Latest / The Birth Lounge Podcast / Ep. 469: SI joint relief and clenching in pregnancy with Hayley Kava

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Ep. 469: SI joint relief and clenching in pregnancy with Hayley Kava · The Birth Lounge Podcast

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we want to have pelvic floor PTs and have more pelvic floor PTs who are taking this sort of zoomed out approach because it's not w- we don't wanna keep blaming this poor little pelvic floor for all of our problems, right? Like, it's, it's, it's going through it.
It's, it's having a hard time, and it's really often I find, like, yeah, it's the victim.
Hello, and welcome back to another episode of The Birth Lounge Podcast.
All right, we do a lot of talking about our pelvic floor, what she does, what the purpose of her is, how she gets out of the way in birth, how our pelvic floor actually isn't the one that pushes out our baby, despite all the messaging online.
You know, that can be a little confusing.
But your, your pelvic floor sits below your baby and so what actually pushes your baby out is your uterus.
Now, this doesn't mean that your pelvic floor is not important, because she absolutely is.
She holds up your pelvic organs.
She holds up your internal organs.
She holds up the weight of your growing belly if you are pregnant.
And then postpartum, she's got some relearning to do.
She has to strengthen up.
She is gonna probably need some rehab, to which you would see a PFPT.
I'm so excited to have on today someone who I followed and revered online for a long time, Hayley Kava, and she's exactly that.
She's a pelvic floor physical therapist And the owner of UMA Pelvic Health in Arizona.
Hayley became a pelvic floor physical therapist in 2017 after a birth injury opened her eyes to the limitations in traditional pelvic rehab.
She took her postural restoration and sports medicine background and dug deep into the literature, over the years developing an integrative whole person method to treat pelvic floor.
Hayley has helped thousands of women.
She has become passionate about sharing her method with not only her clients and staff, but to the masses via social media.
Aren't we all trying to just reach those masses? But for me, Hayley does it a little differently.
She's always got these amazing analogies.
She's always got these amazing visuals, and you're gonna see that even in today's episode.
If you're just listening to the podcast, you may want to take a little trip over to YouTube because Hayley at one point has a arm full of model pelvises that she's gonna use to help us understand exactly why sometimes pelvic floor dysfunction can lead to SI joint pain.
Now, you guys pop into my DMs, you email me, I get texts and calls from friends and family in pregnancy every single day, and I'm not lying.
I, I truly mean at least once a day, somebody is asking me about symptoms that sound like SI joint pain.
And you know me, if I'm not the expert, if it's not my wheelhouse, I wanna bring somebody on who can speak to you and, and give you tangible steps to helping you get better, feel better, heal faster, and that's why I had Hayley on the show today.
Today we're gonna talk about shutting off, uh, bad patterns.
I'm really lacking, uh, the be- better term there, but patterns that don't serve you in the best way, and how do we relearn and then turn on new patterns? And when I say patterns, I'm talking about, like, functional movement.
How do you bend? How do you reach? How do you sleep? How are you sitting? How are you getting up and down? What kind of patterns have you developed throughout your life that are probably unconscious that may or may not be serving you in a good or a bad way? Then Hayley, of course, is gonna give us solutions.
We're gonna talk about putting together your absolute ideal pelvic health team in an ideal world, and I want to get her opinions on things like belly bands and SI joint bands If you are thinking about having a baby soon, if you are pregnant, or if you have already had a baby and you still have questions about what the heck that pain was that you were feeling in pregnancy, this episode is going to change, this episode is going to change your life.
Without further ado, Hayley, welcome to the show Hi, hello.
I'm so excited to have you.
It's always funny to have another Hayley on the show.
Mm-hmm.
Um, and there's always different iterations of the spelling, but I'm like one Hayley to the other.
Hi, welcome.
Um, Hayley, I'm super, super excited to dive into today's topic because I feel like so many people know about the pelvic floor.
It has definitely gotten a lot of light in the recent years.
I feel like, not all, but there are a good amount of OBGYNs talking about this.
Midwives are talking about it.
Um, a lot of people are starting to realize, like, "Hey, I could really use some pelvic floor support in pregnancy."
Where at one ti- at one time it was really just a postpartum thing, or people really thought about it as, like, postpartum and you're having problems, like severe problems.
And you're like, "No, it's for way more than that."
Um, I think we finally have covered that, so people kind of know about it's for a lot of stuff.
Now, the problem that I find is people are like, "But for what?" Like, it's for a lot of stuff, but, like, what exactly? Mm-hmm.
And so today I wanna talk about probably the number one thing that I hear people talk about in pregnancy, SI joint pain.
I mean, this can cause a big problem.
Lower back pain, pulling in your belly, pubic pain, right? Like your SI joint is connected to a lot of stuff.
I want to understand that, yes, yes, you guys, if you're not watching on YouTube- Pelvis.
Yeah.
Oh my God, we have so many pelvises.
Hayley's like if you're not watching on YouTube right now, y- you've got, like, a whole handful of different sized pelvises.
They all have different things.
Okay.
So- Maybe we j- we m- maybe we start right there.
Maybe the start is, like, what is your SI joint and what is it connected to? Yes.
Yes.
So our, our SI joints, sacroiliac joints, right? So we don't necessarily need to, like, know the anatomy terms, but it helps, right? So our sacrum is sort of the bone at the bottom of our pelvis.
So our spine comes down, attaches onto the sacrum, and the sacrum is five fused vertebrae, and then our tailbone, our coccyx, is at the bottom of that.
Then our two halves of our pelvis, we can call them our, um...
Our pelvis is made up of three bones, but they're fused bones.
So we have our ischium, which is the bottom, like, our sitting bone, our ilium, and our pubis.
Again, no quiz.
You don't need to remember that, right? But the ilium is the back part.
It's sort of the part you would maybe do hip squeezes on.
It's sort of all the big wings.
That attaches into our sacrum, and that's gonna make our sacroiliac joint.
We have in the front part of that, in the inside, but we also have that on the back, and most of the time when people have pain in the SI joint, they're gonna notice it in the back.
Um, but we have to remember that this is a whole ring of bone, right? This is a whole system.
And so this ilium attaches to our ischium and our pubis, and that meets up at our pubic symphysis.
And then when we move and walk and breathe and do the things, we need to be able to transfer a lot of load through these bones, right? We need to do that when we're not pregnant.
