Barbell Shrugged - Optimal pelvic health for improved mobility, strength, digestion, and SEX — Muscle Maven Radio Episode #13

Episode Date: May 2, 2019

Tamra Wroblesky, PT, DPT is a pelvic physical therapist and co-founder of Inner Dynamics pelvic health and orthopedic clinic. She is a graduate of Thomas Jefferson University in Philadelphia, PA. Tamra is an avid mountaineer, summiting Mount Kilimanjaro, Pico de Orizaba, and Mount Rainier. She ran the Ocean Drive Marathon, and frequents the gym for weightlifting. As a former collegiate athlete with an active lifestyle, Dr. Wroblesky has special interests in treating the female athlete, with an emphasis on preventative protocols to limit injury. She is a USAW certified Sport Performance Coach and works closely with several weightlifters, including Katie Montague who took home 6 gold medals when Tamra accompanied her to University Nationals in spring 2017. She also works closely with Crossfit boxes and USA Weightlifting to give her "Pelvic Health for Performance" lecture and her “Supercharge your Pelvis” article can be found here on USA Weightlifting’s website. Dr. Wroblesky became interested in pelvic health physical therapy after her own medical obstacles dealing with severe pelvic and hip pain over six years. She has had several surgeries, including two hip labral tear repairs, allowing her to be mindful of the patient experience.   This episode is all about pelvic health, and how proper pelvic function can have an impact on chronic pain, sexual function, mobility and physical performance, digestion and bowel function, and much more. Ashleigh talks with pelvic health specialist Dr. Tamra Wroblesky about the most common issues she helps her clients with, including incontinence, prolapse, and chronic pain; how to know when you should see a pelvic specialist rather than another doctor or specialist; things you can address personally before medical intervention to optimize your pelvic health; how to educate yourself about options when faced with possible surgeries; and what exactly is a bowel massage? All that and much more in this week’s episode of Muscle Maven Radio.   Minute Breakdown:   3 - 12 An introduction to Tamra and what a pelvic physical therapist does; the issues she deals with the most for men and women including chronic pain, incontinence, prolapse, sexual dysfunction and digestive issues; and how she came into the profession after her own issues as an athlete with injuries, unnecessary surgeries, and painful sex    12 – 23 What signs or symptoms or things you should be aware of that you might want to consider seeing a pelvic specialist for including issues around sexual function and bowel movements: a lot of information about what “a normal” pee and poop schedule should look and feel like!     23 – 30 why women need to be extra careful managing pressure because of our physiology; talking about peeing during exercise, leaking while lifting, and why we should take it more seriously—and why kegels aren’t always the answer      30 – 36 walking through the process of seeing a pelvic health specialist; how they gather information and identify and address the issues       36 – 48  How proper breathing mechanics and recovery relate to pelvic health and physical performance   48 – 57 Talking about the complications of hip and labral surgeries, how to do the right work and PT for your joints both before and after surgeries –how important it is to be consistent and patient, how to know when surgery is necessary, who to talk to and see before taking that step     57: Five Key elements of bowel health. Also…what’s a poop massage?   ----------------------------------------------------------------------- Show notes: http://www.shruggedcollective.com/mmr-wroblesky ---------------------------------------------------------------------- ► Subscribe to Shrugged Collective's Channel Here http://bit.ly/BarbellShruggedSubscribe 📲 🎧 Listen to the audio version on the Apple Podcast App or Stitcher for Android Here- http://bit.ly/BarbellShruggedApple http://bit.ly/BarbellShruggedStitcher Shrugged Collective is a network of fitness, health and performance shows that help people achieve their physical and mental health goals.  Usually in the gym, but outside as well. In 2012 they posted their first Barbell Shrugged podcast and have been putting out weekly free videos and podcasts ever since. Along the way we've created successful online coaching programs including The Shrugged Strength Challenge, The Muscle Gain Challenge, FLIGHT, Barbell Shredded, and Barbell Bikini. We're also dedicated to helping affiliate gym owners grow their businesses and better serve their members by providing owners tools and resources like the Barbell Business Podcast. Find Shrugged Collective and their flagship show Barbell Shrugged here: SUBSCRIBE ON ITUNES ► http://bit.ly/ShruggedCollectiveiTunes WEBSITE ► https://www.ShruggedCollective.com INSTAGRAM ► https://instagram.com/shruggedcollective FACEBOOK ► https://facebook.com/barbellshruggedpodcast TWITTER ► http://twitter.com/barbellshrugged

Welcome, everybody, to Muscle Maven Radio. I am talking today about one of the most, perhaps the most important part of our body, and that is the pelvis. The pelvis is literally and figuratively at the core of our being and thus our health, and it's a place where a lot of our power comes from. It's the place where a lot of stuff's happening, including basic movement, digestion, sex, birth, you know, all the important stuff. So today I'm speaking with Dr. Tamara Robleski.

She is a pelvic health specialist, a women's health specialist, and co-owner of the Interdynamics Physical Therapy Clinic in New Jersey. We met a few months back at a Art of Breath seminar that was happening in Jersey, and I just had to talk to her. She works with athletes and regular people on their pelvic health. She works closely with a lot of weightlifters and female athletes, because as usual, we have a little bit more complicated down there. There's a lot more going on and a lot more that can go wrong. So we talk about her work and the major issues that she sees in both men and women. We talk about her work and the major issues that she sees in both men and women

We talk about her background and history with injuries and pelvic complications And of course we talk about a lot of things that are not really for the faint-hearted and I realize that this may be a theme with my podcast whether I'm talking about sexual health or pregnancy or lifting or whatever. I seem to really like asking people questions that the general population may be a little bit squeamish to talk about. So we get into things like peeing and pooping and what those acts should feel like and be like when you have a healthy pelvis. And she gets into a lot of detail. She's pretty passionate about it. She explains to me what a poop massage is.

So that's in my brain now and in yours too. So you're welcome. Uh, we talk about sexual health and sexual pain, which, uh, is an issue for a lot of people and how that can be related to pelvic health and how a lot of people maybe aren't getting the help they need because they're going to the wrong specialist. Like you might be going to, um, an OBGYN or somebody when really it's an issue that a pelvic specialist could help you with. Like she tells stories about men who are coming to her with discolored penises and their partners think they have STDs and they're getting in big trouble when really it could be something as tame as a pulled muscle. So there's a lot going on that can affect your sexual health and performance. We talk about that. And we also talk practically about some of the assessments and proactive things that you can do to figure out if you have a healthy functioning pelvis and some of the issues that a specialist can help you with.

Basically, a ton of information on what it means to have a healthy pelvis, what it can mean to have an unhealthy one, and how you can address any issues that you might have so that you can make sure you're performing optimally in every area. So this one's got a ton of information. Dr. Robleski is awesome and super knowledgeable and it's good for everybody because newsflash, we all got a pelvis. So that's it. I hope you enjoy the episode. If you do, please share the love. Leave me a nice rating and review on iTunes under Shrugged Collective and share this episode

on your social media. You can tag me at The Muscle Maven and tag Shrugged Collective and Interdynamics PT. So that's it. I hope you enjoy it. And in fact, even my first name, just because it's spelled slightly differently. I mean, I have a pretty like Ashley, especially for someone born in the 80s, is a pretty common name. But I get like Alicia at least once a week. Like people just don't pay attention. Right.

