About Sheela Zelmer

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Breath, Core and Pelvic Floor

About This Episode

Sheela and Kathryn talk about the pelvic floor, core engagement, and breath. Sheela brings more nuance to this conversation as they discus 360 breath, and core tissue adaptation. They cover breath timing with movement, and why we can’t always time our breath with the way we move. They also get into the term “pelvic floor dysfunction” and why in some cases this word choice can be problematic. This is an updated approach to core rehabilitation, and will only elevate your knowledge of your core.

Podcast Transcription

Kathryn:

All right, Sheela. Welcome to the podcast.

Sheela Zelmer:

Thank you so much, Kathryn. I’m so excited to be here.

Kathryn: 00:02:57

Yeah. Me too. I noticed that you live in Newmarket, Ontario. And I grew up in Toronto. And mostly, when I’m interviewing people, it’s very, very international. And so it’s kind of nice to talk to somebody who also lives in Ontario. So thank you for being here.

Sheela Zelmer: 00:03:14

Thanks. Yeah. We’re neighbors. Awesome.

Kathryn: 00:03:16

For the listeners who maybe don’t know about you or the type of work that you do, will you take a few minutes and tell them a little bit about who you are and your work and maybe how you got into it?

Sheela Zelmer: 00:03:26

Yeah. For sure. So I am a pelvic floor physiotherapist, which means that I treat issues that are below the waist, so issues like bladder leakage, bladder control, issues with sex where sex might be painful or tight, or difficulties with orgasms, as well as things like prolapse. I’m also a women’s health coach, so I go beyond physio and talk about nutrition and mindset, sleep, diet, all of those kinds of things.

As well, I’m also an instructor for the postgrad pelvic physio program with Pelvic Health Solutions. So I kind of wear a whole bunch of different hats. And I’m the founder of the Below Your Belt Method, which is a program for women that want to have better bladder control and a great sex life.

Kathryn: 00:04:14

So what do bladder control and sex life have to do with each other?

Sheela Zelmer: 00:04:19

So I think, when we think of the area below your waist, I think, sometimes, we are either familiar with our vulva and vagina and rectum or sometimes, we’re not. We just kind of take it for granted and assume that it’s all good. But the reality is that we have muscles that are in our pelvis.

They are inside the vagina, the rectum. They fill that whole pelvic cavity. And just like any other muscle in our body, we can have issues where these muscles are not doing their job. And so in that case, we can end up with concerns, like our bladder control might not be great. It might be difficult for us to have intercourse, or maybe we can’t achieve an orgasm because all of those things imply that the pelvic floor muscles are not doing their job.

Kathryn: 00:05:06

Okay. So will you start, for people who maybe don’t know exactly what you mean when you say pelvic floor muscles – and maybe, if we can find a good picture for this, we’ll even add it to the show notes, but – can you describe a little bit of what the pelvic floor muscles look like, where they attach to, just some really basic anatomy?

Sheela Zelmer: 00:05:29

Yeah, yeah. Totally, because it’s great that you ask because I think I get so wrapped up in doing what I do that I assume, so for sure. The pelvic floor is a group of muscles that starts from the pubic bone in the front, and it runs all the way to the tailbone in the back, kind of think like a sumo wrestler diaper that runs all the way across. It also runs from sitting bone to sitting bone, so it’s bowl-shaped.

And it has five big jobs. One of them is to act as a sphincter. So we think about that like controlling our bladder or controlling our bowel. It also has a support role. It lifts our bladder, uterus, and rectum. It acts as a sump pump, so it pumps fluid and excess fluid and circulation from our legs and lower body back up to our heart so that we don’t get a lot of swelling.

It also acts as a stabilizer, so it works with the rest of our core muscles to provide stability. And of course, it has a sexual function. It has to relax to have any kind of penetration. But it also has to be strong and toned in order to have good stimulation and to have an orgasm.

Kathryn: 00:06:33

So the one thing that I haven’t heard so much of– I’ve had a few different conversations with pelvic physios. But one thing that I’ve never really heard anyone talk about so much is the sump pump action. And I’m wondering if you could tell us a little bit more about that, and how does that work?