Everyone who's moving and walking needs to do this.
But the hormonal situation and the biomechanical changes of pregnancy require that our body transfers load even differently through these SI joints, through this pubic symphysis, and keeping all of it happy requires that we do a nice job transferring load well from the left and right side of our body as we're moving down the road hmm.
So when I was pregnant, I always had...
'Cause I was going to chiropractic care, right? I always had, and actually PFPT said the same thing, one hip that was always, like, tighter than the other.
Does this have something to do with that? Yeah.
So then if we zoom out from our pelvis, we zoom up, is we have a body, starting from our brain, that is not symmetrical.
Mm.
So the left and right side of our brain is different, and on purpose.
That's good.
The, our left and right eye, they process information differently.
Our left and right ear process information differently.
So our sensory system is not symmetrical.
Our left and right lungs are not the same.
So we have three lobes of lung on the right, we have two lobes of lung on the left, and our heart kind of pivots over toward that left side.
And the left and right side of our diaphragm are not the same.
So our right side is bigger, stronger, and it attaches on further down on the spine on the right, and we have a big liver underneath that right side diaphragm.
So this right side's real supportive.
Right? Our right side of our body GI system, also heavier on the right.
It's why babies like the right.
It's why we like to be on the right side, because we're just heavy over there, and neurologically we're wired over there.
Our right side is our more sympathetic side.
So we can, we can, we can jump down some fun, fun rabbit holes.
Yeah.
This is- As it pertains- like a geek-out.
Yeah.
As it pertains to our SI joint in pregnancy, right? If we are in a pattern of preference to maybe this right orientation, we might be hanging out a little bit more in, like, a stance phase position on the right, and more of, like, a swing phase position on the left.
So sacrum is a little turned toward the right.
And so our ilium is going to be a bit more internally rotated.
Our ischium might be a little more externally rotated, and then vice versa on the other side.
Or whatever terminology you'd wanna use for that.
So internal rotation, external rotation, stance phase, swing phase, orientation to the right, whatever.
You can say whatever you want.
But we're pulled a little more to the right.
Just humans.
Mm.
This is normal.
We're a series of pumps, and pumps work better when they're not totally balanced.
Huh.
So I think sometimes people will get really worried about being totally perfectly symmetrical, but that's not necessarily the end goal because we are not totally symmetrical, and that's not how we're designed.
That's not how we're meant to be.
Right? Most babies, again, maybe we're getting off topic, but babies aren't, don't shoot straight, and that's good, right? We, we ha- we all have these little patterns of, of asymmetry, and I would say as it pertains to pain in pregnancy is that this is sometimes our flag that we're maybe a little more stuck in our pattern, or we've maybe compensated in our pattern a little bit more, and that's what we wanna try to, like, unwind a little bit.
So before we dive into that, I have another question about pain in pregnancy.
Something that I did not experience, but a lot of people do, is turning over in bed, like getting up off the couch, sitting in the car for a long period, and you've got that pubic pain, right? And they're like, "It is just killer."
And you see all these videos of people putting pillows between their knees to turn over.
The SI joint must be responsible for this, or h- it definitely has a role.
Yeah, they're, they're, I mean, they're literally connected in the same way.
So if it's, it's sort of backing up to, to treat this is sort of backing up to understand what's going on, whether you roll over and you have pain in your SI joint, or you roll over and you have pain in your pubic symphysis, or you have pain in your round ligament, or you have pain in your ribs, right? It's so, like, going, okay, let's zoom back.
Let's see how this whole system is working together.
And what I'm looking for, sort of the type of PT that I practice, we're looking at can this pelvis go both ways? So if we always have one side that's tighter, one why, and what are some of the ways that we can oppose that tension so that we can restore better alternation and reciprocation? And that's really the goal.
It's, like, not that I'm always stuck perfectly balanced, but can I go one way, and then can I go the other efficiently, smoothly, without having to compensate? So when we then go...
So the, the, the solution of, like, just keep your legs together- Well, that's not even realistic.
It's like sh- like, that might help symptomatically, but usually my tip for rolling over is we're gonna exhale, reach, use our ribcage, right? Because our ribcage and diaphragm above this pelvis is gonna help influence pelvic motion.
And then, okay, now what do we...
what muscles do we need to help us sit, you know, depending on what pattern our pelvis is in? So if we are tight with the right side and more external rotation and the left...
Or, sorry, if it, with the left side and more external rotation, and the right side and more internal rotation, what are the muscles that help us reverse that? Okay.
So now when maybe we're turning to the left, we're gonna think about pushing through the arch of our foot, use our right glute max, and, like, use the muscles that help us turn.
And usually my clients who are in a lot of pain, they're like, "I'm scared to, like," Yeah move my leg apart."
And I go, "That's a, it's valid.
Let's just try it and see."
And then we t- try and get the right muscles on, encourage the sort of appropriate movement of that pelvis.
Oh, and it's like this fear, like, is able to dissipate because, like, oh, I'm back in control of what's going on here, and I can also sometimes feel the edges of when I'm starting to compensate.
Oh, I can feel when I that pain, and I can make it go away.
And I think a lot of times it's just giving some more control back- Mm over to them.
Mm-hmm.
Mm-hmm.
I love how you describe, like, balance is not necessarily the goal here.
Like, we're not trying to get two symmetrical pieces, but if everything is working well, and you've got the functional movement, and you're comfortable, and you're not compensating.
So for me, I was like, "Oh, okay.
So if everything's working well," and you're, like, not in pain, but the key piece too is, like, and you're not compensating, then it's good to know for the most part, like, you're in good shape.
Now, are you also, while you are introducing these new, like, I don't know, would you call them functional movement patterns? Like, functional...
Like, ways to move your body, right, that are a little safer.
Are you introducing that with strength building so that whatever muscles are a little weaker are actually getting some love? Yep.
So there's sort of two pathways, right, of repositioning we'll ca- I...
And I don't even love the term repositioning, but, like, w- learning about different positions in your body, there's inhibition, and then there's retraining.
So if you're walking around in pregnancy, your back is very tight, and you have a really tight hip, right? There are inhibition strategies.
Maybe we do activities to help release tension in your low back.
Maybe we do massage for that tight piriformis, or we r- you know, we release pelvic floor muscles that are tight.
