SPEAKER_00 0:00

So today we are going to talk about something that affects way more people than I think realize it. Yet most people have really no idea what the pelvic floor even does. So here on Vitals and Values, we have a special guest today to help us understand more about the pelvic floor. We are welcoming Kelly Ruther. She is a pelvic floor physical therapist who works out of Holland, Michigan. And she did her doctorate of physical therapy at her training at Midwestern University and also got pelvic floor training through Herman and Wallace, and also is a dry needle specialist and did postural uh went to the postural restoration institute. Yep. Is that correct? That's correct. All right. Uh anything I missed?

SPEAKER_01 0:43

I also have pelvic floor training through the Institute of Clinical Excellence as well. Missed that one. Yeah. Perfect.

SPEAKER_04 0:48

And I gotta bring this up early. Um is this is my bias and this is my ignorance.

SPEAKER_03 0:54

Yep.

SPEAKER_04 0:55

Is pelvic floor thing just a woman thing or is it a man thing too? Because I both. Okay. Yes. Because I've never heard of pelvic floor up until like a woman thing. So I have no idea how this conversation is gonna go. And I'm looking forward to the thing.

SPEAKER_01 1:08

Yeah. And I think it's a really big misunderstanding, too. And which is unfortunate because then a lot of men don't realize that they can have help for these issues. And so, and also a lot of pelvic floor therapists don't treat men, they only treat women. So there are not many male pelvic floor specialists as well.

SPEAKER_04 1:23

Okay. I'm looking because I what the the there the questions may come out of left field because uh no idea about pelvic floor.

SPEAKER_00 1:32

You think it'd be like, what's this pelvic floor stuff I keep hearing about? I mean, it's a good question. It is. I think it's great because I see so many patients I'm like, oh, they really should they would so benefit from pelvic floor physical therapy. But I uh struggle to be able to, I think, articulate to them why it's so helpful and important. And so hopefully you can help us with that today. Yeah, I absolutely hope I can.

SPEAKER_04 1:54

And I heard you brought a uh emotional distress, uh emotional distress pelvis. It's emotional support pelvis.

SPEAKER_01 2:01

Yep, I love my pelvis. Okay, I gotta she brought it to a this is the pelvis and it moves, so I can really show like how movement can affect the pelvic floor.

SPEAKER_00 2:12

So I met Kelly when we both were speaking at the Women's Health and Sports Expo here in Grand Rapids, and you took your beautiful pelvis with you and you did an amazing talk, and it was so like so clear what you were explaining. Good. So I think this is gonna be a great conversation. Oh, good. I'm really excited for it.

SPEAKER_04 2:30

I hope you can speak laymans enough because I have no idea where this is going.

SPEAKER_00 2:33

I talk to patients every day, all day, so I should be able to. Well, and I think, I mean, since David has no idea what we're talking about, maybe you could start by telling us like when someone asks you, what is the pelvic floor? How do you explain that? Very good question.

SPEAKER_01 2:47

So the pelvic floor is a group of muscles at the floor of the pelvis. So it's kind of what it sounds like. But I love visuals because I'm a very visual learner and I think that resonates with patients a lot. So I like to describe the pelvic floor as a trampoline. So if we think about a trampoline, right, we have the frame of the trampoline. And in that this analogy, that's like the frame of the pelvis or the bottom of the pelvis. Yep. And then you have the springs that connect the frame to the mesh, right? So in this analogy, the springs are gonna be the supporting muscles. So that's gonna be like your hamstrings, your inner thighs, it's gonna be like your um abs, your IOTAs, um, your diaphragm, just kind of all the muscles that help support the pelvic floor itself. And then you have the pelvic floor, which is the mesh itself. And so ideally, we have the frame that's nice and circular, nice and strong. We have the springs that are evenly balanced and nice and supported, and we have a strong mesh as well. Um, and then in addition to that, if we have a lot of weight that's on the trampoline, let's say we like drop a mini cooper on it, no matter how strong that mesh is, it doesn't really matter. So everything connects and supports each other. And if there's dysfunction in one of them, a lot of time there are dysfunction in all of them. So it's a very interconnected system. Okay. And hopefully at the end of today, that will make a lot more sense to you because I know it still is a little like, what?

SPEAKER_04 4:02

Honestly, the visual representation makes sense because I can see because I remember I I did look up an image of the pelvic fluoride. I was like, okay, the dome and like the schwinker. I'm like, okay, got it. Okay.

SPEAKER_01 4:12

Yeah, it's actually the only muscle group that has a hole in it um in the whole body. So it functions very differently than anything else. So it's not like the bicep where it's like contract, relax, right? So that's what I like to describe as a trampoline because it's like you absorb force, so like downward force, like jumping, sneezing, coughing, that force is going to push down. It should be able to rebound back up.

SPEAKER_00 4:31

So And so when we're talking about public floor dysfunction, yeah, it's that specific thing that it can't bounce back, or there's the imbalance that you mentioned. Those are the kind of things that would cause the dysfunction, then you're saying? Yes.

SPEAKER_01 4:46

So it's typically, and it's very interconnected with the whole body, but it's gonna be the primary things that we look for is like how is the frame, right? How is the pelvic position itself doing? And that's gonna really improve the efficiency of not only the mesh or the pelvic floor, but also the springs, which are all the muscles that connect to it. Or you can have imbalance of the springs, so to speak. So you can have like glutes on one side that are underactive, glutes on one side that are overactive or too short or too tight, or like the inner thighs could be imbalanced. I see that a lot in pregnant women. Um, or you can have too much pressure. If you have really stiff ribs or a stiff upper back, that's going to create a lot more downward pressure, aka like putting the mini cooper on the trampoline. Then no matter how strong that mesh is, it can't keep up. So it's kind of a whole interconnected system that should work together. And when one thing doesn't, usually multiple things don't, it causes that mesh to fail or the leaking to occur or prolapse to happen or anything like that.

SPEAKER_00 5:45

So, what kind of things are you seeing people come in for? Like what are these con the most common symptoms, I guess, that are related to the dysfunction of these muscles, this muscle group. Right.

