In this episode, CEO of Julie Wiebe Physical Therapy, Inc., Dr. Julie Wiebe, PT, DPT, talks about running and pregnancy. Today, Julie talks about running/exercise and pregnancy, creating baselines, the research around female running form, and she busts some pregnancy myths. When can you return to running after pregnancy? What is Julie’s definition of ‘postpartum women’? She tells us about structuring exercises around their daily exercises and goals, pelvic health education, and she gives some advice to clinicians working with postpartum runners, all on today’s episode of The Healthy, Wealthy & Smart Podcast. Key Takeaways “Landing mechanics are affected by what’s happening north.” “Let’s understand what they looked like beforehand so that we have a better idea of how to help them find their way back.” “Just because you had a baby doesn’t mean you should be in pain and weak for the rest of your life.” “Listen to what’s happening, but learn to interpret it.” “If your 10 minutes is spent running and that’s your goal, you’ll do it. But if I say you’ve got to lay down on the ground and do rehab exercises that make no connection for you, you’re not going to be motivated to do that.” “Pelvic health does not mean that you have to be clinically prepared to do internal work. It just means that you’re treating the musculoskeletal of someone who happens to have a pelvis, which, last I checked, is everyone. You don’t have to be certified as a women’s health specialist, but you can get information, read books, watch videos, take courses so that you are competent in treating a woman postpartum that wants to get back to running.” “The pelvic floor is not the only gatekeeper that creates pelvic health. It is a component of multiple body systems, and we need to understand that those systems affect the way the pelvic floor acts and behaves. The pelvic floor itself needs to have attention directed at it, but when we talk about just the pelvic floor, it isolates it away from relevance to other areas of care.” “Learn to ask questions, and ask questions that make you uncomfortable. You will get more comfortable with it, and understand that what you’re trying to do is open a door of communication.” “When you read the conclusion in research, is there any other explanation that could’ve come to that same conclusion based on what you’re seeing?” “We need to start broadening our lense, and I think we’re broadening it to look at females as not just little men.” “Instead of thinking of learning as this linear thing, include and transcend. Instead of it being a linear line, let it be concentric circles.” More about Julie Wiebe Julie Wiebe, PT, DPT has over twenty-four years of clinical experience in Sports Medicine and Pelvic Health, specializing in pelvic/abdominal, pregnancy and postpartum health for fit and athletic females. Her passion is to return women to fitness and sport after injury and pregnancy, and equip pros to do the same. She has pioneered an integrative approach to promote women’s health in and through fitness. Her innovative concepts and strategies have been successfully incorporated by rehab practitioners and fitness professionals into a variety of populations (ortho/sports medicine, pelvic health, neurology, and pediatrics). A published author, Julie is a sought after speaker to provide continuing education and lectures internationally at clinics, academic institutions, conferences, and professional organizations. She provides direct care to female athletes through telehealth and her clinical practice in Los Angeles, California. Suggested Keywords Physiotherapy, Pregnancy, Research, PT, Health, Therapy, Healthcare, Education, Training, Postpartum, Running, Exercise, Pelvic Health, Conversation, Use the code: LITZY for 20% off the following courses from Dr. Wiebe: Treating and Training the Female Runner (or Any Female Athlete) Foundations + Running Bundle A Foundations + Running Bundle B Running Rehab Roundtable Live Broadcast https://www.crowdcast.io/e/runningrehab To learn more, follow Julie at: Website: https://www.juliewiebept.com Instagram: @juliewiebept Twitter: @JulieWiebePT YouTube: Julie Wiebe LinkedIn: Julie Wiebe Subscribe to Healthy, Wealthy & Smart: Website: https://podcast.healthywealthysmart.com Apple Podcasts: https://podcasts.apple.com/us/podcast/healthy-wealthy-smart/id532717264 Spotify: https://open.spotify.com/show/6ELmKwE4mSZXBB8TiQvp73 SoundCloud: https://soundcloud.com/healthywealthysmart Stitcher: https://www.stitcher.com/show/healthy-wealthy-smart iHeart Radio: https://www.iheart.com/podcast/263-healthy-wealthy-smart-27628927 Read the full transcript: Speaker 1 (00:07): Welcome to the healthy, wealthy, and smart podcast. Each week we interview the best and brightest in physical therapy, wellness, and entrepreneurship. We give you cutting edge information. You need to live your best life. Healthy, wealthy, and smart. The information in this podcast is for entertainment purposes only and should not be used as personalized medical advice. And now here's your host, Dr. Karen Litzy. Hey everybody. Welcome back to the podcast. I am your, Speaker 2 (00:39): The host, Karen Litzy and today's episode. I'm really excited to round out our month all about running injuries and running rehab with Dr. Julie Wiebe. She has over 24 years of clinical experience in sports medicine and pelvic health specializing in pelvic abdominal pregnancy and postpartum health for fit and athletic females. Her passion is to return women to fitness in sport, after injury in pregnancy and equip pros to do the same. She has pioneered an integrative approach to promote women's health in and through fitness. Her innovative concepts and strategies have been successfully incorporated by rehab practitioners and fitness professionals into a variety of populations, or at those sports medicine, pelvic health neurology, pediatrics, a published author. Julie is a sought after speaker to provide continuing education lectures internationally at clinics, academic institutions, conferences, and professional organizations. She provides direct care to female athletes to through tele-health and her clinical practice in Los Angeles, California. Speaker 2 (01:48): So Julie's amazing. And in this episode, we talk about some myths about running while pregnant and in the postpartum. And of course, the question that everyone always asks Julie is how can we return to run after pregnancy? So Julie answers that question and cause a lot of really helpful hints for practitioners to look for when evaluating postpartum women and those postpartum women, those runners can be anywhere from six weeks to six years, 16 years, 20 years after having a child. And she also encourages clinicians to think critically, to look deeper, to have a framework for evaluation, to try and, and, and get a baseline to ask your patients to film themselves while they're running or exercising so that you can understand what they look like when they're doing what they do. There's a lot of variables to post to running post-pregnancy and Julie really runs through all of them. Speaker 2 (03:01): So I want to give a big, huge thanks to Julie for coming on the podcast today and sharing all of this knowledge. And she also has a discount on the course. So