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I’m thrilled to kick off a brand-new series on pelvic health with one of my favorite pelvic health physical therapists, Mindy English. Together, we’re diving into the critical intersection of pelvic health and female athletes, breaking down what your mom (and probably your coach) never told you about your pelvic floor.
In this episode, we explore:
- What the pelvic floor is and why it’s essential for athletic performance.
- The importance of pelvic health across life stages: pregnancy, postpartum recovery, perimenopause, and menopause.
- How breath, glutes, and movement patterns influence pelvic floor function.
- Practical strategies to address symptoms like leaking, heaviness, and pain.
- The surprising connection between constipation, diet, and pelvic health.
Follow the podcast for more episodes of this pelvic health series, releasing weekly.
Connect with Mindy on Instagram: @mindy.english.dpt
Want to Learn More?
Join me at the Live Pregnancy & Postpartum Athleticism Event this March 29-30 in Gilbert, AZ
Become a Certified Coach: Check out the online Pregnancy & Postpartum Athleticism Certification here
(Auto-generated transcript)
Brianna Battles 00:01
Welcome to the practice brave Podcast. I'm the host Brianna battles, founder of pregnancy and postpartum athleticism, and CEO of everyday battles. I'm a career strength and conditioning coach, entrepreneur, mom of two wild little boys and a lifelong athlete. I believe that athleticism does not end when motherhood begins, and this podcast is dedicated to coaching you by providing meaningful conversations, insights and interview topics related to fitness, mindset, parenting and of course, all the nuances of pregnancy and postpartum, from expert interviews to engaging conversations and reflections. This podcast is your trustworthy, relatable resource for learning how to practice brave through every season in your life. Hey everyone, welcome back to the practice brave Podcast. Today I'm here with one of my favorite pelvic health physical therapists, Mindy English. She is local to me, here in Eagle, Idaho, and I'm excited to kick off this year with doing what we've decided to call, like a pelvic floor Pelvic Health Series, especially as it relates to female athletes, so that we are intersecting our worlds. I feel like Mindy's world of physical therapy, and from like a clinical perspective, oftentimes complicates things for female athletes, and it's not always digestible or really, like relatable, but then my world in the fitness industry kind of misses the mark in so many different ways, where we're not acknowledging the role that our pelvic health has on not just Our performance, but our quality of life across our lifespan. So we're going to be doing a series once a month, hopefully it's we live in the same city, and we are having to record this at 6am because we are both just that chaotically busy. But we're really excited to kind of bridge the gap between Mindy's world and the clinical rehab space, in my world in strength, conditioning and performance, and do so through the lens of female athletes across their lifespan. There are so many topics to tackle. From you know, pre babies, basically what we're talking about today is like, what your mom didn't know to tell you about your pelvic health and what to expect throughout your life, to pregnancy to postpartum, to different symptoms that you're going to be experiencing, to then perimenopause, menopause and beyond, and just off the lens of pelvic health, and combine our world, our brains, and just make this a really conversational resource for you to then apply to your own life and be able to have the right conversations and advocate for yourself accordingly. So with that very long intro, Mindy, thank you for being here. Thanks for doing this series, and please tell us a little bit about yourself. Well,
Mindy English 02:52
thank you for having me and inviting me to this conversation. I think it's a really important conversation to be having. So like we said, my name is Mindy English. I'm a orthopedic and public health physical therapist here in Eagle, Idaho. I've been in the public health realm for about 10 years now, and started my career really focused on orthopedics. And I think I'm one of the few who was fortunate enough, 12 years ago, when I graduated from PT school that we did get some pelvic health education in our program, which, in hindsight, I'm really fortunate, or I at least knew the basics of how to have someone do like a bladder diary, to understand what their bladder habits are, and understand what pelvic pain was, intercourse, and all those kind of basic informational things that you might need to know to get into pelvic health therapy. When I applied for jobs, the number one question I got asked was, if I did pelvic floor physical therapy, because it was still, you know, 12 years ago, it's still a growing field. It's still a new field, not super mainstream like it is now. And so, you know, the person I sat next to in class was super into it, and I was like, that's really cool for you. Go do go do your residency. Go be that specialist, and I'll know who to refer to. And I think the more I got asked if I did it, I decided I needed to figure out how to do it. And kind of leaned on that basic education I had. Did a lot of just kind of self learning online. Who can I gather information from? And then really going through my own experiences once I became pregnant and had my first child, and I realized there's really not a whole lot of information I was active in. I was teaching fitness classes. I was active in a fitness class. I think I was like 39 weeks pregnant and still trying to do jumping jacks. Because, I mean, I think clinically, I knew better, but the athlete in me wanted to, like, prove that I could. And someone in class was like, You're gonna jump your baby out of you. And so then I asked my OB. I was like, am I? He was like, Well, no, but, but also, like, if. That