Pelvic Floor Health

Interview with Susan McLaughlin of Align Integration and Movement

Transcript of video:

Isabel: Today I am so excited to be interviewing Susan McLaughlin of Align Integration and Movement. She’s a physical therapist with a great deal of understanding about the pelvic floor and the abdomen in addition to all of the other work that she does. Thank you Susan so much for being here today.

Susan: Hi Isabel, thank you so much.

I: You have a lot of certifications and a lot of experience in a lot of different areas. How do you talk about your work – how do you describe the work that you do?

S: I am a physical therapist and in my title for my business company I actually really thought that out, and I didn’t want physical therapy in the title. I didn’t want it in in the branding of my business because sometimes I think people have an idea of what physical therapy is, and I feel like even though I’m schooled and trained and a big portion of what I do as the physical therapist is still very true in my practice, what I’m really interested in is in looking at the whole body and how it’s working with each other. And that’s whole body also, not just this physical body, but being aware and have an understanding how much our emotional and our spiritual and our mental plays into our physical structure.

So as a physical therapist who specializes in the area of pelvic health, I really feel like bringing all of that whole person into play make such a big difference, because typically what I see with people (especially with pelvic health) is so much of pain is misunderstood, and there isn’t a specialist who so far has really… well, that’s not true there is a specialist who understands pelvic pain, but lot of times what happens is someone is going through the gynecologist, going to the urologist, going through their GP, going through all these different people, and they kind of throw their hands up and they say “I don’t know what’s going on with you.”

So part of what happens is someone is dealing with this unexplained pain for years and years potentially, and so sometimes what is so beautiful is just being able to have somebody come to me with a pelvic health issue and feel that they are heard and understood, and that’s where and when, in my mind, healing starts a lot of the time, because they actually can go “ah someone’s meeting me here.”

I: Yes that’s beautiful, and can you tell me a little bit about when you say ‘pelvic health’? Tell me a little bit about what that means to you and your work.

S: Pelvic health is actually pretty broad. When you look at the definition of the pelvic area, it’s really quite a span of real estate on the body. It’s anything from the torso down to the knees, so that’s like three quarters of the body right there. Pelvic health – I work with men and women who have any pelvic floor disorder of any kind. So that means dealing with any sort of urinary/bladder pain problems, so interstitial cystitis, urinary retention for frequency. And then on the other end we have that spectrum of incontinence, so urinary leakage, also fecal incontinence, and on the other end of fecal incontinence is constipation. They’re all kind of playing in this web together. 

And then there’s also reproductive issues, so endometriosis and menstrual cramping. I work with people who are in the prenatal or postpartum time period. So their prenatal could be anything from your basic sciatica, pubic pain, SI dysfunction. And then carrying over into postpartum healing. So a lot of times people are really dealing with abdominal wall separation, organ prolapse, urinary leakage, and then painful intercourse, so all of those things. 

And then also there’s random stuff like “I’ve had this pain in my side for years and I don’t know what’s going on,” you know – flank pain. Then there’s also tail bone pain and pudendal neuralgia. The pudendal nerve is a nerve that innervates the pelvic floor, and so more people are having or awareness of pelvic floor disorders. But still it’s amazing how many people kind of get spun through the system.

I: Yes absolutely. So in the course of working with you, anybody coming in with – I mean you can choose one if you want – it’s hard to say like any of those things – but what is the trajectory of their work with you? How do you start with somebody who’s really been in chronic pain suffering for a while and really feeling at a loss for what to do next? I see this a lot too, they feel kind of let down by their practitioners because they feel like their doctors don’t understand, or don’t believe them, or simply don’t have the tools to help them. So you’re saying there’s that sort of whole person issue of they don’t feel heard, they don’t feel understood, they don’t feel taken seriously. Then of course there’s the rest of the physical body that can be addressed and worked with, so when you have somebody like this come to work with you, how does that tend to go? Where do you start?

S: You know for me, I’m really really fascinated by our autonomic nervous system, and actually our nervous system in general, so I really enjoy keeping up with the neuroscience. One thing that I start with with anybody, regardless whether it’s pelvic health, or just a general orthopedic person who has a low back pain or neck or jaw issues is: let’s start to bring awareness to the breath, because first of all, there is movement there, and there should be movement there, and we’re dealing with that whole core system, also it’s such a great entry point into the nervous system.

