Ann Crowe; Physical Therapist on healing running injuries and getting back in shape after pregnancy

About this episode

The fourth in Vance's "exercise series" is a candid, personal 44-minute conversation with his wife, Dr. Ann Crowe — a physical therapist and former aerospace engineer — recorded three months after the birth of their daughter Violet. It opens on Ann's observation about roadside injury-attorney billboards that emphasize "pain," which she argues perpetuates chronic pain conditions by keeping accident victims psychologically fixated on symptoms during prolonged legal settlement timelines. This becomes a broader discussion of pain as a brain-generated prioritization signal rather than a pure physical measurement — pain is weighted by what it threatens (ability to work, an athlete's starting position) more than by tissue damage alone, and different patient types (over-monitors vs. those who ignore pain until catastrophic) require different clinical communication styles. They connect this to Vance's earlier interview with running coach Mark Spewak and his "talking to the pain" concept, distinguishing training discomfort from injury signals. The conversation shifts into deeply personal territory: postpartum joint and posture changes, pelvic floor dysfunction/incontinence (which Ann normalizes as far more common than most people realize, even without a difficult birth), and then their IVF journey — 70+ consecutive days of hormone injections, forced exercise cessation, and glute muscle atrophy from repeated intramuscular injections (100+ shots), which Ann had to deliberately rebuild strength from before pregnancy could safely progress. Both reflect candidly on having delayed starting a family due to career prioritization and unpreparedness for fertility difficulty, with Vance expressing a now-common refrain to younger men about the reality of biological clocks. The episode closes with a plug for Precision Physical Therapy's out-of-network, insurance-independent, personalized-care business model, framed explicitly as "craftsmanship" medicine versus industrialized, insurance-scheduled care.

“The focus on pain perpetuates pain conditions... I find it, it makes me feel a little sick every time I drive by them on the freeway.”

“In our legal system, somebody gets in a car accident and they, you know, it wasn't their fault. They have the opportunity or the right to sue somebody, but then in order that they get the settlement all the way through, they have to continue to have pain.”

“We were willing to make financial and physical sacrifice to have our beautiful daughter that we're so grateful for. But at the time when you go through the initial phase of IVF... you take a ton of hormones and you're not allowed to exercise.”

Key moments

• ~4%: Opening billboard critique — pain-focused injury-attorney marketing may worsen the pain conditions it claims to address.
• ~9%: The perverse incentive built into legal settlements — claimants must keep re-reporting pain to preserve settlement value, prolonging psychological fixation on pain.
• ~20%: Pain as a body-prioritization signal shaped by context (ability to work, athletic incentive) rather than tissue damage alone.
• ~40%: Postpartum incontinence and pelvic floor dysfunction normalized as common even after uncomplicated deliveries — a topic Ann says most men (and many women) are unaware of.
• ~55%: The IVF hormone-injection ordeal — 70+ days of injections, forced exercise restriction, and measurable glute muscle atrophy requiring deliberate PT rehabilitation.
• ~70%: Mutual admission that both delayed starting a family due to career prioritization and lack of awareness about fertility timelines — offered as a cautionary lesson for younger listeners.
• ~92%: Precision Physical Therapy's out-of-network model explicitly framed as "craftsmanship" care versus insurance-dictated, industrialized scheduling.

Notable quotes

“It really was a lot... I think four [sharps containers].”

“The focus on pain perpetuates pain conditions... it makes me feel a little sick every time I drive by them on the freeway.”

“People that didn't have severe trauma during the delivery of their child still face these [incontinence] problems, even if you had a normal delivery.”

“I wasn't prepared to do 50% of the work... there is a real chance that I would've resented the child.”