Episode 185: Laura Glazebrook, DPT The Pelvic Floor and Jaw Connection

Hi and welcome to episode 185 of the Untethered podcast. Today we have Dr. Laura Glazebrook joining us. Laura is a pelvic health physical therapist and scoliosis specialist with a special interest in craniofacial development and airway concerns. In both her personal health journey and her clinical experience, she began seeing connections between ENT history, oral tethers and development of scoliosis. She's now collecting data from her patients with scoliosis to determine any trends. Dr. Laura earned her Doctorate of Physical Therapy at the University of North Georgia and began her career specializing in neurological injuries, including spinal cord and brain injuries. She assisted in the development of a groundbreaking bowel and bladder clinic for the Multiple Sclerosis Institute at the shepherd center and works at part of the interdisciplinary treatment team. She's also on her own airway journey, undergoing adult expansion and preparing for her second frenuloplasty and is the proud mom of two tethered kiddos. Quick Disclaimer all information, content and material of this podcast are the opinions of the speakers and is for the informational purpose only and not intended to serve as a substitute for the consultation, diagnosis and or medical treatment of a qualified healthcare provider. Welcome to the Untethered Podcast. I am your host, Hallie Balkan. I'm a certified orofacial myologist, feeding specialist and mentor. This podcast is all about getting your questions answered and collaborating with colleagues to bring you the most up to date information in the orofacial myofunctional therapy, tethered oral tissue and airway space. I challenge you to keep an open mind and join my mission to get this information out to the masses. Let's get started. Laura, welcome to the podcast. I'm excited to dive into our conversation today. Thank you.

I'm so excited to be here.

So I know that we are going to chat about all kinds of fun things today, but I would love for you to start with your experience. Maybe a little bit about your experience history and if you're willing to go into, you know, your son's history and journey, I think it's always fun to dive into like you know, either how you got into this in the first place or what journey you're on now.

Absolutely. I am all in the I'm learning that my whole family probably has airway issues so background on me. My story really started when I was 11 years old. I was diagnosed with scoliosis at I think it was just a well visit. They took me for of course X rays to what is now children's Healthcare of Atlanta, which they have a fantastic orthopedic team. So it's really great. So I did the typical, okay, we'll check in again in six months. And by the time they did that six month scan, they said, holy cow, she needs surgery. If I remember correctly, my parents said that or he said that I had a 57 degree Cobb angle. So as a frame of reference, you know, zero degrees of. And that's like the angle that they measure on The X ray, 0 degrees is normal. Anything over 10 degrees, they send you to an orthopedist. And the current guidelines for scoliosis is anything over 46 degrees is automatically surgical. So yeah, the doctor that saw me said it was. Didn't say it to me, thank God, but to my parents he said, this is one of the quickest progressions I've ever seen. So that's great.

A little nerve wracking for a parent to receive that kind of information, I'm sure.

Oh, absolutely. So I had.

Did you have any like knowledge of like what was going on or like, did you understand like what information they were delivering or you were just kind of, you were too young and.

No, it's. I think that one of the challenges now, like, and I'll get into in a second, but now when I work with my patients with scoliosis, I really feel like knowledge is power and I feel like that's an element that I'm sure in the MYO space as well, that there's not a lot of great education out there for people. So I literally talk all day long and I would rather overeducate than anything, but all I remember is, you know, I don't have a lot of huge memories of, you know, of course I have those memories of the surgery, but I remember being at that appointment with my mother where the doctor told me that we would have to have surgery. And I remember just being this 11 year old kid that wanted to, you know, try to be brave, but I literally like collapsed and wept silently into my mom's lap. Just like, what is this thing? So, yeah, so I had a spinal fusion surgery at 11. I never really had many issues even though I do have a severe curve fast forward. There were some red flags apparently for the fact that I had some airway or oral function issues that kind of, I feel like is related to this whole journey. For instance, I had a really hard time swallowing pills. I needed speech therapy. And this was back in the 90s. They did just the typical articulation. I did a traditional orthodontic expansion of, as far as, to my memory, just the upper jaw. And I think that's going to play into. I don't know how common that is. I don't have much of a history in it, but I remember having a retainer on my upper jaw, but nothing on the lower jaw.

Yeah, that was very common, I think, when we were growing up, because I also only had like, rapid palate expansion on my upper. Nothing on the lower. I think that the belief, and I think some people still are of this belief that the lower jaw will follow the upper jaw. I'm like, I don't really see that happen, but I mean, anyways, I know they're shrinking, right? And it's a whole right hole, but.

Oh, yeah, yeah. James Nestor's book was like a gateway drug for me with this whole thing. It. It just was a confluence with everything that started with my daughter. And I just, I fell into the rabbit hole and I've not made my way back out, but fast forward. So I, you know, grew up with, fine. I did okay. I've had two kids. I became a physical therapist. I started working in, like, the neurologic population. But after my first son, like, I got into pelvic health and just found out how amazingly connected the body is to start, you know, that's when I started learning about this connection between our diaphragm and our pelvic floor and our tmj, like, our jaw muscles and how everything works together. My daughter was born a month into the pandemic. Oh, God, that was so great. And she, she had a lot of issues. Just, you know, really difficult, calming. She wanted to nurse all the time. Luckily, I am blessed to have had the privilege of knowing a fantastic, you know, tots trained lactation consultant. Talked with her. I learned so much about tethered oral tissues and all of that. So that's when I started learning about, oh, wow, like, this is a whole thing. And it talked about how, you know, when the tongue can't rest up there, the vagus nerve isn't activated and so the kid can't calm. And then, of course, she's not eating efficiently and whole thing. So we started her journey with, you know, I've learned bits and pieces along the way. The first provider just clipped the tie and no therapy before or after. Which now is like a physical therapist. I'm like, wow, why did I not think about that?

