Helping Women Manage Life and Movement with Dr. Sarah Duvall

You're listening to the PT Profit podcast, episode number 172. Today I'm sitting down with Dr. Sarah Duvall, and we're talking all about how to help women manage life and movement. Are you ready? Let's get started.

Hi, I'm Beverly Simpson, former fitness manager turned online personal training business owner. And this podcast is where smart fitness professionals, including trainers and clinicians, discover how to increase client performance in movement, package and position their products and services, and get out of their own way so that they can increase their revenue to live a life that they love without sleazy sales. Welcome to the PT Profit Podcast.

What's up, coach?

Thank you so much for pushing play on another episode of the PT Profit Podcast. I'm your host, Beverly Simpson, and if this is the first time you're hanging out with me, I'm sorry. Super pumped that you're here. Welcome. As you can tell from the audio quality inside of this podcast, number one, I'm currently in Florida and I would really, really tried to record this podcast intro before I left. However, I didn't have a voice. And still, even now, it's not really that great. So I won't blah, blah, blah at you for too long. Especially since this incredible core exercise specialist doesn't need any introduction. Because truly, Dr. Sara Duvall is an incredible human and person. And it was such an amazing opportunity to connect and talk with her, which I hope you hear when you listen to the end of this episode. Because honestly, we laughed, we shared. She is absolutely brilliant and exceptional and she truly raises the industry standards when it comes to helping specifically women in. In their life and in their movement. And you'll hear that inside of this episode. So Dr. Sarah is a wife, mom, she is an adventure sports athlete and an incredible women's health and fitness specialist. She's the founder of Core Exercise Solutions, a center for continuing education and online programs. She is passionate about empowering individuals to learn and grow in their own journey of healing. And when she's not hanging the side of a mountain, she's writing and presenting@core exercisesolutions.com and helping her patients figure out how they can continue to pursue their dreams and lead strong, adventurous lives. So she is an incredible human. I can't wait for you to listen to this episode because she truly is inspirational to me and to the women and the people that work with women. She truly is inspirational to me and to the hundreds of professionals that she has coached and helped them help more women move and get better and live better lives. So without Further ado. Let's go ahead and roll that interview.

What's up, Sarah? Thank you so much for joining me on the show today. How are you?

I'm doing great, Beverly. Thanks for having me.

Oh my gosh. I'm really excited for today. You are a genius. I've been following your work for a while and I have just seen how you have continuously been able to raise the industry standard in terms of women's health specifically. So I'm super excited to get into today's conversation.

Oh, well, thanks. And I do not think I am a genius at all. I think that I can take other geniuses, very complex topics and discoveries and make them easy to understand. I think that is my superpower.

I love that. And that is really, that is a hard skill for a lot of people. So I can't wait to get into it today. So for those of you who are tuning in and have not seen Sarah's work, I would love for you, Sarah, to share with us a little bit about who you are, who you serve and how you got there.

Absolutely. So I started out as a personal trainer in 1999 and then went to physical therapy school and and graduated in 2005 from PT School and went back in 2008 and got my doctorate. I always knew I wanted to be a physical therapist from the time I was 12 because of volunteering in the hospital. Really nothing to do with sports. Yes. I just loved helping people. I loved connecting and I did not like being on the cancer ward. That was my first volunteer was filling water pitchers. You know, it's a little candy scraper on the cancer floor and I just could not handle it. And granted that was the age of 12, I'm sure as an adult that would be very different. But that led me to wanting to volunteer on the PT wing and as a candy striper and led me to loving the PT that was at our hospital system and falling in love with it and wanting to become a physical therapist. So it was from a very young age, which is fun.

That's amazing.

Yeah, I think most people end up in physical therapy because of sports or some other interest. And then I went on and I was a Division 2 athlete for Clemson. I was a pulpalter and had many, many injuries that solidified my desire to become a pt. And then I had babies and was still a fairly high level athlete. So that pushed me into women's health because I was having trouble fixing or getting my issues fixed and knew that there could be more out there for higher level athletic women. That wanted to, you know, pursue things aggressively and have their body work for them after having kids.

Okay. So I definitely want to dive into your experience there, because I can relate in terms of, you know, I got pregnant when I. In 2015. Right. I'm thinking of my eldest, Gwen. She was born in October. So it was 2015 that I got pregnant. And even then, which is not that long ago, there was such a huge gap of information for women. And I think that for me, too, that it was not. Not necessarily just the gap is that it just was never in my context, even though I was working in training with moms, which back then, thank God, humans are resilient.

So when you got 13, which was even, you know, just a few years sooner, but still, I felt like there was nothing.

Yeah. So in 2013, when you got pregnant, you were 2012. Were you already a doctor or. 2012? Yeah. Were you already a doctor? Were you a PT at the time?

Yeah, I graduated with my. From PT school in 2005, and my doctor is 2008. Yeah. So I'm an athlete.

And you're practicing and you're pregnant. Right. So what happened? Can you share us a little bit? What happened?

