The Importance of Cross Training and Your Pelvic Floor
The Importance of Cross Training and Your Pelvic Floor
By Marin Cole
Its that time of year again when we all want to make self care a priority and better ourselves. Whether that means you are going to give up sugar, or you’re going to start training for a marathon, or you are going to ride on your NEW peloton 5 times per week, we all want to stick to our New \Year's resolutions. While New Year’s resolutions are a great idea, I want to talk about what a lot of people mistakenly do when they make them. If you, like me, just got a peloton bike and that is going to be your new method of exercise, fantastic, but keep in mind that cross training is essential!
Cross training refers to the concept of training your muscles in a variety of ways, like cycling, running, or strength training all in the same week instead of only cycling every day. We have different types of muscle fibers in our body, some are used more for strength, some more for endurance, so it is important for us to train the different types of fibers. Functionally, our body moves in all the different planes (up/down/side to side) so it's also important to train our bodies that way too! Lastly, overuse injuries are extremely common, especially for people who start a new exercise routine and do “too much too soon.”
So, if you, like me, are super motivated to hop on your new bike, don’t forget about stretching before and after, and incorporating strength training into your new exercise routine.
If you are newly postpartum and you too are excited about starting a new exercise routine, these “rules” are especially important for you! Keep an eye out for another blog that will be released shortly that goes into more detail about cycling and what current research says about the safety of cycling! If you are a c-section postpartum mama, I would consider joining our C-section Group coaching for more tips and recommendations https://empoweryourpelvis.mykajabi.com/offers/JeMHE3oX
New Year, Same You with New Goals!
New Year, Same You with New Goals!
by Heather Evans, DPT
Happy 2022! This is the time of year when everyone is talking about resolutions – love them or hate them. You will also hear “New Year, New You,” but I don’t love this saying because it implies that something is wrong with the way you are now. Instead, think of this as “New Year, Same You with New Goals!”
Whether or not you jump on the resolution bandwagon, I always encourage people to make and set achievable goals. I LOVE goals (everyone here at EYP loves goals, you should sit in on one of our meetings). So, whether you put them in resolution form or whether you are like me and make daily, monthly, quarterly, and yearly goals, let’s talk about how to help you successfully meet them.
First, goals need to be specific steps. So instead of, “I want to lose ten pounds,” try “I will walk for 20 minutes, 5 days this week” or “I will eat 5 servings of fruits and vegetables today.” When goals are huge, we become overwhelmed, but breaking things down makes them achievable. Let’s consider a pelvic floor example. Too broad: “I want to stop going to the bathroom all the time.” Instead, try “I will decrease my coffee intake from 2 cups to 1 cup today” or “I will record a 3-day bladder diary to discuss with my pelvic PT.” How about a self-care goal? Too broad: “I want to add self-care every day.” Better: “I will complete 10 minutes of guided meditation today” or “I will turn off all screens at 9 pm and read a book for at least 10 minutes.”
Second, write down your goals. Goals in your head are great, but you need to record them to really meet them. Everyone will have different plans that work for them, but I wanted to share what works for me. I use a paper planner, but you can also do this on your phone! I write down at least four goals for the month. For example, my January 2022 goals are to complete the art for my upcoming podcast, choose a website domain, complete the prereading for my upcoming PT course in February, and to finish one specific section of another course I have going. Notice going back to the last tip – I didn’t just write down “make a website” (which I would never get done by January), I made it more achievable by instead writing to choose the domain. I also didn’t write down the name of the course I was taking, I specifically wrote down a section to finish. Then, on each day, I write goals for the day starting with the ones that MUST be done with at least one that I’d like to get done. Be honest when you think about your day. If you have a day full of work and multiple practices for the kids, you may create two goals, not six. You may be able to make more goals on a weekend, but be honest – if it’s something you don’t want to do, try just one of those per day. For example, I need to clean my whole kitchen but today’s goal is to clean the fridge. Here at EYP, we also like to create quarterly goals (what do you want to complete in the next three months) as well as yearly goals. Once you know what you want to accomplish in the next 3-12 months, that will help guide you to create your monthly and daily goals.
Lastly, break your goals into different parts of your life. So, when tackling your goal list, think about goals for your work, your family, and yourself. There will always be times when there are more goals in one section than the other, but as best you can, try to split goals between these areas so you remain motivated, avoid burnout, and continue to take care of yourself. For example, my goals for last year (2021) were work: finish the NICU Mama Survival Guide book (done!), self: finish Ironman Florida (done!), and family: have the kids practice their reading 5 days/week (still working on this one).
So, as we begin to move into 2022, get excited about all the opportunities you have and think about what you would like to accomplish – then put pen to paper (or fingers to laptop) and write down those goals!
*For further reading on setting and reaching goals, I highly recommend the book, Girl, Wash Your Face by Rachel Hollis
How to Holiday-Proof Your Pelvic Floor
How to Holiday-Proof Your Pelvic Floor
By Heather Evans, DPT
It may be the most wonderful time of the year however all of the travel, stress, and sweet treats can wreak havoc on your body - and your pelvic floor! Here are a few tips to help you navigate the holiday season while keeping your pelvic floor happy and healthy.
1) Watch bladder irritants: Extra coffee to fuel those long days of shopping, alcohol at Christmas parties, soda at family gatherings - it's tempting to increase our intake of bladder irritants during the month of December. My top two tips for avoiding bladder irritants:
- Stop and think before mindlessly consuming something - do you really want that next glass of wine or are you getting a refill because someone else is? Do you really need that 3 pm coffee? If you do, then see the next tip. However, if you stop and think about it, you may actually do better with a quick walk or a 5-minute meditation to increase your energy level.
- Water, water, water. Our water intake can drop when we are offered so many other things to drink (cider, hot cocoa, etc), but try not to let your normal intake decrease. If you're going to have a bladder irritant, like the coffee mentioned above, drink water with it!
2) SLEEP: I can't tell you how many social media posts I see around the holidays with parents up late assembling toys, wrapping gifts, cooking, or online shopping. Make a list, and create a plan for when you will get everything done to avoid last-minute late night sessions. Do your very best to sleep 7-8 hours each night so you are properly recharged for the next day.
