Pilates Perspectives
Pilates Perspectives is your guide to how Pilates fits into real life, no matter your experience level. We unpack the method’s many approaches and history, where it sits in today’s wellness landscape, and simple ways to apply it day to day. Episodes range from building community through movement to using Pilates in physical therapy and rehab. We also explore timely topics, including education standards, diversity expansion across the field, and embracing Pilates as a lifestyle that supports both body and mind.
You’ll hear from seasoned teachers, clinicians, and thought leaders who share firsthand experience and evidence-informed insights; useful for curious beginners and long-time pros alike. Our aim is to offer practical knowledge, foster inclusivity, and widen perspectives so the practice continues to evolve for everyone.
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Pilates Perspectives
Pilates for Pelvic Floor Health
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What does the pelvic floor actually do, and why does pelvic floor health involve so much more than Kegel exercises? Joy is joined by Dr. Charisse Balance, PT, DPT, RYT, a physical therapist specializing in chronic pain, pregnancy, and postpartum care with advanced training in Myofascial Release, Myofunctional Therapy, and yoga.
Dr. Balance breaks down the different layers of the pelvic floor, their functions, and their role in everything from sexual health and bowel and bladder function to core stability, Pilates practice, and overall movement. She explains the differences and relationships among structures such as the levator ani and perineal muscles, and why understanding pelvic floor anatomy requires looking beyond a single isolated group of muscles.
Explore the important relationship between the pelvic floor, diaphragm, and breath, including why the timing of diaphragmatic breathing and pelvic floor contraction matters. Learn how mobility and elasticity in surrounding structures, such as the psoas and piriformis, can influence pelvic floor function, along with the fascial connections between the pelvic floor, transverse abdominis, adductors, and the rest of the body.
They also examine common forms of pelvic floor dysfunction, why pelvic floor physical therapy involves far more than strengthening exercises, and how a nervous-system-informed approach is the first step when addressing pelvic pain, tension, or dysfunction.
Listeners will also learn what internal myofascial release is, how trained pelvic health professionals may use it, and simple pelvic floor exercises and strategies to support pelvic floor awareness at home.
Whether you’re a Pilates instructor, movement professional, pregnant or postpartum client, or simply interested in better understanding pelvic health, pelvic floor anatomy, core stability, diastasis recti, breathing, pelvic floor physical therapy, postpartum recovery, and whole-body movement, this episode offers a deeper look at one of the body’s most important—and often misunderstood—systems.
Content warning: This episode discusses sexual health and sexual function in clinical terms. It may not be suitable for younger listeners.
This episode is powered by Balanced Body®.
Hello, co-producer Stephanie. Just popping in real quick to let you know that this episode today does discuss sexual health and sexual function in clinical terms only. This content may not be suitable for a younger audience. Please listen with care and enjoy the episode.
SPEAKER_02Hello and welcome to Pilates Perspectives. I'm Joy, and today we have Sharice Balance on to discuss the pelvic floor. But first, as always, let's check in. Sharice, will you lead our check-in today? I'd be happy to. All right, so we typically start with a breathing exercise. Today we're gonna focus on the breath of fire.
SPEAKER_01Take it away. Okay, so the breath of fire is an activating breath in yoga. Um, on the exhale, you're gonna sharply exhale through your nose, snapping your abdomen back and pulling your pelvic floor up and in. So it's gonna sound like this. Inhale, open, expand, and it's exhale. Focus on the exhale. Keep on going. Five, four, three, two, one. Inhale, open, release.
SPEAKER_02Okay. How many repetitions should someone do when they're doing the breath of fire?
SPEAKER_01You can get pretty lightheaded.
SPEAKER_02So I I would do maybe 10 to 15. Great. And at the end of each one, you should completely exhale. Yes. To allow for full release.
SPEAKER_01Full release of the diaphragm and the pelvic floor.
SPEAKER_02Great. Everybody ready out there?
SPEAKER_01Let's do it one more time. Inhale, open, expand. And on the exhale, you're gonna exhale sharply through your nose. Pull the belly in and the pelvic floor up and in. Inhale, expand, exhale. 10, 9, 8, 7, 6, 5, 4, 3, 2, and 1. Inhale, open release.
SPEAKER_02All right, thank you. Our guest today is Dr. Sharice Balance, physical therapist, RYT200, a DPT, and a pelvic perinatal, musculoskeletal, and chronic pain expert, founder of Balanced Physioga. Sharice offers a wide variety of services that include pelvic floor physical therapy, anatomy education, and wellness support through an integration of physical therapy and yogic principles. You can find Sharice at Balanced Physioga.com. That's B-A-L-A-N-C-E-D, P H Y S I O G A dot com, or Sharice at balanced physioga.com to book an appointment. Welcome, Sharice. All right, welcome. Uh today we have a very hot topic Pilates for pelvic floor health. And we have with us Sharice Balance. Did I say it right? You said it right. All right. We know that that is not my strong suit, so I'm very excited. Uh we decided it's uh Beyoncé, but only for balance. That's what I tell people. Fantastic. Sharice, welcome to Pilates Perspective. Thanks for having me. Um so we're gonna talk about pelvic floor, but before we get started, why don't you just first introduce yourself a little bit to our listeners?
SPEAKER_01Yeah, my name is Dr. Sharice Balance. I am a pelvic PT, um, also specializing in chronic pain. And I work out of San Francisco, Ohio, Ventura. Um, I really blend my whole like yoga with pelvic floor and chronic pain and all the things and really appreciate how Pilates is like the center, you know. It I I use it, I don't teach Pilates, but like I refer a lot to you do a lot of referrals to Pilates instructors.
SPEAKER_02Yeah. But you're a yoga instructor, yeah, right? You have other you teach yoga? Yeah. Yeah. Um so what initially inspired you to specialize in pelvic floor health?
SPEAKER_01Oh, well, we got no training in it in school. Um, because you can't really expect to like sign up for a three-year doctorate and then be like, hey, classmate, you're gonna drop your pants and we're gonna do some digital exams on your holes. You know, yeah, that that would be that would be uh um an obstacle. Yeah. So we never got that training. We probably got a couple slides in our whole three-year doctorate program about at that time it was called women's health, you know, and now it's a lot more um accessible to more to everyone.