she has a course on running a postpartum running. So she has a course for the listeners. So all you have to do is enter the promo code Litzy that's L I T Z Y my last name for 20% off treating and training the female runner. And just to be clear, this is for professionals, not for individuals. So this is for clinicians. So a huge thanks to Julie for that. We'll have all of the information, including links to everything in the podcast at podcast dot healthy, wealthy, smart.com. And tomorrow you can catch Julie live along with Dr. Ellie summers, Dr. Chris Johnson and Tom goom for our live round table discussion. That's tomorrow, March 30th at 2:00 PM Eastern standard time. Speaker 2 (04:10): If you can't make it still sign up because you'll still have a chance to get your question answered by the panel, and you will still get to watch the replay any time you want. And listen, this is a deal. It is $25 for four of, in my opinion, some of the best minds when it comes to running injury and rehab. So sign up today. If you're listening to this today, sign up today because you have until probably, I don't know, it starts maybe until like quarter to two tomorrow, which is March 30th to sign up for our live round table discussion. Again, that's with all four guests from this month, Ellie summers, Chris Johnson, Tom goon, and Julie Wiebe. So sign up to day. Hey, Julie, welcome back to the podcast. I think this is like your third visit to help you well, yes, thank you for sharing your platform with me again. Speaker 2 (05:11): I appreciate it. Of course. And, and this month, the month of March, we're talking all about running, running injuries, running rehab, and I know something that you're passionate about is caring for the postpartum woman that returned to running after giving birth. And, and we'll also talk a little bit about running while pregnant. Right. So I think that there are, there's a lot to cover. And so we are just going to, we're going to zoom right through this unintended since we're on zoom. But let's start first with running while pregnant. I feel like there's a lot of myths around running while pregnant. I don't know that it's understood very well by many people, including clinicians as well as the pregnant women. So I'm just going to kind of throw it over to you and let you just kind of talk about the, the running pregnant woman. Speaker 3 (06:14): Yeah. You know, and I think I think that regarding running and pregnancy, I mean, that's our focus, but really exercise and pregnancy. We still have, we are limited in our understanding of all things. Related to that I think we are started, we have information about things like cardiovascular response or, you know, some of those pieces of the puzzle. But in terms of the musculoskeletal, the neuromuscular, the response of the female host inter like how is that impacting the mom's body systems. Right. and I think that where we are struggling to have a lot of research there in part, because it's hard to find women that are willing to be participate in research. And then there's also a lot of, I, you know, we have to be protective of them. We have to protect them. And so, so it's this, you know, we want to honor that stage of life, but we also need to research it. Speaker 3 (07:13): So so I think we are struggling to, to understand all that, but we're starting to get more and more attention on it, which is awesome. As far as pregnant runners go there's only a few studies that I'm aware of that actually look at the pregnant runner and and of those one is a case study and one is on five women. So we have very limited understanding of what exactly goes on, but there were some themes. So I'll just share some themes. One is that in, in both the studies, they were, they were followed, the women were followed throughout the pregnancy changes were seen in all of the women on how they continue to run through the pregnancy meaning. And particularly the one with the five women, they all did something different, which is the variability is what we're seeing now. Speaker 3 (08:07): Everybody's bodies individually adapted differently. But the through line for them was there was a loss of pelvic and trunk rotation. So when we think about that pregnant runner, this is the way I've started describing it. The belly covers a ton of joints. Like it goes from the thorax to the pelvis. It it's basically, it takes all of these reciprocating joints and it turns it into a unit joint. Like it's one big joint, it blocks motion. So it reduces pelvic and trunk rotation. And so it limits, and then it forces them to rotate elsewhere. All of these are adaptions to help them continue to move through space appropriate for pregnancy and running. But when they go into the postpartum, they carry it with them. And that was what happened in both of these studies. They found that at six months for the woman who was the case study, and then at six weeks postpartum for the women, the five women in the other study, they held onto these, these some of these variables into the postpartum period and where that's significant is that women are given that okay by their doctor at six to eight weeks. Speaker 3 (09:19): This just like, you can just start doing your thing again. But their understanding is I got to just lose weight and get a flat belly. What our understanding needs to be is we need to understand what's changed for them. Biomechanically neuromuscularly emotionally, you know, fatigue, stress, like all of we have to understand all of those pieces and help them restore their interrelationships. Neuromuscularly biomechanically to be more like their baseline in order to prepare them for return to run. Like it's not just, okay, let's get him stronger. It's how do we help them restore that efficiency in their patterns that they lost, but no one realizes they lost it. So six years later, they show up to an orthopedic office and they have some of these running injuries, but how much of it is related to the compensations that they carried into their postpartum. So that's sort of a, an entry point into our conversation. Speaker 2 (10:17): Yeah. And that's, that is so interesting. And it makes sense that they would carry that over because our brain has is plastic and it's going to adapt. And our our sense of where we are appropriate susceptive sense is going to adapt to that. And it just doesn't end because the baby's not inside you anymore. Speaker 3 (10:40): Correct. And you're pulling it off, like in your mind, like you're still pulling off running, like you're actually running. So it, the understanding of what has changed is not understood globally. And I think like, I mean this, the running study related to the five runners that I mentioned, and that was from 2019. So this is, you know, relatively hot off the presses in terms of clinical understanding. So our job clinically is to help restore reciprocation that's really, and we understand the reciprocation is so important for all sorts of pieces of the puzzle for running. And one of those things is actually reducing ground reaction forces, getting our center of mass over that lead leg. Reciprocation is a huge piece of that. And so understanding just that, if that is all you walk away with today, understanding