Why Women Should Pay Attention to their Pelvic Floor According to Physical Therapist Patricia Ladis
Show Snapshot:
Think about your pelvic floor much? Women’s wellness expert and physical therapist Patricia Ladis thinks you should. Your core matters: think bladder and rectal control, improved sexual function, support for your spine and neck, and more.
Patricia offers scores of tips to keep your core in tip-top shape and dives into middle-age pelvic floor dysfunction, including biggies like bladder problems, incontinence, pelvic pain, and organ prolapse. We uncover pelvic floor exercises beyond Kegels, why to get a pelvic floor evaluation, and walk through a simple at-home wellness evaluation you can try as you listen to the show.
Bonus: we talk midlife exercises for active aging, proper breathing for optimal health, and the fitness activity Patricia thinks everyone should add to their 2022 exercise mix.
In This Episode We Cover:
1. Yes, your pelvic floor matters. But so does the rest of your pelvic “canister.”
2. What’s your core canister? Glad you asked! We get to the bottom (pelvic floor), and the top (diaphragm), the front (transverses abdominis), and the back (multifidi / lumbar spine muscles) of your canister on the show.
3. True “pelvic floor” health requires a 36O-focus on your core canister—which powers key daily life functions like bladder and rectal control, and optimal health of the spine, pelvic and sex organs.
4. Common pelvic floor dysfunctions (bladder control, pelvic pain, incontinence), what to watch out for, fixes to consider
5. Surprising pelvic problems (yup – your bad back and sore neck may be rooted in your pelvis).
6. How simple breathing exercises can improve pelvic (and overall) health.
7. Wondering if you should see a pelvic floor therapist? We walk through an easy at-home evaluation to help you decide?
8. Think beyond Kegels. Injury-free exercise ideas as you age, hacks to help pelvic health (stop crossing your legs!), strategies to squeeze exercise into a busy day, and THE exercise to take up in 2022.
Quotable:
Your pelvic floor at the bottom could get tight in the back, tight in the front, loose in the front, loose in the back, could have some scarring from vaginal birth, some asymmetries because you do a certain sport, or you played an instrument, or you like to cross one leg over the other all the time and it changes your whole alignment. So, it’s not just, “Oh, I have to make sure I do my Kegels.”
Don’t just focus on cardio because it’s not going to get you the results that you want. You need to start strength training because our hormones change and building muscle is key for keeping all of these wonderful systems of the body active.
More Resources:
Follow Patricia:
Patricia’s Book:
The Wise Woman's Guide to Your Healthiest Pregnancy and Birth: From Preconception to Postpartum
Transcript:
Katie Fogarty (0:04):
Welcome to A Certain Age, a show for women who are unafraid to age out loud. All January long we’re talking about the systems that support and guide us, that keep us on track, that center us; which is why I’m so excited about today’s show, our focus on our actual literal centre, our pelvic floor. Now you did not get to midlife without knowing about the pelvic floor; the hammock stretching between the tailbone and the pubic bone that supports your uterus, bladder, and rectum. But there is a chance you made it to midlife without knowing how critical this part of the body is to daily life. The pelvic floor controls your bladder and rectal urges, keeps your pelvic organs in place, is key to sexual function, and helps support your core and spine—basically all of the things. But guess what? Your pelvic floor, just like the rest of you, changes as you age.
My guest today is somebody whose idea is to keep your maturing pelvic floor and body healthy and dives into common challenges to tip-top functioning as we age. Patricia (Ladis is a licensed physical therapist and expert on women’s perinatal wellness and the leading practitioner of orthopedic physical therapy in New York City. In addition to her expertise in women’s wellness, she specializes in treating professional dancers and athletes and has worked with Serena and Venus Williams and tennis players of the US Open, Wimbledon and the Olympics. Welcome Patricia.
Patricia (Ladis (1:29):
Thank you so much for having me, I’m so excited to be here. Happy new year.
Katie (1:33):
Happy new year to you too. I’m really excited we’re kicking this off for a bunch of reasons. I have wanted to talk about the pelvic floor since my very first show when my inaugural guest, Dr. Anita Sadaty got to the end of her conversation about menopause and the vagina and said off-camera, "Katie, you absolutely need to get somebody in here to talk about the pelvic floor." And that was 18 months ago, so we’re finally doing it.
Patricia (1:58):
Awesome.
Katie (1:59):
So, I want to dive in, set up a little bit about the pelvic floor which I’m going to admit I learned from the Google.
Patricia (2:06):
Yeah, not bad.
Katie (2:07):
Not bad, good. I want you to tell us more about the pelvic floor and things like childbirth and menopause and aging and how it can sort of impact its health, broadly as a stage setter.
Patricia (2:17):
Well, just as you just described, the anatomy and what the function is, a lot of people don’t realize that it’s a very responsive structure to breathing. So, I happen to also be a behavioral breathing analyst. So, the pearls you’re going to learn from me today are a little bit more deeper than Google would give you which is that it’s really a circuit, you’re dealing with an abdominal canister that has pressure, it’s a pressure system. You have a top, which is your diaphragm; the bottom which is your pelvic floor; the front which is your transverses abdominis, your abdominals; and in the back, your multifidi, basically your lumbar spine stabilizing muscles. That whole 360 circuit provides a level of support.
