75. Biopsychosocial Approach to Pelvic Health with Teresa Waser
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If you're a physiotherapist working in pelvic health, if you struggle to navigate the biopsychosocial influences to pain and offer the most empowering care to your patients, you'll want to tune into this episode!
Surabhi interviews Teresa Waser, physiotherapist, educator, clinic owner and mom, as we explore the TIIPPSS-FC framework for Reframing Pain, Pelvic Health, and Performance. We start with the Biopsychosocial Approach, discuss psychosocial influences on pain including asking the right questions on intake forms. We discuss the importance of experiential learning for patients. Teresa shares her journey into pelvic health, highlighting the pelvic floor's vital role. We touch on Diastasis Recti, addressing disordered eating, and the challenges of perfectionism in physiotherapy. Plus, we share exciting updates about upcoming courses and delve into self-care and pessary fitting for pelvic health.
We discuss:
TIIPPSS-FC framework for Reframing Pain, Pelvic Health and Performance
What is the Biopsychosocial Approach?
Addressing psychosocial influences to pain and symptoms as a physiotherapist
Intake Forms and Screening Questionnaires to include
Using experiential learning to show patients how they can move with less symptoms
Teresa's journey into pelvic health
Pelvic floor being the missing link in physiotherapy
Factors to consider in Diastasis Recti & Postpartum Recovery
Addressing Disordered Eating as a Physiotherapist
Balancing motherhood, business ownership and teaching
Perfectionism in Physiotherapy and Letting it Be Enough
TIIPPSS-FC Live-Online Course in October 2023 and in-person course in Ireland in March 2024 (links to register below)
Self-Care as a Mom & Business Owner
Pessary fitting for pelvic organ prolapse and stress urinary incontinence
Today’s 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!
Bio for Teresa Waser:
Teresa Waser is a passionate educator driven to help healthcare and fitness professionals reignite their curiosity, challenge what they believe, and strive towards a truly biopsychosocial approach. She teaches online and in person courses, is a pelvic health and orthopedic physiotherapist, and owns RX Physiotherapy in Leduc, Canada. She is a former running & CrossFit coach and while she stepped away from group coaching a few years ago, she still works with clients in a 1 on 1 basis. Teresa is also a mom of 3, including a set of twins. She loves traveling, horseback riding, and lifting heavy-ish barbells repeatedly.
Connect with Teresa & Important Links:
—https://www.facebook.com/teresa.graysonwaser
—https://www.facebook.com/rxphysiotherapy
—https://www.instagram.com/rxphysio/
Courses:
—TIIPPSS-FC: Reframing our Approach to Pain, Pelvic Health and Performance Live online, Oct 21 & 22, 2x4hr sessions, plus 2hr recorded research review, hosted by Reframe Rehab, only $249CAD https://reframerehab.com/products/tiippss-fc-reframing-our-approach-to-pain-pelvic-health-and-performance-north-america-may-6
—Beyond the Pelvis: Live online, Nov 4, 8hr course, extremely practical, Hosted by Pelvic Health Solutions, only $199CAD https://courses.pelvichealthsolutions.ca/products/beyond-the-pelvis-exercise-for-the-whole-body-and-the-everyday-person-online-november-2023
—TIIPPSS-FC Masterclass in Cork Ireland, March 23 & 24 Live in person, 2x8hr, plus 2hr recorded research review https://rxphysio.ck.page/products/tiippss-fc-masterclass-cork-ireland
Connect with Surabhi:
Website: https://www.thepassionatephysio.ca
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Episode starts at 01:44 after ad from sponsor Embodia, teaser and intro music.
Surabhi: [00:01:44] Hi, everyone. And welcome to another episode of Mom Strength. This is your host Surabhi Veitch. And I'm really excited to have on a special guest today. Teresa Waser, who I met About three years ago now, um, online through Antony Lo's, The Female Athlete Course, I was recently postpartum with my second child and I had to take this course because I wanted to learn everything there is to know about coaching in the pregnancy postpartum space and just expand my own knowledge.
And I met Teresa, who is one of the TAs. And Teresa is brilliant. She's compassionate and I want to just give a brief bio before actually welcoming her on. So Teresa is a passionate educator driven to help healthcare and fitness pros reignite their curiosity, challenge what they believe, and strive towards a truly biopsychosocial approach.
She developed TIIPPSS-FC, a framework for creating change in how we help those with pain, pelvic health issues, and or performance concerns. Teresa, I am so excited to [00:02:44] have you on here today. Thank you for. coming and sharing your yourself
with
Teresa: us. Yeah. Thanks for inviting me on.
Surabhi: So I would love to first of all, get an idea of where you work, um, what types of clients you support, and then I want to know everything there is to know about your course.
Teresa's clinic and work
Teresa: Sure. Uh, so I work in Leduc, Alberta, Canada. I own a clinic RX physiotherapy. It is a bit of a mixed bag practice. We treat orthopedic concerns, uh, so all kind of the standard things that we might think about when we think about physiotherapy. And then we also do a lot of pelvic health in the clinic. Um, so, yeah, I do clinical work.
Uh, still work in the clinic, seeing people on a regular basis. Uh, and then I also have the great privilege and honour of educating. Uh, so I get to... I do still TA a bit for Antony, and then I also have my own courses, TIIPPSS-FC being one of [00:03:44] them, and then I have another course called Beyond the Pelvis.