So anyway, I'm just very, very hyper aware of saying people's names properly. So, yeah. Awesome. Anyway, Tamara, thank you for taking the time to be on the podcast and chat and teach us all something today. I appreciate it. I'm happy to be here. Happy to help. So we actually met a couple weeks ago. And it was like a lucky meeting for me because we were both attending the power speed endurance art of breath seminar in Jersey there. And you were giving us all a lot of great information. And it and as somebody in your group, I guess was kind of talking about, we had like broken into groups, and we were talking about something. And we're like, where's all this great information coming

from? It's like, oh, you're a pelvic health specialist. That's why. Also, what is a pelvic health specialist? So I'd love for you to just kind of start and tell us a little bit about yourself and how you got into this line of work. Absolutely. So my name's Tamara. I'm at the Jersey Shore right now. I'm the co-founder of Interdynamics Physical Therapy. We're a pelvic specialist clinic, but we're very orthopedic based. And we've been open for about four years now. And we actually just opened a second location in Toms River, New Jersey as well. And I think that just shows how much we've truly grown over the past couple of years because pelvic health is everywhere. And I hope everyone gets that from today that, you know, a child has a pelvis, a man has a pelvis, a woman has a pelvis. And I hope everyone gets that from today that, you know, a child has a pelvis,

a man has a pelvis, a woman has a pelvis. And for some reason, there's a lot of practitioners that just kind of forget about it or don't look closely enough at it, especially when you're having low back issues, abdominal issues, hip issues, leg issues. So a pelvic specialist basically takes us a good pelvic specialist takes a step back, looks at your whole body and sees how your pelvis, your core is interacting with everything. And so there's certain things that we treat a lot, which is, would be incontinence, whether it be urinary or fecal. So that's when you're peeing or pooping when you shouldn't be. We treat a lot of prolapse. So that usually is with women post-pregnancy who have kind of this falling of your pelvic

organs. But I've also seen men with prolapse of their rectum if they're straining a lot on the toilet. We also see a lot of chronic pain. So we see a lot of pelvic pain, whether that be for women, vaginal pain, pain during sex, for men, testicular pain, penile pain, pain during sex, groin pain, low back pain, hip pain, all those things that kind of happen if you look like under your rib cage to past your hips. That's really where we take a close look and see what's going on there. And then, sorry, the other big thing we treat is constipation and a lot of abdominal issues like post C-section scars, post hernia surgeries, things like that. Okay, tons of questions already. So that's great. What did you what what brought

you into pelvic health specifically? Like what made you decide to pursue this career? My path was that when I was 18 years old, I was I was a college athlete. And then all of a sudden, sex started hurting. And it had never hurt before. And I just remember, I remember exactly where I was, it was a sharp pain. And then from there, I just got led down a rabbit hole of all the wrong information for almost six years. So whenever you're having pain in these areas, which people to the OBGYN. And then they do lots of testing. They make sure you don't have a UTI. They make sure that you don't have a bacterial infection. They don't make sure you don't have an STD. Then they do a biopsy.

And then you go through all of these things and no one can figure it out. And then now that your pain has become chronic, it gets worse and worse and worse and kind of leaks into your glutes and your inner thighs and then you're not moving great. And then I kind of just got led through all these wrong things. And then finally, I actually started writing a blog about everything that I was going through. And someone directed me to go to a pelvic PT all the way out in San Francisco at the time. This was many, many years ago because Um, cause there was not a lot of good pelvic PTs out there doing this work. So I went out there, they took a better look at me and like actually showed me how the hips and the pelvis interact together. You know, I was a tennis player. I was doing a lot of asymmetrical rotation. Um, and so then I came back, I had two labral, um,

hip surgeries, which we can, that's a whole nother story, which I don't think I actually needed at the time. But now I actually treat a lot of people who are either post that surgery or who have labral tears and we're trying to avoid surgery. And then I've had a groin surgery as well, which I also didn't need, but I didn't know at the time. And then I decided I've done all of this stuff and I've been led all the wrong ways. I want to become the person that I needed 10 years ago. So I wanted to go back to school and become a pelvic PT. And that's kind of how I am where I am today. Okay, that's amazing.

And now I have so many more questions. But it does seem like from my research, like all the people that I interview that are doing like really kind of important work or work that they're passionate about or successful, it's because they are doing something or created something or offering something that they need it. So I think that's really kind of interesting that that's how you came to it. And then I want to go back to the painful sex thing, because that's an important topic. But just to rewind it a little bit. So you were saying that you guys

have like an orthopedic focus. Does that mean that you're like focused on the musculoskeletal kind of part of this as opposed to other parts? Or can you just kind of explain that a bit? Sure. I think right now there tends to be two camps of pelvic PTs. And this might be for any specialist. Like if you go to a knee specialist or a hip specialist, when you become a specialist, I think the problem is people then just look at that part of your body when you come in. And that's important to be an expert in that part of the body. But you also have to realize that your whole body is a system and other things are going to play a role in that. So I guess by saying we're very orthopedically based is that when you come in, we're not just going to do a pelvic assessment. A lot of people

get really scared to come into a pelvic PT because they think all we're going to do is do an internal exam on you and that's it. And while that might be very valid and very important, sometimes we don't do that. And sometimes we're looking in a completely different area than your pelvis. A lot of times our pelvic muscles tend to get tight in reaction to something else, usually pressure from above. So which is usually like improper breathing and constipation and mid back mobility issues. And then sometimes it's from below like chronic ankle sprains leading to problems in your gait or problems when you lift. So we take a real big step back and look at your whole body, which I think is so important for people. Absolutely. I mean, I think that's something

that we're starting to see with general health too, is people who, and it seems like it is more of an issue in the States. Like I'm Canadian and American. So I have access to an experience with like the medical system in both countries. And Canada is this way too, but even more so in America, like we are all about specialists. Like we have our finger hurts. We go to like the finger doctor instead of, and they never are connected. You know, like we never kind of connect them all all. Our doctors aren't communicating with each other. We don't know how these things connect or begin. And we're kind of treating symptoms all the time. And it seems like from what very little I know about the work that you're doing, it is a very

complex and layered area. And it's a part of our body that there are just so many things going on. And the issues can be, as you said, coming from so many different places. So I guess my next question is, and this goes back to your challenges and your issues before, how do we even begin to know that whatever our issue is, or whatever we're suffering with, could be something that a pelvic health specialist could help us with? So if we're having painful sex, or whatever we're suffering with could be something that a pelvic health specialist could help us with. So if we're having painful sex or if we're having, if it hurts, our low back hurts when we lift or when we walk or when we sleep, or if we're having digestive issues, how would we even begin to know that you guys would be the place to go for help?

That's a great question. And I think the best thing to do is to, for me to kind of give you a basis of what's normal and what's not. And if you're, if a lot of these boxes, you're kind of checking off like, Hey, that makes sense. That sounds like me right now. If you're checking off a lot of those boxes, it's probably a good idea to go get evaluated by a pelvic PT. So when we talk of why it's so important to see pelvic health as an orthopedic issue is because there's these muscles in your body, just like there's muscles anywhere else in your body, but they get this taboo aura around them because they're involved in sexual function. They're involved in your bowel and your bladder. And so then people aren't so willing to talk about it.

