Latest / The Body Pod / Pelvic Floor Therapy for Everyone: Debra Goldman on Healing, Strength & Support

Transcript

Pelvic Floor Therapy for Everyone: Debra Goldman on Healing, Strength & Support · The Body Pod

0:00
Speaker 1: Hey everyone, This is Haley and I'm Lara, and welcome
0:03
Speaker 1: to the Body Pod.
0:11
Speaker 2: What if the.
0:11
Speaker 3: Key to unlocking your core strength, easing chronic pain, and
0:15
Speaker 3: even improving your emotional well being was hidden in your
0:18
Speaker 3: pelvic floor. Today we're diving deep, literally and figuratively with
0:23
Speaker 3: pelvic floor therapist Deborah Goldman. As a leading practitioner in
0:28
Speaker 3: pelvic rehabilitation, Deborah helps people reconnect with the most foundational
0:33
Speaker 3: part of their bodies. This is a conversation that just
0:38
Speaker 3: might change the way you think about your body.
0:46
Speaker 1: Welcome Deborah Goldman to the Body Pod. We are so
0:51
Speaker 1: thrilled to have you here. This is a very different
0:53
Speaker 1: subject and we've had we haven't had an expert on
0:57
Speaker 1: in this pelvic floor area.
0:59
Speaker 2: So welcome, thank you. I'm so excited to be here.
1:03
Speaker 2: It's truly in honor.
1:05
Speaker 1: Can you just give us a little just give us
1:07
Speaker 1: a little intro about yourself and how you got into
1:11
Speaker 1: pelvit floor physical therapy, because I don't even know that
1:15
Speaker 1: every woman knows what that entails. They might have heard
1:18
Speaker 1: the name, but couldn't tell you exactly you know what
1:22
Speaker 1: actually happens.
1:24
Speaker 2: Okay, Well, I'll start off by saying I'm a late bloomer,
1:29
Speaker 2: so I didn't go to physical therapy school until I
1:33
Speaker 2: was thirty three. After a career as a career as
1:38
Speaker 2: a modern dancer and movement teacher, I taught exercise at
1:45
Speaker 2: NYU's fitness center. I did body work. I became certified
1:51
Speaker 2: in something called the Alexander technique, which is all about
1:54
Speaker 2: posture and breathing. And then and that was, as I said,
1:58
Speaker 2: I was dancing, and then I realized I needed a career,
2:02
Speaker 2: and I was attracted to physical therapy because I had
2:05
Speaker 2: always been very active and physical. And I went to
2:09
Speaker 2: school after completing my prerequisites, even though I had two
2:14
Speaker 2: other degrees, because I managed to avoid science and math
2:17
Speaker 2: for so long that been there. Yeah, and so graduated
2:26
Speaker 2: from Northwestern University, a fantastic school, with a degree in
2:32
Speaker 2: physical therapy, and immediately went into moved back to New
2:36
Speaker 2: York and went into sports medicine and orthopedics for twelve years.
2:41
Speaker 2: So I worked at a wonderful training and physical therapy
2:49
Speaker 2: facility in the World Financial Center, and I had a
2:54
Speaker 2: really great experience reading every type of sports medicine and
2:59
Speaker 2: orthopedic surgeries, knee surgeries, you know, elbows, backs, lots of
3:08
Speaker 2: great collaboration too with fantastic orthopedist orthopedists in New York
3:14
Speaker 2: who loved s tending their patients to physical therapy and
3:17
Speaker 2: really believed in what we did. But I started to
3:20
Speaker 2: have an interest in women's health too. And then when
3:24
Speaker 2: I was there for a few years, then I had
3:30
Speaker 2: my I was pregnant and at forty and with my
3:35
Speaker 2: one and only, and I discovered a book called The
3:40
Speaker 2: Essential the Essential Exercises for the child Bearing Year, which
3:46
Speaker 2: was written by an Australian physical therapist. I know you
3:51
Speaker 2: love Australian people, and so and Elizabeth Noble was someone
3:56
Speaker 2: who had come and moved to the United States, I
4:00
Speaker 2: think in the late sixties, but wrote this book in
4:04
Speaker 2: nineteen seventy six. There was nothing else like that, So
4:08
Speaker 2: and she actually started in my professional organization, the American
4:13
Speaker 2: Physical Therapy Association, the kind of the groundwork for what
4:18
Speaker 2: we know as public floor physical therapy specialization. So when
4:24
Speaker 2: I was pregnant and postpartum, I used her book as
4:27
Speaker 2: my guide to my postpartum recovery. And it was really
4:32
Speaker 2: more exercise base at that time, but there was nothing
4:37
Speaker 2: else like that. So fast forward a couple of years
4:41
Speaker 2: and I started a practice in New York at a
4:46
Speaker 2: midwiffery run child bearing center, which was one of the
4:49
Speaker 2: few of its kind, and I worked closely with the
4:53
Speaker 2: midwives and the assistance there, and so I started seeing
4:57
Speaker 2: a lot of pregnant postpartum patients and I knew I
5:01
Speaker 2: was missing something, but the pelvic floor aspect wasn't really
5:07
Speaker 2: in my consciousness at that time. That was like nineteen
5:10
Speaker 2: ninety nine. But in any case, and I a few
5:14
Speaker 2: years later, in two thousand and two, my family moved
5:17
Speaker 2: to New Jersey, and I was trying to figure out
5:20
Speaker 2: what I was going to do because I didn't want
5:24
Speaker 2: to work for a big practice anymore. And so I
5:28
Speaker 2: was trying to figure things out, and I had put
5:31
Speaker 2: myself out there on my professional organization as someone who
5:34
Speaker 2: was interested in women's health. And I was contacted by
5:39
Speaker 2: a young physician who was just starting his eurogynecological practice
5:44
Speaker 2: at a local hospital. So eurodynecology at that time was
5:48
Speaker 2: a relatively new field too. Eurogynecology is kind of the
5:53
Speaker 2: marriage of obstetrics, gynecology, and neurology with emphasis, you know,
5:59
Speaker 2: solely on women's pelvic health. So I met Yeah, so
6:04
Speaker 2: I met with him, doctor Siegel, and he convinced me
6:09
Speaker 2: that I should study pelvic floor therapy because he was
6:14
Speaker 2: looking for someone to refer his patients to. And it
6:18
Speaker 2: just was kind of serendipitous because I really was looking
6:21
Speaker 2: for something else and I just kind of dove into
6:26
Speaker 2: the coursework and immediately loved it and found it incredibly
6:32
Speaker 2: interesting and realized this was my niche because this was
6:37
Speaker 2: everything that I kind of wanted to put together that still,
6:41
Speaker 2: you know, having the orthopedic sports medicine mind, but really
6:45
Speaker 2: focusing on women's health. So I quickly started my own
6:52
Speaker 2: private practice. Plus I worked with him at the hospital
6:56
Speaker 2: one day awake, one day a week for eight years years.
7:00
Speaker 2: So I learned a lot about your guide, about prolapse,
7:03
Speaker 2: about eurodynamics. I had residents and medical students shadowing me.
