Physical Therapist Explains Why Pain-Focused Injury Ads Make Recovery Worse

Ann Crowe [00:00:05] They did not feel their pain to be worried about it. They didn't worry about it, they didn't feel it. They didn't know it was there until it completely limited them from doing anything. So those are kind of two different people in the way that they have pain. And so we, the way we communicate hopefully is different in the clinic to each of those individuals. Howdy. I'm Hannah Newin Wonderer, a production lead at a soybean seed facility in central Illinois. And you're listening to the Vance Crow podcast.

Vance Crowe [00:00:34] Welcome back to the podcast. I'm glad you're here. Today's interview is with Dr. Ann Crow, who happens to be my wife. This is a part of the exercise series that we've decided to do on the Vance Crow podcast. In the future, I'm going to start picking out groups of topics that allow us to do a deep dive. And if you've been listening to this whole series, you got to hear Mark Sp Walk, who is one of the greatest running coaches in the St. Louis area. And today we're talking to my wife, who is actually a physical therapist that specializes in helping runners overcome the pain that they experience while exercising. This is a pretty deep interview. It's one that Annie and I have talked about for months and months because while we were locked inside of our house during Coronavirus, we were also preparing for the birth of our daughter Violet. So actually, after we get through some of the general parts of exercise and pain and how do you overcome that pain, we talk about some of the challenges that Annie and I went through while trying to get pregnant while she was going through IVF and what happens to a woman's body as she is trying to come back and get in shape after having been pregnant. This is an interesting interview. It's going to be a little bit emotional. So buckle up. The reason that we're doing this series is because of the Articulate Ventures network. Inside of that network, there are people that are, start off as fans of the podcast, but have become a part of a community where they're helping each other achieve dreams, get to places that they've always thought in the back of their mind.

Vance Crowe [00:02:10] I'd love to get to, but I don't really know how, so I'm not gonna take that first step. And during the month of October, we did a topic called Dragon Spotting, where what we tried to do was figure out what are those things that we want to overcome and we don't really know how. And one of the things that came up was exercise. How do I get started when I've not done it for so long? How do I get myself into a position where I don't fail and quit and give up? And so that's what started this whole process of doing these deep dive interviews, which we're happy to give to you to just listen to at your own leisure. But if you're interested in joining a community that is focused on things like this, then I would recommend it checking out the Articulate Ventures network. You can learn more by going to Network dot Articulate Ventures and sign up for a membership. You can do it for a month or a year and join a community of people that are all striving to achieve on a whole bunch of different levels. And it's a really great community. So I hope you'll join us there. Now we're gonna head into this interview with my wife, Dr. Ann Crow of Precision Physical Therapy, Ann Crow. Welcome back to the podcast.

Ann Crowe [00:03:21] Thank you.

Vance Crowe [00:03:21] So this is the first time I have done an in-person interview since Coronavirus hit. But yesterday or two days ago, we were driving down the road and for anybody that doesn't know you are my wife and you are an aerospace engineer turned physical therapist. And you made an observation about the billboards that are up, that talk about reducing pain or pain. That shocked me. I just, I was totally surprised by it. So I thought, you know what, we should sit down and talk about this. So describe the billboards that you saw and like what you were talking about there.

Ann Crowe [00:03:53] The billboards are next to the freeway and they have, you know, a number to call and part of that phone number says Pane, PAIN. And the word pane is bold and large, and the colors behind the sign are accentuating the, the word pane. I suspect those. So I didn't call the number. So this is what I think is happening, but I'm not sure. But is that it's, it's referring to people who have been, you know, a victim in a car accident, somebody that was in an accident and something happened to them. And because of that they have a lasting pain condition and someone is trying to sell them probably their legal services, maybe, maybe some other service, maybe maybe a pain clinic. I don't know. Probably not. I, it is upsetting sort of to me. I mean, I, I understand that people need to be able to find attorneys when they need them. And so it's important to market to your target audience in effective way. But the focus on pain perpetuates pain conditions and their, therefore I, I find it, it makes me feel a little sick every time I drive by them on the freeway.

Vance Crowe [00:05:15] We made the comparison that it was like, it's not different than somebody posting up about gambling, right? And then you have these people out there that they either are addicted to gambling or they're, it's something that's a deep pull to them. So it's almost like taking advantage of people because it's like they're in pain. You are highlighting pain, you're trying to activate on it, and it just seems like it doesn't feel quite right.

