22. Flipping the Script on Pelvic Pain in Pregnancy with Dr. Sinéad Dufour

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Show Notes

On today's podcast. I chat with Dr. Sinead Dufour about her work surrounding pregnancy related, pelvic girdle pain. And if that sounds complex, don't worry. All it means is pain in your pelvis during pregnancy or into the first year postpartum. We talk about the myth that relaxin is the cause of all of these pains in your pelvis and how we can better approach pain in general during pregnancy. So whether you're a clinician or currently pregnant and wanting to improve your pain. I know, you'll find this episode intriguing

You're listening to the Resource Doula Podcast, a place where we provide information to help you make informed healthcare decisions for yourself and your family.

Resources Mentioned

• APTA Pelvic Health Academy Clinical Practice Guidelines
• Pelvic Guru’s Pelvic Practitioner Directory
• Research Article and Associated Infographic linked here.

Sinéad’s #1 Tip:

“I want people to know that pregnancy related kind of aches and pains is very different than pregnancy related pelvic girdle pain. So it's important that people kind of understand that outta the gate. So that way if you self-identify yourself in this now umbrella of pregnancy related pelvic girdle pain, now where this, in this nociplastic pain, you can immediately understand you need to go to someone to get some guidance and some help. Ideally, someone who has some understanding and pain science. It doesn't even matter if they don't even live in your same country because most of this care can be delivered really well virtually. Sometimes you'll only need one or two consultations with a skilled person to be able to kind of figure things out and get on track.”

Connect with Sinéad:

• Reframe Rehab
• The World Of My Baby (WOMB)
• Dr. Sinéad on Instagram
• McMaster Experts Page

Please remember that that what you hear on this podcast is not medical advice. but remember to always do your own research and talk to a trusted provider before making important decisions about your healthcare. If you found this podcast helpful, please consider leaving a 5-star review in your favorite podcast app, it helps other people find the show. Thanks so much for listening!

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Instagram: @trainernatalieh

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Youtube: @trainernatalie

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Want to start your own podcast?
I chat with Dr.
Sinead do for about her worksurrounding pregnancy related,
pelvic girdle pain.
And if that sounds complex,don't worry.
All it means is pain in yourpelvis during pregnancy or into
the first year postpartum.
We talk about the myth thatrelaxing is the cause of all of
these pains in your pelvis andhow we can better approach.

(00:21):
Pain in general duringpregnancy.
So whether you're a clinician orcurrently pregnant and wanting
to improve your pain.
I know, you'll find this episodeintriguing.
I'm Natalie.
And you're listening to theresource doula podcast, a place
where we provide information tohelp you make informed
healthcare decisions foryourself and your family.

(00:51):
Dr.
Sinead do four is an associateclinical professor in the
faculty of health science atMcMaster university.
She teaches and conductsresearch in both the schools of
medicine and rehabilitationscience.
Her current research interestsinclude conservative approaches
to manage pelvic floordysfunction.
Pregnancy-related pelvic girdlepain and interprofessional
collaborative practice models ofservice provision to enhance

(01:14):
pelvic health.
Sinead stays current clinicallythrough her work as the director
of public health services at theworld of my baby, the womb.
A family of perinatal carecenters in Ontario, Canada.
Sinead has been an active memberof the society of obstetricians
and gynecologists of Canadasitting on two committees and
leading several clinicalpractice guidelines.

(01:34):
Her passion for optimizingperinatal care and associated
upstream health promotion forwomen.
Stemmed from her own experience.
As a mother of twins, she's anadvocate for women's pelvic
health and regularly invitedspeaker at conferences around
the world.

Natalie (01:52):
Hello Sinéad.
Welcome to the show.

Sinead (01:55):
Hi, Natalie.
It's so good to see you.
I'm excited to talk to youtoday.

Natalie (02:00):
Likewise.
I wanted to just dive right inand start talking about your
work.
You've done a ton of researchand work around pregnancy
related pelvic girdle pain andbasically the myths surrounding
it.
What we used to think caused itand now what we know causes it.
If you could talk a little bitabout that to start, that would

(02:22):
be,

Sinead (02:23):
Yeah, of course.
So I'm kind of what you wouldcall an academic clinician.
So I work clinically as a pelvichealth physiotherapist at a
center called the womb, theworld of my baby.
So pretty much the majority ofthe population I see our mamas
going through this perinatalcare stage, right.

(02:44):
Either pregnant or um, havingrecently birthed.
Right.
So I work that clinically, butthen I'm also a professor at
McMaster University in Hamilton,in Canada.
And so I teach and also conductresearch in the School of
Medicine and the school ofRehabilitation Science.
So because of that position, Ikind of have a really unique
opportunity that I can kind ofsee what's happening on the

(03:06):
ground, but I'm also up to datein terms of, of the top
literature because that has toinform our teaching for the
curriculum.
And then of course, I'm alwaysworking on these different sort
of studies.
And so what I started toactually see more in that, that
role, and this was probably, oh,almost a decade ago now, I guess

(03:27):
I would say.
I really started to see this,but this disconnect between what
was starting to emerge as sortof evolved understanding of
science and sort of what'sreally going on when we have
these pains that sort of can bequite distressing and
debilitating and persisting whenwe're pregnant.
And getting some, you know,evolved science there and sort

(03:48):
of queued on differentdirections, but seeing that on
the clinical.
We were really stuck and rootedin those previous ways of
thinking.
Right?
And it was really interesting tome that for other sort of pain
conditions, as our understandingof pain science has evolved,
we've sort of been able toevolve our approach for those.
But this is one painpresentation that has really

(04:13):
been cemented into thoseprevious notions, and it's
really interesting.
Um, but actually it's quiteharmful.
Like we have enough data at thispoint to really see that
following, you know, thoseprevious notions actually does
harm.
And so it's really, reallyimportant that as many of us

(04:34):
kind of, you know, are up todate in setting the record
straight so we can help as manymoms as possible.
So that's kind of, sort of howI, how it got to the space, I
guess I would say.