7:09
Speaker 2: I was able to give grand rounds at the hospital
7:12
Speaker 2: to the attendings and the residents and this pelvic floor function.
7:18
Speaker 2: So I had a great education on that and then
7:21
Speaker 2: I so as I said, I did that for eighty years,
7:23
Speaker 2: and then I kind of focused more on pelvic pain.
7:27
Speaker 2: So I really see a wide variety of patients male, female,
7:33
Speaker 2: you know, all I accept all genders, all sexes, Everyone
7:38
Speaker 2: has a pelvic floor. I don't see children, but that's
7:42
Speaker 2: kind of how the trajectory of my career started back
7:46
Speaker 2: in two thousand and four after my twelve years as
7:50
Speaker 2: an archpedic sports medicine, physical therapy.
7:53
Speaker 1: So let's break down what pelvic floor therapists. If somebody
7:58
Speaker 1: is coming to you, because I I think I shared
8:00
Speaker 1: this with you earlier on another podcast or just when
8:04
Speaker 1: we were chatting, I was I was seeing a physical
8:08
Speaker 1: therapist for a hamstring issue that was not getting resolved,
8:11
Speaker 1: and I don't know why, but somehow she was like,
8:16
Speaker 1: did you have trauma with any birth? And I said, yeah,
8:19
Speaker 1: my last child, blah blah blah x y Z, and
8:22
Speaker 1: she said, you need I think you need to see
8:24
Speaker 1: a pelvic floor therapist. I had no idea that it
8:28
Speaker 1: was like what it was and what it entailed, meaning
8:34
Speaker 1: I didn't know it was an internal exam. I thought
8:36
Speaker 1: I was just like going for physical therapy and I
8:39
Speaker 1: didn't know what they were going to do. So I know,
8:42
Speaker 1: I can't be the only one here. What if somebody
8:45
Speaker 1: were to come to you, Well, first of all, somebody
8:47
Speaker 1: would ask you to what you do? Can you break
8:50
Speaker 1: down what a pelvic floor therapist does and then how
8:54
Speaker 1: a session would go.
8:56
Speaker 2: Yeah with you. So, typically the things that people come
9:02
Speaker 2: to see a pelvic floor physical therapists are bladder symptoms.
9:06
Speaker 2: So it could be you know, urinary leakage, retention, frequency,
9:12
Speaker 2: stress in continents, urge in continence, and we can go
9:15
Speaker 2: into that a little bit more later. Different types of
9:19
Speaker 2: bowel symptoms constipation, hemorrhoids, fecal incontinence, and perenial trauma which
9:27
Speaker 2: can cause all of those above, and that's from childbirth injuries.
9:31
Speaker 2: Sexual dysfunction that includes pain with penetration. The medical term
9:40
Speaker 2: is dysperunea. So even just very right at the entrance,
9:44
Speaker 2: there's pain or pain with deeper penetration difficulty or pain
9:50
Speaker 2: or leakage with orgasm. Then there's kind of the umbrella
9:55
Speaker 2: term of pelvic pain, which could include people who have endometriosis,
10:02
Speaker 2: so they have adhesions, they have restrictions, they have they
10:06
Speaker 2: have their public organs don't move because of those restrictions.
10:11
Speaker 2: I see patients post hysterectomy, both surgical medical and natural,
10:19
Speaker 2: or you know, menopausal. I see patients with who have
10:24
Speaker 2: had post gynecological cancer surgeries. I see people with abdominal surgeries,
10:33
Speaker 2: so I see patients with tummy tucks because that can
10:37
Speaker 2: really affect the bladder function as well. You would also
10:42
Speaker 2: see patients who have coxic or tailbone pain, so it
10:46
Speaker 2: could be a trauma from falling or even a childhood
10:50
Speaker 2: fall on the coccic or even from a seat belt
10:54
Speaker 2: injury from having COCs of pain. And then I see
10:58
Speaker 2: pregnant patients, So I see pregnant patients who have pelvic
11:03
Speaker 2: girdle joint pain, you know, pubic synthesis pain, hip pain,
11:07
Speaker 2: lower back pain, muscle tightness, bladder leakage, or they also
11:13
Speaker 2: want a program to prepare them for childbirth, and so
11:18
Speaker 2: we can include that. Then kind of the bread and
11:22
Speaker 2: butter is postpartum patients, so people who have had childbirth
11:28
Speaker 2: injuries from non physiological childbirth, you know. So that can
11:34
Speaker 2: include episiotomy, the use of forceps or a vacuum, or
11:41
Speaker 2: just some some women are induction. They have inductions, and
11:47
Speaker 2: it's they're kind of encouraged to push before they're really
11:49
Speaker 2: ready to push, so that all of those things can
11:52
Speaker 2: cause a lot of pelvic floor trauma. They also might
11:57
Speaker 2: come for diastesis recti, which is the separation of the
12:03
Speaker 2: rectus muscle prolapse, So pelvic organ prolapse can happen during pregnancy,
12:10
Speaker 2: and it can happen postpartum. And then I see also
12:15
Speaker 2: a lot of women in perry and menopause right now.
12:19
Speaker 2: So perimenopausal women are you know, coming to me with
12:25
Speaker 2: also some of the same same complaints, but it's now
12:29
Speaker 2: it's kind of being mediated by hormonal changes. So pain
12:34
Speaker 2: with pain with penetration, the bladder leakage, not able to
12:40
Speaker 2: have the same kind of core strength they might have
12:42
Speaker 2: had before strength programs. I mean, it's prolapse, it's it's
12:49
Speaker 2: really can go on and on with that. I also
12:52
Speaker 2: see men, not as many because men don't like to
12:55
Speaker 2: refer themselves quite as much. But you know, I've seen
12:58
Speaker 2: men who have pelvita from you know, working lifting too
13:03
Speaker 2: heavy at the gym, or or they are they do
13:07
Speaker 2: work that requires a lot of lifting and pressure. And
13:11
Speaker 2: actually that goes for you know women too, like so
13:14
Speaker 2: women who are women who have jobs where they're may
13:19
Speaker 2: be nurses or lifting, you know, people in healthcare situations,
13:24
Speaker 2: teachers because teachers don't get to go to the bathroom,
13:28
Speaker 2: so they might have retention and bladder issues. It's pretty
13:35
Speaker 2: it's quite a long list. So that's why someone would come.
13:39
Speaker 3: That's what I was just going to say. The list
13:42
Speaker 3: is so long.
13:43
Speaker 1: So pretty much everyone, this is what I'm mad about
13:47
Speaker 1: because I found out after I started going, I found
13:51
Speaker 1: out that in France, part of their postpartum care includes
13:56
Speaker 1: pelvic floor physical therapy.
13:58
Speaker 2: Come on, America, Well it's not. It's not only France.
14:03
Speaker 2: I mean, it's most of the Nordic countries, it's I'm
14:06
Speaker 2: pretty sure it's Australia. There might even be other places
14:10
Speaker 2: in you know, the Middle East or India, like there's
14:14
Speaker 2: we are so behind, we are so behind the times.
