Pelvic Health & Training with Dr. Sara Black

In this episode, I’m joined by Dr. Sara Black, pelvic health expert and physiotherapist, to talk about a topic that impacts every woman but often goes undiscussed—pelvic health throughout the lifespan.

We dive into:

• How pelvic health changes throughout our lives
• The connection between pelvic floor function and core strength
• Common myths about training and pregnancy
• How athletes and everyday movers can support long-term pelvic health
• The role of strength training in injury prevention

Whether you’re an older athlete, new mum, pregnant, or simply want to understand your body better, this conversation will give you tools to integrate pelvic health into your approach to fitness and wellbeing.

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Transcript

Hi, I'm Celia Boothman, founder of LTR Coaching, and I'd like to welcome you to the Inspired Triathletes podcast, where I'll be bringing you stories from female triathletes and taking on topics that are important to women in the sport.

Hello and welcome to today's episode. Today we're chatting with Dr. Sarah Black. She's a former college swimmer who's turned her passion for movement into a career helping others. She's also a physical therapist who specialises in pelvic health, pregnancy, and postpartum care. I always think get that word wrong. Um, she's also the creator of the Triathlete Project, which is a bit of a passion side project for her where she helps swimmers, bikers, and runners to to train smarter and stronger. So, I'm really looking forward to diving in today. if you could just give me a little or give us a little bit of background into how you got into pelvic health, physical therapy, and you've got a really strong background in swimming and whether that had an any impact or influence in in that area. Yes. And and thanks again for having me and um just super excited to see where where the conversation takes us. But uh yes, I grew up swimming competitively. I started at the age of four on through uh college and no I think I think that had a huge impact on my um getting into physical therapy and and being really into uh just health and fitness um in general. So um growing up and and growing up in the world where we overtrained and we specialized too early in sport and that was definitely me. I was just a swimmer and I loved swimming and it was a huge part of my life. Um, but injuries, overuse injuries came along with that. So, um, being in in physical therapy and having a personal trainer very early on to learn a little bit more about my body and, um, be able to continue the sport as long as I wanted to. That was that I I do think played a huge role in in getting into physical therapy. Um, but right out of school, I started as a personal trainer and a massage therapist. And so the natural route was was to get into physical therapy where I could combine both of those uh great skills. So, um, yeah, I've been a physical therapist for about nine years now and knew very early on that pelvic health was really what I wanted to focus on and specialise in. I think I'm I'm biased, but I I think that the majority of our injuries uh do extend from the core and if we don't have a very solid foundation and solid core, then um that is going to impact things up and down down the chain. So, I am the owner now of Zia Physiotherapy. I live just outside of Washington DC and do mobile visits for my patients. So I get to see them in their environments and to the for treatment and um really spend that one- on-one um focused time full hours with my patients. And um and that's from patients from new moms to triathletes to to active men and women. But really just helping them build strength and durability and confidence in their bodies with what they love to do. Yeah. So Okay. So when you see you said you like to see people in their environment, how does that impact like how you work with them? Is there you notice habits or patterns of behaviour or movement in those environments? Yes. So I I think very specifically to the prenatal postpartum stages. Um yes, the physical side of things. So how are we breastfeeding? How are we picking up kiddos, even toddlers, but newborns? Um how are you navigating your own stairs? But also, how are things going mentally and emotionally? Is do we have a lot of clutter and we're newly postpartum? Are we handling things well? do we have do we have support partner support and family support? Um so that's in that stage of life it's it's really powerful to see individuals um that way but then also when it comes to um their sport being able to see them in their in their training environment. So whether that's on their bike trainer on their treadmill uh in their gym space that's that's helpful too. So yeah, it's like in real life rather than being in a different room where you're performing in a in a way, aren't you, for someone else or being told to do stuff that you might not do at home. Yeah, that's interesting about the kind of like carrying and picking up children because I didn't give it much thought honestly. It's just like you're tired and you just do what you can to get through a lot of the time. So yeah. Okay. And there's also like that I I did go to someone who did somatics. Have you heard of somatics before? Like Yeah. So he did all that and he was saying well how do you how did you carry your children? Which hip was it? This hip. And I was like yeah like you know it's always on that side. So you kind of do you see a lot of that kind of favouring one side or that kind of imbalance? Does it translate into the pelvis like carrying a child on one side? 100%. Yeah, your your body definitely tells your story. Um and so that with respect to pelvic health and and your deep core that shows up um just as you mentioned. So um misalignment throughout the hips and the pelvis, but also ri flare on one side versus the other. are the generally the side that we tend to to carry on. Um being able to create kind of a shelf for kiddos, for heavier children, um can can really throw things out of alignment and out of balance, out of sync, and um can impact things from head to toe. So um definitely that that shows up a whole bunch in what I do. So yeah. And with that, so you mentioned flared ribs. Would that affect your breathing in some way as well? Absolutely. Yeah. So, so