359 | Unveiling the Myths Behind Pelvic Health, DR During Pregnancy and Healthy Aging with Dr. Christina Prevett

[00:00:06] Welcome to The Optimal Body podcast. I'm Dr. Jen.

[00:00:08] And I'm Dr. Dom. And we are doctors of physical therapy,

[00:00:11] bringing you the body tips and physical therapy pearls of wisdom to help you begin

[00:00:15] to understand your body, relieve your pains and restrictions, and answer your questions.

[00:00:19] Along with expert guests, our goal of The Optimal Body podcast is really to help you

[00:00:24] discover what optimal means within your own body. Let's dive in.

[00:00:28] Real quick, I just want to answer the number one question I get asked all the time.

[00:00:33] And that is what Vivo shoes should I get for XYZ? Whatever it may be, whether it's working out or I

[00:00:40] just want to go for a walk or I'm hiking or... Here's what I will say. If you go to the Vivo

[00:00:45] Barefoot site, which we have it linked up in our show notes, again, use code TOB20.

[00:00:51] And this is only good for the rest of this month. But TOB20 is going to get you 20% off of any shoes

[00:00:58] that are not already discounted. And here's what I'll say about Vivo Barefoot shoes. They are

[00:01:03] barefoot shoes in structure. So unlike other shoes that you go to the store and there's particular

[00:01:09] reasons, you're going to get these type of running shoes and these type of shoes. There's no structure

[00:01:14] to Vivo Barefoot shoes. That's the beauty of them though, is they allow your foot to do what it's

[00:01:20] meant to do. It allows your toes to actually have the space to find the mobility, to find the

[00:01:26] strength to be able to work like it should. When your toes can spread better, the muscles deep

[00:01:32] inside the foot can actually work. This is what helps to support and give your foot stability

[00:01:38] so that if you feel like you're always falling into pronation, now your foot has the ability to

[00:01:44] actually supinate as you go into that gait cycle. So we need pronation and we need supination.

[00:01:50] We need our foot to flatten and lift, but we want it to do it naturally. We don't

[00:01:55] need that arch support. So that's the great thing that you get with Vivo Barefoot shoes.

[00:02:00] Whether you want to go work out, hike or live life, any of the shoes can do well for any of

[00:02:06] those occasions. Now, when you look at the site, they will have different categories. For example,

[00:02:11] going out just walking around, my particular favorite shoes have been the Novus Women's.

[00:02:16] This is what I, they look like typical sneakers just with the foot structure that your foot's

[00:02:22] actually supposed to have. And so they're really cute. So I like to wear them with jeans. I like

[00:02:26] to wear them with leggings. I like to just wear them out and about. But my other favorite are

[00:02:30] the Primus Asana. And because of the structure of the shoe, like the material that's used,

[00:02:36] it's super like just easy to get your foot in. So oftentimes I don't even untie or tie. I could

[00:02:42] just slip my foot right in and head out the door, especially if I'm holding Dante or have a lot of

[00:02:46] things in my hand. That's really an easy shoe to use. But I use that one working out. I use that

[00:02:51] one for several occasions. If I am going and particularly going for a workout, the Modus

[00:02:58] Strength are really good strength shoes, but almost all of them, the Primus Lite Knit, those

[00:03:04] are some of my favorite ones to always come back to. But you can even wear the Primus Lite Trail

[00:03:10] just for working out. So any of them are going to be able to exchange into other areas of life.

[00:03:16] And that's the beauty of buying Vivo Barefoot shoes. You can have one pair. So say you get

[00:03:21] the Primus Lite Knit, you can have that for going out. You can have that for working out. You can

[00:03:26] have it just for walking around or for hiking. Like if it's not a super high terrain hike,

[00:03:32] I would say. But a lot of them interchange for what you want to do. So this is the beauty of

[00:03:39] getting shoes that allow your feet to do what they're meant to do. So if you haven't yet,

[00:03:43] use TOB20 at checkout and go check out some Vivo Barefoot shoes. I am so excited for this interview

[00:03:49] with Dr. Christina Prevett because she is going to help to tear down a lot of myths you might have

[00:03:55] heard about your body. And she's continuing to do it through research. She is one who is really

[00:04:00] full force going out there researching for our profession and getting the knowledge that's

[00:04:04] needed for you. Now, Christina Prevett is a pelvic floor physiotherapist and mom of two who

[00:04:09] has a passion for helping women in different life transitions, including postpartum care and menopause.

[00:04:15] Christina has been a practicing clinician for over 10 years. She completed her PhD at

[00:04:21] MacAster University in 2023 and is a postdoctoral researcher at the University of Alberta. Her

[00:04:29] postdoctoral research looks at high load resistance training in pregnancy and the impact of lifting

[00:04:35] on the pelvic floor. Christina co-created and hosted a group class called Strong Like Mom during her

[00:04:41] first entrepreneurial endeavor, Stave Off. She now does exercise programming remotely with pregnant

[00:04:47] and postpartum CrossFit powerlifting weightlifting programs through the Barbell Mamas, which she owns

[00:04:53] with her husband, Nick. Christina teaches six courses at the Institute of Clinical Excellence,

[00:04:58] including the Pelvic Health Curriculum, where she helps physiotherapists empower their pregnant and

[00:05:03] postpartum athletes. Christina was a national level weightlifter and has competed pregnant,

[00:05:08] postpartum, or both in CrossFit powerlifting and weightlifting. Again, I'm so excited about it,

[00:05:15] so let's dive in. Christina, thank you so much for taking time to be here and answer a lot of

[00:05:20] questions that I have for you today. You are just such a wealth of knowledge, and I know you spend

[00:05:25] so much time teaching and helping so many people from clinicians to everyone, you know, really help

[00:05:32] to understand not only pelvic health and how that changes throughout the years, but also,

[00:05:37] you know, working with geriatric population and everything. And I just appreciate your knowledge,

[00:05:42] your education, and your time. Yeah, thank you so much for having me. A lot of people think that

[00:05:47] when I say that my postdoc's in pregnancy and my PhD's in geriatrics, that they don't

[00:05:52] connect or there's no connection or relationship between the two of them, but that is very far from

[00:05:57] the truth in a lot of ways. Different part of the lifespan, but definitely some of the same

[00:06:02] issues that we're seeing in rehab for both those groups. So I'm excited to be able to

[00:06:06] talk a little bit about both. Definitely. And why don't we just start there? Because

[00:06:10] again, you got your specialty in pelvic health, PhD in geriatrics. Like what made you interested

[00:06:16] and kind of resulted in that arc of your own education? Yeah. So I started out in outpatient

[00:06:22] orthopedics working a lot with older adults and I just fell in love with that population. I just,

