Movement for Life... and Menopause.

Join Susannah, and Gillian McCormick, Physiotherapist and Pelvic Health Specialist, for a wide-ranging conversation about movement as a key element of health care throughout our lives, and particularly for women experiencing symptoms of peri-menopause and menopause.   

We talk about what happens when our bodies start to change and how that might affect our movement, and about common themes around workouts and health. There are ways to balance the proven importance of adding load to our workouts, to the realities in our bodies and minds when we're getting started.   

Understand what you might be navigating, learn where to start and where to find help if you need it. More than anything - be good to yourself and just TRY. 

Gillian mentioned some important resources for information about perimenopause and menopause:

The North American Menopause Society

The Canadian Menopause Society

Menopause Chicks


If you'd like to learn more about menopause & womens' health, check out Susannah & Gillian's interviews with Dr. Dedeshya Holowenko on the Small Conversations for a Better World podcast:
The State of Menopause, Pt. 1
The State of Menopause, Pt. 2
Breaking Down Barriers for Women Accessing Healthcare

And that quote that Susannah couldn't quite get right? Here it is:
"A ship in a harbour is safe, but that's not what ships are built for."
~ John A. Shedd 

Heart of Motion Podcast host Susannah Steers is a Pilates & Integrated Movement Specialist and owner of Moving Spirit Pilates in North Vancouver, BC. She is passionate about movement, about connections and about life.

Through movement teaching, speaking, and facilitating workshops, she supports people in creating movement practices that promote fitness from the inside out. She loves building community, and participating in multi-disciplinary collaborations.

Along with her friend and colleague Gillian McCormick, Susannah also co-hosts The Small Conversations for a Better World podcast – an interview based podcast dedicated to promoting the kind of conversations about health that can spark positive change in individuals, families, communities and across the globe.

Social Media Links:
Moving Spirit Pilates Instagram
Moving Spirit Pilates Facebook

Susannah Steers Instagram

Chapters

• 0:00 Introduction to Gillian McCormick PT & some reminiscing...
• 7:22 Gillian's Move to Physiotherapy
• 10:24 Movement as Therapy
• 16:14 The Challenges of Peri/Menopause
• 22:36 Physical Activity for Perimenopause and Beyond
• 28:55 A Question of Lifting Heavy
• 33:19 Movement as Preventative Health Care
• 41:58 Where to Go for Help
• 45:18 Connecting the Dots with Gillian McCormick

Transcript

Susannah Steers (SS):  Today, I am thrilled to introduce you to one of my favorite people, someone I talk to a lot about movement, about health, about life, and about our place in all of that.

She is my good friend, physiotherapist and women's health specialist, Gillian McCormick. Welcome to the show, Gillian!

Gillian McCormick (GM): Why, thank you so much, Susannah Steers.
This is really fun to be recording with you again.

SS: It is, right?
We've shared a mic before, over six seasons as co-hosts of The Small Conversations for a Better World podcast.
It kind of feels like coming home.

GM: Yeah, exactly.
And wow, I kind of miss it, actually. I'm here with my big mic in front of me, and I'm all set up, and good times.

SS: Yeah, good times.
When I look back at that podcast, we started it after we'd had countless coffee conversations, and maybe some wine conversations too, about health.

Small Conversations evolved from those chats and from a shared desire to learn more about what health is and how we can better support it.

I think we were both interested in trying to break down some of the silos of thought and practice that we saw around us, and we were looking for ways to create some connections and points of intersection.

So I think you'll agree, it took us to some very unexpected places along the way.

GM: Absolutely, absolutely.

SS: What were a couple of the most impactful things that you learned, or what are some of the things you remember most about those six seasons of the podcast?

GM: Yeah, I have sort of recently figured out that I would conceptualize the things that I really get involved in, or deep dive, as ways of helping myself understand my world.

And I feel like as we started to cruise into conversations about starting the podcast, I'd been in healthcare for such a long time. I got into physiotherapy school when I was 17. I felt in some ways like I was losing the forest for the trees, you know? Like, how did all of these things make sense anymore? What am I actually trying to accomplish with this work that I have dedicated my adult life to?

And our podcast really helped me to come back to kind of home, as it were.
Which is, is that very thing you said -  the importance of breaking down the silos, of trying to understand how all the disparate things fit together to create the beautiful whole.

And then understanding maybe more of like where my part was in all of that big picture.

So there can be no silos.

We talked about that so many times that really all, oh yes, my favorite one.

To be healthy is to be well resourced.

SS: Yeah. And all that that means.

GM: All that that means. And I know that for a lot of people, the first thing that you think of when you hear the words well resourced is financial resources.

And that isn't actually the only thing that's important. Now, I'm not gonna lie, financial resources at a certain level, open a ton of doors, there's tons of evidence to support that within economics and health, that a certain financial status really does make you happier and healthier and opens doors. But after a certain point, is no longer contributes to those things either. It's not like more and more and more is what's necessary.