SPEAKER_02Um so why is it why is it under women's health like not optimal? Because everyone has a pelvic floor. Yes.
SPEAKER_01I I just think that statement is worth saying.
SPEAKER_02Everyone has a pelvic floor.
SPEAKER_01Everyone has a pelvic floor. Yeah. Um, and some people, you know, that don't identify as female come and they're like, oh, do I can I be helped with this too? I'm like, yes, you also have a pelvic floor. This is what's holding you up. This is what's holding you up, you know? So well, I got into pelvic PT because I was working in chronic pain. Um, and I had a patient that fell. Um, she just fell on her butt and she had a displaced coccyx, which is the tailbone. And I didn't know how to help her because I didn't get that training.
SPEAKER_02That's very painful.
SPEAKER_01I can imagine. Yeah. Right. And so I was curious and I took my first Herman and Wallace class, uh, pelvic floor one, and then I was like, what is this? Why didn't anybody tell this, tell this to us in PT school? This is like the missing link. Um, because it's like, sure, we talk about like, you know, the core and all that stuff, but they don't talk about the pelvic floor, um, let alone like teach people how to examine it internally, um, all the muscles. So that that's how I got into it. And then I came to the age where I wanted to start having kids of my own. Uh-huh. And I know how, you know, the system here treats pregnant people. So I'm like, I'm gonna help myself because I kind of was doing You wanted to be your own advocate. Yes. Yes, yes. I wanted to be my own advocate. And I wanted to know the things to help myself. Right. And since I was in the field, I'm like, well, I want to know. So then I went, uh, after taking all the pelvic floor classes, I went the pregnancy route and started really specializing in pregnancy. Um and partially because I was really scared because I'm not five feet and I'm like, how am I gonna have a child? Is this baby gonna make it? Yeah, I know how I'm not in, but I don't know how it's gonna be. I know, I know. How is it even gonna fit? You know, so I really just wanted to empower myself with that education and that information, and then I went down that route.
SPEAKER_02So, so you know, empowering yourself with that information, can you can you give a brief overview of the pelvic floor um and its functionality?
SPEAKER_01Yes. The pelvic floor, which is not really the floor, is kind of a misnomer because you think of it as a hammock, but it's more like a bowl, right? Think of it as a pelvic bowl at the bottom of your entire core. So if you imagine you're and whoever's listening, I invite you to feel in yourself, like feel your pubic bone, right? Which is like if you find your belly button, walk your fingers all the way down, you'll feel like a hard bone. That's your pubic bone. And then if you place your flat hand on your sacrum and walk your fingers in between the crack and find a hard bone there, right? And it'll be it'll be right above the anus. That's your coccyx, your tailbone. And so if you close your eyes and imag, if you feel close your eyes and feel comfortable and imagine, okay, a diamond, that's the top and the bottom of the diamond. Um and then if you sit on your hands, if you're sitting, sit on your hands and maybe do a couple cat cows, you know, just rolling your pelvis back and forth, feeling those sit bones in your hands, those are the outer corners of that diamond. And so everything in between that diamond is all pelvic floor muscle. Right. Everything that that that traverses or closes in that space is pelvic floor. Yeah. Um, and the pelvic floor muscles are skeletal muscle, just like your biceps, just like your triceps and quads and glutes. They just these muscles just happen to be inside. Skeletal muscle just means that these muscles are under voluntary control. So if you say, I want to close my front hole, my middle hole, if I have one, and my back hole, you should be able to do that consciously. And if you want to say you pull up and in, I think we're all we can all do that. We're all doing that.
SPEAKER_02We're probably doing that now. We can't see you do it, but you're probably doing it. Right. Okay, wait, wait, my eyebrows went up.
SPEAKER_01Does that mean I'm doing it? No kidding.
SPEAKER_03That's right.
SPEAKER_01That's right. Um, so the functions are uh the pelvic floor muscles have a lot of um play an important role in sexual function, uh-huh. Play an important role in going to the bathroom, playing an important role in core stability because it's the bottom of your core movement.
SPEAKER_03Right.
SPEAKER_02Um so it keeps things in that needs to stay in, it lets things out that need to come out. Your baby had to come out. They had to come out, all three of them, yeah. All three of them, right? Yeah. Um uh why is it important for instructors to have an understanding of the pelvic floor?
SPEAKER_01Yeah, because you can't see these muscles in the mirror, right? So when I teach yoga, I I cue the pelvic floor, I cue your holes, I cue the sphincters, and I feel like this should be common language in classes because we need to bring awareness to this place, these spaces, so that people um I mean can can be aware during movement because these muscles play a vital role in movement, in stability, right? I think a lot of Pilates um, why I like Pilates is because, as my um my neuroteacher said in PT school, proximal stability before distal mobility, right? And I feel like Pilates does a really, really good job at the proximal stability um and the distal mobility, but like, man, my friend Steph Forester, she does Prego Pilates. I do the what's that coraline thing? The coraline, yeah.
SPEAKER_02I'm like, yeah, yeah. Coraline, you want to talk about pelvic floor. You do that point push and you shuffle for a little while. It's like you are singing so much. So hard.
SPEAKER_01But that is the proximal uh stability, right? That is important and and the pelvic floor plays a big part in that.
SPEAKER_02So we often hear about the pelvic floor when it comes to pre, you know, uh and postpartum. But that's not the entire picture. Like talk to me a little bit more about pelvic floor health for all individuals.
SPEAKER_01Yeah, everyone has a pelvic floor. You know, if somebody, I mean, I primarily treat pregnant postpartum people, but everyone has a pelvic floor, you know?
SPEAKER_02So um and and and let's talk about this concept of your pelvic floor is is too loose. It's too, it's too um uh hypertonic. It's too like like or or just tonicity, general tonicity of the pelvic floor.