14:19
Speaker 2: And you know, it's I mean, and it's scary because
14:23
Speaker 2: I think things are just going to get worse for
14:25
Speaker 2: women's health right now. So and I think that we still,
14:34
Speaker 2: you know, women are still being gaslighted about their experiences. So,
14:42
Speaker 2: I mean, when I started back in two thousand and
14:46
Speaker 2: three or four, and I've had so many women tell
14:51
Speaker 2: me that they were having leakage. They might have had,
14:54
Speaker 2: you know, a few pregnancies, and they would complain to
14:58
Speaker 2: their physician and they were they we literally were told,
15:02
Speaker 2: what do you expect you you had children, you were pregnant,
15:06
Speaker 2: or I have other patients who have pelvic pain and
15:10
Speaker 2: they're still told have a glass of wine, or go
15:15
Speaker 2: for a walk, or relax, or just go bear through
15:18
Speaker 2: the pain. So I'm sorry to say that it's still
15:24
Speaker 2: really bad, that it hasn't changed much. I mean, what
15:28
Speaker 2: has changed? What has changed? Because menopause is having a
15:32
Speaker 2: moment finally, So now they're on social media, there are
15:37
Speaker 2: you know, people can learn from the there's some really
15:40
Speaker 2: great doctors as you know, you know, Rachel Ruben and
15:43
Speaker 2: Kelly Casperson, people I've met at conferences in New York,
15:46
Speaker 2: and so they're on board with pelvic floor therapy, but
15:51
Speaker 2: they're also on board with just saying it like it
15:54
Speaker 2: is and helping helping women find their voice to fight
15:59
Speaker 2: back because for a long time, you know, my profession,
16:03
Speaker 2: we were in the trenches. I've been seeing her menopause
16:07
Speaker 2: and menopausal women you know for years and to try
16:12
Speaker 2: to communicate with their physicians that maybe try some vaginal
16:16
Speaker 2: estrogen or it was torture. So now there's a little
16:21
Speaker 2: more opening up, but it's still a very difficult road.
16:25
Speaker 1: Okay, So then what does that look like somebody, here's
16:28
Speaker 1: all of the symptoms that they might have or a
16:31
Speaker 1: reason to come to you. So they come to your office,
16:35
Speaker 1: and what does therapy look like? And can they do
16:38
Speaker 1: some at home? I absolutely did some stuff on Zoom
16:41
Speaker 1: when we had the pandemic and nobody was seeing anyone
16:45
Speaker 1: in person. So what does that look like?
16:47
Speaker 2: You know? I will tell you during the pandemics, I
16:50
Speaker 2: had never done virtual therapy before, and my phone was
16:53
Speaker 2: ringing off the hook and it worked better than I thought.
16:59
Speaker 2: It was good though, And I'll show you some of
17:03
Speaker 2: the things that I use to So when someone comes
17:06
Speaker 2: to see me, you know, I send them a detailed
17:10
Speaker 2: intake form because I want to know what's going on
17:13
Speaker 2: and have some background. And I mean, you know, as
17:17
Speaker 2: I'm saying, I can have such a range of patients.
17:20
Speaker 2: So there's not one prototype. There's not one. You know,
17:25
Speaker 2: everyone is individual. But I look at them as a
17:28
Speaker 2: whole person, and you know, I start with the subjective exam,
17:32
Speaker 2: and then I do a movement exam, so I look,
17:36
Speaker 2: you know, with their clothes on, so I look at
17:39
Speaker 2: their spine, I look how they're moving. I do functional movements.
17:42
Speaker 2: I have them twist, I have them bend, I go,
17:44
Speaker 2: I look at a squat. I put them on the
17:47
Speaker 2: table and I check their hip range of motion. I
17:51
Speaker 2: check their hip strength. I check their their parts of
17:55
Speaker 2: their nervous system, what's called neural tensions, to see if
17:58
Speaker 2: there's any nerve pain. I look at their abdominal wall.
18:02
Speaker 2: I check for diastesis. I check with them lying face down.
18:07
Speaker 2: I check all the different el the girdle joints. I
18:12
Speaker 2: check their spine, I check their ribcage. I see how
18:14
Speaker 2: they're breathing. And then I invite them for a pelvic
18:19
Speaker 2: floor exam. SO pelvic floor exam so so and I
18:23
Speaker 2: explained that a pelvic floor exam is not like going
18:27
Speaker 2: to the gynecologist. It's a muscular skeletal exam. So, so
18:34
Speaker 2: I'm looking at I'm looking at the muscles and the
18:39
Speaker 2: nerves and the ability of the muscles to contract to relax.
18:44
Speaker 2: Are there trigger points? Are their tender points? How does
18:47
Speaker 2: it function? Can I? And I will also do an
18:51
Speaker 2: exam of the what's you know referred to as the perineum. So,
18:56
Speaker 2: and this is very typical. It's there's a is called
19:00
Speaker 2: a Q tip test. So you use a medical Q
19:02
Speaker 2: tip and you check along the peranial body, along the labia,
19:08
Speaker 2: in the labium, manure and majora. You're really looking to
19:12
Speaker 2: see is their tenderness, is their inflammation, what nerves are involved,
19:18
Speaker 2: because there's several different nerves that innervate all different parts
19:22
Speaker 2: of the pelvic floor. And then I have that objective information.
19:26
Speaker 2: Then I put on my gloves and we use lubrication
19:30
Speaker 2: and I explain the popasaf so then I do. So
19:36
Speaker 2: they are lying on their back with their knees up,
19:39
Speaker 2: and I use one or two fingers, left fingers, and
19:44
Speaker 2: I come in and I check the integrity of the
19:48
Speaker 2: So these are more of the superficial first layer muscles
19:52
Speaker 2: as I just described it about the paraneum. And then
19:55
Speaker 2: I go and I checked the deeper muscles. So the
19:58
Speaker 2: pelvic floor is a sling and a bowl, and so
20:05
Speaker 2: just like any other floor, it's there to serve as
20:08
Speaker 2: support for whatever is on top. So I'm looking at
20:12
Speaker 2: the deep muscles and I'm asking them, you know, I'm
20:16
Speaker 2: seeing can I do I feel that they can contract?
20:20
Speaker 2: Do I feel that they can relax? Is there any pain? Tenderness?
20:25
Speaker 2: Is there? Nerve pain there? And then I'll go to
20:29
Speaker 2: the other muscle I'll do the same thing. And then
20:33
Speaker 2: I'll check the muscles that are up in the area
20:37
Speaker 2: behind the pubic bone, because this is where the urethra
20:40
Speaker 2: and the bladder live, so I want to check the
20:43
Speaker 2: integrity of those muscles. I'll check. For a female, I'll
20:46
Speaker 2: check the integrity of the anterior or front vaginal wall.
20:51
Speaker 2: I'll actually check on the urethra and see how that feels,
20:56
Speaker 2: because it should feel firm and not mashey. And then
21:00
Speaker 2: and then I'm going to check I'm going to check
21:05
Speaker 2: the muscles that are what we call the fast switch muscles,
21:10
Speaker 2: So those are the muscles as a where eye on
21:13
Speaker 2: these behind the urefair because these are the muscles that
21:16
Speaker 2: have to quickly close the sphinters if there's a bladder issue.
