OTs In Pelvic Health

Are We Underloading the Postpartum Core?

• Season 1 • Episode 74

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Meet my guest, Rachel Parrotta

Where to find her:
www.RachelParrotta.com
IG:  @Rachel.Parrotta.DPT

Rachel has focused a majority of her career on the specialty of Pelvic Health Physical Therapy. She has over a decade of experience supporting people of all genders with a wide range of pelvic health conditions. Prior to attending graduate school, Rachel worked as a Certified Athletic Trainer with a men’s professional hockey team. Her background in athletics gives Rachel a unique perspective in helping clients return to the sports and activities that they love.

Books recommended by Rachel:
Womb : The Inside Story of Where We All Began by Hazard 

We chat about: 
1.    What does "Return to Exercise/Sport" look like Postpartum?

2.   Why do you Think We are Under-Loading the Core Postpartum? 

3 . Do you think we have focused too much on Diastasis? 

4. What do you wish pregnant people knew about Prolapse? 

5. What books are you reading or podcasts are you listening to? 

6. Where do you go for pelvic health inspiration? 

7. What do you love to do to recharge/ reset your nervous system?

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Lindsey Vestal My guest today is Rachel Parrotta, who has focused the majority of her career on the specialty of Pelvic health physical therapy. She has over a decade of experience supporting people of all genders and a wide range of pelvic health conditions. Prior to attending graduate school, Rachel worked as a certified athletic trainer with a men's professional hockey team. Her background in athletics gives her a unique perspective in helping clients return to sports and activities that they love. And that's exactly what we talk about today, as Rachel's passion is now supporting the pre and post natal person, Rachel and I go way back. I'm not going to bore you with a story because I actually talk about it in the episode, but Rachel and I were part of a pelvic floor study group in New York City that we started because I just felt like I was in such a silo and being able to meet with like minded individuals whose passion was angered and Pelvic health was the start of really bringing the community together in a way that shed light on the abundance mindset. We were all together and it could have seemingly looked like we were competitors, but actually we came together to roll up our sleeves and learn alongside one another. And it was such a breath of fresh air. I met some of my closest friends to date in that pelvic floor study group, and I consider Rachel to be one of them. So I can't wait for you to hear today's conversation. 

Lindsey Vestal New and seasoned oats are finding their calling in Pelvic health. After all, what's more adult than sex, peeing and poop? But here's the question What does it take to become a successful, fulfilled and thriving O.T. in Pelvic health? How do you go from beginner to seasons and everything in between? Those are the questions and this podcast will give you the answers. We are inspired, OTs. We are out of the box, OTs. We are Pelvic health. OTs I'm your host, Lindsey Vestal and welcome to the OTs and Pelvic health Podcast. 

Lindsey Vestal Rachel. It's a blast from the past to be speaking with you today. Such a pleasure to have you on the OTs for Pelvic health podcast. Thank you so much for being here. 

Rachel Parrotta Thanks. I was so excited to talk to you and your community today. 

Lindsey Vestal Yeah, we you know, I've, I've read your bio and I love people tend to know that aspect of your professional career. But I have to just let our letter listeners know that we go back to when I started my private practice in New York City, and you were just such a source of inspiration for me. You were part of a pelvic floor study group that we had started, and you are always the first to raise your hand and ask such thoughtful questions. You brought such positive energy to our monthly meetings. And so I just have such oxytocin this afternoon talking to you. And again, I'm just I'm really grateful we're going to be talking about something that I know is just incredibly important to you as a person and as a professional. And I'm riveted by it, too. So let's get into it. I'm just so happy you're here. 

Rachel Parrotta All right. I'm ready. I have a lot of passion, so I'm going to try to share that with everyone. 

Lindsey Vestal Well, I love that about you. I love that about you. All right. So I got to I got to start with kind of like maybe like a little bit more of a overarching question, which will get us right into it. And that is, Rachel, what does return to exercise or return to sport really look like postpartum? 

