374: The #1 Pelvic Floor Mistake Women Make in the Gym – and How to Fix It with Dr. Courtney Johnson, DPT

Introduction 

You're listening to Biceps After Babies Radio Episode 374.

Hello and welcome to Biceps After Babies Radio. A podcast for ladies who know that fitness is about so much more than pounds lost or PR's. It's about feeling confident in your skin and empowered in your life. I'm your host Amber Brueseke, a registered nurse, personal trainer, wife and mom of four. Each week my guests and I will excite and motivate you to take action in your own personal fitness as we talk about nutrition, exercise, mindset, personal development and executing life with conscious intention. If your goal is to look, feel and be strong and experience transformation from the inside out, you my friend are in the right place. Thank you for tuning in. Now, let's jump into today's episode.

Hey, hey, hey, welcome back to another episode of Biceps After Babies Radio. I'm your host, Amber Brueseke, and today is one of those episodes that I wish every woman who lifts, runs, jumps, or even just sneezes or jumps on a trampoline could hear because we're covering a topic that gets ignored until it becomes a real problem, and that is our pelvic floor health. Here's the thing, pelvic floor dysfunction doesn't just happen after pregnancy or later in life, and the truth is if you are active, if you're lifting heavy, if you're pushing your body, we need to be talking about your pelvic floor because it is a part of the conversation, and that's why I invited Dr. Courtney, also known as The Female Athlete Doc on Instagram, onto the podcast. She is a physical therapist who specializes in the pelvic floor, and she also simultaneously speaks the language of lifting, and she's not afraid of barbells, and she doesn't just tell women to stop working out if they are struggling with leakage or pelvic floor prolapse. She wants to be able to help women to be able to stay active, stay in the gym, stay lifting, and do it without pain, without leaking, or without fear of doing it wrong. So today in this episode, we dive into what the pelvic floor actually does, why Kegels aren't the cure-all that maybe you have been told that they are, and really what I loved from her was this idea that every single lift is an opportunity, if you use it, to train your core and to train your pelvic floor. And we get into the nitty-gritty of exactly what that means and exactly how to do it and what you should be thinking about as you are lifting. So my goal is for you to walk away from this episode feeling educated, empowered, and probably rethinking a little bit how you brace during your next squat. So let's jump into the episode. 

Amber B 02:44

I'm so excited to welcome Courtney to the podcast. How are you doing, Courtney? 

Dr. Courtney Johnson 02:49

I'm doing so well. I'm so excited to be here and just yap about pelvic floor. 

Amber B 02:53

I know. Courtney told me before that she's a yapper, and I was like, excellent, we can yap about pelvic floor. Fantastic. Let's start with an introduction. Just tell us a little bit about you and what you do. 

Dr. Courtney Johnson 03:05

Yeah. So I'm Dr. Courtney. I live in Phoenix, sunny Phoenix, Arizona, where it's already 95 today, middle of March. Big outdoors person, pelvic floor physical therapist. So I came to physical therapy, not with the traditional story that's like, oh, I injured myself or, oh, I had a baby and it inspired me to be a pelvic floor PT. I came from the perspective, I just wanted to work with female athletes. And so in order to do that, I had to get trained in the pelvic floor in order to fully actually work with women athletics. Otherwise I was kind of stuck to her like ACLs and shoulders and like hip pain, which is like fun and cool and all, but like pregnancy and postpartum is way cooler. So that's my jam. I'm athletic myself. I work out a ton, like it's my passion and staying outdoors, staying active and all facets of that and just being able to shine light on how important fitness is for longevity of life. And I think my platform speaks to the same people that I am, right. And probably the same people that are listening to this podcast and they want to be active and they want to be healthy, but maybe are limited by pelvic floor dysfunction or hip pain, back pain. And so that's my jam. I talk a lot about that and I like to travel and hang out with my boyfriend, also a physical therapist, and we have dogs, no kids yet, and we just live our best life. 

Amber B 04:43

So fun. Okay. I want to start with a little bit of just defining something because I think sometimes we just like throw out this term pelvic floor and people have like a general concept of what that means, but it is fairly specific. So can you kind of explain what the pelvic floor is and why every woman who has one should care about the conversation that you and I are going to have today? 

