Thinking Of Your Body As An Integrated System with Claire Bernard Miller, DPT | Koopcast Episode 146

what's up trail and ultra people I am Stephanie Howe and I'm filling in for Jason Koop who's out traveling the globe right now on an athlete project I'll be here for a few episodes talking to you with some really exciting guests lined up today I have a good friend of mine Dr. Claire Bernard Miller she's gonna talk to us a little bit about common injuries in runners and how thinking about it from another point of view might help us to overcome these injuries and not just treat the symptom I've personally learned a lot from Claire over the past couple years working with her as my physical therapist to learn some more about my body and how my feet are kind of the Achilles heel if you will of most of my problems it's been really great to to learn and to be able to troubleshoot and think of ways to to fix my issues or to help my issues in in a different way Claire is full of information and has gone through a lot herself as a runner so she has the professional background as a doctor of physical therapy but then also she's a runner she's been injured and she understands what that's like Claire is the founder owner of her practice in Fairfax California activate

wellness and physical therapy and she's also a virtual practitioner for gate happens which is a clinic based out of Colorado that focuses on the feet and the gate and treats endurance runners of all sorts but particularly runners and so today we'll talk through some of those things what Claire has learned how she approaches injuries how she approaches working with runners and hopefully you'll learn something I learned something I always do and I hope you really enjoy this conversation so sit back and grab a notebook and a pen and get ready to learn a lot from Claire hello hi how are you I'm good I'm great how are you I'm good we're talking on opposite coast right now I'm over in Maine and I'm over in France so we have a close time difference going on I'm in the dark in my backyard and yeah it looks like it's midday over there yeah I'm in my in-law's house in their living room and uh it's a nice like 60s ish outside versus the heat wave in California right now yeah we're both from the bay area and they're experiencing a heat wave over 100 degrees so I think we're both very glad not to be there right now yeah yeah for sure so Claire really excited to talk

to you today and learn a little bit um about just what you do how you can help runners um but before we get into that let's just go through an introduction um so where are you from uh where did you go to school what got you into physical therapy cool yeah um so my name is Claire Bernard Miller I grew up in Cincinnati Ohio um and then I moved to DC for college I went to Georgetown um and then I met my now husband there we moved out to San Francisco um in 2013 and then I went to PT school at UCSF and uh now we still live out there in Fairfax California um yeah so we love Fairfax and uh I started my own practice uh kind of in the heart of COVID um I left my job at a pretty high-paced outpatient orthopedic facility um and went out on my own and now my practice is activate physical therapy and wellness in Fairfax California yeah yeah very very cool and it was very excited for you to take that leap it's it's a big thing to to start your own business uh especially in the middle of COVID yeah yeah it was definitely a leap um I knew that I always wanted to um own my own business and do my own physical therapy practice

um but I probably wouldn't have thought I would do it in 2020 but um COVID was kind of the impetus to do it so um that was one kind of highlight that came out of COVID for me so defining so let's let's pick up a little bit and um talk about just your I guess you said you grew up in Cincinnati and you went to Georgetown and you were an athlete as well and so you've been a runner um and you run cycle swim now um but talk a little bit about your background in sports and how that maybe brought you into uh what you do now sure yeah so I'll start back uh in like elementary school I well actually before that I dabbled in lots of sports I did like figure skating um I also played cello not not necessarily an athletic activity but um then I did soccer um and then going into so my um high school it was kind of like a middle school high school so entering seventh grade I missed the soccer tryouts um because we were on a family vacation so one of my friends said hey do you want to go to this cross-country uh practice and I was like yeah sure whatever and we ran around a um a cemetery and uh and yeah I just kind of was hooked from there so I joined the cross-country team in seventh grade um and then I did it through high

school um and then I did the club team running at Georgetown for a little bit and I met one of my best friends um through that running club um and then Levi my husband ran for the Georgetown team um so running's just been a big part of my life part of our life um and then through my own injuries is how I came about to find physical therapy and the amazing things and impact physical therapists can have on people um which really inspired me to get into physical therapy myself um and then through my own injuries I've also found uh really a passion for other sports I mean running's always going to be my love and my life like that is what I would do every day if my body could handle that but I've also been able to find like a love and a camaraderie and like a social um community around cycling and swimming too so um I don't do them all together I'm not a triathlete but I do enjoy all of those three sports yeah yeah I love that and I really love that you have been injured before I mean I'm not happy for you that you've been injured but I think it makes you understand and it makes it more you know like when you learn things you can be really book smart and you can know all the science and all the research

