Speaking of Women's Health
The Speaking of Women's Health Podcast is excited to bring you credible women's health information from host and Executive Director, Dr. Holly L. Thacker. Dr. Thacker will interview guest clinicians discussing relevant women's health topics and the latest news and tips.
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Speaking of Women's Health
Pelvic Floor Therapy Starts With The Right Diagnosis
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A torn ACL can change a teenager’s life in a single play, and it can echo decades later as arthritis and knee replacements. Speaking of Women's Health Podcast host Dr. Holly Thacker sits down with physical therapist Vince Whalen to talk about why ACL tears hit female athletes so often, why many happen without contact, and how a simple prevention approach can make a measurable difference. Vince breaks down the FIFA Plus routine and the mechanics that matter most: hip control, balance, landing position, and the glute strength that keeps the knee from collapsing into risky alignment.
Pelvic floor therapy is a major focus, especially stress urinary incontinence and chronic pelvic pain. We unpack a key insight: many patients have too much pelvic floor tone, so doing random Kegels can actually worsen symptoms. Vince shares how to find a pelvic floor trained therapist, what to expect if you’re nervous about internal exams, and how telehealth physical therapy can help after an in-person evaluation. They close with the McKenzie Method for back pain, posture habits that drive symptoms, and practical training tips for golfers and active adults.
Welcome Back To Physical Therapy
Dr. \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 another edition of Speaking of Women's Health. And I have a recurring guest who was just so fabulous on the last podcast on physical therapy. It's Vince Whalen. And uh let me remind you about him. He's a seasoned physical therapist that has a wealth of information. And in the last podcast, we talked all about vestibular testing, aging shoulders, balance, um, activating the glutes, trying to stay out of a nursing home. So if you miss that podcast, you have to go back and listen to it. Um, whether you're recovering from surgery or dealing with chronic pain like so many of our patients, uh, or navigating female issues like postpartum changes, uh, midlife women's uh health, physical therapy's really been a game changer. It certainly has been for me and and my family members and so many of my patients. Uh, but before we dive into part two of physical therapy with Vince Whalen, let me tell you a little bit about him. He is the co-founder of Wadsworth Family Physical Therapy with Kathleen Whalen. He attended and graduated physical therapy school at Columbia University, and then he returned to get his doctorate in physical therapy from Regis University. He is McKenzie certified uh for over three decades. And I've done a previous podcast on back pain and sciatica and a little bit about the McKenzie method. Not that I am an expert, but 80% of us have back pain at some point in our life. And when my brother was having trouble, you know, he's a big-time barefoot water skier and competitor and weightlifter, it's like my siblings, they really out outclass me in terms of physical activity. Uh, but he was having problems, so I did that. And really everyone should have an awareness of that. Uh, Vince instructs physical therapy students, he pays it forward. Um, he's also authored a book, and he's an expert in dizziness and vertigo. So, welcome back, Vince. Thanks so much for joining us again.
SPEAKER_00Great to be here again.
Dr. \And in the last podcast, you told us about the services that your team, your large team provides, and how people can access physical therapy directly or through uh referral. Um, what I want to do on this episode is uh talk some specific things about women's health and some of the issues uh that you deal with in women.
Why ACL Tears Hit Girls Hard
Dr. \Um and I remember you previously mentioning uh things about the female knee, and obviously women have a lot of muscle imbalance, a lot of ACL issues. Sometimes it can be menstrually related, or they might be more at risk for injuries. Um tell us about the female knee.
SPEAKER_00Yeah, so ACL is absolutely an epidemic, and um, you know, I played soccer my whole life, so now the guys that tore their ACLs in our 20s and 30s, now they're my total knee patients in our 60s, and and we really need to break this cycle. Um But there is a program called FIFA Plus that was developed in part with by Holly Grinnelli, and it was developed for soccer players, and it's a 20-minute program, two or three days a week. It was found to decrease ACL tears 50% in female soccer players. Um, it's been around for a quarter of a century, and we really need to get that word out. So it's FIFA Plus is the program, and it's basically looking at um how patient how the athlete moves and strengthening their hip muscles, uh, working on their balance, working on really the mechanics, um, avoiding the positions that tear ACLs. A lot of these ACLs are just um non-contact tears. And so that's one thing I really want to emphasize is that prevention, if we can get our coaches to kind of integrate this program more readily into uh the high school um athlete, I think would really help cut the cut the risk. So we know you know the hormones play a role, the pelvis changing plays a role in females. Maybe males are more active a little bit, maybe males are in the gym a little bit longer. But the fact that this program cut the risk for ACLs 50% tells us how important movement patterns and strengthening are to prevent these these horrific injuries. Because you know, they they take a high school girl and they they throw them out of their sport, they lose their social connection. It's really almost always a year to get them fully back to their sport, and and we see way too many ACLs in our office still.
