476 | Pelvic Floor Health in Exercise and Performance: Going Beyond Pregnancy and Postpartum with Dr Rachel Selman

[00:00:05] [SPEAKER_01] Welcome to the Optimal Body Podcast. I'm Dr. Jen and I'm Dr. Dom and we are doctors of physical therapy bringing you the body tips and physical therapy pearls of wisdom to help you begin to understand your body, relieve your pains and restrictions and answer your questions. Along with expert guests, our goal of the Optimal Body Podcast is really to help you discover what optimal means within your own body. Let's dive in.

[00:00:29] [SPEAKER_02] Before we get into it, I have such an exciting free webinar coming up. This is going to be such a cool one. It's called The Mobility Myths That Need to Die. And this is why stretching, foam rolling and your massage gun haven't quite fixed it and what actually does. There's a lot of stuff out there on social media and I want to help clear it up plus get you back into your body understanding what actually needs to happen when it comes to making true mobility gains. What does it mean? Where does stretching even fit into that path?

[00:00:58] [SPEAKER_02] How do we use the picture? And how do we use it under load? There's so much in this webinar that we're not only going to talk about, but move through. So if you want to get into this, I highly recommend we're going to have a link in the show notes. Go and sign up now.

[00:01:12] [SPEAKER_02] We are excited to welcome Dr. Rachel Selman to our podcast, a fellow doctor of physical therapy with a ton of certifications behind her name as well. Now she has hands-on training that was completed with Georgia Tech basketball and the sports medicine department at the Children's Healthcare of Atlanta. And post-graduation, she obtained her certification as a strength and conditioning specialist, as well as performance and sports scientist through the National Strength and Conditioning Association.

[00:01:39] [SPEAKER_02] Each of what allows her to develop deeper into the athleticism behind rehabilitation. She's also certified in dry needling and specializes in orthopedic sports medicine, as well as pelvic health, which is majority of what our conversation today is going to be about. Now her research has been published in the International Journal of Sports Physical Therapy regarding elbow pain in college baseball pitchers, as well as creating the first exercise protocol for pre and postnatal athletes.

[00:02:07] [SPEAKER_02] She's the founder of stirrups to sit-ups, a program designed to guide athletes of all levels through their postnatal recoveries. And she's adamant about a lot of things. One of them, that motherhood and athleticism are not mutually exclusive. And the other is that physical therapy should go beyond just baseline restoration of function. We're so excited about this conversation. One of the main things we are talking about is her new book called Floor.

[00:02:36] [SPEAKER_02] We're going to talk all about it, but you can go look up Floor It it right now and get your hands on a pre-ordered copy. Rachel, I'm so honored to have you here. A recent find for me on social media in the last year, but you put out incredible content. And with your new book coming out, I'm really excited because I feel like everyone can be an expert in pelvic health these days.

[00:03:01] [SPEAKER_02] And so understanding the nuance of what that really means and how that relates to what we're actually trying to do, which is move, exercise, feel good in our bodies. So I'm really excited for this conversation. So thanks for being here. Thank you for having me.

[00:03:17] [SPEAKER_03] So your book, Floor It, which is available now for pre-order. Congrats, by the way, on writing it. But what possessed you to write a book other than being so passionate about pelvic floor and getting out information to people that would be very helpful? Why write a book about it?

[00:03:36] [SPEAKER_00] Yeah, I think the ultimate kind of goal that I keep coming back to is like, what would I have wanted to read? Honestly, before I had kids, I mean, I played sports in college and I think about like this entire part of my body that I just knew nothing about. And then when I got pregnant and was postpartum, obviously it became something that was much more at the forefront. But even then there was so little information available.

[00:04:00] [SPEAKER_00] So I had my first in 2017. The first, you know, even just article that I remember reading about running and pelvic health came out in 2019. So being pregnant and delivering a child in 2016 to 2017, there was like nothing to pull from. So I was lifting, I was running, I was doing all these things and had really conflicting information in all directions. So different information from my OB versus person traders that I worked with versus the physical therapist that I work with.

[00:04:26] [SPEAKER_00] And so it just brought to light like how little we were talking about this part of our bodies. And I remember having the thought of like, okay, if I went to physical therapy school, I have my doctorate and essentially this human body. And I don't understand how this part of my body works or how to connect to it or how to train it. How the heck is anyone else supposed to know what to do? Like this is my job. This should be my job. And to not understand it myself was incredibly frustrating.

[00:04:55] [SPEAKER_00] So my kind of journey in pelvic health really started there. But I think what happened with time is now I work with a lot of women who are, they hesitate to say postpartum because they had their kids, you know, maybe even a decade ago, two decades ago. But they're still having symptoms that started with pregnancy and postpartum. And so my practice became more and more of that.

[00:05:17] [SPEAKER_00] And I remember just thinking like, I wish there was just a resource that just taught you about your body, like taught you about this part of your body, not just for someone who's in the general public, but even for, you know, people in PT school or orthopedic PTs who want to understand how this played the role and want to be able to integrate it into their practice better. Something that just gives you access to credible information about how your body works.

[00:05:43] [SPEAKER_00] And so when we were trying to decide, you know, I wrote a lot of the content and reached out to publishers, cold called them essentially. And, you know, she read through it. She was like, this is really great. I'd really like to move forward with this. Do we write it towards coaches or do we write it towards the general public? We kept landing on the general public. Like they deserve access to this information so that they can learn how to advocate for themselves.

[00:06:07] [SPEAKER_00] If you don't know what it is, you don't know how it works, you don't know what symptoms it can and can't cause, then you don't know how to go into a doctor's office and say, hey, this is what I'm experiencing. Or maybe you don't know that it has anything to do with your muscle at all. And so we kept just coming back to this goal of advocacy. We want the general public, you know, athletes, clients to be able to read something that helps them better connect with who they are and how their body works. And so that's really what the book was written for and tailored to.