[00:06:29] we have such a huge role to play in rehab, but when we have an older adult who's really getting

[00:06:35] close to that line where they could lose their independence, you can legitimately change the arc

[00:06:41] of their life. Like the arc of their golden years, like you can change it. And it made me really fall

[00:06:47] in love with working with that population. Taking a quick pause from our interview to

[00:06:52] talk about an aspect of our health that all of us could afford to focus on a little bit more,

[00:06:57] and that is our hydration. It's something that we can easily just take into our own hands,

[00:07:02] but staying hydrated isn't just about drinking enough water. It's about getting the electrolytes

[00:07:07] back into our system that we are naturally losing throughout the day by going to the bathroom,

[00:07:12] sweating, and ways that we don't even realize we're losing the sodium, potassium, and magnesium

[00:07:17] that our body needs to function its most optimally. And that is why Jen and I drink

[00:07:22] Element Electrolyte Mix on a daily basis. It has the sodium, potassium, and magnesium that we need

[00:07:29] for those internal bodily processes. It can help you feel less brain fog, feel more mentally acute,

[00:07:35] have better bowel movements, sleep better, and so much more. If you go down to the link in the

[00:07:40] show notes, it's just drinkelement.com backslash optimal. That's Element spelt out like L-M-N-T.

[00:07:47] You can get a free sample pack with any drink mix order so that you get all the flavors.

[00:07:53] You can try them all and inevitably when you come back, you know which flavor is your favorite

[00:07:57] to get more. Element has also just come out with their new sparkling version. So for those of you

[00:08:02] that like a little bubbly in your life, you can get Element Sparkling and have the same amazing

[00:08:07] benefit of getting those electrolytes back into your body. Again, that link is drinkelement.com

[00:08:13] backslash optimal. You can check it out in the show notes as well. Let's get back into the interview.

[00:08:19] But I was starting to get frequent flyers on my courses of care where individuals would come to

[00:08:25] rehab. We would strengthen their body because it was a resiliency issue or their body wasn't

[00:08:30] strong enough to handle what they were asking it to do. Got them stronger, discharged them,

[00:08:35] and then a couple of months later, they came back for either a very similar complaint or an

[00:08:40] exacerbation of that condition. It made me start thinking about our rehab models. A lot of our

[00:08:47] exercise programs were extremely underdosed. I had done a strength and conditioning internship.

[00:08:52] I'd done a lot of work in getting my exercise prescription knowledge up to where I wanted it

[00:08:58] to be. It just felt like something was wanting. I'd always been kind of a research nerd.

[00:09:04] I started becoming really excited about trying to really load older adults heavy and what that

[00:09:12] meant. I went back and I started my PhD for fun. Dustin and I from the Institute of Clinical

[00:09:18] Excellence, we started chatting on his podcast. It really just started to change

[00:09:24] the way that I perceived everything. When we started talking about this in geriatrics,

[00:09:28] about loading older adults heavy and how we're really doing them a disservice by

[00:09:33] underdosing their exercise, we would get people at conferences put feedback for me of,

[00:09:39] she has no idea what she's talking about. You've never seen my caseload before. There is no way my

[00:09:45] older adults could do this. It was just really fascinating to see how much pushback we were

[00:09:51] starting to get. That has changed a ton. I was doing a PhD for fun and I am in my late 20s.

[00:09:59] I got married and then all of a sudden the baby fever hit me so hard. I was in my PhD part-time,

[00:10:07] but I got pregnant with my daughter. I have been a barbell athlete for years and years.

[00:10:13] I'm probably on 12 or 13 years where barbells are my love language and they will never get out of my

[00:10:20] hands when I die, basically. It was funny because one of my PhD supervisors or one of the supervisors

[00:10:28] on my committee, he said to me, and I don't even think he realizes the influence that he had.

[00:10:33] He's like, if you think that our older adults are underdosed, oh my goodness, pregnancy.

[00:10:40] I was pregnant at that time. We were in a committee meeting. Of course, I go into the literature and

[00:10:46] I was like, oh man, yikes. The loading of this was so brutal. I'm lifting. I was a national level

[00:10:55] weightlifter before I got pregnant with my daughter. I'm still weightlifting during my

[00:10:58] pregnancy and that was where the trolls are coming out saying your baby's going to die

[00:11:03] and all this kind of stuff. I started looking at this literature and I was like, oh my gosh,

[00:11:08] we are dosing our 90-year-olds with multimorbidity and frailty heavier than our individuals in

[00:11:16] pregnancy where the protocols are one by 10 with a red Ther-band. What? It was crazy.

[00:11:24] I started a side project on my PhD that was not related to my PhD rather with Dr. Margie Davenport,

[00:11:31] who's now my postdoctoral supervisor. I said, we don't have anything, but I treat these

[00:11:37] individuals all the time. At that point, the pelvic division had started with ice.

[00:11:42] That was where our cross-sectional study had come from talking about heavy lifting during pregnancy.

[00:11:48] There's a lot that goes into the way that that research has built. If we got a lot of

[00:11:53] nerds listening to this, then we can really go into it. It was the first study that even

[00:11:57] explored individuals who self-selected to lift heavy during their pregnancy.

[00:12:04] We saw a lot of really positive things, but it's cross-sectional and we have a lot more work to do

[00:12:09] before we can give really clear guidance on heavy lifting during pregnancy. It turned into

[00:12:16] what my love of geriatrics, of high load resistance training,

[00:12:20] it went into my postdoctoral work during pregnancy. Now my goal is really to look at the interaction

[00:12:26] of estrogen status, so pregnancy, estrogen high, menopause, estrogen low,

[00:12:31] high load resistance training and pelvic floor dysfunction. Really trying to... My postdoc's

[00:12:36] working in pregnancy, but my big hairy audacious lifetime goal is to really look across the lifespan.

[00:12:42] That is amazing. I feel like you probably hit on some things that people are going to be like,

[00:12:47] well, that scares me for a lot of things. Talking about lifting heavy for geriatric patients,

[00:12:54] so what age are we saying for geriatrics? It's a constantly moving target. In research,

[00:13:00] it's always over 65. We now in research, it makes me so mad that they say it like this,

[00:13:06] but they call it the oldest old, which is over 80 because we have so many individuals who are

[00:13:10] living longer. I know it just makes me cringe, but technically it's over 65. We have some evidence

[00:13:18] around individuals in their 80s and 90s. We have more evidence going into individuals in their

[00:13:22] hundreds plus because we're just seeing an expansion of the lifespan. We're getting a lot

[00:13:28] more evidence in our older old categories. But yeah, over 65 is generally in that older adult

[00:13:35] category. I just want to say before we get too far away from it, how you were early on talking about

[00:13:41] loading up the older individuals heavy. People heard that. I heard that. I wasn't the one who

[00:13:47] heard you and said, you're crazy. I was the one who was in my acute and skilled nursing

[00:13:52] clinicals doing Olympic style movements modified with the people and seeing the results.

