Latest / The Driven Athlete / Pressure Management For Pelvic Health with Dr. Letycia

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Pressure Management For Pelvic Health with Dr. Letycia · The Driven Athlete

• 0:00
  SPEAKER_02: If you're a driven, active person who wants to reach and pursue a higher quality life with some ambition, then guess what?
• 0:06
  SPEAKER_02: This podcast is for you.
• 0:08
  SPEAKER_02: This is the Driven Athlete Podcast.
• 0:12
  SPEAKER_02: What's up, y'all?
• 0:12
  SPEAKER_02: It's your man, Dr.
• 0:13
  SPEAKER_02: Kyle.
• 0:14
  SPEAKER_02: Welcome back to the Driven Athlete Podcast.
• 0:15
  SPEAKER_02: We got a cool guest with us, super unique, Dr.
• 0:18
  SPEAKER_02: Leticia, right?
• 0:19
  SPEAKER_01: Yes.
• 0:20
  SPEAKER_02: Down in um Miami or Fort Lauderdale.
• 0:22
  SPEAKER_00: Delay Beach.
• 0:23
  SPEAKER_02: Delay.
• 0:23
  SPEAKER_00: Yes, yeah.
• 0:24
  SPEAKER_02: You live in Fort Lauderdale.
• 0:25
  SPEAKER_00: I live in Fort Lauderdale.
• 0:26
  SPEAKER_00: I can commute to Delray.
• 0:27
  SPEAKER_02: But we actually, you actually went to the University of Miami.
• 0:29
  SPEAKER_02: Yes.
• 0:30
  SPEAKER_02: And I went to Miami, so we're, you know, we're related in that kind of exactly.
• 0:33
  SPEAKER_02: Um but tell people where your clinic's at and and what you do.
• 0:37
  SPEAKER_00: Yeah.
• 0:37
  SPEAKER_00: So my clinic is located in Delay Beach.
• 0:39
  SPEAKER_00: Um, I'm just like right south of Atlantic Avenue.
• 0:42
  SPEAKER_00: It's kind of like the main downtown area of Delay Beach.
• 0:44
  SPEAKER_00: And I'm a public floor physical therapist.
• 0:46
  SPEAKER_00: So most of the population that I work with is like pregnancy, postpartum, but I also see a lot of women who are like more sports related, who are like lifters.
• 0:55
  SPEAKER_00: Um I've worked with women who are after like an endo excision surgery.
• 0:59
  SPEAKER_00: Um, so yeah.
• 1:00
  SPEAKER_00: So I kind of work with everything in between the belly button and like just below the groin, pretty much.
• 1:07
  SPEAKER_02: Cool, good.
• 1:07
  SPEAKER_02: I mean, that's there's a huge need for that.
• 1:09
  SPEAKER_00: Oh, yeah.
• 1:10
  SPEAKER_02: Especially with like, I mean, just something I wasn't really aware of.
• 1:13
  SPEAKER_02: But um, like my wife, you know, we have three kids.
• 1:15
  SPEAKER_02: So it's stuff that she's gone through and the awareness around all that stuff.
• 1:18
  SPEAKER_02: And then I have other classmates that have gone the pelvic floor route, but just the commonality of a lot of the same issues that seem to pop up.
• 1:25
  SPEAKER_00: Yeah.
• 1:25
  SPEAKER_02: And then it's like just not a lot of attention on it, you know.
• 1:29
  SPEAKER_00: No, there's really not.
• 1:30
  SPEAKER_00: There's really not.
• 1:31
  SPEAKER_02: So people don't even know to even seek help.
• 1:32
  SPEAKER_02: Yeah, it's like, oh, this is the way it is from now on.
• 1:35
  SPEAKER_00: For sure.
• 1:35
  SPEAKER_00: I've had so many patients who have found me on Chat GPT.
• 1:38
  SPEAKER_00: Like ChatGPT was the one who told them to come to pelvic floor therapy.
• 1:40
  SPEAKER_00: I'm like, that's insane.
• 1:42
  SPEAKER_03: That's cool.
• 1:42
  SPEAKER_00: You know, that's scary.
• 1:44
  SPEAKER_00: It's scary and it's like kind of comical, but at the same time, it's like I just picture them, Google like on Chat GPT at like two in the morning.
• 1:50
  SPEAKER_00: Like, what are these symptoms?
• 1:51
  SPEAKER_00: Like, what does this mean after they've gotten like gaslit from their physician or something like that?
• 1:55
  SPEAKER_00: And then they're like, oh, what's this?
• 1:57
  SPEAKER_00: And then, you know, it kind of goes from there.
• 1:59
  SPEAKER_00: But good.
• 2:00
  SPEAKER_00: Yeah.
• 2:00
  SPEAKER_02: But that's good though.
• 2:01
  SPEAKER_00: Yeah.
• 2:01
  SPEAKER_02: Um, where are you from originally?
• 2:03
  SPEAKER_00: Um, I'm originally from Orlando, like the Winter Park area.
• 2:06
  SPEAKER_00: So I don't know if you know where like Rollins College is or anything like that.
• 2:09
  SPEAKER_02: I'm from Winter Park.
• 2:10
  SPEAKER_02: Oh, yeah, yeah.
• 2:11
  SPEAKER_00: So I'm born and raised from there.
• 2:12
  SPEAKER_00: I went to Winter Park High School.
• 2:14
  SPEAKER_00: Cool.
• 2:14
  SPEAKER_00: Um, and then yeah, I came down here for undergrad and I like never left.
• 2:18
  SPEAKER_02: Yeah, yeah.
• 2:18
  SPEAKER_02: So you went to you went to Miami for undergrad?
• 2:21
  SPEAKER_00: I went to FAU for undergrad.
• 2:22
  SPEAKER_02: Oh, FAU, okay.
• 2:23
  SPEAKER_00: Yeah, I went to FAU and then um after that I was working at a local PT clinic just to get some experience.
• 2:28
  SPEAKER_00: And then um I went to UM after.
• 2:30
  SPEAKER_00: Cool.
• 2:31
  SPEAKER_00: And kind of just slowly stayed in South Florida.
• 2:34
  SPEAKER_02: Yeah, yeah, yeah.
• 2:34
  SPEAKER_02: What led you to want to do like PT?
• 2:36
  SPEAKER_02: Did you always know you wanted the PT route?
• 2:39
  SPEAKER_00: You know, I always knew I wanted to do something in the healthcare field and I wanted to do something active, if that makes sense.
• 2:47
  SPEAKER_00: Like um, I grew up as a competitive dancer, so I feel like movement and all of that was always like something that was very like um attractive to me.
• 2:56
  SPEAKER_00: And then as I got into college, I like, you know, was asking around different options of what I could do.
• 3:03
  SPEAKER_00: I thought about med school, I thought about PA school, and then I shadowed a physical therapist and I was like, wait, I love this.
• 3:08
  SPEAKER_00: This is this is really cool.
• 3:10
  SPEAKER_00: Um, and then that's kind of like where it started.
• 3:13
  SPEAKER_00: And then once I got to PT school, like it was very different.
• 3:18
  SPEAKER_00: So yeah.
• 3:19
  SPEAKER_02: Um, did you know pelvic floor PT was like what you want to do?
• 3:22
  SPEAKER_00: Not at all.
• 3:23
  SPEAKER_00: No.
• 3:24
  SPEAKER_00: It's funny because when I was in PT school, like I loved neuro.
• 3:27
  SPEAKER_00: Like I was convinced I was gonna be in neuro PT.
• 3:30
  SPEAKER_00: Like I loved working with the spinal cord injury population, post-stroke, because that was what I did one of my clinicals in.
• 3:36
  SPEAKER_00: Um I think Dr.
• 3:37
  SPEAKER_02: Moore still down there.
• 3:38
  SPEAKER_00: Uh yeah.
• 3:39
  SPEAKER_00: Yeah.
• 3:40
  SPEAKER_02: He's a good dude.
• 3:40
  SPEAKER_00: Oh yeah.
• 3:41
  SPEAKER_00: No, he's awesome.
• 3:42
  SPEAKER_00: Um, so yeah, so I I loved it when I was in school, but I think I liked the academic piece of it.
• 3:48
  SPEAKER_00: I loved like learning about neuro.
• 3:50
  SPEAKER_00: And then when it actually came to like applying it in person, um, it was it was really hard, I you know.
• 3:56
  SPEAKER_00: Um so then I worked in acute care for a while after I graduated.
• 4:01
  SPEAKER_00: And then it wasn't until I kind of hit a ceiling, I feel like, in what I was learning that I started to explore a little bit more of like what the options were.
• 4:09
  SPEAKER_00: So it's funny because I really didn't know much about it in PT school either.
• 4:12
  SPEAKER_00: I think there was maybe an elective.
• 4:14
  SPEAKER_00: It wasn't even a class yet.
• 4:16
  SPEAKER_00: So nobody really knew much about public floor PT, honestly.
• 4:18
  SPEAKER_02: I actually took that elective.
• 4:20
  SPEAKER_00: Did you really?
• 4:20
  SPEAKER_02: I was the only guy in there.
• 4:22
  SPEAKER_02: I wasn't really sure.
• 4:24
  SPEAKER_02: I really wasn't sure.
• 4:25
  SPEAKER_02: Like, this is women's health.
• 4:26
  SPEAKER_02: Cool, cool.
• 4:27
  SPEAKER_02: I was like, oh, I didn't know this was where we're going.
• 4:28
  SPEAKER_02: All right.
• 4:29
  SPEAKER_00: Yeah, you're like, oh, this took a hard turn.
• 4:31
  SPEAKER_00: I had no idea where this is going.
• 4:32
  SPEAKER_02: Learn some stuff.
• 4:33
  SPEAKER_02: Sounds good.
• 4:33
  SPEAKER_02: You know, that's cool.
