6 Reasons to See a Physical Therapist BEFORE the Baby Arrives

If you’re like me, you grew up thinking that having a baby looked kind of like this: 

Your water breaks in a really dramatic gush. You rush to the hospital (that baby is coming any second!) then suddenly are lying on your back with your legs in the air while a doctor in a white coat catches the baby.

Add in some dramatic screaming and pushing and you’ve got the picture.

Can anyone else relate? While yes, there are births that I’m sure look like that—it’s TV.

Many people have days of labor, change positions too many times to count, and give birth not only in a hospital but perhaps a birthing center or a pool or the bathtub or their living room. The possibilities are almost endless, but—especially with the first baby—it’s usually not a quick process.

Labor & delivery is often a long, exhausting event. It’s something you need to prepare for—get in shape for, if you will. For example, if you’re pregnant and want to labor in a squat (a great option for opening the pelvis), you need to make sure you can squat before those contractions even begin. A deep squat takes strength, endurance, and a lot of hip, knee, and ankle mobility.

This is where physical therapy comes in to play with L&D. Most people don’t think of PT before labor, unless they’re having pain of one variety or another and were referred by their midwife or OB. Seeing a PT during pregnancy can prevent pain & discomfort, and prepare you for the big event.

6 Reasons to See a Physical Therapist BEFORE the Baby Arrives:

1.     They can teach you perineal massage. While we can’t say if this truly prevents tearing during delivery, we do know it helps you learn how to keep your pelvic floor muscles relaxed during the discomfort of a lot of perineal stretching. A relaxed pelvic floor = an open path to the exit!

2.     You can learn how to actually push during labor. Ask your friends: how many of them said they didn’t know how to push when the nurse or midwife started telling them to do it? A PT can help you learn what it feels like to lengthen the pelvic floor while pushing with your abdominal muscles so it’s familiar when the time comes.

3.     Practice labor & delivery positions. A PT can make sure you have the joint mobility to get into a deep squat, a lunge, hands and knees, and any other variety of positions that can help open the pelvis and move the baby down. We can educate you on the benefit of different positions and help you figure out which ones you need to practice before the big day.

4.     Make sure your partner knows how to physically support you during labor. Bring your partner to an appointment or two so they can learn ways to support you in a variety of labor positions, perineal massage (you might not be able to reach eventually!), and comfort measures.

5.     Balance the pelvis & uterine ligaments. If your pelvis is a little shifty or your ligaments have restrictions, it may affect baby’s ability to move down. As long as you’re later in the pregnancy, a PT can use manual techniques to make sure everything is balanced and ready to go.

6.     Get educated on postpartum care. When can you start doing kegels? When can you start doing abdominal exercises? What do you do if you had a cesarean? How do you get out of bed comfortably? We can give you guidance on all of this and more (with handouts, of course) so if you have questions after baby comes, you have the resources right there.

If you are expecting (congratulations!), I can’t recommend seeing a PT enough. If you’re in the Tacoma area, schedule a FREE 15-minute phone consult with me to get started. If you’re farther away, check out these resources here and here to find a PT near you. The best thing you can do during pregnancy is to educate yourself and be prepared for anything. Making a PT part of your team will be a huge benefit to that end.

Did you have PT during your pregnancy? How was your experience? What else would have been beneficial to know going into labor? Share in the comments!

These Are A Few Of My Favorite Things

Welcome to December. I like to refer to the time between Thanksgiving and New Years as the “slingshot season.” It’s like someone pulls back the slingshot in early November, lets it go on Thanksgiving, and sends us flying into the new year. It’s fast and furious, and typically comes with no small degree of stress.

I’ve taken a new method to gift giving in the past couple years, and it’s led to a lot more peace in this season. I’ve allowed myself permission to buy gifts when they strike me—no matter what month it is. Last year my holiday shopping started in August and was done by early November. With that, I’ve also tried to not stress over the perfect gift, but rather when something calls to me with a certain person in mind, I go ahead and buy it. No one on my list needs any of the gifts I’m buying, so it’s more about finding something that brings me joy to give, and will bring them joy to receive (yep, that’s straight up Mari Kondo right there!).

If you’ve still got some shopping to do after this weekend, here are a few of my favorite things. I think they make great gifts, though have to admit not every family member will be thrilled to open up a big box and find a Squatty Potty inside. Choose wisely. 😉

Dr. Mandi’s Gift Guide:

1.     For your partner: a Squatty Potty—the Unicorn in the commercial does not lie! Placing your feet on a stool really does open up the rectum and makes doing your business just a little easier...and frees up the bathroom faster ;) (Pro tip: I’ve heard Costco sometimes carries a 2-pack!)

2.     For the girlfriends you’re cycling with: The Moon is My Calendar—You’ve been hearing me talk about this, but I won’t stop! It has changed my life, and I can’t recommend it enough. (note: this is an affiliate link, fyi)

3.     For your yogi friend: Jade Harmony Yoga Mat—this is my favorite yoga mat, with the perfect amount of stickiness. They are also sustainably made! (Your local REI likely carries them)

4.     For your friend who wants to break up with their gym: An Ascent Fitness Class Punch Card—this is the best gym in Tacoma, in my opinion. ;) Share a few classes with a friend to bring in the new year! (Email move@ascent.fit to purchase)

5.     For your pregnant friend: Prenatal Yoga classes at Fern & Foster with Erica Davis. (She offers in-home private yoga too! Check her website for pricing)

6.     For your postpartum friend: Buy them a giftcard for some Physical Therapy! Whether they’re a few weeks out or a few years, if you keep hearing them say they should see someone, give them a nudge in the right direction. Email me to talk details.

