The Ultimate Guide to Pelvic Floor Strength and Sexual Wellness | Dr. Lance Frank | Better Man Podcast Ep. 044

Dr. Lance Frank: Yep I will say I have a little bit of a like allergy cold thing going on. So if I sound a little stuffy or if I cough that’s what that is going to try to keep it to a minimum. But.

Dean Pohlman: Okay, cool. We can talk about my talking about my favorite cold remedies. All right here we go hey guys it’s dean welcome back to the better man podcast today I am joined by Lance Frank who is a. Pelvic floor physical therapist specialist which is a title I just botched but he will be able to give you the official title shortly? um and he is going to be talking with us about pelvic floor and men’s sexual wellness issues in general. So this can be a really cool episode. Um lance.

Dr. Lance Frank: Thanks for having me I’m excited to talk about it.

Dean Pohlman: Thank you for being here. Yes, and if you could clarify your title and your education all that stuff for us. So we So we so I don’t sound silly at the beginning.

Dr. Lance Frank: That’s okay I am a physical therapist I am a doctorate in physical therapy. Um, and I have a specialty and pelvic floor dysfunction. So I’m a pelvic health physical therapist.

Dean Pohlman: So My wife is a physical therapist. She’s a Pctp T O T O C S and I’m curious because I from my understanding pelvic floor specialist the physical therapist who specialize in pelvic floor is not super Common. So what. You know what kind of extra training. Did you go through for that or what’s what’s unique about being a pelvic someone who specializes in Pelvic Four health.

Dr. Lance Frank: Yeah, so I to be a pelvic floor pt there’s a series of continuing education certification courses that you have to take and if you would like kind of like your wife if she’s a orthopedic clinical. Specialist. She took her ocs and passed past that certification exam to be a pelvic floor pt there is no official certification exam from the american physical therapy association the abta like the Ocs or if you’re a neurological.

Dean Pohlman: Are.

Dr. Lance Frank: Clinical specialist. You have an ncs or a pediatric those are recognized certification exams by the apta currently, there isn’t one for pelvic health but there are other governing governing bodies if you want to call it that specifically Herman and Wallace is one that I’ve taken all my training through.

Dean Pohlman: And.

Dr. Lance Frank: They have a certification exam that has been an immensely you know tested and that’s what I’m currently working towards so their certification is pelvic real rehabilitation Practitioner Certification prpc.

Dean Pohlman: Um, okay, cool. So so what is the scope of your work as someone who specializes in pelvic floor.

Dr. Lance Frank: So I’m planning to take that in december.

Dr. Lance Frank: Um, hi I Like to tell all my patients. Everything above the knees and below the rib cage is kind of my specialty so peing pooping issues with having sex any kind of general pain complaints in that region. That’s that’s my my. That’s my forte.

Dean Pohlman: Okay.

Dean Pohlman: Um, okay, and what is let’s actually clarify what what is the pelvic floor because I think there’s a lot of misconceptions about you know the pelvic floor is not your entire core area or you know what? what would you call your pelvic floor.

Dr. Lance Frank: The pelvic floor is a group of muscles that sit in your pelvis and they’re the main muscle groups responsible from a musculoskeletal standpoint. They’re the they’re the main muscles responsible for our ability to urinate defecate and have sex. And if somebody has a uterus reproduce so and childbirth but from a male perspective being pooping and getting an erection ejaculation. All of those roles are primarily driven by the muscles of the pelvic floor.

Dean Pohlman: Yeah. In.

Dean Pohlman: Are these are these muscles are your pelvic 4 muscles is that something that is generally exercised in you know, like typical exercise or is it something that you know you you, you might have to train specifically.

Dr. Lance Frank: It depends. Um, you know everybody knows well most people know whenever you say you know a kegel most people know what a kegel is and whenever people think of pelvic floor PT that’s the most common question I get they’re like so you just teach people to do kegels all day from why I mean no yes and no, but.

Dean Pohlman: Um.

Dr. Lance Frank: With regular exercise you know the pelvic floor is best friends with our abdominal wall The rectus abdominous and the deepest layer of the the abdomen the transverse ab dominance the T a and the pelvic floor are best friends and so it’s physically impossible to engage your core.

Dean Pohlman: Um.

Dr. Lance Frank: And not engage your pelvic floor. So anytime you’re doing a crunch anytime you’re doing a sit up anytime you’re doing a plank Your pelvic floor is inherently turned on and so whenever I’m trying to teach functional strengthening for the pelvic floor. It involves a lot of the traditional like mindset of what a core exercise regiment would be um.

Dean Pohlman: Um.

Dr. Lance Frank: But if somebody is having a lot of incontinence and they just have 0 idea how to engage their pelvic floor at all. Well, that’s when I’m directly targeting and going after the pelvic floor muscles with exercises similar to a kegel.

Dean Pohlman: So these muscles are basically there’s there’re theirre ago or yeah, their agonist muscles or there they work in synergy can.

Dr. Lance Frank: Yep, you physically cannot contract your pelvic floor and not contract your abdominal wall they with those 2 contractions happen together simultaneously.

Dean Pohlman: That is really interesting because I actually heard like the exact opposite from somebody else like a few months ago so I’m not going to say who it was I’m just going to assume that you are correct. Um, but that’s interesting. That’s news so you can’t you cannot isolate your. Your pelvic floor and just like use your pelvic floor on its own.

Dr. Lance Frank: You I mean you can bias the pelvic floor but you’re never going to not contract your abs at the same time. The.

Dean Pohlman: Okay, okay, and I’m doing this right now I’m like I’m doing kegels and I’m like thinking like is my is my are my abs working as I’m doing this.

Dr. Lance Frank: If you feel and so it’s not your 6 pack muscle. It’s not the recus of dominance. It’s the deepest layer your t a your transverse of dominance and so if you if I’m having a hard to if people are having a hard time getting a pelvic floor contraction I’ll have them focus on engaging their TA.

Dean Pohlman: Are.

Dean Pohlman: Um, what’s your what’s your favorite exercise for engaging ta transverse of dominus.

Dr. Lance Frank: Because that. I Mean the most basic one where I always start is just having people lay on their back with their feet up with their knees up towards the ceiling and this hook lying position and just have them focus on doing engaging their engaging their core. So If if people are listening and if you want to do this too. You can put your.

Dean Pohlman: Yeah.

Dr. Lance Frank: 2 fingers on the insides of your hip bones just inside the hip bones there and if you think about you know I there are a lot of contract or a lot of cues that I can give people but the most common one is try to try to flatten your back into the table or try to.

Dean Pohlman: Um.

Dr. Lance Frank: Turn on your abs as if you’re trying to bring your belly button towards your spine and so it’s or a lot of my a lot of my guys resonate the most where think about somebody’s about to punch you right in the stomach most people would want to do a little bit of a brace and so.

Dean Pohlman: Um.

Dean Pohlman: Um, yeah.

Dr. Lance Frank: If people are laying on the table and I I don’t I don’t actually hit my patients. But I you know I go think about if I’m going to hit you in the stomach. What? what would you do turn your abs on and most people know how to do that and so it’s not excuse me. It’s not a you know a really intense brace or a bear down people aren’t like you know straining.

Dean Pohlman: Um, yeah, yeah, instinctively.

Dean Pohlman: You know.

Dr. Lance Frank: But it’s once they feel what should be happening in their abs and then I’m like okay now give me like 50% of that and once they get that then we start to incorporate that contraction into other positions. Whether that’s hands and knees or standing or in a squat because if people especially my guys that have just gone through.

Dean Pohlman: Um.

Dean Pohlman: Um.

Dr. Lance Frank: You know a prostatectomy after prostate cancer if they’ve had their prostate removed a lot of guys have a lot of issues with incontinence and so if those muscles are just so so weak and they have a hard time even feeling a contraction down there. Well I normally with those guys start with just a lot of core.

Dean Pohlman: Um.

Dean Pohlman: Um.

Dean Pohlman: Got it. That’s ah, that’s that’s really that’s real useful information. Um, thank you? So um, what are some of the let’s just let’s just get to really broad spoke here spoke so scope here. What are some of the.

Dr. Lance Frank: Strength and development.

Dr. Lance Frank: You’re welcome since this is.

Dean Pohlman: You know the biggest problems when it comes to men for for pelvic floor.

Dr. Lance Frank: I would say by and large the most common diagnosis that I see is a condition called Prostatitis or Aka Chronic Pelvic Pain Syndrome um and it just all that generally means is you have a generalized pain in your perinem or in your.

Dean Pohlman: So that’s the the pelvic floor is specifically that area right? under? yeah.

Dr. Lance Frank: In your pelvic floor. The space between your testicles and the anus prosetitis is a yeah, the space between the testicles and the anus throughout this you know interview you’ll hear me say words like Perinem. Pelvic floor pelvic girdle pelvic diaphragm they all mean basically the same thing and it’s the space between the testicles and the anus you’ve got muscles on the outside that you can touch. But you’ve also got muscles on the inside that you can’t necessarily touch unless you’ve got a finger up your butt which is one of the ways that I assess somebody’s pelvic floor internally.

