80. Kegel chairs, Incontinence & Pelvic Pain with Dr. Sinéad Dufour
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Can Kegel chairs fix your pelvic floor issues?! Is your “unstable pelvis” causing pain during pregnancy? Tune into this episode to find out!
Surabhi chats with Dr. Sinéad Dufour, leading researcher and pelvic physiotherapist in a conversation all about incontinence, pelvic girdle pain and HIFEM technology.
We get into:
The benefits of virtual and hybrid models of care when it comes to pelvic physical therapy
What the research says about pregnancy-related pelvic girdle pain (PGP)
Reducing fear of movement and getting moms moving
Understanding physiologic vs structural pain
Pelvic floor dysfunction and urinary incontinence
High-intensity focused electromagnetic technology (HIFEM) like Emsella and other “Kegel chairs”
✨This episode is sponsored by Embodia https://www.embodiaapp.com/ - use code momstrength to save $20 off your first month’s Tier 3 membership.
✨Click here to learn more about How I use Embodia as a Pelvic Physiotherapist!
Dr. Sinéad Dufour Bio:
Dr. Sinéad is an academic clinician who shares here time between clinical pursuits as the Director of Pelvic Health at the WOMB and academic pursuits in the Faculty of Health Science at McMaster University. She has been a practicing physiotherapists for 20 years. She completed her MScPT at McMaster University (2003), her PhD in Health and Rehabilitation Science at Western (2011), and returned to McMaster to complete a post-doctoral fellowship (2014). Her current research interests include: conservative approaches to restore pelvic floor function, pregnancy-related pelvic-girdle pain, interprofessional collaborative practice models of service provision to enhance pelvic health and perinatal fitness for elite athletes. Sinéad is an active member of several organizations charged with optimizing perinatal care and pelvic health and has led and contributed many national and international clinical practice guidelines to improve care provision. Sinéad also currently serves as a council member for the College of Physiotherapists of Ontario, Canada. Sinéad is a well-recognized speaker at conferences around the world and a sought out expert to consult with companies whose aim to improve perinatal care and pelvic health.
Connect with Dr. Sinéad & Important Links:
—Instagram @dr.sinead
—Work with Dr. Sinéad at Urospot and Compass Rose Wellness
—Dr Dufour’s publications: https://experts.mcmaster.ca/display/sdufour
Connect with Surabhi:
Website: https://www.thepassionatephysio.ca
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Episode starts at 02:19 after ad from sponsor and intro music.
Surabhi: [00:00:00] Hi, everyone, and welcome back to another episode of Mom Strength. I'm your host, Surabhi Veitch, and I'm so excited and very privileged to have on a special guest today, Dr. Sinéad Dufour. Um, she is an academic clinician who shares her time between clinical pursuits as the Director of Pelvic Health at the womb and as well as academic pursuits in the Faculty of Health Science at McMaster University.
So she is a researcher, a clinician, and she's So great at disseminating information so that all physiotherapists can understand what the current evidence is, how the direction of our field is constantly evolving, because I don't know about you, so she's been practicing as a physiotherapist for 20 years, I've been practicing for over 12 years, and things have changed.
Even in the past five years, things have changed. So it's really important that we translate the information that's there right now and, um, translate it and incorporate it into clinical practice. So thank you so much, Sinead, for being here. I'm so [00:01:00] happy, um, to be having this conversation
Sinéad: with you. Hi Surabhi and hi everyone.
Um, I'm so excited to chat with you today. So thank you so much for inviting me.
Surabhi: So today I wanted to talk about your work. So you work at two different, um, spots and let's start by talking about, you know, the hybrid model of care and how you see that to be beneficial for your clients. Cause I'm a huge believer in this as well.
Um, so I'd love to hear your take on this.
Sinéad: Absolutely. So the whole hybrid model of care piece, I think, marries in nicely with what you said in my intro in terms of evolving our practice, kind of following the science, following sort of the current epidemiological trends, and what really is the best way to help people, and what do we deem is the most effective, and what are different modes of doing things that actually remove barriers to access, and so on.
And so really and truly that has landed me in a place where I very much enact [00:02:00] a hybrid model. So I enact a hybrid model for all of my teams at the womb, the world of my baby. We have multiple sites in Ontario. I run my practice out of the Burlington site. But I also direct a whole team of over 20 physiotherapists actually in a different company.
I don't run my own practice through this company. But I've sort of, um, set up the care model based on what I do at the womb. And that practice is much more focused around really sort of urinary incontinence and what I call more modern physiotherapy. So we can maybe talk about that next, but what I'll talk about first is what I actually do at the worlds of my baby.
We're a huge population of mine is actually pregnancy related pelvic girdle pain. And so really how this model came to be. It was born out actually of me starting to do virtual care way before the COVID pandemic, but actually for my pelvic peds clients, [00:03:00] because I was finding these young ones, um, you know, we're, we're sort of agitated in the visits.
Um, you know, parents, you know, feeling uncomfortable of me talking to their parents about some of the difficulties that were going on. And really the recognition that, you know, certainly from a foundational perspective. The more majority of what kind of needed to be translated. It was actually between me and the parents.
So saying, you know what, let's actually do the first meeting virtually. You know, and, um, and then sort of after a visit or two, we can get, you know, your little one in and kind of do some of that bit. And so in many ways. By the time COVID happened, you know, I was sort of familiar with being able to really develop, deliver valuable care in this virtual context and what I found actually through COVID when it wasn't hybrid care, it was all virtual.
It was all
Surabhi: virtual. Yeah. All
Sinéad: virtual. What I found actually, and it surprised me, you know, but it was a nice way to sort of force me to [00:04:00] reconsider some of the assumptions I had been making in my practice. But it actually showed me that for pregnancy related pelvic girdle pain, my outcomes were better without even touching people, without even seeing them in person, with really having to rely on my skills more as, as a coach and facilitating people to actually, you know, find their own tools and sort of heal themselves.
