The Silent Epidemic

with Vicki Hemmett

This is an unedited transcript.

 

Welcome to this episode of the Mondays podcast. I’m your host, Holly Lowe. And I have the privilege of chatting with Vicki Hemmett today, Vicki is a Canadian born mama as well, and she grew up here. So this is a neat thing to talk a little bit i We have a lot of American guests and people from all around the world. So I always love it when we get our Canadians on here and local. Sure. Yeah, local women, foreigners. And we’re going to talk today, our whole thing we’re focusing on right now is just the concept of trauma. But it has so many facets to that. So birth trauma, body trauma, emotional trauma, all the things that can build up and affect so much of our health, fertility especially, but so many other functions in our life. So that’s a big, big over, you know, overview of where we’re going. So a lot of the guests that we’re chatting with right now, are pulling in. And I love diving into this with all of you because I’m learning so much. You’re all bringing me something really tangible and educational that I can take away with this. And I hope our guests you know, I know our guests are, are feeling the same once we have these combos, and they’ve listened to some of our other episodes, I’ve heard the same kind of feedback, even from the experts, you know, that we’re we’re all learning and I like that. So you are going to talk a little bit about pelvic Well, a lot about pelvic floor right about pelvic health. Yeah. And this is a big part of healing and a big part of what we do as women as we go through birth and all the different things that happen in our body. So I’m gonna let you give us the story of how you got here and what it is you. Okay, perfect. Well, thank

you so much for having me. And I love, you know, the Canadian connection. And I have to tell you that, you know, a mutual friend, you know, kind of brought us together, and I’m so grateful for, you know, that connection. And I just think what you’re doing is fantastic. And just providing this, you know, forum for women in general and Mama’s and I think, you know, to your point, like weaving in all of these different aspects of healing, so important, and most people will either experience a lot of this trauma related, and non trauma related, you know, kind of physical physicality, showing up and not really talks about it, you know, and I kind of specialize in pelvic floor health. And we kind of describe it as a silent epidemic, which I think could probably be used to describe many of these dysfunctions that a lot of mothers are feeling, and just kind of, like brush off as normal or like, and normal outcome for, you know, postnatal, and even prenatal, and just kind of like women’s healthcare in general. It’s like, oh, well, I had a baby. So this is just normal, but it really isn’t, you know, and it’s a silent epidemic. So, you know, I’m really hoping to, you know, our kind of tagline is like, blowing the whistle on the silent epidemic, and then just to validate for women, what really is happening with their body, so identify it, to diagnose it, and to like, really bring in these conservative easy treatments that will provide these lifelong empowerment strategies, once you get healing that you can like, really have these, you know, optimal lives, despite, you know, some of these issues that that can be really reversed.

Yeah. But yeah, I didn’t start with us. You didn’t start in public health. Did

you? Oh, my gosh, no, no, no, no. Well, yeah, so I was born and raised in little old Chatham, Ontario, and I love I love Chatham, most of my family actually are still there. A lot of my friends you know, kind of actually have settled there. And so just outside of COVID, you know, you know, before COVID I would go and visit and you know, just really get that same kind of like butterfly feelings when I was going down like my road, and it really truly just does feel like home. But I always knew I wanted to get into healthcare at some aspect. My My dad is a dentist, my mom was a nurse. So it’s kind of like looking more into that healthcare realm. And more or less, I would say, stumbled upon chiropractic. In my third year at Queen’s so I went to Queen’s University, and I went into the my Bachelor of physical health and education with a combined science degree at BSC degree and I kind of was looking at pre med, but really, medical school just didn’t resonate with me for some reason. I just, I just felt like I just, it just was not my thing. And I was looking into PT and massage therapy. And then I heard a chiropractor talk I’d never been to a chiropractor never really been exposed as a kid or anything, never had anything heard anything about it. But when I heard him talk about, you know how they’re bringing in kind of like the mind the body and then just kind of like this preventative nature is like, oh gosh, that makes A lot of sense. So fast forward went to National University of Health Sciences and near Chicago in Lombard Illinois. So that’s the same, you know, kind of four year program as a medical degree, we just go through the summertime. So it’s a 10 trimester thing. And I met and married, and my husband who was in my class, and he was from Vermont, and we decided to move back to Vermont in 2002. And we bought a really busy orthopedic chiropractic clinic. So it was very much, you know, kind of high volume high paced. And then he was a gentleman who owned the practice and is like, really, really busy. And it was, it was great, because it provided me a lot of exposure to adjusting and really kind of bringing up my my clinical skills and diagnosing, but it just didn’t feel like it was like my kind of like, felt my burning desire. So I knew I always wanted to work with women. And so what I did is just kind of schlepped out to all the OB GYN ‘s in the area and say, look at we can have this collaborative relationship. And only one, you know, practice was really kind of interested. So we kind of like to fast forward this a little bit. We work collaboratively for about five years. And then at that five year mark, they are amazing practices, the biggest OB GYN practice in Vermont, and they deliver more babies in the hospital system. So they’re, they’re awesome. They have like the lowest intervention rate also. They’re really, really good. So it’s a collection of nurse practitioners and midwives and OBGYN. They’re fabulous, fabulous women. Yep. And so they had this vision of bringing an integrative health care building, and they wanted to work independently. So they invited us to join into the practice, and that was in 2008. And so we have now a primary care naturopath based office, we have an acupuncturist. We have the the largest OBGYN clinic. And then of course, we have our health there, which

gosh, that sounds like a dream. Dream. It’s a turning over month, every now

it’s like such it’s such a wow, integrated health building. And that was when I was would be it was designed for right. So we each kind of bring our own certain strengths. You know, and most patients come in and they’re like, oh, I can get my primary care here I can get here. It’s just such a beautiful setup.

