, tendon ice is really scar tissue in the tendon. So we have to remodel that collagen so it it becomes normal movement again. So what we're doing, we're finding a lot of people really isometrics are and maybe up to half of the tendonitis are really the best way to load that tendon. So you start a patient, for example, just maybe with like 10 seconds a couple times a day. The next day, if they're more sore, then you back them down in half. If they're not, if they're about the same or a little better, you slowly bump their hold times, and we've been moving up to two and three minute holds. And that's been a big help in just kind of thinking of tenants, see how you are the next day, because load is always the problem. So how you feel the next day determines if you if we overdid it, and if we did, then we got it back down. If we didn't, then we want to keep keep loading it so that tendon can remodel. And um that that principle of loading the tendons is is really good, and it's really helped us um get these tendonitis better, faster. And of course, looking at the mechanics for the lower extremity, my good friend Chris Powers, he's a PhD at USC, and he really thinks overall, like for lower extremity tendons in the knees and the ankle, the glutes just aren't working enough. So, you know, the glutes, you're big muscles. So mechanically, he thinks your calf or your quads are doing way too much. So we use a lot of his concepts as well, where you're trying to get the glute to do more work, um, especially when runners, having them lean forward a little bit, do a lot of glute training, and get their glute to do the work rather than the the uh ankle or the the knee, which is getting overburdened, which is why it's one of the reasons it has a tendon, I use from overuse.

Dr. \ 27:56

Fascinating. Boy, you're just making me want to go to the gym right now and start activating my muscles. I was having some hip problems a few years ago, and when I went to a physical therapist, I was shocked at how weak my glute uh minimus and and medius were. I just thought, oh, I got a big butt, I got big glutes. I I just thought it was perfectly fine, and I was shocked about just how you start overcompensating and using other muscles, and you don't realize it, but then you're actually causing harm on another level.

SPEAKER_01 28:25

Right. And when those abductors are weak, then subtly you have a little drop in your pelvis, and then that forces your femur to rotate in, which affects your knee mechanics and your foot mechanics. So, really getting the glute to work um is really a really important thing for the lower extremity. And for a lot of lower extremity pain, that is really the solution.

Dr. \ 28:44

Interesting. Um, and I I've had uh some acupuncturists on our podcast, and I know that they're really big on doing acupuncture for tendinitis, and it doesn't, I I don't understand how this ancient Chinese uh works, but do you work in conjunction with dry needling and or acupuncture in addition to the physical therapy for people that have a lot of pain?

SPEAKER_01 29:05

Yeah, we do quite a bit of dry needling. So think about it again. If you're this is a normal tendon, on a cell level, you have scar tissue. So the dry needling, the idea is to go in, move the move the needle around and try to break some of these bonds up so that they can remodel. So it's it's on a cell level, um, breaking up those tendons. And like on the shoulder tendon, which is so small, it doesn't really take much needling to get some of those adhesions to break up and then take them after the dry kneeling and start getting them exercising. So I think dry kneeling has uh a good role. We need more research on it, but I think it has a definitely definitely worth trying for a tendon for sure.

Dr. \ 29:40

Uh and I I've done some podcasts on nutritional stuff. People are always asking me about collagen and um, you know, what's the best protein? Whey protein apparently is the only protein that helps with you know human tendon repair. It's just so slow. So you really probably have to do multi-modalities. Now, I have seen some women that are postmenopausal uh get, I don't know if it's a glute tendinosis or some calcium deposits of the tendon. And I was talking with a sports medicine doc, and they're doing like a form of lithotripsy on that tendon to like shock it. Do you have any experience with that?

SPEAKER_01 30:17

Or I have not seen that yet.

Dr. \ 30:19

I am vibrational. I'll have to get them on the podcast. I know that some of these, some of these services, like uh PRP, that's like all out of pocket. And apparently this shock vibrational stuff is is too. So I think people should be proactive and try to get on their problems early. And generally, physical therapy is usually covered by most insurances, right?

SPEAKER_01 30:41

Yeah, physical therapy is yeah, that shockwave therapy. I'm I've not seen it. I'm familiar

Direct Access And Final Takeaways

SPEAKER_01 30:45

with it, but I've not seen it used. I know it's definitely not covered. Um, but it's it's supposedly the the next big thing coming.

Dr. \ 30:52

So can someone just self-refer themselves to you, or do they actually need a clinician, physician, or APP or someone to actually make that referral? How how does that work for patients?

SPEAKER_01 31:02

Yeah, in Ohio, uh anyone can come direct access. And then, like everything else, the insurance decides, you know, if you need a referral or not or not. So for federal Medicare, uh, they still require a referral. Um, but the patient's still allowed to come, but then they just have to get a referral, the plan of care sign basically for Medic for Federal Medicare. But almost all the other insurances don't require a referral at all.

Dr. \ 31:25

Oh, that's very interesting. Well, this has just been so informative. We have to bring you back um for another podcast because there's so many things that we haven't touched on that I want to uh touch on. But I want to thank our listeners for joining us in the Sunflower House. Uh please share this podcast with friends and family. And if you don't already uh subscribe to our podcast, please do. It's just a little click, it's all free. Um, if you want to make a donation to our nonprofit, you can do that on speaking of women's health.com. Uh remember, be strong, be healthy, and be in charge.