Ann Crowe [00:05:36] It doesn't, I guess I have, I have such a hard time with this because I struggle because I do, I know people that when they're in an accident, they have a lot of costs and they need, they need legal representation to help them recoup those costs. And some people are in really bad situations and, and they do need help. But the focus on pain, I think is the thing that really bothers me. Because once you're in one of those accidents and you have something that happened to you is out of your control, you experience trauma to your body, your body's now operating different. As you continue to relive that experience over and over again, it changes the way that your body interprets sensation. It changes the way your brain prioritizes the pain and how you actually sense different areas of your body change. And so by continuing to focus on the pain, by continuing to relive that experience and describe your level of pain and the number on the scale it is, all of those things make, can make worse. The the pain condition that you have and, and individuals are experiencing pain. So they are absolutely living with it, which is, is, you know, I don't, I guess just a, it's a part of life, but it's very unfortunate they're suffering. So people are suffering with it. So I don't, I don't wanna minimize,

Vance Crowe [00:07:04] Well it's a weird thing, right? Because 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. So every time they go to a doctor, if they say, eh, my pain's a three instead of a seven like it was before, there's always the chance that that would reduce the amount of their settlement. And can they pay their legal fees and can they pay all these things? So we have a system set up, which you need justice, justice takes time. And yet then that puts people in the position where they're focused all the time on pain, which, because pain is only found in your brain, it's like your brain telling you something's wrong. It can do all these weird things to the way you experience people

Ann Crowe [00:07:51] Well and the financial stress of all of it because you have people going for such a long time before they would receive their settlement. There are cases all have to be completely closed, you know, you wanna know what is the sum total of all of your medical fees and billing before the case would be finished. And so you have a prolonged period of time where you're living in that state of maybe stress or anxiety not knowing what's gonna happen, what's gonna be the outcome of your case. And that in addition to having to revisit the experience over and over again, I mean it all just, it tying the emotion to the memory and the experience of pain and having it last, having to relive it for more than six months, create a opportunity in your body to interpret sensations differently and rewire the way that you interpret the, the way that you experience the pain. And it's very hard to get away from and, and it can cause people to suffer for a lot longer than maybe they would have otherwise had it not been an accident that was associated with a, a legal and a car accident and a prolonged period of time. I mean, some people are going to have pain for a long time because their accidents are so severe. So I mean, to minimize that,

Vance Crowe [00:09:15] Yeah, I mean pain is such an odd thing because you know, as I was growing up as the middle child of seven, if you were experiencing pain it was unlikely that you were gonna go to the doctor unless like you were bleeding or the bone was sticking out of your skin. And so therefore I just didn't think about pain very much. But now as an adult and I get injured, pain seems to me to be so much more acute than it used to be because now I see if I can't stand upright, I can't do this work, I can't get this thing done, I have all these other problems that stack on. And it's weird to think about pain as being psychological 'cause you're not minimizing the fact that it is real. But it is so much about the story that's written into your brain about what you, what's actually going on

Ann Crowe [00:10:00] Well in your prioritization. So as in your example, you're describing that that pain may limit you from being able to work, which limits your ability to make money. So there's a lot of, there's a lot more tied to that improving just like maybe an athlete that had a, a scholarship and then got injured. There's a lot more tied to of financial emotion, stress and event. All of those things tied together change how your body's going to prioritize that symptom. And so your, your pain that you might have that would limit you from working your body would see as much higher as opposed to if you had a pain that maybe you were trying to hide because you thought it might limit your ability to work. If that pain, if people knew about that pain, you might experience that differently. Or an athlete who has something coming, an event or a race or something coming up and they don't think the pain is gonna limit them, but maybe it keeps them from being the starter, they might not experience that pain as as high. They may not see it as high a priority because they don't want it to be there. It doesn't benefit them in any way for that pain.

Vance Crowe [00:11:13] So then when somebody comes in to talk with you about, I'm in this pain doc, I need you to help me with, you know, my back or when I'm running or how much do you take seriously their pain? Like that seems like a weird question.

Ann Crowe [00:11:24] Very seriously. Yeah. And I guess our, the way we help people to overcome it is to become in control of, in control of their body and their movements so that they can minimize stress on an injured tissue so that they can be in complete control of when they experience the pain. So if they were having a symptom that was preventing them from sleeping, if we can give them three strategies to get rid of the pain and go back to sleep, now it's no longer interfering with their night's sleep and their next day. And so we're trying to help people put people in control of their symptoms. But the challenge to that is when they come into the clinic, then we're asking them, does this make your pain better or worse? Because we're having to identify what are the specific movements that are aggravating that symptom. So how is the joint moving? How is or multiple joints moving that are causing the pain to happen? And so we, we'd never wanna focus too much on, once they know and can recognize the symptom, is it getting better or worse? But not necessarily is it a five, is it a six, is it a seven, is it a two? Like on the pain scale, what is the pain number? So is it improving or not is what we try to move to pretty quickly just because we're not trying to keep that focus on pain. We don't want them to overfocus on it, we just want them to be able to recognize it. So I work with runners though and there are plenty of runners. So that's kind of in people that are at risk of it turning into a chronic issue.

