Episode 15: Pee, Poop and the Pelvic Floor with Dr. Kyle Brunelle
Question: What do pee, poop, and farts have in common?
Answer: Sometimes, your ability to keep them where they belong hinges on the efficiency of your pelvic floor!
Wait! What the heck is a pelvic floor?
In Episode 15 of the FRW podcast, my friend Kyle Brunelle and I discuss all things pelvic floor and the benefits of out-of-network (cash-based ) physical therapy.
Kyle Brunelle graduated from Utica College in Utica, NY, with his Doctorate in Physical Therapy. He has since dove into continuing education to ensure he provides the best and most effective treatment for his patients. He is a Certified Integrative Dry Needling provider and has taken extensive education on modalities like taping, scraping, and treating common musculoskeletal injuries. He also has advanced training in pelvic health for both women and men and is proficient in treating pelvic health concerns.
Kyle’s passion lies in listening to his patients’ full stories. It’s essential to Kyle that you feel heard and listened to. He is dedicated to helping you understand what’s going on so you can work together to determine the best solution for your life and get you feeling better faster.
As an avid outdoorsman and athlete, he’s experienced frustrating injuries and setbacks and can relate to the athlete and active human you are. He’ll be your personal hope dealer and solution provider so you can get back to what you love doing without being held back by aches, pains, injuries, or the fear of getting hurt. His approach is movement-biased, with a great blend of manual techniques like blading, massage, needling, cupping, and more.
So what, now what?
Everyone, including firefighters, has a pelvic floor. And some of the actions we take to survive the day (the safety pee or the 'holding it during a big job') can contribute to issues. You now know you HAVE a pelvic floor, and you can screen yourself for pelvic floor issues below! Remember, as Kyle states, "you have a pelvic floor challenge until proven otherwise!"
See if you might have pelvic floor dysfunction with the Nicole Cozean Pelvic Floor Dysfunction Screening tool
Listen to the Renegade Performance Podcast
Check out the pelvic gym DIY program
Follow Renegade on IG
Schedule an appointment with Renegade:
603-267-0432
Book here!
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Annette Zapp: 0:02
Thank you for joining me on the fire rescue wellness podcast. I'm your host AZZ. I find the research and resources and then provide the fire service with the so what now what? To ensure the health and well being of every member of our profession. Together. Let's thrive. Welcome back everyone to Episode 15. I am very excited to be here with my friend Kyle Brunelle. Kyle say hello to my people, folks. That's a good one. Kyle. Sometimes we get lackluster hellos, that was a good one, I give you 10 out of 10. So as I start every podcast, the vast majority of my guests are my personal friends. And so I'm going to tell you how I met Kyle. mile is the other half of my main woman, Lex Lancaster. You've probably heard me talk about Lex before. She is my virtual assistant. She is beyond amazing. And in 2019 Lex and Kyle were traveling to Alaska to start a what do you call those things? Traveling PT? Is that right?
Kyle Brunelle: 1:10
Yeah, we're on our way to Alaska to start a traveling, physical therapy assignment. And AZ was nice enough to like gracious enough to offer her own home for us to stay a night or two.
Annette Zapp: 1:23
okay, and it was beyond fun. And it was one of the greatest weekends. I think it was weekend. My friend Zamia was here with us, Lex and Kyle. We did all the fun things. But if we're being honest, Kyle was a little apprehensive.. he and Lex for driving here and Kyle's was like are you sure? And everything was great. Once he got here, am I right?
Kyle Brunelle: 1:45
Well, I mean, at that point, I didn't really know you. And I don't know if Lex really knew you that well, either. And I was like, this lady is extremely nice. Maybe she's like, gonna kill us?
Annette Zapp: 1:55
There's a really good chance that I could have been a serial killer, like 15 out of 10 chance, but I wasn't and we had a great time. So I start every podcast style with three rapid fire questions. Are you ready?
Kyle Brunelle: 2:09
I'm ready, I think. Okay,
Annette Zapp: 2:11
Kyle Brunelle, Who are you?
Kyle Brunelle: 2:15
I am a husband, a dog dad, and a physical therapist, working with sports and performance, folks and pelvic health,
Annette Zapp: 2:25
ah, pelvic health, we're gonna dig into that later. And what sets your soul on fire.
