Smart Athlete Podcast Ep. 164 – Dr. Sarah Zimmer

[00:00:00] What’s funny is I feel like it’s evolved as I’ve learned more about the profession. So honestly, in the beginning it was maybe a simple explanation of, “Well, I want to help people. I really love the health care field.” And I was an athletic person kind of my whole life, so my mom was an X-ray technologist for an orthopedic surgeon, and so her office was right by physical therapy. And I would shadow sometimes and get to see what they would do. And just as I got to see what physical therapy was and all of the different settings and things that the profession does, it just really, really spoke to me. I love, I love movement. I love working with people and I love that physical therapy is really just teaching somebody how to move better and that you can use your own body to heal itself.

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Jesse: [00:01:38] Welcome to the Smart Athlete Podcast. I’m your host Jesse Funk. My guest today is a distance runner. After my heart always love having a distance runner on, also a cyclist. She has her doctorate of physical therapy and most importantly, which we’re saving for last. She was a winner of a Michael Jackson Moonwalking competition back in 2014. So that’s definitely going to be the entirety of the podcast today. We’re going to talk about Michael Jackson. You can find her on Instagram @boulder_sports_physio. Welcome to the show, Dr. Sarah Zimmer.

Sarah: [00:02:15] Jesse, thank you so much for having me and for the wonderful intro. I love when people highlight my dance moves. For some reason, I keep that semi-private. So when it comes out.

Jesse: [00:02:28] I feel like. I feel like, you know. There — So you live in Boulder. So to be clear for people with the Instagram it is Boulder as in the city, not Boulder as in she’s bolder than other people, although that may also be true, but for spelling purposes. So I mean, so you live in Boulder. And I mean, it seems like everybody I talked to lately, he lives in Boulder, so I feel like maybe I should just move out there and we can just do all these podcasts in person.

[00:03:02] But you know, Boulder is full of very active people, lots of runners, lots of endurance and athletes, trail runners, ultra runners, cyclists, all these kind of things. So, I mean, I think if you think about from a branding standpoint, you go, okay, yeah, I’m a runner and I’ve got my doctor of physical therapy and I do all these things, but what do I have that other people don’t have, I won that Michael Jackson competition. I should make this my calling card, like you should do the whole dress-up like Michael. Like, do the poses have the silhouette on your business card, like, I think you should go all in.

Sarah: [00:03:41] That’s brilliant. I should have meshed in, like, moonwalkers.

Jesse: [00:03:45] Yeah.

Sarah: [00:03:45] Yeah, okay.

Jesse: [00:03:46] Like, very specific injuries that nobody else knows how to treat, because they’re like, how did you like what kind of moves did you do to get these injuries? And then you’re like, “Oh, yeah, you were trying to do the lean over thing, but your shoes weren’t attached to the floor. And you fell and cracked your head like.”

Sarah: [00:04:03] Totally. You know, there’s quite a lot of crossover, too, because to moonwalk you need good ankle mobility, you need stable hips. So there’s a lot of crossover. I could use some of the same videos.

Jesse: [00:04:16] There you go. What do you think? If I just say goodbye to my current companies and I just open a marketing agency, do you think I have a chance at helping rebrand people and really taking them to the next level?

Sarah: [00:04:28] Oh, my gosh. I’m sold. I’m sold. Create a business of me listening to Michael Jackson and teaching moonwalking. I’m sold, but I also love what I currently do.

Jesse: [00:04:39] Yes, unfortunately, I would guess that the time for that has passed, even though the King of Pop will probably remaining the King of Pop. We have a Gen Z now who I don’t know how aware of Michael Jackson they are or not. So it may be a little bit tougher, but I guess if you’re after the demographic, it’s going to be Gen X, maybe boomers and then millennials. Everybody’s getting older. You start teaching those dance moves, then you can bring in the physical therapy component when they eventually hurt themselves because they weren’t in shape to be doing the dance moves.

Sarah: [00:05:19] This whole new endurance sport to Boulder that I’ll bring, moonwalking.