that you're a female that has a postpartum is postpartum, meaning they have a pregnancy in their history when you're working with them related to it, running injury. Speaker 3 (11:39): If it has a ground reaction force components like a knee or anything, you should be looking North of the border, not just foot strength, not just cadence, not like you have to look North and understand, are they actually reciprocating? Where's that reciprocation coming from? Because when you have a unit joint of the lumbar spine in the lower, the only thing that's left is like TL junction and above. So that's where they're reciprocating is way up high at the chest. And if you watch Fumo runner, that's what they're doing. They're punching the sky, it's all up, up, up, up chest high. And it's, that's the pattern that they partially developed during the pregnancy to continue running and pregnancy. There's nothing wrong with that. It co it's an appropriate compensation, but it does. If you don't restore actual reciprocation between the trunk and the pelvis, that's what you're looking for. And if the woman is in gripping her abs, cause she wants to get flat abs again, that's a UDA joint, it's a uniform engagement of the abdomen is what most women hang on to, or try to do while they're running. And that continues to keep their reciprocation high. So it's like understand what's going on North of the border for these women, versus just looking at things like landing mechanics, landing mechanics are affected by what's happening North so Speaker 2 (12:59): Well that's so, yeah, that is so interesting. And now I'm going to be, you know, in central park watching all these women to see, okay, are they just running with their, from like the thoracolumbar junction up? And then just having legs move like a cartoon character or are they actually getting excursion and rotation through the trunk? Speaker 3 (13:19): Amen. Yeah. And then we're getting into summer, right? I mean, I'm here in California, so we're gonna be able to see people's abdomens. And the thing that I, my cue for my clinician friends is what's going on with the navel. Like if their navel is staying straight, dead, straight, the whole time they're holding their abdomen. So stiffly through their run, that they aren't reciprocated. Like they can't be like, that's an indication that's a quick and dirty clinical sign that you can see that that means the reciprocation is likely coming up higher. And then it'll sort of clue you in and you'll see it. And they're, they're the ones punching high in the sky. They've got ribs flared up, like it's sort of, and that's a lot of our female runners. And it's a lot of our women that have never had children because they're holding their abdomens. Speaker 3 (14:03): Cause that's what they think they're supposed to do. And we also have studies that have shown us that stiff abdomen when they had men jump off a height actually increase their ground reaction forces. So it makes sense it's part and parcel, right? Like, you know, we just got to sort of brought in and I think that's my hope when I talk about stuff like this with my ortho and sports medicine, friends and colleagues because that's really, I'm a sports medicine, PT, I'm not a traditional pelvic health PT, but is to broaden our lens and add these ideas into our differential diagnosis. Like we need to start thinking about how these things are affecting. Some of the things we look for in sports medicine. Like we understand to look at how ground reaction forces what's happening, but we don't often this into our thought process. Like how, why is that a typical running pattern for women? It's not just because we have brought her hips and Q angles and, you know, blah, blah, blah, look North, look North with me. There's more going on for these women. And and we have some strategy pieces that we could add into our thought process to help them Speaker 2 (15:13): Yeah, amazing coming in hot, right out of the gate pair with a great tip for everyone. So thank you for that. And one one question that I want to ask, just so the listeners really understand when you talk about postpartum women, can you define what that means? Speaker 3 (15:32): I'll give you my definition. Sure. It doesn't necessarily mean that it is the definition. But I consider anyone who's ever had a baby. And, and here's what I'll say about that. I think technically it's the first year that might be kind of more of a technical thought process. And that's mainly because I started learning this backwards when my, on my patients who were 35 and 45 and 55 and 65. And they still look like me. This is million years ago. Now when I was at postpartum early postpartum, like the way that I was using my body and it was creating issues for me, they were using their bodies that same way. And they were like, well, they had grandchildren at that point. And so once we start understanding, yes, it's a normal process that women go through, but our job is to understand what they went through and help them find their way back to efficiency and effective use of their structure and their systems and their like I D I was Chris. I love that Chris Johnson talked about their ecosystems, like, you know, like looking at all of those pieces for them and understanding our job is to help them get back to their baseline, their individual baseline. Cause my torso is this, like this with this link legs. Some people have long legs short, let you know, like to understand that. So my, one of my big pushes I hope to achieve at some point is to get baselines, like, let's start getting baselines. I was women. Yeah, go. Speaker 2 (17:09): I was just gonna ask that you, you beat me to the punch. I was just going to say, so if someone is coming to me as a woman who is a runner and she had a child would say a year ago or two years ago, even how do I know what her baseline is? Speaker 3 (17:27): Correct? Well, what I do is I have them try to bring me film from prior to the injury. So these are for women that haven't had babies or like what they look like running prior to having a baby. And again, so many women have said to me, well, I leaked even before I had a baby when I ran. So then you might find stuff in their running form that might help explain that like Mabel's that go straight ahead? You know, things like that. But it does give us sort of an understanding of, is the running form that we're seeing right now, is that speaking to why they're having the injury, the, whatever it is, or is this the running form they've always had and they used to run without any difficulty. Like, you know what I mean? Like, so for me, that's how I started to create their baseline. Speaker 3 (18:15): Even if I can't see what they look like. And a lot of women will, like, when we talk about diastasis, like, you know, something like along those lines, which I might have to define for the audience, but some women will send me pictures of them in a bikini from like their early twenties. They're like, Oh my gosh, you're right. I actually had a line down the middle, but I never gave it any thought because my belly was flat. But now that my belly is not flat, you know? So it's like, that's where we can start to kind of get some comparisons for baselines. But