Nourish & Empower

From Pain to Ease: How Pelvic Floor PT Changes Everyday Life

• Jessica Coviello & Maggie Lefavor • Season 2 • Episode 8

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Leaking when you laugh, hip pain that keeps returning, or sex that hurts are not things you just have to live with. We invited Dr. Courtney Smiach, founder of Rebel PT and a licensed pelvic health physical therapist, to unpack the real reasons behind pelvic symptoms and share practical steps to feel better—without shame and without the “that’s normal” brush‑off.

We dig into the core canister—diaphragm, abdominals, back muscles, and pelvic floor—and why pressure management is the hidden engine behind so many issues: urinary urgency, incontinence, constipation, pelvic heaviness, and stubborn low back or hip pain. Courtney explains how pregnancy changes posture, breath mechanics, and stability, what that means for SI joint pain and pubic symphysis popping, and why smart movement, breath work, and gentle core training during pregnancy can reduce pain and accelerate postpartum recovery. We also explore vaginismus and pain with intimacy as practical barriers to conceiving, plus the nuanced ways pelvic PT collaborates with dietitians, OBs, urogynecologists, and mental health providers to deliver real results.

If you’ve ever been dismissed by a provider or told your symptoms are “just part of life,” this conversation offers a different path: consent‑led care, clear education, and tools you can use right away. Courtney shares what to expect from pelvic PT, when internal exams help and when they’re not necessary, and how to find qualified specialists even if you’re outside North Carolina. Along the way, we highlight the growing (but still under‑researched) field of pelvic health and the community‑driven model behind Rebel PT + Cycle.

Subscribe for more honest, evidence‑informed conversations on pelvic health, pregnancy and postpartum care, mental health, and body image. If this helped you or someone you love, share it, leave a review, and tell us the one myth about pelvic health you want to see retired for good.


For more information on Rebel Pt, check out https://rebel-nc.com/


Show notes:

Trigger warning: this show is not medical, nutrition, or mental health treatment and is not a replacement for meeting with a Registered Dietitian, Licensed Mental Health Provider, or any other medical provider. You can find resources for how to find a provider, as well as crisis resources, in the show notes. Listener discretion is advised.


Resource links:

ANAD: https://anad.org/

NEDA: https://www.nationaleatingdisorders.org/

NAMI: https://nami.org/home

Action Alliance: https://theactionalliance.org/

NIH: https://www.nimh.nih.gov/


How to find a provider: 

https://map.nationaleatingdisorders.org/

https://www.psychologytoday.com/us

https://www.healthprofs.com/us/nutritionists-dietitians?tr=Hdr_Brand


Suicide & crisis awareness hotline: call 988 (available 24/7)


Eating Disorder hotline: call or text 800-931-2237 (Phone line is available Monday-Thursday 11 am-9 pm ET and Friday 11 am-5 pm ET; text line is available Monday-Thursday 3-6 pm ET and Friday 1-5 pm ET)


If you are experiencing a psychiatric or medical emergency, please call 911 or go to your nearest emergency room.


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SPEAKER_01:

Join us as we redefine, reclaim, and restore the true meaning of health.

SPEAKER_00:

Let's dive into the tough conversations about mental health, nutrition, eating disorders, diet culture, and body image. This is Nourish and Empower. This episode is brought to you by Hilltop Behavioral Health, specializing in eating disorder treatment.

SPEAKER_01:

Hilltop offers integrated therapy and nutrition care in one compassionate setting.com because healing happens here. Hi everybody, welcome to this week's very exciting episode. We have with us Dr. Courtney Smitch. She is the owner and founder of Rebel PT and is a licensed physical therapist. She specializes in helping active women overcome things like back pain, hip pain, urinary leaking, and pain with intercourse, just to name a few. She is here to tell you that things like these are not normal, despite what society and even some practitioners have led us to believe, and that physical therapy can help you overcome these issues. She created Rebel PT because she wants women to have a safe space where they feel comfortable opening up about their concerns and a space where she can provide the best one-on-one physical therapy experience. Just a trigger warning before we start, today we'll be discussing fertility, postpartum, mental health, eating disorders. Listener discretion is advised. This show is not medical nutrition or mental health treatment and is not a replacement for meeting with a registered dietitian, licensed mental health provider, physical therapist, or any other medical provider. You can find resources for how to find a provider as well as crisis resources in the show notes. Courtney, welcome. Thanks for joining us.

SPEAKER_02:

Yeah, thank you. I'm excited to be on and like talk with you guys today.

SPEAKER_00:

We are thrilled. Especially, and I know I'm a broken record, but especially because I'm in my postpartum era and I deal with a lot of the questions that we're asking today. A lot of them came from my own personal experiences. So I was like, great, I can ask someone about these things. So I'm so psyched to have you on today.