Dr. \My older son's uh girlfriend in high school who was like a really top volleyball player, it really took her out and she had to have surgery, and so I remember kind of reading about that. And is it frequently that their quads are stronger than their hamstrings? And so that puts some in tension on things, or there's definitely muscle imbalance of the problem.
SPEAKER_00You know, the the hamstring does the same thing as the ACL, it keeps the tibia from sliding forward. So strong hamstrings are important, but it kind of gets back into that the weak glutes again where the the fumur is rotating in and then the knee is not lined up for a lot of the activity. You know, how someone lands for a basketball player, if you land with bad mechanics, no matter how strong you are, it doesn't really matter. You're putting abnormal force on your on your joint there. And and in the ACL, you know, in women it runs a little different, it's a little thinner. Um but you know, it's a problem in men as well. So I think really looking at um having these coaches really watch and learn about mechanics, you know, we've learned all we've done this big push for uh concussion, and I think now we need to have this big push for uh the lower extremity injuries in terms of training our coaches.
Kneecap Pain And Glute Strength
Dr. \And and uh what it what is there anything new in patella femoral syndrome? Um I know that's another issue that young girls see tend to have issues with.
SPEAKER_00Right, it's it's um kind of the same movements that get the ACL. You know, your kneecap is supposed to track in a in a groove, and when the femur rotates too much, then the kneecap tracks laterally. And was we start seeing that really in the kids in uh late grade school because their bones have grown so much, but their muscles can't keep up. You know, we always it was always the model in PT was strengthen the quad, strengthen the quad, strengthen the quad. And I think I mentioned a lot last podcast my friend Chris Powers at USC has done all this work on patellophemoral, that's his whole career, and really showing how important glute max, glute medius are, and we really just need to really make sure we're training those uh in our young athletes because when they're weak, that throws the lower mechanics into a bad position and causes, sets it up for ACLs and kneecap issues.
Dr. \Well, I'm so glad I'm learning about this because I just found out I'm expecting my fourth granddaughter. Um and so I I can just tell, just based on their fathers always were very, very athletic, and and uh their mothers are are too. So I think I'm gonna have some tall female athletes in my family, so that will be good information. Um so one of the other issues, of course, that a lot of female athletes get into, depending on their sports, is like the uh female triad syndrome, where they lose too much body fat and they stop their menstrual cycle, so then they don't mineralize their bones. And I think some sports are worse than that than others, like um ballet and and gymnastics or um well, in wrestling. That was the one sport my kids didn't do. I was glad, like trying to make weight, like anything that's too negative about the body weight, I I don't really like. So I imagine as a physical therapist, you must interface with some of those issues.
SPEAKER_00Yes, yes. We always keep you know, the the eating disorders is certainly still uh a big problem with our high school kids. So I think we're we're really concerned and keep and keep an eye on uh on that. And uh, you know, for those problems, we obviously contact their family doctor and get them involved to help us with the nutrition end. But yeah, this uh, you know, our Facebook society is certainly not easy on uh anyone's self-esteem, I think.
Dr. \Yeah, that it that is true. And I think encouraging people at all ages to be physically active, it's good for cognition, it's good for the mood, it's good for socialization, uh for so many for so many things.
Pregnancy Preparation And Postpartum Recovery
Dr. \Um moving into the pregnancy realm, um, I like I often said, I wish I would have gone for physical therapy for just gait and pelvis and strengthening. I had to go after postpartum because of neck pain from breastfeeding, and I really got so uh you know improved by that. Um so you want to tell us about some of the pregnancy or postpartum type type type services or issues that you see females getting into?
SPEAKER_00Yeah, so our public therapists um are big fans of getting um women in before delivery to uh show them how to stretch and strengthen up their muscles to help them through and kind of educating them on how things are gonna be post-stop or post-delivery, hopefully not post-stop, what to strengthen, what to stretch, and then post stop or for post-stop after a um history uh uh fat section. Sorry. Yes, after a C section. You can tell this is not my area. Um then obviously they're working the scars and trying to teach them how to get the abdominal muscles strengthened up again. The SI joint is you know 70% more common in females, and you know, with pregnancy, a lot of times during pregnancy, the SI joint is very painful as as the body changes. So a lot of times they'll use maternal maternity SI belts to help support that. They find that helpful. And then um after birth, uh there's often a lot of SI joint work and teaching them how to strengthen everything back up so that they um you know don't have issues. So many women, you know, when as we're talking to them, you know, my backstory after delivery, and so we had our pelvic health program, really, there was they they just live with it for the for years and years um because a lot of a lot of it was SI joint pain that was never addressed.
