The Barbell Mamas Podcast | Pregnancy, Postpartum, Pelvic Health
The times are changing and moms have athletic goals, want to exercise at high-intensity or lift heavy weights, and want to be able to continue with their exercise routines during pregnancy, after baby and with healthcare providers that support them along the way.
In this podcast, we are going to bring you up-to-date health and fitness information about all topics in women's health with a special lens of exercise. With standalone episodes and special guests, we hope to help you feel prepared and supported in your motherhood or pelvic health journey.
The Barbell Mamas Podcast | Pregnancy, Postpartum, Pelvic Health
Breaking Down "Floored": A Critical Analysis of Pelvic Floor Advice
Dive into a thoughtful critique of "Floored," the bestselling pelvic floor health book by Dr. Sarah Reardon (The Vagina Whisperer). This episode unpacks both the groundbreaking achievements and potential shortcomings of this influential text that's reshaping how we talk about pelvic health.
As a pelvic floor physical therapist and researcher, I offer a balanced assessment of how this book succeeds brilliantly in making pelvic floor conversations accessible and shame-free. The conversational tone and clear explanations of complex anatomy deserve significant praise, especially in the excellent chapters on sexual function and pain management.
However, I challenge several recommendations around posture and exercise that don't align with current evidence. Claims suggesting crossing your legs or specific sleeping positions cause dysfunction aren't supported by research. Similarly, the advice to "always Kegel during resistance training" and "always exhale during exertion" oversimplifies the complex, integrated nature of how our bodies naturally function during movement.
Most concerning are statements suggesting women can cause "permanent pelvic floor dysfunction" by returning to exercise "too soon" after birth - language that inadvertently blames mothers for symptoms largely determined by genetics and birth trauma. These symptoms are expected parts of recovery, not indicators of failure.
Whether you've read the book or are curious about pelvic health, this episode offers valuable context for understanding how we can empower rather than frighten women with health information. Let's celebrate progress while continuing to evolve our understanding based on the best available evidence.
What pelvic health books or resources have you found most helpful? Share your thoughts and join the conversation about evidence-based approaches to women's health.
___________________________________________________________________________
Don't miss out on any of the TEA coming out of the Barbell Mamas by subscribing to our newsletter
You can also follow us on Instagram and YouTube for all the up-to-date information you need about pelvic health and female athletes.
Interested in our programs? Check us out here!
Hello everyone and welcome to the Barbell Mamas podcast. My name is Christina Previtt. I'm a pelvic floor physical therapist, researcher in exercise and pregnancy, and a mom of two who has competed in CrossFit, powerlifting or weightlifting, pregnant, postpartum or both. In this podcast, we want to talk about the realities of being a mom who loves to exercise, whether you're a recreational exerciser or an athlete. We want to talk about all of the things that we go through as females, going into this motherhood journey. We're going to talk about fertility, pregnancy and postpartum topics that are relevant to the active individual. While I am a pelvic floor physical therapist, I am not your pelvic floor physical therapist and know that this podcast does not substitute medical advice. All right, come along for this journey with us while we navigate motherhood together, and I can't wait to get started. Hello everybody and welcome to the Barbell Mamas podcast, christina Previtt.
Speaker 1:Here and today we are going to do an episode that's a little bit different than things I've done in the past. I am actually going to be doing a book review on a very exciting new book that came out called Floored. So Floored was written by Dr Sarah Reardon. Most people know her on social media as the Vagina Whisperer she is approaching on, I think you know, 500,000 or 700,000 followers on her Instagram profile and has done a lot to really push awareness of pelvic floor issues and giving of pelvic floor advice, reducing shame and blame around pelvic floor dysfunction to the general population. Many people know her because she dresses up like a vagina and her head is the clitoris of vulva, external genitalia, and has made herself kind of known in that way and in an attempt to break down some of the barriers of talking about really you know hard to talk about topics In this review I want to be highlighting the good and then being critical about some of the areas in this book where I disagree. The first thing that I think I want to just talk about first is how incredible it is that this book was published right. It is a huge win for pelvic floor dysfunction, for our role as physical therapists working in pelvic floor dysfunction, that books like this have a platform, and part of that is the accumulated work that Sarah has done over many years.
