AUTO-GENERATED TRANSCRIPT

Brianna Battles  00:01

Welcome to the practice brave podcast. I am the host Brianna battles, founder of pregnancy and postpartum athleticism, and CEO of everyday battles. I’m a career strength and conditioning coach, entrepreneur, mom of two wild little boys and a lifelong athlete. I believe that athleticism does not end when motherhood begins, and this podcast is dedicated to coaching you by providing meaningful conversations, insights and interview topics related to fitness, mindset, parenting and of course, all the nuances of pregnancy and postpartum, from expert interviews to engaging conversations and reflections. This podcast is your trustworthy, relatable resource for learning how to practice brave through every season in your life. Welcome back to the practice brave Podcast. Today, I’m here with Mindy English. It is early because that is the only time that Mindy and I can coordinate our schedules to record. Mindy is a pelvic floor physical therapist, has a background in ortho and sport, and this is part of our podcast series, which is pelvic health for female athletes. And today we’re going to be talking about what to look for in a pelvic floor physical therapist. It’s a question that we both get pretty frequently, and we’d like to have a bit of a nuanced conversation around that, just to give you scope on something that likely you have no idea how to have scope on. So Mindy, thanks for being here. Give everyone a little bit of a rundown on your background if they haven’t listened to other episodes

Mindy English  01:39

with you. Yeah, thanks for having me. So like Marie said, I’m Mindy English. I’m a pelvic health and orthopedic physical therapist. I’ve been practicing for over 10 years, and if you had told me when I first started that I’d get into pelvic health, I probably would have thought you were crazy. Just didn’t seem like a realm that was interesting to me. And what I’ve discovered over the past 10 years is it’s a really fun realm where I get to blend both pelvic health and orthopedic background and get really creative with helping people who are struggling with whether it’s leakage, with running, jumping, playing with their kids, or heaviness or pain, all those fun things that come up as as we’re women, and as we gracefully age through our lifespan and so. So it’s been a really fun journey for me, and it’s been fun to collaborate with you and collaborate with other coaches and professionals to really figure out, how do we do this really well, especially for women who are wanting to perform at really high levels?

Brianna Battles  02:42

Yeah, absolutely. And, I mean, I think it’s not an area that either of us thought we were going to end up in. I think because when you come from a sport background, you’re like, Well, I don’t talk about like that stuff that’s like a totally different realm. And I think it’s not until you start coaching or treating a lot of female athletes that you realize it’s just so interconnected. And if we care about fitness and sport, that same conversation has to extend into the quality of life long term for women, for female athletes, and that’s where I think this becomes part of the conversation. Like I never cared, and never cared about any of this until I started coaching and realizing, oh my god, like so many people and so many women, have pelvic health symptoms, and I just didn’t realize the interconnectedness of exercise and that quality of life and what it like actually meant to have those symptoms long term. So I think that if you coach women, if you are a woman, if you treat women in any capacity as a practitioner, you have to understand that, like, pelvic health is part of the whole picture of what we are coaching, of what we are treating, of what we’re trying to help people improve their quality of life. Long term, it’s not just like solely focus on pelvic floor, it’s the whole system, and how we approach treating them, how we approach coaching them,

Mindy English  04:07

yeah, and I think the more, the more I’m in it. And, you know, I used to think youth athletes were like my favorite population, and I still really enjoy youth athletes. But now what I see I get to the opportunity to work with some young youth athletes who leap when they do their sport. You know, they’re gymnast, they’re cheerleaders, they’re dancers and and I commend them for being brave enough to say that this doesn’t feel right and I think something’s wrong. And I appreciate the people around me who realize that pelvic floor physical therapy can help them, yeah, and because then what I see is, if they didn’t get the resources when they were young, now we’re adults, and we’re having these same conversations, and 20 years ago, we didn’t always necessarily have those resources or no but just becomes this lifetime of patterns and problems. Problems that they just thought was normal or they didn’t want to say anything about. And now we’re trying to just unwind a lot more years of movement patterns, and it’s still doable. It just, we just have to be a little bit more patient with it. So it’s nice if we can catch people early on

Brianna Battles  05:15

totally and I feel like it’s the same kind of conversation where it’s like symptoms present after, either during pregnancy or postpartum. And people are just like, well, it’s not that big a deal. It’s only when I do double unders, or it’s only when I do X, Y or Z, or, yeah, it happens when I sneeze, but, like, whatever. And it’s sort of like this dismissed symptom, but really it’s the long term, I guess, consequence of that, like, maybe it’s manageable now at 30 something, when you have other ways to compensate, I guess, or it doesn’t affect you as much. But like, let’s talk about perimenopause, menopause and aging. Like, that’s when all that, like, probably will start to matter more, because, again, it’s these embedded patterns that we could have kind of proactively treated to improve that long term quality of life.

