Ep 41 with dr. christine pieton.

Speaker 2 - Ailey (00:06)

Welcome to In This Body, podcast where we dive deep into the potent power of embodiment. I'm your host, Ailee Jolie, a psychotherapist deeply passionate about living life fully from the wisdom within your very own body. The podcast In This Body is a love letter to embodiment.

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Welcome back to In This Body. Today's episode centers on the art and science of embodiment, movement, and holistic healing. I'm thrilled to be joined by Dr. Christine Pieten, a physical therapist and Pilates instructor who specializes in women's health, pelvic floor conditions, and sports specific rehabilitation. Christine is the founder of Pieten Physical Therapy, where she integrates personal care, therapeutic movement, and holistic perspective to help her clients reconnect with their bodies and recover their full potential.

At the core of Christine's philosophy is the idea that the human body is an integrated system, one that requires attention not only to physical mechanics, but also how we feel and relate to our one and only body. Her work highlights the transformative power of connection, how understanding and caring for areas like the pelvic floor can reshape the way we experience ourselves from the inside out.

Today we'll explore how personalized physical therapy can serve as a bridge to greater self-awareness and the unique role that the pelvic floor plays in our overall health. We'll discuss how healing goes beyond recovery, offering a chance to build a more deeper and harmonious relationship with our body. Christine, it's such a pleasure to have you here on In This Body, the podcast with me, Ailee Jolie.

The first question I have for you today is what does being in your body mean to you specifically?

Speaker 1 - Christine (02:20)

Being in my body means having a moment to really connect and nurture the relationship I have with myself. And for me, that often involves being very intentional about having time with myself to be able to give back to myself because I'm in a field that is very much giving to everyone around me all the time, which I love and is something that I enjoy doing.

weaving that in on a more intentional regular basis is really helpful and important and often involves me moving my body out in nature to be quite frank.

Speaker 2 (02:52)

can relate to a lot of what you just shared. I would love to hear from you. What led you into dedicating your life into supporting so many people in the ways that you do.

Speaker 1 (03:02)

I went off to grad school and started out being a running specialist in the clinic that I was working at. I still love supporting runners. I'm a runner myself, but my female runners who had babies and tried to go back to running and then came to me saying, Hey, stuff's not feeling good in my body anymore. After doing this, how do I get back to it? Actually was the accident that led me to start to specialize in pelvic floor physical therapy. In addition to my sport and orthopedic background.

I always say that it was the best accident that ever happened to me because I would not have chosen pelvic health as a specialty myself. I always saw sports and orthopedics and was always drawn to that and thought that it was separate from pelvic floor. And now I can't see my days not nurturing and supporting pelvic health ⁓ because pelvic health is not just in a box. It is actually what is necessary for, I argue,

our overall health to be thriving. If we have a really strong foundation of our pelvic health, meaning, know, bowel and bladder control is feeling available, our, you know, sexual health is comfortable and nurtured. If we are able to move well without feeling like that area of our body is limiting us, I say we have a really high quality of life. But if any one of those three buckets is feeling challenged, then I argue that an individual isn't going to very quickly start to feel like their quality of life.

is very much impacted and is narrowed. And not only does that affect the individual, but I argue that really affects the relationships that they have with other people that they love in their life. The ability to be physically intimate, the ability to feel like they can go out and adventure with the people that they love without being worried about, is there gonna be a bathroom nearby, as an example. Or just being able to move their body like we were talking about, being embodied in ourselves and wanting to go out and maybe go for that hike and...

be out in nature for a while and not be concerned about whether or not our body is going to be able to manage how far we might want to go. It's just a few examples. And so these are things that have become a really big passion project of mine and one that I love to help and support and educate both in my clinic, but also out in the community in a variety of ways and partnering with a lot of other providers that help collaborate and support in these other ways.

Speaker 2 (05:15)

What are some misconceptions around pelvic health that you have come across? Definitely as a therapist when it started to enter my practice, that was kind of the first time I was like, ⁓ physiotherapy, pelvic health, okay, interesting. My clients are telling me about this. I'm going to go have my own experiences. And I did, and it was so, so helpful, but it wasn't where somewhere I would have gone. You know, even being trained as a sex therapist, it wasn't really a part of that conversation.

And so I would love to hear from you some of the misconceptions that do exist around the work that you do, how it actually supports people, and some of those other pieces that I'm sure you come across in your profession.