but if you haven't gone through it yourself that's like a whole different different arm of uh of working with someone and so having been injured yourself and really finding your passion in helping people to to get back to their sport um and maybe find sports that support their body I think is is a really important thing and and really cool I think it makes you more relatable and you're able to apply all of your knowledge uh to people because you've been there yeah and I think I use myself as like uh um an experiment or like I I just I delve into the areas that I've struggled with my on my own and use that to help other people so like my kind of I would say I'm ever evolving in in the things that I'm interested in but the things that have kind of stuck with me um and and also because of my own injuries have been like the pelvis and the foot and the ankle um and through my those are those have kind of been like the two biggest injuries that I've dealt with um but through that that's really kind of like guided my career along with pregnancy and having a baby um to to really dive deep into those areas and help other people yeah that's that's a great segue so let's talk a little bit about the foot and gate happens and I personally have learned a lot from you about myself and um a lot of other

runners I know have learned so much about thinking about injuries in a different way or how things start from the foot and work up so uh let's talk a little bit about uh gate happens and how did you well what is it to start what is gate happens yeah great question so gate happens is a um a company started by Courtney Conley and Jen Perez and um they're two chiropractors out of Colorado um and funny and so so they've actually created their business on Instagram and and they're working to to kind of reach a larger market but um they help people from all over the world so I joined um their team probably like a year and a half ago treating virtually um and so we treat people from all over the world which is super cool like I'll get on a call I mean just like we're on a call now across the world um similarly I'll get on a call with somebody in Hong Kong and talk about their foot and watch them walk and watch them move um and look at their range of motion their mobility their strength and uh then give them exercises so it's it's really cool um the way that uh these two chiropractors have set up this business um and not only do they do virtual consultations but they give so much free information out there through Instagram which is kind of weird like I never would have thought

Instagram would be part of my um like job which I'm sure a lot of people say but like me specifically I'm horrible with social media um and this company has grown through that um and so they so if you go and follow them on Instagram you just find out it's basically like lower body health so we say both we look from both the top down and from the bottom up so if somebody's coming up to me with big toe pain we can't just look at the big toe we have to look okay what's the driver of the system what's the stabilizer of the body like how is the core and pelvis functioning um and how is the foot functioning um so that's kind of like a big overview of gait happens um and then they also do courses so courses for the general population so you could go and just do their foot health 101 course and just learn a little bit about overall body funk lower body function or if you're like a healthcare practitioner they do continuing education courses and they just started um an in-person course uh this year it's called functional gait assessment and I actually had the opportunity of teaching that course in July um and I'm going to teach it about two or three times in 2023 around the country um which is super exciting um but so that course is for healthcare practitioners and you learn gait assessment so then

you can take all that information and help your clients yeah super cool information and I love the videos um and learning just about how different things in the foot like things that I haven't even thought of probably a lot of runners haven't even thought of um are important for our ability to run so like uh for example big toe flexibility for me has been something that I really struggle with and not really connecting that that's why I have some issues that I have so I really like the the Instagram account of this you know simple exercises and just connecting some of those dots um I think is a really great resource for so many runners and like you were saying the the virtual consultations that's another really cool thing that we have that maybe you know a few years ago wasn't so much of an option but working with someone um you know across the globe watching them walk and being able to help them troubleshoot I think is a really cool way that we're expanding our access to um providers who can really who can really help us and who are really experts in the field so how did you um first get introduced to get happens did that come through a personal like injury like seeking them out or was it something professionally that you guys connected it was um it was both actually so when I was at my former job I was treating a girl a high school girl um dancer and um she had a neuroma which for those

people that don't know it's kind of like a irritation of the nerves between um some of your toes um and so for dancers it's common because they're you're just wearing like really narrow toe like your belly shoes or your pointe shoes or the dance shoes are so narrow and you're up on your toes and so it can get really irritated um and so I was doing the things that I knew from PT school to help her and it was like okay it was like just getting her by and she would come in and it would be a little better but then like we never really got anywhere like we were just kind of treating the symptoms and not the actual cause um and I just got kind of frustrated like I would then pass her off to the aid uh and just not really like I just didn't have any exercises to give her that I actually thought were helping so then I started looking on Instagram for for other ideas and that's when I came across skate happens um and then it was very eye-opening I was like wow I don't know any of this stuff and and I feel like I should um and so then I just started following them um they were hosting a course in LA this was before COVID um and so I went to one of the courses um and then I sought out Courtney um for my own foot I fractured my calcaneus and so I tried to um treat myself and did a lot of the stuff that I knew and