• 4:34
  SPEAKER_00: Yeah, I definitely wish I had taken the elective, but I think like in the moment I was like, I I didn't know enough about it.
• 4:40
  SPEAKER_02: So yeah, yeah.
• 4:41
  SPEAKER_00: Oh, yeah.
• 4:41
  SPEAKER_02: So did you have any major injuries or anything like doing dance?
• 4:44
  SPEAKER_02: Because I know it's super and it's a lot.
• 4:46
  SPEAKER_00: Oh, for sure.
• 4:48
  SPEAKER_00: I mean, I sprained my ankle, but like that was kind of the extent of it.
• 4:52
  SPEAKER_00: So there wasn't really any major injury that like pushed me to be like, okay, this is exactly what I want to do.
• 4:56
  SPEAKER_00: But I knew I always wanted to do like something active.
• 4:59
  SPEAKER_00: So it kind of just like really worked out that way.
• 5:02
  SPEAKER_02: It's good.
• 5:03
  SPEAKER_02: It's good.
• 5:03
  SPEAKER_02: We need more dance pelvic floor therapists.
• 5:06
  SPEAKER_00: I know.
• 5:06
  SPEAKER_00: Oh, yeah.
• 5:07
  SPEAKER_00: Especially like in the sports population, it is a whole different world when it comes to like the pelvic floor.
• 5:11
  SPEAKER_02: Yeah, yeah, yeah.
• 5:12
  SPEAKER_02: So your clinics down on Delray Beach.
• 5:15
  SPEAKER_02: Um, what what what's like the you do both pelvic floor and some sports, all usually all women.
• 5:21
  SPEAKER_02: Do you have any men client?
• 5:22
  SPEAKER_00: Yeah, I don't, I don't um work with men.
• 5:24
  SPEAKER_02: Okay.
• 5:24
  SPEAKER_00: But yeah, only women.
• 5:26
  SPEAKER_02: What are the some of the main things women call you for?
• 5:28
  SPEAKER_02: Oh my gosh.
• 5:30
  SPEAKER_00: So most of my population right now is women during um pregnancy.
• 5:36
  SPEAKER_00: So I work a lot with like birth prep, kind of getting them to advocate for themselves, especially in the delivery room, getting them prepared, especially if they're already very active.
• 5:45
  SPEAKER_00: Um, I mean, I get anything from just overall pelvic pain or pelvic pressure.
• 5:49
  SPEAKER_00: So if there are like any symptoms popping up that correlate to like a pelvic organ prolapse, which is very common, especially like postpartum or like, you know, well into menopause, that's pretty typical.
• 5:59
  SPEAKER_00: Urinary incontinence, I would say, is pretty common with the population that I see for sure.
• 6:05
  SPEAKER_00: Um, abdominal separation, um, painful periods is another big one.
• 6:11
  SPEAKER_00: Painful sex is huge as well.
• 6:14
  SPEAKER_00: Constipation.
• 6:15
  SPEAKER_00: The list kind of goes on, but it's funny because it's very rare that it's only one symptom.
• 6:19
  SPEAKER_00: It's usually like a cluster of symptoms.
• 6:21
  SPEAKER_00: So it's kind of interesting to kind of piece together exactly where it's coming from.
• 6:25
  SPEAKER_00: Cause usually all those symptoms are leading into something obviously deeper.
• 6:29
  SPEAKER_00: So it's kind of like figuring out exactly what the root cause is.
• 6:32
  SPEAKER_02: Yeah.
• 6:32
  SPEAKER_02: Um, so and that's the puzzle piece part, is yeah, interesting.
• 6:35
  SPEAKER_00: Oh my gosh, it's so fun.
• 6:36
  SPEAKER_02: Yeah.
• 6:37
  SPEAKER_00: Yeah.
• 6:37
  SPEAKER_02: What like what happens with that?
• 6:39
  SPEAKER_02: Like, so urinary continence, right?
• 6:41
  SPEAKER_02: That's a simple one, I feel like, to start off with.
• 6:43
  SPEAKER_02: But like it's um pelvic floor weakness.
• 6:47
  SPEAKER_02: So you can spasm.
• 6:48
  SPEAKER_00: It's so you can have urinary incontinence with both a tight pelvic floor and a weak pelvic floor.
• 6:54
  SPEAKER_00: So a like a lot of the advice that a lot of women hear online is like just do a bunch of kegels, get your pelvic floor strong, sit on the um cello chair, like blah, blah, blah.
• 7:03
  SPEAKER_00: Um, and really that's never gonna solve it because more often than not, like the first thing I take a look at is how they're managing their pressure above the pelvic floor, targeting that, making sure we know how to engage TA, take the pressure off of the pelvic floor in the first place.
• 7:19
  SPEAKER_00: Um, and then we address whether the pelvic floor is like truly like weak or whether it's like hypertonic or like tight, for example.
• 7:26
  SPEAKER_02: Overcompensating.
• 7:27
  SPEAKER_00: Yeah.
• 7:27
  SPEAKER_02: For a lack of core stability or awareness.
• 7:30
  SPEAKER_00: Exactly.
• 7:30
  SPEAKER_00: So usually the pelvic floor will take over.
• 7:32
  SPEAKER_00: Um, the nervous system is also like largely correlated to if there's pelvic floor tension.
• 7:38
  SPEAKER_00: Um, but also too, like if I see a lot of like stress urinary incontinence in the postpartum population, usually it's like a coordination and a timing thing as well.
• 7:46
  SPEAKER_00: So it's not even just a strength thing.
• 7:48
  SPEAKER_00: Um, it's just teaching the pelvic floor when to contract and how.
• 7:53
  SPEAKER_00: Um, so that's always like Interesting.
• 7:55
  SPEAKER_00: Yeah.
• 7:56
  SPEAKER_02: How does how do you what's the treatments for that stuff?
• 7:58
  SPEAKER_00: So, first of all, it's um usually the first line of defense is like awareness, having them bring awareness to their breath and taking a look at whether they're truly getting like diaphragm excursion and looking at the rib cage.
• 8:10
  SPEAKER_00: Um, I don't know how in depth you want me to get into this because I can really talk like pretty deep about it.
• 8:16
  SPEAKER_00: But um, that's usually the first thing I look at is like what did their breath pattern look like before I even put my hands on them?
• 8:21
  SPEAKER_00: Are they breathing into their chest?
• 8:22
  SPEAKER_00: Yeah.
• 8:22
  SPEAKER_00: Are they like, you know, kind of guarding?
• 8:25
  SPEAKER_00: Um, a lot of times when I see them like breathing into their chest like this, and their ribcage not isn't really expanding, pelvic floor is definitely getting impacted to some capacity.
• 8:34
  SPEAKER_00: So that's like first thing that I take a look at.
• 8:37
  SPEAKER_00: And then we slowly start making our way down.
• 8:39
  SPEAKER_00: Um, especially with a lot of like the um like my power lifters, strength trainers.
• 8:45
  SPEAKER_00: I see a lot of bearing down when they think they're engaging their core.
• 8:48
  SPEAKER_00: That's also a super common compensation that I see too.
• 8:51
  SPEAKER_02: So totally the same.
• 8:53
  SPEAKER_00: Yeah, yeah, sure.
• 8:54
  SPEAKER_02: Yeah, yeah.
• 8:55
  SPEAKER_02: Cause I would say like back, you know, back pain, hip impingement, SIJ, cigarillac joint, like instability.
• 9:01
  SPEAKER_01: Uh-huh.
• 9:02
  SPEAKER_02: It's totally like a recipe of some core stability, glute activation.
• 9:05
  SPEAKER_00: Yeah.
• 9:05
  SPEAKER_02: Do you do like glute stuff too?
• 9:07
  SPEAKER_02: Like glute activation.
• 9:08
  SPEAKER_00: Yeah, for sure.
• 9:08
  SPEAKER_00: For sure.
• 9:09
  SPEAKER_00: Especially with like postpartum population too, or even this like low back pain, typically, like it, you know, a lot of times they'll feel it in their hamstring before their glute or anything like that.
• 9:19
  SPEAKER_00: So kind of like retraining that and having them like, you know, re-engage.
• 9:23
  SPEAKER_02: Yeah.
• 9:23
  SPEAKER_02: So yeah, timing and cueing.
• 9:25
  SPEAKER_00: Mm-hmm.
• 9:25
  SPEAKER_02: Um but no, I I mean, I feel like there's a lot of women that probably are like, I would hope would lean into this conversation and then be like, we'll want to learn more, but like, okay, what exactly is going on though?
• 9:36
  SPEAKER_02: So from a so I we can get, you know, we can dive in, but like from a from a pelvic floor standpoint, um, if they are overcompensating because of a lack of core and diaphragm contribution, is that what you're saying?
• 9:48
  SPEAKER_00: Yeah, yeah.
• 9:49
  SPEAKER_02: Um, what's happening?
• 9:50
  SPEAKER_02: So it's it's just over spasming, it's tight, it's guarded.
• 9:54
  SPEAKER_00: Yeah.
• 9:54
  SPEAKER_00: So well, so there's a couple of different ways that we can take a look at when it comes to a pelvic floor that's too tight.
• 9:59
  SPEAKER_00: We'll kind of use that perfectly as an example.
• 10:01
  SPEAKER_00: So nervous system is huge.
• 10:03
  SPEAKER_00: So, like typically if they like are um jaw clenchers, like they're grinding their teeth, bearing like um like night clenchers, pelvic floor often is like very, very tight.
• 10:13
  SPEAKER_00: Um, then even in addition to that, like if they have a history of any sort of sexual trauma, that can also lead to guarding.
• 10:19
  SPEAKER_00: Or if they just like have recurring like painful intercourse in general and they kind of just try to push through it, pelvic floor naturally is gonna guard.
• 10:26
  SPEAKER_00: So those are like more from the nervous system part that we take a look at.