Speaker 1 (05:54)

I think one of the big misconceptions, I'll speak kind of to, even though I see myself as sports, orthopedic, and pelvic health, I'm going to bring more from the pelvic health misconception lens. I think one of the biggest is the fact that only women have pelvic floors and pelvic floor issues. Every human being has a pelvic floor, so therefore we may need support at some point in our lifetime around our pelvic health. Quick statistic, one in three women and one in five men.

will encounter a pelvic floor condition at some point in their lifetime. And I argue that those statistics are actually under-reported. So just to put that there in terms of the importance of our pelvic health and to your point, kind of misconceptions around this area of our body. I think too, the other piece is that, you know, we, the prerequisite for pelvic floor symptoms is that we must have been pregnant or gone through birth in order to have these things. And while that is a very common

point in someone's life where our pelvic floor often needs more support and often where pelvic floor symptoms will occur. It is not a prerequisite for people to have or need pelvic floor help. And then I think another big misconception is that some of these quote unquote very common pelvic floor symptoms, i.e.

pain with sex that leaking at some point in our lifetime, especially women, which is what I will mostly speak to because that is my specialty within the women's health lens, that leaking is just sort of a normal part that will kind of happen to us at some point in our lifetime. And we just have to sort of deal with it. Also, if you just walk into the drugstore aisle and see all of the incontinence products, it just sort of seems like it's going to be part of your future and that we're just signing up for that at some point, but it is absolutely not something that we have to just accept and often has a lot of

solutions that can be facilitated with a pelvic floor physical therapist. And then I think one of the last ones too, I'll speak to perimenopause and menopause. There are a lot of different hormonal changes during that particular chapter of someone's life that are systemic in terms of those hormone changes, but they really have a big influence on the pelvic floor and our pelvic health. And pelvic pain can become a really big outcome of that because of those different changes and a lack of

education, both in society, but also into our medical system about how to better support that. So this is another big lane that I, as a public RPT, am supporting patients on, educating them on those things, helping to build a collaborative care team with them around that. It's just a few examples of misconceptions in my space.

Speaker 2 (08:21)

love to hear from you why you perceive there to be or why you know there to be a lack of education around pelvic floor health. If there are some things in society that really come to mind, I'm also imagining going through the training that you've come into those blind spots and been like, ⁓ that's why this isn't spoken about.

Speaker 1 (08:37)

I think there are a number of things, but some that I witnessed for myself as well as have had a lot of conversations with patients. think one is looking at, again, I'll preface with speaking to society. I think that there is, if we think about the kind of first touch point of where we as young girls are introduced to our pelvic health and the pelvic region of our body is often when we start to go through puberty and when we encounter our first period. So the concept of

learning about a part of our body that A, we need to, you know, start to experience discomfort. Sometimes we are bleeding. We are told that now we could possibly get pregnant. So we need to really protect this area of our body. There are a number of messages there that I would argue are not really like, woo, really want to learn about this part of my body. Really want to get in touch with that. It's like, Hey, this is sort of labeled as a problem. then think another sort of layer in that is also how many of us even

would sort of hide the fact that we might've even been on our period does not invite a really positive first touch point into this part of our body. And I hear a lot of my patients share that as well. I think too, looking at how sex education is often delivered around this time in US schools and abstinence still being the primary recommendation about our sexual health. And I'm not saying that we should

not be thoughtful of the age demographic that we are educating, but where's the, where later on is the next sex education class that really then helps give us better information about our body when we are maybe at quote unquote, a more appropriate age in the U S there is none. So I see this really big gap. And then if we insert, let's say, you know, other family dynamics, other cultural influences, maybe religious influences, these can all also play a really big role on how people might feel.

encouraged or discouraged in learning about this part of our body and how that can kind of perpetuate into the rest of our life. Not only the relationship we choose to have with that part of our body, but also the relationship that we may choose to have with other people in our sexual health and relationships. And then another big thing that I see with many of my patients is that there's a lot of shame and embarrassment about not knowing about this part of their body.

they start to encounter symptoms. They don't really know who they're supposed to ask about it, or they feel like, don't know why this is happening, but I feel like I should know, but I'm gonna hope that it just goes away and how that can kind of snowball. And then I think a third piece that I see a lot with my pregnant and postpartum patients is that even they too are like, I'm going through this really big transformation and I'm recognizing that I really don't even know anything about my pelvic floor.

I don't know even know really what a picture of what it looks like. I don't feel, you know, confident knowing about this area, let alone the big changes that it's going through. And then even postpartum with maybe birth injuries and different things that might happen. A lot of my patients saying, I don't even know what my baseline of my pelvic health was before. Now everything feels so different and that feels really overwhelming and discouraging. And I feel embarrassed that I'm at this point in my life and I don't actually know that.

