Pelvic Floor Therapy with Dr. Rachel Selina

I had the awesome opportunity to interview pelvic floor physical therapist Dr. Rachel Selina from Melior Movement Lab about pelvic floor therapy, and pregnancy + postpartum fitness. This article is a can’t miss!

1) Introduce yourself! Who are you? Where are you located? How did you get into pelvic floor physical therapy?

Hi!  I’m Dr. Rachel Selina, physical therapist and owner of Melior Movement Lab.  MML is a small cash-based clinic located within CrossFit Melior in Highland, MI.

I also teach with a continuing education company for physical therapists (where my primary focus has been running related injuries, CrossFit injuries, neck and back pain) but a few years ago we welcomed a new division to our company that focused on treating the pregnant & postpartum athlete.

I soon realized that this was a big piece I was missing…how do I help my runners get back to running postpartum?  How do I know which movements my CrossFit athletes need to modify and when do they need to do that during pregnancy?  How do we actually improve symptoms of leaking and heaviness postpartum, instead of just accepting them as the norm?

My focus is consistently on helping people continue to pursue fitness through every season of life.

2) What do most women come in to see you for?

The most common complaints I see are leaking with particular movements postpartum, pelvic pain postpartum, and modifying activity during pregnancy (that one I see from both a physical therapy and a coaching perspective).

3) What exercises do you prescribe the most often or which exercises do you see helps with common symptoms the most?

One really helpful thing, particularly in terms of addressing leaking or preparing for birth, has been learning to relax the pelvic floor.  We can use a stretch like happy baby or a deep squat, paired with deep diaphragmatic breathing, to train those muscles to relax and reduce tension.

4) What does a typical appointment look like for women who have never gone to one before?

A typical first session/initial evaluation would be 60 minutes.  It would start by first laying out all the painful/problem areas or concerns and then a deep dive discussion into how those symptoms started and how they behave.  That helps me determine which particular areas need to be evaluated.  I do not currently do internal examination or treatment (I will be trained in that this May) so anything we examine would be external.

Once we have a better idea of what is driving your symptoms, we would begin to treat it.  Treatment might be anything from soft-tissue work, joint manipulation, analyzing a lift or running gait, or training a muscle to fire correctly.

The session wraps up with assigning a few things to continue working on at home/at the gym and establishing any follow up treatment we think will be necessary.

5) From a PFT perspective, and from your personal fitness background, what are some form cues or recommendations you’d give to women that want to lift safely during pregnancy and build back strength postpartum?

Breathing and bracing is huge here, specifically learning how to brace without bearing down so that we don’t put unnecessary pressure on the pelvic floor.

Thinking of the midline as two bowls has been helpful too, your ribs and diaphragm form the top bowl facing down, your pelvic floor forms the bottom bowl facing up.  In all movements (squats, presses, running, double unders, etc.) the more we can keep the bowls aligned, the better our positioning will be to allow the pelvic floor to function optimally.

6) What is one thing you want all women to know about PFT/the pelvic floor in general?

One thing I would want all women to know about the pelvic floor is that it is a muscle group.  So just like other muscles in the body, we can strengthen the pelvic floor if the problem is weakness, we can help the pelvic floor to relax if the problem is tension, and we can train the pelvic floor to learn new patterns if the problem is coordination.

I think there’s a lot of stuff out there that over-complicates pelvic floor therapy making it seem unapproachable or scary when it doesn’t need to be.

7) What is your biggest piece of advice in terms of pelvic floor health for pregnant women? Postpartum women?

For pregnant women, the biggest piece of advice would be to stay active as much as possible throughout the pregnancy.  There is so much research now supporting the continuation of exercise during pregnancy as safe and beneficial.  How you feel and how well you are able to maintain abdominal/midline control during pregnancy should dictate which movements you modify or replace, not arbitrary guidelines.

For postpartum women, my advice would be to start seeing things as common, but not normal.  It is common for women to experience leaking, but not normal.  It is common for postpartum women to experience pelvic pain, but not normal.  “Normal” means that we just have to accept it and deal with it but that is not the case! Most times, there is a way to treat the issue and see improvement.

8) We don’t know what we don’t know – any other bits of advice you can give from your perspective?

I think the other advice I would give for women postpartum is that there is nothing magical about 6 weeks, the timeframe commonly recommended to resume exercise after giving birth.

There really is no evidence to support waiting to resume activity until 6 weeks postpartum. What you do for exercise in those early weeks might look different than what you do at 6 weeks, 8 weeks or 12 weeks postpartum, but that doesn’t mean there aren’t safe ways to begin postpartum fitness earlier than 6 weeks.  That might be a soapbox for a different day though.

9) Where can people reach you (email, phone, location, whatever info you’d want people to have)?

The best way to reach me with any questions is by call/text a 810-373-2267 or email at meliormovementlab@gmail.com.  The best way to set up an appointment is online at meliormovementlab.janeapp.com.