Surabhi: Yes, which is about exercise for the whole body, and I, I strongly relate to that, especially somebody who went through two pregnancies and births and experienced pelvic health concerns as well as diastasis.
TIIPPSS-FC framework for Reframing Pain, Pelvic Health and Performance
Surabhi: Can you tell me a little bit about TIIPPSS-FC,
Teresa: so TIIPPSS-FC came to be because I was going around teaching, having conversations with a lot of fellow brilliant clinicians and fitness professionals. And we all have our own biases. We have learned certain things in courses. We have our own personal lived experience for things that made Might have worked within our own bodies.
Uh, we have that confirmation bias of we try something that we think works with our clients and it does work. And so then that kind of, you know, um, makes us feel like, oh yes, like this is the right thing to do. This is what everyone should be doing. And those times where it doesn't work, we are, you know, we're all kind of a little bit [00:04:44] prone to maybe discounting that.
Uh, and so TIIPPSS-FC was really a framework that I came up with first, just to help myself pull all of this together, uh, to make sure that I was challenging my own biases, to not just fall into the things that I usually do. And then also to really start to embrace a more biosafety. So we're not just looking at issues in the tissues, and yes, that biological piece matters, and we're still looking at that within the framework, but also considering all the psychosocial aspects that, you know, intimately relate to how our biological systems work, and hopefully giving folks a framework to pull this all together and, um, hopefully instill some creativity, some inspiration, uh, to question and to do things a little bit differently.
Thank you
Surabhi: I love that you also called it a framework because so often in school we learn, um, this is, these are the exact questions you need to ask. This is exactly what you need to do. This is how you do [00:05:44] an assessment. And especially for new graduates and new practitioners, you just blindly follow it, um, without awareness of, Oh, you know what?
Do I actually need to do this assessment? Do I need to do this test?
What is the Biopsychosocial Approach?
Surabhi: Can you talk a little bit about the biopsychosocial model and what it is, just for people who maybe are new to this terminology or don't actually understand what that means?
Teresa: Yeah. So I think that, um, speaking from my experience, uh, doing a Canadian physiotherapy program at a Canadian university, um, where did you go out?
I went to the U of a and Edmonton. Okay. Nice. Yes. Many years ago. Um, but yeah, so I can't speak to what the program is like now, but I can speak to what it was like when I went through it. And we certainly did have discussions. We had courses that touched upon those psychosocial pieces. But then there were also courses that were very manual therapy focused, even my early postgraduate education, you know, I went [00:06:44] through the orthopedic division levels and same thing was very much focused on, you know, pathoanatomical drivers of symptoms.
Um, and not really. That step or, you know, to take that, um, bridging of the gap between, okay, yes, these factors do matter. And yes, we can potentially create change by addressing these biological factors. But how the heck do we incorporate all this other stuff? Right? So what's going on with their sleep?
What's going on with their nutrition? What's going on in their world? Um, Thank you. What are the, the social determinants of health that could be influencing the person in front of us? What is going on in their inner narratives? Um, and so, yeah, I think that while, you know, our introductory level physiotherapy education is a beautiful start and we all have to go through that, um, there are still some gaps and.
You know, [00:07:44] really practically applying that biopsychosocial approach that how to actually do, do that with a human in front of us, um, is not always super apparent to people.
Surabhi: And I like that. So often we think soft skills are just innate, like, Oh, you just have it or not, you're just good with people or not.
And I do think there are some people who naturally have that gift. But I do think that the way you're teaching it is, it's also makes it easy for the person to learn these skills and learn how to navigate. If that person in front of you has, uh, a marker where you're like, you know what, this is a large influence in there.
Like something as simple as sleep, you know, I work a lot. I'm sure we both work a lot in the pregnancy postpartum space and lack of sleep is huge. And it's sometimes out of our control. And so if we're thinking, oh, it takes, you know, X amount of weeks to strengthen a muscle and you're not better yet. Like what, what, what am I missing?
If you're missing something as simple as. poor sleep, poor nutrition, you know, those are huge impacts [00:08:44] in that person's symptoms. And, um, I love that the way you're talking about it too. Like in school, when I went, when I graduated from U of T, we definitely learned the biopsychosocial approach, but we learned about it in theory.
We didn't actually learn. Okay. Now what, how do you actually address it in the patient in front of you? If you, if you hear that they have depression or they have, um, some cultural belief that it may be impacting their recovery.
Teresa: Yeah. And I think that same for me, there was this awareness that these factors can influence someone's symptom presentation, but there wasn't necessarily, okay, how do I truly assess for that?
And then what the heck do I do with it without leaving the person thinking that I'm saying that it's all in their head.
Addressing psychosocial influences to pain and symptoms as a physiotherapist
Surabhi: That's what I was going to ask next is actually how do you address it with the patient when I find that many people are so ready to accept, oh, you have a torn ligament, you have a weak muscle, a very structural, um, impact or [00:09:44] contribution to their pain or symptoms.
And some people may be a little bit more, um, uneasy or unwilling to accept that, oh, you know what? This actually has a lot to do with, um, you know, Your mental health, for example, or your beliefs, or, you know, the big fight you just had with your partner. Like, those types of things that are not what we went to school for, right?