[00:06:36] [SPEAKER_02] Which is incredible because more knowledge means more understanding of exactly what you're saying, what you can ask, what you need, and being able to get to an ultimate plan and goal of what people really want in their life. There has been a breakthrough in prenatals and we need to talk about it. So Nita just came out with a prenatal multi-gummy. And you guys, this is going to change the game completely because I can remember my first trimester, give me all the carbs, give me all the bagels. I don't want anything nutritious. I cannot hold it down.

[00:07:05] [SPEAKER_02] And there are so many women, friends I know that had such a hard time taking all the capsules that are needed to get the nutrition that you're trying to get because you don't want to eat anything that's actually good for you. And this is why 95% of women stay nutritionally depleted even while taking a standard prenatal because most are dosed at the bare minimum. Not needed. Now listen, I know that gummies are usually the biggest offenders, right? It's so hard to get the proper nutrition into it.

[00:07:34] [SPEAKER_02] And that's why Nita spent four years working with formulators to really break through that ceiling. And it's finally here. The best part is you only have to take three gummies a day with or without food. You're nauseous and you can't handle taking the capsules or the powder. Now it has eight times more nutrition than leading prenatal gummy and four times more than the average leading prenatal capsules included. It has your 17 key nutrients that are in bioavailable form.

[00:08:04] [SPEAKER_02] It has a clean label, no synthetic dyes, no artificial sweeteners, no sugar, alcohols, no gelatin, nothing that if you're worried about anything, trust me, needed has thought about it. They really think about women. And it's something I use when trying to conceive during my pregnancy journey postpartum. And I'm still taking their women's multi-omega threes and creatine myself. Listen, you don't want to have to skip your prenatal. So if you've been hesitant, I would highly recommend sharing this, taking this, tell all your friends about it.

[00:08:33] [SPEAKER_02] The new needed prenatal gummy is going to change the game. If you haven't checked out needed and all that is available, head to thisisneeded.com and use code optimal for 20% off of your first order. That's T-H-I-S-I-S-N-E-E-D-E-D.com and use code optimal for 20% off your first order. All right, let's get back into it.

[00:08:55] [SPEAKER_02] Now, if someone's feeling like, but I'm not experiencing pelvic floor symptoms, would this be something that they should still consider reading and why?

[00:09:07] [SPEAKER_00] I'm going to be obviously biased here, right? But I'm going to say also 100% yes. I think, you know, step one of that question is really understanding that there are so many symptoms related to the pelvic floor that you may not even realize have anything to do with the pelvic floor. So things like hip pain, back pain, repeated groin strains, sports hernias, hemorrhoids, like pressure management situations can be pelvic floor muscle related. And you may have never realized that those two could even be related in any way.

[00:09:35] [SPEAKER_00] So I think that's step one is understanding that you may be having symptoms that you're not actually even aware of in relation to the pelvic floor. But I think that, you know, step two of that question is that when we look at the pelvic floor, we are just getting started in terms of linking the pelvic floor and training the pelvic floor to actual performance. So let's say I have zero symptoms at all, but I want to pitch faster. I want to hit the golf ball further. I want to jump higher.

[00:10:03] [SPEAKER_00] There's a really study, interesting study that came out in March of this year, where when athletes trained with biofeedback on the pelvic floor, their jump height increased. And so can we use this really cool group of muscles that affects force and pressure distribution and use it in a way that actually makes us just perform better, even if we have no symptoms at all?

[00:10:26] [SPEAKER_00] So I think even if you're, you know, listening or thinking about reading and you're kind of like, I don't I don't really think I have any issues. The big one's always leaking, right? Well, I don't leak. I don't need that. Even if that's you. And even if that's where you fall, if your goal is to run faster, jump higher, move better, improve your longevity and exercise and sport, it's something that I think you need to understand and be able to implement into your training before it becomes a problem.

[00:10:51] [SPEAKER_03] So I resonate with this a lot because I'm not the one who was pregnant twice. I'm not the one who birthed two children or had a major abdominal surgery, but I was a college athlete and also went through DPT school. And as somebody who was considered a high level, I wouldn't say elite level athlete, but like a high level athlete, I looking back at my history was having major pelvic and lower abdominal symptoms from the time I was 17 years old.

[00:11:20] [SPEAKER_03] I had mesh placed for bilateral inguinal hernias. And so the mesh fixed it, but I continued to have lower abdominal and pelvic pain into my early 20s and into when I was playing college football. And then, yeah, I get through PT school and I'm in the clinic having pelvic floor related symptoms that are scary because I am somebody I'm like, I should know how to deal with this. And I don't. And so, yeah, really scary stuff when you feel like you should be.

[00:11:51] [SPEAKER_03] You should have expertise in this area, but you don't even really know how to deal with it. And once I met Ben. Well, it's so common.

[00:11:59] [SPEAKER_00] It's so common. And especially when we talk about men, like, you know, men and male athletes just tend to think that this doesn't apply to them. And I actually taught a lecture last night for a group. I think they're in Indiana. And they one of the questions at the end was like, how as incoming providers do we bring this up to males? And my response to that was like, do you ever hesitate to bring up the Achilles to someone who's female? Do you ever hesitate to bring up the adapters to someone who's male? You don't.

[00:12:29] [SPEAKER_00] We talk about the pelvis. We talk about the glutes. We talk about the adapters. You have this group of muscles at the bottom of your pelvis. And just because it's called the pelvic floor, we're scared of like bringing it up and treating it. So trying to reframe it as like, listen, it's a group of muscles that helps you manage pressure. And everything you do athletically is a pressure management problem. How does my body respond to that? If I can generate huge amounts of intra-abdominal pressure, tons of pressure on my core. I think about like a Coke can. I take it.

[00:12:58] [SPEAKER_00] I shake it up. How much pressure can that can tolerate? The more pressure I can tolerate, the more power and force I can put into my sport, which is the entire premise of performing at a very high level. So in your case, where you're talking about like the inguinal hernias, you know, the front of that Coke can, the front lower portion was having too much pressure on it. And so there's too much pressure there. And eventually that thins out and we see, we shake that Coke can. We start to see those hernias push forward a little bit, right?

