Bridging the Gap Between Healthcare & Fitness with Dr. Rebecca Maidansky

Hi, welcome to the Pelby Biz Podcast. Are you a pelvic health PT or ot? Struggling to start your own practice? This podcast helps pelvic health PTs and OTs get out of debt, gain the income they desire, be able to treat patients without insurance restraints, and learn how to create time freedom for yourself and your family. I'm your host, Dr. Kelly Alhui, founder of Ortho, Pelvic Physical Therapy, Pelvic health Business Grower and Pelvi Biz. Over the last two years, I went from a solo entrepreneur to a seven person team in counting. I'm here to help provide a clear path to grow your pelvic health business as fast as possible so that you can gain the time freedom, decrease debt, increase income, and live the life that you desire. Before we get started today, make sure you click the link in our bio to grab your ticket for Pelvi Biz.

Now let's get into today's episode. Welcome to Pelby Biz Podcast. I'm your host, Kelly Alhui. I am here with Rebecca, aka known as a LadybirdPT on Instagram. Go ahead and give us an intro and tell us where your practice is located as well.

Yeah, that sounds great. Well, hello Kelly, thank you for not immediately calling out that I was 14 minutes late and I just told everybody myself, so I guess it doesn't matter. But my name is Rebecca Madansky. I am a pelvic floor physical therapist and I own Ladybird PT like Kelly said, which is a clinic in Austin, Texas that specializes in perinatal folks. So we treat pregnancy pain, birth preparation, postpartum recovery is kind of our bread and butter and that's where we're at.

That is awesome. So give us an insight like what made you actually want to be a practice owner and what also made you want to do pelvic health?

The answer to both of those things are very different and kind of unrelated. I ended up in pelvic health. I used to say accidentally, now I say serendipitously in PT school. And my closest friends in PT school really wanted to go into pelvic health and I didn't get it. I was just like, I don't understand. I want to treat ankles and knees. I want to work with athletes. And then I started working with athletes and I started seeing all of these people with pelvises and women who are coming in who maybe we're pregnant, maybe we're postpartum, but people just had no idea how to treat them and they might have just been a soccer player. But they were pregnant or they were postpartum, or they were a runner who wanted to figure out how to get back to running after having two kids and have hip pain or back pain. And I just started seeing this huge hole in how those people were treated because my male counterparts were scared to touch the pregnant people. And my. All of my PT colleagues had no idea really how to look at that person holistically because that's not a thing you talk about in school. And yet 50% of our population can get pregnant. So what do you do with that information? So I went into pelvic floor PT when I moved to Austin because I met my previous boss, Kimberly Sullivan, who had an amazing pelvic health practice. And I was really interested in this opportunity to learn more about pelvic health, to then go back to my orthopedic population and be able to treat them like a whole person rather than somebody who has a waist and above and then hips and below. That's why I ended up in public for pt. And then I, after about a year and a half working in a pelvic floor clinic that specialized largely in chronic pain and chronic pelvic health conditions, I knew that that wasn't the area that I wanted to be in long term. I knew that for me personally, that wasn't where my passion lied and that also just. I didn't have the ability to navigate dealing with such chronicity. It was just really emotionally draining for me and really emotionally taxing. And I loved working with pregnant and postpartum athletes and just people who wanted to go back to physical activity. And so I started Lady Bird really with the goal of taking all that pelvic health knowledge and marrying it with my passion, working with active people and also doing it in a way that didn't force PTS to treat 40 patients a week. Back to back to back to back with no break to eat or pee. So it was a combination of things. But it's been such a blessing. Yeah.

So really, you know, a mentor, I always say a really good mentor is always amazing to have to start out.

I feel like, especially in our field.

And then it kind of gives you inspiration and it is really interesting.

Rebecca.

I have the same story. I work with Julie Sartin. It's a really well known chronic pain really center. And I was like, hey, I want to combine orthopedics more with this and get people moving. And I did the same thing. You know, it's just awesome. That's, that's great because we really should be treating holistically so. I love that.

And I think more and more, I mean, I don't know about. Kelly, how long have you been a PT?

12 years.

12 years. Okay, so you've been in this field way longer than I have. I've been a PT since 2017, so five years this year. And even in the past five years, I feel like when I first started out in pelvic floor physical therapy, there was no conversation about how to do orthopelvic care. No, this was not a thing.

I came up with the name of it.

You did. You coined it. There was orthopedic physical therapy, and there was pelvic floor physical therapy, which is a ridiculous delineation considering that your pelvis is part of orthopedics. And so I think that this story I'm starting to hear more and more from people that were just like, I don't want to do one or the other. I want to do the whole thing. I want to do the whole body.

