Episode 34: Caught In The Gut: Why Your Back Pain Might Be An Inside Job

Have You Ever Wondered if Your Chronic Pain Might Have Deeper, Hidden Roots in Your Inner Organs? (Previously episode 5 of season 2) 

In this eye-opening episode of TMI Talk, Dr. Mary Grimberg welcomes Anna Hartman, an athletic trainer who provides private consulting to professional athletes for injury prevention, rehabilitation, and performance optimization. She also teaches physical therapists and athletic trainers how to get better outcomes by combining an osteopathic approach with a traditional orthopedic approach for assessment and treatment (manual and exercise-based) for injuries, pain, and performance. Her approach considers the whole person- including the viscera and the nervous system, not just the musculoskeletal system.

They dive deep into the often-overlooked realm of visceral referral and its critical impact on musculoskeletal health. If you've been struggling with persistent low back or pelvic pain and traditional treatments haven't worked, this episode might just be the revelation you've been searching for.

Key Highlights:

1. Visceral Referral: Anna explains how internal organs, or viscera, can cause pain in muscles and joints, particularly focusing on the small intestines, kidneys, and pelvic organs.
2. Industry Standards: A candid discussion on why the current standards in orthopedic physical therapy might not be enough and the importance of considering the whole person in treatment.
3. Nervous System's Role: How your nervous system can sabotage or support your healing process, especially if you've experienced trauma.
4. Pelvic Health: Insights into the interconnectedness of the uterus, ovaries, rectum, and even the colon, in influencing chronic pain.
5. Practical Advice: Tips on how to start exploring visceral mobility and improving overall body awareness from home.

Discover how a holistic approach considering both the mind and body can bring you closer to relief and a better quality of life. Listen to the full episode and take the first step towards understanding the bigger picture of your pain.

Learn more about Anna here below!

https://www.movementrev.com/

IG: @movement https://www.instagram.com/movementrev

Her podcasts UNREAL results: https://www.movementrev.com/podcast

Learn more about the Barral Institute 

https://www.barralinstitute.com/

Timestamped Overview:

00:00 Blame the Patient Bias
07:01 Behavioral Psychology in Physical Therapy
14:24 Pelvic Floor Therapy Insights
20:37 Supporting a Friend with Chronic Pain
22:06 The Power of Trauma-Informed Care
26:52 "Noticing Bodily Responses"
36:13 Body's Protective Anatomy Hierarchy
37:19 Visceral Impact on Back Pain
45:44 Constipation: Structural or Functional?
50:54 Relieving Constipation Through Massage
56:04 Stretching for Colon Mobilization
01:00:02 "Thoracic Rotation's Role in Pelvic Pain"
01:03:42 Complex Causes of Back Pain
01:11:50 Nervous System Responses: Survival Asset
01:14:23 Body Awareness Without Contraction Focus
01:22:55 Uterus Malposition: Impact on Legs and Fertility
01:25:57 Endometriosis and Pelvic Alignment Connection
01:31:28 Assessing Uterine Mobility Externally
01:37:49 Visceral Mobility and Dysfunction Causes
01:41:43 Movement Rev: Body Trust and Mobility
01:

If you have any other questions or topics you want to talk about, send me a message on Instagram. And if you loved this episode, please leave me a rating and a comment with your feedback. Please share this with your friends and loved ones, too!

I’ll see you in a week!