then I had learned from them um but I kind of had like a big setback we did this like brick project and I like rebroke my foot by lifting too many bricks um and so then I I sought her out for a virtual consultation um and also wanted to see like how do these virtual consultations work um so yeah I kind of connected with her there and then I and then I joined their um it's called a gate guru membership um where that's healthcare practitioners it's also an amazing uh thing that they do as well where um any healthcare practitioner who's interested in this kind of stuff can join this membership and they do monthly zoom calls they do continuing education um so I did that and I basically did like all of their different courses I was just really interested in all of it because I mean I think we me as a healthcare practitioner will continue to learn like throughout my career um and I love learning about things that I don't know about and that I like very applicable to the patient population that I see um so I yeah I did their um their courses and their membership and then they reached out to me um saying that they were looking to hire another virtual practitioner um and asked if I would be interested so uh they hired so it was Jen and Courtney and then they hired myself and a woman Aaron out of um Ohio um to be two more

virtual practitioners and since then they've hired two others from North Carolina as well so um it's cool to see their company growing and it's really cool to be a part of it um and I've learned so much through them that has also helped my own practice and I think what's another wonderful thing about Kate happens is that they really want to help promote my own business and Aaron's own business and everybody pretty much I guess all six of us now have our own businesses and um they're they're trying to help bring people into our doors because they all do virtual if somebody's in the bay area and they want to see me in person they come to my business um I also do virtual through my own business um but they kind of really promote like people coming in person to my business in Fairfax yeah yeah that's really cool to work synergistically and I love that um I mean you know you learn so much when you go to school like I've gone to school um for a long time as well I have a PhD and you learn so much but there's so much that you don't know and you realize that the more you learn the less you know and so searching out more knowledge and how can I help people more it requires things like that and like I said earlier it's just really cool that we have the opportunities to connect in those ways so that we can be uh the best we can to to help uh other people so I'm curious um so a runner comes to you um or comes to

gate happens and they like I'll just use me like my my Achilles is bothering me and I really want you to look at my foot I want to figure out what's going on so what does that process look like how would a runner who wants to connect with you or with gate happens like what would that process be like yeah so I'll give an example so great example of the Achilles I actually just treated a guy yesterday virtually um through my own business um so he just found me um and signed up online and so if if you're if I'm treating you virtually I have you send me um videos of you walking and running if you're a runner running um both walking barefoot and then running in your normal running shoes from like a side view and a back view and a front view um so I can just see how you move and then I have you send me pictures of you standing and then like a close-up of your feet from the front side and back um so I can kind of get an idea of what does your overall posture look like and how do you move before we go into like a virtual consultation if you come into me in person I do all of that in my office um and I'll oftentimes throw someone on the treadmill but there's actually quite a few number of people that like have no idea how to walk on a treadmill so I'm like do you feel like you're walking normally and then if you're like uh not really I'll just like have them walk

outside um which is pretty funny but also understandable because like there's a good number of people who have never been on a treadmill before um so anyway so yeah I'll I'll have you I'll see the way that you move see your posture um what's a benefit of coming in person is I can feel um like your the joints or the soft tissue of your foot of your achilles um and and then I'll I'll do um an assessment of I oftentimes love to look at people's heel raises because that gives me a good um indicator of how strong your gastroc your soleus is your posterior tib how well you're able to supinate and pronate your feet I think one um area where um kind of like popular media has give done a disservice at this point is thinking like pronation is bad pronation is not bad and supination is not better pronation and supination are very normal parts of the gait cycle we need both and we need to be able to control both um so that oftentimes will um have to do with like an achilles problem um bunions are a lot of um things that I see um neuromas a lot of like I mean forefoot injuries are actually the most common injuries um maybe not in runners but just in the general

