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Jenny Swisher: [00:00:00] Welcome friends to this episode of the [00:01:00] sync your life podcast. Today. I have good friends of mine, Sarah King and Julia Baker. They are pelvic floor occupational therapists. That’s a mouthful. Um, they’ve been on the show before. In fact, they were one of my first interviews. So 200 and some episodes, no 300, 307 episodes ago.

Um, I interviewed them in the very early days of this podcast to touch on the topic of pelvic floor. This is something that I find that. Okay. Hey, not a lot of women know about, or they don’t think they need, or they ask their doctor about, and they’re told, I don’t really know, or you don’t really need that.

And it’s actually can be game changing for a lot of people. I’ve had multiple friends, um, say that it was, it was a huge game changer for them in just getting more efficient in their workouts, getting more efficient in their life, feeling like they’re not. Um, you know, dealing with these sort of uncomfortable symptoms so much.

And as I was just saying to my community, cause I just had them go live with me in our community page, you know, we don’t have to suffer from a lot of things that we suffer from, there are ways around it. There are things that we can do both lifestyle wise and just. Learning [00:02:00] the basics of proper breathing techniques and things that can really eliminate some of that frustration.

So we’re going to touch today on pelvic floor. Um, I’m going to link up for you guys in the show notes, the first episode that I did with them so that you can get more of a baseline for what I would call the basics of understanding this topic, but we’re going to go deeper today into the topics of leakage.

Um, we’re going to talk more about pain during sex. We’re going to talk about some of those more nuanced things, um, that we haven’t touched on before. So Sarah and Julia, welcome back to the show. If you would just kind of remind my listeners who you are. How you guys met. I know you guys are besties. Um, so tell us like how you guys came together and what you do.

Sarah King: Sure. Um, so my name is Sarah and, um, I met Julia. Gosh, it’s probably been close to 10 years now. Not quite 10, maybe eight, eight years ago at church. And, um, she said that she was an occupational therapist and I looked at her and said, Hey, me too. And, um, after, um, conversation, we realized that we had actually been at the same school [00:03:00] just.

at different times. Um, and we formed a friendship. Our youngest daughters are besties, and it just has transitioned into this part of our life where we get to use our OT brains. And we really applied it to ourselves. When we were going through postpartum with those last kiddos, because we were both struggling, but we were both struggling in different ways.

And so it led us to this continuing ed course where we learned more about biomechanics and how that relates to the pelvic floor. And, um, it started as, you know, our own business wanting to help other women. When we recorded that first podcast, we, we had our own business and we were working with women, um, just in the basement of our house.

Um, and as God would have it, that was not that was not what he wanted us to be doing. But, um, two years ago, we actually started [00:04:00] with a local OBGYN clinic, midwifery clinic here in Fort Wayne, and we get to see patients and come home and do our mom thing as well. So.

Jenny Swisher: Best of both worlds. We were just touching on, like, I love, I love when women can create their own life and say like, this is how I can serve other people, but also my family is a priority and I’m making both happen.

So I love that for you guys. Okay. So let’s, you know, let’s touch on this idea of pelvic floor. Like, again, I know, I know, um, Julia likes to use visuals, but this will, this will be an audio podcast. So if you can tell us like audibly. Um, what is the pelvic floor? Why should we care as women and, and, you know, kind of lead us into our conversation.

Julia Baker: So the pelvic floor are all the muscles, they call them the bicycle seat muscles. I think it’s an easy way for people to understand. So if you think of your pelvis as being a bowl, they would be all the muscles that are on the inside of your bowl and they, they play some really important functions. I mean, for one, it stops all of [00:05:00] your vital organs from.

plopping out of the bottom of your body. Um, so it is a support system. It’s a shock absorber. Um, it allows us to maintain continence, so to not leak urine and stool. Um, it has a dynamic in breathing. Um, and then of course has important roles in, um, sex and intimacy. So, uh, the functions of the pelvic floor, um, would be to support all of those organs in that way.

Jenny Swisher: Now that’s a really cool way of thinking about it. Like what would happen if it wasn’t there? I mean, so, yeah, so let’s, let’s touch too on just, um, There are so many things, I think, that women, I think misconceptions too, right, like we were just talking to the community about the fact that I have never delivered children, like I’ve never given birth, I have two adopted children, but I’ve also learned about myself that I think what Sarah was mentioning about tight pelvic floor, [00:06:00] it tends to be kind of what I deal with, um, and so I want to touch on that, but What do you see most often in your practice?

Let’s start there, like, what, what are women coming to you for? I mean, I know maybe you mentioned like diastasis recti, that type of thing. Um, but what do you see most often now that you’re working with women again?

Sarah King: So we see a whole gamut of diagnoses come across our, our, um, practice and most of them are referred to us because of pregnancy or postpartum.