21:21
Speaker 2: The muscles of the deeper part of the pelvic floor
21:23
Speaker 2: are those are your endurance muscles, So I'm checking for
21:27
Speaker 2: a more like endurance or longer rest. And then that's
21:35
Speaker 2: pretty much the basis for the pelvic floor exam some patients.
21:41
Speaker 2: Some patients I might do the exam rectally because if
21:47
Speaker 2: they have so much pain and they're not able to
21:50
Speaker 2: tolerate any vaginal penetration, I can get very good results
21:55
Speaker 2: from doing a rectal exam and you get to check
21:58
Speaker 2: the muscles that are deeper by the tailbone. But I
22:01
Speaker 2: can even get up to this deep opperator muscle there.
22:04
Speaker 2: So you really want to find you really want to
22:07
Speaker 2: find the driver for what's happening in the pelvic floor
22:11
Speaker 2: in order to have a plan of care.
22:14
Speaker 3: Okay, I did not realize how thorough and how much
22:19
Speaker 3: went in to the exam.
22:21
Speaker 2: It's a lot, and sometimes you don't do it all
22:26
Speaker 2: at once.
22:27
Speaker 1: Yeah, if you if okay, so you find something that's
22:29
Speaker 1: tender or or that you know doesn't feel like it's
22:33
Speaker 1: up to par, then you know what, what does the
22:37
Speaker 1: therapy look like?
22:39
Speaker 2: You know what? I also what I left out is
22:41
Speaker 2: you know, for for for females, I can also see
22:45
Speaker 2: and check if there's a prolapse. So I want to
22:49
Speaker 2: know is there a bladder prolapse? Is there a rectal prolapse?
22:52
Speaker 2: I can also check and I can actually go on
22:55
Speaker 2: try to find the cervix and see if that's moving correctly. So,
23:00
Speaker 2: so if it was someone who had pain with penetration,
23:09
Speaker 2: who had what we call non relaxing short type pelvic
23:14
Speaker 2: floor muscles, that's going to look very different than someone
23:18
Speaker 2: who has perhaps weakness with overly lengthened pelvic floor muscles.
23:25
Speaker 2: So for someone with very tight muscles, if we're able
23:29
Speaker 2: to do an internal vaginal exam and they're able to
23:34
Speaker 2: tolerate that, then this is one of the tools that
23:39
Speaker 2: we would use for home, which is called a pelvic
23:43
Speaker 2: wand so it's a medical grade silicon wand that because
23:48
Speaker 2: of the way it's designed, it has a smaller end
23:52
Speaker 2: and a bigger end, So someone can actually initiate their
23:56
Speaker 2: own therapy using the wand to do some at the
24:01
Speaker 2: superficial layers, but also I teach them how to view
24:06
Speaker 2: the stretching and the mobilization of these tissues at the
24:09
Speaker 2: deeper levels. But it really helps if they're able to
24:14
Speaker 2: tolerate my manual work doing it, because that way they
24:21
Speaker 2: will be able to connect more with their breath and
24:24
Speaker 2: I really integrate it with mindfulness and diaphetic breathing. So
24:31
Speaker 2: having an exam, having an exammed by a public therapist
24:36
Speaker 2: can really help you understand what is exactly the problem.
24:40
Speaker 2: So once I know that, then I can prescribe this
24:44
Speaker 2: and teach them how to use it, and we might
24:47
Speaker 2: start with that and it might take a while for
24:50
Speaker 2: them to even feel comfortable to do this, you know,
24:53
Speaker 2: and I try to, you know, not put pressure on people,
24:57
Speaker 2: like keep it by your bedside table, even if you
24:59
Speaker 2: do for two or three minutes a day, that's a start.
25:04
Speaker 2: And then once they get comfortable with this, they learn
25:07
Speaker 2: to relax and really feel what's happening in their body,
25:13
Speaker 2: because I think that's often the disconnect. It's like, you
25:17
Speaker 2: know you have pain, you know it's hidden inside of you.
25:22
Speaker 2: You can't see it like you can see your bicep.
25:26
Speaker 2: So you know, some people think like, oh, is it
25:29
Speaker 2: just a hole that's tight. So once you really learn
25:33
Speaker 2: about your own body and what the model looks like,
25:36
Speaker 2: becos it becomes a conversation with your nervous system more
25:41
Speaker 2: than anything else. And so it allows the muscles to
25:46
Speaker 2: relax around the nerves and that way to diminish the
25:50
Speaker 2: tightness and to get a more integrated feeling for what's
25:54
Speaker 2: going on and what happens is So then they might
25:56
Speaker 2: do that and then all of a sudden, there seeing
26:00
Speaker 2: their bladder more efficiently, or maybe they're they're they're realizing,
26:05
Speaker 2: you know, they don't have to stop and start having
26:08
Speaker 2: a bowel movement four times a day, they can just empty.
26:13
Speaker 2: So those are some of the things. And then we
26:16
Speaker 2: also might use vaginal dilators, which I'm gonna show you.
26:21
Speaker 2: So they this way someone can practice penetration without the
26:30
Speaker 2: pressure of having a partner. And because you know, I
26:33
Speaker 2: mean most partners they don't want to, they don't want
26:36
Speaker 2: to cause pain. They don't want to, they don't want
26:38
Speaker 2: to you know, it hurt you. But but there's still
26:43
Speaker 2: this need for intimacy and for sex, and I think
26:46
Speaker 2: a lot of people feel pressured. So if you start
26:49
Speaker 2: with I mean, this is a very you know, this
26:51
Speaker 2: is a teeny leany little vaginal dilator and this is
26:54
Speaker 2: the same company Intimate rows. So these are all medical
26:57
Speaker 2: grain silicons. This would be for someone who you know,
27:00
Speaker 2: really has a hard time having any penetration. They go
27:04
Speaker 2: up sequentially. Most people will graduate to something like this,
27:10
Speaker 2: but they come bigger. So this way they have a
27:13
Speaker 2: home program where they can first use the wand get
27:17
Speaker 2: that relaxation. Because I think it's important to think of
27:23
Speaker 2: the public floor three dimensionally, which it is, so it's
27:27
Speaker 2: that bottom, it's the top, and it's the bowl, and
27:31
Speaker 2: then you can use your dilator to practice penetration and
27:34
Speaker 2: breathing and use that to bring you closer to your
27:38
Speaker 2: goals with your intimacy.
27:40
Speaker 3: So is titless one of the most common issues you see.
27:44
Speaker 2: It's a very big issue. Yes, and I will tell
27:48
Speaker 2: you that I see a lot of young women who
27:52
Speaker 2: have that. So they are you know, they're pre p perimenopause.
27:57
Speaker 2: I'm talking about you know, young women in their twenties
27:59
Speaker 2: or you know, early thirties. They have a lot of tightness.