But even if you don't have financial resources, you can still be a well resourced human being that can be healthy and have a beautiful quality of life.

You just need to know how to look for it and advocate for it.

And that is a concept that comes back to me over and over and over again, even in my everyday practice.

While I treat my clients that are, as you noticed, a lot of women, I do treat people of all genders for all issues of pelvic health.

But a lot of issues of pelvic health are, I'm gonna say, experienced by people that have a vulva, a vagina, a uterus.

And so those are the bulk of my clients over the course of my lifetime.

SS: Well, there's something that you said in that last little piece that I really resonate with.

You know, we were looking at all the various parts of health and the disparate pieces and how they all come together as a whole. And I think that, for me, I wasn't finished yet. And that's where this podcast is born, from The Heart of Motion Podcast, because I think this is a way for me to find a way to feeling whole.
And movement is a huge piece of that for me, and it's not just exercise.

Movement is a way that, for me, I make sense of the world.
I am on this little quest to learn from all kinds of people in all kinds of different ways what movement means to them.

We can talk about the things that are mechanical and physical and biological in terms of fitness and health, but I think there's more to it.
And that's what I want to dig into in so many ways.

GM: I actually, can I ask you a question about that?

SS: Yeah.

GM: Can you say more about how movement helps you understand the world?

SS: Well, I think in some ways, when I am in motion, I am more present in my body than I am at other times.

A lot of my life, I trained as a dancer, and so a lot of my capacity for expressing myself in a number of different ways, creatively, emotionally, all of those things is clearest to me in movement.

When I look at relationships, it's about the movement, the dynamics, the things in relationship to each other.

And so for me, movement is more than just a body walking around in the world carrying my brain around. Movement really is the thing that helps me feel whole.
I can connect to all my various bits and pieces in movement.

GM: That's beautiful, all of it. And I think that you said it right off the bat.
When you are in movement, you are the most present in your body.

SS: Yeah.

GM: Yeah.

SS: So I'm on a quest because I know not everybody feels that way, but I do believe that movement can be a powerful tool in coming together.
Here I go again.

GM: Creating communities and connections. She can't help herself, ladies and gentlemen. She cannot help herself. Beautiful fit.

SS: Well, now I get to turn the tables on you, my good friend.
You've been a physio for 26 years.

GM: And counting.

SS: What took you down that path in the first place? So you're a 17-year-old kid.
What makes you say, hey, I want to be a physio?

GM: I think I've talked about this a little bit even on Small Conversations.

I knew I wanted to be in healthcare, but I didn't want to be a nurse because my mother and all of her friends were nurses. I had a lot of nurse energy in my life.
I didn't want to be a doctor because I was intimidated by the amount of school you had to take to become a doctor.

And my mom told me there's these things called physiotherapists, and they get to work with people about movement, and you'll always have a job.You can travel with it.

And then she had me at "You can travel with It."

So I have to admit that I really didn't know a lot about what physiotherapists did.
I did shadow the physio in my home community, but I would still have had a heart.
It looked like this was interesting. I really liked that he got to work with people and seniors, but still like what we did and how we did it, it took a really long time for me to figure that out.

But I liked the learning.I liked the journey a lot, and it has been a tremendous, tremendous career.

SS: When you think about movement today as an adult, is it different than what you...   I mean, I don't even know if you thought about movement as a kid or if it was just something you did. Is there something that's changed for you or evolved in some way from the beginning of your career to now?

GM: Well, like, wholeheartedly. My family weren't a bunch of movers, really.
So, you know, we just... They did stuff. They were physical.

My stepdad was in construction. He just went and did stuff with his body, but wasn't sporty, not athletic. He liked golf, but he wouldn't call himself athletic.

My mother didn't show a movement practice. She'd done stuff like when I was a little kid, like play... She loved softball, so she played on any team she could get onto, and she said she played until the younger adults would lap her as she ran the bases. She wasn't as fast as she needed to be, and they were right behind her yelling, Run, run faster!  So she moved on from baseball at that time.

But we weren't... We didn't talk about movement. We didn't talk about sports.
All of us as kids had a sport that we played, so that was just a thing that we all did.
It was an expectation, but I wasn't very good at any particular sport, but I tried them all.

So every year was something new. Until I got into competitive swimming, I stayed in that for probably the longest time.

And then I got into school and I learned about physiotherapy, and I still really did not fully understand the things I was being taught.

And I think that that's just because I was young, right? Like I just had no life experience.

So over the years, I've really become like a movement therapist. Like I care a lot about how somebody moves and how much they move and their relationship to movement.

We know that movement in terms of human health is crucial on so many levels.
And I think we're going to talk about this in detail a little bit later in our conversation.