It actually reminds me a lot of sorry, to Georgia, it reminds Germany. So we we’ve been to Germany and for our business and talking to the practitioners and I’ve trained you know, midwives and doulas and so on, and other parts of Europe, that’s pretty much the European model of healthcare is you just go down the hallway and you can see a naturopath and you can tell how do you get acupuncture you go see your family doctor, they’re gonna massage down the other Hall, you know, like, it’s just there, it’s part of what they do. Well, and

I think what you know, kind of how we describe it is like, it’s a patient centered model of care, right, so the patient’s in the middle only think of a spokes of a wheel, right. And every, you know, you may need to see your OBGYN if you have like a raging you know, UTI that requires antibiotics, right. But you also probably have some pelvic floor dysfunction and spasm around that. So then you come and see the primary care or excuse me, see Mike knee, the pelvic floor, and then you need to re establish that, you know, real healthy probiotic flora. So you go see your naturopath, some awesome, you know, so it’s like for that one condition, all everybody has their own, you know, kind of impact on the patient. And it really is a wonderful model of care. So I mean, I, that’s our first baby, and I love it. And so in 2008, they’re saying it would be great to have an in house pelvic floor provider. And at the time, I actually had zero, you know, exposure to that as a chiropractor. And, you know, just and at the time, I actually had two kids myself, and I didn’t really know about that at all. So after some research, I said cheese, this sounds like a musculoskeletal issue, which is 100% in my wheelhouse. And I was curious, right, because I knew the overlap with the prenatal postnatal realm. And so I went to a seminar, I think I was the first chiropractor because typically the, the PTS, like really dominate the, the, the scope of pelvic floor work, which I think is great. And so they said, Wow, you’re in DC, and you want to do this, I was like, I just want to learn a little bit about it. And really, I have to tell you, so in there, we learned a lot about anatomy, and then we you know, we did an intro vaginal exam, to kind of understand how to treat and as soon as I did my first intro, vaginal, pelvic floor exam, it was like, that was my massive like lightbulb moment. That was my Oprah aha moment. I was like, oh my god, I totally 100% Everything came into clarity in that exact moment I can remember is like, one of those moments in your life that you remember, and I can you know, on one hand, it’s like The birth of your children, like when I said I do to my husband, and like, that moment was right up there with their with, like, I knew that this was gonna shift shift big time for me. Um, and so and I hate to be dramatic, but like, really, it totally has shaped the way, you know, the way I practice and ultimately where we are right now in life, it really was attributable to that moment, right. And so what I realized was that, you know, from a PT perspective, it’s very much an external biofeedback, like that kind of is industry standard on how to identify and treat these pelvic floor conditions, which I think is, you know, I think it’s great, but I also felt like, as a chiropractor, who works primarily with certainly manual adjusting, but like, 90% of the time, I’m doing soft tissue release techniques, I just felt extremely limited by not having any, you know, kind of manual therapeutics to offer my patients. And it also just didn’t, you know, to be perfectly clear, I wasn’t even sure I was going to pursue this. And it was a couple $1,000 I was like, I don’t even know if I’m going to, like, invest in this because I was gonna pursue it. So I was like, I think I can manually, you know, just kind of hand this as opposed to, you know, just give verbal feedback versus what’s digitally kind of like press, you know, onto the screen. And so, you know, to, you know, to that end, I also became slightly obsessed, right. So we are very, you know, evidence based in our practice, I think that that’s very important to look at, like all of the science behind what has been in the profession and like looking to future and what that looks like. So I kind of did like a deep dive and it was like Pandora’s box. So you just kind of like open one thing and another and another and another. And it was super exciting for me to be able to have the, you know, the confidence of my patients, the confidence of the referring providers, to bring them to me, and it was just something that was very intuitive for me. And so what I did, in the absence of like this manual technique, I just kind of developed and took these concepts that I was doing externally and just kind of like created something that was missing in the pelvic floor realm. And I just kind of created what I what I now have patented is the you know, kind of pelvic power releases what I call it and combine that with external manual muscle work. Combine that with the the chiropractic manipulation, because all if you think about it, again, this kind of goes back to the science, all of the pelvic floor muscles attach to those bony components of the pelvis. Which all sense.

Yeah, anatomically, neurologically everything. So the hips, the SI joints, the lumbo, pelvic region, you know, I was getting these anecdotal really amazing, quick results with these women. And, you know, to back that up with our science, and it was showing that, you know, the manipulation also had a huge impact neurologically, and physiologically to the muscular baseline. Yeah, it was very, very exciting. So that’s kind of how I got into it. And now, you know, my practice is at least 30 to 50%, pelvic floor conditions. And it’s, you know, um, I don’t know how much you want me to kind of go into, like, where I’m where I’m at now. So, you know, I’m doing a lot of hustle doing a lot of, you know, Mama. You know, I’ve seen a lot of hats in my, in my world. So I like I said, I have three kids, they are now just barely 11 His birthday was on my son is 11 His birthday was on Saturday. And he’s a you know, real sporty kid. He’s really awesome. And then I have a 13 year old girl who’s in eighth grade, and a 15 year old girl who is in 10th grade. I feel really blessed that I have a great partner in marriage and in life in business that we really, you know, split everything 5050. So he would go to work for one day, and then I would go to work for one day and back and forth. And I know that you I just actually realized that you homeschool your kids and we also for the past four years. We’re homeschooling our kids. Oh, wow. Yeah. So