And because in a virtual model, you know, There really is not this kind of elephant in the room of let's get on to it and start doing what really matters and start doing the physical things.
Surabhi: Yeah. Like let's get you on the table. Like it's almost like in person. That's kind of the goal, right? Okay. We chat and then we get you on the table.
And I totally agree with the virtual model. You take that out of the question. The whole conversation is important, not just what's at the end of the session.
Sinéad: Exactly. Exactly. I agree with you a hundred percent. And you know, [00:05:00] that really allowed me to really, I think in a better way, sort of learn to focus on holding the space to really, really listen, using the time to kind of summarize back and really kind of shifting in and developing my health coaching muscles like yes, better and actually finding.
How much better that worked. And really, I mean, as an academic, that reality triangulates very well with the data, right? I really do think that it is very much perspectives and beliefs of our own colleagues that aren't Allowing us to kind of get out of that mode that, as time goes on, really is not substantiated.
I mean, the data is very clear. We really need to be approaching all care, especially in this intimate region of the pelvis and dealing with reproduction and these types of issues. We really need to approach this through, you know, a biopsychosocial trial. evidence informed, [00:06:00] psychologically informed lens.
And, you know, we need sort of time and space to actually do that well. And if we're constrained with needing to getting to do biomechanical things, that can actually be unhelpful. Yeah. Right. So at this point in time, the majority of my practice is actually virtual. I see clients from all around the world.
Amazing. And my team at the six different wombs all run hybrid practice, admittedly more in person than virtual. Um, but you know, I would agree that some version of a hybrid is probably optimal, but not to underestimate the power in, in virtual only, even in pelvic health. And that's kind of been, been proven to me over time.
Surabhi: I love that. I, um, switched to virtual only in 2020. It sounds like you were ahead of the curve and you were already doing some of that before. And I found the same. So I came from, um, orthopedic sports physio, you know, musculoskeletal. I was an F camped. I am an F camped. Um, so [00:07:00] all the manual therapy training and then 2020 hit and I was like, why are my clients getting better faster virtually?
Because another big piece is they start to believe in themselves and in their own capacity and their own ability to heal themselves and do their exercises and listen to the strategies that I'm suggesting. So I found the same. And then even in pelvic health, you know, I worked virtually for Almost three years and only this fall I added back in in person care and I'm fine.
I'm really liking this hybrid model, but I am a strong believer that virtual helps so many people Get better faster, and I love the accessibility piece because you live in Burlington I assume where you work in Burlington but there are many people in Ontario in Canada around the world without access to a pelvic PT and This way they're not feeling like they're getting You know second class pelvic physio.
They're actually getting expert Pelvic PT, um, from the comfort of their own home, wherever they are. And so that's something that I really wanted to highlight from what you're saying and the data is [00:08:00] showing as well. Um, can you talk a little bit about pelvic girdle pain in pregnancy? And you are, I always think about you anytime I think about pelvic girdle pain, you've done so much research and you've talked about this so much.
Can you talk about? A, what it is, um, how does it impact people, where is this pain? So kind of the basics, the foundation.
Sinéad: Yes, yes, of course. Of course. So this really marries into sort of why is it that a virtual only model works so well with this thing? Because we used to think it was about biomechanics and surely then we need some of that.
And the fact of the matter is, you know. That's not the case. Like what we used to think, um, we now know really was the wrong path, right? So pregnancy related pelvic girdle pain essentially is just pain experienced anywhere in the pelvic girdle region of the body. So I always kind of say this geographical region of the body, someone says, Oh, in this place, like I perceive pain in this place, [00:09:00] whether it's at the symphysis pubis joint at the front, which is a very popular, um, sort of specific area where people will experience this pain, or the sacroiliac joints at the back, or really anywhere in between.
So if someone has pain in that area, they're either pregnant or in the first post, first year postpartum, we classify that as pregnancy related pelvic girdle pain. We are really You know, urged as far as scientific consensus is concerned to not be speaking in terms of even symphysis pubis pain or sacroiliac joint pain because we've seen in the data that sort of doesn't mean anything.
We know there are not dysfunctions at the level of these joint structures. And so, you know, a pain experience, it's sort of more appropriate to align with the guidance of the literature to say anytime we have pain in this area. We should just be referring to it at pregnancy related pelvic girdle pain.
Cause at the end of the day, we know that no specific structure is involved. The same [00:10:00] conclusion at this point, honestly, with low back pain, right? So that's one thing that's important, you know? And then I think the other thing, um, that is important is to understand the difference between pregnancy related aches and pains.
in the girdle area and pregnancy related pelvic girdle pain because they're different. So when we're talking about, so even if I reflect on my own experience being pregnant with twins, Was there probably a day or two that I thought, oh yeah, you know, my SIJ is a little sore. This is, and I'm finding it's like, I'm sort of hitching a bit with it when I'm walking, and this is a bit dodgy, but you know what?
I'm going to do a bit of extra yoga. I'm going to throw a heat pack on it. I'm going to, and I could sort of sort it out. Right. That would be a pregnancy related aching pain. I never actually had to go in and seek care about it. I could kind of sort it out and I would argue probably every single mama is going to have that.
I mean, when we think of everything going on, it stands to reason that that's going to happen, [00:11:00] right? The issue with pregnancy related pelvic girdle pain And when you look at the literature base around it, it's a very different path of physiology. It's one we've kind of stepped out of just nociception, and we've kind of stepped into the place of nociplastic kind of changes.
Because The data is quite clear. These are people who there's comorbid depression. There is comorbid catastrophization. There are people have to get time off work. So again, it's people who have kind of slipped into this kind of poor coping when we think of that sort of threat model. And we know that once we've slipped into that, we know that cortisol inflammation goes up and We see outputs of that pathophysiology consistently are an amplified pain experience and frankly mood distortions, usually anxiety, depression.