Sheela Zelmer: 00:06:47

Well, 40% of our body’s lymphatic system– so the lymphatic system is a waste sort of disposal system. 40% of that is actually in the pelvis. And so we have all these veins and arteries that are responsible for increasing our circulation, getting rid of waste, pumping fresh blood.

And a lot of that is right in the pelvis. And so when we have muscles that are not functioning optimally– so all of those things that I described, those five functions, are the functions of the pelvic floor.

But if the pelvic floor is not doing its job, we call that dysfunction, so having all the swelling in our legs or even things like hemorrhoids, varicose veins that can form in the vulva, around the groin. All of that is the sign that the sump pump feature is not working properly.

Kathryn: 00:07:34

And then how do people start to work on that sump pump feature? Is it exercises? Is it alignment changes, positional changes? How can people start to go through that?

Sheela Zelmer: 00:07:47

So our pelvic floor doesn’t work in isolation. Our pelvic floor is part of a whole unit that goes with our abdominal muscles, our back muscles, so like our core if we think about it that way, but also our diaphragm, our breathing muscle. Each one of those is listening and reading the other ones and responding to the demands that are placed on it.

And so when we talk about something like, say, for example, the sump pump or anything, even if it’s something like bladder leakage, we need to make sure that those muscles are working in a whole system, that we don’t have too much ab activation. So someone who is habitually clenching their tummy all the time, maybe they fell self-conscious about themselves and their clothing. Maybe they have back pain, so they’ve learned to sort of hold their abdominal muscles in all the time.

That’s a lot of pressure that the pelvic floor is perceiving from above. And so it’s got to be able to work in conjunction with everybody else. If somebody’s overworking, it has to understand. So simply doing exercises, which are Kegels – that’s usually what people think of when they think of pelvic floor exercise – it’s not as simple as that because it depends on what their body requires. Do they have too much activation or not enough?

Kathryn: 00:08:58

Oh, so many good things. I feel like we’re getting right into all of the big questions I wanted to ask you. I was going to ask you about isolation of pelvic floor exercises. I was going to ask you about breath and core and the whole body core situation. So wow, we are getting right into this.

Sheela Zelmer: 00:09:16

Okay. Awesome.

Kathryn: 00:09:18

So how might somebody– aside from going to a physiotherapist or their healthcare provider, how might somebody start to navigate their own pelvic floor stuff to be able to tell, “Is my pelvic floor functioning optimally? Is there some type of dysfunction going on?” How can people start to just even consider that?

Sheela Zelmer: 00:09:40

So the first thing that I would say is, if you are experiencing– and I’m going to go for the big ones that are common. So if you’re experiencing anything like feeling like you are not going to quite make it to the toilet or you can’t quite get your pants down quickly enough because you’re going to pee yourself, or that you’re leaking when you cough or sneeze, those quite common things.

I find, a lot of times, women will just discount it, saying, “Oh, well, I’ve had kids. Of course, I leak,” or, “Oh, I’m going through menopause. Of course, I have these issues.” Those things are not normal. So right away, if you’re experiencing things like bladder control issues, urgency and frequency, but also things like painful sex, difficulty reaching an orgasm, a lot of swelling in your pelvis, like hemorrhoids, varicose veins, that kind of things, prolapse, a feeling of heaviness, these are all signs that you do need to address the pelvic floor.

We need to start thinking that there is something that could be optimized here, as opposed to just thinking, “Well, this is just normal, and I’m going to live with it.” So I would encourage everybody to recognize that, if something’s going on, it’s worth a pause and asking yourself, “Hey, can I optimize this in some way, shape, or form?”

Kathryn: 00:10:55

Can I ask you about the term pelvic floor dysfunction? I’ve been just kind of pondering this word a lot. And I think this gets thrown around a lot, especially in my industry, which is more like movement and exercise.

And I’ve also been studying pain science and the biopsychosocial model quite a bit over the last couple of years. And I’m just wondering about the word pelvic floor dysfunction. And I guess, what does it mean? Why are we using that term in particular? And do you think it has some negative feelings that people could maybe take from that and then maybe not feel so good about themselves on more of a psychosocial level?