Dr. Courtney Johnson 05:07

Oh my gosh. Everyone have their ears open, right? I okay. So what exactly is the pelvic floor? So the pelvic floor is a group of muscles that lie at the bottom of the pelvis. They're a muscle group composed of slow twitch fibers and fast twitch fibers. That's just jargon for literally they're composed of the same muscle fiber types that any other muscle in your body is composed of, which helps you to understand how important they are because they're not just these little tiny little muscles that have no function and they don't matter and nobody talks about them and blah, blah, blah. Like they have a lot of important functions. They have five major important functions, which are one is sump pump function, which is a lot for like inflammation and pumping out bad things and getting rid of bad inflammation. I just repeated that, but good nutrients. So good blood flow, right? So a sump pump function is very important. We have stability. So it helps with the bone structures and keeping everything together. We have support for the pelvic organs. We have the sexual function, which we all know what that is. And then we also have sphincteric function, which helps being remaining continent. So those major functions are really major. Like we're not dismissing those. And that's what a lot of people don't realize what the pelvic floor is, what it does, where it is until they have an issue. And I love talking about preventative side of things. So anytime I'm talking about the pelvic floor, I'm like, okay, listen, you are, you're a male, you're a female. Everybody has pelvic floor. You can be preventative about all of these issues that I'm talking about right now. It doesn't have to be until you have a baby. So it's really important that every woman out there, especially active women to know what these muscles are, what they do and how to best support them for the rest of their life.

Amber B 06:59

Yes. Oh, so good. And that's really why I want to have this conversation because again, I think so many women kind of take their pelvic floor for granted until it becomes a problem. And then now it's a problem. And, and there could have been a lot of things that we could have been doing up into this point to prevent it from even getting to that point where it becomes a problem. 

Dr. Courtney Johnson 07:17

Exactly. There's so many preventative measures and it's not like, okay, you have to do core and pelvic floor exercises. It's literally like there's no such, I mean, there's no such thing as a core and pelvic floor exercise. First of all, let me throw that out there. Every exercise in the world of exercises is an opportunity to work on your deep core and your pelvic floor. All you have to do is know how the muscles work, what their functions are, how to get range of motion to it and how to breathe. If you can do those couple things, you literally can do squats and support your pelvic floor. Like you don't have to do the boring Pilates, lay on your back dead bugs forever. Like that's not what it is. So just throwing it out there right now.

Amber B 07:59

Can we like dive into that and break that down a little bit more because I do think that there is this misconception that there are like certain exercises that we should be doing kegels or a dead bug or whatever that are like, these are my pelvic floor exercises. And what I'm hearing you say is like literally every time you go and lift is an opportunity to be working on and strengthening your pelvic floor. So how does one do that? Or what do we need to be thinking about as we go into doing a squat or a deadlift or a lateral raise or whatever it is that we're doing? How can we use that as an opportunity to simultaneously improve our pelvic floor? 

Dr. Courtney Johnson 08:35

Yeah, great question. So in terms of the function of the pelvic floor, because it's a muscle just like every other muscle in the body, it lengthens and it contracts. So a lot of times people assume that when they're doing a deep core exercise in order to tap into the pelvic floor, they also need to Kegel at the same time in order to engage that muscle. That's not true. We don't want to Kegel when we're exercising. Like, let me repeat that. Like we do not want to grip and grab and contract our pelvic floor when we're doing exercise like squats, for example, or a lateral raise or a dead bug or whatever, like leave the pelvic floor alone. The pelvic floor needs to move because it moves by itself on its own. Like you don't need to grip it at the same time. However, I will say there's a caveat to this because there are times when there's in coordination of the pelvic floor muscles, right? It can't lengthen, it can't contract, it doesn't know when to do when to do what. And so if that's the case, then like a Kegel is necessary on its own to train it how to contract and relax properly. But you don't need to train your pelvic floor to lift when you're trying to lift, if that makes sense, because if you just focus on breath mechanics, literally just breathing inhales and exhales, your pelvic floor moves with your breath. So if you focus on a squat, for example, and you're going down into the squat, that's a point where you could inhale, right? Because you're, you know, you're getting air into the lungs and that will lengthen and create intra-abdominal pressure into the abdomen and lengthen that pelvic floor.

