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Chad Woodard, DPT | Physiotherapist for Men | Pelvic Health Summit

Chad Woodard, DPT | Physiotherapist for Men | Pelvic Health Summit


(gentle chime music) – Welcome back to the
Pelvic Health Summit. I’m sitting here with Chad Woodard who is a physiotherapist and founder of Symbio Physical Therapy
located in Manhattan, there are two locations. Thank you so much for being here. – Thanks for having me. – So tell me a little bit about
yourself and your practice. – Myself and my practice,
I’ve been a physio for going on about 10 years now. And about two and a
half years ago I started my practice called Symbio Physiotherapy. It has exploded and
grown and lots of reasons that we’ll save for a talk about being an entrepreneur I think,
but just loving my team. So we’ve grown, we’re 15 strong now, we’ve just brought on a
new pelvic floor therapist, his name’s Adam, and planning to bring on another one this summer,
and then myself of course. They can’t get rid of me. (Pamela laughs) Myself, I’m also a full-time professor. I’m an athlete myself, a tri-athlete, and a general doer of ridiculous things. That’s me in a nutshell. – Awesome, thank you. (laughs) So happy to have you
here, so tell us about the common patients you
see who are coming in. – Sure, so I see men, I
only treat male patients. And then common diagnoses
range anything from chronic non-inflammatory prostatitis, or urinary dysfunction,
or sexual dysfunction, or sometimes just general
pain of a nondescript origin, just things hurt and we
don’t seem to know why. – Will you tell me a little bit about the patient journey, what happens when they step foot in your practice? – Sure, the journey starts,
the patient comes back with me and just like any other physical therapy or physiotherapy appointment,
the first thing we do is we chat and I ask them what’s cooking, how come you’re here,
what can I help you with? And we do a whole subjective
of why they’re there and what’s going on with their body specifically their pelvic function, that is not going as well
as they want it to go. This is usually a point
in the first session that most men, I won’t
say all, but most men are pretty nervous and
apprehensive about the situation. A couple of reasons why,
and it’s quite normal to have that apprehension
or those nerves, is number one they don’t
know what’s gonna happen in that session, and they’re
sitting across from me and they don’t know what I’m going to do. So it’s my job to explain
it and to calm, right? The second reason why,
there’s kind of a lot of pent up energy in a lot of
the guys that I’m seeing is because they’ve been
dealing with some sort of condition in their pelvic floor
or in their general health that’s just non-ideal. That could be from long-term
sexual dysfunction, or erectile dysfunction,
or it could just be they’ve had pain and
nobody seems to know why. So they’re coming into the situation with quite a back story. So after we chat for
a while, then probably my most important job, at
least to start their journey, is to convince them that
it’s not all in their head because a lot of guys have
come to me and they say, “I’ve seen other
practitioners and they say “I’m just too stressed out,
and I try to decrease my stress “and that makes me more
stressed,” paradoxically. So to demystify some of that and then to, usually quite helpful,
especially for my men, is to say here’s anatomically
why you are feeling what you just described you’re feeling. When I can hold up a
picture and show these guys this is the thing, here’s what it’s doing, and here’s how it manifests
into your symptoms, the temperature just cools. Everybody says whoo, okay, or they say, “So you’re saying I’m not crazy?” And at this point, I’m a hugger, so I just want to like
reach out and be like, “It’s okay dude, yes, you’re
not crazy, everything’s fine.” So that’s step one. Then based on what we find and what we do then we continue on to
answering questions, treatment, home exercises, factors that are
propagating these symptoms. Then we go through just
one step at a time, just like any other, just like if your knee hurts or something. – Awesome, that’s super
helpful to just kind of understand the process. So for those people who are out there who aren’t in New York,
what are some common at-home things that they could do maybe to just relax or feel into their body before they go and reach out to someone who has a similar expertise? – Don’t go to Google and
type in your symptoms. That usually makes it worse. Don’t go to Google and
type in your symptoms. (Pamela laughs) But if you do, which
everybody does anyway, common at-home things that I would say even if they haven’t come in
to see me or one of my team is learning how to breathe,
which sounds kind of a miniscule thing but truly
doing just deep belly breaths. Then just relaxation cues. Often, no matter what the condition, most of my men that’s the
first thing they need anyway is me teaching them how
to take a nice deep breath and then also a cue that
does relax their pelvic floor because that’s mostly
what I am seeing is just pelvic floors that are
all wound up and in spasm. So if I teach a fella how to breathe and then give him a couple of cues like as you’re laying down and
breathing can you imagine the two bones you’re