Jesse: [00:05:24] Changing the culture. So on a more serious note, I was like to ask, like. It’s kind of a broad, but how did you get to where you are? Meaning not “Well, my parents met in 1985.” Not. Not that. Not that far back. But just like. You know why go into physical therapy? What? What’s the driver? Was it just like “I think that looks cool. We’ll try it out.” Is it as just as simple as that?

Sarah: [00:06:00] No, that’s a really good question. And what’s funny is I feel like it’s evolved as I’ve learned more about the profession. So honestly, in the beginning it was maybe a simple explanation of, “Well, I want to help people. I really love the health care field.” And I was an athletic person kind of my whole life, so my mom was an X-ray technologist for an orthopedic surgeon, and so her office was right by physical therapy. And I would shadow sometimes and get to see what they would do.

[00:06:28] And just as I got to see what physical therapy was and all of the different settings and things that the profession does, it just really, really spoke to me. I love I love movement. I love working with people and I love that physical therapy is really just teaching somebody how to move better and that you can use your own body to heal itself and stay active long time.

[00:06:55] You can get rid of chronic pain, you can avoid surgery. You can do all these amazing things by just learning how to move correctly and finding what form of movement works for you and that you love. So I’ve just have really loved that. And then of course, I moved to Colorado. I grew up in Wisconsin and went to school in Wisconsin, but moved to Colorado after I graduated from PT school.

[00:07:20] And since moving out here, I knew I wanted to be in the sports setting, but really wasn’t sure what that meant. And then about three years ago, I started my private practice boulder sports physio and have just really niched in the athletic population, which funnily enough is like the entirety of Boulder. Like I tell every single person that they’re an athlete no matter what, because everyone’s just so active, which is great.

[00:07:51] But it’s been really, really fun. And I’ve just found this really fun passion in working with athletes and getting helping people to like, continue to do what they love to do and continue to push themselves in ways they never thought they could, which is so rewarding.

Jesse: [00:08:08] One of the things you’re talking about, I always think is fascinating. And I’m kind of curious if you have any, as I ask you this, if there’s any client stories that stick out to you. But thinking about like. Like reteaching people, biomechanics or how to activate muscles they haven’t been using. I’ve gone through a little bit of that this last year as I, you know, here sitting in the chair doing all this podcast, like lack of activating my glutes while I’m running, which led to problems.

[00:08:40] Like, it’s something you take for granted. It’s like I’ve been running for 20 years. You would think, “Oh, I wouldn’t have any problems.” But just nowadays, too much sitting, basically. And I also think about my friend, who she had a very competitive athlete and she just had so many biomechanical problems. Like, I know she basically had to built from the ground up, like relearning how to walk and just I mean, she wasn’t, like, paralyzed or anything, but the way she was moving caused so many injuries and chronic pain that she literally had to start over.

[00:09:19] They like — I can’t. I don’t know all what was involved, but she was flying across the country to see specialists and all kinds of things. She wore like this adjustment for her jaw. That helped the line just lots. But it changed the way she moved and then changed her ability to be consistently active because of reaching all those things. And this isn’t a slight to her or to myself or to anybody.

[00:09:49] But on the one hand, I think about like how we’re so “dumb” that we can’t move our own body, but then like also can like we can make we make those connections or make those connections for the first time and learn how to activate things like in the more proper pattern. So I’m just curious if there’s any stories or thought you have in that direction that kind of stick out to you?

Sarah: [00:10:16] Yeah. I mean, man, there’s quite a few. I feel like that’s most of what I do, what’s interesting about the human body and I think this is true for everybody, but specifically for athletes, is that the human body is like so smart. So it will keep moving if it has to and not necessarily in the best ways all the time. But it will find compensations, it will find new routes, it will create new motor patterns to do whatever it is that you need it to do.

[00:10:46] And unfortunately, when that happens and when it happens for such a long time, it it’s a harder habit to break out of. And it normally it leads to injury or sometimes chronic injury, which is unfortunate. So I have I have so many stories where, you know, the person maybe went to a different clinic or went somewhere else and they were treated for where the pain was. So they had Achilles tendinitis and so they were just treated for that. They kind of were just looked at as a diagnosis instead of as a person. And so maybe some of it worked initially, but didn’t quite get them the full 100%.

