Episode 233: Understanding Your Pelvic Floor with Britnie Hornsby, PT, DPT, Cert DIN, Cert VRS, PCES

Hi and welcome to episode 233 of the Untethered podcast. Today we have Dr. Brittany Hornsby joining us and Dr. Brittany is a creator and director of the Pelvic Docs, a pelvic floor physical therapy practice challenging the standard of care for all. Britney is passionate about destigmatizing pelvic health conditions while also empowering those with pelvic floor dysfunction to seek the care they deserve. When not working, you can catch Brittany outside or exploring new coffee shops. She and her husband JR have two boys and one on the way, Wesley, 5, Zachary, 3 and baby number three in early 2024. Quick disclaimer all information, content and material of this podcast are the opinions of the speakers and is for the informational purpose only and not intended to serve as a substitute for the consultation, diagnosis and or medical treatment of a qualified health care provider. Welcome to the Untethered Podcast. I am your host, Holly Balkan. I'm a certified myofunctional therapist, feeding specialist, podcaster, business owner and mentor. This podcast is all getting your questions answered and collaborating with colleagues to bring you the most up to date information in the orofacial myofunctional therapy, airway, tetradural tissue and pediatric feeding therapy space. If you're new here, I challenge you to keep an open mind and join my mission to spread this message far and wide. If you've been around since June 2019, thanks for being a loyal listener. As we jump into today's episode, remember to listen with correct oral rest posture, tongue up, lips closed, teeth apart, breathe through your nose. Let's get started. Brittany, thank you so much for joining me today on the podcast.

Thank you for having me. I'm so excited to be here today.

I am like very excited about this topic and I know we were chatting for a few minutes before we recorded and it's something that I've always said to the team, we need to have more conversations around this and it's not my area of expertise. So I'm, I am so excited for this conversation because I just think it's a topic that every single female needs. I mean really, I know there's males too, but female especially surrounding pregnancy. Which leads me into my next question. I know you have a story of, you know, how you got into this specialty of yours, as many of us do with our specialties. Are you willing to share with us, you know, what brought you to the pelvic floor world?

Yeah, so I had been in practice for about three, four years prior to becoming a public health specialist And I grew up as an athlete. I played collegiate soccer and have remained active my whole life. And that's something that's really important to me, is being able to move my body and enjoy it for all of the benefits that exercise brings to us. And. And when I got pregnant, I was already starting to have these questions like, you know, why am I getting women better with their back pain, but they're still having pain with intercourse, they're still leaking with exercise. But I didn't really know the answer and I really wasn't like, honestly motivated at the time to figure it out. Sadly, like, I know that's not not the best answer, but when I get. When I got pregnant with my first, I had a lot of questions about what I could and couldn't do and what was safe and not safe and what would lead to the best outcome postpartum that would ensure that I could continue on my lifestyle. And the answers were very like, meh, do what you're doing. And I'm like, well, that doesn't seem right. Like, this seems like a very big change that I'm going to be going through over the next nine months. And then, you know, giving birth, whether I didn't know what the outcome would look like, I just figured there had to be something that could be done preventatively and prophylactically, but also if something did go wrong, there had to be a solution for it. And that's when I was like, you know what? All these other women have the same questions that I have and they're having the same issues and I need to figure out the answer. So I took my first. We call it Herman and Wallace. It's like one of the institutes that provides public health education. There's many out there, but that's kind of more of the well known one. So I took my first class and I went in like full heartedly and be like, I'll learn something new for myself and it'll be cool and I'll be able to use it here and there for patients. And I went into the class and I was like, oh my God, this is where I belong and this is what I need to do and this is where I can make an impact. So I took all the other courses that were required to kind of get into that specialty, and I started diving in and that's how I landed here.

I love it. And it's, you know, we were also talking about how so many of my guests on the podcast these days, I feel like, have come from their own type of Origin story, if you will, where they were doing something else in their field, like, you know, either related or completely unrelated to their specialty. Now and then, something either in their life, whether it was something medical that they experienced or having children, whether it's a mother or a father or whatever is going on, you know, they're like. And because of that, I have now totally deep dived into this specialty. Here I am. It's basically the thing I never knew I needed. And I was having this conversation just yesterday with another guest, and he was saying, sometimes these things, like, happen to us because it's like that catalyst in our life that is kind of directing us almost on the path that we're destined for, and we didn't even know it. And I think it's so obviously not that I want anybody to struggle or be in pain or have to go through any of this with themselves or their children, but it's so fascinating to me how so many of us have these massive shifts and what we're doing. We figure out our specialty and we're like, these are my people. This is my thing. Like, this is what I know, like, in my knowing. Like, this is what I need to do. And it just. I love that. I love hearing these stories, like, story after story after story, because I know it's like, at the end of the day, you're like, I don't want anyone else to have to experience, like, what I did or if they're going through this. I want to be that person who can help them and, you know, not have them running around to all these different professionals telling them, that's normal, that's fine, you're good. Like, don't worry about it. Kind of the gaslighting and the dismissing. Totally. Oh, yeah. Oh, yeah, Yeah.

