Healthy Wealthy & Smart

Healthy Wealthy & Smart: Where Healthcare Meets Business. The Healthy Wealthy & Smart podcast, hosted by world-renowned physical therapist Dr. Karen Litzy, offers a wealth of knowledge and expertise to help healthcare and fitness professionals take their careers to the next level. With its perfect blend of clinical skills and business acumen, this podcast is a one-stop-shop for anyone looking to gain a competitive edge in today's rapidly evolving healthcare landscape. Dr. Litzy's dynamic approach to hosting combines practical clinical insights with expert business advice, making the Healthy Wealthy & Smart podcast the go-to resource for ambitious professionals seeking to excel in their fields. Each episode features a thought-provoking conversation with a leading industry expert, offering listeners unique insights and actionable strategies to optimize their practices and boost their bottom line. Whether you're a seasoned healthcare professional looking to expand your skill set, or an up-and-coming fitness expert seeking to establish your brand, the Healthy Wealthy & Smart podcast has something for everyone. From expert advice on marketing and branding to in-depth discussions on the latest clinical research and techniques, this podcast is your essential guide to achieving success in today's competitive healthcare landscape. So if you're ready to take your career to the next level, tune in to the Healthy Wealthy & Smart podcast with Dr. Karen Litzy and discover the insights, strategies, and inspiration you need to thrive in today's fast-paced world of healthcare and fitness.
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Now displaying: February, 2019
Feb 25, 2019

On this episode of the Healthy Wealthy and Smart Podcast, Jenna Kantor guest hosts and interviews Phil Tygiel on bylaws within the APTA Private Practice Section.  Phil Tygiel, PT, MTC, is the PPS Bylaws Committee Chair.  The Bylaws Committee reviews, maintains, and updates the Section bylaws to meet the needs of the membership and the requirements specified in the guidelines set forth by APTA.

In this episode, we discuss:

-What information is contained within the bylaws

-The process for changing a bylaw

-The multiple avenues you can enact change within your professional associations

-And so much more!



PPS Member Bylaws


FOTO/NetHealth Outcomes Conference (use the code LITZY)


For more information on Phil:

Phil Tygiel, PT, MTC, is the PPS Bylaws Committee Chair.  The Bylaws Committee reviews, maintains, and updates the Section bylaws to meet the needs of the membership and the requirements specified in the guidelines set forth by APTA.

For more information on Jenna:

Jenna Kantor (co-founder) is a bubbly and energetic girl who was born and raised in Petaluma, California. Growing up, she trained and performed ballet throughout the United States. After earning a BA in Dance and Drama at the University of California, Irvine, she worked professionally in musical theatre for 15+ years with tours, regional theatres, & overseas ( until she found herself ready to move onto a new chapter in her life – a career in Physical Therapy. Jenna is currently in her 3rd year at Columbia University’s Physical Therapy Program. She is also a co-founder of the podcast, “Physiotherapy Performance Perspectives,” has an evidence-based monthly youtube series titled “Injury Prevention for Dancers,” is a NY SSIG Co-Founder, NYPTA Student Conclave 2017 Development Team, works with the NYPTA Greater New York Legislative Task Force and is the NYPTA Public Policy Committee Student Liaison. Jenna aspires to be a physical therapist for amateur and professional performers to help ensure long, healthy careers. To learn more, please check out her website:


Read the full transcript below:

Jenna Kantor:                00:00                Hello, this is Jenna Kantor. I am here with Phil Tygiel who is the head of the bylaws committee for the APTA private practice section. So first of all, thank you so much for coming on to healthy, wealthy and smart to be interviewed. So I just wanted to do this podcast for people to get a better understanding of bylaws and their value and why it can be a long process for some, for change. You were actually, before we even started, you started to talk about how there is this rule where it's like this five year rule and I would love for you to go into that. Why there's a five year rule for change.

Phil Tygiel:                                            We're actually, that's for APTA, not for the private practice section.

Jenna Kantor:                                        Oh, okay. Okay. Oh, thank you. So there we go. It's something you already clarified. Thank you. So for the private practice section, is there some sort of rule like that?

Phil Tygiel:                    00:51                No, you can bring up bylaw changes anytime you want to. I always discourage it. I always say my job as chair of the bylaws committee is to put the bylaws in an envelope, seal the envelope and keep it sealed for the duration of the president's term. Bylaws are great. They outline rights, privileges and responsibilities, and they are not to be taken lightly or changed lightly. And very often people will come to me and say, we need this change in the bylaw. And when I look at what they want to do, they don't have to change the bylaws to do that. Bylaws, as you mentioned, are somewhat rigid and they're supposed to be, they're not easy to change. It requires prior notice to all of the members that you intend to change the bylaws. And the reason for that is you're changing their rights and privileges.

Phil Tygiel:                    01:41                They have a right to know that you're changing the rights and privileges. You have to have prior notice of at least 30 days prior to the meeting. And then there's debate and it takes a two thirds majority to change any bylaw. As I said many times, the board will come to me and say, I want to change this bylaw. And I usually try to discourage it and figure if there's ways to do what they want to do without changing them is all too often people run to the bylaws and we have to change this when actually the bylaws are pretty good. They don't need change. For instance, there was one year the board, I think it was the membership committee wanted to have lowered starter dues for new members and they wanted to change the bylaws. Biggest dues are outlined. The dues structure is outlined in the bylaws. But I looked at the bylaws though the board had the right to lower the fee but not raise it. So they didn't need a bylaw change to get that starter dues change in that case and discouraged it. And we didn't go in there and change the bylaws.

Jenna Kantor:                02:47                So you were saying that you guy’s meet and they have to submit it 30 days prior. So I'm wondering for the 30 days prior, like how often do you guys meet in general, so how many times would there be that opportunity for it to be heard and voted upon if it would get that far?

Phil Tygiel:                    03:07                Technically we have two meetings a year, one at the private practice section annual conference and I think they have one at CSM this year. I'm not even sure about that. So those are the only two times that you can change the bylaws. You do need a quorum at a meeting, which was a certain number of people have to be there. And usually the CSM of business meeting you don't have one. So pretty much the only time we tried to change the bylaws if needed is at the annual conference. As I said, the 30 days notice goes out and all of the discussion occurs at the business meeting when we vote yes.

Jenna Kantor:                03:46                How long have you been in this position, first of all. And then from your experience and all the years that you've been in this position, how many bylaws have you actually changed?

Phil Tygiel:                    04:00                Yeah, I think I've been doing it about 20 years now. Nobody else wants it. So I keep on getting recycled and in those years I think we've probably changed, made minor changes to the bylaws about five times. Don't ask me what those changes were. I put the envelope away.

Jenna Kantor:                04:23                So for you it doesn't sound like it makes much of a difference when these bylaws are changed that much because it really is set up pretty well already.

Phil Tygiel:                    04:33                I think they're pretty good. I mean they let members know what they're entitled to do, what the dues are going to be. If they have concerns how to raise those concerns. It tells them how often we have meetings. What prior notice we have for those meetings. It lays out the fiscal responsibilities of the board and all the board positions. So most of that doesn't have to be changed. It can stay where it is. Sometimes I've been in situations where one of the positions on the board has certain responsibilities that are assigned, like they're in charge of three committees and sometimes people want to put that in the bylaws that the vice president will be in charge of these committees. And that's usually a mistake because you'll change committee liaisonships based on the new personnel you have, you know, you're going to let new people every three years and you might have one person who's vice president who was very good on programming. So they will be liaison to the program committee. The next vice president might be much better off from communication. So they'd be the liaison to publications committee though, that type of thing. So you don't want certain things you don't want etched in stone and the bylaws, remember, if you make a mistake with the bylaws, it also takes a two thirds majority to correct that mistake. So sometimes bylaws mistakes stay in place for years and years. So again, you want to tread very lightly on changing them.

Jenna Kantor:                06:11                Well, I mean you were already saying that you're only meeting two times a year, so that already is a limitation on getting that two thirds majority vote. So I can definitely see how that could be impeding on change. No, I definitely have to be honest. From my perspective, this seems like a definite area where there might be room for change and my mindset, because I'm a new Grad, so I'm thinking, oh my gosh, this sounds so stagnant. Like there is not a set way to really make big, big changes. I would love for you to speak on where my brain is going and educate me.

Phil Tygiel:                    06:47                Oh, actually there's a way, there's lots of ways to make big, big changes that don't require bylaws changes. For instance, let's say there was direction that you wanted the private practice section to take, you wanted them to lobby congress to do something and you wanted to make that a priority. That's not a bylaws issue. You would show up at a business meeting and say, I move that the private practice section endorse this position. Okay. Now, first of all, it does not require prior notice. It only requires a majority vote, not a two thirds vote. And those are the more important things that most of us are concerned about. Which way we're going, what do we want to accomplish? Those things are not in the bylaws. What is in the bylaws is how you can do those things. The fact that you have to have these meetings, that you have the right to speak, that you have the right to vote, that you have the right to make motions. So that's a very, very fluid process. Also remember sometimes if you have a really good idea that nobody else thought about, you can go to the board and say to the board, hey, why doesn't the section do this? Same with your state association and all that. So you can just say, let's make this happen. And that can be done with the snap of a finger. So not being able to change the bylaws does not restrict what you want to accomplish. Does that make sense to you?

Jenna Kantor:                08:10                And then what you do as somebody is saying it's not in the bylaws, it doesn't allow it in the bylaws and then you can't find that it's in the bylaws. What is the professional way to handle that kind of communication with that individual that you're trying to work with?

Phil Tygiel:                    08:28                The first thing I usually do is ask what is it you are trying to accomplish? And I want to see if there's a way they can accomplish that without having to change the bylaws. If we find that they do need to change the bylaw to accomplish what they want to accomplish. Let's say they want to add two new people to the board of directors, that would require a bylaws change. We would then draft a motion and to change the bylaws by changing this section on the board of directors by adding two positions.  The executive board would look at it and see if they approved it, which they don't have to do. Membership has priority over leadership. We should always keep in mind that the pyramid is inverted. Membership is on top president is way at the bottom.

Phil Tygiel:                    09:22                So the membership has the right to do what they want to. So anyway, then we would draft the bylaw in the case of APTA sections, chapters, any bylaws change that the section has, has to be in keeping with the bylaws of APTA. So we'd run it by APTA to make sure it's not in violation of anything that APTA wants to do or says you have to do. For instance, let's say we wanted a bylaw change that would prevent life members from being members of the section. I don't know why anybody would want to do that, but the APTA would look at that and say, you can't do that. That's a violation of the APTA bylaws. So we do have that higher authority anyway. If the bylaws are keeping with what the APTA will allow we would publish it to the membership and probably in Impact or maybe online saying we will be voting on this bylaw at the next meeting.

Phil Tygiel:                    10:31                Next meeting comes and the bylaw is moved. And someone has to say it and then there's debate and then they call for a vote. Since you need a two thirds majority with a standing vote, it's carried if it's not clear with standing vote, but it could be close, you do a roll call vote where everybody stands up and counts off. And if you don't get your two thirds, you don't get the bylaws. And it's important to remember what I said originally. The bylaw protects your rights and privileges as do Robert's rules of order. So even if there’s a fairly hefty majority that feels that their rights and privileges of being violated, they have a right to say we're not going to let you pass this.

Jenna Kantor:                11:21                I like how you connected it back to the APTA because they are the Higher umbrella organization if you will, of the private practice section. And this actually can segway into what I was mixing up at the beginning of this interview. So if you wanted to make a change but it didn't go in accordance with the APTA bylaws, now this is where they have the time limit on how often?

Phil Tygiel:                    11:47                Yes. It got to be a nuisance of people would come in with requiring bylaws changes every year and many of them were really not necessary, but they are very time consuming to debate. So many years ago, and don't ask me how long ago it was moved and seconded and passed that it's in the bylaws that you can only have bylaws amendments every five years I think it is with the APTA and that goes through the house of delegates which is a completely different process membership doesn't vote, your delegates do. That can be bypassed. It requires a two thirds vote just to hear the bylaws if you want to do it in an off bylaw year. So it got rid of some of that cumbersome activity that really wasn't necessary.

Jenna Kantor:                12:38                No, it's good. It's really good to hear your perspective and just gain a better understanding of how well put together everything already is and why it may not be the fastest for the change, but there's a big reason for that. So thank you so much Phil, for coming on to just share your knowledge. So people who are looking for change, they may not necessarily, well now they know they may not necessarily need to go to you to find out about how to change the bylaws. They are actually still a lot of opportunities to get it done elsewhere. So thank you so much.

Phil Tygiel:                    13:10                My pleasure. I think the main messages that the association, whether it's private practice section, or any other section, belongs to the membership and they have rights and privileges. They can make change and sometimes the change comes from a single person with a new idea and sometimes that new ideas violently objected to by people in leadership, people who have been there forever. But there is a mechanism to be heard. There is a mechanism to make change and advance and we do very well with it. Sometimes, a good idea, it takes three or four years to pass. But that's not because of the system. It's just cause it took you that long to get people to understand what you were trying to do. That's not necessarily bad.

Jenna Kantor:                13:50                That's good. And I love that. I like how it really does revolve around membership because we are all in this together. And for us to just come forward with an idea, thinking, oh, I'm right, I'm right, I'm right. That's not how it works in a community at all. So thank you. Thank you so much.

Phil Tygiel:                    14:04                Thank you.



Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram  and facebook to stay updated on all of the latest!  Show your support for the show by leaving a rating and review on iTunes!


Feb 18, 2019

LIVE from the Combined Sections Meeting in Washington DC, I welcome Dr. Mike Pascoe on the show to discuss the use of social media to disseminate physical therapy educational resources.  Mike Pascoe, PhD, is a neurophysiologist and assistant professor in the physical therapy program at University of Colorado.  His scholarly efforts center around the investigation of constructivist approaches in technology-enabled learning environments (e.g., wiki usage, interactive modules, cadaver skin examination, etc..) to improve learning outcomes and student satisfaction in anatomy courses.

In this episode, we discuss:

-Research highlights in the field of cadaver anatomy

-How Mike utilizes social media and live blogging during his anatomy courses

-How the Anatomical Board serves anatomy educational goals in Colorado

-Cognitive principles of learning for success in PT school

-And so much more!



#APTACSM Twitter

Mike Pascoe Twitter

Mike Pascoe Website 

Mike Pascoe Snapchat

TedxBoulder - Mike Pascoe - The Ultimate Gift - Donating your Body to Science

Learning Scientists Website



For more information on Mike:

Mike received his PhD in neurophysiology from the University of Colorado (Boulder) in Dec 2010. He then joined the faculty of the Physical Therapy Program in the School of Medicine at the University of Colorado, Anschutz Medical Campus. He teaches clinical anatomy and in his spare time loves hanging out with his wife Stephanie and their dog Maia.







Read the full transcript below:

Karen Litzy:                   00:01                Hey everybody, this is your host, Karen Litzy and we are coming to you live from the combined sections meeting in Washington DC. And I have the pleasure of once again seeing assistant professor Mike Pascoe. I saw him late last year in Denver. So Mike, Welcome to the podcast. Thank you for coming on.

Mike Pascoe:                00:18                It's my pleasure. Thanks for having me.

Karen Litzy:                   00:20                All right, so we read your bio, but what I would love to hear from you is a little bit more about yourself so the listeners kind of know where you're coming from and what we have in store for our talk today.

Mike Pascoe:                00:32                Yeah, let me give you some things about myself that I really just drive who I am and what I do. So I am a Colorado native, so there's just a lot of fun things to do in Colorado and I've managed to stay in a really awesome place. And so there's a lot of fun to have there and a lot of that fun I have with my family. So I'm married to Stephanie Pascoe, she's a PT, so she's the clinical half of the marriage. And so we liked doing a lot of things together and we like keeping our two daughters busy as well. So very family driven and we've got a lot of fun with a five year old and a three year old girls. So I like to bill myself as a minority in a sorority. That's what things look like around my house. Lots of pink and yeah, so I basically am here at CSM with Stephanie and we both get to go do our own things and check out the various different talks, different posters, different presentations. And I've been able to come to CSM since I started at CU in 2011 so yeah, it's been a great conference. Great to catch up with old friends and make some new ones.

Karen Litzy:                   01:36                And so today we're only on day one of the conference, but have you gone to any lectures or any poster presentations that really stand out in your mind?

Mike Pascoe:                01:45                Yeah, I really wanted to see what Chad Cook and others had to say about predatory publishing. So that was very informative. I'm aware of the concept and fortunately have not fallen prey myself, but it was good to just see the numbers and how big of a problem in this, you could, you could call it an epidemic. So

Karen Litzy:                   02:03                Yeah, package that really well. Predatory journals, predatory conferences, things like that. I mean it's a thing and people fall for it.

Mike Pascoe:                02:11                Yeah, they said that the analogy is everyone's got a rich relative in Africa that just died and wants to offer you $1 billion. So it's a new spin on that old email tactic.

Karen Litzy:                   02:23                Exactly, exactly. And it's unfortunate. It's unfortunate, but hopefully they're chorus kind of gave you a little bit of insight on what to watch out.

Mike Pascoe:                02:33                Yeah. If you go onto Twitter, which if you're not on Twitter, then I don't know what's going on. It's the best way to find out what's going on, at the conference. Great #APTACSM. And that's where a lot of us are sharing the real pearls from the session. So there's a lot to catch up on there. But then following that was a real exciting meeting of special interest group with the Academy of physical therapy education. Then that's the anatomy educators special interest group. So that grew last year was the first year there were maybe 50 of us and now there's 133 so we're really growing a nice base and we're really starting to cut our teeth on what we wanted to find and how we want to really enhance PT education specifically in the anatomy domain.