Oh, well, my first pregnancy was very interesting. My husband lost his job, so was under a lot of stress. And I think the stress contributed to a lot of what I experienced. I started having contractions that led to dilation. And so basically, I was going into early labor at 19 weeks, and my doctor freaked out and put me on bed rest. So that was fun. Not fun. And then he ended up finding a job. We moved. When I was eight months pregnant, I sold my PT practice. I had, like, a practice and a physical building and everything. And I have the most amazing PT that bought it. She's incredible. Um, and has continued it, and it's still going to this day, which is kind of fun. Uh, so, yeah, I had a. I did not really work out a whole lot during my first pregnancy because I got put on bedrest fairly early, and I was doing. I was wakeboarding a lot back then, doing cable, park stuff, kite boarding, and those are not really pregnant conducing sports to somebody with my worry level. I know there are women that pull it off, but I just was terrified of hitting the water hard. Uh, and so I stopped most of my athletics and just picked up a little bit of running and things like that.

While you were pregnant?

Yeah.

Oh, my God.

I can see your low level.

Yeah, yeah, yeah, yeah, yeah, yeah.

I'm not impacting anything very hard physically.

So yeah, yeah, yeah, yeah. Oh, my gosh. Okay.

So was fine with that. She was, you know, even way back then, she was just like, yeah, run. Just don't get overheated in the first trimester was her only advice for me.

Okay, amazing. So then now you're on bed rest, and then you had the baby, and then what happened?

And then I started back into rock climbing because we've moved to Virginia. And that was fun and, you know, exciting because I was really out of shape. And I think there is some benefit to being on bed rest versus being in shape. And I know that sounds silly to say, but I wasn't able to start out hard. I literally had nothing because I was so rested after my second. I could do whatever I wanted because I'd stayed in such great shape. I climbed a rock climb through my entire second pregnancy, and I stopped, I think, about three weeks before he was born because I was getting pubic symphysis pain, because climbing is very like, put your foot up really high and pull with your adductor. And I just reached a point of, you know, pelvic instability where that did not feel comfortable anymore. But I was in such good shape. I definitely did too much postpartum after my second because I felt great. And so I think there is some danger to staying in really good shape through pregnancy because you had the baby, and then you're just like, the rest of my body feels really great. And your pelvic floor is like, well, I need a little bit more time than you're giving me to recover. Or you're a C section. Needs a little more time. So for me, the first postpartum was very easy in the fact that I would try to go for a walk, and I could barely walk down the street and back because I hadn't walked. It kept me really low level. Yeah. So I think that's an interesting take on it having had dramatically different pregnancies.

So this is amazing, actually, because it kind of leads me to this one, this myth that I think we hear both in pregnancy and postpartum, which is, listen to your body. Where, you know, your body knows what it.

Oh, yeah. No, no, no. The second time I would tell my. If I could go back and tell myself, I would say, do not listen to your body. Your body is wrong. Wanted to go work out, and I wanted to do stuff, and I wanted to climb, and I felt great, and it was not good at the time. And I think it additionally contributed to the prolapses that I experienced postpartum by Doing too much too soon. Because you're in this great healing window. And I'm happy to share. I'm a very. About that because I know a lot of postpartum women that are athletes deal with prolapse, and it's not something that's always talked about, but. Yeah. So I think it. You're in this great kind of healing window postpartum. And I. I made things worse. I took what was a grade one prolapse, and I pushed it into a grade two because I did too much too soon.

Oh, my gosh. Okay. So, you know, this also is. I have so many things to ask you, so there is just such a really good point in terms of, you know, remembering, too. And this is, you know, for you and for your clients when they're telling you that, you know, they feel great, it's that they're. The body is complex, and people don't know what it is that they don't know. And so one part of their body might feel really great in that healing component, but then there's a whole other, you know, pelvic floor component. Even for people who have had C sections.

Yes. The pelvic floor spreads, you have the same similar, like, preparation for birth and spreading of the pelvic floor that can increase your risk of prolapse during pregnancy. So pregnancy itself is a risk, which, if I am honest thinking back, I described prolapse symptoms to my midwife while I was pregnant, and she's like, oh, oh, that's fine. She's like, oh, that's. That's. You know, I haven't heard that before, but, oh, it's. It's fine. Whatever. Let's not worry about it.

This is your second pregnancy or first?

Yes. So this is my second. And I did not do internal checks on myself. Like, I should have to monitor it better. And if you're not going in to see a pelvic floor pt, if something feels funny, like, go get. Go get somebody to check you. And I should have just stayed on top of it more, and I didn't. I dropped the ball because it's like, I don't know, you know, how it is. You know, things, and you take care of other people, but when it comes to taking care of yourself, sometimes you're just like, it's, you know, I had a toddler. I was pregnant. I was running a business. I was trying to, like, stay in shape. Like, these are just too many things on somebody's plate.

So what I'm also curious about, too, in that. And we Can I, you know, I'll ask you to unpack. It is. Is what's interesting to me is I had a friend who was pregnant and I sent her. She was talking about prolapse symptoms. She was talking about how she was feeling pain in her pelvis. And I said, just go to the PT now. Just go to the pt. And they turned her away and said, no, no, come after.

Oh, go find a different pregnancy. Go find a different pt. I mean, there's a great pelvic floor pts that help women prepare for birth, teach them how to push, make sure pelvic floor muscles are relaxed, like, just find a different pt.

I know, but it was just surprising to me that even. And this was not that. I mean, that was. This was 20. That was 2019. So it's just interesting to me that. And it's an important reminder that not all pts are equal.