3) Don't neglect your bowel health: Holidays can lead to all kinds of bowel issues, such as constipation or diarrhea. This can partly be due to decreased water (see #1!), but I know I'm guilty of dropping my fruit and vegetable intake when I'm presented with a holiday feast filled with casseroles, stuffings, ham, and so many desserts. I KNOW I do this so I make myself fill at least half of my plate with veggies - I find the salad, the green beans, the brussel sprouts. Yes, they may be doctored up a bit more than normal, but it still helps to get those veggies in. If I know I have a holiday lunch coming up that day, I try to focus on really eating an extra-healthy breakfast to start the day off right in order to balance some of the treats later that day.
4) MOVE: Try to fit in a workout before you meet up with the family at noon. Take the dog for a 2 pm stroll when you are feeling overstuffed. Join in with the kids' backyard game of tag or sledding. You will feel so much better, and this movement will really help with digestion, stress level, and good blood flow to the pelvis.
5) Pre-plan ways to address stress: I LOVE Christmas, but even though I find everything super fun, it can still be stressful planning everything and making it as magical as I can for my kids. I know many people have much greater stress levels during the holidays - dealing with difficult family members, caring for aging parents, struggling with the loss of family members, or dealing with issues that seemed heightened around the holidays (such as infertility). Before you reach the peak of this stress, acknowledge that it is coming and make a plan for what will help you the most. Everyone's way to cope is different, but some ideas may include: doing some yoga in the mornings, taking a walk, doing a 5-minute meditation, journaling, reading a book, delegating tasks to other family members, or taking a warm bath or shower. If situations become too intense, always remember that it is okay to walk away and give yourself a break.
You give so much of your time and energy to others this season - don't forget to take care of yourself!
I hope you all have a wonderful December. Here's to keeping our pelvises happy and healthy as we head into the new year!
Breastfeeding and Your Pelvic Floor - Part One
Breastfeeding and Your Pelvic Floor - Part One
Excuse me?
How are these related? Your upper and your lower lady parts? Your breast and your pelvic floor?
And to be clear, not only breastfeeding. Pumping, breastfeeding, combo feeding in any capacity; if you are a lactating mama this pertains to you!
The honest truth is a lot of the aches or discomforts you may be physically experiencing could be linked to the hormones your body is producing during lactation, or your positioning during breastfeeding or pumping. BUT, don’t fear! Help is on the way, dear!
Here's the why:
Your posture:
You’re tired! You just made a human, and you brought them into this world. Your body has been through quite the experience, and hasn’t had time to recover, heal, or gain back strength. Then you just go on being a mom; giving all you can to your sweet baby. And sister, if you don’t take some time for yourself to move, stretch, and educate yourself, your body is going to be talking to you.
2. Hormones:
The queen bee herself, estrogen. When you’re breastfeeding you have lower levels of estrogen. This can be related to vaignal dryness and muscle tension, which can be linked to pelvic pain and pain during intercourse.
And good ole’ relaxin. She was there for you to relax the ligaments in your pelvis and soften the cervix in preparation for labor. You needed that help. But the girl can’t quit when she’s ahead. Relaxing continues to hang out in your body, at lower levels, while you’re lactating and continues to provide a little extra mobility in places you may not need it anymore.
The good news is, you have the power to overcome the back, hip, pelvis, wrist, neck, or whatever pain you may be having in relation to these changes.
I’m writing about this because, well, it’s personal. I breastfed and pumped with my first baby, and am now doing the whole song and dance again with my second baby. It’s hard work. I’ve had these aches and pains. I’ve had wrist pain when I tried to return to yoga. I have experienced my back, hip, and pelvis hurting for no apparent reason. I’ve felt my pelvis “pop out of place”, and it did not feel good. I’ve had mid back, rib, and low back pain from the way I was sitting while nursing. I’ve had neck pain from looking down at my sweet angel while she was nursing. I’ve had vaginal pressure from the way I was standing while baby wearing. I’ve had pain during intercourse when returning to sex postpartum. In fact, right now I can feel my SIJ (sacroiliac joint - pelvis) is going to shift into the wrong position if I keep sitting how I am. I FEEL YOU.
You don’t have to keep enduring these discomforts. They may be common, but none of this is normal.
OK, so what can you do about it?
Breathe: If you use your breath intentionally, you can create mobility in places that are stiff/ tight, and you can protect areas that may be healing or need some extra support.
Create mobility and stability: You have to strengthen muscles that have been sleeping or underused, and lengthen muscles that have been taking on too much burden.
Improve your movement patterns: This may be the most valuable piece of the puzzle. It earns MVP because it applies to patterns you use over and over again every single day. If you are moving through your day with poor posture or body mechanics, places like your pelvic floor and abdomen are going to have a hard time healing.You have to move in ways that allow your muscles to engage and protect your organs and joints. It can be as simple as lifting your baby out of bed, or how you bend down to pick up the laundry basket!
Lastly, if you’re having pains like I’ve mentioned above OR you need more help to heal your body and improve your movement patterns please reach out to a pelvic floor therapist! We are here to help you overcome your pain, regain your strength, and feel a little more like you again.
More to come about exercises and movement patterns you can start implementing at home to combat some of the above impairments.
XOXO
Dr. Erica Magruder PT, DPT
Heather's Ironman Journey
Ironman Florida Race Report
Heather Evans
A blustery wind. People rush about wrapped in hoodies, hats, and gloves. Noses are red, and teeth chatter. Were they preparing for a winter event? Not exactly - this was the scene on November 6th as I prepared to attempt my 7th Ironman and 50th triathlon - Ironman Florida. Except it was 40 degrees with a windchill in the 30's and it didn't feel like Florida, it felt like my hometown of Kansas City in the winter and 2600 people were about to swim through 63 degree ocean water and then jump on a bike. Yet another adventure in the crazy world we call Ironman.
For those of you who aren't familiar with Ironman, this is a long-distance triathlon that involves swimming 2.4 miles, biking 112 miles, and then running a full marathon (26.2 miles). Ironman Florida would be my 7th race of this distance, but only the second since having kids. The first one was two years earlier and the heat index was over 100 degrees, so I chose Florida in part for the nice weather. That part didn't exactly pan out, but after an emergency trip to Dick's Sporting Goods, I had added extra gear and prepared to race.
