Interview with pelvic floor expert and Doctor of Physical Therapy, Kailie Denham: Topics include how the pelvic floor impacts riding, why breathing is so important for equestrians and why strength training will keep you in the saddle.

Interview with pelvic floor expert and Doctor of Physical Therapy, Kailie Denham: Topics include how the pelvic floor impacts riding, why breathing is so important for equestrians and why strength training will keep you in the saddle.

Below is an interview May Babes did with women's health and pelvic floor expert, Kailie Denham. Kailie treats patients at her practice in Idaho as well as offering virtual appointments. You can find her here: 

In the interview we cover breathing mechanics, working on your weak and dominant sides, leaking while riding and how what your body is doing today doesn't mean that is the way it will be forever. Kailie is a wealth of knowledge in her field and has dedicated her professional life to helping women.

****As with any health related article, we must include that this is not medical advice and you should speak with your Dr. or Physical therapist before embarking on any treatment plan.

The article discusses topics like pelvic floors, continence, bodily functions, sex, and aging. 


Emily: So the first question is, how does our breathing affect riding? I think that this is a really cool question because it's pretty broad within any athletic endeavor that you get into. Breathing is something that's really important, and I've noticed that finally there's a little bit of a tide change or people are realizing that your breath is pretty important in all that you do.

Kailie: Yeah. So I was talking to you like, Oh, with the equestrian's only, but then you said ‘athletes' because equestrians are athletes as well. When we're talking about breath, we're talking about this pressure change that happens when you inhale and then you exhale. When you inhale, you increase abdominal pressure because your lungs are filling up with oxygen. Everything just has to move down to accommodate the oxygen in your lungs. There's more downward pressure onto the pelvic floor, the abdomen, all of your internal organs with inhale. I want to say something: When I see clients in person or even virtually and consult them, a lot of women inhale in reverse of what is supposed to happen, which is interesting. Back in the day, I think I just intuitively thought you inhale and everything comes up, and that's when you button your jeans. You inhale and suck in. But when you inhale, it's important that you're thinking everything needs to move down. When you exhale, there's a decrease in pressure as you exhale all the CO2 out of your lungs.

Your abdominals, your pelvic floor, all of that, they're tight, the pelvic floor is lifting. It's all to help with this breathing. If you're breathing incorrectly or the timing isn't right and you're doing this inhale up instead of inhale down, and then you're breath-holding, all of that will increase pressure when it's not supposed to be increased. That's huge when it comes to prolapse (and pelvic floor function problems like continence) and it’s because of these pressure changes that the pelvic floor muscles are not strong enough. The pressure of the pelvic floor muscles around the pee tube (urethra) is being maxed out from up above. It's from things that we're doing that are behaviors. Breathing is so important that you learn that coordination of inhale, everything moves down, exhale, everything moves up, and not breath-holding because that's what our go-to is, is we're going to hold everything in and just hold our breath, and then we're increasing pressure while we're holding our breath. And then we wonder why we're experiencing leaking or other problems.


Emily: Yeah. Well, and that makes total sense because if you have... If it's an equestrian or an athlete and you are nervous, then you're tense and you're holding your breath waiting for either the next moment of something to start or a test or a jump or something like that, you're anticipating and then unknowingly, you're creating actually more pressure down on your pelvic floor. And I think that's super common. But I also feel like a lot of moms that I've talked to-even though this is not geared just to moms, but I do think that a lot of moms that I've talked to, we all have joked around about how we breathe weird or we hold our breath all of the time! Do you think that that's because of the space that a baby can take up when you're pregnant and it changes your behavior?

Kailie: It changes your behavior, it changes your posture, and then all of a sudden, you're just postpartum in your body, your diaphragm is really high. Your diaphragm is really high, your ribs are flared open, your back is really tight, and your body just is like, “Where are all these organs going and settling?” A lot of times moms will say, “I just can't take a deep breath.” Just teaching them how to breathe again efficiently and teaching them what their pelvic floor is doing when they breathe. When you inhale, the pelvic floor is lengthening, and then when you're exhaling, it's contracting. This breath-hold or this shallow breathing all the time, your pelvic floor isn't able to go through its full range of motion. You're only really using a very small amount of your pelvic floor. When you go to a jump or you go to do something that requires a big inhale or a length change of your pelvic floor, your pelvic floor has only been strong right here and it's never been allowed to lengthen and then contract again. 

Just teaching women how to get to their pelvic floor by taking a really big breath is huge because a lot of times it's as though, “Do you know where your pelvic floor is?”

I ask patients, “can you contract it? Do you have an awareness of what it's doing?”

When you're riding a horse, that's so hard to feel that, but knowing that you're controlling your pelvic floor through your breath, you can feel that breathing, and that's something you could think about, and it might be enough to just distract you from holding your breath.