Unknown: 2:32
Education, both for patients and other clinicians. I love a good riff on really any kind of clinical or business topics. So education and really just yapping. So fitting that we're on a podcast? So individually, with each of my patients, both for
Annette Zapp: 2:45
Yes. Well, and fun fact, if you you know me, you know, I do not stay up past eight o'clock. And when Kyle and Lex were staying with me, I actually stayed up pretty late one night, I think it was almost 10 o'clock. And you know what we were doing? Were sitting around the kitchen table talking about performance and wellness and fitness. So yes, I love these things. Alright, last question, Kyle. This is a tough one. How are you changing the world? like, again, movement and sports performance, keeping them active and healthy and doing their thing, or keeping them from, you know, peeing their pants when they're trying to do this thing. And then as a group as a whole kind of having more broad impacts, helping train other providers, students and such. I absolutely am on board with everything you're saying. And I just made a note because I'm old and I forget things...peeing your pants we're going to talk about later. Okay. I try to stay organized, Kyle. So first, I want to start off, your PT practice is unique. And actually you guys were building that practice during the, like a heart of COVID If I remember right, and so you actually treated me and we live 1000s of miles apart. So you treated me virtually, which was a new experience for me. But also, it was quite successful. So tell us first about your PT practice, about Renegade. And then how do you actually treat people virtually?
Unknown: 4:18
Oh yeah, so Renegade is an out of network practice, or a lot people call it cash-based, meaning that patients are responsible for the financial part of their own care. The reason we did that is insurance sucks. And long story short, it creates a culture and atmosphere and environment where you cannot treat the people, who will at least for me, the people I wanted to be able to see and in the way that I wanted to be able to treat them.
Kyle Brunelle: 4:42
So largely, you know, most PT clinics don't have barbells and dumbbells and the opportunity to spend an hour working with the person one on one looking at like, you know, heavy squats and deadlifts and things like that and those people I wanted to work with so I got out of that real quick and created my own business and yeah, I mean, it's I always joke folks like I wouldn't own business otherwise, Although leadership also is something I'm not unfamiliar with. But at any rate, we created a clinic so that I could work with the folks I want to in the way that I want to help them. To that end, virtually, sometimes is an option that I offer folks, because not everybody lives, right in my immediate vicinity, as AZ pointed out. And so yeah, it's a great option allows me to get a bit more creative when I do see folks virtually, because obviously, I can't put hands on, obviously, I'm looking at a screen in 2D versus a person in 3D. we have to get a bit creative. And also, there's the constraints of what does a person have available to them. Now I was working with AZ, she has a whole like, full ass gym in her basement. So it's pretty sweet. So that was easy. But yeah, it's, it's cool. And it's a great option for folks. Because there might not be somebody who fits your vibe and can help you with the things you want to work on in your immediate area. And so if you're listening to this, that's a great option, whether it's, you know, obviously myself shamelessly promoting but, or somebody else that does the same thing offers virtual options, that can be a great way to access care, and work with somebody who gets you and can help you get back to doing the things you want to do versus seeing the local run of the mill, you know, insurance based practice.
Annette Zapp: 6:19
I definitely try to talk less and listen more during my podcast, but I'm gonna quick relate. I'm a big person...analogies, and metaphors really work for me. And so what Kyle is talking about when you truly vibe with a health care practitioner, it makes a huge difference. I saw the same dermatologist for 10 years, and we had this understanding of how he was going to treat me and what kind of patient I was going to be. And it was perfect. And then he sold his practice to a large, it's called Rush Hospital, a large, hospital from the area. And so I was inherited by another dermatologist who I saw last year. And I just couldn't stand him like, if we're being honest, I could not stand that guy. I made another appointment just because I felt like I had to. And when they called to confirm it for this year, I was like, No, I'm not going. So then I got on ZocDoc and I just started scrolling through, and I picked at random practitioner and I saw her yesterday. And it was like magic. It was like we were our best girlfriends after seeing her once and this is what you're looking for in practitioner. And so what Kyle's talking about is important.
Unknown: 7:31
Yeah, it's super important that you find somebody that vibes with you. And there's something for everybody. And that's why I think like in PT there was a whole New York Times article came out about this guy who had, you know, a knee injury or something. And as a reporter, he went around all these different practices. And he got all kinds of different treatments and approaches and treatment narratives and stuff like that, from different for like five different PTs, he got five different opinions, basically.
Kyle Brunelle: 7:53
And he wrote this whole article, and it kind of, you know, brought up this whole idea about like, practice being individualized versus like, variations in care, basically, what came up and the white paper that was wrote about it from our profession. The APTA was like, Oh, we have to get rid of this. And I was like, No, absolutely not, we should not get rid of this. Because every human is different. Everyone's an individual. And so my vibe, and my biases are going to be great for certain folks, and not so much for other folks. And there might be somebody else who's a lot better suited for the folks that maybe aren't, you know, vibing with me. So it's super important that you find someone who's aligned with your values, and vibes with you.
