What is a PELVIC FLOOR SPECIALIST PT? And how can they help Mamas before during and after having a baby. Join me as we discuss this great addition to the care team for Moms through pregnancy and after delivery.
episode Transcript:
All right. Welcome back to first breaths to first steps. I am blessed today and joined with Kristine Godsil. She is a physical therapist in Colorado practices, orthopedics, pediatrics, but her specialty is in pelvic floor physical therapy. I have been lucky to meet her and kind of learn about what can she do for us and our population in particularly with our moms in the fourth trimester and right before delivery. Kristine started with Active core in March of this year, due to wanting more one-on-one time with her patients. And so I thought who better to interview than Kristine and talk with her about her passion of getting patients pain-free, but finding what’s actually generating their pain and, or dysfunction and providing tips and tricks for those individuals to get healthy and be the best that they can be.
With that let’s get started. Welcome, Kristine. I’m so glad that you’re here with me today. Yeah, absolutely happy to be here. Today we’re going to talk a little bit more in the prenatal realm. I’ve kind of titled our discussion today, ready or not, here I come. As far as here comes our baby. And what can we do?
Can you define for me what a peri natal, meaning that you help in before pregnancy, during pregnancy and after, but as a pelvic floor specialist, can you define for us what exactly your role. Absolutely. So in that time period before pregnancy or during, I think it’s most important that, for mamas or are soon to be, that are trying to get pregnant if -you have any sort of like movement dysfunctions or any pain with back hips or pelvis. It’d be a good time to come in especially, as you guys are trying. Cause unfortunately, sometimes when we get pregnant, those pain generators just get heightened. Trying to get that all weeded out on the front end of it can make that a little bit smoother transition, as you and baby grow But then also in that same breath, during pregnancy, if you have any pain, any sort of leaking or incontinence, issues with constipation and or bowel movements, those kinds of things.
That’s a great time to just stop and come in to see a pelvic floor therapist. We can help out with any sort of rib pain, back pain. What’s the other ones pubic synthesis, round ligament, pain, those kinds of things. So any of those, more mainstream terms, I think a lot of mamas have heard, but don’t necessarily know what to do with is a great time to come in that way we can get rid of it. Especially during that pregnancy, I always like to say, you’re already growing a baby. Why would you have to be in pain or why do you have to suffer through it? Let’s make sure it’s as smooth as possible and then prep you for labor and delivery. So once we get to that pain free mark, I generally like to see my mamas in between 32 to 35 weeks. We can talk about what you can do before labor and delivery and how to set you up for success during that process. If you have some predisposing conditions beforehand earlier, addressing those issues to get you as healthy as possible before you were even pregnant is ideal. But typically kind of checking in around 32 weeks with a pelvic floor specialist, just to get you in the know and ready to go to have the healthiest body mechanics possible. Yes, absolutely. If you don’t have any pain during that pregnancy, no reason to come see us before getting into that third trimester. So that’s perfect.
Yeah. And that way too, you know, all the options. The stages look like of labor and whatnot. Cause it shouldn’t be a mystery, right? This, it should be all readily available and you should know what you’re getting yourself into. I know, I always like to say, you don’t know what you don’t know. For those of us in kind of this realm of surrounding pregnancy birth, and then, after our babies are here, Important to inform you. Hey, you may notice this, or you may have issues here, here, and here and this is information or at least where to go, to get good information about how to treat some of those things. Totally. Yup.
Let’s move into the nitty gritty. Let’s talk about some prenatal issues that maybe some of our moms are experiencing once they are pregnant. I think probably one of the biggest things is how do I get comfortable and sleeping in my last trimester when we’re really, maybe our body is changing shape, size, all that good stuff. How do you think are some of the best tips and tricks for that? Yeah, no. And that one question that I get a ton Biggest thing is pillows. Make sure you have them handy. I don’t think there’s a magic pillow out there. I know people that invested in certain body pillows, or I know that there’s big pregnancy pillows and stuff like that, that are on the market. But making sure that optimally setting yourself up so that hips are level and a neutral. Then making sure to, if you need to be elevated, like say if you’re having issues with acid reflux while you’re sleeping or as you’re laying down or you just kind of tend to get more out of breath, those kinds of things, that you feel most set up for success.
