 Well, good afternoon everyone. Welcome to another episode of Dr. Jill Live on this Friday afternoon. I don't know where you are listening in the world. Please pop in the chat and say hello. If you are live with us, tell us where you're from. But today here in Boulder, Colorado, it is hot, hot, hot. It's dry and it's above 90 degrees. And I was just telling Gina full disclosure, I went on a hike this morning. It was amazing and I had a great time and I crashed. I think that he just totally took it out of me. I'm back up and ready to go and got a little tiny bit of coffee. Here's some good, clean coffee. Super excited. I did not want to miss this. And I just say that because I was literally lying flat an hour or two ago and here I am because I am so excited about this guest, Gina Takoni Moore. Hopefully I said that right, Gina? You did, you got it. Good, good, good. We met through mutual acquaintance that it's masterfully helps us with marketing and different things. But she said, you too have some things in common and you have to meet. So I was super excited and even in our conversation just the last few minutes we found all kinds of fun things that we have in common. Let me introduce her and then I'm gonna jump right in. So Gina's a pioneer in the world of manual therapy with knowledge that goes far beyond the four walls at how is your primary care position? She spends her time answering mystery pain and it's not magic, it's mobility is kind of one of the things that she goes with. You're gonna learn a lot about her and why she's so special and why she's so good at what she does. I can't wait for you to hear her story. She is an accomplished clinician, businesswoman running her own practice. And what's neat is the things that I can read all the great accolades that you have but the things that I think are really special are mutual acquaintance who introduced us said she's one of those people that doesn't even need advertising. Like it's word of mouth when someone gets helped by her, they tell people and it's you help some pretty influential people. So I hope it's okay that I don't read all of the bio that so many accolades to your name but she still pursues crossfit weight training literature into your design and we both decided we love going deep reading books. I was telling you before we started I was I'm like a secret closet librarian because we're like introvert extroverticide. So Gina, welcome, welcome, welcome. Tell us a little bit about your story. First of all, a lot of people are probably like what is this? What do you do? We'll get there but how did you get to where you are now? What's the story of how you landed here? Sure. So first, thanks for having me. It's a pleasure. So the story begins with my shins. In a former life, I was a sprinter, short distances anything beyond 200 was just not my bailiwick but I had really, really nasty shin splints for about eight years or so. And then I got it in my mind that I wanted to run a Tough Mudder and knew that I was gonna need something a little bit more aggressive than the yoga that I was doing in order to prepare me for that. And so I found CrossFit and I had a very adept trainer who was really kind of on point with his recommendations and stuff very conservative as far as CrossFit goes but I was constantly subbing in anything else besides running because it just hurt. And he said, look, you're going to run 12.1 miles with obstacles and stuff but you're gonna need to get your body fixed before you go and do this because you can't row and you can't aerodyne your way through a Tough Mudder it's not gonna work. So I said, okay, so I went and on his recommendation to this gentleman who did active release techniques. Oh yes. And so there's a lot of familiarity I think in this space with that technique and I gave him what was going on and three or four fairly uncomfortable sessions later I was about 80% resolved and that was the first time that that had happened because in high school they would stick me in a whirlpool bath and kind of tape up my shins like a racehorse and that was sort of the end of it. So like a litter bandaid on the problem. And the change was so profound with those visits that I was like, I have to figure out how to do this for other people. This is crazy. So I found out that I just needed a license to touch. So I pursued a course in massage therapy and as soon as I got myself accepted to the massage school, I started signing up for active release techniques seminars. And before I graduated with my license I was full body certified in ART. And it was great because you're like, this works I want to do this. I want to make sure that I'm licensed to be able to that's amazing, love it. Yeah. I mean, I just, it was I don't do well with waiting when I find something that I really want. Yes. So, it seemed like a natural progression to me. And I knew that I wanted to do something with a clinical focus that was going to be sort of under the umbrella of wanting to help specific issues. So, I give a lot of credit to folks who are in the space providing therapeutic massage for stress and reduction and that because that absolutely is required and it's really, really needed. But this, the stuff that I do is much more individual outcome focused. How much can we reduce your pain? How much can we improve your range of motion so that you can get out there on the 12.1 mile course and run the Tough Mudder or whatever it happens to be. So in the midst of that I was also opening my CrossFit gym, CrossFit Lowell, which I founded 10 years ago and has since, has moved on, but it's still in functioning. And so if you're in Massachusetts, check out CrossFit Lowell. And so I found that being a CrossFit coach and being a body worker, a manual therapist, whatever you want to call it was really complimentary because I could see biomechanically things working out on the gym floor and then see kind of consequentially