Rachel Parrotta Sure. This is such a fun topic. I love working with folks that want to get back to exercise really in any shape or form. Some of my clients just want to get started and some of my clients are higher level, higher level athletes. And what I think the missing pieces for a lot of athletes is the progression from early postpartum back to their regular training. And I think what comes naturally to us as rehab professionals breaking down tasks, breaking down movements, the things that we train so much for, and sometimes we might assume this is common knowledge is really a missing piece for the client and the client athlete. And I think that's where we can really shine and bridge that gap. So I can give a couple of examples of that if you'd like. 

Lindsey Vestal Yeah, I would love that. 

Rachel Parrotta Sure. So I would say the postpartum recovery is so individualized, as you said. I think the common theme is progression. So I have some folks who will get started at sometimes 3 to 4 weeks or the six week mark. And let's say they're a semiprofessional runner. So everyone is starting from the same place. In terms I always tell people, even if you were an Olympic athlete, the core is so changed in pregnancy that everyone's starting from a place of having to find new movement patterns or refine movement patterns. Everyone's starting from a place where it's going to take a lot of work. But if you watch people move, someone that you know is a semiprofessional runner, their next 6 to 8 weeks is going to look very different from somebody who has much less movement background or is looking for a different return to exercise. But what I hope people don't feel intimidated by is that even, again, these higher level athletes, the piece that they don't know is how to break down movements like we do. So I've worked with recently with a semiprofessional runner and I run a little bit and I'm like a fake runner. I like running, right? But I don't know, running like she knows running. But again, don't assume that client knows rehabilitation like you do. So, again, this runner is missing this huge piece of information. They think they can kind of hop back into their regular routine and then they experience some pain and some challenges. And we're really there to break down their movements for them and give them that progression. So again, I encourage everyone not to be intimidated. If you don't feel you have the training for higher level sports or CrossFit or weightlifting specifically. But a lot of times there's just this huge gap where people don't know how to go from early postpartum back to their activity. 

Lindsey Vestal I agree with you, Rachel. I think that so much of our clients desire is to get back to what they were doing. It helps them feel like themself again. It helps them to, you know, feel like it's possible to have have expanded this welcome this new member of their family into their into their environment, but also that they still have that sense of self about them. And so I think there is. A lot of, you know, conversation out there about this desire to bounce back because what we were doing it before so we can do it again. And what I really hear you saying is that the core changes so much. And so even just sharing the knowledge around that and still supporting them to reach those goals, right. You're not preventing them from from reaching those goals at all. It's just giving them that support of progression, which does involve task analysis so that they can get there. And I love that. And I also really appreciate you bringing up the fact that we may not know the activity that our client wants to get back to, but that you're really saying that that shouldn't let it limit us. So it could be CrossFit, it could be running, it could be, you know, swimming. It could be an activity that we ourselves have never taken part in, but that we don't have to be an expert in it to to be able to support them with our rehab knowledge. 

Rachel Parrotta Yeah, absolutely. I think two things that you said stick out to me. One, a lot of my clients feel behind they feel behind in this rehab process. It's incredible because they're comparing themselves. They're comparing themselves to people that are professional athletes full time. They're comparing themselves to friends or what they see online. And part of our work, I think, is so much of the psychosocial support for these young parents and taking them through that process and being that support person and sometimes being the only person in their circle to show you on that their process is going well and try to compare it sometimes to different rehabs. People would do when they're injured or try to help their more athlete brain make sense of the process and help support them and show them that they're not they're not behind. Like we have to break this down. So that's the first thing that jumps out at me. And then the second thing was not being intimidated by the activity. I think we all should know our expertise. You know, for example, if someone is at a certain point in a rehab, I might refer them out to a running coach or back to CrossFit. But I often find myself, even with a strong background in sports, that sometimes I get a little nervous, like, can I really serve this client? But then when they come in or you meet them online and you watch them move and see where they're at again, I do think most of us have the skills to get them, at least through this early rehab process. They're looking for so much support, the things that we know how to do that. And that again, is a missing piece. They've never even if they're, let's say, a certified CrossFit coach, they know how to train people that are not immediately postpartum. Right. If they haven't taken that training. So this is again, it's a it's a space where people don't know what to do bridging that gap. So I encourage people to give it a shot, try to bridge that gap before returning that person back to their local gym or their local class or their local coach that can serve them once they are in a bit of a more rehabilitated state. 