I agree. It's tough.

Yeah, yeah. But so let's talk about pelvic floor. Let's talk about, like, for someone who's like, okay, well, great. I get they conceptually understand, like, what it is, where it is. Can you, like, dive into, like, pelvic floor 101 for us and tell us a little bit about, like, what is the pelvic floor? And, you know, what is it for?

Yeah. So I always love to just start off by saying that the pelvic floor, in my opinion, is almost kind of like the foundation of our home or our house. And you don't have to fully understand anatomy to kind of get that visual. But if you think about the pelvic floor as being a foundation, the way that it's oriented is it sits against gravity, so gravity is acting on it. And there's no other muscles in our body that are in that position or orientation. So she's going to be instrumental in providing us with a lot of support and stability as we move about our day, whether we're pregnant or postpartum or we're never going to have children. She's the foundation that's holding us together. And it's comprised of muscles and tendons and ligaments. And for a long time, we really, like, looked at the pelvic floor as, like, oh, just do your Kegels and everything will be fine. But research and expertise and more people being in this field and have really shown us that it is important in a system. So it's working with your core muscles, it's working with your back muscles, your hips and everything to provide that support and stability, but also help you be able to maintain your bladder and your bowels and engage in sexual activity without pain, but also engage in sexual activity that you enjoy. And I think that's a missing link that a lot of people don't acknowledge publicly floor pts can do is if you have a lack of sensation, that is a pelvic floor issue as well. So, you know, the functions of it, like, we just kind of touched on is in, like, preventing incontinence, whether that's urinary or fecal, allowing for support and stability of the pelvic organs, but the whole body as. As it moves, and then ultimately allowing you to engage in intercourse that is enjoyable. So that's where I say it's a foundation, and it is vital to our overall identity. And it's an area that when something is wrong, we know that there's a lot of emotional and mental health conditions that may follow. And so that's where, in my mind, it really encompasses all the pillars of health. So the mental health and. And all of those things are going to play a role in that too. So that's why she's the foundation in my mind.

I love that. I love how. I love that you call it, call her she, first of all. Oh, yeah, I love that. And I love that, you know, and. And, you know, I think my mind's even, like, being opened at the moment because I'm hearing you speak and I'm like, oh, wow. Like, I've never actually thought about all of, you know, it's sort of what is, like, the snowball effect, right? Something goes wrong and then all these other, like, layers to the onion or the snowball that just keeps, like, rolling down that snowy hill and getting larger and larger and larger. Like, there's all these different layers to it that I don't. I've never known about or known to even consider. So that's. That's pretty interesting. And so is it something that, you know, people tend to have injury surrounding based on something that's happened. Is it something that, you know, it. It's. I mean, I know pregnant pregnancy, and I know delivery obviously disrupt the pelvic floor, but, like, what kind of patients do you have coming to you? Like, do you know the root cause of a lot of pelvic floor issues?

That's the really cool thing about pelvic health and the world of rehab in general is that the cause of something can be really multifaceted. It can be a singular medical reason, and it can be a medical reason and then a movement reason and a coordination reason. And I would probably say that's more. What happens is it's more maybe there's a little bit of an underlying medical condition or issue that leads to dysfunction in the tissue or at that tissue level. But the patients that are coming through our doors are through, like, every stage of life, every age group. And I. The more and more I am into the field, the more and more I start to believe and question whether we all kind of had pelvic floor issues from an earlier age. And as we go through life and maybe get injured or have pregnancies and have postpartum experiences, that's when we start to actually see the warning signs or the symptoms. But I would say there's a lot of dysfunction that's probably underlying, and it's okay. It's okay to have a body that's not functioning perfectly all the time, but it does put us more at that risk for injury once that catalyst is there. So I think that's kind of what we see a lot of. It's like, that probably was there for a while, and then this is what brought it to light. So I would say the people walking through our doors, all stages of life, all conditions and pain is probably the driving force to why people see us. And then the second thing is leakage.

Interesting. Yeah. And it's. Again, it's one of those things where I think I've always kind of associated pelvic floor dysfunction with pregnancy. And, you know, I'm hearing you say, well, that could be the catalyst. That could be like, the last straw. That kind of like, you know, there was dysfunction present already. You're carrying a baby. Obviously, it's changing a lot of things in your body, especially putting pressure on that, that. That base of support, right? Especially when you're seated or walking or whatever. And then you, like, have the baby and all of a sudden, you know, now it's like everything's kind of hurting or it's no longer tolerable. And I think that's interesting too, because we talk in the myofunctional therapy world about how so many adults walk around not knowing what's typical versus not typical because they've had it their whole life, right? And it's like, until you address it and they now are on the other side of it, that they kind of go, wow, like, I really didn't know what I was missing out on. And it almost sounds similar in that people just don't know that's their. That that's their normal, right? That's kind of their bodies learn to compensate or whatever until they no longer can. And that's when they're like, okay, I'm in pain. I can't take this anymore. Now I need to see somebody. So I think that that's very interesting. It doesn't surprise me, but it definitely just kind of opened up my brain a little and I was like, oh, yeah, okay. I mean, the human body, this probably happens in every single part of our body. Oh, yeah. Depending on, Right?