what was happening in my clinic. And so I went about and did that for a while and had some wonderful mentors along the way, specifically Tom Myers who wrote Anatomy Trains and that was really where I got my foot in the door with the dissection work that I do. And so the approach now that I have developed which is called Interstructural Release is sort of a marriage between all of the work that I've done in the dissection lab, the work that I did as a CrossFit and Olympic weightlifting coach and just the work that I've done over the past 10 years on, I don't know, thousands of bodies at this point. And it's just, it's sort of a culmination of all of that learning in addition to, as we were talking about before sort of standing on the shoulders of giants in this brilliant borrowing thing. So that's what I'm trying to say. And clearly, I mean, I didn't mention but I kind of wanted to make sure people know, like you have been a renowned consultant with high-profile sports teams, NFL, MLB, PGA, other sports people, again, in this field that you are known and it's kind of what's neat is you've really taken kind of your own approach and pulled some things together. Like it's interesting to ART, I didn't realize that was one of the faces because probably 20 years ago when I first started running I didn't know anything about what I was doing. And I'm like, oh, this barefoot running sounds cool. So I got myself a pair of five fingers and I went out running. I had no idea, I totally was a heel striker. I got, you know, fracture, stress fracture in my companion, so clearly was not running right. And ART was the thing that actually helped me back then. And so I remember like a carpenter who did it nearby and it was one of the things like, okay, there's something really different here. So I totally know the power of that personally and that was decades ago. And to understand, again, I would have not been able to hardly walk for months were not for that technique at that time. So you kind of taken that, made it your own. And then you just briefly mentioned the dissection, but this is what's so unique about you. Tell us more about like you are like an expert. What do you even call that? And forgive me for not, like a... No, I mean, disector I guess is fine. So, you know, again, in studying with Tom, you know, I think that he really attempts to take a holistic look at the body. And in doing so, you know, I've likened my job, you know, the job of the manual therapist in general as, you know, hearing a terrible noise in your car, driving into the mechanic and saying, okay, I've got this terrible noise in my car and I need you to fix it, but I don't want you to put it up on the lift and you definitely can't look under the hood. So, I mean, that's sort of what we have to do, you know? And so being able to get into the dissection lab was a way to look under the hood. And, you know, having those images that are not computer generated, that are not out of a textbook, that are just sort of behind my eyelids at any given moment has given me an atlas that I can utilize anytime I have a patient under my hands, which is really awesome. And really, I mean, particularly where the method that I've developed relies on separation of tissues, sort of at the borders and margins and things like that, having a really solid idea of what the topography of the inside of the body is, just makes the work that much easier, honestly. So that got parlayed. I did a bunch of labs with Tom I did a few labs independently as well. And then I was invited to be part of the dissection team at the Plastinarium that was creating the world's first facially focused Plastinet model. So she's in existence now. Her name is Freya. She's over at the Body Worlds exhibit in Berlin. And, you know, we had these major non-reality based dreams when we were starting, you know, everybody wanted to be able to essentially disarticulate the fascia from muscle mature and stuff like that completely. The Plastination process is a fairly brutal one just on tissue and things like that. And so we sort of compromised by starting with various areas and showing how those are facially encased or, you know, whatever. So, so it's not quite the full ghost body that we're hoping for yet, but give us, you know, seven to 10 years and we'll get there. So is this a model or is this actually a real preserved? Is it just a model like a man made model or is it actually a preserved tissue? It is preserved tissue. So it's a full body cadaver. Okay. Yep. And like I said, the process of Plastination is, you know, years long. So we started this process about four years ago now. And like I said, she's, she's finally done. So. Wow. Okay. That's fascinating. I'm just like loving this so much. And I can see how that totally gives you the ability to see or feel. And you mentioned just before we started to like this movement and the smoothness. And it's almost like if there's a tear or a rub or tell us more about, cause you can feel if things are, cause just like a, you know, well-oiled hip or a, you know, a cog and a wheel or whatever, you're going to have that smooth motion or you have this creaky, greasy sound, you know, sound. So can you actually tell with the tissues on the exterior, like things are not moving like this should like little. And again, I don't know the vocabulary very well, but. Yeah. Absolutely. So, you know, basically what I, what I've said to my students and what I've said to, you know, patients as well is that healthy, well-circulated solid tissue feels like a freshly set bowl of jello. That's the secret. Yeah. And anything that feels anything other than that is what I go after. So, and, you know, I'll say that and people are like, well, surely it can't be that simple. It is because otherwise, you know, you can really kind of get lost in the sauce in the, you know, analysis paralysis sort of realm of things. If you start thinking much