These would be inhibition strategies, which might help us feel like, okay, if we're more stuck in a position, they might help us, like, "Oh, okay, I can, like, settle back."
But our retraining strategies are turning on the muscles that oppose that pattern- So a specific example here would be if we're in a pattern where that right hip is more, our more dominant side, we're really loaded into our right hip, and we're, we're not able to shift well over to the left, we would do a lot of training of the left hamstring, left adductor, left ab wall to help encourage our body to be able to get over to the other side.
Then we might do some inhibition of, like, the right QL, the right intercostals, the right side so that the right side is willing.
And so we're combining these things all the time.
And I'd say in the beginning, sometimes that feels like a lot of mental work, but that's our job.
We, like, teach you the things.
Then it starts to become a little more integrated, so like, "Oh, now I'm walking.
I can feel what Hayley was talking about."
Like, feel what it feels like for my hamstring and my inner thigh to, like, help encourage this pelvic rotation.
Um, an analogy I use a lot is that we wanna, um, we're kind of like a Rubik's Cube.
So we have three rows of a Rubik's Cube.
Our pelvis is the bottom row, our low back is the middle row, and our ribcage is the top row.
In pregnancy, if we lose our top row and we lose our bottom row because it's stuck, we're gonna be only moving through that low back, and that, that low back, and then again sort of strain at SI isn't gonna be moving very efficiently.
So with our exercises, we're teaching that lower row, right? So if you're just spinning through the, the middle row, you're never gonna solve your, your cube.
We need all three of these rows to be able to interact.
So let's teach top row how to rotate a little bit better, ribcage, thorax.
Let's teach how does that interact with pelvis.
That can alternate left, right, move a little bit better.
And now we're gonna decrease the tension strain through that middle row So that now we're working together more, more efficiently.
That is- And so- so cool.
Mm-hmm.
Yeah, and it's just a...
And that perspective and that take really works for anything, right? And so it's like that could be helpful for SI joint pain.
That could be helpful for constipation.
That could be help- you know, whatever the thing is, is because that you're always working in system with the...
Like, your whole body's always working in system.
That relearning part that you're talking about was the hardest because, oh my God, when you have compensations that you were not even aware of, you literally don't even know you're doing them.
It ta- Mm-hmm it took me, oh my gosh, months.
And it was things like you were talking about.
It was, you know, things like the breathing that you talked about.
Mm-hmm.
Like brace your pelvic floor before you pick something up.
Brace your pelvic floor before you sneeze, right? Like little knacks that you do to protect your pelvic floor, loosen up your hips, be nice to that lower back, things like that.
Um, the relearning, holy mackerel, it's a lot.
Mm-hmm.
And I would say, again, it's like in the beginning, yes.
Um, my sort of take on the pelvic floor is that I really don't want my clients thinking about it that much.
Yeah.
After learning- I think- how to do it again.
Yeah.
I don't really want my people squeezing before they sneeze, or squeezing before they bend.
It's like before you had...
Before you were pregnant, before you had pelvic floor problems, never thought about these muscles because our pelvic floor muscles, I don't think, are really truly orthopedic muscles, right? These muscles are nervous system muscles.
These are digestive muscles.
These are sexual function muscles.
These are b- like birthing muscles.
And so these are like...
I'd call these, like diff- like they're, they're different.
They're just anatomically different.
They're, they're, they're just not the same.
And so they work, right, so if, if the pelvic floor is in the bottom here, if our pelvis is able to move and move well, the pelvic floor that's in the bottom, I say it's like it's just living in the cage of your pelvis.
So I would say the focus would be the things outside.
So more of the big muscles.
Like let's get the big muscles that attach on this pelvis doing what they're supposed to do well.
And now when you sneeze, it just works.
Even if you're pregnant and you have a huge belly? Even, mm-hmm.
Really? You don't always have to just brace your pelvic floor in pregnancy? Wow.
No.
Nope, because...
Yeah, no.
Mm.
In that if...
What, what is happening in pregnancy, right, what changes are happening is that as belly grows, our center of gravity is getting pulled forward, right? We're trying to oppose that pull forward maybe by engaging muscles of the, like, our, like, our low glutes.
We're, like, trying to clench our butt cheeks, clench our pelvic floor.
Our low back is taking over 'cause it's, we're getting pulled forward.
So all those things that oppose us pulling forward are trying to pull us back.
But what we actually need to train are the muscles that help us just step back.
So get the hamstrings on, that attach on the sitting bones pulling us back.
Get the adductors that attach here pulling back.
And these muscles positively influence that pelvic floor to be able to just do what it's gotta do.
Mm.
Mm-hmm.
Right? And so when it comes to a sneeze, right, the front and back of the pelvic floor works a little bit differently because of the things it attaches to and its orientation.
So if we're really tight in the back of that pelvic floor and we try to squeeze before we sneeze, we're gonna squeeze what's already strong, which is the muscles of the back of the pelvic floor, and it may or may not help us stop peeing.
Sometimes it might work, sometimes it might not.
Hmm.
But if we improve the orientation where we can actually lengthen into the back of the hip so that when we go to sneeze, now those muscles can load- And efficiently contract because now they're in their more, like, optimal loaded position, then we won't have to contract.
They're just gonna recoil and reflexively work the way that they're meant to.
Yeah And so- Without you thinking about it.
Without you thinking about it.
Mm-hmm.
Um, yeah, and that's...
And, like, do we sometimes use strategies to help in the interim? Sure.
Right? But I'll usually tell my, my clients, like, like, try it at home the first time you cough or sneeze, right? But try to actually just, like, I usually say, "Well, get back onto your, like, left heel.
Shift back a little bit into that left hip and come back.
Now before that sneeze comes, relax, then just sneeze" Hmm.
Because if we think about the, the efficiency of a muscle, right? So if our pelvic floor is, um, already t- pre-tensed, we're tense because of our position and then we're tense because we're squeezing.
Mm-hmm.
Now we sneeze, our bladder comes down.
It's landing on concrete.
We wanna be able to catch our sneeze with a hug, versus r- r- restrain our sneeze with concrete.
And so sometimes w- we get into the habit of c- a concrete pelvic floor.
Mm.
