Speaker 1 3:14
Music, hello and welcome to uplift for her. We have a really fun podcast today, and I am, I just can't wait to dig in. We have a special guest named Christina Hanson. Christina is a pelvic floor physical therapist, and we've just been here talking shop already. We should have pushed record a half an hour ago, because we've had so much fun talking about the most random things that come up with, really the pelvic floor and with pelvic floor physical therapy, when you get a pelvic floor physical therapist and a gynecologist together. There's, there's some sort of end to that joke, but we are gonna have a lot of fun talking, that is for sure. So welcome on. Thanks for coming.
Speaker 2 3:49
Oh my gosh, Mallory, thank you so much for having me. We both have almost the same business name. So yes, uplift, pelvic health and wellness in your uplift. For her, it was Kismet. We were meant to have a podcast together just
Unknown Speaker 3:58
down the street from each other. No relation. No relation.
Unknown Speaker 4:00
No relation. Yeah,
Speaker 1 4:01
I love it. Well, wonderful. Well, thanks for coming. Will you start by telling us about yourself and sort of how you got into specifically pelvic floor physical therapy and what that training was like for you? Yeah,
Speaker 2 4:12
that's a great question. So this is my 18th year as a physical therapist, and I have always been somebody who gets really excited about lots of things, so I have done the gamut of PT, so I've worked in trauma one hospitals, doing neuro rehab for stroke, spinal cord injuries, traumatic brain injuries. I've been a travel PT, I've worked in ortho clinics, acute care, wound care, aquatic care, and I started about eight years ago. So I had two kids. I had a separation of my pubic bone to get a little TMI. I also had a grade three tear. Had a lot of pain, discomfort. Didn't know what to do. As a physical therapist, I didn't know what to do. And I went to my OB GYN at the time, and she's like, here's a handout to do Kegels. And I was like, that's it. And it didn't solve the problem. And actually, it. Was my son's pediatrician who was like, oh, work your abductors to help with your pubic bone. I totally helped. And I was like, Okay, this is crazy. I need more pediatrician. It's good pediatrician. No, totally, exactly. But it was, it was that lack of knowledge that I had and the lack of ability to get to a solution. So social media was getting popular, and I was starting to just stalk different pelvic health therapists. And when we moved to Park City, I interviewed for the Park City Hospital, and they said, Well, what do you really want to do? I said, Well, I really want to be a pelvic floor physical therapist. And it was a call to action at that point. And so I was fortunate enough to be invited to be a pelvic health therapist. But you can't just be a pelvic health therapist out of school like you don't come out with those skills. You come out very much being a generalist, yeah. And so I immediately went to Herman and Wallace as a big organization, started doing training with them, and then went to a pelvic health female athlete training course, because I wanted to be able to help people both internally and through dynamic movements. Since then, and over the course of three or four years, I took like 21 courses. So really took a deep dive at this point. I have stopped counting. It's probably close to 40. I have well over a master's degree in additional training, specifically in pelvic health. And so for me, it was a lack of knowing, and I wanted to serve that gap in what was happening in our community, and also, just as a woman having children and feeling that once my child was born, all of the energy and focus went to them, and I felt like, well, but I have things going on. Yeah, I need, I want women to feel like they're cared for and they're hurt and they're having solutions to the problems they're just kind of suffering in silence with,
Speaker 1 6:35
yeah, gosh, that is so amazing. I'm already I have a million things I want to say about that, but thank you for sharing that for those who don't know, tell us in a keep going along that line about so what does a pelvic floor physical therapy do? Like, you've said it's so different, but how is it so different? I think a lot of people say, Well, I've been to physical therapy, right? Like, oh no, no, no. Pelvic floor physical therapy is a different a different animal altogether. Tell us about that. Yeah, yeah. It is a I mean,
Speaker 2 7:01
it's the same, but it's different. It's, some people will call it orthopedics in a cave. But really, to me, the way that my practice is is that I'm looking at your whole body, which I call a system, and the pelvis is the center of that system, and the pelvic floor has five major functions. And I know we're going to get into this a little bit, but essentially, sphincterix, so bowel, bladder gas, sexual satisfaction, the ability to have babies welcome them into the world. It supports all of our organs, and then it provides stability at the center point of our body. So when people come in to see us, I'm asking about all of those different areas, and then connecting it to their lifestyle, and maybe the lifestyle they really want to have that they've stopped having too. So we're connecting it back to function, which is what PTS are really good at. So it's, it's taking all the tools that I have as a doctor of physical therapy and then applying it to the complex system of the pelvis, pelvic floor, and its connection to the nervous system. So even talking about the nervous system connecting too, which I know some of the questions
Speaker 1 7:58
will get into that as well. Yeah, that's so great. Tell us about just the initial how people get to a pelvic floor physical therapist. I think that a lot of people come through their OBGYN, but I will say, I'm going to kind of take a small detour here to to really explain what happens from the OBGYN perspective. As an OBGYN, I very early on, learned a little more about pelvic floor physical therapy because I was curious, and sort of went down that road and started to realize, Wow, I, as a doctor, as an OBGYN, am really missing a lot of these tools. And I wouldn't say missing, like, I have a lot of tools. You know, I have my set of responsibilities, and my set of responsibilities is a large part of OBGYN training is surgery, learning how to safely do hysterectomies, learning how to remove ovarian cysts, learning how to help women diagnose if they have a cancer, learning how to help women safely through a pregnancy, learning how to do a C section and how to safely deal with emergencies that come up with C sections. The reason I say this is because I hear a lot of patients be like, Well, my OB GYN didn't know that. And I will say, for better or for worse, the focus of OBGYN training is largely on surgery and safe surgery, and we want that if you need a C section, you want an OB GYN who can do a really fantastic surgery for you and and help you get your baby there safely, and help you deal with some of these things from a surgical perspective, there's also lots of other components of OBGYN training, but that training involves almost nothing about understanding the function and the movement of the pelvis in all of those things that you just said in the sphincter, we're trained sometimes to assess that and say, it sounds like there's an issue with leakage. It sounds like there's an issue with something else. And depending on the OBGYN, some of us will have gone down a trail where we learn more about that. But your average OBGYN is not really a. Equipped very well to know exactly what to send to the pelvic floor physical therapist. Does that resonate from where you're coming from? Percent?