[00:11:27] And I think the stories I can think of for patients is that maybe came in with that is as I start to listen to them and listen to their story, I start to find out like, “Oh yes, you have this Achilles tendonitis, but you also had like a bike accident you fell on your hip a few years ago and as a kid you got bucked off a horse.” And I don’t know, that’s a weird one, but it happens. And like all these little things like “Oh okay, you’ve just been creating these bad motor patterns for a while now.

[00:12:02] It’s not just about your Achilles anymore. It’s about like everything that we’re having to unravel and fix and addressing all those little pieces so that your whole system moves appropriately and the Achilles tendonitis goes away. If that answers your question, I feel like I actually do that a lot, which is the part of my job that I love. Like I love the I have to be a detective and pick out all the clues and everyone’s story and putting all the pieces together like a puzzle and “oh, okay, that’s why this is happening. Let’s make sure we addressed all of these pieces,” which sometimes can make it seem like the process is a little overwhelming or it takes a little bit longer, which I’m hoping it doesn’t feel overwhelming to people.

[00:12:46] But once you explain the full picture, it kind of makes sense and people understand like, “Oh, okay, that’s why I have to strengthen my glutes for my heel pain to go away.” And then it kind of makes sense.

Jesse: [00:12:58] Yeah. I mean, I actually went through that where it was like I was having pain presenting on my left glute and I had like glute medius issues kind of before that I worked through. So I went in. Saw someone. We kind of worked on that that went away. Then the right side started hurting and it was like, “We’ve got that glute going. But then the Achilles tendon was a problem and the hamstring was a problem.” It’s like we basically like worked our way back around the chain from like probably the source of the problem being the lack of glute activation leading to the Achilles tendonitis or tendonitis at this point.

[00:13:36] And then that caused the overcompensation back the other direction, which was stronger, getting weaker pain. So it’s like it. In theory, it’s nice to go like like I do the running show and people ask questions or I do video and like how to deal with this particular injury. It’s like, well, we can talk about. You know what the prescription is for this particular muscle or movement or tendon or whatever. These are the exercises. But I do try to mention it’s a system and there are and I’m not qualified. You are to help diagnose people and really work through the entirety of the system and changing all of the problems that can crop up.

[00:14:23] And luckily, there’s more people kind of looking at us holistically instead of just in in isolation, because when we go out and run or when we swim or bike or go lift weights or whatever, like it’s all compound movements. We’re not just like, you know, doing a calf raise or doing a bicep curl. Like it’s not a single, single muscle focus. So I think I’m talking to a couple of different PT people the last couple of weeks.

[00:14:58] And I think one of the challenges you face and maybe you can talk more about if you have a general prescription, is how to appropriately continue to load people. So like maybe you work in isolation to begin with, but like the loads and stress that you put on your body when you’re running is different than like in my case, I’m still working to the end of my progression for the tendonosis of doing like eccentric calf drops with weight, which is good, but just like the amount of load while I’m running is very different than that kind of activity.

[00:15:31] So how — not necessarily for my case in particular, but just in general. Do you have a kind of framework you work with in trying to move people from isolation to like full motion?

Sarah: [00:15:46] Yeah, yeah. I love that question. I do have a general kind of plan or protocol, if you will, for a lot of these different things. But of course, it does depend on the person and what they tolerate, what their sport is and where it’s coming from. You know, a lot of the times it’s gosh, it’s really that I only am doing like isolation at first. Like there may be a little bit of that and more. So the purpose of the isolation is just to bring the person’s awareness back to that muscle.

[00:16:21] So to make that brain-body connection of like, okay, like this is the muscle I’m talking about. This is can you feel it? Do you know what it feels like when you activate it? That is the purpose of this isolation exercise. I feel like when that comes to mind is clamshells. Like, I feel like in the past few years clamshells are being hated on is like “Duh! Clamshell. It’s such a dumb exercise,” but I do use it from time to time for that, like, I want you to feel like your glute muscles.