you don't have to keep jumping if that doesn't feel good. And so I got cleared to return to exercise at two weeks postpartum, because he knew I was really active before, but I also again clinically, and because I was pregnant with a couple other friends who had babies at the same time, I felt this really strong pull of I want to be active. He told me I could do whatever I want, but I also want to be a good role model for these other moms, because I inherently know that like just being cleared for whatever at two weeks isn't probably super helpful for most people either. And so anyway, so it took me down this really interesting winding road to a passion that I feel really strongly about, is helping people understand their pelvic floor, understand that there's things we can do to help understand that we can exercise safely during pregnancy. We can exercise safely after pregnancy despite having maybe some symptoms that we didn't have before. And then now even helping women understand as they go into perimenopause and menopause, and we're starting to see more people wanting to be active in those phases, that, yeah, we might have some symptoms pop up for the first time or again, and that there's still things we can do about
Brianna Battles 06:16
it. Yeah, absolutely. And I love that lens, because it's like again, whether, I guess it's we haven't been taught about any of this, whether it's in school, like through exercise science or kinesiology, and most of our certifications within the fitness industry, this has not been a an angle that's been acknowledged or taken in a practical way. And I love that you have an ortho background and sport background so that you can understand how these things, you know, pelvic health, isn't in its own category. It affects everything like it's all intersected. It's all connected. And we have to figure out a way to combine the sport and ortho world with pelvic health, and then put it into that kind of fitness in order for it to, like, actually make sense and be practical, especially for female athletes, because you cannot tell them, Well, just do, like, 15 Kegels a day, or don't run, or don't squat. Like, none of those pieces of advice are going to work. Or, like, just do these three sets of 10 exercises for six weeks, and then you should be good, like, that's not how it works. So we have to figure out a more practical lens. And I feel like that's what you've done. And if we can do that during these seasons where we're kind of capturing a lot of women's attention because their body is changing, and maybe they're sort of forced to be more aware of their pelvic floor. I know that was like me. It wasn't until I was trying to rehab my diastasis that I was like, what does the pelvic floor have to do with my abs? Like, I'm fine. I don't have any symptoms, but it's more so just bringing that level of like, self awareness and understanding of your body that unfortunately most women don't get until they are already pregnant, and then they start to learn about their body, which is crazy.
Mindy English 08:01
And I think the thing I'm starting to see now so a lot more people are aware of pelvic floor pelvic floor therapy, which is amazing. But I think still, they come into my office and they say, so I know I'm supposed to do this. I don't really know what that means. And even I've had kind of a series of middle aged women this past week or so, and all of them, you know, I give my spiel about what we're going to do in pelvic floor physical therapy, and all of them have taught me and said, Can you just explain to me, like, what is the pelvic floor? Yeah, and it's like mind blowing to people that there's muscles there. And I mean, to be fair, I don't think until I went to school, I knew there were muscles down there, right? It's just not, it's not something we think about. It's not something that anyone talks about, you know, maybe in college or, like, reading a Cosmo and about doing key goals. And you're like, okay, cool, but, yeah, I don't know what that means, right? And so it's, it's been super interesting this week, just, like, just to have multiple people say, like, I don't know what that means. I don't know what the pelvic floor even means. To, like, pull out my anatomy model, show them that there are actually muscles there, and everyone's like, wow, yeah, I didn't know. I didn't know there were muscles there, right? Because
Brianna Battles 09:18
I think that we traditionally are like, Oh, the I have a period from there, I pee from there, I poop from there, and I have sex, and I have babies like that, and right there's holes there. And, like, we don't even really know oftentimes, what hole does, what like, what the function is of these things. So it's like our anatomy, we just don't have a lot of self awareness around and, like, from a young age too. Even if you have a very well meaning mother, like, I'm in my 30s, you're a little bit older than me. But both of us kind of grew up where it's like, this wasn't a I think talking really openly probably was. Isn't a thing because our own mothers didn't have much understanding of their bodies at all, and plus, it was really taboo for the reasons I just stated, like, these things aren't really talked about commonly. So talking about your, you know, bowel health, or your pelvic health, or what is a pelvic floor, and anything that's related to what's essentially normal or not normal, or symptoms or not symptoms. It wasn't their fall. It was no one's fault. It's just like, they just literally didn't know. So what you mentioned that you've had people come in and a little confused. They're seeing you for obvious reasons, but they're still like, what is the pelvic floor? So can you explain to us? And hopefully, semi simple, I guess, terminology and concepts. What the pelvic floor actually is? I think it's a super fair question.
Mindy English 10:48
Yeah. So essentially, the pelvic floor is, it's a sling of muscles that goes from the pubic bone to the tailbone. So pull out our model.
