94. Support and Bracing for Hypermobile Joints with Susan Chalela, MPT, and Guest Cohost, Scott Borjeson

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Linda Bluestein, MD (00:04.364)

Before I introduce your guest today, I would like to introduce my guest co-host for this episode, Scott Borgeson, who has 30 years of international medical device and management experience in both Europe and North America. He has been with Bendy Body's founding sponsor, Bauerfeind USA, for the past 13 years in multiple capacities and is currently an executive vice president. Scott, it's so great to see you and have you co-hosting today.

Scott (00:31.063)

Hey, thank you for the invitation, Dr. Bluestein I'm delighted to be here together with you and Susan. You know, at Bauerfeind we feel your work is so important and valuable in terms of increasing awareness and understanding of hypermobility syndrome disorders and EDS. This benefits patients and family members as well as clinicians, so great to be here.

Linda Bluestein, MD (00:55.04)

Wonderful, and thank you so much for the kind words, and I love our partnership. And you all are in for a really big treat. Today's guest is physical therapist, Susan Chalela, owner of Chalela Physical Therapy Institute for EDS and CCI , upper cervical instabilities. She is a neurological physical therapist specialist who primarily treats patients with central nervous system compromise due to cervical instability.

She is a founding member of the EDS Center of Excellence at the MUC. I just made a mistake.

Susan Chalela (01:30.701)

Thank you.

Linda Bluestein, MD (01:34.168)

She is a founding member of the EDS Center of Excellence at the Medical University of South Carolina. She is developing and teaching her successful Finding Functional Foundations approach as a continuing education series through the EDS ECHO program. She is currently a PhD student at MUSC and regularly lectures internationally and nationally. She is co-author of the recent International Collaboration Consensus Recommendations

for conservative care of cervical instability, which we discussed in a previous episode, number 66 with Dr. Leslie Russek Susan, hello and welcome to Bendy Bodies.

Susan Chalela (02:11.982)

Hi, nice to meet you and thank you for having me on your show.

Linda Bluestein, MD (02:16.448)

We are thrilled to have you. Okay, so I'm gonna start with some questions. Susan, can you tell us how you got interested in working with patients with joint hypermobility?

Susan Chalela (02:28.963)

So number one, I live with hypermobile EDS. And I think all the way back to my childhood, dislocations and subluxations that just randomly happened, didn't really understand or know what they were at the time.

you know, just kneeling on my knees, playing with Barbies when I was little and I'd go to get up and my kneecap was subluxated and it would lock out and I couldn't get up, but I didn't understand why, but I couldn't move and everybody ran away. And then if I sat there long enough, my muscles would relax and it'd pop back in and I'd get up, run into the house and tell my mom and she's like, you look fine, continue on. So yeah, that's happened a few times. And, you know, just further injuries with sports and subluxations in my shoulder.

hips and then in college I had a just I was rowing crew in college and after a race you have to carry your boat and I was in an eight woman crew boat and the boat is heavy even with eight women carrying it and after the race I fatigued and I just insidiously dislocated my shoulder and it stayed out for over an hour. And so

you know, when it eventually popped back in because they dropped the stretcher with me on it and it went back in, it was fine and I didn't want to go to the hospital. And, you know, but while it was that, I mean, it was horrifically, you know, debilitating and painful and, you know, what is this? And why is this happening to me and nobody else? And this is in my undergrad.

So my interest continues on, you know, my interest in undergrad really was in sports medicine and trying to understand why this is all happening and why really I was different. So I got interested in biomechanics just in general, but in sports and not looking at the everyday life situation, which again, as I...

Susan Chalela (04:27.306)

As I understood more as a physical therapist, I realized that bringing everything back to the basic and the biomechanics of just sitting the right way, standing the right way, walking the right way, even sleeping supported the right way is super important to protect our joints, you know, in the longevity factor. So that is what I teach now. That's kind of how things came about. Again, I look back to my childhood and all that.

rare like rashes and hives and things that happened to me that nobody could explain, but they didn't want to really call it allergies or treat it. And I just lived with it, eczema, things like that. You know, all those random things. And in PT school, there was two sentences in our differential diagnosis class, and that was it. So there's my diagnosis. So I ran back to my doctors and...

And my primary care physician said, I know what's wrong with me. It's called this. And of course I got the, what is that? So I gave up kind of using that. And again, so because that, in this journey of becoming interested in this, the medical world didn't seem to understand it. And so as I was getting help, I was being dismissed, dismissed more so because they didn't know what it was and didn't understand what it was.

So my journey proceeded in realizing that I really had to try and figure this out within my profession and my scope of practice, but also educate medical providers outside of that so that we can share this education so as they're seeing more patients that present this way or they hear these things subjectively that they're able to say, oh, I've heard this before at least. So

Yeah, and then I progressed into kind of after my undergrad into working in a physical therapy clinic and heavy industry and workers comp and kind of the wellness side of getting a injured worker back to work. And even there, I recognized a lot of, I learned a lot about functional training and how to now back up and look at the way somebody lives and carries and pushes and pulls, the way they sit, the way they stand.

Linda Bluestein, MD (06:41.42)

Mm-hmm.

Susan Chalela (06:49.83)

And so yeah, my interests just have progressed all along. After that, I had a stroke about three years out of physical therapy school and I was doing heavy industry work. And there I was in rehab for about two years, paralyzed on my right side, lost my speech, lost my immediate memory, seizure disorder. So.

Linda Bluestein, MD (07:01.517)

Mm-hmm.

Linda Bluestein, MD (07:11.253)

Wow.

Susan Chalela (07:12.522)

Yeah, so even there, I think that's where my neurological interest came in was in my rehab and recovery of, I have to do everything really fast, and I'm just going to fix this, and I'm going to train it, and I'm just going to jump right back in. And when the neurological system is affected, that doesn't happen. That is where

Linda Bluestein, MD (07:32.042)

Mm-hmm.

Susan Chalela (07:34.15)

It's so slow. There's so much frustration. Depression sits in, you know, kind of sets in and it becomes pretty horrific. And even at that point, I laid in bed and as depressed as I was, I had no other options than going up or either laying in my existing, you know, bed and doing nothing about it because I was going to give up or

Linda Bluestein, MD (07:39.284)

Mm-hmm.

Susan Chalela (07:59.334)

work really, really hard every day. And I might not show much progress, but keep, you know, keep working towards, you know, my, the healing of my, my neurological system, but also, how can I say it, educate my neurological system in a way and get my neurons to fire. So when you have a stroke, part of your brain, the area that's affected dies. And so it becomes non-viable tissue.