sitting on, your sitz bones, can you imagine them just drifting apart? And they’re like, “Yep.” “Great, there’s your homework.” And often they don’t need
me to do anything magical or radical, it’s just
remembering to breathe. Then the second thing
that I almost universally every male patient that I see, in addition to all patients in general, is just good balanced
movement, whatever that means. That could be from whatever
the activity level is now, to the next step, so
that might be somebody just going out for a walk
or doing some sort of group class that feels good to their body, but just doing some sort of movement to keep the hips and
the pelvis just moving in a more optimal, ideal way. – So tell us, what are common myths around especially men with pelvic
floor and pelvic pain, dysfunction, that you
can address other than the big one, that you’re not crazy, which has been a theme this
whole time, it’s so important. – Common myths, yeah, you’re not crazy. There is a reason why this is happening. I will say that there’s a
very common and an expected link, emotional link,
to having a pelvic floor that isn’t functioning
the way we want it to. And if I can speak frankly, whether it be a cultural
thing or a societal thing, almost any man that has
had one experience of not being able to stay hard
as long as they want to, and then in their brain now they have the two dreaded letters, ED. Then the next time that they
are in a sexual experience or with a partner, then the
first thing they think about is, “Oh God, what if it happens again?” So it’s super normal, and
I have yet to meet a male that hasn’t experienced that at some point if they’re past the age of 14, right? So there is this emotional
like, “Oh my gosh, “what if it happens again?” Or “What does that mean about me?” Or if we’re in a certain
stage of life or something, “Oh, well I’m in my mid-30s
so it’s just normal now “that I can’t have sex like I used to.” So there’s a lot of attachments
to having a pelvic floor that isn’t working the way
that a man might want it to. So there is that association with the dread of oh God, if it happens again. But yeah, other common I think myths are oh well, I read on
Google that I’m whatever, 38 years old and that
means my testosterone is naturally supposed to
lower, and so that means that I shouldn’t be as sexually active, even though I really want
to be, so this is just life, this is my body changing. I’ll acknowledge of course
that as the body ages it does change, but to
kind of resign yourself to a lifestyle that
isn’t optimal is garbage. – Definitely, garbage. (laughs) – It’s a strong word. – It’s a very strong
word, but it’s important to advocate for yourself
and to live your best life and the life you want. So we touched upon erectile dysfunction, can you share a little bit more about other pelvic pain
conditions that you treat? – Sure, one of my favorites
because it’s my least favorite is the non-inflammatory, or
non-bacterial prostatitis which basically means
that it’s not prostatitis. When pelvic floor spasms
in a man, it mimics the symptoms of a prostate
that is inflamed or infected. So what a lot of guys that
come to me with that diagnosis, their story very often is, “Well, I went and I got
prescribed antibiotics “and I went on those for seven to 30 days “depending on the antibiotic.” And then of course then
I ask, “Did it help?” And the answer is usually, “Kind of.” So if there is anything
other than yes, that helped, then it wasn’t a bacterial infection, or the antibiotic was incorrect. But if they say maybe it kind of helped then that tells me cool, that
wasn’t a bacterial problem. The problem with that
is then these guys go on and off antibiotics
for a very long time, because it’s just misdiagnosed. Then that leads to other
things like digestive issues or misdiagnosed irritable
bowel syndrome or whatever, because of this prolonged antibiotic use. So I see a lot of guys
with that and really all it is, is just like I don’t know, you can kind of make
the analogy to getting a cramp in your calf at night,
a charlie horse, or a spasm. So it’s just you have these
muscles in your pelvic floor that when they go into spasm it mimics the signs of prostatitis
which is burning or pain with urination or ejaculation, or it could even be pain with erection, or pain with sitting, or whatever, so it sounds a lot like prostatitis. So I see a lot of guys with that. Erectile dysfunction,
usually guys will come in and they will tell me about
their erectile dysfunction but there’s a very few number of people that come in with pelvic floor dysfunction that don’t also have erectile dysfunction, and there’s a perfectly
reasonable reason for that, reasonable reason,
because one of the muscles called ischiocavernosus that’s
responsible for erections is in the pelvic floor. So if that muscle can’t
function, neither does the penis, it just doesn’t work. So usually that comes along with it, that’s the baggage that they
nervously don’t want to tell me and I’m like yeah, got it, I get it. Then also just kind of other
general diagnoses that I see are gonna be nondescript
pain or a very specific pain. So by nondescript I mean like yep, it hurts right
where I sit on a chair, or where I would sit on a bicycle. Or I have pain at the tip of my penis, or when I run really far
my left nut really hurts or whatever, so some sort of
a pain diagnosis somewhere. But those are probably the most common. – Thank you. Can you tell me a little bit more about when someone comes in and