one of my goals is to reach into the medical community, meaning the obstetricians and the midwives and the nurse practitioners. If any of you are out there is to say, let's start creating baseline. You're the first contact for some women they'll come in for a prenatal visit or something like that. Like, let's get some baselines, encourage them to take video. How will they're lifting how they're running? You know, how are they doing these things that they want to get back to afterwards so that they have a library of their own baseline? Like let's understand what they look like beforehand so that we have a better idea of how to help them find their way back. Speaker 2 (19:18): Yeah. Yeah. Great answer. Thank you. And so we've talked a little bit about this return to run after pregnancy. And I know you said that is, that's what people want to know from you. How do I go back to running after I had a baby and you know, everybody wants a protocol. If you could do this, then do this and this then do this. Right? Right. So when someone says to you, when can I start running after I had a baby, what is your answer? Speaker 3 (19:50): My answer is, and everyone hates it. It depends, but I tell them what it depends on. And so, and that's what it does get a little tricky in a situation like this, because these are some of the variables that I want to know. So my, whenever I get a question like that, my favorite is when I get it from a practitioner, what should I tell my patient who wants to get back to running? And I'm like, okay, well, my, my response to you is I actually wrote a blog like this. Like, and I always get, Hey, quick question. And I'm like, it's not a quick question. It shouldn't be a quick question. You know, did they have a vaginal delivery? Was it traumatic? Did they have forceps? Did they have a Syrian? Was it, you know, did they have bed rest? Were they on bed rest? Speaker 3 (20:29): If you're on bed rest, no, you're not gonna start running right out of the gate. You're like, you know, like there's so many variables there was it a complicated pregnancy? Was there, you know, what's been happening to them during the recovery process, have they, you know, are they having postpartum depression? You know, what's the you know, what are all these variables that they're experiencing? Where are they having postpartum depression? Or are they depressed or having baby blues, partly because they've lost their exercise program. Like what, what are all of these variables that we're looking for and what was their athletic capacity before? What is it now? Or what are their goals? Cause I like to make goal specific recommendations. So those are some of like, those are just that's scratching the surface, but I don't want to make it sound like this is an inaccessible population to work with because you don't know what all those things are. Speaker 3 (21:19): But what I usually talk to my patients about is I understand their goals and then I break them down and we start preparing for them. So my program for you needs to prepare you for what you want to do. And I need to understand the demands that you're up against. If you want to run, I need to prepare you for impact. I need to prepare you for endurance. I need to prepare you for power and possibly change of direction, depending on what you want to do. Trail runs and jump over rocks and things like that. Like I need to prepare you for what it is you're going to be up against. And part of that preparation is looking at your form, giving you great form twos, helping you build in new form, creating an interval program, getting you impact ready. Like there's, it's not just, I need you to do some curls and tell me stuff and some cables, and now you can run. Speaker 3 (22:10): And I think that that's, but that's a typical postpartum recovery program, but it isn't a prep for return to run. I need to teach you to reciprocate. I need you to strengthen into those reciprocal movement patterns. I need you to do single leg work. I need you to do single leg loaded work. I need you to do single leg impact work. You know, I gotta get you practicing some of those pieces. Then I know you're prepared. And if you're leaking or having pain or having an I give you these things we're looking for while we're doing the prep work, we're just not quite ready. We need to modify those things. Keep giving you opportunities to build capacity and strategies for the kind of work you want to do. I'm going to build that back into your system so that you're ready. And if you're, again, if you're symptomatic during all the prep work, we're just not quite ready for the actual events, but let's figure out what still needs to be tweaked and what needs work. You know what I mean? And then like, let's start with elliptical, let's start with hiking. Let's start with things that don't have impact. If we're not, if we're having symptoms with impact, like sort of really parse, what's still creating the problems so that we can troubleshoot that. And then, and then get you back into interval prep, walk, run. You know what I mean? Like it's yeah. So it's yeah. So that's running, that's more running specific. Speaker 2 (23:27): Yeah. So if you're not, it's not like, okay, the doctor gave you the all clear at six to eight weeks depending. So I'm just going to give you a walk run program. And that's what you will do. There is a lot more building because like you said you to monitor, you want to give people their program, you want to monitor their, their reaction to it, their symptoms, and then make the necessary adaptations that you need to make and use your clinical judgment. Because we know that there's not a whole lot of research around even returned to run after pregnancy. There's not a lot of research to that, correct? Speaker 3 (24:05): Yeah. We're getting, we're starting, we'll give credit where you know, we're trying, but we, yeah, we have a lot of work to do. We need to figure out there's a lot. We need to understand just basics. But, but like some of the things that I, I I'm trying to create like little things, people can remember, like prepare, then participate, monitor, and modify. Like just keep get like put those pieces together for yourself. Cause some people don't have access. That's the other thing, like if anyone out there doesn't have access for whatever reason to the practitioner, like you are, you have a lot of power by knowing what to monitor for knowing it's not normal to have pelvic pressure or leaking or pain while you're running. It's not normal. Like we want you to feel good while you're running and you know, just cause you had a baby, does it mean that you should be in pain and leak for the rest of your life? Speaker 3 (25:01): Like that's an incorrect, like I think we did. We say we're going to bust myths. Like that's a myth D please don't buy into it. So yeah, and I think I lost your question in there somehow. Did I? No, no, no, no. Boston my own head. No, not at all, but it is. It's like these, like what else? You know, and then follow the other thing I try to tell people is follow your success. If it seems to be that you're having more symptoms on the flats, but you're okay if you are going uphill, which is not unusual because it sort of