Now things like jumping, landing, walking, now the pelvic floor goes, "Oh, I have to be concrete all the time," and now we're gonna leak other times, or we're gonna have tension.
So sorry, bring it back to SI, but like, then we're gonna think, "All right.
What I have to do to support myself is clench, work," when in reality it actually needs to like give and let go.
And so that's where we need some inhibition and some retraining so that now we can get this alternating, shifting, flowing, which is also really convenient because that's what we need to train for labor and birth.
Mm.
Okay, so I was gonna say the same thing.
I was gonna say so much of what you're talking about sounds like birth, right? Like, yes, you want a strong pelvic floor, but you don't want one that can't yield and get out of the way of your baby.
Your pelvic floor does not actually push your baby out, your uterus does.
So like your pelvic floor has to have this, like, ability to relax and kind of let a baby pass through, and I feel like so many people get hung up there.
So our SI joint, if it is tight in pregnancy, does it mean that it will be tight in birth as well? Not necessarily.
N- no, because pain is complex Right? So it's not, like, that linear.
What I would say is if you are in...
How I've explained it to some of my pregnant clients is our job in PT as we're working through pain and preparing for labor and birth is we wanna be able to have access to any of the movements that you might intuitively choose to use when you're being supported and you're feeling supported while you're laboring.
So that person...
And then we also have our doulas that are good observers and go, "Hmm, maybe we're hung up here."
Like, so we need a team.
We can't do this we're not doing this alone.
Of, okay, we're working on things in, in pregnancy that are going to help improve how the SI joint feels But that also is gonna be movements that we want to practice so that we could potentially access that when we're in labor.
Mm.
So, so a classic example is, um, lots of people like to labor, like leaning over the side of the bed, right? So like they're, or like their, their elbows are down or their hands are down just rocking, swaying.
So we're, we're essentially we're tr- or, or that intuitive movement is this, or we're in a stage of labor where we're doing this side to side intuitive movement, swaying, rocking, maybe b- they, you know, depending on where baby's at.
Now, now we might need a little bit more space to help shoulders turn on one side or the other, or we just need to be able to do this.
But if we've avoided that all pregnancy because it, because of pain or because we've been restricted or tight, then we're not gonna, we're not gonna intuitively access that in, in labor.
And that, and that might be fine.
It might still be enough space and room and the power of the uterus and, and all that might be such, or like some really good hip squeezes or some really good other sport, or an epidural or whatever other tools that you might access will maybe allow a baby to still make their way through.
But if we now have access to this and body and baby go, "Ooh, I need a little more, I need a little more space by that ischial spine."
And then we have ac- we like, "Oh, I've practiced that.
Practiced that hip shift.
I've practiced using my body in that way."
It's not a conscious process that's happening, right? Because like my patients aren't going, "Oh, Hayley had me practice these hip shifts and, and at, at this many centimeters in this station I should do this?" No.
Like, I don't want them thinking about that at all.
We might talk about it a little bit.
But we're thinking what are maybe we're gonna practice, rehearse, reinforce in, in pregnancy, and then create an environment such that you can access that and use that when you might need it.
Mm-hmm.
And perfect, perfect situation is that they don't need to do any of the movements or things that we practice because we're just rocking and rolling.
But yeah.
I'd say like if, we're having pain and we're in a position in our body where we're really tight, really restricted, not moving well, it might play a role.
But I wouldn't feel comfortable saying like, yeah.
Like Yeah, like not everybody who has tightness, but if you have tightness, I'm just thinking in my own brain, like that is absolutely something you might want to think about working with somebody.
So you had mentioned a team.
Obviously, you were talking about a, like a birth team, you know, like we, we want PTs, we want, you're a medical provider, you want a doula.
Like, what else, who else would you add to your team? Are you thinking like chiropractic care? Are you thinking like, um, an acupuncturist? Now, obviously, things are expensive and, you know, access is- Right wonky all over the country.
It kind of depends on where you live.
But in an ideal world, if you, you know, if everything was kind of- Yeah coming up for us, what would you put on a team? Who would you put on a team? Um, really, I, I, you know, um, you wanna put on your team- People who are, like, working together collaboratively.
'Cause I think sometimes we're going in, we're like, "Okay, I'm gonna see acupuncture, check.
I'm gonna see med- the PT, check.
I'm gonna get my doula, check.
I did it."
But it's like, are we all talking about the same person, and are we supporting this person in a way that's gonna feel continuous? So, like locally here, we have a couple doulas that we work with really c- pretty closely, and we, like, are texting, and she'll be like...
She'll, like, send me pictures and be like, "What do we need?" Like, with permission of our clients.
Yeah.
Obviously, it's like, um, we've been s- we've been here for a little while, and usually it's something simple like, "Oh, put a little, uh, yoga block under her foot and try that."
Or you know, with chiro, often the chiropractors we work with are seeing the same patterns that we're seeing.
They just have a different treatment approach.
So they're gonna do their adjustments to restore that movement or restore that position.
Yeah.
And then we're gonna say, "All right, now you gotta own it."
Mm-hmm.
Like, you gotta earn your adjustment, right? It's like, now we...
And, and they may have their own theories on that, but when the chiro I've worked with is...
He's...
And maybe it's that business model, but he's like, "Oh, when my clients work with me and you, they see me, they have to see me less because they're maintaining position because they're strengthening the things that help keep them there."
Mm-hmm.
So a PT who's comfortable having those conversations with the chiropractor, a PT who's comfortable with having those conver- conversations with the doula or the midwife or the OBGYN, right? And I think that's really the, the key there.
Um, yeah, I teach a pay-what-you-can class, classes.
Um, and in order...
Is that, is that as good as one-on-one care? No.
But it's gonna give us perspective where we can self-assess and self-evaluate and, and embody and understand what some of these patterns and asymmetries might feel like in our own body, s- and that's, that's super valuable also.
Yeah.
Yeah, I think one-on-one's not for everybody either.
Like, some people love that group me- you know, method, and some people love the self-assessment skills that you wouldn't get in one-to-one because your PT's doing all of it.
Mm-hmm.
I, for me, I love that you talked about the, like, kind of trinity, and it's like exactly what you said.
My chiropractor used to- When they would adjust me, they would, like, put me back into place, is what I used to call it.
And I used to joke around.
I'd be like, "All right.