And that's awesome. Yeah, that's awesome to hear. I mean, I love that because I truly believe that that's how we should be treating. And if you're a really good pelvic health physical therapist, you really have to incorporate all the other domains that the physical, the mental, the pain science, collaboration with everyone in your community as well, and forming that team for that patient to really make the care, you know, exponential. So I think that's fantastic. Yeah. Yeah. So question for you. What was like, a big problem that you had to solve in. Over the last, let's just say, year, and that you were like, man, how am I going to solve this problem? And how did you, like, overcome it?

Oh, man. Something about you smiling when you're asking a question makes me very nervous. A big problem. I mean, I don't need to go back that far. We were just talking before. Before we started recording. Do you mean. Okay, do you mean a business problem?

A business problem. A Covid problem. Whatever problem you want to give us, we're here. We're here for it.

I mean, you could ask me for a big problem in the last week, but I would say so I'll give you a 2022. I'll go in the last year, since we're a month in a 5.5weeks and some change into this year. We were just talking about this before we started recording, but In January of 2022, I don't think I'm exaggerating. January 4th, the first day Monday, I got a text that I'm, like, trying to remember the order that our physical therapist, who we trained through all of December, who was starting her first Independent Week January 4, that her daughter or son, I forget who got it first, tested positive for Covid. And then we were like, okay, you know, not a big deal. 10 days quarantine, you'll be back. It's okay. Life happens, Covid happens. Here we are. I think it was 10, nine days later, like, right at the end of her quarantine, she was testing negative, feeling fine. Nobody was symptomatic. Then her daughter tested positive for Covid. And then I think about a week later, she tested positive for Covid. So now we are on week three. She just tested positive, and she's vaccinated. Just tested positive. In the meantime, our office manager's child tested positive for Covid. And then a week later, she tested positive for Covid. So for January, 50% of our staff was out for the entirety of the month because Covid, fortunately, roughly 50% of our patients had Covid too. Everything kind of fell apart for a solid 30 days. And here we are on February 9th, and it's the first day this year that my whole staff is in the clinic. So how we overcame that, honestly, how do you overcome that? You have to roll with it. I bitched a lot. Can I swear? I'm sorry. I complained a lot. And we got through it. I mean, I think that that's, like, the biggest life lesson of being a practice owner, business owner in general, is you just. You cannot control these variables. And Covid is just another variable that happens to be, at this point, fortunately, largely just very inconvenience, since most of the folks getting Covid are doing pretty well. Obviously, in 2020 and 2021, it was more than just an inconvenience. It was really scary and stressful and all sorts of things, but, you know, you just get through it.

Yeah. So did you guys try to convert to telehealth? Because I know for us, like, we really now what we've been doing is, like, on initial evaluation, really preferencing that you're going to see us for 12 visits. And part of these 12 visits, guess what? There will be times that at least probably two or three of these will be televisions. So do you guys. Have you guys been stating that more upfront? I mean, how have you guys kind of pivoted? Have you done telehealth? Or are you like, look, we'll see you next week when you get better?

Yeah, you know, in 2020, we were definitely doing a lot of telehealth. Especially because at that point, nobody felt comfortable coming into the office. We didn't feel comfortable treating patients either. So we did everything telehealth in 2021. There was more of a mix at this point. I think that our, our model. It sounds like our model is different. On average, we see our patients about six times over the course of two to four months. So because we see people relatively infrequently, we tend to lean towards rescheduling if there is a Covid exposure. We're also, because we're such a manual based clinic that tends to be more appropriate. However, of course, there are all those people that are coming in for birth preparation and wellness visits and exercise progression. So we absolutely do virtual visits when it's appropriate. But I think that more often than not, because of the frequency of visits that we have with people, because of the way most of our therapists treat, we will push back a week if we can. But I definitely have people who have been virtual the whole way through and we absolutely have people who've transitioned to virtual. So we do it, but we do for the most part still bring people into the clinic.

Yes, good.

I was. And if we were seeing people for 12 visits, more like the program that you have, I think it would be way more, way more doable for us to do a couple of visits virtually versus if we see people six times and three of them is virtual, we miss out on a lot of that manual opportunity. Right.

And especially at first there's a lot of that lengthening which requires the manual. And yeah, they really need that attention. If that's, you know, really what they're coming for, then yes. Yeah, like that's. That completely makes sense. Yeah, definitely. So your clinic, is there a certain population that you guys. I know you kind of touched on this a little bit, but do you normally treat the orthopedic and the pelvic health or is it just really postpartum? Like what is your niche market in the pelvic health realm?