more, you know, complicated than that. So, you know, the idea of this whole method is that somebody comes in with an initial complaint and it can be anything from carpal tunnel to plantar fasciitis to, you know, chronic lower back pain. All of that, I would kind of label that under the sort of more common things that I see to pelvic floor dysfunction and incontinence and temperament, gibular joint disorder and, you know, chronic headaches and things of that nature as well. So, you know, so somebody will come in with an initial complaint and say, you know, it's this, it's my shoulder, it's my back, it's my whatever. And so I'll start at that area, but rarely do I stay in that area. You know, one of the sort of guiding tenants of this is that it's the victim that cries out, not the perpetrator, right? So the thing that hurts is not necessarily always going to be the source of your problem. It's certainly the source of what's causing you to not sleep or have to change your posture or whatever, but what is maintaining that pain? And that ultimately is what my job is, is to find the source of that pain and attempt to resolve it. Wow, so often, like you said, probably knees are coming from hips or ankles are coming from hips or, you know, your elbows lateral up, the condylitis is coming from, I'm assuming, yeah, so wow. So that's manual therapy, fascinating. And I love how you've combined that. And the thing that I hear too is, you've got obviously an incredible analytical mind and you love to go deep and study, but you've also clearly developed this tactile sense, right? That's like probably extraordinary compared to the average person because that's what you do. Like you use, and I always admire those people who take, because that's like the right brain, left brain stuff, right? Like you've got the tactile intuitive sense that you probably like trust that you, just like you said, if you think too hard, and I do that in medicine too, it's interesting because I used to be purely analytical, but over time with experience, often I'll have kind of a gut feeling and then I'll prove it with the science, but it feels like to me, feels like literally, like you're actually getting very good clues from your fingers, from your touch, from your tactile sense, and then kind of thinking through where it comes from. But that had to be developed over time. Did you feel like over time, like how many years have you been doing this? So 10 years at this point, and there is a funny story related to the times actually. So as I said, I started in massage school and we really launch into things right away. So within the first week, we had hands on each other in the class. And because ultimately with a massage therapist, manual therapist, it's that haptic sense, that perception that is really what sets us apart as well from other folks who are doing good work in this field. In chiropractic school, in physical therapy school, places like that, there just isn't the emphasis that there is in massage school with develop phases, your primary tools of assessment. Because truly, we don't, in a traditional massage school setting, you aren't getting a huge amount of education about orthopedic tests or anything like that. So you really are taught to rely on these very portable tools that you have with you at all times. So it's the second week of my time at the massage school. And we're working on finding, it's sort of the point of physical innovation at the trap up here. Some people might call them trigger points. So I've got my partner down and I'm working and I'm working and working. And the teacher is saying that these are, they're pretty obvious, you're gonna find them no problem. And I'm like, oh my gosh, I can't find these anywhere. And so I wave her down, she just comes gliding across the room. She's talking to another student and literally just puts her hand out and lands directly on my partner's shoulder. And she goes, ow, that's it. I said, oh my gosh, I'm never gonna be that good. That is remarkable. But so that was a little bit of humble pie right out of the gate. But it's like anything over time when you get used to using a tool in a certain way, you become adept with it. And my tools just happen to occur at the end of my wrists. And it's funny because I was having a discussion with my husband not too long ago, just about perception and stuff of the hands. And I was like, he was working on me. That's what it was. He was working on me. And I was like, gosh, you're so pointy. I taught you better than that. Pull out and start again. He's like, well, but I can really only feel at the very tips of my fingers. And I was like, really? Because, I mean, my point of contact, and this is why I can't handle it, when I work with someone is right along the side of my finger or sort of right in through here. And I didn't even realize that that was the point of the most sensation in my hands until a couple of weeks ago when I was talking about it. So in college, I did a course in reflexology and for a short time I did that for just a little extra on the side. And so if I remember very clearly, we really targeted this little section of the thumb on the side where you can get more pressure but also feel again, I'm no expert, but I remember that little bit. And I'm like, oh yeah, that makes a total sense. Yeah. So let's talk about patients. Tell us a story of someone that was, and it sounds like a lot of people come to you who've been, that's the commonality with us too. It's like, with our mutual acquaintances, like you both are like these mystery, medical mystery people who people have been everywhere tried everything and they haven't gotten the help they need. So I can totally relate, but tell us about a situation where maybe they've been places where they were getting ready for surgery or maybe they've been post-surgery and they felt like they were unhealable. And you remember the best. Yeah, I mean, that's