Brianna Battles 10:58
Yes, and if you are, if you're just listening, if you want to watch this, you can, it'll be on YouTube, and you can see Mindy's pelvis model here. So
Mindy English 11:07
it's just, it's a whole sling, and it's a dynamic sling. And so the muscles are actually really cool. They help support our organs and help keep our organs up and lifted. They help keep the pm poop in and let the pm poop out. They have a sexual function to them. I think, what I think their coolest role is, and the most often overlooked role, is their stability function. So their role between the low back and the hips and the pelvis for helping us move and walk and jump and run and do all those things, and then they have a sump pump function. So they kind of help with lymphatic fluid and blood flow in our body. So they serve lots of different roles, not just keeping pee and poop in, letting pee and poop out. And I think that's oftentimes when we start talking to people about pelvic floor, that's where our mind go, that that's their only right? And the lens I like to take is yes, and why is it not functioning in these other roles where you're now having symptoms when you jump, run, sneeze,
Brianna Battles 12:17
yeah. And what's been interesting to me from a, I guess, sports performance and strengthen your seeing perspective, is like, Well, yeah, that's like, your it's like your athletic base. That's everything that we are taught is like, this is your center of gravity. This is your most stable position, if you're going to get hit, if you're going to be in the ready position, if you're going to tackle, if you're going to absorb force or produce force that, like hips back and like kind of just basing into that pelvis, that's the ready position. But I don't think that we've acknowledged the role of the pelvis and pelvic floor much in sports performance. Nevertheless, what our typical understanding of it is like related to continents and sexual health and stuff like that, but the role that our pelvis and that part of our body plays into our sports performance is significant. You mentioned low back and hip and knee pain like there's so many different orthopedic symptoms, injuries and different considerations that can all we can tie the pelvic floor into. So can you talk a little bit more about
Mindy English 13:22
that. Yeah, so I'm always screening people for low back hip pain and the history of knee pain, ankle injuries when we're talking about pelvic health. And I do that for everyone, but especially for my active people, I really want to know what your history is, because you know it is, it's, it's the base of our athletic support, and it it needs to be responsive to what we're doing. And so I would never train an athlete to jump with really stiff ankles and knees and hips, right? And I think as as humans and as fitness coaches, we understand like we understand bending our knees like we want to bend our knees when we land from a jump, yeah. And I'll even sometimes stand up in the clinic and, like, demonstrate a Stephanie thing. And people, you know, they get this, like, cringy face, like, yeah, that looks Yeah. But what we often do because we're leaking or because of an injury or something like that, we kind of start tightening all of our muscles because we don't want to leak, or we don't want to hurt, we don't want to have pain, right? Tightening is our brains protective mechanism for pain. And so now, now that pelvic floors of being responsive and able to absorb and help as that base, now you have this really rigid base. And so then something has to give somewhere, right? Our bodies and face, our brain wants to be successful, especially if you're an athlete, you're going to find a workaround. Athletes find all the work around until the workaround doesn't work, and then they'll still kind of find a workaround. And so then we start having our hip hurts a little bit, or our back starts to hurt a little bit, and then I might start to leak urine. A little bit, and it's kind of this, this vicious chain that once it finally gets bad enough, someone might think I need to go do something about it. And oftentimes that might look like my back is hurting and I can't lift anymore. And that's sometimes how they end up in my office, is because they have back pain, and then I'm asking them about their pelvic floor. Pelvic floor, and they say, Yeah, well, yeah, but I had babies, so of course I like leak when I cough or jumper,
Brianna Battles 15:28
right? So it almost can be like a sneaky the sneaky culprit, so to speak. But then the symptoms manifest in a different place, because we've just sort of accepted as, like, leaking or some discomfort in the pelvic floor as just a part of normal motherhood or aging. I really like that stiff knee analogy because I think it, it's um, it helps us visualize the role of the pelvic floor and what it does we're like. In order to absorb force, there has to be like that lengthening, that shortening there has to be like the muscles and the joints that flex and and then extend, and the pelvic floor does the same thing, right? So can you talk about the relationship the diaphragm and pelvic floor has, and then how the abs are connected to that at all? Because I remember that was such a confusing thing for me whenever that was, like, probably 10 years ago now, when I was learning just how all of that is actually connected again. What is my diastasis have to do with my pelvic floor? I don't have pelvic floor symptoms. I'm just worried about my abs, you know, and like so people, I think diastasis is oftentimes the gateway drug that's like we lead with the fear that my abs are ruined, but ultimately it unlocks so much more awareness about our pelvic health, which is what we really need to be mindful of, especially across what I refer to as our lifetime of athleticism, because as we get older, there are more changes to our structures, our symptoms, tissues, muscles, all of that. So tell us how it's all related. Yeah. So
Mindy English 17:02