So those different areas of the brain also, that viable tissue also has a function to it. So it controls a function. And when you lose that, you lose that function initially, but the brain, because it's plastic and we only use a small part of our brain in our lifetime that we can just by...

forcing something and practicing through repetition and really thinking through things. It's called neuroplasticity We can fire more neurons and we can start to develop, you know that other area of the brain Just by firing those neurons and really thinking through the function that you want to be able to do and you'll it's still slow-going But but you do start to form those other Circuits if you want to call that, you know those you know, just

improve those circuits and it is different. It's not innate, but again, the neurological system is fascinating, especially from the CNS. So that's where my neurological interest came in. And then living in South Carolina, you know, there's a lot of industry here, but nobody really wanted to do anything preventative. And when I returned kind of back to work, I went back into ergonomics in the DC area.

And I loved it, it was great. And I always worked in a clinic part-time. And when I got down here, really my option was to go outpatient again. And so I was always wanting more. Then I started seeing these patients come into the clinic that had this instability in the cervical region. Now, mind you, this was probably eight years after our smartphones took off. So smartphones, the iPhones, the inner ergonomist by background.

Linda Bluestein, MD (10:13.932)

Mmm.

Susan Chalela (10:17.974)

the looking down at cell phones. So now you're looking down. The cervical curve is supposed to go the other way where it balances the head over your shoulders, over your body. But now that we're looking down all the time and now that these kids younger and younger have cell phones in their hands and they're looking down as they develop, their curve is developing reverse. So think of an older person, you know, a much older person who has a forward head posture.

This is happening now at younger years. And when this kind of came about, this whole phenomenon, I said, this is gonna be a, you know, start to cause problems. And so sure enough, ergonomically, you know, I started seeing this forward head posture with our developing children and teens. And then I started seeing these neurological effects of these patients that have

If you listen to them, the subjective history and objective, just hearing them and knowing their history and looking at them, this hypermobility status. And so then probably around 2015, 14 and 15, I started seeing more of these patients because one of the neurosurgeons in our area also at the same time was taking an interest in this, unbeknownst to me.

And, you know, I said to myself, what is this? And that's kind of the beginning of the adventure, you know, that I took on to trying to learn about this and better understand this. So that's where I am now.

Linda Bluestein, MD (11:56.032)

Yeah, and I want to touch on what you were just saying about the loss of the cervical lordosis So I'm gonna turn my head to the side for a second Well, actually that my camera is gonna do something funny, but so you're talking about normally it would go Let's see. I'm trying to figure out the right way to Normally it would go like this and then it gets straight, right? so when that I feel like around here, I've had a lot of people that are Being encouraged to do curve correction training

Have you seen people do that? And I'm just curious, a little side tangent before we get onto the next thing, what your thoughts are about curve correction training.

Susan Chalela (12:36.706)

So the curve correction training that I am aware of is mostly chiropractic, osteopathic, and it's more the roles that they put under their neck or the curve enhancement devices that are supposed to increase their curves. The problem is when you're dealing with a connective tissue disorder or and or an instability,

Linda Bluestein, MD (12:43.739)

Mm-hmm

Susan Chalela (13:06.526)

and you're increasing the curve or you're forcing the curve, you're stretching out other ligaments, but you're not getting the ligaments that are damaged to in any way, you know, tighten up when you're doing that. So it also causes almost a traction when you're enforcing the curve, it's almost a traction to lengthen the neck, which a lot of my patients, you know, and the history, my clinical

Linda Bluestein, MD (13:19.576)

Mm-hmm.

Susan Chalela (13:36.898)

Kind of what I'm seeing clinically is it fires their neurological system more in my brain. So I'm hearing that from their symptoms that they're complaining of, but I'm also thinking through the saying, all I see is more stretch of more ligaments and traction and stretching and compressing more than neurological systems. So I didn't see how that was going to help.

And so I left it to the patients that would go through these, you know, and try these other, they've already tried it and they've come to me. And so I would be hearing that same thing time and time again, that it didn't help, it actually made their symptoms worse. So in my situation, I learned to, not because of that, but because of that, not force anything with these patients. It's about being able to.

find position proprioceptively and being in your personal neutral and understanding what that feels like because your body is a balanced system. The muscle system is a balanced system. It's a push-pull system. So if you're pushing one way, you're moving that way. If you're pulling the other way, you're going the opposite way. So there's got to be that middle. There's got to be that balance.

And so when you have that balance, that's your neutral. That's where in your spine, at the level of your spine, your discs should all be of equal disc pressure. Your ligaments should all be soft, but not on stretch and not compressed. Your passive structures are all protected when you're in that so-called neutral. It's not the natural posture of just standing there because when you're hypermobile, we all hang on ligaments.

but it's about engaging muscles and finding proprioceptively from the ground up, that balance of your musculature, understanding it starting from the ground up. And the best way to kind of start is lying down on your back where you get more proprioceptive feedback in finding that neutral. So.

Linda Bluestein, MD (15:42.124)

And that's a perfect lead-in to my next question, which whether we're dealing with cervical instability or instability somewhere else in the body when you're working with people. I was going to ask you what you find most effective and you and you started with the with this concept of the ground up and I know you've developed to this approach that we talked about in the in the bio. So we'll get into that in a second.

Linda Bluestein, MD (16:11.932)

might be not super beneficial, but people might be exposed to in a more regular routine type of physical therapy practice.

Susan Chalela (16:23.626)

Yes, so what we're kind of hearing from our patients and we always hear the same thing is traditional physical therapy. So when we graduate physical therapy school, we have a box of interventions for different diagnostic issues. And we never really learned about hypermobility when I was in school, so.

So again, we just took our box of cervical tricks, whether it be soft tissue, whether it be head laser training, whether it be dry needle, any soft tissue work, cupping, things like that. Strengthening, isometric strengthening, deep neck flexors. So everybody thinks that deep neck flexors, hey, put the patient on their back and have them do chin tucks and that will give them a nice, sorry.

a nice isometric contraction. The problem is when you're doing a chin tuck, you're actually working out of neutral. You're taking neutral out and you're straightening the spine. So if there's an instability going on, you're gonna compress and stretch and aggravate those levels where the instability are. You're gonna aggravate the nervous system. So traditionally the chin tucks, I mean, chin tucks is an OA shearing force. So somebody with an instability is going to the...

irritated by that. Somebody with mild hypermobility or hypermobility who is not symptomatic, they may get away with it just fine. And normal, you know, the normal population get away with it without being symptomatic. But if there's an instability and underlying instability there, you're going to hear about it. If not right at that moment, you're going to hear about it later when they come in next. So yes, that's a problem. Traction. So even Manuloc traction, mobilizations were so...

Linda Bluestein, MD (18:08.587)

now.

Susan Chalela (18:17.162)

as PT is so trained to put our hands on people. I went to a Manuloc therapy school. So getting in there and really feeling around what feels different and what feels out of place. The problem when there's an instability is you're mobilizing things that, you're mobilizing that instability. Again, that can irritate the neurovascular system. So, so.

