Reflex-Driven Strategies for Pressure, Posture & Pelvic Function with Dr. Susan Clinton

In this episode, Laura Rowan sits down with renowned physical therapist and educator Dr. Susan Clinton to discuss her upcoming course on Reflex-Driven Strategies for Pressure, Posture, and Pelvic Function. Together, they explore how the nervous system, cervical spine, diaphragm, vestibular system, ocular reflexes, and pelvic floor are deeply interconnected—and why treating pelvic health in isolation may be missing the bigger picture.

Dr. Clinton shares how chronic pain, urgency, dizziness, posture changes, and pelvic floor dysfunction can all be tied to reflexive nervous system patterns rooted in safety, orientation, and survival. This conversation dives into how practitioners can move beyond symptom-focused treatment and begin working with the body as a coordinated, integrated system.

They also discuss real-life client scenarios, nervous system regulation, ocular fixation, anticipatory bracing, and how improving safety and variability in the body can unlock faster, more meaningful healing outcomes. This episode is packed with clinical insights for pelvic health therapists, rehab professionals, fitness providers, and anyone interested in the deeper connections between the nervous system and pelvic function. 🔥

🔑 Topics Covered

✨ The connection between the cervical spine, diaphragm, glottis, and pelvic floor
 ✨ Why pelvic floor dysfunction is often a “downstream” issue
 ✨ Reflex-driven approaches to pelvic health and nervous system regulation
 ✨ The role of vestibular, ocular, and cervical systems in coordination and recovery
 ✨ How chronic stress and hypervigilance impact pelvic floor function
 ✨ Ocular fixation, dizziness, and “Dizzy Mommy Syndrome” postpartum
 ✨ Understanding pressure management and anticipatory bracing
 ✨ Why safety and orientation come before strengthening
 ✨ Integrating reflexes and nervous system strategies into pelvic rehab
 ✨ Real client case studies involving postpartum pressure, urgency, and dizziness
 ✨ How practitioners can use simple drills for rapid system changes
 ✨ Moving beyond isolated treatment toward whole-system coordination

📚 Learn More

🔗 Reflex-Driven Strategies for Pressure, Posture & Pelvic Function course
 🔗 Nervous system regulation and pelvic health
 🔗 Vestibular, ocular, and cervical reflex integration
 🔗 Pressure management and diaphragm-pelvic floor coordination
 🔗 Clinical leadership and burnout prevention for practitioners
 🔗 Pelvic rehab approaches for chronic pain, urgency, and instability

🎓 Course Details Mentioned in This Episode
📍 Hosted at Essential Pelvic Health Headquarters
📅 June 20–21
🎟️ Limited seats available for an intimate, hands-on learning experience
💸 A 15% discount is automatically applied at checkout — no code needed!

👉 Register here:
https://lti-physio.kit.com/products/albany-cs-course-2?promo=EPH15 

Transcript

SPEAKER_01 0:02

Welcome to the Essential Pelvic Health Podcast, where we break the silence on the topics that matter most to your well-being. This podcast is for all gender diversities, for individuals looking to better understand their bodies, and for medical and wellness professionals looking to better support their clients. I'm your host, Laura Rowan, proud pelvic health occupational therapist, helping clients and clinicians live their best lives through pelvic rehabilitation, education, and advocacy. Join us as we explore the ins and outs of bladder, bowel, and sexual health. No topic is too taboo. We'll also dive into the role of hormones, the nervous system, and of course the pelvic floor to empower you to self-advocate for the care you deserve. Together, let's unlock the secrets to a vibrant life so you can keep doing what you love and feel good doing it. Welcome, Dr. Susan Clinton. My name is Laura Rowan. For those of you who don't know me, I'm a pelvic health occupational therapist, and Dr. Susan Clinton is here with us to talk about her course that she's going to be hosting, or I'm going to be hosting here at the EPH headquarters this coming June. Um, June 20th and 21st. We're going to be talking about reflex-driven strategies for pressure, posture, and pelvic function. Love it. And it's basically from the cervical spine to the diaphragm and pelvic floor. So welcome, Dr. Susan Clinton.

SPEAKER_00 1:31

Thank you. I'm excited to be here and to uh talk about the course.