really my bread and butter. So the one that comes to mind is I was working with a first responder and major city. And this person came to me on a Monday and said, okay, here's the deal. I've got surgery scheduled for Friday, same week. Yeah. You got two days. Yeah, absolutely. No pressure, this is great. And so what they were recommending was, because he had a chronic mobaccan. So what they were recommending was going to be a laminectomy, that's actually a double laminectomy, but on the same side, so it's lateral. And he was like, I really don't want to do that. I have young kids. I want to continue to be active in my work. So for him, it was his livelihood and also just his ability to have a good quality of life with his family. So again, there's- Like what decade, like 20s, 30s, 40s, 50s, what kind of a- He was early 40s. Okay. Early 40s. And he had tried, according to him, fundamentally every conservative measure under the sun, been to chiropractors and physical therapy and he'd done all of the kind of like cryotreatments. And he's like anything holistic I could think of, I tried. And he had gone and he'd been to a neurologist and a pain specialist. And the pain specialist basically said, look, when are you gonna start taking this seriously and actually fix it? And so that was really what kind of prompted him, bullied him maybe in the surgery. And so he was like, I, you're my last ditch effort before I get cut on and I really don't want to. So, what can you do? So again, starting with the initial area of complaint which was on the left side of his back, I felt around and yeah, there was maybe like a little bit of tightness but certainly nothing I'd read home about, right? And so I just kind of followed the tissue down sciatic path kind of thing. So, I'm in through glute and piriformis and down through hamstrings and so forth. And I'm like, gosh, I really am not finding anything remarkable in here. Maybe I can't help him, you know? So I sent him home. I was like, look, you're gonna have some residual soreness just get in touch with me in 24 hours. Let me know a bit better and different how things are doing. So in the meantime, I went home and I'm now racking my brain because I don't like failure. And I'm like, I can't, I have to figure this out, right? And so I really just, I like to draw schematics of the patients I'm working with that I can't solve on my whiteboard to just draw out the structures that I think are involved and then look at what I might be missing with my trusty net or textbook or something like that. So at any rate, I went home, I thought about it and realized that I had fundamentally skipped over his entire adductor group. So I was like, okay, well, that's something that I can check. I've got a little breadcrumb now, right? So when he called me, he's like, yeah, I'm probably 20% better. I'm not sure, I'm like, none of that matters. I miss something. So come back in because we checked all the obvious stuff in that pass, but I missed the stuff that was maybe secondary or even tertiary. So he comes in, you know, checked out because I like to do just a subjective pain scale with folks before we start. And he's like, yeah, I'm probably at a six right now, which is, you know, that's better than moderate. So, and so I'm like, okay, I'm gonna just sort of look down into your adductors and see what we got here. Sure enough, there is a spot in the adductor magnus, which is the big one that's kind of like in the middle of your leg. It's called the adductor hiatus. It's there on purpose, it's basically just a hole that allows nerves and vascular structures to pass through. And so I look at that and I'm like, man, this thing feels like it's got a zip tie around it. So I'm like, okay, this is, you know, it's a bit of a crapshoot, but let's just see what we can do. So I worked through the hiatus and was, I mean, I felt the, the neurovascular bundle just do that, like travel all of a sudden. And he went, holy crap. And I went, holy crap. And so cleaned up a little bit more, just, you know, kind of doing the diligence down into the lower compartment of the leg and all of that traced my steps back up to the lower back. And I was like, okay, get up off the table, see what you think. And he got up and he was like, it's gone. The pain is gone. He's like, and he's bending and moving. Exactly, because, you know, one of the things that I asked my patients to do most of the time is, you know, if I feel like I'm at a place where I've gotten to a certain resolution, I'll say, okay, try to make it hurt, right? Because that's sort of the limit. Exactly. Yes, they know what movements they can do to produce the symptoms that they're having. So, I mean, this guy is all but cartwheeling all around my office to make it hurt. And he's like, it's gone. It's absolutely gone. So I was like, okay, so let's just not jump the gun. Do me a favor, wait another 24 hours. Let's just see if this thing, you know, has settled in basically if the body has accepted our suggestion, right? And sure enough, a day later, he called me and he was like, I canceled my surgery. So, look at that. I love that so much. And it sounds like, again, with my familiarity there, it's like entrapments, isn't it? I mean, I'm sure it's way bigger than that, but at a core level, a lot of times these things just get trapped and you're releasing them from captivity. Exactly, yeah, it's just a stickiness thing that, you know, the body has thousands of gliding surfaces. And the key word there is gliding. They are intended to do this on each other. But, you know, if the body all of a sudden gets the message usually from a joint that there is some cause for alarm, like if there's a perception of instability as a, for instance, you know, then because the body is smart and adaptable sometimes to its own detriment, it'll step in and start laying down additional layers to web these things together so that now