What To Expect From Your First Visit

I know that it can feel really scary to make that first phone call to a pelvic floor therapist, but I want to tell you that it will be worth it! I get on phone calls with new patients at least once a week to help them better understand the landscape of that first visit.

What should you expect from your first visit to a pelvic floor physical therapist?

• A conversation

  • This will be about about your concerns, symptoms, goals, and past medical history.

  • I will talk about what might be contributing to your symptoms either from the musculoskeletal stand point or from a more medical standpoint.

  • This can be a quick conversation lasting maybe 10-15 minutes or it can be the bulk of our evaluation time depending on your history and symptoms.

• An orthopedic movement assessment

  • If I’ve done a good job of learning about your symptoms and medical history, I will have a good understanding of what structures are contributing to your symptoms. That conversation will drive the assessment part of your evaluation

  • The evaluation might look like a movement assessment of your spine or hip. It might look like an in depth assessment of your core muscles and how they are working through a variety of movements. It might be a combination of all of these areas. This is the type of assessment most people expect from a traditional physical therapy assessment.

  • The pelvic floor is part of a larger system and if I miss a problem elsewhere (back, hip, core, etc) in this system, the pelvic floor piece will be meaningless.

• Maybe a pelvic floor evaluation--this totally depends on your comfort level!

  • The pelvic floor muscle assessment is different from your traditional medical exam because I don’t use stirrups or a speculum to do my assessment. I just use a gloved hand.

  • Your medical provider has an end goal with their pelvic exams because they need to assess your organs.

  • A pelvic floor muscle assessment can be done externally around the genitals and rectum. This can give me a ton of information about how these muscles are working.

  • A pelvic floor muscle assessment can also be done internally. I can assess those muscles through the vagina and/or the rectum. The decision to do an internal evaluation of these muscles will depend on your symptoms and comfort level. Palpating the pelvic floor muscles is very similar to palpating the quadriceps in a patient with knee pain. I am looking for tightness in the muscle that would contribute to pain or limit the muscle from getting stronger.

  • I will check to see if you can contract those muscles, relax the muscles, and gently lengthen the muscles. Again, this tells me a lot about the function of your pelvic floor muscles.

  • If you consent to a pelvic floor muscle assessment and at any point you start to feel uncomfortable and want to stop, then tell your therapist. They will stop the exam.

• And lastly, another conversation about the findings from the evaluation and how your therapist is going to help you meet your goals.

The first and last conversations are the most important part of the evaluation. If you need help finding a pelvic floor therapist in your area, check out my blog here for links to the most commonly used directories for pelvic floor physical therapists. If you have any other questions, please feel free to reach out! I’m always happy to help!

Diasta---what?!?

Life has slowed down in the last few weeks and I found myself lost down a rabbit hole of misinformation.

Diastasis rectus abdominis (or DRA) is such a hot top these days. It is so nice that most of my patients (especially postpartum ladies) are aware that this is even a thing, but the fear and misinformation around a separation in the abdominal muscles during or after pregnancy makes me sad.

▪️What is a DRA? This is a separation of the rectus abdominus muscles or your six pack muscles. This can be very small and is usually measures in fingers or centimeters.

**Permission to use copyright image from Pelvic Guru

▪️Is it normal to have a DRA? Yep! We have a separation in our abdominals when we are born and over the first two years of life, this will come together in most, but not all toddlers. This is also normal to see during pregnancy and during the postpartum time frame. Similar to what we see in children, this can heal on its own in most postpartum women.

▪️Should you be aware that you have one? Yes!! Absolutely!!

▪️Should you be afraid that your abdominal muscles will never be functional again? No!!!

▪️Is DRA preventable during pregnancy? Nope. Your uterus needs room to expand and your linea alba (the tissue between your 6 pack muscles) is designed to stretch to let this happen.

▪️If you have a diastasis, should you avoid certain exercises? Maybe! In PT school, I had a professor who would say “it depends” and just walk away without explaining further. Managing DRA is about learning how to use your core as a whole versus just closing the gap. There might be times where certain core exercises are not the most appropriate activity for you YET. I think it is always worth a try to get back to exercises you love or feel are valuable!