Like there's a very clear cut pathophysiology around, you know, maladaptive response to a fear based threat. And so we have to [00:12:00] understand that we're not talking about just the aches and pains. We're talking about this other situation. So it means right out of the gate. I mean, all of the ways we'd be thinking of an amplified system and more of this no see plastic pain situation.
We have to start applying all of that to this context. Right. And of course, how do we do that best? Well, it's through a lot of our tools that can be delivered virtually, frankly, right. Helping people to understand their pain experience for what it really is, helping people to understand how even like Our notion as a collective public has changed about this issue as science has evolved, right?
And then really making sure we're individualizing care because every little person is different and certain things are going to be very clear that they're amplifying one person's system versus another. So that's a little bit of a summary of a contextual backdrop
Surabhi: of it. And I think so many great points there, so understanding [00:13:00] that pelvic pregnancy related pelvic girdle pain is different than the regular aches and aches someone might get during pregnancy, which I agree, I mean, your body is changing rapidly, it makes sense that you might notice a bit of ache and pain or you know, sore back when you're waking up, but this issue is different and yes.
I, I really believe that this is why when you work with someone virtually, even with after the first session, their pain is drastically improved. It's because of that anxiety and the catastrophization piece that once they understand the education behind it, and their anxieties and their fears kind of dull, their pain starts to rapidly improve in some cases.
And, yeah. Then they think, Oh, it's because I did this one exercise, but it's actually all the education piece and the reassurance and the coaching that they're getting during the session with you.
Sinéad: Yes, I agree. A hundred percent. Like when someone actually understands their biology. And they understand the fact that when they started to have this ache and pain, but then someone told them, Oh, you're getting symphysis pubis [00:14:00] dysfunction.
That's an instability. So even our existing narrative actually can, you know, transfer someone's regular ache and pain actually into this process. And once people understand how that happened and actually, you know, this is more of a. Physiologic issue, not a structural issue. That in and of itself, there's a huge amount of fear that can be lifted just understanding their biology.
And then in being empowered to say, and these are all the things available to you to dial that knob down. So before you birth this beautiful baby, you can be feeling great. You know, then, then that's kind of the next piece, that hope piece that's empowerment piece. So I would agree a hundred percent sort of be with everything you said.
And I
Surabhi: think the other piece is many of us who come from a manual therapy background and that instability and oh, you know, their hormone relaxin is causing everything to be, you know, unstable. It's, I really encourage people to listen to this conversation and just challenge some of [00:15:00] that, those biases that we have from the way we've learned because the reality is the person is.
We're designed to be pregnant and go through these hormonal changes and there's nothing unstable about it. And so even using this language can scare people and, you know, you, I'm sure you've had to do this, you know, the damage control many times from somebody who's already seen someone else, whether it's a pelvic physio or doctor or healthcare professional and heard this language.
And then now they're coming to you with fear or, you know, the assumption. That they come in and I see this too with people who have poor body image or prior history of injury. So they're, they're thinking already my body's broken. I'm doomed to be a failure. My body's not going to be good at this pregnancy thing.
And so they're more likely to end up with pregnancy related pelvic girdle pain or other pelvic symptoms. And so reassuring them that their bodies are capable and strong and [00:16:00] all of the things is so key. Can you talk a little bit about movement for people with pelvic girdle pain. Are there those, you know, before you used to learn here are some restrictions, don't do this, don't do that.
Can you talk a little bit about how you approach movement for people with pelvic girdle pain?
Sinéad: Absolutely. So this is so important because at the end of the day, I mean, we need mamas to be moving and healthy and we know like the benefits of movement and then kind of beyond just getting movement and safe movement back and progressing that to a degree of conditioning is so critical for mama and baby on so many fronts.
I mean, for pelvic Absolutely. And For health, but for satisfaction and to reduce the likelihood of blood sugar dysregulation and diabetes. And if you have gestational diabetes operation, rate of, um, aspects of birth is more common. That's then a pelvic floor issue. I mean, the list goes on and on, right? So it's [00:17:00] pelvic PTs.
We want. To get our mamas moving and then exercising, right? So it has to be kind of like one of the first things on our little agenda list, right? We're going to kind of be getting the individual in front of us to the point we can get them there. Right? And so what does this look like when the system is so protective and so sensitized in these areas?
So you're quite right that the first part is helping the person to first understand that there, You know, structure is not damaged. It's not unstable. It's robust and okay. I mean, that's first and foremost, because until someone can really make peace with that, you are never going to get anywhere, right? So that's key.
And it's key to help people understand. Yeah, this isn't a stability issue. It's a sensitivity issue, right? And there's lots of different things that we can do to kind of dial down the amplification. So I'll often use the analogy of a guitar. Right? So say, you [00:18:00] know, if you have an acoustic guitar and you strum on the strings really aggressively, it's an aggressive force and it's going to sort of match the output that comes out.
It'll be a big, loud sound. And quite frankly, you might even snap one of the strings, right? However, if we have an electric guitar and we have the amp right up at 10 at the top, We will gently strum the strings, and it's this loud, roaring sound that comes out, so it's like the input doesn't really match the output.
And I help people to understand that that's sort of what their system is doing. Like, they are simply just attempting a gen gentle lunge, but their system is so amplified, it's like it's this roaring sound that it's making you think like you just snapped a string off. But
Surabhi: it is right. It's this huge dialed up response.
It's
Sinéad: this dialed up amplification. So really what we're trying to do is focus at the level of the amplifier. What are all the different things we can do to turn the amplifier down? Can we build up [00:19:00] resilience in terms of getting you doing very intentional things? To get your body into parasympathetic mode during the day, particularly when your energy system crashes around 3 o'clock, then we really kind of reverse engineer your day to protect your physical repair sleep between 10 p.
m. and 2 a. m. And we really think about, you know, things that are likely sort of providing, you know. Inflammation in your system, you know, maybe like consuming sugar and things like that, that might help. Can we help you to understand that, you know, a lot of the things that feel like it's the structure off, it actually isn't by like proving it to you.
