Pelvic Floor Secrets for Hypermobility (Ep 127)

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Dr. Linda Bluestein: [00:00:00] Welcome back, Every Bendy Body, to the Bendy Bodies podcast with your host and founder, Dr. Linda Bluestein, the Hypermobility MD. Today we're going to be chatting with my physical therapist, Emily Bohan. Emily has gotten me out of pain multiple times, so I'm really excited for her to share her insights. Dr. Emily Bohan brings a decade of experience in the personal training and health and wellness industry, as well as years of experience as a physical therapist specializing in orthopedic and pelvic health for men and women. Since 2016, Emily has been a certified 200 hour yoga teacher and is also a certified nutrition coach through the Nutrition Coaching Institute.

A passionate athlete, she has competed in powerlifting, horseback riding, [00:01:00] and dance. In the past year, she has opened her own business, Bohan PT Training, to help individuals resolve their pain and optimize their health. With a comprehensive approach to health and fitness, Dr. Bohan is dedicated to empowering clients through physical therapy, fitness, and holistic wellness strategies.

As always, this information is for educational purposes only and is not a substitute for personalized medical advice. Be sure to stick around until the very end so you don't miss any of our special hypermobility hacks. Here we go.

Okay, Emily, I'm so excited to chat with you. So can you tell us a little bit about your background and training? Because I know you have kind of a different path that landed you where you are right now. 

Emily Bohan: Yeah, absolutely. So I was a athlete in high school. And then when I got to college, um, I ended up getting an injury that took me down the route of getting into yoga, personal training, and also weightlifting, [00:02:00] um, made me want to become a physical therapist.

So that way I could share some of my expertise with the people around me. Um, when I got into my doctorate program, that's where I learned about pelvic floor physical therapy. Um, and I felt like it was just like, Area of the body that was like so untalked about but so relevant to so many people's dysfunction And so I really took a deep dive when I was doing my doctorate degree of doing some specialized pelvic health courses so I could learn more about pelvic floor and its interaction with the body and then also specific pelvic floor diagnoses.

So one of my most um One of the moments that made me really want to become a pelvic floor PT was at one of my weightlifting competitions, um, when I actually missed two of my lifts, um, because of a year, a little bit of urinary leakage and one of the guys who is helping coach me was like, Oh, that's normal.

Like that's, that's what that mop [00:03:00] in the corner over there is for. And I was like, we should not have this much dysfunction in our pelvis. So after experiencing it myself, I'm like, All right, we can make some good changes in the athletic community, but then also in general population too. We don't have to live with issues like that.

Dr. Linda Bluestein: So that's really interesting. I saw a study about rhythmic gymnasts and incontinence, which is really fascinating because rhythmic gymnasts, I mean, they're the bendiest of any athlete as far as I'm concerned. I mean, ballet, elite ballet dancers, of course, are super crazy bendy, but rhythmic gymnasts You're talking like, you know, actual competitive rhythmic gymnasts.

They are crazy, crazy flexible. And I remember coming across a study that said that a lot of them have urinary incontinence, which I thought was really interesting. I don't know if you're aware of that study or not. 

Emily Bohan: Yeah, there's quite a few studies out there that show that, um, athletic populations, even in High schoolers, so think like 15 to 18 year olds, urinary incontinence happens in over 50 percent of athletes.

Um, so it's really, really [00:04:00] common, especially in the female athlete population. So, we have a long ways to go with education with those folks. 

Dr. Linda Bluestein: Super interesting, but that's potentially treatable. 

Emily Bohan: Yes, it absolutely is 

Dr. Linda Bluestein: treatable, so. So you are trained as a physical therapist, but you specialize actually in pelvic floor physical therapy, correct?

Emily Bohan: Yes, absolutely. Okay, so 

Dr. Linda Bluestein: can you tell us what that is and why it's important for bendy bodies? 

Emily Bohan: Yeah, absolutely. So pelvic floor physical therapy, it focuses on, um, any sort of diagnosis that has to do with the pelvic region. As urinary incontinence, fecal incontinence, pain with intercourse, um, pain with tampon insertion.

I can even include other like generalized pain in the pelvis too. So if you have a lot of pain with sitting, for example, or painful periods, um, that is all diagnoses that pelvic floor PT can help with. Um, where that is helpful for bendy bodies is a lot [00:05:00] of the individuals that I have worked with who have hypermobility.

Um, their body likes to create stability somehow, and that stability doesn't necessarily come from ligaments and joints like other folks who don't have these hypermobility conditions. And so sometimes those muscles end up compensating for what ligaments and muscles aren't doing, which can then lead to dysfunction in the pelvis.

Dr. Linda Bluestein: So I'm going to hold the microphone for Emily while she shows us what the pelvic floor is. And if you are Listening right now on a podcast player, you may want to check out this portion on YouTube so you can actually see what the video is like. And I believe we now have the video up on Spotify and some of the other podcast players as well.

But if you are listening and not watching, you may want to Check out the video portion of this so you can see what we're actually talking about. 

Emily Bohan: So here's the pelvic floor to orient you to the pelvis first. Here we have the spine or the back. The front of the abdomen would be here and then on [00:06:00] either side we have our hip bones.

Um, so we have a more external superficial layer of pelvic floor that is here. Um, this is a female model. Um, where the labia would run right over the top of the muscles here. All of the pink here is pelvic floor muscle. Um, these muscles help with control of urine as well as the control of, um, stool too.

Sometimes if these muscles get really tight, it could also create closure of some of these openings including the vaginal opening. Then we have our more, our deeper pelvic floor muscles that really help a lot with. The support of the pelvic organs. Um, and so if my fist here was our pelvic organs, that's going to be like our bladder, our uterus, our rectum.

Um, it sits right here in the bowl of the pelvis. And these deep pelvic floor muscles really help with [00:07:00] support of those pelvic organs. 

Dr. Linda Bluestein: And I, I may need a little therapy after, after hold it. That microphone is not very heavy, but man, holding something away from your body like that. Of course, you've been working on my shoulders and neck for years now, but it's like, it's like that was harder than I thought it was going to be.

Very interesting. Um, so that's really fascinating. I think most people don't, at least I didn't realize until. I guess I realized a few years ago when I, I've had pelvic floor physical therapy myself, but until I actually had pelvic floor physical therapy, I didn't really realize that there were muscles in that part of the body.

And I think a lot of people don't really realize that there are actual muscles down there. 

Emily Bohan: Yeah. It's kind of like this black hole with a question mark for most people of. As long as things are functioning like kind of okay, right? Most people don't really think about what's happening in their pelvic floor.

Um, but society doesn't really have conversations around pelvic floor, normal pelvic floor function. [00:08:00] Um, and so I think that's why sometimes pelvic floor can be this overlooked piece when it comes to even things like low back pain or, uh, hip pain. 

Dr. Linda Bluestein: That's, that's so interesting. And I feel like even surgeons who operate in that part of the body are probably not super knowledgeable, uh, to put it mildly about the pelvic floor and how it could possibly impact other conditions.

