Do you leak when you run? Try this!

I love running. To be honest, I’ve been out of a good running routine since Mary was born. She’s one now. I would like to change that. I’m scheduled (yes, my husband and I literally have to schedule everything with our crazy work weeks!) for a run this week and I’m thrilled.

As a pelvic physical therapist, my goal is always to help my support my patients in whatever exercise or fitness routine they enjoy. Sometimes, pelvic floor problems get in the way. I can’t tell you how many times I’ve heard things like: “I used to run all the time, but ever since I had a baby, I just can’t” or “I tried just wearing a pad while I was running, but I can’t get over the feeling that I’m making everything worse” or “I can run if I go first thing in the morning, empty my bladder before I leave, and then stop at the park on the way to go again.” Bladder leakage during running is ANNOYING. It can be so impacting to people, and for many, it can lead them to stop a movement or activity they enjoy, for the long-term.

5 years ago (has it really been that long!?!) I wrote on the topic, “Is running bad for the pelvic floor?” after receiving that question several times. Spoiler alert: There are times when it may be appropriate for someone to stop running for a period of time to retrain their body and regain their pressure modulating system optimization– however, running can be an excellent way for someone to exercise and move! There are no “Bad” exercises, just bodies that sometimes aren’t quite ready for them.

So, if you’re struggling with leaking every time you hit the pavement, what can you do?

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Let’s consider what happens during running, from a pelvic floor standpoint. Several studies in the past few years have demonstrated that the pelvic floor muscles are active during running. This study from 2017 used EMG electrodes at the pelvic floor muscles, and found that there was increased activation of the pelvic floor prior to heel strike and reflexive activation after heel strike during running. This is in line with what we know about the pelvic floor muscles. They play a crucial role in anticipating movement, preactivating, then have modulating force during movement based on the task at hand. And, this is protective. We would want the muscles to have varying levels of activation so that we can support ourselves during movement, support around the urethra, not leak.

What happens then when someone is leaking with running? We of course, want to say that this reflexive thing is not happening. This review did show some alterations in the way that those who leak contract vs. those who do not leak. However, this study found that the reflexive action was the same in those who leaked and those who didn’t. This one also found that patterns of engagement were the same. So, it is likely that there are sometimes differences, but sometimes not. And this seems in line with what we know about leaking. Leaking during running is a pressure system problem. So, to help it improve, we have to address the whole system– which includes the pelvic floor muscles, but not only the pelvic floor muscles. It makes sense that sometimes the issue is stemming from these muscles not activating at the right time, with the right force–but sometimes, the pressure problem is from something else.

How can we address the pressure modulation system?

First, we need to evaluate the system to see how the structures are functioning, and this includes looking at you– the full person– to see how you control pressure through your pelvis. So, we need to look at how you move from head to toe, then evaluate your running mechanics, then look more closely at your breathing pattern, your abdominal wall, and your pelvic floor muscles. Once we do this, we often have a clear idea of what is happening and can make a strategy to get this better.

So, my big Tip #1– Go see a pelvic floor PT–but make sure it’s someone who is trained at looking at the whole person and can really evaluate you well.

If you’re nervous about doing this, I feel you. It can be hard to talk to someone about very private things. And I totally understand that the idea of having an internal examination can be a barrier for some people. BUT, know that those of us living in the pelvic floor world talk about this stuff ALL THE TIME. You won’t surprise us. Seriously, we hear this stuff all day. And, if you don’t think you’re ready for an internal exam, that’s cool. Honestly, we don’t mind. There is SO much that can be done to help the pelvic floor and bladder leaks that can be done without an internal exam! If you want to learn more, give us a call. One of our doctors of physical therapy will be happy to do a virtual consult with you and get you started!

Ok, off my soap box… What else can you do to impact the pressure modulation system and decrease leakage?

Tip #2: Breathe!

This seems so simple. I know, you’re thinking, “Of course I’m breathing!” But, are you? Or are you going through a series of breath holds? Next time you run, pay attention, and keep your breath flowing in and out as you run. The diaphragm is the major pressure regulator of the body. So, we need to keep your breath moving so pressure is spread out!

Tip #3: Let your ribcage move!

Many people tend to run with stiffness, locking down their ribcage. This can funnel pressure downward toward the pelvic floor muscles leading to increased load, and potential leaking. Instead, relax your ribcage, let your arms swing and allow your trunk to rotate. This will actually turn on more of the muscles around your core improving the synergistic activation of your pressure modulating system.

Tip #4: Lean into the hills! 

When going up or down hills, it is easy to lean back to try to control the movement. This can alter the position of your ribcage over your pelvis which will impact your pressure control. Instead of doing this, lean into the hill as if you have a strong wind blowing against you (I love this visual I got from my friend & colleague, Julie Wiebe!). When going downhill, lean into the downhill and let yourself pick up a little speed instead of leaning back to slow down. Relax into the hill. Many of my patients find that doing this actually reduces the pressure they feel and can decrease leakage.

Tip #5: Get a running evaluation!

Running form matters, it really does! So, go see someone and have them take a look at your running form to offer you guidance on how you can optimize it! Be sure you’re using the best type of shoes for your foot as well! This can make a big difference! Awesome running stores in your area should be able to help you with this!

I hope this is helpful! What questions do you have about running and the pelvic floor? Ask away! We are here to help!

