Jen:
Hey Jo, welcome to the Mumsafe Movement podcast. How are you?
Jo Murdoch:
Hi Jen, I'm very well, thanks for having me.
Jen:
I'm excited, I'm super excited that you've made today happen. Just to give everyone a little bit of an insight, you're in a hotel room, you've juggled a light behind your camera, you've brought your microphone with you.
Jo Murdoch:
It's all good. We're action women, aren't we? Just get it done.
Jen:
Oh yeah, absolutely. So I'd like to start every podcast or I start every podcast with three questions. So three fast questions. So if
Jo Murdoch:
Mm-hmm.
Jen:
you can share with us a word to describe how you're showing up today and
Jo Murdoch:
Mm-hmm.
Jen:
it doesn't have to be a positive word if it's not a positive morning, a win and also something that you're working on.
Jo Murdoch:
Oh, okay. Well, a word, family, probably, because we've, my husband's just organised a massive family reunion of in the, I'm going to say about 100 people have been around family, which is very heartwarming. So yes, word family long weekend here in New South Wales. So lots of people hang out with their family, no doubt. A win. Mm. Oh, goodness. It's tough, isn't it? A win. Parenting, maybe? The children have been very good this weekend. And we were like,
Jen:
Awesome.
Jo Murdoch:
oh, that feels like a win. Often
Jen:
We like
Jo Murdoch:
it doesn't.
Jen:
that.
Jo Murdoch:
In fact, rarely. Rarely it feels like you're winning when you're parenting. So that feels good. What I'm working on, tons of stuff, but. One thing that I'm super passionate about is working on a conference that is designed for all health professionals, including exercise professionals, working with women who have endometriosis. It's a
Jen:
Mm-hmm.
Jo Murdoch:
one-day conference, and this year actually we're holding it in Queensland, in Brisbane. Some of you will remember that last year we held it on the female athlete. The reason we're working on this one... on endometriosis in particular is because again, there's sort of this explosion of information, some of which is accurate, some of which isn't. And we need clinicians to get across really accurate information faster so that we can do a much, much better job for women with endometriosis, because to date, arguably, we haven't done amazing things because we haven't understood the disease very well. So we're getting better and together, if we come together and continue to collaborate, we'll do a much, much better job.
Jen:
I love it. So I think Joe, it might be a good idea. We'll put a link to that in the show notes for anyone that
Jo Murdoch:
Thank
Jen:
would like
Jo Murdoch:
you.
Jen:
to come and find out more about that. Awesome.
Jo Murdoch:
Thank you.
Jen:
So let's, we met, I was thinking about this morning, Marley had been born. I had launched Body Beyond Baby. He was born 2008. So we must've met 2008 or early 2009 because I know I
Jo Murdoch:
Yes.
Jen:
looked for you really early into my fitness journey. But I'd like to backtrack a little bit before that and tell us what led you to being a physiotherapist to begin with and then also a women's or pelvic health or physio. I'm not sure what label you give yourself.
Jo Murdoch:
No, me either. We like, we don't like to call ourselves pelvic health physios now, because it's such a broad demographic that we treat. So, well, physiotherapy, I mean, a lot of physios become physios because they really like sport or activities themselves, they're quite physical in nature.
Jen:
Mm-hmm.
Jo Murdoch:
And so that sort of, that was as simple as that. That's what I did. And then pelvic health really was one of those things I fell into. often you'll find physios merge into public health once they've had their babies because you know, that process opens them up to the profession but I fell into it really literally by virtue of where I worked. So yes, I think it was quite incidental. I actually didn't go to uni thinking I really want to do women's health
Jen:
Okay.
Jo Murdoch:
at all. I just landed in it because we had a clinic that saw a lot of pregnant women because we were we're very good at treating pelvises and lower backs. And then as we started to treat the pregnant women, we went, gee whiz, there's a lot to understand in this space. And so that's what took me on the journey to understand pelvic health in more detail.
Jen:
Okay, and what was the landscape like when you first started? Well, let's talk about where it was and then also maybe compare it to where it is now because it's quite different.
Jo Murdoch:
Yeah,
Jen:
Feels like it's different.
Jo Murdoch:
absolutely. We've come a very, very long way since I started. There were some amazing trailblazers when I first started, but literally I did a weekend course, learnt how to do a vaginal exam, learnt tons of theory that I sort of probably didn't absorb at all, but came away from that course and was working in pelvic health. Full stop.
Jen:
Nice.
Jo Murdoch:
Whereas now obviously there's postgraduate certificates at universities. There's master's programs and the Australian Physiotherapy Association have a much, a much more structured pathway. And there are tons and tons and tons of physios interested in pelvic health. So it's when I was around, there really truly weren't many of us, but it exploded, which is extraordinary because it means you can generally find one. in most places, even rurally and regionally, there's usually someone. And we have lots of pro mental programs that reach people all around the country now to help these physios and guide them. So yeah, I mean, the landscapes changed enormously. And I would argue that we are much, much better at what we do. And there's lots more of us.
Jen:
like it. So when we first met, I knew I know that I was very early into my PT journey. I had done a very kind of low level, not low level, it was what it was at the time, it was a pre and postnatal course for trainers that wanted to work with pre and postnatal women. The majority of that was pregnancy focus, there was very, very little education in working with postpartum women, women. And I remember getting on the internet going, how am I gonna learn more? And stumbling upon the physiotherapy clinic coming in to meet you. What was, where were you at? So I was right at the beginning of my journey then in 2008, 2009. How far in were you? I think it was similar, maybe a little bit
Jo Murdoch:
Yeah,
Jen:
further.
