The Beyond Pain Podcast

Episode 33: "Whole-istic" Healing with Diana Zotos Florio

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Summary
In this episode of the Beyond Pain podcast, hosts Joe Gambino and Joe LaVacca welcome Diana Zotos Florio, a physical therapist and yoga teacher. Diana shares her journey from personal training to physical therapy, emphasizing the importance of blending movement, mindfulness, and breath work in her practice. The conversation explores various themes, including the significance of addressing emotional and psychological factors in pain management, the holistic approach to pelvic floor health, and the importance of community and connection in healing. Diana also discusses her upcoming course on pelvic floor manual therapy and the need for awareness and education in this area. The episode concludes with practical takeaways for listeners to enhance their relationship with their bodies and improve their overall well-being.

Takeaways
Diana emphasizes the importance of consistency in practice.

She integrates physical therapy with yoga and mindfulness.

Understanding the emotional aspects of pain is crucial.

Community and connection play a vital role in healing.

Pelvic floor health is often overlooked but essential.

Breath work is key to regulating the nervous system.

Diana's personal pain journey shaped her approach to therapy.

Empowerment is a core value in her practice.

The BPSS model helps in understanding patients holistically.

Awareness of bodily sensations can lead to better health outcomes.

Joe Gambino (00:01)
Welcome back into the Beyond Pain podcast. I am one of your hosts, Joe Gambino, and I am here with our other co-host, Joe Quaddzilla Lavaca. I always give any of these quads. Yeah, I was. You know, it came to me late last night as I was laying in bed. I don't know why. I was just thinking about you, Joe.

Diana Zotos Florio (00:10)
Okay.

Joe LaVa (00:11)
Wow, you were working on that one. You were working on that one.

The more you think about me laying in bed, particularly my legs, makes me very happy.

Joe Gambino (00:22)
Yeah, see there you go, I'm glad I made your day there You can find this on social media at Joe Gambino DPT for myself and at strength and motion underscore PT for Lavaca did I get that right? I feel like I just messed it up Okay, great and this podcast is on Instagram as well beyond pain podcast and you can find this episode live on YouTube as well cups of Joe underscore PT and we do have a guest with us today

Joe LaVa (00:38)
Mm-hmm, mm-hmm, native.

Joe Gambino (00:51)
Diana Florio, she is a physical therapist, yoga teacher, the co-founder of Three Physio Yoga. Welcome into the show.

Diana Zotos Florio (00:59)
Thank you so much. so excited to be here with you guys. This is so fun.

Joe LaVa (01:04)
Yeah, thanks for not signing off the minute Joe started talking about me in bed last night. So I was like, what's the quickest way to make our new guest uncomfortable? That's it right off the bat. First intro sentence. So thanks so much, Diana, for being here. We're so excited to have you.

Diana Zotos Florio (01:06)
I'm

Joe Gambino (01:09)
Hahaha!

Diana Zotos Florio (01:12)
Yeah, right off the bat.

Joe Gambino (01:14)
That's it.

Diana Zotos Florio (01:21)
It's so fun.

Joe Gambino (01:21)
Yeah, hope we didn't lose too many of our 16 listeners either,

Diana Zotos Florio (01:25)
Yeah.

Joe LaVa (01:25)
No, it's growing Joe. It's getting bigger. It's getting bigger. We're on the cusp. I can feel it. I can feel it. So Diana.

Diana Zotos Florio (01:32)
Consistency is key. You guys are doing it. Yeah.

Joe LaVa (01:37)
Tell us about yourself, for the people who may not know you. What do we do? Where are you from? We'll start there. Anything interesting, and then we got some fun questions for you.

Diana Zotos Florio (01:50)
wow. So I am, I live in New York in Long Island and I live quite close to you, Joe, which is fun. I am a physical therapist and a yoga teacher and a strength and conditioning specialist. I love blending the modalities of all things, movement, mindfulness, mindset, breathing, because I really.

Joe LaVa (02:00)
couple blocks away.

Diana Zotos Florio (02:16)
I was lucky enough to see myself and my patients and my clients as whole people who need all of the things all of the time. I became a PT after being a biology major in college and being pre-med and taking the MCATs and then never giving that folder of applications to my advisor because something inside me said no. And I started personal training and I became a student in physical therapy school. And then.

I got led to yoga and all of it all came together for me in several ways, but it really became clear when I was a PT working at the hospital for special surgery in Manhattan in sports medicine that there is just so much more than three sets of 10 for rehab for anyone with an injury. And I just started merging yoga mindset, breath work and PT together.

And so I guess when my first kid was born, I was really starting to use PT and yoga together in Manhattan with a lot of private clients. And I got together with a friend of mine, Emily, who also worked at HSS and was working with yoga training schools, bringing physical therapy principles to yoga training schools and teaching yoga teachers how to move.

better, smarter, safer. And we decided to create a teacher training and that teacher training was for yoga teachers. And that was the first instance of physi yoga existing in the world. So that's sort of my professional story. I also have three children, 11, nine and six. They're very busy. Myself, I love to, like in the perimenopausal era of my life. So I am strength training like a beast.

and I am doing my HIIT work. I just attended a live symposium with Stacey Sims. I am drinking the Kool-Aid. I'm going for it. I do my yoga every day or my meditation. I walk. I really try to practice what I preach. So that's my story for the first part of it, I guess. There's a lot more.