Have a great week!

~ Jessica

 

Daily Movement Sequence for Pelvic Pain

Happy baby pose with knees up and open, supporting legs with hands

May is Pelvic Pain Awareness Month, so I thought it was only fitting to write something about pelvic pain before the month is over. Pelvic pain impacts so many people, in fact, the International Pelvic Pain Society estimates that over 25 million women suffer from chronic pelvic pain. While the number is generally lower in men, some studies estimate that around 1 in 10 men experience chronic pelvic pain (often termed chronic prostatitis).

Next week, my clinic is officially re-opening our doors for in-person sessions, after operating completely virtually for the past 2.5 months! During this time, I tried to stay as connected to our patients as I could, and sent out a newsletter each week full of pelvic health tidbits. One of the new things I created was a daily movement sequence for pelvic pain, and I wanted to share it with all of you here!

Getting Started

Before we get started, you should know a few things about pelvic pain. First, each person with pelvic pain is a unique entity. So, while this sequence can feel lovely for many people with pelvic pain, some may not be quite ready for it. For others, they may find that doing it actually increases their pain (clearly, not our goal). For rehabilitation for a person with pelvic pain, it is very important that exercises, movements and activities are done at a threshold that does not increase or aggravate pain or discomfort. This is, as we have spoken about very often, because we want to create positive movement neurotags for the brain. Basically, we don’t want your brain to think that movement is bad or dangerous (because as we all know, it should not be bad or dangerous!). If we do movements that increase our discomfort and make us feel worse, the brain can build a connection between moving that way and bad/pain feelings. Instead, we like to move at a threshold where the body does not guard or protect by pain. So, why am I telling you this? Because, if you start doing these movements and your symptoms worsen, or it doesn’t feel therapeutic to you, you need to stop doing it and see a pelvic floor therapist who can evaluate you comprehensively and help you develop a specific movement plan that IS therapeutic to YOU.  And lastly, remember that anything on this blog is not in any way a replacement of in-person care. You need to consult with your interdisciplinary team (your physician, PT, etc!) to determine the best approach for your health! (And if you’re not sure, schedule a virtual consult with a member of my team to help figure out where to go next!)

Daily Movement Sequence for Pelvic Pain

So, let’s break down this sequence.

Diaphragmatic Breathing

Diaphragmatic breathing with hands placed at ribcage If I could give any person with pelvic floor problems a single exercise to do, it would be this. The breath is SO powerful, and sync’d with the pelvic floor. For diaphragmatic breathing, you want your breath to move into your belly, expand your ribcage in all directions, then lift your chest. A misconception of diaphragmatic breathing is that the chest should not move at all, and this is FALSE. The chest should lift–but–so should the ribcage and the abdomen. You can do this in sitting or lying down. As you inhale, aim to lengthen and relax your pelvic floor muscles, then exhale, allowing your muscles to return to baseline. Start your sequence with 2-5 minutes of this breathing. (and toss in some focused relaxation of each part of your body while you’re doing it!)

Happy Baby or “the Frog”

Happy baby pose with knees up and open, supporting legs with handsThis one is a key movement for anyone with pelvic pain! To perform this, lie on your back and bring your knees up to your chest. Reach your arms through your legs to grab your lower shins, support your legs using your arms, and allow your knees to drop open. You can alternatively hold your legs at your thighs, depending on your comfort and your hip mobility. From here, aim to let go of muscle tension. Then, take slow breaths, directing your breath to lengthen and open your pelvic floor muscles. This is a great position for relaxation and lengthening of the pelvic floor!

Segmental Bridge

Bridge- knees bent, feet flat on the floorThis is a nice movement to warm up your spine and practice using small amounts of tension to perform a graded movement (you know I love my slow movements!) For this exercise, you will lie on your back with your knees bent. Then inhale in to prepare, exhale and slowly begin to roll up off the mat, lifting your tailbone, then sacrum, then low back, then mid back, then shoulder area. At the end of your exhale, slowly inhale, reversing the movement. You can repeat this 5-15 times, and do 1-3 sets. (Vary this based on what feels healthy and helpful to you!). Sometimes people get back pain when they do this (usually their back muscles are trying to do the job of the glutes). So, if this happens, try to bring your feet closer to your buttocks, and press through your feet while you are lifting. If it still happens, stop the exercise, and talk to your physical therapist.

Reach and Roll

reach and roll- lying on side- description belowI love this exercise for improving mobility of the upper back (thoracic spine). For this exercise, lie on your side with your knees and hips bent to 90 degrees, arms stacked in front of you at shoulder level. Inhale, reaching your top arm forward, exhale, and slowly roll your hand across your chest, opening to the opposite side. Keep your hips stacked so you don’t rotate through your low back. Pause here and inhale in, letting your ribcage expand, then exhale letting the hand glide across your chest to meet the opposite hand again. Repeat this movement 5-10 times on each side (You can do a few sets if you would like!)

Cat-Cow

cat-cow exercise in hands/knees positionSo, this is another one of my top exercises. I love the cat-cow as it promotes segmental mobility of the lumbar and thoracic spine into flexion and extension. It is another great movement to encourage minimal tension, and coordination of breath, so it’s a big favorite for people with pelvic pain.  To do this, get into a quadruped position (hands and knees, with hands aligned under shoulder and knees aligned under hips) Inhale, allowing your tailbone to come up and your back to dip down, head looking up. Exhale, dropping your head down, rolling your back up and tucking your tailbone. Perform this movements slowly, using small amounts of tension. Repeat this 10-15 times, 2 sets. You can alternate each set with child’s pose, listed below.