Speaker 2 (11:57)

I'm going to put you on the spot a little bit and I acknowledge that we don't have a picture for the listener in this moment, but maybe they can look one up. For someone who is a little bit bamboozled, they're like, my pelvic floor, what does that mean? What are the muscle groups? Could you walk us through how you describe that to someone who's like, I don't know what that is because I know that there are listeners who are just like the pelvic floor. What are we getting into? I have a general vague sense of this, but I exactly know.

Speaker 1 (12:25)

Totally. So if you are listening to this and you have access to the internet, I highly encourage you to just Google pelvic floor muscles. They're really rad. Okay. And yes, I'm biased, but I have yet to have any patient that I show the diagram to in the picture that goes, eh, not that cool. Everyone's like, whoa, that's what that is? That's so rad. So the pelvic floor, like to describe as a muscular group and it is a suspension system in the base of your pelvis. And it's a very thick muscle because it needs to

fold up all of the internal organs inside of our body. And it's spanning 360 degrees throughout the bowl of the pelvis. So a visual I like to give to patients as a metaphor is the pelvic floor is like a trampoline. If you think about a trampoline, that kind of, you know, the piece that we jump on is the group of muscles. The springs on the outside edge of the trampoline that are attached to the frame are like the muscular tendons that are attaching to the pelvic bowl.

And so the pelvic floor is designed to have a certain amount of resting tension to be able to support all the things that we just mentioned. It also needs to have the ability to contract further when we need to, let's say we're lifting, carrying, jumping, doing some more higher impact type loading. And then we also need the pelvic floor to be able to lengthen and relax if we are doing activities such as, know, bowel and bladder control, also intimacy.

but also to be able to rebound while we're moving. So the pelvic floor is not a static system. It's very much one that is oscillating throughout our day and helping to manage all of those movements and pressure inside of our torso. And so that muscular group, like I said, is spanning throughout the pelvic bowl, but it's not just isolated there. There are a few of the pelvic floor muscles that also reach further out to each hip to help with distributing load for movement. So,

These are some of the other, what I think are cool features of the pelvic floor, that it's not just a static system that's sitting underneath controlling just for bowel and bladder, although it's needing to do that while we're also moving, while we're also being sexually active, all of these other things. So she's multitasking all the freaking time and doing a really great job at it most of the time. And so being able to kind of see that picture and notice how the different

muscles are kind of spanning in those 360 degrees is, I argue, really cool. And with a picture of that, you can start to see where those different structures are being supported, but really the sophistication of the support design of the pelvic floor. And the male-female version of the pelvic floor and its support system is not that different. So if you're looking at those pictures, a quick view of whether or not it's the male or female is that if you see

two particular canals, i.e. vaginal canal and rectal canal, then that is the female. And if you just see the rectal canal, then that's the male. But that deeper internal structure of the pelvic floor is very, very similar, regardless of gender. And then obviously the external plumbing is a little bit different, but gives you a really good picture and appreciation for this unique muscular system in our body.

Speaker 2 (15:39)

spoke

earlier about the shame and embarrassment that can come with this part of the body. How when you have someone, they come in, you do that fabulous description that you've just done. How do you work with the shame and embarrassment that might be there as they start to access this part of their body and start to learn about it as well?

Speaker 1 (15:57)

I think first and foremost, what I find to be really helpful is just calling it out and saying, hey, this is something that I hear a lot from my patients. Does this feel true for you? And, you know, not assuming that that someone's experience, but rather sharing that, you know, this is a really common feeling because I have the gift of being able to hear from a lot of people about this, but most individuals are not having experiences where they feel comfortable bringing this up with anybody else. So I'm often the first person that they might be discussing these things with.

And so bringing that up and putting it on the table, I think also being able to have conversations with my patients around, you know, not just the muscles, but explaining the emotional relationship that we have with ourselves and how that, you know, creates a relationship with our pelvic health. And that while many of these symptoms that people experience with their pelvic floor are very common, it doesn't mean that we can't, you know, ask or that we don't deserve more help and support.

learn more about this part of our body because once again, like I said, when were we ever given a good introduction? And I often say that to patients and I like, yeah, I never was given one. go, yeah, me neither. Okay. We don't even talk about the pelvic floor in US physical therapy training yet. It's a part of the body that we completely skip over. So I argue there's even, you know, I have some questions for our medical field going like, is our medical field afraid to talk about this? I think there probably is some, some fear and concerns. Yeah.

Speaker 2 (17:21)

I would love to hear from you how the absence of talking about this part of the body plays into our overall wellbeing. Before we hopped on, you mentioned the nervous system. And I know that there's a huge link between the nervous system and the pelvic floor. It's what made me so curious about this part of my body and really dedicated to working with someone because I knew it would give me that sense of regulation. I knew a lot of my dysregulation was actually from that area of my body and feeling so disconnected. If you could break down that relationship,

to the listener so that they have maybe a more holistic understanding of how the pelvic health ties into the health of their nervous system, but also their overall well-being.

