The PERFECT Pelvis

The “PERFECT” Pelvis

 

So…What is a PERFECT pelvis? Where there is no right answer. But there is a script we use that helps us.  And actually everyones pelvis and pelvic floor musculature doesn’t have to be working 100% to keep bad symptoms away. Below I go over your pelvic floor anatomy, what it does, and how is plays a role in everyday life! Take a look……

What is your pelvic floor? 

 

-The pelvic floor contains 3 layers and there are actually 15 muscles in your pelvic floor! 

-It acts like a “hammock” holding up your internal organs 

-it is the midpoint between the top part of our body and the bottom part of our body! 

-it is always in use!  (wow…so we need to relax it, right)

What does it do? 

 

-supportive, sphincter control, sexual, stability, sump pump (venous and b. supply), posture and breathing!

 

Your “true core”? 

 

-lumbar multifidi (deep low back muscle)

-diaphragm 

-transverse abdominis 

-pelvic floor muscles

 

 

Clinical concept of Pelvic Floor Rehab? 

 

-Strengthen or lengthen? Hypo vs. hyper tonic 

 

-Does the pelvic floor need to increase strength? Or have better coordination? (neuromuscular/motor control)

 

-A “tight” pelvic floor can act weak (MIND BLOWN!)

 

-Is the pelvic floor shortened, have tight muscles that need more relaxation?

 

-diastasis recti (separation of rectus abdominis muscles) effects how the “core” works- balloon analogy 

 

How the pelvic floor muscles are tested? 

-external exam of surrounding musculature

-internal exam of all 3 layers of muscle 

 

-PERFECT test: 

P= Power (max voluntary contraction, based on squeeze and lift) 

E= Endurance (how long contraction is sustained up to 10 seconds)

R= Repetitions (relates to the number of reps of the specific times MVC)

F= Fast twitch contraction up to 10 (important for sphinctric control) 

ECT= Every contraction timed

 

 

When to seek help from a Pelvic Health Physical Therapist

-just want to learn about pelvic floor or prevent issue (wow, crazy idea right? )

-if you are pregnant

-needing to urgently or frequently go to the toilet to pass urine or bowel movements

-accidental leakage of urine, bowel motions or wind

-difficulty emptying your bladder or bowel

-vaginal heaviness or a bulge

-pain in the bladder, bowel or in your back near the pelvic floor area when exercising the pelvic floor 

-pain during sexual activity

 

Helpful tips: 

Avoid bladder irritants if you have any urinary issues or urgency:

Citrus fruits and juice

chocolate

tomatoes

artificial sweeteners

spicy foods

vinegar, raisins, bananas, onions, asparagus

carbonated beverages, caffeine, alcohol 

 

Water

Consume 64-80 ounces of water/day

 

Lubricants

use coconut oil as personal lubricant or water-based lubricant (Good clean love, woot!)

 

Other helpful tips:

-Do NOT use soap between the labia

-DO NOT HOVER OVER TOILET

-use a Squatty Potty!

Merci Treaster Comment
Once Postpartum, Always Postpartum

Once Postpartum, Always Postpartum!

 

If you have been following my postpartum journey as a pelvic health physical therapist, then this blog is for you. If you have not been following my postpartum journey but you are currently pregnant, plan to get pregnant, are a new mom, or have multiple kids already then, this blog is also for you. I am not embarrassed to discuss the symptoms I had postpartum because I want women to know that they can discuss these symptoms with me, their healthcare providers, and friends. 

 

Currently in the United States, there is no standard of care for postpartum women. Yes, the 4thtrimester” is now a term, but it is not implemented consistently, yet. At your 4-6 week checkup after childbirth your head is a mess, you are sleep deprived, still bleeding, possibly still in pain, weak, and not thinking about the future of your pelvic floor, right? However, right now in this model of healthcare it is up to you to ask questions regarding the status of your pelvic health! You most likely will not have your abdomen assessed, pelvic floor assessed, body biomechanics assessed, and posture assessed. You may have urinary issues already like diastasis recti, painful sex, urinary leakage, pelvic pressure and not know that those are not normal. (Yes, these are all very common pelvic floor issues). You may mention them and hear “oh, it will get better, you just had a baby!” I do not want to talk about all 4-6 week checkups like this, because in my area there are many providers that now have the discussion with all patients! However, it is not standard of care for all practices. 