▪️Will crunches make my separation bigger? If you are using your core correctly, this is not likely! This separation comes from sustained stretch over time, not because you did a few crunches or sat up out of bed “wrong.” Lists of exercises that you should NEVER DO AGAIN are trying to take a complex system and pigeon hole it into a nice list of rules. This is not how the body works.

When I first graduated PT school, the discussion around DRA was to close the gap. With additional research, we are learning that it is more important to have a firm linea alba, strong abdominal muscles, and good pressure management strategies even if your gap is out of the normal range.

▪️How do I know if I have a DRA? You can perform a self check like in the video below or your can have a physical therapist or personal trainer who has had additional training on pregnancy & postpartum check out your muscles for you.

▪️What do I do if I have a Diastasis?! Call a pelvic floor physical therapist for a full assessment of your core system. If there is not one available in your area, please reach out to me and I will help you find a therapist or coach who can assess you and help you move forward with your DRA.

What Is My Core?!

Welcome back!! On the last blog post (many many moons ago!), we talked about the pelvic floor and how it is a part of a larger pressure system. This week, we will talk more about how to find your core muscles!!

In my early days of working out, I hated core work outs because they consisted of sit ups. And more sit ups. And more sit ups!! That’s really all I knew to do to work my “core.” Once i started practicing yoga, I finally understood that I could have a strong core without ever doing a sit up. As my journey through physical therapy school progressed, I learned how the Transverse Abdominis (TA) muscle is the deep root of our core. Our current working theory, is that these muscles help to support your organs so that your mover muscles-the Rectus abdominus muscles, the internal oblique, and the external oblique muscles-will let you do whatever it is that you are trying to do.

Permission to use copyright image from Pelvic Guru LLC

This idea has become more prevalent in the fitness community over the last 15++ years and I know I often hear cues about “locking your belly button back to your spine” to try to activate the TA muscles while doing movements. In reality, these muscles (or any other muscle!!!!) cannot function at the top of their game if they are 100% locked down. Think about how it feels to do a bicep curl.

Once you have reached the top of the curl, that muscle has nothing else left to give. As humans, we don’t bring any other muscle group to a full contraction and ask it to perform starting in that position, so why do we ask our TA to do this?! Personally, I tend to over use my TA if I am not careful. A better way for me to use my TA is to perform a GENTLE contraction of this muscle before doing the core exercise or activities in my day where I might need additional support. When I am having a day where I feel clenchy, I will gentle engage my TA and totally let it go before performing exercises. This allows my brain to still think about these muscles and cue my brain into them, but use them in a way that helps me complete the movement instead of get in the way of my exercise. I’m all about working smarter, not harder!!!!

Now you know the importance of these muscles, but how do you find them?! The transverse abdominal muscles start in your back and wrap around to the front.  In workout classes and videos this is often cued as “draw your belly button towards your spine.”  I find that this cue causes people-myself included-to hold their breath and tighten their upper abdominal wall instead of their TA muscles. When the TA muscle tightens, it will gently sink down while your pelvic remains level & you continue breathing normally.  If you feel a slight tighten in your pelvic floor (like you’re doing a Kegel), that is normal because these two muscles are a team. You can use your hand on the inside of your pelvis (as pictured below) to help feel this muscle move. Try all the cues listed below and see which one works best for you!

5 Cues To Find Your TA Muscle:

1. Gently tighten your lower abdomen like you are zipping up a tight pair of low rise jeans, but do not let your pelvis tilt with this!!

2. Gently draw the front of your pelvic bones (the bones on the outside of your hand if your hand is placed on your stomach as pictured) closer together.

3. Try to gently draw your pubic bone (the front bone that your pelvic floor attach to) towards your spine without tilting your pelvis.

4. Take a normal breath in & let everything relax with your hand placed as pictured above.  As you are breathing out, feel your lower abdominal area gently tighten and sink down towards your spine. As you breath in, you should feel the muscles totally relax and your abdomen should become soft. After you get this feeling, try the cues above again and see if you can better find these muscles.