I've had a ton of male patients come in recently, both athletes and non-athletes, who were so nervous to come in and so nervous to talk about this and really went the wrong direction where they went to their urologist and who treated them for pseudo-UTI, put them on antibiotics, which is not good, and didn't give them the right diagnosis when really it was just a simple muscle strain, like a simple either pelvic or hip strain that then caused all these other weird symptoms. So when you want to break it down, I actually wrote an article about this for USA Weightlifting, which is called Supercharge Your Pelvis. So I'm sure we can link that to this episode.

That lays out everything really great and talks about all the things I'm about to discuss. But you want to take a look. When you're having any sort of pain or problems from below your rib cage to kind of below your hips, you want to take a step back and see what else is going on. So you want to make sure that your bladder is okay. So when with our bladders, we should be able to hold for on average two to three hours a day, then that should be pretty easy to do. Now, if you're drinking a lot of water, obviously, that's going to change a little bit. If you're drinking a lot of alcohol, that's going to change a little bit, but you should feel comfortable with holding your bladder. Shouldn't cause increased pressure

in your stomach or your groin. You should feel no urinary urgency to go. And when you go to the toilet, you should have a nice steady stream. It should come out right away. I have a lot of people who have problems starting their urine stream. It shouldn't dribble when you're done. And then also take a look at your stream. It shouldn't be going to the right or the left. When we talk about these pelvic muscles, there are these small little muscles that lie at the bottom of your pelvis. And then on either side of those pelvic muscles are actually hip rotator muscles.

So just like you have a rotator cuff of your shoulder, you have a rotator cuff of your hip, which no one really talks about. Most people know what the piriformis is, but they don't realize that that's part of that cuff. And one of your muscles, your obturator internus is an internal muscle, and then it actually comes out and is an external muscle. So it's a really poorly designed muscle and is prone to a lot of problems because it sits on the side of your pelvic floor and then comes out and around and attaches to the side of your hip. Which is why I have so many people who have chronic hip pain and then also have, you know, some bladder issues that are just blown away when they come in.

And I tell them, no, it's just like a simple hip strain. So you want to make sure all of those bladder things are okay in your body. And then the next is your bowel. So your rectum actually sits to the back of your bladder at the bottom of your body and your pelvic floor helps control that as well. So you want to make sure that you're pooping correctly. You should be going one to two times a day. And I have so many people who come in and I ask if they're constipated and they go, oh no, I go like twice a week and I go, that's constipated. So there's new research out where maybe if your whole life you've been going

every other day, maybe that's normal for you and that's okay. But for the most part, you should be going every day and it shouldn't be a whole long process. You should be able to sit on the toilet, relax your pelvic muscles and it should come out. There should be no straining. It should look like a nice, firm log that's not too hard, not like rabbit pellets, not too soft like diarrhea. You should feel completely empty when you're done. And you should have obviously no pain with your bowel or your bladder. So that's bowel, bladder.

And then I'd say with sexual function, that's a big one too. So I have men who come in with red penises and are freaking out because their wife thinks that they have an STD or that they don't know what happened. And that's actually, there's branches of nerves that come out towards your testicles, towards your penis that can get it affected and actually cause that redness. So that can actually just be a somewhat of a simple hip strain causing those symptoms. So if you're having any sort of penile pain, testicular pain, for women, if you're having any vaginal pain, vulvar pain, if you feel that deep pain during

sex, if sex doesn't feel pleasant at all for both men and women, if it's difficult to orgasm, if it's painful to orgasm, all of those things could be related. If you see a change, men, in your erections, if it's difficult to get an erection, if it's painful to get an erection, all of those things are so closely related to these pelvic muscles and these hip muscles that it would behoove you to go to a pelvic PT just to get assessed and to see what's going on. Wow. There's so much going on here that I had never heard of or thought about. Or I mean, the whole like discolored penises thing. Like imagine the conversations that are going on at home when the

poor guy's just like, I don't know what's happening either. And the wife is like, sure you don't, dude. Like, sure. Exactly. It's such a hard thing to talk about. So at least I think if people can start to understand that how closely related all of these things are and start to talk about it more, that that's what I'm looking to do. Because when I was going through this, you know, 10, 15 years ago, everyone was quiet about it. No one wanted to talk about it. And it's not like I want to shout from the mountaintop about my vagina, but we should be able to be able to talk about these issues in a safe way and in a way that we understand that it can be very closely tied to orthopedics, to our fitness, to a problem. Like we can talk about a low back strain, no problem.

If we're out of work for a long time, that's like an acceptable excuse. But we can't talk about some of these issues just because where they are and how close they are to other things in our body. Yeah, that's so interesting. Okay. All right. So I have some specific questions that I want to ask. But first, because our listeners tend to be fitness people and people who work out a lot and lift a lot, do you see different challenges or issues for people coming in who are big time kind of fitness people, people who work out a lot, people who lift a lot of weight versus more sort of chronic just life issues? Like are there kind of different challenges that people need to be looking out for when they're lifting a lot of weight or working out really hard? I've seen certain

patterns emerge in athletes. And I think I can still see those patterns in the general public. But yes, and most recently, especially with with all my high level athletes, I see a lot of left sided hip pain, left hip pain that doesn't resolve. And a lot of these athletes are constipated and having bowel issues. And obviously, you know, your descending colon is on the left side of your body. So if that's not emptying fully, you know, your descending colon is on the left side of your body. So if that's not emptying fully, you actually have this extra weight that you're carrying around on the left side of your body. So obviously, your left hip muscles are going to get tight to try to support that weight throughout the day. So that's something I've seen actually

very, that's very common. Because again, when you're working out a lot, you need to make sure that everything is working okay. Are you drinking enough water? Are you balancing enough protein to fiber? Are you getting enough recovery? Are you getting enough sleep? Things like that, that would affect, that would affect your bowel movements. So left-sided hip pain, I see a lot of groin pain with athletes. And groin pain being like if you go to your lower stomach, like right on either side of your pubic bone, a lot of men and women have groin pain, whether it be both sides or one side. That's actually that obturator that I talked about. That's where it is in the front on either side of your bladder. And then it kind of wraps around.