Well, you know, as new moms also, like, give yourself some grace. Like, not new moms, like you've had other children. But as soon as we have a baby, no matter if it's our first, second, or third, I feel like our therapy brains, like, our professional brains just literally turn off and everything. I feel like I knew. I was like, okay, well, I know my child has a toddler, but the rest just went out the window.

I know. Well, thank you for saying that. I feel like, too, there's such a. Because your nervous system is hyped, right? Because you have this kid that's not sleeping, like, wants to. You know, it's literally screaming all the time. And you're like, anything.

Fight or flight. Yeah. Everyone's in fighter, like, survival mode. So you're really not, like, focused on, like, the clinical side of, like, what can we do in this situation? If I was working with a patient who you're like, no, somebody helps.

Yeah. Yeah. But the good news is I've learned a lot in the meantime. But the. The short story is, my. My daughter has since, like, she did ot. She did craniosacral. She got a second release. She's doing pretty well. Like, she's still nursing at night, which I kind of want to cut out, but at the same time, I'm like, but the oral motor development. And I learned that my son, who is 5, has the same issues, probably all the same ties, but he was just a chiller kid. And so I didn't know. And so he just got supplemented with formula and was fine. Anyway, so I have him in expanders already. He had a tie release. We're in this journey with him. I'm in my own journey, where I started learning that I was starting to have bite changes, more pressure on the right side. Part of that, I chalked up to the scoliosis, but then I was like, this is strange. So. So I started my own airway journey, and that's been a bit of a roller coaster. So. But by listening to. I mean, I love your podcast. I have all of these, like, airway podcasts on my. On my feed. But between that and just all of the mistakes I've made in myself, I have a lot more information. So.

They're our best teachers. They really are. I feel like my own goodness. I. I tell everyone. I'm like, I was doing feeding therapy, and it's so funny. Like, I started in the schools, and it wasn't until I worked. I mean, I did start, and I got, like, thrown right away into, like, working with some very medically complex children in the public schools, but it was. I started working with children on the spectrum, and I Was like, wow, like these. There's a lot of similarities and patterns and like, why is it that they tend to cut out their foods and they start to food jag and they really have patterns and like, colors and textures and what is on. And I, you know, I'm like, are there vitamin deficiencies? Is it, you know, is there this gut brain connection thing? I was really looking. I was looking at, like, the GAPS diet and this SCD lifestyle diet and all these different things, trying to make sense of, like, what was going on with these kids, just to have an understanding for myself. And as I got further into it then, I had my own children I was working mostly with, like, toddlers on up. Had my first child seven, you know, just over seven years ago, and she's the one who threw me deep into the rabbit hole of tots when I realized she had. You know, I didn't know in the. Until she was 2 years old that that's what was going on. Even though I saw specialists and. But just to see everything that she went through and certain things that seemed to be like, she was. Seemed to be advanced in her gross motor skills. But I now realized she was also just like, really tense. Like my kids at birth. And, you know, my second one was not as tense as the first one, but could also hold her neck up at birth, but, well, tense in a different way. Not really.

It's hard.

Dragged one leg way to go to pt, Ended up going to cranial, you know, craniosacral therapy, osteopath and anyhow. So, yeah, I mean, it's just so interesting to see, like, how it carries out and manifests like, the same issue, but differently. And two children, and I'm like, knowledge is power. Like, they have. They have been. My best teacher is like, obviously all my patients too, but, like, just living with them and seeing the changes and still being on journey with both of them at four and a half and seven years of age and having gone through, you know, expansion myself, I'm like, who? Like, it's. It is. I can't imagine not having access to the information the way that I did is like you said, it's just in health care, I feel acknowledged. For parents, it's so hard to come by. And then when you do get professionals and everybody says something different, you're like, well, who do I listen to? You're saying this, they're saying that, or two people are saying this, three people are saying that. And, you know, it's. It is hard. Parenting is hard.

Oh, my goodness. Yeah. It is abysmal part of. So I actually I have like a website and I've started a blog with sort of the idea of having just something that is searchable for just some information on. So now I also do scoliosis specific PT called the Shroth method, which you may be familiar with. He talked about it a little bit and James Nestor talked about it in his book a little bit. But I feel like there's not a lot of information on anything. And of course you go to Google or WebMD and it's, it's mind boggling and it's all negative and it's not empowering at all. So it's, it's so frustrating. Yeah. But I feel like that's, that's why I feel like what you're doing and the things that like just getting the information out there for people to hear is so important.

Yeah, no, I agree. I love that you have a website. So is that the doctor Laura Great Blades Book Glazebrook website? We'll put it in the show notes because I'm like, yes, it's okay.

Yes.

I couldn't say that before. So we will make sure that's in the show notes. Dr. Laura glazebrook.com and so yeah, let's, let's dive in a bit into like some. So you're a pt, right? So yes, let's talk about like some of your theories or like what you see in practice. Like, because I love to, I love to hear things from viewpoints of other professionals in this space that have kind of like also fallen into the airway realm. Like I tell people, like one of my most favorite memories is just sitting around the table with like my team pre pandemic and looking all looking at the same case and having like the PT who's also an osteopath and his, you know, his wife who's an osteopath and the OT and RDH and you know, I was a speech mayo and then the airway dentist and then there was the oral surgeon, there was a vision therapist and we all were sitting around the table together, passing the computer around, looking at images, talking about the case. And everybody had such different like perspectives and input, but it was, they were all such important pieces to the puzzle to really figure out how to best proceed with the case. And so I love.