breathing um it it is just with respect to the pregnant woman, it is totally normal for ribs to expand and flare. We need to rate make room for baby. uh sometimes those ribs don't go back to baseline on their own and and so that at that point it's it's tapping into um very specific muscles to help I think of the core as a canister but to help the core canister kind of get back to balance and get back to neutral. Um but that that impact on breathing um will certainly have an impact on the pelvic floor and how that's functioning. They your breathing diaphragm and your pelvic floor work in parallel. So, okay. It's all connected. Yeah. Oh, wow. I didn't know that. Interesting cuz I've always I'm keen on like core strength and I think it is like you say, it's really important for stopping or helping to prevent injuries. And yeah, I you know, you see people don't always have that core strength on the bike. You need it quite a lot. And I don't know if people really understand how much it impacts on on everything really. It's not just being on the bike. It's like your daily life, isn't it? Right. Yeah. Yeah. Yeah. Go on. Just uh being on the bike, too, that your your pelvis is one of your main contact points. So, we're not stable supported throughout the whole core. that can have a huge impact on um on how you're functioning on the bike for sure. And so for pregnant women that those huge changes in posture, that's where and and we were talking about bike fittings. That's where we 100% need a bike fit postpartum if we're returning to sport. Um to to um maybe put a band-aid on on some things and try to support where we need a little bit more support while you're healing. Um but yeah, really making those adjustments on the bike can can have a is just essential. Yeah. Yeah, definitely. Yeah, because your body's like I don't think we appreciate because you don't you can't see all the changes, can you? I mean, there's an obvious change of a big bump, but you don't see everything that's going on internally and structurally with your body. And so we don't really know what's happening and you just assume everything's fine and and gone back to normal. So So when you're working with um people that are in that stage of life when they're in their kind of postpartum more pregnant, do you see people throughout that whole process? Can do you have contact with them or do you usually work with someone like before or or after? or is it during the whole or does it vary? It probably varies. It certainly varies. I think generally we're getting much much better with being proactive versus reactive. Okay. I in a perfect world, I'm seeing a woman who's considering getting pregnant, who is trying to conceive and in that fertile window. Um and so getting a baseline um because there's so much about diastasis, abdominal separation, um pelvic floor strength, and if we don't have that baseline pre-reg, it's really hard to say, okay, well, um maybe this was your normal before pregnancy and you're doing just fine. Um, but yes, I I do have a birth prep package. Um, kind of a prenatal postpartum package to help with anything that's going on during pregnancy, but then um really focusing care on what uh what mom's um uh birthing preferences are. Right? So if we are for a vaginal delivery, anything can happen, right? But if if that is the goal, then we need to work on uh different laboring positions and what it means to actually push and should we be pushing and how can back to breath, but how can your breath really help you in um in lengthening the pelvic floor and and and setting the pelvic floor up for success and to prevent um more significant tearing, prolapse, uh forceps, vacuum delivery, um as best. So, so yeah to long long answer right for short but um would my preference is to see pregnant women and and to see them um pretty quickly postpartum too within the first two to three weeks getting started. Yeah, that makes sense because like you say about the baseline, I mean there's quite often you get advice and it's just generic, isn't it? It's like, well, you should be doing this. And it's like, well, how do you know? Because you don't know what what that person was like. You don't necessarily know what that person was like before or or after. Exactly. So, you've got nothing to compare it to. So, that's great if you can do that individually for people. Yeah. Um, also how fit someone is, how much they have been exercising. Um, women are often told during pregnancy that they need to take it easy. That's still ice and no you can't run, no you can't um bike. Biking is a little bit different. We have to be careful for safety. But um yeah, helping a woman continue to do what she would like to do during pregnancy because movement is is truly key um in that stage and and um will set the stage for how someone's feeling postpartum. So yeah. So, how can if you are a triathlete, you're an active individual, how can you sort of support your pelvic health? Are there any sort of after just saying you're given generic advice, are there any generic or general advice that you can give to people who are in that stage of life? Sure. I think the biggest one is that kaggels aren't appropriate for everybody, right? doctors are very quick to say, "Oh, just let's get started with your K goals." Um, but I would argue more often than not that the pelvic floor really needs to work on being lengthened and um being strong in that lengthened state. Um, certainly if a vaginal delivery is the goal, we we need to make sure that we can lengthen the pelvic floor appropriately. Um and and so that's that advice is still out there. Just continue to kaggle. And that's just one piece to to the puzzle with the pelvic floor. Um just like your bicep needs to your arm needs to completely bend and completely straighten the the pelvic floor does does as well. Okay, that's interesting. Yeah. So for people that don't know, can you explain what cake is if anyone doesn't know? That is a a term that is thrown out there all too often with the pelvic floor. The kaggel is a voluntary muscle contraction of the pelvic floor. So, it's your squeeze and your lift. Um, if you're actively trying to contract the pelvic floor, um, which is important. It's important. I I think I like to think of the pelvic floor as an elevator. Um, okay. level, ground level, levels one