From Delayed Diagnosis To Daily Relief: Pelvic Floor PT, Pain Science, And Smart Self-Advocacy: With Taylor Reyes PT, DPT

Endometriosis pain gets labeled, but rarely decoded. We sit down with pelvic floor physical therapist Dr. Taylor Reyes to untangle the “messy middle” where endo, scar tissue, and musculoskeletal compensations blur together. Instead of chasing one culprit, we map how delayed diagnosis rewires movement, ramps up the nervous system, and turns the pelvic floor into an overworked backup for a weak or unstable core. That orthopelvic lens helps us ask better questions: Is this pain endo, or is it fascial restriction, nerve tension, or pressure mismanagement?

Together, we break down pain science in plain language. When symptoms linger, the brain’s sensory map can amplify normal input into alarms, especially after years of flare cycles and medical gaslighting. Excision can quiet a storm but isn’t the finish line; scar tissue is part of healing, and new patterns need training. We share a simple triage method: list every symptom, color-code likely drivers (endo, scar tissue, EDS, PCS, MCAS), and choose the target that improves function and quality of life first. You’ll hear clear strategies for self-advocacy, how to vet real excision specialists and manual therapists, and why outcomes and training matter more than titles.

Expect practical tools you can use today. Learn breath-led bracing for safer movement, graded mobility in pain-free ranges, and fast nervous system resets for commutes and high-stress moments. We talk specific visceral mobilization, when it helps reduce pain enough to retrain patterns, and how to build an anti-inflammatory lifestyle that fits your budget and reality. Most of all, we focus on agency: pairing pelvic floor and orthopedic therapy with mental health support, setting honest expectations, and rebuilding trust in your body. If you’re ready to swap confusion for clarity, hit play and join us. If this conversation helps, subscribe, share with a friend, and leave a review to help others find the show.

Chapters

• 0:00 Setting The Mission And Guest Intro
• 2:01 Dr. Reyes’ Background And Orthopelvic Lens
• 5:35 Delayed Diagnosis And Pain Science 101
• 12:50 Scar Tissue, Surgery Limits, And Vetting Surgeons
• 19:20 Expectations, Tornado Analogy, And Post-Op Realities
• 25:55 Three Pillars: Nervous System, PT, Lifestyle
• 32:20 Practical Tools, Self-Triage, And Daily Habits
• 35:59 Part Two Teaser And Next Steps

Transcript

SPEAKER_00: 0:00

What happens when you put a pelvic floor physical therapist and a podcast host both absolutely obsessed with bridging the gaps in endometriosis care behind the same mic? You get a conversation that finally makes sense of the messy middle, the parts of chronic pain that aren't always endo, the sneaky musculoskeletal pain generators no one's talking about, and the practical, doable tools that help you reclaim your body piece by piece. We're diving into why the delay of diagnosis creates long-lasting challenges in the musculoskeletal system and what you can practically do about it. It's validating, it's energizing, and honestly, it's kind of the conversation that makes you feel like someone finally turned the light on. And joining me for this powerful, joy-filled deep dive is the incredible Dr. Taylor Reyes, doctor of physical therapy, board-certified functional manual therapist, chronic pain educator, and someone who brings both expertise and genuine heart into every word she shares. If you've been trying to connect the dots in your own Indo journey, or if you've ever wondered, is this pain indo or is something else really going on? Or if you just love hearing two passionate humans absolutely nerd out about healing, you're in the right place. You're gonna want to stick around. Welcome to Indobattery, where I share my journey with endometriosis and chronic illness while learning and growing along the way. This podcast is not a substitute for medical advice, but a supportive space to provide community and valuable information so you never have to face this journey alone. We embrace a range of perspectives that may not always align with our own, believing that open dialogue helps us grow and gain new tools. Join me as I share stories of strength, resilience, and hope. From personal experiences to expert insights. I'm your host, Alana, and this is Indobattery. Charging our lives when Indometriosis trains us. Welcome back to Indobattery. Grab your cup of coffee or your cup of tea and join me at the table. Today I am thrilled to be joined by Dr. Taylor Reyes, a powerhouse physical therapist whose work beautifully blends science, compassion, and true whole body healing. Dr. Reyes is a licensed physical therapist, doctor of physical therapy, and a board-certified functional manual therapist. She's known for treating patients from all walks of life and for her passion in helping those with chronic pain shift their mindset, rebuild their trust in their bodies, and reclaim an empowered healing journey. Her approach is rooted in what she calls the pillars of healing, exercise, nutrition, and sleep. Her training is extensive and continually evolving from gynecological visceral manipulation to advanced obstetrics and pelvic floor physical therapy and board certification in functional manual therapy, a system that honors the intricate interconnectedness of every tissue and system in the body. With national and international experience and deep commitment to patient-centered care, Dr. Reyes brings heart and expertise to every conversation. So grab that cup of coffee, settle in, and help me welcoming Dr. Taylor Reez to the table. Thank you, Taylor, so much for sitting down with me. I am such an admirer of everything that you do and all the work that you do for both the advocacy aspect of chronic health conditions and um physical therapy and public floor physical therapy and everything you do online. It's just been amazing. So thank you for sitting down with me today. I'm excited to get into this conversation. Thank you. And I'm so honored.

SPEAKER_01: 3:36

Likewise, like all of the resources you produce, I use them for my patients. Like, hey, go learn more.

SPEAKER_00: 3:42

Oh my gosh.

SPEAKER_01: 3:43

On Indobattery.