Jo Murdoch:
yeah. No, I would have been also right at the beginning. I did my postgraduate training in Melbourne in 2008. So I suppose I was really at the beginning as well. I think we probably learned together.
Jen:
And it's funny
Jo Murdoch:
I mean,
Jen:
that you say that because I'll go.
Jo Murdoch:
no, I was just going to say what was great is, from memory is meeting you and you had quite a strong following at that point, I remember, which meant I saw quite a clients. So I do feel like we genuinely sort of learned together as we were going.
Jen:
Yeah, that's what I was gonna kind of touch on because I think sometimes as exercise professionals, we think that we don't know enough or we don't bring to the relationship what a physio can bring to the relationship. So from your perspective, from having that exposure to more moms, what was the benefit for you of working with a personal trainer at that point? Or even now, I guess.
Jo Murdoch:
Yeah, exactly. Even now, I mean, the value of seeing lots of patients is you see lots of different bodies and their different presentations, their different birth stories, and you get, you just have to start to think about what that might mean for exercise and how maybe exercise needs to be modified, etc. So I think, yeah, I think what happened is we just you know, I figured out what you were doing with them, which is obviously extremely important on so many levels. And then how their body was looking at whatever time they were postpartum. And then we just started to think, well, what maybe should we modify considering that their pelvic floor is not optimal at the moment? Perhaps those stair runs, maybe not the best thing for them right now. Can we modify that to just step ups? You know, those kinds of things. Do you remember we would just workshop it and then Over time, we've got lots and lots more research showing us true values of pressure and etc. for various exercises. So we can be a little bit more scientific about how we're modifying exercise. But in the beginning, it was really just using our brain and thinking about it.
Jen:
Yep, absolutely.
Jo Murdoch:
I mean, in terms of the value of exercise professionals and what they bring to the relationship, it's not just the patient, the patients sending us patients,
Jen:
Yeah.
Jo Murdoch:
it's highly valuable. But I think it's the communication that you guys are very, very good at, which in our world we call soft skills. But I've said this many times to you, I know, but I've just always been fascinated how your clients trust you so much that they will do whatever it is that you say. So I've often they'll, they'll be they'll be at the clinic and you'll be like, Oh, why here? Oh, well, Jen sent me or whoever the exercise. Oh, why? Oh, I don't know. She said I needed a checkup or something or da da. Like, oh, it's so interesting. So there's that there's that soft skill that's very highly valued, I think.
Jen:
Yeah, and I think on that, that's interesting. Do you like I believe and you can say something different. I believe every mom that's ever had a baby needs to see a women's or pelvic health physio. And I believe that every trainer that works with a mom needs to have a partnership with a women's or pelvic health physio so that can happen. Where do you stand on that?
Jo Murdoch:
Yes, well, firmly beside you, I would say.
Jen:
I was like, yeah.
Jo Murdoch:
Well, because like we've always said, you know, the whole process of pregnancy and birth certainly puts your body through a lot. And the reality is, is often women are asymptomatic with dysfunction. And so obviously, it's like any screening in medicine, like it's like any screening tool, if we can screen you and pick up those dysfunctions and then intervene, we absolutely can prevent issues in the future. It's, you know, we're devastating when you see someone with pelvic organ prolapse or incontinence or feacal incontinence and you just listen to their story and you think, well, that could have been prevented, that was just unnecessary. So it's just that driving force behind. And often the intervention is quite innocuous. It's not difficult. It's just okay, let's do x, y and z. And here's the reason why. And I think in the early days, we probably were too cautious with a lot of things. But we've learned over the years, and we've become just by virtue of seeing lots of patients. And physios generally always want to keep women moving. but there was certainly a period of time where we were a bit scared that we're gonna give everyone a prolapse if we let them load too much, for example. But we understand like Lori Fauna, for example, has done tons of research in this space as have others. And we just understand a little bit more about what exactly, what cases we need to be cautious of and others that we don't.
Jen:
Yep.
Jo Murdoch:
But yes, I think that screening is. extremely valuable.
Jen:
Okay, let's dive a little bit deeper into that. So I think some people will now be going, whether it's a mom listing themselves or a trainer that works with moms, like what are those things that you're looking for that are asymptomatic? And what are the processes or the things that I could do in an exercise environment or a trainer could do that could be detrimental to that thing that we don't even know exists?
Jo Murdoch:
Yeah, okay. All right, well, if we start from, let's say, I mean, it's a bit of a whole body approach. Our screenings always let's look at this whole body, not just the pelvic floor, and not just the abdominal wall,
Jen:
Mm-hmm.
Jo Murdoch:
because obviously, everything's connected. So we would just look and go, Okay, well, let's just have a look at how you're moving. And usually, they're extremely stiff through their mid back or their thorax, what we call their thorax, because, you know, their boobs have grown enormously, often they're breastfeeding. So even the impact of having a really stiff thorax is an important thing to consider. And you know, we've always talked about mobilising through the thorax as a part of your warmup. Why? Because all of this, so many muscles attached into the thorax and particularly your abdominal muscles. And I know, you know, a lot of women are really keen on rehabilitating their abdominal wall postpartum. But if you've got a very stiff thorax, let me tell you, your abdominal wall muscles are not going to work very well, no matter what fancy exercise to do. Nor is your shoulder
Jen:
Mm-hmm.