Natalie (04:44):
I love that.
Yeah, it's kind of like theperfect combination.
You've got the research side,you've got boots on the ground,
and Yeah.
That's, that's amazing.
So what did we used to believe?
What is the deal with pelvicpain specifically?
Pubic joint dysfunction,

Sinead (04:59):
I think that's a really important place to start,
Natalie.
So of course, you know we haveour synthesis pubis joint at the
front of the pelvis, right?
And this is a joint that it'sactually one of the strongest
joints in our body because it'sheld together by fibrocartilage.
Most joints are sort of heldtogether by ligamentous
structures, which are much moreelastic, right?
But this is probably the mostrobust joint structure in the

(05:24):
body.
And it makes sense because youknow, for mamas, you are
actually going through quite afe of physics to sort of get
something that's quite large outof an area that's quite small.
So, I mean, it stands to reasonthat this structure needs to be
able to be adaptable andmalleable, but also fairly
robust.
Right?
And it is, but it's a structure.

(05:47):
That, you know, over the courseof time, many mom ups have
found, has gotten sort ofsensitive or felt uncomfortable
through their pregnancy.
And so, you know, it kind ofcame to reason.
Well, if there's pain there,then clearly that means a
dysfunction, which we know nowactually that that's not true.
Right?
So pain equals some type of atissue distortion, right?

(06:09):
And you know, if there's sort ofa tissue distortion there when
people are pregnant, surely itmust be just the relaxin from
the pregnancy is just makingeverything too lax, too loose.
Now we have too much movement.
Now we have a distortion or adysfunction at the structure.
And clearly that that's why wehave the problem.

(06:30):
And in fairness, in ways.
It's actually a plausibletheory, and I think that's why
it has really stuck.
Right.
It kind of sounds like, oh, thatcould make sense on a bit of an
intuitive level.
That theory kind of seems likeit makes sense.
The trouble is we have nowlooked at this issue from very

(06:51):
different perspectives.
You know, different researchteams all around the world.
And even as far back, so this isa decade ago, a systematic
review was published in 2012,which is a review of all the
randomized control trials.
So this is kind of like thehighest evidence we have.
So a systematic review was doneand concluded, no, relax, and

(07:11):
has nothing to do with this paincondition.
You know, just because we havemore motion at a structure
doesn't mean that, you know,that's going to translate to a
pain experience.
And certainly we don't getenough sort of movement through
these structures of the pelvis.
This, the synthesis pubis at thefront, or even the sacro iliac
joints at the back.
Those are the two back joints.

(07:32):
We don't get enough movement,those joints, even in pregnancy,
that should, we should even betalking in terms of dysfunction,
right?
So, I mean, that's even where wewere a decade ago and, and here
we are and just kind of likemore info and more inform, more
info.
Kind of confirming that, yes, itwas a plausible theory, it made

(07:53):
intuitive sense.
It's been proven wrong and weneed to kind of start following
the right path.
Right?
So that's, that's kind of wherewe're at now.
But that's what we thought.
And that's I think, why it'sbeen such a compelling story is
because on one hand it sort ofmakes sense that it could be
plausible.

Natalie (08:11):
It makes sense logically if you think about it
that way.
Like, oh, okay, I have morerelaxing, more relaxed tissues
and obviously it's gonna beweaker.
Um, but, and that's the way Iwas taught, that's the way that
I learned it from the verybeginning, which informs how we
practice with clients andpatients.
Right.
So would you say that theresearch has made its way into

(08:34):
practice for all, likephysiotherapists and osteopaths,
or would you say that we'restill behind?

Sinead (08:44):
No, definitely we're still behind.
I mean, and this is one of thereasons why I'm continuing to do
research on this and, you know,trying to do other different
research studies rather thancollecting raw data, trying to
synthesize the data and publishsomething more in an infographic
form and kind of get it out topeople that way.
And just different ways oftrying to get out what we know,

(09:05):
get it out to the public becauseit really, it isn't, you know,
it isn't being, um, put outthere in practice,
unfortunately, I have beeninvolved in studying this in
Canada, Ireland, and just mostrecently the UK really looking
at physiotherapists.
So just to use that specificprovider group, it's one of many

(09:27):
that are gonna have a role here.
But even just looking at thatprovider group, we see that, you
know, still the majority ofphysios, even though they are
moving to start conceptualizingthis pain experience more from
what physiotherapists will calla biopsychosocial perspective,

(09:48):
which really is just meant tomean we're not just kind of
looking at the tissues and themechanics.
We're understanding these othercontextual factors really
actually have something to dowith the global experience of a
pain experience.
So certainly we're seeing thatphysios in all those countries.
Are starting to adopt thatconcept.
But then when we ask themquestions in the survey specific

(10:11):
to assessment and treatment,like the so what, okay, so
you're thinking of it from theslightly more broad perspective,
but how do you assess it?
And then what do you actuallydo, do about it completely
reverts back to thebiomechanical test and
strengthen the core.
And it's a weak core andstability training and manual
therapy to make sure everythingis kind of balanced.
And so it sort of reverts backto those previous notions.