Um, but Julia and I often joke that, that we would be able to treat any woman who walked in front of us, um, just because every, everybody has a pelvic floor and it’s so important into how the body, works and how, um, how everything is integrated. And so we have seen, you know, diagnoses such as the diastasis recti from somebody who’s been full term.

Or we also see a lot of patients who have had C sections because a C section is a [00:07:00] very, um, aggressive surgery. We cut through layers and layers of muscle and tissue. And then we send women on their way and say, good luck. Um, but in our particular practice, we see, um, a lot of postpartum women who have gone through C section to help recover from that pregnancy.

We also see, um, women who, um, are looking to return to active duty. Um, we have a, a National Guard here in Fort Wayne, and so I’ve, we’ve seen several women who are trying to get back into shape to pass the physical fit test for that. Um, we’ve seen, um, Professional

Julia Baker: dancers. We see people who have leakage, um, both stool and urine.

We see people who, um, Sarah and I in particular, um, in our practice, we have two therapists who do internal work. Sarah and I do all external work, but we’re very. Uh, knowledgeable [00:08:00] on, um, internal work as well and actually are going through some training on that as well right now. Um, so if somebody comes to our practice or to this, um, clinic and is complaining of painful intercourse, typically, um.

most of the time that will require some kind of internal work, but we absolutely address it when we’re seeing patients as well, um, for painful intercourse. We’ve also seen patients who have endometriosis and either, um, or recurrent miscarriage infertility. Um, I have found some of those patients fascinating to work with because we talk about tension and we talk about, um, how often.

They hold all of this tension in their core, and the core is intimately related to the pelvic floor. So the pelvic floor is then tight. And so then they have symptoms of pain and leakage and sensitivity around your patient that [00:09:00] struggled even to wear clothing to wear pants. Right? Um, and that, you know, We can help with those kinds of things.

So you name it, we can probably address it in some way.

Jenny Swisher: Yeah. Well, when I used to train in my gym, right? So I worked with both male and female clients. There was sort of this like inside joke amongst the women that would take my insanity classes at the time, right? But the high intensity cardio classes. Um, so most of them, like I would say we’re probably nearing in on the age of 40 or so, right?

Had children and they would. Joke that they couldn’t do the jump detox, or they couldn’t do the jumping activities, because if they jumped, they would leak. I also know that the average woman sometimes struggles with leakage, right? That’s something that I’ve, I know my parents generation, I’ve heard them talk about, I’ve heard, I’ve heard this come up.

So, let’s start, we’ll talk about these different things that you’ve said, right? You’ve, you’ve mentioned leakage, pain during sex, like, let’s touch on each of those, because I’m sure my listeners are like, ooh, that might be me, that might be me. So, Tell us more about the leakage, um, phenomenon, like what’s happening there and what would be maybe one thing that [00:10:00] people could, you know, could take from working with an OT in that regard.

Julia Baker: I think we are on the cusp of a cultural change when it comes to leakage. And unfortunately, there are some setbacks in that culture, I think, right now, given Some new commercials that have come out. But I think with leakage has been going on forever. And I think that there was a generation of women who did not talk about leakage.

It was something that happened and you didn’t talk about it. And I think that we have gotten past that, but my concern is that now we talk about it. And we joke about it like it’s normal, you know, you just mentioned that, you know, like, like, it’s a funny thing, like, like, you know, I can’t do my jumping jacks because then I’ll pee or, you know, I need to wear a diaper or a pad because of this.

And what I would like to see and I think it is happening, but we need to keep talking about it is we need to move from a. Okay, I’m glad it’s out there. We know that it exists and we’re talking about it. Now let’s talk about the fact that there are inter, you don’t have to live with it. And there are [00:11:00] interventions that can be done to, um, get rid of it or at the very least, greatly reduce the incidence of leakage.

Um, a lot of times, you know, we’re talking about the tightness in the pelvic floor. Two things can exist at once. You can have a tight pelvic floor and a weak pelvic floor. pelvic floor. Those two things can be together because essentially pelvic floor is a group of muscles. right? And so they behave like muscles all over the body.

And the bicep is usually one of the easiest muscles for us to just use in the clinic to explain to people, um, what is going on. So if you took your bicep and you took your hand and you placed your hand all the way up at your shoulder into a full on bicep curl, okay, maybe I put weight in your hand, maybe I don’t.

But I ask you to just carry your bicep like that. All day long. It’s contracted. It’s tight. You’re going to [00:12:00] lose the ability. One, you’re going to lose the ability to lengthen it. You’re going to go to lengthen it and it’s gonna be like as you’re trying to lengthen it to eventually if you asked it to do something, it’s going to be like I already used all my energy being clenched like this all day, lady.

I’m not going to be able to do something for you. And three, it can’t reach out and grab something because it is tight. So the fact that it’s been sitting there contracted all day, every day. without a break is going to lead to weakness. So those two things can exist together, the tightness and the weakness, but we need to deal with the tightness and the lack of range of motion.

