#PTonICE Podcast

Dr. Jess Gingerich // #ICEPelvic // www.ptonice.com In today's episode of the PT on ICE Daily Show, ICE Pelvic faculty member Jess Gingerich defines hypertonicity as it relates to the pelvic floor and the role of the pelvic floor in the body as contractile tissue. Take a listen to learn how to better serve this population of patients & athletes or check out the full show notes on our blog at www.ptonice.com/blog. If you're looking to learn more about our live pregnancy and postpartum physical therapy courses or our online physical therapy courses, check our entire list of continuing education courses for physical therapy including our physical therapy certifications by checking out our website. Don't forget about all of our FREE eBooks, prebuilt workshops, free CEUs, and other physical therapy continuing education on our Resources tab. Are you looking for more information on how to keep lifting weights while pregnant? Check out the ICE Pelvic bi-weekly newsletter! EPISODE TRANSCRIPTION JESSICA GINGERICHGood morning PT on ICE podcast. My name is Dr. Jessica Gingerich, and I am on faculty with the Pelvic Division here at ICE, and I am coming to you today to talk about the hypertonic pelvic floor. We got a great question in our online course about hypertonicity in the pelvic floor around pregnancy. And so before I dive into this, when we talk about hypertonicity in the pelvic floor, we really don't care necessarily if it's prenatal, pregnant, postnatal, really anywhere in the lifespan. We're gonna treat it relatively the same. there may be some factors that we think about at each stage of life but relatively we're treating it the same. DEFINING A HYPERTONIC PELVIC FLOOR So first and foremost the definition of a hypertonic pelvic floor and the reason I put that in air quotes is because we will hear so many different things overactive pelvic floor tight pelvic floor is when the pelvic floor muscles are in a contracted state um or a spasm And so, the symptoms of this can be leakage, heaviness, pressure, a dragging sensation in the vagina, painful insertion, whether that is during intercourse, a tampon insertion, vaginal exam, or anything else. urinary urgency, frequency, constipation, incomplete emptying that could be of the bladder or of the bowels, coccyx pain, pelvic pain, low back pain, and hip pain. So when you have your client that comes in and they say, oh my pelvic floor is so weak because I pee all the time I just can't control it. recognize that that could be their pelvic floor sitting in a contracted state with the inability or I want to say inability or awareness to relax. And so when we think of that contracted state with the inability to drop, recognizing that with that could come weakness as well. So there's a lot of different bubbles that we want to make sure that we are not missing when it comes to a tight pelvic floor. THE ROLE OF THE PELVIC FLOOR The role of the pelvic floor is to contract. So if you can kind of conceptualize my shoulders as the pelvic floor, we want to close the holes and lift and we want to also be able to open the holes and drop. We want to be able to do this during a lot of different tasks and that can be toileting, intercourse, achieving an orgasm, lifting weights during daily tasks, so that's your laundry basket, the kiddos, or even your body weight, lifting your body weight up off the floor or out of a chair. And then as well as just the gym, being able to do things in the gym and having the ability to essentially tension your pelvic floor to the tasks in front of you. When we think of a tight pelvic floor, we kind of have, as a pelvic floor profession as a whole, have kind of gotten into this, the Kegel, you know, not doing the Kegel, it's kind of like lost its meaning in our space, right? If you have a tight pelvic floor, stop doing Kegel, stop, stop, stop, stop, stop. Really, that's not what we want to do. We often hear to not do the Kegel because you're in that contracted state. So if I'm already here and I do a Kegel, I'm not getting much range of motion. I'm not going anywhere. However, we need to know how to do a Kegel for a couple of reasons. A, when you cough or sneeze, the