SPEAKER_02:

Yeah. Yeah. I think that's perfect because honestly, the questions, I'm sure the questions you have are what everybody else is looking to find out too. So yeah, I'm ready for them.

SPEAKER_00:

I'm gonna make it. Awesome.

SPEAKER_01:

So just to even get started, we're just curious of you know what interested you about pelvic floor PT and kind of your journey to get where you are today.

SPEAKER_02:

Yeah, yeah. I feel like I always end up telling the same story because it was kind of personal one for me, but I'll try to keep it short. I mean, if we flash back to school, it was not something I ever thought I would get into, the pelvic part, not really because I wasn't interested in it per se. It just was kind of a small niche in physical therapy. It wasn't something that is very common. So I knew of maybe one PT that did it in my town, wasn't very familiarized with it. So kind of had the typical path of wanting to do sports or though. I feel like that's the more popular area of PT and why a lot of people get into it initially. So it wasn't until I was full-on orthopedic, started my second job, moved to North Carolina, was actually doing a residency, which is optional for PTs just to expand their skills faster and have good mentorship in orthopedic. So I was locked in ortho, sports, all the things. And I got a kidney stone out of nowhere that I would say wrecked my life in a lot of ways, was kind of a mental and physical battle for a while, which led myself to see a pelvic PT after it had passed. I was still having a lot of symptoms that were very dismissed, unfortunately, by a lot of doctors. And so it really took that to kind of kick me to see a pelvic PT. Um, and there weren't many around. So I was even driving an hour to see them after work and an hour back home. It was either Raleigh or Fayetteville in North Carolina. No one was in between. So it was kind of challenging to even get in with someone myself. So saw them, they changed my life, and it kind of opened my eyes at that point to seeing there was a lot of things even in ortho that I was missing. I'm like, wait, these women with chronic low back pain, we hit 80% better, but they keep coming back a year later for the same thing. It just keeps coming back, or chronic hip pain, just things in that pelvic region. I was like piecing the dots together and thinking, wow, there's I'm missing things here. So if I want to be the best for them or my patients, like I need to get some training and connect the dots. So that was really honestly how it how my interest started. And then I took my first course and it was kind of history after that. About, I mean, I've been a PC almost eight years now, so that was five, six years ago now. So pretty crazy.

SPEAKER_00:

I love that you're doing this first and foremost, but it all makes me like frustrated when I hear that providers like dismiss symptoms and just make it seem like what someone is going through is in their head because obviously, right? There are mental health conditions where things are in your head, but a lot of times that's not the case. And it always makes you so frustrated. So I love that you didn't just stop there and you kept going, and then you were then someone who took your own experience, saw what was happening in our field, and then took it to then solve it for other people.

SPEAKER_02:

Yeah, yeah. I hate, I really hate to say that people were dismissive. Like I feel like I, being a practitioner, I try really hard to give the benefit of the doubt, probably more than most, of like, well, maybe they're having a rough day, or maybe it's the system that they're stuck in, and you know, all the things. But there was a lot of red flags that just kept happening in that experience for me to the point of like portal messages basically saying, like, we don't really know how else to help you, but not really providing like what's next. So it took my boss to see how bad I was struggling to say, hey, court. And speaking of chronic pain, I mean, I was stuck in a really true chronic pain cycle at that point as well, with physical things going on. There was a there was a a branch of the two. And my thank goodness my boss was like, Hey, you need help. We've got to get you out of this. And I think you need to see a public PT. So it really, you know, I've it's I know it's hard for people to talk about and even admit it's chronic pain is a whole other conversation, but it happens to a lot of us, even if we know about it and are educated. And that was a big step for me to realize like, hey, my brain is stuck in a chronic pain cycle. I shouldn't be ashamed of it. It can happen to anyone, even if you know how to treat it. I treat patients with it. So yeah, that's just a little thing to talk out there that it absolutely happens. It can happen to anyone, and there are pathways out of it for sure.

SPEAKER_01:

Yeah, that's such an interesting point, too, about being a provider, but then being in the patient role. And how is a provider, you know, you think one thing, but when you're in the patient role, it's so different. But it just really emphasizes the point too. And I know we, you know, Jessica and I, we always talk to clients about this too, just like advocating for yourself and you know, and that you are your best advocate and like you know your body better than anybody else. So if something feels off, then you know, continuing to follow through and like, you know, ask the questions, demand like what the next steps are until you find that answer.

