Episode 53: How the Pelvic Floor Affects Constipation, Back Pain, IBS, and Urinary Incontinence

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Dr. Reshma:

So people tend to they think they can activate their pelvic floor by stopping the flow of urine of pee as well as as they’re urinating. And that’s definitely the wrong thing to do. You can use it to identify the pelvic floor, but not to retrain the pelvic floor. And essentially what you’re doing is you’re sending mixed messaging because as your as your pelvic floor should be relaxing, so that you can void and urinate, you’re tensing up the pelvic floor. So it’s kind of sending that mixed messaging to the brain and that in itself can create at the start of a of a situation or a dysfunction.

Dr. Andrew Wong:

Pelvic Floor dysfunction is one of the most under diagnosed root causes of conditions that include urinary incontinence, constipation, sexual dysfunction, back pain and irritable bowel syndrome. How can we do better at identifying and treating pelvic floor dysfunction? Today, we have two amazing doctors of physical therapy, Dr. Miriam Graham and Dr. Reshma Ruth Aude. They’re here to help us understand how the pelvic floor impacts our entire body health. We know from functional medicine that in fact the entire body is connected. It’s just that the pelvic floor often gets kind of under the radar, so to speak and ignored. Today we have an enlightening conversation about pelvic floor function, how to tell if you might have pelvic floor dysfunction, and what doctors Miriam and Reshma do as physical therapy doctors to help their patients actually achieve optimal pelvic floor function. I am Dr. Andrew Wong, co founder of capital integrative health, which is a clinic community and movement focused on root cause health care transformation. The capital, integrative health podcast is dedicated to transforming the consciousness around what it means to be healthy, and understanding the root causes of both disease and wellness. If you are someone who has struggled with constipation, urinary incontinence, sexual dysfunction, or pain, or have irritable bowel syndrome, don’t miss this conversation.

Thank you so much, Miriam Reshma, for coming today to our podcast. Welcome. And we’re so glad you’re here.

Dr. Reshma: 

Thank you. Thanks, good to be here.

Dr. Andrew Wong:

So we are talking today about pelvic floor therapy type of physical therapy. But as I think we talked about before we started recording, this is really part of physical therapy, part of you know, whole body assessment. Let’s kind of talk first though, about kind of both your backgrounds, you know, we’ve known each other for a long time, you’re here locally, and rockfill, on a practice restore motion, which has been open, which I just realized for 18 years, which is amazing. So congratulations on that. Thank you. We’d love to just hear your stories, both your stories about what inspired you both to become physical therapist, and specifically kind of working on maybe pelvic floor as well as part of your practice?

Dr. Reshma:

Yeah. Do you want to go first or do you want me to go first Miriam?

Dr. Miriam:

You go ahead, go ahead.

Dr. Reshma:

So I physical therapy, you know, I knew I wanted to be in the healthcare environment. And you did, I was officially a candy striper in high school, and explore different options of you know, different health care professions and physical therapy definitely interested me but I wasn’t quite sure exactly what I wanted to do. And then I took one of those, those occupational tests, and in middle school or high school, and the three options, were a teacher, a hairdresser, a physical therapist. So I decided to go on the physical therapy route and did some observation hours, you had to do some observation time to apply to graduate school. And so really decided that’s what I wanted to do. And, you know, I tell my daughters that my I think I’m kind of more of the anomaly where I knew from high school, this is what I wanted to do. I kind of went straight and narrow through college and grad school and I’m still in my profession. I’m practicing my profession, and I enjoy my profession with what I do. So, you know, my I’ve evolved from I started often with working with those with stroke injury and brain injury rehab, to musculoskeletal disorders. And then, and then honestly, I think I was bribed by my supervisor at the at the National rehab hospital to start specializing into the pelvic floor. And I resisted and resisted, resisted until she, she said that she will act they would actually pay for me to go to this course. And I thought, well, it doesn’t hurt to go and learn something new. And I went to this one course and definitely felt that was the missing link to the treatments that I was doing for the back and they’ll hips and the legs. So yeah, so that’s the that’s my journey into the pelvic floor arena. And I feel like we’ve helped out many, many, many people in this area.

Dr. Andrew Wong:

Yeah, yeah. Before we get to Miriam story I’m curious about sort of traditional PT school is it really emphasized very much in their pelvic floor therapy in terms of like, how it’s connected the rest of the body?

