Why I Don't (usually) Recommend Squatting During Delivery

“Is squatting an optimal position during delivery?” A common question I get from pregnant people and from some of the lovely birthy people in my circle. 

My answer, in short, is no.

There are lots of reasons why pelvic physical therapists will educate birthing people to consider (or avoid) certain positions during labor and delivery. Someone who is working through SPD (symphysis pubis dysfunction) may want to avoid asymmetrical positioning (½ lunge, foot on chair, etc) as one example. Every pregnant person at our clinic receives a thorough evaluation which takes into consideration many variables including symptoms and results from a functional movement screen in order to support them on optimizing their birth outcomes. 

And as I thought about this further, many questions came up for me. People have been squatting for birth since the beginning of time. What has changed? What am I noticing with squatting in clients that would lead me to recommend other positions during delivery? What do I know about body mechanics and birthing that has led me here? As I dove down this rabbit hole, I realized there were many variables in western culture that informed my present day guidance on this. 

To sum it all up in one succinct sentence....We do not squat correctly! 

  • See Image 1 below. Working with weight-lifters, I see it all the time. The ‘butt wink’-Google it! Essentially this is where the butt bones and tailbone tuck under, the lumbar spine curves and the pelvic muscles shorten. This often happens before we even reach the deep squat position. This is due to many variables, one big one being that functionally we never use a squat. We don’t socialize, eat, cook, clean or eliminate in a squat. What we don’t use, we lose (or in reality, never had)

  • See Image 2. Also, we tend to turn our feet outward, externally rotate our hips and come up onto the balls of our feet. This is likely due to poor ankle and hip mobility and if we accommodate like this, it becomes a much more comfortable deep squat.

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Why does squat form matter for birth outcomes? 

  • When we butt/tail tuck, this reduces the pelvic outlet space. This position might be advisable in the early stages of labor when we want to increase the pelvic inlet space but not advisable when we want to open the pelvic outlet space for delivery.

  • This changes the orientation of the pelvic outlet and we may end up working against gravity, which is one reason why we educate birthing people on concerns with lithotomy position! 

  • This shortens the pelvic muscles and makes them less resilient. Resiliency is key to having an intact perineum. Empirically, the incidence for perineal tearing in this position during delivery is higher. In addition, many of the pregnant clients we work with already have over-worked and tight muscles, so this just adds to it. 

  • When we turn our feet out and externally rotate our hips, this compresses the sacroiliac joint and may restrict motion. Often times (and for many reasons) we may educate people on keeping hips neutral among various birth positions or even coming into slight internal rotation to free up that pelvic outlet space, especially during delivery!               

I would love to hear your experiences with squatting for delivery, please let me know! The more we discuss, debate and learn from each other, the better for the people we support!!

Note: Not every person has poor squat form and with guidance, squat form can improve. See my attempt to compensate and improve squat form below however, even with compensation, my butt tuck and pelvic outlet orientation is not drastically improved. I truly don’t believe there is a ‘perfect’ way to squat. However, we can’t NOT squat regularly and then expect it to magically work well during L&D based on the above biomechanical considerations.   

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It's All About That Pressure

I recently attended a visceral manipulation course and re-learned something REALLY important that pertains to the pelvic PT work we do.

As you can see in my lovely illustration below, high pelvic pressures are attracted to areas of lower pressure (abdomen and lungs) which keeps the pelvic organs pulled UP and in place. You have all seen my balloon model explanation about optimizing pressures and how we can have symptoms if the system is not balanced. One example is how diastasis recti can cause an imbalance in the balloon pressure. 

Interesting point is that a cough is +300 cm H20 and birth is upwards of +500 cm H20. It is no wonder during pregnancy, L&D AND in the postpartum period we have trouble readjusting this pressure system. With support and guidance, we can:

*Protect the pelvic organs (read: reduce/prevent prolapse)

*Re-establish pressure balance to improve tolerance to load (read: sneezing, laughing, running, jumping)

*Eliminate unwanted symptoms (read: peeing your pants!)

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Congrats! You've Been Cleared to Return to Exercise in the 4th Trimester

It’s been 6 weeks. Your check-up goes ‘well’ and you’ve been cleared to return to exercise. So you lace up your running shoes, head out the door (possibly pushing a stroller?) and go for your first run. 

For some, all may go well. For others (many, many others!), there may be symptoms. The focus of this blog is to discuss a few possible symptoms. What is normal and what isn’t? 