Dean Pohlman: Are.

Dean Pohlman: Okay.

Dr. Lance Frank: With an internal exam. Um, but yeah, the collectively the paraneum or the pelvic floor is the space between the testcules and as.

Dean Pohlman: Okay, so what are some of those that the most common problem you mentioned is that is that pain. What about some other ones sorry that was me interrupting and and I apologize because I’m like I’m just interrupting you to ask like questions that are.

Dr. Lance Frank: Oh right? ah hit Well, that’s okay here, but it’s great. Um.

Dean Pohlman: Like oh well, what about this I’m I’m curious about this like what about this. So so ah yeah.

Dr. Lance Frank: Yeah, common common conditions that I see a lot of so like I said Prosetitis Chronic Pelvic Pain Syndrome Um I see a lot of testicular pain that a lot of times patients think is their testicle actually hurting. But it’s a lot of times referred pain into the testicle from.

Dean Pohlman: A.

Dr. Lance Frank: Pelvic floor muscles or the surrounding hip muscles. Um, it’s ah these guys have been bounced around from uurologists to primary care to oncologists and nobody can figure out where their testicles testicle pains coming from and a lot of times if there’s no like infection or if there’s no.

Dean Pohlman: Oh man.

Dr. Lance Frank: Mass If there’s no like medical reason. Usually it’s a muscular skeletal issue and it’s a pelvic floor problem. So I see a lot of testicular pain or.

Dean Pohlman: Wow I mean I didn’t think about that like I think about like I think about like you know trap tightness trap tighttanness like you know radiating to your neck but like I didn’t I did not think about like pelvic 4 tightness radiating to 1 of your balls.

Dr. Lance Frank: Yep it it does it does suck but you know among the different conditions that I treat it’s it sucks because a lot of guys I have a guy now that I’ve been working with for three weeks that has had.

Dean Pohlman: That sucks.

Dr. Lance Frank: Left sided testicular pain for 6 years that nobody’s been able to figure out and we’ve reduced his pain almost entirely in three weeks just by addressing the pelvic floor and so it’s it’s a it’s a shitty condition to have because a lot of times. It takes a long time to get to somebody like me. But it’s one of it’s.

Dean Pohlman: So.

Dr. Lance Frank: I would say the easiest conditions to treat Once you get it actually somebody that knows what they’re looking for.

Dean Pohlman: And so there are no muscles in the penis itself or in your testicles but pain can radiate to your testicles.

Dr. Lance Frank: There’s no muscle in the shaft of your penis and the like guess I should say in the external shaft of your penis the part that hangs there’s no muscle in that there all are also no muscles directly in the testicle and so most of the time. The the muscles that refer into the testicle I wish I could share my screen and I’m a visual learner and so I have ah an anatomy app that I love because it’s Great. It’s a 3 D model. But um, anyways, the adjust if people are listening at home or if you want to do this too think about.

Dean Pohlman: Me.

Dr. Lance Frank: Touching that perinem that space between the testicles and the anus and if you slide your fingers upwards towards the shaft of your penis that about inch to two inches where that forms that almost like a bulb down there. It’s called your bulbose spongiosis and that muscle is your the primary muscle that allows us to ejaculate.

Dean Pohlman: He.

Dean Pohlman: Um.

Dean Pohlman: Me.

Dr. Lance Frank: So whenever we have orgasms it has like 10 to 20 rapid contractions that eject semen out of the penis. There’s another one at this and that pretty close to that same spot. It’s called your isio cavernosis and its main job is to get an erect allows us to get an erection and so.

Dean Pohlman: Um.

Dean Pohlman: Um.

Dr. Lance Frank: There’s no muscles in the out the external part of the penis where it hangs but that the very base where it attaches into the paraneum. That’s where those 2 muscles exist and so and those 2 muscles often refer into the testicle whenever there’s a trigger point or overactivity in them.

Dean Pohlman: So are there exercises that now I’m like thinking for myself. Are there exercises that like specifically strengthen your ejaculation muscles or does it it. There are.

Dr. Lance Frank: I Mean it’s essentially all the same. It’s all like kegels I hate calling him kegels because it everybody’s just like it’s so general and a lot of people don’t know what they’re doing like I have a lot of patients that if I just ask them like show me what you think a kegel is people will be.

Dean Pohlman: Um, it’s so general. Um.

Dr. Lance Frank: Squeezing their butt cheeks together or they’ll be like squeezing their inner thighs together or they’ll just be really tightening their abs like a lot of my patientss have no idea what their pelvic floor is and whenever they think that they’re doing a kegel. They’re absolutely not and so a pelvic floor contraction is usually what I call it I want you to do a pelvic floor contraction.

Dean Pohlman: Um.

Dean Pohlman: Um.

Dr. Lance Frank: Think about the cues that are mostly going to target the the Bulbo and the isio are make your penis jump or try to make your penis shorter. Um some that another cue that some people don’t always get is think about trying to lift your testicles.

Dean Pohlman: Um.

Dr. Lance Frank: Up into your abdomen lift your nuts to your guts Those also engage the the more anterior or the penile muscles Isio and Bulbo um spongiosis.

Dean Pohlman: Um.

Dean Pohlman: Okay, now I’ll be honest I’m doing I’m like practicing this as you’re saying this because I’m curious and like it I actually felt a difference between the make your penis jump and like and then then make your penis shorter are there those 2 different muscle muscles.

Dr. Lance Frank: It is yes and no, um so we’ll think about you know we’ve got fast Twitch and slow twitch muscle fibers and you know there are muscle groups that are fast Twitch that are more like reactive like they are quicker to turn on and then you’ve got more endurance or stamina muscles.

Dean Pohlman: Okay, are they muscle you go ahead.

Dean Pohlman: Me.

Dr. Lance Frank: That are more slow Twitch the same principle can be true in the pelvic floor and specifically for the penis you know ejaculations are quick the rapid fire so think about make the cue make your penis jump is mostly for bulbo spongeoses.

Dean Pohlman: Ah.

Dr. Lance Frank: Isio Cavernoussis erections. You know we have to be able to not only get an erection but maintain that erection So It’s more of an endurance exercise and so the queue try to lift your lift your testicles up off the table or lift them up off the floor and um, try to make the head of your pen or make your penis shorter Those are. I’ll have people do those contractions but then I’ll tell them. Okay, now do that contraction and hold it I want you to hold it for as long as you can. That’s more of an endurance. So it. It depends on what people are coming in for and which exercise that I’m giving them if that makes sense.

Dean Pohlman: Um.

Dean Pohlman: Yes, okay, and I do want to ask specifically about the most common problems for men in their fifty s and sixty s because that’s the majority of the people I think listening to this podcast and people in Mantle Yoga are in that age demographic. However. I am selfish and I want to ask a question for people who don’t have any acute issues which you know I don’t I don’t know. Actually what we’ll get into talking about just how many issues just how many just what percentage of men do have acute issues with pelvic four health because I think that’s a understated. Um, but if you have. Relatively no noticeable acute issues. You have you know, have decent sex life or decent erection strength decent ejaculation. Can you by doing this type of these types of exercises on a regular basis. Are you going to have like is your. Is your sex life going to like or the the strength or the pleasure of your erections or your ejaculations is it going to go up like like can we train this to the point where you’re like all of a sudden sex is like 3 times as good as it was or are you going to be are you going to notice like more like marginal like maybe 20 to 25% or has this even been quantified as this something that even is like or is it just like you can come or you can’t.

Dr. Lance Frank: Um, I’m going to have to break that down a little bit into separate answers. Um, and the reason being is that first there’s no like to my knowledge I don’t know that there’s ever been a study that’s looked at that you know.

Dean Pohlman: Okay, all right.

Dr. Lance Frank: Can pelvic floor therapy or can pelvic floor specific exercises actually enhance the qualitative measure of increased pleasure I don’t know that that’s ever been looked at I mean I’m sure it has yeah um I don’t know that that’s ever been looked at.

Dean Pohlman: Thank you, Thank you for saying that in a way that was medically acceptable. Yeah.

Dr. Lance Frank: In my brain and and whenever I’m thinking of rehabbing patients and I and the reason I wanted to break this up is because while we’re talking about the what so far everything that we’ve talked about is more of a strengthening based mindset. For more of ah, an underactive pelvic floor or a low functioning pelvic floor by and large the majority of my patients had the exact opposite problem. Their pelvic floor is doing too much and so I it’s rare that I give them these.

Dean Pohlman: Um, interesting.

Dr. Lance Frank: Actually give them these strengthening exercises a lot of the stuff I would say those are usually my low my younger guys the the twenty twenty 30 40 s um, generally once we get into the older kind of age ranges. Those are the more.

Dean Pohlman: And what age are those guys. Okay. Are.

Dr. Lance Frank: I would say I don’t want to say underactive but less active patient or pelvic. Um activity patients that was I botched that. But.