Speaker 1:There are more and more people who are becoming very loud voices in this space, which I think is great, and I legit saw this book when I went in. So I'm from Canada, so Indigo is essentially our equivalent to Barnes and Noble those are the two big and Waterstones in the UK, depending on where you're at. Our Indigo had this front and center as new release nonfiction that and it had a lot of copies in my local store and so this is getting a lot of traction. This is very front and center. When that happens, books like this are going to define the narrative. Many people are going to read it. I hear at kind of inklings that this is becoming a bestseller, that this has done very well upon its publication, which is amazing. But what that also means is that I feel like there's a sense of responsibility, when you're bringing out a big book like this, to ensure that everything and all the advice that you were trying to give is factually accurate and is reflected in our evidence, and so I really want I'm not going to nitpick at this book because I don't feel like that is helpful, but I have like a lot of tabs here of where there was information that was presented that I think the interpretation of that could be fear invoking, which is the exact opposite of what we are trying to do. So I want to be constructive but also acknowledge the goods in this. So I want to start with the good. I think that this book makes pelvic floor and talking about pelvic floor, talking about sexual activity and pain with intercourse I feel like it makes it approachable.
Speaker 1:Sarah wrote in a tone that was very conversational. I could tell that she was very aware of ensuring that she wasn't talking in a way that would be very difficult for individuals who do not have any medical training to be able to understand. I've had some people talk to me saying that you know there's a lot of pelvic floor physical therapists that are going to be reading this. Agreed, and I think the goal of this book wasn't for pelvic floor physical therapists, it was for you all who are athletes or women, people who are menstruating, going through the lifespan and wanting to learn more about the pelvic floor. And so, because this, in my mind, is aimed at women and the general population, I think it was written in a tone that was very approachable. Sometimes it seemed a little bit too conversational. Like you know, she was putting in little asides as if you were having a conversation with her, but I think that that was done intentionally to try and bring down the hesitancy or, like you know, the feelings and emotions when you start talking about the vulnerable black box which can be our pelvic floor.
Speaker 1:Another thing that I think that she did really great was to break down the anatomy and break down some of the bigger issues that we are seeing in pelvic floor dysfunction. So she had a chapter on pain with sexual function. She talked about stress, urinary incontinence, urge urinary incontinence and some of the changes that happen across our lifespan, for example, around the pelvic floor, and I think she made a lot of those recommendations very approachable and so there was a lot of really big positives about this book that I think a lot of people are going to get some good from. Where I became very critical of this book, or where I would like to gently call in for a change of mind, is around a lot of the recommendations related to posture and exercise, and you knew that I was going to go there on the exercise piece. When she in chapter two she's starting to talk about protocols for how to help with pelvic floor dysfunction.
Speaker 1:She kind of tries to give an if this, then that around the pelvic floor. So let's kind of just talk about this first. So you know she says if you're having stress, urinary incontinence, it's likely a weakness issue and if you're having pain it's likely a need to relax. And I totally understand the desire to create this level of simplicity, except that our evidence isn't really supporting that. It is that simple. And so what that means is and I think part of this is a bias that I have because I work with individuals who are highly active and highly stressed where their stress urinary incontinence can actually come from a failure to relax. And later on in the book she does create some clarifying points with that, but the sentiment had already been said in chapter two. So some people are just going to skim and they're going to look for what they need and they're going to have this table that says if you are peeing when you cough, then start doing Kegels and you'd have to get into the weeds and kind of read and read critically down in the next chapters, when she kind of, you know, gives some clarifying points that you know, not everybody is going to be there and she does try to say you know, this is kind of a general starting point which I can totally appreciate, but I think that we're seeing that it's a little bit more nuanced than that and when you have a book that's 300 pages. The great thing about a platform like that is that it's not a 30-second post on Instagram or TikTok. It's a way for us to really dive into what is going on From there.
