The Sad Moms Club
A podcast to connect Utah women--especially those who are infertile, pregnant, or postpartum--to the local maternal mental health resources available. I interview providers around Utah to help bring therapy tips and coping skills conveniently to your ear-holes.
The Sad Moms Club
46. Pelvic Pain, Accidental Peeing, and Intimacy Struggles with Dr. Dan Johnson, DPT
In this episode, Dr. Dan Johnson, a physical therapist specializing in pelvic floor therapy, discusses his journey into this specialized field and the founding of Keystone Physical Therapy located in Kaysville and Millcreek, Utah. Originally driven by personal experiences with pelvic pain and his wife's postpartum challenges, Dan emphasizes the importance of addressing pelvic floor dysfunctions in both men and women. He explains common concerns such as pain, bowel and bladder issues, and intimacy problems, outlining various treatments including manual therapy, dry needling, and radio wave therapy. Dr. Johnson also highlights the need for early intervention and continuous care during pregnancy and postpartum periods, advocating for a more integrated and supportive approach to pelvic health.
If you're interested in working with Dr. Dan Johnson, you can contact him through the website or through texting or calling their business phone number 801-204-9204.
Follow along on The Sad Moms Club's Instagram: @the.sad.moms.club
Follow along on The Sad Moms Club's Instagram: @the.sad.moms.club
Hey all welcome to the sad moms club. In this episode, I talked to Dr. Dan Johnson, who owns the company, Keystone physical therapy here in Utah. They have offices in mill Creek and Kanesville, and we talk about. Everything. But the first thing I addressed with him, because I felt like it was important was why is a man working with lots of women with pelvic floor dysfunction? And he does a great job of explaining kind of how he got into this field. Reasons why he's passionate about it, but also reasons why it's helpful to have a man working in this field. And I'll let him explain further. Some basic things. We talk about our, why might you go into pelvic floor PT? What are common treatment options and his responses to common concerns. Like it's not really that big of a deal, or I don't have time to go to physical therapy or. It's really embarrassing and I'm not going to go. a few specific things we talk about that are a little different than other pelvic PT episodes. We've done. If you've listened to them. Is about blood flow restoration for vaginal pain and vaginal health, and then couple training and pain relief during pregnancy. I thought this was really cool. Basically. He's helping the partner, the non birthing partner learn some of these common movements and exercises to give their birthing partners some relief during pregnancy. I think that's all I have to say. So let's get started. Today we have Dr. Dan Johnson, who is a physical therapist here in Utah. Dan, can you just start by telling me about yourself and where you're from? Just anything you want to share.
Dan:Yeah. Yeah. Thanks. I'm, first of all, really excited to be on the podcast. I've really enjoyed listening to a lot of the other podcasts. I am, like you said, a physical therapist. I specialize in pelvic floor physical therapy, so I think really pertinent to the theme of this podcast. My wife and I started a company called Keystone Physical Therapy just a couple years ago, maybe a year and a half ago. And we really focus on that in this area. We both grew up here. grew up in Bountiful, Utah. She grew up in Farmington. We've lived kind of all over Florida, Nevada. But this is originally our home and now I hope we're here to stay.
Joni:Cool. Is your wife a physical therapist as well, or does she do more like business admin stuff?
Dan:Yeah, she's a nurse. there are some things that she will do in the clinic, but she'll help me do group classes. We do like pregnancy classes and things like that, but she helps me with a lot of administrative stuff.
Joni:Awesome. Okay. So just to start off, there's kind of like, An elephant in the room or a 500 pound gorilla, whatever the phrase is, that you're a man that often works with women and pelvic floor therapy. And so I'm just curious, how did you end up? Um, being interested in this specialty of, physical therapy.
Dan:Yeah. Thanks for asking. And it does come up a lot in our conversations. So I guess how I got into pelvic floor therapy in the first place I had pelvic pain several years ago and I just did not get any answers for it and I went to my urologist and they didn't have any answers and it eventually got well enough that I just could ignore it. But then when my wife had our first two kids, she had a lot of the common pelvic floor issues. that come with being pregnant and having a baby. And the only advice that she could get from her OB was, well, sweetie, that's what you get for being a mom. And we just felt like there had to be a better answer than that. And there had to be more out there. So I found a friend of mine who I've gone to physical therapy school with who had become a pelvic floor therapist. And I was talking to her and I said, why don't more people talk about pelvic floor therapy? Why is there such a dismissive attitude about moms and postpartum health? And why don't we have more people? And she said, Dan, we just don't have enough of us doing it. And then back in the city that we lived at the time we were in Las Vegas, there really weren't very many pelvic floor therapists at all. And she said, Dan, why don't you do it? And I laughed and I said, you know, I'm, I'm a man. And you're talking about women's health where women therapists treat women for womanly problems. And she said, no, you don't get it, Dan. We just need good therapists. And by the way, only 50 percent of the people with pelvic floors are women. And I kind of laughed at that, but I guess that's true. What really sold me is I went to a training course and it was just kind of an introductory weekend course, like not even enough to really say that I was trained in pelvic floor therapy, but I went and I completely fell in love with it and just what we are able to do and the kind of help we were able to give. Being able to bring that home and help my wife and then start helping other women and help other men with problems that. They didn't know that there was hope for, problems that they didn't know how to help. So I have fallen in love with it and I just haven't turned back since. I've completely focused my, the rest of my career so far on pelvic floor therapy. I thought, well, I'll be there and I'll be a pelvic floor therapist. And a lot of people won't like that. I'm a man. And that has been true sometimes. But what I've found is a lot of people either they really don't care. They just want good help. And if I can give them really good help, then they are more than happy to come in. And a lot of women actually have expressed such a gratitude for having a male therapist. That they wish that they had access to male providers that had that level of care. Just interest and devotion to women's health and a lot of them have actually found it very Comforting to be able to come in and work with a man for women's health issues.
