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KERRY 0:19
So getting your heart rate up in a safe and controlled environment like an exercise class or an exercise program is a great way to train your baby for labor and delivery. So mimicking that labor and delivery journey of like spiking your heart rate, bringing it back down with control and then spiking it again and bringing it back down with virtual is so good for both you and your baby
INTRODUCTION 0:49
and a healthy Denver podcast where we discuss all things revolving around health, fitness and wellness in the amazing state of Colorado so you can get behind the scenes information from industry insiders, special events, and more coming up because our host physical therapist and strength coach Dr. Jamie buffet, and here we go.
JAMIE
Your lady who’s been pregnant thinking about being pregnant or has had kids this is the episode for you. I learned a ton in this episode and you will as well. We talked with Carrie and Courtney about the benefits of exercise while pregnant, what exercises you can and can’t do during pregnancy, the benefits of the diaphragm and the pelvic floor during exercise when you’re pregnant. Why crunches are a bad idea when you’re pregnant. Babies you need to know the myths and things you need to know about key goals. And what you’re doing and maybe causing bladder leakage and how to fix it. And when it’s too late to work on healing after pregnancy. Stay tuned to the end. You’re gonna love every bit of this. Welcome everybody. We have two special guests today. This is our first episode where we’ve had two guests but I thought it was really important and this is an interesting podcast because I will probably be doing very little at the top talking because this is not a topic that I’m an expert at. So we have brought two experts in on all things pregnancy, fitness, pain, injury, everything that a woman who is pregnant or wants to get pregnant would want to know as well as postpartum, especially we’re going to talk a lot about fitness. So today our guests are Carrie Adi Carrie is the owner of Pearl Street fitness. She is a postpartum corrective exercise specialist. She is an instructor at the bar standard. She is a pre and postnatal alumnus and this one up Carry Trainer trainer and also a mother of three. And one other thing that I will say about Carrie and I know a lot of women who go out there and they see these women who have these giant bellies and then about four months later they have these six pack abs get really angry. And Carrie is one of those people you can get angry at because she has done you know if you follow her on Instagram you kind of have seen her progression and Carrie that was amazing. Like everything that you did, how fast you got your body back to you know just six back and everything else. Very impressive.
JAMIE
I think she I think she kept her six pack even
JAMIE 3:36
so we will talk about how you do that. Not only for yourself but for your clients as well. Because I know a lot of people will want to know that. Also, as of yesterday, we have Dr. Courtney gatesman coordinates as the director of the Women’s Health Division of kinetic chain divert physical therapy and in the women’s health and pelvic floor rehab. Welcome Courtney. Thank you. All right, Jackie. Thank you. I had a lot to memorize. So let’s start off with misconceptions, myths. And what are some misconceptions about pregnancy and fitness that you’d like to address?
KERRY 4:23
Yeah, I love this topic. I think there’s this feeling of fragility around a pregnant woman sometimes. When really it’s like the strongest that you’ll be in your adult female life. Think about you’re growing not just the baby, you’re growing and other organs so your body’s doing so much on its own and supporting that with fitness and health is paramount to having a great journey. So some of the myths that are somewhat outdated and can still be given as advice from, you know, people that have been pregnant in the past. Even doctors will say like you can only get your heart rate up to a certain threshold while you’re pregnant. And the best part about our bodies is that our bodies keep us safe. You know, like you’re gonna pass out before something happens while you’re working out. And the same thing is true while you’re pregnant, like you’ll pass out before anything happens to your baby. So getting your heart rate up is actually excellent training for labor and delivery, because your heart rate spikes naturally with your contractions and your babies get used to that kind of stress. So getting your heart rate up in a safe and controlled environment like an exercise class or an exercise program is a great way to train your baby for labor and delivery. So mimicking that labor and delivery journey of spiking your heart rate and bringing it back down with control and spiking it again and bringing it back down with virtual is so good for both you and your baby.
JAMIE 6:02
What are some of the benefits of exercise throughout pregnancy? I have to imagine there’s several for the mother and there’s probably several for the baby as well.
