Why Physical Therapy Is Key for Pain Relief and Full Body Recovery | Dr. Jen Fraboni
I have been following Dr. Jen Fraboni on social media since around 2018, not long after I started posting myself, and I will tell you why she caught my attention immediately.
As an orthopedic surgeon, the people I trust most in patient care are physical therapists. Not because we always agree, but because when we are aligned, outcomes are genuinely better. I tell my patients constantly: I can do the most perfect surgery in the world, and if you do not have good physical therapy before and after, my work is not going to show. The partnership is the thing. And what I saw in Dr. Jen's content was someone who understood the body the way I understood the body, but from a completely different vantage point, one that was filling in gaps I did not even know I had.
Dr. Jen is a Doctor of Physical Therapy, mobility educator, and co-host of the Optimal Body Podcast, known across her global platform as Doc Jen Fit. She has built her following by saying things that are true and useful and sometimes uncomfortable, and this conversation was no different. I learned things. I also had a few moments of recognizing that I could be doing better by my own patients.
This one is for anyone who has been told their MRI is a disaster, anyone who has been handed a Kegel and sent home, and anyone who has been quietly wondering whether surgery is actually the answer.
The Thing Nobody Wants to Hear About
Let's start where Dr. Jen ends, because she closes with the most important piece and I do not want it to get lost.
Her one non-negotiable, the single thing she would tell any person regardless of their condition, their fitness level, or their goals, is breath work. Not a particular exercise program. Not a supplement. Not a specific stretch. Breath work. She said it knowing exactly how it would land, and she said it anyway, because the evidence behind it is real and the reluctance to do it is almost universal.
Here is why it matters more than most people realize. The core is not your abs. It is your entire trunk, from the shoulder blades down to the pelvic floor, and it functions as a pressurized canister. When you inhale, the diaphragm drops, pressure moves down through the abdomen, and the pelvic floor should naturally lengthen and expand in response. When you exhale, both structures reflexively return. That rhythm, when it works properly, is the foundation of how your body manages load, protects the spine, and supports every movement you make. When it does not work properly, no amount of Kegels or core exercises is going to fix what it cannot fix, because you are working on top of a system that is already dysregulated.
The most common dysfunction Dr. Jen sees, particularly in women, is a pelvic floor that is not too loose but too tense. A pelvic floor that has never been taught to lengthen cannot contract effectively either. It is doing a bicep curl that never fully extends. Women who are leaking and doing Kegels and getting nowhere are often doing exactly the wrong thing, not because Kegels are bad, but because the prerequisite work has never been done. That prerequisite is learning how to breathe from the rib cage, feel the full three-hundred-sixty-degree expansion on the inhale, and allow everything to soften on the exhale without forcing it.
She offered a simple check: sit in front of a mirror and breathe. Do your shoulders rise toward your ears? That is a sign the breath is not going where it needs to go. The goal is expansion into the hands placed on the lower rib cage, not elevation of the shoulders. That is where the reset begins.
What Your MRI Is Not Telling You
One of the most useful things Dr. Jen said, and one that I wish more patients heard before they ever saw an image, was about what scans actually show and what they do not.
Thirty-seven percent of twenty-year-olds will show disc degeneration on an MRI. Eighty percent of fifty-year-olds will show it. In the study she cited, none of them reported back pain. A separate study looked at two hundred and thirty knee MRIs taken from people between twenty-five and seventy-five years old who were completely pain-free, and found that sixty-two percent showed signs of osteoarthritis, with forty-one percent showing severe osteoarthritis at level four. No pain.
I can attest to this from my side of the room. People come in carrying their images like a verdict, certain that what they are seeing on the scan is the explanation for everything they are feeling. And sometimes it is. But very often it is a piece of a much more complicated picture, and treating the image rather than the person is one of the ways we get patients into procedures they did not need and outcomes they were not expecting.
Dr. Jen's point was not that imaging is useless. It is that the conversation about what we are going to do with the results needs to happen before the scan, not after. What story are we telling ourselves about what we might find? What are we prepared to do if the image looks frightening but the clinical picture is manageable? Because once someone sees the word degeneration or herniation on a report, the psychological weight of it becomes its own variable in the pain experience, and that variable is real and measurable.