Annette Zapp: 8:30
When when you go to say, Burger King, you have an expectation from Burger King to Burger King, the fries should be the same, the Whopper Jr. should be the same. But that's not where we want our healthcare. We don't want cookie cutters in our health care, because we want the opportunity, like Kyle said to vibe with someone. It's so cool. Amazing. So from your perspective, Kyle, again, I don't want to be the one doing the primary amount of talking...so I was your patient. But from your perspective, can you just tell the listeners what that was like? Greeting me 1000s of miles away? On? Basically, camera?
Unknown: 9:12
Yeah, so really, the only difference is hands on to test things and hands on treat things. Now, for me movement is the bias my treatment anyway. So again, balance is good finding the middle and not leaving the pendulum swinging from one side or to the other side extremes to extreme, finding that middle ground and that balance is good, right. But for me, certainly movement is a bias. And I think most people come to me with challenges with movement. So I want to get them moving and being able to do movement again, because that's their original challenge, right? So largely, I don't do much passive treatment anyway. That said, that's the only constraint you have with remote with remote care, right is that the provider can't physically touch you.
Kyle Brunelle: 9:54
However, just like in person, when I do cupping, or if I do like the Graston scraping tools on somebody, for instance. Oftentimes in person I recommend and I actually have available in the clinic for purchase, I have those tools for the patients and teach them how to use it on themselves anyway, because autonomy is like one of my number one goals for people, and that they have ownership of their own healthcare in their own body. So as much as I can, like, the only thing I don't send patients home with is like dry needling, right? Like that's invasive and can cause some, some problems safety wise. So outside of that, I'm teaching folks how to use the same things, I would use them anyway. And then the only challenge might be like, if it's an error, you can't reach or something, right. So even virtually, you have options for manual therapy stuff. And you might just have to recruit a loved one or a friend or something or do it on yourself with those tools. So really, that's the only difference is that you can't touch the person. And even then there's a lot of workarounds for again, being able to get in like if manual therapy is gonna be super helpful. You can certainly through a video medium, teach folks how to do that or teach somebody that they trust doing that with them on how to do it for them as well.
Annette Zapp: 10:55
Kyle. Autonomy is sexy. I love that so much. Yes, or teach a man how to fish, or a woman rather than just giving them a damn fish. Exactly. I love, love, love it. Okay, Kyle, you are maybe going to have to correct me because I've sort of gone off the rails on this thinking and I might be wrong. Earlier, you mentioned peeing your pants. And I know you are a pelvic floor specialist, that's kind of your jam. So again, correct me if I'm off base here. But I think firefighters might be a population that could suffer from some pelvic health problems. And here's why. We have these issues where we quite literally have to hold our waste, say we're on a long job, we're on a fire, we needed to pee six hours ago. So we're literally holding our urine or feces, or the other end of the spectrum: people actually call it the safety pee, they go to the bathroom when they don't have to this because they're afraid are going to be on a fire for five hours. Also, I think maybe many of our female firefighters are coming back to work too soon after giving birth because they don't have enough time off. And I think there's just this whole spectrum of issues that might be contributing to pelvic floor issues, can you just start giving us the information on pelvic floor, we'll find it on there.
Unknown: 12:31
in depth one as well. But I'll ramble on a little bit about that. So Pelvic Health, and the pelvic floor for those that don't know, is a bowl of muscles that kind of bridges the gap at the bottom of the pelvis, like from your tailbone to like the front part, that pubic symphysis basically, where you'd sit on like a bike seat, right, your perineum.
