056 – Dr Tracy Sher – Pudendal Neuralgia – What Health Professionals Really Need to Know to Provide Care and Hope

Yes it has been over 2 years since our last episode, but we’re back and full of excitement about the guests to come!

And what a great episode to kick off the re-boot. On this podcast we interview Dr Tracy Sher about all things related to Pudendal Neuralgia. Dr Sher is the Founder/CEO of the global platform, Pelvic Guru, LLC/Pelvic Global and the Global Pelvic Health Alliance Membership (GPHAM). She is also the Owner/Clinical Director of the private practice, Sher Pelvic Health and Healing in Orlando, Florida. 

In this podcast we cover:

  • Pudendal neuralgia versus pudendal nerve entrapment. 
  • Some basic anatomy including the pathway of the pudendal nerve and where it might become irritated or entrapped
  • The “Pudendal Tour” – ie the challenging journeys that some patients will go on, including multiple scans, nerve conduction tests, injections and surgery.
  • Some of the signs and symptoms that clients might present with
  • What a physiotherapy assessment might look like and how to prioritise what to look at on day one
  • The importance of a multidisciplinary team in the management of pudendal neuralgia and some of the specialties you might want to include in your team
  • Some interesting case studies including patients who have been diagnosed with pudendal entrapment but there was something ELSE was going on…
  • Acute onset pain that often gets missed (think post-surgical!)
  • How we as health professionals need to be careful with our language (avoid nocebic language!) and can provide hope for these patients
  • What might conservative Mx might look like for someone with pudendal neuralgia

Correction: Tracy wanted to add after the conversation:

“Numbness can end up being part of pudendal nerve entrapment. The Nantes criteria actually lists: “no objective sensory defects” but those who treat this clinically will see sensory changes. This was the original Nantes criteria – but we see many more nuances to this: pain limited to the territory of innervation of the pudendal nerve, pain predominant during sitting, pain does not awaken the patient from sleep, no objective sensory defects, a positive effect of anaesthetic infiltration of the pudendal nerve.The key is to do all differentials as it isn’t a typical symptom. 

 I also stated S1-3 in the beginning and meant to say S2,3,4.”

As always, we felt like we could have picked Tracy’s brains for hours, so might have to get her to come back again in the future (or encourage her to come to Australia!).

You can reach Tracy at:
Website:  www.pelvicglobal.com  
Email: Tracy@pelvicguru.com
Instagram: @pelvicguru1
Twitter: pelvicguru1
Free Facebook Group: Pelvic Guru Academy 

055 – Antony and Marika – We’re Back! Antony and Marika Catch Up!

And…we’re back!

After a two-year hiatus, we’ve decided to kick off
the Women’s Health Podcast again. We’re excited to interview some incredible guests on the show in the months to come and would love to hear your suggestions!

In this chat, we discuss what we’ve been up to over the past two years (and all the places Antony has been to!). We have a bit of a chat about principals rather than protocols when treating pelvic health conditions and the importance of personal experience as a motivator for change. We also talk about collaboration between health and fitness professionals and how this can benefit women.
It’s a bit of a random chat, but hopefully you enjoy it!

We’ll see you soon with our first guest for 2023.

054 – Kieran Richardson – What Is The Future Of Physical Therapy and Evidence-Based Practice?

Today we have the pleasure of speaking to Kieran Richardson.

Kieran is a Specialist Physiotherapist and the Director of Global Specialist Physiotherapy, a consultancy company providing Professional Development, Formal Mentoring and Non-surgical opinions for patients. 

Kieran and his team of academics, expert clinicians and researchers consult to multiple clinics and health care professionals in Perth, Western Australia, and well as nationally and internationally via online platforms such as Zoom. 

He also has various online courses for both clinicians and patients, specifically covering non-surgical management of ACL tears. 

He also has successfully overseen 100’s of full thickness ACL tears of patients both in Australia and internationally via the Telehealth method.

Today we talked about:
– Kieran’s career journey – from considering a life as an accountant, doctor or lawyer to choosing to be a physiotherapist
– how the specialisation process helped – in particular the mentoring/peer review
– how applying evidence-based practice can be a tricky balance 
– how ACL management is VERY surgical focussed in Australia and how this has been very slow to change in spite of the current research
– how healthcare is very medically dominant – we (physiotherapists) would need to be a combined force to have a strong say
– the evidence for and against manual therapy – are we throwing the baby out with the bathwater?
– communicating with colleagues online. Could we do better?
– the business of healthcare and how profits can impact on management.
– ACL pathways. What is considered best management? How is ACL surgery/rehab funded in Australia?
– whether or not physiotherapists could play a bigger role in musculoskeletal pain in primary health care settings to help reduce medical burden
– why important intra- and interdisciplinary collaboration is so important
– his top tips for new graduate physiotherapists

You can find Kieran at:
kieran@globalspecialistphysio.com 
https://www.instagram.com/global_specialist_physio/    
https://www.facebook.com/globalspecialistphysio 

Check out his references at: www.globalspecialistphysio.com/acl  

053 – Dr Adam Culvenor and Dr Andrea Bruder – How Do We Prevent and Manage ACL Injuries In Women and Girls?

