The Most Common Pelvic Floor Fix Is Making It Worse

[0:00] If you've ever been told to do Kegels or try to do Kegels at your desk, or maybe you've had children, or maybe even before you had kids, had issues with your pelvic floor. Kegels are not the answer. Day is the day you wanna listen in. I actually had urinary leakage as a young gymnast. We are gonna be talking with Ember Smith, a physical therapist, actually a doctor of physical therapy. And just because something is common does not mean it's normal. She has specialized training in pelvic health, and she runs a clinic called Well Balanced Physical Therapy

[0:31] here in Sioux Falls, South Dakota. I'm super excited. I'm gonna pepper you with all kinds of questions today because this is something that many women are meant to. We're gonna talk a little bit about that. It's never too late. It is never too late. You can always impact the pelvic floor. You can always impact the body. Most of us deal with at some point in our lives, and so I'm really excited to dig into this. We don't talk about this probably often enough, and it's something that affects almost all of us. Yes, absolutely. Health and wellness is confusing. There's a new trend every week. Everyone's got an opinion, and half the time, you can't tell what's legit and what's just good marketing.

[1:03] And we get it. We're in it too. Welcome to Dialed In Health. I'm Melissa Goodwin. Every episode, we bring in the people who actually do this work, providers, practitioners, the experts who see clients and patients every day. We ask the questions you'd ask if you were sitting across from them so you can find the right people, make better decisions, and feel confident about what's out there, whether it's peptides, gut health, water quality, ADHD, biohacking, or something you've never heard of, we're covering it. So let's get into it. Let's get Dialed In. (upbeat music) Thank you for being on the show, Ember.

[1:38] Thanks for having me. Tell us a little bit about your background, your specialized training in pelvic health, and why you kind of, you do all kinds of things here at Well-balanced physical therapy, but tell us a little bit about why you decided to get the specialty training in pelvic health. Yeah, sure. So I've been a physical therapist for five years now. I've been at Well-balanced for three of those five and kind of dove into the pelvic health right from the beginning at Well-balanced. I grew up as a gymnast, as an athlete, and I actually had urinary leakage as a young gymnast, as young as high school. And so with that background

[2:10] and then starting to get into childbearing years and starting to do some family planning with my husband, I decided that this was kind of the route I wanted to go. I didn't know enough about it for myself. And if I didn't know enough about it as a physical therapist, I knew there was a need for it in our community as well. Went to USC for that and then did two different pelvic health certifications. Went to Herman and Wallace for their level one certification and that touches on actually men and women's pelvic health. Didn't have any male models in class, but they go over kind of some basics with the men

[2:41] and then got our intravaginal training there. I also did one through the Institute of Clinical Excellence and that one was a completely different approach. And so most pelvic floor PTs just go to the one training and kind of go on their own way with a one. I loved my first training, but my second actually did intravaginal examinations and standing. And so a lot of women have had intravaginal exams at the OB, if you know, pap smears or during pregnancy, cervical checks, after delivery for prolapse.

[3:14] But a lot of women have symptoms in standing or when we're active. And so that course really shifted the way I evaluate and the way I treat because we get to look at that female in standing, which is when she's often having symptoms. So took those two courses, have taken several others. I won't go into those, but love to learn lifelong learning. So as a gymnast, you were young, right? So what did you do when you were young? Did they give you, did you talk about it with anyone? Was there any help for you at that time? No, there was not. And we like at the time it was embarrassing, but I also like your teammates become

[3:46] some of your best friends. And so we just kind of like giggled about it and brushed it off. It wasn't a big deal. I would wear like a little panty liner as a high school gymnast and nothing was ever done about it. And then as I started to get older, I started to realize how abnormal it was, right? Like I should have known because my teammates weren't having the same struggles while we were tumbling and doing the floor exercises and it's resolved, which is great. But yeah, no help at the time. I think just not enough conversation around the topic. And I think, again, you hear pelvic health

[4:17] and you just assume you need to be pregnant or more post-part or more have had kids at some point in your life. And obviously that is not the case. Yeah, so what do you know now that you wish you would have known when you were a gymnast? I wish I would have known that there's resources out there and that's not something I had to have lived with and that I could have and should have addressed it really as soon as symptoms started. And so I always tell people too, if you have symptoms and it's changing your behavior or it's changing your function, it should be addressed. It should be seen for those.