SPEAKER_00: 3:44

Thank you. That means a lot to me. That means a lot. I, you know, one of the things that I love about your platform, and I've kind of told you this already, is just how not only authentic, but how much you advocate by not just going with status quo, like really inserting the facts of what you do and your expertise. Like you don't let things go by the wayside for patients to figure out later on down the line that it's not actually what this influencer said to do. It's actually there's something medical to it. I love that about you. I love how authentic you are. What is it that you do on your career side and what has led that in social media? Thank you. Yeah.

SPEAKER_01: 4:25

So I am a pelvic floor physical therapist in Dallas, Texas. And my my kind of background is in orthopedics. So initially, all of my professional training was pretty strong, heavy into manual therapy, orthopedic, visceral therapy. And then as my career grew, I started adding in the pelvic floor because we realized very quickly that it's like if you care about core function, you have to address the pelvic floor. You know, true core function is comprised of the diaphragmatic pelvic floor and spine stabilizer, basically like orchestra, so to speak, their ability to work together appropriately. So, you know, whether you're a shoulder patient that needs to throw something or lift something, you have to have core good core function to produce good pressure management. Or if you're trying to pick something up heavy, or if you have pain with sex, which a lot of endometriosis patients do, you know, what's going on that's perpetually creating tension in those muscles? Is it pathology or is it poor body mechanics? So all that to say, it's is we that's where we say orthopelvic therapy. So we know we like to do a little bit of both. Um I've been practicing for about 11 years and full transparency. I also have endometriosis and adenomyosis. I've had an excision surgery. So a lot of the information that I am presenting is it is based in evidence. It is objective, but there is there is some clinical and anecdotal experience woven in there because kind of like you and I had chatted about before, like really truly how to manage endometriosis holistically, we're at the genesis of what the research is or is not. You know, there's across the board we can say, like, oh, you know, well, there's no studies to support X, Y, and Z. And it's like, okay, well, the study just hasn't been done, you know. Or did you use X, Y, and Z variable? Because one change in variable can completely influence what it is that you're actually finding. That being said, a lot of our goal in our clinic is to really help bridge those gaps between the orthopedic patients and also our autoimmune population and the endometriosis population, because yeah, endometriosis isn't considered autoimmune, but I always kind of cheeky, cheekily say, like, if it walks like a duck, talks like a duck, also it'll probably just be renamed to something else completely different in 20 years, but that's future. So we we have a heart for really working with the clients that, like we said before, have they have endometriosis, but they also have MCAS like mast cell activation syndrome, uh, POTS, postural orthostatic tachycardic syndrome, ADS, like Ailer Stanlow syndrome, um even craniocervical instability. Like those types of patients come in and it's like, what's what? So all of that, that's kind of a long way to say that we in the clinic, I see a lot of different stuff. So a lot of my content is inspired by conversations that we have. Because when we're looking at all of these complex cases, one of the big variables we have to consider is accessibility to care. Right. So what because most of the providers that can really get you where you need to be, and this is not a blanket statement, but just in general, might not be an inch, not might not be a network with your insurance provider. So, okay, how do how do we live in a world where as a professional we can create, we can create good quality care for the people who are in front of us, but how do we also get information out there to people so that they know, like, oh wait, I've been gaslit my whole life, which unfortunately comes through the territory. Or are there things, am I better equipped when I walk into a a doctor's visit to know like, hey, this plus this plus this shouldn't equal this? You know, on my Instagram page, I like to, my kind of tagline is talking about smart stuff in a silly way. Because when we're talking about chronic illness, chronic fatigue, disability, painful sex, trauma, like, yeah, we can we can talk at it with a heavy heart. We can come in at with a with a sensationalized viewpoint, which I don't think is always the best thing, the most therapeutic thing for viewers to be sensationalizing content, but to just be like, hey, this this kind of sucks, but like what can we do about it? And hopefully it makes it more abs absorbable for the the viewer.

SPEAKER_00: 8:44

No, I think that's true. I mean, like, we as people living with chronic illness, living in chronic pain, need hope. Like we need a hopeful way of treating it. Because we get so many times we go to the doctor and we're like, I'm feeling X, Y, and Z, and they stare at you like a deer in the headlights, or they placate you with fancy words, but leave you with very little hope. And so if there's direction and a hopeful direction, I think that's something that we can all grasp onto, which is something that I love. I feel like there's a lot of times you've hit content on your page where I'm like, that's me. And if you can identify yourself in something with good evidence-based backing and say, this gives me direction, I just feel like patients are becoming way more savvy and they're looking at how can I better advocate for my care. And if they're given the tools to do it, I feel like their care by and large is much, much better. And that's why, like for me, looking at your content and recognizing I'm familiar with that. Here's a tool, a like tangible tool that I can do or use to help me, that's hopeful, you know, and if you laugh along the way, great. Like that's right, that's kind of what, you know, something that I've always strived for, even with this podcast, is like, I want to make it hopeful. I don't want people to feel more depressed leaving than when they came. I want them to leave with good information, something that's a tool to put in their tool belt and that they can advocate better for themselves in their care. And whether that care is at a physical therapist office, at their OBGYN, or any other practitioner, I think that we as a community want more information, but sometimes that's a lot of noise too. So we have to be careful with the information in, you know, that we take in, but there's evidence behind what you put out there, which is what I love. I love that you call that out too.

SPEAKER_01: 10:38

Yeah. I I like to say crunchy-based evidence or evidence-based crunchy because yeah, there's like there's some stuff, it's like, okay, just physical exercise is natural. It's crunchy, you know, it's holistic.