Sounds lovely as a patient that's, that's going through this. That sounds like the dream dream.

But yeah, I mean so yeah, I'm curious to know like in terms of like tethered oral Tissues and airway and how, you know, and even going into the whole scoliosis, I know we've now gone down a whole rabbit hole. But you know, the connection, like your theories, what do you see in these patients?

Oh, my goodness. So I am a bit of a research nerd and I just, I love, I'm just learning how interconnected everything is. So like I mentioned, I'm a physical therapist. I got my doctorate in 2012. So I've been practicing for 10 years. I just started noticing as I started taking these different courses, you know, I've done a little bit of pri, I've done public health training, I've done a whole gamut of things. I'm just learning how interconnected everything is. And I had a fantastic mentor in pelvic health that she started really bringing up that connection between the jaw and the pelvic floor. So if somebody has TMJ issues or grinding, clenching and grinding with stress, well, they're probably also clenching their pelvic floor. I started noticing in these patients that I would ask them in their intake, okay, do you have TMJ issues? And if they'd say, you know, right versus left, I'd be able to palpate differences in their pelvic floor muscles and see that they had more tension in the pelvic floor on that corresponding side. Same thing with breathing, but it all goes back to. So if you look at like the airway stuff, tethered, oral tissue, scoliosis, it actually all starts in utero. It starts at an embryonic level, which to me is, I mean, I. It's surprising, but it's not surprising. Yeah, but I mean, like when you think about Dr. Baxter and his, his theories on, or at least the ones that he spoke about the 12 weeks gestation, so, you know, like a little teeny tiny ball of cells, there's a lack of cutting those tissues. You know, there's a lack of the apoptosis where like that, that little tie gets snipped. And even in the scoliosis world, there was a fantastic paper in 2016 where they talked about the same thing, embryonic, like, they noticed that there was just differences between how like the bone cells, like the osteoblast and the fat cells and how tension in the nervous system can lead to some more of that, like they call it asynchronous neuro osseous growth. But essentially there's tension in the nervous system that causes asymmetrical growth of the spinal segments and that leads to scoliosis. So I'm sure you also know as well. So kiddos, with, with that same kind of tension will lead to like torticollis. There is a huge link between torticollis and scoliosis. So I. All of that. I love all of that. So I of course, like when I evaluate pelvic floor, but also specifically for the scoliosis people that I see, like people with scoliosis, I've noticed that just everybody loves to hear about how, how this happens in our bodies. And it's the piece that nobody talks about.

My P.R. i p. T. Like that I had in Maryland. I would literally lay on the table and like, he would just like tell me everything. And like it was all, you know, very anatomy, physiology based. And he's like, I can't talk to myself. Patients like this, like most patients, it's like, you know, he's like, I tell them what I'm doing and why I'm doing it as I'm going through it and everything. He's like, but our conversations were like, next level. Because I was like, okay, oh yeah, connected to that and this and that. And he was, you know, talking about different theories and things that they're seeing. And I was like, this is, it's so fascinating. And you know, to your point, right, we don't, first of all, we don't talk enough about like typical in utero development. That's something that, like we've made a point of talking about that in my feeding course that I teach and feed the peeds because I was like, okay, some people talk about like traditional development, but it usually focuses on like once you're out of the womb. So we need conception and talk about what happens over, you know, the pregnancy and through, you know, the in utero with the infant's development. Because also around that 12 week, 12 and a half week in utero, you know, gestation point, that's also when we start swallowing. So yep, yep. You know, so apoptosis hasn't happened. And hi, we've got tethered tissues. And that can happen throughout the body. It's not just in the oral cavity. We then can also develop a swallow that we're compensating from day one. And so it's, you know, they talk about babies having like hiccups in the womb.

Why?

You know, and they say, oh, it's normal for babies to have hiccups in the womb. Like, yep, both children.

Both children. I, I made the mistake. I asked the OB about it. Had like, oh, we don't know. I made the Mistake of going on to Google and how the number of things that I saw that said things like, oh, it's.

It's a.

It's a cardiac issue. And of course, then you get into the scary place in your head. But no, yeah, learning. Learning now about, like, the swallow and how it's all affected. I'm like, you know, I wish someone would have just told me that, you know, it was something to look out for, but maybe given me something between, you know, your child has a cardiac issue and, oh, it's fine. All kids have. Yeah. The middle ground.

All babies do that. So you just don't notice. They're like. I mean, that was. I was literally told, like, all babies do that. Some people just don't notice it or don't feel it. Like, that's totally normal. And I'm thinking, like, how do you know? How do you know that's what tells you that's normal? And then I realized, no, my. My. Because Mia did it a little bit my second. My first did it a lot more. And she also was a kiddo who was like, had that colicky witching hour and. Yep, be on an angle after feeds and always wanted to be on me. Breastfeeding and really tight early, gross motor skills and, you know, held her head up at birth, you know, and everyone's.

Like, oh, your kids have such strong heads and necks.

And by the second one, I was like, no, no, here we go again. Like, the first time, I was like, oh, it's amazing. Like, she was a kid I've talked about in the podcast. Like, she would literally at, like, the little gym, crawl up a rock wall at, like, seven months by herself.