We’re excited that today we have a dynamic duo on the podcast: Dr Andrea Bruder and Dr Adam Culvenor.

Adam is a Physiotherapist and Research Fellow at the La Trobe University Sport and Exercise Medicine Research Centre, Australia. He has combined a clinical career in sports medicine together with research investigating prevention, management and long-term outcomes of sports-related injuries, and life-span osteoarthritis. He has a particular interest in anterior cruciate ligament (ACL) injuries; in optimising return to sport, identifying risk factors for poor long-term outcomes, and developing and testing novel osteoarthritis prevention strategies. Adam has written more than 50 publications on the subject of ACL injuries and osteoarthritis, has been invited to speak at numerous international conferences, and is\ currently leading the first clinical trial in the prevention of osteoarthritis in young adults following ACL injury.

Andrea is a physiotherapist, Lecturer in Physiotherapy at La Trobe University and Post Doctoral Research Fellow in the La Trobe Sport and Exercise Medicine Research Centre. Her research focuses on improving injury prevention and rehabilitation practices after musculoskeletal injuries. Andrea has a particular interest in reducing the risk of ACL injuries among women and girls playing Australian football, and for those who do sustain an ACL injury, how we can improve rehabilitation practices to reduce the long-term burden.

In this podcast we talked about:

  • what the ACL is and how it can be injured
  • some risk factors for ACL injury (in males and females)- including some of the social, environmental factors
  • some of the current programs that exist that have been shown to reduce lower limb injuries…but how the uptake has been poor
  • surgical versus non surgical (sexy, cutting-edge rehab) management
  • why a trial period of this kind of rehabilitation may be of benefit, even if the client goes on to have surgery further down the track
  • how the rates of arthritis are similar between the two treatment options

If you’d like to check out their blog, head to http://semrc.blogs.latrobe.edu.au/blog

Their website details:
https://scholars.latrobe.edu.au/display/abruder
https://scholars.latrobe.edu.au/display/a2culvenor

Email addresses:
a.bruder@latrobe.edu.au
a.culvenor@latrobe.edu.au
aclstudy@latrobe.edu.au

Twitter: @AndreaBruder
Twitter: @agculvenor

052 – Molly Galbraith – Strong Women Lift Each Other Up

We are again blessed to have the amazing Molly Galbraith on the podcast!

Marika and Antony have both had the pleasure of getting to know Molly over the past 5 years and are thrilled to talk to her about her new book, Strong Women Lift Each Other Up.

Molly Galbraith, CSCS, is the cofounder of Girls Gone Strong (GGS), the world’s largest platform providing evidence-based, interdisciplinary health, fitness, nutrition, and pregnancy education for women and the health and fitness professionals who work with them—including industry-leading certification programs and coaching.

The “Strong Women Lift Each Other Up” philosophy is woven through the fabric of GGS, as Molly leads a team of women from the US, Canada, UK, Mexico, India, and Australia. From employing and educating, to featuring, collaborating with, and investing in women, GGS is dedicated to serving their community of women from 80+ countries around the world.

In the podcast we talked about soooo much great stuff, including:

  • how this book came about and how women lifting each other up has helped Molly get to where she is today
  • some of the statistics around representation of women in government and executive positions… and ways that we can help change this.
  • why making the biggest difference with the least amount of harm is her highest value
  • why the book is structured the way it is – to help the reader move through the stages of working on their own care first (eg on jealousy and the comparison trap) in order to feel able to truly support other women
  • why understanding your values truly helps you a more fulfilling life and be true to yourself
  • how helping lift other women up can be small, simple things such as a compliment or a recommendation
  • how you can find your superpower and level up your support of other women!

We love Molly’s book and would love everyone to get out and buy it and tell us what you think (no, we are not making commission!!). The book is not only filled with fabulous advice, interesting stories and reflective questions, but also a ton of online resources.

You can buy her book at https://www.mollygalbraith.com/book2

Check out Episodes 12, 24, 35 and 36 which also stars Molly!
http://womenshealthpodcast.com/uncategorized/012-molly-galbraith-feeling-fragile-uncomfortable-and-lack-confidence-in-your-post-baby-body/
http://womenshealthpodcast.com/uncategorized/024-molly-galbraith-how-can-i-heal-my-relationship-with-my-body/
http://womenshealthpodcast.com/uncategorized/035-molly-galbraith-ask-me-anything-part-1/
http://womenshealthpodcast.com/uncategorized/036-molly-galbraith-ask-me-anything-part-2/

https://www.podbean.com/media/player/uak35-fb43f5?from=pb6admin&download=1&version=1&auto=0&share=1&download=1&rtl=0&fonts=Helvetica&skin=1&pfauth=&btn-skin=107

050 – Dr Clare Minahan (PhD) – What Are The Unique Physiological Differences Of Female Athletes?