our respiratory diaphragm is going to sit right under our rib cage, and it's kind of shaped like a dome. So when we inhale, that diaphragm lowers, and it's going to lower your abdominal contents and put a little stretch in the pelvic floor. And we know, if we put a real time ultrasound and visualize someone's bladder, and we can see the pelvic floor, we know that just with natural breathing, that's what we see, and then when. So that's kind of like stepping on the trampoline. When we exhale, everything comes back to its resting position, kind of like stepping off the trampoline. So it's really this nice rhythm, especially at rest, when someone's just lying on a table that high in so your breath can really influence the pelvic floor. And, you know, we can get into, like, breath holding and strategies and stuff like that, and and how that can impact the pelvic floor. But so, so that breath really influence how that pelvic floor is able to respond to things. And then our abs are kind of the front part of this canister or container, as it's been described. And so if you think of a lot of women are, and I've said this, I'm totally guilty of this. As someone who's taught fitness classes, we're told to suck in our stomach and and we kind of want to suck in our stomach sometimes to like, feel like we have a flatter stomach. It feels more esthetically pleasing. And there's certain sports that you're told to Suck in your stomach. My kids, I feel like, as a four year old in gymnastics, she was told to suck in her stomach, and I was like, oh, yeah, totally. And so then when we start getting tightness there, it creates, it's a pressure, right? It's a little bit of pressure that is created in our stomach. And our stomach's not filled with air, but if you imagine creating some pressure there, it's going to put some downward pressure on the pelvic floor. The force has to go somewhere, right? Like it's it's kind of basic physics. If you give force in one place, the resultant force has to distribute somewhere else, and so, so oftentimes it is going to go down into the pelvic floor depending on your strategies and breathing and movement strategies, your brain chooses, yeah. For everyone, not everyone's going to have those problems, but a lot of people do again because of just kind of how they've been trained. Yeah,
Brianna Battles 19:19
like, just like all our different like, mechanics and what the patterns that we've developed over time. If you're somebody who's sucking in your stomach, well, then that that creates force in other places. If you're somebody who braces a lot, well, that creates force in other places. If you sneeze, that's like Max force to the pelvic floor. Even though that's not like dead lifting 300 pounds, it's still a lot of force on your body. It's like cold and flu season here in the winter, people are coughing. I'm sure you're getting a lot of people coming into clinic saying, like, I have had this sickness. I've been coughing so much. I am peeing myself so much more right now. Again, because these are like, one maxes of the pelvic floor. Where it's having to absorb that force of that chronic cough, or if you are somebody who runs and now we have the repetitive force, and so again, it's like the pelvic floor is having to be responsive to all of these different demands, all of these different tasks. And sometimes it's a fatigue thing. And I think a lot of people assume my pelvic floor is just so weak. But really, I believe what you're saying here is it has so much more to do with, like, that coordination and where that force is going, and how we've been able to guess, ultimately, the solution of being, like, able to redistribute that force and pressure and coordinate that system in more appropriate ways. So can you talk a little bit about that?
Mindy English 20:42
Yeah, so I think the longer I've been in the game, and the more reps I've gotten with different people, but I think especially with athletes, is it's it's not just as simple as we just need to strengthen the public floor, like sometimes people do, and I don't want to discount that, like, I think there are people out there who legitimately need to strengthen their pelvic floor. And
Brianna Battles 21:05
do you see that often with female athletes as being those that need to strengthen their pelvic floor? Or is that more of like a, I guess, like a sedentary population? I know we don't want to put like, absolute labels on things, but what do you often see,
Mindy English 21:21
like all things that's going to depend. I mean, athlete early postpartum certainly probably needs a little strength and activation of the pelvic floor, depending on their birth story and kind of how their body has reacted to that. I would say a lot of athletes come to me with pretty efficient pelvic floors, honestly and and to be fair, sometimes I get, I think I get people because they've already done some pelvic floor therapy, or they've done some home programs where there's really great education, whether it's your postpartum program, so they understand, they understand how to find their pelvic floor. And they'll say to me, like, I get breathing. I understand the breathing. Yeah, I understand how to contract my pelvic floor, but I still leak when I run. And so for those people, like telling them to contract their pelvic floor or hold a pelvic floor contraction for 10 seconds, doesn't get you through a 10 mile run right without leaking. It doesn't get you through 100 double unders without leaking. And so again, we have to think about how, how is that force being distributed, and what's happening in our other muscles of our body, like, what are our glutes doing? Our glutes are a big powerhouse muscle of the body. They work really well with the pelvic floor. And so strength of other muscles can often help the pelvic floor be more effective. And so if I think of my runner, I think of someone who's jumping, I want to know, like, what does the strength of their glutes look like? Because are they getting, are they fatiguing in their pelvic floor? Because they're also fatiguing in their glutes, right? And I'm going to get a lot more buy in from an athlete saying, Okay, we're going to, we're going to do some lunges, we're going to do some step ups. We're, you know, let's really strengthen your glutes to maximize your athletic performance and see if we can get the pelvic floor to come along with that that feels a lot cooler and like, right? Like athletes want to feel like they're doing something right, like they want it to feel productive, right? And so if I can get them strong, and we do a little bit of work with pelvic floor or positioning or force distribution with our breath, then we get a win right, right from them, because they want to do the exercises, because they start to feel stronger, right? And they stop leaking or having heaviness or pain or whatever their symptom is, yeah, like, it's not because we just, like, did 1000 Kegels, right?
