In this episode of HANDS ON HANDS OFF, host Dr. Moyo Tillery sits down with Dr. Sarah Shaver, a clinician, educator, and researcher focused on gender considerations in orthopaedic manual physical therapy. Together they explore why common assumptions about female athletes and chronic pain patients can perpetuate inequities—and what OMPT practitioners can do to change that.
From ACL injury risk factors to concussion outcomes, manual therapy decision-making, and care for transgender and non-binary athletes, Dr. Shaver challenges listeners to reflect on their own biases, apply equity-based care, and use available research to transform outcomes.
What you’ll learn in this episode:
- Why gendered assumptions about ACL injuries and concussions can lead to inequitable care
- How “hands-off” approaches to chronic pain disproportionately affect female patients
- The difference between equality and equity in clinical practice
- Practical strategies and resources to recognize and reduce bias in your own treatment
- How to create more inclusive environments for transgender and non-binary athletes in OMPT settings
00:00:01 --> 00:00:02 All right.
00:00:02 --> 00:00:05 Welcome to Hands On, Hands Off.
00:00:05 --> 00:00:05 Today,
00:00:05 --> 00:00:08 we are diving into a topic that's
00:00:08 --> 00:00:12 often overlooked but deeply impactful,
00:00:12 --> 00:00:13 and that is the role of
00:00:13 --> 00:00:15 gender in OMPT practice.
00:00:16 --> 00:00:18 I'm your host today, Moyo Tillery,
00:00:18 --> 00:00:20 and joining me is Dr. Sarah Shaver,
00:00:21 --> 00:00:23 whose work and insights are
00:00:23 --> 00:00:25 helping us rethink how
00:00:25 --> 00:00:26 gender dynamics shape
00:00:27 --> 00:00:27 patient provider
00:00:27 --> 00:00:29 interactions in manual therapy.
00:00:30 --> 00:00:33 Dr. Shaver, welcome to the show.
00:00:33 --> 00:00:33 Thank you.
00:00:34 --> 00:00:35 I'm excited to be here to
00:00:35 --> 00:00:37 talk about gender and physical therapy.
00:00:37 --> 00:00:38 Outstanding.
00:00:38 --> 00:00:39 It's great to see you.
00:00:40 --> 00:00:41 So let's start with a little background.
00:00:41 --> 00:00:42 Can you just briefly
00:00:42 --> 00:00:44 introduce yourself and your
00:00:44 --> 00:00:46 journey into orthopedic
00:00:46 --> 00:00:48 manual physical therapy?
00:00:48 --> 00:00:48 Yeah.
00:00:48 --> 00:00:50 So my name is Sarah Shaver.
00:00:50 --> 00:00:53 I use she her pronouns and
00:00:53 --> 00:00:54 I've been practicing for
00:00:54 --> 00:00:56 about nine years now.
00:00:56 --> 00:00:58 I did my DPT at Husson
00:00:58 --> 00:00:59 University in Maine.
00:01:00 --> 00:01:00 I went on to do an
00:01:00 --> 00:01:02 orthopedic residency and
00:01:02 --> 00:01:03 become OCS certified.
00:01:03 --> 00:01:04 I did that out in Oregon.
00:01:05 --> 00:01:06 And then I gleefully moved
00:01:06 --> 00:01:07 back to the East Coast to
00:01:07 --> 00:01:08 Boston University where I
00:01:09 --> 00:01:10 did my fellowship in
00:01:10 --> 00:01:13 orthopedic manual physical therapy.
00:01:13 --> 00:01:15 And I am currently at the
00:01:15 --> 00:01:17 tail end of my SCD program
00:01:17 --> 00:01:19 at Bellin College.
00:01:19 --> 00:01:20 But in the meantime,
00:01:21 --> 00:01:22 I am working full time
00:01:22 --> 00:01:23 treating in a clinic in
00:01:23 --> 00:01:25 Providence in an outpatient
00:01:25 --> 00:01:26 orthopedic setting,
00:01:26 --> 00:01:29 working with a lot of young athletes,
00:01:29 --> 00:01:30 predominantly female or of
00:01:30 --> 00:01:33 the LGBTQIA plus community.
00:01:34 --> 00:01:37 But this topic of gender in
00:01:37 --> 00:01:38 practice is one that is
00:01:38 --> 00:01:39 near and dear to my heart.
00:01:39 --> 00:01:40 And I feel pretty passionate
00:01:40 --> 00:01:42 about its involvement and
00:01:42 --> 00:01:43 consideration in the role
00:01:43 --> 00:01:45 of health care in general,
00:01:45 --> 00:01:46 but even more specifically
00:01:46 --> 00:01:48 to physical therapy and LMPT.
00:01:49 --> 00:01:49 Yeah, I mean,
00:01:49 --> 00:01:51 I think you've queued us up
00:01:51 --> 00:01:52 perfectly with your
00:01:53 --> 00:01:54 background and your current
00:01:54 --> 00:01:55 work environment to dive
00:01:55 --> 00:01:56 right into this topic.
00:01:56 --> 00:01:59 So let's do it.
00:01:59 --> 00:02:01 What inspired your interest
00:02:01 --> 00:02:02 in exploring gender
00:02:02 --> 00:02:05 dynamics and then gender
00:02:05 --> 00:02:07 dynamics specific to OMPT?
00:02:08 --> 00:02:09 And perhaps before we even
00:02:09 --> 00:02:11 go deeper in our discussion,
00:02:11 --> 00:02:13 can we just level set for the listeners?
00:02:13 --> 00:02:14 Can you help us define
00:02:14 --> 00:02:16 gender in this context and
00:02:16 --> 00:02:18 perhaps why it's important
00:02:18 --> 00:02:20 to distinguish gender from
00:02:20 --> 00:02:22 sex when discussing clinical care?
00:02:24 --> 00:02:25 Yes.
00:02:26 --> 00:02:27 So, yeah,
00:02:27 --> 00:02:28 I think it is really important
00:02:28 --> 00:02:30 first to differentiate
00:02:30 --> 00:02:31 between gender and sex.
00:02:31 --> 00:02:34 For the majority of this podcast,
00:02:34 --> 00:02:36 when we refer to females
00:02:36 --> 00:02:37 and males and men and women,
00:02:37 --> 00:02:38 we're going to be referring
00:02:38 --> 00:02:41 to the cis female and the cis male.
00:02:42 --> 00:02:43 And that is those assigned
00:02:43 --> 00:02:45 female at birth and those
00:02:45 --> 00:02:46 assigned male at birth.
00:02:46 --> 00:02:46 Right.
00:02:46 --> 00:02:48 That is their sex.
00:02:49 --> 00:02:49 We're going to speak in this
00:02:49 --> 00:02:51 way largely because of how
00:02:51 --> 00:02:52 research has been conducted
00:02:52 --> 00:02:53 up until this point.
00:02:54 --> 00:02:55 Research today is still
00:02:55 --> 00:02:57 grossly and overwhelming
00:02:57 --> 00:02:59 lacking for the transgender,
00:02:59 --> 00:03:01 gender fluid and non-binary community.
00:03:02 --> 00:03:03 I fully recognize and
00:03:03 --> 00:03:05 validate that community.
00:03:05 --> 00:03:06 I'm a member of the LGBTQIA
00:03:06 --> 00:03:08 community myself,
00:03:08 --> 00:03:10 but for the purpose of this podcast,
00:03:10 --> 00:03:12 because of how research has
00:03:12 --> 00:03:12 been conducted,
00:03:12 --> 00:03:14 we'll be using male and
00:03:14 --> 00:03:15 female to talk about the
00:03:15 --> 00:03:18 cis male and the cis female.
00:03:19 --> 00:03:21 So the sex assigned at birth
00:03:21 --> 00:03:22 by the provider.
00:03:24 --> 00:03:24 That's awesome.
00:03:24 --> 00:03:27 Thank you so much for grounding us there.
00:03:29 --> 00:03:32 I know that when you and I chatted before,
00:03:32 --> 00:03:34 we talked about some of the
00:03:34 --> 00:03:36 things that maybe
00:03:36 --> 00:03:39 catapulted you into this
00:03:39 --> 00:03:43 line of research and work and practice.
00:03:43 --> 00:03:45 Some of them involving
00:03:45 --> 00:03:47 existing discrepancies,
00:03:47 --> 00:03:49 gender-related discrepancy in
00:03:49 --> 00:03:51 medicine and healthcare,
00:03:51 --> 00:03:52 but in PT specifically,
00:03:53 --> 00:03:54 and maybe some of your
00:03:55 --> 00:03:57 personal experiences,
00:03:57 --> 00:03:58 meaning you've observed
00:03:58 --> 00:03:59 some powerful antidotes in
00:03:59 --> 00:04:00 your clinical work,
00:04:01 --> 00:04:02 particularly around maybe
00:04:02 --> 00:04:04 female providers feeling
00:04:04 --> 00:04:05 somewhat misunderstood or
00:04:05 --> 00:04:07 invalidated by their patients.
00:04:07 --> 00:04:07 And again,
00:04:07 --> 00:04:09 that patient provider relationship.
00:04:10 --> 00:04:11 And, you know,
00:04:11 --> 00:04:13 leaning into your presentation at AOMT,
00:04:13 --> 00:04:14 you reviewed a large
00:04:15 --> 00:04:16 retrospective analysis with
00:04:16 --> 00:04:19 a huge number of cases,
00:04:19 --> 00:04:20 over three million.
00:04:20 --> 00:04:21 So can you tell us a little
00:04:21 --> 00:04:24 bit about maybe what you took from that?
00:04:24 --> 00:04:26 What did the data reveal
00:04:26 --> 00:04:27 about patient provider
00:04:27 --> 00:04:29 gender discordance?
00:04:29 --> 00:04:31 And how does it compare to
00:04:32 --> 00:04:33 maybe what we see in
00:04:33 --> 00:04:35 broader health care literature?
00:04:35 --> 00:04:36 Can you just kind of take us
00:04:36 --> 00:04:38 into your world there?
00:04:39 --> 00:04:40 Totally.
00:04:40 --> 00:04:42 So there were so many things
00:04:42 --> 00:04:44 that contributed to me
00:04:44 --> 00:04:45 heading down this road of
00:04:45 --> 00:04:46 interest and passion.
00:04:46 --> 00:04:50 And the first is that overwhelmingly,
00:04:50 --> 00:04:53 especially when entering my fellowship,
00:04:53 --> 00:04:55 a huge overwhelming
00:04:55 --> 00:04:58 majority of my direct mentors were male.
00:04:59 --> 00:05:00 I really actually had to
00:05:00 --> 00:05:02 think deep into this to
00:05:02 --> 00:05:04 realize I had one mentor
00:05:04 --> 00:05:06 early on in my residency that was female.
00:05:06 --> 00:05:09 But overwhelmingly in the world of OMPT,
00:05:10 --> 00:05:12 My official mentors were male.
00:05:12 --> 00:05:13 I didn't have a lot of
00:05:13 --> 00:05:15 female representation from
00:05:15 --> 00:05:16 the mentor side of things.
00:05:16 --> 00:05:18 And it feels kind of similar
00:05:18 --> 00:05:20 when you walk into the AOMT conference.
00:05:21 --> 00:05:21 Sure,
00:05:21 --> 00:05:23 there are females walking around and
00:05:23 --> 00:05:23 they're there.
00:05:24 --> 00:05:25 But overwhelmingly,
00:05:25 --> 00:05:27 we see a male presence.
