Ep.66 The Many Facets of Physical Therapy and Why It May Be Right for Midlife

There is so much that we do in midlife in the name of prevention, such as eat well, exercise, and focus on self-care.  When you think about the physical therapy, we typically put it in the category of reacting to an injury or recovery post-surgery, rather than prevention.  My own recent experience opened my eyes to the many facets of PT, and it is astounding to me the amount of training and specialization physical therapists complete.  Think of it as your whole body being connected and your physical therapist is the sleuth that solves the puzzle and comes up with a holistic treatment plan.

Sarah Crawford, PT, DPT, is not only a first-class physical therapist, but she is a visionary, who fulfilled her dream as the founder of Anchor Wellness and Wave Physical Therapy in Cincinnati, Ohio.  Sarah and her team bring highly specialized, collaborative, and patient-centric care to their clients.  Whether you have a creaky back, pesky bladder leakage, or an osteoporosis diagnosis (to name just a few), you can consider PT as a very viable option.  It's not just for rehab!  

Some of the topics Sarah and I discuss:
- What it takes to become a physical therapist and why they are required to know the mechanics of the whole body
- Assessing chronic pain
- The role of fascia in the body
- Using pilates and yoga for prevention and healing
- The difference between dry needling and acupuncture
- Osteoporosis - building muscle and lifting heavier weights and the importance of balance
- Gait analysis and how it can help prevent injury for walkers and runners
- Massage therapy benefits
- TMJ and physical therapy
- Considering pelvic floor therapy 
- Why everything seems to tie back to hormones for women

You can find Sarah Crawford, PT at: 
I highly recommend you check out their social media posts for great tips and reminders!
https://anchorcincy.com/
https://www.instagram.com/anchorwellnesscincy/
https://www.instagram.com/makeawavecincy/
https://www.facebook.com/anchorwellnessinc
https://www.facebook.com/profile.php?id=100091617177601

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*Transcripts are done with AI and may not be perfectly accurate.

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Transcript

Asking for a Friend
The Many Facets of Physical Therapy and Why It May Be Right for Midlife
Michele Folan
Sarah Crawford, PT, DPT

fascia, physical therapy, pt, muscles, patient, physical therapist, pain, pelvic floor, exercise, point, body, cassie, hormones, joint, system, women, evidence, studied, estrogen, sub specialties

Speaker 1  0:00  
Prevention. There's a lot that we do on a daily basis to prevent things from happening. In the name of self care, we try to eat well, we exercise we take supplements when needed. But when I thought about the discipline of physical therapy, I've always put it in the category of more of a reaction to say, an injury or post surgery, rather than prevention. My own recent experience opened my eyes to the many facets of PT. It really is astounding to me the amount of training and specialization some therapists complete. If you think about it, it's like your body is all connected. And the physical therapist is the Sleuth that connects the dots to come up with a holistic treatment plan. And you know, those, like creaky joints, or maybe your lower back, maybe it's pesky bladder leakage when you try to exercise, or even unexplained jaw pain. Yep, physical therapy. It's not just for rehab. And in this episode, you're going to hear from a very passionate physical therapist and entrepreneur.

Speaker 1  1:22  
Health, Wellness, career, relationships, and everything in between. We're removing the taboo from what really matters in midlife. I'm your host, Michele Folan. And this is asking for a friend. Welcome to the show everyone. My guest today is a physical therapist and a visionary. Dr. Sarah Crawford fulfilled her dream as a founder of anchor wellness, where she and her team bring highly specialized, collaborative and patient centered care to their clients. Welcome to asking for a friend, Dr. Sarah Crawford.

Unknown Speaker  2:05  
Thank you. Thank you so much for having me.

Speaker 1  2:07  
I am a patient at anchor wellness, and found you all through connections of women's groups and things here in town. I was very fortunate to come across you and I worked with Cassie there. I really wanted to have Sarah on the show, because going to anchor has really opened my eyes to the world of physical therapy. I want to just start there. But first of all, let's go back, I'd love for you to tell the listeners a little bit about you where you're from and where you went to school.