28:04
Speaker 2: They might have undiagnosed endometriosis. So that's something that you know,
28:11
Speaker 2: I will take a more of a history. You know,
28:14
Speaker 2: they do they have very heavy periods where the period's
28:19
Speaker 2: so bad that they had to miss school and or
28:22
Speaker 2: work or were they never able to put a tampon in,
28:26
Speaker 2: Because that's a big clue, So that there's millions of
28:31
Speaker 2: young women who have those issues. I mean, I have
28:33
Speaker 2: a young woman who had a hysterectomy. She's thirty one,
28:41
Speaker 2: and because she had cervical cancer. So you know, after hysterectomy,
28:46
Speaker 2: your muscles can tighten up and it's very painful, especially
28:51
Speaker 2: someone who can't take any type of hormone, including including
28:54
Speaker 2: topical hormones, so that is a very very large component,
28:59
Speaker 2: and it can happen after a C section two.
29:02
Speaker 1: So I assume you're a fan of vaginal estrogen very
29:07
Speaker 1: much because I think, well, you tell me, but I
29:12
Speaker 1: would imagine that some of these symptoms maybe present later
29:18
Speaker 1: on in life around perry and postmenopause, with bladder leakage
29:24
Speaker 1: and vaginal dryness and pain with intercourse and all of this.
29:29
Speaker 1: So I mean, yes, does not get worse as we age.
29:34
Speaker 2: Well, it can because all of the tissues of this
29:41
Speaker 2: first layer, the vulvar, the vestibule, which is the deep
29:46
Speaker 2: layer right above the vaginal opening, these are all hormonally dependent.
29:53
Speaker 2: So as you start going through perimenopause and you start
29:57
Speaker 2: feeling some irritation there, there might be some you know,
30:02
Speaker 2: some redness or some some irritation. The extra estrogen will
30:10
Speaker 2: help that because it will plump up the tissue and
30:14
Speaker 2: and add collagen to that area. It's referred to as
30:18
Speaker 2: the genito urinary symptoms of menopause. So that's that's a
30:24
Speaker 2: you know, a collection of symptoms that includes all of
30:28
Speaker 2: these things I described, which used to be described solely
30:31
Speaker 2: as vaginal atrophy. Now it has a broader, broader, A
30:40
Speaker 2: horrible men, you know, I just I mean back in
30:43
Speaker 2: the you know, twenty tens, like I had choked saying
30:47
Speaker 2: that word because it was we didn't have that estrogen supplies,
30:53
Speaker 2: you know, all of these tissues. But it also it
30:56
Speaker 2: also affects the urethra, So the urethra and the bladders.
31:01
Speaker 2: So as we go through perimenopause and start to have
31:06
Speaker 2: those changes, the stiffness of the urethra decreases, which is
31:11
Speaker 2: also an aging issue, because I mean, here's a fun fact.
31:17
Speaker 2: So after around age twenty, the strength of the urethral
31:22
Speaker 2: sphincters those are the muscles, the internal external sphincters that
31:28
Speaker 2: close off the flow of urine. They decrease strength by
31:32
Speaker 2: two percent every year.
31:34
Speaker 1: So this is like any other muscle. It starts, yeah,
31:39
Speaker 1: to lose strength towards Okay, yes, no difference in the pelvis.
31:45
Speaker 2: No. But and interesting enough, just this past year, a
31:49
Speaker 2: group I think their residents or interns of that work
31:54
Speaker 2: with doctor Rachel Ruben and Sexual Medicine in Washington, they
31:59
Speaker 2: propose and now we're using the term the genito urinary
32:04
Speaker 2: symptoms of lactation because the same issues happen if you
32:09
Speaker 2: are breastfeeding and your postpartum because when you're when you're breastfeeding,
32:16
Speaker 2: the hormone trolactin is in abundance to encourage milk production,
32:23
Speaker 2: and it's decreasing estrogen, so now you have ice. So
32:27
Speaker 2: so many of the patients that I see, they also
32:31
Speaker 2: need vaginal estrogen and it's you know, perfectly safe as
32:34
Speaker 2: your if you're breastfeeding, but they are trying to recover
32:39
Speaker 2: as well, all of these tissues and with the same
32:41
Speaker 2: issues as perimenopause, you know, trying to have sex, having
32:46
Speaker 2: painful sex, having some bladder leakage, having muscles that are weak.
32:50
Speaker 2: So it starts in a way, it starts in postpartum.
32:56
Speaker 2: And then if if you don't get any treatment and
33:01
Speaker 2: then wait, you know, say ten or fifteen years to
33:05
Speaker 2: start getting treatment, you can still get better, but it's
33:09
Speaker 2: kind of laid the groundwork for you know, maybe there
33:12
Speaker 2: is maybe there is a little more prolapse, maybe there
33:16
Speaker 2: is now there is pelvic floor muscle, true atrophy in
33:20
Speaker 2: the muscle, and that's something that a pelvic floor therapist
33:23
Speaker 2: can feel like one side just might feel really thin,
33:26
Speaker 2: the other side might have good bulk. It could be
33:29
Speaker 2: because of the way the baby was sitting, and you know,
33:32
Speaker 2: towards the end of the pregnancy, it could be from
33:34
Speaker 2: the you know, just the pressure. But they're related, and
33:38
Speaker 2: they're very much you know, it's very much a continuum
33:42
Speaker 2: of the same issues that happened and that we treat for.
33:46
Speaker 3: So bladder control can affect women that have had children
33:51
Speaker 3: or someone who hasn't had children, just with age, like
33:55
Speaker 3: you were saying, with a two percent decrease.
33:59
Speaker 2: Correct, yes, yes, but there's a high number of young
34:05
Speaker 2: elite athletes, female athletes who leak and is not because
34:09
Speaker 2: of movement, that's because of tightness. So it might be
34:13
Speaker 2: so if they are if they have if they're super
34:18
Speaker 2: you know, they're strong, they're doing their sport, they might
34:22
Speaker 2: have so much tension in their pelvic floor that at
34:25
Speaker 2: certain points in their you know, maybe in their lift
34:30
Speaker 2: or maybe in their you know, if they are volleyball players,
34:33
Speaker 2: in their in their whatever it's called push, that's where
34:36
Speaker 2: they're leaking. So that's also a thing. And children, i
34:41
Speaker 2: mean children can it can also start in childhood because
34:46
Speaker 2: children who are chronically constipated and don't want to go
34:49
Speaker 2: to the bathroom at school, they develop these bad habits
34:52
Speaker 2: and then they have type pelvic floors also, so it's
34:56
Speaker 2: really a continuum from childhood to adulthood. But it's all treatable.
35:02
Speaker 2: I mean, that's the good news. There are there are
35:05
Speaker 2: options for treatment. But with exercise, you know, that's a
35:10
Speaker 2: whole other thing. And and I see that in my patients,
35:16
Speaker 2: and I see that in the you know, general community
35:20
Speaker 2: of women who lift and exercise, and I think that's
35:25
Speaker 2: also really important to talk about because there is treatment
35:29
Speaker 2: and that can change, but we need to be really
35:32
Speaker 2: specific about figuring out what it is that's causing that leakage.
