Postpartum Running Research You Actually Need: What Science Says About Returning to Sport —with DR. RITA DEERING

Today I speak with Dr. Rita Deering, a women's health physical therapist, associate professor of physical therapy, and researcher who investigates postpartum neuromuscular function and perinatal exercise. Her PhD work evaluated postpartum abdominal muscle function and she completed an Advanced Fellowship in Women's Health where she looked at running mechanics and abdominal muscle function in postpartum runners. Dr. Deering has several peer-reviewed publications on postpartum return to sport and running.

We talk about:

-BJSM Postpartum Return to Running Consensus Statement Part 2

-working with what you have

-psychological readiness

-“normal” pain in running

-crowd sourcing medical information 

-finding a knowledgable provider

-breathing

-when to scale back

-screening for RED-S

Time Stamps

1:00 Introduction

3:34 explaining a Delphi study

9:20 where there was consensus

12:36 where there were inconsistencies 

19:45 where moms get information

27:29 uninformed returned to run programs

38:06 recommendations for training

47:00 education versus fear-mongering

48:08 listener questions

68:03 rapid fire questions

CONNECT WITH CARRIE

IG: https://www.instagram.com/carriepagliano/

Website: https://carriepagliano.com

CONNECT WITH RITA

IG: https://www.instagram.com/ritadeeringphd/

Website: https://www.carrollu.edu/faculty/deering-rita-phd

Research: https://bjsm.bmj.com/content/58/4/183

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Transcript

SPEAKER_00 0:02

You're tuning in to the Active Mom podcast with physical therapist Dr. Carrie Pigliano, a real mom's guide to all things postpartum return to workouts after babies. If you're a postpartum mom, coach, trainer, or physical therapist looking for answers on how to get back to running, CrossFit, yoga, Pilates, pit, you name it without the fear of public floor issues or doing something wrong, this is the podcast for you. Let's start the show. All right, I know how you guys love having researchers on the podcast, and I'm excited to bring our next guest on. It's our second time on the show. Researcher Rita Deering has dove headfirst into all things pregnancy postpartum, running all the things that we love here. Um, so thank you so much for coming back and joining us on the Active More Postpartum Podcast. It's been a little while. So in case somebody didn't see you the first time around, um give us a quick download, who you are, where you're from, what you do.

SPEAKER_04 1:01

Sure. Um, so I worked as a um PT for about five years before I went back for my PhD. Um and I did a little bit of everything in that five years, but um, the last you know, couple years of my full-time clinical career was outpatient ortho and women's health. Um, and so I got into women's health by teaching an exercise class for pregnant women um and got a lot of questions about um DRA. And that's what led me back to my PhD. So my PhD looked at muscle function of the lumbopelvic muscles, so abdominals and lower extremity um strength and fatigability um compared to women who had never been pregnant. Um, and then I did a postdoctoral fellowship um at UW Madison with the Badger Athletic Performance and looked at postpartum runners. So um runners who are up to two years postpartum and um did an abdominal training program with them and kind of looked at running mechanics and um interact eye distance there. And um now I'm an associate professor at Carroll University in Wisconsin. Um so I'm continuing to study postpartum muscle function, postpartum exercise, um, still on um running and and postpartum return to sport in general, um, and was really honored to be part of this group that put together these two Delphi studies and consensus statements. It was um really a powerhouse group, and um, it was really fun to be part of. And um, yeah, it's great to get those studies out into the world.

SPEAKER_00 2:43

Yeah, no, I I I'm a huge fangirl of everybody in that author group. And we had Shafali on to talk about the first part. Um, and I was like, Shafali, just let's do the first part. And when Rita's coming on, she'll handle the second, it's all good. Um, because there's just so many good little tidbits in there. So why don't we just dive right into that one? Um, and uh, I'll pull up the title here in case anybody's looking. Clinical and exercise professional opinion on designing a postpartum return to running training program, written in the English, like the proper English program, an international Delphi study and consensus statement. All right. Um, quick explanation um what a Delphi study is and the depth that you guys went to in this Delphi study, because I have since learned that some people don't go as deep as y'all did. Um let's let's start with that piece because I think that's actually quite relevant.

SPEAKER_04 3:33

Yeah. Um, so Delphi studies are used when there isn't a lot of research on a given topic. And um, I think everybody can agree that we don't have a lot of research in the postpartum space in general, but specifically when we're looking at sport um or or higher level exercise. Um and so what we did was um we designed this Delphi survey for um exercise and um clinical professionals who are working with postpartum runners. So um our criteria was they had to be working with postpartum runners um for five years, or if they were working with postpartum runners for less than five years, it had to make up more than half of their caseload. Um and so, and it was an international study. We we um distributed this worldwide to the people who met the um inclusion criteria. And a Delphi is a multi-uh stage study. And so the um first phase of the Delphi is we give them open-ended questions. And so we ask them like, what are the key milestones that you look for when you're working with a postpartum runner? Um, you know, how do you initiate their training? How do you progress their training? Um, what key muscle groups do you um focus on when you're designing a strength training program for them? Um and so we got all of their typed answers back. Um, you know, and there were over a hundred respondents to that first round. So it was no small feat. Um and and we're verbal about what we like to do too. Yeah, I'm sure those were long. Yeah, well, you know, and it's it's interesting too because um everybody interprets the questions a little bit differently too. So maybe what we thought we were going to get for a given question, we may have gotten more than that. So it's like, oh, okay, we didn't even think of that. So that's a good thing. Um, so then four of us, so myself, Shafali, Margie Davenport, and Sinead Dufour um got together and did what's called thematic coding. And so we look through, we read through all of those responses and we pull out what is common among them. Um and then we use those themes to build the second part of the survey, which is we then give them statements and then they um either agree or disagree on a Likert scale, and then we compile those results, and then we send out round three. So normally in a consensus statement um or a consensus process, you would all be in one room or on one, you know, video conference call, and there would be some degree of discussion, right? So I might come in believing that A is the way to go, and then we talk about it, and I think, oh, well, you know what? Actually, maybe B is the better option.

SPEAKER_01 6:35

Yep.

SPEAKER_04 6:36

Um, and since we didn't have that model, like it's hard to get it was hard enough getting the authors together, let alone you don't want a hundred public floor physios and coaches and trainers in a room because we won't shut up.

unknown 6:48

Right.

SPEAKER_04 6:49

And just finding a time that everybody's available. Um, so instead, what the Delphi does is um that round three is you get to see the voting results previously. You don't know who voted how. Um, you don't even know who the other people are, so that you're not swayed by like, oh, I really respect this person, and they thought it was A, so I should choose that. Um, but you can see how how people voted, and then um if that changes your vote, then you can you have a chance to vote again. And if it doesn't, then you just put what you voted in round two. Um, and so that's where we identify consensus. And so we define consensus as um 75% or higher agreement um or disagreement if it if 75% or more disagreed. Um and then what we did that is a little bit unique is that we then took that consensus and we did a literature search based on that to see if what these experts are recommending is supported by the research evidence. Um and so that that's what was kind of unique about um about these two consensus statements. So that's why it's written as Delphi study and consensus statement, because um sometimes um we as authors would uh change the recommendation to make sure that it was supported by evidence.

