00:00:00
Well. Hey there. Welcome back. Today we are going to be talking all things pelvic floor and hip related. I am super excited about this topic because as a trainer and working with clients and being online, I feel like these two areas are so confusing and so complex and can be very discouraging when we're having pain in them.
00:00:21
And my guest today, Dr. Jessica Warnecke, is going you break them both down and explain how interconnected and related they are. I have actually followed Jessica on Instagram for a long time because she is so clear in the way that she communicates issues with the hip and low back and pelvic floor. And a couple of months ago, I actually asked her to be a contributor into the Expert section on the app I'm coming out with. I know I've mentioned that I'm working on an app and we have an entire section where we are bringing in outside experts on different topics to break them down in simplified videos for people to understand.
00:00:59
And I knew I wanted Jessica to cover hips in detail and how it is connected to the lower back and how it can even be connected to the pelvic floor and the knee. Dr. Jessica Warnecke is focused on helping health conscious women feel strong and stay healthy throughout each stage of their life. As an orthopedic and pelvic floor physical therapist and founder of Pace Physical Therapy, Jessica brings a wide variety of treatment interventions and utilizes a full body approach to understand, examine and assist her patients to complete recovery. Jessica focuses on finding the root cause of dysfunction to heal the source of the patient's concerns rather than simply treating the symptoms.
00:01:38
And you're going to see that today how she connects the symptom with the kinetic chain, with the nervous system, with our feelings, and so much more, and how it really is all connected. Because of her own journey with chronic hip pain and pelvic floor dysfunction, Jessica focuses a lot of her work on teaching her patients how to truly tune into their body and recognize what their symptoms may be really saying and feel empowered to use the tools to help them heal. And truly, you are going to love her and I'm so excited for her to share some information on this complex subject and to honestly even share so much more information and very simple digestible videos in the app, in the education section with all of the other amazing experts. But she is going to be a go to for you, for hip. And if you find this episode helpful, don't forget to share it with your friends and family or let me know by writing a review wherever you listen.
00:02:32
Today I want to give a shout out to Pjammer 49 So so educational fascinating podcast with a must for all women, especially moms who want to learn more about women's health. When it comes to fitness and nutrition, Andrea does her research, so it leaves you feeling empowered and informed. Thank you so much, PGMR 49 for the review. I am truly here for you. I don't know everything, I truly don't, and I will never pretend I do.
00:02:56
But what I do know is I can research to teach you and I can bring experts on to teach you in subjects that I am not the main source. And that is what I even wanted to do today with Jessica to take you up another notch to talk about some of the things that we experience with our hip and signs and symptoms and other things to be aware of as we talk about this today. She's also going to give a couple of videos to help teach some of the concepts we talk about. I will add them in the Show Notes and on the podcast page. I will also add some information from this episode, some videos or some audio so that you can remember some of the things that we pointed out.
00:03:31
That Podcast page is make it simple, Podcast. And that's on Instagram. Again. Make it simple, Podcast. And if you have a guest that you want me to have on, go to the Show Notes and click on the button where you can enter a topic and you can also enter a guest that you want me to have on and that will be labeled just the make it simple podcast guests and topics in the Show Notes.
00:03:57
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00:04:53
All right, let's get into it and talk all things hip and pelvic floor.
00:05:35
Hey, Jessica, I am super excited to have you on. I'm not going to lie, this has been a long time coming from me because I followed you for a really long time. Thank you. I'm so excited to chat and just like dive in, finally getting this on the calendar and getting the chat with you. I know.
00:05:48
So we've been talking about the App expert videos and you're doing videos on hips and low back and all these things, and I thought, I need her on the podcast to talk about some of these topics and break them down, even in more detail because I don't think I know very many women who don't struggle with hip pain or back pain or pelvic issues. And it's just all connected, which you know yes, absolutely. And I think too, part of my journey obviously is stemming from my own personal experiences, which let's be honest, those. Are the best journeys because that's when it's like deep in people's soul and they're like, I need to teach you this. Exactly.
00:06:24
And then being able to be aware of how prevalent it really is, it's like, oh wow, this is actually a thing. It opened your eyes and really teaches you what empathy is. I understand it's like thou disasterecta. I understand what that mom feels like because I have felt that way. So you get that even on a level from a doctor, you're like, oh, I've been there and now I'm a doctor and I teach it.