through five. And just like other skeletal muscle, there are a whole bunch of differences between the pelvic floor muscles and and other skeletal muscle, um, biceps, hamstrings, quadriceps, but similar to those muscles, we need to be able to work through the full range. We need to be able to go all the way down to the basement and all the way up to level five um, without feeling restricted. Um, and there's a whole bunch of the factors that kind of play a role in u someone being able to to work through that range. Um, but all too often there's a whole bunch of other things going on in in that stage of life. And so we we tend to hold on to tension and become guarded and overactive in the pelvic floor. And um that needs to be addressed uh first before focusing just on cables. I I rarely prescribe those voluntary muscle contractions alone. Okay. So how do you lengthen the pelvic floor? How how do you do that? It certainly depends on uh on the the person. Um, back again back to that diaphragmatic breathing. Um, we're using the breath. We're using the breathing diaphragm to naturally get the pelvic floor muscles to lengthen with a with a good strong inhale and being to expand the ribs out like bucket handles to really get that good length down in the pelvic floor. So that's that is um a great place to start. Um sometimes the pelvic floor muscles develop tender points and knots um very similar to what we what we feel in the upper neck and and in other and um you could you could do a million breaths per day and and those pelvic floor muscles are not going to release and lengthen like you want them to. So, sometimes there's internal um digital releasing or there's there's um pelvic trigger wands on the market to to assist with that. But sometimes there's massage and myofascial releasing that needs to happen too. So, okay. Okay. That's interesting. Yeah. I'd never thought of that. Like I have heard of people being too tense in that area and I remember being taugh you know when I was younger hold your stomach in you know it's good to sort of tense like not tense your stomach but hold your stomach in or or something. um she doesn't she's not like that now, but it was something that people said and you kind of stand there all tense like that and it's probably I don't think that's good for you, is it? Like long term to be in that tense state and and you're that's you bring up a really uh really great point. As women, we tend to um draw in um for aesthetic reasons. M I I think we're getting much much better as a society with that and and being more accepting. But um drawing your stomach in if you have any kind of bloating um or to appear more skinny um that plays a huge role in how your pelvic floor muscles are functioning and tends to tends to contribute to overactivity of that pelvic floor. So, wearing tight-waisted, high-waisted skirts and um leggings can have an impact on that core canister as well, what we were talking about. So, okay. Um if so, leakage, urinary leakage, bladder leakage is a very popular pelvic health concern. Um one in three women experience some sort of pelvic floor dysfunction and that's that makes up a good bulk of it. And generally we're thinking, "Oh, well, my pelvic floor muscles are too weak, have that good squeeze, and that's why I am leaking because I can't uh I can't hold in my urine." Um, but sometimes the the pelvic floor muscles are too tense, and so they're having a hard time uh getting down to that basement level and accepting a change in pressure in the bladder with coughing, sneezing, laughing, and um It it can it's very yeah I have heard that before that it's it can be due to tension rather than you know not having this the strength or the tension in the muscles. So how would you know like which way it was? Would you be able to tell or I guess generally not easily. It's it's hard for us first off because we're not really taught about our pelvic floor. um as we're growing up um it's in an a somewhat invisible location. So um that and then there we're talking about teenytiny muscles. So we have a hard time sensing what what they're doing and and when they're doing it. Um, so it it can be super hard to tell um on your own, but that that would be a a main reason for getting in with a pelvic health specialist, physical therapist to determine what's going on with your pelvic floor and what the main driver is for your symptoms. But yeah, you wouldn't know yourself because yeah, you have no idea. I suppose you could make a guess as to whether you were you tended to tense up or you didn't, but it's going to be a bit of a Yeah. And and I think some other symptoms tend to show up. That would be your first cue. Uh I have I have a really great questionnaire on my website to kind of check off yes or no. And if you mark three or more, then then we most likely have some pelvic floor dysfunction. But that can that can stem from um bladder urgency, frequency, feeling like you have to if you get the urge to go, you really have to go. You feel like you're not take it. Um constipation, um pain with intimacy, pain with use of feminine products that those are all um good indicators that we might have some overactivity in the pelvic floor. Okay. Okay. Low back pain. Low back pain is a big one. How many of us have ever had low back pain? Um, and that's that's a good majority of the population, but 95% of folks with low back pain have pelvic floor dysfunction of some kind. Oh, right. Yeah. That's interesting. Yeah. Yeah. Yeah. Oh, lucky I haven't had that. Good. Yeah. Yeah. It's in my upper back like like across the mid part that my uh mine tends to go when it goes, not the lower back. Although it did happen once. Oh, it's horrible. So bad. Lower back pain. It's like you can't forget about it, can you? No, it's it's debilitating. And and there there are a whole bunch of people that um gosh, percentage wise, I think it's uh upwards of 70%. Wow. Uh of adults have experienced some low back pain in in their lifetime. And it's that's huge. That's that's a lot. It's a lot. Yeah. It is when it's like I know my mother-in-law has a low back and it's like all the time and she just can't sort of say still because it's so uncomfortable. Um Yeah. It's not nice. Yeah. But it can be fixed by the sound of it with some That's right. care and attention. Yeah, certainly starting with the deep core