Speaker 2  2:43  
Thank you for that introduction. By the way, I never considered myself a visionary but it's become increasingly more evident that that might be a new title that I use. I am a doctor of physical therapy. I studied at the University in Miami, Florida. And I think that's a really imperative part of my story. Medical Schools, physical therapy schools, all schools are ranked based off of a lot of different factors. And one of the primary factors is who's teaching it physical therapy has been trying to move in the direction of medicine, where you graduate as a generalist, and then you go into these specialty populations. Physical therapy now offers a residency and fellowship in these sub specialties after PT school, and my faculty at the University of Miami, most of them started the subspecialties physical therapy, the topic of this conversation, the many facets of physical therapy. There are now I believe nine sub specialties, Women's Health sports, geriatric, pediatric neurologic, cardiopulmonary prosthetics and orthotics is another one. So there are these really sub specialties that allow a physical therapist to specialize. I came out of a school where they really pushed you and they said, You don't know diddly squat. This is the beginning and you got to keep learning. And that is not typical. So I feel really fortunate to have gotten into such a strong program and and to have learned from some of the leaders in our field who are in NIH studies and are producing the research that drives our profession forward. I started taking postdoctoral continuing education before I even graduated PT school, which opened my eyes to the world of pain science. And pain is an interesting phenomenon. We used to think that biomedical model meant that pain meant damage. And what we know today is that pain is not always associated with damage. Those studies that I did before I graduated opened my eyes to the fact that there's more to the health equation than just physical therapy. And then I started practicing and an insurance based practice and very quickly realized my goals were always still the same to help people live well. Insurance goals were to pay the least amount possible. To me that just kept getting in the way of consumers progress towards wellness, the amount of bureaucratic red tape that it took to be seen by somebody that I was referring them to. And by the time you had somebody's motivation to get better, and then they finally get to the doctor, something else is changed. I started anchor in 2019, for a multitude of

Unknown Speaker  5:26  
reasons right before the pandemic.

Speaker 2  5:29  
Yes, great timing, July of 19. One, I was a practitioner who I had a vision, I had this dream of where I wanted to work and what I wanted it to look like, but it didn't exist. So I built anchor to house other like minded providers. The anchor Wellness Center is a collection of independent businesses, who we support from an operation administration and strategy standpoint. And I own way of physical therapy and Pilates, which is housed inside of it, which is where you've been seeing Cassie, I did that to try and build these little systems so we can support the multifaceted individual. Without all the bureaucratic red tape and getting the highest level of care from people who want to work together. I just got out of a meeting with a friend who's a physician who used to be in one of the big networks here in town, he was talking to a friend of his who's still in that network. And those physicians in that network and it's not exclusive to one network are only seeing patients who are referred internally, really, this is the move of healthcare, because they want to keep people in the system. So in order to get an internal referral, you have to go find a primary care doctor within that system within that system. How much money are we wasting in time? Are we wasting, getting people into your system to just collect them, and they're not even getting high quality care or collaborative care? Right, that same system. My dad recently had a health event, and I asked the urologist to talk to the cardiologist and bring them up to speed. And the neurologist said why, huh? So these are the things that I'm trying to solve for is like, let's get people the care that they want, and they need when they need it without having insurance dictate intervention, speed in what you're getting it and who's delivering it.

Speaker 1  7:22  
Sarah, you have a bunch of letters after your name. I was wondering if you could explain what each of those designations are

Speaker 2  7:32  
DPT is Doctor of Physical Therapy PT is just the state licensure CLM T is certified orthopedic manual therapist, that is a Australian based training. Most countries in the world except for the US physiotherapist are used to triage patients often see physical therapists before they see orthopedics a little backwards here that credentialing is consistent with how a lot of Australian based physical therapist, evaluate and assess.

Speaker 1  8:02  
Okay, that's interesting. Why do we do it the other way?

Speaker 2  8:05  
I don't know. My guess is because we have non centralized health care. Insurance companies really dictate a lot of the systems of how we access care. Yeah, I don't know though. I really don't know the answer to that question.

Unknown Speaker  8:21  
And we probably have a strong physician lobby.