Jo Murdoch:
girdle, you know, so just clearing tension through the thorax is probably really important. And one of the screening tools that we look at what how are you moving? What do I need to tell the trainer to really focus on, da da, and then moving down the abdominal wall. The one big thing that we try to prevent is a gripping pattern through external oblique. And we rave on and on and on about that in our clinic. And that's because when they come when the what happens, obviously, is if your deep core system is difficult to access, it's weak, your brain doesn't want to be bothered accessing it because it's hard to find, it has been so
Jen:
Hehehe
Jo Murdoch:
goddamn stretched through pregnancy, da da, then obviously your brain will just pick up muscles that it's easier to recruit, which are usually big superficial muscles and external oblique is one of them. The problem with that is then people become reliant on using external oblique to stabilise to stand upright. It's that's not its job. Its job is to rotate your thorax. And so if it becomes stiff, step one, you can't rotate anymore because it's too stiff. So you've lost that function. And step two, what it does if you can imagine that big superficial muscle ovithorax gripping down and holding on tight, it creates a whole lot of intra abdominal pressure.
Jen:
Mm.
Jo Murdoch:
And intra abdominal pressure is meant to fluctuate, calm and go depending on whether were coughing or jumping or sneezing or laughing, not be constant. So if we have this constant state of intra abdominal pressure, a couple of things can transpire, you can end up with that pressure going forwards and you end up with a little pressure belly,
Jen:
Yep.
Jo Murdoch:
which women hate. It's like a little pot belly and people say I've always had that little thing. And what do you do when you hate your belly, you suck it in even more.
Jen:
And then you do lots of sit ups because you think it's going to make it better.
Jo Murdoch:
And then you do lots of sit ups. Yeah. So you, so you continue to train the pattern that's inappropriate.
Jen:
problem. Yeah.
Jo Murdoch:
Yep. And then you, and then suddenly the pressure belly just gets worse. Doesn't look great. It's not very functional. And it puts pressure down through your pelvis. And two things can happen there. One, it can just kind of make that whole system sort of the pressure can just push it down. It can push organs down. It can push down on the pelvic floor muscles. And or the pelvic floor muscles are meant to respond by contracting to pressure. So an intra-abdominal
Jen:
Mm-hmm.
Jo Murdoch:
pressure happens, you cough, you laugh, you sneeze, automatically your pelvic floor muscles contract. Beautiful thing. Keeps us continent, keeps our pelvic organs supported. If you're under constant pressure, it will constantly sit at a higher. what we call tone or slightly contracted all of the time. A slightly contracted pelvic floor muscle system all of the time is a dysfunctional system. So we're just looking to go, okay, what's happening, you thought, what's happening in your abdominal wall? What do I need to do here to optimise the motor patterns? And then what's happening through this pelvic floor? What do I need to do here to optimise the patterns or, you know, I guess we're always searching for where the deficit is. If there is one. Sometimes women come in and you're just like, you are sweet. Like no issues. Like goodbye,
Jen:
love that.
Jo Murdoch:
have fun.
Jen:
We have to say that because we're always talking about what could be wrong, right. So I love that you've said that.
Jo Murdoch:
Yeah, and it happens more often than you would think. And one of the I guess, massive shifts when you were talking about how the landscapes change, that I failed to say was that more and more women are coming in for screenings.
Jen:
Mm-hmm.
Jo Murdoch:
And we and I would say that's a win in the last 10 years probably since we started. And and I would say you and I and probably plenty of others were part of that shift of educating women, no, come in for a screening. And that's the thing now people just do it, right. And we push so hard for it. Remember, you've got to get your six weeks screening with the Visio. It feels like people just do that now. Certainly where we work. Yeah, maybe not everywhere. And if
Jen:
I think there's
Jo Murdoch:
you're
Jen:
like,
Jo Murdoch:
listening,
Jen:
yeah, there's more people definitely going, but there's still not everyone going and that's due to accessibility and, you know, finance in some people's parts. And even we're still in that area of you don't know what you don't know a lot.
Jo Murdoch:
Yeah, yeah. Yeah, so
Jen:
Yep.
Jo Murdoch:
I suppose if that's not happening for you, then make it happen, because it's not that hard. And I would say, yeah, finance is always a consideration, but we're talking about a screening, and if you can prevent something happening, you're gonna save yourself a ton of money in the future.
Jen:
Absolutely.
Jo Murdoch:
So I would say it's a good investment. And accessibility, like I said, there's so... many more pelvic health physios out there now than there was 10 years ago. So I'm sure most people will be able to find one. And there's people offering telehealth and all sorts of things. So yes, so I think hopefully, that postpartum screening is just is just what happens now. And the next thing that sort of started to happen in the last few years is we're now getting women screened in their pregnancies, which is probably a dream of ours to get women in their pregnancy so that we can help them a through their pregnancy, but primarily through their birth. So that hopefully they can have a better birth and be better postpartum. Because once again, you sit there listening to their stories and listen to their birth story and, and their history. And often when you put all that together, you think could have been better than that.
Jen:
Yeah, I think there's a massive thing around being in the fitness industry with prevention being better than a cure. And it's also hard to get people sometimes to take notice when they're not in pain yet, or it's not a problem. And I know we said before we started, we'll do a whole episode on the value of working with a physio before birth. But the fact that we've brought it up, I remember doing a I was in a conference, it's the only medical conference that I've done speaking about what we do and there was an obstetrician speaking before me and he was talking about how they try and prevent tearing during a delivery and he was saying that they use massage, perineal massage in the delivery and I'm like, dude, you fucking missed the point. Why haven't we sent them to a, why aren't you there saying we work hand in hand with pelvic health physios, we send them to the pelvic health physio at 20 weeks pregnant to make sure that they can. properly relax and contract and relax their pelvic floor so that when they're in that birth process, they know how to do that. And I just think it's something that is massively missing in the industry, that collaboration
Jo Murdoch:
Yes.