First, we have to be able to take that hand away from our shoulder, lengthen it before I can give you a weight and ask you to do a bicep curl in order to get it stronger. And I would say [00:13:00] that 95 percent of our patients that we see have high tone in their pelvic floor. And we can tell, you know, as external pelvic floor therapists, like a lot of times I can tell just from looking at you or the symptoms that you describe.

Um, you know, if you’re somebody who comes in and tells me that you have a lot of constipation, I know that there are many, many factors to constipation, of course, but if you have made all of the dietary changes, you’ve added supplements, you’ve done, you’ve done all the other things, and you are still having constipation, it is perhaps possible that your pelvic floor is so high and tight that it will not lengthen and relax to allow this You know, good consistency of stool that you have created to come to come through to pass.

It’s

Sarah King: hitting a brick wall. Yeah. And the other thing that can happen with those tight pelvic floor muscles is it can literally change the position of the urethra. [00:14:00] In your body. So the urethra is the tube that, that, um, the urine comes out of the body and it’s, it sits at an angle that allows you to maintain continents when you move throughout different positions.

But when you have a tight pelvic floor that can actually change the position of the urethra so then when you change positions now gravity is just pulling that urine out because of that tight pelvic floor. That makes total sense.

Jenny Swisher: Yeah, well, I’m glad you said that about like, you know, Julia, you said that about, um, women kind of poking fun at it, right?

I see, I see that happen with Menopause, right? Like, I mean, and joke about hot flashes, right? And, and part of me wants to say, sometimes we, I think we, as women do that because if we don’t laugh, we’ll cry,

but

Jenny Swisher: you know, you’ve heard that saying of like, I don’t know how to deal with it. And when you, when you actually take a look at like the lack of research on women and the fact that women.

Ultimately, well, I should say practitioners, 97 percent of practitioners don’t know how to navigate things like hot [00:15:00] flashes or menopause because they’re not menopause informed. Right. So there’s just this huge disconnect to, I think, just in the medical space of like, how to truly help women. But it’s like, when you figure out that women like you, this is your specialty, like, this is what you’re looking at.

This is what you can do both internally and externally to help that. Yeah. You know, maybe, maybe you’re just being misguided prior to that. Right. So I think it’s, it’s huge.

Julia Baker: I love humor. I’m a goofball. Okay. I enjoy it. I will laugh with you and then,

Jenny Swisher: and then

Julia Baker: let’s talk about how we can do something else.

You know what I mean? I’m not saying don’t joke. I’m just saying, let’s talk about it.

Jenny Swisher: Absolutely. Yeah. It’s, I mean, it’s, I see so many women suffering and it’s like, the suffering is covered up by, by like the joking and all the things, right? It’s an

Julia Baker: opening. It’s an opening to start a conversation. Right.

You know, when we were on the call, you said, you know, this might be TMI. This might be TMI. I, first of all, with us, there’s literally no such thing as TMI. Um, and I think occupational therapists. Occupational therapists are the best place [00:16:00] to start. Um, it’s very rare, I think, to find an occupational therapist that there is like such a thing as TMI, because we literally deal with

toileting,

Julia Baker: bathing, dressing, you know, all of these intimate parts of life.

And I think that it’s important to talk about these things, and it may be uncomfortable, and it’s important to find the right therapist that you can have the therapeutic relationship with to talk about these things. But without talking about them, they will not improve. Right. We can’t find solutions.

Yeah.

Jenny Swisher: Yeah. I think for me, the TMI for the, we just did a live stream in my community page for those of you listening and For me, I was like, I feel fine telling you guys as occupational therapists. I don’t know how I feel about my community of 500 women.

You

Jenny Swisher: know, I think, um, yeah, I mean, so many women do. I mean, whether it’s leakage, constipation, right?

Like, and it’s like, you do need. You need to go deeper sometimes on like why these things are happening instead of just living with them. Um, you, I love that you touched on the tight versus weak pelvic floor, how it’s often connected, but you work on the tightness first. That makes [00:17:00] sense. Um, I also, I want to kind of circle back to this internal versus external work too, because I have a good friend of mine who, um, she started seeing Must, must’ve been seeing someone like you guys that does both internal and external work.

And she said she wasn’t really anticipating that they were going to go internal in the appointment. And so that was really kind of a surprise to her, but how much better she felt. So she was dealing with like, I think, painful periods and some other things. Ironically, just to kind of throw in a side story, my functional doctor told me, I think it was about 10 years ago to see a.

I’ll probably mess it up. It was a Mayan massage. I think I know it was Mayan massage. I’ll say therapist. So I drove to Bloomington. This was about 10 years ago, about an hour and a half away and saw this woman who specialized in this Mayan massage. And it was basically, um, She asked me if I felt comfortable with the internal approach.