• 10:29
  SPEAKER_00: Then even beyond that, if there's like hip instability, glutes are not activating, adductors are not turning on, TA is not turning on, the lower pelvic region is looking for stability somewhere.
• 10:40
  SPEAKER_00: So pelvic floor naturally is gonna like tighten up and be like, okay, well, this is where we're getting our stability now.
• 10:45
  SPEAKER_00: Um, so it's kind of a combination of getting the pelvic floor to relax while also training and giving the stability from the outside of the pelvis as well.
• 10:52
  SPEAKER_00: So we can kind of offload um how much you know effort is being overtaken like by the pelvic floor.
• 10:59
  SPEAKER_00: So yeah.
• 11:00
  SPEAKER_02: Would there be so what interventions help besides we got core stability and activation, glute strengthening, stuff like that?
• 11:06
  SPEAKER_02: And then like other relaxation stuff to help with muscles guarded in the pelvic floor?
• 11:10
  SPEAKER_00: So pretty easy ones that I will teach is like four, seven, eight breathing.
• 11:14
  SPEAKER_00: I know that's kind of like a more basic one, just to kind of overall like start from the beginning.
• 11:19
  SPEAKER_00: Body scans is another huge one.
• 11:21
  SPEAKER_00: Doing a jaw release, like and starting up from the top, is also huge.
• 11:24
  SPEAKER_00: So I'll teach my patients how to do a mastod release themselves, even with their hands, or if they have a gouacha, which obviously is like very trendy right now, too.
• 11:31
  SPEAKER_00: So almost always a gouacia.
• 11:33
  SPEAKER_02: I've never heard that.
• 11:34
  SPEAKER_00: It's like it's like a little jade tool that looks like a C kind of.
• 11:39
  SPEAKER_00: It's like very trendy in the skincare world.
• 11:42
  SPEAKER_00: So a lot of my patients.
• 11:43
  SPEAKER_02: Well, I would never have seen it.
• 11:44
  SPEAKER_02: Yeah.
• 11:44
  SPEAKER_00: Yeah.
• 11:44
  SPEAKER_00: Your wife, I'm sure, has one at home somewhere.
• 11:47
  SPEAKER_00: But um, a lot of my patients have one.
• 11:48
  SPEAKER_00: So I'll teach them how to use a gouacha to like release some of the tension that's in their pelvic floor, too.
• 11:53
  SPEAKER_00: Um, teaching them to actually lengthen their pelvic floor, depending on what's causing the tightness.
• 11:59
  SPEAKER_00: So having them bear down gently or doing what's called like pelvic floor drops or like breathing down into the pelvic floor is huge.
• 12:05
  SPEAKER_00: Um, and then also getting them to coordinate their breath with the diaphragm.
• 12:10
  SPEAKER_00: So similar to when I was talking about, they're breathing into their chest.
• 12:13
  SPEAKER_01: Yeah.
• 12:13
  SPEAKER_00: Um, teaching them to breathe all the way down into their pelvic floor.
• 12:16
  SPEAKER_00: So the diaphragm and the pelvic floor can both descend at the same time.
• 12:20
  SPEAKER_00: Um so that's kind of some like easy basic stuff that I give my patients to take a home, take home with, like from the first session.
• 12:28
  SPEAKER_00: But then of course, as we progress, it gets a lot more complex and catered specifically to the patient.
• 12:33
  SPEAKER_00: But really from the get-go, it's like bringing them awareness because a lot of times most women don't even have um like a connection to their pelvic floor.
• 12:42
  SPEAKER_00: I'll have the ask them to do a Kegel and they're like, What?
• 12:45
  SPEAKER_00: What?
• 12:46
  SPEAKER_00: Yeah, you know, or like the eyes.
• 12:48
  SPEAKER_02: I don't, yeah.
• 12:49
  SPEAKER_00: Yeah, they're like, I'm trying, and like they're squeezing their glutes, or I'll have them like gently bear down too, and they're like, Am I doing it?
• 12:54
  SPEAKER_02: I was like, No, not yet, not yet.
• 12:57
  SPEAKER_02: We'll get there.
• 12:58
  SPEAKER_02: We're learning how not to do it.
• 13:00
  SPEAKER_02: So we can check that off the box.
• 13:02
  SPEAKER_02: Great.
• 13:02
  SPEAKER_02: We're making progress.
• 13:03
  SPEAKER_02: Let's keep going, man.
• 13:04
  SPEAKER_02: We're working.
• 13:05
  SPEAKER_01: Yeah.
• 13:06
  SPEAKER_02: So what about um um the weak pelvic floor?
• 13:10
  SPEAKER_02: And what would you what would you do there for that?
• 13:11
  SPEAKER_02: Kegels?
• 13:12
  SPEAKER_02: Is that one of the interventions?
• 13:13
  SPEAKER_00: So I very rarely will have a patient just do kegels because the pelvic floor also gets co-contraction from the adductors and from TA.
• 13:21
  SPEAKER_00: So when I am training somebody to strengthen their pelvic floor, I usually will start with them just being lying on their back, knees bent, and then doing adductor presses with like a yoga block between their knees and then doing a deep core engagement and then lifting up from the pelvic floor.
• 13:37
  SPEAKER_00: So doing keegels alone isn't really what's gonna bring carryover more into like functional ability.
• 13:43
  SPEAKER_00: So it's making sure that it does know how to contract with TA, with adductors, so then we can carry it over to like squats, deadlifts, picking up their toddler, like moving the car seat, all that kind of stuff.
• 13:55
  SPEAKER_02: Yeah, car seats are heavy, man.
• 13:56
  SPEAKER_00: Yeah, exactly.
• 13:57
  SPEAKER_02: So a lot of my post-just the worst posture, you know.
• 14:00
  SPEAKER_00: Yeah, because you have to like move the car seat like so far away from your center of gravity.
• 14:04
  SPEAKER_00: So a lot of my postpartum moms have back pain that we work through to help get them, like even just like better body mechanics.
• 14:10
  SPEAKER_00: So it's huge.
• 14:11
  SPEAKER_02: Totally, man.
• 14:12
  SPEAKER_02: All the mom activities, I mean and dad activities, you know.
• 14:14
  SPEAKER_00: Yeah, exactly.
• 14:16
  SPEAKER_02: Bending over, picking up, yeah, rolling around.
• 14:18
  SPEAKER_02: Usually wrestling, you know, that's my role.
• 14:21
  SPEAKER_01: Yes, exactly.
• 14:22
  SPEAKER_02: If there's like people are like, your back looks tight.
• 14:24
  SPEAKER_02: You look like your back's tight today.
• 14:25
  SPEAKER_01: Yeah, they're like, on the floor, wrestling with my kids.
• 14:28
  SPEAKER_02: Like, if there's a video, it'd be like them just like one's jumping in my back, like on my shoulders.
• 14:33
  SPEAKER_02: I'm laying on the floor, one's jumping, I'm doing trampoline jumps on my back.
• 14:38
  SPEAKER_01: That's incredible.
• 14:39
  SPEAKER_01: Yeah, how old are your kids?
• 14:40
  SPEAKER_02: Uh, my daughter's five and a half.
• 14:42
  SPEAKER_02: Oh, my son is gonna be four next week.
• 14:45
  SPEAKER_00: Oh my god.
• 14:45
  SPEAKER_02: And then my youngest son is um will be 17 months.
• 14:48
  SPEAKER_00: Oh my gosh.
• 14:49
  SPEAKER_00: So they're like all close enough in age to where I'm sure they gang up on you.
• 14:52
  SPEAKER_02: Oh yeah.
• 14:53
  SPEAKER_00: All three of them.
• 14:54
  SPEAKER_02: And then someone's getting rolled over, you know, and like somebody, you know, just gets torqued the wrong way.
• 14:59
  SPEAKER_02: Someone's pulling someone's hair.
• 15:00
  SPEAKER_02: The baby's usually, I'm like, we gotta be careful with him.
• 15:03
  SPEAKER_00: Yeah, they like don't understand.
• 15:04
  SPEAKER_02: They're just like just wrestling, you know, mania, you know.
• 15:09
  SPEAKER_02: And he's yeah, he but he does well.
• 15:11
  SPEAKER_00: I get it.
• 15:12
  SPEAKER_02: Baby does well.
• 15:12
  SPEAKER_00: Listen, he's gonna come out on top one day.
• 15:14
  SPEAKER_00: I'm the youngest out of like my I have an older brother and older sister, so I understand.
• 15:18
  SPEAKER_02: Yeah, I'm the baby.
• 15:19
  SPEAKER_02: Yeah, yeah.
• 15:19
  SPEAKER_00: It's babies being the baby's the best.
• 15:21
  SPEAKER_02: Yeah, yeah, yeah.
• 15:22
  SPEAKER_02: You learn you learn quick.
• 15:23
  SPEAKER_00: You learn very quick.
• 15:24
  SPEAKER_00: You're bullied like right when you come out of the womb.
• 15:26
  SPEAKER_00: Yeah, yeah.
• 15:27
  SPEAKER_02: But um, and another one that people, you know, will ask me is like, and I'm curious your if you what you say for all your postpartum women, yeah.
• 15:34
  SPEAKER_02: Um, is middle of the night bending over the crib to lift the baby.
• 15:39
  SPEAKER_02: It's like there's I don't know, there's it's just a cold Jefferson curl.
• 15:43
  SPEAKER_02: Yeah, like not warmed up, yeah, you're tired, yeah, poor posture, you can't.
• 15:47
  SPEAKER_00: Very sure.
• 15:48
  SPEAKER_02: What have you made any suggestions on that?
• 15:50
  SPEAKER_02: Like for people?
• 15:50
  SPEAKER_00: So I'm all ears.
• 15:52
  SPEAKER_00: Yeah, I mean, it really does that sounds like a personal question.
• 15:55
  SPEAKER_02: Let me get my pen ready.
• 15:57
  SPEAKER_00: Yeah.