Jen:
on that part. Yeah.
Jo Murdoch:
Well, yeah, I mean, me too. In their defence, it's just, it's never, from what I understand, it's just actually never crossed their path. They've not thought about the pelvic floor muscles being a potential obstruction to delivery, for whatever reason, but, and I've certainly come across plenty of resistance to that concept from obstetricians in the form of comments like, oh, don't worry about the pelvic floor muscles until after the birth. You know, so we're like, huh, what? Which is why, so, you know, as you know, we're embarking on this massive research project so that we can, I mean, it's saying that there's actually more and more articles coming out every day that are helping prove this theory that... these dynamic muscles that have to stretch three times their resting length, if they're tight, if they're really non-distensible in pregnancy, then maybe
Jen:
Hahaha
Jo Murdoch:
they can't stretch three times their resting length. And the thing with that is, of course, is that that's a very treatable thing. Like
Jen:
Mm-hmm.
Jo Murdoch:
it's skeletal muscle, tight skeletal muscle from a physiotherapy perspective is probably the easiest thing we treat. that's not difficult. So, and the ramifications of it are so huge. So if we can, first of all, we need to show that it is a thing that yes, if someone has a non-distensible pelvic floor muscle system, antenatal, then yes, it does impact their birth. If we can show that then we can show that it when we intervene, we can optimise birth. If we do that. then we change the postpartum pathway.
Jen:
Yeah, massively. I love that you said duh, cause I'm like, well, a fucking tight muscle is gonna, you're gonna find it hard to push through it, right? It's like, it feels
Jo Murdoch:
Yeah!
Jen:
so simple and I don't understand how it's not.
Jo Murdoch:
Yeah, I think, again, I mean, I don't understand yet, but hopefully one day in the future, I will understand in more detail. But there are so many things for obstetricians to think about. And midwives, so many things that we don't know either. So they're probably
Jen:
Yes.
Jo Murdoch:
they'll probably sit there and go, Oh, well, duh, like, you don't have to worry about getting this baby out of life. So I, I think there's a lot, but hopefully because this layer is not that complex. I mean, it's not complex for us. And as you say, if it's too complex for obstetricians and midwives, no big deal, send it off to the pelvic health physio. There's one on every corner now. So hopefully, again, when we're speaking on this podcast in five years time, it will just be a thing. That's
Jen:
Yeah,
Jo Murdoch:
done.
Jen:
absolutely. Yeah.
Jo Murdoch:
Yeah.
Jen:
If anyone is listening and would like to find a pelvic health physio, you can go to the Mumsafe website and we've got quite an extensive list now if you type in your location and you can have a look and see if there's a pelvic health physio near you. So Joe, if the people listening are a personal trainer and they would like to connect with a pelvic health physio, how would you say the best way for them or how would you like to be approached? I mean, I know how I tell people to approach you, but what works for you?
Jo Murdoch:
works for us. I mean, anything a phone call and email. Hi, I'm such and such I work with moms. I'd love to meet up and we usually straight on that. Yes, let's do it. Let's meet and talk about the demographic you're working with how we can help. It's as simple as that. Like it's a phone caller. It's an email. It's not that big a deal. I wouldn't have thought. And hopefully you it will be met with warmth. I don't know many sort of pelvic health physios that would resist that.
Jen:
Mm-hmm. Do
Jo Murdoch:
Yeah.
Jen:
you, would you recommend that a trainer went and got a screening themselves, obviously within reason, they might not want an internal screening, but they might want real-time ultrasound, and we can talk about what that even is in a second.
Jo Murdoch:
Well, I just like you learn so much from your own body, don't you?
Jen:
Mm-hmm.
Jo Murdoch:
So even just learning the process of what that appointment looks like is, I think helpful, because you can explain it to your clients. But also your most public health physios are very willing to show any exercise professional around what they do and explain it and help them understand it because that's better for everybody.
Jen:
Yep. Do you think there's still some physios out there that are kind of scared of personal trainers? Because there definitely was the, you know, I work with my clients
Jo Murdcoh:
Mmm.
Jen:
or my patients and we do all this great work around, whether it's abdominal wall, pelvic floor, pelvis, and then I send them off to bootcamp. And I'm gonna say that, yeah, anyway,
Jo Murdcoh:
Yeah,
Jen:
with
Jo Murdcoh:
I
Jen:
respect
Jo Murdcoh:
know what you mean.
Jen:
to the bootcampers out there.
Jo Murdcoh:
Yeah.
Jen:
And there's this concern that we're gonna break them or we're gonna undo all that hard work.
Jo Murdcoh:
Maybe I mean, I would say that would in some way be the responsibility of the pelvic health physio because our role is also to communicate with you guys and go, you know, she's joining, she's joining a class with her mates, which is great. So good for so many other reasons. Can you just be careful of x, y and z? Here's why.
Jen:
Mm-hmm.
Jo Murdcoh:
So yeah, I mean, and also educate your patient as well. Like even if you don't have access to the personal trainer, you don't have time to call them. Sometimes we don't just say the patient, listen, when they say do this, you do that. And here's why. So everybody's across the rationale. I mean, maybe, but I would hope not. I mean, like everything, there's not great accountants, there's not great lawyers, there's not great physios, there's not great personal trainers. Like, I mean. I think I would hope as a general rule that everyone is just open to working together and communicating as opposed to being scared of each other.