Now, your pelvic floor at the bottom could get tight in the back, could get tight in the front, could get loose in the front, could get loose in the back, could have some scarring from vaginal birth, could have some asymmetries because you do a specific type of movement pattern or you like to do a certain sport in your life, or you played an instrument, or you like to cross one leg over the other all the time, which creates almost like a tendency for one side to be slightly tighter than the other, and it changes your whole alignment, possibly. So, it’s not just, Oh, I have to make sure I do my Kegels as I age because my pelvic floor is gonna get weaker, I’ve had kids or I haven’t had kids, or I did a lot of this sport or that sport. It’s also, do I have balance there? And is the rest of the circuit working so that my pelvic floor can optimally work? Because it’s not just in isolation. And that’s the one thing that I think a lot of people miss. They just think, Okay, I gotta make sure that I do my Kegels, I gotta make sure that I’m strong, I gotta make sure that I stretch out my legs and I keep my pelvis strong, but they don’t think about, Am I actually breathing the right way? Because theoretically, when your diaphragm is actually active, all of these muscles are ready to stay online. It’s kind of like the electricity plugged into your computer to get your computer to work. Your pelvic floor won’t work if your diaphragm doesn’t work, period.
Katie (4:42):
This is so fascinating. First of all, when you started talking, I literally uncrossed my legs [Patricia laughs] I was like, I’m probably doing something wrong that I shouldn’t be doing. The image I used earlier that I found on Google is that of a hammock but I loved what you talked about, the canister. That it’s like really 360, there’s a top, there’s a bottom, there are sides, they’re in the middle. If we’ve had some of the challenges that you’ve talked about, what are some of the common issues that we might see. Again, I’ve read things about like, diastasis recti or maybe incontinence or uncomfortable sex. What are some of the challenges that women come to you with when this area of the body is not aligned the way it should be? Let’s start with that and then we’ll talk about what you do to address those.
Patricia (5:32):
Well, there’s a wide range of things from, I’ve got literally feeling like a sharp searing pain at my vagina, right, or at the pelvic floor. Or, I can’t make it to the bathroom, right, incontinence, or stress incontinence. Or, I’m having painful sex. Or, my back keeps going out and kind of travels down into that region. Or vice versa, I have this pain from my pelvic floor that shoots all the way up to my back. There are so many, vast, different types of symptoms and pain processes that happen and sometimes even like, I just herniated my disc and now my pelvic floor is a mess. I never had incontinence before but ever since I threw out my back, I don’t feel strong down there anymore.
So, anything can feed into this area. And as you said about the hammock, I like to think about it as a diamond, like a baseball diamond; front, back, side to side. The front is your pubic symphysis; the back is your tailbone, your coccyx; the sides are the two bones that you sit on, the sits bones or the ischial tuberosities. And that whole span, that diamond, really needs to have that good tensile, that hammock that you’re talking about, it has to have good fibers or you’re just falling through. And if one side is a little too cinched compared to the other, there’s going to be a lack of kind of coordinated contraction. And so, that’s just local at the pelvic floor. But you could have all sorts of issues. I’ve had people that call it a headache in the pelvis. Sometimes if you’ve had a bad fall to your butt, maybe you skied or maybe you just slipped and fell, and never took care of it and all of a sudden you started getting headaches, literally cervical spine problem, neck problem. Sometimes I have to go down and work on the pelvic floor and you don’t even know you have a pelvic floor dysfunction.
Katie (7:34):
Wow, that’s amazing.
Patricia (7:35):
So, it’s like you may not even have pelvic floor issues, but yet you have this other thing, I’ll always check you just because you have neck pain, you have to look at the opposite end because it could feed into it as well. Sometimes you don’t even know it, right. And it’s funny, because I talk a lot about care around pregnancy and around the time when your pelvic floor gets the most stress obviously—this big watermelon coming through—and sometimes right after that, you will have either adhesions, scarring, so there’s actually force trauma to the area and that sometimes is not handled. In a country like France and some European countries, women get 12 visits with a pelvic floor physical therapist after birth so that they can prevent these issues later on.
Katie (8:28):
That’s so smart. [laughs]
Patricia (8:29):
Yeah. So, it’s kind of like, Oh I’ve run the marathon and I think I’ll just get up the next day and start running again. No, you need a break, you need time to rest and heal those structures. But what if those structures didn’t heal in a balanced way? Right, so it’s always really great to, no matter what, at what age, you can change this and having a pelvic floor physical therapist, a women’s health physical therapist, helping you, should be normal, like almost like a physical physical. Getting a physical for your physical body should happen because we can prevent all sorts of hurt later in life.
Katie (9:09):
This is so fascinating. You touched on something, how there’s no age at which it’s too late to get this evaluation and get this fixed. I want to dive into that when we come back from this quick commercial break.