Take a picture of it online. It's very hard to describe if I don't have my pelvic model. But then it wraps around and goes like down your sit bone and then out the back of your hip and attaches to the side. So very often they'll have like problems with that either because they have kind of lack of hip mobility issues. So a lot of athletes don't really work enough on their hip internal and external rotation. So I have a whole hip mobility series that I do with people and have them work on, especially with weightlifting, because it's usually in one plane for the most part. And then, you know, with that muscle, there's also problems with a lot of pressure from

above. So that can also be constipation that can also be a lot of athletes don't really work enough on their, their thoracic mobility, rib cage mobility. I see a lot of athletes who are working out a lot. And this is why I also, you know, took that course with you a month back, because our breath is so important. So our diaphragm is actually the top part to our pelvic floor. They lie in this cylinder together, and they're a whole pressure system that work throughout the entire day. So if your diaphragm is not moving in the way that it should, then that's going to affect your pelvic floor, your hip muscles, things like that. So I see a lot of athletes who don't do recovery breath enough. And that's something really interesting that I've noticed as well. What about differences between men and women athletes do

because we've got even more complicated machinery, probably, than men do. Is there anything that we encounter as women who are lifting a lot of weights that men don't have to deal with? Right. So women have an extra hole. And with that extra hole means that we need to be even better than men at regulating pressure. And this I talk about in that article, if you take a look at it. So I love weightlifting. I love working out. Weightlifters more than any other sport than I can think of need to be like excellent pelvic health people. You need to be able to regulate pressure the best because you're lifting so much overhead than any other sport that your system needs to be working very efficiently or else you're

going to see problems. So with women, a lot of the athletes that come see me have all the issues that I just talked about with pain, but they also have problems with incontinence. I see a lot of women who are leaking on the platform or leaking during double unders during CrossFit or the other big one is box jumps that they're leaking. And they've been doing this for so long and not ever realizing that it was a problem. And that's something that I'm really trying to change as well, because even still every day I see people and they almost laugh it off like, oh yeah, that's just been going on. Or I joke about that with my friends and I don't want

it to be joked about anymore. I want it to be taken seriously like it's an injury because there's so much that you can do to fix that. And once you do fix that, my female athletes are lifting so much more than they ever have and feeling awesome. So a lot of incontinence and then pelvic pressure as well. So I have a lot of women with prolapse. And so they feel that pressure when they're lifting, especially when they're lifting overhead or doing max lifts.

So we work with that as well. is the concept of, I think a lot of us, when we think about issues with like leaking or like peeing while we're doing double unders and maybe post-pregnancy issues like that, we think because we have like weakened pelvic floor muscles and we need to do more Kegels. But I've just recently learned that there is, there can be equal challenges when you have like an overactive pelvic floor versus an underactive and that just kind of prescribing like everybody just do Kegels all the time doesn't necessarily always help everybody. Can you talk a little bit about the difference between maybe having like underdeveloped or underactive muscles there versus overactive and how you kind of deal with both sides?

Sure. That's basically if you told someone, hey, I want to squat more. I'm having, I don't know, I'm having problems getting higher up in my squat. And then I gave you bridges to get better. That's essentially what saying to a woman, like, just go do Kegels is it's what a Kegel actually is, is a pelvic contraction. So it's actually engaging those muscles at the bottom of your body, which is absolutely very important. But like you said, you need to take a step back and look at what the true issue is. Maybe I have a lot of people where they're very tight. And so by further contracting them, you're just going to make things worse. A lot of times these muscles aren't really

supposed to be playing a large role in stabilizing our pelvis their their job is to support our organs throughout the day and then they're like marathon runners they're supposed to have this low level tone throughout the whole day so we don't pee or poop ourselves and then when we go to the bathroom they have to fully relax so that we can go to the bathroom and then they go back to being that kind of that low level tone throughout the day. So they're really endurance muscles for the most part. Now, when you do higher level activities like working out and you go and you do the jumping motions or heavy lifting overhead, yes, then they have to work a little bit harder. And then that's where the sprinting comes in with the fast twitch fibers. But then after that, they need to learn how to relax

and go back to being marathon runners again. So a lot of times they don't do that. So we need to work on actually down-regulating them versus just kegeling. And then a lot of times, like I said, that hip muscle is so closely next to your pelvic floor that if you have really bad hip mobility or hip tightness, that that can actually pull on your pelvic floor. So that even if you went to go do Kegels, it wouldn't really work effectively because you're kind of getting pulled to the side by that hip muscle. So you can't really strengthen what's in the middle. A lot of times

when people are having incontinence or pelvic pressure, things like that, what we're most working on is number one, you have to make sure that you maintain your breath throughout all these exercises. I see a lot of athletes who overdo and they're holding their breath for like 70%, which is not good. So anything, I tell my athletes, anything 80% or less, I want to make sure that you're holding, that you'll be able to maintain your breath throughout and that you're not holding your breath. Holding your breath is a very advanced technique and the Valsalva really

shouldn't only be used until you're at these really high, high rep or your one rep max. You really shouldn't be using that very often because that is something that should only be used, you know, just a tiny part of your training program. So you really need to maintain your breath. And then a lot of these people, I'm working a lot of core stability because your core is this big muscle that wraps around your abdomen that kind of catches all that pressure before it goes down your pelvic floor. So we do a lot of core work and core work is not just crunches. You have to be able to do core work in different planes. So we have a video on our website called the magic

ab video, go take a look and see if you can get through that. I had one of my athletes do that for me. And that kind of kills a lot of athletes that try and do that. So if that's hard for you, then you need to be doing that more. I also see, for some reason, a lot of CrossFitters that I see have weakened adductors. So your inner thigh muscles, some really, really strong guys who they really don't have anything there. Um, so we do a lot of exercises for that. And then I have a lot of people who have, um, weak hip AB doctors. So your glute med, which is a lot of, um, lateral plane movements, that's crab walks, side lunges, things like that. I think more and more people are getting better with that. I think, um, the athletic world is starting to have more of those exercises. Um, But I still think that there's problems with core stability and,

and big muscles surrounding the pelvis, not, not working correctly. Okay. So because I do want to give more attention to some of these issues that, that women are dealing with that maybe we either don't talk about or we joke about, or we kind of just play off as something that like, Oh, it's just another awesome thing about being a woman is that you may pee while you do double unders. Like let's, let's think about that a little bit more. So if someone comes to you and they're, they're having this issue, they're saying, you know, I'm fit and I work out all the time. And sometimes when I do box jumps, I'm like peeing a little bit. What do I do? Can you just walk us through like the kinds of testing or whatever that you would do to

kind of determine, first of all, what the issue is and then how you would address it? And I know that this is obviously very individual and that people are going to come in with really sort of like personalized challenges or issues. But if you can just kind of like high level walk us through the process of discovery there. Sure. So if you came in and told me, Tamara, I'm leaking during box jumps, and that kind of that's your problem. So then I would ask you, are you leaking during any other activities? So first, I need to find out exactly when you're having the incontinence because that tells me where we need to focus. So I have some people where, no, it's literally only this one activity. It's the jumping movement. So double unders, box jumps, things like that. Okay. Then I see that,

can you do that activity at a lower level and not leak? So for the box jump, like what height are you leaking during the box jump? Can we bring it down halfway to where you're not leaking at all? Because I need to find that threshold. So when treating incontinence, it's all about trying to step as close to that line as you can, but not cause the incontinence. That's really the true trick because the closer we get to that line, we're able to make changes in your musculoskeletal system so that we can continue to push that threshold up. So if I can get you to jump at a lower box and you're not leaking, then I would just have you work in that for a longer amount of time and to allow some muscles to catch up. So I won't know right off the bat and have to take a closer look at you. But it just might be that, again, your pelvic floor isn't used to all of these