Speaker 1 (18:01)

One big piece and theme that I'm often sharing with patients is that our nervous system, that fight or flight or rest and digest, kind of those two branches of our nervous system are directly connected to our pelvic floor. And what I mean by that is saying that in order for our pelvic floor muscle group to be able to respond in those ways that I mentioned, right? Its ability to have that resting tone for regular life, to be able to contract.

quickly if we need a little bit more support and the ability to lengthen if we have other activities that we need to lengthen for is all directly related to how well our nervous system is able to function. Is our nervous system able to also oscillate between increasing that fight or flight when it's appropriate and also being able to shift back into that rest and digest mode throughout the day?

If we have a situation where most people are living in that fight or flight more often throughout the entirety of their day and week, that's also going to have a direct impact on how well that pelvic floor is also going to feel and function. And it's going to upregulate as well and have an appropriate response to that higher sympathetic drive, which is that fight or flight.

meaning that we're going to often have a lot more tension, tightness and tone in the pelvic floor because it's also guarded and preparing for fight or flight. so thinking about our mental health and the environment of our mental health is important when we are also then supporting and considering our pelvic health. And unfortunately in our, I'll speak to again, the US medical model, these are often treated as separate pieces that are on their own islands. And I argued they could not be further from the truth.

they absolutely need to be co-supported and acknowledged in terms of their relationship because a lot of people also don't know that piece. And then speaking even further to let's say, know, is our mental health sometimes driving some of those pelvic floor symptoms? Absolutely. Can our pelvic floor symptoms be the driver then to some of that mental health, you know, stress? Absolutely. Can it be then kind of this feedback loop back and forth? Absolutely.

So it's not just one directional and also to echo that as a physical therapist, I am acknowledging these things with my patients, but it's also not my direct medical training to be able to then deep dive and facilitate that. But I'm talking about it. I am acknowledging it with patients. I'm helping them to start to notice patterns that may be coming up in their day to day or week. And then also helping to facilitate referrals to my other mental health providers in my area to be that point person for them in that area, depending on

my patient's situation and depending on how much support we might need there and their desire, of course, to want to have that additional support.

Speaker 2 (20:48)

You find that people are often quite open to having that additional support once they get that link of understanding between the nervous system and the pelvic health. Do you feel like they are quite keen to keep exploring or do you notice sometimes that shame kind of comes in there maybe gets in the way?

Speaker 1 (21:03)

I

see both, but I will argue that more often than not, as people start to have more knowledge and education and the conversations that we continue to have of them seeing the link between that, very rarely do I still meet a lot of resistance with patients. Often the resistance comes from, again, the burden of, okay, so I feel like I'm ready now, now how do I find someone to do that? So I feel like it's usually more that starts to feel the resistance. I'm like, don't worry, I got that covered for you. I have my people.

Here's my list, I'll immediately email that to you. Reach out and have some conversations with these therapists to see who's a good fit for you, to be able to do that. But I think that, again, it's more of the burden of trying to find a provider that they feel comfortable with. But if we can remove that barrier, a lot of conversations are like, you know what, this makes a lot of sense. I always say to them, look, the fact that you're already talking about it with me, the harder part I would argue, you've already gone through.

being able to continue to learn more and to feel the impact of that in your life and to be able to continue to have more tools in your toolbox to nurture that relationship with yourself and others. People are like, yeah, I want that. I'm ready for that.

Speaker 2 (22:15)

I'm assuming since your scope of practice isn't the emotional aspects, that there wasn't a lot of training on those pieces. I'd love to hear from you how you started to become aware of those links, if it was through clients you worked with yourself or just general curiosity of starting to put some patterns together. Because so often I am hearing those links, they've gone to the pelvic floor physio or I'm the person who's kind of sending them there, redirecting of like, there's only so much we can actually do.

in therapy and this other piece is super important. How did that start to come together for you?

Speaker 1 (22:48)

For me, to be quite frank, it was my own journey in talk therapy. So I see myself as someone who already was very thoughtful of the emotional link and our body in general. That's always kind of just been me as a human being. So that shows up in me being a PT. I'll be honest, I was actually teased in former clinics that I worked at being like, you talk with your patients a lot about how they're feeling. Like get back to the PT part. The patient sought me out for that.

because they connected with that. They understood and appreciated me bringing up those things and looking at them as this full person, not just a body part. But when I became a pelvic floor PT, that really illuminated to me an even more heightened sensitivity around this mind-body connection. And especially because of the potential for a history of trauma with particular patients. And in some of my PT and pelvic health training, pelvic health more specifically,

Having instructors who planted the seeds of saying, hey, it's better to assume that when patients come into your office, that they may have a history of trauma. They may not share that with you or they may not share with that with you right out of the gate, but it's better for you to assume that there might be and be thoughtful of the environment, the words that you use, the touch that you use, the involving them in the, giving them more autonomy in the appointments to be the driver of their treatment.