[Ad break]
Katie (10:25):
Patricia, we’re back from our break. I want to surface what you said about; it’s never too late, there’s no age that you’re at where you can’t address some of these issues. So, how does one do that? Do you recommend a baseline evaluation for all women to see what’s going on? Or should women be experiencing symptoms and pain before they come see you?
Patricia (10:47):
I see a wide range, I would say either. Obviously if you have symptoms, you have to take care of it because it can get worse. Now, it can resolve on its own but if it doesn’t within three to four weeks, you need to go see someone. In general, do I believe that women should have women’s health physical therapy at some point in their life? Absolutely. I had no symptoms after I had my three children and I’ve had all three births. But I went to one of my employees and, you know, made sure. She’s like, you have a little bit of you know, scarring here and scarring there.
I think a good way to take this message home is to explain one example I have. So, I had a patient that I was treating and she was complaining about her mom. She was like, you know, my mom she always had a bad back and she would tell me, Patricia can you prevent me from having a bad back? She was coming to me for a hip issue and she’s like, I don’t want to have a bad back that my mom does. Once a year or twice a year she is bedridden for about a week when she has her back “go out,” quote-unquote. But lately, this past year it’s happening like every other month. It seems like she’s working from her bed literally for a week and then she feels fine and then she forgets about it that month and then it happens the next month again. I said, well if she went from one to two times a year to every other month, she really needs to check this out.
So, she came in and yeah, she had some back stuff and yeah, she had some stuff and what I ended up doing with my evaluation was I went deeper. Because our methodology is getting to the root cause, like why? It’s not just like, “Oh I herniated a disc, oh my pelvis is a little off, oh I’m always crooked a little bit,” or, “I carried my kid on one side,” or, “I played soccer in college, whatever and I have these issues.” No. What is the root cause of why you’re having pain now or why your body isn’t balanced enough that you’re not doing everything you love to do well? And I figured out that a lot of the vectors of pull in her body that were causing her back not to be able to be balanced and feel good was actually coming from her C-section scar. This woman was 65 years old and she had had her last baby at 30. So, this is 35 years of her having a scar issue that was tugging on her back and basically probably whatever she was doing at the time, if she stressed it out a little bit, her back went out. The victimized issue was the back because it was compensating for an imbalance around the scar in her pelvis, right, her pelvic region. And so we released it and in three sessions she had no back pain and she has not come back. I see her daughter still once in a while just for check ups and things and I’m like, how’s your mom? And she’s like, fine. [laughs]
Katie (13:44):
That’s astonishing. And how do you release the C-section scar, what does that entail?
Patricia (13:49):
Yeah, so it’s manual hands-on work. One of the things that I feel very blessed is that I always loved helping people. I was a professional dancer, we were always around injury and helping each other and figuring it out because who had money? And it was all about getting into things with your hands. And when I went to physical therapy school, I loved the manual therapy aspect of things. I didn’t want to not touch my patients and just show them exercises. I didn’t want to not touch my patients and throw them on E-stim and ice and heat, I really wanted to feel what was going on. So, I took a lot of extended coursework in trying to sense and get really refine the skill set. So, it’s really about getting to a very trained, knowledgeable person, who has really good hands who can actually sense different pulls in the body and feel where they’re coming from. Now, this woman, it didn’t have to be her C-section scar. It wasn’t that I was obsessed with making sure that the pelvic floor and the abdomen was working right. It’s literally that I was pulled there when I was doing my assessment. So, you need a very thorough biomechanical analysis and really use your hands to unwind all of that.
The good news is that the body, honestly, I come from the whole rationale and thought process that your body is wise and it is meant to heal and help you. But, it could have some barriers. So, I look at a physical therapist as the person that helps to remove those barriers so then your body just innately heals, right. That innate wisdom takes over of the body to just heal and eliminate the pain. That’s why I made the practice Wise Body, because I do feel that way. I always tell my patients, I empower my patients: your body is not working against you, it’s just doing as well, as best it can with what its got.
Katie (15:38):
What its got. Is that what biomechanics is? Tell us a little bit more about that.
Patricia (15:43):
Biomechanics is really like, how you move, right. There’s an optimal way that each joint moves and supports itself, whether it’s muscle A, B, and C has to turn on A, B, and C and it has to glide, the joint has to glide a certain way. If you keep rotating your body and improperly, let’s talk about the knee which is the easiest to think about. If you bend your knee and your knee doesn’t go straight ahead—your foot is straight ahead, your hips are straight ahead and your knee is supposed to bend straight ahead, let’s say in a squat or something, or bending down to sit down in a chair—if your knee constantly drifts inward, that’s rotating and crating a torque at your knee, at your ankle, and at your hip. So, you can compromise any of those by doing that and the average person sits and stands, 50 times a day. So, you’ve just had 50 squats of rotating your knee and jamming and jamming and bam, bam, putting all the torque and forces on the body, eventually will break down. Maybe you don’t feel it in your twenties, maybe you don’t feel it in your thirties but like, forty, fifty, sixty, something is going to catch up with you at some point.