Transcript

0:36

Hello, everyone. Welcome back to TMI talk with doctor Mary. Today, we are gonna be talking about something that is rarely talked about, visceral refer referral and how it affects the musculoskeletal system. So basically the joints and the muscles and the viscera are internal organs. So this episode is for you if you've been experiencing ongoing pelvic or low back pain and traditional treatments are just not cutting it. To this is just another perspective for you to look at the entire picture. So today we have Anna Hartman. Anna is an athletic trainer who provides private consulting to professional athletes for injury prevention, rehabilitation, consulting to professional athletes for injury prevention, rehabilitation, and performance optimization. She teaches physical therapists and athletic trainers how to get better outcomes by combining an osteopathic approach with traditional orthopedic approach for assessment and treatment, for injuries, pain, and performance. Her approach considers the whole person, including the viscera nervous system, not just the musculoskeletal system. So thank you so much for being here, Anna. You're welcome. I'm so happy to be here and be chatting and sharing with your people. Yeah. I love your nonconventional approach to looking at the entire body. It's I'm all about it because I've been in orthopedics for now 13 years, and I'm like, the traditional shit just isn't cutting it. Not all the time. Right? Like, I think there's still a lot of great stuff. But for those more complicated cases that just aren't aren't getting better, this is something I've always wondered why we don't really dive in more to this. And so as a pelvic floor physical therapist, I see it often that the viscera can cause referral. But for you to come on and talk about it, I'm excited. Yeah. Yeah. It is. Working with humans is funny like that because and this is the thing. Like, I think the industry has settled settled for mediocrity, because it's standard. Right? Like, I feel like I I always ask practitioners, like, well, this is, like, as I've grown my business and, like, worked on, like, my messaging and how I'm trying to, like, relate to people. And and I used to be like, do you want better results? And and people didn't resonate with that because they thought they were getting good results. Because what is standard in the industry that is that good results doesn't equal a 100%. Good results equals 70%. Yep. And some of my PT friends who who have worked in clinics, like general clinics are like, Anna, you're being generous. I'd say that people think good results is like 50 to 60%. And I was just like, what? Yeah. If that. Right? Like, she's like, you're being really generous when you say 70%. And I was like, wow. You know? But, like, my perspective, I've always worked in a very, like, niche. I've only ever worked with athletes. And so, I, you know, that's a total I'd say in the athletic population, good results standard is 70%, but I'm like, yeah. I guess maybe general pop, it's even less than that. And I just haven't been in those types of clinics long enough to have a general, like, idea. And so but that's the thing is, like, that's a problem. Like, if you think good results is helping 5 out of 10 people, like, what the heck? You can say 5. I don't know if you can say 5. I was like, I don't know if this is an explicit buyback. An explicit. It's 18 plus. That word's like a normal part of me. Oh my god. Me too. Hard for me to catch it sometimes. But, yeah, I'm like, what the fuck is that about? Like, how is mediocre results, like, average or below average, mediocre results, like, a norm, an industry norm. And the excuses that the physical therapists and the doctors give are often, like, well, 1, they blame the patient all the time. All the time. All the time blame the patient. And I did a I did one of my podcast episodes on this, actually. It's called the fundamental attribution error, and it's like a psychological, like, standard practice that when something goes wrong, you are very quick to blame other things and other people piece instead of taking responsibility for yourself. And so I think, like, I don't I try not to shame the clinicians and be like, you're blaming the patient, but also, like, you don't even realize you're blaming the patient. There is a a general, I thought process of, like, saying that the assuming the patient's not doing their home exercise programs. There's a general assumption of body shaming the patients who are not in perfect health or perfect fitness, like, shape physiological shape. You know? And a lot of it comes from just, like, society norms of, like, people, like, assuming there's something wrong with you if you're overweight or assuming that you're lazy if you're overweight or assuming that you're, you know, not taking care of yourself if you're stressed out, those kind of things. And so there's a lot of shaming of the patients without people really even realizing they're shaming the patient and pushing the problem of like, well, it's you, not me. My programming is great. My rehab choices are great. Like, you're not getting better because it's your fault. And it's like, what the hell? That is wild to me. It's ego. I mean, I, you know, I was traditionally ortho for many, many years, and I'm still ortho, but I'm pelvic floor too. And that was a game changer. Right? And Mhmm. I just remember seeing some of these some patients with complex PTSD and a lot of nervous system and autoimmune dysfunction and just these pain the pain cycle that nobody could understand that then they were like, oh, it's them. It's their fault. Until I became that patient. And then I was like, oh. Yeah. You're like, this is not my fault. This is not my fault. I'm dealing with complex PTSD that I didn't even know I had. Yeah. Like and then most people, like, you have to work with the behavioral psychology. So if you wanna shame somebody for not doing their homework or whatever, you know, well, let's talk about it. What about what is the the mechanical block of keeping them from doing it? Right? Because so many people don't do their exercises. We have to work with their behavioral psychology versus, like, oh, that's your fault. And the ego in our health care system and especially in physical therapists, I just can't. Like, I the amount of times people come into our clinic, I have I'll be like the 5th PT sometimes, and they're like, oh, this PT said this isn't this can't happen. This can't happen. I'm like I just had you know, I I get this a lot where somebody the other day came in or for TMJ and headaches and the PT multiple PTs that said the TMJ and neck are not related. I'm like, I can't. What? I can't. I just can't. I I where have we gone as an industry? Because Wow. It, you know, you can relate the left right foot to the left shoulder. Look at the fascial patterns. Everything's connected. We were literally one, you know, joined egg. Do we need to sing the song? The what is it? The leg bones connected? Exactly. Right? Like, seriously. 1 the funny thing about home exercise programs, Sue, when they're like you know, when you're talking about the behavior psychology, you know what the number one thing is why people don't do the home exercise program? Because they've done it and it hasn't changed anything. And so the the patient's smart. They're like, fuck this. I'm not gonna do that. Like, I literally do these exercises. I take precious minutes out of my busy day to do these exercises that the PT told me was gonna help me, and they don't do shit. I feel the same or worse after or afterwards. My favorite is when they for a week. My favorite is changed. My favorite is when they'll say, like, oh, well, I heard after. They're like, well, that's normal. Like, it just takes time. I'm like, no. It just takes time. Oh my gosh. No. That is the biggest cop out of all time. Like, it actually sometimes it takes time. Yeah. That can be true Yeah. But not as true. Not as often as as physical therapist will lead lead you to believe. 100%. I think we should be seeing results really fucking fast. Yeah. That's like fast. I'm like, I'm I that's my, like, whole thing with my people. I'm like, I guarantee results in 1 to 3 visits. And if I can't get it in 1 to 3 visits, like, I'm missing something. I know I'm missing something. And I didn't just pull 1 to 3 visits out of thin air. Like, it was, like, most like, not even most of the time. Like, I get results in 1 to 3 visits. So if I don't, I know something's up. I've either missed something, or, like like, we're not, you know, like, not even that's it. I've missed something. It's not even on them. Well, it's not. It could be that you we just need to redirect. It could be also that they it could be non musculoskeletal and even well, you know, we're talking visceral too, but it could be that, hey, we need to get imaging to make sure maybe something bigger is not being missed. Right? It could be a lot of things, but that's what I mean. Like, I missed it. Yeah. Like, you know what I mean? Like, that's nothing like, that's not the patient's fault. Like, it might be physiological or it might be visceral. Like, that's me. I missed it in those 3 visits that I didn't consider those things. And so it's like, I need to go back and consider those things. And you're right. Like, and even with the visceral, and we can talk more that about that. You know, I kind of just jumped into, like, stop blaming the patients. I'm tired of it too. Yeah. But, it you know, it's like one of the things and kind of what you said, you didn't realize it until you went through it as a patient. And it's like, yeah. Like, there can be visceral things, and then there can be systemic physiological things. And, like, as women, we experience this with, like, going through the different phases of our life because we are very I always think women are the easiest well, when I'm teaching, pelvic floor physical therapists are the easiest, like, market for me because you see how viscera affects the musculoskeletal system on a daily basis. I don't have to convince you that there is that connection. You do with ortho. And then You do with ortho. Oh, yeah. Some yeah. Yeah. Some, I still do. But for the most part, like, if I had a group of physical therapists and 5 of them were pelvic floor PTs and 5 of them were strict ortho, like, the pelvic floor PTs would be like, oh, yeah. I could see that. Like, yeah. Many of my patients with endometriosis have all these musculoskeletal things, and then they got the surgery to get rid of the endometriosis and all their musculoskeletal issues went away. Like, they've seen it. So it's easier for them to believe it. The orthos are like, nah. That's no. You don't know what you're talking about. Yeah. And but then also, from a patient population standpoint, the patients who get it the most are women. Because from an early age, we have felt back pain from our menstrual cramps. You know? And then it just gets wilder as we enter the different stages of, like, perimenopause you know, pregnancy is a whole another thing. And then perimenopause and menopause, like, comes with that a whole new slew of systems, like, symptoms. Right? Like, you know, lately, I'm getting, like, headaches and low grade fevers every afternoon. And I'm thinking it was because of an illness I had. And I just realized like, oh, this is happening at the beginning of my cycle every month. Like, oh, this is actually hormonal. And so I'm like, fuck. Like, well and but and it feels like neck pain. It feels like back pain. You know? So it's like I can blame a lot of other musculoskeletal things, but I'm like, no. I know better than this. Well, it's it's funny because even with ortho, like, not all orthos are like this, but, you know, I'll get like, it like, I've heard ortho say, like, fascial restrictions isn't a thing. I'm like, I can't. I just You're like, what? You can literally see it. Cut like, we we did cadaver lab in PT school, which cadavers, if you don't know, are dead people that have donated their bodies to science. And you have to literally cut through fascia to get to the muscle. And so if you don't know what fascia is, think about like a chicken breast. Right? When you peel apart the chicken breast, there's that white membrane there. That's just the closest example I can give of, like, what human fascia would look like. And when we have, you know, pain or restriction or surgery or scar tissue, the fascial restrictions can cause more impairments as well, and that can also affect the lymphatic system because our lymphatic system is right there. And so all of it. And so I feel like our clinic sometimes is on an island because I'm like, I can't I don't even know how to relate sometimes to the physical therapy realm except for, you know, pelvic floor and stuff. But even pelvic floor is so disconnected from ortho. And I'm like, it no. Like, we have to look at them all. I don't understand why I'm having to, like, really advocate for this. Like, if if you have pelvic pain, you should be able to treat the knee because they're just, like, related. You know? Yeah. They're the same. That's why I'm like, well, people are like, when do you see pelvic floor patients? I'm like, well, yeah. Because it's, like, all part of the like, I'm like, everybody's got a pelvic floor. Uh-huh. And and I'm like and then also because, again, like, I teach a lot of pelvic floor physical therapists. So it's like, again, when I am teaching my assessment protocol that helps figure out if there is a visceral or a nervous system issue and, like, how to sequence the treatment. Like, sometimes they're like, well, how do I know if this helped their incontinence? And I'm like, well, how did you know that you helped their incontinence in the first place anyways? Like, didn't you gather orthopedic measures before you did your internal work or whatever, like whatever you gave them, whether it be internal, external exercises or manual therapy? Like, didn't you assess something to know that I have a index of suspicion if I, if they show me more hip mobility or show a change in their pelvic position or show a change in their breath or whatever it may be, that I have a good chance of changing their incontinence. Because, yeah, you're not going to know in an hour session if they go from being incontinent to not incontinent, like, duh. So I'm always surprised. I'm like, well, aren't you checking orthopedic things? No. It's not. Yeah. I don't, which is surprising. It's And I'm like, well, how do you ever know if your treatment works? It's, there's not, you know, ortho a lot, you know, when, when