SPEAKER_01 5:54

Good question. So urinary leaking is a really common one that we see, especially in females. And so that can be either stress incontinence, which is leaking with like jumping, stays and coughing, or urge incontinence, which is more leaking with a strong urge to go. You treat those two things very differently because one is more neurological. Well, they both are, but one is more like you put a mini cooper on the trampoline, right? Another one is your brain is telling your bladder it's time to go when it's not yet. Um, and then there is things like fecal incontinence or like fecal leaking, or um, if you can't hold your bowels in. We do see that in men more, um, but females absolutely can have that too. Um constipation, which is kind of the opposite problem, whereas the pelvic colour doesn't know how to relax to allow um bowel movements to happen. Um, you can have pain with intercourse, um, you can have erectile dysfunction, you can have pain with ejaculation, inability to orgasm. Um, I could prolapse, pelvic organ prolapse, you can have back pain, hip pain, groin pain, a lot of the time pelvic floor is contributing to that.

SPEAKER_04 7:01

I can also see from a man's perspective, uh half of those things no man wants to ever talk about.

SPEAKER_03 7:11

Exactly.

SPEAKER_04 7:12

Like I'm like, oh, okay, yeah, I can see why that's a very uncomfortable conversation. It's like, I'm just gonna man up and not talk about it. Right.

SPEAKER_00 7:19

I think that's very common.

SPEAKER_04 7:21

Yeah.

SPEAKER_01 7:21

Yeah. And it's I mean, it's it's true. It's like a lot of the things that public cloud dysfunction can cause are things that happen in private. And so we don't like to talk about it in public. And it's for some reason we have a feeling of like shame about it, but it's no different than having like dysfunction in your knee. It's just a different muscle group that happens to cause things that we don't like to talk about. Um and so it is sad that especially for men, um, and both women and men, but especially for men, it feels like humbling. I don't know if that's the right word for it, but you feel like you said some shame around it where there absolutely shouldn't be shame around it because it can happen to anybody. It's nothing that you did wrong. It's not like a weakness, you know.

SPEAKER_00 8:03

So what things cause that dysfunction then? It's like it's not anybody's fault. So what kind of bringing it on?

SPEAKER_01 8:11

Yeah. So it's gonna be dysfunction of one one of the pieces of the trampoline, typically. And it really can be like anything. The pelvic floor's so incredibly interconnected, you can't separate it from the rest of the body. So that's why it's like things like Kegels are it's just like that's like I've heard that term.

unknown 8:29

Yeah.

SPEAKER_04 8:30

I I know what that is. Yeah, at least I think I know what that is.

SPEAKER_01 8:32

There you go. I know most people at least know that. That's all the imp oh no, I think. Yes. And it's like we don't ever just isolate one muscle group. Like when during our day, do we only use one muscle group? I love even at the gym. But even then, you have to stabilize your core to be able to do the bicep curl. You know, it's like you're still working other muscles.

SPEAKER_04 8:53

Lara teases me on this. I'm a bodybuilder, so I use a lot of machines, which is pure isolation movements. He tries not to use his core. So like I there's no coming.

SPEAKER_00 9:02

Maybe why he has back pain.

SPEAKER_04 9:04

No, I shenanigans.

SPEAKER_00 9:06

Like, whatever. But so lots of things can disrupt. Yes. Yes. Yeah. A lot, a lot of things. Um, and what like what misconceptions do people have coming in? Do you think that maybe make this more challenging to treat? Or you have to overcome, I suppose?

SPEAKER_01 9:23

Yeah. I think a lot of people, well, one, this is kind of answering the question, but that keeps them from coming in is they think it has to be like bad enough. Like it they think it has to be like this like crazy dysfunctional pattern to get help. When in actuality, the sooner they come in, usually the faster I can fix it because they don't have all these compensation patterns. And then also structural damage then likely hasn't occurred yet. I'm whereas when women come in in their 50s, 60s, which is totally great, that it's never like too late, so to speak. But if they um sometimes I'm like, I would have just seen you in your 30s. Like I could have prevented one pain and dysfunction for years, but also I could have prevented some of the structural changes that have occurred from there. Um what was the question?

SPEAKER_00 10:12

Um what was the uh misconceptions people? Okay, yes.

SPEAKER_01 10:17

Um, but I think a big misconception is that the public floor does work in isolation. Is okay and then also that it's a simple problem when in actuality it is unbelievably complex and it works together so much with the rest of the body. So they come in thinking like, oh, I'm just gonna do Kegels. And very actually, I cannot tell you one time in 10 years that I have just given someone Kegels.

SPEAKER_00 10:39

Um You do do Kegels, but just with other things or not even that. I'm just curious.

SPEAKER_01 10:43

Yeah, no good question. There I I typically don't. Um I have, but generally I do not. There is a time and a place for them. There is some research to support it, but in my opinion, and really research shows it's not the most efficient way to fix the pelvic floor because again, we don't just use our pelvic floor. And so if you work your glutes, if you work your core, you're automatically coactivating the pelvic floor. And so, in my opinion, why not work other muscles, some of the springs, while you're working the pelvic floor in a functional pattern to therefore fix the issue? Does that make sense? Yes.

SPEAKER_00 11:23

Well, and I think I think you said this is complex and people think it's simple. And I'm like just listening to the first two minutes of you talk, it's like, yeah, this is so complex. Yeah.

SPEAKER_04 11:32

All right. From my point of view, then, how okay, and this is kind of completely off tangent of the timeline or that the sequence. How do you even start to unpack where the strengths and weaknesses are in someone that comes in? Like someone comes in with low back pain and you have this inclination, it's this. How do you discern that? Like, what is the process?

SPEAKER_00 11:54

You should have been at your talk because you gave some examples.