Yeah, it's. It's pretty wild. I mean, like, I try to, like, equate it to things that are a little bit easier for patients to see. Like, we, we know that female athletes are at risk for ACL injuries, right? Like, the ACL injury is the catalyst that leads them to have to do surgery or rehab. But a lot of times there's a dysfunction in their strength instability and proprioception, and then there's hormones and things like that. And then all of a sudden that catalyst happens and their whole world changes. And that's the same with pelvic floor dysfunction. Like, it, it's there and we're all dealing with it to a certain extent and we're functional, so it doesn't matter. And then boom.

Yeah. So as, as we're talking about this, I'm thinking about, I just did this like, free five day screening. I have this like pediatric feeding screening tool. And one of the little sections looks at posture because, you know, when we do a full evaluation, like, I'm, again, I'm not a pt, I'm not an ot. But we know, we always say what you see on the hips, you see on the lips, right? And so we know if there's oral dysfunction going on. We have to look at the core. We have to look at our base, you know, our base of support. We talk about that 90, 90, 90, you know, seated position for at least feeding to support what's going. What we're doing in our mouth. But one of the things that I like to do, it's like my favorite thing at the very end of one of the trainings on during that week, I go, okay, adults, like, sit in your chair. And I basically put them into like an anterior pelvic tilt, and I have them take a sip of water and swallow. And then they put them into a posterior pelvic tilt, and I have them take a sip of water and swallow. And then I have them sit, like in a neutral position and have them take a sip and swallow. And I'm like, what did you feel? And everyone's like, it was so much harder to swallow the water when either in anterior and or pelvic tilt. And I was like, okay, now look at all the kids on your caseload. Like, so many of these kiddos, for whatever reason, again, I'm not the OT or PT here, so I don't know if it's a strength issue. I don't know if there is a low tone issue going on. I don't know if they're hypertonic and if they're hyper fixed into a certain position. But I'm like, if that child is like, you know, their. Their pelvis is tilted anteriorly and you kind of see them coming forward or they're kind of slouching into their seat, you know, I'm like, that's where we have to kind of go like, okay, there's something else going on, and we probably need to bring somebody else into this team to support these children before we expect to make progress in their mouth. And so anywho, that's where my brain went because I was like, yeah, base of support. And we do talk about it a lot, but I never, you know, even though it's called anterior and posterior pelvic tilt and that light bulb didn't go off of my brain, that I'm like, oh, pelvic floor dysfunction in a child. Okay, so do you see these kids?

Yeah. So I don't personally treat pediatrics, but I have pts on staff who do. And a lot of it comes down to postural issues and tone issues and coordination issues of the trunk and core muscles. And we work a lot with feeding specialists as well, because a lot of that, you know, dietary intake and what they're able to get in. And what they're eating is also going to affect ultimately their digestive system. And it's funny because when you're talking about the mouth, we treat a lot of jaw and a lot of neck stuff. And I always equate it to the glottis being a very similar orientation and looking much like the pelvic floor. And the major divider in those two systems is the diaphragm. And so a lot of things come from the diaphragm. So it sounds like our world's like, intersect in a very different way.

I mean, no, I feel like most, most people are not breathing properly. So that's that, you know, so we know that they're either not breathing well with their diaphragm, they're not using the diaphragm in the way it's intended to be used, or if they are, they're still. There's like a lot of, like, hyper and hypoventilation going on. There's a lot of breathing from our clavicle and our chest and, you know. Yeah, yeah. And when we start to look at a lot of that and how it's just also interconnected and, you know, when we go back to like, the babies with the suck swallow breathe, we have these infants, like, who can't coordinate that. And everyone's so hyper focused on the suck. Work on the suck training. And that's great. We need to work on that. But I'm going, how are they breathing? Are they noisy? Is their mouth open? Like, what does that look like? And I also feel like a lot of these children who continue to struggle with that are a lot of the same children that tend to have either lower tone in their body or there's something posturally that needs to be addressed. And yeah, I mean, it just, it comes so full circle. And then these are the kids who, if not addressed, turn into older children and teens and adults. And I'm sure that's who. You know, you said you get a lot of the, like, temporomandibular joint pain dysfunction type of patients and then neck issues. I mean, again, we know it's all like, so interconnected. So are you. And I don't know if there is, like, research on this or numbers or whatever. I mean, I know, for example, like, almost, I think it's like 99.8% or 7% or something really high of people with temporomandibular dysfunction have orofacial myofunctional disorders, which makes MYO disorder. But also, like. Yeah, I Mean, there's. Your mouth is not going to be in a proper position. You're going to have a hard time getting your tongue up to the palate. You're not going to be nasal breathing especially. And it's just, there's so much going on that we tend to see they're not doing properly. They have, you know, oral phase two bolus prep and, you know, swallow initiation that is off because of the orofacial pain. Yeah, I mean, it's. It's fascinating. So now I'm going, okay, how do we dive into this, like, and connect it with the pelvic floor? Because obviously it is very connected.