5. Imagine a trampoline.  When you step on it, the bounce mat (or fabric part) will tighten but sink away from your foot.  You want to gently tighten that lower abdominal area while letting it gently sink away from your hand.

You can blow the air out with any of these cues to help support the TA activation especially when you are first learning to use this muscle. It can be tricky! I always think of the scene in Forgetting Sara Marshall where Peter, played by Jason Segel, is trying to learn how to surf. The instructor keeps telling him to do less and less, but he can’t just lay on the board—that’s not how surfing works!

Once you find the muscles, what can you do with them? Well, the possibilities are endless!! Try adding the gentle tighten into your normal core routine, but make sure you are letting these muscles totally relax once you’ve used them. You can try the strategy where you gently tighten the muscle and totally let it go before you do the core exercises and see if that allows you to complete the exercise with increased ease. You can even add this gentle tightening into your normal activities like lifting your baby or lifting your groceries. Remember, just like the pelvic floor—and really ANY muscle—you want these muscles to be strong and flexible!! This means you don’t want to hold the muscles tight at all times!!

I can’t wait to show you guys what I have been working on over the last few months! Sign up to join my mailing list and stay tuned for big things coming!!

Welcome to Pace Yourself Physical Therapy!

I’m Emily and I am originally from Knoxville. I was so fortunate to discover at age 16 that I wanted to be a physical therapist.  This firm knowledge pushed me through undergrad at ETSU and the desire to be a PT didn’t waver--until I was getting ready to apply to PT school.  I decided to take a year off (to the dismay of my loving parents) and took a job in a therapy clinic to make sure this is really what I was really supposed to do with my life.  

I was so blessed to end up in a clinic that treated a huge variety of conditions including orthopedic, neurologic, pediatric, and pelvic health.  I was so intrigued by the incontinence program this therapist was running. I had no idea that physical therapists could help with these symptoms!  And even more importantly, I was seeing these patient GET BETTER! It changed their lives in such a different way than fixing their shoulder or knee that I was hooked!! I spent my 3 years in PT school working my tail off to learn everything I needed to know to pass boards & start my career, but I also sought out opportunities to learn more about pelvic floor dysfunction.

When I initially moved to Johnson City, I swore up and down that I would never live in Knoxville again.  Well, I have learned to never say never!! I did my last round of clinical internships in Knoxville and had so many amazing opportunities here that I didn’t want to leave.  I fell in love with Knoxville all over again as an adult. I love all the outdoor space, the shopping, the events, the community as a whole, and most importantly--the food!!  Even when other opportunities presented to leave the state, I couldn’t bring myself to leave.

There are so many reasons I am passionate about treating pelvic health, but I think the main one is that it gives me huge opportunity to serve an underserved community.  You can throw a rock in this town and hit a PT clinic, but there are only about a dozen pelvic health therapists working in the greater Knoxville area (which is up from the 6 that were treating these conditions when I started!!).  I have built a wonderful practice at East Tennessee Spine & Sport in Oak Ridge, but I know there are still so many more opportunities out there to help more people.

I am creating these programs for a number of reasons:

1. There are so many people who cannot make it to physical therapy and I want to be able to provide a variety of resources to help these people.

2. Most people don’t understand they have pelvic floors or how these muscles can impact their lives.  If people know anything about their pelvic floor muscles, it is usually a vague knowledge that if they do their Kegels they should be good to roll.  But most people have very limited awareness of how amazing and wonderful this group of muscles can be when they are working properly.

3. I want to normalize utilization of pelvic floor treatment throughout the lifespan.  I treat patients as young as 14 and as old as 96 who have a variety of conditions and concerns.  Pelvic floor physical therapy can help all of them!

4. And lastly, I want to try to work myself out of a job.  The number of people who have had urinary incontinence or pelvic pain for years is heartbreaking!! Many of these people think that they have to live with it or that it’s normal. My goal is to increase awareness of how these muscles can contribute to various dysfunctions and how physical therapy can help.  Just like any other condition, the earlier we catch these problems the faster we can fix these problems!

Now you know a little about me, jump on social media and follow me there.  I will post updates about the program and my life on there!

Fair warning, my social media is usually full of my dog, my travels, and pelvic health info I come across!!