Brianna Battles 23:51
And I think, like, the the glutes make it they're such a great teammate to the pelvic floor that if you can improve the glutes and their strength and their function. The pelvic floor is an incredible byproduct of that, like it benefits greatly from improved glutes. Whether that's just the glutes ability to absorb that force or produce force, it's taking that away from the pelvic floor. So it's not just the pelvic floor. We manipulate that through, yes, breath, like you mentioned. And I think in fitness, a lot of times it's manipulating their position. It is manipulating how we've been taught to brace and manipulating how we've been taught to hold tension to make this really practical for those for women that lift, a lot of you have been taught to like when you deadlift. For example, when you get to the top, you're gonna really squeeze your glutes, you're gonna shift your hips forward, and now you're sending a lot of forward pressure, not just on your midline, but you're tucking that pelvic floor under, and therefore it's not absorbing the force as well of the weight on the barbell, plus gravity like that's just a. Lot of force and pressure for the pelvic floor to hold, and now we're going down again and pulling up, and it's like we're re we training this position and this pattern of the pelvic floor, which that's when we see a lot of symptoms, similarly to when people are doing a heavy back squat and you're coming out of the bottom, and where do most people pee when they're doing a heavy lift, it's in that like couple inches coming out of the bottom of the squat. When you're maybe your pelvis starts to tuck a little bit because you're kind of grinding out of that position. That's where we see people experience a lot of pelvic health symptoms and incontinence. But again, that's because we're looking at the position of the pelvis, and then the ability for the pelvic floor to absorb force as well, because now the glutes aren't involved as much when we're in that forward, tucked, squeezed position. So I like to just try to create these, like these visuals for that, because I think it's we, if we can go through the lens of the glutes, it makes it so much easier to understand the function and the role of the pelvic floor. And
Mindy English 25:59
if we can just help people, like, maintain that position, that those glutes aren't tucking under and they're being a little bit more functional. The other thing that that does is it puts your pubic bone, kind of under you a little Yeah, and I remember I was taking a class, and someone said I would never tell someone to answer your pelvic till I said, I'm not asking them to go into like, an extreme position. I'm just asking them to stay, like, potentially, kind of neutral and not tuck under prolapse when they're lifting really heavy, especially like, maybe lifting overhead really heavy. So if we can just get you in a position where you can use some bony structure to help you a little bit and use your glutes to help you a little bit more, and then all that force isn't coming down on your pelvic floor. Yeah, that's a big win. And we're not talking it's, I mean, we're talking like a centimeter. It's not a big
Brianna Battles 26:47
it's not a big range, yeah, and it's not unsafe. I'm not,
Mindy English 26:51
like, putting in your back in a precarious position. It's just, it's working with the person in front of you and saying, Okay, does this feel? Okay? Right? Let's try this and see,
Brianna Battles 27:01
right? Yeah. It's like, I like that, that analogy of like the pubic bone, because it's like, we're giving like the pubic bone provides the structural support for the front of the body, and then the glutes provide the more muscular support for the back of the body, and the pelvic floor is there in between, and we're putting it in the most ideal position possible to absorb the force of a sneeze, or to absorb the force of a 300 pound deadlift or whatever it might be. And it's it's using these, like our own body levels of body awareness, to make some of those mechanical adjustments and exercise as a way to then retrain that system. Because I think what was interesting to me, was learning that okay, like I feel like I'm so hyper focused on my core system now when I'm exercising, and that can be really overwhelming. Be like, Wait, when am I supposed to breathe? How am I supposed to be moving? Where am I when do I squeeze? When do I not squeeze? What do I do? And ultimately, when it comes to our pelvic health and integrating that into exercise if you're symptomatic or if you're really trying to be mindful of your body. Ultimately, we're trying to retrain your brain and create new patterns so that you're not robotic, you're not like, hyper focused on that when you exercise, because if you're an athlete, you cannot be so distracted by like, is this good for my pelvic floor? Am I doing this right? You just gotta, like, be able to move. You gotta be reactive. The pelvic floor is very dynamic. And so there's really, like, a neuromuscular focus when we talk about all of this, versus a, you know, I guess being so hyper aware of where I'm breathing and when, where and I'm engaging when, what position I'm in, we have to go we like, use the body first, but mostly to, like, retrain the brain. So can you talk about the automaticity aspect of the core system? Yeah,
Mindy English 28:49
so I think automaticity is super important, because, like you said, I don't want to think that hard, right? Doing an athletic thing, whether that's running or doing box jumps or steps in a class. I don't want to think that hard, right? I don't want to have to think about, okay, am I doing my full 360 degree breath, and is my pelvic brain tight? Like I don't have time to think about that. I have 30 seconds to jump up on this box as many times as I can. Yeah. So what I always tell my patients is, yes, we're going to spend some time coordinating and like really thinking about when our public floor is contracting with some movement to retrain that right and and sometimes that might feel kind of boring as we're doing it, but there's a reason behind I wanted to create this relationship remind our brain that the public floor is anticipatory it. We know from our research that it contracts before we move our arms or move our legs, so we're just re reacquainting ourselves with that automaticity. But my patient, we go out into the gym, and I always tell people, like, I'm not going to really talk about your pelvic floor in the gym because there might be some dude over here doing a shoulder rehab. So that's not going to feel good for you if we're like talking about your pelvic floor out in the middle of the gym. Um, so when we're out in the gym, I might cue you first, like some breathing and positioning. But we've already, we've already done a lot of the work for that pelvic floor to start to be automatic. And to me, like, you know, I can't feel my pelvic floor, like, let's say we're doing just like a lateral walk or something like that. And they'll say, even a squat, they'll say, I don't, I can't feel my pelvic floor. And I say, that's okay. Like we've practiced this, like we've practiced the rhythm of timing, enough that you'll know that it's working because you're not having symptoms, yeah, and that's how that you know. Again, if we go back to the knee. I love knees easy for people to think about. If someone has knee pain. I know that the exercises I've been doing, the things I've been working on, are working, because when I ask someone to squat, they either have knee pain still, or they have less. And it's not because I'm saying like, Oh, are you squeezing your quads? Right? It's not because of that. Even though we have worked on some of those things, we worked on some strength of the quads and different muscles. And so I think the pelvic floor has to be the same way. And I think you're right. I think my profession, we try and over complicate it, right? It's like, oh, now you have to, you have to squeeze at this moment and right, feel it and, and sometimes I say, You know what? Like, let's just, like, just breathe. Like, basic principles, breathe on exertion, right? And hopefully they've done enough work that your pelvic floor is responding. If it's not, then, right?