SPEAKER_01Yeah. So all of our all of our skeletal muscle holds um a certain amount of tone, right? Like if you touch your glutes, there's a little bit of tone there. Your your fingers don't just like squish all the way down to the bone, right? Same thing with the pelvic floor, the pelvic floor holds a certain amount of tone. Now, I think that our um society is very kegel-centric, you know. Um, even at a certain hospital that I will not name, everything is about like kegels, do the kegels. All you need to do is kegels. And that's the extent of what pelvic floor physical therapy is at that hospital, you know? And it like makes me cringe because that's like one part of the assessment. Right.
SPEAKER_02Just tell everybody what a kegel is for those who might not know.
SPEAKER_01A Kegel, which I don't like to call a kegel because it's somebody's name. Um, but from like a kinesiological perspective, a kegel is uh a closing all of your holes and pulling up and in. It's a pelvic floor contraction, right? Right. So that's what I call it in practice.
SPEAKER_02So, so um there's research out there that when you cue the pelvic floor that way, sometimes uh because there's such a relationship, let's let's do this. What's the relationship between between the pelvic floor and the diaphragm?
SPEAKER_01They're best friends.
SPEAKER_02They're best friends, they're best friends, right? They respond to each other, yeah, sometimes playfully together, sometimes in opposition. Right, right? Right. Um, so then therefore, breath is very important to pelv, good pelvic floor health, would you say?
SPEAKER_01Oh, absolutely, yeah. So the breath, right? Our ribs surround our lungs. What my yoga teacher says is where we have ribs, we have lungs. And at the bottom of our ribs is the diaphragm, right? Who is besties with the pelvic floor. So the more that the pelvic, the diaphragm, I'm sorry, can descend and release and lengthen, right, so can the pelvic floor. Right.
SPEAKER_02Right. And that and and and the space in between is the abdominal cavity. So, so that means intraabdominal pressure and the changes in intraabdominal pressure are also going to influence the pelvic floor. Is that correct? Absolutely. Um, so in terms of training, uh, understanding breath, understanding um, oh, I don't want to say intraabdominal pressure because that's a really hard thing, but the way the volume changes inside the abdominal cavity are all important factors in in getting getting out of our own way to let the pelvic floor do what it needs to do. Is that a comfortable statement?
SPEAKER_01Yes. Yes. Like um, like managing your pressures, right? We have certain canisters in our body. There's a canister from like our our throat to our diaphragm and our diaphragm to our pelvic floor. Right. Right? Those are some of the canisters. And it's like, do you open or close those holes? And when do you do that? And like the timing of that is super important. The timing is super important. The timing is super important.
SPEAKER_02Yeah. Would would you say in pelvic floor dysfunction that that that the timing is off or that there is a dysregulation in that timing, whether it's neurological, physical?
SPEAKER_01Yeah, there's like uh, I guess in PT you could call it a dissynergy, right? Sometimes uh the first thing I do when I do an assessment is assess someone's breath. Um, and I say, okay, are you breathing and expanding the abdomen? Uh, I'm sorry, the the rib cage, which then expands the abdomen, which also helps the pelvic floor release, right? Or actually what I see a lot is people breathe in and they pull in, right? So that is in PT what we call like uh that's an improper pattern, right? Uh improper breathing pattern, dysynergy. Um, I think that people learn this. I don't know, in in the way people cue, maybe in some exercise classes, because they were taught to do that at the gym or whatever. Nothing against people that cue like that. But just know that that is not the um normal way that we breathe without being cued. Sometimes we get in our our own way.
SPEAKER_02Sometimes we get, yeah, yeah. You know? So we can cue people in opposition to what could be healthy for the pelvic floor.
SPEAKER_01Exactly. And what I see is that we might cue it in a class, and I see this in yoga all the time. You might cue it in a class, and then they take it out of class, and then they they breathe like that in life. Right. And so then that affects everything. That affects daily activity, that affects how their pelvic floor functions on a daily. So I think it's really important to cue. If you are gonna cue like that for whatever reason, say that this is for this exercise, you know, um, and then educate, you know, your students that uh in normal physiological breathing, this is what happens. The rib cage expands, the diaphragm expands, the pelvic floor lengthens.
SPEAKER_02Um you talked about the diamond, the pubic bone, the coccyx, the sitting bones, and the um do you ever cue the bones? Oh, all the time. Drawing the sitting bones together or the coccyx and the pubic bone together.
SPEAKER_01Yeah.
SPEAKER_02But do you ever cue the muscles like lift your bubble spongiosis? No. Yeah. I mean, unless I'm teaching an eye-based. By the way, I I use any opportunity I can to say bubble spongiosis. I often try say, try to drop it into a cocktail conversation. It would, it's always, it's always worth it. That's a good one. That or the corpus cavernosum. I don't know what you want to call it. Um, so so you you would cue bones. Why, why would the bony landmarks be a good cueing um strategy?
SPEAKER_01The bony landmarks are a good cueing strategy because they're accessible, right? You can feel them like we did earlier. You can feel your bones. And when you cue from the bones, and this is what I do in yoga, um, people can get that body awareness. They can get that kinesthetic feedback from their bones, right? Now, when we activate the pelvic floor, the bones don't really move that much. Um, but if you like picture it in your mind's eye, you can imagine those bones coming together, right?
SPEAKER_02So I invite listeners, because you can do this anywhere. You could be driving and do this. Uh, I want you to think of a Kegel, right? So, how would you right? You're like, I don't want to. Pelvic floor contraction. Yes, a pelvic floor contraction. And then, and then hold that thought, seriously, let it go. Seriously, let it go. And then, and then think of drawing the sitting bones closer together and the coccyx and the pubic bone closer together. And do you feel a a a different sort of uh quality of that? Um, I know I do. Um, so so just something, something to consider. Yeah. Yeah. Um, when did you first become aware of Pilates sort of as a practice, but but even beyond that, as a potential collaborator for you in your PT practice with your clients managing pelvic floor dysfunction?
SPEAKER_01I became aware of uh this what it was during my prenatal yoga teacher training with Jane Austen. Jane and Stephanie.