SPEAKER_00: 10:52

Um, it's not a pharmaceutical, uh, and we don't have to equate evidence with pharmaceuticals, but well, and one of the things that I love that you it's so because it's so tangible, I think it allows people to work on things that are out of the surgical realm and maybe preparation for surgery or even after surgery or understanding their body better. And that's something that you and I have talked about is like there's this large delay in diagnosis, right? Like we hear seven to ten years. I think it's more personally. I think most people it's anywhere from 12 to 20 years of onset of symptoms. And my experience is what I, you know, have talked to others about. So my thing about that is that I feel like we grow up around these chronically ill bodies. And I have experienced where, you know, I've done the excision surgery and I've done pelvic fluor PT and I, but I'm also experiencing other musculoskeletal issues along the way, but it's because of the way that my body has for so long compensated. And in your experience and your practice, do you feel like the delay of diagnosis makes care harder for you to give to your patients when you have that?

SPEAKER_01: 12:04

Yes and no. And I say that from the perspective, so from the patient side, yes, the journey is more complex. From the clinician side, longer history where we can really take this 30,000-foot view and like see the history of bowel changes, bladder changes, neurological issues, histamine intolerance, like all of these things, but also having years where they have tried different things and we can kind of say, like, that didn't work. So we need to, we need to put that on the drawing board. It kind of helps us fine-tune, like, okay, yeah, we're we probably need to get you in front of a surgeon, or like because you've tried X, Y, and Z already, because I I never want to spin somebody's wheels and waste their time.

SPEAKER_00: 12:49

Right.

SPEAKER_01: 12:49

Because pelvic floor therapy is very therapeutic, but sometimes it's you know, putting trying to put a wildfire out with a Dixie cup of water. So, you know, it's like is if it if it works, great. If not, you know, what else can we do? So from the clinician perspective, sometimes it's it makes my job a little bit easier. But from the patient perspective, we are working through what has what has your brain developed as normal. Like let's look at it from the pain science perspective. So, really, three, three, and and this is general rules of thumb. I and I and I say this with empathy here. A lot of what is in evidence are are guidelines and based on averages. There will always be outliers. So if you hear something and say, like, well, that's not me, that's okay. Like this is for some people it might be, for for you, it might not be. And and because, you know, I wish we could create a perfect protocol for everybody, but we can't. So, you know, we're looking at the pain science perspective. So if you have something going on for three plus months, sometimes even shorter than that, you're you're the sensory part of your brain, like the sensory homunculus. If I like to use the the example of phantom limb pain, right. It's a very one-on-one kind of watered down explanation. But for those who aren't aware of it, say you you have you move your fingers, right? You're you're sitting there wiggling your fingers around and you touch your fingers. There's going to be representation on your brain that's going to light up for each one of those fingers. So say you have your hand amputated for whatever reason. Just because your hand is gone does not mean those sensory pathways do not still exist.

unknown: 14:21

Right.

SPEAKER_01: 14:21

They will be retrained, they will change, but for a period of time, sometimes a long time, you will still have those pathways saying, like, wait, this is my finger. But it's like, wait, no, it's not. And a lot of times the brain can express confusion in the sensory side of thing or in the neural pathways as pain. Right. So it's like, okay, when we have, when your brain has been accustomed to pain uh associated with different whether it's just like in your cycle, right? It's like, especially if you have PMDD, you know, it's like, okay, we're ramping up. This is familiar to my body. My body knows X, Y, and Z is normal. What does it look like to retrain that? The more years you have under your belt, that become being the norm, the more difficult it can be. It doesn't mean it's always difficult, but the more difficult it can be. And sometimes people require different, different therapies for that. Sometimes it's just as simple as identifying the pattern because the brain is so powerful. And once you can like, oh, I get that. Just like if you this is again a low-hanging fruit explanation, but if you don't know you're in labor, you think you are dying or pooping out a watermelon, one of the two. But it's intense regardless. So, but if you know you're in labor, like, okay, yeah, I know what this is. And there's there's this uh into the there's a light at the end of the tunnel here. Right. And so your sympathetic nervous system does not go into fight or flight. Hey, we're being chased by a bear. Your cortisol levels are not gonna spike the same way. Cortisol can be like gasoline on a pain flame. No, so we have all of that. And then I think most of your listeners, viewers are are very familiar with gaslighting and what that can do to your nervous system. So, yes, like that's an element we have to consider, but also just from the physical standpoint, like, okay, weakness, muscular weakness can create pain. So, how long have you been limited in your mobility that you have, or how extreme has your fatigue been? Because we know that fatigue is like the like every single endopatient has fatigue to some degree. So, you know, especially if you're a working parent or you're not a parent and you just work a frickin' lot or whatever, whatever the situation is, do you have like does the the all of those factors lead up to where it's very difficult for you to have exercise tolerance and then you develop weakness over time? And that contributes, contributes to the pain. Not saying that if you strengthen the muscle, that your endometrosis symptoms are gonna go away, but it can contribute and increase the intensity of what you're experiencing. There's there's an analogy we use. I use it with runners often, but it's also for this, it works well too. If you're gonna fire a cannon, would you rather fire a cannon off of a canoe or a battleship? Right. Like our yeah, our physical bodies, like having strength, having stability, shout out EDS people because insert other barrier. But you know, that's where that's where we find modifications. So I also tell people like, if you care about the strength of your pelvic floor, you care about your physical body first, because if your pelvic floor is overcompensating for the lack of strength, and that's just in the normal human with or without a pathology, but say you have an overactive pelvic floor because of your endometriosis and your physical body is also literal, there's objectively weak, how much more strain, how much more dysfunction and intraabdominal pressure are you putting on that body? Like there are so many things to tease out here. And then we go into the neuromuscular issue. Like, how long has your brain known a poor compensation strategy? So is it actually something that's tight or weak or whatever, or is it compensation? So the more years of having this disease under your belt, the more things we have to tease through. And again, sometimes it can just be as simple as identifying it because the brain is very powerful and it can click, or sometimes it's just we identify it and then we, you know, it takes about three months for the body to really like with strength training, with training new postural habits, training new anything to become automatic. It takes about three months with consistency. So, you know, what are we looking at there? So if we as we start to tease through symptoms, because symptoms are very subjective with endometriosis, and there's a lot of things we have to consider. So, and then also scar tissue, right? So, like just in the pure mechanical sense, how long have, you know, the inflammation, the lesions, how much have they been impacting your fascial systems, your musculoskeletal system? You know, do you have like crazy neural tension? Like, does it feel like you have a disc issue that's causing your leg pain, or is it scar tissue? Right. And even then, I mean, that's even when we can kind of go into post-surgical management. Like you have, say you have significant endo on your bowel and you have that excite, not necessarily, I'm not talking about bowel resection here, which that could apply. But if we're just talking about like the recto-vaginal pouch, especially, so you're used to having adhesions there and now you have scar tissue there. It's therapeutic scar tissue, like it would be awesome if we could do surgery without creating scar tissue. But the fact of the matter is, is there will always be a certain degree of scar tissue. So now the pain that you're feeling, was it those decades of having restrictions on your bowel? Or is it just you're restricted, but not because of the endometriosis, but because of scar tissue? And do we have to retrain that? Right? Do we have to work on being able to lengthen the pelvic floor? Do we have to work on improving your fiber? So your rectum isn't taking such a beating every time you have a bowel movement.