Karen Litzy:                   03:16                Great. So now let's talk about that. So let's talk about your teaching background and what you’re doing over there at the University of Colorado medical campus.

Mike Pascoe:                03:27                Yeah, so about 80% of my time on campus in my role is as a teacher. So I'm really striving for excellence there. And basically I started in 2011 they hired me with very little teaching experience at the professional level, but I really had a passion for teaching undergraduate students when I was a graduate ta. So that's where I first fell in love with teaching anatomy. And then I got on board with CUPT and I teach PT anatomy. That's my main role. About 50% of my job is designing and delivering the content for the PT students. But I've also been able to extend into the physician assistant and a medical student anatomy courses. So that keeps me pretty busy. It's a lot of gross anatomy. It's a lecture in the morning and then going into the lab in the afternoon and looking at the cadaver donors.

Karen Litzy:                   04:17                I remember those days.

Mike Pascoe:                04:20                I'm telling Ya, it's the most memorable and favorite course of all PT students

Karen Litzy:                   04:26                It actually was my favorite course and I firmly believe every human being should take gross anatomy because you should know what's going on in your body.

Mike Pascoe:                04:35                You should know how the equipment operates. And there's some real good research out there and you know, a lot of people can identify where the heart is, but you ask them where the liver is and that's where we need a little bit of improvement.

Karen Litzy:                   04:46                Absolutely. So now outside of teaching, what other things are you working on? Any kind of research?

Mike Pascoe:                04:53                Absolutely. And you know what I've learned from all the excellent mentoring I've had in my role is that you should really cover your basis. It should really be optimized in what you're doing with your research as an educator. So what you do is you do education scholarships. So I walked away from bench research and neurophysiology and now my laboratory is the classroom. So I do educational research. It's every bit as rigorous as looking through a microscope and you know, modifying genes in a lab. But basically the students are my subjects and I will take an idea that I think is going to be a way to improve my anatomy, teaching, design a protocol, get my IRB approval, collect the data, get some graduate students under my mentorship to help run through the project. Sometimes we find a positive result and sometimes we don't, but we send those results out anyway and I've been able to get some projects out the door.

Mike Pascoe:                05:46                Just a couple of highlights. There's a type of photography called light field photography, so that's been really interesting to see how you could change the focal point of a cadaver photo after the photo's been taken. Lot of anatomy clustered together, so it's often hard to get everything in focus so that gets around that. But also publishing on students using a Wiki to organize their study materials and why blogging. Actually I got to do a lot of live blogging, have a PT conference and we surveyed the people using a viewing the coverage and they really had positive rankings and satisfaction with the coverage. So I'm really promoting that and hoping that more PT conference organizers jump on top of that. It's a compliment to Twitter.

Karen Litzy:                   06:31                So how were you live blogging and how is that different? I was going to ask is that, what kind of platform is that?

Mike Pascoe:                06:37                Yeah, we use a platform called cover it live. They're still out there. No conflict of interest, no disclosure, no relation, but basically what you do with live blogging as you can really issue more of a transcript of what's going on there. No character limits. Like Twitter, Twitter is usually more about the bite size pieces, but a live blogging is much more of a script and you can really capture a lot. You can integrate photos. And what's been really fun is to capture the question and answer session part of the session. People really rated that as a really good feature of live blogging.

Karen Litzy:                   07:11                So you pretty much have to know how to type well to do that.

Mike Pascoe:                07:14                Right.

Karen Litzy:                   07:16                Because for someone like me who has to look at the keys at the same time, cause I never learned how to type. Yeah, that would be my problem.

Mike Pascoe:                07:23                Hunting and pecking is hard, but the bigger skill is contextualization and knowing your audience. And it was real good for me to learn about how to interpret what a physical therapist was saying about a whiplash and the anatomy of neck muscles and how that can be put together so that way a PT audience would benefit the most. So yeah, that's a big skill as well.

Karen Litzy:                   07:47                That's awesome. I've never heard of that. I mean I don't think I can do it because like I said, I can't really type, but I love the fact that it's long form. And so if I wanted to, if, if I wanted to watch you do this, how do you, how do you do that Mike as not for you as a person blogging but as the consumer.

Mike Pascoe:                08:09                So we have to get a marketing campaign out there. And what we ended up doing was just promoting the link to the webpage through social media. So fortunately people are very aware of that conference has come with their own hashtags and people are having conversations around the conference leading up to the conference. So we took advantage of that. Now we would just publish in advance, these are the sessions Mike is going to be covering. So come back this day at this time for the live coverage. The real beauty of this platform too, as you can play them back, well you don't play them back, you, you scroll through a timeline and you get to look at the content that way. So it was really rewarding to know that you're helping people real time, but for the busy clinician that can't step of treating patients at 2:00 PM that could come in and look at it later. That's really good.

Karen Litzy:                   08:59                Sounds great. So aside from being a little more innovative in your teaching and in academia, in education, which obviously, is a must these days. What else are you doing as your role at CU or your role as an educator?

Mike Pascoe:                09:19                So another real cool role that I took over about a year ago was, it's an administrative role, but it's for the state, Anatomical Board of Colorado. I serve as the secretary treasurer. And so I oversee the day to day operations at the anatomical board. And basically this is still educational because what we do with the anatomical board, our big mission is to serve the educational goals of anatomy education in the state of Colorado. So think of every health care profession program, PT, OT, MD, dental graduate programs. Whenever a program would like to use a donor for an educational resource, they approach us, they make a request, we take a look at how many donors we have available. And we're very fortunate in Colorado that we have a very large donor pool, a large donor base, and I help assign the donors. And so indirectly I'm able to impact thousands of students a year with anatomy education simply by facilitating the use of cadaver dissection.

Karen Litzy:                   10:21                That's awesome. Very cool. I often wondered how that worked now, well at least now I know how it works in Colorado. So you had mentioned earlier the use of social media. So if people are listening to this and they're not familiar with you, I obviously suggest following you on social media, but how has your use of social media impacted the way that you teach and the way that you sort of view education in physical therapy?

Mike Pascoe:                10:51                Yeah, so I incorporate social media into my teaching directly and indirectly. So directly I have recognized that there's a real power behind this, this cognitive psychological principle called retrieval practice. So any way you can get your students to practice retrieving information without the learning materials in front of them, they're going to benefit. Studies have shown that for decades. So how am I going to, aside from doing like the polling audience response system, how can I really get their attention? And I found what's really successful is to use social media and people are doing Twitter, people are doing Instagram, but students really pay the most attention to content on snapchat. And if you're not familiar with snapchat, the thing that makes it different, what sets it apart is that the content disappears after 24 hours. So when you're doing retrieval practice, you don't need it necessarily for the student to preserve the questions and answers.

Mike Pascoe:                11:49                They just need practice interacting with the content that goes away. And they know this. So there's something about the way the brain is wired and the brain pays more attention to ephemeral content so they know it's going to go away. And so I, I push out questions during the semester and they get the question, they get the answer later. So it's great for the students, but it's great for me, the educator I found with Twitter and Instagram, it really took so much time, to perfectly create the right content. But everybody on snapchat understands that it's raw, it's unedited and it's uncurated. So as long as I put the correct information out there, it's quality enough. So it's very quick. It's very rapid. And every time the students find out that I run in anatomy related snapchat account, they can't believe it. At first they’re in disbelief like what's going on.

Mike Pascoe:                12:38                But once I convinced them that this is educationally based on sound pedagogy, they're onboard. And then I'll have a break from it and they'll bug me. We need more snaps. Pascoe put some more content out there. So if you want to check out what I'm talking about, the handle, the username on snapchat is anatomy snap. I'm all one continuous word and I'm telling you, it's been really exciting. I collected data this summer. I'm looking at the data now and hoping to see, number one, if students found it satisfactory, but number two, how did their exam scores look? They could have been the same. They could have been worse, it could have been better. The exciting thing is I've learned how to put a protocol together that will allow me to level up beyond satisfaction. And did your learning change has your knowledge base change? So stay tuned for that publication.

Karen Litzy:                   13:28                Awesome. And now can you give an example of some of your snaps? So yeah, give me a couple of examples so that people kind of get an idea of what you mean. Like what do you mean you're putting stuff out for anatomy? Like just taking a picture of like a muscle or dissected bodies. So give me an example, but before you do well give me an example for us then I have another question.

Mike Pascoe:                13:53                Yeah, no, it's good to leverage it. Leverage the principles, you can get retrieval practice and you can also get leverage examples and just to like real life examples. So you're at a table, you're just going through the upper extremity anatomy and you're between lectures or whatever you're doing as an educator. Put your hand on the table and elevate your thumb and get the extensor pollicis longus tendon to pop up. Take a picture, add text. What tendon end do you see here? Drawn Arrow. Then you can take it further. Just keep building, keep elaborating. What's the line of inquiry that the student would go through? How would you go through this at the cadaver? What anatomical region does this tendon define? Anatomical snuffbox? The next snap question is now what structures as a physical therapist are you most interested in finding in the stock box? So then you could go through that. You can step through a very sequential Socratic series of snaps, and then you can say, okay, everybody send me a snap of your snuffbox if you so choose. They'll usually do this without solicitation. But that's an example.

Karen Litzy:                   14:59                So I think that's great and it actually leads perfectly into my next question is, are you creating a curriculum for your snaps or is it just off the cuff?

Mike Pascoe:                15:10                You know, I'm very mindful and aware that doing things intentionally is the best way to go. So what I did for the summer is I did focus my snaps on a specific aspect of anatomy in the course and that was blood flow diagrams. So I do look at my learning objectives and those informed my teaching methods. So these snaps, although they seem frivolous and accessory, what they really do is there a direct extension of being able to describe the path that blood takes from the left ventricle to a distant site in the body. So it is very informed. It's very intentional, it's in the curriculum, but you have to be mindful that not all students are going to go there. It has to remain optional. I do not think it's appropriate to push your students into social media. There's a lot of valid reasons students don't want to go there, but for the ones that are there, I've found it's 90 to 95% of the students. And you know what? It's a great way to role model and show them how to be professor professional and how to use social media in an appropriate way. That's beyond tearing down somebody's beliefs and ideals.

Karen Litzy:                   16:16                Well said. So there is a method to your madness is what you're saying. There is not, it's not random like, oh, I stub my toe today, I know I'm going to do something on the foot.

Mike Pascoe:                16:28                Yeah, exactly. It's intentional and yeah, it's been out for so long that it's just time that everybody had a good understanding of how to use it appropriately and then how we can really think about incorporating it into education.

Karen Litzy:                   16:40                I think that's a great way to incorporate into education and hopefully people listening to this will now follow anatomySnap. No S. I follow you on snapchat and I can say that it's really interesting. It's really interesting even as a, a more quote unquote seasoned PT because I feel like you can never have too much anatomy. That's so great. Now, anything else that you're doing that's kind of outside of the box with your students or even without your students as far as furthering your education?

Mike Pascoe:                17:16                I think that another thing to bring up here is how there's a real need for physical therapists that are anatomy instructors to understand what is needed to know and what is nice to know. So that's my second area of work. The first area is the technology integration, but I've really developed some nice ways to look at what do anatomist that teach physical therapy students need to teach their students. So I'm just looking at the data now, but I recently put out a survey to about 200 people in the, that our stakeholders for the physical therapy programs, talking faculty, clinical instructors, recent graduates, the two most recent classes. Do you and your opinion think that in your practice you need to name all 10 bronco pulmonary segments of the lung? That was an example of an objective for which most people rated. No.

Mike Pascoe:                18:11                Like that is not essential. So I take that feedback and I improve my curriculum. On the other hand, should a PT student be able to know name every spinal segment that is serving a muscle, the myotomal innovation and most people, the majority came back saying, yes, that's neat to know. So it's been really nice not being a PT to survey a wide base of people. The next step is going to be to survey the community at large to kind of level up the methodology, get a consensus document together and then present that to the educators in the PT Community.

Karen Litzy:                   18:49                Great. Well it sounds to me like you're up to some really fun stuff and I look forward to touching base again when you have a lot of this data together and you're ready to present. So is there anything that we didn't touch on?

Mike Pascoe:                19:03                Well, Gosh, let's see here. Anything else? I guess if you're really interested in body donation, it's often, it's often confused with my driver's license has a heart.

Mike Pascoe:                19:17                But that's organ donation and that's totally separate. You do need to opt into whole body donation. And I go through this concept in a six minute ted talk and basically if you, if you just search youtube for Pascoe Ted x, you'll find a nice little talk I was able to put together for Tedx Boulder in Colorado and just kind of let people know what body donation is all about. And the title of the talk is the ultimate gift because we have extreme gratitude to the individuals that make this choice to, to give us the ultimate gift, the body that has served them all of their life. And now we'll go on to serve health care professionals as they work toward being able to take care of, to treat those patients.

Karen Litzy:                   20:04                I love it. So everyone, don't worry, we will have links to everything on the show notes under this episode. So before we wrap things up, I have one more question. Given where you are now in your life and in your career, what advice would you give to yourself as a new Grad or to your students? Like when you were a student, what advice would you give to yourself?

Mike Pascoe:                20:40                So there's two I want to give you. One is more like the life side of things and learning to say no, I had definitely gotten myself in trouble. Okay. So I'm super passionate about teaching and every time I was approached with a teaching opportunity I rationalized how I could make it work and I trick myself and I got way overloaded with teaching. So I would go back to, you know, 27 year old Mike. Like you're going to have a lot of opportunities, but there's a, there's a tactful way to say no. And even though that time may not be the right time, things do cycle back around, you'll get another pass at it if it was meant to be. And then the other more practical. For those of you that are PT students, those of you that are looking at getting into PT school, you have to look at your study techniques.

Mike Pascoe:                21:27                So I've totally revolutionized the way I do office hours. When students come in and they've had a bad performance on an anatomy exam and they say, I don't understand, I studied so much, I blow a whistle and I throw a yellow flag on the ground and I say, hold up. The penalty on the field is quantity does not equal good learning. So you have to look at these psychological, cognitive principles of learning and what got you through in Undergrad will not get you through in PT school. The volume is too much. So in the show notes, I'll give you a link to a really excellent website that summarizes these key principles of learning and you've got to look at your study habits. Then you've got to be prepared to change them. Otherwise you're in for a really painful and arduous path through your physical therapy curriculum, in other programs that you might be pursuing.

Karen Litzy:                   22:20                Amazing advice. Thank you so much. What's the name of the website?

Mike Pascoe:                22:24                So the name of the website is a learning scientist. And I believe if you just Google learning scientists, you're gonna find a website that has principles of effective learning.

Karen Litzy:                   22:36                Thank you so much for sharing that. And I'm sure the students and myself will greatly benefit from that. So thank you. And now where can people find you on Twitter? We know where they can find you on snapchat. How about Twitter?

Mike Pascoe:                22:49                Yeah, go ahead and look for me @mpascoe. You know what, if you're looking at the Hashtag for the conference, I'm tweeting up a storm here, so that will be a good place to catch some of my contributions and go from there.

Karen Litzy:                   23:05                Awesome. Well Mike, thank you so much for taking the time out at CSM where we, everybody's busy. I get it. We're all busy. So I really appreciate you for taking the time out coming on the podcast and sharing all this great info. So thank you so much.

Mike Pascoe:                23:19                Yeah, my privilege and thanks to you, Karen, for getting everyone together and being a vessel for getting this information out.

Karen Litzy:                   23:25                Thank you very much. And to all the listeners, have a great couple of days and stay healthy, wealthy, and smart.



Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram  and facebook to stay updated on all of the latest!  Show your support for the show by leaving a rating and review on iTunes!


Feb 14, 2019

On this episode of the Healthy Wealthy and Smart Podcast, Shannon Sepulveda guest hosts and interviews Shayla Swanson on her company, Sauce.  Sauce was founded by a former Canadian national team cross country skier as a way to support her ski racing. Sauce founder, Shayla Swanson, was frustrated with traditional winter headwear that she found to be too hot, too itchy & too ugly. An avid sewer, Shayla set out to create functional, stylish and comfortable products that met the needs of elite athletes and outdoor enthusiasts alike.

In this episode, we discuss:

-The story behind the beginnings of Sauce

-How Sauce tailors and personalizes their products from Bozeman

-What is in the future for Sauce

-Shayla’s advice for female entrepreneurs

-And so much more!



Shannon Sepulveda Website

Shannon Sepulveda Facebook

20% off with code “hws19” on: Sauce Website

Sauce Facebook

Sauce Instagram


For more information on Sauce:

Sauce was founded by Shayla Swanson, a former Canadian national team cross country skier as a way to support her ski racing. Sauce founder, Shayla Swanson, was frustrated with traditional winter headwear that she found to be too hot, too itchy & too ugly. An avid sewer, Shayla set out to create functional, stylish and comfortable products that met the needs of elite athletes and outdoor enthusiasts alike.


Sauce started as a hobby for Shayla while she was ski racing and working through her degree in Exercise Science from Montana State University. She began selling Swift Toques to teams and clubs who wanted a custom item for their group. The product line evolved from there, and soon saw the additions of the Swift Headband, Ventilator Headband, and the fleece-lined Chill Toque. After several exciting seasons of ski racing full-time and a near Olympic team miss in 2010, Shayla decided to jump into Sauce full time, putting 100% of her enthusiasm and effort into the entrepreneurial venture.


Commitment to pursuing one’s goals, a strong belief in one’s own potential, and using constructive evaluation for growth, are all important ingredients for a successful athletic career. While skiing and sewing hats are not the same, it turns out that those behaviors are also the key to making it as an entrepreneur. The lessons learned in Shayla’s ski career have helped her navigate the business world and grow Sauce into a company with distribution across North America and beyond.