Kyle Brunelle: 13:00
Otherwise, there's no bony structures, there's no nothing else there to prevent literally your organs from falling out falling out your ass basically. Right? Cool. So that that group of muscles then very important for several functions, support of all those organs as we just mentioned, but certainly also stability, like manually the muscles pulling on the bones around largely like the tailbone SI joint, and the pelvic ring, sphincter function. So again, keeping you from peeing and pooping yourself and releasing gas, we don't want to. Stuff like that stability function, because it's part of the core canister. So imagine like your favorite soda, seltzer beer wine's now canned I guess too. And it has a 360 degree wall around the outside, and it has a top and a bottom. And it's pressurized. So the same thing is true of our core canister, the top of our diaphragm, the bottom's our pelvic floor, and the continuous sidewall is largely or what we call our core muscles. And so it has a lot of function in regulating pressure and stability there as well. And certainly, it's important for not only bowel bladder function, but also sexual function. So a super impactful area of the body, it's a group of muscles, that's not just oh, it hurts, and I can't like lift things or move that body part. It's like it affects all of those different areas and all those different functions. Men have pelvic floors as well. And so I know the fire service is largely dominated by male folks. And they also might have a lot of pelvic floor challenges as well. But certainly also the females are likely to have pelvic floor challenges as well. So yeah, I kind of like joke like everybody has pelvic health challenge until proven otherwise, because it's an area nobody nobody even knows they have. Their mind is aware of and their mind is doing anything for their own wellness. So think about if you had like if your knee was something you didn't know you had, and you never did anything for it. Therefore we never took care of your health and wellness, your knee, your knee probably would hurt and have some problems, right? We've never done anything to treat any. Well, same thing but for your pelvic floor. So that's kind of some background there. Now, primarily people have several different challenges in that area. incontinence, and that can again be urinary incontinence. That can be fecal incontinence. And that can be gas incontinence as well, which can happen with a multitude of different situations. So a lot of people are aware of like the, you know, jumping or running or whatever else, some people leak urine, notably. But certainly there can be strong urges and triggers that the urge gets so strong that people all of a sudden again, then lose their control and have incontinence happen that way. Actually, incontinence can happen during intercourse as well. And it's called coital incontinence. So that's, that's the thing that happens as well. And then pain and pain can happen. There's a lot different pelvic pain syndromes and stuff like that. But largely, a lot of them happen during sexual activity. And some of them are maybe more occult. And this is the last part that I'll kind of mention here is hip impingement, or any kind of hip problems, SI joint, or tailbone, like low back type, pain, things of that nature, basically, anything above your knees, and below your neck, and maybe including your neck, can be linked to or the pelvic floor can be even one of the causal driving factors for that pain and those problems. And so that was kind of my why for getting into pelvic health was the orthopedic side of things, and how it has a huge impact on the core canister and everything from again, like low back pain, rib pain, odd like flank and abdominal cramps, stuff like that, to like, again, femoroacetabular impingement like hip injury, hip type stuffs, and things of that nature. If we think about it, part of the pelvic wall is a rotator cuff, basically, for the hip. And it's your hip, external rotators. And that's one of the main things that can cause challenges for again, hip and low back stuff, and certainly is a leak or a gap in performance. When we start thinking about kind of what the function there is, again, think about as a shoulder, if your rotator cuff wasn't functioning so well, not only might you have shoulder problems and pain, but on top of that your shoulder function is probably not gonna be optimized, you're probably not going to be able to, you know, push as much weight overhead or benchpress as much weight because you're not stabilizing the joint. So same thing, but for your hip. And so imagine how important your hips are for any kind of performance activities, as well.
Annette Zapp: 17:13
So much to unpack, Kyle, this is so good. First of all, we will link that Renegade episode in the show notes. Lex is going to be so excited-- go SEO. Also a quote that I know is going to resonate with my firefighters: "The pelvic floor keeps your organs from falling out your ass". So good. So good. Well, here's the thing, Kyle, I think most of us are probably familiar with one and only one exercise for the downstairs. And that's the kegal. Because who knows, probably Jane Fonda in the 70s told women and probably not men that they should do kegals. What other first of all, I know that that is not even necessarily the right exercise for most people. But what other exercises could we possibly implement for self care? Or do we absolutely need to be assessed before we start messing with this stuff?
Unknown: 18:11
No, exactly. Just hit as many kegals as you can. And that'll be super functional. No, I'm just kidding.
Annette Zapp: 18:16
Yes. Yeah. So I was hoping you'd say that.