[00:16:49] And sometimes you have to do that in clamshell and the various, like the different variations of a clamshell. So you get all aspects of your glute. Great. You can feel it. Let’s see if you can maintain that. And now putting it in a more functional position, like maybe a bridge or maybe a standing exercise like a fire hydrant. “It’s okay. I can feel that. I can see how it’s supporting my foot.” Like I’ll do exercises in standing with people “Okay, now you. You can feel that glute muscle. Now let’s see if you can feel it while also creating foot stability. So you’re lifting your arch, your balance, your grounding through your big toe. Can you also feel how that requires glute activation?” So do exercises like that and people can see like, “oh yes, when I activate my glute, my foot is my arch is stable or whatever.” 

[00:17:40] So it’s like that. But to go in your point, especially with tendon-related things, depending on how like severe it is, maybe not so much isolation but a lot of like isometric. So just getting a lot of blood flow to the area. So for Achilles tendinitis or sometimes patellar tendonitis at the knee, I’ll give people just like isometric exercises. Meaning like for Achilles, you stand on your heel, so you kind of go up into a calf raise, but you stay there so that you activate your calf, but you’re not putting your ankle through that range of motion.

[00:18:16] So you’re not irritating the Achilles per se but you’re getting a lot of blood flow. You’re activating that muscle. That’s a great way to kind of start somebody somewhere. And then you go into the eccentrics because the point of an eccentric is trying to strengthen the muscle, but you’re trying to realign all of the tissues because a lot of these indices, there’s an inflammatory response, but there’s also like a degenerative response, if you will, like there’s micro tears, there’s breakdown.

[00:18:45] And so the point of an eccentric is loading the muscle, but in a way that realigns the tissues so that they’re all uniform and can work together. And then once it feels good and it’s strong and that, okay, now we go to functional movement pattern, so now let’s load it eccentrically while landing because that’s a lot of people’s problems. So like maybe you’re stepping off of a step and you’re landing on it. Now that feels good. Maybe we can start some plyometrics.

[00:19:12] And not to say that you can’t do all of those things in one session, but that’s kind of the general protocol that I follow and trying to add weight to it, too, especially for runners I think. Runners are starting to dabble in strength training, which is awesome. And how that looks is different for everybody. But at some point, like running is a plyometric exercise and you put like 2 to 3 times your body weight, at least with every step into your body.

[00:19:42] So if you’re only doing bodyweight strength training, that’s awesome. That’s a great place to start. But at some point you need to load those tendons and ligaments and tissues with more weight because that’s what you’re doing when you’re running is doing 2 to 3 times your body weight through that tissue.

Jesse: [00:19:59] I think so — if you, the listener, have any kind of tendon problems. I think part of the difference with that is that the adaptation time is so much longer than like muscle rehab. It can be frustrating if you haven’t done it before. I know I haven’t really had tendon issues prior to this and this has been a long one. So I started rehab back in December. I think it was race probably a little bit too early, blew it up and then had to start over because I was basically like had gotten I hadn’t finished through the whole progression. But then I was able to be at the track do speedwork, pain-free, all that kind of stuff. And I did this race and just it was not good or it’s not good, but so now I’ve learned my lesson, I guess. So —

Sarah: [00:20:52] No judgment. PTs make those decisions too sometimes.

Jesse: [00:20:54] Yeah, you know, it’s like it just is what it is. But give me more time to do more podcasts and work on the business more. I’m not running as much. So I did want to ask you about so like one of the things I was introduced to and I think you’re certified in this as well as a number of other things I kind of want to ask you about what I would call like unusual therapies or techniques, things that maybe people haven’t heard of, like Graston, which is what I was introduced to I go see a gentleman every two weeks now to have him scrape my ankle, basically, which is a fun exercise, but you always feel better afterwards.

[00:21:39] So I guess I wanted to ask a little bit about that, just some of the things that. Maybe people have heard in passing, but if they haven’t seen somebody like you, maybe you just don’t know that’s available. And then as a two-parter, because I know like if I wanted to, I could like go on Amazon and buy muscle scraping stuff. Can you talk to why maybe that’s not the best idea. I guess. I guess unless you disagree. But I’ve heard it’s maybe not the best idea.

Sarah: [00:22:14] No, I appreciate that question. Well, first, I’ll answer kind of what that is or like the different types of treatments maybe. I think a lot of physical therapists are starting to do more manual treatment, which I do, a lot of which I think is helpful. But specifically the graston I’m not certified in Graston, but I do very similar do very similar treatment using like a scraping tool.

