AUDIO Epi 6: Why Pelvic Floor Matters for Your Overall Health NOW!

This IPZO facto FULL Episode (Uncovering Mysteries of the Pelvic Floor) features a discussion on the importance of understanding the **pelvic floor**. Many people don't realize the impact of **anatomy** and **muscles** on overall **health**.  Ingrid Harm-Ernandes emphasizes the need for more information and awareness regarding the musculoskeletal system's role in wellness and the innovation techniques for physical assessment and collaborative care that have emerged through discovering the mysteries of the pelvic floor and resolving issues for patients through specialized physical therapy. See below for more resources.  

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Ingrid Harm-Ernandes
Instagram: harmernandes
LinkedIn: https://www.linkedin.com/in/ingrid-harm-ernandes-5057773b/
Facebook: https://www.facebook.com/ingrid.harmernandes.71/

Board-Certified Clinical Specialist in Women's Health Physical Therapy
Author: "The Musculoskeletal Mystery: How to solve your pelvic floor symptoms"
Member of Medical Advisory Committee for National Menopause Foundation
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RESOURCES

“The Musculoskeletal Mystery: How to solve your pelvic floor symptoms” can be found at: DesertHarvest.com: https://desertharvest.com/shop/the-musculoskeletal-mystery-how-to-solve-your-pelvic-floor-symptoms

Amazon: https://www.amazon.com/Musculoskeletal-Mystery-Solve-Pelvic-Symptoms/dp/0578903563/ref=sr_1_1?crid=2DH1L8R2BJJ57&keywords=the+musculoskeletal+mystery+how+to+solve+your+pelvic+floor+symptoms&qid=1683122510&sprefix=%2Caps%2C616&sr=8-1

DH FB group: Desert Harvest: Advancing Pelvic Health Naturally

The Pelvic Detective:  
Episode 1 Intro https://www.youtube.com/watch?v=RFu3ZvxLLDA
Episode 2 Core: https://www.youtube.com/watch?v=uNaO5fNlJfk
Episode 3 Terminology: https://www.youtube.com/watch?v=4t-uCmWGqco&t=1s
Episode 4 Pelvic Floor Contractions: https://www.youtube.com/watch?v=VX5xbvdGA_8&t=13s

Paper: Angelou K, Grigoriadis T, Diakosavvas M, Zacharakis D, Athanasiou S. The Genitourinary Syndrome of Menopause: An Overview of the Recent Data. Cureus. 2020 Apr 8;12(4):e7586. doi: 10.7759/cureus.7586. PMID: 32399320; PMCID: PMC7212735

Because with healthcare Innovation, there is No Way But Forward!

Transcript

Different than what you usually hear. Most people don't take care of our pelvic floor. We are probably gonna have issues elsewhere, but we don't know where to look. The story of the human body and how it works. 

I called the book, The Musculoskeletal Mystery, is a mystery to almost everybody, and literally and physically is, you know, on the same page, understanding the language and helping each other get that care and treatment. 

How little this information is, it legitimizes the conversation no matter which side you're on. We don't just look at an organ. We look at the whole body. Five, 10, 20, 30 years, these patients are suffering with conditions. 

Patients, do you think are misdiagnosed or misunderstood? You talked about before, you know, women's health was considered this whole, like, reproductive maternal care, and that's super important, but that doesn't mean we should ignore to address all of the, you know, how much we treat in the pelvic world. 

You know, where they are in their life, and then what do I need to do back to the highest level of function they can? So you really do have to be creative. You really do have to be a detective. You were speaking of this genitourinary syndrome of menopause, GSM for short. 

It is replacing the word vaginal atrophy in order to get them to stop having it, right? And a pill's not necessarily gonna change that. It may help it, but we work in conjunction. Maybe the pill gets them going in the right direction, and we give them all these great possibilities of how to control it, and they come off the medication, and here each patient gets that individual care. 

Well, hello. Welcome to the next episode of the Ipzo Facto podcast. I am so pleased to have with me today Ingrid Harm Hernandez, and she has a very, interesting unique background and career and I learned about this recently in area I didn't even know about so have you ever wondered about your female body and how it works and new information that actually gives a different way of treating some conditions and I'm sure you're gonna learn some things today that you never knew so today bringing on Ingrid and we're gonna talk about some of her information that she has shared she's I would say a detective and this has come through in some of the works that she's put through she's the author of the book the musculoskeletal mystery and she's also had a YouTube series called the pelvic detective So this will be a really unique discussion, 

not your typical healthcare professional dry talk, but by someone who is a creative in her own right. So Ingrid, I'm so excited to have you on the podcast today. I'm pleased if you could introduce yourself so the audience gets to know you. 

And what inspires you most? Well, first, thank you for having me. And I'm excited, always excited to talk about the pelvic floor, which sounds kind of funny. But when you're in this field, you feel like you really want to get that information out there. 

Because so many people do not know what their pelvic floor is and what is involved in pelvic health. So I've been a physical therapist for 40 years, but I've been a pelvic health physical therapist for about 30 years. 

And there's that big gap in between becoming a therapist and a pelvic physical therapist, because when I started, there really wasn't anything called women's health or pelvic health, as it is more known now, because everybody's got a pelvic floor. 

So we treat everybody. But the interesting thing is it has improved over time, but at a really, really slow pace, and I would love it to improve more. So some of the things over my career have included education on all different levels. 

And that's education, whether it's to another physical therapist, to medical practitioners, to lay people, I go to libraries, I go to conferences, wherever I can, where someone's going to listen and try to understand a little bit better what what is that pelvic floor? 

And how do I get care for it? We have we had the first residency program for pelvic physical therapy, women's health physical therapy in the country at Duke. And I've done all different I've written some papers to try to help other practitioners understand what a musculoskeletal assessment is because I'm sure we'll go a little bit into that mystery component down the line. 

And then I also have done some research with different organizations to try to kind of bring to light a little bit more what physical therapy can do because that's also a mystery and early on was not researched well and that is improving but we really need physical therapists to be in there to kind of help develop those protocols. 

So I've been part of that which is exciting but one of my main goals and my main drives really is you know trying to get patients and people care earlier, appropriate care, care that helps them live their lives and get back to that quality of life that it can be so, so affected and poorly affected or negatively affected, right? 