00:06:47
Absolutely. So powerful. So tell us a little bit more about your background. Yes, so I've been in this PT industry now almost a decade. Typical kiddo, grew up playing just plenty of sports, loved exercise, loved moving my body, and I was also really interested in medicine and in understanding the biology of the human body and the movement patterns.
00:07:10
And so physical therapy was just the best combination of exercise, fitness, sports and medicine. And so dove into it, tried a couple of different things early on and really enjoyed the orthopedic world. So orthopedics meaning the typical aches and pains, back pain, neck pain, that kind of thing that you think of post surgery even. And I found myself gravitating obviously, to more of the athletic population. That was really fun and it was interesting because I would see so many back pain cases or recurring hip pain injuries, knee injuries with running, and patients would do better, like they would overcome their injury, get back to their thing, but they would either re injure themselves or they would never fully feel 100%.
00:07:59
And it's like, okay, well, what's good? What's good enough versus what am I just being okay with and what am. I passing by with? Exactly. And so this is like I mean, I did an orthopedic residency.
00:08:10
I dove really into the clinical side and really understanding all of these specialty courses to be able to support my patients. And coming from that, I was like, okay, well, what's the one area that we just never talk about? And so that kind of opened my eyes to the world of pelvic floor therapy and it really got me intrigued in just so many different courses and correlations between chronic hip pain, chronic back pain and the pelvic floor. And now obviously, I was also going through my own chronic hip journey and as I was working to heal myself and understanding the complexities of it, even if I was seeing good Pts, seeing good chiros, I was like, there's something more and there's deeper. And the best part for me, I think, was the fact that I could take more courses to better understand all the missing links that nobody else could combine and put together in order to better understand my own body and in order to heal my chronic pain and then get me back to not only pain free, but, like, squatting a lot, right?
00:09:13
Running, jump, like all of these other higher level activities that I wanted to do. And I was just so intrigued by the science behind it, but also the psychology and all of the different emotions that go into dealing with a chronic pain or just feeling limited when your mind wants to do more. And so now, thankfully, I have my own business, and so I get to just focus on these types of situations and help these types of clients, and it's just been so fun and so rewarding. I'd like to say I feel like having a therapist that actually can handle both is very unique. Because I've seen pelvic floor doctors, and then I have to go to different doctors to see for knees or shoulders or whatever.
00:09:53
And then I'm there doing some other things, and they say, oh, if you think it's pelvic floor, go to this doctor. So the fact that you can mold both is actually very unique in some ways because I do feel like there is still kind of a split where they're separate and you're really able to mold both together, which is an amazing talent. And you're going to be able to see the bigger picture more than someone who's just an expert in one or the other. So to me, I'm like, oh my gosh, I would love to see you in person. Yes, no, and honestly, you hit the nail on the head.
00:10:28
They do their due diligence and it's more appointments. I just want to go to one. Doctor and say, what is going on? Yeah. They're like, okay, well, at least this person is helping me a little here, and this person is giving me some insight.
00:10:38
But there just comes a point where you need to bridge the gap, right? We're 100% so far, and so it really needs to be on the same. Page, and I love that you're doing that. So let's get into this a little bit more. There's so many reasons, obviously, that people have hip pain, but what are the most common ones that you see?
00:10:53
Good question. So I primarily work with active women, so just that demographic, a lot of times I'll see the chronic injury is something that was maybe started it was a minor thing, right? Not even necessarily like a major injury, but it was just something that was pushed to the side or compensated on over the years. And so it kind of develops and grows on itself and just becomes something that wakes people up at night or is really talking to them. So sometimes there's not even one event or one major injury that causes things.
00:11:31
And some other factors such as having a lot of stress or a stressful event, going through childbirth, going through an orthopedic type of hip surgery. So for laboral, tillers or even like knee injuries, right, having a knee surgery. And the rehab focuses just on the musculo, like the knees, the hips, stuff like that. What occurs deeper within those deep hip muscles and those pelvic floor muscles comes out to play an effect in hip stability, core function, things like that. And they're just not addressed in typical care, typical rehab, and so they'll present later on.
00:12:13
And then sometimes too, it's just with really active women, right? We do a lot with our bodies and so compensation patterns develop. And it's typically one side is that recurring side of re injury or tweaking something over and over and eventually it just kind of, like I said, keeps building on itself. So those types of things I honestly see way more often than like a slip in a fall or more of a traumatic incident. But obviously other factors can be laboral, tears, tightnesses, or weaknesses, having an impingement because of the anatomy of the body.