We didn't go to school to handle those specific conversations, but we, yet we still deal with it every day. Ah,
Teresa: yeah. It's a huge answer. Yeah. So, I think that it starts right from our very first conversation. Contact with the person, which in our case is usually our intake forums, right? So whether someone is calling in and booking it into the clinic or whether they're booking in online, um, their first kind of conversation with us is the intake form.
Intake Forms and Screening Questionnaires to include
Teresa: And so our intake forms, they have things like the DASS-21, [00:10:44] um, the Insomnia Severity Index. Uh, the CSI, um, the PANAS, which is looking at positive and negative affect. They have all of these evidence based outcome measures that are inlaid into the intake form. Partly because I don't want my biases to influence like, Oh yeah, you should get these questionnaires and like, Oh no, I think you're right.
So everyone gets them, um, they are not a mandatory part of the forum. So if, you know, if you have someone who. They're like, yeah, I don't want to deal with this, or I don't want to fill this out, or I don't think that this is relevant. They do have the option to bypass that. That also gives me good information.
Yeah. Part of it is assessing their readiness, um, because just as clinicians and fitness professionals, we have our own beliefs, experiences, expectations, stories. So too does the individual that is coming to get help from us. Uh, so I think that I kind of have, you know, sort of a stepwise [00:11:44] approach. The first step is seek to understand.
So when that person is coming in for their initial consultation with me, I'm reviewing their intake form ahead of time. I have questions that are inlaid within that, um, in terms of like, how can I make this the best experience for you? Um, you know, what I love that question, um, because I, I want to get a sense of, you What do they think is going on?
What are the things that are most concerning for them? I'll also ask them, like, what have you tried before? Right? Like what has been really helpful and what might you have tried that isn't helpful? And in that subjective history, there's so often gems in there. Yeah. We're asking those questions of when do your symptoms occur?
What are things that might make your symptoms worse? What are things when you actually feel better? Um, they are giving us so much gold in that conversation that we're having with them and us giving them the opportunity just to hold space, to hear their story out without [00:12:44] interrupting them. Um, like we might've done when we were fresh physios.
I cringe. I cringed back then. Yeah. Yes. I was there too. I was there too. Um, so I think that's the very first step for me is seeking to understand. Um, and within that seeking to understand, I'm trying to kind of feel out what is their, their readiness, um, to potentially consider something different. Uh, so like you mentioned, if they come in and they really have a very patho anatomical narrative for why they think they have, um, XYZ symptoms.
Um, or their expectations for what physio is going to look like are very much like they want you to fix them. They want you to structure that is at fault and do something with your magic hands or your magic needles to make them better. We need to know that, right? And that there may be this disconnect between what they're saying, what their narratives are, what their [00:13:44] beliefs are, what the evidence tells us is true, and the way that we may ideally practice within our field.
So if you said our beliefs and experience and knowledge, um, so we have to, um, you know, check and see where are they at? What are they potentially ready for? And try and find that middle ground with them. Um, I really like to ask for permission to explore. Oh, you can ask that question. Like How would you feel if we talked about another possible explanation for the symptoms that you're experiencing?
Or what if we, you know, if they have a symptomatic movement, um, what if we get up and try that movement? And we see what is their self selected way that they're currently doing it that might be generating some symptoms? And then without telling them any explanation of, you know, what might be going on and why we think this might be working and why do we think that the thing that they're doing is not helpful for them right now?
Using experiential learning to show patients how they can move with less symptoms
Teresa: Um, we just get them to [00:14:44] do it differently. We go through some movement experiments and if we can show them, give them that experiential experience, being able to do the thing that they want to do without having their symptoms, or at least with significantly less symptoms, that can be that light bulb moment.
where it's like, Oh, I thought that this was because my pelvis was out. Hey, well, guess what? I didn't touch your pelvis. And you just did that thing without symptoms. So what does that mean for the narrative that my pelvis, right? That's why I'm having issues and I need you to fix it. Right? And we don't need to say those things.
They'll have those light bulb moments on. Yes. I
Surabhi: almost think that that's yeah. Or I do think that's more powerful than telling them this big long winded explanation first trying to prove to them that no, this can't just be structural versus let's show them through through movement and let's show them that their body is capable of You know, doing XYZ symptomatic movement without even [00:15:44] changing the structure or poking with needles or massaging it or ultrasounding it or whatever they believe needs to happen in order to be able to accomplish their, their goals.
I absolutely love that. And your approach to even including these questions Same thing. I have some questions on the intake form, but I love some of the ideas that you have is it also preempts that person that, Oh, this person is going to be asking me questions about my mental health. This person may be asking questions about this so that it's not a shock.
This is something for new graduates. I remember I was like 25. I'm like, I feel awkward asking this. 50 year old personal questions about their, like, who am I? I'm just a kid, right? Like, you have that sensation or that feeling, that belief, but this allows you a bit more flexibility in how to start these conversations if that person has already, you know, voluntarily told you what's going on.
Teresa: Totally. It sets the stage and helps create those expectations that, hey, yes, These [00:16:44] things are fair game and you are, you have permission to talk to me about these things too, because this matters. You're a whole person. You're not just this pelvis or this knee or, you know, this
Surabhi: isolated, um, joint walking
Teresa: in.
Yes. Um, and even our whole body, our whole body is not an isolated thing, right? We have so many environmental factors and life factors that are going to be influencing how we're feeling. And also what we can potentially do with that person from a physio standpoint, right? We can have like on paper, like this would be like the perfect program to address, you know, all the things that are, are bothersome for you.