Holy cow.

And then, like, I would be there to, like, spot her, but she could, like, get her little body around to, like, slide on the other side. Like, I taught her at 6 months how to get off, like, a very low sitting couch, like, on our deck outside. And she took that and turned it into crawling up the stairs, like, within a day. And then was able, like, within, like, I don't know, because I taught her how to get off, like, backwards down that couch. She, like, seven months, was crawling down the stairs, and I was like, I mean, I didn't know any better. So I was just like, of course.

Yeah.

And then my second one, I was like, okay. She didn't crawl until after she walked. And until after she saw, like, craniosacral therapist and osteopath, and they basically kind of got everything aligned the way it should. She stopped dragging me. And. Yeah, I just. I remember that, like, a week after she walked, she, like, crawled across the couch, which is not a stable environment. And I was like, what? Crossing midline. Everything was like, you know, symmetrical. And I'm like, why does. Go in. I was like, okay, all right. It's exciting. She's crawling. And my husband's like, what does it matter? She can walk. I'm like, oh, it matters. Everything's integrated.

I got so irritated at my daughter, I thought she was going to skip crawling altogether. And of course, as a pt, I was like, oh, no, you're going to crawl.

Doesn't matter what you say. You know, CDC crawling is important. I know.

I'm just gonna push you down on the floor. It's okay, baby. Go get that. Oh, no, don't get up on your feet. Crawl. Gosh. But yeah. So I all of that to say I've noticed that I. In my journey, I had a tongue tie release. And it turns out that this was what started me thinking, well, I should start looking at this link because I see a lot of scoliosis patients. Like, I work in a practice where we teach adults, teenagers, kids, scoliosis exercises. There's a lot of evidence behind them. In my clinic, we see a lot of patients with scoliosis. And one of the things that I started noticing was I would ask about ENT history, and I noticed that there was. And of course, this is still a limiting factor. I think at some point, when I have time and money for more courses, I would like to be trained in how to assess oral motor function. Because a lot of times maybe they do have history, maybe they do have a tongue tie, or maybe they do have some of these issues and they just aren't aware of them. But I started noticing that some of the kiddos that I would see, they did have a history of a tongue tie, or they have had a lot of ENT procedures. And now they're coming in at, you know, 11, 14 with scoliosis. So for my five year old, I had a feeling. I knew just statistically when I had fusion at 11, there were probably signs of scoliosis when I was much younger that nobody knew what to look for. I am, for better or worse, a specialist now. So I was watching my son. I started to see it at four and a half, and I was like, oh, no. So anyway, I started to just include on my intake forms just literally all of those. So I would be specific. History of ent, follow up, frequent ear infections, tethered or remote, you know, tongue tie or Lip tie, adenoid and tonsil removal. And so I'm just collecting data on how many people are coming in with BO and seeing what I can do because I think there's more info in the airway space about this. But in the scoliosis research, it's still not very well delineated. So I think part of what I'm trying to do is I'm trying to make those connections so that hopefully more people will start to make that connection. Because especially as you know, there's these periods of growth where we are trying to do everything we can to work on the symmetry. And if we're only working at the spine when there's something higher up or when it's an airway issue, it's not going to fix the problem. Yeah.

So, yeah, no, I mean, it's like you said, like everything is so interconnected. And I remember when I was talking to Ron Ruska and we were like, he was talking about, he was like saying like, we've got ties like throughout our body, like their body ties, it's not just, you know, in the oral cavity. And I was like, oh, well that makes sense, you know, and, but you know, when we look at the airway and how all of our airway based, you know, organs are functioning and we start to address things on a deeper level and we start to look at, you know, why are we asymmetrical, why are we not, you know, using everything to its full capacity? That was really eye opening to me. And you know, I think the work, like you said, your PR, you've taken some PR courses. I just think that some of the courses like that they're doing over there is just, they're so informational. I feel like anybody and anybody working with pediatrics should be taking those courses.

Yeah.

Because it just, it's eye opening and it at least alerts you to be like, oh, hey, maybe I should refer this child for an evaluation because I have concerns about X, Y and Z. Right. Whether it's to like a PRI trained PT or they're going to OT or speech, you know, for airway issues, feeding issues, you know, whatever the case may be. It's just, it's very, the whole thing is just very. We treat in silos. Right. In the United States of America.

Exactly, exactly.

It's harmful, you know, when, when doctors enter into a space where they, you know, this whole do no harm. Well, why are we not collaborating more? I know the answer. I know it's monetary based, I know it's insurance driven. But at the end of the day, we're only helping patients become sicker because we're putting a band aid on symptoms instead of working together to find the root cause. Right. And if we could truly jump into a different model of care where we can sit together and I'll talk about the patients in front of us for more than maybe like 20 seconds. I know they do rounds and then they have meetings and hospitals and stuff like that, but in private clinics, it's harder. You know, I know that. It's just, it's something we can do if we choose to, but we also have to build that into our, our working day. And sometimes that comes at an expense because either it's something that you can't build to insurance and. Or our fees have to reflect the time that we're spending on patient cases outside of actually being face to face with them. Which I know in a private, you know, pay situation, it. It increases fees for patients on the front end. So it's, you know, it's like that's. That it always comes back to money. I'm like, if that's really the biggest.