Mindy English  06:02

Yeah? And it’s amazing how, I mean, even my patients who come to see me for back pain or hip pain, and I I always ask and screen for pelvic health stuff. And it always amazes me how, just like, casually, people say, Well, yeah, I leak when I cough and sneeze. Yeah, like that. It’s just like, just gonna slide that in there, but it’s just like, it’s fine, like, why wouldn’t I? And so it’s a great opportunity to help people realize that that doesn’t have to be the case. I know it’s

Brianna Battles  06:31

always fun, like, I have so many of, like, my very close friends, people that fully know what I do and the stuff I yap about, and then they’re like, Well, I was like, doing jump and jump to get I, like, Pete myself, or I was just doing this and I peed myself. I was laughing so hard. Laughing so hard. I’m like, Do you know what I do? Like, yeah, I know, you know. But like, hey, people don’t care until, like, they want to care sometimes too, or they need to care. So let’s dive into the specifics, like, what to look for in a pelvic floor physical therapist? Because as some context, a lot of people will go, and they often feel like they’re not understood, or a they don’t even know what a pelvic floor physical therapist is. It’s kind of taboo they’re going to do what to me. And there’s like, a lot of resistance to going, or there’s a lot of like, I didn’t even know that was a thing, and then the experience of actually being there. So if they can get over that, that hurdle of the initial hurdle, then they get there, and sometimes it’s always like or it’s not always the best experience. I think we should talk about what to expect and what to look for. What do you got for us?

Mindy English  07:35

Yeah, so that’s a lot to unpack right now. I know. So I think there’s a couple things. So I think first, let’s start with what to expect when you go to pelvic floor physical therapy. Because I think, I think you’re right. A lot of people know about her or hear about it, but don’t necessarily know what that what does that even mean? What are we going to do? And so, much like if you went for shoulder pain, we’re going to talk a lot about your symptoms and what’s been going on. We’re going to get a little bit more into details, usually, of your pregnancy history, your if you have delivered, what did your birth experience look like? Were there complications? All those things. And I don’t care if you’re 20, or if you’re 75 I’m going to ask you about your birth experience, because it just helps me know, and grant the 75 year old might not be able to tell me as many details anymore, unless it was, like, a very memorable thing, but I still want to know, like, was it vaginal was necessary? Do you remember having any complications? And then we’re going to decide how it’s best to evaluate the pelvic floor. And sometimes that does involve an internal evaluation, and that’s always with someone’s consent. And sometimes people say, Well, my gynecologist or my urologist, they did that. And I say they did, but they’re looking at things differently than I’m looking at with an internal evaluation. We’re looking at strength of the muscles as the true way that we can measure strength of a muscle, and we can get into the nuances of pelvic floor strength at another time, but it helps us understand is there tightness in the muscle tissues? How are you able to contract and relax the muscles, because a lot of people will do a kegel, and they’re actually, like, bearing down, or they’re squeezing their abs a lot. They’re not actually squeezing the pelvic floor muscles. And they’re muscles that are kind of hard to identify. We don’t always realize that there are muscles down in that region and but there are. It’s a it’s a beautiful network of muscles and fascia and ligaments that all work really well together. So so we can kind of evaluate those things, and then we look at some of the orthopedic stuff too, or hopefully we’re looking at the orthopedic stuff too. I mean, I think especially if, if you’re having a hard time making it to the restroom, like for some of my older adults, I’d like to know, what does your hip strength look like? What does your mobility look like? Because is it just a pelvic floor issue, or if can you just generally not make it to the bathroom in a timely manner because of limitations in how fast you can move, or how well you move, for my active people and maybe a little younger people, I want to know also, what does your strength look like? What does your flexibility look like with all the other muscles around the pelvis? What’s your history of low back pain and hip pain and knee pain and ankle pain, all the things so that we can really start putting the pieces of the puzzle together. And so I think the biggest thing I hear from people is, especially if they’ve done some pelvic floor therapy before is I didn’t feel like my therapist understood what I was trying to do. And so I think that’s the hardest thing, because sometimes you don’t know until you get to a place that you might not vibe well with someone and and I think that’s going to be all healthcare professions, right? Like you can have your doctor, and you get there and you’re like, it just wasn’t, it’s not quite the right fit and and I get like, I’m not the right fit for everyone either, and that’s okay. There’s a ton of people out there, and there’s an abundance, and we just have to find the person that really understands what we want to do, supports us and what we want to do will advocate and has resources to help if they don’t have all the resources for you. And and to be fair, like nobody has all the resources, so you should have a vast network of people that you can refer to and and things like that to really help people get the help that they need. And then I think, on the other end, if you feel like you’re not getting what you need. One you have to advocate for yourself and ask questions, and if the person you’re working with is resistant to that, then that’s not

Brianna Battles  11:49

right, because it should feel like a collaborative experience, where like you’re being heard and understood and seen, and they’re tracking with what you’re saying, but you’re also able to interpret what they’re saying too, like it shouldn’t feel really forced, because ultimately, it’s a pretty vulnerable and intimate conversation. Most of us are not used to talking about our pelvic health or symptoms that we might be having during sex or during our period or whatever it might be, or like peeing or fecal incontinence or prolapse, something’s falling out of my vagina. What does that even mean? And like, being able to even verbalize that, like, You got to be able to share intimate details and feel like the person you’re sharing it with, like there’s a good level of like, understanding and professionalism. And I think the professionalism is like, that’s consistent, but it’s more so, like, your ability to have the conversation around that and feel like you’re being understood, and able to communicate what you’re experiencing, and then ultimately, like, communicate what it is you’re looking for help with, if it’s sport related, if it’s that, like, just trying to make it to the bathroom in time that urge incontinence, where you’re like, Oh my God. I mean, like, in my pants, I’m not sure I can make it or hold it, like being able to share all of that and then figure out, like, what, what’s the outcome that you’re trying to achieve? So then that’s really clear to the practitioner,