Lindsey Vestal I think that's excellent, excellent things to consider. And I'll just add to that, like what I've done in the past, I remember the first time I ever had a client who lifted kettlebells, which now it's like, that's my go to like I that's my favorite thing to do. Well, one of my favorite things to do when I have some time for when I make time for exercise. But I remember the first time I was so intimidated, I was like, okay, I've done some dumbbells before, but the shape of that kettlebell, are you kidding me? What are we even doing with this? And so some of the things that I did was a YouTube stuff, right? So I was I was YouTubing a lot and watching the movement, I would slow it down half the speed and just kind of watch the person go through some three or 4 or 5 common exercises. And that helped me a lot. And then the other thing I did was I was just really direct with my client. You know, I just looked her, looked her in the eye and said, you know, I haven't looked at kettlebells before. I may be asking you some questions throughout our process together so that I can best support you. Even things like, what about it? Do you love you know what it what what is it that really lights you up when you're doing this activity so that I can really get a sense of sort of what their passion is and what it is about them so that I can also mimic other activities that are like that or etc.. It just kind of helps me understand them a little bit better. So I those are just some things that have worked for me in the past. 

Rachel Parrotta Yeah, absolutely. I agree. I think you don't have to be an expert in it. If you have an opportunity to go to a CrossFit gym and do a workout with a coach that you know or try an activity you haven't done before, it does add a ton of insight. I've learned so much about running and leaking with my own pelvic floor trying different things. I think it's fascinating. You know, if you're in the movement profession to really try different things, and I do the same thing with my clients. I have a lot of clients or CrossFit coaches, and I'm very honest about what my knowledge is and their knowledge. But you're a team and together it's so cool. You can really come up with things. Your clients adding just as much. Information to the story as you think you're adding for them. And together the collaboration is really those are my most, I'll say, my most fun clients, but I love when they the client has a great expertise because together you come up with such great ideas and start to problem solve 100%. 

Lindsey Vestal I love the way you describe that because I think that really will encourage people who are into the in that place of a little bit of intimidation to actually see themselves on the other side of that. Of like, wait, actually, I could I could be really collaborating with my client and doing best by them when I come in with this beginners mindset. And then continue to carry that forward as we work together as a team. That's that's beautiful. So, Rachel, I know that one of the things that you're really passionate about, in addition to, you know, progression postpartum, is this idea that people are under loading the core postpartum. Can you talk with us about that? 

Rachel Parrotta Sure. I like to get on my soapbox about certain topics, and this is one of them. And I think for a couple of years I felt maybe alone in this when I was like, am I the only one pushing people and doing all the things that we were told not to do? Perhaps postpartum went diocese recti, but. This is how I feel. Although we focused a lot on the diagnosis or dialysis, the widening of the rectus. And what I think we haven't focused on is the fact that that doesn't account for the full change of the pregnant abdomen. The pregnant abdomen, not only do the rectus widen, but they also lengthen and all of the abdominal musculature lengthens greatly. Like we look at a pregnant person and we're like, the belly is so big. But I don't think we always internalize that That's musculature that changes. So I think over the years, what I would see is people would come in and say, I have back pain, I have all these different pains and compensations. We say, that's the diet these days, this sort of access. And it just started not to make sense to me that we were saying, okay, like the rectus widen, but they also elongate. And then we were saying with dialysis treatment for a while, then don't use the spread. That was like the advice when I started was if someone has a diocese's, then no longer flex the trunk, never flex the trunk. But that's what the rectus does. So it just it felt Now, looking back at it now, that's the opposite of rehabilitation. We were telling people, don't use these muscles that have changed. And, you know, I've gone further into why now? When I look at the pregnant and postpartum abdomen, I'm like, wow, I like to shorten back up these structures. Not only do we need to load the abdomen, but we need to like double, triple, quadruple down on loading because the amount that it changes in pregnancy, even to get it back to neutral takes so much work. And then to get it beyond neutral, I just think takes a lot more focus on the core musculature than a lot of people acknowledge. And then folks are coming in with pain. And I'm like, they told me they haven't been exercising because they were so restricted in their movements that I think we were really keeping people back and holding people back and from, you know, feeling good and being rehabilitated. So that's one of my passion points currently. 