SPEAKER_01 1:37

Yeah, I'm I'm excited. This kind of happened organically because I saw the course come up and I I'm all about the nervous system these days. And I was bummed when I saw that course come out and I couldn't make it. And uh, and you were like, would you like to host? And I was like, absolutely. So I'm very excited to be able to take this next level. Um, because the way you explained it, that's what really intrigued me was it was kind of beyond the vagus nerve, beyond kind of all the stuff that we've been hashing out and really getting into reflexes. And I've been I've been getting really into um kind of those retained reflexes. So I'm interested just even in this conversation to learn a little bit more about what that even means um and how that applies to our practice. Sounds good. Yeah, yeah. Let me give you um, let me give the audience a little um background on uh who you are if they don't happen to know. So um there's a whole bunch of letters after her name. Um uh Susan is an award-winning physical therapist and founder of LTI Physio in Sault Ste. Marie, Michigan. She's got over 40 years of clinical experience. She's board certified in both orthopedic and women's health physical therapy and is a fellow of the American Academy of Orthopedic Manual Physical Therapists. So that's a pretty big deal. And Dr. Susan Clinton is an international instructor, mentor, and coach specializing in pelvic health, orthopedic manual therapy, and clinical leadership development. So um we actually were just, I was listening to you on the birth healing summit with uh Shulte, and uh I went through your um saboteur work so that was very helpful. Um, so really, you know, I love how you're diving into this um kind of inner work, um, being able to really be able to um, you know, for entrepreneurs be able to come into their own, be able to advance, enjoy your career and profession, and and be able to to navigate that, especially as we kind of mature and advance through different, you know, hormonal stages of our lives too.

SPEAKER_00 3:55

100%. And I think my passion is for all of us that are doing this work. I want people to have fun and be happy and enjoy it because it's needed. And I really don't like people working themselves to death or working too hard or getting burned out, which hints this course. It's another way of us coming together and working through systems with our clients that could be aha moments, that could have almost immediate impact on client performance and opens up the space for everybody to do a little exploration, innovation, and have a little bit more of a um handle into the entire system versus just one region or one part of the body. Yeah.

SPEAKER_01 4:45

And uh so I even just often I have clients say, I know this isn't your area, or I feel like I'm taking you away from what your expertise is when we get into the neck or anywhere away from the pelvic floor. Um, and it's just a great opportunity to explain to them how it's all interconnected. Um, so for practitioners who potentially are treating the neck and the core and the pelvic floor as separate problems, um, what are they missing when they do that?

