The Sad Moms Club
A podcast to connect Utah women--especially those who are infertile, pregnant, or postpartum--to the local maternal mental health resources available. I interview providers around Utah to help bring therapy tips and coping skills conveniently to your ear-holes.
The Sad Moms Club
27. Rehab Your Pelvic Floor During Pregnancy and Postpartum with Vagina Magician Betty DeLass, PT, DPT
Dr. Betty DeLass is a passionate pelvic floor physical therapist and business owner in Utah. She owns Reborn Pelvic Health & Wellness and talks with us about why women should prioritize pelvic floor treatment, symptoms PT can improve, and treatments for different conditions. We talk about pain with sex, sciatica, symphysis pubis dysfunction, and peeing and farting when you don't mean to. She talks about what to expect at a first appointment and the importance of consent along the treatment journey. Reborn specializes in working with pregnant and postpartum clients. To contact them go to their website for their phone number or follow them on Instagram @rebornpelvichealthandwellness.
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Good morning. I don't know if it's morning for you, but I woke up at 7:00 AM, which is not early for you. Probably. But for me, it felt early today. I think I went to bed at like 1:00 AM last night. So. Six hours. I don't know why I feel like this is one of my favorite things to do is to tell people how many hours I've slept. Which is just comical because I'm talking to people who are sleeping. Far less than I am. But I love to complain and garner that sympathy when I have slept poorly. Anyways, I woke up early because I've been putting off recording these intros and outros for far too long. And I tend to get things better done, right. When I first wake up. So here we are. Today we have Dr. Betty Dulles, who is a pelvic floor, physical therapist and owner of reborn, pelvic health and wellness. We born now has two locations, one in west Jordan and a new location in Lee high. Right next to the Edna sign. If you've seen that sign off of. You're going to learn a lot from this episode. I had a different pelvic PT on the podcast at the beginning of this year. And I still learned a lot of new things. So recommend listening. We talk about what pelvic floor PT is like. We talk about her favorite exercises that she gives people to work on so that they can strengthen their pelvic floor. Uh, they're not key goals slash kegels. We talk about common reasons people come in and some potential treatments that her team might decide to do based on the problem you're seeing them for. So, Some things that we talk about, like urinary incontinence, pelvic pain with sex. Low back pain, pain, where your scar is from like an episiotomy or from tearing or from a C-section scar. We talk about sciatica. And pubic symphysis dysfunction. So, yeah, all sorts of things. It's really helpful and great information. And you can tell that Betty's just really passionate about what she does. And helping women live a full life. So I'm going to play a quick clip before we jump in. Uh, just cause I had started recording before we started actually talking and I didn't have a place for it. So I just thought it was a really good intro. So you can kind of get an idea of how great Betty is so we're going to listen to that and then we'll get started.
Betty:My biggest, like my biggest thing that like I'm super passionate about is if you were to have like an A C R tear or shoulder rotator cuff repair, you would start rehab right away and you would do it for months. But what we do with having a baby is you just get sent home and six weeks later, come back to be like, oh yeah, you're cleared to do everything. And it like unravels my strengths.
Joni:Thanks for being on. Betty, do you say your name? Delas
Betty:Yeah,
Joni:Betty Delas. Can we start by you explaining what is pelvic floor, physical therapy, and what is the pelvic floor even?
Betty:What I like to tell people is that pelvic floor physical therapy is it should be anyway, physical therapy. Orthopedic physical therapy and pelvic floor physical therapy. So basically we're the nerdiest nerds of nerds and couldn't stop until we arrived at the pelvis and we're like, oh, this is the missing piece.
squadcaster-562j_1_08-30-2023_132707:We do it all. We do physical therapy things. We do orthopedic therapy things. So when people think orthopedics, like back pain, neck pain, shoulder pain, knee pain, hip pain, the general ortho stuff. And then we also specialize in pelvic health. And that's why typically most people come to see us. And so pelvic floor therapy incorporates all of those things plus the internal exam with the examination of the pelvic floor. So from an evaluation standpoint, we do a full body movement analysis on everyone. We'll have you come in, we'll have you move all different directions, squat, lunch, balance, jump, run, whatever you're able to do at that point, that's appropriate to do. And then we may add some of those things in later. And then we will dive deep into each area of your body. We'll look at your entire spine. We'll look at your rib cage, your breathing patterns. We'll check out your abdomen. We'll check for diastasis recti, which is the separation of the ab muscles that happens normally during pregnancy. And then we'll assess your organ mobility. We'll see how your intestines and organs are moving.'cause sometimes that can get locked up with. Other surgeries or if you've had a C-section or babies kind of move and push things around. And then we'll dive deep into your low back, your hips, your pelvis, your SI joints, your tailbone, pubic bone, all the way down to your feet. We'll switch gears and do an internal exam, which is similar to an OB or a midwife in the sense it's an internal pelvic exam. Completely different because it's through the lens of a pt. So there's no speculum. There's no stirrups. It's just. Glove finger and lube, and we're assessing everything through the lens of a pt. So we're looking at range of motion, strength coordination, trigger points, scar tissue prolapse, pressure management, endurance, all sorts of things like that. And then we compile everything we found internally and externally.'cause a lot of times it's things in the pelvis and outside of the pelvis that are contributing to the pelvic floor problems. And then come up with an individualized plan for each and every person that comes in to be like, this is what you need in order to. Get rid of X Z because we could literally have 10 people walk in and say, I pee my pants when I sneeze a cough, or jump on the trampoline. And it would be for 10 different reasons. So we have to figure out the underlying root cause of why are you peeing your pants? Could be a weak pellet floor, could be a tight pellet floor, could be in coordination, could be pressure management, all sorts of things that could be contributing to that.