Ann Crowe [00:12:59] I work with runners and many of them just don't feel their pain. And so then I'm much less concerned about is it getting better, is it getting worse? What is the number? 'cause for some people they have to be able to, it is part of them improving, being able to identify that they're actually experiencing pain before it's a 10, you know, before they, their leg is buckling and they just can't take another step. So, you know, there's a lot of different, there's a lot of different experiences. So somebody that's worried that pain is going to limit them from running is a different way you would approach that. You wouldn't keep focusing on the pain as opposed to somebody who came in and they can't provide any resistance in a certain muscle group 'cause they've strained that muscle to such an extent that is not functional. Like they did not feel their pain to be worried about it. They didn't worry about it, they didn't feel it, they didn't know it was there until it completely limited them from doing anything. So those are kind of two different people in the way that they have pain. And so we, the way we communicate hopefully is different in the clinic to each of those individuals. So

Vance Crowe [00:14:01] Earlier in this exercise series, I spoke with Mark SPI Walk, who's this running coach. He's fascinating way to think about how to get runners to, to perform at the level that they want to, whether it's just like getting out and doing two miles versus running a marathon. And he had this phrase called talking to the pain. So when you get to three quarters through in your race, you now are hitting a point where in order for you to fully succeed and to embrace and to go the distance, you've gotta be able to talk to that pain. But when you're talking about pain, it's different. So like's a

Ann Crowe [00:14:32] Different pain. I know we missing

Vance Crowe [00:14:33] Words in the English language

Ann Crowe [00:14:34] Or I maybe we are. So we would describe pain as you know, in the clinic. I would try to piece that out, help somebody to piece that out. Is it sharp shooting, aching, burning, numb, tingling, dull? Like how is that, is that a pain or is the muscle really tired?

Vance Crowe [00:14:49] It's so funny when you say that because like I'm laughing when you ask me is it burning, blah blah blah. I'm like, it, i, it hurts, right? Like I don't even want to take the time to think about what kind of pain it is because all I can say is like my, my brain is telling me fix this problem, it hurts.

Ann Crowe [00:15:04] But most recently you told me throbbing. So you have actually been able to label label things

Vance Crowe [00:15:08] Only because you won't start unless I tell you

Ann Crowe [00:15:12] So. And that's the runner that we talked about that comes in that's complete, like can't do any, can't, they can't move a certain limb. They've like completely just run through, not notice their symptoms. They're the ones that have a hard time saying is it muscle exertion? Is this physical exertion? Is that the pain? Like Mark is talking about, mark is not, I suspect advocating people to run through a joint pain or nerve pain or injury. And I think it's important to have a coach also to help you be able to identify the difference. And there is always some amount of aches and pains that come along with running. And so it's identifying when those are are an injury, are those something you need to treat or is it something that's gonna get better in a day or two and you just need to keep going.

Vance Crowe [00:16:00] It seems like that is a really important word for us to figure out. Like, because there really is that difference between I am feeling something that is discomfort because I wanna run faster or I want to go further versus like, I can't sleep or my arm doesn't work or whatever that is.

Ann Crowe [00:16:19] It's

Vance Crowe [00:16:19] Odd to me that we don't have work to distinguish those.

Ann Crowe [00:16:23] I should know it if there is one, but I I, I don't have a clear, I don't have a clear answer for you on what that word is. But in swimmers we also have a really, really big problem with this in swimming. And there's actually been articles published about it because there's just a common expectation that shoulder pain is to be expected and is common and is part of the sport. And I know myself, I didn't address my shoulder injury when I was training until I couldn't physically lift my arms up over my shoulders anymore.

Vance Crowe [00:16:56] And

Ann Crowe [00:16:56] So at the time I didn't know anything about physical therapy or pain or all I knew is that I wanted to swim. But in, in that sport now they have recommended decision trees for coaches on when to send an athlete to a medical professional and they go something like, has the pain been there more than three to four days? Is it limiting you from washing your hair after practice? Is it making you change strokes in the middle of practice? Is it, is the pain lasting for more than two hours after you swim? All of those things don't send somebody to a medical provider. It has, it's like over, there's like a whole nother column where they're like, you can no longer practice at all and you can't, I mean like the extent of which the shoulder pain is recommended in the literature that somebody go in and see a medical professional is really severe. And it's just such a shame because there's so many things that we could do to help someone physical therapists could do to minimize that pain when they first start to experience it as opposed to when they can't reach up overhead.