Speaker 2  8:25  
That's a really good point and physical therapy does not right. And then my CMT PT is certified myofascial trigger point therapist. That is the credentialing for my training and trigger point dry needling. trigger point dry needling. I'm not sure if you've tried it yet with Cassie. It's a wonderful technique when added to a plan of care. But I trained with the Dutch PT who brought dry needling to the US. Oh, most of my team has as well. We are practicing the way that the evidence supports practicing.

Speaker 1  8:58  
Could you explain the difference between dry needling and acupuncture?

Speaker 2  9:02  
Similar needles and that's about where it ends. We use the same needles then mana filiform needles. trigger point dry needling came from Dr. Janet Charvel and Dr. Simmons Dr. Janet travail was JFKs personal physician while he was in office, she's a cardiologist. And she kept finding patients who were having chest pain but didn't have any cardiac markers to indicate that they were having any cardiac events. She along with Dr. Simmons who is an astrophysicist and he treated astronauts he studied astronauts to figure out why they came back with so much pain, the two of them collected to find what was causing this pain and they found out it was trigger points in traditional Chinese medicine, and acupuncture with the way that acupuncture has practiced is this philosophy that our body has all these channels of energy, and that if a channel gets clogged or blocked, then whatever system it's feeding isn't getting the amount of energy it needs and so acupuncture needles are placed along those highways or those open channels to help stimulate energy flow. And trigger point dry needling what Dr. Simmons and Treville studied was okay, we know that these people have these taut bands and their muscles are what you feel is a knot. We know they're painful, so Let's inject them with an analgesic. And they did that and they got good relief. And they studied those trigger points further, and found that they also contained inflammatory markers. So they said, Alright, Let's inject them with an anti inflammatory. They did, and they got better. Ah, then they did randomized control trials, and the control group actually did the best at long term follow up. So they deduced that it was the needle, not the actual injection or the fluid that they were injecting. So then they started playing around with needles, because the needles that we use to inject our hypodermic needles, they have little teeth that cause tissue damage when we inject it, when we put it into the skin. So thin mana filiform needles, which are the needles that acupuncturists use, don't cause any local damage, what we do is we poke that trigger point or that top band with that needle. And evidence doesn't show why it happens. But it elicits a little twitch response. So the difference is dry needling, we're going kind of directly to a source of pain or dysfunction. Whereas acupuncture thinks a little bit broader, more from a complementary therapy standpoint, in that we're talking about energy flow.

Speaker 1  11:31  
Okay, because I have done dry needling and my husband who both of us had good results, when people start thinking that's woowoo medicine, it's not, it is very much science based. That's one thing that I think you and I, in our previous emails back and forth is really everything that you all are doing is science based. There's tons of research that's gone into this. And I think it's cool how you guys keep expanding the different services that you offer?

Speaker 2  12:01  
Yeah, again, I was just having this conversation. Science is great. I mean, we're so grateful for science and the advances that have happened. Evidence is hugely important when we're making decisions about somebody's well being. What we do here. And what I think sets us apart is we use evidence informed care, we use evidence to say, Okay, we know this is best practice, but you, whoever sitting in front of me might not have qualified to be in that study, you might have had a health condition that would have been excluded from that study, we have to use evidence to understand physiology and pathology and inherent risk. But then we have to use the individual and how they're presenting and what motivates them and what their psychosocial well being is like to make decisions about what is going to be best for that human, we really rely on evidence informed care. And dry needling is a wonderful technique should never be used in isolation. A lot of practitioners around the country who have been taught dry needling, don't use it, because they don't realize how to use it to complement the other work that they're doing.

Speaker 1  13:09  
Right? Because I think most people, me included, when I was thinking of PT, I was thinking of is necessity post surgery or post injury. And it's also about prevention. Correct?