rather than multiple structures moving as multiple independent structures, you have more or less like four cased sausages wrapped up in saran wrap and nobody's going anywhere independently. Yeah, this one pulls this one with it and like, oh, that, yeah, okay. Yes. So I just think, again, as a physician, I know anatomy, but not like you do. And certainly not to the thought process and I'm not anywhere near anything what you do but I'm so fascinated because I understand the process behind why it works, why it makes sense and why you're so unique because of your background of the intense knowledge about dissection. I mean, that just gives you this, I bet you're one of the only ones in the world. You've got to be the only person like this. They're really amazing. I love it. And I love that. And I'm sure you have many other stories you could tell us like that because that's what happens when you have that kind of unique base. How cool. Yeah. As you said in some of the stuff you gave me that you think there's three unique bodies, what does that mean? And tell us more about when you perceive that the unique bodies that a person that you see has are a patient or a client. Yeah, so, you know, this again is just sort of extracted from my own time and in the field and so forth. But so, I mean, I encounter the fascia body, the fluid body and the breath body. So, you know, and those cross every conceivable system that we have because you really, you can't, you know when people say that they're like fascia specialists or something like that, well, yeah anybody who puts their hands on another human body for therapeutic purposes is a fascia specialist because you can't contact anything without contacting fascia like just by proxy. So that is, I mean, it's truly a ubiquitous structure in the human body. But then again, so is fluid, you know we've got all of these different highways and so forth, some of them with their own pump like our circulatory systems and some of them, you know do the brilliant part of the thing like lymph, right? So, and then, you know, the breath that's one of those things that, you know over the course of time I've just come to realize how critical good breathing techniques are and how bad most people are at this really, really basic very life-giving sort of thing. And so, you know, when I encounter a particularly difficult case and this ultimately is sort of where you know, the three body theory purview sort of came through which is that, you know, typically I'm starting with fascia which, you know, because you've got every single cell, every single muscle every single muscle group and then your entire body sort of encased in this particular material it's really easy to start there because you kind of have to, you know and I mean, you're contacting it regardless. So, so, you know that's sort of my first line of defense is the fascia body and the restoration of gliding surfaces. And sometimes that doesn't work. Sometimes that'll get somebody to 50% better or 60% better but not 100%. And so that's where I'll start to look at things in a more granular way. So more of, you know, like, okay well, let's check out your fluid exchange. You know, do you have like boggy tissue at your ankles that we need to look at? And, you know, that's a really good indicator that maybe your lymphatic flow is not necessarily where it should be. And then, you know after we've checked that box and if the person's still at like 50, 60, 70% then we'll look at the breath body. And it's like, okay so you are moving fundamentally everything certainly in your thoracic cavity when you breathe and, you know, a lot of other things sort of go along for that ride. And so, you know let's look at how deep you're getting your breath where you're getting it to let's look at your lung expansion. Let's feel how your organs are moving. You know, because organs articulate in a very certain way when you breathe. And your hands on them, you know as a breathing that makes a ton of sense. Yeah. And that's, I mean I tend to leave the breath for last because it really it's intimate as well. I mean, you know it's very, very rare that people are getting hands on sort of in that thoracic cavity. Yeah. Yeah. And typically it's because something very invasive is about to happen. Yeah, yeah. And so, you know just out of respect for the way that I feel that the treatments should unfold that's sort of the last thing so that we've already established a rapport and I'm not just like diving into your abdominal like uninvited basically so. I love that you say that though cause I have a massage therapist in my clinic is amazing and she does abdominal massage and but I've gone to hundreds maybe thousands of other massage therapists and rarely do they ever which is perfectly okay, I get why but it's one of the things like the psoas and some of the things you can't get to and through the you know through that cavity and I've always found it profoundly helpful to my love, you know so it is a really such an important place and it's pretty much ignored all this and again again it's like the dog you know if you put your belly up this is the most vulnerable part of ourselves, right? Right. So I still get why and I think that's super respectful of how you practice but it's also like if you're out there and your massage therapist has never touched your abdomen or you have a great relationship with them that's a really powerful place to get healing. Absolutely. And I mean, look if you're out there and you have a great massage therapist who you trust, just ask them. That's exactly what you know, right? You're trained in it. It's just like you said the intimacy of life who are really nervous over the year or they have the reflex you know the rectus abdominis like don't go there but anyway I love that you address that and the breath is huge. The thought is coming to my mind as you're talking so here I am like in my clinic with