Vance Crowe [00:18:05] Well I know the reason why what before I met you, like if I had pain, the idea that I was gonna have to jump through hoops to be able to get to a doctor or go see this person that would then refer me to this person now inside of the calculation is am I feeling enough pain that I'm willing to sit on hold that I'm willing to go look up the numbers that I'm willing to go do all this like bullshit that I don't

Ann Crowe [00:18:28] Wanna do? Well that's what we're trying to cut out with our business. We're trying to make it easier for people they can access physical therapy without as much of that. And so yes, we still require referral in the state of Missouri, but as long as someone has a primary care or a physician that they check in with and maybe an orthopedist, someone they check in with relatively frequently about their musculoskeletal issues, we can do an evaluation and send that evaluation call and talk to the medical assistant or the MD yesterday kinda MD on the phone for one of the patients and talked about what I saw and they're happy to send the referral. So that's been, that whole process is as we've continued in business, we've seen it to be not nearly the barrier that we expected it to be. So yes, it's terrible to sit on hold, but hopefully you don't have to sit on hold at our clinic.

Vance Crowe [00:19:21] Yeah, no I I mean I don't mean it for you, I just mean like for basically any medical problem. And that's one of the biggest challenges of people getting help now is that like, it's not just, am I gonna go get help? It's am I gonna have to figure out how to navigate the, the system in order to be able to get help. And it's just an interesting challenge. So you and I just had celebrated the birth of our little child three months ago and because you were the one that had to carry the the baby and be pregnant, you now are in the experience of getting back into shape after having many, many months of not being able to exercise. What has this been like for a person that was always in shape their whole life and then had to stop?

Ann Crowe [00:20:04] Well actually I would say maybe I've been in shape since I met you, but I haven't always been in shape. And so in some ways I look at it and, and, and I'm a little overwhelmed 'cause I know how much work it's going to be because I've done it before. So I, I did it multiple times in my life, unfortunately get very out of shape. When I was in engineering, I was working a full-time job and took, did grad school full-time 'cause I wanted to be done in two years. And at the end of that is when I decided to train for Iron Man because I had gotten myself so incredibly out of shape and not prioritized my sleep or exercise and I was just pretty unhappy with what I was able to do physically. And so I decided to make a huge change and I don't anymore have the time to do something like that even though I'd love to in the future. So I guess I just feel like I, I know how much work it's gonna be to get back.

Vance Crowe [00:21:04] Yeah. And so for people that are starting to get back into exercise, what do you know now about getting back into shape that you didn't know before you were a physical therapist?

Ann Crowe [00:21:14] Well, what's so wonderful now is that I can fix all of my own joint problems. So when an acre pain comes up, for the most part I know exactly what to do and to get rid of it and I can continue on. And so those types of things don't derail me in the way that they used to. There were so many times that I would decide, you know, a New Year's resolution or I would decide I'm going to run, I wanna be able to run that's easiest form of fitness or even I'm just gonna do the elliptical for 45 minutes a day and then my feet or my knees or my back, something would be irritated and before I became a physical therapist, then I would just rest. Right? Because you're like, well I don't wanna aggravate my joint, I need my knee for the rest of my life. And and then you'd stay outta shape because it just kept happening. So my my the, the best advice I have for individuals that are trying to make a change in their life is to make sure that you have a plan. And that's what you heard from Mark. You have a plan and you, part of that plan is knowing who you're gonna contact if, if a a acre of pain comes up that's preventing you from continuing to exercise. It's just so much more fun to be physically active when you don't hurt. And as we talked about already today, some people don't experience pain in that way, but, but there are a lot of people that experience it the way I do and and worry about it and wonder what's this gonna mean for my long-term ability to exercise.

Ann Crowe [00:22:45] And, and they're not the individual that's just gonna push through it. They're gonna rest when their joint hurts and when something like that happens, we can help you get rid of it really quickly and keep you on your plan of making a life change.

Vance Crowe [00:22:58] I know you're not a women's health, you know, specialist, but you've definitely been around in this world and one of the things that surprised me at least, nobody tells, you know, a 20 or 30 something year old guy that women, when they go through pregnancy, then they have all these added challenges like problems where they leak urine and where they have trouble like doing all, all kinds of things that I never had any idea about. What are the unique challenges after a woman gets done, you know, having a baby that, that people don't know about.

