Latest / The Driven Athlete / Pelvic Floor Health w/ Dr. Katie Usher | Ep 52

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Pelvic Floor Health w/ Dr. Katie Usher | Ep 52 · The Driven Athlete

• 0:00
  Speaker 1: If you're a driven, active person who wants to reach and pursue a higher quality life with some ambition, then guess what this podcast is for you.
• 0:07
  Speaker 1: This is the Driven Athlete Podcast.
• 0:10
  Speaker 1: What's up?
• 0:12
  Speaker 1: Y'all?
• 0:12
  Speaker 1: It's your man, dr Kyle.
• 0:13
  Speaker 1: Welcome back to the Driven Athlete Podcast.
• 0:15
  Speaker 1: We've got our special guest with us today my previous classmate and roommate at one point, dr Katie Usher.
• 0:22
  Speaker 1: So thanks for coming in.
• 0:23
  Speaker 2: Yeah, absolutely.
• 0:25
  Speaker 1: Thanks at one point, Dr Katie Usher.
• 0:26
  Speaker 1: So thanks for coming in.
• 0:27
  Speaker 1: Yeah, absolutely Thanks for having me.
• 0:28
  Speaker 1: You're a busy individual.
• 0:28
  Speaker 1: You have your own pelvic floor physical therapy practice in Palm Beach Gardens.
• 0:30
  Speaker 1: Yes, Tell people what it is where you're at and what y'all do.
• 0:35
  Speaker 2: Yes, so our business is Kaizen Pelvic Wellness.
• 0:38
  Speaker 2: We are in Palm Beach Gardens and we treat any person with a pelvic floor issue.
• 0:45
  Speaker 2: So pregnancy, postpartum men, kids, um, geriatric athletes, pretty much across the board.
• 0:51
  Speaker 2: We are pretty um we attract more of like pregnant and postpartum population Um, but yeah, we see everything.
• 1:00
  Speaker 1: That's cool, that's interesting.
• 1:01
  Speaker 1: Um, and so we all know now that we went to school together at University of Miami, go Canes.
• 1:08
  Speaker 1: After that, where did you go for work and training and school and stuff?
• 1:15
  Speaker 2: So most of my pelvic floor training is through the Herman and Wallace Institute.
• 1:20
  Speaker 2: They do most of the pelvic floor post-con education.
• 1:22
  Speaker 2: They do most of the pelvic floor post con education.
• 1:23
  Speaker 2: So those are all basically like weekend trainings and stuff like that.
• 1:28
  Speaker 2: So we're also trained.
• 1:31
  Speaker 2: There's four people on our team so a couple of us are trained in craniosacral dry needling.
• 1:36
  Speaker 2: There's a bunch of different like post education.
• 1:40
  Speaker 1: Yeah, pathways and stuff.
• 1:42
  Speaker 2: Yes.
• 1:43
  Speaker 1: What made you want to get into pelvic floor?
• 1:44
  Speaker 1: Did you always know you wanted to do that?
• 1:47
  Speaker 2: yeah, no.
• 1:47
  Speaker 2: So for a long time I thought I was going to do, either, like a p, I did a pediatric um rotation in pelvic floor or sorry, physical therapy school um, and I also was really interested in neuro.
• 1:58
  Speaker 2: I wanted to do a neuro residency in pt school.
• 2:01
  Speaker 2: I got more into pelvic floor therapy after graduation.
• 2:05
  Speaker 2: My sister in law had a pretty traumatic birth and I kind of watched that whole thing unfold and I knew that she needed pelvic floor therapy and she wasn't being referred or recommended.
• 2:17
  Speaker 2: And at the time I, when I graduated, I started doing travel physical therapy.
• 2:22
  Speaker 2: So I was in Colorado in an outpatient clinic and we were getting some referrals for low back pain and as I was treating these people I was like realizing that it actually was a pelvic floor issue.
• 2:33
  Speaker 2: They were also having incontinence and other things.
• 2:35
  Speaker 2: So I decided to take the weekend course to learn how to treat the pelvic floor and when I did it it basically just like changed my life.
• 2:44
  Speaker 2: Because once I started telling even my close friends that I was like going down this route, people just started coming out of the woodwork of like, oh, you know this, it's like the same thing when we graduate PT school, everybody's like, hey, can you look at my knee?
• 2:56
  Speaker 2: and um, but it was the same thing with the pelvic floor.
• 2:59
  Speaker 2: They're like, hey, like this hurts when I'm having sex is normal, or I pee when I stand up from the toilet.
• 3:05
  Speaker 2: And I was just realizing that the spectrum of pelvic health is so vast and so under talked about and so undertreated that so many people suffer in silence for years before they find the help that they need.
• 3:21
  Speaker 2: So, yeah, it just like drove me in and then once I started actually treating it was.
• 3:28
  Speaker 2: it's like I'm changing people's lives, like you feel that already, when you know when people can like run again after an ACL repair or something.
• 3:35
  Speaker 1: Yeah.
• 3:36
  Speaker 2: But when you have people who would tell you that they wouldn't leave their house unless they knew where the next bathroom was, it's like it really changes people's quality of life and um so yeah that makes total sense.
• 3:48
  Speaker 1: I was gonna say how else, like what do people say that it's like had no idea that their quality of life was that altered because of this, as in like, uh, we, we got to plan out where the bathrooms are before we leave, right, Right, that's that hinders a lot of just like freedom.
• 4:08
  Speaker 1: What else do you hear with that?
• 4:10
  Speaker 2: Well, one of the big things too is like getting up at night to pee, like people start to.
• 4:16
  Speaker 2: That starts to become like an issue that people start to normalize oh, I was up anyway, so I just go to pee and it can go downhill really quickly where we hear from people a lot where it's like you're getting up four to five times a night to pee, which is not normal at any stage of life and when you really, when we understand how important sleep quality is for function, it's like a bladder issue can permeate everything, and so and one of the important things to notice is like visceral tissue so our bladder, our rectum, our uterus, our stomach, our intestines most of the things are operating at an autonomic nervous level where we're not aware of its functioning day in and day out.
• 4:59
  Speaker 2: But a lot of times with pelvic floor dysfunction, if the tissue is that tight and it's like compressing on the organ, people are feeling pain or they're aware of their bladder all day long or their period pains are excruciating and it's so.
• 5:16
  Speaker 2: It makes a huge difference for people to just even not have that like mental load of what's happening in their pelvic floor.
• 5:22
  Speaker 1: Yeah, like the awareness for that.
• 5:24
  Speaker 2: Yeah.
• 5:24
  Speaker 1: What is that?
• 5:25
  Speaker 1: How's that?
• 5:25
  Speaker 1: How does that begin Like?
• 5:28
  Speaker 1: Besides like a traumatic, I could imagine a childbirth experience, right, that's a lot, of, a lot of evolutionary changes have happened on a female woman when they get pregnant and then get birth, right, like a lot of traumatic things occur.
• 5:40
  Speaker 1: Yeah, so that's totally understandable.
• 5:42
  Speaker 1: How the other things you're describing people that haven't gotten pregnant how does that unfold like that?
• 5:55
  Speaker 2: It's a really good question and it's a very loaded question.
• 5:56
  Speaker 2: Um, it's different for everyone and so, again, like what I started to say at the beginning is so most people that know to seek out pelvic floor therapy tend to be in the pregnant and postpartum population.
