Art of Prevention
Our mission is to decrease the prevalence of preventable injuries and athletes therein optimizing performance by decreasing the time that our athletes spend benched due to injury. We are going to distill information and practices from experts in the field of injury prevention. High level coaches and top performing athletes. We believe this information should be accessible to everyone so that we can reduce the rates of preventable injuries.
Art of Prevention
Optimizing Pelvic Floor Health: Prevention and Empowerment for Climbers with Juliana Merighi, DPT, OCS
Unlock the secrets to safeguarding your pelvic floor health in this enlightening episode of the Art of Prevention podcast. Join us as we welcome Juliana Merighi, a dedicated doctor of physical therapy who specializes in pelvic floor issues within the rock climbing community. Juliana sheds light on the often-misunderstood realm of pelvic floor health, sharing her journey from a small gym in South Florida to becoming a beacon for climbers seeking to overcome pelvic floor challenges. With insights spanning both men and women, this episode promises to reshape your understanding of the pelvic floor's vital role in maintaining continence, supporting sexual function, and keeping internal organs in check.
Discover the hidden risks that high-intensity training poses to pelvic floor integrity, particularly for athletes. We delve into the nuances of breathing techniques that can make or break your pelvic floor health during intense activities like climbing. Juliana shares her expertise on the unique challenges faced by pregnant and postpartum athletes. Learn how individualized fitness plans can empower athletes to return stronger and healthier, debunking outdated myths about prenatal exercise. This episode is packed with strategies that emphasize the importance of maintaining an active lifestyle during life’s transformative periods.
Bust the myths surrounding pelvic floor dysfunction as we challenge the notion that Kegel exercises are a one-size-fits-all solution. Juliana and I explore the importance of first mastering the art of muscle relaxation before engaging in strengthening exercises. With a focus on building a strong mind-body connection through breathing, visualization, and meditation, we offer practical tips for enhancing control over your pelvic floor. This episode serves as a comprehensive guide to understanding, preventing, and managing pelvic floor issues, with a heartfelt reminder to seek professional help when needed. Join us for a conversation that champions awareness and empowerment in the realm of pelvic health.
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Hello everyone and welcome to yet another episode of the Art of Prevention podcast, and today we have a special topic with yet another very special guest.
Speaker 1:Today I am sitting down with Juliana Mariki and we are talking about pelvic floor issues, specifically in rock climbers. So rock climbers are a community that me and Juliana really love, and it's a community that we are both a part of, and this is a very specialized issue that many individuals face. The highest risk populations would obviously be the female population. However, one thing that we do want you to take from this is that men can also very much be affected by pelvic floor issues. So today we've got Juliana, who is really niched down into helping out this community and spreading awareness about pelvic floor issues, especially in the rock climbing community. Now, if you are someone, like a human being that has a pelvic floor which is most human beings then you will also benefit from the information that's being conveyed in this podcast as well. So, juliana, tell me a little bit more about yourself and why you really got into this special population of rock climbers and, specifically, pelvic floor issues in rock climbing.
Speaker 2:Yeah, thank you for that introduction, nick. And so I started climbing while I was in PT school and I was going to a really small gym in South Florida and I felt like, because it was so small, I knew everyone, and so everyone knew that I was in PT school, and so everyone was coming to me about different aches and pains that they had. And, man, I love chatting with them about how they can heal their bodies, how they can climb better, how they can climb through their injury, and the best part was that they listened and they actually did it and they got injury. And the best part was that they listened and they actually did it and they got better. And so I was like, man, I want to keep working with climbers because they, like, really care about their bodies and are interested and they want to learn, um. So that's how I got into working with climbers.
Speaker 2:Immediately after, uh, after graduating, I moved out to Colorado and I was like all right, this is the population that I want, um. At the same time, I was like, what's going to make me stand out? And I was. We, I had taken a couple of classes um in PT school about the pelvic floor, um. And so I was like I'm going to pursue that because it's cool and it's going to help me stand out a little bit, be honest. Um, so the first like continuing education course that I took as a PT was about the pelvic floor, and that was super cool, like original it's not. It's not a super exciting story like, oh my gosh, like all this pelvic floor stuff. I was so passionate. It was just like I found it fascinating to help people specifically like women regain their power through pleasure.
Speaker 2:That's how it started, and because of that, you see a lot of others. You don't just see people who want to have orgasms. You end up seeing people who are peeing and pooping themselves and all the things, and you can empower people from not doing that as well too. So then I started working a lot with the pelvic floor and I wasn't seeing climbers like climbers and climbers with pelvic floor issues. I was just seeing people with pelvic floor issues, climbers and climbers with pelvic floor issues. I was just seeing people with pelvic floor issues, but it was like runners and CrossFitters and skier like all all other athletes, and at the same time, I was seeing climbers or like fingers and elbows and shoulders, and I was like wait a second. Climbers have pelvic floors and climbers get pregnant, and climbers sometimes pee their pants, and so I started to blend those two things together, and here we are today.