Thing, it really does. And that's why I feel like there's. I'm so glad to hear there are some treatment centers that are coming together. Like, I know here in Atlanta we have a couple of multidisciplinary, like, kind of airway focused places. Because I know, especially for me, when I was, when I had this itty bitty baby that was struggling so badly at the height of the pandemic, I had a really hard time trying to get in front of the right people. And you know, I. I had a toddler at home. I had a three year old, and just. I wasn't sleeping and I was feeling terrible and it was just so maddening. And I realized the amount of privilege that I have of kind of having the right people to at least give me the information of this is what you need to look for. And that information can just be so hard to find. I think to your point of the working in silos, that is a huge. That is a huge problem. I'm finding as well is because there is a little. People are aware of overlap between certain areas, but they're not connecting the whole body. So for instance, one of my favorite. I don't know if you're familiar with anatomy trains. It's a. Yeah. So talking about just how. Yeah. How the fascia and the muscles literally connect head to toe to support us in different planes. And there's. There has been research on for instance between like the muscles in the jaw and the pelvic floor. So they have done research and they've used like real time ultrasound to be able to visualize what someone's pelvic floor is doing when they're humming or when they're talking at a low tone versus when they're speaking at a higher tone or yelling. So there is information available for certain regions, but it's like the whole body is not being connected. And I mean, I know you've mentioned it before, but evidence is so far behind practice. And I think one of the issues, at least in the PT world is everyone's like, well we need the evidence. And I'm like, well someone needs to collect the evidence.

Right. Well that's an issue I think in all of our fields. Right. Like I know in ENT it's like hard for ENTs in the airway space to step out and like truly, you know, promote themselves as like these airway centric, I know they don't like to call them that, but like these, these airway forward ents who are looking at airway differently than like what they're traditionally trained to look at because they get ridiculed. And you know, and I know that that's true. I know that there's like this big divide in like the speech world. Like it's 50, I joke, I don't know for real if it's 50, 50 split, but I say it's 50, 50 split. You've got the people who are like, we know that it's important, but the EBP triangle also includes experience and patience. You know, like what are the patient's goals, what are the patient's concerns? You know, that's equally as important as that research based evidence as well. We need to consider all of it. But at the same time understanding, like you said, research tends to be about 17 years behind. And there are certain things that either can't truly be researched the way that they need to be in order to like apply it to practice. Like when working with infants, for example, like things are just unethical that will never get passed by an IRB board and, or just they just can't be done. But at the same time there is a lot of other research that is being done and we are starting to get more information, you know, published. But it's going to take, it's going to take time. It's going to take so long. And you know, I find that the therapists who are critical thinkers who can take what is out there Take research that's being done that maybe isn't published yet, but also, like, you're doing like, my intake is long and it's long and it's. I'm like, we put it, we finally, like five years ago, put it like up in our EMR so that the patients can like, click through it instead of like doing it on paper and everything. But it's long because we're taking an extensive history and we look at patterns too, and we notice things and people ask things like, well, why do you have like a question about whether or not they can ride a bike on your intake? Like, you're a spe, you're a speech ot, like, you're not pt. And I'm like, Because it's all interconnected. These kiddos who have trouble with balance, who have, you know, like, we see patterns and it. Just checking that box, yes or no for a five year old can tip us off into having a very different conversation. You know, the same way that we ask sometimes if kids ate their first birthday cake, you're coming to us for feeding therapy. We're like, well, why'd you ask if.

They ate their first birthday cake?

You know? Well, some kids who, like my daughter, who seemed to be okay with all of everything feeding, and for the most part, like, wasn't really showing a ton of like, you know, sensory processing things that would like, tip us off. At age 1, she would not touch her birthday cake. It was very, very interesting. And then around like 15 months or so, she started to become really picky. We started to see, like, she didn't like how tags felt on. She didn't like how the seams on socks felt. Like just. It was like one of those early signs. Like it might mean nothing, but in the overall picture else, maybe it was there a little bit earlier and we just didn't notice it. And it's been there all along. And so there's like these little things that we look at. Like we ask about ENT history and airway history as well. Like, we want to know, like, you've been. Is there a history of ear infections? Is there a. Do they have PE tubes in their ears? Do you know, have they had tonsils or adenoids removed? What's medication history look like? You know, have they been hospitalized? You know, all these questions that, like, I think a lot of other, you know, speech therapists may not always ask. They may ask some, but not all. We really dive deep because we're trying to look holistically at that whole child and figure out like, are we even the best? Like, yes, we want to do an eval at least, but are we the best, like, first line provider right now, or do we need to, like, work with a team to get you on track somewhere else first or along with what we're doing?

Right. That is a huge thing for me, and I feel like it's important for us to know, especially locally, the people that we can connect patients and families with. I will see. I have been known to have pelvic health patients coming in with pelvic pain, and I ask that question about, oh, you know, are you. Have you had any issues with your tmj? And they're like, oh, yeah, you know, I've cracked three teeth. I definitely, like, I definitely grind at night. I've ground through three, you know, bite guards. And so I, I keep a list of. All right, so take this for what it's worth. You know, I realize this is not in my scope as a pt, but we know through research that X, Y and Z are connected. Here's a list of people that you may want to consult with. And I feel like that. So I have even as a physical therapist, you know, it's like that silo of staying in my lane. But I will tell people, all right, I know of, like, some great myofunctional therapists. I know of some craniosacral therapists. You know, you may want to get assessed for X, Y, or Z. And this is why. And again, like, going back to that knowledge is power. At the very least, it's. You can put a bug into someone's ear because how many patients have you talked to or families that have heard from someone, oh, this isn't connected. You know, people will come in with, like, nerve tension in their arms, and the doctor's like, oh, that's not connected with your scoliosis. I'm like, yeah, but your trunk is rotated and those nerves are being stretched. Of course it's connected.

