Pelvic Posse Peeps
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,
Lessons from a Halloween Skeleton
Lessons from a Halloween Skeleton
Happy October!
As physical therapists, sometimes we see things out in the world that make us think about our patients. This happened to me this week with a ... Halloween decoration! A Halloween skeleton, to be specific. Which part made me think of physical therapy? The rib cage! One thing I have learned working in this field over the years is how important the ribs are and how they can affect so many areas of your body. So what is normal for the rib cage?
First, let's talk about good rib position. Find your sternum right in the middle of your ribs. Now, place your flat hand pinky-size down under each side of your rib cage. (For even better info, take a washable marker and draw a line underneath each side of your rib cage). The angle between the two sides of your rib cage should be about 90 degrees.
Next, place your hands flat on the bottom of both sides of your ribs. Inhale - your rib cage should move up and out. Exhale - your rib cage should move back down and in.
What do you find? Is your angle too wide? We see this a lot, especially after pregnancy when the organs push up toward the ribs.
Do your ribs move properly? Do they feel stuck?
No matter what you find, a good place to start is with focused breathing. Lay on your back with your hands cupping the lower part of your ribs (your pinky sits a little below). Inhale and focus on expanding your belly (not your chest and shoulders) while thinking about your ribs moving up and out. Then, exhale and feel them move back down and in. If your rib angle is too wide, focus on a stronger, deeper exhale to encourage the ribs to move back into the proper position.
As always, for specific help working on your rib angle and movement, grab an in-person or virtual session with us at EYP.
Happy fall!
Heather
Breastfeeding and Your Pelvic Floor - Part Two
Breastfeeding and Your Pelvic Floor - Part Two
Ok friends, let’s get into it. How can you improve all those crazy things we talked about last week?
Here are few easy tips:
Pillows are your “breastfriend”.
When you’re nursing your little babe or pumping, be sure you have appropriate low back support and arm support.
Use a pillow or towel roll to support your low back if you’re in a sitting position.
Use a pillow or few pillows under your arms to support your baby’s head and buttock.
Bring your baby up to you; don’t bring your breast down to your baby.
There are a lot of products out there designed for breastfeeding support, but find what works for you.
I have a few of the pillows designed specifically for breastfeeding, but because my torso is so long they aren’t enough support. So, don’t believe just because you have a pillow designed for this purpose it will be enough. Really look at your posture and how you’re holding your baby.
LUBRICATION
Lubrication may not be the answer to all of your pelvic pain during intercourse, but it sure can help.
When you're lactating, your estrogen levels are lower and this lends itself to vaginal dryness. So sister, use some lubrication!
The lube you use matters. What you put in your vagina is absorbed into your body. Read that again. The lube is absorbed.
Pick a clean product. Here are some of the products I recommend to patients:
Good Clean Love
Coconu
Slippery Stuff
Create some mobility.
You can do this with your breathing, and some specific mobility stretches. You often experience rounded shoulders, an aching back or neck, and an abdomen that’s confused from the recent stretching then sudden deflation it went through. You have to teach your body how to move again!
Here are some examples of exercises to get started:
360 Breathing:
Begin working on this laying on your back or your side
Breathe into your lower belly (let your belly expand), back, and tailbone
Exhale and relax
Arm Angels: Laying on your back begin with you elbows in by your side, and your head, back, elbows, and backs of your hands in contact with the ground
As you exhale raise your arms up over head, keeping everything mentioned above in contact with the ground
Inhale and bring your arms back toward your side
4. Create some stability
After being all loosey goosey during pregnancy, relaxin hormone hanging around, and the muscle imbalances you’ve likely developed during pregnancy and recovery, you need to provide some stability for your back, core, and pelvic floor muscles.
Try out this stability exercise:
Zip It Up:
Start laying down with your knees bent (same as 360 breathing position)
Inhale into your belly, as you did with 360 breathing
As you exhale, engage your lower abdominal muscles to “zip them up” starting at your pubic bone moving up to your breastbone
Your belly button should move up toward your breastbone - you should not have lower belly pooching or doming in the middle of your abdomen
Hopefully this is good kick start to your recovery and healing!
Good luck out there ladies! Please reach out to us here at Empower Your Pelvis if you’re having persistent aches, pains, or pelvic floor dysfunction!
XOXO
Dr. Erica Magruder, PT, DPT
Why Pelvic Floor PT as a career???
Why Pelvic Floor PT as a career???
In honor of October being National PT month I wanted to share my journey to landing in the specialty of pelvic floor physical therapy.
Stick with me here, we’re starting back at the beginning.
During my senior year of high school my dad had a brain tumor. He required surgery to remove the softball size tumor, and after surgery was paralyzed on the entire right side of his body. He required extensive physical therapy to recover. He had to stay at the hospital and in an acute rehab setting for about 1.5 months before he could return home. My sister and I got to visit him on the weekends because the hospital he was at was an hour away from our house. Two of the only things my dad found joy in at the time were seeing my sister and I, and his therapy sessions. He would be happy talking about his therapists and the progress he had made. I remember distinctly one day when we visited he told us “I snuck into an extra PT session today” with pride and joy. He was able to make an impressive recovery and return home. After seeing the impact his therapists had on his overall wellbeing I knew I wanted to pursue this career path.
The bottom line is, I decided to become a physical therapist to help people. I think that’s why most of us choose this profession. To help people heal and gain back their independence.