Peeing in your pants. Common, not normal. Pelvic PTs use a balloon model to describe the pressure system of the deep core (including your pelvic muscles). Please see our other videos and blogs on these details as this is SO IMPORTANT TO UNDERSTAND. Sometimes the muscles of the balloon cannot regulate pressure well and when this happens, that darn urine escapes the bladder. Knowing WHERE the problem is in the balloon is key to correcting urinary concerns. 

Urinary Urgency. Common, not normal. Sometimes with impact (running, jumping, etc) the bladder muscle gets irritated. This may increase your urgency or even cause urgency that leads to incontinence. It’s the feeling of “I have to go right now” and then you may or may not make it to the toilet in time. Sometimes this can even happen when there isn’t much urine in the bladder!

Pooping in your pants. Common, not normal. See the ‘peeing in your pants’ section and replace the word urine with poop and the word bladder for rectum and there you go. 

Heaviness or pressure low in the pelvis. Common, not normal. This may be a sign that the pressure system is off. It is the optimal pressure INSIDE the balloon that keeps pelvic organs supported and in the right place. If the pressure is off, pelvic organs may adjust their position in the pelvis. 

Difficulty keeping a tampon in. Common, not normal. If you are so fortunate to have your period return early on (like me at 6 weeks, ugh), then you may be returning to exercise and returning to menstruation at the same time. With impact activity and a poor pressure system, it may be difficult to keep the tampon in place and it requires constant re-positioning. One solution (either temporary or, if you like, more permanent) is the Flex. This is actually a disposable menstrual disc that stays in place better (based on my experience and those of my clients!) AND can be worn up to 12 hours. I have no affiliation AT ALL with Flex, other than I like the product. 

Pain. Common, not normal. A small clarification here. Muscle soreness? Sure. Low back, hip or pelvic pain? Not okay. You are just 6 weeks out from the marathon of delivery. A 2-3 day marathon for some. Plus, you still have hormonal influences throughout your entire body. Breastfeeding? Even more hormonal influences on your ligaments and joints. Decreased spine, core and pelvic control may cause pain when exercising.

So...if I have symptoms, what should I do? There are many options! 

  • Ignore them and hope they go away (not recommended)

  • Pretend Kegels can fix everything (also not recommended)

  • Give yourself ample time to heal and SLOWLY return to exercise (good advice)

  • See your Pelvic PT who will support your body specific to its unique needs (best advice)

As a pelvic PT, the advice is simple. New recommendations indicate that no person who has given birth should return to running prior to 3 months postpartum! Once you are cleared for exercise (at 6 weeks-ish), it may not be time to lace up those running shoes just yet. There is a graded and therapeutic approach to returning to impact activity. This starts with loading your deep core (including your pelvic muscles) gradually over a period of time. We need to retrain the muscles of the balloon to all communicate and coordinate in order to effectively attenuate pressure with impact! Think of it in Phases. In Phase 1, we chose loads that your body can currently tolerate (may be LOW loads) without symptoms (see list above!). Good, now Phase 2. All the way to the last Phase which is going out for that two to three mile run pushing the stroller up/down hill. 

As you can see, it is not as simple as just doing your kegels (you’ve heard this by now I am hoping??). The postpartum body is complex with lots of cogs interacting within the machine. A pelvic PT is the expert in helping you discover exactly which cogs need some love and support in order to optimize function and quality of life.  

All women’s bodies are unique. If you would like to talk about how the above relates to your specific condition, feel free to contact me on FB. If you'd like to read more, you can visit our blog here or our YouTube Channel here.


Women Benefit from Seeing a Physical Therapist Early in Postpartum Period

We believe all women should have a postpartum pelvic exam and a supportive treatment plan with guidance from a specialized physical therapist. This is usually initiated 6 weeks after vaginal birth or 8 weeks after cesarean birth and should absolutely be a standard of healthcare in the US (another blog post, perhaps?). New moms have numerous physical postpartum concerns. Whether it is a urinary or bowel concern, a sense of pelvic heaviness/pressure, perineal discomfort, diastasis recti, or back pain, these can all be symptomatically overwhelming. And often these are the symptoms that can fall through the medical ‘cracks’ with standard postpartum care.

Ginger Garner sums this up with a beautiful blog where she quotes Robyn Lim, a maternal health advocate.