Would you say that's fair to say? 

Emily Bohan: Yeah, definitely. Um, in my time, um, as a pelvic floor PT, I've even treated a few OBGYNs, um, and they are incredible at what they do, but I wouldn't say muscle function in that region is like a very well known train of thought, right? So, 

Dr. Linda Bluestein: yeah, it's kind of like, it's in the region of where OBGYNs are going to work, but it's more a musculoskeletal type I mean, obviously it can affect the function of the bladder and the bowels, and we're going to talk about that too.

But yeah, so I, I agree with you. It's like this black hole that [00:09:00] it's, it's quite, uh, quite interesting for sure. Who would be a good candidate for pelvic floor physical therapy? 

Emily Bohan: Yeah. So, um, I mentioned before some of the things that people could be experiencing, like urinary incontinence. Um, if you have urgency, you feel like you have to rush to get to the bathroom, um, Um, even for cases like people with constipation could be a candidate for pelvic floor physical therapy, um, because the muscles do control what's happening with everything that comes to the bladder and the bowels down there.

Um, so I also think for anyone who's potentially Um, experiencing other things like hip pain and low back pain, you know, screening, uh, the pelvic floor, especially if you've been in physical therapy for a while and things aren't improving very well, I think pelvic floor PT can definitely end up being the missing piece there.

Dr. Linda Bluestein: Mm hmm. And, and we read your bio at the beginning and then you explained a little bit about what you, uh, All the different types of training that [00:10:00] you've had, but you do musculoskeletal type physical therapy and pelvic floor physical therapy, right? So. 

Emily Bohan: Yes. So I treat both orthopedics and pelvic floor PT.

Um, the way pelvic floor PT is, we like to think about it as like musculoskeletal PT. It's this like big group, right? And pelvic PT, we're like a small specialized portion within that, but the pelvic floor interacts with so many other areas of the body. Like it doesn't function Um, completely on its own, right?

Um, and so that's why it's really important to kind of have a, the whole look at the system and see how everything's coordinating. 

Dr. Linda Bluestein: Yeah, 

Emily Bohan: no, 

Dr. Linda Bluestein: that makes sense. And I know from the patients that I treat that constipation in this population of people, whether they have EDS Danlos syndrome syndromes, or hypermobility spectrum disorders, or if they have mast cell activation syndrome or postural orthostatic tachycardia syndrome, a form of dysautonomia, all of which Can influence function of the gut.

[00:11:00] And can lead to constipation. Um, so for any of those people with pelvic floor physical therapy be a reasonable thing to try, do you think? 

Emily Bohan: Yeah, absolutely. I mean, constipation can happen for multiple reasons. Um, including a little bit what you just touched on there, but in a lot of my people with hypermobility, The pelvic floor tends to compensate and get really, really tight.

And so your, if your pelvic floor is tight, one of our pelvic floor muscles, it's called your puborectalis. It almost acts like a sling around the rectum. And so if that muscle is really tight, it can create outlet constipation, where it's a lot harder to actually get the stool out because that muscle isn't fully relaxing.

Interesting. 

Dr. Linda Bluestein: Outlet constipation. Okay. That's interesting. And if you're, if you have connective tissue that's weak and other parts of your body are stretchy, then you could have, your bowels could be more stretchy and then that could make it, you could, you could have that combination of things where the muscles are overcompensating and they're [00:12:00] super tight plus the bowels are, you know, more stretchy.

So you can see where that could turn into a big problem pretty quickly. So, yeah, but the pelvic floor, what I love about pelvic floor physical therapy is. It's not surgery, so you're not having like the potential complications from surgery, and you're hopefully dealing with the problem at one of its root causes, so you're hopefully going to have more lasting effects.

Emily Bohan: Yeah, absolutely. It's an area of the body we never get trained in how to use correctly, right? Um, and so when I ask people to activate their pelvic floor, and also be able to fully relax their pelvic floor, Um, if anyone watching right now wants to try and do that, a little bit of a lifting sensation in the pelvis, like you're holding back urine or gas.

And see if you can also feel it relax afterwards. Often, um, one of those movements is kind of like a big question mark on what's actually happening, right? And so regaining that, that full function back can be really, really useful for, [00:13:00] um, both constipation, but even in cases like urinary urgency or any sort of leakage too.

I think most of society, we think. That the pelvic floor is maybe getting weak and that's what's leading to leakage and issues, but actually sometimes the pelvic floor is so tight. That I like to say it's leading to functional weakness, um, because you can't contract an already contracted muscle, right? So we actually have to work on getting that full range of motion back in order to get proper function of the pelvic floor.

Dr. Linda Bluestein: Okay. That, that's really interesting. That makes sense because I think too, a lot of people, when they think of pelvic, if they even know what pelvic floor physical therapy is, when they think about that, I feel like they might think of like Kegels, for example. So could you explain what Kegels are and.

Physical, pelvic floor physical therapy is way more than just Kegels, right? Oh, absolutely. Yes. 

Emily Bohan: Um, yeah. So Kegels are the feeling I just described, that feeling of holding back urine and gas at the [00:14:00] same time. Um, it's almost like a lifting sensation from within the pelvis. Um, however, if you are one of the people who you tend to hold an extra tension in your pelvic floor, if you're constantly working on Kegels, we're potentially going to make that tension worse, um, which, which can actually lead to your symptoms feeling worse.

Right. Um, I always like to tell people, like, do you hold stress in your neck? I think we can, most of us can relate to that feeling of holding stress in our neck, right? I think a lot of people don't realize they also hold stress in their pelvis and I would say around. At least 80 percent of the people I work with have some increased resting tone in their pelvic floor that we need to work on first before we work on kegeling for strength, right?

A lot of those folks, when we get things to fully relax, we get that functional strength back and we don't really need to work that much on, um, strengthening and doing kegels. It's actually that full range of motion that relax and then the ability to contract [00:15:00] that's really important. 

Dr. Linda Bluestein: Interesting. I was going to ask you about bladder function next, but so are you saying that if somebody has, of course, there's so many different bladder problems that a person can have.

Um, but are you saying that if a person does have some urinary type symptoms that they might actually get better with relaxing the pelvic floor and they may not like Kegels may not be the secret to improving their incontinence, for example. 

Emily Bohan: Yeah, absolutely. Um, Yeah, like I said, around 80 percent of the time, if not more, I would say that kegels are not the answer in the beginning.

It's actually getting that full relaxation so that way we can get that full contraction. So when you have that moment of like, oh, am I going to leak or, oh, I have to get to the restroom, right? We can actually use those muscles to their full capability because they're coming from a more relaxed position rather than this like constant clench.

Dr. Linda Bluestein: And what about people who have, for example, urinary frequencies? So they need to go. To the bathroom really frequently or if they have urinary urgency. So [00:16:00] I think you mentioned this already, like they feel like they have to go and they better get there fast. Right? Yeah. So can pelvic floor physical therapy help with those things?