I’ve worked in many different settings with many kinds of patients. I mostly recently worked in acute care physical therapy seeing patients in the hospital. The patients I worked with could have several ailments, or one specific problem. They were all unwell to various degrees and weren’t always excited to see the “physical torturist”. This job was mostly that, a job.
I told my husband for years I just hadn’t found my calling yet. I hadn’t figured out exactly what I was supposed to be doing to make this world a better place. I kept searching for what I could put my heart into; what I felt passionate about.
In that pursuit of finding my passion and searching to feel whole, my husband and I decided to start a family. I had my first baby, and he was wonderful. But, I was not. I didn’t know much about the specialty of pelvic floor PT so I fell into the trap of “do your kegels”. This in fact did not help me heal after the vaginal delivery of my son, but quite possibly worsened my symptoms. Initially postpartum things seemed as normal as I could expect them to be, but the farther out I got from delivery the more I suspected something wasn’t right.
My husband and I would go on walks with our new baby, and I loved walks! I loved being outside and moving my body. Then I started experiencing urinary urgency. Which is exactly what it sounds like. When I had to pee, I felt like I HAD to pee… like right then. I was also going to the bathroom “just in case”. I would go every time before our walk and still feel urinary urgency while walking. My breaking point was the day I had to squat outside to pee. And this wasn’t out in the woods, in a semi secluded area. No, this was right in the middle of our neighborhood and I had to find the best cover I could because if I didn’t pee right then I was going to completely pee my pants. When this happened I knew I had to figure out a way to resolve this problem because there is no way on God’s green earth I could continue to live my life this way.
I asked my doctor for a referral to pelvic floor PT and came to Empower Your Pelvis as a patient. When I saw Heather for our first visit, I cried. I realized how overwhelmed and devastated I was because of these symptoms. I was only 30, I had birthed one baby, and I couldn’t participate in exercise or activities I enjoyed because I felt like I was going to pee my pants! Then, she told me I shouldn’t have to experience pain with intercourse postpartum either! And my mind was blown. I dealt with these symptoms for months and I didn’t have to. Heather listened with compassion and prescribed the exercises I needed to rehab my body the right way postpartum.
As I continued working with Heather, I realized how stinking cool pelvic floor physical therapy was and discovered pelvic floor therapy was my passion. It’s what I was meant to do to give back to the world. I started all the continuing education required to transition to this specialty, and told my husband how much of a dream it would be to work at Empower Your Pelvis.
Now, I’m here! Two babies and my own pelvic floor rehab experience later I’ve figured out where I’m supposed to be, and I couldn’t be happier.
Erica Magruder PT, DPT
How To Poop 💩
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
What if I haven’t had a baby yet…?
What if I haven’t had a baby yet…?
Something that always surprises people when I tell them is that we treat women who have never been pregnant and have never delivered a baby. Just because you haven’t been pregnant or haven’t had a baby does not mean that you too can’t experience pelvic pain, urinary or fecal leakage or urgency or have a diastasis recti. I want to get a little personal here. I am newly married and haven’t been pregnant before. However, I had multiple abdominal surgeries as a baby and was diagnosed (during a course while in graduate school) with a diastasis recti. Now, does this affect me on a daily basis, no, but do I need to consider this when I eventually do become pregnant, yes that would probably be smart…
So, I haven’t had a baby, I have mild diastasis recti, AND I went through a phase of pain with intercourse with my husband. Okay, so I have diastasis, I had pelvic pain (it’s better!), AND for about 1 year I was experiencing urinary urgency and had a few nearly “uh oh” moments! Well, it turns out my pelvic floor muscles were not moving very well (they were too tight)! After a few sessions of pelvic floor physical therapy and my own knowledge, I know my triggers for urgency and I no longer am experiencing pain with intercourse!
Alright I’m getting really personal here. Why? Because I want people reading this to know that just because they haven’t had a baby these are issues that can occur and the sooner it is addressed the better the outcome! I have had patients with severe pelvic pain the first time they have intercourse and for a period of time think that it’s just “normal,” these are the ladies who really benefit from starting PT ASAP and not letting the pain become chronic. I have ladies who have pelvic pain with intercourse OUT OF NOWHERE, and this can usually be traced back to a traumatic experience, stress, life changes, etc. And then I have patients who are in their early 20s and LEAK URINE. While this is less common in the clinic, these are the ladies we want to see NOW and not when they’re 70.
So if you can relate to anything I’m talking about here, please tell your doctor or send us an email or message. We are here to help no matter what phase of life you’re in.\\
Marin Cole, PT, DPT
October Pelvic Posse Stars
October Stars of the Month
Heather’s Pelvic Star: Elizabeth Harding
While attending physical therapy at Empower Your Pelvis, Elizabeth rocked her first marathon (Chicago) in October and is now preparing for her second marathon (New York) in November. She has done all this while raising five children. We are so proud of you, Elizabeth!
Morgan’s patient of the month: Ashley Gilbert
“Ashley has had a really tough postoperative journey with her diastasis recti. She has had her ups/downs with recovery but has stuck with it all and has made amazing progress!”
Marin-Patient: Jamie Raymond
Jamie started coming to PT over the summer and was really feeling hopeful. Over the summer and fall she has travelled to help her family multiple times, but even when we go weeks without visits she keeps in touch, she does her homework, and she has recruited her husband to help with as much as he can! He came into a session the other day and plans to join at future visits so he can learn how to help when they eventually move in a few months! It has been so wonderful working with Jamie and I am so proud of her progress and her motivation!
This photo is of Jamie and her Husband!
