Why Pelvic Floor Strength Matters with Michelle Murphy

We sit down with pelvic health physiotherapist Michelle Murphy to talk about how pelvic floor function links to strength, pain, hormones, and confidence across the lifespan. We challenge the “fix me” mindset and map a practical path from isolated pelvic floor work to real-world lifting, running, and living well. 

• mental health concerns in a fast-changing online world 
• learning to read what patients mean beneath words 
• Michelle’s path from hospital physio to pelvic health 
• why pelvic floor dysfunction is under-taught and under-discussed 
• how physiotherapy shifts from manual fixing to resilience building 
• managing expectations when people want a quick fix 
• using language carefully around scans and diagnoses 
• coaching older women through prolapse and incontinence with realistic goals 
• what the evidence says about pelvic floor muscle training outcomes 
• integrating pelvic floor cues into squats, deadlifts, and impact work 
• knowing scope and building referral networks with trusted coaches 
• men’s pelvic health needs after prostate cancer surgery 
• signs of pelvic floor overactivity and pelvic pain 
• what preventative musculoskeletal health could change at scale 

Don’t overthink it. Just start, just do something small. Go and see a pelvic health physiotherapist, even if you’re not sure about issues or not.

Transcript

Welcome And Guest Introduction

SPEAKER_00 0:01

Welcome, ladies and gentlemen, back to the Science of Fitness podcast. And today I have a fellow practitioner, if you will, Michelle Murphy, all the way from Western Australia, sitting in beautiful Perth. Michelle, how are you?

SPEAKER_01 0:13

I'm really well, thank you. Very excited to be here.

Mental Health And Modern Childhood

SPEAKER_00 0:16

Very excited to have you. And uh thank you very much for for jumping on today. So you're probably third or fourth physiotherapist we've had um on the show. Uh and uh I think it's sort of particularly this topic around pelvic health, which is probably going to be the main thing we we speak about today. It's um certainly emerging and I guess the importance from an overall longitudinal health perspective. Um, it's one of the most sort of important things for for anyone to be conscious of. So I'm sure there's plenty for people to learn. But before we sink our teeth into what you do as a professional, um, I want to get to know more about you as a person. So the person behind the practitioner. Um, first few questions that I ask everybody that comes under this podcast. Um, we'll start off with the first one. If you could change one thing about the world, what would it be?

SPEAKER_01 1:04

Look, I have to confess I I hate this question because it just sent me down rabbit holes and rabbit holes of, well, if you were going to change that, then you'd have to change that and then you'd have to change that. But um I I think um it would have to be something around mental health. So it obviously had to be something health, but I think uh we're in a world where things are becoming so much easier from a labor perspective, but mental health in our communities just continues to deteriorate at an alarming rate. And as a mother of two young children, I find this unprecedented um access to the internet, to social media, to um cyberbullying, to artificial intelligence, it's it's it's scary to navigate. And I think as a parent and as someone who has navigated life into my 40s now, I feel pretty well equipped to deal with the rapid rate of change and what life is sort of throwing at us. But um, yeah, I do worry for for my kids and and for children in in general.

Reading People Beneath Their Words

SPEAKER_00 2:12

Absolutely. It's pretty hard to sort of comprehend um, particularly that rapid rate of change, as you're saying, in terms of yeah, uh the internet and the phone. Um, you know, I was managed lucky enough that it was just coming in in my last few years of school, but uh essentially dodged a bullet, um, particularly the social media side of things, it hardly existed. So yeah, I can I can't even begin to imagine what it's like as a you know 12, 13, 14-year-old trying to navigate all of that, it'd be uh it'd have its challenges, which is pretty obvious in the data at the very least. Um, second question. If there's one skill that you've developed professionally over the last 18 plus years, um, what what really stands out? What did you walk into your career thinking, you know, nothing of it, and then you've really had to develop the skill?

SPEAKER_01 2:56

Yeah, I think it would be my witchy abilities to read people. So um, you know, call me psychic. Um I have a really good ability to read what people are saying uh beneath what they are saying, if that makes sense. So I think uh the more people you work with and the more people you talk with, you quickly realize that what they're saying with their words is often not what they actually mean underneath that. And by working with people for so many years, you can start to actually read what someone is going through. And it's an amazing skill because it allows you to disarm people in a way very, very early on. So if they're saying, oh yeah, I just want to, you know, get a bit stronger or a bit fitter or what have you, and you're like, that's not actually the the pain point, um, then you can really cut through the crap a lot quicker and develop that deeper connection that can allow you to co-create what a pathway to recovery or whatever their goals might be. So yeah, you know, I frequently see it in postnatal women, for example. They'll sit down and I can tell straight away those that are that are coping and those that aren't by how they sit down, how they smile, how they say, Yeah, I'm fine. I'm fine. And sometimes I might just gently say, It's okay if you're not fine. Um, and that will, you know, open the floodgates. Similarly with men who've just been diagnosed with prostate cancer, I find um, you know, men, particularly in their 60s, so that generation, 60s, 70s, um have a bit of a reputation for being quite stoic and will often sit down and go, Yeah, yeah, it's fine, good. Yep, just need to know what I need to do. Um, and you can very quickly um disarm them in a way that allows them to be vulnerable and that opens a window opportunity for true connection and um and creating a safe space to work together towards what is lying underneath, if that makes sense.

