¶ Pelvic PT and Patient Care Rise
In the last 10 years , our field has gone from an unknown specialty to a household name . This brings unprecedented opportunities , but we need to rise up to meet them and give our patients the care that they deserve . In order to help others get better , we need to be better .
This podcast will help you to become more confident with your patients , more successful in your practice or business and a leader in pelvic health , and we're going to have some fun along the way . Join us as we rise together .
We're Jesse and Nicole Cozine , founders of Pelvic Sanity Physical Therapy and the creators of the Pelvic PT Huddle , and this is Pelvic PT Rising .
Hey guys , welcome back to another episode of the Pelvic PT Rising podcast with Jesse and Nicole Cozine . Hey , nicole .
Hello .
Well , nicole , I think you're doing a great job .
Jesse , thanks , I think you're doing a great job too .
Doesn't that feel nice , see ? That's going to make a whole lot more sense in a little bit of time . So we're going to get super tactical with you guys and give you a phrase that's going to work really well with your patients and something Nicole feels like is a little bit overlooked . Before we do that , just a reminder .
We are doing our annual State of Pelvic Rehab Survey . We've now done this four years in a row . We've gotten thousands of responses and it really helps us kind of get our finger on the pulse of the trends in the field of what you guys are thinking , what you guys are looking for more of Love . Seeing these .
We're going to do something a little bit different this year . So you can go to PelvicPTRisingcom . Fill that out . It's going to take five minutes . There's no trick questions , we promise , but for this year , for the first time ever , we're going to actually be giving away something to a couple of random lucky folks .
So if you complete this , we're going to choose one grand prize winner who's going to get one free rising course . You'll be able to select from any of the four that Nicole has Essentials , essentials Strengthening , rectal Evaluation , treatment or Interstitial Cystitis . And for the person who comes in second place .
You're going to be able to get one of Nicole's masterclasses for free . So either the down-trading masterclass if you guys haven't listened to that one , you just need to or the medical procedures masterclass . So a little incentive for you guys . I know a ton of you do that without the incentive .
We appreciate you , but the more people we get in , the more data we have and we will share that data with you guys on the podcast . So we want to make that a real positive for the field as a whole . So again , that's PelvicPTRisingcom . You can go , take that . It'll be five minutes .
It really helps us out and it really helps us to really understand what's going on in our field , especially year over year .
Yeah , and kind of piggybacking on that . Our word of the year in the Cosine household is abundance , and I'm really excited to also use that survey to kind of see , like Jesse said , what you guys are wanting more of . We are going to be doing a lot of cool free stuff this year .
I know that we already do that stuff , but we're just really excited to hear what you guys want , what's most important to you all , and be able to deliver on that .
All right , so we are going to talk about some really tactical stuff today .
But , nicole , I think one of the first premise of this podcast is to realize that just because you guys listening to this podcast are excited when a new patient comes in with something that you guys can help and you're super pumped and excited to work with them , it doesn't mean the patient is that pumped .
Yes , you know , I think that sometimes we conflate the patient being grateful and thankful and excited that there's somebody that helps them , but at the end of the day they're not super stoked to be having a pelvic floor problem . And so I feel like sometimes we lose sight of that .
When we're in this echo chamber of pelvic rehab professionals that are so stoked and no problem talking about poop , pee sex , like we're the ones that nothing is TMI . But to a lot of people TMI is a thing and they get uncomfortable and they don't want to talk about it . They don't want to have a problem with this .
They would choose to have their right hand cut off then have a burning vulvar problem with vestibulodinia . I feel like we just need to make sure we're not losing sight of that
¶ Validation and Encouragement in Patient Care
. I think one of the points I want to bring home today right is that if you think about the patient's journey , most often our patients are not in an acute pain state or an acute wound problem state .
Maybe you can argue that maybe a postpartum person is still in that acute phase , but essentially they're in acute on chronic phase because they were pregnant for a while .