Brianna Battles 31:37
Yeah. And like, you know that what I try to do with people is like, bring less focus to the pelvic floor and more focus to things they're already going to be doing. So if it's dead lifting, then I'm going to be maybe focused on their form. If they're trying to lift really heavy, well, then I'm going to be focusing on how they're breath holding. If they are running, I'm going to be focused on their gait mechanics and just like their tendencies under fatigue, it's like, we can kind of troubleshoot from the outside in, as for movement, instead of being, like, making them think inside out. And that tends to help a lot with making this stuff a lot more practical and for them to be able to, like, consistently implement. Because again, they're like, oh, breathe into my lats. Oh, just like, stand straight up. Don't squeeze my glue to the top. Okay, got it. And, like, they can use things that, like, they're kind of used to doing anyway, because there is a bit of a learning curve, you know, I think about, like, when you really are trying to understand, like, okay, when I inhale, the diaphragm goes down and everything lengthens, and I, you know, if I'm holding tension, then it's not going to be able to lengthen and expand as much. Oh, and then I'm trying to create a really subtle pelvic floor contraction like so when I exhale, diaphragm goes back up, pelvic floor recoils, and that naturally creates a little bit more support. Now if I bring some more mental awareness of that, well now I can actually engage that. And a cue I like to use, which is super inappropriate, I'll say it so that you don't have to on this podcast, but is like, zip your clip. Because so many people, when you tell them to do a pelvic floor contraction, what do they do? Mindy, they squeeze their butt, right? Yeah. So because, because that's where we have, like, more awareness to is like just squeezing the glutes, thinking that that's a pelvic floor contraction, and most of the time, it's really hard to engage more like that forward position of the pelvic floor. So I hope most women know the anatomy of where their clitoris is, and if you can focus on lifting that that kind of engages more of that front part of the pelvic floor, and then people are like, Oh, that's different. That's different than anything that I've been doing. So again, it's like, it's finding practical cues in ways for people to understand their body more, so that as they age, they're not shocked. It's not another damn thing for them to worry about when they're postpartum, when they're already, like, in the trenches of that, or when they're in perimenopause, and they're like, why is like, everything around me kind of falling apart? And now this, you know, like, we're trying to eliminate one other thing for women to have to be so conscious of throughout their life.
Mindy English 34:20
Yeah, and I think, you know, something that I've heard a couple times this week actually from both, like, females and a male, you know, we we talked a lot about, you know, strategy and breathing and happen to be with, like, urge stuff, right? Like walking is pretty common, especially as we get older. Like that can be an activity that a lot of women choose to do because it feels right, but they get a lot of urge when they're walking, and so they can't go very far because there's not a bathroom. And so, you know, we've gone through, we've we've talked about all the things and like, Yeah, but when I'm walking, these strategies don't work. And you know, when you start asking their questions, it's like, they're like, trying to hold everything in you. When they're walking, and so there was, like, this little disconnect of when we do those things, and again, just going back to, like, Let's breathe, let's swing our arms, let's Yeah. Also, like, let's look at how you're walking and see if we can change some of those variables, right? Because I know you can contract and relax your pelvic floor, but the goal was never for you to, like, squeeze it tight, or, like, try and time it with every step. Like, that's not practical, but people want to be good students, and so that's what sometimes, what they think, yeah, that you want them to do. And so you have to, you just have to get curious and have to, you just have to be asking lots of questions to make sure that they're not over complicating something and trying to brain,
Brianna Battles 35:42
yeah, no, absolutely. I think it's such a real it's such a good point, because people do over complicate things. And so I try to tell, like, my athlete brained good students to just, like, try to be a C student. And like, less is probably going to be more for you overall with your pelvic floor contractions, if you're somebody who's gonna, if I tell you to do that, and you're naturally someone who's like, a I'm gonna try my hardest 10 out of 10. I'm more like, Let's aim for a three out of 10. And that's like what, that's more of what we're looking for here. Because, again, we're not trying to create like, so much muscular control. It's more about like that, neuromuscular control where we're creating that brain, where it should be really subtle, like we're trying to train consciously, train the subconscious, for our body to be able to respond really dynamically and anticipatory, you know, like that anticipatory reaction, so that when you do jujitsu, When you do CrossFit. When you compete in your triathlons, you're not worried about if your pelvic floor is going to be able to handle the different demands and the time and the movement and whatever it might be. All right, I'm going to wrap this up with one last question, because I do think this translates to conversations that maybe aren't had often, or there's just like, there's a disconnect with how something like constipation and bowel habits early on in life can then influence pelvic floor symptoms later in life. Oftentimes, we have a lot of kids that are constipated, or I haven't talked to my girlfriends, and they're like, I only poop a couple times a week, and I'm like, Oh my God, and just how much constipation and our our like, I guess bathroom habits influence pelvic health symptoms. We haven't ever really been taught what is healthy, what we should be doing, what we should not be doing. So can you talk to me about constipation?