00:12:49
And also too, things like within our muscles and our pelvic floor, if hormones are changing, whether it's during something like pregnancy or something like perimenopause or menopause, those factors can also predispose some of my clients to notice more stiffness or pain within their hip itself as well. So when most people come in, obviously they have tears, impingements. Do a lot of people complain about hip flexors? Or do they feel like it's more deeper issues or I guess it just varies across the board. Yeah, hip flexor, like chronic hip flexor tightness is a really common one.
00:13:22
Deep hip pain, like deep glute pain or even hamstring pain, like under the sits bones is another really common one. And then like groin pain, like some people, they're like, well, I have pain in four different places depending on the day. And sometimes it's the outside, sometimes it's the inside. And so that, again, it cues us into the importance of making sure that we're assessing everything dynamically and not just focusing on certain structures or certain muscles. And if you ever look at the diagram of a hip, you'll see how many ligaments and muscles and everything connect.
00:13:53
It's like even the inner thighs, people don't realize like, oh, leakage, that's affected by inner thighs. Squats are affected by inner thighs. So many things that they don't think about, they're just like, oh, I want inner thighs, realize it's all stability, like you said. And then it's a kinetic chain situation in many situations. So let's talk a little bit about the connection between chronic pain and stiffness and the pelvic floor and what we can do about that.
00:14:17
Because obviously there's going to be tight muscles, there's going to be impingements, there's going to be different things. But what are things that we can assess and notice ourselves and then connect that with? Our pelvic floor? Yes, the pelvic floor. It's such a host of so much valuable information.
00:14:31
Right. And so just from an anatomy standpoint, so our pelvic floor has three layers of muscles and that deepest layer shares muscle fibers and muscles with the deep hip rotators. So operator internus is a very commonly affected area that we need to incorporate into a lot of the chronic pain recovery. But there's other deep hip rotators, even piriformis, and even just more than the muscles themselves, the timing and the way the muscles within the pelvis and pelvic floor coordinate and activate in relation to the other bigger hip muscles like the piriformis, the glutes, the adductors, obviously. So as iliacus, those guys all have to be in a harmonious relationship where things are timed at the right time, working through the right motion, built up with enough endurance so that they can do their job and the other muscles don't have to pick up the slack.
00:15:31
So just from a musculoskeletal standpoint, the fact that the pelvic floor and the hips share the same muscles is really huge and something that we never learn in school. Literally. It took me so many years to understand the value of these deeper hip muscles. I'm like, why don't we talk about this? But I think that's really helpful for people to be aware of because it can be affected even if you don't go through childbirth or you don't on paper have pelvic floor issues, that doesn't necessarily mean that these muscles aren't involved.
00:16:02
And then on the flip side, there's also just other factors or other functions of the pelvic floor, like circulation, lymph, drainage, supporting, supporting our organs and helping with sexual function, and just what our nervous system does throughout that area, how we hold on to emotions or traumas and things like that. Our pelvic floor just holds on to so much of that and it's hard for us to always be aware of it because we can't see it and we can't really physically feel it or stretch it. And so it's just an area of the body that it's easy to ignore and overlook for so many reasons. So how would someone go if they can't, let's say they can't get into a PT and they're having pain, what would you give them? Signs or symptoms or things to be aware of?
00:16:50
Like it could be this, anything they could do on their own or until they could get in with a PT. Like any ideas for them? Yeah, I mean, obviously it depends on a number of factors. Yes. In general if there's pain, especially if there's pain with things like sustained settings.
00:17:10
So like their tailbone bothers them or their sits bones bother them, or they have pain trying to use tampons or with intercourse, oftentimes that pain can signify that the muscles are too tight, so they're shortened and they're not able to expand and contract the way we want them to. And or they might be guarding. So if people have a past trauma or injury, whether it's like physical or mental or emotional, that type of stimulus to the nervous system can also cause those muscles to just guard up and try to protect so that nothing enters or leaves that area. And so with that type of trigger or symptom diaphragmatic breathing, really getting some good expansion into the pelvic floor, into the low back can be huge. There's a couple of really good yoga poses that help open up the pelvic floor that can be helpful as is, like hip mobility and low back mobility.
00:18:07
Can you give us a couple of examples of a few of those? Yeah. So if somebody from a hip standpoint can tolerate a primal squat, like just sinking deep into the hips, even if they need to sit on a roller or sit on a yoga block I really love that position for the pelvic floor and then adding some deep breathing. Where? On the inhales.
00:18:26
You're literally trying to breathe into the pelvis and expand your sits bones apart. I absolutely love that for pain. So that's a really helpful one. Whether you're seeing a PT or not, it can help very quickly. That's actually one I've worked on.