Joni:Can you explain just what pressure management is? I don't know
squadcaster-562j_1_08-30-2023_132707:Yeah. Yeah. So pressure management is, you have an internal pop can in your belly. So you have your diaphragm on top, pelvic floor on the bottom. Your abs are in the front, and then your low back muscles are in the back, so it forms this pop can. We need to be able to pressure manage that pop can. So if you cough or sneeze, what you're doing is you're pressurizing down and it puts pressure on the pelvic floor. And if you don't combat that pressure, you pee. But you need to be able to contract against that and pressure manage that. Or if you're jumping or lifting something heavy, you wanna make sure you're using your breath to pressurize that internal canister or pop can, if you will, so that you're not leaking, you're not hurting your back, you're not doing weird things.
Joni:You used the word pop instead of soda? what I'm understanding.
squadcaster-562j_1_08-30-2023_132707:yes, I'm Wisconsin, so yes, I, it pop there.
Joni:have a cousin who always calls it pop. And when you said it at first, I'm like, does she mean. She's about a soda
squadcaster-562j_1_08-30-2023_132707:Yeah.
Joni:Yeah. Okay, making sure we're on the same page. Cool. Can you just explain like basic of basics, what even is the pelvic floor, what's included in pelvic floor? What's not the pelvic
squadcaster-562j_1_08-30-2023_132707:Yeah, so the pelvic floor muscles is this bull that goes from your pubic bone to your tailbone and it sits underneath you. It's basically what you sit on top of and it's just a sling of muscles. There's actually three layers of muscles there, and they control the functions of the pelvic floor to support the organs. Sexual function stability of the pelvis and all sorts of things like that most of the time if your pelvic floor is working well, you don't even know you have a pelvic floor, which is a good thing. But when it's not working well, you have lots of problems or some problems and you're like, this is miserable. And it's a hidden thing too,'cause no one sees it because you could leak and no one would know. Or you could have pain with intercourse and you could just like, Not tell someone about it or have low back pain and just push through. I always like to equate it similar to mental health is it's there, but it's a hidden thing if you're not talking to someone about it. And so a lot of times people can be embarrassed or they don't know how to find help or who the right person to go to is. But know that, if you're aware of your pelvic floor or something isn't working right down there, there's a hundred percent help for that.
Joni:I imagine a lot of people also are just like, I guess this is just what, having a child did to my body and it's never gonna be the same again. Or this is what age does. And they just resign themselves to the symptoms for the rest of their life.
squadcaster-562j_1_08-30-2023_132707:Yeah. A lot of people are just like, oh, my mom peed your pants. I'm gonna pee my pants. It's genetic. This is just normal. This is how it is is the price of having kids. no, no, no, no, No. It doesn't have to be that way. We can do so much to help and you don't have to live like that. And we have proof time and time again of Successful patient graduations all the time that they're like, oh my gosh, you changed my life. Didn't know this was possible. I didn't even need help with this. And it's super rewarding, especially for the patient to, to be able to control and have control back over their body.'cause so many people feel like I've lost control over my own body.
Joni:Yeah, absolutely what are some reasons someone might seek you out? You mentioned peeing your pants. What are other common symptoms people experience?
squadcaster-562j_1_08-30-2023_132707:So a lot of times people might have low back pain or si joint pain, so that'd be like the side of them, their low back. Sciatica, tailbone pain, s p D, which is pubic synthesis dysfunction. Or some people call it lightning crotch where it hurts right in your pubic bone when you're pregnant. Birth prep. Postpartum recovery, postpartum, return to exercise or running um, or sport or whatever it is. We see a lot of people with prolapse symptoms, which is the sensation of your organs falling down or feel like your vaginas falling you. Also the incontinence, whether it's urinary or fecal. So if you're farting when you don't mean to fart or you have fecal smearing on your underpants, or you have to wipe multiple times we can help with all of those things. So those would be some of the like common things. Diastasis, recta, again, any core management of stuff. All of that stuff from head to toe, basically.