SPEAKER_00 8:18

Yeah, which is tricky in a situation like this because we don't have a lot of evidence.

SPEAKER_04 8:24

So there certainly was some extrapolation that had to occur um from research evidence in other populations or just in general, you know, running um injury um research, not necessarily specific to postpartum, but um yeah, so it was it's you know the best recommendations that we can make with the information that we have at the exactly, exactly.

SPEAKER_00 8:45

And having it in print, I think it's gives us again, like it's it's establishing that foundation. So we've got to start from somewhere. And and you guys have done a lot of legwork on kind of pulling this together to be like, what are we doing now as kind of a field? And then where are the gaps and where do we need to fill in? So um, so so so let's start with the fun stuff. Like, where where did you find like, hey, we're all in rah-rah? Research is good here, we're fine.

SPEAKER_04 9:12

Um yeah, um, so for this one, um, I don't I don't think the designing the program was as contentious as the establishing readiness. Um that that was a little bit trickier. Yes. Um, but basically, you know, they identified some um, you know, some key muscle groups to train. Um I think there was no um real argument in the fact that progression needs to be gradual, right? So um, and that's really even non-postpartum, that's where you see the injuries happening, right? When you um progress too quickly. Um, and so I think that was something that was really um that came out strong um from both the consensus, the Delphi consensus and the literature review. Um what was also nice was to see that um, you know, they highlighted a lot of additional factors that we need to consider specifically for this group, right? So like fatigue, sleep, um, lactation, um, nutrition and hydration, things of that nature. Um so again, things that we may not have a ton of published literature on, but that um, but that the experts are are acknowledging that these are important things to ask about and to monitor, um, and definitely should be included as part of the training program. You know, it's not just about mileage and strength training. Um, there's a lot more that goes into that.

SPEAKER_00 10:58

Yeah, no, I I I think that's such a good point to make. And and I think it can be overwhelming, but also comforting because on one hand, we're like, oh my gosh, we have all these variables from sleep to fueling to uh training load to like life stressors, like all these things. Like, how how can we possibly quantify that and make you know, like an algorithm or something? But at the same time, I think that opens the door for individuality and individual treatment of who's in front of you because um you're not automatically marked with the red X. It's like, no, we can work with this, it's just gonna look different, yeah, person to person.

SPEAKER_04 11:36

Right. And it might also help kind of temper some expectations too, right? Like your progression may not be linear because there are these other things that happen, right? So, like if you're doing great and then all of a sudden kiddo has a sleep regression, which means you do too, right? Maybe things back up a little bit, and then you can start going back up again when the wheels are back on that sleep train.

SPEAKER_00 12:00

Which you and I both know that even once they sleep train, um, they're still gonna have those wonky days. Like we're just finishing end up the school year and it's been a show, and I'm sure you've gone through the same. It's like, no, things go chaotic from time to time, kids get sick, like all sorts of life stressors happen. Get into the habit of, you know, maybe you pop into like a you know survival mode strategy where you're running for sanity and doing basic strength or something like that, and then you get to do, you know, good training another time. Right, exactly. Yeah. Yeah. So where were the more um the I guess more the inconsistencies that were kind of identified where there was um a little bit more kind of all over the place um things that people brought up?

SPEAKER_04 12:45

Um so I think in the looking at like the muscle groups to train, um there again, I think most of these reached consensus, but there was a little bit more discussion about like back extensor muscles and um and even like some of the lower extremity muscles, where you know, particularly when we were talking about it in as an author group, there actually was one um author who um disagreed with you know the inclusion of lower extremity muscles because there just isn't much literature on it. So that author just had a hard time saying, like, I we can't definitely say this because there's no literature to suggest that training this is going to influence their injury risk. Um, and so that that I think is probably like the biggest point of contention. Um, something else was, and actually, now that I'm thinking about it, I don't remember if this was in the first paper or our paper, but when we talked about paper blend, yeah, support items. So um, you know, there were some people who said like, yeah, side belts are okay, and then some people who were like, no. Um, so that was probably like I don't think that came to consensus. And so that that was interesting. Um, but um what was again, I think the the hardest piece was not necessarily the Delphi consensus, but the um the finding the literature to support what um what the clinicians are doing, right? Which again, you know, like you mentioned um in the um the reel that you did on Instagram about it, is that it really helped us to identify what some of the gaps are in the literature that need to be filled. Um, so thank you for the job security. Um anytime. Um, and also just you know, the um something that we talked a lot about as authors too, particularly with gonna bring in paper one a little bit with the time frames that came out in the consensus, is it's a tough line to walk between letting people do what they're ready to do and advocating for like parental leave and things of that nature, right? So, like and we talk about that a lot in the discussion of this paper, is that you know, just because they might be ready to return, you know, before 12 weeks postpartum, because that's what the consensus came to, um, doesn't mean that there isn't value in having protected time off. Yes. Um, so you know, not it's parental leave isn't just about musculoskeletal recovery, right? There's so much else that goes in that. And again, that I think that was highlighted in in this paper of the designing the training program when they talked about things like the fatigue, the social support, um, you know, emotional recovery, right? I mean, childbirth is traumatic for some people, and and not only do they have to heal physically from that, but they need to heal emotionally and psychologically from that as well. Um, and that's something that we see in the sport literature also, is that you know, you there has to be a psychological readiness, um to physical readiness, and so um, so I think that was probably the most contentious piece of of this study as a whole, um was was trying to walk that line between yes, some people will be ready to return to running early, but that doesn't necessarily mean that they don't need parental leave.

SPEAKER_00 16:58

Right. Yeah, no, and I again like it's it's so multifaceted um in that respect from a societal perspective, and then just from a straightforward, you know, MSK training and and you know, all of that. Um, you know, and I and you know, when you're doing the literature review, you're saying, you know, we're we're pulling from these other kind of adjacent areas as much as we can. I there isn't necessarily, and correct me if I'm wrong, I don't know that we've come to like a massive consensus to say, hey, when you're coming back from just like general injury, these are some of the things that you need to do generally across the board. Like, I don't think there's consensus there. So it makes it really challenging to now say, okay, we have this whole new scenario with multifaceted issues. Right. This is in black and white what we do. Right.

SPEAKER_04 17:50

You know, it is, it is. And and the other thing that kind of muddies the waters when we're looking at running in general is that it is a sport that has very high pain and injury rates, right? So, I mean, take the pregnancy postpartum piece out of it completely. Right, most runners will experience running related pain or running related injury at some point, right? And so that was also kind of a struggle, too, of like, well, if we wouldn't have told them to stop running pre-pregnancy, why are we gonna tell them to stop running now?

SPEAKER_00 18:33

Because it doesn't make sense, right?

SPEAKER_04 18:35

And and again, the and there actually there is literature to show too that when you tell runners to stop running, they don't replace that physical activity with another mode of physical activity.

SPEAKER_00 18:47

No, because you can't.

SPEAKER_04 18:48

So so right. So now we're opening a whole nother can of worms, right? Of now we're increasing their cardiovascular disease risk and all this other things that comes from being sedentary.

