In Your Pants with Dr. Susie G - Massage therapy for pain and sexual function

Starting point is 00:00:00 you're listening to the in your pants podcast i'm your host dr suzy gronski your penis friendly pelvic health physical therapist sex counselor and educator helping you get in the know down below hi friends dr susie g here and welcome to another in your pants podcast on today's show i have jocelyn curtain who is a registered massage therapist in british columbia canada jocelyn and i talk about the role that massage therapy plays in pelvic and sexual health concerns Jocelyn walks us through her biopsychosocial approach when working with her clients and we have a discussion about internal manual therapy and how that may or may not fit within the massage therapy scope of practice we also talk about the challenges and some of the pushback

Starting point is 00:01:18 within the massage therapy profession when it comes to being an advocate for sexual and pelvic health concerns within the massage therapy space. Jocelyn provides us with practical ways to bring up perhaps difficult conversations or wanting to add sexual and pelvic health as part of your treatment plan with your massage therapist so she walks us through how to bring up these difficult conversations with your massage therapist from the person seeking massage therapy and services and also from the perspective of the massage therapist of how to talk about bladder bowel and sexual health with your clients we also broach the topic of sexual ambiguity especially when addressing pelvic and sexual health concerns within the massage therapy spaces and elsewhere

Starting point is 00:02:18 we know how difficult it can be for any of us to talk about sexual health with other people so there are some really awesome practical strategies tips and also amazing modeling of what it can be like to have a multidisciplinary support system for sexual and pelvic health concerns. You don't want to miss this one and I hope you enjoy the show. To formally introduce our guest Jocelyn, Jocelyn Curtin has been a registered massage therapist in British Columbia, Canada since 2013. her education and practical experiences have given her the unique opportunity to incorporate her knowledge base that serves people living with abdominal and pelvic pain jocelyn use utilizes a biopsychosocial understanding of the people of her people she works with to best serve their goals

Starting point is 00:03:22 with a combination of education manual therapy movement and mindfulness she collaborates on an individual management plan forward. In addition to her practice, Jocelyn impacts the massage therapy profession by educating registered massage therapists on the positive effect the profession can have for people dealing with abdominal and pelvic pain that is evidence-based and above all safe. I hope you enjoy the show. Jocelyn, welcome to the show. I'm so happy you're here. Thank you so much for having me. This is like a dream come true for me. So I'm so happy to be here and have this conversation with you today. Well, thank you. I'm very flattered and humbled really because you're going to be talking about several important topics around massage

Starting point is 00:04:15 therapy and the role that massage therapy plays in pelvic health. So let's just start there. what does massage therapy um play in pelvic health okay that's a big question so if you need you know me to like expand on something a little bit more just jump on it so i've been working with pelvic health uh population for about seven years now and uh kind of at the beginning of my approach it was kind of pretty mechanical uh and then as i kind of started getting to know people that's when I really started to understand like the missing piece I feel massage brings to the pelvic health management table. And that is very much the exploration of touch that feels safe, feels good. And also helping people advocate for themselves kind of, especially when we're dealing with pelvic

Starting point is 00:05:10 health and elements of kind of sexual health. It's a really good way for people to kind of quote unquote, help practice advocating for themselves to explore kind of touch that feels good. Now, in my scope here, I don't do internal exams without a scope of practice for massage therapists in BC and Canada. But getting people kind of used to like, certain phrasing or language to use to kind of help with that element in their life, if that's impacted, help helping people kind to manage aspects of mental health, not so much to the level of a psychologist, because again, scope issues there. But massage feels really good. It's really calming for the nervous system. It really helps modulate kind of someone's pain experience. And I find for a lot of people,

Starting point is 00:06:02 it really brings an element of empowering them to be a self advocate for them for themselves, whether that is with sexual partners or within the health care system itself. It also presents the opportunity for a massage therapist to be an advocate for people who are living with pelvic health concerns and pelvic pain. Because often in my practice, I see people who are very apprehensive and scared to interact with the medical system because of how invasive it can be. And when you surround yourself as a massage therapist, I surround myself with like-minded clinicians, pelvic floor, physiotherapy, urologist, gynecologist, midwifery. When you have a like-minded team behind you, making those meaningful referrals, and that's a topic I'll probably keep circling back to, is really one of the best things you can do as a massage therapist. we have time on our side when we work with people we spend anywhere between 30 to 90 minutes with someone and it really gives us the platform to establish strong therapeutic rapport and alliances