KERRY 6:10
Yeah, there I mean, the list is endless. A good rule of thumb is like whatever you were doing prior to getting pregnant you can continue to do so. If you are a cyclist or you love to spin class, go for it as long as you can maintain proper posture and regulate the pressure within your core. We can get to that later. But if you know if you enjoyed hit classes running like you can continue to do that as long as you feel good doing it. And then the benefits are, you know, you can minimize the risk of gestational diabetes and your blood capacity expands greatly while you’re pregnant. So taking advantage of that cardiovascular expansion is a great way to train yourself to have more endurance after pregnancy and beyond. So getting that fitness level up a little higher while you’re pregnant is totally possible, which is you know, kind of fighting and then other benefits are you know, like your baby will have a great environment to grow in and thrive in so you can minimize having like an overly large baby, an underweight baby so you’ll have like you know, a nice, fit, healthy environment for your baby to grow in. And then benefits for a mom or like you’ll have more energy you’ll maintain that muscular strength that you need to recover postpartum carry a baby around like we forget that you’re carrying around this week that just continues to grow. So you’re constantly in progressive overload, carrying this baby that continues to grow up so staying strong. It’s awesome.
DR. COURTNEY 7:46
Yeah, I think so. It’s interesting. I think piggybacking off of carry to this is kind of another myth. I think a lot of people, you know, just assume okay, you know, after I have a baby, I’m going to have to give up everything that I was doing. Like if I was in mountain biking before I was taking HIIT classes before doing yoga, that that’s all over and I can’t return to my favorite activity or sport or whatever it is and and of course, you know, you want to always talk to your doctor, you definitely don’t want to go out of the gate right away and you want to make sure that you’re cleared and everything like that. But as far as getting back to the activities that you know, what you love, if you were doing before or even doing throughout your pregnancy is 100% doable. And I think some people just assume that they don’t even give it a chance and they just assume oh, if I was doing this activity, I know that I’m never going to be able to return to it. Again. And I think that that’s definitely
KERRY 8:43
yeah, I mean, the hardest part about that is finding the topic. But other than that, it’s definitely doable for sure.
JAMIE 8:52
Well, are there any exercises that women should avoid during pregnancy?
KERRY 8:58
100% Yeah, thanks. for bringing that up. So the biggest thing that you want to have control over is pressure within your core. So if you go back to just basic core function, your diaphragm and your pelvic floor need to work together and your bellies are already expanding outwards. So maintaining that pressure in a safe way to mitigate the amount of pressure that comes outward along that connective tissue between your abs is super important. So any exercise that does not allow you to regulate that pressure is one that you should avoid. And this goes back to another pregnancy myth like some movements are fine for some women and some movements are not fine for some women. So like if I use myself as an example, I was able to do a full plan pretty much right up until I delivered because I was able to maintain that core connection. But some women have to stop doing foot planks at 20 weeks. Another myth is like Oh, pregnant women cannot be on their back. And that’s a very day to day situation. It’s not like a market boat once you hit 100 days pregnant, it can’t be on your back anymore. And the reason that they say not to is because the baby can press down on the vein vena cava, which can like make your heart rate slow down, which would affect the baby’s heart rate too. So that’s really just dependent on the baby’s positioning that day, and things like that and where the baby’s lying within your belly. So you might be fine on your back one day and then not find it on your back another day. So it’s very day to day and very specific to the woman at hand but to make the answer shorter. You should eliminate crunches because they serve no purpose while you’re pregnant. There’s no reason to strengthen your six pack abs while you’re pregnant because they need to stretch. So teaching them to stay short with crunches is just going to make it harder for you to regulate that pressure in between.
JAMIE 10:58
Yeah, that makes sense. So I heard you say it’s very individual and not only is what you can and can’t do individually it’s day to day. Yes. 100% Yeah, it’s kind of a gray area. In other words, there is no black and white but if I was a pregnant woman with that, what I would take out of that is great. You know, now I can. I can probably do more than what I read on the internet says you know, at 100 days you have to do this 200 days you have to start doing this. So I think you know, getting with somebody like yourself who actually knows these things and has taken other women and who has gone through these things can be very beneficial. Now a couple of times you mentioned the pelvic floor, what happens to the pelvic floor with pregnancy and then also with aging so as you’ve now had I don’t know how far apart your kids are, but you’ve had three different kids now, and you’ve aged this time. So what happens both to the pelvic floor with pregnancy and with gauging? Are there different things you should do at different ages as far as fitness?