SPEAKER_00 19:02

So um, yeah, it's not to mention mental health and all that other stuff. If you tell somebody they can't run, and yeah, there's um a bunch of um Facebook groups that I'm in um that the most fascinating questions come up in, and one of them actually, it's not even a maternal running group. It's um it's a group that supports um, it's it's from a woman who does a running podcast. And there's some amazing questions that pop up in there, like, hey, I'm running and this happened to me medically. What should I do? Like crowdsourcing medical information on Facebook. And I'm like, there's a couple of us that are pelvic floor PTs, and we're trying, you know, to kind of seed some good information and that kind of stuff, but like it's amazing. Like on one hand, people are like, Oh, we don't talk about it, but on the other hand, like there's these corners of the world where people talk about it and they're trying to grab this information. And I think what's really hard is um, you know, what you guys are trying to do is basically say, like, hey, there's a lot we don't know, right? Period. Um, so how do you provide um, you know, somebody with concern and fear and questions and potential mental health implications to be able to say, yes, you need to do this, or no, you shouldn't be doing this when there's so much variability. Right.

SPEAKER_04 20:22

Um, and then it actually brings up something else that came out in the study. So we asked the Delphi participants, um, like, where do your patients come from? How do they find you? Um, and how do they pay you? Um and a lot of them were self-referred, yep. Um, and paid out of pocket. So cash cash-based practices. Um, and so you know, that was something else that we found that we thought was really important to highlight is that um, you know, the beauty of running is that it's pretty low cost, right? You need to've that's about it, right? Um and actually some people don't even do that, right? They do barefoot running. But um, so the people who are getting the help that they need from the experts in this field are finding them on their own and paying for it on their own, which is excluding a lot of people.

SPEAKER_00 21:21

It's a point of privilege, 100%.

SPEAKER_04 21:23

Yeah, yeah, for sure. And so, you know, that was something else that we highlighted in that, you know, we need to have better access, uh, and we need to have better training of healthcare providers, you know, whether that is birth providers to know where to find the people to refer to, um, or if it is, you know, the run coaches, the PTs, um, who need to have um better training and how to handle these. And that, you know, and that was part of the goal of these papers is yeah to make them accessible. So we were very um fortunate to have the. Um selected as editor's choice so that they are open access and people can can access them. They're not behind a paywall, so that clinicians can you know grab that and have at least, like you said, a starting point, right? So yeah, you know, every patient that they see is may be very different, but at least they have some guiding principles to grow off of.

SPEAKER_00 22:23

Yeah. No, I and there's a couple points you kind of bring up there. One is um, I think the variability and practice patterns internationally.

SPEAKER_01 22:31

Yes.

SPEAKER_00 22:31

Um, I think that's very evident. I don't know. Like to me, it's incredibly evident. The the first time I ever went to a World Congress, um, oh gosh, it was like 2017, I think it was in in Cape Town, and just talking to um just straightforward pelvic floor physios, and so many of them just trying to get care for women, period, because of the social inequities and that kind of stuff. And um, and just the difference in education and background and that kind of stuff. And and even in you know, first world countries, there's such um a difference in base level of care. And I think that's also become incredibly apparent when you have people that will DM you from all over the world and say, I'm trying to go to a pelvic floor physio, I'm active, I'm a runner, I'm a lifter, you know, whatever it is. And they're just giving me Kegels, which is like basically us back in like 2000. And what's very hard, I think, as a consumer is like, okay, I know I need to do more. Yeah, this is not what's here. How do how do I move forward? And um, and to your point, you know, about access and privilege and that sort of thing, like I really think it just needs to come down to do you have internet, which I know is is also a problem all over the world. But like, can you find somebody, one that you can relate to, looks like you, like you can connect with that will provide you the information that you need? And and you know, people ask me all the time, like, why do you do this? Do you do your own social media? I'm like, yes, I do every damn post, every little thing, because there are people out there that do not have access. And if we can even just give them a the tiniest bit of knowledge and acknowledgement that what they're feeling is is what they're feeling, and can we there's a path forward, like that's why we do it. But um, it's so hard because I don't think there's any way to standardize it. Um and for those physios that you know are in those countries and being like, hey, I need to do more. I don't know how to figure this out. The other thing, too, that I figured out is y'all don't get paid for the paper from the journal.

SPEAKER_01 24:35

No.

SPEAKER_00 24:36

And I I've had intermittent relationships with academic institutions and had varying levels of access to um uh research. Umil the author. Yep. Research gate, those two things. Authors want to get their information out there. And and if they can't, because of hey, I can't release this for another couple of weeks, they'll tell you. And then just set a schedule Google email to check back in in three weeks. Like researchers want to get their information out there. And so this barrier of paywall, I think we're finding a way around because just like pulling the curtain back that right. I think I used to think I'm like, oh, well, of course you want me to buy the journal and all that stuff because you you get paid by the re nope. Nope, I don't see a dime. So if you want something that's not open access, email Rita. Um no, but and am I wrong here? Like you you guys, like that's the plan is you guys get this into as many hands as possible because that's how we're gonna make the change, right? Yep, absolutely, absolutely.

SPEAKER_04 25:40

And yeah, you know, and back to your comment about um, you know, the variation in uh geographical um, you know, areas, I think that was the nice part about this being an international Delphi uh survey and about us being an international author group. Yes, because yeah, there were like, you know, there were quite a few times where you know Shafali and I would get on a call with uh Grania and Emma and just be like, okay, I don't understand what what this person is saying, and they would have to like explain to us the UK uh medical model. And again, then some of the concerns are different then too, because access is very different. And um, you know, and so if if you know that people don't have the access, then yeah, maybe you're gonna encourage them to be a little bit more conservative because they might not have a public health physio within you know 150 miles. So um, yeah, so that was really eye-opening for me um to to see that how different it is in in varying countries and um and again just to highlight the fact that we need more people who understand the um physiological, psychological, you know, the whole biopsychosocial implications of pregnancy, childbirth, parenting, yeah. Um, because those all factor into training.

SPEAKER_00 27:19

Yeah, yeah. No, I I think so too. Um one of the things I I've it's kind of kind of been, I think, more apparent to me lately, and I would love your thoughts on this. Um, so as you're putting this statement out, specifically speaking to training and practice patterns and things like that, I have noticed a growing trend as we have more and more people. And if I didn't see it in black and white, I wouldn't believe it. Like literally four years ago, no one was talking pregnancy postpartum running, like just wasn't. Um, barely like the the 19 guidelines were barely out yet. Like it just it wasn't a thing. Now everybody and their brother has a postpartum running program. And I dare say most of them are relatively benign and you know, they're not gonna screw up anybody or anything like that. Um, but what I do find is that the programs and the people that are putting them out there don't necessarily have a background in running, other than, hey, I've always been a runner, and so I'm gonna do this, and this is what you should do. Yeah. Um, or hey, here's the drills I did in high school track. Da-da-da-da-da. Like what do we do with that? And was that reflected at all um in kind of the the feedback? Like, was there a clear awareness of hey, that we've got some some other nuances here um to kind of navigate? Um what do we do about it? That's a loaded question. Um start with the simple one. We'll we'll we'll get to the more complicated later. We'll fix the world later. Yeah.