So when people have discomfort when they walk, when you're guiding them through either virtually or in person to say, okay, so let's just sort of challenge that hypothesis. And I want you to walk backwards and tell me what your pain experience is. And, and it's not, you say, okay. So we have the same load, right?
So it's your brain feed forwarding and anticipating a problem with walking because there's already a neuro tag there. So we kind of can [00:20:00] just start to give them analogies so they understand the situation and poke holes in the theory, but also follow the principles of Gentle, more restorative movement that we can modify in different ways to kind of make this the situation contextually different.
It's what we call novel movement, the walking backwards instead of forwards. When we're doing this movement, rather than being in the same room we usually are, let's go in a different room on a different service and actually visualize something different happening. So we're just putting sensory.
Different sensory input into the system. Um, so we're kind of blocking that feed forward mechanism, but all the way, we're reassuring this individual that this construct is actually more about sensitivity and amplification and instability. And usually, I mean. these shifts, as you know, can happen quite quickly.
Um, and you know, and the more the individual is actually [00:21:00] understanding, okay, you know what, this is actually making sense, you know, um, the more they can kind of move along. So absolutely we need to target and sort of bridge that fear of movement and amplified state over into. novel gentle movement, which requires them to understand their pain experience for what it actually is and what the drivers actually are.
And then we can kind of build from there.
Surabhi: Right. And it's, it sounds like many, many people, some people will either just not move at all because they're in pain, or they'll just say, I'm going to ignore it and do the same things that Already was doing. And so what you're introducing is the novel movement concept where it's not the same thing you were doing that causes pain It's something new or even something similar, but in a different context.
So in the Amplification of that sensitivity is dialed down Yes I love I love that analogy by the way of the guitar string because I haven't heard that and it's fantastic I use It's a [00:22:00] similar but different analogy of eating a piece of chocolate cake that's delicious. If you eat it, you're sitting calmly, you're looking outside the window, and you're enjoying your piece of cake.
You're going to enjoy it more than if you're in a really stressful meeting and people are trying to debate something and you're trying to talk at the same time as you're shoving this piece, shoveling this piece of cake. You're not even going to notice, A, that you ate it. You're not going to even taste the deliciousness of it.
So the way you respond to whatever input. It's going to depend on your, the status of your nervous system, your mood and so many things. So if we can dial down that fear, that expectation of pain and even introduce new movements, people are more likely to be successful with it. So if someone's listening to this episode and they're a pelvic PT or maybe they're a pregnant person and they are experiencing pelvic girdle pain, I think this is a really powerful switch.
I also want to. ensure that people understand that when we talk about pain, catastrophization, or fear, these [00:23:00] are very common, and there's nothing wrong with you if this is the state of how you are, but there are strategies to help with that. Because sometimes people feel like they're alone in this, like they're, they're the ones that are only anxious about their pain, but so many people are, and there are real strategies that we can help
Sinéad: with, so.
Absolutely, and just to add on one final point here before we maybe move on. is on that note exactly. I think it's really important that people understand that their physiology is doing exactly what it is supposed to do. So many people who see me, they really feel like their body has gone rogue. It's done something wrong.
And that's another thing that can actually contribute to their distress and contribute actually to the amplification in their biology. And what I will say is. I would have expected your biology to do this, given this history of trauma, [00:24:00] given, you know, your dissatisfaction at work, given that you were told this has something to do with the pregnancy, these are all established risk factors for this issue.
So I would say, I would fully expect those things to translate to this, your body is doing exactly what it was designed to do, the problem isn't your body, the problem is someone should have never told you this, the problem is you should have never, you know, had to endure that trauma you did, and so actually It's very predictable what your biology is doing, and just as predictably, we can put in new inputs and we can, we can get you out of this.
And, and so catastrophization is a very understandable response to some of those things. So we kind of acknowledge. That's expected physiology, right? And you know, it is those something that's going to keep you amplified. So now we need to deal with it. I think you're quite right. And frankly, we're much more equipped to sort of [00:25:00] talk through these things without the pressure of let's get onto the physical stuff, right?
So it's another example of how some, you know, virtual sessions to really hold space and go through this, uh, can go a long, long
way.
Surabhi: And I would say we're, we're specifically talking about pregnancy related pelvic girdle pain, but the same, same thing can exist even prior to pregnancy, people with pelvic girdle pain or postpartum pelvic girdle pain, um, there is, it's the same kind of model, right?
And I guess this is the, the question related to that. Can people prepare for pregnancy if they already have existing pain with the same type of treatment and um, approach that you, you use with pregnancy?
Sinéad: Yeah, absolutely. I mean, we have pretty good data to show that people who are sort of like exercisers, that is actually a protective factor for developing pregnancy related pelvic girdle pain when you're pregnant.
So I would really be arguing like all along the way, our [00:26:00] goal is to get the amplifier down to get the system and homeostasis to get people fit and happy and well. And those are that's always going to help them. And I mean, with that, we also want to make sure people have a sense of like the pelvic floor.
And what is that structure all about? How might that help them? Because we have some good data to that. A nice fit, robust pelvic floor is helpful, not specifically for public girdle pain, but helpful for a myriad of other things. And I mean, at the end of the day, we don't treat conditions. We care for people.
And so, you know, when I'm working with someone when they're pregnant and their main sort of motivator for coming to see me as this awful pain experience they're having, yes, I'm thinking about the amplification in their system, but I'm also thinking about them having an amazing birth and a great recovery and note, like we whole picture for people.
Right. So, yeah, we want to be thinking of all these things. Absolutely.