[00:13:59] And I'm like, I can't argue with how well this person's progressing over my few weeks of working

[00:14:04] with them. And so, yeah, it's anecdotal at that point. And yeah, we need more research, but

[00:14:10] it's hard to argue when you see the change in people.

[00:14:12] But that's the scary thing because so many people are going to doctors and you're being told,

[00:14:16] load less, don't put as much onto your body, do low impact as you start to age.

[00:14:22] And there's so much fear because people are coming in with aches and pains and like,

[00:14:26] oh, look at this MRI and what you're seeing. And so, don't do this. Don't put any load on your back.

[00:14:31] And why is it important? Why is it important to lift heavy and continue loading even as we're

[00:14:39] getting older or old? What is it? The oldest of the old. And how does that

[00:14:47] impact or improve your body even if you are seeing these changes on MRIs?

[00:14:52] Yeah. So, if I could give anybody at any age a piece of advice, it would be to start strength

[00:14:59] training, build as much muscle as you can and hold onto it for the rest of your life.

[00:15:04] Because muscles around joints help to protect those joints. And so, yeah, this is a lifespan

[00:15:12] approach, but we can never work in reverse the aging process, but we can slow that process down.

[00:15:21] When we think about our muscles, we are going to lose strength with age. But if we are physically

[00:15:29] inactive, if we have a lot of time sitting like I do when I'm doing research, if we have extra fat

[00:15:35] around our bodies that is pro-inflammatory or we have chronic diseases that we're being diagnosed

[00:15:40] with, that can accelerate some of those losses. And really what we're talking about is reserve

[00:15:48] around the body. How much strength do you have that you can tap into for your activities of

[00:15:53] daily living? And so, the best way for me to kind of give you an example of this is if I have a

[00:16:00] person who has a 300-pound deadlift, them picking up their 30-pound little dog is not a ton of strain

[00:16:08] on their body. But if they have a 25-pound deadlift, they can't pick up that dog anymore.

[00:16:14] And so, they self-select to not do that anymore. And that's what happens over and over and over

[00:16:20] again as people get older, right? The amount of weight that they can move or the amount of load

[00:16:26] that their body can handle before it becomes too much or the strain is too high starts to decrease.

[00:16:32] And we then are met with these decisions as we age of maybe I shouldn't do that anymore.

[00:16:41] This is starting to hurt when I do this. My doctor now says, well, if it hurts, don't do it.

[00:16:48] But that means that I can't take care of my house anymore or I can't access the second

[00:16:54] story of my house where my bedroom was. And now, I'm going to sleep in the recliner on my first

[00:16:59] floor, right? My family is starting to tell me that maybe I shouldn't be living at my house anymore

[00:17:05] and I need to go to a retirement home. The impact, the downstream impact of those decisions are

[00:17:12] gradually people are taking decisions away from you and you gradually start to lose independence.

[00:17:17] And so I think of myself, I'm in my mid-30s. I think about I want to be the best,

[00:17:22] kick-it-est great-grandma, Gigi, at 90 years old being able to get onto and off the floor.

[00:17:28] What do I do today to allow that to happen? And I'm not perfect, let's be real. But

[00:17:35] that strength training piece is such an important part because as we get older,

[00:17:40] we start to lose some of our strength in our muscles and we start losing some of our strength

[00:17:45] in our bones. And even now in my mid-30s, I see my little kid, I have a four-year-old who's almost

[00:17:50] five. She jumps up high things all the time. She just loves it. She's like, I'm going to try and

[00:17:56] jump from this really high ledge. And I think about the impact on my joints when I do that in

[00:18:02] my mid-30s. I was like, ooh, my body is not used to this impact anymore because I don't do those

[00:18:07] high impact, those jumps anymore. And I think about that and then I think if that's compounded

[00:18:14] by 30 years where I haven't jumped off a curb in 30 years, then of course my body's not used to it.

[00:18:21] And then we say, well, this hurts me or I shouldn't do this anymore or this is dangerous.

[00:18:26] And so we kind of get comfy in our little bubbles. And when we are trying to get individuals who are

[00:18:35] completely sedentary, who are not moving their bodies at all and get them into a really active

[00:18:41] technique, Jeff Moore, who's the CEO of the company that I work for for ice, he said,

[00:18:45] you're never going to move from sickness to fitness without bumping into aches and pains.

[00:18:50] And I thought that was so brilliant. I have been an athlete for 10 plus years. I'm not in a

[00:18:55] competitive season right now, but I haven't gone through that entire career completely pain-free.

[00:19:01] But pain isn't something that scares me because sore is safe. I just have to make modifications

[00:19:06] and adjustments based on what my body is ready for right now and what it isn't.

[00:19:11] So I think there's a lot of reframes. That's a very long answer for saying we have a lot

[00:19:16] of reframes that we need to think about. And as healthcare providers, we need to be really

[00:19:21] important that our messaging isn't contributing to deconditioning as we get older.

[00:19:27] That's huge.

[00:19:28] And it's just such a stark contrast to the message that

[00:19:32] is preached at people by most providers. And that's the difficult thing is you might be

[00:19:37] the first person that someone runs into that says, no, pain isn't bad. Sore isn't bad. It's a message.

[00:19:44] And we get to listen to it and we get to learn how to work with that to start to incorporate

[00:19:48] some of these things. And so, no, I think that, yeah, like you said, long answer, but that's

[00:19:54] sometimes the education and the conversation you need to have with people to help them understand.

[00:19:59] Same with Jen and I. There are periods I go through where I'm not doing as much strength

[00:20:02] training. I played football in college and was doing tons of the Olympic lifting.

[00:20:06] And just recently, we had a challenge with Jen's community and it was heavier strength training.

[00:20:12] And the first day, I'm like, ooh, I've had problems with both my knees throughout athletics.

[00:20:16] And I said, ooh, my left knee is really giving me some... It's talking to me a lot.

[00:20:21] By the end of the 30 days, I was telling Jen just the other day, and then I've continued it since

[00:20:26] because no more knee issues. My body talks to me the same way in my early 30s as I'm sure it will

[00:20:34] the rest of my life. And I just get to adapt and listen to it and change the dosage. And

[00:20:39] the challenge is, for many people, they weren't trained in that understanding of the dosing and

[00:20:44] the progression. And you go too hard two days in a row and you're laid up for five or six days.

[00:20:50] So, what's the best way for someone to understand? How do I start to work this in?

[00:20:56] Yeah. Yeah. So, I think you touched on something really beautiful. Aging is hard. Aging deconditioned

[00:21:02] is harder. And just like pregnancy, pregnancy is hard. Pregnancy deconditioned is harder.