Katie (16:54):
It always does. [laughs]
Patricia (16:56):
Yeah, and then it’s like, oh you know, I have arthritis. Well, wait a minute, there’s plenty of people that have horrible arthritis, horrible MRIs, yet they have zero pain. Why? Because they keep their muscles pristinely balanced like a fine-tuned instrument that then, who cares? So, you have wear and tear. The degenerative process starts at 25 years old, nobody knows that. And it’s like, well okay, why was I fine at 25, 35? Once I hit 45, crap what’s going on? [Katie laughs] Well, it’s catching up, it’s catching up.
So, you know, we don’t get away with things as easily, but there’s no reason why, with a little manual therapy and specific stabilizing, followed by strengthening exercises, you can’t get better. And also just the knowledge, I’m not supposed to torque my knee, oh, I never noticed that I was doing that, right. I never noticed that my knee was drifting every time I’m doing my squats or every time I’m doing my Zoom exercise, in front of me. Look, I grew up as a dancer with a mirror in front of me every single day of my life. So, I was constantly, meticulously working on my alignment and I have to say, I was a dancer that didn’t really end my career with injuries, I didn’t have a lot of pain during my injuries but I was obsessed with the body moving really well and I happened to be with a lot of great teachers that forced me to move really well.
But it’s really about wise, biomechanics is wise movement, moving within the range that that knee is supposed to move, or that joint, or that shoulder, or that neck, or that back or that pelvic floor. And breathing appropriately and efficiently throughout that movement because breathing is your foundation. Oftentimes, I work with professional athletes and they come to me and they’re finely tuned instruments, they’re working on this thing all day. We don’t have time for that maybe as a regular person to constantly be pummeled and stretched and strengthened and fitness. I mean, their whole day is all about that.
Katie (18:59):
Yeah, it’s a job. Totally.
Patricia (19:00):
And you maybe say to yourself, these people are in such great shape, what the hell do they need care for? They’re doing everything already. Well, sometimes there’s a couple of things that they’re doing that aren’t being caught biomechanically and that maybe their foundation, which is their breathing, has not been addressed very well so they’re holding and they’re clenching and then all of a sudden their pelvic floor and then all of a sudden during a match they strain their abs. Well, if your diaphragm is really working, has a good dynamic ability to engage and open and close kind of thing, inhale and exhale properly, then you really have the most power revved up. Almost like, think about those shock things when your heart goes.
Katie (19:45):
Yes, what are they? The defibrillator.
Patricia (19:48):
It literally jump starts your core, it jump-starts your core.
Katie (19:51):
By the way, breathing is very hard Patricia. Years ago when I was in graduate school for broadcast television, I was studying broadcast journalism, I was told by a teacher that I was breathing wrong. I had shortness of breath when I was speaking. And we had to lay on the floor and put your stomach on your abdomen and breathe with your abdomen versus your chest, which is the way so many of us do and it was astonishingly difficult. So, if we’re at home thinking, I want to be breathing better, I want to make sure that I’m in alignment. Because we don’t get to forty, to fifty, to sixty without crossing our legs a lot, or perhaps having a baby, or even if we didn’t have kids, we carried a big overweight bag on our shoulder on the New York City subway for years. Do we work with a therapist, can we work at home? Break it down for us. How much of it is working with a physical therapist, how much of it is exercises at home? What can we do to better take care of our body now, today?
Patricia (20:57):
I would say, you try things at home first and if you feel like, I don’t understand this, this isn’t working, I’m not seeing the results, then you probably have a few things that need to be worked out, you need more support in order to get there. I’ll take you through something real fast, but if you start doing the things that I’m going to tell you right now and you’re like, “I don’t get it,” then that’s probably because you have a restriction that’s preventing you from doing what I’m trying to get you to do. But if you say, oh yeah, that feels different wow, I like this, then maybe you don’t have that many barriers you just were stuck in a bad habit.
Now, a hundred percent of women have a breathing dysfunction when they’re pregnant because the baby takes up all the room, the diaphragm can’t expand, can’t contract, can’t do the breadth of work that it normally does. The problem is after pregnancy, if you don’t correct that, if you don’t go back to your maybe better breathing habits—maybe something happened, maybe your baby was colicky, you really were stressed out—you never returned back to your better breathing, you may actually be breathing, even into your sixties as you were when you were pregnant, which is not good.
Katie (22:12):
I feel like this is gonna be me. [Patricia laughs] I feel like I’m definitely… [laughs]
Patricia (22:17):
Yeah. And then you may have had also you know, like I’ve had patients that come to me because they’re pregnant and they have pain and the baby’s rump was literally up in their diaphragm and for nine months literally having pain but that’s a whole other story where you can actually have a distortion in your diaphragm which needs some manual work. So, just take into account that your average massage therapist will not do this work, you really have to go to a physical therapist that has good manual therapy skills, that can get into, that maybe even does something called visceral mobilization, you can look that up, and that’s just kind of you know, releasing the fascia and the connective tissue around the organ systems. But these are very deep structures that you need a little extra training for. So, just understand that you should go for a physical therapist rather than a massage therapist for this kind of thing.