So why do I love Ironman? Let me first just say that although I wish I could say I was fast, I'm a solid middle-of-the-packer at this distance, and I race it only for myself. Me against the clock. I love to give myself a challenge and work hard until I prove that I can meet the goal. There is no better feeling than crossing through the finisher chute and hearing "Heather Evans, you are an Ironman" amidst a cheering crowd and blinding lights. That being said, the time required to train for such an event had been practically impossible with kids, and I wanted to have a solid race so that I could retire the distance at least until my kids were older so I didn't take any more time away from them. My 100-degree Ironman two years before had ended poorly, and I just couldn't go out that way, and I was determined that Ironman Florida would be a success.
The swim: 2600 wetsuit-clad athletes huddled together and moved slowly toward the ocean (Social distance? What?). In the middle of all of these people, I managed to find my friend, Kevin, and his two friends, Scott and Alexis. Usually before the Ironman swim, I just head to the water either barefoot or in flip-flops however this time, the sand was so ice cold, it almost felt like it was burning your feet so I wore new hiking socks and an old pair of tennis shoes all the way up to the start. Athletes tossed sweatshirts, shoes, slippers, and more to the side right before they hit the water, and they were all donated to a local homeless shelter. As we shuffled toward the ocean, a signal went off every 3 seconds, sending two more athletes into the water. Finally, it was my turn, and I ran into the ocean. The swim would be two 1.2 mile loops around a pier and as I headed out, it felt normal - at first. However as we swam further out, the chop and current both picked up, and I became thankful for the Dramamine I took before the start. The further out I swam, the worse it got. I was trying to sight the big orange buoys however because of the current, there would be times I would look, swim for a while, then look again and realize I hadn't actually moved forward. I would turn my head to breathe and the chop of the waves would send me a lungful of saltwater. My first (of three) jellyfish stings was to my face. Swimmers were plowing all over each other, trying to navigate the chop and avoid the riptides. I tried to keep my mind in a positive space remembering what I was thankful for, and what I repeated the most was most definitely Dramamine. I would normally finish the first loop in about 40-45 minutes. I finished it in 57. I went out for the second loop determined to stay more on course by sighting better which I did, but still battling the current and waves, I couldn't pick up any speed. I finally exited the water to someone reassuring all the athletes, "don't worry, it was hard for everyone, let it go." I heard later around 500 of the 2600 people did not make the swim cut-off time, and people were being rescued by jet skis and kayaks. While I was way off my predicted time, I was proud to have finished what was the hardest triathlon swim I had ever done.
Swim time: 2:00 hours
The bike: I had planned for months the gear I would wear - a new bike jersey repping a local bike shop (pink so my family could spot me), the bike shorts I knew were the most comfortable, etc. Because of the sudden change in temps, I wore two jackets including one from 2007, $20 Amazon leggings over top of my bike shorts that I had happened to pack for the trip, and two new pairs of hiking socks. Brian (my husband) used duct tape to cover all the vents in my bike shoes. I probably looked a bit ridiculous, but I heard later they were pulling people off the course due to hypothermia, and I was actually super comfortable. The winds, though, were crazy. For the longest time, it was headwind, headwind, headwind. There was no casual chatting amongst cyclists - we were all tucked down, just trying to endure. No "good jobs" to each other like I usually notice at Ironmans, just one big sufferfest. Thankfully, around mile 70, we turned and headed back into town which meant a tailwind. My family found me at a water station around this point and assured me it was mostly tailwind all the way back, and that gave me the motivation I needed. Despite the cold, I was able to stay on top of my fluid, electrolytes, and calories, probably the best I've done all year (thanks for the advice, Coach K!). By the end, we were riding in a narrow bike lane with cars zooming past us on the highway. I focused on staying safe more than anything, and finally we reached "Bike-in." We all dismounted, and I happily racked my bike and sat down in transition.
Bike time: 06:59:52 - hey look, under seven hours by eight seconds!
The run: Again, I had planned for my most comfortable tank, shorts, etc., and this gear had all stayed in the condo. I did strip off one of my coats, the hat, and the gloves, but everything else stayed on because I knew by my second lap, the sun would be gone and the cold would be back. I took off at a jog and actually felt pretty good (though obviously tired). I found my family, and my kids and mom had made a hot pink posterboard sign and gotten a yellow happy face balloon. (They also told me fudge was waiting back at the condo). I was hoping to do intervals of 8 min run/1 min walk which I did manage a few times however the fatigue from the day's conditions set in faster than I had hoped. Soon, this became a 5 min run/1 min walk. The run was two 13.1 mile loops, and as I headed back into town after the first loop, the sun had set and it was dark. I found my family and stopped for hugs and high 5's, and I told my husband how dark and lonely it was out away from town. He told me to count during my walk breaks to try to limit them to 30 seconds which is what I did the rest of the way. My runs in between got shorter and shorter, but I kept the walks at 30 seconds. I started drinking Coke and chicken broth at the water stations. Miles 14-23 were dark and lonely. Outdoor bars were full of people laughing and singing karaoke, and there we were, still shuffling along in the bike lane. Around about mile 17, my left ankle became tight and twingy, the result of a fall on the trail during my last long run. I stopped to stretch a few times, and this helped enough to keep jog/walking. Brian found me around mile 23 and stayed with me until 25. At that point, runs were down to about 20-30 seconds, followed by 30 seconds walks, with me cringing about both my ankle and just overall fatigue. It was getting cold again, and one of my big motivations was remembering that the slower I went, the colder I was going to become. We hit mile 25, Brian peeled off to head to the finish line, and I managed to jog a bit more once I could see the bright lights and hear Mike Reilly announcing finisher names. Finally, finally, I reached the finisher chute. There were the crowds, there were the blinding lights, and the fans cheered so hard for every finisher, you would think you were the athlete they had come to support. I headed down the chute, trying to raise my arms above my head (they were so tired, I made it about 1/2 way up), and I finally heard, "Heather Evans, you are an Ironman!"