(10:33):
So we still do see somecognitive dissonance and lack of
really kind of, um, implementingthis on the side of
physiotherapists for sure.
Because, I mean, we've studiedthis.
I would stay clinically everysingle day probably I have at
least one client because this isa, a pain experience that I work
with a.
So I have at least one clientwho has come to see me, um,

(10:58):
after already seeing manydifferent well-meaning
practitioners, you know, in manycases, sometimes already seeing
a physio, already seeing apelvic health physio, chiro,
osteo like everyone, and, youknow, still is kind of spinning
their wheels.
And, you know, often, again,it's very well meaning, but it
has been communicated to theindividual in front of me that

(11:20):
yes, this has to do with likethe biomechanics of your tissue
and this is kinda off and thisis dysfunctional and this is
this imbalance and this ismoving too much and this is
this.
And it's not any of that, right?
So, very well meaningpractitioners, um, who are just
kind of focusing on the wrongtargets.
And if you're focusing on thewrong targets, I mean, you're
never gonna get anywhere, right?

(11:41):
So as soon as we kind of getthese folks actually on the
right path, they do well sofast, right?
And they're really able tocompletely nip this issue in the
bud before they birth theirbaby, right?
So it's important that, um, moreof us are kind of getting online
in terms of, you know, what isthe state of the science and

(12:01):
kind of what should we be doing?

Natalie (12:03):
That's so, so interesting to me because what
I've heard from other clinicianshas been like, oh, this is
basically to cure this or to getit better is to birth your baby.
And so like you can't really doanything except like just
relieve your pain and do dothings that can kind of help
make you more comfortable.

(12:23):
Um, but you're saying thecomplete opposite, you can
actually improve it to the pointof a hundred percent recovery
before giving birth

Sinead (12:32):
Absolutely.
Cause at the end of the day, andI mean I see that play out in my
practice every single day.
I mean, after just one time ofseeing someone, by the time I
follow up with them four weekslater, they're like, oh my
goodness, I'm so much better.
Like I don't even wanna talkabout that anymore.
Let's talk about the birth and Iwanna have an awesome birth.
And we're kind of onto the nextimportant focus, right?
And I have colleagues I'vecollaborated with in Ireland and

(12:53):
England who have run proof ofconcept studies, which has
essentially shown the exact samething when you actually target
the central factors, and this ismore mediating from central
factors, not peripheral factors,you nip this thing in the bud,
we can help people understand itin ways by saying, look, if this
actually had to do with thepregnancy, why doesn't every

(13:14):
single person who's pregnanthave this issue?
Cuz they don't.
It's about 50%.
And why do we see this much moreoften in a second?
Or third pregnancy.
It's very, very rare in a firstpregnancy.
You know, if it has to do withthe pregnancy, that's a
consistent factor.
We should see consistency, butwe don't.
If it had to do with thepregnancy, then some of the

(13:36):
established risk factors forthis issue, which there are many
that are very robust riskfactors, would have something to
do with the pregnancy and not asingle one of them does.
So we know that this is asituation that has to do with
all of these other factors thatare winding up the system and
the pregnancy is like the strawthat breaks the camel's back and

(13:58):
is the thing that finally pushesthe system to the edge that a
threat response comes out.
Because in fairness, when weare.
Every single biological systemis really taxed and put to the
edge, right?
We know even, for

Natalie (14:13):
Mm-hmm.

Sinead (14:13):
estrogen increases a thousand fold estrogen's,
actually a bit of a sensitizer,you know?
So it's actually more plausiblethat if any hormone has
something to do with it, itwould be estrogen.
But we know that estrogen isonly a problem if we're kind of
dysregulated to begin with,right?
People who get cramps andpainful periods and have these
other issues through theircycle, that's a sign you're

(14:34):
dysregulated.
You should never have thatissue, right?
So it's kind of a sign thatthese folks are sort of going
into pregnancy already with somelike kind of close to the edge
in their system, or somethinghappens through their pregnancy
that puts them close to theedge.
So it's not the pregnancy,itself.
It's all of the other things andall of the other things we wanna

(14:55):
help people understand.

Natalie (14:57):
Oh, I, I wanted to ask you too, because personally I
have endometriosis and I knowthat I have estrogen dominance,
but I've never made theconnection that estrogen is a
sensitizer and that's why theremight be more pain.
Um, so is that true foreverybody who has estrogen
dominance?
More pelvic pain in general.

Sinead (15:20):
uh, you, you could be more likely.
And not just pelvic pain, justmore pain.
Like it, it's a sensitizer, itcan make the tissues more
sensitive.

Natalie (15:28):
Okay.
Interesting.
Interesting.
That's something more

Sinead (15:32):
And endometriosis is also inflammatory condition too,
right?
So you're also gonna have morepain mediation from systemic
inflammation, right?
It's also considered anautoimmune issue.
So, you know, as it ebbs andflows and you're in flares, when
you're in in a flare, that's atime when your body's in kind of
disrupt with your gutmicrobiome.
So that's gonna be anotherreason why things are like a

(15:54):
little bit more sensitive anddysregulated, like there's a lot
of factors.
Do you know what I mean?