[00:22:39] And so the kind of way that I approach it and the idea behind some of these, like the Graston and these scrappy instruments is specific to tendinopathy sort of things. I use it on muscle tissue too, but I use it a lot for tendinopathies. And going back to I think what I had said before about a lot of these injuries are like degeneration of a tissue. And then as your body lays down new tissue, it doesn’t always lay it down in the right patterns.

[00:23:08] I think the best way to describe this, I learned this from a book by Jay Dicharry. He wrote he writes a lot of really great resources for runners and books. He developed the Mobo board if people have heard of the Mobo board. But the way he describes this is like if you take a pile of pickup sticks or a pile of sticks and then you let the sticks, you stand them up on a table and then you let them go. Those sticks laid down all in all sorts of crisscross, disorganized patterns, if you will.

[00:23:36] And that’s essentially what’s happening in your body as it’s trying to heal itself. So when your Achilles starts to have those tears and degeneration or your plantar fascia and as the tissues lay down, it’s laying down in that disorganized way. So with the scraping tool, what you’re doing is you’re trying to break up that tissue. Break it up, break it up, break it up. You get some blood flow to the area, which is always good, especially for warming up a tissue.

[00:24:01] And then once you do that, like when I do it in the clinic, I’ll do that a bunch. And then I immediately have someone do exercises, especially eccentrics, because then you promote those tissues to lay back down again, but in a uniform way is the theory and the research behind it. And so that’s kind of the point. That’s why people take out these crazy, scrappy things. I think physical therapy is kind of funny. Like when people come into my clinic, I also do dry needling.

[00:24:29] So first I like poke them with a bunch of needles and then I take out this like machete looking device and I scrape the grip. I’m like, I promise all of these pokey scrappy things will make you feel better. But this like a torture chamber. And I do realize that. But it’ll work, I promise. So, yeah, it’s funny. But anyway, to answer your second question, I definitely think it’s something people can do at home.

[00:24:53] And actually I’ve talked to a few of my patients about buying an instrument and I teach them how to do it at home because I, I guess I have a funny business model in that I don’t really want people to come see me. Like I want everyone to be healthy and come see me for some help and to get it figured out. But then let’s teach you all these resources so that if it comes up or you need it, you know how to address it or use it as a preventative tool at home. And so I, I have someone buy a tool and then I teach them how to use it. But I will say I think the important aspect of that is me teaching them how to use it.

Jesse: [00:25:28] Right. That’s kind of I think what, what I had heard about not basically using it improperly could potentially be more harmful than helpful. I didn’t know all of what that would entail, but you might be more versed in that regard.

Sarah: [00:25:47] Yeah, I think where people can sometimes get those things wrong or maybe not use them correctly is a lot of times just overdoing it. I’ve actually seen that with the massage guns. Like I’ve had people come in and they had like a bruise or a scab somewhere because they like massage gun too hard. I was like, “Oh my gosh, I don’t even know if I could tell her doing that” that hard to myself. But yeah. And so it’s, it’s overdoing it like with those stripy things, you definitely need a certain amount of pressure and you want to feel that you’re, you know, scraping up some things, but you don’t want to be, like, digging super hard and creating almost more trauma to the area because we don’t want more trauma.

[00:26:29] That’s not good either. And that’s true for anywhere like in my Achilles or in my plantar fascia. You have to be careful around joints, too. You don’t want to injure your joint doing something like that. So and then that’s why there’s all these certification courses that professionals take like Rastan, because there is a very strategic way to use them or and there’s research behind it and they teach a very specific way to do it in different muscles, have their fibers aligned in different directions. And so, you know, the goal, the ideal way to use it is to really follow the way that the muscles align and those tissue fibers are aligned.

[00:27:09] And so you would only well, that would only but you would know that by learning how to do it the correct way. And also I when I teach people how to use it, I tend to tell people to kind of just scrape towards what I say is distal to proximal. So like starting from the joint away from you or you start further away from you and you scrape towards you.