Sleeping that rest and recovery is just as important during that pregnancy. And especially at the end here, your close. What I mean by hips in neutral, right? We want to make sure that your knees aren’t coming in together too much, or they’re not too separated that can put extra pressure on the pubic synthesis or onto the hips. Especially for more in that stagnant posture for like six to eight hours. And then making sure your back’s not kind of swayed or any sort of wonkiness. Because with that extra weight or with baby growing, anytime that we get into certain positions and we’re there for a few hours, we can start to get strains or get more uncomfortable.
Sure. Looking into good wedge pillows, or just making sure that you have, have some handy so that you can set yourself up for success. Right. Getting those knees in a neutral position, not too far apart, but the middle there, maybe if you’re a side sleeper putting that pillow between your knees and then supporting your back that way.
Are there any positions that you should avoid being in when you’re later on in your pregnancy when you’re sleeping? I’d say it’s more on that back for sure. More than that supine position. I’d say being in that laying down position, it doesn’t necessarily bother everybody for an extended period of time. It just makes sure that mom is safe, especially throughout the duration of the night. We don’t want to put extra pressure on to any sort of vessels making sure you’re not getting out of breath while you’re sleeping. If you can avoid it. If you are a huge back sleeper, right? I I’m more pro sleep, but then being like, let’s change up your whole routine. Finding a good wedge pillows. I’ve had patients sleep in a recliner if it’s more comfortable for them. Those kinds of things, just so that you still have that input and most comfortable position for you. But again, we’re making sure that you’re not uncomfortable or putting any sort of stress on your entire system. I’d say probably, it’s not fair game of laying on your stomach. It’s the one not going to be super comfortable and I haven’t heard anybody successful with it pregnancy. Absolutely. But options for that, right. It’s almost like a quarter turn side sleeping. So I’ve had people do that successfully. And what that looks like, if you’re not a super comfortable side sleeping solely you can have that top leg in front of you on more pillows, stacked pillows. That gives that input of almost sleeping your stomach a little bit better. Right. And still keeps that pelvis in that neutral position. Exactly. You got it. Right.
I would say probably another really popular question that pregnant moms ask me about is urinary incontinence. Losing that sort of function as well as abdominal wall health. Can you address both of those in the respect to latter pregnant? Totally. Yeah. And I, I always like to make sure that moms know this too, is that it’s totally normal to experience any of these things, whether it’s abdominal separation pain during pregnancy incontinence, anything like that, it’s just not normal to have to live with. Right. Making sure that, you know, you have options . I mean, the body is amazing and it does a lot of change. So I think some of that you’re right, is just kind of knowing, yes, this may happen. You may have issues with this. I think that knowledge is kind of powerful. Absolutely. And now I, to you don’t feel alone because I feel like either that’s too much information and we don’t know what to do with it, or we don’t know that our friends or sisters went through that as well.
So it’s nice to know, oh, wow, okay. This I’m not crazy. This is normal. And that’s okay, but making sure you know, that it can be fixed afterwards or during. If you’re having. During your second trimester, don’t feel like you have to wait until postpartum to get that result either. A lot of the times with urinary incontinence, it depends on what the source of it is. So our pelvic floor muscles, they have the option or the opportunity to contract, relax, and then push. What we’re looking for there’s weakness. That would be your standard of okay, we’re going to work on strengthening. We’re going to pair pelvic floor contractions or Kegels with your functional movements. Or it could be already in a contracted position. Thinking as if like pulse squatting, your pelvic floor muscles are mighty, but they’re small. So if they’re already contracted. Position. And then we’re asking it to, stop the flow of urine when we sneeze, it doesn’t have much room to go to maintain. So then we need to know how to relax the pelvic floor down, kind of retrain it into that normal strength. So it knows how to let go after a sneeze, after her cough, those kinds of things. And then the last option of it all is discoordination. Meaning you have functional strength. You’re able to relax your pelvic floor. It’s just doing the opposite of what it’s supposed to. So when you sneeze, it actually relaxes or, we’re pushing when we’re supposed to be contracting those kinds of things. So finding. The nitty gritty of that, which sounds confusing. That’s why we’re here is so that we can tailor it to you and what specifically is going on.