these complex chronic it would be inflammation, infection, toxicity all those kinds of things but it's gonna manifest in the tissues and my expertise is using the mind and the testing to do that I'm not touching the patients as much but clearly you are and can you tell whether it's a post infection or some sort of inflammatory condition? I'm sure you can actually see and feel the tissue difference there too. So even if you weren't like looking at a lab value you would you be able to like say we were working together on the same patient would you be able to tell me yeah, there's a lot of inflammation or there's some because of the feel right? So I'm gonna say yes with an asterisk because I operate in shades of gray exclusively there is no black and white but yeah, so for the most part and you know look as you know markers of inflammation walk and lockstep with each other. So you know if somebody has you know uterine fibroids and IBS and swollen ankles and you know chronic lower back pain. Okay, well you know maybe we need to look at elevated factors of tumor necrosis factor alpha or something like that, right? Which by the way nobody's doing blood tests for those for people with lower back pain which is insane, but at any rate I'm gonna go with you. I totally agree because I think it's like the structural issue where there's a weak link, right? But then on top of that inflammation is what kind of takes people over the edge often and whether it's infection or toxin or poor posture or poor breathing or. Yeah, absolutely. So to answer your original question there are some cases that you know like the markers of inflammation in the body that are palpable are you know things like heat if things feel particularly boggy if things are especially stubborn also that's another one. You know an interesting thing that I've discovered over the time in this field is that you know working on people who are chronic smokers is very, very difficult for a number of reasons but not the least of which is that firstly their tissue globally muscle tissue tends to feel very much like beef jerky I guess. And you know with that also even when I do sort of restore some circulation to tissues like that it doesn't stick. So for people who are active well hydrated and good breathers. Yes. I see them maybe four or five times and then they're off my case load. But for people who have inflammation markers or are heavy users of intoxicants or nicotine or stuff like that what I found is like I said that the quality of the tissue is just that much worse and it won't take the same way that it would in a body that is otherwise well hydrated and not using intoxicants. So I love that you mentioned the smoking because my one experience in medical school of course we had cadaver lab for six months and we each had our own cadaver that we worked with the whole time that we held a hide not like the difference with you with the fresh you know it's very different tissue we were talking about too but the one I remember is we had a smoker and his 50s who died of a heart attack and I remember like compared to my colleagues cadavers the heart was just one big very, very thick not pliable muscle and there was no lungs were these chunks of black and our colleagues who had nonsmokers were still soft and viable very, very, very different. And then all the arteries we dissected like even it was so clear they were like plastic tubes. Yes. So that little bit that I remember I was like I remember so and I've never smoked a day in my life but it was so visual that I was like I will never ever be susceptible to cigarettes because I can see how big of deal and I think what you're describing too is the hypoxia that happens and we see that with other infections too but when you have tissues that aren't getting good oxygenation it's gonna absolutely affect all of these things and especially pain because the oxygen takes away delivers nutrients but also takes away debris and junk and garbage. That's right, absolutely. And one of the labs that I was at we were here so we didn't we're in this country what I mean. So we didn't get a medical history just based on the body donor program. But I mean that sort of became part of the intrigue of that particular lab because we had one cadaver who I mean I would put him probably I don't know mid to late sixties or so but we were all convinced that this was a COPD patient because he had the massive barrel chest. I mean the heart that like fill and then overflow both hands. Which as you know is not normal. And it's funny because I'll just mention that because even this for young men who are like using steroids or whatever I've seen a number of young thirties, forties where there's massive hypertrophy and people think oh these muscles are great right but you could have a heart and it can't pump anymore. That's right. The other thing that you know because you were asking about can I feel kind of the inflammation and it's interesting that you were steroid use because I can absolutely feel a steroid user because their muscle feels literally inflated. It's like squeezing a beach ball as opposed to squeezing somebody who has earned it the traditional way. So yeah I mean there's definitely people might be pulling the wool over eyes of folks at the beach but not when you get into it. One other thing I found really interesting in your bio and some of the info you gave me is some things that you wouldn't think for someone a manual therapist would be like erectile dysfunction in cotton and constipation and for my patient population small bowel overgrowth bacterial overgrowth SIBO or something with a mild obstructive kind of pattern where it's adhesions and stuff. Those cases and it sounds like those you can often get them in and out in a three, four, five sessions and have success. That's right, yeah. So right now I really love working on visceral stuff and you may find this too that in your practice