But if they are currently a postpartum mother, as an example, who is sleep deprived, um, who is incredibly stressed, maybe they're little as having
issues with a tongue tie, or maybe we're having some issues with, um, you know, colic or whatever. Maybe they also have two other [00:17:44] kids. Maybe they have a spouse who is currently unemployed. Um, maybe they have a parent who is ill. Um, you know, we can have life plates that are so incredibly overflowing that they come to us.
And if we might give them You know, all these things that, you know, in theory, sure, those things might be super helpful for this person to do, but if it's not matching the, what's sustainable and realistic for the individual, I personally think that it can be harmful because it just adds onto the shame, the guilt, um, the overwhelm.
Absolutely. And just makes them feel hopeless. Um, and that's the exact opposite of what we're intending and what we're wanting to do.
Surabhi: And I think we've all been there as. practitioners where, you know, I'm like, Oh, this is the perfect thing you need to do. And this, this will 100 percent improve. And then it doesn't improve.
And then, you know, this person is constantly, you know, like you said, sick or has other appointments or [00:18:44] has other things going on in their lives. Hurricane season, like there's so many things, you know, world disasters, all of these events do impact the person. And so we can't just say, Oh, just do your exercises.
And I've had clients who, um, Are given 20 exercises, you know, a whole email with a whole sheet and you're like what this person is barely even able to get in one. So where can we start with that is, like you said, sustainable, realistic, so the person doesn't feel like they're failing. Right? Because they're, they're not failing at that point.
It's our, our inability to see what the person actually needs.
Teresa's journey into pelvic health
Surabhi: Now you mentioned postpartum and I know you have your own children. Is, did you get into, or did you have more passion in, you know, pelvic health after you had your children? What was that journey like for you? Um,
Teresa: yeah, so I think, I think that there are [00:19:44] many, many pelvic physios that come to, um, the practice of pelvic health following their own challenges throughout pregnancy and postpartum.
Um, wasn't actually my experience. Okay. Nice. My initial daughter. Um, you know, I did not have any significant issues during pregnancy or postpartum with her. Um, with my twin pregnancy, I definitely did have more challenges. Um, I experienced, uh, pregnancy related pelvic girdle pain with my twins. Um, I experienced a C section recovery.
Um, and I experienced being in... The trenches, so the trenches of trying to care for two newborn babies alongside a two and a half year old toddler, my gosh, and just trying to really survive that gives me remembering what it felt like, um, and how accessible exercise and, you know, these self [00:20:44] care strategies.
Felt to me during that period, it gives me a lot of pause in really making sure that when I am working with someone who is postpartum, that I have a good sense of where is their mental health right now? What does their life plate look like? What feels like it's realistically sustainable and achievable for them?
Uh, and not everyone's experience is going to be like mine. I 100 percent acknowledge that, uh, definitely postpartum moms who have lots of support systems. Um, they may have the babies that just from day one sleep for longer stretches, bless them. Not my
Surabhi: experience. Yeah. Um, and so
Teresa: I didn't necessarily come from that, from having any significant pelvic floor dysfunction.
Um, I did, however, following the birth of my twins have a very significant diastasis, uh, which I, you know, that's, we could do a whole podcast on going through that. Uh, but I was an [00:21:44] orthopedic physiotherapist and, um, I was working with a lot of female athletes and working with folks who were coming to me and sharing that they had some pelvic health concerns.
Pelvic floor being the missing link
Teresa: I would certainly do what I could from an external approach, much like Anthony Lo does. But I am, I am someone who I want to know all the things, right. Just learn all the things. Yeah. So I went on my very first pelvic floor that introductory in Canada, the level one, uh, with pelvic health solutions, uh, really because I just wanted to know more, right?
I wanted to see what is this all about, uh, with no expectations that I was actually going to go on to Do pelvic health myself. Yeah. And it blew my mind. It was so amazing. I'm like, this is the piece that I have been missing and I was so excited. And it's been like a hundred miles per hour since then.
That's amazing. I love pelvic health. Um, So that was, uh, sorry, a lot of [00:22:44] information.
Surabhi: No, that's just really interesting to me because you're right. Most people that I know who entered pelvic health did so because of their own experiences. Let's say pregnancy, postpartum, or maybe even their own pelvic health issues.
from growing up or bladder, you know, health concerns. And so it's also interesting to see that, that transition. And, you know, what I found is I worked my first job. I worked in orthopedics for many years as well. And my first job was at a CBI, you know, Canadian Back Institute. So I saw a lot of back pain and I love treating back pain and neck pain.
I loved spinal injuries and issues and it blows my mind that I treated all that and missed the pelvis and pelvic floor stuff that we, you know, now learn later on. And I do hope that that, I think that has changed in the introductory like master's, um, physiotherapy program in Canada. I think there are including more pelvic floor or pelvic health stuff, but, [00:23:44] um, yeah, so much tailbone pain, butt pain, pubic pain, like there's so much that incorporates the pelvic floor.
And I think it is something, um, That we all could learn more about whether or not we're doing internal work.
Factors to consider in Diastasis Recti & Postpartum Recovery
Surabhi: Um, can we talk a bit about, I know you mentioned, um, that you've had Diastasis Recti. You have twins. Anyone who has twins or like multiples, I'm just like, wow. Like, wow. That's, especially being a mom, I now have so much compassion for moms who struggle with anything postpartum, because it is really hard, and when you're in the trenches, like you say, you can't see an out, and so every day feels really long, really hard, and if you have No partner support or your partner is away for work a lot or you don't have a family around you.
