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Kerry 0:06
And my main focus is like it’s not about getting your body back, it’s about feeling good in your body again, regaining strength, maintaining strength, stuff like that so that mommy tummy doesn’t have to be part of your life. You might not look the way that you looked before you got pregnant but you’re gonna feel stronger
Introduction 0:28
to the fit and 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 is our host physical therapist and strength coach, Dr. Jamie buffet. And here we go. This is a part two episode so if you have not listened to part one, you don’t have to listen to it before but definitely listen to it after there’s a ton of great information in there. So in this part two, when we’re talking with Carrie and Dr. Courtney, we talk a lot about how breathwork enhances exercise while your pregnancy is going on as well as before and after. When it’s safe to return to exercise after pregnancy. What to avoid after pregnancy, the things when you should see a pelvic floor physical therapist. How do you determine if your back hip pain is actually coming from something else? What’s the one simple exercise you can do to start improving your pelvic floor? That five piece to know and the best way to heal diastasis recti or some people call it mommy telling and when to go to a personal trainer versus when to go to a pelvic floor physical therapist. Alright, stay tuned to the very end because we’ve got some interesting things that Dr. Courtney has offered our listeners. So stay tuned until the very end. It’s okay, so I know I know people will have questions because you mentioned how you train the breathing and how that works and what the pelvic floor is but I know people will kind of want a little bit more from you. So what So how do you so just tell us a little bit more about how you train these muscles and exercise and like how what’s what a session would look like with you? And I know that’s a general question, but what would it be? What would a session look like with you?
Kerry 2:20
So we always chalk them first like you know what’s going on your body? What are your goals, all that stuff? So simple questions of like, you know, are you leaking? Are you not? If I asked you to do a pelvic floor contraction would you know how and then we go from there. So then I just watch them breathe and like okay, take a deep breath for me and more often than not, their shoulders travel up towards their ears. So that shows me that their dining room is in fact not traveling down. And we got to work on just a breath pattern in general and retraining that breath pattern. As a society. We’re very shallow breathers and take a deep breath and it all comes up instead of going down and out like it should. So we start there. And then I start to check on that breathing pattern in different positions. So in a tabletop position, so on hands and knees, and then can you do a bird bug and keep that pressure canister intact? Can you extend an arm and a leg without changing the shape of your back? Do you know the difference between engaging your transverse abdominals versus just bracing your core which is very different so I think especially women that come from a CrossFit industry and that side of fitness. Bracing is our very big tool that they use and bracing does regulate the pressure in your canister and protects your spine. But it’s not a super functional way to engage your core.
JAMIE & KERRY 3:48
And there’s more bracing because they’re bracing so hard and it’s kind of hard to do other movements. Yeah. So like if you were if I just told you to brace your core for a punch right now. Yeah. Can you take a deep breath at the same time? No, you can. So if you fully made your core in a functional way from the bottom up, you can still talk and have a conversation and maintain that contraction in your core and like go about doing some other things with your body which is cool. So I teach the difference between bracing and engaging. And then we just keep working on that breath movement within movement patterns. So like can you do a squat and inhale as you travel down, and then exhale as you can track to lift up out of that squat? And then you can actually feel your pelvic floor working and you can start to connect into the difference of like lengthening and contracting. So a typical session was me starting with gravity breathwork. We would move through some actual exercises, you’re not just creating a promise I’ll get your heart rate up and getting stronger. But it will always be functional and cater to the individual. So if you have to work on lengthening your pelvic floor, we’ll be working on that. And if you have to work on tightening things up, we’ll be working on that and I have to imagine the difference between bracing and engaging only gets more important, the bigger you get throughout pregnancy as internal pressures and internal sizes and the way you have to move changes. Yes 100%. So like, like we talked about earlier, your six packs abs are basically what you’re bracing your superficial muscles. You’re bracing your hairstyles and your six pack abs usually when you brace because you just think like tighten up and like to track that air. And when you engage you’re bringing that air out so that you can fully take another big deep breath in and as you get bigger, that pressure outward along that midline is super important to regulate. So if you can connect in and engage your transverse axis, you can actually have your baby have an end, make your bumps smaller and travel, bring your belly button up, then you can learn how to really engage that transfer stuff so while you’re pregnant, it’s a great way to actually connect into that muscle group because you have such an awesome visual to watch it happen.
