Where do fitness and pelvic health overlap?
A conversation between a pelvic floor therapist and me!
If you’ve been around here for a while, you know I’m at least mildly obsessed with the pelvic floor. It’s an area of focus for my work, and I’ve personally witnessed how powerful it can be when you get relief from symptoms of pelvic floor dysfunction:
I’ve talked about pelvic health a few times here as well:
I was so psyched to “meet” pelvic floor therapist
here on Substack a few months ago, and you may recall our conversation about, as Cait calls them, “illegal kegels”:
Anyway, Cait has become a beloved Substack pal, and last month she asked to interview me for her newsletter,
. She kindly gave me permission to republish the interview here, and I hope you enjoy! Please subscribe to Cait’s work if you can — she’s just so great. (This “do I need pelvic floor therapy” self-assessment quiz is genius.)OK, letting Cait take it away below (the intro to the interview is in her voice):
After my substack therapy session earlier this week, it got me thinking a lot about interdisciplinary collaborations in the pelvic floor world. We so often work in silos, but there’s a whole world of folks who support pelvic floors out there: urogynecologists and OB/GYNs, obvs, but also — personal trainers, pilates, yoga, and other fitness instructors — the list goes on.
And some of these folks are absolutely fantastic assets to a treatment team. I personally feel that fitness trainers are a pretty underutilized resource. Anna Maltby is one such amazing human. She’s a personal trainer with serious pelvic floor chopsanda great journalist (if you aren’t subscribed to How to Move, an anti-diet newsletter on exercise, you’re really missing out). So when I thought about interviewing a personal trainer on the intersection of pelvic health, personal training, and pelvic floor therapy, Anna seemed like the obvious choice.
Let’s do this! Anna and I talk about the breakdown between pelvic floor therapy and personal training, what to look for in a trainer (and what to look for in a red flag), and when you might want to see either or both! Anna drops an insane amount of wisdom re: the nuance of finding a trainer who knows their shit. Plus we discover a mutual colleague/friend in the best small world moment!
Cait: So despite being a huge fan of yours, I know very little about how you came to personal training as a professional pursuit. Can you tell me about that journey, and how it intersects with your personal relationship to and knowledge of pelvic health?
Anna: My background is mainly as a journalist and magazine editor. I went to j-school in Chicago and moved to New York to work in magazines. I kind of fell into the health magazine space, and eventually fell into fitness editing specifically. When I had my first job as a fitness editor, we ran a lot of workout stories with original photos. We'd hire a model and hire a personal trainer to come on-set to oversee the form. I knew a couple of fitness editors who were also CPTs, and got to thinking that my company could probably pay for me to become a CPT and end up saving money on hiring someone to come on set (since I had to be there anyway!).
So I did that in 2015 — and by the way, that magazine was Fit Pregnancy, so from the beginning I was extremely curious about prenatal and postpartum wellbeing, pelvic health, and the like. Interest in this area was definitely baked in to my "fitness professional" journey from the get go. Anyway, I have been certified ever since — including taking specialty courses in functional training and prenatal and postpartum exercise, and I also did my mat Pilates certifications (beginner and intermediate) in 2021. But I never actually trained clients until four years ago, when I took a buyout from what I call my "final" staff editor job (though who knows!). I'd just finished my Pilates certs and really loved the practice teaching I'd done, and decided to go freelance and take on a few training clients as part of my constellation of freelance work.
I've been doing that ever since! Training folks and doing various editorial-related jobs, almost all of which also intersect with fitness in some way. A big one of these was the (M)ove Like a Mother program I helped create for Nike back in 2022: I served as editorial and fitness director, which essentially meant I helped create all the content and oversaw all the exercise guidance. I loved doing this project for Nike because they are so well resourced and truly listened to my recommendations even when they were a little expensive or took extra time, which among other things insisted that I assemble an advisory board with a brilliant pelvic floor therapist, OB/GYN, and other experts.