 

Rewind to my birth, (refer to my “Birth Story” blog), just 12 short months ago; I had a 3rddegree tear, a million stitches, a minor rectal prolapse and I was told to return to all normal activity prior to giving birth because my stitches had healed. Guess what normal activity is for me? Orange Theory Fitness, running, jumping, biking, and other high intensity exercises. If I would have returned to normal activity I would not be where I am today. Fast forward 2 weeks, I saw my amazing pelvic health physical therapist, she addressed my level of scar tissue, pelvic pain, posture, core weakness, and addressed why I was having fecal incontinence. After a few weeks of doing my own homework (daily) I was “cleared” by my physical therapist to begin returning to my normal activity level. Hint the work “begin.” How long did it take me to return to my normal activity, pain free intercourse, coughing without leaking, running without leaking feces on myself (yep, that happened), and sprinting 10.0 on a treadmill during orange theory? It was not until around 6 months postpartum that intercourse was comfortable again, I could run without leaking, cough without leaking, and 10 months postpartum that I was exercising at the same level that I was prior to giving birth. It was a long road. I did exercises related to my pelvic health daily. 

 

What did my postpartum physical therapy look like? 

-internal (vaginal and rectal) release treatment for my scar tissue, tight musculature

-re-educating my pelvic floor and core musculature

-addressed hip immobility

-posture support

-self care

-core stability

-hip stability

-home exercise program (just a few minutes a day)

 

 

Fast forward to current day, June 20, 2019. Right now, I am exactly 12 months postpartum. It took 12 months of diaphragmatic breathing, scar tissue release, neuromuscular control work, pelvic strengthening, core strengthening, endurance work, postural support, mental support, and time to get to where I am today. I am proud to say that I am here. I am not upset it took me this long. Do you know how long it takes other injuries to heal? Think about all the athletes with ACL tears, achilles ruptures, shoulder injuries? 

 

I can tell people my birth story and my recovery story but also tell them that I do not have any of the symptoms my clients report to me on a daily basis. Why am I going on and on about this? Because I see way too many women come in 1 year postpartum, 2 years postpartum, etc. with all of these signs/symptoms that have never been addressed and they are frustrated, upset, and worried they will never resolve. My goal: that every woman knows what to look for postpartum to address their pelvic health. I want every woman to know the terms pelvic organ prolapse, incontinence, scar tissue, high tone pelvic floor, dyspareunia, vaginismus, pessary, (I can go on and on). 

 

So why the title, “Once Postpartum, Always Postpartum,” ? Well, I believe this is a fitting title because even one year out I am still constantly working on things related to my body being pregnant, having Oliver, and recovering from my birth. You are not “done” just because your pelvic health physical therapist discharged you from care. Just like an athlete is not “done” because they returned to their sport. My weekly exercise routine includes stability work for the musculature related to pregnancy and beyond. In the car, I continue to work on diaphragmatic breathing and releasing my pelvic floor. I am constantly monitoring my body when I do new core exercises. I make sure to stretch and work on posture due to Oliver growing by the second! This is never ending right, because every day there is a new challenge. Just because my posture is good with a 3 month old doesn’t mean it will be good with a one year old! 

 

Daily I hear from my patients that, “I had no idea this is what we would do in physical therapy after I had my baby,” and “why didn’t anyone tell me about this?” So, my goal is to change this, to improve the awareness of pelvic health physical therapy. Pelvic health should be the standard of care for all women. 

Getting in to exercise again, post baby!
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I get a lot of feedback from my clients about how difficult it is to find time to exercise in their hectic lives. I never truly understood, until now…

Whether you are exhausted from taking care of a newborn, chasing after toddlers, driving around kids to after school activities, a day can be 6pm without any exercise in sight. If you are like me then your feel guilty taking the time away from your child to do a structured workout. 

Exercise has always been a part of my life.. not only for my physical well-being but my mental well-being as well. As a pelvic health physical therapist, I know the importance of exercise so I have to practice what I preach, right? 

With that said, I make the time…even if it is just 20 minutes before I have to do school pick up. One time I literally walked into the gym and did bosu ball exercises for 10 minutes and then left. I also include Oliver in workouts all the time! Walking, jogging, and at home strengthening are all great ways to exercise with your little one.  