So the breath to me it is the first step regardless of their pain area, because when people can start to connect to themselves even just in a simple breath cycle – and it doesn’t have to be big diaphragmatic buddha belly breathing or anything – it’s just bring awareness to allowing the movement to occur, because usually when we’re in a pain cycle we’re holding, we’re protecting, we are not feeling safe, and the biggest thing for me is we need to get this person in a place where they’re able to start to feel safety in the body and to start tuning into the body. Because usually we want that pain gone, it’s like “I don’t want to feel it I don’t want it to happen,” and so we start to try and wall it off. And as you know, we actually need to get into it, aware of it to allow it to dissipate. And so breath is a great way that I see people can reconnect with themselves.

I: That’s amazing. Yes, I think that’s so great and that makes so much sense. A lot of what you’re describing sounds to me not like what we would think of as like standard physical therapy. So as far as what you do, how do you feel like that sets you apart from when your doctor says “oh, go see a physical therapist,” and you just pick somebody off a list?  It sounds to me like what you’re doing is is really robust and really kind of well-rounded in a way that sometimes it’s not when you go to see a physical therapist. Do you have thoughts on that?

S: Well unfortunately I think what kind of happens – and I would say this probably happens in health care in general – but with physical therapy typically we’re in a big clinic setting. We’re so driven by that insurance based system that we don’t get to spend the quality time typically, and so there’s these standard movements and exercises that are going to help a certain area and I think sometimes it’s really easy to kind of do that cookie cutter approach, although I think a lot of people would say they don’t do cookie cookie cutter, or the kind that run people through. But it happens, I see it over and over again – people are coming to my office, and they’ll just say ”I went to this PT place, I didn’t even see the PT more than five minutes. I was with the aide and I was doing all these exercises, and I don’t really feel like it did anything for me.”

So I think the difference for me is I am 100% there with them for one hour. So I’m using my eyes, I’m using my hands to observe what’s happening with the body, looking at the connections in the movement. I’m watching them walk, I’m watching what happens when they lift their arm. Where do I trace those lines? What might be playing and interacting with this person’s shoulder dysfunction? Can it be traced to that opposite side? Looking at at that.  I think that’s that’s the difference. 

Also one of the things I feel fortunate getting into the niche of pelvic health because I really had to maybe be softer and kind of back off, and observe a little bit more. Because sometimes the intensity is just so high, and the person is very fragile, that what I have discovered is ‘less is more’ and subtlety is wonderful.  I think what I see a lot in a traditional PT is if someone has a jacked-up back, they just need to get their core stronger so they’re doing all these birds or dogs and they’re doing all this stuff, but they’re missing I think some of the key pieces is really seeing and understanding how this core is working together. Because someone can attempt to get strong, which really just means usually what I see is people are building up tension.

They’re not creating strength they’re building tension! They’re trying to get stability on an unstable system. So it seems like it’s either strengthening or flexibility you’re gonna stretch yourself and that’s going to cure everything. And really it’s just it’s a fine line, it’s a dance, it’s like incorporating everything. Yes, they’re strengthening, but maybe this person needs to be able to let down so the muscles can actually get to their resting length tension to even be able to contract appropriately to create force generation. So those are some of the big things, especially people coming in with urinary leakage, and I think a lot of people just assume “oh my my pelvic floor is loosey-goosey because I’m leaking urine,” and a lot of times I see just the opposite. The muscles don’t even know how to generate force anymore because they’ve been held, or they’re not used effectively.

I: That’s so interesting, and that brings up a question for me. I’ve worked with a lot of people with mesh. Sometimes it’s hernia mesh, but sometimes it’s the bladder slings, things like that. So when you have these surgical alterations that sometimes work perfectly according to plan and sometimes do not, do you see a difference there from people who are pre-surgery versus post-surgery? Do you have thoughts about that?

S: Well I would say in 99% of cases surgery is not addressing what got the tissues there. So it can help resolve something for a while. I don’t know what the percentages of needing recurrence of a surgical procedure. Very often the slings will either need to be redone later on down the road, because that person hasn’t changed what created that prolapse to begin with. And that’s where surgeries go wrong, and unfortunately what I typically see – and this has been a while, but when I was in the medical system I would just see women who were just destroyed. I mean just so many botched up surgeries.

And it’s almost like there’s just so many factors playing in. So for me looking more at the root: why is the pressure downward, why are the organs descending, and how can we go about changing the tissues? Because most of the time with an organ prolapse, the tissue isn’t so far gone that they actually need surgery. 