And that was a light bulb for me in the sense of, yes, I want to make sure that I'm that provider. And then also a light bulb in the sense of, wow, why am I not thinking that way for sports and orthopedics also? Because the emotional piece makes sense in all of those realms, not just pelvic health, but it was highlighted there for more obvious reasons. And so that started to just give me a different way of, Hey, I'm going to, I'm going to use that lens for all of my patients. And then folding that into my own journey of intensive therapy for a few years for myself.

I don't have a history of sexual trauma, but I had other things that needed to be nurtured and worked through. And that work really was not just transformative for me as a human being, but it really changed how the questions I asked and how I showed up with patients and how I wove those pieces into sessions. Again, not trying to replace bringing a talk therapist onto their team, but rather the questions I would ask to help them be able to understand pieces about themselves or

how their own fear or shame or trauma was actually like preventing them from feeling comfortable in a particular movement or afraid that they would injure themselves again, or, you know, in the blank there. saying, Hey, let's pause there. What story are we holding in our, in our brain right now about this movement or this activity? Can we talk about that? Is that still a true fear? Let's break it down. And then, you know, do we need more support here? Okay, let's, let's build that team or Hey, now that we're talking it out loud, does that still feel relevant now?

What new tools do you have? How do we want to, how do you want to change that movement then? And inviting them to be more of the driver in that. And what I see myself is like, I'm the supportive co-pilot with the map going, hey, we could explore it a couple different ways. Which one feels good to you today? And navigating from there.

Speaker 2 (25:59)

There are

many things that you said that I would love to just pick out a little bit more, but the first one that comes to my mind is the piece of kind of this baseline assumption that there may be trauma in the body that you're working with. And I would love to hear from you about how taking on that assumption has changed you as a supporter and as a PT.

Speaker 1 (26:19)

Yeah, I think meeting my patients in every session with that kind of supportive assumption has helped me to create a more supportive space for my patients to step into because I tell them most times it is a really vulnerable act to ask for help period. It is also a really vulnerable act to be a patient at any point in our medical system. And then it's

even more vulnerable, I argue, to come in and talk about this extra vulnerable part of our body by the medical provider. So I see it as a critical role for myself, A, saying that out loud, validating that for them, because sometimes patients might be feeling that, but they may not actually know that, or they may know that, and it feels really validating to have a provider to say that back to them. And for me to say to them, it is always my goal for you to feel safe in this room.

while also acknowledging that I may do something that I think feels safe that doesn't feel safe to you. And I want to know if that happens. I want you to know that I welcome you to share that with me because I want to be able to make those changes if something doesn't feel safe. I think the phrase of, this is a safe space is a nice idea, but it needs to be a continuous dialogue. My goal is to want to continue to help support and keeping this space safe, but what is safe?

what is safe to you. And so that is something that I'm regularly bringing in with my patients and our movement. Even as an earlier clinician in the sports and orthopedic space, it was never invited to me to ask the patient if it was okay. May I touch you here? Can I move your hip? Can I do the range of motion? It was like this assumption that this patient walked into my office, they scheduled a PT appointment, they are here to see me and they're saying, hey, I have hip pain. Okay, let's you get up on the table after I take their history. Let me do some things.

But I realized there was a lot of this assumption of consent rather than actively asking. I even had patients that will say to me, yeah, of course you can touch it. And I'm like, thank you. And I will say to them, hey, I like to ask these questions because very often, especially in different medical settings, patients may have had situations where they didn't feel like consent was asked. So I like to really be thoughtful and making sure that you know that consent is important to me for here in this room. And also so that

If this feels good to you, that you can also take that with you when you might be in other settings to ask for that if that's not happening. So there's little pieces, but I argue those little things make up really big experiences for people or can really help to build that bridge of trust when it may have been injured or broken. so continuing to weave that in with therapy, regardless of whether it's talk or physical, is important.

Speaker 2 (28:58)

Do you see yourself as someone who is increasing their sense of embodiment in the work that you do? Is it something that's in your mind or is it because I'm hearing in the language they use, it's like that bodily autonomy, that sense of consent, all of these like bodies respect all these beautiful pieces. Is that something that's in your mind as you're working with someone?