Speaker 1:The part where I think that this book can be harmful is some of the conversations that she has around posture. So in this book she says things like if you cross your legs, you can have pelvic floor dysfunction. She says things like if you are lying on your stomach with one knee up, you're going to create asymmetries in your pelvic floor that are going to lead to dysfunction. A lot of. If you are putting your body or having your body in this position, you are causing harm to your pelvic floor or you are putting your body at risk. And what these are? They're danger messages around. I caused this because my posture was like this, or this is my fault, because this is the posture that I'm in, and I don't really even think that that was the intention. And if we had evidence that those positions that you place yourself in, like crossing your legs or sleeping on your stomach, causes pelvic floor tension, then I could get on board right. Then it's a message that we need to disseminate and bring forth to the general public.
Speaker 1:The problem is that none of our evidence around posture has really been substantiated in the literature, and so we are creating fear around our movement when that fear should not exist. What we should be encouraging is that the best posture is the next posture and, in general, our strongest length tension relationship of our pelvic floor is in neutral right. When we think about our core canister as this box, when you stretch one side or close down one side because your back is arched or you're in anterior pelvic tilt or you're slouched and in posterior pelvic tilt, your muscles can react, work just fine at lengthened positions or closed positions, but you're stronger in the middle right. If you think about that like a pull-up right, the hardest part of doing a pull-up is the first two or three inches from a dead lockout and the last two or three inches at the top, and that's because we're in a lengthened position at the bottom and a closed position at the top, and that is where we have relative weakness across the working range of motion of our muscle. And that's what our evidence is saying. Is, you know, when we put ourselves into these neutral positions, or if you're pregnant and have a full bladder and you're reclined on the couch, sitting up onto your sits bones can just help your pelvic floor, give it a little bit of a oomph, because we're in a lengthened position in that slouchy, that slouchy posture.
Speaker 1:But the message isn't that if you sit like this, you're going to have pelvic floor tension. If you sit like this, you're going to create we don't even have evidence around asymmetries in the pelvic floor, if I'm being really honest at all. Not to mention it's being caused or blamed because of posturing. And there was just so many examples in this book where she was making a big leap of if you sit like this, if you walk like this, if you do this like this, you're going to cause dysfunction and none of our evidence supports that. And I think that's really important because you know she makes claims like don't listen to these influencers that are not going by the evidence. And then in her same book, she's going against some of our evidence or making jumps based on a theory that has not been substantiated. And so whenever we're making recommendations, we always have to think about the interpretation and the fact that there's a big salience in our mind when we make negative statements. So you could have 10 people that tell you that doing sit-ups during pregnancy is safe, but the one person that says you're going to give yourself a split abdomen. You're going to pay way more attention to that person saying your abs are going to split and you're going to have to very conscientiously ignore that one person, even though the vast majority of your messages are saying that your body is safe, you can do those exercises Like that is okay, and so when we have it in a book like this and it's repeated multiple times, it can be quite damaging, and so we want to be talking about that.
Speaker 1:Next kind of point that I think is really interesting was some of her conversations around exercise In general. She did a great job of encouraging exercise, that she is a person who exercises, she is a big proponent of exercise. But some of her recommendations around how to exercise with the pelvic floor I have issues with and again, when you are making these blanket recommendations, you're going to make mistakes because blanket recommendations don't exist, right, like, if you get one thing from my podcast, it's that blanket recommendations don't exist. So there are three instances, two or three that I think are really problematic, that I'm going to push back on. That I'm going to push back on. So number one is that you always have to Kegel every time you do a squat, a lunge or any type of resistance training exercise.
Speaker 1:I am adamantly against that type of messaging. Why? Because our voluntary control of our pelvic floor is an all or none phenomenon. You may think that you're only contracting at 50%, but what our EMG data, what our evidence when we are actually looking at the contraction, is that you contract your pelvic floor or you don't. When we are thinking about how our pelvic floor works, it does not work in isolation. It works as part of a system, and when we are bracing, our body automatically is going to contract our pelvic floor at the intensity that it needs to meet the demand of the activity that you are doing.