00:18:43
And I do have a question for you because I do have some hip issues and I sometimes can't sit into it. So I will wrap a band around for me, it's around a row grack. But if you had an island or whatever, because it helps me to not fold forward, I can kind of sit back into it. And I feel like the gravity helps me get a little bit lower. Is that still effective or should I do it on the yoga block?
00:19:04
Because I feel like I get a better range of motion when I almost do it that way. That lets gravity almost push me down. But my posture is good because I'm holding the band out in front of me to help me sit up and not roll forward. Yeah, no, that's great. Honestly, the main goal with that one is you want to feel like you're able to relax and lengthen rather than, like, guarding and you're trying to stabilize to keep you upright.
00:19:25
Right. So the way you have it set up, it's great. Use the arm. Yeah, if I was just balancing you're right, nothing would be working right. And everything would be tense.
00:19:32
But the band helps me just relax into it because I don't have to worry about my weight. So okay, sorry to interrupt you. Let's do a couple more ideas. Yes, another really good one. I like child's pose in a couple of different positions.
00:19:43
So if you're in typical child's pose with your feet together, your knees apart. And of course, adding in that breathing into the low back, that can be really helpful for pain more in the front part of your pelvis. If you're somebody that can tolerate instead of having your feet together in child's pose, you separate your feet so your knees are coming together a little bit and then you're sinking back towards your feet, but your feet are separated. That helps open up the muscles around the tailbone and the sits bones and the backside of the pelvic floor. So that's a great position if somebody has tailbone pain to work through the breath sequence just to help open and expand that.
00:20:21
And then of course, things like Happy Baby and whatnot are just there's so many ways to modify it to fit what your body can get comfortable with, which is awesome because we want you to feel relaxed. We don't want the stretch or the position to feel like it's challenging, painful or just a big effort for the rest of your body. We want you really to relax and just calm down so that you can breathe in and relax and open up that pelvic floor. Ironically, I just filmed a tight pelvic floor video and I did a child's pose and I like to support it with a pillow. But I'm like, oh yeah, I'm going to turn my knees out next time.
00:20:54
I filmed it for this coming week. But I'm like, I'm going to turn my knees in and my feet out and see how that feels. That's a nice variation. Yes, I really love that one. Especially for people who if they sit all day for work and they're like, I can only do so much, I have to be here.
00:21:12
I'm like, get on the floor, do a couple of reps of this. It just helps reset you a little bit. And also too, like people that have pain at the top of their hamstrings, I work with a lot of runners, so if people have that hamstring strain or that hamstring irritation, this can also help it too because it kind of just helps stretch and open up all of those muscles around where the hamstring inserts as well. So from a relaxation standpoint, from a pain standpoint, those are some of the guidelines that I start with. Then on the flip side, obviously if somebody is having a lot of, let's say, leaking or bowel limitations, we can have the cosby because things are too tight.
00:21:52
We can also have the cosby that things are just too weak and we can't activate know from a motor control standpoint, coordinate what we need to do. And so that's where I think just getting guidance from a PT skilled in that type of treatment is really helpful because it doesn't have to take a whole lot of effort or it doesn't have to take a long time. It just helps to have somebody cue you in the right way that your body can respond to so that you know how to activate those pelvic floor muscles by themselves but also in correlation with everything else that needs to help with something that's more of a weakness based symptom as opposed to a pain based symptom. That makes sense. What are the muscles that most often overcompensate when it's weak?
00:22:36
Because I know a lot of times after someone has a baby and then they have a weak pelvic floor which basically just it's not activating and then it stays for a long time. Are there other muscles that are starting to overcompensate? Obviously we know the lower back, but what other things could people be aware of that possibly in that situation where it's not tight, it's weak, which could cause pain in other areas and they're not recognizing, oh, this is the pelvic floor. You know what I mean? It's not connecting.
00:23:02
They're thinking it's something else in the kinetic chain. If they felt weakness from a core standpoint and they couldn't do something like a Kegel without squeezing their Adductors or squeezing their glutes, those are really common compensations, I find. People are like, Well, I'm doing a Kegel but literally they're tightening their thighs or they're squeezing their butt. So that's a pretty common one, I think. Other things too, that a lot of the moms I work with will start to have like foot or ankle pain and they're like I've literally just been walking.