“All too often, the only postpartum care an American woman can count on is one fifteen minute appointment with her doctor, six weeks after she has given birth. This six-week marker ends an arbitrary period within which she is supposed to have worked out most postpartum questions for herself. This neglect of postpartum women is not just poor healthcare, it is abusive, particularly to women suffering from painful physical and/or psychological disorders following childbirth.”

So, hopefully we can agree that a skilled pelvic examination 6-8 weeks postpartum should be a standard for women’s health and wellness. However, I have also seen the value supporting women even earlier in the postpartum period.

We believe new moms greatly benefit from early access to a pelvic physical therapist for general postpartum education.

We believe, with early postpartum support and education, (and with continued guidance beyond 6 weeks), women can become more mindful of postures and behaviors that exacerbate symptoms. A pelvic examination would NOT be indicated at this time, but general education and support is indicated. Small bits of immediately applicable information help women feel supported and confident that they can have a positive impact on their postpartum body. Navigating the do’s and don’ts is overwhelming and, quite frankly, the approach should be individualized rather than integrating general info available on the internet.

We believe it is important to provide a safe, open and supportive environment where new moms get extended one-to-one time with a specialized health care provider (that’s us!). Because of this, we are able to screen and make early referrals as necessary for any other medical concerns.

We believe (and know!) that women want reliable and individualized postpartum medical information sooner rather than later and seeing a pelvic physical therapist is certainly a safe and cost-effective resource. A recent client of mine was referred in her early postpartum period, about 1 week after giving birth. She had numerous concerns about the physical sensations she was experiencing in her newly postpartum bod. Most concerning for her was a sense of heaviness or ‘falling out feeling’ in her pelvis and stress on her perineal tissue every time she moved. Although pelvic exam was NOT indicated at the time, here is what her session still included:

  1. Standing postural education to reduce pressure in her abdominals and pelvis

  2. More appropriate ways to hold and wear baby to promote postpartum healing

  3. How to breathe correctly, which is essential for increasing blood flow, circulation and gentle mobilization to perineal scar tissue

  4. Education on how to reflexively activate the deep core in order to support her core/pelvic organs when picking up her baby, transitioning sit to stand, and protecting diastasis recti if present

  5. Recommended baby-feeding postures to reduce strain on her neck, shoulders, abdominals and pelvis

  6. Water intake and output goals to decrease urinary urgency, frequency and incontinence concerns

  7. Positioning on the toilet and behavioral techniques to ease pain with bowel movement.

The above education is a partial glimpse into the information pelvic physical therapists can provide for women, which is information all should have access to! Daily I hear “I wish I would have had access to this information sooner” or “Why didn’t I know about this?” or even worse “Why did I just suffer through this for so long?” My opinion continues to be that early postpartum education, specific to each woman’s unique concerns, can help a woman feel more empowered and supported when navigating her newly postpartum body.

All women’s bodies are unique. If you would like to talk about how the above relates to your specific condition, feel free to contact me on FB. If you'd like to read more, you can visit our blog here or our YouTube Channel here.



Pelvic Rehab for Mom: Just as necessary as knee rehab for athletes

Seeing a physical therapist after spraining an ankle or sustaining an ACL injury is a fairly common practice for athletes and weekend warriors. There is a fault somewhere in the athlete’s system. It needs some TLC. If the athlete wants to obtain pre-injury level of activity (ie return to football or marathon running), physical therapy is important. Most people would concur, no questions asked.

And then there is diastasis recti, perineal tearing or c-section scarring. And hip pain, low back or SI joint pain. Women have just gone through 9 months of carrying and growing a baby. And the marathon or ultramarathon of labor and delivery. And yet, at our 6 week follow-up (6 weeks!?) we are told all looks good. You can resume life. And for some women, this is true. But for MOST women, it is not.

Many women continue for months (even years!) to experience pain with intercourse, pressure/heaviness in the pelvis, sneeze pee, pain with bowel movements and difficulty restoring pre-baby physical function. There is a fault somewhere in the woman’s system. It also needs TLC. Every woman deserves therapeutic guidance when it comes to reclaiming her body. After all, we wouldn’t blindly let an injured football player figure out his own rehab or even worse let him return to the game without any rehab. WHY SHOULD POSTPARTUM PELVIC REHAB BE ANY DIFFERENT?