Dr. Reshma:

Not when we were school? No, I don’t think it was even addressed. When we went to school when we went to school, the SI joint didn’t move, or that’s what they told us. And then, but now, actually, both Miriam and I have been adjunct professors at local universities, and we’ve done lecture series on the pelvic floor.

Dr. Andrew Wong:

So you’re changing the education, which is great. Absolutely. Next Generation of Yeah, absolutely.

Dr. Reshma:

We’re also restore motion is also an approved educational site for internships for doctorate, physical therapy students. So those students that want to specialize in pelvic floor, pelvic floor physical therapy, they can actually come to our site through their university for credit. It’s almost like a residency or an internship experience, so that they can actually learn a little bit, get hands on training forever. That’s

Dr. Andrew Wong:

good to know. Is that after they get their DPT or

Dr. Miriam:

process in,

Dr. Andrew Wong:

yeah, yeah,

Dr. Reshma:

they’ve had all the didactics work. And now this is your clinical work experience

Dr. Andrew Wong:

to really learn it. Yeah. That’s awesome. That’s so great. Great to know that you’re you guys are a site. So Miriam, what’s your story of how you became a physical therapist.

Dr. Miriam:

So kind of the polar opposite of Russian, I didn’t know what I wanted to do. I had been studying ballet, and went half day to ballet, Washington Ballet and half day to high school. And then when I graduated from high school, I continued dancing and ended up doing about a four year gap year with musical theater. During that time, I realized that dance I loved, but I didn’t see it as a long term situation. So when everybody else was graduating college, I started at 22, and did prerequisite work at University of Maryland, and then transferred to Thomas Jefferson University in Philadelphia, for a master’s in physical therapy. And that’s where I met Reshma, it was first day of orientation. And we were cadaver buddies. And we figured if we could do that, then we could just about do anything. As RESPA said earlier, we both worked at the National Rehabilitation Hospital for about 10 years. And during that time, one of our influences we did work in osteopathic manipulation through Michigan State College of Osteopathic Medicine. And that really looks at you know, the whole body, the integrative system, of how the body framework works together. And through that, it was very eye opening. It’s right in keeping with integrative medicine. Much like Reshma, my supervisor said to me, Well, you know, we really need someone to go do this course. And I actually didn’t know what was going to happen. So I’m like, Okay, I’ll do a course. And then I realized, with the pelvic floor, it was so much more than I had realized before. And as we were saying, Before, the recording started, this idea of the pelvic floor being a functional set of musculature that helps facilitate load transfer, from the legs to the core. And from the, you know, super incumbent weight of the body down on the pelvic floor, is just a hub of activity. So, you know, we’re familiar with elimination, and childbirth and sexual function, but the mechanical piece of pelvic floor is what really applies to everyone, regardless of their condition. Or health.

Dr. Andrew Wong:

Yes, and we know that, you know, at least traditionally, I always thought of like pelvic floor therapy being mostly for women, but really, every, you know, men and women, you know, every every body has a pelvis, right? I mean,

Dr. Miriam:

that’s exactly right.

Dr. Reshma:

We’re even seeing pediatric, the pediatric population here now. Address you’re having issues with constipation, and we’re starting to see a handful of the transgender population as

Dr. Andrew Wong:

well. Yeah, yeah.

Dr. Reshma:

Cuz everyone, I guess you said everyone has the pelvic floor. Right?

Dr. Andrew Wong:

Right. So the pelvic floor is, let’s kind of maybe more formally or just basically define what the pelvic floor as we already talked about why it’s important. What is the pelvic floor and how how do you assess the pelvic floor function?

Dr. Miriam:

So the pelvic floor is, is a group of muscles that are in the floor of the pelvis. So if you think of sitting on a saddle, anything that’s touching the saddle kind of in that central area is going to be the pelvic floor, it’s between the two sit bones side to side, the pubic bone in the front, and the tailbone or the coccyx bone in the back. And these muscles work together with helper muscles in the hips. So the inner thighs, the hip rotators, the buttock muscles. Those helper muscles can either facilitate pelvic floor function, or make it more difficult. So in folks maybe who have pelvic pain, one of the culprits might be tight inner thigh muscles tight adductors, or dysfunction in the hip rotator muscles that contributes to that. So that thinking of that saddle area, that’s the pelvic floor, they’re also talked about as a group of the levator. Ai, there are three groups, three muscles that make up the levator ni group, and they will wind contracting closed off openings. And when they released they can allow passage through the pelvic floor openings.

Dr. Andrew Wong:

So when those openings would patient,

Dr. Miriam:

yeah, they would be the openings would be the urethra, female vagina and a anus to allow for passage of stool.