35:38
Speaker 2: Because for one person, it could be you know, as
35:42
Speaker 2: soon as they do a lift. For someone else, it
35:45
Speaker 2: could be jumping on the trampoline. For someone else, it
35:49
Speaker 2: could be you know, even just taking a walk. So
35:54
Speaker 2: I think that's a you know, for perimenopause and menopause
35:57
Speaker 2: of women. This is a really good place to have
36:01
Speaker 2: a discussion because there's forty percent at least of women
36:07
Speaker 2: in this country leak, and they leak with exercise.
36:11
Speaker 1: All right, let's take a quick break to hear from
36:13
Speaker 1: some of the body pod sponsors. We'll be right back. Well, okay,
36:21
Speaker 1: let's maybe look at like, if somebody were to come
36:24
Speaker 1: in with prolapse, well, prolapse number one, but then also
36:30
Speaker 1: just like, I want to know the limitations for somebody
36:33
Speaker 1: that because I get this question all the time. I
36:35
Speaker 1: have prolaps, you know, do you think I can lift heavy?
36:40
Speaker 1: And first of all, I'm like, I'm not your physician.
36:44
Speaker 1: Number one, wrong person to ask, and I'm always going
36:49
Speaker 1: to say ask your physician, but for like, what are
36:52
Speaker 1: the limitations for someone with prolapse specifically?
36:59
Speaker 2: What is that look like?
37:00
Speaker 1: Would you say don't lift heavy? You know, there's a
37:04
Speaker 1: lot of mixed conversations here.
37:06
Speaker 2: Yeah, well, I think I think first of all, it
37:09
Speaker 2: depends on it. It depends on their symptoms and when
37:14
Speaker 2: they feel the prolapse. So if they only feel the prolapse,
37:19
Speaker 2: if they only feel that vaginal pressure and prolapse when
37:22
Speaker 2: they're doing you know, lift X at so many reps
37:27
Speaker 2: in this range, then bring it down. So let's try
37:32
Speaker 2: to train the pelvic floor with that in that exercise,
37:37
Speaker 2: because you know, maybe it's their breathing pattern. Maybe they
37:41
Speaker 2: just are not coordinating their pelvic floor with their you know,
37:46
Speaker 2: the stiffness and the abdominal wall. Maybe they're they're have
37:49
Speaker 2: too much of a forward posture when they're lifting, So
37:52
Speaker 2: it really has there's a lot of nuance that we
37:55
Speaker 2: can break down and I would never tell anyone just
37:58
Speaker 2: stop lifting, So I think that's really important. I also
38:03
Speaker 2: think that there are things women can use for prolapse
38:08
Speaker 2: to try to see you know, sometimes sometimes a Pessori
38:13
Speaker 2: is a good option. So a pessori is a hard
38:18
Speaker 2: plastic object that you would get from a eurogonecologist or
38:23
Speaker 2: now in our country, some public dutias are being trained
38:27
Speaker 2: in pessor reinsertion, which is fantastic, but because it might
38:32
Speaker 2: be that just getting that bladder or bladderneck up a
38:36
Speaker 2: little bit higher in the pelvis allows the muscles to
38:40
Speaker 2: contract more more robustly, and then it eliminates that feeling
38:45
Speaker 2: of something coming out of the vagina. So we really
38:50
Speaker 2: need to look specifically at each person. But there's no
38:55
Speaker 2: hard no in having prolapse. But you would want to
39:00
Speaker 2: keep going on that same path where you're doing that lift,
39:04
Speaker 2: where you're you know every time you're reinforcing that you're
39:07
Speaker 2: feeling that pressure because you know that that you're you're
39:11
Speaker 2: you're going to be you're not going to feel good
39:15
Speaker 2: and you're going to limit. Ultimately, you know the pressure
39:20
Speaker 2: dynamic in your trunk and you know, so there are solutions.
39:25
Speaker 2: There's definitely solutions. It's very specific.
39:28
Speaker 1: Also, I mean that the breathing comes into play too,
39:31
Speaker 1: because I've had people that when I talk about bracing
39:36
Speaker 1: for lifting to protect the spine, they almost are down
39:40
Speaker 1: where then they because they're pushing pressure down when you
39:45
Speaker 1: know you shouldn't be pushing pressure down exactly.
39:49
Speaker 2: Well, that's why I mean, one of the things that
39:52
Speaker 2: I think can really help with lifting and if someone
39:56
Speaker 2: has a weak palplic chlore has proaps is to use
40:00
Speaker 2: the to use these vaginal weights because this is something
40:06
Speaker 2: these are different different weights that time in six sizes,
40:12
Speaker 2: and I think that it can give someone the feedback
40:16
Speaker 2: to that they're actually lifting and pulling in their palvot
40:20
Speaker 2: floor as they're recruiting their their abdominals and then going
40:25
Speaker 2: into the lift. So you know, it's it's again it's
40:31
Speaker 2: if you don't if you're not aware of what's what
40:34
Speaker 2: you're feeling and what the feedback is, it's really hard
40:38
Speaker 2: to get better. But you you can. You you can
40:41
Speaker 2: have these options for improving with with weights, with coaching.
40:46
Speaker 2: You know there there's just there's no reason now to
40:53
Speaker 2: not have those options in order to continue your your
40:57
Speaker 2: fittest journey.
40:59
Speaker 1: Okay, I love the ways I ordered them. They still
41:01
Speaker 1: haven't come to my house. It's been like a month.
41:05
Speaker 2: Back.
41:06
Speaker 1: And look, maybe you know how sometimes you think you
41:08
Speaker 1: pross that that there actually purchased. So I got to
41:13
Speaker 1: look at that. But the weights they come in obviously
41:18
Speaker 1: different weights. They look like little mice to me.
41:22
Speaker 2: I don't know. They tell yeah, there's there's you know.
41:26
Speaker 2: So the white is this the lightest, then it goes
41:29
Speaker 2: to pale, pink, a little darker pink, a few shack
41:34
Speaker 2: and then I always when I show patients this one
41:37
Speaker 2: is if you're like a serious cross trainer or a
41:40
Speaker 2: more Olympic lifter. Okay, because this one's pretty heavy, But
41:45
Speaker 2: I think there it's a great tool, you know. And
41:49
Speaker 2: it doesn't mean that doing keegels alone is the is
41:53
Speaker 2: the answer to the problem. But you have to use
41:57
Speaker 2: the pelvic floor to understand what it is and to
42:00
Speaker 2: integrate it into the exercise and the activity and the breathing,
42:05
Speaker 2: because one of the main tenets of breathing awareness and
42:11
Speaker 2: diatramatic breathing is understanding that every time we breathe, we
42:14
Speaker 2: take a breath in thee our breathing diaphragm, which is
42:18
Speaker 2: three hundred and sixty degrees around and the pelvic floor
42:22
Speaker 2: are always moving in the same direction. So you take
42:24
Speaker 2: a breath in the pelvic floor and the diaphragm push
42:28
Speaker 2: down and create that pressure. And then when you breathe
42:32
Speaker 2: out and if you brace your abdominals, everything comes back
42:34
Speaker 2: to its resting position or you get a contraction. So
42:38
Speaker 2: learning how the breathing is with the pelvic floor integration,
42:43
Speaker 2: I think is critical for anyone who wants to lift
42:46
Speaker 2: heavy or just lift or do you know, high intensity exercise.