there are kind of seasons of things that show up where you're like, okay it's raining like left wrists this week or something like that. And so in the past 18 months the focus has really been on pelvic floor dysfunction which would include, I'm gonna kind of umbrella that to include ED, include incontinence and then bowel issues like constipation as a for instance. So the easiest way to be able to sort of figure out what's going on with somebody with some sort of a gastrointestinal upset that is mechanical and not chemical or disease related in nature. So I just want to put that ass sort of scout there is that basically like your colon is more or less forming a bit of a rectangle with a shoot at the end of it, you know what I mean? And so I'll start just by listening with a stethoscope to just hear what is going on at like the cecum for instance, which if you're listening and you're like, what the heck is that? That is sort of the gateway between the small and large intestine. And then I will look up sort of into the corner of ascending and transverse and then to the corner of all of that other stuff and just sort of see like, okay if I'm getting noise at the cecum, which I typically am then where am I not getting noise in response to pressure? And so that's typically where I'll start is just more or less like lifting the margins of the colon to just see, is it stuck to the greater momentum? Is it stuck to the peritoneal wall? Is it stuck to itself? Is there an adhesion somewhere internally? And generally speaking, I can find that through palpation and certainly through patient reporting, right? So I'm like, yes, exactly. I'm relying on the person who's under my hands to be able to help and guide me. And so the cool thing about that without kind of wandering into a two-graphic territory is that when I've got somebody in front of me who's constipated, I can feel where the blockage is residing. And we can really physically kind of like inspire some motility in the large intestine. And I mean, I've had people get up in the middle of sessions to be like, okay, it's right now. Yeah, no, totally. And makes someone, I mean, that's what our body, from a clinical perspective, what I see a ton of is small intestinal either bacterial overgrowth or fungal overgrowth. And it's all of that ileocecal region. Like you said, if that flap is stuck closed or there's an adhesion or there's no motility there, it's almost like that flow between meals and things where you should get cleansing and clearing out of the bacteria is not working. So you don't have them, what we call it migrating motor complex is not working. It's not clear between meals. But a lot of it is to do with this manual piece of there's old surgical adhesions or old stickiness from maybe a peritonitis or something going on there. And so when you manually actually kind of break up those adhesions and allow for movement, I find again, clinically, I can do all the medications or the herbs or those things, but I would say 50% of the time with the small bowel or the large bowel issues, it needs some manual therapy. So I see that too. And I think it's so powerful because that stuffness, no medication, no herb, nothing is gonna fix if there's an adhesion where two pieces of the bowel are stuck together and not moving well, right? That's right, exactly. And the piece that you look at is both mobility and motility. So it's kind of an inside outside sort of thing. So once again, we're back to the fascia body and to a lesser extent, the fluid body and to a lesser extent, the breath body because all of that is together. Absolutely, in healing that particular region. And so we have to make sure that not only are the exterior gliding surfaces of the structures not stuck to other gliding surfaces of other structures, but also that the smooth muscle inside is doing its job as well. And that also, that's sort of where the breath comes in and so I'll send people home with some rehab stuff to do because your breath really helps to again, inspire the motility piece that is directly in the smooth muscle tissue of your bowel. So, and then as far as the pelvic floor stuff goes that started, my curiosity developed really early with that and it goes back to my CrossFit gym. So, at that point in time, there were not a huge amount of female coaches and even fewer female owners. And so it was a unique experience to have one of my younger, I mean like early 20s not a childbearing person come to my door and say like, hey, so I just did a heavy deadlift out there and I peed a little, I don't know what that's about or it was box jumps or it was jump rope or it was- Now I love you to say that because I bet there is 50% of women listening out there that have had that experience and it's so, I mean nowadays you talk to your girlfriends or whatever but it's so common isn't it? Yes, yes, and that's exactly, but that's really the drum that I've been beating for so long is that it is super common but not normal. So let's fix it. Let's talk about it first off. Let's demystify it. And so, that really the fact that I had all of these very fit young women coming to me and saying like, I'm being myself on a regular basis led me just to look at some osteopathic journals to understand better what the pelvic floor was and all that stuff. And what came out of my research was that fundamentally the argument in this one paper there are like four conditions that the pelvic floor can be in. So you've got your kind of like high and tight you've got your low and loose which is what I think most people would associate with pelvic floor dysfunction or incontinence and that would be the case of women who have born children and particularly vaginal births and that kind of thing. And then you've also got sort of like the low and tight and high loose. So you've got all these different kind of conditions that the pelvic floor can be in. And by the way, since reading