Starting point is 00:07:17 with people under our care um which i've seen in my practice uh makes people feel safer talking about certain sensitive elements that come with uh pelvic health concerns and issues so that's kind of a in the box. That's a big box. You are filling some really big shoes here as far as advocacy for this particular niche or population group. And I can imagine how other people in the community, whether that's, you know, clients who come to see your patients And even other health professionals or even within your own profession, how there might be some pushback, really, because it's not traditionally just, you know, it's not a traditional thing you hear as far as massage therapy being an advocate for pelvic health or being one. And I don't know where physiotherapy started to claim pelvic therapy or pelvic health. I have to say, I don't know where that came from, but we don't own it as a physiotherapist,

Starting point is 00:08:39 as a physical therapist. I'm here to say we don't own pelvic health. And the fact that you're bold and courageous to say, hey, we have a role to play as licensed massage therapists and body workers to help folks with pelvic pain, like you said, that are less invasive, that help to modulate the nervous system. So how has the community responded to your messaging? There's been a spectrum. um so i am really happy that you said that physio doesn't own kind of pelvic health management um i am very fortunate with the pelvic uh with the pelvic health physiotherapists uh in victoria the ones that know me they're all curious about what i do and um in particular

Starting point is 00:09:32 two of them who i refer to regularly um they we've learned a lot from each other from interprofessional collaboration. I've been able to kind of go in and demonstrate like just nonspecific touch that feels good through the area. I've been able to show them how to conduct a non-internal pelvic floor exam. And our consent process with massage therapy here is very lengthy because we are a regulated healthcare profession in bc and uh so even just going over like language during a consent process they've been so open to that so i'm really thankful uh i haven't met a lot of pushback from the pelvic uh pelvic health kind of physiotherapy community for the most part they've been very embracing and they're very curious what i do which is awesome um i've met

Starting point is 00:10:30 a lot of pushback from the massage community. And yeah, and this is where like, I had a lot of online scandal in the last year, particularly because everything about my practice and the way that I approach care challenges traditionalism within the massage therapy culture. And one of those elements is working with penis owning individuals they have pelvises too i hate to break it to you uh and talking about things like physical arousal erections uh sexual health um you know having converse like just conversations and dialogue around like you know the that an erection during massage is normal and going about kind of management strategies, being comfortable talking about that with people. I have made videos, I have made

Starting point is 00:11:35 like resources on how to navigate kind of that sexual ambiguous situations that come with those appointments. And for the most part, some people, especially kind of the, I would say kind of the the individuals who've been in the profession for a longer period of time um that threatens legitimacy of massage therapy for them I think and so I met with a lot of discrediting backlash uh in the form of you know being sexualized on platforms of over 3,000 of my colleagues so it's uh existing as a woman on the internet is already hard enough um you know I like I don't worry about this but apparently it bothers people in my community how I move my body online you know the language I use online the fact that like I wear red lipstick and like it yeah

Starting point is 00:12:37 welcome to the club uh there is ingrained uh sexism here that i am really coming up to face and and i'm challenging in my profession so yeah it's it's a spectrum it's a large spectrum of uh how people react to my content um the people who have reached out to me so just kind of patient or like the public like people that are living with pelvic health concerns uh they love it they've been nothing but supportive even just to reach out and and just provide some words of support uh i'm so thankful to those people um and then also they kind of reached out and asked for some referrals as well so yeah it's a wide spectrum of reactions i've had mortgage work well yeah And it's so hard. And, you know, really, I just want to acknowledge that. Thank you really for sharing in your experiences, those challenges, because it's hard. You know, it's hard when you're trying to change the narrative. And when people are comfortable with the current paradigm, it's just comfort.

Starting point is 00:13:47 And so when there's something different or new, then it really is their own individual fear and their own internal identity and voices that they're hearing but are being projected onto you. So it's unfortunate that you have to experience such behavior with some of that community and also that those that support you are vocalizing their support and, you know, your boldness and courage, which is what encouraged me to get you on this show. because I admire I was saying this off the air and I admire your boldness and courage and to just really be genuine on authentic as a female identified provider who does work with all pelvises which includes those who own penises which we know is controversial it's very controversial and we need to man like there needs to be more of us who are looking that controversy in the face and just being like i'm going to deal with this because this is an incredibly underserved population of people and uh the fact that uh i can provide what i hope to be as what i intend

Starting point is 00:15:15 to be a safe space for someone to come in regardless of who they are and and what their goals are and and I just I want someone to come in and feel safe talking about you know sensitive topics in my practice that is so important to me and having the time to talk about those concerns um is that is my the foundation of my practice really uh I just want to listen to people I want hear about you and what your concerns are and how i can help you uh within the means that i that i can exactly exactly shifting away from this idea of i understand to help me understand what you're going through and and again expanding and challenging you know people's idea of what massage therapy is i know even within my own profession as a physiotherapist you know and