when you get into those teen years, right, it changes a bit. It changes big

time, like not only from you know, what they what I think the kids need in terms of just kind of like exposing them but like content wise, it’s like, whoa, okay, I need to really like get myself in order. But I

have to wear a teacher hat for you know, where you can get away with it with the little guys and all that but I have a 14 year old in grade eight and I’ll just Oh, I know. I

know. But on the flip side, like my sixth grader who’s doing you bet US History Of course, you know I’m here. It’s like, oh, I didn’t really know, know that. And, you know, I’m learning along right with them, which is like such a blessing. But we actually the girls are we put, we enrolled them into public school this year. So they, and we also move, so I’ll kind of go into that too. So we moved from Vermont, to Naples, Florida, which is where I am right now. Yeah. And so Naples, Naples is like this little slice of perfection in our mind. It hits all of our, you know, our checkboxes, and we moved in, in July of 2000. At well, just this year. And, you know, we’ve been in business for about 19 years, right. So we, Eric, Dr. Eric, and I were thinking, what are we going to do, we always really wanted to retire here and COVID really like everybody, you know, kind of kind of shifted our worlds a little bit and put everything in perspective. And we thought, why are we waiting. And so what we have now is a wonderful, like capable, like fantastic team in Vermont. And so we have the one associate who’s managing the bulk of the chiropractic patients. And we also work collaboratively with two licensed athletic trainers. So we have this like rehab team, that is great. They work all of our orthopedic patients, but they really bring in this pelvic floor work, too. And they’re each certified, which is so cool in rectus, diastasis, management and postnatal, yeah, Scott, because of course, we have 80 to 90% of our patients are medically at our referrals from medical docs. And the bulk of those are female patients, either prenatal or postnatal. And we just feel like I you know, from a chiropractic standpoint, I have a lot to offer these patients, but it’s not really, you know, I’m not, I feel like truly, I can’t do everything. And I don’t that’s just my the rehab piece is just not my strength. But it absolutely is the the rehab team that we have done there. They are amazing to bring in the diaphragmatic breathing, the rectus diastasis management with ta activation. And I will tell you that this is also something that I have learned with the pelvic floor work is that, you know, when we talk about the core, I think the huge missing piece is this pelvic floor, it’s the bottom of the core, right? So the core for sure, like is this transverse abdominus, that muscle that runs underneath these pretty six pack muscles. And I tell my ladies all the time, it’s like, yes, these six pack muscles are like awesome, but that’s not the one we’re actually targeting. Under knee that transverse abdominus is that like, you know, it’s like a Home Depot brace, you know that these back braces, it looks identically to that the muscle fibers run. So circumferentially around the spine in the front, that’s the one that we’re targeting. But it’s like having an open cylinder without a top and bottom. So the top is the transverse, you know, the diaphragm, and the bottom is this pelvic floor. So, you know, I refer patients down to my rehab team once the pelvic floor is really rehabbed. And the spastic component is kind of like taken away. And I teach women how to do an effective, you know, kind of Kegel or pelvic floor contraction exercise, because statistically speaking, these women are not, you know, to their best effort, they don’t really understand how to do an efficient or effective pelvic floor contraction. And so they’re spending all this time and energy into this and it’s just not effective and frustrating, right?

Yeah. I remember that was that happened to be that was my first time it was actually my first time at therapeutic Pilates. Okay, yes, I had pretty severe diastasis. And I explained that to her, and we had kind of a one on one session to look at everything. So she knew how to modify and help me through the classes. And I remember her coming right over to me during like a group class and she took her finger and she was like, Where are you going? And she poked, like, right down to my pubic bone. Almost. Okay. Like, she asked me for it. She’s like, do you have this out? I’m like, yeah, she goes, this is where you’re contracting, not here. And I’m like, I knew this in my head. But to know that connection, it was like, oh, and she went and gave this great little talk just and she’s just, uh, I mean, just I see just where I go, but little, like pelvic floor, you know, walk and said, I guarantee all you ladies in this class, we’re all women. All you ladies in the class, have no idea how to do Kegel correctly. Yes, I’m going to teach you them. But before we leave the class, and it was mind blowing, mind blowing. I love it.

I love it. It’s so so important. So and so we’re very sensitive to that in our clinic where it’s like, I just don’t want to send you down to rehab because I want to make sure that you that a and I’m going to get into this in a sec but a you don’t have like a spastic component in your pelvic floor. So you don’t want to actually be doing key goals yet, and that you’re actually doing them correctly. So, um, you know, our rehab team is amazing. We have some like, you know, a fabulous front end back end to our, to our helmet health clinic in Vermont. And so what is happening, I’m actually flying down, flying up next to one suit once a month for a week to treat patients to kind of continue with that collaborative networking to support a practice up there. So it’s so far it’s been working beautifully. And so it’s really great. But yeah, I think this is a really good time to really talk about that pelvic floor misconception to that, you know, when people think about pelvic floor dysfunction in my you know, experience is that most people think, Oh, we, you know, we pelvic floor muscles, organ prolapse, peeing my pants, not being able to, you know, jump on the trampoline with my kids t right. And while that’s certainly some portion of pelvic floor dysfunction is like, it’s just like this little snippet of this, like, broad based, you know, range of dysfunctions within, within, you know, women’s healthcare. And I do want to mention, too, like, men suffer from pelvic floor dysfunction as well. And that’s a big deal. It’s just not what I treat. So I don’t have any expertise in it. But I encourage you know, if ladies have, you know, their partners, or husbands or brothers or friends who have male pelvic floor dysfunction, there are really great providers out there. So I’d encourage, you know, just encourage women to go seek out your, like men to do that, too. But it’s just not anything that I have any experience. And

when I when I start the daddies podcast and

my counterpart, I know he exists somewhere.