SPEAKER_04 28:57

Um so again, that because the Delphi is based on themes, yes, that helped. Um in that yeah, there were a lot of um responses that you know had similar themes and often were pretty well based in um you know what we know about running in general, um, or what we know about the postpartum period in general. Um, but what didn't make it into the survey were some of those like one-off statements, right? And so, you know, yeah, there certainly were some um comments that um may have seemed a bit strange, or like, I don't know that I would do that, but that's working for you. Okay. Um, we need examples now.

SPEAKER_00 30:03

Um gosh, that's I mean what was the one that was the most off the wall? What what what's the one that's stuck in your brain?

SPEAKER_04 30:11

Um I don't even know that I can think of a specific example, but there were some things, again, with it being like an international thing where we would meet as an author group and you know, I would be reading the um themes that came up. And so, for example, there was a question where somebody, some one of the other authors said, like, okay, so is um like the staging, I think it was either for prolapse or for tearing, I forget which one it was, but like, is the staging different in the US than it is in different countries? I was like, Oh, I guess I never really thought of that. I don't know if it's different. And they're like, because like we don't have a stage five, but this statement says stage five. And so I was like, oh, I was like, and honestly, I don't know the country of origin of that right statement. And I mean, it could very well have been a typo, but what we did was we included that so that when they got round two and they were looking at it, they're like, Well, I said stage five, and this only says stage four, so I'm gonna disagree with it, right? So it was and he said like stage four or five or something, and so some of the authors were like, Hold on a second.

SPEAKER_00 31:19

Well, that's when you you go back and you're like, Okay, we don't have great consensus in like you know, how many times if we change the staging on that, how many times if we change our terminology, we have we have crappy consistency with terminology anyway, so that makes it really tricky throwing a bunch of different countries, and yeah, it's exactly yeah, yeah.

SPEAKER_04 31:36

So I think that was probably the bigger one that like started out was just some of some things like that, and again, could have been an honest mistake, right? Like, I mean, how many times do I spell something wrong or hit the wrong key? Um, but no, I mean, I think for the most part, um, or there are just some things that and I might I might catch some hate for this, but um I'll love um something that we talked about a lot and that came up in the survey was breathing, right? So like and that's huge in pelvic floor in general, right? Like you've always got to train their breathing, but when you look at the literature, doesn't really add anything. Um, and so that was maybe like another thing that was um, I don't really want to say contentious, but I mean, but it it met consensus on the experts. And then when you look at the literature, the literature doesn't say that.

SPEAKER_00 32:36

People feel really strongly, yeah.

SPEAKER_04 32:38

Um, yes, and yeah, like yeah, people do feel very strongly about it. So um so I think that's you know, part of the hard part too is that like you were saying, where like everyone and their brother has you know their postpartum running things now, like um and people tend to like really dig into their own trench. And when something comes up that refutes that, it's difficult sometimes to change your position. Um which is unfortunate. Um, because again, you know, it's we're finding new things out. And you know, if you look at, you know, even the 2019 guidelines, there were there are new studies that came out after that, right? Which is part of the reason that we decided to do this Delphi survey too, is you know, to see do those new studies that come out do they change what people are are doing in their clinical practice? Um, so yeah, I think most people have seen that um statement where it takes like 17 years for research to get into practice. We'd like to try to shorten that.

SPEAKER_00 33:49

Yeah, no, I'm a fan of that too.

SPEAKER_04 33:52

Um yeah, so you know, it's okay. It's okay for your practice to change, it's okay for your opinion to change when when new information comes out. Um, and it doesn't, you know, it doesn't mean that you were wrong or it doesn't make you a bad person for believing what you believed. You know, we're just all doing the best we can with the information that we have at that point in time. And um so yeah, so and so again, what what we put out in these um consensus statements in a couple years, there may be new evidence that says this is wrong. Um and I'm okay with that. Um but but really what we did was we identified that we need the research, like we need somebody to come and prove this wrong.

SPEAKER_00 34:40

Right. No, exactly. And then and I mean, I think it's incredibly important to to to check yourself when you have biases and why you have those biases. Um, like is it, you know, and and are you keeping up with the literature, which it's hard to do. And that's why I'm always, you know, that's why you know, conversations like this are incredibly important because not everybody has time to sit down and read the whole paper, and not everybody wants to.

unknown 35:00

Right.

SPEAKER_00 35:01

And yes, you need to read beyond the abstract.

SPEAKER_02 35:03

Yes.

SPEAKER_00 35:05

Anyway, that's a whole nother podcast. It is. Um, no, but I I think you know, it it sheds some light on, you know, when we have these trends of like over minutia and people get stuck there, and then there's you know, I it's so funny the other day. I it it I I'm just enough in social where like you have to kind of sift through to see what the shit is so you know what to refute and kind of pull the good information for, but you got to make sure that you're not like drawn down into it and have it impact you mentally. Um no, but it's where you're like, oh, you should do this, or definitely do this, or um, you know, breathe a certain way or do the certain exercise. And the fact is, like, you could be incredibly overwhelmed with all the options out there, even if you were like, okay, I need to, you know, connect neuromuscularly to muscles that that changed in length and that kind of stuff. I I need to do some sort of exercise that's going to address bone density as a lactating mom. I need to do something that's going to address tenants. Like, you could even get overwhelmed that way, you know, by by kind of going down those specific sort of running rabbit holes. Um, but it cracks me up. This person was like, you know, we no one's addressing the gap between the treatment table and the trail. I'm like, um, what have we been doing for 25 years? Like, y'all, we've been over here doing stuff. But it's so funny that people are like, oh, no one's doing this. I'm like, oh, that's why there's statements like this. Like, yeah. Yeah, it's into the party. We're happy to have you. We've been here for a while. Right. Doing the best we can.

SPEAKER_04 36:47

Yep. Yeah, yeah. So yeah. So thank you for having a platform that makes it more accessible. Because yeah, I mean, I try on social media, but it's it's tough to juggle all the things.

SPEAKER_00 36:58

It's a again to my point, like it's it's one of those things that like you got to dip in just enough to know where the the stuff is, but not get sucked down with it and kind of and again keep looking where their gaps are because yeah, that gap between the treatment table and the trail, that was um, that was my lived experience.

SPEAKER_02 37:17

Yeah.

SPEAKER_00 37:17

Um, that was very much the impetus for me being like, oh no, because there were no other options and I was gonna run and just doing it and being in pain and not having other alternatives was not good enough. And I think those stories need to be punted forward to be like, hey, that's how we are here. That's how there was, you know, 19 guidelines. That's why you, you know, have research agendas and stuff that you're working on. Like it's been very much a lot of people have been putting work on this. Now that it's the cool kids, um, yeah, like now let's take that notoriety and and let's push it towards, you know, making these research questions and being a participant in some of these, you know, studies and things like that.

SPEAKER_02 38:00

Right.

SPEAKER_00 38:00

Um, so kind of looking at training, you know, my my gut initially was like, okay, when I read this, am I gonna come out being like, hey, I should be, you know, addressing this type of exercise or making sure that I check this box? Like, what were the things that kind of like if somebody doesn't have time to read this paper and they're like, hey, I I want to know baseline recommendations if I'm gonna work training-wise with somebody, what would be some of those kind of points that you would want to bring forward?

