Pelvic Floor Therapy: Why It’s Crucial and Who Needs It with Kerry Boysen, PT, DPT

[0:00] All right, welcome back to the PTCH Podcast. Today we’re diving into a topic that doesn’t always make it to the dinner table conversation: pelvic floor health. Kathy: Well, let me just tell you, if you live at the Boen household, it does make it to the dinner table Jason: and the breakfast table and the lunch table. Kathy: Okay. And this is why I live at my house. Jason: Well, today we’re talking leaks, lifts, and life changes, especially during menopause. Kathy: Yes. Joining us is Dr. Carrie Boyce from Restore Physical Therapy. She’s here to clear up some myths, break down the

[0:30] science, and maybe even convince you that pelvic floor therapy can be empowering. Jason: So whether you’ve sneezed and crossed your fingers, or just wondered what exactly your pelvic floor does, you’re in the right place. Let’s jump in. This is the PTCH. Kathy: What happens when a chiropractor and a physical therapist get together to make a health and wellness podcast? Jason: But chiropractors and physical therapists don’t like each other. Kathy: Oh, think again. I’m Dr. Kathy Lynch, physical therapist who likes to help people move and get stronger. Jason: I’m Dr. Jason Young, an evidence-based chiropractor who uses

[1:00] humor just as much as adjustments to help people get better. Welcome to the PTCH Podcast. Kathy: Remember, there’s no I in PTCH. All right, we are back. Jason: We’re back. Kathy: We’re back. Jason: Joining us today is one of my very good friends in town, Dr. Carrie Boen, physical therapist. Do you feel intimidated? You got two PTs here in the room. Kathy: How you feeling right now? Carrie: Oh, you know, I’m very secure because I’m a chiropractor. Jason: And

[1:31] today’s episode is the PT, PT. Kathy: Our topic today is stuttering. Jason: No, we’re really excited to have you here, Carrie. So, Kathy, tell us here. Kathy: Tell us who Carrie is. Jason: Well, what is she doing here? Kathy: Carrie’s actually going to give us her personal story. I know that she started out as an ortho physical therapist and then transitioned. Carrie: I did. I’d spent about seven years as an ortho PT at a

[2:02] health system in Portland, Oregon. And the manager at the time said, “How about you transfer to the women’s health clinic?” And I said, “Well, I don’t know anything.” And part of the deal was all the continuing education that I would need to get up to speed to provide those services. And you know what it’s like to pay for continuing ed. I jumped at the chance. So, interestingly, the first class I signed up for was a musculoskeletal changes in pregnancy class. Jason: Oh. Carrie: And by the time I attended the class, I

[2:32] was pregnant for the first time. So, sitting in that class getting all this information and realizing no one knows this information. I wasn’t getting that information from my OB. I wasn’t getting it from anywhere else. And that just really fueled a passion for educating women about women’s health. Jason: That’s cool. So, the timing couldn’t have been more perfect. Carrie: Could not have been more perfect. And then really my career in women’s health, pelvic floor physical therapy has

[3:02] followed. I mean, now I’m pregnant. Now I’m postpartum. Eventually I’m perimenopausal and probably now postmenopausal. And so all— Jason: Well, it’s a good thing you didn’t get into mental health. I mean, Carrie: now I’m crazy. Now I’m really crazy. We can’t use the C word anymore, I hear. Right, “crazy” is off limits. Jason: It is definitely off limits. Carrie: Dang it. All right. Jason: Yeah. So, that’s how it started. Carrie: Awesome. Yeah. So, Carrie joins us as

[3:32] owner-operator of Restore Physical Therapy. Tell us when that started. Carrie: So, the year was 2015. It was a dark— it was a dark and stormy night. Well, and I think it’s fair to let people know that like I was like I’m going to question you like where were you on Thanksgiving 2004? And she was like 2004 is when it all started. So when it all started, pelvic health began. Carrie: Yes. So 2015, my family had just moved back to

[4:02] the community. We had been in Corvallis from 2006 to 2014. I’d worked in other practices doing mostly ortho but some pelvic health. And I came back to the community and knew there was a gap in services. At that time there was maybe five-ish people doing pelvic floor PT in the valley and there was a need and I wanted to meet that need. So I opened the specialty practice of Restore that focused on obstetric health and women’s health, pelvic floor health, treating

[4:33] only women. And here I am 10 years later. So, and so for people that are wondering, because I’m sure there’s already people like, okay, like where do I find her? So, where is Restore? Are you in Corvallis, Albany? Like, where— Carrie: I’m in Corvallis, same place I’ve been for 10 years. This is what I say when people call. Do you know where the French bakery is or do you know where Papa Murphy’s is off of Circle? I am in that same strip of businesses right in the center with the sign that says Restore Physical Therapy. It’s a great place for it,

[5:04] especially if your business is called Restore. Carrie: Yes, it is. It’s just me. I’ve been a solo provider and practitioner. Sometimes I wonder if I don’t play well with others. I’ve thought about employees, but it just stays me. Jason: I hear that. Kathy: I hear that for sure. Jason: That’s cool. Well, I’m so glad that you’re on the show. Carrie: Thanks. I get to interact with other— Jason: with adults. Carrie: Yeah. And you know me. Jason: Yes. Oh, yes. Yes. The chiropractor.

[5:34] Carrie: Yes. Jason: Okay. Well, I think we’ve said it many, many times now. The pelvic floor. Kathy: What is it? Jason: What? Kathy: Well, and I think it’s a legit question because there’s some people that are going to be watching and they’re like, “Oh, yeah. You know, the pelvic floor. I tuned in for this. I slogged through those other 20-whatever episodes so I could get to the pelvic floor episode,” because we’ve had people ask about this a lot, but then legitimately we just had to explain to

[6:04] somebody, wait, a pelvic floor? What is— Jason: What is the pelvic floor? Kathy: I’m a man. I don’t have a pelvic floor, Carrie: right? So, men and women have pelvic floors. Jason: Okay. And I don’t go many places without my pelvis. I’m going to talk about it. Kathy: If you’re watching on YouTube, please check it out. Jason: Tune in— Kathy: or Spotify. We have Spotify video, too. Jason: Yeah. This is so advanced. This is a wow. Kathy: Okay, so here’s a pelvis. It happens to be a female pelvis. Carrie: The pelvic floor is the structure of