Surabhi: Thank you so much. Um, let's talk about some of your work with [00:27:00] urinary incontinence because I'd love to hear I work with a lot of people with incontinence as well and virtual works amazingly Tell me a little bit about your work there.
Sinéad: Yeah, so I mean Of course, I, I see and have for the last decade working at womb worked with individuals with urinary incontinence, but at this point in time, really more of my focus is around pelvic pain and specifically pregnancy related pelvic girdle pain because I've just garnered so much expertise in this area over the years.
However, I see. And I still very much keep my foot in the space of urinary incontinence with the work I do. It's actually a collaboration between a company called Urospot and Compass Rose Wellness. So it's a really neat integrated collaboration between those two companies. You know what we have set up there and essentially is the director of physio sort of for that group, I'm really the one who's mapped out this care model, but it's a care model that the physiotherapist works work all virtually [00:28:00] only that having being said, they are connected with, you know, local pts and sort of each sort of city.
If there is a desire on on part of the client or really a thought from the perspective of the PT that in this instance, you know, something in person might be useful. We have those circles of set care set up as needed, but really, it's this virtual model that essentially. Emphasizes, um, sort of like the health coaching bit of things as well as really helping people to understand their pelvic floor and where the partnership with Europe spot comes in.
It really is in ways almost around, um, the idea of help seeking. So one of the things we see with urinary incontinence, and I mean, I just was one of the leads on writing the chapter on this topic for the, um, international continent society. Right. And even still in like 2023, [00:29:00] only 25 percent of people with urinary incontinence actually come forward for help.
Help seeking is still so, so low. And, you know, unfortunately PTs and other healthcare providers really aren't great at letting the public know exactly what we do. We have a conservative care solution for your problem. We're terrible at that. And I'm all about Collaborating, collaborating, collaborating so we can actually get sort of, you know, the right thing to the right person.
And so Urospot is a company that they first kind of like came onto the market space actually through COVID. Um, using Emcella, a high fem technology, so a more advanced version of electrical muscle stimulation. They kind of came onto the market. And we're really kind of looking for the right partners of physio and nursing to really make sure they did this thing right.
And so, you know, in meeting [00:30:00] with the CEO, who I actually happen to know as a child, we went to the same, um, you know, school of the performing arts together as children in London. You know, I helped to explain where I thought something like this could really kind of change the world if it was done right.
Yeah. And really the bit from my perspective was more around the help seeking part, because at the end of the day, more of the public. Is interested in a technology like I'm Sela, then they are sort of traditional services. The other thing I've discovered through some of my work on lower back pain. Some of my research on lower back pain is there is still a high proportion of people who are not interested in internal work.
They're not interested in an internal exam. It's one of the reasons why, you know, virtual care can be helpful. Yeah, I think it's something that we just have to even acknowledge on the treatment side of things. So to have a modality and a modality now that I've studied myself, actually, we have a publication, um, just [00:31:00] submitted looking at all forms of EMS, including these newer ones that are higher intensity with the magnetic component.
And it does show that these ones are more effective in a much shorter time. So, I mean, We see that, but also the acceptability component of people not having to take their clothes off, right? So, you know, people are coming forward to Urospot in droves who aren't interested in traditional physio, who aren't, but they're interested, they're not interested in medication, they're not interested in surgery.
Surgery, yeah. They're suffering and they want a solution to this problem. And so once they come in Urospot's door, Urospot is very transparent to say, yep, this is a great adjunct, but really what's going to actually help you is you understanding your biology and you being able to figure out all the other things.
So let's also have you work with some of our virtual PTs. Amazing. And so it's this beautiful model where like the PT part. [00:32:00] So, so the Hythem technology actually isn't even a part of the PT. It's really what the nurses deliver on site, but it's partnered with the PT. So it's a really beautiful model to actually get.
Us with our expertise to be able to extend our tentacles so much further, because quite frankly, many of these people wouldn't come for our care. And the outcomes people are getting through this model of care are mind boggling. Like my whole team of PTs, you know, they do a couple hours kind of on this virtual team, they get awesome mentorship from me, and it's a great team.
But they're seeing like the outcomes are just outstanding and they're able to now apply some of these kind of more health coaching, better psychologically informed care in their own practices in the area of urinary incontinence and other forms of pelvic floor dysfunction. So that really, like my collaboration with Urospot and what we've been able to achieve and continuing to achieve has just been awesome.
Like myself [00:33:00] and Erin, who's the CEO, we kind of that it's like modern physiotherapy.
Surabhi: I was going to say it's It's that evolution part, because I find that, I remember years ago I was at an OPA, Ontario Physiotherapy Association conference, um, or meeting, um, AGM, something like that. And the question that was asked is, are physiotherapists replaceable?
Are our jobs replaceable? And just with new technologies and stuff, and the older school physios, many of them are fearful of change, understandably, this is all new to them, and even for me. in my class, there was like three people with laptops. And now if you go into a PT class, every single student has technology in front of them, right?
And so with changing technology, even for me, it's like a bit of resistance, like, Oh, is this going to work? Is this going to replace us? And what you've just described is not a replacement. It's an adjunct to help people who otherwise would never come in for PT care, receive the help that they need. Well, also receiving that coaching [00:34:00] aspect, because with urinary incontinence, so much of it is strategy is the education and the behaviors and the habits.
So absolutely, the strength alone is just one part of it, right? And so I love that.
Sinéad: Yes, absolutely. Absolutely. So. So yeah, that's kind of the bigger way. I'm kind of have my foot still in pelvic floor dysfunction and urinary incontinence, but it's been so rewarding, you know, and being able to take so many of these PTs through to actually understand their evolved role in this more psychologically informed care, this kind of more behavioral approach and seeing how effective it is.