Speaker 1:Too often clinically, I have people that are trying to squeeze as hard as they can because they are leaking with exercise and they end up overcompensating and it's causing pain in the hip, pain in the low back. What we also see is that our active individuals with leaking with exercise have stronger pelvic floors than those that don't, and so that constant override with a Kegel is incorrect and we cannot make blanket statements. And she said it in a way that said, from a prevention perspective, you should be Kegeling every time you are lifting, and that was permanent and that was 100% of the time. Her language was very clear around her thoughts on that and there was no wavering, and I very much disagree with that sentiment. To build on that, not only do I not want you kegeling every time, she also said that you should always be exhaling on exertion to prevent permanent pelvic floor dysfunction and risk of prolapse. And again there is where there is a very nuanced conversation that has to happen. That would have been possible in a book that allows for nuance and discussion.
Speaker 1:That recommendation of exhaling on exertion can be helpful when individuals are rehabbing or they are working through pelvic floor dysfunction and are having leaking with lifting, because that exhale out takes out some of the air in that balloon and you're getting less pressure against the walls of your core canister. It can also be helpful when you are working through bracing mechanics or when you are rehabbing back, for example, early postpartum, when you are working back to exercise. What it also does is makes you weaker, right? What we do know is that when we're not paying attention to our breath, when we are just responding to strenuous activity as effort goes up, our breath, our inspiratory volume, how much air we take in, goes up, and then our inhale air we take in goes up, and then our inhale exhale stops right Over 80%. And what that means is is we do that intentionally because it provides a performance advantage, and if you all have listened to me, you know that I very strongly believe in giving breath strategies based on where you're at and allowing you freedom to move within those breath strategies. Do I recommend exhale on exertion? Yes, and allowing you freedom to move within those breath strategies. Do I recommend exhale on exertion? Yes, especially in high intensity scenarios, especially in early rehab. And then I work towards being able to also not breathe while you are bracing because you're stronger.
Speaker 1:What we are seeing, and where again the nuance comes into this conversation, is that 30 to 50% of women, whether you've had kiddos or not, are leaking with heavy lifting causing excess tension on the pelvic floor compared to the other sides of the core wall, core canister, versus a need to always go away from high interabdominal pressure or high strain activities, and so both of these things lack nuance, and then both of these things can create fear when they are not doing that Kegel or they are not exhaling on exertion. The other thing that this can create is that any feeling of movement down in your pelvis can be seen as a threat or something that is wrong. When you do a very highly strenuous exercise, especially if you have had a vaginal birth, you are going to feel some downward movement of the pelvic floor. That does not even mean that you are fully bearing down. It means that your pelvic floor is accepting the pressure that you are generating when you brace right. Your inner abdominal pressure is increasing when you are bracing, and you are going to see some acceptance of that pressure by your pelvic floor. It's supposed to be able to accept that load, and what we don't want, though, is that, instead of keeping that contraction and accepting that load, it looks like you are bearing down right. So some movement is important. It's going to be there, but too much movement is when we can have this mismatch and we're putting too much pressure down on the pelvic floor. That does not mean that we can never hold our breath, and, again, this book specifically said to protect your pelvic floor never, ever, ever hold your breath, always exhale and her language was very, very adamant around that never exhale on exertion and maybe it's the researcher in me, but never and always are two words that are. You're not going to hear that from me, because our research is always based on averages. There is always going to be error around the mean and then my clinical hat is always going to say it's going to depend on so many things around the person.
Speaker 1:The last thing kind of in the exercise space that I think was really harmful was some of her advice around diastasis recti. So I kind of knew going in that this was her thoughts and opinions on this. I have done response reels to this in the past. She made a comment that well, kind of A and B. She made a comment that well, kind of A and B. One is that you cannot do a sit-up or even go from a reclined position on your couch forward because it's going to put too much pressure on your abdominal wall. It's going to create risk for diastasis recti. What I did love was that she never used the word splitting. She did use the word lengthening and she didn't use the word separating, which I think is also really important when we're talking about diastasis recti. It's a lengthening of that six-pack line, that six-pack tissue You're not splitting. Splitting is a hernia. That is something that is different. So she did use that language, but she said that you cannot go from a reclined position because it puts too much pressure on your ab wall and it's going to cause pelvic floor dysfunction, lumbopelvic pain.