I have good news. There is a specialized physical therapist just for you, to help you navigate the aftermath of being postpartum. I believe every woman should see a specialized physical therapist after the arrival of baby (or even before). I believe every woman should know this is even an option. I believe every woman deserves basic education and guidance on postpartum pelvic health. I believe that one day this will be the standard of practice.

All women’s bodies are unique. If you would like to talk about how the above relates to your specific condition, feel free to contact me on FB. If you'd like to read more, you can visit our blog here or our YouTube Channel here.

 

Kegels and Crunches Are Out, Hello Reflexive Core

Understanding the Reflexive Core

The Reflexive Core is comprised of the respiratory diaphragm, deep abdominal muscles and the pelvic muscles. This is a pressurized system among all of these muscles (think of a full balloon). The respiratory diaphragm and pelvic muscles are the exact inverse of each other, so these muscles make up the top and bottom of the balloon. The abdominals start at the front, wrap around your sides and connect in your back so think of them as 360 degrees around the center of the balloon.

 

 

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How it works:

Some functional anatomy, here it goes! The diaphragm, abs and pelvic muscles are connected. These muscles have to coordinate and communicate with each other in order for the reflexive core system to function appropriately. See this video for what actually happens every time we inhale and exhale.

  • Inhalation:  diaphragm lowers, pelvic muscles yield to the pressure change, abs open and release.

  • Exhalation:  diaphragm elevates (recoils), pelvic muscles recoil from elongated position, abs engage.

  • This is a balanced system and what it should look/feel like in every person when we breath correctly

  • This system should activate ‘reflexively’ (ie pelvic muscles tighten, abs engage) with movement or any time there is increased pressure through our center (think: moving sit to stand, bending to lift weights/children, coughing, sneezing, running, jumping, etc)

Sometimes, there is a fault SOMEWHERE in this system. It could be due to:

  • Diastasis Recti-a separation of the ab muscles. Think about a slit down the center of the balloon

  • C-section or perineal scarring-This can inhibit the elasticity/stretch of parts of the balloon

  • Weak pelvic muscles-not enough support/recruitment at the bottom of balloon to respond to changes in pressure inside the balloon

  • Pelvic muscles that are too tight-what if the bottom of the balloon was so taut that you couldn’t breath into it and get it to open and expand? Due to its decrease in elasticity, It certainly can’t absorb any pressure/force. Tight pelvic muscles= WEAKNESS.

  • Over-gripped abdominals-Think about just squeezing the center of the balloon. Where does the pressure go? This makes for very unhappy and compressed/descended pelvic organs.

  • Decreased awareness of alignment/posture-the ‘lean back & butt tuck’ posture or ‘slumped’ posture make for a balloon that isn’t stacked. These muscles can’t communicate!

  • Poor body mechanics/exercise techniques-breath holding, bending incorrectly, or exercise techniques that isolate only 1 part of the core system. What if only center of the balloon gets exercised?

  • Hormonal changes that occur throughout the lifespan

A fault somewhere in the system leads to SYMPTOMS that may include:

  • urinary incontinence-ANY involuntary loss of urine

  • urinary urgency-intense urge to urinate, with or without urine loss

  • urinary frequency-more than 7x/day, 0-1x/night

  • pelvic organ prolapse-heaviness/pressure into the pelvis or vagina

  • bowel incontinence, urgency, frequency, constipation

  • pain with intercourse, pelvic pain, low back pain, hip pain, perineal pain, c-section pain

What does this mean?

Correct the faults and decrease/eliminate the symptoms.

Note: This is why performing ‘Kegels’ or traditional abdominal exercises may not be effective or allow you to meet your goals. One must consider retraining the entire core system and addressing all faults in order to be most effective for optimizing pelvic health.

So, immediate actions:

  • Watch your standing and sitting alignment. The system has to ‘stack up’

  • Breathe correctly. Breathing with your diaphragm (360 deg rib cage expansion) decreases pressure on the pelvic floor and abs and brings diastasis separation closer together

  • Exhale to activate the reflexive core when lifting, standing up from a squat, etc

  • Be mindful of exercise techniques that could be contributing to faults and symptoms (This could be an entire other blog post!)

  • Seek help from a specialized PT, of course!

How will Physical Therapy help?

We have highly specialized training and we understand the pregnant and highly complex postpartum body in depth. However, we do have training to support women throughout the entire lifespan, even through menopause and beyond!