Kyle Brunelle: 18:18
Somewhere out there there is a pelvic therapist listening to this. And they're cringing because they are just that first audio bit. But no, yeah, kegals are very contentious. And the reason is, again, think about your bicep. I wish this is a visual medium for the podcast listeners. But hopefully, I can do a decent job describing verbally thinking about your bicep. So if you hold your elbow up, and it's flexing like 90 plus degrees, and you're like really contracting your bicep hard, right, and it was stuck in that really shortened contracted position. If you then try to contract it more, probably that wouldn't be so useful. It might be helpful if you could get that muscle to relax, and to get that full range of motion back for your elbow, right to be able to fully lengthen things. So that's why one of the reasons why kegals are contentious is because people oftentimes have a lot of pelvic floor tension. And they're contracted at baseline and there's like holding an isometric all the time. And so that's not super functional for what we need the pelvic floor to do. And it'd be great if we can get that to first relax and fully lengthen. And then we can work on the contract. And then we can work on doing more like a concentric and an eccentric or a positive or negative type contraction, right and moving the thing through its full range of motion. Beyond that, we also have to consider that like there is both a power and strength function, but also an endurance function of the pelvic floor, because it is kind of supporting and doing his job throughout the day, all day, right? And so it has to have a lot of endurance. And that's why we see like 70% or so the fibers are typically more endurance type muscle fibers, and about 30% Or more like, you know, fast which type fibers. So, with that we should train accordingly. And also let's point out for Kegel to pelvic floor contractions, a lot of folks, there's studies that have have done a lot of folks, even despite having great training aids and great education on how to do that still won't access and connect to their body to do that kind of contraction accurately. And so I see oftentimes, clinically, as people like, I'll ask them to do a kegel or pelvic floor contraction as part of the exam. And they actually just bear down and they're trying to like blow pressure down low, because it feels like things are moving, right, because that intra abdominal pressure is pushing down on the pelvic floor. So things are moving. But it's actually the opposite we're trying to do that's not a contraction, you're actually, you're not actually actually even relaxing or contracting, you're just bearing down and trying to blow the barn doors open with that pressure. Or, you know, people get there's a squeeze and a lift function there, people oftentimes will get one or the other, a lot had to go will have like one hemisphere, like one side will do better than the other, or maybe the front of the pelvic floor or the back of the pelvic floor will be able to be activated a bit more. So for all those reasons, it's kind of the same idea as if you said to somebody like, Hey, I know you're not working out, I know you have like a tight like shoulder and pain there. Why don't you just go try some bench presses, and the person would probably not be largely very successful because recommending one exercise for a complex multifactorial problem is probably never going to be a good strategy. That said, I do differ from a lot of my peers in that I will sometimes use contraction based stuff to help with lengthening help with relaxation, thinking about that as like a PNF, contract, relax, or DNS or like there's a lot of different kinds of techniques that we accept as like, you know, strain counter strain muscle energy technique, stuff like that, where you are contracting it and then relaxing it and maybe getting a bit of lengthening there. So maybe go from like 70% contraction to baseline and things are super tense and tight to like 90% contracted, and then you relax and let go of that. And you get back down to like 60 or 50% contract, and you keep going through and eventually you get more and more relaxed. Basically, you're just using the contraction, then as a way for your body to feel like oh, shit, things were tight, maybe I can relax and release some of that. And our body's good at measuring magnitudes of change. So think about like a temperature in a room. If it went from 70 to 71 degrees, and it did that over like four hours, we wouldn't really notice that at all. If it went from like 50 degrees to like 90 degrees and did that 10 minutes, we'd be sweating your butt off and be like, what's wrong with this thermostat right now, right? So it can be helpful to feel one end of the spectrum to the other or a max contract to a more maximum relax. And that can help our body kind of be more aware of what's going on in that area. Bigger movements, and then we can start to fine tune that down the road. Also, the pelvic floor doesn't function in isolation for any of those functions. And so we have to then look at breathing because that's gonna change largely pressure and myofascial tension and a lot of other things. So we have to, like look at breathing and our core pressurization strategies, basically, how are we pressurizing that can and when and why and what strategy we're using, we certainly have to look at hip strength. So that's another thing that like, hey, for functional pelvic floor strengthening probably should include like, if a lot of that pelvic floor is connecting to the hip, as we talked about and acting as a rotator cuff, it'd be great if we strengthen that as a rotator cuff. And maybe even for dynamic like weight bearing closed kinetic chain exercises like squats, deadlifts, and Single Leg stuff as well. And largely, that's one of the things that people are challenged with most often. Orthopedically is like, for instance, on squats, people's knees caving in, and they're not accessing like their, quote, unquote, their glutes as much. And so we put like a band around their knees. But the challenge with that is biased more of an abduction, like frontal plane, in out type motion, as opposed to a rotational type motion. And so we access maybe glute med. there with that band, but we don't access the external rotation at the hip, using again, that deep, deep hip part of the pelvic floor. So you can kind of look at it from more of a movement perspective and orthopedic and how do we like strength training that way? You can look at it from like a breathing perspective, and how do we breathe and then pressurize the core and then use different strategies to maintain core stability throughout different movements. And you can look at it pelvic floor in isolation, and specifically as well, and try to do things consciously controlling pelvic floor there as well, with the idea that that can help relieve symptoms in the short term and also can help folks kind of find and be more aware of that area. And the hope would be in the long term that we can tie that into with other movements as well and then tie that into Okay, now, it's not conscious control anymore. It's more subconscious. And this is just our default strategy we don't even have to think of it's more reflexive.
Annette Zapp: 24:16
Kind of hearing, Kyle, though, this isn't a DIY. I can't probably just read a magazine article or whatever, I probably can't navigate this on my own. I probably do need to get assessed.
Kyle Brunelle: 24:31
Yes. That would be I mean, I'm biased clearly. But even checking my bias. Yeah, I think DIY is going to be for most folks, most times the less successful option. There is I forget who actually put out this product but it's called pelvic gym.
