Pelvic Weights and Avoiding Gimmicks

And so what type of injuries do you usually see in women related to a dysfunctional pelvic floor I think the obvious ones, you know, everyone knows kind of like leaking. I see a lot of prolapse so like heaviness, pressure A lot of clients will feel like they're sitting on a ball. This is what I dealt with after my first pregnancy when I went back to running too soon It's where the organs don't have the support that they need. And so it does feel heavy and like there's pressure and swelling down there. And so we can train the muscles to kind of help lift and support so that you don't feel that heaviness. The less obvious ones are like recurring low back pain U tailbone pain, A of hip injuries, groin strains, hamstring strains Those were current muscle strains that were kind of like, whyy is my hamstring always tweaked? or why is my glute tendon always really irritated Hello and welcome to another episode of Find Your Fuel. I'm your host, Erin Martin, and today we sit down with Dr. Rachel Selman to talk about one of the most neglected parts of our bodies, the pelvic floor Most of us throw out a wish and a prayer after having kids that will miraculously heal and don't give it a second thought when working out even though athletes are far more likely to be affected by pelvic health conditions than non athletes We train for speed, strength and endurance, but also forget that every single movement we make relies on a deep connection to our core and pelvis. Dr. Selman is a performance sports scientist, orthopedic and pelvic PT and founder of syynthesis phhysical therapy She's also the author of a new book, Flort, which is a first of its kind guide to pelvic floor health, specifically for athletes. And so today we go beyond the basics of kegeles, talking about reverse kegeles and what we can do if we're lifting or running I have a lot of personal takeaways that I am going to be incorporating this week for myself, personally when it comes to the pelvic floor. And so our conversation with Dr. Selman is your fuel for today. I am a physical therapist and strength and conditioning coach. I started in what is probably considered more trraditional physical therapy, so very orthopedic, sports minded Al alsoso like working with ACL repairs, rotator cver repairs, sports injuries, that kind of stuff. and then I got pregnant and was really disappointed by how much information was out there that all contradicted each other. And so there was a bunch of like blurbs and thoughts that were present at the time. So this was twenty seventeen. And so there were a lots of thoughts and it depended on who you asked, whether it was like OBGYN or personal trainers or physical therapists. Everyone had something different in terms of what was safe and what was not I' coursece went along with what my OBGAN said because that was my medical provider and I want to do what's safe for me and baby At the time, the recommendations were no heart rate above one hundred and forty, donon't lift more than twenty five pounds, no core work, all the kind of very conservative stuff So I followed that, but I was very active before pregnancy. And so going from that level to following these very conservative guidelines, I lost a ton of strength. I lost a ton of endurance. and at the time, I thought it was just you know, doing what was best for me and for baby Now we know that none of that is true. But then I got frustrated after pregnancy and postpartum because After I had the baby, then it became wild wild west of like, okay, baby's out of your body, you can do whatever you want whenever you want So it was very regimented, check in with the doctor, talk to the doctor, check in and in person appointments, like all the time in pregnancy. And then postpartum, it was kind of like, e, we don't care, like whatever you want to do, just go for it, listen to your body which I think truthfully such bad advice for women who been historically kind of like neglected by the medical system because We are really good at like ignoring pain, ignoring symptoms, pushing through things we shouldn't be pushing through when no one tells us otherwise. And so ended up with a lot of symptoms in postpartum that I think I would not have had to deal with had I had the education that I do now, And work through all those symptoms with PT on my own now don't have any symptoms, but I understand how lucky I was to know that Pubic PT was even a thing And now Jokingly, my husband says it's my whole personality because I have turned it into this like It's rehab for me to see women not have to go through what I went through, to have all this guidance of you can do this and you can get back to this. And here's a general idea of what I would expect for X,Y Z versus over cautious, over monitoring in pregnancy, and then as soon as you have your baby Do whatever you want whenever you want So that's kind of how I ended up where I'm at Now in the pregnancy and postpartum space And that has slowly shifted even into just more athlete care, recreational elite, really trying to help people understand that the pubvlic floor is not a muscle group that isolated to pregnant postpartum women. It applies to every single person, male, female, kids, no kids It would be the same thing as me kind of ignoring a quad in someone just because they're a guy. Like they have those muscles too And we know from the research, the little research we do have that athletes are more prone to pelvic floor dysfunction, regardless of if they have children or not I say all the time my job now is like pulling people out of the river and I would really like to stop people from falling in in the first place. And so that's kind of where I'm at this season of my career is can we Be more preventative and proactive about this. Yes. And I think especially there's just this wave probably our generation and before us who did not have support And so now, I think one thing you talk about a lot is just how O injuries in your body can be related to the pelvic floor. So it's like, okay, we have ignored this or known about it, but not really known what to do for so long. And then later on, you know, after kids forty, fifty, sixty, we've got injuries or different things happening and it actually is related to the pelvic floor So I'm also curious as a background, can you explain the pelvic floor a little bit more because I am not gonna to lie before this If I had to recap what the pelvic floor was, I would say it's your undercarriage and probably like space just in between like the bottom of your