high levels of pressure. And that's why weightlifters and athletes and things like that, just sometimes you just need to train longer so that the pelvic floor just catches up. Like the pelvic floor can make structural changes and become a stronger muscle. But sometimes you just need to train longer so that the pelvic floor just catches up. The pelvic floor can make structural changes and become a stronger muscle, but sometimes you just need to give it time. I have some people who get so excited about working out and then kind of get launched into that world, and they just don't allow these smaller muscles to play catch up because all of a sudden these bigger muscles are able to do more, but these smaller muscles just need a little bit extra time. And then I'm also making sure that when you do that box jump, that you're not holding

your breath. So I've had some really fun cases where it's super simple for me where, you know, I have a, I had a woman who only leaked when she deadlifted and I looked at her breath during deadlift. She completely did the opposite breathing that she needed to do. We just changed her breath as far as cueing during the deadlift, and then it was fine. So we didn't even have to do any sort of pelvic strengthening, things like that. So those are the two things that I would take a look at first. What activities cause it? Can we slightly reduce that activity and take away the symptoms and and then can we are you holding your breath can we change your breath work a little bit to help regulate pressure better yeah and then if that doesn't jump out then we kind of take a we dive deeper and then

we look at okay where are you having like big muscle asymmetries? What's weak around your pelvis? What's not probably kicking in as much as it should? Then we would probably do it like an accessory muscle program for a month or so where you're training that muscle to hopefully catch up everything else around your pelvis. And then, you know, do we need to take a look at your pelvic floor? So we, as pelvic PTs, we do do internal exams. So for women, you know, for women and men, so whether it be a vaginal exam or a rectal exam, we can actually take a look at these muscles, which is really important. I have some people who go to a pelvic PT who never do an internal exam

and just hook them up to a biofeedback machine. And I would recommend not doing that. You need to make sure that your muscles are actually working the way that they should. So an internal exam will help me decide, okay, is there any prolapse going on? Is there any kind of pelvic pressure pushing down on the pelvic floor? Are your hip muscles tight on either side of the pelvic floor? Is your pelvic floor tight? Are you able to contract fully? Are you able to relax fully? And then a lot of times I just need to teach people how to Kegel correctly. A lot of

people aren't Kegeling right. You know, cosmopolitan tells you to like squeeze your butt cheeks at the red light. And that's not how you train a muscle. Like you don't do just a contraction every time you think about it throughout the day. So some people just need structured pelvic floor strengthening programming. And then that would be that, you know, that's why it doesn't just get fit under the umbrella of Kegels. I have some people doing quick contractions because they really need to work on those fast twitch fibers. I have people working on more endurance contractions because they really need to work on those fast twitch fibers. I have people working on more endurance contractions where they're holding for longer and doing it with

their breath. So there's all kinds of things that you could be doing. And then how much I give you sets and reps is dependent on what you have and what we're training for. So that's why like three sets of 10, you know, do Kegels every day, that's not going to work for everyone, you need a specific programming for you and what you want to do. Okay, how much did the Art of Breath seminar inform or change sort of, or, you know, whatever, has it changed at all, the kind of work that you're doing, or how you're looking at it, because it seems like you obviously know a lot about the connection with breath and the body and movement and all of that stuff before taking this course. And this is a big part of what you're looking at and prescribing. So

has that, did the course kind of like teach you anything new or change anything for you? I love the course because as a pelvic PT, I like taking other orthopedic or other courses outside of my wheelhouse to see how that affects the pelvic floor. And I knew about the connection, you know, the diaphragm and the pelvic floor and the pressure system. And we have some breathing exercises that we give people. But I wanted even more than that. And I knew I've heard about this course for a long time, because I actually went to school with Kevin, who taught the course. And so he and I talk quite a bit, because he actually had one of his female athletes

come when I gave my talk at a female weightlifting camp in Las Vegas. So we talk a lot about how it is almost the same world where all of these, I think we're starting to get down to the nitty gritty of what's really important to make sure that it's operating efficiently before you take a look at anything else. And that would be like your breath, your diaphragm is the top part of that cylinder, and then your pelvic floor is the bottom. So that helped connect a lot of things for me. It just gave me a higher level programming for athletes, especially for recovery breath work. And it's also having me take a closer look at expiration.

So I know a lot about inhalation. I really cue a lot with the rib cage moving, you know, your rib cage should be moving three different ways when you inhale to help reduce pressure. But during expiration, you really want your rib cage to move downward and in. And it helped me start, I'm starting to do a little bit more research about that. Because I think athletes particularly don't recover enough with their expiration and don't get that movement of the rib cage. So then they're almost flared out a bit. So I'm finding that interesting and kind of researching more about that. or recommend a separate like separate from their PT or their their training, like a meditation or breathing practice? And do you do one yourself? Is this or are you doing just like art of breath

stuff now that you took the course? Like, do you ever recommend to people that they spend some time like literally just working on their breathing? Absolutely. So we actually, again, we can link this in the notes, but I have a YouTube channel for our clinic. And so we have a series of like breathing exercises you can do, which are really fun, like the lion's breath and things like that. I'll have people do that. I love meditation. I'm a very A-type personality. So I didn't want to do it for the longest time because I just couldn't bring myself to. But I love Insight Timer. I've had on my phone for a very long time. It's a free app. And I do that before bed almost every night and pick either a sleeping meditation that I like, or I'm a mountain climber. So there's a mountain meditation I like, and I really try to focus on my breath. And more recently, you know, as an athlete myself,

I've been trying to focus on my breath during training. So the other reason why I took that breathing course is I'm going this summer to climb Denali in Alaska. And in high altitude, you have even less oxygen. So I want to be even better personally at maintaining my breath and being able to do these physical activities at a lower aerobic output. Ooh, Denali. Okay. I want to make a note of that and ask you about the vibrator. That's fun. Okay. So I want to talk about a scary word that you mentioned earlier, and that word is prolapse. And yeah, it just sounds terrifying. So can you talk a little bit about for men and women,

how this happens? What's actually happening? How it feels so that we can recognize if something's going on and get treatment and what can happen if we aren't paying attention to it and don't get treatment. Let's just talk about all of that. Sure. So again, this is a very calm, more common for women in the, the few times that I see it in men, it's obviously their rectum. I've never seen a bladder prolapse on a male, but I do see a lot. I've seen a few men who their rectum started to kind of fall inward because they had so much straining that they were doing chronically that that became a problem and their bowel movements were affected. But for the most part, usually because they're constipated and that's why they're straining so hard. Yeah, possibly. Or I mean, that's a whole nother rabbit hole too. There's like optimal

position for your hips during a bowel movement. That's where the squatty potty comes in. Like we were meant to squat in a hole in the ground. And now we have these high toilets, which is causing our anorectal angle to be essentially like 90 degrees instead of straight. So make sure when you poop, you get your legs up, and that you're in more of that deep squat so that you don't have that problem. But for women, this tends to happen more often after after childbirth. And it can happen. It's usually when people come in, they feel it's like a pelvic heaviness. That's how they describe it. Pelvic pressure, they feel like a low tampon is in their vagina. It's uncomfortable during sex, they feel like something's in the way. That's very often how it's described. And the best thing I can say to the women listening to this is the best thing you can do is not be fearful if you're feeling those symptoms. Just go to a pelvic PT, get checked out, but there's a lot of help for you. I have a lot of people who get, obviously,

it sounds like it's an awful word and it sounds scary. And then when you get fearful that you have it or that something is wrong, what are you going to do? You're going to hold your scary. And then when you get fearful that you have it or that something is wrong, what are you going to do? You're going to hold your breath. And then when you hold your breath, what's going to happen? You're going to increase pressure going downward onto your pelvic floor. So now you have extra pressure pushing down on those organs, which is going to make it feel worse. So if you learn anything from today, you really maintain your breath during the day, during athletic movements. It's really important. You don't want to be increasing pressure going downward on your body.