7.     For your Mom—Surprise your mom with the gift of bladder control with my Live online Mind Over Bladder Workshop! It will be an early gift so that she can really appreciate the benefits by the time Christmas rolls around (seriously, the benefits are that quick!)

8.     For anyone else you’re stuck on: Give the gift of your time. Make a date to go on a walk. Give the classic homemade coupon book to babysit their kid (or dog) so they can get out. Make a brunch date. Sign up for a 5k together...and start training together.

Whether you’re a big shopper, making all your gifts, or nixing gifts all together this year, I wish you peace in this season. (But really, do get a Squatty Potty anyway.)

Mind Over Bladder: How to Take Back Bladder Control

Have you seen the commercials? You know, the ones where the woman is out shopping, or hiking, or at a wedding, and she’s holding hands with a little pink bladder that keeps pulling her towards every bathroom in sight. I’ve seen them. And they kind of make me mad.

If you can you relate to the woman—feeling like you need to go every time you see a bathroom sign, or needing to rush inside every time you put your key in the front door—I feel you. But of course, the commercial is for a medication. And frankly I get pretty frustrated at how much money is spent to reinforce the suggestion that most things can be fixed by a little pill.

The issue that this particular commercial is addressing is an overactive bladder. This typically presents as a strong sudden urge to empty your bladder, needing to get up more than once at night to pee, needing to rush to the toilet, or leaking on the way to the toilet. Basically—your bladder is bossing you around. It’s really frustrating!

But here’s the good news if this sounds all too familiar: you don’t necessarily need a pill.

Yep, there’s an alternative. It may take a little more work on your part, but the only side effect is a more well-behaved bladder.

I’m talking about Bladder Training. No—not potty training. You’ve gone through that already and possibly trained a couple of other humans yourself. This is grown up bladder training to get your own to behave. In fact, the American College of Physicians strongly recommends Bladder Training before medication. That’s straight from the top!

What does it entail? First of all—and possibly most important— you need to understand how your bladder works. Because when you understand how it works, you’re better able to tell it what to do. I covered a lot of the basics in my 3-part series on Urinary Urgency, which you can find here, here, and here.

I cover a lot in those 3 blogs, and it can be challenging information to digest just reading it. For that reason, I’m super excited to tell you that I’m launching some online learning resources—starting with a LIVE online Workshop called Mind Over Bladder on December 11. In the 2-hour workshop I’ll walk you through how your bladder works, teach you the steps to control your urges, and give you a ton of self-care tips for keeping your bladder happy. Check it out here!

If Bladder Training is not something you’re looking for, but you want to learn online from me, tell me what you want to learn about! Just comment below!

(Image source)

Disclaimer: This information and course is designed for educational purposes only, and is not intended to diagnose or treat a condition. It is also not intended to take the place of 1:1 medical care.

Do you NEED to do kegels?

I was talking with a fitness pro who I really respect recently. She told me that she always tells her clients and classes to just not do kegels. My ears always perk up when I hear recommendations like this, but instead of getting defensive, I got curious. Her reasoning is that she’s found more of her clients have tight pelvic floors, and aren’t having symptoms anyway. So all that tightening they’re doing may be doing more harm than good.

Well when you put it that way, I can say the same for a lot of my patients.

So that got me thinking: does EVERYONE need to do kegels? That’s kind of been the going narrative, right? If you’re a lady, do your kegels. If you had a baby, do your kegels.

And that leads to more questions:

How many do I need to do?

Do I need to do them for the rest of my life?

Am I even doing them right?

Let’s address the initial question at hand: Who needs to do kegels (aka pelvic floor exercises)?

You might need to practice pelvic floor exercises if:

-       You leak when you cough or sneeze

-       You know you have a prolapse

-       You leak urine or stool with exercise

-       You feel heaviness in your pelvic floor after a walk or run

-       You have trouble controlling urges (bladder, bowel or gas)

If you said yes to any of those, you might need to strengthen your pelvic floor. However, if you’ve tried and haven’t been successful, I 100% recommend you get in to see a Pelvic Floor PT to make sure you’re doing them correctly and that there’s not something else going on. If you want to check yourself, download my Guide to a Proper Pelvic Floor Contraction.

If you answered NO to all of the above questions, and have an active lifestyle, you probably don’t need to do kegels. Say what? Yep, you’re off the hook.

More importantly, you should not do kegels if:

-       You have pain with sex

-       You have discomfort wearing tampons or menstrual cups

-       You have tailbone pain or pain with sitting

-       You have trouble emptying your bladder

-       You have frequent UTI’s

If you fall into the latter category, you probably already have a tight pelvic floor. Trying to do 100 kegels a day will only make things worse.

Can you relate to symptoms in both lists? Is it keeping you from doing what you want to do, like run or hike or pick up your kid? Get yourself to a Pelvic Floor Physical Therapist! We can help you determine what’s going on with your pelvic floor muscles and how they can work better for you. Hop on the phone with me for a Free 15-minute phone consult, or find a PT near you.