SPEAKER_04 38:27

Yeah, so um the main thing is that so we talked to you about how there's going to be some recovery period, right, after childbirth. Um, and that that looks different for everybody too. And so your starting point is really gonna depend on you know what their training history was and what that recovery period looked like. So how much how much deconditioning happened during that recovery period? And so you're gonna start them, you know, relatively low level for them, um, and then progress gradually. And the the thing to that is important is, you know, the other paper looks at run readiness and that screening, right? And and determining when they're ready to start running. And what this paper kind of tries to um highlight is that it's not just that one-time screen, right? It's not the I did the screening to say that they can start running, I'm out. We need to be continuously monitoring as training progresses. Um, and so that was really important too. And I think the other um key thing that this highlighted is that so I think when we think about training programs, a lot of times, like the um kind of default or like cliche way of thinking it of it is that it is only a progression, right? Right. Going from stage one to stage two to stage three, right? Until you get to whatever your goal is and then you have a maintenance phase. Um, and that's not necessarily the case when we're looking postpartum, is that there may be times where you need to regress that training program. I thought that the you know, the respondents did a really nice job of highlighting that, and you know, and we did have some um research to support that as well. And again, not just biological or physiological issues, but also some of those things like sleep, like mental health, um we might need to scale back. And so um, I don't know if if this came up with Shafali, but you know, she a lot of times at conferences and stuff will kind of get laughs when she talks about her Delphi study that said, like, or no, it wasn't even her Delphi study, it was her postpartum runner study, um, where it was like if they got less than 6.8 hours of sleep that they were more likely to have running related pain, right? Yeah, so everybody chuckles, right? And so that's like that's what she always says too is it's it doesn't mean that if you got less than that, less than 6.8 hours of sleep that you can't run. It's just if if your training program said you're supposed to go out and do sprints or you're supposed to do your long run that day, that you just change it, right? So it's like I had really poor sleep last night, I want to do something, but I don't have enough in the tank for that long run or for sprints. Yeah, you you regress it that day and you come back to that when you're ready. Um, so I you know, I thought I thought that was one of the key takeaways from this, and that the you know, the the respondents did a really nice job of highlighting. Um, and then also um just looking at the fact that some things might be a little bit more complicated in this um population than in just a general um running population. So, you know, and I know you mentioned um my Reds paper too, but that was something reds came up um quite a bit throughout the Delphi survey, and um and screening for Reds looks very different in a postpartum population than it does in a non-pregnant or postpartum population. Um, so there's a lot of um you know physiological overlap between what is considered normal in the postpartum period but what is abnormal, um, if you're doing like a red screening. So, for example, like you might be working with a runner who has lactational ammonrhea, so they don't have a menstrual cycle. And that's not abnormal. That's not necessarily that they are underfueling, right? Um, whereas, you know, if you have a runner who has never been pregnant and doesn't have a menstrual cycle, that's problematic, right?

SPEAKER_00 42:48

Right.

SPEAKER_04 42:48

So it gets a little stickier.

SPEAKER_00 42:51

Um you almost fly a little bit more blind, quite honestly. Um, because you don't have that data point. Yep.

SPEAKER_04 42:57

You gotta you gotta dig in a little bit more. Um, and and that's really where that a multidisciplinary team is very important. Um, and again, we completely recognize that that again is a point of privilege, right? Not everybody will have um access to a team or or the resources to support bringing in a full team. Right. But again, I think that's another reason why we need to make sure that we as providers are educating ourselves as much as possible so that if we are working with somebody who doesn't have the resources to work with a lactation consultant or a nutritionist or you know, something of that nature, that we can at least point them in the right direction to make sure that they're getting the support that they need and that they, you know, are are caring for themselves the best possible way to make sure that they can meet their training goals and not be injured.

SPEAKER_00 43:53

Well, even just simple acknowledgement that overtraining on Underfueling to lose the baby weight may not be a good choice because you might be putting yourself at risk for these other things, including bow stress injuries. Like the average bear does not know that.

SPEAKER_01 44:10

Right.

SPEAKER_00 44:10

Um, and I think it's finally getting out. But again, like I'm sure you're you're similar to me. Like, I didn't start fueling before runs until my 40s because we just didn't, you know, like it just it wasn't, you know, the thing that it is now. Like, I and I I think, you know, we're taught, okay, we're lactating, um, drink more. Yeah. But does anyone and and when we're pregnant, you're like, oh, you're eating for two. Like, well, okay. Um, but like, can we change those societal meth uh messages to be like, okay, actually, this is the um, and I I think I heard something the other day that they they've finally now calculated the the metabolic um uh cost of pregnancy. And it's like, okay, well, what's that of lactating? What's that of a lactating athlete? Like, keep going, keep going. Um, but even just the idea of I should not try to over-train to lose weight. I should not try and cut my calories, right? Even though society's told me that since you know the time that I could watch television, that that's the right thing to do. Um, I had a mom ask me the other day, she's like, Hey, what do you think of intermittent fasting? She's like, obviously, I'm not going to do it in in um, you know, while I'm still breastfeeding. But I'm like, there's, I mean, we're still fighting all that information in perimenopause, menopause, all that kind of stuff. Like, and it's sensitive. There's a lot of issues get that get wrapped up in it and misinformation and all that crap. But even just to start with the messaging of now's not the time.

SPEAKER_04 45:40

Yeah.

SPEAKER_00 45:41

Let's have a discussion later. Make sure you eat, make sure you drink, make sure you sleep, make sure you don't train too much, even if it's your job.

unknown 45:49

Right.

SPEAKER_04 45:50

Yeah. You know, and the other thing that I've noticed too is that um we're really quick to like pinpoint that one thing is the problem, right?

SPEAKER_02 45:59

Like one thing, no, right?

SPEAKER_04 46:00

Like, oh, you're you're having pain when you're running because you have DRA, or or you know, or you have you have a stress fracture because you're running. Um, and and well, one, we need to step back and realize that running related pain, running related injury is multifactorial.

SPEAKER_00 46:19

Very much so.

SPEAKER_04 46:20

It's never gonna be one thing that causes a problem, unless it's an actual like a specific mechanism of injury, like I fell off this curve, right?

SPEAKER_00 46:29

Yes, it has to be trauma related for it to be one thing. And even then, okay.

SPEAKER_04 46:36

Um, but yeah, like the the again, a fine line to walk between providing appropriate education and and appropriate um you know care or caution and fear mongering, right? Like yes, yeah.

SPEAKER_00 46:59

So whenever you have somebody that thinks they have the answer to everything, walk away. They don't like no one does, no one does, and that's okay. Yeah, right.

SPEAKER_04 47:08

And I mean, again, you bone stress injuries, there are documented cases of sedentary lactating females getting bone stress injuries. So again, it's not necessarily the activity that you're doing, it's just that you may be genetically predisposed to that.

SPEAKER_02 47:22

Yeah.