[00:21:07] And so, we have to though take that into account of body readiness. Just like you said,

[00:21:15] I don't run right now. I'm a barbell athlete through and through. I'm not going to sign up

[00:21:20] for a marathon next week. I'm not ready for that. I would do better on a couch to 5K. That's like,

[00:21:26] gradual progressions for where my body is right now. And I think that mismatch is where us as

[00:21:34] coaches come in and say, okay, let's try and figure out what your body is ready for

[00:21:39] and make little tiny progressions and celebrate those successes and changes along the way

[00:21:45] and allow our body to increase what it's capable of doing. So that your day becomes easier.

[00:21:53] Just like you said, your knees were bugging you on your squats. But once you started to build the

[00:21:58] support around your knees, no more knee pain. So as we do these strength training, but it's all

[00:22:04] incremental and it's allowing yourself to have time in between to get a little bit of recovery

[00:22:12] so that you can get stronger. Our breakdown of our muscles happens when we're lifting. The recovery

[00:22:17] is what makes our muscles stronger. And then know that it's never going to be a straight line

[00:22:22] because life's not like that. It's just so heartbreaking to when I still hear that a friend

[00:22:30] went to an OB and they said, don't lift over 20 pounds now that you're pregnant.

[00:22:34] And I'm thinking...

[00:22:35] You said red TheraBand earlier, get that person a yellow TheraBand. Red is way too tense.

[00:22:42] It breaks my heart that we're still in this mentality, even though now we are coming out

[00:22:47] with research to at least start to prove that it doesn't lead to miscarriages and all this other

[00:22:54] stuff. So what are some of the most common pregnancy myths? And where can someone start

[00:23:01] in becoming more confident to be more active during pregnancy?

[00:23:05] So let's give a little bit of history to some of these myths because I think it's important when we

[00:23:11] understand where some of these things are coming from. CrossFit and heavy lifting for female

[00:23:17] athletes is relatively new, right? We haven't had a lot of strength and conditioning coaches who are

[00:23:24] pushing our women to be lifting really heavy weights outside of the last decade. Like there

[00:23:29] were probably a little bit, but one of the things that CrossFit has done incredibly well is encouraged

[00:23:35] females to be strong, right? And then you take a subset of these individuals who started lifting

[00:23:41] and now they get pregnant and they want to keep lifting, but it started as a small group of

[00:23:46] individuals and it grew and it's continuing to grow. And so now we're getting more and more

[00:23:51] individuals who are saying, no, I do not agree with this. Like I have a 200 pound deadlift.

[00:23:56] 20 pounds is now 10%. That's very different from somebody who doesn't lift, right? That

[00:24:01] relative reserve is different and are starting to push back against that. But we don't have

[00:24:07] anything around heavy lifting. So what individuals were doing where they were looking at our

[00:24:14] occupational heavy lifting literature. So heavy lifting in the occupational setting is individuals

[00:24:20] who have to continuously or with higher exposures lift more than 10 kilos or 22 pounds for their job.

[00:24:28] That was considered heavy lifting and it has been linked to early labor and some other adverse

[00:24:36] events. But doing 30 to 45 minutes of resistance training is not the same as 40 hours a week.

[00:24:44] And I can skip my workout if I'm feeling like trash, I can't always call out of work, right?

[00:24:50] So there's these parallels aren't appropriate, but that's even like trickled into where our

[00:24:58] research is. So I'm working on a systematic review right now and this is where I'm getting all mad,

[00:25:02] getting all huffy looking at the stuff coming out because there is a person who's saying that

[00:25:08] this is moderate intensity resistance training and the max that the person was able to lift

[00:25:12] was five pounds. And it was never progressed, it was never changed and it was done over 16 weeks.

[00:25:20] What we know about musculoskeletal adaptation shows that we need to be making things harder.

[00:25:27] And I would argue that the purse that the person carried into that exercise session and the baby

[00:25:34] that's about to come out of that vagina or out of that belly is more weight than what they are

[00:25:38] putting in these exercise programs. So it's trickled into our research where now they're

[00:25:44] saying, well, our research can't have that heavy lifting either. And now we have this body of

[00:25:49] literature that's all underneath that threshold and we don't have anybody pushing into it.

[00:25:56] So now we have this group of women who is like, no, I love this. This is something that

[00:26:02] really brings me joy. My community is here and they're starting to push. And because of that,

[00:26:08] people like me greedily have this group of individuals that now I can say, hey,

[00:26:13] these are individuals who are doing this anyway. Let's start building our evidence around this.

[00:26:18] But because all of our evidence is here and I'm like, no, I want them to lift 200 plus pounds

[00:26:24] during their pregnancy, you have to kind of take the right steps. So we have our cross-sectional

[00:26:30] paper where we asked individuals who are now postpartum about lifting heavy during their

[00:26:36] pregnancy. And we asked like, when did you start modifying these things? How did your labor and

[00:26:40] delivery go? How did your baby do? All these types of things to try and basically show that the

[00:26:46] people who are ignoring their OB's advice and are lifting heavy are doing okay. And we did see that

[00:26:53] our rates of high blood pressure or blood sugar issues like diabetes, rates of C-section,

[00:26:59] rates of mood disorders were well below our national averages. So hinting at it's not only

[00:27:05] not bad, but it might be healthy to lift heavy weights during your pregnancy was our first step.

[00:27:12] And then we have to start, I can't say our body of research is saying use five pounds and I'm

[00:27:17] going to do a randomized control trial that's at 200. So we are now doing our retrospective and

[00:27:23] prospective study that we're currently recruiting for, if anyone's listening and pregnant, shameless

[00:27:30] plug, to try and just build and say, okay, now we're going to take these individuals who were

[00:27:35] just pregnant and look at their pregnancy logs and say, this is how they modified, this is how

[00:27:40] they modified their volume. And we're going to take individuals, we're going to follow them forward

[00:27:45] and see. Because the other thing is maybe there are some muscles or joint things that we need to

[00:27:50] pay attention to, I want to know that information too. I want to show that just like in my clinical

[00:27:56] practice it's okay, but also if there is things that we need to be mindful of, I want to know that

[00:28:02] information too because as a physiotherapist, I want to be able to counsel on that. So

[00:28:08] I'm giving you guys such long-winded answers. But like heavy lifting during pregnancy is probably

[00:28:13] where my soundbox is the most. Well, I think it's fascinating to also understand

[00:28:19] where that came from and in the research and why that's still being said. I think that's an

[00:28:25] important thing to understand because to me it just sounds ridiculous. But then when we start

[00:28:31] to understand it a little bit more, okay, I can have a little bit more understanding,

[00:28:34] but it still doesn't help if someone had a toddler and has to lift their toddler during

[00:28:39] pregnancy but is told that they can't lift over 20 pounds. Well, what if they're a single mom?