Dr. Andrew Wong:

If the levator Aina is not working that well what kind of conditions are you seeing in those situations? So constipation we want and I guess, but but other ones too, right?

Dr. Reshma:

Sometimes just pain, pelvic tension. So often, in the female population, if the levator Ni is tight, they could have difficulty voiding because it’s urinating in the pelvic floor muscles are just so tense that they have a hard time relaxing. Sometimes the pain with penetration. So sometimes even a gynecological exam, a tampon insertion, or any sort of sexual activity could contribute to that pain and discomfort.

Dr. Andrew Wong:

Yeah, yeah. And other other signs, besides with Lipitor, and I, what are some other signs of pelvic floor dysfunction that that you see in clinical practice.

Dr. Miriam:

So when people are having to urinate frequently, and you know, people may be aware of that as men age, the prostate, and larges. And so men have to void more frequently, because they’re not able to efficiently void because of that, but also, pelvic floor dysfunction will show up with increased urinary frequency or urgency. And that can be very limiting for people because, you know, think about getting on the beltway, you know, you never know if you’re gonna get so you know, or being able to sit through a meal, or go to a movie, things like that. Another issue that happens with women more than men is pelvic organ prolapse. And this is where the organs that are suspended within the pelvis, the uterus, or the rectum, or the bladder, can start to slide down and get in the way of pelvic floor function.

Dr. Andrew Wong:

And the muscle, the organs that slide down like the, like you said, they slide down because of the pelvic floor dysfunction or some other reason.

Dr. Miriam:

Well, in say someone who’s had multiple pregnancies and deliveries, they might have laxity in the tissue and weakness in those muscles. And that’s happening. It could happen in someone who maybe has hypermobility, and say, they just don’t have the connective tissue strength to maintain. It can also happen with folks who have poor toileting habits, maybe they’ve had years of constipation, and they’ve been straining at stool. And so they’ve been over time stretching out those muscles because of poor function. They’re not using the pelvic floor to eliminate efficiently so they’re stretching out those supporting structures in that musculature.

Dr. Andrew Wong:

You also, I think, talked about how the hip muscles, the buttock muscles, you know, the core, they’re all related to the pelvic floor. Do you also see the opposite where you can somewhat can have sort of a lower abdominal pain or hip tightness or even back pain as a result of pelvic floor dysfunction?

Dr. Reshma:

Oh, absolutely, absolutely. It’s a, you know, one affects one affects the other, right? Yeah, if I were doing a continuous unit. So often, if there’s tension in the hip muscles, we might become suspicious of a weak pelvic floor, if they’re, if they’re complaining of pelvic floor symptoms, only because if the pelvic floor muscles are weak, then the surrounding muscles that the the muscles that want to help the helper muscles will increase in their pension to support that weakness, and vice versa.

Dr. Andrew Wong:

Yeah, how do you how do you assess, say, the function of the muscles of the pelvic floor versus say that the fascia, you know, the connective tissue is is there a way to differentiate that in terms of what’s going on with the person?

Dr. Reshma:

Yeah, so there’s definitely some objective measures that we could, we could use and implement, one would be taking a look at the strength of the pelvic floor and differentiating it between the pelvic floor and the in the hip muscles or the back muscles. So we’re able to identify and isolate those muscles. Here at restore motion, we have a dynamic ultrasound machine. And so we’re able to visually see how those muscles are being recruited. And we were able to identify the pelvic floor muscles versus any of the other surrounding muscles to and to see how those muscles are, are activating and will and in that situation, we’ll be able to see if it’s a maybe a fascial restriction or a delay in muscle contraction as well.

Dr. Andrew Wong:

That’s awesome. So dynamic ultrasound machine, meaning that your, your, the person’s on the table on the exam table, they’re contracting or relaxing different muscles. And you can see in real time, what’s going on, whether it’s a muscle or fascial release issue.

Dr. Reshma:

Yep, yep. And then we also use our general like osteopathic exam, examination tools that we have just through palpation. Just through range of motion, strength, testing, mobility testing.

Dr. Andrew Wong:

And you treat both you said kids, but also also men, women transgender, what do people need to know about about going to see, let’s say, they’re gonna go to see one of you or one of your staff at risk promotion? What what kind of things would they expect with with, say, pelvic floor therapy? Is there? Is there internal work going on? I mean, I think just what are people? What should people expect?