Speaker 2 10:09
And I love that you're clarifying where your role is and how different our role is. You and I both practice in the same area of the body with an extremely different lens. They are complementary. And there it works well for patients to have us both collaborating. Having said that, this is i distill it down, and I'm very much oversimplifying it, but I will often tell my patients, your OBGYN is there to save your life, cancer prevention, cancer treatment, surgeries, all of those things make sure your healthy, babies healthy, all of that. Our role is quality of life. So let the doctors do their really, really important work. And if they didn't know it, it's because we are studying different aspects of the same area of the body. Just like I wouldn't make a recommendation on what surgery or how to do the surgery, because that's not my expertise or my wheelhouse. That's when I go, let's go, have you go have a conversation with your OB GYN and see if this is appropriate. So I loved that clarity and that differentiation between what we do same area, very different skill set. Yeah. And
Speaker 1 11:11
I will add one more thing, since you say that, I think it's one of the reasons why I'm doing now what I'm doing, which is integrated women's health, because I think having this conversation a lot of women will feel like there's a giant gap. Then, like, Wait, so I go to my OB GYN for sort of routine screening, and if I have big, big problems that need surgical or medical approaches, but like, What about just feeling my best? And what about, like, making sure my body's working well? And what about assessing where I'm at right now? And so I will say that that's what I'm particularly passionate about, is really bridging that gap, to say, Okay, before you need a surgery, come see me here as an integrative women's health specialist, so we can really dig into the lifestyle and the function and all of that. And so just because I think women are going to feel like it sounds like there's a gap in my care, and I do think that's true and it's unfortunate, but what we're going to talk about is how they can feel empowered on their own. We shouldn't criticize, you know, gynecologists for not knowing these things. They do know a lot, and our continuing education is, you know, preventing post operative wound infections in a hysterectomy and preventing, you know, this outcome with a C section, so they're not sitting around learning nothing. They are learning really, really important things. But I full disclosure, like, I think there's a big gap in women's health training for practitioners. So along those lines, just a quick question that will come up is, so if a woman goes to her gynecologist, she addresses these issues, doesn't feel like, doesn't feel like she's getting the help she needs. And listening to this now, she feels empowered, and she feels like maybe the next step would be a pelvic floor physical therapist. Do patients need a referral? Do they need an OBGYN to send them to a pelvic floor physical therapist? Or could they Google pelvic pelvic floor physical therapy near me and go make an appointment? So
Speaker 2 12:59
great question. So in the state of Utah, and it is a little bit different, I do believe we're now at direct access as physical therapists throughout the country, but within that, every state has different regulations. In the state of Utah we have free, COMPLETE direct access, so your OB absolutely can send a referral, but they don't need to. You could literally go to Google and say pelvic health therapist near me and and find a provider that resonates with what you're looking for. And just like all obs and just like all functional medicine and Kairos and PTs, we're not all created equal. Yes, we don't all have the same philosophy physical therapist. It's the art and science of healing. And so we all come out with this core curriculum as our doctors of physical therapy. However, even with our Con Ed training, just like you were listing off Con Ed training, I chose the path that made the most sense for what I was seeing with my patient population. And for me, I find it to be important to be really holistic, which is why I commonly refer to functional medicine, because there and mental health, because there's an end point of what I can do, and I can see that we need more delivery of full, holistic care of that person. And so we do have a little bit of differences, which I do think Google internet referrals from other people can be really helpful, because they can talk to the experience they've had and the solutions they've gotten. But I think we also need to reframe, What solutions can you expect from your provider? Yeah, we are so stuck in, What does my insurance provide? And really, we should be asking, Well, what I really want? What am I really looking for? And how can I get the care that I'm really asking for, instead of getting stuck into, well, my insurance will only allow this.
Speaker 1 14:39
Gosh, it's so important. And I think I don't want to get too much off of this, because we have so many good things to talk about. But it is important for people to understand how the insurance system works, which is random people in the insurance world, typically men will decide whether something is valid or. Worth it to cover, and it sure. I mean, I'm getting flushed even starting to talk about this, because they are not making these decisions from a place of the average woman's well being at all,
Speaker 2 15:17
at all. When I worked in the insurance model, I was not allowed to write goals that a female could have pain free sex, because insurance companies don't actually care about that for Viagra. But I could write a goal that a patient could tolerate a speculum for a medical exam, and then maybe they give me, like, four sessions, and they want you to be just good enough, where what you're doing is bridging that gap, and you want people to live optimally, and what I am doing is wanting people to not have restrictions in their life and live the life to their fullest, right?
Speaker 1 15:50
And insurance says they didn't die, so we don't have to pay for anything, right? So that's just important to recognize. I also think that in choosing a pelvic floor physical therapist, from my personal opinion, the more hippie, the better. I think that a lot of pelvic floor physical therapists, because of the nature of what they're doing, tend to be, I think a lot of physical therapists are scientists, yes, and we like that, yes, absolutely. Pelvic floor physical therapists seem to have a little more openness and bringing in the what I call the hippie, the the more holistic, the softer side, the breathing side, the nervous system, the understanding and I think if you're treating anything related to the pelvis, because the pelvis is a really crazy place, you know, it's where we have intimacy and we have sex, but it's a really fragile place. When you're talking about abuse, you know, or or any sort of forced interaction there is a really big deal. But then the next minute, that pelvis is also supposed to be the, literally, the birthplace of something so beautiful and wonderful. It's a complex part of our bodies. And so I find that a lot of the really great pelvic floor physical therapists really do have this, you know, arms wide open approach to healing of like, little bit of science, you know, a lot of science, a lot of physiology, a lot of function, little bit of Woo, you know, a little bit of hippie, a little bit of, you know, whatever it takes to help you feel at peace and feel functional
Speaker 2 17:13
absolutely and also, it's really important that we create a safe space, yeah, because it is so vulnerable. And we're talking about when you're treating the shoulder, for example, 100% you can treat a shoulder in a public room where we're talking about things that they might not have even disclosed to their most intimate partners, yeah, and so it's really important in my practice that people feel heard, seen and safe, to communicate what they need, and that they know that they are in charge and empowered for however the session goes, there's never any have to. So
Speaker 1 17:40
when someone first meets their pelvic floor physical therapist, I think it's more you want to be looking for a little bit of a relationship, you know, you want to feel comfortable. And I don't think there's anything wrong with saying, like, I didn't get a good vibe. Or, Yes, I'm not sure this is the best fit for me. I think when you think about, like, if you're hiring a painter for your house, they're going to bring the paint, they're going to paint they're going to paint up and down, they're going to tape, they're going to do that thing, and they're going to get the job done. That is not the approach with hiring a pelvic floor physical therapist. I think, I think it's a little more like hiring an artist, where you say, like, is their style my style, and are they going to be focused on the same sort of outcome that I'm focused on? Yep,
Speaker 2 18:18
I totally agree. Which is why, when people come through our clinic, the first step is a screening, because we want to make sure that it's we have a solution to your problem, and that this feels like a good fit for you, and we're not the right fit for everybody, and that's okay. We want to be an amazing fit for whoever we're an amazing fit for. So I think it's good. Also, when you're calling, it's not Hi, what's your insurance, what's your schedule, it's
Unknown Speaker 18:42