[00:28:44] There's just so many factors where that's not able to be the case. So how can we empower moms

[00:28:49] to feel strong so that they can take care of their everyday life as well?

[00:28:53] You bring up a super important paradigm that I don't think I've ever thought of

[00:28:56] either that we have the research that is referenced, that's what's there and that's

[00:29:02] what's accepted. And like you said, it's hard to suddenly get research approved where you're

[00:29:07] telling someone to lift 40 times the weight that is in the current research. And I can't imagine

[00:29:12] trying to work that through the review boards and say, well, here's what we want to do.

[00:29:16] They're like, no. And that's the unfortunate thing about how research is approved and created

[00:29:23] for safety reasons. But because it was built in this way, it's hard to start

[00:29:29] moving in that direction. Let's try to pick a slightly different topic and talk maybe

[00:29:34] after pregnancy, post pregnancy. What are some current things that you will consult people in or

[00:29:40] recommend when they're trying to return back to getting with their beloved barbell?

[00:29:46] Yeah, absolutely. So I guess the first thing for me is that I am adamantly opposed to the

[00:29:51] six weeks do nothing. I am very, very against don't return for six weeks. The reason why

[00:29:59] is because if you are in the United States listening to this, you don't have the opportunity

[00:30:04] to take time off. I'm in Canada. There's 12 to 18 months of maternity leave.

[00:30:09] There's time for a reconditioning window that does not exist in the United States.

[00:30:15] What part of rehab would we say, don't do anything for six weeks and then go back to

[00:30:19] full work duties? But that's what we tell individuals who are postpartum. And in all

[00:30:25] of our other, like if I have a person who's had a hip replacement or a lumbar fusion, or they have

[00:30:30] a zipper across their chest because they just had a major cardiovascular surgery, we are getting them

[00:30:34] up and moving around the next day, if not same day. Because we know that it leads to better outcomes

[00:30:40] because we don't want to decondition individuals. But again, we're telling individuals after a baby

[00:30:46] that they shouldn't do anything for six weeks. They're made to feel bad for picking up their

[00:30:50] little ones. And I don't know about you, but like I was two days postpartum and I picked up

[00:30:56] my daughter. And I was three weeks postpartum and I was baby wearing my son. And I was at the park

[00:31:01] with my daughter who's 35 pounds. And she started screaming as the toddlers do because she didn't

[00:31:05] want to leave the park. And so I was farmers carrying her with my son on me with 50 pounds

[00:31:11] and walking home because that's what I had to do. And if we are to say like, oh, everything's going

[00:31:18] to be ruined because you did that, like it's just creating so many problems. And so the first thing

[00:31:24] is that I just I don't agree with the six weeks, I think we have to do a graded approach back to

[00:31:30] exercise that can start super early postpartum. And I'm not saying like go lift 200 plus pounds,

[00:31:37] though some people are at eight days postpartum. I'm saying like you can start with bodyweight

[00:31:43] movements and a little bit of movement of your body and you are not making anything worse. Like

[00:31:51] you're not putting yourself in danger. You're gradually bringing yourself back to fitness after

[00:31:57] an injury or a surgery, which is like bachelor birth or any type of tearing or a belly birth,

[00:32:04] like a C-section. So the first thing is like we're not going to... If you don't want to wait

[00:32:09] six weeks, don't wait six weeks, which is probably controversial. Yeah. Let it ride.

[00:32:16] So right now I'm involved in one small section of some postpartum return to exercise guidelines

[00:32:24] where we're trying to clearly say like what is an absolute and relative contraindication? And

[00:32:30] it's been so fascinating because I think that's where we have to go, right? If we are thinking

[00:32:34] about postpartum, what is truly a reason why you should not be exercising after having a baby?

[00:32:41] And then that's not to say like go back to full work duties or go back to full barbell stuff,

[00:32:46] but like what is a reason for you to not be able to move your body after baby?

[00:32:51] Because that's what we need. And then graded exposure is going to be where we start to

[00:32:58] get more clear ideas. So I'm excited that we have those things on the horizon because I think

[00:33:04] they're so needed. When it comes to returning to barbell activities, I always ask people,

[00:33:10] what's your day-to-day required? Like if you have a toddler at home, you're lifting up an

[00:33:15] empty barbell every single day. That's where I don't get very concerned. I'm going to give people

[00:33:23] guideposts and say, if you're feeling like you're peeing, like you're having big clots,

[00:33:29] if you're still bleeding, if your incision site is feeling really painful or it's starting to throb,

[00:33:35] again, you are safe, but your body is telling you that like you've hit a fatigue point or a

[00:33:41] tired point for where you are in your postpartum journey. So I think that the phrasing needs to be

[00:33:47] a little bit different where instead of saying these are absolutes other than obviously

[00:33:52] contraindications of don't do anything for six weeks, let's give you the buoys and say,

[00:33:57] hey, like these are the signs of what your body is ready for and what it isn't.

[00:34:02] And then let's gradually get you back to doing the things that you want to do. And I'm not just

[00:34:06] talking like athletes. I'm talking individuals who have four kids at home who their partner has

[00:34:12] to go back to work the next day. Like they're going to be doing a lot of activity. And if we

[00:34:18] make people feel like them having to do the things that are necessary for life and motherhood,

[00:34:25] that they are setting themselves up for a long-term failure and dysfunction. I just

[00:34:29] think that the messaging is so poor on that, that I just try and change it.

[00:34:34] Yeah. I think that's so important and understanding. I think what's other,

[00:34:38] the hard part on the flip side is having the support to understand what to do,

[00:34:43] what gradual exposure really means and how do I know what I can start with? Because

[00:34:49] I did have a cesarean and it was tough in the beginning in the sense that I needed to be,

[00:34:57] I had to be aware. We had friends come over like a couple weeks after, I think,

[00:35:02] and I was going up and down the stairs and I was like, oh, can't do that. I'm really sore.

[00:35:06] And so understanding how to really listen into my body of what was okay, what was not, but then

[00:35:12] take me four weeks after or three to four weeks and I was able, I remember putting him down to

[00:35:18] sleep by doing squats and lunges because I wanted to get some movement in my body. And so I was

[00:35:25] holding him and having fun doing squats, lunges, he went to bed and it was great.