Starting point is 00:16:12 and a sex counselor of, of blending the two that in itself, you know, is a very challenging for some individuals to, to embrace and talk about sex. And it's like, well, how can you not talk about sex and, and that person's history with their sexual self and, and work on the pelvis when you have an organ and a body part that has a function, it's like, you know, going in for ankle rehab and someone talking about your knee or your back and saying like not that that's not relevant but you know it's so completely disregarding that part or anything that has to do with that part you know and as you said jocelyn so well that there's a spectrum obviously of people's perspectives and and really it comes down to a battle of perspectives that's and it's you know

Starting point is 00:17:04 people who kind of lack the insight to see that they're projecting whether it's their you know feelings or insecurities or whatever it is on to me that's what i deal with a lot of so uh yeah they when i try to kind of kindly unpack that sometimes with people i mean i have boundaries right and when someone is calling like I've been called the madam of a brothel before I've been called yeah I've been called that I was selling my body for a course um oh yeah yeah that's an interesting perspective yeah I was that's where I'm like nope I'm gonna draw the line and then I'm gonna make a 17 minute minute like rage video about why that is not okay right Right. Yeah, exactly. That language and those comments are inappropriate and really not productive. I mean, what is the intention behind that? Right. I mean, other than to, in my opinion, to be malicious or something's coming up for that individual that is stirring up an internal conflict with their own values and their own views around sexuality and their own internal rules implicitly or explicitly known.

Starting point is 00:18:19 And that that is when, you know, that that doesn't serve any healthy discussion or help even to open the conversation to getting to know one another and getting to know and understand, you know, maybe there's knowledge that they don't know that, you know, or that you don't know that they know. And it's like, how do we open up the dialogue in a safe and healthy way to understand each other better, not to attack one another? oh yeah and you know i just i just was stirring the pot on that one too because i just had enough of it but i was like you know for a profession like in canada i'm not really sure about the scene in the united states i do have american or like i guess your lmts down there um and like i i have colleagues down there and we kind of try to hash out like the cultural differences uh but massage here is very much medical like it is very medicalized because we are or we used to be like a 3 000 hour program uh physio and massage therapy in bc grew up together

Starting point is 00:19:24 uh so yeah we're siblings uh so when we there's a lot of uh this like professionalism that I call it toxic professionalism that gets kind of perpetuated through the community because it's like you're expected to behave a certain way. And if you violate those expectations from the community, you're just like booed off the Internet or they really do like shame you in any way that they can. And I just said, you know, I don't think this is how health care professionals act. act i don't think health care professionals should be sexualizing their colleagues on social media platforms like this is if we're going to talk about professionalism for a second year how about you reflect on your own right now instead of projecting uh you know whatever it is this is right now onto me uh and that was met with a lot of people liked that and then there's also a lot

Starting point is 00:20:29 the people who took issue with it, but that's, that's just who I am. And I understand there's a lot about me that is kind of threatens the norm. And I'm totally, I'm always open to conversation and differing point of views. But I'm not okay with personal attacks and intentional ways of trying to discredit me or really any of my colleagues. Right, right. Yeah, it comes down to respect and respecting each other, you know, understanding, yes, we have different views and perspectives on, you know, what our practices maybe should look like or what our role is in particular situations or with certain patient populations like pelvic health and so forth and sexual health. And, and yes, can, can we still respect each other in that, in that dialogue? So I, again, I appreciate the, I mean, I have no other words other than boldness, courage, and bravery that you are demonstrating and modeling for not only your profession, but for other practitioners or providers who have same feelings and want to push the boundaries and, and do something different, but may, might be afraid to, to do that because of, um, some of the scrutiny that exists and the, uh, uh, yeah, some, some of that, that might go on with that. So, um, speaking of, I, I, I want to segue to, you know, when you're, when you're

Starting point is 00:21:59 working with clients directly and, and someone may bring up the topic of, you know, well, how actually this is what I'm trying to ask is how can someone who, who wants to work with you is working with you as a massage therapist bring up topics of you know pelvic health or sexual health without feeling like they're going you know there's this crossing of boundaries like i don't know what's appropriate how do i ask this i don't want to tarnish the relationship you know i often get this you know i don't want them to take it the wrong way kind of quote right so and i hear this a lot too from you know penis owners who i i work with a lot and and who have had other practitioners and asked me, can we brainstorm ways to talk? How can I express what

Starting point is 00:22:48 I need or what I'd like to explore in my therapeutic sessions without tarnishing the relationship or having the other person take it the wrong way? What are your thoughts, Jocelyn? Okay. So when I read that question on your question sheet, my initial reaction to it was like, we should just be asking that question. Because, you know, when I took your lovely course a year ago, and there was that stat about how 48% of cisgendered men believe that their healthcare professionals should be asking spontaneous questions about their sexual health. I was like, well, yeah, why can't we just be doing that? And then we don't, I don't, you know, this shouldn't be a question, but unfortunately, it is. So for I'm going to kind of break this down into two