Joni:Yeah. That's interesting. Definitely not what I would expect. Why do you think that is? Is it cause they've had male providers that weren't as focused on women's health? Where do you think that comes from?
Dan:yeah And this this may be a little heavy But part of it is I had several women who came in and worked with me who had been sexually assaulted and their physician knew that they would benefit from pelvic floor therapy because of some injuries that they'd sustained or pelvic floor dysfunctions that they'd sustained. And they came and they found me and said, I am so glad you're here. And I said, why? A couple of them said, nobody ever bothered to ask me down. Everybody assumed that I was assaulted by a man. Yeah. But I was actually assaulted by a female. I remember a handful of these. One was a female healthcare provider. One was a family member who's female and the list goes on. But they said, nobody ever asked me. They just assumed that I'd been assaulted by a man. And so they always referred me to women and it was like, I was reliving my trauma every time. And finally I heard about you and was so happy that I could come and work with you. Other women said a lot of my trauma actually came from. Men, whether a sexual assault or medical trauma or birthing trauma where they didn't have a supportive man through the process. And they said it has been so healing to have a man that just reminds me that, okay, it's not just us girls against the world. There are other people out there that are in this with us. And I know sometimes it doesn't feel that way. I think a lot of the time they just say, I don't know Dan, I had a friend that you helped and she got way better and I don't care if you're a guy or a or whatever you are, I just want to feel better. And so, I think that's kind of the more common attitude.
Joni:That's really helpful. you're right. I always assume when I'm talking to a female that it was a male that abused them. So
Dan:And statistically that's, The most common scenario is a girl or a woman who is assaulted by a man, and it's usually somebody close to them. That is statistically the most common scenario, but it is definitely not the only scenario. up to a quarter of men will be assaulted at some point as well, uh, depending on the statistics. and there are a lot of perpetrators who are, uh, Also women. So yeah, I think the point is just try not to try not to assume too much, but
Joni:Yeah. Well, and also we need providers. yeah, that's helpful, uh, even if it's heavy. Okay. So I feel like pelvic floor can sometimes be a little bit ambiguous. Can you explain what is the pelvic floor? What is pelvic floor therapy?
Dan:sure. Yeah, of course. The pelvic floor is just the describing the muscles and ligaments that support the bottom of your pelvis. But more generally it's talking about the muscles, ligaments, soft tissue, blood vessels that help with the functions of core strength, bowel and bladder function, sexual function, and breathing. And these are the areas that are sitting. in and at the bottom of your pelvic bone. A pelvic floor therapist is somebody who specializes in treating those functions, whether that's core strength, pain in that area, sexual function, bowel function, bladder function is a very common one, or even just abdominal or low back problems. A pelvic floor therapist is somebody who really specializes in those things.
Joni:And that seems like pregnancy postpartum is a time when people start realizing that there might be bigger issues that are going on.
Dan:yeah, definitely. Pelvic floor problems tend to show up around pregnancy, birthing, injuries, and other important milestones in life.
Joni:I feel like one thing that I come up a lot against when I'm advising someone to go see a pelvic floor therapist, because obviously I don't do that, is one, it's not that big of a deal, I can deal with it. Two, I don't have the time, um, Or three, it's just like embarrassment. Like I, I do not feel comfortable doing that with someone. So how would you address those concerns with somebody?
Dan:Sure. You know what? If it's not that big of a deal for you, then it's not that big of a deal for me. And I've been to plenty of pelvic floor training sessions and physical therapy school and my undergrad and my whole career of people saying, well, this is how you convince people that they need to get help. And I just don't buy it. I really just don't. if you're happy, then I'm happy. And if you have a pelvic floor dysfunction, but it's not interfering with your life. more power to you. I'm not going to try to get in the way of that. So if it really isn't a big deal, then it's not a big deal. Now, unfortunately a lot of the time that message comes from other people where a woman has a pelvic floor dysfunction, urinary leaking or pain, difficulty with intercourse and somebody else tells them, Oh honey, it's not that big of a deal or suck it up buttercup. Or like in my wife's case, sweetie, that's what you get for being a mom. And that's when I really try to emphasize if it bothers you, No matter how common or normal or whatever else it is, if it bothers you, then it bothers me. We're going to find a way to get you some relief or fix it. But if it really doesn't bother you, don't let anybody else tell you that it should bother you. that's my answer to that first concern there. The second one you said about time, oh my gosh, the biggest population of people who have public board problems are new moms. And the people that have the least amount of time are new moms. They don't have time to go to a physical therapy session all the time. We try to be flexible. I'd be honored to work with you. I would love to have you come in and work with me and help resolve those issues. And if that's twice a week, wonderful. But if that's not realistic for you, Fine, we're going to slow it down. We're going to schedule at your pace. What works for you? You need to bring your kiddo in. Great, bring them in. I love the excuse to hold babies because we're done having kids. So Wife and I sometimes need that, just to fill our, tank as well. But we're going to work with you, and we're going to figure something out that works with your schedule and in your time frame. As far as being embarrassed to come, if you are embarrassed to call and get help