population and that's actually because of our footwear because most of our modern day footwear has a like a narrow toe box and so that's just cramming your toes into a bad position and that's what leads to most bunions um most forefoot injuries um but kind of going back to achilles um achilles depends on if it's mid belly or insertional achilles tendonitis um and that will kind of lead to two different paths of how to treat it and then um because I know your feet very well um we'll talk about like a rigid foot type so rigid foot types are called pes cavus foot types and I have a similar foot type and those are um like feet that like people think like high arches or like like a good arch um you don't have a problem with supination but it's harder to get you to pronate so that's where a lot of like lateral insertional achilles tendonitis will um come about or hagglin's deformity or any sort of like kind of lateral injury up the chain so think like it band things like that um a lot of a lot more lateral issues because if this is my foot and this is my heel I'm just like loading the lateral side and you're not able to get to the medial side of the foot pronating is

pronating I think this is probably good to um explain is where your arch is lengthening and supination is where your arch is shortening so um yeah so then I'll uh what did I say I said look at heel raises look at big toe range of motion look at dorsiflexion range of motion and then kind of do like a muscle just a general muscle screen uh and then look at hip stabilization core stabilization um we can't just look at the foot we have to look at what's driving the foot as well that's a very general yeah no that that's great and it's it's good to hear because I think people are curious about how a virtual consultation would work and like how you actually can see and I I think that's you know you you can see everything you need to see from a video and photos and watching the body move I think is um you know key to to learning about a different body and and what it needs um I'm curious if you have any recommendations or just anything uh runners can think about for their feet so say I don't have an injury right now but I want to make sure that I'm I'm doing the things to prevent an injury so are there certain things with the feet that you can do to just be proactive about um keeping your your feet healthy or things that tend to be I don't know if they're they're tight or tend to be stiff in runners um what would you recommend yeah that's a great question so I think overall foot strength is really important so uh one thing

I didn't mention uh about like when somebody comes in is most of the time I check like what does their foot intrinsic strength look like so foot intrinsics are small muscles that start and end in your feet so we've got so many muscles in our feet and most people don't even know the muscles um and so I like to test toe yoga so toe yoga is where you lift your big toes up keeping your small toes down and then you switch can you push your big toes down lift your small toes up so there's varying degrees of ability to do this some people cannot dissociate their toes at all so that's just a great place to start so even if you've like and it's kind of like a brain game too your brain is telling your your toes to move and some people can't move them at all so so that's when I'll have somebody okay just use your hands one hand is pressing down on the small toes the other hand is pulling up on the big toe try to hold that okay then switch and so and some people like use their fingers to do it while they're moving their toes um oftentimes you'll have one side that's easier to move than the other and so then I say okay use your stronger side to teach your weaker side um and so that simple exercise of just dissociating your big toes from your small toes um is a great intrinsic foot muscle strengthening exercise and then to get more picky about it if you're able to move your toes without

your hands helping um don't let the rest of your foot move so don't let your foot pronate as you're lifting your small toes up don't let your your small toes scrunch into the ground as you're lifting your big toes up so there's like varying um abilities and kind of like um degrees to which you can work that exercise and that's a really easy one to do you just have to have your shoes off you don't need any equipment um so that's foot um control and then um I think soleus strength is a really really big uh need in runners so your soleus is your deeper calf muscle it makes up two-thirds of your achilles tendon and it can take up to 11 times your body weight when you're running so soleus strength um so the way that you would target your soleus is a bent knee calf raise so if you just think of like a heel raise a calf raise same thing a straight leg is like what people normally think about so you're lifting your heels up you're going on to the balls of your feet you always want to think about pressing through your big toes because your big toe provides 80 of stability in your foot and your ankle there is a reason why your big toe is a bigger bone than your small toes we want to access that big toe bone so um to target the soleus you would bend your knees a good amount so you could

either do like a bent knee calf raise or I love to do wall sit calf raises so if you think about a wall sit like most people think to go down to 90 degrees I have people go into a shallow wall sit so we want to target the soleus and the soleus is targeted by 60 degrees of knee flexion so if you think about your knees bent at 90 degrees for a normal wall sit you would go to 60 degrees so it's more shallow that's kind of like this angle I don't know if people can are watching this but um so just a shallow wall sit and then you're holding that and then you're lifting your heels up and slowly lowering and a lot of people will shake their legs will shake right away as they're lowering um and then you can load that up by holding weight on your thighs and um so you really want to load up your your um soleus so that it can withstand all of the impact forces in running yeah I'm smiling because uh these are two things that I have done and I struggle with the toe yoga for one I am one of those people that would just like it's like rubbing patting your head and rubbing your stomach at the same time I just like it's so hard for me it's like mental focus and I definitely use my hands just like yeah like my toes will follow my hands um but it's such a good thing to do and then those uh soleus calf raises um also just incredibly hard so I think you know and I I'm I've been a runner for