Again, it's about doing no harm to these patients. So I recommend if you hear or suspect that there's an instability, especially if you're not used to treating it, just to lay hands off of that area, you can work above and below it where it's more stable, like the upper traps, which are always up in the ears within an unstable patient. So get those upper traps to stand down, you know? Because when you're getting those upper traps to stand down,

you're taking up the slack of the soft tissue to better balance the pumpkin on the stick, okay? But if the ears, cold, tired, and stressed are here, where's the head going? Forward, and everything's compressed. So, you know, this is where it fires my instability and my hands go numb and tingly and everything if I'm too cold for too long or too stressed. But it is about where you are in space and being in alignment and not firing.

that, you know, in aggravating the nervous system in that respect. Isometric exercises, you know, you can put your hand on your head and you can push all day long. But if you're not in neutral alignment or proper alignment or in proper balanced system and you have an instability, it's a dysfunctional alignment drives dysfunctional movement. So all you're doing is aggravating more. If you don't understand what your alignment should be.

So yeah, I mean, in physical therapy, we do all these neck exercises. They even have patients like I've heard, they lay on their back over a treatment table with their head off and they're holding their head up. So they're actually promoting that forward head posture even more and they're firing even more the anterior area or the front area of the neck, just to again, make the front of the neck stronger. Well, it's always short and it's always looking down. It's always looking forward at computers.

Susan Chalela (20:36.414)

So you want to strengthen and encourage the posterior chain to do its balanced job to the anterior chain. So that's where we should be working in physical therapy as opposed to kind of pulling out the old bag of tricks that we were taught. But this is kind of a new phenomenon that needs to be very carefully taught.

Linda Bluestein, MD (21:02.068)

And how do we do that then?

Susan Chalela (21:06.683)

Well, I'll tell you what, it's not easy. I have to say the history is Dr. Patel used to see all these patients that would come from all over and they'd come in town and they'd say, go see Susan and we'd squeeze them into the schedule and they would say, Dr. Patel told me you would give me neck exercises before I leave. Well, these patients, if they don't understand what alignment is, you're giving them exercises that actually in turn will cause more damage. So it's a...

process, you have to start at everyday normal functioning, the basic of functioning, your basic of functioning, you sleep, you sit, most people stand and walk, not everybody, not all of my patients, some of them are bed bound. So even if they're getting up during the day to go to the bathroom and going back to bed, they're still standing and walking involved. So if they're doing that stuff, we have to make sure that they understand how to do it correctly so that they're protecting.

their nervous system. Because again, you've got a 12 pound pumpkin on a toothpick. And if there's an instability up there, you know, that pumpkin is just kind of all over the place. So you've got to get stability from the ground up. So that's where you work. I mean, you work on alignment, you work on these basic functional things that are so important. Because if you can't get those...

you're not going to, everything else is gonna be dysfunctional past that. And remember, it's all about quality of life. So I can have a very severe patient, so their doctor will come back and say, their neurosurgeon say, this is a severe case and you need to be fused sooner than later, blah, blah. Yes, I get it. But then I have patients like that are working. But then I have patients that say, yeah, he says I just have mild instability and I just need to do PT.

But what happens there is then they're in a severe irritable state where they're laying in bed and doing nothing. And then when they go to PT, they're getting all the wrong things. So it's keeping them irritated. And it's not, you know, they're not getting out of that very irritable state. So it is about, you know, doing the right thing. And it's not a quick fix. It is a lifestyle lifetime change that you're learning from the ground up, learning alignment, then learning proper.

Susan Chalela (23:28.258)

proper movement, proper dynamic function. So like I said, it's a process and it took me a very long time to figure this out using my industrial brain background and using my neurological background and listening to my patient and feeling proprioceptively like what I'm teaching, am I using the right cues? So, you know, PT is gonna be taught this and you know, again, Dr. Russek I...

I cannot thank her enough. She has pulled, she's the, what can I call her? The herder of all information, and she puts it into an amazing workable format so that I am able to teach this to my colleagues. So that's my goal, is to get my profession to open their minds to understanding this, learn about it, and understand what they can do for these patients, because when you look at, as a PT at your bag of tricks,

Linda Bluestein, MD (24:04.098)

Mm-hmm.

Susan Chalela (24:24.458)

and everything that you do to that patient is irritating them, as a PT you feel like I'm failing them or they're not trying hard enough, right? So it's gonna go one way or the other. It's gonna be very either dismissive, gaslighting, or you just don't know what else to do and you throw your arms up in the air and you're like, I don't know what to do for you, but everything I do is making you worse so I can't see you anymore. And I wanna change that. I want to change that because over the last seven plus years

what Beth and I are teaching our patients are giving them tools for a lifetime to help protect them. It's about managing. We can't fix, but we can manage these irritability states and manage the amount of damage and progression that's happening with hypermobility and living with hypermobility and worse, an instability or unstable joints. So it's complicated, but it can be done.

Linda Bluestein, MD (25:24.14)

Sure. And so is that what you were describing just now? Is that your finding functional foundations approach? Is that what you were just okay? Can you elaborate on that how that works? And especially I think a lot of patients are going to hear this and they're going to think, well, I've had this happen. I've been to physical therapy and it did make things worse. So what can I do? Because maybe I don't know of another physical therapist to try and I want to maybe

Susan Chalela (25:33.139)

1. Yes.

Linda Bluestein, MD (25:52.34)

try to access this information for myself.

Susan Chalela (25:55.402)

Yes, so on the EDS Society, so we're in, we just started, we just finished the first third of our course. It's a 13-week long course, but it's actually nine two-hour sessions, and we go three weeks on, two weeks off. And the two weeks off is so that the clinicians can learn to use in the clinic to use these skills that we are teaching them and to see how they work. So all along,

They're supposed to be applying that to their patients. And this isn't only specifically for hypermobile patients or EDS patients. All of these tools are functional tools. So they help every patient. You can have an Olympic athlete and you can improve their performance and their biomechanics of what they do through this. It's called a neuroplasticity, proprioceptive biofeedback methodology. So we actually use biofeedback.

And then we use that through proprioception to improve neuroplasticity of the brain. So think of it as thinking and doing, thinking and doing. And the more that you think and you do, so you think about the right way to do something because we've taught it to you. So we've given you a methodological approach, for instance, how to sit right or how to stand right.

your patient is going to go through that. Now, every time when they leave the clinic, they catch themselves out of alignment, they put themselves in alignment because these old habits are old habits that are not healthy habits. And so what we're doing is we're creating that, we're teaching them and creating new healthy habits so that again, every time they kind of catch themselves, they are correcting, they are correcting. So you tell patients too, you know, it's about cross training.

So you don't have to sit perfect in that perfect gold standard alignment that we teach you. You can, you know, I can sit here and lean with my head here, but I'm not in any extreme stretch or movement. I'm just kind of mid-range relaxing a little bit. So I stay here a few minutes, and then I go back and I correct into healthy alignment. And I hold that for a period of time. But my brain should be over time, more sensitive to the fact that...