00:23:34
I mean, they're probably obviously walking a lot, chasing little kiddos or holding somebody and they're like, Why are my feet hurting? And it's really interesting, the connection and this can be it for a different day, a conversation, but the feet and the pelvic floor and the hip are so entwined and so many people don't understand the connection or the compensations that go on between the two regions. And so that's another really common one I see, that I think can be helpful for people to understand other things too. Just like if people start to have pain in their low back or their knees oftentimes, if, like, glutes and quads or hip flexors are constantly tight or they're constantly working, we really need to just work on the mobility. And the stability above and below the pain points themselves so that the areas that we're feeling pain are just better supported and stabilized dynamically.
00:24:25
Especially with loading or with exercise. Oh, I love that you said that. First of all, it's good for anyone to know if you're having feet issues and leakage, it could be linked because I don't think everyone realizes that. So that alone is great. And then to point out above and below the body is all connected, everything connects.
00:24:42
We learned that funny song when we were little. The hip bone connects but everything is connected. So if you're having chronic knee pain, what is your quad and hamstring doing and what is your calf or feet doing? If you're having hip pain, what are your glutes or hamstrings or quads doing, like, recognizing, thinking, where is my pain? And as you pointed out, look underneath and look above, and maybe that can help offset some of that pain because all of those are connected.
00:25:07
Like, it's a really common one. As you know, more than anyone, people have low back pain. And it's really because the hamstrings are tight and they're pulling on the low back. And then we think, oh, the low back, low back, low back. And it's like, well, it's actually because the hamstrings are so tight that they're yanking on the lower back.
00:25:23
So that's such a good point to bring up that you did that. I really love that. Yeah, and I think, too, just kind of because I know hamstrings and hip flexors are two very common areas that people are like, I'm just chronically tight here. And for a lot of cases, I think it's helpful for people to understand that chronically tight things are weak things. Okay?
00:25:43
And so if we just stretched away, it literally is not going to do anything long term. Yes. And so I love eccentric loading for those muscle groups. I love dynamic coordination for those muscle groups to literally retrain them into how to support and work with everything else through that full flexibility, through that full range of motion. And I think also, too, when people are like, well, I do this bridge, but I feel my quads.
00:26:08
Right? So if there are certain areas of your body where you're trying to work those muscles, but you can't feel those muscles, that's a good indicator that there's just a compensation pattern going on. And so recognize that, right, and work through it or look for more information on it just so that you're not just going through the motions and not reaping the benefits of the exercise that you're trying to do. I think we do think as a society, like, oh, the hip flexors are tight. Just stretch, stretch, stretch, stretch.
00:26:34
Constantly stretching. But you're saying they're weak. You can stretch all you want, but the pain is not going to go away until you strengthen them and do some loading on them. What are some quick things that people could do? For example, hip flexor, tightness, besides stretching, as you mentioned, we need more.
00:26:49
Yes. So eccentric strengthening. So eccentric, meaning the controlled lengthening of the muscle contraction is amazing. One of my favorite positions to do it is lying down on your back in the leg 90 90 tabletop position. Because I love the core stability, we get in that position.
00:27:06
So I love putting a band around my feet and slowly straightening and lowering a leg and then alternating. Yes, that's one of my favorites. Yes. It's killing so many birds with 1 st, we get the core stability, we get the loading. We're working both sides.
00:27:24
It's typically a pretty safe position, obviously. And there's so many ways that we can make it easier. Or harder. So that's one of my favorite. It also helps for a lot of people having the cue of just like how their trunk feels on the ground is a nice cue so that they know that they're maintaining good control, good function.
00:27:43
So that's one of my favorite ones. But I mean, obviously you can work it in so many other positions. And I think, too, finding a good balance for the hamstrings, right? Like, can you do the eccentric component of a bridge or a leg curl? Can you do a slow, controlled hip hinge or deadlift right.
00:28:01
Don't forget the value of the slow lengthening load. Yes. To the other stuff that we do so often in our workout, I think. We start to load our dumbbells or bars or whatever, and we're like, okay, I'm going to lift this much. And then people, their range of motion shrinks and their speed multiplies so fast.
00:28:19
And even as I was lifting for the app, sometimes my husband would say, slow down. He's like you're lifting fast. Because I was tired and that's not effective. And so he knew to cue me for that because you get tired after a couple of hours and he would say, you're moving too fast and then people copy you. And so I was like, oh, yes.