Emily Bohan: Absolutely. So both urgency and frequency, I often see that again with people who are holding excess tension in their pelvic floor. Um, We can also train our bladder. Our bladder tends to have habits, right? Um, and so there's a stretch reflex within our bladder wall. And usually when we get our first call to go, it's when that bladder has stretched to about halfway full.

If we ignore that urge, then it'll fill up a little bit more, and then we'll get that call to go again. In some people, that stretch reflex has gotten really sensitive. Um, and so that's what causes this, like, this extreme urgency to go. Or sometimes we like to say, like, key and door, right? Like, sometimes there are triggers that make us feel like we really have to get to the bathroom quickly.

Um, so whether you're walking in to your house, um, from being out somewhere or, You're about to go to bed and that's like, [00:17:00] awesome. That could be a trigger for you as well, right? We can actually train our bladder out of those habits, um, by working on some delay techniques and then working on pelvic floor function too.

Dr. Linda Bluestein: Interesting. Okay. And what about. So I know there's such a prevalence of urinary symptoms in the hypermobile population, whether they have, you know, joint hypermobility, uh, symptomatic joint hypermobility, or maybe they have dysautonomia, MCAS, all of these things are, you know, cause bladder problems and bowel problems.

And another one that we see is incomplete emptying or a sensation of incomplete emptying, which of course, Mm hmm. If you have a sensation of incomplete emptying, so you feel like after you go to the bathroom, you feel like you didn't empty all the way. Same thing for the bowels, I'm sure. It might be that that's an accurate sensation, but it's also possible that it's not accurate, right?

Like, can pelvic floor physical therapy help with that? Also, the incomplete The sensation of incomplete emptying of the bladder. 

Emily Bohan: Yes, it can. Um, so the incomplete sensation [00:18:00] of emptying can also be coming from if your pelvic floor isn't fully relaxing when you're urinating. Um, and you're feeling, feeling like you have to push or strain to get that last little bit of urine out.

First of all, we never want to push or strain. When we're urinating, um, that's important. 

Dr. Linda Bluestein: That's very 

Emily Bohan: important. Yes. But yeah, getting, getting that pelvic floor to fully relax. And if we need to use a little bit of some gentle intra abdominal pressure, especially for bowel movements, that's fine, but should never feel like a big pusher strain.

Um, in your hypermobile. population. Um, sometimes also working on positioning can really help too. So like leaning forward when you're urinating to help get the bladder into a more optimal position. Um, strategies like that can help. So I also often see in people who work fast paced jobs. So my nurses, my teachers.

My dancers, right? Like you guys are go, go, go, which I love the work ethic, but sometimes you like to power pee and you [00:19:00] rush going to the bathroom, right? And so making sure you actually give yourself time, like sit down and relax on the toilet, like take a breath into your belly, do some diaphragmatic breathing to make sure that pelvic floor relaxes.

That can really help with that sensation of incomplete emptying as well. 

Dr. Linda Bluestein: Okay, so I feel like what you just said is so incredibly important because I feel like, I feel like I'm guilty of this when I used to work in the operating room and it was like, okay, you have, you know, five minutes to eat your lunch and go to the bathroom and get, and get your next case.

Okay. So. You're saying, if I am hearing you correctly, that in order to urinate, in order to empty our bladder, we're supposed to be relaxing our pelvic floor. We're supposed to just like, it just should be happening rather than us like pushing power P as, as you called it. Um, that's really important, especially since a lot of people have pelvic organ prolapse and especially if people have symptomatic joint hypermobility, we know that we're at increased risk of pelvic organ prolapse.

So we don't want to be pushing and, um, you know. Potentially causing more [00:20:00] dysfunction down there, right? 

Emily Bohan: Yeah. Long term pressure constantly going downwards. So that includes like pushing when we urinate, pushing when we have bowel movements, um, breath holding instead of engaging our core correctly. Like all of that can put pressure downwards on pelvic floor.

And I'm not going to say like a hundred percent for sure, but it can contribute to pelvic organ prolapse. 

Dr. Linda Bluestein: What about sexual dysfunction? Are there things that, uh, pelvic floor physical therapy can help with that? In that regard, 

Emily Bohan: yes, absolutely. Um, so there's a few different diagnoses that can happen within sexual dysfunction.

So one of those diagnoses is where it's really painful to have something inserted, um, vaginally, whether that's a finger, that's a penis, that's a toy. Or even a speculum at the gynecology office. Um, the muscles can actually create this big guarding response where it doesn't want to allow anything in. We call that vaginismus as definitely something that pelvic floor PT can help with by [00:21:00] helping to relax those muscles and desensitize that area.

So it's not causing so much pain. Um, Also, we can have pain with deeper penetration as well. If you think about a muscle knot in anywhere else in your body, a lot of us have a muscle knot somewhere like up in our trap, for example, right? It hurts a little bit when you press on that muscle knot. Pelvic floor can also have similar trigger points in them too.

So if you think about a trigger point being deep in the pelvis and now we're putting pressure of something against it, um, Such as, um, a penis or a toy or anything like that, that can also create pain during intercourse. Um, and, uh, doing some hands on manual therapy, doing some deep breathing, doing certain stretches can also help alleviate some of those trigger points that we get in the pelvis.

Dr. Linda Bluestein: We may talk about this a little bit as, as well, but also I'm thinking about, uh, in terms of sexual function and dysfunction, also joint, um, Instability potentially in the hips [00:22:00] or otherwise in the musculoskeletal part of the pelvis, I take it that could be a factor as well. 

Emily Bohan: Yes, absolutely. So the, the hip muscles, um, the hips, the abdominals, the low back, the diaphragm, and the pelvic floor, they all work really closely together.

So often if someone has something going on in the hips, pelvic floor is somehow involved too. Um, I see that almost every single time someone comes into the office. 

Dr. Linda Bluestein: So a lot of my patients tend to be. Younger and when, if I mentioned pelvic floor physical therapy and I recommend that they try this, they're like, Oh my gosh, they're going to do something invasive.

And, you know, they get it. Once I explained to them what it is, you know, they're like, Oh my gosh, I don't, I don't know. Like oftentimes I get a hard no, the first time I bring it up and then I bring it up again. And I explain, you know, well, they're going to talk to you before they do anything. You know, is it possible to treat people without doing.

Intravaginal work or, or that kind [00:23:00] of thing. 

Emily Bohan: Yeah. Not everyone is comfortable with doing an internal assessment. Many pelvic floor PTs do prefer to do that because we can look directly at the muscle function. If that's something someone's not comfortable with, or in the case of vaginismus, that's again, where we get such a big guarding response to those muscles, you literally can't get anything in there, right?

That no longer becomes an option. We want people to be comfortable coming into our office. Um, the pelvic floor. Interact so closely with these other muscle groups that if we can work on the other muscle groups and also work on how are you moving, right? Like, do you breath hold every single time you pick up your groceries and you're putting pressure on your pelvic floor and so your pelvic floor is just fatigued and tight because it's, Sick of getting all this pressure on it, right?