from a pelvic floor therapist, you are in good company, because it is not easy. Having pelvic floor problems is hard enough by itself, whether it's pain or bladder problems or whatever else it is, that is hard enough. Then the idea of going to see somebody that you don't know and talking about some of the most personal Functions in your life is not an easy barrier to overcome for any of us, myself included. When I had pelvic floor pain, it took me months of suffering before my wife finally made me go see a urologist. And to show up and just get shut down as though my problem wasn't really a real problem was very embarrassing and it made it very hard for me to seek in the future. And I get that. And a lot of people have been through that same situation. So if you're uncomfortable, the first thing I would say is you're in good company. It's hard for all of us. When you're ready, we're going to make it as comfortable as possible. When you come in, we're going to go at your pace. You're going to be in charge and make the final decision of any treatments that we do, any assessments or testing that we do. I'm never going to tell you that you have to do anything. We are here to help. I'm here to help you feel more comfortable. And if that's working out great, if it's not that we're going to change directions. I also do a free consultation for people that just aren't sure. If you're just thinking maybe pelvic floor therapy might help you but feels uncomfortable, you're not really sure what that looks like, I tell people just call, come into the office or call and we'll spend 15 20 minutes just answering all your questions, tell you all about what therapy might look like for your specific scenario, and then you can make a more informed decision about moving forward. Most of the time people feel much more comfortable once they realize what pelvic floor therapy actually looks like, what the office is like, see the equipment we use. They realize this is not like other pelvic exams that they've had in the past. This is not like visits to the OB. And most of the time people find that it's much more comfortable than they thought it was going to be.
Joni:Oh, that's helpful. Thank you for addressing all those concerns. I feel like you've touched on a few things, but what are some signs, symptoms that a person might be having that would, lead them to come and visit you?
Dan:Sure, sure. Yeah, this is another common question I get. If you're having pain, then that's not normal. Pain is your body asking for a change. If you're having bowel or bladder problems. So if you are leaking in either of those areas, whether that's urine or stool or flagellants, or if you need to go to the bathroom, if you need to urinate more than seven or eight times a day or more than once at night, or if you are having a hard time making it on time, then those are all signs that there's a pelvic floor problem. If you have to push or strain during bowel movements, Or you have to poop more than you would like to or less often than you feel like is comfortable for you. Those are signs of pelvic floor problems. Healthy pelvic floor will help you have pleasurable sex without pain and good orgasms. For most people. So if you're having struggles there, then that's likely a pelvic floor problem. Or if you're having a feeling of instability. In your pelvic area, in your low back, in your abdomen, you don't feel like you have good strength, or you don't feel like your body is supported well, and there's a good chance you have a pelvic floor problem. So, any of those things, I'd say, if they're bothering you, Come on in, we'll see if we can figure it out.
Joni:Awesome. I'm guessing that there's some overlap too with medical issues Like, I'm guessing there's a point where you're referring out, like, okay, we've done what we can here. You're going to have to get this type of procedure done or you need to talk more with your GI doc. how much are you overlapping with other providers?
Dan:Almost 100%. If people come in, I almost always, if they aren't already working with another provider, whether like you said, GI or colorectal or urology or very commonly OBGYN, if they haven't already worked with those people, I'm usually going to, start working with them, if it's indicated. And the other big side of it that you didn't mention is mental health. I am very sensitive about, if you're having problems with your bowel and bladder, if you're having pain or intimacy struggles, it's going to affect your mental health. And especially in the postpartum stage, that is hard enough already. I've got a sex psychologist that I work with. I've got a handful of sex therapists that I work really closely with. We do group classes out of the office, but we work really closely with a lot of other providers. Lactation consultants, that I've got in the office, so definitely a lot of overlap.
Joni:I think that's fantastic. That's good to hear too that maybe you could be like a, help in navigating where to go next because, that's part of the struggle with healthcare is just not knowing who am I supposed to be seeing for this and who can actually help me. So that's good to know. How common are pelvic floor problems? Do know? Is there like a statistic?
Dan:Yeah, there are lots of statistics, and I'm sure I have learned all these statistics at one point, and I just don't keep them in my brain. Most of us, at one point, are going to have a pelvic floor problem. One kind or another. they're very very common. Now, I am careful not to say normal because normal makes it feel like you should just accept that, and that's not the case. But if you've had a baby, there's a pretty darn good chance that your pelvic floor could benefit from some rehab. If you have been through menopause, or if you've had a prostate procedure, Or if you've had any kind of medical surgery or injury in the area, like a tailbone injury or hernia repair or anything like that, there's a very good chance that your pelvic floor is probably struggling to rehab after that. So, in all of those cases, I recommend come get it checked out, especially if you're noticing any of those symptoms.
Joni:Okay. What happens at a pelvic floor therapy visit? I guess there's like an initial assessment and then what does it look like when they're visiting you regularly?