Katie (23:07):
Yes, okay makes sense.
Patricia (23:08):
While I do love massage therapists.
Katie (23:10):
Sure, that has its place. We like both.
Patricia (23:14):
So, let’s all sit down, put your feet on the floor and just sit up tall or up against pillows behind your back or up against the chair back but really just stay upright. What I want you to do is put your hands to the back and sides of your lower ribs, not your mid, not where your bra is, but down a little lower to where the bottom of the ribs are. People think your ribs are up in the middle but they can go all the way down to your waist for some body types. So, you’re looking for the end of your ribs. Now, what you want to do is think, I’m going to close my mouth, I’m going to put my tongue to the roof of my mouth, I’m going to breathe in and out through my nose, and I’m going to gently think about filling my hands with air. So, you’re expanding, like a 360 breath, all the way around. Like if you had an umpire waist dress or something, just right around the lower part of your ribs, I want you to think about expanding outwardly, the sides and back of the lower ribs. So, inhale, they billow out, exhale gently and they billow just and of nicely fall down. I don’t want to go [breathes in an exaggerated way] none of that, everybody wants to do it really well.
Katie (24:27):
[laughs] No cheating, no cheating.
Patricia (24:28):
Right, no. you want to do it really softly so the person next to you doesn’t even know you’re there. You’re breathing so softly, so quietly, so you’re just doing it ever so gently, but you’re just directing your breath to the point where you can go out and in. I actually have another like, deeper tutorial of this on my Instagram so you can look at that, look at my IGTVs, those longer videos where we go over how to actually properly breathe but that’s basically the basis of it. You do get some accessory billowing in the belly, but the main thing is, you do not want the area around your necklace, the upper chest, to move. That is not where we breathe from, that is where you hyperventilate from during emergency situations. That’s the only time it’s okay to breathe up there. So, a lot of people come to me with neck problems for years and years and the whole time they’re just breathing with their accessory breathing muscles. No wonder their neck is killing them, they’re actually using those muscles all the time.
Katie (25:32):
Totally. So, if we’re doing this exercise that you just walked us through that you also can find on Patricia’s IGTV and her website, which I will link to in the show notes, so if we’re doing this exercise and it’s not going well, how do we know if we’re not doing it correctly or if we have a restriction that you referred to?
Patricia (25:52):
If you’re doing this breathing and you’re like, “This feels good, I feel like I can actually do it, I feel my ribs coming out and expanding out to the sides,” you’re probably on the right track. If you don’t feel like you could do it, if you constantly feel, or you can even watch in the mirror, “I am moving my upper chest no matter what I do. I kind of feel a little light-headed.” It’s normal to kind of yawn and that sort of thing because you’re manipulating your breath and you’re starting to change things, that’s okay, that’s just a transitionary thing. But if you’re feeling like, light-headed, you feel kind of crappy, queasy, you’re probably going into hypocapnia, you can’t coordinate this well, probably because your diaphragm is quite restricted and you can’t access it on your own at this time. Which means you could either go into down dog, an inverted position, go into a position where your head is lower than your butt, like somewhat of a, you know, my best way to say it is an inverted position. You could also lie down on your back and put a bunch of pillows under your tush and go on an angle. I know I have a pregnancy book out, but these chapters are really good for everyone because it shows you specifically, every single chapter in the book has breathing tactics and it shows you how to access your diaphragm better. So, a lot of material, including stabilizing exercises for the pelvis, just your foundational principles that every single person should be doing, it’s in there. If you’re not following me here, there’s like real literally pictures and details in there. But if you lift up your tush and you kind of make your head lower than your pelvis, you actually have, you’re giving an advantage to your diaphragm to open.
So, those are ways to access your diaphragm in better ways. If none of that works or nothing feels right, then I would suggest to get some care and really get some manual therapy to open up your diaphragm. And sometimes it’s literally like two sessions and then you feel like a million bucks and then you just work on it. But I would really, really say that I see the biggest change when people do little bits throughout the day. So, maybe you have a meditation practice. The first couple of minutes of your meditation practice, I want you to be thinking about this breathing, not the other breathing. Okay, other breathing is never going to be what you breathe throughout the day. This is changing your mechanics so that you breathe this way throughout the day. This is your foundation for every single thing that goes on. Even access to your brain so that you can be more productive, so that you can reduce anxiety.
Katie (28:19):
This is so fascinating. There’s also a very popular book that was out this past year, I think it was called Breathe, I’m forgetting the name of the author but I will look that up and put that into the show notes as well and along with your book, so people can see the images that you talked about, about the different ways that you’re doing that.
Patricia (28:38):
And I like to say, you need about three to five minutes to really change it and then you have carry over, it lasts sometimes for hours after, sometimes as little as 20 minutes, as much as hours. So, if you just said to yourself, I’m gonna give myself three to five minutes of doing this, let’s say in the morning to start my day, maybe you don’t like meditation, maybe you feel like you’re not great at it. What if you just did a breathing exercise, where you’re really thinking about breathing in this way, the way that we just talked about, for three to five minutes? Then for one minute at the top of each hour, or every two hours do it for a couple minutes. That is how you get that automatic change and then you don’t have to do it again. So, you put in about as little as two weeks as much as a month of doing this every single day and it just starts to become automatic again. I tell my patients, you just put in a little bit of time, for all these years that you’ve had a breathing dysfunction, you just give yourself a month to turn it around, and you’ll be golden.