Emily: I noticed that when I take a deep breath, you can, I think that you've given me a visual before that's similar to this, where you feel yourself expand. And I can tell that my seat changes when I take a deep breath, because it's almost like everything takes a moment to relax. Everything is not so bound up. And it just is interesting because I think that that's why breathing is so important if you want to do something that is athletic. I feel it's like when other moms I've talked to said, they won't leak at all and then all of a sudden they'll laugh. And then they'll leak when they laugh. And is that a similar thing where all of a sudden your muscles are used beyond that range of motion that you've trained? 


Kailie: It is like laughing and coughing more. They've actually studied that, using coughing as an exercise for the pelvic floor. But because you can't sneeze on command or anything like that, but you can cough and figure out things such as, “I don't leak when I cough once, but if I leak, I leak when I cough three times” or something similar, and you find out where your limits are, just like if you are doing weightlifting  and you're trying to find your one rep max or something like that, you're finding that weakness. Or with running, and you run for 10 minutes. But you only leak when you get past that 10 minute mark. You're trying to find that spot where you're not strong, and then you're trying to strengthen that and move the dial, so to speak. There's so many different methods to improve function. I was just talking to my other PT about this. Leakage, urinary incontinence is so multifactorial. There's so many different factors for why somebody leaks. That's one reason for the physical exam and I'm sure we're going to get to it, but the physical/internal exam to help find out for you: is it the squeeze pressure around the urethra  that's not strong enough to withstand the pressure from above, or are you breath-holding? Or is your pelvis in a really weird position that it's putting extra pressure down onto the bladder? But it's all about that squeeze pressure. How do we get that stronger? How do we get that pressure to increase so that it can withstand riding or jumping or coughing or sneezing or any of that? There's things that you can do with just pressure changes, with breathing and not holding your breath. There's things you can do with pelvic position and rib position. There's a lot you can do to check some of the boxes, and then it's like, Well, we need to look at the pelvic floor, see what else is going on.

Emily: Yeah. So it's not just the pelvic floor alone. It's a whole system that reacts to one another.

Kailie: And as demands change, it changes. 

Emily: Yeah, that's really interesting.  So going into our next question that I received, which is similar: Are equestrians likely to have tight pelvic floor muscles. Why does somebody have a tight pelvic floor?

Kailie: Yeah. I was trying to look up some research articles. There's not a lot on the questions so equestrians have while riding. But I have heard that equestrians can have tighter pelvic floors or more tension in the pelvic floor. I did see something that was talking about it; they tested some female equestrians, and they were looking at the pressure, the pelvic floor tension. They noticed that as you went from standing still on the horse to cantering, the tension in the pelvic floor increased the most out of cancer. Which makes sense because you're going faster, you're having to hold more with your inner thigh muscles. I think that's probably part of it. Your inner thigh muscles attach to your pubic bone and your pelvic floor muscles attach to your pubic bone, and they share a lot of the connective tissue. If your inner thigh muscles are squeezing, which they have to, so if you stay on course, it makes sense that as you go faster and have to hold on tighter, that the tension in the pelvic floor would increase and increase and increase. I think the important part with that is to know when to squeeze tighter, let's say with the canter, and then if you're just walking and knowing what that feels like. And being able to tell, Oh, I'm squeezing extra tight when we're just standing here and not moving or just walking, and I shouldn't be doing that.

Being aware of, “Oh, I am clenching right now when I shouldn't be,” and the canter is when I should be bringing on that pelvic floor tension because the pressure is changing and things are going up and down. I thought that it was interesting that, yeah, during different cycles of the horse's gait, your pelvic floor muscles will tense more. I have only ever ridden Western, and so it was always like a lope instead of a gallop. They were talking about a two-point canter and something else. Can you explain that? Because it was saying the two-point canter is the one where the pelvic floor tension increased the most. I was like, Oh, what's the difference? Are there different canters?

***Edited to add: Two point position in the canter was what the study referenced

Emily: But that's really interesting to me because going back to the tension part during any gait is that most riders can tell when they're gripping too much, too high or low through their calves. So if you're really gripping with your thighs and really gripping with your seat, your horse reacts to that and is not as loose.

It makes sense that the appropriate thing to do with your pelvic floor would be being able to have enough body awareness to adjust that tension based on either the speed, like a gallop as opposed to a canter, or the particular movement even. So if you're a jumper, you're adjusting your tension in a similar way before you go over a jump, or maybe even a stride or two before you go over a jump. Or if you're a dressage rider, when you're getting into a more advanced movement like a piaffe or a passage, that you would have ideally the ability to adjust, just like you would adjust your hands, or adjust your ankles, or anything like that that you would adjust your breathing and notice your pelvic floor. And maybe that's what a lot of people think when they adjust their seat. Maybe they're not in tune enough to know that it's their pelvic floor, but maybe it really is their pelvic floor when you think of your seat. And I know that there's certain practitioners that are bringing some of this into the equestrian world, which is really cool. So there's the Franklin method where you ride on things that are inflated or water filled balls, but that you can use that can help you correlate your brain with where your body is and make those adjustments.