SPEAKER_02:

Yeah. Yeah. Yeah. I think that that's kind of that set the premise for Rebel PT. So the name, I kind of just randomly talked about this yesterday on my social media pages, but it really did just set the tone. Like the name is a little rough around the edges at first. And I'm sure doctors, if they see my notes come in for their patients, they're like, What is this? But it really is that it's kind of a reminder to like stand up for yourself and advocate. And if a provider is not helping you, move on to the next one. Or, and that's kind of like I'd say a little mission statement for for myself and my PTs or anybody that jumps onto my team here is like, if we can't help someone, honesty is key, transparency is important, like we're working within our scope, but we're gonna make sure they find the next person or who is able to help them in our area. So, you know, we can do what we can, but we can still help people find other practitioners that are trustworthy as well. So I'd say that's just kind of like the tone of Rebel PT at the at the end of the day.

SPEAKER_00:

I love that because that's even something that like Maggie and I, in like another episode that we're that we want to talk about too, is like the importance of finding the right provider for you. Because people don't realize that if you don't drive with someone, it's okay. You don't have to feel guilty or feel like you have to stay with that person. And so I think it's even more empowering that you, as a provider with your own practice, will be like, hey, if we're not for you, I will help you find someone. And I think that just speaks volumes to your character and the type of environment that you're creating for people because you're saying if my business isn't for you, I'll help you find it elsewhere. And not a lot of people will do that. So I just think that's incredible on top of everything else that you're doing. I just think, like, as a provider, I think that's just like top-notch. Love that.

SPEAKER_02:

Thank you. I think it's just it's like be a good human, right? At the end of the day, yes, that's what it's about. So yeah.

SPEAKER_01:

So, okay, so jumping into pelvic floor stuff, like pelvic floor 101 for our listeners. So if you could just explain to us kind of the basics, what are the main causes? What does this even mean? Okay, yeah.

SPEAKER_02:

I feel like that's the hardest one because there are so many things. There are a lot of directions it can go. But I would say the most common things that make people think of pelvic PT, or that would be symptoms that I would say be on the lookout for would be, especially the most common one we all know of mostly is peeing our pants, right? It's kind of the age-old thing that has been passed down from our grandmothers, our moms to say, Oh, if you have a kid, you pee your pants, right? So urinary incontinence, and I will say you don't have to have had a child or have ever been pregnant to have these symptoms. It just is more common during pregnancy and after with the mechanism of everything that happens with the body, but you could absolutely have all of these just on their own as well. So, like, and that was me, for example. I haven't had a child or been pregnant, so that you know, was just my prime example of not having that. But yeah, urinary um leaking or on the flip side, urgency. So, like feeling like you have to pee all the time, pain with intercourse is definitely one, or just intimacy in general. That could even just be even kind of along the lines of like difficulty with tampon wearing, a lot of pain that would be more than what you'd expect to be normal with an OB exam, so a papsomere or just a pelvic exam. Those are the big hitters. And then when it starts to branch out, you can talk about things like constipation, bowel issues can be related or influenced by the pelvic floor. And then, like I mentioned early on, chronic low back pain that's not going away with your typical treatments, hip pain, things like that is when you start thinking maybe there's some component to this from the pelvic floor. I mean, just being the muscles that like I know we're on some video here, like the bowl, like it's the muscles on the bottom that kind of hold us together, or like the bottom, they say, of if you picture a soup can or a soda can, it's the bottom, right? So it's kind of the base, the stability. We've got our abdominals on the front, perispinals in the back, and our diaphragm on the top. So it's this little system that all works together until there's a missing link or a deficit in one of those areas or multiple, where we start to then the pelvic floor just gives way, can't do it anymore. And that's when we see pain, leaking, urgency, those types of symptoms.

SPEAKER_01:

No, that's I mean, I find physical therapists so impressive, and I've I have a bunch of my family, and so I feel like I know a decent bit about it. And I feel like too, to even hear everything that you just explained, specifically with pelvic floor PT, like the awareness that you have to have about anatomy, about GI symptoms, like it's just there's so much there. It's it's such a wealth of knowledge, it's so impressive what you're doing.

SPEAKER_02:

Yeah, I'd say, like you said, it's actually intimidating getting into it because when you think about orthopedics, we have so much research. So if you come in with low back pain, we have a whole classification system that we have in our heads, but we can pull up if we need it to kind of feel out where a patient fits. And then you have the, you know, the level one evidence to follow, or what are your best treatments? And there's a lot of things like that sprained ankles, tennis elbow, disc issue. Like we have so much to fall back on, but in the pelvic health space, you don't. It's really hard to research these symptoms because they're so different and can be so individualized. And then I mean, women's health doesn't definitely just doesn't get studied as much. So it's it's kind of you learn as much as you can and you have to just go into it being very, I'd say, willing to think outside the box and just try things. And then a lot of like this, what we're doing, conversations, groups of PTs collaborating and helping each other because we don't have as much to fall back on, unfortunately. So we're really kind of problem solving as we go and doing the best we can, like you said, with a lot of things that can be involved.