Katie (29:36):
A month sounds totally doable.
Patricia (29:38):
I think so, I think so.
Katie (29:39):
So, the breathing kind of reboot that you’re doing for a month is one thing that we should be doing to care for our, not just our pelvic canister but for our whole body. What are other things that we could be doing? We’re in January right now, people are looking at boosting their fitness routines, really taking control of their wellness no matter what it might be; maybe addressing those back pains or pelvic pains, bolstering their systems. But midlife and aging impacts our ability to do sports well. What would you want people to think about beyond breathing as they look to retool exercise in the new year?
Patricia (30:20):
So, there are so many muscles that don’t get addressed with things that we do. A lot of women will focus on cardio and I hear a lot of women basically anywhere spanning from, you know, 45 to 85, and they’re saying to me, “The cardio that I used to do is really not changing my body.” I think you probably heard of some women they say, obviously I’m partial to dancing, but they’ll say, I was doing workouts for my whole life and my body was just not changing and everything was getting worse and I felt like I was just maintaining and nothing was getting better and all of a sudden I started dancing and it transformed my body. Well, you’re changing around your breathing, you’re changing around activating different muscles during that time. So, my pearls here are: don’t just focus on cardio because it’s not going to get you the results that you want. You need to start strength training because our hormones change and building muscle is key for keeping all of these wonderful systems of the body active. So, you really do need to build muscle and I like to build long, lean muscle and working on eccentric contractions, which are lengthening contractions of the body, are key.
Katie (31:40):
And how does one do that? Is dance one?
Patricia (31:42):
Dance is a great one because you are working in larger ranges of motion with control, and I see people that are like…
Katie (31:52):
Patricia, you have not seen me dance. [both laugh] There might be large ranges of motion but there’s very little control because I am going left when everyone’s going right.
Patricia (32:03):
Wow, yeah and that is really good for your brain function.
Katie (32:04):
I love it, but I’m not good. [laughs]
Patricia (32:06):
No, it doesn’t matter, you don’t have to be good. Listening to music, just getting into your body and rhythm, it doesn’t matter even if you don’t have rhythm, as long as you’re moving though fluidly just kind of going from one to another, it wakes up so many centers of your brain, it’s amazing. You have Parkinson’s patients getting better from doing the tango.
Katie (32:33):
Wow.
Patricia (32:34):
And this is documented, better than their medication.
Katie (32:38):
So sweet.
Patricia (32:39):
I mean we have to understand that movement is the key to life, so don’t just get on a bike and feel like you’re doing your Peloton only. That’s great, I love it, but it’s a repetitive movement in the seated position, you are not challenging your pelvis at all and you need to strengthen your pelvis, your whole life, especially after 40, okay? And then, you have to strengthen your gluteus medius muscle, the outer glute muscle is huge for controlling torque in the body, controlling those ways that we start to cheat when we get weaker. We need those muscles to be pristinely online, strong, and stable.
So, you know, it’s very hard on a podcast to explain exercises, but there’s a few, many, many of them that are there in my book and out there, you can just Google I’m sure, see someone, a personal trainer, a physical therapist and really work on a little circuit that you might do. Maybe it’s five exercises, maybe it’s ten that are just addressing your female body that needs a little bit more strength in your transversus abdominus, your multifidus, your pelvic floor, your diaphragm we’re already addressing with the breathing, and your gluteus medius, your lower glutes. Everybody’s like “Oh, I’ve got that middle-aged butt, [Katie laughs] I used to hate my butt and now it’s gone, where is it? I don’t have it anymore.” So, we need different ranges to work and access those muscles. It’s not that you can’t, it’s going to be a little harder but there’s ways to do it.
Katie (34:18):
Are we talking like step aerobics too, would that help? Or squats?
Patricia (34:21):
Not really. There are certain squats, yeah. I don’t love step aerobics because it became not a fad because all the women that were crazy steppers, step aerobics instructors were in the worst pain of their life right when they hit like forty, fifty. They were done. I still see women in my clinic, in their fifties and sixties that were crazy steppers, one that had a completely deformed knee, I’ve never seen anything like it. So, I’m not a fan, I’m very happy that that fad went out. But can you do a little bit of it? Sure. Should that be the only thing you do? No.
Katie (35:02):
So what are safer ideas? Is it yoga? Is it pilates?
Patricia (35:04):
I love pilates, I think it’s fantastic. The best thing is, I like a Mediterranean diet, a little bit of everything. Not just tunnel vision, this is the one thing I’m gonna do. First of all it’s boring. Second of all, it’s not the way our body functions. You know, you go from this to that and there’s so much variety. So, I feel like, changing things up to where you could dance on Monday, strength train on Tuesday, do a little step on Wednesday, do your Peloton on Thursday… Or do a little bit of peloton for 20 minutes and then do a couple of strengthening exercises. Notice how Peloton actually provides now so many different other workouts because they know to balance you and to keep you feeling good, it’s not just being on the bike. It’s really about variety.