Hi, what's
Speaker 2 18:43
your problem? Okay, this is something we treat all the time. This is our approach. Does this make sense to you? Yeah,
Speaker 1 18:49
I love that. So let's get into the nitty gritty. Then tell us some of the conditions that you treat. I don't, I don't think people know this. Okay, okay,
Speaker 2 18:58
yeah, this is great. So if we're talking from a bowel perspective or sphincteric perspective. So we would have leaking. And leaking can be either stress urinary incontinence, you think, cough, sneeze, run, jump on a trampoline. We have urge urinary incontinence or extreme urgency. And so that's sort of like the classic key in the door, or you see a toilet and you start peeing before you're sitting on the toilet. You could have fecal incontinence. You can have the opposite of that. You can have constipation. Anal fissures are a very indicated reason to come to see pelvic PT, hernia, so more abdominally separation of the abdomen, so a diastasis, any form of abdominal surgery. We should almost call ourselves pelvic abdominal therapists, because we're really treating connected. They're absolutely connected. And then for men, it's going to be like testicular pain, premature ejaculation, erectile dysfunction, that has been shown not to be cardiovascular in nature, because obviously there's that's sort of a canary in the coal mine. Back to women, so infertility, pregnancy, preparation, comfort. During pregnancy, birth preparation so that they can my whole approach is I want women to feel calm and confident that they know what they need to do in labor and delivery, because it is such a vulnerable unknown time. Nobody knows what it's going to be like. And so if you know okay, I confidently know how to position my body so that I can push appropriately, how to push appropriately, what breath sounds, what vocalizations, what other things, and then that postpartum recovery, and we can totally get into the details of that perimenopause to menopause. So as our hormones start to dip, there's almost this unmasking of pelvic floor dysfunction that had been there. And it starts to get worse, any sort of chronic pelvic pain. So if you've fallen on your tailbone, if you have pain with intercourse, if you have pain because you cycle for too long or sitting too long, anything. So any sort of pain in the pelvis, SI joint pain, so the sacrum, the bottom of the spine, low back pain, hip pain. There are lots of orthopedic complaints that, if they're not resolving with quote, like traditional orthopedic PT, is probably because they haven't really, truly looked at the pelvic floor, or maybe the organs and their positioning. So looking at all of that,
Speaker 1 21:10
I think one thing you brought up earlier, before we were recording, is hemorrhoids as well. Yeah, absolutely. And understanding that hemorrhoids don't come by and large for no reason. They often come because there's, there's a connection to what's just above the hemorrhoids, which is the pelvic floor and the abdomen and the breath and how you're exerting pressure there absolutely. So
Speaker 2 21:28
I think of it as there being three diaphragms. Some will say there's some diaphragms in the head. I go just more muscularly. Our vocal cords are a band of horizontal muscles, our true diaphragm, our respiratory diaphragm, horizontal, though dome shaped, but still horizontal relatively and pelvic floor shaped like a bowl, but still relatively horizontal. They're absolutely interconnected, both neurologically and physiologically. And so those sometimes that develop hemorrhoids are singers or those that play horned instruments, or it could be they have fecal dysenergia, so they have discordordination of their anal sphincter muscles. Sometimes people forget how to poop, right? And so they're paring down and they're straining. If you have a timer in your bathroom because you sit there too long to have a bowel movement, you should probably see a pelvic health PT, no matter what gender you are. And I mean, honestly, I think all of us would benefit from rectal exams like I think we just need to make sure those muscles are coordinated. But also, that also helps women who are pregnant, because learning how to poop properly helps you learn how to breath properly, because they're very similar mechanisms and to breathe properly and to breathe properly? Yes, absolutely.
Speaker 1 22:28
So I think when a lot of people think of physical therapy, people think of sort of, well, how could she accomplish all of this magic? You know, that is a wide range of symptoms, and she's a physical therapist, you know, she's talking about, like, you know, she's gonna give me stretchy bands, and she's gonna, you know, maybe take me somewhere, or maybe have me do some stretches. Like, tell us about the tools that you use, because I do think that pelvic floor physical therapists do have a wider variety of tools. But when we think of physical therapy, you know, we instantly think of like, well, I saw one once for my knee, and they told me, you know, to give me the stretchy band and do this one exercise for, you know, three weeks, and that's it. So tell us how what you're using, what tools you're using to help accomplish all of this magic.
Speaker 2 23:12
That's a great question. So it's multifaceted, and it depends on what somebody comes in the door for lot of the tools we have. So I do a lot of nervous system testing and regulation. So teaching breath work, assessing them through some standardized screening tools we use, I like to say, our tools in our toolbox. Craniosacral therapy, visceral mobilization, dry needling, scraping Gua Sha IASTM, all kind of the same thing.
Speaker 1 23:35
Just said a whole bunch of things all at once. So let me slow you down, because you're amazing. When we're talking about this, you're talking about the nervous system, meaning when we get stuck in fight or flight, responding emotionally, but our body is also responding to get ready to help us sprint or to get ready to help us, you know, prepare for that attack somehow so physically in our body, things Adjust and start there from that little pearl, because that's massively important to understand that if we're stuck in chronic fight or flight, it's not just a mental thing. It actually is a physical muscle thing. Can you talk about that? And then we'll come back to some of those treatment modalities,
Speaker 2 24:12
absolutely. So this is where it's interesting, where I know we're going to talk more about leaking later. But a symptom of being stuck in fight or flight could be leaking. It could be constipation, because if our pelvic floor is too tight, and so if we talk about so hard, because there's so many things we want to talk about, but a lot of times, people think like, I need to tighten my pelvic floor. I need to strengthen my pelvic floor, I
Unknown Speaker 24:34
should do Kegels. I
Speaker 2 24:34
should, yeah, I should do Kegels. If that were the solution, we wouldn't exist as a profession, right? Like everybody just do Kegels, problem solved. But honestly, most of us, because of how a lot of us run in our society, we tend to be more in sympathetic overdrive. We're draining fight or flight. We're in fight or flight too often, and when that happens, we can end up developing tension, jaw tension, neck tension, pelvic floor. Or tension. So even like pain with sex, sometimes that's secondary to being stuck in that fight or flight response. So teaching somebody what are their triggers, where is that coming from? And that's where partnering with a mental health therapist can sometimes be helpful, because it can go outside of our tool toolbox of what we can provide, but teaching them okay with breath work, how can we down regulate what is the resting tone of our muscles? Are we walking around like this? Are we breathing up shoulders hunched? Is our breath up high in our chest? And you think, Oh, if we can just even shift that you do a minute of focus down regulated breath work, you could instantly create a change in your nervous system. And so even just teaching that awareness, so a lot of what we're doing is a reflection back, okay, what's going on, and diving into what are those pieces that could be triggers for you? And how can we help you have more tools in your toolbox? So when those things happen, because life happens, things are stressful, how can we help you manage and move through that without having those same physical sequelae that happen as a result? So
Speaker 1 25:59
what you're saying is, when we're in fight or flight, we will develop muscular, by and large, muscular or physical reactions to that fight or flight that you know, if you imagine someone sneaks up behind you, and you go, right now all of my muscles are tensed. My shoulders are up to my ears, my pelvic floor just went clenched. Right we do that, and then what we think happens is, oh, I'm safe, and everything relaxed. But not everything always relaxes. And the more that we live in that state of activation, that state of fight or flight, even if it's not someone physically sneaking up behind us. You know, I use the example of like, oh, shoot, I forgot to bring cookies to the potluck, right? The brain doesn't always know the difference between I forgot cookies for the potluck and I might die. And that seems silly, but truly, the body and the brain don't so if we're living in that state, then some of those muscles that that clinched don't always remember or become trained to go back. Is that what?