Joni:Yeah, that's a lot. Why should someone prioritize doing their physical therapy like right now? Why would you recommend they do it sooner rather than later?
squadcaster-562j_1_08-30-2023_132707:Yeah, that's a great question. So I'll walk you back in time and kind of lens out a little bit. I've been practicing for 11 years and about halfway through my career after I started doing public health I was working at a place where most of the clientele coming in was 55, 65 year old women. And they had already had all the imaging, the surgery, like everything, and PT was their last resort. And so they came into the clinic, I'd see them for five sessions and then they'd be in tears. And I was like, what's wrong? And they're like, how come you've helped me in five sessions and done more for me than that surgery and all this other stuff. And I was just like, oh my gosh, these people still need help, don't get me wrong, but we have to go upstream. We have to prevent this from happening. And me personally,'cause I was in a stage of life of childbearing years, and I had two kids already. I was like I need to change the world I need to go upstream. I need to catch people. Or when they're having babies, before they have babies, after they have babies. And really focus in. And that's why it's super important to go in sooner than later. And I always wanted to say this too as a disclaimer, like it's never too late either. So like the oldest lady I've ever helped was 92 and I helped stop her from peeing her pants after eight visits. If she can do it, there's still hope, so I don't wanna discredit anything that you can't get help if it's oh, it's been 20 years since I had kids. It's not true. We can still help you. It's just easier to prevent things and maybe less sessions and less, investment of resources and stuff like that. If you can catch it earlier and be well set up down the road. If you were to tear your a c l in your knee or have a rotator cuff tear in your shoulder, You would start rehab either before you had surgery or like immediately after you'd had surgery. And you would do rehab for not just one or two sessions. You would do it for six to nine months, for one little ligament or tendon. And we do that regularly. If you had surgery on your shoulder, you would expect to go to rehab. You would do the routine, you would go through all the exercises, you'd build up the strength, you'd build up the endurance. You'd do some manual therapy, you'd do some cupping. You'd do all sorts of things to get back to doing the things you needed to do, whether that was walk stairs, run, throw a ball, pick your kids up, lift them into a swing you would do those things for this little area of your body, what we do. Which is changing thankfully, is now the standard of care is pelvic floor physical therapy. If you're not getting pelvic floor physical therapy, you're missing out on the standard of care. That is true standard of care now. That's always lagging, right? Especially in America, what happens is people have their baby, oh, yay, baby. Go home. See you in six weeks. So you're left with sleep deprived, healing your body from giving birth, whether it was a C-section or a vaginal delivery. Both you need to heal from and having to still pick up the baby and pick up the car seat and do some laundry and go grocery shopping all this stuff and you're just like, good luck. And then you come back in six weeks and they're like, great, you made it six weeks. You're cleared. You can go back to having sex and running and doing all this stuff. And I won't wanna rip my hair out when I hear anything about six weeks. Because your rehab should start way sooner than that, and it should go way longer than that. Just like an a c l tear or rotator cuff repair. There's so much that changes in your body during pregnancy and then you go from really pregnant to not pregnant at all. So much has happened. You really need to rehab that. You need to prehab it during pregnancy to prep for labor and delivery, and you need to rehab after, in the postpartum period to get back to doing everything you want to be able to doing. And that looks different for every person, right? some people wanna get back to. Doing extreme things in extreme sports where other people would just wanna be a mom and push the stroller around the block. And there's nothing wrong with either one of those things, but you need to be able to do the things you need to be able to still be intimate with your partner. You need to be able to, pick up a Costco box carry it in the house. You really need to reset all of that stuff. And the pregnancy and postpartum is the biggest, like bigger than any other surgery, minus some like catastrophic thing of change that happens in your musculoskeletal system. And so why would we not? That's the part that like gets me is we should be doing this. Everyone should be doing this. that's what we're really passionate about. Reborn especially, is just to change the world one vagina at a time because it really does change the world. Because if mom can do what she wants to do, when she wants to do it, how she wants to do it without being sidelined by back pain or leaking, or be able to jump on the trampoline and have joy with her kids versus sit on the sidelines, that's what it's all about.'cause then if mom's happier and she can do all these things, then she's better able to serve her family, her kids, her significant other spouse community, church, whatever she's participated in. And then from there, it just ripples.
Joni:I love that. I have a few thoughts while you were talking. One was about the standard of care when you say standard of care, is that standard of care, like in the physical therapy world in like OB G Y N world? Has that actually changed?
squadcaster-562j_1_08-30-2023_132707:Great question. Standard of care in Europe is 12 visits postpartum of pelvic floor physical therapy. So Europe's been doing for some years. We've just changed our language to be that, of no, this is standard of care. I'm sure there's some OBGYNs and I do know some that are very pro pelvic PT and send people and things like that. The problem is we're just so specialized in what we do. We don't know what each other does and most people think that pelvic floor therapy is kegels and biofeedback and that's not the case. It's way, way more than that. And there's still a lag in America for sure.
Joni:Gotcha. My other question was I imagine it'd be easier to Start seeing someone like you before you're having issues that you're concerned about and that are maybe embarrassing to talk about, but if someone's in the spot where these things are already happening and they are embarrassed or they're nervous to make an appointment how do you walk someone through those feelings?
squadcaster-562j_1_08-30-2023_132707:Yeah, that's a great question. On our website, it's very content heavy, so we have a lot of things where people can read. We have some YouTube videos. We have some free downloads, so like people will start to get familiar with us. We also do a free phone consult and we also have. A free introductory screening assessment where people can come in and meet the provider, get a little screen through that. We don't actually do a full evaluation on those things, but we can have conversations and ask questions about that. And we always tell people too when we talk to them of nothing is t m i, nothing is too much information for us. We've heard it all. We've seen it all there's a safe space. And I think that we as pelvic health providers just almost take that for. Everyone coming in is talking about pooping peeing and sex and like what problems they're having and they're just like, I can't do this and I can't do this and this happens. And it's almost like normal talk for us in our clinic. So know that we are never the barrier to making that a safe space too. And. That kind of dovetails me into a little bit of the trauma side of things too. There's a lot of people, most people that we see have some sort of trauma history. And we are all trauma informed therapists, so we will walk you through those things. If you're not ready to do something, we're not going to push you to do it it's on your timeline for sure. And everything's consent driven and it's ongoing consent throughout the whole process.