As with most things in life, all of this is not black and white. You can leak even if your pelvic floor is strong. You can have painful sex if your pelvic floor is weak. You can have all of the symptoms above! And most importantly, you can overcome them all.

Is Sitting the New Smoking?

I’ve been thinking a lot about sitting lately. If you follow me on Instagram, you’ve seen me post a lot about it recently too. And—no surprise—I’ve been sitting a lot lately.

You’ve likely heard that “sitting is the new smoking” but I have to say, I completely disagree. Yep—you heard me right:

SITTING IS NOT BAD!

Let’s be real: a person can stop smoking. And we know smoking is bad for your health. But I dare you to try and stop sitting. You just can’t! And you don’t need to. Because it’s not a bad thing.

Sitting does not equal sedentary—necessarily. Yes, we know that there are tons of negative health effects on a sedentary lifestyle. We are not meant to be sedentary beings. Just look at all the ways our bodies are able to move—they are built to move! But throughout the day we tend to sit only in one way: in a chair, legs forward (or crossed). Hips flexed, knees bent, back probably a little slouched. This is fine for a while—but I bet after some time your legs fall asleep, your back starts to ache, and your butt gets store. Right? Then you feel like you need to get to a yoga class just to get your angry body moving. And quite honestly—your pelvic floor isn’t loving it either.

What if you could get through your day and not feel stiff because you moved your body throughout your day? What if you didn’t need to exercise your pelvic floor because it’s just working with you throughout the day? (More thoughts on exercising the pelvic floor coming next week ;) )

Here are some ideas to give your body some variety:

-       Move your laptop to the coffee table.

-       Read on your belly, or on your back.

-       Take phone calls or meetings walking.

-      Change up the way you’re sitting often

-       Stand on something at your standing desk (rocks, a tennis ball, Pranamat).

-       Send something to a printer across the office so you have to walk to get it.

That’s just the tip of the iceberg. We don’t have to make huge shifts to feel huge shifts. Choose one thing to change this week and see how your body feels. Maybe it’s just one hour sitting at the coffee table, or meeting a friend for a walk at lunch on one day.

What’s your favorite way to sit?

An Exercise About Exercise

Let’s do a quick experiment. 

Close your eyes. Well, no don’t do that because then you can’t read. But take a moment to just check in with your body. We’re going to do a word association experiment.  

Read the following words, then take a moment after each one to notice what your body feels like. What emotions come up? What physical sensations arise in your body? What stories come to mind about the words?

Here we go:

Exercise

Workout

Movement

Play

Take a moment with each one. You might want to write some things down if one brings up particularly strong feelings or stories. What stories do you tell yourself about working out? About play? How do you feel about yoga? Exercise?

This is a good exercise to check the barometer of your relationship with movement. Movement is really what all of the other words have in common, yet I’m guessing that “movement” might be the word you had the least strong feelings about. I can’t tell you how often I get the response “No but I should...” when I ask someone if they do yoga. When I ask how often someone works out they inevitably say “not as much as I should.”

I used to be the same way—a “workout” only counted if it was at least 30 minutes 4-5 times/week. And I had to sweat. Even in yoga. Somewhere along the line that shifted though. Now my “workouts” are just movement. And movement is something my body wants to do. It might mean 10 minutes of sun salutations in the morning. A walk with the dog. MovNat ground movements that I learned online.

Yes I go to the gym a couple times most weeks (and not just because I’m paid to be there!), but I go because the classes are fun and I like the people! It feels more like play most days than a workout. It’s sneaky fitness.

If you had a lot of negative associations with the words above, or if the stories you tell yourself are that you should do this or that, I encourage you to expand your definitions. Find a playground and hang from the monkey bars. Take out your yoga mat (or pull up some carpet) and move in ways that make your body feel good. Make it up as you go. Your body is wise and will tell you what it wants—that’s really what pain and stiffness often is, just a signal that your body needs something different.   

I want people to be liberated from the “workout” expectations that our society has built. It doesn’t have to be complicated. It doesn’t have to be expensive. You don’t have to look a certain way or wear certain clothes. It just needs to feel good.

So tell me: where are you going to start?

3 Weeks to Happy Hips

One of my favorite things about traveling is just walking.

According to my phone’s Health app we walked between 16,000 and 25,000 steps each day during our trip to France. We walked everywhere—to the boulangerie, the market, museums, sight-seeing, the train station. We had one day of bike riding, and took the metro quite a bit in Paris.

But all this walking was bookended by the other extreme: sitting. Door to door each trip took 24 hours. Between a 9-hour overseas flight, connecting flights, trains, taxi’s, and the metro, there was a lot of time on our tushes.

What do walking, biking, and sitting all have in common? They make my hips stiff. They all involve this isolated forward and backward movement (or just a flexed position of the hips, in sitting, of course). Sure, I tried to sit cross-legged as much as I could on the plane (until G got annoyed), but mostly it was just forward, then backward.

Our bodies aren’t meant to only move in one plane. They are meant to rotate and twist and turn and bend and have multiple ranges of movement. They want to move in variable ways.

The first thing I did when I got wherever we were going was just that: give my hips different ways to move. I’m not shy to do yoga or stretch in public. This pic is at the Dallas-Fort Worth Airport after the flight back from Paris (and felt oh so juicy—for my swollen feet too!).