Erica-Patient: Pam Sweezy
Pam is a two time cancer survivor and has kicked her pelvic floor symptoms to the curb! She's worked so hard during all of our sessions, and is now working hard to strengthen her muscles to maintain the progress she's made. Pam is excited to be able to return to the gym and go on vacation with her husband! She's booking her vacations as you read this!
When should I check for diastasis recti? I'm 4 weeks post-partum
When should I check for diastasis recti? I'm 4 weeks post-partum
By: Marin Cole
Diastasis recti, better known as abdominal separation, is a physiological process that happens in 100% of pregnant women by week 37 gestation. In other words, diastasis recti is NORMAL. You often will hear a physical therapist talk about things that are “common but not normal,” well this is a little bit different in that regard. Now, there is a point in which this is no longer “normal” and needs to be addressed.
No matter what your injury or surgery is, the average time it takes tissue to heal is AT LEAST 6-8 weeks. We are talking about a c-section, vaginal delivery, abdominal surgery, or an ACL repair. What that means is when our tissues have undergone trauma it takes them time to heal. That being said, I wouldn’t recommend checking for diastasis recti in the first 4 weeks after getting home from the hospital after a vaginal delivery or c-section, because your tissues are still healing, give them time. On the other hand, we need to be aware of how we are moving our bodies during this time because there are things we can do to help our abdominal separation heal, and there are also things we can do in this time that can make it worse!
How to help your abdominal tissues heal?
Belly breathing. This is an EXCELLENT exercise to start in the first few days post partum to get your tissues moving safely.
Zip it up. This is an exercise we teach to our clients often at their first or second visit. This exercise involves contracting your deep core muscles by imagining you are zipping up a tight pair of jeans.
How can you hinder the healing process of your abdominal tissues?
Sitting up quickly to get out of bed. We teach our clients to first roll to their side and then sit up to get out of bed AS they breathe and zip it up. This helps to support the abdomen instead of adding more pressure to an already vulnerable area.
Starting “sit ups” too soon. This is probably something that we talk about most often with our patients because in their own research they have found that sits up are BAD. What I tell my clients is that they are not good to do IF you have a diastasis recti, so they should learn how to engage their other abdominal muscles FIRST before they get back to doing more advanced core exercises.
If you find that you have a diastasis recti at 4 weeks you should start with the above exercises and recommendations. If your OBGYN/nurse midwife confirms you continue to demonstrate a diastasis recti at your 6 week postpartum check up you should definitely ask for a referral to a pelvic floor physical therapist if they don’t already recommend that for you! We are able to assess your diastasis recti in the clinic and provide you with strengthening exercises, manual therapy, strategies to improve your movement patterns, and recommendations for external wearable support if we feel that would assist in healing the diastasis recti.
How Can Pelvic PT Help Endometriosis?
How Can Pelvic PT Help Endometriosis?
By Heather Evans
We get this question a lot. I totally understand. Endometriosis is a disease – what could physical therapy possibly do? Let me answer that question by saying it can entirely change your pain and your function…but let’s break down some specifics.
First of all, if you don’t know, endometriosis is a disease in which tissue similar to the lining of the uterus grows outside of the uterus. Common areas of lesions include in the abdominal cavity (between and on the various organs themselves), but it can extend throughout the body to places such as the diaphragm and spine. Commonly seen signs of endometriosis include very painful periods, pain with sex, and infertility. That being said, there is a vary wide variation here. Some women have pain all throughout their cycle, other women have no pain however endo is discovered during fertility testing. Treatment often includes surgery, medication, dietary changes, and – here we go – physical therapy.
While we cannot remove the endo lesions themselves, we can significantly reduce endo symptoms because over 80% of women who have this disease also have pelvic floor muscle tension. Why? Well, one of the main symptoms is pain, and what do our muscles do when we are in pain? Tighten up and guard. So where do we often see these muscles guarding when endo is in the pelvis and abdomen? You guessed it – the pelvic floor.
When I see a patient with endometriosis, treatment includes posture analysis, breathing education, internal and external manual therapy to decrease tension, education on good daily lifestyle habits that decrease pain, bowel health education (bowel dysfunction is also very common with endo), and guidance in a home stretching program to gain flexibility and strength where it is needed. Also, I teach the patient how she can perform her own manual stretching at home to further decrease pain and improve her ability to live her daily life without restriction.
Want further information? Check out our two online courses Empowering You with Endometriosis Levels 1 and 2. Level 1 is created for women who are in a fairly severe amount of pain and are just beginning to progress toward movement and stretching. Level 2 is more advanced and includes slightly more challenging activities. Both include tons of information on endo itself, nutrition strategies, mindfulness education, self-massage, stretching, strengthening, and more!
Surviving The First Year of Motherhood
Surviving The First Year of Motherhood
This may sound dramatic, but sometimes this is how it feels. You’ve just been blessed with the most perfect little angel, and they poop all the time. Your new baby brings a joy to your life you didn’t know could exist, and you’re exhausted. You’re learning how to feed another human, and you can barely find time and energy to feed yourself. The first year with your new baby is so beautiful, and sometimes it’s hard.
Then the phrase I’m guilty of using: “find time for yourself.” Yes, I will find time for myself while we both require a bath because there’s spit up and poo everywhere. Yes, I will find time for myself while I fall asleep feeding my baby… or doing about anything for that matter. Yes, I will find time for myself while my baby demands through his or her cries that I hold them all day long.
It can feel impossible to take care of your baby and take care of yourself. But, the truth is… you need to.
You need to find a bit of time to help yourself heal physically and restore yourself emotionally. We can’t be our best selves if we aren’t prioritizing our own health.