KERRY 11:57
So I don’t think it’s really anything to do with age as much as it is like successive pregnancies. So your pelvic floor takes on a huge role when you’re pregnant, and that’s holding all of a sudden more weight. your center of gravity changes so it’s dealing with that your postural changes, so it’s dealing with that, and then your bombing floor has to stretch immensely, and then come back together. So it does a lot more than we realize. It’s not really something that we think about on a day to day basis, but it’s basically the camp like I like to describe it as a hammock within your calmness that holds up a lot of your organs. But it also assists you in getting baby hours unless you have a C section and pelvic floor is just doing the work while you’re pregnant. So that’s another myth that like if you have a C section then your pelvic floor is okay. But it’s still doing a lot of work to hold that baby weight while you’re growing. So you still need to think about it in your recovery. So that constant like pressure that you put on while you’re pregnant, and then again giving birth and then recovering and then doing it again is more so I think what you need to think about rather than how old you are. That age does play a role in how you recover of course, because as you get older, it’s harder and your regenerative cells like slow down and all that stuff. So that’s something to consider for sure. That basically you want to train your column Explorer to come back to the state that it was in before you’re pregnant. So train it while you’re pregnant. To both lengthen and contract is super important. And you do that with your breath. Does it all by itself regularly but training it under a load like in your squat or while you’re running is super important that it has that reflexive strength again. Okay. Yeah, I feel like the coordinates would expand on that a little bit too.
DR. COURTNEY 14:04
Yeah, so I was just gonna add to that, I think kind of another myth and some things that I hear. You know, patients seem to especially if they’re just on YouTube or hearing from other friends is like the good old fashioned cable. It’s like there’s good and bad with it. And I think that a lot of women they know know about it, they hear about it and they just assume that that is like the one and only thing to do to recover as far as pelvic floor goes, after half the time when you really dive into it. Half the time patients don’t even really necessarily know what the cable is doing and what the purpose of it is. Some of them don’t know how to do it or if they are doing it correctly. It doesn’t necessarily mean that they’re doing it in the corrective exercise or the corrective posture for them because someone Miche could easily be able to do a cable and a squat or could be learned quick to do a cable while they’re running while others might need a much longer time to be able to maybe just start in hook line on their back or maybe it’s sitting and then typically, I think we’re kind of there’s a little bit of faults who is a lot of times I think, you know not kind of getting the appropriate feedback for people to knowing how to do a kegel most just kind of looked at what use like them are quick stretch response is kind of how we refer to it. So I kind of called like bobbing for apples like when you were a kid and you just kept going down and up and up really quickly. And that really is not necessarily going to be beneficial in any way to actually strengthen the pelvic floor. So I think it’s a big myth for people to just tell women, you’re fine if you just go do a kegel because it’s such a great area to have, do they know how to do it? Do they know what it is and what the purpose of it is? Can they do it in multiple positions and so that can be from a provider standpoint, can be kind of frustrating because I think it’s just in general out there in the tabloids and online and all that stuff. It’s just cable cable cable and no one really knows the background behind it.
KERRY 16:13
And I think the disconnect there is that they’re not taught to then lengthen. So Kegel is just only about contracting in terms of how it’s presented in the mainstream. It’s just like, oh, just tighten up, tighten up, tighten up, but that’s kind of like doing a bicep curl only at the top half over and over and over. And if you don’t fully release that muscle then contract it again. It’s never gonna get stronger and it’s never going to be functional. So you have to learn how to also lengthen it and relax it and release it. Which yes, good point and I think a big cue people here for Cagle is like stop the flow of urine or like hold your pee and that really only contracts the front part of your pelvic floor and it leaves the whole rest of it out and it’s a full circle so like just only contracting if you think about it like a clock only contract at 12 o’clock. You’re leaving behind the whole mess. not get any new work or so. Yeah, that biofeedback that you can get from like a pelvic floor physical therapist is huge and should be 100% part of your postpartum journey.