And people don't know how to ask for that help. So that's what I want to change. I want to change that ability for people to get that help. And that's why I'm so grateful to always go on a podcast and talk about this and let more people know who don't even know what they don't know, right? 

To really learn more about pelvic health and what physical therapy can do. Ingrid, thank you for sharing that. It's really interesting, especially as you describe, it's an area that has actually evolved from what I understand in what you've stated. 

And so as you mentioned, you've been a pelvic floor physical therapist and a detective in that case, because of course this is a new area. So in that vein, can you share what first drew you to this field and what keeps you passionate about it today, especially in an area that is new and evolving? 

Yeah, I would say so many, many years ago when I was in a private practice setting, I would end up having a lot of the pregnant folks. And interestingly enough, enough of them would kind of confide in me and quietly say, you know, Ingrid, I have this leakage, you know, I have this urinary leakage and I don't know what to do about it. 

And so I'm going to really date myself, but I had to go to the library to go look up, you know, what, what is this? What's going on? And then I discovered that in Australia and in some parts of Europe, and physical therapists were actually treating incontinence. 

And I thought, well, that's interesting. And so I learned a little bit myself. I just kind of taught myself some things. And I thought, wow, just these little things are ready, you're making a difference in my patient's lives. 

So as I, luckily I was up in New York at that point and the guru of our pelvic world and physical therapy was at one of the conferences and I took one of her courses. And then over the years, I just took as much as I could, taught myself as much as I could, and then that grew. 

And I started doing this work when nobody really knew what it was. I would go to the doctors and say, look, I can treat patients for all these different things. And they'd be like, what? As if I had lobsters crawling out of my ears, you know, what are you talking about? 

But when they finally sent a patient, and the patient did so much better. And the patient's like, why was I not here? Why was I not referred to you before? And the doctor's like, wow, this really works. 

This is really good. Then they would refer more patients. And it grew from there. And then luckily, our profession has grown, you know, over the years, and there's more education, there's more opportunity, our board, our national board as a board certification for women's health. 

So in pelvic health. So that's really cool to see many, many changes. And then like I said, we have the residency program, now there are a number of them across the country. So there's more opportunity to learn. 

But I say what, you know, you're asking what kind of keeps that passion going is the fact that every time a patient walks in the door, and I can see how they get their life back, that just keeps me wanting to do more. 

And now because I do more education, every time I do education, and I've done, you know, book signings at farms, you name it, I've done it. And to see people walk up and at first be kind of like, I don't know if I want to talk about this to like, I need your book. 

And I so you know, need this help. And then, you know, I go back to the same venue, let's say a couple months later, and someone will say, I got your book. And it made such a difference. Again, to see that, that wonderful, wonderful change in someone's life, just makes me want to keep doing it more and more to educate more and more. 

And I would say that just keeps the fire going, you know, to help people out and to get this education out there. Well, I mean, so many people are benefiting from this and, you know, from your passion. 

And I think that's just fantastic. And you're really leading from your passion and purpose. How beautiful to have that all combined and so well and what you do in your profession, and your creativity in. 

to this as well by how you share and how you educate is in different forums. So we mentioned your book. And so let's start there. So your book is called the musculoskeletal mystery. And so maybe let's go. 

What is that mystery that you talk about? What kind of inspired that detective level as in your YouTube series and mystery aspect that you're bringing into it. And from from what I recall in your book, you also talk about patient stories. 

So not only are you actually learning in the field or practicing and experiencing patients journey through this type of treatment through the physical therapy that's applied with the doctors that you work with. 

But someone who is curious about this can actually read your book and learn somewhat firsthand in that story of the patient's experience on how this works and how others have benefited and experienced that different type of treatment. 

And I just wanna double down here because you talked about women's health a couple of times, but I think you also mentioned back in the day, no one mentioned women's health, right? I mean, really, if you think about it, it's only, it's relative, but it's very recent that anyone's really talking about women's health and how we're defining women's health has also evolved. 

So when you started, there wasn't such a thing as women's health and it was more, I guess, reproductive limited to that thinking. So as you describe your book and the mystery, as I mentioned, can you also just pause for a second and talk about what the pelvic floor, like just for the audience is kind of orient. 

What is the pelvic floor and what does that mean? And then we can get into your mystery and detective story from there. Yeah, so the pelvic floor is basically, I like people to think of it as a bowl at the bottom of their pelvis. 

So kind of from the tailbone to the front, what's called the pubic bone is a sling like this, kind of more or less. So we have to think of that as a hammock and a bowl, like I said, where if that hammock is working well, all those muscles hold all the organs up and hold everything up no matter what you do in your life. 

And if that hammock isn't doing a good job, it's kind of like a hammock that. hangs down. So if you imagine like you've got a hammock that's very loose and you go to get in the hammock, your bottom is gonna hit the ground, right? 

So I like people who think of this importance of this hammock or bowl idea, right? So it's three dimensional. That's all muscle, right? And here's the funny thing is I don't think of muscles as being part of pelvic conditions. 

No, it's my bladder, it's my bowels, it's my uterus, it's whatever. But no, this pelvic floor is the key to our pelvis, really. And so what I like people to think of is this is all muscles, and these muscles have many jobs, many, many jobs. 

So they have the support that we just talked about here, this feeling like everything's being held up, right? So if I cough or I sneeze, my pelvic floor has to be able to respond. If I lift a weight, my pelvic floor has to be able to respond to active all the time. 

Yeah, then there's a sphincteric function and what that means is we have muscles that form sphincter So open and closed like this right and for a pelvic floor some of them are what are called voluntary that means that You know if I don't want to pee it's closed if I do want to pee it's open So we can control that same with our bowel And then sphincteric we go to sexual function. 

It's got a very important sexual function It allows us to have intercourse. It allows us to enjoy intercourse. It's all part of that whole sexual function Right, and then we have a what's called a sump pump. 