But most of our patients have had these issues for a very long time , and so by having a pelvic health problem or a pelvic floor dysfunction issue in continents prolapse , urgency , frequency , pelvic pain , painful intercourse they can very much feel like they're failing , their body's failing , and it can be like a huge downer moment for them .
It's not a very positive experience . It's not something that's really oh super exciting that I have this major problem with my bodily functions . That's not fun .
And you guys often are the first provider that they've seen . So they may have felt like they failed with a general practitioner or with a medication , or that they were told they needed surgery . So if we think about some of just what I hear at the front desk , that's also a little bit of a downer .
Their body's failing them in this way Then they've also maybe felt like they failed or even failed at another pelvic PT . In our case we see a lot of people who've been other places .
They could have been gaslit by a practitioner . They could have been . Is this really in my head ? Is this even a thing ? And we cannot underestimate the amount of just personal life distress that the patients might be in to bring on these kinds of destabilizing pelvic floor conditions .
There's not , especially if you treat pelvic pain , but quite literally also in the pregnancy , postpartum world . That is an area that has been fundamentally , essentially disrupted .
And so people that are going through a stressful time in their life will meet a lot of times like just push over that symptom threshold line and then they start having a pelvic floor issue . So that's very common for our patients . And so then , if you think about the next phase of that , they come in .
It's kind of in this like oh geez , here we go , I can't believe I'm here , right . And now in the evaluation they meet us . We're super hey , I'm so glad you're here , kind of attitude . And then all we do is essentially find things that are wrong .
And even if we don't present it to those patients in that way , or we're very careful in how we word our findings and stuff like that , at the end of the day we're finding dysfunction , we're finding impairments , we're finding things that could potentially explain their symptoms . But we have context to that .
They don't a lot of the times and so we're basically saying like they're already kind of in this down place and then we're like , yay , we found all these things . And they're like that's not .
Yay to me , there might be , we might even be finding stuff that they didn't even know was related , that we can be finding stuff that they didn't even think was a problem , and now we're telling them something's a contributing factor to this . Right , I mean , it's can be a not a fun time .
Well , as a patient , I've been to my fair share of physical therapy and I always leave thinking I've never once had somebody look at one part of my body and was like , wow , that's functioning great , jesse , your hips are just pristine yeah especially not your hips , has never been set right .
Jesse , your elbow is definitely bending , exactly how he wants an elbow to bend . It just doesn't . It doesn't happen . Maybe that's just me , but I do feel like , yeah , I can totally understand that kind of patient perspective of and especially you're finding things that they didn't even know were wrong and now it's part of that laundry list .
It's like , oh great , add that to the list .
Right . So then I feel like we also lose sight of the fact that we're trying to and I know you guys don't like this term , but we are trying to like fix some shit . Right , we're trying to help them relatively fast , get them a quick win , and so we have a tendency to bombard them with home program things .
And right , because even if we have the best of intentions , we're so stoked we have your hips , or this , your pelvic floor , is that here you're going to do this exercise and that exercise and that stretch and that deep breathing and this meditation , and it's going to be amazing and then they come back , if we're lucky , and then we're like well , how did you
do on all of those things that I told you about ?
And , jesse , from patient perspective , oh shit , I was hoping you weren't going to ask me that , because it probably did not go perfect .
Okay , I did not do half of the things that you guys told me to do , and the half of the ones that I did do , I didn't do as often as you told me to , and then I did a bunch of other things that I wasn't supposed to do . So please don't ask me how it went .
Right , and so this is true for the majority of our patients . No matter , we can have the best intentions , but I want to kind of bring back to the forefront of our brains the fact that sometimes we forget to say the most obvious phrases that patients can hold on to that are simple .
I've done podcasts before on the phrase we Can Help you and for this phrase that we're going to talk a little bit more about on why telling somebody they're doing a good job is really , really important .
Well , talk to me about why this popped up . This was in your copious reading .
So I don't read a ton . It is actually on my personal development list of things to do , this 2024 . It's great . But last year Dr Yenny Abraham I've triggered a pelvic PT in Texas was a Pelvicon speaker and she is super awesome . She was so great to have her at Pelvicon and she gifted me a book .