Like that, those kinds of things we can work on. Like another good example is like doing some hip stretches can really help relax the pelvic floor. Um, in research doing happy baby pose, for example, in yoga has shown to really be able to relax pelvic floor. [00:24:00] Um, so there are definitely things that we can do also in a lot of, um, in office settings as well, they can do some external electrodes as well.

So they can look at pelvic floor function. Um, but yeah, I really like to focus on like, how are all the other muscles interacting with pelvic floor? Cause that can give us really good insight to what's actually happening to the pelvic floor itself. What is the happy baby pose? Um, so that one is where you are laying on your back, um, and the full expression of the pose is where they're grabbing, you grab like the inside of your feet.

Um, but you can always do a modified version where you just bring the legs up, you can hold on. Above or underneath the knees and kind of let the legs drift apart. 

Dr. Linda Bluestein: Oh, okay. So that's why it's the happy baby pose. The baby's laying on its back and it's holding on to the inside of its feet. And it's like, I can just picture that now, like the baby's giggling or whatever.

So, okay. Fantastic. We are going to take a quick break. And when we come back, we are going to [00:25:00] talk more about the pelvic floor and how that impacts other things like, for example, low back pain. So we will be right back.

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Okay. We are back with Emily Bohan, physical therapist, pelvic floor, physical therapist, and my physical therapist, most important, but super important. So, uh, we've been working together for like a couple of years now. Does that sound right? It's been at least two. Yeah. It's been a while. It's been a while. Um, you've taught me a lot, which is, which is amazing.

So the pelvic floor affects a lot of things. Other aspects of the body, as we've been discussing. Um, but that's also true of other parts of the body too. Like, like we get referred pain and can you explain to [00:27:00] us, I guess, what referred pain is and also about myofascial pain and how that works. 

Emily Bohan: Yeah, so, uh, referred pain or myofascial pain, sometimes we get what we call active trigger points.

And this is, um, think a muscle knot in the body, but where the pain is, is not exactly where that knot is. Um, so for example. We have one of our rotator cuff muscles, um, that sits right here above the shoulder blade. Now that muscle, when it gets irritated, people often feel it actually down the arm, sometimes even a little bit past the elbow.

Okay. Um, and so, yeah, so referred in myofascial pain doesn't always mean that the location of pain is the culprit of the pain. What is happening? Um, another good example that I really like is the rectus abdominus. So think your six pack muscle in the front here. Um, that can actually refer pain when it's a little bit lower, sometimes the low back.

So on the other side of the body. Um, and [00:28:00] so that's where treating globally as a physical therapist can be really important to make sure that there's, um, not these like other contributing muscles that are. It feels like further away from where the, um, the pain is. 

Dr. Linda Bluestein: That can be so confusing. So because a person can have pain in a certain part of the body, but that might not be actually what's causing the problem.

Emily Bohan: Yeah. Yeah, exactly. So, um, another one that I think is also really interesting, I just had to share this. For anyone who's experienced sciatica, the, um, gluteus minimus muscle, so that's the one that kind of sits right in the glutes, like at the top of the pelvis here, that can actually mimic a similar referral pain to sciatica.

Um, and so that's where it's really important to be with someone or see a specialist that is able to kind of rule out a few different pieces and make sure that myofascial or referred trigger point pain, um, see if that's a present part of your presentation. 

Dr. Linda Bluestein: Okay. [00:29:00] So I feel like this is super important and we're going to digress just very briefly from pelvic floor physical therapy, because I think, you know what?

I'm going to ask you. So a person may have sciatica and they may have had an MRI of their back. And so then if they read the report and they're like, Oh my God, you know, cause they're going to see, I mean, they don't have to be that old, right. To have some little disc. Bulges and, and, and things here and there.

So you're going to have, see a lot of things on your report, but that definitely might not be the cause of your sciatica. It might not be coming from actually the spine. It could be coming from someplace else, even if there are some apparent findings on your MRI report. 

Emily Bohan: Yeah, absolutely. Sciatica could also come from compression of that sciatic nerve under the piriformis muscle.

So still having to do with your hip here, right? It could be coming from a gluteus minimus trigger point that's creating sensation down the leg. So one in four people over the age of 25 have some sort of findings in their low back on imaging. [00:30:00] However, there's no correlation between imaging findings and pain findings.

There are plenty of people who have. Something going on in their low back and they live pain free. And then they also take imaging of people with severe low back pain and they don't have, um, any, any sort of findings on imaging. So I think that's really important to emphasize because. I do think sometimes we get caught up into this mindset of the body is fragile, but the body is actually really resilient.

Um, and even if you do have some structural changes, I think learning what you can do to work with those structural changes and get really strong and move well can go so far for pain. Um, Yeah, I, low back surgery, the success rate, I believe is around 60 to 70%. It's not very good. Um, so to me, what that says is what do people's lifestyles look like?

Like how strong are they? How much are they like loading their muscles versus like loading some of the other passive structures, right? Um, I think [00:31:00] ruling out if there's anything going on in the musculoskeletal, how the body is moving first. is important before doing something that's like surgery, right?

Because if we don't fix potentially the movement dysfunction that's causing the pain, the low back surgery is not going 

Dr. Linda Bluestein: to help. And that's so interesting because when people have joint hypermobility, we tend to lean more on our or hang more on our ligaments and our tendons because oftentimes our muscles aren't as strong.

So that's where we can really get into a lot of trouble, right? 

Emily Bohan: Yeah, absolutely. So yeah, the body always likes to be Pick the most, um, efficient way possible, right? And that's hanging out on joints and tendons, right? And someone who's not hypermobile, that doesn't create quite as many issues as someone who's got really, really far end ranges.

Um, and so making sure that the muscles are, um, strong enough to create the support [00:32:00] rather than the joints is really important. 

Dr. Linda Bluestein: So that's where I feel like, I mean, there's a lot of reasons why people have limitations and how much they're able to move, but that's why. At all possible. We want to try to move more, move better and, um, develop that, uh, stabilization and strength in our muscles, whether it's the pelvic floor or any place else, right?

Cause that's if we can get our muscles to support our joints, that's That's the best medicine. 

Emily Bohan: Yeah. Right. Absolutely. So, um, yeah. And to kind of circle back around the pelvic floor here, like I do think that the pelvic floor tends to be that missing piece and, um, a lot of athletes and just general people, we think about like strengthening our abs and like, um, protecting our back.

Right. But we don't think about the top and the bottom of our core canister and that's our breathing. And then our pelvic floor. Um, and so If we're having some dysfunction going on in the top or the bottom there, that can also create [00:33:00] pain in some of these other areas because now low back is having to work harder because you're not breathing very well or your pelvic floor isn't able to support, right?

Dr. Linda Bluestein: Okay, so if someone is having low back pain. Then some targets to work on would be both the diaphragm or the top of the canister and the pelvic floor or the bottom of the canister. Is that correct? 