• 6:04
  Speaker 2: One part of the population that I really love working with is men, because men tend to suffer for a very long time before they seek out help and most people don't understand the pelvic floor at all.
• 6:20
  Speaker 2: And I say that to say that, like that is a society problem.
• 6:25
  Speaker 2: And it's also like when we were in PT school.
• 6:27
  Speaker 2: You know, we actually did cadaver lab for anatomy at the beginning of PT school and we didn't dissect the pelvic floor.
• 6:34
  Speaker 2: So we graduated pelvic floor therapy, physical therapy school with not even knowing like the anatomy of the pelvic floor.
• 6:50
  Speaker 2: Most people don't understand that unless you were to Google it or like really have um education in it.
• 6:52
  Speaker 2: So there is part of it where there's a lack of understanding of what's happening down there.
• 6:57
  Speaker 2: Um, a lot of times for people it starts with like a blunt trauma, like a fall on the tailbone.
• 7:03
  Speaker 2: It starts with like a blunt trauma, like a fall on the tailbone.
• 7:07
  Speaker 2: Sometimes it'll start with um like a bad sexual encounter, like uh, an abuse or or traumatic birth.
• 7:10
  Speaker 2: Sometimes it's GI issues, it's like people having IBS, where you're like really irritating the pelvic floor or the rectum or, you know, it starts like or a situation of chronic constipation that turns into hemorrhoids, which creates like spasming of the pelvic floor.
• 7:26
  Speaker 2: Yeah, it's different for different people.
• 7:30
  Speaker 2: Sometimes it does stem from childhood, whether it's like an anxiety of going to the bathroom in public, where it creates like holding patterns and then pelvic floor issues.
• 7:40
  Speaker 2: And sometimes it can be related to sport If you know, there tend to be more pelvic floor dysfunction issues in gymnasts and dancers and sometimes even like weightlifters anything where you're required to hold a posture for a long time or it's just an awareness of guarding of the pelvic floor Interesting.
• 8:06
  Speaker 1: So holding patterns, can that facilitate frequent urination at night?
• 8:12
  Speaker 1: It comes to the point where it's like, yeah, I've been going to the bathroom four times a night.
• 8:15
  Speaker 1: At this point, like I say, somebody says that Can holding patterns throughout several years prior kind of facilitate that progress?
• 8:23
  Speaker 2: Well, yeah.
• 8:24
  Speaker 2: So the bladder works on a feedback loop with the brain.
• 8:27
  Speaker 2: So what I'll tell people a lot of times is we can train our bladder, similar to the way we train puppies to potty train, right.
• 8:38
  Speaker 2: So if we are going to the bathroom on an hourly basis, your brain is going to start sending that signal prematurely that it's time to go to the bathroom, even if your bladder isn't full.
• 8:48
  Speaker 2: So in a normal feedback loop system, as the bladder is filling, it's stretching, it's sending a little bit of signal you're 25% full, it's stretching.
• 8:58
  Speaker 2: You're drinking a little bit more, it's 50, 75% full.
• 9:00
  Speaker 2: It's like, okay, you need to find a bathroom, right.
• 9:02
  Speaker 2: But what happens when we have holding patterns where we're either, like, going way too long sometimes we see that in like shift workers where you know, like nurses, if they're going to the bathroom once every eight hours, you're disrupting that signal.
• 9:16
  Speaker 2: Right, every two to three hours is what would be considered normal, and then all night would be considered normal, five to seven times a day.
• 9:22
  Speaker 2: So you can either have both ends of the spectrum where, like, you're holding it way too long and then and then you're having more dysfunction at night, or you're going too frequently and then that's signaling to prematurely to go to the bathroom.
• 9:34
  Speaker 1: Does that make sense?
• 9:35
  Speaker 1: Yeah, interesting, and that makes total sense.
• 9:37
  Speaker 1: We've in the past delved a little bit in pain science or the feedback loop with pain science and just like the neural pathways and then the brain, um, also contributing to how sensitized it is to receiving signals and then can feed more of the process.
• 9:54
  Speaker 1: So that makes a lot of sense too viscerally, like you know, that makes that makes a lot of sense and I do.
• 10:00
  Speaker 2: I spend a lot of time educating on the nervous system with the pelvic floors, like what you were just talking about with like pain science and neurofeedback loops, and because the pelvic floor is so close, like the nerves that supply the pelvic floor are coming out of that sacral plexus.
• 10:17
  Speaker 2: The cranium and the sacrum are responsible.
• 10:19
  Speaker 2: That's where our parasympathetic nerves come out.
• 10:21
  Speaker 2: For people who aren't familiar with what that is, it's your rest and digest.
• 10:25
  Speaker 2: It's like the calmed part of the nervous system and so if that is dysregulated, a lot of times we see pelvic floor dysfunction and that's also why there is a large connection between the pelvic floor and your head and your throat and your jaw.
• 10:41
  Speaker 2: People tend to have jaw pain or TMJ or like cervical, cervicogenic headaches.
• 10:48
  Speaker 2: There's tend to be a connection with pelvic floor.
• 10:51
  Speaker 1: Interesting Parasympathetic link that makes total sense.
• 10:56
  Speaker 2: Because if the whole system is dysregulated, it can affect a lot.
• 10:59
  Speaker 1: And the dysregulation being stress anxiety.
• 11:03
  Speaker 2: Stress, anxiety, holding, holding patterns, tension, interesting yeah, that makes a lot of sense.
• 11:10
  Speaker 1: The autonomic link, um, and the sacral involvement with the parasympathetics, that makes a lot of sense, um.
• 11:17
  Speaker 1: So what other neural education do you give patients?
• 11:19
  Speaker 1: So you're um, like just the dysregulation you're talking about for muscle firing and muscle function, same kind of thing as in like hypertonicity, guarding tension, muscle tension.
• 11:31
  Speaker 2: Yes, so we do spend a lot of time going over the breath with people and like trying to teach them how to basically reverse, engineer, tapping into that nervous system if they are having a hard time.
• 11:46
  Speaker 2: So a lot of times again, because going through, like the nervous system connection, pelvic floor and respiratory diaphragm are neurologically connected.
• 11:57
  Speaker 2: So a lot of times if we're seeing that they're stiff through the diaphragm and the rib cage, they're going to be stiff through the pelvic floor as well.
• 12:03
  Speaker 2: So in order to get things moving well, you have to really work on both.
• 12:10
  Speaker 2: So I do.
• 12:11
  Speaker 2: we do a lot of like working on mobilizing the diaphragm, working on like a 360 breath and to almost again like if there is some level of like stress component or hypertonicity or stiffness or just like rigidness there is because of the vagus nerve, like going through that diaphragm hiatus.
• 12:36
  Speaker 2: It's very important that the diaphragm is able to move and like massage those tissues and actually like send those signals to activate more of that part of the nervous system.
• 12:46
  Speaker 2: And if the diaphragm is stiff, it affects that.
• 12:52
  Speaker 2: So that makes total sense it helps, you know, manage heart rate and blood pressure and anxiety, because if you can't take a good breath, you're going to feel, you're going to feel a little anxious.
• 13:01
  Speaker 2: So not to say that that's a one size fits all, but we as a society it sounds like way too basic, but we do not breathe well at all Um, and even just the ability to like take a full exhale, you can't.
• 13:16
  Speaker 2: It's.
• 13:16
  Speaker 2: We're not doing that most of the time.