00:05:27 --> 00:05:28 And we often see that even
00:05:28 --> 00:05:30 reflected on the stage in our presenters.
00:05:30 --> 00:05:31 So I think that that is
00:05:31 --> 00:05:32 improving with time.
00:05:32 --> 00:05:34 Um, so that was, that was the first thing,
00:05:34 --> 00:05:35 just feeling like,
00:05:35 --> 00:05:36 even though I'm technically
00:05:36 --> 00:05:37 or theoretically in a field,
00:05:38 --> 00:05:39 female dominated field,
00:05:39 --> 00:05:40 then when we look at OMPT,
00:05:40 --> 00:05:43 we see a much more male dominated,
00:05:44 --> 00:05:45 dominated specialty,
00:05:45 --> 00:05:47 but even more so than that,
00:05:47 --> 00:05:49 even more meaningful to me
00:05:49 --> 00:05:52 is that whether it's a
00:05:52 --> 00:05:55 result of internalized bias,
00:05:56 --> 00:05:58 internalized sexism or overt bias.
00:05:59 --> 00:06:00 I'm not sure.
00:06:00 --> 00:06:02 It's probably a combination of both,
00:06:02 --> 00:06:04 but overwhelmingly I've
00:06:04 --> 00:06:06 personally watched so many patients.
00:06:07 --> 00:06:08 I have personally experienced,
00:06:08 --> 00:06:09 I have seen and felt the
00:06:09 --> 00:06:11 collective experience of
00:06:11 --> 00:06:13 the female of walking out
00:06:13 --> 00:06:14 of a healthcare appointment
00:06:14 --> 00:06:16 and watching that patient
00:06:16 --> 00:06:18 feel invalidated, misunderstood,
00:06:19 --> 00:06:20 belittled, gaslit.
00:06:21 --> 00:06:22 Oh, maybe it isn't that bad.
00:06:22 --> 00:06:24 It's, it's, it's, I, um,
00:06:25 --> 00:06:26 isn't as bad as I thought it was.
00:06:27 --> 00:06:28 I'm not, it wasn't taken seriously.
00:06:28 --> 00:06:29 My tests were negative.
00:06:29 --> 00:06:30 I was dismissed.
00:06:31 --> 00:06:32 I'm not sure I got to say
00:06:32 --> 00:06:33 everything I wanted to say.
00:06:33 --> 00:06:34 I'm not sure they understood
00:06:34 --> 00:06:35 what I was saying.
00:06:35 --> 00:06:36 I just overwhelmingly was
00:06:37 --> 00:06:39 watching females feel
00:06:39 --> 00:06:40 invalidated and
00:06:40 --> 00:06:41 misunderstood when they
00:06:41 --> 00:06:43 left a patient appointment.
00:06:43 --> 00:06:44 And we see this reflected
00:06:44 --> 00:06:45 quite frequently when
00:06:45 --> 00:06:46 females intentionally go
00:06:46 --> 00:06:48 out of their way to request treatment.
00:06:48 --> 00:06:50 another female provider
00:06:50 --> 00:06:52 they're seeking someone
00:06:52 --> 00:06:53 that they think has the
00:06:53 --> 00:06:55 capacity to understand
00:06:55 --> 00:06:56 their perspective a little
00:06:56 --> 00:06:57 bit more and who perhaps
00:06:57 --> 00:06:58 will listen to their
00:06:58 --> 00:07:00 perspective a little bit
00:07:00 --> 00:07:03 more and listen I fully
00:07:03 --> 00:07:04 believe that physical
00:07:04 --> 00:07:05 therapists are in this
00:07:05 --> 00:07:07 field with good intention
00:07:07 --> 00:07:08 but this collective
00:07:08 --> 00:07:10 experience is so broad that
00:07:11 --> 00:07:12 it's impossible to ignore
00:07:13 --> 00:07:15 I mean, when we look at the ED,
00:07:16 --> 00:07:17 we see that men's pain is
00:07:17 --> 00:07:18 taken more seriously.
00:07:18 --> 00:07:19 They're triaged more quickly
00:07:19 --> 00:07:20 than the female.
00:07:20 --> 00:07:22 We see that female patients
00:07:22 --> 00:07:23 are interrupted more
00:07:23 --> 00:07:25 frequently than the male provider.
00:07:25 --> 00:07:27 We have all this data to say that somehow,
00:07:27 --> 00:07:28 for some reason,
00:07:28 --> 00:07:29 females aren't quite
00:07:29 --> 00:07:31 receiving the same
00:07:32 --> 00:07:33 treatment or response when
00:07:33 --> 00:07:35 they're seeing their healthcare provider
00:07:36 --> 00:07:37 And we can maybe perhaps
00:07:37 --> 00:07:39 extrapolate that to physical therapy,
00:07:39 --> 00:07:40 and we'll talk about that later.
00:07:41 --> 00:07:44 And then really what was the
00:07:44 --> 00:07:45 straw that broke the camel's back,
00:07:45 --> 00:07:45 if you will,
00:07:45 --> 00:07:47 is the study that you alluded to,
00:07:47 --> 00:07:48 which was by Wallace et al.
00:07:48 --> 00:07:50 And it was one point three
00:07:50 --> 00:07:51 million patients.
00:07:51 --> 00:07:53 It was a retrospective
00:07:53 --> 00:07:55 analysis looking at patient
00:07:55 --> 00:07:57 outcomes between surgeon
00:07:57 --> 00:07:59 and patient based on sex
00:07:59 --> 00:08:00 concordance or disconcordance.
00:08:00 --> 00:08:02 So whether or not the
00:08:02 --> 00:08:03 surgeon and the patient
00:08:03 --> 00:08:05 were of same or differing sex.
00:08:05 --> 00:08:07 And what was found, again,
00:08:07 --> 00:08:08 a retrospective analysis of
00:08:08 --> 00:08:09 over one point three
00:08:09 --> 00:08:11 million patients is that
00:08:11 --> 00:08:12 when the male surgeon was
00:08:12 --> 00:08:14 male and the patient was female,
00:08:15 --> 00:08:16 the patient within thirty
00:08:16 --> 00:08:18 days of surgery was at a
00:08:18 --> 00:08:19 statistically significantly
00:08:20 --> 00:08:21 increased risk for death,
00:08:22 --> 00:08:23 worse overall
00:08:23 --> 00:08:24 post-operative outcomes and
00:08:24 --> 00:08:25 readmission to hospital.
00:08:27 --> 00:08:29 And that was the first
00:08:30 --> 00:08:31 peer-reviewed paper that I
00:08:31 --> 00:08:33 had read that truly just
00:08:34 --> 00:08:35 validated and almost
00:08:35 --> 00:08:36 slapped me in the face of
00:08:36 --> 00:08:37 this is happening.
00:08:37 --> 00:08:39 It is undeniable and it is real.
00:08:40 --> 00:08:43 And that kind of cascaded my
00:08:44 --> 00:08:47 interest and my involvement, I think,
00:08:47 --> 00:08:48 in this area of physical
00:08:48 --> 00:08:49 therapy and OMPT.
00:08:50 --> 00:08:51 Yeah, that's scary.
00:08:51 --> 00:08:53 That's really scary.
00:08:53 --> 00:08:56 And anyone listening,
00:08:57 --> 00:09:00 you know at least one cisgendered female,
00:09:00 --> 00:09:00 right?
00:09:00 --> 00:09:01 You know at least one.
00:09:01 --> 00:09:03 And so if you're feeling
00:09:03 --> 00:09:05 separated or not connecting
00:09:05 --> 00:09:06 to this topic,
00:09:07 --> 00:09:08 you know at least one person, right,
00:09:09 --> 00:09:11 who could be the person who
00:09:11 --> 00:09:12 experiences these negative
00:09:12 --> 00:09:14 outcomes because of a lack
00:09:14 --> 00:09:16 of conversation around this topic.
00:09:16 --> 00:09:18 So this is serious and this
00:09:18 --> 00:09:19 is very scary and everybody
00:09:19 --> 00:09:21 has to be thinking about this.
00:09:21 --> 00:09:24 So I'm thankful to have, you know,
00:09:24 --> 00:09:25 clinicians and leaders and
00:09:27 --> 00:09:28 innovators like yourself in
00:09:28 --> 00:09:31 this space to bring us all
00:09:31 --> 00:09:33 to a level of practice that
00:09:33 --> 00:09:35 we should be at the level, obviously,
00:09:36 --> 00:09:38 of a fellow of manual therapy,
00:09:38 --> 00:09:39 but any clinician, even at entry level.
00:09:40 --> 00:09:43 So this is a crucial conversation.
00:09:43 --> 00:09:46 And you said something, Dr. Shaver,
00:09:46 --> 00:09:49 about kind of what led to this,
00:09:51 --> 00:09:52 the things you were hearing
00:09:52 --> 00:09:53 female patients say,
00:09:53 --> 00:09:55 and the female experience.
00:09:57 --> 00:09:58 And at the foundation of
00:09:58 --> 00:10:00 that is seeking concordance
00:10:01 --> 00:10:03 and seeking understanding.
00:10:03 --> 00:10:05 And I think that part of it,
00:10:05 --> 00:10:06 just to contextualize it
00:10:06 --> 00:10:07 again for the listeners,
00:10:07 --> 00:10:08 if you're feeling separate
00:10:08 --> 00:10:11 from this topic, any human being, right,
00:10:11 --> 00:10:13 regardless of sex and gender,
00:10:14 --> 00:10:17 race and other identity differences,
00:10:17 --> 00:10:18 most people just stop.
00:10:19 --> 00:10:21 speak concordance and understanding.
00:10:21 --> 00:10:24 That's just human nature, right?
00:10:24 --> 00:10:26 So just trying to frame this
00:10:26 --> 00:10:28 work contextually in different ways,
00:10:29 --> 00:10:30 everyone has to connect to
00:10:30 --> 00:10:32 this topic because it is crucial, right?
00:10:32 --> 00:10:33 And we don't need our
00:10:33 --> 00:10:35 patients to suffer and outcomes,
00:10:37 --> 00:10:38 like you mentioned,
00:10:38 --> 00:10:40 be perpetuated because of a
00:10:40 --> 00:10:41 lack of knowledge, awareness,
00:10:41 --> 00:10:44 or tools to kind of right the ship,
00:10:45 --> 00:10:45 right?
00:10:46 --> 00:10:47 I know that in your work as well,
00:10:48 --> 00:10:48 Dr. Shaver,
00:10:48 --> 00:10:53 you have specific clinical
00:10:53 --> 00:10:57 examples to further help us
00:10:57 --> 00:10:59 connect to this data and
00:10:59 --> 00:11:01 this topic and this work.
00:11:02 --> 00:11:03 You and I talked a little
00:11:03 --> 00:11:05 bit about maybe more common
00:11:05 --> 00:11:07 trends that we've heard of
00:11:07 --> 00:11:08 as physical therapists.
00:11:09 --> 00:11:12 ACL injury, tears, female versus male.
00:11:14 --> 00:11:14 You know,
00:11:14 --> 00:11:15 I think most of us know it's
00:11:15 --> 00:11:18 maybe more common for some
00:11:18 --> 00:11:19 reasons that we're kind of
00:11:19 --> 00:11:22 taught in a narrowed focus way.
00:11:22 --> 00:11:23 Q angles increased, right?
00:11:23 --> 00:11:24 But there's more.
00:11:25 --> 00:11:25 Let's talk about that.
