Interview with Justine Cosman, PT of Whole Body Health Physical Therapy
Transcript of video:
Hello everybody, this morning I’m here with Justine Cosman from Whole Body Health PT in Portland, Oregon. I’m very excited to have her here. In full disclosure, Justine is my physical therapist and she has helped me through so much of my own chronic pain and the arthritis stuff that I deal with. And in working with her the reason I am so excited to be interviewing her this morning is because she has really helped me develop a much better understanding of how important it is for the whole body, all of the systems in the body, to support whatever sort of the weak area is or the problem area is. And so Justine I’m so excited to be here with you this morning, thank you so much!
I’m excited to be with you too, Isabel! So yes, I’m a physical therapist in Portland Oregon, and I’m a co-owner of a clinic that has now been open for about two years. We are outpatient orthopedic physical therapists, and we specialize in chronic pain. That can mean several different things to people, whether it’s the entire body or one specific location, we try to address all of those components together and get them moving and get them going towards their goals.
I: Which I think has been one of the most amazing things about working with you, is your approach is really different from other PT that I’ve done in the past. So in terms of chronic abdominal pain, which is what we are often talking about in all of the work that I do, how do you see your work fitting into sort of the chronic abdominal or pelvic pain piece of it, and how the whole body can can support the work that you do there?
J: Absolutely, individuals with chronic pelvic pain, whether that be from surgery, or from pregnancy, or from age, there’s so many things that can go into that. Oftentimes they may be inhibited from doing a lot of activity because of their pain response or condition, or there might just be a fear component to doing some movements, because some things may hurt.
And so the way that I see myself fitting in is that as they’re receiving treatment from their pelvic health specialist or abdominal massage therapists, all of the things that make that area feel better, they still need to reintroduce their body to movement. So things become de-conditioned over that period of time, whether that’s the abdominals, or the hips, or even the arms with lifting. And so we have to reintroduce some of that slowly, and I feel that most often when we’re older we don’t always think about that. We’re so used to having things instantly, and sometimes that can be what brings about new pains, and new fears, and new avoidances. And so I’m just kind of there as a guide to help individuals find what’s right, what’s wrong, and then try and give them a more global perspective as to why their body may be sensing what they are. Because it’s not only musculoskeletal, but you’re also dealing with a psychological component of it.
I was mentioning that kind of fear or avoidance, and if we don’t understand something, at least coming from my point of view, it can be scary, it can be stress inducing, it can almost perpetuate some of the cycle. So I can definitely help with that component alongside other practitioners, such as counselors or psychologists, to to get people back on track. Sometimes it takes that team approach.
I: Yeah, and I think that’s one of the things that I appreciate so much about you and all practitioners who I enjoy working with, is that there really is that sense of of the team, and that each of us has a little bit of a different focus, or different talents, and that it really takes sort of the whole team to distill that down. Like in the body, even as you’re improving in one area, in our case the abdominal or pelvic area, it really does take the rest of the body feeling supported in order to maintain that change, but also feel even better than just having that initial problem spot resolved.
J: Absolutely, and that abdominal and pelvic area, I mean that’s the core of your body, that’s the center of your balance, your center of gravity so to speak. And so when that’s disrupted, you start moving differently through other components of your body as well. So as you strengthen that, you kind of have to reteach your body how to work with the system again. It’s such a central component, so it’s nice for instance, like working with you, working on an abdominal “restructuring” if you will, with soft tissue, then applying that to exercise to rebuild those fibers appropriately, and then apply an exercise so that those fibers know what they’re doing, it’s a really cool process.
I: Yeah it is, and one of the things that you said I want to pull out a little bit, is this idea of reteaching movement that kind of gets forgotten or lost in the recovery process because there’s so much pain. And then the thing is that the pain tends to build fear and I know this is a very personal thing, this is what happened for me, and that you helped me work out of. But I see it in my clients all the time – they’re afraid of doing certain movements or living certain parts of their lives. Sometimes they’re even afraid of going out to take a walk anymore, because they don’t know how their body is going to respond to that. So in terms of the fear of even engaging with movement because there’s been so much pain or so much dysfunction, in your practice, how do you tend to work with people around that type of thing?
J: Well, I would say that it’s definitely a very individualized approach, because some people can address their fears and sometimes they like to get straight to the point, and other times it can be a little bit of a slower process. Most of the time a slower process, and so I like to build from positions that are more supported to the body or what we would call anti-gravity positions, so it’s less weight, less stress on the body. The body can feel it just feels less need to fear, so we start in positions that are comfortable, and then from there we progress it.