Susan Chalela (28:15.19)

The longer I spend in these poor habits, the more chance or risk that I'm taking to do insidious damage to my passive structures, ligaments, joints, discs, nervous system, just anything within there. So it's about frustrating, it's about moving, spending more time in the more healthy habits, but then.

not staying there for too long because the two things that break down hypermobile or people with instabilities or hypermobile EDS patients is prolonged postures and repetitive movement. They're going to catch you every time. So don't do them. Don't go into prolonged postures. So if you have to sit through a two hour class, so you can shift weight, come back to center and shift the other way, go back to center. Okay. I'm tired of sitting. Stand up, make sure you have the accommodations, you know, if you're in school or work.

Linda Bluestein, MD (28:49.758)

Mm-hmm.

Susan Chalela (29:09.09)

have accommodations to be able to sit to stand desk or to be able to stand up in class. You can march in place. There are lots of things that you can do to move in and out of things. So going from sitting the right way, standing the right way, marching in place or shifting weight the right way. And then you can even, there's room for error there that is not terrible and not bad. But again, it's about getting through that day without

using all of your spoons or burning down the house because what I had to do today was sit in a class for eight hours and I sat for eight hours. So it's about being smart about changing things up and using the basic functions that you have in the situation that you're in at that point in time. So we teach that. We teach our patients to be very sensitive to not push through. These patients are also used to pushing through their fatigue and pushing through pain and.

and pushing themselves into these poor postures because guess what? Fetal position feels so good for everybody and especially for us. But fetal position for us is so much more than a normal person. So yes, it does jeopardize and stretch our nervous system even more. So then we find ourselves in maybe a tethered cord or a heightened nervous system.

symptom that is just sits there for a while because we laid in that fetal position for the whole day because we weren't feeling good, right? Because we had a cold or whatever. But again, it's just knowing what to do. Same thing with being on the computer. It's the ergonomics of sitting in the car, being in your computer situation, whether you're a student with a laptop all the way to somebody who works 10 hours a day or 12 hours a day in a desk situation.

Like what do we do here? How do we survive? How do we get through that because we have to do it or we can't work, right? So it's about accommodating so that we can sustain in a healthy manner through function.

Susan Chalela (31:15.97)

Did that answer that kind of thing?

Linda Bluestein, MD (31:16.056)

Okay. Yeah, yeah. And I'm gonna say the word mistake right here because I want to make sure that I that I mark this spot. I'm not sure, I don't think it's me, but somebody's, I'm hearing occasional dings of someone's either email or something.

Susan Chalela (31:31.987)

It's not an email notifications. How do I turn that off on my computer? Do you know?

Linda Bluestein, MD (31:38.628)

Um, I know mine's connected. So when I hit my notifications, so while you're looking for that, and if you can't find it, it's not the end of the world. It's not like it's happening that often, but it would be nice not to have the ding. Um, I was going to try to come up with a transition type question to get us from this topic into bracing and then Scott's going to ask you the bracing questions.

Susan Chalela (31:39.938)

Hold on.

Susan Chalela (31:53.042)

I mean, that was doing it.

Susan Chalela (32:05.43)

Okay, hold on a second. I'm gonna go to my settings and see if I can turn off notifications. And hopefully that'll turn off all notifications. All notifications. This thing is locked. It's not locked.

Susan Chalela (32:24.538)

Let me just turn this off and see if this makes a difference.

Susan Chalela (32:31.658)

Hopefully that'll work. Okay.

Linda Bluestein, MD (32:35.659)

Okay.

Susan Chalela (32:37.07)

Let's see.

Linda Bluestein, MD (32:39.084)

So it makes sense that people should be working on alignment and moving. I've heard some physical therapists say to me, because I also have hypermobile EDS, that's also how I got into what I'm doing now. It's a common theme, of course, that we hear a lot, that it's important to move better before we move more, and to really be thinking about, like you said, the correct posture, whether you're sleeping, sitting, walking, whatever.

I have found for me personally and for my patients that oftentimes using bracing as a way to help support joints and get that better alignment can be really, really helpful. So I definitely want to make sure that we talk about that as well. Is that something that you have observed with your patients?

Susan Chalela (33:29.47)

Yes, so bracing and supports is very, very important. So yeah, I was talking more about the exercise and the alignment side and all of that, but we have a whole section where we look at bracing and supports. And we're also looking at that along the way as patients move through their plan of care here. So as you're looking at, as you're teaching the patient proper alignment, let's just say, let's say,

proper walking, okay? And the patient is telling you that their foot doesn't feel right, even when they correct this alignment. So what's their other option? Compensating, right? So a compensation, if you think of it as a therapist, it's a bad habit. You're creating another bad habit to create, to replace the bad habit that you have. So our goal is, especially with hypermobility, hypermobility is moving parts. So the dysfunction can move from here to here, you know? It can go from one area to the other area.

So when you hear that the patient is struggling in proper alignment, you have to kind of figure out why. Well, what the problem typically is with somebody that's hypermobile is the fact that we're not controlling the motion. The feet and ankle have a, so if you start there, there's a lot of moving parts when you look at feet and ankle. There's a lot of ligaments in play. There's a lot of joints in play. And then we have an arch that collapses every time we wait there.

And so we tend to be guilty of that collapsing arch phenomenon. So when you watch people walk, and I'm being a therapist, it's terrible, my eye just goes right to it, I'm watching people's ankles on every step of wayfaring, their arch collapses in and that medial malleolus, the medial ankle bone, slides and glides in, slides and glides in every time they walk. And you can see in their shoe, if they don't have a good, rigid, stable shoe,

you're just watching the shoe collapse in with that, right? So that is uncontrolled motion. So they're going, they may heel strike okay, and then dysfunction, or they may not heel strike okay, and go right into a dysfunction. And that's not okay, because that dysfunction, again, starts at the ground and makes you dysfunctional all the way up to the head. So we wanna try and control that amount of movement that we're seeing all the way from the foundation. So again, you know,

Linda Bluestein, MD (35:24.062)

Yeah.

Susan Chalela (35:49.322)

if they're in the right shoe wear for the right level of activity with the right type of support in the shoe, then look and see how they do. If they come in flip-flops one day, just make sure the next time they come in their sneakers that they would wear if they were on their feet all day. And see what they have, evaluate, teach them what they need. But again, when they're in that shoe and you're teaching them the proper biomechanics of walking,

Linda Bluestein, MD (36:00.184)

Thanks for watching!