muscles that we're talking about. And um you know, we've already mentioned the breathing diaphragm and the pelvic floor muscles. You also have your deep abdominal muscles, the transverse abdominis, and teenytiny muscles lining your spine, the multifidi. All of those muscles make up the canister, so to speak. It's the best way to kind of describe that. Um, throughout your midsection, and they are meant to prepare the body for movement, we're we don't um if things are functioning well, that's on a subconscious happening on a subconscious level. Um and and that again to prepare us so that our large glute muscles and quad thigh muscles, hamstring uh muscles can propel us and actually take us through the movements that we love to do like like triathlon. So yeah. Yeah, definitely. So when people are returning so obviously like your abdominal muscles when you're pregnant it's quite difficult to like look after or work those abdominal muscles and everything's kind of stretching isn't it? So have you got any tips for people returning to running and biking and swimming after they've had a baby when that's happened? And can they maintain some level of core strength throughout pregnancy? How easy is that to do? Yeah. So, so as far as focusing on the core during pregnancy, kind of starting there. That's that is essential for how you're going to feel postpartum. and okay, again, I'm biased, but meeting with a pelvic health specialist to get your baseline um and to really sort out what how the new posture, new changes in your body are are having an impact on how you're how you're moving and how you're functioning. um big key things postpartum. Um certainly getting in with somebody that can help you tap back into your muscles that have been lengthened for several months. Um and the heavy hitters are the the abdominals that have to lengthen, have to separate to make room for baby. That's totally normal. And the pelvic floor that just takes on that extra pressure and load. Um, we have to be mindful and respectful of healing times. You cannot rush that when when returning to sport and returning to activity. Um, spec more specific to running. I'm I'm generally waiting a good three months until I recommend returning to running just because of the healing times. So at 6 to nine months postpartum, we're only 67% healed throughout the fascia, the the tissue that connects everything together, muscles, tendons, um our connective tissue has not healed yet. And then tacking on top of that, breastfeeding and these new postures holding kiddo constantly um creates muscle other muscle imbalances. Um not to mention ones that have lost their muscle mass and function because you were pregnant because of growing chest and growing stomach. All of that all of that should be assessed and and uh focused on postpartum to get you back to sport. Um and your your body's going to be different. It's it is you have a new baseline and and that goes into new bike fit, um running gate analysis, swimming analysis, uh specific to triathlon, but checking in on how your body is moving, making sure that you have a personalized progressive strengthening program to get you back to those things safely. And so would you say like strength training is probably more of a priority than getting back into your sport? Yes. And um definitely I I think for triathletes in general physiologically we we need it. Um my I look at strength training for us as non-negotiable. Um and and that's at every stage of life because so much load with swim, bike and run on on our tissues on muscles, tendons, ligaments and um we have to be durable. So durable us more miles and more time on feet. It's it's having that tissue capacity matched to to the demands that we're placing on it with training. Um, and then that's more important if you're postpartum because of the healing, because of the tissue healing. So, yeah, that's I I am big on strength training. That's a big part of my work is um is offering personalized strength training for individuals that um want to be active and that, you know, that's that's all sorts of sports. Um, yeah, definitely. And it's like a founda. It's you're building a foundation again really, aren't you? When you've had a baby. So use making sure everything kind of moves the right way, I suppose, before you go back into those intense sessions. I was terrible at that, I will say. I didn't know. Right. It's because it's hard. It's It's hard. Um especially when you're feeling pretty good. You're like, "Okay, I can I can go do this. I I think my body is ready. Um, and you want to get moving because that's a big part of you and and your uh your life, right? Just to get back into it. But, um, this whole concept of being able to bounce back quickly, it's just physiologically not not possible. Um, though some some individuals make it seem that way. Um, we have the full picture. we don't really know what's going on and maybe it's not showing up after your first kiddo but maybe it does catch up with you second delivery, third delivery and and so on. So I think it's a lot better now. there's a lot more people sort of saying don't rush back into things whereas I was just like there was more of a a sort of atmosphere of come on bounce back and it was praised at how great and it still happens now I'm not saying it doesn't happen but it's a bit less like that now and people are a bit more honest about what they're doing and how they're doing it I follow a few people that have just had babies um And it's interesting to see how they describing it. You know, they're sort of talking about what how they've tried to get back and it's been frustrating and then they've backed off. You know, it's like it's a bit of finding out where you are and and what you can do and then you can't just race back into things and and expect to be okay. Although some people will be, right? and and you know that's I think there's other reasons for that. Um but no, I think as a society and as women we are much more um oh what's we're we're just much more supportive of each other and and yes that information is out there. that pel the whole world of pelvic health has has totally shifted for the better and um women are more educated and they do know more about pelvic health and the fact that that doesn't just mean that we're going to focus on the pelvic floor muscles. It means