• 13:20
  Speaker 2: If we were to, if we were to take every person off of the street and actually like watch the way they breathe most people are very shallowly breathing and that affects.
• 13:28
  Speaker 2: It affects everything.
• 13:29
  Speaker 2: It affects our nervous system, but it also affects our cardiac system.
• 13:33
  Speaker 2: It affects our core function, because the pelvic floor is the bottom of our deep core, diaphragm being the top, totally, and so you're you're also, from um musculoskeletal standpoint, putting your back at risk and your core is not going to fire as as well yeah those aren't working well we work I mean from sports, sports pt standpoint um, we work on diaphragmatic breathing a lot.
• 13:59
  Speaker 1: Just, we know that there's a huge link between a lack of diaphragmatic breathing and chronic back issues like back pain.
• 14:05
  Speaker 1: And the diaphragm is like what I've heard before A core musculature is like a Coke can, yes, where the abdominals and the transverse abdominis and obliques wrap around the front and sides and then the erector groups are in the back of the Coke can and then the top of the Coke can is the diaphragm and then the top of the coat can is the diaphragm and then the bottom of the coat can is a pelvic floor.
• 14:26
  Speaker 1: Yes, um, and so, yeah, we, we definitely work on a lot of diaphragmatic breathing.
• 14:31
  Speaker 1: A lot of athletes, they, they don't know how to diaphragm breath.
• 14:35
  Speaker 1: So I'm like, from a core stability standpoint, of preventing back issues or sacroiliac joint pain, like SI, joint pain and hip pain, whatever, we're always like working on that at some point.
• 14:47
  Speaker 1: I'm like yo to be a core stability ninja.
• 14:50
  Speaker 1: First, there's three steps.
• 14:52
  Speaker 1: I'm like yo.
• 14:52
  Speaker 1: First we need to get awareness, as I'm like can you access your core appropriately with this exercise as an example?
• 14:59
  Speaker 1: And I'd be like where do you feel it?
• 15:00
  Speaker 1: Let's say you're doing this plank, you have back pain, right?
• 15:04
  Speaker 1: Okay?
• 15:04
  Speaker 1: What does that tell you you're using?
• 15:05
  Speaker 1: Can we use everything as much as we can?
• 15:07
  Speaker 1: Of course we can, but right now we're not, because you have back pain.
• 15:09
  Speaker 1: We're not actually moving your back and you're still having back pain.
• 15:12
  Speaker 1: You're just contracting things, right, okay.
• 15:15
  Speaker 1: So I'm like yo first step is can we reverse that and get a lot of the other core muscles to be contributing, thus taking some stress off the low back?
• 15:28
  Speaker 1: So we'll work on some stuff in session one.
• 15:29
  Speaker 1: They're like doing the same plank and they're like yeah, my back doesn't hurt and I feel my, my abs, I feel my core Cool.
• 15:31
  Speaker 1: Next step being like can we translate that to a more challenging functional, multi-joint movement, like a squat thruster or a landmine thruster or a box jump or a mid-ball slam or something like that.
• 15:41
  Speaker 1: It's like remember the core stuff we worked on to like last session?
• 15:44
  Speaker 1: Now can we have that be involved and contribute to this multi-joint med ball slam, you know?
• 15:51
  Speaker 1: And then like the third step, though, is at the same time, now can you breathe with your diaphragm while doing this multi-joint movement with your core being involved?
• 16:00
  Speaker 1: Like that's a core stability ninja.
• 16:01
  Speaker 1: So I think the diaphragmatic breathing is the link of like the end state, like cherry on top icing on the cake, of like getting the core super involved and strong.
• 16:12
  Speaker 2: No, I totally agree with that and it's interesting because you could take a high level athlete if they haven't had this training.
• 16:19
  Speaker 2: It's to watch someone lift or squat 250 pounds.
• 16:24
  Speaker 2: It still doesn't translate to mean that they understand how to brace properly and that is why we do see injuries and abdominal hernias or sports hernias or even leakage, like for women, or prolapse when they're under heavy load.
• 16:39
  Speaker 2: Because we are strong and we're determined and so, like you can, anybody can compensate and like move the weight, but to do it well and to really understand how to brace well and protect your pelvic floor organs and and your spine and you know, to do things without getting injured.
• 17:00
  Speaker 2: it's like a different story.
• 17:01
  Speaker 2: So a lot of times what we're doing is we are like totally peeling back the stages of like phases of treatment and going to the very basics of watching.
• 17:14
  Speaker 2: Take a breath Now, add some movement onto it.
• 17:16
  Speaker 2: Now, add more complex movement.
• 17:17
  Speaker 2: Now are you doing that while breathing but also bracing?
• 17:22
  Speaker 1: Yeah.
• 17:22
  Speaker 2: You know, because those are different things and it's yeah, it's interesting.
• 17:26
  Speaker 1: It's overloading for people and they've never done before you know.
• 17:30
  Speaker 2: And it's hard.
• 17:30
  Speaker 2: And sometimes it is hard when people have been used to training a certain way for so long that it's re.
• 17:36
  Speaker 2: It's relearning how to coordinate a, a movement which can be difficult, and that's what's really interesting.
• 17:43
  Speaker 2: That's why I really enjoy working with, like, pregnant and postpartum women, because that that in and of itself is like not to say you're starting from scratch, but you are starting from a different baseline after you have a child Like there is a different level of laxity and rebuilding and it's.
• 17:59
  Speaker 2: I actually think it's like a beautiful time and way to train properly at that point, to like relearn how to engage well to protect yourself.
• 18:09
  Speaker 1: So how do you yeah, how do you go about that then with, um, let's say you have a, I would imagine a very common case Female uh has a baby, a brand new postpartum month old baby, three weeks old maybe.
• 18:22
  Speaker 1: So they're three weeks out of a birthing process which is very intense and now they're having leakage or low back pain and pelvic floor pain.
• 18:34
  Speaker 1: Is that a pretty common description, or like, what does that look like?
• 18:39
  Speaker 2: It is Well, and so I'll back up even further, and that's.
• 18:50
  Speaker 2: I will say that's why I am a big fan of people doing prenatal pelvic floor therapy to a prep for birth as well as they possibly can and to hope for the best outcome, that there is as minimal damage as possible, um.
• 19:01
  Speaker 2: And to obviously have the best birth experience for the baby as well, um, but also be to prep for the postpartum side, to say, like week one, this is what you say.
• 19:11
  Speaker 2: Like week one, this is what you're doing.
• 19:13
  Speaker 2: Week two, this is what you're doing, week three.
• 19:14
  Speaker 2: And to really be able to break it down, because there isn't enough guidance in our current maternity care system, where it's like you're being seen at six weeks and you're like, okay, good, go do what you're going to do, and it really leaves women in the dark a lot of times where they're either not doing enough because they don't know what to do, or they're doing way too much, and then they're putting themselves at risk for, like, a hernia or a disc herniation or leaking or public organ prolapse.
• 19:45
  Speaker 2: So, um, so yeah, we basically usually start with a mat type of basically pilates based ta, like regaining all of that in a very, um, systematic way.
• 20:00
  Speaker 2: It's more so like dns, like dynamic neuromuscular stabilization.
• 20:04
  Speaker 2: It's a lot of times.
• 20:05
  Speaker 2: Oh sorry, what I'll tell um women is like think of the way your baby is going to develop to walk and run, and it's re kind of doing it in the same way where you're going to work on these exercises on your back and then you're going to work on rolling and then side lying and hands and knees and getting yourself up to be able to do a lot more dynamic stuff.