[00:27:33] And the only reason why I tell people to do that is because sometimes when you scrape, you’re inducing this localized like swelling response or inflammatory response, or if there’s any swelling, ideally you want that swelling to be flushed into your lymphatic system. I have I remember this patient one time who scraped his quad and he scraped it the other way, and he went towards his knee. And then he said, all of a sudden, at the end of the night or later that day, his knee got really swollen.

[00:28:03] And I’m not sure if it was exactly from the scraping, but if it was, I could see where. “Well, you just induced a bunch of that to your quad and then you went towards your knee. I’m curious if you had went the other way, if that would have still happened” because of some of that like minor swelling response that can happen. So there definitely is a finesse to scraping, but I teach it to my patients all the time and then once they learn how to do it, I actually think that’s where I’ve been doing some telehealth or like consults recently too, with patients, and that’s something you can totally teach someone virtually.

[00:28:39] The tools are pretty cheap. There’s actually a company in Boulder called Wave Tool, and they’re fantastic. It’s a very similar instrument that has different edges and, and beveled components to it. And it’s a really, really great tool for runners, for climbers or whatever I send people to, to buy that. And then we have a telehealth conversation and we kind of go over how to use it, where to use it, and yeah, it can be really helpful.

Jesse: [00:29:09] I think that as you kind of pointed to, I think the tough part is that like. And maybe this is a symptom of A type personalities. The people that get into competitive sports and want to push and all those kind of things is the like more is better mentality. Like you go from “let’s work out really hard” and put it like, I’m going to frame this in terms of runners just because that’s where it came from. “Let’s put in all these miles and do all the speedwork and do all the things. And now we’ve worked too hard and we’ve heard ourselves because we did more better. So let’s take that same mentality. Let’s go hard with the recovery and then let’s just do more and then that’s not good.”

[00:29:52] So balance is hard, I think, is what I’m trying to get at. If you’re if you don’t know what you’re doing and you’re not being instructed or guided by somebody who does know what they’re doing, I think it’s hard to get away from that. More is better mentality. Also a little bit of the type personality thing, but also just like the tendency to want to feel like I’m doing something like I can do something to make myself better, not just like I have to sit and wait because that feels almost like interminable.

Sarah: [00:30:32] Yeah, I completely agree. And I’ll be the first person to admit that I am a type-A runner. So I completely understand. And I love the passion that comes with that. Like when people come in, they’re like, “All right, what can I do? I’m going to do all these exercises. You tell me times ten, I’m going to do them times 20. I got this. I’m going to do it. I’m going to go my heart.” And I love that passion. I love it. I love it.

[00:30:56] It’s really helpful that people are so motivated. But I agree with you. It’s it’s hard. You know, I rarely tell an athlete or someone in my office to fully rest unless they absolutely have to. Like if it’s a bad bony injury and we just need to offload everything for a little bit, you know, those cases. But most of the time there is always something that you can do, like working on mobility. There’s core exercises, there’s always because again going back to like, well, the whole system.

[00:31:29] So we want to address these things while you’re resting something else or offloading something else. So there is always something you can do. But to speak on what you just said, I do have the conversation often about I ask an athlete like “okay, well, what are you currently doing right now? What exercise are you doing? What? Tell me all of it.” And I have to have the conversation of like, “Whoa, I think we’re doing too much.” Like, they’re asking me, “What other exercises can I do?”, “What other things should I be doing for my heel or my hip or whatever?”

[00:32:02] And I sometimes would be like, I think nothing. Like, I think you’re a) either doing enough or b) I think we just need to make it more efficient and tone it down because it’s sometimes it is like loading a tissue, so it actually is time to recover. And then once that happens, now let’s reload it in the appropriate way. So it’s an interesting conversation to have. It was not something I talked about in other clinics that I worked in, but now working with runners and active people, it’s like, okay, sometimes we have to sometimes we have to do a little bit less and we don’t realize like what’s going on internally because we can’t always feel it. But, but our bodies, like working so hard on the inside to, to do it and we just have to trust the process. But it’s hard. Yeah.

Jesse: [00:32:49] Yeah, I just I think anybody that has that, that tendency towards being active, putting in work, all those kind of things and then to go. You also like, like in my case, I do three sets of ten twice a day. It’s not much. Doesn’t take long. And you go, “Well, yeah, but it’s not much. What else can I do?” I think it tended to just take time to adapt. Like there’s you can’t. There’s no rushing. It is what it is like. Your body’s going to take time to adapt. That’s the tough part.