  • Proper evaluation is key. We will look for any and all faults and customize women’s physical therapy experience

  • Manual therapy. We will used skilled touch to address internal and external soft tissue concerns. Trigger points, fascial restrictions, nerve irritations, poor musculoskeletal alignment

  • Education. This is where we make behavioral, lifestyle, postural, ergonomic, body mechanics changes needed for women to succeed in healing her condition/concern

  • Exercise. No more Kegels or crunches please! I could talk about this forever. We guide women on re-training their entire system in a very functional way (ie how to bend, lift/carry babies, run, weight lift without losing urine, etc)

Who can this approach help? 

  • moms (pregnant or postpartum)

  • female athletes

  • women in menopause

  • any female experiencing pain or inability to wear tampons, pain or inability to undergo a gynecological exam or concerns with sexual health

  • any male experiencing pelvic, hip, lumbar pain or urinary symptoms

The good news...symptoms and conditions are highly treatable, don’t have to be endured, and it’s never too late to seek care!

If you cannot access a Physical Therapist, or need a home program to compliment your physical therapy plan of care, I highly recommend Restore Your Core ( at any point postpartum) and One Strong Mama (prenatal) because they address and incorporate all the important concepts discussed in the blog. Both being a very safe and effective approach to optimizing your core, pelvic, and whole body health! (FYI: I am an affiliate of both programs and I have been through the content extensively prior to becoming an affiliate!) 

All human bodies are unique. If you would like to talk about how the above relates to your specific condition, feel free to contact me on FB. If you'd like to read more, you can visit our blog here or our YouTube Channel here.

 

 

Immobility is Hazardous to Our Health

There have been several studies and articles citing the negative health effects of sitting at a desk for 40+ hours per week. Quite honestly, we can take a peek back even further to realize we have been sitting at desks, all day, since kindergarten. Between school, workstations, cars, couches and kitchen chairs, we are all spending too much time in the same alignment with little variation. Muscles and joints shorten to adapt to these positions. There is less blood flow. There is no doubt an increase in the rates of diabetes, heart conditions, metabolic disease and spinal pain. But can it be blamed only on sitting? Or is there a bigger concern?

As a PT, I can agree that we need to sit less overall but what I see as being the biggest contributor (outside of nutrition) to the decline in our health is the fact that we all need to move more. (Full disclosure is that I was sitting, reclined in my chair, with my laptop actually on my lap at the start of this blog. And then I moved).

Here is what the solutions are not

I have suggested ‘optimal’ ergonomics for my clients’ workstations for 10+ years. But fancy chairs and desks will not be able to replace our bodies innate need to move more. And a solution I can’t agree with is the popular idea to move everyone to a standing desk. While standing is certainly better, It is still not ideal to sustain ANY static postures (static = non-movement). So the problem with the standing trend is that we are just replacing one static posture for another!  Movement is essential to improving the current state of our health (or rather our un-health).

People who are ‘on board’ to improve their health get themselves to the gym for 1 hour/day. Although movement is good, the concern I have with this is that we cannot expect 1 hour of intense exercise to counter the negative side effects of otherwise being stagnant for 23 hours/day (I might be exaggerating, but only slightly). We have a  extensive lack of movement in our lives when we consider how we commute to work, sit to eat, sit to watch TV/play on the computer, sit to read, sit to socialize and lying still while sleeping. Honestly we don’t move enough. So, would 2 hours of exercise be enough? Maybe 3? I can’t find that kind of time.

So what is the solution?

I am encouraging my clients (and myself!) to move more throughout the day. In current culture we are encouraged to “work smarter, not harder”. But, I would counter that we need to sometimes work harder, to get little bits of blood flow, joint loading, muscle stretch and strength organically throughout our day. It’s as simple as taking the stairs, parking a bit further away, stretching while chatting with friends/co-workers, and even sitting but with variations in position. My friend asked the other day “how can you sit on the floor like that?” Because I do it. Regularly. And that’s how my joints and muscles will continue to know how to do it.

Even bigger solution: Changing the work culture

A dynamic work station is a good start to adding more movement to your work day. This means having the ability to change positions often, quite possibly every 30 minutes or less. It means sitting across various surfaces which changes the angles on our joints and demands on our muscles. It means standing a bit, maybe to stretch our spine, chest, calves or quads while we are on the phone. It means taking a few quick laps around the office while we take screen breaks. It may even mean doing a few deep squats to release even further. What about having our meetings while walking (2 birds with one stone. Seriously). This would mean changing the typical work culture as we currently know it. Please read “Don’t Just Sit There” by Katie Bowman if you want more easy-to-implement ideas and a read which certainly inspired this blog post!