I don’t know, I don’t know if he’d be talking to that one or not. Oh, my God. Pause for one second, never back. And I don’t go anywhere, everybody, because we’re going to pick your brain a little bit about, I want to know, symptom wise, how do we know from you this kind of help? I mean, I think everyone does. But that’s not like when when should you be thinking about treatment? And really, I want to touch on C section just briefly. Oh, yeah, I know, I get asked that a lot. So we’ll be right.

Okay. Yep.

All right. Let’s get back at it. So I’m going to I want to jump into the C section question first, if we do that, because you mentioned that band and about how the muscles run. And it’s interesting, because when I was training to be a labor doula, I mean, we’re, I mean, we’re nowhere near trained as a midwife. That’s good. That distinct? Yes, I understand. A lot of people make that, you know, misunderstanding, even my listeners will message me with questions that are well beyond my field of expertise. And referring the one we did I mean, over the years, 18 years of being at birth, and listening to OBS and learning from you, and therapists and whatnot, I’ve just collected all you know, the good information, because I love it, I soak it all up. But C section trauma in a sense, and that muscle trauma that happens and that rebuilding has to take place. Even things like that VBACs and, you know, doing vaginal birth after a cesarean, from your perspective, what like what’s happening in there after even just technically speaking, what’s happening in our body after a C section? And how can we help with that?

Yeah, for sure. So I full disclosure, I’ve had three C sections, personally, myself, you know, the first two were just not at all planned. And the third one was planned. And that was the only time my little stinker decided to come into this world two and a half weeks early. And so I, you know, I had to have more of like, a very quick transition into that C section. So I, you know, I’m sensitive and, you know, I empathetic to women who have been through C sections, especially after, like, for me, it was like 24 hours of labor and then ended in that season. So, um, you know, to your point, unfortunately, having a C sections does not, you know, protect you from any pelvic floor dysfunction. And if you think about it, there’s an for many levels, right, so just from the first level of just being a pregnant mama, right, so this baby, who you know, is from four to 10 pounds, give or take, you know, just kind of rests in your pelvic floor for nine to 10 months. And with that, you get those hormonal changes, right, so you get this relaxing, and the relaxing. Only really, this is also a misconception the relaxation works on your ligaments, but not your muscles, which is, which is so interesting, so Mm hmm. So it’s only targeted to ligaments, right. So that is why you feel like loosey goosey and all your joints because the legs are soft tissue structures that attach bone to bone to create that stability within the joints. So you feel kind of loosey goosey, but the muscles do not they don’t have any receptors for relaxing. So the muscles are just detected These loosey goosey nature of the muscles which are of the joints, right? So what do they do they are actually spasming in for stabilization or writing it, yeah, interacting it. So what’s really in from a chiropractic standpoint, this is how we teach our prenatal women is that not only are we going to be, you know, we have to target the muscular structure, especially this piriformis muscle, which is like the kind of the target muscle in the rear the backside, because it attaches on the inside portion of the sacrum, and then all the way over to the greater trochanter of the femur, which crosses the hip. So in the pelvis, that’s the one that engages to stabilize not only the SI joint, but the hip better, both kind of naturally, you know, kind of widening, which is what we want to happen. But we just want to keep it balanced with appropriate muscle engagement, which is why we send them down to rehab. So you have a good idea of how to do that. But we also kind of work with, you know, muscle release techniques, and then adjusting where we need to adjust. But I’m kind of going a little bit off course, but for the relaxing part. So when you are pregnant, that’s going to impact your pelvic floor, because all of the muscles that create this, like beautiful functioning pelvic floor, attached to that pelvic rim, so they are going to be influenced by it just by way of being pregnant, you know, by by relaxing. So that in itself is a reason to have a pelvic floor examination, you know, six weeks, or whenever you’re cleared by your OBGYN provider postnatally, just to, you know, kind of see where you’re at with him. But yes, to your point, absolutely, you know, the access point, super pubic Lee, you know, with the incision, you absolutely have to go through not only going through skin, adipose, and like several layers of this muscular structure, you’re also kind of like, really, you know, disrupting the fascial connections in this fascia is what I kind of describe it as like Saran wrap in your body. So it’s like this, like really like gliding material that’s like strong, but like interweaves between layers of muscle, you know, from top to bottom, and, you know, like inside to outside. So it’s like, it really helps the muscles function well, because they can kind of glide between each other. But with any kind of, you know, kind of surgical procedure, you’re going to get this reaction of adhesions, scar tissue, just with that. So really, really important to identify that because then you’re not going to have a really good activation for this ta right. So because we’re kind of knitting that ta together midline, and that’s going to be disrupted a because physically it was cut, but be because there’s going to be some scar tissue there. So your rehab therapists really should be doing, we are rehab therapists do Graston work. So it’s like this instrument assisted really like kind of F Mirage almost to kind of, like get some movement within that scar, when it is, you know, capable to handle that. And really kind of decrease the amount of scar tissue that gets built up. So you can have that engagement. And you know, it will absolutely affect the function of the pelvic floor, because that fascial layer kind of helps the support system within the within the pelvic floor. So C sections, absolutely, you need to be in the even in the absence of symptoms, which we’ll talk about holiday in a minute. And you know, even in the absence of symptoms, to be able to make that connection because there is you know, some potential nerve damage that happens with this. So there’s, you know, then most women who have a C section either have, you know, temporary or permanent, you know, kind of skin alteration, because their nerves are just had been damaged. And so that ability to have that mind body connection with the pelvic floor may be altered, because there’s that neurological disruption, so that’s really important to identify, too.