I'll call it. It actually helps Out of the pelvis, right so we don't have a congestion in the pelvis So we're already going through numerous things that the pelvic floor is responsible for it also has a kind of support in a different way Stabilization which means that it links to our whole core So I talk about the core very different than what you usually hear Well, you know my six pack is my core Well, 

no, that's like the most minimal part of our core It's the abdominals are a whole series of abdominals with the rectus the the washboard Look only being one tiny bit our transverse abdominis like a natural corset It goes around our whole abdominal area inserts into our back and works in tandem with the pelvic floor So when our pelvic floor works our transverse abdominis works like two sisters holding hands, 

right? Yeah, and then if we move to our back muscles They also work in conjunction and our hip muscles and work in conjunction with our pelvic floor and then our diaphragm So what we breathe from is also a muscle and every breath we take influences the pelvic floor and vice versa, so when you're breathing properly you're actually getting your pelvic floor to work. 

It's a whole structure. And then what I'll do is I'll take it one step further and say that I want you to think of your core as your house or your apartment complex. And when you, when your foundation of your house or your apartment starts to crumble, something else is going to have an effect. 

So in other words, the rest of the house or the apartment might start to collapse because the foundation isn't there for it. So if we don't look at the foundation, our pelvic floor, and we don't take care of our pelvic floor, we are probably going to have issues elsewhere, but we don't know where to look. 

We don't know to look at the pelvic floor's origin of the issue. And on top of that, the pelvic floor is a birthing. So it's a breathing process and a birthing process too. So I just named something like seven different functions for a pelvic floor. 

Yeah. Nobody even knows what to ask or even knows that these things are interconnected and that we, if we treat our pelvic floor well, we're going to be able to treat our body well, right? Wow. I just learned many things I didn't know. 

And I thought I knew the anatomy pretty well. Wow. Okay. That's really interesting. So I can see how you kind of took the mystery, detective route here. First of all, I think it probably makes it a lot more interesting. 

Just as you described just now, it's very engaging. You're telling a story of the human body and how it works. But in so doing and all these different ways that the pelvic floor connects and integrates with the body, it's with so many different functions you just mentioned and so many different activities. 

And so is this kind of what inspired you to take this tact approach in describing? Yeah. Yeah. So I would say, you know, I called the book The Musculoskeletal Mystery basically because it is a mystery to almost everybody. 

And this is lay people and professionals, medical professionals. It doesn't matter, like to be able to put that all together, to integrate it in a function rather than just, this is the anatomy. But no, it's, this is the story exactly like you said, and this is why it's so impactful. 

So when I wrote the book, I kind of thought, how do I, how do I approach this to make it understandable? And I thought, well, how do I educate my patients when they're in clinic? And that's how I educate my patients, just telling them this is how it all works together. 

And I would see these amazing light bulbs just go off. And when I started to present and do a lot of education, I would see the same things like oh my gosh. I didn't know what I didn't know, you know, it's so It's such a great thing to see people make those connections And then I added, you know how to solve your pelvic floor symptoms because I wanted people to say well if I understand better What's happening in my musculoskeletal system? 

I understand better why I could have an issue and understand better how I need to get it treated so the book follows that process of This is the musculoskeletal system. These are the conditions that you may have This is what might happen in a therapy session This is how you can help yourself like I just made it flow like that to everybody No matter who you are You can take that book and go into the doctor with you and say this is what's going on a doctor Yes You know, 

it helps everybody be I call it on the same page, literally and physically is on the same page, understanding the language and helping each other get that, you know, that care and treatment. So, you just got something forward that I didn't think about and first of all, I'll say. 

Um, people should should look at your book to to understand this because there are, you know, variety of different impacts with the pelvic floor and understanding that can help you understand. Um, what options there may be for you, but really, like you just said to have that conversation with your physician and the way the book is presented. 

Um, you know, the hard copy is is so nicely present so easy to read and you have a very good descriptions in there. So I think I encourage people to to go take a look there and you're you're bound to learn something that that you didn't know. 

But in particular, really looking to see, you know, maybe, maybe you see yourself in the descriptions of some of the patient journeys and stories that that are there. And so, with this book, do who would you say it's it's it's written for is it is it you just, you just talked about how the book could be used. 

So I guess it can be used with with clinicians or clinicians on on their own to understand more as well on how to talk with their patients or, you know, so really looks like the audience is quite quite broad. 

But when you were writing it, what was what was your intent of the audience? Yeah, so I thought my first thought is I want to help patients understand what's going on. But, you know, as I was writing it, I thought to myself, no, you know, when I've done education and I'll go way back, you know, quite a number of 20 plus years ago, I was. 

to do a talk on pelvic health and pelvic physical therapy for physicians and nurses. And the physician that I was working with who invited me to do this in the Bahamas of all places, said to me, you know, are you nervous about it? 

I said, I'm not so much nervous, but like I'm concerned, I'm not gonna be able to really educate them. What, you know, what do I have something to offer? And he said, they have no idea what you're gonna talk about. 

They've never learned this before. It is not in medical school. It is not in nursing school. It's not anywhere. And you know, when I did that first talk, a lot of what we just talked about, similar stuff, they would just hammered me with questions. 

Oh my gosh, what about this? We didn't know about that. This is interesting. Can you explain it more? We just don't, we aren't taught this. And it really taught me how little this information is out there, right? 

That's what kind of. Really started me thinking, you know, this education needs to be for everybody so everybody is on the same page like I was saying before, you know that a Physician nurse has it in clinic with them and can explain something to a patient or a patient can have that book Put it in their purse go in and say look this is what I have, you know, can I get help for this, right? 

It legitimizes the conversation no matter which side you're on And it gets everybody saying well, you know, there are many ways to look at this We don't just look at an organ We look at the whole body and that's one of the things I talk about there to mean I guess Advocacy groups under this pelvic health is one is more that you know, hey we need to yes We need to talk about it, right? 

We need to get the information out there, but it's also how do we help others? How do we talk about it in a language that other people can get help too, right? So we want to make sure that we're capturing everybody and that's what the book does. 

It lets everybody feel brave It lets everybody say I can be part of this and that lets everybody see Wow if I talk about it It's not just myself that I'm helping but hopefully thousands and thousands and thousands of other people Yeah, amazing and you know here here you think with the advancement of medical care, you know what? 

You know other than kind of a very deep cellular level genetic level, you know You would have thought anatomically everything was kind of known by this time in 2025 But actually that's that's not the case. 

Maybe that was my naiveté but You described, you know how Patience first came to you right and they were a little bit shy or hesitant to talk about things. And so you mentioned I think also about, you know, this as the hidden body part. 