00:11:26 --> 00:11:27 Can you give us some
00:11:27 --> 00:11:28 clinical examples that
00:11:28 --> 00:11:29 you've seen in your
00:11:29 --> 00:11:30 practice or that you've
00:11:30 --> 00:11:31 read about in your research
00:11:31 --> 00:11:33 that helps us parse this
00:11:34 --> 00:11:35 out a little bit further?
00:11:35 --> 00:11:35 Sure.
00:11:36 --> 00:11:37 Totally.
00:11:37 --> 00:11:37 Um,
00:11:38 --> 00:11:39 so there's kind of two parts there and
00:11:39 --> 00:11:41 I'll start with the more
00:11:41 --> 00:11:42 broader question here.
00:11:43 --> 00:11:43 Um,
00:11:43 --> 00:11:45 and then I'll dive into the little bit
00:11:45 --> 00:11:47 more PT and ACL side of things.
00:11:47 --> 00:11:47 Um,
00:11:47 --> 00:11:50 so I would like to zoom out because I
00:11:50 --> 00:11:51 don't know that we can
00:11:51 --> 00:11:52 analyze where we currently
00:11:52 --> 00:11:53 are and figure out how to
00:11:53 --> 00:11:55 go forward without looking
00:11:55 --> 00:11:56 left and right and without
00:11:56 --> 00:11:57 looking backward.
00:11:58 --> 00:11:59 Um, and by that, I mean,
00:11:59 --> 00:12:00 I wanna talk about a couple
00:12:00 --> 00:12:01 examples where there's
00:12:01 --> 00:12:03 clear differences in sex
00:12:03 --> 00:12:05 based outcomes in physical
00:12:05 --> 00:12:06 or in healthcare.
00:12:07 --> 00:12:08 And it goes all the way back
00:12:08 --> 00:12:09 to nineteen ninety three
00:12:09 --> 00:12:10 because it wasn't until
00:12:11 --> 00:12:12 nineteen ninety three that
00:12:12 --> 00:12:13 women and minorities were
00:12:13 --> 00:12:14 required to be included in
00:12:14 --> 00:12:15 a medical research.
00:12:15 --> 00:12:17 So we have this huge body of
00:12:17 --> 00:12:19 data that is really was
00:12:19 --> 00:12:20 done on men patients,
00:12:20 --> 00:12:22 male patients that
00:12:22 --> 00:12:23 researchers and health care
00:12:23 --> 00:12:25 have just chose to assume
00:12:25 --> 00:12:27 perfectly extrapolates to
00:12:27 --> 00:12:29 the cisgendered female patient.
00:12:30 --> 00:12:31 And the truth is, is that it doesn't.
00:12:31 --> 00:12:32 And that's starting to
00:12:32 --> 00:12:33 become more and more clear.
00:12:33 --> 00:12:34 And unfortunately,
00:12:34 --> 00:12:35 we're seeing it come out in our outcomes.
00:12:36 --> 00:12:38 We can talk about the world
00:12:38 --> 00:12:39 of pharmacology,
00:12:39 --> 00:12:40 where women are nearly
00:12:40 --> 00:12:42 twofold greater risk of
00:12:42 --> 00:12:44 experiencing an adverse
00:12:44 --> 00:12:46 drug reaction across all
00:12:46 --> 00:12:47 drug classes and are
00:12:47 --> 00:12:49 significantly more likely
00:12:49 --> 00:12:50 to be hospitalized as a
00:12:50 --> 00:12:52 result of these adverse drug reactions.
00:12:53 --> 00:12:54 We can talk about females in
00:12:54 --> 00:12:55 the emergency department,
00:12:56 --> 00:12:57 where a female is more
00:12:57 --> 00:12:58 likely to be wrongfully
00:12:58 --> 00:13:00 discharged from the ED with
00:13:00 --> 00:13:02 symptoms of unstable angina
00:13:02 --> 00:13:03 or myocardial infarction.
00:13:03 --> 00:13:05 That risk increases if the
00:13:05 --> 00:13:06 patient is not white.
00:13:06 --> 00:13:07 We can talk about how a
00:13:07 --> 00:13:08 female presenting to the ED
00:13:08 --> 00:13:09 with a myocardial
00:13:09 --> 00:13:11 infarction is two to three
00:13:11 --> 00:13:12 times more likely to
00:13:12 --> 00:13:14 survive when being treated
00:13:14 --> 00:13:16 by a female provider.
00:13:17 --> 00:13:18 We can get away from the ED
00:13:19 --> 00:13:20 and we can talk about
00:13:20 --> 00:13:23 non-alcoholic septohepatitis or NASH,
00:13:23 --> 00:13:23 which is
00:13:24 --> 00:13:24 experienced,
00:13:24 --> 00:13:26 fifty percent more likely by females.
00:13:26 --> 00:13:27 However, men,
00:13:28 --> 00:13:29 despite controlling for all
00:13:29 --> 00:13:30 sorts of variables,
00:13:30 --> 00:13:31 are eleven point nine more
00:13:31 --> 00:13:33 likely to receive a liver
00:13:33 --> 00:13:35 transplant plant and women
00:13:35 --> 00:13:37 are more likely to die
00:13:37 --> 00:13:38 while waiting on the wait
00:13:38 --> 00:13:40 list for their liver transplant.
00:13:40 --> 00:13:40 They're more likely to be
00:13:40 --> 00:13:42 removed from the wait list
00:13:42 --> 00:13:43 altogether due to
00:13:43 --> 00:13:44 deterioration from condition,
00:13:45 --> 00:13:46 and they're more likely to
00:13:47 --> 00:13:48 just remain on the wait
00:13:48 --> 00:13:50 list indefinitely and
00:13:50 --> 00:13:51 unfortunately experience death.
00:13:52 --> 00:13:53 we can again we can zoom out
00:13:53 --> 00:13:54 even farther we can look
00:13:54 --> 00:13:55 farther left or farther
00:13:55 --> 00:13:56 right we can look at a
00:13:56 --> 00:13:58 retrospective analysis by
00:13:58 --> 00:13:59 doria rose looked at over
00:13:59 --> 00:14:00 fifty five thousand
00:14:01 --> 00:14:02 individuals and looked at
00:14:02 --> 00:14:03 the performance of
00:14:03 --> 00:14:05 sigmoidoscopy is right and
00:14:05 --> 00:14:05 whether they're performed
00:14:05 --> 00:14:07 adequately or inadequately
00:14:07 --> 00:14:08 and we see females
00:14:08 --> 00:14:09 significantly more likely
00:14:09 --> 00:14:10 to have a procedure that
00:14:10 --> 00:14:11 was performed that was
00:14:11 --> 00:14:13 deemed inadequate and of
00:14:13 --> 00:14:14 those that had an
00:14:14 --> 00:14:15 inadequate seizure they
00:14:15 --> 00:14:16 were three times more
00:14:16 --> 00:14:18 likely to go on to develop
00:14:18 --> 00:14:19 colorectal cancer
00:14:20 --> 00:14:22 And you mentioned earlier, right,
00:14:22 --> 00:14:22 this is scary.
00:14:22 --> 00:14:24 This feels terrifying to me
00:14:24 --> 00:14:28 as a cis woman that has
00:14:28 --> 00:14:31 health needs just like any other human.
00:14:31 --> 00:14:33 And I know in physical therapy,
00:14:33 --> 00:14:34 we're unlikely to be
00:14:34 --> 00:14:36 detecting on the regular
00:14:36 --> 00:14:38 colorectal cancer or heart attacks,
00:14:39 --> 00:14:39 right?
00:14:40 --> 00:14:43 And when I give this information to people,
00:14:43 --> 00:14:44 what is most commonly said
00:14:44 --> 00:14:46 to me by other therapists is,
00:14:47 --> 00:14:49 But physical therapy is different, right?
00:14:49 --> 00:14:51 We see our patients often
00:14:51 --> 00:14:52 two to three times a week.
00:14:52 --> 00:14:54 We see them for extended periods of time.
00:14:54 --> 00:14:56 We form relationships in
00:14:56 --> 00:14:57 ways other healthcare
00:14:57 --> 00:14:58 professionals don't.
00:14:58 --> 00:15:00 And listen, I hear you.
00:15:01 --> 00:15:03 But it is really difficult
00:15:03 --> 00:15:04 for me to believe that
00:15:04 --> 00:15:05 somehow we see these
00:15:05 --> 00:15:07 discrepancies in the rest of healthcare,
00:15:08 --> 00:15:09 and somehow we as physical
00:15:09 --> 00:15:11 therapists are immune.
00:15:11 --> 00:15:13 It's really difficult for me
00:15:13 --> 00:15:15 to believe that somehow,
00:15:15 --> 00:15:16 given our current society,
00:15:16 --> 00:15:19 that these biases haven't
00:15:19 --> 00:15:22 permeated or affected physical therapy.
00:15:22 --> 00:15:23 And it's really difficult
00:15:24 --> 00:15:27 for me to hear you dismiss it so easily.
00:15:28 --> 00:15:29 I think that brings us to a
00:15:29 --> 00:15:32 couple more PT specific examples.
00:15:32 --> 00:15:35 And the ACL is a classic one.
00:15:36 --> 00:15:37 It's commonly talked about
00:15:38 --> 00:15:40 how women are more likely
00:15:40 --> 00:15:41 to tear their ACL.
00:15:41 --> 00:15:43 They have wider childbearing hips.
00:15:43 --> 00:15:43 They have estrogen that
00:15:43 --> 00:15:45 makes their ligaments more lax.
00:15:45 --> 00:15:47 They have a greater Q angle, right?
00:15:47 --> 00:15:48 This is, I would say,
00:15:48 --> 00:15:50 probably commonly known and
00:15:50 --> 00:15:51 accepted language.
00:15:52 --> 00:15:52 However,
00:15:52 --> 00:15:53 when we look at that a little bit
00:15:53 --> 00:15:54 more closely,
00:15:54 --> 00:15:55 there's several variables
00:15:55 --> 00:15:57 that really should make us
00:15:57 --> 00:15:58 question that women are
00:15:58 --> 00:16:01 inherently more likely to tear their ACL.
00:16:02 --> 00:16:03 And the first is that we've
00:16:03 --> 00:16:05 watched over time the rate
00:16:05 --> 00:16:07 of male ACL tears decreasing.
00:16:08 --> 00:16:09 decline and we've seen the
00:16:09 --> 00:16:11 rate of female ACL tears
00:16:11 --> 00:16:12 either incline or stay the
00:16:13 --> 00:16:14 same kind of depending on
00:16:14 --> 00:16:15 what you're referencing.
00:16:15 --> 00:16:18 So why do we have this graph
00:16:19 --> 00:16:20 that doesn't match,
00:16:20 --> 00:16:21 especially when we have
00:16:22 --> 00:16:23 known and cited and
00:16:23 --> 00:16:26 researched ACL tear prevention protocols
00:16:27 --> 00:16:29 that have been designed for females,
00:16:29 --> 00:16:30 like the PEP program that the IOC,
00:16:30 --> 00:16:32 the International Olympic
00:16:32 --> 00:16:33 Committee put out.
00:16:33 --> 00:16:35 We have these known programs
00:16:35 --> 00:16:36 that can decrease ACL tears
00:16:36 --> 00:16:38 by the right of sixty to eighty percent,
00:16:38 --> 00:16:39 depending on the literature
00:16:39 --> 00:16:40 that you're looking at.
00:16:40 --> 00:16:41 And they're not being used.
00:16:42 --> 00:16:43 And again, my question is,
00:16:43 --> 00:16:45 why is that ignorance?