Dr. \Yeah, that is just terrible. Um, and also diastasis recti because you know, of course, the expanding baby, you know, some women have twins, even triplets, you know, it just like pulls that muscle apart. So um I imagine like some sort of modified sit-ups to strengthen the abs to kind of get that back in shape.
SPEAKER_00Yeah, that deep transverse abdominus is uh that's your deep abdominal muscles. A lot of times when you're doing crunches and sit-ups, you're really just pulling that abdominal wall apart. Um, the pelvic therapists really work on trying to get that deep abdominal muscle um to strengthen up to prevent that from getting worse. And often they do very well and they tighten
Pelvic Floor Tone And Leaking
SPEAKER_00back up.
Dr. \Now, another problem that women have with aging and also pregnancy and trauma to the pelvic floor, of course, is stress urinary incontinence. Like I'm always telling women, well, you know, when you have a vagina, that's a hole in your pelvic floor, so you don't have as much support for the bladder neck. And obviously there's gravity, there's aging, you know, weight gain, pregnancy, trauma can all affect that. And then there's genetic factors I think that affect uh other connective tissue support. So a lot of women think it's normal to leak when they cough or sneeze, which of course it's not normal. And if they're doing physical activity like running or jumping, that puts more uh stress on the pelvic floor. So, do you want to talk about some of the pelvic floor services that your team offers?
SPEAKER_00Yeah, talking to our pelvic floor therapist, they said really there's kind of two big categories of pelvic floor problems. One is there's too much tone, too much tightness.
Dr. \Yes.
SPEAKER_00And then the other ones that don't have enough tone and not enough tightness. So the people that have too much tone, doing kaggles is only going to feed into the problem and make it worse. They're good for the people with low tone. So you really got to figure out, you know, your body to urinate and to perform, it has to be able to relax some muscles in order for that to happen. So they really feel like most of their patients have too much tone on their pelvic floor. So they're working on techniques to try to decrease that tone. Um, a lot of times the hip flexors are tight. Uh, if they've had any abdominal scarring, even up higher, can can tighten things down low. Uh, stretching their hips uh becomes pretty important. So it's it's pretty important that you you get evaluated before you I think just start randomly doing kegel exercises.
Dr. \That's a that's a great, a great point, I think. And one thing that I tell my patients, and I have some terrific uh nurse practitioners, APPs in my practice who help me, you know, by doing routine exams so that I can do the consults. Uh but when I do do a pelvic exam and how I taught the nurse practitioners, and I tell my patients, you know, wherever you're getting your routine gynecologic care, the person who's doing your full pelvic exam shouldn't just be vaginal. You also need rectal because you need to feel that whole pelvic uh floor should assess to know if you even know how to do a Kegel correctly. Because I would say about 10 to even up to 20% of women don't even know how to activate their pelvic floor. Those are the muscles that contract with climax, uh, those are the muscles that either contract to stop urination or relax. Uh and some people just aren't wired to know how to do that, even they though they may be very, very athletic. Um, on the other hand, a lot of women because of trauma or endometriosis or surgery or sexual assault, you know, falling on a bike as a young child, pelvic fractures, a lot of different things that can happen can have a lot of tenseness, a lot of muscle spasm. And like you said, that can even affect the gait, the bowel function, the bladder function, uh, and certainly a vexing problem that some women you know deal with. And I didn't realize it was that difficult until I was uh reading a chronic pelvic pain book that one of uh my colleagues had recommended, that uh a pretty decent percent of women post-delivery have chronic pain, chronic pelvic pain. And so I you want to talk a little bit about how someone can find a physical therapist that's trained in the female pelvis and what some of those caveats are.