Emily Bohan: Yeah. Yeah. So there's a, um, research study that showed that 95 percent of people with low back pain also had pelvic floor dysfunction.

And so, yeah, so treating the pelvic floor can be really helpful for low back pain. Um, there's also another piece of research or research that was done in weight. Um, so people who are lifting heavy amounts of weight, overhead, snatch, clean and jerk. Um, but they split that group into, um, or they split the participants into two different groups.

Um, a group that had chronic low back pain and another group that didn't. And they found that the group with chronic low back pain actually had, um, [00:34:00] uh, thinner diaphragms. They didn't have as good expiratory pressure. Um, and so that shows that, yeah, part of our, like, stabilization of this area, um, comes from how do we breathe?

Like, what does the function of the diaphragm look like? 

Dr. Linda Bluestein: That's fascinating because in both of those groups, you would think that they're pretty fit. Yeah. Right. 

Emily Bohan: Mm hmm. Yeah. But, um, especially once you start looking at like chronic pain conditions too, like you have to start asking, like, how is the body like started compensating for this pain and compensation isn't always necessarily a bad thing.

Right. Um, but when pain has been going on for a while, we also have to reverse some of those strategies that the body is trying to use. 

Dr. Linda Bluestein: Interesting. And I'm wondering, as you were explaining about this weightlifting study, if, if there are people who naturally have a less strong and, and, and, or a thinner diaphragm and therefore they get back pain, or if people who are trained, training differently, get [00:35:00] a stronger diaphragm and therefore Less back pain.

Like I'm wondering what the, what the actual sequence of things might be there. I mean, we don't, I don't know if we know based on the study, but. 

Emily Bohan: Yeah, I'm not, um, I would have to double check and see if they came to that in the study. Yeah. Which came first, the chicken or the egg. Right. But I do think that working on like proper breathing strategies, um, it helps with good pelvic floor function and it helps kind of regulate the pressure in all areas of our core canister.

Um, and so. Breathing is, is important regardless, um, especially for the pelvic floor function piece. 

Dr. Linda Bluestein: Mm hmm. And, and this is where I think your background is so helpful because you've worked as a yoga instructor. You've trained to be a yoga instructor and, and done that. And then you also trained as a yoga instructor.

Uh, personal trainer, correct? And you've done weightlifting and a physical therapist and a pelvic floor physical therapist. So you've kind of, you have all of this different, um, education and training that you've kind of been able [00:36:00] to put together, which I think is really, really helpful for people. 

Emily Bohan: Yeah.

Yeah. I'm very passionate about, um, everyone should. Be as strong and lift weights, whatever they are capable of. Right. But I think the stronger you can be, the more resilient you are in life. You don't want to be like one rep max living at all points in time. Right. Like if you're one rep max, pick something off the ground is 20 pounds.

Right. Every time you pick up a 15 pound grocery bag, you're like pushing the limit of your body, um, which makes you more prone to injury. Right. And so if we can like build the strength of your whole body, um, that. That can really help with just overall quality of life and making sure we don't end up in a place where we get injured, right?

Rehab is better than rehab. 

Dr. Linda Bluestein: Mm hmm, yeah, yeah. And, and tissues need to be loaded in a Or they should be loaded in a certain way in order to get stronger, right? If tissues respond to load by getting stronger, I mean, in general. Now, obviously some [00:37:00] people really struggle with that more than other people, but even in bendy bodies, right?

That's what we should be trying to do in order to get our tissues stronger. 

Emily Bohan: Yeah, I especially see in my folks with hypermobility that they're even more sensitive to increases in load, especially if you make big jumps. So it doesn't have to be big jumps. I feel like the fitness industry has trained us to do like all or nothing, like six days a week, these like intense workouts.

It doesn't have to be that, right? Like you haven't been lifting at all. Doing one set of an exercise every day, still more than what your body has been doing. And it's still creating, um, good, uh, changes in the body, in that muscle strength and all of that. Um, and so I think knowing like where you're starting and it doesn't take much to start making good changes, right?

Work smarter, not harder. Um, if you're so sore from doing exercising that you're like holding onto the counter to sit down on a chair, like, We don't need to push the body to that [00:38:00] level. Um, just add that, yeah, add one set of something, right? Like slowly start building the resilience of the body. 

Dr. Linda Bluestein: And you've done a great job of all of that with me of like, you know, sometimes having to back off a bit and be like, okay, well, let's modify this exercise and do this in a, in a more gentle way.

Now we're just going to use the weight of the arm or whatever that, you know, but you have to get especially creative, right? When you're working with. People with hypermobility. 

Emily Bohan: Absolutely. Yeah. That's those really small incremental changes. So that way the tissue doesn't, um, overreact essentially. Right. Um, cause yeah, we definitely don't want to create any flare ups, but that gradual increase in tolerance to strength and pressure and, and all of that, I think is really important.

Um, and then also taking into account, like people's stress in life too. Right. So like. If your dog just died and you're having family stress and you've been working 12 hours, right? Like maybe now is not the time for that hour long fitness routine. That doesn't mean you can't do something. [00:39:00] Um, but I like to think of it as a stress bucket.

All of those stressors go into the same bucket. And so account for this other stressors in your life on how much stress you should be adding from exercise. 

Dr. Linda Bluestein: Getting back to the pelvic floor specifically, I took, I took us down an interesting extra path there. Um, uh, People that are assigned female at birth versus people assigned male at birth, the pelvic floor is going to be different, correct?

And I know that you work with, um, people that are assigned male at birth a lot with pelvic floor physical therapy, which a lot of people might be like, Surprised to hear that that's something that can be beneficial. So can you tell us maybe what some of those differences are that we might want to know about or what health pelvic floor physical therapy can be beneficial for, you know, different populations?

Emily Bohan: Yeah, absolutely. First of all, men, you also have a pelvic floor. I feel like there are a lot of like guys out there, they don't even know that. Um, But the, the pelvic floor in men and [00:40:00] women are actually like surprisingly similar. Um, so the men, they have a narrower pelvis, right? So that's going to change a few things.

Um, I would say the biggest difference is the hole essentially that goes through the pelvic floor for the vaginal canal. Um, men don't have that. And so that's why we tend to not see like quite as many pelvic floor issues sometimes in men, um, is because just the integrity of not having the. Vaginal canal there, um, can be helpful for men.

Um, but otherwise like internally, those deep pelvic floor muscles, all those guys are the same. Um, even some of the external muscles. Um, so the muscles that run right under the labia called bulbous spongiosis, um, the men, they still have those muscles. That's, um, really close to where the penis is though.

Um, so yeah, pelvic floor PT for men and women actually look Quite similar, um, despite the fact that we have differences in [00:41:00] external genitalia. Um, that being said, um, men, um, they can produce, uh, they can present with issues like testicular pain, penile pain. They can also have urinary urgency, frequency incontinence.