Ann Crowe [00:23:29] Yes, so many gosh. And I feel like there's now having gone through it, I understand them so much better. I had just learned about them before and seen patients struggle and now I know. So I've been working with Legacy and Brooke at Legacy Physical Therapy and she's done a wonderful job helping me. But when you come back, so a lot of your joints are impacted by pregnancy from just the way that you stand and the way your back is positioned to the hormones you release in order to be able to birth the child. You know,

Vance Crowe [00:24:01] This part's crazy, right? This is the part that I like while you are pregnant, you start having these hormones that allow your pelvis to like become more flexible.

Ann Crowe [00:24:12] Your ligaments relax. Yep. So they kind of are more going to be more stretchy than they usually would be. Yep. And so that way the bones of your pelvis can shift around a little bit as as the, to get ready. So that's in the first and third trimester. And so in the first trimester I definitely got to experience those aches and pains related to that. But again, thank goodness I'm a PT so we could get rid of them. So fortunately I was able to get rid of them and keep running until I was so sick I couldn't run anymore 'cause the doctor said that I shouldn't keep running 'cause I had so much vomiting. But, but yeah, so that's in the beginning and the end. So first and third trimester, it really impacts you

Vance Crowe [00:24:57] And it changes like the way that you stand and the way that like you have your posture,

Ann Crowe [00:25:01] I would say the weight, the weight that you gain changes the way that you stand and the way that you gain it. And so also as your abdomen continues to expand, you know the abdominals aren't going to support your standing posture in the way they did once. And so people develop just poor postures that oftentimes they don't get rid of after they have the baby. 'cause then they're holding the baby in front of them and so they're in postures that just aren't ideal for glute recruitment. It's not great for your back and your abdominals. It's not good for the nerves and your spine. So there's a lot of positions that you adapt to during the pregnancy and while taking care of the child that are not great, not great for your joint health. I guess

Vance Crowe [00:25:44] If so imagine you were in a pt. Do women know about this? Like it never even dawned on me that when you're gonna be nursing a child, you now have actual milk in your breasts and that is actual weight that you're now carrying around and it shifts and it changes. Like none of these things occurred to me.

Ann Crowe [00:26:01] Right.

Vance Crowe [00:26:02] But do women know about this?

Ann Crowe [00:26:04] I mean, you know, I guess so I think it's a lot in the running world and also in CrossFit it's becoming a lot more athletes are aware of pelvic floor problems after pregnancy and I think there's been a lot of push, there's a lot of physical therapists at work in the women's health pelvic health area who are trying to increase awareness so that people know that it's not problems that they might, might have with incontinence aren't normal and that there are ways to improve it and even get rid of the symptoms completely. And that

Vance Crowe [00:26:37] What is incontinence?

Ann Crowe [00:26:39] So if somebody might be leaking urine when they're running, for example, or when they go to lift a heavy weight or if they were to go to the trampoline park with their child or in some people just when they get up out of the chair and they have to put more effort forward. And so if you address those problems early, then it's much easier to get rid of them than addressing 'em 30 years later. But you can still make a difference 30 years later. You can still improve somebody's quality of life and you know, they're, you, you have muscles that are controlling that just like muscles everywhere else in your body that can be trained. But just like anywhere else in your body, if you don't use a muscle well or if it's used in, you know, poorly for a long period of time, you can change the fibers themselves. They can, they can become more stiff or less compliant or you know, it's just, there's so many, so, and I, this isn't my area, but you know, the pelvic floor muscles can be too tight. They can be not recruited well, they can not recruit at the same time as your abdominals. You can have a poor abdominal recruitment pattern that creates too much pressure down on your pelvic floor. I mean, there's a lot of things that can cause incontinence, but you should interview somebody that this is their whole area because they'll be able to speak to it. I mean if if I have a problem, I'm going to see

Vance Crowe [00:28:01] A specialist. Yeah, I mean the reason I bring it up with you is that because, you know, I had read about this happening to women in Africa, right? Where they have some problem and the leaking causes them to, to like smell bad and, and it just thought like, oh that's a problem that people have. You

Ann Crowe [00:28:16] Read about fistula,

Vance Crowe [00:28:17] Right?

Ann Crowe [00:28:17] Yeah. So that's a, that's a bit different of an issue.

Vance Crowe [00:28:21] But what I'm saying is my, what I, what I was imagining is these are problems faced by people far away. And I did not realize these are problems that women, regular women face all of the time. And so like as a man don't,

Ann Crowe [00:28:35] Yeah. People that didn't have severe trauma during the delivery of their child still face these, even if you had a normal delivery and you had minimal tearing and, and things went fine, you can still experience some of these problems.