You are going through it often all by yourself and we don't have that village system that maybe people did have a hundred years ago. So I really [00:24:44] appreciate you sharing that because I think a lot of people will, um, hopefully it takes the guilt and pressure off needing to do all the exercises at like six weeks postpartum.
I know some who do, and I know some who can't even think about it for two years postpartum, right? They just don't have the capacity and both are okay. It is not too late to strengthen, um, or recover.
Addressing Disordered Eating as a Physiotherapist
Surabhi: Let's talk about disordered eating. So change in topic, but this is really important to me because this ties into your biopsychosocial approach as well.
And this is something that I see a lot. I work with dancers a lot too, and I see so much disordered eating that is normalized. Can you talk a little bit about how we as physiotherapists navigate this with our clients?
Teresa: Yeah, well, I think that as pelvic physios, those of us who are pelvic physios, we really do need to have, um, our alerts on, uh, for disordered eating.
And just to take a moment to clarify, there is disordered eating, [00:25:44] which is a spectrum of behaviours, thoughts, these kind of things in regards to food, um, that is not, Eating disorders, right? So we're talking about bulimia, anorexia, these kind of things. But disordered eating is very, very, very common. It's common in our postpartum moms.
It's certainly common in our female athletes. Something that, uh, the research has correlated with pelvic floor dysfunction. Um, so we need to be thinking about this cause it is happening with many of the people that are coming to see us. Um, and I think pelvic physios were already talking about, um, nutrition from the standpoint of things like gut and bowel health, uh, if someone comes in and they're having issues with constipation, we might already be jumping into, you know, how do we, uh.
intervene at that nutrition level to increase their fiber, to increase their water intake, um, to try and create these easier passable [00:26:44] stools. Um, you know, if they're having bloating, these kind of things, but also from an inflammatory standpoint. So if we have folks that are having Endometriosis, if we have some of our older clients that are reporting, um, symptoms of joint pain from osteoarthritis, all of these things, we're seeing a big link, uh, between symptoms, um, with these inflammatory conditions and our nutrition, what we're eating.
And so it makes sense that we, you know, want to be thinking about these things. We want to be discussing nutrition with our clients, um, but we also need to. Kind of in the sense be trauma informed around this. Yes. You don't know if someone comes in, do they have a past history of an eating disorder, an actual eating disorder, or are they somewhere that is, you know, on that eating disorder spectrum that is not very healthy?
And the questions that we're asking, the strategies that we may be suggesting may not necessarily [00:27:44] be appropriate for them. Even if on paper, we think, yeah, this would be good for your bowel and gut health. This would be good for helping Um, to, you know, curb the inflammation that's within your body. Um, so yeah, we have to be mindful of that.
And then again, it comes into that standpoint of seeking to understand, um, you know, asking those questions about, um, how do you feel about your nutrition? How does that currently look like for you? Do you have any concerns or past issues or current issues with respect to nutrition that you'd like to share?
Um, and then, yes, there is again, a spectrum of nutritional strategies where we may have that athlete that comes into to see us and they are already, um, maybe working with the nutrition coach, there may be already tracking their macros. They can tell you exactly how many grams of fiber, how many grams of protein, how many grams of carbs.
We can still look at nutrient quality with them. Um, but you know, these are factors that [00:28:44] we need to be aware of because maybe they're doing that and maybe it's working well for them. Or maybe they're also the person who is experiencing a relative energy deficit, um, is influencing their symptoms and performance.
Um, maybe from a hormonal standpoint, um, we're having issues there that are affecting things like libido. Um, you know. There are so many different things sleep can be impacted and we know we talked earlier about the ripples of if we're not getting enough sleep, how that can influence so many different systems within our body.
Um, so this is so interconnected and we need to be sensitive, um, to how. How this can be for someone who maybe has had this previously, and also to be sensitive that we don't want to be the trigger that creates a relapse if they have had issues in the past, or [00:29:44] the impetus to send them on a trajectory that leads them into disordered eating,
Surabhi: or, and then the other aspect is the shaming, I find that a lot of the times, We mean well, but there's this sense of judgment like, Oh, like you're not eating enough fiber, you need to eat more veggies, or like, there's this you need you need you need.
And I especially find this from people who, like a lot of physios, generally speaking, are thin, are active, they maybe come from an athletic background. And so they may not lack The lived experience or they may lack the lived experience of how it is to be in a larger body, the social pressures of losing weight, postpartum, all of those factors.
And I really think that your approach is coming from a very compassionate, sensitive and, trauma sensitive Way rather than like a, Oh, well, you're not eating enough of X, Y, Z and you need to do X, Y, Z, you know, the seeking to understand. I love that because when we even [00:30:44] just ask why or how or like what their beliefs are around this, they tell us everything.
Like my clients will tell me, you know what? I do need to eat more veggies. I know this. I don't drink and have water. It's not like they don't know, right? They already know. It's just yeah. leaving space for us to have these discussions. Um, and I do think that a lot of physios avoid discussions of this cause they think it's someone else's scope, but especially in pelvic health, their nutrition is important for us to understand because that impacts bowel, bladder health, inflammation, energy.