Right. So we talk a lot about incontinence and pelvic floor weakness, but what, or how would a mom present when you’re in that contracted state rather than I’m losing urine? What did those moms experience? Yeah. I think a lot, especially from my practice, what I’ve seen a lot is a history of either pelvic pain any pain with intercourse, those kinds of things. If you know that you’ve had issues of inserting a tampon or pain with gynecological exams, that tends to be the case. I wouldn’t say it’s a hundred percent, right. You’ve worked in medicine, not everybody’s cookie cutter fits in that box, but usually with that goes hand in hand with a lot of that already tightness in the politics for increased tone.
Well, and I think that’s so important. You and I throw these terms around like, oh, you got tightness in your pelvic floor. And people are like, what how’s that gonna look like? Do I have that? Do I not? Sometimes identifying that symptom and saying, oh, this might be an issue. Kind of gives you an equal playing field to come and talk to a pelvic floor specialists like yourself to say, Hey, I think maybe this is what’s going on. Or to even know, to look for that. Totally. Absolutely.
And to go off of your, the last of that question, I don’t want to forget about the abdominals either. It’s so important. What we look for for abdominal wall health is making sure that they’re able to support the system. Meaning that we’re not having any back pain, you’re not getting round ligament pain. Cause that would mean that our abdominals aren’t helping support baby’s growth growth. Making sure that you know how to engage your deep abdominals, we’re not having any sort of coning or doming.
What that looks like is , if you were to get up from bed or say you’re in a reclined position, you’d see almost a little bit of a pouch or it comes together at the top and your abdominals. Meaning that we’re just kind of pushing our abdominals to make sure we’re getting that forced to come up. And so then that way we’re not using them for the strengths that they’re there for that. Is an issue with that is it starts to create that process of separation. That’s not always the case. There’s mamas that have smaller frames. There’s mamas of all different builds, right. That it’s just a natural compensation of the body to have separation. But what we want to look for is make sure that there’s no pain associated with it and there’s no other symptoms involved. It’s okay to have separation during your pregnancy, but we want to make sure that . It’s not causing me back pain. You’re not having any sort of incontinence or any sort of round ligament pain, or even just right on the abdominals. Those would be things to look for, to make that staying nice and healthy and just keeping in mind for that postpartum journey.
Besides looking for those types of symptoms, what are proactive activities or exercises that you can do for abdominal wall health? Absolutely. I would say making sure you know how to engage your deepest abdominal layer, to which is your transverse abdominous.
I always like to call it our anatomical corset. If you look at an, a picture, you know, Google transverse abdominis, it truly wraps around hori zonally all the way to the back. And so once that cinches it. Almost lifts up the belly and protects the back in that way, maintaining the whole core system and how usually the cue uses that pulling belly button into spine. Not necessarily sucking in or holding our breath. It’s truly just that, small engagement of polling inward. You should feel that all across our, or all the way down to pelvis and that’s where too, we can notice if we have any sort of separators. If somebody starts to engage their deep abdominals and they only feel it right below the belly button, maybe their mid transverse and upper transverse abdominis doesn’t know how to fire or it’s separated too much for them or whatnot. So things we keep in mind. Having that contraction and using it in transitional motions. Sit to stand, getting up from a surface, getting out of bed, those kinds of things. Those will help with making sure that abdominal wall stays nice and hot. Right? So it’s kind of coaching beforehand and getting into the habit of trying to engage as you’re doing those daily activities.
You got it. Yep. Awesome. Awesome. I think probably one of the biggest complaints that both you and I hear about is lower back pain. Especially as we get further along in our pregnancy, what are your insights with regards to lower back pain, but also maybe some preventative measures that moms can do.