Mindy English 37:41
Love to, I love to start the morning talking about poop. I thought,
Brianna Battles 37:45
so, you know,
Mindy English 37:48
yeah, so a lot of people are chronically constipated. And I think the more I dive into some pelvic floor issues with kids, the more I realize how many people are chronically in constipated. And again, you know, 20 to 30 years ago, we didn't talk to parents. We didn't know that there were things that we could do. We didn't know that there was pelvic floor therapy to help kids understand how to get the poop out of their body. And so, so the result of that is, now I see adults, and when I ask about their bowel habits, they say, Well, I'm constipated, but I always have been, right? This is not, this is
Brianna Battles 38:24
normal for me, yeah, yeah.
Mindy English 38:28
And so, so then you have someone who's constipated, and so essentially, now it's going to put some increased stress on the pelvic floor, because there's some more bulk that's there. And it also starts to press on the bladder, because the colon, where poop is being stored and our bladder are really close to each other, so that can start to create some symptoms or some irritation to the bladder. We just get this, like, internal boxing match that's happening, yeah, and then we're telling people to, like, breathe, and they have so much poop, like in their upper colon, right under the rib cage that they can't, like, breathe into. The course that they need is just this really frustrating spiral for a lot of people. But also, people don't know that only pooping once or twice a week isn't really normal,
Brianna Battles 39:15
yeah. So what is normal? Would we say? Obviously, normal is a range. Yeah. I
Mindy English 39:20
mean, we'd love for people to poop every day, at least every other day, with a good bowel movement of, like, I told my kids, a big pile of mushy poop. Yeah?
Brianna Battles 39:30
Like, consistency, yeah,
Mindy English 39:33
right. Consistency is really important. You don't want little, like, rabbit droppings, yeah? So people can poop every day and have little rabbit droppings and you're constipated, yeah, because it's not good, it's not good quality, and so so it has a huge impact on us. We know that in adults, physical activity can really help with constipation, so that's good, but again, we have to get people not having pain feel comfortable. With their symptoms to feel comfortable moving right. And then, of course, diet and water intake and all those fun things,
Brianna Battles 40:06
which I have found really interesting since I started. When I started competing in Jiu Jitsu, I started counting my macros more often, and then you just sort of get insight on where you might not be getting as much macro or micronutrients as you need. And I know that everyone is, like, really hyper focused on fiber. And don't get me wrong, fiber is so important. And when I work with a lot of female athletes, like they're very healthy people, they oftentimes have so much fiber that they're not that they're that also makes them constipated. It's almost like too much of a good thing, and even fat content. So many people of our era ish have grown up in like, diet culture where like fat is bad, or, you know, like one macronutrient is like, is eliminated, right? Like, we're not focusing on fat, or I'm gonna have low carb or whatever, and we don't realize how, when we're reducing, or really, like, out of synergy with the main macro nutrients or even some of the micronutrients, how much that truly impacts constipation and your metabolism? Like, if you're constipated, your metabolism is not working efficiently. That's going to influence not just constipation, but your health, overall health, your hormones and your ability like to truly, actually get all of this shit out of your body like that is important. So if you are constipated, that's absolutely something to look into. And it doesn't have to be, we'll go to, like, a GI doctor, maybe. But that doesn't have to be your first step. I would say Your first step is to track your macros for like, a week. And for me, it was really eye opening to be like, dang, I like, naturally, just kind of eat, like, lower fat content. And okay, I need to, like, up that a little bit. And then when you do that, you start to notice differences, like your your bathroom habits, your poop can tell you a lot about your health, a lot
Mindy English 42:10
Yeah, and yeah, I think this is a different rabbit hole. But all constipation is not created equally, right? Like, everyone's Yeah, systems are a little bit different. And so I think you're right. Like, we can emphasize fiber. And if someone has, like, a little transit, like, that's going to make them more backed up, right? And so I think finding that balance and water intake, water intake is important. And if you think about So, if we're constipated, but we're also leaking urine, our instinct is, well, I just won't drink as much water, right? Because
Brianna Battles 42:38
I'm going to go on this walk, I don't want to have to pee, so I'm not going to drink a whole lot. Yeah, and
Mindy English 42:43
so then we're drinking less water. And so then we're our body. Our body needs water. That's how it functions best. And so then if we have poop inside of us, our body is going to pull poop or pull water out of poop, making it drier and harder to get out. And then again, it's like, it's this really vicious cycle. And then you're eating more fiber to make it better, but you never got all the other stuff out first. And really, sometimes you just, you need, like, more fat, better balance, more water right, just to make the whole system function right.