So, I mean, what. I don't know the numbers off of hand, but usually when we're talking to a patient and they're coming. They're not coming to us straightly for, like, their jaw pain. You know, they're coming in for pelvic floor stuff. So usually anytime a patient is coming in with, like, urinary urgency, painful urination, urinary frequency, and then any sort of pelvic pain or tension, I'll start asking questions about other areas. And usually we land on the jaw and they have a history of things going on up there, or upper cervical pain, headaches, migraines, those types of things. So I don't have exact numbers, but my clinical expertise will always go there and ask those questions. Because even if they don't have it at the time, they might be like, deal with TMJ pain in college. And then I'm like, okay, so during high stress situations, your body's probably not functioning optimally. So just trying to come back to those parallels.

Yeah, no, and I love it, too, especially when patients are like, why are you asking me about this? And I'm like, I'll get there. Because it's all interconnected. And so many of you have such similar symptoms or signs that are interconnected and what's going on? Yeah, it's fascinating. So I'm trying to, I guess, make sense of it in my head too. Right. So we have. Because we obviously get a lot of patients that come to us because of jaw pain or TMJD or whatever may be going on in the mouth. And now I'm going, huh, Okay. I mean, we. We do refer for, like, certain types of body work. Like, I personally worked with a physical therapist who has trained through pri, and, you know, that really helped me with certain things. But I wasn't your TMJ patient. I was going through expansion, and it was kind of like a nice Byproduct of like, hey, while we're doing this, let's unlock the body as we go. I also saw him before I had my second child because I knew I was not breathing properly. And I was like, before I carry another baby, I want to get like all of this in check. And you know, again, it, for me, it wasn't. Well, actually, I take that back. It probably was pelvic floor dysfunction, now that I think about it, because, you know, I went in with my first child at like month seven to a chiropractor and I was just like, I think a physical therapist assessed me and then the chiropractor in the practice like, treated me and they worked very closely together and they were like, oh no, you don't really have like sciatica pain. And I was like, but like, you're touching this and saying this is like my sciatica area and that's like where the pain is. And they're like, well, it's not a sciatica issue. And I was like, okay. So I'm like, whatever it is, can you just make me feel better? Like I don't care what we call it? And they did. It was amazing. And so like with my second child, I was like, all right, I'm going to work on my breathing, I'm going to try and work on my posture. I'm going to work on all these things. And then just from a preventative standpoint, I'm going to go back to that, that PT and chiropractic practice that kept me, that got me out of pain, to see if I can stay out of pain. And it was great. They were like, you are like the only like 8 month pregnant woman who's not wobbling around. You're just like walking like a normal human. There's no big thing hanging off the front of your belly. And I, that's the goal. But now they think about it, right? I'm like, it was probably connected to pelvic floor dysfunction. I'm a low tone human. I know my posture is off. I know that I don't sit on my pelvis correctly. I actually had an injury like a year ago, a little over a year ago where I. We were moving, I had all the stuff all over the floor and I just like slipped on the bag, fell on my tailbone. And you know, I didn't think much. I mean, it hurt like hack, right? But like, I didn't think much of it at the time. But now I cannot sit like in my, I can't tilt My pelvis. And the fascinating thing is not that it just. It's uncomfortable when I do that. I'm like, it must be hitting a nerve somehow because I start to get a post nasal drip. It is the most bizarre thing. And I've never, like, actually said it to anyone or asked anybody about it because every time it happens, I'm just like, oh, sit. Like, sit up straight, Halle. Like, you're obviously starting to, you know, tilt your pelvis. I'm like, so what a great reminder to sit up straight. But then, you know, certain seating positions or chairs or scenarios are really uncomfortable. Not painful, but uncomfortable. And it's. Again, it's just like, okay, we're gonna. We gotta work on this. But yeah, no, it's. I guess it all goes back to my pelvis. Really?

Yeah, it's pretty wild. I mean, you have to like, remember like that. That start of the pelvic floor, the deepest layer, there's three layers, but the deepest layer is gonna start at that tailbone and go all the way to the pubic bone. And so any, like. So one of the screening, like, we have a screening tool that we'll use developed by one of our well known practitioners in the field. It's called the Cozy and Public health screen. And it's 11 questions. And if you answer yes or no to them, then you likely have a pelvic floor dysfunction. And one of the questions is, can you recall or do you remember falling on your tailbone? And it, like, it can be like, as a child. It could be as a child, it can be as an adult. Because we just know that that trauma to where a muscle is kind of originating and can be kind of an It. It can lead to just those muscles starting to misinterpret the environment as a threat. So that tissue is probably well healed in your. In your case, like you said, it was a little while ago. But the memos that are getting sent to the brain when you sit, that's where the central nervous system is, is not. Didn't get the memo that you're healed. So, yeah, yeah.