And I guess with the book, what that enables is what you just said is it's enabling people to have that conversation, like you said, it legitimizes. And so maybe it helps people to speak up and describe using words and and illustrations and such from the book that they wouldn't have otherwise known how to describe what they're experiencing or how to ask the physician about, you know, is this something that's going on here? 

You know, let's talk about this right and kind of describe their condition. So I think I think that's really powerful because you're kind of bringing the invisible to become visible. Yes. Yeah, exactly. 

We want to make sure, because I mean, when I was working clinically, I'd say five, 10, 20, 30 years, these patients were suffering with conditions. And it was frustrating to see that it was either they didn't know what to ask for or the provider didn't know to offer physical therapy, right? 

So it was so frustrating to talk to myself, I can't stand by anymore. And patients had been begging me for years, please write a book, everything you talk to me in clinic, everybody needs to hear that they need to hear your voice and how you're describing these things, which is also what helped me with the format of the book is my patients really are, okay, who told me this is what we need, right? 

And then the clinician started saying to me, Ingrid, you know, please, you know, talk about this, do this. And so it was really cool that on both sides, I'm getting this encouragement to say, let's get a better job of explaining these things out there so people get care. 

So I would say that frustration that the patient had that I had of them not getting care is what really, really pushed me, you know, to write the book and to get that information out there for everybody. 

Incredible, Ingrid. And so given that in the situation where, you know, it's not taught in medical school or hadn't been right, I think it's beginning to, as you stated, you've engaged with some curricula. 

But when you when you think about dysfunctions that are caused by this area and the muscular impact of conditions, which conditions do you think are most often misdiagnosed or misunderstood? You know, even within the medical system, as it is. 

today? Yeah well unfortunately all of them but quite honestly so even something as straightforward as you think is urinary incontinence so that's out in the media more now people are talking about a little more which is kind of good it's kind of an introduction into these are pelvic conditions but people don't understand for I'll give you an example overactive bladder you hear all about medications for this that and the other thing but what you don't hear is that oftentimes the pelvic floor is what is creating or adding to the overactive bladder and it's not truly just a bladder issue it is also a pelvic floor issue and there are many things that we can do at the pelvic floor at the abdominal area even in the back area that help reduce these overactive bladder symptoms and you know medication I've had many patients who come in and they're on all these medications and we work on things and they can come off the medications right so that's just that's just like one example of something that's a little more heard about, 

but still a mystery. And then things like prolapse. So prolapse is basically a protrusion of one of the organs through the vaginal canal that creates like a bubble at the vaginal opening. And unfortunately, many people freak out. 

They think they have cancer, what's growing there. And it's really this protrusion, right? What a big mystery for people on the pelvic floor is really important to you early in life. And then another thing, another huge misconception is that during pregnancy and after pregnancy, it's okay to have pain, back pain, pelvic pain, incontinence, constipation, fecal incontinence, that these are things that women who are pregnant afterwards are just told, 

hey, go live with it. You know, women have been dealing with us for centuries. No, this is not so we can get that treated. And if we get it treated earlier in life, we help as we progress through life. 

What I call the continuum of life, which isn't just a reproductive component, which is what you talked about before, you know, women's health was considered this whole like reproductive maternal care. 

And that's super important. But that doesn't mean we should ignore the perimenopause or menopause transition time frame and the menopause and post menopause. We really need to address all of these components of our life in order to realize, well, if we treat everything early on, we're less likely of the risk factors later in life for it, right? 

So that's another thing. And then constipation, people think Oh, that's just my bow. The pelvic floor has a huge influence on our bowel movements and can be the cause of constipation if we don't know how to treat it properly. 

And then lastly, the big category that split into two one is pelvic pain. And I'm going to put sexual dysfunction and pain with sex in under that is something people do not want to talk about. and we really need to talk about it and it gets blamed on dry tissue and low estrogen when a lot of times it's tired or musculature and then pelvic pain is a large large category all on its own that encompasses hip pain back pain pain at the pelvic floor abdominal pain it's all in there huge huge category that you know even endometriosis which you think of what can pelvic PT do because that's a growth of endometrial like tissue so the lining of the uterus for those who aren't familiar with it the tissue that is like that lining can grow outside the uterus and in the abdominal cavity and over our fallopian tubes and all over the place although that's a growth the secondary musculoskeletal issues that grow from that can very well be treated by pelvic PTs right so conditions people do not just have you Yeah, 

there are many. I mean, I could spend three hours just going over all the conditions, but that's in a nutshell, how much we treat in the pelvic world. Yeah, that's really, really interesting and great. 

And I guess it makes sense because I'm so glad I asked you to describe the pelvic floor because that's giving a good context to everything you're talking about. So in how you describe the pelvic floor and the core, actually there's so much integration, right? 

That, okay, it kind of makes sense now on how that, like you said, it could be direct or it could be secondary to some of the conditions you talked about that can be treated through physical therapy. 

But now what just came to mind is physical therapy as a profession, as a treatment approach in and of itself is an integration, right? So you don't just take the diagnosis into consideration. You're kind of looking at the condition as a whole. 

So can you describe from a physical therapist lens how this is different than a traditional treatment lens of maybe pharmacological or surgical or otherwise? Right, right, so we look at things in a functional capacity. 

So what I mean by that is instead of taking a diagnosis and saying, this is the diagnosis and I'm gonna treat it because this is what the diagnosis is, we're saying this is what's happening with the person and we want to bring them back to their ability to- do their daily routine. 

So if I kind of clarify that a little bit it would be I might have two people coming in that have urinary incontinence as their diagnosis but I may treat them totally differently because they're different people. 

One might be you know a mom with four kids and a job and she's running here they're in everywhere and the other one might be you know a retired lady who's 72 years old she has a little bit more time she likes to garden she's still very physically active but her life is very different. 

So I'm going to create a plan that lets them get back to their life where they want to be. So for me once I get through my whole subjective and I ask them all questions and we take like a half an hour and in the book I describe this like we take a long long long time to really say what are you where are you as a person right now and what affects your life. 

If they have incontinence, I'm still going to ask them about sexual issues, I'm still going to ask them about bowel issues, I'm going to ask them about their past pregnancies, I'm going to ask them all these questions because it lets me know where they are in their life. 