00:28:36
But it's important to remember that that the muscle is broken down. The muscle works under slow movement. It's not about how fast you can do it because if you're super heavy, your range of motion is low and you're flying through it, you're not going to get the work like you pointed out, as if it's slow and controlled. Do you have some videos on some of those as well? I'd love to link them in the show notes on hamstring hip flexors.
00:28:58
We'll put them on the show notes so people can see visual cues for that. Yeah. So let's talk next about the nervous system and how that helps connect. Because obviously we talked about finding the pain points above and below slowing things down. What if the pelvic floor is tight?
00:29:12
What if it's weak? Kind of some ideas about that. How else can we heal through the nervous system? Yes, the nervous system, it's so powerful. Honestly, the more I grow, both personally but also with business and working with clients, the impact the nervous system has is, in my opinion, the foundation of almost everything we do because of how it affects the mindset, the hormones, the nerve tissues themselves that are necessary for the muscles to contract and activate.
00:29:44
And in our day to day life, there's so many stimuli that are I'll call them stressors to the nervous system. Not in a good or bad way. They're just factors that feed into our daily to day life. But I think especially from a chronic pain injury or from even things like chronic fatigue or chronic just like aches and pains, I think it's really important to understand what are we doing for the nervous system? How are we feeling things?
00:30:15
So we can talk about stress itself and the actual cortisol in your body. We can talk about the time somebody has been under stress and what that does to the mindset changes or how they view events or like a fear avoidance tendency if they've had back pain from a certain type of movement or exercise, fearing that movement or guarding against that movement and not working through it. Most of that comes from the brain trying to protect us from that future injury. And so we have to really work to rewire that pathway. So that's not our new normal because we know physically our body can do it, right?
00:30:55
So, yes, I work a lot with people that have just they're scared to do a deadlift because they've hurt their back doing a deadlift. And mobility is fine, strength is fine. They'll do random things. I'm like that's essentially a deadlift movement, but you're just not recognizing it. So it's really cool to just kind of play with the human psychology and the mindset around certain things like this.
00:31:21
And then obviously there's the other factor where sometimes people maybe have tightness or weakness or like a structural component that might feed into pain itself, like a laboral tear or like a hip impingement. But the trigger that increases the pain or makes it feel like it's getting worse and worse and worse or traveling to other areas of the body is if they're under a lot of stress, like from a job or from home demands or from relationships or whatnot. And so just the continual elevation of cortisol feeds into the irritability and the intensity that the brain perceives pain receptors of. And so that's another thing where we could stretch and strengthen all we wanted, but we really have to address the nervous system to kind of take it out of that sympathetic state of fight or flight and bring it back into that more parasympathetic state so it's a lot more calm. So those are a couple of really important ways, obviously.
00:32:19
And then like motor control, right? Just making sure that the timing of when the nerves are communicating with the muscles and the balance and the stability and one side versus the other, as long as all of that is on the same page, that I think is really important to help with just overall health and function of the nervous system itself. So ironically, that actually happened to me. I mentioned I had hip issues. I was diagnosed with AVN two years ago and then this last year they actually did another MRI.
00:32:49
And I don't have AVN. I have something called transient osteoporosis hip, which was often misdiagnosed as AVN. But long story short, I was doing PT. I was very limited in my motion about a year ago. And one of the things I did was when I would squat because that hip was a little bit more impinged.
00:33:07
It just didn't have the range of motion. My squat would shift and one of my hips would shift. And as my range of motion came back and I worked on it and some of the things that motion stayed because I was scared, which is exactly what you said. And a couple of months ago, I went to the PT and I was like, my hips are still shifting sometimes. And he was like, that is your brain pattern creating that mechanism.
00:33:28
It's like any thought, we think it starts as a stream and if we continue to do it, that stream gets bigger and bigger and then it turns into a river going that direction. And he's like, you can squat straight, but you have created that mechanism pattern from when your hip was more limited. And so I have to often think about it, and when I'm really tired, I will shift back into that incorrect pattern and I just have to be really aware of it. And it's gotten better and better and better and better with time, but it takes time for you to move out of that. So if you're in a situation where you are noticing these things that you're overcompensating or you do have funny patterns, give yourself time and maybe get into a PT to make sure that you can do it correctly or they can help give you cues.
00:34:13
Because I know for me, there were some cues that he taught me that I still use when I'm like, oh, I'm tired, I can tell I'm shifting. I have to be really aware of it. So I love that you pointed out how strong the nervous system is because at that point, it wasn't my hip anymore, it was my brain doing it. Yeah, it's so powerful. It's so fascinating.