So for instance, if we felt that the most supported position was lying flat on the ground, we might build up to doing something where you’re seated but you have a chair back, or may build it up to where you’re standing but you’re using the back of a wall. Just something where you still feel like you’re not out in the open, still supported but can do the activity. And sometimes they’re just minor changes. Sometimes that’s the way that the the the body needs it, where it can’t just be abrupt or the body will respond by sending warning signals or pain responses, telling you “no don’t do that, this has been not good in the past.”
So we really just have to go about that gradually and then recognize that some of what we’re feeling, whether that’s the fear or whether that’s the pain component, it’s not always biologically or tissue based, which is fascinating. So you know, even though there might be pain, there’s not necessarily damage happening. It’s more of just a protective response. And so that’s what I build upon, we navigate what their body’s response is, we let it know that nothing that we’re doing is damaging to it in that moment, and we talked about that cycle and what’s appropriate, and build from there.
I: Yeah, and I think that’s really important. That’s something I see a lot too, is that in myself again, and with my clients, is that we do tend to equate pain with damage and sometimes that is the case. I mean certainly especially in the post surgical situations, and I know you’ve worked with a lot of post-surgical stuff.
So maybe if you could talk about the question I get a lot, that I would love to hear your answer to as well, is how do I know if I’m doing more damage, either with the movement or with the hands-on, or whatever it may be?
J: Absolutely. Well, we stick to a more or less generalized rule of thumb, where we have a pain scale where it’s from zero no pain to ten emergency room pain, and it’s very subjective. People can be anywhere on that scale and feel pain very very differently. So let’s say we have somebody starting with three out of ten pain. And if we’re doing an exercise routine, I don’t want to push it more than two points on the pain scale. So they can go up to five out of ten pain, but I don’t want them going six and beyond. Because often times exercise or our doing some movements it can create some discomfort, and so we expect that.
And then we monitor what the response is after. So does the pain settle back down, if it does that’s generally an okay thing to feel. But if it’s something that heightens or it’s continuing to kind of build upon itself, then that’s where we know okay maybe we pushed the system a little too much.
The other rule of thumb is if you are in fact dealing with an inflammatory response, so as you said like post-surgical, you’d expect there to be a certain level of inflammation. Sometimes the body’s response does not happen or peak until 24, to 48 hours afterwards. And so we also have clients monitoring not only in the moment but what happens later on into the next day or the day following. If our exercise program caused pain to peak further out than two days, then we know too once again, okay we did a little too much for the body. That could have been, I wouldn’t say damaging, but I think it would just be, it was a little too stressful. Damage I feel like is such a harsh term, and that would be in a sense if you were creating an inflammatory response, and just continuing to perpetuate that.
For instance, I think something that’s easy for people to relate to is maybe like a sprained ankle. If they roll their ankle and then it swells up, well, if you were to run around and never give it a chance to to heal or to get out of that phase, that could be damaging. But if you give it a little bit of the rest it needs, a little bit of the light movement that it needs, and that might still be a little sore, you’re still in a healing process that’s good.
I: Yeah and thank you for bringing all of that out, because I think that you really, and this is one of the reasons I love you as a practitioner, is because I think you really have a good understanding of how people feel about their pain, which is often just very scared, and often there’s so much fear about re-damaging, that sometimes it’s hard to take those steps forward into new treatments. Because sometimes quite frankly, you don’t know where the practitioner is on that scale and what their level of tolerance is.
And so I really appreciate you sort of teasing this out for us, and and I think it’s so important for people to hear how practitioners, and in this case you specifically, think about that, because I know that there are lots of different ways of approaching this, and certain practitioners have higher tolerance for how much pain or discomfort exists after treatment and things like that.
This is a big one, and I don’t want to spend too much time talking about the fear equals pain thing, I think we’ve covered that quite well, but there is this question that I have about it’s a little bit more specific. So in the case of whether it’s post-surgical or unknown origin of abdominal pain whether that’s upper abdomen or pelvic floor, how do you feel like the work that you do can help to support that, even when you don’t necessarily know what’s causing it?
J: Absolutely. Well the way that I kind of approach that system, and again this is something that I do with multiple practitioners – coordinating with their primary care, as well as massage therapy, acupuncture, a lot of different pain management approaches, I would say that in terms of the abdominal work – oh I’m losing my train of thought Isabel, sorry about that.