Natalie (15:59):
Yeah, that makes a lot of sense.
So people who are pregnant andhaving all of these issues, you
said their system, it's like thestraw that broke the camel's
back.
Like they have all of these,these upregulated systems and
pregnancy pushes them over theedge.
So what are the other causes orcentral issues that contribute

(16:19):
to the the pain?

Sinead (16:23):
Yeah.
So if we look at the establishedrisk factors, right, and we see
that, you know, one of the firstones on the list that's very
robust is previous trauma.
Right, and we know from lots ofdata what, what a trauma will
do.
Like trauma when you are achild, right?
Adverse events as a child,there's so much data to show

(16:47):
that that actually literallyupregulates and kind of changes
the signature within yourautonomic nervous system, and
your fight or flight response iskind of tied into that system,
right?
We also see that whenever wehave a trauma, you know, forget
that sort of signature if thisis happening at a critical time,

(17:07):
like when you are child.
But there's a lot of data toshow that actually when a mom
births her baby that this is areally powerful, critical
transitional time.
In a mama's life, andunfortunately the percentage of
women who come out of a firstbirth experience and experience

(17:30):
trauma is very high, right?
So, you know, there's now somequalitative data, sort of
triangulating, okay, you havethis trauma with your first
birth, you know, that has kindof like this priming and
signature effect in your nervoussystem.
Is it really a surprise thatthen you get pregnant the next
time and your whole system islike, uhoh, here we go again.

(17:53):
Now we're back in the state.
And, and that's gonna happenagain.
Like that's how our systems aredesigned, right?
For survival.
So that would be considered morecentral factors, not, you know,
peripheral tissue relatedfactors.
So there's previous trauma is.
Parity is one meaning you'remuch more likely to have it the
second time you birth right,rather than the first time.

(18:15):
And so, I mean, that's a factorthat has nothing to do with the
tissues.
So you have to kind of take astep back and say, well, why
might that be?
Well, one.
Go back to the first factortrauma.
It could be that somethingtraumatic either happened in
your birth and the time in thepostpartum period, or even in
the time between your last birthand this birth.

(18:35):
You know, when we think about,you know, the rate of
miscarriage and baby loss isactually way up in the last few
years, we think of the rates of,you know, fertility
difficulties.
Even if you've, you know, had notrouble the first time around
having some difficulties thesubsequent times around.
And we see that all of thesefactors kind of span across with

(18:56):
this concept of reproductivetrauma, right?
So it could be that the paritypiece is actually connected to
trauma, but it also could bethat we know from an energy
system perspective that when wedon't have enough energy to go
around, that's another thingthat is interpreted as
threatening to our brain.

(19:17):
right?
And so if we think of a mama whois now pregnant for the second
time, She is not nearly as sortof like recouped in terms of her
battery being recharged thistime around.
She was the first time aroundbecause, you know, she's caring
for a toddler, you know, she'sback to work.

(19:38):
She's juggling how to be, youknow, the type of professional
she was before in her work andalso be a mom at, with a child
at this very, very busy age.
Now she's pregnant again andgrowing a human being.
I mean, that's a lot of energythat is required for those
things, right?
So it stands to reason that, youknow, some people's scenario, if

(20:02):
they really didn't recoup theirbatteries, like even to the bare
minimum that they needed to,that their system is going to
start hollering at them.
You know, that, you know, thingsare sort of, you know, not
optimal.
And pain is an output that'stelling us, you know what,
something's kinda up,something's not optimal here.
right?
So we think that that might beplaying into the energy system

(20:23):
component.
Again, that's a central factor.
That's not a tissue relatedfactor.
The next risk factor isincreased bmi.
We know that increased BMI whenwe have increased bmi,
particularly, um, if we haveincreased, uh, waste to he
ratio, like we have increased,um, weight around the middle,

(20:44):
that that correlates with ahighly inflammatory environment
in the body.
And we know that inflammation isa sensitizer.
The next risk factor is smoking.
Well, smoking is inflammatory.
So again, it's that vector ofinflammation.
These, again, are physiologicalcentral issues, not tissue
issues.
And then the last.

(21:06):
Is lack of a belief ofimprovement.
This is not only a risk factorfor this issue developing, but
it's also a risk factor for thisissue persisting, you know, well
into the postpartum period, andthis one's really, really
important.
Because if you think of thecommon incorrect narrative that

(21:26):
this is an issue that has to dowith the pregnancy, you are
going to get more pregnant astime goes on.
So this issue is going to getworse as time goes on.
And then you are going to beasked to birth this baby through
this dysfunctional structure.
And then hopefully it was alljust because your pregnancy and
then hopefully it just goes awayafter.

(21:46):
So you can appreciate that mostpeople aren't going to feel like
it's gonna get any better beforethey birth that baby.
They are going to have a lack ofbelief of improvement, right?
So this is kind of where we'reat with our established factors.
They all point towards centralfactors and they all kind of go
hand in hand with us, disprovingsome of the notions around the

(22:07):
local biomechanics of thetissue.
So actually all the data's kindof coming together.

Natalie (22:12):
This is like making my brain explode in a good way.
there's so many questions that Ihave, so I'm just gonna kind of
go back over it because I thinkit's really important that
people hear, like you said atthe beginning, that pubic
synthesis in the front of ourpelvis is robust.

(22:32):
I have never heard it describedthat way, and most people assume
that it's weak or not robust atall.
Some the opposite of robust.
Um, and so we're perpetuatingthe narrative that.
Women are weak through theirpelvis.
Therefore they will have painjust because of pregnancy and
it's not gonna get better untilthey have a baby.