Not all personal trainers are equal, not all contractors. Not. I mean, you know, you just name every profession. Every profession across the board has, you know, we all know what we know because of our life experience and then what we've chosen to study.

Yes.

And this is very different diversity within that.

Absolutely. And this is also why it's so important, too, for a lot of new coaches, I think, out there, too, as they're pursuing different certifications and wanting to learn more, they get into this, and I know I did. Is this. This habit of thinking, oh, well, you know, I don't need to do that because there are so many other people that are doing it. Why not me? And that's just. We get stuck in our context box, and it's literally 1% of people and of the. Of the profession. So I just think that continuing to educate yourself is just so important to the masses. It doesn't matter how many people are doing it, in my opinion.

No. Yes, I agree completely. I would like to add one thing about the whole prolapse story, though. Please do. Sure. I had a grade two prolapse, meaning you could see it visually from outside the pelvic floor, and I worked really hard on healing it. It was not caused by tightness. I know there's, like. The biotensegrity model is a very popular thing now, and I treat a lot of women that had prolapse due to tightness, so they fit within that biotensegrity model. So I think it's a very good model, and I do think it applies to a lot of people, but I don't think there is anything in the entire world that applies to everyone. And so this is no different. I didn't have any pelvic floor tightness. I just had stretch fascia. I'm one of those kind of blacks ligament people. Genetically, my entire family, everybody has a hernia. Like, grandmother had a hysterectomy. Like, I should have seen that coming. Like, how many fascinates do you need in a family tree?

I know. Oh, my gosh. Also, as you know, in while you're backing up, can you just unpack a little bit about what prolapse is specifically.

And how we can start? One of the questions that I love for strength coaches to ask the new moms or the current moms are working with is, do you have any family history of hernias? Prolapse isn't always talked about. And that's when your pelvic organs start to descend in to your vagina and out. And so you might hear about hernias more because they're not kind of taboo. People will talk about them. Or, you know, having a hysterectomy can also be a sign, depending on why the hysterectomy was performed. You know, was it performed because of uterine? Prolapse is. So prolapses basically think about it just like diastasis, you know, it's just an opening or like a stretching or thinning of the fascia where we have some give. And generally prolapse in the pelvic floor is made worse by bearing down. And so a lot of athletes will do a bracing out strategy where they bear down. Like, this is really common in the athletic world. You can even. You'll see guys lifting with a weight belt on. And if they have on like a tight shirt, you might even see a little hernia poking out right above the waist belt, because that is a point where that pressure is leaving their body. And so for women, we have more vulnerability in our pelvic floor than guys do because of the nature of our pelvic floor and how it's more open to get out a baby. And so if you have a strategy of bearing down, which I did, which took me forever to fix, because I would only bear down in sports where I was not focused. I was fine lifting weights like a deadlift. I could do whatever the weightlift. Leaving the weight room always made me feel great. But, you know, sports are another story because there is just a lot going on, so retraining those habits. So anyway, for coaches, one thing I would recommend always asking is, what's your family history like, especially if you're dealing with somebody pregnant or Postpartum, because then that might give you clues like, okay, maybe we need to be a little more careful. Maybe we really do need to be mindful. Are you bearing down at all? What are your strategies? How are you loading the fascia in your body at the vulnerable points, like your linea alba, like your pelvic floor, and then that way you can keep them safe. Because I feel like prevention goes a long way for not making things worse. And I do believe that fascia, in some cases, not all cases, but in some cases can heal and heal quite well. I have seen lots of women resolve their prolapse. I've seen even more women resolve their diastasis. It just fascia takes a long time to remodel. I mean, you're looking at sometimes years. I usually tell people, give us a minimum of a year to really see fascial remodeling. Now, sometimes you'll see that, like, spontaneous healing. That's probably more of like, let's connect some muscle, and you're fixing breathing, and things are just kind of coordinating so you can get that spontaneous coordination that then makes things firm up or come together, respond well. In the pelvic floor, you decrease tightness. That can instantly make a prolapse appear better. If it was caused by tightness, I like to think about it as an accordion. So as you pull out on accordion, the walls flatten, and as you squish in, the walls bulge. If you think about the pelvic floor, if we pull it tight, we're going to make the walls bulge. Then generally that will make that aha moment for a woman who's dealing with tightness with prolapse symptoms. And she's like, oh, that makes sense, you know, so to put that, like, a happy ending on my personal story, I just went and had my physical earlier this year, and I asked my doctor to check to see how my prolapse was doing, because I can check, but I wanted that independent. Like, tell me what you think, because I think I'm doing quite well. And she's like, I don't. She had me bear down as hard as I could. And she's like, there is absolutely no visible prolapse at all. And internally, she checked. And she's like, I don't feel any prolapse internally. And I was just like, yes, that is awesome. There's a lot of stuff out there where prolapse can't heal. And I do think you have to have the right environment, which is not always in your control. I think genetics does play a role in that. And so I think we have to give that the space that it demands. Because even if you do everything right, sometimes there's just too much fascial damage, sometimes genetics. But nutrition, sleep, stress, doing the right exercises, the right amount of loading to stimulate remodeling, not too much, not too little. I feel like people want to rest and don't strain and don't stress when they're dealing with things like that. And the body needs, it needs that stimulation to remodel. And I think a lot of times we're scared to stimulate enough.