I say ortho for people listening, it's like orthopedics is traditional, like neck pain, back pain, shoulder pain, rehab, when you think about PT. Right? And then pelvic floor physical therapy, I'm sure some people even listening to here have tried it, and they say it doesn't work. And then I ask what they did in pelvic floor physical therapy, and I am told that they do internal the entire session. And I cringe. Wow. That's insane. I cringe because I'm like, wait a second. So we're massaging muscles intravaginally where a lot of people have experienced sexual abuse. Okay? So what about massaging internal muscles? Like, why are the muscles tight in the first place? Why are they tight? Is it breath work? Is it nervous system? Is it referral from lumbar spine? Is it hip? You know? And so I try to tell people, like, hey, if you've had pelvic floor physical therapy and it didn't work, it is a wild, wild west for pelvic floor physical therapy. So, like, bear with us. There are really holistic ones out there, including myself and, and, you know, the PTs at our clinic. And so it's it's giving people hope, like, hey. There are more treatments out there. And even with traditional, you know, orthopedics, you know, I'll ask people. I'm like, what did you do in PT? Did they work on your back? Did they work on your lumbar spine? So that somebody will come in with, like, hip or pelvic pain, and maybe I'm, you know, the 4th or 5th PT. This is a common theme that we see in the clinic. And I'll ask, did they look at lumbar spine? Did they look at thoracic? Did they do this? Did they do that? They're like, no. They massaged my hip for maybe 2 minutes, and then I did exercises with, like, 20 other people. And I'm like, that's not PT. I'm sorry. It's not. It's not. You're right. It's shit. It's shit PT, and we need to step up as, like, a profession. And there are plenty of wonderful PTs as well. Yeah. But Oh, for sure. It's just there's just you know, in any industry, there's so many there's so many mediocre ones, and there's it so can be hard to find a good person. And it's, like, why you gotta you know, it's one of I always compare it to massage therapists sometimes. Like, we've all probably experienced that we've gone and gotten a massage somewhere and, like, loved it and then gone to another place and been like, oh, don't like it. And you're not like, I'm giving up on massage therapy. Massage therapy doesn't work. You're like, no. I just didn't like that therapist. Yeah. But PT people tend to say, like, the opposite. Right? They'll be like, oh, I tried PT and it didn't work. I'm like, no. Yeah. So I'm never going back. And I'm like, no. It was probably just the therapist that you use. Yeah. Yeah. Exactly. Or maybe I mean, the other thing to consider too is personality type too. It's like Absolutely. If you walk in, you know, trauma informed care is is so it's not even in every other industry, like, in massage, in yoga, in chiropractic care that's talked about. In physical therapy, it's not. And I'm like, no. Trauma informed care is basically just being kind to the patient, meeting them where where they're at, like, matching a similar tone when you're talking to them, not just Reading their body language, paying attention to them. Yeah. But I think Making sure they feel safe. I think so much people are caught up in their own head and their ego that they haven't checked their ego at the door. Right? Oh, for sure. Because if you don't get somebody better, you're not a shitty PT. Like, let's just throw that out there. Like, we just weren't the perspective that we're seeing isn't working right now. Yeah. Well, I'm like, you're a shitty PT if you're not getting people better and you don't care. Or you're blaming them. Fine if you can't get people better. Like, I like, you know, every once in a while, there's someone I can't or not can't, but I am very challenged with helping. But I am, like, 100% in, like, trying to figure it out still. I'm not just like, whoop, sorry. Can't help everybody. Well, I yeah. And I'm sure you've seen this where sometimes I'm like the last stop where they're like, we've tried everything. Either I I either even surgeons say there's nothing I can do. I've tried all these things. I've tried medication. I've tried all this stuff, and I'm like, okay. We're gonna figure this out. Like, just bear with me. We're we're gonna we're gonna get to the bottom of this. If I can't help you, I'll refer to somebody who I trust that I think can help you. To the bottom of this. If I can't help you, I'll refer to somebody who I trust that I think can, but I I I just know what it's like to be on the other side and be like, there's nothing more we can do, basically implying that it's in my head. And there's nothing more sickening and just shameful. And I just remember just soaking in that shame and just feeling, like, so dismissed by the health care system that I was like, I don't want anyone who I ever come in contact with to ever feel this way again. To feel like they're broken and not not helpable. Like, what? No. Yeah. And even if, like, all we do like, I have a I have a good friend actually that is, like, has chronic migraines, like, not even migraine. She literally has a intense chronic headache every day all day long and has for years and has been to every type of practitioner you can imagine, every doctor, every like, everyone. And I just feel for her so much. And, you know, whenever she asks me for help, I'm like, 100%. Like, what do you need me to, like, take point on? Like, what ideas do you need? What do you wanna try? Like, do you wanna repeat things? And it's like, I can't imagine not making her feel like we're all in this together, and I want the same outcomes as you do. And I'm gonna, you know, try to you know, I'm gonna even though you're maybe even not seeing me regularly anymore, like and not just because she's my friend, like, if I see a treatment or, like, if I learn something that might help you, I'm texting you and be like, oh my gosh. Have you considered this? I just learned this new. Like, let's try this next time you come in or give this to your practitioner and see what their thoughts are. Or have you tried this? Like, you know, so it's like it's so important for patients to feel like they have somebody on their team helping them because they've just come to you for help. And for you to be like, well, the help I can give you, it's just it's not for you, and I can't help you. So, like, sorry. There's nothing I can do for you. I'm like, literally, this person is just asking you to be on their team. It's and their team being on their team might be finding them another team member, or it might be just, like, sticking with them and, like, there's so much value kinda like you said with the trauma informed care. Like, some of our chronic pain patients, part of coming to see you, they know they're not going to get better in 1 to 3 visits. They just want you to sort of hold space for them so they can feel for a moment like they're being taken care of and cared for. And that is so, so powerful for their nervous system to help with that regulation and help, like, shift them into a more self healing state that is like I always tell I always tell my, clinicians I'm teaching them, like, when you have your nervous system regulated so you can help co regulate for your clients, you do more than you ever realize you're doing for them. And that person wants to come back and see you because you've created that space, like, because you're that healing energy for them. And so it's like, this is what people want, and this is what people are paying for. Yes, the results. But at the end of the day, like, if the results are hard to get, they just want to know somebody is on their team. A 1000%. You know, if if you know, thinking about the nervous system. Right? So if you guys are listening and you're thinking like think about how tense you are when you go to a medical facility and then that and noticing how your body feels. Right? Just notice the tenseness in your body. You notice clenching and then tightness. Right? And maybe you already had this, and then you're going to seek help, and then your, your clinician doesn't hold space for you, and it feels like you're almost trying to prove that you're not insane. Right? And then that takes more energy that you don't fucking have. And then at the end, you're just like, oh, I'm in this same cycle again. And now picture, you go to a practitioner where you're validated. And when I say hold space, when I was, learning all this, I didn't know what that meant. I meant like, what what does holding space mean? Holding space means that you have a safe space to be heard, to be listened to without judgment and without shame. Right? And when you can have that, it is so healing to know that you have that space. Right? And I think so many clinicians, especially PTs, don't think about that aspect. I think that we're just so caught up in, like, the special test and this and that and yada yada. And and, you know, over time, I've mentored so many PTs over the years, and I would teach physical therapy courses. And, you know, I could see the PTs just being like, I don't know. Like, da da da. I'm trying to be perfect at these special tests. And the irony is that sometimes when I would work at clinics and I'd have a new grad maybe that worked there and maybe they didn't know the special test or these different things, I would see their patients get so much better than even the the, you know, the, more experienced clinicians because I'm like, they're holding space. Yeah. Because they're because they're so new to it. They're not, like, burnt out on it. And so they're just, like, happy to be working with people and happy to be the person looks to for help and are like, I want you to get better. And I, like, truly, like, let me just listen to you because there's nothing else I really can do, like, which is fine. And it's also, like, the most powerful thing. It is. And, yeah, when I teach my courses, I'm like, you know, how the quickness of which you place your hands, the where your body is, the tone you're talking, like, your eye contact, like, all these little pieces that are actually not little, they're big, to, like, set the environment to this, like, safe place for the patient. It's not only more comfortable for the patient, it's gonna get you better outcomes. Well, yeah. I mean Because then you're working with the body instead of on the body. Yeah. Like, when people come in, right, they'll be like, just dig in there. I'm like, no. We have to work with your body. Right? So it's like Yeah. Hey. I'll go in there, but, like, if I just jump right in and dig in your you know, I have an issue when when practitioners are so, like, oh, we're just gonna go really deep in there and Yeah. I'm like, what are you doing? Think about your body. It tenses up. It tenses up. Why not work with the body so, like, you can kind of ease into it? You know, there's this intuitive sense where you're just, like, easing into it and then kinda getting some of the movement. I hate, you know, the saying no pain, no gain. There are certain things, like cupping and and fascial movement sometimes can be painful because you're moving the tissue that's been restricted. But there's a difference between that and, like, just digging into these muscles and, like, causing the whole nervous system to tighten up. And so Yeah. Like you're saying, and it's something I've seen is that just noticing your nervous just notice your body. So if you're somebody that you're struggling with any type of chronic pain, but, you know, we'll talk more about low back and hip and pelvic here in a minute, but just notice. I think a lot of people are just unaware somatically of of their body's nervous system response. And so when I say nervous system, I mean, notice how your body feels when you're not listened to. Notice how your body feels when you are. Just pay attention to what your muscles are doing. Pay attention to the feelings that you're feeling in your body, and you're just noticing them. I have people practice this in general. Like, just notice your body's reactions to things because we're always head up. Right? Our society makes oops. I just hit my mic. Head up. Right? And so let's start kind of paying attention to our body and how we respond. And if we're constantly in a tense state, like, who you know, what practitioners do you feel you can let your guard down? Yeah. And and where do you need a tense? And just you just you just notice and just see. Right? And how Yeah. How they talk to you. Like, if you're standing and they're looking down at you, you know, making eye contact, speaking at the same tone. Right? How often they ask for consent, like, when they're touching different parts of your body. Like, that's I'm all I always saw my athletes. I was like, you know, it's okay to say no. Yeah. You know, and going back to even those painful treatments you you said, I'm like, permission to always tell the practitioner that you don't want that today. Yeah. And I I think so often patients think that because they're in with a health care professional that they are just like, whatever the health care professional thinks needs to be done is, like, you should grin and bear it because that's what's needed. I'm like, no. No. No. No. That's not how it works. Like, if it doesn't like like you're saying, like, if it does if it's not a yes to your body, it's not a yes. Like, it's like a not okay today. And I was like, so if someone doesn't ask consent to do a treatment on you like, every my athletes are like some of my athletes are like, Anna, like, whatever do whatever you want. But I'm like, I continue every time to be like, hey. We're going to do this. Is that okay? Like, hey. I'm gonna put my hand here. Is that okay? And some of them, it's redundant. But you know what? My female athletes especially, they actually are like, thank you for asking. They're like, no one ever asks. And I was like, you know, like, gosh, that's a shame. And so then now I tell them. I was like, hey. When you're working with other clinicians at other clinics or in other situations, it's okay to say no, even because they won't ask like I do all the time, unfortunately. I was like, but if they do something that's making you feel uncomfortable, whether it is an assessment or treatment or whatever, I give you permission to stand up for yourself and tell them no and ask for what you need. And if they don't accept that, then that's not the right practitioner for you, and you can I was like, and you should leave? Well, they don't know that, and