(22:55):
And good luck having a vaginalbirth because you already have
dysfunction there.

Sinead (23:01):
Right.
That's exactly it.
Like all of those narrativesare, are false.
It requires a huge, huge, hugemechanical force to be strong
enough to bust the fibercartilage of that joint, right?
So it's not to say that it isimpossible for that to happen.
Of course, anything can happenin the human body.

(23:24):
Anytime.
Right.
So there are specific cases ofpregnant mamas experiencing an
extreme mechanical trauma thattraumatizes multiple structures
in addition to that one.
And in that case, absolutely youwould have dysfunction at that
joint.
But when we're talking aboutmamas just spontaneously kind of

(23:46):
their synthesis, pubis muscle stor or joint kind of starts to
hurt and it kind of starts tohurt when they're like getting
changed or they're standing onone foot or they start to walk.
But then we might notice, butsome days it doesn't hurt and
some days it hurts more thanothers.
We're already poking holes inthe theory cuz if it's
mechanically disrupted, It'sgoing to consistently hurt every
single day, whether you'rewalking forwards or backwards.

(24:08):
And we see that it often won'thurt if you're walking backwards
cuz that's a novel movement.
And so like we can poke holesall over this theory, right?
It's made of fibro cartilage,which is like way stronger than
ligaments or muscle tissue.
Right?
But you're right that mostpeople have been led to believe
this other narrative.

Natalie (24:27):
Hmm.
Wow.
Okay.
This is, this is good stuff.
So talk to me a little bit aboutnovel movements and your
approach to treating to thephysiology of the problem with
those central causes rather thana biomechanical approach.

Sinead (24:44):
Yeah, of course.
So the first thing is peopleneed to understand their pain
experience for what it actuallyis.
And we need to start there.
That's critical.
So most people are coming inthinking their pain experience
has something to do with therelationship of those

(25:06):
structures, the integrity ofthose structures, those
structures not being strongenough, those structures being
too loose.
Most people have these falsenotions, so we have to make sure
people really, reallyunderstand, you know, that that.
Isn't likely given what we know.
And in addition to going throughand explaining all the science

(25:27):
and biology to people,oftentimes when I'm with them in
clinic, I have an opportunity toprove it to them in their body.
So if they really kind of, if ittruly is a weakness causing the
problem, we know at minimum withconsistent training, we're not
gonna get a strengtheningeffect.
For at least sort of three orfour weeks of a consistent

(25:48):
training protocol.
So when I have someone in myoffice and I can kind of be
talking to them about what'smore likely at the root of their
issue and just kind of gettingthem sort of slightly shifted
onto potentially exploring thisdifferent way of seeing their
issue.
And then I'm kind of doing somegentle kind of different
movement techniques with them.

(26:09):
I'm guiding them with it.
That's what we'll call, we callnovel movement, and I can talk
more about that later.
But what I'll do with thatprocess is we have some very
basic testing that we use forthis issue.
That's sort of like my beforeand after litmus test.
So one of them is called anactive straight leg raise.
And I love this test because iteven allows me to execute it

(26:31):
when I'm working with clientsvirtually.
And at the moment, I, a lot ofmy care now is provided
virtually.
And so, you know, you just askthe individual, they're lying on
their back.
You just ask them to lift theirone leg up about six inches
without even thinking about it.
And people who have thissensitivity through their pelvis
structures for all these sort ofrisk factors we've discussed

(26:52):
already and kinda what that isactually doing in their system,
you know, they will find it verydifficult and uncomfortable to
do that movement.
Right.
So we'll kind of score positiveon the straight leg raise.
And then after I've kind oftalked to them and taken them
through some of the movement,maybe I've also kind of done an
internal exam to check theirpelvic floor.

(27:12):
You know, always we find withthis issue, because when you
think of all the risk factors,it's gonna map onto this
problem.
But the pelvic floor held up inthis very, very protective
position, right, which certainlydoesn't lend well to optimal
blood flow and oxygen movingthrough that space doesn't allow
for.
Proper coordination of muscles,um, muscle activation.

(27:34):
So you are gonna get this likebracing and these aberrant
movements, right?
So, you know, might check thepelvic floor, give the
individual some strategies fortheir brain to connect to their
pelvic floor, send a safety andrelease, and we kind of do like
just these basic little things.
And then I'll redo the activestraight leg raise.
And of course it's a milliontimes better.

(27:55):
And I can say right in thatmoment, see, it's not a strength
problem.
All we did was a few differentthings to put a slightly
different input in your system.
Really sending a signal ofsafety and getting the
protection mechanisms out,getting that anticipatory, feed
forward, pain out, put somenovel, safe inputs in.
And look, it's a dramatic, soit's not a strengthening

(28:16):
problem, right?
And you can kind of prove it tothem.
And a lot of people do need thatproof because they've really
been told by a lot of people,this has to do with posture and
weakness, and I have a weak coreas this, that, and the other
thing, right?
So you need to first get peopleunderstanding the pain for what
it actually is.
That's first, first, first.
But then always your goal has tobe, how am I gonna get mama?