Speaker 1 (29:17)

Yes, I would say that it is not from a standpoint of being afraid, but rather that is the lens that I am regularly appreciating and wanting to reflect to my patients. And it is something that continues to help me feel more in alignment with my work and what I'm doing and how I'm showing up for people. And I would argue that the other beautiful piece of that is also the reflection of my patients back to me and that what information they share with me and how

how they take that experience and how it creates different perspectives for them outside of our therapy office, whether that's with their own children, whether that's with other family members, whether that's with other medical providers that they're working with. It has this beautiful ripple effect. And I argue too that oftentimes my patients will come back to me going, I hadn't even really realized that I was showing up for some of my medical appointments or.

other, you know, experiences in my life and already being really guarded, but not really knowing why. And through some of our work and some of the questions I may ask them about things, they're like, I've actually borrowed those questions and then looked at the situation and been like, what do need here? I'm like, that's really rad.

Speaker 2 (30:31)

thing that really stuck out to me in the language that you were using was almost this, not almost, it is a very corrective medical experience that you're providing. Is that something that's intentional for you? And if it is intentional, is there a reason why it's so intentional? Because it's beautiful.

Speaker 1 (30:47)

It has become intentional. And the reason it's become intentional was through, my own experience with talk therapy, some of my own experiences with my own medical journey and finding myself not being respected, validated, having things explained to me well. And I, in these cases was already a medical provider and realizing I'm someone who is better educated is coming into the system, knowing how to navigate it better. And I'm already feeling.

these challenges so acutely. And while I had the tools to be able to navigate better or choose different providers or to be able to speak up in those cases, realizing how hard that already still felt for me, even with that toolbox. And then reflecting into what I do, especially with pelvic health and recognizing that a lot of individuals have been told that their symptoms are either not bad enough or sometimes they just have to deal with are minimized way too often patient sharing experiences where they've

felt like they've been gaslit with numerous providers about what's going on has really also then highlighted for me the importance of wanting to not have them feel that way in my office ever, but also to your point, wanting to help them have a positive experience with a provider because I know that I'm not going to be the last one that they probably have to interact.

Speaker 2 (32:03)

One thing that floated to my mind when you were speaking earlier was just the level of medical trauma that I've heard my clients have around their public health from various different providers. And I would like to hear from you the medical trauma you've kind of worked with, how that shows up in the body, how you specifically work with it, and maybe what are some signs and symptoms of medical trauma in public health.

Speaker 1 (32:26)

Yeah, I think when I'm first working with patients and things like that, you know, and taking a history, I'm listening very acutely for not just what symptoms they're feeling, but asking what has their experience been as they've been navigating these symptoms with medical providers, if they've been seeing any, and are the providers on their team, do they feel supportive for them? And starting to already get a little bit of insight and a picture into that. And if we, if I'm hearing that someone doesn't feel supported,

Then also starting to help them, Hey, would you, would you like to expand your team or switch providers out or different things like that? And also letting them know that they can do that because I can't tell you how many times I've also had patients not really realized that they had that option. again, the trauma I think can sometimes also create a sense of not.

feeling in control of a lot of other pieces of the puzzle. And then in that, when I'm also explaining to patients about, let's say, the pelvic model and where they're having pain and different things like that, before I even do an assessment or an exam, I verbally say, hey, I'd like to take a moment to explain to you what the exam could entail. And I want to talk through it so that you know, and that then you can say, do you feel comfortable doing that or not?

because I think there's also a really big misconception in the medical field, myself included, when I've been a patient of, we're going to do this assessment, but very rarely is it explained before we do it. So we're saying, okay, but what are we actually saying okay to? Sometimes we don't even know. So with a pelvic floor exam, for example, nobody, for the most part, unless you're a pelvic floor PT and have gone through it, knows what a pelvic floor exam might include. So I go, let me explain it to you. What questions do you have?

Are there parts of this exam that you feel comfortable with and maybe parts that don't feel comfortable? We don't have to do the whole menu. You get to choose. And so I'm looking for body language. I'm looking for their response to that. Not just a yes or no, but if they say yes, I'm also looking and assessing does their body language match what they just said? And if not, I have that conversation too. I go, look, I want you to feel comfortable with this. We don't need to push it. We don't need to force it. There's other things that we can.

work on and explore and different things like that, because I would much rather someone feel emotionally and physically ready to explore that when we do that versus trying to push through it, because that can also still not support the nervous system in that. And I will explain that to patients. And then if someone does say, yes, I'm ready and their body language matches that and we're going through the exam, there can still be times where their body might start to say, Hey, I actually don't feel comfortable anymore. And I will say that to patients too, before we do the exam.

and say, hey, sometimes this happens. And if this does, I want you to know that I want to be able to support you in that. And I want to pause the exam. We do not have to, again, push through or anything like that, but know that sometimes our body might start to have a different reaction than we were expecting when we're going through that. And then at that point, sometimes patients might share, you know, I actually had this history of trauma. Thank you so much for sharing that with me. You know, do you still feel comfortable doing this today? And I will hold that. So I'm looking for those cues.