SPEAKER_00 5:07

Absolutely. It's um you're not the first physio, particularly female physio that's said that, um, that I've heard that, and and yes, some some of the more well-respected physios that I've worked with sort of say the same thing in their own words. And and and I have actually heard the witchy abilities, like, I don't know, she's a bit of a witch, she gets it. Um and it's true. And I think uh, you know, I can imagine physio as a practice, you're also working with people in pain. Um, and there's a degree of vulnerability that someone needs to show to help you potentially resolve that um and help them navigate it. And you know, you as a practitioner, this is this stuff's unquantifiable. We can't put science and evidence behind it. Uh, but it is a very big part of of what you do, I'm sure, particularly in the pelvic health space, which is an even more vulnerable area for a lot of people.

SPEAKER_01 5:56

Yeah, you get very good at digging deep um pretty quick. It does make me pretty rubbish at small talk. So, you know, the school mum talk before school, I'm I'm pretty crap at it because I'm just like, let's go deep and let's go deep quick.

SPEAKER_00 6:10

Yep, yep. I'm with you. I've been there. I actually I'm I'm I'm very much the same. And you know, from my lens, it's a little bit more of a strength conditioning and performance perspective, but you know, people of all ages and there's always a degree of pain or a degree of vulnerability that's motivating them to want to make this change. Um, but yeah, you do you hone in on those skills really quickly because at the end of the day you want to make a difference and you want to help. Um, but you've got to kind of peel back the layers, and it gets a bit what feels messy for the person. But um, I guess if you're the practitioner on the other side, and I know we're sort of going off topic already, but that's where I want to go. Um the managing the judgment and the I guess the load or the psychological or cognitive load that comes with that, like is that something that you are pretty okay with? You sort of go, listen, this is me just facilitating the space for you and you can handle it and let it go, or how how have you worked with that as you've developed your skills?

SPEAKER_01 7:02

Yeah, that's a really good question because obviously mental load and burnout, um, emotional load, particularly in the pelvic health space, is a bit of an issue. Um, you know, if you are dealing with um really private, stigmatized issues, and you have worked hard to create that rapport in that space, then you do get a get to a point where people are really unloading, and it could be about everything relationships, sex, how you poo, how you wee, you know, what happened when you weed in public, you know, all of these really um sensitive things, which is beautiful and it's a privilege to be able to have that safe relationship with people. But yeah, it can take its toll. I'm I'm really good at that now, to be really frank. I um my boundaries are strong and I've really worked hard to um build those boundaries in every aspect of my life, being busy. I'm sure you can um relate, um, juggling a million things. I've had to be really strong about um, how my time and energy are spent, but also um my capacity to give and empathize, but without allowing it to um impact my own emotional or mental health. But it is it is something you have to actively work on. And I think mentorship is really important for that. So certainly over my career, there's been many mentors that have helped coach me through some of the more challenging phases, and I now strive to obviously be a mentor for not only my staff at the clinic um, but other health professionals more broadly as well.

From Hospital Physio To Pelvic Health

SPEAKER_00 8:39

Yep, amazing. So let's take a step back. Let's give everyone listening a little bit of context about um who Michelle Murphy, the physiotherapist, is. Um, talk us through, I guess, yeah, the start of your journey. You probably finished school and went, what am I doing? And were you pretty dialed in as to what you wanted to do? And then, yeah, all the way up to now. I mean, you've been a practitioner for 18 plus years. Run us through it.

SPEAKER_01 9:03

Yeah, so uh when I went through um high school, I wanted to be a dolphin trainer, and it really wasn't until I hit my T and I was getting pretty good. It was called T E then was getting pretty good marks, and I thought I should take advantage of that. So I looked through the TISC book that had all the courses and um decided physio would be a good one because I wanted to um work with the West Coast Eagles. So very immature career goals, if I'm really honest. Um, and uh then uh it I I went into private practice and quickly realized that um it was actually really, really hard work physically. Um a little bit embarrassed to say it, but I I'm quite um petite. I wasn't particularly strong in my arms and hands when I first started my career. And I was going home from uh private practice um with just my hands and thumbs just aching. And um, so I pivoted it into hospital work. I worked in hospital for 10 years across a broad uh spectrum of clinical specialties, ended up um deputy head of department at Royal Perth, had my son, well, fell pregnant with my son, and then that really was where I pivoted into pelvic health, which is a common tale, to be honest. I think, you know, as a um blessed to be, you know, healthy and proactive as well, of always have been around my health, but um it had never been on my radar before pelvic floor dysfunction, if I'm completely honest. It's not something you get a great deal of training about in the undergraduate degree. So my training, my initial training in pelvic health was through the school of life. Um, so yeah, pregnancy, childbirth, postnatal recovery, uh, and then some hormonal roller coaster rides afterwards really opened my eyes to A, the really tumultuous time that this is for women, and B, just how little information there was, support. I really felt a bit lost. And as a very health literate health professional, I was like, if I am finding this really hard to navigate and find support with, then what is the average person who doesn't have training or knowledge in the health space, how do they navigate this? And it was a bit terrifying in some ways, and so that really drove me because I thought I can um I can be an informed uh health professional in this space who can provide perhaps what I didn't get at times where I could have um could have had some more support.