Sheela Zelmer: 00:11:38

Totally. So when we think about things psychosocially, psycho, we’re concerned about our thoughts, about our feelings, because our thoughts are nerve impulses too, right? So when we are thinking negative thoughts or we have a negative perspective on things, it does shape how we perceive things.

So I’m going to use the example. If we talk about our period, for example, we call it the curse. We dread it, that time of the month, aunt flow. All these sort of negative connotations, that forms our view of how we perceive our period. So for sure, using a term like dysfunction, which is a very medicalized term– so when I use that term, that definitely is something that you will find will be communicated by a doctor, or it’ll be in a medical journal or something. It’s basically an umbrella term to indicate that the job that the pelvic floor is supposed to be doing, it’s not doing it.

And so again, from that social aspect of psychosocial, social is sort of like our identity, how we see ourselves. So if I was to use the example of a woman who is leaking when she, say, goes to workout, she’s going to her exercise class, and she’s noticing that she’s leaking. And so she now has this self-consciousness, this concern about odor, about wetness, about the bulky pad, and everything.hat shapes how she sees herself as a woman.

That shapes how she sees herself as someone who is attractive, as someone who is vital. And so it is important that we recognize that some of our language, as in saying pelvic floor dysfunction, can be scary for some people and not necessarily helpful. But I guess I want to use that term to sort of illustrate that these things that we experience are not something that you should just accept blindly, like leakage, pain. Those are never things that we should just accept. It is something that warrants attention, for sure.

Kathryn: 00:13:33

Cool. Awesome. That’s super helpful. I’ve been thinking about this a lot, and I have not formally asked anyone yet on the podcast, so thank you.

Sheela Zelmer: 00:13:41

Yes. Okay.

Kathryn: 00:13:42

How did you get so into this stuff? Why pelvic floor physiotherapy? Why do you have this emphasis on the bladder and women’s health?

Sheela Zelmer: 00:13:50

So I’ve been a physio for almost 26 years. And I think, when you sort of have been doing something for a while, you start to think like, “What’s next?” So I had probably been working for about 18 years. And I’m thinking like, “My 20-year sort of physio anniversary is coming up. What’s next for me?” I don’t want to open up a clinic, but I want to do something else.

And I really believe in messages coming to us, and I just felt like– I have a peer mentor. I have colleagues that I really value, and I was hashing all of this out. And at the same time, I’m getting flyers that are being mailed from my professional association talking about training for pelvic floor. And so I thought, “Okay. Is this a sign? What do I think? Is this what I want to do? How do I feel about this?” And I had a great mentor who said, “You’re not going to know until you try. You got to do it. You may love it.”

And after the first course, the first morning coffee break, I called my husband and said, “This was what I was meant to do.”.So that was six years ago, and it’s all I do now. So it is such a wonderful profession.

And it is fantastic to allow women to understand their body to feel empowered because I think, as women, we have a lot of fear and misunderstanding about what’s going on. And we have a lot of shame about asking, and so I am grateful to be able to share with the clients that I serve.

Kathryn: 00:15:17

And does your practice include a variety of counseling and exercise and manual therapy? Or do you focus more on one than the others, or are there other things you do?

Sheela Zelmer: 00:15:29

So because I wear multiple hats– so as a pelvic physio, I focus sort of within my scope of practice, as in I’m treating the muscle dysfunction that I’m seeing, the postural dysfunction, exercises, and things like that. And when it comes to nutrition recommendations, some lifestyle stuff, I have a great network of colleagues that I will often refer people to.

But it was in this health coaching sort of umbrella that I expanded and did nutrition training and exercise training and stress management training, libido, sort of psychosocial training. And that is what I’ve formed to sort of help women put the pieces together because I feel like, a lot of times, we are searching for things. And we’re looking in a whole bunch of different areas, and there’s not a lot of overlap. So that’s kind of why I developed that program to put it all together.