[00:13:27] [SPEAKER_00] If I had more equal pressure distribution across all areas, I may have not seen that an adequate area in the front there that had thinned out and then seeing the associated symptoms with it. So would that have kept you in your sport longer? Would that have made you more able to tolerate things like repeated hits or big throws or falling, you know, from a high position and hitting the ground in which we increase pressure? And so it's incredibly common.

[00:13:52] [SPEAKER_00] And I think, you know, part of this discussion is taking away some of the taboo of it's pelvic floor. You know, I see it in women, too. They think it's only going to affect them if they're pre or postnatal. Absolutely not. We know from the research, which we need more of, but we have enough to say this confidently. Athletes are more likely to have pelvic floor dysfunction than their non-athlete peers, period. Even if we're not talking about pregnancy postpartum, we're just talking about day-to-day stuff.

[00:14:18] [SPEAKER_00] Before you even have babies, before you even think about having babies, you are more likely to have pelvic floor dysfunction because you play a sport. The same way you are likely to tear your ACL because you play a sport. You're exposing your muscles and your tissues to big high demands. You're doing more than someone who is working at a desk job and maybe more sedentary. So we can expect your muscles have a higher demand and we should be training those associated with that demand.

[00:14:42] [SPEAKER_02] Well, I think what we're seeing as well as this becomes more popular in social media is that, oh, well, if a woman leaks when she's lifting really heavy, that's normal. Or recently with the high rocks competition, if we have fecal incontinence, that's something that might happen in a high training situation. And so at what point are we trying to normalize and not shame and make this okay?

[00:15:06] [SPEAKER_02] And at what point are we saying, okay, this is something that we actually need to be addressing and understanding how training can work within this? Yeah.

[00:15:14] [SPEAKER_00] And I think part of it's understanding that a lot of pelvic floor symptoms are not what we would call time loss injuries. So, for example, like leaking, you can participate in sport and have leaking, right? And just compensate for it in other ways. Maybe you wear a hat or maybe you don't do that particular lift because you're more prone to leaking there. So you work around it in a lot of ways. And athletes do this too in sport.

[00:15:37] [SPEAKER_00] Again, even before we talk about pregnancy and postpartum, you'll have athletes who say, well, I drank less water this morning because I knew I had a competition and I didn't want to leak in competition. So I drank less water. Well, guess what affects competition performance? Hydration, right? So now you drank less water. So you wouldn't end up leaking. And now our performance is affected because of that. So they don't take you out of sport per se. But I think what we will see eventually in the research is that these non-time loss injuries, so things like hip pain, hip soreness, low back pain, low back soreness,

[00:16:08] [SPEAKER_00] pelvic heaviness or pressure, or again, something like leaking. Those are kind of early like, hey, let's fix this before it becomes a real problem. So no, right now it's not a time loss situation. But if we could go ahead and fix it and talk about it now, then we could stop it from becoming a sports hernia that now requires surgery, right? So there's early flags of like, I need to know what these symptoms are. And so does my coach.

[00:16:33] [SPEAKER_00] So that when I go tell my coach, hey, I'm experiencing leaking, you know, and they're not embarrassed to bring that up because it's not such a taboo subject anymore. When I bring that up, what does my coach do? Does my coach actually know anything about it? Do they laugh it off? Do they say like, ignore it, move on? Or do they realize, hey, let's go ahead and fix that now before it becomes a recurrent hamstring strain that you cannot compete through anymore?

[00:16:55] [SPEAKER_03] So you already touched on the early warning signs. And that was something I was going to ask about. And we didn't even really address like, what does the pelvic floor do when we are lifting heavy, when we are running, when we are doing explosive type work? Like, what is the pelvic floor's job? And when we might start feeling some of these early warning signs, what's happening?

[00:17:17] [SPEAKER_03] What is it not doing well that is resulting in some of these warning signs like heaviness or hip pain or et cetera?

[00:17:25] [SPEAKER_00] The pelvic floor, the easiest way to think about it in these types of explanations is one, the coke can, like we talked about earlier, or two, a trampoline. So if we look at a trampoline at rest, it has some tension to it, right? The pelvic floor is never meant to be just off. It helps us maintain posture. It helps us maintain continence. So at all levels of the day, at, quote, rest, it is still on to some extent. Now, it is not on to the point that the springs are rigid and it's not on to the point that the springs are sinking down.

[00:17:53] [SPEAKER_00] So at rest, I want the pelvic floor to sit at the bottom of my pelvis and maintain a little bit of tension. When I put force on top of that trampoline, I want that trampoline to lower. I want the springs to lower and accept that force. And then I want them to have the capacity and the strength and resiliency to go in the other direction and either get me back to neutral if that's what I need or continue to spring upward if I need more recoil for the task at hand.

[00:18:20] [SPEAKER_00] So you can think about it like a trampoline in terms of function. It needs to be able to lower but not give out. It needs to be able to recoil to the point of whatever amount of spring I'm looking for. And it also needs to be able to maintain a resting tension throughout my day. What I see in a lot of athletes is they are able to either maximally contract, so maxillociegel, okay, or they have no idea how to actually just move it.

[00:18:45] [SPEAKER_00] So if we compare that to a knee, because it's easier to visualize, maybe I can flex, but I can't extend. So I can bend, but I can't straighten. Or maybe I only have partial range. So now that trampoline only moves a little bit down and a little bit up, okay? And you can see how if I put a bunch of force on that trampoline, that would be pretty problematic. It's not a very effective trampoline. So if we go to the coat can example, now we talk about shaking that coat can.

[00:19:11] [SPEAKER_00] If I shake a coat can hard enough, I expect to see some deformation in the visuals of the coat can, right? The front should expand, the back should expand, the bottom should lower, and top should rise. So if I shake it hard enough where it sits in my hot car, the increase in pressure causes the walls to expand in all directions. Now, what I want is equal expansion in all directions, and I want the ability to lower and accommodate that increasing pressure.