How Physiotherapy Has Evolved

SPEAKER_00 11:36

Yeah, totally amazing. Um it's it's funny, and you know, you're not the first person that I've heard say that. And I think it sort of goes not just pelvic health, but it's obvious it's one of the main ones where we're going, hang on a minute. I am a practitioner, I am involved in this space, and oh geez, I don't feel like there's many corners I haven't like not looked at, but there's no answers for these certain areas that I'm navigating. So yeah, it's um it's it's it's pretty funny. And I think that evolution of physiotherapy as well, um which I'm sure we'll sort of touch on, but that whole, you know, my thumbs are tired and hands are tired to now this really comprehensive understanding of the whole musculoskeletal system. Um talk us through that. Like talk us through what you were doing as a practitioner in you know what, 2000 and 3004, 5, early before 2010, versus what we're probably seeing most physiotherapy practitioners doing now. And then I'll add a second part to that question, but answer the first part.

SPEAKER_01 12:33

Yeah, so yeah, um well picked up. So, you know, it at 20 plus years ago, it was it definitely more structure and impairment based and um manual therapy. Let's find the pain and dysfunction, let's find the tight tissues, the stiff joints, and let's let's fix them. And over time, what's evolved is uh both the evidence and um and how we practice as well. So our understanding of pain and dysfunction, um, it's rarely, rarely, if ever, just about tissue. We now understand load, capacity, nervous system sensitivity, hormone influences, sleep, stress, our belief systems, our past experiences, all of these factors contribute to how people move and how they experience the world, how they experience pain. So physio has definitely shifted from primarily about kind of fixing the injured part and is more now about building resilient, adaptable humans. And at our clinic, that's um something that um we very much embrace. So even if we are talking about pelvic health and we do offer musculoskeletal physio as well at our clinic, but it's not, you know, the pelvic floor is not just a muscle that we need to squeeze in isolation and then off you go. Um, it's part of a pressure system, it's part of a movement system, it's part of our nervous system. Um, and the phases of life that are impactful for the pelvic floor, so obviously pregnancy, postnatal, perimenopause, menopause, these aren't diseases, they are normal physiological phases, but they require intelligent and progressive strength and capacity building to thrive. And I think we still have a way to go in, well, we do, let's be honest, in every in every field of health, in being proactive rather than reactive. But certainly around pelvic health, um, it it's it's an issue that um we've got a lot of work to do still.

Fix Me Thinking And Scan Stories

SPEAKER_00 14:34

Absolutely. Let's so so then the second part to that question is how are you finding navigating that with patients? Because I think, and this is me just sort of anecdotally summarizing it, but the public perception of physiotherapy is still that sort of let's go in and they'll release it. They'll release the pain, they'll put their hand on money and do some needling maybe. Um, and then often people are walking in and getting given exercises and giving actual, you know, strengthening things and consider your whole system and and that sort of changing. So, how do you guys go with navigating that?

SPEAKER_01 15:07

Yeah, it it is a it's a it's a tricky balance. Um and I think one-on-one, there has to be a bit of compromise, to be to be honest, because particularly in private practice, if someone walks in with a very clear expectation of what they are paying for, I believe if you ignore that completely, then you lose the opportunity to um introduce uh more client-initiated progressive change in the future. So you do have to build that rapport and get them on board. And if you see them once and they go, She didn't even touch me, she just told me to go and do stuff, uh, they won't come back. And then you just don't have the opportunity to make change. So, you know, this is something we talk about obviously with our staff, um, around that balance of absolutely, you know, manual therapy techniques, they have their place, they provide short-term relief. Anyone who's had anyone go, oh yeah, that feels really good. You walk out, and you get to, um, you know, with consent, you get to put your hands on someone, and that immediately creates a connection as well. But um, yeah, it it is a tricky balance. I think where I have seen my role more, particularly sort of in the past five to ten years, has been more about how can I and we be more impactful at a broader scale, because one-on-one is sure, that's um that's really important. But now in our social media and our clinic newsletters, and more around how I am trying to sort of increase my visibility, if you will, is around trying to be a part of that broader message because we still, you know, largely want to find that quick fix, that person that can fix us, that answer in a scan, that um simple black and white solution. Um and that narrative, you know, we need to be a part of trying to change that.

SPEAKER_00 17:17

Yeah, yeah, absolutely. I mean, you know, I'd probably be um I'll give you a chance anyway. If you were to sort of pitch a message to the the the patient or the potential patient listening to this that doesn't have the literacy or the luxury of what we do in terms of understanding, oh wow, there's so much more to this. How would you sort of I guess suggest to them in terms of approaching their next or their first physiotherapy appointment if they haven't had one?

SPEAKER_01 17:45

Yeah, so obviously um there's so much nuance and it depends on that patient's journey. But um I I guess a good example is you know, the patient that has come in with a scan that said a uh a specific diagnosis or has um been told something, and this is why language is is so important and how we educate and how we interpret um things like x-rays and scans and whatnot. So I think it has to be gentle, but um it is around honestly, you you have to have some hard love conversations often, but you also have to gently question some of the underlying beliefs. And that can that can take time, but it might be just one little piece of information that you can insert into that session while still keeping them engaged so that you know they'll come back and then you get to to chat more and introduce more. But it might be just, you know, I mean, um, showing them some research around how a scan um could look identical with um uh with very, very different presentations or symptoms. So that might be something to just open their mind and go, huh. Okay, I just really thought I was just, you know, osteoarthritis or prolapse or whatever it might be. I just thought I was broken, damaged, no return. Um yeah, it it's um I think a gentle approach because you you you want to keep them engaged, but it might be just one little piece each session.