Annette Zapp: 24:48
And you'll have tobe careful where you look this up. Sounds kinky.
Kyle Brunelle: 24:54
You might find mixed results there. SafeSearch on No. So the pelvic gym is is basically put together by a group, like a consortium of other pelvic therapists and sex therapist and a few other allied health healthcare providers and stuff. And it is kind of more of a DIY option. And they do even have I think a lot of is free content. And I think there might be a membership that you might get access to other content as well. But I'm pretty certain it's called pelvic gym anyway, that would be a DIY option that I think, as far as my knowledge goes, is one of the best options I know. Move U also put something out, but I'm not super confident in, I haven't experienced that product. So I really can't speak to it. And yeah, no. So largely in that you're correct in saying like, I really would recommend getting a coach and a coach would be a pelvic floor therapist. Now. They're kind of like three or four main archetypes of pelvic therapists. So there is the pelvic therapist that says their pelvic therapists and you go there, and they do work around the pelvis, right? On the outside external only. And really, it's an orthopedic therapist that just is claiming to do pelvic, then there is the internal therapist, but all they're doing is using biofeedback machines. And so they might, they might use probes and sensors and stuff externally on the on the pelvic floor area or internally. I mean, they're intra vaginally or indirectly, but they're largely just like computer games and probes or steam or something like that, right. Which, as it might sound is kind of threatening and also probably not super functional to be playing games with your pelvic floor, and it's gonna somehow translate to like heavy squats and deadlifts probably not a thing. Then there are internal therapists who do manual internal examination, and they do a lot of manual therapy internally to the pelvic floor or externally. And maybe they might even do like Pilates or yoga based stuff. But largely, it's a lot of like on table treatment, and again, still not bridging the gap and still not approximating demands, in my opinion. So that's a that's a large percentage of my peers that do pelvic health therapy that way. And then there's folks like me who Yeah, if it's indicated, and if the person wants to, and that's a whole thing as well. If it's indicated and the person wants to have external and internal pelvic floor examination treatment, yeah, we'll do that. But also, we have to put it in back into the context of, okay, well, how do we bridge the gap between what we're doing here on a table and actually standing up and then putting a load on the back and doing stuff? Or if you're in like, for instance, and fire service, you know, dragging bodies out of burning buildings? Like, how do we translate those things, and how we bridge those gaps. And for that reason, I oftentimes, again, depending on the person depends on the comfort level, whatever else, but I oftentimes will, at some point, do a pelvic exam and standing and sometimes even with movement, because we want to know what's happening and what's functioning with your pelvic floor as we go from a gravity minimized, you know, on a table position to a gravity engaged upright position, and maybe even a gravity engage upright position with some demand. You know, like squatting and dead lifting and hinging and lunging all the things?
Annette Zapp: 27:46
That to me sounds a little bit scary, when you definitely need the right person for that. And how do you you sort this out? So you have these four archetypes of physical therapist? Is there any way to sort that out? Before you ever even see a Physical Therapist? Do you just kind of ask them? Hey, are you the guy? Or are you the physical therapist that treats me only on the table? Or? I mean, do you just let ask flat out?
Kyle Brunelle: 28:18
Yeah, so kind of things to screen for if you're considering engaging with a pelvic floor therapist, and you know, trying to work on your on your stuffs, things to kind of consider as far as screening goes, so you make sure somebody fits your vibe is like, okay, cool. What is your website look like? What's your social media look like? And what is your messaging, if they have any other kinds of content? And you know, email newsletters, whatever else, podcast stuff like that, right? What is your messaging and does what they're saying vibe with my own personal biases and opinions, hearkening back to what we said before about, like, again, making sure that the person that you're going to see that provider, that coach is going to be aligned with your values as well. So, again, if you're somebody like me, and you love movement, you're like really active and sporting, does the person's content look that way as well. So if you go to like the Renegade's social media, I'm like slapping barbells around and dumbbells and like doing crazy stuff all the time, right? So that kind of makes sense that's aligned for somebody like me, as far as providers go, and that's why I see again, the pelvic health folks I see are like doing Russian hardstyle kettlebell stuff or only lifters or they're like CrossFit, athletes, stuff like that, right? Or runners or stuff like that. I don't see typically as many of like the yogi's or just like sedentary people who don't really have like a driven movement practice in their life. So screening, those types of things, you certainly can also call their clinic and talk to them. Most good providers in my experience would offer a free consult call or will talk to you, you know, prior to coming in for care, it's certainly what we do. And so you can definitely ask them questions. The questions you might ask are, what does a typical plan of care look like? Not only how many like, you know, times and treatment, days and whatever else, stuff like that, but like, what are we actually doing in each session? What's the first session look like? What do follow up sessions look? like stuff like that? Do you do a lot of treatment? Manual Therapy wise are on the table? Or do you do a lot of treatment movement wise? And if you are like, movement wise, what are you doing? asking them about the equipment they have in their space will tell you a lot about that. So again, if you're looking for like somebody's gonna, you know, you're you're a CrossFitter, you're a lifter, you're an athlete of some sort, lifting and doing stuff with your body. And you ask them like, Hey, do you have dumbbells and kettlebells? And maybe barbells in your clinic? And they say, No, I don't have any of those things. Well, maybe that's not going to be somebody it's aligned with your values. Or if they do say, Yes, say, Okay, well, re they pink three pound dumbbells? Or do you have like, what weights you have? How much weight you actually have? And that will be really telling as well.