Low back pain is where this matters most in my practice. It is very hard for patients to understand that low back pain in itself, without nerve involvement, without radiating symptoms, without weakness, does not have a good surgical option. My first line is always physical therapy. Dr. Jen's approach when she receives those patients is to start not with the spine but with everything surrounding it: sleep, stress, hydration, social connection, inflammation, nutrition, hip mobility, breath, and core function. A parent just died, she mentioned at one point. That is heavy in the body. It shows up physically. You cannot treat the disc without addressing what is happening in the life attached to it.
Active, Not Passive
There is a phrase Dr. Jen used that I keep returning to: why are we thinking that laying on a table and passively having someone do something to us is going to create an active change in our body?
She is not dismissing hands-on treatment. She does it herself and values it. But she is precise about what it does: it gives the nervous system access. It calms guarded muscles enough to create an opening. It is the entry point, not the destination. The change comes from what happens after, from the patient doing something different, consistently, on their own. Passive treatment that never transfers into active practice produces temporary relief at best.
This shapes everything about how she works, including why she left the traditional clinic model. Insurance companies want you focused on the injury site. They want documentation, sessions condensed into weeks, the same two exercises repeated until coverage runs out. Dr. Jen wanted time to hear a patient's full story, because pain is biopsychosocial, and if she is not accounting for what is happening in someone's life, she is treating only a fraction of what is actually driving the symptoms. She went private so she could do the job correctly.
On resistance training, she was equally direct. Getting close to failure matters. Under thirty repetitions, loading the body to the point where one or two more reps would be genuinely impossible, that is the signal the body needs to build strength and support the structures we are trying to protect. The compound exercises popular in group fitness formats are a fine entry point, but if you are always squatting while simultaneously pressing, you are never loading either movement enough to actually approach failure in either one. Intentional, focused strength training is different from high-energy group classes, and both have a place, but they are not interchangeable.
For the women who grew up in the aerobics era, or who watched their mothers treat three-pound dumbbells as the upper limit of what a woman should lift, this is the conversation that needs to happen. Dr. Jen's own mother has knee and shoulder osteoarthritis and is still doing HIIT training, still jumping, still adapting. The adaptation is the point. There is almost always a way to continue doing the things that matter, if someone knowledgeable enough is helping find it.
What We Are Not Teaching Women
Pregnancy and postpartum is an area where the gap between what we know and what we tell patients is still embarrassingly wide, and Dr. Jen and I spent time sitting in that discomfort together.
She recommends at minimum one pelvic floor therapy visit in the second trimester and one in the third, for every pregnant woman, regardless of symptoms. Not because something is wrong. Because these are structural, hormonal, and mechanical changes happening to a body that deserves informed support, and because the window to establish good habits is open and closing. The research from Dr. Margie Davenport and others is now showing that maintaining and even continuing to strengthen during pregnancy is not only safe for mother and baby but genuinely beneficial. The old guidance to rest and protect has given way to something more nuanced and more useful.
The instinct during pregnancy is to stretch. It feels good. The ligaments are already lax from relaxin and the other hormonal changes, and more loosening is the last thing most pregnant bodies need. Strengthening and stability work is what actually addresses the SI joint pain, the pubic symphysis discomfort, the sciatica that shows up and refuses to leave. Dr. Jen's framing for her own pregnancies was to treat every uncomfortable sensation as information rather than threat, thank the body for responding to the changes it was navigating, and then ask what strategy could help. That reframe, she said, kept her moving when the impulse was to stop.
I wish we had taught this in medical school. I wish I had known to have these conversations fifteen years ago with the women coming into my clinic in their forties and fifties with frozen shoulders and tendinitis appearing in multiple joints at once. Nobody mentioned estrogen decline in residency. Nobody drew the connection between perimenopause and the cascade of musculoskeletal symptoms that can accompany it. We are learning now, in 2026, what we should have been taught at the beginning, and the least we can do is say so directly.
Connect
You can find Dr. Jen on Instagram @DocJenFit, on YouTube at Doc Jen Fit, and on the Optimal Body Podcast, which she co-hosts with her husband, also a Doctor of Physical Therapy. Her app, Jen Health, includes a fully free Discover section where you can search by condition and find relevant videos at no cost. For more conversations like this one, subscribe to The Resilience Factor wherever you get your podcasts, and find me @dr.pamelamehta on social media.