Today I'm really out of, I'm really out of place, so put me back into place today," right? And they're, they're just, like, getting you straight again.
And then my PT would help me know what muscles were weak, what muscles were too tight, and then I would go to the gym, and I would be working on the things- Yeah.
Yeah that my PT told me.
And then I would go back to the chiropractor, and they'd be like, "Oh, my God, your body's holding so well."
And it was just this, like, really sick cycle of satisfaction to see my body get better and better and stronger and stronger and stronger.
And then for me, it was also like, I wanna keep this up, right? Because I knew that everything I was laying right there in that pregnancy will come back and serve me in future pregnancies.
Obviously, I mean, you mentioned relaxing in the beginning of the episode, but, like, hormones are gonna make you weak regardless, so you still have to work out in those other pregnancies.
But the things that I have already rewritten and relearned, they're now part of me, and I get a chuckle now because I'm not pregnant, obviously, and I don't have a big old belly, and I still do those things, and I'm like, "Ha ha, that's kind of funny."
Like, Mm-hmm.
Um, although, I mean, I think it's, it's just better overall functional movement in every phase of life.
Right.
But it's funny because in my brain they're, like, associated with pregnancy, right? Mm-hmm.
Yeah, we all have these patterns of, like, compensation, and they just get exaggerated in pregnancy, right? Pregnancy's just gonna- sort of exaggerated, and that's fine.
We just have to f- I, we gotta just fight back a little bit harder as, as, uh, as baby gets bigger.
Yeah.
Okay, now we talked about patterns, like having patterns, um, you know, be turned on and turned off.
So you've got a lo- a lot of these patterns that are not good for us necessarily, or maybe we're not even thinking about them.
Maybe they just kind of developed over whatever, and a lot of them are compensation, and we wanna turn those off and new patterns on.
What are some of the patterns? Because like I say, there were so many that my PT and chiropractor would be like, "Do you do this every day?" And I'm like, "Yeah.
How do you know that?" And they're like, "I can feel it in your body."
I'm like, "What?" And they're like, "Yeah, that's really not that great.
Like, try to do this, this, and this instead."
For me, I used to...
I don't do it anymore, although I do miss it.
Every now and then I find my body, like, instinctively just going into it.
I call it the flamingo stance, where I'm just standing on one leg- Mm-hmm and I have my other arch of my foot on that knee that is standing.
Mm-hmm.
Right? And I used to stand at the counter that way, brush my teeth that way.
Oh my gosh, I would be leaned up against our couch that way scrolling on my phone, like fold laundry that way, talk on the phone that...
Like, I did that all the time, you guys.
And so when both of them were like, "That is not great," like, "You are doing so much stuff to your body," like, "We've gotta find something different," I was like, wow, I did not...
First of all, yes, I do that, but I didn't realize how much until I started pa- and I was like, oh my God, I literally do this all day every day.
So what are some of those things? I imagine things like twisting, lifting stuff up.
Like, what do we need to be thinking about in terms of, like, is this good or bad, and, like, am I even thinking about what I'm doing to my body? Yeah.
I think when we...
Yeah, when we start thinking about...
I think it comes up in my office as it pertains to pain, right? So I'm having SI joint pain, and then we'll go, "Okay, here's the things we're seeing in your body.
Here's the patterns that we're, we're seeing.
Here are the muscles we wanna, like, strengthen, and let's talk about some of these, like, lifestyle things that are gonna help us," right? And it is normal for us to wanna default back into our habitual patterns, positions.
I always tell people...
So one of the common ones is that people do tend to, like, stand and, like, to stand on their right leg or stand with their body kind of oriented to the right and then their left leg kind of turned out.
That's pretty typical.
Or forward, where we're hanging on the front of both hips and kind of butt is clenched, and we're, our, our weight's really forward, and so we're like, that's, like, our crossed arms, hip and pelvis, like, swayed forward.
So I'd say our two most common is that we're popped into the right or we're standing on the left, but our pelvis is still turned to the right.
Hmm.
Like, right orientation is pretty common because of some of that, like, internal asymmetry that we- So heavy.
Mm-hmm.
And so, so we'll go, "Okay" wh- if you feel your pain come on, your SI joint pain, or you're like standing for a while or you're waiting at the grocery store, like whatever it is that you're doing, it's like just check in.
Like, let's have a mindful moment here and be like, "I'm having pain.
Does this mean that like I'm wrecked?" No.
It means like check in, "Hey, where am I at?" And oftentimes it's like, "I'm hurting and I'm flamingo standing."
Yeah.
I'm doing it again.
And so like, yeah.
It's like, okay, let's, let's try to find something different.
So something that I often will tell people, I'm like, "Let's see if we can find our left sitting bone when we're sitting," right? Let's see if we can find the sit bones.
Can we, or can we find our right one, or can we find our left one, or are we dumped back on our sacrum? Right? So okay, I'm hurting.
Where am I? All right, let's find a sitting bone.
Let's get comfy.
'Cause we don't need to also be so worried about, like, holding ourselves, ourselves in the right place all the time, 'cause I think that al- also sometimes puts some undue pressure on ourselves, and I think there's already so much pressure to, like, do everything right, where it's like, okay, loosely.
And then, you know, notice where do I drift.
Mm.
Right? I'm gonna drift over to this right elbow.
If I'm concentrating and thinking and trying to say the right things, I'm gonna drift onto that, into my pattern.
That's hu- normal human stuff.
But then, oh, I'm feeling some discomfort in my low back.
Okay, let me see if I can kind of shift over to the other.
And oh, okay, that goes, goes away.
Cool.
So it's giving us some of that, like, internal awareness, right? That internal self-assessment, internal, uh, you know, application or, like, integration of the skills that we're practicing with the exercises.
And then I would say things like, "Okay, let's try, when we're standing, let's try to stand on our left leg," right? Our left side also being the more parasympathetic side.
Let's stand on our left leg.
Let's feel our left heel and our left big toe.
Let's see if we can maybe orient and feel our zipper or our pelvis sort of turning a little toward the left, and then our shoulders can come back straight.
And oftentimes when we're moving someone out of their typical pattern, it's gonna feel really twisted up.
Yeah, it does.
So it's like, that feels wrong, and then I'm like, "Can I just take a picture of you real quick to show you? You look perfectly normal."
But it's like, I feel like I'm, I'm twisted because our, our habitual patterns are, are so different.