00:16:45 --> 00:16:48 Is that overt sexism?
00:16:48 --> 00:16:51 Is it subconscious bias?
00:16:53 --> 00:16:54 But inherently female ACL
00:16:54 --> 00:16:56 tears don't have to be at
00:16:57 --> 00:16:58 the rate that we are.
00:16:58 --> 00:17:00 And truly we could even back
00:17:00 --> 00:17:02 up even farther and we
00:17:02 --> 00:17:03 could look at studies of
00:17:03 --> 00:17:04 dancers that started when
00:17:04 --> 00:17:05 they were young.
00:17:05 --> 00:17:06 And the unique thing about
00:17:06 --> 00:17:08 these young dancers is that
00:17:08 --> 00:17:09 men and women often start
00:17:09 --> 00:17:10 dancing at the same age and
00:17:10 --> 00:17:12 they train for years.
00:17:12 --> 00:17:13 And what we see in dancers
00:17:13 --> 00:17:14 is that there's very little
00:17:14 --> 00:17:16 difference between males
00:17:16 --> 00:17:17 and females between their
00:17:17 --> 00:17:18 jumping mechanics.
00:17:19 --> 00:17:20 their landing mechanics
00:17:20 --> 00:17:21 between their quad to
00:17:21 --> 00:17:22 hamstring ratio and their
00:17:22 --> 00:17:24 ACL tear rates are about the same.
00:17:25 --> 00:17:28 You contrast that to something like soccer,
00:17:29 --> 00:17:30 where females are largely
00:17:30 --> 00:17:32 starting playing in their
00:17:32 --> 00:17:33 post-pubescent years.
00:17:34 --> 00:17:35 Males are starting to play
00:17:35 --> 00:17:36 in their pre-pubescent years.
00:17:37 --> 00:17:38 And we zoom out even farther
00:17:38 --> 00:17:40 and we see difference in
00:17:40 --> 00:17:41 strength training and kind
00:17:41 --> 00:17:43 of cultural upbringing in
00:17:44 --> 00:17:46 based off of gender, right?
00:17:46 --> 00:17:47 My brother was asked to
00:17:47 --> 00:17:49 stack wood and carry the groceries in.
00:17:49 --> 00:17:53 I was asked to sweep the ground, right?
00:17:53 --> 00:17:56 So even from a really super young age,
00:17:56 --> 00:17:59 we are strength training in
00:17:59 --> 00:18:02 a really gender segregated way,
00:18:03 --> 00:18:05 our males and our females differently.
00:18:06 --> 00:18:07 And then we're starting our
00:18:08 --> 00:18:09 sports at different times
00:18:09 --> 00:18:10 based off of women,
00:18:10 --> 00:18:12 females go through puberty
00:18:12 --> 00:18:15 one to two-ish years before males, right?
00:18:15 --> 00:18:16 So males are strength
00:18:16 --> 00:18:17 training and doing their
00:18:17 --> 00:18:18 sport at the peak of their puberty,
00:18:18 --> 00:18:19 at the peak of the time
00:18:19 --> 00:18:20 where their muscle building
00:18:20 --> 00:18:22 and bone density mass is
00:18:22 --> 00:18:23 most influential.
00:18:24 --> 00:18:25 females are starting after their puberty.
00:18:26 --> 00:18:27 And then we're socializing
00:18:27 --> 00:18:27 and training them
00:18:27 --> 00:18:28 differently and not
00:18:28 --> 00:18:29 initiating and providing
00:18:29 --> 00:18:30 them with the same
00:18:30 --> 00:18:33 resources and knowledge to
00:18:33 --> 00:18:34 strength train and work on
00:18:34 --> 00:18:35 these mechanics, right?
00:18:36 --> 00:18:37 So I really like to
00:18:37 --> 00:18:37 challenge the idea that
00:18:38 --> 00:18:38 women are just inherently
00:18:38 --> 00:18:41 more likely to tear their ACLs.
00:18:41 --> 00:18:43 And maybe this comes down to
00:18:44 --> 00:18:45 societal expectations,
00:18:45 --> 00:18:49 how we are gendering tasks
00:18:49 --> 00:18:51 that we give our children and even
00:18:53 --> 00:18:53 um,
00:18:53 --> 00:18:55 the information that we're giving them
00:18:55 --> 00:18:57 in sports and in physical therapy.
00:18:57 --> 00:18:58 I feel really frustrated.
00:18:58 --> 00:18:58 It happens all the time.
00:18:59 --> 00:19:00 Females come into the clinic
00:19:00 --> 00:19:02 and they're like, oh, you know,
00:19:02 --> 00:19:03 it's just like women are
00:19:03 --> 00:19:04 more likely to tear their ACL.
00:19:04 --> 00:19:05 I'm the fourth person on the
00:19:05 --> 00:19:06 soccer team this year.
00:19:06 --> 00:19:08 That's torn their ACL.
00:19:08 --> 00:19:09 Like it's just going to
00:19:09 --> 00:19:10 happen to the other side.
00:19:10 --> 00:19:11 You know, it's just more likely a woman.
00:19:11 --> 00:19:12 And there's this inherent
00:19:12 --> 00:19:13 sense of I'm weaker.
00:19:14 --> 00:19:14 I'm frailer.
00:19:14 --> 00:19:15 I'm been defeated.
00:19:16 --> 00:19:17 I'm probably going to tear
00:19:17 --> 00:19:18 the other one next year
00:19:18 --> 00:19:18 because that's what
00:19:18 --> 00:19:19 happened to women in soccer.
00:19:20 --> 00:19:20 Um,
00:19:21 --> 00:19:22 I would really like to
00:19:22 --> 00:19:23 challenge that notion.
00:19:25 --> 00:19:26 Yeah,
00:19:27 --> 00:19:28 you're challenging it right now in
00:19:28 --> 00:19:29 real time.
00:19:29 --> 00:19:29 It's happening.
00:19:29 --> 00:19:33 And it starts with increased awareness.
00:19:33 --> 00:19:35 I sincerely appreciate your zooming.
00:19:36 --> 00:19:38 You're zooming out and taking us back to,
00:19:39 --> 00:19:43 you know, where the yardstick is off.
00:19:43 --> 00:19:45 If we're measuring something
00:19:45 --> 00:19:48 against something that is not accurate,
00:19:48 --> 00:19:50 everything from there is
00:19:50 --> 00:19:51 going to be inaccurate.
00:19:51 --> 00:19:51 And that's
00:19:52 --> 00:19:52 essentially,
00:19:52 --> 00:19:54 it sounds like that's what we're seeing.
00:19:54 --> 00:19:56 And that is really powerful
00:19:57 --> 00:19:59 to kind of back it up and say that.
00:19:59 --> 00:20:00 And, you know,
00:20:02 --> 00:20:03 I've never thought about
00:20:03 --> 00:20:04 what you just said,
00:20:04 --> 00:20:05 which is we're training
00:20:06 --> 00:20:08 kids, right?
00:20:09 --> 00:20:10 I've never thought about the
00:20:10 --> 00:20:12 biomechanical implication
00:20:12 --> 00:20:14 of boys do this and girls
00:20:14 --> 00:20:16 do that and gendering and
00:20:16 --> 00:20:17 roles and things like that.
00:20:17 --> 00:20:18 I mean, that is really powerful.
00:20:19 --> 00:20:19 Maybe others have,
00:20:20 --> 00:20:22 but I find that really
00:20:22 --> 00:20:24 insightful within the
00:20:24 --> 00:20:25 context of this conversation,
00:20:25 --> 00:20:27 but of course, after that, beyond that.
00:20:28 --> 00:20:31 And continuing to zoom out,
00:20:31 --> 00:20:32 you said something that I
00:20:32 --> 00:20:35 find also really powerful, which is
00:20:37 --> 00:20:38 It's an excuse.
00:20:38 --> 00:20:39 We as physical therapists
00:20:39 --> 00:20:40 are part of the health care system.
00:20:41 --> 00:20:43 And so whenever, you know,
00:20:43 --> 00:20:44 and I think in the company
00:20:44 --> 00:20:46 of fellows in this
00:20:46 --> 00:20:47 community of practice where
00:20:47 --> 00:20:48 I think we tend to think
00:20:48 --> 00:20:50 outside the box by default,
00:20:50 --> 00:20:51 which is sometimes why we
00:20:51 --> 00:20:52 pursue fellowship training is.
00:20:53 --> 00:20:55 whenever I hear something is
00:20:55 --> 00:20:57 inherent or like you're
00:20:57 --> 00:20:58 predisposed to something
00:20:59 --> 00:21:00 especially when it comes
00:21:00 --> 00:21:03 with um the context of
00:21:03 --> 00:21:04 something really narrow
00:21:04 --> 00:21:05 like gender or height or
00:21:06 --> 00:21:08 age or race or upbringing
00:21:08 --> 00:21:09 or it just it's a red flag
00:21:09 --> 00:21:11 for me so I I appreciate
00:21:11 --> 00:21:12 that you're pushing back
00:21:12 --> 00:21:14 and challenging this this
00:21:14 --> 00:21:16 well you know she's gonna
00:21:16 --> 00:21:18 be more lax because she's a
00:21:18 --> 00:21:19 dancer or she's gonna be
00:21:19 --> 00:21:20 more flexible because she's
00:21:20 --> 00:21:21 good she's a dancer
00:21:22 --> 00:21:22 Maybe not.
00:21:23 --> 00:21:24 Maybe there's more.
00:21:24 --> 00:21:25 And what I'm hearing you say
00:21:25 --> 00:21:26 is that there is more.
00:21:27 --> 00:21:30 But the research to support
00:21:30 --> 00:21:31 that is lacking,
00:21:32 --> 00:21:34 at least specific to physical therapy.
00:21:35 --> 00:21:36 I have so many things...
00:21:37 --> 00:21:38 you know,
00:21:38 --> 00:21:39 that I want to ask you about and
00:21:39 --> 00:21:40 chat with you about.
00:21:40 --> 00:21:41 But for the sake of time,
00:21:42 --> 00:21:47 can you bring us into maybe
00:21:47 --> 00:21:48 where you are now,
00:21:48 --> 00:21:50 some of your parallel
00:21:50 --> 00:21:51 collaborations and maybe
00:21:52 --> 00:21:53 others that you've
00:21:53 --> 00:21:55 networked with and talked
00:21:55 --> 00:21:56 to who have worked in or
00:21:56 --> 00:21:57 around this space?
00:21:59 --> 00:22:01 What are those conversations like?
00:22:03 --> 00:22:04 What are you finding,
00:22:04 --> 00:22:07 whether it's in certain
00:22:07 --> 00:22:09 groups of athletes or certain ages?
00:22:10 --> 00:22:11 Can you just talk to us a
00:22:11 --> 00:22:12 little bit about the
00:22:12 --> 00:22:13 research side and the
00:22:14 --> 00:22:16 scholarship side of what's happening,
00:22:16 --> 00:22:17 what's developing,
00:22:17 --> 00:22:18 maybe where you see things
00:22:18 --> 00:22:20 going as far as your
00:22:20 --> 00:22:21 specific work in this area?
00:22:23 --> 00:22:24 Yeah, I mean...