The run: 05:49:37
Total time: 15 hours, 15 minutes, 30 seconds
This was my seventh Ironman and my 50th triathlon. It was the hardest triathlon swim I've ever done, and it was my second slowest Ironman time, but I am PROUD of this one. The conditions were brutal, and it's the best I've done since having my 8-year-old twins. I feel like I can now retire this distance, at least until my kids are older, since I proved to myself that I could do it, even after becoming a mom. Who knows what will happen when the kids are older, but for now, I plan to continue to race tri's at a shorter distance and spend all the time I can enjoying my family.
Thank you to my coworkers at Empower Your Pelvis for constantly cheering me on, asking about my training, and offering such encouraging words. Thank you to my parents for coming to help wrangle the kids and living this crazy world which is Ironman for a few days before our "real" vacation. Thank you to my coach, Kevin Foth, for preparing me physically and mentally for such a tough day - I know that without such good preparation, I never would have made it through such brutal conditions. Thank you to Josh Wolf, for constantly encouraging me, setting me up with Coach K, and adding in your great advice! Thank you to my twins, Hannah and Gavin, for dealing with Mommy training so much - sorry, guys, you're about to get much less screen time :) And finally, thank you to the best husband EVER, Brian, who managed the kids throughout my training, offered continual support, was my extra coach, took care of all my bike mechanic issues, rode long circles around the airport with me, offered tough love when I needed it, sherpa-ed me and all of my gear the week of the event, and pushed me through the miles when I needed it that day. I love you so much! Next time, let's both just do a half-Ironman and spend the rest of the vacation at the beach :)
4 Ways to Improve Bowel Movements
How to Poop
By: Marin Cole
Did you know that there is a correct way to poop? Probably not because who talks to you about how to poop? Oh ya, we do! As someone who has dealt with undiagnosed digestive issues for my entire life, using the following techniques that I teach my patients every day has made such a difference in my life. Have you gone several days without being able to use the bathroom, or feeling bloated like you just need to empty your bowels but nothing is coming? Try these techniques!
Squatty PottyⓇ: Using a squatty potty allows for your knees to be slightly higher than your hips and this “shuts off” your pelvic floor muscles so that you can pass stool more easily! You don’t want your knees up in your chest so make sure not to get one too high (I usually recommend a stool that is 5-9 inches high, but this varies depending on the height of your toilet!) Another note, you should NEVER be hovering over a toilet. I know, toilets can be gross, but find another solution, your pelvic floor with thank you!
Abdominal Massage: An “abdominal” massage or “colon” massage is used to help stimulate peristalsis, the natural contractile motion that happens in your colon to propel stool through to your rectum. This is also a great way to activate the parasympathetic nervous system, the system responsible for “rest and digest.” Start with the pads of your fingertips on the right side of your body between your hip bone and belly button and gently massage upwards towards your rib cage, then across to the left side of your abdomen, and then downwards towards your left hip bone.
Physical Activity: Movement. Your body loves movement for so many reasons and digestion is one of them. So get out there and MOVE! Go on a walk, do yoga, stretch, lift weights, get your body moving and you’ll get your bowels moving.
Breathing: When you poop you should not be turning blue in the face or “bearing down” heavily! You should be breathing as you poop and thinking about your pelvic floor LENGTHENING and not contracting as you exhale. Try it, it’s harder than you think but so important.
If you want to learn more about how to help your bowels, reach out to a pelvic floor physical therapist or take our new course offered at our website: https://www.empoweryourpelvis.com/new-products/em-poo-wer-your-pelvis
September Pelvic Posse Stars of the Month
September Pelvic Posse Stars of the Month:
Morgan Clark
Pelvic Posse: Christine Michaelsen
“Christine is very positive every time she comes in! She is so calm and peaceful.”
Heather Evans
Pelvic Posse: Cynthia Johnson
Cynthia has the best attitude about life and health. She is an extraordinarily hard worker, and I have really enjoyed watching her make such amazing progress. My favorite quote of Cynthia’s is about retirement “it’s not about the wealth, it’s about your health.”
Marin Cole
Pelvic Posse: Donna Brice
I have absolutely loved my sessions with Donna. She truly sees the value in physical therapy and has really become an advocate for pelvic floor physical therapy among her friends, colleagues, and greater community. She made amazing progress in physical therapy and I am grateful to have had the opportunity to not only help her but to learn from her,
Amanda Fisher
Pelvic Posse: Kari Comer
I have enjoyed coaching Kari through her postpartum journey after her second beautiful baby, Kari is an inspiration to so many women and has been working her butt off to get her exercises in while taking care of her kiddos and going back to work.
Did You Know?
What Types of Patients Need Pelvic Floor Physical Therapy?
By: Marin Cole
I am calling this blog post “did you know?” because there are so many things that we as pelvic floor physical therapists think of as “common knowledge” but we have come to learn they are not.
NO, Peeing your pants is not normal.
I don’t care what your mom told you, or your friend, or your husband, or your doctor. It doesn’t matter your age, your gender, or your past medical history, you owe it to yourself to tell someone about leakage if you’re experiencing it because there are options other than spending hundreds if not thousands of dollars on pads!!
YES, we treat men.
This is one that I get A LOT! When you enter into our office you’ll see an all female staff, we talk a lot about pregnancy and postpartum recovery, and the majority of our patients sitting in the waiting room are female, but we do also treat men, and quite a few of them! We treat men of all ages experiencing pelvic pain, men who have had a prostatectomy or prehab before their surgery, men who have urinary and fecal urgency or incontinence, and men with hip and back pain.
NO, Kegels aren’t always the answer!
Unfortunately when people experience symptoms related to their pelvic floor or their bladder they usually turn to the internet, which tells them to just “kegel.” Are you as confused as I am, or is that just me? In the majority of cases our patient’s symptoms improve when we teach them how to RELAX their pelvic floor through breathing, stretches, and manual therapy and then educate them how to correctly do a “kegel?” A kegel is both a contraction AND a relaxation of your pelvic floor. Moral of the story… if you are having issues and google “what do I do when…” and it tells you to kegel, it’s time to talk to your doctor and ask for a referral to a pelvic floor physical therapist!
NO, unfortunately we don’t learn much of this in physical therapy school but YES, we have to go through a lot of training and certifications to do what we do!