that article and since just doing my kind of anecdotal study there's way more than four. That was sort of a one size fits most model but it worked well enough for me to start with just a little kind of case study thing with the female athletes in my gym just knowing what I knew from dissection lab again. So again, if you're a manual therapist or a body worker or a yoga teacher or a gym teacher or a coach or anything like that and you can get yourself to a dissection lab please go and do it because it is going to be so edifying and so life changing for you. So that's my plug for dissection labs. But at any rate, what I learned in the dissection lab is that we've got muscles that are part of our deep six lateral rotator in the back of the hip that fundamentally are like the, if you picture it like your pelvic floor is a hammock these are sort of like the trees, right? And so if it's the obturator internist and so if they're really tight what will happen is that the trees will fold in and you've got kind of this like lower hanging pelvic floor at that point. It doesn't mean the pelvic floor is loose though at that stage because especially if you are bearing down a huge amount as in weightlifting or whatever or you're doing something percussive like running or jumping then you're going to be, you know you're clenching basically. And, you know, if I put a pencil in your hand and said, okay, I'm gonna give you $100 if you know you don't let me pull this out of your hand and you're squeezing, squeezing, squeezing and I pull it out there's no more strength left in this hand. You can want to squeeze more but you're not gonna be able to do it. Why? Because you've already maximized that muscular potential. And so the same is true of pelvic floor and continents and people who are otherwise not childbearing and very fit. Yeah. Those muscles are in contracture and they need to be released. Yeah. It's the opposite of what you think it's not more kegels. It's... It's not. Because that really and particularly at that point in time you know, we're going on, I don't know eight or seven or eight years ago at this point that's what was available literature-wise was just one size fits all, right? That's right. Yeah. So I said that clinically too and I'm not the expert. I always send them to someone like you or a physical therapist but it's very true. It's not a one size fits all. And a lot of women are real frustrated because they're like, well, I really do my kegels. I know how to hold the pelvic floor and I still can't protect from loss of urine with desertion or whatever. So... Yeah, exactly. Wow. Oh my gosh, this is so amazing. I love love. I could talk to you all day. I'm like, this is... Any last bit of wisdom. I mean, you're so unique. First of all, I'm sure there's a lot of people listening here are going to want to get a hold of you and you were telling me your website and stuff is being built. So that's coming, you know, all the data and stuff that will make sure people can still find you. And no matter when that happens, we'll make sure that that is wherever you listen to this we'll link that up. And it's your name, right? Which give us your name and spell it for us really quick so that... Sure. The audio, look it up. It'll be GinaTakoniMore.com G-I-N-A-T-A-C-C-O-N-I-M-O-O-R-E.com And yeah, so that'll be where, you know, you can find out what I'm doing and book a consult with me and just generally kind of step into this very nerdy anatomical world. I love this nerdy anatomical world. I love that you encouraged anybody listening doctors, physical therapists, carpenters, anyone to think about dissection and anatomy because I, again, mine, my experience is 20 years ago and it's pretty rusty. And it's so funny because most, you know, people assume that doctors are, you know, but even for me sometimes the muscle, I'm like, what muscle is that again? That's muscles, not nerves and all the other. And of course I do all that at one time. So you are encouraging me to go back to that too and make sure that it's all fresh. Any last bits of, you know, just giving someone hope or parting words of wisdom or any last little bit of pearls that you want to leave that people with. Yeah, I mean, you know, I would say, especially having worked with some populations that have really seen a lot of life, you know, people who have survived catastrophic injury or illness and, you know, are still struggling with some of the after effects of things like that all the way to, you know, somebody who's like, man, you know, I just, all I want to do is be able to control my bladder. I would just say, you know, think outside the box a little bit. Think from an anatomical perspective to practitioners. Please think about things from an anatomical perspective. You know, Oliver Sachs was beating this drum way back in the day and all he did with case studies. And, you know, his encouragement was to really bring the patient and their story to the forefront of treatment and prevention. And so that would really be, you know, kind of the soapbox that I would get on for anybody who is in the business of treating any human bodies is just put your patient in front of you, keep them in front of you. And if you're smart enough, they will teach you how to treat and cure them. Oh, I couldn't have said it better myself. That is so beautiful. And so, so I no wonder that our mutual acquaintance was like, you guys got to meet really truly that listening. And I can hear that. And even the fact that the story you told us you like went home, you drew it out. You're like, I'm going to figure this out. Good for you. I know that you're already so successful. You're just going to continue to catapult. And what I hope is you get a chance to continue to teach people and really spread this method and the things you've done. So thank you so much for your time today, Gina. It has been a pleasure. Yes, definitely. This has been great.