[00:19:37] [SPEAKER_00] The challenge with a lot of athletes that I work with is they have the ability to lift, which would be a kegel. They do not have the ability to lower. And so when their foot hits the ground or when they get tackled and there's a big, fast increase in core pressure, the pelvic floor can't lower the way it's expected to. So if it tries to lower, it either lowers slightly and then gives out, and then we see symptoms. Or it is so rigid that it can accommodate the pressure above it and the pressure has to go elsewhere.

[00:20:04] [SPEAKER_00] So then like a disc herniation or a sports hernia or things like that. So in thinking about how this all looks functionally, it would be like jumping on a trampoline where the springs are incredibly rigid and tight. That's not going to be a super fun experience. Now I've got, you know, all this really jarring joint pain in my ankle or my knee or my hip or my back because I'm jumping on a surface that's not very accommodating. So if we walk around just day to day, the bottom of the pelvis, the, you know, let's just say estimated.

[00:20:33] [SPEAKER_00] Estimated force is it's lifting up against about six pounds of pressure. So downward pressure from gravity, organs, etc. If I cough, laugh, sneeze, that pressure now increases to 60 pounds. So my pelvic floor needs to be able to resist 60 pounds of downward force. When I land from a jump, we're looking more at like 100 to 120 pounds of downward force. If I can't accommodate that 120 pounds of force, then I'm going to tend to see symptoms associated with that.

[00:21:03] [SPEAKER_00] So we're asking our pelvic floor to do very high demand things. So, for example, with volleyball players, pelvic floor dysfunction is incredibly common because they're landing repeatedly on a very hard jarring surface. And so they are repeatedly asking their pelvic floor to accommodate 120-ish pounds of downward pressure on a surface that has no forgiveness. Right. Those cords are not going to give you anything. You have to create that in yourself.

[00:21:30] [SPEAKER_00] And so 120 pounds of downward pressure over and over and over on a very jarring surface. When you've got springs that don't lengthen and move, you can imagine how that would create a lot of symptoms in sport.

[00:21:43] [SPEAKER_02] When we talk about jumping, because I think this is something that is common amongst a lot of postpartum moms that I know as well, where it's like, well, I've gotten to the point where I can jump. I can move. I can do a lot of my athletic performance, but I get on a trampoline for the first time and forget about it. So why does the jumping change in the pressure for a or the capacity on the floor versus something bouncier like a trampoline?

[00:22:07] [SPEAKER_00] So you can think about that with the trampoline, kind of like we would use a Bosu or a foam pad in the clinic, right? I'm changing the stability in terms of that surface. And so what moms may notice is maybe I can jump on, you know, a fairly rigid surface and figure it out. Maybe I can do that from an eight inch drop, but can I do it from a 10 inch or a 12 inch? Can I do it on one leg versus do I need both legs? So more than likely what's happening there is that stable surface they're landing on.

[00:22:34] [SPEAKER_00] They're able to recruit maybe more of the surrounding musculature. So maybe the adductors or the outer hips, they're providing more support. So if I have someone come into the clinic and they are having the game with jumping, strategies we may try would be to like squeeze a Pilates ball between the knees while we jump. Does recruiting the adductors seem to help, right? It's why kids when they really got to go to the bathroom, they cross their legs and they squeeze. It helps to support the pelvic floor. And so they may be losing some of that support on an unstable surface like a trampoline.

[00:23:04] [SPEAKER_00] That's not as kind of rigid there. They may not be able to recruit as well in that particular position. But we can change so many things about the jump that allows us to get to that point. So can I increase the height at which I am jumping from? So if I'm jumping down, can I increase that box height? Can I increase the amount at which my adductors and my glutes are able to contribute here? Can I train those things on unstable surfaces in the clinic? Can I train rate of force development?

[00:23:32] [SPEAKER_00] So maybe I can use my pelvic floor for squats and deadmits that are really slow, but I'm not able to recruit it for something that requires a really fast contraction. So all of those things are things that we're checking out in the clinic to see where the limitation is. Why can I tolerate this task, but not this one? And then how do we create a program that bridges? Yeah.

[00:23:52] [SPEAKER_03] So I'm sure this is something that could be difficult to just like talk through on a podcast. But you mentioned that some of the main issues you see are people who are really good at contracting fully or people who don't, you know, just have an understanding or don't have that full range. How does somebody go about one understanding where they're at themselves and then developing that tension through the length,

[00:24:18] [SPEAKER_03] the, you know, being able to contract and have strength through the full range of their pelvic floor? Because before we even get into training, I feel like that's probably where someone starts.

[00:24:30] [SPEAKER_00] Yeah, totally. So I use kind of like a four-step framework. This is what we kind of talked about in the book is it starts with coordination. If you don't have the coordination, it's very hard to take that into any type of training. So the first part of that four-step framework is coordination. Can I Kegel and can I reverse Kegel? A lot of people know Kegel or at least know about it. A lot of people don't know reverse Kegel and don't understand what that means. There is a self-evaluation in the book, but we can talk through it here just for people who are listening

[00:24:59] [SPEAKER_00] because it's easy to do at home to kind of just see, do I have any connection to this or not? So if you are listening, then what I would have you do is take your hand, put it out in front of you, your fingers are facing away, and I'll actually have you sit on your hand. So turn that hand back towards you so fingers are facing back towards your backside and sitting so that the sitz bones are on either side of your head. Okay, so the pelvic floor sits like a bowl at the bottom of the pelvis. And so I need to get my hand on those muscles. We don't have to be internal here.

[00:25:26] [SPEAKER_00] I just want to sit on my hand in a way that I can feel the muscles between my sitz bones. So if I'm sitting on my hand, when I do a Kegel, I should feel an internal listing of my muscles off of my hand. Now, I'm not squeezing my butt cheeks. I'm not squeezing my inner thighs. I'm not holding my breath. I am just lifting the muscles off of my hand and I should feel a nice little list there. All right. We, when I'm teaching this virtually for like telehealth purposes,

[00:25:55] [SPEAKER_00] I talk about like a, like your tight butthole. So like when your kids are like right on the edge of the pool and you're like this, like, oh my God, like they're going to fall in. You're waiting for that to happen. That feeling is a pelvic floor contraction. So we use all kinds of cues for that. Like a jellyfish floating up towards your head, like drinking a milkshake through a straw. For guys, we use nuts to guts a lot. So can you do that little lift off of your hand? If so, good sign. That's Kegel.