Speaker 1:Awesome, I love that. And this is really such a large issue in medicine that for I mean, for the last couple of decades and centuries even has just been swept under the rug, mostly because most of the thought leaders in the medical community were predominantly males and like, oh yeah, females, they just like have stuff going on down there. They can't have any specialized or specific issues to them. Let's backtrack a little bit. What do we mean when we say the pelvic floor?
Speaker 2:Yeah, yeah, that's such a great question because so many people don't know what the pelvic floor is, especially from what I found, too, is like men I'll tell men that they have a pelvic floor and they're like their jaw drops and they're like what do you mean? I have, I have a. What I thought only women have, that, so yeah, so if you like, and you can just like, use your hand, if you feel comfortable doing that, like you put it on your butt, you can feel like that bone right there, right, the ischial tube. So in between your ischial tuberosities lays like a bunch of muscles deeper than the glutes and that's your pelvic floor. There's three.
Speaker 1:In between the two sit bones. The ischial tuberosities are the fancy terms. In between. There we've got our pelvic floors exactly regardless of if you're male or female.
Speaker 2:Yeah, anything in any other denomination yeah, like individuals with vulvas and individuals with, like a penis. There's really only two muscles that are different, between three different layers of pelvic floor muscles, and those three layers serve to help with keeping pee and poop in. Keeping pee and poop, letting it go out, helps with sexual function, and then it also holds everything up. It holds all of our organs up in place, especially our bowels, our bladder and, if you have a vulva, your uterus. Those organs sit within the pelvic floor. So if you, for example just to put this into perspective like, let's say, you have constipation, there's many reasons why you could be constipated and one of those reasons could be all right. Let's say you have a pelvic floor with increased tone, so it's like the muscles tight, we'll call it that could be compressing on a part of your bowel and not allow and causing that sensation of constipation.
Speaker 1:Yeah, so it's not just about fiber intake, then I'm assuming.
Speaker 2:No, it's not. It's not. And it's so funny too. When I work with someone's pelvic floor, I'm like you're welcome, because you're probably going to have a really nice poop after this, and they typically do. They're like all right, I'm out of here and I'm going to the bathroom and thank you.
Speaker 1:So multiple functions of the pelvic floor, for incontinence, so like restroom issues or holding things in, we could say, but also for like physical performance and like stability.
Speaker 1:Like for me, I've learned most of the information, the light amount of information, that I know about the pelvic floor through DNS, and whenever they talk about the core we could say they talk about 360 degrees around your torso and then the upper or the ceiling of your core being your diaphragm and then the floor being the pelvic floor and you have to utilize your diaphragm in conjunction with the pelvic floor in order to maintain stability within the torso.
Speaker 1:So it has a sphincter function, as you alluded to, but it also has a postural and stability function as well. And if you have compromise in your pelvic floor, then you're going to have compromise with all of those things that we just discussed. So what are some signs that, when you're talking to a patient, make you think, or make that light bulb go off of, oh, maybe this is pelvic floor, because pelvic floor issues and pelvic floor discomfort or dysfunction can cause the things that you talked about, but it can also be an underlying cause of things like back pain, hip pain, pelvic pain. Can you elaborate on the signs and symptoms that you see that make that light bulb go off.
Speaker 2:Yeah, yeah. So if someone comes in and they have a history of chronic low back pain, if we look at the research, that the numbers are kind of all over the place, but they're all consistently high with a correlation to pelvic floor dysfunction, high with a correlation to pelvic floor dysfunction. So if someone has chronic low back pain, you can almost make a very smart assumption that they also have pelvic floor dysfunction. So some of the questions that I like to ask someone to tee out if if you do have pelvic floor dysfunction is all right, do you leak yourself when you are picking something up or when you're, if you're a climber, when you do like a challenging, dynamic move or when you fall off the wall, but not just leaking, because sometimes you're like I don't leak, I don't leak at all. But then if you say, well, do you dribble a little bit for some reason, they just they're like, well, yeah, sometimes I dribble. Obviously it's like, okay, well, that's leaking and also having to strain, like straining to pee, straining to poop, that's pelvic floor dysfunction, pain with sitting. So if we go back to the ischial tuberosities, that center part where the pelvic floor is, that there's pain there with prolonged sitting and even sometimes when you're climbing with like a drop knee or if you have a high step, that can cause, if there's increased tone in your pelvic floor, that's going to cause some discomfort there.
Speaker 2:Um, what else I always do ask pain with penetration. You can imagine if a muscle's tight and like something's trying to go inside of there, but it's like it's like it's like pressing on a trigger point. That's not comfortable, um, so always ask about that too. Um, and then very similar. So that's questions. I'll ask both people with vulvas and people with penises. Um erectile dysfunction as well. Do you have trouble umating and maintaining, maintaining an erection?
Speaker 1:Interesting and hopefully not exactly like while climbing right, or maybe while climbing.
Speaker 2:I don't know. I mean, if you're sending your projects, maybe I don't know. But even if you, if you are sending your project and that happens, maybe you also should see a pelvic floor PT. You know, nick, and I think like what would be really helpful for listeners would be like, right now we keep saying the pelvic floor, but what I've noticed in my practice is you can explain what the pelvic floor is, but that doesn't mean someone still understands, like like all right, we're talking about the pelvic floor, but how do I know if I am like engaging or relaxing my pelvic floor? So I think it'd be helpful right now to maybe like have me cue you into connecting with your pelvic floor.