Jen:
Yeah, I agree with that. And I think communication is key. So we work with trainers sometimes that know to partner with a pelvic health physio and they've got that referral relationship as in they're sending women to the physio, but then there's little communication going backwards. So, or they haven't even asked for the communication. So it can't be expected if it's not asked for. I love what you just said about it's also our responsibility to get in contact with the trainers because as trainers, we think that that's our responsibility to get that information from you. How do you like to communicate? Like, how do you, so if I sent a client to you and you find out, you do the consultation, you try and give the mom as much information as possible, but we all know, especially if she's a mom with a young child, she's remembered 5%
Jo Murdcoh:
Mmm.
Jen:
of it. She thinks she knows what she needs to remember. And it's, we need that two-way communication between trainer and physio in order to get the best outcome for her. How do you like to do it from there? Is it an email? Is it a, you know, do you put the file into a Dropbox? Do you need the client's permission or the patient's permission? What's your process?
Jo Murdcoh:
Hmm. Well, we always take responsibility for that first point of contact back to any referrer, whether it's personal trainer or a doctor or whoever. So and it depends a bit who it is. But for personal trainers, generally, I quite like to get on the phone.
Jen:
Yeah, nice.
Jo Murdcoh:
Because some it's sometimes easier to talk through the concepts. But otherwise, it's an email. So our team know that yes, they get consent from the patient that that's okay. And usually it's the patient giving us the detail anyway of the personal trainer or exercise professional. And then yes, as I said, I generally call but some of our team email and in that's probably about as sort of official as it gets.
Jen:
Mm. Yeah.
Jo Murdcoh:
But once you've got the contact, then it's easy to flick back and forth with little questions or
Jen:
Yeah.
Jo Murdcoh:
you know,
Jen:
What do you think of a trainer that says, Oh, I don't understand what you're telling me.
Jo Murdcoh:
are clever for speaking
Jen:
Nice.
Jo Murdcoh:
up
Jen:
Yep. So you're too
Jo Murdcoh:
because
Jen:
super open. Yeah.
Jo Murdcoh:
Yeah, I wouldn't expect you to. Um, you know, like it's a completely different field. So yeah, I mean, don't you find with your courses that actually the people that ask the questions, you're like, Oh, at least you're thinking about it and, um, you want to understand as opposed to the people that say silent. They worry me more.
Jen:
I agree. I also know that there's trainers out there going, oh, I've sent this person to see the physio and now if I don't know what they're telling me then I look stupid or I look like I'm not, I don't know enough to be working with this person. So you gave me the right answer
Jo Murdcoh:
Oh,
Jen:
to
Jo Murdcoh:
no,
Jen:
hopefully
Jo Murdcoh:
I don't
Jen:
put
Jo Murdcoh:
think.
Jen:
their mind at rest.
Jo Murdcoh:
Yeah. Oh, gosh, no. I mean, that would be insane for us to expect you to understand. Like we've done. I mean, it's a different profession.
Jen:
Yeah,
Jo Murdcoh:
Yeah.
Jen:
absolutely. And I always say that you, Joe, were my biggest teacher in terms of extending my knowledge in working with moms. And I like to believe that every trainer and physio can have that relationship. And obviously there's gotta
Jo Murdcoh:
Mmm.
Jen:
be a personality thing. You gotta like each other. And on that, I guess, like if someone comes in and there's no, you don't mesh with that person, it's absolutely okay to go find somebody else. You don't have to work with
Jo Murdcoh:
Mm.
Jen:
the person, the first person you come across.
Jo Murdcoh:
Absolutely, because of course there's variations on the theme everywhere you go. So, but
Jen:
Cool.
Jo Murdcoh:
there'll be someone for everyone.
Jen:
Absolutely,
Jo Murdcoh:
Usually is.
Jen:
great. So I touched on real-time ultrasound before. Now, I know when we teach in Safe Return to Exercise that real-time ultrasound is a really great tool. It's not the gold standard, but it can be a really good way to get women in a room, help them to understand that brain-muscle connection. Do you wanna tell us a little bit more about what real-time ultrasound is and how it can be beneficial, both for a personal trainer and also for the mom that they're working with?
Jo Murdcoh:
Yeah, yeah. Well, you know, we're obsessed with it in our clinic as well. And that's simply because I've never worked without it. So when I started in our clinic 20 years ago, we had one, which was quite a novelty back then. But now most people have got one, which is fantastic. And we use it much more than we ever did. So we use it around the abdominal wall, which is very important to, I suppose, quantify what's happening in terms of diastasis. and also just muscle function. So in turn, I said before, if the core stabilizers aren't working optimally, it's very difficult to feel that, but you can see it brilliantly under ultrasound. And it becomes of course a biofeedback tool so the patient can watch it and see and understand. We use that in much more detail now. We would use it as an outcome measure. So if we're doing a treatment, then we would wanna see if that treatment has affected the core stability function. We'll... We'll use it during exercises. So we'll watch what happens doing a, I don't know, a squat, a lat pull down, a row, a box jump or whatever. And then trans-abdominally, you can look for definitely pelvic floor muscle function. You can look for bladder filling, bladder emptying. Probably our new favorite thing to do in the last couple of years is trans-perineal ultrasound. So it's still external, but it's on the perineum
Jen:
Yep.