Annette Zapp: 30:41
I have yellow, mini bands. Yes. and, green. RED FLAG!
Kyle Brunelle: 30:46
Yes, that, like I have dumbbells up to five pounds, or maybe like eight, and I have yellow and red Thera bands. And we have one kettlebell and it's pink and from Walmart, and it weighs like eight pounds, I think, no...
Annette Zapp: 31:01
These are not your people.
Kyle Brunelle: 31:03
So all those things are very telling in my experience. And also, don't be afraid to fire the person you're working with, right? Like, if you think somebody's aligned, you go in for a visit or two or whatever. And it's like, this isn't really my jam. Don't be afraid to fire them and work with somebody else.
Annette Zapp: 31:16
I like that. That's great advice. Okay. I have one more major question before we get to like the important thing, which is Moose. But I see this messaging mostly in Olympic weightlifters and power lifters who basically pee on the platform, and then everyone kind of is like, that's okay. That's normal. But then the message is: it's not normal, but it is common. So that's sort of the messaging that's getting it out to that group now that hey, go get your shit fixed. What kind of messaging could we use with firefighters, just to sort of increase their awareness of pelvic floor? I think you hit
on some of it: 32:03
hip pain, back pain, et cetera, but kind of give us a line of messaging that we can use to get the word out.
Kyle Brunelle: 32:10
Yep. So I'll borrow Krystyna Holland's language here.
Annette Zapp: 32:13
Love her.
Kyle Brunelle: 32:14
Yeah, she's awesome, especially for trauma informed care stuff. That's kind of her shtick. But yeah, so Krystyna Holland uses these this wording, and I've kind of stolen that sense. Things are common, but not inevitable, right. So just because a lot of folks are having this doesn't mean that it's unavoidable, inevitable, you have to deal with these symptoms. Whether somebody chooses to deal with the symptoms or not, is really super up to them. I've worked with folks, I've talked to folks and I'm actually like, hey, that's that's your life, you get to do with you what you want with your body, right? But I've worked with folks that certainly are like, I have a little bit of urine incontinence, it doesn't happen frequently enough, or to a large enough, like volume or intensity. It only happens every once in a while I control it with like, maybe like wearing a pad or something or adult diaper. And that works for them. And they're like, You know what, like, I'm not, I don't need to invest the time and money. Maybe they have like traumas, a lot of people who are seeking have like sexual or physical traumas. And they are not ready to access care and work through that. Cool, maybe that's serving them well. So the common but not inevitable. hold space for people to feel like Alright, cool. Like, I'm not the only one. But also I don't have to keep working, working through this or suffering with this. And also hold space for people who maybe don't want to address it. Yes. Yeah. Right. So common, but not inevitable. And then something that's really helpful is the cozine, pelvic health screening tool. And that's Nicole Cozean's work. And it's basically a 10 question, questionnaire check yes? Or no? Does this happen to you? Or do you identify with a statement or not? And ask questions like, you know, have you ever had like a tailbone injury? or things of that nature, basically. And so somebody who's like, well, maybe they have pelvic floor dysfunction? I don't know, can go through that, and then check yes or no. And then I think it's three out of 10. If you check three or 10 or more, you're super likely to have pelvic floor dysfunction, and therefore, things to work on. Literally, not everybody has pelvic floor dysfunction. There's not I mean, I thought I had a strong healthy pelvic floor and I went to some coursework when I first was learning stuff, and I have my own challenges. So thinking about that, again, I was saying earlier, like, everybody has pelvic floor challenges until proven otherwise, most of us do. And it can be something as simple as like, constipation. And constipation is another thing people are like, No, I'm not constipated, like, oh, how long have you been until it for for a bowel movement? Oh, like, you know, 10 or 15 minutes? And like, is that just scrolling time? Are you actually trying to go? And they're like, oh, no, I actually have to work for that long to actually pass a bowel movement. I'm like, you're constipated. Most of our firefighters if we're being honest, almost everybody and there's a lot of dietary stuff that goes on there as well. I know in the firehouse but I'm thinking about your three bags as the same cheese being open right now AZ but no so. So there's a lot of challenges there as well with like diet and like health and wellness from that end of the spectrum to but stress stress is one of the things that will cause your pelvic floor to be super tight and tense. Think about it, like people are aware that in their neck and their shoulders and like being like super stressed, they're clenching their jaw. Well, those areas are a connected literally and neurologically to your pelvic floor. But B if you have tightness in your shoulders and neck because of stress and strain and emotional trauma in your life, that's, that's oftentimes happening with your pelvic floor as well. And so thinking about seeing the stuff that fire service men and women see and deal with on almost daily basis, even if you want to say like they're micro traumas or trauma, little "t" or whatever, there is emotional and psychological trauma almost every day, they're even just the perception that awareness of like, hey, like, this day might be my last because I might go on a call and not come back or my friend might not, you know, those types of things are certainly going to lend itself to things being a little more tense and tight and trying to kind of like our bodies guarding trying to protect. So I would I would posit that most of the fire service likely has probably poor challenges just based on even like the emotional and psychological strain they're under.