For more information on Shannon:

Shannon Sepulveda, DPT, M.Ed., CSCS, WCS is the owner and Physical Therapist at Shannon Sepulveda, DPT, PLLC. She is an Orthopedic and Women's Health Physical Therapist and is currently the only Board-Certified Women's Health Physical Therapist (WCS) in Montana. Shannon received her undergraduate degree from Dartmouth College, Masters in Education from Harvard University (M.Ed.) and Doctorate of Physical Therapy (DPT) from the University of Montana. She is also a Certified Strength and Conditioning Specialist (CSCS). She has been a practicing Physical Therapist in Bozeman, Montana for over 6 years. In her free time, she enjoys running, biking, skiing, hunting and spending time with her husband, son and daughter.


Read the full transcript below:

Shannon Sepulveda:      00:00                Hello and welcome to the healthy wealthy and smart podcast. I am your guest host, Shannon Sepulveda and I am here with Shayla Swanson. Can you tell us a bit about who you are and what you do?

Shayla Swanson:                                   My name is Shayla Swanson. As you said, I am the owner of a company called Sauce and we specialize in headwear and select apparel pieces for endurance athletes. My background is in Nordic ski racing. So I spent my teens and twenties training really hard to try to make the Olympics in cross country skiing. I didn't quite, but I got close and I got to do some really amazing things. The other thing is that I was always a sewing nerd and I love to sew and make clothing. So I began making headwear for my ski team and other ski teams. In the early two thousands, we found that most of the headwear we were given was really hot, too itchy, really ugly.

Shayla Swanson:           01:02                And so we set out to kind of fix that situation and things moved from being kind of a hobby or an accidental business and to being a real business. So that was pretty exciting.

Shannon Sepulveda:                              Take us from your competitive Nordic ski days to just like why you started the company, where it was, what you did, like the start of the company.

Shayla Swanson:                                   The start of the company was really just me talking to a couple of teammates saying, hey, I have this idea, let's make some hats and try to sell them to stores and then we can make a little money to help support some of our ski racing. And I had at that point made maybe a couple of orders for local ski clubs and then realized I didn't like sewing that well. So I got some people to help me.  My tolerance was about two CD's worth of sewing.

Shayla Swanson:           01:59                Like I would listen to two albums and then I was, I was done but that didn't get me very many in the grand scheme. So these teammates of mine said, yeah, we'll help. And we basically devoted a weekend to cutting and sewing and making hats to try to sell to some of the local stores and our connections in the ski world helped us. So they said, yeah, we'll put these in our store and put a little tag on them that says the proceeds benefit you guys. And so that was kind of your one. And then from there things changed and you know, some of my teammates weren't interested anymore and they didn't like sewing all that well either. And so we basically, from there it was kind of me and one of the teammates, my friend Rhonda, that continued on with the business.

Shayla Swanson:           02:49                So Rhonda and I started turning things into a little bit more of an actual operation where we would create a catalog and send out to stores and actually try to sell at wholesale. We also had a custom program that we offered to teams and clubs and events. And amazingly enough, it kind of, it worked. So that was in 2000 probably, that was from like about 2003 until 2008 and all that time we were operating under the name SOS headwear and the name SOS came from a blog that I had and my blog was where I updated results and stuff that I was doing skiing and it stood for Shayla on Skis. So we were at SOS headwear, and then in I think it was 2009 that we decided to kind of rebrand and there was a nice little phonetic connection between SOS, which you know, is phonetically pronounce sauce and then the brand name sauce, which is the topping that you use to spice something up.

Shayla Swanson:           03:54                And so we thought that are colorful, boldly patterned headwear that kind of worked. It still confuses people and I get email solicitations from India, but that's kind of where the name came from. 2009, we started operating under the brand name Sauce.  Rhonda and I were both still ski racing, trying to make the 2010 Olympics in Vancouver. Unfortunately neither of us were successful in that, although we both got really close and she knew at that point she wanted to go and work in a different field. So at that point she kind of left the business and I carried on and I started attending trade shows and actually trying to sell some product. So I would say the start of the official like 100% effort toward the business started in 2010. And it's been quite a rollercoaster ride of fun since then.

Shannon Sepulveda:      04:50                That's awesome. So I should say to our listeners, for those of you who are not familiar with Sauce headwear, if you can picture a kind of like a workout hat and really, really fun prints, that's how I would probably describe Sauce Headwear I know this podcast is based in New York and we were in Bozeman, Montana. But whenever I wear my Sauce hats in Manhattan, I always get comments like, people love them. They're like, where did you get that? And I was like, I'm going to try to get Shayla to get these in the stores in Manhattan. But I was running in central park with all my Sauce stuff and I always got compliments because they're just kind of fun. They're not muted in any way.  I did not grow up Nordic skiing because I grew up in New York, but, I did not know that.

Shannon Sepulveda:      05:43                I feel like the Nordic see culture is kind of fun in that sense. Like they tend to wear really bright, fun colors. And so that's kind of what Sauce headwear looks like. And you now, not just, you don't just make hats. Now you make other things. So why don't you tell us about branching out from hats?

Shayla Swanson:                                   We are not trying to be a huge apparel line. What I think our sweet spot is and has been, is bringing a product to the market that we think we can do a better job at, I guess do something a little different that isn't out there and really focused on kind of our elements of like making stuff that's just right, warm, really comfortable and easy to wear and you know, brightly patterned and really pretty. So we make a couple of leg where styles, one of them that I think is our most unique and really applicable to our female athlete audience is our flurry tight.

Shayla Swanson:           06:45                We've put some fleece lining on the quad and also sections of the butt where you get cold in the winter. Those are the two areas where, you know, you come in from a winter run or a winter ski and you think, Oh, I'm freezing on my butt and on my quad. So what we did was we left the rest of the tight unlined cause those areas stay pretty warm and I'm just focused on those spots. So, that's an example I guess of one of our apparel pieces. And we also do like a winter skirt and we have a summer product line that includes some tights and a tank top. And then also another product that I think I liked this one because of the name, we call it the cheeky retreat. So what it is just a nice skirt to cover up your tush if you really don't want it on display. Anyway, that's some of our other stuff.

Shannon Sepulveda:      07:29                I bet you that skirt would be really good for like changing out of your bathing suit, like on the side of a river wherever you are.

Shayla Swanson:                                   Yeah, it's an excellent, it's a great little coverup.

Shannon Sepulveda:                              Yeah, it keeps things hidden while you want to change underneath. It works out really well for that. And I have tried the flurry tights. I loved them because yes, when you're a female and you run your butt gets cold and your thighs get cold and everything else does not. So it's really nice to have, you know, your calves can breath.  What Shayla does is also takes her hat patterns and creates leggings out of them.

Shannon Sepulveda:      08:22                So they're just the really fun colors. And why don't you tell us a bit about like your custom program, because I know at least for most of the races in Bozeman and probably Missoula and probably Canada to lots of light, lots of places, in our race bags we get Sauce hats or headbands that have a logo of whatever the races generally which are awesome. So why don't you tell us a bit about that custom program?

Shayla Swanson:                                   One of the really great business avenues that we sort of happened upon by accident was custom headwear for teams, clubs and events. We do two different options for custom. One is we take our stock product, so all of the hats and head bands that we have in stock and we add a logo to them. So we call that are basic custom program.

Shayla Swanson:           09:16                And it's really great cause that allows we can do orders as few as 12 and it's really relatively inexpensive and it’s kind of a nice option for people. And then we also do what we call our full custom program. And that involves working with a customer to put a design together that is totally unique to their event or their store. We’ve outfitted orders that are like just an event order, but we've also gone as big as working with the whole, Canadian Jack Rabbit program, which is a youth scaly program in Canada that has over 10,000 kids in it. And they submitted drawing ideas to us and we held a contest to see who liked, you know, which design idea they liked best. And then we turned that little kids designed into a hat pattern and outfitted the whole country's youth programs. So that was pretty exciting for us. We currently don't do that order anymore because they have a sponsor that outbid us, but we loved it. It was awesome. Sometimes we have worked with, currently all of our product is sewn in our facility in Bozeman. In the past we have worked with manufacturers based in Los Angeles to help us out with orders that we couldn't quite handle on her own.

Shayla Swanson:           10:36                So the nice thing about it though is that with the options that we have, we can accommodate, you know, we can really be, you know, cottage industry and do something really small and unique for a small customer. And then we can also access those other avenues to produce larger orders for big groups. So it's kind of fun.

Shannon Sepulveda:      10:54                So along those lines, why don't you tell us about like your manufacturing, cause I think you do everything in Bozeman, right? Which is really awesome. So tell us a bit about that.

Shayla Swanson:                                   Sure. Initially when we started doing this, I did not really contemplate the idea of doing all of the sewing in house. I was kind of content working with the manufacturer. But then we started just running into situations where you get a batch of hats back that weren't quite right. Or you know, you wouldn't be able to tweak a sizing concern until you already, you know, had placed your order with this group. And anyway, we just were running into all these situations where I thought, man, it'd be awesome if we could just make this stuff here. And so I bought some industrial sewing machines.

Shayla Swanson:           11:41                Industrial sewing machines are interesting because they only do one thing. So unlike a home sewing machine that can do a bunch of different stitches in a programmed, you know, design, basically industrial machines only do one thing. So in order to make our products, we have four different machines that are able to do all the stitch patterns that we use in our stuff. And yeah, I was lucky enough to find some amazing sewers so, Bozeman is a funny little space in the world of manufacturing because we have several different companies that are much larger than we are, but they make all of their product here. So there's this weird little, like sims makes their waders here and mystery ranch backpacks. So we have access to are sewers in town who are, who are really skilled at what they do.

Shayla Swanson:           12:28                And I was lucky enough to actually hire on three former sims employees, sorry. Sims. And they've been awesome. So they love it. They are given super flexible work hours. They do what works for them and they just sit around the machines and laugh and talk and have a great time and they make all of our stuff and they're really fast and good at it. So it's really fun. We have rolls and rolls of fabric and the corner of our space, we have a big cutting table. We use a big upright solid to cut all the patterns out. We're able to, you know, make small adjustments to sizing on the spot, you know, which is really great.  And then they just sewed them up, finish them up, keep them in our inventory space where our office is basically a large garage. So it's not pretty, but it works really well for our purposes. And it's just really fun to think that of all of the love that goes into each thing that we ship out the door.

Shannon Sepulveda:      13:32                So I want to know how you create your patterns. And how you get that fabric made because you have fun new patterns every year. And I didn't know if that was like your brainchild or if it's a couple people's brainchild or if it's the company's brainchild or how you pick what pattern you'd like.

Shayla Swanson:                                   Yeah. So it's not all me, that's for sure. There are trending reports that come out for the outdoor industry and I don't think they're as important in the outdoor industry as they are in, you know, the fashion industry. But, but what will happen is, a couple of companies come out with these trending reports that, that show you kind of what colors they think are going to be on trend for the upcoming season. And then what we do is we are an accessory piece.

Shayla Swanson:           14:24                And so really we don't need to follow, we don't need to create our own trends, but we need to kind of follow what the other brands are doing. So if we see a company if the trending reports are coming out that, you know, really muted colors are, are going to be more prevalent than we want to try to offer some of those colors in our prints and patterns so that we can match your jacket from say Patagonia or something like that. So what we do is we just tried to I work a couple of different graphic designers who specialize in textile design and they'd come up with some concepts based on textile trends as well as color trends. And then we put that all together to try to make our line a really nice, complete offering to people cause you also want to make sure, you know, we want to make sure that if somebody loves pink, they can find a little pink in one of our hats.

Shayla Swanson:           15:11                So we try to make sure kind of every main color is offered as well. So it's something between the science and art, I guess it's not all just creative energy going into that. We have to also look at some of the other factors and figure out where we fit in the mix. It's pretty fun and exciting. I wish I, I can't, I'm not as adept to the graphic design part of things. So I don't do a lot of the actual design, but I get to pick what I like best and, and where to go next. So it's really cool.

Shannon Sepulveda:                              Especially because I love you Patagonia, but this year their colors were terrible. They were all these like muted colors. They had maybe like one bright color. And so I was like, I guess I'm just going to have to get a muted color and like wear a fun sauce hat.

Shayla Swanson:           15:58                Well, I hope you were at least able to coordinate one color out of our hat with your jacket.

Shannon Sepulveda:                              I was, yes, I was. I appreciate that you have fun colors. Oh, I'm hoping next year Patagonia, we'll have more bright colors. Bright colors will be back in season.

Shayla Swanson:                                   Right. What I've actually had to do is, because I'm always going to be wearing one of our hats and I don't want to buy a new jacket every year is I've had to resort to black and gray in my outdoor apparel, because then I know I can always look okay with whatever hat I'm wearing and not have to buy a new jacket every year.

Shannon Sepulveda:                              Yeah. I also think another great thing about Sauce hats, so, so Shayla and I both have kids is that and we both have a boy and girl is that, you can throw a toddler girl in all boy clothes and put a really fun toddler pink sauce hat, and then they look really, and then they look really cute. Yeah. So it's pretty awesome. Oh, why don't you tell us about your Kiddo?

Shayla Swanson:                                   Oh my. I have two little ones and they are really fun and really hard at the same time. But it's been kind of fun because we made a baby hat for a while. And I was sort of like, yeah, it's really super cute, but I couldn't really get behind it as far as like whether or not it was a great product for kids. But yeah, we have this little chill hat that we make and I should also mention, we call our hats tukes that stems from my Canadian background.

Shayla Swanson:           17:32                Winter hats in Canada are called tukes and it's spelled in a way that makes everyone want to say Toke or Torque even. So, it's a little confusing for people. But anyway, we make a little chill tuke for kids and it's been like the best hat for my young ones. I can't believe it. It's like I just have this constant stream there. I start them in the small move them up through the other, the other sizes. And what's great is that they're tight enough that they stay on their heads and I think they forget that they're on, which I think helps they so they don't pull them off. And the other thing is that they're warm but they're not like so hot that the poor little kid is like drenched with sweat underneath their hats.

Shayla Swanson:           18:12                So they don't try to rip it off because they're uncomfortable either. So our chill tuke for kids has been amazing. My daughter who is almost a year, wears our large and my son who is three, where's our toddler size and yeah, it's been great. I can get behind them now.

Shannon Sepulveda:                              Yeah, they're pretty awesome. Cause they have just like a fleece band. Right. And the top doesn't have fleece. So like when kids are playing hard, they don't totally sweat.

Shayla Swanson:                                   And that's kind of our whole little goal with our headwear line is just to make sure that we're keeping, you just right warm. We want to make sure that you don't notice your head when you're out there exercising. Because I know for myself, I've worn Wool hats and been drenched with sweat and miserable and then you want to pull them off and then your hair freezes and then you're more miserable.

Shayla Swanson:           18:57                So that's kind of our whole mantra is just let's keep you warm but not too warm.

Shannon Sepulveda:                              Yeah. So, along those lines, since not everybody Nordic skis or lives in a place for Nordic skiing so runners really wear these hats a lot. I see out even when I was visiting Seattle, I saw a lot of runners in Seattle wearing the hat. So why don't you talk to us about just like other sports that they're useful for?

Shayla Swanson:                                   Our line has now expanded to be a 12 month, you know, four season line we have some of are products that are ideal for summer activities. And then we also have our winter product line. So our winter product line, I would say we're kind of geared really, you know, well basically any activity really, I mean anything where you want to be comfortable and colorful and you might work up a sweat.

Shayla Swanson:           19:54                So that might be running or hiking or skiing. And also we're a great little, like if you're an alpine skier and you wear a helmet so you don't really need a hat while you're skiing. We do make a helmet liner that fits under helmets. And then we also make a lot of our products are great little like lodge hats. So if you want to cover a pure helmet head and feel like you have put a little bit of effort into your appearance our products are great for that. And the other thing that we have when we expanded into this spring summer product line, we've introduced a couple of visor styles that have really flexible brims. They can be worn under helmets if you're a cyclist. They are great for running and hiking. And then we also have a product that's like a kind of two ways visor that can be worn.

Shayla Swanson:           20:37                It's really if you're hiking and you're not sure what the weather's going to do, so you can cover, you can kind of cover up or wear less people say they love those on a boat too, because it keeps you from burning. That's our viser. I think what the feedback that I'm thinking about what's coming from this woman who said she loved, she always wore her hair in a ponytail and she always had like a part in her ponytail, in her hair, you know? So the way she would brush her hair back, she would always end up with like a sunburn in that area. But she said that with that product, she loved it because she still had plenty of room to like get her hair out the back, but she could kind of pull that piece back and so she didn't burn her head.

Shayla Swanson:           21:21                So anyway, just little random stuff. Some of the stuff that, some of the benefits we claim are things that we thought of. A lot of them aren't benefits that we didn't think of, but there were people have decided works well for them. So that's pretty nice to hear that stuff too.

Shannon Sepulveda:                              Why don't you talk about your tassels because I feel like you're the only, I don't know. I haven't seen any other hats that have flower tassels.

Shayla Swanson:                                   The Flower Tassel. Yes. So, so our idea was kind of to bring a little bit of fun and spring summer brightness to the coldest dreariest winter day. So along those lines, we started using these little tassels on the top of some of our hats. Some people love the tassels, some people hate the tassels, but there are enough that love them that we definitely keep doing it.

Shayla Swanson:           22:11                And so we offer three different styles of Tassel on the hat. And one is like a traditional kind of looks like a graduation tassel. And they're kind of popular in the Nordic world and maybe not anywhere else, but a runner sometimes or sometimes they bounce a little in your head. So, yeah. But they're cute. They're cute. And the colors are really pretty. The other type of tassels that we make is a flower tassel. And those come with mixed reviews. But again, it's one of those things that people who love them love them. We have a few stores that order exclusively flower tasseled hats because they know they will sell them because people think they're cute. In our offices I will say that we don't love the flower Tassel because while we've been able to outsource manufacturing of most of the tassels just cause they're kind of a pain, we have, we still make the flower tassels.