SPEAKER_02Jane Austen, she did a prenatal. I didn't know that. I thought she was like, also a writer.
SPEAKER_01Different Jane Austen. Uh they um are our practitioners in San Francisco supporting pregnant and postpartum people. And Stephanie came in and talked about Pilates for the pelvic floor during pregnancy. Um, and that's when I was like, oh, what is this? Um and then I went my down my deep dive learning with her. Um, and I took her classes while I was pregnant, and it was just so helpful the way she cued, right? And I to be honest, like I would only go to her class or somebody that was trained by her because not all instructors cue in that way, and the cueing is so important, especially during pregnancy.
SPEAKER_03Right, right.
SPEAKER_01Because during pregnancy, like the opening and lengthening is so important, especially as you're preparing for birth. Um, and so if we keep on cueing like the contraction, that is kind of doing people a disservice.
SPEAKER_02Yeah. Can you over cue the contraction? Can you create too much tonicity in the pelvic floor?
SPEAKER_01Oh, yeah, absolutely. Yeah, absolutely. And so, you know, I always tell my students, like, sure, you can do uh or my patients, you can do a pelvic floor contraction, but make sure to follow it up with a release and lengthen. You know, it will it's not black or white. It's not like never do Kegels or a pelvic floor contraction while you're pregnant and always do a pelvic floor contraction when you're postpartum. You know, it's not black and white like that. It's like you need both, right? But also remember you don't get stuck up in the contraction, follow it up with the release because that's um that's healthy. Right.
SPEAKER_02Because it has to hold the things in and it has to let things out. I like that. I'm gonna use that.
unknownUse that in practice.
SPEAKER_02Um, what are some of the similarities and differences across biological sex?
SPEAKER_01There's a lot more some similarities than people think. I mean, the muscles are all the same, you know, like um the clitoris and the penis are the same. If you look at the anatomy, I know I know that that's not like the pelvic floor muscle, um, but the way that those tissues, those erectile tissues, um, become erect is because of the pelvic floor muscles, right? And that's another thing that the pelvic floor muscles uh do. They contract for sexual function and are also a sump pump to help move fluids out of the area. So I'm now I'm gonna get a little technique.
SPEAKER_02Would you say the perineum muscles are more oriented toward uh sexual function? The levator, more sort of that structural hammock.
SPEAKER_01Is that sort of the organization of this? Layer three, the deeper layer, the pelvic floor is more meant for pulling up and in on those pelvic supporting those pelvic organs. Is what? Um are you gonna make me name the muscle? No, you don't need the pubo, the pubo coccygius, the aliococcus and the cocygius.
SPEAKER_02Right, which are the levator muscles. Levator and eye muscles. Yeah. Yeah. Um, and that's more for, I'm sorry, say that again for that's idea of for supporting the pelvic organs. Right, for supporting the pelvic organs. So those, those, those ham, and I don't want to say hammock because you said bowl, more bowl-like muscles that support the pelvic um uh basin. Um they also have they they also have like really lovely fossil integrations, don't they? In and up into the body. Oh yeah. Um so that that's it's kind of what gives it that elastic quality, right? So, so um some of them with um uh the psoas, the piriformis. Yeah. Uh so so so your pelvic floor, and the only reason why I'm bringing this up, guys, and if you don't know all of these muscles, that's totally fine, but it's really exciting if you like look at them, it is is because your pelvic floor should feel like it moves, shouldn't it? It should feel like it should be reactive, right? It should be reactive. Yeah. Um, and so that elasticity, it it actually feeds up into the body in such a lovely, almost really artistic way.
SPEAKER_01Oh, absolutely. If you look fascially, I'm also a myofast release therapist too, so we could nerd out on this at a whole thing. So happy to go go there, go there. I'm gonna go I'm happy to go there with it. Deep front line, yeah, right? That goes from the tongue down into uh does it cross it deep front line? Anyways, it crosses down into the pelvis, into the um opposite adductor and comes down into the big toe, right? So that fascial connection, that's that continuity all the way from the tongue to the big toe through that pelvic floor is so important, right?
SPEAKER_02Also it's con I love that word, continuity. It's just it's sort of a continuity and um and almost like an energetic sharing. Um and and that'll pass through to the pelvic floor. It's just it's just good to know that we're, you know, we're not just talking about Kegels. We're really talking about a whole body experience.
SPEAKER_01I mean, the pelvic floor is fascially connected to your transverse abdominis, right? Also fascially connected to your ad doctors, which bring your knees together, squeeze your knees together. Um, and so that's an important connection.
SPEAKER_02That's a huge connection because I want everybody out there to think about like, I don't know, you're you're you're out shopping all day and you get like to that last gift you need to buy. And all of a sudden you're like, oh, I have to go to the bathroom. But then you think, well, you know what? I'm gonna wait till I get home. But then you try to get to your car. And as you get to your car, guess what happens? The urgency starts to show. And what do you do? You internally rotate and you pull your knees together, your adductors. It's the thing that's gonna get you home.
SPEAKER_01Sorry. Yeah, it helps to close the holes because it helps to activate the pelvic floor more. Right, right, right.
SPEAKER_02So there's a really lovely practical, like if you understand what you just said, there's some practical ways for us to train without having to tell people to lift their pelvic floor because oftentimes what I say is lift the pelvic floor is a different sensation internally.
SPEAKER_01Yeah. People might be feeling it in a different way.
SPEAKER_02And or they might not be feeling it at all. Or some people don't feel that, you know. So those fascial connections into the like like it's it's it's great to understand that.
SPEAKER_01Yeah. I want to talk about one more fascial kit, two more fascial. Go for it.
SPEAKER_02I can't guarantee you I'm not gonna launch into a story because it's very exciting for me.
SPEAKER_01So the psoas, psoas I was saying, and the diaphragm have a common attachment at the um anterior bodies or at the lumbar spine. Right. And so, and then the diaphragm and the pelvic floor are best friends, right?
SPEAKER_02So it's like a party going on.
SPEAKER_01Right, yeah, right. They're all they all are going to the party. And so we need to make sure they're all on the same page going to the party, wearing the same outfit.