Annette Zapp: 36:06
My bias has been confirmed. Just kidding. Listeners, we will link that if you call it the Cozean questionnaire, is that right Kyle?
Kyle Brunelle: 36:15
Yep. Nicole Cozean
Annette Zapp: 36:16
We will link that questionnaire in the show notes so you can see it. So we're gonna get rolling on I guess the the outro. Here Kyle is actually Bless his heart sitting in his truck outside of the groomer, waiting for the real star of the family who is Moose, so tell us about Moose, Kyle?
Kyle Brunelle: 36:36
Moose is our golden doodle who just turned a year old and she's a blue merle golden doodle. So everywhere we go, people ask what kind of dog she is. And we have to say golden doodle. And then they're like, but she's not like golden doodle color. What is she? Because she's like black and grey. And yeah, we love her lots. And yet she's right now in the groomer, because she's quite shaggy at this point!
Annette Zapp: 37:00
Fresh to death. And also moose has her own Instagram handle, which is @doodlegirlmoose. Is there an underscore in there? Kyle? I don't remember. I don't either. I think there might be. I'll put it in the show notes. All right, Kyle, if anyone listening today, their interest is piqued they maybe want to get treated by you at Renegade, or maybe just have that brief discovery call to, you know, suss out if whether they would be a good patient, how would you like people to get a hold of you?
Kyle Brunelle: 37:28
Yep, so they can. While there's a lot of different options, so I support patients through texts. So certainly At Renegademovement on Instagram, and on Facebook. And people can text or call the clinic number, which is 603-267-0432. Outside of that, you can certainly send us an email info@renegademovementandperformance.com. All spelled out. I know, that's long, I apologize, trying to get Lex on that. Outside of that, you can contact us on social media as well. then I think that's the primary ways you can get in touch with us outside of that you can certainly schedule as well, I can send AZ the link for the show notes for Jane, we use Jane app as a scheduler and the documentation software. And that allows folks to book right online. So super low barrier to entry there, you just click the link and click the appointment type you want and put in some information and find a time on schedule and you're done.
Annette Zapp: 38:31
We will get all of that information in the show notes for you. Okay, Kyle, if there's one thing that you would like to leave the listeners with that I didn't ask you, or if you would like to reiterate something, now is your time.
Kyle Brunelle: 38:45
Yeah, I would say from the theme of our conversation, you know, a lot of things are common, but not inevitable. And I am just talking about pelvic health challenges. Now I'm talking about general health and wellness challenges. A lot of things are common, but not inevitable. And there is always going to be help and hope for you. It just might be a matter of finding the right person to help you with whatever is going on in your life and what your goals are, which sometimes can be a journey. And sometimes it's very challenging and defeating and frustrating. But there is somebody out there who is aligned with your goals, who does have the skills and the biases and expertise to help you get where you want to be regardless of what the challenge is. So I just want everybody to kind of keep their eyes focus on that light at the end of the tunnel because there is somebody there to help you. Again, it's just a matter of finding that right person
Annette Zapp: 39:36
I endorse this completely, you put that so well Kyle. Well with that we're gonna wrap up another episode of the Fire Rescue Wellness podcast. This has been AZ and Kyle and we are most definitely out. Thanks for listening.
Kyle Brunelle: 39:50
Thanks, AZ