Despite having had a prenatal/postpartum certification for several years and having had two babies by this point, my collaboration with the pelvic PT on my advisory board — Laurel Proulx, PT, DPT, PhD — taught me SO MUCH about the pelvic floor, including that A) a lot of what I'd been taught was not quite accurate and B) I had been experiencing pelvic floor dysfunction for many years and just thought it was normal.
(As a side note, (M)ove Like a Mother is still available in the Nike Training Club app and it's completely free! I highly recommend it for prenatal and postpartum folks who want an evidence-based, easy-to-follow exercise program.)
So I got pelvic floor therapy myself for the first time (shoutout to the amazing Molly Caughlan here in Brooklyn!), which was life changing — I was experiencing urinary frequency and went from having to pee at least once an hour to only having to go a few times a day — and then got a new and much better postpartum certification, through the incredible Jessie Mundell, who is the BEST and whose certs are so comprehensive, so inclusive, and so intersectional, I can't sing her praises enough. (I'm currently working through her prenatal cert.)
Cait: OMG I MENTOR MOLLY!
Anna: OMG no wayyyy. She is so great. My close friend is a professional dancer and had horrible pubic symphysis pain during pregnancy; she saw Molly and recommended her to me — I feel like when a pro athlete recommends a therapist you know they're gonna be good :-) I've also collaborated with Molly to support a few of her postpartum patients too!
Cait: Gah, that’s amazing! I’m loving our small world.
Okay, so I'm loving hearing about your background because it's so hard core and amazing and also you highlight one of the points I've been thinking about a lot lately -- that a lot of what you were initially taught is in fact inaccurate. Can you tell me a little bit more about that, and maybe give an easy example?
Anna: I think the big thing my initial education left out is just how common it is to have pelvic floor muscles that are overly tight and/or have trouble relaxing. It was very old-school in terms of the focus on kegels and keeping the pelvic floor as strong as possible. There was also a lot of misinformation about diastasis recti — I really had no idea that you could have a pretty damn functional core canister and few if any symptoms and still have a noticeable, visible separation. That's not to say that diastasis recti isn't a big deal or doesn't warrant attention or treatment, but I think I'd learned a lot of scary stuff about it when really it's super common — and aesthetics do not predict function.
Cait: Yes! Aesthetics are totally valid but not everything when it comes to function. And this leads me to thinking about the breakdown and hopefully harmonization of personal trainers and pelvic floor therapists. Since so much of pelvic floor recovery is often full body strength and pattern optimization, I see personal trainers as invaluable team members and assets. But I also feel like truly competent and informed trainers are rare gems.
What do you feel like folks should be looking for in a personal trainer if they're coming in during any part of the perinatal period, or are struggling with a non-perinatal pelvic floor challenge like endometriosis? Are there any specific trainings you'd recommend looking for, or alternatively -- any red flags to avoid?
Anna: This is such a hard one. As I'm sure you know, the world of fitness certifications — ESPECIALLY specialty certs — is a bit wide and wild. There are so many out there and not all of them are well-vetted, even if the major players (ACE, NASM, etc.) accept them for continuing education credits. So if you're looking at a trainer who has some kind of pelvic health or perinatal cert, that's a great start, but doesn't necessarily mean their knowledge is up to date with the latest research and approaches.
I can certainly say that Jessie Mundell's certs are excellent. I know that Pregnancy and Postpartum Athleticism is also highly regarded. I have heard good things about the prenatal and postpartum coaching certs from Girls Gone Strong, and I think the AFPA prenatal and postpartum cert is pretty well regarded too.
I feel like your best bet is generally word of mouth, although of course that has to be taken with a grain of salt as well, because you may be getting a rec from a friend who had a super uncomplicated situation — or maybe one that was complicated in a way that's totally different from yours, and the trainer in question was great with your friend's situation but wouldn't be awesome with yours.