• 15:57
  SPEAKER_00: So it really depends on like the setup of the crib ultimately.
• 16:01
  SPEAKER_00: So one thing I would say, like if you have a stool to be able to actually like see if you can have more of like a hinge at the hips, that would be number one.
• 16:08
  SPEAKER_00: Um, if you're able to actually lift from the inside of the crib for the baby to be a little bit higher, obviously, like not to where they're gonna like roll out of the crib, but um, that would be like another suggestion too.
• 16:18
  SPEAKER_00: Um, if you even have the time, obviously you could do like cat cow and stuff like that, but you're probably not yeah, but you're probably not thinking about that.
• 16:25
  SPEAKER_00: Like when your baby's crying and you wake up in the middle of the night to cry.
• 16:27
  SPEAKER_02: You totally could.
• 16:28
  SPEAKER_00: Yeah.
• 16:29
  SPEAKER_02: You totally could.
• 16:29
  SPEAKER_02: Like it just depends, man, like this is another conversation, but like if the baby's crying, you know, it's just usually moms are a little bit more like ready to go.
• 16:38
  SPEAKER_02: You know, I gotta get them immediately.
• 16:39
  SPEAKER_02: I'm like, well, you know, we could take a time, go to the bathroom first, maybe.
• 16:42
  SPEAKER_02: Yeah, yeah.
• 16:42
  SPEAKER_02: If I'm gonna be in there for 15 minutes, trying to put them back down.
• 16:45
  SPEAKER_02: But yeah, I totally could do some cacos just to warm up.
• 16:48
  SPEAKER_00: Exactly, like any like little mobility exercises just to get the spine warmed up.
• 16:52
  SPEAKER_00: But then even after that, the next thing I would say is coordinating the breath pattern with as you're bending forward and then exhaling to make sure TA is engaged as you're lifting the baby up to give you a little bit more stability.
• 17:02
  SPEAKER_02: So it goes goes a long way.
• 17:04
  SPEAKER_02: Yeah, like it's super important.
• 17:05
  SPEAKER_02: I mean, how many times are bending over to pick stuff?
• 17:07
  SPEAKER_00: First sure, and then you have like the rounded shoulder, and then you're kind of just like in the little turtle position.
• 17:12
  SPEAKER_02: Yeah, yeah, it's hard, man.
• 17:13
  SPEAKER_02: It's tough.
• 17:14
  SPEAKER_02: Well, are you you're um how long have you been married?
• 17:17
  SPEAKER_00: Um about two years.
• 17:18
  SPEAKER_02: Okay.
• 17:19
  SPEAKER_02: The kids aren't on the horizon.
• 17:20
  SPEAKER_02: Like, what are you?
• 17:21
  SPEAKER_00: Soon.
• 17:21
  SPEAKER_00: So we're like plan, we're in the planning stages.
• 17:23
  SPEAKER_00: So, you know, we're kind of just making, I mean, with my practice being as busy as it is, I want to like try to set everything up as well as I can.
• 17:30
  SPEAKER_02: Yeah.
• 17:31
  SPEAKER_00: Um just making arranged.
• 17:32
  SPEAKER_00: Yeah, exactly, exactly.
• 17:33
  SPEAKER_00: And then taking a step back.
• 17:35
  SPEAKER_00: But hopefully by the end of the year is kind of what we're thinking.
• 17:37
  SPEAKER_00: So soon.
• 17:38
  SPEAKER_02: Yeah, really soon.
• 17:39
  SPEAKER_02: Yeah, exactly.
• 17:40
  SPEAKER_00: Yeah, cool.
• 17:41
  SPEAKER_02: Yeah, so we're excited.
• 17:42
  SPEAKER_02: All right, good, good.
• 17:44
  SPEAKER_02: Um, what would you say?
• 17:45
  SPEAKER_02: So I was gonna ask with the with the pelvic floor dysfunction um and the sports powerlifting type population, right?
• 17:53
  SPEAKER_02: Um, what would that be also postpartum women seem to be the struggle the most in that category?
• 18:00
  SPEAKER_02: Or was it like 21-year-old competitors?
• 18:03
  SPEAKER_00: Um, I would say I would put postpartum women in that category as well, but it depends on if I'm working with them during pregnancy or not.
• 18:10
  SPEAKER_00: So I'm a very like root cause type practitioner.
• 18:13
  SPEAKER_00: So usually when they're working with me during pregnancy, they usually don't have to be coming to me consistently postpartum because I've given them the tools to carry over with them to like the exercises that they're already doing.
• 18:25
  SPEAKER_00: So, like let's say like they're doing Pilates consistently, they're doing like heavy workout classes pretty consistently, that kind of thing.
• 18:31
  SPEAKER_00: Um, so usually there's like pretty good carryover from there.
• 18:35
  SPEAKER_00: Um, but as far as like, do you mean like symptoms that they that I typically see with that population or like what in which, yeah, which demographics the more common, which postpartum women?
• 18:47
  SPEAKER_00: Yeah.
• 18:47
  SPEAKER_00: So I would say like very common symptoms that I see is of course like stress urinary incontinence when they're lifting or urinary incontinence when they're running, if they haven't been built up appropriately.
• 18:59
  SPEAKER_00: Um, and then I would say like I don't see too many women come in to see me like before pregnancy and postpartum, mainly because they don't know that it's an option.
• 19:09
  SPEAKER_00: But I have had a handful of women who come to see me like well before like kids are even on the horizon, just because they're feeling like pelvic heaviness, pelvic pain.
• 19:17
  SPEAKER_00: Sometimes they're having leaking and they don't know why because they're like, I haven't even had kids yet.
• 19:20
  SPEAKER_00: Like, what's what's up?
• 19:21
  SPEAKER_03: Yeah.
• 19:22
  SPEAKER_00: Um, and like I mentioned, you more often than not, it's a pressure management thing where they're bearing down every time they go to lift heavy and their pelvic floor just doesn't have the capacity to bear that much pressure as they go up.
• 19:34
  SPEAKER_02: So interesting.
• 19:36
  SPEAKER_00: And especially when they're like lifting really heavy and they're like holding their breath doing valsalva, of course.
• 19:41
  SPEAKER_00: For for men, like usually that's when you start to see like hernias.
• 19:44
  SPEAKER_00: For women, that's when you start to see a history of like pelvic organ prolapse that will more so show itself in menopause once like tissue elasticity starts to decline.
• 19:53
  SPEAKER_02: Yeah.
• 19:53
  SPEAKER_00: Um, so yeah.
• 19:55
  SPEAKER_02: Interesting.
• 19:56
  SPEAKER_02: Yeah.
• 19:56
  SPEAKER_00: Pressure management, pressure management is so huge.
• 19:58
  SPEAKER_00: If there is like one thing that I were to have anyone take away from pelvic floor therapy, even if they're just curious about it, is that pressure management can really make such a huge difference in quite literally everything that you're doing.
• 20:11
  SPEAKER_02: So I believe it.
• 20:13
  SPEAKER_02: That's good.
• 20:13
  SPEAKER_00: Yeah.
• 20:14
  SPEAKER_02: Um walk us through like what an eval would look like.
• 20:18
  SPEAKER_02: Let's say somebody finds you on Chat GPT, they're like, Yeah, I found you on Chat GPT.
• 20:21
  SPEAKER_03: Yeah.
• 20:22
  SPEAKER_02: Um, and I just had a kid, right?
• 20:23
  SPEAKER_02: Let's say they're like, you know, eight months old now.
• 20:25
  SPEAKER_02: So they've been out of the game for they've been a mom for eight months at this point, but they're having some stress incontinence type symptoms, pelvic floor, pain, maybe some back pain.
• 20:35
  SPEAKER_02: And they want to come in for an eval.
• 20:36
  SPEAKER_02: Walk us through like what's what's that look like.
• 20:38
  SPEAKER_00: Yeah.
• 20:39
  SPEAKER_00: So I always like to start an eval with like just a very casual conversation.
• 20:44
  SPEAKER_00: They're sitting across from me, kind of like how you and I are.
• 20:46
  SPEAKER_00: And I try not to make it so like I'm badgering them, like interview style, but like just like a simple conversation, like so like tell me a little bit what's going on.
• 20:53
  SPEAKER_00: And then we're kind of just talking through, like hearing every day exactly like what's popping up for them.
• 20:58
  SPEAKER_00: Um, I try to tease out exactly like when and how those symptoms are popping up for them, when it started, so we can really get like a clear picture of what's going on.
• 21:06
  SPEAKER_00: But um, even beyond like the symptom stuff, I'm always asking them about like what their lifestyle is like.
• 21:11
  SPEAKER_00: Like, are they wanting to just get back to being functional or are they wanting to get back to running a half marathon?
• 21:17
  SPEAKER_00: So, like really teasing out what their goals are.
• 21:19
  SPEAKER_00: Um, and then also talking about dietary habits, stressors, what they do for work, what their relationship like is with their partner, because that's huge as well.
• 21:26
  SPEAKER_00: Um, and then kind of that's like more of the basic interview portion of it.
• 21:31
  SPEAKER_00: Um, then once we start getting more into like the physical evaluation, I always clear the spine.
• 21:37
  SPEAKER_00: So always taking a look at what their lumbar and thoracic mobility is like.
• 21:41
  SPEAKER_00: Um, so having them bend forward, lean back, twisting, um, and then side bending as well.
• 21:47
  SPEAKER_00: And then once I get them onto the table, that's when I'm really taking a look at everything.
• 21:51
  SPEAKER_00: First of all, I'm watching how they get on the table, because that will reveal a lot.
• 21:56
  SPEAKER_00: Um so especially like for postpartum patients.
• 22:00
  SPEAKER_00: Like depending on if they have like a C-section or not, sometimes they'll sit down and kind of like kick their leg out and kind of be in this awkward diagonal position, which depending on if they have the core strength yet or not, they can be putting a lot of pressure like in between those two six-pack muscles.