Lindsey Vestal I'm curious, you know, you had said you felt alone years ago when you had really kind of come to this conclusion and started scratching your head. And I have to tell you firsthand, it's one of the things I love the best about you and being able to, you know, be in so many study groups with you. When I was in New York City, I, I this was this was something I was often so inspired by. You would often question the status quo and look beyond. And so I'm curious in this journey of looking further into under loading the core postpartum, like who have you found to be inspirational for you to kind of lean into and have more of these conversations with and learn from? 

Rachel Parrotta Sure. So I think Anthony Low was a big or is a big mentor in this space, particularly because when I went to one of his first courses, I finally felt like someone was saying it was okay to feel this way. And I was like, Who this is? You know, you want to do the right thing as a professional. So when I would come into a situation and be like, You know what? I'm not I'm not caring that much about the, the with or the depth and this stuff. And you don't want to be doing the wrong thing in your profession. So to have another physical therapist or physiotherapist teach on it and say, You know what, I'm kind of seeing the same thing, that we can load more, that it's not dangerous and we don't see harmful outcomes. I think that was a helpful moment for me. Say, okay, I'm not kind of crazy, you know, other people think this is safe. So I do like his work. I follow his work. I think it continues to evolve where I've become. Even more willing to kind of push the boundaries with folks that have pretty large diseases after birth to really be more what I would consider aggressive and loading early on and seeing really good outcomes in function, not always cosmetics, right? That part there's good connective tissue part that is not always changeable, but I've seen good results and again, I'm just passion. Even if it's not about correcting or fixing a diagnosis, just it helping people be strong and functional. Because I think when we're too restrictive, we hold people back from achieving that that goal. 

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Lindsey Vestal I'm curious, Rachel, when you have a client that is really focused on her diagnosis, you know, is is we've all had them, right. Who constantly wants us to measure or is asking a lot of questions. And we can tell that there's there's a preoccupation on it. How do you what what language do you use to the client to kind of help them see this this refreshing perspective that you're sharing with us today? 

Rachel Parrotta Sure. So I think sometimes it's pretty jarring when they come to see me because I think we we hear so many things about dialysis and diseases, and I'm really telling them things that don't go along with that that information. I was one of the things I focus on for them is I really try to differentiate the cosmetics from the function to help them understand what PT or OT can help with and what might be more cosmetic. I've been trying to focus really on the functional for them. So one of the things I have been doing recently is showing them examples of folks that have evidence of diseases or dialysis, meaning you can see. So these are professional athletes and you can see the connective tissue is then you can even see maybe a hernia. There is a runner, Stephanie Bruce, who I look up to, she won a race locally where I live on Long Island last year. And one year later, almost to the date, she gave birth for a third child. And she is a pretty significant diocese says you can see the connective tissue is very thin in her belly and you can see hernia. I've not treated her, so I'm just looking by observation and I show folks that, look, she's really functional. She was the national champion in the road ten K, That's how functional she is, you know. And so I do try to show them that if they're coming to me for a function, I know I can get them functional or we together can get the body functional and that cosmetics is a different piece. I do hold a lot of space for nobody should have to live with a cosmetic issue that they don't want to, you know? So I really hold no judgment if that. I want people to have all kinds of options. But I do like to show these examples of athletes who have diseases and their top of their their top of the field. And I think that helps shift the thinking a little bit in terms of function. And again, if someone is concerned more about the cosmetics, that's totally fair. And a lot of people, the connective tissue will not change enough for the cosmetics to reach where they would like it to. And then I support them in that, you know, how do we find a surgeon for you if that's what you want? What is the support look like? What does post-surgical look like? So that's how I try to manage those types of those visits. 