I'm like, okay, so clearly I need to go see a pelvic floor. Pt. Guys wrote it down. I'm like, pelvic floor, pt.

Okay, got it.

Schedule, schedule appointment.

You won't regret it. I always tell people it's the best decision you'll make, even if you only go once.

Yeah, yeah. No, you know, I, I love this kind of stuff because I also feel like, like if you can support your body in the right way, like, then it just benefits you across the board in all aspects of life. And so I am very much so for, like, what does my body need? Like, lean into that. And, you know, but sometimes I think in my brain, I just didn't really put two and two together that, like, because I was like, oh, I just. I fell on my tailbone. And I. I googled it, and it kind of suggests that, like, if you want to fix, like, a broken tailbone, that may be healed incorrectly, if that's what even happened, that, like, you might be looking at surgery. And I'm like, I don't think I'm there. And so my brain's just like, we're good. We're fine. I can function. I'm like, okay, I'm functioning. But, like, am I functional? Like, am I 100 functional?

No.

Like, really, it impacts how I sit, which to do throughout the day. So here we are.

I love it. So no matter what, rehab professionals make the worst patients. Yeah, that's so true. That is so true.

So what do. Like, what does it typically look like when a patient comes in? Right. You assess, like, is there a typical course of treatment? Is it so highly individualized that it's like, you can't really even put a number on it or, you know, it.

It obviously is very individualized in what we prescribe or recommend to that patient, but the evaluation process will look really similar across the board. You know, I think if you're with working with a really good pelvic floor pt, they're going to spend a lot of time talking to you about what's happening physically, but they are also going to be asking questions and inquiring about the other facets of health, like your stress and your sleep and your diet and then going in. And they're really going to. We evaluate full body. Like, I was talking about the jaw. Like, sometimes it's us not evaluating the jaw and the neck. So looking at how are those surrounding areas or influential areas also working? We look at, like, feet sometimes for people and balance and all of those things because we know that there's correlations to leakage and other pain issues when there's not a good balance in that system. So really diving in and based off of what the patient is coming in complaining of, we're then looking at full history, screening them through orthopedics. And then if a patient is comfortable and consents, a pelvic floor PT will offer a pelvic exam. And that looks different than, like, your OB GYN exam. Like, we don't have, like, the stirrups or speculums or anything like that. But we're doing a manual muscle testing. We're looking at general tissue quality. Like, we would look at your quad. Like, if you came in and you're like, my quad hurts. Okay, what does that muscle feel like? Is it. Is there tone? Is there tension? Is there tightness? Is it not moving the way we would want it to? Is it strength? Is the strength impaired? Is the flexibility impaired? So we look at that, and we do that in our clinic. We do that lying down to start off with, but we always try to also focus on standing assessments. Because the reality is that what we do in the life or in our real world is up against gravity. And since that is a foundational structure, we need to know how that foundation is when the rest of it is acting against it. Like, if your house is laying on your side, well, who cares what the foundation is doing? But when your house is upright, then that matters. So those are the components of a really good exam. And from there, depending on what the patient is having issues with, we may coach through stress management, we may coach through sleep and diet, and then exercise prescription, manual therapy. We in Arizona are really fortunate. And we can perform dry needling, and we do a lot of dry needling. And that's because of how we can influence not only the musculoskeletal system, but also the central nervous system in a way that can down regulate and help us kind of communicate with some visceral and systemic structures that are not always easy to do. That's.

That's amazing. I love hearing about, like, the full body evaluation. I love that, you know, you mentioned you also, you. You ask about sleep. I got so excited when you said that, like, that is not so common outside of, like, my world or, like, you know, oh, really? Well, you know, and it's like pediatric feeding therapists, most are not trained to look at airway or sleep. Like, they think airway. They think like, lower airway, not upper airway. And I'm, you know, thinking more like, I'm not working with feeding patients that have, you know, personally that have, like, tubes and lower airway issues. And, you know, I'm looking at the kids who have more of the upper airway issues that are constantly sick, that are breathing through their mouth. They're maybe the enlarged tonsils and adenoids and all that stuff. And so sleep is huge for us because obviously sleep is going to be impacted. And then we know if your sleep is impacted because your airway is impacted. So is everything else. Right. So it's like. It's just that downward spiral. So I. Yeah. I mean, to hear another provider be like, and we asked about sleep, I'm like, what? That's amazing. Like, I love this.

I love this.