Joni:That's awesome. What if they're just worried to make that first phone call? Is there any, I just, I like personally know someone who like, I, I won't go.
squadcaster-562j_1_08-30-2023_132707:Yeah.
Joni:do you, I mean, I can't push'em to, but is there anything you would say to them?
squadcaster-562j_1_08-30-2023_132707:besides just referencing some other, like Google reviews or having them talk to a friend that's gone, or if they know someone or if they wanna talk to someone who's already been to therapy sometimes that helps to just ease their nerves. Obviously we can't force anyone to do anything they're not ready to do. And we have people all the time that they'll be like, oh yeah, I've been following you for over a year on social media, and I've just, I just haven't done it. And finally I took the plunge. And then they usually come in and it's always the same story each time. I should have done this sooner. Why did I wait so long? But you also have to, you have to be ready yourself. I don't know if there's like a good way to say that besides talk to more people or talk to people who have done it and, continue to work on that yourself to see when you're ready to do that. We always tell people too we're ready when you are. We're not going anywhere. A lot of the things that we deal with too aren't necessarily, they're not life threatening, so it's not gonna be the end of the world if you wait a month or two or a year.'cause we have people all the time that are weren't ready a year ago and now they are
Joni:Yeah. Um, So you kind of walked me through what an initial evaluation looks like. How long does that first appointment take?
squadcaster-562j_1_08-30-2023_132707:Yeah, all of our first evaluations are usually an hour long and each session's an hour long and it's one-on-one in a private treatment room. We might take you out in the gym to do a couple exercises or something like that, just depending on what's going on during that session.
Joni:And how frequently do you meet with patients? I'm sure it's individualized, but what's common?
squadcaster-562j_1_08-30-2023_132707:Yeah. I'm gonna also lens out on this one too and talk about our four phases of treatment. So we take everyone through a four phases of treatment. The first phase is really figuring it out, making the goals and what's going on that's causing all of your symptoms. And then the second phase is getting rid of the symptoms. So whether you have pain or whether you're leaking or you have some prolapse, whatever that is. So those first two phases, we generally see people two times a week, and then we'll phase down after phase two when we jump into phase three and we're building resiliency in you. And we're adding things back in. So let's say you had pain with sex and now we're like, okay. Now it's time to go have sex again, report back, collect some data. And then we are entering that phase back in. And so you might have a couple things that still creep up. You're like, oh, it actually was not that bad. I just had a little pain insertion. And then the rest was fine. Great. That was some data. Then we continue working on that. or you're getting back into running. So then we start. Adding some running things in, and then we usually seeing you once a week for that. And then after we've gotten through that building resiliency, adding things back in and you can do everything you wanna do and no symptoms are coming back, then we transition into phase four, which is. The optimal vagina phase is what we like to call it. It's more of the health and wellness and you can literally do everything you want. You're not even thinking about your pelvic floor anymore, and you graduated from physical therapy in that sense, and then you can come back whenever you feel like you need it. We kind of then leave on the patient of If you need tuneups, you can come back. If you wanna stay in health and wellness maintenance mode, you can come back similar to a chiropractic model of if you wanna come back every four to six weeks and get a little dry needle tuneup, we're here for it. We wanna keep people in that health and wellness phase and not have them slide back down. Once a patient, always a patient, and then we like to work people all the way through those phases. Generally speaking, most people come to see us anywhere from eight to 20 visits. The average is around 12. And that's the national average across. The US is 12 visits of pelvic floor physical therapy. Some people are gonna be less than that, some people are gonna be more, and it really depends on like how long have your symptoms been going on? Is this years or is this just a recent thing? And all of it's individualized.
Joni:Cool. That's really helpful. What are the most common, like three most common reasons people are coming in?
squadcaster-562j_1_08-30-2023_132707:I would say most of it would probably be some sort of incontinence, prolapse, pain with intercourse, low back pain, si joint pain. That kind of stuff yeah.
Joni:so let's take the, what was the first one you said? Prolapse. So if someone has prolapse, what types of treatments might they expect? Again, I know it's individualized, but are that are typical? I.
squadcaster-562j_1_08-30-2023_132707:What I like to tell people with prolapse is a system problem, so it's usually not Prolapse itself. It's like, okay, why are you having prolapse symptoms? A lot of times it's'cause of tightness. It could be tightness in the low back or the abdominal muscles. It could be tightness from a scar tissue that you have. And then once we work on all that tightness, basically the prolapse symptoms go away and we teach you how to pressure manage through that too, so that you're not constantly bearing down into your pelvic floor and putting pressure on the pelvic floor, creating that prolapse. And maybe some Constipation things or pooping mechanics that we can work on so that you're not creating tons and tons of prolapse all the time.