Dean Pohlman: Um.

Dr. Lance Frank: And pelvic floor therapy patients typically fall into 1 of 2 categories. It’s either an underactive pelvic floor or an overactive pelvic floor a hypo tonic pelvic floor or a hypertonnic pelvic floor most of the patients that I see on a day-to-day basis fall into the overactive or the hypertonic pelvic floor and so those are the guys that i’m. The the 20 to 40 ish age range that I’m not giving them a kegel as but not any time early in their their therapy. Maybe even ever because they are the the fit the the super tense the type a I always joke. These are my tightass patients. These are the patients that just never ever ever relax their pelvic floor and so the last thing I want them to do is to do a kegel because it’s just like it’s only going to make all of their problems worse, especially if there’s pain but to your your question about the older you know demographic 50 6070 s

Dean Pohlman: But.

Dean Pohlman: Um.

Dr. Lance Frank: Those are the guys where yeah I might want them to be doing some targeted strengthening exercises depending on what they’re coming in for usually it’s Ed Usually it’s some sort of incontinence related issue. Whether that’s fecal or urinary incontinence. Ah, that Demographic is usually doing a little bit more strengthening.

Dean Pohlman: Are.

Dr. Lance Frank: And so yes targeted pelvic floor contractions but also all the core you know, upregulated or upregulation exercises planks. You know, um pal off presses those types of over entire core based exercises.

Dean Pohlman: Wow. Okay, well, that’s cool on on 1 hand that’s cool because it validates you know the kind of a lot of the content that I’ve a lot of the content that I’ve created with core strengthening having to do with improved you know, sexual health which. To but to my understanding and you know everything that I knew about it like okay this makes sense this this helps but it’s cool to hear that oh it does actually from somebody like you. So um, what are some other you know I I think we covered a lot of the big ones we talked about um. You know, sexual dysfunction. Um, but it sounds like those guys who are twenty s thirty s are they people who tend to have more premature ejaculation or they just have okay so can we talk about the difference between like what’s what is premature ejaculation by the way.

Dr. Lance Frank: Well medically premature ejaculation is defined as an ejaculation that occurs prematurely or earlier than one would like um, usually with it’s within a couple you know.

Dean Pohlman: Yeah.

Dr. Lance Frank: It’s rare that it’s over a couple minutes usually it’s within a couple seconds and so it if.

Dean Pohlman: It’s that that definition is interesting because I remember I made a video on on premature ejaculation ones and it’s all about it’s all about controlling your breathing. You know it’s about slowing down controlling your breathing and controlling your and controlling your body with that. But 1 guy left the comment and he said maybe you just need to like maybe we just need to lower our expectation of what our our ejaculation should be like maybe it’s you’re doing this all wrong like you’re making people feel bad about coming too quickly I’m like I don’t I don’t know if that’s the way to look at it. Um, but sure.

Dr. Lance Frank: No, um, you know the right. There’s a difference between intentionally dragging it out or intentionally you know, delaying ejaculation and not having the ability.

Dean Pohlman: There was a very it was just a very unique response that I thought I should bring up.

Dean Pohlman: So.

Dr. Lance Frank: To delay ejaculation like not having control over your pelvic floor control of your your penis enough to where it’s just happening like I evaluated a guy last week who he was like on a good day 2 minutes on a bad day. 20 seconds

Dean Pohlman: Are.

Dr. Lance Frank: Like that was his spectrum and he was like if if I’m having sex with my wife and we go if I go like 5 or 6 rounds. Well then yeah by the last round it’s going to be like 15 minutes and he’s like but how many times have you been able to have sex 5 times in a row back to back to back. He’s like it’s I can do it but it is it.

Dean Pohlman: What what? What is what world is this guy living in where that’s like that’s normal. It’s like oh well yeah yesterday was like an average day just 5 times in 2 hours like oh okay.

Dr. Lance Frank: Right? right? ah.

Dr. Lance Frank: Yeah, right I was like um Wow Okay, um, but so from a pelvic floor standpoint if there’s no like premature ejaculation I don’t want to put.

Dean Pohlman: Um, that’s insane.

Dr. Lance Frank: Plant seeds in anybody’s heads. But there are medical reasons as why people can have premature ejaculation if there’s like a spinal cord issue if there’s like a brain stem issue. Those are very very very very rare. Um typically kind of what you were talking about earlier. There’s a breathing people don’t have control over their breath.

Dean Pohlman: Yeah. A.

Dr. Lance Frank: And they don’t have control over their pelvic floor and so the pelt the way that we as men or people with penises ejaculate and have orgasms is the pelvic floor has 10 to 20 rapid really strong contractions that initiate this.

Dean Pohlman: Um.

Dr. Lance Frank: Physiological process in our spinal cord that sends it to the brain and it’s like all right, It’s time to come when those contractions happen. That’s whenever we ejaculate and so the threshold when we’re talking about underactive versus overactive Pelvic floors.

Dean Pohlman: A.

Dr. Lance Frank: There’s a certain threshold in which the pelvic floor has to contract in order to initiate that orgasm and if you think of your scale think of your pelvic floor on a scale of 0 to 10 if the threshold to get to an orgasm is an 8 out of 10 in terms of strength and 8 out of 10 contraction.

Dean Pohlman: A.A.

Dr. Lance Frank: And you live your life every single day just your baseline is a six or a seven that window to get to that threshold is going to take you know a lot less time than somebody who lives their day-to-day life and a 2 or 3 out of 10 threshold and so.

Dean Pohlman: A.

Dean Pohlman: Ah.

Dr. Lance Frank: When when I’m working with patients with an overactive pelvic floor or premature ejaculation I’m trying to get them into more their body their minds, their nervous system and to more of a down regulateulated state which you know before you I Love Absolutely love what you’re doing with all of you these guys.

Dean Pohlman: Um.

Dr. Lance Frank: But before I knew you and before I knew of your account manflow Yoga A lot of what I gave people already was very meditative. Yoga-based flexibility movements because and we talked about this in our call few weeks ago like yoga and pelvic floor Pt especially with the overactive pelvic floor.

Dean Pohlman: A.

Dean Pohlman: Um.

Dr. Lance Frank: Such a beautiful marriage because a lot of my movements and a lot of my exercises I borrow from yoga and yoga practices. Um the pelvic floor and the Diaphragm the muscle that helps us breathe are are and is another best friend group so we talked about the Ta and the pelvic floor earlier.

Dean Pohlman: Um.

Dr. Lance Frank: The Diaphragm in the pelvic floor are also best friends and if things are working functionally and optimally they should be working in tandem when we take a big breath in when the the lungs inflate the Diaphragm drops down it pushes all of that pressure on top of the pelvic floor. And if the pelvic floor is working appropriately and correctly the way it should It should lengthen and relax to accommodate all of that pressure kind of like a hammock or a sling or trampoline whenever we Exhale the lungs deflate The Diaphragm rises everything in our abdomen gently shifts upwards and the pelvic floor should if it’s working correctly, contract and pull up and in.

Dean Pohlman: Are.

Dean Pohlman: On.

Dr. Lance Frank: So there’s this Piston mechanism between the Diaphragm and the pelvic floor they play catch with one another with internal pressure and so whenever people have an overactive pelvic floor. They’re clenching all the time usually every time they take a big breath in the the diaphrames or the pelvic floor either doesn’t move or.

Dean Pohlman: Ah.

Dr. Lance Frank: It does the opposite of what it of what normally happens it relaxes when it should contract and contracts when it should relax when I’m evaluating people on the table and I have them do all I do which if you’re not in the exam room and you don’t know what pelvic floor Pt and you don’t know what I’m looking for it sounds kind of strange. But.

Dean Pohlman: Yeah.

Dr. Lance Frank: I have people lay on the table and I have them lay in a butterfly position and I’m literally looking in between their legs I’m lifting up the scrotum if it’s’ ah if it’s in my way I want to see what their perinem. Their pelvic floor is doing because when people take a big breath in if you think about filling up a balloon with air How the balloon kind of expands outward.

Dean Pohlman: Are.

Dr. Lance Frank: That’s what should be That’s what should be happening with the space in the space between the testicles and the anus and so I have people take a big breath in and just observe what is happening down there and a lot of times. There’s either no movement or it contracts when it should relax like it. It kind of puckers up and in when it should expand outwards.

Dean Pohlman: A.

Dr. Lance Frank: And so when we’re talking about premature ejaculation and overactive Pelvic Floors. We talked about that threshold in which it takes to achieve an orgasm or ejaculate if people can learn to control their breath by the the most common thing that I see with people people do that have premature ejaculation is hold their breath. They’ll hold their breath and their tent. They’ll tense their abs which as we know the Diaphragm and the ta are if you’re contracting those two. The pelvic floor is going to be locked up and so a lot of what I do with people is teach them how to breathe teach them. How to do a diaphragmatic breath and drop their pelvic floor at the same time.