Speaker 2 26:59
Absolutely so we stay in just this elevated resting muscular tone, and as such that can cause a host of pelvic floor and other impairments.
Speaker 1 27:09
What are sort of those muscle groups that can stay without technical terms, but what it what does that feel like if someone is having some some heightened resting tone? Because I think when we think of physical therapy, we think, Oh, she's going to tell me, I need to strengthen muscles. And maybe I'll stop there, actually, for a second. How much of what you do is strengthening muscles versus relaxing muscles? Is it 5050?
Speaker 2 27:32
Well, that's a good question. So I have a three phase method. I take people through and the whole entire first plate first phase is, I call it the restore phase. So it's really it's a lengthening phase. It's a nervous system reset phase. It's getting bones and joints to move through a full range of motion and allowing muscles to move through a full range of motion. Because if we're stuck in a tightened, shortened muscle, and we just keep shortening, strengthening through that shortened muscle, then when we do finally have it lengthened, it's not going to be connected, and it's not going to be strong through a full range so strength training, I'm a huge fan of strength training. I want to load tissues. I want people to be doing Plyometrics, sprinting, heavy biking, whatever really calls to them. And we know there's tons of benefits to strength training, so I really want to load tissues, but I want to make sure that we're loading them in an appropriate border. So strengthening is definitely a part of it, but lengthening first. So, yeah, probably 5050.
Speaker 1 28:20
Yeah. Interesting. Okay, so I cut my myself off there. So we're talking about, what are those muscle groups then that when we're in stuck in chronic fight or flight, might be in a higher, a too high resting tone, so
Speaker 2 28:34
any muscles of the pelvic floor. So it varies a little bit for people. A lot of times it's going to be like those deep hip rotators. One of those deep hip rotators actually connects to the pelvic floor. So the only difference between a hip rotator and the pelvic floor is one ligament that divides them, so you can actually manifest it as deep hip pain. But it's really something from your pelvic floor. Same thing. We have muscles that come up and attach to the sacrum, the base of the spine, and if those are over tight, sometimes you'll feel pain around your low back that's actually from the pelvic floor. In addition to that, people, it might manifest in clenching, grinding headaches because the neck and the shoulders are holding too much. So those are sort of the common areas where people hold that extra tone. So it is pelvic floor, but it's not only pelvic floor.
Speaker 1 29:18
And then you mentioned one of them before, but let's make sure we have these so people understand. You mentioned some of the symptoms that can come from that long term, heightened muscular tone. You mentioned urinary leakage can actually be too much tone in certain pelvic floor muscles. What else? What other symptoms would someone have where they would be like, oh gosh, maybe my holding muscles is causing problems.
Speaker 2 29:44
I would say over 70% of the people that walk in my door fall into this category. So all the normal dysfunctions that somebody would come in for, there's probably something going on with their nervous system, so urgency, leakage, either pain when they get close to orgasm. Painful orgasms, inability to have an orgasm, constipation, hernias, anal fissures, all of that, spending too much time on the toilet, all of that can be symptoms of pelvic of your pelvic floor, holding too much tension.
Speaker 1 30:11
What other symptoms outside of the pelvic floor would someone have if they had too much tension in the pelvic floor? You mentioned, actually, tightness in the jaw. What about any connection to the breath? Oh, yeah, absolutely
Speaker 2 30:20
so, so. But okay, so I just want to say this. So if we look at basic embryology, when we were first in our mothers, when we were a tomb with a tube within a tube. So opening for mouth, opening for the bum, the bum, they were one long line. So both neurologically and embryologically, the jaw and pelvic floor are connected. So I'm often screening, Oh, do you also happen to have jaw pain? Or do you have, I say, tinnitus? Tinnitus, whatever it is, ringing in the ears that oftentimes, is a strong connection to the jaw. Also, when we're in more of that fight or flight, our breath moves up higher. And so not only are we not allowing our breath to let our organs get a little gentle massage, we're also denying the breath into our pelvic floor and allowing it to move. So now it's getting shortened, not only because the nerves going to there are tightening it, but also because of how we're breathing. So just in how we breathe, we can affect so many different parts of our body, not just nervous system regulation, but then that secondary, that nurturing and nourishing of all the organs just by our
Speaker 1 31:19
breath. Gosh, this is, I wish, I hope, people can understand actually, how truly important this is, because it's, I've said it before, and I'll say it again, the body is one interconnected animal, like it's not our brain and then our uterus and then our GI tract. We are beautifully built, so that all of our parts speak to all of our parts, and as we heal all of our parts, all of our other parts heal. So the breath is really, really important, and just so people understand when you're talking about the pelvis, it's that bony pelvis. I think a lot of people can picture a skeleton, and it's that bowl that sits at the bottom of the spine. And if you take a sheet of muscles and laid it into that bowl, that's what we're talking about in large part, when we're talking about the pelvic floor. And that sheet of muscle that that lines the pelvic bowl, or the pelvic floor, is parallel to our diaphragm. And what we want those to do is we want both of them to be flexible and fluid and moving, and just like you described, if we're in fight or flight, we're going to hunch up our shoulders and we're going to take our breath into the top part of our lungs. And when we do that, we see our chest rise so we go, and we can even hear it, because it's constricted and it's tight and it's higher in our body. And tell us what happens. Then again, with the pelvic floor, that sheet of muscles that lines the pelvic bowl. What's happening to those muscles if we're breathing up? And then what happens? Then explain, how should we breathe, and what happens to the pelvic floor when we actually breathe, how we're supposed to breathe. So I'm gonna
Speaker 2 32:55
also say, I'm gonna answer this question. I'm also gonna say how we sit can also influence the same issue. So if we sit with our legs crossed all the time like a proper lady, or if we sit with our legs together all the time, we're not allowing the pelvis to be able to move freely. So I usually tell my patients to sit like a dude, sit with your knees at least as wide as your hips, so that you can allow that breath to get into your pelvic floor. So when we're in fight or flight and we're breathing really up high in our chest, even also, if you notice somebody when they're really stressed, they'll almost talk higher. And when we talk higher, we're closing off our vocal cords, and we're not allowing our diaphragm to move down. So essentially, when we're breathing up higher, our lungs are still filling up. We're probably not even getting air into the lowest lobes of our lungs, which, that's a whole other situation that can be happening. But we're denying our diaphragm to come down, so then the pelvic floor, that bowl isn't also moving downward towards the floor or towards your feet, whatever way you're oriented, right direction the right to write in the correct direction. And we really need that movement, and especially you think, what's in between your respiratory diaphragm and your pelvic floor diaphragm, all your organs and one of your nerves, the longest nerve in the body, the vagus nerve, that innervates or connects to and interacts with every single one of your visceral organs. We're not allowing that to help regulate our nervous system. So it's like one of those vicious cycles where our voice is higher. We're closing off our muscles. We're not breathing down into our pelvic floor. It's tightening. We're not allowing the nerves to even have the opportunity to respond, because we're not allowing them to move because of how we're breathing. So if people take nothing away from this other than looking at how they breathe, that would be hugely important. So
Unknown Speaker 34:30
then the follow up question is, where
Speaker 2 34:31
should we fill our breath? And I will typically tell people, I want them to think about a third of their breath in their torso, a third of their breath around their diaphragm or kind of upper belly area, and a third of their breath down into their lower belly, like below belly button.