SPEAKER_00:

It's just so crazy to me that because, like you said, they're like feeling like you have to constantly pee, peeing your pants, it is a thing. Or like, you know, having you know, pain, all of that, like during like sex or tampon wearing, during paps moves and stuff, those are all the things that you think of right away when you think of pelvic floor stuff, right? The fact that it could affect constipation in your bowel movements blew my mind. That's insane.

SPEAKER_02:

Yeah, that's a big one. And and actually it's it's interesting because the PT that's going to be joining our crew here soon and stepping in for my colleague that's gonna be on maternity leave this early winter time. She actually does pediatric palpapillar too. So there's like a plethora of all genders can benefit from it, all age groups, and now what that looks like is completely different for kiddos versus adults. Yeah. Um, and there are things you would do on exam and absolutely not do in kids, but she's actually a pediatric therapist by trade originally, and then gone into women's health and pelvic floor, and constipation is huge in kiddos, and then that can lead to urinary leaking and just things that are putting more pressure on the bladder and impacting how their pelvic floor muscles can function. So it is really much like a cascade of if one thing happens, there can be all these other little things that follow suit just because in the pelvis, there's so much that's so close together. Like we are squished in this little pelvic bowl. And if the muscles, let's just say the pelvic floor is tight, I mean, we are, you know, impacting the urethra, the bladder, the bowels, ovaries, reproductive system. So it is just a lot in a small space, we we could say.

SPEAKER_00:

That's crazy. And to think that there isn't a lot of research or there isn't a lot of like outcomes or like support for something that can affect so many different medical pieces, also is just very shocking to me. But one thing you said, and so I want to pick your brain on it a little bit. When you said all genders, so do men, I mean, this is probably such a dumb question. I know zero of anatomy. I'm not a science person, but like, so it's a good question. So men get it all the time. Like, men have a pelvic floor, like they need pelvic floor help too. Am I dumb? Is this real?

SPEAKER_02:

No, not dumb at all. I we have done women's health workshops at gyms, and the men are like kind of creeping. They're like, could we come too? And we're like, this is definitely a talk for women, but they do men do have pelvic floors, same muscle groups, just slightly different orientation of how everything is there and functions, but it that's I would say, even again, it's like pelvic floor rehab is a niche in itself, but then there are even these other niches within it. So we really love doing pregnancy postpartum care and kind of the women's health aspect through that phase of life and menopause and our practice. But I have friends and colleagues across the country that do specialize in male pelvic health. That's a whole while conversation of things that I'm seeing them treat in men that are awesome. Like a couple visits, and people are like totally overcoming their, let's say, like erectile dysfunction, that could be very disruptive to someone's life, trying to have kids. I mean, their relationships and they're avoiding medication and all these other surgeries and things that are being offered to them just because their pelvic floor was tense and maybe they didn't know how to relax it or have that awareness, or a lot of my friends say it's very connected to the low back pain and hip pain as well, just like in women. So there's a whole other world out there. I have not opened up my skills yet to treating men, but I'll never say ever because it's definitely another growing area, too.

SPEAKER_01:

So interesting. And even what you were saying about constipation earlier, because as a dietitian, when we talk about GI symptoms all the time, but I mean, to be transparent, and we're we're all learning here, which is why we have you here. Like, I have never connected the thought of constipation being related to, you know, something going on with someone's pelvic floor. So that's that's fascinating. I want to learn more about that.

SPEAKER_02:

Yeah, and I think it's I was gonna say that earlier to you as well. I mean, it's like a definitely multidisciplinary area. I would say there are cases where they just need pelvic PT, but more more often than not, we're pulling in dietitians. We are referring to urogynecologists or OBs that specialize in like vulvar care and hormones. I would say, I mean, the practitioners doing hormone replacement now through menopause, like they're and then mental health specialists. So I would say it's very, very common for our patients to we're just one piece to the puzzle. And like you said earlier, sometimes we're just guiding the ship to try to get them to who else they need on their team because it is so multi-dimensional in what they need.

SPEAKER_00:

So, two questions for you, because I can never ask one. You will you will sure learn. How can like pelvic floor difficulties or issues affect the ability to get you pregnant, like for one to conceive, but then also how does pregnancy affect your pelvic floor like during and after the whole role that creating a human is?