And then what do I need to do to come back to the highest level of function they can? So you really do have to be creative, you really do have to be a detective, you really do have to figure things out, like to wrap together what you were saying before. 

As a physical therapist, we look at it from that capacity instead of a diagnosis, right? So it doesn't constrict us down to one thought of this is how we're going to do it, instead it's like, oh, I can do this and I can do this and I can do this. 

And guess what? Let me talk a little bit about the interdisciplinary care role because it's a big thing we're always talking about is, I might say, you know, let's say it's a sexual issue, I might say, hey, we can do this, this and this, but we need a sex therapist in here. 

We need a urogynecologist to look at what's on the medicine side of things, right? We need an acupuncturist, right? And I'm going to pull all these other disciplines in to say, we need to look at all these different aspects if we truly want to treat you as a whole person and get all of this resolved, right? 

So I think that's the difference with, you know, physical therapists and the medical profession is we truly, we're like that center spoke and I've been yelling about interdisciplinary care for decades and it's getting there, it's a slow go, but we really need to look at our people that way. 

It's like, how do we treat them on many levels? Not just this is their diagnosis and this, I'm going to put my blinders on, that's how I treat them. Yeah, amazing and Greg, and, you know, you were practicing interdisciplinary care before. 

I guess the word, the term was even well defined. And, you know, the other thing, from my perspective, it's only, again, kind of recently that you hear people talking about whole person health, right, and as an actual goal, or looking at patients or people beyond one lens alone, because someone can be, as a description, I like to use this, they could be diabetic, but they could also be an athlete, 

or they could have some other sort of condition. But we tend, our healthcare system historically, traditionally has tended to label people based on the disease or condition they're in, in just that, as you said, that kind of really narrow scope. 

right? But as you're bringing forward, you're kind of expanding my lens, my scope here on this whole person health and how you're describing physical therapy lens in that interdisciplinary approach, which is, I mean, that that's so critical. 

Because as you say, it doesn't just work alone, it has to integrate with everything else. And there are, you know, the physical function, but there's also a lot of physiology, there's pharmacological, maybe interventions. 

There's so many different aspects that can be brought in, you even mentioned acupuncture as well. So really interesting. And I think the way you described just now, and we'll maybe double down on this a little bit later, is this customization, it's very personalized, it's customized, just because it has to be, right? 

This is what you need to understand on how to, you know, what methods of your physical therapy approach or other disciplines that need to be brought in. But you need to understand the whole person, their history, their other conditions they might be in, but even their lifestyle, so that if there are things that they can do at home or in their daily lives that help them to improve, you need to know, 

well, what are they actually capable of doing? Can they integrate that? Another integration, can they integrate that into their own lifestyle? So really interesting. I can see why you have to take a lot of time to really understand the patient, not just the condition that They're coming to talk to you about, but, you know, the whole person really, really interesting. 

And so, as you as you mentioned, you know, the interdisciplinary approach, let's let's kind of dial it back a little bit on. Given that this is a very specialized area. And an area that's emerged, right and you mentioned earlier in 1 of your earlier presentations that you gave that. 

Many in the audience are saying, well, we've not learned this in medical school. So, tell us more so. Yeah, you know, I'd like to get your, your view on. As more and more people are learning about this. 

Um, but. the awareness, it seems, is still something to be scaled, I suppose. So is that true? And what education and awareness do you think is necessary to coordinate with the interdisciplinary approach? 

Because if physicians, nurses, clinicians, you know, how generally are they aware of physical therapy as a whole in terms of how it can be integrated and where it can be used. But now you're talking about a specialized area of physical therapy. 

So what's your view on the education awareness and how do you bring in that interdisciplinary approach in the sense that for the other disciplines to actually accept what you can provide in your sessions, but, you know, interdisciplinary means you're working as a coordinated team. 

So how do you get, how has your journey been on those disciplines, you know, in inviting a physical, specialized physical therapy and kind of that give and take in treating each patient? Yeah. So not, not an easy road, because when I started, like I said, a lot of people thought I was absolutely crazy for saying I could treat them. 

So the first step was just to convince them that it works, right? And when I convinced them it worked, they would ask some more questions. When I came to Duke, what I was really, really fortunate about is that we had so many different types of clinicians treating so many different things, but it still to me seemed scattered in that, you know, well, you have mental health care here and you have OB-GYN over there and so forth and so on. 

So what I really, I needed to do is, is the first step was doing even in services. So I know that sounds funny, but I did in services for our own physical therapists in our own department to describe what we did so that they would be better. 

So the example would be an orthopedic physical therapist would be treating someone with back pain and they were not. And then I would say, so if you feel some screening tools, do you feel like this may be an issue? 

They would then refer. And after a while it became easier. They'd say, Hey, Ingrid, you know, I've got this patient. I think maybe they've got some pelvic floor issues. Would you do an assessment? And then we would work. 

I would say tag team. We would work together to get that patient better. And then I took it the next step and I did. work in services with our OB-GYNs, with our urogynes, and so on. Then I took the next second and I did step and I did grand rounds. 

So now it's educating two and 300 physicians and fellows and residents at one time. And then we took it a step further and we started, we opened a clinic within the urogyne clinic. So a couple days a week, physical therapy was happening in the urogyne clinic, which was amazing because they could ask me a question or I could jump in with a patient if I needed to. 

And we really started to coordinate the care. And then I started to learn more about who are acupuncturists and go do in services for them. Then the next step was have them shadow in clinic with me while I was treating. 

Fellowship program at Duke, a requirement is that they spend not just their third year, which is where we started, but all three years in clinic with us a couple days each year. And it blew their mind. 

They were like, I totally understand now why I need to send a patient over to you. It was not clear until I was in the car. So then we got OB-GYN residents to shadow with us. So what happens, and there are some larger organizations now that have their fellows and their residents shadow with pelvic PT. 

So they're in the clinic and they see the response, they see the change. So it took years, years and years to develop that. And then I started realizing I need to get on bigger stages, talk more, do all of this. 

So once my book was published, I went out there and, you know, whether it's doing a podcast or doing an educational session or whatever it may be. So I think education is key, but you have to be so willing to continually be after it. 

because people still don't know what they don't know, you know, that's still something that I'm coming up against and now of course is social media can be beneficial and it can be awful because it can really spread very wrong information or it can spread good information but a lot of times it's just from one one lens and one idea instead of like a broader spectrum. 