00:22:25 --> 00:22:27 the scholarship in this area
00:22:28 --> 00:22:29 and the progression in this
00:22:29 --> 00:22:30 area is in a really really
00:22:31 --> 00:22:33 fun time um one of my
00:22:33 --> 00:22:35 favorite places to network
00:22:35 --> 00:22:36 and discuss with other
00:22:36 --> 00:22:38 clinicians and providers
00:22:38 --> 00:22:40 interdisciplinary is the
00:22:40 --> 00:22:42 female athlete athlete
00:22:42 --> 00:22:42 conference I'm going to
00:22:42 --> 00:22:44 give a little plug here
00:22:44 --> 00:22:45 female athlete conference
00:22:45 --> 00:22:47 happens in boston
00:22:47 --> 00:22:49 massachusetts every other
00:22:49 --> 00:22:49 year and it's an
00:22:49 --> 00:22:52 interdisciplinary conference
00:22:52 --> 00:22:55 full of physicians, orthopedics,
00:22:56 --> 00:22:57 physical therapists,
00:22:57 --> 00:22:59 nutritionists that are
00:22:59 --> 00:23:02 coming together to overall
00:23:02 --> 00:23:05 discuss physiology, pathology,
00:23:05 --> 00:23:06 and the treatment of truly
00:23:06 --> 00:23:07 the female patient,
00:23:07 --> 00:23:08 but a little bit more
00:23:08 --> 00:23:10 specifically the female athlete,
00:23:10 --> 00:23:11 and where I get to hear and
00:23:11 --> 00:23:12 talk to a lot of really
00:23:12 --> 00:23:14 cool researchers and hear
00:23:14 --> 00:23:17 some really novel research in the area.
00:23:17 --> 00:23:18 It was at this conference a
00:23:18 --> 00:23:19 couple years ago that my
00:23:19 --> 00:23:21 perception of very similar
00:23:22 --> 00:23:23 kind of concept, the ACL,
00:23:23 --> 00:23:24 my perception of
00:23:24 --> 00:23:26 concussions was challenged.
00:23:26 --> 00:23:29 I think really similarly to ACLs,
00:23:30 --> 00:23:31 providers often think about
00:23:31 --> 00:23:32 concussion and think, ah,
00:23:32 --> 00:23:33 females have worse outcomes
00:23:33 --> 00:23:34 when it comes to concussion.
00:23:35 --> 00:23:35 And I, you know what,
00:23:35 --> 00:23:37 I'm sure there's data that says that.
00:23:38 --> 00:23:39 But Christina Masters
00:23:39 --> 00:23:40 presented at the Female
00:23:40 --> 00:23:43 Athlete Conference and
00:23:43 --> 00:23:44 specializes in concussion
00:23:44 --> 00:23:45 and works for the NFL and
00:23:45 --> 00:23:46 the National Women's Soccer League.
00:23:47 --> 00:23:48 But she put out a paper in
00:23:50 --> 00:23:52 looking at over a thousand
00:23:52 --> 00:23:54 concussions from thirty
00:23:54 --> 00:23:56 different institutes and
00:23:56 --> 00:23:57 really challenged the
00:23:57 --> 00:23:58 notion that females have a
00:23:58 --> 00:23:59 worse prognosis because she
00:23:59 --> 00:24:01 found that within these D one schools,
00:24:02 --> 00:24:04 when time to concussion to
00:24:04 --> 00:24:06 referral and first seeing
00:24:06 --> 00:24:07 the provider was the same,
00:24:08 --> 00:24:09 the prognosis between the
00:24:09 --> 00:24:10 sexes was the same.
00:24:11 --> 00:24:12 She then went on to look at
00:24:12 --> 00:24:13 the same thing with the
00:24:13 --> 00:24:14 pediatric population and
00:24:14 --> 00:24:16 found the same outcome.
00:24:16 --> 00:24:18 This is just another topic
00:24:18 --> 00:24:19 where I constantly hear
00:24:19 --> 00:24:21 presented and talked about
00:24:21 --> 00:24:22 how women have worse outcomes.
00:24:22 --> 00:24:22 I mean,
00:24:22 --> 00:24:25 it's been drilled into my head for
00:24:25 --> 00:24:27 a really long period of
00:24:27 --> 00:24:28 time to really be
00:24:29 --> 00:24:32 questioned and not
00:24:32 --> 00:24:33 supported by this research
00:24:33 --> 00:24:35 that Christina Masters is doing.
00:24:35 --> 00:24:36 It's just another area where
00:24:36 --> 00:24:38 we're letting preconceived
00:24:38 --> 00:24:40 beliefs and notions
00:24:41 --> 00:24:43 have a strong influence on
00:24:43 --> 00:24:45 our practice because we
00:24:45 --> 00:24:46 haven't taken the time as a
00:24:46 --> 00:24:47 society or healthcare to
00:24:47 --> 00:24:50 really look at this sex specific data.
00:24:52 --> 00:24:53 But other,
00:24:53 --> 00:24:54 so Christina Masters did that
00:24:54 --> 00:24:56 work on concussions,
00:24:56 --> 00:24:56 and I'm sure she's
00:24:57 --> 00:24:58 continuing to research that.
00:24:59 --> 00:25:01 But also in this area, I mean,
00:25:01 --> 00:25:02 you can find references
00:25:02 --> 00:25:04 through the Australian Sport Institute,
00:25:05 --> 00:25:08 FASTR, F-A-S-T-R, through Stanford,
00:25:08 --> 00:25:09 where there's
00:25:09 --> 00:25:11 constantly updated research
00:25:11 --> 00:25:13 about female physiology and pathology.
00:25:13 --> 00:25:14 And it's one of the places I
00:25:14 --> 00:25:15 go to kind of look for some
00:25:15 --> 00:25:16 new female specific
00:25:16 --> 00:25:17 research or an area that
00:25:17 --> 00:25:19 I'm trying to learn more about.
00:25:21 --> 00:25:22 Yeah.
00:25:25 --> 00:25:26 Thank you for sprinkling
00:25:26 --> 00:25:29 some of those resources for us,
00:25:29 --> 00:25:29 for all of us.
00:25:32 --> 00:25:33 Appraising the evidence I
00:25:33 --> 00:25:34 think is something that we
00:25:35 --> 00:25:36 all as in this community of
00:25:36 --> 00:25:38 practice can really
00:25:38 --> 00:25:40 appreciate and bridging the
00:25:40 --> 00:25:41 gaps in where we are as
00:25:41 --> 00:25:43 individual practitioners
00:25:43 --> 00:25:44 relative to some of the
00:25:44 --> 00:25:47 topics that we talk about on this podcast,
00:25:47 --> 00:25:49 but obviously in clinical practice.
00:25:50 --> 00:25:51 I think you and I had
00:25:52 --> 00:25:55 another discussion where you, you know,
00:25:55 --> 00:25:56 provided some insight and
00:25:56 --> 00:25:58 really enlightened me on
00:25:59 --> 00:26:00 something that I think
00:26:00 --> 00:26:02 clinically I sort of
00:26:03 --> 00:26:04 witnessed and just
00:26:04 --> 00:26:07 uncomfortably brushed away as well,
00:26:08 --> 00:26:10 which is the use of manual
00:26:10 --> 00:26:13 therapy in chronic pain.
00:26:15 --> 00:26:16 And, you know,
00:26:16 --> 00:26:17 the impact of this being
00:26:17 --> 00:26:19 more negative towards women versus men or,
00:26:20 --> 00:26:21 you know, female versus male.
00:26:22 --> 00:26:24 Do you mind just telling,
00:26:24 --> 00:26:26 retelling that story from
00:26:26 --> 00:26:28 your perspective and just
00:26:28 --> 00:26:29 any other nuggets that you
00:26:29 --> 00:26:32 have around the topic of, you know,
00:26:33 --> 00:26:34 the maybe inconsistent use
00:26:35 --> 00:26:36 of or inappropriate use or
00:26:37 --> 00:26:38 disuse of manual therapy to
00:26:38 --> 00:26:39 address chronic pain,
00:26:39 --> 00:26:41 which has that influence on women?
00:26:42 --> 00:26:45 Yeah, so a couple of things come to mind.
00:26:45 --> 00:26:48 Women, anything can be disproven,
00:26:48 --> 00:26:49 but women often have more
00:26:49 --> 00:26:51 chronic pain than males.
00:26:51 --> 00:26:52 We see higher rates of
00:26:52 --> 00:26:53 things like cervicogenic headache,
00:26:54 --> 00:26:56 autoimmune diseases, right?
00:26:57 --> 00:26:59 So I think if I was to ask
00:26:59 --> 00:27:00 you to close your eyes and
00:27:00 --> 00:27:02 picture the chronic pain patient,
00:27:02 --> 00:27:03 I don't love that language,
00:27:03 --> 00:27:04 but picture a patient
00:27:04 --> 00:27:05 you've had with chronic pain,
00:27:06 --> 00:27:09 most providers probably picture a female.
00:27:10 --> 00:27:12 And a really recurrent motif
00:27:12 --> 00:27:14 I've seen in the clinic,
00:27:14 --> 00:27:16 it's kind of one of two
00:27:16 --> 00:27:17 things that more commonly
00:27:17 --> 00:27:18 are providers being like,
00:27:18 --> 00:27:19 this is a chronic pain patient.
00:27:20 --> 00:27:21 This is not someone we do
00:27:21 --> 00:27:22 manual therapy for.
00:27:22 --> 00:27:23 We need to do X, Y,
00:27:23 --> 00:27:25 and Z to address their pain,
00:27:25 --> 00:27:26 but we shouldn't do manual
00:27:26 --> 00:27:27 therapy for a chronic pain patient.
00:27:28 --> 00:27:29 And first I really want to
00:27:29 --> 00:27:30 challenge the notion that
00:27:30 --> 00:27:31 any one diagnosis,
00:27:32 --> 00:27:33 no one should have something.
00:27:33 --> 00:27:35 Similarly to every one of
00:27:35 --> 00:27:36 your patients shouldn't have one thing,
00:27:37 --> 00:27:37 right?
00:27:37 --> 00:27:38 We don't,
00:27:38 --> 00:27:41 we need to be individualizing our care,
00:27:41 --> 00:27:43 but this concept of, Ooh,
00:27:43 --> 00:27:44 hands off for chronic pain
00:27:44 --> 00:27:46 patients is
00:27:46 --> 00:27:49 disproportionately impacting
00:27:49 --> 00:27:50 female patients.
00:27:51 --> 00:27:53 It starts off with a tone of
00:27:53 --> 00:27:54 I'm inherently making a
00:27:54 --> 00:27:55 judgment and deciding you
00:27:55 --> 00:27:55 don't get this treatment.
00:27:56 --> 00:27:58 It's belittling.
00:27:58 --> 00:27:59 And doesn't allow for a
00:27:59 --> 00:28:00 thorough assessment because
00:28:01 --> 00:28:01 you've already made a
00:28:01 --> 00:28:02 decision based on a
00:28:02 --> 00:28:03 diagnosis and what
00:28:03 --> 00:28:04 treatment this patient is
00:28:04 --> 00:28:05 or isn't getting without
00:28:05 --> 00:28:08 considering their history,
00:28:08 --> 00:28:09 the other health care that
00:28:09 --> 00:28:12 they've received, other personal,
00:28:13 --> 00:28:14 socioeconomic,
00:28:14 --> 00:28:15 racial things that might be
00:28:15 --> 00:28:16 going on that we might need
00:28:16 --> 00:28:17 to consider with this patient.
00:28:17 --> 00:28:19 You've pre-decided based on
00:28:19 --> 00:28:21 a diagnosis what is going on.
00:28:22 --> 00:28:23 and what you need to do and
00:28:24 --> 00:28:25 not do about it.