SPEAKER_00: 19:57

I'll I'll give you a really clear example of like exactly. Exactly what you're talking about, and something that I've explored personally is the fact that because I've had you know two C sections, I've had laparotomies, I've had everything, tons of scar tissue, right? It pull like when that starts pulling in, it's really hard to differentiate between back pain from something else, or is this just scarred tissue? From a personal perspective, I can tell you, like as a patient, it is really hard to differentiate your signs and symptoms when you're going into a provider trying to figure out what's hurting, what is, you know, like, yeah, I know I have pelvic floor dysfunction, but there's other things that are bothering me too. How do you as a clinician manage that with your patients? Because it's overwhelming to walk in with symptoms that don't seem to resonate with one pathology or another. It just seems like a gumball jar of things. You know, like there's take your pick, you might get a blue, you might get a red, you know?

SPEAKER_02: 21:00

We don't know.

SPEAKER_01: 21:01

Yeah, it's it's fun, kind of exactly what you're saying. So there's, you know, one way that I manage it and our team, like my whole team manages it this way, is sometimes with those cases, we literally pull up a dry erase board and we write down every single symptom they are experiencing. And we take a green marker and we say this represents endometriosis. Check, check, check, check, check. This blue marker represents scar tissue. Check, check, check. This red marker represents EDS symptoms. And we go through and kind of tally so they can kind of see, like, okay, we're dealing with a lot of stuff. And then really fine-tune A, what symptom bothers them the most? Right. Because you can walk in with a thousand symptoms, but you're like, okay, maybe your lack of hip mobility limits your function the most physically, but the patient's goal is just to be able to poop better. You know, so it's like there could be like objectively, what's the worst, but subjectively, what do I care about more? So we kind of look at this broad sheet of things to figure out what's really driving all of this. What do we want to work on the most? And then this is our plan. But I do feel like with a case like that, which we see a lot of, one of the most important variables is saying, like, I do not know with a hundred percent certainty what is causing this exact symptom.

SPEAKER_02: 22:26

Right.

SPEAKER_01: 22:27

Sometimes it can't. I mean, sometimes we do know that. But the transparency and the open dialogue with a patient is really important because at the end of the day, they need to be a part of the rehabilitation team as much, if not more, than the therapist because it's their body. And they mean what if they move states, right? What or what if they can't afford therapy? Or what if I'm like peace, I'm going to Bali? I don't know. Like, you know, what what if what if they no longer have access to care? Like this shouldn't be information that is gay as being gay cat, gape, gay, yeah, that, yeah, by the provider, right? So it should be, they should be able to access their own care and reproduce it or at least be the facilitator of it with somebody else if they if they need it. So that that transparency and that dialogue is incredibly important. Um, and kind of just to a little other caveat, you're saying that you've had, you know, you people would come in that's have multiple surgeries. Is this scar tissue? Is it are these lesions? What's going on? Hey, I've already had excision surgery. Yeah. So in theory, we should be able to check endometriosis off the box. Not necessarily, because it really, and I hate to say this, but just because it's a fact doesn't mean like I'm just the messenger here. Who is your surgeon? Because excision surgery is becoming very trending, and a lot of people are happy to say that they're an excision surgeon. But what you need to look at is what are their patients' long-term outcomes? And unfortunately, that involves a lot of footwork on the patient's part, but it is what it is right now. And I will say there's resources out there that say that they are the hub for endometriosis advocates and surgeons and therapists. Um, no, and I'm not referring to Nancy's Nook. Nancy's amazing. I love her. Yes. I will, I will stand behind her every day, all day. Um, but there's other platforms out there. And like even as a therapist, the ability to get on that platform, the only thing that was keeping me from the only thing that allowed me on there was the honor system. Like I, there was actually no true vetting. Like, you know, open book test. It's my word whether or not I've seen patients. And looking at that list, I can look at other therapists and say, like, they are not, they are not specialists. So I'll to go back to say, like, did you have the excision surgery? I know that can really, that can feel aggressive. Like if you're sitting there, you had excision surgery, and I'm not necessarily talking about a really like category four deep infiltrating, you know, stage four, however we want to refer to that. I'm not necessarily like there's outliers here, but I'm talking about like, well, I had excision uh surgery with this guy who said he's a specialist in about a year and started coming back. And it's like, I can hold space and acknowledge like that sucks to try to process that possibly the surgery I had did not actually do what they said. But it doesn't like just because it sucks doesn't mean we shouldn't look at it as a variable. And unfortunately, right now, there's it's really hard unless you vet the heck out of your surgeon, like make it a part-time job. It's really hard to know what you're getting. And then, like we talked about before, the just the way the healthcare system is set up, a lot of times these surgeons, the surgeons that we can kind of say with confidence are where you need to be are in a network. You know, I I had surgery with an out-of-network provider. I get it, I get the burn. I understand the burn. And the burn can be different for everybody. But all that to say, there's a there's a lot of layers to managing acute. Like, hey, I'm at the beginning of my endometriosis journey, and then there's the endometriosis veterans. Being able to manage across the board is really complex. But I think, again, transparency and honesty within yourself and is within the provider is the most important thing.