So it drops it, it lengthens the pelvic floor, it relaxes it. And then as you're standing up with that squat, that's when you can implode or employ like a exhale. And that will bring up that pelvic floor as you're standing up in the squat. So just literally by manipulating your breath, your pelvic floor can move. So you don't have to do a Kegel with it unless you're literally so incoordinated that you don't even know if you're breathing right, your pelvic floor is moving right. You don't even know how to activate your core right. And if those three things are happening, we should probably back off doing some squats and figure out how to get those things to fire first. 

Amber B 11:02

Right. Yeah, exactly.

Dr. Courtney Johnson 11:04

So yeah, it's really hard. 

Amber B 11:07

Oh, yeah. And I would love to back up a little bit because I do think it's like knowing how to brace is, you got to know that first before you start to drop down into a squat. Otherwise, right, we're gonna have even more problems. So can you talk a little bit? I mean, I love how you're so focused on the breath and how we're breathing during these exercises. Can you talk a little bit about bracing and some of the mistakes that a lot of women make as they start to go into doing heavy squats and they don't know how to control their breath? 

Dr. Courtney Johnson 11:34

Right, right. Okay, so this is really, really good because there is a difference between bracing and bearing down and the Valsalva, for example, like, and I'm not going to say start by saying that the Valsalva is bad because it is not like there comes a time and a place when you need to learn to use the Valsalva to create intra-abdominal pressure, especially if you're lifting really, really heavy, like 90% one rep maxes, right? Like we're going pretty heavy. And in that case, like, you don't just need to Valsalva and bear into a belt or bear into the abdomen and bear down into the pelvic floor. You can still Valsalva and engage your core at the same time. And so what I focus a lot on and what I talk a lot about is bracing with the abdominal muscles first before taking that big inhale and pushing into the belt or pushing down into the pelvic floor. Because if you're just like pushing into the belt or the pelvic floor, you're bearing down and putting a lot of that intra-abdominal pressure, that negative pressure into the pelvis, into the pelvic organs and into the pelvic floor, which is like further exacerbating like any potential problems that could be like contributing to weakness already. So that is like the far end of the spectrum where it's like, we don't want to do that. And then we have the people that are like really, really, really squeezing, you know, sucking in everything super, super tight, and they can't even breathe. And that's the opposite end of the spectrum where we don't want to be. We want to be right in the middle where we're able to manipulate our breath, but still engage the core a little bit. And I always like to talk about the fact that like women are not small men in lifting. And there are a lot of coaches out there and trainers that treat them the same. And now it's come to, you know, over the last 15, 20, 25 years, like pelvic floor health has really like opened up. Like everyone knows what pelvic floor is like, you know, for the most part, I would say like a lot of people know what it is now. Whereas when I was getting started lifting, I was out of college, you know, like 13, 14 years ago, I didn't know what the heck I was doing. I was, I joined a CrossFit gym and I was told to put the belt on and bear into the belt and bear down and hold my breath. And it's like, I was taught that at 18 years old and I was doing that until I became a pelvic floor PT, lifting heavy at CrossFit. And I'm like, oh my gosh, if I could go back and just like thump myself in the head, I'm like, Courtney, like you didn't, you could have known so much differently if somebody had just been a little bit more educated on women needing to protect their pelvic floor for longevity and like female, you know, hormone health. And, you know, cause as you get into menopause and perimenopause, like it's harder to build strength down there. Okay. So now is the time to like really build up that strength. And I was just contributing to an issue. So all in all, there is a proper way to brace with the core and not bear into the pelvis, bear into the abdomen. And that should be the way that everybody, not just women, everybody should lift. And not only just focusing on that big intra-abdominal pressure, like held.