Joe LaVa (04:41)
We will definitely dive into a lot more of that. A couple of fun things there. You also mentioned your three kids, but I think you left one out. I think you have an older child as well, Kellett.

Diana Zotos Florio (04:46)
you

yeah, I thought, yes. I think you're totally right, I did leave him out. He is, I would say, I do parent him in a weird way. I mean, I give him a lot of Professionally, personally. I know, he would say the same. Yeah.

Joe LaVa (05:02)
Yeah.

Kellen, we love you, buddy. We're just messing with you. We just mess it with you. Exactly, exactly. So what have you, just sticking to your quick professional side, because I know you mentioned the perimenopausal stuff. That has been a hot topic for a lot of people, including Courtney and I, you know, in our conversations. What are you working on? Anything coming down the pipe in that sort of vein where we can get excited about?

Diana Zotos Florio (05:18)
Yeah.

Mmm.

Totally. So in the distant future, we are in the very early stages of developing a program, programming for perimenopausal women. We really want to piggyback off of Vonda Wright's paper, the musculoskeletal syndrome of menopause and talk about all of the changes that happen, arthritis, sarcopenia, frozen shoulder, blah, blah.

and also how we can use down regulation techniques for thermoregulation. So those hot flashes, we know their science behind down regulating and navigating those. But that's in the distant future. What's in the near future is something I'm really excited about. In the last few years of my life, I have embarked on a whole new discipline or a whole new part of my skill set, which is pelvic floor manual therapy. I always felt like the pelvic floor was sort of a missing piece for all PT's. I think

all PT should understand the function of the pelvic floor. It is such an integral piece of how we stabilize, breathe, digest, move, pee, poop, have sex. And I think if we're working with an athlete or a postpartum mom, everyone needs to have a functional pelvic floor. So I've developed a course around how to unlock the power of the pelvic floor without doing any internal work.

So this is for personal trainers, yoga teachers, Pilates teachers, PTs, OTs, anyone who wants to understand how the pelvic floor is related to how we breathe, to our mindset, to our stress state, to what our foot can do, our hip can do, our spine can do, our pelvis can do, our neck and head can do. So it's a framework to looking at the different pieces of the body, body, breath and nervous system. And then it is a system of

learning and exploring different restorative tools that you can use to help people progressively unlock their pelvic floor. Like I said, you don't need to do any internal work. Everything is basically movement-based and talk-based. I'm really excited that launches in January, along with some live stuff and bonus content and all the fun things. Yeah, super excited.

Joe LaVa (07:43)
That's amazing.

Joe Gambino (07:53)
think we'll have a lot of questions for you about that today. Before we get, I have also another question for you, but before we get into the questions, we have one question we have to ask you at the, mostly at the start of the show, and it's how do you take your coffee? Since we have this coffee theme on the podcast, it's, yes, go for it.

Diana Zotos Florio (08:01)
You

so good. Wait, what if I didn't drink coffee? Would I not be allowed? I grind my beans the night before and I brew in an electric Breville pot and I drink it with raw sugar and half and half, like full fat dairy.

Joe Gambino (08:14)
That's an acceptable answer. can get right off the podcast.

Joe LaVa (08:16)
then the interview would be over.

Joe Gambino (08:36)
There you go.

Diana Zotos Florio (08:37)
Yep. I'm a believer in all that whole food stuff.

Joe Gambino (08:41)
Now any reason for the grinding the night before?

Joe LaVa (08:41)
And wait.

Yeah, that's what I was interested in, yeah.

Diana Zotos Florio (08:45)
Yeah, so I want to have it ready for me when I come downstairs. I am like kind of like a zombie at 630 with kids begging for three different breakfasts. I'm like, just give me a second guys.

Joe Gambino (08:51)
There you go. I like that.

Joe LaVa (09:01)
Yeah, Joe, I thought there was some unlocking of aromas. Diana, we've learned so much.

Joe Gambino (09:04)
Exactly. Yeah. Well, based on previous guests we've had, they've, you know, everyone has this, you know, very unique way. I thought there was something behind it, but yeah, I like the reason. Hey, make it easy for you in the morning. That's exactly what I would need in my life. my

Diana Zotos Florio (09:09)
Hmm.

Ritual? Yeah. Mmm. I could surely come up with something. No. I wish.

Joe LaVa (09:14)
Yeah, I thought I was gonna learn something new.

Diana Zotos Florio (09:22)
Yeah, it's so good.

Joe LaVa (09:23)
Yeah, well, I feel like both of you have this system though. know, Joe's system is so wonderful and I was actually able to taste Joe's iced coffee and it's just amazing. It's absolutely incredible.

Joe Gambino (09:33)
Yeah, I just, don't even want to bother having to, I should grind my own beans, but I am too lazy for that. So I just, when I get the beans at the place, I just have them grind for me. It's not the best, it works. So, and I just actually really hate cleaning the gr, the.