Unknown Speaker 34:47
I feel myself practicing while you're describing this. So yes,
Unknown Speaker 34:50
I'm sure listeners are too,
Speaker 2 34:52
and I will say most people can breathe through their upper chest really easily. We need more awareness. So a lot of times, there's even some different breath styles with. Yoga where they'll have them breathe into their pelvic floor first, so breathe it to the bottom and then breathe up after there. So there's lots of different ways that we can get ourselves to connect down into our pelvic floor. So whatever resonates with you position can also affect it. So lying down is oftentimes a little bit easier to access your breath all the way down into your pelvic floor. We don't have a lot of proprioception, which is the type of nurse that tells where we are in space, because our pelvic floor doesn't necessarily need to stabilize us on one leg or with our eyes closed. So as such, it's harder sometimes for us to feel if our breath is actually getting into our pelvic floor. So you might find sitting on like an exercise ball to be really helpful, or even placing your hand inside of your sit bone to see, as you inhale, do you feel your pelvic floor moving downward towards your feet, and as you exhale, returning to a resting position without you having to do much other than breathe downward? Yeah,
Speaker 1 35:52
I think this is so interesting, because just as you're talking through this, like, I'm just feeling where my breath is, and you start, as you get more in tune with this, you start realizing, like, Oh, I was flexing that pelvic floor muscle. Why? Why was I holding that there? I didn't need to hold it there. And so as we learned that, like, it's okay to release, then things go better. And just that little comment you made about sitting like a lady, I think this is actually a really big deal. I think, you know, I, I grew up being taught that I should tuck my butt under right, that I should my butt would look smaller if I tucked my butt under, and my belly would look smaller if I tucked my butt under. And, you know, fast forward 40 years. A physical therapist trained me to to release that and to let my butt stick out a little bit, and it fixed my feet. It fixed my posture. It fixed my breath. It fixed my pelvis. I was, I mean, like within days, within single digit number of days. So as we're talking through this, I think that you know, a little bit of commentary on feminism and on the way that you know, be smaller, take up less space. Don't breathe big. Don't separate your legs. Don't you know, my legs are crossed at the ankles right now. Make sure that you're, you're like you said, sitting like a lady. Make everything contract and small and skinny and hold it. Do not let go whatever you do. And we could take some deep dive here, and we won't, for sake of time. But I want to transition that to say, I think that if someone is listening and they feel like they would benefit from being evaluated by a pelvic floor physical therapist, they would and that I want to use to transition one of the things that you do is really a functional assessment. And tell us what that means with a functional assessment, because I think it for people who are like, well, I don't have a lot of pain. I don't have a lot of this, but I do feel short of breath sometimes, or I can't exercise as long as I want to, because I run out of breath, you know, or like, I'm fine as long as I don't bend over a certain way. If I bend over a certain way, something catches. Or I get a lot of patients who say, like, I just want to age gracefully. I don't want to have injuries. Tell us how you use the functional assessment to evaluation to really support women as they age and as they're functioning, just on a day to day. So
Speaker 2 38:11
I love this question, okay? And I just want to dovetail with the tail end of what you just said, not only people who clench their glutes. So you'll see people and they're standing with their butts tucked underneath. We look at that. We also look at the rib position. So a lot of us will end up thinking we need to sit upright, and so we'll sit almost in this hyper vigilant chest open, military type position. And with that, we have a disconnection to our core canister and ability to contract appropriately. So functional screening is going to be looking at what happens when you stand on one leg. We can see so much from that, what happens when you squat, when you bend over, when you jump up onto a box, when you jump down, when you run versus when you walk. All of that is giving us really good information. How do you bend over to pick up your kids? How do you bend over to put your shoes on? Because all of those things we our bodies are beautiful, and they want to find homeostasis, and they will compensate and learn alternate strategies that may not serve us short term it may, and it will lead to secondary dysfunctions. And so sometimes it's a dialog. So a follow up to that also is so were you somebody that was taught to always sit with your legs crossed? Were you somebody that was taught that you needed to suck in your belly so you looked smaller all the time. Now, if you're sucking in your belly all the time, reflexively, your pelvic floor is tightening as
Unknown Speaker 39:27
well, and you're not breathing and you're not breathing, and then we
Speaker 2 39:30
put on high heels, and we put on corsets, and we put on all these other things again to make us smaller and take up less space. And no wonder why the end of the day we were so miserable and unhappy and
Unknown Speaker 39:41
have prolapse and hemorrhoids, and prolapse and hemorrhoids that
Speaker 2 39:44
are in a bad mood because we've just completely drained our cortisol because we've been in Firefly all day. Yeah, so looking at function and asking questions in terms of what are their beliefs and how they should even sit and exist. Yes, all of those things influence your health. Help and your overall health. And I think I love your point to saying, Well, why should I go to a pelvic PT, I'm not really in pain. Maybe I'm not even leaking. A lot of times, people will come in our door and they've actually been living with leaking for a really long time, and something else that brings them in. I actually think we should be doing a better job, not just as pelvic physical therapists, but as physical therapists in general, to be a part of primary care, yeah, because you go to a doctor and you get a physical, and they're looking at your lab work and your lungs and your heart, and they're updating your medications, and they're doing lots of, again, massively important, vital things to your well being. How many people come in with low back pain? They're like, Oh, but I just bent over to pick up this item off the floor. Now that was just the straw that broke the camel's back. Proverbially speaking, something was going on in a dysfunctional way. And so we like to look at that early on. And if we can prevent massive things from happening, where you're bed bound, or you have lots of quality of life, or you start falling, you
Unknown Speaker 40:55
can get off the toilet by yourself, by yourself,
Speaker 2 40:57
like, just, there's some standardized tests we can take people through, like, can you reach forward falling off so you don't have a fall risk? Can you sit to stand in a certain amount of time? So we have some standardized things, but also just looking at global function. And a lot of times when somebody gets fatigued, you'll start to see knees start to move in certain ways. And I go, oh, something's going on with the hips. So we like to train the way we want people to move without having issues. Sometimes it's the issues that bring them in. And sometimes it's, oh, I just want to maintain myself. Yeah. And that's where I think functional medicine. And I would almost say, we're like, the functional medicine
Speaker 1 41:28
of physical therapy, physical side, yeah, yeah. Do you think that? I'm not sure that this functional sort of assessment, if someone goes to a physical therapist and says, like, I don't have any problems, I just want to make sure I'm moving. Is that bread and butter for most pelvic PTS, I don't, I don't think it is so.