DR. COURTNEY 6:09
I’ll just play because I’ve seen you do it with videos that are so fantastic. Not only explaining but describing it every single time you’re doing some type of movement whether it be like the simplest of exercises or you’re going through squats or something like that. You are so conscious about the breath work of it. And I love how you tailor that in with everything because a lot of people in general don’t even realize just how simple what breathwork can add to their body let alone women especially after pregnancy and how important it is. So I think you do a fantastic job of it.
JAMIE 6:51
Talked a lot so hopefully everybody can now see the benefits of strengthening of working on breathwork building the pelvic floor during pregnancy, pre pregnancy. Let’s talk a little bit about postpartum issues. So when is it safe to return to exercise after pregnancy?
KERRY 7:12
So the general rule of thumb in the medical field is six weeks and that magic number is tied to stitches. And that’s it. So typically, if you tear after giving birth, you have stitches and stitches dissolved within six weeks. So that’s why you have a six week checkup. There’s absolutely no other reason than six weeks. So that is like the baseline and that’s like the minimal amount of time that you should take.
KERRY 7:43
Another thing to keep in mind is that like that organ that you grew to help grow your baby, your placenta leaves its dinner plate size wound inside of you, which is a pretty powerful visual.
KERRY 7:55
So you need to heal that too. So the general rule of thumb is that you’re no longer bleeding.
KERRY 8:02
You’re no longer in pain.
KERRY 8:05
And you know, you’re feeling like it would feel good to move your body in a new way. And so resting is super important. Your blood volume doesn’t return to normal until eight weeks, which is not talked about often.
KERRY 8:22
And it’s also very dependent on the type of birth and labor and delivery that you experienced. C sections can take a little longer to heal from vaginal births and can take a long time to heal depending on if you did tear how severe that tear was. If there were complications.
KERRY & DR. COURTNEY 8:40
There’s, you know, a whole host of things that need to be considered. But the very minimal amount of time is six weeks. I will see from a physical therapist standpoint, a lot of this is going to be dependent kind of like Carrie said on the birth and the woman and everything like that. But there are definitely certain exercises that you should wait a little bit longer and in general you would not want to just directly the day that you’re clear from the doctor or you feel better just go do so. For example some of those, especially as far as making sure you can train the pelvic floor and your diaphragm as well. Like doing heavy crazy amounts of heavy lifting right away are not going to be good and a big one is running because we have a lot of runners and runners love to run page like that even women will still run like all the way up until they give birth and it’s going to be dependent but typically you actually want to wait a couple of months. You really want to make sure that you’ve dialed that pelvic floor and then also just from the orthopedic standpoint, aside from the pelvic floor, going through lots of changes. You know the rest of your body is to your hips, your SI joint, your back, all the muscles surrounding your upper thighs, your adductors, abductors, everything like that can get really tight or weaker as well. And so before you go out and do these heavier activities, you’re definitely going to go to want to make sure that that you’re clear in that sense and that you can not only make sure your pelvic floor is okay that that the rest of the musculature in your posture has has returned as well or else you could cause other injuries.
JAMIE 10:21
Okay, so, Courtney, I know I think I’ve heard a statistic correct me if I’m wrong, but something like 80% of women have SI pain, low back pain with pregnancy, and they could benefit from physical therapy. And that may or may not be kind of pelvic floor and maybe more orthopedics outside kind of work in the joints and muscles.
JAMIE 10:42
And so when I’ve talked with obese, they have our OBGYN. They told me that essentially 100% of women would benefit from a pelvic floor therapist working with them after rehab. So they don’t really give any timelines on that. You’ve kind of told us why they need to be able to do certain things.
JAMIE 11:07
Let’s make it easier for somebody to try to know when to let’s we’ve kind of talked about when to return to fitness, when to use somebody like yourself to help speed up the process of getting back into an active lifestyle.
DR. COURTNEY 11:24
Again, it’s a gray area.
DR. COURTNEY 11:28
But similar to what Carrie was talking about, usually as far as pelvic floor therapy six weeks just because you do want to make sure all the bleeding has ceased. If there were stitches or things like that tearing up we definitely don’t want to be doing internal exams with all that stuff still trying to heal or see if there was like, you know, the infection or something like that. We always just want to make sure that that area is cleared first, but then Yeah, as far as king of the outlier stuff. So say like, si hit back pain.