[6:34] muscles that sits at the bottom. It’s a diaphragm. Its role is to help support the pelvic organs. Its role is to be the center of gravity. Kathy: So pelvic organs — Jason: well, let’s think about it. In a female pelvis, it’s the uterus, ovaries, fallopian tubes, bladder, rectum. Kathy: Mhm. Jason: So guys have some of those too. Kathy: Couple. Jason: Yes. Some of them. I’m not going to specify which — the difference is our pelvic outlet in a female is wider, which makes

[7:05] us more susceptible to dysfunction, strain, injury. Jason: It’s not as much. There’s only one opening to a male pelvic floor. That’s via the anus. And in a female, we’ve got the urethral opening, vaginal opening. Kathy: Mhm. Jason: So in eastern religions, this is considered where the life force energy resides, which I think is awesome. Kathy: Again, center of gravity. It’s where motion is initiated. It doesn’t sit in isolation. We’ve got pelvic floor at the bottom, diaphragm at the top, transverse abdominis, multifidi, commonly known as

[7:36] the core. Jason: So we need our core to help give support to the sacrum, spinal column. Kathy: There it is. Jason: Pretty important. I think we’ve talked about some of those muscles in past episodes, and like when things become dysfunctional with those you can get all kinds of problems. So Kathy: yeah, Jason: it’s good. But why doesn’t anybody want to talk about the pelvic floor? Kathy: I don’t know. I think historically, society, we just didn’t want to talk about that. It’s fascinating to me the

[8:07] number of patients who come in who don’t know about their anatomy. Jason: I think we’re doing a better job. I think I have a 19-year-old daughter who’s got more knowledge because we do talk about it at breakfast, lunch, and dinner at the Boyd household. Kathy: I think more and more people — it’s all over TikTok. It’s all over social media, which is not where it was 10 years ago. Now in town, I’d say we’ve got more than a dozen pelvic floor PT providers, Jason: which is great. Kathy: It is. Jason: Well, I mean, it’s taboo. I mean, you even said it earlier like you called it

[8:39] naughty bits. Kathy: Yeah. That is — that’s not — that is not what we learned in school. Jason: I went to school in England and they called them the naughty bits, but I feel — yeah. You know, like the things — it’s just taboo, at least in our culture, to talk about our genitalia. Kathy: Yeah. Jason: Well, when you’re a child it’s called your private parts, right? So we keep it private. Kathy: Yeah. Absolutely. And there can be shame

[9:10] associated with it. And then I think some of the dysfunctions that show up can feel embarrassing or feel a little bit shameful. Our society has done a great job at providing things to treat the dysfunction. Like walk down a women’s care aisle in the grocery store and there’s so many products for managing your incontinence, for example. And it doesn’t have to be that way. Incontinence is not normal. Jason: Yeah. I mean, it’s just like I think in general the whole thing is kind of a conversation stopper.

[9:40] Kathy: Mhm. Jason: Oh, hey, let me tell you about my prolapse problem. It’s like, oh, you know, actually, I have to go do literally anything else. Kathy: Do you? Jason: So, yeah. Does it get awkward and people are like, oh, so what do you do for a living? And you’re like — Kathy: well, that’s a good question because I’ve always been forthcoming with it, but it’s definitely been an evolution over the years. And my spouse, who has graciously stood by me during these conversations, he now has all the language to say she’s a pelvic health provider and this is what she does and a

[10:10] menopause expert. And so I think as society has come on board a little bit. Jason: Yeah. Kathy: The conversation happens more. Jason: Okay. Kathy: Yeah. Way more comfortable. I also used to say, “Give me a glass of wine and I’ll talk about the pelvic floor.” Now we’re just spraying water. We don’t need — we don’t need anything, right? Sober all the way over. Jason: There’s no two-drink minimum on your pelvic floor. Kathy: No conversation. Jason: Please do not come to your appointment with two drinks.

[10:40] Kathy: Got to show up sober for that. Yeah. Yeah. Jason: Well, and I think, you know, kind of alluded to it, but especially taboo for men to have pelvic floor — Kathy: absolutely — Jason: conversations. And unfortunately, there are less providers that treat men. In my setting, I don’t treat men — while I’ve had that training. And it’s Jason: it’s a tricky thing. Kathy: Um, one because it’s just me in the clinic — to be treating a male, I would need to have a third person there.

[11:10] There’s just, you know, different issues to think about, but men do — like especially prostatectomies, there can be incontinence issues. Super helpful to have pelvic floor PT. Pudendal neuralgia is another dysfunction that a lot of bike riders — Jason: oh yeah — can get from being on the saddle for too long. Super helpful to see a pelvic floor PT. So there are a couple in the valley that will treat men, but unfortunately not at Restore. Jason: Yeah. So pudendal neuralgia that you just talked about — it’s when you get too much pressure on the pudendal nerve.

[11:42] Kathy: Yeah. Jason: Yeah, goes across the — Kathy: the nerve is coming right through kind of a canal here, and so muscles impact that, sitting impacts that, Jason: sometimes it’s unknown why it gets angry. Kathy: Can get angry. Jason: Gotcha. I think that’s a good segue into what are the common issues — Kathy: pelvic floor dysfunction — Jason: yes — Kathy: right, so — Jason: I like the way that you light up whenever pelvic floor dysfunction — Kathy: floor dysfunction, let’s talk about it.

[12:12] Jason: Give me a bottle of wine. Kathy: Here’s how I break it down. I break it down into two categories. It can either be overfunctioning or underfunctioning. Okay, so let’s start. If your pelvic floor is overfunctioning, it tends to be in a state of hypertonicity. It’s tense. This can be because of history of trauma or abuse. So you’ve got this guarding and protecting. It can be due to chronic holding patterns, just because maybe you’re type A and you hold everywhere. Pelvic floor can hold that

[12:43] tension. If you’re holding tension here, you’re probably holding tension. Kathy: Like if you’re anal retentive. Jason: Yeah. Kathy: Yeah. I haven’t heard that Jason: literally. Kathy: Well, literally you are anal retentive. Jason: I think — I think there’s probably a number that are coming to my mind now, but just all those kinds of things, right? So then think about if those muscles aren’t relaxing, it makes pooping difficult. It makes going in — like penetration — difficult. So tampon use or intercourse, right? Those things can be uncomfortable. So that would be

[13:14] the overactive pelvic floor. The underactive pelvic floor, which is what people I think typically associate with pelvic floor PT, is: I’m leaking, right? I leak when I cough, sneeze, laugh. I can’t jump on a trampoline. Jason: So that underactive pelvic floor is always — Kathy: I can’t jump on a trampoline for other reasons. Jason: — the advice of every healthcare provider, right? Kathy: Jumping on the — Jason: but the underactive pelvic floor is going to be your incontinences, pelvic