Speaker 1:Sounds great.
Speaker 2:Yeah, cool, let's do it. Um, so I'll just have you sit up nice and tall. This is what I usually take my clients um, take my clients through and just notice, notice the surface underneath of your sits, bones, just like bring your awareness there.
Speaker 1:Okay.
Speaker 2:And then place your hands on the bottom of the front of your rib cage.
Speaker 1:Bottom of the front of my rib cage, the intersection between my ribs and my stomach exactly, yeah, cool, and I'm just gonna have you take an inhale into your hands.
Speaker 2:Inhale into your hands like fill up the rib cage okay and then use your hands to help press the rib cage down and in on the exhale and exhale with an open mouth. Okay, so inhale through your nose, fill up the rib cage down and in on the exhale and exhale with an open mouth. Okay, so inhale through your nose, fill the rib cage, exhale through open mouth, press rib cage down. Cool. Now imagine that we're moving the rib cage you mentioned it earlier in 360 degrees of expansion. So on an inhale, the front, the sides and the back, like a canister, it's all going to expand. And then on exhale, it's all going to come in. So let's just do that. One more time Inhale and then exhale Cool.
Speaker 2:So we talked about the rib cage. Now we're going to think about the throat and also the pelvic floor. So the rib cage, the throat and the pelvic floor are all are going to meet. So on an inhale, notice a little bit of like heavy, not heaviness, but you're just pressing a little bit more down into the surface you're sitting on. And then on an exhale, there's a little bit of a lift, that canister, it's like coming in. Cool. So let's in, inhale through your nose, exhale everything meets in the middle. Cool. One more time inhale, exhale Cool Did. What did you notice in regards to like the muscles in between your pelvic floor muscles and the surface of the seat?
Speaker 1:I think it's important to have that, that, that awareness, and I've been like kind of cued through these things before with some of the coursework that I've taken, so that, like on the exhale, it's almost like that work that I've taken, so that, like on the exhale, it's almost like that.
Speaker 1:that lowering down towards the, the, the seat that I'm sitting on, on the inhale yeah, did I say exhale, Sorry? So on the inhale, that lowering, or sometimes they call it like eccentric lengthening towards the seat and then that little bit of rising as I exhale. And I like that cue of like bringing everything a little bit together and then expanding everything a little bit apart. So expansion with everything with the inhale and then bringing everything a little bit closer together with the exhale.
Speaker 2:Yeah, yeah, and that's like it's so important to understand how to feel these things and incorporate your rib cage and we didn't really talk about there but hopefully, like your transverse abs, like your deep core muscles are also intuitively being engaged, and usually that's something that I have to work a lot with. People Cause listeners, if you, if you just tried that, you could be like that seems opposite. People say that all the time where it's like that, that you could be like, that seems opposite. People say that all the time where it's like that exhale, they're bracing, they're preparing for, like lifting or climbing and doing a dynamic move, it's like, and then they press down and they bear down on their pelvic floor and that leads to pelvic floor dysfunction. It's not how we should be supporting our muscles and our organs.
Speaker 1:And Juliana, what would you say to somebody who just listened to us and tried to follow along? But they were like I have no freaking idea what you guys are talking about.
Speaker 2:Yeah, there's so many cues that work for some people and don't work for some people. I would, I would definitely cue them to breathe heavier so like sometimes if people are like I can't get that pelvic floor salute contraction, I'll have them exhale like, and if you do that right now, you can like hopefully you can feel your pelvic floor come up, but like the louder the exhale with an open mouth. That really helps get that.
Speaker 1:Yeah, and if we think about climbers, some of the best climbers in the world are known for yelling really loudly whether it's Adam, andra, chris Sharma, all these really top level performers. And what I often tell people is they've intuitively figured out ways to increase their intra-abdominal pressure and ways of stabilizing their torso and their core when they're making really big dynamic movements. And sometimes we just have to utilize some of those same things when we're coaching our clients or patients or whomever. And there have actually been a couple of studies that show that doing like a grunt or an exhale during like a punch or a specific weightlifting task that it can improve power and stability. So those guys aren't doing it to be showy or anything like that. They're doing it because they've intuitively figured out and they understand that when I yell or when I grunt, then I actually have more power and I have more stability and I'm going to increase the probability that I'm going to be able to maintain latching, this hold or perform whatever tasks that I'm trying to perform.
Speaker 2:Yeah yeah, that's so true, and unfortunately, a lot of what happens is when you're climbing at your max. You want to hold that tension, and so you hold your breath.
Speaker 1:And I do that yeah me too.
Speaker 2:I just did it this weekend. I was like halfway up the water, I was like I need to start breathing, but what happens is then you, your pelvic floor there's a lot of it increases the amount of tone because it's just holding there, it's not moving through its full range of motion, and then down the line. Okay, let's say you start that pattern when you are a youth athlete and then you become really efficient at having that pattern when climbing, and then yours go down the line and you choose to get pregnant and then all of a sudden your pelvic floor dysfunction comes up. Or maybe you don't choose to to get pregnant and then you go through menopause and all your pelvic floor dysfunction comes up. Or you're a youth athlete, you have all this tone in your pelvic floor, you're dribbling in your pants when you fall from a climb, and then you don't talk about it, because who's talking about that?