Shayla Swanson:           22:58                We’ve tried to find someone who can help us make them but no luck so far. So, so we have some weird weird little non transferable skills that we joke about in our space where like we're really good at tying knots really quickly because you need to tie four knots on a flower tassel. And then we have a pom pom we can put it on the top of our hats too. A little pom is really cute. We get lots of different colors and anyway, that's another piece when we try to pick our prints and patterns, we have to try to figure out if we have tassels that work with the prints and patterns.

Shannon Sepulveda:                              And so if someone wants to do a custom order, they can pick their hat print, tassel, logo.

Shayla Swanson:           23:44                And that's kind of what's nice about say working with us versus other larger businesses that do custom work is that we can really say like, you'll get, you know, get an email saying like, these are all of your tassel choices, these are your fabric choices for your hats. It's kind of very customized. Very cool.

Shannon Sepulveda:                              So why don't you talk a bit about your price point? Because for the life of me cannot understand how you make everything in Bozeman and the hats are still $30. Wow. Because that's pretty awesome, I think for a company to be able to do that.

Shayla Swanson:           24:20                Yeah. The honest truth of it is this is the healthy, wealthy, smart podcast. Let's just say I probably won't be getting overly wealthy, but I love what I do. And so it doesn't matter too much. But it is true. There's something, the reality of it is that if you want to be really profitable in the apparel industry, I think you definitely have to send your stuff to places where they don't have to pay people much to make it the reality was sewing a hat or a piece of clothing is that it's touched. Every single seam is basically driven by a person. There are a few exceptions, but in general, a person is responsible for every seam on your clothing.

Shayla Swanson:           25:11                Unlike an injection mold plastic piece or something like that where it's, you know, where it's really mechanized and automated. And so, yeah, as far as our price points go, we have to maintain some level of competition or competitive, you know, placement in the industry. So, yes, it is true that our profit margins are not as great as they could be, I suppose. But then we couldn't offer, we really, I think that we wouldn't have a business if we outsourced to somewhere like Asia or places because they have high minimums. They can't offer the flexibility that we can. So I feel as though, it's an interesting situation because I don't think we could do what we do using a different type of manufacturing model. Yeah. So what's really been great for us is that we have, this year in particular, we have really streamlined a lot of our production processes.

Shayla Swanson:           26:07                I think we're getting faster and faster at everything we make, we're cutting down on complication and skews and things. Anyway, everything we can do to basically improve our efficiencies and make sure that we can be competitive with our price point and also be a healthy business. Yeah. So, yeah. So it's interesting.

Shannon Sepulveda:                              Can you talk a bit about the contest? It seems like you have every year where someone designs a hat.

Shayla Swanson:                                   Yeah, that's a fun one. So one thing that we have started to do, well I guess it's been probably five years of the contest now. We have a contest that runs every year in August or September, we call it our special sauce design contest. And what it is, is we basically send out a little pdf template and people can download it and basically send in a design idea.

Shayla Swanson:           27:04                And what's really great is that we used to get comments, people would email us and be like, hey, why don't you have any hats that are blue? Or why don't you do this, this, this, or the other thing. And so it's been really great to be able to put the ball in our customer's court and have them tell us what they want to see. Every year we receive entries and we put them up on Facebook and we also allow people to vote on our website. You know, Facebook may or may not be a great avenue for that but yeah, people vote for their favorite designs and then we make them. So this year we had two really beautiful, we had a really beautiful floral that came through. We had basically two that were really neck and neck for first and second, so we decided to produce them both.

Shayla Swanson:           27:49                And this graphic designer in town here in Bozeman that submitted this ridge line mountain design. And then what's really cool is that at the end of the year we kind of tally up how much we sold and then a percentage of the sales go back to the winners chosen charity. So yeah. So this year one of the hats we'll be donating to a foundation called the neo kids foundation. It's up in Sudbury, Ontario, which is where the winners of the contest live and that's where they wanted their proceeds to go. And then one of the designs here is going to go back to basically a fund for the Bozeman education. That foundation that supports kids that are homeless basically, who come and need some assistance that way.

Shayla Swanson:           28:41                So we're really excited about that part of the contest too, cause it just gives us a chance to give back.

Shannon Sepulveda:                              So we can find you in Bozeman. We can find you online. So why don't you tell us a bit about like where you're located in the country, what types of stores and like if people want to check out your products, where would they go?

Shayla Swanson:                                   We are carried by about 200 retail locations across North America. So if you go to our website does have a store locator, which I will admit is about 90% complete. It's really hard to stay on top of all this stuff. We are distributed in the types of stores that carry us or generally like running shops. More like outdoor stores.

Shayla Swanson:           29:32                Also anything that's kind of got a Nordic edge to it. Those shops typically carry us. So yeah, so we're available online. They're available about 200 retail locations and if somebody out there can think of a store that we should be in in that we're not, we always take suggestions for wholesale accounts that we should be reaching out to. So that's where you can find us.

Shannon Sepulveda:                              Yeah, I was thinking about that when I was in Manhattan in November. I was like checking out stores. I was like where it just be as so many people complimented me on my hat. Cause I feel like New York is a lot of people tend to wear more muted things. Or in big cities in general, I think it's more muted. It's more muted.

Shayla Swanson:           30:22                And that is one thing I will say is that we do, well, a lot of our patterns are kind of bright and colorful. We always make sure we have a black and white option. We always make sure we have a gray, you know, it's like we try to make sure we can also appeal to the more subtle Palette. Our winter product line has men stuff. And we always carry a black plain old basic black as well too. Our neck gator product is called our frosty. Kind of like the buff is sort of the Kleenex or the bandaid.  The brand that became the thing. So, my parents used to call it a chill choker.

Shannon Sepulveda:      31:10                That was a new brand, like back in the 80’s. But we as children, I was growing up, we used to always call the chill choker. And I feel like it was wool and we wanted to just like rip your neck off and awful. And then they were like turtle fur, do you remember that?

Shayla Swanson:                                   Well and that brand is still that brands still around there. You see them in places that carry us as well. Occasionally. But turtle fur is still around. We have a product coming out next fall. We currently make a like a neck breeder, but it's a lightweight net gate or color frosty for the neck. Next season, next fall we have a product that'll be coming out called throat coat. It's our aligned neck warmer.

Shannon Sepulveda:      31:57                Oh, that's such a good idea. My son had, I think I got it at your clearance sale at the Cammo.  But it's really good idea to get, um, like a fleece lined one for the really cold days for, especially for downhill skiing.

Shayla Swanson:                                   And the product we're, we're using the liner, we use them polar tech products to line our stuff. So for installation their fabrics and we're using a kind of a mid weight style, so it's like warm, but it's not going to be like saturated with breadth and moisture, like a fleece might be. And then it like freezes and it's stinky. My team might still be stinky, hard to say, but yeah, there anyway, all this stuff you try it, you try to think about, but it's something that's just a reality.

Shannon Sepulveda:      32:49                There’s a place in Bozeman where you can Nordic ski and it's like all sourdough, right? So it's all up for nine miles, go all the way up for 10 all the way up for 10 miles. And so you get super sweaty all the way up and then you come down and you pretty much don't really have to ski on the way down and you're buff just becomes like an icicle because just like knock knock, by the time you get to the trail head because you've sweated all the way up and then you just freeze, freeze all the way down, all the way down. That's a tough, tough trail to dress for. You have to have like a backpack of layers to it. Right. To get down, to get down comfortably. I typically choose to just be really, really cold at the bottom. Yeah. And then turn on and then get in your car and turn on your seat heater. By the time you get to the house, then the cars finally warmed up and then you feel pretty good. What's new in the future? What can we look forward to?

Shayla Swanson:           33:50                We have a few new products next season. We have really cool new patterns that are kind of basically images of our natural world that are going to be placed in the hats and the headbands anyway, so we're venturing out a little bit from what we typically do, but I'm really excited about. It's been well received by the stores that have seen the line already. So we have some new prints and patterns. It's usual. And then we have a couple of new headwear products that are sort of like hybrids of stuff we've already been doing just to I guess diversify the line a little bit and make sure everyone can find products that are aligned and warm enough for them.

Shayla Swanson:           34:37                Anyway, that's kind of confusing. But I guess just in general, I'm our main product designer and I've been having children for the last few years and I haven't been feeling overly creative. My mom brain has, has really, I would say, shut that down for me. So I'm feeling like I've turned a corner here. I have a nearly one year old and I can, I'm feeling like I can start to think again. And so I'm looking forward to seeing what that, what that brings because it's always when I'm outside skiing or outside running or hiking that ideas come to me where I'm like, Ooh, this is, this would be a great product. So I'm looking forward to that. And so as far as what's coming next, I have a few things on the immediate horizon and then after that we'll see.

Shannon Sepulveda:                              Cool. Yeah, I feel like you need like for at least for headwear winter headwear I feel like you need like the fleece line warm hat for like walking around town. And then you need like the thin hat for exercising and then you need the thin headband. Cause sometimes it's just your ears it get cold. And then you need the fleece lined headband. And then you probably need more stuff, but those are like my four go tos for like winter. But you definitely need the like non, it's nice to have the nonactive totally fleece lined hat for like warmth.

Shayla Swanson:           35:30                The two products that we make that I think are good for casual or activity on a cold day. If you will athleisure headwear, we make a slouchy beanie. It's kind of like a slightly more, styled hat I guess. And it's, and it's really warm and cozy. So I, that's my like where around Go to and then we make our chill.

Shayla Swanson:           36:19                Tuke is another one that you can wear casually in and look pretty cute, but it also works really well if you're skiing on earth, doing something on a cold day. And that's the one that has our little swirl closure at the top where you can kind of create some space and vent a little bit if you get too hot or you can throw a topknot out there if you, if you're so inclined. I never have hair long enough to do that. And that wasn't an intended benefit. The ponytail through the hole. People have figured out how to do that. Ooh, it's really cute picture of that on our website. And right now actually of someone doing that who had long, beautiful hair and just put the hat down over top of it and it's like, anyway.

Shayla Swanson:           36:55                We have products that have more of like a standard ponytail hole right at the back of your head. But this one is kind of more at the top, which makes it a little weird, but it's still pretty cute if you have the right length of hair. I have recently kind of refallen in love with is our Bandura and it's basically like a kind of a pocket band. But what's nice about it versus some of the other brands that make more of like an active pocket band is this one. It doesn't, it looks more like an intentional addition to your outfit. So it's something you can work casual or active and basically it just looks like a little tank top sticking out from underneath whatever your layer over top is.

Shayla Swanson:           37:39                So it's kind of hard to explain I guess on audio but it's like a fabric piece that goes around your waist. Elastic. Yeah, it's like a, it's kind of like a tapered fabric piece that goes around with the band around your waist. And it separated into six pockets and all the pockets are kind of semi secure, so they have a little flap over top and then they have an elastic drawstring waistband, so it's got some nice integrity. If you do pack it with stuff, it's not going to fall off. And like uses that. I, you know, I've been using it recently to cross country ski and I've thrown my water bottle in the back. And then I put my keys and my snack and my kick wax and my cork and I'm all, I've got everything I need.

Shayla Swanson:           38:23                And what I also like is it's not tied around my waist. So that's really comfortable for me too. And then but other things I've heard people say like I've been at events where someone will come by and say, Oh, I wore this and while I was backpacking in Europe, I need another one. It was amazing. Like, so she said that she wore it everyday in Europe as kind of a money belt, but what was great is it just looked like a little black layer sticking out from under her shirt. So she's just, it was funny, she came, I didn't expect such a rave review from somebody, but she came back and was thrilled. And then it can also turn like any, it's great for cycling because if you want, if you want extra pockets but you don't want to wear a jersey that has pockets. You can throw that around your waist and then you can turn any shirt into a jersey.

Shannon Sepulveda:      39:11                How about the sports bars or you're going to start making sports bras?

Shayla Swanson:                                   I don't know. People ask me to, the two questions I get a lot. Are you going to make sports bras and then also are you going to make like cycling shorts with shammies? Oh, the thing I feel about both of those products is there's a lot of r and d that goes into making the perfect shammies and making the perfect sports bra and, and I'm just not sure we're, we're up for that. I don't want to throw something out to market and then being like, oh that actually is really not as good as the other ones you can find out there. So you know, maybe maybe it would be like, uh, yeah, probably not is realistically the answer.

Shayla Swanson:           39:49                But I think what would be interesting is maybe we can find a way to supply people with like cute little shammy containing underwear that, you know, I can buy from someone else and then they can make sure that they can wear it under our shorts and then it would be kind of work for that as well.

Shayla Swanson:                                   So to answer, I guess I should probably clarify like that's the kind of sports bra that maybe we could make, but if, but when it comes to making something that's really supportive and actually does a great job for women who have larger breasts, I don't think that would be hard.

Shayla Swanson:           40:33                Yeah, there are some really great brands. Like there's actually a Montana based company called Anelle and it was founded by a woman in a small town in Eureka, Montana who I think she, well their company's based in Eureka. I think that's where she's from, but they make this amazing Bra for women with large breasts and like sports bra. They do a really great job and they're there. I see them at some of the trade shows I attend and am friends with some of the people that work for that brand, but so yeah, I think we'll leave it, leave it to the experts.

Shannon Sepulveda:      41:06                Awesome. Anything else you want to add or talk about as far as Sauce and your company, Bozeman? Did you start it in Canada and then came to Boseman?

Shayla Swanson:                                   Yeah. I moved here in 2003 to go to school. So I think we had made hats for one year before I moved here and then I moved here and I kind of became the US distribution center. Rhonda was still in Canada. But no, I guess, I mean it's become this really great and exciting thing. I didn't ever really anticipate for my hobby to grow into a business that would actually pay me a wage and it does. So it's pretty awesome. And I really like what I do, although I do wish every now and then, there wasn't a day when I learned, like, I kind of would like to like not learn an important lesson every day, be nice to have one or two days where I didn't think to myself, oh, that's something I need to remember.

Shayla Swanson:           42:01                You know, I'm sure that's the case for most of us that you, I mean, you never want to stop learning, but sometimes you just wish it was a little bit easy for most entrepreneurs. I have been pretty good. I think one thing that has really helped me is that I truly have this, I learned how to lose early on, I guess with my ski racing. Like it's, you know, it sounds like a weird thing to say, but it's true. You know, you win some, you lose some. And I think it's important to learn how to lose and understand that it's not the end of the world and understand that really every time you try something, as long as you learn something from it, it's a success, you know?

Shayla Swanson:           42:43                Yeah. So that's kind of how I try to move forward. I've only made one or two, like really expensive mistakes, so these ones are harder to deal with. But you know, we're all doing our best, so you gotta just have to do what you can and, and move forward.

Shannon Sepulveda:                              Do you have any advice for any other female entrepreneurs?

Shayla Swanson:                                   Oh, I think one thing I'm not doing a great job at, so this is I guess me telling someone to do different. I love every part of my business and the problem I'm having right now is that I'm trying to do too much of it. And I've heard that that's a kind of a common thing, probably also a barrier to really making it big in some of these things as I have a little trouble letting go of certain aspects of my business.

Shayla Swanson:           43:30                But truly it's not necessarily because I am like super type A and can't let someone else do it. It's more just cause I really liked doing it. So anyway, I have to, I have to figure that out for myself. So I guess my advice to someone would be if you can, you know, delegate and do a good job of getting someone else to take care of some of this stuff off your plate is probably a good idea.

Shannon Sepulveda:                              What I find is, I mean, after I started my own practice, it was great and I love it, love it, love it. But you can't turn off. No, there's no, especially with kids too, it's like I would love to be able to turn off, be present, and I'm trying really hard to do that. But it's hard. There's always something to be done.

Shayla Swanson:                                   And that's one thing, you know, having kids, like before I had kids, it was, I worked long days, I liked what I did and then I went home and that we didn't even have internet at our house at that time.

Shayla Swanson:           44:21                We did that on purpose. My husband and I just decided like, we want to work when we're working and we want to not work when we're at home. And so we had this great little like work home separation was really helpful. And now I can't have that because there and we don't really, we, my husband and I swapped to take care of our kids. So basically I'm either working or I'm taking care of the kids and there's never enough time to do either one. And then you have to sleep because if you don't sleep, you get cranky. So yeah, I don't have a great solution for that. I think you just have to do what you can to try to turn off when you're with your kids and keep a list. I think a list is really critical because then you can turn off your brain as long as the stake has been planted somewhere where you know you won't forget what to take care of.

Shayla Swanson:           45:05                I read that in a great book. It was called, I think it was called getting things done and that was his main, main, main advice was you only have, like if it's, you have one place where you keep track of that kind of stuff and only one, like you don't have a phone and then a calendar and a little mole skin notebook. And then you have one place where you keep track of things and you always write down what you're doing and what you need to do. And then that way when it's time to not think about it, you don't have to think about it cause you know where it is. And you know that you won't forget because it's in that one place.

Shannon Sepulveda:      45:40                That's such a good idea. It's really helpful because like last Friday it was late. I was trying to get all my paperwork done and I knew I had all day. Monday is my admin day, but I still felt like I needed to get it done on Friday. But if I had just re wrote it down, these are the things we're going to do on Monday, then I come back on Monday and I finished that. Right. All there.

Shayla Swanson:                                   Thank you. Getting things done. Book. I don't remember who, that was helpful. It was a good book.

Shannon Sepulveda:                              Why don't you tell us where we can find you? Social Media, etc. And how we can get in contact with you.

Shayla Swanson:           46:32                Sure. So I'm online, we are at I'm on social media. You can find us at Sauce active on Facebook. That's Facebook and Instagram primarily when we actually post. And if you want to get in touch with us by email is probably the best email address.