(28:40):
We need mamas moving andexercising and really kind of
thinking.
Yes.
Once we kind of get over thishiccup of this pain experience
and sensitivity in the tissue,then we're gonna be on like
prepping this mama for themarathon of birth.
So she has an awesome birth andan awesome recovery, right?
So it is totally not acceptableto think that it's okay to be

(29:02):
trying to just manage discomfortand have people not moving.
And so we always start withnovel movement.
Cause novel movement's reallygood to calm down, a cranky
nervous system novel movement ininvolves, you know, the brain
and mindfulness and kind ofreally intentional sort of
thinking and cognitivelyreframing the sensations you're

(29:26):
feeling.
And oftentimes it does require adegree of guidance from, you
know, someone who is sort ofskilled in some of these
strategies, these cognitive andmindful strategies.
So we incorporate that sort ofwith movement as a form to
actually rewire the nervoussystem, improve sensory motor
mapping, right?
And then it can be helpful, youknow, if you're skilled in

(29:46):
hands-on techniques to just dosome of those gentle techniques
externally, internally, onto thepelvic floor.
Again, just to kind of start tonudge the system to a place of
safety and a place of differentpossibilities, right?
To get it kind of out of thiskind of wiring threat mode.
Right?
then sort of beyond that, it's amatter of the individual then

(30:10):
understanding what are their ownunique things.
So someone who maybe had a lotof trauma, not with their last
birth, but in that postpartumperiod, they kind of
acknowledge, oh my goodness.
You know, breastfeeding was likereally, really tough and maybe
had a tongue lip tie and oh mygosh, like even thinking about
it now, like my heart rate'sstarting to go up and I had kind

(30:30):
of just like tucked that underthe rug.
You know, helping people to beaware of things that might still
be driving that excessive sortof, um, cycle of their
hypothalamic pituitary adrenalaccess.
That's your stress responsesystem when that system's kind
of going.
you know, that does dysregulateyour other biology, you know,

(30:52):
does actually create a slightlypro-inflammatory environment.
So we need people to be aware,maybe of traumas that have not
been processed yet and are kindof in their body, sort of
wreaking havoc.
We need people to be aware if,like sleep has been a big, big
issue cuz now they're pregnantagain, but they have a two and a
half year old who still is likeup three times a night crawling
into their bed and they got,they're, they're thinking, oh my

(31:14):
gosh, what am I gonna do when Ihave like baby?
And we helped people tounderstand, you know, how these
impact their biology, howthey're probably impacting their
current circumstances and weproblem solve around them to try
to find some solutions, um, tosort of get things so at least
the system's not quite so taxed.
So, you know, it's, yes, everysingle person needs to

(31:36):
understand their pain experienceand every single person needs to
engage in the novel movementinitially and then working
towards more of a.
An exercise plan that kind of isinspiring to them.
But then beyond that, it's quiteindividualized and it's just
tackling all those differentthings that are going to make
the tissues more sensitive andthe brain more likely to

(31:57):
interpret threat, which is whatpain is, cuz it's an output.

Natalie (32:02):
Right.
Wow.
Okay.
Yeah, you've got my brain going.
I have so many questions.
Um, so it's more of a, it's,it'smore of a brain thing than it is
a strength or biomechanicalthing, correct?

Sinead (32:17):
Well, pain is always a brain thing, right?
And it's not just the brain, butat the end of the day, what pain
is in any circumstance is thebrain kind of making a bit of
the determination is this, youknow, do I need to sort of
communicate with the organismthat something might be up?
Right?
That's what pain is.
It's an output, it's acommunication.

(32:39):
Right.
So pain is always that.
So when we have very specific,like I, you know, stub my toe
and I have pain at my toe, theprimary mechanism for that pain
is a process called no csection,right?
And in that case, it's like youbanged your toe, your brain's
gonna be like, okay, payattention.

(33:00):
Like you might need to get abandaid on it or you might need
to, but really it's all thesesort of chemical receptors are
now fired up because you havethis in flood of the different
sort of immune components thatare coming into play.
And that's what's called sort ofthe process of no C-section,
right?
But you can have differentthingss that will color that
pain experience.

(33:22):
So I can be, you know, with allmy girlfriends, you know, having
a glass of wine and really greatmood and be getting up to get
something and kind of stub mytoe.
And I might not honestly evenreally notice it until the next
morning and I see a bruisebecause in that moment your
body's kind of like, yourbrain's like, nah, you just

(33:42):
bumped your toe.
But honestly, you're good.
Like there's no threat.
You're with your girlfriends,you're having a good time,
you're no threat.
Or I could be in the context ofsort of tidying up like the toy
room and my children have leftit in this and I'm really like
mad.
I'm furious, I'm already tiredand whatever.
So my system is already in a bitof a different state and I stub

(34:02):
my toe the exact same way.
And it can be interpreted as.
A hundred times is threatening.
So then it's gonna feel like, ohmy gosh, that's so sore.
Right?
So in acute pain, the primarymechanism is no csection, but
it's still always influenced byall of these other factors.
Once we are beyond acute pain,so pain that just lasts for a

(34:26):
day or two, anytime we stepoutside of that, we have to
start thinking, okay, the painis gonna be more likely colored
less by no, no csection, andmore by these other things like
the inflammatory atory status ofthe system, and then what are
the things that are driving upthat protection and
inflammation, right?

(34:46):
So I mean, really it's alwaysthe brain is putting out a
communication tool for any pain.
It's just this one.
Anytime we're thinking ofbiomechanics and tissue related,
That's really implying that youunderstand the main mechanism to
be no csection, where this isnot that.
Right.
Many mamas will come to me atlike 27 weeks and say, I've been

(35:10):
having this issue since 14 weekspregnant,

Natalie (35:13):
Mm.

Sinead (35:14):
so this is not something that's just gone.
This is something that'spersisting and persisting and
persisting.
So we're stepping into what'scalled noy plastic pain.