SPEAKER_00: 26:12

Yeah. And I think one of the things when, you know, we were talking about like the surgeons and kind of vetting your surgeons, which mind you is very hard because just because they appear to be great either on social media or they have great bedside manner doesn't necessarily speak for their skill level. And that's a really hard thing to differentiate as a patient, right? Is their skill level. So when you're seeing a PT, like it's important to still talk about that being an option, even at the highest level of surgeon. Like it is always on the table, doesn't always mean that it's the reason for your pain or persistence of pain. I think oftentimes persistence of pain is something else, usually, that we haven't addressed or even recognized. Like for me, and I can only speak for myself on this, is like I went into my excision surgery thinking that once it was done, I was gonna be magically cured from every pain that I had. Let me tell you just the amount of like emotional trauma that caused me later on that I'm still dealing with in a lot of ways because now I'm having to see doctors for all of these other variables that I didn't expect or even think of or even know about when I had my surgery. I mean, I had my surgery in 2020, so it's been a little bit. And so I think one of the things that I've worked on recently and something that I encourage people to do is come up with a care plan map. So, like mapping it out, which is kind of what you're talking about, is like you are mapping out not only the signs and symptoms, but what would that care look like? Like realistically, is this achievable to be completely pain-free? For me, I could I can tell you it's I will probably never be 100% pain-free, but can I have a better quality of life? Like, I think there is that expectation that we have to kind of set realistically in those rooms too. Do you do you feel like in your practice and and what you've experienced, do you think patients have that expectation of like complete healing? Or are they coming in Leary? Like, what I what do you typically see with these patients? Yeah.

SPEAKER_01: 28:21

Um I there is there is so much hope that that goes into a getting surgery in general, like being willing to have surgery, but two, when we finally reach the excision specialist, you know, when we finally reach the person who we have vetted, it is like it is really difficult to not say it's my time. It's like like it's time to feel better. I am so tired of this. I actually had a patient the other day, she had surgery by a great surgeon, or I should very skilled surgeon. And immediately, immediately, and I know she wouldn't care if I shared the this, I'm not sharing her identity, but just some if tidbits of information. She's a hairstylist and she stands a lot. And her primary symptom was hip pain, not period pain, not pain with sex, which she realized she was having pain with sex, but not until after the surgery when she realized, oh, this is what sex is supposed to feel like. After I saw her for a couple months, and you know, she was responding like, yeah, okay, like, yeah, this is kind of getting better. Like, you know, we can't take out the repetitive activity of standing because that's your money generator. It's gonna take a little bit longer for this hip pain to get better. But finally, it was just like, you know, between the the the lifespan of this hip pain and the little bit of constipation you have and the general fatigue and anxiety levels you have, let's go get a consult. So she she got a consult, did a surgery, and it's like that hip pain gone. Yeah, hundred percent gone. But again, as we uncover like the loudest pain in the in the group, other things can start to to pop up. And so she uh she's like, we had this conversation at maybe like seven or eight weeks after her surgery. You know, she was saying, Hey, I noticed a twinch here, and like, and she got a little misty and she's just like, I just wish I could unsubscribe to this. Like, I don't want this content anymore. And I was like, that's a really great way to say it because it's like we we come out like, yes, this is this is gonna this is gonna help us. This is we're gonna be here. And then and then you do notice it does, but there's still other things because endometriosis sits in a body with multiple systems. There's multiple pain, put possible pain generators going on. There's multiple possible constipation generators. And I say that because a lot of endopatients deal with constipation. There's multiple avenues to have bladder urgency, anxiety being one of them, or even just the scar tissue healing. I mean, scar tissue takes about a year to really mature, sometimes a little bit longer. So as you heal, like you kind of have to address the scar tissue in different ways. And, you know, some people will poo-poo that, some people don't. So it's like, who do you want to listen to? So, in the sense of like everything's gonna be better, it's like, okay, well, did you and this is where we kind of go back to the conversation about how long have you had endometriosis undiagnosed? Do we are we now also dealing with pelvic congestion syndrome? You know, is there a vascular issue going on that's creating symptoms almost identical to endometriosis? So it's like, and it's it's a not hard, but it's a it's a heavy place to help walk your patient through that to kind of be able to hold space for them as they have that revelation that things aren't gonna be perfect and that this is a process. I use this analogy with my patients that endometriosis is like a tornado. And then the excuse in surgery is the tornado going away. And then after surgery, what you're doing is you're doing the cleanup, you're getting rid of all the trees that have been broken down, you're you're repairing the houses that got torn down, you're, you know, repairing the schools, you're cleaning up the debris. You know, we live in Tornado Alley, so that's like an easy analogy for us, but it's not it's not done. Surgery is like just the beginning. It's a step in it, yeah. Or maybe a pit stop, because it's definitely not the beginning of someone's journey, but it's it's an important factor, especially to getting that huge load of inflammation down. I I use this example with my shoulder patients, especially. Like, we don't like, you know, stero steroid shots are very controversial in orthopedic care. But if you cannot lift your arm up at all because of the pain, sometimes you just need some steroids. PT first, but sometimes you gotta load yourself with steroids so you can actually do the exercise. So it's similar, like, I mean, just again, low-hanging fruit example, but get cutting out, cutting out all that junk so that your body can actually take a breath and get a second win to say, like, how are we going to recover from this? So, and you know, every once in a while, I'll have a patient. I actually a couple months ago, I had a patient who, when I wrote their eval note to their surgeon the couple weeks before she had surgery, I was like, you know, I even wrote in the assessment, like, okay, you know, patient presents with classic signs consistent with X, Y, and Z. But I made a note, like, hey, this patient, if GI bowel bladder symptoms have not improved within eight to 12 weeks of surgery, it is recommended that they see a gastrospecialist andor nutritional counseling and have testing for SIBO and H. pylori. Like I was convinced. I was convinced that they were not going to get the relief they needed. And this sweet person comes back a week after her surgery and she's like, oh, my GI pain is gone. And, you know, she's like, however many, like it's been months and she's still amazing and like needs zero therapy. And I'm like, wow, that was a learning lesson for me. You know, I didn't see that one coming. So every once in a while we'll have people who are just like, I'm amazing. Like, I'm so happy for you.