SPEAKER_02:

Yeah, you might have to remind me of that second question as I start talking about the first one. But there's like I said, there's not a lot of research on if pelvic floor dysfunction actually like. Directly affects fertility per se. Okay. I know there are some PTs digging into that more and more, but it's still a little newer. But I would say it's more so on the symptoms. Usually probably pain is a big one. Because if there's a lot of pain with intimacy, then that is a barrier, just you know, with trying to conceive can be lengthy for a lot of people and take time and a lot of effort. Contrary to what we kind of grew up thinking, you know, that like you like touch someone and you get pregnant, and that's like not how it goes for most people. So that can be really difficult if someone's dealing with a lot of pain, and that, you know, just thinking about if that took a year or two to conceive and the consistency that intercourse needs to be had, like that can be a big barrier for people emotionally and physically. There is like a condition that is called vaginismous, which is actually when the pelvic floor isn't just tight, but actually is so tense that like any sort of penetration is not possible. So, like getting a pelvic exam could be impossible for that person, whether it's painful or the muscles just clamp down so intensely that they can't even get a pap smear. So we see people with that not as often, but it does happen where we really have to pull in kind of the psychology barriers to that, dig deeper as to why that's happening with them, if it's a pain response or actually just a structural thing that's going on. So more of I'd say like a symptom or like a maybe a physical limitation for trying to conceive would be more of what we see. And then you asked about pregnancy, right? How it affects the body.

SPEAKER_00:

Yeah, question number two on the list, if that also helps you.

unknown:

Yeah. Yeah.

SPEAKER_02:

Yeah. So I mean, I think it the easiest way to think about it is just going back to if we think of musculoskeletal. So just kind of the so yeah, if we think about just the structural side of pregnancy and all the changes that are going to come with just growing a baby, our posture changes, the pressure on our pelvic floor changes. That's gonna kind of go back to that soda can. It's like if someone opens the top, the pressure system is gone, right? Or disrupted. That changes as our posture changes, as baby grows, placenta grows. I mean, we just physiologically change with like our blood volume and the fluid retention that we have in our body. So it's just all more just physical stress on the pelvic floor, essentially. It's more that it needs to support. And the posture change, especially in the second and third trimester, where you kind of see the pelvis kind of tilt forward more, the brain kind of stops using our glutes as well and all these other muscles, especially the abdominals as they're stretching, essentially, they're they can get weaker over time. So all those muscles that support the pelvic floor and work together are now having to work harder. So that's a big reason why you'll see pelvic pressure, heaviness, the leaking symptoms start to pop up during pregnancy, but also the hormones. So the hormone shift in itself can cause a lot of urgency in the first trimester, just with estrogen and progesterone changing, it does affect the bladder a little bit. And this is kind of up for debate now, but we always think about relaxing and getting like a little more relaxed and kind of loosened in our ligaments throughout pregnancy, which does happen. But there's a little bit of debate on like, does that really lead to pain, like low back pain, or does that really uh impact the pelvic floor? I think it does. It's just not as much like cause and effect as it used to be. I think it's a little more hormonal and how that even affects your pain sensitivity now as we learn more about the brain and pain at this point in time. So yeah, a lot going on at once, but it definitely is just different angles on how it could lead to symptoms there.

SPEAKER_00:

It's such a beautiful experience, it really is. But it I'm trying to say this to not because it's a beautiful experience for anybody who has been pregnant yet, but it really does like tear up your body.

SPEAKER_02:

Yeah, it's like if would we say that? No, in that way, but it yeah, the that's the simple way to say there's a lot going on, a lot of change, so much, which is why I'm passionate about what we do. I'm like, we need to support women through that time as much as possible because I I can truthfully say I've had some of the sickest of the sickest pregnant patients before. And even the little, like the smallest amount of exercise or the smallest little things that they can still do, I see pay dividends in their postpartum recovery. So sometimes it's not even about being perfect or being able to do everything that we want to do, maybe exercise-wise or strengthening, but the little things still pay off massively. I can't quantify that in research, but I see moms, regardless of how delivery went, just from keeping up with a few areas throughout pregnancy, just thrive so much faster in their recovery. And then second or third time moms tell me that maybe they didn't put their first or their second. And so they're kind of comparing subjectively and they're like, I wish I had this the whole time. So, like you said, being at least a little voice of reason or guidance during all the changes for people, I think is just so helpful.

SPEAKER_00:

Yeah. Because it is, right? That's why people say, you know, keep moving during pregnancy too, because movement within itself is also really good for the body. It helps for delivery. And I feel like I can imagine, please correct me if I'm wrong, that like even for your pelvic floor, it's probably great to move and to not have everything kind of like stiffen up and like stay tight. It probably allows you to keep things loose. Which brings me to another question. And this is a very personal question for me. Because when I was pregnant, my pelvic floor would actually pop, snap, crack every single time I like got out of bed or like got out of the car. And so for me, I remember with my you know anxious brain, I would sit there and be like, oh my god, my whole body is breaking, my baby's about to like fall out of my body. And it's like, obviously, that's not what's happening here, but it is a very uncomfortable, painful experience to have. And there's and like you said, there's no conversation about it. Like, even my OBs, like there wasn't a hey, this could happen to you, or hey, just be aware. And then you go to the doctor and they're like, Oh, yeah, it happens, it's normal. And I'm like, okay, but what does this mean? Like, is my body breaking in half? Like, I don't understand what's happening here. So, like, what is what is because then of course, you know, I'm trying to do my own research, and then I find like the pelvic girdle pain, symphysis, pubis dysfunction, or pelvic organ, like what are all of the things? And like, how does pregnancy cause these things to happen?