they have been diagnosed, what’s kind of the
protocol of working with different practitioners
to kind of round out that team approach to care? – So team approach, I mean
the first thing I would say that’s on my mind is
pelvic floor dysfunction can be a symptom of a general
health condition of some kind, a cardiovascular thing,
a blood sugar thing. So probably the first person in mind that I want to make sure
that I’m collaborating with is their general practitioner
or the referring physician, just to make sure that
we’ve cleared any other general health things,
that they are overall a healthy person and
that they’re appropriate to come in to see a physiotherapist. Otherwise it depends on their situation. I might collaborate quite
closely with a urologist if they have a urinary
dysfunction of some kind. I might collaborate with a proctologist or a colorectal specialist
if they’re having trouble with bowel
function or incontinence. Depending on how strongly
they are attached to kind of the emotional side of their condition, then a talk therapist might
be great or a psychotherapist, something, or even a social worker, just so that way they
have kind of an outlet to talk about how this has
affected the rest of their life. So otherwise different
physicians, you know, depending on what their specialty is, but those are probably the bigger players. – Some. Are any of these conditions preventable or is there something that
you’re seeing people come in with and maybe they didn’t know
not to or to do something that could lessen the symptoms, or have prevented the condition? – Preventative. Well you’re asking a
physical therapist, right? If you have a hammer,
everything looks like nails. But my bias towards general health is the magical thing, the gift
I give to most of my patients is telling them not only
that it’s safe to move but healthy movement will in fact manage a vast majority of their symptoms. They don’t really need me
to do anything drastic. So one of the first things
that I tell my guys is to do some sort of hip mobility. That could be a yoga class
if they jive with that, or at my clinic we teach
a thing called Kinstretch which works on opening up your hips. The anatomy of the hips
and even the thighs, the muscles, the fascia,
blend completely intimately with the muscles and the
fascia of the pelvic floor. So I don’t know, if you
line up a hundred guys and you tell them to start salsa dancing, then we all giggle because
most men, we’re like, “What do you mean move my hips? “I don’t understand the words.” So we don’t do salsa dancing at Symbio. Yet, but getting people just
to be able to move their hips is often a rehabilitative thing, but absolutely a
preventative thing as well, can be a preventative thing, just because of those
anatomical connections. Otherwise, preventative,
this is my annoying answer is just more general overall health. Optimal sleep, stress management, hydration, nutrition,
fitness, all of those things often lead to a dysfunctional
pelvic floor as well. – So how do most of your
patients come to you, how do they find you? Is the partner telling them to go in, or is it a doctor, are they
finding you on their own? – Probably the tried and true way that people don’t find me
is from my current patients, because most men aren’t gonna sit down with a bunch of their
buddies over a few beers and be like, “Guys let me tell you about “my dysfunctional pelvic
floor, this is a great story.” (Pamela laughs) That’s usually not what’s happening. So it’s often not a
word-of-mouth referral. However, I’m finding
people that have found me and I don’t even know how it’s happened. Part of it I think is
because I am a male therapist treating men, that either
something gets written up, or somebody does Google it, or a referring provider, of course. If a patient is telling their urologist yeah, I have to go into
PT but I prefer to have a male therapist, then that’s just I think kind of a bypass to a
normal referral source. But I think also it’s
happening quite organically. I just got a patient a
couple of nights ago, got my name from a mental health provider and I have no idea who that person is nor how they found out who I
am, but here they are, right? So I think a lot of
it’s just word-of-mouth. Then there’s things like this, right? Of just having general awareness. I have been shocked at the number of men that I am now treating that came to us because of some other diagnosis, but as I’m sitting and talking
to them about their back pain they’re basically just
telling me almost verbatim, “Oh, it’s actually my pelvic
floor that’s a dysfunction.” But you know, one
weightlifter that I treated, a power lifter, he had a little
bit of urinary incontinence, and some pelvic pain,
erectile dysfunction, and I knew him quite well. So we were just having a
chat about it and I said, “Oh, well, that’s your pelvic
floor, let me treat that,” and had a fantastic result. Not to say this is a norm,
but we had one session and poof, everything was great. And then just a maintenance program. He even went and told all
of his weightlifter friends because so many of them have it, but we absolutely can’t talk about it. So he mentioned, “Oh,
I had this crazy thing, “you should go and see my
friend Chad over at Symbio,” and then in they come, right? So I think some