Yeah, 100%. So how. So do you work with mostly adults or do you see any pediatrics?

I see a fair. I see about probably more teens, like, older peds, but I have treated, of course, my own son at 5, but I have treated 4, 5 and 6 year olds with teaching them their scoliosis corrections. That's amazing.

It's so hard to find, like, PTs in this space who work with, like, the younger pediatrics and who really get airway and, you know, you have an even, like, deeper specialty with the scoliosis side of things. So that's. That's amazing. Now, when you work with them, are you. Are you that you're collaborating with other professionals? But as far as, like, treatment planning and everything goes, like, do they come see you like once a week? Are you doing, like, kind of traditional, like semi traditional PT type exercises or. I know you said there's a certain methodology you use for scoliosis patients, but, like, I'm just curious, like, what. Not super familiar with it, but like, what.

Sure.

That entails or like, looks like to the best that you can explain, obviously, on a podcast. Right.

I feel like we. Part of the issue is our I, because I run a specialty practice with my business partner. There's three of us therapists that do this very specialized scoliosis exercise. And unfortunately, we don't have the availability even to get people in once a week for when children are growing. And we know those risk of worsenings as we grow. I usually recommend, okay, try to get in every week, every other week. But then, of course, they will leave at their first session. We will take them through not the evaluation, but the first treatment session. We will take them through their entire exercise program and they will get a video and they will get handouts. They get all of the resources ahead of time. In an ideal world, I would love to be able to see my patients especially that are in those periods of growth once a week. It's not feasible. Where we are right now, we are always recruiting. So if you know anyone that wants to get trained in Shroth exercise, that would be great. But part of my job is to encourage them. Like, we know the research shows that doing the Shroth exercises are most effective if you can do them daily for 15 minutes. And so we know that times of growth are more. There's more of a risk of progression. So especially for. I see a lot of girls in my practice that are in those teenage years, and we know those first two years, like after someone starts their first menstrual period, they have. They have more of a risk of curve progression because there's those growth spurts. So part of my job is just encouraging, empowering them that they need to take this on because this is a chance that a lot of us did not get. We know that we can positively impact the spine with these exercises and the muscle balance throughout the lifespan. But to get the best possible correction and encourage growth in the right direction, we really want to nail this while they're growing.

Yeah, no, that makes sense. That makes a lot of sense. No, thank you. That's. It's helpful. It's definitely something. Like I said, it's hard to find professionals that are in certain specialty spaces. So maybe somebody's listening that's interested. Maybe they'll reach out to you. And.

Well, I do know I love Instagram because I find like, I find the best professionals on Instagram, but there are some shroud therapists and like, I don't know, I think there is one in South Florida that I'm connected with, but definitely should connect with her because I am finding that it's probably good to screen these kiddos for scoliosis because I feel like there is a relationship, especially if they have a lot of preference, one side stabilization of one side of the job versus the other.

So, yeah, so if, if there is like a professional listening who's like wondering how you're doing your screens, you know, for like working with pelvic floor patients. And you had mentioned screening for like TMJ and airway concerns. So they know like when to refer out and everything. Is it mostly through like your intake that you're doing that or do you have like a specific way that you screen beyond intake?

I try to get as much info as possible during the intake because I feel like that helps with just save time. Because as you know, even if you have the privilege of seeing somebody one on one, which my practice model allows for that there's just so much to cover. And of course you want to give space for people to tell their story. So I don't always get through everything in the first session, but for me I have like a little, I guess, flow sheet in my brain, or they call it algorithm, where I say, okay, if they said yes to this question. I can think of all these other things. So, yeah, I try to have a really specific intake. I've tried to determine from all the providers that I work with the red flags that they're seeing. And I try to determine. And this is still something that I could use some, like some research or knowledge in is knowing what comes first. Because I feel like none of us know because we treat in silos. None of us know what started, like, what's the driving force. But I feel like the more information, you know, in the beginning and having that wide net of resources can only help the patients and the people that we work with.

100%. Awesome. Thank you. So I think we got a little extra time. So let's talk about some of the other things we wanted to chat on if we, we said if we had enough time. One of the things like jaw tension. Right. And Positioning and how that can either help or hurt. Right. Or ability to have a baby or even a healthy bowel movement.

Yes to that.

Because I'm like, I think that's a fun topic.

It. I mean, I do too. I realize I'm a little bit biased, but so. So anyone on here that has ever had a baby or tried, you know, prepared to have a baby, there's any number of. If you've followed any of the natural childbirthing, I don't know, books, resources. You may be familiar with the name Ina Mae Gaskin. She is. She actually. I mean, this was, gosh, years and years ago, but she started to bring awareness to the fact that if you have tension in your jaw, you can't. You can't have an open cervix. Right. Those pelvic floor muscles, which. Their main job is to get out of the way, like, people think. People think they need to do a lot of Kegels and stuff for childbirth, but no, actually, those pelvic floor muscles need to, like, lengthen, they need to release, they need to allow for baby to come through. So that's their job. But they can't do their job if we're clenched down up here. Like, they just can't. They can't release the way they need to. And that can lead to more bad outcomes for mom. That could lead to tearing, that could lead to more, like, inflammation. That could lead to more prolonged birthing times and longer pushing times. So, yeah, describing me, I mean, yeah, hello.