Vance Crowe [00:28:46] I think that this is one of the parts of the conversation that I, I don't know if men used to know this or they never had to know it, but it seems to me like I would have been far more understanding of my work colleagues that had had a child, had somebody sat me down and been like, alright, when a woman has a, has a baby, it's not just that she gets big and she puts on weight and it's a little uncomfortable. These are all of the things that are gonna happen to her. And then once she's done having the baby, the baby now cries, you know, maybe eight hours a day on top of trying to fix these problems. And so for me, not knowing those things made it so it was not possible for me to have any concept of what my colleagues around me were experiencing. In fact, I, like, I'm embarrassed of, I don't think I was ever rude to anybody, but at least in the way that I thought about it,

Ann Crowe [00:29:39] I guess I knew a lot of these things and I still think I could have been more compassionate. So it's not just you.

Vance Crowe [00:29:46] Well that's good.

Ann Crowe [00:29:47] Yeah. Anytime you, I think anytime you experience something that's challenging than or maybe a close person to you experiences something that's challenging, you become more sympathetic.

Vance Crowe [00:29:58] So you and I pathetic had went through the experience of IVF. So we had had a whole bunch of challenges having a child and one of the things that happened around IVF that I really didn't know is that in order to prepare your body to have this, to go through this procedure, you had to have shots. Sometimes two shots a day, but definitely one shot every day for 70 days in a row. What did this do to your ability, like your muscle? Like, you know, you don't think about things like you're putting a shot into your muscle a whole bunch of times. Yeah,

Ann Crowe [00:30:31] Well, so there's the systemic change, which seemed present, but then there's also just the muscle that you're injecting into. And so some of them are subcutaneous injections and some of them are muscular intermuscular injections. And I, I was pretty being a muscle person, I was pretty worked up over the whole thing. So of course 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 before the egg retrieval, you take a ton of hormones and you're not allowed to exercise. I wasn't even allowed to do a flip turn in the pool or do yoga where you're doing an inversion. So there's significant limitations to exercise during that phase. So you're beginning to atrophy, you're taking all these hormones that, that I, I mean I gained weight every single time we did it. And, and then on top of that, the injection is into the gluteal muscle, which I have a history of back and knee pain, which I have been able to solve, which is wonderful. But a huge component of that is gluteal muscle strength and the ability to recruit those muscles. And when you inject oil into them every day, it's really hard to get them to work. So, you know, that kind of sets you up for challenge. So I feel like we went back and forth on, you know, and I was able to regain all my glute strength.

Ann Crowe [00:32:04] So it did, it came back. But it came back because I knew that it had to be worked on and I was really diligent about about addressing it and I knew that if I didn't get it back by my second or third trimester, as I started to get bigger in pregnancy, I was gonna be really painful. And so I was fortunately able to control all the pain even despite the fact that we went through that multiple times and that there were like, I don't know, hundred more than a hundred gluten injections.

Vance Crowe [00:32:33] Oh my god, you filled up like yeah, a lot of oil.

Ann Crowe [00:32:35] I mean it really like was a lot

Vance Crowe [00:32:36] Those biohazard like containers. Yeah, those sharps ones, you're like, who eats those? We did and we filled up several of them.

Ann Crowe [00:32:43] Yeah, I think four.

Vance Crowe [00:32:45] And, and like I think that the, one of the interesting things from me, from my standpoint, I'm the one putting the injection in you every time. At first, if somebody had been like, oh you have to have 70 injections or you gotta go through this process for three months at a time, it would've been not that big of a deal. But when you started bringing up like, wait a second, what's this gonna do to the muscle? Like what actually happens? It doesn't matter what liquid you're putting in there. If you put a liquid in this muscle again and again and again and again, what's gonna happen? And the doctors who were amazing, I have nothing but positive things to say

Ann Crowe [00:33:18] Care.

Vance Crowe [00:33:19] Well they were like, I guess I never really thought about it.

Ann Crowe [00:33:21] Yeah. And they're, look, I tried to look up studies on this and it seemed like there were some studies about weightlifters who injected oil, or not weightlifters, I forget the name of the body. The It's like a body image competition. Yeah,

Vance Crowe [00:33:35] Body bodybuilders,

Ann Crowe [00:33:35] Bodybuilding. And so that they would inject certain areas of their muscle to enhance the, how it looked as opposed to make it perform better. Which to me seems, I mean, and people do all kinds of things for aesthetics, but I, yeah, so they had like significant changes to their muscle fibers. So they, when they did MRI studies of those muscle groups. And so then I read that and I started to become more worried. But, so I'm sure that there's scar tissue, I'm sure I have scar tissue and it probably, hopefully will change. We keep a, he's stemming it and made it go away. I dunno.