Um, we can also treat them for constipation as well. Um, and so, yeah, I have treated quite a few men who. Um, they have been diagnosed with chronic prostatitis, they've been on multiple rounds of antibiotics, nothing seems to really quite help, um, and so pelvic floor PT, especially with those guys, can be really, really helpful, um, for addressing some of that pelvic pain.

Do you see 

Dr. Linda Bluestein: that men tend to be less Amenable to that, or are they, if they're coming to see you, they've already discussed it with their doctor probably, and they're pretty open. 

Emily Bohan: Yeah, so I think we have a long ways to go in education of men with pelvic floor issues. A lot of the [00:42:00] guys I've seen have had pain or issues for so long that they're willing to do anything at that point.

They're like, anything that will make me better, right? And coming back around to the not doing internal assessments. Not all guys are okay with an internal assessment. It is a rectal exam. Um, but working on some of those external muscles can be really helpful. Um, one of the things that, um, can often pop up is testicular pain.

And if we have trigger points in some of our abdominal muscles, That actually refers pain to the testicles. So I've worked on guys where we hit a good trigger point up here in the abdomen and they're like, that's my pain. Like I feel that in my, in my scrotum. Right. Um, and so, yeah, so there's multiple ways to approach it, um, even for men who maybe aren't so sure about pelvic floor PT too.

Dr. Linda Bluestein: Oh my gosh, that's so important. So some people probably know, I know you know, I'm married to a urologist, so he would, [00:43:00] they call it ball pain, you know, and I mean, I don't know if you guys do too, but, uh, and, and sometimes people want to have surgery for that and or they might be referred for surgery. And when you were saying that my, my head just exploded cause I was thinking, can you imagine having a testicle removed when really, What you needed was to have like a trigger point worked on in your abdomen.

Emily Bohan: Yeah, oh, I've treated guys who have had surgery, um, for that, and it doesn't help because it's coming from somewhere else, right? Um, so, yeah, I mean, I've treated a lot of guys with, with pelvic, um, Issues going on, um, that, yeah, it's been going on for years, especially in some of my, like, younger male athletes.

I think that population, it's even less talked about. Like, you're not going to talk to your friend about your ball pain, right? Like, you feel really isolated. Um, and after you've taken these antibiotics and everything like that, no one thinks about, like, the musculoskeletal side of it. Um, [00:44:00] and so, yeah. Yeah, I think the young male athletes that, and then my post prostectomy guys dealing with urinary incontinence, those two groups really, really benefit from pelvic floor 

Dr. Linda Bluestein: PT.

Okay. I'm going to repeat that last part. So my husband is a, actually is a robotic prostatectomy surgeon, or he's retired now, but he, he was a robotic prostatectomy surgeon. So you're saying that if you have had a robotic prostatectomy or maybe it wasn't robotic, but if you had prostatectomy surgery. Um, and of course, we'd like to so much for being 

Emily Bohan: on 

Dr. Linda Bluestein: the 

Emily Bohan: show today.

And we'll see you next time. Bye. See you then. It fits. Thanks for joining us. I'm your host, Jaime. I hope [00:45:00] you have a great day. Part of your prostate removed because of overgrowth, you've been pushing to get urine out for a long time. You've been putting a lot of pressure downwards on pelvic floor, which is what we don't want.

But now we take out this like natural stopping gate that has been the overgrown prostate, right? We just went from like a dripping faucet to a fire hose. So we got to retrain the pelvic floor on like the appropriate timing to be able to stop leakage from happening. 

Dr. Linda Bluestein: Oh, that's really, really interesting.

Hmm. Okay. That's a fantastic, like, I feel like if you're post post op, like initially, yes, they, apparently everybody leaks. That's what my husband says. Yeah. But, but yeah, if you're a ways out and you're still leaking, like that's amazing. If you can do pelvic floor physical therapy and that can help with that, that's huge.

That's wonderful. Are there other things that the pelvic floor, especially in bendy bodies, especially people with joint hypermobility or, you know, if they have a [00:46:00] connective tissue disorder like EDS. Yeah. Um, are there other things that the pelvic floor can affect that we have not really covered so far?

Um, 

Emily Bohan: I think something that's maybe worth having a little more conversation around is, um, certain hip, um, pains that can be really tied in with pelvic floor. Um, so a good example of that is, um, labral tears, for example, the obturator internus, it's not directly a part of pelvic floor, but it's this big fan shaped muscle.

Like right there with pelvic floor, pelvic floor and obturator share some fascial attachments. They work together really closely. If obturator and pelvic floor are irritated or tight, it can create pain that mimics labral tear pain. Um, and so. Like, especially in my folks with Bundy bodies, I often see that there's some sort of like hip pain or like hip issues going on.

And so I think getting that ruled out, if you have some of that like wraparound pain or even if [00:47:00] you've been diagnosed with a labral tear, right? Like look at what your pelvic floor and how your pelvic floor is functioning and rule out musculoskeletal piece, um, that's contributing to your pain. 

Dr. Linda Bluestein: Yeah. You definitely don't want to have surgery on your hip.

If you have a problem that is potentially amenable to physical therapy, pelvic floor, physical therapy, um, et cetera. 

Emily Bohan: Yeah, exactly. Yeah. 

Dr. Linda Bluestein: Those, those, uh, labral tear surgeries, especially for bendy bodies are so tricky because afterwards and with non weight bearing, you know, using crutches or in a wheelchair, whatever's really, really challenging.

I want to talk about another specialized population. So when people are, when women are pregnant, um, what should we know about the pelvic floor in pregnancy? 

Emily Bohan: Yeah, so, um, the pelvic floor, like all other areas of the body, you know, as we progress through pregnancy, our hormone relaxin increases, that makes everything even more loosey goosey, right?

Um, so I see in a lot of my women, um, as they [00:48:00] get later in the pregnancy, um, they As everything gets even more lax, the pelvic floor really tends to tighten up to try and create stability, um, because we have so much more pressure that's going down on pelvic floor, but then it's also trying to compensate for some of that laxity that's happening in the system.

Um. Also, as we go through pregnancy, um, we end up with that anterior pelvic tilt to help make room in the, in the pelvis opens up a little bit too, to make room for growing baby. Um, but that also increases that pressure downwards onto the pelvic floor. Um, so the most common thing I tend to see is pelvic floor.

It gets a workout through pregnancy, right? But that doesn't mean we can't still work on, like, motor control and function. Um, and once again, part of our support system, right? A lot of women, especially as they get into the later trimesters, they start battling with some low back pain or Pubic synthesis pain.

And so having pelvic floor on board as much as we can get it, can help with combating some of the [00:49:00] pain that sometimes comes along later in pregnancy. 

Dr. Linda Bluestein: Mm-hmm . Mm-hmm . Yeah, that makes sense. And the pubic synthesis being where the bones connect in the front? Yes. Yes. Just below the bladder. Okay. Mm-hmm . Um, there was a question from a listener that I want, that I want to read.

