Why can pain suddenly feel harder to manage in your 40s or 50s - even when scans show nothing new?

Pelvic health physical therapist Dr. Anne Collins Duch joins Holly Osborne and Dr. Megan Steele to explain how hormonal fluctuations during perimenopause and menopause may affect the nervous system, joints, sleep, pelvic health, and pain sensitivity.

The conversation explores menopausal hormone therapy, vaginal estrogen, bone health, chronic UTIs, and why treatment decisions should be based on each person’s risks, symptoms, and goals. You’ll also learn why strength training does not have to mean lifting the heaviest weight possible, and how bodyweight exercises, resistance bands, heel drops, and modified movements can still support muscle and bone health.

Anne and Megan also share practical ways to work with pain rather than pushing through it, including improving sleep, supporting bowel health, adjusting exercise during a flare, and tracking small signs of progress. If menopause has changed how your body feels or responds to movement, this conversation offers a more flexible path forward without asking you to give up the activities you love.

Guest: Anne Collins Duch, PT, DPT

Dr. Anne Collins Duch is a board certified pelvic health physical therapist and an E-RYT 500 hour yoga teacher with 27 years of experience in treating a wide variety of pelvic health conditions. Her Wilmington, Delaware private practice is housed within a vibrant yoga studio where she is able to educate her patients and yoga students on the benefits of establishing a sound movement practice that integrates effective nervous system regulation strategies for a more complete whole body experience.

Dr. Duch has a special interest in the Polyvagal Theory, which led to the development of her virtual course offering, What Happens in Vagus Doesn’t Have to Stay in Vagus: Nervous System Regulation Course. She served as a panelist at the Endometriosis Summit, the Elhers Danlos Global Learning Conference, and the Pelvic Global Menopause Conference and presents to various professional organizations and fellow clinicians about pelvic health topics, as well as the use of vagal toning strategies as part of their health and wellness management.

Physical Therapy for Women

Anne Duch, Instagram

Links to interesting things from this episode:

• “What Happens in Vagus Doesn't Have to Stay in Vagus.”
• “Estrogen Matters” by Avrum Bluming and Carol Tavris
• Dr. Jen Gunter

Why does pain fade for some people but persist for others long after an injury?

Dr. Derrick Sueki joins Holly and Megan to explain how memory, associative learning, and emotional cues can influence chronic pain. Using examples from Pavlov’s conditioning research and his clinical work, he explores how fear, anger, sadness, loneliness, and shame may amplify pain responses.

The conversation also covers the difference between acute and chronic pain, why communication between patients and providers often breaks down, and how understanding a person’s “pain language” can support treatment. For clinicians and people living with chronic pain, this interview offers a practical reminder: empathy, safety, and hope can be important parts of the healing process.

Guest: Derrick Sueki, PT, DPT, PhD, GCPT, OCS, FAAOMPT

Dr. Derrick Sueki graduated from the University of Southern California receiving his Doctorate in Physical Therapy. He completed the Post Graduate Certificate Program in Physical Therapy at the University of South Australia with a special emphasis in Manipulative Therapy and Pain Mechanisms. In 2016, he successfully defended his PhD dissertation studying the role of memory, trauma, and injury on pain and muscle responses.

Since 1999, he has been a primary instructor in the Department of Physical Therapy at Mount Saint Mary’s University and in 2015, he accepted a professorship in the Department of Physical Therapy at Azusa Pacific University.

Dr. Sueki is a chief editor of two orthopedic textbooks, Orthopedic Rehabilitation Clinical Advisor and the Orthopedic Physical Assessment Atlas and Video. In addition, he has authored and contributed to numerous chapters in orthopedic and rehabilitation texts, and peer reviewed journals.

Dr. Sueki is currently serving as Chair for the Orthopedic Specialty Council and serves on California State Physical Therapy Association's Research Council. Since 2001, he has been a primary therapist for the Association of Volleyball Professionals and current serves as their Southern California Medical Coordinator. In the past, he has also served as a consultant for the Chapman University's Women Basketball and Volleyball programs. He is a certified Orthopedic Clinical Specialist and a Fellow of the American Academy of Orthopedic Manual Physical Therapists.

Dr. Sueki is a noted leader, author, researcher, and expert in the field of chronic pain and the pain sciences having presented at both the national and local levels. He is currently on the work group to develop practice guidelines for physical therapy management of chronic pain.

Knight Physical Therapy

Links to interesting things from this episode:

• “The Five Love Languages: How to Express Heartfelt Commitment to Your Mate” by Gary Chapman

Chronic pain can change how you see your body, connect with a partner, and experience sex, but it doesn’t mean intimacy is over.

Licensed sex therapist and clinical sexologist Dr. Deborah Caust joins Holly and Megan to explain how pain, stress, body image, medication, and caregiver dynamics can affect sexual desire and response. They discuss how the nervous system influences arousal, why touch may help reduce pain, and how couples can move beyond an all-or-nothing view of sex.

You’ll learn practical ways to reconnect with your body, communicate with a partner, explore touch without pressure, and redefine intimacy around what feels possible now. Whether you’re partnered or single, this conversation offers a realistic starting point for rebuilding pleasure, trust, and connection while living with chronic pain.

Guest: Dr. Deborah Caust, Ph.D.

Dr. Caust holds a Doctorate in Sexology from the Institute for Advanced Study of Human Sexuality and a Master's in Counseling from San Francisco State University, specializing in marriage, family, and child counseling. She is a licensed psychotherapist and works with clients through her private practice. She is board-certified by the American College of Sexologists, a Diplomate of the American Board of Sexology, and a Fellow of the American Academy of Clinical Sexologists. Dr. Caust has also taught human sexuality courses at several California universities, and served as President of the Northern California Chapter of the Society for the Scientific Study of Sexuality. She is a member of the California Association for Marriage, Family Therapists and the author of the Q/A column “SexSense.”

Deborah Caust, website