DR. COURTNEY 12:01
There are still some other minimal things that can be done prior to coming into public or actually digging into the internal stuff. And we talked about it a little bit. Something very simple and basic is just diaphragmatic breathing, working and breathing. Things like that, that can kind of start to heal up and work your way into pelvic floor 30. But for the most part, I think I would be definitely doing a disservice to women. If, if all I did treat was was just the pelvic floor no matter what every it’s all a kinetic chain is what kind of what I say and I think that that not only can yes to can women benefit from pelvic floor therapy, but I think that you kind of have to treat the whole the woman as a whole because during pregnancy lecturing mentioned there are so many changes that are happening postural wise, pelvic floor wise, and back hips and side joint all of it. So as far as all of that stuff goes, you can definitely find at least with the treatment from me that there’s going to be some form of all of that being taken into account.
JAMIE 13:14
Some problems like hip pain, back pain, can actually be referred pain meaning the back pain isn’t actually coming from the back of the hip, but it may be coming from the pelvic floor or I’m assuming some other areas as well. How would somebody after they’ve had a baby? No, no when that pain is coming from something else. So let’s say I have hip pain. How do I know that? You know, stretching isn’t going to get rid of it and it’s actually coming from something else? And I’m really working on the victim and not the culprit.
DR. COURTNEY 13:44
Right? Well, the easiest answer is definitely going to be coming in to get a checkup, you know, some type of pelvic floor therapist, of course because they will not only be able to ask the appropriate questions to kind of dive into you know, when you get the pain is it during certain activities, can you point to where it is? Is it sharp? Is it gold, numbness, tingling, all that kind of stuff. They can do a background check of that. But then of course doing an external and internal pelvic exam is going to be really important as well because I like a lot of things in the medical field that can be missed all the time. And I’ve seen it with patients before. Yeah, but they find fear with thinking that you know, oh, it’s my hip and it must be you know, a label tear or it’s just this really tight muscle and they’ve gone through all these different practitioners. And no one ever thought to ask them a basic question of, you know, is it is sex painful to insert a tampon? Painful is there are leakages like all of these basic questions that come as far as colic foregoes that are completely missed. And if someone would have just stopped and asked those guys those simple basic questions, it could pretty much lead you right to pelvic floor therapy. And so that’s something that as soon as I kind of hear a red flag from a woman with a sweater, or you know, speaking as far as if they’re coming in saying I’m treating it and treating them for back pain or hip pain, and all of a sudden I hear Him say something where I’m like, wait a minute, that that doesn’t sound right, that doesn’t correlate at all, you know, let’s dive into this a little bit, a little bit further in. So yeah, very much. So just like any other parts of the body, things can refer to pain. But I think ultimately getting to the root cause and asking those questions which some providers I think, maybe just get a little bit frazzled. To ask but they’re so so important because big things can be missed. And patients go to yours, you know, doing, you know, regular therapies and all these other practitioners, possibly even MRI surgeries, when really at the end of the day, it could have just been something simple like pelvic floor. Sure. And I think, you know, I’ve learned a lot from both of you today. And I think the thing that I’ve kind of taken from this is, you know, there are personal trainers, and then there’s somebody like Kerry, who’s really specialized in this kind of discipline. And the same thing for you, Courtney. So the thing I’ve learned from both of you is, you know, while yeah, maybe a personal trainer can help you with some general fitness. This is beyond general fitness. So really work with somebody who’s kind of a specialist in their field.
JAMIE 16:19
And who can listen for those very simple things like that, you know, maybe a simple question that somebody else wouldn’t think to pass can give you I don’t wanna be too dramatic, but life changing results. So yeah, that’s, that’s really helpful, I think. So, a lot of these questions today were asked in our Facebook group, the fit and healthy Denver Facebook group. And so I want to ask, there’s only one more that I have left that was put in the group. And so you’ve answered part of the first one, which was Do women really need to settle for having bladder issues after giving birth, which I think is pretty clear now, as you were both vigorously shaking your heads. And so what should women do to help the pelvic floor? Now I know the answer for both of you is independent three individualize. But the answer somebody wants is just give me something to start with. Right. So is there something that is a failsafe? Yeah, maybe it’s not the most effective but it will help a little bit we can give our listeners. Yeah, I can. I’m gonna jump in here. 100% diaphragmatic breaths. That’s your number one tool to connect to your pelvic floor to get it to function properly. And as a great starting point of like, do I even know where my pelvic floor is? I think the reason I got into this field is because I had no idea that I needed to worry about dialysis or die or prolapse or my pelvic floor. I was like, I’m just having a cool baby. I can still do push ups. I can still do this. And I couldn’t. And after my first baby, I was dealing with a whole host of issues and like nobody knew how to help me. So diaphragmatic breath is definitely the number one. And then number two is like actually you connect that area, feeling it function. So like when you do a hip bridge and you add some weight to it. Do you feel pressured downward? Or do you feel like you have control? Do you feel like you’re going to pee or do you feel like you have control? So starting there, like just connecting into it and feeling it for maybe the first time and then learning how to engage your core in a way that regulates that pressure? That’s the number one thing so my favorite thing is the PS. So if you feel pain, pressure, peeing or popping, then you need to either back off or reconnect. So those are some things that you can think about, like while you’re moving while you’re running, while you’re doing squats when you pick up your kid, when you lift groceries out of your car, like everyday movements, check in with those keys and see where you’re at.