Sure. So pregnancy, birth preparation, postpartum recovery is our niche. Like that is. That is really what we focus on, which means that we do orthopedic and pelvic floor because in pregnancy people have orthopedic and pelvic floor issues. Birth preparation as a combination, postpartum recovery is absolutely ortho and pelvic combined. So we see a lot of back pain, hip pain, knee pain, ankle pain. I would say if somebody were to call for a shoulder issue or like a rotator cuff tear, we would refer them out. It's just not our niche. We, I mean, we have therapists who've been orthopedic pts for a long time. We could treat it, but it's definitely not our area of expertise and we really do try to stay with what we love to do and what we're really good at doing and refer to other people who are better at the other things.

Yeah.

So pregnancy, pregnancy, birth prep, postpartum. I would say the biggest thing that we see that I think is different than what I definitely different than what I was used to in my previous job is we do a ton of wellness, like a lot of. And that's why we see people so infrequently. A lot of our patients come in feeling pretty great, just wanting some more guidance for returning to heavier weightlifting, higher, like longer distance running and managing, running through pregnancy, managing like, you know, some mild pain that they're experiencing that they don't want to get worse throughout pregnancy. So that's kind of more like our niche as long winded answer.

I know, I love it actually. And I think this is a, this is perfect because people, I think a lot of PTs come out of PT school thinking there has to be pain for me to treat this patient. There has to be some issue.

Right.

But what, what you just said was perfect because we really should be the people that are actually bridging in the gap between pt, AKA like having pain and then also the wellness aspect, getting back to running, getting back to weightlifting. Why are we not the ones carrying out that plan of care or carrying out the wellness visit and truly showing these patients, hey, we are the experts in this area and we have a plan based on research, based on, you know, what we've been doing for a very long time to get you back to that and I think that's huge is to really bridging that gap, which.

It seems like you guys are doing.

That makes it really well rounded. PT clinic, you know.

Yeah. I mean, you know, like when you think about nutrition, people don't wait until they get sick. Hopefully a lot of people don't wait until they get sick to start figuring out how to eat better. Right. Like at some point people realize like, I don't feel 100%, I think that my diet probably has to do with it. I'm going to start eating more vegetables and less sugar. A lot of people kind of have a moment that doesn't, it doesn't have to be a reckoning. And I think that with our physical health, for some reason we wait until things really Deteriorate. We wait until things are really painful. We wait until things are really. I mean, I don't love the word dysfunctional, but, like, we wait until things are bad to start seeking treatment. And in reality, I mean, like, I know that in physical therapy, we have this distinction between wellness and pt. When I say wellness, we are still doing physical therapy. It's just that people are coming to us for optimization, and it's still physical therapy. Somebody who has some hip pain when they run and is pregnant and wants to make sure that they know how to modify throughout pregnancy, that is wellness, because we're not treating a huge problem. But if you can make that hip pain go away and also prevent it from getting worse, I mean, we know we can't prevent all injury. We know we can't prevent all pregnancy complications, but we can certainly reduce the risk, reduce the severity of those symptoms, of those issues from occurring. So why do we need to wait until somebody is 12 weeks postpartum running with severe leakage and heaviness in their pelvis to start talking about protecting the pelvic floor and.

Yeah.

Managing health through pregnancy.

No, that's. That's amazing. Yes. That's so true. And why does that pregnant lady have to wait and be like, okay, I'll just deal with this pain because I don't know where to go. I don't know what to do. Right? Like, oh, my God, pregnancy. Let her do whatever she wants through pregnancy. Don't limit her.

Yeah. This rhetoric of, like, just wait, right? Like, just wait till you give birth. It'll be fine. Just wait till you're done having babies. Oh, you want two more? There's no point to address your leakage or heaviness or pain or whatever. Like, you just wait five more years, have two more kids, and you can deal with that all at the end. Like. Like, as though that's convenient for people, you know? Like, I. It's so frustrating. I mean, the things people say to pregnant and postpartum people are right. I think everybody knows that at this point, that it's frustrating. But. But, yeah, there is so much that can be done to reduce the risk, to help, and also just to empower people to know if certain things do happen postpartum, that you don't have to suffer in silence, that there are options available that things can get better, you know? Yeah.