Susan Chalela (36:14.878)

If you're still hearing that there's an issue, well, I can't do that, this hurts too bad. And you're gonna hear this. And you're gonna say, okay, well, we need to look at this to evaluate to see what more is going on. So sometimes if you, and we have, you know, a lot of our supports embracing here that we can try with our patients, we will try that. We will go ahead and support. You can even use kinesiotape, but you can try and support and give a little bit more control to those bones biomechanically.

and see if that decreases their symptoms. So we'll pull out, you know, less is more. So we'll try a support first, see what they look like in my eyes from behind. Are they still collapsing? Are we getting more control? Maybe they just need better shoe wear. If they're in good shoe wear now, and now we can try supports, maybe a sport, you know, ankle support, where it's a figure eight, almost like sport taping.

and you're now kind of giving a little more support to that foot and ankle. How are they doing there? Oh, that feels good. Oh no, it still doesn't feel right. That's uncomfortable. It just, it's so painful. So then we can go to one more rigid brace. So then we can try a more rigid brace. Is that controlling the motion? What do they look like in that brace, you know, with their shoe wear and kind of go from there. But the goal is to be able to control the motion. And if you get the motion control,

and you get that patient to be able to perform dynamic movement correctly, okay, that's a win. If not, and the patient's still struggling, and they're in this rigid brace, and rigid braces are not, they're not as comfortable, they just aren't because they're more rigid, then you may have to consult out for a follow-up, a foot and ankle guy who understands hypermobility and EDS, I would hope.

and just do a consult and see what things look like radiographically, you know, or being evaluated by that specialist. But yeah, I always try my supports and bracing first just because of the amount of movement that's going on. So yeah, I start there and then you know, the pelvis, especially in sitting is another primary foundation when you're sitting. So it does matter where the pelvis is because the pelvis sets the tone in the alignment for neutral posture.

Susan Chalela (38:37.502)

So you got two pelvic halves Can I actually, it probably wouldn't be good. Hold on a second. It would be good for me to actually go to my charts, would it? Like I teach telehealth.

Linda Bluestein, MD (38:48.181)

When you say, I'm going to say the word mistake, so we remember just to take this out. So when you say go to your charts, like obviously we don't want any HIPAA. Oh, those charts?

Susan Chalela (38:50.341)

Thank you.

Susan Chalela (38:58.18)

parts.

Would that throw you off though if I, for instance, did something? Or why don't I bring the chart over here? Can we do that?

Linda Bluestein, MD (39:05.076)

No, I love visuals.

Linda Bluestein, MD (39:11.072)

Yeah, no, now that we have episodes on YouTube also, it's great to have visuals. So yeah, if you can bring.

Susan Chalela (39:18.738)

And I don't know, you can kind of cut in case to the foot and ankle so they can see. I'll just show you the chart and maybe you can just put it in there for a snapshot. But feet and ankle, ligament bone-wide.

Linda Bluestein, MD (39:31.944)

So I'm gonna, we're gonna start again, like I want you to kind of, I'll be quiet, but while we're kind of like, this part's gonna be cut out, right? So I'm gonna ask Scott, after Susan starts, after Susan shows this, if you wanna take the next questions. Okay.

Susan Chalela (39:37.582)

Okay, go through belly.

Scott (39:50.667)

Yeah, sure. Go ahead.

Susan Chalela (39:54.142)

Perfect. So here's your feet and ankles. There are a lot of moving parts, a lot of bones, a lot of ligaments. You see that arch. So every time they step down, because of the hypermobility, the arch is collapsing and you're getting a lot of movement going on in those bones, more so with some people than others. So you wanna be able to control that movement with your shoe wear, your supports, your bracing, okay?

No mistake. Let's stop a second. Now I'll come back in and let me do pelvis.

Susan Chalela (40:28.322)

Okay, so the pelvis is also another place that is a foundation. It's the foundation for sitting, the primary foundation. So you can see here that the pelvis has two halves. So you have a sacroiliac joint here. So here's your sacrum and you have two parts of your pelvis that are joined together here the pubic symphysis and they're connected to your hip bones and your lumbar spine. Okay, so

Hypermobile people tend to have a lot of low back pain at times and a lot of it is the pelvis shifting up and down. Okay, so these are movable joints. There's less movement here, although with a hypermobile person or an EDS person, you may get a little more movement here, which is not fun. A little more movement in the tailbone as well. So

What works really well here on the support side is the Sacro Lock that Bauerfeind has, and I call it the Cadillac of all SI joints, joint belts. And so it's really nice because it goes around the two pelvic halves and it approximates the two pelvic halves into the sacrum. So it actually controls the amount of movement that's going on in these two joints and gives you more like...

know, just support in general, more control so that you can do a little bit more. You can sit a little longer, stand a little longer walk, you can even sleep if you're a side sleeper, you know, a lot of times our pelvis, pelvis shifts and as a woman during hormones, our monthly cycle when we get that swing of relaxation and the ligaments when we're side sleeping

That's where we wake up in a lot of pain or we go to lay down in a lot of pain. Wearing your Sacro lock because it is a support, it is not a rigid brace. Supports are not going to weaken your muscles. They're only gonna, they're gonna support your joints and support your muscles. So it's a good time to wear the Sacro lock, during that time. So again, that's a nice support for the foundation of the spine and the pelvis and supports everything going up the chain.

Susan Chalela (42:47.974)

And then of course there's more rigid bracing for the spine. You know, if the patient's really having a hard time, you know, with fatigue, back discomfort, TL junction issues, you know, and they have to be up because of their job or because of school, you know, using one of the more rigid products like the Lumboloc ES, you can even go to something, you know, more consistency, but that might be enough to kind of get that patient through.

what they need to do for their daily function. Okay. Want me to talk about neck braces at all? Mistake, let's just put that in there. Do you want me to move up to the neck or?

Linda Bluestein, MD (43:32.036)

I mean, I think that would be helpful. Is that okay, Scott? Okay, I'm gonna say the word a little bit louder, mistake, just in case the software didn't pick it up. Yeah, and we'll let you put those back.

Susan Chalela (43:34.518)

Yeah.

Scott (43:35.043)

Yeah, absolutely, absolutely.

Susan Chalela (43:55.09)

Okay. So then as you move up to the shoulders and the neck and the head, there's shoulder supports. Mostly we just find shoulder supports that help out and kind of help approximate the ball into the socket a little more. So I do use the Omotrain. I also use something that they don't make anymore. And it's called a posture stabilizer. There are...

posture shirts through AlliMed, that we will recommend for our patients. Again, because they're supports, not rigid braces. So they're just, they're not going to weaken the muscles. They're just gonna facilitate the positional sense of proper alignment. So they're really nice to have, but again, compression can get annoying. So it's not about being in it all day long and pushing through because that will cause a discomfort. So it's about taking it off and putting it on when needed.

and using it during the times that you absolutely need it. And then when we get to the neck, we have soft collars and then we have hard collars So the soft collar would be, you know, used more just to, it's soft. It's not gonna hold the head up. You can still move in it. It's there to just remind you that it's gonna limit your range of motion so that maybe range of motion might be more irritable in general, you know, for you as a patient.

just by wearing a soft collar, which is more comfortable. That soft collar will just remind you not to, you know, move through that full range of motion during the day, you know, when you're doing things functionally. You can sleep in it too, if that's, you know, comfortable and it's reminding you not to end up in these really poor postures when you're sleeping. The hard collars now are a rigid brace. It's an exoskeleton.

can't really move in it much at all. It's there to protect. It's there to let your muscles rest and recover. So I like to use rigid bracing for my cervical instability patients so that when they have the symptom of feeling like a bobble head or any type of symptoms that come on neck, head, neurological.