So I feel like I spend a lot of answering on people's posts and I'm not a social media person. I don't really care for it but I realize it's important to help get good information out there. So I try to be that person that is like making people think a little different, think outside the box so to speak and just get that that information out there. 

So that's that's kind of that rough road to getting it out there. And there are other pelvic health therapists trying to do the same thing, really trying to get some information out there. And I see it going in a positive direction slowly, but surely I would love to have it go much faster, but it is what it is. 

So we just keep plugging away. That experiential aspect that you mentioned when with the in-services, how amazing that must be, because you see the lights come on and you described some saying, aha, now I understand which patients might benefit. 

I mean, that's pretty amazing and game-changing because some of the so-called traditional therapies or other therapies that were used in the past may not actually be correct or right at that time, or maybe it's okay, but there's a different way that maybe it will be more comfortable for the patient overall. 

And so you mentioned about how people talk about this and how that's changed, right? There's new terminologies and this is a different area. And there was a paper that you mentioned to me that came out last year, I think. 

And there's different terms that are used. And in the paper, there was a term called vaginal atrophy. So could you kind of maybe explain, first of all, maybe describe what that paper was and will include things, and it will include all information and the show. 

shown out so that everyone you can benefit from the information that Ingrid is sharing. But also with this paper, because I was really interested in the different uses of terminology now, and also, you know, just musculoskeletal as well. 

So could you talk a little bit about that? Yeah, yeah. So that has a twofold part. So what I'll say is, what you're speaking of is genitourinary syndrome of menopause. So it's a mouthful, GSM for short. 

It is replacing the word vaginal atrophy. And I am so, so, so glad it is. So GSM was first kind of talked about about a decade ago, roughly 2014, 2015, somewhere in there, where it started that that's where you'll see those first minutes. 

but really didn't gain traction until a little more recently. And basically it is, it means that someone who has this, it's not, so vaginal atrophy just sounds like the vagina is kind of, you know, falling in on itself. 

It's terrible. It's not what's happening at all. Or my tissues are dry, you know. Really what it means is this syndrome is, it occurs more likely during menopause transition and menopause. That's the most likely time for it to happen. 

And it involves our bladder, urinary symptoms. It involves the vaginal tissue. It involves quality of life, right? So that's what this term kind of encompasses. The paper that you asked about, that was published last year, is the musculoskeletal syndrome of menopause, which I was so, so, so excited to hear about because they're talking about the musculoskeletal system. 

Finally, yay! But they're only got two lines in that paper about GSM, which means although they're talking about the musculoskeletal system, they're not really talking about the pelvic floor. Now I had the great privilege and honor to speak to one of the authors of the paper. 

Luckily, so I was introduced, we went to an M factor. She coordinated an M factor, which is about menopause screening. And I was one of the panel members and I talked to her a little bit. And I said, hey, you know, GSM, it's pelvic floor. 

It's musculoskeletal. So they are now looking at their next paper, including more about the pelvic floor, which I'm thrilled, absolutely thrilled to have. But to take it back to the musculoskeletal syndrome of menopause, the reason why that's important and why their paper is groundbreaking is because it talks about the fact that we have things like joint pain, joint stiffness, toes and shoulder, hip pain. 

We have muscle menopause. Mass loss, we have bone density loss during this time frame of our life. And as we go through menopause transition, which by the way happens a lot earlier for many women than people think it can happen in our 40s, some people as early as 35, which is kind of a premature menopause transition, just a side note, but 40s to 50s. 

And then menopause and post-menopause continues to the rest of our life. So we are talking about decades, decades of life, not just one, two, three years, this is many years. And in this time frame is when some of these changes accelerate, when we lose estrogen, some of these problems accelerate, right? 

So instead of just aging, they suddenly get much worse. So now they're looking at why is it, what do we do about it? How do we address it? So they named it. Thank you. now we can talk about addressing it. 

And that's why this is, I think, going to be such a landmark paper, is that it's looking at things very differently. And my hope is looking at the physical, the musculoskeletal, and all of that is being such a huge part of menopause transition and menopause. 

It's not just hot flashes. That is the tip of the iceberg, or the long tip. If I may say that a small, small part of it, that even studies are showing that physical exercise and activity can reduce the amount of vasomotor, so hot flesh symptoms that someone has. 

So if we, you know, go to physical therapy early, we learn things earlier, and we learn how to take care of our body earlier, we can actually help ourselves with these menopausal symptoms that people think are just going through menopause, I can't do anything about it. 

No, there are tons of things that you can do for muscle mass, for bone density, for cardiovascular health, for pelvic floor health, all of that, that people shouldn't feel like they just have to put their hands up. 

No, there's so much we can do for it. So really what you're talking about here is empowerment. It's empowering the individual. As you say, traditionally, it's kind of throw your hands up in the air. It's like, okay, it's that time, and it's a fait accompli. 

However, it's the look of the draw, how mild or intense the transition will be and experienced differently by everybody. But traditionally, it's like, well, it's just menopause. And actually, that might be what you're told many times, oh, you're just going through menopause, you know, and treat the symptoms or alleviating symptoms. 

You feel kind of there's nothing else you can do about it. Right, right, and unfortunately, it's not true. There's so much that can be done, but people don't know what to ask for. Yeah, yeah, and so for someone who may be kind of struggling silently, right, whether it's, you know, life transition menopause or other types of pain or pelvic pain or other conditions that, you know, that really haven't found answers to yet. 

What would you say to these people? How would you advise them to kind of approach, you know, where where to go? Because it could be some have gone to their GP and You know, GP might not be necessarily a specialist in this area and may not have learned, you know, yet about, you know, gone through the programming and such. 

That's that's a that's being made available, but that might, it might not have been something they've integrated with yet. So for from a patient side and someone struggling and things have not worked for them, right, and that sense of empowerment feels lost. 

Well, what would you suggest? Yeah, so stick with it. I know. I know that sounds like, OK, I'll try to stick with it. But what does that mean? So basically, there are there are practitioners now that are getting certified in menopausal health, like perimenopausal, menopausal health. 