Lindsey Vestal That's fantastic. Yeah, that's great. That's great. So I want to shift topics slightly here to another area that you're really passionate about, which is which is prolapse. I'd love to know what you wish pregnant people knew about it. 

Rachel Parrotta Yes. If there's something I'm more passionate about than the core, I think it's talking about prolapse. So I don't know if you have similar scenarios. But I often probably at least I feel like once a week someone reaches out and they're feeling very distressed because they realize they have they either see a change in the vaginal tissue. So they have given birth recently and they see a bulge or they see a stretch or they feel pelvic pressure. And nobody yet has ever given them context around prolapse. So they they Google. I've had clients go to the e r not knowing what it is. I find this is just a very traumatic experience for folks. And then that breaks my heart because no one's given them the background information about prolapse so I can share with you. I really am passionate about speaking more about it. I want pregnant folks to know about it. I teach a class in pregnancy currently and I talk about prolapse, and I think in the past maybe we'd shy away from some of these topics. I think just culturally we feel that me and you or anyone listening as a culture, I think there's this idea, you know, don't scare people in pregnancy, focus on the good stuff. But there was a research paper, Kimberly Johnson, I believe her name is she for her PhD candidacy, published a paper that showed. Prenatal education on birth trauma or birth injuries actually improves mental health postpartum. So I like to cite that as evidence that we need to educate folks in pregnancy. So with all that as the background, I can tell you a little bit about how I approach the conversation, what I tell people about prolapse and in pregnancy and postpartum. 

Lindsey Vestal Yeah, that'd be great. 

Rachel Parrotta Okay. So what I'd like people to know, this is how I explain it. With the current information we have, and I think one of the challenges is we don't have as much research and a lot of these topics when it comes to female public health as we would like. So your gynecology, even itself is a rather new subspecialty. So I say what I say based on the information I have now, and I think it continues to evolve. So. I tell folks that similarly to how the Corps elongates and expands or descends in pregnancy, the pelvic floor, the adults are not the public. The vaginal walls also stretch or distend in pregnancy similar to the abdomen. I say, but nobody tells you that. And so what happens is postpartum a lot of people, if they were to look at the wall, they might notice this stretch, they might notice a bulge or something looks different or they might feel symptoms of pelvic pressure. I tell folks that this is actually more common than people think. One study showed that at eight weeks postpartum, 88% of the people in this study had a diagnosable cyst this year. So 80% is pretty high. So now we're thinking almost everybody has some amount of tissue change to the vagina walls. So I like to use as a background. I think sometimes right away people like, like a sigh of relief, like, okay, you know, I felt very isolated. I didn't understand. So I start with that. I do tell folks that I find in my practice that it is common for people to have symptoms of pressure or discomfort. The first 6 to 8 weeks, I see people early on and try to get them moving early on. I do find that the better the body is moving, the more efficient the body's moving. Turning back on muscles in the glutes. The core, I find the symptoms start to come down as the body can better tolerate movement. And I tell folks that I want to see the symptoms start to light in around the 6 to 8 weeks. That's a very general and generalized timeline. And one of the things we don't know, of course, is that who will continue to have these symptoms? Some people continue to have symptoms of pelvic pressure. Some people do not. We don't have a great way of figuring out who is who at this point. To my knowledge, you know, and then I take them even further into the future. You know, if if you do continue to have symptoms like this, there are ways to manage it. Continued strengthening and rehabilitation can help. We don't want people to stop being active. So some folks might wear a PSA. Re at a course. I went to the physio referred to it as a sports bra, the vagina, which I just love. Like sometimes we need more support. So destigmatize that and I take them through, you know, looking ahead, even though it's jumping way ahead for the early postpartum person, just letting them know that the goal is to stay active on people, stay active and symptom free. And telling them what that looks for looks like for them. 