bottom. Like that is it. L that would be my definition of it, which is incorrect and there's more to it. There's a lot going on down there. I would going say that that looks pretty good. I've definitely heard worse. So the pelvic floor is a group of muscles. It can be anywhere It depends on who you ask because some people include some muscles of the pelvic wall in the pelvic floor. So let's just say like nine to thirteen muscles. It's a group of muscles And it goes from the front, that pubic bone in the front of your pelvis that you can kind of feel if you press on the front underneath, like you said, to all of those openings for women or underneath for men and then to the tailbone. So it sitss kind of like a hammock from front to back So I tell people if I take my palm and like put it under and between my legs, that's where the pelvic floor is So it sits like a hammock at the bottom of our pelvis and it has really big jobs like holding up our organs, managing pressure. It helps support the hips and the core and the back. So those are all very closely related for a lot of what I work with with again recreational athletes is it helps absorb force. And so when I'm doing tasks that require force like running or lifting or cough, laugh, sneeze All of those things, we have to be able to distribute for us. And if we can't, somethingomething's going to do it. And so if the pelvic floor has some give to it, if it's able to relax and contract and do that on demand and match the actual demand that's necessary, then I don't see an overflow of force into the hips and the low back and the discs and all those types of things. And so I want the pubet floor to be able to move, but I want it to be able to move in a controlled way. I don't want it to be something that's like a light switch where it's on off. I want it to be more like dim or light Like, hey, I need eight out of ten when I cough But I need a three out of ten when I go from sitting to standing. And so I don't need a ten out of ten Every time I go to standing, right? And if I do that every single time, when I actually do need a ten out of ten, it's not going to be available to me because I'm doing that at times that I shouldn't be And so just like again, all of our other muscles, we expect him we expect the need to fully bend and fully extend to be able to control that range back and forth versus just full extension, full flexion We need the callallet for to do that too but it moves a little differently. Kind of like a trampoline. I want the trampoline to have springs that have enough give so that when I jump, there's some downward excursion. And I want those springs to have enough recoil that they bounce me back up If the springs don't enough recoil and I jump, I just keep sinking and there's nothing pulling me back up. If the springs are too tight and there's so much tension there, when I jump on that trampple, it's very jarring. And there's a lot of again, forced to other areas that there shouldn't be. So I want those springs in my pelvic floor to have enough give to like length in when I need that length then I want them to be able to recoil and help distribute that force when needed as well. So both directions are incredibly important. Yeah. And so what type of injuries do you usually see in women related to a dysfunctional group Pelvic floor The obvious ones, you know, everyone knows kind of like leaking. like leaking has come a really long way. even with leaking. we used to like not realize that that was pelvic floor related. But I think most people now realize when they leak That's probably a public floor dysfunction issue. So leaking is a really obvious one. I see a lot of prolapse, so like heaviness, pressure A lot of clients will feel like they're sitting on a ball. This is what I dealt with after my first pregnancy when I went back to running too soon It's where the organs don't have the support that they need. And so it does feel heavy and like there's pressure and swelling down there. And so we can train the muscles to kind of help lift and support so that you don't feel that heaviness. So I dealt with that and I see a lot of that. The less obvious ones are like recurring low back pain tailbone pain, so there's three muscles that attach directly to the tailbone. So if we have tailbone pain and it's not resolved with traditional physical therapy, a lot of times we just didn't hit the pelvic floor U a lot of hip injuries, so things like label tears, groin strains, hamstring strains, Those were current muscle strains that were kind of like, whyy is my hamstring always tweaked? orr why is my glute tendon always really irritated U Sometimes that can present like bursitis, but to me, it's usually more of a glute tendon issue teendons are interesting. and they I think are just so slow to respond to training, doesn't mean that they don't, but they're slower to respond. So the muscles respond a little more quickly. We train the muscles by a lot. Tndons take a while to catch up. and so I feel like they usually end up kind of being the ones that send this signal of like, hey, pay attention to me And so if the pellet four is not doing a great job, we tend to see a lot of like tendonopathy tendon cases and issues Now, I say all of that and to clarify We don't have research on that. You know what I mean? Like there's not going to be a paper where you read and it says, oh, if your're pel forest dysfunctional, you're this much more likely to experience tendon dysfunction. I can tell you clinically that that's what I see in ten years of practice But if you go search for a research study, you're not going to find one that says x equals y I hope that that comes out in the future so that we can be better about treating these things. But I can tell you again, having worked before you know, in just regular what regular PT There are probably so many cases that I've technically mistreated and maybe they made some progress, but not resolution or maybe we didn't get resolution, they ended up doing an injection or surgery, and it's potentially because I didn't integrate the pelvate floor into their training And so I hope that it's something that with time, the clinical patterns that we see will be further research, which will give us more backing to like integrate this on a moreular more regular level. And just a sidebar on the tendon piece real quick. That is one area where I started lifting heavy this past year and didn't realize a lot of what I was feeling and the soreness in joints was my tendons not actually getting older or joint pain or anything. I