How do you take care of your hips? Do you have a sitting job or long commute where they’re stuck in the same position all day? Do you do a lot of running or biking or walking where they’re always moving in the forward plane?

I’ve got a 3-week series coming up called Yoga + Anatomy: Hips Edition at Yoga Wild. With new inspiration from my trip (a mini-travel flow that doesn’t require putting your hands on the nasty airport carpet), I’ll teach about the bones, ligaments, muscles and joints that make up the hip joints. Then we’ll move them, using asana (postures) to open them up and stabilize them too.

The class is designed to give a novice yogi a solid foundation, and experienced instructors some new inspiration and deeper understanding of these important joints. We’ll talk about emotional patterns of holding tension in our pelvis too, which can lead to various discomforts.

By the end, you’ll feel more knowledgeable, open and grounded.

If you’re local to Tacoma, I’d love to have you join. You can register here. (But hurry—there are only 6 spots left!)

If you’re not a local, I’m curious: does this sound interesting to you? And is it something you’d like to see as an online course? Drop me a line and let me know! I’m toying with the idea of online courses and would love to know what you want!

How to Show Up for Someone After a Miscarriage: 4 Things TO Do

I already shared some things to avoid saying to a loved one or colleague who has shared they had a miscarriage in this post. It can be such a lonely experience, and people often don’t know how to talk about it. or they fall into the too-common trap of “not wanting to remind you of the hard thing.” Trust me, we haven’t forgotten. In fact, the silence around it can be more painful than any mention of it.

Not a day goes by that I don’t remember I am supposed to be pregnant. There was supposed to be a baby. When milestones come up, the reminder feels like a punch in the gut. I went shopping for a dress the week before a friend’s wedding in August. I had put off buying one earlier because I wasn’t sure how much I would be showing. My eyes teared up in the dressing room knowing that I was supposed to be pregnant at the wedding. The reminders sneak up on me. Grief comes in waves; I understand what that means now.

Here are some ways you can show up with love for someone after a miscarriage.

1.     Let them know you are thinking about them. A quick text saying “Thinking about you and your baby today” can be so helpful. Try to avoid “How are you?” I often ignored those texts because to try and explain how I really am on a given day is just not going to happen over text. I appreciated the brief messages that told me they were thinking of me and that they care.

2.     Try to remember milestones. Remember the due date. Be aware of when they would have crossed into a new trimester. Reach out on the holidays, especially on the holidays, knowing that those might be even more painful reminders of what is missing. While the holidays are meant to be a time of good cheer, in these years of infertility the constant messages of joy and peace and thanksgiving have felt jolting when I’m feeling deep grief and sadness.

3.     Remind them that they are loved and whole; remind them that their worth does not depend on their reproductive system. Especially if the end of their journey does not include a child in their arms, they need to be reminded that they are enough in and of themselves.

4.     Acknowledge that the father or partner lost a baby too. Most of what we see about miscarriage and infertility are so focused on the mother or the one carrying the child. The father or non-bearing partner lost a child too, though. Honor that their loss is no less than hers; it is not secondary, and their grief is just as real and deep as hers.

Remember that grief is not a linear, one-size-fits-all formula. It is deeply personal, and experienced differently even within a couple. It may take months or it may take years or it may take a lifetime. Don’t be afraid to bring it up; they will let you know if they don’t want to talk about the baby, but they often won’t bring it up themselves. I am often afraid that I talk about it too much, but I so appreciate it when others bring it up. I think about our baby every day, and I’m confident I’m not alone in that.

October is Pregnancy and Infant Loss Awareness Month. If you know someone who has lost a baby, whether it was months ago or years ago, reach out to them this month. Tell them you are thinking about them and their baby (by name if you know it). It’s ok if you don’t get a response. They’ll know you care.

How to Show Up for Someone After a Miscarriage: 4 Things to Avoid

I truly believe that people are kind and have good intentions. But sometimes what they say just sucks. Where is the class in Life School that teaches how to respond to someone going through something hard? How do I sign up? (Or sign someone else up...?)

Here are some tips for how to support someone who has had a miscarriage. We know you have the best intentions with your words, but here are some ways to keep it sensitive:

4 things to avoid saying to someone going through a miscarriage (and what to say instead):

1.     “What can I do?” Instead of this, just tell them you’re there if they need you. Especially in the first weeks and months, they may not be in a space to ask for anything, but need to know you are thinking of them and ready to help if needed. One of the best things I got was a package from a friend that had a necklace, chocolate, and a packet of forget-me-not seeds. I felt so loved by this simple, unexpected gesture.  

2.     Avoid telling them a story about someone else that you know who also had a miscarriage but then went on to have a healthy baby. Shifting the story away from them can feel dismissive of their experience, and is likely done to make you feel better. “I’m so sorry” is enough to let them know you see them. If they ask for a hopeful story, that’s your entry. Otherwise please keep your (or your friend’s) experience to yourself.

3.     “At least you can get pregnant!” Again, this feels dismissive of the loss. Yes, of course I was thrilled to find out that I actually can get pregnant after 5 years of negative tests. But hearing this sounded to me like I was supposed to stop being sad about my loss and focus on the positive instead. Grief looks different to every person, but it is not linear and usually not quick. Try to sit with them in their discomfort, even if it means it’s uncomfortable for you too.