SPEAKER_03Right, right.
unknownThat's right, that's right.
SPEAKER_01So, like, you know, just knowing that like the position of your lumbar spine, how that affects your breath. So maybe doing some uh cat cows and noticing like when you're in a cow, how are you breathing, right? Compared to how you're breathing when you're tucked and rounded in a cat. I always get those animals mixed up, but I'm with you.
SPEAKER_02I get the I get the animals all mixed up all the time. But but what I hear you saying is is the way we move. Uh-huh. Um, the the breath patterns associated with that, if we almost get out of the way, then the pelvic floor is is going to be responsive to its partners, its friends. Yeah. Yeah. Um, that's that's great. What are common dysfunctions that you see most frequently?
SPEAKER_01I mean, in the population that I see, um, dissynergy, right? Maybe the pelvic floor. Um, it's not all about just strength, right? Because people think, oh, I'm I'm postpartum, because I work a lot with postpartum people. I just need to strengthen my pelvic floor, right? But sometimes it's um maybe your pelvic floor isn't responding to the breath in the way that it should, right? It's not lengthening with the inhale, maybe it's pulling up with the inhale, as we talked earlier. Um, or maybe it's not activating at all. You think you're doing a kegel and there's no contraction, right? So it's like re-establishing that neurological neural pathway, that connection. Um, and then, you know, what people know pelvic floor PTs for mostly is like, you know, going to the bathroom, right? So um stress incontinence, urge incontinence, frequency, um, pain. If you have a vagina, pain with penetration, or even even if you don't have a vagina, you can have pain with penetration. But you have a people have rectums. So um but pain with any penetration, right? That um is a sign of pelvic floor dysfunction. Um and what else? I think that was a lot of it.
SPEAKER_02Yeah, what what would be some of your your recommendations for um urinary incontinence associated with age?
SPEAKER_01Associated with age. Um well, control the controllables, as Michelle Lyons says. Which are um so as we age the urethra just gets more becomes more open.
SPEAKER_02So that's that's where I was hoping you were going. So some of the smooth tissue becomes less contractile.
SPEAKER_01That's right.
SPEAKER_02And it almost and I the only reason why I think that's important is I think everybody thinks it's it's all about strengthening the pelvic floor, but you're also the the the urethra is involuntary.
SPEAKER_01Mm-hmm. There's voluntary and involuntary fibers of the urethra. Right. Oh, of the urethra, sorry.
SPEAKER_02Yeah, like the actual urethra is smooth, more more smooth. Yes, yes. So how then can we support that with pelvic floor training?
SPEAKER_01Right. So the smooth muscle as it as it becomes more relaxed with age, the pelvic floor muscles, right, in layer one um also help to close the whole that hole. Right. So we can't control how much that hole opens as we age, but we can control how how responsive and you know reactive those layer one muscles are that act as sphincters.
SPEAKER_02Yeah, and I think that I just think that's a really important thing to understand because again, it's not just a question of strength, it's also a question of how that strength is supporting the structure as a whole. What about um someone who suffers from pain, that maybe there's a hypertonicity? Yeah. What about it? Um, like what's what's a first strategy there? First strategy is And and is it more male to female that you would see something like that?
SPEAKER_01It depends on what their history is. You know, it's your the pelvic floor is so it's a sensitive area because it is where our genitals are. We hold a lot of tension. Some people hold a lot of tension there and they might not know it because you can't see it. It's not like when you hold tension in your jaw, you can see you're clenching your jaw, or you hold tension in your shoulders and you can see your shoulders up to your ears. You just can't see it. So um somebody that might have gone through a traumatic event or some, you know, history might be holding there and they don't know it. They might not have a sensation there or awareness there because they don't want to have awareness there for whatever reason, right? And so it's it's um having hypertonicity, I the way I treat it is number one is the nervous system, is with deep breaths. Because as we said, the diaphragm and the pelvic floor are best friends. And a lot of times if people are stuck in a fight and flight response, they're not breathing expansively, right? And if your diaphragm isn't descending and your ribs aren't expanding, guess what's going on with your pelvic floor? It's not expanding and opening either, right?
SPEAKER_02So you know, we um pelvic floor trauma can come physically, right? An accident uh of some kind, um, but it also can be emotional. Oh yeah. Um so do you do you find there's a lot of holding, uh emotional holding the pelvic floor?
SPEAKER_01The amount of times that people have cried on my table when I'm doing an internal pelvic floor release. You know, and it's like I'm just holding space. You're just holding space. I love that. Because they're processing whatever went on um and releasing, you know, whole hoping hoping that they feel safe. They are releasing, um, because I feel it under my fingers. And it's just, it's yes, we we all hold some people hold tension there and emotion there.
SPEAKER_02Today's episode is supported by Balanced Body. If you love the roots of the Pilates method and appreciate smart innovation, Balanced Body speaks your language. Our equipment honors Joe's original designs while embracing modern engineering and manufacturing methods. The result is equipment that is intuitive to use and offers new ways to teach, explore, and progress. Receive $20 off your equipment order of $100 or more by visiting Pilates.com slash podcast dash discount and follow the prompts. You described your postpartum experience is having the information fresh in my body. What was it, what was it like to experience pregnancy birth and postpartum through the lens, your pelvic floor PT lens?
SPEAKER_01Yeah, I'm yes, I was like, this is why I took all those classes. You know, it's so interesting because with my first, before I ever had babies, um, I used to help guide clients, like, this is how you're not gonna tear in your pelvic floor. We're gonna prevent tearing. And guess what happened after my first baby? I had a third degree tear all the way to my external anal sphincter. I and you you could you knew it. You were like, I knew it. And when they were sewing me up, I was like, be careful. I know, I know what you're doing. Yeah, they did a great job. I healed beautifully, right? But I was like, thanks, universe. I know, sure, I would be the one to get the third-degree tear. Wow. And I felt all that, yeah. It felt, I appreciated that really um personal learning experience. No class can teach you that. Um, but that, you know, I think the biggest takeaway is your body expands when you're pregnant, right? Your pelvic floor is meant to open 250% its normal length. Wow. Right. Um, and your abdomen, your transverse abdominis, all those muscles also lengthen. And everything feels so weak and heavy. The amount of like, I just felt so disconnected because the muscles were, as we in PT say, passively insufficient, right? They were so lengthened that the actin and myosin filaments couldn't contract. And it just takes time.