Vance Crowe [00:34:17] Well it was just, it was a wild experience that, again, I would say it was one of those things that maybe even if somebody had told me about, I wouldn't, I definitely wouldn't have understood. But I don't think that people like you think about, oh, we're gonna go through IVF, right? Like people have no idea. It's not like, oh, you just stop down to the hospital and you get your procedure done. You are doing months and months of preparation, you're injecting hormones into your body, you're like preparing your body to do all these wild things. So it was one of those things that, you know, that IVF is out there, so you're like, oh, well if we get a little too old and you know, we have trouble getting pregnant, we'll just do IVF. But nobody is sitting there being like, you want to really avoid this if you can, because it is going to be a very difficult road.

Ann Crowe [00:35:07] Well, to think of like if, like let's say you're a run, you're a woman and you're a runner and all of, so all of the lead up to your pregnancy then is spent ruining your glute muscles and getting outta shape. And then once you, once you hopefully finally get pregnant, which is so wonderful, then you continue on with these injections as you're trying to maintain your fitness and sanity and, and you know, stay on that 30 pound recommended weight gain. And it is a challenge, but we have our baby's perfect and we love her so much. Yeah.

Vance Crowe [00:35:46] And

Ann Crowe [00:35:47] We're so happy.

Vance Crowe [00:35:47] I mean, I and I have said this several times, like I would not have been as grateful for the child. Like there is no moment when the child, I can't say no moment, but when the child is scream, crying, you know, doing its best job to not go to sleep at night.

Ann Crowe [00:36:03] Yeah.

Vance Crowe [00:36:04] I am sitting there being like, you have no idea how hard we work to get here, baby. I don't care if you cry right now. Like, it's totally fine. But that does bring up like another thing, and we've talked about this as something that we feel like is important for us to share with other people was that we both took for granted that getting pregnant was easy and would just kind of happen or we could wait as long as we wanted. What do you think you learned about prioritizing our careers and kind of time instead of ha instead of starting this process earlier?

Ann Crowe [00:36:45] We, it wasn't just that. I think there were, I think there were more pieces to it than that, but if we focus on that aspect of it,

Vance Crowe [00:36:55] Well, you can talk about whatever pieces you want. I, I know that I just didn't know if it was important. Didn't know if it was gonna be something I wanted to do, didn't, didn't think that it was an important component of life.

Ann Crowe [00:37:05] Yeah. I don't know, you're listeners all want our like marriage issues, but I would kept keep asking you like, are you ready to do 50% of the work? And you would say no. And, and I would get mad and so then we wouldn't talk about it for another two years. And so then we just kept postponing it. I think I also looked around in my first career and saw moms that were really stressed and that were struggling between managing their work expectations and wanting their career to excel and getting to spend the time with their kids. They wanted to. And so I want, I knew I wanted to make a change if we were gonna have a family and that process of making a change took a really long time. And so I don't, I think the effort required to make a change, to have the life that I love, that I have now would've been really hard now that we have Violet. If I would've been trying to take that on as well, I doubt that I would've have done that until she would've been older. And at that point, you know, I don't know what decisions I'd make. So I am still glad that we chose, I chose to make a career change before, before she came into our lives. But like all the years of the process of making that change, I do wish we wouldn't have waited.

Vance Crowe [00:38:25] I mean, I talk with young men about it when, when they say, oh, we got married and I, you know, I don't bring it up, you know, in an uncouth way, but if we start talking about having kids or starting a family, I am the first one to tell them like, Hey, one of the big mistakes I made was thinking you can just wait. Right? But there is a real thing, a biological clock, and there are real challenges that come with being an older parent. Whether it's either getting pregnant, staying pregnant, or even then just how tired you are because you're doing this in your late thirties as opposed to your twenties. Like, I used my twenties to drink wildly and not have hangovers when you could have been using those, you know, resilient ability to wake up with no problem, to cater to a screaming child. But those days are gone now. So I'm

Ann Crowe [00:39:13] Tired all the time. Yeah. Like we talked about before, I used mine doing full-time work and full-time grad school and then training for an Ironman. Like I had a lot more energy. I always had a lot more energy, but maybe we're wiser now.

Vance Crowe [00:39:26] Yeah, definitely. And I wasn't, I mean, like you had said, I wasn't prepared to do 50% of the work and there is a real chance that I would've resented the child. Now I think about it and know that once you have that child, there's something just so that changes inside of you so

Ann Crowe [00:39:40] Much. Yeah.