So that's. I. I think that's fantastic. And then, you know, you're mentioning the whole body. You said feet. And I. My. My brain went, oh, yeah. There was the one time where when I was younger, they were like, oh, yeah, she has a leg that's shorter than the other leg. And they, like, actually wanted to, like, do surgery. And then I finally found somebody who was like, no, your legs are the same length. Your hips are misaligned. Like, let's adjust. Just, you know. So again, that comes back to my pelvis. Right. And my hip. And, like, it's that core area that has, I think, always been a problem for me, like, since I was a child, a young child, for whatever reason. And once we got things kind of. We worked on things and things were aligned, it was like, oh, look, amazing.

Your.

Your body.

Yeah.

Actually, like, your legs are the same length. And I was like, oh, I do have flat feet. And I do tend to, like, pronate them if I'm standing in the kitchen, like, on my computer at the counter or something, and it's so not good. But I, like, turn them in, I turn them out. I, like, leave them flat, although they are also flat.

So it's all good. I always say, like, hey, even if things aren't perfect, you could always work on the strength and coordination of it. We're not really going to, like, have too much influence on what skeletal structure has already been developed and formed, especially after, like, that adolescent age, but we can influence how those things show up. So. Yeah. Yeah.

No, it's. Again, I feel like it's fascinating because it all seems to kind of come full circle. And, you know, and like, you said, like, that our pelvis just being such a foundational part of our entire system, you know, I don't think most people really stop to think about that and how, again, like you said, the base. If the foundation of your house is falling apart, we got problems. And, you know, like you said, also if you're laying on your side for an assessment, you're not, like, actually on the foundation, then you're also kind of missing a big part of the puzzle, so.

Totally.

Yeah, I can appreciate that. I know, like, with the eval that. That I have had, most recently with the physical therapist, you know, we did everything from laying down Standing up against the wall, standing on my own sitting, you know, all different kinds of positions. And, you know, it was very fascinating just to see the process, because, you know, I don't know. I don't remember if, like, the pelvic floor was even something we really even we're addressing, but, you know, I think he probably was looking at way more than I even realized when I kind of was just like, oh, yeah, assess me and make sure I'm functioning okay. Like, big tall order. I don't know what's going on, but.

Gonna get pregnant again.

So let's go.

Yeah.

Yeah. So do you have a lot of. So you mentioned you don't work with pediatrics, but others do where you. Where you work. So you guys have, like, the whole lifespan of. Of peds and adults come in through that door. So do you have a lot of patients or even parents of patients who are just, like, totally new to this, Confused, like, needing lots of education? Is that a big thing for you all with us?

Oh, yeah. Oh, yeah. I mean, education is probably, like, we always joke that we do physical therapy really well, but we're really just coaches who are educating patients on what's happening, how it's different than the norm, and potentially why it's happening. I think the why is really important to people, and so education is huge. And getting to the why is this happening? But then also turning that around, especially when working with the pediatrics and the pregnancy postpartum population is they just want to know what they can do. Like, they've been thrown through doctor visits after doctor visits a lot of times and just told that, hey, it's normal. Especially, like, the pediatrics. I know Dr. Stephanie, who works with our pediatric population, like, she'll just be like, oh, yeah. They've seen so many pediatricians. They've seen so many, like, people, and everyone's like, well, it's fine. They poop at least once a week. Like, they'll grow out of it. And it's like, no. Like, that's not ideal. And parents are like, yeah. I mean, like, they're telling me it's fine, but I don't feel like it's fine. I think it's something. So I think it's finding that answer, but educating on some of the potential reasons why it's happening and giving hope.

Yeah.

So we spend a lot more time educating.

Oh, yeah. No, I mean, I would say it's very similar with, like, the work that I do, too. It's just, you know, I think. Think people also need to under, like you said, they need to understand that why if it doesn't make sense to them, they're not gonna, one, they're not probably not gonna come back. Right. It's like they go for all these appointments, but if you want them to come back and follow up with you and actually like do the work at home, which is actually like the real work outside of our sessions, you know, it's. I think they really need to be bought in. And I think it then falls on us, right, to kind of like you said, like you guys like educate and you encourage your patients and you kind of, you want them. It's like you're empowering them, right. To really take their own health into their own hands. But, but we all have to know why. And I think that a lot of providers don't provide the why. They're just like, oh, this is what I see and this is what you need to do. And here is your list of exercises. So I love that you guys definitely take more of that like, holistic care approach and kind of, you know, pulling the patient into the process. Because truly without them there is no process. Right?

Totally.

Yeah.

Yeah. And we try to create educational content and things like that for our clients that go above and beyond because I think, you know, when you work with people in person, they hear one thing and then they can go home and they'll try and communicate it to their significant other or somebody else and that loss in translation thing happens, which is fine. It's not their area. They shouldn't, they shouldn't know it after a 30 minute conversation with a provider. So we provide a lot of educational resources, online modules and resources for our patients too, so that they can re. It's reiterated, the verbiage is said over and over and over again so that it sticks and the importance of the why is there.