SPEAKER_01 11:56

Yeah, I was um so we practice something called the Ruther method. It's the method that we practice at our practice that I have kind of developed over my 10 years, not kind of, I have developed over my 10 years of of treating and then my eight years of education before that. And so we start with understanding the position of the body because everything is gonna work in a an efficient link tension relationship. So it's not just is it long, is it short, is it strong, is it weak? It's why is that happening in the first place? So we look at the position of the pelvis and the position of the rib cage, and then we look at the link tension relationship of the muscles because they're gonna, like I said, work in an efficient position. So if they are too long, they actually can act weak. And a lot of people think more flexibility is better, but that's not actually true. Um, and then we look at the pressure system, which is the entire core system. Um, and that is like I like to describe the core as a coat can. So if you think of a coat can, or on the outside, we have our deep abdominal, so it's like our transverse abdominis and our obliques. And then the bottom of the coat can is our pelvic cloor and the top of the coat can is our diaphragm. And so those things create a pressure system. And if there's dysfunction in one of them, there's dysfunction in all of them. Kind of like if you dent a coat can, it isn't, it's collapsible, it's not strong anymore. Kind of the same concept. And then we look at um on like figuring out what the compensation patterns are, um, and then really making it more functional, and then finalizing with neuroplasticity. So it's we have like a whole shwugh of, I don't know if that's a word, but shwugh, actually.

SPEAKER_02 13:30

There it is. Yeah.

SPEAKER_01 13:31

A whole shrough of um tests that we do to really dig down into these things. And then all those tests tell us information to kind of like narrow down to what muscle or what muscle group or what um functional pattern is dysfunctional.

SPEAKER_04 13:48

So that totally makes sense. And the reason why I'm gonna go on a tangent with that is my hypothesis of why I have low back pain is I have spent the last 20 years doing the pattern of you try to make your belly smaller. So you do the what's it called? You suck it in? Yeah, you suck it in. And so I have always had a very hard time of flexing my rectus abdominis in a way that has that almost like the I suck the cocaine from the front in and now it's all unstable. And it's so hard for me to break that pattern. I just like right now, like you just you I instead of just sitting normal and like I always want to just kind of suck in the the belly button to the back of the of the back, which then doesn't allow you to use any of the front abs.

SPEAKER_01 14:30

Mm-hmm. Yeah.

SPEAKER_04 14:31

Just my hypothesis.

SPEAKER_01 14:32

It's definitely, I mean, it's I shouldn't say definitely, because I haven't tested you. It's very likely a piece of it. And I do see women, especially if I'm treating them for an overactive pelvic floor. I'm not saying that's what you have, but um, I ask them and they have like a regression for some reason. I asked them three things and lit I have yet to have it where it's not one of these three things. I say, Did you do something different this week? Like, like, oh yeah, I snow shoveled for three hours for a time in the season. I'm like, well, yeah. Um, or I say, Did was it really stressful week? Because that's very interconnected. Or I say, Were you on, were you wearing a bathing suit and were you sucking in? Because that is going to increase downward pressure. Um, so you because you're sucking in, making the stomach smaller, adding that downward pressure. But in addition, you're, like you said, denting that coke can, making the pressure system less effective. So I mean, it's very likely a piece of the puzzle. Is it the puzzle? Probably not.

SPEAKER_04 15:23

I have a finicky low back, and part of it, like I've I've taught I'm actually hypermobile, and that's part of my problem, which is kind of rare. Um, and that's the exact same problem I have. Yes.

SPEAKER_01 15:34

So hypermobility I see, especially with people with an overactive pelvic floor, which we don't really talk about much because again, ever knows kegels. If you have an overactive pelvic floor, do not do kegels, please. Um but I see that so often. I'm at our practice, we see a lot of patients that have gone to PT elsewhere and it didn't work. So we tend to get like more of the complex ones or the ones that other PTs can't fix. And we see hypermobility so, so often because people don't really know what to do with that. Um a lot of people don't even know they're hypermobile. So I'm impressed that you know that.

SPEAKER_04 16:06

Well, the joke is because like I can palm the floor. Yeah. So with straight, with straight legs, I can palm the floor. And Lara's always like, How do you how do you do that?

SPEAKER_00 16:14

I'm not hypermobile. Let's just say your hamstring springs are really long. Yes.

SPEAKER_02 16:19

Yes. Yeah.

SPEAKER_00 16:22

But because I think um you how you talked about, I think you mentioned that coke can analogy at your other talk that I was at. And and then I've seen stuff online, I know, like, you know.

SPEAKER_01 16:32

Well, no, there's some good information. Right.

SPEAKER_00 16:34

But there's some Palmi 4 people online that I think are good when legit. But they were always talking about the diaphragm and how you breathe and how important that is. And I always find that really complicated, like in my brain. Yeah. And how like is that something that you talk with a lot of your patients about? And how do you talk about that?

SPEAKER_01 16:49

Yeah. I do think I kind of want to start with the diaphragm concept is kind of like the new Kegels.

SPEAKER_03 16:55

Oh, really?

SPEAKER_01 16:56

Is there obvious it's very important. I don't want to minimize that, but it's not the puzzle, it's a piece of the puzzle again. Um, and so yes, your diaphragm and the pelvic floor are the two top and bottom of the coat can. So they're gonna provide a lot of stability and efficiency. Um also the diaphragm and pelvic floor sink. And so they create like a pumping mechanism. So every time you inhale, they both descend down, and every time you exhale, they should, if they're working properly, ascend or recoil up. So that pumping mechanism helps with the GI system to kind of move things through as well. And so sometimes with constipation, if your bowels sit in your intestines too long, it keeps pulling water out of it, and then that can also make it harder to pass. Um but and so if you have tightness in the diaphragm or like if it's stuck in that descended position, so like if your ribs are really flared, um, which we see a lot in postpartum women, um, and anyone in general can have that, but that's gonna create that flattening of the diaphragm, which is more of a contracted state. That is ultimately can lead to pelvic floor overactivation because then that also gets stuck in a contracted state. And then and causing can cause low back pain too, because then that diaphragm is pulling because it attaches to the top of the low back. And so then it stops being more of a respiratory muscle or a breathing muscle and starts to more be a spinal stabilizer.

SPEAKER_02 18:16

Yep. Okay.

SPEAKER_01 18:17

And then you're gonna recruit muscles in your neck, which can cause carrying stress in your shoulders, which can cause jaw pain. It can kind of like snowball from there.

SPEAKER_00 18:25

Gosh, there's so much.

SPEAKER_01 18:26

I know. I'm sorry, I'm probably not making it more.

SPEAKER_00 18:29

I think it's great. Well, I think that's important.