00:28:25 --> 00:28:25 Again,
00:28:25 --> 00:28:27 we see this with autoimmune conditions.
00:28:27 --> 00:28:28 We see this with chronic
00:28:28 --> 00:28:30 pain and the cervicogenic headache,
00:28:30 --> 00:28:31 where we've pre-decided a
00:28:31 --> 00:28:33 treatment route based off
00:28:33 --> 00:28:34 of maybe an area
00:28:36 --> 00:28:38 that I think most therapists
00:28:38 --> 00:28:39 or a lot of therapists
00:28:39 --> 00:28:41 prefer not to treat even
00:28:41 --> 00:28:42 and have decided they're
00:28:42 --> 00:28:43 not going to receive manual therapy.
00:28:44 --> 00:28:45 Just like not everybody
00:28:45 --> 00:28:46 needs manual therapy.
00:28:47 --> 00:28:48 We don't get to say, hey,
00:28:48 --> 00:28:49 this diagnosis doesn't get it at all.
00:28:49 --> 00:28:50 That's really
00:28:50 --> 00:28:51 disproportionately impacting
00:28:52 --> 00:28:53 female patients.
00:28:53 --> 00:28:53 Yeah.
00:28:53 --> 00:29:00 And that brings me kind of
00:29:00 --> 00:29:01 to the thought process of
00:29:02 --> 00:29:05 really similarly therapists saying, oh,
00:29:05 --> 00:29:06 like,
00:29:07 --> 00:29:07 I'm not biased.
00:29:07 --> 00:29:09 I treat everyone the same.
00:29:09 --> 00:29:12 This is a really similar concept.
00:29:13 --> 00:29:15 And I hear that you saying I
00:29:15 --> 00:29:17 treat everyone the same has
00:29:17 --> 00:29:18 really positive intent.
00:29:20 --> 00:29:20 I don't think it has
00:29:20 --> 00:29:23 positive outcomes and does
00:29:23 --> 00:29:24 not play out the way you want it to be.
00:29:25 --> 00:29:28 Equality and equity are not the same.
00:29:28 --> 00:29:29 And if we are treating
00:29:30 --> 00:29:31 everybody in the same capacity,
00:29:31 --> 00:29:33 I treat everyone the same, right?
00:29:33 --> 00:29:34 That sounds so inclusive.
00:29:35 --> 00:29:35 What you're doing is
00:29:35 --> 00:29:37 fundamentally excluding and
00:29:37 --> 00:29:39 not considering certain
00:29:39 --> 00:29:41 factors that may impact one
00:29:41 --> 00:29:43 individual or a group of people.
00:29:43 --> 00:29:44 And it leaves us a lot more
00:29:44 --> 00:29:45 susceptible to practicing
00:29:45 --> 00:29:48 with bias and unconscious
00:29:49 --> 00:29:51 or internalized sexism or
00:29:51 --> 00:29:54 racism or other discriminatory ism.
00:29:55 --> 00:29:57 We have to consciously and
00:29:57 --> 00:29:58 intentionally consider the
00:29:58 --> 00:30:00 things that are different
00:30:01 --> 00:30:05 from ourselves in order to
00:30:05 --> 00:30:06 give our patients the best treatment.
00:30:07 --> 00:30:09 Yeah, no, this is so good.
00:30:11 --> 00:30:12 There's so many things in
00:30:12 --> 00:30:14 what you just said that
00:30:14 --> 00:30:18 boil down to why this matters.
00:30:18 --> 00:30:19 Previously,
00:30:19 --> 00:30:21 we talked about even delayed
00:30:21 --> 00:30:23 access to care, right?
00:30:23 --> 00:30:25 Like maybe female injured...
00:30:26 --> 00:30:27 young females are not
00:30:27 --> 00:30:28 getting sent out for care.
00:30:29 --> 00:30:29 And of course,
00:30:29 --> 00:30:31 that's going to impact outcomes, right?
00:30:31 --> 00:30:34 But then more concerningly, maybe,
00:30:34 --> 00:30:37 or equally concerning is the topic of
00:30:38 --> 00:30:40 these preconceived notions
00:30:40 --> 00:30:42 that still serve as a
00:30:42 --> 00:30:44 barrier once these
00:30:44 --> 00:30:46 populations are in our care.
00:30:46 --> 00:30:48 Oh my gosh, that is really scary.
00:30:49 --> 00:30:51 So it's one thing to not get the care,
00:30:51 --> 00:30:54 but then to finally be in a
00:30:54 --> 00:30:55 position to get it,
00:30:55 --> 00:30:59 but the practitioner with good intention
00:31:01 --> 00:31:02 The outcome is still negative.
00:31:02 --> 00:31:04 The impact is still negative.
00:31:04 --> 00:31:07 I mean, who wants to be that clinician?
00:31:07 --> 00:31:08 Not me.
00:31:08 --> 00:31:10 So I want to be enlightened
00:31:10 --> 00:31:13 to not treat everyone the same.
00:31:13 --> 00:31:13 I mean,
00:31:14 --> 00:31:16 I feel like maybe some of us
00:31:16 --> 00:31:18 listening are uncomfortable
00:31:18 --> 00:31:20 with that because now I
00:31:21 --> 00:31:22 think historically we hear, well,
00:31:22 --> 00:31:24 don't focus on the differences.
00:31:24 --> 00:31:25 Focus on what we have in common.
00:31:27 --> 00:31:28 In this case, right,
00:31:28 --> 00:31:30 equitable care and
00:31:30 --> 00:31:31 equitable clinical decision
00:31:31 --> 00:31:33 making and practice,
00:31:34 --> 00:31:35 the distinguishing factor
00:31:35 --> 00:31:38 is what helps you individualize the care.
00:31:38 --> 00:31:39 So we can't ignore that.
00:31:39 --> 00:31:39 I mean,
00:31:39 --> 00:31:42 that it seems like an
00:31:42 --> 00:31:43 oversimplification of a
00:31:43 --> 00:31:45 pretty complicated concept.
00:31:46 --> 00:31:46 thing,
00:31:47 --> 00:31:49 but we have to pay attention to what
00:31:49 --> 00:31:51 makes each patient different,
00:31:52 --> 00:31:53 specific obviously to this
00:31:53 --> 00:31:54 topic of gender.
00:31:55 --> 00:31:56 So thank you for kind of
00:31:57 --> 00:31:58 going there with us and
00:31:58 --> 00:32:00 really shedding light on
00:32:00 --> 00:32:02 maybe when our intention
00:32:02 --> 00:32:03 doesn't match our impact
00:32:03 --> 00:32:06 and that sort of ongoing reflection.
00:32:07 --> 00:32:10 That needs to happen, you know,
00:32:11 --> 00:32:12 with clinicians from
00:32:12 --> 00:32:13 patient to patient and
00:32:13 --> 00:32:15 sometimes with the same patient.
00:32:16 --> 00:32:17 We've got to step back and reassess,
00:32:18 --> 00:32:18 you know,
00:32:18 --> 00:32:19 what worked last time may not
00:32:19 --> 00:32:21 work this time because they
00:32:21 --> 00:32:22 have experienced something
00:32:22 --> 00:32:23 in the health care system
00:32:23 --> 00:32:24 that is now challenged
00:32:25 --> 00:32:27 their thought of where they're going,
00:32:27 --> 00:32:29 their recovery patterns.
00:32:29 --> 00:32:30 That's something else that I
00:32:30 --> 00:32:31 think we chatted about.
00:32:31 --> 00:32:32 Please go ahead.
00:32:33 --> 00:32:33 Yeah.
00:32:33 --> 00:32:36 Good intentions only go so
00:32:36 --> 00:32:38 far because you can't see
00:32:38 --> 00:32:40 or address what you're not looking for.
00:32:41 --> 00:32:44 I'm thinking of a paper by Stenberg et al.
00:32:44 --> 00:32:45 This was twenty twenty one.
00:32:45 --> 00:32:47 It's entitled Gender Matters
00:32:47 --> 00:32:48 and Physiotherapy.
00:32:49 --> 00:32:50 Please go read it.
00:32:51 --> 00:32:54 But this paper looked at men and women,
00:32:54 --> 00:32:57 cis men and women, and found that
00:32:58 --> 00:32:59 this was in a study,
00:32:59 --> 00:33:01 this was kind of a collection of review,
00:33:02 --> 00:33:03 but that men often viewed
00:33:03 --> 00:33:06 their pain as proof of hard labor,
00:33:06 --> 00:33:07 where women were more
00:33:07 --> 00:33:09 likely to feel shame and
00:33:09 --> 00:33:11 self blame for pain.
00:33:11 --> 00:33:12 This was after leaving a
00:33:12 --> 00:33:14 primary care appointment
00:33:14 --> 00:33:15 and that men tended to
00:33:15 --> 00:33:17 place blame outside themselves.
00:33:17 --> 00:33:18 They tended to blame their
00:33:18 --> 00:33:19 pain on external factors.
00:33:20 --> 00:33:21 Women were a lot more likely
00:33:21 --> 00:33:22 to internalize feelings of
00:33:22 --> 00:33:24 guilt and see causes within
00:33:24 --> 00:33:26 themselves for pain, right?
00:33:27 --> 00:33:29 At face value, your patients,
00:33:30 --> 00:33:31 cis men and cis women,
00:33:31 --> 00:33:33 are coming to you likely in
00:33:33 --> 00:33:34 a very different place.
00:33:34 --> 00:33:35 They have different health
00:33:36 --> 00:33:37 care experiences.
00:33:38 --> 00:33:40 They might even feel fearful
00:33:40 --> 00:33:41 of what you're going to say
00:33:41 --> 00:33:43 or fearful of how you're
00:33:43 --> 00:33:44 going to perceive them or
00:33:44 --> 00:33:46 fearful of being judged.
00:33:46 --> 00:33:47 They're foundationally
00:33:47 --> 00:33:49 coming to you at a different place.
00:33:50 --> 00:33:52 And I treat everyone the same or, oh,
00:33:52 --> 00:33:53 I just treat the patient in
00:33:53 --> 00:33:55 front of me leads us for so
00:33:56 --> 00:33:57 many blind spots.
00:33:57 --> 00:33:57 Because, again,
00:33:57 --> 00:33:59 we cannot see what we're
00:33:59 --> 00:34:01 not looking for when we're
00:34:01 --> 00:34:02 treating our patients.
00:34:03 --> 00:34:03 And I always kind of come
00:34:03 --> 00:34:05 back to this thought process,
00:34:05 --> 00:34:08 this like gut check.
00:34:08 --> 00:34:08 Right.
00:34:08 --> 00:34:10 Like if I'm sitting here and
00:34:10 --> 00:34:11 saying this and your gut
00:34:11 --> 00:34:14 reaction is I'm good, I'm not biased,
00:34:14 --> 00:34:16 then truly I'm very
00:34:16 --> 00:34:18 specifically and directly talking to you.
00:34:18 --> 00:34:18 Right.
00:34:19 --> 00:34:22 If your internal dialogue is, oh, well,
00:34:22 --> 00:34:23 I don't think I'm biased,
00:34:23 --> 00:34:24 but how could I assess
00:34:25 --> 00:34:26 where there is something
00:34:26 --> 00:34:27 that I'm doing impacting my care?
00:34:28 --> 00:34:29 How can I dive deeper into this?
00:34:31 --> 00:34:32 Then I support that.
00:34:32 --> 00:34:33 That is what your internal
00:34:33 --> 00:34:34 dialogue should be.