was like, oh, I need to actually build strength in my tendons. Yeah. So just tendons being this whole other thing on top of muscles to work is kind of wild. And do you approach that in any different way or is it just folded into the pelvic floor training and rehab that you do? I approach it differently. I say metrics are something that there's been a lot of chatter about in the rehab space lately, which I think is incredible U tendons love load. and so we actually like don't even use or we tried not to use the word tendonitis anymore Um, because tendons from what we can tell don't really get inflamed. They actually change structure. So instead of them just being irritated and inflamed, where you could just take an advil and it goes away The tendon itself is actually changing structures. So we call it a tendonopathy, which means a literal change in the condition of the tendon. And so when you're experiencing something like tendon pain, the tendon itself, instead of being you know like a nice organized rope, has started to almost like fray a little bit And again, you can have a really strong glute or quad or hamstring and the tendon just didn't get what it needed to catch up. And so you're like, I am lifting more, I'm doing more, I amm stronger Where is this pain coming from? And the tendon just hasn't had the input that it needs to keep up with your muscle. So it's usually just a mismatch Kndans love load and they love prolonged load. So isometric holds where you know we are moving in a movable object. Holding that for thirty to forty five seconds Um I love this for runners too, because it's actually not very fatiguing to your muscles. So like if you're running and you're experiencing tendon pain, but you don't want to sacrifice your runs from being sore from lifting, we can do a lot of tendon work and still get really strong springy tendons without you know having you be sore and down and out for two, three days, where you know, sometimes with lifting the reality is we are sore and it does compromise the quality of our runs So tendons love load and isometrics have a really big role in that The other thing that has been really interesting was tendon health lately in the world that I work in is that we're acknowledging now that tendon health changes with hormone changes So like with peri menopause, for example, which is up to ten years before menopause We if they call it like the zone of chaos wherere like, one month, your estrogen's fine, the next it's not, the next month, it's like, kind of there. And so it's very up down for ten years. And then post menopause, estrogen is low and stays low In a lot of ways, it's actually kind easier on our body when it just stays low because it's not that chaotic up down, up down So the ten years riding a roller coaster? Yes. The ten years before Menopauseus is very unpredictable and that andpredictability makes it difficult to kind of like judge what's going on in our tendons. So tendons have estrogen receptors And when our estrogen starts to fall, we do see a decreased quality in tendon health. And so it's actually now called the musculoskeletal syndrome of menopause should probably be periim menopause, but musculos skeletal syndrome of menopause So if I have a client who is, let's say a recreational runner, you know, raising a family. She's in her late thirties, early forties It's something where I might sit down if we're noticing tendon pain that's recurrent or is covering multiple tendons. That to me is more of a systemic issue where it's not just this particular tendon is problematic because you've overloaded it. Now we're seeing this not resolved the way I wouldd expect it to, or it's my patellar tendon and it's my biceps tendon. And it's a bunch of tendons at one time that keep kind of flaring up That's where we would have that discussion of like, okay, could we get some estrogem on board potentially, and more and more doctors are willing to have that discussion. There's a lot of doctors that are very behind on that. but I can do all the work in the world on the tendon if it doesn't have what it needs from the body, whether that's through nutrition or hormone replacement or whatever it is I'm only going to get so far And so that is I always tell people, that's not my scope of practice, but it is my job to understand how they are affected so that I can refer out when I need to And that doesn't always mean like refer out, I'm not going to work with you. It means I want what I'm doing to actually be able to do its job. And so if we do that with someone who's qualified in that area then we're going to see better results. So J knowing that those tendons, yes, they're affected by the pelvic floor But especially you know, if we're in that certain age range where we're approaching periimenopause menopause, knowing that estrogen and the chaos that comes with that has a big role in tendon health. The joys of periimenopause just don'top stop coming. And one thing you mentioned with the isometric holds then, what specifically type of movements or isometric holds could people do to work on tendons then Yeah, so it depends on like if you're having pain in a specific tendon, then obviously you're going to want to bias your training towards that tendon. So like let's say I've got an Achilles tendonopathy where my Achilles tendon is just really ticked off In those cases, I want to do some really heavy heel raises, which again sounds s like the total opposite. it's not restust ice, compressed, elevate. It's load it. And I want heat. I want to heat it after I'm done if possible. So I will, for example, get under a barbell, take the barbell off and put it under. the J hooks or under an imovable object And then I'll calfrise to where my heels are off the ground, but I'm pushing the barbell up. but I can't actually do the full heel raise So I can lift my heels, I can generate force. I'm pushing my toes into the ground to activate my calf and Achilles but I'm not actually moving. So I'm not sitting there cranking out tons and tons of reps because those reps are going to help the muscle, Not to say they don't have to tit at all But they're going to help the muscle get really strong They still don't give the tendon much of a chance to catch up. And so getting under the bar, moving that, holding that, if an Achilles is a problem, then that's a great and easy one U I love like Bularian split squat position where the front leg I lift the heel and I'm really driving into the floor Um And sometimes I'll hold weights. you want it to be heavy. Like if it's not heavy and it's