But I think that it's like anything else where seeing a PT like you would help, you can help tell me if my brain is actually making a specific area do what i am telling it to do. 

Kailie: I think that's so important because you can say, Relax your pelvic floor. But most women don't know what that means. It's as though, Relax your pelvic floor and think. I'll say, “Think about spreading your sit bones wide or feeling more of the chair or the saddle.” Because if you contract the pelvic floor and the glutes, you would naturally raise up because your sit bones come together and everything moves, it'll move you up. Feeling the similar, “I'm going to melt my sit bones wide on that saddle” and notice how you lose some of that height. Then if you tighten, then you're going to get higher. Being able to feel the difference between that, I think would be important for equestrians. Then what are you doing with your hands, your toes, all that, because the pelvic floor will respond to that, even clenching your teeth. Trying to get this whole body relaxed and the horse responding to that can be key because if you're gripping the reins versus a light hand, then you know your pelvic floor is going to respond to that.

If your jaw is more relaxed, your pelvic floor will respond and be more relaxed. If your toes aren't clenching. It's this full body mapping. Okay, is my jaw relaxed or my hands relaxed? Is my seat melted on the saddle and then my toes? Kind of this whole thing.

Emily: Can you explain why the jaw is related to the pelvic floor or why there's that? Yeah. What makes that a thing?

Kailie: Yeah. There's- There's fascia connections from the jaw all the way down to the arches of your feet. Actually, they've studied this, in TMJ problems and plantar fasciitis. If you have those, a lot of times you're going to have a tight, overactive pelvic floor because of the fascia attachments from the ground up. A lot of times when you are giving birth, you're going to be told, Relax your jaw, relax your hands, relax your toes, don't clench, because they know that it will help relax the pelvic floor. These fascial connections, those little things that can just be enough to be like, “Oh, I do clench my jaw, or “my toes are always curled,” can affect the pelvic floor. Just these small behaviors that we're doing.

Emily: That's really interesting. Is there something that… If you have a tight jaw, do you suggest rolling out using a ball? I use yoga tune up balls for this quite often. 

Kailie: Yes, you can literally massage those tight muscles. You could take your thumb inside your mouth and massage in there or on the outside of your jaw. And then for the feet, taking a ball and rolling your arches. Roll your arches! And in so doing this body care before you even get on a horse or do whatever activity you're going to do can be a game changer. If you know you are a jaw clencher and your pelvic floor is on the tighter side, you can do some of this body care beforehand to influence the pelvic floor.

Emily: That's super cool. Rolling your feet out could make your seat I think that's really helpful for a lot of people too, just to see what the response by the body is by doing those things. And then if they notice a difference, then it's even more a reason to go in and see a PT like you and get an assessment and get on the right track on getting everything squared away, just on maintenance. The older you get, the more you have to maintain. But it does keep you feeling good. So for me, it's worth it. If it takes me 10 minutes to roll out my jaw and the arches of my feet and I wake up feeling good every day, then that's a good use of time. 

All right. So the third question that we have is a two part question. We've covered it a little bit, but the third question I received was about incontinence. I think that the most positive thing that you can take away from practitioners like you and physical therapists in general, is that the baseline thought is that you can do so much to heal your body, help your body out, that something that is happening today doesn't mean it's going to be happening in two months or two years or whatever. But I did get a lot of questions about leaking. So one was specific about leaking over jumps (as a jumpers rider). 


Kailie: This goes back to that first question of pressure control. The pelvic floor muscles don't actually squeeze. What they do is they kink. They push against it. But we just say squeeze. But they are contracting. It's just not around. It's more of a push this way.

Emily: Oh, okay.

Kailie: That pressure, that urethral pressure has to stay higher than the pressure from above. There's been studies on this. The pressure increases from when you're sitting to when you're standing to coughing to jumping to going over a jump, all that stuff. It's figuring out quick things that you can do, such as, are you holding your breath as you take flight? Because that's going to increase pressure onto the bladder. One thing that I would say, and this is for any athlete that I have, if there's something that you do where you know you hold your breath, whether it's a lift, a jump, anything- mounting the horse. Whenever you notice that you have a breath-hold and a leakage, I say time your exhale for that moment. Because when you inhale, the pelvic floor comes down and it lengthens eccentricly, so that's a contraction. Then when you exhale, it shortens and lifts. If you're going to breath-hold, that's just going to put more pressure down onto the bladder and maybe you're leaking because of that. I would say, can you time your exhale for the take-off or whenever you're leaking in that jump and see if that doesn't change your leakage?