[00:26:23] [SPEAKER_00] For the reverse Kegel, you're thinking the opposite. So now I'm still sitting on my hand and it's kind of cradled between the sitz bones there. When I take a deep breath in, my diaphragm actually lowers. And with that should come some pelvic floor lowering and lengthening as well. This is where athletes have a really tough time. So a visual I'll use for them a lot is a pepperfish. When a pepperfish fills with air, it expands in all directions. But the bottom of the pepperfish also drops.

[00:26:51] [SPEAKER_00] So if I'm sitting on my hand and I take a deep breath in, my ribs expand, I should also feel like my pelvic floor moves away from my head and into my hand a little bit. So I should feel some downward lengthening into my hand. I do not like the word push, especially with athletes, because they do this technique, which we call arm gripping, which is just squeeze the abs as hard as I can and force my pelvic floor to move downward. Okay.

[00:27:20] [SPEAKER_00] Visually there, you can think of like a tube of toothpaste. And I want to be able to unscrew the top. And I still in control. But if I can't do that, I could force the top off by squeezing the tube of toothpaste as hard as I possibly can. Yeah. That's what a lot of athletes do when they're trying to access length. So if I'm sitting on my hand and asking you to lengthen, a lot of times the word push just makes you squeeze as hard as you possibly can. So I'm looking for length. I'm looking for the ability to open sometimes as a good cue that works really well.

[00:27:50] [SPEAKER_00] And honestly, the best phrase that most people connect to the easiest is to breathe into your bubble. So when you take a deep breath in and you are guiding air towards your backside, that helps to expand and lengthen, which with training will help your body accept more force. And with more force absorption, we get more recoil, which means you get more power as well. So deep breath in through the nose. We should feel a gentle push down into the hand or opening, breathe into the ball, whatever cue works.

[00:28:20] [SPEAKER_00] And then with the exhale, as the air empties, the sides of the pepperfish would constrict. So your rib cage would come in and you would get that little lifting of the poly floor with the exhale as well. And once we get the hang of that, we can move really fluidly between those positions. We know what they feel like. We know we're not stuck here or at the bottom. We can go all the way down and all the way up with control. Then we can start to put that into practice with training.

[00:28:45] [SPEAKER_02] And this is like the number one thing also on social media is that we see some videos that go viral that are like, OK, lift, hold and then go down and then, you know, blow out and go to the bottom. And I get the intention, right? Trying to increase the awareness of the pelvic floor and all of that for people. But that also then puts into play, OK, I should be doing this at certain times throughout the day. How often and, you know, a lot of athletes, especially they want the prescription. Well, how often am I doing Kegels? How often am I doing a reverse Kegel?

[00:29:15] [SPEAKER_02] Like when when is this put into practice? Am I doing this every time I squat, every time I move, every time I lift? And there's also certain breath patterns that have also been ingrained since pelvic health has been more talked about. Always exhale on exertion. So what are some of the rules that people can be thinking about now when it comes to maintaining a healthy pelvic floor?

[00:29:36] [SPEAKER_00] My ultimate hope, especially if I'm working, you know, with a client is that once you discharge from here, you don't ever think about your pelvic floor again. That's the goal. I don't want you having to do isolated pelvic floor contractions, you know, multiple times a day. If your pelvic floor is working and it's working well, it should be a very subconscious muscle that works when you work. So you being active, you going to the gym, you doing your squats, your lunges, your lateral lunges, your planks, your pushups, your pelvic floor is involved in those things because

[00:30:04] [SPEAKER_00] all of those increase demand at the core. So if I have a great functioning pelvic floor, it's getting worked on when I do my normal workouts. So these videos, like you said, yes, they do a great job bringing awareness to the pelvic floor. But for example, with an athlete who has an overactive clenched pelvic floor that's really rigid is, you know, doing this squeeze, hey, exhale, squeeze, squeeze, squeeze. Is that going to help them? Probably not. It's probably going to make their symptoms worse.

[00:30:31] [SPEAKER_00] The other thing that I see is that a lot of these videos, when they talk about lowering, they don't actually go below kind of neutral. So again, now I've got a trampoline that can go to neutral, but can't go below it. We never talk about the other direction. They just kind of talk about letting go, which gets you back to neutral, but your body needs more than neutral just to tolerate things like jumping, running and landing. And so a lot of times I kind of miss the nuance of the position that athletes actually need

[00:30:58] [SPEAKER_00] to access to be able to accept and generate force. So my hope is always that like once we learn about it, once we teach it, once we train it, that if you just go about your day-to-day life, it's fully integrated and you don't ever have to think about it again. I will say if we're talking with teams and we're trying to talk about the pelvic floor in general, I will ask for strength and conditioning programs. Can we do one workout in months where the workout is just focused on the pelvic floor? That doesn't mean I'm changing the workout.

[00:31:28] [SPEAKER_00] I might have them do the exact same things, a deadlift, squat, lunge, Copenhagen, all of those things. Maybe we still do those, but it's a day where we kind of lighten the load and we focus on control. What am I feeling? Can I connect to my pelvic floor here? And my general thoughts are that if we could do that just once a month, that would be such a win because it would help us pick up on things before they become problematic. If you have an athlete saying like, hey, this exercise is Copenhagen. It's really killing me. It's spurting in the front of my pelvis and I can't figure out what's going on.