Kathryn: 00:16:20

Cool. When you talk about nutrition, I think some people might be wondering, like, “What does nutrition have to do with my pelvic floor?”

Sheela Zelmer: 00:16:27

So our pelvic floor muscles respond to our hormones. And so over the course of our life, from when we begin to menstruate on to our childbearing years and then into perimenopause and then post-menopause, we are subject to a lot of different hormonal changes, hormonal surges and falls.

We can have issues with infertility. We can have issues with period difficulties, challenges with menopause. There could be all kinds of things along the line. But some of the biggest chemical messengers in our body is the food that we eat. It affects our hormones on a very, very intimate level. And if we think of all the hormones in our body– we are aware of things like insulin, for example.

But insulin itself is a hormone, and insulin works with our sex hormones too. So making sure that we are eating a good diet and a diet that is designed to optimize our hormone health is really important.

So again, that’s kind of the stuff I do as a health coach, to make sure that women are addressing things so that their bowels are functioning properly because our bowels are how we eliminate excess hormones.

We want to make sure that we’re consuming the right kinds of fruits and vegetables to optimize the good kinds of hormones as opposed to hormones that are giving us hot flashes or breast tenderness or moodiness around our period. So it’s a big topic. But food, for sure, is a hormone messenger.

Kathryn: 00:17:48

Okay. I want to come back to the pelvic floor and the core. So I think that people have a lot of misconceptions about their core and even how it should look or what they’re supposed to do with it.

I think this is probably one of the most misunderstood parts of the body. People have, I would say, relatively functional ideas about what they should do with their shoulders or their leg muscles or something like that. But we have a lot of really varied ideas about the core. And I’m wondering if you could share with us your definition or description of the core and where it is in the body. And what does it include?

Sheela Zelmer: 00:19:23

Oh, wow. Okay. So that’s a big topic. And so what I would say is the core is the whole synergy of the pressure canister. So that sounds like a big term, but I would consider it like a cylinder of our diaphragm on the top, our abdominal muscles in the front, our back muscles around the back, and the pelvic floor on the bottom. And the core’s job is basically transmission of force, right?

So if we need to lift, it needs to provide some stability and counter-pressure so our legs and arms can do the work so that we’re not pooping ourselves if we force and strain too hard, for example. So there’s a lot of synergy that these muscles have got to work together. So it’s like I can’t even see it as one piece. It’s one big unit, and it all has to work together, everybody reading each other. And the challenge is we develop bad habits.

I find a lot of people are tummy holders. Some people might even be breath holders, or they’re very shallow breathers. And in each of those cases, that part of the system, that part of the four pieces of the core is not doing its job properly.
So everybody else has to either kick in the extra effort or you function on less, right? So if we use the example of someone who’s always clenching their tummy in, for example, if I’m holding it in– and even right now, the listeners, if you were to try to hold in your stomach, engage your stomach as though you were trying to make your stomach quite flat– now, try to do that and take a deep breath in. It’s really hard to do that.

Try to do that and cough or sneeze at the same time. It’s almost impossible. And so when that happens, force is pushed around all over the place. And that’s how we can end up with things like leakage, for example, or back pain, right? So the back muscle’s overworking because the stomach is clenching so hard all the time.

Kathryn: 00:21:16

Yeah. This is huge. I noticed myself, probably from years and years of movement practice where the teacher would say, “Pull your navel to your spine. Now, take a deep breath in.” I have some really interesting habits around pulling my stomach in and pulling my navel in all the time, which I don’t think are super helpful.

And even when you just said that, when you said, “Okay. So if you’re listening and you notice that you’re pulling your navel in, notice what it feels like to take a breath,” I had a moment. I was like, “Why am I pulling my navel in right now? I’m sitting in this chair. I’m by myself. I’m relatively relaxed. This is not a time where I need to be engaging my core like I’m doing a big deadlift.”.

But it’s so interesting because it’s such a habit, even for someone like me who is super aware and has heard this messaging time and time again. It is extremely habitual.