I would do that first-time the exhale with your jump. You're going to maybe, let's say it's right at take off. You're going to inhale right before and then you're going to exhale as you jump. Then you're not just going to hold your breath after the exhale. You're going to go right back to inhaling and then exhaling. Maybe you have to bring it down to just going over some ground poles that and see if you can get that coordination down of the exhale timing. Because I guarantee you're either breath-holding or you're doing maybe an inhale when you should be exhaling or something funky. But I would go there first and see if we can just take some of the extra pressure from a breath-hold off of the pelvic floor so that your pelvic floor muscles can be more than the pressure from above at the bladder. Be aware of things. For me, I think about the laundry I need to do. Because that's, I don't know, I guess that's just where my brain goes. But I'm sure there's other moms that ride that are out there that probably, who go to the other life responsibilities in the moment. And that affects your breathing and your body awareness a ton.

Something else that made me think of if you go from a canter to a walk, it's like this boom, boom, boom, boom, boom, boom. Just like some women have trouble going downhill, walking or running, there's this extra piece to it,  you contact the ground or you contact your saddle for that moment, but everything internal is compounded. It's like this domino effect. It's the exhale, but making sure that you have an idea of what your pelvic floor is doing. Is it so tight that there's no give? The pelvic floor should be like this trampoline. It shouldn't be so tight that you're going to hit it and blow through it, so to speak. It should have this give on that. Making sure that the pelvic floor has a little bit of back and forth give from the breathing will help because the pelvic floor will respond to that. Then it's, do you have enough pelvic floor strength in the sphincters around the urethra? Because some of the pelvic floor muscles they push on the urethra, and some of them lift the bladder.

You need both to happen because if your bladder is not being lifted up high enough, then you're not going to get a good squeeze, so to speak. That could be from different things, ie birth, delivery, where your bladder is hanging a lot lower in the pelvis than it should. That pressure from up above is actually supposed to help kink the urethra. But the bladder has to stay high enough. You want the pelvic floor muscles to hold the bladder up so that when you have this high pressure from up above, like a cough, a sneeze, a jump or something like that, that it does this hug to the urethra. If the bladder has lost that lift, then maybe you're hugging it up high and it's just enough pressure to overcome the pressure, squeeze, and kink of the pelvic floor muscles that are kinking it down below. That would take a pelvic floor exam and somebody who knows how to differentiate that. But a lot of times that lift is the backside, so it's the deep layer of the pelvic floor muscles. A lot of times the cue is stop yourself from passing gas. Use those muscles.

That's easy for everybody. That's the one I always go to. When you're doing the canter to the walk or wherever that is, that's the second thing that you could try, is pretend like there's a microphone at your bottom or something, and you're going to stop that toot from coming out as you're exhaling, which is going to be a good coordination test to see if you can figure that out. You're going to lift that backside and keep the bladder up high and see if that does or doesn’t help.

Emily: Yeah, but I think that this is really good because as with any sport, if you look at the best athletes, a lot of times they're very much in the moment, or they're very internally focused. And I think that that's a testament to when you are, whether it's riding or weightlifting or running, you're there either out of enjoyment or, I guess it doesn't matter, necessity or enjoyment, you are there putting in the time and the effort because it means something to you. And so it's beneficial to just be in that moment and to take the time to realize what your body's doing, because at the end of the day, it's going to make you a lot better. And it's that all those little steps adding up to something really big. You can take five minutes to do work on transitions and your brain and focus on that. And I think that the reward for it will be huge. You don't have to spend your entire hour riding or your entire lesson time doing it, just small steps.

Kailie: If you put in 10 minutes here and there, I think that it would be really beneficial for everyone, especially for people that are dealing with any dysfunction or pain.

And just like anything that you try that's new, it's going to feel so weird. But the more times you practice it, you're trying to build that that reflex that happens. It's supposed to happen automatically. And a lot of times it's postpartum. In postpartum, that coordination and that reflex doesn't happen like it should. You're retraining it to happen. Here's something else I was thinking of. My horse growing up was a half Arabian, so my saddle wasn't that wide versus a horse like a Fjord. They are so wide. Think about jumping jacks or women who have trouble with jumping jacks. The vulnerable position is that spread leg. Something that you can do out of the saddle is work on however wide your horse is. You need to be able to utilize your pelvic floor muscles in that wide, vulnerable straddle. Being able to get into that position or have your pelvic floor PT check you in that position and see what your pelvic floor and body are doing, plus if it's wide enough, you're in a full stretch, which is going to tense the pelvic floor. You might have to do some work on your inner thighs, like rolling them, because just that full stretch is going to make your pelvic floor tight and tense. But you can figure that out. 

Looking at the whole fascia system and the connections, anything that you can do to free up some movement is going to be helpful for the pelvic floor, especially the inner thigh muscles, so roll those out! We talked about your arches, but go into your calf, go into your inner thigh all the way up to your pubic bone and free that up. If you have a really wide straddle when you're on your horse it could be very helpful.

Emily: Yeah, that's great advice. That's really something that I don't know that I've ever even considered, but it makes sense that you test in the environment or as close to that environment as you can. So like you said, having your pelvic floor PT check you when you're in that position because that's the position you're in when you are either, like you said, they're tight or or leaking or anything. 