Natalie (35:21):
you've, it's got my brain going more.
This is great.
Thank you for schooling me onall of this stuff.

Sinead (35:27):
Okay, good.

Natalie (35:29):
Okay.
So basically the approach wouldbe down, regulate the nervous
system, try to reduce as manyinflammatory issues as possible
prior to even going intopregnancy, but then also during
pregnancy.
And I guess my next question is,do you know, has there been any
research done on people who areapproaching.

(35:51):
This, these issues in a morephysiological way, the outcomes
of their birth and postpartumexperience.
Is there any research to backthat up?

Sinead (36:01):
There is research to back up that people who have
this issue, so what I wouldcall.
Unresolved pregnancy relatedpelvic girdle pain.
And it's either gonna beunresolved cuz you didn't seek
care or you were given the wrongtype of care.
Right?
So we see that unresolvedpregnancy related pelvic girdle
pain makes it more likely thatyou'll end up with a cesarean

(36:22):
birth or all sorts of sort ofextra interventions in your
birth.
And the trouble with that is anytype of operational assistance
for birth, whether it be, uh,forceps, vacuum, or cesarean
birth, like anything kind ofoperative actually is a risk
factor for more persistence ofpelvic pain in the postpartum.

(36:44):
So that's kind of the irony,right?
Is that then the birth endingthat way and, and births like
that oftentimes are felt to bequite traumatic now for these
people.
So now we're compounding thesystem with these other things,
right?
And we see that it's more likelyto have this issue than in the
postpartum period.

Natalie (37:03):
Okay, so you could infer that the opposite would be
probably a, a more smooth birthand postpartum experience if
they get the correct treatmentand resolve the pain,

Sinead (37:16):
Well, yeah.
I mean, if people are kind of,they don't have that issue
anymore and they can actuallystart to switch their focus onto
the birth and they're no longerthinking, oh my gosh, my pelvis
isn't gonna be able to birth thebaby.
I have a dysfunctional pelvis.
My synthesis puts in all thesenarratives that will go through,
right?
So if people have kind of hadthe record straight, they

(37:37):
understand this was sort ofphysiological, it was related to
tissue sensitivity.
They effectively weren'tempowered in terms of how to
dial that down.
They feel kind of in control.
If anything, those people think,oh my goodness, I was able to
turn that around.
And here I am, like, I got this,like I'm empowered.
Like I, I'm gonna get this with,with my birth.

(37:57):
I mean, in fairness, the peoplewho I'm seeing.
People who are seeing me, andI'm also a pelvic health physio,
so I mean I'm also going throughall the other things to have a
great birth right.
Making sure their pelvic floorsare good.
And I'm kind of going throughall of the clinical practice
guidelines around pushing andpositions and all the things.
So they're getting all of thattoo.
So I mean, do my clients haveexcellent outcomes with this?

(38:21):
Well, yes, but I'm doing a wholebunch of things in addition to
just looking at the pelvic pain.
Do you know what I mean?
And probably that's one of thethings that's gonna be the most
helpful is if we're kind ofdoing all of that.
But absolutely, I wouldn'texpect for a second someone
going into a birth with the painin their pelvic girdle that they

(38:42):
have, thinking it has somethingto do with their pelvis being
dysfunctional.
How on earth is that persongoing to be empowered to, you
know, have a, a good birth?
Right.
So, Yeah.
And we do see that, that playout in the data that they
consistently don't

Natalie (39:01):
Hmm.
I feel like women's health ingeneral, and specifically around
the prenatal, you know, birthand postpartum space, we are
constantly telling women theycan't do something one way or
another.
Whether it's actually sayingthose words or convincing them
that they're not.
You know, their body is brokenor they're not able to do

(39:21):
whatever it may be, breastfeedor give birth vaginally or, you
know, like that is so common andI'm realizing how common it is
through doula practice and, andworking with clients in exercise
physiology.
Like there's so much that needsto change for us to get back to
empowered birth for everyone.

Sinead (39:41):
Yes, I agree with that.
Um, that narrative of, you know,your body is just not up.
The task of this, you know, thisis why we need all these medical
interventions because yourinnate systems are just not up
to it.
I mean, that is so problematicon so many levels, but also
really is an important vectorfor this issue of pregnancy

(40:05):
related pelvic girdle pain.
So it's gotta change.

Natalie (40:08):
Yeah.
Yeah.
So what about like, SI joint?
either during pregnancy or not,or other types of pelvic pain.
When should someone seektreatment and kinda what's the
approach to those?

Sinead (40:22):
So actually it's the same, any pain within sort of
the geography of the pelvis.
So the synthesis pubs at thefront, the two sac iliac joints
at the back, or any of thetissue, even just right around
that pelvic g.
Right, any pain in that region,there is now consensus.
We shouldn't be referring to itas synthesis, pubis, pain, or

(40:45):
sac, really act joint pain.
It should always be under theumbrella, pregnancy related
pelvic girdle pain, and thatcovers off the entire time
you're pregnant and the fullyear postpartum, pregnancy
related.
And all of it is this approachbecause we see that all of it
has very little to do with thestructure and everything to do
with all of the other thingswe've talked about.

(41:06):
So it's all under the same.

Natalie (41:08):
Okay.
Okay.
That makes a lot of sense to me.
And our pelvis is like, theyhold a lot of weight in terms of
value and where we hold trauma.
And so it just, it just makes somuch sense that you would have
to approach it this way.