Brianna Battles 43:15
And then when we think about, like, those that have been sucking in their stomach, or where, like, maybe have a really tight pelvic floor. They grip their glutes naturally. Like, it's really hard for that body, for their body to then lengthen and actually poop. So, like, basically, these gripping habits are also contributing to the constipation. Like you said, it's not just like macronutrients. There's there could be a lot of different things going on. The bottom line being, if you are constipated and you're not pooping, like, once a day, or the content of your poop isn't substantial, that is something to look into and say, like, well, what are my tendencies? Like, my eating is dialed Okay, then, like, what am I doing outside of like? Or what are my my habits? What are my hydration habits? What are my eating habits, what are my movement tendencies or gripping tendencies? And then being able to kind of troubleshoot from there. And I know this is, like, kind of a weird thing to be aware of, but it truly affects so much of your health, and it is not something you've been taught to, like, really think about or acknowledge. And I'm seeing that so much more now in my circle of friends where I'm hearing, like, what has been normal for them? Well, I I only poop a couple times a week, and I've always said I'm like, that's why we're having problems here. Like that is a contributor to so many things, like, certainly something to address for reasons far beyond pelvic health, yeah,
Mindy English 44:39
and if that's something you've done for a long time. The pelvic floor gets tight and tired, yeah, and a lot of kids withhold because it's painful or fear. You know, there's lots of reasons withhold, and that can if that never got addressed as a child that carries on into adulthood. So now you have this lifetime of just kind of a movement pattern that your brain adopted to. To be right, to hold tension, yeah, right. Then they sit on the toilet and they don't understand how to relax the puppet for it feel weird, right? Like, just, they're not used to it. They're used to having to, like, really strain and bear down. And our bite, that's not how bison or bite designed, actually, to just relax in if you're in a good alignment, the poop should just come
Brianna Battles 45:21
out. Come on out. Yeah, man, we have so much to talk about in terms of pelvic health, from, you know, like we didn't even and we weren't going to today, but like throughout the series, we're going to be talking about different forms of incontinence, pelvic organ prolapse, pregnancy, early postpartum recovery, and things that you can do, like we say, like perimenopause and just like the aging experience, things to anticipate, things that you can do, things that are in our control and not in our control, but essentially what we haven't been taught to know about our body and our pelvic health as it relates to our lifetime of athleticism. And for me, when I say lifetime of athleticism, that truly means, like, the quality of life that I want to have as I get older, you know. And like, how do I want to feel at my mom's age in my 60s? How do I want to feel at my grandma's age in my 90s? Like I want to do what I can now to set myself up as best as possible, and so much of that comes down to body awareness, body education and movement. So that's what we hope to communicate through this like pelvic health focused series, really doing it in a way that is practical and complementary to your fitness and quality of life.
Mindy English 46:37
Yeah, it's gonna be fun. I'm excited to continue the conversation. Yes. Thank
Brianna Battles 46:41
you so much. Mindy, I know it's still early, and you have a big day in front of you. I'm super grateful for your time here, and thank you for listening everyone. Thank you so much for listening to this episode of the practice brave podcast. If you enjoyed the show, please leave a review and help us spread the work we are doing to improve the overall information and messaging in the fitness industry and beyond. Now, if you are pregnant and you are looking for a trustworthy exercise program to follow, I have you covered. The pregnant athlete training program is a well rounded program for pregnancy with workouts for each week that are appropriate for your changing body. That's 36 weeks of workouts, three to four workouts each week, and tons of guidance on exercise strategy. We also have an at home version of that program. If you are postpartum and you're looking for an exercise program to follow the eight week postpartum athlete training program would be a really great way to help bridge the gap between rehab and the fitness you actually want to do. From there, we have the practice brave fitness program, which is an ongoing strength conditioning program where you get new workouts each week and have a lot of guidance for myself and my co coach, Heather Osby. This is the only way that I'm really offering ongoing coaching at this point in time. If you have ever considered becoming a certified pregnancy and postpartum athleticism coach, I would love to have you join us. Pregnancy and postpartum athleticism is a self paced online certification course that will up level your coaching skills and help connect the dots between pelvic health and long term athletic performance, especially during pregnancy and postpartum, become who you needed and become who your online and local community needs by becoming a certified pregnancy and postpartum athleticism Coach, thank you again for listening to the practice brave podcast. I appreciate you, and please help me continue spreading this messaging, this information and this work. You.
MORE ABOUT THE SHOW:
The Practice Brave podcast brings you the relatable, trustworthy and transparent health & fitness information you're looking for when it comes to coaching, being coached and transitioning through the variables of motherhood and womanhood.
You will learn from athletes and experts in the women's health and coaching/performance realm as they share their knowledge and experience on all things Pregnancy & Postpartum Athleticism.
Whether you're a newly pregnant athlete or postpartum athlete, knowing how to adjust your workouts, mental approach and coaching can be confusing.
Each week we'll be tackling questions around adjusting your workouts and mindset, diastasis recti, pelvic health, mental health, identity, and beyond. Through compelling interviews and solo shows, Brianna speaks directly to where you're at because she's been there too!
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