Kailie: Yes. And how many of us or other people, if we're going to cross our legs and get our legs as close as we can. And so that's just that's why I say it's such a vulnerable position because a lot of times you're not seeing somebody sneeze and do the splits. It's just so far.Maybe you're going to do sumo squats or something really wide to train that really lengthened position. It's important to do that outside (out of the saddle) work.


Emily: Okay, well, we'll move on to the next question. I wanted to find out, I think this is super important, what does a virtual appointment with the PT entail? So you do both in person. I know you see a ton of patients in person, but you also, I've done a virtual appointment with you before.

The person who asked me this question did so because they do not have a public floor PT that's even close to where they live. I mentioned they should try a virtual appointment, and they said, I didn't even know that that exists. I thought we would talk about that.

Kalie: I think virtual appointments or consults are so great for the rural community because, like you said, pelvic floor PT may not be close to them. A lot of what I do anyways in person is education, just like I'm doing right now. The more you know about, Oh, I didn't know the pelvic floor did this when you breathe. A lot of it is education. The biggest part is the education and triaging like, Oh, yeah, I think education and you trying these helpful tips or rolling out this or that would be helpful. Then, no, I think you need to find a pelvic floor PT who can do an internal assessment. It's that triage and getting them that education right away of what's going on and practical helpful tips they can do right now today. That's a lot of it, is the education and some practical, general tips like I'm giving you right now. And then go see. And sometimes that's all it takes. That's pretty much all I do virtually. But I think that is so key, the education piece and then, hey, I'm looking at your posture. How about you try this type of posture, or roll out? 

I think that we don't realize that the positions that we're in all the time every day affect us so much until you go to roll out and you realize, Oh, my gosh, the back of my neck is really tight. And then you roll out your neck and you think, Okay, well, then maybe my shoulders are okay. And you roll out your shoulders and your shoulders, you can feel the points that are sore or tight. And then all of a sudden you go down your whole body and you realize that your whole body would benefit from being more consistent with the rolling out. Well, it's so easy. It's that education piece of this is why your body is just remembering this position and you've got to get strengthened. You need to get the stuff that's really stretched out, tighter and stronger and the stuff that's really tight, lengthened and open. 

Because of where our organs are as well, like most people have a tighter right side than their left, just because of where organs are placed.

Emily: Oh, that's really interesting. Well, actually, that leads into my next question. So this is something that I really want to bring up because I don't know that the majority of the population knows a practitioner like you would exist for it. So the question is, what is visceral manipulation and how can it help athletes, women, equestrians? I mean, the list goes on.

Kailie: So visceral means organs, the viscera. Those are organs like your heart, your lungs, your liver, your spleen, your intestines, uterus, all that. And then mobilization is movement, getting things to move. Something that I've been trained on as a visceral mobilization specialist is from a physical therapy standpoint. The way that we move and we see bodies as muscles and joints and you're going to move this way or that way, it's not just muscles and nerves and bones affecting that, it's your organs also have to move. They've studied this and they know that, for instance, when you inhale and I was saying everything moves down, they know that the kidney is supposed to move down three centimeters. That when the kidney is not moving well because maybe you've had a kidney infection or you fell on your back multiple times off of your horse.

The psoas, the hip flexor muscle is really close to the kidneys and it will protect all major organs. If you have blunt-force trauma, it's the liver, it's the spleen, it's the kidneys, they're on your backside, and the psoas will wrap around and protect because if you lose one of your major organ, you die. What can happen though is afterwards, the psoas is staying tight. I'm taking the kidney, for example, isn't allowed to move down the 3 centimeters as it's supposed to. What I will see when I'm testing this on my clients is a lack of hip extension because the kidneys can play a big part in that ability for you to extend your hip. That's what we were taught in one of our classes, is to check hip extension. If you know there's a history of a fall or kidney infection or something like that, and maybe they haven't responded to traditional physical therapy where they're ruling out musculoskeletal things, then I can perform visceral mobilization to the kidneys. What is important to know is that you're connected via fascia over all of your organs.

There's visceral fascia and connective tissue. Unless you've been cut open, it's continuous and there's no beginning, there's no end. Just like if you were cutting the skin off of chicken, there's that white stuff that's connective tissue. We're using the major organs as a handle. All the organs have ligaments and connective tissue and they connect to each other and they slide and glide and move over each other. We're just checking to see if the movement is there or not. We're trying to restore the movement of the attachment of ligaments and connective tissue from the organs onto each other. A lot of them hang off of the diaphragm. Like the liver hangs off the diaphragm and that weighs 2-4 pounds. That can affect breathing and the kidneys roll over the liver. The right kidney rolls over the liver when you do a forward bend and touch your toe. There's just these movements that happen via the ligaments and these heavy organ attachments. If organs aren't moving well, then a lot of times they're not getting good blood flow. With organs, they have referral patterns.

Emily: Oh, wow. 