4.     “Do you think [fill in the blank] caused the miscarriage?” A miscarriage is no one’s fault, but it is natural to look for something to blame. She’s already probably going through a list of things she did (or didn’t do) that might have caused it (that second cup of coffee? too much exercise? sex?). Please don’t offer more for her imagination. It was not her fault.

If you read these and think “Oh shit, I totally said that,” don’t sweat it. We all make mistakes. We can all do better. Just take it as a lesson and move forward. The biggest thing is to just let the person know you see them. Even if you can’t relate, you are willing to honor their grief by not dismissing it.

At the end of the day, if you can’t remember what to or not to say, keep it simple with “I’m so sorry.” That’s enough.

On Miscarriage.

October is National Pregnancy and Infant Loss Awareness Month. This creates the opportunity to bring to light some hard topics that we just don’t talk about.

Our society prizes childbearing, and we are taught from childhood both implicitly and explicitly that motherhood is the ultimate prize of being a woman. So when that path is a struggle, whether it is through infertility, miscarriage, or stillbirth, it’s easy to feel that shame creeping in again. It is easy to blame your body, to feel that it is failing you, that it is not working the way it was meant to.

I haven’t shared a lot about my own infertility because I am still in the midst of the struggle. All the feelings I’m sharing here are my own, and I know I am not alone. I struggle to believe that I can truly be a full woman when my body seems to not be able to carry a child. Over my years of navigating infertility, I have often felt broken. I know this is a lie, but it’s a lie that is whispered in my ear over and over again. Maybe you can relate. Maybe you’ve heard those whispers yourself. Know that you are not alone, either.

I want to share a little more about my story.

After years of navigating infertility and trying all-of-the-things, my husband and I finally had a positive pregnancy test earlier this year. We were elated. This was the one. We had been working so hard and waiting for so long for this. We celebrated every moment of being pregnant and tried to push down the fears and what-if’s that came with it after such a long wait.

Six weeks later, I started spotting. We had an ultrasound that showed the baby was a week behind. My doctor recommended “cautious hope,” but within a day I knew we were losing it. We had a miscarriage.

I have spent the past few months in various stages of rage and grief and sadness and even still joy at times. We had already told our families and several friends, and now had to share the heartbreaking news that we lost the baby. I ran out of emotional capacity to keep telling the story. I wanted people to know, but it has taken some time to share the story. It’s hard to know how much is too much to share.

I want to share my story because I want to remind myself that I’m not alone. I want others to know that they aren’t alone. And I want the friends and family and coworkers who are witness to the grief of a miscarriage or infertility to know how to hold that person with sensitivity and kindness.

Even if you can’t relate personally, you probably know someone who has lost an infant or a pregnancy. 1 in 4 pregnancies end in miscarriage, yet it is still something we rarely talk openly about. 1 in 8 couples in the US struggle to conceive, and we talk even less about infertility. It is a lonely struggle, but you are not alone. Your loved one is not alone either.

As I said at the beginning, October is National Pregnancy and Infant Loss Awareness Month. The next two weeks will bring you blog posts about what to to say or do and what to avoid when you find out someone close to you has lost a pregnancy. If you have experience with this yourself, I’d love to hear your story. Comment below or find me on Instagram. We are truly stronger together, and you and I are not alone in this.

How to Contract your Pelvic Floor

Pelvic Floor Contractions are a SUPER important exercise to have in your repertoire. (If you always thought they were called something else that starts with a K, read this post for clarification).

Click HERE to get a free PDF Guide to a Proper Pelvic Floor Contraction, then keep reading!

How to contract your pelvic floor:

Start in sitting, or any comfortable position. Gravity makes a difference, so you may feel it more in an upright position, or you might feel better lying on your back.

Draw your attention to the perineum, which is the triangle between your pubic bone in front and your sitbones in back (think bike seat). Sitbones are the bony part of your backside (think sitting on hard bleachers). Imagine pulling your sitbones together, or your tailbone toward your pubic bone. Now pull up and in. Keep your glutes, thighs, and belly relaxed. Release.

If those cues don’t connect, try these:

Squeeze as if you’re stopping the flow of urine (but don’t do it on the toilet! It’ll confuse your bladder!). Release.

Squeeze as if you’re holding back gas. Release.

Pretend you’re sitting on a kidney bean, then try to pull it into your vagina. Release.

Pretend there’s an elevator in your vagina. Bring the elevator up a few floors slowly, then lower back down. Release.

You’ll notice I’m reminding you to release after each contraction. That’s because some of us are basically squeezing ALL THE TIME which leads to other issues to discuss another day. Always let it go!

Other things to avoid: bearing down, pushing out, holding your breath, squeezing REALLY hard. Try it gently—less effort is definitely more. They are relatively small muscles!

Even with the best cues, many women still do PFC’s incorrectly. If you really want to know if you’re doing them right, see a Women’s Health PT. We test them in the clinic by observation of the perineum, and most often an internal exam. No speculum, no stirrups, just a finger inside the vagina. We test your strength, endurance, and coordination. Then we help you train them to be strong and coordinated. They are a group of muscles just like any other muscle, and we can train them just like any other muscle too. They can be too weak or too tight, just like any other muscle as well.

Did you try it? Think you’ve got it? Tell me which cues work best for you!