Speaker 1:Yeah, and one thing that we started out by saying was you know, everyone can get pelvic floor dysfunction. However, there are certain populations that are at higher risk for pelvic floor dysfunction. Could you elaborate on those?
Speaker 2:Yeah, so high level athletes, for sure, because we're working at where? Well, I'd like to say I'm a high-level athlete. High-level athletes work at such a high intensity and when you learn at a young age to work at such a high intensity, all of your muscles, most of your muscles, are helping you accomplish that movement and that task, and so through that, the pelvic floor can become a little neglected and become weak. Or what I just said, where you're working so hard and you're using your abdominals and you're clenching and you're just like so engaged. There's all this tone and you're so good at being active, but you're not good at relaxing and letting things go.
Speaker 2:Individuals with vulvas are definitely more at high risk. Just because there's they don't have to deal with just one hole, there's two, so that's going to be like us. That is a split in your muscles, so they're not going to be as. That's just allowing things to. If they're not strong enough, we have risks of prolapse until things can start to fall out. Um, I mean, we could there's not great research to support this but stress like we are, we're just all getting so stressed out and our pelvic floor holds that stress. If you think about uh, what do you do when you're stressed, usually start clenching your jaw and you're like, all right, like we're holding it, and then our pelvic floor is holding that as well, because if you have an open mouth, it's your pelvic floor can relax.
Speaker 1:but if you're clenching your jaw, you'll notice your pelvic floor starts to clench as well oh yeah, I mean the comorbidity between like temporomandibular joint disorder and low back pain and neck pain and then things that are swept under the rug like pelvic floor issues, is just so freaking high. I mean, I've done a decent amount of coursework for like temporomandibular joint disorder or TMJ for those of you listening and the the correlation between that and neck pain and back pain is just so high.
Speaker 2:It only makes sense that you could extend that to one level further, to the pelvic floor itself yeah, definitely, definitely, and uh, pregnancy and postpartum, I mean it's the most natural thing, uh, but it is, I like to think of it as the most natural, beautiful injury to our bodies. Your risk of prolapse with every pregnancy or every subsequent pregnancy increases by more than 10%. It's just, it's a lot of stress to the pelvic floor, it's, which is normal, but there's things that we should definitely be aware of and address.
Speaker 1:I am. In one of the courses that I took they described pregnancy and giving birth as an athletic event, which I think is. I mean, just, you know, seeing that kind of stuff happen it's like, yeah, it's, it looks very athletic. I mean, seeing that kind of stuff happen, it's like, yeah, it looks very athletic. I mean the significant amount of exertion and bodily changes that occur, like this is basically like training for a marathon and then executing a marathon, except if that marathon sometimes took like 24 hours, you know.
Speaker 2:Yeah, definitely.
Speaker 1:So I know it seems almost obvious, but why is it that peripartum or around pregnancy a lot of these pelvic floor issues will come to the surface and then potentially remain after giving birth?
Speaker 2:Yeah, great question. So we can still compare it to let's just still compare it to an athlete working at their max effort. If you don't have the strength to perform, then you're increasing your risk for an injury, you're increasing your risk for compensation and then probably injury, right? So with the pelvic floor there's so much stress and demand that is that that's placed there.
Speaker 2:When you become pregnant, your pelvic floor has to support a growing baby and at the same time, your hormones are going crazy and not allowing you to properly recover from whatever you're doing. So let's say you used to work out in whatever way before you became pregnant and now you're like I'm going to work out the same exact way, the same exact intensity and volume, and I'm not going to take any breaks and this is going to be great. Well, your body's just not able to recover from that, and so it can result in pelvic floor dysfunction and like showing some of these weaknesses. It can also show like poor pressure management. So if you're not able to manage the pressure increase on your pelvic floor and you're used to like pressing down when you exert yourself instead of contracting and engaging, well, that's going to show and then we might end up with prolapse? Does that make sense?
Speaker 1:Yeah, so it's just putting a lot more stress there. And if you're already operating at a high percentage of like, one theme with a lot of the episodes is if you're operating at a high percentage of your like one rep max, you're more likely to injure yourself. Because if your activities for your sport are at such a high percentage, then you're more likely to injure yourself. Because if your activities for your sport are at such a high percentage, then you're maxing out the capacity of your tissues. You're more likely to compensate, you're more likely to adapt and use a movement pattern that might not spread out those biomechanical loads effectively, etc.
Speaker 2:And then when you really increase that load by forming a baby or something like that, then all of these things get amplified and then you see more of the problems arise yeah, definitely, and I think especially working with climbers, where climbers are pretty freaking strong and it's it's remarkable what we can do with our bodies, and so there's a little bit more wiggle room to get away with some things.