Kailie: They have referral patterns to the frame of the body. The most common one is when your heart is not getting enough blood flow, it refers to your jaw, to your shoulder, your arm, your scapula. When you have pain from the organs, it's very broad in general. It's like, I hurt here versus if it's muscular or something, it's like, I hurt there, and you touch it and you can reproduce it. With kidneys and liver and all that stuff and the heart, they refer to the body. We call it the somatic frame, so the joints and the muscles and stuff like that. But the most common one and the most famous, I guess, is the heart. When it's not getting enough oxygen and blood flow, it refers to the arm. But the liver refers up to the right shoulder and neck. The colon, the large intestine can refer to the SI on either side. If you're constipated and things aren't moving there, you can have sacral pain, you can have back pain because the large intestine goes right along the back, the spine on either side. Rib pain could be coming from stomach or liver or intestines that are right underneath the skeleton or the rib cage.

That's how I'm doing visceral mobilization and how I was taught as a physical therapist is to look at, Oh, you're having right hip pain or shoulder pain or SI pain, and you've gone to a physical therapist and they can't quite get you all the way, I'm looking at the organs and why they're being protected by the brain and therefore not moving. And usually it's because there's a fall in the past.

Emily: Yeah. Yeah. And so this really speaks to me because I feel like this is... Well, the majority of equestrians are women; amateur riders that are women. And then falls are part of it. I mean, that's an unfortunate part of it. And iI think that we have all of our protective gear on and everything, but it still doesn't take away the body's natural response to the protection and everything. So that's super interesting that it does that. I mean, it's amazing that our bodies do that.

Kailie: You're just going to lose range of motion. So there's going to be an asymmetry right to left. I'll check the left hip and the right hip for extension. And you're like, Oh, that left side moves a lot, and this right side is being protected and it's not moving. Where is that coming from? Oh, you had a fall on that right side or whatever. You're trying to find out where the body is protecting and see if you can get… My instructor said you're just having a conversation with the brain. If the brain thinks that there's danger, it's going to protect that area. We're just having a conversation saying, There's no danger. We need this kidney to move on the right side, and then all of a sudden you get this of hip extension, for example. It can be that fast. Wow, that's cool. Or if you've ever ridden Western and you come down onto the horn, there's a lot of groin injuries that have happened, and then there's going to be this protection. Maybe you think it's like ovary pain or ovulation pain, but it's coming from a uterus that's not moving or endometriosis in your past or something like that.

Emily:So adhesions or anything like that. 


Emily: That's where my mind went-I know a lot of people and myself included that have had a C-section and I know that that fascia impacts that, or that impacts the fascia. And this wasn't one of our questions, but the one that I've seen in mom groups that I'm in is the C-section scar, pain with with it, or burning, or itching. It just seems like it's very common that there's something about the rigidity of their scar that really bothers them.


Kailie: Yeah, and that's one, or like a patient with two C-sections and a hysterectomy, and they've never been touched, that incision has never been touched. And then there's all these areas right around that aren't moving well, and it's just angry tissue that's not getting blood flow, it's not getting movement. Movement. You can have C-section scars or abdominal surgeries, you lose a lot of that trunk extension. So being able to come backwards just because you're being held really tight there. So doing a lot of mobilization to that area. The bladder is right under that C-section scar.  It's just important that that is worked on afterwards so that you don't have any bladder urgency, leakage could come from there, just the bladder not moving well, the uterus not moving over the bladder. If you do have a uterus, as the bladder fills up with urine, the uterus is supposed to come up and off the bladder so that it can fill up. If you have a sticky uterus that's not moving nicely, then you're not going to be able to fill up the bladder as much. You're going to be having increased frequency to pee, maybe some urgency every time your bladder fills up because this uterus, that C-section it's tacking down the uterus and it's not moving well.

That's another thing that a visceral mobilization therapist can do.

Emily: That's really cool. I actually know quite a few C-section moms that have said that... Well, there's two things that I hear that I've heard the most with C-section moms-where it feels like they have to go to the bathroom a lot, like their bladder can't fill up. And then the other one was painful sex. And is that because of the uterus not being able to to move is that- Yeah.

Kailie: So the uterus, when you have sex, the vaginal tube, this tube is supposed to lengthen and the uterus moves. The uterus has a muscle and it contracts. When you have sex, the uterus is supposed to contract from the base to pull that semen up. Then the reverse is supposed to happen when you are going through your period and the uterus contracts from the top down. If the uterus, these uterosacral ligaments that attach to the sacrum are not moving well. If the uterus isn't moving well, then you can have that back pain. The sacrum and the uterosacral ligaments are supposed to attach, so you can get the back pain. But if those aren't moving well, then maybe the uterus isn't contracting the way it's supposed to with sex, with menstruation or with bladder filling. They're like this inside the bowl. 

So it makes a lot of sense as to why there's some things that can happen after you have a C-section. I know that there's different things that can happen with modes of delivery, basically. But it does seem like the majority of people that I know have had C-sections, those are the two issues most commonly.