Susan Chalela (46:11.022)

Pop that rigid brace on, make sure that brace fits you, make sure it's the right one for you, because everybody has different length necks and thicknesses and things like that. And I'll talk a little bit about that in a minute. But again, I use it in the sense of having my patients wear it for about 10 to 15 minutes when these symptoms of fatigue come on or mild symptoms, pop it on right then. Don't wait until the symptoms get worse and worse, but let those muscles rest and recover.

your muscles are your backup stability for your ligaments and your ligaments are faulty, they're not doing their job. So your muscles need to be able to do their job. And when muscles fatigue, they turn off and then you're hanging on ligaments again and you're just fatigued and you start to become a mess symptomatically. So if you wait that long, you're gonna be in a lot of pain. But if you start to pick up on the sense of fatigue, then pop that collar on.

Let your muscles rest and recover for about 10, 15 minutes. And when you pop it off, you're able to function again and go again. Now, as the day goes on, depending on the requirement of what you have going on that day and how irritable you are, you might have to wear it a little longer. But remember that if you put it on and wear it all day long, because you're just having a bad day, just realize that your muscles are checked out. They're not having to engage. And when they're not engaging, they become weaker over time.

So we've got to be careful with that. Sometimes cervical collars are used by certain doctors diagnostically and they like to say, okay, put the hard cervical collar on, wear it for two weeks. Let's see if we can bring down your symptoms and your irritability status. And it might be, by the way, a good, you know, for that physician, that might be a good indicator that you need to be fused. But that's not always, because not everybody tolerates a hard cervical collar.

A lot of people are very sensitive to that, to them. A lot of people will, it'll make them fire their symptoms and make them even worse. So you got to take it on a case to case basis there. In a car, traveling, car and plane, both of those, very good to, you know, benefits outweigh the risks at that point. You know, when you're a passenger in a car, you know, or you're just riding in a plane that.

Susan Chalela (48:31.458)

that humming effect kind of relaxes your muscles. So our head kind of falls into this, you know, slipping and sliding, you know, the different levels of the vertebra kind of slip and slide because we're relaxed. So having that column one is protective. It's also probably a little protective if somebody hits you, may, you know, help out in that sense. So there are, you know, reasons to wear that collar a little longer than not, okay?

The different collars that I typically find work best for my patients. There is a new one coming out So we're playing with that one right now. It's really nice. It's lightweight. It has a lot of adjustments on it So we'll get back to that. Let's got talk more about that. I'm right now I'm using the same clips collar. There's an extended for taller people Larger people and then there's a regular eclipse

The chin section on that is a little rigid. So patients that have TMJ or jaw pain tend to not really like that collar because it's so rigid. But sometimes if they double pathone, they can get away with it. But it's nice because the chin goes down and up. So if you have to look downstairs or you have to look down, you can just let the chin down and look during that period of time. The Aspen Vista is, the Eclipse, the other thing is, is once it's kind of

Linda Bluestein, MD (49:50.706)

Mm.

Susan Chalela (49:59.626)

set for your neck, it's just pop in, pop out. Now the Aspen Vista and the Miami J are all velcroed, so you're velcroing them on, so they're inconsistent with every time you put them on and how they fit, and then you kind of have to play with a little bit, get a good fit. Best to lay down and put the collars on if you're in a place where you can. If you can't, then sit against a wall or something straight to put the collar on from the back first and then the front.

If you have a long neck, short neck, skinny neck, wide neck, like our Down syndrome patients with cervical instability who also have a connective tissue disorder, right? They tend to do better with the Miami J short, you know, small. That's what's going to fit them. Then we have the long thin petite little people. They do, Miami J does also another size for that. Aspen Vista does a thoracic extension.

One that doesn't only, you know, it's just not a brace for the neck, but also to brace the thoracic spine as well. So yeah, depending on the need, there's different braces out there, but they're the typical ones that we use for now.

Scott (51:15.423)

Hey, Susan, thank you for sharing your experience. That's a wealth of experience. And I'm curious to what your recommendations would be for a clinician who is considering starting to dispense DME and bracing out of his practice. I know it's been a journey for you. Would you mind sharing some of the considerations and maybe give a few recommendations in that respect?

Susan Chalela (51:46.15)

As far as carrying the products here in our office and trying them and figuring out what the patient needs, I would love that. And one of the big wins for us, and I haven't talked about yet, is the CoxaTrain. So it's the Sacro lock plus rigid hip hinges, so the metal hinges, and then thigh pads. So it's added stability to the hip joint.

Scott (51:54.135)

Yes, exactly, exactly.

Susan Chalela (52:14.706)

as well as the pelvis. So that's one of my big ones. And so that's where, you know, that's an insurance grade brace. And so when we talk about the braces here, the supports insurance will never pay for it's always cash, you know, the patients have to pay cash for supports. So your Sacro lock your sport ankle supports your wrist, sport wrist supports, I keep all of that in stock because

If my patient comes in and they're fired up, I have something to put on them that day to kind of calm things down. It's not a rigid brace, but it's just to calm them to get them out of the flare. So I keep those here. The more rigid braces, so we are not a DME, but I do have my rep who does all of our pre-fab stuff, so Steve, and so...

I will measure a patient for a brace that then can be processed through him, through actually he goes through a pharmacy as a DME to process the insurance. So really we do the measuring and then when we get the brace in, we put the patient in the brace, we have them do the function in that brace. We want to make sure that it fits correctly. It doesn't always. Sometimes we have to switch out components.

on certain braces and we'll try different things, you know, until we get the fit that we need. Also these braces, the rigid braces, some of those can be adjusted. So we can through heat make some adjustments to make them a little more comfortable. But yeah, so we process that, you know, that order through him and then the brace arrives here for my practice in house. And then like I said, we

put the brace on, we go through the function, we really educate them on how to put the brace on and off correctly, when to wear it, when not wear it, because if you don't educate them in that, they think that they have to live in the brace sometimes, and then that will make them worse over time and more sensitive and irritable. So you really have to look at the function of each patient and what their requirements are, job, school.

Linda Bluestein, MD (54:22.348)

Mm-hmm.