FIFTIETH EPISODE SPECIAL!!

Antony and I were thrilled to talk to Clare Minahan, PhD Scientist and champion for women in sport.

Clare Minahan is an Associate Professor at Griffith University, Queensland Australia, and has led the Griffith Sports Science group since 2002. Clare’s interests are in the advancement of human performance with a key focus on the determinants of performance in female athletes. She has documented unique responses to exercise in female athletes including muscle damage, thermoregulation and immune function. Clare is a founding member of the Australian Institute of Sport’s Female Performance and Health Initiative.

Some of the topics we cover in this episode include:

  • some of the differences between male and female athletes in terms of how they respond to training and recovery
  • how the oral contraceptive pill (OCP) influences things like thermoregulation, immune function and recovery from acute bouts of intense exercise
  • how the hormones fluctuate over the menstrual cycle and how this may influence training choices
  • why training needs to be individualised and based on tracking of the athlete’s cycle
  • that around 50% of athletes are on the OCP, so we need to understand better the effects. Clare also discusses the different generations of OCP and acknowledges that these will have different effects on the athlete (there are at least 35 different types of OCP just in Australia!)
  • how female athletes are at a 3x increased risk of ACL injuries. Studies showing that landing strategies seem to changes during teenage years for girls. This could also be related to hormonal changes – there are some studies showing increased risk during late follicular phase- but there is still much more to learn on this. Could also be related to changes in body composition through the teenage years
  • females with higher circulating levels of testosterone. Do they have a competitive advantage?
  • the advantage of having a regular menstrual cycle in terms of giving us a picture of our health. Withdrawal bleed while on OCP is not the same thing.
  • if not able to properly track menstrual cycle due to OCP use, Clare talks about other ways that we can monitor for RED-S (hint: performance, fatigue, mood, immune function)
  • why it’s important to get the basics right (sleep, nutrition, stress etc) before manipulating your training around the menstrual cycle

If you would like to get in touch with Clare, you can best contact her on twitter @clareMINAHAN
or via the Griffin University website.
c.minahan@griffith.edu.au

049 – Amanda Thebe – The Menopocalypse Is Coming For You!

On this podcast, we chat to Amanda Thebe, fitness professional and author of the book Menopocalypse: How I Learned to Thrive During Menopause and How You Can Too!

Amanda has over twenty years of experience in the fitness industry. She is a popular guest on podcasts and online summits, and her health and fitness tips have been featured in media outlets like Shape, Prevention, Healthline, and Global News. She lives in Houston, Texas.

In this episode we talked about:

  • Amanda’s recent experience with COVID-19 and how it knocked her for six for a few months. The post-viral syndrome left Amanda with a lot of fatigue and she struggled with daily activities for a long time, but is thankfully now on the mend!
  • her story about when she first started experiencing symptoms of menopause (ie migraines, vertigo and depressions) and how it took two years and several health practitioners to find the answers she was looking for
  • how surprised she was to find out that she was perimenopausal at the age of 42 and how so few people were talking about the subject! This led Amanda on a journey of discovery – she dived deep into the literature to learn more about menopause so that she could help herself and others. This led to her writing a book on it!
  • the frustration that Amanda felt when she couldn’t find the answers to what was going on. She felt so much despair and thought that she was going to be feeling like that forever.
  • how little medical professionals get trained on the topic of menopause -including the management. But this seems to be changing in the UK with new guidelines and mandatory training
  • some of the common symptoms that women experience through the perimenopausal period (that no-one talks about!), such as vaginal dryness, urinary incontinence and sexual dysfunction.
  • what happens to oestrogen and progesterone during the perimenopausal period. Amanda also talks about leptin and ghrelin and how these hormones can impact our hunger and satiety cues.
  • some of the physiological and psychological changes that occur through the perimenopausal period and how we can become more susceptible to things like cardiovascular disease, Alzheimers disease and osteoporosis
  • the controversy around hormone therapy, how the medication has changed over time and how incredible helpful it is for so many women
  • how physical and emotional stress can impact on symptoms during perimenopause – and some things that you can do to reduce these!
  • why women tend to put on weight around menopause and how there is often a change in body shape around this time.
  • how perimenopause can be a tough time for many women as they are often not only working and raising children, but also looking after elderly parents too. She discusses how useful it can be for women to spend some time exploring their values (see website below) and learn to make values-based decisions. And say no!