Um, and that's. That's spreading then to their other more traditional practices. It's been really, really exciting. So, and so how
Surabhi: do people access Urospot if it's, it's a virtual and onsite
Sinéad: model? So how people access Urospot is quite frankly, they go, they first go into Urospot and once they go into Urospot, and usually they're kind of intrigued by Msella and some of the [00:35:00] great marketing that this company does, because in fairness.
They do excellent marketing, which can really help the help seeking piece. And once they get into Urospot, and I mean, there's a dozen locations across the province at this point, like it has spread in a really big way and just opened up in COVID actually. So it's been really exciting to see. So that's very new.
And very new and really, you know, cause there's a need. There's a need for this, right? So they access Urospot. And once they get into any of the Urospots, that's when the team at Urospot will say, Hey, you know, you really should sort of build a PT component on some clients will decline that and they will decide they just, and that's okay.
They'll just work with the nurses and it's different. the Urospot teams themselves see how much better the outcomes are with PT. So they are always trying to like, you know, encourage people to kind of connect up with the PT side of things, which has been really cool. And
Surabhi: now [00:36:00] it's called Urospot, but does it also help with conditions like pelvic organ prolapse or other pelvic floor conditions other than urinary incontinence?
Yeah. So, I mean, the
Sinéad: data around IFAM, as I said, we've gone through this in detail because we've just submitted our scoping review for publication. The most, uh, rigorous data for hyphens specifically, um, Is
Surabhi: HiFem the same as Ensemla?
Sinéad: Yes. Ensemla is a version of HiFem. Healthy Power is another one. It's just the most, um, well known, but HiFem technology is high intensity sort of electromagnetic stimulation.
So it's very, like, intense and focused compared to the lower intensity ones that don't have magnetic, which are traditional probes. And so the data is most specific. to incontinence. But honestly, studies on EMS, like across the board, actually show improvements in various parameters of developing pelvic floor fitness.
So, I [00:37:00] mean, I think if in your mind, and then there's also really good data for the high fem technology around sexual pain and sexual dysfunction for men and women. Hmm. Right. And so, you know, I think that's important for people to understand is that, you know, BTL, who is the manufacturer of the machine, they sort of market this as a product that just does a lot of kegels, but that's actually not what the tool does.
You know, the tool really Takes people through sort of a whole program of neuromuscular sort of reeducation and, you know, and that's why it's not surprising that even at the most recent, um, International Continency Conference in Toronto, just this past September, you know, the top recommendation and the top tool for urinary incontinence among anyone with an incontinence, In a neurological population is actually EMS over individualized muscle training.
So we know that EMS actually really has more of an impact to really like balance and turn on the system. And we can [00:38:00] see that in these trials that we're kind of. Getting people with incontinence coming in the door, but then through their outcome measures saying, oh, also their painful intercourse improved.
Well, we wouldn't expect that if someone actually was doing repeated Kegels, right? Like, we know that. So, we have to make sure that, you know, unsubstantiated marketing claims, you know, we're teasing that apart from what we know is, is Physiotherapist in terms of mechanisms of action. So yeah, I would say that any time your client would benefit from, you know, just developing more fitness capacity in their pelvic floor, or you really feel like the wifi signal kind of between their brain and their bladder and their pelvic floor is just despite what you've tried to do, it's a bit dodgy.
Yeah. You know, high fem can be really awesome. adjunct that clients really seem to have high acceptability, uh,
Surabhi: with. And is it, um, do you need a few [00:39:00] sessions? How does that work? Is there like, do they retest strength or what are the outcomes? Yeah, so
Sinéad: I mean, certainly if people are, are under the physiotherapy side of the program, which I mean, that's the side I work in.
So like, as far as I'm concerned, if you're a physio, and this is something you're integrating, well, of course, you're doing all your outcome measures anyways. And this is only one part of your care, one part of your care. Yeah. So you'll be deciding like, how is the global care plan helping? And my bias is always that the kind of more health coaching and behavioral changes are always going to trump something like manual therapy or a therapeutic modality, that's my bias, right?
So I think as PTs, of course, we're tracking our outcomes, right? Certainly when you look at parameters, because anytime we're using a modality, we want to make sure we're using like the proven parameters. Studies on high FEM have mostly looked at six sessions, two a week for three weeks. Some studies have shown 10 sessions and really like the data so far didn't really show that 10 was any better than [00:40:00] six.
Like, so, so currently, you know, the, the program that we work with is six, you know, there's no need to kind of do more. Yeah. It's, it's a time commitment coming into these places, but it's also an opportunity to get connection in with sort of like a loving team who can kind of be reminding you of some things.
And that really helps the health coaching. The other nice thing about hyphen is that people can notice like a real change in their body after one or two sessions. Wow. So it can really bring out that hope of, Oh my goodness, this might actually. Change like I might not actually have to live with that, this and then those individuals really seem to be much more motivated to carry out the PT plan which I would argue in my bias is really where the real magic is.
Yeah. So, you know, any type of a tool that kind of boosts that capacity of hope or motivation in some cases maybe that is a manual therapy initially and maybe I think those can [00:41:00] be very, very helpful, um, to kind of what we're trying to achieve ultimately in the long run. I mean, ultimately in the long run, we're always trying to do ourselves out of a job, right?
We want to get people, you know, creating their own health and they have all the tools to the point they don't need us. And I mean, life's going to happen. It might end up with about a bronchitis in the winter and their symptoms there, and they can always come back in, you know, for a booster session and a reboot.
You know, I think that's kind of how we both practice and, uh, yeah, it's been exciting kind of having my hands in a few different sort of pies, clinically
Surabhi: speaking. That's, thank you for sharing all that because that's stuff that I didn't really understand that much before about the, um, these tools and how, how you describe it as an adjunct and as well, it is marketed as a, you can do a 11, 000 Kegels in 20 minutes or whatever the, the marketing is, but.