Speaker 2  13:27  
Yeah. And so this is the cool moves that our profession is making. We have historically been amenities in the health care equation, not terribly well respected. To your point, okay, we'll just push a patient there after surgery. And they can prescribe some exercises and you're on your way. Interesting thing is physical therapy. Education doesn't have that much in terms of exercise prescription, it's very basic. People weren't getting better. You've got the beauty of the internet, is that we've got therapists coming out of school with a lot more exposure into how to utilize the skills they're being taught. We're seeing this really cool move towards preventative medicine and performance medicine, where we're saying, Okay, let's not just rehab you after an event or an injury. But let's catch you before you get hurt. And you know what, you've gotten back to baseline, but let's help you get even better than that.

Speaker 1  14:22  
Okay, because I was thinking about the difference between what you're doing and chiropractic, but you guys really employ some chiropractic type of

Speaker 2  14:35  
techniques. Yeah, I mean, physical therapy and chiropractic are always I think, going to be confused for one another. I think really, what it comes down to is the difference in didactic education, what we're learning in books before we leave the classroom. Like I mentioned at the start of this, the Doctorate of physical therapy became a thing to help make us more autonomous practitioners. So We have baseline education equal to medical students in neurology, cardiology, pulmonology, pharmacology, all these things where we should know if you come in and you tell us a certain list of drugs, we should be able to pick up that blue. Okay? Those two drugs shouldn't be used together, or could those drugs be causing this thing that you're experiencing? And we need to roll in and out neurologic components. So I think that's the big difference between chiropractic care and physical therapy is our ability to affect all of the different systems.

Speaker 1  15:35  
I want to talk about fascia because you hear about it. And I have done a little research on my own because I wanted to see what the correlation is with fashion some of the issues I've had because God knows getting up in the morning is a thrill some days. Would you explain what the fascia is and how you differentiate between what's something that's the fascia is causing the issue or is it truly say sciatic

Speaker 2  16:04  
fascia is a thin connective tissue layer beneath the skin above the muscle? If you think of a piece of chicken like a live chicken, we pluck the feathers that's skin. The skin that we eat on a piece of chicken is fascia. That skin that lies over top of the chicken breast is fascia and it should glide and you should be able to pick it up and you should be able to rub your hand underneath it to put all your savory marinates that is fascia. So I like to think of fascia. The way I explain it to patients is it's kind of like a wet suit. And the pioneers of myofascial studies, one of which was my professor at the University of Miami, Carol Davis. She's John Barnes, right hand man and John Barnes is really the Pioneer behind myofascial release the technique, but fascia has been theorized to be connected one continuous piece of connective tissue. And if we could take a cadaver and dissect out skin, nerves, vessels, bones, muscle organs, your fascia would remain intact, and it would look just like you. Oh, wow. What's really neat about fascia is we know it holds our memories. So when we think of muscle memory, muscles don't have the ability, the elasticity, there's constantly a cycle, basically like a cleanse cycle that goes on and soft tissue. Fascia is what holds those memories. So if you're somebody who has been in a car accident, and your head goes to fly off the top of your shoulders, that fascia is going to be what contracts and reaches an end zone, where it won't let your head fall off. If you're somebody who sits at a computer for 30 years, that posture that you hold sitting at a computer, that's all held in fascia. If you've ever read the book, the body keeps score, it very clearly proves that memory emotion traumas are all stored in fascia. The wild thing about fascia is it mimics a lot of pain that we're taught in traditional health care. It can feel sharp and stabbing, which is what somebody would say is a nerve. It can feel dull and achy, which we would often say is a joint or a muscle, it can radiate, which we would think is a disc. The relevance comes in this goes back to that difference between chiropractic and physical therapy is we have to rule out the other systems. We have to know the neurologic system to make sure that it's not nerve. So what else are we looking for? Fascia is a wild component of the body that I think largely is ignored, especially in orthopedics.

Speaker 1  18:36  
When you have a patient and you know, it's a fascia issue is that when Pilates and yoga can come into play for that patient, or is it more massage therapy or something along those lines?