not challenging, it's not to do a lot for the tendon And so a lot of these tasks, we really want the weight to be again so much that you cannot do the actual rep, but you can activate and hold against it If I'm working more on like the glutes, for example, I get the same barbell, get under the J hooks and a squat push up into the bar into the J hooks so that I'm not actually moving, but I'm still connecting and activating my muscles and that can help with reorganization of the collagen and the tendon. So that tendon, that is frayed, it's us kind of taking those little frayed pieces and putting them back together and back in line And then I usually will do that in combination with strength training because muscle training is obviously still incredibly important So for me, it just depends on the day if I do it before or after training I've had some glute tendon issues in the past. So like right now when I do my workouts, I'm about to start a marathon training plan. I don't want that glute tendon to flare back up So I'll do my normal lifting and then I'll finish with something like a star plank, where I'm like driving that bottom foot into the ground, activating the glute on that bottom side, and I'm holding it for thirty to forty five seconds, three to four reps I can do a split squat ismometric, right where I go into a split squat I'll take the barbell again under the J hooks. push into the split squat so that my front leg is activating U So you can kind of look up some of those like split squat isometric mid die pool is another great one for the glutes and hamstrings. U If you've got hamstring tendenopathy, like lying on your back and doing that like bridge position Um But with one leg, right? So again, making it very challenging, digging your heel into the ground devining that hamstring tendon and holding for an extended period of time Um, But it has to be a heavy enough load to actually make the change and it has to be a long enough load. The easiest way to think about it, what I describe to patients is like if I have a sponge that's really like full of water and junk It's much more efficient for me to take it and squeeze it really, really hard and hold that squeeze for a very long time versus like doing a bunch of like little squeezes, right? I would take that sponge and wring it out and hold it there until all that fluid gets out That's kind of what we have to do for the tendons because again, they don't really have their own This is oversimplified, but they don't have their own kind of like inflammatory markers. So we have to kind of like give them a little bit of extra help So us doing those itometrics is kind of squeezing all that gunk out of there so that they can heal and can change and can be more efficient. And this is the wild part of the pelvic floor to be because we learned about the pelvic floor and now we're on tendons. And so I think it can be so overwhelming for women on where to start as well. like especially just thinking about myself I started lifting heavy. I love to run. so kind of a hybrid athlete, mom trying to do a million things. and the thought of going in to a pelvic PT is probably a great idea and I need to do it. It's also a barrier for me to be able to do it. So is there anything that's like an at home self assessment that people can do to just to the lay of the land and understand the type of exercises or PT that they can fold in at home? orr what would you tell someone like me who's probably should, you know get theirselves in, but also has limited time and is just looking for something that they could get themselves knowledgeable about their bodies themselves one hundred percent. So I think Th number one is that if the pelvic floor is working well then your normal workouts probably already include probably for, you just don't realize it. So if you're not having symptoms, if you're noticing, you, pain or problems, It's not something Even as someone who you wants everyone to be aware, I don't w to like make it the villain where like everyone on the planet has pelvic floor problems. If you're not having symptoms and you're feeling really good and your workouts are going really well, your pelvic floor is probably working fine. Again, the same way I don't really think much about my calves when I go to the gym, they just do what they need to do when they need to do it. I don't connect to them I don't think about them too much. I just let them do their job. If we're not having symptoms, then the public floor is probably doing an okay job and your normal workouts will include the pelvic floor. So squats, lunges, even push ups activate the pelubvate four because it activates the core so much, and the pelvate floor and the core work together. So if you're kind of listening or learning about this and you're kind of like, I feel pretty good, then there's probably no need to like go crazy and try to like pathologize everything that comes across our table because there's too many things, right? Bween perairam menopause and kids in life, there's too many things and like you said, it can feel very overwhelming. So if you're not noticing symptoms, more than likely when you go work out, you are also working out your pelvic floor If you start to notice symptoms and you're kind of like, huh,t I don't really know what's going on. One, of course you know, just professionally, I have to say one on one nuanced care is number one. I am also a mom of kids. I'm also training for a marathon. I also own a business. And so I understand trying to find time for an appointment is not always doable for people. is one of the big driving forces as to why I wrote the book was because the resources when people reach out and ask that same exact question were so limited. And so in writing the book We worked really hard with the publisher The publisher doesn't have pubvlic health background. They have sports background They don't have public health background because it's not very many of us, much less in publishing world. And so I would kind of write all my thoughts. She would take it and kind of frame it as like, okay, I as a general reader, general athlete, want this to be digestible too. And so the book itself is actually written to Recreational elite. It's written to you as an athlete. How can I learn about my body without overthinking and spiraling and making it feel like this is just one more thing I need to add to my plate So the book was meant for that purpose. The book will also have like resources, like questionnaires that you can fill out that are kind of like, am I experiencing