reflexive nature of your pelvic floor should be to squeeze. We want that reflex, we want that ability to be able to do that. We want to train that. But the other thing that we can do is we can utilize the Kegel to improve our proprioceptive awareness, right? So if I am in this contracted state and then I go and do a maximal Kegel, I might be able to then now, okay, here, that's where I'm in that down or relaxed position. It can help improve your proprioceptive awareness. So key goals should absolutely be a part of the plan of care. Teaching the person what a pelvic floor contraction feels like, so what does it feel like when they are closed and up, as well as what does it feel like when they're open and down. So we call that the attic and the basement. We've said this before, it's really nice to use those terms. So if you're out in the gym or out in public, you can ask your client, are you in the attic? Are you in the basement? Rather than asking them whatever cue you gave them during their pelvic floor exam, you're not out there asking if they're squeezing their buttholes. That's really kind. Teaching them how to do this can be done with internal cues or external cues, recognizing that someone may respond better to one or the other. And so you're gonna need to be able to do both. If you are a therapist who does not do internal exams, that's fine. You can refer or you can take our live course and learn how to do the internal exam. and teach this person how to do a Kegel with right there feedback, there's your tactile cue, squeeze my finger. That can be so so helpful and remembering that this is going to create awareness and just teaching them where they are in space. Now, we talked about the kegel. Other passive interventions are gonna be that diaphragmatic breathing. We talk about this all the time. Using that big belly breath as the diaphragm descends, it's gonna take the pelvic floor with it. It is a passive range of motion of the pelvic floor. They can do this in different positions. They can do this in child's pose. They can do this in a happy baby. They can do this in a supported squat. And then also lastly is the functional dry needling. We can use dry needling to help calm down the pelvic floor. Now, the last bits around what we wanna do in the plan of care for a hypertonic pelvic floor is not discharge once this person says, oh my gosh, I know I'm in the basement, I can feel it, I just know I'm there. Or I'm in the attic, my holes are closed, I know that. We want to load them. We want to make sure that when this person comes in symptomatic, that we are teaching them where they are in space, we are changing their symptoms, but now we are loading them. We are getting them back to where they were, ideally beyond where they were. We want them to not have symptoms, but we want them to not need us, really. So getting them stronger, so getting them into a gym, whether you are teaching them about, or I guess really learning what their love language is around exercise, and then leaning into that. And showing them the type of programming that they may want, encouraging them to certain gyms. I know here in Greenville, we have a ton of gyms. I've got a lot of options with a lot of wonderful coaches that I can essentially push these people towards. once they are symptom free and feeling a little more confident in the gym. So that is what I've got for you today. Join us online or on the road. So head over to PTOnIce.com to look at where we are next and we look forward to having you. OUTRO Hey, thanks for tuning in to the PT on Ice daily show. If you enjoyed this content, head on over to iTunes and leave us a review, and be sure to check us out on Facebook and Instagram at the Institute of Clinical Excellence. If you're interested in getting plugged into more ice content on a weekly basis while earning CEUs from home, check out our virtual ice online mentorship program at ptonice.com. While you're there, sign up for our Hump Day Hustling newsletter for a free email every Wednesday morning with our top five research articles and social media posts that we think are worth reading. Head over to ptonice.com and scroll to the bottom of the page to sign up.