Starting point is 00:23:43 parts. So for people who are seeking care, or wanting to have that conversation with their massage therapist or healthcare provider, and then to from the massage therapist aspect of things, because there's two really important pieces there. So first and foremost, if you're someone who is listening, and you are wanting to, you know, ask your massage therapist, perhaps, It's about lower abdominal, groin, hip massage. It kind of depends. Again, massage therapists, the hip is different. Sometimes it's considered a sensitive area and somewhere here it's not.

Starting point is 00:24:20 But I'm just going to throw it in there just to kind of cover all my bases. But if you are inquiring about that, because you are someone that does live with, you know, with pain or certain symptoms or like, tension or whatever it is through the area, and you've noticed getting massage feels really good, because it's helping modulate the nervous system. um my biggest like don't do this is don't ask during the massage um just because of the the dynamic like this kind of unspoken dynamic that exists especially as someone um if you are someone who owns a penis uh during a massage especially when you're face up and you're asking it it can sometimes come across as like maybe it's awkward for you to have that conversation but you kind of feel like you have a good rapport with your massage therapist they might be perceiving that as like oh this person is trying to solicit something from me that i'm not about

Starting point is 00:25:23 uh because the unfortunate reality with massage therapists is that we really have thrown the baby out with the bath water when it comes to any elements of of um uh kind of sexual pieces that come up in clinical practice. So if that is something of interest to you, I would recommend when your massage therapist takes you into the treatment room, there is a little bit of a sit down or there is a little bit of a conversation. We have to do full on assessments here. So sitting down and like getting to know you and collaborate with you is very much a real part of work here. I'm not sure what that looks like in other places in the world. But if there is a little bit of a short consult, um, just ask your massage therapist, Hey, I do have concerns of a sensitive nature

Starting point is 00:26:09 that I'm wondering if you can help me with. Um, and I understand how this might come across, but I just, I want to have this conversation with you just to establish, uh, like a, a comfort zone about talking, talking about kind of my struggles with pelvic health. And if you want to throw in sexual health concerns in there too, go for it. Um, and how I think massage can help me? Are you open to that? And if it's approached that way, I don't think you'll run into the problems of being misperceived, and then being told to the treatment over get out of the treatment room, you've sexualized the clinical nature of the environment, which in itself is kind of traumatic, at least for some people I've talked to. So if you're going to if you want to

Starting point is 00:26:58 bring that up with your massage therapist or do it before you get on the treatment table or you can do it afterwards just don't do it during uh just to kind of prevent that misperception there um if you are a massage therapist listening to this right now um and you are wanting to get into a focus in pelvic health uh and you're kind of struggling with how to bring that topic up or even just to have a conversation about how normal erections are physical arousal is during a massage um have that don't have that conversation with people on the table just don't um because that is also as massage therapists there's also the nasty reputation that we get where we as a community are known for the predatory nature that you know not all professionals but there are

Starting point is 00:27:55 the few um who unfortunately abuse that position so don't do it when someone is on the table because we have to think for a second um that position of power that dynamic right you have someone who is either semi or fully undressed underneath a thin sheet uh you're standing over top of them uh and that presents a lot of kind of that's a huge position of power there that we need to be very mindful of. So sometimes during the massage, especially if there's conversation, you know, it might just come up. And the way that I kind of navigate that is like, hey, I want to validate and hear about your experiences and the things that you're and the goals that you're wanting to achieve within our time together. Let's save that for next time so that we can sit

Starting point is 00:28:44 and have a face to face about it. So don't bring it up when someone's on the table. Don't use your like i feel this is tight and now i'm going to use this to talk about your sexual health just don't do it uh because you don't know how that person is going to perceive that and that can be that element of touch combined with a question that is sensitive in nature that can also be misperceived as well so don't do it um again the consult that sit down session that's probably the best time to have that conversation or if you've noticed something during the treatment bring it up afterwards when someone is fully clothed and they have a clear option to leave if they don't feel comfortable with how you're conducting those questions um and the way you bring it up keep it

Starting point is 00:29:33 general do you have any concerns about your bladder bowel bladder bowel or sexual health that you would like to discuss with me today and often you're met with oh no no no it's fine everything's good and then almost always the next appointment they'll be like so you asked a question and then that's just kind of a great way to keep it keep those uh the door open to that conversation and i always end that question if someone goes no no i'm good i'm like okay if that changes at all like feel free to just you know ask me or bring that up and we can talk about that so ask it leave the door open and then also knowing your boundaries within those conversations as well um often okay don't get me wrong love pelvic floor physiotherapy y'all bring

Starting point is 00:30:24 like a much-needed piece to the table but the courses i have taken some of them um there's kind of this yeah i know you're smiling right now there's a little bit of this idea where it's like it's a body part who cares like don't make it weird and or if someone decides to share whatever it is that they want with you um you know you should applaud them because they feel comfortable sharing that amount of information with you absolutely true 100 but we also need to know our boundaries within those conversations because as massage therapists i often refer to us as the bartenders of musculoskeletal health care in that people like to talk.