SPEAKER_04 47:23

Um now the flip side of that is again, yeah, we do want to make sure that you're progressing appropriately so that you aren't increasing your risk of bone stress injury. So I'm not saying that overtraining can't lead to a bone stress injury. It's just that like it's it's more complex than that.

SPEAKER_00 47:41

Yeah. No, and and again, I think that there's there's hope in that, there's good in that. Like if it's complex, that means there's there's variables that we can navigate, there's things that we can work on. Um, it's not do or die kind of scenario. So I find it hopeful, hopeful. Some people find it complex and overwhelming. Um, I don't know, maybe that's just getting older and I've accepted the gray. Yeah, that's fair. All right, I have some questions from the internet. Um, the first one is a really nice one. It says, tell us about your love for Shafali. Is that from Sifali? It's totally from for Sifali. I will ask her that.

SPEAKER_04 48:25

Um, I do love her. Um, yeah, she's very driven and um I'm glad that we were connected professionally and we've become friends. And yeah, it's it's great.

SPEAKER_00 48:38

Yeah, no, I I forget it was I I don't even know when. I think it was a number of years ago. I have a friend at the Cleveland Clinic, and and I was like, you know, who's who's hanging around in sports and doing kind of running pregnancy and stuff? And she's like, Oh, you gotta you gotta meet Shafali. And so he kind of pointed me in her direction. And um, yes, no fangirl ever since. So um yeah, no, 100%, 100%. All right. Next not that the last question wasn't legitimate, but this one is legitimate. All right. This one, uh, do you think running early postpartum increases the risk of prolapse?

SPEAKER_04 49:13

Yeah, so uh we don't have that literature yet. Um, and it also kind of depends on how we're defining prolapse. So um there was a study um by Ingrid Nygaard that looked at um early activity, so um like within the first two weeks um postpartum, and some of them were doing some high impact activities like running. Um and what they found was that um it was kind of like an inverted you where the when you looked at support, um the individuals who were in kind of like the middle quartiles of doing some um higher intensity activity or just doing a lot of physical activity, um when they looked at objective support, they had worse support, right? So like um measurable prolapse, right? But when you looked at symptom burden, theirs was actually lower. Well, even though their you know objective measure of prolapse was worse, the symptoms that they felt, like that heaviness, pressure, dragging, you know, or feeling like something is actually um coming out of the vaginal opening was less in that group. Yeah, um, so there's certainly more work to be done in that space, um, so that we can have um you know better answers to questions like that. But my opinion and and what was kind of reflected in the paper is that the symptoms are probably more important than the affective measure. Um because you can have you can have symptomatic or asymptomatic prolapse at any stage of prolapse. Right. Um and even what ACOG says is that you know you should seek treatment if it's symptomatic.

SPEAKER_00 51:13

Right. And I I think that clarification is incredibly important because that wasn't always the case. Like it was, you know, this anatomical sort of thing. Um and back to kind of your reference there. Like if you feel like you have prolapse symptoms two weeks postpartum, I can guarantee you're not gonna go out and run. Like I can 99.44% guarantee you were not going to do that. Um, and I think Lori Foreigner had a similar paper kind of looking at lifters with prolapse. The ones that lifted heavier actually had less reported symptoms or something along those lines. So it's it's similar. I feel like we have still so much that we don't understand about prolapse etiology. Why are those people that um you know don't necessarily have anatomical prolapse, but they definitely feel it? What is going on there? Um, I was talking to Linda Linda McLean about that a couple of weeks ago. And I was like, um, I know we try and pinpoint on a maybe over activity and make a parallel with you know pelvic pain, and but like, I don't really think that's it. What is it? And she's like, we need to work on tools, we need to measure. I was like, okay. In the meantime, we'll keep doing what we're doing because it's working.

SPEAKER_04 52:14

Right. Um and something else that the that came out with the survey um is that you know, they really said that the that how you return is really more important than when you return. Right. And and there have been multiple studies, you know, from multiple groups, you know, Shafoli has a paper out. Um Grania and Izzy have a paper out, where and um, and actually there is a paper. Um, oh I'm totally blinking on the last name right now. Derek, Derek, I think it is, probably butchering that last name. But um, where if you look at these postpartum runners and the ones that have pain or the ones that have like pelvic um health symptoms, it doesn't correlate to when they started running. Right. So, you know, and and we highlighted this in the paper too, that probably what the bigger concern is is how quickly they progress their running. Right. So, um, so no, I I I would be hesitant to say that running is going to cause your prolapse. Yeah, I would agree. But perhaps not progressing gradually enough may increase your risk for it. But again, we don't have the hard and fast evidence to say that.

SPEAKER_00 53:31

I I would agree. And anecdotally, I would say that the person that's gonna come scared into my office is gonna be like, hey, I went out for a run and all of a sudden I feel this. The running did it. And then when you actually go back and look, did they do any sort of readiness screen? No. Did they do any sort of readiness prep? No, typically, like, let's just go run and see how it goes because they got their six-week clearance. Um, or they had a couple minutes and oh, I'm just gonna try this and see what happens. That I would say is probably the thread that would connect a lot of it. So that would validate kind of what you're saying as well. But what's hard now is now they have that thing stuck in their head of this was the thing that caused my XYZ. And one of the things that I do to combat that um is whatever that activity is that they feel, assuming it's not sex, um, assuming it's like an exercise activity, the first time that they go back and do that as we've moved through rehab, I will do it with them. Um, so if it's running, I've got an alley outside my office that I will pace them slower than they want to.

SPEAKER_01 54:37

Yeah.

SPEAKER_00 54:37

Um, we do 90 seconds, that's it. And because they're scared as I'll get out and they think it's gonna come back. And I know that that plays into it in a lot of different ways. And I think that's the thing that if you if they do think there was that pre, if there was that incident that caused it, no matter how much you say that it's not, they're gonna still hold that, which again that kind of pulls over to pain science, you know, whatever you want to extrapolate from that. But like providing them a safe environment to reintroduce that where they feel supported and not alone and vulnerable, I think can be incredibly important in reintroducing that activity. So I don't know what paper you're gonna do to justify that. I'm gonna keep doing it, but I'm just gonna cut with a list.

unknown 55:18

Yeah. Yeah.

SPEAKER_00 55:20

No, I guess it's fair. Yeah. Yeah, that's a good one. All right, next one. Um, how do you navigate around the you're ruining your pelvic floor by running narrative? Um like, yeah, that's so every time, like as as you do the scroll, like how many uh do you like is your algorithm toxic or is your algorithm happy? Um what's your algorithm? Let's analyze. Yeah, it's mixed. Um I'm gonna wait till your answer before I take a sip. Yeah.