Amber B 14:51

It’s really good. And I'm going to ask you some questions about bracing your course. We're going to get to that. But I do want to ask you about, because, you know, you made this point. It's like we all have a pelvic floor. It's like you hear a lot about it with women a lot more than men, but men have a pelvic floor as well. So if I'm hearing you right, you're saying that the same recommendations you're giving in terms of bracing and protecting your pelvic floor, men should be doing the same thing as well. Do they have as much, you don't hear as much about like pelvic health with men. So I guess I'm just asking what is the difference if there is any in the structure of men's pelvic floor versus women's pelvic floor? And why do we hear more about women? And do men need to be listening to this conversation too? 

Dr. Courtney Johnson 15:35

Absolutely. Men could listen to this conversation and learn too. It's the same. Like, I think there is a better way there, you know, good, better, best kind of thing. Like there's no, there's, like I said, there's nothing wrong with the Valsalva, but if you're doing that all the time, like that's where I'm going to raise a little bit of a yellow red flag. I'm like, we should probably work on this and focus on this. So that way they don't also contribute to issues down the line.

Amber B 16:01

So you're saying like doing like a one RM, maybe we're doing a Valsalva on that. But if you're working at 60% of your one rep max, like why are we Valsalving? Is that what I'm hearing you say? 

Dr. Courtney Johnson 16:10

Yes. Why are we also using a belt all the time? Like he gets the belt too? Like that's a lot of pressure, especially if we're not bracing correctly. And men don't have the highest amount of risk, right? Like women are more at risk for pelvic floor dysfunction, but that doesn't mean that men can't get it. I've treated males in the past when I used to work in the clinical setting and I saw a lot, I treated a lot of like triathlete males, right? Like a lot of men that put a lot of pressure to their pelvic region can cause a lot of pelvic floor dysfunction, a lot of pelvic pain. So men alike can also focus on range of motion of the pelvic floor and breath mechanics. So that way they also can reduce their risk of developing pelvic floor issues as well. 

Amber B 16:58

So good. Okay. Let's talk about properly bracing your core because I'm sure everyone's listening is like, oh my gosh, am I doing it right? Am I properly bracing my core? So what does it look like when somebody does it properly or how can we know, what can we check to make sure that we're doing that correctly before we go into that squat? 

Dr. Courtney Johnson 17:15

Oh, absolutely. So I have, I think I have a couple of videos like on my YouTube on how to actually properly do this. If anyone wants like a visual representation, but for the descriptive presentation, so I like to use a couple of different cues. Some cues hit better for others than others. You know, the belly, the traditional belly button to spine when you're engaging that deep core. That's a good one. I also really like wrapping, like bringing hip bones together, ribs together, and then meeting all four in the middle towards the belly button. That's a really good one. And the wrapping one, I like a lot because some people will tend to pelvic tilt when they do belly button to spine, they'll kind of like tuck their butt, like butt under their tailbone under and then like flatten their back. And that is a lot of real, or that's really, really common in like Pilates and like yoga movements where they tell you to tuck your tailbone under while you're engaging your core. And, and when I go to those classes and I'm like, no, stop telling you, but that is like one of the ways that you don't want to engage the core. The transverse abdominus is a muscle group that will back up till it is not vertical. So if we're engaging that muscle, it's more of a brace and more of a hug and more of like a tightening than it is any pelvic movement, any rib movement, anything, right? Like it's just wrapping. So I like to use the cue hip bones together, belly button to spine, but I always cue it with the breath. Because if you think of like body mechanics and you were to Google right now, pelvic floor and diaphragm relationship, you're going to see how it moves all together. So when you're engaging the core, you want to do it with your breath. So as you inhale into the belly, everything is relaxed. And then you're going to engage that core on that exhale because that's the, but biomechanically, that's how the diaphragm and the core and the pelvic floor all move together on that exhalation when they all contract together. And it's literally, that's just biomechanics and that's how we do it. 

Amber B 19:24

So good. Yeah. That's a really good like checklist for people to know if they're doing it right. Because this is something that, like you said, is every lift that we're doing, we should be bracing that core. Like it's an opportunity to be able to practice that. The breath, the bracing of the core, keeping everything tight without a Valsalva unless we need it. 

Dr. Courtney Johnson 19:42

Yes. And without tugging that pelvis and clutching the glutes. They didn't get invited to the party. 