But just to even start with that, the World Health Organization has recommended that all adult humans and even children, human seniors, pregnant people, get 150 minutes of movement every week, and that this dose of movement will prevent all-cause mortality by up to 40%.

All the things that make us sick and kill us can be prevented, like 40% of it, if we are active enough.

SS: Wow. And that's only 150 minutes a week.

GM: It's only 150 minutes a week. Exactly.
So some people look at that and they think, oh, that's a lot.
But no, no, no, no. If you break down those minutes, you can do like 20 to 30 minutes every day, and that's enough.

Now, we have to get a little deeper into the details of what is truly enough to do the supporting on all the levels. But even if you do some of it, you're going to be helping yourself be a healthy human.

So, barriers to positive movement experiences, that's a big deal in my book.
I want to deal with those things.

SS: You've seen your share of people struggling with stuff that means that they don't feel good moving in their bodies for various reasons: injuries, illnesses, pregnancies, and for those of us of a certain age, menopause.

Obviously, individuals will be different, but in general, what do you see happens for people when movement becomes limited or challenging in some way?
Like, I'm sure there are big impacts and small impacts, but what are some of the big things you see?

GM: I feel like that's really kind of a broad question, but we could start with things like, they're frustrated and upset and maybe more so anxious and depressed because we use movement, in a lot of ways we use movement, whether we know we're doing it or not, to calm ourselves, to handle our mental health issues, to make ourselves happier and less anxious, to process our thoughts, our feelings and emotions.

We use movement to do that, and maybe it's movement in the garden, or maybe it's running, or maybe it's riding our bike, but there's going to be a mental health piece, whether you cop to that or not.

So they're frustrated, they're sad, and some people are really sad.
Their whole identity is wrapped up in how much they move and in the ways that they move.

I see a changing in body mass and in body composition.
So people begin to gain weight, or their musculature becomes less about lean body tissue and more about fat body tissue.

And that can be hard from a cultural standpoint because we have these standards, these beauty standards in our communities and in our lifestyles.

So then we're back to a mental health struggle to deal with that or in relation to that. I see, to do with that lack of lean body mass, weakness and a lack of strength, right - developing because they have to be relatively sedentary for whatever reason.

And what that contributes to over time is greater incidences of injuring yourself in different ways or pain, stiffness or lack of confidence in your ability to move around in your life.

An increased predisposition for falls in certain populations.

Really, I want to go back to that lack of confidence.

If you don't feel comfortable and confident in your ability to move, you feel like a less competent human.

SS: Right.

GM: And so your world gets smaller and smaller.
So those are the things that I see, to name a few.

SS: Yeah. I'm curious too, because movement is sometimes one of those things that we mostly just take for granted, like our health, until we hit a wall or something happens and suddenly we can't do what we've always been able to do.

And it seems like, for a lot of people, we go through our lives doing what we do, but there can be these kind of stealthy incremental changes to how we move that can eventually lead to changes in our ability to actually do the things we like to do.

And we don't notice the changes until we can't do the thing. So it's like on a smaller scale, it's like an I've fallen on I can't get up kind of moment.

Maybe we've been going to the gym, maybe we've been staying active, or maybe we've been chained to a desk for 30 years. But there are sometimes changes in our physicality that we might not feel coming. All of a sudden end up in a place where, oh, wait a minute, something's wrong.

I see that a lot in the Pilates studio, and I just wonder, I'm sure you must see it in your clinic as well.

GM: I think it shows up as those like insidious pains that like, one day I woke up and I had hip pain, or whatever pain, fill in the blank pain.

Yeah, it's really tricky, isn't it too? You talked just about the insidious nature of it.
You just don't feel it coming.

Your body feels like it always feels like, or you're doing the things in and around your life that you always did, and it seemed like it worked before to give you a certain level of health and capacity, and suddenly that changed, and now it doesn't work.

Yeah, you can get really lost in the gray sometimes, about why is my body doing the thing that it's doing right now?

SS: And this brings us to the topic of perimenopause and menopause.

GM: Yeah, it sure does. Yeah, it does.

SS: I know this is a massive topic, and we'll never cover all of it in one little episode, but what are some of the challenges? And we can dig into them deeper as we go along, but what are some of the challenges that perimenopause and menopause can bring for women in terms of their movement and their physical capacity as they ate?

GM: What you said a minute ago, I'm doing all the things, and suddenly I just don't feel good. I can't do the stuff anymore.

SS: That was kind of my experience in menopause, and it was terribly frustrating.
So I'm curious, what do you see and why does it happen?

GM: Okay, so I want to preface that while I have treated a lot of people who have ovaries within my lifetime, I am not actually a menopause specialist.

So at some level, I'm not going to take you further in this conversation, but I know a lot.