[4:50] Yeah, so for any other gymnasts that are out there that might have that issue, what are some of the causes of that that they can maybe train or get some help for? So I think, again, strength was not the issue. I could do 100 leg lifts, I could do pull-ups, way more than I can do now, right? So I think just telling any athlete, gymnasts, whoever it might be, if that they are having issues that it should be addressed, I guess, sooner rather than later, but at the same time, I know that it's also never too late too. Yeah, so let's back up and just tell me,

[5:22] what is your pelvic floor? What does the pelvic floor do for you? Yes, I love this question. A lot of people that I see in clinic think that the lower abdominals or like the front part of the pelvis is their pelvic floor. The pelvic floor is a skeletal muscle that forms a sling at the bottom of the pelvis and it's the skeletal muscle that you and I are actually both sitting on right now. Okay. Supports the pelvic organs, helps with sexual function, bowel and bladder function, and then also helps connect to core, hips, and also our breath. Okay, core, hips, and breath.

[5:54] Okay, interesting. So what does a pelvic floor PT actually do? Pelvic floor PTs can do a variety of different things and we don't always look at the pelvic floor when somebody comes in with pelvic health concerns, especially on that first visit. Sometimes we think it's a pelvic floor issue when in fact, like I said, it could be a coordination issue or a relaxation issue and because of the fascial attachments, and I always describe it to you, the pelvic floor attaches to the pelvis. It's not the only thing that attaches to the pelvis. Our hips attach to the pelvis,

[6:25] our back muscles attach to the pelvis, our abdominal wall attaches to the pelvis, and they don't just share, I always call them neighbors, but they share a wall, so it's like a townhouse, right? You share an attachment, which means we can't just look at the pelvic floor in isolation. We need to look at kind of the whole body, and so when someone comes in, we often are starting with posture, with breath, their movement patterns, and then from there, what do we discover? Let's break it down and then look from there at maybe specific range of motion for the joints or strength for the joints, pelvic floor, same thing. What's the range of

[6:57] motion of the pelvic floor? What's the strength? How is it coordinating with your core? How is it coordinating with your breath? So a lot that can be done, a lot that can be looked at, but we often, like I said, are looking, I shouldn't say often, I would almost say always, are looking at more than just the pelvic floor. So if someone thinks they, often like, so you say like, oh, I have a pelvic floor issue because when I sneeze, you know, some urine comes out, or if I can't make it to the bathroom in time or something like that, what are all the other issues that might signify you might have a pelvic floor issue?

[7:29] Yeah, any sort of leakage, whether that's bowel or bladder. People obviously talk about a lot of urinary leakage, but same can happen with bowels. The pelvic floor spans front to back, so pubic bone to tailbone, and so really anything in that region, which again, includes bowel and bladder, can be impacted, pressure and heaviness, pain, chronic low back pain, abdominal weakness, hip pain. All of those things? Yes. Okay, so who typically walks through your door? What are they saying to you? What are the words that they use or the phrases that you hear a lot?

[8:01] Yeah, I always say any really female, and a lot of men too, could benefit from pelvic floor PT. The typical patient that I see, some of their complaints, I would say one of the more common ones is the urinary leakage, but pain with sex is also very common, pain with bowel movements or constipation, very common, difficulty not even just holding their bladder, but difficulty emptying, pressure and heaviness, I think I maybe said that with running or standing at the end of the day, so those are, I would say, the most common. So a lot of times,

[8:33] there's a lot of information now about pyramenapause and menopause, and we're taught if you are having some issues with leakage, get your hormones checked. How do you know if it's a hormone issue or a pelvic floor issue or are they connected? Tell us a little bit about that. Yeah, definitely connected, and I can't talk a ton to the hormone space that's outside of my scope, but with the little that I know, hormones impact the whole body, and oftentimes it's likely both, truthfully, and so that's where the interdisciplinary care comes in, is that you're seeing