Mindy English  13:15

yeah, and I think that’s where things get missed sometimes, is there’s just, like, a miscommunication of what, what the ultimate goal and outcome is going to be. And I think it’s probably on both ends, right? Like, I think sometimes as clinicians, we don’t communicate very well what someone’s expected, like outcome could be, or prognosis, or how long it could take to really improve their symptoms. And so I think sometimes people feel like they fail physical therapy because they just didn’t give it enough time. And that’s probably on the practitioner end of not being really clear of expectations of how long it could take. How long does it take for strength gains to take effect? What does the research say for how long it could take for incontinence?

Brianna Battles  14:00

Yeah, I think the thing that we miss is, like, so much of pelvic health, like rehab and improvement is a neuromuscular thing. It’s not just attached to, like, be stronger, like, you need a stronger pelvic floor. It’s like, no, it’s like, literally rewiring your brain. There’s an element of, like neuroplasticity there, where you’re having to re coordinate aspects of like signals from your brain to your like pelvic health, to your muscular system there. And just like, I use this analogy a lot, so I know some of you listening are probably rolling your eyes, but it’s like, when you’re learning how to Olympic lift, you’re working with a PVC pipe for so long because you’re trying to, like, train that pattern so that it’s automatic, so that when you load that barbell over time, your brain and your body know how to coordinate that, like, pretty complex movement pattern, and the timing of it right. So much of Olympic lifting is it’s timing, it is timing, and it’s explosiveness in the right place. It’s. Absorption in the right place, and you drill that with a PVC pipe and unloaded barbell for a long time, and then, like you revisit training at lower loads for a long time, and that’s just part of that process for something that’s so dynamic and so kind of complex, like a complicated movement pattern. So when you were trying to sort of retrain your whole core system, which involves your pelvic floor. There’s a lot of undoing that has to happen initially, and retraining your brain to then coordinate with that system again so that then it becomes automatic. You’re not going to be a robot when you’re lifting or when you’re trying to, like, absorb the force of a sneeze or whatever, but that just takes a little bit of time. So I think when we can communicate to our patients, but also, like, practitioners have some some words to use with your clients, like, that’s how you help manage expectations. Yes, it’s not like an overnight fix. I’m not just gonna, like, press on the inside of your vagina and suddenly you’re going to be better, maybe for some people, that improves some some pain or some symptoms, but ultimately, it’s just like an undoing, and that doesn’t mean that you have to be sidelined. It just means that when you’re doing the activity, say, lifting or jumping, that you’re bringing a different level of intention and mindfulness to those movements than what you traditionally have, and that’s like, where we can create that buy in, and those, like, quick wins instead of like, we’ll do these five exercises a few times a week, and whatever, like, you’re not going to get most people to do that compliance is going to be, like, pretty freaking minimal. What are your thoughts? Yeah.

Mindy English  16:40

Yeah. I mean, I think it’s always a collaboration. But I mean, I think as practitioners like, we have to be the leaders of managing those expectations. And I think you’re right, the brain always is going to take the path of least resistance. And especially for athletes like they find every work around possible. And you can drill something and have, like, broken it down for a long time, and then you get someone, like, under a little bit more load or in competition, and it all goes out the window. And, you know, I was actually thinking about this. So my daughter’s 10, and she plays volleyball, and it’s they practice, like, let’s pass that hit. We know that’s what’s supposed to happen, but it starts getting, like, competitive or a little chaotic, and their instinct is to just pass that ball right over the net without, like, using their teammates. They’re just gonna they just, like, react right? And I think, like, it’s such a natural instinct at an early age, like you’re just your brain, just trying to figure out how to, like, survive, essentially, and get the task done. And so even though you’ve repped a bunch of times how to do it a different way, it doesn’t mean that it’s like a natural pattern yet, right? And I think of that all the time, of like, okay, we’ve rep this, and then we’re going to try and do a double under, or whatever it is. And maybe now I can do five, but I still leak after five, and if my goal is to do a lot more than five, if we’re not having that conversation and celebrating those little wins and also looking at, okay, well what? What else is missing? Like, is there a different strategy? Is there some capacity somewhere else, like in different muscles that needs to get built. Like, what’s the missing piece of that? So we can keep moving forward and then help help our patients understand, like, this is part of the process. We’re going to have ups and downs. We just don’t we want to try and avoid big peaks and valleys.