Child’s Pose (Wide-Kneed)

Child's pose with knees in wide position, reaching arms forwardChild’s pose is a beautiful exercise that also encourages opening and lengthening of the pelvic floor muscles. It is nicely performed between sets of Cat-Cow. I like to modify this slightly by bringing the knees into a wide position to further encourage relaxation of the pelvic floor muscles. To perform this, begin in the quadruped (hands/knees) position as above. Open the knees into a wider position, keeping your feet together. Drop your pelvis back toward your feet, reaching your arms forward and relaxing down toward the mat. You can use a pillow (or 2 pillows!) to support your trunk and decrease how deep your child’s pose goes. Hold this position (and make sure you are totally comfortable!) for 60-90 seconds, breathing in long, slow breaths, encouraging lengthening and opening of your pelvic floor. Repeat this 2 times, preferably, interspersed with the Cat-Cow exercise.

And there you have it. My daily sequence for people with pelvic pain to get some movement in!

There are so many other great exercises for people with pelvic pain! Do you have any favorites I didn’t include in this sequence? Any movement challenges you want help solving? Let me know!

~ Jessica

 

 

How to build a stellar bowel routine

Bowel problems are so frustrating. Let’s be real. Constipation remains the #1 GI complaint in the country and impacts millions of people (pun unintended, but I’ll take it!). I love writing about pooping, and we love treating poop problems at Southern Pelvic Health (both virtually & in-person!!). The cool thing about poop, is that often the smallest changes in our habits can make BIG differences. A lot of this is due to the physiology of the digestive tract. Our habits—what we do during the day—can hugely impact this physiology, and that’s what I want to talk with you about today.

How do you maximize the efficiency of your digestive system and build a stellar bowel routine so you can poop better?

To understand this, let’s look at the digestive system a little more closely.

When you eat food, digestion begins in the mouth. Chewing helps to break up the food, and your saliva begins to break down the nutrients. Chewing alone is an essential part of digestion. In fact, most of us don’t tend to chew enough. I’ve been there! Years of working as a physical therapist at busy practices, led to a habit of inhaling my food rather than eating slowly and actually enjoying the process. Did you know that in order to adequately digest an almond, you have to chew that almond over 20 times? I learned that a few years ago when I interviewed Jessica Drummond- an incredible clinical nutritionist who also happens to be a pelvic PT. You can see the whole interview here if you’re interested!

Image Blausen_0603_LargeIntestine_Anatomy_-_File_Blausen_0603_LargeIntestine_Anatomy_png_-_Wikimedia_Commons

After we swallow our food, the food travels down the esophagus into the stomach. Here, the stomach churns the food, mixing it with acid and juices and continues the process of digestion. When food enters the stomach, this triggers an important reflex called the gastrocolic reflex, which pushes prior meals and snacks through the rest of the digestive tract. This reflex is SUPER important to know to help stimulate regular movement in the GI system.

The food then exits the stomach and enters the small intestines. Did you know that if you uncoiled your small intestines, they would be 20 feet long? The intestines are where the majority of digestion occurs. Juices from the pancreas and gall bladder are added in here to aid in processing our nutrients. Food moves throughout these coils, then enters into the large intestine via the ileocecal valve.

The large intestine, or colon, is the major water recycling plant in the body. The colon recycles about 70% of the fluid we take in to use throughout the body. It continuously removes fluid from our stool…. So, what do you think happens if you don’t drink enough fluid? Or what do you think happens if your colon moves a little too slowly? Yep, that’s right. You end up with hard and dehydrated stool. When stool enters into the last part of the colon, the rectum, the stretching of the walls of the rectum trigger another reflex. First, an incredible reflex called the “sampling response” takes place. In this reflex, a small amount of contents are allowed to enter the anal canal. Your nerves here sense what is present, and tell your brain if the contents are liquid, gas or solid. (Amazing, right?!) Now, this reflex can sometimes be dysfunctional. So, if you struggle with feeling a strong need to poop, and when you get to the bathroom, it’s only gas? That’s this reflex. OR, if you feel like you have some gas to release, and when you release it, it’s actually a little bit of stool? That’s a sampling problem as well. And guess what—we can actually do things to retrain and improve this reflex.

Image Defecation_reflex

As the stool is filling the rectum, and stretch occurs, the brain will receive the message of what is in the rectum, and gets to decide what to do about it. If there is just gas, you may choose to release it or wait a bit to release it. If it is liquid, your brain knows you better get to the bathroom QUICK! Liquid stool is hard to hold back for too long—the muscles fatigue—THIS is why chronic diarrhea can lead so often to bowel accidents! And if the stool is solid, you can actually defer and postpone the urge, until an appropriate time to go. The challenge there is that postponing frequently can make it so the muscular walls of the colon help you less when it is actually time to go to the bathroom.

When it is an appropriate time to go, you then sit on the toilet, relax your pelvic floor muscles, and this stimulates a defecation reflex which will allow the rectum to empty via the anal canal. Sometimes, we need to generate some pressure to assist this process, and sometimes, the muscular walls of the colon take care of it themselves.