No, it's so, so, so huge. Okay, I'm going to pivot here. One last question. So if someone is just starting out in pelvic health and they are like, hey, I kind of think I want to start a practice. I don't know if I want to start a practice. Like, any advice on what they should do? Just coming out of school, maybe, and they're like, hey, I kind of like pelvic health. Should they get a good mentor? Should they, you know, go in network and work with someone? Should they go out of network with someone? Like, any advice that you would give to someone that's brand new coming into.

This field, that is such a big question, and I feel like I could argue any. Any answer. So if anybody's listening to this and disagrees strongly with what I'm about to say, I get it. But I, you know, I think for somebody initially starting out, it really depends. I think a huge part of that is their personality, like, what it is that they need, what it is that they're ready for. Because I started my business two years out of school. Is that true? Close to two years out of school, a little bit under. And for me, that was a really good fit. I felt like being in network and employed at a larger clinic with a lot of mentorship and a lot of support early on, allowed me to gain my confidence really quickly, allowed me to ask a lot of questions, allowed me to feel really ready to go out on my own and to feel really good about doing that. But I think that the most important thing for being a provider, and I mean, and being in network or out of network, is feeling confident that you're providing value and that you also feel confident that you know how to continue learning. So I could see somebody coming out of school and starting a clinic right away not feeling confident that they know how to continue learning as a clinician. So I think I would argue that the absolute best trajectory would be whether it's in network or out of network. Start at a clinic where you have support because you want that mentorship in the beginning. You want to have pts you can collaborate with in the beginning. And when you're further out into your career and you have colleagues, you don't need to be in the same building in the same facility to collaborate. But I do think that everybody who has a clinic needs collaboration. We will never know everything. Whether you've been a PT for two months or two years or 20 years, you will never know everything. So you have to know how to connect with other pts. And that would be my one concern with somebody starting a clinic before they have those connections in the field. But I think you can gain those connections in network or out of network. I do think that There are a lot of limiting beliefs about being out of network, that you need to be this extremely experienced expert in your field. I think in reality, new grads have a lot to offer. I think it's totally appropriate for the right new grad to be working in an out of network space with the right support.

Yeah, I think it's huge. I personally agree that having a mentor coming out, I mean, I was mentored for what, eight or nine years before I started, you know, my practice. So I didn't take the leap until later because I was a slow learner, I guess.

I don't know. But I. I think it all depends.

You know, I just wasn't ready maybe, I don't know, you know, I just felt like, hey, I need that support. I wanted great mentorship. And I do think, you know, having that mentorship was actually something that gave me confidence to be like, you know what? I could really treat this. And then, you know, the business aspect I've always loved. So I've always, you know, done the clinical director thing and help people grow their own business, their practices. And yeah, I think you got to just find your own. Like, you're kind of saying is, hey, maybe you're going down this path, maybe you go down this path, you know.

Yeah, I think there's no one path to land yourself in a good position as a business owner, as a clinician. I think that everybody needs different things. I will say, as somebody who started a practice pretty early on in my career, I see a lot of benefit to having waited, like, for people who've waited longer. Like, I see a lot of benefit for people who grew into a clinic director position in a network clinic prior to going into out of network. I have found that as somebody who never really had that opportunity to grow with within any clinic, I had to learn a lot more lessons for myself on my own dime, with my own back being on the line. And so I think that, you know, taking the time to get to know the industry better, to get to know the field better, to get more confident in your clinical skills, and also just to understand PT as a field would absolutely serve you, but I don't think it's 100% necessary. Yeah, I agree.

Because, yeah, I was able to grow practices and not have to spend my money. And that was a huge, huge positive.

Because I was like, does this work?

Does this not work? So, yeah, yeah.

If you can learn lessons without putting your money online, I mean, I'm all for it.

Right, right, right. Well, this has been awesome. Thank you so much for your knowledge on this. Can you tell everyone where they can find you so that people can go check you out?

Yeah, absolutely. And thank you, Kelly, so much for starting this podcast, for the work that you do, for being such an awesome leader in our field. I really appreciate you having me on and all that you do, but. But yes, you can find more information about Ladybird on our website, which is www.ladybirdpt.com. you can follow us on Instagram, which is probably where we're the most active. It's just Ladybird pt. We have a blog on our website that we update pretty frequently. We have a YouTube channel that's Ladybird PT. Our Twitter is Ladybird PT. You Google. You Google Ladybird PT. You will find all of our. All of our stuff. And. And I'm always happy to chat with new pts and people in the field, so I'm always happy to connect.

That's awesome. Yeah, we repost a lot of your stuff all the time because we love it. So keep putting it out. Yeah, keep putting it out. All right, thanks again.

If you are ready to change your life, click the link in the show notes to get your ticket to Pelvis.

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