Jo Murdoch:
on the outside. The reason that's so fantastic, again, is a biofeedback tool. You can see and assess what we call urethral hyper-mobility, which is one of the primary dysfunctions in stress urinary incontinence, which you can't feel. So for us, that's super exciting. Plus the patient can see it. Plus they can see it when it changes with the pessary, for example. And we also use that to see if a woman's bearing down properly. So in our... prenatal assessments, are they bearing down and pushing really well, or not, and how to optimise that. So yeah, it's this just amazing tool where I think you coined the term that we can sort of see the inside of the of the their
Jen:
on
Jo Murdoch:
body
Jen:
the inside.
Jo Murdoch:
and eyes on the inside,
Jen:
Yep.
Jo Murdoch:
that's it. And you definitely can. And so for us as clinicians, it's excellent, it really does make our clinical reasoning more detailed. And for the patients, they love it. course.
Jen:
Mm hmm. What do you see when you say the patients love it? What are the main benefits for the clients?
Jo Murdoch:
think it's just understanding their anatomy a little bit better and understanding how that anatomy might change with if we change certain tasks, or we get them to recruit a certain muscle and they can understand how that it supports the organ or changes the urethral hyper-mobility or, you know, optimises their abdominal wall. So and then also if they're struggling with it, sometimes it's just that visual cue that helps them recruit better.
Jen:
Yep. So if I interpret it a little bit in my kind of brain, there a woman, when we as trainers are teaching or helping someone to understand their pelvic floor, all we have is external cues and external touch and feel. So we can give them some feedback, but we can't tell them a hundred percent what we're doing. And it can be a bit of a head-fuck for a one to a better phrase to try and teach a woman how to do something that she can't see, she can't feel, you can't see
Jo Murdoch:
Mm.
Jen:
and you can't feel externally. So
Jo Murdoch:
Mm.
Jen:
when she goes and gets real time ultrasound, she can see whether it's pelvic floor, abdominal wall, perineum on a screen, and you can give her a cue and she can then go, oh, when I hear that cue, this is what my body does. And now I can see it's like a mirror.
Jo Murdoch:
Mm.
Jen:
Is that, that's about right?
Jo Murdoch:
Yeah, exactly. Yeah.
Jen:
Yeah,
Jo Murdoch:
And that's
Jen:
cool.
Jo Murdoch:
what we would coin biofeedback. Yeah. So bio body, getting the feedback on your body and understanding
Jen:
Yep.
Jo Murdoch:
it. Yeah.
Jen:
Okay. And if somebody was reluctant to go and see a pelvic health physio, because they were scared of an internal examination, you'd start with real time ultrasound,
Jo Murdoch:
Mm, yeah, exactly.
Jen:
would you
Jo Murdoch:
That's
Jen:
then
Jo Murdoch:
right.
Jen:
do the do an internal anyway? Or would you? I don't know what would be the protocol be there?
Jo Murdoch:
Um, I mean, yeah, I mean, the internal exam is very helpful for lots of reasons. Um, we're also very used to it. So we, uh, physios are quite tactile. So feeling things, um, helps us make more sense of it, but, um, it depends entirely. If the woman does just doesn't want the internal exam, then absolutely. We would never do it without sort of her feeling comfortable. Um, and we get, we get good information from the ultrasound like good enough. And plus we take some other measures on the outside. So we can definitely make sense of someone's body enough with ultrasound if we have to. But I think just, you know, just you get just that next layer of detail if you can do an internal exam, particularly if you're worried about pelvic floor muscles being a little bit more hyper tonic, a little bit higher in tone, which is the dysfunction. So is the problem
Jen:
Mm-hmm.
Jo Murdoch:
they are too tight. That you can't see very well, we take some measures on the outside and we so we can get a pretty good idea. But nothing, it's nothing quite like feeling the muscle.
Jen:
Yeah, so a tight, we've talked about hypertonic or too tight muscle a couple of times. That is a, we sometimes mistaken it as exercise professionals or anyone is, it's too strong and strong I think has this positive connotation to it. But a hypertonic muscle is still a weak muscle. Do you wanna talk to that a little bit?
Jo Murdoch:
Yeah, yeah. Well, it can be either. So
Jen:
Okay.
Jo Murdoch:
hypertonic, I suppose just means too much tone. It's, it's all it's overactive. And that in itself is quite difficult to understand. You can have muscles that are just tight.
Jen:
Mm-hmm.
Jo Murdoch:
And you can have muscles that are actively too tonic. So they're just But the reality is if someone has had a tight or overactive muscle system for a long time, so it's been in a shortened position for a long time, it's not moved through its full range of motion, it can't be strong. So in those cases, sometimes if it's been just sort of in this overactive state for not so long, you can release that overactivity and bring the tone back down to normal resting tone. And then you'll find that actually they still have strength. So they don't have a strength deficit. I think it just depends on the amount of time that it's been sitting in appropriate tone levels. So yeah, no, hypertonic doesn't really give us any information about that level of strength. And we can't
Jen:
Okay.
Jo Murdoch:
judge the level of strength until we've got the tone back to a normal resting tone.
Jen:
Cool, got it, that makes sense. Tell us about prolapse. So prolapse can be scary for a lot of women. We did a podcast with Mish Wright and she was told that her pelvic floor was too weak and she was potentially gonna end up with a prolapse, which is quite a scary kind of language. What would you say to one, a trainer who is talking to a mom about... what could eventuate if they have a weaker pelvic floor. And obviously within scope of practice, it's not within our space to go, oh, you're gonna end up with a prolapse. But also to a mom that hears the word prolapse in her kind of, whether it's in a consultation with yourself or she's reading something on the internet, what should she think about prolapse? Is it so scary? Yeah.