I'll get message. They're like, thank you so much for telling me I can advocate for myself. I'm like, oh my god. Yeah. Like, I'll work on them. I'm like, can I push on your butt? And they're like, yeah. You don't have to tell me. But I've had you know, I'm like, yeah. But I want you to tell me. Yeah. Yeah. Yeah. Because even though I could push on your butt last week, doesn't mean you're okay with it today. Yeah. Consent is It's like and it it's like to me too. I'm like, and I work with a lot of men, which is nice. And so I'm like, this is how consent works. And I was like, you know, because no one's ever taught you this in your whole life. And this is part of the reason we have such a, like, huge, like, sexual assault thing is, like, people not realizing that they need to ask consent every time and consent that given 1 at one moment is not the same as consent an hour later. I was like, so it's like I like, it's my mission to remind you that in every aspect of your life, but especially in medical care, you have permission to stand up for yourself. Every time. Every time. Deny care. Ask for different care. Every time. Like, ask for a different clinician. Like, I was like, and if the if the clinician or the clinic or the doctor's office has a problem with it, that's not the doctor's office for you. Yeah. Or that's not the clinic for you because the the clearly, they don't care how comfortable and how safe you feel. And if they don't care about those fundamental pieces of healing, then you're never going to probably have good outcomes with them. Yeah. Because you're not being listened to. And I think when you've experienced trauma, we tend to kind of, oh, well, I don't wanna make a big deal about it. I'm gonna I'm okay. It's my fault. Somehow, I did something. Right? And it's like, hey, like, the something. Right? And it's like, hey. Like, the same thing. I give you permission to stick up for yourself. If somebody behaves in a way and then turns it back on you and gets angry It's called gaslighting. That's gaslighting. That's medical fucking gaslighting, and I'm over this shit. Right? And so if you're uncomfortable, bring somebody with you. Right? Bring an advocate, and and you get to ask questions. Right? Like, I had somebody the other day just kinda going through, a medical treatment, and they're like, well, they wanna put me on this medication or this. I go, ask why. Like, ask, like, what are the side effects? Is this good for me? Like, you know, ask questions. You don't have to just blindly take it. Ask questions. And they went in and they asked the provider, and the provider was like, well, it's you know, you don't have to, but this is protocol. Most protocols in the medical in western medicine is, you know, SOL. Right? Wait. No. Wait. Cover your ass? What is it? CYA? Oh, yes. CYA. Yeah. I'm like I always mess up. CYA because you're SOM. Yeah. So CYA. Right? So they're just trying to CYA. Right? Like, cover your ass. This is massive. I'm a cancer survivor, and so, like, it is massive in the cancer community too, where people are, like, well, I don't wanna take tamoxifen because I have horrible side effects with this. And I'm, like Yeah. Well, you talk about that with your oncologist. Your oncologist is shaming you. Right? There's also quality of life. Right? Like Yeah. For sure. If I know if I if I think a medication is gonna, like, help me live 5 years longer versus, like, you know, not maybe not 5 year maybe I'll live another 20 years, but if I take this medication, I'll take another try. But those last 5 years or those 25 years, I'm gonna feel like shit. Fuck it. I am not taking that. It is a quality of life issue. So even in cancer treatment, a lot of it is just survival, not quality of life. And so we have to weigh those pros and cons too, and you get to ask those questions. And when there's And the practitioner gets to, like, should value what you want and then be like, okay, we'll figure out a plan without it. Yeah. Like, you know, my my mom went through that with her cancer treatments too. It's like there was this drug that they were recommending and it was still in clinical trials and the side effects were, like, not looking great. And she was like, I'm scared of it and I don't want to do it. And I was like, okay. Like, that's fine. And I like her. She had such a great oncology team because he was like, okay. I respect that. And we will get you the best outcomes with the options that you are wanting. And, like, that's what they did. And there there was no, like, you're dumb for not wanting that. Like, it was just like, okay. But that happens a lot. Yeah. I mean, she got somebody that listened, but, I mean, I'll have people that are just it's funny because, you know, I mean, this could go on in another direction, but, basically, like, you know, we have autonomy over our bodies. Right? Like, we get to ask. We get to there's no hierarchy. It's, evidence based medicine is three things. It is evidence. It is the practitioner's experience. And guess what we forget a lot? Oh, the, patients' consent and what they want. And beliefs and, like, designers and yeah. Who knew that was their experiences. Evidence based medicine. When did we forget that? You know? And so Yeah. It's crazy. With, you know, your visceral approach. Right? So with Yeah. Could've redirect you back a little bit more to that. Like, what do you feel? So when somebody is experiencing, you know, pelvic or low back pain, what do you see is often missed? Because I see a variety of things, but I'd love to hear what you say. From a visceral perspective or even ortho. Like, what, you know, what do you what do you see? Well, I mean, it's kind of all linked. Right? Like, to me, in my opinion, it's all linked. So I see the musculoskeletal system, so the bones and the muscles in fashion and everything. Like, they're protecting the organs. Like, ultimately, we have this drive for the organism's survival. So we have a organism priority of, like, safety and survival, which were this is the whole conversation we've had going on. Right? Feeling safe. And not even just nervous system, like, autonomic nervous system, but, yeah, just everything being protected. And what keeps us safe and not only is our nervous system and, like, being aware of threats out there, but is, the bony structure of our anatomy keeps our vital organs safe, because our vital organs staying healthy is key to staying alive. And so this is too, like, why we look at the body and how it's, structured. Like the most important organ is the one that is most contained within a container, right, our brain. And then our heart and lungs are the next container that's very safe. And then you've got the pelvic organs, which are really important for the survival of the species with reproduction. And so they're in a little bit of a harder container too, though they're exposed, you know, not as exposed as the small intestines. And so then you have the rest of the soft organs in the abdomen that are within a more of a fascial and abdominal layered container for safety, not a hard frame. And so that just gives us an indication of like what organs are the most important. And what we sometimes forget about too in orthopedics is in our limbs, in our arms and legs, is an extension of our brain, heart, and lungs. And so oftentimes, even like a limit a limb immobility or like poor strength or whatever, is the body protecting those nerves and vascular structures as extensions to those important organs? So when I look at someone with, like, low back pain, you're like you're saying, My first always my first idea is or my first question is, like, what's going on viscerally? What could be driving this viscerally? Because I know that most of the time, even if there is a like, even if there is, like, let's say, a disc herniation, that's not like, whatever. If there's a disc herniation creating pain, my question, just like an orthopedic physical therapist would be, is, like, what biomechanics have led to that? And then I take one more step deeper is what visceral protection patterns have driven those biomechanics? And is the pain truly being generated from that herniation? Or is the pain possibly a visceral referral pain? And so those are the questions that I'm sort of like asking with my assessment, is like, where is this actually coming from? And when it comes to back pain specifically, there's 2 mistakes, I think, clinicians make in terms of when someone comes in with back pain, is assuming it's low back pain, and when they say low back pain, assuming it's lumbar, and not asking the person to point to where they're feeling. And if they point anywhere on the sacrum, usually 9.9 times out of 10, it's visceral referral. If someone has pain on their sacrum, it's always from a pelvic organ. It is never not from a pelvic organ. And so I think that misses like, people miss out a lot because people point to their back. And when this is, again, going back to I teach practitioners and I'm floored often that when I point to an area on somebody's body and I say what part of the spine this is, people say it's lumbar when it's actually their sacrum. And so it's a, like, general awareness of, like, where the sacrum is and where the lumbar spine is. The lumbar spine is actually small. There's not a whole lot of, real estate of the lumbar spine. There's a lot of real estate of the sacrum. And so, this is a problem, is just identifying where the pain is. And then, also, then, so that's the first mistake everybody makes is, like, oftentimes it's from the viscera just purely based on where it is. If it's truly lumbar spine or lower thoracic spine, now we're like, okay. Better chance of it being orthopedically pain driven, though there probably is still some sort of visceral protection pattern leading to that biomechanical problem, in my opinion. But also, now we look at the visceral organs that could refer to the, specifically the lower thoracic and lumbar area, and this is like pretty much all of the, all of the visceral organs. The most common ones I'd say, is the small intestines. Yeah. The small intestine root, is rooted, at in the posterior abdominal wall. So it's right at the spine and, the fascia that creates the mesenteric root is the fascia that lines the entire abdomen on that posterior abdominal wall, and so it comes out of it. And so when that small intestine doesn't feel very good, it's like literally pulling at the spine. And so that is probably the most common visceral referral is small intestine to lumbar spine or lower thoracic driven mechanical back pain or even, like, neurological back pain. And then, you know, the liver can be kind of just a big driver of all things, but like most commonly at back is small intestines. And, if you're now, if you're, some people say they have back pain when they actually just have leg radiculopathy. Right? They're told that the sciatic nerve issue is coming from their back. Then it's like, it's often liver, often sigmoid colon, often combination of the 2. Could be other side of the, larger colon, could be kidneys. Kidney is a big one for front of the leg pain. So but, yeah, like, kidneys, I mean, kidney is a big back pain one too. So general flank pain, like, when people are, like, just pointing to one side of their back, always kidneys. Almost always kidneys. Yeah. It's funny because, like, from a PT perspective, the biggest thing we screen on is kidneys. It's like, oh, you know, if it's mid back to low back, like, right in that center area in between the two, it's it could be kidneys. Right? But Yeah. For people that maybe are unaware of some of the terms that you use, I'm just gonna kind of summarize a little bit. And so, basically, what she's saying is the thoracic spine is the mid back, and then the lumbar spine is the low back, and then the sacrum is part of the pelvis. Right? So that's the lower part. And so when you said, like, the posterior fascia, so the fascia along the backside of the abdominal wall is connected to your small intestines. And so when your small intestines are irritated, then that can potentially be tugging, kinda causing some low back pain. And the sigmoid so the colon is the large intestine. So just kind of explaining that for people so they can understand. Because I'm sure I know clinicians still listen to this podcast too, but Yeah. For people that maybe are not aware. Looking. Yeah. I think it's I love that because we just don't freaking think about it. We just don't like, there's something about orthopedics where I'm like, wait. Nobody touches the abdomen. Even if you're not doing visceral mobility or maybe you don't understand what that means and you're a clinician or you're a patient and you haven't been assessed, like, even just abdominal, like, fascial restrictions, like the long and obliques, I'm like, why are we not looking at this? You know? Yeah. And so that can make a a big difference too. And so from like, if somebody is listening to this. Right? So say they're having low back or pelvic pain. Right? So we haven't even gotten into the ovaries and uterus and bladder. And, you know, we did talk about the colon a little bit, which those sit inside the pelvis, and so the intestines are gonna be more like your abdomen area. And then the liver is gonna be up, near, like, the base of the ribs as well. And then the kidneys are gonna be more on that backside where the low back meets the mid back. So what could you know, what are some ways that, say, somebody is experiencing low back pain? And maybe they don't have a clinician that necessarily understands visceral. Right? So as much as I wanna promote your work and get everybody out there that's taken your training, I know your work is oh my gosh. I love I freaking love what you're doing. What are some things that maybe they could look into? So maybe, you know, even just understanding your digestion. Like, hey. If you're having this low back pain, it's funny. People don't correlate. Like, even if you look at where the rectum is, so the rectum is the the basically, the end of the colon, so the large intestine, and it sits right in front of your sacrum. Right? And so a lot of people are unaware that constipation can cause pelvic and back pain. Oh, yeah. And sciatica. And sciatica. And so what are your poops like? So Yeah. What, like, what would be something you would tell somebody who's listening if they're having low back pain, they're not getting the results that they want, and, yeah, like, what would you just be looking at digestion or looking at different foods? Like, is there something in particular you would Yeah. Well, it's always one of