Yeah, I remember in when I used to teach middle classes, we had this it was done with foam, you know, just the fun foam Cooper knees all the layers that get cut through and yes, yeah, we actually had it was saran wrap. That was the just things that well and I remember one of our clients coming back you know, probably a couple months later for like our little reunion class we did with the band and she said to me, I could not she ended up with a plan C section we did. Baby was a frank breech there was nothing moving and that was her and but she said I knew going in that I wanted the setup. So she actually did like a six week plan like we were putting it ahead of time with their person did all of this. And it was she was great advertising for them because she just said, like the amount of pressure that was relieved in my even what she felt in her abdomen. And yeah, we’re talking about just having some of that gentle motions through the even the superficial parts of difference for her age difference. Most part and then you get you’re working on a baby and you’re trying to just get sleep and are happening, you’re not going to be thinking, oh my gosh, you know, I’m so bloated, Phil, are we gonna have a bowel movement? Like I used to think that way? Yeah, no,

this fourth trimester I think is really where medicine in general, you know, and that’s, you know, that’s allopathic that’s cam, that’s everything really have dropped the ball. And not purposely for sure. But like it just, that’s where I think, you know, when you’re pregnant, you can you’re kind of like lofted into this, like beautiful position. I remember love being pregnant, because people like open doors, and smile at me and like, it was like,

well, your woman just snapped back into it, let’s go right, get on with it. It’s a very, like, strong seated thing that has gone on for centuries, right? Just for women in general,

what and you can say it’s, I would say that it’s, um, you know, very prominent in the North American culture, and not necessarily all cultures, because there’s other cultures that ver that are, you know, kind of honor this, like, 40 days, postnatal, and like, you know, I have a lot of support from their female family members. And so I think that we can, you know, learn a lot from that. And from those, it’s not, I don’t want to be negative about it. But it’s something that we can have, you know, providers in place to, you know, again, validate for these women that this is okay. And this is probably actually the hardest trimester out of all of them, to be honest with you.

As a postpartum doula. I remember trying to get in with local caregivers. And finally doctors and places like just to put a pamphlet out. And it was always a no, like, No, we don’t want to promote anything you’re doing. And it’s like, I’m here to help like our for free, I don’t care, you know, that you’re right, it is a very North American thing. And I

think it’s super short sighted, right. And this is, this rolls into the pelvic floor dysfunction, because it’s like, most women, you know, let’s just call an ace and Ace when you have a vaginal delivery and to NC sections to an impact, like, there is a muscle in your pelvic floor that stretches 250% of its resting state. And like in like in a healthy vaginal delivery, 15 to 30% of the time it either partially or fully of pulses, from the you know, the attachment on the pubic bone. And if you think about like that, if you think about, like, being in labor, or, you know, I mean, which is, I don’t want to call it a trauma, it’s a beautiful thing, but it is an Olympic, it’s an Olympic event that requires a lot of, you know, physical, mental, you know, whatever spiritual, you know, impact and strength from this mother. And just from a musculoskeletal pelvic floor perspective, I’ll kind of focus on that, but I do, you know, appreciate all of the other components to that. But this is my specialty. Like, if you think about just someone falling off of a curb, and like springing their ankle, it’s like, they go through like, six to eight weeks of rehab to make sure that you can walk, okay, and it’s like, this muscle in your vagina that just changed 250% of its natural resting state. And think about, like how everything has to accommodate this baby. And it is absolutely important to identify that and to appreciate that. So most women have some, you know, urinary incontinence, like immediately postpartum, that, you know, largely disappears within a week, I would say, and that’s kind of an accepted kind of thing. And I think that that’s okay. But what’s not okay is that when it persists, and it may take, it may dial down from like, let’s say, 100% of the time to, let’s say, like, 20. And this is where we, as women in that fourth trimester just don’t have time to like, recognize this as a symptom. And it’s that proverbial pebble in your shoe that just kind of like will get, you know, kind of get under your skin over months and years. And the thing is, is that it’s never really going to get better on its own, it’s only going to get worse. While you may just have you know, urinary leakage or fecal in incontinence, which is also a very common thing that no one wants to talk about, but it absolutely exists. Or bowel retention.

That was another one I just learned to where if you have a prolapse in the bowel, it can actually cause issues constipation feeling like yes, it is complicated, you

know? Yes. Well, you

figure this out, and it was my pelvic floor therapist who’s like, how’s that working for you? And I’m like, Oh, I just figured I always that’s just me. She’s like, was it all new? And I’m like, new, actually was my first was a very traumatic birth and record, everything kind of went downhill. Right? She’s like, well, we can’t fix that. That’s a that’s a surgical thing down the road. If it became a real issue, she said, keep it from getting worse. yet. I remember looking at her and I said, Why did I not come here sooner? Right. Like I for pregnancy later, I could have done something after the first issue. Yes, yes. Well, first, you want anything from this? Yeah.

You know, from a symptom standpoint, yes. I mean, constipation is, you know, a huge, huge marker of pelvic floor. spasticity. Yeah, right. And this pelvic floor spasticity. So let’s say you do have an organ prolapse, which is it can be bowel, it can be vagina, it can be uterus, can be all three at the same time, you know,

unfortunately, the find prolapse for us, because I know where to look it up the first time.

Okay, thank you. Yep. So PRP or pelvic organ prolapse is super common. So it’s when that organ kind of descends through the pelvic floor, right? So it’s it descends through the vagina, and there’s four, there’s four levels of it. So there’s for grades 123, and four. So grades one and two really are. And they kind of measure it by like, almost like the the length of your fingernail, just to give you an idea of like, what that looks like. So sometimes you can have a great one. And you can kind of visualize, some people say, it just does not look the same down there, you know, and it just

seems awkward during intercourse, like

we’re during intercourse.