Joni:What about urinary incontinence? Are common treatments for that?
squadcaster-562j_1_08-30-2023_132707:Yeah, so again, more of a system approach too, of like, why are you leaking? Usually it's a combination of pressure management and either some scar tissue or tightness in the pelvic floor, or there's some weakness in the glutes core, things like that. So we will strengthen what needs to be strengthened, loosen what needs to be loosened, and make sure the whole system is working really well especially with breathing patterns. A lot of times people just need to change their breathing patterns and then they can stop leaking almost instantly.
Joni:That seems. Too easy. It seems hard to but too easy like, wow, that's not that bad.
squadcaster-562j_1_08-30-2023_132707:Yeah. It's not bad.
Joni:are there a lot of exercises they're doing daily between your appointments?
squadcaster-562j_1_08-30-2023_132707:Yeah. That was a great question. Typically we try to limit our exercises to three, literally three things we want you to do because we know with research, we know patients are not compliant. And if we give you too many things, you're not going to do them. And we want you to be successful. So we like to snowball success with three really important things, and we try and make'em very functional, meaning that we try and put them in your day. Let's say you're brushing your teeth, you brush your teeth twice a day, okay? When you brush your teeth, you're gonna do this exercise. And when you get your kid in and out of the car, you're gonna do this exercise. Or every time you get off the toilet, you're going to do. So we try and pair things and task batch throughout day and give you those things so you can. Strategically work on them in your day and not have to take time out of your day to be like, oh, I have to do my PT exercises right now. Because we all know no one does that. We try and be mindful of that. And most of the people we work with are moms. And so we have to be very cognizant of that too, of like, how can we incorporate this in when you're doing something with your kids and that makes them feel successful? That gets good. Continuity between sessions and then we're able to build on that. I always like to tell people, even if you didn't do your exercises, you can still come back to your next appointment. Don't cancel. Like we will still make progress so that's always important to know. Like even if you don't get'em done, it's okay. We're human and we don't expect you to be perfect.
Joni:I imagine it, the more consistent you are, the more effective the treatments will
squadcaster-562j_1_08-30-2023_132707:Totally. Totally. Yep.
Joni:you'll see results.
squadcaster-562j_1_08-30-2023_132707:Yep. And the thing is too, is like we're not gonna progress someone on their exercises until they're ready. So if they worked on'em and they worked on'em hard, but they're not quite ready to go the next level, then we'll just be like, okay, you have the same exercises between now and next session too. Like you have to solidify these a little bit more before we can add more on or change it to move it. Advance it up.
Joni:How many minutes do you think those exercises take if they're doing three? 20 minutes?
squadcaster-562j_1_08-30-2023_132707:prob, probably not even that. I would say 10, 10, 15 max is okay, we want you to do this. But most of it, again, like I said, you can space it out and pair it with something in your day. And initially this is more of a treatment philosophy that we take too, is I. We are not super prescriptive in the exercises in the beginning.'cause we want you to have the foundation and we want that intrinsic knowledge of like, where is my body in space and am I activating the right thing? So we would rather have you do two reps of something really well and be like, yes, I nailed those two versus I did three sets of 15 and they were Crappy not good form. We don't get prescriptive until you've accomplished a certain X, y, z of these exercises from an intrinsic awareness of your body, and then towards the end of the phases will be more prescriptive.
Joni:Gotcha. You mentioned that pelvic PT is not just ke Kegels, kegels, however
Betty:can say it either way.
Joni:okay. They're both right.
Betty:they're both right.
Joni:Okay. But can you gimme an example of what an exercise might be like? Are they exercises do when you're lifting weights what would that even be?
squadcaster-562j_1_08-30-2023_132707:Yeah, so my top three favorite exercises are single leg squats, deadlifts, and lunges. And they ha Yeah, I know most people are like, what? You contract your pelvic floor and activate your pelvic floor more during a squat than you would during a q. So as soon as people know how to move their pelvic floor and know how to contract, relax and bear down through the pelvic floor with good range of motion and control we are never doing a kegel again. We just functionally put it into movement because that's how your pelvic floor works. It works with the rest of your body. And we just need to make sure that you know where it is, how it moves, and you can connect to that, and then everything falls into place after that.
Joni:Can you do those three exercises? Do you have to do them with weights or in the beginning are you just doing it without
squadcaster-562j_1_08-30-2023_132707:Yeah, with without weights for sure at first. And we make sure that you find your glutes and you know how to activate your core. We take it down to very basic fundamentals and really stack that foundation well.'cause you wanna build a pyramid that has a solid base and not one that's gonna. Top over. So we foundationally work really hard at first to make sure that's all good, and then we start stacking on top of that. It's always body weight first. And then as we continue to build resiliency, then we'll add in weight or we'll add in more dynamic things with twisting or turning or weights or overhead things we can get real creative.