those things that you have to consider, like, is it a functional issue or is it a structural issue causing the constipation or causing the visceral issue that then the musculoskeletal system is then creating this protective response around. And just like other parts about like, it's they're seamlessly integrated. Right? Like, function dictates the mobility, mobility dictates the function. And so you can really attack it from either direction. When it comes to constipation specifically, my first things are going to be, what's your, like, general lymphatic congestion like and your, like, vascular return like? So, like, are you getting swelling in your legs? And you might not even think that you're getting swelling in your legs. Best indication is if you wear socks or like, sweatpants to bed. Do you wake up with a little bit of an indent from from the from the top of the sock or the bottom of the, sweatpants? If that's happening, then you have a congestion problem in your pelvis. Can you? Because that's sort of like where the legs are draining into to get the fluid back to the heart. And so, if you have a congestion problem in your pelvis, that's going to really affect the colon, the rectum function, and just space to move. So that's number 1. I was just going to kind of make it a little bit more, like, so if somebody doesn't understand. So basically, congestion is going to be pressure in the pelvis from the lymphatic what's that? I said bloating is a way for, like, patients to understand. Yeah. Yeah. Like bloating, some yeah. Bloating's like the perfect example. So just wanted to kind of say Fullness. What's that? Fullness and pressure. Those are probably another feelings. Like a similar feeling, again, if you're female, you know, or a person who menstruates, like, you know, when you're on your period, that full, heavy feeling you get in your pelvis, that's congestion. And, sometimes, when we have general systemic lymphatic congestion, you're so used to it, you don't notice it feeling that heavy and uncomfortable in the pelvis because it's just always there. So it becomes your standard until it goes away, and then you're like, oh, I feel so much better in this area. So that's that's a big one to start with. Yeah. Well, part of it is is if people are unaware, a lot of times it's because we're not aware of our body. So even just Yeah. Pulling in, if you're listening to this and you're like, what does that mean? I'm not really sure. I don't know. So we have to observe our body. Our body has its own brain. Right? Like, the way we talk and when we communicate with people, we're using our conscious brain. Like, I'm consciously thinking about the words that I'm saying to you versus your unconscious brain is like your body and your body's response to things that your unconscious brain will remember, but your brain doesn't. So we have to incorporate the 2 and start looking. So if you're not sure and you're like, I don't know. Do I have pressure? Do I have these things? Just start observing. You don't even necessarily, like, need to change anything right now. Just start being aware because, oh my gosh, there is power and patterns and understanding and recognizing different things and noticing. So, basically, what you're saying is is, hey. If you feel like you're experiencing this lower pelvic pain along the sacrum, so that lower part of your lump below the low back, your low back and your and your, you know, mid back area. If you feel pressure maybe in the abdomen area or bloating or just just tenseness in there, and then you're noticing maybe some swelling in your legs, just even just lightly like you're saying, like, you know Yes. It doesn't have to be, like, dramatic, but just enough to leave a little indent. Like, a lot of what happens and why I start asking it that way is because a lot of patients are like, no, I don't get swelling in my legs if I just ask them. And then I take their sock off and I'm like, you you do. And they're like, oh, yeah. That happens, like, every day. And I'm like, yeah. That's swelling in your legs. Yeah. Well, also And then, like you're saying, the more you then pay attention to it and see the patterns, then you get to know, like, what's normal for you. So like, for me, not only is it that indent on my leg from my sweatpants, but I also know how swollen I am based on the size of my ankle and if I can see the, line of my shin bone. And if I can't see the line of my shin bone and there's a certain size that I know now of what my ankles are when they're not swollen, then I'm like, oh yeah, I'm swollen. That's my check-in for myself based on observing patterns. And because it's not something, because when you're used, because we have a lot of fascial spaces that can like, contain fluid. And so if you're not paying attention, you wouldn't even know that it's there or not. So that's a big one. The other one, too, with the constipation, from a structural standpoint, we have these things, this anatomy on our colon. If you ever look at a picture of our large intestine, our colon, you see it's like this tube that has, like, little balloon shapes in it, and then you have, I think 2, maybe 3 of them. These, it looks like somebody sewed, like, a ribbon along the colon. And, honestly, I don't remember an anatomical what they're called right now, but that, those tensioning things, they all connect to the bottom of the beginning of the, of the large intestine, so the caecum, which is the right side of the low intestine, sorry, of the large intestine, around where your appendix is. So when you're having constipation, even if the constipation is from the colon on the left side, which is a common spot for things to get clogged up as the colon goes, from anterior to posterior, so the front of the body or the back of the body to the rectum where Mary was talking about, You should do manual therapy or stretching or just self massage on the right side at the bottom of the large intestine because those ribbon bands connect through the whole thing. And so tensioning them there actually will reflexively affect the entire large intestine. So oftentimes, you can get the things that are backed up and you're constipated on the exit going by stimulating the beginning of it. Oh my gosh. I love that. I love that. Yeah. So it's like oftentimes people are, like, massaging and rubbing the left side because that's where it's stuck. But I'm like, go to the right side. Especially, especially if you've been doing the left side and it's not helping, go to the right side. The right side is like a spot where it can affect it quite a bit. Functionally, if you're having diarrhea, or not diarrhea, functionally, if you're having constipation, meaning constipation's more from a hormonal standpoint or from a digestive standpoint, the right side is also where it's being happening at, because that's the transition from the small intestine to the large intestine. And so it has to do more with, like, the function of your colon. And so it's also a good spot to do treatment anyway. So it's like the side of the colon that people forget to do treatment on because it's not the exit, but it actually drives a lot of constipation symptoms from those ribbon like structures I was telling you about as which is being more of a mechanical constipation, but then also from a functional constipation. It's the right side that is more sometimes more the driver. So Yeah. So it's kind of like that area being kind of more restricted is restricting the full movement of the colon. Yeah. And think of the colon almost like piping. Right? Like Yeah. We need to kinda get things out of, you know, in out of our digestive system and then out of the rectum and out of the anus. But in order to do that, we need to make sure that the whole system is is moving and flowing. And if you kind of that right sided pain so that right sided area. So with people that don't know where the appendix is, you're gonna take, like, your belly button and then your front hip bone on the right side where you feel that the top of your pelvis, roughly. Right? And it's going to be halfway in between those two areas. So that's an area that that she's that she's discussing about. Okay. So the third thing I'd say when it comes to constipation and the colon in general is, there the colon is very linked to your kidneys. And so this, again, why I started this whole thing with, like, a fluid, like, fluid, because of the fascia they share. So the the fascia that covers the front of the kidney is the fascia that it it, like, backs up to the fascia that covers the, holds the tubes of the colon in place. So it's called the fascia of Talt or Taltz fascia. So why I share this is because the cool thing is is tubes, so the colon, the tubes like to be stretched. And, one of the things that you can do, again, besides massage, is to stretch the colon is not just side bending, which is probably more common, but you need to add rotation to it because the colon goes from the front of the body to the back of the body. So there's an oblique or, like, diagonal to it. So we need to add in rotation and side bending to get the colon really well, as well as when you do an inhale breath, what happens is the diaphragm drops down, but it pushes the colon, the ascending and the descending colon, it opens them up to the sides of the body, which really helps to stretch that fascia of tolt. So when we can add in sebumin and rotation and stay there for a second and really emphasize this feeling of the, handles, right, the long tubes of the intestines on either side of our body. When we can imagine them opening up to the sides, it helps to mobilize things really well too. And that's the thing too is, like, I was one of the things you said is like, I wish everybody you know, not everybody has access to visceral work, which you're right, but what we forget is the viscera always attaches to the musculoskeletal system. And so if you understand where the viscera is and you can imagine that the shape of the viscera, the quality, the tube like quality, and you can direct intention to that as you stretch versus the spine, it's a completely different experience. Well, yeah. When you embody the organs. And so when you're doing, when you're constipated and you're adding movement in to get things moving, I want you picturing the intestines. That's what you're trying to stretch and move. And so it's like understanding all these connections is important. But the cool thing and why I talked about the connection of the kidneys is the kidneys live right at the thoracolumbar junction, and so what helps them to pump and get the fluid moving out of your body is rotation as well. So all of these organs are set up to support the fluid system from a rotational thing. So rotation needs to be in everyone's daily activity, but it's the one thing that most people don't put in at all. Oh my God. It's also why walking is so powerful because it's built in rotation. But sometimes when you have back pain, you stop using the rotation in your spine when you walk, so you don't get the benefits of the walking. So you need to do a rotational stretch first, maybe before you go walking. I, oh my gosh, I love that because so much to kind of talk about there. So when she said their echo lumbar junction, that's where the mid back meets the low back. It's okay. It's okay. I know you're used to talking to clinicians. Yeah. So I just like to digest. The whole point of this podcast is I want people to feel like I'm, like, their best friend, like, explaining, like, medical stuff. You know? And so if you are unaware of what the colon looks like, pull it up. Go look at in a at an anatomical model. Like, there's tons of pictures online. Right? Look at it and start just noticing it. Everybody should understand how the body, at least just like a basic understanding. Right? So the more you know, the more you can visualize these things. Right? And so look at the intestines, look at what she's talking about, start noticing those patterns. Right? And so if you notice that maybe you are having some of the swelling or maybe you are experiencing some constipation, you know, adding in that thoracic rotation and, you know, even mobilizing or just massaging, like, your lower part of your abdominal area like we talked about. I mean, it's not gonna be exactly like if you had a clinician, but, I mean, as long as you're starting to understand. Because intuitively, you you know like, what's really cool and what we don't actually talk about at all, or at least in my training, is our intuitive wanting or need to wanna do something. Right? I I saw one of your posts the other day, and I loved it because I was like, oh, yes. Like, finally, somebody's talking about it is notice what your body wants to do. Like, it it will notice it's gonna tell you. And that's what's so cool about our body is it's gonna be like, yeah. That makes sense. Oh, that feels good. I'm I'm gonna go there. And people will say, like, is that okay? I'm like, how does that feel for you? Like, does that feel good? Is it, like, a hurt so good or a, oh god, that doesn't I need to stop. Right? And so what I love about you talking about thoracic rotation, it's missed so much in pelvic pain. Because even just from a you're talking, you know, pelvic congestion, so, like, swelling in the pelvis and putting pressure on the pelvic organs, and then that potentially causing pelvic pain. And adding that thoracic rotation kinda helps kind of almost milk it, like, kinda get it moving and kind of get it gliding so that way the body can kinda do how it what it naturally does. But the other aspect too is, like, if we think about it from a so your mid back and your low back. Right? So when we walk, we need our our I actually am just posting a reel on this today, but it's that I recorded yesterday, coincidentally, is how when we walk, our our mid back rotates, say we're gonna rotate left, and then our pelvis is going to rotate the opposite direction. So we need that to propel forward. And so sometimes even in in when we experience pain or we're in this kite and like think about our body when we get stressed, we tense up our thoracic spine, we hold our breath, and then we're walking. And then our thoracic spine, the way it's lined our low back, the way it's lined up, it's just mainly meant for the joints. It's mainly meant for flexion, extension, and very little rotation. You can look up the joints and see what that looks like. And so if we're not getting thoracic, the mid back rotation on top of what you're saying too, is that we're kind of jamming into the lumbar spine over and over and over, and we're