On Kegels.

I’ve always disliked this term. I hadn’t ever fully fleshed out why until earlier this year, when I read a beautiful Instagram post by Latham Thomas of Mama Glow about the colonization of womens’ bodies by men. There are at least 5 glands and parts of the female pelvic anatomy alone named after male anatomists or physicians, and a long list of other anatomical parts throughout our body named for the men who “discovered” them. That list includes the elusive “G-spot”—named after Ernst Grafenberg (spoiler: it doesn’t actually exist!)

Arnold Kegel was a gynecologist in the 1940’s who was the first to publish anything about pelvic floor exercises, which he named after himself. That’s why they’re called kegels. That’s it.

I have learned over the years how much baggage the term carries. Just last week I had a patient say (and I’ve seen this a hundred times) with a little guilt in her eyes: “I’ve been really bad with doing my kegels.” Guilt! That’s often what I hear when women talk about “kegels”. They are this thing that women may or may not have been told to do by their doctor, or maybe just read about in Cosmo, but they don’t really do them, or they tried and “it didn’t work” so they quit. Often times women ask with skepticism what I can do for them, because they already tried kegels and “failed.” My response: Do you really know how to do the exercise?

There have been several studies done assessing if a woman is doing a pelvic floor contraction (PFC, I’m not saying the other name anymore) correctly. The consensus seems to be that around 40% of women who have been taught verbally (either by a doctor or written instruction) know how to contract the muscles correctly. The others are either not doing anything at all, squeezing other muscles instead (hey glutes and inner thighs!), or they are actually doing them backward—pushing out instead of pulling in.

So how do you contract the muscles correctly? Check out this post on PFC’s. I wanted to rant about the colonization of female bodies first, and that topic deserves a full post.

On to you: what’s your experience with the word “kegels”? What emotion does the word bring up for you? Please share below—I’m really curious!

Moon Journal

Let’s talk about the moon.

I’ve always been fascinated by the night sky, whether it’s a full moon or stargazing. Growing up in Montana, I adored nights under the stars. It truly is Big Sky country. I remember my parents stopping the car on the highway and turning off the headlights so we could see the immensity of the sky full of stars. It’s pure magic.

I was introduced to The Moon is My Calendar last year by my Naturopath, and it has changed my life. Each month has a circular calendar that you draw symbols in for each day about energy levels, exercise, meditation, mood, etc. Then there’s a small space for each day to just jot down whatever notes I want to.

If you’re like me and have been tracking your cycle for eons, it’s similar, but is intentionally about so much more than just when you bleed.

I took it on as a science experiment. I’ll do this every day, then after a few months I’ll look back and calculate when I felt what, etc. It didn’t work like that, though. 

I found that by taking a moment at the end of each day to just reflect on my day, the knowledge integrated into my being. I started to notice patterns naturally. I really do have more creative energy when I’m ovulating (and I’m oh so aware of when I am). I gave myself permission to say no to pretty much everything the first couple days of my cycle so I can just be by myself, probably on the couch (in sweats), honoring what my body is asking for.

Even in business—I have wanted to start my own practice for years, but it wasn’t until this spring that the Universe conspired to bring it to be. I am working hard, but in all honesty, it’s all flowing because I’m paddling downstream. I learned that from the Moon, from my cycles, and from listening.

If this intrigues you, I invite you to do the same. Maybe you jot down notes on a sticky pad or in your journal. Maybe you just spend some moments at the end of each day reflecting. Maybe you already have a Moon Journal. If you are interested in The Moon is My Calendar journal, you can order your own calendar journal here. (It’s an affiliate link, so I get paid a small portion of your purchase, fyi).

I’ve heard from many friends that they are intimidated and want to do it right, but the beauty is that there is no right way to do it. It’s a practice just like yoga and journaling and art. You just do it and see what comes out.

I’d love to know what you have learned from the moon and your cycles— Share in the comments!

Pelvic Floor + Core at A2 Physical Therapy

Do you pee a little during your workouts? Are you terrified of jumping jacks or jump rope or box jumps or just jumping? Do you avoid running because you might leak?

Maybe it’s not a leaking issue—maybe it’s feeling heavy “down there” after a workout, or a walk, or just being on your feet all day. Maybe you’re not quite sure what’s going on but it’s not how it used to be.

Maybe your core just isn’t the same after having a baby.

Maybe high school sex ed just didn’t cut it and you want to know more about your body.

If you relate to anything I just said, join us for this workshop, because we’re gonna cover all that, and more.

We’ll talk about:

• The pelvic floor: what it is and what it does

• The core—in detail!

• What to do about leaking

• What normal bladder and bowel habits look like

• How to use your pelvic floor during exercise & daily life

• How to lessen pain with sex

• And more!

We’ll incorporate pelvic floor and core exercises throughout the workshop to give you some real-time feedback so your body learns how to incorporate the pelvic floor with movement throughout the day. There will be time for Q&A too!

This is a workshop for you no matter what your exercise and fitness background. It will also be full of incredible information for personal trainers, yoga or pilates teachers, and orthopedic physical therapists who want a little deeper focus on local core activation for your clients.

Ready to join? Sign up at http://bit.ly/A2PelvicFloor

Details:

Open to all self-identifying women.

$15 to join, all proceeds donated to YWCA.