So if you feel those symptoms, go to a pelvic PT. Let them check everything out because there's a lot that we need to look for and to assess. And they can give you a better idea of what's going on. And what are generally some of the ways that you can address these issues, both for men and women? Is it sometimes just prescribing some PT? When does it become a medical issue, if ever? So your pelvic organs are attached to the side of your pelvis with ligaments. And so as we age and get older and go through childbirth, there's some laxity in those ligaments. So no, I can't help you with those.

But what I can help with is the support from below with your pelvic floor. So a lot of times with prolapse, we are doing some pelvic strengthening and getting your making sure your pelvic floor is working optimally to support all your organs, and as well as like hip stability and abdominal strengthening to make sure that everything is is stabilized. So you absolutely should go to physical therapy first to see how much your symptoms reduce with just conservative strengthening. And sometimes it's not just straight strengthening. Sometimes you actually need to relax certain muscles. We've already talked about the hip muscles that could be tight or pelvic floor muscles that are not relaxing

all the way. I see a lot of women who come in who are so scared that they have it that they've just been like in a constant kegel since they learned about that word. And then that's not good either because then they're not relaxing that muscle. So basic strengthening is something that you would do. And you need to do that for a while and be committed to it to see how much better your symptoms can get. And then there's other things that you can do as well. There's pessaries that you can use, which for some reason in the United States is not used as much as it is like in Australia and abroad. And for some reason, pelvic PTs aren't allowed to fit pesteries here like they are in Australia.

But go, you know, work with a good OB. Your pelvic PT will tell you where to go to. What is that word that you just said? What is it? Yeah, what is that? It's basically a knee brace for your prolapse. It's something that you insert into your vagina and then kind of is extra support for the prolapse. It's something that you insert into your vagina and then kind of is extra support for the prolapse. So you can Google images online. There's lots of different

ones. I have a lot of women, young women who go to their OBGYNs and ask for one and they laugh at them and say, that's just for old ladies. So make sure you're working with a practitioner that knows what they're doing and, and understands what kind of your goals are athletically or personally, but there's ones that look like, like a ring. So you would fold it up, insert it in,

and then it comes out like a, like a circle underneath the prolapse to support it. There's ones that look like cubes that you can insert in. And now there's even over the, I think poise makes these tampons that are like removable pessaries as well that the premise is they go up into your vagina and then expand outward so that they're creating almost this shelf to help support your prolapse, which is great, can be great training tool, because then, like I said,

it's like a knee brace, it's something to help you get back to moving, help you get back to getting stronger in the short term. And then I have some people who use them long term. Right, but we're assuming we're hoping that these are things like you said, that are sort of like tools and aids that you use temporarily so that you don't have to use forever. Like ideally, we don't all want to be wearing knee braces for the rest of our lives, right? Right. And then after, you know, after strengthening pessary, if things are still really bad, yes, there's always surgery and surgery is not always a bad thing. So there are, that's when you've heard about the sling procedures where they're able to help lift your organs off your pelvic floor.

And I have a lot of women who are scared when anyone mentions mesh because of all the things in the news about mesh. But there's some really great surgeons out there who do a great job of helping support your prolapse again. But I will say, don't just go rush. Even if you know you need surgery, don't go rushing off to surgery because get stronger before you go because whatever caused the prolapse to happen in the first place, like that weakness underlying is still gonna be there.

So get strong before you go and then go through the surgery and then come back and rehab afterwards, just like you would for a knee or a hip or a shoulder. All right, let's talk unnecessary surgery now. Because that's something you you mentioned earlier on, it's something that I, I see probably more than obviously, we would like to in my community of athletes and people who are going very hard in the gym and then inevitable injuries. And I actually have a story kind of similar. I've managed to avoid the unnecessary

surgery, but I took, it's like a decade ago, I was doing like a, it was like a CrossFit strongman certification and I hurt myself badly doing something improperly. It was like a really heavy tire flip or something. And I really damaged what I thought was my shoulder. I went to see a specialist. This was in New York. And they were like, you have a labral tear. We're going to go in there and do a surgery. And I'm terrified because I hear about these like slap tears or labral issues and how it's like a major, major surgery. Of course, when you're dealing with a shoulder or a hip, it's such a big deal. And I went to get a second opinion. And the second opinion was like, nah, you're all right.

You just like broke off like, I don't know, a piece of bone in the shoulder socket. And if it's not impinging you, it's going to reabsorb and you just need to go to PT. And I didn't get surgery. And I did like six to eight months of PT instead. And I'm like a hundred percent. But I was like this close to just listening to what an authority figure told me and getting a major surgery that could have been well, completely unnecessary, but also maybe could have like made things worse. So let's talk a little bit about your, your experience with that

and just the concept of sort of, I don't know, like second opinions, unnecessary surgery, all that kind of scary stuff. Yeah, I would love to. And know that I obviously have a bias going into this. Like I had two hip labral surgeries. It was very emotional and a groin surgery. And I don't like that I had them. I wish that I had a good PT, however long ago that I could have tried to see how much I could have done mobility exercise, done strengthening, done breathing exercise to see how much better I could have gotten. So I have that bias going into it. I'm not saying that all surgery is bad. But you definitely need to go to someone

who can evaluate your whole body instead of just looking at that specific point that hurts to at least see if something is affecting that. So if you're talking about shoulders, like did someone look at your mid back, your rib cage, things like that to see if they're operating efficiently. And if there's more that you can do in those areas, why don't you try to do that for a month and see how much you can get because that might increase that threshold enough where your shoulder feels fine. But the problem in our day-to-day is everyone wants it to be fixed now. And they don't want to put in months and months of work to get better. It's hard for me to convince people sometimes to do their mobility work because it doesn't

make that nice change overnight. You have to just keep doing it. Connective tissue takes a long time to make changes. I mean, that's why it's connective tissue. It's supporting our joints. It's not going to just change overnight. Muscle changes in six to eight weeks is what muscle does. So that's why strengthening gets pretty exciting because in a short-term period, you can see

yourself get a lot stronger. Mobility gets really frustrating for people and they don't want to keep doing it because they don't see that change. But that takes like six months. So it's just something you need to commit to. You need to pick a couple of exercises to do and give that a chance before you go and rush off and do things. Because very often, I see a lot of people post-surgery. And like I said, I see a lot of people post-laboral repair, especially for the hips, because now you've done the surgery. You still have all the underlying problems that caused the problem for you to get surgery.