I said, no, at the time, looking back probably would have been beneficial, but it was like this weird uterine manipulation, almost like you would think of [00:18:00] chiropractic, um, for your spine, only it was real low in the abdomen. So it’s very interesting to me that there’s both these external exercises, breath work, things that we can do.

Like I I’m thinking like physical therapy, probably similar, but then that there’s this internal approach as well. And so I think that’s, that’s something that I’ve never really. Um, and then I’m going to go into, can you tell me more about like what that looks like for, for different things?

Sarah King: Sure. So in our particular practice, like Julia said, we have two pelvic floor, four therapists, one who is a PT, one who is an OT, and they have taken this pelvic floor specialty, um, even more specialized.

And they, um, specifically work on the internal health, um, of the pelvic floor. So when you’re talking about tight muscles, you can often get adhesions, knots, trigger points because of the tightness associated with those muscles and internal [00:19:00] pelvic floor therapy can help relieve some of those trigger points and really just get, um, palpation on those pelvic floor muscles that we can’t have any other way, um, just to see how is the muscle contracting.

Um, there are tools such as biofeedback where we can kind of measure the strength of a muscle, muscular contraction, um, and then internally trained pelvic floor therapists can do that. manually with their, with their fingers, um, they can feel what happens to those internal organs when a patient coughs. Um, those types of things that, that we can’t necessarily, we can assume by different things from the outside, but it’s just a way to get, for lack of a better term, deeper, um, and have a, have a better understanding of the function of that pelvic floor.

It

Julia Baker: doesn’t have to be all or nothing. Either is the thing. So what could this look like? So [00:20:00] externally, um, I frequently will take my patient and there’s a nice cushy couch that’s very convenient actually where we treat patients and I ask them to sit on the couch and we talk about where your sits bones are, you know, because a lot of people sit on their tailbone, not their actual sits bones.

And I ask him to squish around on the couch until they can feel the cushion of the couch actually up touching essentially your lady bits. Okay, and then we use that cushion to give tactile feedback and we talk through a Kegel and a reverse Kegel and we talk about how it connects with breath work and can you actually feel the sensation.

It could also look like asking a patient to place their hands. On their pelvic floor muscles to put their hands to sit on their hands or to, um, cup their pelvic floor muscles and this is all fully clothed. This would be what we consider more of like an external but fully dressed, um, assessment. [00:21:00] It could look like, um, disrobing in a private exam room and only being a visual exam, you know.

Now I’m going to hold up this mirror. I want you to take a good inhale and I want you to see what’s happening at your muscles here. Now I want you to lift or to kegel and see what’s happening at these muscles with no touching. It could also look like only an external exam. Right? So you’re disrobed in a private treatment room and with a gloved hand, there’s going to be touching and tactile input so that you can assess for mobility, the provider can assess for mobility, scar, those types of things, and provide feedback to the patient of what they’re feeling when they make different movements.

And then it can be all the way to an internal exam, which I think that I would kind of compare if you had a trigger point on the inside of your shoulder blade, you know, and you go up to your partner spouse and say, God, could you, could you rub this, [00:22:00] this trigger point out in my shoulder? It’s the same.

It’s just, um, it’s a muscle. The pelvic floors are the pelvic floor. Is muscles, is muscles, , , um, you know, and so that would look like inserting a gloved digit, um, through the vagina or the rectum and releasing trigger points from inside the pelvic bowl. So it can be the whole gamut.

Jenny Swisher: Yeah.

Julia Baker: All pelvic floor therapy.

Jenny Swisher: Yeah. Yeah. So cool. So cool. Okay. So let’s, I want to touch on a couple more things before we wrap it up. One is painful sex. Cause this comes up a lot. Um, in the consults that I do alongside Dr. Page, I know, you know, and I’ve talked on this podcast about things like vaginal estrogen and what happens in perimenopause as our hormones decline.

And yes, there is that sort of hormonal factor, but there’s also, as you’ve talked about this tightness, tightness slash weakness. There’s also this component as well. And I’d love for you guys to touch on what you see and maybe again, um, what there can, what can you do about it?

Sarah King: Absolutely. So if you [00:23:00] think about a tight pelvic floor, the tightness is going to make entry points more constricted, right?

Those, those tight muscles are going to make it harder for insertion, um, whether it’s fingers or male anatomy. And it takes women on average 40 minutes to warm up and prepare and be ready for any kind of intercourse. Um, and that’s, that same fact is not true for men, right? And so often in this world, it’s like, okay, let’s go, let’s get it over with.

Um, and we are not fully prepared as women for intercourse when it comes to our tissues. Um, and that’s, so that’s, there’s that piece. Then there’s the piece of, can

Julia Baker: we go ahead? I think one thing I want to talk about with that is that like. Female [00:24:00] genitalia is internal, right? Okay. And so I think that people don’t realize that there is lengthening and, uh, increased blood flow and stretching that happens.