00:34:34 --> 00:34:35 But if you're hearing this
00:34:35 --> 00:34:36 and you're thinking, that's not me.
00:34:36 --> 00:34:36 I'm not biased.
00:34:36 --> 00:34:38 I treat my patients great, right?
00:34:38 --> 00:34:40 I'm not letting this seep into my care.
00:34:40 --> 00:34:43 Then truly, I'm directly talking to you.
00:34:44 --> 00:34:45 That sense of defensiveness
00:34:46 --> 00:34:47 that you're coming up with,
00:34:49 --> 00:34:50 that tells me that maybe
00:34:50 --> 00:34:51 some bias is seeping into
00:34:51 --> 00:34:53 your care and that you're
00:34:53 --> 00:34:54 unwilling to assess it.
00:34:55 --> 00:34:56 Yeah.
00:34:56 --> 00:34:57 You just said it, right?
00:34:57 --> 00:34:58 You took the words from me,
00:34:58 --> 00:35:02 which is sitting with being
00:35:02 --> 00:35:04 uncomfortable is good, right?
00:35:04 --> 00:35:06 We all sort of know that
00:35:06 --> 00:35:07 that's where growth and
00:35:07 --> 00:35:09 transformation happens.
00:35:09 --> 00:35:10 We tell it to our students.
00:35:10 --> 00:35:12 We tell it to our patients.
00:35:12 --> 00:35:13 And behavior change models is
00:35:15 --> 00:35:16 Are you willing to change?
00:35:16 --> 00:35:17 That means you're willing to
00:35:17 --> 00:35:18 step into a place of discomfort.
00:35:18 --> 00:35:20 And so that obviously
00:35:20 --> 00:35:21 translate into our own
00:35:22 --> 00:35:24 reflections on our practice.
00:35:25 --> 00:35:27 I've never met an orthopedic
00:35:27 --> 00:35:29 manual physical therapist
00:35:29 --> 00:35:32 or fellow who doesn't care
00:35:32 --> 00:35:34 about improving their practice.
00:35:34 --> 00:35:36 And if you're wondering why this matters,
00:35:37 --> 00:35:38 why we're talking about this,
00:35:38 --> 00:35:39 this is because
00:35:40 --> 00:35:41 We're telling you it will
00:35:41 --> 00:35:42 influence your practice.
00:35:42 --> 00:35:44 It will drive your outcomes.
00:35:45 --> 00:35:46 And that awareness is really
00:35:46 --> 00:35:49 exciting to now go back and practice.
00:35:50 --> 00:35:53 what you're hearing, even without maybe,
00:35:53 --> 00:35:55 if you haven't gone into the research,
00:35:55 --> 00:35:57 you know, to the extent that you have,
00:35:57 --> 00:35:58 Dr. Shaver is like,
00:35:59 --> 00:36:01 I am now being fed some
00:36:01 --> 00:36:02 information that should
00:36:02 --> 00:36:03 trigger some reflection.
00:36:05 --> 00:36:05 So I love that.
00:36:05 --> 00:36:07 Thank you for this conversation.
00:36:07 --> 00:36:08 It's so important to
00:36:09 --> 00:36:11 understand how this is
00:36:11 --> 00:36:11 going to influence our
00:36:11 --> 00:36:12 day-to-day practice.
00:36:12 --> 00:36:14 I remember, you know, during
00:36:15 --> 00:36:16 residency and fellowship training,
00:36:16 --> 00:36:18 just really enjoying the
00:36:18 --> 00:36:19 training because I always
00:36:20 --> 00:36:21 walked away with tangible
00:36:21 --> 00:36:24 tools that I could implement directly.
00:36:24 --> 00:36:25 And I think a lot of times
00:36:25 --> 00:36:26 that's what we're looking
00:36:26 --> 00:36:29 for as clinicians is not this abstract,
00:36:30 --> 00:36:30 you know,
00:36:31 --> 00:36:33 study, those are great,
00:36:33 --> 00:36:34 but how do I translate that
00:36:34 --> 00:36:35 into clinical practice?
00:36:35 --> 00:36:37 And that's what you're giving us.
00:36:37 --> 00:36:37 So thank you for that.
00:36:39 --> 00:36:41 And kind of along this conversation,
00:36:41 --> 00:36:42 you've sprinkled
00:36:42 --> 00:36:44 beautifully lots of tools
00:36:44 --> 00:36:47 and resources for us, the listener,
00:36:48 --> 00:36:52 to help us be aware of our bias,
00:36:53 --> 00:36:53 but then to also
00:36:55 --> 00:36:58 start to move the needle a little bit.
00:36:58 --> 00:37:00 This is a continuum and a journey.
00:37:00 --> 00:37:03 And I remember thinking too, you know,
00:37:03 --> 00:37:04 patient to patient,
00:37:04 --> 00:37:05 depending on who the
00:37:05 --> 00:37:06 patient is in front of you,
00:37:08 --> 00:37:09 It's almost an ongoing
00:37:09 --> 00:37:13 within a day of as a new patient comes,
00:37:14 --> 00:37:15 I'm in a different place in
00:37:15 --> 00:37:17 my continuum of growth and learning.
00:37:17 --> 00:37:18 And that's OK.
00:37:18 --> 00:37:19 Patients are supposed to
00:37:19 --> 00:37:22 challenge us to meet them where they are.
00:37:22 --> 00:37:23 And we say that a lot,
00:37:23 --> 00:37:25 but we can't meet patients
00:37:25 --> 00:37:26 where they are if we don't
00:37:26 --> 00:37:26 know where they are,
00:37:28 --> 00:37:29 which I think is where a
00:37:29 --> 00:37:31 lot of what I'm hearing
00:37:31 --> 00:37:33 from this conversation as well.
00:37:35 --> 00:37:36 Dr. Shaver,
00:37:37 --> 00:37:39 I'm always curious about what
00:37:40 --> 00:37:42 people are doing related to
00:37:42 --> 00:37:43 or not related to this topic.
00:37:43 --> 00:37:44 But before we go there,
00:37:45 --> 00:37:48 are there any other things
00:37:48 --> 00:37:49 that you want us to be aware of?
00:37:49 --> 00:37:51 Any strategies or
00:37:52 --> 00:37:54 suggestions just specific
00:37:54 --> 00:37:56 to our topic of OMPT,
00:37:57 --> 00:38:00 gender considerations in OMPT practice?
00:38:00 --> 00:38:01 Is there anything else you
00:38:01 --> 00:38:03 want to kind of just give us today?
00:38:04 --> 00:38:05 Yeah.
00:38:05 --> 00:38:05 I mean,
00:38:06 --> 00:38:08 I wish I could give you one
00:38:08 --> 00:38:10 succinct clinical pearl,
00:38:11 --> 00:38:13 but if there was one thing
00:38:13 --> 00:38:15 you were going to do is to
00:38:15 --> 00:38:17 intentionally and
00:38:17 --> 00:38:19 consciously spend the rest of your day,
00:38:19 --> 00:38:20 your week,
00:38:21 --> 00:38:23 thinking about what biases you
00:38:23 --> 00:38:25 may or may not have,
00:38:25 --> 00:38:27 like to truly take a deep
00:38:27 --> 00:38:29 dive into your practice and say, oh,
00:38:30 --> 00:38:31 did I use language that
00:38:31 --> 00:38:33 happened to set that patient up?
00:38:33 --> 00:38:35 to feel like it was her fault?
00:38:36 --> 00:38:39 Did I skew my manual therapy
00:38:39 --> 00:38:41 practices in a way that was
00:38:41 --> 00:38:42 not beneficial to them
00:38:42 --> 00:38:45 because of their gender or sex?
00:38:45 --> 00:38:47 How do I change this in the future?
00:38:47 --> 00:38:49 How do I better validate and
00:38:49 --> 00:38:50 listen to my patients that
00:38:51 --> 00:38:52 have historically been
00:38:52 --> 00:38:54 invalidated and felt belittled?
00:38:54 --> 00:38:56 Like I want you to truly
00:38:56 --> 00:38:58 take the time to
00:38:59 --> 00:39:00 intrinsically process and
00:39:00 --> 00:39:01 think about that.
00:39:01 --> 00:39:04 And the truth is, almost inevitably,
00:39:04 --> 00:39:05 you've probably let a bias
00:39:05 --> 00:39:06 seep into your practice in
00:39:06 --> 00:39:07 the future or in the past.
00:39:08 --> 00:39:09 And almost inevitably,
00:39:09 --> 00:39:10 it'll probably happen again
00:39:10 --> 00:39:11 in the future.
00:39:12 --> 00:39:13 And that's okay as long as
00:39:13 --> 00:39:14 you're willing to reflect
00:39:15 --> 00:39:16 on it and acknowledge it and grow.
00:39:17 --> 00:39:18 It's when it goes unchecked
00:39:19 --> 00:39:19 that it's a problem.
00:39:21 --> 00:39:22 And reach out to people that
00:39:22 --> 00:39:23 are of different
00:39:23 --> 00:39:25 sexes and gender from yourself,
00:39:25 --> 00:39:26 talk to them,
00:39:26 --> 00:39:27 ask them what works for them,
00:39:27 --> 00:39:28 what they have seen,
00:39:28 --> 00:39:30 like bring this to your clinic,
00:39:30 --> 00:39:31 bring this to your place of work,
00:39:31 --> 00:39:32 bring this to your
00:39:32 --> 00:39:34 university and discuss it
00:39:34 --> 00:39:34 with people and make it an
00:39:34 --> 00:39:37 active conversation.
00:39:37 --> 00:39:38 This can't be a passive,
00:39:38 --> 00:39:39 this can't be a passive
00:39:39 --> 00:39:39 change for the field of
00:39:40 --> 00:39:41 physical therapy or OMPT.
00:39:42 --> 00:39:45 My second recommendation is to read.
00:39:45 --> 00:39:48 It doesn't need to be in the
00:39:48 --> 00:39:49 depths of your university library.
00:39:49 --> 00:39:50 It doesn't need to be
00:39:50 --> 00:39:51 peer-reviewed journals.
00:39:52 --> 00:39:54 Pick up Roar by Stacey Sim
00:39:54 --> 00:39:56 and learn about female physiology.
00:39:56 --> 00:39:56 Pick up
00:39:57 --> 00:39:59 Unwell Woman by Eleanor
00:39:59 --> 00:40:01 Klanghorn and learn about
00:40:02 --> 00:40:03 the history of gender
00:40:03 --> 00:40:05 discrepancy in the
00:40:05 --> 00:40:07 healthcare in the United States.
00:40:08 --> 00:40:09 Pick up He, She,
00:40:09 --> 00:40:10 They by Skylar Baylor and
00:40:11 --> 00:40:14 learn about non-binary and
00:40:14 --> 00:40:16 transgender individuals and
00:40:17 --> 00:40:20 like intentionally read
00:40:21 --> 00:40:22 even outside of your field,
00:40:22 --> 00:40:23 and learn about the
00:40:23 --> 00:40:23 collective experience of
00:40:23 --> 00:40:24 the people that are most
00:40:24 --> 00:40:26 different from you so that
00:40:26 --> 00:40:27 you can best help them when
00:40:27 --> 00:40:28 they're in front of you.
00:40:29 --> 00:40:30 I love that.
00:40:31 --> 00:40:33 Those are outstanding resources.
00:40:33 --> 00:40:34 Once again,
00:40:34 --> 00:40:36 you're giving us things we can use,
00:40:36 --> 00:40:36 and I love that.