[00:35:29] And so, but that's me understanding what that means and how to listen to my body where I've

[00:35:36] heard of other people who have ruptured their cesarean scar because now they've overdone it

[00:35:42] within their body and they haven't had that understanding of what that gradual kind of

[00:35:47] exposure really means. And so it's just, I guess, how does someone go about learning or reaching

[00:35:56] out for the proper resources and understanding? And I like that you kind of gave some things to

[00:36:03] look out for in terms of peeing or soreness or things like that, but where can we kind of turn

[00:36:09] to to understand what we should be doing? Yeah, that's a great question. So obviously

[00:36:15] your medical provider, your birth provider is somebody who's going to be able to help.

[00:36:20] I think as physical therapists, sometimes we can feel like there's a turf war between us

[00:36:25] and obstetrical providers and really we need to be locking shields, not having shields against each

[00:36:31] other, right? We need to be on the same team. Having a pelvic floor physical therapist who's

[00:36:37] in your corner is wonderful, but I also recognize that that is a privilege that some people do not

[00:36:43] have. And so I think it's important for if you have access to pelvic PT, like I'm a big proponent and

[00:36:52] my team is in the pelvic division of the two week checkup. Like I'll get individuals at their last

[00:36:57] pregnancy visit and we'll check in at two weeks because there's a lot of questions, right? Like

[00:37:03] that happens for new moms. Like is this normal? This is what I'm feeling. Is this what I should

[00:37:08] be feeling? Like, is it okay that I have having these sensations and waiting six weeks can feel

[00:37:14] like a lifetime, right? And so having a provider that can be your kind of help and guide can be

[00:37:23] unbelievably beneficial. But if you don't then have other resources that can be helpful. So I run

[00:37:30] a podcast called the Barbell Mamas and my goal with every single episode is what do I wish I knew

[00:37:38] when I was early postpartum or during my pregnancy? Or if I'm seeing somebody in the clinic, their

[00:37:43] homework, the first time I see them sometimes is to just go through a couple of these episodes

[00:37:47] so that they can get these deep dives and true appreciation for like the nuance and the gray

[00:37:54] that can sometimes be hard to digest when you're in a clinic or your baby is screaming or like,

[00:37:59] you know, you're being distracted or all those things that come with the messiness. That's

[00:38:03] the beautiful part of motherhood, but also the really hard part. And so having those resources,

[00:38:10] and I'm sure your podcast, you have a couple of episodes that you've done the same thing where

[00:38:13] you try and create some clarity around here's your sign that maybe you're pushing it a little

[00:38:20] bit too far. And here's the sign where it isn't right. Like the early postpartum healing after

[00:38:27] a cesarean, like that time before that scab has healed, that's a really sensitive time because

[00:38:34] it's a new scar, right? Like, so we're going to be a little bit more cautious. But you said that

[00:38:39] you're already doing squats and lunges at three to four weeks post surgery. That's not the normal,

[00:38:45] right? Well, it's the normal with a lot of people that I'm seeing because I'm saying,

[00:38:48] it's okay. Like you can do those things once you're at this point. But, you know, having

[00:38:55] some of those like that was the reason why my podcast started because I just wanted to help

[00:39:01] with the clarity of messaging because it's just, it's so hard to get. Like, you know,

[00:39:09] like I even influencers try and online and be so helpful by saying here's core safe programs during

[00:39:15] pregnancy. I was like, yeah, but now you've made everybody think that everything outside of this

[00:39:19] list is unsafe and that's not true. Right? Like even like your attempt of being helpful of saying,

[00:39:25] you know, these are safe. What you're insinuating is that the other stuff isn't safe and that's

[00:39:30] not true. Like, you know, and it's, yeah, it's tough. Like, yeah, it's hard to find those

[00:39:38] resources. It's hard to understand what to do. Yeah. Yeah.

[00:39:40] And educating well is difficult because in the world of social media, when you have someone's

[00:39:45] attention for 12 seconds to maybe click in and see this program of safe core exercises, like

[00:39:52] you're playing the time battle with someone where as a physical therapist, you're blessed to

[00:39:56] have a more extended time, hopefully 45 minutes or an hour with somebody to maybe more fully educate

[00:40:03] and get specific to them. And that's where I appreciate you bringing up, you know, like you

[00:40:07] said, the privilege of getting with a pelvic health therapist if possible, or a physical therapist

[00:40:13] and the plea to providers to like quit the turf wars. Like it's just a bunch of BS that

[00:40:19] even if you disagree with someone, there is still some common ground in that you're seeing

[00:40:23] the same patient and you're trying to do them the best you can. And if you can just like connect on

[00:40:30] that factor, like here's what they want to do. I know that we disagree on something, but what can

[00:40:35] we do to help them the best we can? Like, that's really where we as providers should be.

[00:40:40] And I encourage that for my patients as well, right? Like if I come to you as a physical

[00:40:44] therapist, like you're dumb, I think you're wrong. The first thing that happens is that

[00:40:49] people get really defensive and I would get defensive too, right? So when people get that

[00:40:54] recommendation, don't lift more than 20 pounds. My counseling to my patient is like, why don't we just

[00:41:00] need to ask more questions? Like be really curious and say, I have a 200 pound deadlift. Does that

[00:41:05] still apply to me? Like 20 pounds? Is it really heavy? I have a toddler at home. She's 30 pounds.

[00:41:10] Is it dangerous for me to pick this toddler up? Like ask those questions and then you're going to

[00:41:16] see that the answer is more of an ish and it's going to, they're going to talk a little bit more

[00:41:21] about the nuance and it's going to make a lot of one really fruitful conversations with you and your

[00:41:29] provider because you can be on the same page. And then also it allows individuals to also feel safe,

[00:41:36] right? Because individuals who have had miscarriages or those who have had to spend a lot

[00:41:41] of money by having IVF or IUI to get pregnant, like the thought of going against their provider

[00:41:47] because they just, they've wanted to get pregnant for so long. That can create even more heightened

[00:41:54] senses around being fearful. And if they're saying don't lift more than 20 pounds and they're like,

[00:41:58] if something goes wrong, this is something I've wanted. Like I don't want to do anything that my

[00:42:02] doctor doesn't say is okay. Then it gets to be really, it can be really difficult. And so

[00:42:09] having those conversations where you continue to ask questions can just really change the sense

[00:42:15] of safety that the person who is pregnant feels and then give them more freedom to have

[00:42:23] conversations about exercise that they love and exercise they enjoy. Yeah. I think asking questions

[00:42:29] is huge and like one of the best ways to open that door with the provider rather than being

[00:42:33] defensive with them. And I want to go back, you touched on like core safe exercises during

[00:42:39] pregnancy and I love, you know, let's get into some myths and some truths behind especially

[00:42:46] diastasis recti because there's so much around that of like, well, if you do this or you see

[00:42:53] this, that's going to cause diastasis. What do we know is the truth with diastasis recti and what is

[00:42:59] false? Yeah. So you guys are your PTs, but if you have shoulder pain and you're a person who's

[00:43:09] a painter, so you use your shoulders a lot, we would never say, okay, you have shoulder pain.

