A Conversation With a Pelvic Floor PT

Hey friends, Rebecca here. Sarah and I are so excited to kick off our Shift for Health interview series with Dr. Missy Gallow, a core and pelvic floor specialist! Missy earned a Bachelor’s degree from OU in Exercise Physiology and a DPT (Doctor of Physical Therapy) from the University of Dayton, and works as a physical therapist specializing in postpartum and pelvic floor therapy. She is a wife and mama of 2-year-old twin girls, and understands firsthand how pregnancy can impact women. She is driven by her passion for educating and empowering women to feel their best and we’re so excited to learn from over here at Shift for Health!

You went from working as a general physical therapist to specializing in postpartum and pelvic floor physical therapy. Why have you felt called to this more specialized work?

I was working in outpatient orthopedic therapy when I got pregnant with my twins and started having a lot of pelvic pain - which motivated me to learn more about the pelvic floor - and I just became really passionate about it! My own journey and recovery from a very intense pregnancy, delivery and c-section, and then trying to heal a Diastasis Recti (abdominal separation) motivated me to learn all I could about pelvic floor and core physical therapy, and it turns out the information out there is really confusing and overwhelming! I thought, “If I’m feeling frustrated and confused than other women must be feeling very frustrated and confused.”

Just because I’m curious and I know our readers will be too, how long did you carry your twins and how much did they each weigh?

I carried my twins to 37 weeks and the girls were great! They were healthy at 5 lbs 13 ounces and 6 lbs 4 ounces. We didn’t have to do any NICU time or anything so we were really fortunate.

I know it was a long road to recovery for you.

It was rough. I was on modified bed rest the last month of my pregnancy and had to stop working which was a huge mental strain. Everyone told me to just enjoy it and binge watch Netflix, but I was so bored and uncomfortable. It was horrible. The most I was physically capable of walking was 2500 steps a day, so going from that to full activity again was really, really hard.

I know you used a lot of physical therapy to recover from your twin pregnancy and your diastasis recti, how is your recovery going?

Really great. There are seasons where you feel like you’re making good progress and seasons where you feel like aesthetically you still look pregnant or you don’t feel as good about your body, so there have been a lot of ups and downs. But I’m two years postpartum now and it’s taken a lot of work and diligence with core exercises, exercising in general, working on nutrition, etc.

We talk a lot about mindset on social media and with our group and one-on-one clients. When it comes to post-partum bodies - and particularly pelvic floor and core issues - the general mindset seems to be one of resignation. Like, "Well, I guess this is just how it is now!.” Help us shift that mindset! What are you seeing with your patients who come in directly after giving birth or even 10 years after giving birth?

Mindset is huge! I often use the phrase, “It’s common, but not normal” when moms tell me that they still leak or think it’s normal to pee themselves or have these pelvic floor issues. I teach them that it’s common to have these issues, but it is not normal - it’s not how your body is meant to function. Through physical therapy, I’m able to help my clients improve drastically and often completely fix their issues. I always tell women it’s never too late to go see a physical therapist!

We don’t have a lot of awareness out there that pelvic floor physical therapy is even a thing. So one of my goals is to create more awareness that it’s normal to see a PT postpartum. It’s normal to get an internal PT assessment from a trained physical therapist to see what the function of your pelvic floor is, etc. Your OB isn’t checking the tone, tension and strength of your pelvic floor when you go for that 6-week visit, or for subsequent visits. They only check to see that the tissue is healing, or to do a pap smear, etc. They’re not super concerned about the pelvic floor muscles. That’s why it’s important for women to see a pelvic floor PT after giving birth.

In European countries, isn’t it the standard of care for all women to receive postpartum physical therapy after they give birth?

Yep, it is standard in Europe. And I know that some countries are now even having pelvic pt’s come to the hospital to start educating women on pelvic floor rehabilitation right away. We have a lot of catching up to do in our standard of care for postpartum women in the United States.

One of the things I've noticed from participating in group fitness classes, is that many women don't have the core strength to properly do core exercises in class. Why is that? Why don't our bodies just "bounce back" after giving birth? Is there a good way to know if an exercise is appropriate or not?

That’s a good question! The problem is that I’m never sure what “core exercises” means since your core is made up of a bunch of different muscles. I always need to see specifically what exercises my patients are doing and how they are doing them before I can help them figure out what is appropriate or not.

Your core is the most dramatic thing that changes when you’re pregnant. Those muscles go through a lot of trauma stretching as the baby grows! And when those muscles get stretched they turn off and your body learns how to adapt and use other muscle groups to stabilize everything. During pregnancy we fall into new movement patterns and habits that often linger even after we’ve given birth. It’s common after pregnancy to use the superficial core muscles like the obliques and the six pack muscle and to stop using the deep stabilizer muscles. Until you know how to teach your brain to find those deep core muscles, you may just be compensating and doing core exercises incorrectly or using other muscle groups to get the movement done.

It’s hard to know if you’re doing a specific exercise wrong. Obviously pain is your guide. If a movement is causing pain that’s a good sign that you’re doing it incorrectly or using the wrong muscle groups. Another sign (if you’re postpartum) is if you see abdominal coning or doming, which tells you that you’re not managing that inner abdominal pressure well and that you have connective tissue weakness in that midline that you need to still work through. Breath holding is another cue that something is too challenging. If you have to hold your breath to get the exercise completed, that’s a sign that the exercise is too challenging and that you need to modify to a new movement that you can breathe through.

What is a good starting place for someone wanting to strengthen weak core muscles? And when do you know when it's time to call you, or any pelvic floor/core PT?

To answer the second question, I think it’s always time to call a pelvic floor PT! Even if you’re not having an issue, let’s prevent the issue from happening!