Emily: And that makes sense that things might be a little sticky from the surgery. I mean, it's again, our bodies are really super smart, and it sounds like they're just trying to, at the end of the day, protect us from further injury. Okay, so we are close on time, so I want to make sure that I... get the last question that we have is: “I'm worried about how menopause is going to affect my pelvic floor, so my riding, and my athleticism. Is there anything I can do?”

Kailie: Well, menopause and then early postpartum, you lose that estrogen. And estrogen causes plumpness and things to stay up and lubricates things. When you lose estrogen, you lose the plumpness. What happens to your face is happening down in your vagina. With menopause, what you're going to see if you don't have estrogen on board is going to be decreased lubrication of the vaginal wall. You're going to have less blood flow to the area as well. That blood flow is important because it helps with the kinking of the urethra, so leakage increases. The urethral wall and mucosa, I don't have another word for that, but just the lining changes because there's not estrogen. Your risk of UTI’s or bladder infections goes up. You're going to lose lubrication in the vaginal wall, and so sex could be painful. When you lose that lubrication and plumpness of the vaginal wall, you may have always had a prolapse, but it's that raw feeling and the change in the lubrication from the estrogen and the plumpness of the vaginal wall to where prolapses are being felt felt or that heaviness or fullness or feeling like your insides are coming out is being felt more down there because it's like having really chapped lips.

Let's say chapstick is the estrogen, well you would never open your mouth really big if you're so chapped. But down there, that's exactly what's happening if there's not that chapstick, so to speak. It's painful. It hasn't been moisturized from the estrogen. Then you're just going to feel more prolapse-type symptoms. I know there can be a lot of debate about topical estrogen, but I think it's something to consider is a topical topical estrogen, so discuss with your doctor about that. It's topical, you're getting it right where you want it. It's not going systemic and through your body. You may not need estrogen. There are other things, there are other hormones that you can put on there topically that can help with the bulkiness that estrogen will give, the lubricating effects. That's the reason why in menopause, all those changes happen. Not only bone loss and loss of muscle, but just estrogen does a lot for the continent system, so helping you not be incontinent, and the pain that can happen with sex because it's like, Oh, you're not fertile anymore.

Those are things that are happening specifically to the pelvic floor and the organs down down there. The things that you can do right away or right now to prevent some of that is the strengthening of your pelvic floor because you do lose muscle strength every decade of your life starting in your 30s. So the stronger you are, the better.  And impact will help with bone density, so walking and running and jumping and stuff like that really helps you maintain strength. 

I think that if you're in menopause or close to it, that means that you not only do some strength training outside of your riding, I mean, you continue your riding, but you add on a routine that keeps your muscles and bones engaged and as strong as possible.

It is overall keeping a base level of strength is what will help you maintain over time your, I don't want to say, fountain of youth, but in terms of if you have a strong base or a strong foundation of all the other things, we can face the challenges that come with life. We can't avoid avoid menopause, it’s just nature and and biology, it's one of those things where the more you know, the better. 

We know that every decade of our life, starting in our 30s, we're going to lose muscle. So for women, it's important that we have a strength training program. And it doesn't have to be these ridiculous weights. You just need to be lifting some weights. I'll say functional weights, whatever you need to lift, a bale of hay, a dog, dog food, those are functional weights that you're going to be lifting. Just continuing to do that because it's coming. 

Emily: That was a very interesting question because I'll turn 40 soon (at the time of this interview). And I'm not planning on having any peri-menopause or anything yet, But it's almost like the missing thing in women's health that nobody talks about right now. And it frustrates me because if you look at women in their mid 40s, 50s and 60s, we're at the highest income level. We are a huge part of the equestrian community. We have, I think I said income, but disposable income. And I think that that's really broad across a lot of other industries, is that we have the ability to do a lot of things and make a lot of change. And the older you get, the more you almost disappear. Nobody talks about menopause. And I think it should be something where it's like, hey, these can be like really great years of your life. You just have to take care of yourself. You can be the equestrian that you want to be when you're in your 40s and 50s, you just have to advocate for yourself and take care of your body. In some ways, I'm a better athlete now than I was in my early 30s because I actually have to take the time to dedicate myself to it, and I'm more responsible about it.

But menopause is still not talked about or even perimenopause. And it's just like, okay, well, if you're lucky, if you're blessed to live that long, then you're going be affected by it. And I got the question, I thought, Oh, yay. Because I hadn't thought about asking about menopause and how it relates to somebody that sees themselves as an athlete.