At the same time, I would say that with confidence. I think what your question was, why does it change?

Why does our physicality change in perimenopause and menopause?

And the simple and complex answer to that is estrogen, and the way in which the balance of estrogen and progesterone in a female body, lack of a better word, female body changes almost every tissue in our body or impacts every tissue in our body.

So every single tissue that we have, from skin to muscle to our neurons, to our fat, to muscle, to bone, has estrogen receptors in it.

And when we start to have our ovaries produce less estrogen, and that is the time of perimenopause, sometimes we've got less estrogen, sometimes more estrogen, our ovaries are kind of on a, they are less predictable in that stage of our life, and it can start at the age of 35 for some people to the time when our ovaries completely stop making estrogen and we stop having menstruation sometime around 50 to 55, where we would be called menopausal or postmenopausal.

We can really change how we experience the world, how our bodies are physically, just because we go through like an estrogen withdrawal.

We are not having our tissues fed this particular chemical that had been there in a certain way for a very long period of time.

And that the way that it arrived and was there and fed our tissues contributed to how we felt in the world, how our physicality could be, how we think. And so it can, for some women, really feel like a real change, right to their essence.

SS: Yeah.

GM: So from a movement perspective, there are definitely some things to be aware of.

Our collagen changes, our makeup of our tissues, so we can feel more stiff.
We can feel like our tissues don't allow us the same ease of movement or range of motion in our joints. It doesn't come as easily because of that tissue change.

I had a friend refer to it as a drying out of the tissues. I'm not sure about the actual biology of the drying out. But that's how it feels.

SS: Definitely.

GM: And we can be dry in other ways, so I think the analogy has moved forward into a lot of different processes.

Our skin can get really dry, and our vaginas can get really dry, so I think the dry analogy, maybe it has more wings than it should.

SS: Right.

But if we use that as an analogy for how it feels when our tissues change in that way, a lot of people nod and are like, oh yes, yes, this is what I have.

I have more stiffness. I have more reluctance to move well. I feel tired.

Our ability to maintain our lean body tissue really changes as we move through those years and certainly post-menopausal. And lean body mass, to be perfectly clear, is muscle, right? When we lose muscle, we become weaker.

And I've already mentioned how being weak impacts us in so many myriad ways in how we experience the world and how we move and how we feel. It changes where we deposit fat. I always think this one is actually a wonder.

This one is like, really? Our hormones determine where we deposit fat.
So when we're premenopausal, we deposit fat around our hips, right?
And our butts and our boobs.

And we're supposedly supporting our fertility and reproduction, the reproduction of the species, shall we say.

Well, when your ovaries are done producing estrogen, in some ways, there's this maybe idea that we don't need to support those systems as much anymore, and we start to deposit our fat in different places.

So I will never forget that my mother was like, Oh my God, I can fit the smaller size of jeans, except for the waistband. The waistband doesn't fit, but my hips and my butt are smaller, you know? Well, she was losing the fat on her hips, but it then settles in some ways in our viscera. It was in her belly, is maybe what I should say.

And what's happening there is we get, as women, postmenopausal women, we get bigger bellies because the fat actually changes, and it begins to deposit around our organs in our abdomen.

It's called visceral fat. It's a bit different than the fat that is subcutaneous or underneath the skin. I know there are health concerns that go along with having more visceral fat that are different than the ones that we carry when we have the other kind of fat.

So it just blows my mind that your hormone messengers are responsible for where fat settles in your body.

SS: It's so unfair.

GM: Given the societal norms around what female bodies are supposed to look like, big air quotes, they're people, it is so unfair.

I could just go on about my personal feelings about it for a really, really long time, but that's not what we're here for.

SS: Okay, well, I'd like to ask you now, what kind of physical activity do you think is best for women as they move into perimenopause and into menopause?
And maybe there's not a best, maybe there is a best.
I'd like to hear from you your thoughts.

GM: Okay, right, physical activity. It's a really, really hot button question right now.
Ah, no, I know it. And I'm having one of those moments where I'm like, somebody else could probably say this better, but I'm going to do my best for you.

What we always need to be looking at is what is going to help us be healthy humans for the length of lifespan we are privileged to live?

And maintaining health requires movement.

It's been stated, World Health Organization, I'm not here to argue about that.
That's just a fact.

Movement science and exercise science is one of those sciences that actually, I mean, we can deep dive the various ways in which you might exercise principles of movement science.

But at the end of the day, there's a few basics that in my career, I learned about at age 17 or 18, and they have not changed.

But they go in and out of fashion.

One of the things that hasn't changed is that we need a certain percentage of lean body mass to fat body mass.

And lean body mass is muscle.
And the ways in which we build muscle has not changed.
Building and maintaining muscle mass requires resistance training.
However you get that.
It requires resistance training that is progressive.

SS: Got it.