Katie (35:58):
Patricia, I’m throwing hiking in there too.
Patricia (35:59):
Oh yeah.
Katie (35:59):
Because my friend Lisa took me on this two-hour hike recently and talk about feeling it in your gluteus maximus. The next day I was like, all right, I would not have been able to get myself to do that on my elliptical, I would have quit already. But it was great to be outside and it was so beautiful.
Patricia (36:16):
I’m so happy that you said that because I’m a huge proponent of doing things in nature and being outside because you actually get more health benefits. But for all your listeners, you get the maximal health benefits of doing something you love. So, if you hate going to the gym and doing certain exercises, you may not be getting the best health benefits. So, find a way to enjoy the things that you know, need to do, or look at the things that you like. Like you just said, maybe you hate the elliptical and going to the gym but you love going out there and hiking. Don’t feel bad that you’re not in the gym, get out there and hike. But just make sure that you’re putting it in the calendar and you’re actually doing it and that you’re wearing smart shoes when you’re outside, that’s the only thing.
Katie (37:01):
Such great advice.
Patricia (37:02):
Or, do yoga outside, I love you know, being barefoot on the earth, it’s a huge thing, a grounding practice. That’s huge for your pelvic floor, for your breathing and really for your psyche as well as your body. You actually get a negative charge, this is a real little quick tidbit on the side here—is that when you’re walking on the ground, or doing movement or let’s say, gardening or whatever it is during you know, with your feet on the ground, you’re actually getting an electric charge that actually super charges some of the back muscles so, you decrease your risk of back pain by doing that. It’s kind of crazy.
I look at also the day-to-day life tasks, aerobics. So, you’re going to your dishwasher to get things out of the dishwasher. Are you doing it in a smart way? Can you do it with a nice flat back squat, lift it up, put it on the counter. How are you washing your dishes? How are you cooking? Can you stand on one leg and balance as you’re stirring something? What are you doing day to day that could give, like, how you do your laundry? These are ways that you can actually activate all of these good, stabilizing, deep muscles of the body in a positive way instead of, “Oh I’m doing these tasks all day, doing it the easiest way possible,” which is how we’re wired to do it—to save energy even though we don’t have to do it that way but that’s what it is, hereditarily and just kind of, you know, Neanderthal genes, save energy, save energy—but that’s not how we need to do it. We need to do it in a very smart way.
Katie (38:39):
Patricia, I love this. I love that first of all, I love that you started with, "find something you love." you don’t need to go to the gym and also just be smart about incorporating small changes into your day-to-day life. And when you said that, it triggered a memory that when Dr. Vonda Wright was on the show, she talked about fitness and aging after 50 and she talked about brushing your teeth standing on one leg and if you’ve been listening to this show for a while listeners, you know that I still do it. I am on one leg and alternating every time I brush my teeth.
Patricia (39:08):
And then if you wanted to challenge yourself more you could close your eyes, that’s what I tell my patients.
Katie (39:11):
Oh okay, I’m not doing that. [laughs]
Patricia (39:15):
Hold onto something though and then slowly take it off, I don’t want you falling, tipping over.
Katie (39:19):
No, but I was gonna say, now I’m gonna stand on one leg when I’m at the stove stirring things because that’s just a great way. If you’re already there doing these things, you might as well zhoosh it up with a little something-something that’s going to make yourself healthier and fitter and just more stable.
Patricia (39:35):
Sure, and if you’re gonna lift up, you know, a couple of dishes out of the dishwasher, it’s pretty low, you can do it on one leg, knee bend, doing a single let squat, there you go. So, there are ways that you can weasel this in. Because the biggest complaint that I get—because of course my practice is in New York City and no one has time for anything—is, when am I gonna have the time? I love doing my Peloton, I’m not gonna stop that, I don’t have the time for this. And I’m like, okay let’s build it into the things that you have to do in your day.
Katie (40:02):
Yes, build it into your day. This is such perfect advice.
Patricia (40:06):
Or maybe it’s three to five exercises that you absolutely need. That’s okay too, you can start with two, three, four, five, six exercises and that’s it. That’s it.
Katie (40:17):
You’re making it easy, you’re making it easy on us, I love this. We are near the end of our time together Patricia but I could talk to you all day long about this. I want to move into a very quick speed round which will allow us to have a little bit more of your thinking before we wrap. So, the speed round is something that we do to end, it’s a simple maybe yes or no, or one word, maybe two word answer to complete these thoughts. Are you ready?
Patricia (40:40):
Yep.
Katie (40:40):
I feel like I know the answer to this one but I’m asking it anyway because I want to hammer this home: pelvic floor evaluation for everyone, yes or no?
Patricia (40:48):
Yes, absolutely.
Katie (40:49):
Okay, I’m doing this. I’m putting this on my 2020 list. Wait a minute, 2020? Oh my God, I’m in a time warp, 2022 list.