• 20:28
  Speaker 2: I mean, I'm a runner, so I I always for women to like want to go out and run.
• 20:34
  Speaker 2: I empathize with them a lot, but that is like most of the time, one of the worst things to do, like first out after having a kid.
• 20:41
  Speaker 2: But people want to lose the baby weight and so they don't really know it's a lot.
• 20:46
  Speaker 2: You know.
• 20:46
  Speaker 2: It's like your best to work on building up stability and a safe way first and then slowly get back to whatever it is you want to do, whether it's weightlifting or running, or yeah, okay, running is a lot of impact.
• 21:01
  Speaker 2: It's a lot of impact.
• 21:03
  Speaker 1: So you recommend pre before birth women that are going through the pregnancy process to do pelvic floor therapy purposeful exercises to set them up for success, for the birthing process when it happens, and then afterwards pelvic floor therapy to um get things to be more stable and moving better.
• 21:25
  Speaker 2: Yes, so when I first started doing this, I told you I started I got into this because my watching my sister-in-law have the birth that she had.
• 21:36
  Speaker 1: Yeah.
• 21:37
  Speaker 2: So when I started doing pelvic floor therapy, I was really passionate about working with postpartum moms because I saw postpartum pelvic floor therapy as preventative medicine for the postmenopausal stage where women are, you know, leaking and like the depends.
• 21:54
  Speaker 2: The depends industry is like insane of urinary incontinence I don't even know what it is so I'm not going to try and guess, but it's, it's very big.
• 22:01
  Speaker 2: So I saw postpartum care as preventative medicine for postmenopause Right, and the more I was doing it, I was like you know what?
• 22:11
  Speaker 2: Actually?
• 22:11
  Speaker 2: It's the prenatal care.
• 22:12
  Speaker 2: That is the preventative medicine, because women go through some I don't want to cuss on your podcast, but SHRT, you know, some people have beautiful experiences.
• 22:24
  Speaker 2: Some people have really traumatic experiences and some of them probably would have been unavoidable no matter what.
• 22:31
  Speaker 2: But I I just having two kids myself and to like listen to the things that some women go through, I'm like God, I wish I had been able to work with you pregnancy Like how much of this would have been avoided, how much of if we could have actually trained the pelvic floor to open well and to teach you how to do your own internal like mobilization so that the muscles weren't guarding and causing you to have like a failure to progress or something like that.
• 22:58
  Speaker 2: You know, um, because I do think again like we were talking about the neurological system and everything.
• 23:05
  Speaker 2: And yes, there is the exercise component of postpartum, but but there is also so much more.
• 23:12
  Speaker 2: It's like the psychological and the mental and emotional and spiritual and when women feel good in their bodies they show up differently when they're exercising but also in the world for their babies and for the partners and for their families, and so it feels to me like much bigger than just like rehabbing the platform.
• 23:35
  Speaker 2: You know what I mean I love that for sure.
• 23:37
  Speaker 1: Um, I totally hear what you're saying.
• 23:38
  Speaker 1: Like, um, when I can't speak, I'm not a woman, right, but speaking what you just said, when they feel better in their bodies, they show up differently for the world, their occupation, their partners, their family.
• 23:52
  Speaker 1: They show up differently for the world, their occupation, their partners their family.
• 23:56
  Speaker 1: As ever, true Men, same thing.
• 23:57
  Speaker 1: You know Totally Like that makes total sense.
• 23:58
  Speaker 1: And from a female standpoint of like after birth, that's a different.
• 24:03
  Speaker 1: It's a different position you know to be in.
• 24:07
  Speaker 2: Yeah, and it just makes there's so much.
• 24:12
  Speaker 2: I mean, everything about having a child is life-changing it adds another layer of difficulty or or adjustment when you're also dealing with like a fourth degree tear and fecal incontinence or you or like so much pain that you can't have sex with your partner.
• 24:29
  Speaker 2: Those are, those are like you expect, the change of like having kid but, you don't expect all of the other things that make it like way more challenging way more challenging, and for someone and myself included, I that.
• 24:43
  Speaker 2: That's why I do feel as passionate as I do about this topic, because I have an identity around, exercise Like, and it's, it's.
• 24:51
  Speaker 2: That is just like who I am and that's what makes me feel good mentally.
• 24:57
  Speaker 2: And so when that is taken from people because of the situation of, you know again, like whatever it is, um fourth degree tearing or or just like the inability to do what they want to do because of how their birth went, that upsets me.
• 25:15
  Speaker 1: So um, it makes sense.
• 25:16
  Speaker 1: So, when you say very, very, I'm just interested I'm sure other people are interested to traumatic experience, like a very traumatic experience with the birthing.
• 25:25
  Speaker 1: What does that mean?
• 25:25
  Speaker 1: What are some examples?
• 25:27
  Speaker 1: You said fourth degree tearing.
• 25:29
  Speaker 2: So that's a that's a really good question too, because that is in the eye of the beholder.
• 25:34
  Speaker 2: I think, um, I, I have seen people who've had emergency C-sections who didn't feel mentally or emotionally traumatized by the situation, and I've had women who wanted a natural birth and didn't get it, and they felt traumatized even though everything was fine the whole time in terms of safety of baby and themselves.
• 25:54
  Speaker 2: So there is um, there is a subjective component to it, um, but I would, I would classify anything as, or trauma, to be, anything which was out of the expectation of the family got it um so.
• 26:13
  Speaker 1: So, from just an objective, physical standpoint, what are some examples of physical, traumatizing birthing experiences?
• 26:21
  Speaker 2: Okay, that's another really good question.
• 26:23
  Speaker 2: I'm glad you asked because I think birth in and of itself, no matter what, is a trauma to the body.
• 26:29
  Speaker 2: Pregnancy is changing fundamentally the tissue of the body, and so I will give myself as a an example.
• 26:38
  Speaker 2: I had natural births and I didn't even I didn't have any pelvic floor tearing and um, because I was already in this field and I was already doing a lot of things and I I really focused a lot of time and I also got lucky.
• 27:00
  Speaker 2: There is a level of just like some things just happened that we don't know, but I still was a wreck postpartum and again, that was another thing that just kind of like confirmed that this is there needs Like everybody needs pelvic floor therapy after birth and, in my opinion, um I I had what most people would probably look at and think were ideal births and I still have dealt with prolapse and diastasis recti, like the separation of the abdominal wall, and things that I've had to like really be careful of and be mindful of, and in some days and I did prolonged breastfeeding, which also creates like an extended period of relaxin in the system which just makes your joints more susceptible to injury.
• 27:39
  Speaker 2: So there was probably a five and a half year span where every time I went for a run, I'm kind of like micromanaging each step and like am I, you know?
• 27:49
  Speaker 2: So there is um, from an objective standpoint, I again I think like birth in and of itself is a trauma to the body.
• 28:00
  Speaker 2: You know, it's like we roll our ankle and there's no thought you're going to pelvic or pelvic floor.
• 28:06
  Speaker 2: You're going to physical therapy for a couple weeks to like make sure you're stable and you're not going to injure yourself.
• 28:13
  Speaker 2: You push a baby out of your vagina or you have an abdominal surgery for a C-section and there's there's really, from a society standpoint, like no guidance of how to rehab the abdominal tissue, how to do soft tissue work on yourself, how, even if you had a first degree tear and you had two stitches in your vagina like scar tissue changes the function of the tissue.