And now you have even more tightness surrounding the joint for you to get surgery. And now you have even more tightness surrounding the joint because you had the surgery. So I had people come back in eight, nine years later after this surgery with a whole lot of issues because it just kind of compounded over time and they never did that work in the first place to get that joint moving better. So, but when there must be sort of a point where it's like surgery is across the board, the way to go. And then there, there's like a big gray area where it's like, well, this is an option, but also doing the hard work of some physical therapy for six months might be an option too. Like, when do you kind of know, is this again, just, just doing your due diligence and seeing a couple of different people and trying to get,

um, I don't know the best advice from a range of specialists or like when, when, how, what, how do you make that decision? How do you make the decision where, you know what, in this case, surgery probably is the best option versus I'm going to like, just live in pain and do some PT for a while and see if it gets better. There's no easy answer to that. You have to definitely get looked at by lots of different people. So when you go see a surgeon, make sure you're going to see two or three surgeons and that someone can speak to how good they are. And then also make sure you go see like a body specialist, like a physical therapist.

And I would even go see, you know, two or three to have people take a look at you and see what they might find. And then I would definitely try to do something, not too many things, but pick five or six things to focus on and at least give that two months to see if you're making any difference in your symptoms. And then it also just depends what your goals are. Yeah, I mean, there's a lot of athletes who can't afford to spend the next year or two of their lives doing the mobility work and doing the strengthening like they need something a little bit quicker. So it just depends. And that's a crappy answer,

but it does. No, no, I mean, it's a good answer. Because it's the whole everything about this is nuanced, right? And it very much, as you said, depends on a whole host of personal details, like money and time and jobs, and, you know, your personal preferences and all kinds of stuff. But I think, ultimately, like the answer for almost everything is sort of do your your own research and educate yourself and inform yourself and put your own due diligence in before you, you can make an informed decision, I guess. And I will say, make sure that you know, like imaging is not very scientific, not very symptom based. So you can, I think labor, like labral tears are the new herniated discs. So if you were to pull 100 people off the street, no matter who they were, I would say most all of them are going to show L4, L5 herniation.

That's just what happens. You can have someone who feels awesome and is having a great life, have a severe herniation of L4, L5 and not even know it. And now what would be interesting is That's just what happens. You can have someone who feels awesome and is having a great life, have a severe herniation of L4, L5, and not even know it. And now what would be interesting is all of a sudden if you tell that person, hey, you have a severe herniation of L4, L5, then they might start experiencing back pain because now they're thinking about it. Now they're holding their breath. Now they're fearful to move. So don't just trust what the imaging says. I have people who bring in awful imaging reports and they don't have the awful symptoms to match that. So pain is an experience. Pain is not what shows up on imaging.

Pain has so many factors and pain science is a whole nother thing that we could spend a long time talking about. So I think that most people are going to show on MRI that they have a labral tear of their hip. I do because of the way that we move our hips throughout the day, because we don't have as much hip rotation as we should. That's just kind of normal wear and tear. So don't try not don't let I think a lot of physicians and physical therapists and trainers and coaches are promoting too much fear. Don't let someone scare you with imaging, with a diagnosis. I really don't like to give out diagnoses half the time because I don't want people

to be thinking about it. If you tell someone like your right pelvis is off or it's like stuck here, if I tell you that, you're going to be thinking about that all throughout the day and walking around like you have a stuck right pelvis. Like that's not very helpful either. So just make sure that you're going, I guess you got to find the right people. So ask around, do your research. Don't just go to like the fancy offices, make sure that you know, you're going to people that you can trust who know what they're talking about, who are

experts in what they do. And then go to someone who has nothing to do with what your complaint is, and almost take a step back and get almost a macro view of what's going on to see like, hey, maybe something else is going wrong down the chain that if I fix that, maybe my shoulder will start to feel better. Next, I want to talk about, because we're talking about so many fun, personal, squeamish topics today. Next, I want to talk about constipation. This is something that you've touched on already. And I coming from more of a sort of nutrition background, when I think constipation or like, not less than ideal bowel movements, I'm immediately going towards what are people eating. And I kind of never even thought about the idea that it could also be connected to some like muscular issues or tightness or imbalances that are going on in the

pelvis. But is this sort of like a chicken and egg scenario? Like it could be one or the other, and then they could be compounding because you're also kind of not eating properly, or you're also super tight and messed up. Talk a little bit about how to deal with or manage or address bowel and digestive issues from a from your perspective? I love talking about poop, and I can do it all day. Because I think it's so important for, for everyone, and especially for athletes. And if you, you know, we don't have that much time to talk about it today. But I did a podcast just on poop with the movement maestro. So if you go look at that podcast. Or we can do a part two and just talk all about poop for the people who are in it. Yeah, I would love to. I honestly am diving more into that because I see it,

that as the kind of the primary driver to a lot of pelvic issues. Because I've talked kind of this whole time about how when you increase pressure from above your pelvic and your hip muscles are going to react below. So with, with her, I talked, I read, um, the power of habit, which I love, um, the book, which talks about how in, in your personal life, in businesses, in everything, there's usually a keystone habit. It's one thing, like if you go and you focus all your efforts on fixing that one thing, then everything else starts to fall into place. And that's where all the, it comes from, like, if you make your bed in the morning, that's why everything kind of falls into place. That's usually a keystone habit for people because then they feel like they've done something to start the day, they feel organized, and then just everything kind of evolves from there. I think the keystone habit for pelvic health is poop. I really do

because so many people are not, are not pooping. Right. And I don't know why it's not talked about more. So the, basically the five things that are involved in bowel health, which I explained to all my patients are, and then we go through them on the five and we just, again, this is all about threshold, right? So I need to find of those five things, what the threshold is for each. And then once I'm able to reach them all, it's like ding, ding, ding. Then all of a sudden you're having good bowel movements. So it's very frustrating to treat because it takes a while because number one, I can only affect one of the things of the five.

It's a lot of homework for people to do. And just people don't like to continue to try things for long periods of time. They'll try it for a week. And if it doesn't work, they're like, she doesn't know what she's talking about. I'm done. I'm not coming back. Yeah. So the five are number one, are you getting enough water throughout the day? So your your poop is 80% water. And that's how it moves. And I have some people who even think they're getting enough water and they're not getting enough. So make making sure that you're that, making sure that I constantly am carrying an allergene with me in and out of patient rooms, because if I didn't, and I've noticed the days that

I forget, I'm so dehydrated because I can't catch up in time. You can't just like drink a big glass of water in the morning and then catch up when you get home. So what's your rule of thumb for enough water? Because I hear a lot of different opinions about that too. Whatever. Well, I have Nalgene. It's 32 ounces.