most of my life um and I've run a lot and that's super challenging for me so it's it's sometimes we always think we don't always think but a lot of times we think that training and um running hard that's going to make us a better athlete but if we don't focus on those little things the foundation slow down take your time work on your work on your imbalances um you're missing out on a lot and potentially missing out on something that could uh prevent an injury in the future so I I really like this is good for me to hear right now because I have not doing my heel raises which I'm going to promptly do after this call um but uh yeah that's that's really I think a lot of people can do both of those they're very simple um especially the toes you know you I think it's easy to ignore your feet um shoes and you know we don't they're not like a muscle that gets sore that we massage and um there's so many things that they can uh that I guess there's so many things that can go wrong because the feet are are not functioning they're not absorbing or they're not controlling uh movement like you said yeah exactly what you just said um not only for injury prevention but also for performance like if you can access that powerhouse that soleus muscle like not only will that benefit you because you'll be able to run more and without injury but you'll be able to perform better which I

think a lot of people want as well yes definitely um so let's change topics just a little bit and talk about your other area that you've been focusing on which is um the pelvis and I I think that's kind of something that we we know the word people know what a pelvis is but they don't really understand how it's related to running and I think um you know what what why is the pelvis important um and like what we can talk about it in in terms of like postpartum and pregnancy but also just for every runner I think can benefit from learning a little bit yeah yeah so why is the pelvis important so the pelvis I mean it is a it is a big part of your skeletal system um and it's kind of like what connects your legs to the rest of your body pretty much um and everybody has a pelvis um your pelvis is part of your core canister a big part of your core canister and so we've talked about the feet and the importance of foot strength and calf strength but your pelvis and your core are really the big stabilizers of your body so if you don't have a strong stable base your legs can't move with good mechanics so I would say the the pelvis and the core is where you have to start so if somebody comes

into me with like a foot problem but their core control is they have none we can't we can't get anywhere with the foot unless we have we can work on their their pelvis and their core stability first so it's really like the driver of your whole body and so what does your core consist of it consists of your respiratory diaphragm on top your pelvic floor on the bottom your deep abdominals so your abdominal corset so that's your deep abdominal muscles and some small muscles in your back and then what what some muscles that are often forgotten about are the deep hip rotators and they um I wish I had my pelvic model here but um they you're the deep hip rotators help suck the femur into the hip socket and also support the pelvic floor so your pelvic floor is a bowl of muscles that sits on the inside of your pelvis um and it helps support your bowel and bladder function um and also supports all the impact of uh the forces when you're running so um your pelvic floor works with your respiratory diaphragm to control your the intra-abdominal pressure so it works with your respiratory diaphragm so when you breathe the two muscles are working together so um so those are those people that can't see your um your respiratory

diaphragm is a dome um and if you think about your rib cage it's kind of like the um it's like an umbrella and then your pelvic floor is like an inverted umbrella it's so there's two um semi-circles um and so when you're breathing in your um diaphragm contracts down and your lungs fill with air in order to respond to that your pelvic floor expands down and then on your exhale your diaphragm goes back to its resting position and your pelvic floor lifts up to help control that intra-abdominal pressure in the same way so it's all about control of the pressure and um it work your pelvic floor functions with your breath so i don't think a lot of people know that um and the and it's all about stability with running so um some people will have stress fractures in their pelvis so that's like pubic stress fractures sacral stress those are two really common ones um femoral neck stress fractures have a lot to do with the control of the deep hip rotators um and so that's a big reason why runners should care about um the pelvis um but there

