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Dr. Heather Salzer DPT

@hsalzer

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Co-owner @onwardbellingham 👩‍⚕️
Faculty Pelvic Division @icephysio 👩‍🏫
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Layla has had our costumes picked since July 😂 Hopefully today lived up to everything you were hoping for and more my little bestie 💕 by @hsalzer

Same scar. Different surgery.

Two people can have the exact same C-section scar on the outside and a completely different surgery underneath. Fascia cut or stretched. Bladder flap made or skipped. Uterus closed in one layer or two. Peritoneum closed or left open.

A 2024 WHO-funded review of 38 systematic reviews found that C-section technique varies even between surgeons in the same hospital, and 256 of 345 surgical comparisons had no clear answer.

The part that stopped us: there isn’t a single systematic review on how to close the fascia and rectus, the exact layers we load and rehab.

So what do we do on Monday? Treat the scar as a stack, not a line. Read the op note. Ask layer by layer. Map sensation. Test glide at every depth. Then load it, and watch how they braces as the load goes up.

And if this is your body: you’re allowed to ask for your op report. 💚

🎧 Full breakdown on the PT on ICE Daily Show (10/19) and in the ICE Pelvic newsletter.
📄 Gialdini C, et al. eClinicalMedicine. 2024;72:102632 by @hsalzer

Fall things 🧡💛🎃🍎 by @hsalzer

Your ferritin came back “normal”… but is it?

This one matters for so many of the women I see in clinic. The American Society of Hematology just released its first evidence-based iron deficiency guidelines, and they raised the ferritin cutoff to 30 or below for most adults, including pregnant and menstruating people.

Here’s the catch: a lot of labs still only flag you below ~12–15. At a cutoff of 15, only 41% of true iron deficiency gets caught. At 30? 67%.

If you’re pregnant, postpartum, have heavy periods, or you’re a runner who feels flat no matter how much you sleep, it’s worth a second look at your labs.

Know your numbers. Look at the actual value, not just the flag, and bring it to your provider before starting iron on your own. 💪

Save this for your next lab visit, and send it to the friend who’s been told she’s “just tired.” by @hsalzer

When your bestie comes to visit and you actually manage to get some pics together instead of just of the kids 👯‍♀️ From best friends at first sight in PT school, traveling the world together, and now getting to figure out motherhood together @court.aayers has been there for me through it all 😘 Love you and so glad we got some time in person together ❤️❤️❤️ by @hsalzer

At @pelvic.icephysio @icephysio, the standing exam is part of our LEVEL 1 Material.

Why?

Because you need to learn a fundamental, functional pelvic floor exam before we get into the weeds.

For us that means
- range
- coordination
- strength
- palpation
- in supine AND standing

There’s lots of little intricacies for the exam that you can learn. But FIRST you need a foundation.

You need to be Monday Morning Ready and know what to do when that first pelvic patient walks in your door by @hsalzer

Alaska trip through family selfies @alexbdpt 💕 by @hsalzer

Good luck to all the runners racing at the Bellingham Bay marathon and all other races today! Stop by at the finish line for a private and cozy place to breastfeed, pump, or snuggle your baby. Open to racers and spectators! @hsalzer and @thetrailsidedoc will also be at a booth to answer all your pelvic health questions! by @hsalzer

13 years together, 7, years married 💍 Happy anniversary my love 💕 Here’s to all the different life stages we have already figured out together and all the ones to come 😘 by @hsalzer

Pelvic Live Female lands in Anchorage Sept 12–13. Two days, hands-on, lab-heavy, with lots of fun along the way! Stress urinary incontinence, prolapse, pelvic girdle pain, diastasis, managing symptoms with lifting/running/jumping; it’s the stuff already walking into your clinic, taught the way you can actually use it Monday morning.

Heather believes people learn best when they’re engaged, asking questions, and having fun, so don’t be surprised if there’s plenty of laughter throughout the weekend.

Fly in, learn hard for two days, and leave enough room on the calendar for a trail that ends at a lake. We won’t judge.

And if you’re already in AK, this is the one to grab while it’s close to home!

Seats are limited. Grab yours: https://ptonice.com/courses-events/pelvic-live-female-anchorage-9-12-13-26/

#PelvicLive #ICEPelvic #PelvicHealthPT #AnchoragePT #WomensHealthPT PelvicFloorPT by @hsalzer

Things that weren’t the problem...

❌ She was 25 wks pregnant
❌ She wanted to run 25K
❌ She had urinary urgency

The actual problems:

- Under-fueling
- First-trimester fatigue
- Training progression
- Symptom management

Great clinicians don’t just treat the diagnosis.

They identify the limiting factor.

In this case, it would have been easy to blame pregnancy. Instead, the biggest barriers were changing throughout training… under-fueling, training progression, and managing urinary urgency. Once we identified the actual limiting factor, we could adapt the plan while keeping the goal the same.

That’s clinical reasoning.
If you want to hear how we navigated this case from the first trimester through race day, check out this Monday’s PT on ICE Daily Show: Helping a Client Run 25K at 25 Weeks Pregnant

And if you’re looking to become more confident treating pregnant runners come join us in our ICE Pelvic courses! by @hsalzer

FREE Pelvic Health Screens at RYZE!

Leaking during workouts? Pelvic heaviness? Pain with exercise? Questions about pregnancy or postpartum?

Come chat with @thetrailsidedoc and @hsalzer ! (doctors of physical therapy from Onward Bellingham)

Tuesday, August 4 & Thursday, August 6 from 8:00–11:00 AM

- Free 15-minute screens - Sign up at the gym or just drop in!

We’re here to answer questions and help you keep doing the activities you love. 💪 by @hsalzer