SPEAKER_00Yeah, I think if you go into the there's definitely a women's health section in the American Physical Therapy Association, so you can go to their website and find find therapists that do women's health. It's definitely a very unique specialty. You know, there's a lot of things we can all do, but definitely the pelvic floor patients, you know, we have two therapists that do that, and those are the only two that have the skill. Um, so it's important you find someone that does that. And both both of our pelvic floor therapists wanted me to emphasize that um internal exams often keep people from coming to therapy because they're they're afraid of how painful it's gonna be, how awkward it is. And they just wanted us me to really reassure everyone that they can still get better without having that done. And you know, we can start start with some exercises, and a lot of people never even need to have that um done to them if they're not comfortable, can still get benefit. Um, so that was one of the big emphasis. So I think you just gotta really find um, you know, this is not something that just a random therapist can do. You gotta find someone who actually um has advanced training because that it's really not taught in schools, it's it's just touched over, but the the instruction is really postgraduate for for the uh pelvic exams.
Finding Pelvic PT And Telehealth Options
Dr. \So upper level. So you have been listening to the Speaking of Women's Health podcast, and I am your host, Dr. Holly Thacker, in the Sunflower House with a recurrent guest, physical therapist, Vince Whalen. And we've talked about female athlete triad, knee problems in young athletes, the importance of the glutes. Uh we've kind of moved into the pregnancy, postpartum realm, chronic pelvic pain. Uh we had a prior podcast with uh minimally invasive surgeon and chronic pelvic pain specialist Dr. Ashley Goobel. So if there's any listeners uh that have dealt with uh chronic pelvic pain and poodental neuralgia, endometriosis, that's a good podcast to go back to listen to. And I hope to have her back again on um our podcast. Uh I would say that one of the points that she made, because she sees patients come from all over the country and all over to see her, and in a lot of rural areas uh or underserved areas, there's not a good um pelvic physical therapist. So, like what do you do? Do you have patients come from far away for like an initial assessment? And then can your therapist communicate with a general therapist? You know, um are there ways to give them the program that they can do, or is there any remote access or virtual physical therapy? I'm wondering.
SPEAKER_00Yes, um, actually uh remote physical therapy is covered uh still. And so usually the evaluation needs to be done at least in person, but then after that, a lot of the coaching can be done remotely for sure. But there is definitely a tremendous need for uh public health. And and you know, men have these issues also after prostate and um so it's in that area is super underserved. You know, there's hardly any men doing this, um, which is something our profession I think really needs to work on. As a lot of men would be more comfortable going to another male.
Dr. \Absolutely. Yeah, I know that the clinic only has one male physical therapist of in the whole system here in Northeast Ohio who's trained in the the male pelvis, but obviously with I would think radical prostatectomies or trauma or excessive, you know, bicycling, you know, can obviously injure the pudental nerve, which comes out in a number of different areas. Do your physical therapist um use TENS units or biofeedback to try to help teach the person uh how to control some of these muscles that aren't fully under conscious control?
SPEAKER_00Uh yeah, yep, they do. They use biofeedback and uh I don't think it's much tens units, but definitely biofeedback is is a pretty big part of what they do. Especially with patients that have too much tone.
Dr. \Now, I I know with certain chronic pelvic pain, um Dr. Goobels was talking about like trying to figure out if it is it pelvis from inside the pelvis, or is it actually back related? And how I don't know if there's some AI that people look at. Do you have any comments about patients using AI to try to figure out what their musculoskeletal problem is? I'm curious.
SPEAKER_00Um, you know, AI is you know, we had Dr. Google before, now we have Dr. AI. Dr. AI is definitely better than Dr. Google. Um, so you know, I think an educated patient is is a great thing. And then if they bring that to us and we talk about it and share it, I think I think it it's I think it's been overall a good thing so far. You know. Um with with the pelvic floor, you know, the the referral patterns, the the higher lumbar nerves refer into the pelvis. Like L1, you know, goes into the groin, uh T12 goes just above that area, the hip refers to the groins. A lot of the a lot of the people that are pelvic floor really are referred pain from the spine or from the hip. So a lot of times the patient will call saying, Well, I haven't this groin pain. Well, it really turns out they have a really bad hip or they have a lumbar issue. All that has to kind of get sorted out. Um and obviously a stiff hip, you know, is a problem with uh sexual function for a lot of women. An arthritic hip can get in the way. Um so sometimes uh the biggest thing we're doing is really identifying what their pain generator is and then getting them on the right path.
McKenzie Method For Back Pain Control
Dr. \Excellent, excellent. Now, um I think we should probably move into chronic back pain and and McKenzie in one of your uh also your areas of expertise. Tell us what is the McKenzie uh method? Should everybody know about it or just people that have back problems?