• 28:43
  Speaker 2: Go years and think like, oh, this is how.
• 28:50
  Speaker 2: I just thought, this was how it was going to be, like I was always going to only have to be on top to to, like enjoy sex after having kids, or I was always going to be on the trampoline, or like certain things would always be painful, and it's like no, that's so sad that that's what you thought, because probably two sessions and I could have showed you like no just to.
• 29:10
  Speaker 2: It's a simple thing, actually but you just have to do it, you know.
• 29:14
  Speaker 1: Yeah, yeah.
• 29:14
  Speaker 1: So what are the things would be like like a running extra painful, like it was, like that's not supposed to be painful Running exercise, intimacy, sex with your partner.
• 29:25
  Speaker 1: This is supposed to be like that.
• 29:26
  Speaker 1: What else?
• 29:29
  Speaker 2: Everything, everything that you did before that wasn't painful, shouldn't be painful.
• 29:33
  Speaker 1: Gotcha.
• 29:34
  Speaker 1: Um and I also too.
• 29:36
  Speaker 1: I was gonna say like I totally appreciate where you're coming from, of like every, every birth process is a physically traumatizing event, Like cause.
• 29:45
  Speaker 1: I like I mean we have two kids right and I was, I was there during the process, the whole time helping, and I'm glad that I was.
• 29:53
  Speaker 1: I know that some husbands or partners want to be out of the room, you know, which is understandable, but if you had the fortunate opportunity to be present, I'm sure you can acknowledge like what I'm saying with this, Like man, it is intense, it's unbelievable.
• 30:13
  Speaker 2: It's like it's unbelievable.
• 30:15
  Speaker 1: It's unbelievable, it's different.
• 30:20
  Speaker 1: What different I was expecting.
• 30:20
  Speaker 1: You know, like you see movies and stuff like does not have to get too graphic.
• 30:22
  Speaker 1: The thing doesn't just like slip out, you know, it migrates downwards millimeters at a time and when they say like oh, we were in labor for eight hours, it's like that thing is in the middle of the perineum or like down the pelvic floor and sitting there for hours, like that changes some things.
• 30:41
  Speaker 1: And imagine if it's like a 10 pound baby yeah, you know what I mean, yeah and episiotomies were not really a thing anymore.
• 30:48
  Speaker 1: right, which, unless necessary, unless necessary, yeah, but imagine not, not as not as common, like dude, that's like very intense and very traumatizing.
• 30:57
  Speaker 1: Like we, yeah, but um, we were, we were fortunate.
• 31:01
  Speaker 1: You know from my, from my understanding, um like a great experiences, you know both ways, but um, for both kids, but um, man, it's, it's very intense.
• 31:10
  Speaker 1: You know, I think, like from birth, from like conception to the whole process to birth, and then now are playing with our kids, like it's just amazing, it is on, it's unbelievable, like how that happens.
• 31:26
  Speaker 2: It is unbelievable.
• 31:27
  Speaker 2: I agree with you and I think that, again, going back to what we were saying, is that most people don't even understand what the pelvic floor is, and that's why I feel so strongly about the prenatal pelvic floor therapy, because there is just something so empowering to be like okay, oh, that's where I'm supposed to let go, where I'm supposed to let go, and this, a lot of what we're doing in the prenatal therapy is like no, you don't need to be super strong.
• 31:55
  Speaker 2: Everybody kind of thinks it's like you have to be strong to push out a baby.
• 31:59
  Speaker 2: You have to like, let the process move through you.
• 32:01
  Speaker 2: You have to be able to relax, and that goes back to the nervous system and being able to again breathe through something that is not comfortable and recognizing that from a neurological standpoint.
• 32:16
  Speaker 2: A lot of times people are birthing in situations that are less than ideal.
• 32:22
  Speaker 2: It's like the lighting and people coming in and out and people you don't know that you've never seen before, and it's such an intimate experience, and so being able to have some autonomy over what you are experiencing and having some control over that, it is a situation where it's like people either feel really empowered by their birth or they feel stripped of the experience that they could have had, and some of that again.
• 33:01
  Speaker 2: Of course, always, there's always room for things to go wrong and there to be unexpected circumstances, but a lot of things it's like no, if we could have managed that a little differently, we could have had a different outcome.
• 33:15
  Speaker 1: So, yeah, so that's a good, that's a great point.
• 33:18
  Speaker 1: So the um bringing to light some expectations before the birth and being like no, no, no, do this instead.
• 33:26
  Speaker 1: No, no, no, let the process flow through you, versus being strong and pushing Um, that could totally change the game and then at least bring some confidence into the situation so that when it's very challenging, it's very challenging and it can be very challenging, it could be easier for some people on a spectrum like you were saying, at least being able to have a little bit of confidence in the process, which is the neural standpoint that is going to change the muscular, the objective muscular structures and pelvic floor maybe to be better.
• 33:58
  Speaker 1: Is that what you're saying?
• 34:00
  Speaker 2: Totally, and what I'll often, because, for people who don't really understand what I'm saying, the example that I'll give most of the time is like just think about how common it is for people to go on vacation and not be able to have a bowel movement, because that, like that level of like, regularity and safety of your own bathroom is like a thing.
• 34:22
  Speaker 1: That's a great point.
• 34:23
  Speaker 2: It's the same and that's that's your nervous system at play, and it's the same thing.
• 34:28
  Speaker 2: Like most people wouldn't be able to have an orgasm if they had lights on them like this and that's an obvious thing, right?
• 34:37
  Speaker 2: Like if you can't be able to get in the mood and to be able to have a baby.
• 34:41
  Speaker 2: Those are similar processes, it's a great point.
• 34:47
  Speaker 2: And some of that in a hospital is like we can't control those things.
• 34:51
  Speaker 2: So let's control the things we can control and see if we can like change the experience.
• 34:55
  Speaker 2: Yeah, great point.
• 34:57
  Speaker 1: I think it's something I've talked about a lot on this podcast, like just in general pain science again, and coming back to the point of like, I think in general it's the, the psychological component of the human experience, and pain experience being one of those two, and physiology of our body systemically, is very, very undervalued.
• 35:19
  Speaker 1: I feel like there's a lot, not enough weight placed on that, an argument being like our, we can't separate the mind from the body, no matter what we do, right, and there's always a psychological component with a lot of all these experiences, pain being one of them and with chronic issues going on, we know for a fact that psychological contributions can lead to physical changes, right, like hormonal dysfunction, um, autoimmune dysfunction, pain like that stuff is, um, very undervalued, I feel like.
• 35:54
  Speaker 1: And we know for a fact, like it is not up for woo-woo, uh, just a disagreement like mental and stress, anxiety and our psychological statuses can dictate and change physical symptoms and manifest physical attributions.
• 36:09
  Speaker 1: And on the public force standpoint, that's a great point.
• 36:13
  Speaker 1: Have you ever gone traveling and not had a bell?
• 36:15
  Speaker 1: You know a bowel movement?
• 36:17
  Speaker 1: yeah, for sure right nothing changed, just your location, but you're still like on earth, like you're not like in space.
• 36:24
  Speaker 1: You know what I mean.
• 36:25
  Speaker 1: Like the only thing that changed, then, is just the psychological component, right, and that's changing physiology.
• 36:31
  Speaker 1: That's a, that's a great, that's a great point.