we're know we're going to get you back to what you want to do and what you love to do chasing these kiddos around but also being back in your sport. So, and I think a lot of the time you see people online or whatever and they're they're maybe an elite athlete. They've got a load of support, but I know the people that I follow, they're actually talking about the support that they're getting. So, it's like most people don't have that level of of support with, you know, child care and them being able to invest time in getting back to how they were before, you know, because it does take time. It's not like you just switch instantly. And if you haven't got the hours in the day, then it's it makes it harder and it takes longer. So yeah, that your your support system is um is huge. And uh yeah, that's very valid point. Yeah. Yeah. And not even to mention hormones and and that whole side of things, but um that's having an impact on on your recovery and tissue healing as well. So, and then cesareian section. So, now we have how's that affecting your trunk mobility? Um, and being able to run and bike and swim. So, yeah. Yeah. I had a C-section the first time and it was like, yeah, different totally different experience to to vaginal birth. So, yeah, I can had both and I can definitely say it's different.

So I think it's it's long it did take me well I could feel you know I'd had abdominal surgery basically and it's pretty pretty extreme abdominal surgery isn't it you know you don't think it's much but it is quite a lot right and uh you're exactly right it's it is it is deep um it's a deep incision right all the way to the uterus to to get kiddo um and that is impacting all of the layers of tissue. So, um, certainly all of the the abdominal muscles, um, and then we've got scar tissue, everything's connected, right? So, we hip flexors in that area. We've got the bladder, we've got the GI system, um, and and that scar tissue. um the the collagen reorganization of that scar really needs to be um respected and needs to needs to be addressed um in a personalized manner as as you go through recover. Yeah, I could feel it for a long time. Like where the scar was, it was like quite, you know, that lasted for I don't know how long. I can't remember now, but it was it was quite a long time. And every now and again, you'd feel it and be like, "Okay." Yeah. And aside from um delivering kiddos, um just abdominal surgeries in general and um recognizing that appendecttomies and tucks, abdominastes um these are huge. they're having a huge impact on on your uh core and and how that's so um yeah scar scar tissue is a big one that can stay with you for for a while and yeah yeah definitely yeah it's yeah I'm pretty sure it's still like some well there scar tissue doesn't it ever like completely go away doesn't it for a surgery that big Um, not necessarily, right? But every body is different. Your genet genetic makeup is is different and how your tissue is going to respond. Um, the best thing for scar tissue is movement. So, not rest by any means, but um, we just do the best that you can, but sometimes that scar tissue works against you a little bit. So, yeah, like pulling and tightness in that area. Yeah. And it's not so much getting rid of the scar tissue, it's just making sure that that scar tissue can move in every which direction. Every direction that you um we're talking about the abdomen specifically, but every direction moving that scar tissue needs to go with it. Yeah. Okay. Okay. Yeah, that's good to know. And so moving but gently, not like out and running a marathon or something like that straight after, but like walking and things like that would be suitable. Oh yeah. Yeah. And that's um that's one main reason behind as long as you are healing well and you're you're able um walking every single day, short walks, but yes, get get out in the sun, get outside, um get your walk, get some movement, that's that is a big one. Um as soon as you feel like you are able to do that. Yeah, definitely. How about like pushing because a lot of people have got pram that they have to push. Um, how's that for recovery? Strollers. Yeah. Uh, yeah. Well, um, you definitely want some support early on, but, um, that's not always an option. Um so that that is the idea behind getting into u exercise personalized exercise within by two to three weeks postpartum. Once eating is calming down a little bit and and you feel like you can manage some exercise and some load, we need to load appropriately to be able to to tolerate pushing a stroller because pushing a stroller is is just a a constant front plank if you think about it. Yeah. So, not being afraid to or hesitant to do those movements, but making sure that you're doing them safely and and again, that's that's a big part of my work is um just making sure we're meeting your body where it's at, allowing it to heal appropriately, but part of that healing is going ahead and loading that tissue to to promote the healing. So, yeah. Yeah. cuz I know it is like with a C-section is really difficult because you kind of like it's frustrating and you want to go out and I remember trying to push the pram and it was like I think it was a week after we went into a really busy uh town and I was like oh it's it was really hard cuz there's people everywhere and then you've got you know trying to put it up the curb. I mean my mom was with me so she helped me as well but it was like this is intense. This is like you know quite you know just pushing that thing and avoiding people cuz you do you don't realize how much you're using your abdominals in so so many like little situations just sort of like tweaking here and there when you're moving things and it's kind of traumatic. It is right and that's um the great thing about our bodies is that your body will tell you. Yeah. And as long as we are good about listening to it and um again that support system is is huge uh in that stage. But yeah, as long as we're listening to the body um and progressing um in a meaningful way then then we we tend to end up okay. Yeah. Okay. Yeah. Well, I'm okay. So, I must have been all right. Must have done something right. Um Okay. So, I think we've covered a lot on on pregnancy and postpartum. So, what are some issues that can happen as we get older um with our pelvic health or just generally for triathletes?