Dr. Reshma:

Yeah, I feel like, you know, people are very, very nervous coming in for physical therapy, because I don’t think they have pelvic floor physical therapy. Right?

Dr. Andrew Wong:

Right. Right.

Dr. Reshma:

You know, we have six private rooms here at restore motion to address your needs. We’re, you know, it’s always warm and comfortable, and we want to hear their story, we want to hear their story, you don’t need to have an internal exam at the very first visit, often what we try to do is take a look at the biomechanics and where or the world or the faulty aspects of their biomechanics and that when I mean, biomechanics, it’s again talking about the mobility, the strain, the, the, the mechanics of your joints. And then if needed, then there would be a discussion if an internal exam is applicable or not, and it can be done day one, or it could be done there as a subsequent treatment session.

Dr. Andrew Wong:

Great, that’s great to know, for all the listeners out there,

Dr. Miriam:

you know, and I’d like to just, oh, and I just like to elaborate on that. It is very important that listeners know that at restore motion, it is not a one size fits all for the exam, you know, we really want to tailor what we look at. And when we do it, based on that person’s history, you know, some people have history of abuse or other issues surrounding the pelvic floor. And we understand that it’s a very, I guess, emotionally charged area. And so we really focus on approaching that with respect, in partnership with the patient and the patient’s physician. So we really do strive for a teamwork approach to make sure that everything is on, you know, all people are on board. And with this, you know, I’ve worked with both and rushman, the staff has worked to with the physician, ordering the treatment, as well as sometimes mental health providers, family members, we can provide as much support because ultimately, it’s the patient that gets better. You know, we’re there for an hour, maybe once a week. And so we really want to empower people in a way that they feel most comfortable moving through this kind of dysfunction.

Dr. Andrew Wong:

That’s a great point marriage, just just to kind of understand that, like you said, it’s a partnership, it’s like trying to create a safe environment, a personalized environment where it’s really looking at the individual and what they need, as opposed to like more of a cookie cutter approach, that’s really great. Speaking of more of an individualized approach, it might be nice just to kind of bring it to life for our listeners, maybe if you have a sample, sort of case of you know, someone that, you know, who would someone you know, who would consider to pelvic PT and like, what, how long would that treatment B and that kind of thing? How would you kind of walk through it with someone? So what are the kind of common conditions you would consider for for pelvic PTN? Sort of? Maybe like, how long and you know, those type of things? Would they need to be treated?

Dr. Miriam:

I think that if you look at it in terms of stories, you know, we’ve we’ve, we’ve said that everybody with a pelvis is is a possible candidate for pelvic PT. So I think if you know, we start with, say, an 11 year old boy, okay, maybe too busy to go to the bathroom, got other things to do. Held stool, and then it hurts to go to the bathroom, it hurts to move his bowels. And so there’s this avoidance cycle going on. And, you know, the parents may or may not be aware, but then eventually they might be referred to us by their pediatrician or by a pediatric gastroenterologist. And so, really, that first day is going to be education, understanding assessment, finding out the child’s body awareness, you know, with during the pandemic, there is homeschooling, and not a lot of getting out and playing, there’s lot of video activity, there might not be as much movement in general, and the pelvic floor takes a while to fully differentiate in in children. So that session, it might be understanding, you know, what a bowel program is to help facilitate consistency of stool to be able to pass working with the parent on charting progress, parent and child and working on gross coordination, physical activity, coordinating the legs and the trunk and the core to be able to facilitate movement. So I mean, that might be four to six sessions. of understanding there depends on how willing the the child is the parents are, are open and really the participation you know, is that team approach again. So that’s when

Dr. Andrew Wong:

Yeah, when uh, let’s let’s do one more I think just having maybe maybe it’s the child’s mom but like a 45 to 50 year old female maybe perimenopause, menopause, how to hormones affect the pelvic floor and how would you treat someone like this woman with maybe painful sex, you know, or maybe they start getting vaginal dryness? Maybe they’re getting some other sort of pelvic pain, maybe interstitial cystitis, you know, all these different things. We could list a lot of things urinary incontinence, you know, maybe there’s there could be different things. But I am curious, because, you know, hormones is everyone’s favorite topic. So, just kind of understanding how hormones are affecting the pelvic floor, I think it’d be really helpful.

Dr. Reshma:

So I think hormones definitely affect you know, there’s definitely a strong influence of hormones within the pelvic floor. And we’re definitely we’re seeing a good population of those perimenopausal female mirror and what’s the stats again, with with menopause,

Dr. Miriam:

5 billion, 5 billion with a B women are going through menopause in the next five years.