SPEAKER_00: 33:50

I've not experienced that, but I'm glad that you have. Yeah.

SPEAKER_01: 33:54

Yeah. And I mean, the the even anecdotally, like, I'll tell people, I shared this briefly. Like, I had my surgery and then two weeks later, my I had my excision surgery. Two weeks later, I ended up with a blocked bile duct. So insert three-week story of like me being in the hospital for a week, having an emergency gallbladder removal, and they had to go in and like cut up with my bile duct. Turns out that duct had been scarred for years. I'd been telling doctors that I was feeling this pain, especially after I'd eat, but they said it was stress and anxiety. And my liver is like misshapen, you know, because of how scarred it was, all because of poor motility. So, kind of even going back to the conversation of like how long, like the longer you have this, but that's not something we can address in pelvic fluorotherapy because that's that's like part of the gastro and like that's organs that that's not our scope of practice necessarily. That's like honestly, partially stretch stress management, uh, addressing things nutritionally, because there's not really you can't do a scope for that. Like, what are you gonna do? I'm not the my point is is like I'm not the only one with those types of experiences.

SPEAKER_02: 34:57

Right.

SPEAKER_01: 34:57

It's like you have the surgery done, and then it's like, oh, this is hanging out, also.

SPEAKER_00: 35:02

Right. Well, and like and what you were saying and the pain science aspect of it too, is like we can have the surgery, but if we don't address some of that pain science, you know, where the pain generators are coming from, whether that's because our brain is so used to feeling that pain that anytime we get close to it, automatically we're gonna like think we're feeling this pain, right? Like, how do we differentiate that? And I do think therapy is a huge part of this process. And that's something that I've experienced in my journey is being able to be open and having those having therapy mixed with my physical therapy because I do think that they play hand in hand a lot. And I don't know if you've experienced that with you or or with your patients. Like, I think that there's healing to be done simultaneously between the two or in tandem.

SPEAKER_01: 35:49

Yeah, absolutely. And there so I wrote an ebook called the endometriosis solution a few years ago. It's spoiler alert, there is no one solution. So, so, but the and that's and it's really it's just meant to be a rapid fire resource. It's at it's time, I need to update it. So don't go buy it. I I need to update it because there's so much new information out there, right? It's like, who has time? Just follow my Instagram. Um, but what I will say, because we do have those patients who, whether whether they have had surgery or maybe they don't want to have surgery because of finances, because of lack of support, because um, I do work with a lot of patients that are very deeply in the natural holistic world that do not want anything to do with the medical community. And that's I will I will respect that. So, how do we serve the person in front of us, not the condition, but the person? So, if we are kind of again to kind of take this 30,000-foot view, how do we serve somebody who is either still struggling or doesn't want surgery? The three pillars that I talk about are downregulating your nervous system. Meaning, how do we teach your body that you're not being chased by a bear all the time? And then how pelvic floor therapy, right? Because we are training the physical, the physical body. And this is where we can kind of reinsert how do we, how do we find modifications for our mobility limitations, our energy conservation limitations, et cetera, et cetera. And pelvic fluorotherapy does not necessarily have to be intravaginal or intra-rectal therapy. I have plenty of patients where we we may assess the first visit internally, but we can absolutely create a plan of care that does not involve going in any orifice. So, because we have to have that for people who, you know, anyway, so there's the pelvic fluorotherapy to retrain the body, to retrain muscle patterns, to even do visceral mobilizations, like for lack of a better word, just mobilize the guts because it just can create, and whether or not, like again, there's people who poo-poo manual therapy, fine. You do you poo. Like they can, they can live, they can live their happy manual therapy free lives. But what I will say that what patients keep coming back to us for over and over again is the visceral mobilizations because there is therapeutic value in even just feeling better, even if it's not fixing the issue, because mobilizations will not fix endometriosis. It does not fix scar tissue, but it can reduce the pain associated with it. And that's what we care about. So, and there's also a study, it's you know, the level of evidence in this study is like it could be better, but rice et al. It's like 2011, and it talks about it's a 10-year retrospective study on manual specific manual therapy to the reproductive organs and how it improves pain infertility related to endometriosis, um, how it can improve the efficacy of IDF, PCOS, like I mean, it's kind of wild. And so when you're, and by skilled manual therapy, I don't mean about just doing like a general like abdomen massage. I mean, we're we're talking about specificity. So again, when you're vetting your therapist, just the same way you should vet your surgeon, you need to ask, like, where is their training from? So that's where I'll say, like, we operate through our orthopedic um manual therapy training is functional manual therapy. So there's the instant for, you know, so if you're searching for a therapist, there's the Institute of Physical Art, IPA, and you can be IPA trained or you could become certified as a certified functional manual therapist. They really get into the weeds about specificity with total body manual therapy, and they have a visceral mobilization course as well. So all that to say it's like, well, manual therapy didn't work for me. I'm like, well, maybe you had bad manual therapy. I don't know. Or, you know, maybe it just doesn't work for you. Either way, I just I try to encourage people not to throw the baby out with the bathwater, right, with an N of one. So going back, circling back around to, you know, we have downregulating the nervous system, we have pelvic fluorotherapy, which can involve a lot of pillars. And then I don't, I'm trying to decide how I want to say this because I don't know that I love this title anymore, but like an anti inflammatory lifestyle.