Yeah. So kind of moving into that next stage would be pmenopause and menopause uh and starting in our mid30s sarcopenia. So that age related muscle mass loss starts starts to happen. That's um it's don't want to think about it being that early as well. It's like oh my god. Yeah. your 30s and it's like okay now our body's working against us a little bit and okay goes back to the strength training. Um my my recommendation especially for triathletes where we tend to to skip the strength training training um we've got to have two to three times a week of total body strengthening 30 to 45 minutes heavy heavy repetitions working our way up to heavy uh three to five sets of three to six repetitions to to try to combat that. Um, and that is super important. The earlier you start, the the more likely you are to to be consistent and to stick with it. Um, and and so that's yeah, that's just super important in that stage. Um and it's it's also a time where we are are generally masking symptoms by birth control synthetic h and it's just a tricky stage of life. So um that plays a role in and everything. Um and you know I have I have opinions about that. I think there's there's other ways to go about that and there's there's preferred birth control options over others um for that reason, but that's where our supplements come into play as far as managing symptoms and and um and yeah, it's that's I think the biggest thing with respect to physical therapy is is the strength training and making safely. Um, but there's a whole bunch of other factors and and making sure that you feel like you have a good support team, um, someone that can help you with functional nutrition, the strength training side of things, mental health if that's if, um, if that's necessary, and having your your team, your support team through Yeah, it's gets it is a tricky time um, with so much going on. There's just a lot, isn't there? And I think I I'm assuming you kind of mean about birth control like contraceptive pill like artificial hormones is is not ideal. Um, like for me anyway personally, I have a very similar opinion because I I went off them like quite early because I thought I don't like the idea that this is that I'm having artificial hormones in my body and I don't really know the impact it's having on me. Re, you know, if you're starting if you're having them and you've you've been taking them for so long then it is like you say masking things and you don't really know what's going on underneath. So I came off them quite early and and did other stuff. But yeah, did other stuff. That sounds a bit weird. It's like what what were you doing? More holistic. Yeah. I just didn't want to be on hormones. Yeah. And and I think if we and that starts with women in their 20s. Um if we're having debilitating period pain for instance, that's a reason um folks go on on birth control or um the the big question is why? And and yes um the birth control form of contraception is going to um is going to be very effective in that. But um we're not meant to have debilitating pain. um cramps and and um a response to the inflammatory process. Okay. But um it it does it starts in adolescence and in in uh your 20s and you know are we masking something that maybe should have been diagnosed a long time ago and are you paying in your late 30s and 40s um things and and what I'm speaking to is um things like endometriosis. Yeah. Things that that will continue to get worse over time. Um so yeah but but um synthetic hormones and and what that will do to our tissue health and um yeah just the body as you mentioned it's just um what's that doing to our body and um is that the the right move and and sometimes it is um but sometimes it's not. Yeah. I mean everything's got a payoff and and disadvantage hasn't it? So you've got to weigh up like is the payoff worth the whatever the negative effects are. You know anything that you take or do or just literally everything has you've got to weigh up those things with your decisions. So you know like you say for some people that is going to help them totally and other people it's not and it's there's other ways that you can manage whatever it is you're trying to manage. So yeah. My big frustration with that is we we aren't able to make informed decisions when we don't know what our other options are. Yeah. Exactly. All that we're being offered or um very common in in in the 40s range that we're talking about uterine ablations. Um you know what what's um what are our other options? What's what's going on here? what you know that that's um that's that's a big part of this per menopause menopausal state. So, so yeah, that's that's a big one. I will I treat women often in this stage of life that have never had children and are now experiencing pain with intercourse, um urgency, frequency, and goes back to, okay, what um is this because of an estrogen um concern, lack of estrogen? Um do we need a little bit of support there? Um, have we been overworking our pelvic floor muscles in our sport for years now? So, sometimes 15, 20 years at this point. And is that catching up to us? And so, yes, that that's another popular group of of women that I I tend to see is okay, now some things are catching up to us and need to be addressed. Yeah, it is like that that you kind of think like you could get away with not doing the strength training but you can't now. You could get away with doing all sorts of stuff and it's like no and I think being prepared for that like you said you know we know that from the age of like mid30s