Sheela Zelmer: 00:22:07

Well, it is. And I think, many of us, we don’t even realize where we got it from. I know my mother was very much a person who talked about posture. This is like family of origin. Posture, hold your stomach in. Keep nice and aligned. And so I learned that habit. And like you said, if we’re sitting in a chair right now, this is not hard work. We should not be engaging and gripping with our abdominal muscles just to simply sit in a chair, right?

And I often find clients have developed this habit, maybe because they’ve had a history of, say, lower back pain. And somewhere along the line, someone has sort of told them, “You need to have stronger abdominal muscles to protect your back.” And so they internalize that as, “I need to keep my abs on all the time.” But if we think about your torso, okay, as a balloon that’s inflated, right, and it’s tied off– so it’s an inflated balloon. We have the stomach in the front, the back muscles in the back.

The diaphragm is at the top of the balloon, and the pelvic floor is along the bottom.If I squeeze the stomach of the front part really hard, it’s going to push out the bottom. And so you’re going to have the pelvic floor that therefore has to work extra hard. If not, it’s going to bulge down below.

Nobody wants to pee when they’re holding their tummy in. So what does our pelvic floor do? It engages to meet that pressure. And it’s a matter of recognizing that we are over-training the whole system. And by far, by far, more people are overactive in their pelvic floor than underactive, and so recognizing that and learning to let it go.

And half the time, we don’t even know how to do that, right? We don’t even know what we’re talking about is challenging for people.

Kathryn: 00:23:49

Yeah. Okay. So you mentioned the balloon. There are some great pictures of this online. I think Julie Wiebe has a really good photo. Maybe I’ll ask her if we can use this in our show notes. I’ll send her an email. Yeah, so there is this idea of the core. It’s like this fully pressurized system.

So if you squeeze the front, the pressure’s got to go somewhere else because there’s no empty space in there. And I think, when we explain that to people, they really start to get it. They start to be like, “Oh. Okay.” So pulling the front of the belly in is actually affecting the other parts of this canister and the intra-abdominal pressure. So in my work, I teach a lot of this thing that we call the 360 breath.

So we breathe into all sides of the rib cage and focus on that expansion, all the way down to the pelvic floor on the inhale, and then the shrinking back on the exhale. And I think this is quite common. And I find that people are usually super on board with it. And I don’t even really know what I think about this, so that’s why I want to ask you.

There are other comments about, “Well, what if somebody has a diastasis recti? Or what if somebody is experiencing a prolapse? Should they still allow this 360 core expansion to happen while they inhale?”

Sheela Zelmer: 00:25:06

Okay. So if we look at that as two different things, like prolapse versus diastasis recti– if we talk about diastasis recti, that linea alba, that seam down the center that is thinned and lacking tension and firmness that is causing the abdominal muscles to be, not only wider apart but not able to hold the pressure, the only way that kind of connective tissue grows and firms and responds and solidifies is by stress being placed on it.

So when we breathe, when we stretch it and it recoils, stretch it and it recoils, it recoils, and it becomes more tense. By keeping it immobilized– so oftentimes, a woman, after she’s had a baby, if she’s been diagnosed with diastasis recti and she’s self-conscious about the way her abdomen looks, she might then start to hold in her stomach, right?

But if we bring the stomach in, you’ve actually just put slack on that tissue. You haven’t firmed it up. You’ve actually made that seam a little bit more loose. Well, it’s not going to firm up in that position. We’re wanting to create tension in that area, create firmness. And so using that 360 breath is fantastic because that is a day-in, day-out, all the time thing that somebody can do.

Never mind this 10-minute exercise routine once a day. But this is something that is directly stimulating the way that those fibers, the collagen, is remodeling in that tissue.

Kathryn: 00:26:35

That’s such a great perspective. And what I’m hearing from you is those tissues in your abs are like the other tissues of your body, which need that little bit of progressive force to be applied, and the stress and the recovery. Very cool. Okay.

Sheela Zelmer: 00:26:52

Yeah, yeah. I think a lot of women– it’s changing now. But I’m going to say like two years ago, it seemed like everything in that post-baby fitness realm was, “Don’t do any abs until your diastasis is closed.”. That was the message. And I feel like people are understanding, “No, no.That’s not it.” You’re not going to firm that up until you start working it.