Dr. Reshma:

Right? Crazy. So

Dr. Andrew Wong:

5 billion people,

Dr. Miriam:

women, women, women,

Dr. Andrew Wong:

women, just women. That’s That’s incredible. It’s a lot. It’s hard to wrap my it’s just hard to wrap my head around. Yeah,

Dr. Reshma:

we saw that set. We’re like, wow, there’s a lot of people that are gonna need our help. And so um, yeah, so what happens is when there’s estrogen depletion, you have vaginal atrophy. So that’s just the tissues around the vaginal area become thinner. And that can lead to it can lead to some pain issues. Because of the vaginal dryness. You know, there could be some tension related to that. And in that case, we would address working on the pelvic floor, sometimes internal internally, sometimes externally just to some it could be a massage, it could be stretching It could be some exercises to help improve the, the the function of that. And in those cases, we also, we also try to improve that just the, what we call the length tension relationship of the muscles. So we want to have good tension not too tight, but we also have want to have good length and not, you know, to generate that force that we want. A lot of times when that length tension is off, that can also lead to incontinence right some some weakness, and so sometimes when just an abnormal pull to the muscle or can lead to the the incontinence situation. So it’s not to say that your muscles could be weak, sometimes the muscles are weak. And those are predominantly seen, like after childbirth or something like that. But usually for parent Peri menopausal, it’s almost like a disuse, not a disease, but it’s just a general gradual. Weakening or inhibition is what we’d like to call it. And sometimes, improving core stability, would help with improving core stability would also help with addressing the whole aspect of that of the pelvic floor. So we’re, you know, we could do some hands on treatment, and with the manual therapy aspect of it, but then there’s also the exercise based approach to treatment. And depending on where that that person is, and their symptoms that could take anywhere from like three visits, but it could take as much as you know, 10 or 12 visits, depending on the extent of their pain or their dysfunction.

Dr. Miriam:

Well, can I kind of just say, for one of the offerings that we have, there’s a class that we take for up to four students for it’s called floor of the core. And in this class, it’s for anyone, you know, you could be a tennis player of computer scientists, what have you. And it goes over in four separate modules, how to be able to address the core appropriately incorporating pelvic floor. So this is fully closed out in the open area of our office. And it’s been very helpful for people because, as we said earlier, everybody has a pelvic floor, and this is a way to make it accessible. And open it up for ease of use.

Dr. Reshma:

Ma’am, do you have the pelvic floor workshop is that some you know, community outreach that we have? For?

Dr. Miriam:

Yeah, I guess we have three of those really, we have the keeping, keeping it healthy, your pelvic floor keeping it healthy, which is a course for some free workshop that’s done every other month, about pelvic floor function. Many of the participants have been female, but it’s also open to males. We have a the prostate talk, lecture workshop, which is for men who have prostate issues and want to make sure that they don’t let it run their life. And that’s offered quarterly. And then again, every other month, we have the strongest the mother, which is a Peri partum, postpartum course, on pelvic floor. And again, all of these are free of charge. They’re open for the community. And it’s done by zoom right now, it seems like people like the convenience of being to log on anywhere. All of that information is on our website.

Dr. Reshma:

I also wanted to share another case study if that’s okay, um, Andy, you talked about the kids, we’ve talked about the perimenopausal female, but I also want people to realize that you don’t have to be at the extreme of the range of age range because we see plenty of active and in this case, I’m gonna say females but males and females, we’ve seen ballerinas we’ve seen professional tennis players, professional soccer players come through. And in the case with a professional soccer player, she had recurrent hamstring strains. And so for about 16 months, she kept restraining her hamstring and wasn’t able to play professional soccer. And it turned out that it was actually her pelvic floor tension that was contributing to her chronic hamstring strain. So addressing her pelvic floor appropriately, you know, she was able to get back onto the field and perform and you know, plays for the national team. So it’s just, it’s just that addressing that, you know, a chronic situation, one aspect could be actually coming from somewhere else, and that’s what was happening. You know, she got plenty of treatment in those 16 months, but until her pelvic floor was really addressed, that’s when she really started noticing the change.

Dr. Andrew Wong:

Yeah, I’m not a professional athlete, but I definitely noticed when running that my my left hamstring is chronically tight. I’d love to hear your thoughts about how to address tight hip flexors. This is kind of a tangent, but this is what happens in this podcast. You know, should I look at the pelvic floor? Or should I do something with the hip? Just curious about because everyone has tight hips, you know, everyone out examined pretty much in my office has tight hips. And I feel like I have that too.