Dan:So, the first couple visits are all about assessment, trying to figure out what is causing your problems. So, we're going to ask a lot of questions, let you ask a lot of questions, do a lot of assessments. There's going to be some movement assessments, seeing how your body moves, how your hips move in different places. exercises, things like that. I do a pelvic exam, oftentimes, whether that's, internal or external or usually both. Just try to get an idea about what is causing the problem, where's this problem coming from. And then the things we do to actually resolve those are varied and it really depends on the person, what their needs are and what is most comfortable for them. I am really big on hands on therapy. So we call it manual therapy, whether that's massage work or passive stretching or joint mobilizations around the SI joint, sacrum, tailbone, low back, just to move things around. Of course, I'm a physical therapist, so I'm probably going to give you a couple of exercises to do at home. I'm really big on dry needling. So dry needling is a treatment that we use where we use really fine needles and we place those into. target muscles around the problem area to help release those muscles or to activate those muscles. I do electrosimulation with my dry needling. And that's where we use kind of a gentle electrical wave that goes through the needle, and it's much more comfortable for most people, and it helps us get a bigger target area with the dry needling. Very, very cool for postpartum, if you're having any kind of pain or trouble recruiting certain muscles. I also do, radio wave treatments, it's kind of a, a newer technology that we use, a very fast pulse that goes through the skin to help. Bring new blood flow into areas that maybe don't have great blood flow.
Joni:Yeah. That's a lot of neat stuff. Are there like common exercises you end up giving people? Cause I know it depends on what's wrong, but at least one pelvic floor PT I talked to, they were talking about pretty common movements, like squats they recommend a lot, not that someone needs to go off and do this by themselves, but just curious, because most people think like Kegels and apparently that's not. A lot of what is recommended or it depends on the problem. I don't know.
Dan:That's actually a really great question and I will tell you Kegel's are way over prescribed. I am not anti kegels, but gosh, I spend more time fixing the problems that people have from doing too many kegels than I do prescribing kegels. So if you do them, please do them wisely and be gentle with your poor little body. But yeah, some of the common things, definitely glute strength is a common problem. So we're doing things like squats, hip hinges, step ups, stuff like that. I do a lot of breath work. If anybody's worked with me, they're going to tell you how sick of doing breath work they got with me. We do a lot of work with the diaphragm to help balance the pelvic floor. They work together as a team. And so I do a lot of breath work. It's very gentle. It's very comfortable, especially after delivery. I love that strategy. That's a really common one. I do a lot of mindfulness. So I do a lot of cognitive exercises as well, where you're using your mind to manipulate. how your body is holding itself, especially around the pelvic floor. So we get into a lot of that and I do some yoga. There's some different yoga stretches, some of the common ones. If you really want to get a headstart, get really good at child's pose and happy baby, maybe mountain pose. And those are gonna just really set you up for success with pelvic floor health.
Joni:as far as the breath work? I feel like there's one, I think it's the first PTA I interviewed that talked about it's the diaphragm and the pelvic floor is like the bottom and top of a soda can or something like that.
Dan:Yeah, I think Betty talked about that.
Joni:Can you explain a little bit more about why that is helpful?
Dan:Oh my gosh, I could talk about this for hours. So try to keep, me reined in. your pelvic floor and your diaphragm are best friends. They work together to control the pressure in your abdomen. So if you imagine that analogy of a soda can where the pelvic floor is at the bottom and the diaphragm is at the top, if the diaphragm is pressing down and is tight or firm, then the pelvic floor is either going to get pushed down as well, which can cause pelvic floor problems, or the pelvic floor needs to tighten up and activate to counterbalance that pressure coming downwards. Likewise, if your abdominal muscles or your lower back are too mobile or too stiff, then your pelvic floor has to adjust to make sure that you're having the right amount of pressure through your lower abdomen and pelvis. So, for example, if I'm out hiking in the woods and I need to go to the bathroom, I'm going to look around and find a tree to go squat behind and have a bowel movement, and in that moment, I'm squatting down, my pelvic floor is relaxed, my breathing is relaxed, and I have low pressure through my abdomen. To allow for me to have this normal bowel movement. Well, let's say the next day I go on a hike and I think I need to go to the bathroom and I walk around the tree and there's this big hungry bear standing there and he's licking his lips, looking at me thinking I look delicious and I'm not thinking. low pressure, relax, have a bowel movement. I might have already had a bowel movement, not on purpose, but I'm thinking high pressure. I want my pelvic floor tight, pulled up and in active. My diaphragm is going to be activated, tight, rigid. My back abdominal muscles are going to be strong and tight because I need to not die in the next 30 seconds. So I'm going to run away from this bear, I'm going to fight this bear, or I'm going to freeze and let this bear beat me up a little bit and hope that I survive. But I need firm, tight, strong muscles all around my core to get me through this next experience. Sometimes after an injury, after child delivery, after surgery, or just with high anxiety or stress in my life, Those muscles go from relaxed, easy going, chill, low pressure mode, to try not to die in the next 30 seconds mode. And some of us just walk around like that all the time. And that's what creates a lot of pelvic floor problems, especially issues with intimacy and pain. But also bowel and bladder problems. A lot of people think that the answer is just to do kegels and strengthen that area. Unfortunately, it's just not that easy. More likely, most of us are holding on to too much tension in our pelvic floor, and we need to do work to help relax that. And breath work is a really accessible way to approach that. It's something you can do on your own at home. It's something that anybody can learn to do. And it's not painful, but it's a really great way to switch that. survival mode from don't die in the next 30 seconds and get away from this bear mode to relax and let my body function like normal mode. And so I do a lot of breath work, especially early on in the first few visits, if that's what people need. And then they work on that at home. And we don't spend a lot of time in the clinic, but we spend a lot of time in the first couple of sessions, really getting that down and making sure that that's something that people really feel a good response from. So they can go home and apply that.