You know, it’s very obvious with male anatomy, the erectile function that is taking place. You can see when that anatomy has gone from you know, day to day to prepared for intercourse. You can’t see what’s happening internally. That doesn’t mean it’s not happening. And so I think that just being aware that, you know, the vagina lengthens, that it, that it, um, that it does get increased blood flow, all of those things.

And so taking that time is not wasted.

Jenny Swisher: Yeah. Well, I just want to interject really quick before you finish. I just heard Dr. Casperson say on her podcast that the average length of sex, um, from a study that was done here in our country is seven to 12 minutes. [00:25:00] And so when you figure that so many women are coming to their doctor saying, why does sex hurt?

And then you have experts like yourselves that are like, it takes the average woman 40 minutes to be ready for penetration. Maybe the issue is that we’re not warming women up enough, or we’re not learning about how women really it’s required for us to have that sort of. For, for play and intimacy. I mean, I could go, we could have a whole podcast on this in itself, because one book that I, by the way, that I refer out often for people is come as you are.

Um, and I actually recommend that book for both you and your significant other to read, because I also think that there’s a disconnect to maybe blame it on, I don’t know, like our lack of sex education. You know, I, for me, middle school sex education was about how to not get pregnant at the age of as opposed to really understanding my anatomical parts or.

How sex even should work, but when you realize like the wiring, so to speak of how men are wired for sex versus women are wired for sex, it all starts to make sense. And so sometimes. I find [00:26:00] that like, it’s the basics that we’re missing out on, right? Like, do I have something wrong with my pelvic floor?

Again, I feel like women are so prone to like, what’s wrong with me? If this hurt, like, what’s wrong with me? Why am I having this? Whereas really like, it could be as simple as like, what happens if you spend the extra time? Like, what happens if we, we warm you up enough that, um, maybe that pain wouldn’t happen.

So I love that you said that because. I love that we didn’t just skip over that and go straight to, um, yeah, so go ahead. I’ll let you finish.

Sarah King: Well, and I think the other thing too is an understanding of when we, when we know what our bodies, how our bodies are designed, then we can, um, use them in the way that God intended us to, to, to make that more pleasurable for each other.

Um, I think the other thing that is fascinating is that the vaginal opening for most women is about four inches. And if you, the length, the length of the opening, the length of the, yeah, [00:27:00] not that. Yes. Thank you. The length, the length is about four inches. And so rest. When it is at rest. And so in order to give it time to lengthen, it is going to be more pleasurable and less painful.

And that incorporates, um, being in tune with our breathing and being in tune with our body. with what is stressing me out. What am I thinking about? What can I get rid of so that I can focus on this intimate act, um, to prepare my body so that it is more enjoyable for both partners.

Julia Baker: Cause you’re talking about the tight pelvic floor and, um, you know, so much of tight pelvic floor, I mean, some of it is like.

actively accessing it, but, um, a lot of it comes from, I don’t know if I want to say subconscious, but like this, um, anxiety, this upregulation, this, you know, higher cortisol, this fight or flight, they call it the fight or flight, you know, it’s a fight or flight [00:28:00] response kind of Well, the Oscillations, the rhythmic movements of the pelvic floor is what leads to pressure, uh, pleasure in insects, not pressure, um, you know, and so if you have high tone, uh, uh, you know, a tight pelvic floor, it’s not just about the tightness for penetration.

It’s about the actual range of motion and the ability to have rhythmic contractions in order. To make things more pleasant.

Jenny Swisher: Yeah, yeah. Um, one of the things that I think has been really interesting, um, for me to learn also from Kelly Casperson too, is this, this idea that a lot of times, um, we don’t think about our brain being our largest sexual organ.

Like, we think about like, how do I warm up the parts, right? Or like, And like you were saying earlier with men, it’s a little bit more obvious, but actually the brain is where the signaling is coming from. Right. And again, back to that book of [00:29:00] come as you are, like when you really dig into what gets a woman in that space to be ready for sex, it’s actually a lot about what she’s thinking about.

It’s a lot about her, her brain. So again, point you toward, you know, Kelly Casperson for future references. She’s got some great content on this, but also come as you are as a book. Um, I also have to, I wouldn’t own the trademark on sync if I didn’t bring up like the changes that are. Sure. Our pelvic floor goes through over the course of a month, um, and this is interesting too because obviously when we’re in our ovulatory window mid cycle for the typical menstruating female who’s ovulating, you know, I do, I’ve at least found from personal experience may not take 40 minutes.

I might be in a better, a better zone at that time of my cycle, but if you’re going to come at me, bro, like three days before my period, like. We might need some extra time right to get ready. So, um, could you touch on like maybe just the changes that we experience from like a vulva perspective over the course of our month?

Because a lot of people don’t realize this. Like I have some friends who get really deep on cycle [00:30:00] syncing and they don’t just track their saliva pattern changes. They don’t just track their basal temperature. They look at cervical mucus and they look at positioning of, you know, like that you were talking about the different tilts and things, um, of the vaginal canal.