• 22:15
  SPEAKER_00: So that's when you start to see like abdominal separation pretty commonly postpartum.
• 22:20
  SPEAKER_00: Um, but yeah, so I'm just kind of like watching their mechanics, like whether they're getting in and out of bed or how they're getting in and out of bed.
• 22:27
  SPEAKER_00: That's typically the first thing that I look at.
• 22:28
  SPEAKER_00: And then I have them on the table and I have them take a deep breath in.
• 22:32
  SPEAKER_00: And that, similar to kind of what I mentioned earlier, their breath pattern can reveal so much with where they're carrying the tension, where they're allowing that breath to go.
• 22:42
  SPEAKER_00: Um and so for like the chest breathers, if the diaphragm is not fully descending the way that it needs to, and they're only breathing up into the chest like this, then the pelvic floor isn't getting that ability to just gently descend as well.
• 22:54
  SPEAKER_00: Um, so I, you know, take a look at that, see if there's um tension along the diaphragm.
• 23:00
  SPEAKER_00: So if their rib cage is like being is um kind of locked down, we take a look to see what's going on with that.
• 23:06
  SPEAKER_00: Um, take a look at how they're engaging their core, then look at hip range of motion.
• 23:09
  SPEAKER_00: So it's very, it's very in-depth.
• 23:11
  SPEAKER_00: Um, and then even I start like up in the head usually as well to see like SCM, like the sternocleidomastoid, seeing if there's tension along there, um, seeing the tension along the masseter.
• 23:21
  SPEAKER_00: And then I also look at feet as well, seeing like how their feet actually like are laying and resting on the floor, like when they're standing.
• 23:29
  SPEAKER_00: And then I'll usually test for a squat.
• 23:31
  SPEAKER_00: That's fine.
• 23:32
  SPEAKER_02: Oh, good.
• 23:32
  SPEAKER_02: Okay, yeah.
• 23:33
  SPEAKER_02: Some functional movement stuff.
• 23:34
  SPEAKER_00: Yeah, exactly.
• 23:35
  SPEAKER_02: Um, that makes total sense.
• 23:36
  SPEAKER_02: Like um keeping an eye on like like just how they get on the table, their gait pattern, and then like squat, of course, like all the functional stuff.
• 23:45
  SPEAKER_02: Um, I know a common thing that I've heard is women get like their feet get bigger after pregnancy.
• 23:49
  SPEAKER_02: Yeah.
• 23:50
  SPEAKER_01: Yes.
• 23:51
  SPEAKER_02: They get wider, maybe a little longer.
• 23:52
  SPEAKER_01: Yes, yeah, exactly.
• 23:53
  SPEAKER_02: Like my wife used to be like, I don't think she grew half a size.
• 23:56
  SPEAKER_00: Yeah, I I know I hear that quite often.
• 23:58
  SPEAKER_00: I don't have an answer for you in depth in terms of like how and why, but yeah, I have heard that.
• 24:04
  SPEAKER_02: Yeah, I mean it makes a lot of there's of course there's more, you know, pressure being placed downwardly.
• 24:08
  SPEAKER_00: For sure, for sure.
• 24:10
  SPEAKER_02: From all the yeah, gaining weight.
• 24:11
  SPEAKER_02: I saw a really funny video the other day that's like, you know, guy humor, but it was like the lady comes home, she's like, Yeah, so the baby weighs like eight ounces now.
• 24:18
  SPEAKER_02: It's pretty crazy.
• 24:19
  SPEAKER_02: He's like, Wait, didn't you gain like 30 pounds though?
• 24:21
  SPEAKER_02: Oh my like that wait, that doesn't make sense.
• 24:24
  SPEAKER_02: Have you gained like 30 pounds?
• 24:26
  SPEAKER_02: And it cuts to him like dead.
• 24:27
  SPEAKER_01: I was about to say, like infantly like jail, straight to jail.
• 24:32
  SPEAKER_02: Wait, that doesn't make sense.
• 24:33
  SPEAKER_02: So then where's the rest of the oh wait.
• 24:38
  SPEAKER_02: That was really funny.
• 24:39
  SPEAKER_02: I said it among my buddies, yeah.
• 24:40
  SPEAKER_02: I was like, maybe we know what not to say.
• 24:42
  SPEAKER_01: Oh, it's yeah, exactly.
• 24:45
  SPEAKER_01: Keep that in the back pocket of things to not tell your wife.
• 24:48
  SPEAKER_02: Yeah.
• 24:49
  SPEAKER_02: Um but that's good though, and you know, comprehensive.
• 24:52
  SPEAKER_02: Yeah.
• 24:52
  SPEAKER_02: Um, and um looking at functional movement patterns.
• 24:55
  SPEAKER_02: Oh, for sure.
• 24:56
  SPEAKER_00: See, yeah.
• 24:57
  SPEAKER_00: That's good.
• 24:58
  SPEAKER_00: And also, like, that's kind of like my beef with when people think pelvic floor therapy is only Kegels or the biofeedback machine or the M Cela chair, because I don't use any of that stuff, you know, like I don't use any machines because ultimately the way that I treat is the patient already knows what to do and how to treat themselves, but ultimately it's just giving them the guidance and the education to where they're able to reheal themselves, if that makes sense.
• 25:23
  SPEAKER_00: You know, um, because the second you start bringing in all of these like external devices, you're basically teaching the patient you actually can't get better without this external device.
• 25:32
  SPEAKER_00: Um, so yeah.
• 25:34
  SPEAKER_00: So it's kind of interesting because pelvic floor therapy can really differ depending on the setting that you're in.
• 25:39
  SPEAKER_02: Interesting.
• 25:40
  SPEAKER_00: Yeah.
• 25:41
  SPEAKER_02: Let's say at the end, people were like, um, at what point would people, would a patient be like, you know, I'm noticing improvements?
• 25:48
  SPEAKER_02: Let me start noticing that.
• 25:49
  SPEAKER_00: It really depends on the criticity of what's going on.
• 25:53
  SPEAKER_00: Um, I've had patients see results as soon as like five sessions, and they're like, oh my God, this is, I mean, everything has like been resolved and they're like thriving.
• 26:02
  SPEAKER_00: Um and I've been working with patients like longer than that, like maybe like 20 plus sessions, or like been working with them for a few months.
• 26:08
  SPEAKER_00: But it really depends on how long um they've been struggling with their symptoms.
• 26:13
  SPEAKER_00: Like I have a patient right now, she's seven years postpartum.
• 26:17
  SPEAKER_00: Um, so her symptoms have been going on for about seven years.
• 26:22
  SPEAKER_00: So it's a lot of like retraining, unlearning.
• 26:25
  SPEAKER_00: Um, so it takes a little bit longer than a postpartum mom who is like six weeks postpartum, for example.
• 26:31
  SPEAKER_00: And there hasn't really been much learning of compens compensatory habits.
• 26:35
  SPEAKER_00: That makes sense.
• 26:36
  SPEAKER_00: Totally.
• 26:36
  SPEAKER_02: Yeah, it's a unit's a harder to unlearn thing than that.
• 26:38
  SPEAKER_00: For sure.
• 26:38
  SPEAKER_00: 100%.
• 26:40
  SPEAKER_02: So someone that boat, um, were they living with symptoms for seven years?
• 26:43
  SPEAKER_00: Oh, yeah.
• 26:44
  SPEAKER_02: Wow.
• 26:44
  SPEAKER_02: Yeah.
• 26:45
  SPEAKER_02: And they thought it was normal.
• 26:46
  SPEAKER_00: Oh, yeah.
• 26:46
  SPEAKER_00: She like, I mean, you know, she didn't really know that there was like options like pelvic floor therapy to be able to treat it because especially like in the pelvic floor world, there is a really common narrative, like, oh, like that's just part of being a mom.
• 26:59
  SPEAKER_00: Like, I thought that was just something I had to live with.
• 27:01
  SPEAKER_00: That's just like what happens.
• 27:03
  SPEAKER_00: And it's a very common thing that I hear with like a lot of the moms that I work with.
• 27:06
  SPEAKER_00: Yeah.
• 27:06
  SPEAKER_00: Um, they're just like, why did nobody tell me about this?
• 27:09
  SPEAKER_00: Or like so many of my friends just like pee their pants when they start laughing and they think it's like normal.
• 27:14
  SPEAKER_00: And I'm like, no, it's not.
• 27:16
  SPEAKER_02: That can be fixed.
• 27:17
  SPEAKER_00: Oh, yeah, exactly.
• 27:18
  SPEAKER_00: So, but I think the narrative that's just been kind of a blanket over motherhood for so long, it's really hard to um have some moms like unlearn that identity, if that makes sense.
• 27:33
  SPEAKER_02: Yeah.
• 27:33
  SPEAKER_00: Um, because they, you know, yeah.
• 27:36
  SPEAKER_02: So yeah, I I I can see that.
• 27:38
  SPEAKER_02: Yeah.
• 27:38
  SPEAKER_02: But also, like it's just such a busy time.
• 27:40
  SPEAKER_02: Like, you can't, it's so hard to get just time a little away.
• 27:45
  SPEAKER_00: Oh, for sure.
• 27:46
  SPEAKER_02: Like, how are you gonna schedule a doctor's visit?
• 27:47
  SPEAKER_00: Yeah, exactly.
• 27:48
  SPEAKER_02: You have like 15 other ones for your other kids.
• 27:50
  SPEAKER_00: Oh, for sure.
• 27:51
  SPEAKER_02: You have two kids.
• 27:51
  SPEAKER_00: For sure, exactly.
• 27:52
  SPEAKER_02: And then snack time and dinner, yeah, nap time, cleanup, dishes, laundry.
• 27:56
  SPEAKER_00: Like, so it's interesting that like a nap.
• 27:58
  SPEAKER_00: Yeah, exactly.