Shannon Sepulveda:                              So if someone who is listening has a great store that says, Hey, they should carry sauce, we should email you.

Shayla Swanson:                                   That would be great. That would be great. If you have anything to anything to say, we'd love to hear from you.

Shannon Sepulveda:                              Do you have a newsletter?

Shayla Swanson:                                   Oh Great. Yes, we do have an email newsletter that we send out. It's not super regularly regular, so don't, don't be afraid that of a bombarded inbox. But there is a newsletter sign up at the bottom in the center of our website, so we do send that out.

Shannon Sepulveda:                              Cool. And why don't you tell us about the gift to our listeners.

Shayla Swanson:           47:23                That is great idea. So if you want to buy something on our website, we would love to offer you 20% off if you enter code hws19. So that's hws19 20% off online

Shannon Sepulveda:                              That's a good deal. It's a really good deal. Especially, like I was saying, I don't know how you make hats for $30 in the US because they're awesome and we support the local community

Shayla Swanson:                                   And you're supporting our sewers, Linda, Laura, and Karen, which I think is pretty fun. So you're not just, you know, buying a hat. You're actually supporting Linda, Laura, and Karen and Shayla.

Shannon Sepulveda:                              Well, Shayla thank you so much for coming on the program and we really thank you, it was really great talking to you.

Shayla Swanson:                                   Thanks. Thanks for having me. It was really fun.


Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram  and facebook to stay updated on all of the latest!  Show your support for the show by leaving a rating and review on iTunes!


Feb 11, 2019

On this episode of the Healthy Wealthy and Smart Podcast, I welcome Dr. Sarah Haag on the show to discuss pelvic health for the non-pelvic health PT.  Sarah has pursued an interest in treating the spine, pelvis with a specialization in women’s and men’s health.  Sarah looks at education, and a better understanding of the latest evidence in the field of physical therapy, as the best way to help people learn about their conditions, and to help people learn to take care of themselves throughout the life span.


In this episode, we discuss:

-Intake questionnaires to screen the pelvic floor for patients with low back pain

-Pelvic health red flags

-How to address pelvic floor health with a conservative population

-Assessing the pelvic floor muscles without doing an internal exam

-And so much more!



Oswestry Low Back Pain Disability Questionnaire:

Sarah Haag Twitter

Entropy Physio Website

Home Health Section Urinary Incontinence Toolkit


For more information on Sarah:

Sarah graduated from Marquette University in 2002 with a Master’s of Physical Therapy. Sarah has pursued an interest in treating the spine, pelvis with a specialization in women’s and men’s health. Over the years, Sarah has seized every opportunity available to her in order to further her understanding of the human body, and the various ways it can seem to fall apart in order to sympathetically and efficiently facilitate a return to optimal function. Sarah was awarded the Certificate of Achievement in Pelvic Physical Therapy (CAPP) from the Section on Women’s Health. She went on to get her Doctorate of Physical Therapy and Masters of Science in Women’s Health from Rosalind Franklin University in 2008. In 2009 she was awarded a Board Certification as a specialist in women’s health (WCS). Sarah also completed a Certification in Mechanical Diagnosis Therapy from the Mckenzie Institute in 2010.  Sarah has completed a 200 hour Yoga Instructor Training Program, and is now a  Registered Yoga Teacher.

Sarah looks at education, and a better understanding of the latest evidence in the field of physical therapy, as the best way to help people learn about their conditions, and to help people learn to take care of themselves throughout the life span.



Read the full transcript below:

Karen Litzy:                   00:01                Sarah, I was going to say doctor Sarah, hey, it just feels weird because we've known each other forever. But Sarah, thank you so much for coming on the podcast to talk about pelvic health for the non-pelvic health PT. So there are a lot of physical therapists who I think are interested in pelvic health, but maybe they don't want to like dive in literally and figuratively. So what we're going to do today is talk about how we as physical therapists can treat people with pelvic conditions, with pelvic issues without necessarily doing internal work. What are the functions of the pelvis, really important for bowel and bladder health, right?

Sarah Haag:                  00:49                I mean, it is very important for survival, sex, very important for quality of life and propagation of the species. So these are all things that matter. But also when people come in with low back pain, when people come in with hip pain, I always find it very interesting that people say, but I don't do the pelvis. You know, the pelvic floor is only a musculoskeletal structure. We're not trained in most programs to palpate or to touch. It's just skeletal muscle. That's all we're assessing for really as pelvic floor PT’s. So I just think it's interesting. It's like a blurry void when you're looking at a body diagram.  Oh, there's your knee. So it's really important I think to understand what's there and you don't have to go there, but you have to know what's there and know that some people need help there and help them find the help.

Karen Litzy:                   01:34                So if someone, let's take this person that has low back pain because that's a diagnosis that we can all agree that we see on a regular basis. So what are a couple of questions you can ask during your initial evaluation?

Sarah Haag:                                          So the subjective part of the initial evaluation that perhaps a lot of people are missing or that can take in that pelvic area. There's a couple of ways that you can kind of like cheat your way in where you don't even have to think about what to ask to begin with. If you have a red flag questionnaire, there is a bowel and bladder question on there. So, it’s really interesting because people will sometimes circle yes on those and then never discuss it. Like, wait a second, we asked the question, they said yes, it's a thing.

Sarah Haag:                  02:22                So there's your in, it was like, I noticed you, you marked yes on the bowel and bladder changes. Can you tell me a little bit more about that? Most of the time it is not truly a red flag. Most of the time it is not a sign they need to be referred to a physician.  Most of the time it's like no one's ever asked me that. Yeah. Stuff is different. There's your in. And then also if you use the classic Oswestry. So it was modified I think in 2001 or 2002 to take off a sex questionnaire. The second question of the questionnaire and it was revalidated and all of those things, but if you use the original, it's pretty awesome because now they're like, Huh, nobody's asked me about sex. And then you'd be like, ah, I see that this is an issue.

Sarah Haag:                  03:06                One of my favorite Twitter stories is I get a direct message from someone asking me about a patient who was having pain with intercourse and I was like, thanks for reaching out. Absolutely. Can you tell me more about when they're having trouble and where it hurts? Would you like to know where it hurt their knees in one particular position? And I said, fantastic. You can help with that. So, so it's not always, it might be a sex problem, but it's not necessarily that problem. So we have to not be shy about asking those. Low back pain is the most expensive health care problem we have in terms of multibillion dollar, probably millions and millions worldwide. And so of course addressing back pain, we're still working on the best way to do that.

Sarah Haag:                  03:52                But there’s a high prevalence of urinary incontinence and people who have low back pain. So if you're seeing people who have low back pain and after, if anyone else went to the pregnancy talk this morning, after vaginal deliveries, the prevalence of incontinence goes ways up, goes way up. So if you're seeing someone with back pain, if someone has had babies, all you can eat what you can do. So we were like, well I see this in your history cause that's pertinent history for back pain. Correct. And then it's like, Hey, I noticed this, any issues with this? And here's the reason I'm asking because you can't just go, do you pee your pants? Because people like, do I smell like what happened? Like, so if you're just like, you know, there is a really high prevalence and the nerves in your back go to your pelvis and all of these things.

Sarah Haag:                  04:32                So I'd be really curious to know are you having any issues in this area? Cause there's help if you are. And then kind of go from there.

Karen Litzy:                                           And I want to backtrack for just a second. When you were talking about red flags and said some are truly red flags and some aren't. So just so that we're all on the same page, what would be those truly red flags?

Sarah Haag:                                          Truly in the pelvic world or in the entire rest of your body world is any unintentional weight loss or weight gain, 10 or 15 pounds over a short period of time. Also like fever, like temperature issues, loss of appetite when you have those other constitutional symptoms that go along with it. So just having some quirkiness with your bowel and bladder, it's really no reason to panic. But if you have also a fever and also a recent traumatic event, no, no, we want to just make sure everything's okay.

Sarah Haag:                  05:26                And the cool thing is that if you go to the doctor, it's like you don't have a UTI. Everything else is looking fine. Awesome. Then I can help with that. But the red flags, there's been a couple of great papers that have come out where it's like, it's not like if you have pain at night, freak out. No, no. If you have pain at night but also a sudden bowel and bladder change and also, okay, now we need to check in for it. But don't panic if it’s the only one.

Karen Litzy:                                           And now let's say you're using these questionnaires and someone puts on bowel, bladder or someone circles sex as something that they're having difficulty with. And I love this question because this was something that was brought up last year at CSM. So there was a physical therapist there who said, well, I live in the south and these are not easy questions to ask because people are more conservative or they don't want to talk openly about their bowel and bladder issues or about sex with their partners.

Karen Litzy:                   06:28                And so what do you say to those people? Those therapists that, are dealing with a population that's maybe much more conservative and they're not sure how to approach those subject matters.

Sarah Haag:                                          I always say just always with kindness and with a good intention and with a good explanation. So you can't not do it because it's awkward for you. You should be asking for a medical reason, right? So quality of life is in our wheelhouse, right? Like we're doing all sorts of quality of life questionnaires. Pee in your pants is a huge detriment for your quality of life in many cases, not being able to have sex can impact your relationship with your partner, your feelings of ability to even have a partner, having babies. All of these things that end up being huge stresses, which is gonna make a lot of other things not as good either.

Sarah Haag:                  07:28                Just start simple if you're asking questions. So if someone comes in with like straight forward knee pain, I'm like, how sex, no, that's not how, that's not where we go with that. But if someone's coming in with low back or pelvic issues, the way I usually approach it is to bring it up anatomically. So this is the anatomy. This is what we're doing. These are where the muscles go. Most people don't think about them. And when they're, if they're having issues like incontinence or have had babies, those pelvic floor muscles are muscles. Like everything else. We're going to work in PT. So I'm going to ask you some questions and I try to do it in a spot where you have some privacy. I know some PT places you're like in the middle of a gym.

Sarah Haag:                  08:06                If you can find a quiet corner, do everything you can to put them at ease. But just to be like this is why I'm asking. And if you can see that resistance be like all right, like it's not necessarily the number one priority for this treatment anyway, but if those things happen to be issues there is help, it can get better and you just let me know if you have any questions. Cause not everybody wants to talk about it and it's not my job to convince you to deal with it. It's my job to help you if you want help.

Karen Litzy:                                           And if you're a physical therapist that isn't specializing in pelvic health, it's a little bit different. Cause if you're specializing in pelvic health and people are going to you because you specialize in pelvic health it’s way easier, you know, these questions are going to come up.  But for those of us who don't specialize in pelvic health, then those questions can be a little bit more sensitive. So I just want you to make that distinction there for people.

Sarah Haag:                  08:48                Yeah. And also if you're going to ask if you're going to take that step and be like, all right, I'm going to ask about the incontinence. I mean cause sometimes you're in situations where it is an obvious issue. Other times it's like, well, based on their history they're actually at risk for it. Then you can talk prevention, which has always been kind of fun. But just if they give you some information, especially if you got up the guts to ask them, then please, please do something with it. Don't just be like, oh yeah, so great incontinence noted in the chart. I'll put it on the diagnosis list, like how the plan and there are some things you can do without doing a pelvic floor exam that can make amazing changes.

Karen Litzy:                   09:49                How can you evaluate pelvic floor muscles without having to go internally? I think that's a question everybody wants to know.

Sarah Haag:                                          Great question. I'll be honest, some people don't want you to touch him there like full stop. And so I will actually give people, I would say it's kind of like a choose your own adventure. So we can actually, we can all check our own pelvic floor muscles right here. And I would basically talk you through it. You would tell me what you felt. I keep an eye on everything else to see what else you were doing. But it would be very honest that my assessment is going to be, I believe you, it seems you're doing it correctly. Right? But I have to believe you, but you can actually palpate externally. As a clinician you can actually do it and you can do it in sidelying.

Sarah Haag:                  10:33                You can do it in hooklying and some people will do it in prone. I'm not a super big fan cause I can't see their faces. And also it can be kind of a vulnerable position. Basically if you just palpate, if you find the ischial tuberosity, you know about where the anal sphincters are. Okay. There's normal human variation. So I always say move slow and make sure you're asking for feedback. But you know, mid line is where the sphincters are going to be. We're not going midline. So you just kind of find that ischial tuberosity and palpate your way around to the medial part of it. And that's where the pelvic floor attaches. So then you can kind of talk them through, like I'd like you to squeeze and there's a bunch of different cues.

Sarah Haag:                  11:22                One of the most common cues, especially for the back end, is to like squeeze. Like you don't want to pass gas and that's awesome. But if you're a main problem with urinary incontinence, that's the back side, back side, not the front side. So how do we get it up there? So another cue that has been found to be very helpful, it's only been studied in men, but it is, shorten your penis. But what's interesting is ladies, I know we don't have them, right? Imagine that feeling, right? So like just imagine like pulling in, right? It totally changed where hopefully if this is a class, it would have asked where did you feel it? But like it, it changes it from the back and biases it towards the front of it. So find a cue that gets them to go, oh my God, I felt something.

Sarah Haag:                  12:07                You're like, awesome. So if you're doing a Kegel and like this happens, you're probably not doing it right. If that's happening, you're probably not doing right. But if like I'm Kegeling now and then I let go, you shouldn't have seen me get taller or tensor or breathe funny. It should be very sneaky. So as you're palpating on the medial side of the ischial tuberosities your feeling for those muscles to contract. So it's kind of like a gentle bulge and you can totally feel this on yourself here if you're comfy or somewhere else. But when you feel it, it's almost like when you're feeling like if you have your biceps slightly bent and you kind of like contract and you feel at tensioning and like a little bit of a bulge, that's what you're feeling for.

Sarah Haag:                  12:51                Okay but it can always be tricky cause I use the word bulge. Some people will have people push down. So we should also be able to like relax your pelvic floor and push down, like having a bowel movement. That shouldn't happen when you're trying to contract. So like when I say bulge, you should feel like a gathering of the muscle. That's what you're feeling. If you feel your fingers get pushed down in a way they're doing the opposite of a contraction. So there they're relaxing.  It would kind of depend on what they were doing and the cues you were giving. So it could just be like, I'm pushing down like doing a Valsalva. But it is basically a lengthening into the pelvic floor. I don't know if it's always a relaxation, so to speak.

Karen Litzy:                   13:33                It's kind of lengthening. And what is the difference between that Valsalva or lengthening and that small bulge? Like why is that significant?

Sarah Haag:                                          When you feel it, you'll know it's significant because if they're pushing down in a way that's not a contraction. So if you're going for strengthening or more closure to hold things in, yeah, you want that kind of like tensioning and bulge. But if you're actually the problems, constipation, I can't get things out, you want them to be able to relax and link them.

Karen Litzy:                                           Got It. Okay. All right. So now we know how we can kind of feel our pelvic floor muscles without having to do an internal exam. So once you figure out, and kind of what you said sort of leads right into the next question is if you have someone that's coming in with incontinence and you are looking for that sort of tightening or gathering up of the muscle, which I think that's a nice cue for people to understand because bulge can sometimes be a little confusing for people, but I liked the cue you're feeling the gathering of that musculature.

Karen Litzy:                   14:45                Is that something that you are then going to add into a home exercise program or like once you find that the pelvic floor muscles working or it's not working, what next? What do you do?

Sarah Haag:                                          Well, so I'll be honest. It's always I like him and people are brave enough and the patients were brave enough to be like, sure you can have a feel like let's figure this muscle thing out. I usually try it in a normal active kid in a normal setting. So not a public one. No pelvic settings are normal too. But in like just a normal like say outpatient therapy, be it or orthopedics or neuro, I would actually have them ask more questions about incontinence before even checking the pelvic floor muscles. Because the different types of incontinence are going to kind of tell you a little bit more about what you should do.

Sarah Haag:                  15:35                So some people have incontinence when they tried to go from sit to stand or when they cough or when they go running. So I want to know a little bit more about when is it happening because if it's only ever when you're putting your key in the front door or when you're running into the bathroom, that's more urgent continence. Would pelvic floor muscle exercises help? Maybe, but also probably looking at their overall bladder health, which is where a voiding log would come in very handy. And actually a shout out to the home health section and they have an incontinence urinary incontinence toolkit. It's free for members for sure, but I think it might be free for everyone.

Sarah Haag:                  16:15                So it's a pdf that actually talks you through the different types of incontinence because the most common form of incontinence urge incontinence, which is you're an urge incontinence is proceeded by a strong urge to go. So this is one of those things where, so there's a bathroom at the end of the hall. So if you're like, I'm totally fine, but then your eyes wander, you're like, oh, I could go and I didn't have to go. And then I would get up to go and I got to the bathroom and all of a sudden it's like, oh, where did that come from? Like all of a sudden it felt like your kidneys did a big dump, but they don't, that's not how kidneys work.

Sarah Haag:                  16:59                It's just how it feels to you. So what that really is, is your detrusor muscle kind of going, I'm so excited. I imagine a puppy, like have you ever like gone to let a puppy out the door? Like, so they're like, hey, I want to go out and you get up and you make a move for that door. And they're like so excited. Your bladder is like that sometimes. So that's more of a behavioral thing because what would you do with the puppy who's now like, wait, every time I do this, she lets me out. Pretty soon you're letting that puppy out every 10 minutes because yeah, because that's what the puppy trains you to do. So that's kind of more of a behavioral thing. And so that's proceeded by a strong urge. So it's not just when you're going to the bathroom, but if you get a strong, unexpected urge and leak, and that's usually a lot of people also experience some urgency and frequency.

Karen Litzy:                                           So if you feel like you're not getting to the bathroom in time, what would be a really logical plan to that?