Joni:When you said that some areas are too tight and others are too loose, do those types of exercises work on both of those things or are there different things you're doing?
squadcaster-562j_1_08-30-2023_132707:We typically do a ton of manual therapy, so if things are really tight, we'll be manually with our hands working on the pelvic floor or using dry needling or cupping or all sorts of different things to get that tissue to loosen or relax. And then once that tissue is moving then we will start strengthening. If it's too mobile, then for sure we start stabilizing and strengthening. So we might do more like hold things. We're holding this position, we're holding that position, versus moving through the position to build stability first. And then we'll move into the, create your own adventure stuff of getting crazy with things.
Joni:Gotcha. You mentioned dry needling on your Instagram the other day. Is that a common treatment option guys use?
squadcaster-562j_1_08-30-2023_132707:Yeah. So we love dry needling at reborn. We love, love it. It's one of the requirements I have for my therapist, even before I hire them. They have to be,, be able to dry needle. And in the state of Utah, you have to get a certain certification for that as well. So dry needling It's the same needle as acupuncture needle, but acupuncture is a totally different thing. Acupuncturist, Chinese medicine, chi energy, acupuncture points, like all this, stuff like that. But, and that's basically what I know about it. And then dry needling is taking the same needle into a muscle belly that has a trigger point or knot. So most people are familiar with knots, so some of those knots are painful, some of them are not. We take a needle into the knots and it makes a twitch response. It's a reflex. You have no control over it. It feels like when your eyelid, twitches. That twitch with some like spicy, sparkly electricity, kind of like the candy you ate when you were a kid, like the rock pops. It's like p kind of feels like that. Another analogy I like to use is you're walking into a haunted house, something's gonna jump out at you, you just don't know when. And so that Twitch can be like, ugh. A little more surprising. Now I always get the question too, does it hurt? Again, it depends. Depends on the person's nervous system. Some people are like, oh, this is amazing. Or relaxing, they could fall asleep. Other people are like, oh my gosh, I hate this. Don't ever stick a needle in me again. So there's that end of the spectrum. Most people fall right in the middle and they're like, it's not the most comfortable thing, but the results are freaking fantastic. Yes, do more, so that Twitch, what happens from. And I'll get nerdy with you. Here is your muscles. contract and relax? Normally, when there's a trigger point or not, it gets contracted and bound down in that muscle. And then what happens physiologically is blood flow drops, oxygen drops, the pH drops, and all these neuropeptide chemicals sit there, signal to your brain and say, ow, pain, dull, sharp, stabbing, whatever. And then we take that needle. Twitch it and it goes like that immediately. Blood flow comes back in oxygen, comes back in the pH gets restored, those chemicals release and get washed out of there. And you have better contractility, better activation, less pain, better range of motion, all these wonderful things immediately. So it's very fast. What we can do in five to 10 minutes of dry needling would take six to eight sessions of manual therapy with our hands. So very, very efficient. And that's like what the game changer with dry needling is. So we'll do that on any trigger points, whether that's in your low back, your piriformis muscle, your hip muscles, your inner thigh muscles. And then we'll also do it on scar tissue. The scar tissue lays down all haphazardly. And then you take the needle in there and you, it sounds barbaric, but it's not. You stick the needle in, you twist it, and what happens is that fascia or that scar tissue wraps around that needle and it communicates with your nervous system that there's tension and pulling, and then your nervous system says, oh, I should probably Give some more slack there. More slack. And so it like goes, huh, and let's go. And then we literally take that needle out and all of a sudden everything moves way better. And people are just like, what just happened? I can't believe this. They'll like literally stick their head up, like in a headlight. What? You're kidding me. This is magic.
Joni:Is that mostly like C-section scar? I guess with the pregnancy postpartum, are C-section scars and like episiotomies
squadcaster-562j_1_08-30-2023_132707:Any peroneal scars. Yep. Any surgical scar too. So there's people who have like their appendix out or they've had their gallbladder out or any abdominal surgery, basically a scar anywhere in the body. You can put a needle in and help with mobility.
Joni:Are people pretty hesitant for you to put needles near their vagina? I
squadcaster-562j_1_08-30-2023_132707:That's a good question. Again, there's a spectrum, like some people are like, this is what I came here for. And then there's other people are like, you do what? You stick a needle. Where we always ease people into the dry kneeling aspect. So we'll start and do a small dose on your low back or something like that, or somewhere where it's a little bit less reactive if you will. And just see how does your nervous cyst handle that? What happened? Was it painful to you? Was it not painful to you? Can we do a little bit more next time and we get an assessment from there? And then we'll start to add things in? Typically, we're not needling a public floor on the first visit, just'cause we wanna introduce dry needling first. and obviously if someone hates needles and doesn't wanna do it, we're not going to do it. it's all consent driven on that too. And then eventually we'll get to that piece where it's okay, I think you would benefit from a. A needle right here in your pelvic floor. And we walk them through that. This is what we'll do, how we do it. Like very educational through all of it so that they can make an informed choice for themselves if that's what they wanna do. Most of the time when people have experienced dry needling other places, they're like, yeah. If that's gonna take care of that pain there and I can have pain-free sex with one needle. Absolutely. Like, why would I not? And some people choose not to because they're like, that's just too scary for me. And that's okay. We have lots of tools that we can use. Either the dry needling or. Manual, skillset of manual myofascial mobilization or other things that we can have them do at home, it just might take a little bit longer. That's why dry newling is one of our favorites because it's so efficient and effective. But we have to treat the patient in front of us, so whatever works best for them.