And, some weeks it is easier than others. You may be able to exercise, get coffee with a friend, or take a relaxing bath by yourself one week. Then the next week just brushing your teeth feels like an accomplishment.
When you’re having one of those harder weeks, use these suggestions to sprinkle in some self care.
Practice Breathing
Breathe into your belly, back, and ribs while nursing baby in a side lying position or pumping.This breathing pattern allows you to use your breath to create mobility in your back, ribs, and pelvic floor while beginning to engage your abdominal muscles.
Add In Variety
Sit in various positions when you’re on the floor playing with your baby. We often find ourselves sitting criss-cross applesauce, and this actually isn't’ the most beneficial for your core, pelvic floor, or hips. Switch it up! It’s not that this position is always bad, but our bodies crave movement and we can help our body out by trying new positions, such as: 90/90 sitting, laying on your stomach, or sitting into a deep yogic squat
Go For A Walk
Sometimes the only way to get movement in throughout your day is with your baby. So, load up that stroller and go for a walk! Our pelvic floor muscles move when we move, and they love a good ole walk down the street.
Create A Wearing Schedule
Whether you’re actually wearing your baby in a carrier, or just holding them for hours on end your body gets tired. And, when your body is tired, your posture is compromised. It may not seem very important at the time, but when we aren’t able to maintain good posture our back, core, and pelvic floor take the hit.
Lastly, and in my opinion most importantly, give yourself grace. Reassess the expectations you’ve created for yourself. Remind yourself, you’re keeping a human alive, and that’s a pretty big deal. Your body has done some pretty amazing things creating, and/or caring for your sweet baby. Acknowledge and appreciate what your body has done. And remember, you are enough.
XOXO,
Dr. Erica Magruder, DPT
Caring for your Fur Babies and your Pelvic Floor
Caring for your Fur Babies and your Pelvic Floor
By Marin Cole, PT, DPT
A few tips for the dog moms or cat moms out there who aren’t sure if their back pain or pelvic pain might be coming from taking care of their fur babies!
Cleaning out the cat litter
When you’re doing the dreadful task of cleaning out your cat litter there are more correct ways to lift and bend. You want to make sure that when you are bending down to pick up the litter you are first of all breathing in as you lower down (we will get to that later) and bend from your hips and knees, not your spine. Then, as you stand back up you want to make sure to engage your butt muscles to propel back up to standing, while you exhale! If you are going to be cleaning the cat litter for any length of time I would also recommend a kneeling position so you are not forced to bend over the entire time.
Putting the leash on your pup
If your pup is anything like mine, getting their harness and leash on usually involves some jumping, tail wagging, and of course rolling around on the ground. If this sounds like your experience too, you can imagine how your back may hurt from leaning over for 30-60 seconds trying to deal with their excitement. If your dog is calmer I would recommend doing what I discussed above and just bend from your hips and knees as you bend over to attach the leash. On the other hand, if your dog is wild one, I would recommend resting on one knee so you are more on the dog’s level and not having to lean over.
Walking your pup
Walking your dog is similar to pushing a stroller, a great workout, but done poorly can definitely contribute to back pain and pelvic floor dysfunction. Now I’m definitely not a dog trainer so I can’t be the one to tell you how your dog should walk, but I am a pelvic floor physical therapist so I can help you learn how you should walk. When you are walking, whether you’re pushing a stroller or being dragged by your dog there are a few things to be mindful of. Firstly, breathe. Make sure you are not holding your breath. This will make sure that your pelvic floor muscles are moving appropriately as you walk. Second, posture. The easiest way to think about having “ideal” posture for your pelvic floor is to have your ribs stacked directly on top of your pelvis, in other words, don’t push out your butt or ribs, and don’t round your back!
Carrying your pup or cat (especially if your cat is 15 pounds like mine!)
Carrying your dog or cat is kinda like carrying your kids. They get heavier with age, they wiggle, and if you are constantly holding them the wrong way, your back and pelvic floor will let you know. As mentioned above with walking, you want to keep your ribs stacked on top of your pelvis whenever you are carrying your fur baby. This will allow for your abs to be engaged and distribute weight evenly throughout your pelvic floor. Take breaks. If you love to carry your fur baby whenever you are at home, just be sure to take breaks. Usually this isn’t as big of an issue with our pets, but this is extra important with your kiddos, because well let's face it, they’re tiny humans and can be more demanding.
When Should I Start Pelvic Floor Physical Therapy After My Delivery?
When Should I Start Pelvic PT After My Delivery?
By Heather Evans
I had a patient earlier this year who, upon being told she had a fourth-degree tear after she delivered her daughter, announced in the delivery room before even being stitched up, “I need a referral for pelvic floor PT!” Spoiler alert – she started physical therapy early in her rehab and graduated a couple months later with no symptoms at all. Now, while I will admit I did get super excited when she told me this delivery room story, I don’t expect all patients to be planning their first visit the minute after a baby is born. That being said, we do get the question a lot … “how early after delivery should I begin pelvic floor PT?”
I usually tell new mamas to give themselves the first couple weeks to go home and get settled in. Get rest when you can, drink water, and eat warm, nourishing foods. Some moms then feel up to their first PT chat a couple weeks post-partum. Some women will come into the clinic while others choose to do a virtual visit which are a wonderful opportunity for new moms – you don’t have to leave the home, you can demonstrate to your therapist how you are holding and lifting your baby, you can even feed your baby during the session if you need! If you had a c-section especially, there is great benefit to chatting with a pelvic PT within a few weeks post-partum.