All of our therapists and Empower Your Pelvis have graduated with our doctorates of physical therapy from graduate programs around the United States. In addition to that we have all taken extensive course work through Herman and Wallace or the American Physical Therapy Association. Not only have we practiced all of the skills that we use in our office, but we have had everything that we work on with patients done to us as well!
Unwanted Pain With Sex…
Pain with Sex…
By: Marin Cole
Why is talking about sex such a taboo??
I remember living in France when I was only 18 and being asked, why does it seem like all Americans are afraid to talk about sex? I never really had a good response to this until I was older and entered the world of pelvic floor physical therapy. People don’t talk about sex because we aren’t asked about it regularly by healthcare professionals and it is often viewed as an “inappropriate” and “personal” topic to discuss, so it is just swept under the rug. Maybe this is why people are afraid to speak up when something doesn’t feel right? Way too many men and women go years and years suffering in pain when they try to be intimate with their partner and think its’ NORMAL! As a physical therapist one of the hardest things to hear is when a patient tells me that no doctor has ever inquired about their sexual health and they’ve never felt comfortable telling anyone about their pain because they didn’t think it was “that bad,” or they thought it was just the way it is.
With it being pelvic pain awareness we want people to know that the pain you are experiencing is common but not normal! And we are here to help!!
Pelvic pain during intercourse is broad and we can organize your pain symptoms into various subcategories or diagnoses. A woman can experience dyspareunia, which is the fancy way of saying “pain with sex” without an underlying disease associated with it. Then there is vaginismus which is when a person experiences pelvic floor muscle spasms during intercourse (or a pelvic exam or tampon insertion), making it painful, difficult, or even impossible for penetration. Then we have vulvodynia which is chronic pain of the vulva, the external area of the genitals that can cause mild to severe pain with initial penetration. There is also pudendal neuralgia which is when there is irritation or damage to a nerve in the pelvis region that can also contribute to pain with intercourse. There are so many different types of “pelvic pain” that may result in pain or discomfort during intercourse and pelvic floor physical therapy can help! Oftentimes treatment of some of these conditions require a team of clinicians to ensure we are addressessing the person as a whole, but physical therapy is most often the first defense and most conservative method that is offered.
Treatment can include anywhere from retraining how to use your breathing diaphragm to using a vaginal dilator or pelvic wand for further assistance to address the muscles internally. No two people experience the same symptoms, and no two people respond the same to treatment, each person’s story and experiences are unique and that is how we treat pelvic pain here at EYP. If you experience pain with sex, we encourage you to tell your doctor and reach out to a pelvic floor physical therapist, you will be happy you did.
May Pelvic Stars of the Month
May Pelvic Stars of the Month
Morgan and Kalyn
Our therapists pick a patient of theirs once a month who goes above and beyond with their pelvic floor physical therapy.
Here are our MAY STARS:
Morgan’s star: Kalyn S.
Kalyn is a mom of 4! She came into pelvic floor physical therapy not knowing what to expect and has kicked her symptoms’ butt to the curb. Such a joy to work with!
Marin and Meghan
Her testimonial on google: “Morgan was awesome! I was so nervous going into the appointment, and she and the ladies in the office did a great job making me feel at ease.”
Marin’s star: Meghan W.
Meghan is a postpartum mommy and she always has such a positive attitude at physical therapy! She has worked so hard over the last three sessions to help heal her body and she is making excellent progress. She is such a pleasure to work with and we enjoy reminiscing about our common interest in rowing!
Heather’s star: Jessie H
Heather and Jessie
Mama of four, most recently boy/girl twins who are 8 weeks old, and a military wife. Jessie has been so proactive in her rehab journey all while caring for four children and preparing to move across the country for her husband’s job. She has been a joy to work with!
Amanda and Sam
Amanda’s star: Samantha B.
Sam is such a joy to work with. She is a mom of two and works her butt off retraining her pelvic floor and building her overall strength. She shares her journey on Instagram and is a hoot! She brings laughter and smiles to every pelvic floor physical therapy session.
Sam’s Google Review: “Dr Fisher and team are beyond amazing! I've come so far in my Pelvic floor health. Dr Fisher always listens with a non judgmental ear and gives clear open answers to any questions or concerns I have. I can't recommend her enough!”
Pain with Using Tampons…
Pain with Using Tampons…
Take yourself back. You’re 14 years old and it's the first time you have to use a tampon because it's THAT time of the month, the time you’ve been dreading your entire 14 years of life. Your friends have told you about it, your mom has tried to talk to you about it, but you’re 14 so you probably know everything already, right? Wrong. You go to insert the tampon and… OUCH! So then you decide to use a pad. Now you’re 21 and you’ve been using pads for the past 7 years and it’s time for your first gynecology appointment. You tell the doctor that you started your menses when you are 14, and your answer to “do you use tampons?” is “no.” And thats that. The doctor tells you that the pain will decrease after you have sex. Oh yeah, I forgot to mention, you have tried having sex with your boyfriend and that has been excruciatingly painful. So now you keep wearing pads, you finally, somehow, are able to have sex with your husband and you get pregnant. You have a baby. Maybe you tear, maybe you don’t tear during delivery. You are referred to physical therapy at your 6 week postpartum check up because you tell the doctor it hurts to have sex with your partner.
This is a story we have heard too many times by our patients. And it comes back to that first time you tried putting in a tampon and weren’t able to because of how painful it was. We wish we had seen you years earlier because you aren’t alone. While it is not as common for doctors to refer the pediatric population to pelvic floor physical therapy we CAN help these patients with learning strategies to have greater success with tampon insertion. Even if you are an adult now but unable to use a tampon because of pain, pelvic floor physical therapy can still help!
There are several reasons why there may be pain with inserting a tampon. Look back at the blog titled “Pain with Sex” for a few different diagnoses that may explain your pain. Not only might something physically be going on that we can help with, but there may also be a psychological component that could be contributing to the physical pain. If this is indicated we will also suggest talking with a therapist, they are there to help too. Moral of the story, just like pain with sex, just like peeing your pants when you laugh, pain with inserting a tampon is common but NOT normal. We encourage you to seek out a pelvic floor physical therapist, take control of your pain.
Also, please see video below for some quick tips on how to decrease pain with insertion!
What Exactly Is Pelvic Pain?