is a whole list of other things that um of why the pelvis is important um for running but those are kind of what popping into my head right away so how can we work we know it's important how can we work on our pelvic floor then um knowing that it is the core um of our our stability um what are some things we can do to to make sure that it's it's functioning correctly so breathing breathing is the first place to start um and it's kind of breathing is a lot of times overlooked by people kind of like the toe yoga exercise like people are like oh yeah yeah okay i did it once i'm i'm good but really that's how you control um your pelvic floor and for runners specifically because it's an it's a high impact activity oftentimes our pelvic floor will be hypertonic which means that it's in a constant state contraction so if you and i like to give the analogy of a biceps um like a biceps a bicep curl so if you think about a bicep curl you're straightening your arm and then you're fully bending your arm and then you're going to straighten your arm again and oftentimes it's with weight so if you weren't able to fully extend your arm and your arm was stuck at like 90 degrees and then you're only going into full um bending and then back to 90 and you're just doing a bicep curl with that range of motion you're

never going to get the full strength of your biceps that you can take that analogy into the pelvic floor because if you're never able to lengthen the pelvic floor then you're never able to fully strengthen it so in a hypertonic pelvic floor you're just constantly trying to contract it your body is trying to control that pressure um but it's just in a contracted state so you're never able to get that full strength of those muscles um so for the breathing exercise and maybe we can link like the toe yoga exercise and this breathing exercise into like the show notes or something um because i have a good um breathing exercise video um and so i would say focus on more of the relaxation part rather than the contraction um for most runners and that's a very over generalization but you can't really go wrong with just first working on the relaxation of your pelvic floor i think breathing exercises are another thing that are easy to do we just need to make time to do them and again it's all those little things um and knowing that it is important uh for your running uh for performance and um i i think too learning about the pelvis and the pelvic floor and how it is interrelated with everything else in your body like you said your femur you know that connects into your pelvis that's an

important part of of running um i'm just curious if you could talk a little bit about uh how you how you treat uh people when they come in for a session or i guess how like hip pain can be treated through pelvic uh pt work because i think that's something that is maybe new at least in um i'm not in in that world so it's new to me like learning about this and learning that this is an option and that this is something that we do we we treat people like this and especially we can talk about um pregnancy and postpartum too but um what does that look like for for treating some uh different conditions yeah that's a great question so um hip pain um i mean can be a lot of different things but very common in runners um so i um similarly to what i was saying with the foot um i'll have somebody walk and i'll have somebody run um look at their muscle strength look at their mobility um and then i'll usually ask about like history of childbirth history of any trauma to the pelvis um and there are a lot of things i can do externally um to help with hip pain but um if it's more of like okay i think the pelvic floor is implicated in this um i only uh treat internally uh with females at this point i haven't done the

training for males um so uh with females i will say um i will kind of explain what i was talking about with breathing um and then i'll say uh or i'll explain like what an internal exam would look like um and i usually devote a separate session to an internal exam if that if i think that's warranted and the patient is interested in it it's not something that has to be done um but in order to really understand if the person is fully relaxing their pelvic floor and fully contracting their pelvic floor an internal exam is the best way to assess that well i was just gonna say and i think that's like a really it's just something that i i didn't know existed until i was pregnant and i i um sought out treatment and i think it's it can do so much like you said it's you you can you can do so much more and so i think it's a really up-and-coming area and i'm i'm really glad we're talking about it and hopefully spreading the word that this is um something that that can help a lot of different problems yeah yeah and i'll even speak for my uh like with personal experience i in pt school i was running a lot and i had a pubic um stress reaction pubic bone stress reaction um and i went to so many people under the sun to try to figure out why um or how to get this like after i had done the rest and

kind of the progression back to running i was still having pain and i went to a pelvic pt and i went to a chiropractor and massage and like i went down all of these roads and i even thought about like going to dr meyers in philly to get adductor surgery because i just couldn't get this pain to go away and it wasn't until finding the right pelvic pt for me that she really helped and like now she's one of my mentors because i've learned so much from her and i want to help other people just in the same way that she's helped me but it made such an impact on my life because i was just in constant pain for years um and it was really like i had seen another pelvic pt who was also great but it just wasn't the right one for me um and so i think that there is so much um opportunity to help other people and running specifically like at that point i had not had a baby and i was not thinking about um children at all but it was just the impact of running and the um the lack of control in my pelvis and my core um that caused so much stress to my left pubic bone um and so yeah i think that all runners could benefit from pelvic pt yeah yeah and i think you know you have to find the right person for you and almost be