Dean Pohlman: Oh.

Dr. Lance Frank: If we can if I can get patients to sync up their diaphragm with their pelvic floor and learn to relax it usually most of the time I have success with patients being able to extend or prolong their ejaculation or their orgasm.

Dean Pohlman: Wow, That’s so Cool. So and if you do just a let’s say you just lay on your back and you do a a normal diaphrogmatic breath or like what would be considered proper technique for a diaforgmatic breath. And I’ve got some videos on this by the way I have a blog if you if you’re listening to this right now and you want to or I think we already talked about you know the diaragmatic breathing here too. But I do have a blog on this. Go check it out on the website if you need a more in-depth tutorial the Diaformatic breathing. But if you do that is that if you do that properly is. Is that just going to do what your pelvic floor naturally should be doing like if you have a proper diaphragmatic breath does that mean that your pelvic floor should you know be doing what’s supposed to do.

Dr. Lance Frank: Not always um.

Dean Pohlman: And so and that kind of and that question leads me to to what extent is this a physical issue and kind of to what extent is this a a nonphysical issue like to what extent is you know, um, stress and anxiety um or unusually high levels of that or you know. What else is is going on here.

Dr. Lance Frank: I Would say when we’re talking about Overactive Pelvic floors The most common question I get whenever I’m talking and going through all this education with patients is like why is this happening to me What like why? me? what? What am I doing that you know this happened. And I would say time and time again the most common cause is stress anxiety depression that like we live in a very high stress environment a very high stress anxiety. Um environment. Um society and.

Dr. Lance Frank: When patients don’t have any productive or constructive outlet to rid that in their day-to-day life. You know we we hold tension and stress a lot of people hold it in a lot of different ways. Some people hold it in their shoulders with their upper traps. Some people hold it. And their hands are in their feet. Some people most of my patients hold theirs in their pelvic floor and so kind of what I was saying earlier when I a joke that like my my overactive pelvic floor patients are the tide asses. They are the the high strung the stressed the anxious you know the depressed.. There’s a huge psychosocial aspect to pelvic floor dysfunction and to answer your question about diaphragmatic breathing. You know you could do diaphragmatic breathing all day long and while it’s great. It’s exactly what I I teach patients to do It’s your. You’re taking a step in the right direction but you’re also only doing half of the puzzle piece or half of the the puzzle with the breath work. There’s also there also has to be a pelvic floor involvement and if patients have a lot of times patients have no connection to their pelvic floor. They have no idea what’s happening down there.

Dean Pohlman: Um.

Dr. Lance Frank: Might be able to do the contraction but whenever we go into the the relaxation or the drop phase patients are like I can’t feel anything happening down there like I just don’t know what’s happening with that part of my body and so sometimes I spend 2 or 3 sessions going over this with patients. Through various ways different different types of breathing techniques different hands-on techniques. It’s a ah huge part of what I do is getting patients to like connect with that part of their pelvic floor with their brain and learn how to gain control over it again and so. While knowing how to do a diaphragmatic breath is great. It’s even better if patients have that intuition that like mind body connection to be able to feel what’s happening in their pelvic floor at the same time and this like I said I don’t want to and over I don’t. Want to undersell how hard this is for a lot of people especially whenever patients have chronic pain or they’re dealing with erectile dysfunction or whatever other diagnosis. They.

Dean Pohlman: A.

Dr. Lance Frank: If this part of their body has been shut off for so long. It’s really hard for people to wake it back up.

Dean Pohlman: Um, wow. Okay, so that’s all really helpful and also super interesting I’m wondering on. Can you talk to the other end you know so it’s to me. It’s really striking how the issues go. Like 1 at 1 end or the other right. You’ve got some people who are too active and then you have people who are the not active enough. So do you want to talk more to the the people who are not active enough. Those people who are in their 50 s and sixty s and having you know, um. Having erectile dysfunction there. Um, but and I also want to just plant the seed I also would like to talk about um urinary incontinence. Um, because I think that’s you know I think that’s something that I don’t I’m not I’m not I’m not I’m not sure. But I think that. Talking about urinary incontinence would be even you would if you had it if you had to choose between 2 problems to talk about I think I’d rather talk about erectile dysfunction versus urinary incontinence right? or I don’t know what the which is more which has more shame behind it so to speak.

Dr. Lance Frank: Um, you’re well I was about to say that’s a really hard question to answer I mean they they’re both patients that walk into the door with either either dysfunction.

Dean Pohlman: I Mean that’s a relative question. But yeah.

Dean Pohlman: Oh.

Dr. Lance Frank: Carry a lot of shame. Um the reasons behind it are very different though and the the E D patients you know those like let me I’ll break it down like this in car. That’s okay.

Dean Pohlman: What’s let’s talk about I asked I asked too many questions at once. Um it was go ahead though. Keep keep keep going to train of thought.

Dr. Lance Frank: Well I was going to say incontinence is usually associated with some sort of post Prostatectomy Rehab like patients that have gone through some sort of cancer treatment. Whether that’s a surgery a removal a radiation chemo like usually it’s cancer.

Dean Pohlman: Okay.

Dr. Lance Frank: Related and the shame comes from the inability to maintain their dryness and so they’re going through pad after pad after pad and depends in diapers and um, it lingers for months and so there’s this hygienic.

Dean Pohlman: A.

Dr. Lance Frank: Aspect of shame and this inability to control your body shame. But Ed is not just limited to 1 diagnosis like most of the the incontinence patients are ed. Can be a result of and I know you want to just to spend some time talking about the the underactive demographic but ed can be a result of both parties of both of both sides of the of the coin. Um, if it’s an underactive.

Dean Pohlman: A.

Dean Pohlman: It.

Dr. Lance Frank: Um, usually it’s hormonal. It’s there’s a hormonal aspect to it. There could also be a cancer treatment aspect to it. Um, especially you know the the prostatectomy patients that have had their prostates removed like there’s almost always some level of Ed with that.

Dr. Lance Frank: Um, also just generally as as men age like I talked about the hormones but just aging in general the elasticity of the muscles. The the weakness of the muscles. The elasticity of the blood vessels that maintain the erections like there’s a lot of. Aspects that go into an underactive pelvic floor and the reason why they have Ed um from an overactive standpoint patients that have too much activity in their pelvic floor. It’s um, the best way that I can give anyone to explain this phenomenon is.

Dean Pohlman: A.

Dr. Lance Frank: What I call the clenched fist analogy and I I kind of want you to do this with me Dean so just take your fist and like squeeze it as hard as you can just like squeeze squeeze squeeze the hell out of it and then now let go and take a look at your palm. Usually you’ll see some like this influx this flush of blood going back into your palm.

Dean Pohlman: A.

Dr. Lance Frank: If you walk around your day-to-day life with a clenched fist in your pelvic floor. It’s going to be really hard to get blood into that part of your body. The blood vessels are so C clamped off because of the muscles are so tense down there that people just have a really difficult time even getting blood into the penis.

Dean Pohlman: On.

Dean Pohlman: Here.

Dr. Lance Frank: Let alone maintaining it in there and so if people are are walking around with an overactive pelvic floor for whatever reason you know, stress surgery a fall sometimes falls can impact the the function or the pelvic floor. Um.

Dean Pohlman: Ah.

Dr. Lance Frank: From an overactive standpoint it. It Ed can also be a symptom of that and said the way that I treat it is completely different based on how people walk in the door and it’s really the only way that I can. Differentiate what category people fall into is by doing a pelvic exam and usually that entails an internal pelvic exam because the strength aspect of it and what I mean by that is if if somebody’s coming into my office and I’m evaluating them and them doing their pelvic floor exam. I’m inserting a gloved finger into the rectum and all I’m having them do is a pelvic floor contraction I’m I’m telling them. Okay, now do what you think to be a kegel or do what you think that it is to do a kegel you know make your penis jump make your penis shorter try to hold in a fart all of those cues are to engage.

Dean Pohlman: Um.

Dean Pohlman: Here.

Dr. Lance Frank: The pelvic floor and the only way that I can tell what category people fall into is how well they’re able to recruit the muscles to squeeze around my finger if it’s like a flicker of a contraction. You know in therapy we grade ah strength on a 0 to 5 scale with pluses and minuses I always kind of say that 0 is like 0 out of 5 as you’re you’re dead. Everything’s flaccid completely just there’s no tone at all.

Dean Pohlman: Ah.

Dean Pohlman: Yes.

Dr. Lance Frank: Ah, 5 out of 5 is like you’re squeezing the hell out of my finger and not only squeezing it. You’re pulling up and it pulling it up inside on a 0 to 5 scale. What if I’m evaluating somebody and checking their strength but however strong their contraction is and it’s all subjective to right? So like my scale. Even though it’s pretty standard 0 to 5 my subjective qualitative scale might be a little different than your subjective qualitative scale and so inter relate inter. Um inter rate or reliability is. You know the difference in in measurements between 2 people and how they measure things you know my my scale might be a little different than yours. But regardless when I’m evaluating somebody. That’s really the only I don’t want to say the only true method.