My first daughter, like, before, I fell more into, like, a natural world and everything of, like, home. I do a lot of homeopathy now with my kids and just trying to, like, you know, a lot of chronic issues and things. I'm trying to, like, do, you know, homeopathy for. Anyways, I clearly had jaw tension and didn't real. I mean, I knew that I was clenching my jaw. I knew that it was partially my bite, but I don't think I realized it all until, like, after I had my first child. And then I actually went to my train PT between kids and I was like, hey, before I get pregnant again, I want to work through, like, my diaphragm. I just. I was like, I love that, like, release, like, the chest muscles and breathe better and. And I even had people say, like, you don't walk like a pregnant woman. Like, you don't. You look like you. You just look chill. Like, you look like you're on. I was. I was fine with my second. My first was tricky. Like, we had. I was like heavily monitored, they weren't sure that my uterus was the right shape or enough space for her and then it was fine. But then because they were monitoring us and maternal, fetal, then I was going a lot towards the end and they thought I had gestational diabetes, but I did and I actually have an intolerance to like, like I couldn't process the glucose drink they gave me and like I couldn't process corn very well at the time. It was like a food sensitivity. So I passed like hour one and two, but not hour three on the three hour test they sent me for. And you know, it was just, it was like a whole thing. So then I was doing that and I was like, you know, pricking my finger and everything and I'm like, I can literally eat. And I just, I wasn't eating this way during pregnancy but I tried it because I wanted to test it. I could eat a slice of pizza, I could eat a bowl of ice cream and I still, my blood, my blood sugar didn't spike over like, like the levels that they said that they should have at that point. So I was like, I don't think I actually have this problem. But whatever. There was that and I was monitored, monitored after birth. So didn't have it with my second one because then they let me actually like bananas or something that I could process and I was fine. Yeah, I like advocate a lot for like after learning a lot with my first, yeah, my second I was like, we don't want. And then because I was being monitored so much, they, towards the end they were like, well, the baby's, you know, not getting enough nutrients to her belly. It's all going to her brain through the umbilical cord, so we might need to deliver early. And eventually they were like, okay. No, we think it's okay now. And so whatever, right. So it's like all these things that you would normally know. So I feel like I, I, I'm a person where, you know, at least at that time in my life where when I have these big unknowns, especially like medications related, like it doesn't matter how many, if I take a class, if I read a book until I experience it myself. Like I think I was so tense over the childbirth that I, which I.

Mean, to be fair, it is, it's.

A very anxiety, I mean, or anything. Right. But I'm like, I think I was just carrying so much tension and I was also driving a lot to see patients and like traffic is something that causes tension. I know I would clench in Traffic. And so by the time they sent me in to deliver this baby, they. I had a planned. What's it called?

Induction.

Induction. Thank you. Yes. So planned induction. We call and they're like, oh, we don't have a bed. And I, I was so, like, at the time. And like, I've. I've changed a lot. My children have changed me a lot. But I was so no, like, it is happening tonight. Like, I, like, I just was like, I'm like, there's very little I can control in this scenario. But that I. So anyways, I ended up going in and to a bed until like 1:00am Like, I didn't go until like midnight. Got into a bed at 1am they put in like cervical. It didn't work. Ripen. They started Pitocin at 8am after they took cervical out, they had me on like 18 out of 20. Nothing was happening. I was contracting. My cervix was not opening. So when you just said that, I was like, yeah, my goodness, would you look at that?

Because also when you know, coming, right.

What does your body do if you know, it could anticipate, like a contraction coming. You like, like, yeah, thing. Yeah. Finally at like, I don't know, my water broke. Middle of the afternoon. They were like, okay, now we have to deliver the baby. They were going to stop and restart everything. I was like, no, you are not. So then, thank goodness my water broke because they were like, okay, now we have to continue. And I finally was like, give me an epidural. Like, I'm just. I'm done. Like, give me an epidural. And I think at that point it had been like the, like one, like 15 hours.

Ish.

And so, yeah, so they gave me the epidural. I fell asleep and woke up 0-7 cm in 30 minutes.

Yep, yep. You want to know why? Because your nervous system chilled the heck out. That's why you allowed her to come.

Down Long labor and delivery. We. I pushed for a long time with the first one. It was like tour. I mean, all the things, like, everything you said.

Well, but. But again, like, who knows? No one tells you. I feel like the obvious, like, I am a huge advocate now for doulas and that prep, like, that prep. Birthing work, I feel like is so important. But similarly, so even if. Even if someone chooses not to have a baby, we all, whether we want to or not, have to have a bowel movement. And so I work. So I, you know, I've seen in my son, you know, he's. He's had some issues. I work with a lot of scoliosis patients and pelvic health patients that have issues. And so part of it, I do believe, like, there's tension that we're working through. But also it's the same idea of if you're holding a lot of tension in your jaw, and if you're bearing down, then those pelvic floor muscles are being stretched, like, stressed, essentially, and they're not allowed to relax because they're supposed to allow, again, get out of the way when you're having food. So I. One of the big things I tell in all of the different environments where I work, but I'm always telling people, like, are you. Are. Do you have a soft jaw? Can you make a little soft sound as you're having a bowel movement like us or. And. And trying to. Instead of, like, you know, vapor locking and not breathing to allow them to actually pass something. So even just from a mechanical perspective, like, some things are also great, like squatty potties or having your feet up and not, you know, being up on your toes on the toilet, but, like, allowing. If we can relax the jaw, that can relax everything in the pelvis a little bit, too. So, like, why not make our lives easier in that teeny, tiny way?