Joni:It sounds too easy, but apparently, but it makes a big difference.
Dan:It is easy and I'm telling you people love it. People eat it up because it helps so much and it's, they just need to teach it to new moms. Even during first trimester.
Joni:Wouldn't that be nice?
Dan:Yeah, wouldn't that be nice?
Joni:Yeah. That kind of brings me to a thought I've had in an ideal world, When would you first want to start seeing someone? Before they start trying to conceive? You know, right when they're first pregnant? Right after postpartum? What would be the ideal treatment for you?
Dan:Sure, if I were the king of the world, then I would say every time a mom finds out that they're pregnant, they're going to come in for a pelvic floor physical therapy exam during the first trimester, early on, or between the end of the first trimester and the beginning of the second trimester. And they're going to come in and just get an exam. Even if it's just an external exam, we're checking for muscle coordination, Can those muscles relax? Can those muscles activate? Can you use your mind to make those muscles tighter or more relaxed? Do you have good core strength, good glute and hip strength, low back strength? And just talk about ways to maintain healthy pelvic floor throughout that process. We would screen for problems. If there's a red flag, then we're going to get you onto a normal routine of working on those things to help you through the pregnancy. and reduce chances of pain later on in pregnancy. Of course, we're not going to eliminate that, but to reduce how much discomfort you're experiencing. But in many cases, it's just a one time checkup, a little bit of education to make sure you're feeling good, and we send them on their way. And then after they have a baby, they're going to come back. Now, if I were king of the world, it would be day one. If you have a baby at your home, or in a hospital, or in a birthing center, I would love to have a pelvic floor therapist show up where you're at. And start right then the next day if you're feeling ready at that point. We're not doing internal exams at that point, but just helping with basic core control movement. We can start working on cesarean scar treatments pretty early on. Really gentle things just to start the healing process and just to start some gentle movement and control of the pelvic floor. And then at about six weeks, we're probably going to ramp things up. And that's where you see in other countries, sort of a standard of care where postpartum moms are coming in. Whether they talk to their OB or not, they're just coming in for pelvic floor therapy just to get checked on to start working on recovery for rehab, just like we would do for any other injury or surgery on the body. You go to physical therapy to rehab, and I think it would be the same thing for postpartum, and that would start around 5, weeks, whenever the mom feels like she's ready to start that, but right in that window.
Joni:Yeah, I love the comparison that I've heard multiple people make. It's like with, I used to work on a med surg floor, so there was a lot of like total knees, total hips, and the physical therapist is up with them immediately. We're encouraging them to move as nurses. And then, you know, 50 percent of the population gives birth about, and they don't necessarily have that same support. Most people don't.
Dan:definitely not.
Joni:So it would be really cool. I like that version of the world where women are really supported physically throughout the whole process.
Dan:Yeah, I really laugh about it. That I had. Back surgery. And it honestly was a pretty minor back surgery, but I had nurses in my room every couple hours. I had a physical therapist. I had an occupational therapist come and visit me and. They were saying, okay, don't do this. This is how you lift. This is how you don't lift. Don't bend over. Blah, blah, blah, blah, blah. You're gonna follow up with physical therapy at this point. You're gonna follow up with your doctor at this point and this point and everyone is just so careful my wife had a Emergency C section with two tears, anterior and posterior cervical tears. And they hand her a baby in a car seat and say, Okay, bye, good luck. Oh, try not to lift anything heavy. Bye. And I thought, are you kidding me? You know, this cannot be the way we handle this. And what she went through was so much more severe and so much more difficult on her body than anything that I went through. The difference was, it's just sort of expected. Because it's this whole experience of matri essence. That's just what women are supposed to do. And just figure it out. And it's really not enough. And it really is a disservice to, to anybody who is childbearing. So, we're working on it. And I think, you know, it's getting better. But, for now we can just do what we can do. And that's where I hope to fill in some of those gaps a little bit. In care, is just to be here and to be available for moms. Uh
Joni:yeah, definitely. It seems like it's getting better. It would definitely be nice if it was just like the expectation, because then, then you don't have to go out of your way to search for it. And like you said, those postpartum moms don't have the time. And so then it's hard to like, Oh, I need to look for somebody and then I need to call them. And then I need to actually go and who's going to take care of the baby. Or am I supposed to bring them with there's just so much that goes into that. And that can feel like very painful. tertiary on their list of needs, like maybe their mental health is priority or maybe their baby's not feeding and they really want to breastfeed and it's just fraught with stress. At least that's what I hear in my office.
Dan:Well, you're so correct. You're so correct. It really is a disservice. But, it is getting better and we're just doing as much as we can. And there are enough allies, I think, working together. We're going to see changes. But, in the meantime, you know, advocate for yourself. I hate saying that because you should have a hundred people advocating for you. But if you don't, there are people out here that are so excited and will be so honored to help you. And, I hope that you can count us as allies in this journey.
Joni:Yeah, that's a good point.