Dean Pohlman: And.

Dr. Lance Frank: Categorizing somebody. But that’s how I categorize them is with that internal exam to check their strength. Um I forget why we were talking about Ed and incontinence and categories and but.

Dean Pohlman: You said a bunch of helpful stuff I don’t know how we got here. But but that’s so that’s okay, we’re here. Um, so you know I mean that that that that kind of train of thought you just went on to me that that leads to the question can people.

Dr. Lance Frank: Ah, but we’re here.

Dean Pohlman: You know to what extent can people assess themselves or are there other you know how can people kind of I mean I don’t I don’t I’m not telling you to go home and stick your finger in your butt right now but like what are what are things that people can do to.

Dr. Lance Frank: The.

Dean Pohlman: You know are there are there things that men can do to kind of kind of assess.

Dr. Lance Frank: The I would say the first. The first thing the most helpful thing that page that people could probably do is. This diaphragmatic breath work that we were just talking about like if you’ve already got a ah very detailed blog about and ah and videos and resources for it. What I would encourage people to do is in the privacy of your own home. You know strip down to your birthday suit work on this breathing and.

Dean Pohlman: Okay.

Dr. Lance Frank: Place you know 2 fingers underneath your testicles and just feel what your body’s doing down there if you take a breath in and you can feel the tissue kind of plump up into your fingers. Well then your pelvic floor is likely relaxing and doing what it’s supposed to if if patients.

Dean Pohlman: Um.

Dr. Lance Frank: Or if people are doing a ah diaphragmatic breath and they can feel the pelvic floor kind of squeeze and pull up and in if it feels like it’s tightening or retreating away from their fingers while they’re likely contracting and they’re doing the opposite of what it should be doing which to me.

Dean Pohlman: If.

Dr. Lance Frank: Is a hallmark sign that it’s a little it might be a little too overactive and so that that movement of the pelvic floor is really the indicator of of which side of the spectrum people fall on and I wish. Ah, there was an easy way for me to say to give you and your listeners of how to assess themselves and I guess another way would be thinking of just subjective symptoms. You know, do patients. Do they have pain. Do they have. We haven’t even really talked about the full scope of pelvic floor dysfunction and like what that really means but there are symptoms associated with it that sometimes people don’t even know our symptoms that they just like can assume are normal like 1 of the.

Dean Pohlman: M.

Dr. Lance Frank: Most obvious well not most obvious that’s a incorrect wording the the people. It’s a symptom that people a lot of people have that they don’t even know that it’s a problem. Is something called post void dribbling. That’s a super common in men where you know we go to the bathroom we stand at the toilet we put our penis away. We walk to the sink and a few more drops come out or more than a few drops come out. That’s something called post void dribbling you know unless it’s like a drop or 2 anything more than that. It can be an indicator of pelvic floor dysfunction and usually it’s an overactive pelvic floor and this is actually one of the reasons why I got into pelvic floor therapy because this was a big problem for me I was just finished going through my last year pt school and 1 of the most stressful times of my life that last semester. And I developed this problem this pete post boy dribbling problem where I would go I would take a piss I’d walk away and like it was like a tablespoon of more urine that would come out like to the point towards the end of the semester when I was like the most stressed I’ve ever been in my life. Would go to the bathroom and and I’d walk out of the bathroom and like pee would have soaked. Not only my underwear but my outerwear too like I couldn’t wear Khaki pants anymore because it was just like so embarrassing and so.

Dean Pohlman: Oh Wow did you ah did you intuitively create that connection between your stress and the physical issue or did it did you.

Dr. Lance Frank: I didn’t at the time once I started going through all this training I was like well no shit I had all of these pelvic floor issues because you know I I have never been that stressed in my life. But um, but yeah, so like. I’m just going to run down the roster of some of the most common symptoms that patients come in with and kind of put them into Categories. So.

Dean Pohlman: Um, yeah, if you could tell us which ones are again most people listening 5060 s so like or even 40 s 50 60 seventy s so you could keep that in mind as you’re going through the roster I think that’d be helpful for everybody listening.

Dr. Lance Frank: Yeah I’ll start with an underactive pelvic floor. Um the most common ones that we’ve already talked about incontinence or um, whether that’s fecal incontinence or urinary incontinence. Um erectile dysfunction. And not just like it’s difficult to get and get an erection but also it’s difficult to get and maintain an erection most common or most evident for underactive is the ability to maintain or yeah, the ability to maintain an erection um delayed ejaculation. Somebody that you know just has a really hard time getting to the point of an orgasm. Usually there’s some form of hypo hypo tenicity or underactivity happening because they’re pvic floors not strong enough to get them to that Threshold. Um.

Dean Pohlman: Ah.

Dean Pohlman: Oh.

Dr. Lance Frank: Let’s see um in terms of we haven’t really talked about much like bowel dysfunction but but on bunch the um.

Dean Pohlman: No, we haven’t even gotten to that Shitty territory yet sorry had to do it.

Dr. Lance Frank: I would say the inability to hold back gas people don’t think that that’s a and it’s not like a problem per se but I have a lot of patients that are like if there’s gas down there. There’s no stop in it like it’s going to come out and that can be really embarrassing for people and so that is sometimes. I would consider a sign of an an underactive pelvic floor. Um.

Dean Pohlman: I Find that working at home I have very um lack I have very very undeveloped stopping your fart muscles because I just typically find myself environments where I don’t have to regulate.

Dr. Lance Frank: Ah I mean but there’s a difference between allowing it to happen and not allowing or not. You know if you’re actually you know like no one’s around I’m just going to like push one out real quick.

Dean Pohlman: Yeah.

Dr. Lance Frank: Completely different than like walking out in ah the grocery store and just like inadvertently letting one rip and you’re like holy shit how did that where’d that come from? um though I would say those are probably the biggest like underactive.

Dean Pohlman: Ah, yeah.

Dean Pohlman: A.

Dr. Lance Frank: Symptoms if I had to rank them you know E D and then incontinence and then delayed ejaculation and then we would put you know flatulence issues with in there with that too. Um.

Dean Pohlman: And are those is there a gender not a generalization but is there a correlation between under you know under and I forgot what term use but under under activation and and.

Dr. Lance Frank: Undering.

Dean Pohlman: And the older population or is it. It is okay.

Dr. Lance Frank: Yeah, yeah, usually usually the older population swings more towards the underactive pelvic floor unless you’ve like and this is I’ve had patients like this and less patients are seventy seventy five that are avid cyclists or that are. You know marathoners or people that you know outside of the typical demographic usually as patients age they tend to fall into the more of the underactive camp of patients the younger more active you know.

Dean Pohlman: Um.

Dr. Lance Frank: Patients tend to fall more into the overactive category. Um, and with I know I heard you say that you wanted me to kind of keep the listener base and demographic in mind. Um, but just to make sure that I’m covering the full spectrum.

Dean Pohlman: And.

Dean Pohlman: Oh.

Dr. Lance Frank: Overactive pelvic floor patients. It’s you know urgency urinary urgency urinary frequency um pain with urination waking up in the middle of the night more than when we’re talking about bladder norms. You shouldn’t be waking up at all in the middle of the night. But if you do like 1 is acceptable any more than one like that’s something’s happening there that should probably be looked at um.

Dean Pohlman: Yeah I think just to address this question. Specifically I think there is especially among the people that I that I email and interact with through the manful Yoga Community I think there is a big conception and I would like to say misconception. That getting older just means oh these are issues that I now deal with because I’m older and a lot of people and they they kind of just accept it. It’s kind of like oh I’m in my sixty s so like now I wake up when I now I wake up at night to Pe. You’re like oh I’m in my Mm fifty s Now. So and and I kind of hear that I’m like well well no, that’s that’s just that’s that. Just because you’re in your sixty s doesn’t mean you should be waking up 3 times per night to go pee that that that’s ah.

Dr. Lance Frank: 1 of my one of my favorite I didn’t coin this but 1 of my favorite like taglines if you will is common does not equal normal.

Dean Pohlman: And.

Dr. Lance Frank: Common does not mean it’s normal just because something is common and a lot of people experience. It does not mean on a physiological level that it’s normal. It shouldn’t be happening and that what you just described waking up 3 4 or 5 times a night to go to the bathroom is common as we age but that doesn’t mean that it’s normal and so.

Dean Pohlman: A.

Dr. Lance Frank: That is something absolutely something that Pelvic Pt can help with I mean movement in general but you’re doing great work with manflow yoga. But there are a lot of commonalities that are not normal that can be addressed on a therapeutic level.

Dean Pohlman: Like.

Dean Pohlman: Here.

Dr. Lance Frank: Um, people just a lot of people just don’t know about it and that’s the the shitty thing ah a lot of people don’t know that pelvic floor therapy is a thing what part of the reason why I started my Tiktok page was to just get more awareness that men’s health and men’s pelvic floor therapy like there are people out there that treat these things that can help. Um.