helps you have a better running form automatically. Then let's walk the flats, run up the Hill. You don't like listen to what's happening, but learn how to interpret it. I think that's what I'm hoping clinicians can be, is really great interpreters of what's happening with the patient standing in front of them so that they can they can be better guides. Speaker 3 (25:54): I mean, that's really ultimately what we're doing. We're guiding people through their process because everyone's process is going to be a little bit different. It should be. And I would love for, I would w I went a hundred percent with lots of over the protocol, charge everybody 10 books now, but it doesn't exist because everyone is different everyone's path through pregnancy is different. That one study we have was so fascinating. All those women did something different to get through the pregnancy running. So, so we, we were just learning, right. We're learning about, about everybody's path through, through all this stuff. So how can we guide them? And I think monitoring modifying, progressing not gradually in a scared way, but in a smart way, like, Oh, we tried that. That was too far. All right. So backing off a little bit. Let's try this. Let's modify, modify, keep adapting. So I don't know. Now I'm going down a whole nother rabbit. Speaker 2 (26:48): No, no, no, that's it. This is all, this is all amazing. And I, and I really think the listeners will, we'll definitely come away with, you know, the, the monitor and make it adaptations and watch and listen. And also, like you said you sort of referenced Chris Johnson, sort of talking about the whole ecosystem. So again, I think it's important to when you are sitting down with this patient for the first time, you know, you have all these questions, but then your other questions are, well, how old, how old is your child? Do you have more than one? What are your responsibilities at home? Do you have a nanny? Are you a single mom? Are you working? What are your time constraints? Like, because all of that feeds into what kind of program you can give this person, because they may say, Hey, listen, I have 10 minutes a day to do some exercises. And, and what happens a lot is people think I only have 10 minutes a day. It's never going to work. Right. So how do you get around those with your clients? Speaker 3 (27:51): I usually use their exercise program is their fitness program, whatever it is, like rather than ask them to stop. I, and so, I mean, we're talking early postpartum versus someone who's maybe coming back two years later. Right? So you know, I try to integrate, my goals have always been, or my path has always been about building brain strategies, neuromuscular. So then I'm teaching them how to re-establish. Some of the, the, the, so let's talk early postpartum things get kind of funky in terms of how components of the central stability Central's control system operates. I'm working on helping them reconnect and implement it into their function. They have to take care of their kids. If you're lifting your kid, we're going to do it in a way that sort of pulls in the brain's going to use all these components to help them start, to learn, to be reintegrated into your movements, just movement going up the steps. Speaker 3 (28:50): Guess what steps is just like running. We're going to actually, if your goal is running, I'm going to make going up and down the steps with your laundry hamper or your baby as your prep for return to run. But we're going to do it super low impact. We're going to think it through. We're going to have to, like, we're going to rebuild that reciprocation through walking up and down the steps. We're going to, you know, match it to your function right now. But if you're two years out and you're, it's a different ball game, I'm going to use your running as your program. I'm going to adapt your running and keep you below your symptom threshold or make it look a whole heck of a lot like running so that you're motivated to do your, if your 10 minutes is spent running and that's your goal, you'll do it. Speaker 3 (29:32): Do you know what I mean? But if I say you got to lay down on the ground and do these rehab exercises that make no connection for you, you human, emotional, or your brain to your goal. You're not going to be motivated to do that. So I have always broken down their exercise programs, if they are CrossFitters or going to gym or whatever it is, show me three exercises that you like to do. Yoga, Pilates, whatever it is, what are three things let's implement these ideas and strategies under something that you enjoy, because I know you'll be compliant. And then they know you're listening. That therapeutic Alliance is there, like out of the gate, you want to help them get to their goals, Speaker 2 (30:11): Right? So it's, it's like, you can take things they're already doing and modify, adapt it, allow them, give them the tools they need to implement. What will help them in that exercise. And ultimately perhaps help them get back to their running or whatever it might be. Okay. Speaker 3 (30:31): Break it down, break it down and then build it back up. That's got it. That's a pretty straightforward way to do it with any athlete. It doesn't have to be running. But you got to know what they're up against. So I, if I am not familiar with something, I just say, show me, I don't know, show me what that is. And I don't know the words, I'm the first one to admit it, but I can't remember what that, can you just show me that and they'll sh and then you can break it down. Like, I think that's, to a lot of people's barriers to working with athletes is they don't feel comfortable with the sport. And then of course we have, you know, members of our community that say things like, well, do you lift, do you even run? I know. And it's like, like, it's really I don't, I don't surf and I will never, my first surfer when I moved to California, you know what I did, I looked at YouTube and I looked at, I watched, I watched videos. Speaker 3 (31:30): I looked, I tried to understand what are the physical demands of surfing, but that didn't mean I couldn't help him. You know what I mean? Like, don't get me started. So anyways, so I think that it intimidates because also like, that would mean that men couldn't work with female athletes too. Like, cause you don't have a vagina. Like that's, it's a, it's an illogical argument and it makes me mad. So anyway, surfing is I that's one of the examples that I use because I don't surf and I never will because I'm afraid of sharks. So we w w your job, our specialty physical therapist should be movement analysis. That to me is a pretty basic part of our definition. And I know that you can at least pick out efficiency. Do you know what I mean? Like, you can pick out efficiency and I use video, like crazy. Speaker 3 (32:19): Have them bring you videos of them. Weightlifting have them bring you videos of running, and then you can slow it down. Look at it, really carefully. Look at it at home before you stand in front of them, start to break it down, look online. What is a clean and jerk, and then ask them to send you a video of a clean and jerk compared them and start to pick out where it's different. There