I: So in the case of (and this is something that I see and hear about a lot to) is this cascading effect of botched surgeries. Like you said, it happens a lot, and it’s really hard on people. So in that case, do you feel like there is a point of no return where you feel like you just can’t help them? Or do you feel like there’s always something that can be done to start to bring that back into better function even though there has been so much alteration?

S: I feel like I’m an optimist, so I feel like there’s always hope and there’s always a possibility for change. And I may not be that person who who can help facilitate or be the co-team person in that instance, because there are so many different ways to create and change a pain experience. So I do feel like there is always a potential to heal. Always always always. And I’m sure you feel that way too.

I: I do I absolutely do, and I have that same sense of it, and I think that’s partly why I’m so excited to be doing these interviews with other practitioners who are like-minded and have this broader understanding of how to work with one part –  like one organ, or one system, or the results of one or two or three surgeries that are not doing so great right now. But the reason I’m so excited to talk to other practitioners about this is because I really do think that same thing. There’s always hope. I I have yet to talk to anybody, even in the most dire circumstances, that I don’t think there is something that can be done here. It’s just a matter of figuring out what combination of things, or which person is going to be your best guide in that. I do I agree completely, there’s always hope. So I just want to talk briefly about the extra certifications, some of the certifications that you hold. One of them (actually the way that I got interested in your work) is the Restorative Movement. Is that what it’s still called?

S: It was Restorative Exercise, and she’s rebranded and it’s now Nutritious Movement. I got into the program because when I was first in the niche and doing my the pelvic health courses, I’m not going to lie, I was really I was overwhelmed and excited at the same time. Because it wasn’t just the musculoskeletal system, it wasn’t just the pelvic floor, it’s all these systems. It’s reproductive, it’s urinary, its digestive, and they’re all kind of wound up together usually. 

And so we have this list-serve where we clinicians can share clinical stuff. And one of the things that we learn in pelvic health is that a lot of the rehab is the pelvic floor contraction – the Kegel. And doing different types of Kegels to help to get the pelvic floor back online. And what I was noticing with my clients is some people did really well with that. It was kind of a protocol, and they did well with it. And a lot of people didn’t, so I was like what’s going on?

So in this list-serve, someone had posted a blog that was written about this woman Katie Bowman who was the creator of this program. She was talking about no more Kegels. So really rather than looking at the muscle in isolation, looking at how the pelvis is used bio-mechanically in functional movement, and how can we look at the muscles in opposition, and how is the pelvic floor being positioned in a day-to-day basis, and our sitting and our standing habits or pressures and all this kind of stuff. And to me it was fascinating because I it kind of clicked. It’s like oh maybe maybe this is this is the piece of the puzzle that i’m missing with these clients who aren’t responding very well. 

So i just devoured everything on her website and noticed that she was doing a training. And so for seven months, one weekend a month I would fly to Ventura, California and I would do the training. So now the course is all online, but I’m kind of hands-on person anyway, so I really I really enjoy that experience, I think it was really great. And that really solidified for me, I had always been someone who looked at the whole body, there’s another posture method that I had studied as well. But this one really made sense to me and I really saw big changes in everything that I shared with my clients.

And personally, I had chronic back pain and hip pain, SI stuff for 10 years. And when i started to pay attention to how I was carrying myself, how I was holding tensions, and giving myself more opportunity to load myself better, within three months I was pain-free. 

I: Wow that’s so fast that’s amazing! 

S: It’s like one of those things, one of the days you wake up like “oh well I don’t know, I’m not having pain, what’s going on?” so it wasn’t something that was actually “I’m doing this to get out of pain,” it was just something that happened when I started becoming more aware of the day-to-day stuff. More and more I hear from other people it makes sense, and so it’s something to me that I can really share with people. Because it’s just about bringing the connections, better loading, bringing the mind into everyday things that become so automatic. So for me it’s a really powerful tool, and it’s a different perspective.

I: That’s all so exciting to me, I love it! One of the things that I actually wanted to bring out for people who are watching this, and maybe are interested in working with you: can you tell me a little bit how you work with people? Because i know you have of course your in person practice, but I know that you also have Skype sessions with people so that they can work with you if they’re not where you are. Can you talk about that a little bit?