SPEAKER_04 18:32

It's like so many things in life. It's like you know true professionals because they speak in context and nuance versus like it's the diaphragm. Duh. If you're having a low back brain, it's a diaphragm. Exactly. Or it's like it's like that's what social media loves to hear. They love to hear the this is the root cause. Yes. And anyone who's truly a professional at a craft go, well, you're right. There's actually a lot of people that have that problem, but that's not the end-all be-all of this subject.

SPEAKER_01 19:00

I think that's the hard thing with social media. And I mean, I have a social media platform, and you'll you will never hear me say it's always, it's always, it may be, it could be, it might be. But virality loves simple, virality loves concrete and like 100%. I'm not willing to say that because I don't believe that is true or correct, but it's it's like POV. You do this one exercise and your back pain melts away. And I'm like, maybe for like one person, but like it's never that simple.

SPEAKER_04 19:32

Well, it's like uh I went through a phase where I thought my low back pain was coming from deep. Okay, hold on. Uh the piriformis.

SPEAKER_03 19:40

Okay, yeah. Yeah.

SPEAKER_04 19:41

I just do the piriformis. I almost bought the little piriformis, like uh little deep massage thing because I'm like, well, that makes sense. And it's been it was always that kind of find a one-stop shop to to fix all your problems instead of go to professional.

SPEAKER_01 19:54

And it's a money grab, right? I mean, everything is a business. And so you always have to look at like what is their ulterior motive with this too. And of course, I mean, like I post online because I want to educate people. Like I had no intention of going viral. I had absolutely zero thought in my head I would have a large following. It was just I wanted women to know there's hope and I wanted women know there's help. But there is a lot of time, it's like, oh, if I just buy this one tool, it's gonna fix it because it makes us feel like we're getting one step closer. But uh, I mean, we in our office we use a ball, a band, and your body. Like you don't need that much. That's great. I think people appreciate that simplicity.

SPEAKER_00 20:30

And I think that um, so when you have someone who comes to you, or like if I was referring someone to you, I think they don't know what to expect. So I think that's part of the reason they don't want to go to is because there's some fear there or uncertainty. And so um, what is your initial process and how do you make that not scary for people? Yeah, good question.

SPEAKER_01 20:50

Yeah, it can feel very intimidating or very vulnerable, um, especially with situations like if they're having pain with intimacy or leaking or with men with pelvic floor. So the first visit we do, we sit and we hear your entire history. So every visit with us is an hour long and to allow us to really have time to dig in. Um, and so we really dig into like, okay, when did all of this start? What are all of your pain points, not just this specific one, because everything is connected. Um, and then we go into full body testing. So we look at, like I said, pulp position, rib position, hamstring length, we look at upper back mobility, we look at um some stabilization or stability and muscular testing. Um, and then we will do some hands-on work. We at our office don't tend to do internals on day one. We don't need to do internals. If someone doesn't feel comfortable, we never ever would push someone into that. It can be a very helpful tool to know to be able to actually assess every muscle of the pelvic floor internally so that we know is it overactive, is it underactive? Like we can really pinpoint down into that. Um, but it's not necessary. Like you have to do. Yes, it does speed up the process. And we at our office, we have um two therapists that do male and female. And so if we need to with men, we can do a rectal um assessment as well. Um again, it's not necessary, but it can help speed up the process. We don't do that on day one, though, um just because we want people to feel comfortable and take me to dinner first. I know, right? Yeah. Yeah. And then we'll do a couple extra. I'm sorry. Yeah. Yep. So we work on the springs before we work on the mesh. Gotcha. Yeah. Makes sense. Yeah.

SPEAKER_00 22:37

How long do does it usually I mean, I guess it's not usual, but like how much work do you have to do with an individual typically to see results?

SPEAKER_01 22:47

So we see objective improvements on day one. So you're gonna see like testing changes on day one. Does that mean your leaking is gone after day one? No. A lot of it depends also on how long it's been going on, what structural damage has occurred. Um sometimes people will see improvements in leaking after day one, but I would never guarantee that because I don't know exactly what is going on with that person. I'm from day one until like creating that neuroplasticity, making sure this doesn't come back and it's actually gonna last and your body has adapted to the new changes. We like to say around like 14 to 15 visits total to go from and that doesn't mean you're not gonna see symptom resolution until that. That's like you are we are confident this isn't coming back. But usually within four to five visits, they're gonna see significant subjective or symptom improvement.

SPEAKER_03 23:40

Okay.

SPEAKER_04 23:40

There actually is always one when it comes to physical therapy in general, and like it goes into uh I always the hardest part about clinical research behind physical therapy is humans doing the physical therapy and sometimes it's continual use. How that whole process, like what you're doing, is there long-term process to it, or is it like once they've kind of re-established the the problem, does it cut like do they have to do like a monthly kind of touch point, or is it like, oh, it's pretty, pretty much set? Yeah, I have no idea how that works.

SPEAKER_01 24:18

Good question. So and I this word I hate to use because it is such like a trigger word right now.

SPEAKER_02 24:22

Yeah.

SPEAKER_01 24:23

But if you actually do get to the root cause of the issue, like if you truly do uncover the compensation patterns and fix the cause of it, um you shouldn't have to do them for the rest of your life. No. I'm what we do is so that's what that like neuroplasticity comes, is we actually every exercise we give is a functional process of the day. So most of them um are pieces of the ambulation cycle or of walking, we break that down into exercises so that it ends up being walking is your PT in the end. And so we retrain your brain how to walk and using the right muscles, if that makes sense.

SPEAKER_04 25:04

I said, when when you start saying what you actually use tools for the process, I'm like, oh, this sounds like something that once you build the pattern to it, it's pretty rhythmic.

SPEAKER_01 25:14

Yeah, yeah. So our goal is always that they are good from there. And typically it is. Will there be times when like you do it? Like, for instance, I go wakeboarding once a year just to prove to myself I can still do it, but I don't really like to wakeboard. I just want to be like, oh yeah, I can wakeboard. And so usually that will kind of throw me out. But then I know my go-to exercises and I get on the floor, I do it, I stand up, and I'm fine. And so I give people their go-tos so that if they have something in the future, they can reset themselves to hopefully not need me. Because that's my ultimate goal is you don't need me anymore.

unknown 25:47

That's great.