And so is that, again, do we need to be perfect with that all the time? No.
But we do need, we wanna be able to shift in, in and out of that to help us manage symptoms.
I'd say, yeah, if we're not having symptoms, like, and we're thinking more along the lines of, like, birth prep, sure.
Like, we can...
Do we need to be perfect? No.
Is it good things to be aware of? Absolutely.
Do we wanna integrate this into our strength training? Do we wanna integrate this into our rehab stuff then? Yeah, ab- absolutely.
Um, yeah.
Those tangible steps of like, okay, when you feel pain, check in with your body and, like, make adjustments, are so helpful because I feel like so many of us in pregnancy are like, okay, this is hurting, but you don't necessarily know what to do about it.
And I think for me, that's what that trinity did.
It was like chiropractic and PT gave me the tangible steps of things to do in my life, and then, you know- The strength training allowed me to work on the things they were telling me to do.
And then, like I say, I really cannot tell you how good it felt to go to those two and they'd be like, "Wow, your body's, like, stronger.
Your body's not doing X, Y, and Z."
Or like, "Oh, you're holding so much better."
It made me feel so good and I was like, "All right.
It is working."
And it was just so good to see.
One of the things that really helped me when I had first started PT, which was like, oh my God, way before I got pregnant, 21, 22, and, um I was working on pelvic floor stuff back then, like a really tight pelvic floor, and one of the things I did was I set, uh, an alarm for, it only took me a little bit, but every hour during the day that I was working, and I would, the alarm would go off, and I would take a breath, and I would, like, check in with my pelvic floor, see where she was at.
Like, was she tense? Was she cli- clenched? Was my jaw clenched? Like, tightness here.
Where were my shoulders? Were they up by my ears, or were they just, like, in a nice, relaxed...
Like, how was I holding my body? Um, it reminds me of, like, tension throughout the body that's not necessarily in your pelvis, so you don't think about it.
So for me, it was jaw clenching.
It was holding your shoulders up.
I even had some ankle pain.
I just happened to mention this to my PFPT, and she was like, "Oh, yeah, that's probably your pelvic floor."
We worked on some stuff inside my pelvic floor, and it went away.
Talk to us about, like, overall tension of your body, especially pertaining to pregnancy, 'cause, you know, you mentioned that it's like you got so much to do.
You're trying to see all these things.
You're trying to get to all the appointments.
If you have more children, it's like now you are doing all, like, there's just a lot in pregnancy.
The mental load is a lot.
The emotions of it adds to all of that.
Then you've got the physical stuff.
Like, you know, tell us about overall tension and what that has to do with our pelvic floor.
Mm-hmm.
Yeah, I think that's where we want to have pelvic floor PTs and have more pelvic floor PTs who are taking this sort of zoomed out approach because it's not w- we don't wanna keep blaming this poor little pelvic floor for all of our problems, right? Like, it's, it's, it's going through it.
It's, it's having a hard time, and it's really often I find, like, yeah, it's the victim.
So at the root of it is, again, for me and, and how I practice is, like, we just need our body to be able to move from side to side.
And when, when we move side to side, our head and neck needs to move side to side.
We need to have our eyes and our visual system able to, like, look around.
And so there are lots of, like, really outside-the-box, like, zoomed out ways that we can tune in and check in to help reduce tension that don't require us, like, you know, laying down on the floor.
And d- do things like body work and pelvic floor release work, do all of those things really help and help us sort of break out of our habits and our patterns? Absolutely.
Um, but I think, yeah, it's sometimes, sometimes integration of, yeah, like, some of this mindfulness, some of this awareness, and, and pregnancy's such a time where you're, you're leaning into kind of connecting with your body and tuning in with your body, that that's also so valuable.
Mm-hmm.
Mm.
Yeah.
Um, okay, one last thing about, like, the SI stuff.
Guarding, what does this mean? I see it all over Instagram, and, uh, what, what, what is guarding, and do we need it? Um, it's, I guess guarding just being, yeah, like how our muscles protect, right? And again, there are kind of a few different schools of thinking on the SI joint, okay? And there is s- often discourse online about that the SI joint does not move, and it's inherently stable, and so we don't need to be afraid.
We just need to strengthen it and not worry about any of that.
And then there's other school of thought that goes, "Yeah, the pelvis moves.
The pelvis alternates.
We need to have good control of it.
We need to stabilize."
And I would say, like, kind of both can be true.
The SI joint is incredibly strong, is incredibly stable.
Your body's incredibly resilient.
And sometimes there are little movements and little things that we can do to help us feel safer and more supported.
So guarding really being a nervous system response to a sense of maybe movement that we don't control or changing in our body as our body is changing.
So we maybe feel a bit of pain, and we guard, and we fold, and then we are keeping ourselves stuck.
And a lot of times how we see that evolve throughout pregnancy or helping dealing, someone dealing with that pain is l- okay, let's experiment with a novel position that maybe you haven't done before, and let's see how that feels, and then let's breathe with that.
Let's use our breath.
Let's use things outside of our SI joint.
Let's maybe bring in the foot, or let's bring in the neck or the jaw, and go, "Oh, okay.
Now we can move, and that did not hurt."
Now we're rewiring.
Now we're creating a rewiring of our interpretation of pain.
We're not catastrophizing that pain, and so we're working on both our brain and our mechanics because I think both are essential, right? Mm.
So yeah, I think w- that logic, the logic of, like, just squat heavy and deadlift and get strong and, like, your SI joint is fine, yeah, doesn't really apply in pregnancy.
In that, like, yes, we wanna keep moving.
Yes, we wanna keep strength training, but we wanna be intentional, and we wanna help you get out of pain as quickly as possible and move well, and that is gonna have good alignment with birth prep and labor and all that.
So guarding is protective, and we do need it kind of in the immediate so we don't stay in pain, but it should not be your long-term solution.
Like, you, you shouldn't just like, "Well, I just won't do this for the rest of pregnancy, and it'll go away after I..."
Uh-huh.
Right? Like, get to a PT.
Mm-hmm.
Go see a chiropractor.
You know, don't, um- Don't live with those bad compensations.