I love that. So now I do have some questions regarding, you know, how you, how you define athletic. Right. So what I think is very exciting in our time now is that there are a lot of people and women specifically, who are actually of an athletic environment and they have an athletic mind, but yet they might not even consider themselves an athlete yet. So I'm curious, you know, you bring up such a huge. You bring up such a really good point when you talk about how they do really well in the weight room. Like, even if your client is seeing you three times a week, that's three hours out of 160ish week or hours in the day. So how do you define. And for people training moms, like, how do you define what an athlete is and how their everyday activity is affecting their prolapse or potential?

So sometimes on every day, how they sit at their computer can make it a lot worse and they feel great after their workout. So I would probably define somebody wanting to pursue a little bit above average. Like if you go to the gym and you do the elliptical for 20 minutes and then you maybe do, do bicep curls with the pink weights and then you walk out of the gym. I don't, you know, I don't really think that pushes us into the athlete category, But I think women who are going hard or what they would consider hard for their body and kind of pushing that envelope and staying on the, you know, I might not be able to get out five more reps. I'm stopping when I only have two left. Like, so they're moving heavy weight for what their body can handle, or they're pursuing. Maybe they signed up for that 5k and they've never run more than a half mile. So now they're in a training plan. I consider that to be when we cross over that threshold of I'm somebody who walks around the neighborhood to I'm now an athlete.

Okay, I love that. And then also too, you know, what about moms who are, are, you know, dealing with this with their second baby and they're chasing around a toddler and laughing or a preschooler and picking them up and then having, you know, there's athletic components to just being a parent that they might not necessarily have done previously.

The biggest danger to prolapse and hernias getting worse is being weak. I mean, the worst thing you can do is tell a woman prolapse to stop lifting weights because then her kid is going to get heavier and she is going to get weaker and then exponentially more pressure management problems that happen. So the stronger somebody is, the better able they are going to be able to manage their pressure and their life. Carrying in the groceries, picking up the kid. Like, you have got to have strong muscles.

Yeah. And I know for coaches it is really scary because the first thing, I mean, the first thing they want to do if their client says, hey, I have a prolapse, they're like, okay, well, let's just not do anything.

Yeah.

So it can be really scary to navigate that.

One trick that I have for coaches that I love to use is if they feel comfortable touching somebody, they can touch them. Or if they're not comfortable or they're, you know, wherever they're coaching, it's not allowed. Because I work with coaches all over the world and I'm surprised at how different regulations are. You can have the client do it, but if you just take your fingers, place them right inside your asis, so like the front of your pelvis, go right inside there. And if that area, those lower abs, if they flatten a little bit when effort is being given, then your pelvic floor is almost always safe. If that area.

Oh, my gosh, I didn't know that.

Yeah. So it's. So it's so easy to see if somebody's bearing down. So you're just like, yeah, go and do that overhead press. Let me watch. Watch what your lower abs are doing. If their lower abs flatten a little bit when they press overhead, tell them keep pressing overhead all day long. Probably go up and wait. Not a problem for their pelvic floor. If that's a great way to check if somebody is not in tune with their pelvic floor. But I highly recommend go in and see a pelvic floor PT if they're not in tune with their pelvic floor, figure out what bearing down feels like, and then they just own it everywhere. When they're getting the car seat out, when they're putting the stroller in the back of the car, they can then really own it. Um, but if they don't know, that's like.

You just blew my mind with that.

Oh, yeah.

I was like, did not even know that. Because that's like one of the big questions too, is like, it's so, you know, sometimes people are bearing down and they don't even know it. So I was one of those people that had an incredibly tight pelvic floor and didn't even know it.

Yeah, because you were probably bearing down and then your pelvic floor was countering the pressure, whereas I didn't counter anything. My pelvic floor is just like, whatever, I don't care. So, you know, I mean, we often aren't. Even if you teach it to other people, you often aren't aware of it unless you spend just a critical amount of time obsessing over it.

Yeah. Okay. So you also talked about the different grades in prolapse. So can you talk a little bit about what those grades are in terms of, you know, when is surgery? When, How. When do we need to start having. And I know that it's going to be different, but, you know, I'm just curious, like, what are some of the baseline metrics that you are measuring with your patients and your clients?

So most low level prolapses are not a problem. It will often bother women emotionally, and so then they'll want surgery more for the emotional impact of, like, I have prolapse. But most prolapses, low levels like grade one and grade two are not an issue as far as needing surgery per se. Usually I. Women will often have surgery but then still leak after or still have pain after. So it doesn't fix what they think it's going to fix. And I think a lot of women confuse prolapse and tightness, so they think the surgery will fix their pelvic floor tightness. Because all their symptoms are related to pelvic floor tightness. Maybe they're leaking, maybe they have deep butt pain, maybe they have pain on penetration and they think it's the prolapse and it has nothing to do with the prolapse and everything to do with the tightness of the pelvic pelvic floor. Because often when women feel that prolapse, they feel that bulge, it feels uncomfortable, so they try to pull it up, and then that compounds their tightness and makes their symptoms worse than they feel more bulgy because they've been tightening their pelvic floor.