GM: You have to increase a load or your body doesn't get the impulse that it needs to build or maintain the muscle.

SS: Needs to be stressed.

GM: It has to be stressed, which means some components of exercise are hard.
There's a difficulty. And some people thrive on hard things and other people do not. And that is a challenge.

And I have giant compassion for the folks that just do not get thrilled by the difficulty of exercise or the difficulty in how it feels in their bodies.

But at a certain level, we must have stress or challenge or we cannot build or maintain our muscle.

Also, bone.

And we didn't talk a lot about bone yet, but bone is also influenced in our postmenopausal time.

And one of the big things in later life that could really impact our physical health and our ability to move is osteoporosis.

The tenets of building and maintaining bone health were taught to me at age 17 and have not changed.

Load.

Your bone has to have load or you can't maintain your bones.

So then we're back to resistance training.

When we look at the science around, because we're all going to have challenges to our health across our lifetime, we're either going to get sick or we're going to get injured and hopefully not both at once, but bad things happen to good people, the odds are you're going to have a health challenge in your lifetime of some kind.

All of the evidence around who does better, whose outcomes are better, who feels better is in those people who have been physically active and in the best way possible maintain physical activity, their outcomes are all better later.

That hasn't changed.

That was research that I was looking at and interested in in the early and mid-90s amongst the HIV AIDS population, which of course at that time was such a different story than it is right now.

They've done, I mean, I saw a study that was published this year around cancer patients of a certain kind.

Well, if they were physically more active and were fit than they were, their mental health was better, they actually fared better, they had better quality of life metrics because they could move and were moving.

Those things have not changed.

But what we see in our social media and even in women's health research is just a plethora of suddenly the conversation. And I'm so happy that the conversations are happening. Finally, finally, finally, they are happening.

And the conversations are such like, well, we've had no research to support, what should we do to keep ourselves healthy in menopause?

Because they didn't acknowledge menopause in the healthcare world because they couldn't treat it.

SS: And women are just so hard to study.

GM: Women are so hard. They have those cycles every month, and it's just they don't stay the same. And well, they're humans, so we can just do studies on men and extrapolate it to women. It should all, no, no, no, the outcome here.

This is the biggest thing that has changed, I believe, in the research world within my career, is that we are finally, finally, finally willing to admit that women are different than men.

SS: And require different information and different investigation and different supports.

GM: Oh, mind-blown.
One of my favorite concepts is that good evidence is a clinical duh.
Oh, gosh, like really, really, really.
Anyway, oh, personal feelings, I could go on at length about this.
But finally, the women are getting their day.

And there's much, much more conversation about that menopause exists and that there could be better and worse ways to maybe handle this time in our lives.

There's a lot that we don't know yet because the research has not been done.

And that makes me excited for my daughter and her daughters because the whole world might be a different place by the time they actually get to menopause.

Meanwhile, some of us are here now.

SS: Managing what's happening in the moment.

GM: Yes. So I want to circle back to like, okay, right, lifting heavy and resistance training. And what does this really mean for me?

SS: Thank you. That was my next question for you.

GM: Yeah, because not all bodies exhibit the same potential. Right?
We can agree on that? Not all bodies exhibit the same potential.
You might sum this up as like, not all bodies experience the world the same way.

SS: Yes, exactly that.

GM: Right?

SS: Yeah.

GM: So while we know what the evidence says would be the quote unquote way that makes the most sense from a scientific perspective, we can say this as a fact that you will move better for longer if you have muscle.

And you'll handle the metabolic changes of menopause if you have more lean body tissue. So that visceral fat weight gain thing that I was talking about is one of those metabolic changes, and that visceral fat has its own metabolism.

It's very complicated, and I am not an expert, so I'm back to that.
But my understanding is the way that we help to regulate that is by supporting lean body mass. So we're back to resistance training.

If you're in one of those bodies that's had a real hard time navigating, lifting things, pushing and pulling and working your body in an intense manner, you could feel like you're being left out of something pretty crucial.

Or you could feel really overwhelmed and demotivated by the concept.

And I just want to tell people that you have to start where you are.

SS: Thank you for that.

GM: Yeah.

SS: We see, and you spoke to it earlier about that, you know, we see it everywhere.
It's in social media. It's like this little soundbite moment. Everybody's woken up to the idea that we need strength training. So we see encouragement for heavy lifting and going to the gym and lifting weights.

And that's just not a thing that a lot of people will do it and be very happy doing it.
There will be other people who will force themselves to do it and hate every minute of it.

GM: Correct.

SS: There will be other people who will choose never to walk into a gym.

GM: Yes.

SS: And I'm curious, there's two things:
One is if you're going from never having done any strength training and feeling like you don't have a lot of strength to start with, is the best place to jump in and do heavy lifting at the gym or is there another way to start?