6-8 pm on Thursday, Sept 19

A2 Physical Therapy

3819 6th Ave in Tacoma 

Questions? Hit me up!

I'm Moving to Hilltop!

I’m moving! As of September 1, my treatment space will be located inside Fern + Foster Family Wellness at 1402 S 11th St in Hilltop.

It has always been my dream to work within a multi-disciplinary practice to meet the needs of patients in multiple areas, so this move is VERY exciting for me. Other services provided in the space include massage and acupuncture from Hello Pelvis, lactation services, and midwifery. There will also be classes and workshops across a wide range of topics, including a postpartum movement class taught by yours truly! You can check their calendar of events here.

AND there is a small yoga studio, so no more trying to do yoga and exercises squeezed between a massage table and a chair!

If you’re a current patient, mark your calendar and look closely at your appointment reminders to make sure you head to the right place come September! I can’t wait for you to see it!

Should Sex Hurt?

Should sex hurt?

BIG, FAT, NO.

Pain with sex is never normal, but unfortunately not all that uncommon. I’ve often heard from my patients that they just have “the normal amount” of pain when they’re with their partner. They often just “grin and bear it.” Sister, there is no normal amount of pain with sex! It’s supposed to be fuuuuun!

In the medical world, we call pain with intercourse Dyspareunia. There are all sorts of sub-categories that I’ll get to in a different post, but in general, we can lump it all under dyspareunia.

Before we continue, I want you to know that dyspareunia is VERY treatable and NOT something you just have to grin and bear. THAT’S GOOD NEWS!

Here’s a simple breakdown of what might be causing the pain:

Tissue stretch.

This will typically be pain at initial penetration that may get better as you keep going. It’s common after having a vaginal delivery, especially if there was tearing. And it’s often pretty quick and easy to treat with desensitization and stretching—good news!

Try this just before penetration: put some lube on your thumb, then place it just inside the vaginal opening. Press downward to stretch the tissue, while focus on relaxing the muscles.

Overactive pelvic floor.

Our muscles react to pain by bracing for it, right? If you’ve had pain with sex in the past, your pelvic floor is likely bracing for it, aka tightening up. Which will likely, in turn, cause pain. And make you tense up more...and on and on. The key here? Learn to release the muscles. Sometimes it’s as simple as learning to relax the muscles. Other times, especially if it’s been going on for some time, the muscles may need to be released by a professional like a PT (basically a massage, but internal.) These muscles can get knots and trigger points just like any other muscle, and can be released just like any other muscle too.

Try this: Focus on your sitbones widening as you take in a big inhale, then release the breath. Now try pushing out with a big inhale. Focus on breath and pushing out to actively release the muscles while your partner pushes in.

Tightness in the hip rotators.

I can’t tell you how many times I’ve heard someone say “it feels like he hits my cervix.” The cervix is not typically sensitive! Most often when this occurs, usually with deep penetration, it’s a deep hip rotator called the obturator internus. More good news? It’s often easy to release.

Try this: Pull your knee toward your armpit (kind of like a one-sided happy baby pose), and relax there for a couple minutes. Or try that position during sex and see if it helps.

There are more complex causes of dyspareunia that we’ll get to later, but these three are the top ones I see in the clinic. Can you relate to something in here? Take it as good news! Find a PT (make a free 15-min phone appointment with me!, or if you’re not in my area find one here) and let’s get it taken care of. Often times it can be addressed in just a couple visits.

I can imagine a world where no woman says she just has to “grin and bear it.”

YOU are worth more than that.

Urgency Part 3: Mind Over Bladder

Bladder training: it’s like potty training...yourself. Because really: who teaches us what’s normal once we’re adults? No one. Unless it’s a problem. Then it’s often me (or another Pelvic PT). Just call me your Bladder Coach.

(If you haven’t read Urgency Part 1 & Part 2, head back to them first. It’s imperative to understand what urinary urgency is and why your bladder is giving you funky signals before any of this bladder training makes sense. After you read those, then carry on!)

Here’s how to train your bladder so it listens to YOU, instead of YOU being bossed around. I call these steps “Mind Over Bladder”:

1. When you get an urge, DON’T RUN TO THE BATHROOM. Stop where you are. Sit down if you can. Just don’t head to the loo.

2. Start squeezing your pelvic floor (yes, cross your legs too if you want!). Squeezing your PF actually tells your bladder to chill out and calm down. 

3. Distract yourself. Count backward from 100 by 7’s or recite the Star-Spangled Banner in your head. Try not to think of how bad you have to pee.

4. Stay calm & breathe. An urge is literally a contraction—it will end eventually, no matter how strong it seems to get. Ride it out.

5. Once it’s gone (or *mostly* gone) calmly head toward the toilet. If it starts up again, start back at step #1.

The goal is CONTROL. Your bladder is highly trainable, and it’s used to getting what it wants (to be emptied) after it sends you the urge signal. You need to train it out by separating the urge from the reward. As you practice this consistently, you’ll start to notice more of that normal feeling of FULLNESS instead of the urge, and it will get easier to control.

I know it might sound crazy, but this stuff WORKS. There are countless women who are just handed a pill when they complain of urgency, but best practices recommend bladder training BEFORE medication for urgency. If this is you, try these steps! I’ve helped women wean off of bladder meds they’ve been on for years.