Wow. Okay. So you also started to talk about, you know, some of the symptoms. So how. What are some of the. And I'm also curious too, in terms of, you know, time of the postpartum timeline. So like you were saying, fascia can take years to, you know, restore. So, and yet we're all heard, like, six weeks, six weeks, blah, blah, blah. So some of these, like, prolapse symptoms. You know, I remember working with a mom who was three years postpartum and hadn't dealt with this and was still managing symptoms. So I'm just curious, like, in terms.

Of when some women manage them their entire lives. Yes, it's some of. Sometimes my goal is healing, complete healing for people, and sometimes my goal is to get them back doing whatever they want without their prolapse getting worse. And that can be a major win. So it just all depends. You know, that's a. That's a tough thing. I mean, we look at research on dialysis, right? What is it like 60% of women have a doctor at, what is it like six weeks and then 30% at six months or 10 months or something. So when we look at fascia healing across the board, I mean, for everything, it just takes a really long time. But I do think there's a sweet spot really early on where our pelvic floor and our abdominal wall is very vulnerable to getting worse. I've had a lot of patients where they have gone to some mommy baby boot camp class, and maybe initially their diastasis was three finger widths and maybe down to the first knuckles. It really wasn't that bad. And then they go and do these hard abdominal exercises right at six weeks postpartum. And then their dasus just opens and deepens and they do more fascial stretching, which would be the same thing of you can. Same thing that happens to the pelvic floor. So I feel like in those early days, we're really vulnerable to making that fascia where it's like, okay, I just got stretched out. I just had a lot of giving me. Now what do I do? Do I come back? Oh, you're pushing lots of pressure on me and bulging me out more. Okay, I guess I need to stay out more. So it's. I feel like it's in that sweet spot of what it's. What it's doing in that state you're trying to. To tell it to go in, which, you know, can be. Can be hard because patients is very, very difficult.

Well, especially athletic patients, like patients who, you know, I mean, I'm my sister. I took it to the extreme. So my pregnancy first for Just for context, like someone told me, don't Google when you're pregnant. So I did it, but then I literally didn't to the point of like, my sister called me right before birth and was like, hey, you're still gonna look pregnant when the baby comes out. And I'm like, what?

No, I'm not.

The baby's out.

It's gonna instantly get back.

Yeah, I'm just gonna go back to what I, like, knew nothing that is.

H.

And you know, and, and I knew. I thought I knew better.

Right.

I had an arrogance about me at the time. It's. Which is now it's, you know, thank God for it because I learned so much. Right Where I was like, oh no, everything's gonna be. I mean, the stuff I did when I was pregnant, just thank God humans are resilient is all I can say.

I know, it's incredible. I feel like it's just so incredible. And what I, what's been fun for me is, is I've got this group of women that I've been working with and it's been really fun to share my story along with them. And just over the years, looking back over that, like sharing the seven month update and the 10 month update, and I had a big change at 15 months I quit breastfeeding at like 13, 14 months. And at 15 months I had a big change in my body. And so it was incredible to see that and that lasting effect of breastfeeding. I think it's, it's three feedings a day, your hormones, where your hormones kind of drop off. But for me it was, I could still make milk come out like a year postpartum after I quit breastfeeding.

Oh, my sister.

I was like, I had a two year old and I was like, I need to make milk come out. Like, this is ridiculous. I could be one of those milkmaids. This is crazy. But I felt a change after I could quit making milk come out, you know, like, well, because the only way I could tell is like somebody's kid would be crying and I get that let down feeling and I'm like, oh great. Like, I know what that feeling is. So when that finally stopped, I felt like another change.

Oh my gosh.

You know, it's just interesting over the years.

Yeah, that's amazing. So what would you say are your. Some of your biggest lessons that you learned from pregnancy one, going into pregnancy two, that you wish that you could have told yourself back then?

I get very impatient with most things.

Oh yes, the human condition.

I want that now. I want to do that now. I want to say it now. And so I think if I could go back and tell my former self to just be more patient and back off quicker. And you know what, getting a little bit out of shape will be fine. And you don't have to do everything and you can, you know, cut back and take things more easy and. And not try to be superhuman. Postpartum as well. I worked a lot postpartum, and that was stressful. And now looking back, I'm like, oh, that was stressful. But when you're in the mix of it, you just don't see it.

So were you working postpartum first and second or just first?

Oh, both. Yeah.

I also think that people have a very. Are a little bit disillusioned about stress and about what stress actually feels like and that we have. That we're often in the sympathetic state without even realizing it.

Oh, yeah, My body gives me all sorts. I have heartburn or my eye twitches or I have stomach pain, and it's just like, oh, those are all stress related. All right, I need to do nothing for a little while and cut back and get rid of some of these symptoms.

I'm also curious about your bedridden. Just circling back to that.

I wasn't on complete bed rest. I was on do not bring on contractions, which meant I would go to work and just sit on, like, a exercise ball and direct people and do a tiny bit of manual therapy very carefully from a seated position. I like, move the table down, too. So, yeah, you know, so it was. It was. I was very careful with that. I couldn't walk to the back of a grocery store. If I'd walked to the back of the grocery store, I would get contractions. Contractions. So I could do. I wasn't on bed rest. Bed rest. So I think that is much more challenging emotionally. But I was on, you know, do not do bring on contractions and absolutely no sex until you're ready to have the baby. Which was magical. We had sex, and then she was born. That night was right. Because we were like, okay, I think we could have a baby. Now. It's right before Thanksgiving. Our family's coming, and it was 37 weeks.