Speaker 2  18:48  
It depends what's driving the dysfunction in the first place. I use this example all the time. My very first patient, my very first job came in with radiculopathy or pain down her leg. I had my manual therapy training my Maitland training already done and I'm like I've got this in the bag. This is easy peasy. I can get that just to reduce no problem. And I went to lift up her shirt to start working on her back. And she had keloid scars from tip to tail all on her back because at four years old, her older brother put her in the bathtub and it was too hot. All the manual therapy in the world and all the joint mobilizations or manipulations, I was never gonna get through the amount of scar tissue and fascial adhesions that I needed to get to to get the joints to move to help reduce the disc impingement. And I have learned myofascial release and quite frankly in PT school, I thought it was a little wheel. But I learned everything. I went back to my boss at the time. I'm like what I do literally, that's my very first patient. And he was like, Well, you have myofascial release training. Try that. And I'm like, Okay, here we go. She touched her toes for the first Time in 10 years after that session,

Unknown Speaker  20:02  
wow,

Speaker 2  20:04  
the thing is, is you got to figure out what's causing the restriction and fascial. It's usually a disused overuse, blunt trauma. But it could be a sexual trauma, it could be loss of a child, it could be loss of a parent, it could be financial stress, all those things that make us go with it. There's a whole body of work in the visceral world, the brawl institute that says the body's mode of protection, it prioritizes brain organs skeleton. So if you ever missed a step in caught yourself real quick, body's going to protect organs because the organs all have ligaments and tendons around them. Or if you've had a concussion, body's going to protect brain. But that wet suit, that is fascia, this continuous layer of tissue, think about if somebody held like a lighter up to your wetsuit, up in your neck. If you want to side bend or rotate, it's gonna yank on that wetsuit, and it's gonna yank and pull and eventually, it's going to cause muscles to have to work harder. So it just depends. Sometimes it's soft tissue work or myofascial release. Sometimes it's joint mobilizations, sometimes it's breathing exercises. And sometimes it is just movement, sometimes we just need to what we call milk, the joints or just increased fluid movement through tissue. That's where we pride ourselves on being root cause providers, a lot of our evaluations, we don't even get to touch the patient. Because we're just asking all the questions take us way back, take us to when it started.

Speaker 1  21:34  
I am sitting here going, oh my gosh, because I think about how our bodies change in midlife, and the importance of mobility. And I told Cassie, when I came to see her, I said, one of my goals is that in 20 years, if I fall, I can get myself up off the floor unassisted. And I know, am I setting the bar that low. But every that is truly a concern of mine and my mother fell, could not get up, stayed on the floor for a very long time and is bad. And I know a lot of our listeners probably have experienced something like that with a grandmother aunt or a mom, when you talk about prevention. And I think I immediately go to Pilates and yoga and weight bearing exercise for those clients that you have coming in. What else do you do to help people stay mobile and have that strength in their later years?

Speaker 2  22:33  
I don't think I had to go to PT school to learn this. But if you don't use it, you lose it. It doesn't get much more difficult. Have you ever read or listened up on the blue zones? I have not by Dan Buettner. The Blue Zones are these five regions of the world. Dan Buettner found them. He was a researcher for National Geographic, these five regions of the world where people typically live past 100 years old. And he found nine similarities across these five regions. He calls them the power nine, the most interesting thing, these people don't exercise. They don't have CrossFit gyms and they aren't going to Pilates and yoga. They are people who walk to the coffee shop in the morning and meet a friend. They walk home and they pull out some crops for breakfast. They do whatever work that they have to do they move every 20 minutes. Generally, they're just people who are not sedentary. To answer that question. I think the current media climate has really made exercise and fitness and health while aging feels so far from being achievable for a lot of people. When you get into parenthood, and you get into prioritizing your children, and you're working, or you're managing a house, for females, often that means you have totally self sacrificed. And then you get to the point where your kids leave the home, your spouse is getting ready to retire. And you think, Okay, time to pour back into me. But I haven't done that thing for 20 years or 25 years. Where do I even start? Where does balance come from our ankles, hips and ears, in terms of maintaining our ability to balance? Walking is truly one of the best things a human can do. And there's a plethora of evidence to support that. Is there evidence to support weight bearing and weight training exercise 100% There's evidence to support yoga and pilates. There's evidence to support all of it. I think what I care about is finding things for people that is achievable, that's practical, and that they enjoy

Speaker 1  24:41  
that they're actually going to do it. Exactly.