Sarah Haag:                  17:52                You'd go more often, you're like, Ooh, maybe I need to not wait so long. But the thing is that then you're training yourself to go more often, your bladder is perfectly capable of holding more that kind of sensitivity and those signals you're interpreting or like, ah, no, I should go now. And then pretty soon you're that person who can't make it through a movie. You're that person who can't make it past a bathroom without needing to go. And you're the person that no one wants to go on a road trip with because you're stopping every like hour on the hour and every rest stop. But now is that because your brain is interpreting this as such? I know that there's a physical manifestation obviously, but is that like have you trained your brain and to feel that way to interpret that as such? I would say yes because most of the time, even if it wasn't intentional, like it's kind of like a slippery slope. It's like I almost didn't make it that one time. I'm going to plan ahead. And then what starts to happen, especially if you're like, all right,

Sarah Haag:                  18:54                your bladder is filling up. You kind of feel like you need to go and you go to the bathroom and it came out and it's like, all right, so that was nice and normal. But then imagine that time where you're like, hold on, I almost didn't make it, but you were stretched this much. You're going to start going when the bladder stretches this much. And then pretty soon if you let it so you're like, Ooh, now I'm going down here. Now I need to go sooner. And this is one way you can tell this is happening. And it can happen sometimes without ending up with a diagnosis of urgency, frequency or incontinence. But where you get to the bathroom and you feel like you've got a goal, but then nothing happened. Goals, like it's the smallest tinkle and you're like, I thought it wasn't gonna make it, but that's ah, that's all that's in there. And so that was like big urge little output. That's kind of a mismatch. And that'll happen sometimes.

Sarah Haag:                  19:48                But like if you're paying less than that, that's not much more than your poster board then a nice healthy post void residual. So you don't have to empty at that point if you're bladder’s saying, empty me now. And that's all that's in there. Yeah. So it's kind of like you're the sensitivity of your bladder has turned way up. Just like how we would compare that to the pain. So the sensitivity is turned way up so that it takes less of a stimulus in the bladder itself to trigger that feeling of you have to go, even though the bladder is barely full.

Sarah Haag:                                          And there's actually some interesting conversations with urgency and frequency in that feeling of extreme urge, can that be considered a pain? And so it's kind of interesting conversation because there is normal, there is a normal sensitivity of normal urge, but when that urge becomes pathological, yeah.

Sarah Haag:                  20:47                Too bothersome. Does that crossover into it? Distressing emotional experience? I would think so. Like can you imagine if you're like on a train or something like that and you have to really, really, you have, you're having that urge. I mean, that's very distressing dressing. That's very distressing. That's like you're suffering. So if you have someone like that what do we have them do? So they keep a diary, which you can get on the home health section and we'll have a link to that in the show notes. You basically ask them to keep track of things for a couple of days. I tend to keep it simple with what are you drinking and when and when, when are you going to the bathroom? If people are willing to measure, that's the best, but not many people are willing to measure.

Sarah Haag:                  21:37                So what I try to have them do is to kind of come up with their own plan. And I tell them this is not an exact science because you're not measuring, but that's okay because if you have a strong urge, which is kind of a lot, but you have like a little tinkle, that's kind of a mismatch. If that only happens after your third Mimosa, okay, that might actually be like a normal bladder thing. Do you know what I mean? So we kind of look at things that they're bringing in that may or may not be irritating to them. We look at are they getting enough fluid and bladder loves, loves water. But the first thing most people cut out if they're having urgency, frequency or incontinence is water is they cut out their water. It'll almost always backfires.

Sarah Haag:                  22:19                So don't do that anyone watching. It also makes you constipated, which you can increase your urgency and frequency. So, so yeah, so surprise. Everything needs to work well to work well. Okay. But yeah, so you kind of look at that and I just look for patterns and then I have people try to change one thing at a time. If all you're drinking his coffee all day, but actually you have good data, good parts of your day and bad parts of the day. Is it the coffee? Because if you're drinking coffee all day, you're probably not going to be very nice to me if I say, how about you stopped drinking coffee? Um, emotional response up. So you just kind of look at it. It's like, Oh, when does this happen? What do we need to change? And it can really help you narrow down. Is it really urge incontinence? Is it actually just frequency and they're not leaking like they thought they were or you know, is this primarily a stress incontinence issue?

Karen Litzy:                                           Well, so it sounds to me like there's not a lot of hands on work there.

Sarah Haag:                                          No, no, it's more behavioral.

Susan:                          23:27                Do you ever use pelvic tilting to get the posterior versus anterior pelvic floor?

Sarah Haag:                                          So that's a neat work with from Paul Hodges Group. So however you're sitting, most of us are Slouchy, just do a pelvic floor contraction, however your brain tells you to do that, do it and just feel where you feel it. But then if you get yourself in a situation where you like get more of that Lumbar Lordosis, and so like you stick your tail out, you get more lumber lordosis and then you do the exact same thing. So you're not changing your cue. For most people it's cuts to the front. And it's kind of neat because one of the things, one of my pet peeves is when we were talking about earlier is my pelvic floor therapist get tunnel vision and are just doing pelvic floor exercises, but not reintegrating it into how they're, they're using their body.

Sarah Haag:                  24:18                So if you have a runner who's a chronic but Tucker and she's leaking out of the front, obviously, how would it feel if you like got those glutes back a little bit? Because you can't run and Kegel at the same time. You can't, you can try. It's not going to go well. And certainly not for like a 5K and let alone not a marathon. So changing how that is biased because most of us don't think about the pelvic floor until you have a problem, right? But they've been working, right? They've been doing their thing. You're using them when you walk up those stairs you're using them when you're getting up off the floor. So they do something, the key goal is like your bicep curl. You want a stronger bicep, you're going to do some curls, you want a stronger pelvic floor, you're going to have to do some pelvic floor exercises.

Sarah Haag:                  25:07                But that's not your management plan. You kind of want to, someone said it yesterday, kind of like the core muscles are there like automatic, like when you get ready to do something you don't think, okay transversus were good. Like it just all happens and you want to kind of get the pelvic floor back into that system and make sure it's strong enough and coordinated enough to do its part. So you don't think about it.

Dave:                            25:37                So along those lines then, would you say that if somebody is more lordotic, they're more likely to engage the anterior floor and then flat back more of the posterior floor?

Sarah Haag:                  25:47                That tends to be what they're finding on like EMG studies and what I will see clinically with people if they do a ginormous buttock. It’s really interesting if you're like, how's your breathing when you do that and, and how good is your squat, let's say when you do that. And it's like, Eh, it is what it is. I'm like, okay, so what if we do kind of take it into where some people, especially if they've been told by other practitioners to like watch your Lordosis, it's kind of huge. Which isn't really a thing. But you know, they kind of, they're kind of like going in there, they're like, I'm so scared but it kind of feels good and then you have them do that movement or try that exercise. Usually they're like, that was way easier than I thought it was going to be.

Sarah Haag:                  26:30                But again, if it's not working, then we try something else cause everyone's anatomy is different. Sometimes if they have a lumbar issue, getting into the ideal position for their pelvic floor, may or may not be easy for them, at least at first. But I think you need to play around with how it feels and how it's functioning as opposed to, I mean, I've been guilty of it in my career of like, ah, you need more or less of what you're doing with your spine and were just different. So it's where it works best is where it should be.

Jamie:                          27:03                So for a lot of the outpatient conditions and orthopedic setting, there's still an emphasis on giving some kind of qualitative documentation to the muscle contraction, whether it's a manual muscle test or something like that for payment purposes. So what are some strategies or tips for clinicians to be able to take that palpation externally and then relate that into their strengthening documentation?

Sarah Haag:                  27:29                So if you're just checking externally, like just palpating outside, it's like a plus minus like, Yup, I felt it. Uh, they couldn't find it. So kind of plus minus, cause you can't give it more than that. We also have to remember, so when I write about pelvic floor strength in my documentation, I have a number I can put and you can grade it. You have to do that internally, which is why if you're like, ah, we need to know more, refer him to a friend or go to the training. But I usually give a lot more information. So like, all right, so they, you know, they had like a three out of four, three out of five squeeze. The relaxation was not very coordinated and kind of slow, but then their subsequent contractions were five out of five.

Sarah Haag:                  28:09                All right. Do you know what I mean? We have to, because of payment and insurance and all of those things, we have to write something down. So what I do is I write down what I find and I'm happy to talk about it. So if you want to deny it, I can talk vagina all day with you. And I have, and their questions usually get shorter and shorter. Um, because really they're asking for information that isn't necessarily the most helpful. So if you're checking an externally plus minus, but also I've had people who five out of five but still incontinent,

Sarah Haag:                  28:41                So then they're like, well they're not weak but you put down, you're going to do strengthening. I'm like, well yeah, because it's more of a strengthening, not just a strengthening with a functional goal attached to that, if that makes sense. So sometimes it's more words, but don't be shy about one. Well, first of all, please be honest, be as accurate as you can be, but also don't be shy about doing the best care and be willing to stand up for it. If it gets denied. It's not cause you gave crappy care likely. I mean, do you know what I mean? I'm like, I dunno how long you practice, hopefully. Good. But if you get denied, it's not necessarily key because you gave bad care or even did a bad note. It's because they decided they weren't going to pay based on something. Hopefully logical that you can talk about. You can always appeal. So don't let payments scare you away from giving the best care.

Sarah Haag:                  29:36                Sorry. Another soapbox of mine.  So that was urge incontinence. Stress Incontinence.

Karen Litzy:                                           So let's talk about that because I think that gets the more airtime, so to speak. So that's when you see the crossfitters are the weightlifters or there's a great gymnast pitcher yesterday going backwards where you there backwards over the pommel horse, not the pommel horse. It's the worse just a horse. A spurt. Like it was, yeah. And you're just like, that could be photo shopped, but also it probably isn't. Yeah. Or like we've all seen like the crossfit videos where women are peeing and then everyone high fives them because they worked so hard that they peed, which, you know, not normal. We know that that's been addressed by a lot of a pelvic health physical therapists.

Karen Litzy:                   30:32                So I would like to know first I think we just gave the definition of stress incontinence, but I'll have you give the definition quickly. But then I'd like to go back to something that the question that Dave had asked about the positioning and how that works within weightlifting or within, you know, waited or loaded movements. But go ahead and give the definition of stress incontinence first.

Sarah Haag:                                          So stress incontinence is basically when there's an increase in intrabdominal pressure that is greater than the closure of pressure of the urethra. And you have some sphincters as well as the pelvic floor helping keep all of that closed. But if you increase the pressure enough on the insides, and that's why you hear, and again, it's primarily women, but also a lot of men after prostate surgery, they cough and you get a spurt or you know, you jump and you feel it come out.

Sarah Haag:                  31:21                Those are usually because the closer pressure has gone down or the intra abdominal pressure has gone up.

Karen Litzy:                                           Okay, great. So now what does that look like? For the average physical therapist who's not a pelvic health therapist. And let's say they are seeing someone for hip pain and you ask them, are you ever incontinent? Or if they are, you know, heavy lifters are, they are adding load and they say, oh yeah, but that's normal. Or they have low back pain and they say, yeah, but that's normal. Everybody does it at my crossfit box or whatever at my gym. So how do you then, if you're not you, you are someone who's not a pelvic health therapist, how do you address that?

Sarah Haag:                                          Well, first of all, what all of us should know while incontinence is super common, it is not normal.

Sarah Haag:                  32:16                Not ever being dry is normal. So we need to get away from this idea that like, well, everyone's doing it. It's like does that make you want to do it? Like I feel like, no, I feel like no is the answer. So first of all, just, and sometimes they don't know that. Like, I know that in some like young girl gymnastic teams, like the color of their leotards are chosen to like, not show the pee because they're incontinent that young. Yeah. And I see a lot of women as adults sometimes before they've had babies sometimes after, right? So like what's the, what came first? But they've had lifelong issues with what's essentially public flourish. She's with incontinence, sometimes pain with intercourse, all of those things. Competitive gymnasts, competitive cheerleaders. Dancers tend to be probably the biggest, runners or another group.

Sarah Haag:                  33:12                There's been some studies, there's one study and I cannot recall it. I mean, it's probably like 15 years old now. We're 100% of this division one female track team reported urinary symptoms. 100%. Like every girl. So common. Heck yeah. Normal. So many girls. Yeah. So the biggest thing if you're not a pelvic floor therapist is to check out their function. So if they can identify when they're having issues, it's when I get to this particular weight or it's when I get to mile 17. Okay. And I usually throw in, like if I ran 17 miles, I'm not really sure what my body would do. Like I dunno, but it still shouldn't leak. But if you can find out where that breakdown in the coordination in the endurance and the strength and whatever it is happens and look at what's happening there.

Sarah Haag:                  34:04                Because if you can run 17 miles or you can lift 200 pounds without leaking, but then you do, you're not, you're not weak. Right? Like if you can do all of that, something's happening there to make this happen. Cause if you can lift 200 pounds in that league, something's working, it's just not still working when you try to live 210. Okay. So let, let's look at what's changing or number of repetitions. Right? That’s what you're looking at.

Sarah Haag:                  34:52                So if you collapse your chest and which I would probably do after running 17 miles and I'm like this. And now what happens when I collapse what happens to my bottom half when I collapsed my shoulders? Well my butt just tucked. Cause I'm just trying to get through now. The funny thing is the breathing is also harder. So while I'm doing this as kind of a mechanism to keep going, it's harder to breathe because nothing's working diaphragm to have a full excursion, right? Yeah. So, so I like to look at if you're running fine for 17 miles, I want to see you at mile 16. I want to see what's changing over that mile. I want to see what you looked through my team. And can you, when you start to get to that point, can you make an effort to change something?

Sarah Haag:                  35:32                Do you notice a change in your breathing when you're lifting 210 instead of 200 and kind of look at it from that way cause you're not going to kegel why you do that. What do you mean? Oh well say to like precontract and prime and all these things and, and that's fine, but it's like if we go back to the running, you're not kegeling and all that time your pelvic floor after like 30 seconds is like, dude, you don't want me to get that tired. Like it's going to be like, we're going to stop that now. So yeah. So the way I would approach that, if you're not me, yes and not going to do a vaginal exam, is you look at their performance. So if they said, I have knee pain when I do this, when I go from 200 to 210, they're my squat.

Sarah Haag:                  36:13                How they do, they're looking at the mechanics. You would look at what's happening, what is different? Cause you know, the joint can do it, you know, the muscles can do it. What's changing. And you would address that. So it’s really no different if they can tell when they're leaking, you're just looking what can, what are the things that can change it? Usually the tail lift and looking at their breathing or two really easy ways to go about it.

Karen Litzy:                                           Okay. All right. That's great. And, and, and that goes with that. Does that also work with, let's say instead of you're not a runner weightlifter, but you’re like a new mom or something like that and you're okay, but then by the end of the day after you've been maybe lifting the baby or you know, doing whatever you're doing it, it doesn't necessarily have to be sport related is what I'm saying.

Sarah Haag:                  37:06                I think about like function, but definitely, I mean, you asked about, but no, just everyday if getting out of a chair makes you leak, that's, but then it's basically a squat. So you are, you're looking at the activity that they're having difficulty with and making small changes got in most cases.

Karen Litzy:                                           So I think the biggest takeaway here for me is that not everything is solved by doing a kegel.

Sarah Haag:                                          I think a lot of non pelvic health PT’s may have that, that misconception that if someone has incontinence, well Kegel time. Right? And that's all you gotta do. That's what most people do. If they go to the doctor and they mentioned it's like, ah, you know, that's pretty normal. It's not, it's common. And then they'll be like, do some kegels and, and a lot of women and men don't know how to do them.

Sarah Haag:                  37:53                So then they're just, I'm squeezing stuff and it didn't work. And it's like, Oh, before we get too far, can we check and see how you're doing them? And I think that's kind of a beautiful segway. So let's say you have your new mom or you have your athlete or whatever and you are, you've tried some stuff, right? Cause none of this is life or death, right? I mean it's fine to try some things. So already not doing anything about it. So trying to change up a couple of things is perfectly within your purview, especially again, you're seeing them for hip or low back. It all, it's all together. You're good. But if it's not changing, if it's not getting better, if when you ask them, you know, can you contract your pelvic floor, what do you feel? They're like, I got no idea.

Sarah Haag:                  38:33                And they're like, but please also don't touch me there. Or are you touching there and you're like, yeah, I don't feel anything either. And I've used all my cards but I don't know what to do. That's when you refer. Because just like any other things, somebody coming to see you as a physical therapist, you're going to do some things. And if those things are not working or they're getting worse, you're going to try something different. Or call the doctor or refer to a friend. Right? So if you change some things and you're like, I'm amazing, they're all better. Awesome. Do they need to go to pelvic floor therapy? I'd say no if their incontinence resolves or their pain resolves. But sometimes with especially we see it a lot more in I would say the more active athletic population is a pelvic floor that's more like this.

Sarah Haag:                  39:19                So it's like tight and there's a hundred people call it hypertonic or high tone or short pelvic floor and all these things and basically in my brain, the way I categorize it is like you should be able to contract your pelvic floor and you should be able to let it go. And we can all get better at that. But if you're like, I'm here, how good is my contraction going to be? Because I'm not showing you my pelvic floor. Like it's not going to, it's going to taste like it's going to not move very much. But if you get them to relax more or they're like, oh, I didn't know that was there, that's better. Then you all of a sudden you have a good contraction.

Karen Litzy:                                           How do they relax? Do you just say relax?

Sarah Haag:                  40:01                Before somebody tells him to relax, the worst thing to do is be like, can you just relax? So I try to have them feel the difference between contracting and not contracting. Because what will happen and people use what the traps all the time is like. So like, ah, so much tension. All right. Again, telling you to relax your shoulders. Things I didn't think of that. But if you squeeze and let go like as a little bit of like, Oh, I feel that, oh, oh there's some more space there. So I start with that. Okay. The pelvic floor. But again, if they're like, I just don't know, that's something that is so easy to feel with a vaginal or rectal exam. So that's where it's like, ah, you're having some trouble. I would recommend, would you see my friend for one visit have this exam, they're checking out your muscles and just see if he can feel that relaxation and then come up with like cueing or a plan that works for them.