Speaker 2:And so you could have someone who's pregnant and they're climbing and they're, they're listening to their body and they're feeling great, and they don't see a pelvic floor PT or they don't check themselves for how they are managing this pressure, and then you get into your third trimester or you get postpartum, and then all these things come up. And so I tell everyone I mean, the best time to start working with a pelvic floor PT is right when you find out you're pregnant, just to make sure that you have these checks and balances so that you can safely continue to do what you want to do, because for the most part, you can keep doing your activities, but there's resources out there, so might as well use them.
Speaker 1:Yeah, I typically will make a recommendation of at least like making a consult and getting a couple of cues and then exercises for the pelvic floor to one prepare for prepartum or prepare for delivery, but then also have a lot of these systems and exercises in place for post pregnancy, even if, like you're, you're a healthy individual that has had no signs of pelvic floor issues. It's like we've got to be educated about some of the things that you need to do in order to mitigate the chances of sustaining a pelvic floor injury or having a pelvic floor injury down the line. What are some of the exercises or techniques that you utilize in order to mitigate pelvic floor injury?
Speaker 2:Yeah, so I mean that drill that we just did earlier. I start that off with every pelvic floor client. Um, because that's just that is basic, like concentric and eccentric movement of your pelvic floor. And then I usually go into all right now, because when you pick up something, or you're lifting or you're climbing, you're climbing, you're not moving your core, you shouldn't be like inhale, lengthen, exhale contract, like that should not be happening.
Speaker 2:And so teaching people okay, how can you keep the tension in your core, in your pelvic floor, and then lengthen elsewhere? So like how can you move your rib cage while you're keeping tension there? And so I teach both of those things. So when they're climbing they know keep the tension, but then once they get off the wall, they can properly relax everything. And then another big thing is making sure that glutes, hamstrings are super strong. Because if the glutes and hamstrings are strong and you're able again to do the same thing the concentric and eccentric lengthening then the pelvic floor is typically doing the same exact thing that the glutes are. So we do lots of deadlifts, lots of hinges, especially as you're pregnant, because glutes and hamstrings, as your body is adapting to like the baby growing in front of you, your hamstrings and glutes lengthen and so we lose that length tension relationship, and so making sure that that stays nice and strong.
Speaker 1:Gosh, and then having that higher capacity just improves your resiliency and robustness for that athletic event of being pregnant and oftentimes will decrease the likelihood of other musculoskeletal complaints as well. So, if you're I think that we were talking about this in our pre-recording call it's like if you don't exercise and then you become pregnant, the best time to start exercising is a few years ago, but there's no time like the present. You still need to start and perhaps have the guidance of a professional that's accustomed to working with these special populations like yourself. But you still need to start, and that's not only for the health of the mother but the health of the baby as well.
Speaker 2:Yeah, it's so good for your baby. There's studies that show that the baby then it will have like a healthier weight when it's born. It's protective against you from getting gestational diabetes, it's just like it's, so it's so important. It's so important to exercise when you're pregnant. I I'm thinking of a client right now where she actually came to me and she wasn't working out and she came to me really early on, like I think maybe like right after her first trimester, and now she's six months postpartum. But I remember she was like gonna do in two weeks and she's like I've never felt so strong and I was like what let's go? And she's just doing fantastic now and I see her just just one time a month. She'll come in and we're just continuing to check to make sure that, as she's increasing the activities that she's doing, and we're just continuing to check to make sure that, as she's increasing the activities that she's doing and she's getting back into running and lifting heavier, that she doesn't revert to some patterns that aren't helpful.
Speaker 1:And I think there are a lot of really incredible women that have really changed how the medical world really views that time period of pregnancy. It almost seems like it opens up a window of opportunity for perhaps even enhancing athletic performance. You know, I mean I think some individuals like from the track world you've got Alison Felix one changing contractual obligations of corporations like Nike, where Nike if a female ever got pregnant they would just drop that athlete. And then Alison Felix was like screw, screw you, I'm gonna come back. And then she wins gold medals at the olympics, the next olympic cycle. And then wasn't simone biles pregnant during the olympics this year?
Speaker 1:wait, was she I'm pretty sure that she's like. Early on I heard that from someone that could be or could not be true well, if that's true, that's so badass.
Speaker 2:I don't know if that's, we need to look that up. I heard I thought I heard that she might not be in the next olympics because she wants to get pregnant.
Speaker 1:But I hope she's pregnant, that's cool I'm gonna, I'm gonna look it up right now.
Speaker 2:I mean that'll be remarkable because that's I mean I can assume then she'd be in her first trimester, which is like such a crappy time to be performing and like it's so badass.
Speaker 1:Yes, there are a bunch of rumors about it but I don't know.
Speaker 2:Simone, if you're listening, let us know. We won't tell.
Speaker 1:Yeah, we'll maybe have to like look that up later and I'll probably have to like edit whatever stuff.
Speaker 1:But yeah, I think you know, now that we see pregnant individuals as like truly just athletes that are also pregnant, it's like, yeah, like having a, you know, an athletic routine or like staying physically active is actually beneficial, whereas previously, like you know, 20 years ago, the guidelines were, oh, you're pregnant, time for bed rest until that baby's out of you, and then at six weeks, then now you're magically able to go back to full capacity and full training. What are some of your guidelines and recommendations for after an individual has a child and they want to return to their sport as soon as possible? Because I've seen this go a couple of different ways. Some athletes are like, oh, I'm not doing anything for the next rest of my life, and then some athletes are like two or three weeks in and they're like doing RX, crossfit workouts and it's like, whoa, can we like chill, like for a second here, like can we have a slow roll into it? What are the recommendations that you commonly give?