[9:04] someone for your hormone health, but also seeing a pelvic floor PT for the musculoskeletal component of things. Estrogen, progesterone, all that impacts the muscle and the tissue even in the vagina, in the vaginal canal, so yeah, it's hard to say is it one or the other, what's causing that, and that's truthfully, we're going in and seeing the providers to get that examination, to get that evaluation done, is super important. Yeah, and I've seen a lot of machines now that are claiming to help, and what are your thoughts on that? Do you have any experience with those? I don't have any personal experience. I'm aware of them, and there

[9:38] are lots of pelvic floor PTs in Sioux Falls, I can guarantee you that every pelvic floor PT in Sioux Falls is against them. Okay. Because Kegels are not the answer, just like a chair that helps you do a Kegel is not the answer. Okay, so tell me more about Kegels. I grew up and it was like, I don't even remember how many you were told to do, but it was like two Kegels. 10 to 10, do them at every single red light. And you do it once a year, and you're like, oh, I should be doing those more often, but who thinks about that, right? Tell me the good and the bad about Kegels. What's the myth and the reality? So a Kegel is basically a

[10:11] pelvic floor contraction. It was then termed a Kegel. Do you know where the word came from? Was it a guy named Kegel? I think it was a guy, yes. Of course. I don't know, right. Like, let's name this exercise after me. And it was a male, right? And now we're telling all the women to do Kegels. Yeah, so Kegel is a pelvic floor contraction. The good, it can help strengthen. If they're done properly, if they're dosed properly as far as reps and sets. When I say if they're done properly, I have females that come in clinic and I ask them to do a

[10:43] Kegel externally or internally. And instead of their pelvic floor narrowing and lifting up, which is what a Kegel should be, they're pushing down and out as if they're pushing out a bowel or pushing out a baby. So now women are doing 100 reps of a Kegel and they're not doing them properly. They're pushing down and out. So they're doing the opposite of a Kegel? They're doing the complete opposite. Which would be a different name. Yeah, bearing down or pushing. (laughing) Yeah, probably. I don't know. Do you want to turn that one? (laughing)

[11:14] Yeah, so not only like, is a Kegel being done properly, right? But in my case, I had the strength. I could almost guarantee it. I was in some of the best physical shape of my life when it comes to muscular strength. A lot of times women come into clinic and we need to lengthen. We need to relax. Okay. If a muscle is tight and it's in a contracted state and you add more contractions, you're going to likely exacerbate or worsen the symptoms or the problem that you have going on in the first place. Okay. So still today, I'm a mom of two.

[11:47] Just had our daughter seven months ago and in one of my trimester handouts, it said in there to start or to begin or to continue doing Kegels or pelvic floor contractions. And so unfortunately, that information is still circulating through handouts at large health systems and it's inaccurate. And not only is it not helpful, but it can cause problems. So what do you do instead of a Kegel? What should we be doing? Nothing as if you don't have symptoms. Okay.

[12:18] Yeah, go and see a pelvic floor PT if you need individualized advice. You can do your research online. There is a lot of good information online. And I honestly appreciate when people do Google or use AI to look at things because that just shows that they care. But use that information sparingly and then come in if you have specific questions. The pelvic floor is individual to each person, to you, to me, to whoever is coming in. Some people do need Kegels. Again, is a Kegel a universal fix for everything? Absolutely not. So if you're not having symptoms, you don't need to do Kegels?

[12:50] Correct. Okay. So because a lot of us do have issues with leakage, one baby, three babies, or after you, especially you have a child or as you get older, right? For sure. What should we be doing? In general, staying active. Okay. Keeping your body strong. How so are there specific exercises or things we should do for our pelvic floor versus other things? I wish there was, because that would make my job easy and it would make everybody's lives probably easy, right? If there was one fix and one exercise, but no.

[13:21] I would say there's not one exercise including Kegels, right? But in general, staying strong, staying active is going to be beneficial. When I say that, it needs to be an exercise that gives your body the right stimulus. That's relative for all of us, right? If I have a patient come in who is, say, 75, her standing up and down from a chair is gonna be more challenging than somebody who comes in who's 25 and not even pregnant and standing up and down from a chair. So exercises are relative to the person in front of me,

[13:54] which is where that individualized approach and going and seeing a physical therapist is incredibly valuable. What do you think are people are most embarrassed to say out loud when it comes to pelvic floor issues? Usually the leakage or just even that something is wrong because it's not talked about. And just because something is common does not mean it's normal. So if you are leaking and then your friends are leaking, people often write it off that it's normal. But again, common is not normal and it should be addressed. If it's impacting your function and your behaviors.