You know, it's. My husband would probably die if he knew I was about to share this, but I'll go. So he never listens to the podcast, and if he does, he'll. He'll. He'll be like, what? You said that. But we. It was my. The tightness in My pelvic floor was so excruciating, even during birth, that it was like, penetration ended, like, first trimester.

Yeah, you poor thing.

Because it was like, oh, my gosh.

Oh, my gosh.

And then it was almost nine months after, and it was, like, horrible because I would be screaming in the shower like, this is worse than labor. And he'd be like, you cannot understand. You. You can't imagine how horrible that is to hear.

Oh, that would be so horrible to hear, per guy. He was probably so upset.

Oh, my gosh. It was like. I was like, we teach abstinence by talking about this.

Oh, my gosh. And that's when your pelvic floor. PT needs to be your bff.

It was just. It was. It was. It was amazing. It feels so long ago, but also not really. It's only, you know, seven years.

Yeah. But it. But stuff like that really sticks with you. My. I had. I had prodromal labor with my second, which meant, like, he was just not coming out, but I was having really bad contractions. And so I was like, let's have sex twice a day. That's gonna get the baby out. And finally, after, like, a week, my husband's like, we're done. I can't have sex with you. I gotta wait. I need a break. I was like, it's gonna work. It's gonna work today. I mean, I was up, like, all night. I was. I was going nuts. This was awful. Finally, I went. Bought castor oil, and then it was everything. I went into labor that day.

I mean, oh, my gosh. I mean, there's so much. It's so much stuff that I wish that we had known back then. Like, there. I mean, it's just. I still feel like there's just. I still feel that there's so much that is available to women that they just don't realize.

Yes.

They don't realize what's possible for them.

Well, now that we've shared all of our personal, intimate details, what is. Hopefully our husbands don't listen to this.

Oh, my gosh. My client. You know, listen. My clients are used to me talking crazy, so they're not. They're going to be all right. I just, you know.

You know, I love teaching for a living, and I just feel like if you can't relate to people, it just is so hard to learn from them. It just makes it so much easier when it's the relatable circumstances.

I absolutely agree. And I also will remember those moments. And I think this is really important for personal Trainers specifically is that they often are the first line of defense. Like moms don't like. I remember going through that experience and I'm like, I am surrounded by professionals and I don't know what to do. I'm like, this is. No one's ever talked about this before. And I'm not about to Google, you know, this because God only, God knows.

My vagina is too tight. That's going to bring some good stuff.

I'm not about to Google, like, fire, pain.

Okay. Oh, goodness.

Right?

You're in a good place. If you can laugh about it now, like, that is a good place.

I mean, I can now, but I mean, back then I couldn't. Back then it was like, I feel this was worse than being a teenager of like, oh, my God, what's going to happen?

I can't believe you just said that. And for Everybody listening, it's 10:30 in the morning. We are not drinking.

I know, but, you know, so, so oftentimes, like, nobody, no one wants to.

Talk about this stuff, you know, so.

It'S like, what are moms supposed to do? And so I'm curious, you know, since you do work with a lot of professionals, what are some of the bed. Now you gave us some really great, like, family history stuff. What are some of the other questions that are usually asking and encouraging coaches to ask their clients?

So the number one thing I have found is what I've already been demonstrating. The more comfortable you are about talking about pelvic floor issues, the more comfortable they will be with sharing. So it is. I mean, I feel like this is especially. I think that probably most of the male trainers listening, so I turn it off by now, but I feel like, I feel like there is this. Male trainers feel like they can't talk about it or it's uncomfortable. But there's plenty of male doctors, there's tons of male obese. So I feel like they need to think about that with their uncomfortable level and realize it's them, it's not being male. Because there's plenty of male healthcare providers that are completely comfortable talking about this and plenty of females that are comfortable talking to males. So I think the more comfortable and professional meeting the person where they're at. You know, we read personality types for a living. We know the person we can joke around with. We know the person we can't. That's part of. I feel like, especially being a personal trainer, your job is, is reading people. And so I think that would be my number one advice is just bring it up Have a conversation about it. Share something personal if you feel comfortable. Because then that opens that door for that person to be like, you know what? I experienced that too. Or I am experiencing this. Do you know anything about, can somebody help me? And so I feel like that is. And if you're a male trainer, maybe telling a story about your wife or just say, I took this course and I learned xyz. I am passionate about making sure women get the help they need. And this is a very important topic we don't talk about enough. And then they can maybe share a couple of things they learned in the course. Like, these are some interesting things that I learned about, you know, female anatomy and weightlifting and where we need to be careful. And then all of a sudden, maybe she feels comfortable. You know what? I have to pee before we do box jumps. Like, that's something. And that's another thing you notice. You pick up on, like, where she's like, oh, let me rung a pee every time before this exercise. Then you might be thinking, okay, well, maybe there's a problem there that can be helped. So you can look at clues. Because people aren't always going to be truthful and they're going to think it's normal or common. I mean, I feel like there's been enough publicity of incontinence in a way that's normalized it to where I feel like women aren't seeking help now because. Because it's been so normalized.