Dr. Miriam:

Well, muscle balance is king, when you can get proper muscle balance, that link tension, that rationalist talking about, you’re going to have improved function and hip flexors are certainly easy game because we do a lot of sitting. But you know that that tension, sometimes the tightness is a weak, you know, tightness and weakness go together. So, yeah, it really does take having somebody assess it to kind of help tease it out. It’s frustrating when you know, you’re in the profession and you know, so much and then you can’t figure it out on yourself.

Dr. Andrew Wong:

No, definitely can’t. Someone else, I would just say that, in general, you know, the physical therapy approach you you and your staff take is really great, because you’re looking at how the whole body is connected, right. And that’s where that’s where it’s not just about the hip or the pelvis, but it’s about hip pelvis, back core, all the other muscles myofacial how everything is connected, right, that sounds like which is kind of going back to Integrative Health and functional medicine, which is what we do here, right? It’s sort of like, the same philosophy of understanding the connection between the body.

Dr. Miriam:

Absolutely.

Dr. Andrew Wong:

So if someone is coming in and you know, wondering Yeah, exactly. Having a sense of should I do physical therapy? Should I do pelvic floor PT? I mean, it really sounds like anyone could get assessed at least to see if it’s helpful for them if they have, say, a health issue, or even trying to prevent things. Do you ever do like preventative consults, if someone’s just like, I just want to see how my pelvic floor is, you know, what the health is kind of like a checkup? You know, I’m curious on that on that just, you know, you have athlete or someone that’s activated, they might just want to know, how they’re doing, you know, how do you keep the pelvic floor healthy? How do you prevent pelvic floor dysfunction? You know, we know that this is going to be another cliche, but you know, an ounce of prevention is worth a pound of cure. Right? So how do we become more proactive about these things to not only restore our motion, but also to, you know, keep it add to throw your company? Moving? Yeah. Yeah. Keep it moving. Keep it moving? Yeah,

Dr. Miriam:

yeah. You know, um, I don’t think that we’ve had anybody just call up and say, Hey, I’d like a pelvic floor assessment who didn’t have symptoms. And I think that’s partly because there’s not the awareness of the, of the role of the pelvic floor in as Russia was talking about the biomechanical model of, of function. So I think that it’s because of lack of awareness. But we do have folks who have seen us maybe graduate from physical therapy, and then come back and say, Hey, I just want a checkup, I just want to make sure that I don’t let anything get away from me. And we kind of like that dental model of, you know, come in just to make sure. And we can tweak the exercises or the flexibility or, you know, kind of gives some suggestions on on that pathway to health. But again, just just calling up say, Hey, can you check out my pelvic floor, I haven’t had

Dr. Andrew Wong:

no one’s running in for a pelvic exam. No one’s running

Dr. Miriam:

in for it.

Dr. Reshma:

I’ve actually had a few a select few folks come in as a preventative, and only because it was a word of mouth referral. So the mom has come in because of an incontinence issue. And she’s like, Hey, can my daughter come in to check things checked out? Or, you know, I bet my daughter just delivered a baby and she doesn’t, she’s fine. But can she just get checked out. So I think as as one family members learning more and more about their situation, they’re sharing that information to a loved one, and then that loved one will come in for a quick check. And you know, and it’s great to have these preventative consults, because, you know, you’re making a difference, you know, that you can actually start nipping things in the bud before they progress. So just giving some basic exercise some basic, you know, education can go a long way.

Dr. Andrew Wong:

Education is empowerment, and I think that’s one of the purposes the podcast is, you know, you know, really empowering listeners empowering the community to really understand how important in this case the pelvic floor is and how it’s connected the rest of the body. What are your duties, top recommendations for keeping the pelvic floor healthy? For someone that, you know, may or may not have pelvic floor issues, but just how do you keep it healthy over time, which I think you probably cover some in your classes, but just to give people a preview.