Diana Zotos Florio (09:44)
Well, what about this? some, I don't clean the grinder. No, I don't clean it. I'll send you the one I use. Yeah, yeah. But when I grind the beans, I put my hands on the grinder because we have a baratza and it takes like two minutes. I just give, I actually do ground myself then and like take a few diaphragmatic breaths because it's just like a ritual. Yeah, there we go. Yeah.

Joe Gambino (09:49)
I hate having to clean the grime. No?

Maybe that's my trick that I Okay, perfect.

Joe LaVa (10:10)
Here you go.

Diana Zotos Florio (10:14)
So you may want to get a grinder and just hold that space.

Joe Gambino (10:14)
I like it. there you go. Maybe I'll give that a try. Yeah, send it to me for sure. I'd be interested in looking because I hate the bean grinder we have here. But my first question for you really is you have this unique background and it's, know, for me, I was a PT first. I did a whole bunch of strength and conditioning at the college level and then I became a PT. And I feel like all those things have combined and created my philosophy. So

Diana Zotos Florio (10:22)
Mm-hmm.

Yeah, I've been through a lot.

Joe Gambino (10:42)
It seems like it's been similar for you. started as a trainer, you went into PT school, you started yoga. How have all of these things come together to impact your overall philosophy?

Diana Zotos Florio (10:56)
I just feel like from being a personal trainer, it was really the first place where I got my lens at really looking at how people move their strategies, their motor control, how their day that they had before coming into the gym affected how they moved and what, what they might've needed at that point.

And so I think I've always been a people person. Like I've always wanted to understand people, understand their why, understand their route, understand what's going to work for them. And so I think in personal training, I really understood like, okay, this person really needs to just beat it out before we can even slow down and work hard on like meaningful work.

This person needs to ease in slowly and feel safe and supported and feel like I'm really cueing them to, you know, engage their abdominals properly before we do anything else. Like just understanding people. I think I brought that into physical therapy. Like I said, when I was working in sports at HSS, I was a unicorn. I was one of the first people there, whoever even thought about how their patients thought and breathed.

And it was really about movement. And so I was really able to use my people understanding what makes this person tick, what motivates them, what makes them feel safe, what challenges them in that space. And then when I brought the yoga in, I was like, my gosh, this is kind of what I've been doing, but almost codified into a system of how we can.

think about ourselves, think about the world, think about our affective people in the world, our affect on people in the world, and how we can put that into practice, into like a little bit of a package. And so everything became unified in that place. It gave me a way to unite mindset, breath work, movement, and look at how people put all these different pieces together.

And so I feel like all of my patients get a unique blend of all of these things, depending on their story and their goals and how they look, how they present, how they breathe, how they move.

Yeah.

Joe Gambino (13:38)
Yeah, no, I like that.

Joe LaVa (13:39)
And yeah, and one of the things I was thinking of there when you were mentioning all these different types of people and bringing in the blended approach, people are consciously dysfunctional to some degree, right? They seek us out because I have knee pain. doesn't move. My back is stiff. Very rarely though, are people aware of how maybe opportunistic their movements are. And I find that they're

probably even less aware of how stress, mindset, like kind of impacts all this stuff. So maybe we put that in like the unconscious, like dysfunction, right? No idea, not even on my radar. So as you're taking all these like blended approach, do you have specific things that you look for, your team looks for to maybe prioritize or educate the client in front of you so they understand a little bit more about maybe the

that they can pick to achieve their goals. And maybe like mindset, breath, work, exercise, you know, we hear all these things all the time.

Diana Zotos Florio (14:47)
I think I can tell you about how we evaluate and how we train people to evaluate. We always teach, we teach in our yoga teacher training, the BPSS model. So when you're doing an interview, you're looking for, and you're listening for pieces of a biological story and looking at a movement assessment.

that we've developed and you're picking out like, yeah, that foot doesn't pronate so well. And then you're looking for a psychological pieces of the story. What are they telling you? They're saying, man, feel like I feel so out of shape and I've gained so much weight. Like that's piece of that psychological story. And then they may say something and then we look for social cues. Like, I'm just like.

I'm so busy and at home I feel so unsupported. There's just, you know, what's it like to be you? What's it like in a day to day? Well, I come home and I do all these things and like I'm cooking and cleaning and then we say, well, you know, is there anyone else around or are you connecting with friends? And they're like, it's not really time for that. And then we ask questions based on the spiritual, like, well, what do you do to get outside your head? What do you do to find joy?

And we listen, do know, does this person have gratitude? Does this person have the sense of awe? Do they have a sense of greater joy and exploration outside of them? And so we collect all of these pieces and it becomes sort of like, what are the things that we found? And we move from there and we try to attend to all of these pieces because again, we're all whole humans. And we know from countless articles and pain science literature that

everything we feel is developed from a multifactorial web that our brain constructs. And so if I want to change this pain web, I have to attend to all of the different pieces because that's how the brain is wired. The brain is wired for efficiency. It's going to pull on all of the things that are stressing to create the output of pain. And so...