SPEAKER_00: 39:50

Right.

SPEAKER_01: 39:51

Because it's like inflammation can be different for every person. It can be more food based, it can be more home, home independent. Endocrine disruptor based. We know that a lot that products containing endocrine disruptors can obviously disrupt the endocrine system, but is there research specific really strong evidence saying that an endocrine disruptor is going to increase your endometriosis symptoms? I'm not going to say I'm just going to say I haven't seen it. I'm not going to say it doesn't. I'm not going to say it does, right? Like, I think it's something kind of like we don't need a study to say to tell us that the femur is connected to the tibia. Like we just know that. And it, you know, A plus B equals C. We can say, like, okay, let's take that into consideration. So if it's not going to put us into financial despair to buy products that don't contain endocrine disruptors, like, let's do it. You know what I mean? It's like, let's live that anti-inflammatory lifestyle. But fact of the matter is, is it can be a little cost prohibitive to some people to really like, because we can get into food deserts, we can get into even just the, not just the food deserts, but like if you use an app like Clearia or Yucca or EWG to walk through Target and to try to find hair products that aren't like toxic, like good luck. And if it is, if it is non-toxic, it probably doesn't work. So it can be a little bit of a cluster to try to figure out where do I want to land with all of this? But if you can find a way, like, does vinegar work just as well as a cleaning solution as Clorox? Sometimes. Right. Depends. Yeah. But is vinegar not actually getting rid of the mildew in your shower? But Clorox will. And how bad is it for you to be breathing in that mildew? Like, this is just where we can't give, right? Right. We just have to kind of step back and like gather the information and then take the parts that make the most sense for us. Right. It's it's it's frustrating. It's frustrating how much work you have to do just to exist, but we can have empathy, right? We can have empathy. We understand. And it's like until there's a better solution, that's just what it is. And hopefully, somebody who has the time and the funding, the non-biased time and the un or the unbiased time and the unbiased funding to do these studies. Like, I'm here for it. It's not me. It's not me. I don't think it's you. So you're not. You and you're not going to be able to do it.

SPEAKER_00: 42:12

If we're being honest. Like professional patients. And let me just tell you, there is so much to be said about, you know, a lot of what you're talking about is like figuring out that balance, right? Like we hear the word zen a lot, right? Finding that zen within. There's a lot of times that I don't even recognize in my own daily lives that I am in that fight or flight. I have no recognition of that sometimes, right? And then it's it can be someone that I see, whether it's my therapist or whether it's my physical therapist, who's like, are you're holding on to that really tight. And it's interesting because I was seeing my went to my public floor physical therapist and I was in a lot of pain. And she's like, Okay, I'm gonna have you. It was something very simple, like the way I was lifting my leg or whatever. She goes, You realize that you tightened one side to move the other in a way that was counterproductive, right? Like you are so you're expecting that pain right now. And I didn't think of it that way. Like it wasn't something that I was cognizant of. And that's why I think like when you're pairing this physical therapy side, the manual therapy, whatever that is, and also like it's okay to go talk to your therapist about it too. Like, this is what's happening in physical therapy. I'm really struggling, but I don't know where it's coming from. I think that is there's a lot of healing that I have done through that avenue of like recognizing those patterns and then kind of addressing them twofold. And I think sometimes those that's where the healing really comes in and where it's help been helpful in my physical therapy when I do do that therapy, because then I'm able to identify why some of these things are happening from the cognizant part of my brain now, not just like a reactive part, you know. I think that's what's really hard for a lot of patients is we get so stuck in, I'm just in pain. And if you're not seeing the right person, sometimes they can't identify why. It just is like this hamster wheel of like we keep trying the same things, or I'm gonna try something slightly different to get a different result and nothing changes. Maybe we have to switch up our approach and combine that. I always say it, I don't know if there's ever been an episode I've not talked about, having um multidisciplinary approach because it truly is multidisciplinary. Like I really truly will stand by this, and I'm a broken record at this point. I know, I know. But that we have to address all of it because there's not one avenue that's gonna be helpful. And that's why I think like pain generate and the other thing, maybe you can speak to this too. Something that I think is interesting is that sometimes I will address one pain generator and think that I'm good, and then another one pops up. It's like my trainer calls me a little onion. He's like, and I tell him, like, at least I'm sweet, I'm a sweet onion, but I like on covering those layers. And I think a lot of that is those years and years of delayed diagnosis, failed treatments, and not understanding the disease and all of the subset diseases that kind of followed after, you know?