So, uh, they said I'm female and when I have. Sex, my hips tend to sublux or sometimes even feel like they dislocate. I lay there for a while to get my hips back in place and hours later, things seem to subside. How can I better support my hips? Do you have any suggestions for that one? 

Emily Bohan: Yeah. So, um, that was an interesting, interesting question.

Um, I would say trying to create some external support for them would be really important. So whether that's, um, if you're having intercourse and you're laying on your back, maybe that looks like we're putting pillows on either side of you to help create some external support for those hips, right. Or getting into a position that maybe isn't, [00:50:00] um, quite as subluxing for, for the position of the hips.

Right. Um, so it's. Um, my question for that listener, I think, would be like, what, um, positions seem to cause the most, um, of that subluxing feeling. Right. Um, but yeah, I think external support is probably the best way to go with that. Um, but then also. Hey, I would wonder if there's a little bit of pain that accompanies that.

I would want to know if obturator internus, once again, that muscle that refers pain to the hips. Are we getting some referral pain from that obturator that feels, almost feels subluxy, but it's actually, um, a trigger point that's getting irritated during intercourse. 

Dr. Linda Bluestein: That's really interesting because hips are really hard to dislocate, correct?

Emily Bohan: Yeah. Your, your hips do not like to dislocate. You're going to be in the hospital for them to dislocate, um, but that doesn't mean there isn't like a little bit of movement, but it's more likely coming [00:51:00] from, um, pain or position, um, than an actual subluxation. 

Dr. Linda Bluestein: Mm hmm. And a subluxation, I should have, uh, said that first, subluxation is a partial dislocation, correct?

Subluxation and dislocation is when the bones have completely, like, dislocated. Come out of contact with each other and it's completely out of alignment. So, uh, the shoulder is a lot more mobile than the hips, correct? And the hips, oftentimes, if we feel like we have a subluxation or a dislocation, it's more often snapping hip syndrome, correct?

Emily Bohan: Yeah, there, it can be snapping hip syndrome, um, which can be sometimes if like there's a tendon rolling around, um, the way the hip joint moves, we have to get a little bit of some forward and backward movement within the hip. Um, and if that movement isn't, um, happening correctly. So for example, when we bring our leg up towards us, our femur actually has to move a little bit backwards in the socket, right?

If we're not getting that backwards movements because of. For example, like a lot of [00:52:00] tightness back in the glutes that can make it feel like things are kind of out of place when they aren't actually. The hip joint is very deep, so it is very hard to get the femur out of the hip joint. Unlike the shoulder, I like to think of it almost like a golf ball sitting on a golf tee.

A lot of our shoulder stability comes from our muscles versus the hip joint. Because it's such a weight bearing joint, um, that already has so much inherent stability just from the deepness of the socket. 

Dr. Linda Bluestein: Which actually leads me to another question. So if somebody has hip dysplasia, so they have a shallow hip socket, would they be somebody who might be more prone to dislocation?

I mean, they could actually maybe dislocate their hip. 

Emily Bohan: Yeah, I would say, yeah, someone who has hip dysplasia, yeah, for them, they might actually be more prone to that. Um, but for most people, we all have variations in our anatomy and the angle of that femur within the hip joint. Um, but for most individuals, that hip socket is deep enough to create some inherent stability.

Dr. Linda Bluestein: And I'm sorry, I should have explained hip dysplasia, meaning that there's a very shallow hip socket. Okay. [00:53:00] So I know that you have, um, as I, as I mentioned, you had training as a personal trainer, I believe, in addition to the yoga and physical therapy. Could you maybe tell us a little bit about that? In terms of, um, if somebody is, is listening to this and they're trying to figure out, well, should I try to work with an athletic trainer or should I try to work with a physical therapist or, you know, a personal trainer, um, or a yoga instructor?

Like, do you have any suggestions for how a person might find somebody that would be a good person to work with and how they might choose amongst those different fields? 

Emily Bohan: Yeah, that is a great question. Um, so I like to think of whether it's a physical therapist, a personal trainer, um, a yoga teacher, we are like your hairdresser, right?

Just because you got a bad haircut one time doesn't mean you should never get your hair cut again. Right? We all have different treatment styles that fit our specialty populations and, and all of that, right? Um, so I'd say that's like the main thing. Just [00:54:00] because physical therapy didn't work for you once, doesn't mean it won't work for you with someone else's style.

Um. We all have this, like, amazing training, right, of getting our doctor in physical therapy, but the human body, to some extent, is, it's an art figuring out what's going on. And so finding someone who can think out of the box for you, I think, is really important, especially for my folks with hypermobility, right?

Um, because there are little nuances that make a big difference, um, for anyone who has that, the hypermobility in their joints. Um, I. Of course, um, bias towards physical therapists, because we've had so much training in movement mechanics, um, and all of that. I think personal trainers can be really good too, but the barrier of entry is lower to get into personal training.

And so I think really doing your research on, um, You know, how long, um, have people been in the field? Like who do they work with? Like, don't be afraid to ask a lot of questions of these folks to make sure that they are a [00:55:00] good fit exactly for you and your, and your goals. Right. Another thing that's a benefit too about seeing a physical therapist is like, we're trained in the exercise selection to like help get you stronger, but we also have some of those hands on skills, um, that some of the other professions like athletic training, um, and, Personal training don't necessarily have and sometimes getting your hands on someone's body can really give us a lot of information, too.

Dr. Linda Bluestein: A lot of information and a lot of relief like I and a lot of relief I love it when you I love it when you're when you're gonna work on my body and i've been in Like a lot of tension in my neck and in my, um, like upper traps and stuff. I'm like so excited. Yes. I get to see Emily today. That's going to really 

Emily Bohan: help.

That's actually a great example though of like, so some of my folks with hypermobility, you know, they have all this like muscular tension, um, and we've talked about this a little bit. I don't always like to dry needle my folks with hypermobility because sometimes if we Everything too much, [00:56:00] right?

Initially, people are like, I feel great. But then the body goes, oh, we have no stability. And there's like this backfire response that happens, right? Um, and so I just think that's an important piece to bring up, too, of knowing, like, the balance of sometimes the body Wants a muscle tight for a reason and like let's find out why that's tight Rather than just like let's just release all of it, right?

Especially if you don't have a whole lot of that joint stability I think that's really important to like figure out underlying pieces of like why has that muscle gotten tight? 

Dr. Linda Bluestein: Mm hmm. I think I think I told you that Another physical therapist once dry needled my shoulder so much, the pain completely went away, so that was great, but at the same time, like, literally my shoulder felt like it was falling off.

Yeah, that's okay. Maybe a little, a little too loose. So, so a lot of my patients, I mean, a lot, Have tried physical therapy and they literally will say to me, physical therapy does not work for me. And I always feel like [00:57:00] it's a matter of finding the right physical therapist. I love your analogy about that haircut.

And we've all, I mean, I think most people have had a bad haircut, so we can like really relate to that. 

Emily Bohan: Um, 

Dr. Linda Bluestein: do you have suggestions for people who, you know, maybe it's not, it's not one, it's like, it's like multiple different physical therapists that they've worked with and they're, they're really feeling.