Dan:I'm also really glad that you mentioned trying to conceive. I don't know that that needs to be a standard to come and see a pelvic floor therapist, but it is very, very common that people have some difficulty with intimacy, whether that's trying to conceive or not. And if you're running into problems, Definitely come in and see a pelvic floor therapist. We can help you figure out whether it's the male side or female side or whatever side we can help you find out. Sometimes it is a pelvic floor problem, especially if you're having discomfort or difficulty with sexual function. There's probably a pelvic floor problem there. Yes. If you're having difficult time conceding, let's get you in and get a medical viewpoint on this as well and make sure is there an implantation issue, sperm count issue, et cetera, et cetera. But if you're having any sense of discomfort or difficulty with sexual response, there's probably a pelvic floor component as well. And that really is something that we are equipped to help with, and especially in my clinic, that's something that we really specialize in is helping resolve that. And we would love to see people just from the get go coming in. Earlier on, because we've helped people that are, have been trying for years without success. And then finally, as their last straw come into pelvic floor therapy, and we're able to help them, but it doesn't need to be that way. You know, sometimes we can help a lot sooner.
Joni:can I ask what would be something that would cause an issue with conception with the pelvic floor. We had like infertility. So we did the whole reproductive endocrinology route. Um, but what types of reasons do you find
Dan:Yeah. So a lot of times it is just pelvic floor tension and it comes down to that, autonomic nervous system, which we've talked a little bit earlier with that bear analogy of, is my pelvic floor in a relaxed, comfortable state am I in a safe situation in my life to become pregnant? And if not, then my pelvic floor is going to function differently and those muscles are going to be responding to intercourse in a different way. And a lot of the time that shows up as when people start trying to conceive, they find changes in their physiological responses, changes in pleasure, changes in orgasm, or discomfort is a really common one. Pain with intercourse. Those are all things that we help resolve.
Joni:Sounds like it's something that people could go to when they are sexually active in general. They don't have to be trying to conceive in order to start actually, uh, addressing those issues. Okay. Thanks.
Dan:yeah, certainly don't need to wait till you're trying to conceive. The other thing we work on is scar tissue. If you've had any sorts of surgeries in the past, or if you've had children in the past, and now scar tissue is getting in the way of trying to conceive, then that's something that we can work on as well. Whether that's abdominal scarring, or pelvic organ scarring, or vulvar scarring, those are all things that we can help mobilize that tissue to make it more possible to try to conceive? Sure, a lot of times it's scary with intercourse, especially surrounding pregnancy, trying to conceive during pregnancy after delivery. Is this something that's safe for me? Is it something that I'm going to enjoy still? Is it going to be uncomfortable? And how do we start? All of these things. And I really just want to emphasize that one of our biggest roles is trying to empower couples and individuals that they can feel comfortable in their own bodies and comfortable with their sexuality. And it doesn't need to be a scary thing. Yes, there are things to be careful about, but we can help you figure out what is safe for you, what is appropriate. For you as far as returning to intercourse or continuing intercourse, that's really one of our specialties.
Joni:How does that come up in sessions? Like, is that a reason people are coming to you in the first place?
Dan:Yeah, that's a common thing People will seek us out Either they'll go to their OB and say hey it hurts when we have sex or I'm having a hard time getting an erection or I'm having a hard time with orgasms or whatever and They'll recommend that they come over and see us or a lot of the times people just Find us on their own and that's one of the things that I try to advertise is Intimacy, wellness, and people will come and find us that way and just say, Hey, Dan, I feel like this could be more comfortable. I feel like this could be more enjoyable. Can you help me out with that?
Joni:Awesome. One thing you like to talk about is partner and couple training for pregnancy pain relief. What specific types of pains might they complain about and how do you relieve them with your partner?
Dan:most common things that we get are low back or abdominal pain, kind of round ligament pain or pelvic floor, vaginal or vulvar pain. And a lot of those things we can treat. And there are ways that we treat it that really you just need to come in and have it done by a therapist. You know, whether it's dry needling or radial wave or a lot of the hands on therapy, but a lot of these things are things that you could do on your own at home, especially if you have a partner. If we can teach them certain passive stretching or massage techniques or how to do different kinds of taping or things like that. I love to have people bring in their partner and say, okay, put him to work. And I teach the partner how to do different massage techniques, do any of those things I just described so that they can continue doing that on a regular basis, whether that's a couple of times a week or in some cases, even every day, just to help maintain that comfort and maintain that function through the pregnancy, especially the last trimester. And also when it comes to intimacy wellness, Gosh, I really nerd out about it. And there are a lot of great treatments that we have to help people be comfortable during intimacy. We are not going to perform a lot of those interventions in the office. It just is not appropriate that way. But we strategize together. We bring partners in and we educate partners and between however many of us are there, we come up with a plan that they can go home and implement on their own. Whether that's specific hands on techniques or whether that's different ways of thinking about things. or exercises they can do to just help resolve whatever that problem is. It really works well from that team approach, where both partners are in there, or all the partners are in there, and we work on it together. And then they go home, and then they practice it, and then they come back and move on to the next step.
Joni:As far as like in pregnancy, it's nice to be able to assign your partner something, help them. I guess be more involved and maybe feel a little less resentful towards them. Like I am suffering and you are not being helpful, but then also an intimacy, not feeling like you're the only person with the problem, but this is something we can work on together.