problems? am I missing symptoms? A lot of people don't realize that feeling of needing to go to the bathroom when you start your workout is a pubvlic floor dysfunction issue in most cases. So it kind of like pulls that to the front of like, are you experiencing these symptoms that maybe you didn't know were even pubvlic floor problems what severity are you experiencing them at? And then based on that, Should I seek out a professional or is this something that I might be able to handle at home So those questionnaires are kind of meant to help you just be aware Keep track. So like again, you score yourself on those questionnaires. So do I see my score going down with time, meaning that my symptoms are improving Or is it going up with time as I enter perimenopause and realize that I maybe do need to pour into this a little bit more specifically? And those questions can go to your provider. So like here's the things I'm experiencing, H's how severe they are or are not, right? And so the scoring on that, I think we have it right now set it's like zero to five is is kind of like a hey, probably monitor Maybe make some adjustments, you know, if you like can connect to those muscles in the way that we teach in the book Do that in little training room a little bit more, work on your breath workk, work on the basics, see if that integrates into your strength training. but using those types of tools to help people decide What's next? Becauseuse like you said, I don't know. Maybe I do have pelvic flore symptoms. I can't really tell. I don't really know what that means. I don't know if my hamstring strain is from my pelvic floor Those questions, I mean, let's say that you also check the box that you have pain with sex or difficulty emptying or increased urgency. thenen you're kind of like, hm, more and more kind of indicators that maybe that hamstring strain has something to do with my pelvic floor versus just a plain old hamstring straing So those resources in the book itself, that's what that was meant for was because that question comes up regularly I can't get in there. so like what can I learn something in the meantime some hopeful, hopeful, hopeful that will help to start to bridge the gap a little bit. Yeah, And is it mostly just looking at symptoms that you have in terms of identifying it? or is there anything physically too that we could feel to identify either when we're lifting running? You know, you already talked about leakage, like someome of those obvious ones, Is there anything else that comes to mind and the physical part that could ceue us into, yes, maybe explore this more? One things that we can outline in the book is to see if you can actually contract and relax. because even when we say contract and relax the pelvic floor, a lot of people don't know what that means because they've never been taught We hear the word Kgel all the time, but no one ever teaches you how to do a kegel or what that actually means And then the reverse keagle like has an OPR, right? Like no one ever talks about that part. So the key goal I don't know what that is. Yeah. So and for athletes, it's really your bigger your bigger point, the bigger thing that you need to know. So the key goal is just a contraction. We actually feel like we're trying to move away from the word keingle, but it's also so prevalent that Kgel is just the doctor who discovered the pelvic floor contraction And so we don't call the biceps, you know, a bicep curl by who discovered it. I don't know why we do it for the public floor At Kgel or pubic floor contraction, those are synonymous, and so sometimes I'll go back and forth between them just for efficiency. So kegel is a lifting and a closing of the pelvic floor. okay? And a reverse kegel would be the opposite, which is just a lengthening. So the pelvic floor moves down and opens. So for example, when we go to the bathroom, we have to do a reverse kegel. We have to open and lengthen to let things So if we have a client who's experiencing chronic constipation or needeing to double void where they go, they urinate and then they stand up and they think,, kind of feel like I need to go again We may have a difficulty with pulet floor lengthening. U And so can you move in both directions is really a big foundational piece to me. You can check that at home. So again, I have people like sit on their hand. So put their hand under their butts, sit tall And can I feel my pelvet floor lift up in the kegele And can I feel it pushed down? in the reverse kegel. Now there's nuance, again, my professional disclaimer of just because you feel movement doesn't mean that it's perfect But it's a way to start connecting The diaphragm also works with the pelvic floors, so we can use our breath to connect to it a little bit easier So when I exhale And I blow out air That's when the keyl should happen The lifting should happen. So as I am exhaling like I'm blowing out a candle, I tell people to think about a puffer fish. So as it empties, the air comes out, the sides constrict, we feel bracing in the core, but the bottom of that puffer fish is also going to lift up. Right? So that's where that like bottom piece happens When I inhale Again, going back to the pyrofish, the sides expand The bottom also falls. So when I take a really deep inhale, I should feel a lengthening and an opening of the pelvic floor Honestly, one of the keys that works best is to breathe into your pothole So as you breathe in, push that air kind of down towards the backside don't love the term Push especially when we're working with fairly active individuals because When we say push, what I see is people just squeeze the crap out of their core. So again, all the analogies, if I squeeze a tube of toothpaste and shoot the top off of it, Yeah gooal accomplished, I got the top off. doesn't mean that it was really the right way to go about it. I would like for us to be able to just slowly turn the top and get it off, you without having to squeeze so hard that we force it So a true reverse keyl or true punk for lengthening should just be an opening And those muscles can lengthen and stretch. And that's where most recreational athletes are stuck is they can kegal and they've connected to that and they use it on a regular basis have a hard time going in the opposite direction The challenge with that is if I'm stuck in a kegel and I'm stuck in that contraction When I go to a heavy deathif I go to a heavy squat and I need my pelvic four to move with me can't. it's kind of stuck there. So it's going back to that tramppling example of We're