Lindsey Vestal Your clients are so lucky to have you, Rachel. I love that. It's so relatable, so disarming and just so accurate. That's fantastic. So I'd love to know what what books are you reading? What podcasts are you listening to? Where do you where do you go to for for your own inspiration? 

Rachel Parrotta That's a great question. I've been trying to read more for me since I had my kids. I think readings were the things that fell off a bit more than I would like. I recently did get from the library, the book room, The Inside Story of where we all began. That's Leah Hazzard. She's a midwife. I think probably anyone listening to this podcast would love the book. It was. Have you read it, Lindsay or No, not putting on the spot, but just curious. 

Lindsey Vestal I have not. I'm really excited to add this to my list. I haven't read. 

Rachel Parrotta It. I think you would love it. It's so fascinating. There's we don't know as much about the uterus as we should, but the little bit there are people working on it. There are people interested and it's so wild. If I could give one example of what's in the book, they talk about menstrual blood and how no one really wants to study this. We study, you know, blood draws from other places. We know so much about different parts of the body. And just this idea that maybe we would get some more answers in terms of fibroids or endometriosis or other gynecological conditions if anyone would just like to study like what comes out of the uterus. And it's just I don't know, this stuff is mind blowing to me. I'm like, Wow. Like, so the book is I thought it was fantastic. I think probably most people, again, listening to that this podcast would enjoy that. 

Lindsey Vestal I hear you about not being able to read as much post kids and then I know yours. Your ears are still pretty young. I think you had one who's just started kindergarten. So it's, you know, I'm always still trying to sneak in moments here and there. And for me, since leaving New York City, actually my podcast, consumption has gone way down because walking first of all, just being a pedestrian and having the pedestrian lifestyle. But I love that 15 minute walk to the kiddos school because I got to get in like a decent amount, if not an entire podcast between the way there and the way back. 

Rachel Parrotta Yeah, it's funny, I was trying to read this book at my son's soccer and my other son was like, Money, can you read your book to me? And I was like, I mean, I don't mind. I don't think I really enjoy this, but I think, you know, like, all right. Will read boom to you. 

Lindsey Vestal He's he's going to be a great kid. He is a great kid. That's awesome. And then my last question for you, Rachel, is what do you do to recharge or reset your nervous system? 

Rachel Parrotta Sure. So I think there's probably about three things. One, I do like to run. I told you, I'm not a great runner. I but I do like to get out. And, you know, everyone says clear your head, I guess. Clear my head and just, you know, feel myself moving. So I do enjoy that whole time to myself at reading, you know, I've been trying to get back to that. And then I think community I think community gathering with people in community has been really something that recharges my my energy. 

Lindsey Vestal Amazing. My goodness. Thank you so much for sharing your time and and wisdom with us today. 

Lindsey Vestal Thanks for listening to another episode of OTs and Pelvic health. If you haven't already, hop on to Facebook and join my group OTs for Pelvic health, where we have thousands of OTs at all stages of their Pelvic health career journey. This is such an incredibly supportive community where I go live each and every week. If you love this episode, please take a screenshot of this episode on your phone and posted to IG Facebook or wherever you post your stuff and be sure to tag me and let me know why you like this episode. This will help me to create in the future what you want to hear more of. Thanks again for listening to the OTs and Pelvic health podcast. 


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Lindsey Vestal

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