Vance Crowe [00:39:41] But at the time, the lead up to the process, it would've been like, why am I giving this up? This, this life is for me. And then, you know, you, you can't make the calculus that you have when you have a child. But I do think that our society, or certainly when I was going to school, no one was sitting me down and being like, biological clocks are real th this, there is a real chance that you may struggle, you may go through a period where you lose pregnancies. And I really wish someone had, because I was completely unprepared for how difficult this road would be. And even if somebody had told me it wouldn't have made it necessarily easier, but I would've not been so shocked at every step along the way. Well,

Ann Crowe [00:40:23] And as a woman I thought like, oh, it'll be somewhere between a few months and you know, six to eight months and then it'll, and then you know, when we wanna get pregnant we will. So yeah, just, yeah.

Vance Crowe [00:40:35] I mean it's laughable now. Right. That's

Ann Crowe [00:40:36] Funny.

Vance Crowe [00:40:37] And you,

Ann Crowe [00:40:37] And I mean, I remember being worried about stupid things like, wow, am I gonna be pregnant at that wedding? That's dumb. Yeah, yeah.

Vance Crowe [00:40:46] But you just couldn't know. And so I think it's, it's, it's one of those things that I try and have the conversations that I wish people would've had with me. Because that's the only thing, that's the only thing you can do from learning from this suffering is, is like one, be grateful for what you have. Which I think it's, it's been easier for us to be grateful. I've known other parents that it came easy to them and the experience of like being a little mad at your child for crying or for taking away opportunities is just easier. 'cause you, it came easy to you.

Ann Crowe [00:41:17] I'm sure that's how all things are in life.

Vance Crowe [00:41:20] Well Ann, I know that we have a hard stop because you have a little child that needs to be fed and that is your, you

Ann Crowe [00:41:25] Do, I would like to just take the last opportunity to point out that for people who are runners who have gone through IVF and then continue to have either multiple pregnancies or C-section on top of that, I think keep in mind that there's a lot of changes that your body goes through and when you get back to running, it completely changes your running form. It changes how your muscles fire, it changes how you move and stand and there's a lot of things physical therapy can do to improve that and help to recover from those.

Vance Crowe [00:42:01] Well we had even talked about how, you know, you wish it was easier to reach out to people and tell them there are preventative things that you can do. There are things you could go visit somebody and have them help prepare your body for this is what you're about to go through.

Ann Crowe [00:42:14] Right, right. And I mean, I would, I'd love for any IVF providers out there that wanna learn more about what, what someone can do, who's going through all of this when they get a runner that comes into their clinic, reach out to me, Ann Crow at Precision Physical Therapy.

Vance Crowe [00:42:32] Yeah. So if people wanted to learn more about your physical therapy clinic, first of all, you have a, you have a business partner who is exceptional. What is Jesse Velo tell, talk a little bit about her work and what she does.

Ann Crowe [00:42:43] She is, she loves to treat patients who have back pain. So she's an expert in back pain. And whether it is with golfing or gardening or picking up your kids, that's, that's her passion and her love and that's what she likes to do.

Vance Crowe [00:42:58] And you guys run the clinic where you're not, you don't accept insurance. Right. It's a, it's, it's

Ann Crowe [00:43:04] An out of network clinic, which makes it the same price for everybody that comes in, which is significantly lower if you have a high deductible plan. But it's, you know, it's higher if you have, you know, a Cadillac plan. So it's just, it's the same price for everybody. They know exactly what to expect. There's no surprises. And

Vance Crowe [00:43:21] I think the best part about it is that you guys are just, it's, you run a clinic that is the size that you can care for every single one of your patients in, in just a different way than the industrialized system is. It's almost, I don't wanna call it a boutique, but it's, it's like craftsmanship, physical therapy.

Ann Crowe [00:43:40] Yeah. We can, we make our decisions on what's best for each patient, when they need the care, how much care they need, and how far apart it needs to be. Spaced is all based in what they need and what fits into their life and their work schedule

Vance Crowe [00:43:55] As opposed to what their insurance will schedule out and what you can fit into the Exactly.

Ann Crowe [00:43:59] Electronic

Vance Crowe [00:44:00] Medical records system system. Well, Ann, if people wanna find out about Precision Physical Therapy, where should they go?

Ann Crowe [00:44:06] Our website, www precision s tl.com. P-R-E-C-I. It's hard to spell. Spell

Vance Crowe [00:44:15] It again. You, you kinda laughed it out.

Ann Crowe [00:44:17] P-R-E-C-I-S-I-O-N-S-T l.com.

Vance Crowe [00:44:20] Alright,

Ann Crowe [00:44:21] Well

Vance Crowe [00:44:21] Ann, thanks for stopping down here, being my first post COVID Pandemic live interview. This has been a lot of fun and we'll have you on again.

Ann Crowe [00:44:30] Thank you. Ah.