42:51
Speaker 2: It's really an important part of that rehab journey.
42:56
Speaker 3: So a lot of this therapy is probably creating awareness
43:02
Speaker 3: body awareness, even because I'm exactly, if you tell someone, okay,
43:08
Speaker 3: tighten this part of your pelvic floor, they I don't
43:14
Speaker 3: even know if I would know specifically how to do
43:19
Speaker 3: certain exercises. So is that part of the beginning of
43:22
Speaker 3: the therapy is breathing or like contracting certain aspects of
43:28
Speaker 3: your body.
43:29
Speaker 2: Yeah, it's exactly because there are you know, over the years,
43:35
Speaker 2: I've had many patients who I might be doing the
43:38
Speaker 2: exam and asking them to contract. And there's different specific
43:43
Speaker 2: cues I might use, So I might say contract like
43:46
Speaker 2: you're stopping key and or construct contract like you're stopping gas,
43:51
Speaker 2: because then we're you were accessing the deeper levt or
43:55
Speaker 2: Ani muscles. But some patients do something the op so
44:00
Speaker 2: they might be they might bear down when they think
44:03
Speaker 2: they're contracting, and then they're contracting when they think they're
44:06
Speaker 2: barren down. So and that technically is called disenergia. It's
44:12
Speaker 2: like a complete mix up of what you actually want
44:15
Speaker 2: to do. So so getting someone to be able to
44:20
Speaker 2: feel that and understand that and not and to be
44:23
Speaker 2: able to do it without engaging their glutes or pulling
44:27
Speaker 2: their ad doctors together or sometimes they do this is
44:31
Speaker 2: like it's it's a tremendous shift in their awareness. And
44:36
Speaker 2: to me, that's foundational, Like that's the foundation of how
44:41
Speaker 2: you heal of the floor dysfunction. It has to start
44:45
Speaker 2: with this inner awareness. And I think you know, it's
44:49
Speaker 2: the hands on therapy, it's the breathing, it's using these
44:53
Speaker 2: tools that help give someone, you know, the their toolbox
44:58
Speaker 2: to be able to to go on with this. So yeah,
45:02
Speaker 2: one hundred percent the breathing and and you know, I
45:05
Speaker 2: always ask people, you know, are you doing any kind
45:07
Speaker 2: of mindfulness program? Are you taking any time to like
45:12
Speaker 2: just use maybe use an app, Like I'm a big
45:16
Speaker 2: fan of Headspace, the Headspace app because you can open
45:21
Speaker 2: the app and they have a one minute breathing exercise
45:26
Speaker 2: with a visualization. Like even if you just do that,
45:29
Speaker 2: that's a lot. Like now you've also you've you've calmed
45:33
Speaker 2: your nervous system, you've relaxed your public floor, You've had
45:38
Speaker 2: that integration of the central and peripheral nervous system. Like
45:43
Speaker 2: that's priceless, and that's foundational for all this work. So
45:49
Speaker 2: you know, it's kind of the same way I approach.
45:52
Speaker 2: Once I get someone to do more exercise, like I
45:55
Speaker 2: give them some foundational strengthening if they need it. So
45:59
Speaker 2: maybe just you know, lambshells or or bridging or something
46:07
Speaker 2: to just feel the muscles and then progress too more
46:12
Speaker 2: to standing, to different positions, to waits, Like you have
46:15
Speaker 2: to have the foundation, I think in order to go further.
46:21
Speaker 1: So if somebody were to come to you, I know
46:24
Speaker 1: this could be a huge range, but how many visits
46:28
Speaker 1: on average would somebody come? Is it like twenty five?
46:35
Speaker 2: Is it ten? Is it?
46:38
Speaker 1: What does that look like?
46:39
Speaker 2: People do ask that and it's and it's a hard question,
46:43
Speaker 2: but I mean there's I can give them certain guidelines.
46:46
Speaker 2: So because I don't when they asked that before I've
46:50
Speaker 2: met them and evaluated them, I don't know, you know,
46:54
Speaker 2: I don't. I don't even know you like, so that
46:57
Speaker 2: I have to, you know, I tell them, let's have
47:01
Speaker 2: the exam. Because after the exam, we sit down, I
47:03
Speaker 2: talk about what the findings are, what I think, in
47:07
Speaker 2: my best professional opinion is the best plan of care,
47:11
Speaker 2: and then we go from there. And you know, I
47:14
Speaker 2: know people have expectations and financial considerations too, so I
47:19
Speaker 2: want it to be I wanted to be work best
47:22
Speaker 2: for you, But you also have to commit to doing
47:27
Speaker 2: the homework that I'm telling you to do so because
47:30
Speaker 2: you'll get the best results if we really collaborate together
47:33
Speaker 2: on this. So we know that basically with muscle strengthening,
47:38
Speaker 2: it takes eight to twelve weeks for muscle to change.
47:41
Speaker 2: So if someone was really working on prolapse and strength,
47:45
Speaker 2: I would say it's probably going to be you know,
47:48
Speaker 2: eight to twelve visits. If someone If someone comes to
47:51
Speaker 2: me with pain, plot pain that they've had for five years.
47:56
Speaker 2: I'm going to I might say it's going to take
47:58
Speaker 2: a minimum of twelve visits and you know, and then
48:02
Speaker 2: we'll re reevaluate and see from there.
48:05
Speaker 3: What about bladder control?
48:08
Speaker 2: Bladder control? You know, So with stress and continents, we
48:12
Speaker 2: have the best We actually have the evidence based studies
48:16
Speaker 2: on palvit floor physical therapy for stress and continents. So
48:21
Speaker 2: a typical program could be twelve weeks, but that doesn't
48:25
Speaker 2: mean that they're coming to see me for twelve weeks.
48:28
Speaker 2: They might come for six visits and then they might
48:30
Speaker 2: do the rest at home, and then they might come
48:32
Speaker 2: back and check in. So because we have very good,
48:37
Speaker 2: good stats on that, we know that and this is
48:41
Speaker 2: over many years in several countries that at least around
48:46
Speaker 2: fifty percent of women who do pelvic floor therapy for
48:50
Speaker 2: stress and continents have one hundred percent recovery, which is really.
48:54
Speaker 3: Good, great news.