All human bodies are unique. If you would like to talk about how the above relates to your specific condition or work environment, feel free to contact me on FB. If you'd like to read more, you can visit our blog here or our YouTube channel here

Response to NPR's article "Flattening the 'Mummy Tummy' With 1 Exercise 10 Minutes A Day"

The latest NPR article about “Flattening the Mummy Tummy” came into my world from 5 different directions today. I read (initially between clients) and then re-read and then re-re-read this article. I desperately wanted to agree however it has my radar up, to say the least. In all fairness, I am not familiar with this specific technique, I have never been to a class and I can only speak about the method within the context of how it was written in the article. I do have some concerns (read: major opinions) and would like to open up more dialogue around this and all exercise techniques in the postpartum period.

  1. Mummy Tummy.  We need to change the culture around the ‘flat is fit’ mentality. Let’s just focus on being functionally strong and well supported in our day to day lives!

  2. 10 min of exercise will cure DR. First of all, just no. No, no, no.  It is a major disservice to tell women that one exercise for only a few minutes a day will fix Diastasis Recti (DR). What about how we are using our bodies the other 23 hours and 50 min? I think it is way more important to consider how we sit, stand, carry babies, lift weights, bend, squat, and carry car seats! It isn’t about ‘exercising’ the core but rather about ‘re-training’ the core. I have worked with many clients with DR and I am certain it isn’t a simple or quick fix.

  3. The ‘sucking in’ idea has to go. Far, far away. Sucking in the tummy muscles can do more harm than help. Think about squeezing the center of a balloon. If we create excess tension in the center, where does the pressure in the balloon go? Up and down. Either direction is problematic, but especially concerning is down due to pressure and stress on the pelvic organs and pelvic floor.

  4. Reflexive core. I do think these instructors are focusing on the involuntary contraction of the lower abdominals by utilizing an exhaling breath. This exhale is attempting to activate the reflexive core but really it is the combined function of the diaphragm, abdominals AND pelvic muscles.  This is what should kick in for us naturally as we move and I use an exhale technique to help my clients retrain the reflexive core. But I don’t cue ‘tighter, tighter, tighter’ at the abdominals. I cue a coordinated contraction among the muscles. And cue the ability to generate only the appropriate force necessary for the demand of the task. A simple roll over in bed has a different contraction and demand than when we are running or jumping.

  5. DR doesn’t have to completely close to have a strong, functional core. Not much else needs to be said here. My goals for a client are never to decrease DR by X amount. My goal is for the client to stop peeing when they sneeze or to decrease low back pain when carrying baby.

  6. This type of exercise isn’t functional! This is already somewhat tied into my other points. But sitting cross-legged, on your hands and knees or performing this while standing doesn’t exactly replicate life. What about holding a 30 lb toddler while reaching down to pick up a heavy bag? THIS is life. And often times, the postpartum reflexive core needs to be re-trained to know how and when to kick in with variable demand situations. A suck in and hold is just not how the core system works.

  7. A piece of me feels this preys on the desperation of women. Fix DR in 10 min over 12 weeks? Lose inches off my waist without doing anything else? I will have a completely flat tummy again? And finally....Let’s all measure and compare ourselves during class? Yikes.

  8. I am biased. I believe all women should have access to a Pelvic Health Physical Therapist in the postpartum period for solid guidance and support. For BIG PICTURE pelvic health and body wellness over the long term (because postpartum bodies are more complex than DR and belly fat). I am also a strong proponent of home systems such as Restore Your Core and One Strong Mama because we all provide so much more than just ‘quick fixes’. I also want to mention the phenomenal Julie Wiebe, PT as I have learned a TON from her educational series!

All women’s bodies are unique. If you would like to talk about how the above relates to your specific condition, feel free to contact me on FB. If you'd like to read more, you can visit our other blogs here or our YouTube channel here

Why Kegels might not eliminate urinary incontinence

As a Pelvic Health PT, I’ve been at odds with the over-prescription of Kegels as a silver bullet ‘cure’ for all things wrong in the pelvis, specifically urinary incontinence (UI). This could be a much longer blog post, but I stuck to the top 3 reasons why I think Kegels are generally ineffective.