Oh, yeah.

That I almost feel like that in a way is good and bad. You know, it's good for it to be comfortable to talk about, but bad because, you know, seeking help is. We don't want it to just be normal. You have to live with it, you know?

But I mean, scary mommy always comes to mind because she's always joking about her pelvic floor incompetent in her pelvic floor incompetence. And I'm like, no, no. And then yet makes the stance for alcohol because, you know, mommy, wine time, time, right? And I get like, it's not to criticize, it's just to acknowledge that.

That whenever.

And it's so important that. That if you have the law of polarity, there's going to be really good and really bad in terms of, you know, people need to joke about it in order to talk about it. But then it makes it seem like, oh, this is normal. So that when you're working with a mom who's maybe five years postpartum leaking, she's like, oh, well, that's just. I have to live with that.

Yeah, yeah, yeah, exactly. So bringing up having a topic about that, maybe even stating what you just stated. Perfect. Open that door. That shows your passionate shows you have, you know, maybe even so in my pregnancy and postpartum course we have handouts or just to hand out and checklists and things like that. So it just. Yeah, I find that there are ways if you can get creative. I mean, you read people for a living. So I feel like the more comfortable you get, then the more comfortable other people will be with you talking about it.

And I also really love that you brought up the fact that it's so important to recognize that you don't always have to be the avatar of the person that you're serving that male trainers, they need or even females who've never. Or women who've never had babies. Like there's a whole. You don't have to be the avatar in order to help them.

Yes. And we go back to the medical profession for that as well. Like nobody in medicine feels that way, you know?

And I mean, I know for me too that when I, when I went back to work and when I went back to working out, like, I didn't want to talk about my kids.

Yeah.

I didn't want to.

I was, if you have a life outside your children, let's be careful. That is another touchy topic.

But yeah, I mean, I didn't, I didn't always want to be in an environment with someone that, you know, had to be me. I wanted to be. I got. Diversity is actually one of my core values.

I go, I go to the climbing gym and I literally climb with like 20 year old guys and I don't think they have any idea I have children. It's just nice to be around people where not everything, not my whole world does not revolve around children. But, you know, that's to each of them because I just, I admire the women that can have their whole world revolve around children because I don't think I could. It would be very. Well, it was very difficult over the pandemic. It almost broke me. But that's a whole different topic.

Oh my. I mean, me too. I mean, I was a stay at home mom for nine months and then I used to yell at my husband being like, you get to go to work and it's vacation.

Yeah.

And he'd be like, I'm going to work. I'm like, you're going on vacation.

You can never complain about work being stressful. Yeah.

I have to, you know, now, like as they're getting older, I have to check myself because, because I can have these conversations when they're not in the house, but if they're in the house, then they're like, mommy hates us.

No, that's not what I'm saying. One day you will understand. I love you very much. Just like you need your alone time.

Oh my gosh. I know. I just think that, you know, and you mentioned this earlier and I think it's just so important to reiterate that you're your mom clients that you're working with or that your mom clients specifically, like this is their, they need this time for their mental sanity.

Then laugh a little bit with a good story. It's even better. I just, I love the difference between personal training and physical therapy and I love the environment of personal training and how it doesn't have to be so serious. And I took a lot of that from my personal training days into my work as a PT and had an out of pocket pay practice. And I feel like connecting with people helped it excel more than not connecting. And which would be a typical clinic, you know, hospital setting where you're kind of filing people in and out.

So good. So good. And so to that extent I'm care, you know, and we, we kind of gave some examples earlier about, you know, some, some things to be keeping in mind when it comes to recommending a professional. So what are some of the things that a strength and conditioning coach could be, you know, aware of when they are recommending a pelvic floor professional? Like what are some of the questions? What are some of the things that they need to be keeping in mind that their clients need to specifically ask.

So for if they're worried about prolapse and they're worried about specific lift lifts, have them find a pelvic floor PT that is comfortable feeling internally during that movement. So like get on the floor, do squats. Like if you have a comfortable pelvic floor pt, they will let the patient get up off the table. So I think that can be important because a lot of women have that question. Like, I feel fine when I'm on my back, but when I do lunges or I do squats, I feel like I'm bearing down. And so having somebody check and then helping teach them to check can be very helpful. So making sure if there's somebody high level and they do have questions, questions in different positions, like just finding a pelvic floor PT that's comfortable with that, I would also maybe investigate A little bit on how much they kind of buy into the whole kinetic chain. I mean, because there are still some old school PTs around that are like giggles, nothing but Kegels. And you know, as somebody who experienced tightness, that can be very bad if it's not a good fit right in your face right now. It's hilarious.

I. I mean, oh, my God, I can't. You can't eat it. And again, it was not even my doctor. It was like, from watching television. And it's like, you just don't know what you don't know. And I didn't even think to ask, like, hey, are Kegels bad?

Yeah, but they probably gave you a handout too. They probably gave you a handout that said do Kegels. That's part of like, I remember.

I mean, there's a Sex in the City episode that comes to mind with Samantha specifically where she's literally teaching, like the whole episode is like how to do a Kegel. And I'm just like kicking myself that it's okay, it's okay. You learn. You learn.