I think that's an important distinction to understand. It is not just Kegels, because if it's helping with things like sexual pain, [00:42:00] that's, it can't just be a thousand Kegels and, or 10, 000 Kegels. And I think it's that neuromuscular, that sensory piece too, is if it's changing how you feel, how your muscles feel, how your body feels, the sensation, um, it's an immediate change in.
Um, the mental state too, like you calm down, you're not as stressed about it. 100%. Um, that's awesome. I'm going to look up where the nearest, I'm in North York, so is there a North York location for you?
Sinéad: Um, there is actually, there's Vaughan, but I think there also is North York as well. So yes, check it out, Surabhi, and, um, I think there's a, I think there's a couple near you actually.
Nice.
Surabhi: Um, awesome. I would love to hear a little bit about you, um, and just have some final thoughts. I would love to find out what are some things that you do for yourself as a very busy person and a mom of twins. How old are your twins? They
Sinéad: are in grade eight. So they are, um, twelve. They'll be thirteen next [00:43:00] month.
Surabhi: Is that what transitioned into, transitioned you into pelvic floor physical therapy or were you always?
Sinéad: No, it is actually my PhD and postdoctoral fellowship research had nothing to do with pelvic health or, you know, perinatal care had everything to do with primary health care and self management support and really looking at the epidemiology of like, where should we be like focusing our and how can PTs do a better job?
So I, of course now bring all of that. into this domain. But yes, I got pregnant with these two little blessings at the end of my PhD. And so it was kind of after going through that, I thought, you know what, like, we have major gaps here. And, you know, it was sort of serendipitous, the timing, because that was just, I defended in 2011.
My PhD, and in 2012 here in Ontario is when our directives changed, where you didn't need a medical directive to be a pelvic PT, but you could actually roster for it. [00:44:00] So, you know, once that decision came through, I think I was one of the first people to take the course to get rostered. Amazing. For a decade now.
So yeah, my own personal experience got me here, like many of us, right?
Surabhi: Yeah, yeah, exactly. And so what are three simple things that you like to do for yourself every day? Yeah. For self care or for, for yourself.
Sinéad: Yeah. So one of the things I'm a pretty big stickler on is really trying to protect my sleep, my restorative sleep.
So I have sort of two different things I do through the day. One at the beginning of the day, one at the end of the day, sort of to try to assist this. So the one thing I do, and it's a non negotiable for me is a morning walk. And this is partly, you know, it's just like a nice time of kind of clarity setting my intentions for the day, but it's also for the biological benefit of getting natural sunlight into my system.
That's going to sort of program the balance of cortisol and melatonin throughout the day in a more constructive way from our circadian rhythm. So some days, [00:45:00] quite frankly, this honestly might just be five minutes, depending on what my day looks like. It's me getting out there, walking around the block, maybe checking my mail at the mailbox and getting on with my day.
But days that allow it, I will definitely do that longer. So that is definitely one thing at the beginning of the day. At the end of the day, I'm a big stickler for no phones and electronics that give off EMF are not allowed in the bedrooms of anyone in my house. So at the end of the day, we all put the electronics in my husband's office, in my husband's home office, and that's sort of where they stay.
And, you know, that's just another, um, practice that I, I just think so many people underestimate the influences of these EMFs, even if they're things on airplane mode, I'm a big person to kind of recommend just an old school alarm clock. So you're not using your phone,
Surabhi: um, even because when you're using your phone, you're also likely to.
[00:46:00] Check your email or check
Sinéad: your tax and it's also the blue light exposure to, I mean, you know, circadian rhythms that are bungled up, like they are really, I think at the more root are more at the root of problems than people realize. So you know, these are things I discuss with my clients, but quite literally I practice what I preach and then I would say through the middle of the day is my third thing.
I try to honestly get as many hugs as I can. I'm a hugger. So hug my kids every day, hugging my teammates at the womb, you know, hugging sort of my colleagues, the hockey moms when I see them or dance moms when I see them. And I really think people underestimate, you know, that connection, that oxytocin release like that.
So that's another thing I do for just like my own well being. And I think to kind of maybe pass it on to give someone else a little oxytocin
Surabhi: kick as well. I love this question and I love your answers because it always [00:47:00] You know, you're a successful, very busy, you know, academic and clinician and mom. So I always love this question because I want to know what are simple ways people can actually incorporate self care?
Because for some people, when they answer this question, they don't do anything. And they're like, I don't do anything right now. And I love, I actually want to have a post where I share some of these ideas because You should! I'm actually going to make a post of this because these are fantastic ideas. The morning, um, sunlight.
I find on days that I don't actually get out for a walk, even just looking out the window and just eating breakfast, looking outside, just having some sunlight exposure, um, can be helpful, but that protective sleep from 10 to two, many people are not getting it.
Sinéad: They aren't, they aren't. And it's so important.
Oh my gosh. Especially for mamas who are So depleted, you know, and you know, their systems are kind of like in the ground. It's like, we need, like, we need that. I'll often be like, how might we reverse engineer your whole day [00:48:00] just to protect this first? Like, what might that look like? What might we be able to do to try to kind of get this going?
Yeah. It's so important.
Surabhi: Okay. So what are you really passionate about right now? It could be work related, not work related.
Sinéad: Well, I would say something I'm really passionate about now, and it's interesting. It's kind of something that sort of fell in my lap, and it sort of found me. But it's the work I'm doing with FIFA.
So, I've been hired on as one of the experts for the FIFA Female Health Project. What? That's incredible. Yeah, so I've had a contract with them since March. And really kind of as one of the pelvic floor perinatal care experts and trying to bring this to like high level athletics and how can we kind of inform return to play and continue to play guidelines.
So I work with this amazing kind of working group on this. And, uh, like right now we have two studies out that we're working on. One is kind of looking at the impacts of sort of like breastfeeding [00:49:00] and these elite athletes. And the other is a survey that we just closed, but looking at like contact athletics and during pregnancy.