9 Types of Pelvic Pain
Pelvic pain. You hear us talk about it all the time, and with May being Pelvic Pain Awareness month, I wanted to provide some information on this broad diagnosis because pelvic pain can mean so many different things. It can be felt in different areas of the pelvis and with different activities. Everyone and every situation are unique, but I’ve given some details below on some of our most commonly treated pelvic pain conditions.
1. Pelvic pain with daily activities: This can be felt anywhere in the pelvis, but commonly painful areas include the vaginal region, the rectal region, the groin, the lower abdomen, and around the sit bones. Pain may increase with sitting, exercise, or stress. Some patients have time when their pain is resolved however other patients always report a low level of pain during their daily routine.
2. Pain with sex: People can have pain with sex and also have pain with daily activities OR they can be pain-free during the rest of their life, but have pain with sex. This can begin during their first sexual experience, after having a vaginal delivery, after a c-section, during menopause, after a surgery, after an orthopedic issue, or for a variety of other reasons. Some patients report their pain immediately resolves after intercourse while others may have some lingering soreness. Along these same lines….
*If you are having pain with sex, check out our EMPOWERED IN THE BEDROOM PROGRAM!!
3. Pain with tampons/menstrual cups/speculum exam: Basically, this is pain that occurs any time something is inserted into the vaginal region. Some patients report they have always been unable to use tampons or menstrual cups due to pain and others report this began after a change, such as after delivering a baby. Switching to a 100% organic tampon may change pelvic pain as well. One brand we recommend is TOP Organic. Use code EYP25 for 25% off your next purchase.
*Check out this video on YouTube
4. Pain with bowel movements: Some patients report pain that increases with bowel movements while other patients report having pain before a bowel movement that improves once the stool has been eliminated.
5. Pain with bladder filling/emptying: Some patients report pain in their bladder with daily life that may increase as the bladder fills. Some have pain, such as burning, with urination (testing to rule out a UTI may be recommended). This may or may not be accompanied by frequent urination.
6. Pelvic pain with pregnancy: This can be a few different things. Some women report pelvic pressure in the vaginal region during pregnancy due to the weight of the uterus/baby placing increased pressure on the pelvic floor muscles. Other patients report pain at the SI joints in the back of the hips or at the pubic symphysis joint in the front of the pelvis, and both of these often stem from hormonal changes that affect ligament laxity.
7. Period pain: Many women brush off pain that occurs during their period as normal, however if you are having cramps that are severe enough to cause you to miss school, work, or daily activities, it is too much and should be considered pelvic pain.
8. Orthopedic pain: In addition to what was mentioned above during pregnancy, non-pregnant patients can also experience orthopedic pain at and around the pelvis. This can include (but is not limited to) hip pain and low back pain.
9. Pain associated with other conditions: This includes pain (can be vaginal, abdominal, low back, or lower extremity pain) that goes along with conditions such as endometriosis, interstitial cystitis, IBS, fibromyalgia, etc.
All of these conditions can be treated with pelvic floor physical therapy. This includes pain that has begun recently as well as pain that is chronic (lasting longer than six months). No one should have to avoid activities they love because of pain, and we encourage you to take the first step to healing by contacting a pelvic floor PT.
What really is a Pelvic Health Physical Therapist?
What really is a Pelvic Health Physical Therapist?
Left to Right: Heather, Morgan, Amanda and Marin
By: Morgan Clark, DPT
I wanted to give our Pelvic Posse an idea as to what being a pelvic health physical therapist really means. This is the speciality that we are here at Empower Your Pelvis.
Let’s start on with what the beginning of our journey looked like! To become a physical therapist we had to complete a four year undergraduate degree. Those bachelor degrees can range from kinesiology, physiology, sports/exercise science, nutrition, health science, biology, or or whatever it takes to get the prerequisites to be able to apply for physical therapy school.
It has been known that physical therapy programs are very competitive to get into all around the country. I personally lost my hair (literally) when I was applying to physical therapy school because of the amount of stress I was under. There is so much that goes into the application process like having a high grade point average, scoring well on the GRE, being involved in activities/community service/groups, and (not to mention) the stress of starting a rigorous program.
Once we were admitted into our physical therapy programs, the three year commitment of the doctoral program began. Physical therapists do not come out of physical therapy school with a specialized PT degree. We learn it all! From pediatrics to neurology to orthopedics and more. The reason that we physical therapists have our doctorate now instead of a masters is because the programs have added pharmacology as well as other research-based intensive classes.
However, we didn’t learn a lot about the pelvic floor other than where these muscles are, what they do, and what nerves are associated with them. We all took extra training with continuing education specifically in pelvic health. This helped us understand how to actually treat pelvic health patients and create individual treatment protocols.When you see a physical therapist that specializes in pelvic health, that means that this person has put in extra time outside of their doctoral program to learn more specifically about bladder, bowel, sexual, and overall pelvic health to further their skills
At Empower Your Pelvis, we are really passionate about pelvic health. We like to call ourselves a niche within a niche because not only have we specialize in pelvic health but we also tend to see quite a bit of postpartum and pregnant patients. That being said, we still see patients who are not in the postpartum or pregnancy realm. We also see male patients, urological patients, neurological patients, GI patients, etc.
And the learning never ends for us!
We continue to push ourselves with taking new courses regarding the specific passions that we have within pelvic health.
Beyond the Pelvic Floor: The Hip
Beyond the Pelvic Floor: The Hip
Heather Evans
Sometimes the terms “pelvic health” or “pelvic floor physical therapist” can be deceiving. While the pelvic floor muscles are often an important area we address during treatment, it is only one of the many areas we work on. Treatments can actually span the entire body from the muscles of the foot to head and neck position. Today’s focus is one of our very favorite areas to address – the hips.
So, let’s say you are leaking urine when you sneeze or maybe you are having pain with sex – you might think, “why do I care about my hips?” In reality, the hips are very important – their strength, their range of motion, and their flexibility. If your pelvic floor muscles are weak, we are often working on improving your pelvic floor muscle coordination, strength, and endurance. The hip muscles are actually next-door neighbors to the pelvic floor and another essential part of your core. If we work on improving your pelvic floor muscle strength, but don’t address hip weakness, then that can be a missing piece to your individual puzzle, and it might keep you from gaining all the improvement you otherwise could.