SPEAKER_00 5:16

So that's a great question. And one of the things that I think we we know and we understand as practitioners and clinicians that the body itself is is organized into systems. You know, we know the musculoskeletal system, we know the endocrine system, we know that, you know, we have all of these systems, but I think we forget and we look at these systems and we look at things in system, but sometimes we forget the connection of all of the systems together. It gets to be a little bit overwhelming. And so one of the things that I like to think about is that what if our systems organize themselves around survival orientation, pressure management, and safety when it comes to like considering the whole entire pelvic health system? And then that begins to bring in the possibilities of you know, speaking and the glottis and how we, you know, um organize ourselves in that way? How do we handle balance issues and problems? What happens when balance gets pulled off? What happens when we have a system that's upregulated all the time? And how does that affect not just the pelvis or pelvic health, but what about the rest of the body and how those two and those three things can play into each other? So the cervical spine, the diaphragm, how the abdominal wall behaves, the vestibular system, the glottis, our larynx and pharynx, the pelvic floor, they're all constantly communicating through that system you just talked about, the neurological system. It's also included the autonomic nervous system beyond just the vagal nerve, right? There's an entire trigeminal alarm system that occurs in the upper cervical and through the cranial system, which is our immediate response system. When we get triggered, that's something it has to be attended to, or we need to be safe, or we need to figure out if we're going to run from the tiger or if we're gonna turn and fight. Um, that's our first, you know, warning and alert system. When we have people who are in chronic situations, and this could be as much as like pelvic pain, back pain, neck pain, migraines, or it could be something as simple as urinary urgency and incontinence. The system tends to be upticked through that, and so if it's upticked through the pelvic floor, so we all know that oftentimes with urinary urgency, the pelvic floor tends to be less less coordinated, a little bit more rigid, um, you know, always on. But there's other parts of the body that are on too. There's that system like, oh, I gotta go to the bathroom and what if I can't find one? So that pulls all of that nervous system into a lot of these different areas that we really can consider because sometimes we do a lot of work to get the pelvic floor to like calm down or to be more coordinated. But the minute that the bladder swells or fills up to a certain point, it all starts all over again. What if we were able to be more complete and take a look at this system, not just from the feet and the pelvis, but all the way up into the cervical spine, into the throat and the glottis, and into the trigeminal system, to be able to, so we all, you know, to be able to help generate and change that system beyond the uh little um dialogue we give people to do. So when they get the urgency, count backwards from 20, slow down, take a breath. All of those things work, but what if we really could come in with a handle on that system and find out are they holding their breath when that happens? What are their eyes doing? Oftentimes when we're hijacked or upregulated, our gaze gets fixed. And when we have a fixed gaze, we don't have a lot of variability in our movement system because everything starts to be held still. The head comes down into a little bit more of a forward position. The vestibular system gets retrained to be there all the time, so it loses its variability and ability to kind of stand on one foot or lean over, because a lot of people will talk about, oh, I'm okay until something hits me and then I leak. Or I'm okay until I get upset and then I really feel like I have to go to the bathroom. And so really being able to work into all parts of that system can make the entire system much more dynamic. So it's like uh additional access points. Yeah, yeah, additional access points, actually, you know, and that maybe the pelvic health expression is a downstream of what's going on because we know there's a certain population that is going to have, you know, uh urinary incontinence or urinary urgency. It can start as young as, you know, three or four years old. It can, you know, it happens throughout the lifespan and it doesn't have to mean the traditional things such as postpartum or perimenopause, right? Or some sort of accident or injury, you know, birth injury to the pelvis. But oftentimes it can be there for a long time. And as we age, of course, and we lose a lot of that variability through our system, oftentimes these present as bigger and more challenging problems.

SPEAKER_01 10:45

Yeah, like they they didn't quite resolve, but they just weren't present until they're now highlighted.

unknown 10:51

Right.

SPEAKER_00 10:52

And if you think about, yeah, and if you think about the pelvic and the pelvic system and the core and the muscles and all of that part from the diaphragm down to the pelvis, you know, all of that still needs to do things such as have nice coordination, have rotation, have the ability to shift side to side to do all of these things. And when we have the system upregulate all the way up into like the cervical features that we were just talking about, and then the the cranial features with the vestibular and the ocular uh system, when that system gets held rigid, it really affects the way we can coordinate the rest of our muscles. So if we could get that system moving better while we're working with the pelvic system, the payoff is so much better because now we're working really in things that are relevant for our clients because they're gonna tell you that I don't have urgency when I'm sitting in a chair. I have urgency when I'm you know at the grocery store.

SPEAKER_01 11:52

Unless, you know, unless they're at work and there's something that triggers them in their chair.

SPEAKER_00 11:57

Exactly, exactly. But you know, those types of things, but it helps, you know, take them into situations of where, like, well, let's just get the pelvic floor working first and then we'll do all these other things. And oftentimes we can really get our clients much more involved in doing some activities through by using all of these systems versus just isolating to one system and hoping that gets a little bit better and then layering things on. It's kind of almost like unwinding it a little bit and let's work on two or three things within the system and get that coordination going from the very get-go versus trying to just isolate and then build. Okay.

SPEAKER_01 12:34

Uh, can you tell us like uh maybe a case scenario, like a client case, um, with that continuum from the glottis to the pelvic floor, like walk us through a scenario?