JAMIE 17:20
Yeah. All right. So, since you’ve since you brought up kind of like with the cue of just stop your urine, I know both. During pregnancy as well as postpartum many times, there are some issues, bladder issues, and there can be problems with leaking, and I think I didn’t know how quite how prevalent this was, but it’s actually I heard a podcast a couple years ago, and it was like a CrossFit podcast and there’s two ladies and they were talking about, you know, peeing their pants a little bit when they do double unders. And there’s this big joke about kind of, oh, that’s just normal. And I think every, you know, physical therapist and Gary trainer, like you was just like, Oh my God, that’s not normal. We all kind of recoiled in horror. And I think there’s a difference between what’s common and what’s normal. And I think it’s probably a very important message to get out there that you know what is common versus what is normal. So let’s talk about that a little bit. So what what are some of the things either during pregnancy or post pregnancy that can be changed and fix that women don’t have to just live with
KERRY 18:35
I love that. You said that it’s common, but not normal, because it is super common to leak a little bit, whether you’ve had a baby or not. And that’s a huge sign of just pelvic floor dysfunction in general. And it’s fixable in lots of ways. I think the main thing that you need to work on is your breath, and making sure that your diaphragm and your pelvic floor function together to again minimize that pressure dysregulation in your core. So if a lot of pressure is going down to your pelvic floor constantly, you’re going to deal with some pelvic floor issues and it could prolapse. It could be an overworked pelvic floor, and leaking can be a sign of either a weak pelvic floor or an overactive pelvic floor. So if you’re too if you’re holding your pelvic floor too tight all the time and it’s not getting that chance to lengthen it’s kind of like just constantly holding that bicep curl again, and then like it’s going to fatigue in a way that’s not It’s not functional, it’s not getting stronger. So it’s like fatigued in a way that like I’m so tight right now, I can’t tighten up anymore to hold this urine in for you. So I have to lengthen so that I can learn how to, you know, again, deal with this pressure. So the number one thing that you need to work on is your breath and make sure that your breath is functional and it’s readily a diaphragm in your pelvic floor, right? And then the other thing to focus on, especially specific to a double under, is your posture while you’re doing that double up or like is your diaphragm stacked over your pelvis in a way that you can minimize that pressure? Or are you flaring your ribs and getting back and like breaking that core canister? So there’s a lot of things to focus on for sure that says super like the answer. Especially depending on the person that you’re talking to. But getting into a pelvic floor physical therapist to find out if you are in fact weak, or overactive is definitely the number one place to start because if you’re weak then cables will make sense for you. But if your overactive cables are no, no,
JAMIE 20:42
sure, Courtney, Carrie kind of set you up for this one so that she mentioned the pelvic floor physical therapy once you jump in and kind of just give us kind of your thoughts on that as well.
DR. COURTNEY 20:51
Yeah, I definitely agree a lot with what Carrier was saying. And I love the fact that she mentioned because I hear this a lot from patients. as well. As far as pelvic floor therapy goes, you do not have to have a baby that doesn’t have to be the only reason to come to even just normal. Like just regular leakage doesn’t necessarily mean again that that’s normal. It can be common, it doesn’t mean that it’s normal. And so you can certainly come to pelvic floor therapy, whether you’ve had a child or not of any age, shape or form. You should not have to deal with constant leakage, especially if you’re experiencing it during a workout and it’s very frustrating from a provider standpoint to hear when people say that it is normal or it’s just like, oh, yeah, girl, just you know, just for a cat and it’s fine like that, you know, and it’s like, we need to, we need to really get away from, like diminishing this and making women feel like instead of actually seeking out extra help seeking out a physical therapist or someone like Carrie, who can, you can learn how to tighten up the core and either relax those muscles or strengthen and lengthen those muscles. Instead, we’re just throwing you know, it’s kind of like in the medical profession, just throwing pills at a patient or surgery when there’s other options. It’s like no, you shouldn’t have to just wear a pad or just double your underwear or just you know, not do double unders and take them out of your workout. There are other options out there that are known to work and unfortunately, there’s this IPL in general in this deal. It’s not only just a lack of education, that’s present to the public but it also just comes from these people who just assume that there’s a normal seat because that’s what it is in our culture. It’s just all these things are just supposed to be normal for women. And so this is how we grow up and this is in tune. You know, we keep replaying this in our heads and until we actually believe it that oh, what I’m going through every other woman is going through and it’s fine and we just have to deal with it for the rest of our lives. And we should perform.
JAMIE 23:07
So quickly. Let me push back a little bit because in my head, I can already kind of see some questions about some of what you just said. So question number one is any amount of leaking normal. Then question number two is if that is normal, when do they know when to take action? Or like at what point is it appropriate to start trying to work on us?
DR. COURTNEY 23:33
Of course, yeah. I think this is kind of a bit of a gray area. I think it depends because you have to kind of figure out who the person is what’s what’s going on. What are there are other symptoms underlying it and what kind of leakage that there is because there is a different, a couple of different types of leakage and to know kind of when it’s happening, and kind of what’s going on with that but the biggest thing I would say too is that if if it’s starting to affect your daily life in any way, like if you’re having to for example, when you’re working out if you’re modifying your workouts or you’re completely getting rid of exercise because of it or even just the sheer fact that you’re embarrassed like you have to put extra pads in your purse or wear two pairs of jeans. That’s a definite problem. And I would say that that is not normal in any way that should not be normal. I know some women kind of probably get in the habit of telling themselves that it is but if it’s if it’s affecting your daily life to that point, that magnitude, there’s something going on that needs to be looked at. But in terms of leakage wise, and the pelvic floor you really shouldn’t have much leakage when you’re when you’re when you’re doing workouts or laughing or anything like that. And so, if you recognize that and if it’s something that’s happening consistently as well, then again, it’s something that’s definitely going to need to be checked out just to figure it out as well. Again, since there’s different types of leakages going on when you are having it, what activities are causing it? And it’s progressively getting worse over time as well.