Around six weeks, you will see your OB-GYN and typically receive clearance for intercourse which means you are also cleared for an internal assessment by a pelvic floor PT. This is a vital time to schedule a visit. At this six-week OB-GYN visit, you will also likely be cleared to return to pretty much everything – exercise, running, etc. and I strongly encourage you to see a pelvic PT first. So much happens during pregnancy and delivery. Certain muscles can be tight and many muscles will be weak. You may think you are able to return to exercise however it is only with a pelvic PT visit that you can truly know where your body stands in terms of what your various muscles can withstand. We hear so many stories of people who return to activities too soon and end up with urinary or fecal leakage, prolapse, or pelvic pain.
Now think if you have perineal tearing, an episiotomy, or a c-section scar. Several techniques can be taught to mobilize this tissue prior to your six-week follow-up and even more can completed once the scar has healed. Remember c-section mamas (that’s me!), it’s not just the scar you can see – seven different layers were cut to reach your baby inside the uterus. Imagine an orthopedic surgery that major – you’d be in physical therapy straight away!
In addition to the pelvic floor and abdominal muscles, did you know that pregnancy can also affect your foot position? Your balance? Your ribs? Your breathing? You grew a human! That’s an amazing feat – and you completely deserve to recover with proper guidance in order to reach your goals and avoid injury. Schedule a pelvic PT visit between 2 and 6 weeks post-partum to begin this journey.
One final note – if you are a new mama and you are five months (or five years) post-partum and you read this, don’t feel upset if you haven’t started PT yet. Go ahead and schedule now! It’s never too late to reach your goals.
Don’t give up, there may be an answer you haven’t found yet.
Don’t give up, there may be an answer you haven’t found yet.
By: Marin Cole
This blog is for the men and women who have seen doctor after doctor, done their own research, and have maybe even been told that your symptoms are normal and it just is what it is. I am talking about those of you who experience pelvic pain, or poor bowel or bladder control. I want to tell you what you can expect at your first visit of pelvic floor physical therapy at Empower Your Pelvis that may be different from these other experiences.
We LISTEN. We VALIDATE. We EDUCATE. Pelvic pain is complex, and it often takes a village of providers to achieve your goals, but something I can guarantee you will receive from one of our physical therapists is a listening ear. And in my experience, my patients who feel their issues have not been heard start noticing changes with just the validation that their pain is not in their head. If you have been told by a provider that “sometimes people just have pain,” what do you have to lose by trying pelvic floor physical therapy? It is non-invasive, it does not involve medication, and maybe you will learn a thing or too that will help you take charge of your bowel and bladder health as well!
My patients who come to physical therapy with the goal of not having surgery are SO HAPPY when they come in after a few visits and realize they met that goal. So many of my patients are under the impression that if they have any sort of urinary leakage then surgery or diapers are their only solution. It is our goal as physical therapists to provide you with the knowledge of your condition so you know your options when it comes to treating your symptoms.
Something else I find a lot of people experience is nervousness coming to see a pelvic floor physical therapist!! I absolutely understand why they would be nervous. They are going to see a physical therapist for pain with sex, or loss of bladder control. Aren’t physical therapists supposed to help you walk again or get you back to playing a sport? Yes, that is the training we all have gone through to get our doctorate, but we have all decided to take additional courses to be able to help people with pelvic floor dysfunction.
So next time you talk with a friend, a parent, or another healthcare provider and they tell you that your pain is normal, or leaking urine is just part of aging, find a pelvic floor physical therapist. We hear this constantly, and we want people to know that we are here to help.
I want to end with one of my favorite quotes. “Everything will be okay in the end. If it's not okay, it's not the end.”
What should you expect at pelvic floor therapy?
What should you expect at pelvic floor therapy?
Do you feel welcomed when you walk in the door?
Pelvic floor PT is a pretty personal and intimate experience. You should feel comfortable from the moment you walk in the door. At Empower Your Pelvis we like to refer to this as the “teal carpet experience.” We want our patients to feel welcomed by the staff and the environment. We make a conscious effort from the set up of our lobby, private treatment rooms, and dedicated 60 minute individual sessions to make each person feel heard and safe.
2. Does your therapist talk about YOUR goals?
We truly believe your goals as the patient are the most important goals for us to focus on during your PT sessions. Your goals can be as modest or ambitious as you want. Do you want to stop leaking urine when you’re jumping on the trampoline with your kids? Great, we’ve got you. Do you want to train for a triathlon without pelvic pain? Great! We’ve got you too. Do you want to have more regular bowel movements without pain? Fantastic, let’s work on that. Do you want to feel stronger after you’ve had your baby? Super, we can get you there. Or, do you want to stop leaking a bit of urine every time you sneeze? Yes, we can improve that too.
The ball is in your court. We’re going to guide you and help you work toward whatever goals are most important to you.
3. Do you have the ability to talk to your therapist outside of appointments?
You are here to improve your symptoms. And, we believe our patients need to understand their home exercise programs, bring new symptoms to our attention, and share their wins in order to be successful. We are available via email during the work week to check in on your progress, review parts of your home exercise programs, and guide you on any changes you may experience between visits.
4. Does your therapy clinic offer a variety of interventions?
Your concern that brought you into pelvic floor therapy may not be solved with only one type of therapy approach. You need to have access to several types of interventions to address the whole problem. At Empower Your Pelvis we provide soft tissue and myofascial techniques, joint mobilizations, visceral techniques, functional dry needling, assessment and modification of functional movements, therapeutic exercises, and neuromuscular reeducation to treat the whole body and assist you on your road to recovery.