[13:44] organ prolapse, that type of issue. Jason: Two categories, simple. Kathy: Gotcha. And which one — like, is there one or the other where it’s like, “Oh no, it’s this,” or, “Oh, this is easy,” like I can — we can handle this before I go to lunch? Like, what’s kind of easier? Like when I look at my roster I’m like, “Oh, this will be easy.” Kathy: I think all of them involve a huge amount of education, and I think that’s what is

[14:15] most helpful and what I’m most good at, if you will — just really explaining, because again, if people don’t know their parts they can’t understand what’s happening. So all of them — overactive, underactive, dysfunction — start with basic education, and then I think it gets easy from there for all of it once they understand what’s happening and what my role is. I get excited about all of them. Jason: Yeah. Kathy: All of them. Jason: Can we back up and can you explain what a prolapse is? Because I think that word

[14:45] gets tossed around a lot and people are like, “Oh yeah, prolapse.” And they just nod. Yes, I know what that is. Kathy: Prolapse. Jason: Stop talking to me. Kathy: Yeah. It’s very common. And there’s a certain level that’s okay to have. And then there’s the — this needs to be treated, sometimes surgically. Jason: Yeah. Kathy: Prolapse. Okay. Imagine this is your vaginal canal. You’ve got your bladder on one side, your rectum on the other. When there’s a weakness of the wall, it

[15:15] allows the bladder to fall in, or it allows the rectum to fall in, or the uterus can descend. Those three things can prolapse, and then it’s graded. How far is it descending? Is it coming just into the canal? Is it coming to the opening of the vagina? Is it extending beyond — like, something’s actually falling out and you’re pushing it back in? That is the surgical situation. Prolapse happens because of genetics. It happens because of tissue health. It happens because of prolonged labor and delivery or a really big baby.

[15:46] Some factors you just can’t control. But once you have it, learning how to manage it and mitigating pressure systems and how you’re breathing — then you can have success, and so there’s rehab for the pelvic floor. Jason: Absolutely. Kathy: Those things. Jason: Absolutely. Because I think a lot of people, whenever you start talking prolapse, are like, “I’ve got to have surgery.” Kathy: Yeah. Jason: Yeah. And research says that you will have a better outcome with surgery if you’ve done pelvic floor PT first. Jason: That’s kind of shocking. Kathy: It’s kind of like all surgeries in PT.

[16:16] Isn’t that weird? Jason: Right. Yeah. Yeah. The more you know, the better you’ll do. Kathy: Absolutely. Jason: Yeah. So, here’s my question. Sometimes I want to refer somebody to pelvic floor therapy, and it’s one that I make like a few times a month at least. And — wait, I haven’t seen any of those. Kathy: Young, I did. I had misspelled the name of your clinic.

[16:46] So, when I’m trying to explain it to people, they’re like, “What are they going to do if I go to pelvic floor therapy?” So, could you — Kathy: What do you say? Jason: Well, I say you’re going to have to find out and get back to me about it. No, I tell people — well, I’ll give you my answer and then I want to hear the truth. Okay. So, I tell people about the education, right? I tell people that you learn some

[17:18] self-care things, that there’s some pelvic floor PTs who will do some manual therapy, and yeah, that’s pretty much it. So, how far off was I? Kathy: Well, you’re pretty on. Jason: Yes. Kathy: I give a little more — I want the patient to feel at ease coming in, right? So, first and foremost, no pelvic floor internal exam is going to happen before we’ve had a conversation, before they’ve given consent — written and verbal — before we feel comfortable with each other and there’s a little bit of

[17:48] rapport. And nothing’s going to happen unless the patient feels comfortable doing that. I’d say 100% of patients walk out the door at Restore and go, “That was way more comfortable than I thought. You put me at ease. That wasn’t embarrassing.” So, it’s a safe space. It’s a private space. It’s a trauma-informed space to do that. Education for sure is going to happen, right? We’re going to look at the pelvis. We’re going to talk about the anatomy. We’re going to go through what their dysfunction is. And then once

[18:19] again, that consent happens and we do the exam. It is an internal pelvic floor exam. I always say it’s not like the OB or the gynecologist. There’s no stirrups. There’s no speculum. It is just assessing the muscles, how they function. And depending on what you find, there can be manual therapy. And I don’t just dive into the pelvic floor — I want to know what the lumbar spine looks like, what the hips look like. There’s a lot of hip dysfunction related to the pelvic floor. So, it’s a full comprehensive exam that

[18:50] includes a pelvic floor exam. Jason: Right. I think that’s a great answer. Kathy: There you go. Jason: And guess what? When I see you at the farmers market, Kathy: I’m not thinking about the market. Jason: I’m not — I’m not — I think in an earlier podcast you talked about something where like Kathy: and I don’t want to — I’m going to avert my eyes if I — No, I’m good at it. Jason: Yeah. Yeah. Kathy: Yeah. I think you might be talking about my experience with Tom. Jason: Yeah. Kathy: Yeah.

[19:21] Yeah. So I think that that’s really good to share because I’d say that there’s a good amount of the time whenever I talk to somebody about that and they just get this kind of look of panic Jason: and they’re like, “Okay, dude. I’m trusting you.” And so yeah, it’s — I think that’s a really good description for people to hear because yeah, that’s — I think that could be scary for some people. And I’ve had people over the years like want to come to the clinic, want to see the space, want to

[19:53] know. Kathy: It’s totally legitimate. Jason: Mhm. Kathy: Yeah. Jason: Right. Kathy: Yeah. Jason: Cool. Kathy: Yeah. Jason: Yeah. I have heard — I’ve gotten that same question. What are they going to do? Kathy: Yeah. Jason: Well, here’s what’s going to happen. Kathy: It’s going to be great. Jason: And people get great results. And sometimes the reason I’m making the referral is because somebody has like a tricky hip problem. So sometimes it’s difficult to tell, you know, is this problem actually coming from the hip? Kathy: Or is it coming from somewhere else? Jason: Mhm.