you go. You know what I mean? Like, I think that we create this barrier for clinicians to be able to participate in this kind of care if we make it unattainable because they don't actually participate in it anyway. Yeah. Speaker 2 (32:56): Listen, I could not agree more. I think that's the dumbest dumbest argument against a qualified physical therapist, seeing the person in front of them, because what if you're the only physical therapist for 50 mile radius? What are you supposed to like, sorry, pal. I'm not an Olympic lifter can help you. Speaker 3 (33:17): Yeah, it's so stupid. It's so stupid. Well, and it's really the other thing too then is it's also important to sort of highlight and carefully and kindly and respectfully say that's also how pelvic health is understood by so many. Well, it's not, that's not my department, but it's physically inside the woman standing in front of you. It's part of her department. So like, you may be the only practitioner for miles and you are the only person that understands the human body, the way you do as a physical therapist. It behooves you to start understanding some of these processes. When we start to talk about our differential diagnoses for runners is to understand what is happening, what, how might this have affected what I'm seeing clinically? And then it's not, it's not pelvic health, like in this movie way, it's pelvic health as a, it's a, it's a friend to helping you understand what's going on with these patients. Speaker 3 (34:16): So, so again, like in the same way that, you know, folks get scooted away from participating with female athletes or athleticism, we don't want to scoot them away from pelvic health because it's scary or UV, or it's not their department. Like we need to open those doors broadly and say, let's, let's skill everybody up. Let's equip everybody, the pelvic health community to understand fitness better, and the fitness community to understand pelvic health better. Like let's everybody come to the middle and not create barriers inside the community to those things. Like, let's appreciate the perspective that we each bring so that we can optimize the care for our patients who don't have resources to go down, you know, and with telemedicine creates new opportunities until unless we can't do it nationally. Right. Can we have a talk about that? Speaker 2 (35:08): Yeah. I would love to have a talk about that. Like maybe every, every licensing board across the country, again, it's so stupid because we take a national exam, but we're only licensed in anyway. Yeah. We could have, we could have a round table on that one. But you know, what you said is really important about so for the physical therapist or even other health professionals listening pelvic health, it does not mean that you have to be clinically prepared to do internal work, right? No, not necessary. And it just means that you're treating the musculoskeletal health of someone who happens to have a pelvis, which last I checked is everyone. And so, and so you should, you should be able to do that. You may not ha you don't have to be certified as a women's health specialist, but you can take get information, read books, watch videos, take courses so that you are competent in, let's say for the sake of this month, I'm runners treating a woman postpartum that wants to get back to running. Speaker 3 (36:25): Right. And there, and that's, and I think that that's partially, I mean, to just be fair, I think we all learn pelvic health in a very isolated way in PT schools. You know what I mean? So I think that there's been a huge change in the conversation in the pelvic health community over the years. And it's just starting to get out there in, in other ways. So it also behooves those of us. And again, like I find myself always serve in the middle of these worlds. Those of us who communicate it in a way that's relevant to like, let's be communicating in a way that is enticing to learn more. Like, I want those to gain those skills and and understand it in a way that is relevant. And I, and so, yeah, so we have a lot of work to do to the physical therapy educational programming to start to build it into models a little bit differently, so that it's under some of the other side a little differently too. Right. So it's just, we're all we're evolving, but it is true that it has classically been defined that way. Right. Like, right. And so I think so anyway, yeah. So I, I agree with you, there's a lot we can do there. And it's also like, can you at least talk about like, and to have some ability to do that is important, you know, so, Speaker 2 (37:45): Yeah. And, and hopefully people like yourself and maybe podcasts like this and other podcasts that are out there will really help clinicians. And non-clinicians, you know, your, your, your gal that, that just had a baby. Who's like, I, I don't know what to do. How, what do I do? Yeah. You know, I just had someone contact me today who is eight months pregnant and she's starting to have a little low back pain. And she said, you know, should I just go to the doctor or should I just go to any PT or what should I do? And and I was like, Oh, I'm so happy that she's reaching out for a physical therapist, you know? But a lot of people just don't even know that that's an option. Right. So, Speaker 3 (38:32): Yeah. Cause the messages, while you're pregnant, low back pain, you're pregnant, you know? And, and so it's really, there's a lot of education that needs to happen, but I do think you know, so much of it is around I'm trying to think of a good way to say this, centering the woman as like that, those concerns just because they're common. I hate the common. Not more, it's not, I hate that. I get it, but it's also like, it just always has been, but that doesn't mean that's how it should be, or it has to be moving forward. Like I think we're starting to get more female researchers, myself trying to do that too, to help, you know, we're trying to have females asking questions for females and to the credit of this one particular, he will never know. I should write him a note, but like I had a conversation once with a running researcher. Speaker 3 (39:28): And I was like, did you think about the fact that that lady was probably in continent? Like he had just done something at CSM and he goes, that would never have crossed my mind. And I, and he wasn't like a poopoo that couldn't possibly be a variable. He was like, it looks like you need to start doing some research. And it was, it was literally like the last nail in the coffin of me, like meeting that, like I knew I wanted to go that direction, but it was one of those, you know, those really landmarking conversations that just sort of are like, w wait, wait, wait, wait, wait, I'm point. Knowing what I'm doing, like cooking you in the right direction. Yeah. It's to say, you know, this is you, you understand it. And I think that's, you know, again, you know, we talked a little bit about clinical utility and research, like trying to ask the questions that women need to ask, you know, so we need for your eight month pregnant lady, we got to get better information to her and to people that can care for her in her local community. Speaker 2 (40:25): Yeah. And, and