Starting point is 00:31:08 And the problem is when you're dealing with a topic that is sensitive in nature, if you are just expected to be a blank canvas and have someone just kind of divulge everything that they want to share with you onto that canvas, that might lead to blurred boundaries a little bit. And it might create more of like a, I call it girl talk or like a friendly, more of like a friendship dynamic instead of a professional

Starting point is 00:31:39 one. So also understanding your sexual boundaries when it comes to those conversations and sitting down with yourself and unpacking, okay, what do I need to know? What do I need to know to provide care for this person versus what is just gossip? And I think that conversation doesn't happen enough within the pelvic health community. Right. That intention, you know, the intent of why are you at, I mean, what's the point of even asking a particular question? How is that going to either one, uh, allow that person to reflect perhaps on their situation in a different way, right? So more of a metacognitive process of, of insight and reflection, or are you truly looking for, um, some piece of information that might add to a meaningful clinical encounter that might maybe

Starting point is 00:32:30 adjust the way you, you know, what assessment tools you're going to use or what treatments you might offer. And so, yeah, I think you're right on. We shouldn't just arbitrarily be asking questions without purpose, but really taking the time to think about our intent and the impact that that particular inquiry might have. Exactly. Yeah. No, thank you, Jocelyn. This is very wise advice. And I really appreciate the tangible, practical ways to even just down to like having like a script and saying it out loud, like even before you meet with your client or patient, because that's where we, you know, when we're caught off guard is when we tend to feel flustered and unprepared. And so what you just provided for providers and for folks who are

Starting point is 00:33:20 seeking massage care or massage therapy is a way to practically ask the questions and practice that, you know, talking to their fridge, for example, or in the car, just say it out loud, get used to saying it because it takes the edge off of the fear and the uncomfortable and unpleasant feelings that might arise when we're trying to have these difficult conversations and oh i was gonna say out there too uh adding on to that uh for any like the people listening just use me i have this conversation all the time on instagram with people reaching out if you're scared just like if you're worried or anxious about having this conversation just throw me under the bus hey there's this massage therapist i know who deals with

Starting point is 00:34:10 like pelvic health you know and uh i was wondering if you could if that was something you did and if not if you could reach out to her and and for some ideas that has happened so you can totally use me too i do i like that i like that really yeah like i heard this professional talk yes on a podcast. So yeah, you can use me as well. So exactly. Right on. High five, Jocelyn. I do the same thing. Like, Hey, just tell them it's me, you know, tell them it's me. If they have any questions, they can call me. We can chat. We can have conversation around it. If there's any confusion. Yeah. Yeah. No, I get it. I totally, I love it. It's great. So I want to segue into maybe for those who are listening, who want to incorporate massage therapy and care into their,

Starting point is 00:34:59 whether it's sexual health pelvic health concerns what what should what can they expect you know you're it sounds like you're really pioneering uh this this shift in the narrative and you know what what can folks expect as far as uh working with with with you you know what would that look like what are some things that might be part of their therapeutic session that would address some of the pelvic and sexual health concerns they have? Great question. So typically, as you're probably aware of those lengthy intake forms, that's kind of part one. I understand how frustrating those forms can be. But I always kind of just preface them with the more data you give me kind of before the appointment, the more I can get a sense of like the the biology of kind of what's

Starting point is 00:35:52 going on in an area because i want the time that we have together i want to focus on you i don't want to be asking like these kind of menial like you know what is your bladder frequency like you know how often are you going during the night like you can answer those questions so that's why those intake terms are very lengthy so i apologize but they just give me data um what i typically do uh, those appointments are about 90 minutes long and they are, we sit down, I get to know you, what your goals are, what your concerns are. Uh, and because it's like, this is kind of new coming to a massage therapist for a pelvic health concern. Um, I opened the door for like them to have questions regarding the nature of the treatment, uh, and, and their concerns if they