I have had to be very creative with finding time to exercise as well as what type of exercise to do.  

I wish I had the perfect response ! But...I can give you some ideas! 

-do a few exercises throughout the day spread out
-do a few exercises every nap time
-wake up 15 minutes earlier
-go to bed 15 minutes later
-put a sticky note on your fridge as a reminder
-set a reminder from "siri" daily to do 10-15 mins of exercises
-take baby/kids for an afternoon walk
-include baby/kids into exercises (they will think it is play time)

Simply put, we have to make time for ourselves! If we are in pain, have muscle weakness, and our bodies are unstable we cannot be the best we can for our kids. 

So where should you begin? Breathing. Below are simple steps on how to conquer the diaphragmatic breathing exercise to prepare your core and pelvic floor for exercise. 

Inhale through your nose and exhale through your mouth. Think of your breath in thirds. The first 1/3 is breath into your chest, the second 1/3 is breath into your rib cage, and the third 1/3 is breath into your belly. You should not feel any accessory muscle activation from the neck and shoulder musculature. As you inhale, your diaphragm will drop and ultimately your pelvic floor should relax. As you exhale, your diaphragm will rise and your pelvic floor and core will engage. This creates an internal piston- like system that will create stability for our bodies during daily tasks and exercise. 

Diaphragmatic breathing is a type of a breathing exercise that helps strengthen your diaphragm, core, and pelvic floor.

Jessica FreemanComment
Pelvic Girdle Pain

Symphysis Pubis Dysfunction (SPD), also known as Pelvic Girdle Pain, affects 1 in 300 women during pregnancy and postpartum. In my experience, I think it probably affects more than this number but is not diagnosed. SPD/pelvic girdle pain means that the ligaments which normally keep your pelvic bones stable and aligned become over relaxed/stretched out during pregnancy, which can make the entire pelvis unstable. 

Signs and symptoms include: instability in pelvis, pubic bone pain, perineal pain, upper leg pain, low back discomfort, clicking or grinding in pelvis, difficulty getting comfortable sleeping at night, pain during intercourse. The discomfort/pain can become worse with change in position, rolling side to side, single leg activities, stair climbing, and getting in and out of the car.

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Causes: A hormone called RELAXIN (yes, that is the actual name of the hormone), causes laxity and stretching of the ligaments and connective tissue in your body over time so that your little baby can ease his/her way out! In general, if you had increased mobility (ever told you were “double jointed”) prior to pregnancy, more than likely, you will have extra mobility during pregnancy. 

What can we do: 

-Keep active! 

-There are some good kinesiotaping techniques that help support the pelvis that can be found on youtube! There are also pelvic support belts that create a “corset” around the pelvic bones which can help stabilize the pelvis. 

-Stabilizing the pelvis through pelvic floor exercises, core exercises, and exercises for hips/pelvis (refer to blog posts on Functionize Facebook) 

-Avoid single leg activities, avoid heavy lifting, sit down to get dressed, engage proper musculature with stair climbing

-Use a pregnancy pillow/body pillow to find a good sleeping position 

-Avoid crossing your legs at knee

Here is what I have been doing to stabilize my pelvis during my 2nd semester: 

Orange Theory 2x/week (I have stopped running the entire time due to some lower pelvic/abdominal discomfort that I don’t want to push through. So instead I will break up running with incline power walking)

Elliptical/bike cardio 3x/week: I love the elliptical because I feel very stable on it and I can increase my speed and resistance without discomfort. 

Interval/resistance training 1-2x/week: I have been choosing 3-4 exercises that focus on core and hip stability and doing 2-3 sets of them on my cardio days.  

A few times I have tried taking my dog for a run/walk but I take it easy if I feel lower abdominal discomfort. During pregnancy it is best to try and do some sort of exercise most days of the week. Even if that means going for a 30 minute walk, working on proper breathing, or getting in some good house cleaning! Movement is good!

If you are currently pregnant and experiencing any of the signs/symptoms listed above or want to learn proper exercise training during pregnancy, don’t hesitate to come see me! 

Thanks for reading,       

Merci Treaster PT,DPT 

Jessica FreemanComment
What is the 4th Trimester?