Speaker 2:yeah. So I definitely don't have like one recommendation fits all. You have to take into consideration what were they doing before they got pregnant and then what were they doing throughout their pregnancy. But no matter, we still have to honor healing, whether it was a vaginal or a C-section delivery. I like to say you can start simply breathing and practicing, relaxing and contracting your pelvic floor immediately. Do you want to give yourself a couple days off just to enjoy your baby? If you want to give yourself a couple of days off just to, like, enjoy your baby, if you want to, yeah, but if you want to start immediately, you can start doing those contractions immediately.
Speaker 2:Um, and continuing to do that with like some like nice movement, like nothing crazy, for like up to the first four weeks and then at four weeks I mean first four weeks and then at four weeks, I mean depending on, again, what you've been doing you can go touch a wall, for sure. There's things I like to look out for, though. So, like I want to make sure, are you appropriately managing pressure? So like when you cough, when you sneeze, simply laying down on the table, can you properly manage that by contracting and not bearing and pressing down? Because if you do that laying down, you're going to do that on the wall and you're going to just continue to reinforce a bad habit. So, around after that four weeks, I'm checking to make sure that they're able to appropriately manage pressure. Also, too, around that four weeks, it's like, all right, let's start hinging. We can start doing that if you're appropriately managing pressure to get that.
Speaker 1:What do you mean by hinging?
Speaker 2:Yeah, so like deadlifts, rdls, eccentric glutes and hamstrings right, I talked about earlier as you go through pregnancy we lose that length tension relationship. So it's like it's hard to hold tension in that lengthened position, and so I'm going to make sure that, as you are I don't know how do you say, as you're doing, an RDL is that? Do we know what an RDL is?
Speaker 1:Yeah, so Romanian deadlift.
Speaker 1:A lot of times, like with low back patients and things like that, it's important for us as practitioners to teach people how to move at their hips and not always move solely with their knees or their low backs, because oftentimes when we see individuals they act like they've got three hips one left hip, one right hip and then one hip in their low back, and the reason they come in to see us is because you know they're just using that hip in their low back and bending just in their low back, which is not to say that bending in your low back is bad or anything like that.
Speaker 1:I don't want to get called out by the evidence informed police or anything like that, but you ought to be able to move and quote unquote hinge at your hips in order to bend forwards. So for those listening me and Juliana like, it's a huge thing for us to make sure that people have awareness, not only in their pelvic floor, but awareness and the ability to utilize their very mobile hip joints in order to bend forward or hinge forward and pick things up off the ground or perform climbing movements, et cetera. So sorry for sorry for, uh, interrupting you there. I know that you have some great stuff to talk about.
Speaker 2:I'm like I'm so visual so it's like challenging for me to not like I want to stand. I want to stand up and start like doing things you know but, yeah, um, yeah.
Speaker 2:So, yes, exactly what Nick just said. Um, and then also I kind of stopped talking about this. But oh, it's so important getting your rib cage to move because, as you went through pregnancy, your rib cage cage is like flaring out forwards to create space for a baby, right? So we want to make sure that you're not just breathing to keep getting that rib cage forward and that you're breathing into the sides and you're breathing into the back, you're breathing into the top and bottom, so like just doing different exercises to help move that along.
Speaker 1:Yeah, I agree, and especially looking at like junctional areas, like for me as a chiropractor or somebody with the ability to perform spinal manipulation, looking at regions like the junction between your mid back and your low back, which we'd call the thoracolumbar junction, especially because this is where, like, an epidural is often performed and you know hate to say it, but every now and then there are complications with epidurals. So we have to be aware of and cognizant of those things having a downstream effect on areas like the low back, the pelvic floor, et cetera.
Speaker 2:Back the pelvic floor, et cetera. Yeah, so, so, yeah, that's that's kind of like the regimen I. I take them through and then, as they're, as they're returning, I definitely recommend starting with top rope and then, if they're like lead climbers or boulders, if they're a boulder and they want to start falling, I do recommend they wait for at least three months to take those falls from like. If you can like take small falls, but if it's a little bit higher, just because when you land it's so much stress and force through your pelvic floor and it's just not enough time for healing to take place for it to be able to tolerate all of that stress. And that's pretty consistent with running literature as well. Most running literature won't recommend returning to running until three months, and there's some pelvic floor PTs that I know that won't have people do it until six months, just because there's risk for stress fractures, especially if you're breastfeeding.
Speaker 1:Um, I haven't even thought about that, yeah.
Speaker 2:Yeah, yeah. So that's why I'm like it's so hard to say this is what I recommend, because there's just so many nuances, um. But yeah, with breastfeeding, um, it's just requiring so much energy to produce that milk. So you have to make sure that you're eating enough protein, like all you're getting all the calories that your body needs to do the activity that you want to do and to breastfeed. And then also, when you're breastfeeding, your hormone levels stay all over the place and so your rate of recovery and muscle recovery is just it's slow.