Speaker 2  24:45  
I mean, if it's 30 minutes across town and your old Lego with a friend. I mean, it is wonderful to have that social connection with somebody and sometimes that's the extrinsic motivation people need but I think we can learn from these civilizations that have survived 100 years. barriers with little effort. It's about making simple steps, it's about walking the stairs to go down to get a cup of coffee, when you're sitting at the office, it's about walking to the neighbors around the corner to deliver the cake that you made, as opposed to getting in your car. That, you know, there's a lot of simple things,

Speaker 1  25:16  
it's just being very intentional it is it is, in terms of mobility,

Speaker 2  25:19  
the thing that we haven't touched on that I think is really relevant. And I'm really excited to listen to the podcasts that you just released, is hormones play a huge part, I think hormones are what make the world go round in our body. Estrogen is incredibly neuro protective. So when I mentioned that balance comes from the ankles, the hips in the head, we need free flowing and cycling estrogen and estradiol to allow the synapses in the brain to connect to say, oh, there's a little bump in the road there. Or oh, there's somebody coming towards me in the hallway, are the systems that we have that are constantly working to tell us what's in our environment? And what do I need to predict? And what do I need to do before I get there? Those are all really reliant on neurotransmitters, which are also a lot of our sex hormones.

Speaker 1  26:10  
Oh, yeah. I mean, we could talk for days, days about hormones. I have another show that I'm doing in the next couple of weeks recording with a company who makes bioavailable hormones that people can get online. Because they do telemedicine, I'm going to continue to research the whole hormone connection. So I appreciate you bringing that up, because that's not something I had heard before about the neuro connection with estrogen. It's super interesting. From a

Speaker 2  26:41  
musculoskeletal standpoint, estrogen is what allows soft tissue to be elastic. Think of a wet sponge versus a dry sponge. And most women when perimenopausal report vaginal dryness, well that's not exclusive to vaginal tissue. So all of a sudden, your hamstrings and your glutes and your biceps and your triceps also have that same dryness, you just don't feel it, then when we go to make a quick move, those tissues need to be able to be elastic and move quickly. And if they're super dry, then they can't. So that's that connection of the body is a really wild fancy machine. And everything's got to be pumping at all gears for us to be able to continue to thrive.

Speaker 1  27:20  
Well, I was joking before when I said when I wake up in the morning, it choices first couple of minutes of walking around and just 20 years ago, I didn't have that problem. It's now I came to you guys because I was panicking because I had an osteoporosis diagnosis. I was a little freaked out. I wanted to make sure that I was doing things preventatively and making sure I was moving correctly lifting weights correctly because I don't want to risk fracture. We talked a little bit about building the muscle and balance and then lifting weights. How do you typically go through a diagnosis with a patient like me?

Speaker 2  28:03  
What do we know about arthritis? Where does arthritis come from and osteoporosis is a different category. But arthritis is overuse of joints. So the whole skeletal system is set up to be a shock absorber. And when the joints are efficiently moving part of a joint takes excess force than what it is set up to take. That's where we end up with these arthritic changes. arthritis or advanced arthritis tends to turn into osteoarthritis. osteo Peenya is a totally different phenomenon. As a petite white female, you're almost guaranteed to deal with the diagnosis that you were given. Where we have an impact and an ability to your point is to slowing the progression of it, and to preventing advanced arthritis. Because any degradation of the bone sets us up for further degradation of the bone. The role that we as physical therapists play in the plan of care that has been between you and Cassie is how can we improve the biomechanics? The way that the bones from tip to tail are moving and aligning, and muscles move bones. Ligaments hold bones in place. Tendons connect muscles to a bone and muscles spoken to by a nerve via the brain. In order to prevent that for the progression of your disease. We need to prevent progression of any other disease like an arthritis. So a lot of that is strength training, mobility work. Again, making sure that your neural muscular system is resilient and fast acting. And then there's certain things that we can talk through from a dietary nutrition lifestyle standpoint that I know you're addressing with other people as well.