But in terms of the abdominal work, sometimes when it comes to chronic conditions, our body releases a lot of different chemicals into the body. It creates a lot of different changes, whether that’s when it comes to the stress levels like we were talking about, or even with digestion, oftentimes when we get into these types of pain cycles our body doesn’t really care about “rest and digest,” it doesn’t care about reproduction, it cares about the moments, and I always think about all of the different thought processes that might go through your head if you were running away from a bear, that’s what your body cares about. And so oftentimes your GI tract or your abdomen can be part of that, and it can be a very global response. And so I think that by reducing some of that that fear-based component and getting people to move more can help move the abdomen, the GI tract, everything else.
And we have a very general saying which is “motion is lotion,” like it keeps things moving along. It’s very healthy for our body, it helps keep our structures strong. So I think that the same stress that people may be apt to not want to do, are the very things that can be quite healing for them when it comes to their their abdomen and pelvic floor.
I: And then I think one of the other things that I hear often is “well, I’m doing some movement and it’s not making it worse but I just feel like I’m not doing enough, so if I’m not doing enough movement why even bother?”
J: Oh goodness yeah, that’s a difficult one and I would say you know, any movements better than no movement. It’s very rare these days that anybody prescribes bed rest, because that’s when just everything becomes de-conditioned, and then it’s even harder to kind of get back on track. So sometimes what we do is we’ll use things like an activity log to kind of see over the course of whether it’s a day or over the course of a week what real movement is actually occurring. And sometimes those same people who tell me that they’re only doing a little bit of movement are actually doing a lot of bit of movement, and they just haven’t incorporated all of the other regular activities of daily living that they’re already doing. And so then we work together to find what’s that baseline you know, what can you do really really well, and then how can we add on to that gradually so that the body’s okay with you moving more.
I: Yeah that’s beautiful I love that. So then last question, so obviously you give people very individualized sort of routines. I mean I almost feel like in a way (at least speaking from my own personal experience with you), it’s it’s not like “go home and do this without fail,” it’s like “go home and try and see which parts of this really seem to help, and then we’ll get together and we’ll figure out how to build on the stuff that did help, and if we need to change the stuff that didn’t help,” you know so there’s a lot of very personal stuff, it’s not like “Oh, you have low back pain, do this set of movements, see ya!” Which I love, and I guess I’m just thinking if somebody doesn’t have access to a totally awesome PT such as yourself, do you have a recommendation for how they can try to support their whole body through this experience of chronic abdominal pain?
J: Well absolutely, I think that it’s really important to note – I keep talking about kind of this team approach. It’s not just the practitioners you know, the client should definitely be an active part of their health care, and they should be one of those team members. I think it’s really really important to give your practitioner feedback and to let them know like, this felt like too little or too much, or I’m not quite sure about this let’s review it.
That feedback only helps your practitioner help you more, and so that’s what I would say, is to be vocal about your care, and if it hurts one session, don’t think “well okay this is definitely not going to work for me,” use that as something constructive to your care. And if that if that continues for you and you’re not seeing the progress, well then of course you can find another practitioner or find another method that works for you.
But it’s definitely something that you have to to stick with and to be very much an active player in your health. And whether it’s working with the practitioner, or also just like with your podcasts, seeking information and looking things up online and just reading and educating yourself. And of course take things that you find online or on Google with a grain of salt, because it can lead you in all sorts of directions. But you know maybe come back with that knowledge and become an active conversationalist with your practitioner. And even if you’re not right on the mark, you’re part of that that process.
I: Thank you so much for saying that. I feel like that’s something that a lot of people start to feel disempowered around is, and I I love that you invite that with your own patients, and that you just invited everybody to really take that step for themselves. I think that’s huge, and I do think it makes a difference, so thank you!
I: Well wonderful, please feel free to say if there’s anything else that you want to add to what we’ve discussed already, but most importantly please do tell us where to find you in the world.
J: Very nice. Well, I am located in downtown Portland, also in North Portland, and a little town called Vernonia. Our center again is Whole Body Health Physical Therapy, and you can find us at www.WholeBodyHealth-PT.com. And if you ever have any questions regarding PT or the process, you can always feel free to contact us.
I: Thank you so much, and thank you so much for being here today Justine! This means a lot to me, and I thank you.
J: Thank You Isabel, I really appreciate it.
I: You’re welcome. Have a good day.
J: You too.
- Isabel Spradlin is a Registered Nurse (RN), Licensed Massage Therapist (LMT), and abdominal adhesion specialist in Portland, OR. She specializes in educating people about manual treatment (massage) for abdominal pain and dysfunction, especially when it is adhesion related. Please see the "Programs" page to see her offerings.