Dr. Reshma:

So, um, so I mean, I think the one thing is just to have awareness of the pelvic floor, there’s many people out there that they have no idea that there’s something between their back and their legs Right. And often it’s it’s a topic that they haven’t really talked about, or they grew up not talking about,

Dr. Andrew Wong:

maybe it’s taboo or something like it’s, you know, yeah, it’s like, what there’s pelvic floor, what is that, you know, like genitalia are there. So I’m gonna like steer away from

Dr. Reshma:

talk about that part. And you know, and even in our school, it wasn’t really talked about. And so in our so I think just awareness and just having that connection and the mindfulness of that pelvic floor is a huge topic. And so once when people know how an understanding and they can have that mind body connection, they think that in itself, is just the beginning. Often also, people tend to, they think they can activate their pelvic floor by stopping the flow of urine of pee as well as as they’re urinating. And that’s definitely the wrong thing to do, you can use it to identify the pelvic floor, but not to retrain the pelvic floor. And essentially, what you’re doing is you’re sending mixed messaging, because as your as your pelvic floor should be relaxing, so that you can void and urinate, you’re tensing up the pelvic floor. So it’s kind of sending that mixed messaging to the brain. And that in itself can create the start of a of a situation or a dysfunction. But to to work on relaxing that that pelvic floor is key. So strengthening is just as important as relaxing the pelvic floor.

Dr. Andrew Wong:

Yeah, yeah. I feel like I don’t know the x. Muscle balance. Okay. Muscle balancing, making sure things are symmetrically even strength wise and maybe flexibility wise link tension on both sides. Is that what you mean? Yes,

Dr. Miriam:

absolutely.

Dr. Andrew Wong:

Any any yoga, any yoga asanas, or poses that you would recommend? I’m not an expert on yoga, but just I just feel like, you know, a lot of yoga poses us, you know, use the core and the pelvic floor muscles.

Dr. Reshma:

There is the expert on that one.

Dr. Miriam:

Yeah, yeah. So there is some research for folks, they’re having difficulty with their period, you know, you know, pain, that triangle pose, it’s helpful. I think that one of the ones we give many people with pelvic tension is happy baby. And so it’s on diaphragmatic breathing during happy baby. So again, things that involve inner thigh mobility, and gentle rotation of the torso can be very helpful.

Dr. Andrew Wong:

Great, great. Thank you so much. And then when one more thing on pelvic floor, it was kind of a general question, but how often should we be? You know, moving around, so like, what’s the maximum time you would think we should sit before we start getting up and moving our bodies since we’re all kind of at a desk a lot of times or zoom? Or different things? Right?

Dr. Miriam:

Yeah, um, since

Dr. Andrew Wong:

since I know that this is contributing to pelvic floor,

Dr. Miriam:

this right, right, there was a huge spike in people with pelvic pain. First time during the pandemic, when people were sitting, were at home and not commuting. So I’m a big fan of, you know, 25 minutes. You don’t have to do a marathon, just get up just change positions. You know, a lot of folks have the ability to either stand, or work or sit at their desk. That’s really important. But I would say probably, if not the 25 minute mark, every hour just to get up and move.

Dr. Andrew Wong:

Yeah, keep keep active. Keep moving. Yeah, that sounds like a good, good, good advice. So So we’ve kind of talked a lot today about about pelvic floor health, how to kick universal body. Thank you very much to both of you for coming on today. We do have some closing questions that are typically very fun for our guests. If you wouldn’t mind both. At you know, just sharing your morning routine. We know that that’s really helpful for health. A lot of times it’s kind of establishing kind of something you do every day to kind of get off the day, you know, get off to write the red start. If you could talk about that, if you wouldn’t mind.

Dr. Miriam:

So I am morning person. So I’m gonna go first. Great. I usually wake up around five. Sometimes before my alarm. I have a fantastic espresso maker. And I make one shot of half Caf espresso and I sit out on my porch and look at the sun and the deer and all of those little critters out there in the backyard and have my espresso. And that’s how I start my morning every day.

Dr. Andrew Wong:

Great. Thank you for sharing.

Dr. Reshma:

Mine’s not at mine’s pretty boring. I am in the office at seven o’clock a couple of days. So I wake up at it’s very difficult for me to wake up by 530 with no alarm. But I get myself ready to pack my lunch. I don’t have coffee. I don’t I don’t even think I have water and but I get in the car and I’m at the office by 650. So my morning routine is a bit boring.

Dr. Andrew Wong:

Yeah, but both both kind of getting up activating your body’s event. At least you’re moving. You’re getting up with that. Yes. So no Netflix in the morning. It doesn’t sound like anyway,

Dr. Reshma:

no Netflix, no exercise on in the morning for me.

Dr. Andrew Wong:

Yeah, yeah. What is one thing that you have both done that you think has maybe finances individually, but that has changed your health for the better than the most, you know, whether it’s movement or something else, you know, healthy practice, we can kind of have this idea of, you know, there’s a lot of things that we can do to improve our health. What have you both found to be really helpful for you?