SPEAKER_00 19:27

Yeah, and that's just it. It's sort of small little drips start to fill this bucket that um I I like to sort of think of it in this in the lens of um I guess educating the person for lack of a better term. And it's it's it's a weird position, and I'm I'm sure you can probably relate in that, you know, you might have someone that's an accountant and a lawyer, and we tend to operate in a way that goes, oh, my business accountant, I'm just gonna go to the accountant, I'm gonna go to the lawyer for the legal, and oh, I'm gonna go to the physio for the pain. But then we sort of are in, you know, physio or even someone that I'm gonna come to the trainer for my fitness. Um, it's like, hang on, it's yours, and you need to learn about it and you need to learn what works for you. I'm just gonna provide a ability to navigate it, um, and and I guess leaning on what we know, but you're actually gonna have to take care of it. I can't do the reps and sets for you to make you fitter or stronger. You can't simply trigger a shoulder and say, that's it, it's gone, it's gonna be fine now. It's we now know, oh, it's actually how that person understands themselves and takes care of themselves, which makes it sort of hard. It's like, yeah, you know, we we are gonna help you, but you actually need to help yourself ultimately.

SPEAKER_01 20:30

Yeah, it is a whole paradigm shift, which is interesting. Um, because I think that uh yeah, that authoritarian, I need to go somewhere to get fixed. Uh look, unfortunately, it is still prevalent. You know, there there are still plenty of places you can go where they will say, well, you know, you've just got to keep coming in and we'll we'll keep fixing you. But I guess the way I present it is if you want to run, then you have to have the load bearing capacity to run. If you want to lift heavy weights, you have to lift heavy weights. If you want to run after your kids, you need to have load capacity. And the way you build load capacity is by building load capacity. I can't build your load capacity. You have to build it. Um, I guess another good example that I see a lot of is abdominal um separation, abdominal weakness uh after um pregnancy. You know, if we wrap women in cotton wool and say, oh gosh, don't do anything because you might damage um your uh abdominals, goodness me, if we don't do anything, then we're going to get weaker, more than automatically. You know, so it just, you know. Um, but you obviously, yeah, you have to be gentle around how you present that because sometimes you're just like, my God.

SPEAKER_00 21:56

Yeah, yeah. You sort of feel like a cowboy and they they they get. Yeah.

SPEAKER_01 22:01

Yeah, exactly. But if they've been told, Oh, be really cautious, don't, don't do anything. And I I see them at nine months and they've got no tone, no strength, and I'm just like, oh God, okay, we've got a uh we got a bit of work to do. And um this could have started, you know, eight and a half months ago.

Coaching Older Women Through Prolapse

SPEAKER_00 22:17

Absolutely. How do you, you know, sort of help older women navigate that, particularly sort of the strength element? Um, not necessarily the bone loading look at my muscles, which is obviously all the rage right now, um, but the pelvic health strength. They've lacked awareness, they haven't had that sort of education, as you mentioned, you know. Um when you went through, you know, having babies take another at another 20 years before that, you know, people women in their 60s now, it's sort of like they're coming into this phase of life where they're going, oh my gosh, I don't actually know, struggling with pelvic floor prolapse issues. Um, where do you tend to start with them?

SPEAKER_01 22:56

Yeah, it's um it's all too common. And you're absolutely right. Unfortunately, um there are generations where women were not provided with uh any level of educational information to allow them to really make a difference, and as a result, the vulnerabilities are unmasked as they age and with uh the hormone shifts um after menopause. Um I I I really I guess present myself as a coach to them, and it it it's not, you know, I don't give any uh false uh hope that I'm going to be able to magically cure them, but I will talk them through the evidence, I'll talk them through the strategies that we know that can be effective. I'll be very honest. I'll say, you know, if if we want to get on top of this, uh the evidence says that we can, but only if you do this diligently. And that that is backed up with the evidence. You know, if you're doing a couple of ad hoc pelvic squeezes here and there, I'll be very clear you will not see improvement. So um, you know, it it is I'm like, I will be your coach in this space. Um, there will be no judgment, no stigma, but you need to show up and um do the work. And I always I'm generally very confident that we'll see significant improvement. Um, but I'll never talk to them about cure or you are never going to leak again or you're never going to have symptoms again. But um, and you know, there's always the old the best time to start was 20 years ago, the next best time, next best time is right now. So you're here, let's let's get on with it.

SPEAKER_00 24:35

Get into it. Yeah, absolutely. Um and it's a funny thing because I'm sure you've probably anecdotally had experiences where women suddenly are able to manage leakage and great, but then the next person does the same amount of work with the same intent, maybe even better, and isn't. And it's you know, it's really grey in terms of the evidence, in terms of our understanding of that, because you know, some women are in that very position, they'll go to a gynecologist, they'll just be given a diagnosis, it would be you know, looking at hysterectomines and major surgery interventions, um, and then or you know, where do we go? Is there any other hope? What do we understand now after hopefully, you know, a couple of years of research under our belt and hopefully a bit of structure? What do we know?