[14:26] What do you see at different stages of life? So you were a gymnast and you had some issues when you were younger. There's sort of the childbearing years where you have a set of issues. And then as you hit menopause and perimenopause, there's a set of issues. Then as you get into your 80s, there's other issues. What do you see that people are doing right or wrong? Other than, you mentioned exercise, right? Exercise, exercise, movement is medicine. I would say the biggest thing that I see people doing wrong is not addressing their symptoms. So they have kids, let's just say, right? They start having urinary

[15:00] leakage, they never address it. They just wear a panty liner. They go on as they age. Muscles, generally atrophy, right? We get weaker as we age. Our strength reduces, our power reduces and they're not necessarily intervening. And if they are, it's still going potentially to decline at some point, right? And so then as years pass, those issues can compound. So what went from like a small panty liner, now they're wearing full pads or maybe even diapers. Maybe they're getting UTIs because of some of those chronic issues. And then when you get

[15:30] a UTI that can cause, right, cognitive issues, it can cause confusion. It can cause balance problems. Now you're at increased risk of falling. If you're at increased risk of falling, you've got bad bone mass because you're postmenopausal, right, so it compounds. The earlier you can address your symptoms, the better. But with that being said, it's never too late. I think about women who are older, my mom, for example, again, this was not talked about. Like even as a gymnast, she didn't know. She didn't have tools and resources to point me to or to help me and she'd been more than willing. So I think about people like her.

[16:03] It's never too late. It is never too late. You can always impact the pelvic floor. You can always impact the body. Okay, so another thing since we're talking a lot about childbearing years, there's something called diastasis recti. So I've seen like a couple of fitness people talk about this and doing exercises for it. What is it and how is that related to pelvic floor? Yeah, so diastasis recti is essentially you've got the two six pack muscles. There's one on each side. Well, some of us have a six pack muscle. You do, you say everyone has a rectus and there's a right and a left.

[16:36] And we call it the six pack muscle just because it's visually, right? You can imagine that on bodybuilders or yourself or whoever it might be. And as we get pregnant, our bodies are incredibly amazing. I'll say that, right? And our body adapts and changes as that baby grows inside. And as that baby grows inside, those muscle bellies start to move further apart. Okay. And that tissue between which we call the linea alba, it's fascia, starts to essentially thin. It's a natural adaptation to childbirth and pregnancy. It has to happen for your baby to grow. Now, most often those

[17:09] muscles start to come back towards in one another once baby has been delivered and you start to move again and things kind of start to find that balance or they're restored right back to pre-baby or pre-pregnancy function. Pre-pregnancy-ish. Ish. Now people are like, let's close the gap. Okay. There's always a gap. There should be some sort of a gap. And I don't love the word gap, but there should be some distance between those two muscle bellies, always. So we don't ever expect that gap to be non-existent. You'll see online like two fingers

[17:41] or two and a half fingers and greater is considered a positive test for diastasis recti. That's what we use in clinic as the two and a half finger rule. So what are you measuring exactly? Or how are you using the two fingers to find the diastasis recti if it's still apart or not? Yes. Typically they're in supine or on their back. Okay. Hopefying potentially too. And we start down at the pubic bone. So we start at the pelvis and we basically walk our fingers all the way up to the xiphoid process, which is the bottom of our breastbone or bottom of our sternum. And then along, we're looking not only for the width, like I talked about,

[18:13] is it greater than two and a half fingers wide? But something that's not talked a lot about online is the depth. Okay. So underneath of that rectus or that six pack muscle, we've got our deep core system. And that deep core system is what's preventing our fingers from pressing deeper, sinking deeper into the abdominal cavity or deeper into the abdominal wall. So we're always assessing depth and width. Online you might see the two fingers and it's technically two and a half. So we'll bust that myth right there. It's two and a half fingers. And like I said, two fingers is normal for everybody. Now you might have one