SPEAKER_00 25:48

And it's like to come back once a month for a reset or something.

SPEAKER_01 25:53

No, some people were like, can I come in just to kind of like assess myself and make sure, especially like people who are high in athletics, we see quite a few athletic individuals. Um and if they're really pushing themselves, that is an option, but it shouldn't be necessary.

SPEAKER_00 26:08

And um, you said the walking, like you take the walking and make the other PT. Can you give an example of what you mean by that?

SPEAKER_01 26:16

Yeah. So for instance, if we are in left stance, okay, so right swing, so you're standing on the left leg, a right leg is swinging through. You are in left hip internal rotation, working your left glute me and min, left adductor, while your right glute max is kind of helping swing your leg through. And so we will take that part of the gait cycle and break it down and make that an exercise. So it imitates that portion of the gait cycle. That's the exercise. So that when they are in left stance phase, they're using their glute meat and min, they're using their adductor on the left side, they're using the right glute max. And so then when they're walking, that is ultimately activating the muscles that we need or the springs that are underactive. Um, making it so that in the end, that walking is what is activating the muscles we need. Instead of them having to do like reverse clamshells and ball squeezes and glute bridges to maintain stable. Uh-huh. Does that make sense?

SPEAKER_00 27:13

Yeah, because that's what a lot of people are doing. Yeah. Okay.

SPEAKER_01 27:16

Yeah. We only give two, maybe three exercises, typically two.

SPEAKER_00 27:20

Uh-huh.

SPEAKER_01 27:20

Um, because that's only need because they are incorporate so many different muscle groups. So it should only take like five, 10 minutes a day for their exercises. That's how we do it.

SPEAKER_00 27:28

And how often do you tell people to do that? Is that an ever like while they're in treatment, is that every day they have to be doing that?

SPEAKER_01 27:35

Twice a day. Oh. Is ideal. So morning and night, it's like I said, just two exercises. So it doesn't take more than 10 minutes total.

SPEAKER_00 27:43

I've I've gone to PT for other things and it's like the easiest stuff you don't remember to do. It takes five minutes and you still don't do it.

SPEAKER_01 27:51

Yeah. And what we what we do and how we practice is if someone is like, I am struggling to get this in, yeah, I say, what can you do? And so then I can make an exercise that they do while they're brushing their teeth. It's just I it's like I will try to work it around their life instead of saying, Shame on you. Yeah. Why aren't you doing this? Like, I get it. I'm busy, I'm a mom, I have a business. Like, it's hard. I even have a hard time and I'm the PT. So it's like, okay, how can we fit this in to habit stack, I guess, to make it so it's you're an atomic habits?

SPEAKER_04 28:22

Yeah. Yes. What's always the classic uh the quote of what's easy to do is also easy not to do.

SPEAKER_02 28:27

Yeah. That's true.

SPEAKER_04 28:28

Yeah, it's just like it's it seems so menial at times that you just don't, oh, yep, you miss one day, and then before you know it's a month, and then you look back and you're like, oh, you wonder what happened.

SPEAKER_00 28:37

Yeah. It's very true. Yeah. Now while one population that I think, at least I've always heard would be uh is important to consider PT, pelvic floor PT, but I don't think it's talked about that much, is women who are pregnant. Do you encourage women at that stage to do it before problems arise? Highly, highly.

SPEAKER_01 28:56

And so we have a pregnancy program at at Ruther Health and that we work women through. And so some of it is going to be symptom-wise. It's like, okay, if you have like quote unquote fire crotch, is what some people call it, or like pubic symphysis dysfunction or round ligament pain or back pain, we'll manage those, but we also start from the beginning to prevent those because there's so many things that you can do to prevent pain dysfunction. But also we walk women through um labor and delivery strategies as well as getting their pelvic floor to relax before labor and delivery. Um because your pelvic floor just needs to get out of the way. Like that your public floor does not push the baby out. That's what I think a lot of people misunderstand. It's like we teach it how to chill so that it can labor and go smoothly. Um, it also significantly helps the postpartum rehab. It's pretty incredible. That's fun. Yeah.

SPEAKER_00 29:46

So start early, even if you don't have problems.

SPEAKER_01 29:48

Highly recommended.

SPEAKER_04 29:50

Okay. I just got another tangent. So the push when women are having what is that then? Because I assume like that, what is the push?

SPEAKER_01 29:59

Yeah. So your uterus is going to be the primary thing that pushes. When you are pushing, I mean your diaphragm helps, your lats can help. Like those are really the primary too. Your abs can help, um, but your pelvic floor should not be contracting. That is needs to just get out of the way. Get out of the way. The baby can't come out. Yes, that helps with tear reducing tearing significantly.

SPEAKER_00 30:19

Oh, that makes sense. I never thought about why that helped with that.

SPEAKER_01 30:22

Ah, okay. Makes sense. Yeah. Yeah. I've seen some women for they've had three kids and then they're pregnant with their fourth when seeing me, and they say that their fourth delivery, because they see me during the fourth, but not the first three, is so much easier. And they're like, I recovered so much faster postpartum just because we prepped their body for it.

SPEAKER_00 30:41

That's great. All women to do that. Yes, highly recommend it. Highly. And I know you don't treat men, but you didn't mention some of their issues. And so is it a very similar type of experience for men as women? Like it's not really that different.

SPEAKER_01 30:56

Yeah, it's it is very similar.

SPEAKER_00 30:57

Yeah.

SPEAKER_01 30:57

So two of our therapists at our practice do treat men.

SPEAKER_00 30:59

Uh-huh.

SPEAKER_01 31:00

And I just don't because I didn't have space on my schedule for it. Um, but yeah, so we do like full body testing. We can do an internal if they're comfortable with that, if we think it's indicated. Um we also do can do dry needling, not at the pelvic floor, but like around it, like in the glutes can really significantly help. Um, or like the hamstrings.

SPEAKER_04 31:20

Can you explain? Okay, I've heard dry needling a couple times. What is dry needling?