SPEAKER_00So McKenzie um started this this uh the system in 1956 in New Zealand for the for the lumbar spine. He kind of switched the paradigm from physical therapy. Originally it was everything was a muscle, so treatment was really heat, massage, stem was really the cornerstone of what we did. He got to start thinking about the discs and the joints and really looking at how different movements and postures impacted pain. So he took this idea and had people do repeated movements, repeated uh static postures, and see if they could figure out what where the problem was coming from, and from there, how to treat it. And from there, most importantly, which is the great thing about Mackenzie, is how to prevent it and how to deal with future episodes. So it's a really empowering system. So often, you know, we could go in and um you know do a manual skill to fix the patient, but then they're really not learning how to take care of their spine. So, really, the initial visit for McKenzie's really trying to teach them the movements to get their pain under control. In most cases, we're not laying hands on the first day. At some points, we do to help them get over the hump. Uh, but that's really the genius of Mackenzie, is teaching you why you got here. You know, are you sitting wrong in your car? Are you lifting wrong? You know, what's really causing your pain is is the cornerstone. And then from there, um, the treatment is pretty obvious. And then a lot of people just need a little bit of maintenance. A lot of our people, you know, with disc bulge and stuff, they need to take care of their backs, like they take care of their teeth and do a little bit of stretching in the morning and evenings, and then they they do very well. Or if they know they've been on a long car ride, they gotta counteract that with some stretching. So now it really now the system's in 40 countries, and we use it on the neck and the extremities, the SI joint. So it's really a whole body approach now to physical therapy.
Dr. \Boy, that is really um fascinating. And uh for people who don't have any back or neck problems, although I'm sure a lot of people are going to get there, uh everybody's always down looking at their stupid phone all the time. Um should people be proactive because chronic back pain is such a a problem, like in terms of doing work to to stabilize those core muscles? Because a lot of people have we weak muscles and don't even know it, right?
SPEAKER_00Right. Core strengthening is obviously really important for prevention. But Kenzie Pro interesting is really not that big on strengthening, um, but it was developed really with a blue collar population in New Zealand, so you know. These people were lifting. It's our our American, you know, modern day system is a little different that way. That's one of the weaknesses of McKenzie. It's not really a big emphasis on core strengthening at all, but a really big emphasis on static posture. He thinks really overall the theory is that all this rounded forward head posture is what's getting most of us in trouble, that we were never designed to be sitting like this. And obviously, we're sitting even more now than when he first developed the system. So static posture is one of his big uh cornerstones of treatment. So trying to have a little bit of an arch in your back, your chest up, and your chin in is uh a really important part of the McKenzie system for for most people. As you get the older population, they start getting into stenosis. Then we kind of actually tell them to round up a little bit and walk a little flex. It it works once you get into the later years and stenosis becomes a problem, that narrowing of the spine, then we switch paradigms a little bit on that.
Dr. \Interesting. Yeah, that certainly can be a problem. I have some patients with cervical myelopathy, and if they have a lot of arthritis at the upper part of their spine, that controls the whole rest of their body and balance. And I know in the last podcast we talked about uh assessing for balance or or dynamically improving people's vestibular system to reduce falling.
Practical Training Tips For Golf
Dr. \So I uh as you know, I love golf, and so I'm I gotta get ready. I gotta get ready for the golf season. So are there any specific things I should or shouldn't be doing to kind of get that spinal flexibility and get that swing going?
SPEAKER_00You know, certainly strengthening the core and lower body is really important. In golf, you know, it's it's you know, we're all no one golfs both-handed. Everyone has either right or left-handed golfer. So if you think about it, if you're a right-handed golfer, you're always twisting left. So over time, you're probably gonna need some work stretching the other direction. Okay. So trunk rotation is really important to keep that symmetrical. So one of my uh one of our therapists, uh Mansky, really wants to be a pro golfing instructor, and he's really into it. But that's really he really has them flex over in the golf position and really sees how well they they rotate, and almost invariably they're blocked the opposite way that they swing. So kind of for prevention, going the other direction. It's also a lot of force on your knees. Um, your inner thigh muscles are really important for golf, actually. That's the one sport is you transfer your weight to your adductors. So um getting those strong is really helpful. And then, you know, those golf carts I always go back to. But you know, I always go with my kids and they bounce me around like nothing. So trying to keep your posture good on the golf cart, I think is really important. And probably the less you're in that thing getting bounced around. I almost think the golf cart sometimes is harder than the game, at least when I go with my kids.
Dr. \My husband always complains about my driving, but of course, some of his driving, he's flown flung me out of the golf cart one time making a turn. Those golf carts can really be quite dangerous.