an advocate for yourself of like if something isn't working to keep seeking out and and learning about what's out there um and again this is really good information because i think a pelvic pt isn't something that's widely known so hopefully uh spreading this message will just make a difference in a few people's lives who maybe are struggling and just haven't figured out answers to like you know like you said having this pain and not being able to figure it out so um i think like most people think about pelvic people or like hopefully people are thinking about pelvic pt around childbirth whether you're pregnant or postpartum but there's a whole nother like i mean there's the whole population of in the running community in the gymnastics community like dancers all of these people like deal with pelvic pain and oftentimes just think that it's part of their sport yeah yeah and it does you don't have to be in pain all the time yes yeah yeah you don't have to leave on either yes yes well let's talk a little bit before we wrap up um just about uh pregnancy and postpartum and how that's i mean obviously i said you're you're a new mom i'm a new mom our our kids are similar age your little boy just turned a year which is very exciting um but uh even more so you know for for everyone we can benefit from pelvic

physical therapy but i think especially any woman who is pregnant or postpartum um you know you you have like one checkup maybe two checkups after you give birth and they maybe check and just make sure everything looks fine and they're like okay go on your way and there is so much more um and i'm still learning this and it's been um you know almost two years but i think it's uh is something that impacts every woman differently and the like now i like the information you have like learning about this as a professional but then also going through it with your own story and journey um i think is really a i mean again an incredible mix of of knowledge that you have um to help people yeah yeah it has been like it's another experience that just helps me be better at my job um which is kind of cool um so i had i i think nobody's i don't know any person whose birth has gone exactly how it was they wanted it to um but i definitely had um what i would consider a traumatic birth at the end a long labor and a traumatic birth um and the thing that i thought afterwards was this is going to make me a better pelvic pt um so so going through pregnancy and postpartum i mean it was it was a definitely a

learning experience um and i think that every person's ability and every person's experience is different and unique um and i guess um through the pregnancy journey like it's been very interesting to see like in the athletic population and just people who kind of post on social media um the differences of um ability or like what people feel like they can do like um i know you have said you've told me before that like you were able to push yourself like with biking um and you were able to run through a good portion of your pregnancy and and i i probably ran like up to six months of my pregnancy um and i was thinking about people like women who have run like up until the day they gave birth and i'm like oh my god my pelvis would never feel good doing that um but every person is so different and i think um what i've heard you say before like it's just important to not only talk about um the the amazing accomplishments that moms have been able to do athletically but also talk about the hardships and um i think amy leadham is a great example of like she's she puts herself out there and she talks about the struggles being like two years postpartum and um it's for me it's been very up and

down like i'm one that shies away from like an injury right away because i know it's not going to help to just run through pain but that comes with a lot of frustration and struggles too because i want to be like i love running and it's the thing that makes me feel like myself um the most out of any activity um but it's not always accessible for me um and i know that i'm not alone in that um and there's just so many highs and lows like through pregnancy immediately postpartum and then even now like a year later um it's still up and down but like finding um i think people to to go outside with whether it's running or hiking or like going to lunch like with you it's been really helpful to like find friends that are in like similar situations um and then knowing like okay all of these experiences are going to help help me help others as well yeah i i think you kind of nailed it with um like it's great to celebrate women who can do these incredible things while they're pregnant and newly postpartum of being able to like look i have a three week old and i'm running already but it's also kind of like cautionary because that makes the person who can't run feel inadequate of like well you know i see all of these other people getting back and here i am just you know

like five months and i still can't run and so i think we need to we don't we don't need to not celebrate that those great accomplishments but we also need to make sure that we are saying hey you know what you just grew a human birthed a human and you're still like feeding and growing it after it's born like that is and that is amazing and um you know your body goes through a lot like you said it's you like your your experience was a traumatic birth experience but i think any birth is going to be somewhat traumatic on the body you know it's totally it's an it's not an athletic injury but it is an injury to your body it takes time to heal and recover and um going back to like the pelvic uh pt and support i think again that's something that like inner society is really hard to do because uh we saw the same person and she wasn't in she wasn't local like we had to drive a couple hours and then you're thinking about okay so i'm driving with my new baby or i'm getting a babysitter and then i have to think about pumping and i have to pay for this out of pocket because insurance doesn't support it so there is like i mean we could go on and on about this there's so much that makes it challenging as a new mother uh to take care of your body um but to connect it back to running i think if you do have a desire to to run um and to perform and to you know get back to