SPEAKER_02:

Yeah, all goes back to the hormone changes and everything I was just talking about, and just the biomechanical changes because like our hips are gonna widen a little bit to make room for baby and delivery. Our rib cage, you might be like thinking about this, the rib cage kind of expands a little bit again. And that all goes back to that core canister along with hormones, allowing that to happen. Because I kind of forgot to hint about that with the rib cage, orientation can change a little bit. That's like where we don't have space to take a deep breath anymore. Like our diaphragm doesn't have room if it wants had. And so that right there already affects the pelvic floor. But you nailed it. Like, I wouldn't say that specifically the popping or the snapping was the pelvic floor, since that's just kind of like the base of muscles at the bottom, but absolutely the pelvic girdle. So our hip bones where they connect, our pubic symphysis and the middle, the back side. I'm like, I should run to my office and grab my pelvis in there. But the sacrum and our tailbones kind of like a triangular muscle on the back side that kind of completes the circle. That's probably exactly what you found that pelvic girdle pain because of all those changes and things relaxing more and moving differently, especially like standing on one leg to put your pants on. That's a common thing. Getting out of the car, people feel that pop, that click. And yeah, so it is kind of that like the changes, but that lack of core kind of strength and coordination, that lack of stability. So it could be anything, any fault in that system. But most commonly that is like an SI joint or low back kind of thing. Or if it is in the front, that is really specific to pregnancy being that pubic symphysis dysfunction. But we would treat it by as much as we want to keep you mobile for delivery, we want to really make sure you can connect to your deeper core. You can still do a little bit of strengthening. Maybe we modify how you move just to kind of think about minimizing the one leg reaching out really far or making sure you kind of like keep your body two feet on the ground as much as possible and make what could be like a lunge, more of a squat just to calm things down and provide that stability with your muscles. Um, if it gets really bad, we usually start to play with like external support, SI belts, compression garments to kind of give you more if your body's unable to do it for itself. So that's a great question because I we definitely I would say that's a reason that prompts women to come in because they start having those pains in like the second trimester. Usually I see it more in second time moms than the first, and I don't think it has anything to do with one or two kids. It's more that like most of the time now they're pregnant chasing like a two-year-old. So they don't get to rest, or they're chasing, you know, chaotic kids around, and they're like, Whoa, this is different. And I'm like, Well, you are like picking up your toddler, they're 30-something pounds, they're also like writhing around, not like picking up a 30-pound kettlebell that's not moving. So I see that just challenge the body in a whole different way if you've had multiple children, and that's where those things start to present themselves.

SPEAKER_00:

Yeah, it's a wild experience. Like I remember just like in the middle of the night, just wanting to roll over one side to the other, and just the motion of one leg going and then the other. It literally was like open, pop, close, pop. And I was like, that'll really wake you up in the middle of the night. But so it's just so, yeah, it's just so interesting. Like, again, I like want to get pregnant again so soon. Like, I loved the experience, but no one tells you what the heck your body goes through or what could happen. It's crazy.

SPEAKER_02:

Right. And like you said, your OV team or midwives, they're very quick to say, Oh, yeah, that's normal. Don't worry about it. And it is true, it's okay, and it's normal, but it can be really uncomfortable and really painful. So that's just where we're looking at it from our scope of practice and saying, Oh, we can do stuff for that. You know, even if it was just teaching you like little tips and tricks to kind of get through that time. Like, I'm immediately like, pillow between your knees, if you have that awareness to be awake enough to do that, to roll over, we'll minimize that. Or like you squeeze a little pillow between the knees before you stand out of bed. Just some little activity modifications can minimize the stress in those areas, so it's less painful. And then that opens the door to get a little stronger with exercise. And those are the same things I see pay off in postpartum recovery, too. So just a little bit of core stability and strengthening. And it is okay to strengthen your core during pregnancy. That's a big stigma. So yeah, that's what I think about for you in that situation. But a lot of people go through that.

SPEAKER_00:

Corney, do you do virtual PT?