Dean Pohlman: Um.

Dean Pohlman: Um, yeah.

Dr. Lance Frank: But just to continue going down the roster hope. So go ahead.

Dean Pohlman: So so and and for all of these things is is pelvic core strengthening the answer like for it’s not so what we just discussed you know, um, waking up at night to to pee or to urinate what is the what’s the answer to to help with that.

Dr. Lance Frank: No, no, no no.

Dr. Lance Frank: I mean usually outside of lifestyle changes. You know limiting fluid intake 2 hours before bedtime limiting limiting any kind of bladder irritant um patients.

Dean Pohlman: A.

Dean Pohlman: Ah.

Dr. Lance Frank: A lot of times have an ah ah impaired connection to their pelvic floor meaning that and that mind body awareness and people live in this overactive state and so kind of the same thing. It’s same principle different different kind of physiology of. What happens but that threshold of the of getting to an ejaculation or orgasm our bladder also has fill levels that send signals to the brain that tell us you know there’s something in here. We have to pee. There’s like 4 different fill levels and.

Dean Pohlman: Um.

Dr. Lance Frank: We’t We don’t know that it’s happening. These are just subconscious cues that are being sent to our brain that are like hey you know you should probably start paying attention. You should probably go to the bathroom soon. But when somebody lives in their day to day life with an overactive pelvic floor.

Dean Pohlman: Oh.

Dr. Lance Frank: Then like the nerve endings the little spidey senses in the bladder are hypersensitive and so they’re sending signals to the brain way before they should and so a lot of times patients will say you know I go to the bathroom and then I’ll lay back down and then five 10 15 20 minutes later I’ll get another feeling of an eating to go to the bathroom or you know even an hour 2 hours later they’ll wake up and it’s like they’ll go to the bathroom and a half a cup of year and will come out and it’s like well what the hell this shouldn’t have like woken me up from a deep sleep when I just went to the bathroom like.

Dean Pohlman: Are.

Dr. Lance Frank: My bladder wasn’t even full and a lot of times like it says just all of that tension going into the pelvic floor creates an upregulated nervous system and if people are already upregulated from stress or you know, anxiety or depression. Everything.

Dean Pohlman: A.

Dean Pohlman: In.

Dr. Lance Frank: Everything is just kind of ah this is ah kind of an extreme analogy but like I always say like your house is on fire like the signals are everything is like sounding alarms all over the place like your nervous system is just so excited right now and not in a good way and so.

Dean Pohlman: Um.

Dr. Lance Frank: Being able to get patients to quiet their nervous system to put out the fire through different whether that’s movement whether that’s breathing whether that’s meditation mindfulness like there’ll a lot of ways to turn the dial down on somebody’s nervous system but generally.

Dean Pohlman: A.

Dean Pohlman: Um.

Dr. Lance Frank: For what I do. It’s learning how to relax your pelvic floor getting flexibility into the pelvis and in the hips and getting you moving like I want to get you moving in a productive therapeutic way.

Dean Pohlman: Um.

Dean Pohlman: So what are the exercise. What are that you mentioned you know prescribing basically yoga poses. What are the what are let’s let’s just say like 5 poses you recommend to people to help a relaxing pelvic floor.

Dr. Lance Frank: I Don’t know what it’s the yoga name for it I call it a deep squat but a supported deep squat I think it’s like okay, good and it’s a supported deep squat. Um I have people up against a wall.

Dean Pohlman: Oh I don’t I don’t speak sanskrit. We didn’t grow up speaking sanskrit in my house. So like I don’t I don’t know without it. Yeah okay, cool.

Dr. Lance Frank: Down if their knees allow will allow for it I’ll have patients where they can use a yoga block under their butt or they can just use the wall to be fully supported but ah, a fully supported deep squat. Um where their hips are below their knees like people aren’t doing wall sets I’m not making them work their quads I want them.

Dean Pohlman: Yeah, yeah.

Dean Pohlman: Um, yeah, right? Okay, got it and just just for people listening because I know a lot of guys would not have the the knees.

Dr. Lance Frank: You know ass to the grass knees spread trying to get a stretch into the pelvis that’s by and that’s my favorite pelvic floor stretch exercise.

Dean Pohlman: Um, or the hip mobility to be able to even do that passively. So um, you can recreate that lane on your back right? up against the wall with your feet pressing into the wall and you can recreate that movement and it might even be more relaxed. So.

Dr. Lance Frank: I Ah my preferred modification which that one’s great and I’m not trying to like step on anybody’s toes I Love that one as well. If people. There are a thousand ways to modify exercises If people can’t do the supported deep squat. My next favorite modification is somebody on their hands and knees doing like a frog or like a child’s pose. Those those are just using somebody’s body weight combined with gravity is going to help open things up much more than somebody laying on their back like I’ll give happy baby like somebody laying on their back.

Dean Pohlman: Oh yeah.

Dr. Lance Frank: If people are like you know, being in that that child’s post position or that frog position just still really hurts my knees Well then then my next go to is happy baby like having somebody on their back with their with their legs up on the wall or just holding their knees. Um, my next favorite one is pigeon.

Dean Pohlman: Um, yeah.

Dr. Lance Frank: But rather than having people do it on the ground I’ll have people do a standing pigeon with one leg kind of elevated on their bed or their couch or some kind of surface because it just helps to open up all of the deep deep hip rotators.

Dean Pohlman: Um, yeah.

Dr. Lance Frank: A lot more in my opinion a lot more than somebody being on the ground if they can’t if people either don’t have a surface at home that they can’t get their leg up that high um usually people have like a bathroom vanity or a kitchen counter or something that’s like about hip hype. But if they don’t um. The the the floor Pigeon pose is completely fine as well and and does what I want it to as well. Um, really, ah.

Dean Pohlman: That’s a good That’s a that’s a good list of poses far as I’m concerned you you don’t have to force more if there’s oh okay.

Dr. Lance Frank: Well I was going to say I I have like 6 that I prescribe on a regular basis for people but they’re not necessarily. That’s why I was like kind of they’re not really yoga poses I guess you could ok, but.

Dean Pohlman: That’s I don’t care if their yoga poses specifically if they’re great stretches great like you know we do tons of non-y yoga poses and manful yoga. So.

Dr. Lance Frank: Yeah there’s like I said I try to target the main muscle groups in the lower body and the hips with every patient that I get every overactive patient that I get and so like a kneeling aductor stretch where you’re on 1 knee 1 knees tucked underneath you and 1 leg is extended out to the side. That’s one of my favorite stretches. Um a kneeling hamstring stretch or even a a seated hamstring stretch with one leg kind of extended out in front of you and kind of betting over and touching the the the toes um a hip flex or stretch just being you know.

Dean Pohlman: A.

Dr. Lance Frank: Tall kneeling one knee down I like to add in a little bit of an overhead reach to get some of the lateral abdominal wall muscles people with testicular pain. This is a great one for one knee one knee down one knee up just kind of reaching up towards the ceiling and doing a little bend.

Dean Pohlman: Um, yeah.

Dr. Lance Frank: To try to get all of the front of the pelvis and the the lateral abdominal wall to stretch. Um gosh I like to do there’s a there’s a thousand different names for it I call it Ninety ninety just sitting on the ground with one one knee in front.

Dean Pohlman: That’s that’s what I’m doing right now.

Dr. Lance Frank: Yeah, Ninety ninety s one of my favorites that just yeah, um, depending on what people have going on I’ll have them do kind of ah a static position like you’re doing or a dynamic position where they’re kind of windshield wipering their knees from side to side really helps to open up the hips those are probably I would say my top 5

Dean Pohlman: Yep.

Dean Pohlman: Got it I mean but the overall goal with all of these. It’s all hip openings I mean that’s basically what it is.

Dr. Lance Frank: Prescribed exercises that I give people literally opening up the hips people we live in a society where we sit all day long and the hip flexers get tight. The glutes get shut off you know the abductors and hamstrings get really tight and so all I’m really trying to do is just open up the hips.

Dean Pohlman: Um, for sure, got it. So I want to I want to I don’t want to spend too much more time on on this this portion. But what other what other common issues have we not already mentioned.

Dr. Lance Frank: Get people to open up their pelvis.

Dean Pohlman: If we could mention them and maybe succinctly because I do want to ask other questions too. Okay, yeah.

Dr. Lance Frank: Yeah, well we haven’t talked a lot about bowel dysfunction and so I do think that it’s important to kind of talk about some of those diagnoses So constipation can be a function of of pelvic floor dysfunction. Um hemorrhoids fissures ah tears in the rectal canal.

Dean Pohlman: Are.

Dr. Lance Frank: Um, can be ah of a function of pelvic floor dysfunction any sort of oops.

Dean Pohlman: Are Those are those things that can be um, are those things that that can be helped with I I Always assume that was that was genetic. Um, which now thinking back on my overall approach to everything health and wellness genetics is not like the sole thing. So I’m wondering. Yeah, So what? what. What does help with um, um, with fissers and and those things.