I'm 5'10", 155 pounds. I should be drinking three of those a day. So I have a lot of people who are not even close to that. So if you're not close, it depends how much you weigh. It depends how tall you are. It depends what you're eating. So the rule of thumb is to usually try like 16 to 32 ounces more than what you're doing now. Unless you're at the opposite end of the spectrum where you're drinking so much water and then you don't want to be drinking more. So there's no like this many ounces per pound of body weight kind of situation

that you try to like a benchmark that you want people to hit? Not really because I've seen that go wrong. So I usually do the Nalgene thing. We have Nalgene's at our office. Again, they're like 32 ounces. So I make sure that they're drinking at least two of those a thing. I give, I, we have Nalgene at our office again, they're like 32 ounces. So I make sure that they're drinking at least two of those a day. And then from there, we'll start to slowly increase, slowly decrease depending on the person. Okay. Um, so are you drinking enough water? Number two is what, what is your diet like? And it's interesting with your background from, from my perspective, that's usually the least involved in these five where diet is absolutely important. What you put in your body is absolutely important. But

if we make changes and all the other ones, that doesn't seem to be like I have people who eat perfectly and they're still having issues. So are you getting enough fiber, which is incredibly important. And I see a lot of athletes who are eating all this protein, and then they're not getting enough fiber to kind of balance that out. Fiber is something that kind of holds the bowel movements together and helps move it and get it out of you nicely. Yeah. Yeah. And Americans tend to not get enough. I think that's we're supposed to get 35 get 35 grams. And you can look up fiber tables online on which are higher levels.

And that's a supplement you might consider taking as well. And then you want like good leafy greens where you're actually chewing and using your teeth to actually get the fiber out of it. So that's number two. So water, diet. Then we have your activity levels. And for athletes, that's usually fine. They're getting plenty of that. But I have some people who they literally just start constipated when they went in the winter when they stopped walking as much. That is like movement is helping, I guess, move along the stuff in your intestines, too. That's the thinking? Absolutely. So when you move, you're getting blood flow to your abdomen and you're promoting

your bowels to move as well. And when you move more, your rib cage is moving more, your hip flexors, all these things like surrounding the abdomen are moving as well, which kind of like is almost a bowel massage, which gets it to move. So movement is important. If you just sit or stand in one position, your body doesn't like that. It's not going to be more prone to movement. So water, diet, movement, activity, and then the last two are the hardest. So number four is stress levels. So stress plays a huge role in your bowel movements when you are stressed out. And this is where the breathing course comes into play. When you're stressed out, you're breathing from your upper chest. Um, and you're not taking these nice deep breaths, which also means you're not taking these nice diaphragmatic breaths, which also means you're

not moving your rib cage in the top part of your abdomen to kind of move along the stool. And then you're also not in your parasympathetic nervous system enough. When you're stressed out all the time, it's like a bear came into the room and never left. And so, you know, it's very important for us to activate our sympathetic nervous system. So if the bear came into the room right now, I should be able to, you know, fight the bear or go and escape. But eventually, I need to kind of slide back down to rest and recover, rest and digest, get my bowels to move. So I see a lot of people where that's the big problem. And then this is where you can do more of the breathing-based exercises and kind of get that recovery breath and spend more time in that parasympathetic state, which is a lot of nasal breathing. So I've been having people focus on that more, which has been helpful

because it's not helpful to tell someone who's stressed to stop being stressed. There are stressful things in life. We're going to have to learn how to deal with them. So nasal breathing is a really cool thing to give them to focus on when they are stressed, to go back into that parasympathetic state. And then the last of the five, which is the only one that I can help you really affect is your abdominal and your hip and pelvic mobility. So again, if we look at your like under your rib cage down to your hips as a cylinder, the top part of your cylinder is your rib cage is your diaphragm is your thoracic spine. So do you have good mobility of all of those things? Is there

tightness anywhere? And then the bottom would be your pelvic floor is your pelvic floor able to contract and relax correctly um and then your hip muscles on either side are they weak tight how's your hip mobility and then all the stuff in the middle i can actually do like you know i do visceral mobilization basically poop massages where i work on people's stomachs. I'm able to actually move the intestines back and forth, which feel really good. And there's a video on our website about a bowel massage, which sounds hokey, but it actually really, really works. And you're able to kind of mobilize your intestines, kind of trace the colon. And then there could be tightness all across stomach. So I had people, like I said, who had abdominal surgeries,

like hernia surgeries, C-section. I had a lot of people who get constipated after a C-section. So then we can do some scar work around there. You want to make sure like your abdominal fascia, which is the covering over muscle, is moving in a good way. So stomach shouldn't be tight at all. They should be able to move so that all of that, you know, blood flow gets to your bowels. So your bowels are able to move up and around your hip flexors cross that kind of centerpiece. You want to make sure, like, do we need to open them up? Are they just tight because you're like your hamstrings are not strong enough. So it's taking a closer look at how all of those things play together. All right, poop massage is something that I have never heard of or had,

but I would totally be into it. I don't think it's a coincidence that these these elements of bowel health are also literally the same sort of elements to overall health, right? Like, be hydrated, eat properly, move your body, manage stress. Those are like the key components of just general overall health. I think that it just brings this full circle that all of this is connected and that your health in any one specific area is about your overall health and that all of these elements can help in all of these areas. So I think that that's like, I guess that's a good place to end off. Cause I know you have to go get, um, get some stuff done before your, your client this morning, but, um, we can definitely do a

part two cause there's so much more obviously that we could talk about. And I'm, I'm kind of excited. I'm like taking notes here. I've got lots, we have to do a part two and talk about some sex stuff. Sex and poop is part two. And let's, you know, let, let, you know, let people ask questions. I love to answer questions. This would be a great, you know, safe place for people to kind of find out information that they didn't know, especially they don't have access to a good pelvic PT by them. So yeah, let's go part two, sex, poop, and whatever else you want to know. I love it. And maybe this would be a good thing. We'll we'll post this interview and then allow listeners to kind of

ask follow up questions, ask questions, I'll collect them. And then we'll do a part two, because I definitely think that this is super, super valuable. And I've learned a lot as somebody who again, like I'm sort of like a quote unquote, general fitness person, I talked to a lot as somebody who, again, like I'm sort of like a quote unquote general fitness person. I talked to a lot of smart people. I interview smart people for a living. And a lot of this stuff was like really news to me. So Tamara, I really appreciate you taking the time before I let you go. Can you tell listeners where they can get access? And we'll put some of these links in the show notes, but just like your website, how to connect with you, how to learn more, where they can go online. Sure. Again, I co-founded Inner Dynamics Physical Therapy, I-N-N-E-R Dynamics. We're on the Jersey Shore in Ocean, New Jersey. So you can go to our website at innerdynamicspt.com. You can reach me there. My email is Tamarara t-a-m-r-a at interdynamicspt.com if you want

to shoot me an email um and then again we have a youtube channel as well the videos are on our website definitely subscribe to our channel because i'm starting to put a lot more content on there that can help with all of these things especially for people who don't have access um to a lot of these resources. All right. Thank you for your time. I'm going to go check out the magic app video and I'll let you know how it goes. Yeah.

Everyone, please check that out and tag us on Instagram when you try it out because I've seen a lot of, it's funny to watch a lot of people try it for the first time. Yeah. I'm scared. All right. All right, Tamara. Thanks for your help today. All right.

Thanks so much for having me. Okay, that's it for Muscle Maven Radio. I hope you learned a little something. And as always, I want your feedback. I want to talk to you. So hit me up on Instagram at the Muscle Maven and let's have a chat. And next week, I am talking about my favorite topics of all time, functional strength and sexy ass muscles with none other than Mr. Six Pack himself, CrossFit legend, Marcus Philly. And we're going to be talking

about his functional bodybuilding programs, which are right up my alley. And I'm sure you're going to like it too. So don't miss it. Join me next week. And thank you for listening.