Brianna Battles  18:35

And I think that capacity piece is so, so key for everybody to communicate. Because if we can think of it like, again, it’s it’s how we explain this to the people that we’re working with, both from a coaching perspective and from a practitioner perspective. Is like we know that if you injured your knee, that you wouldn’t have these expectations to be under a 300 pound barbell at six weeks post knee injury most of the time, right? You would understand that, like, Man, I got to go back to some basics. I got to, like, get some treatment. I got to, like, build the musculature around there. I got to improve my range of motion. I got to give it time. And then ultimately, when I start getting under load again, or I start doing more dynamic movements, more high impact, it like might hurt still, or I might still have symptoms. And we don’t look at that as like, Oh my God. What a like. I’m broken. This is a setback. It’s not working. We’re just like, oh yeah, obviously that makes sense. Like, I haven’t done this in a long time. I’m still kind of rehabbing. It’s still not 100% that’s why it’s hurting, because you haven’t rebuilt that capacity yet, and it’s the same conversation with managing pelvic health symptoms. But again, we kind of look at like pelvic health through a vacuum, like an all or nothing sort of thing. So you can’t I mean, I know that a lot of you listening will, but like when you get discouraged because you can only do 10 double unders without peeing now, and you want to be able to do 50. Like, you got to really build that capacity, and know that that takes a little bit of time and a lot of reps, and, like you said, building that the system around it to better support that. But it’s not necessarily that, like it’s not working, or that that’s set back. It’s just that’s your current capacity. The same way that if you injure any kind of orthopedic injury, it’s a long runway to feeling like yourself again.

Mindy English  20:23

And I think that all or nothing mentality is really true. I think with leakage and prolapse, it like it’s either there or it’s not right. And I think because it’s such a different experience, and experience that is, like foreign, for lack of a better word, for a lot of people, then it feels like, if it’s there, then I’m, I’m failing, versus, like, pain. We all can have, like, work through some sort of pain at some point, yeah, and realize that we can make it through. We’ll, we’ll survive whatever we’re doing. And we have pain scales, right? Like in the medical world, we have pain scales. And so it’s like, oh, well, this is like a one or a two versus a nine out of 10 pain versus with like prolapse and leakage, that’s harder to quantify, because, again, it’s either there or it’s not there. And you can’t really say, Well, is it like a little bit of heaviness or a lot of heaviness? Because for most people who experience heaviness, like it’s just there and that’s uncomfortable, and I can’t Gage, like, is it just a little bit

Brianna Battles  21:20

absolutely so not every pelvic health professional is going to have a sports and ortho background or even like way of thinking. Yet, a huge demographic of people that pelvic health professionals are starting to see is the more athletic demographic who’s like, Excuse me, I am a proactive person. Something is wrong here. I’ve heard of pelvic floor. PT, and now, like that, volume of clientele has increased dramatically within what, like, the last decade, would you say, but probably even more so within the last five years, where it’s like, oh, this is a thing. There’s help. And female athletes are pretty, like, motivated to, like, I just want to freaking fix this. So if you’re a practitioner a pelvic health, PT, and you don’t really have a sport or ortho or, frankly, like a fitness background, what do you suggest to those professionals? Because this is like a huge deficit at this point, and people like my sister are frustrated and being told, I can’t help you beyond this point. Like, that sucks to hear, and I was pretty shocked that. Like, I appreciate the ownership of like, I can’t really help you beyond this point, but I’m also like, it’s not that hard. Like, it’s not that hard to simulate real life experiences, loads, volumes, intensities, whatever patterns. But like, it’s not always intuitive. So that’s me being frustrated. But give me your scope, because you’re the one actually in that world.

Mindy English  22:51

I mean, I think to start, I think the background to understand is that for most pelvic health physical therapists, the classes they’re taking are not teaching pelvic health evaluations in a functional manner, right? Like you, you learn it lying down. I think there are groups that are starting to teach it. But in general, for like the general, most popular level one, this is how we do pelvic for physical therapy, it’s not taught. And so if you have someone who’s only taken those classes, that’s all they know. And I think I’ve said before I didn’t think about a standing exam. I think I was listening to a podcast, and someone else talked about staying an exam. And I thought, well, that’s interesting. And so I think if you’ve not done a standing exam in your pelvic health physical therapist, find someone to try it with. It’s not as weird or scary as it sounds. And I think especially for active people, they really appreciate it, right? And they might kind of look at me with wide eyes when I first suggest it, but when I kind of give the why of like, I need to understand, like, how your muscles are functioning when you’re standing and, like, when you’re squatting, because, quite frankly, it’s different those and we know there’s some research coming out of like, how much pelvic floor activation is happening in a squat, which is great. It’s great to have that information, but the pelvic floor doesn’t function the same lying down as it does standing. And again, from a motor pattern perspective, from the neuromuscular perspective, it’s just it’s different, yeah, and I can’t think of a person off the top of my head that wasn’t different standing versus lying down. And so I think if you don’t have that information, you don’t have that background, you just, you have to get reps in it and when it’s appropriate, and or you have a colleague or someone that you can kind of practice like, how does this work? I think you just, you have to do it, you know, to try and get comfortable with understanding how the public for. Works in different positions. And then I also think if you know that you don’t have like estrom and ortho or sports background, it’s either like taking the classes to understand that, like, whether it’s taking your certification, or just taking like basic, like back and hip classes, right, or things like that, to just really broaden your knowledge of how to treat the whole area. And then also, like, I get there’s there’s rural areas, and there’s people who, like, they’re the one stop shop in town, and but there’s always people, there’s always personal trainers, there’s always someone nearby that you can collaborate with. You just have to go. You have to look for it. And I’m probably, I don’t know, I just, I like to go meet people. Like, I started following someone local the other day, and said, How’d you find me? I said, I just heard about you a little bit. And so I was just curious, like, curious what you do. Like, this is what I do, and I do both orthopedic and pelvic health, and just like to know who else is in the area and how we can be resources Wow each other.