Alan Fredendall, a fitness expert known for his work with #FitnessAthleteFriday, dives deep into creatine and its many facets. He demystifies the sources and benefits of creatine, clarifying common myths, particularly about its safety for young athletes. The discussion also highlights how creatine supplementation can enhance cognitive performance, especially for younger vegetarians and older adults. It's an enlightening look at how this supplement affects various populations and the science behind its impact.

Dr. Lindsey Hughey, an Extremity Management division leader specializing in myofascial decompression, delves into innovative techniques for treating patellar tendinopathy. She explains how to identify symptoms and demonstrates effective cupping techniques live. Lindsey emphasizes the importance of reassessing tenderness and strength after treatment. Tune in for insights on improving patient outcomes and the broader applications of myofascial decompression in physical therapy!

Dr. Jeff Musgrave, a lead faculty member in the management of older adults, discusses the importance of encouraging seniors to embrace life instead of living in fear. He shares insights from a recent motorcycle adventure, emphasizing the need to balance risk and reward. Musgrave warns against overprotecting patients, which can lead to deconditioning and social isolation. Instead, he advocates for empowering older adults to engage in meaningful activities that promote independence and enrich their lives.

Dr. Lindsey Hughey, the leader of the Extremity Division, shares insights into the role of tendons and innovative treatments for tendinopathy. She discusses traditional rehabilitation methods and critiques a new procedure called TENEX, revealing it does not score a 10 for patient care. Lindsey emphasizes the importance of holistic, conservative management alongside modern techniques for effective treatment. Gain valuable knowledge about tendon health and the latest advancements in physical therapy!

Dr. Heather Salzer, a specialist in pelvic health and nutrition, shares her insights on tackling postpartum recovery. She discusses strategies for mothers to meet their caloric and protein needs, helping them avoid relative energy deficiency in sport (RED-S). Through a compelling case study, she emphasizes the power of thoughtful meal planning and dietary adjustments. Listeners will gain valuable tips on nutrition that can enhance recovery and performance for new moms juggling fitness and motherhood.

Zach Long, lead faculty for the Fitness Athlete division, dives into the crucial role of lats in CrossFit. He emphasizes how strong and flexible lats act like the glutes of the upper body, vital for enhancing performance and preventing injuries. Zach also shares exercises to strengthen these muscles and spots deficiencies in athletes. Tune in for a fresh perspective on optimizing your fitness game!

Dr. Christina Prevett is a specialist in geriatrics and rehabilitation, shedding light on the complexities of treating older adults. She discusses the unique challenges clinicians face in rehabilitation, stressing the importance of positive patient interactions and tailored exercise programs. The conversation also addresses the confusion stemming from mixed messages in healthcare, the impact of professional burnout, and the ongoing efforts to enhance geriatric care. Dr. Prevett expresses gratitude for her colleagues and highlights educational opportunities in the field.

Dr. Zac Morgan, leader of the Spine Division and breathwork enthusiast, dives into the transformative power of breathwork strategies. He shares three key techniques: box breathing, physiological sighs, and 4-7-8 breathing, explaining how they can help manage stress and improve client outcomes. Zac reflects on his journey from skepticism to advocacy for these practices in physical therapy, providing actionable insights for professionals looking to enhance their approach. Tune in to discover these strategies and their impact!