• 36:33
  Speaker 1: I love that, um, but yeah, so all those um moving parts, with the whole birthing process having bright lights on you you're naked, you know what I mean.
• 36:43
  Speaker 1: Like it's not exactly, uh, like as you're in a hospital.
• 36:46
  Speaker 1: So they're professionals, of course, but it's still like.
• 36:48
  Speaker 1: For some people that can be a lot more difficult to manage, and other people, um and uh, just very uncomfortable.
• 36:56
  Speaker 2: Right.
• 36:56
  Speaker 1: So at least having some confidence going into that and some training uh uh in the mean like a prior can definitely make it more manageable.
• 37:03
  Speaker 1: I totally believe that it makes total sense.
• 37:06
  Speaker 2: Yeah, and then even from, like the orthopedic side, it's like I mean, we know this, you know it's, then you have.
• 37:14
  Speaker 2: Then you have a woman who's, like you know, five, ten years postpartum and bends down to pick up a pen off of the ground and her needs a disc in her back and no one would ever correlate that that had anything to do with like her core dysfunction that started when she gave birth.
• 37:29
  Speaker 2: Yeah, totally, totally.
• 37:30
  Speaker 2: But it's like those are the things that, like, they build on each other over time.
• 37:36
  Speaker 2: So it's like you didn't.
• 37:37
  Speaker 2: We didn't rehab you well, and then sure you could have gone back to doing whatever it is you were doing, or yoga, or whatever.
• 37:45
  Speaker 1: But if you don't have good integrity of your deep core system, your spine is going to be more compromised or it's more unstable or just more susceptible to um for long-term changes, totally, and then it's only going to get like at least what we found like for sports as an example.
• 38:04
  Speaker 1: Same thing let's say somebody's had a traumatic experience and they don't work on it.
• 38:07
  Speaker 1: We're humans, are really good at compensating to just get things done.
• 38:12
  Speaker 1: Those, those compensation patterns get more pronounced and worse over a longer period of time because it reinforces motor patterns in one thing which then suppresses and inhibits motor patterns in the other thing that was affected.
• 38:25
  Speaker 1: So for females that have back pain, SIJ pain, hip pain for five years and they've had two kids, you know like those disparities only have gotten more dysfunctional over the time because it reinforcing other movement patterns.
• 38:40
  Speaker 1: You mentioned relaxin.
• 38:43
  Speaker 1: Can you explain more of that and how that is going to play a role with joint pain and then hypermobility and instability and stuff?
• 38:52
  Speaker 2: joint pain and then hypermobility and instability and stuff.
• 38:54
  Speaker 2: Yeah, so relaxin is the hormone that is allowing the body to stretch during pregnancy and it doesn't go away basically until your three months post breastfeeding is when most studies have shown that you're going to have like it's going to go back to baseline Interesting so yeah.
• 39:14
  Speaker 2: So take myself as an example.
• 39:16
  Speaker 2: You know I breastfed my first for close to two years, but then I was also pregnant.
• 39:20
  Speaker 2: I got pregnant right away again.
• 39:21
  Speaker 2: So it's like you, and sometimes that will happen for people.
• 39:26
  Speaker 2: It's like you could see how easily if somebody has two to three children in a two to three year time span, you have years of relaxing that have been sitting in your chair.
• 39:36
  Speaker 1: It's like four years worth of relaxing, setting some changes.
• 39:39
  Speaker 2: So it's, you know, and I can appreciate Again, like the woman who wants to go out at six weeks and like start working out, but it's just the acknowledgement that it's like, okay, just just pare back a little bit.
• 39:51
  Speaker 2: I'm not telling anybody not to do anything.
• 39:53
  Speaker 2: It's like if you want to do CrossFit, let's do CrossFit, but let's let's actually make sure you can do everything body weight first and and like watch you do all.
• 40:02
  Speaker 2: Like the fundamental tests that like we kind of run through to make sure you have good integrity and stability there before we start adding anything in, and just recognizing that your, your joints are going to be loose, like you're lasting, you're going to have more elastin in your system.
• 40:18
  Speaker 2: So it's just like pretend that you're a really hyper mobile person and you it's like, so most people again, like a really common thing that people think to do during pregnancy is prenatal yoga.
• 40:34
  Speaker 2: Right, that's like one of the most common things that people organized exercise that people will do.
• 40:39
  Speaker 2: But the reality is most people need more stability in their systems when they're pregnant, and same thing early postpartum.
• 40:46
  Speaker 2: So and I'm not bashing yoga, I love yoga, but there just needs to be a balance there.
• 40:51
  Speaker 2: I would yeah let's do some like joint stability work and like banded squats and deadlifts and like that kind of stuff on top of the yoga, the yoga.
• 41:01
  Speaker 1: Yeah, that makes total sense.
• 41:02
  Speaker 1: So you see a lot of um, athletic individuals too, and the common things that you were mentioning were um, because you played basketball I did growing up yes, at uh in high school right and travel ball and stuff like that.
• 41:17
  Speaker 1: So you were a high level athlete, uh, so you had some athletic um the as high level as a five four.
• 41:28
  Speaker 1: I'm sure you had a great shot and good ball handling skills.
• 41:32
  Speaker 1: Um, but a lot of athletic people that have battled pelvic floor dysfunction and that usually looks like leaking pelvic floor, pain prolapse, what else?
• 41:46
  Speaker 2: Um, those are most things, um, sometimes hernias.
• 41:50
  Speaker 1: Oh, okay, sports her else.
• 41:51
  Speaker 1: Those are most things Sometimes hernias.
• 41:53
  Speaker 2: Oh, okay, sports hernias, yeah, yeah, totally.
• 41:55
  Speaker 2: And also this is like the interesting thing about athletics in general is and especially female athletics is because of the Q angle of our hips, like the way women's hips tend to be wider than our knees, and so the risk of injury.
• 42:09
  Speaker 2: A lot of times it doesn't look like it's pelvic floor dysfunction, but if you don't have good core stability and and deep hip rotator stability, a knee or ACL injury or an ankle injury I had.
• 42:22
  Speaker 2: I tore my MCL in high school and I rolled, I fractured my ankle a couple of times.
• 42:27
  Speaker 2: I tore my MCL in high school and I fractured my ankle a couple of times.
• 42:29
  Speaker 2: And yeah, none of that looks like it's a pelvic floor dysfunction, but for sure I was like looking back now I was like, oh my gosh, how were we not doing more stability work?
• 42:38
  Speaker 1: Yeah.
• 42:38
  Speaker 2: Right, totally.
• 42:40
  Speaker 2: So we were weightlifting, but I mean, our basketball coach was our basketball coach.
• 42:44
  Speaker 2: He didn't know what he was doing in terms of like in the locker room or you know, in the weight room in the weight room.
• 42:49
  Speaker 2: So, um, yeah, in my next phase of career maybe that'll be.
• 42:55
  Speaker 2: That is like another passion of mine, but it's just like how many hours in the day, or you know, maybe when my kids are at that level then I'll kind of deviate to that.
• 43:02
  Speaker 2: But I do think, um, from an athletic standpoint, whether in high school or college, or a lot of times things that don't look necessarily like they're a pelvic floor issue actually could be a pelvic floor issue Could be related contributing?
• 43:14
  Speaker 1: Yes, totally so.
• 43:16
  Speaker 1: You mentioned like tell me about the threshold of pelvic floor dysfunction for weightlifting, gymnastics, dance?