tight, the springs are tense. I'm trying to jump and distribute forst, and I'm just getting jarring, jarring, jarring Here and there, not a big deal, right? If it's the end of a set, we're tired, we're fatigued Okay, we're more resilient than that. We're not fragile But if I do it over and over and over for multiple workouts over multiple years, that starts to add up a little bit So I think at home If you're kind of wondering, can I actually do this at all sitting on your hand Do I feel muscles move up and close As I exhale, And do I feel muscles move down and open as I inhale And again, down the line, you can separate the two. We don't have to use the breath to make the peelet hn move. But when you're trying to really exaggerate it to connect to it, I think the breath can be a really good tool and visualizing again, that puffer fish. likeike I expand, I lengthen the bottom drops, I exhale, I contract the bottom lifts. A lot of people have that backwards. Yes. That three hundred and sixty breathing, I completely had it backwards until I finally got it down and could practice for whatever reason it feels like rubbing my belly and patting my head. Like it's just hard to get down. but once you pr this a ton you can kind of get it. And I'm also thinking of the Tell me if this is right. I'm thinking of contracting and lengthening as an actual bicep muscle then. like you're contracting and then you're lengthening But if you're running and lifting, You're contontracting and lifty or contracting and lengthening with your pelvic floor while doing another movement, which can make it something you need to practice and get down. It's not just intuitive for intuitive. Well, this is where I say like Again, even if you're not having symptoms, I think just one workout a month where you can connect to your pelvic floor is important just to check in and keep, you know, that connection with it Those workouts can look just like a regular workout. They're just a little more mindful. So like let's example, take the deadlift The deadlift is a pelvic floor exercise. And so can I deadlift? Maybe I dropp the weight by a little bit just so I can really tune in. But when my glutes and hamstrings lengthen as I go into the deadlift into the hinge, my pelvet flce should also lengthen a little bit too. It's not dramatic but I should get some space. So as I lower into the deadlift, my pelvic floor should also be expanding just a little bit to accommodate that force that's happening in the core And then on the way up, as my glute, my hamstrings shorten, my pelv flce should also shorten because it supports my spine So when I have people who are like, well, I can't do deadlifts, they hurt my back. Okay, have we ever tried to coordinate this part? And again, I don't have a research paper that says Pelvic floor contraction and realization affects the deadlift But I see it every single day in clinic where I'm like, okay, we worked on all this foundational stuff. We did the sit on the hand and the breathe in, breathe out. Now can we put that into a deadlift? okay And I don't want it to be forever. I don't want it to be something where every single time you go to the gym, you have to overthink, like over you know, override or every run. Okaykay, when I hit my foot on the ground, I need lengthening and when I lift up, I need contraction. That's not the point But if I can practice it a few times then hopefully it becomes very subconscious down the line And now suddenly my back doesn't hurt in the deadlift anymore because I've got the support of those little muscle groups. The same way we train the rotator cuff, the same way we train, you know, the obliques p us, the pelvic floor does that too So no, the lengthening and the contraction is not as dramatic as the the glutes and the hamstrings, but it still matters. It's still present, it's still there And so tying those pieces together can make a really big difference Wait. So for the deadlifts specifically, say that again, which going up or down are you doing? the contracting in the Kgel versus reverse Kl So technically when you're going down into the deadlift, so as you're lowering into the hinge you're getting an eccentric kegel Right? It's lengthening the same way your glutes and your hamstrings. When you go into the hinge, they are getting longer, but you are slowly controlling that length, right So you're going into that stretched position, you feel your glutes and, your hamstrings lengening. Your pelvic floor is also doing that. Now again, not as dramatic Not as big of an obvious concern. but I will literally from an external perspective, sometimes with athletes, put my hand right on the inside of their sits bone And as they come into the deadlift, can you just give me a little length, right? Can you just as you come down to the deadlift Can you do that gentle reverse kegel? not push been And then when you go up into the deadlift, I want to feel your muscles move away from my hand. So as your glutes and your hamstrings shorten Your pelvic floor is a little shortening too and seeing if we can play around with that a little bit. So into the hinge would be an eccentric contraction of the pelvic floor C comoming out of the hinge to the standing position would be a content trick contraction the pelvic floor U So again, the lengthening reverse kegel eccentric is all kind of actually the same thing. just depends on how you kind of like want to phrase it. Yeah. I'm one hundred percent doing that this week because I do also have back pain when doing RDLs, deadlifts. and I just thought I was getting into weightlifting and maybe my back isn't strong enough. You know, there's so many things happening when you're starting to get into it that I don't know exactly where it's coming from, but hundred percent know that technique matters a ton and same thing. like I'll just lower weights and do it slower to make sure that I'm doing it right and still get an awesome workout instead of just going for max weight with bad form. So I'm going to implement that one. And then I'm curious on the running front, like when you run or at least when I run, I don't always think about breathing, technique You know, I'm trying to be efficient, but I'm not it's not top of mind and especially my pelvic floor is not top of mind. Is there anything that you would ceue runners into to be more aware when actually running Yeah, I think it goes back ultimately to the same thing. I do not want runners to have to overthink it, but we know that sometimes we need to slow down and practice a little bit and then you know, let's