[20:23] And so I spend a lot of time on lumbar spine, spend a lot of time on glutes, spend a lot of time on the hips. If we’re not getting much traction there, Kathy: then it’s like, okay, we need somebody who can, you know, help assess and teach you how to take care of your pelvic floor. I’m not that guy, right? And so it’s — I think it’s really really helpful because there’s literally no other way that people are going to get answers to those problems, Jason: right? Kathy: Yeah. There’s not a surgery, there’s not a pill, there’s not a stretch,

[20:54] Jason: right? And so Kathy: let’s feel it and assess it and see how that pelvic floor is functioning. Jason: Yeah. And when you said the hips, I think that is one of — I see a lot of people who’ve maybe even had a labral repair surgery. They’ve been dealing with stuff for a long time and kind of the last resort is the pelvic floor PT because no provider knows what else to do with them, right? Kathy: And unfortunately, maybe had they seen the pelvic floor PT first, some things could have been resolved. Jason: Yeah. Yeah. Kathy: Yeah. I will — I will verify that we

[21:24] don’t know what to do with stuff. Yeah. Jason: I mean, you learn about it, but it’s like, yeah, I don’t want to do that. Kathy: It’s like a black box. You’ve talked about that before, haven’t you? It was like a black box in school. Like, we learned about it, you know, maybe one lecture Jason: and moved on. Kathy: Mhm. Jason: Yeah. Most of my continuing education came after school. Kathy: Sure. Jason: Yeah. Kathy: Yeah. Jason: There was minimal. And I think part of it is maybe because it seems like a

[21:56] really kind of high-risk, high-stakes area because you kind of alluded to this — like that yours is a trauma-informed space and not everybody has the same kind of story surrounding their pelvis. Some people never think about it a day in their lives. Some people are dealing with abuse, embarrassment, you know, just all kinds of things that I imagine it doesn’t take just like the average skill set Kathy: to be able to deal with that. So what can you tell us

[22:27] about that? Jason: What’s your skill set like? Kathy: I mean, is this an interview? This just turned into like a job interview? Jason: I think so. Yes. Kathy: Mhm. Jason: Do you need to see my credentials and log of continuing education, Jason? Well, I’m looking at your references here and Kathy: can we — can we call some of these live? Jason: Yeah, let’s get them on the air. Kathy: Phone a friend, see what they have to say. Jason: I mean, I think so. I’ve been doing this for 21 years, right? Delved into this in 2004. There’s been a lot of learning, a lot of experience, a lot of “well that

[22:59] didn’t work” or “gosh, this is what happened in that experience” which drives me to Jason: dive into the literature or research more or take another course and Kathy: yeah, it’s a rich experience with the different things — knowing what works, Jason: what doesn’t — practicing in a variety of settings where you’re like, “Oh gosh, that doesn’t make the patient feel comfortable, so how can we Kathy: improve that?” Jason: It’s not quite a spa experience when you come to Restore. That’s some nice classical music. Kathy: It’s very nice. Welcome to Restore

[23:29] Pelvis Spa. Jason: Does that feel comfortable? Like — although, you know, I should bring up because I think it probably — I’ve found the most success in referring people who know somebody who’s been to pelvic floor therapy, right? And so my dad just turned 77, right? And for his birthday, our gift was going to be a pedicure. Kathy: I didn’t know where that was going. You didn’t think that’s what I was going to say.

[23:59] Jason: Wow. No, that’s 78. Don’t worry, my dad doesn’t listen to the podcast. Kathy: You didn’t spoil anything. Jason: Yeah, we didn’t spoil anything. No. So we were going to take him to get a pedicure. My sisters were like, “He’s gonna walk right out of there. He’s not gonna do that.” I was like, “No, no, no. It’s gonna be fine.” And so like he shows up and I didn’t tell him where I was taking him. We’re walking into the place. I was like, “Dad, you’re going to get a pedicure for the very first time.” And he’s like, “What?” So he’s like, “Okay.” Well, we walk in and

[24:31] the very first thing that he sees is this guy who’s probably around his age, great big handlebar mustache, and he’s sitting there and he’s getting his feet worked on. Yeah. And so I think that instantly for my dad that was like, “Okay.” Yeah. Kathy: Credibility. Jason: Yeah. Kathy: There’s a man in there. Jason: It’s just us. It’s just us dudes here. Okay. All right. Kathy: Well, I think that’s what’s driven the surge in pelvic floor PTs now. If you’re in PT school, a lot of third-year

[25:01] DPT students are attending some of the level one training. They’re coming out of school with some basic knowledge. They’ve done some internal exams. And now there’s a fellowship that you can do for pelvic health, women’s health. People are talking about it, people are having the conversation. It’s being normalized, and for all the awful things that social media can do, maybe it has promoted some good things. Yeah. Yeah. And so I think that’s good, especially as people share, “Hey,

[25:32] I went to pelvic floor therapy, it really worked great for me,” and I appreciate it. It makes it easier. Most of my referrals are word of mouth. There’s some if somebody drops something in a Facebook moms’ group like, “You should see a pelvic floor PT,” or, “You should go see — I did it, it was great.” Yeah, absolutely helps. Yeah. Yeah.

Jason: Kathy, do you refer to pelvic floor PTs?

Kathy: Only to you.

Jason: Okay.

Kathy: Is that the right answer? Yeah.

Jason: But to Jason’s point, like what do you think about — or at what point

[26:02] are you like, “I think the pelvic floor is involved?”

Kathy: When I can’t sus out why this person’s back hurts or their hip hurts — definitely the tricky hips, SI joints — I’ll text you like, “Why do I — this is SI, but it’s not working out for me. How do I know?”

And then you text back, “Try poking the —”

Jason: Okay. When you said poking, this is — so, dry needling. Okay. Physical therapists

[26:33] have not been allowed to do dry needling in this state. Correct. And our practice act is changing.

Kathy: It is. This is a game changer.

Jason: A game changer. I mean, it’s one of those — it’s just another tool in the toolbox. It’s not going to be the end-all be-all. It’s not going to solve all the problems. We’re not going to throw everything else out and dry needle. But the year I was in Wisconsin, I was trained to do dry needling and I saw it really effective, and haven’t used it here because it’s not legal.

Jason: That’s right. And now we can. And so we might

[27:04] be poking some things with needles once I’ve had all the training and am ready to do the pelvic floor. But now it’s going to be possible in the state, which I think is exciting.

Jason: I’m thinking about the thumbnail for this episode and I think that that might be the quote. “We might be poking some things.”

Kathy: Love it.

Jason: Come learn about pelvic floor therapy.

Kathy: Yeah. Well, that’s great.

Jason: Yeah.

Kathy: And that’s a huge deal because opening up your practice act is risky.