SPEAKER_01 31:24

Yeah, very good question. So they're really, really, really tiny needles, like very thin. So, what dry needling is is you don't inject anything. And so they're acupuncture needles that you um insert into the muscle knot or the trigger point. And what we're trying to do is improving blood flow to the area because when a muscle knot or trigger point is what that is, is a muscle, part of the muscle gets stuck in a contracted position. And when it's stuck in a contracted position, it doesn't get blood flow to it. And so then the some no-susceptive chemicals, which are like chemicals that can cause pain, get built up in that trigger point. And so what we want to do is get more oxygen or more blood flow to the muscle knot to flush those out and get that contracted part to let go. And so we're just stimulating um blood flow and stimulating sometimes you can you'll get a grab and a contraction and then a full relaxation.

SPEAKER_04 32:15

Okay.

SPEAKER_01 32:15

So it's to get trigger points to let go and improve blood flow.

SPEAKER_04 32:19

Ah, okay. I've heard the term dry labeling from a multiple people recently, and I still have yet to know that it totally makes sense.

SPEAKER_01 32:25

It's a it's honestly amazing. It works on blue, but it it really feels like it is. It's kind of cool.

SPEAKER_04 32:32

Because I'm sure probably something like that, because it seems that it's quite cause-effect. You do it, stimulation happens, it's done. Yeah. It's very like one where sometimes re like you said, you're looking at somebody, you're working through a low back brain, and you have to discern seven different things while you're working through what it may be. And then it's like if you have a knot and you dry a needle, it's like done. Okay.

SPEAKER_01 32:57

Yeah. And it can come back if you don't fix the imbalance that caused it in the first place. So like if you have a muscle that's overworking because another muscle's underworking, I still want to work on the muscle that's underworking so that doesn't come back again. But yes, it does like very fast um get rid of the muscle knot, which is super super effective.

SPEAKER_04 33:17

Where does does knotting have certain spaces, sp certain parts of the body it leans towards and others not? Like you always hear the traps, the shoulders versus like, but is or is it because I don't know, I just never hear of someone saying they have knots in their hamstrings. But um is it pretty consistent across the whole body or they tend to show up in certain places?

SPEAKER_01 33:38

I think more s more spots are more symptomatic. Yeah. But I do see knots anywhere. Anywhere.

SPEAKER_03 33:44

Okay.

SPEAKER_01 33:45

Yeah. And some are gonna have bigger knots, like more like the upper trap when we needle it, it can grab pretty significantly. Whereas some of the muscles that aren't as like trying to think of another muscle that doesn't really grab as much. Like the bigger muscles, like the hamstrings, the inner thighs, are gonna grab more because they have more mass to them.

unknown 34:06

Okay.

SPEAKER_01 34:06

Whereas some of the muscles that are thinner, like your infraspinatus, I don't the back of the shoulder blade, isn't really gonna grab because it's thin.

SPEAKER_02 34:14

Okay.

SPEAKER_01 34:14

Does that make sense? Yeah. And it's that's I mean it's not 100%, but pretty typically. Yeah.

SPEAKER_00 34:19

I mean, I thought about that. Now um you said you see a decent amount of athletes. Is there specific issues that athletes have that you've noticed that are different than the general population, or is it pretty similar?

SPEAKER_01 34:32

Yeah, it depends on the type of athletics. So I think every sport has its downfalls, right? So, like runners, you're gonna see more repetitive injuries because it's like you have so many steps that go in. Um power lifters, you're gonna see more breakdown in that core canister because you're creating more downward pressure, putting that Mini Cooper down. Um whereas cyclists, you're gonna see more like pelvic pain or nerve impingement in the saddle region because they're spending so much time sitting. So it really depends on the sport that's gonna cause the dysfunction. So I highly recommend cross-training for people. And a lot of time runners don't cross-train, runners run. Not always, but they do. Right, yeah, a lot of the time. And so I see a lot of pain and dysfunction because they're just working in the sagittal plane. They're just going forward. They don't really move use the muscles that move side to side or use the muscles that rotate. So we see a lot more wear and tear and breakdown because they're very imbalanced. Um, so yeah, I I'm a big fan of cross-training.

SPEAKER_00 35:35

Love it.

unknown 35:36

Yeah.

SPEAKER_00 35:36

Me too.

SPEAKER_04 35:37

Now I just like to lift lift heavy things and put them back down.

SPEAKER_00 35:41

You're not listening very well to this conversation.

SPEAKER_04 35:44

I do my best.

SPEAKER_01 35:45

As long as you're living in different planes of motion. Maybe not all isolation though. Debatable.

SPEAKER_04 35:52

What did I do today? Uh, I did a push. It was a seated machine uh decline chest press. And then that went into uh a seated dealt lateral raises drop set, which then you could argue their stability in play into I did uh front, I did cable front raises bilateral, so like there is some stability there. Uh like I'm not crop, but I am there's core stability. Uh I did preacher curls, no stability. Um, that's pure isolation. Uh yeah, that was pretty much all isolation.

SPEAKER_01 36:30

That might be another piece of the back pain puzzle here.

SPEAKER_04 36:34

Don't know. What are you a physical therapist? Yeah, you don't know.

SPEAKER_01 36:39

I maybe have mentioned this to him potentially. Even just alternating. Instead of doing both at the same time, do one and then the other. Like even just that can add a little bit of stability. A little. I mean mild.

SPEAKER_04 36:52

I occasionally we'll do cable crossover, like cross uh crossbody core.

SPEAKER_00 37:01

I think I've seen you do core once.

SPEAKER_04 37:05

Well, because everyone has always said when I've gone to a PT for different things, I don't have like this is the thing. I don't have a strength problem. It's a recruitment problem. Like no one ever says you're weak in a muscle. It's always like, it's always a recruitment problem. But that takes time and I don't like to take time.

SPEAKER_01 37:23

It actually can happen really fast. Actually, facilitation can happen way faster than strength.

SPEAKER_02 37:28

Okay.

SPEAKER_01 37:28

So it's just like retraining your brain that this muscle exists. They're kind of on vacation, whereas the other ones are working overtime. It's like you have a team of five and three of them are like slacking off, and two of them are doing everyone's job. And so that's kind of what's happening. We just need to like tell the other ones like pick up the slack, wake up, stop drinking a margarita and get to work.

SPEAKER_02 37:47

Okay.

SPEAKER_01 37:47

So it's it's more it actually happens a lot faster with recruitment than it does with strength. There you go.