like, why does it hurt? But then your hip flexors have to really propel you forward to help with that. So then we're overcompensating there, plus then add in pelvic congestion. Right? Plus add in, you know, that fluid and and and and already the tightness and all that. Of course, there's gonna be pain with that. And I think so much of us, we sit at our desk and we're slouched forward and hunched here. When we're slouched, we can't get as much thoracic rotation, so mid back rotation. So and then on top of it, thinking about if we're not getting that rotation from our mid back, the pelvis has to take up that too. And so, you know, the pelvis is a pretty strong structure, but we still have the SI joints of the joint in the back. And then in the front, it's called the pubic symphysis. And sometimes, you know, it's rare for those, in my experience, it's rare for those to really kind of be the main source of pain. Usually, there's something else going on that's causing it. But when you don't have movement in your mid back and you don't have movement in your hips, we're gonna kinda get these subtle shifts in our pelvis too. So that's also kind of my soapbox with, like, the thoracic spine from a musculoskeletal standpoint, and then what you're saying from a visceral is like, hey. We gotta pump. Get those kidneys helping with assisting that absorption of the fluid so we can pee it out, essentially. Yeah. Well and it's one of those things too as you're talking through that scenario is, like, it's chicken or the egg. Mhmm. Right? Because, like, when your back hurts and you can't rotate, you have a better you have a more likely chance of getting constipated because now your tubes aren't getting stretched. Because the organs rely on that musculoskeletal movement to help them move the food through. Right? To help assist the peristalsis in moving the contents through for evacuation. And so when we stop moving, we tend to get constipated. And so this is, but then some you know? So it's vice versa. Like, yeah, you can have, like, a true mechanical back pain causing issues. Yeah. But then it's always like I take a step back of, like, well, why did this happen in the first place? And how like, you know, like, was it chicken or leg? Did you get constipated and then you couldn't move through your thoracolumbar junction and your pelvis, so then you had to start over rotating in your lumbar spine? And now you wore out your facet joints and now you have low back pain from neurological reasons? Or, you know, was it like a car accident and you injured your back and then your back stopped moving and then your colon stopped getting stretched and now you're constipated? It's like one of those things, like, I will never know what was the original incident or sometimes it's rare. I I I don't want to say I never know. It's rare to know the original cause of something. And then it's also, like, does it matter? It it doesn't matter. But what you need to do is consider all of these pieces because it's not just your back being hypermobile or not mobile enough while it's being driven. It's like, again, the body wants to protect things that are going to keep it alive. And that's why it's like, if you have a musculoskeletal pain, I always think that there it's like, you gotta consider the viscera because it's the more important structure. Yeah. It's the more it's more important than the discs, like, for function. 100%. And so it's like, you just have to go back in this hierarchy. And sometimes it's not driving it, but we don't know that until we assess it. And so that's, like, the thing too is, like, why these worlds need to be married is because if you're only seeing things from a biomechanical stand up view, you're only assessing the biomechanics, and you're missing what could be driving the problem. Yeah. You know, I I you know what I hate the most? I hate this shit when people are like, oh, like, you know, in PT, it's like, oh, back pain has core strength. I'm like, I can't. I just can't. Like, there are many people that don't do abdominal exercises that don't have back pain. So, like, yes, having a strong core is great. It is definitely something that helps us with function, but it is not Sure. It's not that and then also, like, you know, I had back surgery and afterwards during rehab when I was trying to, like, strengthen my core again, it was hard for me to get a contraction. And the reason being is because I was having a lot of visceral issues going on. And it wasn't until I treated the viscera that then I could contract my muscles. Because my muscles were too busy splinting my organs. They did not want to voluntarily contract and relax because they were like, hey, lady. I'm doing a more important job of making sure your small intestine is safe here. And so, we're not gonna contract during a plank because that's not important to us and you have other muscles to support you in a plank. But it's like, I would do all of these core things and I would never quite feel the engagement in my core And, you know, the PT I was working with were like, tighten, you know, tighten up, like pull your belly button to your spine. And then my body's like, fuck off. Like, I can't do it. Yeah. I can't do it. And it wasn't until I got visceral manipulation and then I went and did a plank and I'm like, oh my god, I feel my abs. It's it's funny. Yeah. It's like sometimes it's not the actual intrinsic muscle. So the muscle itself oftentimes, yes, low back pain, and, yes, we need abdominal strength. Right? I'm not saying that. I'm just saying I hate these blanket statements of just do planks or just do this. Right? Well, and when you're just doing the exercise over and over again and thinking it's going to turn on, no. If it's not turning on, there's a reason. Well, it's also communication, right? So basically what you're saying is just like, hey, the muscles are protecting our vital organs. It doesn't have time to do a plank, right? It doesn't it's thinking survival, survival, survival. Yeah. Right? And so the other aspect too on top of that is, like, if your thoracic spine isn't moving as well or maybe, like, your low back is tight or restricted. Right? We have nerves that come out of that and innervate into into muscles and into, into our the rest of our body, but also it also innervates the viscera as well, so those internal organs. And so if we're stiff in our spine and that's not being addressed, right, it's like I tell people, it's like you can have it's like a communication thing. Like, you and I can be talking. We can have fancy ass cell phones, but if there's no communication, it doesn't matter. So it's like the muscles, right, the brain can't connect to a muscle if we're not getting that signal. And that signal can be impaired because it's either, a, already protecting it from a survival standpoint, or, b, it's not getting the message because there's not as much mobility in that area so the communication can, you know, get that signal. Exactly. Yep. The the muscle contraction is an output. And so it's like, if you want to change the output, instead of like, the industry tries to change the output by just changing the output. They're like, just keep talking about the output. And I'm like, or you could just figure out where the input's off. Mhmm. Which is exactly what you're saying. Like, is it at the spinal level? Is it at the visceral level? Is it, like, you know, something to do with your vision or your vestibular system? Like, there's so many different layers to our sensory information coming in that is going to dictate how our muscles function. Yeah. A 1000%. And it's like, if we're not understanding, like, hey, input. So the muscle can only contract when it gets a message to contract. And if that message is not coming in for the reasons that we talked about, right, you know, there can be some others. Like, there's neurological conditions and stuff like that. But, like, we're talking, you know, just kind of basic, like, anatomy and physiology is that that's gonna be impaired. And the you know what? Another aspect, though, I do wanna touch on is sometimes when I'm working with somebody with complex PTSD, we have, you know, dissociation. So we'll experience dissociation of basically everything from the neck down. And so if it's I'll find that's almost like a global thing where they they just can't feel their muscles activate Mhmm. Versus, like, one particular area can't activate. So I'm gonna treat those two things differently. Right? So sometimes going into your body when you've experienced trauma, it's like dissociation. I didn't even know what that meant until I started realizing I was doing it. It's basically you're unaware of what's happening, and you can't dissociation occurs to say you're in a traumatic environment and you can't physically leave, you leave your body mentally. And when you leave your body mentally, you disconnect from the neck down. And so if you're globally experiencing this inability to contract muscles, I would say that sometimes it's that can be that dissociation where we have to pull ourself into our body and remind our body that we're safe. Right? And so when we do that, that's when breath work and that's when tapping or humming or nervous system regulation come in and kinda help you so you can start connecting to your body because it wasn't safe before. But if you're in a safe environment now, your body is like, okay. I have to retrain your body with that too. So I do wanna mention that because that's a big thing where people are like, is something wrong with me? I don't feel it. I'm like, no. Like, I really think that in this case, it could be this dissociation from the body because of history of trauma. So there's also this nervous system adaptation that needs to occur to do with that. But, I don't know if you've seen that as well. Yeah. No. I mean, in my athletes and my military guys, they are they that's what makes them good Mhmm. Is the ability to dissociate and, like, not feel what their bodies are telling them. Mhmm. Like, that's often you know? And, you know, in the trauma world, often, we see it as like this well, I don't know if we see it like this. Like, I guess it often is seen as a negative thing, like a like a bad thing to be happening because it is associated with trauma too. But it's actually, like well, every response of our nervous system, whether it's disassociating or fighting or, you know, you know, fleeing or whatever it is, like, it's kind of amazing that we do that. And it's all for survival. And you can utilize all of those ways our nervous system reacts as a benefit. Like, so for military people and for my athletes who, like, need to perform physical feats and not hear the messages of their body to stop them, like, this becomes an asset for them. Huge asset. Like, if you are a Navy SEAL, you can't be bothered by your knee hurting when you're on a mission. That is like literally life or death. And so it's like, this is an amazing thing that your body can do is dissociate and not feel what the hell is going on below. Right? Yeah. It's you've heard of Gabor Mate's work? Her work? So I just went to a training with him, like, a few, weeks ago, which I was so stoked about. But, you know, he talks about, hey. Those, are called adaptations. When you need to get through in that environment, you need to just go and do it. So it's the adaptation. So you can survive in it, and those are the things that help us adapt to function in those environments. But once we're removed from those environments, it becomes an impairment. Correct. And he's like, that's when we work on it. But it's a it's a protects you in that moment. Yeah. Right? In that time. Great thing to have. Yeah. Yeah. Well, and I think too, like I mean, to me, like, this is a very classic mom pattern because you sort of have to dissociate because your body does not become it's not yours anymore. It's, like, connected to your baby's too. Like so I'm like, this is, like, so interesting because you just you know, and it's, like, built in biological thing to do that. But it's like they're, like, kind of disconnected from their body because it's like, it's not even mine anymore. Yeah. Which is such an interesting thing. But, yeah, you're right. So, so to answer your question, yes, I do see this in my clients at all levels, professional athlete and like my friends and, family members. And it is like you have to spend some time getting them to feel safe and getting them to feel in their body. And then kind of going back to, your point about, like, with the dissociative tendencies to not feel any contractions in your body, it's one of those things that it's like, for your muscles to function, you actually don't have to feel them contracting. Like, you know what I mean? Like, that like, some people think that there's something wrong with them if they can't feel them contracting, but I'm also like, also, if you're standing up, if you're doing the task, I promise you, your muscle is contracting. You don't have to feel it. Yeah. The industry is, like, hyper focused on having to feel the burn or feel the contraction, and they're just so dumb because that's what makes our brain so amazing, is that all these things are happening in our body and we are sensing our body, I promise you, whether you're dissociated or not, our body's sensing all the things. We're just not spotlighting our attention on it. And so it's also like kind of like going back to ego, like, why do we need to have this attention on the contraction? I can't with I can't with the when people say, like, I've heard clinicians say, your glutes aren't firing. Shut the fuck up. I'm, like, if you're standing up Yeah. You're gonna fall. Person glutes that are not firing is the spinal cord injury patient or the neurological patient who literally cannot stand up on their own. Yep. I I hear that. I'm like, oh, I was told my glutes aren't firing. I'm like, I am sorry your glutes are firing because you would fall, unless there's a neurological condition, which yeah, is a thing. Is a thing. It is. But it's not you. It's not you. It's not you who just walked in the clinic in spandex because you just got done with your workout. Like, it's definitely not you. I promise. Like, yeah, you might not have a very big butt, but it has nothing to do with it firing or not. What does spandex have to do with it? You're just saying, like Well, I'm just saying, like, that's like a normal, like, active population type of person who'd be like, oh, my glutes not firing. Yeah. Get the fuck out. Yeah. No. You're fine. Yeah. Your ass size has nothing to do with your glute firing