Amber B 19:50

They are not invited. 

Dr. Courtney Johnson 19:53

Uninvited.

Amber B 19:54

Okay. You've already given some ideas, but for women who love lifting heavy or love doing CrossFit or love these styles of workouts, what are some things that they should be thinking about as they're challenging themselves? Obviously, I think we talked about bracing, maybe ditching the belt unless we're at like a high percentage of your one rep max, maybe ditching the Valsalva unless we're at a high percentage. But some of these like more dynamic movements, I'm thinking a dumbbell snatch or I'm thinking even like cycling the barbell when you're doing cleans or things like that. Are there other things? I think sometimes, especially with CrossFit, the movements happen so quickly versus like a powerlifting move where it's like you're just going to go do one squat. It's kind of easier to like think about your core, get everything ready, and then go drop down to the squat. When we're cycling the barbell, it's like a little different of experience. Any suggestions or ideas for a woman who is maybe in that dynamic of an environment of things that she could be keeping in the back of her mind to keep herself safe? 

Dr. Courtney Johnson 20:49

Oh, absolutely. Like you're talking like during Metcons and like actually things that are just moving at speed. Breathing, like more than anything, like your core needs to be on all the time. And if you don't have the strength to keep your core on through 10 reps of squats, that's okay. Then break it down into smaller reps. And when you're somebody who is at risk for pelvic floor dysfunction, maybe you've had multiple vaginal births. You've had some history of leakage. You've had prolapse or you're pregnant currently or you're currently early, early postpartum like with less than six months postpartum. Then you might be someone that like breaks it up into sets because we need to focus on breath manipulation and core activation through the whole process. So if you're doing a set of like 10 power cleans or shoulder overhead or whatever, then the focus needs to be breath or core first, breath second. So make sure that core is activated and then keep the core on the whole time. If you can't keep it on for 10 reps, then break it into five and reset the core without throwing the barbell down. 

Second thing would be as you're throwing that barbell overhead, you're cycling it with the cleans or the shoulder overhead or dumbbell snatch. Like you're just exhaling. Every time the bar, you're catching the bar, you're catching the dumbbell is always a perfect opportunity to exhale, which seems crazy if you're going pretty fast. But like generally you have like a second to two between cycles. Like you're not doing it that quick. Like, holy cow, that would be so fast. And maybe you can swing together, you know, one breath every other. But in general, like try to get it on the catch, like exhale as you're catching the bar or like a double under, for example, like exhale as your feet hit the ground every single time. Like a lot of women with double unders always struggle with leakage and it's because they're holding their breath and they're hanging on for dear life. And that breath hold is dangerous zone for that pelvic floor. So always focusing on core first, breath second, and I guarantee you that is like one of the best ways to protect your pelvic floor and reduce the risk of developing pelvic floor issues. 

Amber B 23:02

So good, super, super specific and super helpful. Core first, breath second. I love that. Okay, so we've talked a lot about preventative and like things that we can be doing even if we're not having any problems. I'd like to move a little bit into when problems start to arise and what we can do about that. So what are some signs and symptoms that maybe we are beyond that like preventative and now we're getting to like, oh, now we're having actual problems. What are the signs and symptoms? 

Dr. Courtney Johnson 23:31

Yellow flags.

Amber B 23:32

Yeah, right. It's some yellow flags. That's a great way to put it that we could be looking out for.

Dr. Courtney Johnson 23:38

Absolutely. So yellow flags would be something where it's like things start to feel just like kind of off. Like maybe you're having a little bit of hip pinching or low back pain after like dead lifts or squats, for example, coning and doming in the abdomen if you're pregnant or post partum still. And granted, there's always going to be some level like coning with pregnancy, like that's normal with the ab separation. But it's your degree to be able to control that coning. So that is something to also consider. Some other yellow flags might be like, oh, maybe a little bit of like pressure into the pelvis, like feeling a little bit of heaviness, maybe after like a heavy workout or going for a walk. Another yellow flag might be like a little bit of like dribbling, like leakage with coughing, sneezing, laughing, vomiting, maybe jumping. And then I would say more of the red flags are going to be like a lot of pressure, a lot of heaviness during the workout, after the workout, not going away for multiple days, back pain, hip pain that persists longer than a couple of days, SI joint pain, tailbone pain when you're sitting and it won't go away or after every leg day, you have a lot of tailbone pain, like glute amnesia, which is like a silly word, like it just really means like your glutes are like, I hate saying it's like your glutes are sleeping, but like they're not sleeping, but like you probably suck at activating them.