Like I have to pee every time we or I feel my bowel or my bottom, every time

it’s painful, or there’s something in the way, or it just looks or feels different, which is, you know, relatively common. So usually, like a grade one or two really respond well to conservative management, where it doesn’t really need to have anything, you know, more invasive to correct, when you get two, three, and four for like, four is a surgical repair. Three is kind of like depending on your lifestyle, and your age, and that kind of thing. And that’s when we work collaboratively, of course, with the OBGYN and the surgical team. But yeah, so that, so that’s kind of its grades one through four organ prolapse, which we have to remember will, you know, we can impact and we can reverse to an extent, based on pelvic floor health and education and work. So, you know, I, I would say like, 99% of the patients that I see are referred by their OB GYN because I want to make sure that there’s no visceral complaints that are, you know, kind of dragging that so we’re ruling out, I see patients, a lot of times who had endometriosis, that’s not a contraindication, to what I do. But that’s a complicating factor. So we just have to say your, your progress is going to be slower because you have this right. But you know, I want to make sure there’s no ovarian cysts, or any, you know, God forbid any other like major things happening with the uterus or anything. So I want to make sure that that’s very clear that, you know, I’m, you know, while patients can come see me directly, I always have communication with their OBGYN provider to make sure that we are all on the same page, and that their provider knows are coming to me and vice versa. And I share all of my updates and my clinical exam findings and diagnosis back to the referring provider. So just, that’s really important to do. For all of you ladies looking to hop on this pelvic floor train, which I encourage you to, yes. Your that your pelvic floor providers in contact with your, you know, your OB GYN provider, whoever that may be, just so that there’s clear communication, everybody’s on the same page.

Now, does somebody I know in Ontario, we don’t need a doctor’s referral to make an appointment with a pelvic floor therapist, is that pretty common here, but I was able to walk right into ours and make an appointment.

That’s good. I can’t speak to that, because I don’t know that and I know I mean, in in, in the US, you know, for a rehab therapist, and I’ll may just quantify this a rehab therapist, you do need a physician level referral into the practice. And that’s an insurance based thing, right? And but I will quantify that like, I know a lot of PTS have their doctorates, so I’m not sure if they’re considered physicians, I No doctor of chiropractic, my degree, some states view that as a physician level entry, you know, for access of care station, which is super, like, it’s just unfortunate, because it’s very confusing for me. Yeah,

I always just tell people, it’s worth calling your therapists to find a therapist or get a referral Yeldon and see what’s required if

they need to talk to your doctor, you know, as simple as that. Yeah. And you know, The last and be the last thing you want is like a financial responsibility surprise at the end of care. And so you just want to make sure that everybody’s on the same page and transparent, you know, with what your, you know, not only financial, but like time, you know, commitment is going to be with this because it’s not a one shot wonder where you get this, like, here you exercises and the expectation is that you’re going to do this, it’s like not your team, I’m going to help you with this, but it’s going to require work on your end, the rewards are going to be just like, so incredible for your for your, you know, your life long, you know, just social, you know, emotional, all of that, you know, you have all of you what I say is we move from pain to pleasure, and you know, from fear to freedom, and you have so much more control over your life day to day.

Yeah, I’m amazed, I have to say like I, I’m, I consider myself the kind of person who, when it comes to my physical health, I’ve tried it all. Like, if I have a problem, I am going to march in there and you know, seek it out, I’m gonna, yeah, I will do the work. I have no problem. I don’t, I’m not one who’s gonna be like, hey, just give me a remedy for this. And I’m off, you know, to do the work, I’ll do the work because I know it works. But I was pleasantly surprised by my and like I said, it took me four pregnancies before I even went and visited a pelvic floor therapist for conversations with them over the years to because I am a firm believer and all of us. Sure. But it wasn’t until I started chatting with you know, someone and went, Oh, and all those funny symptoms that over the years I’ve best written off or, you know, I remember she the first thing she said to me was well think of your pelvic floor like a trampoline. And every baby, you have softens the trampoline. And I laughed because our kids have a free form trampoline. Yeah. On both the springs come let go. And so yes, reminds me of our trampoline. I don’t like it like, yes. Jumping on it. It’s kind of like she got laughs She’s like, well, that’s, that’s what we’re doing. We’re gonna tighten those those springs back up. And we’re gonna help that. Yeah. And it was a great visual for me. But it also? Well, again, I can’t wait. Right? I get why did I wait? Like, I mean, not like, oh, my gosh, why did I wait, just like, I want people to know about this.

And I think again, this kind of like brings us full circle to the beginning of the conversation where it is a silent epidemic. And I think a lot of people, you know, just think of people suffering with pelvic floor dysfunction of like, grandma’s buying depends, and you know, not being able to control their bladder. And that’s the end result where we, we don’t want to be. And so we really want to validate for these women. And I will say that it’s not I mean, having a baby and pregnancy is the number one epidemiological risk for pelvic floor dysfunction. But to your point of trauma, I mean, we can have physical and emotional trauma that will sit and rest in our pelvic floor. And that’s really important to acknowledge, I have a lot of female athletes, you know, who are in their teens, 20s. And even, you know, people who are in their 40s, who just choose not to have a family have pelvic floor dysfunction in the absence of pregnancies and deliveries.