Dr. Lance Frank: Fissures Just like if I think of hemorrhoids and fissures in the same. They’re not the same thing but I put them in the same category and generally it’s when patients have.

Dean Pohlman: Um.

Dr. Lance Frank: Too much tension in their pelvic floor. The anal sphincter is elastic. It has the ability to you know, just like every muscle it has the ability to expand and extend. But if somebody is getting chronic hemorrhoids or chronic fissures. Generally they’ve lost the elasticity of their anal sphincter. A lot of times is because people are clenching So Tightly they are walking around with an overactive pelvic floor and so patients don’t know how to relax their pelvic floor have you seen those and I know I’m sure you know what? I’m talking about but those little when I was a kid they had these little little balls that you would squeeze and they’re filled with you know water and you would squeeze it and were like.

Dean Pohlman: Um.

Dean Pohlman: Yeah, yeah.

Dr. Lance Frank: Kind of pocket out another like balloon or whatever. Um, anyways, that same kind of thinking is what happens whenever we get a hemorrhoid. There’s blood vessels and anal sphincter and whenever we’re constantly squeezing and then we’re bearing down and pushing to try to push something out. You know, a lot of.

Dean Pohlman: Okay.

Dr. Lance Frank: Couple of different things are happening. Not only is there tension in a anal sphincter trying to and you’re pushing on top of that to get poop out that is going to create a hemorrhoid if you are constantly living in a clenched pelvic floor state. You don’t know how to relax your pelvic floor and say you are.

Dean Pohlman: Are.

Dr. Lance Frank: You have a bowel movement that’s larger than normal if the pelvic floor is clenched and you’re in something that is bigger than your sphincter is coming out of it. A lot of people will tear and that’s where fissures come from or you know if you’re somebody who engages in anal sex If you’re being penetrated and.

Dean Pohlman: Um.

Dean Pohlman: A.

Dr. Lance Frank: You have a large object going up there sometimes that creates some fissures. Um, then in terms of constipation. There’s a condition called disynergic defecation. Basically people with the pelvic floor is supposed to relax whenever we defecate. But.

Dean Pohlman: Um.

Dr. Lance Frank: People will reflexively contract whenever they’re trying to defecate and so it creates this functional constipation where they they’re doing that their pelvic floor is doing the opposite of what it should.

Dean Pohlman: So.

Dean Pohlman: So so my kind of question here is is this is this is a solution for this is it just training your body to relax. It’s It’s like the same thing we’ve been discussing. It’s getting it’s it’s the breathing. It’s the stretching. It’s the um.

Dr. Lance Frank: All it sounds it sounds way too simplistic because a lot of times. It’s not as simple, a lot of like that’s why I have ah the job and a business because ah I see people on a weekly regular basis. A lot of what I do is just dampening down.

Dean Pohlman: A.

Dr. Lance Frank: People’s nervous systems helping them to quiet their nervous system and to get their body to relax. Um it it sounds easier than or it it. It’s not that simple that what I’m trying to say that’s the solution but it’s not that simple and if.

Dean Pohlman: So.

Dean Pohlman: Got it? yeah.

Dr. Lance Frank: The best thing for people to start that Journey is to just get their bodies moving in a and a healthy way and which is why I Love what you’re doing because it’s it’s it like I said it’s a perfect marriage of what I do and what what I want people to do.

Dean Pohlman: Okay.

Dean Pohlman: That’s awesome cool. That’s great information. Um, and by the way just teasing this but Lance and I have been discussing the potential of of doing a program together. So if you think that’s a good idea, please email me and let me know message me.

Dr. Lance Frank: Since interesting.

Dean Pohlman: However, you you message people. Um and I hope it’s something that we can do because I know that there is I think it’d be awesome and I think there’s definitely a need for it. Um, so anyways, um, are there any other problems like you know.

Dr. Lance Frank: I would be super stoked for it I think that would be a great idea.

Dean Pohlman: Um, know there’s more problems but are there and ah, any other really big ones that we haven’t mentioned yet.

Dr. Lance Frank: There’s a condition called hard Flaccidt out there that medically is not really recognized because it’s more of a phenomenon than a medical issue. But it’s this feeling of always having an erection even though you’re flaccid hence the name hard Flaccidt like your penis feels hard.

Dean Pohlman: Yeah.

Dean Pohlman: That’s weird.

Dr. Lance Frank: But you’re flaccid and it is really uncomfortable for people and it creates this. Um, this hypersensitivity people will um, a lot of times. There’s pain associated with it. Um, that’s a pretty common one that I see in the clinic There’s also a condition called pay Roney’s disease which this one is kind of genetic. It’s not really, ah, a behavioral or a lifestyle condition. This is something where you get a little calcified plaques in the shaft of your penis and it creates a curvature. Um. And ah, almost in ah, an excessive or an extreme curvature I have a guy right now who has like a ninety degree curvature up towards the ceiling like the last like inch two inches of his penis like curves up towards the ceiling or towards the head. Um, but yeah that those.

Dean Pohlman: Well.

Dr. Lance Frank: Plaques impair the penises. Um the tissue of the penis to become they cause it to become less elastic and so it hardens and becomes a little fibrotic and so when that when patients get an erection. The penis will curve upwards. Um, there’s a kind of too obscure I Want to say Obscure. That’s the wrong word, but some of the less common but interesting diagnoses that I see as well.

Dean Pohlman: Yeah, so I and I I did also want to ask about? um I did want to ask about kind of the the shame aspect of this and the you know what aside from this being a a medical issue.

Dean Pohlman: In your opinion or your experience being in the field. What to what extent is to what extent is shame an issue with this and men not seeking treatment because it is you know something to do with sexual function or it it could be something that. You know is associated with I’m getting older and I don’t want to admit this or they’re they’re they’re they’re young and they don’t want to admit it because they’re they’re they’re young and they shouldn’t have these They don’t think they should have these issues So I’m just curious. You know in your experience. What are what are these factors at play.

Dr. Lance Frank: Now. Yeah, now there’s ah, there’s a huge a huge shame aspect to what I do and what I treat and the patients that come in. Um, you know there are some patients that are like I don’t I don’t care who helps me I Just want to get better and so they’re motivated. They just I want this to be gone. That’s. Not was very unlikely um that I get a patient like that a lot of times patients will put this off for weeks months years before they get it looked at because they’re just like you know it’s Annoying. It’s bad but I don’t. I Don’t want to have to do the thing I don’t want to have to admit it I don’t want to have to put in the work because it would mean actually having to ask for help and by asking help some people you know, realize that once they voice it onto the universe then it actually becomes like a real problem.

Dean Pohlman: Oh.

Dr. Lance Frank: And so you know when we’re talking about Ed You know if all the doctors are saying you know your hormone levels are fine. Your blood work looks Fine. We don’t know why you can’t get an erection a lot of guys want want an answer and so I work very closely with sex therapists. Ah, mental health therapists that specialize in and sexual health and intimacy and um, you know I Always tell people like I feel like I’m pretty and I want to say confident but competent and what I do and what I treat I didn’t go to school for the head stuff I went to school for the physical stuff and so.

Dean Pohlman: Um.

Dr. Lance Frank: I partner with a lot of sex therapists here in Atlanta to help with that sign of psychosocial aspect the stress the anxiety associated with their symptoms and so whatever people are coming in for if I sense that there is a lot of shame if there is a lot of embarrassment if there is a lot of anxiety.

Dean Pohlman: So.

Dr. Lance Frank: Performance anxiety surrounding their issues I almost or trauma it’s astonishing even even as men how high you know I don’t want to say sexual assault is.

Dean Pohlman: Or or trauma past trauma right.

Dr. Lance Frank: Super common in men but in my guys that have pelvic floor dysfunction. There are a lot of times is a past history of some sort of trauma um sexual trauma and trauma in general you know death any kind of loss.

Dean Pohlman: Um.

Dr. Lance Frank: Can impact somebody’s mental health which can impact their their sexual health. Um, right, it’s It’s super super common and so shame trauma loss anxiety like I.

Dean Pohlman: Um, yeah I was I was I meant sexual trauma. But yeah.

Dr. Lance Frank: While I I have ah a cohort of sex therapists in the city that I that I work with um, you know? Ah I have to have a pretty a pretty full cup to do what I do I Always tell my patients like we’re going to become best friends by the end of this because I’m going to be asking a lot of very intimate detailed questions about you. And while I understand that this is a very vulnerable place for you to be.. It’s information that I need to know in order to best treat you and so I always kind of say like yes I’m a physical therapist but I’m ah, a lower case PCapitalT most days and so um.

Dean Pohlman: And.

Dr. Lance Frank: There’s ah, there’s a huge just there’s and there’s a big emotional piece to what I do in creating space for people to be vulnerable in here. Um, but if people need more than what I can provide just in their 1 hour session I usually tell them to to partner with a sex therapist that.

Dean Pohlman: Yeah, yeah.