Resources
Menopocalypse book! (BUY HERE: https://www.fitnchips.com/books/)
Oestrogen matters – Dr Blooming and Dr Tavris
XX Brain book – Dr Lisa Mosconi
www.viacharacter.org
www.valuescentre.com

You can find Amanda at
fitnchips.com

amanda@fitnchips.com

048 – Dr Julie Granger – Are Teenagers Children or Adults?

In this episode we have a fantastic conversation with Dr Julie Granger all about adolescent health and well being.

You may remember Julie from our previous episode (#20 “Do you have a hormonal teenager?”)

Julie educates and mentors physical therapists and health professionals to eliminate the awkwardness that comes with helping teens — to instead confidently and expertly guide them and their families toward healthy lives in adolescence and adulthood. She also helps entrepreneurial physical therapists and health professionals who are feeling stuck, confused, or overwhelmed about how to start or grow a practice to tap into their intuition and discover a personalized life and business plan that’s both inspiring and reflects what they truly love in life.

In this podcast, we talk about

  • how teens often slip through the cracks as they don’t fit into either the adult or paediatric models of care
  • how some teenage boys can bottle up their emotions and minimise their injuries – and how we can open up dialogue with them
  • the importance of allowing children to experience the consequences of their decisions in the process of transitioning to independent adults
  • why some injuries and pains are more common at different age points (think: bony changes)
  • why it is essential for health professionals working with teens to know the growth charts and to have good links with radiologists that understand growth plates
  • some tips for communicating with parents of teens
  • how to help navigate the rehabilitation timeline with teens (when a week feels like a year!)
  • how to set up your working environment to make it more “teen friendly”

You can learn more about Dr Granger here:
Facebook: @drjuliegranger
Instagram: @drjuliegranger
Twitter: @drjuliegranger

If you would like to join her FB group and learn more about working with this population head to

https://www.facebook.com/groups/healthproshealthyteens

And for those who want to deep dive and become the go-to expert in working with teens, then definitely check out her online course (commencing November 16th):
http://bit.ly/healthprosforhealthyteens (using this code will help support our podcast by giving us a small commission).

047 – Dr Jo Milios – The Nuts and Bolts of Men’s Health

In this episode, we finally manage to grab Dr Jo Milios back on the podcast. We spoke to Jo for over an hour this time last year…and sadly the technology let us down. Yes…it all got wiped.

So thankfully Jo does not hate us and she kindly agreed to come back on the podcast!

Dr Jo Milios is a physiotherapist based in Perth, Western Australia. She is passionate about helping men with urinary incontinence, Peyronie’s disease and pelvic pain.

Here are some of the topics that we discussed in the podcast

  • Jo’s journey in physiotherapy and how she came to be working in men’s health through a connection with her brother who is a urologist
  • how Jo became so passionate in helping men after radical prostatectomy (RP) regain their continence and sexual function, culminating in her completing her PhD in 2019.
  • the story of how she learnt about Peyronie’s Disease through the experience of a young client and wanted to be able to help him. This led to her reaching out to international colleagues and trying therapeutic ultrasound to great effect
  • Jo then added yet another project to her PhD, demonstrating the efficacy of ultrasound on Peyronie’s disease
    -she discusses the physiological changes that occur during prostate surgery and why there are changes in continence and sexual function.
  • how penile length changes can occur after surgery and some of the things that can be done to help maintain length
  • hard-flaccid syndrome – how some young men are suffering from too much vigorous self stimulation while watching porn. Can lead to hypersensitivity, pain, Peyronie’s disease, depression/ anxiety etc
  • how it can take 2 years for the nerves to recover after RP, so during that time we want to maintain length and function but take the pressure away from sexual function. Only 22% of men regain sexual function after two years and in men over 60 – only 4% will regain sexual function if don’t do penile rehabilitation
  • ultrasound treatment for Peyronie’s disease – how she performed her research study and some of the amazing results found. We may need to pull these machines out of the cupboard and dust them off!
  • why it’s important for men to check their penis regularly (eg in the shower) and feel for any changes such as lumps and bumps.
  • the importance of screening for erectile dysfunction (think: cardiovascular disease), urinary /bowel function and pelvic pain. We as health and fitness professionals need to be more proactive in this!
  • the importance of screening the spine in clients with urinary symptoms and how treatment of the spine (eg through manual therapy and/or exercise) could help relieve symptoms esp in those who seem to have good PFM function

You can learn more from Jo by listening to her podcast with Melissa Hadley-Barrett

https://thepenisproject.org/
https://thepenisproject.podbean.com/

In that podcast, Jo and Melissa talk to everyday men about their experiences post RP.

You can also find Jo here:
www.menshealthphysiotherapy.com.au
jo@completephysiotherapy.com.au