Joni:Totally. That's great. I love that it's all consent driven. That's very comforting. I was asking you about treatments with the most common problems. I don't know, do you feel like that was helpful to talk about it, okay. What were the other ones you mentioned? You said, oh, pain with sex. Panex back pain, low back pain. I'm curious about that. What are typical treatments for that?
squadcaster-562j_1_08-30-2023_132707:Yeah, and that can be, again variable for low back pain, but it's super, super common, like 99% of A human population will have back pain at some point in their life. And so a lot of it goes back to old injuries. So we're diving into histories of what happened here, what happened there? And then treating that root of what's causing the back pain. We do a lot of core stability work and movement, pattern retraining.'cause a lot of people just have poor motor patterns where they somehow develop that. Somewhere along their life where they arch their back too much or they don't use their glutes or they're, hanging out on ligaments and tendons and bone. And so we retrain a lot of movement patterns along with the dry needling and all sorts of things to make sure that they're strong in their glutes and their core.
Joni:I feel like retraining movement patterns, like walking, like how you carry your back would feel impossible. I've been doing this for a while, so don't know.
squadcaster-562j_1_08-30-2023_132707:You. You can teach an old dog new tricks.
Joni:yeah. How long does that take to start changing some of those
squadcaster-562j_1_08-30-2023_132707:Most of the time it's just an awareness. People just don't know where they are in space, and so we create that awareness and teach them like this is neutral, and they're like, what? You're kidding me. This feels so weird. And we just retrain that and we teach them that with some of their home exercise program. A lot of it too is sometimes they don't have the mobility to get there. And that's where dry kneeling can be very effective as we can do some needling in their low back and all of a sudden they're like, oh my gosh, I've never been able to move that way before, where they just didn't have the opportunity to get there. And so then when they have the opportunity, it's oh. That feels really good. I want to do that. So it's, there's a reward with that too, right? It feels good. My back doesn't hurt anymore. So that can be motivation enough and that's why we have a job too, right? It's like we're the ones that are experts in retraining people for those things. But that's why people come to us we help them with that. Otherwise you would be able to figure it out on your own. And people don't.
Joni:I was thinking earlier when you're talking about lifting weights, how if you just like to lift weights, but you're finding that you're getting injuries from it, you could go be like, I wanna learn to squat.
squadcaster-562j_1_08-30-2023_132707:have we have tons of people that do that too. They're like, I don't have anything wrong. I just wanna make sure I'm doing everything correctly so I don't have anything wrong. Absolutely. We love that. We would absolutely love to work as much upstream as possible.
Joni:definitely. And then you mentioned sciatic pain?
squadcaster-562j_1_08-30-2023_132707:Yeah, sciatic pain or like SS p d, pubic synthesis, dysfunction during pregnancy. Those are very common. Not normal, but very common. And we can totally help with those things too. Yeah.
Joni:and it's something you can work on during pregnancy relief during
squadcaster-562j_1_08-30-2023_132707:Absolutely. And most people think it'll just go away after pregnancy. And really what pregnancy does is it takes a magnifying glass on any orthopedic thing you had going on. That just was subclinical before and pregnancy just shines a light in a dark room. And that's why we wanna jump on things as soon as possible. So if you're starting to have aches and pains early in pregnancy, get on it right away because then you can have a more enjoyable pregnancy from a musculoskeletal standpoint, be able to continue doing things you wanna do. And usually it's just a couple sessions and we can get rid of a lot of that pain significantly.
Joni:A couple sessions. Again, is something specific that people might anticipate?
squadcaster-562j_1_08-30-2023_132707:For sure dry needling with those things.'cause usually it's an, asymmetrical balance in the muscles. So like your hip flexors, your piriformis muscles, your inner thigh, your adductors and low back like ql. Not that you know any of these muscles, but those are generally the ones that are the culprits. And so we balance all of those out with dry needling to make sure those muscles are equal and balanced. And then you can contract and relax things and then the pain goes away.
Joni:Is it typically like a needle or is it multiple needles?
squadcaster-562j_1_08-30-2023_132707:question. So we take a needle in and we do like a piston motion to, and each one will get a twitch. So we'll only stop piston for three reasons. One, the patient tells us to stop. Two, there's no more twitches happening and we've. Gotten the trigger points out of that area, or three clinical judgment from us says that's a lot of twitches. I think we're done there and we're like, okay, that was therapeutically enough. We don't wanna overdose right there. So we would do potentially one spot and then move to another spot in that same muscle and then another spot. But a lot of that's clinical judgment of what are we feeling? And we do a lot of test retest. So we'll test something movement wise. We might have our hands on you testing something we'll needle. We'll come back and retest it and we'll be like, oh. Better, worse, or same? That was better. Great. Let's move on to the other part that's locked up and not moving. So it could involve one needle up to many needles, just depending on what areas, the body, how many spots we're working on that day.