Speaker 1  29:53  
You all offer nutritional counseling as well too, don't you

Speaker 2  29:57  
in our current network of anchor wellness We have two dietitians that help coach, mental health therapist, couple personal trainers, massage therapist and physical therapy and Pilates. That's kind of the beauty is, none of us claim to be experts in everything. We know a little bit about a lot. We have this team that's built in where I can look down the hall and say, Hey, this is what this person is dealing with. Can you help me? But yeah, the role of weight bearing and resistance training for women is huge. It goes back to that hormone conversation, you have to consume the hormones to produce more when we build strength. And when we build muscle, we break down, we go through a whole cycle, and then we build back new, that's what challenges the organs that produce those hormones to keep producing them.

Speaker 1  30:42  
That brings up a great topic, because something that I have become more conscious of doing is making sure I have those recovery days. Because I wasn't doing that before. Yeah, I was just going balls to the wall and working out way too much. And that was probably doing me any good either.

Speaker 2  31:02  
You and I have a mutual friend. And I'm constantly saying that to her. And that's the cool thing about this back to this blue zones. And it's probably top of mind for me because I'm getting ready to do another presentation on it. But natural rest these natural stop. Exercise is stress. And exercise is really helpful at training us to be able to handle stress and build resiliency. But if you're constantly exercising, you never get to close your stress cycle. I know I'm gonna sound like a beating a drum. But when cortisol is high, estrogen is low. That's for men and women. That's not exclusive to females. If cortisol is high, estrogen is low, you can't build muscle. Yeah, you can't build muscle.

Unknown Speaker  31:44  
I'm learning so much. You can't

Speaker 2  31:47  
recover. That stress is a wonderful thing. It teaches us motivation, memory, but we have to close those stress cycles, we have to have these times where we just slow down. That's hard for a lot of people, especially for people who really want to hold on to their longevity, because they're like, I'm doing all the things I'm eating the staff, I'm drinking the shakes, I'm swallowing the supplements, I'm working out, I've got this coach and that coach in that boat. But at the end of the day, you can't speed up time. And we are all just one big cellular experience. So it's the cells need time to regenerate. They need

Unknown Speaker  32:22  
rest to be able to do so. I'm pro nap.

Speaker 2  32:26  
I am prone out to I don't get to do it as much as I would like to. But I am very much a pro nap person.

Unknown Speaker  32:32  
My weekend naps are gold. I love them.

Unknown Speaker  32:35  
I've got a five and a six year

Unknown Speaker  32:36  
old. You're not napping.

Speaker 2  32:38  
No, they're still nap. It's wonderful. And my husband loves their nap. And he keeps saying that when they give it up. He's not.

Speaker 1  32:45  
Oh, well, parents we need our naps is that self care 100%. It is totally self care. I have friends that are big runners. I know they've all experienced like the nagging pains and the occasional injury. And then I have friends that are diehard walkers and they're also having some of those same injuries and the hip pain, the knee pain. Do you guys do a gait analysis? Can you put somebody on a treadmill and see if there's an issue with their actual gait to see if that is a source of their pain?

Speaker 2  33:23  
We do it here. But generally speaking, you don't see that you don't see people including a gait analysis. In physical therapy evaluation, you can almost always tell sight and severity of an injury from a gait analysis, whether walking or running. We almost don't even need the rest of an exam. We usually don't even need imaging to know just based off watching how somebody walks or runs, you can say okay, you tend to supinate a lot and you're presenting with lateral foot pain, you probably have a stress reaction. That's the cool thing about our profession and the amount of time that we get to spend with people. And the doctorate level education is that we've been taught all of that. It's just in a lot of places you don't get the time to do it.