Ugh, it's so hard and frustrating! I will say, a lot of trainers are on social media now, and a bit of vetting of what they're sharing there about pelvic health, if anything, could help as well. Are they recommending illegal kegels? (Ha!) Are they giving generic recs across the board without giving caveats about individual circumstances? There are some red flags you can look for there.
I also think in addition to pelvic health knowledge, looking out for inclusive language in terms of gender and bodies can be helpful too, beyond it just being a good and ethical approach. Even if you are cisgender and live in a smaller body, someone who spends the time and effort on being thoughtful on inclusivity is often also humble enough to keep pushing their education and making sure the guidance they're providing is as accurate as possible. It's kind of a green flag.
Cait: Yessss. I love this!
Where do you feel like the line is between personal training and pelvic floor therapy is, specifically in the context of therapeutic exercise? I ask because I frequently work with clients who need movement as their primary rehab tool, and sometimes we get to a place where it feels like what they need is consistency and accountability with basic, solid strength training -- that's when I recommend personal training! But I'm so curious to know about the personal trainer perspective. When do you refer out?
Anna: The big thing for me is, I am not qualified to diagnose or treat pelvic floor dysfunction. I can often provide a really good guess based on symptoms and movement patterns, but I am not a pelvic floor therapist and do not have the education required — and I certainly cannot and will not do an internal exam, which is often also very important on the road to figuring out WTF is going on. Especially since, as you and I have discussed, people can have quite a range of situations going on down there, with one side being tight and the other being weak, or front/back, etc. It's just not in my dance space to sort all of that out! If someone is symptomatic, I really encourage them to see a qualified PF therapist either before we work together, or as we continue working together — and then I want to talk to that therapist to find out from the horse's mouth what's going on and how they want me to tackle it.
There are also times when someone is experiencing back pain, hip pain or tightness, that kind of thing, when I suspect that there may be a pelvic floor situation and want them to get it checked out. Not always but sometimes!
Full-body movement, strength training, all of that is as you say often kind of the biggest thing for the pelvic floor. But there are also times when you really need some individualized treatment that specifically works on the pelvic floor muscles — manual release, some evaluation of what's going on when you breathe and move etc. — and that's where a qualified pelvic floor therapist comes in.
I've talked to therapists who've said they really love when they get to collaborate with a personal trainer because they typically get to see their patients so few times, and trainers often see people on a much longer-term basis. So if we can work together, I can kind of put into practice what the therapist wants their patient to be doing consistently. I think of it like the therapist's work is the foundation, and then we get to build on top of that together.
Cait: Yes!! (Claps furiously) I totally agree re the dynamic of collaborating with personal trainers and seeing my clients less. I like to be pretty minimal with my clients, but personal trainers make that possible. I feel like it should be a new model of care in pelvic health clinics!
Thank you so much for your time and wisdom! Is there anything else you feel like folks considering personal training should be aware of?
Anna: It's been so fun to chat about this with you. I know personal training can be a big investment but when you find the right person it's so worth it. It's really amazing to build a longer-term relationship with someone and work with them through different seasons of life. (I also just love this personally. I have clients I've worked with for three or four years now and have just seen them through so many things!) And just to have the trust and confidence required to be open about what's going on with your body. I think it's also worth noting that, again, it can be hard to find that perfect person, and it's really OK to try a couple of sessions with someone and change your mind and try someone else. It's a big compatibility thing and not everyone is going to be just right for you, so don't be afraid to change your mind — but also don't be afraid to provide feedback and share what you'd like to do more of and less of. We're always learning too!
I can certainly plug my newsletter here as well: I provide weekly video-based workouts (almost always strength, but sometimes Pilates or mobility!), monthly strength-training programming, and other helpful guidance. I also just started providing an "office hours" option where you can sign up for a half-hour chat and we can troubleshoot what's going on with you exercise-wise. It's not the same as 1:1 personal training but it's great fun and SO much more affordable.
Hope you enjoyed! Talk soon.
xo
Anna