Yeah, no, that's amazing. I love, I love the resources and just, you know. Yeah. And I think it's, it's so nice to chat with providers who are putting the time in to, you know, like we said, like I said, empower. Right? Educate, empower, elevate patients. Because I just feel like so much of the medical world has gotten so far away from that and, you know, it's like we can heal together and we can heal ourselves if we have the right people, like in our corner and we have the right tools and if you will. So I always love, like, I just love these, these more holistic, patient centered approaches. I love it. Yeah, I think it's really very cool and you know, as you were talking before, too. Well, first of all, going back to, like, voiding and, you know, all that. It's. It's interesting because, you know, like, one of my kiddos had this situation for a while. Like, it. It went on for months. And we went to a urologist. Nobody ever said to go to a pt. And now I'm like, yeah, we should have taken her to a PC. But it's just that urgency of, like, always having to go pee. But, like, you don't have any diagnosable issues going on, and all of your urine tests are coming back normal, and nobody can figure out why. And we're not, like, over drinking water, but now we're afraid to drink water because we have to pee every seven minutes. Like, it's like, you know, when you're a young child and you. Then you have this fear of not being near a bathroom at school or, you know, I just. It was. That was fun for all of us. And I just. I don't remember, like, how it shifted, because then it basically, at the end, I was told it was behavioral. They're like, well, now it's just behavioral. I'm like, well, sure, there's a behavioral component to every issue because you learn a certain response, like, hello. Antecedent behavior.

Like, right.

So I'm like, yeah, so of course she's learned this. And so, like, well, you have to unteach her that. And I'm thinking, like, like, really? That's our signing. Sure, no problem. I can unteach her this. Whatever this. I'm like, but now she's got anxiety around it. And obviously it didn't just start for no reason, but not one person could figure it out. So I just was like, all right, I'm going to go a holistic route. I'm going to try this, I'm going to try that. And I don't know what. Or I don't know what did it. I don't know what.

Yeah, changed.

But now I'm thinking, like, maybe we should go and evaluate. I'm like, also, was she going through expansion at that time? I have to, like, go back and look at the calendar because, oh, yeah, it had been, like, somewhere around where she got a new appliance put into her mouth. And I don't think my brain connected the two at all. And now we're sitting here and I'm.

Going, I wonder if that would be really interesting. That would be really interesting. And I have.

Yeah, it's, like, well documented because I've used her Case like, in all kinds of things in my business and online and everything. And now I'm like, I have to go back.

But even if something is like a behavioral, that's where, like a provider walking you through the process of retraining would have been, like, invaluable.

Yeah. I mean, basically, they. They were like, the urologist was like, yeah, so just set a timer. Don't let her go until the timer goes off. And I was like, oh, okay. Like, and that's it. Like, that was the whole thing. I was like, like, there's not more to this. I mean, and. And then she was kind of anxious. She'd be like, has it been seven minutes? Has it been 10 minutes? Has it been 15 minutes? And I'm like, no. Like, like, oh, this poor kid. Like, I just, I. You know, you feel bad because you're like, I don't know what to do. And now I'm thinking, like, holy moly. Like, I probably should have taken her to a public who works with pediatric. But live and learn.

Right now.

I know, for next.

Live and learn. Exactly. Yeah. That's the whole point of our jobs is to educate and empower people to see other options in the future.

Yeah. I mean, and this is also like, my. My kiddos, both of them, but especially her with her tongue ties and just like, a lot of tension that she carried as an infant, like, from birth.

Yeah.

You know, constipation was a big issue for her. And the day, like, after she got her tongue tie released, it actually improved and she no longer. Much tension. You know, we were doing other stuff surrounding that too, but, like, all of a sudden it drastically improved and she started being regular. And I was like, what is this? Like, what is this world? But again. And that was one of the things early, early on that kind of tipped me off in this space to be like, okay, something greater is going on that nobody's really talking about. This is not what I learned in grad school. And, you know, I was like, hey, guys. So when you see tissue, like, releases, like, whether it's surgical or non surgical or whatever, are we seeing improvements in, you know, going to the bathroom, regular, like, bowel movements? Are we seeing, like, what are we seeing? So, yeah, it's I. Once a week. No, that kills me. These poor kids.

Like, I know that's not normal.

Not normal ever, ever, ever, ever. But anywho. Yeah, so it's. Again, I just think it's really fascinating when we talk about some of these, you know, things that have been made to be Normal even. You know, you see like the reels of moms after babies talking about like peeing their pants and how you can't jump anymore and how you can't do this. And basically, you know, it's like, oh, just like peed my pants and normalizing it, right? Yeah, got it. I'm sure it drives you guys crazy.

It makes me, it makes me sad more than anything just because obviously like it. You know, I think humor is a really good way to heal things and I'm, I tend to use, use laughter to help people. But I do find it, I do find it sad because I think that that is unfortunate because it really then helps that kind of misinformation continue. And then people don't know that there are solutions out there. And most of the time incontinence is actually quite easy and really quick to.

Manage.