SPEAKER_02:

We do. I feel like that's a another just healthcare aspect. That's what I want my podcast to be about. It's like all these things and healthcare just globally outside of just PT. But yeah, so we can we do telehealth and virtual within the state of North Carolina. So that is a limit for a lot of healthcare practitioners. Like we have would have to be licensed in every state to do that. And it's getting better. They have a compact now where we could probably like if I'm licensed in North Carolina and I activate it and pass a couple state tests. I could, like, their laws and regulations, if they're different, could get approval in other states, but it's still a lengthy and expensive process. So it's not as simple as just kind of like a national, even though it's a national PT exam, we're not automatically licensed in every state since they have subtle differences in their scope. So that is frustrating. I feel like that's where some PTs are like offering coaching to kind of get around that. The legality of that is probably fine, but it's just, you know, what you're willing to take on. So I feel like that's where at least social media education podcasts is helpful. But I always tell people, like, still reach out because we know people all over the country, past colleagues or past people in my PT program, have dispersed all over the place. And if they're not the person, they probably know someone. So I would say we have, as PTs, a really good way of helping people track down good therapists across the country if they need someone closer to them.

SPEAKER_01:

Yeah, that's really good to know because I remember a couple of years ago trying to refer a client to a pelvic floor PT in New Jersey. And I had a really hard time finding anybody that specialized. So it's great to hear that you're so connected. But is that common? Is this more of a growing field? Because I remember really struggling to find somebody.

SPEAKER_02:

Yeah, it's it's interesting to think about the the women that really kind of paved the way from what I've been told, like really kind of started doing more pelvic stuff, I'd say in like the 70s and 80s, like early 90s, like in those decades leading up to the 90s. But then I feel like it wasn't until so they were out there, they were doing the thing. They probably got judged a lot, I would say, and like kind of like looked up over, like, oh, what are they doing, you know? But then it really started to grow, I'd say in the early 2000s, but especially in the last decade, it has like ballooned up because there was definitely a handful of younger PTs that took to it, trained under these kind of people that paved the way. And then social media, it has just exploded, which is great. So the awareness, I'd say, of women's health grew, and then that got a lot of the younger therapists in school interested in it. It's kind of a thing where, like, again, unfortunately, in school, I do adjunct at a local university. So we the curriculum is tailored to what's on the board exam, and pelvic is probably two or three questions. So it's not in the programs as much as we would like it to be. But I mean, the second you get out of school, if you're interested, you can go to the the works with Con Ed and mentorship and things like that now. So I would say you're right, like just in the last 10 years, it's exploded. And then I'd say even more since COVID, even like just in the last five years, it has really become more common knowledge. I think in Wake County here in North Carolina, like we have a lot. We actually have a lot of people doing it in the Wake County like research triangle area, which is really cool.

SPEAKER_01:

Yeah, no, that's that's good to hear. And just one more question for you, and then we want to hear more about Rebel and where people can find you. But I know when when you know I've had clients who have been recommended to go and do pelvic floor PT, there's a lot of hesitation that comes in of not knowing what to expect. And, you know, we all practice from trauma-informed care lenses. And so if somebody is going into a pelvic floor PT session, could you just like generally talk about like expectations?

SPEAKER_02:

Yeah, yeah, for sure. I think that I see it both ways where people come in and some know that we are trained to do an internal pelvic exam. And that's like the first thing they want. They're like, I want to know like what's going on down there. But others have no idea that we even have extra training to do that. So I would say no matter how someone's coming in, but especially if we're sensing hesitation or someone is a little nervous about that, for whatever reason it might be, is that we're always totally down to do whatever they want to do. Like we'll be very brutally honest to say, hey, I do think you'd be you'd really benefit from an internal pelvic exam to kind of really know what's going on. But if there's any hesitation or we walk through what that would look like and they're not comfortable with it, they can absolutely decline. And then we can do the best we can with, you know, their symptoms because there are a lot of symptoms that will be more characteristic of a tight pelvic floor or muscles being tense or weakness in the pelvic floor. So at that point, we would just explain like, hey, we're gonna hypothesize what we think is going on along with everything orthopedic that we're seeing, and we'll start there. And you hope that then symptoms are improving. And if they're not, then maybe sometimes that's where people, you know, they get to know you, they feel more comfortable, and then they're open to something like that down the road just to confirm what's going on. But if someone is just strongly like not feeling that that is for them, we don't ever have to do it. It's it's just an option on the table, I would say.

SPEAKER_01:

Yeah, no, that's that's good to know. Yeah, thank you. Yeah, so okay, tell us more about Rebel PT, Rebel Cycle, and where people can find you if they want to learn more.