So like, if you feel like you, no matter what you do, you cannot activate your glutes. You're so quad, like you walk around with like a pride, like you're like badge of honor that you have quad dominance. Like, oh, my quads are so dominant, like not cool. We don't love that. We need those glutes to fire. So if you struggle with getting your glutes to work in squats or deadlifts, like you're never feeling sore in them, even after like hip thrusts or glute bridges, that's another yellow flag because glute weakness and like inability to activate the glutes a lot, like during your workouts can lead to a lot of pelvic floor issues. The glutes and your pelvic floor, they're best friends. Like when your glutes are really, really, really strong and like solid, like you probably don't have pelvic floor issues. Like, I'll tell you that, like, it's kind of rare. It's very, very rare. Um, so those are some red flags, maybe, um, heaviness, like seeing the prolapse, um, a lot of leakage, like having to wear a pad or panty liner with a run, all jumping, all running like all day long, maybe. Um, and let's not even forget about like bowel issues. Like those are also fair game. So constipation is a yellow flag, um, in bowel incontinence, gas incontinence, um, or not in like flatulence, just like having like an ability to control it. Um, oh my gosh, there's so many I could go on rib flaring. I could go on and on, but those are like the top, like most common ones. I would say. 

Amber B 26:44

That's awesome.

Dr. Courtney Johnson 26:45

Same with intercourse. That's also another one. 

Amber B 26:48

Yeah. Yes. So if somebody is experiencing that, I would assume that that's something that's like your bread and butter, right? That's like what you love to like help with. Um, so that we get it fixed and, and on your merry way. So what are the, what are the, what does the treatment look like? Or what are some of the things that maybe you're working with your clients to be able to get them back to that healthy pelvic floor where they're back in that green flag area? 

Dr. Courtney Johnson 27:12

Yeah, good question. So a lot of my clients are, are athletes or just of the active population or want to be active and they can't be active because of their symptoms or their newly postpartum or pregnant. Um, it just, I hate it, but it depends, right? Like it depends on their, their story, where they, where they are, where they came from their history. And a lot of times, like if they are coming in and they are someone who's like super active, um, the first thing I generally do is get them to downtrain their pelvic floor first. So typically most of the time athletic women struggle with more pelvic floor tension than not. Honestly, everybody does like not even athletic. What’s that?

Amber B 27:52

So you're like, it's like overactive? Is that what you’re saying? 

Dr. Courtney Johnson 27:56

Overactive. Yeah. Cause they're gripping it all the time. Um, and if they're not, here's a, here's a funny, here's a funny thing. Um, if you struggle with activating your glutes, there's a good chance that every time you try to activate your glutes, you're squeezing your pelvic floor. 

Amber B 28:14

Oh, interesting.

Dr. Courtney Johnson 28:15

They feel very, very similar, very similar. So I just made a post about this, like not too long ago on my Instagram that literally said, you're not squeezing your glutes. You're squeezing your pelvic floor during a hip thrust though, because they feel the exact same.

Amber B 28:34

Yeah. 

Dr. Courtney Johnson 28:34

And most women are like, I can, I feel my quads when I do, um, hip thrust, I can never feel my glutes. And that alone can contribute to pelvic floor dysfunction. So, um, that is a big one. So overactivity of the pelvic floor can lead to a lot of the symptoms that I just mentioned. And most people don't realize it. And sometimes you're like, Oh, I have a tight pelvic floor. I don't have any symptoms. And it's like, well, not yet. Like they might show up five years from now, four years, you know, later down the line, because a tight pelvic floor is a weak pelvic floor. It can't move. It has no range of motion. It's chronically on, it's chronically trying to do its thing. And it has very, very poor nutrition, right. And bad blood flow. And it doesn't produce any strength. So overall, like having an overactive pelvic floor is not a good thing. We don't want a tight pelvic floor.