Unfortunately, we don't prioritize one or the other. We always kind of use all of them at once. is a sort of a method that we do. And for me, when I have someone come into my clinic, usually the first thing I do after I do the interview and I bucket their assessment is, do you guys know there's like an emotional color wheel or like ruler and like.

Mark brackets work and all those different colored emotions, right? Like red is anger and blue is sadness and yellow is joy. So I use one of those. say, how are you feeling today? Are you feeling anxious? Are stressed, overwhelmed, fatigued? And so we start there, right? And we say, okay. Say there's a low back pain patient who comes into my clinic and their low back is stiff.

Joe LaVa (17:39)
Mm-hmm.

Diana Zotos Florio (18:00)
And they're like, well, I can't tie my shoes and all these things and I'm afraid to move. I'm just afraid. And so we pick out, yeah, okay, you're afraid. So let's recognize with some awareness that your key emotion is fear. And then let's work on that key emotion. I usually go to breath work because I know that if I can educate someone to breathe, I can regulate their nervous system. So we'll do like an elongated exhale breath. Inhale for four.

Exhale for eight, five times. We know that'll help with the vagus nerve when the diaphragm is moving and that will help us feel like we're in rest and digest. I don't think we can really heal when we're not in rest and digest. We need to come out of that fear state to this middle place. And then, now it's like, okay, so I want you to think about your mindset differently before we move. I want you to move with meaning. So I want you to say,

Look, can't tie your shoes, but you're waking up in the morning, you're getting out of bed, you're making your coffee, you're able to walk to the bus stop. Like look at all these things you can do. And I want you to think about all those things you can do and just keep that in the back of your head as how you are safe in some movements as you do your mobility work. And so then I'll give them a exercise program that is not three sets of 10. It's slow, it's mindful, it's...

Can you keep your breath steady as you do these hip circles? Can you keep that idea in your head of all the things you can do as you do some nerve flossing? And so we're doing it all together at once to unpack and sort of hit all of those layers of the human. Because I think that's just so much more valuable than checking the box of three sets of 10. And I mean, I do that kind of work when I string train.

framework I've implemented. Does that make sense?

Joe LaVa (19:59)
Yeah, I think, yeah, for sure. I think for people listening that I always talk about removing barriers. And a lot of times the barriers for many people is the stories we build about ourselves. And if we don't recognize that we are the narrator of our feelings, of our emotions, of basically everything that happens to us,

and every experience, think that recognizing that is really key. I think that was, definitely answered my question because I think when people recognize that initial barrier, for many people, it's not pain. And we've talked about this on the show a few times. It's this fear, it's the anxiety, it's the uncertainty. So if you can start by addressing that, then I think you're on the same page with kind

co-narrating a new story or a new way of thinking for people, which is, I think you highlighted a lot of things there, like not only this mindset approach, but then reframing or reconceptualizing the good that's still going on in your life that we lose track of. And then kind of moving on to, okay, well, what other physiological movements or things can you manage with or cope with? What I've always loved about

the system that you guys implement is that added S, right? That sort of like spiritual, sort of joyful component. And I'm wondering if there is a little bit of a personal side for you and your team. I do have the pleasure of knowing a few of them. And I know some of you guys have your individual pain stories and journeys. What was that like for you?

at an individual level and that kind of help you with that BPSS sort of approach when you sort of reflect back.

Diana Zotos Florio (22:01)
Yes, short answer. Yeah. I could tell you more. Yeah. Yeah.

Joe LaVa (22:04)
Hahaha

Well, if you want to dive into that personal stuff, yeah, go ahead, please. Yeah, yeah, yeah. think that's the, aside from the coffee question, the other real consistent question that we always have on the show for guests is, you your own personal pain journey and how you grew from that. you know, and again, the model that you have, the team that you've built, they all have such unique stories that I think shape their perceptions and how they help clients. So it's always really interesting to people.

Diana Zotos Florio (22:24)
you

Joe LaVa (22:38)
to realize that they're not alone and me and Joe and you all kind of suffer or have suffered with the same thing.

Diana Zotos Florio (22:38)
Yeah.

Yeah. So the pain story I always tell, and I don't think I've had anything ever as bad as this except for giving birth, which is just an anomaly, was I was in my 30s. I was working in the clinic at Goldman Sachs at the hospital for special surgery opened, which was crazy.

And that's another story. And I went through a big breakup. Like I had been living in this beautiful apartment with someone and I was like, I'm done with this. And I had to move out and I moved into this like tiny, shitty apartment in Brooklyn before a walk up. First time I'd been on my own in the city. I was working really hard.

in and out and I was like, you know what I'm gonna do? Because I'm like, I'm all fired up and I feel a little bit unsafe in my apartment. My best friend Kara, who's part of the team was like, let's do boxing. We're gonna go to the Church Street Boxing Gym down in Tribeca. We're gonna beat stuff. That's how we're gonna get over it. We're gonna up regulate. We're gonna fire ourselves up. We're gonna hit stuff. We're gonna work hard until we feel like we're gonna puke. And that's how we're gonna get through it.