00:40:36 --> 00:40:38 And I want to take a second
00:40:38 --> 00:40:41 to just hopefully everyone
00:40:41 --> 00:40:43 can see the parallel
00:40:43 --> 00:40:44 between what you said as
00:40:44 --> 00:40:45 far as refining your
00:40:45 --> 00:40:47 practice and ongoing reflection.
00:40:48 --> 00:40:50 It's sometimes something
00:40:50 --> 00:40:51 that I feel like we drill
00:40:51 --> 00:40:53 down when we talk about
00:40:53 --> 00:40:54 psychomotor skills.
00:40:54 --> 00:40:54 And again,
00:40:54 --> 00:40:55 we're orthopedic manual physical
00:40:55 --> 00:40:57 therapists, we're using our hands,
00:40:58 --> 00:40:59 you apply a technique, it didn't go well.
00:40:59 --> 00:41:01 So you take a step back and
00:41:01 --> 00:41:03 you figure out what went well,
00:41:03 --> 00:41:03 what didn't,
00:41:03 --> 00:41:05 get the feedback and then improve.
00:41:06 --> 00:41:08 Can we just apply that to
00:41:08 --> 00:41:09 what we're talking about here?
00:41:09 --> 00:41:11 You know, it's the same framework.
00:41:11 --> 00:41:13 It's just a different thing
00:41:13 --> 00:41:16 at the center of that practice.
00:41:16 --> 00:41:17 And so I love that.
00:41:17 --> 00:41:18 For me,
00:41:18 --> 00:41:21 that is a parallel that I really
00:41:21 --> 00:41:22 connect with.
00:41:23 --> 00:41:23 You know,
00:41:23 --> 00:41:26 refining my skills goes beyond my
00:41:26 --> 00:41:28 hands-on skills, right?
00:41:29 --> 00:41:30 It's more than that.
00:41:30 --> 00:41:31 There's so much more to that.
00:41:31 --> 00:41:33 So thank you for those tips.
00:41:34 --> 00:41:35 That's awesome.
00:41:36 --> 00:41:38 And as we're kind of closing,
00:41:39 --> 00:41:41 I want to talk about maybe
00:41:41 --> 00:41:42 some hot topics.
00:41:43 --> 00:41:45 You talked to me about a
00:41:45 --> 00:41:47 course that you're involved in,
00:41:47 --> 00:41:48 a female athlete course
00:41:48 --> 00:41:50 that touches a little bit
00:41:50 --> 00:41:52 on transgender athletes as well.
00:41:52 --> 00:41:56 Can you tell us more, some takeaways,
00:41:56 --> 00:41:57 maybe some things for us to
00:41:57 --> 00:41:58 consider related to that work?
00:41:59 --> 00:42:00 Totally, yes.
00:42:00 --> 00:42:01 So I teach a course to some
00:42:01 --> 00:42:02 sports residents entitled
00:42:03 --> 00:42:03 The Female Athlete,
00:42:04 --> 00:42:05 but I have basically an
00:42:05 --> 00:42:07 entire lecture dedicated to
00:42:07 --> 00:42:08 the transgender athlete or
00:42:08 --> 00:42:10 treating the transgender individual.
00:42:12 --> 00:42:13 And when I talk about this,
00:42:13 --> 00:42:15 what I hear so commonly is, oh,
00:42:15 --> 00:42:16 that's such a small
00:42:16 --> 00:42:17 percentage of the population.
00:42:18 --> 00:42:20 That's not really entry level material.
00:42:20 --> 00:42:21 I really want to challenge
00:42:22 --> 00:42:23 that here and now, because first,
00:42:24 --> 00:42:25 in the United States,
00:42:25 --> 00:42:26 there's an estimated one
00:42:26 --> 00:42:28 point three million transgender humans.
00:42:29 --> 00:42:29 Right.
00:42:29 --> 00:42:31 That is a huge percentage.
00:42:32 --> 00:42:34 That's a huge amount of the population.
00:42:34 --> 00:42:34 And in my clinic,
00:42:35 --> 00:42:36 it's an overwhelming amount
00:42:36 --> 00:42:38 of the population,
00:42:39 --> 00:42:40 a large amount of the population.
00:42:40 --> 00:42:40 So
00:42:42 --> 00:42:44 And truly, like in DPT school,
00:42:45 --> 00:42:47 I did sharps debridement on an orange,
00:42:47 --> 00:42:49 okay?
00:42:49 --> 00:42:52 If that is entry-level information,
00:42:52 --> 00:42:53 then learning about the
00:42:54 --> 00:42:56 musculoskeletal rib and
00:42:56 --> 00:42:57 chest pain that an
00:42:58 --> 00:43:00 individual may acquire if
00:43:00 --> 00:43:01 they are improperly using
00:43:01 --> 00:43:02 their chest binder,
00:43:03 --> 00:43:05 that's entry-level too and
00:43:05 --> 00:43:08 should be in our residency programs.
00:43:08 --> 00:43:11 If my learning how to use ultrasound-
00:43:11 --> 00:43:13 as entry-level material,
00:43:13 --> 00:43:14 then so is learning about
00:43:15 --> 00:43:16 shoulder mobility and pain
00:43:16 --> 00:43:20 after top surgery, right?
00:43:20 --> 00:43:21 Deciding that an entire
00:43:21 --> 00:43:23 minority of the population
00:43:23 --> 00:43:28 is not entry-level material
00:43:28 --> 00:43:30 or is not enough of them to
00:43:31 --> 00:43:32 teach the material in your
00:43:32 --> 00:43:33 residency or in your DPT
00:43:33 --> 00:43:36 program is an example of discrimination.
00:43:37 --> 00:43:39 I think this material is not
00:43:39 --> 00:43:40 difficult to teach,
00:43:41 --> 00:43:43 but should be in our curriculum,
00:43:43 --> 00:43:45 both in residencies and in DPT programs.
00:43:47 --> 00:43:48 And you've probably treated
00:43:48 --> 00:43:49 a transgender individual
00:43:49 --> 00:43:50 whether you know it or not also.
00:43:52 --> 00:43:52 That's powerful.
00:43:52 --> 00:43:53 That's really powerful.
00:43:53 --> 00:43:55 We talk about inclusive practice.
00:43:55 --> 00:43:56 This is what it is.
00:43:56 --> 00:43:57 This is what it looks like.
00:43:57 --> 00:44:00 And you're preaching to me, right?
00:44:00 --> 00:44:02 Because I do feel like I
00:44:02 --> 00:44:03 have a sense of awareness
00:44:03 --> 00:44:05 about some of these topics.
00:44:05 --> 00:44:08 And yeah, I practice inclusively,
00:44:08 --> 00:44:09 but I can tell you that
00:44:10 --> 00:44:11 I have work to do.
00:44:12 --> 00:44:13 After speaking to you and
00:44:14 --> 00:44:16 learning about there are
00:44:16 --> 00:44:18 still gaps and how
00:44:18 --> 00:44:20 inclusive are we truly in our practice?
00:44:20 --> 00:44:22 Now, granted, we are, you know,
00:44:22 --> 00:44:24 subspecialists in the world of OMPT,
00:44:24 --> 00:44:25 which is why I was really
00:44:25 --> 00:44:27 interested in chatting with
00:44:27 --> 00:44:29 you about this is, you know,
00:44:29 --> 00:44:34 gender topics spans OMPT practice.
00:44:34 --> 00:44:36 It goes way beyond that.
00:44:36 --> 00:44:37 But if we're going to be
00:44:39 --> 00:44:41 specialists within a specialty practice,
00:44:42 --> 00:44:43 we have to consider the
00:44:43 --> 00:44:45 minority population, right?
00:44:45 --> 00:44:46 Like fellows, we do tend to,
00:44:46 --> 00:44:48 I can speak maybe for
00:44:48 --> 00:44:49 myself and a lot of my
00:44:49 --> 00:44:52 colleagues in OMPT practices,
00:44:53 --> 00:44:55 you might get that complicated patient.
00:44:55 --> 00:44:56 They tend to give you that
00:44:56 --> 00:44:57 complicated patient because
00:44:57 --> 00:44:58 you're the fellow,
00:44:58 --> 00:44:59 you're going to figure it out.
00:45:00 --> 00:45:02 And so even within our subsets of
00:45:03 --> 00:45:04 of patients,
00:45:04 --> 00:45:06 we have to consider the
00:45:06 --> 00:45:07 minority patient because
00:45:08 --> 00:45:09 they may be more likely to
00:45:09 --> 00:45:11 come and see us because no
00:45:11 --> 00:45:13 one else could figure out what was wrong.
00:45:13 --> 00:45:14 So that is, I mean,
00:45:15 --> 00:45:16 I think what a great
00:45:16 --> 00:45:18 representation and picture
00:45:18 --> 00:45:21 of inclusive practice and how to do that.
00:45:21 --> 00:45:21 So thank you again.
00:45:21 --> 00:45:22 I mean,
00:45:22 --> 00:45:24 so many nuggets I think that you
00:45:24 --> 00:45:27 have given us and tangibles.
00:45:28 --> 00:45:30 I have to now poke you a
00:45:30 --> 00:45:31 little further and say,
00:45:33 --> 00:45:35 What's next for you in this
00:45:35 --> 00:45:36 space or in other spaces?
00:45:38 --> 00:45:40 Maybe in your career trajectory,
00:45:40 --> 00:45:41 are there studies or
00:45:41 --> 00:45:42 initiatives you're excited about?
00:45:42 --> 00:45:43 Tell us a little bit more
00:45:43 --> 00:45:45 about that and then we'll wrap it up.
00:45:47 --> 00:45:47 Sure.
00:45:48 --> 00:45:49 My future is a little bit
00:45:49 --> 00:45:50 vague at the moment.
00:45:50 --> 00:45:51 I'm currently finishing the
00:45:51 --> 00:45:54 DSC at Bellin and I would love,
00:45:54 --> 00:45:55 my ultimate goal is to kind
00:45:55 --> 00:45:57 of transition into academia
00:45:57 --> 00:46:00 and then very intentionally
00:46:00 --> 00:46:01 dive into the world of research,
00:46:01 --> 00:46:03 of researching both gender
00:46:03 --> 00:46:04 discrepancy and working and
00:46:04 --> 00:46:07 researching the LGBTQIA community.
00:46:08 --> 00:46:08 Enough said.
00:46:09 --> 00:46:10 Nothing to add.
00:46:10 --> 00:46:10 That's amazing.
00:46:11 --> 00:46:13 And there's a lot of work ahead for you,
00:46:13 --> 00:46:13 so get ready.
00:46:14 --> 00:46:16 As you can see, in your own work,
00:46:17 --> 00:46:18 you've discovered this.
00:46:18 --> 00:46:19 Thank you, Dr. Shaver,
00:46:20 --> 00:46:22 so much for joining us and
00:46:22 --> 00:46:23 for challenging us to think
00:46:23 --> 00:46:27 really critically about gender in OMPT.
00:46:28 --> 00:46:30 For those of us listening,
00:46:30 --> 00:46:31 those of you listening,
00:46:32 --> 00:46:32 we will be sure to get
00:46:32 --> 00:46:34 these resources out to you
00:46:35 --> 00:46:38 And until next time, everyone stay curious,
00:46:38 --> 00:46:39 stay reflective,
00:46:39 --> 00:46:41 keep your hands on and your minds open.
00:46:41 --> 00:46:42 Thank you, Dr. Shaver.
00:46:42 --> 00:46:43 Thank you.