So, let’s get down to it.

How do you use the process of digestion to build your bowel routine?

Step 1: Eat at regular intervals during the day to regularly stimulate your gastrocolic reflex.

Remember, this pushes things through the system, so it needs to happen often. The colon LOVES consistency, and HATES change. So, skipping meals? Eating really large meals sometimes, then nothing the rest of the day? All of this can impact your bowel function.

Step 2: Slow down & chew your meals.

Remember, chewing begins digestion, so, stop what you’re doing and eat mindfully and peacefully. Also, digestion requires a lot of parasympathetic activity—this is your resting & relaxing nervous system—so, slowing down and making time to eat can help stimulate that too.

Step 3: If you need the bowels to move better, eat “bowel stimulating” foods/drinks around the time of day you normally go to the bathroom.

What stimulates the bowels? Warm drinks (especially coffee—because the caffeine is actually an irritant to the GI tract!) are a great place to start. Also, spicy foods can help stimulate the GI system to move.

Step 4: Sit on the toilet around the same time each day, preferably, after a meal.

Remember that gastrocolic reflex? That reflex is helping to move things through the system, so after a meal is a great time to spend a few minutes relaxing on the toilet.

Step 5: Exercise!

Yep, exercise also stimulates the peristalsis of the GI tract! So, aim to get in regular bouts of exercise. And, it doesn’t need to be too extreme? Even going on a 10 minute walk can help get things moving.

What does this actually look like in practice? Here’s a sample routine!

Jane wakes up in the morning and takes the dogs on a short 10 minute walk. She gets home and makes a cup of coffee and her breakfast. She eats breakfast slowly, taking time to chew her food. (Jane also makes sure that she is getting plenty of fiber and whole fruits/veggies in her diet—because this matters too for her stool consistency!). After breakfast, Jane goes and sits on the toilet. She sits in a nice comfortable position, relaxes, breathes, and thinks about her day—spending 5 minutes without trying to force anything to happen. After a few minutes, she starts to feel the need to have a bowel movement. She uses what she learned in the “How to Poop” article, and gently pushes with good mechanics to assist her rectum in emptying her bowels. Jane then goes about her day, eating small amounts every few hours to stimulate her GI system.  

Now, it’s your turn my friend! How is your bowel routine? What can you change to actually use your physiology and poop better?

Want more on pooping? Check out these articles:

How to Poop 

Dyssynergic Defecation or When the Poop Won’t Come Out 

Sex, Drugs…& No Poop? 

Have a great rest of your week!

~ Jessica

 

 

Mother’s Day Specials!! My gift to YOU!

Good morning friends,

With Mother’s Day around the corner, we’ve been wanting to give back and help out the mothers in our community (around the country…around the world!) who are struggling in this interesting new normal. Figuring out managing caring for children, homeschooling, work/family obligations, all while trying to keep their families safe, sane, engaged. Let’s be honest, being a mom is the hardest, but most rewarding job ever!

To celebrate our mamas everywhere, we have a few discounted specials to roll out to you!

50% off first Virtual Pelvic Floor Consultation

Mother's Day Sale-2

First, we are offering 50% off a virtual pelvic health consultation  with one of our incredible pelvic floor specialists. Honestly, we’ve never discounted our services before, but I just felt like this was the right thing to do. So, for $97 you (or the mama you gift this to!) can receive a 55-minute virtual consultation. If you live in Georgia, this will be a pelvic floor physical therapy evaluation. If you don’t, our license won’t let us provide you with physical therapy, but we can still offer you a virtual coaching consultation.  So, if you’re struggling with any pelvic health problem– constipation? pain with sex? bladder leaks?– or if you need help recovering after children, getting back to exercise, or preventing problems in the future– this deal is perfect for you! Don’t miss out on this opportunity!!

20% Off Online Classes

Copy of Copy of Copy of Copy of Copy of Copy of Copy of Black Friday (1)

Along with this, we are offering 20% off our on-demand classes via the Southern Pelvic Health x The Vagina Whisperer partnership! Each of these classes is 90-minutes and covers SO much information, with great bonuses included! Classes are normally $39 each, so this is a nice discount to get some solid information!! (Gift idea: Consider a birth package for that pregnant mama in your life! Combine our birth prep class with a posptartum recovery class so that new mom has all she needs to rock her birth and after!) Be sure to use promo code MOM20 at checkout! 

These specials are only available through Monday May 11, so don’t delay!

Happy Mother’s Day!

~Jessica

Diastasis Rectus Abdominis (Part 2): How can you help it?

2 weeks ago, we chatted about what exactly is a diastasis rectus abdominus (DRA) and how to check to see if you have one. Today, we’re going to talk about how pelvic floor physical therapists evaluate a person with DRA, and what can be done to improve this. If you are struggling with support at your belly, I also hope you will join us for our upcoming LIVE class focused on this exact topic! Sara Reardon and I invited Sarah Duvall, an incredible expert, to join us for a 90-minute class on Diastasis Recti Rehabilitation. We took a lot of time to plan out this content, and I have to tell you all– this class is going to rock! The LIVE event is coming up Sunday May 3rd at 3pm EST, and it will be available after as a recording. We have a lot of great bonuses also– including handouts on exercises to get started and a lot more! Registration for the LIVE class is limited, so don’t wait to sign-up!