48:57
Speaker 2: Yeah, seventy five percent might have have most issues, you know,
49:03
Speaker 2: improved or full recovery. So there's still some that it
49:08
Speaker 2: might not work for. And if it doesn't work, then
49:12
Speaker 2: we have to look at you know, maybe you have
49:16
Speaker 2: maybe you have a bladder and bladderneck that are sitting
49:19
Speaker 2: too low. Maybe you have intrinsic sphincter weakness, and you know,
49:25
Speaker 2: maybe like we can still do the therapy, but maybe
49:29
Speaker 2: going to the urologist and having collagen injections might help
49:34
Speaker 2: to you know, it really depends because if they have
49:37
Speaker 2: those other issues where the bladder is sitting too low
49:40
Speaker 2: in the pelvis, you're not They're just not going to
49:43
Speaker 2: get that closure of the from the back wall of
49:46
Speaker 2: the pelvic floor where the the so you create a
49:49
Speaker 2: backstop and a front stop, and so we might need
49:53
Speaker 2: to look at other things, but I think overall those
49:56
Speaker 2: are pretty good statistics. So you know, I have some
50:00
Speaker 2: patients who come to me during their the later part
50:05
Speaker 2: of their pregnancy, and it might be because they have
50:07
Speaker 2: those pelvic pelvic joint pain they might have, they might
50:12
Speaker 2: have some and I'm able to do some internal pelvic
50:15
Speaker 2: work with pregnant patients as long as their doctors sign
50:19
Speaker 2: off on it and they don't have any type of
50:21
Speaker 2: placental issues. And then at thirty four weeks we can
50:25
Speaker 2: start doing perineal massage. And again for that there is
50:30
Speaker 2: good evidence based studies that that decreases the incidence of
50:35
Speaker 2: third and fourth degree paranial tears, which can lead to
50:38
Speaker 2: fecal and urinarian continence and chronic pain. So we have
50:42
Speaker 2: studies on things, you know, and so I'll always try
50:45
Speaker 2: to impart as much information as I know. But sometimes
50:50
Speaker 2: it's like, let's try this, let's see how you are
50:52
Speaker 2: for you know, let's see if in a couple of
50:54
Speaker 2: weeks you start to feel improvement. But I do feel
50:59
Speaker 2: when for the most part, I will always tell someone
51:03
Speaker 2: you can be much better, because they probably can't. I
51:06
Speaker 2: know they can and they will. They will because they're
51:10
Speaker 2: already starting something. So you know, I try not to
51:14
Speaker 2: set expectations like you're going to be better in six
51:18
Speaker 2: visits because probably you're not, because most people take seven
51:21
Speaker 2: to ten years to come for treatment or they've seen
51:24
Speaker 2: seven to ten doctors who didn't give them the right informission.
51:29
Speaker 2: So it's really a different journey for you know, for
51:32
Speaker 2: different people, but it's it can be really transformative for people.
51:40
Speaker 2: It can really be it can you know, when someone
51:43
Speaker 2: tells me that the work has changed their life, Like,
51:49
Speaker 2: you know, I don't want to ever retire because that's.
51:52
Speaker 4: Like amazing, very rewarding, very rewarding, Okay, before we before
51:58
Speaker 4: we go, I want to know, do you have a
52:00
Speaker 4: tip that you can give our listeners of an exercise
52:05
Speaker 4: that just strengths strengthens the pelvic floor, like whether they're
52:10
Speaker 4: driving in their car, or they're sitting or there whatever,
52:14
Speaker 4: is there an easy tip or exercise that people can
52:18
Speaker 4: do that just strengthens the pelvic floor overall.
52:23
Speaker 2: Sitting is a great place to start because it's functional
52:25
Speaker 2: and we all have to sit, so sitting in the
52:29
Speaker 2: car or first on a flat chair, and I'm going
52:32
Speaker 2: to just use the you know, finding finding a neutral
52:36
Speaker 2: pelvic position meaning the same as if you were standing
52:39
Speaker 2: up straight and you were not arching or slouching, but
52:43
Speaker 2: just a relaxed neutral position because that way you have
52:47
Speaker 2: the whole sling part of the pelvic floor in contact
52:52
Speaker 2: with the seat. And first breathe and see if you
52:57
Speaker 2: can feel that when you breathe in you can sense
53:01
Speaker 2: that there's some sense of dropping or relaxing the pelvic floor.
53:06
Speaker 2: And then once you do that, exhale and see, you know,
53:10
Speaker 2: if you can contract it, give yourself the queue, stop
53:13
Speaker 2: the gas. See if you feel the anal sphincter tightening
53:18
Speaker 2: and pulling up, and if you do. If you can
53:21
Speaker 2: feel that, then you already are winning because you have
53:25
Speaker 2: some awareness of that. If you're having leakage, do the
53:29
Speaker 2: same thing, but give yourself the queue, stop the flow
53:33
Speaker 2: of urine, because then you're going to work more on
53:35
Speaker 2: the area where those sphincters are. You're still going to
53:40
Speaker 2: get those deep muscles, but if there's a sphincter deficiency,
53:44
Speaker 2: you're going to start to get that as well. So
53:47
Speaker 2: start with something really basic, see if you feel it,
53:51
Speaker 2: and keep practicing that and then you know not everyone
53:55
Speaker 2: needs to strengthen because we talked about people with the
53:58
Speaker 2: high tone, non relaxing. But if you can feel that
54:01
Speaker 2: you can relax and contract, then you know that you
54:05
Speaker 2: have some good mobility there, and good mobility is like
54:10
Speaker 2: the best place to start.
54:11
Speaker 3: Yeah, thank you so much for joining us.
54:15
Speaker 1: This is such a great conversation and so needed.
54:19
Speaker 2: So bad. It's my pleasure.
54:22
Speaker 1: How do people can? Can you work with people via zoom?
54:26
Speaker 1: So how how do people find you?
54:28
Speaker 2: Well, they can find me on my website for Corners
54:31
Speaker 2: Physical Therapy. They can also find me on my Google profile.
54:38
Speaker 2: I actually have a lot of more information. So if
54:40
Speaker 2: you just google four Corners Physical Therapy and SLORM I
54:43
Speaker 2: mean Montclair, New Jersey. You'll come to my Google profile
54:48
Speaker 2: and I have a Facebook business page, so four Corners
54:53
Speaker 2: Physical Therapy. I'm on LinkedIn. I have a Instagram am
55:00
Speaker 2: it's at four Corners PT but it's not great and
55:05
Speaker 2: I have to work on that. I tend to put
55:09
Speaker 2: more other things and those are the best ways to
55:14
Speaker 2: get in touch with me. My email Debra at four
55:18
Speaker 2: Corners Physical Therapy dot com and it's all spelled out
55:22
Speaker 2: f O U R Corners Physical Therapy. So yeah, I'm
55:26
Speaker 2: I'm excited. I'm so excited to share the information because
55:31
Speaker 2: as much as as much as I think and my
55:35
Speaker 2: colleagues and people who are already doing it think that
55:37
Speaker 2: everyone knows, we don't know. We don't know, so and
55:43
Speaker 2: you know, we could we could talk so much more
55:47
Speaker 2: about the more specific things, but this is a This
55:49
Speaker 2: was great and I think that I'm very grateful that
55:54
Speaker 2: you gave me this opportunity. I feel like I'm sitting
55:57
Speaker 2: on the shoulders of some really amazing people that you
56:00
Speaker 2: too have interviews.
56:02
Speaker 1: This is fantastic. So we're so grateful for your knowledge,
56:06
Speaker 1: your education, time to share this.
56:09
Speaker 2: Thank you.
56:09
Speaker 1: But it's a very important subject, So thank you so much, Deborah.
56:13
Speaker 2: My pleasure anytime, thanks for listening.
56:18
Speaker 3: If you enjoyed this episode, please consider giving us a
56:21
Speaker 3: five star review and sharing the body Pod with your friends.
56:25
Speaker 1: Until next time,