Sarah Haag:                  40:54                Cause it's not just about like slacking everything out. It's really feeling that that relaxation, that lengthening of the muscles there and being intentional about it. You don't want to lie there would hope like maybe it'll let go at some point.

Audience member:                               So you talked about kegeling and what about dosage or prescription and quality versus quantity and how you prescribe that to your patient.

Sarah Haag:                                          There is no hard and fast rule as to like how many, how much. So that's where, again, I would have them do some and see how the coordination goes. Cause if they're otherwise neurologically intact and they're kind of getting it, how many do they need to do?

Sarah Haag:                  41:57                I would say it's not unreasonable to go kind of basic strength and conditioning principles of, you know, like I know eight to 12 reps three times a day. That's an okay starting point. And actually, I don't know if you know this, so I'm writing a book on incontinence and the PT people have it, but it's the editor just asked me, she's like, well, since we don't have like a hard and fast number, do we, should we put that in there? And I said, I think we do. So that's a good starting point. Not everyone would be able to do that right off the bat, but also some people be able to do that and they're not getting better. So it's kind of like let's start here and see what happens. And then you can kind of titrate it up and down. If I do an exam on somebody and they can't contract for 10 seconds, they can only contract for five, I'm not going to have them contract for 10 seconds at home. I would probably honestly in that case, have them go, I need you to make sure you can feel the good contraction. So you actually also asked about quantity and quality. I want quality, because all of us can do 100 crappy ones. I'm not sure how much it would help. So really looking to be like, okay, so I feel that contraction and I'm breathing

Sarah Haag:                  43:10                and I usually actually have stopped counting seconds. I've had people go by breath, so if you, let's do it. We're going to squeeze our pelvic floors and you're just going to keep squeezing as you breathe in and breathe out normally. Nothing, nothing fancy. And then keep squeezing while you breathe in and breathe out and let go. And what I hope you felt was a squeeze to start with maintaining the squeeze. Some people will feel kind of like a little, a little wave as they breathe, which is not unusual. But then when you stop the breathing and you let go, you should feel that let go. So if you didn't feel that, let go. I usually say that's one of two things without feeling right. I can't tell without feeling is that you got tired and you lost it or you forgot to let go.

Sarah Haag:                  43:51                So that's okay. Have a wiggle reset and try again. Because if you're not feeling the contraction, what are you doing? Like you might as well take a walk because then you'll actually be using your pelvic floor. I like going with the breath because a lot of people like to hold their breath when they're like, they'll do like they'll just suck at it and it, you'll feel a lift, but it's just a vacuum. It's not really your muscles doing their thing. So by doing the breathing, if you breathe in and out twice nice and slow, it's 10 seconds. You don't have to count. So if I have you do four of those, you just have to like count on fingers, two breaths come and arrest for two breaths. So much easier to keep track of. And then people actually do them. Cause if I could tell them to do ten second holds, one, two, three, four, five, six, nine, done. And that's not really helpful either. So like the too slow breaths. Now you're breathing and don't have to count and you're going to stay honest.

Audience member:       44:57                So trying to bring this into the neuro world for someone who's post stroke and has stress incontinence or they've had neural damage of some sort and have stress incontinence, Are there any PNF techniques where you can incorporate the pelvic floor to help with that?

Sarah Haag:                                          I haven't had PNF stuff since college. And I'm old. So what I would say is, is if I'm recalling that they go through movement patterns and as you're doing those things, there are things will be happening on the pelvic floor. It seems to make sense. What specifically, I don't know, but if you're kind of working more with that tone in general, I've only had a couple of patients come see me like post CVA and feeling their pelvic floors is amazing because while it makes perfect sense that one side might be like hypertonic are nonfunctioning until you feel it.

Sarah Haag:                  45:49                It's like, wow, that's so cool. Like once I totally normal springy, they can contract and relax the other side just like they're, they're hemiparetic arm. It's cool. With stuff like CVA or neurological involvement, you really want to make sure you're on board with the physicians and you know that bladder function is still intact because depending on where the stroke is and what exactly happened or where the spinal cord injury is, you don't want to mess around with screwing up the bladder or the kidneys. So if they're not going to the bathroom or they're only leaking during transfers, that could be stress incontinence or it could be overflow incontinence because their bladder is so distended with the effort. So that's something you would really want to make sure you talk with their nurse or their attending physician and make sure, so how are things working?

Sarah Haag:                  46:38                Because the other thing we need to remember is a lot of things we're still working on people who have had neurological insults, right? So once you're like, okay, bladder is relaxing as it fills, contracting, as it empties, it's emptied fine. We're not worried about this being overflow incontinence. I would actually start to incorporate stuff like blow before you go. Where you're managing it the same way you would for someone not having a stroke, but half of that, the beam continent and actually going to the bathroom it seems, I can make it sound very simple, but I have a slide and of course that I teach where it has all the like the tracks up to the brain and all the tracks who, the spinal cord to the bladder. But we got the sphincters, we got the detrusor, all of this stuff just happens.

Sarah Haag:                  47:25                And when I click the slide from this beautiful simple picture, it's just font about this big, explaining all of the complex things that are happening so far as we know. So again, as long as they're, bladder is functioning on that basic level where it knows when to empty and it can empty, I would treat him like a anyone else and not assume that it's just because of a high tone pelvic floor on that one side. That's the issue. But if you get that person and you do your PNF, please tell me what happens. And if it changes their incontinence, I would really like to know.

Karen Litzy:                                           And when you're looking at the bladder function, that is something the physician is doing through an ultrasound, is that how that works? How did they do that?

Sarah Haag:                                          They can do it through an ultrasound so that that they are, they can look mostly at like post void residual.

Sarah Haag:                  48:12                But then also there's a test called neuro dynamics. And this is a test that involves, a catheter and there you're a threat. And then a probe and another orifice down there to help measure for intra abdominal pressure. And it's kind of a neat test. If someone wanted to do it on me for free, I would probably do it. But they're also looking at an EMG the whole time. So they start to fill up your bladder was sailing so you know how much is in there and you're awake for this test because they go tell us when you, when you feel the first urge to go and they mark where that is. And so you can see how much fluid is in there. And I'm like, tell us when you get like the, I should go to the bathroom now urge. And they mark that and then they're like, okay, tell us when you can't take it anymore.

Sarah Haag:                  49:00                And they mark that. So then they know how much your bladder can truly hold. But also looking at what's your detrusor doing, which is the smooth muscle around your bladder, what's happening to your pelvic floor, where is the weakness? And usually when they're full, sometimes they'll have people cough to see if anything leaks or if any sphincters happen or sphincters what they're up to. But it's, it's involved. But there's a lot of good information. And interesting side note is that if you do so, that's really I think really helpful for like a neurologic population just to make sure. I did have one patient I was lucky enough to work with a PT who became a physiatrist who specialized in neurogenic bowel and bladder and she let me come down to watch  urodynamics of one of my patients who was really against cathing.

Sarah Haag:                  49:46                He didn't want to cath. So she came down, she brought him down to the urodynamics and as it and cause he's like, I am voiding 400 to 600 milliliters every time I have a bowel movement. And like that's pretty good. I mean like most are four to 600 CCS and turns out it was only under very high pressure. He was already getting reflects into his kidneys and after he voided four to 600 CC's, he still had four to 600 left, which is too much. So even though he was having some output, that was the test that really made it clear to him like, oh, it's coming out, but it's not healthy. Like I need to cath.

Jamie:                          50:41                What are some of the considerations that you might go through in your thought process when you're dealing with a male versus a female pelvic pain or incontinence issue?

Sarah Haag:                  50:53                That's a lot. I could talk for days on that. Well I'm not sure. When you're talking about considerations. We need to take into consideration our patient preference and what they're comfortable with. We can tell when our patients are uncomfortable or we should be able to but then kind of try to work out, they might not want to talk to me about this, but who can I get that they would, cause a lot of people would assume that men aren't really comfortable talking to females. But a lot of the men who come to see me, just want help, and we've had several male students come through and you know, they run into like women not wanting a male therapist to do it.

Sarah Haag:                  51:36                It's just finding that, right? Just like any other body part, finding the right person to help. But then if we go to, you know, bringing up those subjects, I don't know that in my brain it's so, so different. Male to female, you're going to take into consideration their history for sure. I feel happy saying that because now with we have kind of like a gender spectrum, right? We have people who, who have transitioned in varying degrees and we have people who haven't transitioned but totally identify with the gender. They weren't assigned at birth and all of these things. So basically I take it functional. So can you just walk me through the issues you're having, your questions, concerns when it's a problem, if anything makes it better, does anything in particular make it worse? And then we problem solve from there?

Sarah Haag:                  52:26                So I guess I didn't really have a good, a good answer, man. Male to female. Their situations are usually different, but it's kind of different across one gender or the other. Anyway. Is that kind of answer it? Yeah. Great question.

Karen Litzy:                                           Well, thank you so much. Thank you. I think we covered a lot and I thank you guys for being here and I hope that you guys got a lot out of this and can kind of take this back to your patients now. So last question that I ask everyone and it's so knowing where you are now in your life and your career, what advice would you give to yourself as a new Grad?

Sarah Haag:                                          Ask more questions. To be honest on, I came out of school pretty much like, like the teachers know best and what I learned is right.

Sarah Haag:                  53:16                And then when you get into the real world, I ended up thinking I was not very good at my job for awhile because like you would do what you were taught to do but it wouldn't work. And then, you know, some things happen and I got older and more comfortable and when you start asking questions you realize there isn't one answer. So if you start asking those questions, you're part of, you're part of the solution. By kind of pushing those boundaries and not like, I wish I would've just asked more questions sooner. I'd be so much smarter than I am now.

Karen Litzy:                                           Where can people find you on social media if they want to get in touch with you?

Sarah Haag:                                          Sarah Haig, PT on Twitter, you can find me on my website, and um, I mean Facebook, Sarah Hague.

Sarah Haag:                  54:07                I don't know what my picture looks like right now, but I'm friends with Karen, so if it says I'm friends with Karen, that's probably me.

Karen Litzy:                                           Awesome. And just so that everyone knows a lot of this stuff that Sarah spoke about, we will have links to it. We'll have links to the home health section. We'll have links to the testing, the urogenic testing. Is that neurodynamic testing? You could just send me a link or something about it. So we'll have it all in the show notes. Thanks everyone for watching the live. We appreciate it and everybody, thanks for listening. Have a great couple of days. Stay healthy, wealthy, and smart.




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Feb 7, 2019

On this episode of the Healthy Wealthy and Smart Podcast, I welcome Jazz Biancci on the show to discuss the power of tuning in to your body.  Jazz Biancci, CAPP, founder and creator of The Consciousness Project 2020, is an Author, Speaker and Channel, helping people access their invisible influences to discover what they don’t know they don’t know, to have a greater impact in the world.

In this episode, we discuss:

-The importance of tuning in to your body’s awareness and emotions

-How to live with more integrity during your daily interactions

-Why you should shift your inner dialogue towards kindness

-And so much more!



Speakers Who Dare

Jazz Biancci Twitter

Jazz Biancci Website  

Jazz Biancci Facebook


For more information on Jazz:

Jazz Biancci, CAPP, founder and creator of The Consciousness Project 2020, is an Author, Speaker and Channel, helping people access their invisible influences to discover what they don’t know they don’t know, to have a greater impact in the world. Jazz has been a speaker at the Fit, Feminine & Fierce Conference in NYC, the Speaker Salon NYC, and a panelist at Soul Clarity & Abundance Live. She is currently the online host and co-producer of, co-host and producer of Spiraling Inspiration on, producer of Healing & Becoming The Divine Masculine, and producer and moderator of The Summer Series LIVE: Anchoring During Troubled Times, and Conscious Masculinity Part ll: Diving Deeper.

Read the full transcript below:

Karen Litzy:                   00:00                Hey Jazz, welcome to the podcast. I am happy to have you on. And for those of you who have not listened to the podcast before and have not heard me talk about the speaker salon that I was involved in over the summer last year and the mastermind that I continue to be involved in through Trisha Brouk, then you need to go back and listen to some of the episodes I did with Trisha Brouk because that is where Jazz and I met. So we met last summer. We were a part of a small group of this speaker salon. And for me it was a real big shift in mindset in life. And I always credit all of the people in the group, not just Trisha for being the leader of the group, but everyone else in the group, and Jazz was one of them. And so that's how she and I met.

Jazz Biancci:                  00:53                Oh, thank you. That was probably a crossroads in my life. It was definitely a game changer.


Karen Litzy:                                           Yeah, I agree. I, um, it changed my life and all aspects of my life, not just speaking, not just business, but personal confidence, everything. It was just this big, big, yeah, crossroads for me as well. I just absolutely loved it. And Jazz was just this amazing public speaker getting up on stage. Like I was saying, I remember the first time I went, everybody got up on stage. And I was wondering, I'm like, is everyone here a professional speaker?

Karen Litzy:                   01:37                What is this? And I was very, very intimidating, but at the end I think we all definitely got so much out of it. And the support and the love, the community was great. But today jazz is here to talk about the power of being in our body. So Jazz, my first question to you is, what the heck does that mean?

Jazz Biancci:                                          It means fully inhabiting your body to allow to provide some feedback that it's meant to provide. So I believe the body is a biological computer and it plugs us directly in to this energetic grid that lays across all things. And so when we're in our body, our sensory system is at work. And we receive messages. So the language of the body is very different from the language of the mind because there are no words. And so to understand and interpret those messages, it requires us to inhabit our body versus, you know, a lot of people live life from the neck up and it's all logic, linear thinking.

Jazz Biancci:                  02:47                And there's a level of detachment. So when their body has a response to something, a person, a situation, they're slower on the uptake if they even feel it at all. Because we can feel residents, we can feel when something is a no.

Karen Litzy:                                           So is this like an excuse my kind of layman's terminology here. Is this what people would refer to as their gut feeling? Or is this something more?

Jazz Biancci:                                          It's a combination. So there's a, there's a heart intelligence and there's the gut feeling and they all worked together.

Karen Litzy:                                           And how do we tap into this? So I feel like I am certainly hand raised one of those people that's probably more head up or neck up then the rest of your body. I fully admit that I am. So how can we tap into those other parts to the heart, to the gut feelings and how can we do that?

Jazz Biancci:                  03:54                I used to be a linear, logical head person too. And I found my way back into my body as an athlete and a dancer. And I started noticing when I was at the gym and in dance class, how the reach of my arm connected me to my heart. And so a great way to start is just to get physical if you can, and if not to take a moment and just put your hands over your heart in the morning. Take 10 seconds to remind yourself that your heart is not only beating to keep you alive, but it's also feeding you information. And then as you move throughout your day and you're having interactions, notice how you feel when you're ordering your coffee and they call your name. How does it feel? And without judgment, but start to pay attention to your responses to people, to the things you're saying and how it resonates in your body.

Jazz Biancci:                  04:58                Because often people will ask us questions like, uh, do you mind helping me with this? And sometimes the answer is no, but we say maybe because we're being polite and feel how that resonates because that lie resonates much differently than the truth.

Karen Litzy:                                           Interesting. And, and I, I think we've all been in these situations, like you said, someone asks you to do something and you say maybe are you say yes. And I was in a situation a number of years ago where I said yes to something, but it was literally giving me stomach pains and you know, it was making me so anxious because I knew deep down this is not right, but I am a bit of a people pleaser. And so I said yes.  So for those people like me, which I, I think there's a lot of us out there and a lot of the people that listen to this podcast are, you know, we work in healthcare.

Karen Litzy:                   05:57                We want to stay healthy. You want to stay fit. And oftentimes were big givers, right? Because we're, we want to heal people. You know, we want to help people, but then it kind of backfires on ourselves. So what do we do in those situations where someone asks you to do something, you feel it in your gut. It's not, it's literally making you sick, but you say yes anyway.

Jazz Biancci:                                          Well it's, it's baby steps, right? It's a process. So the noticing is a start. Like I used to tell myself, yeah, workout in the morning. I am not a morning person. I have never been a morning person. And so starting to notice how that felt in my body, whether I was able to change it or stop saying, oh I'm going to work out in the morning. It was a different story. So we start by noticing how it feels and then we start asking ourselves, well, why did I say yes?

Jazz Biancci:                  07:05                So why did I say maybe when I met and start delving into that because it takes a while before we are in grace enough to say, I would really love to help you with that, but my plate is full right now. Can I help you find someone else?

Karen Litzy:                                           That's great. That's a very, very nice way to say no. And the offer of saying, can I help you find someone else or I have someone else in mind I think is a great way to, from the people pleaser standpoint, again, I'm going to be selfish and go from the people pleaser stand point that you still feel like you're helping even though you're not the one who can do it.

Jazz Biancci:                                          Exactly. And you're in your heart. Because sometimes when we don't understand how to do something and we're, we're getting our legs about us, we can be short or curt or rude just to try to get that boundary laid down, you know? And we don't have to do that. We can take our time with this process and notice what we're doing when we're doing it, understand why we're doing what we're doing, when we're doing at being graced with that and sit in our hearts and give us an answer that's a win win for everyone.

Karen Litzy:                   08:32                Yeah. So when we're talking about, you know, being in your body, we're, I'm just going to recap the steps because I'm a step person. I'm a checklist person, kind of. So noticing first what's happening in your body. And like you said, it doesn't mean you have to sit and meditate for 20 minutes or 30 minutes. It's just take a moment to remind yourself where you are and how you feel in that moment. And then delve into the, why did I say yes or maybe when it should have been a no, and delving into the why is something that we've been talking about a lot lately on the podcast and that why goes pretty deep. So it's not just why did you do this? Oh, because I didn't want to. And that's the end of the conversation. And then finally being graced with your decision. And then the most important is to come up with a win-win response for everyone. Got It. Well that seems easy.