As we discussed previously, DRA involves an increased gap between the two bellies of the rectus abdominis muscle and a loss of support at the abdomen. Often times, people experiencing this will feel like they don’t have as much control or stability at their belly, and they may feel a bulging at their belly (some will even feel like they look pregnant when they aren’t!) We also discussed how to check to see if you do have a DRA. Now, let’s talk about how we approach making this better.

Your first visit 

When we first evaluate someone with a DRA, we always make sure we get a complete history of the problems and challenges they are experiencing. This includes discussing any pregnancies/births (if applicable), their pelvic health (yep– bladder, bowel and sexual function), musculoskeletal challenges, medical problems, and their fitness preferences and routines. Then, we discuss their diastasis and what is bothersome to them. Is it primarily the appearance or the knowledge that it is there? Are they also struggling with back pain or pelvic organ prolapse or other problems? Does their diastasis limit their ability to exercise or lift their children? Our goal here is to really have a complete picture on the challenges they are facing.

The exam

Next, we move into an examination. This can include many different parts. As a diastasis is a pressure system problem, we want to look at everything that could impact the system. This could include:

  • Movement patterns
  • Spinal mobility
  • Preferred postures/positions
  • Ribcage movement
  • Breathing patterns
  • Pelvic floor function (yep, sometimes people with DRA benefit significantly from a specific pelvic floor exam if they’re on board with it!)
  • Scar tissue mobility
  • Myofascial mobility at the abdomen and the back
  • Abdominal, hip, and pelvic motor control/strength

Each of these components can actually influence how much pressure is at the linea alba (between the two bellies of the rectus abdominis) and the control at the abdomen. If someone has decreased movement around their spine and ribcage, this can impact the fascia around the abdomen and contribute to widening at their midline. If they have less optimal breathing patterns, this could be funneling pressure where we don’t want it to go, instead of spreading the pressure out across the trunk and sharing the load.

Once we do a comprehensive evaluation, we develop a treatment plan to address the problems we found. This typically includes:

  • Improving global movement patterns
  • Improving breathing patterns (both in static postures and during movements/activities)
  • Restoring mobility and improving sensitivity at muscles and soft tissues (including scars)
  • Optimizing the pressure system
  • Retraining the abdominal wall

I want to talk a little bit more about how we can optimize the pressure system and retrain the abdominal wall.

Optimizing the pressure system

When improving DRA, it’s very important to keep the pressure system in mind. Pressure at the abdomen and pelvis depends on coordination of several muscles that work together in synergy. This includes the glottis, intercostal muscles, respiratory diaphragm, transverse abdominis, lumbar multifidis and the pelvic floor muscles. Mary Massery (who has contributed SO much to our understanding of these pieces) created an analogy of a soda pop can.

can-307312_1280

In this analogy, the glottal folds are at the top, the pelvic floor muscles at the bottom, and the respiratory diaphragm in the middle. The intercostals, lumbar multifidus, and transverse abdominis are around the can. So, basically, these structures together work together to keep pressure spread out, leading to a strong and functional core. In the soda pop can example, the thin aluminum is pressurized on all sides, leading to a strong can that is difficult to break (Of course, this changes if the can is open or has a hole in it!)

So, in the case of a diastasis rectus, the pressure system is often not working optimally. Basically, pressure in many cases is funneled toward the belly, instead of being spread to all the structures, and this can contribute to gapping, bulging and a loss of support.

So, from a treatment standpoint, our goal becomes to optimize this system. We get to play detective and find out which of these structures are working well, and which need some assistance to do their job optimally. Then, we retrain this system, focusing on the natural synergy that should be present. When this is done well, we help the body learn to spread the load, decrease the funneling of pressure to the belly (or elsewhere) and thus, we improve what the person is experiencing at their abdomen.

Retraining the abdominal wall

After we improve the pressure system, we need to retrain all of the muscles in the abdominal wall. This further helps to improve the pressure system, but it also can assist in stimulating the fascia in the abdomen. Often times, retraining the abdomen starts by building the pressure system base like we discussed up above. This base– the pelvic floor- diaphragm- transverse abdominis- lumbar multifidus- base– is the key to what else we need to do to improve function at the abdomen. The transverse abdominis is particularly important. This muscle helps to tension the linea alba, which improves force transfer through this structure.

Next, we use breathing and awareness of muscles to retrain these muscles in a variety of movements, postures, and exercises. This can start as a simple progression– learning to activate these muscles while breathing and lifting an arm, then lifting a leg– and progressing from there.

We also teach self-awareness of the abdomen. So, this helps you identify how you manage pressure in your abdomen, and this is very important in making sure you are challenging your system, while still being able to control pressure (and not allow the pressure to funnel in your belly and produce coning and doming). As we progress in exercises, we ultimately want to retrain this system within the rest of the muscles in the abdomen, and this is fun, because we can be very creative and often help people progress toward things they did not think would be possible for them. So, can someone struggling with a diastasis eventually do planks? sit-ups? Abdominal crunches? What about pilates? Yoga? Barre classes? Most of the time, we can work together to help you reach the goals you want to reach. I really believe there are not “bad” exercises, but the key thing is determining the readiness of the person to do the exercise well, and ensuring that they can modulate pressure while doing the movement.