No, I mean, both my kids have had struggles with it at one point or another, and I wrote it off to their ties, and it would. Again, this could all be interconnected. Right? The airway with the ties. J. With my second is a grinder. She has such a deep bite that, you know, for her, you know, I would always, like, kind of joke and kind of not really joke. I'm like, if they don't have something green at least once or twice a day, like green beans or broccoli or something like that, which they both love. So thank goodness, like, my kids will eat that. Then they would get constipated. If they eat Mac and cheese, they get constipated. So, like, I look at things where I'm like, I think there's certain foods that don't pass through their bodies well. Or they're not chewing them well enough to break them down to pass through their bodies well, that's my son.

Yeah.

Because of their current. And that's. That's really what it comes down to with a lot of our feeding patients. So many of them learn, like, I eat this food, I love it, but I don't feel good afterwards because they're not able to chew it properly, or they love it so much that they don't Care, they'll swallow it whole even if it makes them feel crappy afterwards. Yeah, I mean, it's, it's very fascinating to work with kids and see like, you know, in feeding therapy, like these, these patterns and how, you know, but also how few professionals actually look at the foods that kids are eating and as well as whether or not they can actually chew the foods. And, you know, if child doesn't feel safe, guess what's going to happen? They're going to cut that food out. So guess what's harder to chew? Things that are fibrous. Guess what we need in our diet? Things that are fibrous.

Like, you know, it's so frustrating and I feel like a lot of pediatricians, I admire everything they do, but I do feel like we have a great pediatrician. He doesn't, he, he missed my son's first, like, school on his scoliosis screening. He missed that there was a little imbalance. He wrote off my concerns about the tongue tie for my daughter. And like, this is, this is a very, you know, well respected pediatrician. But just, you know, again, we're at silos. We don't, we don't know about the connectivity of our bodies and to our detriment.

Yeah, right. And it's, it can be frustrating to no end because you're like, I get DMed on Instagram all the time and I have parents being like, well, why did my pediatrician tell me this? And I'm like, well, they're not trained to, like, they are, you know, they have a lot to cover and not a lot of time. And you know, we love our pediatricians. We can't expect them to become specialists and everything. However, we can expect that they listen to parent concerns and they refer out as needed. Right. And that there is conversation happening. And, and so I think it then falls on a lot of us to try to go and talk to our pediatricians and ask for like a lunch and learn or to, you know, hey, can we sit down for 20 and talk about patterns that we're seeing in our patients? So you know when to refer to us because, you know, arguably, I love when people come to me and they do that because I would rather someone come and say, hey, like you were saying before, like you've learned about the red flags, you, you know, the symptoms to look for, to refer out to certain people, certain other specialists, which is the way we operate too. And so we will happily add another line or two on the intake if that helps. Oh, that, you know, what we need to have A conversation with pediatrician or a PT or an osteopath or you know, an airway dentist or whatever. Because again, it's, it's, it's hard. And the best thing that we can do really, I think is understand what each of us does so that we.

Know when to prefer right and understanding when. Because none of us have a full picture, none of us have full knowledge. And I don't think any of us ever will because the body is so complex. But I just love like that my Maya Angelou quote of like, do the best you can until you know better. Then when you know better, do better. And I feel like as long as you can approach a provider with an open mind, as long as they're conducive to what you say. I mean, I've worked, I've developed fabulous relationships with a lot of doctors where we collaborate. We say, hey, you know, could you screen this person? And it's just a matter of if you can approach it in a way and you can be, you know, not come at them from an accusatory like, hey, you know, this is, this is something you need to be looking at, but to bring the awareness to. I think that these things might be connected. I'm noticing in my patients or I've seen this research that this could be a link. And then if it's a provider that's willing to have that discussion with you, then that's only going to help all of the patients.

Yeah, absolutely. Well, this has been amazing. I always love talking with professionals who are on the same page. Is there anything we didn't cover that you want to talk about?

I don't think so. I, I Breathing. I feel like it all comes back to breathing. So I loved, I loved James Nestor's book Breath. I feel like everybody should read it. And I feel like a good diaphragmatic breathing, like just learning how to activate, like to expand the rib cage and to breathe from the diaphragm and relax. Everything that's not supposed to be helping for two minutes a day is helpful for everyone. I have lots of videos and connections on my Instagram if anybody is ever interested, interested in that. And I'm happy to chat and help refer people to, especially if you live in the Atlanta area. I know a lot of, a lot of excellent providers around here.

And you are at Laura G. Dpt right? On Instagram?

Yes. Perfect. Perfect.

All right, well we will link that and we'll include that in the, your website in the show notes. Everybody knows where to find you and thank you so much again for hanging out today and chatting about pelvic floor and you know, airway and poops.

Yep, all the things spine, pelvis. It was a pleasure. I enjoyed it so much. Thank you.

Thanks for listening to this podcast. If you want to hear more of these Myo Tots, Airway and Feeding related episodes, be sure to leave a review on Apple Podcasts or pledge a small amount on patreon.com if you found value. Others you know in this space will too. So be sure to share this episode on your social media platforms and join us over on Facebook on my Facebook page @hallebulckenbiz, on Instagram Alibulcan. And you can head over to theuntetheredpodcast.com to grab a copy of the Show Notes, where you can also subscribe to be kept up to date on the latest podcast episodes.