DR.COURTNEY 19:00
Yeah, don’t just keep doing 100 crunches every day, ladies.
DR. COURTNEY 19:07
TV or anybody else tells you.
DR.COURTNEY 19:09
You’ve got to make sure you’re curious that you are gauging them appropriately, not just trying to brace and soak in and take all your breath away and just do a bunch of crunches. You’re only going to end up doing more harm than good. Yeah, I could talk about that for another two hours.
KERRY 19:28
Don’t ever do crunches again.
JAMIE 19:30
Never ever shot the king of the other big one that I know of is after bears after pregnancy diathesis Rick tie or some people are gonna call it mommy tummy.
JAMIE 19:41
And I know crunches with that. It’s kind of a no no especially depending on how big it is. But maybe Guinness is the focus that isn’t similar to what you’re working with and where you’re building the canister is different, what needs to change in order to work on that.
KERRY 20:00
Business or diastasis recti is the stretching of the tissue between your six pack abs. 100% of women experience it by the end of their pregnancy because your belly has to stretch. But the difference is that it’s either injury based or it’s normal. So if you injure that tissue in a way that prevents him from coming back together.
KERRY 20:21
We’ll say within 12 weeks postpartum then you know you have some work to do. And regulating that pressure within your abdomen is the best way to heal it. So you’re constantly putting that pressure outward, that it’s never going to get the chance to heal. But at the same time, you need to challenge it enough to teach it to turn back on. So it’s a lot harder. To train tissue than it is to train muscle. But it does want to come back together. And the best way to do that again is starting with that diaphragmatic breath. Your breath is functional and as the mechanics of it are working properly within that canister then you’re going to help mitigate the dysregulation of that pressure outward against that tissue. And when you do crunches and you think about what’s happening to that canister, like think of a coke can and then you try to bend it in half like where that pressure goes. Nowhere good.
KERRY 21:14
You don’t want to do that.
KERRY 21:17
The best way to heal dialysis is to regulate that pressure. So like starting in a band playing when you’re on your hands and knees. Do you have a lot of support? Can you hover your knees off the ground without feeling that pressure outward or down? Then can you progress to an elevated place, things like that you still want to challenge it but you don’t want to eat it up.
KERRY 21:39
And it all comes back to 100%. It is so boring. I breathe every day but if you’re not breathing right then you’re not doing anything good for in pod
JAMIE 21:51
Okay, coordinating dama I think she did a great job explaining it but anything else you want to add?
DR. COURTNEY 21:58
Yeah, I have one last question for you Carrie because you gave birth during this quarantine. So as far as kind of what we’re going through right now.
DR. COURTNEY 22:10
With COVID and everything Do you think that there’s a new set of challenges for women who are pregnant or have just given birth or about to give birth because they’re going to be at home or going back to work, possibly still at home? Postural wise things like that.
KERRY 22:28
Yeah. 100% So, first thing, my six week checkup was virtual. So it kind of fell on my shoulders to communicate like do I have a diagnosis right now? Am I feeling pressure on my pelvic floor because mostly it’s focused on postpartum depression rather than like your physical body at that point. So you really have to advocate for yourself right now. And like if you feel like you need to be seen in person and you’re comfortable with it, then you gotta push for it.
KERRY 23:00
And then just being an advocate for yourself, like seeking out a pelvic floor physical therapist because your OBGYN is not going to tell you about it. 85% of the time, they’re not going to tell you about it. So you have to seek that out yourself. And then another challenge is yeah, we’re home. We’re sitting a lot and now you’re also feeding a baby whether you’re breastfeeding or bottle feeding, you’re sitting with your shoulders probably rounded forward more than you’re used to. And you’re also sitting a lot. So your glutes are suddenly turned off. The pelvic floor has taken a beating from you sitting on a lot of downward pressure and you’re crunched forward in that canister now so that pressure is all going down in and out in a way that it shouldn’t. So just you know being my 100 posture, activating those back muscles, stretching your chest.