One thing that we haven't talked about that I learned in pregnancy was how much my ribs matter when it comes to my pelvic floor and that SI joint, right? It's like when my ribs were starting to flare, it was pulling on everything, and I didn't realize that I even had a rib flare until the chiropractor said something, and then I mentioned it to my PT, and she was like, "Yeah, your ribs are flared."
She was like, "Let's work on that", and then my pelvic floor stuff got better.
Mm-hmm.
It was actually, for me in pregnancy, my hip.
Mm-hmm.
Yeah, so when, right, we talked a lot about how d- how do we get this pelvis moving left to right.
Well, our ribcage, on top of that, we need it to internally and externally rotate as we walk and move, right? This is not a rigid block.
This is our top row of the Rubik's Cube.
Yeah.
We need it, we need it to, to go.
And so absolutely, when, when we do an initial evaluation, we wanna look at all of those layers, and oftentimes when I have a new client, I go, "We're gonna look at your shoulder.
We're gonna look at how your neck moves.
We're gonna look at your ribs, and I know you're here for this, this SI joint."
Um, and I sometimes will joke, I'll, I'll, um, I got myself in trouble once where I was like, "I don't care about your, your SI joint."
I care deeply about your SI joint, but I care about all of the other potential drivers, and how are we gonna fix this? And that, uh, an SI joint is often an angry bear, right? And we don't wanna keep poking the angry bear.
Sometimes we gotta- Again, work on the other, the other things.
Or angry hip, burning pubic bone.
It's like let's, let's, again, let's zoom back, let's look at the big picture, and let's see how we're gonna approach this.
Yeah.
Okay, is internal PFPT always part of fixing these things? I know this is on a lot of people's minds.
Um, uh, no.
It's always optional.
Everything is always optional, just like in everything.
You have to, you have to agree, right? And your PT should be explaining why, risks, benefits, alternatives, so you get to decide.
So I have no, um, I have no preference.
If someone really wants the information from a pel- pelvic floor exam, absolutely, we can add that.
Um, the way I organize assessments is that we're creating and generating our pelvic floor hypothesis based on the testing that we do.
So we do very specific testing, kind of like maybe the chiropractor did, where they're looking at to give us a sense of this orientation.
In each of whatever position we sort of evaluate and we assess is going to give us our pelvic floor hypothesis.
So before even going into a pelvic floor muscle exam, I have a bit of a hypothesis in my mind about maybe where we're gonna be tight, right? What areas of the pelvic floor might be tight, what areas of the pelvic floor might be over-lengthened.
And so I, um- Or already have a, an idea of what I'm gonna do or where, what we're gonna work on even without that information.
So if someone doesn't wanna do a pelvic floor muscle exam, or we wanna focus on global big picture things first and maybe come back to that later, that's all valid, right? I'd say even to the point of, like, any of our assessing, any of our tests, always optional.
You don't want me to touch your ribs? No problem, right? Like, there are ways we can look and see and do and come up with a plan that feels comfortable for whatever, and that's sort of, I think, something that I do as a pelvic PT, and I hope lots of pelvic floor PT, more pelvic floor PTs do, is, like, yeah, you get to be...
You're the driver.
You're the boss.
Um, and then I'm here to just help guide you through that.
Yeah.
And just like your, you know, your care team when it comes to pregnancy, like your midwife, your OBGYN, your nurse, your doula, if you've got a PT that is not aligned with, like, your style or the approach, or you feel not heard, or the opposite, you feel like they're kind of pushy, look elsewhere.
Like, go find a PFPT that makes you feel comfortable and safe.
Like, everyone has a different approach.
Everyone has different recommendations.
So if you're not with the, the right fit, they're not a bad PT, it just means they're probably, like, not for you, right? And then obviously access, but there are lots of people who have online, and then you had mentioned your courses.
I do wanna talk about those, but before we get there, I do wanna talk about, like, things that maybe we should be doing every day.
So, uh, like, if you work at a desk, should you be sitting on a birth ball? I assume yes.
I loved mine in pregnancy.
Should you be making sure that you're getting up every, like, hour to two hours and, like, walking around? Are there certain stretches? Does everybody need a foam roller? Like, what are some things for people listening that you're like, "All right.
If you're pregnant, like, here are just some simple things that might make your life better"? I'd say invest in, like, the good compression.
Okay.
So- Compression socks? C- um, um, like belly and pelvic floor compression.
I really like the Love Study bloomers or, like, just, like, your good...
It's, like, it seems like a really expensive pair of underwear.
Okay.
And it's like, "Do I need to spend this amount of money on a pair of underwear?" But usually when you feel like you really need it the most is, like, the end of pregnancy and into postpartum, and then you're s- kind of scrambling at the last minute.
So, I love like a light compression, sort of belly compression and, like, perineal compression.
Like, that's helpful.
I'd say a...
Here, I have some things.
Get you a small thin yoga block, or literally an old textbook if you have an old textbook or a coffee table book.
Just one inch, one and a half inch.
Not a huge yoga block.
Smaller, because our, the motions that our pelvis has to do aren't that huge.
So sometimes with the things we're doing, we're doing with a big yoga block, we're gonna steal that motion through that middle row versus through, your pelvis.
So skinny, skinny yoga block.
Uh, before I got these, these are, like, actually yoga blocks, but just honestly I'd use an, uh, phone book, and I just taped it.
Um, and then I love these type of balls, like a Pilates ball that has a little hole.
Um, we can use this to sit on for pelvic floor awareness.
We can use this for lots of exercises between knees, um, during workouts.
I, I work out, and I'll, like, when I'm s- lifting heavy, I still use this.
So I use these a, a ton.
Um, yeah, that, ball.
A variety of movements, right? So if we're, if we're working at a desk job, is sometimes sit to type, sometimes sit on your ball, sometimes stand up.
Take a lap, not fearing any one particular movement and that knowing that no movement is that inherently bad, right? I don't, I don't really love a lot of like, "Oh, don't do this.
Do..."
It's like sometimes do that, and sometimes do this other movement and s- so that we're getting a, a variety of things that our pelvis can do and our hips can do and our ribcage can do.
Um, I would say these mindful moments.
So, um, um, I usually will do like a hand towel.
Um, and you wanna get your chair set up so that, your feet are supported, like you can sit and not feel like you have to perch on the edge of your chair.
So, like, you can let your chair work for you.
Um, and I'll usually put a towel on the back of the chair to just remind people to like sit if they're sitting in an actual chair, and then breathe into the towel.