GM: Mm-hmm.

SS: Is that the only way to get resistance training?

GM: I would say no. Of course not. Anytime you lift something heavy, say it's a pot in your garden, that's a load. It's challenging your muscles and your bones and your tissues.

I'm looking at the ocean right now as I talk to you, so thinking about what if you like to paddle a boat? What if you like to sail? What do you like to do with your body?

You should definitely think about the things that you're already doing. How hard it feels like you use your body in those moments. Resistance training can come from a lot of different perspectives, and I think this is where you can really deep dive, actually.

And I think modern day exercise physiologists in some ways might be pulling out their hair because I'm like, it hasn't changed. This is the same research as 30 years ago.

But what has changed is how people think about how heavy you should lift and how much you should rest for. Should you jump off of things? There's plyometrics, there's isometrics. They all do different things within the physiology of your muscle to support healthy muscles and tendons and ligaments.

And so it can be really complicated.
All this to say, there's a lot of variety.

And because of the real lack, and I think this is another area of science that is lacking, is what is good movement and what is required for it.

SS: Well, see, okay, so what I'm hearing is, even if we don't know anything about the science, the big thing is to start where we are, wherever that is, to load, load progressively, to keep growing. So do the hard things, because we know we can do hard things.

GM: That's right, that's right.

SS: And keep doing it and keep moving and keep like, just keep going.

GM: Just keep going, keep being curious about it. If you run into a roadblock, try to enlist some help to get you over the roadblock so you can keep going and exploring your movement potential and capacity in any way that you can - will go a distance toward maintaining your health over time.

SS: Yeah, the deep dives.

GM: So we know we have the Canadian health care system, and that's what we like to call it, but what we actually have is a sick care system where if you're sick, you can access the system and receive treatment, we would hope, good evidence-based treatment.

And a lot of money goes into the research on how to treat the sick.
There is much less money for research to support how to keep you healthy, how to prevent you from getting sick. And movement and how we move and what is good movement is one of those places where it's just not funded.

We don't deep dive human movement nearly enough to figure out how do we prevent ourselves from needing to access the sick care system at all.

So yes, I agree with you. You start where you are. That's a rehab principle from way back. What is your actual strength? And then address, how do we grow your strength? And it might start with, can you learn to find that muscle and turn it on?

If anybody's gotten themselves into an accident or had to have a surgery and then it's time to do the rehab, sometimes it's about like, hey, that's your quad.

Can you squish it? Can you make it contract right now? Pull up your kneecap.
Look, that's your quad.

And then we do that ad nausea in every scenario we possibly can think of until you've got a nice, healthy, bulky quad that knows how to do its job.
Right? So we have to do that at whatever level we're at.

If you've never gone to the gym and lifted, you are not starting at the squat rack.

SS: Yeah. One of the things that I see in my Pilates studio is over the years, people find themselves in an imbalanced place.

They may feel strong in some ways, but, you know, my knees hurt when I do this, or, you know, you get the movement quality that they're not experiencing, the positive movement quality that they want.

So sometimes it's not they're coming in because they're looking for a strength issue. It's because something's happening and they don't like how it feels when they move.

And then we get into those topics, like, oh, okay, look at that. Your quads are really out of balance with the muscles on the back of your body, the back of the hips, the back of the legs.

Can we create some better balance there so that your joints feel a little more buoyant and easy and fluid as you move?

Or the relationships between things. People often come in looking for core strength without really knowing what that's about. You know, that's more about relationships than individual muscles.

And so I just find it interesting that, you know, you're talking about movement quality, and of course, that's my world. That's where I live all day long.

And that's where I sometimes run into when we talk about lifting heavy, and I'm like, yes, yes, that's what we want to do. We want to get lifting heavy. We want to get strong.

But we also want to know that our backs feel good doing it and not going to bed feeling wrecked so that we can't do the things that we like to do the next day.
I think there's a way to do this that supports your experience in your life and your health.

GM: I agree with that statement as a goals statement because I also think that there might be evidence that states XYZ, but then the reality of application into our lives is that it isn't sustainable.

So we need to find ways to support our bodies that are sustainable.
I think that's what you're getting at.

SS: Yes, exactly that.

GM: And sustainable has to mean that, yes, you can get up and take care of your kids the next day and go to your job and take care of your aging parent and not feel as though you've actually injured something.

And quite frankly, you might injure something, right? There's a potential for injury when we don't put in the work to create the base, the good foundation.

And I think that's what you're talking about is foundational skills of knowing how to move your body, having the actual capacity to move your body well through the movements that are required to do the thing. And then progressively over time, add load.

It's a really complicated thing. It's not as simple as, I'll just go to the gym and start throwing around kettlebells.

SS: There's a quote that I love and I can't remember who said it.