As most of you know, 6 months ago I had my little boy Oliver. These past 6 months have been incredible. I have enjoyed every part of motherhood (well, maybe after that first month..haha). As I reminisce on my own pregnancy and postpartum experience, I am thrilled that the “4th trimester “is now a recognized term. Your 1st trimester you are sick and tired, your 2nd trimester you are happy, full of energy, and not that big, and your 3rd trimester you are huge and can’t wait for your little human to enter the world. Well, prior to the term “4th trimester” we just thought women went back to normal, right? You aren’t pregnant anymore so you are done….? This could not be more false! And for some women, the 4th trimester is the most difficult. That was the case for me. 

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My birth story was not what I expected, and I hear that from so many of my clients. I have a whole new appreciation for labor and delivery, which is funny because I grew up totally immersed in it with my mother being an OBGYN.

I will never forget the morning we came in to the midwives office on Wednesday June 20…I did not expect to have my baby that day. We put the bags in the trunk as a “just in case” measure. I truly thought that I just peed on myself and my water had truly not ruptured. That day sitting in the triage room and the nurse coming back around 11 am to tell us that we were being admitted because my water had ruptured tears came to my eyes because I knew that my birth was not going to be what I expected. Working as a pelvic health physical therapist I hear horror stories about inductions and all of them were swarming my brain. At that moment Mitch said to me, it will be okay, we are having our little guy today. 

No contractions and not dilated, I was induced at about 12 pm. The medication caused hyper stimulation and my contractions were very close together. At 5pm I was 3cm dilated and at 7:25pm I had my bundle of love. At about 7 pm his heart rate started to drop and I was told water birth was out of the question. That is when I had to begin pushing due to his deceleration. A vacuum had to be used to get him out quickly and safely. Because of this, I had a grade 3 episiotomy. (For those of you that are not familiar with this term it means that my perineum was cut close to my anus to allow for baby Oliver to exit.) I have no clue how many stitches were needed but I know they were working “down there” for close to an hour. 

That night I could not sit on my bottom. I thought to myself, “hmm…this is super painful, hopefully tomorrow will be better.” After labor, I thought the hard part was over. The next day, my bottom was worse. My internal questions: How am I supposed to feed my baby sitting up? How am I going to walk up my stairs to the nursery? How am I going to pee…or even worse, poop? When will I work out again? How do I function without sleep? Should I have had a baby? I didn’t expect this, did I?  All very valid questions, right? How many women have similar experience with the same questions? The answer: all of them! 

The idea of the “4th trimester” helps women understand that the moment they have their baby is not the end, and that there is help. So what is the “4th trimester”? It is the first 12 weeks of your baby’s life, and your new life as a mother. It is the period in which your baby is not only adjusting to life outside of the womb, but also the period of time you begin to recover from nine months of pregnancy, physical trauma from labor and delivery, and the shock that life is not going to be the same. The 4th trimester is not just focused on the physical aspects but also the mental and emotional aspects. This is such a crucial time period for both you and your baby. 

Remembering there is a 4th trimester reminds us that in the first three months anything goes…truly. This helped me so much. There was no right and no wrong. Some days Oliver did great, I showered, and slept and other days the complete opposite happened. So what can you do to help you thrive during this time? FEEL IT, don’t cover it up! Lower your expectations and accept that you will have good days and bad days. Allow yourself to go to mom groups and talk about anything you want to. Seek out a mental health professional, pelvic physical therapist, discuss everything with your provider at postpartum visits (don’t hold back), and remind yourself “you just had a baby.” 

“This too shall pass. Will you?” This was written out on a clock in my high school calculus class. I used it during my 4th trimester. I reminded myself that nothing lasts forever. 

I cannot speak on mental and emotional help so I can only refer you to my amazing team of healthcare professionals in my area. However, physical help…that I can help with. 

When should you seek out a physical therapist? When you are peeing on yourself 15 weeks postpartum? When you try to have sex and it hurts? When your neck is in spasm from feedings? When you are passing gas loudly in your first yoga class? NO! You should seek out a physical therapist prior….to help prevent all of these things. I saw my pelvic therapist 3 weeks postpartum. I wanted to make sure I was doing everything possible to help myself prior to returning to work, exercise, and daily functional tasks. (Yes, I saw someone even though I am a pelvic health physical therapist. I have had that question a lot.) 

What will a pelvic heath physical therapist go over early on? 