again, you know, we talked a little bit about this before we went on, but, you know, asking the right questions, asking questions, asking simple questions. Because as, as we've spoken about the research for even simple, for simple questions is not there. So before we went on, Julie was saying, you know, we don't know what the pelvic does when we go to sit to stand, what is it doing when we're walking? We don't, we don't know what's happening in the pelvis and the pelvic floor and, and, and articulations above and below. So how are we supposed to know with certainty what's happened when you're running or when you have impact or jumping? So I think these, like you said, these smaller questions need to be looked at and researched, and then hopefully that body of work can build up to something much more clinically. Speaker 3 (41:15): Yeah. We need to sort of, we need to build in the basics and, and, and, and we're working like there are teams working on that, like we have, and we're using computer modeling as a way that this is starting to get there because we can't the issue. And also, I really want to make something super clear before we get moving. This direction is one of the things that I'm trying to be really careful about is not just talking about the pelvic floor, but to talk about pelvic health, because the pelvic floor is not the only gatekeeper that creates pelvic health. And it is a component of multiple body systems. And we need to understand that those systems affect the way the pelvic floor acts and behaves and the pelvic floor itself, you know, needs to be, have attention directed at it. But B because when we talk about just pelvic floor, I think it isolated away from relevance to other areas of care. Speaker 3 (42:05): So I just want to be clear on that. So but we don't know what its behavior is. Cause we can't see it. We can't put a, you know, it's just, we are, but we're starting to get new ways to be able to understand it better through a technology advances. So we're getting there, right? Like, so that's been a barrier to understand this better in in the dynamic, in dynamic activity. And we are seeing computer modeling as an option to help us start to understand this a little bit better, but that modeling is usually done on like an N of one. One of my favorite studies is a computer modeling study, but it's with something, I can't remember the title now off the top of my head, but it was something like, you know computer modeling of pelvic, the pelvic floor during an impact activity and an athletic female or something like that, or for female athletes. Speaker 3 (42:52): But then it literally says in the methods section that the woman they chose wasn't athletic and I'm like, well, crap. Okay. But I mean, it gives us, it gives us new insight. We'll take it. But I would really like to see it on someone who is an athlete, because, you know, we want to understand all of those variables anyways. So, you know, we're just trying to get there, but we haven't always, we can't visualize the pelvic floor in when we're watching a runner, but we can watch it's relationships. We know it's related to the glutes. We know it's related to the pelvis and the low back and the abdomen and diaphragm, we can watch all those other relationships. And we're really good at that in ortho, in sports medicine. So there's all of these interrelationships that we can watch and understand that a little bit better and differently, but you know, there's elements of what's going on there today. I am grateful to our pelvic health community for their capacity to treat directly. Speaker 2 (43:49): Yeah, yeah, absolutely. And now, before we start to wrap things up what I'd like to ask you is for, let's say the clinicians that are listening to us right now what, what is your best advice to those clinicians who are working with, let's say female runners who are postpartum at any point postpartum, whether it be six weeks, six months, six years, what have you, Speaker 3 (44:22): Oh let's see. That's kind of a loaded question, but I think it would be to learn to ask questions like that would be my best advice, like, and ask questions that make you a little uncomfortable. You will get more comfortable with it. And understand that what you're trying to do is open a door of communication. Like create a conversation around this with your athletes. Here's what we know, which is not much, but my understanding is after you've had a baby or two, it affects your running form and you can hang on to those changes six weeks, six months, six years, whatever, wherever they are, unless we actually look at them. So I'm wondering how that as part of your medical history is affecting what you're doing, but along with that often comes problems with how you're activating your abdomen. Or you might have a public health consideration like leaking when you're running or painful sex constipation. Speaker 3 (45:24): Like there's other problems that women have that are under the public health realm. You know, and so so I'm going to ask you, so have them in your intake form, have them, you know, are you comfortable having a conversation with me about that part of your life and your experience? Cause I'm wondering how it might be affecting what we're seeing here. We understand that there's an interrelationship with learning. The research is limited, but, and if you're not comfortable talking to me, understand that, you know, it is something that I think might be a variable. And so I'm going to actually at least try to incorporate your pelvic floor and your diaphragm and some of those interrelationships into our programming. But I also have someone down the street that you can talk to a few, be more comfortable. I just want to open that door, like open the door to a conversation. Speaker 3 (46:07): Like if that, if nothing else, if they aren't comfortable, you also should be skilling up to understand these components. How do you, what should, what do you see in a typical postpartum runner start looking for navels, start looking, going to central park, whatever it is, start to pay attention to these other variables and serve to give fit, give it new. Meaning like I, cause I read a lot of running research and athletics like sports medicine research and the meaning that it's attributed that is attributed to it is often based on what we've understood in men or like a strength based model. Like, well, they're just there post your chain. Isn't strong enough. Well, my question is why, why would every freaking females post your chain the off? Let's put that. Let's start thinking about that. That's the kind of questions I want to ask. Like the why we're seeing that as our common, it's not just structure, it can't just be structured because women aren't all structured the same P S all women do not run it into your tilt. Speaker 3 (47:08): Like they don't, what do you mean? Come on. Nobody does the same thing. All of us. Like it can't be. So it's like with what we've put this meaning on it and if you're postpartum or you're pregnant, you're you have an anterior tilt. Well, we have to have research has shown us. That's not true. So it's like, and then I don't know how you can overstride and inter tilt at the same time. Like, we need to