Speaker 1:All of our data around diastasis recti and pelvic floor dysfunction has been inconsistent at best. For every study that shows a relationship, another one doesn't. And what that means for me is that there's a confounding variable that's probably influencing those findings, and I am going to put the statement out that I think the confounding variable is weakness. Right, we know that individuals with persistent diastasis recti postpartum have more weakness than those that don't, and we also know that strength can be protective for pelvic floor dysfunction, lumbopelvic pain. So that relationship between diastasis recti causing pelvic floor problems that does not exist. But there can be an underlying weakness that could make us more likely to have more length between those two rectus muscles See, I'm not perfect on that language either or it can cause some pelvic stuff, some pelvic stuff.
Speaker 1:Where I really I was really uncomfortable reading was when she said that when you are pregnant, you shouldn't even get up from a chair on your own. You should lean forward and use your hands to stand up. Now for context, for anybody who only knows me on the pelvic side, I have a PhD in geriatric rehab and I teach in geriatrics and I hammer on the fact that if you have to use your hands to get up, you are at a very vulnerable position as an older adult Because if you break your wrist, for example, you're chair bound. That it makes it very difficult for you to go out in the community. If you're trying to sit in a chair that doesn't have any arms, I am very adamant around trying to get individuals to be doing a sit to stand with no arms and that it's a really important marker for strength. So to see that be encouraged in a mostly healthy right, even in the presence of complications, usually that is not a muscular weakness problem.
Speaker 1:To see that that recommendation was made in order for you to prevent diastasis recti, which you're in a neutral position. You are only in a neutral position. Your rectus muscle in particular is not activated in a core contraction. When you are bracing, it is not your six-pack muscle that's turning on, it's your obliques and your transverse abdominis. And so in a sit-to-stand, if you're in a neutral position, maybe slightly arched if you're really pregnant, your rectus muscle isn't even doing the work. And so when you're leaning forward to get up, your rectus muscle isn't even doing the work. And so when you're leaning forward to get up, your rectus really isn't doing anything. And our bracing literature shows that Our obliques are turned on. When we're bracing Our rectus is kind of at a hum like posture, like low-grade activation. And so to say that you have to use your hands to get up to prevent diastasis recti which already is not true and then also to kind of look at it mechanistically it doesn't even make sense, was again very fear invoking, and so those kind of messages were kind of upsetting for me. And those kind of messages were kind of upsetting for me when we went into the pregnancy and postpartum chapters.
Speaker 1:I thought that she did a great job kind of explaining how our bodies change in pregnancy and postpartum. I thought she did a great job of explaining, for example, a cesarean section and how it is a major abdominal surgery that we don't want to minimize or dismiss the rehabilitation process that is required of those things. And I think that messaging is really helpful because oftentimes, because C-sections are so common, many people, especially if they weren't preparing for a cesarean are really blindsided by how they felt within their bodies and how long that recovery process could be, and so I thought that she did a great job on some of that explanation. Where I diverged in opinion was around her thought processes around return to exercise. Now I kind of want to give her the benefit of the doubt, because our new postpartum exercise guidelines and our opinion paper, like our expert opinion Delphi consensus, likely was not published when she finished this chapter, and so there might have to be an addition to this, but even so, she made a statement that I highlighted in this because I was upset by it. That said, I haven't had people come to me because they waited a little bit longer to return to exercise, but I have had individuals cause permanent pelvic floor dysfunction by returning to exercise too early.