SPEAKER_00 12:45

Sure, sure. Absolutely. So when we're thinking about um looking at a client, let's talk about maybe a postpartum client who comes in with pelvic pressure, some constipation, upper abdominal gripping, neck tightness, dizziness with head turns, and a feeling that she can't relax her core, she feels, you know, she just has all this pressure. Um traditionally, perhaps maybe in some practices, we may divide between the pelvic floor, the GI, the breathing exercises, you know, maybe think about dizziness a little bit and what's going on there, and maybe some cervical treatment. But if we're going to look at this through a much more integrative lens, um, we want to start to see more of a coordinated strategy. So when we take a look at, and we do this in the course with the evaluation part, like what's the glottal tension like? And generally in clients like this, it's elevated, just like the pelvic floor would be slightly elevated and on. They generally, what does their breathing look like? It's generally shallow. And when I say upper chest, I mean like the accessory muscles, not the nice pump handle that the chest should do. You know, uh oftentimes a forward head posture, there's some fixation of the ocular, especially with vestibular dizziness. And postpartum is a, you know, a lot of times people have what we call dizzy mommy syndrome. And we don't really know how that comes on, but we do know it's a thing. And if you're not real sure how to like think about this, if you're just listening to the let you know, to the interview here, just think about asking them a couple of questions. When was the last time you stopped riding rides? And if you're driving with friends in the car, where do you sit? And most of the time it's either the front seat or I drive so that they can stay because they can't handle the the changing of the motions because of the ocular fixation. Um I definitely can't do rides anymore.

SPEAKER_01 14:48

Or even spin my kids like a couple spins. I'm like, okay.

SPEAKER_00 14:52

And you know what? We can work with that. Okay, we can help that uh for sure. You know, um, abdominal wall bracing, reduced pelvic floor excursion. So we might, you know, we're not gonna start with strengthening with this. I think everybody understands that, you know, we want a coordinated system before we start strengthening. Um, but we may even need to think even one step back besides coordination, which is orientation and safety. And if they've got an ocular fixation, we can change the entire system by helping them get comfortable and work with visual tracking and visual excursion. When we can get people to, you know, so I might sit somebody down first and you know, put the imaginary clock on the wall and have them do some like tracing back and forth with their eyes, you know, in a very easy horizontal line, and then maybe go to vertical, up and down, and not add in the rotational pieces until they could get that. Then they can move to standing and then they can move to standing on one leg. They can, you know, do it with their head movements. There's a lot of ways we can progress it, but sometimes, and you all can test this with your clients, you can just spend some time with them. I always have them have something to hold so that they're either, you know, it's over here and they're looking back and forth, or they're holding two, you know, pencils out in front of them, so they're looking side to side, or I'll hold them in the beginning. But test them, check them. How does can they coordinate their pelvic floor? What does it look like? What's happening there? What about their muscle abdominal tension? What about their you know, neck range of motion, and have them do this two or three sets for 10 seconds and retest and tell me if you don't see and they don't feel the difference. I'll challenge everybody to do that because it does make a huge difference. And we have, you know, there's a lot of reasons. So people are gonna always kind of say, well, what is the how does that work? And it's like, well, we have the, you know, we have the vestibular spinal system that runs along the, you know, the spinal system, uh, the motor system, and it has direct influence right at the level of the spinal cord to all of these. So we could have a very nice functioning smooth motor system, and all we have to do is have that vestibular ocular system get hijacked for whatever reason, maybe a bump on the head, maybe um because they're afraid, because there's something going on, they're worried about like sneezing and leaking, so they're on alert all the time. And that comes into that system and it actually stalls it, it slows it down, it makes it more clunky, the motor system. This is where we lose our coordination. So we can gain coordination back quicker and easier by adding this system in. And we can also do this, it's very nice to do over getting people to really understand what it means to come down. Our system regulates itself, and so does the vestibular system by the threat. And so we can get up here very easily, like our threat a meter is there and we can get there, but our brain is so efficient that it's gonna say, you know, we've been up here the last few times, and we keep having to come up here. So this time when we come down, we're only coming halfway because we know that we're gonna be back up here, and so they lose that ability to come all the way down. And by working with both of those systems, the nervous system and all the things we know, but adding these reflexible systems, these reflex of systems into it, can actually improve the efficiency and proficiency of the entire system. Great, free them up so everything else can do their job.

SPEAKER_01 18:41

Yep. Okay. What does it mean for pelvic floor to brace instead of breathe?