something that you were previously doing like mileage wise or training wise it's so important to do these things in the first year to take care of your body to go see someone who can help you because a doctor isn't really going to do too much and you know there's a lot that happens and it can really help i i had a few appointments that for me were just eye-opening of like oh wow like that made a huge difference and yeah i never would have done that and having a pt clear you for running is probably the better option of just you know making sure everything internally is is back to normal and is not going to cause an injury down the road yeah there was um a mom i joined a mom's group um and there was a mom this was like immediately postpartum i think she heard her ob cleared her to run at two weeks postpartum and she said she said that she went for a run and she thought she was bleeding but then she realized she was leaking everywhere and i'm like oh my god your ob like do not listen to them i mean i shouldn't say that but i i am saying that um that your ob is clearing you for like major red flags if you want like some more guidance i mean leaking is a clear indicator that your pelvic floor cannot handle the load that you're putting through it um and just a pelvic pt

is going to give you a lot more guidance of like is your body really ready to start a return to run and it's probably not at six weeks um and i think that's hard for runners because we all want to get back there as soon as possible but you're playing the long game and so if you go out running three weeks postpartum and your pelvic floor and your whole body just gets overloaded you're just more likely to develop prolapse which you don't want to deal with long term which is where like prolapse your organs are held up by ligaments and so as your pelvic floor gets more loaded through your pregnancy or if you have like a really long pushing in delivery or you go back to running or high impact activities too soon your pelvic floor can't support those organs so those ligaments get lengthened and then your organs are falling on your vaginal wall and it's just i mean you want to avoid it if you can not all people can avoid it and there are things that you can do with pelvic pts and pessaries and things like that um but your body will just thank you if you take the more um uh conservative approach to getting back to it because running will be there for you it just you want to treat your body well because it did just grow human and deliver human yeah yes i agree and it's you know the the long game is is exactly it and

those first few months anyways i mean there's a lot going on a lot of changes a lot of adaptations you're figuring out a new life and i think sometimes it's like a training is on that amount of stress as is is pretty hard but then going through the physical part as well i i agree with you that waiting longer isn't necessarily a bad thing if you can look at it as like i'm doing this right now so that i can run again yeah and that doesn't mean you can't move your body like you can very much like once you have been cleared you can get in the pool or you can get on a stationary bike or a bike and and move but but everybody is different so so one person's movement like might be very different than another person's yeah yeah it's it's all it's crazy and it lots lots to learn um and like you said every person is different so i think sharing these stories and not just the the happy easy stories is um really helpful for people to hear yeah yeah and even someone like myself who does this for my living like i still get injured and i get frustrated and um have setbacks and um so so i learn from it and i help other people from it but i still deal with it myself yeah and that's just an just an honest thing of of um you know being an athlete and using your body that's going to have some wear and tear and using those

experiences though to help shape your future and to to learn so that you can do it a little bit differently the next time around exactly well claire thank you so much for taking the time to share your knowledge with us today um i learned something every time i talk to you um today i learned a lot of things so uh thank you yeah and where can people find you yeah so um my business is activate physical therapy and wellness in fairfax california my instagram is activate physical therapy um i said this earlier but i'm pretty bad with social media but i do post some videos there um and then i have a youtube channel with a couple more videos too um you can probably find that through my website activate ptw.com um and so i do in-person sessions in fairfax which is just north of san francisco and i do virtual sessions um through that business as well as gate happens and i will link to those in the show notes so people can check it out and um get in contact with you but thank you again and um yeah enjoy your your afternoon i'm gonna enjoy my evening wrapping up here it's getting pretty late so um thank you again and um really appreciate uh walking through this and and talking to us about um

yeah just some some things runners can be aware of with their bodies yeah always fun to chat with you all right there you have it uh some great information for all of us to take and use hopefully um i know after this call i'm gonna go do my toe yoga and uh do some soleus calf raises uh because i've been slacking on them um and that's that's something that i need to make sure to do um and i'm sure all of us could take take some time to do some of these little things that can really make a big difference for us uh in terms of preventing injuries and getting the most out of our running um so thanks again to claire for walking us through some of these things today and again you can find her at activate physical therapy dot com um and you can find her on instagram as she says though she's not super active you can find some videos um but check her out check her website out uh schedule a virtual consultation or if you're in the the bay area uh come see her in person and again uh thanks to claire and hope you guys have a great rest of your day get out for a nice run get some fresh air and we'll well i'll talk to you later because i'll be back you