say you run four times a week, maybe once a week you do a run where you're a little bit more conscious of what's happening at the pelvic floor. Easiest tweak is just to change posture a little bit. So watching that rib flare, like the ribs are not, you know, especially after having babies, right?ur ribs kind of push forward. We see that rib flare Ribflay is having a little moment on the internet right now. so just be careful what you consume out there, but it can be problematic in that your abs attach there. And so if your abs attach there and we've got that flared out, we've got a nice long stretch across the front of the abdomen, which means we're not able to regulate pressure in the core as well So by tucking the rib cage down Unclinching the butt cheeks, right? We're not clinching the hips under. So let your butt relax so that it can do its job when your foot hits the ground U thoseose are two very easy fixes. Third very easy fix is cadence. If your cadence is really low, then you are really sticking your foot out there and demanding a lot of your pelvic floor while the pelvic floor is very stretched So if I am asking my hamstring to do a lot of force generation in a stretched position, I'm not going to get a lot out of it If I can increase cadence just a little bit, shorten my stride, get my foot to land fairly under my body, my peelet floor is going to be able to absorb a lot more force there. So when you go, I mean, we all have wearables now. So if I go into my wearable data and it says my cadence is one hundred sixty, well what if I up that just by five to ten beats per minute Intuitively feels like more work because now you're asking me to turn my feet over faster If you can get used to that in the long term, it's so much more efficient. When you over stride, you're doing gas breaks, gas breaks, gas breaks. If you can land directly or close to directly under your body, we've got gas gas, gas gas now. And so the pelvubic floor has an easier time responding to that The last thing I'll say about running that I think it is an easy automatic implementation Running uphill is actually easier on the pelvic floor It's harder on the glutes, it's harder on the hamstrings, but it's easier on the pelvic floor because you are in that little leaned forward position, right? So if I have a rib flare that I'm not aware of or don't feel like fixing or don't know how to fix, And I run uphill, I almost automatically fix my ribs flare, right? Because I have to do that little lean forward So my body's now able to manage pressure a lot better. So when I'm getting people back to running postpartum Sometimes I will have them do their jogs uphill and then walk back down the hill and then jog up, walk down, jog up, walk down. It's also why when people have leaking with running, it's often downhill running that causes problems. So when I'm running down the hill, my ribs stick out a little bit more. I don't manage pressure as well, and I'm getting that jarring force on my pelvic floor And so using hills to your advantage to integrate a little bit more pelvic floor work postural work is an easy way to do it without having to feel like you're bogged down by thinking about Am I contracting or relaxing or inhaling or exhaling? It's just a good way to practice for your body. And then we slowly remove that, right? So we add speed to the inclines or we go from a five percent incline to the trireadmal to a four percent to a three percent until we're ready to do flat road and then go from there So hills are a good way to implement it without having to overthink. My gosh, I wish I had you and that advice post I my one hundred percent. I one hundred percent fall into that camp and it's still to this day, the only time I have a tiny amount of leak is sometimes running downhill. It's wild. and I don't know when it's going to happen or why like what the combo is, but I do know that it's only on a, you know really large decline running on trails going downhill and just that hill piece. I mean, you can get such a good workout doing hill repeats and you know, just other things out on the trails besides just running if you love running. So I wish I had that piece of advice because that is one hundred percent me and where I'm at. Yeah. I will also say in a case like yours where that I mean, the reality is again, running downhill is very jarring on your pelvet flo. It's a lot of work right? You know when you're going downhill, it's like, boom, boom, boom, it's hard to absorb that force going into the ground because the pelvic floor is such a force absorber, it obviously suffers in that. And so it has to be incredibly resilient and mobile and strong in all forms to be able to tolerate that. So there are pelvic floor weights, which people always are like, what are you talking about? There're these cute little weights. O of my patients calls them their're mice, so I started calling her calling them mice. They're just little weights, they look like little eggs Don't buy the crazy ones on Amazon. Intimate Rose is a brand that's made by a pelvic PT. It's good for your body, It's healthy. It's all the clean things you want U there's six of them in a pack A lot of times I will have clients like in your case use a weight in the shower. So like when you get in the shower, you insert the weight You do not stick it straight up, you're going to insert it kind of back towards your tailbone so that it rests on the hammock of your muscles And you can do things while that weight is there. So like calf phrises, do a couple calf phrises in the shower and see if you're able to hold and lift that weight. You can also tug on the weight and see, can I resist that tug, right? Can I fight against that a little bit? I think that for a long time and still now We have been very hesitant to prescribe weights for clients who we feel like have overactive pelvic floors So in your case, more than likely, just knowing your activity levels, you're going downhill, your pelvic fl is overactive So it's that exact same trampoline example. It's very jarring. And so when you hit the ground, the pelvet floor can't move, when it can't move, can't absorb force something's gott to give If we can use the weight to teach strength, then a lot of times what happens is they stop clinching as much. So I used a phrase a lot like strength gives permission to soften We for so long wouldn't strengthen ense muscles because we were like, oh, it's tight, whyy would I strengthen it? Now we realize It's not the muscle being short. It's the nervous system saying, we don't have the capacity