Brianna Battles  26:08

So when someone is doing a standing evaluation, we do that because it simulates both their normal lifestyle, because, like most people, aren’t like laying on their back day in and day out, like we’re upright, standing, walking on our feet for a long period of time that could create pelvic floor fatigue, especially if someone who’s managing kind of prolapse symptoms. Or female athletes, when they’re lifting, obviously they’re standing up when they are doing impact exercise that’s all standing so what you’re feeling for to just like kind of paint a picture, is gravity and how that is influencing the different like, muscular reactions of the pelvic floor when you add load, when you add volume, when you challenge their capacity. So you typically, again, we’re painting a picture here. I wish, like I’m like, you guys can see this, I wish you could, but like you’re standing behind them, typically, right? And you have fingers in the vagina, and you’re feeling like the vaginal walls, right? And then we’re simulating a movement, whether it’s a cough or it’s an overhead press, or it’s a squat or it’s a hinge, and you’re feeling different points of whatever movement pattern or like scenario, that is how the pelvic floor muscles around your fingers are reacting from a contraction and relaxation standpoint, correct?

Mindy English  27:32

Yes, yeah. And so I usually I’ll have them stand and just do a pelvic floor contraction without any load, without anything first, I can kind of understand their baseline, so to speak. And oftentimes I’ll have them stand on one foot also, because it just again, helps me understand, especially if they’re like a runner or something like that running series of single leg activities. So I kind of want to understand what’s happening just in a static single leg, but yeah, and then we add load and kind of see, and it’s also, it’s first seen what happens. So let’s say someone’s squatting, okay, what? Just do a squat. And I just kind of want to see what happens with the pelvic floor. And then we’ve already talked about where symptoms are potentially in that movement. And so then it’s a nice opportunity to all say, Okay, well, let’s try, like, what happens if you try and contract, like, at the top of this movements keep contracted through the whole movement. Or what happens if we contract at the bottom of the movement? Or, like, what happens if we position your pelvis differently, or we time your breath differently? Like, what it gives a lot of just direct internal feedback, yeah, of what’s happening there. And so then when we have that information, and it doesn’t have to take a long time to figure out that information, like, we don’t have to spend a lot of time with my finger inside of you doing movement, like it really can be like a five to 10 minute process at the most. But then once we have that information, then we can translate that outside, into the gym, into our rehab exercises, to say, Okay, this is how we need to, kind of drill this movement, and this is how you respond best, yeah.

Brianna Battles  29:11

And honestly, I think that’s like, how you create a pretty fast win in office when most of the time, like, it’s you don’t really know if you’re gonna get a win when you send them away, like you’re like, hope that they remember the things that you talked about, and then when they go to CrossFit or they go on their run, that it’s going to be like, clicking. But especially for a fitness minded person, when you can simulate the stuff that they’re doing and you’re giving them those cues in person, it’s going to embed differently, like, they’re going to remember that because their brain understands movement. So you got to, like, use Exercise and Movement as a tool to reinforce some of these concepts that are pretty unfamiliar. Like, even if you’re like, I have great body awareness. Like, no, you freaking don’t. You were not taught any of this stuff. And this is not normal, like, things to pay attention to with your body. So you don’t have high levels of body awareness when it comes to your pelvic health. So that’s why, like using exercise as a vessel to reinforce what you’re saying is is just so incredibly important.

Mindy English  30:07

I think those quick wins are really important. So I think it’s important that we’re for all things, whether it’s pelvic health or ortho. We’re not just putting a band aid over something we want to teach long term changes and movement patterns, but at the same time to get some buy in, sometimes you need those quick wins. So what’s something that is a quick win that is also going to contribute to our path of just lifetime improvements? Yeah? But I can get some little buy in, because when we have some quick wins, we have some buy in, then they’re going to stay with it, yeah? But if you if they don’t like, I’ve had people who say, I mean, I went like, four visits, and we never even, like, assess this movement. And that’s can be really frustrating, right? For people, one, because it’s a cost. And two, you just, again, you feel like you’re on two different roads with your physical therapist.