Dr. Miriam:

I grew up in ballet, as I said earlier, and went to Pilates and yoga, certified Pilates instructor and studied yoga for 20 years. But I think recently, the thing that made a big change for me is I started lifting weights. And I’m a certified kettlebell instructor. Now, that’s been huge. And then the other thing was, I had a consultation for functional nutrition. And that made a huge impact on my life going through menopause. So functional nutrition and lifting weights, I would say didn’t the most recent things that I’ve done has impacted my health.

Dr. Andrew Wong:

Great. Love it shout out for kettlebells and resistance, functional nutrition. It’s all connected right now. Everything is all connected. Thank you, Miriam, and restaurant, how about you?

Dr. Reshma:

Yeah, so I think I’m along the lines of like, also some of the functional nutritional changes that I’ve been making, you know, just little subtle changes, I feel like it makes a huge difference as your body changes, you know, I can’t eat or drink what I used to in my 20s and 30s. And now that I’m in my 50s, things are just a little different. So I just want to make sure I stay ahead of, of what I need to do to minimize any sort of family history, like family medical history. Yeah, so. So that was my rationale for the for the functional Nutrition Consultant changes, I have also started, I do a little bit of running. So I try to run to five K’s a week that in that field, like that helps me move cardiovascularly. And I also do a little bit of the weight lifting as well. I also enjoy just, you know, having dinners and socialization with my family and friends and family, especially in these last couple of years where it’s been so limited, I’m definitely enjoying that a lot more now.

Dr. Andrew Wong:

Super helpful, very, very important for health, you know, opening up a bed socializing more connecting where we know, that’s a big part of health. And then the functional nutrition is to both mentioned that, since it’s so personalized when a nutritional needs and changes do change over time. You know, as we move through life, it’s same with I think functional movement to like, you know, movement, things to focus on might might change over time as well. You know, so that’s, that’s so great. Thank you so much, both of you for coming on today talking about PT, especially pelvic floor therapy, and you know how to how to basically keep the pelvic floor healthy. how can listeners learn more about you guys, your practice work with you, if you want to just kind of give a shout out to your practice and kind of other resources that you have.

Dr. Miriam:

Our website is restore motion.com. And as I said earlier, we have that list of events, you know, the the free workshops that we’ve hold via zoom, you’re welcome to email us either at info at restore motion.com and freshman’s email, as well as my email is there with our BIOS too, so you can get a hold of us that way. I look forward to helping anybody who needs help with this.

Dr. Andrew Wong:

And you do general physical therapy as well. I mean, you don’t do only for pelvic physical therapy is what you can say. Maybe just to get an idea of what percentage of your practice is more say pelvic floor, you know versus general say

Dr. Miriam:

we’re probably at least 60% or more pelvic health. But again, it’s all

Dr. Reshma:

connected. Yeah. So I just want to make sure and just identify that sometimes, if you’re coming in with a pelvic floor issue, we may be treating your back or your shoulder because we feel like it might be connected to your pelvic floor issue. Or if you come in with your shoulder or neck issue or a jaw issue, we’re thinking there might be a situation with your pelvic floor. Let’s go there. So, you know, so it just really depends on it’s going back to the holistic approach. So we’re treating anything from like toe pain to headaches, essentially.

Dr. Andrew Wong:

Yeah. Yeah, kind of reminds me of acupuncture is like if someone’s coming in with pelvic pain, but it’s like why are you putting this needle in my ear? or something, right? Exactly. Yes, yeah. Well, thank you both, for coming on your restaurants. Great to see you great to reconnect here. And thank you for sharing with our listeners, the importance of pelvic floor therapy and, you know, function and looking forward to really learning more about this over time. You know, it’s something that I think has been kind of hidden for a long time, we’re not really recognized. And I think more people, like you said, are starting to know notice the benefits from a pelvic floor therapy and why it’s so important.

Dr. Reshma:

Thank you so much for asking us and thinking of us.

Dr. Andrew Wong:

Absolutely. Enjoy the rest of summer. We’ll talk Thank you. Thank you so much.

Dr. Reshma:

Bye. Thank you. Bye.

Dr. Andrew Wong:

Thank you for taking the time to listen to us today. If you enjoyed this conversation, please take a moment to leave us review. It helps our podcasts to reach more listeners. Don’t forget to subscribe so you don’t miss our next episodes and conversations. And thank you so much again for being with us.