SPEAKER_02:

Yeah, yeah. So yeah, Rebel PT and Cycle is in Fuque, Verena, North Carolina. So if you're listening not from North Carolina, it is a very unique little town. I always say it's kind of like the Foo Fighters. If you listen to rock music, like Fuque, but cute little town south of Raleigh, about 30 minutes south, growing small town. I say that in air quotes, very much so growing. But yeah, we're kind of in the downtown area. It is, I like to say it's kind of like the mullet story of like it's the party in the front, or no, sorry, actually backwards of a mullet, right? Like business in the back of our building where the PT section is and party in the front, so opposite, I guess, with spin. But that was just a personal thing of mine. I used to teach group fitness all the time in college. And my undergrad is in exercise physiology. So just the exercise nerd guru and me always thought if I could have a little group fitness studio, I would. And we were blessed to have the opportunity to do both. So we have spin classes around the PT schedule. And then, yeah, in-person appointments available at our office. We have two locations. The spin studio is our main one, and then just down the road, we have a little extra treatment room and a CrossFit gym in Greater Culture CrossFit. So a little extra space as we're growing. And yeah, we do do virtual telehealth as well within the state of North Carolina. And yeah, we're on Facebook, Instagram, Instagram primarily. So if you want a little laugh and a little like kind of like joy around pelvic stuff that we go through, follow that account. We try to be a little funny about everything and have some lightheartedness around people struggling with things that we're struggling with. Um, and that's that's about it.

SPEAKER_01:

Yeah, thank you. No, and I just want to add too I mean, I found you through, you know, with moving, looking up. Cycle studio, and I always think of things in the lens of like our clients and what our clients might experience. And the cycle studio is just it's so comfortable, it's so not competitive. Like I just feel like it's such a safe environment. And you and and your husband Kyle both like were so welcoming when I first came into you know moved to a new place. You were one of the first people I met. So, you know, anybody listening who's in the area and like is hesitant about group fitness or trying a cycle class too. I feel like your studio is such a like great welcoming environment for people to come in and like see if it, you know, if it feels good to them.

SPEAKER_02:

Yeah, yeah, I appreciate that. A lot of people say I got a lot of hate on that at the beginning for like a spin studio and PTA. And I was just like, listen, they're both passions of mine. And honestly, yeah, they seemed a little discombobulated at the beginning when you look at it on paper. But now, four years later, just reflecting on things, I'm just blown away by how that was kind of the spin aspect is how we grew community and just getting to know people. I mean, we don't have any family here. So all of our friends and community have just been things or people we've met honestly. And I I'm just so thankful for it. I mean, honestly, like just getting to know you, get like that's exactly how we've met so many great people in this town that I really feel like any of us in our little rebel community, if we needed something, you could call any one of us. Like the people coming in the door are outstanding humans. I feel like it must just be the vibe, like they're attracted to you. And it's it's bringing all the great people in the door, and it's kind of just created this little segue between fitness and exercise. And then if people come in and they need PT, they they know me and they're comfortable to come to me or my teammates, and it's just like coming full circle now, which is really, really for me, it's been very humbling and almost like emotionally overwhelming to see it all come together. But it's been really, really neat the last few years.

SPEAKER_01:

Thank you. No, that's great. And we'll post you know a link to the Instagram and your website and everything in the show notes for people, and then we'll be tagging stuff on Instagram. So please to anybody listening, check out Courtney, check out Rebel PT, and just thank you. This was so wonderful, so informative. And you know, we really appreciate you you being so generous with your time with us. Yeah, thanks for having me, you guys.

SPEAKER_00:

Oh my god, thank you for coming on. And I'm so sad you're not licensed in Jersey, but that is all right. I might ask you for resources for those in Jersey.

SPEAKER_02:

Honestly, it message me. I had just like, like I was saying, there's someone that just messaged me. I want to say it was over Thanksgiving week, and they must have known one of my patients down here, and it was a friend of hers, and she reached out and I was like, Oh, I don't know anybody in that area. I think if it was near Baltimore, Maryland, essentially. But our like I still do some business coaching. I probably don't need it that much anymore. But it's just nice to have that network of people when questions come up. So I literally went to the little practitioner map. I looked up her area that she sent me, her area code, and I found like two options that seemed to me vetted, like just looking at their credentials and stuff, sent them her way. And she messaged me last week and she's like, This PT is awesome. I'm so glad I found them. So it is getting easier and easier to just track down. Like I the pal, I would just say the pelvic PTs of the world are like the ones like I don't know, in other disciplines, it can get a little catty, but the pelvic PT world is like the most supportive. So anything to help people and make it more accessible to find. So if you need anything, just let me know. You can track down someone.

SPEAKER_00:

I will. But thank you again so much for being here. This was so exciting and this was so fun. Hopefully, we'll have you on again to talk about more of this. But thank you everyone for tuning in and we will catch you on the next one. Bye. Bye. Thank you so much for listening to this episode of Nourish and Empower Podcast.

SPEAKER_01:

We hope this episode helped you redefine, reclaim, and restore what health means to you.

SPEAKER_00:

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