I was like, yes, I'm in, let's do this. I am tough. I live by myself in Brooklyn. Let's go. And so like five classes in and I like pull something in my back. I'm doing those like sit-ups where you're punching the guy and I'm like, I'm going for it. And I just, something goes, right? And I can't even get home. Like I'm limping, crying down into the subway, up the five flights of stairs.

I'm like, my, you know, I'm, I am F'd. Something so bad has happened to my back. I've so damaged myself and make an appointment. I go see the physiatrist at HSS. He's like, you're fine. I'm like, I'm not fine. I'm hurt. I can't even move. I go to work the next day. I'm crying. I, and, and the long story short, it gets better, right? And how it gets better is I give in to feeling

sad to feeling like some to mourning the relationship that ended. I let myself feel my feelings. I named them. I'm sad. This was hard. I can't beat my way out of it. I need to sit in it. I need to breathe in it. I need to slow down. I started going for walks. I started doing yoga. I started connecting with a community in yoga. I started connecting with myself.

started realizing my patterns. Well, man, I'm really holding my sadness, my frustration, my back and my hips really tight. And I feel a little bit safer and I tell myself I'm safer. All of that tension, let's go. And I have not had a back injury since it was, know, start shooting, cry, pull your breath out of your body pain. And through unwinding the story and not

resisting the story but giving in to what my body was telling me which was you just need to rest and feel it. I got a lot better and I think that that bringing the yoga practice in that's slowing down to feeling to connecting with nature and my friends really was that S that brought me healing. It was crazy.

Joe LaVa (26:28)
It's not crazy at all. Joe has very similar episodes with his back and Joe, I don't know if it was connected to when I left Perfect Stride for you. Was that a similar experience?

Diana Zotos Florio (26:36)
I

Joe Gambino (26:39)
That's when I started feeling better.

You were there while I was suffering, so it was not connected to you leaving. Yeah, I don't know. mean, there was no stressful event around it. It started somewhere in my mid-20s and just lingered on and off for quite some time. So, yeah, I got no real explanation for it. So I never got imaging. I was always too good to go get a looked at by a doctor or anything like that, you know?

Joe LaVa (26:51)
Yeah.

Yeah, well, I mean.

Diana Zotos Florio (27:12)
I totally want to assess you, Joe. I want to dig in. I want to dig in.

Joe Gambino (27:17)
So, there's never, yeah, nope. Yeah, maybe.

Joe LaVa (27:19)
Joe's got buried, buried stuff. Maybe it was with your, maybe, yeah, yeah, yeah. I like this, I like this. We're gonna do a part two of just peeling back the layers on Joe Gambino. Man, I love it, I love it. So Diana, I mean, your personal story there I think sheds a lot of light on your system of approach now. And I think part of,

Diana Zotos Florio (27:23)
We'll find it.

Joe Gambino (27:27)
Just as I said,

Diana Zotos Florio (27:33)
Mm.

Joe LaVa (27:48)
what makes you so relatable and your team so relatable is that you had to go through those lows to kind of recover and recognize what was important to you. So you mentioned a lot of things about community and feeling feelings. mean, is that sort of the biggest gift that you think you have with blending physical therapy and yoga? Are there other elements to it that you'd like to talk about that you think are really important for maybe people who are

seeking alternative types of movement or communities to find some healing in.

Diana Zotos Florio (28:25)
yeah, I definitely tried to, we definitely strive to create community and, in our teacher training and in anything that we're doing with our online studio, we are constantly getting the feedback that we are just, warm and welcoming. And we really don't have, anyone on our team who has an ego, like everybody is inviting warm, gentle.

We're here to empower people, not to dictate what we want them to do. We're here to empower. And I think just by who we are, like part of yoga movement, the poses, the breath work, these are like two of the eight limbs of yoga. are other limbs of yoga called the yamas and the niyamas.

which are sort of this like moral code that was created thousands of years ago by Patanjali and his crew. And so there's sort of like these ideas of how you present yourself in the world. And one of them is ahimsa, which you may have heard before, but it means to do no harm. So as you're moving through life, doing no harm to yourself,

so awareness of any negative self-talk, but also do no harm to those around you. And so there are more than a himsa, but I think all of us, all of us that are on our team, all of us that are teaching the professional ed and the studio classes, embrace this moral code of how to be a human and know that really the only thing that we have that's permanent is our relationships and our kindness and our compassion.

So we are full of that for the community that we're trying to create. And part of that is Ahimsa and not harming and Satya being truthful. Like these are principles that we all stand by and believe. The other thing that I think that we're trying to do, especially in an online studio, which is unique is so much of our online classes are created to teach movement or breath work, but they're...

Through the lens of curiosity, we really want to foster a curiosity in all of our students to explore inside their body. We say, like, how does this feel? Or what do you feel when? Or what does that feel like? And not to judge themselves. So I think we're trying to foster a deeper relationship with yourself through the movement and breath work that we teach so that people can walk away with some understanding of their habits, their patterns, their stories.

how they move, their foot hits the ground. And it's through that lens of empowerment that we want to do that.

Joe LaVa (31:30)
I like that. Empowerment is always a key word that Joe and I talk about so much.