-body mechanics

-posture

-self care

-the “what not to do’s” 

-breathing techniques

-positioning

-intrinsic muscle activation

In conclusion, remember the plane analogy. Put your oxygen mask on before you put your child’s on. This is how we have to think of our bodies and returning to normal day to day tasks during this time postpartum. We have to help ourselves to be able to be strong and stable to help care for our new little ones. 

Jessica Freeman Comment
Incontinence is Not a Laughing Matter

The problem: Urinary leakage (incontinence) affects 1 in 3 women across their lifespan. 

Check out this video: https://www.youtube.com/watch?v=UKzq1upNIgU 

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Wherever you are right now, look around at your colleagues/family/friends/etc. Someone has incontinence, has had incontinence in the past, or will have incontinence in the future. Incontinence is not a typical conversation between mother and daughter, friends at brunch, or even between physician and patient; however, this issue is very common and should not be considered “taboo” during daily discussion. Often incontinence can be preventable. Just to be clear…while incontinence is common (and should be discussed freely), it is not normal.

What is incontinence? Incontinence is the involuntary loss of either urine (urinary incontinence) or feces (fecal incontinence). In this blog we will be focusing on the term urinary incontinence. This can be caused by weakness, pelvic floor dysfunctions, poor motor control, injury to surrounding tissues, and childbirth. 

There are four types of urinary incontinence, the two that we will focus on in this blog are: Stress and urge urinary incontinence 

1) Stress urinary incontinence: urine leakage occurs when there is an increase in pressure exerted on the bladder and/or pelvic floor. 

-This can occur with coughing, laughing, sneezing, jumping, and/or exercising 

2) Urge urinary incontinence: urine leakage occurs when experience a strong urge to use the restroom. 

-This can occur in the presence of psychological triggers such as when you turn the key to your house, as the garage opens, on the way to the bathroom, when water runs, etc.)

Can urinary incontinence be treated? YES!!! Good news, there are multiple ways to help prevent, decrease, and even cure incontinence! There is no easy “one size fits all fix” because everyone’s leakage can have a different cause or combination of causes. I hear from many clients that they have “Dr. Googled” how to cure their leakage and it has not helped. This is why it is SO important to get evaluated by a pelvic health physical therapist to see why YOU are having incontinence. 

As for me…I am 9 weeks away from my due date and… my bladder is feeling it! Little did I know I was going to have multiple of these symptoms that my patients complain of. Urination frequency, urgency, urge incontinence, stress urinary incontinence, pelvic pressure, difficulty starting a urine stream, etc. are all common complaints that I hear on a daily basis related to the bladder during and after pregnancy. It has been good for me to experience the symptoms  that I am helping my clients with on a daily basis. (On the plus side…I get to practice my exercises!) 

Here are some ways to track your progress/gauge your dysfunction/goals to work towards:

  • Urination frequency during the day 5-7x/day 

  • Urination frequency at night 0-1x/night

  • Bladder should hold about 10 ounces of fluid 

Here are some symptoms that would warrant a pelvic health evaluation related to bladder symptoms: 

  • Leaking with cough/laugh/sneeze

  • Leaking with exercise and activity 

  • Leaking with urge to use the restroom

  • Difficulty starting stream of urine

  • Pain with urination

  • Pelvic pressure

Jessica FreemanComment
My Post-Partum Journey – one month out!
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Oliver is almost one month old! That is crazy to even think about. 

I am happy to report that I am feeling great physically! My stitches have all healed (and there were many of them) and I do not have any of the signs or symptoms that would warrant me to be extra careful. This doesn’t mean I can start back at Orange Theory Fitness, but it does mean I can get an exam from a pelvic health physical therapist and start increasing my exercises. I have started walking quicker (19 min mile pace instead of 30 min mile pace) and I have added core exercises in. These are very low impact core stability exercises that focus only on the “true core” which included transverse abdominis (TrA), pelvic floor, diaphragm, and multifidus (low back muscle). I will post a video of the exercises below. In the video I am doing 3 exercises, the first exercise is focusing on the TrA. I am engaging this muscle as I lift my foot off the couch about an inch. My goal is to see if I can limit the amount of him drop on the side I am lifting my leg. (DO NOT HOLD YOUR BREATH). The second exercise I am letting my leg gently fall to the side and using my TrA to bring my leg back to neutral. The third exercise, I am engaging my TrA as I let my leg go out straight. These 3 exercises look very simple, but I am still sore from doing them! As you can see I am always breathing and not "sucking in". 