So, if you’re struggling with your belly…

Know, that there is hope. There is so much we can do to help restore stability at the abdomen and improve the way you move and transfer force through your belly. Come and join our upcoming class (or get the on-demand recording if you’re reading this later!) If you’re struggling, there can really be so much value to being evaluated by a pelvic health provider in person. So reach out! And if you need help finding a pelvic PT, check out this prior blog post to help you!

As always, reach out if you have questions!

~ Jessica

Virtual Care & Pelvic Yoga at Home

If you would have told me two weeks ago that I would have closed the doors to my clinic, Southern Pelvic Health, a week later, and shifted my practice to a virtual one, I would not have believed you. Maybe I was naive (yes, I probably was), but this change came quick to me. It almost happened overnight. And, here we are. I am moving into my second week of working with my patients online. While for many, that seems incredibly scary, I actually think that shifting to an online platform for a while is going to do a lot of good.

Last week, I worked with a few other colleagues to host a webinar on bringing pelvic health online– basically, how do pelvic floor PTs treat most effectively without actually touching their patients? It was a quick production–one built out of necessity–and it sold out in 24 hours because rehab professionals everywhere are trying to figure out how we can still be there for our patients and help them get better during this time. (For my colleagues out there, if you missed it, it’s still available as an on-demand purchase!) I brought together 5 experts from various corners of the country and the world, and we spoke for nearly 2 hours about how we assess the pelvic floor, evaluate patients, and actually help patients get better in a virtual setting. It was full of creative ideas, and also challenged some of the current practice patterns. As you know, I work hard to always question my own practice–learn more–do better– and I’m excited to see what this next period of time does for me as I learn to better and more effectively treat my patients, to be creative with self-care treatments and home strategies, and to use movement to help patients move when my hands are unable to. I will share what I learn with you here, of course.

Pelvic PTs are not the only professionals taking their skills online! Last week, my daughter and I joined a “Frozen Sing-A-long” through a local princess parties company. I have been thrilled to see some incredible resources for people with pelvic floor dysfunction hop online, and I am excited to share some of those with you today!

So, what can you join virtually this week? 

Yoga for Pelvic Health

My dear friend and colleague, Patty Schmidt with PLS Yoga, is incredible and specializes in therapeutic yoga for pelvic floor dysfunction. She is bringing several awesome classes online! AND, they are cheap– $15 per class (which honestly, is a HUGE value for the expertise she brings!) So, I do hope you’ll join in:

Patty also is teaching private sessions virtually at $30 for a 30-minute session. This is a steal, believe me!

I also need to share with you all of the FREE yoga resources through another friend and colleague, Shelly Prosko. Shelly has this incredible library of Yoga options for pelvic health, all available right here.

I hope you are able to partake of these awesome resources. Remember, we are in this together my friends! I’ll leave you with a quote from a much-loved movie in my house, Frozen II, “When one can see no future, all one can do is the next right thing.” Let’s all try to do the next right thing amidst this craziness!

Much love,

Jessica

PS- If you are struggling with pelvic floor problems at home, we’d love to help!! Schedule a virtual session or a complimentary phone consultation with us at SPH!

On Creating Agency as a Patient

Agency is defined as, “the capacity of individuals to act independently and to make their own free choices.” What does this mean for healthcare? How does the healthcare consumer maintain and create agency while also navigating the complexities of medicine?

A few weeks ago, I traveled to Washington DC to teach a group of 40+ physical therapists and occupational therapists about working with people who are dealing with various types of pelvic pain. Over this 3-day course, we covered topics related to diagnosis, medical management, manual therapies, movement interventions, and much more. On the third day of the course, I gave a lecture on “trauma-informed care.” What is trauma-informed care? Trauma-informed care means the “adoption of principles and practices that promote a culture of safety, empowerment and healing.” While we do focus on how widespread trauma is, the varying ways people experience trauma, and strategies to develop sensitivity, respect and consideration for the needs of our patients, we also strongly emphasize the importance of treating all patients in this way.  One of the key pieces in doing this is helping a person develop a strong sense of agency– the ability to make their own educated decisions and partner alongside their healthcare professionals, instead of being the recipient of directed care.

The idea of agency can seem fairly basic. Shouldn’t every patient feel like they can make their own decisions? Shouldn’t they feel like their healthcare providers are all members of the same team? But, that is often not the case. When a person loses this agency, they can end up in situations where things start happening to them, instead of with them, and this can create difficult and sometimes traumatic experiences. This could be a mother who feels pressured to have a birth intervention she was really not comfortable with having. This could be a person being scolded for not being “compliant” with their recommended home exercise program (as opposed to their clinician understanding what happened and partnering with them to fit exercise in their lives). Or, it could be feeling pressured to continue a painful examination that they otherwise would choose to stop.

There are many reasons why losing one’s agency is detrimental. Remember, the pelvic floor muscles respond to threat. So when a person is in a situation where they feel threat (whether that is due to stress, a difficult situation, or other circumstance), the pelvic floor  will activate. When someone is dealing with something like pelvic pain, sexual pain, and other diagnoses, this can lead to a problem becoming worse. So, how can you maintain your agency as a patient?