Dr. Rachel Moore // #ICEPelvic // www.ptonice.com In today's episode of the PT on ICE Daily Show, ICE Pelvic faculty member Rachel Moore highlights the ways the 2024 Paris Olympics are changing the narrative around motherhood for athletes and providing resources and support along the way Take a listen to learn how to better serve this population of patients & athletes or check out the full show notes on our blog at www.ptonice.com/blog. If you're looking to learn more about our live pregnancy and postpartum physical therapy courses or our online physical therapy courses, check our entire list of continuing education courses for physical therapy including our physical therapy certifications by checking out our website. Don't forget about all of our FREE eBooks, prebuilt workshops, free CEUs, and other physical therapy continuing education on our Resources tab. Are you looking for more information on how to keep lifting weights while pregnant? Check out the ICE Pelvic bi-weekly newsletter! EPISODE TRANSCRIPTION RACHEL MOOREGuys, good morning. My name is Dr. Rachel Moore. I am here this morning representing the pelvic crew and I am so excited to talk to you guys about the Olympics and some pretty big stuff that's going on in the Olympics this year. The Olympics is huge in my area. Simone Biles actually lives like five minutes away from me, which is like my claim to fame humble brag. My daughter went to her gymnastics gym. And so if you've seen the Simone Biles documentary that's on Netflix, We were like fangirling and fanboying. We were watching it because we're like, oh, that's where Libby does gymnastics. So Olympics are a pretty big thing in our area, in our neck of the woods. And I think the Olympics this year are really interesting. And I wanted to get on this morning to highlight some of the things, especially when it comes to women in sport. that are really kind of setting apart this Olympics from ones in the past. If you didn't catch it, the opening ceremony was on Friday. It was a really interesting one because they were just kind of doing this parade of river boats down the river. And they incorporated all of these architectural pieces of France architecture into the opening ceremony. So it was pretty interesting to watch. And it just kind of set the tone for how different this year's Olympics are from a lot of the other Olympics in the past. So one of the key things that I think is really interesting, and I didn't even realize this until somebody else on faculty had shared a story about this, is that this is the first Olympics that has been almost equal representation as far as genders go. So the IOC set out to have a goal to have 50-50 participation between male athletes and female athletes. for this year's Olympics. And they actually just barely fell short of that goal. So the way it shook out with the amount of athletes that showed up and qualified and came to the Olympics was 51% male, 49% female. But that's pretty wild to see almost equal representation at this competition on a global level. A lot of us in the ice world are involved in CrossFit. We're kind of used to seeing that 50-50 representation. And that's one thing that really makes CrossFit unique compared to a lot of other sporting organizations. And so it's cool to see this transition or start seeing this change in this shift towards women in sport take this like worldwide platform where it's not a male-dominated thing and we're seeing more females represented and within that we're seeing more women that have children represented so motherhood is really starting to take a front row seat to the Olympics. So Allison Felix, who is the most decorated female track and field athlete, she's a US athlete. She actually made headlines a while ago because she lost her sponsorship with Nike when she told them that she was pregnant. And so that was this huge shakeup as far as women athletes and females in sport of, we are not a liability when we're pregnant. We're not less than because we choose to have children. And a lot of women, we see this a lot where People are delaying having children because of this athletic window and this fertility window kind of overlapping And so when athletes decide to start their families and then there's this response where they get dropped in their sponsorships, that sends us a certain message about what a female's role is and what her worth is in sport when she becomes a mother. And so Alice and Felix really spoke out against this and started this really amazing conversation about this overlap and about maternity leave and about just female in sport and how motherhood fits into that role. She took this to the Olympics this year. Um, so she's at athlete representative for the IOC and she actually started an initiative and it did great. And it's a thing now to open a nursery for mothers with young children at the Olympics. So historically the way it's always shook out in the past is that children are not allowed in the athlete village where athletes and coaches stay for the duration of the competition. So if somebody was breastfeeding a baby and also competing at the Olympics, they either had to choose to be separated from their baby for the duration of that competition, or they would have to kind of foot the cost of lodging for themselves. The problem with that is that Olympics is expensive and not everybody has the funds to even go compete at the Olympics. But then if we're thinking that somebody qualifies for the Olympics and now they have to pay for a caregiver maybe for their child and also they have to pay for lodging for their child or they're not going to be able to To be there that could make somebody not go to the Olympics that had qualified and had earned their spot So it's pretty cool to see this shift start happening. The nursery is actually sponsored by Procter & Gamble So Pampers is like branded all over it it's kind of funny if you look at pictures because they literally put Pampers and like every square inch that they possibly could and But it's a really exciting thing. So it's for children that are diaper age and below and their parents and their caregivers can go and kind of get away from the chaos of everything that's happening at the Olympics and have a quiet space to be together to spend time together. to bond. And then really a big thing is to nurse. The Tokyo Olympics, the last summer Olympics that we had, was right in the kind of height of the pandemic, or I guess kind of the downhill trickling of the pandemic, if you guys remember. And there was a lot of restrictions on the athletes. And so the