[18:44] finger, you might have two, you might have two and a half, but if it's not greater than two and a half, it is normal to have some space between the two rectus muscles. Got it. And two recti. So how does that impact your pelvic floor? Yeah, so like we talked about earlier, the rectus abdominis and the whole entire abdominal wall has an attachment onto the pelvis. That's also the attachment for the pelvic floor. So going back to that townhouse, neighbors, they share a wall. I also treat the whole body because the pelvic floor doesn't really ever act in isolation. And so when we talk about that,

[19:16] we have to think about our respiratory diaphragm, our pelvic floor, and then everything that kind of wraps around and that includes the abdominal wall that we just talked about with diastasis. So they work together as we breathe, they work together as we move, they work together during delivery, they work together postpartum. So yeah, you can't ever just exclusively look at the abdominal wall or just exclusively look at the pelvic floor. So is it fair to say like if you want to strengthen your pelvic floor, you should include sit-ups in some way, shape, or form? Yes and no. Sit-ups used to be

[19:48] online everywhere saying, this is horrible, you shouldn't be doing these, this can worsen your symptoms. Research has shown under imaging, when you do a sit-up or do a crunch or you flex the spine and round the spine, you're actually narrowing the distance between the two recti muscles. So for years, women who were pregnant were told or postpartum, were told to avoid crunches and to avoid sit-ups because it's gonna worsen your diastasis and it's the complete opposite. Oh interesting. It can help narrow that distance between the two muscle bellies. So crunches, sit-ups, are they effective for the abdominal wall?

[20:19] Yes. Are they effective for diastasis? Yes, with a caveat that they're being done correctly with proper breath and when they're done with proper breath, that's when then pelvic floor comes on board. Okay, so the one hard thing for a lot of us because many of us don't have a person there with us saying you're doing it properly or not, what are some things you should really pay attention to to make sure you're doing whatever exercises in a proper way, like what are, use that as an example. Yeah, so it all comes down to pressure management

[20:50] and I would say that's true for the pelvic floor and for the abdominal wall. When we talk about pressure management, you've got your intra-abdominal cavity, which like I said is kind of contained by pelvic floor on the bottom, diaphragm on top, our respiratory diaphragm that moves when we breathe, and then your abdominals, your core, we kind of call it the core canister, right? All the muscles that wrap around the sides, if you will. So if you think about like a pop can, essentially like as your trunk, we consider that your intra-abdominal, your abdominal cavity. There's always pressure in there, but we want pressure to be moving within its canister, if you will, so as we breathe,

[21:25] respiratory diaphragm should move because lungs need to fill. As we inhale, pelvic floor should then move, and then again, same as we exhale, pelvic floor should move with the respiratory diaphragm. So some people think about like a jellyfish or there's that like push and pull. Okay, that makes sense. At the same time, the abdominal wall and the rib cage should be expanding and moving as we breathe, right? So it's kind of all together, managing pressure. When we're not managing pressure is when we typically see symptoms, whether that's leakage of bowel or bladder or diastasis or even pelvic organ prolapse. So we've talked a lot about women,

[21:58] and I know you treat women primarily. What do men run into when it comes to pelvic floor issues? What's some of the common issues that men have? I would say more so like sexual function and urinary leakage, constipation or bowel leakage. And then I actually have seen, I don't see men for pelvic floor, there are special courses that you can take for men's anatomy and men's health, but I have seen men for diastasis. We have the same abdominal wall as men do. And obviously they've never had children, right?

[22:29] And so that's something to note too, is that just because you've had children doesn't mean you're gonna have diastasis and vice versa. Just because you haven't had children doesn't mean you can't have diastasis. So I have a silly question or maybe it is, I don't know. I'll just ask it. So if you have a lot, if you've gained a lot of weight, you have a beer belly, you know, whatever reason, right? Can that cause diastasis, recti as well? Absolutely. And when you think about pregnancy, you're gaining weight as you should. And so some of that weight gain, whether it's for pregnancy

[23:00] or just true weight gain, puts more pressure, push more stretch on the abdominals. And as that stretch happens, the natural adaptation for that to happen, right? To allow you to gain weight or as you gain weight is that that separates. Yeah, so what, how do you, let's say you lose weight, you go on a GLP one, right? And you lose all your beer belly and now you've got this giant gap. Or do people even notice that they have it? A lot of times, yes. During daily activities, getting in and out of bed