Jo Murdoch:
Um, is it so scary? I mean, the language is scary. And the reality can be scary. I mean, it's really quite dependent on the stage, I suppose of the prolapse. The and again, this is like why we do what we do to try and prevent them because in an ideal world, they are preventable and they are. If you've already got to the stage where actually, and we now have a distinction between a clinical prolapse, I am symptomatic, I feel heaviness dragging, it feels wrong down there, and anatomical prolapse. Asymptomatic, but there is some mobility in those vaginal walls, you know,
Jen:
Mm-hmm.
Jo Murdoch:
it's just not feeling normal. So as clinicians, we distinguish between the two. And at any stage you can be symptomatic. So it's quite independent. It's interesting. Everyone can feel things differently. But if you have, someone has told you you've got a prolapse or you feel symptomatic, then there's so much that we can do conservatively. So it's not, oh my God, I need surgery straight away. We use, as you know, Pessaries and there's a thousand different types of pessaries to support the prolapse and pelvic floor muscle training. Now pelvic floor muscle training is never going to change an anatomical prolapse. We cannot do that. But what we can do is change symptoms with pelvic floor muscle training, proven fact, plus we see it clinically all the time. But the best tool we've got are pessaries. And the reason is, is because not only does A, it take your symptom away straight away. B, it prevents it getting worse. see, you can keep doing whatever it is you want to do, whether it's your boot camp, your CrossFit, you're running, whatever. So long as we support that prolapse, we know we can make sure it doesn't get worse and even more exciting, I would say, and the research is coming. And clinically, we're seeing it. If you have a pessary in for long enough, the tissues can start to stiffen back up again, and that we think
Jen:
Okay.
Jo Murdoch:
the pessaries probably will. show us that we can change an anatomical prolapse over time. That's what we seem to see clinically. So hopefully, that'll be a game changer as well. And then finally, worst case scenario, there are very good surgeons who do very good repairs, but obviously that's worst case scenario. So we're hoping to get people before it's even a thing so that we can optimise their pelvic floor. optimise the exercise to prevent it happening in the first place.
Jen:
Yep.
Jo Murdoch:
If we end up with a prolapse because of whatever reason, we manage it conservatively and we do it really well.
Jen:
Yeah.
Jo Murdoch:
And then worst case scenario, we've crossed that line and that happens too. And we do need surgery. That's okay. There's great surgeons and usually hopefully you're in, you're still working with your personal trainer, you're still working with your pelvic health physio and we make sure that we look after that surgery for the rest of your life.
Jen:
that was a thing right a lot of prolapse surgeries would fail and reoccur.
Jo Murdoch:
Yeah, that's right.
Jen:
Yep. Tell me, just, quickly, are pessaries for everybody? As in do,
Jo Murdoch:
Um.
Jen:
well, if someone's like, I really wanna get back to the exercise I was doing, maybe I've got a prolapse, maybe I don't, maybe I'm symptomatic,
Jo Murdoch:
Oh, I see
Jen:
is
Jo Murdoch:
what
Jen:
a
Jo Murdoch:
you're
Jen:
pessary
Jo Murdoch:
saying.
Jen:
a quick fix for anyone with a pelvic floor?
Jo Murdoch:
problem, you mean? So
Jen:
Yeah.
Jo Murdoch:
if it's indicated? Well, I mean, there's a bit of a it does no harm thing.
Jen:
Okay.
Jo Murdoch:
So, okay, so let's say in this scenario that we've got someone who really wants to return to exercise, but we're clinically a little bit worried because we've taken a couple of measures and we're like, there's a few things that indicate here that I could be worried about you returning to sport. We could go, you could go and we could just watch it and we could just see and we could just see or we could prophylactically fit a pessary here to prevent
Jen:
Mm-hmm.
Jo Murdoch:
it. So we definitely do that. And particularly in that case, usually it's just a very easy basic ring pessary, which is in and out and some of our patients just literally use their ring pessary for their sport. So it's not even in all the time, you know. Um,
Jen:
Yep.
Jo Murdoch:
so it's, it's not for everybody because not always indicate it. Like, like I said before, some people come in and their functions unbelievable. And there's just nothing to indicate that they are even at risk. So you wouldn't, of course, you wouldn't in that case. But if there's just that, there's a few indicators, and you like, and the level of intensity you want to get back to, let's do this. And let's just keep watching you. You know, it doesn't, it's not forever. It's just for a period of time. So
Jen:
Yep.
Jo Murdoch:
Yeah.
Jen:
Beautiful. Cool, cool, cool. I had a couple of questions just to start to wrap us up a little bit. If you were to look to the future, what are the key things that you'd like to see change both within the fitness industry and the physio industry working together or allied health and also medical industry? what would the ideal outcome be?
Jo Murdoch:
Um, well, I think exercise is so important. It's so crucial for everything, for everything, like all, you know, all chronic health conditions, you know, and our society is so under-active.
Jen:
Mm-hmm.
Jo Murdoch:
Like, I've been looking at stats recently, and it's in the realms of like 65% of adults are under-active, not doing enough. And that's just based on, you know, global kind of probably not global but like national like physical health recommendations, you know, walk three times a week, people aren't even doing that. So and we just know that it is so important in preventative health for chronic health conditions, mental health, obviously, and obviously for women for so many reasons, but our bone health, our strength is going to decline with menopause it is like fact. So, I mean, I would say maybe one of the things that I'd like to see shift is that, particularly in the medical profession, that they push harder to get people exercising and don't just say it, but actually link. I mean, I think, and maybe it's not across the board, but it feels like... exercise professionals and physios work really well together and we have for a long time and if we're not we should be like that's just
Jen:
Mm-hmm.