And so I have some, I've had people who eat one meal a day and They're just living off one meal a day even postpartum because they don't have time or energy or support to make more food. I'm not giving them a lot of exercise. That's going to suck up even more energy and they're already energy deficient, right?
So those types of things are so important to know.
Balancing motherhood, business ownership and teaching
Surabhi: Um, tell me a little bit about your own. [00:31:44] personal experience with motherhood and because you are a mom, a business owner, you teach courses. Is there a balance to this? How does this work?
Teresa: Oh my goodness. I don't know. I don't know. Um, I think that, uh, Everyone is going to be different.
Um, I think that we all have different levels of family support. Um, you know, what are our individual villages look like, um, can be different. Um, how many kids we have and what those kiddos might need for supports can be different. I am very fortunate that my kiddos are generally. Um, well adjusted. They have good friend groups.
They're involved in sports to, you know, keep them busy and active and happy. Um, academically, they're They're doing good. Um, I have friends who their kiddos require significantly more support. So they're going [00:32:44] through homework with them. They're going through, you know, some additional, uh, educational support with them.
Um, you know, so everyone is, is in a different boat on the sea of life and it's gonna look different for everyone. Um, so I think not comparing, uh, what we can do, right? Like what's going on with our life plate. Um, because it is just different and allowing it to look different depending upon what's going on.
So, you know, I think that it's really important for us as mothers and particularly for those of us that do work outside of the home or maybe You know, we're, we're working in the home, but we're still our, our typical, you know, mom jobs for us to acknowledge that we cannot do everything all the time, right?
Uh, we certainly can't do everything all the time at 100%. Uh, there needs to be give and take, there has to be ebb [00:33:44] and flow. Um, and I think that just allowing that to look different from Day to day from week to week. Um, I, for myself, I go through seasons. Uh, I, if you've heard of the analogy of like, are you a sprinter or are you a marathoner?
Um, you know, marathoners, they're people who they like to kind of consistently chip away at things over a longer period of time. That is not how I work best. And so I don't try to force myself to be a marathoner. Um, I intentionally create space. For myself to be a sprinter, uh, sprinters, we do better when we are able to, you know, have a chunk of time where we immerse ourselves in a project, uh, and we go hard.
And when I have those periods of my life where I'm working on something, um, you know, I'm very fortunate to have a husband that will kind of step up to the plate and, you know, take over a little bit of things, um, you know, take care of the kids for [00:34:44] a weekend. And if I'm kind of like. Down in the basement and just working for a weekend.
Um, and I also am very intentional about making sure that I'm not trying to sprint all the time. Yeah. Cause it's not sustainable. Um, so as much as I may need to be intentional about, about creating space to allow myself to, you know, work hard and tackle something in a shorter period of time. I also need to be intentional about creating spaces in my life where.
I really slow down. I practice my no muscle, uh, where I'm saying no to things, even if they're things that excite me and that I want to do. Yeah.
Surabhi: I don't, this is a lesson I need to learn that I'm, I'm in the process of learning because it is hard when you get excited about things and You like doing things and you like learning and you like you want to say yes, but it also is like you said we only Can't give a hundred percent to [00:35:44] everything and there's only there's a finite amount of capacity We have we can't just like we don't have unlimited capacity and I'm realizing as the kids get my kids are still so young So they still need a lot of Support and guidance.
But, but as they get older, I want to be around for those things too. And there was a while when I first started my business where I was just working so much because my husband was working from home. It was the pandemic. So I felt like I wasn't working because I was still at home with the kids, but I wasn't actually present with them.
So It's been about this, you know, setting these boundaries of when, when are you on and when are you off? And I love that, that sprinting, I've never heard that sprint analogy in, in, um, reference to this. So I really like that.
Perfectionism in Physiotherapy and Letting it Be Enough
Surabhi: And tell me about perfectionism because if this is something that I deeply resonate with and it.
It's, it's hard to let go of that perfectionism mentality and tell me about your, your experience [00:36:44] with this. Uh huh.
Teresa: So I think it is very common amongst us physios to be perfectionists, right? In order to have the GPA that you need to get into physio school, uh, you need to be a high achiever. So we are a group of high achievers and oftentimes with them.
That we have that double edged sword of perfectionism at the perfectionism drives us to be able to get those good grades, to do all the things that we need to do in order to be able to get into physio school and so on and so forth. It can also be really, as Brene Brown talks about this really shield that we create to protect ourselves, to not be allowing ourselves to be vulnerable and authentic.
And. Yeah. Particularly as, you know, if we are working mothers and also physiotherapists and, you know, we can't continue to do everything perfect 100 percent of the time, something's got to give. And [00:37:44] so, uh, you know, putting down that shield of perfectionism is a work in progress for me. Um, it's been the thing that has made the biggest difference.
Um, so my kind of current motto is let it be enough. Um, I am not going to have my house looking spotless every day of the week, not going to have, um, a beautifully curated meal that has like the nutritional density, the protein. Also, my kids are like, this is so delicious. Like that's just not going to happen every single night of the week.
Um, I'm not going to be able to be 100 percent in the clinic and the, you know, demands of running a business. Uh, and my teaching and the marketing involved in all of that. Yes. And not be running at full tilt on every single one of those. Simultaneously. Yeah. And I think a lot of times when we are perfectionist or recovering perfectionist, it's so easy for us to [00:38:44] look at all these different areas in our life and start, you know, waging our, you know, imaginary finger at ourselves and say, yeah, doing this, I should be doing this.