Speaker 1:And that was a very bold statement and one that puts blame for pelvic floor dysfunction on women, when all of our evidence says that usually the reason for pelvic floor dysfunction is genetics and what happened during your labor and delivery, like if you had a grade one tear versus a grade four tear. With the grade four tear, you're more likely to have persistent pelvic floor issues, and when you are recovering from a major injury, like birth, the presence of symptoms of pain or leaking is not a sign that you have done something wrong, like when I am rehabbing a mom after a baby. It is not if you are having symptoms, it's when and where, because if I'm gonna try and increase your capacity, I need to know when you become symptomatic, like my assumption is not that you are going to be symptom-free because your body just pushed out a baby. Your pelvic floor stretched an extreme amount, you just went through a baby, your pelvic floor stretched an extreme amount, you just went through abdominal surgery, and so that sentiment in this book for me was harmful. Moms are going to. I have moms that reach out to me all the time that are asking me did I do this to myself? Am I to blame for this? And it makes me so sad.
Speaker 1:And again, I don't want to seem like I'm just railing on this book, because I think it was presented with such good intentions and I think even sometimes the way she was writing this was meant to be fun and tongue-in-cheek. I listened to some of this as an audiobook and she was the narrator, and so I could definitely see how, if you're having this conversational tone that you can say some of these things without the interpretation of the person being oh my gosh, I did this on my own and I don't even think that that was her intention. But when you are reading this, you one don't know her, you don't know her tone, and so the tone is your own. So if you're already frustrated and then somebody tells you, well, you know, you did this to yourself, even if that was not the intention, like, oh, I came back too early, now it's my fault, I have pelvic floor dysfunction. And then someone like me is saying well, I'm kind of trying to find your pelvic floor dysfunction because you just had a baby and I expect you to leak at higher intensity, higher loads, higher strain, under more fatigue, because I need to know where you're feeling symptoms so that I can help your symptoms. It's hard because now I'm going to be combating the messages in this book with my patients and I've already had clinicians reach out that they've had patients that have read this book that are highlighting these sections and it's causing harm, it's causing harm, it's causing harm. And so there's that.
Speaker 1:When she kind of goes into the menopause chapter, it's really interesting because she essentially says that you have to do Kegels for life three by 10 of Kegels every day so that as you transition into menopause, that you are not going to have pelvic floor issues. She also uses a very extreme example around mesh for a pelvic organ prolapse surgery, and I think this is something that is really interesting to discuss. This is kind of outside of what I usually talk about with this podcast, because I'm usually focusing around pregnancy and postpartum, but there are a lot of young people who are getting slings and getting pelvic floor surgeries. So as we age, we're going to have wrinkles on our outside. We're going to have wrinkles on our inside. So I can totally agree that our pelvic floor is not going to be the same, and estrogen is such an important part of our pelvis. It's why you're seeing a lot of menopause specialists, especially for pelvic issues, start to advocate for using vaginal estrogen, and that's because estrogen helps to keep our tissues plump. It helps with our ligaments, so our static support around the pelvis, and when we don't have that static support, we have to rely more on our muscles, and with age our muscles get weaker, and so I can understand the sentiment right of like wanting to do some pelvic floor strengthening and how we have a lot that we can do on surgery.
Speaker 1:She highlighted a very rare complication which is important to know going into surgeries of when they repair for a prolapse prolapse. Essentially what they are doing is they are tacking up or kind of using sutures and mesh to move the pelvic, the vaginal or vaginal depends if you're in the UK, not if you're saying vaginal or vaginal, but your vaginal wall up, and what that's doing is, you know, as individuals with prolapse, their vaginal wall, that range of motion comes closer to the vaginal opening and with that what we see is that in some cases, because they use a biological, they use a mesh like a conduit. That mesh stays there and for some individuals it can be painful and we don't know like the percentage. It's going to depend on what they're using for the mesh etc. But it is a complication that individuals should be aware of going into those types of surgeries. What we also see is that recurrence rates, where they have the surgery and then either their symptoms don't go away or they become symptomatic again and they have to redo the surgery those rates are actually quite high and I agree with that they are. I have my own thoughts about what we can do to prevent it. But I think it's really hard.