[23:30] is very common or doing a sit up, right? It'll be painful? Not always painful. Usually it's like a visual abnormality that people are coming in with. Now sometimes it is pain or pelvic floor symptoms or not liking the aesthetics or the way their bum and wall looks. Sometimes we see low back pain that can be associated with diastasis. But yeah, most often they're not not painful. Got it, interesting. If you've lost a lot of weight recently, it might be something that you might want to see a PT to make sure that you're exercising in a way that you're helping to remedy that.

[24:03] Yes, and when it comes to weight loss, and I know that's a whole different topic. A whole other country. Yeah, it's literally a whole other country, but something I'm also passionate about is weight loss we want to be coming from fat, not from muscle. So even if you're losing weight, whether it's a GLP one or not, you still want to be making sure that you are building muscle, especially as you age for men and for women. You mentioned movement, but is there, if somebody were to walk in your door and you know that they need to strengthen their pelvic floor, what do you have them start with? In general, of course, there's always like a--

[24:34] Yeah, it's so hard, it's so hard. If I want them to strengthen their pelvic floor, where do I have them start? Is that assuming I know they need strengthening? I guess so, yeah. Just as a general, you know. Yeah, as a general thing, when it comes to strengthening the pelvic floor, it's often not a Kegel. Because I think I've said this, the pelvic floor does not act in isolation. It has those townhouse neighbors, it has the surrounding structures and the tissues that help kind of support it, and they support one another. They've done studies, and now this is not always the gold standard, right? There's studies are not ever perfect,

[25:05] but they do EMG studies, and they say, okay, Melissa, do a Kegel. That then puts a number into the computer or the system that says that, it gives a value, an objective measurement of the strength of that contraction. We then consider that at 100% of your maximum voluntary contraction for your pelvic floor, a Kegel. Okay, now let's have you do a squat. Let's have you do a glute bridge. Let's have you do a single leg squat, single leg glute bridge. Lots of different things. Let's have you do a crunch, right? Now what's happening at the pelvic floor when you're doing those exercises,

[25:36] and what we've found is that you actually get more pelvic floor recruitment, greater than that 100%, when doing some of those exercises. So again, going back to Kegels, not being the perfect exercise, sometimes we do get Kegels. Yes, they are not always bad. And so that almost has been like people are like, okay, now I'm never gonna do Kegels. I don't wanna do Kegels. I've been told they're bad. That is not always true either. I don't like absolutes. But oftentimes when I'm trying to strengthen a pelvic floor, I am doing some sort of glute exercise. I might be integrating the pelvic floor contraction or a Kegel.

[26:06] I'm often doing an abdominal based exercise. And a lot of times single leg exercises over dumb leg exercises are gonna get more pelvic floor recruitment. Okay, that makes sense. So I have a few statements that you can tell me about the way that you do it. We've already talked about Kegels a lot. Tell me a little bit about, there's a huge weighted vest craze. I saw I was driving around last night and I saw it was so funny. I shouldn't say this, but this guy, a very overweight gentleman walking his dog. He's got his weighted little weighted vest on. I couldn't help but think of like the SNL sketch. And it's great.

[26:37] I'm glad anybody who's walking, yes, I'm like cheering for you. So I know that. Absolutely. I was like all these people at the weighted vest. What, is it useful? Is it helpful? Yes and no. So the craze is that weighted vest improved bone density is typically what I'm seeing. And that is not necessarily true. If you're wearing a weighted vest when you're lifting or when you're running or jumping, impact loading, yes, it's gonna improve your bone density, but running, impact loading and lifting without the weighted vest gives you the same effects. Which means the weighted vest is not what's improving your bone density.

[27:10] It's the impact and the lifting, the resistance training. So weighted vests build bone? No. No, okay. So you would say, if you're gonna wear a weighted vest, do you want jump, run, impact? If your goal is to improve bone density, absolutely. Impact and resistance training. Is the walking with the weighted vest doing anything? Yes, it is gonna increase the demand to the heart. It's gonna increase demand to the skeletal muscle, but it's not the same sort of demand that's gonna improve bone density.