Because it's just usually your body, something alignment posturally coordination wise is off and when you start working on those things, you start improving. And so it's like, man, there's a solution that's so simple. You just have to go into that office and see and find it. Yeah. So yeah, it definitely makes me sad.

Yeah, no, I mean I can imagine it's. And I'm the same kind of, I'm the same way where like I totally use humor in any. Oh yeah, like that is just so me people I think to the degree where some people are like why is she laughing about that? And I'm like, that's how I deal with how I deal with things.

Totally.

But yeah, it's, it's definitely one of those like just in TV episodes with kids open mouth breathing and snoring. And then you've got sexy, you know, models walking around with their lips parted because that's what sexy is in our society. And all these like little things that like I look at and I cringe because I'm like, oh, why are we just perpetuating this message?

Can we go, can we just close.

Our lips can still be very sexy with your lips closed, right? Or like no, storing's not super cute. Like that's not what we want to be perpetuating in this. You know, unless we're now going to have this episode where they go for some kind of assessment or treatment. I don't know, maybe that would be cool. But yeah, no, I think again it's just what our nor like what our society is normalized, right?

Oh yeah, for sure.

It's. It prevents people from finding who they need to help them, which Kind of leads me to my next question. Like if somebody is seeking a, someone to help them with these types of symptoms. Right. I know it's not going to be just like any physical therapist. How do they find a physical therapist, a practice, a person who is trained in working with a, you know, patients who have pelvic floor dysfunction or something like these symptoms that we talked about.

So there are some really good resources out there. Pelvicrehab.com is a database that is free for the providers to sign up for and it's free for patients to use. And it basically has anyone who's ever taken that Herman and Wallace programs, those courses, if they've taken the courses and have that training, they will be on that website. And so you can basically go on to pelvicrehab.com, enter your zip code and find a provider in your area. And it's great because it like opens up a map and they're like all there on the map. And then there are some like qualifications that are also listed like and they can have bios and things like that so you can kind of get to know them, find their websites and things of that nature. Pelvic guru.com is another one. She's actually a Florida resident and she runs a database and I really like her database because it, it's not just pelvic health physical therapists or OTs, there are nutritionists for pelvic health, there's gynecologists. So anyone can kind of pay to be on that one based off of their specialty and their interest. But within that pelvic health world. So sometimes we can do a lot, but we also need the help of like minded urologists and like minded gynecologists and, and those providers. So to have them is really awesome and instrumental. So that's another really good database. And then you know what, like online and social media has drastically changed the game. And going online and just like typing in like hashtag pelvic floor exercises or pelvic floor muscle will bring up a load of providers that are active on social media. And that's always another good way to like potentially find somebody in your area that you vibe with and you get to know our personalities. Social media has been a catalyst in our practice that I didn't foresee. I just did it for fun and a way for myself to be uncomfortable talking about or you know, be comfortable talking about uncomfortable things. So that's another really good resource and place to start as well.

I love that. Thank you. So if they Want to find you. Specifically, where are you located? What's your website? And Instagram, how do they find you?

So our website is www.thepelvicdocs.com. and then Instagram is just the pelvic doc, Facebook is pelvic docs. And. And right now all of our content is more patient driven. Like, we've used it for our patients and honored them, kind of buying into the process. But one of our goals over the next 12 months is to provide programs for those who might not be in the area because we right now are brick and mortar out of Phoenix, Arizona, and then also Prescott, Arizona. But we feel that the resources that we've come up with would help others who might not have access to pelvic health. Like, I just moved to Prescott and I will be the only pelvic health provider here. And I mean, it's, it's not, it's not a city, but it, you know, it's a small town, but there's a lot of people that really need it. And so there's probably a million other small towns out there across the United States and across the world that might not have as direct access to pelvic health as they really deserve and really need. So our goal is to get those programs to be up for them as well. So.

Yay.

To be continued.

Yeah, to be continued. I love that. Fantastic. Well, we will be sure to include that in the show notes. I'm over here. Like you'd write you had mentioned the pelvic floor floor, like screening tool. I think the co. It was cozy or something, right?

Cozy. And yeah, I can send that to you too.

Oh, my gosh. Because I'm like, now I need to screen myself and go find myself a pelvic floor PT here. But, you know, totally got resources now. We're good. But yeah, this has been amazing. We'll make sure we link what you shared in the show notes, like I said, so anybody who's, you know, driving, you don't have to pull over. Don't be dangerous. It'll be right below the episode. And yeah, thank you so much for joining me today. This, this has been so much fun.

Yeah, thank you for having me. And I, I just feel honored to be able to talk about what I'm passionate about and share that with people. So this great time.

Thanks for listening to this podcast. If you found value in this episode and want to hear more of these Myotots, Airway and Feeding related episodes, be sure to leave a review on Apple Podcasts and share this episode. On your social media platforms, you can access free resources at all. I offer@halleblkin.com or pop over to allybalkin on Instagram to get all the latest updates.