we start to lose muscle mass. If you can start like start early and and get in there and start being proactive about these things, then it doesn't it's not such a whack on the head sometimes. I think you can kind of manage things a little bit better if you're prepared and you're kind of thinking about the future a little bit more. It definitely helps. It's much easier to be proactive than than reactive. It's um it is by no means like it's it's never too late to start that. It's just harder. It's much harder if it hasn't been part of your life. Um and I think that's where youth sports are getting a little bit better. We we are getting to use strength training. We know that that's not having the impact on growth and growth plates like we once uh thought. Um and and so I think that will help. That's going to take a little bit of time to Yeah, it sort of has to filter through and with the next generation and things, doesn't it? I guess we've still got some old ideas out there, I think, that need to be kind of discounted or like adapted and evolved a little a little bit, right? Yes. So with if you're in parmenopause and menopause, you do analysis of of uh rung gate and bike fit. Would those kind of things change as well? Like does anything happen with your I I guess like with changing in muscle mass, things are going to shift and your body composition might shift or that could impact you. Absolutely. It it could very well um have an impact. So, um just age related changes in our joints. Uh especially if we've been doing a sport for many years. Uh are do we have a little bit less hip mobility that you can't stretch your way out of for instance? And then yes, we we'll need to make some changes on the bike. Um and and with your running and maybe shoe support, what what kinds of shoes are we wearing for that? So yeah, all all of that's um part of the longevity of sport, just um monitoring over time and and making sure we're we're um allowing you to perform at your peak, whatever that is and whatever age and stage you're going through. Um I so u just anecdotally right so part of the permenopausal concerns too for actually being able to perform in your sport it's um helping women manage um performing and racing during the ludial phase for instance when feeling absolutely crummy and nauseous and um low on energy uh I I just experienced that at Iron Man Wisconsin last weekend. Um Okay. Usually I've got I've just been lucky not having to race in that stage, but um just as a permenopausal woman, it's it's really starting to have an impact on on my performance. And I I can improve that to some extent with supplements um and and the functional nutrition side of things. Um, but that's that's a whole other, you know, aside from the strength training and whatnot, that's that's something else that we have to consider and and something else I can help with, too. So, yeah. So, like preparing and being okay with if it doesn't if it isn't all perfect and doesn't all go to plan because it does. Life's like that somehow, isn't it? Yeah. Yeah. How did it go? How did it go? Oh, um that was my first Iron Man. Oh, wow. Um I keep saying it was the hardest thing that I have ever done and it's it was um I I got into long-distance triathlon two years ago. Um I've been in the sport. I decided after my swimming career that um I might as well try triathlon. I've got one part down. Um, so been in the sport for a good 15 years. Um, but the long distance triathon I decided to to kind of go for that um, a couple years back. And so I've I've completed seven halfiron mans and I absolutely love that distance. I I like that you can still race that. Uh, the iron man was a little bit different. It's just survival mode. Um, I'm so happy that I did it. I just think that's a huge accomplishment for anybody that can can do that. Um, but it's hard. It's it'll be a while before I do the next one. Yeah, I remember lying on the floor going, I'm never doing that again. I said that. I definitely said that a couple of times. Um, but yeah, it's just so rewarding. It's like, wow, my can really do that. And that's incredible. That's just Yeah, it's a big accomplishment. So, yeah. And even though you were in that lutial phase, you still, you know, it it was it went okay. You were you thinking about that during the race? Normally, I started my period. It came early. Oh, no. I was but I was more excited about that because once once my once my period starts it things go much better. So it started a couple days before. So there's logistics to to manage with that. Yeah. Yeah. Yeah. But it's much much better than how I've been feeling in the ludal phase um lately. But yeah, I just was very consistent with my diet and uh and again supplements, iodine, magnesium. Um that that can be super helpful for those ludial phase symptoms, the yucky stuff that we get. So yeah, that sucks if you're going into a race as well because you want to be feeling really excited about it and you're just go really like not that's good taper and it's it's like okay is this the taper or is this Yeah. Yeah. And you don't always know the difference either I think with with those you know I every now and then I get a really weird mood and it's just like where has this come from? I don't understand it. And it just it'll last like 24 hours. I'll just be horrendous and then I'll be I'll manage to get myself out of it somehow. I don't know how, but it's it does come from nowhere and it's quite extreme. It's not a pleasant experience. But it doesn't happen that often though. So