Patricia (40:56):
Yeah, no don’t worry we’re all on pause mode.
Katie (40:58):
Yeah, it’s been a weird two years. Kegels, yes or no?
Patricia (41:04):
I would say that’s a maybe. Some people yes, most people yes.
Katie (41:08):
Most people yes. Okay so old fashioned Kegels, or new fangled Kegel trainers like Elvie? Or both?
Patricia (41:15):
I would say most people need an Elvie to know that they’re doing it right.
Katie (41:19):
Got it. Okay, using a pelvic clock?
Patricia (41:23):
Yes.
Katie (41:24):
Yes. Okay everyone needs to go google that if you don’t know what it is.
Patricia (41:27):
Yeah, it’s just good mobility, really good mobility.
Katie (41:30):
A piece of exercise equipment you think people should consider investing in?
Patricia (41:35):
TheraBand.
Katie (41:36):
TheraBand.
Patricia (41:36):
It’s the easiest thing. That’s the whole eccentric exercises that we were talking about, just kind of getting control on the way back as you’re doing the exercise, you get a push to control on the way back and that’s the contraction we’re looking for as we get older.
Katie (41:52):
Nice, TheraBand. Okay, best workout routine for great pelvic floor health?
Patricia (41:58):
Yeah, I’m gonna talk about dance because doing plies and all of these things are the key trajectory of what you want in your pelvic floor.
Katie (42:06):
Nice, okay.
Patricia (42:07):
Like a ballet barre, or a barre exercise.
Katie (42:11):
All right perfect. And how about this: please skip this one in order to better care for your pelvic floor. I don’t even know if there’s an answer to that. [laughs]
Patricia (42:21):
Please skip? Is that what you said?
Katie (42:22):
Yeah, don’t do this one.
Patricia (42:25):
Don’t cross your legs all the time.
Katie (42:27):
Oh, don’t cross your legs. That is gonna be really hard.
Patricia (42:31):
Not all the time. Even limiting it by 50% of what you’re doing. Being cognizant of it and grounding with your feet on the floor is another way to actually keep your pelvic floor jazzed up because now you’re really on both sitzs bones.
Katie (42:45):
I love this one too because it’s simple, you know, it’s something that you can easily do, right.
Patricia (42:51):
Right now, listening to this. Or maybe you’re on a hike during your listening to this so that’s good.
Katie (42:56):
Exactly. But for all those New Yorkers who are saying I don’t have time for this, you have time to not to cross your leg, you can add this to your list.
Patricia (43:03):
Yes, yes.
Katie (43:03):
Patricia, this was a lot of fun and so informational, thank you so much for joining me today. Before we say goodbye, I want to make sure our listeners know how to find you, your book and your exercises, and more about your work.
Patricia ():
Sure, it’s patricialadis.com or wisebodypt.com and it’s the Wise Woman’s Guide to Your Healthiest Pregnancy and Birth. My website, and then, of course, I’m on Instagram, @wisebodypt or @patricialadis and I try to provide a lot of information and little tidbits. But remember nothing trumps individualized care and figuring the right recipe for you because everybody gets treated in a very individualized way because everyone has a different recipe for success. So, don’t just say, "Oh my girlfriend got better by doing this,” that might not be your answer. Your back pain, or your pelvic floor pain might be coming form an old foot injury and for your friend it might have been actually the trauma of vaginal birth. Everybody’s got different reasons why, even though they might have the same pain. So, really getting to the root cause of your why to solve it. And eliminate it, because nobody’s got time for this, you want to really be feeling good so we’re really trying to help save you time and it only takes a few sessions to figure it all out.
Katie (44:30):
Smart advice. Find a practitioner, find a therapist, and get your individual training on track for 2022.
Patricia (44:38):
Yeah.
Katie (44:39):
Patricia, thank you so much.
Patricia (44:41):
Absolutely, thank you so much.
Katie (44:43):
This wraps A Certain Age, a show for women who are aging without apology. Join me next Monday when nutrition expert Elise Museles, author of Food Story, shares ideas for nutritious, joyful eating all year long but most especially in January, a time of the year when diet culture bombards us with negative messages around food.
All month long we are focused on rebooting the systems that support and guide us. Ready to make your 2022 extraordinary? Join the A Certain Age Book Club with best-selling author and productivity expert, Tanya Dalton, author of On Purpose: The Busy Woman’s Guide to an Extraordinary Life of Meaning and Success. Tanya kicked off our 2022 shows and has helped millions of women reclaim their time, make a bigger impact, and be fully present in their personal lives. Find on purpose in the A Certain Age Bookshop over on indie bookseller, bookshop.org, or wherever you buy books. Tanya is joining A Certain Age listeners live for our first-ever Zoom book club on January 24th at noon and we’ll be answering your questions. Want to join us? Email me at katie@acertainagepod.com and put “Add me to the bookclub” in the subject line. Join us for this special book event and make 2022 your year.
Special thanks to Michael Mancini who composed and produced our theme music. See you next time, and until then: age boldly, beauties.