SPEAKER_01 25:21

Yeah, so I I think we we need to uh base our discussions around prognosis on individualized assessment. So when you look at the broad evidence, so say for example, for stress urinary incontinence, which is very common and very bothersome, um, then the cure rates, so uh subjectively a woman saying, I'm cured, I no longer leak, uh, with pelvic floor muscle training are 50%, which you might go, oh, okay, that's one in two. But that's about um, you know, if you think about the out the positive outcomes after surgery, it's it's not actually that far behind, and you haven't had to have surgery. So um, in terms of risk to the patient, we're always going to encourage conservative, exhausting your conservative management strategies first. In terms of significant improvement, we're up at 72%. So this might be your woman who she's her quality of life is much better. Now, maybe if she's got a full bladder and she does seven sneezes, she experiences a bit of leakage, but she's like, you know what, I'm I'm killing it now. I'm I'm happy. I'm not cured, cured, but I'm but I'm doing well. Um there are ways to assess who is more likely to be in that 72%. And often it does come down to honestly, factors around their birth, so of their obstetric history, rather. So if, for example, they had a significant um pelvic floor uh levator muscle avulsion, that can significantly contribute to structural issues which will unmask um more significant dysfunction in future. And if we can assess that, there's there's, you know, um they're gonna be, they're gonna find it much harder to be in that that 72%. Um, and we can be better then about prognosis, about what their options are. Unfortunately, there aren't amazing options in this space, and that's another whole topic in and of itself. So that woman who we say, yes, you clearly had a pretty severe levator avulsion birthing one of your babies, that was 40 years ago. Can we surgically repair that? No. Um, you know, how much is pelvic floor muscle training going to help? A bit. Yeah, so you know, this is um yeah, this is this is the issue. There are there are women um who are going to fall through the cracks in our current uh treatment options where they hit a ceiling and um, you know, aren't what we would in any way describe as having optimal function.

Returning To Lifting Without Fear

SPEAKER_00 28:07

Speaking of that sort of late stage uh work in terms of Pilates and someone's come in and done, you know, their initial work with a physio with yourself and you need to get them back into the gym. Um how do you sort of start to integrate that work? You know, we can be really isolated from a physio and an initial stage rehab perspective, particularly in pelvic health. How do you sort of start to encourage someone to do a squat, do a lunge, some pulling, some pushing, some of the more compound movements while still being conscious of their, I guess, their pelvic floor work that they've done in terms of I guess integrating that back in?

SPEAKER_01 28:43

Yeah, that's that's a very important part of the puzzle in terms of postnatal recovery, or for anyone who has pelvic floor dysfunction and is building their way back to high load and high impact, which is what we want. So we are very much how do we get you from potentially pulling back a bit, or perhaps your load and resilience has reduced because of something like pregnancy and childbirth? How do we get you back to doing the things that you want to do? So obviously having a structured pathway is important because it gives people that sense of safety. So there is still fear around, you know, if I lift weights, is it going to make my incontinence worse? Is it going to make my prolapse worse? And we need to be changing the narrative around how that is presented, in that if we build resilience into the system, then absolutely you can get back to doing the things that you want to do. But um, again, it's around allaying those fears. So it is a gradual and progressive and supported process. And we would say, for example, here in our rehab gym, um, start to integrate um pelvic floor cues into functional movements, like like squats, like deadlifts. It might start with simple things like bridging, right? So there's actually good research to show that um as long as you know how to do a uh correct pelvic floor contraction, that doing it with a bridge can potentially actually recruit more pelvic floor fibers. So we are not just about sitting in a chair or lying down and squeezing your pelvic floor. That's a starting point, but we need our pelvic floor to be strong and functional in day-to-day life. That is what we are doing this work for. So if we just separate the two, we are doing obviously our clients are disservice. So we would move them through adding more load, adding, even thinking about it in terms of higher impact um activity, because it might even be that education around you cannot squeeze your pelvic floor every time you skip or jump or or run. And just thinking about that bigger picture of how, if we've developed enough strength and resilience in our pelvic floor, we can get back to doing those things, and we don't have to constantly be going squeeze, squeeze, squeeze, squeeze every single step. Um, but to be honest, in our clinical setting, there will be a point where we have to push the uh the babybirds out of the nest, so to speak. And um I, you know, I am not a strength and conditioning coach. Um, there's definitely a point where I'm like, you need the expertise of some brilliant uh coaches, trainers, programs locally that I know, that I have met, that I've gone out and seen. And if you are a clinician listening to this or you have a business, I encourage you to build your networks, understand who in your area is doing good things in this space so that when you make a referral to your clientele, you can say, I know Courtney, she does the Limber Mums program, she's excellent. I know that she will support you through and will communicate and make sure you feel safe in that transition. Renee Kabassi out at Say Yes in Bayswater. I know her, I know what she does is great. Um, we'll again will communic communicate and make sure that you feel safe in that transition. So yeah, it's um it's all it's kind of knowing your scope and also when to uh encourage people out of the nest.

SPEAKER_00 32:06

Yeah, yeah, absolutely. It's funny, like I like to sort of consider that last stage after the gym, the day-to-day, I'm just gonna hop off this rock and you know, land on the floor confidently. It's I call it improvise, you know, it's it's you go from isolate, integrate is is connecting the dots, it's taking the chords of the song and piecing them together back to back to back to back, really consciously concentrating so that when you're on stage performing, you don't have to think. It just does.

SPEAKER_01 32:32

Yes.

SPEAKER_00 32:33

And then and that's the whole idea with it, I guess. Yeah.

SPEAKER_01 32:36

That's a really good idea.

SPEAKER_00 32:38

It's it's it's what our industry needs more of. We need more strength conditioning and exercise physiologists that really understand the nuance of what you guys do. They don't need to be able to teach it, do it, study it, understand the research down to the minutiae, which is important for your role. But they need to know what's happened there and then where they come in in terms of that integrative piece. Um, it's it's I think the biggest hole and the biggest opportunity. And once we solve for that problem, there's you know, abundantly, uh, I'm I'm really confident in what exercise and movement can bring for people for people.