athletes weren't allowed to bring support people, families, people had to stay behind. They were traveling with this like skeleton crew. And IOC The mothers to spend time with their children and to be able to nurse was Honestly pretty laughable. It was pretty wild if you if you just google like tokyo nursing room olympics Um, there's a picture of one of the athletes like two-year-olds laying on the floor And there's like a folding table with two folding chairs next to it And that's where the athletes would go To spend time with their children in between their events when they weren't training or they weren't preparing for the games again, if we're thinking about the message this sends that really tells people like you're here to be an athlete and everything else doesn't matter like we don't care that you also might be a mom oh it's it's okay you need a space well here's this like folding chair in the corner that message is so different this year the message the ioc is sending this year is that we recognize that the maternal timeline and the athletic timeline might overlap and your worth is not only as an athlete and we recognize that your worth also exists in motherhood. Allison Felix had this really cool quote. She said, I think it really tells women that you can choose motherhood and also be at the top of your game and not have to miss a beat. That's amazing. We preach that all the time in our division. We talk a lot, again, about how the fertility window and the athletic window overlap. And what we're starting to see is this trend of women pushing back and saying, yes, we can still be athletic. Yes, we can still be in the top of our sport. and also show up for our families, and also feed our babies, and us be their primary source of nutrition while we're training for the Olympics. So it's really cool to see this take, again, a worldwide platform to acknowledge that these things can exist at the same time. There's a couple other countries and groups that are showing up for their athletes as well. So the French Olympic Committee is actually paying for hotel rooms for their breastfeeding mothers. to stay in so again before athletes would stay in the athlete village with their coaches partners and babies would stay elsewhere they couldn't go spend the night with them they had to be in the athlete village so the french olympic committee this year has started an initiative where they're paying for hotel rooms for nursing mothers where they can go spend the night with their baby their partner can be there as well so kind of minimizing this interruption between this mother-baby bond and what's really cool is that they made a statement that this isn't just because quote-unquote the Olympics are here in our home ground This is something that we want to see carry over into future Olympics. So they're really again just kind of setting this example that motherhood matters and that we can do both. So really exciting to see when we look at the numbers. The US has 338 women on their team, which is the highest amount of women. on an olympic team france has 293 so these top two countries as far as women and female representation are really just showing up for all uh seasons of females lives um from what i could find i was trying to google like exactly how many moms are on the olympic team and um i even asked chat gpt i was like what percentage of olympic athletes are moms And it was like, we don't have that data. But I did see several articles that said that this year the USA team has 16 moms that are representing the US and five of them are on the basketball team. So kind of astounding that out of 338 athletes, if that number truly is 16, that's pretty wild. But again, it's really cool to see that representation and that acknowledgement as a whole. it's really exciting that we're seeing this culture shift that we have believed in and we have seen again in the crossfit world with annie thora's daughter and now tia and all of these top athletes really embracing their motherhood and talking about how motherhood has affected them as an athlete and watching this happen not just in the crossfit world where we all kind of live and spend time but in athletic world as a whole is so exciting and I just can't get over the fact that the Olympics, which is this massive platform that so many people are tuning into, are really highlighting and bringing attention and awareness to the fact that these athletes are also mothers. These athletes are doing these things simultaneously and it can be done. It's a really exciting message We are all about it here at ICE. We are here for it. We're excited to see it continue. And here's hoping that at future Olympics, we only see these accommodations grow between other Olympic committees, other country delegations, and that this nursery just continues to take off and that the athletes really enjoy it. SUMMARY If you guys want to hop in to our pelvic courses, we have a lot of chances to catch us in September. So we've got Hendersonville, September 7th and 8th, Wisconsin, September 14th and 15th, and Connecticut, September 21st and 22nd. So a lot of ways that you can come hang with us on the road in September. Our next L1 cohort starts September 9th, and our next L2 cohort starts August 19th. So if you're interested in an ice course, especially in that pelvic division, Head on over to PT on Ice and sign up for your course. Otherwise, keep an eye on the Olympics. If you guys have a favorite sport, comment it below. Let me know what it is that you're going to be watching. Obviously, I'm going to be all in on gymnastics because Simone Biles is essentially my neighbor, even though she's really not. But trying to get my daughter into horseback riding, so I keep hyping up all these equestrian things. so that she falls in love with horses. It's not working yet. We'll see. You guys have a great week. I hope you guys crush it. Thanks for tuning in. Bye. OUTRO Hey, thanks for tuning in to the PT on Ice daily show. If you enjoyed this content, head on over to iTunes and leave us a review, and be sure to check us out on Facebook and Instagram at the Institute of Clinical Excellence. If you're interested in getting plugged into more ice content on a weekly basis while earning CEUs from home, check out our virtual ice online mentorship program at ptonice.com. While you're there, sign up for our Hump Day Hustling newsletter for a free email every Wednesday morning with our top five research articles and social media posts that we think are worth reading. Head over to ptonice.com and scroll to the bottom of the page to sign up.