And instead, what if we just let it be enough? What if we practice that self compassion and say, you're already doing so much? What if we look back and say, look at all you have already accomplished instead of always being so hyper fixated on that next thing that we think we have to do. Um, and like you said, being present.
with our kids, right? Um, you know, if we're always so driven on doing everything perfectly and particularly in our professional arenas, we are going to miss out on things that we, you know, probably don't want to, well, at least for my, I can speak for myself, like I don't want to miss out on. You know, attending my daughter's horse show or going watching my eldest daughter play volleyball.
Yes, those. So those [00:39:44] are non negotiables for me. Um, like I have sacred family time and I'm not a hundred percent of that
Surabhi: either. Yeah. Because I can't. You can't be. And I think that's a, I often think of like, okay, at the end of this life, what matters, right? Obviously you're really passionate about your work and, you know, spreading the message, but you're also, you have a family that you're also equally passionate about.
So it's, Yeah. Finding for me the presence part has been huge because I now at the end of the day, I'm like, I just think about one moment that really brought me joy that really brought me just something, you know, cute that your kid said or did or I've started to actually make a list of that because that reminds me the value in being present because there are so many times where I can get like roped into whatever I'm doing hyper focused and I've It's like I, I don't even see the rest of the, the world and it reminds me of, okay, you can do that for a little bit, but you have to look away and be present [00:40:44] because this is the other stuff that you're going to miss when you're not doing that and removing that, um, guilt and that shame out of it and just looking at it from a, This is how it is now.
What can I do slightly differently instead of, Oh, I'm such a bad mom. I'm such a bad XYZ. Um, because as soon as we start doing pointing that finger back at us and wagging our finger, it just leads to this negative space of like shame and this like wallowing in shame, which sucks.
TIIPPSS-FC Live-Online Course in October 2023 and in-person course in Ireland in March 2024
Surabhi: Um, tell me a little bit about your course coming up.
TIIPPSS-FC is coming up October 21st and 22nd. Um, tell me about. That and how people can sign up for it. Yeah, so
Teresa: this is a course that I've had the pleasure of presenting on several occasions. Um, I think the first time that I did this course was in 2020. So it's been a few years now and the duration gets a bit updated.
Uh, so I'm excited. This course continues to evolve. [00:41:44] It brings my TIIPPSS-FC framework into practical application. Uh, it's filled with experiential learning. So we do a bunch of movement experiments at our own bodies throughout the course. Um, we have a lot of interactive discussion. We have a lot of challenging of beliefs and biases, and we also incorporate well, what does the research actually say about these?
And what can we make of that? Um, there's a 2 hour pre recorded research review where. You know, I, I want the live course to be very interactive, to be moving our bodies, to be, you know, having our, our brains turned on and engaging. Um, and so I took the research part out. Um, and so that's a pre recorded piece that you can watch on your own.
And then we have two, four hour live online sessions where we go through the entire TIIPPSS-FC framework. Um, you know, a bit of a deep dive there. And then we also go through some case studies. Uh, so it's really. a fun, fun course. I have so much [00:42:44] fun every time I teach this. The feedback is always glowing. Um, so it's a really fun course that's incredibly practical.
Surabhi: I love that. For anyone who doesn't know Teresa and has not worked with her or Learn from her. I just know that this course is incredible. And the way you teach is very, I love your examples in your analogies. I'm a very analogy person. Like I have to be able to relate it to something else. And I think that that is really powerful because it helps people make that immediate connection and Put it into practice right away.
I have been to so many courses where you attend the whole weekend and you're like, I don't know how I'm going to put any of this into practice. Like that was nice to learn. Cool. But what now? And I think that the way you teach is very much like, okay, you can actually learn this and put it into practice.
Now is TIIPPSS-FC an acronym? It is. So for people who are unfamiliar with this, it's spelled T I I P P S S F C. [00:43:44] And I will share the link to sign up for this course, um, which is happening in two weekends from now. We're recording this on October 12th. So this episode will come out on Monday, the following Monday.
And I hope that people will, um, go sign up for this. And then you have a one in Ireland as well, is that right? Yeah, so
that is the TIIPPSS-FC Masterclass. Um, so the live online version is eight hours of live time. Um, the Masterclass is 16 hours of live in person face to face time. Um, so we get to do even more fun things.
Very cool. Yeah, we get we go into a gym where we have access to all the gym equipment so we can really put this into practice in a way that people tuning in live online and just using equipment that they might have at home. You can't quite get the exact same. Like, don't get me wrong. It's Still powerful, but, um, actually getting to lift heavy and to witness the [00:44:44] experiences of others around you in the same room, having those dynamic, uh, conversations.
It's really beautiful. We did it last year in Liverpool and it was awesome. I had so much fun with that course as well. And so we're bringing it to Cork in March of 2024.
So cool. That's so cool. Um, I have a few questions for you. Um, some final thoughts about this is you personally unrelated to you and your courses and your work.
Self-Care
Surabhi: What are three simple things you like to do for yourself for self care every day?
Teresa: Um, I like to try imperfectly as best as I can to practice self compassion, um, to honor my now to let it be enough and to continue to come back to that as my mantra. Um, I also like to, you know, try to whatever I can consistently and sustainably do for movement and exercise.