Sarah: [00:33:27] It is. And I will say to that, too, I think initially I think that that conversation, too, happens, because I’ll admit it, it’s happened with me. I think we get afraid of injury and that I would say more often that fear is coming from a fear of time away. We’re not necessarily afraid of like my knee hurting because it’s pain, but we know it’s like not crazy, detrimental or fatal or anything like that. Like it’s not crazy severe.

[00:33:54] But I think what we’re most afraid of is time away, because that’s typically what an injury means is like we get to run less or we do less of the activity that we love to do. But I think injuries pop up for a reason, and that’s super cheesy, but I do think it’s true. Like, it’s something telling you, okay, how, how is my training going right now or how is this activity fitting into my life? Maybe I need to adjust something.

[00:34:24] And it doesn’t always necessarily mean adjusting something as it relates to movement and exercise and training. But like, let me reflect am I sleeping well? Am I really stressed right now? Am I eating enough? Is my nutrition going okay? Is it my shoes? Did I just get it or, you know, what have you like, there’s all of these different components and it’s not just like the physiological system, it’s all of it.

[00:34:51] So I think there are opportunities too. Like, “Well, maybe I just need to step back and look at the full picture” and like, “What can I” if I’m, if I’m trying to find something to do, maybe it’s “Oh, well, I just haven’t been sleeping well or I haven’t been taking enough rest days or I haven’t been eating enough before I run or whatever.” So it’s a good opportunity to do those things too.

Jesse: [00:35:17] I want to switch before we run out of time on. I switch a little bit kind of hard juxtaposition here and ask you about. So on your Instagram, you can see again boulder_sports_physio, your pregnancy and postpartum exercise coach. It’s on my mind since we have an approaching two-month-old baby now. Obviously, I did not have that baby, but my wife did. And eventually, she’ll be getting back to being active. And so I’m just curious about what that means for you and your practice, how you kind of approach that situation. And are there any typical goals for women postpartum trying to get back into exercise or is it really just a case-by-case situation?

Sarah: [00:36:08] Yeah, well, congratulations again to you guys.

Jesse: [00:36:11] Thank you.

Sarah: [00:36:11] That’s really exciting. Yeah. So I, I’ve loved the certification. I got it this year, actually. And I, I do want to say I’m not. So there are like pelvic floor physical therapists that actually get a separate certification and can do internal exams. And I suggest most runners actually, you do not have to go through pregnancy or postpartum or anything to consider physical pelvic floor physical therapy.

[00:36:36] But it is something to my pre and postpartum renders I think it’s you definitely should check in because there’s muscles that are internal that affect our hips stability and our core and you can even get like it can go down to your foot. You’ll develop plantar fasciitis if there’s a dysfunction up there. So I think it’s it’s definitely worth the visit there or to a pelvic floor specific physical therapist.

[00:37:01] But how I use my certification, I got it because I think there’s a lot of myths with pre being pre pregnant and postpartum and there’s still information to be learned about that. But it’s the myths around it are that you like, shouldn’t do a lot of things. Or there’s maybe a lot of stigma in someone who continues to run through pregnancy or they bounce back to activity quicker than somebody else. And there’s stigma with that.

[00:37:32] I think there’s also a lot of comparison going on and this pressure for these individuals to get back to where they were or to get back to a certain body type or a certain performance level. And really, it has to be an individual basis like everyone experiences pregnancy. So different. I have not been pregnant yet, but I’ve had a bajillion friends get pregnant and deliver and I’m like, “Oh my gosh, everyone was so different.” There’s really no way you can predict how it’s going to go.

[00:38:06] But I want to help empower women athletes in this phase because I think there’s a fear of not being able to run again or not being strong again. And after you deliver, after you have a baby, it’s a lot that your body goes through. But I equate it to because the rule right now is that you take six weeks, like completely off after you deliver a baby, which I do think rest is needed for sure.