Speaker 2 41:44
And especially it should be. It should be, yeah, percent agree. And that's why I said, I think we should be part of primary care. Yeah, the way our model is currently set up, health insurance dictates how your care is delivered. So if you're going to an insurance, PT, you are given a script oftentimes, to treat this part of the body, and that's all you look at, is that part of the body. But when you come in to see us, I want to know, do you have a good do you have good enough toe mobility? Do you have enough ankle mobility? Because if you're a runner or somebody who does a lot of hiking and walking, those restrictions can put more force through your pelvis, and that can honestly contribute to your leaking. So leaking is a symptom, not a diagnosis. Yeah. And so we need to look at your whole system, your breath work, your nervous system, all of that to go, Okay, what is it for you that's the contributor so that we can solve that problem.
Speaker 1 42:28
So for people listening, they may actually have to work a little to find a pelvic PT, who can do the functional assessment, but I think it's brilliant. I really feel strongly about it. And just as a side note, I I have interviewed several pelvic PTS because I send patients to them with some frequency, and as part of the interview, I'll usually go as myself as the patient and see what their approach is. And that's how this came up for me, with my my butt tucked under is I was just going because she we were trying to form a business relationship, and I wanted to know if I could send her patients, because I wanted to know what she was about. She was about. She said, Well, let me just do an assessment. Do you have any symptoms? And I go, No, I have zero symptoms, except I have a bunion on one foot, been there for 10 years, went to a podiatrist. They told me it's time for surgery, but I'm a runner, so I don't want to do the surgery. So it just hurts every day. I had to buy new shoes, have to change my shoes, have to take my foot out of my shoe like but that's it. Otherwise, I feel great, no problems. And she did this assessment and and found all these things. The way I was breathing, the way my butt was tucked under. She didn't look at my foot really. She looked at my ankle mobility, but, like, didn't necessarily look at the bunion, but I tell you, after fixing my pelvic positioning, that that bunion, it's still ugly, but it hurts me zero, like there's no pain in there. But what she found was that because my butt was tucked under, then I was walking on the backs of my heels, and then because of that, then my shoulders were hunching forward so I could keep my center of gravity, so then my chin was jutting forward, and I would get these really tight neck muscles. None of that matters. And I'm not saying that like physical therapists fix bunions and all of that. But what I am saying is that I didn't have any symptoms really that were bothering me, but I really believe that I I learned how to stand, I learned how to sit, I learned how to breathe through this assessment. And I really strongly believe that I am preventing, I mean, I certainly prevented a bunion surgery, which I'm so grateful for, but I really think I was able to prevent future problems. So I'm just so passionate about like we should be using our bodies well, and we should make sure that when we're picking down and or bending down and picking something up 50 times a day, are you doing it right, you know, and it because, if not, then it doesn't matter what you're doing at the gym for that 30 minutes. What are you doing all day, every day, and can you do it in a way that it supports your body to prevent injury so you don't end up symptomatic? So I'm just so passionate about that. I totally agree. And
Speaker 2 44:52
I think all physical therapists have the capability to do that. They are limited by insurance, yeah? So if you can go to an out
Unknown Speaker 44:58
of network, yeah, insurance will not cover that. Church does not
Speaker 2 45:00
care if you're functionally optimally. They do not care that your butt is
Unknown Speaker 45:03
tucked in your bunion, yeah,
Unknown Speaker 45:06
yeah. We can do something
Speaker 2 45:07
simple corrective, and who knows what else now it's preventing in your body so that you can run better and try time with your kids, all of that, right? And so I hope that people can see that there is a lot of value in finding the person that's the right fit for them, for the things they need, and also being able to ask themselves, what do I really want from this? People also don't know how to set goals for themselves, and that's where we help coach. But a lot of times, people will just say, Well, I just want to understand my body better. Why do you want to? What does that mean to you? Yeah, so getting in and understanding their deeper why it helps us serve them better as
Speaker 1 45:41
well? Yeah, man, I could talk to you literally for three more hours, and I think we wouldn't get tired of it. I do want to focus on I offered a question box to the Instagram sort of followers to see what questions they had for a physical therapist, and several of them asked about urinary incontinence and urinary leakage. So talk a little bit about that, about what that means when, like, why does that develop, and what impacts it, and what can we do on our own, but also with a physical therapist to try to help that? Love
Speaker 2 46:13
that question. And so urinary leakage is a symptom, not a diagnosis. So I can't give necessarily a canned answer that it's going to be correct for every person's leakage issues. I think a lot of individuals think that urinary leakage happens only in women who have had kids. That is absolutely not true. It's just very underreported and very under talked
Speaker 1 46:33
about, and also only in older women, right? So only in older women. So which is not true. It is not
Speaker 2 46:38
true. I was part of a group to help figure out what the guidelines were for female Olympic athletes. And in that group, there were d1 college athletes talking, and they said, okay, there are 14 women on my d1 basketball team in college, 12 of us League, urine, zero. Wow, important, because if they tell their coach, their coach will pull them from play, and then we have the whole issue with the physician for the gymnast, and that's created a whole sequelae as well. So I think people are ashamed of it. They don't want to talk about it. And so if we can normalize the fact that, if this is happening, is your pelvic floor too tight? Are you bearing down too much? Do you not know how to manage your pressure? I will tell you people, how many exercise classes do people go to and they're told to tighten their core, and they have no idea what that really means. We suck in. We suck in, we suck in. And sometimes we actually only engage, or primarily engage, their upper abs, yeah. And so now you're squeezing, and now your pressure is going down, which can lead to leaking, and it can lead to prolapse. So learning how your pelvic floor and deep core need to be the first things on and the last things off. If you've ever had an episode of back pain, you should have somebody retrain you on how to activate your core. We know from the literature. Same thing with the knee. If you ever have an inflammatory or swelling process in either your knee, but we'll talk about your low back. It causes an inhibition of the very muscles that need to stabilize your spine. Yeah. So it's oftentimes a good idea to just get a refresher on how to move appropriately, and people learn all sorts of interesting patterns. I'll be doing exams on people and their pelvic floor and core Come on. And then all of a sudden, their pelvic floor shuts off, and their core is doing all the work. That could be why they're leaking they're not coordinated between those two muscle groups, even though theoretically they should be well coordinated, yeah. So
Unknown Speaker 48:21
Did that answer your question? Yeah,
Speaker 1 48:23
yeah. Tell us a little bit more about what the treatment involves for the assessment and treatment involves if they come to a pelvic floor. PT, so
Speaker 2 48:30
first of all, is a thorough history. When did this start? What is, what are the precipitating factors for it? Did it just start one day? Typically, it does not. Typically, there are certain things that really will create or cause the leakage. Like some people can run, no leakage, jump on a trampoline, they leak. And some people it's vice versa. Some people it's bending over. It happens. And so is there a prolapse that can be contributing to it? Is there a laxity or a loosening around the urethral sphincter? The urethral sphincter, much like the anal sphincter, has an autonomic muscle and then voluntary muscle. And so sometimes those can become weakened with time, just like any other part of our body, we lose strength if we don't use them. And so a lot of times, even when people are activating their pelvic floor, they're activating more around the back side, around the anal sphincter area, because they're the deeper, bigger muscles. And so we can connect to them and feel them more, or really, we need to retrain the more superficial muscles around the urethra that control urination.