Tried it on your own and didn’t succeed? Reach out for help from a Bladder Coach (aka Pelvic PT). We’re here for you.

Want a FREE Coaching session (aka phone consult?) Click HERE to schedule!

Urgency Part 2: Your Bladder is a Big Fat Liar

In Urgency Part 1 we talked about what Urgency is, and what might contribute to it. Again, an urge is a sudden strong sensation to empty your bladder that is hard to postpone.

What’s so abnormal about this sensation, you might ask? Let me break it down.

Our bladder’s job is to fill, hold, then empty. That’s it. All day long, it moves through that cycle. The walls of the bladder are a muscle. That muscle relaxes to fill and hold, then contracts to empty. It’s a smooth muscle though, meaning you can’t control it—it’s like the muscle of your heart (thank goodness we don’t have to think about contracting that one, right?!).

A normal “full bladder” sensation is a STRETCH, meaning the walls of the bladder stretched or lengthened enough to tell you it’s about full. You can easily ignore this, though, and move on with your day. You’ve had this feeling, right? Right. 

An urge, however, is a CONTRACTION, or shortening, of the bladder walls. Which means it is literally trying to empty, right then and there. No wonder it sends you running to the toilet! What’s the worst thing you can do if your bladder is literally trying to empty? Step your legs apart, right? Walk. Run. Yep, that’s definitely not going to do the job.

This is basically an incorrect signal, and often a false alarm. The strength of an urge is NOT correlated with how full your bladder is. Your bladder is a big fat liar. And the more you follow its command (ie. head to the loo), the more it thinks it’s normal. The bladder is, for better or worse, highly trainable. It squeezes, you run, and it gets reinforced that this is ok. Super annoying.

If it’s trainable, can you train it back, you ask? Absolutely.

How?

The short answer is: stop obeying it! Try to ride out the urge with legs crossed and by squeezing your pelvic floor. If you can wait till the urge subsides, then head to the toilet: you’ve won. Keep doing that and it should start to get easier to control, and sometimes go away completely. 

The long answer: Head to Urgency Part 3 for the full scoop on Bladder Training.

Urgency Part 1: When You Gotta Go

When you gotta go, do you GOTTA GO? Do you feel like your bladder is going to explode every time you put your key in the front door? Does running water send you running to the bathroom?

Urinary Urgency is defined as a “sudden, compelling urge to urinate.” Sure it happens after you hold it for a while, like on a plane or at a movie, which is totally normal. But if it happens ALL THE TIME, and starts to limit your life? That’s a problem. It’s one of those things that a lot of people don’t realize is a problem until they hear that it’s not actually normal.

What causes urgency? There are a few different contributors. The most common is bladder irritants, which are foods and drinks that the bladder just doesn’t like. The big ones are coffee, tea, alcohol, carbonation and artificial sweeteners. (Most of us can relate to hitting the road with a cup of coffee only to stop at the first rest area we come across, amiright?) Others are acidic foods like tomatoes, spicy food, and citrus.

Another big cause of urgency is not drinking enough water. Say what? A lot of people with bladder issues cut down their fluids to AVOID having to pee, but this actually contributes to the problem. If your body doesn’t have enough fluid, the bladder is really unhappy. Why would it want to hold on to super concentrated urine? One easy way to tell if you’re hydrated is to check your output: if it’s smelly, dark urine, you’re probably dehydrated. You want it to be “clear and copious,” as my high school track coach always said (oh the things we remember).

My advice: work toward drinking half your body weight in fluid ounces, mostly water. Don’t like water? Add cucumber or a slice of lemon.

There is usually lot more going on with Urgency, but I don’t have room for it here. I typically spend two whole sessions on educating my patients about how the bladder works and how to retrain it!

If you raised your hand with those first questions, start with looking at what you put into your body (and therefore your bladder). I’ll share more in Part 2, so keep an eye out!

What makes you gotta go? Share in the comments!

On "Doing Yoga"

One of the most frequent things I hear from patients is that they just don’t have time for exercise, or yoga, or their home exercise program. Particularly when it comes to yoga, I think there is a perception that to Do Yoga means to carve out 75 minutes to go to a studio in your Lululemon pants and feel amazing afterward. I don’t know about you, but that’s just not the reality of my life most days. I was stuck in this perception for a long time, too. Even when I started my own home practice, I still felt like I didn’t Do Yoga if I didn’t spend at least an hour and go from “start in a comfortable position” and “end in savasana.”

You know what though? I’m over that. Yoga is yoga is yoga. Yoga is 5 minutes of meditation on the bus or on a meditation cushion. Yoga is standing on my back deck moving through a few postures (asana) before bed, or when I wake up in the morning. Sometimes I get to a class, but now that I’m teaching it’s more common that I’m in front of a class. I make space for it when I can. And you can too.

I try to start my mornings consistently: wake up early, meditate for a few minutes, then move through this seated asana. It moves my spine through all the planes of motion: flexion/extension, sidebending, and rotation. It feels SO good. And only takes a minute.

I posted a video on Instagram and IGTV of my morning routine. Click on the link to follow along—no matter what you’re wearing and where you are. Take a minute to move with me!

Thanks for moving with me today. Thanks for Doing Yoga. Namaste.

What do you find to be the biggest barriers to doing yoga or whatever your movement practice is? How do you make time for it? Share below!