Starting point is 00:36:41 have them. So one of the biggest things that comes up is the internal exam. Now that was a question and I think that's a whole other conversation itself. We should circle back. Which we'll dive into, no pun intended. But I definitely do want to touch on the topic of massage therapist role with internal work. Yeah. So internals are not within my scope of practice and I make that very clear. And which is often why people come in to seek care from me is that it is off the table, pun intended uh so after i get to know someone and we establish kind of our boundaries in terms of what we're comfortable with treating uh drape boundaries um and uh and even like also movement and exercise prescription now that is within my scope of practice as a massage therapist in canada

Starting point is 00:37:28 i know yeah thumbs up thankfully uh that's not always the case everywhere else in the world so I just asterisked that a little bit. And we kind of talk about their movement menu and what that looks like in regards to the area. During treatment, it kind of just depends on the person, but typically I'm doing a lot of work kind of through the pubic bone, low abdomen, kind of high groin. And then there are areas I can access the perineum kind of in and around the medial aspect of like the sits bone. Um, but my scope is, is clear that I can't go beyond like the, the edge of the anal cleft, I think is how they define that. So, uh, yeah, it is. So I can do a little bit of a, we want to call it quote unquote pelvic floor assessment. Uh, what that

Starting point is 00:38:25 involves is, uh, I'll just kind of put a hand there and I'll just ask someone, you know, whatever you think we want to call it a key goal sure whatever you think that is i just want you to like do five of them for me because i just kind of want to feel what's happening through the area and then it's a lot of coaching and queuing and providing like you know if something feels a little sticky with that motion i'll maybe do a little bit of like a kind of like traction or like a stretch through there or something feels a little bit sensitive um you know well i might do what we think looks like a trigger point release i like that with air quotes if you can't see jocelyn she's funny quotes or air quotes trigger point release uh-huh i'm with you that is is i'm

Starting point is 00:39:14 just it's a tender area and um i just go we work on kind of breathing and movement strategies to help modulate the tenderness there um and it's but i'm i'm asked like i'm you know asking someone like, does this feel better? Does that feel better? Which one do you prefer? Because not everyone likes, you know, what I call like a nociceptive driven experience through the area. Can you clarify that? Can we pause for just a second? When you say a nociceptive driven treatment, can you explain that to folks who might not know what nociception is. Yeah, absolutely. So nociception is a noxious stimuli, we have a sensory apparatus that is involved in detecting them and transmitting that information further into the nervous system. And

Starting point is 00:40:11 that plays a role in how you are perceiving or sensing an area. And so when I say nociceptive driven, it means probably a more intense, stimulating, you know, that that that pain that feels I'm saying this in air quotes, because a lot of the pain literature I've read the pain that feels good, but or the therapeutic pain that often gets labeled in therapy, that would be what I would consider a nociceptive driven treatment. So something you feel like you have to breathe through. And yeah, yeah, that face. That's the face I make too. I don't ever want to treat an area that is hardwired for pleasure, like with pain was or something painful. Because often, there's this idea of like, no pain, no gain. And there's a disassociation that can happen

Starting point is 00:41:09 when we are so focused on fixing, no matter the cost, versus engaging in mindfulness and things that feel good and pleasurable through that area. So I make that very clear to people, like, you know it's you do you it's your preference but it doesn't have to hurt to feel better is essentially how it's done that actually uh so yeah i'll do some coaching through there uh with you know either with breathing um i like to also take a look at you know if everything else in the area is involved too so if we have kind of hip involvement groin involvement lower abdominal involvement with that in a way that perhaps isn't serving the area very well uh it's just kind of unwinding those uh that motor pathway those sensory pathways a little bit and creating a

Starting point is 00:41:58 foundation of kind of mindfulness and understanding of how the area is functions before then taking that piece of you know uh control i call it control the pelvic floor and then implementing that back into activities of daily living that have been impacting so whether that is toileting squatting uh you know certain uh sexual positions uh or work sitting for long periods of time driving whatever it is uh yeah we first focus on that whole coordination of the area and then taking that new information and then implementing it into activities i love it i love it for those like maybe see my face or just can't see my face i am just all yummy right here because jocelyn speaking my love language all that that she just said yes yes yes yeah i often think from

Starting point is 00:42:53 like again anecdotally here uh from my perspective of dealing with this uh population is that the kegeling often is just like it's just focused on the movement but taking that piece and then putting it in back into activities they often gets missed so i like from what i've seen is that's actually a very important piece for people to understand like yeah it's not just doing your key goals or like your relaxation exercises or lengthening i call it the lift and length in practice because it just makes sense um but it's also taking that piece and then putting it back into meaningful activities of daily living so 100 how else are you supposed to integrate exactly Exactly. And then the biggest part, so then the final piece of all of that is the beautiful part about my practice is that it gives people permission to feel good.