Brianna Battles  30:59

Yeah, I can’t tell you the amount of people that are like, I went and it was so expensive, and I don’t feel like I got a lot out of it. And so then it’s like, you add the piece of like, you wasted my time, you cost me a lot of money. And like, I’m walking away with like, not a lot of input. So you got to be able to have like, in order to grow the field and the reputation around pelvic floor physical therapy, you have to give them a win, because they have to see the investment being worth it, that there’s actually like, a really good ROI because they’re not going to come back if they feel like, I wasted a lot of time, I wasted a lot of money, I don’t really feel understood and like, how is that actually going to help me to stop peeing when I’m at 90% of my one rep max doing deadlifts, they have to feel like you get them and that you can actually help, of course, like P and Pa coaches, we are the ones that can bridge that gap. Like, I know that this is the symptoms that she’s working with that she has. Like, yeah, I can help her get to the point where she’s not peeing at her one rep max. And I can do that without having to do any kind of, like pelvic floor assessment, like at all. We can coach from the outside in and make a lot of different improvements. But I think it starts it with a physical therapist being able to teach a lot of like the like the PMP principle, basically. So shameless plug for the coach. Course, if you’re a practitioner, it is very much for you to help under like, help bridge that gap between the work that you know and do, and also, like coaching applications to help scale your athletes either up or down by coaching from the outside. And we’re looking at breath, tension, pressure, position, and then connecting it to the particular movement. So there’s five variables that we sort of troubleshoot, and you can do that in an internal assessment, in a standing assessment, because then they can take that feedback and apply it to when they’re doing a deadlift in the gym, or apply it to when they’re doing those double unders, and they have those five variables like, sort of like a checklist to go through that’s being reinforced so truly trying to connect the dots between your world and my world, and the athletes world, that level of compliance and buy in and getting that win is so important, because they got to be able to connect what they’re getting from you feeling like it’s worth it, so that then when they’re going to the gym, they’re like, Okay, I know I know what I’m doing, because I had that there, and I’m reinforcing it here.

Mindy English  33:20

And I think, like, helping people understand. So we just talked a lot about function and standing and stuff. And, yes, I think all of that is awesome. It doesn’t mean that there isn’t a time and a place to be on the table and, like, bring it way back. And, like, really figure out, like, how do we connect? Where? Where do we find some breath? Where do we find some pelvic floor contraction? But you have to communicate that with people of like this is we’re building a foundation here, and sometimes that foundation takes a little bit longer to build. And I think sometimes you see, like on the internet and stuff like function, function, which, again, I am like the queen of we have to do function. But I think what gets missed from that is the work that happened before all that. And so then again, I think it creates this, this feeling of I’m getting less than because maybe my PT didn’t communicate very well with me that we’re starting here. We need to do some of these, like, basic kind of rehabby sort of exercises to then get you to that, yeah, no.

Brianna Battles  34:27

And again, there’s like, absolutely has to be a foundation. Again, like, just like you’re drilling with a PVC pipe for your Olympic cliffs, you’re working to even, like, be able to feel, like, where do I hold a lot of pressure? Where do I hold tension? How do I learn how to let that go? Okay, I can feel what my body’s doing when I inhale. I can, like, now I’m like, channeling some awareness to my pelvic floor and feeling that like, sort of let go and like, drop and release. And then I’m feeling it engaged, like, actually getting that neuromuscular feedback and awareness and connection that is the foundation so that you can scale. Up so that when you’re doing a standing evaluation, so that when you’re in the gym, you know what a pelvic floor contraction is. You know if you’re holding tension there. You know if you and you know how to, like let go of some of that tension. You have those that skill set. Because so often, it’s not always the movement that’s triggering it. It’s the current state of your pelvic floor and what it’s doing and everything prior to being able to perform that particular movement that day. So again, you got to have that like, level of body awareness, which is created most of the time in session. I tell everybody, if you can go to pelvic floor physical therapists and have them give you an idea of what your tendencies are, whether it’s in pregnancy or early postpartum, they’re going to give you an idea of like, okay, you tend to hold a lot of tension in your pelvic floor. Here’s how we do some down training exercises to let go of some of that tension. Okay, this is a full, full relaxation here. Now, like, we’re going to contract, okay, that’s like a three out of 10. Let’s try a 10 out of 10. So you know what that feels like. Okay, now let that go. And like, being able to create that awareness of contraction relaxation, where you send pressure to are you? Somebody who pressures down into the pelvic floor? Most people, that’s very subconscious. They don’t even realize that they do that and how much that’s triggering their symptoms in exercise, but also, like in things like when they sneeze, so redistributing, getting into positions, making adjustments there that can make a really big difference. It’s not just like that. Their pelvic floor is broken because they had a baby. There’s a lot of compounding factors to that.

Mindy English  36:30

Yeah? And I think, just like you said that pressure distribution makes a really big difference, huge.

Brianna Battles  36:35

Yeah, for people, yeah. Trouble shoot that on your own most of the time. Like, I mean, obviously I try to teach that, but like, it’s so helpful to have somebody else feel, watch, observe, cue, and then give you that individualized feedback, because it’s not intuitive. None of this is intuitive. That’s kind of the whole reason both of us have great jobs

Mindy English  36:59

well, and I think, like you said, we all have tendencies. And I always tell people, if you know what your tendencies are, then we can work out of it, yeah, but if you have no awareness of it, then it’s just always going to feel like something’s wrong, or what I’m doing isn’t working, but it like, if you’re doing all this work, let’s say on the table, and yeah, you’re doing great relaxation, but you stand up, and your tendency like, you squeeze your bum and tuck your bum under the whole time, like, but you don’t realize that that’s your tendency in standing and that that can oftentimes create more tension in the pelvic floor. It puts the pelvic floor in a position that isn’t as optimal for different movement patterns. But if you don’t know that, that’s what you’re doing, and you’re like, leaking while you’re doing dishes or holding your kid or whatever it is, or feel heaviness, because we didn’t know that that was your tendency. So you just it’s just awareness. And I think awareness doesn’t mean it’s good or bad. It’s just what it is. Like some of us are wired to be a little bit more wound up. And that’s