• 27:59
  SPEAKER_00: Like they're running around trying to like figure out what's which ways up, which ways down.
• 28:03
  SPEAKER_00: Um, and it's funny that you mentioned that because I actually built out a postpartum program for moms virtually, specifically because of that, because they're not able to always get out and go to a doctor's appointment like every week or whatever.
• 28:15
  SPEAKER_02: Um, so just leave the baby alone at the house.
• 28:18
  SPEAKER_00: Yeah, yeah, exactly.
• 28:19
  SPEAKER_00: Like, yeah, no, no way.
• 28:21
  SPEAKER_00: Um, so I do like a virtual program where I'll build something out for them over the course of eight weeks where we can like nip the incontinence right in the bud um and abdominal separation too, like if they're trying to work through that as well.
• 28:32
  SPEAKER_02: So you mean diastis rectile, right?
• 28:34
  SPEAKER_02: Yes, yeah.
• 28:35
  SPEAKER_02: Um, explain that.
• 28:36
  SPEAKER_02: So, I mean, everything expands, right?
• 28:38
  SPEAKER_02: The stomach grows a lot, and then there's separation of the linear alba.
• 28:42
  SPEAKER_00: Yeah.
• 28:43
  SPEAKER_02: Yeah.
• 28:44
  SPEAKER_00: So abdominal separate or diastysis recti is obviously very common postpartum.
• 28:49
  SPEAKER_00: And I tell every postpartum mom, like, you're there's a 100% chance you're gonna have abdominal separation.
• 28:55
  SPEAKER_00: But the severity and the depth of the abdominal separation is what makes the biggest difference.
• 29:01
  SPEAKER_00: So a lot of people focus on like the width, like whether they have two, three, four fingers of abdominal separation.
• 29:06
  SPEAKER_00: But even beyond that, what's the most important is like whether the space in between the two six pecks or the um the rectus abdominis is firm or whether it's squishy.
• 29:16
  SPEAKER_00: Like, is there still um true integrity of the linea alba, or is it really that overstretched?
• 29:24
  SPEAKER_00: Um, so again, pressure management is like a huge thing that can help heal abdominal separation correctly.
• 29:31
  SPEAKER_00: And that's where a lot of women will end up staying with abdominal separation for years and years postpartum, thinking that again, it's just part of it because they didn't learn the proper techniques of how to engage their core, how to manage their pressure.
• 29:45
  SPEAKER_00: Um, and then they end up getting stuck because they'll use like a generic program or like an influencer's postpartum program or something like that.
• 29:51
  SPEAKER_00: Um, and then they are unknowingly making the abdominal separation worse or keeping it the same, kind of like sticking, keeping them in that same cycle.
• 29:59
  SPEAKER_03: Yeah.
• 30:00
  SPEAKER_03: Yeah.
• 30:00
  SPEAKER_00: Yeah.
• 30:01
  SPEAKER_00: But it's pretty, it's pretty um, it's oh it's very common.
• 30:04
  SPEAKER_00: So I think so many people try to like completely avoid it.
• 30:06
  SPEAKER_00: And it's more so we're just trying to decrease the severity essentially.
• 30:10
  SPEAKER_02: So do you ever use like uh corsets or like compression?
• 30:14
  SPEAKER_02: Like how do you what do you what do you use that with the exercises?
• 30:17
  SPEAKER_00: So when is that helpful?
• 30:19
  SPEAKER_00: Not really.
• 30:20
  SPEAKER_00: So in the very early stages of postpartum, like I mean like week one, week two at most, abdominal, like um, like abdominal wraps and can be great, more so just for comfort.
• 30:32
  SPEAKER_00: Now, beyond that, to heal the abdominal separation, we want to get rid of that because we want to teach the muscles to turn on when they need to.
• 30:40
  SPEAKER_00: If you start using like an abdominal brace or like the fahas are very common, you're essentially teaching the muscles underneath it, like, okay, like you can go to sleep.
• 30:48
  SPEAKER_00: I don't need you because the faha is doing the job that essentially you would be doing as well.
• 30:53
  SPEAKER_00: So, yeah.
• 30:53
  SPEAKER_00: So it doesn't necessarily treat abdominal separation directly.
• 30:57
  SPEAKER_00: It can give you the support that you might be looking for, especially after a C-section, you're probably gonna want a little bit of something.
• 31:02
  SPEAKER_00: But um, but yeah, I typically start again with just reconnecting the core, reconnecting with gently engaging TA.
• 31:09
  SPEAKER_00: And then depending on whether you had a C-section or not, that's when we'll typically introduce what's called like a hypopressive, which is a negative pressure breath that happens like underneath everything.
• 31:18
  SPEAKER_02: So that's cool.
• 31:20
  SPEAKER_00: Yeah.
• 31:21
  SPEAKER_02: That's what how do you teach people that?
• 31:23
  SPEAKER_00: It's a little tricky to be honest.
• 31:25
  SPEAKER_00: So I I don't even make any like educational content on it on Instagram because you really have to watch how somebody's doing it correctly.
• 31:32
  SPEAKER_00: But you basically have them take a full breath in, a full exhale, and at the end of the exhale, you have them suck in from their belly without taking another inhale.
• 31:41
  SPEAKER_00: So if you would like kind of think of a vacuum, it's like a vacuum, exactly.
• 31:44
  SPEAKER_00: Or like if you were to think of like a syringe, like it's kind of like pulling everything.
• 31:47
  SPEAKER_00: Um it's like the same concept.
• 31:50
  SPEAKER_00: But I always like to teach my patients that in person.
• 31:53
  SPEAKER_00: Um what's the benefit of that?
• 31:55
  SPEAKER_00: So if like what is that again?
• 31:57
  SPEAKER_00: The hypopressive.
• 31:58
  SPEAKER_00: Yeah.
• 31:58
  SPEAKER_00: Yeah.
• 31:58
  SPEAKER_00: So the hypopressive basically helps you to reconnect with that deep core like sooner and help create more of that like closed gap of the abdominal separation too.
• 32:08
  SPEAKER_00: So it's really great for patients who have trip like trouble engaging their pelvic floor, engaging TA, because it gives them a sense of like this is where the pelvic, this is where the muscles need to go.
• 32:17
  SPEAKER_00: Okay, and then they can kind of reconnect from there too.
• 32:20
  SPEAKER_00: Great for um prolapse as well, too.
• 32:21
  SPEAKER_02: Interesting.
• 32:21
  SPEAKER_02: I would imagine like so, like first initial inhale, it's contributing.
• 32:25
  SPEAKER_02: Because everything's exhaled.
• 32:26
  SPEAKER_00: Exactly.
• 32:27
  SPEAKER_02: Yeah, it's like an initiation of inhaling to create more abdominal pressure.
• 32:32
  SPEAKER_00: Yeah, exactly.
• 32:32
  SPEAKER_00: Yeah, exactly.
• 32:34
  SPEAKER_02: That's cool.
• 32:34
  SPEAKER_00: Yeah, so it's it's definitely a it's a cool trick for sure.
• 32:37
  SPEAKER_02: Yeah, that is a cool trick.
• 32:39
  SPEAKER_02: What do you find yourself um like suggesting to patients the most?
• 32:46
  SPEAKER_00: I feel like there's a lot that I'm always trying to educate them on.
• 32:50
  SPEAKER_02: I'm sure it depends on each diagnosis.
• 32:51
  SPEAKER_00: It really depends.
• 32:52
  SPEAKER_00: Yeah, it really depends because a patient who's having urinary incontinence, I would probably be giving them different advice than a patient who has like is having like painful intercourse, more so to say.
• 33:10
  SPEAKER_00: I would say like the most generic across the board that I give advice on is nervous system regulation and intention with their exercises.
• 33:21
  SPEAKER_00: That would be like the most basic.
• 33:23
  SPEAKER_00: If we were to zoom out something that I talk about with all my patients across the board, definitely nervous system regulation and then definitely intention with no matter what exercise they're doing.
• 33:32
  SPEAKER_02: Um nervous system regulation.
• 33:34
  SPEAKER_02: What do you mean?
• 33:35
  SPEAKER_00: Meaning, like if they're constantly living in fight or flight mode, typically that's gonna drive their symptoms up, like especially if they have a hypertonic pelvic floor, bladder stuff, nervous system response to that.
• 33:45
  SPEAKER_00: So four, seven, eight breath is huge.
• 33:47
  SPEAKER_00: Making sure that they like kind of take a step back and do like some body scans before they like are kind of just running around from day to day.
• 33:54
  SPEAKER_00: If they have like a really stressful job, like time batching whatever they can, um, giving them like blocks of things to do so their day is a little bit more organized.
• 34:03
  SPEAKER_00: So sometimes I'll help talk them through that, especially for moms who are home and they're like are running around doing a million to one things.
• 34:09
  SPEAKER_00: Um, I'll kind of help them like block off, like, okay, in this 30-minute increment, this is all you're gonna do.
• 34:15
  SPEAKER_00: And then same thing with this, and kind of just help them be like more organized in that aspect.
• 34:20
  SPEAKER_02: Yeah, something with that.
• 34:21
  SPEAKER_02: Like I literally had a patient the other day.
• 34:23
  SPEAKER_02: Um, part of it was like they're just they were working out a bunch, you know.
• 34:26
  SPEAKER_02: But they were like, I was like, I want you to work out, but we're just gonna modify the intensity and the volume of your worker right now to allow things to settle down because you're just effing it up over and over.
• 34:34
  SPEAKER_02: Yeah, it's a bottom.
• 34:35
  SPEAKER_01: Of course, yeah.
• 34:35
  SPEAKER_02: And she, this person was like, So you're giving me permission to not work out?
• 34:39
  SPEAKER_02: And I was like, Yeah.
• 34:40
  SPEAKER_02: They're like, Oh, they're like, Oh, thank you.