Speaker 1:When you're doing a book like this and I understand that there is definitely a you want to understand why this is so important, why this is such a big issue. But when we're highlighting the worst case scenario and like the worst of the worst, without acknowledging how rare that complication is, I think it creates this idea in our mind around what those surgeries look like and what you're going to experience that can actually make our bodies more sensitive and more likely to have pain and dysfunction. And I understand, like too, that this maybe wasn't even like Sarah this could have been her publisher wanting to like make that problem big right. We see this in all of our news articles. We're going to look at the person with the worst case scenario to just scare the bajeebas out of everybody so that they understand why it's so important to read this article and why you have to get the product that they are marketing to Like. That kind of is marketing in a nutshell. You have to get the product that they are marketing to Like. That kind of is marketing in a nutshell. But you know, I think sometimes again, like it's just the nuance has to come in to this conversation.
Speaker 1:Another positive, though, that I thought that Sarah did a really great job of was talking about pain and talking about how it's multifactorial and that there's so many things that can make our nervous system really sensitive and more likely to feel a threat response when we are doing things and a threat response when we are experiencing those symptoms, and that is in line with our evidence, right. What we know is that in all pain, but definitely around pelvic pain, there needs to be a trauma-informed lens One because rates of sexual assault and sexual harassment are much higher than we would ever want them to be. When you are experiencing pain and dysfunction in a very vulnerable area of the body, we can have a lot of internalization of trauma and sensitivity to those conversations, even based on how we were raised and what we were told about sex in that area of the body. If we were told that it was dirty, it was shameful, don't touch there, don't talk about there. That is only something that is done in closed doors and in secret. We could be very sensitive, and when something is going wrong down there, it can be very sensitizing and that can make the pain worse, and so we want to think about not just the injury to the tissue itself but the way that our nervous system and our mind interacts with that pain and how some of those thoughts, feelings and beliefs can interact with that pain and sometimes make that pain worse. And that's not to say and she says this in the book that it's all in your head. It's that, just like our pelvic floor is part of a system and isn't in isolation, the way that we experience pain and the way that we move around our environment is influenced by all of these competing signals. Our thoughts, our feelings, other people's thoughts and feelings, our perceived safety within a relationship, our socioeconomic status, our stress level, like all of those things are going to influence how we feel within our own bodies. And I think that she did a great job of kind of exploring that. I think my favorite chapters from her was her sex chapter and her pain chapter. I thought she did a really nice job with those areas and those I think are super helpful.
Speaker 1:And so to kind of go around and go full circle, I don't know if I would give this to my patients, and it's not because there wasn't a lot of good, it's because some of the points that she made, I think can be net harmful. If I did recommend it, I would do it with an asterisk sign of saying please don't listen to the posture and the exercise piece, listen to my research lens piece. Listen to my research lens Because it required more nuance. And so at the end of this, I don't want it to seem like I am just trying to rip Sarah apart, because that is not my intention at all. I think it takes a lot of courage and a lot of bravery to put out a book that has your thoughts and feelings permanently etched into words, and I acknowledge that that is really difficult because I change my mind all of the time. All of the time, um, and what I used to say, I don't say anymore. So if I was to ever write a book, there would be multiple additions and addendums, and I was just talking to Nicole Cozine about this, where she wrote a book back in 2016 and just did a podcast episode of like what I would change if I was writing this again.
Speaker 1:And so this is not meant to slam or slander, it is meant to drive conversations forward. I think, even if she had started writing this in 2013, with it being published in 2025, the use of always and never and the link towards posture and pelvic floor dysfunction has been debunked, and so, in those areas, I will be critical. And again, I don't mean this to say about Sarah, it's about the concepts. So it is about the concepts and not the person, and so I really want to make sure that while I I gave, or is giving, my very honest thoughts, like I was not given a gifted copy of this, I was not asked to review this book.
Speaker 1:Um, it's just, I've been teaching and people are asking me my thoughts and opinions on it. People are reading it and having very similar thoughts to what I am feeling, and so, yeah, if you have any other questions, if you have read this, I would love to know your thoughts as well. If you are going to pick it up, I think that's fantastic, but please give those sections just a little bit of a grain of salt. And, yeah, I'm excited to hear what you're all's thoughts were. Somebody told me that I have to read Power of the Pelvis, which is maybe the next one I do a review on. I don't know, but yeah, let me know what your thoughts are and I will talk to you all soon.