SPEAKER_01 33:13

Yeah, I agree. Yeah, because there is still fear, you know. I still have pregnant women saying I tried to go to a Pilates class and they said I can't come anymore because I'm X weeks pregnant. I'm like, oh gosh, like you're fit strong. Um, let's let's rectify that. But it just comes from a place of not um having that that knowledge, that expertise. Um which yeah, so I agree.

SPEAKER_00 33:36

It's limiting, big time. Um, so that process, and I think for practitioners to understand other physios, other ex-fys, strength conditioning specialists how would you navigate it? You know, I know for me, I say to anyone that's in that early stage or sort of post-rehab stage and back into let's return to sport, but I'm not quite playing, I'm you know, somewhere in the gap. And I say sport, that's just return to life and training confidently. Um I like to say to the practitioners, send a group message, like a text message or you know, something like an email where the I'm CC'd in and the patient's CC'd in. So we all know that, hey, I've been pushed out the nest. Because if you go, here's the number of the trainer up the road, go talk to them. A lot of people still have that fear, and although you've said it, they they may just wait. Um, what do you do in terms of connecting those dots? And and I guess this is more for practitioners listening to this.

SPEAKER_01 34:30

Yeah, absolutely. I mean, me personally, I'm about building relationships, so it's essential, I believe, to not be siloed. So I actually um I I you know go to a lot of effort to put on events, um, collaborate with uh other health and fitness professionals in my local community so that we're on, yeah, we're on a text message basis and we could um yeah, potentially include someone in a group text or you know, be able to confidently email back and forth and and have that conversation. But it it really helps when you know someone more than just um, I don't know, you know, shake hands and an exchange of business cards.

SPEAKER_00 35:14

Yeah, yeah, absolutely. You've trained with them, you've worked with them, you've referred patients to them, and that loop sort of closes. It does, it goes a long way for the patient's outcome, I think is the biggest thing.

SPEAKER_01 35:23

Um yeah, it's it's so valuable, like with anything, isn't it? If you Google something, you're like, oh, I don't know anything about this uh person. So I I won't refer uh unless I know someone. Um, you know, I'm not just gonna look on Google and go, well, I might, but I'll die, I can't vouch for them. I I don't know them.

SPEAKER_00 35:41

Yeah, yeah. Their website looks good, and that's about all we have.

SPEAKER_01 35:44

Yeah. Great website.

SPEAKER_00 35:46

Yeah.

SPEAKER_01 35:47

Or not the great website, and you're like, could yeah, generally they are.

SPEAKER_00 35:53

It sort of goes hand in hand. Um from a strength perspective, you know, what's sort of the biggest misconception around pelvic health and being really strong?

SPEAKER_01 36:02

Yeah, I think honestly, and we've touched on it, but the biggest misconception is is that somehow they're in opposition, um, and this couldn't be further from the truth. So I think strong functional movement protects the pelvic floor. Um, and it empowers women to do what they love, it allows them to feel good in their body. So yeah, I think that misconception that somehow they're like, you know, yeah, in opposition, that if if you're looking after this one, then therefore you can't be doing well in this one when in fact they are extremely complementary.

Men’s Pelvic Health And Prostate Surgery

SPEAKER_00 36:36

And one and the same. Yeah, fantastic. Um, from uh, I guess the male population that you guys work with and approaching the same sort of thing, uh is it is it very much the same? Is it the same approach of like, okay, let's strip back, work in isolation. Maybe someone's coming back from prostate surgery, um, and then we sort of work out from there.

SPEAKER_01 37:00

Yeah, look, it's really interesting, and we are a clinic that does um have a strong focus on on men's health, and the vast majority of patients that we do see are pre- and post-surgery, and that is because those are the patients that are referred to us. Now, it's an interesting side note. I actually went out to a prostate cancer support group meeting last week. They invited me to speak, and I learnt so much. First of all, I was just so delighted that there are support groups out there like this where men were coming together and they were being open and honest about things that are really vulnerable to speak about sexual dysfunction, erectile dysfunction, incontinence. So I I learned a lot about the lived experience of men in a more relaxed setting. So I was just like, oh my goodness, there needs to be so much more awareness and work done around men's health. Anyhow, um, yeah, so I I guess what's different is that for many men, uh, and I'm speaking broadly, but seeking health support doesn't tend to be, doesn't tend to come as naturally. Women tend to be a bit better at uh being proactive, perhaps about seeking health support. So um it can be a very vulnerable time, particularly if cancer is involved. So I find that it is a really unique opportunity, if you will, where men are open to broader lifestyle change. So yeah, we're very holistic and looking at the bigger picture in terms of an opportunity to optimize lifestyle things like alcohol intake, diet, physical activity, bowel and bladder habits, obviously, mental health support, work, stress. So I feel really privileged actually to be able to work with men through this really often challenging time. So obviously, when you're dealing with cancer, there's going to be a high degree of stress and fear. Other conditions that we do work with men with tends to be more related to pelvic pain and uh pelvic floor overactivity. So it's a little less known, awareness is increasing, but about how common overactivity or held tension in the pelvic floor can be, and the problems associated with that, including pain, uh, pain with intercourse, pain with uh defecation, um, which can be really distressing and um impactful on quality of life.

SPEAKER_00 39:35

And that also goes for female patients as well, really active ones.

SPEAKER_01 39:39

Yes, yes, absolutely, yes.