[00:31:58] [SPEAKER_00] And you're telling me to connect and it can't. Then that gives us a kind of moment of like, cool, let's go ahead and fix that before it's an issue versus now I, you know, my side joint is totally out of whack on the triple jump. Okay. Well, we never, we never trained that and isolated in a way. So I think generally the rest of the month we do our normal workouts and even your pelvic floor workout is a normal workout. Just with a little more focus and intention on the pelvic floor. And just like once a month, if everything's going great, don't create a problem that doesn't exist.

[00:32:28] [SPEAKER_03] I think, I think there's a lot of similarities between training the pelvic floor and training breath work. And I think that they work together super well. I mean, it's those autonomic processes that our body does anyway. We have a lot of autonomic or automatic tone in our pelvic floor and we automatically breathe, but we can also voluntarily train them. And the more that we voluntarily do them, our autonomic nervous system is really smart and it will connect better to that and do it automatically.

[00:32:56] [SPEAKER_03] But then once you develop that consciousness, I love what you just talked about. If you notice something, then let's add more attention to it once a month, once a week, whatever. Once somebody has started getting into training or say somebody is returning to their activities postpartum and they're like, it's been great. I started with really short runs. Now I'm getting up to 15, 20 minute runs and it starts out great. But then I get to 15 or 20 minutes and that's when I start noticing leaking or start noticing

[00:33:26] [SPEAKER_03] symptoms. What's happening there?

[00:33:28] [SPEAKER_00] That's an interesting question. And it's one that's really being like dug into in the research right now, actually. So there's some newer research that came out, I think as of the past year, that talks about like what is happening when we start to see breakdown over a longer time period. So really interesting concept there in engineering world called creep, where these passive structures, maybe not your muscles, but things like your fascia, the perennial body, the ligaments start to deform over time.

[00:33:55] [SPEAKER_00] So again, I have all the visuals because we do this virtually all the time. So when I'm explaining this to a client, I tell them to think about grocery bags. You take your grocery bags, you go get your groceries and your apartment's only one block away. No big deal, right? The bag is holed up, you get to your apartment, no problem. Now let's talk about if we have those same groceries, but your apartment is 10 blocks away. The grocery bag handles start to kind of stretch. And it's not that the groceries got heavier.

[00:34:21] [SPEAKER_00] It's that the actual structural changes that are happening in those grocery bags are adding up over time. So creep is the concept that we have this deformation over time versus, hey, I have this problem as soon as I start my run. So when we start to look at more endurance athletes or adding time, especially in the early phases of healing, there is a component of passive tissue that I think we have not really addressed in public health world. We do a great job talking about the muscles now, especially with pre-postnatal.

[00:34:49] [SPEAKER_00] Get your pelvic floor strong, get your pelvic floor coordinated, all that kind of stuff. But things like fascia, things like ligaments, those connective tissues respond a little differently. I think step one is they have a different healing timeline. Muscles can snap back pretty quick. So you can have a baby and in a couple of weeks be like, well, I can giggle, so I must be ready to go. Connective tissue is different. We see this in the same response with tendons, right?

[00:35:14] [SPEAKER_00] So if we look at a tendon under a microscope and it has some deformation to it, let's say that we have Achilles tendinopathy. I look under the microscope and the fibers of that tendon are all kind of crossed over each other. They're all like wavy, they're crossed over each other, and they can't transmit force very well that way. They're meant to be more kind of parallel and in line. And so we have all this tissue in our pelvis that is passive, that does not contract and relax.

[00:35:42] [SPEAKER_00] How can we change the resiliency and composition of those fibers? Part of that's recovery. So especially in my postpartum clients, it's a discussion of like, I get that your muscles are doing what you think you want them to do. But these tacit tissues heal a little bit more slowly, and they require a slightly different input. So this is where we clinically, I've been using more overcoming isometrics in the same way that we've started using those really heavily for tendons.

[00:36:08] [SPEAKER_00] But if you think about the pelvic floor location, overcoming isometrics for the pelvic floor would just be positions that increase pressure for longer periods of time. So let's say that I have an Achilles again tendon issue. I might have you do a calf raise and just hold that position to help those little fibers in your tendon kind of straighten out. I'm not necessarily changing the quote strength of the tendon, right? It's not muscles. I'm not changing the quote strength of it, but I'm changing the fibers and how they transmit force.

[00:36:38] [SPEAKER_00] But if I look at the pelvic floor, there's no true like quote tendons to it. But all that fashion and all those collagen fibers in there, if I can expose them to pressure for a sustained period of time without exceeding the stimulus, right? Exceeding what I'm capable of in this moment, then do I see passive tissue changes? And that's a question that we still don't know. We still don't know the answer to that. I will say clinically, it works incredibly well.

[00:37:06] [SPEAKER_00] I work with a lot of people who come to me after seeing a different pelvic floor PT or seeing orthopedic PT and they're still having symptoms. And this is kind of their last ditch effort. We throw that stuff in there because it's not quote traditional pelvic floor training, but we throw those types of overcoming isometrics in there, which I actually pulled more from strength and conditioning coaching world. Put that into practice. Expose your pelvic floor to high intra-abdominal pressure for an extended period of time. That's not necessarily changing your muscle, right?

[00:37:34] [SPEAKER_00] But it could change all of that collagen and all the fascial alignment in there in a way that helps you to make it a little further down the block before you feel that stretch associated with that demand. So the good news is our bodies are more resilient, more capable than the grocery bags. If we get that stretch and we create that demand and then we rest and recover, what we notice is the less passive deformations and less passive stretch. So now my grocery bags can make it four blocks where they can only make it two. And then I rest and recover.

[00:38:03] [SPEAKER_00] I do the right training. And now I can make it six blocks instead of two and then eight. And then I can get through my full run without symptoms. So it's an interesting question that I think will be at least partially answered in the next like decade or so. But I will tell you clinically, that's how we're training it right now.

[00:38:21] [SPEAKER_02] It's been really cool to see, you know, your work and your theories around you using the overcoming isometrics and how you're programming it into with your clients. I think it's been really cool to just be able to be a clinician watching and seeing how you're using it. For someone listening, how can, what is an example that you can provide of what that means?