Joe Gambino (31:37)
Yeah, no, I love that as well. I do want to shift gears though a little bit here because I'm just really curious. This is something that I've always, I've been just like, I think a little bit more and more interested, especially with Jen, know, having two pregnancies now and everything that's going to happen as it's affected our body. But I want to shift the question a little more to the topics, guess, pelvic floor in a sense.

Is that something that you've been focusing on? And we definitely have not talked about that at all on the podcast. I guess my first question is, if we're just like otherwise healthy people, maybe they have some pain, they come to see you. What kind of things tend to pop up that make you think that somebody may need pelvic floor work if they don't necessarily know that that may be an issue for them?

Diana Zotos Florio (32:02)
Mm-hmm.

was a good question. You can talk about bowel bladder. So do you poop regularly? What's it like when you poop? Is it hard to poop? Do you not poop regularly? Are you constipated? How many times are you peeing a day? So eight times is kind of norm. More than that, and that's too many usually. How much are you peeing? Are you just dribbling?

Do you pee when you sneeze, cough, jump, run, laugh? Let's see. Do you have tailbone pain? Do you have pain with penetration? So intercourse, tampons. Do you have pelvic pain? And then the second level of questions would be, I've had back pain for years or I've had hip pain for years.

I've seen PT's, I've done PT, I've done manual therapy, I've done McKenzie, I've done chiropractic, I've done all the exercise, I've had a hip scope and they're still in pain. The pelvic floor is right there and it controls our intra-abdominal pressure. So if you have a two-tone pelvic floor, you could create a lot of havoc on your spine.

because you pressurize your abdominal canister to the point where mobility is limited, breath is limited. The pelvic floor creates force closure of the SI joint. It helps to stabilize the hip, the pelvis. You need a stable pelvis for a healthy hip. So yes, those like bowel, sex questions.

but then, and pain questions, but then that secondary like digging, have you tried stuff? And if you have, still are suffering, then I would take a look inside and see what's happening because it's right there. You, mean, the proximity of the pelvic floor to the hip as the crow flies is very close. They're near, they're virtually on top of each other.

Joe LaVa (34:46)
Have you found those conversations difficult to have with clients, whether they're male or female? I feel that there's so much stigmatization associated in that area. People are here to see us for back or hips. So what were ways that you've either gently approached that topic or maybe dealt with some difficult conversations, especially as you were getting going?

Diana Zotos Florio (34:57)
Mm-hmm.

Joe LaVa (35:14)
I think that's really helpful for both the client and the clinician to hear if they're both listening.

Diana Zotos Florio (35:20)
I mean, so I think you can tell through, I wouldn't be the first thing I would bring up. I would definitely have the conversation, peel apart some of the layers. then someone like my husband or someone like that who's very like business, I would say, you know, part of every evaluation I do is I ask about bowel, bladder habits because...

You have muscles there that control those functions and sometimes those muscles can be part of our pain. So I just am gonna ask you, do you pee when you sneeze? And how often are you pooping? Do you ever experience constipation? So that's like the most plain black and white way I bring it up. It's definitely an easier conversation for me to have with people who've had babies.

because they know that we're going to have that conversation. Sometimes I bring in humor and I talk about how, my poor husband, how when he's stressed, I tell him to breathe into his butt and it makes him laugh. And he's like, what are you talking about? And it sounds so ridiculous. But I'm like, no, but can you? Because you might be gripping your pelvic floor because you're so stressed.

Joe LaVa (36:42)
All right.

Diana Zotos Florio (36:43)
We know that when you grip your neck and your jaw, your pelvic floor is gripping as well. And so that could just make you feel crappy. So, and I'll say that to my kids too, and they'll laugh about it. I don't know. And so I'll tell people, hey, know, this is something silly I tell my kids sometimes because they think it's funny, but it's actually something that's beneficial. So I try to humanize it a little bit.

I think if you can bring up the fact that a lot of people are doing pelvic floor therapy, a lot of pro athletes, if you can name someone, I don't know of anyone offhand, but I am sure there are people who have unlocked performance by working on their pelvic floor. I think those are good icebreakers too. It's hard, but the more comfortable you are with talking about it, the more you make it not seem like a big deal, but just part of

the regular evaluation or you can humorize it a little bit, the better. Yeah, I'm just very comfortable with it because it is, it's like the bicep. I mean, that's how much of a role it has. It's more than the bicep. That's how much of role it has in everything we do.

Joe LaVa (37:56)
Interesting. I like that a lot. Yeah. I also liked the idea of anytime Avery is getting stressed out, I'm just going to say, could you breathe through your butt a little bit? And I'm going to thank you for that, Diana, because I do think that that is, you I think it is like you said, like, in the beginning, it wouldn't be the first thing right off the bat. And I always know my intake form with past medical history, know, bowel or bladder issues are there, constipation.

Diana Zotos Florio (37:59)
you

Yeah.

Joe Gambino (38:05)
You

Ha ha.

Joe LaVa (38:25)
And sometimes people check that off and, you know, if we're in the middle of a, assessment or not quite sure where to go, I always resort back to their medical history. Cause sometimes people are more comfortable writing things out or checking a box. Then they are kind of bringing it up. So I think that there's a lot of ways that we can probably broach that topic with people to say, Hey, you know, I know you mentioned in your intake form. wow. A lot of people are like, you read my intake form. I'm like, well, yeah, I wouldn't give it to you if.