Brianna Battles  38:06

talking about Mindy,

Mindy English  38:08

not you or me, not the people who are up at 6am recording a podcast radio, but that’s just how we are. You can’t you’re not going to change that like that’s it serves you well in a lot of different ways. We just have to figure out how to optimize it and how to like not allow that tendency to hold tension to restrict you from the movements

Brianna Battles  38:32

you want. No, I mean, it’s, it’s really like kind of playing that long game of of making small adjustments, knowing that it’s going to be, you know, progress is obviously not linear, and giving your physical therapist a chance to, like, kind of enter into this relationship with you, like a coaching relationship, it kind of has to extend beyond just treatment, because now we’re like, we’re evolving the experience with them as time goes on, it’s like a teaching into like awareness and teaching into application, into trial and error, and ultimately, hopefully, they don’t have to see you forever or for a super long period of time like you don’t. I should probably be careful how I say this, but there’s a lot of practitioners that like you don’t need to be going every single week for the rest of your life. And if you are like, I’d say that’s a problem with a practitioner, you should be able to scale away from having that level of care and be doing a lot of maintenance and management and troubleshooting on your own in the gym and then revisiting as needed. But again, I think in this extends beyond physical therapy. There’s a lot of people that are like, I have to go see this person every week or every other week, or else. I’m broken. I’m like, then we’re missing something. There’s a problem there. There’s a problem there. You’re missing something in your exercise, in your lifestyle, or in your treatment. You should not be that dependent on a practitioner. And I’m sure there is new. Response to that, but for the most part, that seems pretty problematic.

Mindy English  40:05

Yes, there’s always you get canceled. Yeah? I mean, I think there’s always nuance to things, always

Brianna Battles  40:13

exceptions, but

Mindy English  40:14

yeah, and I think being a friend of like, on the patient side, what are your expectations, right? Like, if you tell me, I just want I’m coming to see you, I just need a couple thing. Like, just tell me that up front, I might still educate you on why it’d be good to do some sort of a follow up and just check in and make sure that everything’s going well. Or if you know, I have people who drive a distance to get to me. Like, coming twice a week isn’t realistic. Like, I have people who say, like, I can’t afford the gas to do that. Yeah, right, which is valid. I get that right. And so then again, it’s partnering. Like, what, what makes the most sense from what we know, like, from a research perspective, a clinical perspective, of like, what is going to get us the best outcomes? But then also, how do we meet you with where you’re at too, and then again, managing those expectations, right? Like, depending on your condition, sometimes, again, things take time. And so if it’s only doable to do every other week, that’s fine. We just have to realize that we could have a little bit longer runway to get to where you want. And I say that to people not to like, make you feel bad that you’re not coming all the time. It’s just like, that’s just the reality, and let’s work with where you’re at. But I agree like, it doesn’t, it doesn’t need to be like, a lifetime every week where you’re coming to see me like I want you to work on things for a little bit. Once we get to a certain point, I want you to work on it, and then if something comes back, call me. Let’s revisit it, but, and I’m here for you for your whole lifetime. Like, just keep coming back if you need something, but, but I want to empower you. I want to empower you to understand how to kind of coach yourself through some movements once we get to certain points well, and really from the beginning too. I should say, like, I want you to understand again, understand your tendencies, and then how do I get myself out of some of those tendencies? And then when those aren’t working, then let’s have a conversation to see, Okay, what else

Brianna Battles  42:19

is great? What’s missing? Yeah, so if I’m looking for a pelvic floor physical therapist, one, there might not be one close to me, depending on where I live, because there’s just not access and a lot of different places, more rural communities, and so in that case, there can be telehealth opportunities for you, or like you said before, like someone might drive, and it might be a one off appointment that they come they drive a couple hours to see you. So that’s one scenario where, like, options are just truly limited based on location. Option number two, you live somewhere where you actually do have some some selection. You have options of people that you can go to. I think in the last five ish years, we’ve seen a huge increase of pelvic floor physical therapists, like, in more areas, like, there’s more than just one in a lot of cities now, or a lot of like areas. I mean, we’re like, in the Boise area, and there’s so many now, like, and I know it was not like that when you first started out. So we have a lot of a lot of new practitioners here. And if I’m calling around trying to find who is in alignment with me, normally, I would suggest doing some stalking of the people. Before you’re just like, Oh, I’m just going to go to them. I would suggest looking at their website. I would suggest looking at their background. I would sit like in their educational background, and even like their personal interest, you can get a kind of feel for somebody’s vibe. Look at their Instagram, social media, if they have that, where you’re collecting information, so you can kind of have an idea of like, who in kind of like self filtering, like, who’s going to actually be the person that can likely help me based on what their educational background is and kind of like their vibe, if they’re sport, ortho versus but like, versus somebody who you’re like, you know, I’m not vibing with that. That’s just like, not really my thing. And so you have to be able to sort of vet people based on you, the maybe high strung athlete, brain female athlete who’s like, I want results. I want somebody who gets me. And if that is you, then you’re actually looking for a very specific avatar of a PT, and you can do a lot of that work in your stalking prior. So let’s just assume that happened. Now you call the office, what are some questions that you think can help get an idea of like, is this physical therapist right for like, what I’m looking for? How can I know that?