Jo Murdoch:
a given but wouldn't it be amazing if medical professionals worked more with exercise professionals because they see these type 2 diabetics coming in with you know kidney failure and heart failure and the rest of it like imagine that collaboration would be incredible and also from a women's health perspective because that's what we do. you know, postpartum, we've spoken a lot about pregnancy, we've spoken about really important. But, you know, Jen, as you and I age, we got to start talking about peri-menopause
Jen:
I know!
Jo Murdoch:
and menopause.
Jen:
Yup.
Jo Murdoch:
This population, you know, needs, needs exercise as much as anyone, if not more. So we really have to push, push women to get moving and stay moving. like forever.
Jen:
Yeah, it's funny, I keep I see a lot of my peers, a lot of even some of our moms, they've trainers, they're going from, you know, they they've worked with moms and bums, they've worked with pregnant moms, as they're getting older, they're working with older moms of older children. It's funny,
Jo Murdoch:
Mm.
Jen:
I think if I was still training, I'd still be with the moms and bums. And it's not because I don't care about that. I just feel like if we don't get it right at that stage, and we all just keep moving and going on to now, now I'm older, therefore, I'll just look after the older women. if we don't get it right in pregnancy and postpartum, we don't even get to that bit because they've got prolapses and they can't move or they don't want to move, they don't feel good about their body, they don't know how to move. So yeah, I'm still kind of very fixated
Jo Murdoch:
No,
Jen:
on
Jo Murdoch:
it's
Jen:
this
Jo Murdoch:
it.
Jen:
part.
Jo Murdoch:
Yeah, it's a very good point. It's a very good point. Yeah, it's a slippery slope from that point
Jen:
Yep.
Jo Murdoch:
to pull them back out. And I think also from the mental health perspective, it's just so crucial in those years where you just, you know, those
Jen:
Yeah,
Jo Murdoch:
years
Jen:
absolutely.
Jo Murdoch:
so hard, they're just so hard.
Jen:
So
Jo Murdoch:
So
Jen:
they are, they are. I was going to ask you before what changed for you when you had children because you said right at the beginning, you didn't have children when you first started working with moms and then you did along that journey. Did your perspective
Jo Murdoch:
Mmm.
Jen:
change or did anything change for you?
Jo Murdoch:
Oh, everything changed for me. My goodness. I don't know if I can even remember. Of course, my perspective changed. Certainly. Yeah, just that level of understanding as you alluded to earlier that, like, don't load them up too much. You genuinely can't remember anything. Nor do you have the energy for much. I remember I remember thinking to myself, I am never going to ask a woman to sit up straight in the middle of the night while she's breastfeeding. You know,
Jen:
Ha
Jo Murdoch:
like
Jen:
ha!
Jo Murdoch:
just doing that going, how have I even said to someone to get your posture right at 1am? Like there's no way you can sit up straight when you're just battling. Like what a stupid thing to say. So I mean, there was lots and lots and lots of changes. I mean, having children, yeah, changes your perspective on everything, I think, but certainly makes you. even more passionate. It was probably for me, it was probably my births that really made me more and more passionate about wanting to help women birth well.
Jen:
Yep.
Jo Murdoch:
And then understanding that postpartum journey in so much more, with so much more empathy.
Jen:
Yep, amazing. To wrap us up, Joe, tell us where people can find you. And also, if you've got anything that you'd like to share where they can go and do more education or anything along those lines.
Jo Murdoch:
Well, I suppose we, I'm director of the physiotherapy clinic, which is in Sydney. So you can find us in Bondi Junction and in Camaray and down in the Shire, Woolaware. We're linked with plenty of other pelvic health physios because we run a mentor program. So if you are looking for anybody and you can't find them, please don't hesitate to send us an email. We might be able to find someone for you.
Jen:
Mm-hmm.
Jo Murdoch:
We have designed a women's health course for exercise professionals that was run face to face a couple of times. But I've actually recorded that. So that's also accessible. I've that recording is for sale. So yeah, where are we? We're at physiotherapiclinic.com.au I think.
Jen:
amazing. We'll put the links to that in the show notes. And I want to say thank you for juggling
Jo Murdoch:
My pleasure.
Jen:
hanging out with me on the podcast while you are away with your family. I
Jo Murdoch:
It's
Jen:
really
Jo Murdoch:
okay,
Jen:
appreciate
Jo Murdoch:
my pleasure,
Jen:
that.
Jo Murdoch:
no problem.
Jen:
Thank you for all of the amazing knowledge that you've brought to me over the years and you've continued to share with all of our Mumsafe trainers whenever we ask you. So that's such a, it's such a privilege of mine to be able to lean on you as an, as a specialist in the field and to really help us, well, we work together to lead the way in the collaboration between the fitness industry and Allied Health. Thank you.
Jo Murdoch:
Well done for all your amazing work in that space too, Jen, because yes, you are definitely the pioneer. Go girl.
Jen:
getting there. Thanks
Jo Murdoch:
Play
Jen:
Joe
Jo Murdoch:
on.
Jen:
have a beautiful day take
Jo Murdoch:
See
Jen:
care
Jo Murdoch:
you later.
Jen:
bye
Jo Murdoch:
Bye.