Jason: It was risky. Because when I was on the chiropractic licensing board — like when I just came onto it — we were looking at dry

[27:34] needling, and we fumbled because the way that we went about it, we were like, “Yeah, you know, this is part of our scope,” which we never should have said, because once we said that, then it’s like, “Well, if you’re going to try and expand your scope, you’ve got to open your practice act.” So we looked at that and it’s like, when you open up your practice act,

there is just as much chance that you can have scope taken away

as added to. And so kudos to the licensing

[28:05] board, but also to the lobbyists, the association, that probably did a really good job of protecting

your scope. So that’s huge. That’s awesome.

Kathy: Yeah, we snuck it in.

Jason: Yeah, it was great.

Kathy: That’s good.

Jason: Yeah. Good. So we’ll see what 2026 holds as far as offering dry needling. Yeah, we’ll see.

Jason: What about — talk about the pelvic floor through the lifespan

and periods of life, like pregnancy?

Kathy: Mm-hmm. Well, we can even think about early childhood and adolescent —

[28:36] there are pelvic floor PTs who will treat

pediatrics.

Jason: Wow.

Kathy: Constipation, bed-wetting,

urinary frequency. So there’s that part of the spectrum, and then we can go all the way up to later. So I think you’ve got — I mean, I’d say even before childbearing years, you’re maybe an athlete and you’re running and you’re a college athlete. You might be overusing your hips and the pelvic floor might have some dysfunctions. Then you get to childbearing, and yeah, what’s

[29:08] that pelvic floor doing during pregnancy?

What kind of trauma did it go through with labor and delivery? What about cesarean delivery? So all of that wraps into the women’s health piece. And then once you’ve had a baby, you’re postpartum forever, right? So it can show up now. It can show up 5 years, 10 years, 15 years, which is generally when we’re progressing into that perimenopause. Kathy and I love to talk about menopause. Do you know that we’re also menopause educators?

Jason: Menopause. Can you explain this to me?

Kathy: Look at — I have not heard of this pause

[29:39] of the —

Jason: Oh, yes. Yes.

Kathy: Yeah. Somebody was like, “You guys should do an episode on menopause, ‘cause it’s a real thing.” I was like, “We’re not doing a manopause.”

No, there’s plenty to talk about with menopause.

Jason: Yeah, we’ve got the Novo Collective. Awesome.

Kathy: Little shout out for the Novo.

Jason: Yes. But so that’s another life change — when we start to see decreases in estrogen, right? Declining estrogen affects every part of our system, from our hair to our nails to — all of it. And specific to pelvic floor

[30:11] PT, and I’d say PT in general, that’s where we’re seeing a loss in bone health, changes in heart health. So as a PT, I’m absolutely going to talk about those things. But specific to the pelvic floor,

tissues change. Ready for one of my favorite words?

Jason: Yeah.

Kathy: Vulvovaginal biome health.

Jason: You want to say that like — times? Vulvovaginal biome health.

Kathy: Vulvovaginal biome health.

Jason: All right. Wow.

Kathy: Am I a pelvic floor therapist? Did I do it?

Kathy: Say it. You can say —

Jason: I feel different.

Kathy: Yeah, get your certificate on the way out.

Jason: Yeah.

[30:42] So when tissue changes happen, estrogen decreases — what’s happening with our vulvovaginal biome health, right? We need to make sure the tissues are healthy. We’re going to get a gynecologist, or urogynecology PA, our good friend Jessica, to prescribe topical estrogen to keep those tissues healthy.

Jason: Topical estrogen is like the number one preventer of UTIs as we age.

Kathy: Okay.

Jason: Hopefully soon it’s going to be just an over-the-counter situation,

but we’re so terrible about stuff like that in this country.

Kathy: It was so terrible.

[31:12] Jason: It’s like so terrible. : You know, you go to Mexico, you go to Canada, you just get — it’s not — you can get whatever you want. You can get whatever you need, right? I have like a little business card like on my wall. La Farmacia. Kathy: Mhm. : Yeah. Mhm. It’s right there. Kathy: Yeah. I call up Maria at La Farmacia. : You got to go. You got to go. Kathy: Yeah. But it’s like, I don’t know why. : Yeah. It’s a simple thing that’s going to be a game changer over the — Kathy: just let people get the stuff that they need. : But in that stage, it’s — because of

[31:43] those tissue changes, maybe your sexual health changes, maybe intercourse is becoming uncomfortable. Kathy: Mhm. : It is not a grin and bear it situation. It is — there are things that you can do. Again, because of those tissues thinning, incontinence might become more pronounced. Your prolapse might become more pronounced. So maybe you’d been skating by with some dysfunctions, or you were managing them, but now it feels worse. You’re not willing to put up with the crap anymore. You’re going to make something happen. Kathy: Yeah. : So yeah. Kathy: Yeah.

[32:13] : Because it affects everything, right? It affects people’s confidence and, you know, relationships and all those kinds of things. Kathy: Social activity, like you’re not going to leave your house, right? Right. : And that is one of — I think the most rewarding things about being a pelvic floor women’s health — that I have just loved and stayed in this for all these years now — is that it does impact quality of life. Kathy: Right. If you can now have more control over your bladder and feel more confident in going out in public or enjoying your friends, : having a good laugh without completely

[32:44] wetting yourself. Like, that’s a big thing. We haven’t really touched on bowel dysfunction. I mean, that’s a whole other one. And when you’ve got chronic inflammatory things like irritable bowel or other GI system issues, right, that can lead to pelvic floor dysfunction. So getting people help with that. Jason: There’s a whole industry out there, you know, like Depends. : Oh, yeah. Right. That sells to people with incontinence. Jason: But have any of those people gone to pelvic floor therapy?

[33:14] : Likely not, right? Jason: Likely not. Right. And the incontinence underwear. : Yes. Jason: Yeah. Yeah, you Kathy: should see my browser history. : So many different products. And Jason, you talked about self-care, too. So there is that empowerment piece of, okay, maybe we’ve identified some things. Now we can get into some tools that can go home with a patient that they can use to help Jason: manage their symptoms. : Empowerment. It’s the more you know. I had a woman the other day so excited

[33:44] because — okay, this is getting a little bit graphic — but when you’ve got a rectal prolapse and it’s hard to poop, you might find yourself : applying pressure on your own to your perineum. Kathy: There’s a tool for that. : And to know that somebody invented a tool — it’s not just me, right — those things make a difference. So Jason: hey, what is it — necessity is the mother of invention. : Absolutely. Yeah, it’s out there. Kathy: Totally. So, can you give us

[34:14] one tip. Like, I think that, you know, if you ask Kathy, hey, what’s one thing that everybody should be doing? If you ask me, I’ll tell you here’s one thing that everybody should be doing for their back. Like the average person, whether they have a problem or not, what’s one thing that the average person should be doing for their pelvic health? : To have good pelvic floor health, you should be breathing correctly. I’ve spent a good amount of time educating people about diaphragmatic breathing, because the diaphragm and the pelvic floor are connected fascially. So

[34:44] when we take a deep breath in and our belly rises, our pelvic floor lengthens, and when we exhale, our pelvic floor shortens and tightens. So if you are breathing incorrectly, you might have some holding patterns in your pelvic floor, but if you can get that breath pattern correct — posture — that’d be the one thing. Jason: So take me through something that — like somebody who’s driving their car listening to the podcast right now, what can they do right now that’s going to affect their breathing? : Please, please don’t die while you’re driving. Jason: Should they pull over?