SPEAKER_02I I yeah, I remember, I remember it, the appesiotomy, and I remember like of all the of all the things to say, I remember saying to the doctor, I don't know why they call this an appesiotomy, and it's appeasing nobody. And he looked up at me like he was like, I don't know where that came, like where that came from. But um uh that's a good one. Um along those lines, you stated in a podcast that if we give the body the opportunity to heal, it will heal. Can you speak more on this philosophy and specifically toward postpartum healing? Yeah.
SPEAKER_01Tissue time um healing time frames. Tissue healing time frames. So it takes, you know, the six-week mark is like how long it takes for your for your uterus to involute, which just means it comes back to its pre-pregnancy size. Your pelvic floor muscles take three to six plus months to come back to to pre-pregnancy length, in addition to your abdomen, right? So it's like, um here's an example. I had a patient come to me and she knows I tell this story all the time. She came to me three weeks postpartum. And I like to tell my clients, like, just wait till your six-week postpartum visit, because I don't there's gonna be a lot of false positive tests that are gonna come come up because you're still healing. But she's like, no, no, I want to be really proactive. I want to come in. So she came in and she had like a four-finger diastasis. And if you don't know what that means, it's like, you know, your linea alba that comes down between like the center line, your six-pack muscle. If you uh feel there and do a little crunch, um, there was a four-finger width separation there, right? She freaked out and was like, oh my God, I'm not doing this right. And you know, there's something wrong with me, and um really was troublesome. And then she came back two weeks later, and you know what? It was gone. Oh yeah, she just really needed to let it heal. She just need it, just takes time. And you know, our bodies are have a lot of wisdom. Our bodies are really, really smart, and a lot of times we just need to get out of our body's way and let it do what it needs to do to heal and give it the time that it needs.
SPEAKER_02Well, and you you just talked about the internal release. So you you you uh uh do in um uh internal examinations, yeah.
SPEAKER_03Yeah.
SPEAKER_02Uh I I I I find that fascinating. Um uh A, how do you know when you need to release?
SPEAKER_01Uh-huh.
SPEAKER_02Um, what is that what is that sensation for for the client? And what is that sensation for you?
SPEAKER_01You know, it's such a trip being a myofast release therapist and doing these internal releases. So when I do uh when I first do an in um a vaginal exam, I I always ask for permission to insert my finger to do a digital exam. So I put my finger on the perineum and I feel, is there any excursion in these tissues with the breath? Right. Um, and I'm just assessing and I already know, like if I don't feel lengthening there, there's probably gonna be some tight, there's gonna be some spots. And so when I when I insert my finger and I go around kind of like a clock, right, in layers one and two and then three, I feel, okay, is there any parts that feel kind of more dense than the surrounding parts, right? And I and then I just like wait and hold. And then I wait till the tissue softens, and then it kind of feels like butter melting. And I know there's a release, and it's a trip, but I feel it because I know there's a release because I always feel like a pulse, a really strong pulse. And that's because of the fascial connection, all the fascia is surrounding all the blood vessels on the nerves. Um, and when the fascia releases around the blood vessels, then there's more blood flow.
SPEAKER_02That's so much that it's really sort of cool and interesting to explore. Uh, how you you studied psychology? Yeah, why you guys really did your research on me, huh? I I I want to say we have uh Claire and Stephanie are really on it. They do their research. Um, so you you studied psychology. I did. Uh alongside exercise science. BC Davis, yeah. Right? Right before completing your doctorate in physical therapy. That's right. Um how does that impact your practice as a pelvic floor PT and yoga instructor?
SPEAKER_01Huge. I mean, um, like I said, I started my pelvic floor career because I was treating chronic pain patients in this chronic pain program that um I helped to create in the Bay Area. And it in the program there was a psychologist, the psych, a psych team, a physical rehab team, and a medical team. And after 12 years of practicing that, um, you know, I talked to the psychologist and I was like, you know, we're basically doing the same thing, but using different avenues. Um, so there's a huge impact. It all is all connected. You can't say your mind and your body are separate because it's the way you think, if you think about like, think about being in a dentist chair and them drilling in your teeth. What are your sphincers doing right now? What are they doing right now? They're yeah, right? Feel it. Yeah, let's bring awareness there. But I mean, we're not even in, you know, it's just it's the emotion of being in a dentist seat and like the fear, right? And how that impacts your pelvic floor physically. So emotions um have obviously an impact on our muscles and how we hold ourselves and how our muscles hold themselves. So it's all connected and interrelated. I can't separate it.
SPEAKER_02Can't separate it. The neurology of the pelvic floor, it's a very neurologically rich center, isn't it? Um is that part of why it's easy to come in and out of synchrony or train synchrony or lose synchrony? Does that have anything to do with it?
SPEAKER_01The nerves?
SPEAKER_02The yeah, the neurology of the yeah.
SPEAKER_01You know, I just took a NKT training last weekend and which is what? Uh neurokinetic therapy. Have you heard of it? I I have, but I wanted I wanted to make sure listeners heard. Yes, neurokinetic therapy is it's like the other missing link I was missing after pelvic floor. Um, but it's like it's really simple. It's sensory in, motor out. Right. And what I learned last week is that, you know, we have pain and then we have proprioception, right? Proprioception is knowing where our body is in space, knowing, you know, you're probably sitting here and you're your shirt, you're wearing a shirt, you're wearing clothes, but you don't really pay attention to that. You don't feel it until you bring attention to it, awareness to it. Um, and there's more proprioceptors in our body, way more than pain receptors. Pain receptors are just louder. Um, so yes, there is a vast network of nerves that innervate the pelvic floor, and it's all about like what are you what is taking your awareness? Right? What is what is yeah, what is what in your body is yeah, taking your awareness.