  1. Ask Questions. All the Questions. “The only stupid questions are the ones that are not asked.” If you aren’t understanding what is being recommended to you, ask more questions for clarification. Your healthcare provider should always be happy to answer any questions you may have to help you make the best decisions for your care. This also applies to times when you are in the middle of a treatment/procedure/etc. Ask away.  Try saying:
    • “Would you mind explaining my options again?”
    • “Can you clarify what the benefits and risks would be to…”
    • “Are there any risks in not moving forward with that treatment?”
    • “What are the reasons you think I need to…”
    • “I’m sure you have a busy day, but it would really help me if you could answer a few questions.”
  2. Don’t be afraid to slow things down. If your treatment session or medical appointment is going a direction you are uncomfortable with, or if something is happening that you don’t feel like you understand, feel free to take a break. Try saying:
    • “I need some time to think about that.”
    • “I would like to take a few minutes to consider my options.”
    • “I would prefer not to move forward with that today.”
    • “Can you explain _______ to me again?”
    • “I’m not sure I understand all of my options.”
    • “I’d like to go home and think about all of this. I’ll let you know what I think at our next visit.”
  3. Bring a friend. If you know that you tend to get overwhelmed at your appointments and have difficulty expressing your needs or how you feel, consider bringing a friend/partner/spouse who will have your back! Tell them in advance what you want their role to be and how they can help you! This could be stepping in to ask for some time to consider options, asking a provider to slow down and repeat their explanation, or simply being a person to be present with you during a difficult appointment.

I hope these tips have been helpful in helping you develop strategies to create agency as a patient. If you are a healthcare provider, I urge you to reflect on your own practices. Do your words and actions support your patients in maintaining autonomy? support agency? Do you unintentionally pressure patients into participating in treatments or exams that they may not feel comfortable with? Do you shame patients when they don’t follow your recommendations? None of us are perfect. I truly believe that most health care providers have the best of intentions. But, we can all do better. Reflect on our own words, habits, body language, and be better partners for our patients!

What other strategies have you found to help you improve your agency as a patient?

~ Jessica

 

 

Podcast Interview: Real Talk with the Pelvic Docs

Happy Monday Everyone!

I am 2 weeks in to my new practice, and absolutely loving it! I was fortunate this past week to be a guest on the podcast series, Real Talk with the Pelvic Docs. Jenny LaCross has been a friend for a few years (we connected when she was in her residency program), and she’s doing amazing things for the pelvic health community! It was such a pleasure to talk with her about my experiences with pregnancy, childbirth and my own postpartum recovery. You’ll also hear more about my journey to private practice and my hopes and dreams for the future! I hope you enjoy this podcast as much as I enjoyed recording it!

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Click here to listen to my guest interview on Real Talk with the Pelvic Docs!

Attention Health Care Providers! Come learn about Vulvar Dermatology from Dr. Andrew Goldstein!

I am super excited! I am hosting Dr. Andrew Goldstein at my NEW CLINIC for a one-day intensive course on Vulvar Dermatology on Saturday, November 2nd!!! This course is open to PTs, MDs, PAs, and NPs, and should be absolutely epic!!

Dr. Goldstein is known internationally as a leader in the treatment of vulvar pain disorders, and is very well-published on the topic. It should be an incredible day of learning, and I can’t wait to show you all my new space!!

I hope you will join me for this important class! Pelvic PTs and other HCPs- let’s always keep learning!

Register for the class!!

~ Jessica

Early Recovery After Caesarean Birth

6 weeks ago, we welcomed our second daughter into the world. Mary Lynn was 6 lbs 10 oz of squishy, adorable, babyness. And she came into the world via a Caesarean birth. And it was amazing. And hard. But good.

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In the recovery room right after Mary’s birth!

C-sections come with challenges, just like vaginal births do, and for me, these challenges included a significant blood loss that led to me fainting on the second day, a super low blood pressure due to a response to the epidural that contributed to the fainting but also meant going off of my epidural pain meds really early, and nerve pain that lasted for about a month after Mary was born. (We’ll y’all more about that another time.)

Since I am living the early postpartum life, I thought it would be fun to do a series of posts on my own rehabilitation journey (since, in many ways, each of my births has been a mini-case study for myself!).

So, let’s talk Cesarean rehab in the first 6 weeks!

Moving well after major abdominal surgery

I love when people imply that birthing via Cesarean section is somehow “the easy way out” compared to birthing via the vagina. Hello people, this is major abdominal surgery! All mommas get birthing badges– let’s support each other in our journeys, right?!

Initially after a Cesarean, movement alone can be challenging. Standing up from a chair. Rolling over in bed. Lying down in bed. But the good news is that with some easy tips, this movement can become much easier. First, as you are moving, bending, standing, etc. remember to “blow before you go.” This easy to remember phrase comes from my friend and colleague, Julie Wiebe. This means, begin to exhale before you initiate a movement. Breathing like this with movement helps to control pressures within the abdomen and pelvis, so it can significantly help you in your movement after having your baby- both in terms of ease but also in protecting your pelvis and abdomen.

When standing up from a chair, remember, nose over toes. Scoot to the edge of the chair first. As you go to stand, lean forward first. This puts your body weight over your legs and helps take the burden away from your core.

When you lie down or get up from lying down, channel your inner log. So, when you lie down, first sit on the edge of the bed. Slowly lift your legs onto the bed, then lower the rest of the body down, using your arms for support. If you need to roll over, bend your knees, then roll your body as a unit- like a log. Reverse these steps for getting up out of bed.