SPEAKER_00They can be. They need to get better shocks on those, I think.
Dr. \And and so any other tips for any other specific kind of um physical activity, like something, any tips for swimmers or bowlers or walkers or hikers or um any anyway.
SPEAKER_00Like in terms of lower extremities, so the hip flexors are almost always what is getting tight on us. Those are the muscles in front of your thighs. So trying to stretch those out. Almost anyone who's doing any lower extremity activities, biking, any anything that's rounding, your hip flexors, unless you have a job where you're standing and leaning backwards, get tight. So stretching your hip flexors, I think, is probably the biggest muscle that we stretch for sure. Um, and then for your shoulders, you know, we we talked about the rotation, strengthening that up, and then making sure you keep your shoulder mobility in all directions. People kind of forget about reaching across the front of them. Um for golfers, they often get tight this way. Tennis players get tight there. Uh, we actually do see a lot of tennis players, and I think when you're doing your strengthening, you know, the shoulder is not designed to work when you're rounded up. So when you're doing your workouts with your shoulders, mechanically get your chest up and really make sure that you're that automatically puts your shoulders in a good position so you're strengthening it in the way it's designed to move. So any upper extremity strengthening that becomes super important. And then I think no, go ahead. I was gonna say, you know, if you're doing a lot of rounding, a lot of abs, then most people then need to follow that with a little bit of backwards stretching. So we have a lot of people, you know, in January they start working out, they're doing a million crunches, and now that's hard on the discs. So if you follow that with a little bit of backwards um stretching, that would uh really really help you out, I think.
Dr. \So uh so important. There's so many areas to to work on and balance. I do tell my patients that I think the older they get, it's important to stretch before and after exercise. Would you would you endorse that?
SPEAKER_00I agree. I agree, yes.
Dr. \That that is uh something. And uh any any final thoughts? Um, any how people can contact you, contact your staff? Is there any social media or any resources that you think it would be good for our listeners to know about?
SPEAKER_00Uh we do, yeah. If you type in Wadja Family Physical Therapy, we do have a website that um gives us all the contact information. Depending on what's wrong with you, you know, each one of our therapists is an athletic trainer, so we kind of try to steer you into someone who um is skilled in what in what your problem is. You know, everyone can all do the basic things, but uh we see a lot of failed therapies, so then we try to tape get those people onto the therapist that um has ex extra skill in that area.
Dr. \That's very helpful. And any comments about um I I know that there's a lot of Instagram influencers that you know put out all these little, oh, do this, you know, do this exercise or do this or do that. Any any any comments about that?
SPEAKER_00Um I think some of that stuff is it's interesting to watch. Uh some of it's yeah, entertaining, some of it's quite good, and then some of it's not. Um but I think you know, overall the person has their doctor in physical therapy that I think a lot of those people have a lot of a lot of good suggestions and a lot of a lot of good ideas.
Dr. \Yeah, a lot of interesting YouTube channels um and orthopedic orthopedic channels that I I found. So you I think you were telling me about shoulder replacements in terms of like rotator cuff tears, that that they're they're getting better, so people are going to that faster.
Faster Recovery With Modern Shoulder Replacements
Dr. \Did I hear that right?
SPEAKER_00Yes, yes. Yeah, you know, the rotator cuff um for those big tears are in slings, you know, six and eight weeks, and then they can only move it a little bit, and they're really it's a very, very long process. The total shoulders um for those people that are kind of borderline, they're getting active much faster. They cut 110 in the subscapularis. We have to protect that for about four, four to six weeks, and then people are getting active much quicker. Uh, they really got that down. There, they did that reversal of the ball and socket when they put the shoulder replacement in. Uh, you know, if you're 20, obviously it's not the idea. But for a lot of the patients in their 60s, you know, we're not gonna live forever. How much time do you want to spend on the shoulder? And really, the old design of the total shoulder, all we were trying to do is relieve pain. The new design really were getting their function back to normal. So at the end of the day, there's not a big difference between the total shoulder and the rotator cuff repair in terms of what they can do.
Dr. \So fascinating. Well, thank you so much for joining us, and thanks to our listeners for joining us. Uh, please give us a five-star rating. If you don't already subscribe, you can follow us on Spotify, uh, Apple Podcasts, Amazon Music, wherever you listen to podcasts. Um, forward it to friends. If there's any other topics you want us to cover, let us know. Uh, you can email us on speaking at women's health.com under the contact us portion. And we'll be back next week with another episode. Until then, remember be strong, be healthy, and be in charge.