So I’d love for you to, if you, if you want to touch on that, that’d be great.

Sarah King: So from, um, because we don’t do internal, I don’t have a lot of experience about the position of the cervix itself, but what I do understand is with the cervical mucus, your body produces more cervical mucus, the closer you get to ovulation.

The ideal is that you’re going to have more cervical mucus to trap the sperm to allow for pregnancy to occur, right? The peak will be at, at ovulation, and that provides a natural lubricant, um, in the Volvo, Volvo region. Um, in addition, there’s more blood flow to that area. The the brain is on [00:31:00] board with what is happening with the body.

And so, um. It’s easier to get into the mood when you’re closer to ovulation than it is at towards the end of your cycle, um, because that is, that is how the body is designed to work. Like, it’s, it’s like, okay, we’re ready. Um, all, all systems are go for, um, for procreation.

Jenny Swisher: Yeah, yeah, no, I love this. And it’s, it’s interesting because for me personally, so I remember realizing this when Chris and I were going through infertility treatment in my late twenties, they had me do permetrium suppositories like that.

They were vaginal suppositories and. We really learned a lot about like cervical positioning just from doing those suppositories. We had to do them every day, but you could totally tell like, why is this shifting? Why is this changing? Like this feels different. And again, because women aren’t really taught about our anatomical parts, we don’t spend a lot of time.

Maybe touching down there and feeling how those changes occur. [00:32:00] So I’m glad we touched on that. Okay. So as we sort of come full circle here, what are the things that we’ve mentioned to our community that I would like for you guys to repeat if you don’t mind is this idea of how this ties into the nervous system.

And I know one thing that you’re mentioning, you talked about the piston analogy. I love that. I love the idea of like, you know, carrying tension and how this affects our whole body. Um, can you kind of repeat that for us, for my listeners?

Sarah King: Sure. I think, um, I’ll talk about the nervous system and then you can come in with your piston analogy, but for specifically for the women we treat and really in today’s society, we are all walking around with upregulated nervous systems.

And one thing that happens when our nervous systems are upregulated is we get Um, shorter inhalations and therefore shorter exhalations. And we’re not getting full range of motion of our diaphragm, which then means [00:33:00] that we’re using our accessory muscles. So our neck, um, upper traps, um, those muscles become overworked and tight and can lead to other issues such as headaches, um, pain in those areas.

And just a continuation of this. It’s kind of high anxiety, um, fight or flight mentality. And so one of the, the very first things that we do with any woman that walks through our door is we take a look at her posture and we look at how is this woman breathing? What muscles are, are, is she using when she’s standing, when she’s sitting, when she’s laying down, how does that breath or how does that breathing pattern change in those different positions?

And then how can we adjust the body? How can we adjust the environment to help her regulate her breath, to support and help her body feel safe for the changes that we want to make with the [00:34:00] musculature system?

Julia Baker: Yeah, I find that the more patients that we see, the more I have come to feel very confident that everyone holds tension somewhere.

The question is just to figure out where, and then that’s where you start. To try and untangle those knots, you know, I mean, and I don’t just mean physically, I mean, you know, where is that tension? Um, and there are some common patterns and common places that you would look and where it might move for, and that would be an entire different hour long discussion, but everybody holds tension somewhere.

Is it upper traps? Is it jaw? Is it glutes? Is it upper abs? Um, you know, and what is that doing up and down the kinetic chain? Um, so often I’m going to try and segue. This is that that tension, the pelvic floor has a relationship with every part of your body. Okay? So it really is the shock absorber [00:35:00] of our body.

So if you’ve ever been in a car that has terrible shocks and you’re going down the bumpy roads, right? Um, especially here as we are in pothole season, you know, think about how, if you have a nice, Okay. supple, elastic, moves well, shock absorber that is the pelvic floor and how those potholes are not going to be bad.

But when you go over these potholes with something that is stiff and has no shock, it’s like jarring, right? And it increases all the guarding and the tension. So in order for our pelvic floor to operate as a shock absorber, it has to be able to go up and down. We talk about the pelvic floor being an elevator.

And so the pelvic floor, it actually never stops. But if you think of neutral as being at the ground floor and it needs to come up at certain times and it needs to go down to the basement at certain times. And most of us are actually really good at bringing our pelvic floor up to the second and third.[00:36:00]

Fourth floor. And some of that is because we’ve talked about Kegels so much. So everybody, yeah, right. And so if you think of the Kegel as bringing the elevator from the ground floor up, okay, but nobody’s talking about reverse Kegels, which is the elevator also needs to be able to go down to the basement.