[35:15] : Keep your eyes on the road. Jason: Pull over. : Well, please breathe while you’re driving, too, though, because otherwise — Jason: unless you’re driving somewhere really short, I guess that’s fine. : So you want to make sure you’re not breathing in your chest, right? Only — because I think the more stress we get, we just breathe in our chest. So, is that breath coming into your belly? Kathy: And then as you start to exhale, can you engage your pelvic floor as you do that? Like, think about doing a Kegel. Think about stopping the flow of urine or stopping gas from passing. So deep breath in, belly rises, : and then as you exhale, pelvic floor

[35:46] engages. Jason: And fun fact, when you do that, your transverse abdominis contracts. : What is that? Jason: That’s a part of your core. So we’ve got diaphragm working, pelvic floor working, transverse abdominis working. That’s a core exercise, which is going to lead to stability, which is going to lead to some less back pain. : Awesome. Jason: Awesome. I feel like you’re taking business from all of us. : Stability, back pain. Jason: And then like you just get a breathing exercise. : Deep breathing helps regulate your nervous system. Jason: That’s the other thing. : Calm down. Jason: So, especially the patient who’s got the

[36:16] chronic pain or the holding and they’ve had these inflammatory things — their nervous system, the sympathetic system is in overdrive. : Yeah. Jason: Doing that good breathing, helping the vagus nerve bring it down. It’s actually really interesting because I was talking with my associate today — we were talking about hypermobility, and she was like, hey, you know, what are some of the exercises that you recommend and things like that? And when I was kind of looking at like what I usually give people, that’s one of the

[36:47] things is diaphragmatic breathing and some of the issues that you’re talking about, especially with like prolapse and things like that — if you have hypermobility or a connective tissue disorder, you have a higher rate of that. And so it’s like maybe everybody should just be spending more time working on their breathing and those breathing muscles and we would all just be happier. Let’s just start there. I always say if the world — we could just all stop and take like five deep breaths in there. We wouldn’t need social media.

[37:18] We wouldn’t have all the problems we have, right? We would all just — it’d be a Kumbaya moment. Well, that’s really good. Thank you for — thank you for offering that up. So yeah, cool. Very good.

Jason: When — when as providers should we refer to you? What — what is the sign?

Kathy: Yeah. Well, ask the question first, right? If you’re not asking the question, I would encourage all other providers to have some little screen on their intake form that asks about bowel function, bladder function, sexual

[37:50] health. It’s a quick screen because the patient’s not going to bring it up on their own, right? Go back to those shame and embarrassment things. So if you can screen for it and you can see it, and you as the provider can ask a couple of probing questions — “tell me more about that” — one, it’s going to help you know differential diagnosis, is the pelvic floor involved, and then maybe you won’t spend six to eight visits trying to solve something that you can’t. Send them my way. So ask the questions. Yeah. See if there’s any of those dysfunctions

[38:21] going on. If it’s — I mean anything pelvis, hip, low back, SI joint related, there could absolutely be a pelvic floor component, especially if they’re checking any of those boxes. So yeah, it’s core to it. Okay. So there’s providers listening to this, but then there’s also a lot of patients listening to this. So

Jason: if I’m a patient and I have concerns about my pelvic floor, what should I be saying to my healthcare provider that will then get me that referral? Because

[38:52] there’s a lot of people, first of all, that still think that they need a referral in order to be able to see you. And that’s not true. But there’s also people who feel more comfortable having a referral to go see you. And so maybe to those people who would feel more comfortable with a referral from their provider, what would be a good kind of prompt for them to be able to then get that

[39:22] referral? Like what should they be telling their doctor?

Kathy: Well, some of the magic words would be “I’d like a pelvic floor referral.” Oh — that would — that would start it. And I think — I mean, reality is some of the primary care providers, maybe even some specialty providers, don’t know the extent to what pelvic floor physical therapists do and how to even access that. So it might be a little education and advocating on the

[39:53] patient’s part. But saying things like “I’m having bowel dysfunction or bladder dysfunction or changes in my sexual health and I know a pelvic floor PT might be helpful — could I please have a referral?” But bring it up. And there’s some statistics out there like the average woman lives with incontinence for nine years before they even mention it to their provider. So have the conversation earlier. Just destigmatize it. Again, I wish all providers had that screen to ask and bring it up.

[40:24] But if they’re not, as the patient, you’ve got to bring it up.

Kathy: Yeah, I do ask all of my people because I’m looking for red flags. I’m looking for — yeah — like cauda equina, things like that, right? And I’ll tell you — a really good provider, Jason — okay, anyway. The other thing is I do have people who come in and they’re like “hey, I’m interested in pelvic floor therapy” or “I’ve heard about pelvic floor therapy.” I talk about it with all my

[40:55] pregnant patients who come in, for example, because even if you don’t have a problem now — like, you give it 40-ish weeks and you know, it might be like okay, now we have some needs. You know, what else is really interesting too is I’ve noticed a good number of veterans with pelvic floor problems and they will not — they will not talk about it. And part

[41:28] of that is because — well, something that doesn’t get talked about a lot is there’s a pretty high rate of sexual abuse in the military. And so that’s traumatic for some of them. And so it’s kind of tricky to get into some of those conversations, but like — you know, you were a veteran and now you’ve got like unexplained hip pain and like we’ve done MRIs and stuff like that — and it’s like, that’s not always a really easy conversation to have. You know, and then when there’s a lack of providers to refer them to, that just complicates it. So yeah, that’s tricky.