It's something, I'm going to butcher it, but it's something to the effect of "ships are constructed in the harbor, but that's not what they were built to do."

...No, that's not what a ship is built for.

It's built to go out into the heavy seas and to move and to travel distances and do exciting things in the wind and the waves. And so I will have to look up the actual quote, but it's one that I pull out a lot.

GM: And the analogy being that we are the ship, our body is the ship?

SS: Yes, that our bodies are the ship. We're going to get hurt.
It's going to happen. Our bodies will heal. We'll get back to doing things, hopefully in a way that we're used to doing them. There will be health events.
They will happen whether we are sitting in our ship in the harbor or whether we are out doing things. And as you said earlier, we handle those health events better if we've had some movement and some experiences that build strength within us.

GM: Foundations, right?

SS: Foundations.

GM: No, and you're even talking about there will be a health event or there will be an injury event, but there might also just be an emotional event, right?

Like you might lose someone or suffer a loss or get fired from a job or whatever the case may be. And those things too, there's research to prove they're better navigated when you have a good movement foundation.

So I think I feel a little sad because we get to this part of the conversation and I'm like, uh, what should I say?

And the truth is that you can navigate movement in a lot of different ways.

There's no one prescriptive way, but I want you to think about, does the thing that I like to do with my body actually provide intensity of load?

Is it heavy sometimes? Maybe not all the time, but sometimes is it heavy?
And how do I perform in that way? And if it's challenging and you think you can address it, try. I think that that is a valuable thing to do with your time and your resources, is try to figure out if you can add intensity to your workouts.

SS: And intensity, when we talk load, it's not always necessarily more weight.

GM: Not always.

It can be adjusted in terms of speed, in terms of power, less rest, more repetitions, or the way that you combine rest and repetitions, and here's where the exercise experts would start to be like, talk to me about it.

My day-to-day work is involved in trying to get people into those programs and into those activities.

And sometimes I'm starting with a, you need to find something you do with your body, and sometimes I'm starting from a, I need to build your shoulders so that you can go do that thing that you love.

SS: A woman in my studio the other day said she was new to our work, and she left feeling quite positive, and she said, it's amazing to feel that I don't have to beat myself up to give my body what it needs. And that was really impactful for me.

So I think sometimes again, if you're starting in a place where maybe you've got some stiffness or some pain or some, you know, whatever going on in your system, and you're not feeling super confident in your movement in your body, you don't have to go and throw everything at the kitchen sink and start lifting refrigerators over your head to begin to feel like you are doing good things for you, like you can be kinder and gentler to your body and do hard things.

GM: Yes, absolutely, absolutely. And I want people to have a long game in mind that maybe right now you're starting with a place that is kinder and gentler, to your point, so that you put time into your foundation.

And one day you might wake up and be like, Oh, I'm ready to go a little harder here or try this thing that's a bit harder than I'm used to.

But you'll know that you did all those years of putting in your foundation.
These are all important times. And again, you're interacting with your movement in whatever way that you can, and that's only going to have good outcomes.

SS: Yeah, it serves you to do this stuff.

GM: It serves our human health, our community health, if we are healthier.
All of those big thinking goals are right down here at the individual level.

SS: Movement matters.

GM: Movement matters. It does. It really does.

SS: So we know that movement matters. What do people do when they need help? There are so many different places we can go, especially in a time of perimenopause or menopause. Where do we look for trusted resources, not just your Instagram influencers?

GM: Right. A great question.
And I feel like there's a lot of people within our actual community right here in Vancouver, British Columbia that have questions about this. And I can only imagine that this question is everywhere.

I would tell you that I think you need to get educated if you suspect you're in perimenopause and that it's changing your experience of your body and movement or in sleep or in how you think.

I do recommend the North American Menopause Society.

They've actually changed their name, and now they're just the Menopause Society, just so you know. And you can find them at menopause.org, pretty sure.
It's menopause.org. I'm going to make sure that for you, and it'll be in the show notes. Yep, menopause.org. They have been the go-to place for quality, evidence-based information for a very long time.

We have a Canadian kind of branch, Canadian Menopause Society, and they can be found at sigma menopause.com if you would prefer to have a Canadian source.

Or if you are online and you like a Facebook community, I would recommend Menopause Chicks, launched by Shirley Weir.

She tries very hard to create a local network of professionals and practitioners and provide a resource where you can find a lot of conversations, lots of interviews, videos, information out the wazoo on even where to get started and what might be necessary.

And I think your physician is a person to access if you feel like you need some hormone replacement therapy, for instance, to support your tissues through this transition.

Those are an excellent resource.

If they appear not to have the information you're looking for, keep advocating for yourself to get yourself in front of a practitioner who can have a detailed hormone conversation with you.

There's a couple of clinics, certainly in Vancouver, and they definitely can be a challenge to find and to access. So I understand that.