Amber B 29:28

Yeah. 

Dr. Courtney Johnson 29:29

Right. We want a pelvic floor that is strong, mobile, and has good range of motion. If we can get that, that's when a lot of issues don't happen. Like, and honestly, when we focus on working with women, like we have to focus on that first. I'm not going to get your core stronger. I'm not going to give you kegels. I'm not going to give you all of these glute exercises. If you don't even have range of motion of the pelvic floor to start with, it's all about finding the root of the issues that women struggle with. And a root issue is a range of motion issue. It's often not a, or it's a coordination issue, right? Like it's often not something like, well, you just got to get stronger. We just better do kegels. And that's typically like the blanket most pelvic floor PTs kind of give. It's just like, oh, let's just do kegels. And it's like, oh gosh, like that's not going to help a tight pelvic floor. Like, so I'm down training the pelvic floor to answer your question and then I'm getting them to activate it. So that's when I would be like, okay, maybe we add kegels in, but in all my years of practice, like I rarely give kegels. I will give kegels to the immediately postpartum mom to help with coordination and waking up kind of everything and good blood flow down there. That's really about it. Um, or like sphincteric function. Um, like if someone's really struggling, like stop the flow of urine or something, I might give them that. But all in all, I down train the pelvic floor. Then I teach them to activate their core. I teach them how to breathe. And then I teach them how to activate their glutes. And from those four literally foundational things, that's where I progress a program into functional full body movement training. Cause if they can nail how to breathe, how to brace and how to activate their glutes, then their pelvic floor will start moving better because now the pelvic floor doesn't do everything on its own. And it just moves freely. Like it just does its thing like it's supposed to do. 

Amber B 31:30

Yeah. It's so interesting. Um, I, I was talking to one of the PTs that I was using for a different injury and she was kind of making some of the same point that you're making. It's just interesting. The crossover, it makes sense. They're all muscle groups, but that usually like she has to diagnose whether it's something that's overactive or underactive. And we often go to like, I have to strengthen this muscle group. And she's like, like what you said, it's like, actually a lot of times it's like, that's working too hard. It's too strong. It's overcompensating. We actually need to get muscle groups to start working, waking up the glutes to start working. Um, so it can take, it can remove the pressure on that one muscle group. And so it is, it's just so interesting that it's like, sometimes we just go straight to like, well, I just need to strengthen it. And I think that's where the Kegel idea comes in. And it's like, if that's not the problem, it's not that it's too weak, but rather than it's overactive, well, now we got to pull it back a little bit. 

Dr. Courtney Johnson 32:24

Yeah, exactly.

Amber B 32:25

So good. Um, so I, I would imagine doctors having a husband as a physician, doctors don't get a ton of training, especially in the overlap between like lifting and health. And most are woefully under educated in terms of, of lifting. And so a lot of times when women go to the doctor with these kinds of things, leakage or whatever, then the doctor is just like, well, just stop lifting. Um, which I think you would probably agree as like, why, why are we doing this? Why is that our recommendation? 

Dr. Courtney Johnson 32:56

Exactly. 

Amber B 32:56

But how do we, how do we help to navigate that of like, not necessarily having to stop lifting, but just be able to, like, what would your recommendation be to that woman who's gone to her doctor? The doctor says, let's stop lifting. And then she comes to you for a second opinion. What are you telling her? 