Speaker 1:So and the the elasticity of those tissues is also going to remain elevated for multiple months after pregnancy as well, correct?
Speaker 2:I I actually don't know about. I actually am not sure, because that would be because of the relaxin. It might, I don't know. I think so it might be, and I just don't know.
Speaker 1:I'll have to fact check that.
Speaker 2:Yeah, it's not. It's not that. It's yeah, it's not that. I think it's not. I just might not know that.
Speaker 1:Now I'd love to pick your brain on probably what people think of as a almost like buzzword or word that comes to mind whenever we say pelvic floor physical therapy. So what are your thoughts on things like Kegels or just tensioning and tightening the pelvic floor? I saw a little smirk there, probably because you're like the biggest fan of them and that's all you need to do, it's all you need to do you just need to. You know it's tight, so just squeeze it some more, you know yeah yeah, so I mean it's.
Speaker 2:It's been like the common theme of our conversation thus far where, uh, increased tone, the muscle isn't able to relax, and so that is what ends up happening with with a lot of pelvic floor dysfunction. So if you tell someone to go do a Kegel, which is a contraction, a concentric like on the exhales cueing you to contract, that's a Kegel. Um, but if you tell someone who's like tight to go do that, then they're just reinforcing that tone and that tightness in your pelvic floor. And you know, let's go back to the very first thing we talked about how, uh, if you're, if you're feeling a sensation of constipation and that could be because there's increased tone in the pelvic floor pressing on your bowels, okay, well, then you tell someone to keep doing Kegels, then they're just going to be more constipated.
Speaker 1:So yeah, it's. In some individuals it may be beneficial because it's just bringing awareness to that region, but in some individuals or I'd say more individuals it's probably more akin to treating diarrhea with a burrito, you know, like it's just not going to work out well If you've got too much tension and then you just practice tensioning over and over again. It's like how are we supposed to improve? And oftentimes it's the opposite that's required.
Speaker 2:Yeah Right. And like a muscle that has too much tension, it's not moving through its full range of motion, there's decreased blood flow, that muscle ends up becoming weak, and so eventually, kegels are a hundred percent appropriate, but first you need to be able to relax that muscle and understand how to have that eccentric lengthening, and then we can start talking about a Kegel, because they are important, but they're they're not the only thing.
Speaker 1:Yeah, and I always liken it to like the the plantar fasciitis case that you know.
Speaker 1:I take their shoe off and then I tell them to move their toes up and down or spread their toes out, and they go what the heck are you even talking about?
Speaker 1:I didn't even know that you could spread your toes apart and it's like, well, you literally have zero control over that region of your body, have zero control over that region of your body. So of course your brain is going to revert to the limited motor patterns that it has available to it when you're performing tasks like walking, running, jumping etc. So if you only have a standard set of movement protocols at your disposal, you're only going to use certain tissues over and over and over and over again and you're only going to use certain links of those tissues over and over and over again. So oftentimes it almost seems like a silly thing to do. But in my initial or early stage plantar fasciitis cases it's like, hey, we just have to strengthen this mind-body connection for you to your foot. And it sounds like you're saying similar things about the pelvic floor. It's like we have to get your brain aware that you can control this area a lot more appropriately than you are doing right now.
Speaker 2:You're 100% right. And that can be really frustrating for people because they're like what do you mean mind body connection? Like that's really hard to do and it's mentally exhausting. And I just tell, I just tell people like, just do these really simple things and do them like pretty consistently for a week, and then you're going to come see me or you're going to, you're going to message me and be like oh my, I don't even have to think about it, it's just automatic. So you just have to get over that hump of like there's no way I can move my pelvic floor I don't even know what that means still but if you're just consistent with like something as simple as breathing, it'll be automatic.
Speaker 1:Do you have any other tips and tricks for people that are having trouble with accessing that mind-body awareness? So I've seen some things like sitting on a rolled up yoga mat or putting that in between the ischial tuberosities, going into a deep squat sometimes, although sometimes doing that in a deep squat wouldn't be the best idea if you have pelvic floor dysfunction. Although sometimes doing that in a deep squat wouldn't be the best idea if you have pelvic floor dysfunction. What kind of things do you typically recommend for?
Speaker 2:like hacks. If you will, yeah station yeah, well I'm, I also teach yoga, uh, at the climate around here.
Speaker 2:Yeah, so I I actually bring this to my classes a lot where, yeah, we'll sit on a blanket, where sometimes we'll even like sit on our hands and just like close your eyes, settle your mind, and I'll have it. I'll have people imagine their pelvic floor like a clock and like it's the front of the clock. Is that like the front of your, that bony part, your pubis, and then your coccyx, that like pointy bony part in your and then your coccyx, that like pointy bony part in your butt, and then your ischial tubes right and left, right, and I'll have people just like bring awareness there and breathe and then go around that clock. Sometimes I'll have people do like, I'll have cues like imagine that your pelvic floor is a jellyfish and that jellyfish or octopus is like grabbing something and then it's letting it go. So cues like that, but lots of meditation and there's like you can go on YouTube and do like pelvic floor meditation and that can and like listen to that.