5. Do you practice your exercises in positions that are applicable to your daily life?
You need to be practicing your habits, movements, and exercises in positions that you're struggling with during the day. If you’re constantly having vaginal pressure when you go to pick up your baby, that’s exactly what we want to be working on. If you’re leaking urine every time you stand up from a sitting position, we’re going to practice your exercises during this sit to stand movement to make you successful. Our bodies can be retrained, but you have to train specifically for what you want to improve.
6. Do you discuss your bowel function during pelvic floor therapy?
Yes, your bowel health is relevant and important to discuss. Your pelvic floor is a group of muscles, and these muscles are involved in your bladder, bowel, and sexual health. Discussing your bowel health helps to put the whole picture together and provide you the best treatment.
7. Does your therapist talk about your daily routines and train you in functional movements?
Quite possibly the most important piece of the puzzle is how you’re moving during daily life, because this is what you’re doing the most! We are movement experts. All the therapists at Empower Your Pelvis have earned a doctorate degree in physical therapy, so you could say we’re pretty into analyzing and optimizing people’s movements. Your pelvic floor is a group of muscles and is significantly impacted by how you move throughout the day. We want to look at how you’re moving to unload the dishwasher, pick your baby up out of the crib, or lift a box off the floor for your work. We want to talk about some helpful positions you can sit in while you're on the floor playing with kids or grandkids.If you enjoy exercise we want to look at those movements too! We want to fine tune your posture during your squat or warrior two. We want to talk about how your muscles should be engaging while you’re running, walking, or riding your bike. This is what’s going to help you be successful long term and continue participating in the activities you love.
8. Do you have a plan to continue progressing your pelvic health after you “graduate” PT?
Lastly, we want to send you off with all the tools and knowledge for you to stay healthy and participate in the activities you enjoy! We will help you set up a long term plan of what your pelvic floor needs to stay healthy, and how you can incorporate these things into your daily life.
These are a few of the ways we believe we stand out as a clinic. You attaining your goals is our top priority, and we do our best to facilitate your success.
Please reach out to the clinic if you have any questions about how we can help you with your pelvic health! We offer free 15 minute phone consults, and love to answer any questions you may have about your pelvic health! 816-434-5180
Best, Dr. Erica Magruder, DPT
I’m pregnant for the first time, I’m in my first trimester of pregnancy and I already have a diastasis recti, now what?!
I’m pregnant for the first time, I’m in my first trimester of pregnancy and I already have a diastasis recti, now what?!
By: Dr. Marin Cole
A lot of women who have not been pregnant before have not heard of diastasis recti, so let me first explain what that is. Diastasis Rectus Abdominis (DRA) is when there is separation between the two sides of your 6 pack muscle (your rectus abdominis) from being overstretched. Most often this doesn’t occur until later in pregnancy and sometimes not even noticed until after delivery. This occurs during pregnancy because as your uterus is growing, the outer layers (aka your abdominal muscles) need to stretch to make space for the baby! So while this diagnosis is incredibly common late in pregnancy and postpartum, it can be scary for a first time mom no matter what phase of their pregnancy journey, especially to be told they have it before even they’re showing! What is worth noting about women who are diagnosed with DRA early on, there is a chance that you had a mild one prior to becoming pregnant and the change in pressure from your growing uterus has
So, you go to the doctor, you mention you’ve been noticing a “pooch” in your lower belly that you haven’t noticed before, and they tell you that they feel a diastasis recti AND a hernia… Okay wow, that’s a lot of new information for only being 12 weeks pregnant. I won’t go too much into the hernia here because that is something that the doctor will go over with you if there is something to be concerned about, I am here to go over what you can do about the DR.
You may have seen videos of people on tik tok or pictures of people getting out of bed on instagram who are clearly in their third trimester of pregnancy, well it's your turn to start getting out of bed like those ladies, just a little bit earlier than expected. You need to start rolling to your side before sitting up to get out of bed, no more sitting up super quickly!
Learn to engage your core. This is something you can learn by seeing a physical therapist. We train people to appropriately engage their deeper core muscles to help support your abdomen as your belly continues to stretch.
Improve your lifting. You can still lift things (unless your doctor says otherwise) but the way you lift and how much you lift may need to change. You need to make sure your core is engaging and you are using good body mechanics as you lift!
Support garments. It may be time to start wearing support garments around your lower abdomen sooner than you were planning to, depending on the severity of your DRA. This can be as simple as leggings that have more abdominal support, or what we recommend to our patients often is the ProBump™ Pregnancy Belly Support Band by Bao Bei. Use our PROMO CODE: empoweryourpelvis for a discount: https://www.baobeibody.com?sca_ref=1312719.2HaGsb9M0w
Post-prostatectomy, now what?
Post-prostatectomy, now what?
By: Dr. Marin Cole
First of all, what is the prostate gland and why is it important? The prostate gland lies just below the bladder and surrounds the top portion of the tube (urethra) that drains urine out of the bladder. It is a major gland in males that is responsible for producing over half of the fluid involved in ejaculation. The prostate also helps to squeeze this fluid during ejaculation out of the urethra. The relevance of the location and function of the gland when it comes to removal of the prostate gland during a prostatectomy is two fold. First of all we take away an anatomical support around the urethra, which means less control of urine draining from the bladder down the urethra, and now there is decreased fluid production and excretion during ejaculation. What does this mean for you? After a prostatectomy you will likely notice a big difference during masturbation and intercourse in regards to your ability to ejaculate fluid, and you will likely notice a change in bladder control.