SPEAKER_00 18:49

So um that's a good that's a that's a question we talk about all the time, isn't it? So we do know and we do have some evidence, which is very interesting. Um uh Kohler did one, uh, a study looking at the excursion of the diaphragm along with chronic low back pain people and regular and people who didn't have any a history of chronic low back pain. And they did it under a functional MRI and they did a couple of different things. They only did it laying down. I wish they would have taken this study into standing up, but we have what we have. And what they noticed with chronic low back pain compared to their controls, the diaphragm was in a different position. Just before we even asked the body to do anything, it had a decreased motion to it. You know, the tidal breathing, the, you know, that just kind of goes on, that quiet in the background breathing was had less excursion than the controls. And the diaphragm was in a position to where the cross was actually kind of lifted and pulled back towards the spine. So the diaphragm itself had kind of this steep curve in this chronic, in the in a chronic contracted position, which in the vestibular world we call it in SPR. And the musculoskeletal word, it's kind of like inspiration. They're kind of stuck down in that inspiration, they can't let go, which makes a lot of sense with pain. We don't have long exhales, so we're not getting that good vagal nerve stimulation and calming down. Well, they took that knowledge and they put that together in a couple of other studies with ultrasound and the pelvic floor, and they looked at the same thing with chronic low back pain, and they found not only did the diaphragm have a change in position, but so did the pelvic floor. And the pelvic floor had less excursion, like the diaphragm, and then when we put it under pressure, it had even less, both diaphragm and pelvic floor. So when we talk about that, we talk about they kind of like mirror image each other. So if the diaphragm is going to be up and pulled back in order to become a postural control muscle because of the pain, then the pelvic floor is also trying to do the same thing. It oftentimes it may be bracing because of the pain or it may be trying to bring stability to the system. But we do know that when we have that overlay in there, then we've got the reflexive system on top of it that's keeping that from happening there. So we really want to do the, we really want to bring the pelvis and the diaphragm together here. And when we think about it, if we think about the diaphragm being the linchpin, then we need to track that back up to C4, C5 in the phrenic nerve. And the uh trigeminal nucleus, which uh happened, there's a cervical trigeminal nucleus that's at as low as C3. And gaining mobility and movement in the eyes, the neck, and the vestibular system can begin to alter and change and get them, you know, and get a healthier system so that that diaphragm can let go easily. And move into expiration and come down lower into inspiration and just free it up. We free up the diaphragm, we free up the glottis, then we're going to free the pelvic floor as well.

SPEAKER_01 22:12

Okay. So again, another back door to rather than even like direct diaphragm releases or mobilizations and thoracic, another just another tool, right?

SPEAKER_00 22:24

Yeah, and and we know this for sure with females, but I always suspect it works with males too. But a human under threat is going to have a concomitant response to their pelvic floor. Um, especially women, because if you think about not it, not even 3,000 years ago. I mean, people always say 10,000, 20,000. It's like, hmm, you can even go back 3,000 years ago. I mean, you know, being in the tribe was important. That's where the protection was. Well, if the tribe was overrun, you know, that then the females were, you know, taken in and assimilated into the new tribe and had, you know, had their children. So there was a reason for the pelvic floor to like be, you know, on alert. And oftentimes that's such a basic primal response for for females to be under threat that intervening right at the pelvis may not be the best place to go. Sure. But creating a sense of safety and and orientation and adaptability, you know, through the other systems can help that pelvic floor begin to breathe again with the diaphragm.

SPEAKER_01 23:36

Yeah, yeah, yeah. Direct versus indirect and what the nervous system is ready for. Exactly. Okay. So how does working with the vestibular, cervical, and ocular reflexes change what's possible for clients who feel stuck in their recovery? We I think we've kind of been talking all along.

SPEAKER_00 23:54

We've kind of brought all this together here for this, this um, you know, thing, but um the the these this the vestibular, ocular, and cervical systems are really deeply tied to how the brain determines safety, orientation, balance, spatial awareness, postural tone. And here's the one thing I think is really important anticipatory stabilization.

unknown 24:18

Okay.