Speaker 1:Nice. Do you have any more information about male pelvic floor dysfunction before we wrap up, yeah, I'll say from my clinical experience one of the best referrals I've ever made in my entire life clinically was referring a male to a pelvic floor therapist and it changed their life.
Speaker 2:Yeah, I remember you were telling me about that yesterday, which was super cool, um, and we were kind of chatting about like, yes, there are, there's males definitely are individuals with penises, like they have pelvic floor dysfunction, um, and it's definitely not as common as those with vulvas, um, but they have it and hopefully we start talking about it more. But it's like there's a lot of shame with like, yeah, I also pee myself, or, yeah, also sometimes I poop myself, like that's just that's not in our society, like that's just that's not in our society, like that's not masculine. So go see a pelvic floor PT. There's things that can be done. If you have trouble trouble like starting your pee or your urine, like you are leaking, if you have trouble maintaining or starting an erection, go see a pelvic floor PT.
Speaker 1:Yeah, and I think the stark numbers that you gave me also in the pre-recording call that we did 70% of youth female athletes having pelvic floor issues is just insane and it's something that needs to be brought to the surface and needs to be addressed appropriately.
Speaker 2:Yeah, yeah. And so I would say like I'd love to do this with the gyms actually in my area, just like having conversations with coaches and how to have these, because it's not like you can if you, especially if they're like young, that's like sometimes not the best route, but like having conversations with like the parents to let them know like like sometimes not the best route, but like having conversations with like the parents to let them know like hey, ask your child these questions. I know that the youth team right around the corner from where I live like they went to a yoga class and I think that's great because yoga is actually a really, if yoga is cued correctly, it's a really good way to like find that relaxation of the pelvic floor. So like these kids can just like let go and they don't have to like have all this tension and tone in their bodies all the time. Like just relax.
Speaker 1:Oh, I mean kids. These days they're, they're great at relaxing. There aren't any rates of like ADHD or like inability to focus or any inability to have that mind body connection. They're, they're probably great, you know.
Speaker 2:I? I once saw this girl she must've been like six or seven and she like fell off of V10 and just started yelling and cursing and I was like come on, are?
Speaker 1:you sure that wasn't me? Come on. Are you sure that wasn't me?
Speaker 2:you wouldn't be on v10 nick, come on but I was like oh man, you know, I would love to be like trying what you're trying, and I mean, if this is what you're climbing now, like just even two years from now, imagine, you know. So yeah, kids, these, they just need like a little bit more love.
Speaker 1:Yeah, I love all the stuff that we've talked about, and you mentioned that you do yoga classes at climbing gyms around your around the Denver metropolitan area. Um, how can people find you, juliana, and how can they get in contact with you or be taken on as one of your clients?
Speaker 2:Yeah, that's a great question. So yeah, you can definitely find me at the Movement Gyms here in Colorado. I teach yoga at the Golden location on Sundays and then there's a location in Englewood that I teach on Thursdays. I'm also I have some exciting stuff coming in the very near future for me, like business-wise, so I'm starting in october. You can find me at denver bouldering club. I'll be um doing pt consults out of there, and then you can also find me through camp for human performance with tyler nelson. I'm a coach coach on his website great, and then.
Speaker 1:And then, what's your Instagram handle too?
Speaker 2:Yeah, so it is Dr Juliana. Underscore Mariki, and that's.
Speaker 1:DR.
Speaker 2:Yeah.
Speaker 1:Okay and I'll I'll link to these in the show notes and things like that as well Is is Instagram an okay way for people to reach out and contact you?
Speaker 2:Oh yeah.
Speaker 1:Yeah, awesome. And then any email or anything like that out and contact you. Oh, yeah, yeah, awesome.
Speaker 2:And then any email or anything like that. Um, sounds like Instagram is a good way to go.
Speaker 1:Yeah, yeah, instagram's, instagram's the way. Awesome. Well, if we were to. What I always do at the end of every episode is I wrap everything up into one little ounce of prevention. So, juliana, what is your ounce of prevention? So, juliana, what is your ounce of prevention that would help people mitigate their risk of injury to their pelvic floors?
Speaker 2:Yeah, learn how to relax your pelvic floor and then learn how to appropriately manage pressure by appropriately contracting your pelvic floor as well.
Speaker 1:Great. Thank you so much, and we'll definitely be in touch for some more episodes about the pelvic floor.
Speaker 2:Yes, thank you, nick, for having me. It's been great.
Speaker 1:I hope that you enjoyed this episode of the Art of Prevention podcast. If you did enjoy and or benefit from some of the information in this podcast, please be sure to like, subscribe and share this podcast, or please give us a five-star review on any platform that you find podcasts. One thing to note that this podcast is for education and entertainment purposes only. No doctor patient is formed and if you are having any difficulty, pain, discomfort, etc. With any of the movements or ideas described within this podcast, please seek the help of a qualified and board-certified medical professional, such as your medical doctor or a sports chiropractor, physical therapist, etc.