  1. Urinary incontinence may come from weak pelvic muscles, but not all weak muscles need strengthened. Weakness in the pelvic muscles can be complicated. But simply put, all muscle fibers in our body need to overlap the perfect amount to generate an optimal force. So, if a muscle is too long (over lengthened) then it will be weak because the muscle fibers don’t overlap enough. A person in this scenario may benefit from increased strength training. Conversely, if the muscle fibers overlap too much (ie the muscle is tight) this will also be weak, again because the muscle will not be able to generate force. Tight does not equal strong. Tight= tight=weak! This situation would require a release of the tension prior to focusing on strength. Now hopefully you see why more Kegels (ie tightening) will be ineffective! And as a pelvic PT, I see much more of the latter situation when it comes to the pelvic muscles.

  2. Kegels don’t replicate function. Pelvic muscles never work in isolation, so why train them that way? We are taught to do them in the car while at a stop light. And repeat over and over throughout the day. One thousand bicep curls don’t help you much with a half marathon. So an isolated contraction isn’t actually what is required when you bend to lift your toddler or when you perform burpees at the gym. We need to focus on functional re-training our core system to optimize results. 

  3. Many factors can contribute to UI. It’s just a sign that something is off somewhere in the core system. Let’s also take into account standing and sitting posture (alignment matters!). How about if someone has diastasis recti? What about a prolapse? How about someone who constantly grips their tummy muscles or who truly has a weak transversus abdominus? This list goes on….

The best way to assess all the factors that contribute to UI specific to you would be to see a Pelvic Health PT. And if you are pregnant, you would absolutely would benefit from One Strong Mama, which incorporates an effective and functional way to retrain your core system and provides such an amazing support system and network!


All women’s bodies are unique. If you would like to talk about how the above relates to your specific condition, feel free to contact me on FB. If you'd like to read more, you can visit our blog here or our YouTube Channel here

It's Not a Floor

We know I don't prefer Kegels (in name or function!) I also don't prefer the word pelvic floor muscles. Because it's not a floor. A floor is a hard, solid, unyielding surface.

I like to think of the pelvic muscles like a jellyfish; dome-shaped, soft and adaptable to the ocean currents.

The pelvic floor must release downward with every inhalation and recoil gently upward with every exhalation. And just like a jelly fish, when we change the pressure within our core, the pelvic muscles respond and yield to the demand. This functional system keeps our pelvic organs supported (and keeps us continent!), provides postural support and helps us maintain good sexual health. To consider it a floor doesn't relate its function.

Women's bodies are all unique.  If you'd like to talk about how this post relates to your specific situation, feel free to email at Jessica@mindfulmotionphyiscaltherapy.com or comment below.

Next blog: Your Core Is A Can of Soda which will highlight more about the reflexive core and its function

All human bodies are unique. If you would like to talk about how the above relates to your specific condition, feel free to contact me on FB. If you'd like to read more, you can visit our blog here or our YouTube Channel here.

Thoughts on Kegels Being Useless

Want to get back in shape after baby? Do your Kegels.

Want better sex? Do your Kegels.

Want to get rid of your pelvic pain or back pain? Do your Kegels.

Want to stop losing urine when you cough or exercise? DO MORE KEGELS .

What if I told you that Kegels are not a silver bullet exercise and I am a Women's Pelvic Health Physical Therapist? Kegel advice is still being given by doctors, trainers, and magazine articles. How many of you have done what you've been told, with little or no progress? Many of us have been here.

Kegels are an isolated exercise, and may not be effective (read: even useless!) because the pelvic muscles never work in isolation. I prefer to not even use the word Kegel because of the isolating image this projects. I prefer to talk about the reflexive core. It consists of several muscles including the respiratory diaphragm, transverse abdominals and the pelvic floor muscles. These muscles all communicate and coordinate as part of a larger system of core support.

To see the progress we truly want and need, this means shifting our perspective away from isolated exercise and consider the bigger picture of total pelvic health that includes so much more than the pelvic floor. 

All women’s bodies are unique. If you would like to talk about how the above relates to your specific condition, feel free to contact me on FB. If you'd like to read more, you can visit our blog here or our YouTube Channel here.

Next blog: It’s Not a Floor which will highlight more of how the pelvic muscles actually function!