I'm looking for that dialogue. I'm also looking for when I am doing the exam, if patients have said, yes, I feel comfortable with it, all those kinds of things. I will sometimes notice that patients will start to dissociate out of their body while we're doing the exam. If that's happening, I will often pause there and again, have the supportive conversation with my patient around just, Hey, I'm noticing this reaction. How are you feeling with.

this. And I know that those reactions are often also linked with a history of trauma, whether or not they've shared that with me or not. So I never push anyone to share those things. That's their information and their choice to share if or when they want to. But as a provider, I think it's really important for me to acknowledge what I'm noticing and what I'm seeing and checking in and then making choices accordingly with them.

Speaker 2 (36:24)

Or would you explain a pelvic floor exam to someone?

Speaker 1 (36:27)

So I use the model and I explain to them what I'm going to be looking at and palpating with a gloved hand externally around the vulva and genitalia there and why I'm looking at those things and palpating for different sensitivity or pain patterns based on their symptoms. And then explaining what from there, switching out my gloves, putting some water-based lubrication on my finger, coming to the vaginal opening.

pausing there, making sure that my patients can feel me there and know me there. I know that I always hate when I have an internal exam and it's just like thrown right in there without letting me know. I don't do that to my patients and I tell them that I go, I'm going to let, I'm going to pause there and make sure you can feel me there. And then cueing them to take a deep breath. And then I gently insert my examination finger and then I'm palpating throughout the deeper layer of the pelvic floor.

in specific areas to assess particular muscles and referral pain patterns, depending on my patient's pain and history and other symptoms. And then the other piece of that is also looking for pelvic floor strength and coordination. So doing some muscle testing as well, and then assessing for any other things based on my patient's history that we may need to look at. Any or all of those things are part of an exam or can be, depending on my patient's comfort and what we're looking at.

Speaker 2 (37:41)

Thank you

for giving a description of the exam because I remember the first time I went for mine, she like broke it down so slowly. And I think we had five or more sessions before we even did the exam because she kept explaining it to me. And I really remember wishing that there was just somewhere I could go find an audio and listen to it. Just so I was like, okay, I can like prep myself of what's going to happen. I would love to hear from you. What are some of the kind of signs and symptoms?

from a pain perspective that you often find lead people to find someone like you.

Speaker 1 (38:12)

Yeah, I think one of the bigger pieces often is pain with intimacy. You know, there are a lot of other public health symptoms like bowel and bladder control leakage with activity, those types of things. Obviously those will usually bring people into my office. But if it's a pain situation, it's often pain that is impacting intimacy and or pain that is impacting their ability to move in their day to day. ⁓

This can be pelvic pain specifically, or it can be a pain referral pattern from the pelvic floor out to the hip or to the low back, or a referral further down the leg because of the relationship again that I mentioned earlier in the episode of saying that there are certain muscles of the pelvic floor that actually reached all the way out and are part of the hip rotator muscles. And then also how the pelvic floor is attaching around the tailbone and the sacrum, which is the base of the spine. And so that's also then feeding up and communicating into the low back.

And so these are other areas of the body that if there are mentions of pain or discomfort or symptoms, my brain as a PT is going, I'm suspicious of a pelvic floor and I'm suspicious of the neighboring muscles. What's going on or not going on well enough in these areas that is impacting the neighbor and being able to navigate those things. But often when people are having pelvic pain, it's not usually just isolated to the pelvic floor, although that area often gets blamed or we think that that's the only area that is the quote unquote problem.

But very often the pelvic floor, if we're having pain and symptoms there, I go, yes, we often do need some training of can that pelvic floor fully contract and can it fully lengthen? Often the answer is no. There's usually a coordination issue. That muscle is not able to do its full range and function. It's getting stuck somewhere. And then it's getting fatigued having to stay just in that one position. And then the signal that the body is getting is pain. The other piece is if we have a hip.

that maybe is a lot tighter where you don't have as much mobility or range of motion there, that's going to then create a tug of war with the pelvic floor because of that relationship. And same is true for the low back. So in that case, we can have a pelvic floor that might be sending the message that we need help, but the primary root of the problem might actually be the hip or it might be the back of the example. So these are other things that I'm helping my patients to understand in terms of the relationship of.

the muscles of the body and how no one is working on their own island. They are not in isolation and that pelvic floor physical therapy should be including an assessment around the pelvis in addition to internal, as long as there is consent with all of those things. And then also often exercises will include hip strengthening, back strengthening, abdominal strengthening, as well as pelvic floor rehabilitation so that we have this 360 degree support to make everybody feel

better and also to be able to have improved function long term.