Maybe you have pelvic floor muscle tension, and your pelvic floor muscles do not relax appropriately. Again, we can’t forget the neighboring muscles. We don’t want to focus on lengthening the pelvic floor while ignoring the fact that maybe your hips muscles are shortened and tight, decreasing your overall flexibility.
Let’s consider further into the body. For so many of our patients, there may be other orthopedic issues – nagging knee pain, plantar fasciitis, or low back pain, just to name a few. If the muscles on the outside of your hips are weak, it affects the alignment of your entire lower leg – your knees may move in a bit, your arches may flatten, and your ankles may collapse inward. By addressing hip weakness, this can correct lower extremity positional problems, leading to less pain, better walking, and improved ability to do activities of daily life.
For our pregnant mamas, the hormones in your body right now promote your ligaments to be looser which will prepare your pelvis for delivery. Your body wants to be stable, though, so often muscles in your hips tighten up which can lead to pain in the back of your hip or even down your leg. We want to address any dysfunction in the hip both to improve this tension while also addressing proper mobility so that you can be best prepared for delivery.
In general, the hips are a very important region to address for almost all patients. Optimal hip strength and flexibility can be an important part of reaching your goal whether that is to resolve incontinence, have pain-free sex, run a marathon, or deliver a baby.
For further information on how to improve strength and flexibility of the hip, check out our online course “Empower Your Rear.”
Pelvic Posse Stars for April 2021
Pelvic Posse Stars for April 2021
We love celebrating our patients accomplishments!!
During the month of April, we had a lot of people graduating and meeting their goals (which we love as pelvic floor PTS).
Debbie with her therapists: Marin (left) and Morgan (right)
Here are the EYP’s Team Top Patients for April 2021:
Marin: Debbie Oldroyd: “In terms of “doing something good for me”, this was the best decision I have made for myself in ages. Morgan was very easy to talk to, totally professional and through in her explanation of the anatomy of the pelvic floor, my specific diagnosis and future course of action. I would highly recommend Empower Your Pelvis to everyone.
After four short weeks I “graduated” from therapy yesterday and I can’t give enough positive accolades to Marin my pelvic floor therapist. She patiently and throughly explained every exercise, monitored my execution to make sure that I was performing them correctly and followed up with email as to my “homework”. Marin was very professional, personable and easy to discuss with personal issues. I am so very happy with the outcome of this therapy and my progress.”
Amy Shane
Morgan and Nancy
Heather: Amy Shane: Amy brings such positivity and humor to each session, and her artistic talent has been so much fun to follow. She brings joy and fun to each treatment session.
Morgan: Nancy Grashuis: Nancy is a delight to work with! Being a retired nurse, she is very in tune with her body which makes our sessions so great!
Amanda and Kayla
Amanda: Kayla Gosney is a postpartum mommy and working hard to rehab her body after baby. She’s worked really hard to get her exercises in as much as possible and is dedicated to heal after baby.
Mommy's Tummy Time
Mommy’s Tummy Time
Heather Evans, DPT
We all know how important it is for babies to have tummy time. After a pregnancy and delivery, it is just as important for a post-partum mama to have tummy time, too – just in a different way! While your baby is on their belly doing tummy time, you can use that time to address rehabbing your own post-partum abdomen.
In regards to the abdomen, one of the most common questions we get from our pregnant and post-partum mamas is if they have a diastasis recti (DRA). A DRA is a separation at the location of the linea alba, the line of connective tissue that runs down the center of the “six-pack” muscles. DRA’s are very common toward the end of pregnancy and in the post-partum period. You can begin by attempting a self-assessment or having a partner help you assess. Of course, as a pelvic health physical therapist, I always suggest seeing a qualified physical therapist to truly assess if you have a DRA.
DRA self-assessment:
Lay on your back with your knees bent and place two fingers right above your belly button. Gently press downward to assess how far your fingers can sink. If you feel your fingers sink quite a way down into your abdomen, you should certainly see a physical therapist. Now, lift up your head. Watch for any coning (area of tissue that comes up at your midline) that gives evidence of a DRA and use your fingers to feel the two sides of the “six-pack” muscle. A gap of greater than 2 finger widths indicates a DRA. If you have a DRA, you need to work to properly control pressures in your abdomen. This means exhaling on exertion and correctly engaging your lower abdominals for support during daily activities, such as when you lift your baby.
So, when your baby is doing tummy time, how can you begin to rehab your tummy? Begin with diaphragmatic breathing – inhale through your nose and expand your belly (not your chest!) toward the ceiling. Exhale slowly through pursed lips and let your belly come back down. Practice this for a few minutes. Then, add the “zip-it-up” exercise. Inhale using your diaphragm, exhale and then begin to “zip” up your lower abdominals beginning around your pubic bone and going up toward your belly button. Focus on this specific region of muscles, not letting the upper and middle abdominals take over. Hold the lower abdominal contraction for 5 seconds, then relax. Perform this for two minutes.
As always, for further information on rehabbing your core after pregnancy, please see a qualified physical therapist who focuses on post-partum care. You can also check out BODY AFTER BIRTH.
Don’t Let Your Bladder Be The Boss
Don’t Let Your Bladder Be The Boss
By: Morgan Clark, DPT
Do you have to pee every single time that you pull into the garage or you put the key in the door? I would guess that many of you would answer “yes” to that question. This could be the most frustrating thing because you know the bathroom is not that far away but your body is telling you that it’s right there and you need to go. Bladder urgency can seem like it comes out of nowhere and at the most inconvenient times. We can train our bladders as adults just like a child is potty trained. YOU are the boss of your bladder… not the other way around.
Whether or not you have experienced being pregnant, postpartum, or menopause, that can change the way your pelvic floor muscles and the bladder communicates to your brain. I always tell my patients that it takes three weeks to make or break a habit. And that’s if you’re really consistent with anything. Improving your bladder control will not happen overnight but forming new habits is how to create the change.