SPEAKER_04 37:54

Noted. I think it's just a discipline problem. I don't want to do it.

SPEAKER_00 37:58

You just like what you do.

SPEAKER_04 37:59

I like what I like. Until it hurts.

SPEAKER_00 38:02

Yeah, right.

SPEAKER_04 38:03

It's like a runner. It's like, I like what I like until it hurts.

SPEAKER_00 38:05

Yeah.

SPEAKER_04 38:06

Damn it.

SPEAKER_00 38:07

Yeah. When you see people, like as new patients, is there any red flags that you are like, ooh, you really need to address this first and get this taken care of? Like before they see me? Like if they come, yeah, before they see you, or if they come into seeing and you're like, oh, you have to take care of this before I do anything.

SPEAKER_01 38:24

Okay.

SPEAKER_00 38:24

Um Does that come up ever?

SPEAKER_01 38:27

Yes. Okay. Um for like public floor dysfunction, if I'm seeing signs of a if I'm like doing internal, if I'm seeing signs of like an infection, obviously I will not do an internal. Um if they're postpartum, I don't do an internal until they're cleared by their midwife or their OBGIN. Um if I'm trying to think of other things. I also have a certification to fit for pessaries. Oh, you do? I do. Okay. Interesting.

SPEAKER_04 38:52

Um what is that?

SPEAKER_01 38:55

I know we're going on a whole nother rabble. Um pestery is something to help support the pelvic organs if they're having a pelvic organ prolapse.

SPEAKER_02 39:02

Okay. Gotcha.

SPEAKER_01 39:03

Um and so if they have really low vaginal estrogen, the tissues are going to be really sensitive and really thin. And so I personally do not like to do that until they get vaginal estrogen from their doctor if it's indicated. So I will very often recommend them to see their physician before I um she's another proponent of vaginal estrogen.

SPEAKER_04 39:24

We actually had a whole episode. Not okay, the whole episode was not on vaginal estrogen. We had an episode that involved vaginal estrogen. And I learned a lot there too.

SPEAKER_01 39:33

It can be so helpful. So and especially if like for pelvic floor dysfunction, especially people in their perimenopause or postpartum, I see a big um change in their vaginal estrogen as well. It can make symptoms a lot worse. It can actually cause leaking because their tissues aren't strong enough. It can make prolapse feel worse. It can so it's that's something that we test for and we look for with every patient.

SPEAKER_00 39:59

Yes, our other guest also is a big proponent of that. Give it out like candy.

SPEAKER_04 40:05

To the point where her husband's an ER doc. Yeah, he's actually prescribed it like twice.

SPEAKER_00 40:09

She's like, he prescribes the most vaginal estrogen of any ER doc.

SPEAKER_01 40:13

That's amazing.

SPEAKER_00 40:16

Oh, I know. I know, right? Yeah. I think a lot of doctors have no idea what it is or don't use it much. But and so how uh how did you get interested in pelvic floor? How did this become your thing? Yeah, good question.

SPEAKER_01 40:28

I I had pelvic floor dysfunction myself that no one knew how to fix. So I one night in the middle of the night, I woke up with like excruciating pain. It felt like someone was like trying to claw their way out of my lower abdomen, is the best way I could describe it. And so I had to crawl to the toilet, right? Like proceed to throw up for like 30 minutes from the pain. And then after 30 minutes, it started to subside in 45 minutes. I was like, fine. I was like, what the heck just happened? I went to bed. Because why go to the ER? I thought don't it's gone. Don't do that. But um, I went to bed the next morning. I called my doctor and I was like, okay, something's wrong. And they ordered a pelvic ultrasound. It was clear. And then I went to OB, and their best hypothesis was I had an ovarian cyst that burst, but it wasn't because it kept happening again and again and again. And so then I just dove into research because it's what I do. And that was when I was already a PT. And I found I had something called pelvic venous congestion syndrome. And so blood was pooling in my lower abdomen because it couldn't, my pelvic floor was so overactive, it wasn't allowing um that venous return properly. And so I figured out the the fix was pelvic floor PT. And I was already PT and I had no idea what it was. Really? Yeah. But venous congestion syndrome was at least. Oh, interesting. We had like one lecture on the pelvic floor in school. It's terrible. It's horrible. Does that change or is it still that way? Now it's like a week of lectures. It's for how much it does, it's like maddening how little pop PTs know. And so I had a crazy high deductible. So I could either go to public floor PT and pay like $450 a visit for my that's what if your deductible is not met a lot of time in network, that's what it cost is. $450. Yeah. Oh. It's crazy. Um, not always, everyone's different, but that's pretty standard. Or I could pay to get the certification myself and then help other women. And so that's the route I did. And I fixed myself, and now I can help other women. So that's awesome. Yeah.

SPEAKER_00 42:20

I think a lot of people go into something because of personal experience. Yeah.

SPEAKER_01 42:24

Which I think is super helpful because it makes them so much more motivated to help because they know how it feels to not get answers and to feel like hopeless. And also like some practitioners, not all, of course, hopefully not, will kind of tell women it's in their head or like to just deal with it. Or I've heard some physicians, OBs, say, just have a glass of wine if people have pain with sex, or just light a candle. I've had what? Yeah. It's it's not okay, to be honest. It minimizes these women's and then they and then they deal with it. And then literally, sometimes it takes one internal to have people not have pain with intercourse anymore. Not always, but sometimes it's it's so fast and so simple. And it's instead of it being the last case resort, it should be the first. Um, because you can change someone's life, change someone's marriage.

SPEAKER_00 43:16

Right. Um how did you uh how long did it take you from figuring like from saying, Hey, I'm gonna figure this out myself to when you felt like you got it?

SPEAKER_01 43:25

Like till I like felt like I really understood it.

SPEAKER_00 43:28

Yeah.

SPEAKER_01 43:29

I think I'm still understanding it. Okay. I mean, I don't think I'll ever stop because research is so behind the ball. Um, is that the right phrase? I don't know. Research is is so behind in female, um, especially polyphi core PT, because it really is a pretty new development. Um, and also a lot of the courses are very behind as well. Um, and so a lot of what I have learned is just my own research myself, a lot of me digging into the physics, the biology, Mechanics, the anatomy of it, a lot of trial and error. And I have taken a ton of courses from multiple different programs. Um, but a lot of it is just like figuring out myself and doing my own research and really looking at the anatomy. And I love physics. So looking at how everything works together. Um David would get along.