But it’s listening to our body. We say this a lot as health pros, fit pros, everything. But it really is a matter of saying, “If I am doing an ab exercise and my stomach is doming up like a tent, that means I need to pay attention. I need to revisit this exercise, change the way my body is doing it to see if I can make it not do that,” if that makes sense there.

Kathryn: 00:27:37

Yeah. I agree. I’ve heard a lot of recommendations about don’t do any ab work until your diastasis is completely healed. And I also hear a lot of, “And if you’re going to do ab work, of if you’re going to do a plank or go back to your class that you were doing, make sure you always keep it in. Make sure you always pull it in.” But what I’m hearing from you is it’s like there needs to be a little bit of control of the movement for things to start to adapt.

Sheela Zelmer: 00:28:03

Yeah. For sure. And the thing is, that’s why we can’t say that you should never do crunches or you should only do planks or you should just stick to band exercises because somebody may be able to control that force and do a crunch, do 100.

And in pilates, they can maybe do that. But everybody’s body is different. But a sign that your body is not bearing the force properly is that doming and tenting that happens down the center of your abdomen. If that’s happening, I would say you need to back it up until you can do the exercise at a level that you don’t see that.

Kathryn: 00:28:38

So is there any time that you think the 360 breath is contraindicated?

Sheela Zelmer: 00:28:45

No. I wouldn’t say so because that’s the normal way we’re supposed to breathe, right? I think we’ve gotten into this– we wear bras that are restrictive, so we don’t get this lateral extension out the side. We sit a lot, so our back’s against the chair. So we don’t get that expansion out the back.

But a 360 breath is the way we’re supposed to breathe, right? So I think it’s great. You asked me about prolapse, and I say even in that case because we are not pushing anything out– with that breath because, again, it shouldn’t be a forced breath. This is just a natural awareness of an expansion throughout the whole torso.

But we don’t want anybody pushing as they inhale because that is not great for prolapse.
But someone who has prolapse, we want that lengthening that happens with that breath so that on the exhale, the pelvic floor is going to recoil back up again and lift.

Kathryn: 00:29:31

Amazing. What do you think about timing breath with movement? So I come from a vinyasa asana kind of style of practice where it was like every single movement had a breath. And I’ve had to work hard to let that go [laughter] and go more with a natural breath and a different type of linking of breath and movement. And it seems like different modalities.

Pilates people, they have their own ideas about this stuff. And then you work with a personal trainer, and they have their own ideas about how you could use your breath. And what I hear a lot is that every time you exert yourself, it should be on an exhale. And I hear that a lot from the asana and pilates world. And then I was a competitive powerlifter for a couple of years. So when you’re lifting really heavy weights, no one is exhaling while they lift.

Sheela Zelmer: 00:30:24

No.

Kathryn: 00:30:25

It would just feel like a blood pressure disaster, an intra-abdominal pressure disaster. And so with these conflicting messages, how can people start to get more clear on breath with movement? How can we start to bring that together?

Sheela Zelmer: 00:30:39

So I think, if you can breathe with the movement, that’s what we want. We do want the exhale on the exertion, right? Or so you gave the example of Olympic weightlifting. What about moving a couch from one end of the room to the other? You’re not going to exhale the whole time that you’re dragging the couch across the room. It just doesn’t happen.

So we need to be functional because as much as the pelvic floor does lengthen when we inhale and recoil when we exhale, it works outside of that too. And there are times that we do need to hold our breath in order to generate the power like for Olympic weightlifting. And so when you’re running, for example, you’ve got exertion on every time your foot lands. Well, you’re going to be hyperventilating if you try to exhale every single time your foot lands. That’s not realistic, right?

So I think it depends on the sport. But I think the basic message, if I were to step back a little bit, is that the breath is important. And I think, for a long time, we haven’t paid attention to it. And so I would even encourage the listeners, just getting up and down the couch or just folding the laundry, reaching across and making the bed, are you holding your breath?