And we talked about that, because I wasn’t competitive figure skater. And one of the first things we talked about was my landing leg. And I’m like, Well, I’m right handed, I land on my right leg, all my jumps, fingers. I’m hitting that ice falling on one leg. And she’s like, and I have scoliosis on top of that. So it was like,

okay, depression. You think? I mean, I’m sure that you’re a very capable, you know, skater, but think about how many times you fell in that dark?

Yeah, yeah, no, absolutely. And we just write it off. Athletes are bad for that.

Yeah, well, and whatever. Because athletes are, you know, strong and really have a lot of grit and determination, especially as you get these higher levels, it’s like probably use to pain, pain is actually a good thing. Because it means, you know, like, a lot of people think that pain is a really good thing because they can be stronger and better. But um, you know, it’s really important to do this. And I also want to, you know, make this association. There’s back to the point of the evidence based medicine because there was a great study that was actually Canadian study done in seven orthopedic clinics, Canada, yes. And what they did is they attract low back pain, because low back pain is like the number one cause for women. Well, number one cause for people to seek out medical care. And the biggest demographic for people going to seek, you know, care for low back pain, women who are 40, between 40 and 60 years old. So 95% of these women in these orthopedic clinics, who presented with low back pain, had some form of pelvic floor dysfunction. Almost 100% of them. Wow. So within that 95% Hollies, 71% had a spastic component in this poll The floor, so and so whatever also opens up. So this is like blowing my mind. Right. So, and this also just speaks to anecdotally what I’ve been seeing over the past decade seeing hundreds and 1000s of patients is that this pelvic floor, you know, muscular structure, fast fascial structure myofascial structure is not one thing. You know, there are different muscles that create this pelvic floor, there’s deep muscles, there’s superficial muscles, there’s muscles that are fast twitch muscles, slow twitch muscles. So there’s not just one Kegel, there’s like, I teach three different Kegel. So there’s an endurance type of Kegel, there’s a different kind of Kegel that’s specific to power. And then there’s a superficial fast twitch. And we really need to be able to say, Okay, it’s not just this levator AI, the levator AI has five components to it, you know, and so there’s different striations. So I, you know, what, there’s front to back right to left, so you may be able to have, maybe you have a scar stick in one component, right, this passage is right sided, which is maybe where that prolapse is coming from, so you have this NASM and this holding in that one area, so that’s going to be really loud in the pelvic floor. And maybe the opposite side of the pelvic floor is loosey goosey. So you have these like multitude of symptoms. So just because you have like one or two symptoms doesn’t automatically mean that you have either a weak or as simple as just one of your personas, it occurs on a spectrum, right? And so each muscle really is what I do is identify within each muscle, what that diagnosis is for that muscle right to left, right. So it’s like looking at your entire body and saying, Oh, you’re tight, you know, it’s just doesn’t work that way. So again, so working from a manual perspective to reduce that tension, because a spastic muscle is also going to, you know, have symptoms of stress urinary incontinence, because what I say is that you have this beautiful baseline, or what, that’s what we’re looking for, for this pelvic floor. But if you’re already up to the top, when you go to engage, you’re already at the ceiling, and you’re just gonna burn out. So we have to get here, but we’re, if you’re weak, you don’t have the ability to contract to get to that baseline. So, you know, it’s, it’s really important to any stage have a hint of pelvic floor symptoms, which can range from low back pain, hip pain, and then to what we do think of pelvic floor, you know, symptoms of prolapse, that feeling of like, Oh, I feel like I already have a tampon in all the time, people tell me that all the time, or it feels like things look different. Or now I’m having pain with intercourse, but it changes with certain positions, or it feels like I have no Varian cyst, or I can’t poop or I poop too much, or it’s my stream is different. Or when I like my bum, things are different, like I’ve heard it all over the years. And those are all signs and symptoms of pelvic floor dysfunction. You know, just to identify it, just say, Hey, this is like, really outside of my comfort zone, but I need to identify it. And most public for providers, I would say like all of them have heard it all.

Point to make because to be

a unique case, don’t be embarrassed by it, don’t be by it. Like most women have the pelvic floor dysfunction, and just no one ever talks about it. And it’s only going to get worse. If you do nothing about it.

I have to tell you, so my first visit, this was really funny. It was a fluke, my kids, I booked it for the day that my kids go to forest school, so I knew they’d be out for school. I know we don’t have to so but my six year old woke up that morning, tell me he didn’t feel great. So I’m like, with the way everything he was probably fine those symptoms or anything, but I was like, I’m not gonna risk sending him and he’ll tell everyone there is set. Right? So. So he came with me and I’m like, I have a my first appointment with the fourth floor therapist. So I mean, I love that she’s amazing. He’s like, no problem. You can come Yeah, my thing, right. But here’s something that I think is important. And we’ll kind of wrap this up with this. But I had never been I’ve never even asked a question of what’s involved in an appointment. Pretty good idea just based on years of listening, right? And but the poor kid is sitting at the wrong end of her exam. Like that. Yeah. And he’s on my phone. I gave him that to distract him. But all of a sudden, I noticed him as we got to the internal port part. He’s looking and I’m like, You do not need to be down there, buddy. Like this is so I’m working now her and I are laughing our heads off because we’re like, we did not pay attention to it. So she’s like, you’re my mom’s like stuff. He looks up he’s like, Yeah, that’s better.

Didn’t know what I was gonna do.

Anything else my boys will leave grew up with a pure appreciation for what we go through as women.

I think that’s so important. But yeah, thank you for that reminder, Holly, I think that that

initial like exam just one, what can they expect, so they.