yeah. Yeah. This I've learned how to manage it now as well. I just go out for a long walk on my own and tell everyone else to leave me alone. I was listening to one of your episodes and 11 mile walk and I was better. Yeah, I know. Well, I had to do it the other day. It wasn't 11. I went and slept in the car. It was just like, oh my god, it was awful. And I Yeah, just I don't know. It's like I need to just switch off and I don't want anyone around me. And yeah, very weird. It's and and we're still generally like in go go go mode um and and really at the peak of our uh career too. It's it's a really tough time, but I think um helping women through it and recognizing that you will come out on the other side um better and more feeling more balanced and more centered and more confident in your body. Um you just have to get through some not so great things. And um that's you know a big part of why we need to to promote movement and just staying active and and that bringing joy. Yeah, for sure. Definitely. I think you know and that's I think also there's this the sort of mental aspect of it as well of like it's not you know you don't have to give up and and be but I don't I was talking about this the other day it's like you don't want to do that but you also don't have to be like this amazing super person that does it all either you know there needs to be some kind of balance because you can't try to be young forever you know it's just impossible possible and and why would you want to anyway to be honest? It's like I I wouldn't want to be young again. And there's a lot of wisdom that comes with age that that I think we don't acknowledge in our culture and we don't really respect as much as we could do. And I think if you can think to yourself, no, I've got that and and actually appreciate that about yourself rather than thinking, oh, I'm being old and you know, I some you have these kind of conversations in your head and it's like no, it's having wisdom and experience. It's not it's not necessarily a bad thing. Um, but yeah, it's difficult. Anyway, I've gone off on a tangent as I said I probably would. Oh, yeah. This is this is it. This is what I see day in and day out. Um it's this is life. This Yeah. So, yeah. Yeah. No, it's interesting sort of time of our lives for sure. So, if people want to get some help with you know what, tell us what you do because you do all sorts of things. Just run through what you do with people. Yes. So um I am primarily treating um again as we as we talked about through Zia physiootherapy that's my uh my practice and am a treating physical therapist um and so that's that's the bulk of what I do. I again offer the inhome visits but also um virtual consultations. There's there's certainly time times and place for that option. Um, but always checking in to see if this is something that we could do virtually, whether it's the personalized strength training, the uh running date analysis, swim analysis, um, sometimes bike fitting if if there's some glaring issues that that we can kind of go through. But, um, virtual consultations can be super helpful. It's I have had a lot of experience with that. I think it does take some practice. It's it's it can be tricky. Um but that's that is something that I offer and along with um in home visits if anyone's just outside of of DC in the Northern Virginia area. Yeah. Okay. And how do people get in touch with you if they want to find out more? They can go on to is Z physiootherapy the best place to get in touch? Yep. My website is ziazia physio.com and my Instagram I I do um social media isn't my forte for sure but I I try to post um my thoughts on everything that we've talked about today um through there. So that's uh Zeia physiootherapy and um those yeah those are the main ones. Um my the link to the triathlete project is on the Zia website. Um and that again as you mentioned is is more so my passion project trying to isolate specific injuries and specific concerns that triathletes face whether it's swim, bike or run. Um I have some videos in there with some exercises to get you started so you don't feel like you're lost with with uh those injuries. Okay, that sounds really helpful. So, I'll put all those links in the in the notes below so people can check them out. Um, but thank you so much for your time. It's been really great chatting with you and uh yeah, what's next for you triathlon wise? Have you got anything else coming up or um I I did at in Wisconsin I did make it to Kona. So, Oh, wow. Well done. Um I feel like that's a once in a-lifetime opportunity. So, I'm I'm going to do one more full Iron Man, but yeah, we'll take a little bit of um an active break here and and then get back into things next season with half iron man's hopefully just continue to grow in the sport because I'm still a little bit new to everything. Long distance. Yeah, it's like it's different, isn't it? Different thing. And I think from half iron to full iron is a very big change, you know, it seems like it's a big difference. Yes. Yeah. Um it's it's more so about the fuel. So I think I've got some some things to learn and practice, but um yeah, that's that's it. I just I love the sport and and as long as it makes me happy, I love the training, you know, as long as that's the case, we'll we'll keep it up. Yeah. Well, that's awesome. Oh, well, congratulations. You love Kona. Okay. Well, thank you very much and uh yeah, you have a nice rest of your day. Same to you. Take care. Thanks for listening today. Have a great day. Take care. Bye for now.