[00:38:33] However, now that you have this baby, like you’re still active, like you are picking this baby up and down, you are doing all this other stuff. So if you don’t do any sort of like core retraining. You have to do that in this time as well, which will help you as you return to running. So I am trying to help women kind of feel maybe into the point of like there’s always something you can do, but like, you know, you can start those things now and feel strong now.

[00:39:02] And I think starting those exercises because I think what I’ve seen other women do is they wait the six weeks because I’d probably be this person too, just admitting you wait the six weeks and at 6 to 8 weeks your doctor says you’re good and you’re like, “All right, I’m gonna start running again.” But you’ve done nothing else. It’s kind of like if you had surgery and you waited the eight weeks, whatever, and the doctor was like, “Things are healed, you’re good to go.” And then you just try to start running after surgery like no one does that.

Jesse: [00:39:35] People have tried, but I wouldn’t guess that it goes very well.

Sarah: [00:39:39] Yeah, no. Like, I used to work in the hospital. I used to work at Boulder Community Hospital as a PT there. And like, people get their knees replaced and you’re getting them out of bed 2 hours later. Like, they’re the — you can start to strengthen the body or even do prehab, which is another thing, too, for women who are currently pregnant or thinking about there’s like all these things you can do before to keep muscles really strong before you deliver.

[00:40:06] So, so, yeah, I, I just, I think there’s a lot of myth. I think there’s a lot of pressure. And I just want to help empower women. Like, there are so many things you can do and you can, you can start sooner than later, even just doing some of the maybe more simple kind of minimal things of like floor exercises and get back into running safely because also, no, no one really wants to go through like, well, I got back into running and now I’m can’t run again because my hip is killing me or whatever it is.

[00:40:40] And I think for women and when we have kids, for men and women, men go through the birthing process and having a baby like they go through a lot too. Those outlets are still needed for sanity and stress relief. Like we still want to be active, we still want to go for a run. And I think those things are possible. But I just want to help empower people to understand like how that process can go and that you can stay strong during and after.

Jesse: [00:41:11] Sarah, before we run out of time, I ask everybody the same question each season of the show. So I’ll ask you this season’s questions now. And that question is, how do you celebrate your wins?

Sarah: [00:41:25] Ooh, how do I celebrate my wins? I celebrate them in a variety of ways. I — Oh, gosh, I love this question. I guess I usually celebrate them like with friends and family celebrating those wins. And I’m not someone that likes attention, but I do think that it’s important to recognize when you have accomplished something or like, “oh my gosh, yes, this was a goal. I deserved to, like, treat myself.” However, that may be. And so taking that time, taking that time for me, whatever that may be, again, like maybe that’s treat myself to a fancy dinner or whatever that may be.

[00:42:15] I think it’s important that way to celebrate, to celebrate wins and give yourself a pat on the back. But I don’t think I have a go-to. Even in — I’m a runner and I have only like won one race. I got first place in this trail race I did a few years ago and it was awesome. And to celebrate that one, I just like told everyone I knew about it because, like, I was just so proud of myself that like, you guys, “I won this race.” I, like, put it on Instagram or whatever. And I think it’s okay to, like, just shout out loud about yourself every once in a while because you deserve it.

Jesse: [00:42:52] That’s a good answer. I’m glad. I’m glad you got multiple ways to celebrate your wins. It said it stumped some people, which is why I ask the question. I think it’s something.

Sarah: [00:42:59] Yeah, it stumped me at first.

Jesse: [00:43:01] We should probably spend more time doing so. Yeah. Sarah, if people want to reach out, see what you’re up to, finds you, talk to you, any of that kind of stuff. Where can they do that?

Sarah: [00:43:11] Yeah, people can — you’ve already mentioned my Instagram @boulder_sports_physio with underscores. With underscores and things. Yeah, people can find me on there. They can also reach out to me in a message through their to my email is bouldersportsphysio@gmail.com and people are more than welcome to email me any time I always I feel like I say this on every podcast or whatever, but I really love being a resource and so anyone is more than welcome to reach out any time. My website is also bouldersportsphysio.com. And you can contact me through there and learn more about me. But yeah, those are probably the best ways.

Jesse: [00:43:56] Awesome. Thanks for hanging out with me today, Sarah.

Sarah: [00:43:58] Yeah. Jesse, thank you for having me. This has been really fun.

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