SPEAKER_00 24:18

When we're hyper-vigilant, we're always trying to like brace for it. And so one of the things that clients will will notice changes is when we get them to like really do what I call test retest type of thing. So can you stand on one leg? And let's let's see how that looks. Can you stand on the other leg? Which one was easier? And then take them through a couple of drills where they feel safe, like do they need to have their hands on the wall, do they need to sit down? You know, you know, can we get them moving the eyes and the head, the head on neck, and you know, all of the three, you know, the different ways we can get that vestibular ocular surface going and then have them retest again. And says, you know, huzzar to a client more than them being able to understand that they are able to do something that they couldn't do well before. What really gets fun is our more high-level clients. The high-level clients are can do like show me an exercise that you're really struggling with. It might be only one like a lunge with the foot back up on the step, like a a you know, an unbalanced lunge, or you know, any of those things, and then take them through the drills and then have them retest and see how they are able to accomplish that. So it's it's the the looking at performance is where we're really gonna oftentimes it can be as simple as I feel like I can actually pull my pelvic floor up now. I finally for the first time feel like I understand what you're asking me to do since we've done this. So that's the way that that can always come. And it's basically helping the people understand that their their whole system doesn't have to be on that the more we can get them to be like a willow tree, the more responsive their system is gonna come with the different activities in front of it. Okay.

SPEAKER_01 26:25

Um, and last question for the practitioner who's so for me, like you know, I've been an OT for 26 years, I've been doing pelvic health for 19 years, I teach clinicians to how to do this work. I'm an advocate, a mentor. I'm really excited for this course. I talk about nervous system regulation, I talk about a lot of stuff that you're touched on, but this for me, I'm excited to get into the next level of what this can mean. Um, for the practitioner who's been doing this work for years, what will surprise the most about this two-day course?

SPEAKER_00 27:05

Loaded question. I think the thing that will surprise people the most, especially the um, you know, anybody who's been doing this for five years plus, anybody at any point, really anytime. But I think for the, you know, the thing that will surprise people the most is we do exactly in the course what we're going to be asking our clients to do, so that we can embody and feel the changes ourselves, and how simple and easy it is to make changes when we when we start utilizing the the layering the systems on each other, that it doesn't have to be this crazy strategy to do it, that it's often where do we find the handles, your words, you know, to like to begin to intervene in. Where and it's what makes it so nice with nervous system regulation is that we don't have to go and be the threat to the area they're protecting.

SPEAKER_01 28:06

Yeah, I like it.

SPEAKER_00 28:07

Right? There's if it's the neck and the pelvic floor they're protecting, then we can do something different. We can do something at the diaphragm, we can do something at the feet, we can do something at the eyes. There's a lot of different things that we can do. But I think the thing that most people enjoy from the course is that they they leave on by the time we finish the weekend, they have real strategies that are simple and easy to layer into the good work that they're already doing. And they'll notice that by combining some of these systems and really kind of practicing these drills and feeling the difference in themselves, that they'll be able to really take it and you know, layer it into their to their work that they're already doing.

SPEAKER_01 28:50

Okay, I'm excited. And uh you have generously extended a 15% discount for my audience. So thank you, Essential Pelvic Health. Thanks you. And um, it's limited seats. So we are keeping this small. It's we're gonna I'm hosting it at my headquarters. So this is this is where my lab course, the Pramat, the pelvic rehab manual assessment and treatment techniques course started uh back during COVID. Uh, and so it'll be nice to be able to bring people together for a nice intimate experience and just kind of nerd out. So yeah, thank you.

SPEAKER_00 29:29

Looking forward to it. Um, if anybody has any questions, you can certainly contact uh Laura for sure, or she can get you over to me. Um, I'm happy to answer any of those things. But again, like we talked about, it's intentionally small. Um it just it's easier on people's nervous systems, I think is the best way to say that. It's easier on mine. I love teaching to small groups, but we do have the time to explore and to really do this. This isn't a lecture-driven sit-in-the-seat course. This is a let's get together and really explore and innovate and activate, you know, through these systems in a way that makes sense with lots of time for questions and case talks and organization for everybody to feel good about it. Okay.

SPEAKER_01 30:16

And because there is no internal pelvic floor work, um, this really is available to not not only occupational therapists and physical therapists, but also chiropractors, uh, massage therapists, anybody who can really do manual work or outside of that, or because there's manual or even our fitness professionals.

SPEAKER_00 30:39

Okay. You know, you're taking fitness professionals or taking people through, you know, strength and training and coordination strategies and giving them and working with these easy, simple things can really help improve performance for their clients as well. So we will be able to do all of those things over the weekend. Awesome. All right, I'm excited. Thank you, Laura. We'll see you soon.