SPEAKER_04 44:18

What was the what was the joke I did last time recently on that? I don't know. What did we do? Oh, I was explaining what did I it was something with physics. Uh oh, I went through we oh, it was uh it was when we were in Europe and we were uh someone dropped something in the in the yes, that's what it was. We were hiking Aetna Aetna and one of the volcano uh there was a volcano tube, lava tube there, and you could drop a rock. It was that sketchy one when you were still walking outside. Um and you can drop a drop a rock to see how far it is. And then it was like, well, just count how many seconds, and uh then you can do the like do basic physics. Like, well, actually, I looked at the I think I think I wasn't talking to you, I was talking to this other woman, and I go, Well, actually, you have to subtract the sound it takes to come back to. So while it's that it's not just down, it's also back. It's just she looked at me like with this little smug face. I'm just like nerd.

SPEAKER_00 45:18

I love nerds, I'm such a nerd.

SPEAKER_04 45:20

Too funny.

SPEAKER_00 45:21

Cool. So you're still learning continuous education. I don't think I'll ever stop.

SPEAKER_04 45:26

Except for that, so I'm a little more on in specific. From when you decided to take the class and learn it yourself to basically fix yourself, what was that timeline?

SPEAKER_01 45:37

Let's see if I can remember. This was like nine years ago. Yeah. Um I'm like, is it months?

SPEAKER_00 45:43

Is it years?

SPEAKER_01 45:45

I mean, at this point I didn't know how to efficiently treat.

SPEAKER_02 45:47

Okay.

SPEAKER_01 45:48

So I think like I mean, two to three months.

SPEAKER_04 45:53

I was trying to figure out what you want to do.

SPEAKER_01 45:55

Yeah. So I was still learning. I mean, I didn't have any education in the public except like one lecture. So now I'm so much more efficient at it. And as much as I say, I'm still learning. Like, yes, I am a specialist in this. I am very good at treating this. Um, but I just I think there's constantly more research that's coming out, constantly more information that you'll always be learning about it, just like any medicine, right? Um, but I would say for myself, in the very beginning, I think it was like three months.

SPEAKER_04 46:21

Oh, 100%. Well, it's just like well, because half the rehab stuff of different processes weren't even created yet. So you wouldn't even know what to do. Right. So yeah, the m the fact that it took at least three months makes sense.

SPEAKER_00 46:33

It doesn't even sound that bad if you put it that way. Yeah, yeah. Cool. And um, is there something else that you felt like you pe or I guess what is the thing you would want people to really remember about the pelvic floor? Is there anything specific?

SPEAKER_01 46:47

I think the pelvic floor is only as strong as the system that it's within. So you can't just take the pelvic floor out of the rest of the body. You have to treat the whole system, not just the pelvic floor. And that is gonna get you the fastest roles, the best results, and the results that actually stick. So you don't have to just keep doing Kegels for the rest of your life. A lot of times Kegels actually make people worse. So it's like just stop.

SPEAKER_04 47:13

I think I remember Kegels. Can you explain Kegels real quick too?

SPEAKER_01 47:16

Kegels a is a pelvic floor contraction. Yeah. So it's just like pulling up. Yeah, I'm gonna do that. So it's like trying to stop gas from passing, is the b is what some people describe it as. That's what I thought. A lot of people do it wrong. And then even if you are doing it right, like I said, you can't just assume that's what someone needs because there are so many things that and it can be an overact, it's kind of like if you were to test my grip strength first thing, and then I were to squeeze my fist all day long, and then you were to test my grip strength at the end of the day, it's gonna test weaker because it's tired. And if your answer was okay, let's let's do more grip strength, it's like it's not gonna fix it. No, just stop freaking squeezing your fist, and then you're gonna get more strength back once it can rest. So it's kind of the same concept as if you assume that weakness is caused from true weakness, you could be actually making the symptom worse. Cool.

SPEAKER_00 48:06

Any other questions you have, David, on that?

SPEAKER_04 48:08

I'm thoroughly proud of my four questions.

SPEAKER_00 48:11

And do you want to plug uh your practice and your socials? Yeah.

SPEAKER_01 48:19

We have a practice called Rutherford Health and Wellness. It's in Holland, Michigan. Um, and we do both orthopedics and pelvic floor. Um, and every single practitioner in our office is trained in our method, so the Ruther method. Um I also have an Instagram where I share knowledge on at Kelly K-E-L-O-Y, Ruther, R-U-T-G-R-P-T. Um, and that I just kind of share the behind-the-scenes stuff of what the cause is, what is often missed, and kind of just more of the education understanding around both both orthopedic and pelvic floor conditions. She's great. Uh she's great.

SPEAKER_00 48:51

I learned from you when I see your videos. So everyone should go check that out. And if you're in town, you should go see her. Well, or one of her fellow practitioners. So all right, cool. Well, uh anything else you have to add before we think that's a good one.

SPEAKER_04 49:03

Well, this is a pleasure. I learned a lot about the pelvic floor.

SPEAKER_00 49:05

I feel like I could learn. I have so many more things. Oh, yeah, like I really want to know. But there's I could talk for hours on this. I believe that. I could have you like sleep. You know, like, hmm, what problems can you fix for me? No.

SPEAKER_01 49:18

Um, we'll just have to go a bit there in Holland. Yeah. We'll fix that back pain.

SPEAKER_04 49:23

It's a constant. It's a war every I blow up my I I usually throw out my back once a year, maybe every two.

SPEAKER_01 49:31

Oh, you probably don't need to do that. I know.

SPEAKER_04 49:35

And it happened recently and it was quite brutal. Oh. But we're through it. Okay, great. Until the next time.

SPEAKER_00 49:43

All right. Uh thanks for listening, everybody. Uh, send us your questions. And if you have other local West Michigan people you want us to talk to, we look forward to it.

SPEAKER_04 49:53

Absolutely. With that being said, have a phenomenal day, and we'll talk to you all later.

SPEAKER_00 49:57

Bye.