And also just kind of keep going if you can to advocate for yourself until you find the conversation that you need to find.

I think that to deal with some of the symptoms that might be in your body, like the pain and the stiffness, obviously I am highly biased, and I think physiotherapy is a really great place to start.

I also think you can have benefits from things like massage therapy, acupuncture.
Acupuncture is a great one.  Actually, they can, through the practices of acupuncture, assist you with hormone balance and sugar balance and mental, I don't know, they would do it through the chi. I am not a specialist or a TCM specialist, but know that acupuncture is powerful stuff.

And those are all just things that can help you get through your day-to-day with the symptoms that you might be having related to your menopause and keep you keep going in your life.

I think that there's a lot of different options out there.

And the most important thing is to try to find those places with good quality information to help guide you.

So then we're right back to places like the Menopause Society.

SS: I think in whatever we're doing movement-wise, I know I've found a lot of value in finding people that can help me connect the dots in my movement. And that has been true in my menopause journey as well.

I know that you as a practitioner, Gillian, you don't just treat a body part.
Can you tell us a little bit more about that and why practicing that way might be important to you?

GM: So I think what you're asking is my particular approach to my clients in my physiotherapy practice?

So my approach when someone walks into my clinic and says, I have XYZ issue, be it with their whole body or very specifically their pelvic floor or pelvic health, their bladder, et cetera. I want to know the whole story, so I take a really detailed assessment, like a conversation.

Basically, we have a really long conversation about their health history, both current and past. Also their movement history, both current and past.
Because we're trying to figure out all of the various things that could be influencing how they're experiencing their bodies right now.

And then I can help to try to figure out whether or not physiotherapy might add to their solution to that problem, or if I don't think it's a physiotherapy problem at all.
In a lot of cases, a certain amount of physiotherapy can help, but it certainly isn't always the only solution.

And then I do a whole body assessment of that person in movement. I am looking for the first thing that falls over in their movement system that leads to the stuff that they feel. And yeah, you could think of dominoes.

Our body and how we move is a system of if-then relationships.
And the nitty gritty of that, I'm not even sure we always know as rehab practitioners, but there's definitely relationships between the different parts of our bodies and how they move. And so what I want to do is to treat the thing that is creating the situation causing the dysfunction. And that dysfunction might be somewhere else totally unrelated.

So you might come to me with hip pain, and I have to treat your foot that in your mind has never bothered you a day in your life or your shoulder or your neck or et cetera.

SS: The felt sense experience of that treatment is, oh, that hip feels better now.

GM: Yeah, yeah, exactly. And my hope is to really change your experience of your bodies in a way that you feel and you notice, right? It's not working if you leave and you're like, I don't feel any different.

Often, I aim for always feel different when you leave and perhaps with an aha moment that you haven't had before, or maybe an I knew it.

SS: Well, I think the relationships that you talk about, and we talked about it earlier in the show, the relationships are huge.

And when you can start to understand the relationships of how things relate to each other in your body, you can also start then to feel how you relate to the world. So how you're dealing with your equipment.

Maybe there's something you're doing when you grip your tennis racket, or maybe you're doing something when you're paddling, how you're managing that stuff.

And I always find it, again, this comes back to my passion for movement, is just looking at all the different places and the different relationships inside the body and outside, where movement can really impact every little piece of our lives.

GM: That is the sort of great potential of the work that we do.

And I would think all whole body practitioners are, we live and breathe for that moment when someone says, wow, but even if all I do is get this particular muscle to turn back on, such that now you can ride your bike, then you don't have your knee pain anymore.

I'm great. I'm satisfied with that.

SS: You know me. I'm just that big picture gal.

GM: Occasionally, definitely people are - they have big moments.
And of course, that's rewarding in a really special way.

SS: Well, where can people find you if they want to learn more about your work or for a session?

The best place is probably my website, physiogillian.com.

I work out of a private practice in North Vancouver.
This space is called the North Shore Wellness Center.

So you can find me on social media, but I have to admit that I have given up on social media, so I never post. But I'm there. You can follow me if you want to.
I'm present in my clinic and in my community as best I can be. Physical community as best I can be. I've chosen to put my energy there and not to my virtual community. So, sorry, folks.

Those are the best places to find me.

You can always listen to the Small Conversations for a Better World Podcast for a very big dose of me, where I got to hang out with my bestie and today's host, Susannah Steers, for a good many episodes, where we talk to really smart people about really interesting things, all related to health.

SS: And you can find that podcast wherever you find your favorite shows.
Thanks so much for joining me today, Gillian. I always love talking to you, and you always help me make sense of things. Thank you so much.

GM: Ditto, friend. It was lovely to get to spend this time with you today.

SS: And let's book another kayaking session soon.

GM: Yes, please.

SS: All right. Bye-bye.

GM: Bye-bye.