Diana Zotos Florio (38:53)
Yeah, yeah, Right.

Joe LaVa (38:53)
I wasn't going to read it, right? And they were like, well, I don't think anyone's ever really asked me that. I'm like, well, you thought it was enough to check a box or write a little sentence on it. So I think that could be an interesting way to approach that topic as well. And like you said, with so many different angles of approach, identifying an emotion or the barrier in their narrative to moving on to mindset. And I feel like a lot of the

Diana Zotos Florio (39:06)
Yeah.

Joe LaVa (39:23)
pelvic floor stuff, at least the way that you were initially describing it, comes back to maybe recognizing those emotions and the mindset. So do you feel like there with your treatment applications towards pelvic floor, I know you said there was this online course coming out in January, it's online course, right? So it's non manual based. Do you feel like there's a lot of connection to like the breath work you do with people benefiting their pelvic floors? Because then that would be another

Diana Zotos Florio (39:41)
Mm-hmm. Mm-hmm.

Joe LaVa (39:52)
great selling point for people to approach breathwork where it's not just, whoa, woo woo. It's actually giving them some sort of physiological benefit. Have you found that?

Diana Zotos Florio (40:04)
Yeah, yeah, so much of the course is about breathing for the pelvic floor and about being aware of what your pelvic floor is doing. So a lot of times people who have pelvic floor issues, and just like to go back for a real quick second, I had a person who constipated for 20 years and they're like so fricking desperate that they're like, yes, let's talk about my pelvic floor, whatever it takes.

whatever it takes. So sometimes people are just so at their wits end or if they've had chronic tailbone pain, so just FYI, people are really suffering, then they're ready. So we talked about the whole body, right? So the pelvic floor is affected by the pelvis and the hips and the feet and the rib cage, but the pelvic floor is also intricately involved in how we breathe.

And so I think this is most fascinating when you look at someone who's pregnant. So as you get pregnant, your belly grows, your belly grows a lot. So by the time you're about ready to give birth, your diaphragm, which normally is a flat-ish muscle, and then when you inhale, flattens and descends so that you can take a full volume lung breath. That's because that creates a negative pressure inside your lungs, your pleural cavity. When you're pregnant, your diaphragm is up in your rib cage and stuck

up in your rib cage. So that breathing mechanism is not working. And so every time, so a lot of women have a hard time connecting to and strengthening their pelvic floor postpartum because just like the diaphragm does this with every breath, down on inhale, up on exhale, pelvic floor does the same thing.

So when we inhale, the pelvic floor descends, widens, lengthens. So all two or three holes you have should open on inhale. And that's a lengthening, like your bicep lengthens. And then on exhale, it rebounds and comes back up. So that's how you shorten. If you can't get a full length, if the pelvic floor doesn't fully descend, open and widen because you can't get a full inhale, then if you have a full bladder and you cough, sneeze, jump,

and your pelvic floor is stuck here because it couldn't fully lengthen. It can't shorten to close the sphincters to support the urethra. So that's how a lot of people leak and that's sort of like not able to get that full length. And so we do a lot of breath work to get that 360 jellyfish breath back where you're coordinating diaphragm and pelvic floor.

And because the diaphragm is 360 degrees, some people need more diaphragm expansion in the back versus the front. So that's what the course dives into. As far as mindset goes, some people, I've had women come into my clinic and say, I have a type A vagina because they know, they've seen other pelvic floor PT's who've done just manual work that no matter what manual work they do, they're still here.

Right? They grip, they're stressed all the time because they think they're threatened by the world because that's stress. And, you know, some people grip in their upper traps, some people grip their butts. Check in with your butt right now, can you wipe it now? Can you breathe into it? A lot of us grip our butts. So, but people don't know, right? So a lot of the work we do in this course is to

do a little bit of work on the representation of the pelvic floor and the cerebellum. So we're highlighting or we're sort of like lighting up the pelvic floor in the brain because a lot of people don't even know what their pelvic floor is doing at rest because the representation of the brain and the motor and sensory cortices is very small compared to like our hands and our mouth and our tongue. And so

I'll use different like ball rolling techniques and pelvic floor mapping techniques to increase the density and the connectivity of the pelvic floor and the brain so that it's easier for people to say, I'm doing the dishes. I'm gripping my butt. My pelvic floor is tense. Okay. Diana said I should breathe when I do that. So now I'm going to breathe into my butthole. So now my pelvic floor, which was like this and not able to help me with my peeing or my core is like, okay.

And so it's that repetitive repatterning that I really seek to educate people about in this course.

Joe Gambino (44:56)
I like that. You're starting to answer a question that I had. So you talked about breathing, you talked about the diaphragm, the pelvic floor mapping. My question kind of really is, when I moved here, I worked in network practice for a while, trying to close in a mortgage. can't be a business owner, especially when you move states. It's very hard to do so.