Starting point is 00:43:54 And so I am typically during the massage, I'm showing people like, how to traction the area to recreate those like, you know, I call it the yummy sensations through the area. And, you know, I took a Diane Jacobs, dermal neuromodulating course. I have like rolls of Dyson that live in my office. And I'm literally cutting off chunks of that and giving it to people. and just giving them permission to explore things that feel good for the area. And I think there's something powerful. And it can correct me if I'm wrong here, I'm willing to be wrong. But there's something powerful about having a healthcare provider who understands their scope of practice and being like, okay, like, I am not going to be massaging these areas for you. But you can do that at home, if the area feels, you know, really good. And I there's no right or wrong way to explore that. And sometimes like I do have a model. And I will kind of show like some, some techniques that might feel good through the area, but I'm very clear that there is no right or wrong way in

Starting point is 00:45:11 engaging with your body. And so we just want to focus on, you know, something is a little bit sensitive, like some breathing techniques, or here's another way you can approach it. Or, you know, focusing in kind of on, like pleasurable sensations, or sensations that feel really good, or even if they are just neutral, in an area that is persistently painful, that's also a positive thing, too, that can be a positive thing. So there's something about like, I'll kind of take the reins for a little bit in these areas but then i'm going to give you the reins back to go self-explore and there's something with a massage it's so powerful i can't describe it but uh i think that's probably one of the most important pieces that we have to offer as massage therapists

Starting point is 00:46:00 in that regard i i love it it's including it's a collaborative shared decision making process with with the person and ultimately saying hey you know you know not being like reliant on on an external or some provider not saying that we're not helpful certainly but we're empowered like you're saying we're empowering that person to feel capable and resilient and independent and get their autonomy back for meaningful activities in their life you know so yeah um wow amazing we definitely need more folks like you for sure and i i appreciate i appreciate all the work that you do and in being an advocate for not only not only for your profession but um for breaking the mold and for helping going going beyond that mold to really extend care to people that really need it

Starting point is 00:46:57 and and want it and um yeah that's really awesome let can we circle back briefly to the internal conversation because because in the united states like in north carolina uh miss if to my knowledge massage therapists licensed massage therapists are are allowed to do internal work so i but no one dares you know so no one no one i have broached this topic with other massage therapists in town and and no one broaches that area ever you know it's like well no we don't you know yeah i know we can but we don't cross that line so i i'd like to talk to you about that about the the the internal work controversy when i read that i was shocked uh that is so surprising to me um but at the same time in bc because we were trained under like with physiotherapy up until i think

Starting point is 00:47:58 1994 when we split into our own colleges um we were doing internals was very much a part of our educational curriculum um and then they took it out of our scope of practice when we became our own regulated health care um profession and i think that just has to go especially in bc you can't speak to the rest of canada but they're very stringent like this is your scope this is your scope this is your scope here so it's very compartmentalized um and with that being said it is every month i get a message or two from uh rmt so registered massage therapist uh in canada who are asking if i would ever advocate for internal exams to be part of the scope of practice for a massage therapist and oh this is gonna break some hearts i'm sorry everyone

Starting point is 00:48:52 but I am firmly in the camp that internal exams do not belong within the scope of practice of a massage therapist for a lot of reasons. The biggest one being that we do not have comprehensive sex education as a part of our education curriculum as massage therapists. So we are a very, what I like to label sexually avoidant profession kind of in general. And we don't have the skill set like if we're not even comfortable talking about how normal physical arousal or erections are during a massage why are we insisting on doing an internal with with someone like why I just I really fail to if we don't have this education over here first to lay the foundation so that we're providing safe care for people then like the modality of an internal exam like that's not

Starting point is 00:49:47 even on the table in terms of the way I'm looking at things right now. So that's kind of my biggest number one. Number two, it is not hard to go get an internal exam. We there's a lot of healthcare professionals out there that will provide them. And especially here, pelvic floor physiotherapy is very popular. So again, the biggest thing we have going for us as massage therapists is that we provide a safe space for people to come in to and uh yet that internal component is completely off the table so they don't have to worry about like saying yes or no potentially offending the health care provider uh feeling like they're not getting proper care i say that in air quotes you can't see that because people feel like if they say if they refuse the internal then they're not

Starting point is 00:50:39 the efficacy of the treatment goes down. And so they have a tendency, at least from what I've seen in practice and experienced in practice is that they feel they have to go get this done in order to have a successful treatment. And so as massage therapists, if that is not even offered, then it opens the question to like, well, what is it that you can do for me? And then I can have the conversation of pelvic floor therapy is not about the internal exam. It is a modality. It is a way of interacting with the area. But first and foremost, you need to consent to that. And it needs to be not... I don't know if there is actually a term in research literature around this because I've read a couple of qualitative studies around internal exams and pelvic floor