• 43:23
  Speaker 2: Yes, so there have been studies that have come out out like looking specifically at female weightlifters and because that is a common thing in Olympic weightlifting and powerlifting of women leaking when they're, like, under heavy load, and there have been recent studies that have come out that have actually shown that there are different thresholds for capacity of load of the pelvic floor.
• 43:46
  Speaker 2: It's like everybody has a certain amount of like collagen and elastin makeup in our tissue and so for people that tend to have like more elastin in the tissue, it's kind of the same thing of like how some people are double jointed or, you know, can hyper extend their elbows.
• 43:59
  Speaker 2: Um, where there there's going to be need, there they are going to need more pelvic floor strengthening and support and core stability and, um, you know some people whose tissue makeup is different yeah it's, they're going to look like they don't have any issues because their threshold for dysfunction is much higher.
• 44:21
  Speaker 2: Yeah, does that make sense?
• 44:22
  Speaker 1: totally um so there was a video I had circulated for a while, like a long time ago.
• 44:27
  Speaker 1: It was like this olympic lifter she's huge, she was like very muscular had circulated for a while, like a long time ago.
• 44:29
  Speaker 1: It was like this Olympic lifter, she's huge, she was like very muscular, strong, she's an Olympics like power, clean, snatch have you seen this?
• 44:35
  Speaker 1: And she she leaked like I get that level, like she's clearly done this a million times and she's the strongest of that capacity that a female could get to.
• 44:48
  Speaker 1: You know, at this point, and it was like in competition.
• 44:51
  Speaker 1: And then she leaked, you know, at like the bottom of a squad or something like that, and from a sports physio standpoint we're like, oh, interesting, you know, like, but I'm sure it's embarrassing for the girl, you know for the lady.
• 45:04
  Speaker 2: It's embarrassing.
• 45:05
  Speaker 1: But is that kind of what you're talking about?
• 45:06
  Speaker 1: Like we have very high level athletes and yet they're still susceptible, maybe, for pelvic floor dysfunction?
• 45:13
  Speaker 2: Yes, that's exactly what I'm talking about.
• 45:15
  Speaker 2: What do they?
• 45:16
  Speaker 2: They could teach the form of a squat better than anyone.
• 45:19
  Speaker 2: I'm not trying to teach them on their squat or squat 500 pounds and be totally strong.
• 45:23
  Speaker 2: Right, but it's, but it's actually the coordination of the core and pelvic floor and diaphragm.
• 45:29
  Speaker 2: And yeah, they're bracing technique.
• 45:32
  Speaker 2: It's the same and and to like, put it more practically, for like the every everyday person, that's like at a burn boot camp or a crossfit or something that they purposefully wear black leggings when they go for a run or they go to an organized exercise class because they're going to leak, and it's that all just comes down to the ability to brace and so and it's kind of similar in the same thing of like when we were talking about like pushing, pushing mechanics for birth there is a way to do that well, without damaging the pelvic floor and not having to hold your breath.
• 46:09
  Speaker 2: Most people, because they don't know how to breathe well and they don't know how to brace well, they have no idea what the pelvic floor even is or how they're engaging it.
• 46:16
  Speaker 2: They just aren't coordinating well and so they don't know how to engage well when they're under load.
• 46:24
  Speaker 2: Now, the flip side of that is that because they're leaking, they assume that they are weak, and a lot of times they are.
• 46:33
  Speaker 2: But there's also a lot of people that are actually just so tight and that they can't engage anymore when they're under any more load, because it's already maxed out, maxed out so and when you say tight, like clarify, you mean like they're super contracted and guarded.
• 46:54
  Speaker 1: The muscle tissue is guarded.
• 46:55
  Speaker 1: Spasmed, yes, like an end level guarding would be like a muscle spasm.
• 46:59
  Speaker 1: Yes, like a back spasm, right?
• 47:01
  Speaker 1: Yes, so imagine somebody has a back spasm and they bent over to the dog bowl and they bent over to get up you know their kid and their back threw out and they couldn't breathe for three days.
• 47:09
  Speaker 1: That's like a back spasm.
• 47:11
  Speaker 1: Yes, so that type of mechanism, but in the pelvic floor musculature.
• 47:16
  Speaker 2: Exactly, okay, exactly.
• 47:19
  Speaker 2: They're overworking at baseline, and so when they're under higher load, it's just not there for them, and so that is the misconception.
• 47:25
  Speaker 2: That's why it's it's just not there for them.
• 47:26
  Speaker 2: Yeah, and so that is the misconception.
• 47:27
  Speaker 2: That's why it's it's actually like dangerous, I think, for people to just not get an assessment because they assume they're weak and then they should start doing a lot of kegels.
• 47:37
  Speaker 2: You're just gonna you're just gonna turn this into a chronic pain situation.
• 47:40
  Speaker 1: Not only you're gonna be leaking, you're gonna be having pain and to be like imagine if somebody has a back spasm and you're like you know what you need to do.
• 47:46
  Speaker 1: We need to get on the floor and do hyperextension back lifts to strengthen your back spastic muscles that's what you're saying.
• 47:55
  Speaker 1: Doing Kegels would be like for a pelvic floor individual in that situation.
• 47:58
  Speaker 2: Right, and another thing again.
• 48:00
  Speaker 2: This isn't like a sexy thing to talk about, but hemorrhoids are a really common issue for people, and so it's like just knowing yourself If you know that you have a history of hemorrhoids.
• 48:14
  Speaker 2: Hemorrhoids are a tightness issue, so if you have had a history of hemorrhoids, there is a good chance that you have pelvic floor tightness.
• 48:17
  Speaker 2: So if you're also leaking, it's like something to explore.
• 48:20
  Speaker 1: Interesting.
• 48:21
  Speaker 1: That makes total sense.
• 48:22
  Speaker 2: It's the and so and again.
• 48:25
  Speaker 2: This is kind of just comes back to pelvic floor.
• 48:27
  Speaker 2: If you really were to think about all the things that could go wrong in the pelvic floor, it's like you know endometriosis, pcos, pelvic pain, general hemorrhoids, leaking, prolapse, constipation, painful sex, hernias, hernias, abdominal surgeries, like a lot of a lot of our male patients and female, but it um our post appendectomy surgeries that were like years ago, and the scar tissue and that lower abdominal wall is really starting to affect their bladder and their cycles, and so when you really like look at the ways in which the organs of the pelvic floor and then vice versa, and then the muscles on the organs, how they all interplay, the majority of people through their lifetime would have some type of pelvic floor dysfunction.
• 49:20
  Speaker 1: So it's yeah, it's just an interesting thing that makes sense, how universal it can be, how universal.
• 49:27
  Speaker 2: It can be Right, exactly, exactly.
• 49:29
  Speaker 1: So that's last, before we wrap it up.
• 49:31
  Speaker 1: I wanted to you mentioned very frequently you hear from females that they wear black leggings in anticipation of like when I leak.
• 49:40
  Speaker 1: I don't want people to see it Right, like I'm going to as like an expected thing.
• 49:44
  Speaker 1: Another lifestyle adaptation similar to like we can't go anywhere until I know exactly where the bathrooms are first.
• 49:52
  Speaker 1: It's like it's dictating your life, right, and the freedom's gone as in like just pick up and go, do whatever I want.
• 49:57
  Speaker 1: I'm going to wear red leggings today.