really think about that because, but we've always, that's sort of the lens. And so everything gets filtered through it to the point that we exclude, like other, like, instead of thinking, Oh, well, this can't be the explanation. Let's ask other questions. It's this becomes the definition. Does that make, am I making sense? A hundred percent. Yeah. So it's like, how do we start say, okay, that's we didn't get to the bottom of it. Speaker 3 (47:57): What other questions can we be asking? And and, and to start to look at women, not just women, men too. So it's, it's like, how can we start to ask our questions a little bit differently? How can we start to and really it's to look for the, why's not, what is, why, why in the world are we finding this with all of our female athletes? Could it be the way that we've trained them to suck their stomachs in all the time, since they were 12 and 10, you know, like how could that possibly affect an entire generation of, of participants, right. Let's start looking at this, you know, so yeah. So I love her. Yeah. I mean, we brought up Eric Miura prior, so we'll throw him a little shout out here, but I wanna, I, I heard him speak at a conference. Speaker 3 (48:45): I don't even know time has no meaning now, but and one of the things he said was I, which I love was talking about with research. When you read the conclusion and research, is, is there any other explanation that could have come to that same conclusion based on what you're seeing in the light? And I thought that's so smart because sometimes I'm like, Oh, yay. My biases, my biases, whatever affirmed. And, but I, but so he was referring to that related to the research, but I think one of the things that I keep trying to think through for myself, and I think would be a really wise way for all of us as clinicians to think about it is what are other reasons why they responded to my treatment? What are other reasons that they could be experiencing this problem that has nothing to do with what I've always understood? Speaker 3 (49:28): You know what I mean? And I am sharing my bias. Like when I look at a female runner, I'm not like, Oh, that calf looks weak. I'm like, Oh, wow. Look at their central control system. Cause that's, you know, that's my lens. So I, you know, so I want to be open to understanding all of that other stuff, but I already, I already learned all that stuff. And this piece is something that isn't being considered by a lot of permissions. And so, yeah, so again, we need to start just broadening our lens and I think we're broadening it. I hope to look at females as not just little men and the problem we have wider pelvises, estrogen, and Q angles. Like there's other things happening for us that, that are not explained by those things. You know what I mean? Speaker 2 (50:13): Absolutely. Yeah. Thank you. This was awesome. Now, where can people find more information about you, more information about your, you have a running a female running course, where can, yes. Where can, where can we find all of that? Speaker 3 (50:32): I am at Julie PT and I have discovered that you can misspell my name and still find me. So it's J U L I E w I E B E P t.com. And I have, I do have an online course that was recorded from alive lives online opportunity. So it does have that flair that feel, but it also has the questions, which I love. And, but I also have lots of free resources in terms of blogs, videos. I do a lot of podcasts and have a newsletter to let you know about when opportunities are coming up. Like this one and what's coming up for us this next week to be a part of the round table. But but yeah, and I'm on all the socials Speaker 2 (51:19): You're everywhere. Thank you so much. You're all over the place in a good way. Not in a bad way, in a good way. So thanks so much before we sign off, I'll ask you the same question I ask everyone, and I probably asked you at twice or three times already, but we'll ask again, you can keep giving the same answer I want growing and learning. So that's true, but that's true. Yeah. So what advice would you give to your younger self? You know, what I'm going to share? Speaker 3 (51:49): It's funny. I was just thinking about this before we got on, but, and this is something that I've learned during the pandemic and and it's from Aaron Nyquist just, but he was referring to the spiritual, but I'm going to relate it to our walkthrough. Learning is instead of thinking of learning as this linear thing that I learned this, and now I know this, so that's stupid. I learned I'm making it on my hand. No one can see me. I forgot it was on a podcast, but instead of it being linear, which is so much of what ends up happening in our rural this dichotomy, Oh, well, biomechanics is stupid pain. Science is everything like, instead of it becoming linear in our thoughts is to think include and transcend. And instead of it being a linear line that it'd be concentric circles. And I was like, Oh my gosh, if I could be a learner like that, always if I had started my thought processes that way, like, wow, that would have been important for me as a person growing, but as a clinician growing to like that, instead of it becoming these battles that we get between these dichotomous, like VMO and like Karen, you remember BIMA, well, remember BMO, but instead of these like dichotomous thought processes, let's see, what can we continue to include? Speaker 3 (53:05): And then how do we transcend it doesn't mean that what we used to think was horrible and versus stupid. It's like, how do we keep building on that in concentric circles versus this linear thought process? So, yeah, so that was, that was just on my mind today. Speaker 2 (53:19): What wonderful advice it's like, it's like a reverse, it's like a reverse funnel. Yeah. Yeah. It just keeps getting brought. Our perspectives should broaden our questions should really never be answered. Like we should never get to the end of that. Do you know what I mean? And I just, I, anyway, it was a really just as so much has changed and, and it's been a really challenging year for all of us. I thought it was a, and we're headed back to a new transcendent, normal that I hope will bring a lot of changes for all of us. You know, I just, it was, I, I think it's a really important perspective as clinicians to, so I thank you so much for sharing that and thank you for spending the time today and tomorrow. I know, and tomorrow is our round table with you and Ellie and Chris and, and Tom. Speaker 2 (54:08): And I was saying like, gosh, to have the four of you on like one stage is like, Holy crap. I can't even believe it. So thank you for that. And so everyone you can find out how to join us all by going to podcast dot healthy, wealthy, smart.com. I mentioned it in the beginning, in the intro as well. So Julie, thank you so much. I appreciate you and appreciate your, your knowledge and your insight. Well, thanks so much for having me again, Karen. I appreciate it. And everyone, thanks so much for listening. Have a great week and stay healthy, wealthy and stuff. Speaker 1 (54:38): Mark, thank you for listening. And please subscribe to the podcast at podcast dot healthy, wealthy, smart.com. And don't forget to follow us on social media.