Starting point is 00:51:34 physiotherapy and kind of the rates of dropout during research uh research that's conducted um medical medical consent versus kind of enthusiastic consent and what we often see or what i've seen in these papers is people often have this idea of like well i'll put up with it if it means this helps other people. And yeah, so it's kind of compartmentalizing themselves away from, you know, their body and what's going on with them. And so when that's not even offered, then I can just focus in on the person and their needs. So again, massage, we have our own seat at the table when it comes to pelvic health management there's we offer a piece of the puzzle at the table it just doesn't need to involve internal exams

Starting point is 00:52:32 right a hundred percent and i'm i'm clapping over here because that is that's messaging that should be across the board for all you know health care providers who work with this population that that internal work is not necessary to feel better. And it is a consensual process every single time. And even throughout the examination process to say, you have permission to say no to any part of this therapeutic engagement and respecting, right? Not pushing or forcing or feeling that someone needs to do something in order for you to do your job well. exactly uh i agree um and then finally you know with my profession being what it is uh my concern of over-the-top specific mechanistic explanations um i took a course

Starting point is 00:53:32 a couple years ago that was like suggesting that you could stretch specific muscles of the pelvic floor and yeah i like that i have like a terrible game case it's like terrible i really need to work and i was i i wrote an email back i was pretty blunt i was like you can't like this is not helpful messaging in our community and this is why and if we did have internal exams as part of our scope of practice i feel like the the explanations would be over the top mechanical and then on top of that over the top like palpation dependent yeah and i don't and i just think as someone that studies a lot of pain and and nocebic languages or scary messaging around uh you know pain and uh or even really symptoms symptomatic um presentations of the pelvic floor

Starting point is 00:54:34 and perineum um i just don't i would be just very concerned about that coming out from from the massage community so um yeah i'm firmly in the camp that internal exams they are helpful they can be an important part of someone's uh health care than their management uh but they don't need to be a part of the scope for a massage therapist. Yeah. Thank you, Jocelyn. I would so appreciate your perspective and sharing all of this wisdom that you have with us today. I really appreciate it. And I do hope and my wishes is that this messaging continues and that we can all come to an agreement of, hey, we are just here in the best interest of the people that we serve or the people that we're supporting so thank you so so very much so if folks wanted to reach out to you

Starting point is 00:55:30 connect with you how how could they do that uh yeah uh thanks for giving me a little shameless self-promotion here uh so my i'm most active on instagram and facebook and that's just uh jocelyn curtain rmt so curtain k-i-r-t-o-n uh and then i do have a website uh pelvic rmt.com uh that's in the middle of getting updated right now so it's kind of glitchy but it's getting a bold new look to it because it was literally a wordpress website that i just kind of threw together like uh last year and um what that is going to be offering is like self-directed courses for, oh, it's going to be more geared towards massage therapists, but really any healthcare provider. And also in kind of in-person courses as well. And then also I'm using it as a way to

Starting point is 00:56:29 kind of build up management strategies for people living with pelvic floor or pelvic health, pelvic for abdominal concerns or pain or conditions that impact that area. And also, it's going to be providing a big resource in terms of navigating sexual health concerns for healthcare professionals. So that's coming in the new year. And I'm really excited about that. Awesome. Congratulations. I can't wait for all that to be available as a resource for all of us thank you so very much and you mentioned off the air you had a podcast yeah uh so i have um it's been rebranded now um but it's called behind the curtain and that's it's just me kind of doing a monologuing um that's going to be coming out the fresh face

Starting point is 00:57:25 is coming out in the new year too uh and that's just kind of me it's more geared towards health care professionals than it is uh the with people and the lived experience but uh that's just kind of me talking about some of the traditionalisms and culture within the massage profession that need to change and uh kind of unpacking kind of the uncomfortable unmentionables in the profession so well that's coming out that's coming out the new year i can't wait i can't wait that's well said well great exciting things again wish you all the best with that and thank you so much for being on the show. Thank you so much for having me. This was great. And to all of our viewers and listeners out there, thank you for watching and listening. And as always,

Starting point is 00:58:10 in loving wellness for your pelvis, this is Dr. Susie G. Until next time. Thanks for listening to today's episode. Be sure to visit my website, drsusieg.com for show notes and related resources on today's topic. If you like what you're hearing, head on over to youtube and subscribe to my channel on my youtube channel you'll find content related to sex pelvic health and expert interviews for men if you got a question or a topic that you'd like me to answer on my channel be sure to type it in the comment box below

In Your Pants with Dr. Susie G - Massage therapy for pain and sexual function

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