And there are a couple of different programs, the national men or now it's the menopause society and another company called Perry, an organization that has for years since the 1990s really try to educate people on perimenopause are having certification programs so that it doesn't matter who you are, whether you are in family medicine, OBGYM. 

You're a nurse, you're a doctor, you're a nutritionist, you know, you're medical, excuse me, a mental health care. All of those can be certified in these programs. So some of the things that I'll tell people is A, you know, if you're not getting the answers with that first practitioner, you go to go to another practitioner. 

It really there is nothing wrong with going to a couple of different practitioners to try to find the one that has the answers for you. Because if you're talking about menopause and the immediate reaction is either A, oh, live with it, or B, you know, go take hormones, if it's like this, this like one or the other, then there should be a question mark. 

Maybe I need to talk to someone who's talking about me as a whole. That's talking about many different ways from my diet to my activity level to my pelvic health, right? If they can talk on all those points, then it's more likely you have a practitioner who's really going to be able to help you with different things. 

So it, sometimes it takes a little sleuthing, a little bit of detective work yourself to find those specialists, um, but really do try to see if you can find someone who at least has in there, these days, most of them will have descriptions as to what they specialize in and what they care about. 

Look at those, see if, you know, menopause is really, or is maternal care or whatever it may be. Do they really have a passion about that? Do they really want to work on that? Are they certified in some kind of menopause care if we're talking about menopause specifically, but you know, don't give up. 

I know it can be frustrating, but please don't give up. Um, you know, in my book, I've got a ton of resources go on. There are different websites that are reputable. Don't do the Dr. Google search because the Dr. 

Google search can. It puts you down a pretty bad path, but reputable site is to say, oh, okay. Now I know what's available. Now I know the terminology. Now I know what it really means. Now I'm armed with the education to go into the clinic to say, this is what I've learned so far. 

What do you think? Like, I never say go tell the clinician what to do. You're hopefully going to help you, but instead to say, I've learned this. I have this education. What do you think? What are your suggestions for me to do now? 

Right. So you're working as a team member, talk about an interdisciplinary care model. You're the patient support of that team, right? You've done your due diligence as well. And then you're, you're asking for an expert to say, what do you recommend? 

What do you, what are your thoughts based on the information I've given you, right? To look at it, that in that capacity, instead of just waiting for an answer to come into you, you're, you're saying, I've got this information. 

What, what can you now do for me? What, what are your suggestions? Yeah, that that's so important for patients. I think in this case, and just generally overall, right? No, no matter what you're maybe concerned about, or maybe suffering from is, is really to be engaged with your care and ask questions. 

Don't be afraid to ask questions, understand what's happening. And by having that dialogue, there, there could be other, other approaches that might serve you better. So I think what you mentioned about even lifestyle aspects and other things is, you know, be, bring those forward. 

If something you think is not actually going to work for you, have that conversation. And there might be, you know, a customizable approach or something else that your healthcare professional could help you with. 

If you don't ask, you'll never know. And if you don't engage, well, engagement is kind of bringing that empowerment forward. I think that's such a good point. So when you talk about the sessions that you do, and you started to describe this earlier in our conversation, but what does a physical therapy session look like? 

Yeah, I'm so glad you asked that question. And the reason being is so many patients are afraid to go to pelvic PT, or they just don't understand it. So they're like, yeah, I don't think I want to do that. 

So if that person understands better what is going to happen, they're much more likely to go. So physical therapy session. We, you know, take that from the playbook of all physical therapists is we're looking at getting activity and function and motion back so we do exercises and we do Manual techniques whether that's stretching or what's called mobilization getting the joints going reducing pain Myofascial techniques getting scar tissue going all of that We do all of that like all other physical therapists do but what is very different for us is Is that we then look at the pelvic floor function by verbally going through things at first and then we do an assessment So the assessment is an internal can be an internal assessment to figure out what's happening in the musculature Inside so what I mean by that is remember the bowl that I was discussing, 

right? We actually look at the individual muscles of that bowl to determine what muscles are doing What what are not able to do what they should do what are too tight? What are too weak and we assess what a true pelvic floor? 

contraction is and I spend something like five or six pages in my book going over a pelvic floor contraction and relaxation because I want people to understand what a true pelvic floor contract a Kegel and I I ban the word Kegel if I'm my clinic because there's such a misconception what it is, right? 

I've assessed thousands of people who have said oh I've been doing Kegels for years and they don't do anything and when I assess them not only they not doing it, right? They're doing it such that they're making their symptoms worse And that is key So we really need to figure out what they're doing and then from there we prescribe an exercise program based on that assessment So that they're doing a contraction that they're able to do they're doing a relaxation that they're able to do or maybe they're not doing A contraction at all initially because it's not appropriate for them, 

right? They have to learn to relax their pelvic floor before they can learn to contract their pelvic floor. If someone's arm is like this, I'm not going to have them do a thousand bicep curls like this. 

I'm going to have to teach them how to open their arm up fully before they can really use that muscle 100%, right? Now some folks won't get an internal exam if it's not appropriate, but I'm just saying for a pelvic PT session, a lot of times a pelvic exam is that starter that we really can learn what's going on. 

We take that information and send them home with a program that they that is appropriate for them and then we may do things like we might use what are called dilators because that teaches them teaches them how to stretch their own pelvic floor, reduce trigger points in their own pelvic floor, become like a master of their own program so that at home they can duplicate what we're doing in the clinic and that's super important because we want them to be in independent. 

We want them to be able to do what they need to do in their life without having to rely on, you know, therapy over and over again, right? So that's really important as far as that aspect of it. We may do biofeedback, which hooks them up to internal sensor or little external pads that records the electrical activity of the pelvic floor. 

So on a screen, they can see if traction or relaxation and helps them build the confidence to actually do it correctly and have a little fun doing it. Sometimes it's a graph, sometimes it's a rosebud opening and closing or a space shuttle docking. 

They're all different fun things we can do with that. So there's a way for them to learn a little bit better what's going on with that. And then there's a big compartment of pelvic PT that is what we call behavioral changes, which sounds kind of funny, but basically means, I'll give you an example, urgency, a very common difficult issue for someone who has urgency is they're out and about, they get home, 

they put the key in the door of their house, and all of a sudden they have to go. They just, I have to go. And they say, well, your bladder hasn't filled in a nanosecond, but your brain says, there's a safe, clean bathroom on the other side of that door. 