SPEAKER_02Actually, I want to move to something, I think, aligned but separate. What is taking your awareness? What are some of the like things that that people either say or think about the pelvic floor that you wish you could change?
SPEAKER_01Uh, that Kegels fix everything. That that that's that's the big one. That's really annoying. Um and that all pelvic floor therapists do is stick our fingers up holes. Like that's like one part of the hole.
SPEAKER_02No bottom pops. Yeah. No pun intended. Uh what are some of the things you wish from a client perspective people would would would understand about their pelvic floor or the pelvic floor?
SPEAKER_01Um, that your pelvic floor, I mean, kind of like everything we just talked about, like that the pelvic floor is made of skeletal muscle, that it's made to contract, release, and lengthen. That contracting, releasing, and lengthening is functional and important for letting things in and letting things out, right?
SPEAKER_02How important is our good movement mechanics? Um, things like squatting, lunging, um, adduction exercises, abduction exercises, spinal mobility. How valuable are they as um ways of creating good healthy pelvic floor functionality?
SPEAKER_01Yeah. Our body is one kinetic chain that's connected, right? So, like the position of your lumbar spine is gonna affect the position of your pelvic floor, the position of your hips. Are you externally rotated or internally rotated? That's gonna affect the position of your pelvic floor. Everything works together in synchrony. Um and, you know, like like we were talking about before, like alignment and cueing is super important to make sure everything is functionaling, functioning optimally.
SPEAKER_02Great. And then what recommendations do you have for Pilates instructors who want to better support pelvic floor PTs?
SPEAKER_01Go to Pelvicon. No, just kidding. Is that a thing? Yes, this is this is how amazing. Do you have to come dressed as a pelvic floor? I mean, you can come dress as a Volva if you want. We have many pictures of us dressed as Volva. So okay.
SPEAKER_02I'm trying to figure out what that is.
SPEAKER_01This is how amazing Stephanie and Jane are. Okay. They are Pilates and yoga instructors in San Francisco, and they brought me to Pelvicon as a pelvic. They went the first year. Wow. And then I went, and then we nerded out the next two years together. Okay, so we can go to Pelvicon. We can go to Pelvicon.
SPEAKER_02Um, but in San Francisco, what time of year?
SPEAKER_01Oh no, it's not in San Francisco. No. Where is it? It's in Georgia, Atlanta. It's in Atlanta. Okay, road trip. Um but there's just like uh that's like two days of like everything, pelvic floor, and it might be a lot, but like, you know, take what you want and leave what you don't, and then it's a party. So that's fun. That's a lot of information. Um, I would say, you know, like partnering with or like having communication with a pelvic PT. You know, it's like I really like my I love my um my relationship with Stephanie because she does the Pilates and then like, you know, she'll be like, oh, this person I think has this or that. Can you do an internal assessment? And then I'm like, oh yeah, this is what I found. This is what you can do in your practice when you when she takes classes with you, you know? And it is such a good uh relationship to have because it's so complementary, you know.
SPEAKER_02And if somebody's looking for a pelvic floor PT, what should they be looking for? What are the qualifications they should look for? Not every PT is gonna have the same Yeah.
SPEAKER_01I mean, it's interesting because you can be a pelvic PT and not do internal exams. I guess there's some pelvic people that say that they're pelvic PTs and they don't do internal exams. So I think that the internal it's not everything, but it's super helpful. Uh-huh. Right. So Well, what kind of qualifications do you have to be able to do that? You take pelvic floor one. With who with whom? With Herman and Wallace or the APTA. Or the APTA. Yeah. So there's two routes you can go. Actually. So it's a uh, I'm just trying to get at it, it's a real thing.
SPEAKER_02It's a real qualification.
SPEAKER_01It's a real qualification that you don't just get out of PT school, right? You have to do extra continuing ed for that.
SPEAKER_02Um, are there any exercises or best practices people can do to maintain and support uh pelvic floor health?
SPEAKER_01Your breath. That is the number one thing I tell people to focus on initially postpartum. Um, and just like initially, not even postpartum, right? So I can walk you through it, place your hands around your ribs like you're mad, but like place it under under where your ribs are. Um, and then as you inhale, open, expand into your hands, kind of like a jellyfish, and feel the ribs open into your hands laterally, front and back. And then pay attention to what's going on in in between the sit bones. And then as you exhale, just allow everything to fall back to center. And pay attention to those sensations.
SPEAKER_02When you're doing that, what what what do you experience when you do that?
SPEAKER_01I experience fullness in my rib cage as I inhale, and then my pelvic floor opens, and I picture a jellyfish. You picture a jellyfish?
SPEAKER_02Yeah, yeah, yeah. So that that that's your that's your image. Um can we just go back to the different layers of the pelvic floor? You said layer one, two, and three. Can you just is there a way to sort of for imagine? We know many of our listeners are Pilates instructors, but imagine it's somebody who's had zero anatomy on this. How would you talk about those different layers of the pelvic floor?
SPEAKER_01Yeah. Layer one. Layer one is responsible for closing the holes. So there's a lot of muscles that act as sphincters, um, and also responsible for sexy time, is what I say, is helps to push blood into the spongy tissues of the clitoris or the penis.
SPEAKER_02Those tend to be more circular, and they're they're um if if you guys can imagine rings, right? Small little circular rings in a way. Kind of, except for the um muscle. But yeah, they're like sphincter. Yeah, they're sphincter. I think it is the issue, Kavanosa, if I'm not, if not mistaken. Um uh oh, the sphincter muscle. In my mind's eye, and tell me if I'm wrong here, because I may just totally have it. Those sphincter muscles are gonna be are are are in a way are almost like they're short, they're powerful, they're quick. Yes, right? They're reactive. Fast to fast twitch. Almost like fast twitch muscle fibers, right? Right. Okay, so that's that's your love layer one. It's gonna close off the holes. And for sexy time. And for sexy time, which has to let things in and let things out.
