WOMEN'S HEALTH PHYSIOTHERAPY Q & A with Jillian Palmer, PT, CAFCI
Thanks very much to Kellie Willie from Fit Your Life for me asking these questions!
1. Who should be assessed by a pelvic health Physiotherapist?
Pelvic Physiotherapy is a branch of Physiotherapy that describes the physical (neuro-musculo-skeletal) care of the “lumbo-pelvic-hip” complex and related structures. There are branches that address women’s pelvic health, men’s pelvic health, and children’s and adolescents’ pelvic health.
Women: Incontinence, Pelvic Organ Prolapse, Hernia, Diastasis Rectus Abdominus, Sexual Pain, Physical Birth Preparation, etc...
Men: Incontinence, Erectile Dysfunction, Sexual Pain, etc...
Youth: Bed wetting, Chronic Constipation, Incontinence
I work specifically with women at this point in my career and so I can’t speak to everyone who should see a pelvic Health Physiotherapist (although if you’re a man and you’ve had a prostatectomy…run and don’t walk to the nearest clinic that can help you) but I think that every woman of childbearing age (pre-and postnatal) would benefit greatly from an assessment.
There’s so much that we’re not in-tune with about our bodies. As females, we used to grow up witnessing birth, breastfeeding, and being around other women talking about their physical experiences as women and the changes that occur over the lifespan. It’s not the point of this interview to talk about what a shame it is that we’ve lost that passed down wisdom– but having someone to help decode some of the messages that your body is giving you (such as pain, leakage, heaviness, weakness, etc.) can be really helpful.
2. I am not having any symptoms listed on your website. Should I still be assessed?
Gah! Yes! This is the most ideal situation. I recently learned the (apparently very common) phrase that “an ounce of prevention is worth a pound of cure.” That couldn’t be more spot on. If you’re pre-natal and want your birth and postpartum healing to go as smoothly as possible, pelvic Physio is your place. If you’ve had baby #1 but are looking forward to expanding your family and want to prevent injuries and symptoms in subsequent births, come on in. If you’re done having children and want to maintain your pelvic health well into your postmenopausal years, get checked out!
3. What if you find something "wrong"?
Great! No, seriously. There are conservative treatment options for almost every issue that you could be experiencing. Better to address these things now than later in your life when they’re harder to treat. Having said that, I have a personal philosophy that has been shaped by my clinic experience: you’re most likely experiencing symptoms because of something that you’re actively doing to your body that wouldn’t be a problem if you took away the offending behavior/activity or waited until your body was ready for it. The female body is a masterpiece in form and function and it was designed to work perfectly throughout your entire life. That includes getting pregnant and birthing multiple children (sometimes multiples of children for all my fellow twin+ moms) and returning to function afterwards. Our species would not have been so successful if was inevitable that one out of every three women was left incontinent after children, or one in every two had prolapse, or three in four were riddled with pelvic pain (including sexual pain). Right?
So, in Physio, our job together is to figure out why you’re having symptoms. Address that issue through education, exercise, manual therapy etc…and send you on your merry way.
4. What is one piece of advice you could give women regarding their pelvic floor or core health?
Just one? Oh man.
Ok, It would be this: mind your pressures! Excessive intra-abdominal pressure (anything where you’re holding your breath and squeezing your stomach) can be a real doozy on a poorly functioning core unit and can result in losing control somewhere in the system. This could present as leakage, pelvic organ prolapse, herniation anywhere (though, most often through the umbilicus for those of you who all of a sudden have an outie belly button!), hemorrhoids, back pain, etc…
The best way to deal with any of these symptoms is to remove that excess pressure, figure out where the weakness is, address it, and then slowly re-introduce those pressures until you’re back doing whatever it is that you want to be doing!
5. What is the biggest misconception you see regarding women’s health?
That physical postpartum problems like we’ve been discussing are just a normal part of being a woman who has given birth. Sure, they’re common – super common actually – but so are other injuries such as rotator cuff tears, arthritis, headaches etc…just because they’re common doesn’t mean they come part and parcel of being alive. It just means that if you’re experiencing those problems, your body is trying to give you a message. Will you listen to that message or ignore it?
6. What do you love about your job?
Easy, I love that I essentially just treat different versions of myself all day. Seriously, all of my patients are lovely women who have unique and interesting stories about what brought them in to see me. It’s the people!
7. In your opinion, should every new mom see a women’s health PT after having a baby?
This is the dream! I wish that Pelvic Health Physiotherapy was the standard of care for all women postpartum. In different parts of the world – it is. In some countries, just like you get well-baby visits in your home to address concerns with baby, you’d also get some (6-12) pelvic physio sessions to address concerns with your physical healing! Imagine how much money our healthcare system could save in the long run if we could avoid surgeries for incontinence, prolapse, hernias, etc…just by doing some simple, cheap physio appointments! If anyone has ideas on how to make this a reality – hit me with them. Seriously.
8. What are some tips for women who want to move their body safely, but are waiting to get in to see a pt?
Great question. You bring up the very important point that Pelvic Physiotherapy is under-serviced. Whereas there are countless general musculoskeletal clinics around the city, there are only a few of us who treat pelvic health concerns.
Most clinics around the city have a waitlist and so in the meantime – walk. Honestly, consistent walking everyday will do more for your body than a super hard workout once a week and then nothing the other 6. Likewise, moving your body throughout your day will do more for your body than being sedentary all day and then moving a bunch in a one hour workout.
Another thing is to align your body. Most of us Moms (myself included) have horrible alignment all the time. Between carrying car seats, hoisting toddlers, nursing, and sitting all the time, we barely ever get a chance to align and move our bodies well. Horrible alignment some of the time is totally fine and normal and good actually! But if it’s the only way you line up your body – mmmm, trouble. Everyone is different so there aren’t one size fits all rules about alignment but generally: don’t stick your butt out too far but don’t tuck it underneath you either.
Oh, and mind your pressures. If you’re leaking – stop! If you’re feeling heaviness vaginally or rectally – stop! If you’re doming out of your stomach – stop! If there’s pain – stop! Or at least modify so these things aren’t happening. Please and Thank you!