Susan Chalela (54:35.23)

you know, is it a busy mom with little kids? That's super, super important for you to help guide when to wear these braces. More rigid braces are more protective. So if you have a busy mom and they're going to the zoo for the day, you know, tools in the toolbox. So have your tools in the toolbox. That patient may have like, let's talk about the Sacro Loc you know, that just the support around the pelvis.

versus the CoxaTrain that has the added hinges and thigh pads to give more support to the hips, right? So if they're going to the zoo, don't throw it into baby carriage, but put it on, start out with it. It's protective. You can take it off if it's a long day for a few hours, if you're sitting and you're eating or you're resting, take it off. But if you're up and walking a lot, put it on.

So yeah, and then if you're, you know, the next day you're home and you're not doing much, but you're walking around the house, you don't need that rigid bracing with the hinges and things like that, put your Sacro Loc back on, you know, just use your supports on those days that your, the demands are functionally less. So yeah, it works, you know, that works really, really well for us as far as having Steve and going through.

insurance patients, they will go through him, we measure, we just make sure that everything is what the patient needs, we make sure that it fits, we make sure the adjustments are there, you know, and we're constantly seeing them, these patients are not in and out of the door in four weeks. So, you know, as time goes, we are sometimes having to make some adjustments or looking for either more support or less support depending on the change in their demands of their function.

So yeah, we use a lot of Bauer feind We like the product, it's comfortable. We can make adjustments to it. It's a custom in some ways without custom. Sometimes we do have to go custom. So we do have a brace team that are processes orthotists here. But yeah, I mean, it's.

Susan Chalela (56:45.398)

Been really good. Like I said that the support side we do keep in house and that way we can put out fires before they get really bad. So

Scott (56:56.227)

Great, thank you for sharing. Go ahead, Dr. Bluestein

Susan Chalela (56:57.69)

Thank you.

Linda Bluestein, MD (56:58.981)

I was going to ask before, so are there certain things that if somebody wants to get started and they're thinking, wow, this sounds like a great idea to carry some of these things in the office. But one of the things that's really amazing is the sizing that Bauerfeind has, that they have so many different sizes, which is great, but from the standpoint of like carrying things in stock.

If you're going to carry a size one, two, three, four, five, six, you know, for the wrist or for the knee, of course, there's different levels too for each part of the body. They have so many different products. Are there certain ones that you feel like these are the ones that I most commonly am using and these are the sizes that I'm most commonly using? So if someone was like wanted to pick a handful of, you know, the most common things that you use, do you have suggestions for that?

Susan Chalela (57:48.094)

Absolutely. So let's say the Sacraloc, there's seven sizes. And that's what's so great about this product, because there are seven sizes, and we do have really tiny people, and we do have really big people. So we cover the full gamut here, we are, you know, an EDS clinic. So that's what we see. So we keep all seven sizes in stock.

Linda Bluestein, MD (57:56.446)

Mm-hmm.

Susan Chalela (58:08.106)

But earlier on, kind of before that happened, and I didn't have a lot of money, I just kept the mid-range. I tend to sell mostly threes and then twos and fours. So I kind of kept the mid-range sizes. More threes, few twos, few fours, and maybe a five in there. But because if I have a patient who's a seven and I don't have one in stock and I don't keep one in stock, but I mainly sell it once every two years,

you can order it and then have it shipped directly to the patient. So you just put that order in for your rep and then it is just shipped directly to them. They pay it on that day that you order it for them. You know, and patients don't sometimes want to spend that much money on a Sacro Loc because it's a couple hundred dollars. So they'll buy something else on the Internet. But it's funny how they all come back to me. Most of them, not all, but most of them come back and say.

Oh my gosh, you know, like this isn't as supported as what I thought in your practice. Cause I'll let them try it in here. I'll let them, if they need it and they're going through the viral feedback exercises and their pelvis is shifting and they're flared up that day, we'll put the Sacro Loc on them. Even if they don't have one, we'll put one, you know, it's a good way of also, you know, getting the patient to realize that they are so much better.

It's better with it and it's worth the investment because it's, you know, it's protective in another way, just being supportive and they're able to be successful with their exercises because they're controlling the amount of movement. So yeah, just keeping some of those sizes in stock. As far as the ankle and the wrist supports, they come in extra small, medium, you know, actually the wrists are just extra small, small and medium large. So there's only two sizes and it does cover almost everybody.

Linda Bluestein, MD (59:32.021)

Mm-hmm.

Linda Bluestein, MD (59:57.104)

Oh, really? I thought there was at least one wrist brace that I tried that came like one through six, but obviously Scott's the expert on that.

Susan Chalela (59:58.058)

Yeah, so you just keep a couple of each.

Susan Chalela (01:00:08.402)

Yeah, there are. So they're your Manuloc Yeah, your Rhizoloc your Manuloc locks. So they're your insurance grade braces. And yeah, there's a little more variability there. Scott, what's the one that's just the support? It's the support. That one has a few more sizes in it, I believe. I forget the name of it. Sorry, I'll hand.

Linda Bluestein, MD (01:00:10.429)

Oh, you're talking about a different, yeah.

Scott (01:00:32.419)

Yeah, you may be referring to the Rizolock. The... no?

Susan Chalela (01:00:35.318)

Well, no, I could pull my catalog here and look. But anyway, it's, yeah, but as far as your supports, just putting out little fires in the clinic, yeah, I mean, there's only two sizes in that anyway, and then the ankles are, the sport are extra small, medium, large. And so we don't sell a whole lot on the larger side every once in a while, but we can custom order and have it, they can have it in two days, you know?

Linda Bluestein, MD (01:00:41.631)

So we could...

Susan Chalela (01:01:04.178)

But we try to keep some extra smalls, but mainly smalls is what we use in a few mediums. We could just keep those few sizes in my clinic. And that way if they come in with a sprained ankle or a really irritated ankle, that might provide them enough support to get through, to be able to get through the next few days as they're decreasing their inflammation and getting out of acute stage. So yeah, it's fun. And it's so rewarding to, you know.

Just because they'll tell you, wow, that feels so good. I feel connected again. So.

Scott (01:01:36.767)

No, I think that's a great point, Susan, that you're making, that you actually, you have product in the clinic. Obviously, there is a convenience benefit for the patient to be able to access product there and then. But the other thing is they can just try it because I do think it's very important for patients to try the brace or braces, multiple products before making a final decision.

forward. I think that's a great point.

Susan Chalela (01:02:09.174)

Yeah, because.

We do have samples, I'm sorry, Scott, we do have some samples of the braces, the rigid bracing that's insurance grade here in our office. And that way we can actually try it, even if it's just that middle size, we can at least get a feeling as to do we need to go, you know, then we can measure and get the bigger size or smaller size, but just having the patient see it and maybe try it if it's too small, you hold onto it and kind of finagle it so that it almost fits them just to show them what stability.

it kind of gives them and guess what if it fits you it's even going to fit better and then they're like yeah you know and like I said it is all about protecting their function and making them successful.