Dr. Lance Frank: But I work with.

Dean Pohlman: Yeah, well this leads into a whole and other list of questions that I will probably need to ask you at some other time but but but really to get into the you know things that I’m thinking of like to what extent do guys even know this is an issue like what are they coming in and thinking like I didn’t even know that was a thing um and and know just.

Dr. Lance Frank: Since.

Dean Pohlman: Making that adding that to the the general conversation of men’s health because you know men’s health men’s health is um, you know yes prostate awareness it is um um I’m just trying to think about like my my Movember campaign you know and and what there and there’s definitely a push now for mental.

Dr. Lance Frank: Right.

Dean Pohlman: Wellness for men. Um and and suicide prevention. Um, in particular and you know men’s suicide rates being what 5 times higher than women. Um and and so there is a big push for mental wellness now. But I’m you know wondering? Um, hopefully these these other issues start to make it to the forefront. But we’ll have to do that another time. Um, and now I’m going to transition to my my part 2 rapid firere. Not so rapid fire questions. Um, and you know I’ve you know we we spoke on the we spoke on the phone before this and I kind of got to know you a little bit. Um and you know it sounds like you are you had.

Dr. Lance Frank: Perfect.

Dean Pohlman: Ah, you know you you, you’re in a lot of ways you’re you’re a traditional physical therapist with a focused on pelvic four health but you also started this Tiktok to you know to educate people and it blew up and now you’re you know balancing you know.

Dr. Lance Frank: Just.

Dean Pohlman: You know how am I you know so I guess I just wanted to mention that um in in a sense to kind of prime where you might be coming with where you might be coming from with with your answers to these to these questions. Um, so first question is what do you think is one habit. And belief for a mindset that has helped you the most in terms of your overall happiness.

Dr. Lance Frank: Oh gosh. Um.

Dean Pohlman: It can be anything. It doesn’t have to be like the most effective it could just be mm yeah.

Dr. Lance Frank: Listening Well I was gonna say listening listening to myself like there’s a lot of there are a lot of people that I love and respect that I look to them for answers.

Dean Pohlman: Are.

Dr. Lance Frank: Whenever I and I’m I’m trying to figure out what is the next best move to take but a lot of times like I already know what I want to do I Just need to listen to myself and actually do it and sometimes I I take I listen to too much advice from people when it comes to my own happiness like what’s.

Dean Pohlman: Um.

Dean Pohlman: Um.

Dr. Lance Frank: And just want like a lot of times I work with my own mental health therapist and I always say I kind of joke with him I’m like I just I need you to be my like fairy godfather and be like just tell me what the right answer is and he’s like no like you got it, You got to figure that out for yourself. So I would say just there’s listening listening to myself is has really been consistently.

Dean Pohlman: I Hope yeah.

Dean Pohlman: Yeah, and toquereify listening to yourself in terms of actions you take. Okay, what’s 1 thing that you do for your health that you think is overlooked or undervalued by other people.

Dr. Lance Frank: What has made me the happiest.

Dr. Lance Frank: Actions that I take yes.

Dr. Lance Frank: I Spend a lot of time with myself just like.

Dean Pohlman: That’s so weird. Dude I was just thinking about that like I was literally asking myself the question my head thinking solitude and you answered it weird.

Dr. Lance Frank: Yeah, yeah I spend a lot of time with myself and I I am am naturally an extrovert I like being around people I like giving my energy to people I thrive in in community like situations and settings. But.

Dean Pohlman: A.

Dr. Lance Frank: I Also deeply deeply cherish the times that I have by myself like I am intentional about building in alone time throughout my week just so that I have that time to recharge I mean.

Dean Pohlman: Are.

Dean Pohlman: What’s that look like for you.

Dr. Lance Frank: My clinic is right next door to the park and I think I even took a phone call with you our last my last call I was in the park and going to the park when it’s a beautiful day outside is one of my favorite things just I have ah um, a hammock that I’ll set up between 2 trees and like that is my like I love that I live for that just setting up.

Dean Pohlman: Um, yeah.

Dean Pohlman: And.

Dean Pohlman: Um.

Dr. Lance Frank: Just chilling and my hammock is relaxing is my my my me time.

Dean Pohlman: Nice. Okay, yeah, it’s a great way to do it? Um, what is what is the the most important activity you regularly do for your overall stress management.

Dr. Lance Frank: Oh gosh if I don’t go to the gym I can be a real asshole I’m I’m not a real asshole I’m I’m I’m nice but I go a little crazy in my brain like the gym.

Dean Pohlman: Like.

Dr. Lance Frank: Lifting heavy things and putting them back down again quickly is my form of cardio and like that the gym. The yeah, the gym is my um is my safe space. That’s where I go to just like let it all out.

Dean Pohlman: That counts far as I’m concerned.

Dean Pohlman: Um, nice um I can sympathize with that. Ah, what’s what’s the most stressful part of your day-to-day life.

Dr. Lance Frank: Oh gosh I I love I Love my job but probably running my clinic managing patient care and also running the business at the same time is there I have I have an administrative assistant that helps me. But.

Dean Pohlman: M.

Dr. Lance Frank: She can only do so much when it when it comes to you know, direct patient care and so um, managing a full caseload while running and growing a business is definitely the hardest stressful part of my day.

Dean Pohlman: A.

Dean Pohlman: Um, what do you think is the biggest challenge facing men and their well-being.

Dr. Lance Frank: Toxic Masculinity The idea of what a man is supposed to be and what they can and what they are and are not allowed to be and do you know Vulnerability is really hard for a lot of guys and shame.

Dean Pohlman: Um.

Dean Pohlman: Ah.

Dr. Lance Frank: Really hard for people to deal with men to deal with and so I would say this the toxic masculinity world that we live in this paternalistic world is is probably the hardest part.

Dean Pohlman: He. And. Got it to me. It sounds like your use of the use of toxic masculinity here refers to not just like it being imposed on you but also just the effect that it’s. Purveyance in general society has on your internal you know guidance of how you think and behave.

Dr. Lance Frank: Yeah I I mean I live my life I’m you know, openly proudly out and gay and a lot of my case load a lot of my patients are also somewhere. On the lgbt q you know alphabet spectrum and I you know in building my business I was very intentional about building it around these 2 identities of being gay and also being a man because of what we just talked about of.

Dean Pohlman: Ah, a.

Dean Pohlman: Um.

Dr. Lance Frank: Being difficult for men to be vulnerable and experience shame and deal with these very sensitive issues as a man I fully understand that and so I wanted to grow my brand and my business and be able to talk and speak to any man. Anybody that identifies as a man but also anybody that identifies as gay because this just outwardly and world that we live in there are a lot of nuances and a lot of a lot of ways. In which men are told how they’re supposed to act and what they’re supposed to do and how they’re supposed to behave and it it can really affect. People’s mental health whenever you don’t fall into that you don’t fit into that mold or you do something different that goes against that ideology and so.

Dean Pohlman: Ah.

Dean Pohlman: Yeah.

Dean Pohlman: Um.

Dr. Lance Frank: Um, when I say toxic toxic masculinity. It comes from those 2 viewpoints.

Dean Pohlman: Yeah, that like the man is supposed to behave this way and if you are not behaving this way then you’re wrong. Yeah, and that’s that’s you know that’s regardless of where you are in the sexual spectrum.

Dr. Lance Frank: Um, right? Yeah yeah.

Dean Pohlman: That is like right? That’s like I think that’s the we get that variation of that answer a lot um in the sense of yeah, like there’s there’s so many things telling us how to behave and what to do that. We are neglecting or we are deliberately hurting our. Mental emotional physical. Well-being because we’re listening to them instead of like doing what we feel is aligned with ourselves. So um, cool all right? Well um, Lance thanks for.

Dr. Lance Frank: Right.

Dean Pohlman: Joining me today. Um, by the way you guys should all go follow Lance on Instagram and Tiktok. It’s it’s laance in your pants right? Okay and it is. It is very accurate. So um, that makes sense.

Dr. Lance Frank: Yes, yes, it is Tiktok and Instagram landning your bands. That’s my that’s my user name.

Dean Pohlman: And yeah, um, hopefully um, manful yoga lances in your pants pelvic floor health program coming coming soon. So stay tuned on that. Um it is something that I want to that I want to do and I think it’d be really cool. So um. Yeah I think this is really great I’ve got I got a lot of my own personal questions answered um I think there’s even more if you listen to this and you didn’t get 1 of your questions answered um I would love an excuse to have lance back on the podcast. So um, send me those questions if you’re listening and you’re like hey I had a question about this. Um and what’s ah’s what’s ah.

Dr. Lance Frank: Ah, for sure.

Dean Pohlman: Let’s get it answered so um, yeah, thanks again for joining me today and um I will yeah I’ll look forward to to working more with you in the future. All right. Thanks guys for tuning in I’ll see you guys on the next episode of the better man podcast.

Dr. Lance Frank: Thanks for having me perfect. Look forward to it.

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