[00:38:47] [SPEAKER_02] Because again, someone has no idea what even isometric means. What does overcoming isometrics look like? How can they start to even identify what that means in their body? And along with that, I think comes that breath conversation of what does it mean to breath, to brace or breathe or utilize this intra-abdominal pressure better under load?

[00:39:10] [SPEAKER_00] Yeah. So first thing would be isometrics in general. And isometric is just holding a position for an extended period of time. So the muscle is not lengthening and the muscle not shortening. You have two different types of isometrics. There's yielding isometrics and overcoming isometrics. But yielding isometrics mean that I am fighting against, you know, a force that's trying to move me. So something like gravity, you could think like a wall sit. So I am sitting in a wall sit and I'm fighting the temptation to keep lowering, right? Or I'm holding a lunge and fighting gravity there. That would be a yielding isometric.

[00:39:40] [SPEAKER_00] That can be very challenging for your muscles, for your tendons in those positions. An overcoming isometric, which is what we're kind of using again clinically for this, means that I am pushing into an immovable object. No matter how hard I push, that object is not going to move. So maybe that's the wall. Maybe it's, you know, the way I've got the squat racks set up. But I can push and generate tons of pressure without that object moving. So you asked for an example, and I think the easiest one virtually is to kind of like put

[00:40:08] [SPEAKER_00] your hands on a wall and pretend you're going to push that wall as hard as you can. You can also think about that like a sled push. If I had so much weight on a sled that I wasn't able to move it, but I still tried, that's what I want you generating into the wall. Some hands are on the wall. You're pushing. The wall is not going anywhere, right? You can push as hard as you want. But what I would see as a clinician is if you were pushing into that wall and generating that pressure, if I came up and kind of poked you in the side, you'd probably be pretty tight there, right?

[00:40:36] [SPEAKER_00] Like that pressure increase that when you push into the wall, if we do that and we hold that position, does that expose your pelvic floor, which sits at the bottom of that coat can to increase to downward pressure for an extended period of time in a way that is again, some symptomatic. So not to the point that I'm having leaking, but what I love about that is I can generate exactly as much pressure as my body's able to tolerate and then I can hold it there for an extended period.

[00:41:03] [SPEAKER_00] So if I push into that wall at 75% capacity, oh, now I'm having leaking or a side joint pain or back pain. Great. Do it at 65%. Back it off a little bit. Hold it for 30 to 45 seconds. Continue to breathe. So in your question of breath, when we're doing these long hold asymmetrics, you should not be holding your breath for 30 to 45 seconds. And if you have to do that to minimize symptoms, it's a big kind of red flag of like that's what you're doing to compensate. That's what your body's figured out.

[00:41:32] [SPEAKER_00] If I hold my breath, lock my diaphragm down, my pelvic floor also won't move. Beautiful. That's how I create stability. Okay. So I love the isometrics because I can push into a surface. It's not going to move. It gives me a second to figure out my strategy because sometimes that's part of the problem is if we do movements too quickly, we don't have time to figure it out. And so our body needs a minute to figure out what are you asking me to do and how do I match that demand? So I'm going to push into the wall, let's say 60% capacity.

[00:41:59] [SPEAKER_00] I want my pelvic floor and my floor to match that capacity. I do not want to be braced so hard that I am locked down holding my breath and completely and totally rigid because then you've got a Coke can that when you shake it up, it's so rigid. There's no expansion and that pressure explodes. Right? So I want to match the pressure into the wall. I usually will start with them at like, again, 60% capacity. So not their maximal. What can you hold for 30 to 45 seconds? Three to four reps.

[00:42:28] [SPEAKER_00] We think that's kind of a general idea based on what we know about, again, tendon response. So just three to four times, 30 to 45 seconds, three times a week. Try that position. Can you breathe through it? But you're still braced. You're still active. You're matching the task at hand. And after I get the hang of that, then I will have them go into these really powerful overcoming asymmetrics where like, I'm going to push in the wall, but push at a hundred percent capacity. And that's where you see people, you know, like bear down, pull my breath and push into the wall.

[00:42:56] [SPEAKER_00] But guess what you're doing on the field, right? Guess what you're doing almost every time you're running. It's that rapid rate of force development, match this really intense increase in pressure and do it quickly. And if we don't ever practice that, sometimes it's never going to translate. So now I've got this one that I laid this really nice foundation of these long holds, fix the fiber orientation, really accommodate and learn strategies. And then let's do five reps of five at 90 to 100 percent capacity for five seconds.

[00:43:26] [SPEAKER_00] So push into this wall as hard as you can for five seconds. You're still breathing, right? But maybe you hold your breath for the first second or two to get the hang of it. But you can't coordinate your breath. Again, let's say on the football field with every tackle. I can't wait for my pelvic floor to be like, oh, I need to exhale or I'm going to hurt my back, right? It has to be this very responsive system that works at a subconscious level. And I think overcoming isometrics give us the opportunity to do that in so many different ways.

[00:43:52] [SPEAKER_03] You mentioned football field and it just, I mean, it makes me flashback to everything that I did and how much I wish I knew back when I trained because I'm surprised more guys don't poop themselves on the football field, to be honest. Like, I have to put that out there because yes, big hits. You're not paying attention to anything other than killing the guy in front of you. So there's a chapter in your book that kind of piqued my interest.

[00:44:18] [SPEAKER_03] I think it is something like the big toe posture and the pelvic floor or something along those lines. And people talk about all the time, oh, how the feet are related to the pelvic floor and how our feet mechanics are operating impact the pelvic floor and vice versa, or how your shoulders are positioned can impact pelvic floor and vice versa. Which I love bringing this up to people.

[00:44:44] [SPEAKER_03] And I also think it can be dangerous because it can paralyze people trying to analyze their posture and how everything is affecting everything. And oh, my big toe does this. And that means that my pelvic floor is too tight. And again, I think it's important to understand and appreciate the relationship. So how do you go about, can you just talk about this a little bit more, how our pelvic floor relates to other areas in our body and the appropriate way to apply that in understanding

[00:45:13] [SPEAKER_03] how our pelvic floor works?