[27:42] Got it, okay, that's good to know. Not all bad. And two falls are beneficial because we have a relatively flat terrain, right? So a lot of us can't get into zone two, just walking, depending on how fit we are. And so it does, like I said, increase the demand to our bodies, to our hearts. So it can be beneficial, but not from a bone perspective. Running beats walking. No. It goes back to what is the right stimulus for your body. There are benefits to both. Ideally, you can do both. Ideally, you run at least once a week or get into a high zone once a week.

[28:15] Ideally, you're walking most days of the week. So this is a big thing, especially for your audience here, the strength. All women are not, now, lift weights. Most of us have not been trained. So I grew up in the 80s and 90s, played sports, never hit a weight bench ever because everything was like running back and forth, play basketball and other things. And so it was just running, running, running, running. Cardio, cardio. Maybe a couple of bands. Do some sit-ups, run chili puke. That was it. Do it all over again. That's the training.

[28:45] So I'm curious, when you think about cardio and strength, and I know we want both, what's the best mix? Strength training. Strength training over cardio, if I had to pick one, a mix is best. Cardio obviously is gonna improve your cardiovascular endurance, and we know that VO2 is directly linked to health, span, and longevity. And one of the best ways to improve your VO2 max is high intensity cardiovascular exercise. Doesn't have to be running, but high intensity cardio.

[29:17] Strength training, on the other hand, if I had to pick one, like I said, I would pick strength training, is going to improve bone mass, which improves, sorry, improves muscle mass, which then improves bone mass. When our muscle mass and bone mass improve, more so muscle, we see an improvement in metabolic health. When we see an improvement in metabolic health, we feel better, when we feel better, we move more. So there's like this cyclical thing that happens. Any form of exercise also is great for mental health. It's not always just physical, right? For myself, exercise is one of the best things that I do for my mental health. It's the only time my brain can shut off.

[29:49] And so even as a physical therapist, movement isn't just physical, it's mental too. So, and because I think it's partly just how I grew up, and that was the craze, it was like the Jane Fonda years at the Buns of Steel years. I did learn to kind of like offload energy through just like sweating or running till you puke. And when I lift weights, I feel like nothing happened. I'm not breaking a sweat. Not getting you a good workout. Yeah, so how do you help people work through that? Yeah, for sure reframe. The first thing I'll

[30:20] tell you is that sweating has nothing to do with how productive your workout is. Sweating is a sign of your body regulating your body temperature. So if you are in a heated environment, you're gonna sweat, whether you're working out or not. If you're lifting weights and not sweating, has nothing to do with whether or not that lifting session is productive or not. Okay, reframe. Okay, so I see this with a lot of like young people. And I was one of these young people, like you see like, I don't wanna get any wrinkles. So I'm gonna use all the anti-wrinkle creams when I'm 20. Right?

[30:52] If you're young and you're like, I wanna have babies, but I don't wanna have the leakage and the other issues. And so I'm gonna do a thousand Kegels, which you're now saying is probably not the best thing to do. What can you do in your 20s or maybe even your 30s to make sure that, is there anything you can do in your 20s and 30s to ensure that you don't have a lot of leakage issues when you're 50? Yeah, it all goes back to movement and the right stimulus and moving consistently and moving regularly, not jumping onto trends, going crazy and then falling off. Finding movement that

[31:23] feels good in your body that keeps you showing up day after day, week after week, year after year is really what's gonna help prevent, honestly, pelvic floor issues. Now, with that being said, it's proper movement, right? Proper movement patterns, proper breathing strategies. It's more than just moving, but if you're not having symptoms, keep moving. And if you're not moving, start moving. What's the worst advice you see on social media right now? Blanket statement of, stop doing this exercise if you have X. First of all, that's

[31:53] invoking a lot of fear. And when we have fear, we don't move. And going back to movement as medicine, some movement is better than no movement. So I think it's the blanket statements or the absolutes are really, I would say, broad, but the biggest thing that I see is, this is making your diastasis worse, or don't do this exercise during pregnancy, or if you're perimenopausal, this is the best exercise to snatch your waist. So stay off the trends. Stay off the trends. (laughing) So tell us a little bit about your specific practice.