• 34:42
  SPEAKER_02: Oh my gosh.
• 34:43
  SPEAKER_02: I was like, huh.
• 34:44
  SPEAKER_02: Yeah, I'm ordered I'm like, bad holy like permission, like, please don't work out.
• 34:48
  SPEAKER_02: Like, yeah, I'm just I'm suggesting this right now.
• 34:50
  SPEAKER_02: Take a week.
• 34:50
  SPEAKER_02: Yeah.
• 34:51
  SPEAKER_02: Like, oh my gosh, I can.
• 34:52
  SPEAKER_00: Exactly.
• 34:52
  SPEAKER_02: I was like, uh, yeah, yeah, yeah, you totally can't.
• 34:55
  SPEAKER_00: Yeah, you're like, in fact, I actually want you to slow down.
• 34:57
  SPEAKER_02: Yeah, yeah, yeah.
• 34:58
  SPEAKER_02: Yeah.
• 34:58
  SPEAKER_02: So anyway, it sounds similar where it's like in this 30-minute block, you're not allowed to do dishes or you're not allowed to like prepare for whatever.
• 35:06
  SPEAKER_00: Exactly.
• 35:06
  SPEAKER_00: It's literally just like be intentional with your time.
• 35:09
  SPEAKER_00: So you're not having like split brain into like a million different pieces because your nervous system responds to that.
• 35:15
  SPEAKER_00: Your pelvic floor is going to respond to your nervous system, your bladder habits are like urgency, something very common if you have like a really um like upregulated nervous system.
• 35:23
  SPEAKER_00: So that's huge.
• 35:24
  SPEAKER_00: Um, and then the other thing with that I mentioned was um the intention.
• 35:28
  SPEAKER_00: So, like when you're going to like your workout classes, like I have a lot of women who do like Pilates and stuff like that.
• 35:32
  SPEAKER_00: Like, there's a difference between like doing a quadruped kickback and like actually doing a quadrup quadruped kickback with your core engaged and with your glutes being engaged.
• 35:44
  SPEAKER_00: Or same thing with a dead bug.
• 35:45
  SPEAKER_00: So many women think dead bugs are so easy until I show them how to do it correctly, coordinating.
• 35:51
  SPEAKER_03: This is how, yeah.
• 35:52
  SPEAKER_00: Yeah.
• 35:52
  SPEAKER_00: And they're like, oh, like this is actually kind of hard.
• 35:54
  SPEAKER_00: I'm like, yeah, it's humbling, right?
• 35:56
  SPEAKER_00: Like it's not the easiest exercise when you actually work out like with intention.
• 35:59
  SPEAKER_02: So what what um for the uh oh what was I gonna say?
• 36:06
  SPEAKER_02: So oh for for urinary incontinence, what would you suggest after that?
• 36:11
  SPEAKER_00: Um after like those two, after those two suggestions, so it depends on when the urinary incontinence is happening, like if it's happening from urgency or whether it's happening like stress.
• 36:20
  SPEAKER_02: Okay, delineate the but the two.
• 36:22
  SPEAKER_00: Okay, okay.
• 36:23
  SPEAKER_00: So for stress urinary incontinence, number one thing I would say is we're gonna time when you actually do the contraction.
• 36:28
  SPEAKER_00: So do you have like a you don't have a plastic water bottle?
• 36:30
  SPEAKER_00: Um, but I was gonna say, like when it comes to like pressure and when it comes to the pelvic floor needing to respond in a timely manner.
• 36:38
  SPEAKER_00: So if you go to cough, sneeze, laugh, all that kind of stuff, intraabdominal pressure is gonna skyrocket in a short amount of time.
• 36:45
  SPEAKER_00: Usually the pelvic floor isn't responding at that same time.
• 36:48
  SPEAKER_00: And in addition, if they're bearing down, you're basically taking a lot of pressure and shoving it down on a pelvic floor that's not ready to respond.
• 36:55
  SPEAKER_03: Yeah.
• 36:55
  SPEAKER_00: So first thing we take a look at is making sure that we can um change the pressure management to offload the pelvic floor.
• 37:03
  SPEAKER_00: And then the second thing is teaching them to then do a pelvic floor contraction at the time that they're doing a cough or sneeze or laugh or anything like that.
• 37:10
  SPEAKER_00: Um, so that's though that would be like the quickest way to treat stress urinary incontinence.
• 37:16
  SPEAKER_00: Now, if it's like with laughing or with running, it's very different or jumping.
• 37:21
  SPEAKER_02: It's very trampoline.
• 37:23
  SPEAKER_00: Yeah, with the trampoline, it's very different because now it's not just one episode of intraabdominal pressure, it's a series of repeated downward pressure on the pelvic floor, especially with jumping.
• 37:34
  SPEAKER_03: Yeah.
• 37:34
  SPEAKER_00: Um, and then jumping with two legs is very different than doing jumping jacks because now if you have like the ad doctor on stretch, how is the pelvic floor going to accommodate when they co-contract together?
• 37:44
  SPEAKER_00: Um, so what do you recommend for that?
• 37:46
  SPEAKER_00: Complex.
• 37:46
  SPEAKER_02: So I want to run, like I do a workout, I'm gonna run 400 meters and then come back.
• 37:51
  SPEAKER_00: So when it comes to running, we basically want to treat the pelvic floor to adapt to a series of single leg hops, because that's essentially what it is when you're running.
• 38:00
  SPEAKER_00: It's a series of single leg hops.
• 38:01
  SPEAKER_00: So we make sure that the patient is completely symptom-free with doing like a single leg squat, single leg stance, single leg calf raise, single leg hop, um, and then like slowly build and progress from there.
• 38:14
  SPEAKER_00: Um, when you're doing like jumping jacks, the goal would to help would be to help the pelvic floor adapt every time there's impact, every time like your feet are hitting the floor.
• 38:23
  SPEAKER_00: Um, but it depends on like how quick the jumping is.
• 38:26
  SPEAKER_00: So that's where it like really gets very specific based on the activity that they're that they're doing.
• 38:30
  SPEAKER_02: So what about urgency?
• 38:32
  SPEAKER_00: Urgency is a little bit different because usually it's a lot of bladder retraining and it's very cognitive.
• 38:41
  SPEAKER_00: So um a very common, um, a very common pattern that I'll see is that the second they get the urge, they have to go to the bathroom right away or they feel like they're gonna go to the bathroom.
• 38:52
  SPEAKER_00: There is, depending on how in-depth you want to get into this, there's like two different types of like an overactive bladder, but typically with the urgency that I treat, um, we we usually try to get the patient to naturally adapt to the bladder's urges.
• 39:06
  SPEAKER_00: So it's kind of like when you hear everyone like peeing just in case, kind of thing.
• 39:10
  SPEAKER_00: You're basically decreasing the threshold that your body perceive or that your bladder perceives that it's full.
• 39:16
  SPEAKER_00: So rather than waiting until the bladder is actually full and ready to void, your bladder is now telling you, hey, we have to go to the bathroom, even though like we're only a quarter of the way full.
• 39:25
  SPEAKER_02: So like we're here.
• 39:26
  SPEAKER_02: This is what we usually do.
• 39:27
  SPEAKER_00: Yeah, exactly.
• 39:28
  SPEAKER_00: Exactly.
• 39:28
  SPEAKER_00: So usually like those patients are going to the bathroom every hour.
• 39:32
  SPEAKER_00: They'll go to the bathroom and they feel like there's only a little bit coming out.
• 39:35
  SPEAKER_02: Um So how do you retrain that?
• 39:36
  SPEAKER_02: So wait as long as you can.
• 39:38
  SPEAKER_00: So it sounds kind of weird, but we basically use calf raises to suppress the urge for a short period of time because it stimulates sacral nerve.
• 39:47
  SPEAKER_00: So we kind of just like dampens the urge for a short period of time.
• 39:51
  SPEAKER_00: Um, and it's kind of weird when you first do it and you realize, like, oh, like that's kind of interesting.
• 39:56
  SPEAKER_00: So it dampens the urge.
• 39:57
  SPEAKER_00: And then most often than not, once we're able to suppress the urge, they're able to calmly make their way to the bathroom rather than allowing their nervous system to spike and they feel like they have to run there and then they end up leaking.
• 40:10
  SPEAKER_00: Um, so that's kind of usually the first thing that I'll do is like, okay, let's do calf raises, suppress the urge for even if it's like five or 10 minutes.
• 40:16
  SPEAKER_00: So you can slowly make your way to the bathroom and then you start to trust yourself, like, okay, instead of an hour that I have to go to the bathroom, then I can do an hour and 10 minutes.
• 40:23
  SPEAKER_00: And then you slowly increase the increments that way until they get to about like two to three hours.
• 40:28
  SPEAKER_00: Amazing.
• 40:28
  SPEAKER_00: They can void.
• 40:29
  SPEAKER_02: Yeah, that's a great also too, like retraining.
• 40:31
  SPEAKER_02: Like when I walk to the bathroom, I'm freaking out.
• 40:33
  SPEAKER_00: Oh, yeah.
• 40:34
  SPEAKER_02: Let's calmly go.
• 40:35
  SPEAKER_02: Exactly.
• 40:36
  SPEAKER_02: Or retraining.
• 40:37
  SPEAKER_00: Yeah.
• 40:37
  SPEAKER_00: Or a very common awareness.
• 40:39
  SPEAKER_00: Mental awareness is huge.
• 40:40
  SPEAKER_00: And a very common one too is like, you know, women who um like you walk up to the door, and like the second you see like the key and then putting it into the door, you're like, oh my god, I have to go to the bathroom.
• 40:48
  SPEAKER_00: And all of a sudden, like your bladder is like screaming at you, and you're just like, why?
• 40:53
  SPEAKER_00: Because it's like the visual cue that you're getting.
• 40:55
  SPEAKER_00: It's a conditioning, it's a conditioning, yeah.