These are not hard activities. Yet, we fall into these habits where we’re not breathing properly. And so understanding that we need to breathe and the breathing is going to change depending on the activity because Olympic weightlifting is not the same as marathon running. And it’s not the same as jumping on the trampoline with your kids. And it’s not the same as doing housework. They’re all physical activities, but the type of breathing you’re going to need to do for all of those is different.

Kathryn: 00:32:13

And do you think that that is somewhat intuitive? If someone was really connected with themselves and their core and their breath, do you think they could start to kind of figure that out on their own?

Sheela Zelmer: 00:32:24

I’d think so. I think once people recognize what it feels like to breathe properly, what it feels like to let their abs go– I’m not saying pushing their tummy out, but to disengage so that you’re not constantly clenching your abs, to not clench your bum, to not be gripping with your vagina.

When people recognize that, then I do think it does become intuitive. You recognize, “Hey, I’m unloading the Costco order from the trunk. It’s a bit heavy, but I don’t need to be gripping with everything I’ve got in order to do this.” And so there is this sort of relaxation. And when we relax, we do breathe better, just like I gave that example.

If your abs are clenched in, you’re not going to breathe well. So when we learn to let those pieces go, identify that we’re over-recruiting, then our breath does become a bit more intuitive and a bit more natural.

Kathryn: 00:33:16

So there’s this idea that the amount of engagement should probably match the movement that you’re doing and the force that you’re interacting with?

Sheela Zelmer: 00:33:25

Yes, 100%. So imagine you came home from the grocery store. You had used the grocery store bags, and you had a whole bunch of different things in the bags. But you can’t see what’s in them. The bags are opaque, right?

You might have some tortillas and a loaf of bread in one, and a five-pound bag of apples in another. Your body doesn’t know what it’s going to be lifting, and so it has to respond on the fly to the amount of effort that’s involved. Now a five-pound of apples is still not heavy.

But maybe if it’s awkward – you’re reaching across the set to grab it – you are going to need a little bit more breath and core engagement to do that than to lift up the really light bag of bread.

Kathryn: 00:34:06

And do you think that your body just does that reflexively?

Sheela Zelmer: 00:34:10

Well, research says that it does, right? The properly functioning pelvic floor and whole canister is able to adjust. Now, sometimes, it doesn’t adjust beautifully. Again, if you lifted– you had five bags of five-pound apples, and then the sixth bag was just the loaf of bread.

Our body doesn’t necessarily know that I don’t need to recruit that much for the sixth bag. So it over-recruits, but then it quickly lets go, right? That is the way it should function properly, as opposed to, “I need to bend my knees, keep my spine straight, engage my core, lift up in the vagina,” just to lift this light bag of groceries.

Kathryn: 00:34:48

Right. Okay. Great. So I think that people have this idea [laughter] that, especially in certain types of movement practices, that they need to be thinking about their core throughout the entire movement practice. And I totally recognize that.

A bit of awareness is always a great thing, and being able to come back to that awareness and all of that. But I tend to think that there is sometimes an over-managing of what’s going on in the core in some of these styles of movement that are extremely low-skill, low-risk, low-load.

Sheela Zelmer: 00:35:20

For sure, and even something that is higher load. So let me use the example of running again. It’s not a big skill. If you have to run, you’d run. We know how to do it. We may not be great at it. We may not have great endurance.

But when we try to micromanage the heel strike, the breathe out, the arm pump, it is too much. It’s happening too quickly to look at all the moving parts and address it. So oftentimes, we’ll tell people, “Just run.”.

We’d focus on different variables outside of running, but it’s too much to put it all together. And so when you talk about, say, a pilates class, when we are so hypervigilant about belly button to my spine, pelvic floor lifted up or blueberry lifted in, exhale on this part, it becomes too much. And we’re not allowing our body to move the way it’s supposed to, right?

Kathryn: 00:36:13

Yeah. I think that’s extremely well said. And I also think that people have this– I don’t know if it’s a fear or just feelings. I guess, because we see so much low back pain imaging, even just watching commercials on the television, there’s all of these kind of like nociceptive images of low backs and all the things that can go wrong.