It’s also just really important to see where your baseline is, especially if you’re postpartum. Even if you’re not having pain, you went through a traumatic injury and we want to see what’s going on with your joint mobility and soft tissue in your pelvis and look at the strength of the muscles so that we can set you up for avoiding common injuries and to prevent issues with leaking.

The best place to start is to become aware of your breath again and to figure out if your brain can find your pelvic floor muscles. Can you feel a contraction of your pelvic floor? I have so many women who can’t even feel it! They don’t know if they’re contracting their pelvic floor when I ask them to do a kegal contraction or they don’t know if they’re contracting their deep core muscles because that mind/body connection is completely gone. So that’s where I always have women start: your brain needs to know where the muscles are before you can strengthen them.

And it’s possible to reconnect the muscles and the brain, right? Your brain can remember all of that again?

Yep. We always start with neuromuscular reeducation which is re-establishing that mind/body connection before we move on to true strengthening of those muscles. Because again, we have to make sure your brain knows what it’s supposed to strengthen.

When I came to see you, you totally blew my mind because even though I knew I needed to strengthen my pelvic floor and deep core muscles, you watched me breathe and did a series of tests and told me all these things about my body that I had no idea were still dysfunctional after having 4 babies. And I thought it was so fascinating!

Most women can be very skeptical before the first visit but once they come and see it first hand they’re like, “Oh my gosh, this is amazing. I’m so glad I’m here. I’m so glad that I’m learning this.” They end up finding the process very empowering.

So there is hope for those of us who have to cross our legs whenever we sneeze or who can't run/jump without leaking.

Yes! One of my favorite things is to teach women how to control those leaks because you can make quick progress, which everyone loves. Strength, however, takes more time. But I can make changes in one session with someone’s ability to jump without leaking, so that’s really exciting. And once we can teach your body how to use your pelvic floor and your breath in unison and synchronize that system together, we can make huge changes on leakage, whether that’s jumping, running, coughing, sneezing, etc. It’s huge when women can see those changes immediately. I do love working with those patients!

Tell us about the guide you just released called The Nap Time Project.

The Nap Time Project is a guide I created that contains all the best exercises I’ve come up with after rehabbing myself after my twin pregnancy and that I use with all my moms in the clinic. The guide contains the exercises that I found actually work to make functional and aesthetic changes to a woman’s abdominal wall, and I’m so excited about it! I named it The Nap Time Project because it’s what I worked on for months and months and months while my girls were napping!

The guide is divided into 3 sections: week 1 postpartum, weeks 2-6 postpartum, and then week 6 postpartum and beyond. It breaks down how to work on the mechanics of each movement, and has a ton of pictures and youtube links so that you can actually see how to do all the movements. And then I provide a sample schedule to help you implement the exercises in your daily life.

What about women who are 3-, 5-, or 10-years postpartum, but know that they need help strengthening weak muscles? Would The Nap Time Project still be useful for them?

The Nap Time Project is useful for women if they’re 1-, 5-, 10-, or 20-years postpartum. No matter where you are in your postpartum journey, everyone starts with the same educational tools! I broke the guide down into specific weeks so new moms can know where to start if they’re super early in their journey. But ALL the information in the guide is useful to any woman at any stage in their life which is why I left the “6 weeks and beyond” totally open. Because keeping your core strong and functional is a lifelong project! These are the exercises I’m still doing two years later, and will continue to work on. So, yes, the guide is super useful for ANYONE who feels like they don’t have the awareness or strength in their core that they would like to have.

Tell us about your new virtual coaching practice?

After I created The Nap Time Project, I decided to offer online coaching to help women who might not feel sure about what they’re doing as they work through the guide, and to help moms who might not be able to find time in their schedule to get to a physical therapy appointment in person. My online coaching services will allow me to watch women do the movements, give them advice with symptoms they might be having, teach them breath mechanics, etc.

Tell us where we find The Nap Time Project and the option for online coaching, how much does it cost, etc.

I currently have everything linked in a linktree here or on my Instagram profile. My instagram name is @twinmama.pelvic.pt and I offer a free guide with good foundational information for new moms, and then the comprehensive guide with all the videos and pictures, etc. priced at $39.99. Both are downloadable guides. And then the online coaching services are linked in the PDFs as well as on my linktree with all the coaching services, pricing, etc.

I also work at Fitness Matters which is a private practice in Worthington, Ohio and I see pregnant and postpartum women there on Mondays, Wednesdays and half days on Thursdays. Also, FYI - in the state of Ohio you don’t need a referral to see a physical therapist! You can just call and make an appointment. We are happy to communicate with your primary care or OB if you would like, but you don’t need a referral from them to call and make an appointment.

You do such an amazing job prioritizing fitness and whole foods in your house, even though you have every excuse to throw in the towel as a working mama with toddler twins. What is your mindset like around your self-care routine and how do you make that work with your girls, work schedule, etc?

I’ve become super passionate about self care in the last couple years, probably because I’m a mom now and my mind is blown with how busy it all is! I have a lot of anxiety and so I’ve found that if I don't make time for me then I’m not a good mom, spouse, friend, etc. So I took a step back and figured out what I need for myself so I can give 100% of me to everyone around me. For me, self care involves fitness, meditation, journaling and writing down goals. I also find meal prepping super helpful. Some people find meal prepping really overwhelming, but I find it so relieving - if I can spend 45 minutes on a sunday cooking some food my anxiety goes down and I feel so much better about my week! Life is crazy and is never going to go as planned, but I think a self care routine helps you stay as close to homeostasis as possible.

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Thank you so, so much to Missy, who graciously spent precious "nap time" hours to give this interview!

xo, Rebecca

p.s. Interested in The Nap Time Project downloadable guide? You can find it - as well as Missy's other offerings - here.