And what does that look like? Because right now we've said to athletes, as soon as you're a second past 12 weeks, no contact allowed. But that recommendation is actually based on nothing. And so, you know, that's been really, really interesting. And it's a new space, um, for me as is applying my expertise to this population.
So that's something that's kind of new and inspiring for me right now.
Surabhi: I didn't know that. So that's amazing, I think, and so needed because, um, we're seeing more and more women in sport, through pregnancies, returning to sport. And I think it's a, it's a great time to be alive because we actually get to see that.
Yes, yes, yes. If you could change one thing about the world, what would it be?
Sinéad: I would say, honestly, right now, um, more sort of tapping into [00:50:00] sort of. The spiritual essence of what's going on, you know, I really feel like that aspect of just us being humans kind of got chipped away sort of through COVID and lockdowns and.
Now we're not allowed to hug each other and we have to be afraid of each other. And, you know, lots of just loss and despair that just destroys like the soul, you know, I'm, um, I'm actually doing right now a postdoctoral certification in counseling and spiritual care with the divinity college at McMaster university, which is where I'm a professor, very part time certification.
I'm just taking like one course a term, but it's been really. Wonderful kind of diving into this and helping me to kind of maybe understand, like, how might I be able to bring a little bit of more into my work in an appropriate way? And, you know, even into kind of more of my social context. [00:51:00] So yeah, like that's something that I really think I could change anything.
It would probably be that really and
Surabhi: truly. And that. It goes back to the biopsychosocial, but also biopsychosocial and spiritual model, which we completely ignore. And um, there is a disconnect between humans, I think, especially with screens, but also with COVID and isolation. And I think as I've added back in in person care, even for myself, I've noticed it's not necessarily the, the fact that people need hands on care, but some people are really desperate for just human.
Touch and connection, so I love that I didn't even know that that was, um, a thing that you can incorporate into your care, like with the, with the course that you're taking.
Sinéad: Yeah. So I'm just kind of learning how to do that. I feel like up till now as a clinician, I almost felt like I, I had to not tap into that and I had to kind of [00:52:00] keep it separate, but I'm kind of learning, you know, how it might be appropriate in a very sort of meeting someone where they're at individualized.
Care lens through a psychologically informed lens, you know how it might be appropriate. So yeah, it's been really
Surabhi: neat. That's exciting I'm gonna I feel like I need to keep tabs on that because that's very interesting to me a lot of my clients especially they come from various either spiritual religious or just different faiths and when we don't Discuss it or see it.
See that part of them. We're actually not helping them get better in the best way that we possibly can because it's like we don't isolate the pelvis and just treat the pelvis. So we can't isolate certain parts from a human and just treat, you know, the parts that we're comfortable with. Just being able to recognize what the person's beliefs are and incorporating a little bit of that mind, body and spiritual connection, I think is so helpful because I practice yoga and meditation.
I incorporate a little bit of that with [00:53:00] my work as well. Um, and I find that it's a very powerful tool, um, and cutting through a lot of the fear and anxieties and, um, loneliness as well. Absolutely. My last question for you is what do you think is your biggest mom strength?
Sinéad: I think my biggest mom strength, honestly, is that I'm a connector.
So I feel like I'm that person that I'm always kind of connecting people together. I'm connecting, you know, the hockey moms or the neighbors, or even if I think of how our womb, our first womb, we opened, you know, 10 years ago and now we have six wombs and the franchise owners of every single womb came to do that through me.
They were either a client or they took a course of mine or. So, and I think, I really do think that's my biggest strength because, like, it takes a village to kind of do anything. We, we are always so much better together. And so we need those people who are going to kind of always be [00:54:00] like rallying and connecting people together.
And I would say like, that's something I do and I kind of do well, like it's kind of happens organically. It happens naturally. Yeah. Yeah. So I would say that's probably my biggest mom strength.
Surabhi: I have a friend like that. And I feel like it's so. It's invaluable to have someone you know in your circle who is like that because who takes a bit of initiative around it and makes those connections.
So one more question that I have for you is how can people best connect with you? How can they find you work with you all of that?
Sinéad: Okay, thank you. So, people can probably best, um, connect with me to actually interact with me, uh, through Instagram. I have a professional account at Doctor.
Sinead. A good bit of this is dedicated, not surprisingly, to pregnancy related pelvic girdle pain, but it really is a professional account, not a personal account, so some useful info there. You can DM me there. Um, you can jump into my bio there where I have, you know, the different websites for the companies I [00:55:00] teach for.
I also have my McMaster experts link there. Um, you can just Google my McMaster experts link separately. If you just Google my name and McMaster experts, all of my publications come up. Some of the. Stuff I do with FIFA is connected to their the courses. I teach. Um, I'm on LinkedIn. You can also kind of connect with me there.
And then, of course, there's always the womb, the world of my baby. You can jump onto their website and, uh, you know, you can kind of connect with me and get a sense of sort of what I do that way.
Surabhi: Thank you so much. I will share the links to all the things that you mentioned in the show notes as well, so people can find, um, find you and connect with you more easily.
And I'm going to check out your publications. You have so many. I feel like you're always doing something. So, um, I'm grateful for you in the profession, to be honest, you're elevating the profession by, by sharing this with us as well.
Um, thank you so much, Sinead, for this conversation. I loved hearing your perspective on pelvic pregnancy related pelvic girdle pain, [00:56:00] urinary incontinence, the high fem technology. Um, and I think for anyone who's hearing this episode, whether you're a pelvic PT or somebody, just a human who's interested in these topics.
Um, Do us a favor and go share this episode to your Instagram stories. If you're on Instagram, share this with a friend who need, who would benefit from listening to this conversation. Tag us, let us know what you think. Thank you for listening all the way to the end. And thank you, Sinead, for spending your time with us today.
Sinéad: Okay. Thanks again, Surabhi. And bye everybody.