Speaker 1  34:07  
And then you also i sniffing around Instagram, TMJ,

Speaker 2  34:13  
yeah, hugely related, hugely related to the spine. The reason we teach Lamaze breathing is because the pelvic floor and the jaw do the same thing. Very similar innervation the nuclei that innervate the muscles of the jaw and the muscles of the pelvis are very closely related. Again, our culture or society tends to have a lot of people sitting a lot. This radical shift home and 2020 did not help. TMJ suffers because it became very high stress and the number one response during stress is to clench or grind. dental practices used to be 30% Tooth fractures. They're now in the 70% of presentations to a dental office because people are clenching and grinding so hard that they're cracking teeth. The jaw is the number one place we see stress. The jaw is the only joint in the body, that one side directly affects the other. It's not uncommon to have somebody with left side neck pain, dizziness, headaches, foot pain, that we come all the way back up the system that goes back to that fascial conversation. But it's like there's this clenching and tightness here, which means pelvic floor is also clenching and tight. pelvic floor muscles are also hip rotator muscles. So it's going to change the biomechanics of the lower leg, which means that we're gonna have to modify what's happening at the foot to make contact with the ground.

Speaker 1  35:35  
Oh my gosh, wow, wild, that makes my head hurt. I know, there's so much to consider in there you've got which I've done a show on the pelvic floor. But you all treat pelvic floor issues as well.

Speaker 2  35:49  
So I should be clear in that. Our physical therapy team has a team of seven. All of us are general orthopedist with specialty practices in chronic pain, pelvic floor TMD, sports, running endurance athletes, spine. It's not like every single one of us can treat all of the things but we do pride ourselves on having a team that really can. Vestibular is the other one. Yeah, we do. We have a pelvic floor and everybody should see one a pelvic floor PT is the American Physical Therapy Association mandated that women have a pre and postnatal pelvic floor exam, because we know that 95% of women who come in with chronic nagging hip or low back pain have pelvic floor dysfunction. So your friends who Walker slash runner, they probably are all leaking urine when they sneeze, laugh, cough, jump, and more than likely they have what we call proximal instability with the hip joint is where the peripheral extremities meet the thorax with the spine, there's a lot of dysfunction that can happen there. And it's complicated.

Speaker 1  36:52  
I mean, again, this is why I wanted you on the show, because my mind has been a little blown by all the things that you all can very successfully treat that doesn't require an MD or surgical intervention, just to encourage the listeners that if you have these nagging issues, or you want to be in a preventative mode, in terms of your health, PT is a great, great place to start. I couldn't be happier. And actually, it's also gave me a lot of peace of mind with my osteoporosis diagnosis that I have a plan forward. I have you all to thank for that. This was very informative. And I really hope people are thinking, Oh, okay, this does make sense. I've got an avenue to go before I go see the orthopedic. And I'll

Speaker 2  37:51  
add that in most states, it's not every state yet. But in most states, there's direct access, where you can go directly to a physical therapists without needing a referral from a physician. And insurance will cover it if you are going to an insurance based physical therapist, people ask that all the time, well, do I need a referral for insurance to cover it, we are an out of network provider, which just allows us the time and authority to do what we think is best. And my bias airs on that side. Obviously, as a provider, you're subconsciously making decisions about what you're going to get paid for. It's not fair. It's not fair to the providers in any circumstance. But at the end of the day, you have to get paid. You hear it from your managers, you hear from your leaders saying, get that many units use this diagnosis. We don't always get to choose what is probably the best manual therapy is often not reimbursed by Medicare very well. You see a lot of practices who are purely just prescribing exercise, which isn't always effective. Those are the downsides of a traditional kind of system based pte practice, but I'm thrilled that you wanted to have me on because I sit on a very high throne about the power of physical therapy

Speaker 1  39:07  
as you should, with your 25 letters after your name. But Sarah, I do want to just empower the listeners to seek answers. That's really my mission, and to ask the questions, always, and that's what we're doing here.

Speaker 2  39:24  
I 100% get behind that message. Ask questions, ask for a rationale, ask for reasoning. It's I don't care who you're with, whether you're with a dietitian, your primary care, your PT, your acupuncturist, ask questions so that you understand because when you understand you can make better decisions for yourself. And you're not just following this kind of dictatorship model that I think is a lot of traditional health care.

Speaker 1  39:48  
Agreed. Agreed. Dr. Sarah Crawford, thank you so much for being a guest today.

Unknown Speaker  39:53  
Thank you, Michelle. I really appreciate it.

Speaker 1  40:00  
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Transcribed by https://otter.ai