One of the first things that I suggest is trying to do some diaphragmatic breathing. The way you do this is…
- Start by lying down on your back or reclining in a relaxed position
- Place one hand on your chest and the other on your upper belly
- Relax your jaw by placing your tongue on the roof of your mouth and keeping teeth slightly apart
- Take a slow, deep breath in throughout your nose (at least 2 seconds) and your belly should rise/expand. In other words, your lower hand that rests on your upper belly should rise toward the ceiling and the hand on your chest should remain fairly still.
- Exhale through your mouth even more slowly (at least 3-4 seconds) and let your belly return to its original position. Exhale completely.
- Remember to breathe slowly. Do not force your breathing.
The second thing is becoming more aware of your pelvic floor muscles. The pelvic floor should be at rest when you are resting. For example, when you are urinating, the pelvic floor muscles should be turned off. When you are squatting, the pelvic floor muscles should be turned on. I’m sure many of you are thinking right now, “I’ve never really thought about what my pelvic floor is doing when I’m doing daily movement”. However, becoming more aware of the muscle may help you understand how they could potentially contribute to your urgency.
Bladder urgency means when you get the urge to use the restroom all of the sudden without a signal prior. Your brain tells your pelvic floor to engage to help hold back the urine due to not being in the restroom at the time of the potential urge. However, some pelvic floors are already too engaged which presents with the problem of making the bladder feel claustrophobic/cramped. This will cause increased urgency and potential leakage.
Let me ask you a couple of questions: “Do you ever get the urge to use the restroom even though you just went 20 minutes prior?” If so, “ Do you then have just as much to empty or is it less on that second trip to the restroom?”
Typically, the problem is that the bladder and the pelvic floor are not communicating properly. We need the pelvic floor to relax in order to give the bladder space to help control the urgency.
For more information on how to help your bladder urgency, look into our “Bladder Urgency” four week program on our website:
https://www.empoweryourpelvis.com/new-products/5-tips-for-bladder-urgency
It's Infertility Week!
It’s Infertility Week!
Heather Evans, one of our top pelvic floor physical therapists at Empower Your Pelvis, is open to sharing her struggles about infertility. And I am so proud of Heather for sharing her journey! Did you know, 1 in 8 women can be going through infertility?
Click the video below to hear Heather’s story of how her and her husband ended up with their twins.
In the Know…About Endo
Tips for Endometriosis
Endometriosis…so, what is it anyway? Endometriosis is a disease when tissue similar to the lining of the uterus grows outside the uterus. It is commonly found in the abdominal region (such as on the bowel, bladder, and between abdominal organs) however it can extend throughout the body. Endo is shockingly common and is present in 1 in 8 women though many may not have a proper diagnosis. Despite how common it is, the average time to diagnosis remains 12 years.
Symptoms of endo can vary, but the most common are severely painful and heavy periods, pain with sex, bowel dysfunction, and infertility. That being said, you do not have to have all of these symptoms – some patients may have severely painful menstrual pain while they easily became pregnant three times while another patient may have had fairly normal periods, but endometriosis might be discovered during infertility testing. The take home message here is that period cramps that are so severe that you are missing school or work are not normal.
Physical therapy can help! Most women with endometriosis also have pelvic floor muscle tension which leads to additional pain and dysfunction. In my opinion, any woman diagnosed with endometriosis should be referred to pelvic floor physical therapy in order to reduce pelvic floor muscle tension and its associated pain. In addition, many patients with endo also have bowel and bladder dysfunction which can be addressed with pelvic PT as well.
What else may help? An anti-inflammatory diet which includes a diet low in sugar, dairy, gluten, and processed foods has been shown to be beneficial. Excision surgery to remove the lesions is often necessary. Medication may also be helpful at times. If a patient is diagnosed with endometriosis, they need to build a qualified medical team which should include an OB-GYN who specializes in caring for patients with endo, a trained pelvic health physical therapist, and a dietitian.
If you have endometriosis or suspect this may be a possibility, check out our four-week endometriosis programs. Empowering You with Endometriosis Level 1 is designed for patients who are in severe pain with significant impact on daily function. Empowering You with Endometriosis Level 2 is designed for patients who have mild to moderate pain with less daily disability.
How to Really Get Lucky this March
How to Really Get Lucky this March
By Heather Evans
Ah, March. It’s the time of spring showers, tulips, March Madness, and a whole lot of green. That’s right, it’s when people drink green beer and kids hunt for leprechauns. Shamrocks abound, and many people hope to “get lucky” in terms of more than just rainbows and pots of gold. So if this is you, we wanted to share some advice on how you can really get lucky this year by improving intimacy with your partner.
GOOD LUBE: Lube is great, and not all are created equal. Lube is essential for anyone who is pregnant, breast feeding, or past menopause because hormonal changes lead to decreased natural lubrication. That being said, lube is helpful to many other women outside of these groups. If you have a history of pain with intercourse or if you just feel like your body doesn’t produce enough, don’t be shy about getting a good product to help you out. Our favorites:
Coconut oil (note – don’t use if you are allergic or if you are using condoms for birth control): CLICK HERE and use code EYP for 15% off.
Slippery Stuff: CLICK HERE
Good Clean Love: CLICK HERE
Coconu: CLICK HERE (Use code EYP for 15% off). Amanda is obsessed with the Hemp Oil one for pelvic pain
No pelvic pain: Painful sex is not normal and is never anything you should accept. If you have pain with sex (whether it has been present since your first sexual experience or whether you have pain now after years of pain-free intimacy), see a qualified pelvic health physical therapist. You can also use a pelvic wand at home to help stretch the tissue. Our favorite wands are available at www.intimaterose.com where you can choose from regular or vibrating options. Use code HEATHER12 for $5 off!
Positions: If a position is not comfortable, change it! Everyone is different, but if you have any muscle tension or discomfort, two positions to try would be woman on top (this way, you can control speed and depth of penetration) or while in child’s pose with the penetrating partner behind you since this position helps the pelvic floor naturally relax.
Libido: There is much more to a woman’s libido than simply sexual interest. Women are very affected by other variables such as stress and fatigue. If you’re wanting to improve your libido, begin with self-care in other areas of your life. Aim for 8 hours of sleep, treat yourself to a warm bath or other relaxing activity at night, practice deep breathing, and do a little yoga.
If you want to learn more, JOIN our Empowered in the Bedroom program to help tackle all things intercourse and pelvic health!!! CLICK HERE to join!