SPEAKER_04 55:55

Um so that narrative. I always try to bring it back to pre-pregnancy. Like again, if we look at running or or sport in general, the risk of pelvic health symptoms, particularly urinary incontinence, is a lot higher in active individuals than it is in sedentary individuals. But we wouldn't tell them to stop doing it, right? Like we are not telling you know Olympic level gymnasts who might leak on landing not to do it, right? Um so I think my rebuttal to that is that there's something that we can do about it, right? So we can certainly work on pelvic floor strength, endurance, or if you need relaxation, you know, whatever, we can work on that and we can do it in tandem with run training. It's not like you know, I mean, we've covered this a couple of times already that it's not running in and of itself, right? That is the issue. Um, and again, you have to do a risk-benefit analysis, right? And that's different for every single person. So again, if they are like, I am going to go absolutely bananas if I don't get out and run, okay. Well then let's find a way to get you out and running without symptoms that bother you, right? Or because they might also say, I don't care if I leak, like I can come home with my shorts completely drenched. I don't care. Okay, then run. But we should probably still do something about the fact that you're leaking. But um, but again, it's not it's not a death sentence by any means. You know, you're not gonna have to live your life and depends. Um, we can we can work on that.

SPEAKER_00 57:58

So I think that's probably my biggest rebuttal to that narrative is what yeah, I think it also looks again at it at people's assumptions and biases, and and you know, if people there was a post that I put up this week, you know, like your your uh your birth wrecked your vagina, and I I say that specifically as a Mythbuster Monday, um, because again, like sometimes people come out with that thought and that idea, and you know, there's validity to your experience and all that stuff, but how can your experience impact um your symptoms and your presentation and your approach to exercise and that kind of stuff? And the assumptions that we have, and again, now that we're just starting to get an understanding of like what does a pelvic floor kind of morphology look like in runners, normal and symptomatic? What does a hiatus do or an opening in normal and symptomatic? Like, I think there's a lot of assumptions that we're making um why people have problems that, like, no, actually, the pelvic floor goes through a lot of changes and things, and people that you I mean, I'm sure people listening, like you've had this happen before. Like, you do an exam on somebody and you're like, whoa, they should be having way more symptoms than they are, and they're doing fine. I had a um a DM back and forth on a Facebook group where the person was very focused on I can't get this, um, I can't get this patient to do a cognitive voluntary public floor contraction. I've tried all the things, I've tried all the cues, da da da da da, what do I do? Help. And I was like, does it matter? Um, I've had so many people like, oh, can't get it. And if you go down that rabbit hole, it drives them crazy. They feel guilty, they're like, I'm a ruined, da-da-da, whatever. I'm like, or just skip to the next part. Like, why are we assuming that we have to have that? So I think again, that makes us go back and have to double check why do we think that way? Um, and is that really true? And again, we don't have a ton of evidence, but read the stuff that's coming out and question yourself and be like, you know, same thing with prolapse, like how we were taught about prolapse, you know, even 10, 15 years ago, completely different than how we understand it now.

SPEAKER_04 1:00:00

Yeah, and I think the other thing to consider too is that right now we are we are looking at the effects of you know, of running of exercise, of the postpartum experience without standard PT intervention, right? So, like um, you know, I did a webinar with World Athletics a couple years ago, and Paula Radcliffe was one of the speakers, and you know, she lives in Monaco where they get standard care, you know, standard pelvic health training afterwards. And she was like, Yeah, great, you know, made a little bee fly, and um, and she didn't have pelvic floor issues. So I think that's the other piece that we have to look at is um, you know, would it look different if we addressed it from the get-go?

SPEAKER_00 1:00:51

Yeah, no, I think there's there's a lot of a lot of questions that it like if you have no knowledge versus some knowledge, if you had trauma involved, like so many different things. If you had somebody to talk to, like what where where does that put us? Um, and that's the beautiful complexity, which must drive you nuts as a researcher, um, to control all the variables or ignore some of them.

unknown 1:01:10

Yeah.

SPEAKER_00 1:01:11

But it's what makes this job fun, I will not lie. All right, I've got one last question here. Um, how should one continuously progress strength training after pelvic floor, PT, discharge, postpartum? I think this is a very interesting question.

SPEAKER_04 1:01:28

Yeah. So, you know, while you're treating them, or while if if you're the patient in this question, while you're in PT, you should be learning what those signposts are for progression or regression, right? So um is this exacerbating your symptoms or is it causing symptoms? Because again, sometimes you might you may have had leakage pre-pregnancy that you're okay with, right? So so that's why I say exacerbating or causing, because you may not be symptom-free. But um knowing what what signposts to look for to say, like, oh, maybe this was a little too much of a progression and I need to back it off a little bit. Um but um yeah, so just continuing to be gradual, right? You shouldn't have these huge jumps in training, whether that's strength training or mileage. Um, and um making sure that it is, you know, you that you're using that um principle of specificity, right? So you should have some plometrics within your um strength training program. Yeah. And um, you know, and I don't know, like you, yeah, you might get to a point where you don't need to continue to progressively increase load, right? Like you might get to a point where you're fine with the weights that you're at, but maybe varying positions or varying um movement may be appropriate. But yeah, as as the treating clinician, you need to make sure that you're educating your patient on what to look for when they need to contact you to maybe check-in to see if things are are problematic or if they're doing okay, um, and how to appropriately progress. And if you're the patient, um, you need to be asking those types of questions of how do I know when it's time, right? You know, usually I tell them like if it gets to a point where it's easy, then you can progress it. Um, and you know, and what symptoms you need to watch for um to know because again, there's going to be some soreness when you progress strength training, right? So they need to know what soreness is okay and what soreness is maybe a little too much.

SPEAKER_00 1:03:59

Yeah. Yeah. No, I I get stupid Pacific. Um, so I had a client the other day um where we kind of look ahead and like everything's going great to start. She's gotten through her run-walk progression. We're doing well. And I'm like, okay, tell me what an ideal week, assuming no one throws a grenade into your plans, um, what would an ideal week look for you look like for you as far as how much you want to work out? Um, you know, what does that delivery mode look like? Are you a you know, Peloton app girl? Do you want to go to, you know, boot camp? Do you want to go to Orange Series? Are you going to cross it? Like, what do you want that to look like in frequency and dosage? Um, and then I cross-reference that um with where they might have any particular deficits or needs to address, kind of from my perspective. And then also the piece that has to go in has to be something that they enjoy doing. I'm like, don't tell me you're gonna go do this because you think you have to. I want you to go because you like going to class and you see your friends there and that fills you up because that's what's gonna build that consistency. So we really just look ahead and say, all right, well, what do we want this to be? Um, and for this one person, she's like, you know what? I want she wants to try out this this women's only gym close by. They do some resistance training. I'm familiar with the program. I'm like, great, let's start with once a week on that, as you kind of build back up. And she wants to do Peloton app. I'm like, okay, do the postpartum program. It's super basic right off the bat, but like you're gonna want to kick up pretty soon. But make sure that we do something that has like resistance in it or impact or that kind of stuff. And then I let them out into the wild. And then we bring them back. Yep. And say, bring with me, bring with you a list of what went well, what didn't go well. You know, obviously you can email me in the meantime, but like I need to know where those deficits are because sometimes I won't know until you get there. And same thing with running, we choose. Okay, once you hit that 30 minute mark, do you want to go longer or do you want to go faster? Because those are completely different variables. You might be doing great on the long, slow run, but you start to add an Sort of threshold or interval training in, and all of a sudden we're back to square one and you feel like you've you're you're you're back to you know symptoms again. So we plan that stuff ahead. And I think if you are not well versed on running informed, and I've been using that phrase a lot lately because running informed does not mean I ran in high school. Okay, I'm sorry it doesn't. If you are not running informed, you're not gonna think to ask those questions. Right. Um, and if you don't know those things and you don't want to know about those things, that's fine. Right. Collaborate with somebody who does, whether it's a public floor PT or a running coach trainer that you're going to work with to problem solve these things through. But I think we do our patients a disservice by being like, okay, go do whatever, make sure you do some squats and apply metrics and that kind of stuff. I'll see you. Like get the less brain cells moms have to that stuff out, the better. I'm so much better if somebody's just like, do this, do these things, come back and tell me what worked and what didn't. And then I have to think about it. Yep, absolutely. That's my jam. I don't it's uh I don't know. What do you think?