word-of-mouth, but a lot of kind of back channels. – Definitely, that was
a great success story. Do you have any others that
you could share with us? – Not a single one. (Pamela laughs) Great success stories, gosh, lots of them. I would say almost without
fail, it’s probably a safe thing to say that even session one is almost universally somewhat successful, because as I have mentioned
kind of that common story that men come to see me
with is people have told me that I’m crazy or that
I am making this up, or the antibiotic should have worked, or I’m just too stressed out, or whatever. Just them sitting down
and having a really open, sometimes a little scary,
but conversation about it, and then having somebody
with a bunch of letters after their name say it’s okay,
here’s why that’s happening. And truly like the magical part is like me showing them a picture. I’m like, “See that muscle right there?” And they’re like, “That one?” “Yep, that’s the one. “That thing is in spasm I bet, “and that’s why everything is happening.” And like immediate people are
like, “Oh, I feel better.” And truly, I’ll say,
“How are your symptoms “right now that you know that?” “They’re actually a little bit better.” I’m like, “Cool, so you’re not crazy, “but you see how like dethreatening it “has actually changed your symptoms?” Then that can be quite powerful. But other success stories, yeah, I mean I had this guy, God bless
him, he had pain for 25 years and this is probably the
longest history that I took. He had this lower back pain and hip pain. He didn’t even really
have a lot of pelvic pain but he just has this lower back pain that just was persistent and he went to lots of different
practitioners and was always did lots of core strengthening and interventions with just general health, got all of the MRIs and X-rays and everything came back normal, and nobody could really tell
him why was his back pain. And then truly within one session I found there’s this muscle
called opturator internus and the moment I touched
that muscle he was like, “That’s my back pain, like
you touching that muscle “is turning on my back pain.” And I mean I wanted to shoot
off streamers, you know, because it was like 25 years
you’ve been dealing with this and it’s just this hip muscle. So we worked on that, and he
stood up, and he was like, “That’s the first time I haven’t
had back pain in 25 years.” So it took us a while for his body to then figure out that it didn’t
have to spasm that muscle or overuse that muscle, so
it was a journey for us, but such an amazing experience
that a quarter of a century this guy has had pain in
his back and it was like, oh, it was that thing. So very validating. Usually I mess it up totally
but that was a good one. (both laugh) – No, these stories are
so important for hope because so many of us
have been misdiagnosed and have been running
around and being told that we’re crazy. So hearing the success
stories, I always like to ask because they are the hope. So thank you so much for being here. Can you tell everyone
where we can find you? – Sure, so online is the day and age. I’m all over the social media things, AskDrChad is my handle, so A-S-K-D-R-Chad. My website, www.symbiopt.com, that’s S-Y-M as in Mary, B-I-O. Then we have our offices, I personally treat patients
in our Chelsea office and that’s where our other
pelvic floor specialist, Adam, he works there as
well in our Chelsea office. And on forums and conferences
and things like that. – For those of our
viewers who are out there who maybe can’t come in and see you, do you have any online
resources for men’s health that you can recommend? – Sure, yeah, I think both
for patients and practitioners I did my training through a company called Herman and Wallace, and
they’re quite well known especially in the
physical therapy paradigm for pelvic health, both male and female. So that’s where I did my training, and I think that they
do a really nice job. They also have blogs and
informational segments, and it’s a great place I think to get good, reliable information
that isn’t the Dr. Google terrifying stuff that nobody should read. So I’d say that. I know that we’re
currently working on a blog for men’s health. I’m part of a Facebook
group, Men’s Physiotherapy and Men’s Health Facebook groups,
those can be kind of nice. Most often I’m finding, at
least with the patients, my male patients, is for them to know that this is not a unique thing to them, that other guys have had these symptoms, that I think can be quite helpful and that might even be a
good resource, you know, if there’s a Facebook group of some kind that perhaps you can join anonymously so nobody knows that you’re
in this dreaded thing called a men’s pelvic floor Facebook group or whatever it is. But there’s definitely resources out there that are gonna be having a higher quality or a more accurate level of information, that are not as threatening. – Awesome, thank you so much. And I will link all of that in the group so you can go and do your own research. Awesome, thank you so much. – You’re welcome, my pleasure. – Thank you so much for joining us. Now I would like to hear from you. Please share with us one
takeaway from the interview in the comments below. Give us a like, and share this group with someone who you think
will benefit, thank you. (cheerful music)

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