JAMIE 25:21
You said there shouldn’t be much is there a clinical because to me much, it says a little but it doesn’t really say how much what is not much.
DR. COURTNEY 25:33
So I would say you shouldn’t have leakage. If you’re if your pelvic floor is intact, and like Carrie said as far as diaphragmatic breathing goes, you shouldn’t be just leaking. At random times throughout the day. Granted, that’s I understand that that’s different as far as after pregnancy goes but again, that’s that’s not necessarily that’s common, but it’s not necessarily normal and it’s something that you should go in you should get checked checked out to figure out again, is it because of tightness Is it because of weak and so on and so forth.
JAMIE 26:08
So Carrie is some of this preventable like, let’s say somebody started working with you on some of these things before with the fitness before this ever became a problem is some of this preventable like to so that we can almost eliminate that.
KERRY 26:25
It’s definitely preventable. It’s also like, it doesn’t like we talked about it doesn’t have to be just because you’re pregnant. It could be a postural thing. Like over time, you’ve affected your posture in a way that your diaphragm and your pelvic region aren’t working together anymore. So it’s gonna take a little bit more work to get back to that baseline level. But it’s definitely preventable. If you have that connection to your pelvic floor where you can feel it relaxed and you can feel it contract, then you’ll know like, oh I’m about to sneeze. Let me contract my pelvic floor so I can control that pressure so I don’t leak while I sneeze. Or I’m about to cough or laugh or whatever it is. You want that to be reflexive, so you want your pelvic floor to automatically turn on. But if you can start with making that connection, then you can train that reflexivity for sure. That reflexive part of the muscle I think I just made up a word there. It works. And then it’s also never too late to start healing. So sometimes I hear like, oh, I had a baby 10 years ago and I still like it, so it’s just part of my life and like, it doesn’t have to be that you aren’t working on it at any point. It’s never too early and it’s never too late to start retraining that muscle the same way like all of a sudden you decide I want to be fit. You start working on it. Like I want to stop leaking. You stop, you start working on it. It’s never too late.
JAMIE 27:55
Okay, earlier you had mentioned the canister and the canister for me was one of the things that I thought was the most interesting and visually kind of just put every picture like put everything together for me. So let’s talk about that cuz I think people can kind of get the idea of what the canister is, which muscles are working there, how everything works together, kind of paints a picture of how they can improve these things. So can you describe the canister which muscles are involved, how they all work together just a little bit?
DR. COURTNEY 28:25
Sure. That’s my favorite part of what I do. So the caster is your torso basically so like from your ribcage to your hip bones is a good visual point for you to think about. And the muscles within your ribcage are your diaphragm. I think it’s a common misconception that your diaphragm is actually a muscle and it’s your breathing muscle. So training is super important and it’s also at the same shape as your pelvic floor so they work together and they should stay stacked pretty much over one another. So that’s the top of your canister is your diaphragm and the bottom of your canister is the pelvic floor and then within that canister, you have all of your abdominal muscles and then the muscles of your back neck and stuff like that. So you have your six pack abs which are your most superficial layer of muscles, your rectus abdominis and then your deepest set of muscles, your transverse abdominus which is wrapped around that canister in a 360 degree way. And then within there you have your external leaks, your internal leaks, your power spins the multifidus muscles. Without getting nitty gritty with it. All of your core muscles are part of that canister. So the way that the pressure regulation works is when you take an inhale, your diaphragm travels down as your pelvic floor relaxes and expands. And then when you exhale your pelvic floor contracts and your diaphragm travels back up to where it should go. And then the transverse abdominis will also expand with your inhale and then come in with you when you exhale. So if you can picture that it’s kind of like a giant ocean event. So the jellyfish travels down as you inhale and then comes back up as you exhale. Or you can think of a balloon following up in a 360 degree manner as you inhale and then as you exhale comes back down to a smaller size which is kind of like reverse of what you’ve seen, because when you blow up a balloon you’re exhaling so it’s a little bit of
a backwards way to visualize it, but I think it helps because you can say like, alright, that balloon in your belly needs to expand all the way around and all the way down when you inhale and that needs to come back in and when you exhale. So one of my favorite breath cues is inhaling down and out. Exhale up in
JAMIE 2:35
great detail explaining that obviously you’ve done that a lot before that was fantastic. Alright, so there’s obviously a ton more we can learn. And so we had to break this episode up into two episodes. So stay tuned for part two, with curiosity and Dr. Courtney Eastman, where we will talk about much more, learn just as much I promise, part two is just as fantastic. All right, we will talk to you soon.