And this has a direct relationship with the abdominal diaphragm. Um, I actually have, um, Okay. Like models that I have created that we have in the clinic, and I think apparently I thought it was a very common middle school experiment, but most people tell me they’ve never seen it before, where you have the two liter bottle and you’ve chopped off the bottom of the two liter bottle and you put, um, A balloon down in it and that’s your lung and then you take another balloon on the bottom and wrap around the bottom.

That’s your abdominal diaphragm. And you can visually see that when you pull the plastic balloon or the late the balloon down on the bottom, it creates a negative pressure within the two liter [00:37:00] bottle, which is your plural cavity. And that is what draws the air into the lung. Okay. And then when the abdominal diaphragm comes back up, or you even push it up into the two liter bottle, the uh, balloon will compress and it will come out.

You can YouTube it guys. Um, but then what I did is I took that same concept to show people that there’s a whole nother pressure system underneath the abdominal diaphragm. And so when the abdominal diaphragm descends, and it’s created negative pressure up in the pleural cavity. It’s creating positive pressure down in the abdominal cavity.

In order to accept that pressure, the pelvic floor has to go, the elevator has to go to the basement. If it doesn’t go to the basement, that pressure goes somewhere. It can go up into your shoulders, and so you’re breathing up and tight, and your, you know, your accessory muscles get kind of angry. Or it can give up and you get prolapsed.

Give up is [00:38:00] probably a dramatic term, but um, you know, you get prolapsed, you get leakage. So the whole idea is that with, with every breath and every step and every like impact the pelvic floor acts like a piston and it comes up and it goes down and it comes up and it goes down and it needs full range of motion.

Just like you need full range of motion in your glutes to squat, just like you need full range of motion in your biceps to curl, just like you need full You know, it’s a muscle and it needs the full range of motion in order to do its job. Well,

Jenny Swisher: so good. So good. I really believe that we, you know, we focus so much on training.

We train all the other things, right. But we don’t necessarily always train the pelvic floor. A lot of times women will also say to me, um, you know, they, maybe they’ve been training for years, right. Maybe they do the strength training and they, they’re doing progressive overload and they’re doing all the things.

And they come to me and they say, Like I’m getting toned, like my arms and legs are getting toned, but like, I still like I’m carrying all this in the belly and a lot of times, yes, you know, I’ll refer them to a functional specialist or Dr. [00:39:00] Page or something, you know, to dive deeper on cortisol or blood sugar regulation, that sort of thing.

But there’s also cases where I just have a feeling, you know, I’m like, send me a video of your squat. Send me a video of what you’re doing, because you might be really building out those legs, but not engaging the core in the way that you need. And therefore. The core is remaining the same. And so I love what Sarah, I think it was Sarah that said this at the beginning, right?

Like our core is not just our abdominal muscles. It’s also wraps around into the back. I find a lot of people are really weak on the back side of their body because of the sedentary lifestyles that we lead. So there’s, there’s this whole other element, a dynamic, which really just circles us back to the beginning of who needs pelvic floor therapy, anyone with a pelvic floor, which is everyone.

Right. So I think

Julia Baker: people who are, who lift a lot of weights, who do a lot of strength training, who are a lot of athletes, they connect really, really well with their outer core and, um, not their deep core, man, trying to untrain that as well. It’s hard. I’ve done it

Jenny Swisher: myself, you know? Yeah. And it’s funny you say that.

I mean, you’re, you’re Speaking about me, because [00:40:00] there’ve been a couple of times and Sarah knows this, like I’ve thrown out my lower back and I’m like, what am I doing? Like, I feel like I, and I watch myself. There’ve been times where I’ve done it in a workout, like doing a leg workout. And I’ll watch the video of me injuring myself.

And I’m like, I look like the picture of a form, but I know for sure that every time there’s a breath component to what I’m doing, that’s not in the video. That is every time I’m like, why is that? Why do I do that? It’s like, I lock up. Right. And I know that that’s that sort of deep core that’s getting sort of.

Sarah King: For your listeners that are weightlifters, one thing that I would highly encourage because that I love to lift heavy weights, but I had to retrain myself after my third child was born because I had a pretty significant diastasis. And, um, I mean, I was used to doing Olympic lifts. I would wear the weight belt, all of that kind of stuff.

And what I didn’t realize. was that I was using my middle abs and my lower abs were never engaging. And so therefore, [00:41:00] you can get this, um, pressure down into the pelvic floor. And if the pelvic floor isn’t strong enough to maintain that pressure, then you can also see the leaks or the prolapse or The mommy pooch that so many people want to get rid of.

And all of that is connected to breathing. And so for me, I have, I’m back to doing some Olympic lifting, but I am doing it without a weight belt because I have learned how to engage my, my deep core muscles. And a lot of that comes with remembering to exhale with the exertion part of the exercise. And I think so often we move so fast through the movements that we don’t even think about what we’re doing.

And so I would challenge lifters out there to slow down and use your muscle instead of momentum. And really connect with the breath. And when I, when so often when I am working with [00:42:00] women who are lifters, um, and I say something like, well, what, what does engage the core mean to you? They immediately just stuck in their belly button or crunch.