And every time we go home, we have to run for the bathroom. So kind of a Pavlovian response, I'll call it is, the key means I have to go. And after a while it gets so overwhelming that they start to leak, right? 

The urgency is so strong that they start to leak. So we have to teach them how to overcome this brain to pelvic floor and bladder pattern in order to get them to stop having, right? And a pill is not necessarily going to change that. 

It may help it, but we work in conjunction. Maybe the pill gets them going in the right direction and we give them all these great possibilities of how to control it. And they come off the medication and here we are. 

So we've done even a team work with the pharmacist. in that way is that we're saying, hey, there are all these things that are happening that maybe you need as a starter, but then we're gonna work our way to improving it so you can take care of it yourself, right? 

So it's so multifaceted, there's so many components, but if I had to put all those different things together, those are the main things we'll see. And each therapist approaches it from a slightly different lens and starts on things maybe a little differently, but each patient gets that individualized care based on what we found and what they can do or what they are having difficulty doing and feel like I can't do this now in my life, 

I can't even work anymore because all I'm doing is running to the bone, right? So it's important to get those things, it seemed like funny little things under control because you're not so funny for yourself. 

Yeah, and I guess something like that, maybe people might think, God, it's just, you know, I'm getting old or, you know. I'm just, you know, I have to deal with it. I have weakness and I've just got to run and, you know, but actually there is something you can do about it. 

And lots of people actually may not know that. And I think we've learned so much in the last few years, especially I would think also during COVID, is that behavior impact on healthcare, right? On how we live and the day-to-day activities that we do or those activities that we stopped doing and what impact that had. 

And so, you know, whether it's mental health and otherwise, and even now you're describing a whole other way of looking at biofeedback and in this case, a really, really interesting. So Ingrid, you've already covering a lot of things and you've had all these interesting projects with your book and your podcast series and your YouTube series, detective series, and then, you know, all of the speaking engagements you do and in clinic sessions and it just, 

you've gone through just a phenomenal amount of things and all of these aspects are ongoing. It's not like, okay, it's kind of done, right? You've started it and it continues. But if I may, what's next for you? 

Do you have other projects or training programs or resources that you're developing or maybe redeveloping? Yeah, so I was so honored to do this great thing called a micro series with the National Menopause Foundation. 

So they're an organization that... really looks to educate people everywhere on pelvic floor issues during menopause and this micro series is actually available to anybody. You can get on a computer, go to the library, your own computer and look up the National Menopause Foundation. 

These micro series are available and I was one of those micro courses that you can take in there and that's up and running. It was so much fun to do and I learned so much from my colleagues and just an exciting thing for everybody. 

What I'm working on now is, and it should come, you know, be live any day, is PERI, the organization I mentioned before. This woman has done amazing work in the PERI menopause space and it's a certification program for all practitioners. 

It does not matter what you specialize in. You can take this PERI menopause course. Get your CEUs and CMEs and the credits for it and what she did is each one of us has a module within it and then We just finished filming two case studies so that if you sign up for this certification program You also get to listen to us Look at a case study from each one of our lenses so that interdisciplinary care model that I was telling you about which is why I was so excited to do this with her is it really looks at everybody's lens and Puts the whole picture together for someone who's looking at this series and getting educated through this series And then she'll continue to every year We do little updates and we'll do things that help people stay abreast of all the latest and greatest so to speak education that's out there So I am just so honored to be part of that and and I got to electronically meet the other faculty members Like two weeks ago now when we did that and it was just so exciting You know to learn a little bit more from each of them and feel like I'm a little more grounded in This education because I've learned all the little pieces of how they look at it, 

right? So that's another project and then I'm working on an education piece for athletic trainers. I'm doing a Part of a module system for them too, which is kind of what's happening more now I'm so excited that the interdisciplinary care model is Getting stronger that a lot of these groups are now looking at how do we look at a component from every single group? 

And so those who are being educated earlier now it or earlier in their education I should say they're learning it from the lens of many different practitioners instead of their own little siloed field so I'm excited that we're just about to get that all wrapped up now too and and then aside from that is just all the Different research projects on barriers to exercise in the female You know why why are there barriers especially during perimenopause and menopause? 

when that is when we should be exercising. That is the important time for us to pick up on exercise and help our bone health and our musculoskeletal health and so forth. So doing a little more research in that field and learning more about barriers so we can help people get care earlier and stop the barriers and let people enjoy their life more, right? 

So it's been so much fun to do things across the spectrum like that and just keep going with things. Always a little new project and, you know, and then artwork, keeping myself busy with artwork and it's been a lot of fun. 

Yeah, actually, I want to point out to the audience that this artwork behind you is actually yours. I think you said it was a water, it's a watercolor. Yeah, watercolor, yeah. It's beautiful, really beautiful, yeah. 

They enjoyed doing another creative outlet, I'll call it. So, Ingrid, we'll include a lot of information here in the show notes for people on all the things that you just mentioned and how to access your book and other programming that you have out there that you've mentioned, but if people want to connect with you or follow up with you, what's the best way to do that? 

So, LinkedIn, I'm a fair amount on LinkedIn and I respond to messages on LinkedIn and it's just been a great kind of a business model for me or like business opportunity in that I've met amazing people through LinkedIn. 

And I think that's been so much fun to really learn perspectives from other people. So, I feel like I've learned as much as I've taught through LinkedIn. So, that's a great way. I am on Instagram, I'm on Facebook. 

I'm probably the most active on LinkedIn and Instagram and then Facebook, but any one of those methods are great. But like I said, I do like LinkedIn as a great way to connect with people. Wonderful, Ingrid. 

Well, I'm so honored to have had you on the show today, Ingrid, just a phenomenal piece of work that you brought forward. I learned a lot of new things and I hope that I'm sure the audience members have as well. 

Thank you for bringing to the show and to the audience a different way of looking at things and maybe hopefully bringing some empowerment to people on how they can consider looking at a different way and understanding more what's actually people are experiencing. 

So, Ingrid, it's just been such a joy. Thank you so much for. your time today. And best wishes for everything that you're doing. Thank you so much for having me. I had a great time. I hope your audience really enjoys the different things that we talked about. 

But thank you for having me. I appreciate it. Thank you, Ingrid. Take care.