[00:43:15] I never want you to strengthen your shoulder again because it's under a lot of strain and

[00:43:21] I don't want to make it worse because what we know is that it's going to do the opposite, right? It's

[00:43:26] going to make your shoulder weaker and that is going to make your pain probably get a little bit

[00:43:32] worse because you need strength around your shoulder because you're using your shoulder a lot.

[00:43:37] That doesn't change when we're pregnant, right? Like our core gets under more strain,

[00:43:41] our pelvic floor and our hips go under more strain and our messaging is, well, don't use your core

[00:43:49] because your core is under so much strain. But what happens is we weaken our core wall, which just

[00:43:55] makes a lot of things worse. And so when we are pregnant, our six pack muscle lengthens,

[00:44:02] right? That six pack line lengthens, our six pack muscles move a little bit further apart.

[00:44:07] And it's this beautiful mechanism that our body has created in order to give space for baby to

[00:44:13] grow. It is wonderful and it is necessary. Where we have gone wrong as PTs, and I'm going to take

[00:44:20] ownership because our profession has made this worse, is we have said, don't strengthen your core

[00:44:26] because you're already under so much strain. And what we know about having more separation,

[00:44:33] and I hate the word separation, I always call it lengthening, but people think about it as splitting

[00:44:38] or their abs are separated. That's not true. There's a stretch in that tissue in the six pack

[00:44:43] line. What we know about that is that those who have a persistent stretching in the, what, after

[00:44:50] babies here, they're weaker than those that don't. So their sit-up test is less, their obliques or

[00:44:55] their rotation muscles are weaker than those who do not have those issues. And so over the last

[00:45:02] three or four years, I have been hammering core strengthening with all of my pregnant mamas to be,

[00:45:09] and I have seen a lot better outcomes. So I'll get people doing band assisted or sit-up variations

[00:45:16] right up until they deliver to keep their rectus strong. I will have individuals working on side

[00:45:20] bend and rotation, and I have seen individuals feel a lot stronger early postpartum because

[00:45:28] they've been able to keep their core strong and then their postpartum core strength is better,

[00:45:34] but also the amount of time it's taking for some, this is clinical, but the time that we're seeing

[00:45:42] in the clinic for individuals feeling that support around their bellies has improved.

[00:45:49] And our research now is starting to say the same thing. So what people don't see sometimes with our

[00:45:56] research is that a lot of times we report on the things that are positively associated. So this is

[00:46:02] a risk factor for this, but we don't report on the things that have shown to not be associated.

[00:46:07] And so we have risk factor data now that has shown that ab exercises is not a risk factor

[00:46:15] for diastasis postpartum. And so that's really interesting. And I used to be that provider,

[00:46:21] like Christina of 2020 would say, well, don't cone during pregnancy. And Christina of 2024 is

[00:46:27] like, well, your rectus muscles are kind of far apart because that baby's there.

[00:46:31] You're going to have some coning and I'm not really freaked out about it. Like

[00:46:35] the messaging that you need to turn to the side when you're getting up from a chair,

[00:46:40] I'm like, come on, really? Like we're not going there. Are we like, so there's that messaging

[00:46:46] is very ingrained. And so we're, again, we're seeing a shift there. I'm not ready to say that

[00:46:51] coning doesn't matter, but I'm definitely not nearly as freaked out about it. Like if you cone,

[00:46:56] I'm not, you're, I don't, I'm not worried about it in pregnancy. I'm not worried about it postpartum

[00:47:00] to be honest. I'm more of like, where is your current strength? And you know, are you having

[00:47:04] belly button pain with core strengthening during pregnancy, then we're going to modify around that.

[00:47:08] And you know, your baby makes a bowling ball. So it kind of locks up your, like, you feel like you

[00:47:14] kind of just can't move around as much. So we're going to make modifications for your range of

[00:47:18] motion and how comfortable you feel in different positions. But yeah, I'm, I'm more on the,

[00:47:25] we're going to keep your core strong. Then we're going to let your core get weaker because it

[00:47:29] just, it feels harder postpartum. Yeah. And you mentioned you're not as concerned

[00:47:35] anymore about coning during postpartum. So what's the line there if somebody's noticing

[00:47:40] big separation, they're doing ab exercises and seeing a lot of that coning or poofing

[00:47:45] in the diastasis area? Like, what's the line? You know, are there ab exercises that it's like,

[00:47:50] okay, that's a bit too much. Like we might want to scale down or is it like,

[00:47:55] hey, let's get it strong. So, Margie Davenport is my postdoctoral supervisor. We were having

[00:48:02] this conversation and we don't really know the line. Like there are people really confident

[00:48:07] online about what the line is. But we don't know. Like, it could be there is no line and it's a

[00:48:14] strength problem, right? Like we don't, we have made this into a pathology. So here's an example.

[00:48:22] So we had a study that came out two years ago that took individuals who came into a urologist's

[00:48:27] office and they, so they were coming for pelvic floor issues, but they looked at the gap between

[00:48:34] the two rectus muscles, like how much distance there is. And we always say two finger breadth

[00:48:39] or about an inch is considered to be DRA. But 57% of these individuals had a larger than two

[00:48:47] centimeter gap. And so then I started questioning, I said, well, if 57% of people have two centimeters,

[00:48:54] then isn't that just normal? Like, isn't that just normal variation in a person's anatomy?

[00:48:59] Like, you know, I see it in individuals, like babies have that gap, they cone because they're

[00:49:04] just not strong enough to sit up, right? Like they kind of grunt and they, we see it. My older

[00:49:10] men with central adiposity, they call it their party trick, but we freak out about it in pregnancy

[00:49:15] and postpartum. And then I was like, this is really funny to think that like so much of our

[00:49:20] evidence around diastasis recti is based on a normal value. Like we haven't, we didn't even

[00:49:25] think about what was truly pathological with respect to when individuals have enough of a

[00:49:31] stretch between those two rectus muscles to have impairments in their function,

[00:49:36] like that it's hard for them to get around because of this.

[00:49:41] And so it kind of makes me laugh, but it's also kind of like unsettling to say, well,

[00:49:46] if 57% of people have this amount of a gap, then why are we using that as the threshold

[00:49:52] for what's considered pathological? I don't have the answer. So it's hard because I can't

[00:49:59] really give you guys a good response of like, well, when is it worrisome? But it gives me

[00:50:04] freedom to be like, I'm really not freaking out about it. You know, like I'm going to try and make

[00:50:09] your core as strong as possible. I'm going to try and make sure you're bracing right, that you're,

[00:50:15] you're not pushing out against your belly as you're doing strength. So I think I've gone less

[00:50:20] over the, even the last 18 months around the amount of coning you have to being a coach and

[00:50:28] saying like, does your movement look good? Yeah.