Yeah. We’re going to reframe, like, we’re going to rework that because engaging the core is that entire canister that we want to be working together and not just. putting, um, abnormal

Julia Baker: pressure in the front and the low abs and the pelvic floor are connected. Yes, they’re intricately woven, like they are actually seamed together.

So if you can’t connect. And get range of motion at your pelvic floor, you’re probably not connecting with those connecting and moving your deep inner abdominal muscles, which

Jenny Swisher: would explain why they’re seeing muscle tone, maybe in the arms and legs and other places, but not can’t necessarily, or

Sarah King: these upper abs right here.

So often you can see some depth, like the top two pack

Jenny Swisher: people

Sarah King: will get, and it’s because they’re gripping with those upper abs and the rest are not engaging. [00:43:00]

Jenny Swisher: Right, right. . Wow. This is so good you guys. I mean, it’s, I could have you guys on here for hours. Um, but I think we’ve done a good job of sort of touching on the most common things that people might be dealing with and, and what to do about it.

I’d love for you guys to tell us, I know you guys aren’t working with people virtually right now. Um, you’re working in in person, which is exciting, but I, I still want people to follow you or if you’re open to that or if there’s somehow that they can reach out to you. Otherwise, tell us where people can find a pelvic floor therapist near them.

Sarah King: Sure. So, um, we are both in the sync community. Um, we no longer have a business, um, social media platform. Um, but if you are looking for. an internal pelvic floor therapist. Um, the website that we would recommend is pelvic rehab. com. Um, those that’s a, a database that has therapists who have specifically gone through internal pelvic floor training.

[00:44:00] Um, and then We are both involved in a course that I think will lead to more databases being designed to act for people to access. But for those who are just looking to get started, who may need more of a biomechanical or an external approach, if you go to core exercise solutions dot com and then look under there, you’ll

That’s a certification that both Julia and I have, um, that will lead you to a lot of therapists. And then, um, Julia had a great suggestion of just asking your OB office, um, or whoever you see for women health, women’s health, who they would recommend for pelvic floor therapy.

Jenny Swisher: Yeah. And let’s add on to that too.

Um, one thing that Julia said earlier, which is if you ask your OBGYN or your women’s health doctor, and they don’t think it’s a big deal or it’s frou frou thing, or they don’t have a recommendation, it might not be the right [00:45:00] doctor for you.

Julia Baker: I’ve seen a trend in pelvic floor therapy, where more and more pelvic floor therapists are moving out of an insurance model and working more towards a private pay model.

And I just want to say everybody has to look at their own, you know, financial time, whatever budget, but I would just recommend that. You think about it on the private pay. I think a lot of these,

um,

Julia Baker: public floor therapists that have moved to more of an, you know, have moved to that kind of not Instagram, but like, um, you know, cash based.

That’s the word that I’m looking for. Um, I think a lot of times that’s because they want to take time with their, we’re very blessed. We’re very blessed where we work. We are given plenty of time to work with our patients. Um, we are not hounded about our productivity and getting them in and out, you know, moving the patients along.

We’re very blessed, and that is not the norm. A lot of times in [00:46:00] the medical model, it’s Let’s go. Let’s go. So when you do look at somebody who is looking more at private pay cash, cash based business, a lot of times it’s because they care. It’s because they care and they want to be able to take their time with you.

And it’s a lot of times a sign of they know their worth and that they want to take good care of you.

Jenny Swisher: Yeah, that’s so good. I mean, We work with Dr. Page in our community and she’s the same way people will say, why is, why does she work on a cash based system and a membership plan? I said, because she broke away from the modern medicine system so that she could spend more than 12 minutes with you.

And right, right. So if you get what you pay for, you know, and I think it’s, it’s true here too. So this is awesome. I mean, I took a ton of notes. Um, I know my community benefited from hearing from you guys earlier as well. Again, they’re in the same community, uh, as well. So. I’ll link everything up in the show notes, every link that they mentioned, um, I’ll link up the previous podcast episode that we’ve done.

I’ll also, of course, offer information as usual about our telehealth program and our sync, uh, course and fitness program as well, but. [00:47:00] This is the basics like pelvic floor is mechanics of, of, uh, you know, our body. And sometimes I think we’re so willing to do, we’re willing to do the high intensity stuff or get all the steps in and do all the things.

But if we’re neglecting the basics of, of how our bodies design and really optimizing that like, man, we’re missing the boat and we’re, you know, we’re, we’re confusing ourselves. So thank you so much as always for, for being here, for taking the time. I can’t believe. We’re like, it’s been 300 episodes since I had you guys.

So we’re going to schedule something sooner. I can’t wait 300 more episodes, um, to see you guys again, but thank you guys so much for doing this. And thanks to all my listeners. We’ll talk soon. [00:48:00]