It was actually a book by Oprah Winfrey and a guy named Bruce Perry who's an MD , phd , and the book is called what Happened to you and even though Pelvicon was in September of 2023 , I'm just now getting around to reading it and it's really profound and there are some really awesome ways to describe pain science to folks to .
Basically , it's a book on if we can change our way of thinking about people to what happened to you versus what's wrong with you , then we can have a lot more empathy for folks .
But it basically goes into the neuroscience of trauma and even early childhood trauma and stuff like that Super relevant for us as practitioners , super relevant for all of our patients , and it's really great sort of written for everybody , not written for practitioners . So some of the ways that we can describe things to patients is also really great .
But I was coming along this one section and Oprah was talking about all of the amazing people over the years , over her 40 years or something , of being in television and interviewing really prominent folks , people that are objectively just crushing their careers and their life , and they're very talented , and all of these people that on paper you know , are really
really , really successful . And she said overwhelmingly right after almost any interview she's ever done , even these really objectively successful people turned to her and say was that okay ? How did you think that went ? Is that okay ? Did I do a good job ?
And that was really profound to her because she was like I can't believe that these people are asking me did I do a good job , right when they're super successful ? And so I think this is a fundamental human need to be told that there are people and to know that you're
¶ Importance of Patient Reassurance and Encouragement
doing a good job . So Jesse's going to read a little excerpt from this to kind of explain that a little bit better .
Yeah , so they say remember that we humans are very social creatures . We are contagious to the emotions of others . We are continually scanning the relational environment for signs of approval and belonging , as you put it . He says to Oprah how did I do so ?
When there is an unexpected , confusing or potentially threatening signal , like being in your guys's office , when you're going through , you know , an exam and everything else , we look to others to help determine what's going on . We look to other people , especially their facial expressions , for emotional clues about how to interpret that situation .
And so that's really what we , as patients , are looking at when we're talking with you guys . Right , it's . Hey , you just told me I have a problem with my hip range of motion . I don't know what any of that means . Help me interpret that .
And I think sometimes you're left as a patient kind of guessing , based on your nonverbal cues potentially , or the tone of voice that you have with that . And I think what you're saying , nicole , is be like a little bit more explicit with providing that reassurance .
Yeah , absolutely . And a lot of times and this is just one of the tactical things that I do to set people up for what we're going to do , to make sure that everybody kind of knows like this is what this session is going to look like , this is where we have choices , this is what we're going to plan to do . Are we okay with that ?
All of that kind of stuff . But then when I'm actually getting to , I've done my pelvic floor anatomy talk , I've done all of the things that we're going to be looking for in the exam .
But I also make sure to be very explicit , you know , look at them directly in the eye and be like , as we're going through this evaluation , we're going to be finding a lot of things and , quite frankly , I don't know whether or not I care about anything that I'm finding until we put it all together .
And so I think in that way it kind of diffuses any wondering on the patient's end of like ooh , she's making a comment , or she's hanging out at this hip a little bit longer than she hung out at the other hip . I wonder what that means . You know , they're looking to us to see like , is that okay , is that good , is that bad ? What's happening ?
Did I do a good job with that , with that improvement from last visit ? You know it doesn't have to be just the evaluation , it has to be . It can be also for a treatment session as well .
But I think setting it up like that with hey , I'm not sure we're about to go through a bunch of stuff , I'm not sure about how it all is going to be put together until the end , and I promise you I'm going to explain it all as it's coming but let's just have that sort of be the blank paper that we're working off of , instead of making them assume that
something that we're finding is going to be like quote , unquote , bad . I think that just really helps .
And then , especially that , just that phrase .
If even the president of the United States or Beyonce in Oprah's examples , are wondering if they're doing good at an interview , something that they have done thousands of and , objectively , are in the top 1% of the whole world in doing , how much more so is your patient feeling that way when they're in this uncertain , scared , unfamiliar situation of being in your
office for something that is , objectively , to people who don't know you guys and what you do , pretty fucking weird ?