And how can a physical therapist help with these side effects of a prostatectomy? I’m glad you asked!
I am a pelvic floor physical therapist which means that I can teach you about how the pelvic floor functions to control your urine, especially when it comes to leaking urine! As mentioned above, the prostate gland can be viewed as a sort of cushion around the urethra that helps to control the draining of urine into the urethra and out of the penis when you go pee, so now that you’ve removed the “cushion” support around the urethra, the pelvic floor has more of a responsibility than it is used to. I can train you how to PROPERLY contract and relax your pelvic floor to avoid leaking when you’re headed to the bathroom, when you’re lifting up something heavy, and when you’re getting up from sitting! There is SO MUCH MORE that I will go over with my patients but what it really comes down to is learning to better coordinate your muscles that connect to your pelvis–your pelvic floor, your core, your hips, your back, and even your diaphragm–so that you can perform the activities that YOU want to be doing without fear of leaking!
When it comes to changes in ejaculation or even changes in ability to achieve an erection this is something that is more complex and often involves working with both a physical therapist as well as your urologist to find the right solution for you, but we can work on the pelvic floor muscles that are specifically involved in blood flow into the penis to improve erection!
So, if you have had a prostatectomy, or if you are scheduled to have one in the future, and your doctor hasn’t talked to you about physical therapy, ask them to write a referral for you and get in to to see a pelvic floor physical therapist ASAP, you will be so grateful you did this for yourself!
March Pelvic Posse Stars
March Pelvic Posse Stars:
Alyse Biscan(Marin’s Patient)
Alyse has been so dedicated to her pelvic floor physical therapy plan while also juggling her final year of occupational therapy school! She has been dealing with her symptoms related to endometriosis and hip pain for years and can finally say her symptoms have improved! It is always so great working with Alyse!
Kaitlyn Clark (Heather’s patient):
Kaitlyn works hard balancing work, college classes, and physical therapy. She completed prehab prior to endometriosis excision surgery and is now progressing in her recovery. It is always so much fun to see Kaitlyn!
Tamara Stuhlman-Figge (Morgan’s patient):
Tamara has been dealing with spinal and hip dysfunction for years. She maintains her home exercise program focusing on core and hip stability. Now she is able to take her dog on long walks!
Erica and Cloene
Cloene has been dedicated to her physical therapy and her home exercise program. She has gained significant mobility and is now able to complete her tasks around the home and walk without pain. She is continuing her physical therapy to continue to gain motion and build strength to maintain her progress. It has been a pleasure to work with Cloene!
How "Come As You Are" Changed My Sex Life
How Come As You Are Changed My Sex Life
By: Dr. Erica Magruder
This is not a book review. However, I cannot say enough good things about this book. Emily dives into so many topics regarding sexual health that one may call game changers.
She discusses “brakes and accelerators” how these affect your sexual expereience and what you may need to consider regarding your personal “brakes and accelerators”.
A real “ah-ha” moment for me is when she brought up trust. To take your foot off the brakes and allow your accelerators to kick in you have to trust the whole experience. You have to trust your partner… and here’s the good part, you have to trust yourself! Gosh darn it. Trust your body.
Whew, that is a lot to ask of someone who is experiencing pelvic floor dysfunction. If you’re leaking urine, leaking bowels, or having pain with sex it may feel impossible to trust your body. It is doing things that make it feel untrustworthy. It is not functioning how you would expect or desire.
There are so many layers that can affect your trust. A few of Emily's areas of expertise are the psychological, emotional, and social factors, and she fully explains all of this in her book. I will not try to summarize all of this, because I could not do it justice. So read it! Read her book, Come As You Are by Emily Nagoski.
Then the physical components, that’s my expertise. That’s where all those pelvic floor muscles come into play. They deserve some attention. Your pelvic floor is part of your body. It is a very important part of your body, and in addition to your brain it is one of the most important parts regarding sexual function. You can change how these muscles function. You can get to know your body better, and aid these muscles in their function.
Take a look down there. See what your vulva looks like. Get to know yourself.
Beyond your vulva there are three layers of muscles. And 28 individual muscles. These muscles need to be on board. They need to lengthen, and have the ability to contract to allow you pleasurable sexual experiences.
The physical is one piece of the puzzle in getting to trust your body. Our bodies function in a biopsychosocial manner: bio (physical - anatomy, muscles), psycho (psychological - brain), social (relationships, environment). You have to address all of these pieces to establish trust and experience enjoyment. We can do all the physical work, and if you don’t take the time to process the other components, you may reach a plateau. You could make excellent progress with pelvic floor PT, but not quite get to where you want to be because there are other barriers looming. Maybe you don’t trust your body. Maybe you have negative thoughts about your body that slam on the brakes. Maybe you haven’t allowed yourself to enjoy what arouses you because of cultural contexts that suggest you’re “dirty”.
I needed to acknowledge this side of things. I needed to acknowledge it’s ok to feel sad my body has permanently changed. As Laurie, a character in the book says, “What I need to hear is that it’s okay to feel sad that my body will never be what it used to be. I put a lot of effort into learning to love that body, and now I’ve got to start all over again learning to love this one.” And I do. I have to learn to love this body; this body that I’m living in after giving birth to my second child. Stop the negative self talk and take my foot off the brakes.
I had to embrace my accelerators; allow myself to enjoy what I enjoy. I had to let go of the cultural contexts that tell me what I feel is wrong.
And folks, as I said before GAME CHANGER.