It’s just coming at us in so many different parts of our culture. And I wonder if a lot of that has made people a little bit more fearful of their backs and, therefore, fearful of not doing the right thing with their core.

Sheela Zelmer: 00:36:48

100%. And I think you can even put someone who maybe has a prolapsey feeling in that, although there’s not as much of that messaging. I’ve been working for a long time. And for sure, I’m going to say 15, 20 years ago when I started working, it was all about brace the back. Put a back brace on somebody. Teach them to engage their core all the time, abs, abs, abs, so that we can prevent back pain. That was sort of the idea.

Do all of this for the abs so that they won’t have another occurrence of the low back pain. And that was in the books that came out. It was in the style of exercising that was done. It was in the style of treatment, whether it was physio, chiro, osteopath, all of those things. That was sort of the flavor of the day. And the challenge is that’s just sort of continued to percolate. So you have this whole group of people that believe, “I have to protect my back by engaging my abs all the time whenever I do any exercise. If not, it’s going to go out.”.

And I’m using air quotes right now, the idea that it is that tenuous, that moving the wrong way during a yoga class could set it off. And for some people, they do have dysfunction that needs to be addressed. But this fear of what might happen, I think, keeps many of us sort of over-engaged and overlocked. And the research actually shows that that contributes to more pain when we are overactive all the time.

Kathryn: 00:38:13

Yeah. So how has it been for you as a clinician? Over 25 years navigating these changes in research, changing in opinion, probably changes in your training, what has that been like?

Sheela Zelmer: 00:38:25

So for sure, it’s interesting in the sense that practice patterns are hard to change. There was a period of time when I first started working. I was in downtown Toronto, and I worked at a clinic that was all back, lower back and neck. That’s all I saw all day, day in, day out. And you kind of get into this one mindset.

So when I talk about engaging your abs all the time, this is definitely something I taught patients. I taught people, “Oh. You need to keep your spine straight all the time. Don’t bend over. Bend at the knees,” all of this thought process to absorbing the research that says, “No.

We need to be more fluid. We need to get the tension out of the system.” And also, with the pain science – and you’ve talked about this – that we now have some of the things and the mechanisms from what is causing our pain or what works to help alleviate our pain.

It works, but it may not be for the reason we thought it was, right? The research is always coming out. The science is expanding. And some of the things that we were cautioning our clients against just aren’t true anymore.

So for me, being one of the instructors with the post-grad program has really kept me up to date on the current research because it’s always changing. And that’s the wonderful thing about physio. There is so much research. And when it comes to pelvic physio, there is a ton of research because it is definitely a very hot area of focus.

And so there’s a lot of good research and good quality, not just a single study like, “I saw one client, and this is what I observed,” but really good randomized controlled trials, really getting the nitty-gritty of why things are working and what’s associated with what.

Kathryn: 00:40:04

So great. I feel like we should wrap this up, but this has been incredible. I feel like people are going to listen to this and then a week later, listen again because there’s just so much. And you are a wealth of knowledge. Thank you so much for coming on the podcast. If you–

Sheela Zelmer: 00:40:18

This has been great.

Kathryn: 00:40:19

Yeah. Where can people find you if they want to go to your website or work with you? Or do you do stuff online? Why don’t you share all of that with the listeners?

Sheela Zelmer: 00:40:29

Yeah. So I am, of course, on social media. So I’m on Instagram and Facebook. I also have a Facebook group that is for women called the Women’s Health Community, and I’d love to have any of your listeners join.

And we talk about all kinds of women’s health issues and how it relates to our body and our life as a whole. And you can find me on my website, so sheelazelmer.com. And yeah, I’ll give you all the links to all of those things, for sure.

Kathryn: 00:40:56

Amazing. We’ll put the links in our show notes. We’re also going to transcribe the podcast. So if anyone wants to read along, they can also do that.

Sheela Zelmer: 00:41:06

That’s great.

Kathryn: 00:41:06

Sheela, thank you so much for coming on the podcast.

Sheela Zelmer: 00:41:09

Thank you so much for having me. This has been a lot of fun. I appreciate it.