[00:50:31] And if it looks good, let's keep doing it. But if you're starting to do some of these faulty

[00:50:36] movements where you're really pushing out against your belly or you physically can't do it anymore,

[00:50:42] or you're starting to show some ways that you're kind of compensating,

[00:50:47] then I'm going to start changing it. And like you've kind of mentioned the

[00:50:51] association with like, is there a significant amount of pain in the belly button or, you know,

[00:50:56] if you're getting a lot of pain in the pelvic region, if you're leaking a lot during some of

[00:50:59] these, like those are probably the signs that something needs to change. Those are the buoys.

[00:51:05] Yeah. Or a hernia. Like, you know, if we're looking, we're worried about

[00:51:10] like a true perforation, like the actual splitting is you have a hernia, right? Like a diastasis is a

[00:51:17] stretching of that six pack muscle, but the hernia is when you get the perforation.

[00:51:21] Yeah. I mean, gosh, there's so much more that I had written down that we can get into.

[00:51:28] I hate that we're running right up to the end already.

[00:51:30] But I love, you know what? Go listen to Barbell Mamas. There's some... And follow her. There's

[00:51:35] so much more information that you guys can learn from Christina. And I just appreciate, you know,

[00:51:40] my hope in people listening as well is that it helps to reduce the fear, right? There's so much

[00:51:46] fear around what I can and cannot do and what I should and should not do. And we know we talk

[00:51:52] about this all the time when it comes to pain and MRIs and all this other stuff. Well, now we have

[00:51:56] so much more research to back up, you know, during pregnancy and postpartum. So I love that

[00:52:02] we're continuing to move in that direction and hopefully reduce some of those fears and stress

[00:52:06] on women. But tell people where they can find you and continue to learn more.

[00:52:10] Yeah. So if you are looking for like a lot more nerdy research stuff, you can follow me

[00:52:16] personally. So doctor.christina.underscoreprevet sharing a lot more like research focused stuff

[00:52:23] geared a lot towards the clinicians that I teach. If you are looking for exercise modifications and

[00:52:30] things like that, the Barbell Mamas is where I give a lot of that information that is aimed at

[00:52:37] the person doing the exercise. And then if you're looking for some of the research, my postdoctoral

[00:52:43] supervisor in pregnancy research, her name is Dr. Margie Davenport. I've mentioned her a couple of

[00:52:49] times. Her Instagram is exercise and pregnancy. And so any new study that's coming out of our lab

[00:52:57] is coming through there. Can I talk about my two studies really quick?

[00:52:59] Yes. Go for it.

[00:53:01] Yeah. Okay. So we are currently recruiting for two research studies. If you were like,

[00:53:05] yes, I want to lift heavy during my pregnancy or yes, I lifted heavy during my pregnancy.

[00:53:09] We are trying to gain more research evidence around this. So we have two studies that are

[00:53:14] currently recruiting. If you have given birth in the last year and you tracked all your exercise

[00:53:20] during pregnancy. So you kind of wrote down what you were doing for strength training.

[00:53:24] We are asking you to take part. It's one time. It's about 30 minutes where we'll ask you a couple

[00:53:29] of questions about the ways you modified your exercise, where you got some of your information

[00:53:34] from how you're feeling during your labor and delivery. And then we will ask you to upload

[00:53:39] your training logs to try and look at your, how you changed your dosage across your pregnancy.

[00:53:46] And then if you are less than 20 weeks pregnant right now, we have a prospective study where

[00:53:51] we're going to take from you from the very beginnings of your pregnancy all the way to

[00:53:55] 18 months postpartum where every trimester and then three, six, 12 and 18 months postpartum,

[00:54:02] we're going to ask you about your pelvic health, baby's health, how you did during your pregnancy,

[00:54:07] any complications, things that you want us to know. And then we're going to ask for

[00:54:11] your training logs. So we're really trying to get an idea around the way individuals are

[00:54:16] modifying exercise, where they're getting information to modify exercise, why they're

[00:54:20] modifying and then any complications that might be coming up to get good information so that we can

[00:54:28] really start to change some of the exercise guidelines. Because the more research we get,

[00:54:31] the more we can say that you can choose to go low, moderate or high intensity from a resistance

[00:54:38] training or strength training perspective. I'm going to support you in all of that. And you can

[00:54:43] now have a lot more freedom to choose the exercise that you love to do because the exercise you do

[00:54:48] is the one that's important, especially in our motherhood journey.

[00:54:53] That's amazing. And I would just give a plea out there to anybody listening or who hears this and

[00:54:57] thinks you fall into either of those groups, please, please, please consider reaching out.

[00:55:01] We'll put all this information down in our show notes because we need to build that evidence and

[00:55:06] we need to learn more. And as throughout the podcast, you heard that when there's a lack of

[00:55:12] evidence, even the provider sometimes... We don't know exactly where the line is. And we're trying

[00:55:16] to figure out where the line is so we can give the best guide lines and buoys to people going through

[00:55:23] pregnancy and postpartum as possible. So, Christina, thank you for coming in and sharing

[00:55:28] just a little sliver of your wealth of knowledge. Again, Jen said we have so much more we

[00:55:34] would love to talk about across the lifespan. We still have to have you back. I was like,

[00:55:38] you guys are like my third friend. I feel like this is going to go longer.

[00:55:41] I know. We definitely will have to have you back. And just, yeah, changing the conversation,

[00:55:44] giving people the authority and the confidence to ask more questions and get more curious.

[00:55:49] I really appreciate what you're doing and thanks for coming on.

[00:55:52] Yeah, you're so welcome. Thank you for having me. It was so fun.

[00:55:57] Thanks so much for sticking around for our interview with Dr. Christina Previtt.

[00:56:00] If you think you would be a good participant for any of the studies that she mentioned,

[00:56:04] please go down, check out the links in the show notes so that we can continue

[00:56:08] to advance research in this area. Or if you want to go continue to learn from her or her colleagues,

[00:56:13] check out the links down in the show notes to find more of her information.

[00:56:16] And remember, we are having our Barefoot Summer Challenge that just started today.

[00:56:20] We're having a huge group of people go through our Barefoot mini course to assess and address

[00:56:26] all of the restrictions that they may have in their ankle, foot, and toes. Remember,

[00:56:30] if you use code optimal 20, optimal 20 will get you what was our early bird discount. It'll get

[00:56:36] you an extra $20 off. So go down to the link in the show notes. That's just

[00:56:40] Jen.health backslash barefoot and make sure you use code optimal 20 at checkout. And of course,

[00:56:46] we'll see you next time on the optimal body podcast.