• 40:57
  SPEAKER_00: So it's like the Pavlov's dogs.
• 40:58
  SPEAKER_02: You have to like retrain from you hear the bathroom key, it's like, oh no.
• 41:01
  SPEAKER_01: Yeah, exactly, exactly.
• 41:03
  SPEAKER_01: Triggered.
• 41:03
  SPEAKER_01: So, yeah, yeah.
• 41:04
  SPEAKER_02: Um that yeah, that that makes total sense.
• 41:07
  SPEAKER_02: Um, and also the calf phrases.
• 41:09
  SPEAKER_02: So the goal is to stimulate the sacral nerves, which would be what S1 and S2?
• 41:14
  SPEAKER_00: Yeah, yeah, exactly.
• 41:15
  SPEAKER_02: That innervate the pedun, like, yeah.
• 41:17
  SPEAKER_00: So there's there is a relationship between like the pedundal nerve and then also like the um like the detr the detruser muscle as well.
• 41:24
  SPEAKER_00: So the detrus muscle is like the muscle that lines the bladder.
• 41:27
  SPEAKER_00: So it basically helps to dampen it and make sure that the urge is not like as strong.
• 41:31
  SPEAKER_02: Interesting.
• 41:32
  SPEAKER_02: Kind of thing.
• 41:32
  SPEAKER_02: Yeah, yeah, yeah.
• 41:33
  SPEAKER_02: That makes total sense.
• 41:34
  SPEAKER_00: Exactly.
• 41:34
  SPEAKER_02: You know, people like hopping around if they have to go to the bathroom.
• 41:36
  SPEAKER_00: Oh, yeah.
• 41:37
  SPEAKER_00: Oh my god.
• 41:37
  SPEAKER_02: It's just subconsciously doing that.
• 41:39
  SPEAKER_00: For sure.
• 41:39
  SPEAKER_00: Yep, exactly.
• 41:40
  SPEAKER_00: And then the other thing too is like I had a patient who was struggling with urge for a long time.
• 41:45
  SPEAKER_00: And um, I mean, this is like the part of pelvic floor PT where it kind of gives you this like overall underlying sense of like frustration around the field.
• 41:56
  SPEAKER_00: Cause I had a patient who um was struggling with urge for quite some time and she was bouncing around from practitioner to practitioner, and nobody could figure it out.
• 42:06
  SPEAKER_00: She had a hysterectomy because they were, they thought that there was like some correlation with that.
• 42:11
  SPEAKER_00: She did the M cellar chair, had a sacral stimulator, all these things.
• 42:15
  SPEAKER_00: Um, and we just took the time to retrain the bladder, and I think it took maybe like six sessions really to where she was able to get the urge under control, which was something that she'd had been trying to figure out for a long time.
• 42:27
  SPEAKER_02: So that was a bladder retraining issue.
• 42:30
  SPEAKER_00: Exactly.
• 42:31
  SPEAKER_02: Wow, interesting.
• 42:32
  SPEAKER_02: Well, good, you know, got some help.
• 42:34
  SPEAKER_01: Yeah, exactly.
• 42:35
  SPEAKER_02: Um, I think it's just interesting that um it's it's you know, it seems like it's getting better, but the underlying thought of like, oh, it's just just normal, you know, like leaking, yeah, diets abdominal separation, um prolapse, maybe, you know, painful intercourse, all that stuff.
• 42:50
  SPEAKER_02: Is that another one common one of people like years and they're like, yeah, painful intercourse for like, you know, five.
• 42:55
  SPEAKER_00: Oh my gosh, yeah, for sure.
• 42:56
  SPEAKER_02: All they're don't like communicate with their partner or anything, like, are they nervous too?
• 43:01
  SPEAKER_02: Or do you think it's just normal?
• 43:02
  SPEAKER_00: Yeah, I think there's a lot, there's a lot to it.
• 43:06
  SPEAKER_00: Like painful intercourse is a little bit trickier because it really depends on their relationship with how comfortable they're talking about sex in the first place.
• 43:15
  SPEAKER_00: So if there's any like religious or like shame barriers around it, that's huge.
• 43:21
  SPEAKER_00: Um, again, if they've had like a history in the past, they don't really know any different.
• 43:26
  SPEAKER_00: So painful intercourse is a little bit more sensitive because every patient really is so different.
• 43:31
  SPEAKER_00: Um, there are some patients who I work with who need a session or two before we even attempt to do internal, just because they kind of want to like, you know, be able to like fully relax.
• 43:39
  SPEAKER_00: And, you know, I'm meeting them for the first time too.
• 43:41
  SPEAKER_00: So they're kind of like, I'm not sure.
• 43:43
  SPEAKER_00: Um, so I kind of just like let them lead in that regard.
• 43:47
  SPEAKER_00: Um, and then two, like a lot of it is education.
• 43:50
  SPEAKER_00: So sometimes I'm like, you know, we'll ask them like, so what's foreplay like?
• 43:53
  SPEAKER_00: And they're like, well, minimal.
• 43:56
  SPEAKER_00: And I'm like, okay, we're gonna start with that day one.
• 43:59
  SPEAKER_00: Um, So then I'm kind of like helping them communicate with their partner too.
• 44:03
  SPEAKER_00: But I think they just, you know, feel like it's normal, maybe.
• 44:07
  SPEAKER_00: Um so it's kind of it's kind of tricky.
• 44:09
  SPEAKER_00: Yeah, because it really depends on their relationship with it.
• 44:11
  SPEAKER_02: And I can see the complicated, it's complicated.
• 44:13
  SPEAKER_00: It's very, very complicated because some patients are very, some women are very comfortable talking about it with their partner.
• 44:20
  SPEAKER_00: Um, some aren't, some are not sure if they're gonna be receptive.
• 44:24
  SPEAKER_00: But then you also have a lot of really supportive partners as well.
• 44:27
  SPEAKER_00: Like I have a patient who I'm working with right now, like she's communicating everything that we're talking about in our sessions to her husband, and she like reports back to me and she's like, Oh my god, we're floored, like blah, blah, blah.
• 44:37
  SPEAKER_00: So it's so funny because I'm like basically talking to the both of them, but I'm really just talking to her.
• 44:41
  SPEAKER_00: Um, so yeah.
• 44:42
  SPEAKER_00: So you do see both sides of it, which is interesting.
• 44:45
  SPEAKER_00: Yeah.
• 44:46
  SPEAKER_02: Um, well, I appreciate you.
• 44:48
  SPEAKER_02: We'll have to land the plane, but I appreciate you coming in and sharing more about like all this stuff, this whole realm, you know.
• 44:53
  SPEAKER_02: Um, if there's what what message would would you want to get across to people in this in the Del Rey area, Boca, South Palm Beach?
• 45:00
  SPEAKER_00: Oh my gosh, so many.
• 45:02
  SPEAKER_00: But number one is advocate for yourself and ask questions, especially like when it comes to women's health, like advocacy is so downplayed, like, especially like when you're getting ready to go into the delivery.
• 45:14
  SPEAKER_00: I mean, we didn't even talk about birth, which is like a whole other conversation that we could go down a rabbit hole on.
• 45:19
  SPEAKER_00: But um, advocate for yourself and ask questions and do your research.
• 45:22
  SPEAKER_00: That would be like number one.
• 45:23
  SPEAKER_00: Um, and number two would be don't wait too long.
• 45:26
  SPEAKER_00: Like, even if you don't have symptoms that have been lingering for too long, like don't wait to see a pelvic floor PT if it's anything between your belly button and just below your groin.
• 45:36
  SPEAKER_00: Um, it's worth it to at least get an assessment and see kind of like what they can come up with.
• 45:41
  SPEAKER_02: So yeah, yeah, good.
• 45:42
  SPEAKER_02: Yeah.
• 45:42
  SPEAKER_02: Um, how can people reach out to you?
• 45:44
  SPEAKER_00: Um, so I am on Instagram.
• 45:46
  SPEAKER_00: So Dr.
• 45:47
  SPEAKER_00: Leticia Ori is the best way that you can find me on Instagram.
• 45:50
  SPEAKER_00: And then also my website at an um anatomypelvichealth.com.
• 45:54
  SPEAKER_00: Um, they can see my page on there.
• 45:56
  SPEAKER_00: And then if they want to reach out, you can fill out a form and then I can start a conversation from there.
• 46:01
  SPEAKER_02: Cool.
• 46:01
  SPEAKER_02: So well, thanks for coming in.
• 46:03
  SPEAKER_02: Awesome.
• 46:03
  SPEAKER_00: Thank you so much for having me.
• 46:04
  SPEAKER_02: Yeah, we'll have to get you in and to get you in and talk about the the birthday.
• 46:07
  SPEAKER_00: Oh, yeah, for sure.
• 46:08
  SPEAKER_00: That will go down a rabbit hole for sure.
• 46:11
  SPEAKER_02: Something that was just mind-blowing for me.
• 46:12
  SPEAKER_02: Like just the whole process and like everything that comes about, and like a whole humans created in there.
• 46:17
  SPEAKER_02: It's just really cool.
• 46:18
  SPEAKER_02: Yeah, it's just super interesting.
• 46:20
  SPEAKER_00: Women are amazing.
• 46:21
  SPEAKER_02: They are, they are.
• 46:22
  SPEAKER_02: Well, I appreciate you coming in.
• 46:23
  SPEAKER_02: Um, and we'll uh if you have any questions for Dr.
• 46:25
  SPEAKER_02: Letitia, don't hesitate to reach out and uh you know ask questions and um share this info with anybody else you think that might be needing help in that capacity.
• 46:34
  SPEAKER_02: And if y'all need to battling any iss other sports injuries or issues, feel free to reach out to us.
• 46:38
  SPEAKER_02: We can at least talk on the phone and chat about what you have going on and how we might be able to help.
• 46:41
  SPEAKER_02: And we'll catch you all next time.