Speaker 2 (41:02)

What is one thing that you wish more people knew about pelvic health or just even maybe physical therapy in general that you would like to leave the listener with today?

Speaker 1 (41:14)

⁓ that's such a good question. I think what I would like everyone to know is that pelvic floor symptoms, while they are very common, they do not have to be your forever normal. And that pelvic floor physical therapists are a really important medical provider to have on your team to help you, A, learn about this part of your body to be able to address and overcome the symptoms that are impacting you.

and that it's never too late to reach out to a pelvic floor PT no matter how long you've been having symptoms. I think that's another big misconception that I probably should have thrown in the earlier part of this episode of saying another big misconceptions that if you've been having symptoms for a while, that means that you're past the expiration date of when you can get help. And that's so not true because I argue it's never too late to improve strength around the pelvis. Our muscles are really resilient.

There's never an expiration date on when we can't continue to help them move better and build more strength and capacity, which is a great thing. And that if you, the other, I think misconception too, just like any provider that we may work with, sometimes we need to see more than one to be able to reach the goals that we want. So if you've tried pelvic floor PT before and you said, Hey, it didn't work for me. I would encourage you to try another therapist. Sometimes we need to see more than one to be able to, to get what we need. And so don't give up.

If you've just seen one, see another one, explore another avenue, because I think that a lot of times people will see one and stop because it's not changing.

Speaker 2 (42:43)

That

is one thing that I have come across as a therapist. It is this place of finding one, maybe not finding the match, and then being so discouraged by that experience, which I absolutely understand. But for whatever reason, in the realm of physical therapy, there's less of a mindset that it's gonna be a little bit like dating. And I always say that in therapy realm, like you're gonna have to date several therapists. There's less of a mindset with physical therapy that it is gonna be so individual and unique.

which is why when I heard you on a podcast, I was like, I really would love to hear her speak because in your language, there is such a deep sense of embodiment, but also just respect for bodily autonomy. That's just so beautifully woven in. And I know that that hasn't been everyone's experience with a physical therapist. And yet it can be when you find someone who also has that lens.

Speaker 1 (43:34)

Totally. And I appreciate that. Yeah, it's not. And I wish that it was more common. I wish that there was some more discussion in just PT in our training around that. not saying that there was zero, but I think that it deserves to continue to be woven throughout our curriculum. I think we had like maybe one course in my three years, for example. And I think too, there's a difference between learning it when you're a student and then

going out in clinic and doing some rotations and seeing patients and being in action. And then also having a revisit of that. And how are we thinking about our language and how are we supporting that side of, we still have the word therapy or therapist in our title. Not saying we're, we're, at your level, but to say, there's still, there's still a piece there that isn't involved. And so much of.

what we do as PTs, I argue is you could still be the best technical PT, but if you don't have the ability to create a comfortable and supportive emotional connection with that patient, I go your technical skillset is not going to be worth anything. Thank you.

Speaker 2 (44:43)

so

much for your time today and just everything that you offer. I really appreciate it and find it quite inspiring and it just gives me some momentum in various ways. Is there anything that you have coming up that maybe the listener could join? We'll have all of your information so people can find you on

Speaker 1 (44:58)

No, thank you so much for having me and I appreciate the reflections too, especially from another therapist and someone who is helping to support and do the work in this pelvic health space. It's important and needed. So thank you for that. In the next six to nine months and things, what I'm continuing to nurture and work on are continuing to build out more free accessible content on our YouTube channel. So that's Move with Dr. Chris. So lots of free information there across a lot of different pelvic health topics and chapters of life.

Other places are continuing to build out online educational courses that people can go through. So right now we have kind of prenatal and postpartum topics as well as overcoming leaking with exercise. And these are big topics that I'm regularly treating and supporting in my practice. so creating some online resources for people is something that I've wanted to continue to nurture because not everyone has access to a public therapy team in their area or due to time and finances, sometimes accessing someone like myself can be difficult. So trying to create

other ways for people to learn and access these things and removing some of those barriers.

Speaker 2 (46:00)

Thank you so much for your time. was such a delight to have you today.

Speaker 1 (46:03)

Thank you so much for having me and for using your platform in this way. And it was lovely to be able to connect with you.

Speaker 2 (46:14)

If you found value in this episode, it would mean so much to me for you to share the podcast with friends, a loved one, or on your social platforms. If you have the time, please rate and review the podcast so that this podcast reaches a larger audience and can inspire more and more humans to connect to their bodies too. Thank you for being here and nurturing the relationship you have with your very own.