00:34:32
I love working with it, but it's a very impactful challenge for a lot of people. And it sounds like obviously you had a great PT, but it also just depends on the type of PT you're seeing, right? What their clinical skills are or how much of the pain science world they've been into, but also how much time they have to work with you and to explain things to you in a way that makes sense to you. Because I think it's so important for the patient to understand what you're trying to educate them on. And so we have to do a good job as providers of speaking in their language or like, tweaking the cues to fit what their body responds to or what they're receptive for so that it can actually click, stick and continue on and make that lasting difference that we need.
00:35:18
And so I definitely think it's just not talked about enough, especially in the general population. But it makes such a huge impact in the longevity of just staying healthy. And not even if you have a future injury, like not letting yourself go back into the cycle of a chronic injury or a fear avoidance pattern. Because, yes, you see people walking different after a knee surgery and then all of a sudden their other leg hurts and their other ankle, whatever else, because they're shifting because of an injury and it's really common. And so I love that you pointed that out, that you can't go back.
00:35:52
And even with the stress, I feel like stress, first of all, it just murders your pelvic floor. It is like the home of stress and trauma. It's like, oh, okay, everyone come to the pelvic pelvic floor. I know. So just being aware of those factors, that it's not always physical, that sometimes it's our mental connection we really need to think about.
00:36:12
Yes, absolutely. And it's interesting too, with the pelvic floor component and a little bit kind of back to the comment you made earlier about, I have my hip PT, pelvic floor PT a little different. I see so many clients. Most of the people I work with honestly have tried either other orthopedic PT or pelvic floor PT. And so they'll come to me and they're like, I don't really think it's my pelvic floor.
00:36:39
My PT said it wasn't my pelvic floor, but I saw this thing you did, or I heard this thing you said. So I'm curious. And so if you've been dealing with a chronic injury, especially in the back, the hip, the pelvis even like, the knee area, and it's not improving with typical PT. And your PT tries to clear your pelvic floor by asking if you leak or if you have pain or if you've had a baby, and you say no, and they're like, okay, great. It's not your pelvic floor.
00:37:07
That is so superficial, and that is so not doing your pelvic floor justice. So don't just take that as like, okay, it's not my pelvic floor. Literally have a pelvic floor specialist. And sometimes I don't even have to physically assess anybody. The way I question or ask people certain things cues me into, yes, this is likely their pelvic floor involved in some capacity.
00:37:29
So let's make sure what we're doing for the hip is helping both areas. I could see that. I could see that mistake being made a lot, and people don't realize that that's the connection. So just because you check those boxes, just because you're like, oh, I don't have leakage and I don't have chronic lower back pain or I didn't just have a baby, doesn't mean that it's not your pelvic floor. If you're having low back pain or hip pain, it doesn't mean that at all.
00:37:54
Yes, exactly. What is something that you feel like is also like a myth or something else that's misunderstood about chronic hip pain? Anything that you would want the everyday person to realize about it, because it can be very discouraging. And as we've talked about, there's no one answer. There's no one reason it's not cut and dry where you can say, oh, it's this, that.
00:38:17
You do this one exercise and you're healed. It doesn't work that way. It is a journey. It is a journey. So what is something you'd want that person to know?
00:38:28
A journey is a great way to put it, especially if it's not chronic. But I want to just hopefully provide a hope for people that there is so much opportunity to really better understand your body and to get to the point of fully healing and becoming pain free. It starts with the mind. So if you believe that you can heal, if you believe there's a solution out there and maybe you just haven't found it yet, that is huge because that opens up mentally the option that, yeah, it is somewhere out there, I just need to find it. And I think hopefully with social media the way it is and even just like education being available to the general public easier now more than ever, I think it's awesome for people to get exposure, to see different types of hip exercises or conversations on pelvic floor stuff or back stuff to give insight into how our body truly is all connected.
00:39:26
Not just musculoskeletally, but literally holistically. Right. If somebody has had years of gut health issues or IBS, you better believe their pelvic floor is involved and you better believe there's inflammatory components that are affecting their hip. Yes. So we have to have those conversations.
00:39:41
If somebody's not sleeping all night well, you better believe your musculoskeletal system is not recovering the way we need it to. And so I think it's important to just keep an open mind, obviously, but keep looking for education and information for the full body and don't feel like surgery is the end all, be all. Because oftentimes I've had so many patients that were told by numerous doctors they needed a hip replacement and they literally ran a marathon three months later. I'm one of those. I was told I needed a hip replacement and I don't.