So, when can you get evaluated by a pelvic health physical therapist? What the heck is pelvic health physical therapy? And what do they look for? 

What is pelvic health physical therapy? 

Pelvic health is a sub-specialty of physical therapy. Pelvic health therapists are trained beyond the scope of PT to do internal pelvic floor examinations to asses for anything pelvic health related. Reasons for seeing out a pelvic PT could include anything from pelvic pain, leakage, lack of pelvic floor control, prenatal, postpartum, diastasis recti, post surgical. 

 

When can an evaluation be done? 

Honestly, the rule of thumb is 6 weeks for vaginal delivery and 8-12 weeks for C-sections. But, like many things in our healthcare system..we do them to “save our butts”. We could be evaluating sooner so that individuals have “tools in their toolbox” to help them immediately. If you had any stitches, tearing, repairs done then it is best to hold off on an internal evaluation until after they have healed. However, a pelvic health PT can help educate you on ways to help your body recover immediately. 

 

Signs/symptoms to look out for post-partum:

-core weakness
-instability in the pelvic region
-pelvic pain
-urinary issues (leakage, pain, frequency)
-bowel issues (leakage, pain, constipation)
-pelvic pressure
-low back pain
-hip pain
-pubic bone pain
-separation of the abdominals
-postural difficulty

 

What is a pelvic health exam? 

I get this question a lot! In simple terms, it is just like a musculoskeletal exam of any other body part. It just seems scary because it includes an examination of your vaginal and/or rectal musculature. This is not scary. Ask anyone who has had a pelvic health exam and they will tell you that their provider made it very comfortable and not painful/scary. During the exam your PT will examine everything from posture, breathing, strength, soft tissue, walking, and basic functional movements. They will then discuss the findings with you and go over proper body mechanics, give you a home program to begin working on, and will answer ALL questions related to pelvic health, exercise, and daily tasks. We have heard it all, so ask anything! 

 

Please, comment below with questions regarding pelvic health physical therapy. And, if you have had pelvic health PT in the past, I encourage you to pass along your experience and open up about how it helped you. Many people are fearful of saying they had pain with sex postpartum, that they leaked urine every time they walked up the stairs, or that they felt a water balloon exiting their vagina….these are all things that so many women suffer with and although they are all common symptoms, they ARE NOT NORMAL. There is help out there. You can look on the APTA (American physical therapy association) website and go to the women’s health section and search their area. You can also go to google and type in pelvic health/women’s health physical therapy to find therapists in their area.

My Birth Story

12 days post giving birth to my amazing son, Oliver Ortenzi Treaster. He is happy, healthy, and loves to eat, sleep, poop and repeat. Everyday is a new adventure and I am excited to see him grow...(but not too fast). 

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My birth journey: I thought my water broke on Tuesday June 19th after having a fun birthday celebration for Remi during work. However, no signs of labor happened the rest of that day. On Wednesday morning I went to my midwife practice with no expectation to have a baby that day. After finding out that my water broke almost 20 hrs prior (with being GBS+) I was admitted into the hospital.

At that moment I realized my natural water birth dream was probably not going to happen. No contractions and not dilated - I was induced at about 12 pm. Contractions began shortly after and continued to progress rapidly. The medication caused hyper stimulation and my contractions were very close together. At 5pm I was 3cm and at 7:25pm I had my bundle of love. At about 7 pm his HR had started to drop and I was told water birth was out of the question. That is when I had to begin pushing due to his deceleration. A vacuum had to be used to get him out quickly and safely. I asked for an epidural many times but my amazing midwife and crew of helpers (husband and parents) helped me stay on my path. My pelvic floor is indeed going to need a lot of work and I am up for the challenge. I am happy to say that we are both healthy and doing great. Not every birth plan goes as expected. Luckily, I had amazing people with me helping. I was told to take the next road as it comes. 

12 days later I have been going on short walks with my dog. I am wearing the bellies inc wrap for most of the day to help supports my core, posture, and decrease back pain. As for specific exercises, the only thing I have been doing is diaphragmatic breathing! Daily about 10-40 times.

As for body mechanics, I am working on proper posture with breast and bottle feeding, lifting, and getting in and out of bed! 

Head over to my Instagram @thepelvispro for tips during my postpartum experience