Pelvic Floor Overactivity And Pelvic Pain

SPEAKER_00 39:41

Yep, yep, very interesting. So, yeah, just sort of, I guess, on that topic of um, I guess those hypertonic or hyperactive pelvic flaws, and I guess deep abdominals, you know, as you're saying, you see it present in young males. Um, and and I've definitely seen it, we've got a women's health program that we run here where that was kind of the initial motivation was young, really active, healthy women with the best of intentions were having these sort of excessive pelvic pain type symptoms, particularly in hard training sessions. Um If you were to I don't know it's probably subjective, every individual, but crudely describe how someone might be able to self-assess themselves as they might be struggling with sort of pelvic-related issues, young man or or female, um, in terms of actually being able to calm down the muscles in and around the pelvic floor and the deep abdominals.

SPEAKER_01 40:30

Yeah, well, it's a great question. And it's actually it's very hard to self-assess and self-treat, but um some of the key symptoms are obviously pelvic pain. That isn't uh related to any other specific pathology. So if we saw someone in the clinic, um it might be that we need to send them off to their GP or even a specialist to rule out any sinister pathology. And if that was clear, um, then pelvic pain without pathology is often pelvic floor overactivity. So a pelvic health physio can be a good place to start because we'll be able to tell whether we need to outreach for other assessment. Um, but yeah, pelvic pain, pain with intercourse in men, potentially erectile dysfunction, it can be interrelated with back pain, hip pain, um, muscle tightness, muscle stiffness in this area. And particularly if they have been working on, you know, they've been working on strengthening, they've been working on mobility, stretching, and they're not getting traction. Plus, there's these other symptoms, and that's often the um the tricky thing because if they're not uh connecting those dots, then they're gonna go, well, I've got these issues, but I've also got these issues, and not necessarily making the connection. So that's where I think, you know, that's one of the that's how I found you guys actually. I I um saw the women's health program that you run and then um just sort of saw all the amazing work that you're doing in this space. And um, I'm just really passionate about other people who are doing good things in this space. Um, but I think if you're opening up the conversation, uh then people can start to connect the dots and then they can have awareness and and seek support. So it really comes down to having knowledge and oh, okay, there might be a link here that needs to be uh explored. And you know, um pain with bow movements, like um all of those things can definitely be um higher incidence of UTIs, and this might not necessarily be something they divulge in the gym, but um, they are things that um can start to connect the dots for people.

Why Preventative Health Still Fails Us

SPEAKER_00 42:41

Yep, absolutely. Okay, so I I guess in that context, and this is you know, we're talking about young people, but I guess the overall lens, you know, there's this I like to think, and I live in a bubble and I'm very aware of that. Everyone that I get to work with and see is very healthy and health conscious, and longevity is part of the conversation and preventative mechanisms and you know, what food, what supplements, it's all the time. Yet I think if I were to put myself in, you know, say a hospital type situation, or um, I I guess the general population, it's a very different conversation. But from a proactive as opposed to reactive health mechanism um in an ideal world, um, you know, from a clinical lens, what what does a truly preventative musculoskeletal health model look like? And I know it's a hypothetical thing for you, but how would you, I guess, love to see the system present or at least encourage someone to take that ownership upon themselves, should they have the means?

SPEAKER_01 43:38

Yeah, it's uh it is a systemic problem, and you're right, both you and I do largely live in bubbles. I have worked in hospitals and seen just how uh poorly informed health choices can impact us. So my first rotation at Royal Perth was in the vascular unit, so we're talking poorly controlled diabetes requiring amputations. So um, you know, early 20s. First day on the ward, let's go on a ward round and look at all the amputated limbs. I was like, holy shit, like why? I had no idea diabetes was such a problem. I was like, okay, so you just avoid sugar, don't carb load or what have you. What's the problem? Problem. Um, so so yes, depending on um, you know, uh socioeconomic status, how um how much uh you prioritize health, both uh uh physically, mentally, and financially. Um, and there are many factors that obviously um contribute to how much you can engage, but um it is a it is an absolutely a systemic issue. So our healthcare system is fantastic for emergency care. So I think you know, one of the best in the world. If I've had a car accident, if I've um got a life-threatening condition, I would feel amazing about um the health well, not amazing, but I feel really confident um that the healthcare that I would receive would be, you know, top-notch, um, world class, absolutely. But where we don't do so well is um in our more A persistent conditions, um, persistent pain, mental health, um, and in proactive healthcare. So the model, you know, you can get private health insurance for your ambulance cover and your hospital cover, but it's it's not um it's not really conducive to um being proactive about your health. And until we have systemic models that encourage us from childhood through every phase of life to prevent lifestyle disease, um, then you know, we are in a state of epidemic around lifestyle diseases. It's it's getting worse before it gets better. So yeah, you know, I I don't have any answers other than um uh, you know, I think people like you and I in places of influence need to be trying to do what we do and and getting the message out there and providing that education at every level, whether it be one-on-one with our patients to this level where we're um where we're striving to try and spread that message. And I just think if if you don't have health, you have nothing. So it's not negotiable.

SPEAKER_00 46:22

Totally.

SPEAKER_01 46:23

Um yeah.