SPEAKER_01: 45:22

That and I think there's just also the bittersweet, which I know there's people that aren't gonna like me saying this, but there's also just the bittersweet concept of being a human.

SPEAKER_00: 45:32

Yeah.

SPEAKER_01: 45:32

Like people without pathology still have stuff come up, you know. So it's like, is this my endo? Is this my hashes? Is this my PCOS? Is this my EDS? Is this my MCAS? Is this my, you know, or am I just existing on a planet with gravity? Like we don't know. And so it's like, and I think that's why having some gaining information or having somebody that you can dialogue with when you're like, oh, like OMG, what am I gonna do about this? But not, you know, so and I tell people this, I was like, not every pain has to be processed. Like, you know, as a physical therapist, I my rule of thumb, because I I'm perfectly capable of hurting myself or getting tweaked um or getting a crick in my neck or whatever. And so I'll if I say I wake up with a pain, I'm like, okay, I'm gonna breathe and I'm gonna say, I'm in pain, but I'm not in danger. And that's that's a little bit of cognitive behavioral therapy tips, right? Sometimes when we're we're really retraining a pain pattern, we'll say out loud, seven times I'm in pain, but I'm not in danger. I'm in pain, but I'm not in danger. I'm in pain. Not try to gaslight yourself, but just to like ground yourself, right? Right. So because we're not in danger. Right. My facet joint is being stupid. That's what's happening, you know, or it's like a part of my vertebrae is being weird. So there is no danger. So I'll pause, like, okay, this is what it is, and then I'll get up and I'll move. I'll do therapeutic movement and find just do some movement that's in a there's a difference between sharp, sharp shooting pain and like dull achy pain. Right. Or like, hey, that's a stretch. So find a pain-free or an acute pain-free or a acute pain-free range of motion and just kind of like like, nope, that's not good. But if I do this, I'm okay. And if I breathe while I do that, and maybe I can add some arm motion in, like, hey, like, either in a few hours it's gonna go away because some inflammation probably built up, and I probably need some time for that inflammation to get out of my system. And so after about three to five days, if I'm still really like struggling with it, then I might ask one of my coworkers to be like, hey, like, can you can you like hook me up? Like either throw a dry needle in there or like give me a little pop or some, you know, just something to disrupt the nervous system, right? So that so that the movements are more effective, or I'll pop into one of my Ciro friends and just be like, Help Yeah, I tweak myself. And then you just go about, you know, you just kind of go about your day because we we all are gonna encounter things. And then the kicker, the other thing that is just like awesome about the delayed diagnosis is that typically you're in your like late 20s, early 30s, and then guess what's around the corner? Perimenopause. Yep. So it's like, is this endo or is this perimenopause? Like, I don't know, or am I just being a human? And so just and so I think it's like having, I don't, I'm not gonna call it the ability because really it comes with repetitions in life of experiencing pain, is you just kind of have to be able to step back and just what is the most important question? I am not in medical danger. My life is not in danger. I am not about to have a heart attack, I am not having a stroke, I am not hemorrhaging. Yeah. So what what's the what's the next tier? What's the next level of triage when it comes to pain? And then, you know, what what's in my toolbox? What what has my therapist taught me? When I go to lift my leg, do I need to forcefully exhale as I lift to kind of counter counterbalance that pressure? Right. Because a lot of my patients, whether they're indo, low back, ankle, shoulder, oh, when I moved, it hurt. Okay. Let's let's do that again. But before you do, I want you to forcefully exhale through your mouth and then start to move. And that creates that pressure system. We're not we're not holding our breath, but we're just supporting, we're engaging our core to help support our physical body. And then so again, it's like number of reps you get because it's like we're we're gonna have moments of pain. Right. So how do we manage it? Or like, oh, I'm driving down the toll way and I've been clinching my jaw and my butt all the whole the like for the last 20 minutes because people are psychopaths when they're driving. Do I before I jump my radio is on like a thousand percent volume and I'm sipping on my iced coffee, before I get out of the car, do I need to pause, turn the ignition off, turn the radio off, put my coffee aside, and do some deep diaphragmatic breathing to bring ourselves back down to baseline or to neutral. And I and this is where I'm gonna say, like, yes, before I had my excision surgery and a lot of other people that I work with are the same way, sensory sensitivity or noise and light sensitivity, it's huge, right? So for me, I know I'm having a good day when I can listen to the music on blast. I don't listen to music. I hate music, but like maybe one day a month I like music. Otherwise, I'm just like, it is it's like overload opening and closing a drawer of spoons, and it's like makes me scratchy. So I just don't, I'm like, okay, podcast on low. But make me happy, or just don't listen to music, or just don't listen to anything and reflect. So like, and this is not just me, this is again like clinical experience. I see this with my patients too, but like sitting under a fluorescent light for an hour. No way, that was never never, never gonna happen. But then you take that high volume of inflammation out, and your nervous system isn't like WT WFT, bro. Like, what's going on? We can we can act we actually have a chance of grounding.

SPEAKER_00: 50:59

If this episode resonated with you or helped something click, don't stop here. In part two, we'll explore practical ways to upregulate your parasympathetic nervous system, tools to support your body, calm pain pathways, and create relief when surgery isn't an option. This is about giving your body more safety, support, and room to heal. So until next time, continue advocating for you and for others.