too. It just it can indicate potential strength, but doesn't always indicate. Like Yes. Like, oh, you have no ass. Well, it's not firing. It's like, no. That's Yeah. It is. That's not it. That's not it either. So, yeah, such an interesting kind of like it's just interesting. And and, like, yeah, and and part of the dissociative pattern is, like, it's not that those messages are not happening to your brain, it's that you've stopped placing value on paying attention to them. Because your body's in survival. Because it wasn't safe. Yeah. Right. Because it wasn't safe. And so now, to make it not, you know, to make it not an impairment, we have to spend some time spotlighting our attention on those sensations so we can teach our brain that it's safe to feel them again. Mhmm. And that's what a lot of people are unaware what somatic work means. And so somatic work, a lot of times, is the way I'll describe it is it's pulling yourself into your body. And sometimes even just, like, for instance, I'll have somebody, where they're, like, thinking about something where like, for instance, maybe if I have somebody that they're having pain with sex because they, have history of maybe sexual abuse or something, you know, like that. Right? So I I have them just almost, like, visualize just even somebody touching, like, your leg, not genitalia or anything like that. You're just visualizing. Notice the discomfort in your body. Right. Okay. I feel it in my chest, and I'm, like, sitting that for 60 seconds. You're safe. You're okay. And then after that, you get to move through it through something called resourcing. And so you you either do tapping or humming or, you know, something to kinda pull yourself into your body, like stroking your arms, rubbing your legs, like, anything like that. And so any sort of response that kind of sets you off, I think we're taught, well, if that's uncomfortable, I need to stop. Well, let's assess. Like, am I actually unsafe? That's one thing. If you are unsafe, that is a different story. If you are in a safe environment and you are okay right now, then sit in that discomfort, feel it, and then as your body kind of your body is giving you a message. It's a message. It's saying, I'm unsafe. I'm unsafe. I I I'm not you know, say it with, like, your veterans, right, or somebody that has been around, you know, that had to dissociate to get through. Right? Yeah. When you go pull yourself back into your body, your body is like, oh, hell no. No. No. This isn't okay. This no. No. No. We have to remind it. Hey. Thank you, body. I'm okay. I'm safe. I appreciate the message. And then that's when kind of, like, feeling it, and then the resourcing is moving through it. And that has been a game changer for me and my clients is just, like, recognizing that as well. I mean and that's, like, a big recognition too of, like, your body's working for you, not against you. And and whenever you can accept that and realize that everything your body's doing is to keep you safe and survive, like, it's like, thank you. Like and also, like, how cool is that? How amazing? And, yeah, like, in that scenario, like, yeah. Okay, body. Like, I feel you. You having this memory. Me too. Me too. And thank you for what you did to protect me back then. But today is a new day, and this is a new situation, and we're trying to make new memories. Yeah. Exactly. Let's go. Right? It's so fascinating this work because all people, they're like, oh, I've been in therapy for years, and it's an untouched aspect of I think more and more PTs and and people that work with the body should be more aware of this because Mhmm. We are in an like, the world is literally on fire all the time. Right? We we are seeing people being I mean, we are seeing stuff every day just through our phones that are just insane and and the pain that we can see in this world and all this stuff. Right? And so if we're not understanding our bodies and our response to these things, it's so easy to be repeatedly set off because of that disconnection. And then we're like Yeah. Why are we unhappy? Why are we depressed? Why are we anxious? And then that you know, it's a whole system. And and having cancer myself was a gift. You know, obviously, at the time, it wasn't, but it was something where it just woke me the fuck up. And I was like, how did my body fail me? Like, why did it do this? Like, fuck this. Like, I was eating turmeric smoothies every day and, like, you know, all this stuff. And I was like, no. You were forgetting that your relationship was toxic. You were suppressing yourself in every aspect. You were a people pleaser. You were dead inside. Yeah. Yeah. Actually And your body's like, wake up, and it took cancer to do that for me. Right? And that's just my story. Right? Like, I'm I'm not saying, like, anybody that's been through some Yeah. You're not seeing everyone with cancer goes through that, but that was my experience. Right? That was my awakening. That was me kind of coming more into this. But one aspect of the pelvic and the back pain that we kinda glossed over a little bit, but we can kind of touch on a little bit more, is the uterus, ovaries, rectum, and vagina. Can you kind of briefly talk about, like, the fascial restrictions there and how that would show up as well? Yeah. I mean, so, yeah, anything in the pelvis, so bladder, uterus, rectum, ovaries, prostate, obviously, if it's a if it's a male body. Those will all create back pain. They all often also, hip, groin, and knee pain, and then medial foot pain is very common. So, sort of like that inside line. Obviously, you can get stuff up the chain with it too, but those are the most common things. It's gonna be SI joint pain, general back, like sacrum low pelvic pain, and then hip, knee, and foot issues. And, I mean, they all of those organs have very thick, ligaments that attach to all of the bones of the pelvis. And so it's no wonder that they have such a strong effect on the sacrum and the pelvis and the SI joint itself. And then that is why it relates to leg pain so much is like through those ligaments and fascial containers, the vascular structures and the neural structures that supply our legs have to go through those, too. And so if there's an issue, like, take the uterus, for example, because it's a pretty common one to have like a torsion or like being in a, like, malpositioned. And so that malposition is going to change the tension in those containers that those, neurovascular structures go through and, you know, that's going to cause a lot of issues in the lower extremity. And so, we see them very commonly. And then often, too, like from a fertility standpoint, those malpositions of the uterus can like really be the thing that prevents people from getting pregnant. And so, manual therapy can be really helpful, to support infertility because of that kind of thing. And so, not to mention the blood flow and neuroflow to those organs with those fascial containers, too. And so, that area of the body, too, I think, you know, like we talked about being so full of, like, vascular pathways and, like, there's just a lot of veins in that area to be draining a lot of stuff. And so when it gets congested and full, it really affects the function of those organs. And so that's when you do see, you know, pain patterns, incontinence, frequency, urgency, infertility, constipation, like, you know, prostate issues and like, you know, issues with men's health, like all of that can be really affected. And, And, you know, just to, like, then when you look at the pelvis in relationship to the rest of the body, like, one, it's all connected, but, like, it's because we're upright beings, it's the cavity that takes the brunt of the pressure issues. And so, that just adds to the congestion and the lack of space. And lack of space usually also means decreased blood flow, decreased nerve flow, decreased fluid flow, and all of that means decreased function. So Well, you know, it's one of the things that I'll talk about when I have patients with pelvic congestion symptom or pelvic pain or even prolapse is, like, inverting, so, like, laying with your hips elevated, legs elevated. Oh, good. Because we're sitting so much all day every day that we're not even thinking, hey. Like like, oh my gosh. There's nothing better. If you guys are listening now, before you go to bed, lay down, put pillows underneath your hips, and put your legs up, and tell me how good it does not feel. Like, it is feel good. Feels so good to kind of help support your body. Think of it as just gravity kind of falling and all of that pressure kind of coming down. You know, when you talk about an inverted uterus or the adaptive changes, I was listening to an endometriosis physician or a surgeon specialist, and she was saying she's like her thing was saying, if you have an inverted or tilted pelvis, it's likely you may have endometriosis because Yeah. Endometriosis, what she was saying and, again, I haven't dove into this more, but I was just thought it was interesting. She's like, these are adhesions that kind of bind down and kind of pull. Like, what would actually be pulling it down? Yeah. And I'm like, well, it's hard because, you know, what if somebody's born a certain way? So I don't wanna just, like, have this blanket statement. But she was like, it you know, think about what's weighing it down, that pressure. Is it adhering to a structure? And I was like, oh my gosh. Like, this is I I just love this because it's, like, another way to look at it. Like, oh, you know, could that be a sign too? Right? And so Absolutely. I thought that was really fascinating when she was saying that to kind of understand. And I think we don't think of you know, ask people, like, when they have low back pain or pelvic pain. Right? And if they're menstruating, I'm like, hey. Start tracking your cycle. Like, do you notice it around a certain time in your cycle? I think people think of your cycle. They they're like, just my period. I'm like, no. Yeah. No. The whole month. The whole month. The whole month because the the hormones change so much. You're gonna get more of the follicle stimulating hormone and luteinizing hormone at the beginning of your cycle, and that's basically trying to get an egg, right, for ovulation and then release. And then at the end in the luteal phase, you're gonna see an increase of your progesterone and estrogen. And so during that time, you're gonna get a lot of flow of different things. And so if you start tracking your cycle and start noticing, hey, I'm having pain maybe 3 days after my cycle starts or, like, maybe 4 days before, whatever it is, you can start noticing some of those things. And then that's when we can kinda get some extra help with, like, understanding hormone regulation, which is also the wild, wild west as well. Mhmm. And it's hard for people to kinda understand where to find resources for that, but it is important I find that people that are menstruating aren't aware of, like, the correlation of the 2 as well. And then adding on so say you have really painful periods and you have endometriosis and that the uterus is scarred down, right, and it can't flow as much, I mean, that rectum can be bound down too, and then that can cause constipation. So now you've got a clusterfuck of pressure in the area. And then we're like, oh, we don't know. Well, why are we bloating like crazy? And then they're like, just it's fine. There's nothing wrong with you. I'm like, are you fucking kidding me? Like And then there's a there's even too, you know, going back to our constipation talk earlier, there's a ligament that goes from the, cecum, so the beginning of the large intestine over by the appendix and connects to the ovary called the ligament of cliet. So that can change everything at the colon and the ovary and the fallopian tube and the uterus, like, everything. Well, also the uterosacral ligament as well. So, like, even just if your sacrum if your the sacrum is connected to the uterus and if we've got pressure there, right, and maybe the uterus isn't moving, it's gonna the only thing that can move and tug is gonna be more on the sacrum as well. Yeah. And that's when like, a side note is, like, if and then that if you're then the uterus can kinda if you have utero, prolapse, that's gonna kind of pull down as well. And then that's when Mhmm. I fit for pezary, so then you can stick, you know, an orthotic up there to kinda help with the structure of the pelvis to help with that too. But I think that's so fascinating because you said it was the you said the ovaries are connected to The right ovary specifically has a ligament that goes to over to the cecum. In the cecum, just so people know where the cecum is. The beginning of the large intestine on the right side there where we described for the appendix. Oh, that same area? Wow. Yeah. And the ligament also travels over one of the branches of the, I believe the femoral must be the femoral nerve because, oftentimes, that ligament will be a driver for knee pain, especially during menstruation or ovulation in young adolescents. Yeah. Wow. And that oh my gosh. Right is right side specific. It is not present on the left side. Oh my gosh. Wow. That's Which is interesting too because I think about, like, the women that I have seen when I, am working on their torsion, I'd say or not torsion, working on the ureterus. Most most of the time, it's a right facing torsion, of the uterus. So I guess that would look like it could still look like a right facing torsion in the sacrum, but it's like So the uterus is rotated forward? The uterus is rotated forward to the right. The to the right. So it's like the left side of the uterus is more anterior and the right side of the ureterus is more posterior. It's like on the back. Side is more back, and the left side is more forward. Okay. Mhmm. Yeah. That's that's really fascinating. That's something that we didn't talk on our pelvic floor. That's not Right. That's definitely not Well, I mean, because you might not feel it from, you know, I well, and this is, like, the tough part. I've never taken internal work because it's not necessarily in the traditional I'd say you could probably argue that it's in the scope of practice for athletic trainers, but it's not traditional. I would be very out of the box if I did it. And a lot of places that teach it probably would have a problem with me being in class, being an athletic trainer. But that's a conversation for another day. Either way though, I've never done internal work, so I don't know what you all assess in there. And, but externally, when I'm assessing the, uterus, I'm