Joni:Gotcha. I'm like imagining the anatomy of the skeleton with muscles and like the whole muscle group. I'm not sure if I'm using the right word, but are you guys targeting certain muscle, fibers, like little tiny, not like the whole, you're not like stabbing someone's entire like group or, I know if I'm using the right words, but do you know what I'm
squadcaster-562j_1_08-30-2023_132707:Yeah, it's very, it's a very small, thin needle and it's going to very specific small trigger point.
Joni:Okay. So if it's in their, what was one of the ones you said piriformis. Do you guys by your assessment understand what area of that muscle, or is it just like one spot you'll go that, that typically the issue's in.
squadcaster-562j_1_08-30-2023_132707:Yeah, so it really depends on the muscle that we're talking about. So for piriformis, each muscle has, like, when we go through dry kneeling training, you learn like where you can needle those muscles from a safety standpoint. So we don't needle the piriformis right in the middle of the piriformis,'cause the sciatic nerve is there, it lives right there. So we stay away from the sciatic nerve. So we typically needle along the sacral border and then we're, or we can needle out by the greater ter. Away from that sciatic nerve. And those are two safe zones to needle. And we just know anatomy wise where that piriformis is. So it's a little skinnier over by the greater Roc cantor. It's a little bit wider by the sacral border, so we have a lot more real estate to needle on in the sacral border, and we can span that entire muscle to make sure we're hitting everything there. We're on the greater Trocanter, it's just a little bit smaller and we might hit some other some other external rotators that are attaching there too. Probably a little too high level.
Joni:I remember I took an anatomy class. I remember a lot of those words, but I wouldn't be able to find those spots by myself. No, I think it's helpful to get an idea of, I don't know, I guess I am just someone who likes okay. Is there any last things you would wanna say to someone who's considering going to Pelvic Physical Therapy?
squadcaster-562j_1_08-30-2023_132707:I would make sure that you ask really important questions when you're seeking out a pelvic floor physical therapist of like, what is their skillset? What things do they do? Are they treating full body? Are they just looking at one area of your body? I. We really like to emphasize we do a whole body approach on everything. And so you really wanna make sure you're getting someone who is going to look at you as a person and not just be pelvic centric or just look at your pelvic floor. Because if they're just looking at your pelvic floor, they're missing half of the puzzle. Everything attaches to the pelvis and you have to look outside of that. And then I would say just do your research. Ask your friends get on forums and ask where to go, I think that's the most important piece is to make sure that you feel comfortable, safe, seen and heard that you're getting the right care that you need and deserve and making sure that you feel good with that decision
Joni:Can people not do the internal exam if they're not comfortable with it? Can you still do the
squadcaster-562j_1_08-30-2023_132707:Totally. totally, So, uh, You don't have to do an internal exam to get improvements. We will educate you so that you can make an informed choice through that. Most people that are coming are opting for that pelvic exam because that is what do. But we have people that will go sessions without doing a pelvic floor exam or we might do a pelvic floor exam and we're like, actually it's not your pelvic floor, that's the problem. It's this, and we don't even go back to the pelvic floor again because it's something else. So it's nice to be able to have the pelvic exam to figure out like, is there a contributing factor there or not? But we have some people that they're not ready for it. Or if we have minors that come in, like they're not appropriate for an internal exam all the time, we wanna make sure that we're giving the patient what they need for that current. Time and place and what's best for them. We also have men that come in and see us too. Men have pelvic floors. We don't specialize in male public health, but we do see men of the women that come in just because they're like, Hey, my husband has, shoulder pain. Where should I send'em here? We can totally help with that. So we have tons of guys that come in too, just for orthopedic conditions, and we don't ever see their pelvic floor.
Joni:And then how can people get in touch with you guys if they are thinking about working with you?
squadcaster-562j_1_08-30-2023_132707:you can reach out to us. The best way is on our website, just contacting to schedule an appointment. Our phone number is(801) 216-3117. And then our website is www dot reborn, r e b o r n. P for pelvic H for health, w for wellness.com. That's probably the easiest way to get in touch with us. And then you can certainly follow us on Instagram at Reborn Pelvic Health and Wellness. And then any other major social media thing, we have that too,
Joni:And you guys have two locations now. Now.
squadcaster-562j_1_08-30-2023_132707:correct? Yep. We have a West Jordan location in Salt Lake county. And then we have a Lehigh location that we've been open for about a month
Joni:awesome. Okay. Thank you so much for your time. so great. I learned a ton.
Okay. So I'm going to link a Reborns website and reports Instagram in the show notes. I'm also going to add the event that's coming up on October 15th, which is a Sunday morning. It starts at 11:00 AM and it goes till as late as two, if you want to stay. But the actual activity ends around 1:00 PM it's hosted at the neighborhood hive. And you sign up through Oleo products or websites. So does he kind of know what it's about you'll get there. You'll kind of get to chat with people a little bit. Leisha Nelson. Who's a somatic practitioner. We'll do a lesson On trauma. And then while I'll have the opportunity to write down what we want our intention to be for this candle. So when you light it, what are you thinking of? What are you trying to foster? And if you want to share that with the group, you can, you certainly don't have to, and then we'll make the candle. So they'll take a couple hours and then you're free to hang out and stay for another hour and get to know people. Um look around the store Into your ear holes.