[00:45:14] [SPEAKER_00] Yeah, I think in that discussion, you know, like you said, you have to be really careful because I don't want you to get that paralysis by analysis where it's like, I can't even function because I'm so worried that something's not doing the job as opposed to. I think making clear from the very beginning that yes, in the early phases of rehab, I'm going to have you kind of overanalyze everything so that we can figure out where this is kind of stemming from. My goal in doing that is finding the real root cause. I don't want to put a bandaid on this. I would rather just treat it. So if I can tell you from the beginning, we're going to be very intentional.

[00:45:42] [SPEAKER_00] We're going to focus on multiple body parts so that I can figure out what's happening here. But my goal for discharge and my goal for a return to spur of the rents is that you don't ever think about these things ever again. That's my hope. And that, I think, puts people in a different place mentally. Like, okay, I'll focus on this for a little bit. But even with my runners, because again, let's be honest, if people are runners, they're going to run, right? No matter how many times I tell them not to. So I've really stopped telling them not to run and started to say, okay, well, what can we modify to make this more tolerable for what you're going through right now?

[00:46:12] [SPEAKER_00] With them, I might say, hey, once a week when you run, could you focus on this? And the rest of your runs in the week, don't worry about it. Because it takes a little bit joy out of it when you're focused on every single little thing. So yes, the big toe and the pelvic floor play a role, just like thoracic rotation plays a role, or just like your rib position plays a role, your core control plays a role. All of those things play a role. No one of them, a more important role in the other. The goal should be that they're all working as a team.

[00:46:40] [SPEAKER_00] And what I think we start to see is when one of them does start to break down, then we start to see compensation in other areas. So helping people understand that it's a system and it all works together. The reason your big toe plays a role here, and like you said, you know, your mid-back, your upper back, they all work together, is because again, from that Coke can perspective, I need places to absorb force. And so if my foot, again, is incredibly rigid, it doesn't flatten out. I lose the ability to absorb force there.

[00:47:09] [SPEAKER_00] And when I can't absorb force there, where is it going to go? It's going to go up. So if I can attenuate, if I can absorb a little bit of force in my foot, because I have great control over my foot pronation and that's flattening, now I can take a little bit of force away from what my pelvic floor is going to experience by the time it gets there. And so everything is connected, which is the great news and the bad news, right? So yes, at the beginning of your pelvic health plan, I might look at things like your big toe. I might look at your ability to rotate through your thoracic spine.

[00:47:39] [SPEAKER_00] I might look at your hip rotation. Not because I want to overanalyze all those things, but because the question isn't always just, you know, what's happening at the pelvic floor. It's why is there so much pressure at the pelvic floor? Maybe my pelvic floor is incredibly strong and resilient. I've done a great job on the rehab side. And the problem is my foot won't absorb any force. And so my pelvic floor is being asked to do way more than it should. In that case, me approaching the pelvic floor is not really going to help us very much, right?

[00:48:06] [SPEAKER_00] My pelvic floor is doing everything it was meant to do and more. But if I don't take that full body approach and say, okay, why is there so much pressure there? Then again, we could kind of a bandaid on it or we don't fix it at all. So it's all related. And yes, at the beginning of a rehab plan, we're going to focus. We're going to be really mindful. A lot of brain games, a lot of thinking sitting on your hand. But even in those early phases of rehab, I don't want you thinking about this all the time. I don't want you clenched all the time. I don't want you trying to compensate all the time.

[00:48:35] [SPEAKER_00] I want you to think about this like here and there. Do these specific exercises, you know, whatever our prescription is. And I also want you to just enjoy movement and lice. And then eventually all these pieces will start to come together to where when you discharge, you never need me again. And you don't ever think about this again. That's the ultimate goal.

[00:48:52] [SPEAKER_02] One thousand percent. And the fact that you tie it out up to the entire body, taking that whole approach of a person, not just the body part, is the goal, right? And I hope how everyone starts to appreciate and take notice of their body. There's always going to be something to work on. That's okay. We're human. We have all these things going on. But there's so much more to dive into in this book. And so where could people get their hands on it? You have 15 chapters of all this incredible knowledge.

[00:49:19] [SPEAKER_02] We barely dove into just peaks into it. So how can people get their hands on it to really learn more?

[00:49:28] [SPEAKER_00] So pre-order is live now. If you want it earlier, like in November, you can order directly through 8020 Publishing. So you can just search 8020 Publishing. The book's called Floor It. It'll pop right up. You can buy it directly through their website. If you want it in December, you can buy it through places like Amazon, Barnes & Noble. You just search for it, Rachel Selman, it'll pop right up for sale. But because 8020 Publishing is obviously the publisher, they will get access to the first copies of books. So those will go out first.

[00:49:55] [SPEAKER_00] They will then distribute out to other distributors who will send out in December.

[00:49:59] [SPEAKER_01] Perfect.

[00:50:00] [SPEAKER_03] Awesome. Thank you so much for being here chatting. I always learn a ton and this is a topic that's super important to me and I want it to become more important to everyone, but also men because I'm someone who had a lot of issues that I continue to work on and focus on and retouch on. So appreciate the work you do. We'll have all of those links in our show notes so people can check it out and get their pre-order in. And best of luck with the book launching.

[00:50:26] [SPEAKER_00] Thank you so much.

[00:50:29] [SPEAKER_03] Such a great interview with Rachel. If you're interested in grabbing and getting a pre-order in for her book, those links will be in the show notes. And you know, she touched on a lot of myths about the pelvic floor. If you're interested in diving in on some myths about mobility, Jen has an absolutely free webinar that's coming up. We will also have a link down in the show notes where you can sign up for that webinar. Like I said, absolutely free. It's going to be a great 60 to 75 minute dive into some myths about mobility and what is actually important.

[00:50:58] [SPEAKER_03] If you haven't, please consider leaving a rating and review on your favorite podcasting platform. And we will catch you next time on the Optimal Body Podcast.