Right? As I told my 8 year old and we were talking about, she corrected me on something and she's like, you're wrong, mommy. Ha ha ha. It's like the highlight of her life. But I was like, you know what? I am proud to be wrong. Because being wrong means I'm changing. It means I'm growing. It means I'm becoming a better person. Like, if you're never wrong, you're never growing as a person. What does that say about you? I think that's horrible and scary and awful. So I was like, where it is a badge of honor. You're wrong. Just know you're getting better.

Oh, that is so. That is so powerful. I mean, and so true.

I mean, I have no clowns with being like, oh, I gave people that advice. Oh, that was horrible. I'm sorry. People 10 years ago.

Oh, my gosh.

Me too.

I. I can't even tell you how many times I go back and go.

I learned a lot in 10 years.

Oh my gosh. Oh, my gosh. That's what I mean. I laugh now because. Because, you know, back then too, when. When you're, you know, new and when you're learning, it can sometimes that in my. For me, at least I'll speak to me. Is that. That it was just a band aid for covering up my own insecurity of.

Wanting to just go black and white, you know, don't let niece go over toes. Don't ever Run your lumbar spine. What am I missing? Yeah.

Yes. Yes. Never. Never do. Never. You know, you're. I mean, just. I can't. I can't. The list goes on and on. But yeah, I'm the willing list. And learn, I just think is so important. And then also to remember too, that we have to keep repeating and going back and there's a difference between learning it once and studying it and that things are going to change and that it's an end. That you can have more than one certification. Like, it's just.

Yes. And you need more than one because you need people's differing opinions on how to approach topics. And from every person, you're going to take something away that's then going to be able to. You're going to be able to assimilate that and make it your own. And then the more you do of that, the more you're going to develop your own style, your own approach. That's just very diverse and unique. And I think it's. It's great. I love learning, so.

Yeah. Oh, my gosh, me too. Me too. So, you know, as you continue to grow, like, what are some of the, you know, educational sources that you are always going back to. To?

So I read a ton of primary research, A lot of primary research. I spent two hours yesterday reading studies.

Oh, my gosh. Thank God you do it.

So we don't have. Yeah, I love it. I love it. So, yeah. So I was looking at something with the diaphragm yesterday, and then it led me down this whole giant rabbit hole of research and catching up and I was like, where was that? And when I found new things and it just, you know, so I learn a lot that way. I've taken a lot of PRI classes, as I'm sure you know, a lot of people have. PRI is amazing. I love the way that's what I mean by somebody's genius, like Ron's brain. And then so I do a little bit of teaching on helping people understand. Like, let's make this really simple. I also think that coaches which just a little different. Back to coaches. I also think that coaches need to be able to help women with low level pelvic floor issues because I know a lot of women that refuse to go to pelvic floor pt and I get really upset with the. What's the right word here? When professions are too, like, oh, that's my thing. You can't do that at all. Don't you dare check for a diastasis. Don't you do Blah, blah, blah. Like that's only my thing. And I. That makes me very upset because I feel like there's just a lot of gray. A whole lot of gray. I mean, obviously there's definitely stuff that's physical therapy related and there's definitely stuff that's training related. But I feel like in the middle there can be a lot of gray overlap and you could maybe have an orthopedic PT that doesn't know enough to help somebody with pelvic floor issues that maybe a trainer actually is better at. Help somebody. And I just feel like I've talked to so many women that don't want to go to public floor pt. They're uncomfortable or they don't think their issue is bad enough. Like, I have a little bit of leaking, so what? I'm not going to public for PT for that. So now you've got this coach who needs to deal with it because that's their client. They want to make their life better and if they just learn a little bit, wow. They could change that person's life. You know, I feel like there's just a lot of gray in there and overlap. And I feel like coaches can do a whole lot to help women, not just refer out.

Oh, I think that's so great. And I also, you know, we see this a lot in medical professionals. Like I'll see a doctor recommend something nutrition, you know, or I'll heal someone say, oh, my doctor said something for nutrition. And I'm like, wait, you've had like one semester on that.

Yeah.

And you don't get to be the authority on that, but that's an assumed.

A lot of courses in it and that was their area of passion. And yeah, you know, I do feel like there are some good doctors that understand nutrition, but.

Oh, for sure, for sure, for sure. It's not like a blink. I think that, that at the end of the day, it's the, it's. Everything is mostly a shade of gray.

Yeah.

Nothing is black and white. And it really just. Once you start building your team of professionals that, that for. For the client, that's just going to help them change their life.

And I think it has to be black and white. If you can't admit when you're wrong.

Yes, yes. But you know, your 8 year old shared with us today, it's okay to be wrong.

It's good to be wrong.

Yeah, it's good to be wrong.

Embrace it.

All right, Sarah, I definitely want to be very mindful and respectful of your time, so thank you so much for pouring in to us today. So for those of you who want to learn more about your certification, learn more working with you. What are some of the best places that I can send them?

Oh, I feel like there's we just scratched the surface. Let's talk for another hour.

I know, right?

I have a lot of free resources which are great to check out on my website, Core Exercise Solutions. But if you just google Sarah Duvall pt it'll also pop up. So tons of articles. I've got a six part mini course that is completely free that just is packed full of information. So I highly recommend checking that out.

Out. Okay, cool. And I'll be sure to link all of that up in the show notes.

Thanks so much. This was so much fun.

It was so fun. Thank you.

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