KERRY 23:51
Things like that are going to be hugely beneficial to you if you cannot get into public for PT or your doctor if that’s something you know that you’re not comfortable with doing in person yet. Hard a zoom call. We’re all here for that Id zoom session, just sure to coordinate with you just to see where you’re at. See what you look like with your body.
KERRY 24:11
And yeah, just my best advice is to advocate for yourself because no one’s going to do it for you.
JAMIE 24:17
Alright, so I’ve got one last question for us. So you both work with leads during pregnancy postpartum and we didn’t talk about this but Carrie, I know you also work with ladies of pain. Corti, you work with ladies in pain as well. How would somebody let’s say after pregnancy know when to see carry and how would they know when to go see coordinate?
KERRY 24:43
So how would they make that decision? In other words, so I would say that mommy told me Look where you’re like, hey, I still look like I’m three or four months pregnant and I’m six months postpartum. Sorry, I get a phone call
KERRY 25:09
so that money tells me that distended belly Look, that’s a sign that your core is not healing properly leaking to like bladder leakage. And then if you’re still in pain at the factory, like you can’t be on your feet for a long period of time, or it’s not comfortable to go for a walk. You’re having pubic bone pain, SI joint pain.
KERRY 25:32
Your hips are popping your hearing noises left or right. That’s a sign that you’re not necessarily healing and the way that you could optimally be healing. So outside help is what you should be seeking.
KERRY 25:46
And then also just treating it as self care. Like you’re a new mom. All the focus is on your baby. When’s the last time somebody asked you how you were doing? Like take that time for yourself and seek out the help that you need and it’s going to feel good and you’re going to feel like the best time is the money you’ve spent on yourself in a long time. So like again, it comes back to advocating and if you’re in pain, you don’t have to be at any level of pain past that six week mark. Seek out
DR. COURTNEY 26:16
Yeah, and I think just as long as everything checks off, okay. I don’t think there’s any issue always seeing someone like myself or Carrie at the same time too. And working together. I love being able to do CO treats. I guess if you will, I think it’s going to be more beneficial for the patient. I learned more about Carrie. We can kind of be in tune with everything. So yeah, as long as experiencing a crazy amount of pain or she’s at least able to, you know, fire her pelvic floor muscles, fire her diaphragm then you can definitely seek treatments like both of ours. At the same time as well.
JAMIE 27:01
Great. All right.
JAMIE 27:03
All right. So let’s wrap up to be respectful of both your time. Let’s go on. Let’s put out some socials out there so people can follow you. And so let’s start Courtney, where can people contact you?
DR. COURTNEY 27:15
So people can find me both on Facebook and Instagram. So we’re committed to Denver, but it’s spelled K I N E T i k Chang Denver.
DR. COURTNEY 27:26
We’ve got blogs on our website as well kinetic chain denver.com Anything from leakage bladder stuff diastasis recti I pelvic 14 All that good. stuff. You could go and check it out. In Korea, you are very soon putting free reports on the website for leakage for mummy tummy for pelvic pain as well that people can download for free little simple things they can do to help themselves. Trip those are just getting finished right now. Yeah, they’re a couple of pages long but it’s the third time they’ve got tips and tricks on them. So that’s something that you can check out as well. Perfect. And Carrie, where can people find you?
KERRY 28:04
I am on Instagram Carrie Adi dot set, same email me and Carrie Yachty Doc then@gmail.com And you can find me at crow street fitness and wash park all the time. I pretty much live here.
KERRY 28:18
And I do sessions out of here.
KERRY 28:21
But I also do virtual sessions. And my main focus is like it’s not about getting your body back. It’s about feeling good. In your body again, regaining strength, maintaining strength and stuff like that. So like that. Mommy tells me it doesn’t have to be part of your life. You might not look the way that you looked before you got pregnant but you’re going to feel stronger.
JAMIE 28:41
Great. So if anybody would like to get more fit, get rid of pain and get either a six pack after pregnancy like carry or just get back to normal regular life so that you can more fully enjoy and spend time with your kids. With these two ladies up I’m sure they’d be able to help. All right, bye, everybody.