S: Yeah, so this Nutritious Movement – this alignment based work – it really provides a useful way to be able to not necessarily have to be one-to-one with somebody. Because a lot of it is visual, like how are you moving, and be able to share with people some of the markers for them to start paying attention to how and what they’re doing. So a lot of that educational piece, and I’m really big on on sharing information, and providing education, and re-educating muscles, so this piece that I like to do, and one-on-one, it really carries over well to Skype. So people who are familiar with the restorative exercise who are in training, it’s nice to have another set of eyes, so we’ll do a session through Skype. 

But also I work with people who have some pelvic stuff going on and it’s nice to be able to give just a session or two of kind of that intro information, because even with that people can make some some big changes. So there’s that Skype piece, I’m really a hands-on person, I feel like that’s something that I really enjoyed doing, I love manual work, I’ve done different trainings just to have have other tools in my belt. I love doing just basic soft tissue work and getting in and changing the neurology of the system. So typically when I work with somebody, a lot of it is (in the beginning), let’s see what’s going on, let me let me watch you move, let me feel your joint movements, let’s tickle your tissue flexibility, all that kind of stuff. And let’s see what is going to be the best strategy keeping a home program very very simple. 

I usually don’t give more than three movement sequences or stretches or exercises. Sometimes it’ll just be one or two, but max is usually three. I think when we do more than that, it kind of can get overwhelming, and so I want to just narrow it down to some key movements that are really going to help bring the body into better balance. So there’s that piece, and then I usually spend some time doing some of the hands-on stuff.

I: That’s so fantastic. What you were saying about that you love sharing the information and you love giving this information to people and kind of educating so much about that, I feel like that’s one of the things that we share most strongly, is our desire to help people have this for themselves. And I will say that your website is so robust – you have your blog and your podcast, and your blog is so great it has so many short videos about movement movement pieces that you can do to help start realigning things, and everything you do is so high quality and so beautifully done, I’m so excited to send people your way. I think they can get a lot out of the work that you do. 

S: Thank you, the blog piece is fun, and I really enjoy putting that information out there. I love it when people will comment and share with me “hey I did this, etc., and I’m totally out of pain, and that’s just through doing these exercises in the blog.” So that kind of stuff is super powerful. There’s so much stuff out there I really just love to put out little snippets. 

I don’t know if this happens with you in your office but sometimes when people come in, there seem to be themes. So people will come in with like “it’s all very similar,” so it’s like, okay I’m learning something here, so all right, let’s let’s see what might be helpful, what’s a good movement that can really address some of these things. And that’s what I like to do, so i’ll share that in a blog usually is what i’ll do. I love to do a little bit of info, but then really get more to the motion. 

I think part of what I’ve started to do with my blogs too, is I know myself and it’s like I need to cut to the chase, because for me if something is long it’s like, “oh man, come on, cut to the chase,” so I’m really trying to do as much as I can smaller snippets just to show the motion and get on with it. And I know a lot of times I have a tendency to talk and try and explain, and I’m like “ah!” I need to just share it, I need to just put it out there, do the movement, and then the movement will speak for itself usually.

I: That’s amazing, and I think I do the same thing, I tend to over explain everything. So I love that you’re working with that and just really working on giving the movement getting people doing it actually, actually taking part in it. I think that’s so fabulous. Great! So as we wrap up, please tell people where we can find you, and what’s the best way to get to your website, and all of that good stuff!

S: So my website is AlignForHealth.com so, www.AlignForHealth.com, and on my website like you said, I have podcasts, and yours should be up soon. I got to interview you last week, and the blog is there. Also I have sequences that have been tried and true in my office. So in my store page I have three different movement sequences that are helpful for low back, for hips, and for feet. And i’m going to start getting going on an upper body series. So those are just downloads there, you know, less than the cost of a Frappuccino, so it’s definitely worth getting into. But you can also find me on Facebook, my page is Align Integration And Movement that’s my business facebook.

I: Fabulous! Well, thank you so much and I just really appreciate you taking the time to do this today and I look forward to us communicating and collaborating more in the future!

S: Likewise, thanks Isabel.

Author Profile

Isabel Spradlin
Isabel Spradlin
Isabel Spradlin is a Registered Nurse (RN), Licensed Massage Therapist (LMT), and abdominal adhesion specialist in Portland, OR. She specializes in educating people about manual treatment (massage) for abdominal pain and dysfunction, especially when it is adhesion related. Please see the "Programs" page to see her offerings.

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