You know, anxious about trying physical therapy again. Um, do you have any suggestions for, you know, how you can determine if somebody might be a good fit? 

Emily Bohan: Yeah, absolutely. Um, so I think something that's really important is communicating with whoever you go to see next about like, here are the things I've tried and like, here, what, here's what hasn't worked.

So that way you don't end up in this rat race of like, oh, everyone kind of wants to keep doing the same thing. Right. Um, and I think especially when it comes to, Anybody who has hypermobility, like, ask that practitioner, have you worked with other people with hypermobility, right? Like, do you understand some of the pieces that, um, come [00:58:00] along with some of these hypermobility conditions, right?

Um, cause. Um, most physical therapists I would say have had an experience, um, or worked with people who have some degree of hypermobility, but as you start to get to the more extreme levels, right? Um, that's going to look a lot different, right? Do they work with dancers? I think is like another good question that you could potentially ask because a lot of dancers do have hypermobility.

Um, So, um, yeah, so I'd say those pieces, um, and then also sometimes it can actually help to not stay within a like fast paced clinical setting. You live in a big city that they're seeing patients every half an hour, right? They probably No matter how good that physical therapist is, um, sometimes they just don't have the time to dive into like the nuance of what you might need if you've been dealing with a chronic issue for a really long time, right?

Um, so finding a clinic that's a little slower paced, make sure it's one on one treatment. [00:59:00] Um, unfortunately, Physical therapy has moved in the direction of treating more than one patient at a time, right? And so I think calling ahead and, and making sure that PTs are seeing their patients one on one is really important.

Dr. Linda Bluestein: Yeah, that's, those are such great tips. And I absolutely, like every time I've Gone to see you. It's I'm the only one there like working with you at that time. And that's huge. And of course, also having that stability over time that I've been working with you for such a long time. Like I know, you know how my body works and you know, uh, so I think for a lot of people too, if they, if they then go, I think another mistake a lot of people make is that they don't go back.

So then they don't, like, if they, if they get more sore after a session, they feel like, well, that failed and they don't go back and give that physical therapist the opportunity to act on that information that those exercises were too much for me. 

Emily Bohan: Yeah. It gives us a lot of information, even if things, um, maybe feel a little worse after one session, right?

Like now we know [01:00:00] potentially your body's threshold or you didn't respond well to that. Um, cause I would say, you know, For a certain diagnosis, maybe 80 percent of people respond to this set of exercises. But there's a 20 percent that maybe don't respond or they feel worse. But if we don't get told that things made you feel worse after the fact, right, then we can't kind of switch our mindset of like, okay, let's actually try plan B now.

So yeah, that information is really, really crucial. 

Dr. Linda Bluestein: All right, makes, makes perfectly good sense. We are going to wrap up in just a minute here. Before we go, um, one, I want to see what your couple of key take home points are, um, first of all, and then we're going to jump into our hypermobility hack. So first, what are, what are just like, if you could distill this down into just a couple of key take home points, what would you say?

Emily Bohan: Yes, so my biggest thing is, if you're dealing with any sort of pelvic pain, incontinence, [01:01:00] frequency, urgency, even if you get up at night to go to the bathroom, um, you don't necessarily need to be doing that, um, go see a pelvic floor physical therapist, right? You don't have to live with leakage. You don't have to live with urgency that disrupts your daily life.

Um, intercourse or any sort of intimacy doesn't need to have any sort of pain associated with it. Right? So I think sometimes we just like live with these things happening in the pelvis because we don't know that there's actually someone who can help us work through it. Um, and even if there's not a whole lot going on with it.

Direct pelvic floor symptoms. If you have low back pain or hip pain, um, getting that screen, that pelvic floor, see if pelvic floor is a piece that's contributing to your low back pain or hip pain, I think is really important. Um, so. Okay. Yeah. 

Dr. Linda Bluestein: Okay. And I always like to have a hypermobility hack. So do you have one that you can share with us?

Emily Bohan: Yeah, [01:02:00] so, um, my hypermobility hack would be being really mindful of increasing your Exercise, right? So once again, people with hypermobility tend to be really sensitive to those increases in load. And so start with one set of an exercise, one set of five reps, right? We're still creating those really good changes in the body of like slowly starting to strengthen that muscle without flaring up the whole system.

Work smarter, not harder is the way that I like to think of it. Um, cause yeah, my folks with hypermobility, they're a lot more sensitive to those increases in load. So maybe it's taking a walk up and down the street. That's extra load on all your leg muscles, on your back muscles, on your pelvis, right? Like it doesn't have to be super intense for you to start making some really good positive changes.

Dr. Linda Bluestein: Okay. Excellent. And can you, uh, finish out by telling us what you're up to these days? If there's something that you want to plug, um, I'd love to hear about that. 

Emily Bohan: Yeah, [01:03:00] absolutely. Um, so in the last couple of months I opened my own business, Bohan PT and Training. Um, so I do some in person physical therapy, um, here in Denver, Colorado.

Um, but then I also do some consulting, um, over zoom, and then I'm also doing some personal training as well, diving back into that piece of my background as well. So 

Dr. Linda Bluestein: yeah. Fantastic. What's the best way for people to learn more about you, what you're doing and, or get in touch with you? 

Emily Bohan: Yeah, absolutely. So I have a Facebook page.

Um, BohanPT training, um, is where you can find me on all of those. Um, and then I also have a website as well that is linked in the show notes. Okay. BohanPT. com. Uh, BohanPTtraining. netlify. app. So it's through a different donate. Okay. That's why I'm saying 

Dr. Linda Bluestein: linked. Yes. We will definitely link that in the show notes and Bohan is spelled B O H [01:04:00] A N.

Emily Bohan: Yes. 

Dr. Linda Bluestein: Okay. Fantastic. Well, thank you so much, Emily. Really appreciate all this incredible information. Information that you've shared, and I look forward to seeing you next time. Great. Thank you, Linda.

Wow. That was such a great conversation with Emily, and I hope you learned as much as I did. I want to thank you for listening to this week's episode of the Bendy Bodies with the Hypermobility MD podcast. You can help us spread the word about joint hypermobility and related conditions by sharing the podcast and leaving a review.

This really helps raise awareness about these complex conditions. If you'd like to meet with me one on one, check out the available options on the services page of my website at hypermobilitymd. com. You can also find me, Dr. Linda Bluestein on Instagram, Facebook, TikTok, Twitter, and LinkedIn at hypermobilitymd.

You can find human content by producing team at humancontentpods on TikTok and LinkedIn. and Instagram. To learn about the Bendy Bodies [01:05:00] program disclaimer and ethics policy, submission verification and licensing terms, and HIPAA release terms, or to reach out with any questions, please visit bendybodiespodcast.

com. Bendy Bodies Podcast is a human content production. Thank you so much for being a part of our community and we'll catch you next time on the Bendy Bodies Podcast.