So, um, compression of the back of the ribcage sort of is mirrored by compression of the back of the pelvic floor.
So when we sit back, we need to feel like our back ribs can also expand.
Because if we think about rib flare in the front- If we wanna get rid of our rib flare in the front, we need to open the back.
So we'll see that in a lot of people who are very straight in their thoracic spine, and very compressed in the back of their thoracic spine, also tend to be our tight pelvic floor people.
So just reminding us to, like, breathe back into our ribcage.
Um, and then, yeah, those would be kind of the, the big ones.
I would say I'm not the hugest fan of, like, SI joint belts.
Oh, okay.
Um- What about belly bands? Belly bands, great.
Like so- like compressive banding, the, like, rigid- like, the more structured, um, hard bands where, It's, like, a belt, like the Serola belt or there's a couple other bra- where you, like, are really locking it in, I'd say is, like, good, s- fine for initial symptom management.
But what that's doing is it's sort of, like, locking us in here to, like, decompress, which is good.
We also, though, want to work on this part of it.
So it's, like, use that if you need it, but also let's work on stabilizing the things, and hopefully then we don't need it.
And often, um, of clients that I have had that have them, we don't typically use them for, uh, the rest of their pregnancies 'cause they're like, "Oh, I feel good.
I don't need it.
Ditch it.
Leave it here and I'll give it to someone else later."
Um- Pass on the love.
Yeah.
Um, so, so I think a lot of times people are like, "Oh, I have SI joint pain in pregnancy," and then they immediately get one of those.
And it's like, well, hold on.
Let's see, like, let's see if we can get things moving better.
If we can, great.
If not, okay.
Yeah.
Um, and yeah, that's, that's it.
I tend to be, um...
Yeah, it's just move around.
Be...
Be free.
Yeah.
Free the hips.
Yeah.
Free the pelvis.
Yeah.
Um, oh my gosh.
Okay.
Hayley, this has been really, really helpful.
You've, like, put some pieces together for me.
I never thought about the pelvis being, like, mobile bones, but made up of fused bones.
I have never...
When you said that I was like, "Oh yeah, it is."
Like, what? That's so cool.
Um, also just super helpful to, to hear about, well, first of all, that Rubik's cube visual is so helpful, but also just to understand how our whole body kinda plays into- Ultimately, that SI joint that's gonna, like, be responsible for not the health of your pelvis, but it influences it so, so much.
Okay, we talked about lack of access, plus we talked about people who may not want one-on-one, they want to see people in, um, you know, a group setting or virtual.
Tell us about your services, 'cause you do all of them.
You will see people in person, you have virtual stuff, you have classes.
Like, how can people learn from you, work with you, connect with you, even on social media? Ooh, yeah.
So our new brick-and-mortar clinic, um, that we've just, um, opened is called Uma Pelvic Health, and we're located in Aberdeen, North Carolina, which is about an hour south of Raleigh.
Um, we, um, have a team of pelvic floor PTs, and we all are taking, yeah, this more sort of holistic look at things.
We work with patients in person and virtually, um, one-on-one, and then I, through my Hayley Pava PT, um, side of things, I teach pay-what-you-can virtual sort of group classes, which are, um, twice a week, 30 minutes, four weeks, and it's, um...
There's a, like, a pressure intention class, and then there's a pregnancy-specific class.
And it's just, again, experimenting with all of these different types of movements, um, sort of h- how do we sort of self-assess, how do we progress, and then how do we, by the end of that, how do we integrate this into our workouts or our life? And, um, and then to just sort of give people a foundation of information.
Yeah.
You guys, oh my gosh, what a good episode.
I hope this helped answer a bunch of your questions, because you guys slide into my DMs with SI joint pain, and the only thing that I know is, like, how to identify it.
I'm like, "Yep, that's probably your SI joint," and then it's like, what do I tell them to do? Like, I have no idea.
You need to go with a PT.
Like, they will be able to help you.
Um, also, a chiropractor in your area will be able to help you.
Um, you know, you can tell your OBGYN or your midwife.
Hopefully, fingers crossed, is that they refer you out to a, a, a PFPT, right? Or a chiropractor in your area, or both.
Um- Yeah.
I would say most states have direct access, so depending on your state, you can see a pelvic floor PT even without a doctor's or midwife's or birth provider's referral.
Um, but check your, your state, or they might, you might be able to start with a PT even without a referral.
Um, and then depending on the PT, some PTs, pelvic floor PTs, uh, work with insurance, some don't.
Um, and don't let that intimidate you.
Often, if they don't work with your insurance, it's for a good reason, um, that they're gonna be able to sort of take a different approach, which is maybe the approach that you really need, and it's more about kind of finding that alignment with your- With your provider Much more individualized care, and also they, they get to truly, like, take that time with you, right? Like, a lot of PFPTs, their appointments are one hour long, so you really genuinely get good, substantial time with your PFPT.
Insurance made me think of HSA, FSA dollars.
Mm.
Is this something that someone could use that for? Well, yeah.
Yep.
Cool.
It is.
Oh, my gosh.
All right.
You guys, I'm so glad that you got to hang out with us today.
I love bringing you topics that you guys asked for.
I started doing that last season, and it was so much fun, um, and I get to deliver the stuff that you guys wanna hear.
So, thanks so much for being here.
If you are having SI pain, you guys, tell somebody.
You got people in your area.
If you don't, now you've got Hayley.
She is just a brilliant lady.
She can help you get your stuff fixed, and she's got so many ways to work with her and her team.
So please, you don't have to be in pain in pregnancy.
And you know, my goal is to just help you know what's out there, and if it feels aligned with you, I wanna provide you with someone to get that support.
Oh, Hayley, you didn't tell us where to find you on social media.
Yeah, so my, um, account is Hal- @Hayleykavapt.
So H-A-Y-L-E-Y, so two Ys, um, K-A-V-A-P-T is my handle.
Mm-hmm.
Perfect.
All right, well, there you go.
You guys, follow Hayley on social media, and you can find me @tranquilitybyhehe and at the.birth.lounge.
Until next time, head to your app store and download the Birth Lounge app for evidence-based childbirth education and data-driven postpartum support delivered straight to your phone.
Bye.
Thank you so much for tuning in today.
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