[42:00] Yeah. So definitely an area where there’s need — listen up PT students. So yeah, and traditionally pelvic floor PTs are often female. A male being treated by a female can be an awkward or uncomfortable dynamic. There was a male PT when I was first in the community doing male pelvic floor PT — it was such a blessing. Like, it was amazing. And he retired, so there’s a need there. Yep. Bummer.

[42:30] Yeah. Okay. Well, is it time for the rapid fire segment? Oh, yes. We’re going to give you just a couple of items — just real quick. We just want like your two bits on it. So Kegels — overrated, underrated, or misunderstood?

Kathy: Misunderstood.

Jason: Wow. How so?

Kathy: Well, because there’s a misconception that if you’re leaking urine, you have to strengthen your pelvic floor, so you have to do Kegels. And then if you’re

[43:00] doing Kegels with a pelvic floor that’s already hypertonic or overactive, you’re not helping yourself. So it’s not just Kegels — it’s understanding, do I have the right coordination with my breath? Can I get that pelvic floor to maybe lengthen or relax instead of just — so they’re not overrated or underrated, they’re just misunderstood. Okay. They’ve got to be the right thing. And I guess in fairness, we should have you explain what’s a Kegel. Oh yeah, really good point. Yeah. Yeah. And let’s just take it back

[43:30] to the basics. Let’s run that back. Let’s run it back to right here. So I always say the superficial muscles are kind of the traditional Kegel muscles, right? If you are stopping the flow of urine, stopping gas from passing, that’s kind of the traditional Kegel. Kathy: Oh yeah, I’m good at that. There’s more to — you’re not letting anything out of — Kathy: Thank you. We are in a small space here. So but there’s more to that pelvic floor. There’s this deeper layer which is more of the lift. So in the clinic I

[44:00] rarely say Kegel. I’ll say, you know, these are the Kegel muscles. Dr. Kegel was a man. He invented squeezing things. Jason: It’s like our burpee episode. The Kegel episode. Where did that come from? So the pelvic floor contraction, engaging your pelvic floor — those are the terms I’m going to use more because it’s beyond just those muscles. Jason: Yeah. So it’s engagement of the pelvic floor, both layers, that superficial layer and the deeper layer. It’s a squeeze and a

[44:31] lift. And it’s misunderstood. Misunderstood. Okay. Poor. What’s next on the rapid fire list? One thing you wish postmenopausal women — every post — wait, let me start over. Okay. One thing you wish every postmenopausal woman knew. It’s not too late to address any pelvic floor dysfunction. It’s not too late to possibly have some topical estrogen depending on where you’re at in those post-menopausal years. Yeah. Women in their 70s and 80s that

[45:02] are having recurrent UTIs absolutely need topical vaginal estrogen. Absolutely. Which is different than systemic estrogen and there can be contraindications to that, but not topical vaginal estrogen. Well, and UTIs are important because it’s not just about “it burns when I pee.” UTIs affect your brain health also. And it can be a systemic infection that affects your overall health. Yeah. Not just what’s going on in your

[45:32] pelvis — morbidity almost. My grandma in her late 90s — she lived to be 98 and a half — was having chronic UTIs. So you take the antibiotic, now you have diarrhea, now you’re dizzy and dehydrated, now you fall. Yes. She didn’t, but a lot of women then break a hip. Yeah. And now you’re hospitalized and now you’re dead. So it’s not just “it burns when I pee.” It’s got bigger implications. Yeah. Topical vaginal estrogen. Good place to start. All right. Favorite non-Kegel exercise

[46:04] for pelvic floor health — and not breathing because you already covered that. Second favorite. Your third favorite. Yes. Like a glute bridge. Glute bridge. Okay. But some good breathing. You are a physical therapist. Okay. I was wondering for something. Can you do a PT — This is the first time she talked about the glutes. We can verify her credentials now. Yeah. Okay. Yes. She spoke about the — wrong hips. Welcome to the PTCH

[46:37] Podcast, where we talk about glute bridges. The glute. Yeah. Should we play a game? It’s game time. That’s why I want to be on — to play the game, you know. Yes. Yes. We’ve talked about this. I want to do a live episode of the PTCH Podcast. And like I want it to be like open where people can ask some questions or whatever. So we take audience questions, but then I want the rest of it to be like giving audience members a chance to play some of the games. I

[47:08] think that would be fun. You know, they’re at home listening right now wishing they could be part of the game. They fast forward to the game. They’re like, “Me, me. I know the answer to this.” I don’t know why they have a British accent. Yeah. Terrible British accent. Do we have people in Britain listening? No, probably not. Gosh, I hope not. What? Yeah. We need to go worldwide. All right. I got to find — where do I have the game? Ah, okay. Maybe I’m waiting all day for this. Yes. You will wait a little long. Oh, here we go. I don’t know. What is it gonna be?

[47:40] What’s the game? Okay. We’re going to call this game — oh, what did I — I can’t remember the name of the game, but we’ll call it the infomercial game. All right. Okay. Yes. Your job here is going to be to spot the fake pelvic floor health product. You already kind of alluded to this. There’s so many products out there. Yeah. You just walk up and down the aisles and some of it is pretty darn creative. Okay. So I’m going to pitch you

[48:11] three products and it’s going to be infomercial style and you’re going to have to spot the fake one. Okay, are you ready? Wait, so some of these might be actual products on the market? Two of them are real. Okay. Okay. One of them is fake. Oh good. Yep. Okay. We’re going to go with the Voltwear underwear. All right. Take control of leaks with the Voltwear underwear. It’s the world’s first boxer brief meets TENS unit hybrid. These sleek rechargeable undies deliver gentle electrical pulses to your pelvic floor all day long. With 18 hours of battery

[48:43] life and a handy USB-C charger, you can juice some up right next to your iPhone. Because nothing says confidence like knowing your underwear doubles as a medical device. Wow. Okay, so that’s the first one, the Voltwear underwear. Mm-hmm. Item number two, the NeoControl Chair. Sit down and power up. The NeoControl chair looks like an ordinary office chair, but under its cushions is secretly zapping your pelvic floor with pulsed electromagnetic magic. No wires, no effort. Just plop down and let the

[49:15] science do the squeezing for you. Finally, a chair that tones your muscles while you binge Netflix. If only it folded the laundry. And finally, the Perry Coach. Are you tired of doing Kegels in silence wondering if you’re actually doing them right? Meet the Perry Coach, the Bluetooth-powered trainer for your pelvic floor. Slip it in, sync it with your phone, and voilà — real-time data, encouragement, and even a progress report that you can send to your doctor

[49:45] or your nosy Fitbit friends. It’s like Strava for your downstairs muscles.