Kailie: Yeah. And I worked in the nursing home and geriatric population for nine years. And I could count on one hand how many of the older ladies didn't wear a brief or a pad. They all leak it's just this given like, “Oh, well, you had babies or you're a woman,” But in the geriatric population, the number one reason for them not being able to stay in their own home and having to go into a nursing home is incontinence. What happens is they fall on the way to the toilet and they break a hip in the middle of the night, and then they can't go back home after they have their hip replaced or whatever. It's not just like this funny thing that we're chatting about. This is the future. This could be our future. Working on it now, working on strength and balance, the one test that all geriatric people should do is to get out of a chair with very minor use of your hands. If you can't do that and you're older, that increases your risk of fall substantially. It's just these little things that we're talking about like, Oh, we're in our 40s now.

Can we just maintain athleticism? But what we're talking about also, when we get into that geriatric age group, we're talking about independence and being able to live at home. And so it goes much deeper than just our athleticism changes as we get older, and it's just daily activities. Being able to get out of your chair without using your hands. We take that for granted now, but the statistics are we lose that as we age. I just find that mind-blowing. We lose the ability to stand up out of a chair without our hands, and that increases our risk for falling. Falling. And that could be the difference between having to go to a nursing home or not. I know that's a big tangent, but.

Emily: No, I love it. I think it's ust if you want to be independent, if you're an animal owner, if you want to be able to live at home for a long long time, with your pets and take care of them on your own, or if you want to be one of those people that rides your horses like Queen Elizabeth when you're really old, you better work to keep your strength. If you're an equestrian, you're active, cleaning stalls, stacking hay etc. We have to maintain that.

Kailie: Speaking of stacking hay-figuring out what your go-to is, what your go-to strength is, your dominant strength, and doing it the opposite. Bucking that bail with my left foot, with my left knee coming coming up, the more variety you have and the more strength you have, if you lose that right leg strength or whatever for some reason, if you've already been training the other side and you can do things five different ways, that's only to help you be harder to kill. I've heard that. I heard that statement. It's like the more variety you have, you only have one way to do everything, then you're screwed if you lose the use of your right arm or something. Having variety is something that I'll tell my clients to figure out because it will be working on your weaknesses. I love working on my weaknesses and figuring out what I'm not good at, because then it just makes me stronger and more resilient in the end.

Emily: Yes, that is very interesting. I broke two of my fingers falling off my horse a couple of years ago on my left hand (requiring surgery) and I'm a left handed person, and I am totally useless with my right-hand. It was hard but I came out of it better because I had to learn that. But, it was very frustrating to have to depend on the one side as my dominant side, because I basically had a club hand up to my elbow for a long time. So yeah, that definitely resonates. 

Kailie: I think you're spot on that if you train both sides to be proficient in certain life things, then it's going to end up being beneficial for you with that strength in the end. And a lot of people who have a dominant side, that's their dominant side and it functions better. So if the horse spooks and goes to your non-dominant side, then maybe you're going to be off your horse that way easier. It just makes sense because you don’t want to be saying, my horse can only go this way because I'm really on my right right side. It's going to take that one time that it's going to go the other way and you're completely weak on that side. Train both sides. I like the functional aspect of it, and especially if you live on a farm, bucking bales is great or carrying gallons of water. If you always put it on your right side or always use your right leg to buck that bale, do it on the other side and that's your exercise.

Or raking or mucking things. Raking. Are you only doing it with one side as opposed to two? It's completely awkward and it's not efficient. But if you're like, Okay, I'm going to do this section with my left side, you get rotation, you're getting different abdominal muscles, you're getting a different side of your brain. Just make it so that you don't have such a blaring, weak side. It's only going to help you for the unknown. When your horse spooks and it goes to the left and I'm off the horse because I am not as strong on my left side. 

Emily: That is a very interesting point. I would love to know if that's the thing, and now I'm going to be thinking how often riders fall off on their non-dominant or weaker side. 

Kailie:I bet you can figure it out because as you're going forward, make the horse go right, side step right really quick or something, make it left. Which side did not feel comfortable? Train that side. Rotation is always the weakest for postpartum women. It's going from the side while vacuuming. It's that rotation that’s your weak side and you can figure it out. 

Emily: That's very interesting. If somebody does find out that they have a weak side, say their weak side is they notice it in their abs or in the core. What's something that somebody can do if they notice they collapse (in the hip or shoulder) one way over the other? 

Kailie: Because I was talking about this earlier with the way the organs are, most are going to have their left side be weaker. The one exercise I love giving is a plank on the left side, which means your left side is closest to the ground. Side plank on your left. There's a statistic, but most people are going to be be weaker on their left side because of the way the organs are in your body. Doing a left side plank where your left side is the closest part to the ground is going to be very helpful for you.

Emily: Okay, cool. That is very helpful. Well, I think that that was our last question. Thank you so much, Kailie. I appreciate it. 

Kailie: I love talking about all things pelvic floor. 

Emily: How can people reach you if they want to either make a virtual appointment or if they want to follow you?

Kailie: You can directly DM me @herphysicaltherapy on Instagram or I have my website I can also help if you think that you need an internal exam, I can help find you a PT or the closest one in your city and look through and see if they have what you think that you need.

Emily: Perfect. Thank you.