Abdominal Binders and Compression Underwear? It depends. It may be worth considering  using an abdominal binder for the first few weeks after your birth, progressing to wearing compression underwear or shorts(ie Spanx, SRS recovery shorts, Core shorts). These types of garments provide support to the abdomen and can be incredibly helpful for moving and walking around after your surgery. The flip side with compressing the abdomen is that it can impact how well you can move your ribcage and can influence pressure mechanics within the pelvis. So, if you are already struggling with pelvic organ prolapse or urinary leakage, or if you pushed for a period of time before having a Caesarean birth, it may be worth talking with a pelvic floor PT prior to utilizing this during your recovery. Generally, the compression underwear/shorts provide more support to the pelvic floor and abdomen, so they may be a little better with pressure modulation than the binder. For me personally, the binder and compression undies were amazing! They took away my nerve pain, and helped me move much better. I chose to wear these sporadically during the day (a bit on, a bit off), and practiced breathing well with my diaphragm during the times the binder was off.

Handling your incision

Initially, your main focus here is keeping your incision clean, and monitoring it to make sure it is healing well with no signs of infection. Around 6 weeks, if you are cleared by your physician, you can begin to gently mobilize the tissue around the scar and aim to desensitize the scar. I usually start above and below the scar, before working on the scar itself. You can perform gentle massage to the tissue above and below the scar and gently stretch the skin in all directions above and below the scar. You can also gently desensitize the scar by touching it with your fingers or a wet cloth, and gently rubbing across the scar in all directions. We can mobilize this scar tissue further, but we are going to talk about this in a future post as this post is focusing on the early period of healing.

At this time, you can also begin applying silicone gel or silicone strips to help soften your scar and prevent hypertrophic or keloid scars. Silicone is considered a gold-standard treatment for the prevention or treatment of hypertrophic scars. While most of the research regarding silicone is of poor quality with significant bias, evidence does tend to suggest a positive benefit. My first Caesarean did lead to a hypertrophic scar, so I began applying silicone gel to my scar once cleared by my OB to do so, around 4 weeks after Mary’s birth. I’ll report back on the difference between this new scar and the old one (See, mini case study!).

**I also have to note here that my colleague, Kathe Wallace, has a fantastic book that details some recommendations for scar tissue management after Caesarean. Kathe also offers a free abdominal scar massage guide at her website, which is a fantastic resource!

Exercise in the Early Postpartum Period

If I could give you one piece of advice on this early postpartum period, it would be to relax. Give yourself a break. Allow yourself to recover and heal. I find that so many people want to jump into too much, way too soon, and unfortunately, this can be more harmful than it is helpful. Remember, you just did something incredible. You just had major surgery. You deserve to rest. 

When we think about exercise during this initial period of healing, we are going to start very gently. Here are a few things you can get started on:

  • Walking: I’m not talking about going and walking several miles. During the first few weeks, it’s best to really rest, and give your body time to heal. Getting up, walking around the house as you feel comfortable can be very beneficial.  As you continue to heal, during the next few weeks, you can increase your walking. So, this may include some outings and short periods of walking between 2-4 weeks. Between 4-6 weeks, you can generally consider a leisurely walk in your neighborhood or a longer outing. The key here is to listen to your body. Rest when you need to, but gradually move to increase your endurance. After you see your OB for a postpartum visit around 4-6 weeks, and you are cleaned to do so, you can continue to gradually increase your walking as you are feeling comfortable.  Are you antsy to jump back into running? Zumba? Bootcamp? Pilates? Don’t. We’ll get there. But let’s rest right now.
  • Breathing: You all know I am fairly obsessed with the diaphragm. 4 years after this post was written, I still think it’s one of the coolest muscles in the body. The diaphragm works in coordination with the pelvic floor muscles, deep abdominal muscles and deep low back muscles to provide support to the abdominal organs, modulate pressure in the thorax and pelvis, and provide dynamic stability to our spine and pelvis. Slow breathing, aiming to expand your ribcage and relax your abdomen as you inhale, then slowly exhaling your air can be incredibly beneficial to re-establishing these normal functional relationships.
  • Gentle Pelvic Floor Muscle Activation & Relaxation: First, my biggest recommendation would be to SEE A PELVIC PT before and during your pregnancy so you really know your current function and can have an individualized plan to get the most out of your muscles and your body. I encourage people to discuss their delivery with their OB, and ask about beginning gentle pelvic floor and abdominal exercises. The timeline for starting this will depend on the specifics of your delivery, and we want to be smart when activating muscles that have been cut. When your provider is on-board with you starting, I like to pair gentle pelvic floor and abdominal wall activation with breathing. This looks like this:
    • Inhale, expanding your ribcage, relaxing your abdomen and your pelvic floor muscles.
    • Exhale and gently draw in your pelvic floor muscles, allowing your lower abdominal muscles to also gently draw in. Aim for a “moderate” effort to allow activation of the muscles but not overactivate them.
    • Then, relax your muscles again as you inhale, repeating this cycle.
    • Aim to do this for a minute or two, twice each day.

Stay tuned as we continue this journey over the next few weeks and months! What have been your challenges after childbirth? For my fellow health care professionals, what else do you like people to know immediately after a caesarean birth?

Have a great week!

Jessica