So do it. Read Emily’s book Come as You Are. Look into pelvic floor physical therapy. Do what you can to help yourself.
There is hope. You can see change. You can have a better sex life.
Peloton Blog
Why I love my Peloton
~ Dr. Morgan
When I was in college I started getting interested in doing sprint triathlons. I had done half marathons, 10ks, 5ks, and so on but I wanted to try cross training. My body was really sick of exercising in one plane of motion. When I started training for my first sprint triathlon, I was shocked at how bad I was at the bike. Not like I can’t ride a bike but that my cardio capacity for cycling was poor. I wasn’t expecting this because I had always been an athlete and picked up things relatively easily. I had a hard time understanding how to push myself on the bike in comparison to swimming and running. I think it was more of a mental block, to be honest. I wish back then that I would have had a Peloton to help guide and push me with cycling.
Fast forward to where I’m at now… about 75% of my cardio workouts are cycling. HA! What I thought was my least favorite has now transitioned into what I do the most. About a year and a half ago, my husband and I decided to make the investment to get a Peloton. The product itself was so popular and I felt like it was advertised everywhere. However, I didn’t know if the investment would make sense for my family since I wasn’t a strong cycler in the first place. But like I said, to my surprise, I would consider myself more of a cyclist now than a runner. I have gained a new love for cycling that I didn’t know I had in me.
The peloton is an awesome product because it has so many great live videos and recorded videos that you can use at any time of the day and at your leisure. However in my opinion the Peloton bike itself is not any different than a stationary bike that you may have at home already or seen before. Before we decided to make the investment to get a Peloton, I rode different kinds of bikes at the gym that were very similar to the Peloton and I did the classes through their app on my phone to see if I would actually use it. I am so glad that I did this because I rode all sorts of different brands of upright bikes and I think it is safe to say … I didn’t have more love for one than the other. Sure, some had a couple of features that the other didn’t have but at the end of the day, they felt similar ergonomically.
But I think sets Peloton aside from the rest is the community that they have created. In a world where there is so much craziness (like a global pandemic lol), it is so cool to be connected with people not only across the United States but across the world. I love that the Peloton has different options for classes that include: strengthening, yoga, running, walking, stretching, and more. I use those features more than I thought I would.
So back to cycling and specifically the Peleton. We have had so many questions from patients and clients like, “Is it safe during pregnancy?”, “Is it bad for my pelvic floor?”, “how do I know if my posture on it is okay?”, the list goes on. I’m here to tell you that the Peleton is not the first upright stationary bike invented. This type of workout equipment has been around since the 1930’s!!! (Yes, look it up). My point is, stationary seated bikes have shown to potentially compromise the pelvic floor if you use it incorrectly. Sitting for too long even in a chair at work can do the same thing. It is so important to promote good blood flow to our pelvic floor. This does not mean that we should sit or that we should ride a stationary seated bike BUT we should be smart about it.
Here are 3 pieces of advice when riding your Peloton:
#1: Ease into it. Don’t go from never cycling to doing a 45 minute tabata class every day.
#2: Get out of the saddle. Don’t stay in the saddle for your entire class. Almost every instructor gets out of the saddle to create blood flow during their rides unless it’s a 10 minute low impact ride.
#3: Mobility. Mobility. Mobility. Just because you are cycling doesn’t mean you should throw yoga or mobility exercises out the window. Continue to move your body in different planes and give it what it craves… movement!
I may be biased but I’m being completely upfront with you because I have purchased their product and use it for almost 2 years now. It has been a great investment for my husband and I because it keeps our workouts convenient, thoughtless, and challenging. I think the main thing to take away from this is to make sure you are safe with any of your movement patterns with any piece of equipment that you were using for exercise. You can always find something that is wrong with some type of exercise (running, biking, swimming, lifting, etc.) but if you can do it in moderation and make sure that you are being appropriate with your skill level then you should be good to go.
Men Have Pelvic Floors Too
Men Have Pelvic Floors Too
Marin Cole, DPT, PT
Yes, you read that right, men also have pelvic floor muscles. So because they have pelvic floor muscles, they too can have pelvic floor dysfunction. Men can experience pelvic pain, urinary or fecal leakage, constipation and erectile dysfunction. And their pelvic floors can be trained just like a woman’s pelvic floor to improve these symptoms.
We see men in our office every day. The diagnoses that we see most often in our clinic are men who have undergone treatment for prostate cancer or a prostatectomy. We are also fortunate enough to see some men BEFORE their prostatectomy!
Now, is your husband or partner experiencing “pelvic floor symptoms” and not doing anything about it? I have so many female patients who have divulged information to me about their husbands while we are talking about their own symptoms and this got me thinking… Why hasn’t anyone recommended physical therapy for these gentlemen?
This blog is for you ladies whose' husbands haven’t been able to find the help that they need! I want you to share this with your husband! Many men are under the impression that after treatment for prostate cancer or a prostatectomy or they can no longer have sex with their partners. This saddens me. It is absolutely true that these diagnoses affect their anatomy “down there” and thus affect the muscle function that is responsible for erectile function and continence. But what this also means is that those involved muscles can be retrained. So, that being said, if your male partner either is unable to have an erection or is experiencing urinary leakage, they TOO can benefit from pelvic floor physical therapy.
Next week I will be writing a blog post going over specific things that men can do to start helping with their pelvic floor dysfunction but I first want men to understand that there is hope for them too. Just because they have had prostate cancer or even a prostatectomy it doesn’t mean sex is off the table.
Cheers!
Marin