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Pelvic Division @ Institute of Clinical excellence

@pelvic.icephysio

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Things you don’t think about if you don’t play wind instruments 🎷 but now you will 👌 by @pelvic.icephysio

ugh. the burden of knowledge can be so heavy.

I cognitively knew during my earlier postpartum days that exercise was good for me. That it would help me feel better mentally and physically. That it would even help me sleep better.

Yet the real question of: “but won’t it just drain me?” popped into my mind.

Hello, I’m Alexis & I’m what they call an “all-or-nothing” type of person. 🙃 Exercise for me meant going all out or why am I even bothering? A mile walk with hills and being out of breath could count for other people, but I’d never count it for myself.

And so OF COURSE that felt like too much. OF COURSE the barrier was high. But it was a perceived barrier.

Other mamas feel this. Did you? Do you right now?

I just read a qualitative paper (those are so underrated and I freaking love them!!!) on the postpartum experience & this point just really resonates with me. Because I loved it too.

We have our new (2025) guidelines for promoting exercise now. We know to progress gradually. We know to set our eyes on the goal AND work towards it (& that it’s ok not to reach that goal super fast but take your time).

It’s why I believe every new (or new again) mama needs a good pelvic health provider in her corner. Even I needed these reminders— and I literally TEACH this material. (I get to teach it next Thursday in our current Level 1 Online cohort!)

Knowing isn’t everything. We need guidance and support 🤝 by @pelvic.icephysio

🤲In person, clients are supported by therapeutic touch. 🧑‍💻Online, they’re supported by feeling equipped.

This post was inspired by a question from one of our Pelvic students gearing up for her 1st pelvic virtual eval: “looking for ideas on how to best bring value and effectiveness to a virtual visit?”

⚔️This isn’t about virtual vs. in-person care. It’s knowing how to bring value virtually, and referring out for hands on care when it would change the plan.

Swipe for the full virtual visit, mapped →

💾 Save this for your next virtual pelvic visit

🎧 Full podcast episode from 10/26: “Your ears 👂 are your hands 👐: making virtual pelvic visits count” on the ICE Physio app by @pelvic.icephysio

Menopause is one day. The impact of low estrogen is not.
We’re finally talking about menopause, and I’m SOOOO here for it.

But the conversation can’t stop at the transition.

Strength declines from midlife, estrogen exposure accumulates and exercise rates drop off after 65.

That’s exactly when women need us most. by @pelvic.icephysio

I caught that I accidentally put myself in REDs postpartum with Quinn because my resting heart rate dropped to 42.

I checked in with a Sports med colleague who said yup that definitely could be it! Being postpartum, my cycle couldn’t be used as an indicator.

In endurance sports, low resting heart rate is seen as a flex of your fitness. And it is. But clinical bradycardia is also a relevant data point when athletes are navigating underfuelling.

Cool to see this new statement

*note here- they are VERY careful not to overstate claims and i don’t want to either. It’s an area of active investigation in the female athlete space by @pelvic.icephysio

“I was diagnosed with a partial avulsion and don’t know about my decision to have a second vaginal delivery” what does the evidence say???

Across three studies, the answer is reassuring. The 2013 and 2020 data found essentially no difference between one vaginal birth and more. The newest study, with an eight-year follow-up, found 10 new tears in 150 women who had another vaginal birth. That’s a 6.7% risk, and very few partial tears became full ones. Small, not zero, and now you have the numbers.

Save this for later + Comment “TEAR” to check out my Substack with the full citations and explanations of the studies by @pelvic.icephysio

Breath and the pelvic floor have long been married together and there is often a FEAR that holding your breath is bad for the pelvic floor.

However, the answer isn’t to AVOID a breath hold.

Why?! Because we physiologically NEED it

Avoiding it can make us WEAKER

So let’s learn HOW to breath hold brace instead of avoiding it altogether. by @pelvic.icephysio

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 @pelvic.icephysio

I have always wondered about the natural history of different gynaecological conditions.

Endometriosis is a chronic inflammatory condition that is sensitive to estrogen. So in menopause, it stands to reason, endo starts to resolve

For many, it does.

But I had a client who still had irregular cyclical bleeding until almost 60 but her internal exam looked like she had been low estrogen for awhile.

It made me curious if menopause timing could be misinterpreted as continual bleeding in endometriosis.

This post is super niche and exploratory. Evidence here is low and new.

But welcome to my nerdy rabbit 🕳️ by @pelvic.icephysio

And not just any muscle, we want HEALTHY, ROBUST muscle.

💰 MUSCLE IS YOUR METABOLIC CURRENCY (🎩 h/t @drgabriellelyon)

It’s your body’s biggest blood sugar sponge & helps lower chronic disease risk!

And the returns don’t stop at metabolism… 🦴 It helps keep your bones strong as you age 🏃 It gives your body the capacity to handle life & recover from injury

Plus, healthy metabolism = healthy blood flow to pelvic floor muscle & your bits. Yes, THOSE bits 🍆🍑🫘
 🔥 It plays a key role in arousal, orgasm, and erections 💧 Helps manage leaks & core control especially after birth and pelvic surgery

Every strength session is a deposit that your future self will thank you for. 💸

📍 Clients: Want to invest in your bod, bits ‘n all? Link in bio to book!
🩺 Clinicians: check out our 4 @icephysio pelvic courses that incorporate body systems beyond the pelvic floor!

#physiowithsign 📸: @katiestover_
🏔️: Lily Pond 🪷 by @pelvic.icephysio

I see so many of these drastic hug the baby videos and they’re doing this forced full exhale.

That is NOT the maneuver for lifting while pregnant.

A brace occurs with an INHALE so the movement isn’t as drastic as these videos look ❤️ by @pelvic.icephysio