Dr. Courtney Johnson 33:11

Oh my goodness. Okay. This is my soapbox. So I'll try to keep it tame. Um, so I actually really, really despise this kind of advice because, and it's not because doctors are wrong. It's just that they're not educated enough in this area. They're worrying about other things. Like they're giving you cautionary guidelines because that's what they have to do. Like they just need to tell you what they know enough of and they focus on their medical things. So it's their job to then refer out to a pelvic floor specialist who knows what the pelvic floor muscles are, who knows the research, who knows the evidence. So I don't always like crap on doctors about this because it's like, they just do what they're good at, but also they do need to know better. Right. But that's also our profession. That's probably for PTs that need to go educate them. And like, you know, it's both ways. So if you're the patient in the middle of it and you're being told, okay, stop lifting or reduce lifting. And you go to another pelvic floor physical therapist or, you know, whatever, and they tell you the same advice run, literally run, find another one. But if you go to another pelvic floor PT and they tell you, okay, here's me, this is me where I come in. I'm like, um, modify, we can modify. We can absolutely still lift. We just need to figure out why you're having the issues that you're having. And that goes back to what I just said about finding the root of the issue. Once you find the root of the issue, you can do whatever you want to do. We just need to figure out how to treat the root of the issue. And oftentimes treating the root of the issue is with exercise with lifting because muscles need to be loaded to see progressive change. That's how we get things better. Do not just settle for the advice of stop lifting. You can't do this. You're going to make it worse because that narrative literally holds you back from the one thing that absolutely will make you better. Like, let me say that again. I swear to everyone out there listening to this podcast, like I'm such an advocate for this. I'm so passionate about it. The one thing that will get you better from pelvic floor issues is lifting weights. I swear to you all. Don't let the narrative that you can't do something keep you from that because that is the one true way that you will get better for and keep you better for the longevity of your entire life. 

Amber B 35:49

Right.

Dr. Courtney Johnson 35:49

If you're a woman who is 20, 30, 40, and you haven't even hit perimenopause and you've stopped lifting because of pelvic floor issues, oh my gosh, you are in the danger zone. Because once perimenopause and menopause hits, it's so much harder to strengthen your pelvic floor, to strengthen your body. It becomes 10 times harder. So just if you're in this phase of life where you're still getting our good hormones and you're of the childbearing age, don't take that advice. Go to the next person and find somebody who can truly help you. 

Amber B 36:24

That's really good. Really good. Oh, this has been so awesome. Courtney, if people are wanting to work with you or they want to learn more, where can they find you? 

Dr. Courtney Johnson 36:32

Oh, Instagram. That's my biggest platform, I would say. My Instagram handle is The Female Athlete Doc, D-O-C. And that's pretty much my platform or my handle for all of things. YouTube, TikTok, Threads, Facebook. All of them, I guess. I just try to stay the same. That's obviously my biggest platform to work with me but I also have a free community. It's kind of like a Facebook group, but it's like a Kajabi. So it has a bunch of courses in there and education. It's 100% free and it's a community. So it's a bunch of other women who are in the same position wanting to get better and learn the right narratives that they need to improve their symptoms. 

Amber B 37:24

Love that. Awesome. And we'll link that up in the show notes as well. You can go and find Courtney on all of her places. Thank you so much for coming. This was so informative. You did such a great job of bringing what can sometimes feel like sciencey and complex into something that's really tangible and actionable for my audience. So I really appreciate you. 

Dr. Courtney Johnson 37:44

Thank you so much for having me. I absolutely love educating about this and just being the advocate for people that can't be their own and just being that positive light. Because I'm like, you can lift, you can run, you can do whatever you want. It just takes someone to help you. It just takes the right plan, the right strategy, and the right mindset to get you there. So thank you so much for having me. 

Amber B 38:09

Awesome. Okay, if you're anything like me, you're never going to look at bracing or deadlifts or squatting the same way again. A huge thanks to Dr. Courtney for really breaking down pelvic floor health in a way that makes it feel accessible and honestly kind of excited. I'm excited to get back into the gym and to start thinking about some of the things that she presented on the podcast as I do my lifts. So whether you're dealing with leakage or pressure or hip pain or hopefully most of you aren't experiencing that and you're just trying to avoid those things down the line, I hope today's episode reminded you that, you know, our pelvic floor deserves a little bit of attention. Not just when we have pain or not just when we get to the end of the line, but before it ever even gets to that point. And we can do that with the right bracing, with the right training here and now in our lifts. Heavy lifting is not the problem. It is part of the solution. And I think that was really clear in everything that Dr. Courtney talked about today. That wraps up this episode of Biceps After Babies Radio. I'm Amber. Now go out and be strong because remember my friend, you can do anything.

Outro

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