SPEAKER_04 1:07:03

Yeah, no, I think that's incredibly fair. Yeah, and because sometimes too in the clinic, we're limited with what we can do, right? So yeah, what they're doing in real life is different than let's go get my daughter.

SPEAKER_00 1:07:13

You're fine, we're all good. I build a buffer in. Well, yeah, absolutely.

SPEAKER_04 1:07:18

I think that's I think that's fair.

SPEAKER_00 1:07:20

Yeah, but but again, I think would I have done that three years ago, five years ago? No, right. No, that's from learning. Oh gosh, I let them out to kind of fend for themselves in the murky waters of habits and and life and things like that. And again, none of that, we're not taught that stuff in PT school. And I want to be clear about when you walk out and you're like, I never learned any of this, neither did I. Um, this is just kind of you're in the clinic long enough, you work with people long enough, you get feedback from people, and then your own experience to be like, ah, you know what? I screwed up. Yep, I need to fix that piece of it. They they should not be out there without a lifeline, right? For sure. Cool. All right. Couple questions to wrap up with rando, book your reading or podcast you're listening to, even though you're you're home momming it right now. Yes, I'm reading the A Court of Thorns and Roses series right now. Is that Christina's stuff that she's read or no? Yeah, um, okay, she's all into this. Like, is it sci-fi? Yeah, okay. I I haven't I'm I'm in like summer beach read romance y phase right now, alternating with papers.

SPEAKER_04 1:08:31

That I'm actually reading, and then my book on tape that I listened to Audible is the Bridgerton series.

SPEAKER_00 1:08:38

Oh have you watched the first four of the most recent season? I have okay. How are we feeling about yeah? Oh, is that when it is? Okay, so it's coming up. Um how are we feeling it's it's Penelope, right? How are we feeling about this?

SPEAKER_03 1:08:52

Okay, yeah, um it's okay. Uh again, I think like most things, I enjoyed the book more, but um I mean I watched it, I binged it. I'm gonna binge the the second half when it comes out. So I'm too I'm not displeased.

SPEAKER_00 1:09:10

I do miss was it Regé Jean-Paul or Jean-Paul Regé? Or I no one can beat that. And I think at the time that that came out, we we were just dying for like any sort of like entertainment that you know took us out of the zone of pandemic. It was great. Um, yeah, what was the other thing that I oh I love all the um it's like the vitamin string quartet, like the um the string versions of all the updated songs and stuff. Love that. Yes, love it. Okay, Bridgerton fans unite. Um, okay, I'm gonna add one more because I was asked about like oh, you know, what is it like to be a mom? All the crap. Um this one, who are you fangirling over? And you can't say Shafali because we already did that. Um and I challenge you, I challenge you to find somebody I don't know. Oh, well, that's gonna be tough. Um start start with who you love, and then we'll find another one.

unknown 1:10:04

Okay.

SPEAKER_04 1:10:04

So I was just at um American College of Sports Medicine um conference last week, and I got Shaleia Kip. So that was awesome. Enjoyed meeting her in person. Um she was just on the podcast recently. Yep. Yeah, yeah, it was kind of fun too, because I went to introduce myself to her and she's like, I know who you are. So I was like, So that was weird, yeah. Especially when you are like in mom mode. I just saw a thing on Instagram. It's like who they think they're emailing, and it's like their professional headshot, and it's like who they're actually emailing, and she's like cleaning up a spill on the kitchen floor with her kids on her back. It's like um, yeah, so okay, who do you not know? So yeah, um well, and I will say, like, I I kind of feel bad about this, but I don't remember names. But um, I can Google stock quite a few um PhD students while I was at ACSM last week, um, who were presenting their posters and who are doing some really cool stuff um in the postpartum space. Um, so um there was a student whose poster was right next to me. Um she is in Linda May's lab at East Carolina University, um, looking at like different modes of postpartum exercise and or no, maybe this was during pregnancy, different modes of exercise during pregnancy and the influence on the infant's neuromotor skills at one moment. Really cool. Cool. Um yeah, so keep an eye on Linda May's lab. There's some cool stuff coming out there. Um yeah, and then I think all the other people that I fangirl over you've had on the podcast.

SPEAKER_00 1:12:02

So the podcast is dead.

SPEAKER_04 1:12:04

No, no, no, we're just we're just gonna keep there's people up and coming, is what I guess.

SPEAKER_00 1:12:10

Well, and that's and and and that's my point too. Like, I think back to like Megan James, like working with Izzy and that kind of stuff. Like, there's there's a couple um, I think coming up that I've gotten connected with with uh Jen Lacrosse. Like, yeah, the more that we can elevate and get into this space and get uh women at the research table and amplify, like I'm all about that. And especially uh I have double props for the ones that are pulling clinic duty and research. I don't know how y'all are doing it. I respect you, you speak speak both languages, you're Switzerland. You can talk the talk and the all the numbers and and that kind of stuff and then turn around and interpret it for the rest of us. So yeah, um, so if you're us if you're a PhD student, um postdoc, anything like that, and you're in this space, I want to talk to you, tell me the things you're excited about. We'll get your information out there and um yeah and uh we'll keep growing up. One other quick plug.

SPEAKER_04 1:13:03

Yeah, not MSK, but um in the postpartum space, Emily Little Nation called Nurturally, and it looks at um like breastfeeding and um like equality, so a lot of the like social and um potentially like racial cultural um barriers to breastfeeding and just trying to make that accessible to everybody and then also looking at like the uh environmental piece of it too. Really cool.

SPEAKER_00 1:13:32

So yeah, check her out. Definitely. That sounds great, awesome. All right, Rita Deering, you can find her at occasionally on Instagram, Rita Deering, PhD. Um, thank you as always for circling back. I'm sure when you've got more stuff out, we'll just have you back again. Um, send those uh PT students and PhD students our way. And uh thanks as always for all you do and sharing your good stuff.

SPEAKER_04 1:13:57

Yeah, thanks for having me and thanks for giving us a platform to share it and make it accessible.

SPEAKER_00 1:14:01

Always. Did you enjoy the podcast? If so, leave us a five-star review on iTunes and tell a friend to do the same. Are you a postpartum mom or postpartum pro wanting to know more about getting back to running after baby? Check out all my free goodies on carrypacciano.com. This podcast represents the opinions of Dr. Carrie Peggiano and her guests to the show. The content should not be taken as medical advice, and it's for entertainment purposes only. Always consult your healthcare professional for any medical questions.