I like to get that in because that [00:45:44] tends to be, uh, for me, like the, the domino piece, um, I'm consistently moving, then I tend to sleep better. My mood tends to be better. Just all the things tend to be better if I'm getting that in. Um, and so I still honor my, now I still let it be enough. Um, I don't. You know, I do sometimes have those inner narratives of like, I should be working out more.
I should be more. Um, I observe them and then I let them go. Yeah.
Surabhi: And what do you enjoy for movement? Cause for
Teresa: movement right now, um, CrossFit is my jam. Um, I love that I can honor my now and let it be enough within CrossFit. Um, so I go there, they tell me what to do. I scale it to whatever feels like it's honoring my now for that day.
Love it. An hour. So it fits into my busy lifestyle and it all happens before my kids wake up.
Surabhi: Okay, that is, that is goals. I'm, you're, are you a morning person then? [00:46:44] I'm
Teresa: not a morning person, but, um, yeah, it just, uh, it's what's worked for me. And I will also, I just want to throw out there that it, that would not have been an option for me for years, um, since my kids have gotten older and now they're at that age where they're not waking up, uh, they're old enough if they did wake up and I'm not here, like there's not.
Um, you know, so for many, many years, that wouldn't have been something that I could do, but it is something that is currently working well
Surabhi: for me. Amazing.
Pessary fitting for pelvic organ prolapse and stress urinary incontinence
Surabhi: What are you really passionate about right now? Could be anything.
Teresa: Yeah, right now I'm doing some pessary fitting and I'm passionate about this because it's one of those things that can be a game changer for people that are experiencing pelvic organ prolapse and stress urinary incontinence.
Uh, there is so much that we want to do outside of pessary. So [00:47:44] yes, we're not using this as just, you know, a bandaid approach solution at everyone who has these concerns, but it's one of those things that can make. Such a massive difference in their quality of life right now. Um, you know, cause a lot of those other things, it's not necessarily going to be like
Surabhi: an overnight change.
Yeah.
Teresa: Um, and so we can use pesaries to create that change, um, in a short term, uh, while also continuing to work on other things.
Surabhi: Also, a note that that's kind of a reflection of your beliefs, too, is like, there's one extreme that's a, everything has to be active, active, active, and then there's the other extreme that's like, passive, I fix you, all the products, all the devices, and the reality is the best is somewhat in between, where you're using those devices, you're using the support systems, the hands on support that you need, combining that with active movement and strategies and all that, all of that [00:48:44] stuff.
So, um.
Teresa: Well. I think also just to acknowledge that there are limitations, right? So if we have someone who has really significant fascial descent, um, yes, we can strengthen the pelvic floor. We can strengthen the urethral sphincters. We can change the how of movement, but all of those strategies and some individuals may still not be enough for them to be able to do the things that they want to do.
Um, with a level of symptoms that is. Satisfactory for them. And that's where having, you know, some support from a pessary can make all the difference. I love
Surabhi: it. If you could change one thing about the world, what would it be? I think if
Teresa: we could all just acknowledge common humanity, right? You know, there's always these polar extremes, um, you know, different viewpoints, people against each other.
Um, but at the heart of it, if we strip all of that away, we're all humans. We all have a need for connection, [00:49:44] for safety, uh, and I think that if we could all collectively acknowledge that, the world would be a better place.
Surabhi: start seeing each other, start seeing ourselves in everyone. Like, I think that's the thing is we see people, Oh, you have different culture, different language, different religion.
And we think that is the bigger deal instead of saying, Oh, we're similar because X, Y, Z. Right. And that's something that I actually practice with my kids is often like, if you see a kid in the playground, what do you have in common? Like what, Oh, you both like the slide, like see that first instead of seeing the differences first, because if we focus on the differences.
There's a lot and that's all we're going to focus on, but there's way more similarities than anything else. And at the end of the day, we're all human. Um, I love that. And what do you feel, what do you think is your biggest mom strength?
Teresa: Um, I think it's been a work in progress and I think it's been that journey from perfectionism to letting it be enough.[00:50:44]
Um, you know, we don't want perfect to be the enemy of the good and we can allow it to just be enough and to lean into the things that excite us, lean into that next right thing without necessarily having like this trajectory of like everything being planned out. Yes. So much freedom that that. Provides, uh, and that freedom is, is, has been a gift for me.
And I think that that's where my mom's strength has lied in just those mindset shifts.
Surabhi: And that impacts your kids too, because I know I grew up with the pressure of perfection, even for my parents. And as a parent myself, I, I strive to take that pressure off of my kids because it's, it's not a healthy way to live with that constant feeling of, I need to do better.
I need to do better. And, um, I love that. Thank you so much for sharing your time and your expertise. You are an amazing speaker. I love everything you, um, have to share and your [00:51:44] passion. I'm so excited for you to just keep seeing what you do in this world and the things that you share in this world. For anyone who wants to connect with Teresa, where's the best place to connect with you?
What's your Instagram handle, email? How would you like people to connect with you?
Teresa: Instagram's probably the easiest. Uh, my handle for Instagram is at @rxphysio.
Surabhi: And I will share that in the show notes as well. Um, go sign up for TIIPPSS-FC, um, and stay connected. If you listened to this podcast episode and you enjoyed it, please share it, share it to your stories and tag us and let us know your thoughts.
Um, we always like hearing what people have to say and what they learn from our podcast episodes. And I'm just grateful for everyone who has tuned in today. Thanks so much.