Kathy: Mhm.

Jason: All right. So, by the look on your face, I can tell that you already know which one is the fake. It’s a tossup here. Okay. So, I’m probably overthinking it. But number one, you said TENS. TENS isn’t really used for pelvic floor things. So, I’m thinking that’s the fake one, because really we go with E-stim.

Jason: She’s good. She is really good. Ladies

[50:15] and gentlemen, this is an expert. So, there is no Voltwear underwear.

Kathy: No, there isn’t.

Jason: But there is the chair.

Kathy: Yes, the NeoControl chair.

Jason: I had somebody who came to my clinic and he tried to sell me a $26,000 PEMF chair for people to come in and do pelvic floor therapy, which — oh yeah, and people use it. But the thing is, you don’t need a $26,000 chair. You can get

[50:47] like a $5,000 PEMF pad and just sit it on a chair and you can sit on that. And it does the same thing. So, it’s just electromagnetic waves.

Kathy: Think about how many patients you could have come into your clinic at how many hundreds of dollars a session to sit on that chair.

Jason: And that’s what he was letting me know — like, you can fleece people. I mean, you can help people. Yeah. You can sell them $3,000 packages. And I’m like, no. I would tell somebody, go out and you can get a

[51:17] veterinary PEMF pad for about $1,000. They use them on horses. You can just sit on that pad and it will give you the PEMF waves that you’re looking for.

Kathy: Okay. I know typically we wrap up things with the game, but since you opened up the devices, can we just have a little — because I get a lot of questions about that. So the pelvic floor trainers or these stim machines, there’s a time and a place.

Kathy: My word of caution with the pelvic floor — first of all, I tend to be like anti-device.

[51:47] Like, just do the work.

Jason: Yeah, see a pelvic floor PT.

Kathy: Get an evaluation. There’s no quick fix — understand how your pelvic floor works. Do the work.

Jason: But if you need a pelvic floor trainer, which is a vaginally inserted EMG — meaning it’s going to pick up your muscle activity as a sensor —

Kathy: and you can hook it up to your phone. It can be Bluetooth. There are cute little games to play. It can —

Jason: It better be Bluetooth, because you don’t want the wired one.

Kathy: And it can go to your provider.

[52:17] I had a patient today tell me she sees a virtual pelvic floor PT and she is using one of these devices, but she could not engage her pelvic floor correctly and she was absolutely over-recruiting her abdominals. So guess what — that EMG was picking up her abdominal activity. So it looked like she was doing it right. She’s been doing it for months,

Kathy: still has the problem. So yes, you can use a pelvic floor trainer device, but please see a pelvic floor PT first, be evaluated, and know that you’re doing

[52:47] the pelvic floor Kegel contraction correctly.

Jason: Mhm.

Kathy: Very good. Good advice.

Jason: My soapbox. I will now step down.

Kathy: AI is not taking our job.

Jason: Yeah, you can’t do everything. You can’t do everything over a Zoom call. Yeah, it’s just the truth. I mean, I can adjust over a Zoom call, but you know, that’s the only thing that Zoom calls are good for. So,

Kathy: yes.

Jason: All right. So, shall we do key takeaways? Do you want to start or shall I start?

Kathy: Yeah. How about this? I’m going to

[53:17] start. How about this?

Jason: Know what your key takeaways are.

Jason: First of all, I’m going to start sending everybody to you and only you, right? I had somebody that I was sending people to and she actually even moved away. So, there are really excellent pelvic floor PTs in town, but I have to say I was so impressed with your knowledge and your approach and everything like that. And so, it gives me a high level of confidence sending people to you, and hopefully anybody listening would have that same level of confidence. And so, thank you for making this topic so

[53:48] accessible to people listening, because a lot of people don’t want to talk about this, but they will listen about it and hopefully that will lead to them doing something about it for their own —

Kathy: for a meal and we’ll talk about it

Jason: with the family.

Kathy: Uh, breakfast, lunch, or dinner with the boys apparently. Yeah. Wine optional, right? So,

Jason: Kathy, what about you?

Kathy: Well, this is the second time Carrie and I spent a lot of time together. So, I’ve learned a lot from her, but this is the second guest that’s told us that

[54:19] we need to learn to breathe, right?

Kathy: Yes.

Jason: So, breathing.

Kathy: Mhm.

Jason: I think I need to have my patients start with the breath. It really —

Kathy: It’s actually more than the second. It’s actually more than the second. Yeah. We’ve had Robin —

Jason: Robin Kenan talk to us about breathing. Yeah. This is like a recurring theme,

Kathy: isn’t it? And it’s basic and simple. And sometimes I’m like, am I even doing anything here? But the science is there, too.

Jason: We forget about it because it’s automatic.

[54:49] Yeah. Right. And you can stay alive without thinking about it. But

Kathy: quality of life is what you brought up. So,

Jason: and what it’s doing in your body —

Kathy: super helpful.

Jason: Yeah. Well, awesome. So thank you again — one of our most requested topics.

Kathy: Thank you for having me. So fun.

Jason: Yeah. And you know, if we need you — we might need to have you come back. Okay. So,

Kathy: and yeah, so if you have topics

[55:19] that you want to know about, maybe even things that are a little bit difficult to talk about, we’re happy to take those suggestions. So, please send us your comments. If you have questions for Carrie, leave them in the comments. You can comment on Spotify or YouTube, or you know, you can write them and send them in a letter — but we don’t, I don’t think we have a physical mailing. Yeah. PO box. Yeah,

Kathy: they can email me. You can email me at ptrestoregmail.com.

[55:50] That’s p-t-r-e-s-t-o-r-e@gmail.com.

Jason: Holy presto@gmail.com. Okay. And your website

Kathy: is Restore PT Corvallis.

Jason: Restore PT Corvallis.

Kathy: RestorePTCorvallis.com.

Jason: And I’m kind of on Instagram, but not really. So don’t find me there.

Kathy: Right. And you can also find us on the Novo Collective at novocollective.com.

Jason: Yes.

Kathy: We’ll say it again.

Jason: Yes. novocollective.com.

[56:22] Jason: I feel like I’m part of the collective now. Kathy: Oh my god. Yeah, don’t ask me your menopause inquiries. I will just refer you to no-collective.com. Jason: Absolutely. Kathy: All right. Well, I think that we’ve — I think we’ve probably done enough product placement for one episode. And there’s really one more big item of business left, and that is that there is no “I” in PTCH.

[56:59]