• 49:58
  Speaker 1: I'm going to wear, like, white leggings today, you know, but I can't because.
• 50:01
  Speaker 1: So that's a common thing you hear, right.
• 50:18
  Speaker 2: Is.
• 50:18
  Speaker 2: I'm going to wear black leggings because of this.
• 50:20
  Speaker 2: What would you want to convey to them?
• 50:21
  Speaker 2: Um, I would want to convey to everyone that if, whatever you're experiencing, if it's not pain-free, it's not normal, and if it's not functional, it's not normal.
• 50:25
  Speaker 2: Um, again, the majority of people that have pelvic floor dysfunction, if it's not tied up in pregnancy or postpartum spend, get a run around before they find someone that is able to help them.
• 50:37
  Speaker 1: Yeah, Um, I mean pelvic floor therapy.
• 50:39
  Speaker 1: It's a niche thing, that's not super common.
• 50:41
  Speaker 2: It's not, and so so people do think about pelvic floor therapy and increasing numbers when it's around pregnancy and postpartum.
• 50:50
  Speaker 2: But if it's like a woman or a man who has bladder pain syndrome or is like peeing every 30 minutes or a lot of UTIs or endometriosis, like horrible periods that they like can't get off their bed for a day, their first day of their cycle, get off their bed for a day their first day of their cycle.
• 51:08
  Speaker 2: All of those things are not normal and they are a sign of probably a lot of things like maybe hormonal dysfunction, other things as well, but a lot of times there's a physical component that can make a world of difference for them and a lot of times in the pelvic floor specifically, like the treatment.
• 51:28
  Speaker 2: It's like we're teaching our patients how to do all of this on themselves.
• 51:33
  Speaker 2: Like my goal is to get you as independent as possible as fast as possible, because it's really.
• 51:40
  Speaker 1: the exercises themselves aren't difficult, it's just knowing what to do and and how to like, pare it back and then build forward from there and what does it feel like during Right and what your expected sensations should be in post treatment on yourself, stuff like that.
• 51:55
  Speaker 1: So you're educating them on that stuff.
• 51:57
  Speaker 2: Right, you know, a lot of times I was listening to a birth summit last year and one of the women that was talking she was a midwife and she was talking about specifically like endometriosis and painful periods and infer and period pain too, because we don't even think about the fact that our uterus is a woman's uterus is suspended in space by ligaments that are attaching that into the bone.
• 52:36
  Speaker 1: That's a great point.
• 52:36
  Speaker 2: So if you have SI dysfunction and your ligaments are like off and your whole uterus is rotated or you have a ton of abdominal tightness or something like that, that's compressing, that can.
• 52:47
  Speaker 2: Those are like really simple things that we can fix that could make a huge difference for people.
• 52:52
  Speaker 1: Yeah, that's a great point.
• 52:53
  Speaker 1: I would consider that, as in, the uterus is suspended and it's just connected by ligaments that attach to the SI joint, the pelvis.
• 53:01
  Speaker 2: Yeah, the sacrum and the pubic bone.
• 53:03
  Speaker 1: And when that thing, when somebody gets pregnant, that thing grows in hundreds like a massive amount of time size and that's going to pull on some ligaments Right and then relaxin is flowing through as well.
• 53:14
  Speaker 1: It's a super great setup, unfortunately, for oblique dysfunction, like you were saying.
• 53:19
  Speaker 1: Yeah, the joints to get dysfunctional.
• 53:23
  Speaker 1: I'm just kind of surprised we don't hear more about back pain and women are able to get through pregnancy and be like well, not bad.
• 53:32
  Speaker 1: It's kind of surprising actually, considering all the factors.
• 53:34
  Speaker 2: Yeah it is, or are they just not speaking up?
• 53:39
  Speaker 2: Yeah, I think it's a little bit of that too.
• 53:44
  Speaker 2: I think there's a lot more people suffering in silence than we even account for.
• 53:48
  Speaker 2: But I mean, I'm a huge proponent of just like soft tissue work on everybody.
• 53:53
  Speaker 2: I mean society's past, like many other cultures understand that, and like in Ayurveda, like ancient Indian science my husband is trained in that and they are really big in like oilation and self-massage and because they understand our lymphatic system and our nerves and our vascular system.
• 54:16
  Speaker 2: All of that is running through our muscles and our joints.
• 54:18
  Speaker 2: Everything is it all has to flow well and we don't spend enough time.
• 54:23
  Speaker 2: I don't think as a society just like rolling out on a foam roller or you know, like really getting on a foam roller or you know like really getting into the deep tissue and trying to like allow things to move better and how, how important because of the location of everything in the pelvic floor, especially in that location in the pelvis, being able to like mobilize muscles in the back and tissues in the abdominal wall and hips, how that can affect all of our organs.
• 54:48
  Speaker 1: That makes sense.
• 54:49
  Speaker 1: Yeah, Really cool and enlightening.
• 54:52
  Speaker 1: If people like, seriously, I'm not being, that was very enlightening.
• 54:56
  Speaker 1: But if people want to reach out, how can they?
• 54:59
  Speaker 1: How can they find you?
• 55:00
  Speaker 2: Yeah, yeah, so we are on Instagram is Kaizen Pelvic Wellness.
• 55:04
  Speaker 2: Our website is Kaizen Pelvic Wellness.
• 55:06
  Speaker 2: Yeah, I think that's cool.
• 55:10
  Speaker 2: We, yeah, we're on Facebook, Instagram website.
• 55:14
  Speaker 1: Cool, check them out.
• 55:15
  Speaker 2: Google all the things, yeah.
• 55:17
  Speaker 1: Yeah, Any pelvic floor issues and dysfunction, Um, because we don't do that Right, that's not our thing, you know.
• 55:23
  Speaker 1: So we want to, we want to um send people the way that they need for their.
• 55:25
  Speaker 1: So we want to send people the way that they need for what's most advantageous for them.
• 55:29
  Speaker 1: You know what I mean.
• 55:30
  Speaker 2: Yeah, and that is like a quick important note to make is, when people are seeking this out, you really kind of want to make sure that you are finding someone that is specifically trained to treat internally the pelvic floor, because the pelvic floor therapy has become a little more niche and catch phrasey.
• 55:48
  Speaker 2: There are, um, some hopefully well-intentioned but like misguided people that think that they're, like you know, doing some core exercises and stuff and they're they're claiming to like treat the pelvic floor.
• 56:01
  Speaker 2: It's misrepresentation and for people who don't know and are seeking this out, it can be really like disheartening toening to think that it didn't work for them when they weren't actually getting what it is.
• 56:13
  Speaker 1: 100%.
• 56:13
  Speaker 1: We say the same thing in sports.
• 56:15
  Speaker 2: Yeah, exactly.
• 56:17
  Speaker 1: But I appreciate you coming in.
• 56:18
  Speaker 1: If you have any questions, reach out.
• 56:20
  Speaker 1: Don't hesitate to reach out to Dr Katie and them, or with us, any sports and orthopedic issues.
• 56:27
  Speaker 1: That it's not pelvic floor and we're always open to suggestions, comments, questions, concerns conflicting opinions, so don't hesitate to reach out.
• 56:34
  Speaker 1: We'll have to get you in again together on another one.
• 56:36
  Speaker 2: Yeah, talk about athletes and stuff so fun.
• 56:38
  Speaker 1: But thanks for coming in and we'll catch y'all next time.