Dan:to your population, who are probably mostly women, more often than not, you're probably not the problem. as a man, I, Love working with, even if my client is a woman in a heterosexual relationship, I love it if she brings her male partner in and we can just talk guy to guy. Hey, this is how this works. This is how it doesn't work. This is what you may have heard. This is what you may have seen. This is what you may have expected. But this is what works. And I love those conversations. And when I was a dad, when my wife was pregnant, especially with our first, I was doing. My wife was suffering. She was having all the normal low back, feet, all those pains. And I didn't know how to help her. And I felt useless. And she would come home and she would be like, Dan, what the hell? You're a physical therapist. Why can't you fix this? And I had no clue. So what about someone that doesn't have a doctorate degree in physical therapy? What are they going to do? And that's where we come in. I teach these partners. This is an easy treatment that you can do to help this round ligament pain. Yes, she can come in here and we can work on it a couple times a week and it's gonna be great, but it's not a permanent fix. Not until the baby is born. But what if you can do this four or five times a week? It takes five minutes. You can do this easy stretch on the abdomen and it's gonna help her feel so much better. You guys can do it together. You feel involved. She feels less pain and we're all a lot happier. Not that I don't want to see people, but I mean, if we can help give better relief that way, I'm all for it.
Joni:Yeah. Their partner is usually a lot more accessible than you are.
Dan:Yes, definitely. So I love that kind of training had really good success with it.
Joni:Awesome. So if someone is having, vaginal pain, what, what types of treatments are there for that?
Dan:a lot of what we've already talked about with the pelvic floor therapy, hands on therapy, dry needling, the dilator therapy, et cetera, et cetera, are really, really great for vaginal pain. One of the things that our clinic does that's a little more unique is we do radial wave therapy. It is a device that we use to, um, Bring new blood flow into the vaginal walls. We use it for vaginal wall therapy or erectile dysfunction or tendon injuries where we just need to bring more blood flow, but a lot of the times with hormonal changes and with any kind of injury, the walls just get thinner and the skin and the tissues under the skin just thin out a little bit and it can make, intercourse more difficult that can cause incontinence problems, but the radio wave therapy has really been successful at helping to build up those walls again and bring new blood flow. We actually get new blood vessels that develop to bulk up those walls a little bit so that you get better estrogen flow, you get better blood flow, lubrication, and less discomfort
Joni:How does the radio wave therapy actually work?
Dan:we just have a device that delivers really fast waves. It's a type of shockwave. It's a little bit different than some of the shockwave you've heard about in other areas, but it's just a really fast wave that pulses through the skin into the tissues around the walls of the vagina or into the penis or into the tendons, wherever we're targeting. And it actually stimulates your body to create new blood vessels. And so you get more blood flow in that area than you did. before and sort of restores back to what it was before so that you're able to draw new blood in when you need it.
Joni:Does it feel like, like if you were to put it on your hand, does it feel like a shock? Does it feel like, like a pulse? Does it feel like a, is it vibration? what does it feel like? Is it painful?
Dan:it's going to, feel like a really rapid pulse, almost like somebody's tapping the back of your hand really, really quickly. We do about 14 to 16 pulses per second. So you can imagine that's really, really fast. Taps. I probably wouldn't do it on the back of your hand. That probably would be painful, right over the bone like that. But on the target tissues, it can be a little pinchy. Yeah. People say it can be sometimes a little uncomfortable. If you've ever had a really, really firm massage, like a deep tissue massage, it is not that rough. but it's definitely something that people can feel. You can tell that it's working there, it's usually pretty mild discomfort.
Joni:Oh, that's great to know. Are women in a certain stage when they're coming to you for this? Is it like when they're postpartum, after all these changes of having a baby?
Dan:Yeah, definitely postpartum. I would not use the shockwave while you were pregnant or if you thought you could be pregnant. Yeah, And I know some people will, but I would not do it on your pelvic floor or low back or abdomen during those times. But certainly postpartum, and not during the first couple of months, really at least six weeks postpartum. Because your body's still healing, let's just let your body do her own magic first and work on healing, closing all those tissues out. Let's find out kind of where you are at that point, and if you're still having problems, then we can talk about if radio wave is right for you. A lot of the times it's, after the first couple of months when women are still breastfeeding and they still are just feeling really dry and the walls are still kind of thin just because of those changes in hormones and we can use it just to sort of boost the body's natural recovery or postmenopausal. We use it quite a bit those hormones change again.
Joni:That's great to know. Awesome. are there any other topics or comments you wanted to add before we wrap up?
Dan:think those are kind of the main things we talked about, all my favorite stuff.
Joni:Okay. Awesome.
Dan:what other questions, do you have any other questions you'd like to know more about?
Joni:How often do you usually treat someone for? I'm sure it depends, but is there a typical treatment time?
Dan:Yeah, certainly. And it definitely depends on the person. You're going to get so sick of physical therapists saying that. It always depends. And that is true. For the most common concerns that people come in, I expect to see them for around eight to ten visits. Usually one or two, maybe three visits of assessment. and a handful of treatments just making sure the problem gets fixed, and then a couple of treatments at the end for building up resilience, making sure that it's not going to come back in the future. More complex cases, add another session of assessment or two, a couple more treatment sessions, they're going to end up somewhere around like 12, 14, a lot of the time. But it really depends on the person. How often can they come in? How often are they available? Can they learn some of these treatments that they can do on their own at home or their partner can help them with? And maybe they don't need to see me quite as often.
Joni:Okay. do you have like a preference for like, if it fits in their schedule? Like weekly, twice a week, every other week?