Totally. And again, it’s one of those is making sure where it’s coming from. And I think what’s helpful when I talk with lower back pain with patients is that we’re, we’re looking at that entire core system and I’ve already said it on here. Making sure that we know that that’s not just your abdominals, right? Our core system, it involves that front layer. If you think of it cylinder. We have our abdominals in the front, our back extensors are our back muscles in the back. The top of it’s, our diaphragm and the bottoms of pelvic floor. What happens during pregnancy? When we have that? Babe growing, we get this tilt on the pelvis that it almost puts all of those back muscles in a contracted state, or we put those spinal segments more into an extended moment. If we don’t know how to get out of that, or we’re feeling out there for the whole part of our day that’s where we can start to get back pain. That’s where we can get that pinching of that sciatic nerve or that sciatica people have like kind of a trigger word. Making sure that you have a lot of hip mobility, I usually give people pelvic tilts to make sure that we’re getting some nice mobility into the low back. That’s really looks like rocking onto sit bones and coming forward. It’s almost like you’re pushing your booty out and then coming on to sit bones. You can do hip circles and then making sure everything’s nice and stretched. A child’s pose or if you’re further along a seated child’s pose. You know, your belly’s not getting the way of anything. Just making sure that things are nice and mobile, and that has a chance to relax because it is your body’s changing and rightfully so, but making sure we have things to combat all of those different, different pressures.
Right. For sure. Lastly, I think one of the important things. Obviously to bring up is that you probably shouldn’t be starting an activity program when you’re further along in your pregnancy. But are there activities that you for sure would avoid in that last trimester or, you know, 32 weeks plus in gestation that you think is important for moms to know about. Sure. I think what’s most important is that knowing that that duration intensity of exercises changes and by that point of your third trimester, or probably not going on a five mile run and we’re probably not doing really intense HIIT workout or anything like that. We stopped with planking, those kinds of things. Not necessarily that it’s hurtful. It’s just that at that point in time, especially for that abdominal wall, it’s generally harder to contract those abdominals to make sure we’re not coning or doming. That’s where we’re staying away from. All of those core exercises that are pushing you against gravity, right? So thinking of more stuff of, of almost like Pilates moves or bar moves that you’re, you are doing that deep core activation, and maybe you’re just doing light squatting with it, or, alternating marches and sitting those kinds of things. So that’s where it kind of cues into that duration and intensity changes. You can still stay mobile, you can still be working out. Just making sure it looks a little bit different than probably what your first trimester. Right. And some of those activities that are a little less bearing, a little less pounding are probably a little bit more comfortable. I know when I was further, along in my pregnancy, I loved to get into the pool because I felt like, wow, all of this lovely, extra weight that is somewhat relieved and, took that pressure off my back, off my pelvis, things like that. I always found that some of those things were really helpful transitioning from running to more walking. I loved walking in the water. I thought that was, so much more comfortable. I think, just getting creative and talking with your PT about, what can you do to get into a more comfortable mode for activity? Not to completely stop everything, but just to help us make a transition. You got it. Yeah, absolutely.
What about for those moms that are already go into their pregnancies very, very active. Are there things and, or a timeframe in which you would say, yeah, we need to try to transition things or change things a bit. In that last trimester. Totally. Yeah. I’ve had mamas that are super big into CrossFit and stuff like that. And what I do really big on education for those rounds so that they know when that transition point is, is looking out for certain and red flags in the sense that like, these are things to look out for, not necessarily stop everything that you’re doing. That looks like any sort of abdominal cramping. Also there’s typical cramping in the calf. If that’s kind of a warning sign to any sort of bleeding or spotting shortness of breath. You should be able to carry on a conversation with any of your exercises.
And just knowing that how your energy level feels even into the next day. Right. We shouldn’t be totally zonked the next day, or we shouldn’t having any apotting the next day. Those are all of these different signs that I want people to look out for to be like, okay, maybe yesterday’s workout was a little too much. Maybe I’ll just do 15 minutes or maybe I won’t do as much weight this time around those kinds of things. And, and looking out if we’re having any extra symptoms like incontinence. Are they trying to do double unders are they trying to do box jumps? Which don’t sign me up for that right now, but you know exactly.
And having incontinence, maybe we’re maybe it’s not a good time anymore. Yeah. Right. For sure.
Well, I really appreciate your time. I think you’ve done a great job of outlining some things to look forward to, or look in prevention of, but definitely for our moms that are in that position of ready or not, my baby is coming, what do I do with my activity and my body? I really appreciate your time. Definitely. Great to know, what does a pelvic floor specialist physical therapy Person do for us and how can they help us if we’re having any sort of issues or problems. I really appreciate your time.
If you’re interested in any of the information that Kristine and I talked about today in our podcast, you can reach me in the description down below, and until next time 📍 be well.