The Big Wins Of A Stronger Nation

SPEAKER_00 46:25

It's sort of it's it's actually funny, you know, if you think about it, we've got we've literally got a super system of financial security that is set up to ensure people don't end up paying for lifestyle creep or financial irresponsibility that they may intentionally or not intentionally slip into and they spend their whole career working, suddenly they have nothing for their retirement. So we've got a system in place to protect for that. We are probably sitting here, you know, echo down, cheering down the same echo chamber about the same thing in terms of we need to almost have a super-like system set up for preventative health, which, you know, hopefully one day we do get there. Um let's jump hypothetically. Let's say in 2035, at a you know, macroeconomic, macro government level, we actually are considering these things, they're prioritizing musculoskeletal health and musculoskeletal function as a foundation of preventative health. What early wins would we would we see, um, I guess in the overall health system? And and again, this is hypothetical, but from your experience, you've been in hospital, you've done private practice, you've worked with people that are pre- and post-operative severe situations. What do you think would be looking down the barrel of?

SPEAKER_01 47:33

Yeah, I think the three key changes that we would see if we prioritize musculoskeletal health and strength and that holistic picture would be metabolic health, um, aging, and mental health. So again, you know, we just touched on the impact of diabetes. So um metabolic dysfunction is a big problem. And so many people don't even know that it is a problem. And we are talking about a disease process that can be quite um quietly sinister in the background, and by the time your uh pathology results are screaming at you, it's it's it's trickier to turn that around. So um, if we could see if we could educate about the fact that muscle is a metabolic organ. So having uh good strength improves insulin sensitivity, it improves your uh risk of type 2 diabetes, and it supports healthy body composition. So that I think is is massive. Um, we would see less fragility fractures, osteoporosis in our elderly population, uh, because bone density, tendon resilience, balance would be addressed earlier. Um, and obviously improvements in mental health, which circling right back to how I started, but we know that moving your body, again, I'm I'm preaching to the converted, I know, but movement, physical autonomy, they're connected in with confidence, mood regulation, sleep. Um, so I think they would be, you know, if I was uh pitching to Parliament, I'd be saying, you know, um three quick wins, if you will, that would have um an incredible impact on uh the health of our population at large.

Make Movement Enjoyable And Start Small

SPEAKER_00 49:34

Yeah, absolutely. It's sort of something, you know, I actually get really excited about. And I and and I I would almost love if if if maybe we, you know, I guess as spokesperson, if you will, try trying to encourage this message um could make it an exciting thing. Because I think this is something that everybody needs to understand is that this is not suffering, this is not horrible and hard, and the association of, and I think my end of the spectrum in terms of the industry is failed people. It's either you look this way and you are this person, or you're not, and then if you want to become that person, you've got to sacrifice and you've got to work hard, and it's all these sort of suffering like mechanisms. It's the complete opposite. It is social connection, it's enjoyable, and it's the sense of self-worth. And it doesn't happen after getting really fit and being a certain way, it happens within a session and after it. It happens with this, hey, I practiced my pelvic floor work and I went back to my appointment with Michelle and I did better, and she said, Wow, you've done better, amazing. It it just feels good, and it's something that I think everybody should get excited about, no matter where you are on the spectrum. Um, and then ultimately, as that excitement grows, you know, everybody's momentum is going to go and off we go. So, yeah, you know, speaking to someone like you, it makes me excited. It makes me um excited to again continue to share the message and continue to do what what what we're doing and you know what you are doing so vocally, and I think it's incredibly important. It's obviously incredibly important. Um, but yeah, if anyone is listening to this that has always been contemplating, don't overthink it. Just start, just do something small. Go and go and see a pelvic health physiotherapist, even if you're not sure about issues or not. Um, it's just a wonderful place to start. If I'm teaching anyone to move and train, elite athlete or someone that's you know in their 70s starting for the first time, actually start with breathing and their pelvic floor and their deep abdominals. And it doesn't matter and the amount of elite athletes that have to go back to the beginning and they can't do that. And I'm sure you've seen your fair share, but pelvic health is really the beginning of it all, and and and and its relationship in terms of the way you develop a capacity to move and enjoy moving is the the foundation. So, you know, uh I thank you so much for reaching out um and and getting in touch and um and thank you so much for your time for this conversation. I've certainly had a great time, as uh as uh I'm sure you can probably see. Um, and I think we'll we'll definitely catch up again and and do this once more. Maybe if you find yourself over here on the East Coast or if I find myself on the West Coast, we can we can go again in person.

SPEAKER_01 52:02

Yeah, that sounds great. Look, and I just have to say that was that was so well said. I think you know, we can we can talk about amputations that ain't gonna get people at the gym. Like we've gotta make this exciting, we've gotta make people feel good about moving their body. And you know, it's one of the questions I get asked so often is what is the best type of exercise for me as a physio? You know, what do you prescribe as the best type of exercise for me? And I am like, friend, the best type is the one that you enjoy and that you show up for and that you leave feeling better and vibrant, and you don't leave feeling like a failure. Um, that is the best type of exercise for you, one that is consistent, there what where you wake up and maybe, yeah, it's hard to get up in the morning, but you get up because you know how good you feel once you get home. Um, so thank you for your passion and the work that you do. As I said, big fan. Once I found you, I binged the podcast. And then I was like, I gotta talk to these guys. So yeah, absolutely. I'll definitely have to come over and and see what you guys are doing in person. Um, but yeah, I just um I really admire the work that you're doing and applaud it. And I think the more that we shout this message from the rooftop, then um the better.

SPEAKER_00 53:15

Yeah, absolutely. Appreciate the kind words, Michelle. Thank you very much for your time. And uh we'll definitely chat again.

SPEAKER_01 53:21

My pleasure. Thank you.