SPEAKER_01That's right. Okay. And then layer two, if you look at it anatomically, looks pretty similar to layer one, except for there's a lot of thick fibrous fascia there. Um, so like the um, I forgot the names on the muscles. I yeah, that's all right. Postpartum brain. I blame my postpartum brain, but like um, like that line, the the muscles that line the um the bones of the pelvis, right? Um, there's that. So imagine like a diamond. Imagine the diamond. And then that's inside of that diamond is like the thick fascia. And that thick fascia is important to help, like, you know, kind of like a trampoline for your pelvic organs.
SPEAKER_02It helps to absorb shock for your pelvic organs, which is gonna help then to keep the pelvic floor relatively tone, even if it's letting out, right? It's that's the one thing uh that I think people think it's like it's either on or off. Yeah. It's either on or off. But there's actually almost like I I envision if you're if you if not if you're jumping on the trampoline, but if you're just standing on the trampoline, right, uh as you move your body, the trampoline is gonna move with you. Um, but there's always a tonicity underneath you. Right. Is that do you think that's like a reasonable way to think about it? Absolutely. Um, all right. So that second layer then is gonna help to give that tonicity. Right. Okay. What's the third layer?
SPEAKER_01The third layer is the are the muscles that pull up and in. So these muscles um help to support the pelvic organs and pull the pelvic organs up and in.
SPEAKER_02The primarily the levator muscles, levator cani. Yeah. Yeah. Um so so if if with all of this together, then you have in and up, you have that tonicity, and then you have the sphincters really supporting and like the the actual holes in closing and opening. Right. Right. So that's sort of a I I hope you guys out there can get a like an sort of an internal visual of what that's like. Why is it important for people to understand those structures as a whole, do you think? Because it's the base of your core. Because it's the base of your core, it's the center of your body. Yeah. Right. Yeah. Yeah. Okay. One last before we move into our rapid fire questions. Yeah. Postpartum.
SPEAKER_01Uh-huh.
SPEAKER_02You've just had a baby. Yep. What would be the one thing we could? This is gonna this is gonna be a trick question. What because what is the one thing we should let go of in order to allow ourselves to heal?
SPEAKER_01Expectations. What do you mean by that? Um let go of well, this is what I tell my clients, like uh how long did it take to make the baby? Ten months? Okay, expect that and longer to to you know come back to your pre-pregnancy activity level. Um, don't expect let go of the expectation to which I hate snap back or bounce back. Um because your body is is a new body that has birthed this period. And a lot of that bouncing back is societal. Right. Right, right, right. Um let go of the need to like, especially in the first 40 days in the in the fourth trimester, like to be super active. I mean, I think that's where I see a lot of uh clients um go backwards is they like do too much too fast. Um, and then you know, and then their healing is prolonged. So I I like to tell my clients, like, really take these first 40 days that that fourth trimester to be with your baby and heal and allow your body to do what it needs to do to heal, because it will heal, like I said before, like if you give it the opportunity.
SPEAKER_02Can if we get in the way of that, can we actually end up causing ourselves long-term dysfunction, pelvic floor dysfunction? Oh, for sure. That's I that's why I wanted you to bring that up. Is uh is is um uh uh when you say allow yourself to heal, if we insert ourselves too much in before that, you know, the asking the body to do something it's not ready to do, can we in the long run actually be doing ourselves more harm? Yeah, for sure. For sure.
SPEAKER_01And I've seen it. And it just takes longer to heal, you know. So when else do you have time to just like be with your baby? Be with your baby. Be with your baby, and it's not rest because you know, if you're breastfeeding, you're doing that every three hours. Oh, nobody's sleeping here, but like, you know, you know what I mean.
SPEAKER_02I totally know what you mean. Um, all right, rapid fire questions. You ready? Okay, okay. All right, what does being fit mean to you?
SPEAKER_01Ooh, being fit for being fit to me means that you are able to navigate and move in such a way um that you can go about your daily life without injury.
SPEAKER_02All right. Now you've already kind of answered this, but what's one misunderstanding about your profession that you wish more people understood? Uh pelvic floor therapy is not just about kegels. Not just about kegels. Period. Full bold stop. Bold and underlined. All right. What's one habit that you do for yourself that complements your movement practice? It could be sleep, it could be meditation, resistance training, anything. Yeah, yoga. Yoga. I have to.
SPEAKER_01Perfect. Yeah. How often do you practice? I mean, the physical asana right now, because my kids are small, uh, not as much as I would like to, but the breath and the pranayama and all the other mental stuff every day.
SPEAKER_02Fantastic. All right. Uh, do you have one to three books or podcasts you would recommend to to our listeners?
SPEAKER_01You know, I don't really do the podcast, but I will say some of my teachers that are amazing. Um, Michelle Lyons, she has Molibriety, I think it's a podcast. Um, I've learned from her a lot. And she um is the one who taught me, and she's the one that said control the controllables. She's genius, she's amazing. Um, Uchena Osai, you see, um, is a pelvic PT sexual health counselor. I did my sexual health counseling training with her. Um, amazing, amazing. She's so funny and so smart and so informative. So those are two of my favorites. Great. And pelvicon. Pelvicon and pelvicon. Pelvicon's really fun.
SPEAKER_02Uh okay. Before we conclude for the day, where can our listeners find you?
SPEAKER_01You can find me on Instagram at balanced period physioga, um, and my website, balancefisioga.com. Balanced, just like balanced body.
SPEAKER_02Oh, just like balanced body. Not not balance like Beyoncé. Not Beyoncé body, no. Um uh Sharice, thank you so much. Uh, this was this was really great. Uh you know, the pelvic floor is really still it's it's so interesting. We all we we now understand we all have one, but still it still remains um sort of mysterious. And I'm just so grateful for being willing to have this conversation and to explore all the different ways in which we can be healthier um and how important pelvic floor health is in that conversation.
SPEAKER_01Thank you so much for having me. And I always love to share this information and just want to push it out there to let everyone know you have a pelvic floor. You have a pelvic floor. You can do something.
SPEAKER_02And Kegels are in everything. Nope, that's right. Fantastic. Thank you again. Thank you so much.