Mindy English  44:41

Yeah, so I think there’s a couple things. One, a lot of people do what they call, like, Discovery calls, or like we do, like free screenings, where sometimes I tell people, like, we call it a free injury screening, but like, you can also come and just, like, talk to me for 15 minutes and. And let’s just like, I get to know you, you get to know me, and I can kind of talk about how I might be able to help you to be fair sometimes, like when you call, you get the front office person in, and the front office people run the show, but they might not always be able to answer all of your questions, but they should know, like, does this PT? Do they do internal evaluations? Do they tend to work with a lot of athletes, or someone who does x, y, z, what other sort of treatment techniques might they use, like, all of those things they should be able to, in general, kind of give you an outline of, like, how many visits do patients typically come for? Things like that? And even, is there an opportunity for me to talk to the best Right? Like, is there an opportunity for me to meet her or ask some questions? Like, if someone has questions, like, I will find time to whether I need you to, like, schedule, some time on my schedule, or I make a phone call, like, I will find some time to come and talk to you. And I think, I think that’s really important, and that’s how you can do some vetting before, you spend your money, and it takes some time, right? Like, especially if you’re an area that has multiple clinicians like you might, you might need to do a few visits and kind of see or ask, you can ask your friends that’s a huge thing. Like, who did you go to? How are, how are your results? What did treatment look like all of those.

Brianna Battles  46:43

Yeah, the referrals is so huge like, and so your reputation will precede you in a lot of ways. And so I think that’s why, like, hopefully, I think so many of us who end up in professions where we’re helping others have that growth mindset of like, I want to learn more. I want to do more. Hopefully we’re not complacent in our growth trajectory as professionals, but ultimately, you’re going to have an established reputation in your community for what you can do when what you can’t do, or what you won’t do. And so I do think that this makes for a case of like, if you’re seeing an increase in this population as a practitioner, then knowing it’s time to learn how to better support them, learn how to work with them, learn how to speak their language and help bridge that, because that will be a loyal clientele who will refer to you. I mean, your practice has skilled a lot with just that avatar alone. Nevertheless, all the other people that you treat, because when you start getting known for like, yeah, I can help you, like, Stop peeing, do it when you’re doing double unders, or improve your prolapse symptoms when you’re going overhead in your movements. Like, that’s going to be like, feeling seen and understood. And like, you can actually help deliver results that’s going to be huge for your development as a practitioner, as a business owner, and in terms of getting more more clients and scaling your practice. So again, if you’re a coach who or a practitioner, you want to learn more, consider becoming a certified pregnancy and postpartum athleticism coach, because it is transferable to working with your patients. It is transferable, obviously, to coaching this population, but there’s a lot that we can do to, like, really bridge the gaps between your world as a practitioner in the physical therapy space and my world in the coaching space. And we just truly have to work together, collaborate, bridge that gap, and then our patients and our clients all benefit from that. They do.

Mindy English  48:38

Yep. Collaboration makes everyone better. Yeah.

Brianna Battles  48:42

Well, Mindy, thank you for spending your morning with me. You guys. Stay tuned for more in our pelvic health series for female athletes. If you have questions about this episode or any of the other episodes we’ve done, this is a new thing in 2025 so we have like two, I think we’ve been done to now. This is our third, third episode between Mindy and I. At least on behalf of this series, we have others that we’ve recorded the past as well. But in terms of this series, this is our third, and we’ll be covering one topic a month for this year. This as a way to help make it less confusing out there for you. So Mindy, thank you for sharing your time. Thank you. Bye. Thank you so much for listening to this episode of the practice brave podcast. If you enjoyed the show, please leave a review and help us spread the work we are doing to improve the overall information and messaging in the fitness industry and beyond. Now, if you are pregnant and you are looking for a trustworthy exercise program to follow, I have you covered. The pregnant athlete training program is a well rounded program for pregnancy with workouts for each week that are appropriate for your changing body. That’s 36 weeks of workouts, three to four workouts each week, and tons of Guide. Experience on exercise strategy. We also have an at home version of that program. If you are postpartum and you’re looking for an exercise program to follow. The eight week postpartum athlete training program would be a really great way to help bridge the gap between rehab and the fitness you actually want to do from there, we have the practice brave fitness program, which is an ongoing strength conditioning program where you get new workouts each week and have a lot of guidance for myself and my co coach, Heather Osby, this is the only way that I’m really offering ongoing coaching at this point in time. If you have ever considered becoming a certified pregnancy and postpartum athleticism coach, I would love to have you join us. Pregnancy and postpartum. Athleticism is a self paced online certification course that will up level your coaching skills and help connect the dots between pelvic health and long term athletic performance, especially during pregnancy and postpartum, become who you needed and become who your online and local community needs by becoming a certified pregnancy and postpartum athleticism Coach, thank you again for listening to the practice brave podcast. I appreciate you, and please help me continue spreading this messaging, this information and this work.