because we're not strong enough And so when you teach it to be stronger with something like weights that it understands, okay, that's what you're asking of me. I can handle that. You just have to train it the same way we do everything else So the pelvic floor weights from Intimate Rowose, they're a wonderful tool and I think they're really under utilized for athletes who are trying to do very hard things because the thought is These are only for like older women who are dealing with leaking when they're like working at a desk job or whatever. They're for very active individuals too, if we prescribe them the right way. So in a case like yours, is that something that is something to consider? Can we add weight to the pelvic floor? the same way we do all of our other muscles Yes, love that. And before we go, I am curious then because you talk about weights. Is there things that you see out there where you're like absolutely not Please do not fall for this gimmick. You know you see them all the time or women trying to like use different things for, you know, who knows what?ike any of those where you'd say please, do not use these, touch these. The stay dry chairs. I don't know if you've seen those pop up. There's a couple different brands now. They're the ones you sit on them And they use ESTM, like a tenens unit kind of situation, again, oversimplified, but like, You know, if we can't get your quads to turn on in the reab setting, we might put the little pads on your quad, make up tingle, turn on your nerve, turn on your muscle U they have those now for the pelvic floor And so you sit in this chair, you're fully clothed, but it does it through the clothing And the idea behind it is, oh, you do like a thousand key goals in a session which sounds great on the surface, but again, like you in the weight room, would I ever give you a thousand deadlifts? L never would I do that, right? That doesn't make any kind of sense And then number two, we know that those ESTM approaches only activate what are called type two fibers, which are the big muscle fibers The pelvic floor is seventy percent type one So if I just sit on this chair, it's going to activate my type two fibers a thousand times, apparently But it's only going to get about thirty percent of the pelvic floor. So my big thing is for people like if you are not, if you're like Rachel, I'm not doing physical therapy. I don't want to do the weights. I'm never going to go see anyone and I want to fix my leaking I mean, you can try it. It's not going to be covered by insurance, so it's going to be super expensive. More than likely, the results are only going to last as long as you continue to go back and use the dang chair over and over and over U And again, you're only hitting about thirty percent of the public floor versus if you learn to do it yourself, we can get all of it So to me, they're just a huge cost for a very small potential benefit If you have pelvicar activity, it's probably actually going to make your symptoms worse. So for a lot of people, you're going to go the opposite direction. So if you go to the doctor and say, hey I'm leaking, what could I do about this and they hand you like a stage right chair you know, flyer run go to a pelvic PT instead. So don't don't waste your money on those unless you're like, listen, I'm not doing anything else and I havehing nothing left to lose at this point. then sure. But I will also say in terms of pelvic PT, there's a lot of pelvlic PT's out there who do not integrate athletic performance. So if you've tried Pelvic PT didn't get good results and you're a very active individual, but don't feel like your PT was bridging the gap between that. find someone who's more performance minded because Kicals on a table, reverse Kicals on a table is not going to translate to trying to qualify for the Boston Marathon. right? Those are two very different goals. So you have to have someone who can get you from point A to point B and then takeakes some of that orthopedic understanding So just making sure that the person you're working with actually makes sense given your goals. Love that Well, Rachel, thank you so much for the time and sharing so much of your insights with us. This was awesome. I have a lot of things I'm gonna to do this week. So I'm very excited. If people want to learn more about you, where can they go Easiest place is Instagram. so at doctor. Rachel Selman. I'm fairly active on there. trying to spread my wings a little bit into Facebook and YouTube and whatnot, But truthfully Instagram is the easiest for me. But I do respond to messages so feel free to message me and my email is listed on there as well if you want to work Love it. And then when does your book come out again It will be out on october sixth. so preorders are open now. and as someone who's never written a book before, I had no idea how important preorders are. So if you search just Flor it, Rachel Selman, it'll pop up. You can order it through Barnes and Noble, Amazon, wherever you prefer, but preorders signal to the distributors like, hey, there's interest in this book. And so then they end up getting more of them so it gets to more people. So if you are considering the book, I know the thought of like, oh, I'll wait till it comes out in October go preordder it now because that shows the distributors, hey people actually care about this topic and want to learn more. But you can just Google search floor at Rachel Selman and it'll all pop up. And we'll definitely put those in the show notes. and thank you again so much Thank you for having me. Thanks for listening to another episode of Find Y Fuel. If you enjoyed the show and want to support us, please leave a comment or review. And before we go, I have to give you the obligatory medical and legal disclaimer. This podcast is for informational and educational purposes only. The advice and recommendations we discuss are not intended as medical advice and do not replace the treatment or care of a physician or any other primary healthca provider Using the information shared today does not create a doctor patient relationship, and it should not be used to diagnose or treat any health problem. Always consult with a qualified healthcare professional before making changes to your diet, exercise routine, or medications. The use of any information provided is solely at your own risk. So in a nutshell, let's be smart and remember these stories and conversations are for educational purposes only help other women find the fuel to live their best lives. We'll see you in the next episode