Scott (01:02:59.515)

I don't think I have any more questions. I think because, yeah, full disclosure, I misunderstood Dr. Bluestein. So I sent in some questions that I thought I would be responding to. So, yeah, no, but this was great. This was great.

Linda Bluestein, MD (01:03:19.432)

And yeah, I think we can, yeah, thank you for saying that. And then we can ask the, I can ask Susan, if it's okay with you, Scott, I can ask, do we miss any questions or any final thoughts? And then, you know, cause we're at an hour, at about an hour anyway. So this is probably a good length. And so if there's anything Susan that you didn't yet say that you like, oh, darn it, I wanted, yeah.

Scott (01:03:34.54)

Yeah, yeah.

Susan Chalela (01:03:43.734)

I was going to say, how much do you want me to mention about the EDS ECHO program, the Finding Functional Foundations? It is the teaching program, but we just started and it's already like the clinicians were getting great feedback. Of course, we're going to tweak things as we go, but again, it's the...

Linda Bluestein, MD (01:03:52.401)

So.

Susan Chalela (01:04:06.706)

Only thing out there on the neuroplasticity, the neurological side that really helps these patients that are neurologically implicated, you know, gives them a full system to kind of work through. May have to be modified, but I don't know how much you want me to say on this.

Linda Bluestein, MD (01:04:20.416)

Yeah, I think what's hard for patients is, you know, this, well, I should, sorry, I should back up. So the audience for the podcast is everything, you know, patients, you know, family members, physical therapists, doctors, you know, I mean, it's a really wide, wide range. So I think when I ask you this, any questions or do you have any final thoughts, maybe you can mention again about the program.

Susan Chalela (01:04:39.411)

Mm-hmm.

Linda Bluestein, MD (01:04:49.476)

And if you could maybe have specific comments directed towards physical therapists versus for patients. In the future, patients can maybe look for physical therapists that are trained in this, but they can't do that yet other than you who developed it. So I think that would be the only thing that I would suggest.

Susan Chalela (01:05:05.579)

Right.

Susan Chalela (01:05:10.23)

And I didn't mention telehealth because I have such a backlog like Patty does that if I say telehealth and they're like, oh, I can just get on telehealth. So I don't know that I wanna say that. I can mention it if a, as far as like towards physical therapists, if you have a patient that you are, just they're really struggling and you're really struggling, we do have.

Linda Bluestein, MD (01:05:19.436)

Mm-hmm.

Susan Chalela (01:05:36.97)

You can, I can say you can reach out to me, you know, my office and just let me know you've been working with them, but you're at a place where you need a little more assistance and they can get on with me for telehealth, as opposed to me training 3,000 PT's around the world. That happens. I get so many emails and phone calls and they all want me to, and patients, well, I'm gonna do telehealth, but I need you to direct my physical therapist. And I'm like, how many hours do you think I have in the day?

Linda Bluestein, MD (01:06:04.808)

Right, right. Oh yeah, I know, I know. So, so yeah, so I'll, so whatever you want to say about that, I'll ask, you know, if you have final thoughts, and then you can mention that there. I actually have one thing I'm going to say right before I ask about the final thoughts. So, okay, so I'm going to say mistake again, just so I can find either end of this section to cut out, because it can be a bit challenging.

Susan Chalela (01:06:08.346)

Okay.

Linda Bluestein, MD (01:06:30.964)

So before I ask if you have any final thoughts, I wanna first ask that if someone's watching this on YouTube, I'm gonna say mistake, I'm gonna word that slightly differently.

Susan, before I ask if you have any final thoughts, I just wanna ask the audience members who are watching this on YouTube, if you would please hit the like button if you're finding this video helpful so that other people can find it more easily. And Susan, I just wanna know what final thoughts you have that you wanted to add.

Susan Chalela (01:07:00.174)

My final thoughts are for my profession, for physical therapists, there are tools out there. There is education out there. I know my colleagues, Patty Stott and Heather Purdin, sorry, mistake. My colleagues, Patty Stott and Heather Purdin they have MedBridge courses, so shorter courses that you can take, which are phenomenal.

So there's that education that's out there. There's also my Finding Functional Foundations course through the EDS Society ECHO program. We also have the Allied Health ECHO program. There's a number of modules throughout the year that you can join in on. Just get it early enough when you get on EDS Society because that does close out to a certain number of participants.

The Finding Functional Foundations Program, this is the first one, we started it in January. Registration for the next one, I'm not sure when it will be out, but it will be a fall class. And more details to come on that, but that is more on the neuroplasticity proprioceptive biofeedback approach that works well for me and my patients here. So that will also be out.

So yeah, I mean, and then there is, you know, a good, let's see, Dr. Russek, she's got her hypermobility education program, you know, online, and that's a great way to start. It's basic 101, you know? So start there, you know, as PT's, it's geared towards PT's and patients. My program is just geared towards PT's so that you can help patients.

But there is stuff out there. It's coming out. And like I said, I highly recommend the Echo program. And Patty's Stott has a new book that just came out. So look for that on Amazon. And let's see. Yes Taming the Zebra. I was going to say I think we got it right there.

Linda Bluestein, MD (01:09:08.936)

I interviewed her and Heather yesterday.

Susan Chalela (01:09:11.454)

Okay, mine's right out here. It's a phenomenal book. So, so and the book just Disjointed Nancy Block wrote a few chapters with physical therapy, you know, and that's a whole each chapter is here towards a different topic and a different specialist, a specialist in their field has written each one of those chapters. All of that is very, very helpful, but realize that these patients are different. They needed to be

treated different, not like your same orthopedic patients. Many of these patients are orthopedic, absolutely, but you're gonna hear that they're neurologically implicated too, and that's where you have to be careful, and that's where joint alignment is even more important. So you can reach out to my website as well. I do need to update it. It hasn't been in about a year. So I will have more education information also on https://chalelapti.com/

Um, so there you go.

Linda Bluestein, MD (01:10:11.884)

Okay, great. And we always end with hypermobility hacks. So can you share with us a hypermobility hack?

Susan Chalela (01:10:21.974)

Okay, so I have a whole wall called, and my patients named it Susan's songs. And I could walk out there and show it to you. Um, so I guess my hack is a functional foundation promotes functional alignment in turn promotes functional movement. Dysfunctional foundation promotes dysfunctional alignment, which promotes dysfunctional movement. So there's my hack.

Linda Bluestein, MD (01:10:54.432)

Okay. That's very, that's, I might have to type that out too, because that's, I like that. I'm crediting you, of course, of course. So, all right. Well, you have been listening to Bendy Bodies with the hypermobility MD and today your guest was Dr. Susan Chalela and your guest co-host was Scott Borgeson. Susan and Scott, thank you so much for coming on the Bendy Bodies podcast and sharing your knowledge with us.