[32:25] Okay, so somebody is curious, they want to engage with you, or they're like, do they need a referral? How do they connect with you? Yeah, so you can reach out any way, phone call, text, socials. You do not need a referral in South Dakota, which is awesome. We're very fortunate to have direct access care as PTs. So yeah, reach out any way that's best for you. We'll get an evaluation set up and kind of go from there. So what does the process look like? They gave you a call and they come in for an evaluation. You said, what is that like? An evaluation is gonna look different for everybody, but in general, we always get to know you first, get to know your symptoms.

[32:56] We do a deep dive, detailed medical history on what you've been experiencing and what different factors might be contributing to whatever you have going on. We get to know your goals and kind of what makes you tick, what you're after, what you want to get back to, or what you want to keep doing, just to help kind of guide our treatment strategies. And then we start with a big picture. So we're looking at breathing, we're looking at posture, we're looking at basic daily movement patterns, like sitting in and out of a chair, bending over to pick up heavy groceries off of the ground, maybe climbing stairs. Then based on what we find

[33:27] in our posture assessment and kind of that gross big movement assessment, we can break it down into specific joints typically, or specific muscles. So we look at range of motion or mobility. We look at strength and stability and then kind of go from there. And then you work really closely with a longevity clinic. Tell us why that was important to you in your practice. So my background in undergrad is exercise science and exercise physiology. And exercise is the most impactful tool that you have in your toolbox

[33:58] when it comes to longevity and health span. And so I think as an exercise science background, that was kind of ingrained in me. But when I was an undergrad, there wasn't longevity medicine around or not that I knew of. I went to undergrad up in Brookings. And so I always had the kind of that passion and that knowledge of how impactful exercise can be for our overall health and wellness. But there was no real outlet for that. So when health span had reached out about starting a longevity clinic here in Sioux Falls, it was no questions asked. I'm all hands on. So very passionate about that world.

[34:31] If you had a billboard that you could put up in the middle of town, like that everybody would see, what would it say? Some advice. I think I've said this, but I'm gonna say it again. If you're moving, keep moving. And if you're not moving, start. So hard sometimes. I know, it is so hard. And I think that goes back to not just the motivation and the discipline, but finding movement that feels good that you can keep showing up for. Because once you start moving

[35:03] and you start moving consistently, you're going to feel and see the benefits both. And I think when we see and feel those benefits, that's when we can continue moving. And so until we can start seeing and feeling those benefits, it is hard to show up. So if you're not seeing benefits, you're not feeling benefits, then maybe something that's maybe an indication to come in and see us. There you go. So last question, where do people find you? What's your website? Where are you located? All that good stuff. Located in Sioux Falls, South Dakota, our website is wellbalancedphysicaltherapy.com. We also have social media.

[35:35] Our handles are always well balanced physical therapy. You can give us a phone call, call or text at 605-610-8220. We're located on the Southwest side of Sioux Falls. But yeah, reach out online, reach out via phone. We'd love to see you, love to help you. Amazing. Thank you, Ember, so much for being on this show. This is great. If you're doing Kegels, maybe check in with Ember first. So you can reevaluate if that's the right thing for you. There's lots of options and keep moving. That's right.

[36:06] All right, thank you so much. Thanks. Hey, that's our show. If someone came to mind while you were listening to this, if you thought, "Hey, my sister needs to hear this," or, "I should send this to my mom," or, "My buddy would get a lot out of this," please share it with them. Just hit the share button and send it their way. You never know what one conversation, one episode, or one piece of information can do for someone who's been looking for answers. And if you haven't subscribed yet, please do it now. It takes two seconds, it's free, and it means you won't miss an episode. We've got incredible stuff coming up and I don't want you to miss any of it. And if you're a

[36:38] health or wellness provider and you wanna be on the show, we'd love to hear from you. There's a link in the show notes to get in touch. We're always looking for people doing interesting work who wanna share what they know. And one last thing, I get asked all the time about the products and brands I actually use. So I've put together a list of sponsors and favorite products that have worked for me and my family. If you're curious, that link is in the show notes too. Thank you for being here, and I really mean that. I'm Melissa Goodwin, the line is open. See you next time.