Speaker 1 49:28
Okay, and so what are the things that can cause you mentioned? What are the things that can cause urinary leakage? You mentioned a couple of them, but let's just make a clean list there. I think definitely things that increase intra abdominal pressure, right? So that's chronic coughing, poor breath connection, right, when we're not breathing appropriately. Being overweight has a component there, because it increases that intra abdominal pressure. What else is on that list? So
Speaker 2 49:58
tightness in. Or mid back, so you think anywhere where your ribs are attached, so that it's called the thoracic spine. If that's tight and restricted, we can't expand enough to decrease the pressure, so therefore the pressure has to go somewhere. Oftentimes, it goes out forward through the center of the abdomen, so that leads to that diastasis, or it goes downward, it leads to prolapse and leaking. So even though we're talking about the pelvic floor, we would be remiss if we didn't look at how well does the thoracic spine or that mid back move. So basic physics, the more you increase the volume, naturally going to decrease pressure. So we need to be able to expand appropriately, let our belly relax and be soft, but good joint mobility. What about
Speaker 1 50:37
the link between urinary linkage and leakage and constipation? Do you see a link there? Well, that's
Speaker 2 50:43
a great question. Sometimes, yes, not always, but I do find, especially if it's tight pelvic floor muscles that could be a contributor, or really excessively tight abdominal muscles, or even the fascia that non contractile connective tissue, it doesn't allow things to move. Well, then we go back to our breathing being up high that our breath's not getting down through our colon and small intestine. So it can't move as easily, just slide and glide and follow that peristaltic wave that it should just naturally have occurring. Yeah? Sometimes, yes, not always.
Speaker 1 51:10
Yeah, yeah. I think you've I think that that pelvic floor dysfunction, you know, where it's over, it's over tense in one direction, and Lee and loose in the front direction. So it's over tightening the pelvic floor muscles around that the rectum, and then the other ones are sort of forgotten about. And so the urine, urinary leakage there do also have
Speaker 2 51:30
a reflex that reflexively when we cough, sneeze, laugh, etc, our pelvic floor should automatically contract. That reflex for whatever reason. Oftentimes, can become inhibited. We can retrain that reflex. You can retrain it really quickly. So I'll tell all of you it's called the knack, which just means to be good at something by definition. But essentially, it's a very quick pelvic floor contraction right before a cough, a sneeze and a throat clear, and at some point that will become automatic to laughing. I don't know anybody that can do that before spontaneous laugh, but really like sometimes it's this is where seeing a pelvic health therapist can be helpful, because it's learning to coordinate the correct muscles to do that. There's still some people think, like, oh, I can feel it back here I'm doing something back here is the front that we need two more.
Unknown Speaker 52:08
I was practicing while you were doing that.
Speaker 1 52:13
Yeah, there's, there's something there, yeah, yeah, wonderful. Do you I lost my train of thought, oh, so what are your feelings then about kegels? Because that's going to be the first thing people Google, right? Like, oh, I'm leaking urine. I should do more kegels. What pros and cons there? Pros and
Unknown Speaker 52:31
cons there? Yeah. So
Speaker 2 52:32
I'm of the philosophy that there's some literature out there that says we can do functional strength training and activate our pelvic floor better than just doing kegels. Having said that, do we sometimes need to retrain the coordination, what we call the motor control, but that ability to contract and relax appropriately, that's where I think pelvic floor activation can be helpful, but I prefer once they know how to activate their pelvic floor, to connect it to function, so your squats, your bridges, your bird dogs, all of those things. The cat cow is even going to activate your pelvic floor just in a single, isolated cable. And when people come in and they tell me, oh, what strengthened my pelvic floor in every stoplight? I was like, Well, did you ever have a problem with leaking at a stoplight train to the function of what
Speaker 1 53:11
you're doing? What about those the devices that we see, the ones that go in the vagina and you flex around them, or some of them are, there's some fancy ones connected to apps and, yeah, yeah. I
Speaker 2 53:20
like the ones that can go up and down. So once again, we're focusing on the contraction
Unknown Speaker 53:26
as much as the release. We need to focus on just as much as
Speaker 2 53:29
the contraction. It's not just the part we can feel. It's also that, can you come back down to that resting state? So I have people that come in and they can contract their pelvic floor beautifully,
Speaker 1 53:38
yeah? And they cannot let it go, yeah, yeah, yeah, yeah. And I think also, just a, you know, what am I trying to say? Also, just a reminder of the importance of an exam? I think it's we live in a time where people want to DIY their care, and as much as possible, I want to help people do that. You know, I, as much as people don't need to see me, I'm actually thrilled. But there is something, there's so much that we can gain as practitioners from a history and from the exam. And so when I do an exam on a woman and I see she's got horrible prolapse, or she's got, you know, pain or different things with the exam, those things really help us differentiate. What are these little treatments that are going to be the most successful for you? So you're not DIYing it and not making any progress,
Speaker 2 54:22
absolutely. And there are also some really great at home workout programs that you can do, like prenatally and postnatally. And some are fantastic. But sometimes how the message is communicated is different than how the body interprets it. Yeah. And so I will have sometimes people come in after that and they've made their diastasis worse, or they've made their pelvic floor dysfunction worse, because they're actually doing opposite of what they think they are, especially in an area where we don't have good proprioceptive
Unknown Speaker 54:48
connection. Yeah,
Speaker 1 54:49
yeah. So having that making sure someone's doing it the right way,
Unknown Speaker 54:53
and I understand that there's that barrier of,
Speaker 2 54:56
oh my gosh, I have to get undressed in front of somebody that I'm just meeting for the first. Time. But I will say the value is so profound, because when you know how your body functions, I'm all about let me give you as many tools as you can so you can live optimally, not just good enough, but optimally. And here are all the tools that we're going to give you. So now, if something does come back, because life is life, stress happens, you know how to take care of it. Yeah, yeah, sometimes you need to tune up like you know. So I think there's, it's great to have all of the research that we can have, but sometimes it's hard to understand how that connects to you in particular, and how the body interprets that
Unknown Speaker 55:31
as well. Yeah, completely. I
Speaker 1 55:40
Yeah. Okay, this question you already answered, but I'll see if you have anything else you want to add, is, is lower back pain related to pelvic floor issues? Hard? Yes, yeah. So literature,
Speaker 2 55:51
depending on which literature you read, somewhere between 70 and 90% of low back pain has a pelvic floor component to it, so your back pain is not resolving. Which is like traditional exercise? Come see us. We treat low back pain all the time. How
Speaker 1 56:03
about this question? I went to a pelvic floor PT for about six months and didn't have great results. What should I do? So
Speaker 2 56:08
great question. And number one, that's unfortunate, and I when I have patients come in every single time, I want to know, did the intervention that I gave you this last week that I sent you home with behavior changes, exercises, lifestyle modification. Did it impact your life? And if it did not, we need to be doing something different. So also learning how to not I have no idea what happened in this situation, learning how to make sure that you're advocating and communicating for yourself. And sometimes, depending on where you go, you might only have 15 minutes with a provider, and then you're sent off to a tech who has a high school degree and had, you know, some shadowing on like in person experience. When you come to a clinic like ours, you're seeing the doctor of physical therapy for the entire hour. And I'm not spending time watching you do 30 repetitions of everything or anything. I want to know, can you do this? Can
Unknown Speaker 57:01
you execute this? Well, is there a breakdown in it?