Dan:So if you have a pelvic floor problem that you know needs to get resolved, but you're for the most part just getting through your life fine, then usually once a week, especially for the first few visits, and then we usually transition to every couple of weeks by the end, is what I recommend. However, that fits into your life the best. If you are really having a problem that's getting in the way of your life, you can't get through your workday, or you're just having pain, it's interrupting your sleep, etc, etc, then definitely come in. We're going to work with you a lot more frequently, whether that's a couple of times a week, or in some cases even the first couple visits, we'll do two hour sessions for the first couple, and then once a week for the next few weeks, until we get you to a point that you're feeling Really good. You can get back to your life. If it's something like mastitis, that's just an acute pain that you just need to get in and get it resolved. We might see a two, three times within that first week, just to get you feeling better. And then we can slow it down. Once you're feeling great. If we need to keep seeing you after that, and we'll slow it down to less frequent visits.
Joni:I didn't know that was something you guys would treat mastitis. Okay. That's cool. Do you get referrals from like lactation? I just like would have never known that that would be a potential treatment option.
Dan:I probably should advertise it more then, if that's the case. Yeah, certainly. In fact, I laugh at myself. I hope my wife doesn't get mad at this, but she had some really bad cases of breast pain when she was nursing, and me thinking I was smart. but not really being smart, tried all of the things that massage techniques and the try to milk it out and all those things that only made it worse. And unfortunately, a lot of us just don't know really how to deal with that. But that is one of the things I've done some training for. We've got some lymph mobilization techniques I use, and I'm not a lymph therapist. So don't come see me if you've had, cancer treatments and you need lymph removal out of your legs or something like that. There are other therapists that are much better, but gosh, if you are developing a clogged out. And you want to stop it from becoming mastitis, or if you feel like you have mastitis, but antibiotics aren't working fast enough, come in and we're going to help you get some short term, quick relief through, there's some different exercises and stretches I use, some massage techniques I use for that.
Joni:That's great to know. Your poor wife.
Dan:Oh my gosh, my poor wife for so many reasons, but been so patient with me.
Joni:That's great. How many children do you guys have?
Dan:We've got three.
Joni:So you like learned all this post the three children? Or was it somewhere along the way that you started?
Dan:Yeah, after our second, I started getting into it just a little bit, but it wasn't until really right after our third was born that I really dived into pelvic floor therapy. So, bad timing on my part.
Joni:So she got zero benefit from your training.
Dan:got almost zero benefit from it. Yeah,
Joni:Well, she'll go
Dan:definitely a four.
Joni:there'll be an opportunity in the future.
Dan:There will be more opportunities. There will be lots of opportunities.
Joni:for sure. so if someone's listening and thinking, wow, Dan seems great. I'd like to work with him. What's the best way for them to contact you?
Dan:Just have him call me. I'll give you my number. They can call 801 9204 or text. Just say, Hey, I listened to this awesome podcast and I heard this weird guy talking about public poor therapy. Can he help me? It's a business number, but it takes texts as well. So just have them reach out. We'll get them scheduled or they can get online and they can request a, an appointment on the website.
Joni:Okay. What's the name of your physical therapy office? Again,
Dan:It's a Keystone physical therapy,
Joni:Keystone physical therapy. Are y'all active on social media at all?
Dan:sort of. Yeah, I'm on facebook and Instagram, not as active as I probably ought to be, but I'm kind of old school.
Joni:I mean, if you have patients who cares, what else was I going to ask? Oh, as far as insurance or payment, how does that work?
Dan:So private insurances. We'll cover most of our services. We are out of network with all insurances. And I think you'll find that's kind of a common theme in pelvic floor therapy. But we charge 150 for our sessions. And then, we'll give you what's called a super bill. You can submit your insurances for reimbursement.
Joni:When you're out of network, what, I mean, I guess that means you're not in network with their insurance, but does that mean like a, they would cover like a percentage, how does that typically work?
Dan:Everybody's plan is different. And it's just like in network. It depends on what your plan coverage is. For most people it's a percentage. They're going to cover some percentage of what we do. And we do that so that we are able to do all one on one care. So you're never going to come in and get handed off to an aide. And we can use treatments like dry needling that private insurance usually doesn't cover at all, or if they do, they will only cover a certain amount of that. But when we're out of network, we can build that as a physical therapy service and it's more likely to get reimbursed. and It allows us to do things like the radio wave as well that insurance doesn't really love. They'll still usually reimburse a percentage of it, and so you just kind of have to play their game a little bit. But we do most of that for you. We just put it on a bill that you can submit.
Joni:That's fantastic. and is it just you, do you have any other physical therapists that work in your office?
Dan:So I'm the only physical therapist. I have a medical assistant that does some of the radio wave treatment and my wife does some of the treatments for the pelvic floor therapy. It's really just me. Like I mentioned, we do some group classes and, my wife will help me with that. She's a nurse and she's worked, in postpartum quite a bit. So, we'll do those classes together or sometimes she'll just run them.
Joni:What type of nurse is she, or is she working right now as a nurse?
Dan:Yeah, she's, she's a foreigner. She does MedSearch, MedSearch and ICU.
Joni:Wow. My personal hell, but I'm glad that there's nurses who do it.
Dan:Yes. Well, she's a very good nurse, and I think she'll never be able to get off the floor. She loves it too much.
Joni:Oh, that's amazing. Thank goodness, because. Yeah, I was not built for that, but we need nurses there too. That's fantastic.
Dan:we do.
Joni:Well, thank you for spending like an hour with me, talking with me. I've learned a ton. it's been
Dan:Oh, my goodness. No, thank you so much for this opportunity. I'm so passionate about it. And if there's any way we can get more word out to more people, help more moms, so that fewer people have to go without getting help, I'm all for it. So, thank you so much for the opportunity.