Right , totally , totally . Thanks Jesse for that . That was great , great summary . No , I know .
When you're dating and you have to explain what you do to your potential significant other and it's like , okay , well , sit down and you have to get out like a pelvic model and stuff , Like it's not just like , oh , I do people's taxes .
Perfect . So objectively it's a weird situation for the patient , but you're saying .
You know one of the phrases you've talked about before and we actually have you use on the phone as well in our business mentorship side . We can help you . That's what people want , need to hear in that moment . It's not .
You know , physical therapy has been proven in multiple randomized , controlled clinical trials to be effective for more than 72% of people and decreasing symptoms . It's like , no , we can help you . We can help you Totally .
And same thing with this , this you're doing a good job making people feel that way and think about how you want them to feel when they come into your office .
Totally , and this , you know , I think can also be extrapolated to treatment sessions , where they come in and making sure that we're not inadvertently making them feel like they didn't do a good job by asking questions in ways that are going to make them tell us where they had these pitfalls .
So I want to also point out that when they come back to us , I think that if we think about what the perfect patient would do , right , they would do every single thing that we say . They would do every exercise perfectly . They would like doing it . They would be excited to change they would never overdo it .
right , they would never overdo it the other end of the spectrum .
Right , and I mean that just frankly , never happens and so I also want us to consider the fact that sometimes I would say even the majority of patients the fact that they're coming in is doing a great job . You're doing a great job by being here . That might be it . That might be all of the capacity that they even have .
We may be at their top capacity for them to even step foot in your office . So sometimes , by tacking on other things that they need to do , that might be inadvertently setting them up for failure , feeling inadequate or feeling bad about themselves because they didn't please you .
In that way , I just want us to make sure that we're taking a step back , taking a bird's eye view of what the patient journey is like , and making sure that we're physically telling them , like words coming out of your mouth You're doing a great job by being here .
And even if you didn't do your home exercises perfect or you didn't do them at all , that's okay , which is still great . This kind of goes on to another podcast that we've done a little bit with being like oh , there's no such thing as like a compliant patient . I hate that word .
Non-compliant , I hate the words like measuring whether or not someone's good or not good as a patient is how well they're complying to our plan of care . It's like I want us to consider that sometimes , for most folks coming into our clinics like them being there , maybe on time , is like a really big fucking deal , and they need to know that .
And I think that if you start saying to your patient more often oh great job , a great job being here , Great job on this task that's super simple .
Great job on simply bringing me back information that I asked you to track not even doing any exercise or deep breathing or meditation or anything else , but just bringing me back more information is also doing a great job , and we need to make sure that we're verbally saying that to folks more often than we feel like we need to be or more often than we are .
Absolutely . So let's leave it . I think at that , nicole . I think that's a fantastic summary there of just being able to say that , say that out loud . Same with that phrase of we can help you , but see how that starts to transform your interaction with patients . And I can tell you as a patient that would sure feel nice . It feels nice .
So there's that Just doing a great job on this podcast .
Thanks , nicole , and you guys are doing a great job at listening to this podcast , so doesn't that all feel good ? It really is To be honest with you guys and just a little bit of a side , we do feel like you're doing a great job , If you really think about
¶ Seeking Extra Resources in Pelvic Rehab
it . 99% of pelvic rehab providers are not listening to podcasts about pelvic rehab . This is a total diversion from what we planned to talk about , but I think it's so important . You guys are the elite people because you're doing things like listening to this podcast .
Not that the podcast is magic , but the fact that you're doing this on your walk , on your drive , in that you care that you give a shit enough about your patients to be seeking out extra resources and thinking about your job when you're not on the clock and getting paid for it , that puts you in the top 1% of the people out there , and so you do deserve
some commendation for just listening to the podcast , to just seeking out resources for your people . I think you are doing a great job . I know we started to say that a little tongue in cheek and then I got a little serious about it Brings a great job doing this .
Great job , I concur .
All right , guys . Well , as always , we'd love to hear your thoughts on this . Let us know if this has been helpful for you . We want to keep this conversation going .
And let's continue to rise .