looking at the mobility in terms of how does it rotate on a, on the vertical axis, how does it side bend, how does it go up and down, and then shearing. Can I shear it to the right? Can I shear it to the left? And it should have all of those motions available, but some most of the time when I'm drawn there for the person's treatment, it's like stuck in one position. You know, it's it's one thing, like, if somebody is, like, listening, right, and, like, what to do from what they could start at home. I almost you know, it goes back to, like, you were saying kind of improving more of the fascial mobility along that kind of right sided lower abdomen. I mean, people can probably even do cupping themselves. I just tell people, like, when you cup that area, just make sure it doesn't get purple. Like, you don't want it to get purple or black. You drill gentle Gentle. Emphasize the skin lift and a moving cup. Yeah. You're not I like a twist with it too. I like a twist. The twists are good. But even just, like, if you like, this is the benefit of having a little bit of a belly. If you have a belly, like, lifting it away and, like Twisting it. Testing the range of motion, putting your finger in your belly button, and checking the range of motions like a clock, that's a great one because I like to think of the belly button as, the entire sac that surrounds the organs in your abdomen and pelvis, the peritoneum. All of that sack, I think of it as like a Christmas gift basket cellophane. And the cellophane all comes together and you twist it and then you tie it up. That's what your belly button is. And so I can treat the entire peritoneum through the belly button. Oh, I love that. Oh, my god. That's such an awesome way. Easy thing to do on yourself and you just, like, check all I I basically treat it like center of a clock and I'll test, like, all the directions and see what is tight and what is, easily. And I actually I like to do treatment in the direction of ease. So, like, if it goes easy towards 12 and 3, then I stretch it towards 12 and 3, and I kinda wait, or maybe I'll add a little twist, and then I'll wait and see where I I get patient, pay attention to where I'm at, what's happening, and then you'll start to feel it bring you to a different location and as it kind of melts. And then once it kind of melts, I'll retest and go in the direction of ease next and then retest. And then pretty soon what you'll find is all of the numbers on the clock feel good. I love that. So, it's a really easy way to do it on yourself. But then, like, the gorgeous ball from Jill Miller is a great tool. I suggest only doing sideline in sideline versus prone, but, that's my own personal preference. Any sort of soft massage ball works great along the border of the pelvis. I also love, like you don't have to be like a belly dancer, but the idea of, like, getting that pelvic movement. Right? Like, we're so static. Like, especially in the US, we don't have, like, a dancing culture like other cultures have. Right? And so we're just stuck in static. So even kind of getting, like, maybe after you do some of the visceral movement, kinda like what you're saying is, like, getting in, twisting the belly button, kinda getting that moving yourself, the right lower abdomen, maybe cupping, but then kinda getting, like, these, like, kind of movements of your pelvis to kinda get blood flow now that you've moved freed it up. Like, let's get some blood flow in there. Let's get some movement. I love seated on the physio ball for that. Yeah. It kind of just, like, promotes it. And then the other thing that's really good is long sit walking, which is, like, when you were a kid, you sat on your butt, and then you raced someone to get to the end of the, like, room. Wait. Like, you're sitting and then you're, like, digging with your heels? I'm like, I didn't do this. Heels, though. Yeah. What do you You can't do your heels, though. You gotta, like, use your pelvis to move you forward. Oh, you're scooching your butt. Like, you're So good. So good for mobility of the pelvis. Oh, I love that. That's awesome. Oh my gosh. Wow. This has been awesome. So I'm gonna just kinda give everybody a little bit of a summary here. You know, we talked a lot about how to advocate for yourself in the medical system. So if you've if you've been shot down or maybe people aren't listening, you just there are better providers out there that will listen and that will help. And it's also important, like, that they hold space for you. Right? So, like, you can feel you can have a conversation and a flow without being rejected, without, like, being put down. Right? And then noticing how your nervous system feels when you're in these environments. Are you you tense? Are you relaxed? Like, what does that feel like? And then, consent. Right? Like, your your practitioners should be asking for consent, and you can remove consent, say, if they don't ask and that you can take consent away. And if there is somebody being angry about that or frustrated, that is not you. If you need like, as somebody who has had who has been working through complex PTSD, right, it's not my identity. I'm not like I'm just I share it because I feel like so many. I've had patients come in. They're like, I came to see you because you're so open about this. And I'm like, yeah. Because I know what it feels like to be on the other side of this. And it can be scary to advocate for yourself when you are a people pleaser or, like, advocating for yourself in the past has led to, like, some form of abuse. You it's scary. So bring somebody that can help you advocate for yourself. And then the other thing, you know, we talked about is with low back and pelvic pain. Right? So we're looking at visceral mobility there. So the how the colon is moving, how constipation and just pressure in the area can kind of push on those areas and cause dysfunction. We can get impaired mid back rotation, can limit how the kidneys absorb fluid. Right? And that can kind of affect us as well, which can have fascial restrictions, and then that can cause other things. We also talked about how walking and not maybe rotating our thoracic spine can affect fluid absorption as well. And then the right side of the lower abdomen, kinda between the belly button and the pelvis, you were mentioning that's kinda where we can get some fascial restrictions, and then that can cause constipation, that can put pressure on the back, that can provide some cause some pelvic pain there. Then, you know, as we talked more about then the pelvis itself. Right? And so with the pelvis, we can have restrictions with the ovaries, the uterus. Right? Every pelvic organ that we have. And what you were saying too is there's a ligament right over there by your right ovary in that same area we just talked about in between the belly button and pelvic area. Fascial restrictions there can limit mobility of the colon and also the ovary, and so you can kinda get this cascade of things that might happen during your cycle as well. And then with you know, we talked about, like, a tilted uterus. So, potentially, sometimes that can cause issues because it's not moving as freely, and so that can be potentially a sign of endometriosis, not a 100%. Right? There's still anatomical changes. It's just something to kind of consider with that. And then thinking about the draining of the pelvis. Right? So, like, if we're standing all day just noticing, I mean, it's gravity. Right? So the pelvis can start getting some congestion and pressure there. So maybe even relieving some of that pressure through maybe some form of inversion or elevating, like lifting up your butt and pelvis and legs there. And then overall, kind of the overarching theme here is the nervous system. Right? And so the body is not against you. It is teaching you, and its primal instinct is to keep you alive. And so we're breaking old patterns too of, like, okay. Well, what is safe and what is not? Am I safe now if I'm safe now? We can remind our body that we're safe and kinda use somatic tools to help remind our body that we're safe in this environment. And overall, you know, a lot of this is just, hey. Just understand your body. Understand, you know, just pull up the anatomy book, look at the things we were talking about, and you can the more you start learning, you're like, oh my gosh, that that makes so much sense and understanding how to almost intuitively tap into your body because there's some magic when you do that. And so is there anything that in that summary that I missed that you wanted to bring attention to? I think I mean, that was a great summary. I think too, just, like, remembering that they are both intimately connected and you don't have to necessarily have visceral manipulation specifically or visceral manipulation tools even as a practitioner to be able to affect the viscera. That just knowing that it's there and knowing what it attaches to, you can have a huge effect on it. So I think that's the the biggest thing is people are like, well, I don't have a visceral manipulation person to go to. I'm like, well, you can still affect your viscera through movement. Totally. Yeah. It's like, how much of that is actually making the changes versus the actual structures that we think we're addressing? Exactly. Exactly. So tell me, how can people reach you? We can we'll also put this in everything below. Kinda give us your spiel, and then if you wanna explain, you know, your courses and and just so if there's practitioners here, they can know how to reach out to you. Yeah. Yeah. The best way to reach out to me is Instagram, at MovementRev is my handle. And, I have a website also, www.movementrev.com. That's always a good way to reach out to me. I have for, like, the general person, who wants to sort of explore moving in a different intent of, like, getting to know your body and, like, restoring your trust in your body, I actually have a a bunch of regen sessions, which are like, you can kind of think of it kind of like a yoga session, but it's like, you know, anywhere between 30 minutes and 50 minutes of, you start with the body scan and it's really highlighting intention of movement and then doing intentional movement that is designed around regulating the nervous system and improving your mobility and function of the whole body. So some of them are more visceral based, some of them are just nervous system based, and, that's for everyone. So that's athletes, general pop, clinicians, if they want. That's just like a, you know, on demand movement class. And then the rest of what I do, yes, is to teach practitioners, my specific assessment protocol, which is called the locator test assessment protocol or the LTAP. So I do it online twice a year and then in person, like, 4 ish times a year. I actually recently started doing, certifying people in the practice. So if you are a general regular person that is not a practitioner listening to the podcast and you want to find somebody who's trained in it, I do have a directory on my website and I'm starting to add in, actually, certified practitioners who I have vetted and made sure they're doing things in a certain order and way and getting good results. And so, that is growing rapidly. I think there's, like, 400 people on the directory and That's awesome. Just certified 2 more people. So I've got, like, 12 certified people in the pipeline. And then a lot of them actually do virtual sessions, too. So, even if you don't find somebody in your area, you might find one of the actual certified practitioners can do virtual stuff. So definitely growing it, and then also, you know, not on my website, but in this realm of practitioners, if you are interested in learning and working with, a visceral manipulation practitioner, the Baral Institute is the method that I have learned. And on their website, you can also go and click on find a therapist, and that is a worldwide, education program. And so there's a lot of therapists out there. And so not everybody's going to see things like me, and just like we talked, every like, there's a bunch of therapists out there, and just because they took a class doesn't mean they're actually practicing it, but it at least gives you somewhere to start in your area. So, that is a great resource as well if you want to look into doing, external visceral work. I love that. Oh my gosh. Your work is incredible. I'm so lucky that you were coming on this podcast. I'm excited for to share this information because it just the word needs to get out. Absolutely. People need to know. And, like like you said, if if maybe a practitioner has worked with you isn't nearby and the Baral is I always say the name wrong, but Baral Institute, you might be able to find a practitioner there. And maybe they don't think the way that, you know, you're you're talking or what we're talking about. But if you can understand your body yourself and start knowing, then you can start asking the right questions and then get to that sooner. I'm a huge advocate of people just learning about themselves and understanding so that way I mean, the power that you get when you can do that, I think our health care system takes that away from people. Right? And so intuitively, starting to understand your body, and then, you know, that's when you can kinda get the answers inside, and then you can seek external to kind of understand there. So Absolutely. I do have on my Instagram in in some of the highlights. I don't know if people know what highlights are, but, like, on the profile, right under the links, there are little bubbles of like, you can pin like old stories. I have a whole highlight on how to find a practitioner on the Berral Institute. Oh, awesome. Find a therapist page, like, because they literally list out everyone who's ever taken a course. And so you want to be a little bit particular about who you pick. And so I walk through the steps of, like, if it were me, if I were looking for somebody, I would look for somebody that has taken these courses and says these things. So, that's a resource you can check out too. Yeah. So we'll we'll link all your stuff, below, and, yeah, thank you so much. I appreciate it. You're welcome. My pleasure. You've been listening to TMI talk with your host, doctor Mary Grimberg. Make sure to subscribe wherever you get your podcasts. To learn more about doctor Mary, head on over to doctormary grimberg.com, and make sure to follow doctor Mary at doctormarypt on all social channels. To learn more about doctor Mary's integrative practice for pain relief in Austin, Texas, head on over to resilient.rx.com. Thanks for listening.