Jazz Biancci:                  09:38                It does seem easy. The hardest things usually do.

Karen Litzy:                                           That sounds like I've got it down pat now I just have to practice it. And I would assume just like, you know, you were an athlete and a dancer. How many times did you practice certain movements in order to perfect them? Or to feel comfortable with them. Right. So I would assume that this process is just a lot of practice, right?

Jazz Biancci:                                          Ongoing. And it's not about judging ourselves or being mean or shaming ourselves. It's not about that. It's just like, it's a scientific experiment. That's all it is. How can I improve? How can I shift?

Karen Litzy:                                           And so if you're, let's say you're working with a client and you're working with them on this sort of shift, what pieces of advice seems to resonate most with your clients? And again, knowing everyone is different and has a different path, but are there exercises or things that you do with clients that you're like, you know, this is pretty powerful. This is something that seems to work.

Jazz Biancci:                  10:55                I have them keep a journal. First I just do like the tick system. So noticing how many times a day that you lie. Like when you're like counting and you're like putting like marks and then you get to the five and you cross it over. So it's just that easy to start noticing how many times a day you lie. So you have a notebook and you just make a tick or use your notes on your phone and you just put a one Monday, one, two like you just keep adding ticks and you count it up at the end of the day. Because it's fascinating because we lie a lot, this self-deception is astounding and it does no service to anyone when we're out of integrity because that's what that is. We're being inauthentic in a moment because we are taught to be polite before we consider ourselves and we can do both without being disingenuous.

Karen Litzy:                                           So yeah, it'd be like little white lies or maybe, yeah.

Jazz Biancci:                                          Yeah, because it's all about the observation and understanding what kind of situations prompt us to lie. Noticing when we have fear, because fear is huge. If you're afraid of retaliation or punishment, you're prone to lie to get approval.

Jazz Biancci:                  12:40                So it's like noticing those moments that that turn up the volume and then noticing how that makes you feel. Because there is a different way. We just haven't been taught what that way is.

Karen Litzy:                                           So you start, you have people get a journal or like you said on their phone and write down how I'm going to do this because I wonder how many times do I even say a little white lie. I'm going to do this. I would encourage the listeners to do this as well and we'll see what we come up with. It's really fascinating. Yeah, it sounds really, really interesting. So, all right, let's say I do this system for a week and I like five times in a week. What do I do about it? What does that mean? What does that lead to?

Jazz Biancci:                                          Well, it leads to noticing what kind of lies you're telling it to whom, right?

Jazz Biancci:                  13:30                Because they may, they may be the lie that like, hi, how are you today? I'm fine and you're not, you know, and then reconstructing that answer so that it feels right in your body and appropriate for the social situation. So someone may say, hey, how are you? And you could say, well, I'm hanging in there, you know, that's acknowledging what you're feeling without giving too much information.

Karen Litzy:                                           Yeah, because I would think that you can acknowledge it, but giving too much information, people will be like, why is she inappropriate? So you have to kind of know where that line is between, you know, allow like divulging information but then being like, what is wrong with like why is this person saying this in this context at this time?

Jazz Biancci:                                          So you're honoring and acknowledging and being aware of your environment at the same time because the residents of truth and creating the habit of truth for yourself.

Jazz Biancci:                  14:43                As you begin to notice how that frequency vibrates, the way a drop of water into a glass of water does, you see the ripples, you can feel it. And over time it's, it's a purification. It's a gentle way to start the purification process because the body is an incredible instrument. What I found in doing these practices, I know when someone's lying to me because it feels different than truth. And so it's a confidence of knowing that I can rely on myself and my instrument and my body to provide information that I can rely upon because being able to rely on the body because there are no words attached to it, the body doesn't lie. And so those moments I've had moments. I'm sure you have too, that an alarm has gone off within you that you don't necessarily understand. And do you follow? Do you not follow it?

Jazz Biancci:                  15:52                Is your imagination, are you having an anxiety attack? For me it happened in queue boarding an airplane and I've been flying all my life and I was going to Haiti for work. It was my fifth trip to Haiti. I was excited, our whole team was going and we were waiting in queue and all of a sudden something happened in my core and I was terrified and I went to my friend and my coworker and told you, I'm like, I am not getting on this plane. I'm not going. And of course she was like, what are you talking about? We have a job to do. And I'm like, no, something doesn't feel right. And so we went to the director and she's like, you can sit by him and you've heard me speak about this. And I let myself be peer pressured and I wasn't competent in that feeling yet that alarm is one of the first times I felt that.

Jazz Biancci:                  16:48                And so I got on the plane, I was sitting next to the director and I buckled in and I'm like, what am I doing? But I still didn't have the courage to say, I’ve got to get off of this airplane. I sat there. So we take off, there's this huge commotion and the commotion is moving forward. The stewardesses cannot get the situation under control and the plane has to turn around the air marshals come on the plane and escort the situation off the plane. So the grid that we have within us in our hearts, that electromagnetic energy pulse connects to what's going on in our environment. And I was connected to that woman because she was in my environment and it was an alarm going off for me to get off the plane. It was also a great moment to take notice. Okay. So when my body does this, I now have evidence to listen and thank God it was just the air marshals and an escort off the plane.

Karen Litzy:                                           Sure, sure. That's Crazy. And you know, we've all had these, oh, why am I doing this? Why am I doing this? And then oftentimes that feeling ends up being validated somehow. Now through this work, through this, you know, learning how to be in your body, what has that done for you? So what has that done for your life or for your career that you can share?

Jazz Biancci:                  18:34                It allows me to stand in my power and I'm still in awe of it because it's like there's this super power with that we never learned about. No one tells us about that we can fall into by accident. And it's always there. I've always had this ability to be keyed in. And then, you know, you hit puberty and you're a teenager and you're rebellious and you fall away from yourself because you're trying to fit in and then you fall back into yourself somewhere along the line if you're lucky. And so for me, it's really being able to stand in my body, in my strength and know what is right for me. Because when situations happen, the tendency is to go outside of ourselves and have, a caucus about, well, this happened. What should I do? What should I do?

Karen Litzy:                   19:36                You always reach out to our friends or family and say, okay, what do I do now? What do I do? I want to do this, but I don't know if I should do this. So what do you think? What do you think? What do you think? And you know, it's like too many cooks in the kitchen.

Jazz Biancci:                                          It's too many cooks in the kitchen and it pollutes the truth for us. And so being able to be in our power is about being in authenticity and integrity and in truth so that you don't go to outside counsel because the reality is no matter how many angles I give you of a story, they're not going to give you the full picture. You aren't there and you don't know what I feel inside my body. You don't know the energy of the situation and I'm not going to have that much time to go into depth with you.

Jazz Biancci:                  20:22                So it's being able to hold your own counsel and, and stand in that council because everyone's going to have an opinion about that. So whether it's the choice you make in your career or it's a love relationship, there are going to be outside influences that want to put seeds in your ear. But the reality is only you know the truth. Only you have to deal with the consequences of your actions and only you can know what's right for you. And so being in my body and being in my heart and learning to trust this incredible mechanism has allowed me to do that. And it's changed my life cause I'm not wavering or trying to please anyone because even though we don't think we're trying to please anyone. Well we ask for advice. You know there's like, I remember this was really big for me back in 2005 when like sex in the city and and this whole dating thing and no, there was like the whole Mr. Big and it's a cultural thing, right?

Jazz Biancci:                  21:37                So we can think that we're supposed to behave a certain way and believe that that behavior is right and us, it's who we are. I'm a New Yorker. This is what I do when the reality is if you take a moment and you drop into your body, well maybe that isn't how you feel and that doesn't feed what you ultimately want and you're doing a disservice. Are you strong enough to make another decision and then strong enough to stand in it?

Karen Litzy:                                           Yeah. Doing a disservice to yourself.  And that's hard. It is. That's hard to, to make a decision and stand in it and be confident in that decision and confident with your own self and your ideals that this is what is correct. This is what is good for me when, yeah, you have the peanut gallery and either ear telling you otherwise or maybe agreeing or not agreeing or what have you.

Karen Litzy:                   22:36                But that's hard and I feel like I just want to acknowledge how difficult that is.

Jazz Biancci:                                          It is hard, but you know, it gets easier because you share less things with less people, you know? Because I don't really need to ask someone what I should do in my relationship. I know what I need to do in my relationship. I may need to vent, I may need a hug, I may need to pass an idea over with one of my friends. But it allows me to preface to preface the conversation and say, Hey, I would've had something by you and I want to know what you think about this specific point right here. Or I need to vent. So I really don't need any feedback right now. Are you okay with that? It lets us frame how we need people to show up for us because I don't necessarily want everyone's opinion.

Karen Litzy:                   23:41                Yeah, but you want and an ear to listen sometimes

Jazz Biancci:                                          If I know that I have the deli across the street and I want coffee and all I have to do is go across the street and get the coffee and come back, that's much easier. Okay. Then asking the doorman, the person in the elevator, the fire guide, the fire department guy standing outside, I'm the person holding the door for me when I go into the Deli and the Deli person, what kind of coffee I should get. You know this the same way when we have problems, we bounce like a pinball in a pinball machine back and forth. We know what we want to do. We're just trying to get comfortable with it. But if we are in our bodies and in our hearts and we, we feel the resonance because when something doesn't vibrate properly, like when alive vibrates in your body and you have been doing this practice for a while, it feels violent.

Karen Litzy:                   24:51                That's interesting. I'm kind of thinking on your, I love that example of why do I need to ask every person I come in contact with from my apartment to the Deli across the street, what kind of coffee I need to get. And when you say that, anybody would be like, well that's ridiculous. And yet that's what we do with big decisions in our lives, our relationships in our lives is we ask everyone.

Jazz Biancci:                                          We give our authority away when really we know the answers. It's just working that confidence and that trust in ourselves and the best way to work that confidence and that trust is to sit with what's going on and see what resonates, what choices feel right.

Karen Litzy:                   25:43                So it's really taking time out of your day. Not a lot, but working through those steps that we mentioned earlier. And the more you practice it, like we said, the better and perhaps more efficient you will get at tuning into your body and knowing what that feeling is like, because I would assume if you're new to this, that you're not even maybe sure what you should be feeling. Like how do you know what you should be feeling?

Jazz Biancci:                                          You don't because everybody is different. But if you had a friend who lied to you all the time, you couldn't count on them for anything. That's how it feels from the outside. And you would probably not be friends with that person. Once we start to notice how often we lie to ourselves, we realize that we’re that friend, except we can't get away from ourselves.

Karen Litzy:                   26:51                And so you need to be making some changes.

Jazz Biancci:                                          Because you need to trust yourself above all others. The relationship that you have with yourself is the map you take out into the world. And so part of this practice is seeing how it feels. And at first you may feel nothing. At first it's kind of amusing. Uh, it may make you like a little sad like, wow, why did I just do that? I didn't even have to lie in that scenario and I just did it completely unconscious, you know? So it, it helps you in that consciousness as well. So you can start making informed decisions and start listening because sometimes our mouth is on automatic and it's saying things that are completely detached from our truth. It's the talking of Shit.

Karen Litzy:                                           And only until you can kind of be in your body, can you really get a sense that's what you're doing?

Jazz Biancci:                  27:54                Yeah. That sometimes we talk ourselves out of the things we want. We pretend that we want something that we don't want.

Karen Litzy:                                           Yes, absolutely. Absolutely. That happened to me last year. I kept thinking I should do this. Someone told me to do this, I should like it, I should like it. And in the end I was like, this is not for me. And I just changed the entire thing for me like a year to figure that out here to kind of realize, wait a second. Oh, okay. No, I have a little more confidence and I know how I want this to go now I get it.

Jazz Biancci:                                          Yeah. Because you know it's okay to take your time. There's no rush. We think there's a rush, there's no rush ticket where we're going. We have to figure out how we want to do things.

Karen Litzy:                                           Absolutely. And I think that is a great, great piece of advice. And you know, I have one more question to ask is what I ask everyone. But before I do that, is there anything that we missed or anything that you really want the listeners to take away from everything we spoke about?

Jazz Biancci:                  29:10                I would say engaging with curiosity and practicing tenderness with yourself is epic because we're not tinder, especially if you're in New York. It's very, very rare that you get a tenderness, but it starts to allow you to discover more things about yourself because you start integrating and making space for the child within you. And it's really quite magical. I mean, your life can really change with a little bit of tenderness and it starts with you telling yourself the truth and how you do it.

Karen Litzy:                                           Yeah. That's such great advice and something that over this past year I have definitely started to do more of. We were speaking before we went on the air about how we are always like so harsh to ourselves and it got me thinking like I feel like we are the biggest assholes to ourselves. You know what I mean?

Karen Litzy:                   30:30                Like sometimes like you would never be friends with yourself the way you speak to yourself.  We put up with it, but now I can see through the tips that you've given today, how we can change that. That's a big shift for people and I hope that they use some of these techniques and steps to kind of stop being such an asshole to yourself and instead be the friend that you always needed. We should be able to be all of that to ourselves, like you said. So you can kind of stand in your power and know what you need and know what you want in your life. And I realized that doesn't happen in like a week, but it takes as long as it takes. Right?

Jazz Biancci:                                          Well, I mean it's a commitment, right? It's just like any commitment the gym, your career, they're all commitments and they're all a process.

Karen Litzy:                                           100%. And now before we go, I have one more question for you and that is knowing where you are in your life and in your career, what advice would you give to your younger self?

Jazz Biancci:                  31:51                I used to be, so I still am very sensitive, but I would break my own heart. So I would say I would tell my younger self to be less cruel and more kind.

Karen Litzy:                                           And that's great advice. And I think anyone listening to this can take that advice as well. Now Jazz, what do you have coming up in 2019 and where can people find you?

Jazz Biancci:                                          Oh, I'm so excited for 2019. So if you want to hear me speak live, there is speakers who dare, which is March 26 at the triad theater in New York City. It's going to be amazing. Um, they can find me and I'm working with an editor now, so I expect that my book will be out mid-summer, hopefully sooner. Yeah, I'm so excited. I'm so excited. It's been like a lifetime of making this happen. You can always check my website.

Jazz Biancci:                  33:11                I do a conscious masculinity panel the first Wednesday of every month and the panel is amazing. I am so blessed to have such brilliant men participating. So that's on a facebook live and you can find me on facebook at Jazz Biancci, conscious consciousness architect.

Karen Litzy:                                           Jazz. Thank you so much for coming on and sharing all of this good stuff with us.  And everyone, thanks so much for listening. Have a great couple of days and stay healthy, wealthy, and smart.



Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram  and facebook to stay updated on all of the latest!  Show your support for the show by leaving a rating and review on iTunes!


Feb 4, 2019

On this episode of the Healthy Wealthy and Smart Podcast, I welcome Dr. Mohammad Rimawi on the show to discuss foot and ankle health.  Mohammad Z. Rimawi, DPM, AACFAS, brings a wealth of knowledge and expertise to Grand Central Foot Care in Midtown East, Murray Hill, and the surrounding New York City area. As a board-qualified foot, rearfoot, and reconstructive ankle surgeon with specializations in traumatic foot and ankle injuries and complex deformities, he is able to offer his patients top-tier care no matter what problem they bring him.

In this episode, we discuss:

-The anatomy of the foot and ankle

-The most common foot and ankle injuries

-The differences between a high ankle sprain and low ankle sprain

-The importance of the diabetic foot check

-When surgery may be an appropriate intervention

-And so much more!


“If your body says something is wrong, chances are it is.”


“Proprioception is very key for me in the rehab process.”


“Preventive medicine is the best medicine.”


“Establishing ties with other professions is important.”


“The feet can be a window into your overall health.”


For more information on Dr. Rimawi:

Mohammad Z. Rimawi, DPM, AACFAS, brings a wealth of knowledge and expertise to Grand Central Foot Care in Midtown East, Murray Hill, and the surrounding New York City area. As a board-qualified foot, rearfoot, and reconstructive ankle surgeon with specializations in traumatic foot and ankle injuries and complex deformities, he is able to offer his patients top-tier care no matter what problem they bring him.

Dr. Rimawi earned his doctorate from the New York College of Podiatric Medicine, where he made his mark. Not only did he graduate above the 90th percentile of his class and serve as class president for four years, but he was also recognized with the Student Service Award. That award goes to the student voted by the graduating class as making the biggest impact on the field of podiatry. Beyond his peers’ recognition, Dr. Rimawi was inducted into the Pi Delta Honor Society for his achievements in his research and his studies.

With those accolades to his name, Dr. Rimawi continued on to a three-year reconstructive foot and ankle surgery residency at DeKalb Medical Center and Jefferson Health. His colleagues and the hospital staff at the latter named him the Podiatric Resident of the Year.                             

It’s no surprise, then, that Dr. Rimawi is still impressing in his field. He’s a published author and accomplished lecturer, as well as an associate of the American College of Foot and Ankle Surgeons.                                                                                       In the spare time Dr. Rimawi manages to carve out, he loves to read, hike, and root for his favorite sports teams.


Resources discussed on this show:

Grand Central Foot Care Website

Mohammad Rimawi Instagram

Address: Grand Central Footcare

122 E 42nd Street, Rm #2901

Midtown East and Murray Hill

New York, NY 10168

Phone: 212-697-3293


Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram  and facebook to stay updated on all of the latest!  Show your support for the show by leaving a rating and review on iTunes!


Have a great week and stay Healthy Wealthy and Smart! 


Xo Karen