Speaker 2 57:03
Send you home with how to do it. Ask follow up questions and keep moving the needle forward so people should be making consistent progress. We also have questionnaires that we can ask people so that we can get more of that objective data. And yeah, somebody's not getting better in six months. I would hope that sooner than that, yeah, they're stopping care. It sometimes can take six weeks to see something, but I should be seeing small changes within one session. Yeah.
Speaker 1 57:26
And I just want to second that advocating for yourself, because as a practitioner, most of us, I won't say all of us, but most of us really want to see you improve. So it doesn't do us any good if you're continuing to see us for six months and not telling us that things aren't going well, you know, we and that's, I have questionnaires as well, and I do think that's part of the model of finding a practitioner who's spending time, but that's part of my model. Model is to say, what's going well, what's not going well every single visit, what's going well, what's not going well. Because if you're just being nice to save me heartache, like, if you're just like, oh, doctor, yeah, this is working great, but secretly, you're like, This isn't helping at all. Like, who is that helping that doesn't help me? Like, those warm fuzzies don't do anything. I mean, I'm grateful to nice patients, but like, I want you to get better. I want the
Speaker 2 58:14
good, the bad, the ugly, yeah. I want that for feedback as a practitioner, feedback as a business owner. I want that feedback from their lived experience, and the more that we can create that safe environment, hopefully they can open up more, which is counter to a lot of women. I don't know how men are, in my practice is like 95% female, but as a gender, we're oftentimes wanting to be nice and amicable and talk about and it's like, no, this is your time. Say all of it. Let's help you get better. That's why you're here. That's why you're paying us for this.
Speaker 1 58:43
I think it's also okay to ask the question, like, what's normal here? Like, if I do this, should I see results in one week? Should I see results in six weeks? There's not a lot of things that you have to do for six months, you know that, like, oh, keep doing this for six months, and then you'll see results. You know, most of it. We can help you as experts, help you break down those expectations, so that if you're going astray from those expectations, we can correct and readjust before, you know, two months or four months or six months. And I also think that if, again, follow your gut, that if you're not getting if you don't feel like it's going well, you don't have to stay. I mean, you don't have to stay but we as practitioners usually have lots and lots of tools, and we're not going to pivot if we don't know that it's not working. We can always pivot. We can change the way we're approaching it. We can change the way we're communicating. We can change the way we're supporting you, like we have lots and lots of tools. So the question is, if the patient has not conveyed the lack of improvement to us, so we can't use those tools, or if it's just not a good fit, absolutely.
Speaker 2 59:46
And I think this is also a great place to go. So in a population I'm thinking of is those with chronic pelvic pain who've maybe gone to multiple practitioners, they're still not getting better, getting to okay, what are we? What are we? Sync, and if we're not seeing change in an appropriate time frame, who else can be of assistance? And that's where I think functional medicine is really handy. That's where I think mental health is really handy, especially when we're dealing with potential traumas in the pelvic floor. Statistically, in Utah, 710, women at some point in my life have experienced some form of sexual trauma. Yeah. So the reality is that something has happened, and even they're not able to communicate that, and so getting them resources so that we can help them get to a solution faster.
Speaker 1 1:00:27
Yeah, absolutely. That's a whole conversation that that I wanted to have today, and we just didn't have time to really do it justice. But we'll have you back and talk specifically about sexuality and sexual health. And it's, it's a complicated, I think we think of it so black and white, like, you go have sex and it's fine, right? Like, oh, it hurts the first time, and then you're fine. Like, it is so not that simple. It is so complex in terms of emotion and in terms of perceived, you know, there's sexual assault and then there's perceived sexual trauma. Of of that are much, I don't even want to say they're milder, because they're still a really big deal. But those situations where maybe a woman consents to have sex, but still feels kind of pushed into it, or feels like more, more, you know, pressure was there than she would have liked. So it's not not consensual, but still doesn't feel great emotionally, those things are really, really big deal. So that fight
Speaker 2 1:01:22
or flight part of our system of travel responses, yeah, flight, but it's also freezing and fawning, yeah? And so fawning is that I'm going along with this, even though inside it's not feeling right, but I know I'm supposed to behave this way. Are supposed to go along with this, and whether that's with an intimate partner, whether that's with a medical exam, right? So I go draw my patients before you are in charge of this. Yeah? These are our stop cues. These are raise your hand if you can't even localize that there's something that's not connected appropriately. I've said yes, but in my mind, something's not feeling right, yeah? And I think that's really empowering too. Let's empower women to be able to say, No, this isn't okay. How can we get out of that fawning part of the fight or flight, yeah,
Speaker 1 1:02:01
and recognizing that the brain, even if the brain is making a decision, that the body is responding according to the thoughts, right? Like you may feel like I don't know if I want to do this, but I guess I will, but the body is still saying I don't know if I want to do this, so and that body remembers that. And so there's so much still to talk about here that can be relevant well, so we'll have you back. Christina, this is so great. Tell us where our listeners can find you. Yes.
Unknown Speaker 1:02:27
Okay, great. So
Speaker 2 1:02:28
on on the website, or on on social media, would be uplift phw, or uplift pelvic health and wellness on Instagram and Facebook. Website is uplift phw.com and they can find us in person in Mill Creek, right on Highland Drive, down the street from Dr craycroft, about 4190
Unknown Speaker 1:02:45
South Island drive, wonderful.
Speaker 1 1:02:47
Thank you so much for being on This was such, I think, an important conversation for women to have, and we've got got more to come. So thank you so much
Speaker 2 1:02:54
talking to you as well. I would love to keep having this conversation going. Thank
Unknown Speaker 1:02:58
you so much for having me awesome.
Unknown Speaker 1:02:59
I.
Transcribed by https://otter.ai