So it’s meant to be a little bit different because again, you know, I made a chiropractor who does it. So it might be a little bit different from your PT, but I suspect that your PT would probably do the same thing. So for me, as we talked about, I always do an external exam first, because all of those external components impact pelvic floor. So you know, it’s an external orthopedic exam and treatment, including the manipulation for me. And then, you know, I always tell the patient that we’re going to be doing an internal, intra vaginal palpation it’s, of course, always gloved with hypoallergenic, you know, kind of lube. And I always reassure the patient, if they if they ever feel uncomfortable at any time, like they’re always in control. But it’s a digital mat on manual palpation. And how I describe it, you know, sensation is that you’re with your gynecological exam, and you’re gynecological provider, most of the manual bimanual exams for the ovaries, the practitioners hand is kind of turned up and you know, kind of squishing on on the belly. But what’s going to happen is that the practitioners hand will be turned 180 degrees, where they’re feeling the bottom. So it shouldn’t be painful. If it is the practitioner will hold off a little bit on pressure. But the idea is that we’re looking for tone, we’re looking for texture, we’re looking for potential suturing scar tissue, we’re looking for symmetry side to side, and we’re looking for function. So it’s usually kind of a palpatory, you know, feeling for all of those muscular and myofascial components, you know, kind of anterior to posterior on one side, and then posterior to anterior on the other side. And it may feel like that will pressure it may feel, you know, like, there’s pain, but I tell you, sometimes if there’s pain, there is validation in that, because the patients will say, that’s exactly the pain that I’m either experienced with a bowel movement or with intercourse, or when you’re trying to attempt to have, you know, urination problems, that’s I zactly the pain and I was like, amen. Perfect, rounded. Right. And if we can reproduce it with a muscular palpation, then we can treat it right. And so there’s a huge validation component to it. And they, it kind of breaks the ice a little bit, you know, and how I also say, like, once I’m wearing need to be, there’s no visualization, it’s all just about palpation. And I also at the same time, I have a picture, you know, kind of on top of on top of the patients where they can see. And so I’m teaching them how to identify their pelvic floor, because I think there’s a disconnect between women, they just don’t really kind of a have any anatomical knowledge with pelvic floor, which I understand but be they just don’t really feel like they have that they want to look or know about it. But I think it’s important to like, make that connection like, oh, that’s actually a muscular feeling. That’s a muscle. That’s okay. It’s like working there.

First visualize, it really does, like even when you’re doing resizes, that moving folded to know that that muscle actually contracts this way. And this way, or whatever, like you totally, yeah, well,

yeah, I mean, I think the more cueing that we can do, people are either visual learners, or auditory learners or whatever, like palpatory tactile learner. So I try and bring all three of those into just to kind of help these patients identify how to, you know, take control, or their pelvic floor, because it’s it. Um, you know, for a lot of people, it’s a shame thing, it’s a secret thing, all of a sudden, they’re not going like, oh, there’s an outdoor picnic, I can’t really go because it’s going to be two hours long, and I can’t hold myself to the bathroom, and I either don’t want to go to a porta potty or I’m not going there may not be one or, Oh, it’s a five hour trip, and I’m going to be with my girlfriends, I don’t want to keep asking to go to the bathroom in the car. And that’s just going to be awkward, so I’m not going to go, or I’m not having sex with my husband or my wife or whoever it is, you know, because there’s pain and then all of a sudden that that like just builds into something that shouldn’t have to be there and can easily be identified easily be treated. And you know, really bring bring some empowerment to these to these women and just bring you into this community of like, you are not alone. Everybody has this dysfunction. Just no one ever talks about it. And it’s okay not to talk about it with your friends, if that’s uncomfortable, but absolutely bring it to you in the privacy of your provider and get some acknowledgement with it. Get some help with it, and just see how you’re able to take control of your pelvic floor health which will ripple out to not only how you feel but as a mama, you are, I mean you are the heartbeat of the home. Let’s just call an ace and as you You know, when Mama is feeling strong and healthy and empowered, and like excited and happy and glowing, and like sexy, and you are allowed to feel those ways as a woman, like, it is going to spread and shine in that household, and it has to just start from you. So just, I just this, if I leave you with anything, it’s like, just don’t feel like you can’t identify that. And even if you even if you have like a really super healthy pelvic floor, like just have an exam, and it might, I have said to patients, like you’re spot on girl like you, I don’t need to see you, I think you’re great. Like, this is like you’re doing them correctly, just to validate that you’re doing the pelvic floor contraction. And then just like, This is what you should be looking for in the future. But otherwise, like you are spot on, I don’t need to see you, you know, keep doing the good work.

That’s amazing. Yeah, and I love that. So I I personally, I look at it as people use the term self care. I know we throw it around like crazy now. But my self care is not having a bubble bath at the end of a long night a long day. That’s just life. My health care is investing in pelvic floor therapies, investing in therapeutic Pilates it’s investing in, in those parts of our body that might not like you said might not maybe be causing us issues today. 75 Do I want to be paying the price then I talked to my mom about this too. Why not take care of it now. So I’m gonna I’m gonna wrap it up with that I could talk to you forever. So likewise, like why? Florida? I’ll be definitely looking you up? To do absolutely. Yeah, absolutely. Okay, cool. Well, we’re gonna wrap it up there. We’ll talk again, I know, we can talk more specifically about things too as we go along. So we can

well thank you best of luck. I hope all your listeners can find someone and, you know, there I don’t really have a network. But, you know, I’m looking to maybe bring this technique to Canada and the next, you know, year or two. It’s just like all the legal stuff that has to happen, but I would love to bring it to Canada. So I will. I will tap into your resources probably at that point, but it’s been lovely. I’m filled with gratitude for what you do and for having me on. Amazing. Thank you. Okay, bye. Thanks. Take care.