Diana Zotos Florio (44:58)
you

Joe Gambino (45:22)
But one of the places where I worked, kind of like bumped around between different locations and there was a location that they did a lot of pelvic floor, they were pelvic floor specialists. But when I'm watching them do stuff, as far as treatment goes, it looked no different than if like somebody came in for lower back pain. It's like band work, get on the bike to warm up, know, like typical what you would see in a fast paced PT environment like that. So really the question, I guess, outside of the things that you talked about.

What should somebody who's listening expect from a pelvic floor treatment as far as what's going to be happening in there, that maybe the conversations that are had, as far as the overall philosophy goes, that might help them determine where they are going, if it's good for them, or how to find a good practitioner since.

Diana Zotos Florio (46:12)
Yeah, I think you said how to find a provider that's appropriate for them. So I think.

If you've been suffering with pelvic floor issues or you think you may have been suffering with pelvic floor issues for a long time, I would look to find someone in your town that is a pelvic floor physical therapist, but that can see you for at least 45 minutes one-on-one because so much of the initial intake and treatment is really based in patient education. not only is there a possibility of

manual internal work, which you really should be comfortable with your provider. And that does not need to happen if you don't want it to happen. Definitely not at the first session, but there is a lot of talking about your pregnancy history, any trauma that you may have had. It's nice, or it could be very useful to talk about trauma, big T trauma, little T trauma.

your stress patterns, your bowel and bladder habits, and then there's a lot of education around how much water to drink, what are bladder irritants, what kind of diet should you have so you have regular bowel movements, how should you be moving, how should you be sleeping, how your stress can relate to your pelvic floor. And so much of this is lifestyle. And so a lot of pelvic floor PTs talk a lot about lifestyle.

And then there can be conversations around you have prolapse and you need an external support to help you with that. Or there can be conversations around pelvic wands if you're too tight. So there are a lot of layers to pelvic floor health that happen conversationally. So I think finding someone who can spend the time with you to talk. And then like I said,

An internal assessment is helpful for the provider to understand really what your patterns are, how strong you are, what your endurance is like. If you do tend to toward more tone, then less. And then there should be a prescriptive exercise program. Just like any PT, I firmly and strongly believe that there should be more than just manual work. And I also think that there are pelvic floor PT's that just do manual work.

And there should always be movement, breath work, mindset involved. I think the people that you saw, Joe, in the clinic that were doing the bike and the bands, hopefully they were on a path of strength at that point. And that their PT was educating them how to control, contract, relax their pelvic floor during those exercises, as well as building the surrounding muscle strength, which is really important.

for pelvic floor health as well. We strong glutes, core, hip flexors, hip rotators, feet.

Joe Gambino (49:19)
You answered my question very well there. And I think the big themes that I hear out of this is that it's holistic looking at things, right? It's lifestyle, it's food, it's not just the exercise program or the manual components of things. And I think that's what any good provider starts to do is they start to peel back the layers. It's not just about the movement in itself, but it's about how can you start to complement the person as a whole.

Diana Zotos Florio (49:23)
Okay.

Yeah.

Joe LaVa (49:51)
All Well, this was excellent. Out of respect for your time, Diana, why don't we wrap up with anything that you'd like to leave the audience with that you find important and that you maybe really want them to take away from the things that we spoke about today.

Diana Zotos Florio (50:16)
I think the simplest and maybe the most useful take home that I think is empowering to my patients and they're always like, is to be a bit more embodied and aware and to try to develop a better relationship with yourself. So I always give people simple check-ins like, maybe you're brushing your teeth.

and you want to check in with your brain, like where your thoughts or you're brushing your teeth and you want to check in with your your grips like do you grip are you gripping your shoulders right now can you let them go are you gripping your butt right now can you let them go or maybe you want to check in with your breath so you're maybe doing the dishes and or driving your kids around and you just want to check in like how am i breathing where am i breathing where do i feel my breath i think establishing

a better relationship with your patterns, understanding where your thoughts are, your tension is, your breath is like, it be a nice like first step into exploring doing like some more mindfulness in your whole life, which can be really helpful built into movement for pain. That's really where I'd start.

Joe LaVa (51:35)
I love it. I think that's very, very well put. So if people wanted to get in touch with you, what's the best way to do that? How do they find you?

Diana Zotos Florio (51:42)
.

So we are on Instagram at threesphysioga and we have a website which is threesphysioga.com. can contact us through there. You can join our online library and try some of our classes. And I think that's really it. Hopefully that's enough. And I hope people reach out. I'd love to talk. Yeah.

Joe LaVa (52:06)
All right. No, well, yeah, yeah, I think that the resources that you guys have put together, seeing the some of the behind the scenes work, I think what you're doing is incredible. I hope people go check it out because the resources that you have there are phenomenal. And I think they go well beyond pelvic floor stuff and can help almost everyone that comes across your page. So, Joe, any other last questions?

Diana Zotos Florio (52:19)
Thank you.

Joe Gambino (52:37)
for me.

Joe LaVa (52:38)
All right, well, Diana, thank you so much for coming on the podcast today. We tell every guest we love you. Joe, love you. Listeners, we love you. And don't forget to come back next week for another episode of the Beyond Pain podcast.

Diana Zotos Florio (52:47)
you