00:40:12
So I'm with you on that one. Yeah. So the power of the human body is phenomenal and it's really exciting for me just getting to work with it all, but I just want to share hope with people that might be just struggling and frustrated with something that's so chronic. There is a provider out there. There is a solution for you.
00:40:31
It just might not be the black and white option that you think would work based off of somebody that had a different experience down the road. So compare yourself to you, but don't quit on yourself and don't lower your standards or your expectations with what you want to be able to do. Just know that I think pain and symptoms are a great way for our body to communicate with us and try to get us to understand the story it's trying to tell or the thing it's trying to show us. And we get to grow from that, and we get to learn more about our body, and that is what empowers us from a longevity standpoint to just age well and be well and stay healthy and maintain the quality of life that we really want to. I love that.
00:41:12
And it gives people a chance to be like, just because you went to one PT and you were told something once doesn't mean you can't get online and find so many solid, solid accounts that you can scan videos and learn. I get on accounts all the time and I learn so much from yours, from so many others where I'm like, oh, never thought of that, never thought of that, never thought of that. And no matter how much you think you know, no matter what your profession, non profession, whatever, there's always a lot more to learn and there's always a lot more options and choices. And sometimes it's so hard to be in your current situation and say, it's never going to get better. I'm stuck here.
00:41:48
But you're only stuck if you stop if you stop researching, if you stop trying, if you start giving up, that's the only way you're stuck, is if you stop putting in the effort to figure out what's going on. And it can take time, especially with that complex hip. It is rough. Yes, there's so many moving parts, and of course now we're on the other end, so we're like, oh, yes, of course. Glad I know all this information now.
00:42:12
But it can't feel like a struggle when you're in it, for sure. You and I both understand and so I think it builds character, right? And so you have to just be the type of person that isn't going to settle and you know that you can be better. I will definitely be adding a bunch of your videos on some of the things we talked about in the show notes, and obviously you're an expert in the app that's coming up and you have a ton of educational videos there, but where else can we find you? So I'm most active on Instagram, so Dr.
00:42:40
Jessica PT is my handle. If people have questions, I mean, comment or send me messages, I try to answer them as best as I can. She does a really good job of answering them. I'll just say that I really do. Because I think it's a cool way for one, for me to give back and be able to help people that maybe didn't know what they didn't know, but also too just to give a little bit of guidance or support to get somebody moving in the right direction, right.
00:43:09
It doesn't have to take a whole lot of energy. It's like, let me just guide you. I'll be honest. If I feel like you need a provider to look at you, I will tell you. But I try to do a well rounded job with my exercises to just give people options.
00:43:25
And then my website too. There's some resources on my website, so Pacept.com, you can always send me emails too, if you have questions on anything or if you feel like you need a more in depth assessment or consult just to dive deeper into a specific injury. And she does have a pelvic floor freebie, right? Yes, I have. And she's working on a hip.
00:43:45
One. Pelvic floor freebie is linked on my Instagram. And also too, if you sign up for any of my so if you sign up for the pelvic floor freebie and you get on my email list, I love sending out weekly, sometimes a couple times a week, just some helpful health tips, know, nice, fun things that I get to explore. Well, thank you so much, Jessica, for coming on today. Yes, thank you so much.
00:44:10
It was a blast. I appreciate you. I hope so much that you learned something from this episode. And to be honest, we are just scratching the surface in this episode. But I'm hoping that you learn about some symptoms, some triggers, some things to be aware of.
00:44:24
Whether it's stiffness, whether it's a weak pelvic floor, a tight pelvic floor, whether it's what your nervous system is doing or overcompensation patterns with your mind or even connecting some issues to our feet and the other mechanisms above and below that. Pain, point, injury, all of those things I think we can think about when we think of our own aches and pains and we might be able to find some better solutions. That it's not just always about stretching, as Dr. Warnecke said, but it's also about strengthening and being aware, because oftentimes a lot of our back pain isn't from a tight back, it's from a weak pelvic floor, it's from a weak core, it's from tight hamstrings, as we mentioned. So just being aware of what's happening above and below the muscle is going to make a huge difference.
00:45:10
I will definitely be linking some of her videos and you will learn so much more from her in the app expert videos where she breaks down even more exercises, but in the meantime, definitely check out her page. It's super educational and I hope here you got a little bit more information and you found a little bit of hope if you are experiencing any chronic pain in your pelvis floor or your hip. All right, that's it for today. I promise you are doing so much better than you think you are. And we'll chat next week.
00:45:42
Bye.