Sinead (41:21):
Yeah, exactly.
And even if we think of thepelvic floor, the pelvic floor,
which is attaches to the pubicbone at the front, it attaches
to the tailbone at the back andit attaches to each is
tuberosity or your sit bones oneach side.
Like a big diamond structure.
It's a muscular structure thatis connected to your threat

(41:43):
response.
So there is some automatic orinvoluntary control over the
pelvic floor.
And so anytime we kind of gointo that sympathetic mode of
our nervous system, the pelvicfloor automatically goes up into
a protective position.
So you know if your body isholding onto unprocessed traumas

(42:03):
or other stressors or otherthings.
your system is chronically goingto be in that held position,
right?
So yes, it stands to reason thatyou're not, you're not gonna
have optimal movement throughthe sacc joints and everything,
cuz the whole thing right thereis lifted and anchored and it's
gonna impact all those.
But trying to correct it withstrategies that are right around

(42:25):
those structures is just somisguided, right?
You didn't need to go upstreamto the reason why is there the
stressor or why is it beingheld?
Cuz it's being held by theautonomic nervous system.
So that's what we have toaddress, right?

Natalie (42:39):
Okay.
Yeah.
Another case of the squeakywheel is not the cprit It seems
to be that way commonly.
Um, okay.
I'm curious, do you, are youcomfortable sharing about your
own birth process with twins?

Sinead (42:57):
Yeah, of course.
Yeah.
I'm very happy to.
So, yeah, I, my twins are nowalmost 12 years old and you
know, it's interesting.
So I actually only really gotinterested in this whole area of
pelvic health and perinatal careactually, after I birthed my

(43:18):
twins.
That's what really inspired meto understand, wow, there's a
lot of like dodgy things goingon.
And it was even tough for me tonavigate as a physio.
And I was a physio for aboutseven years at that point in
orthopedics, a manipulative,hands on physiotherapist.
Okay.
And so, you know, when I met myOB.

(43:41):
He basically said, nice to meetyou.
You're having a cesarean birthbecause you have, um, you're
pregnant with twins.
And I was like, oh, okay.
And I kind of thought seems abit weird to make that
determination now, you know, Iget it if as I go along and baby
bees in the wrong position, likeI get it, but it's my first time

(44:02):
meeting you at 16 weeks pregnantand like, you already kind of
know this.
But I thought, you know what?
Honestly, if that's, there was abig story given to me about Baby
B and how it's really tough forbaby B two rounds of
contractions and I was giventhis whole story.
And I thought, okay.
I'm like, sure.

(44:22):
I didn't really have strongfeelings otherwise.
And I thought, okay, you know,there, there must be a reason.
But it's, it was really inhindsight, after kind of going
through that process, actuallybefore I had my babies, they
were both perfectly head down.
They were both, you know.
So I remember leading up to kindof thinking about it, I wonder
why, like, we're not even justgonna kind of try to do this the

(44:45):
way that, you know, intuitivelyto me, I thought made more sense
that it was better for them,right?
And lo and behold, in the end,through my birth, doesn't baby
be end up having problems andneeding to stay in the nicu?
And then I was told, oh yeah,well you know, when you have a
cesarean birth sometimes, youknow, you don't quite get that

(45:05):
sort of healthy stress that thebaby needs squeezing through the
birth canal and whatnot.
And I thought, are you kiddingme?
The only reason why I did thiswas because it was supposed to
be better for baby B.
and now that's my baby who'shaving trouble because it
actually wasn't, it was a lie.
Right.
And it kind of got me intoreally seeing how what happens

(45:25):
in our, in our hospitals aroundbirth doesn't at all correlate
with what the best practiceguidelines say.
So yeah, it really was that mybirth experience, um, that
inspired me to, um, really moveinto the space.
I got pregnant with my twinswhile I was completing my PhD.

(45:47):
I was towards the end of it, butI was looking at actually
primary healthcare and the rolesof physiotherapists and primary
healthcare systems andinterprofessional care and
health promotion.
Like, that's more of what my PhDwork was on.
Nothing to do with this.
So really I was inspired to moveinto this area, um, after

(46:08):
having, uh, my children andwhile I didn't have the issue at
all of pelvic girdle painthrough my pregnancy or in the
postpartum, uh, my pregnancy wasgreat.
My postpartum was great.
Like no issues, no, no pain.
Even with the, even with majorabdominal surgery with the
cesarean, no problems, noissues.

(46:29):
Like that was all fine.
It was more my frustration withkind of what I was told was
gonna be optimal for me in mybirthing.
And really I was told thingsthat weren't true.
And, uh, that got me reallyinterested in kind of trying to
bring to light what actually weshould be doing and helping to

(46:50):
kind of advocate for.
I did have the issue ofdiastasis.
Um, and certainly having acesarean birth is now an
established risk factor fordiastasis rec ado.
So I did have, my abdominal wallwas really not in the best shape
after, um, having my kiddos.
And um, and I also had a couple,um, hernias, so I did need some

(47:11):
surgery for that.
But, um, otherwise, yeah, likeelective cesarean birth really,
like, as far as that was allconcerned.
It was fine.
It was just more, um, myfrustration after the fact of,
you know, why was I told onething, which then when I
actually looked up to see if anyof what I was told was

(47:34):
substantiated, it wasn't.
It was a story that kind of wasconvenient for the hospital to
do the things, things the waythey wanted to do them, right?
So, yeah, so that my, my birthreally doesn't have much, um,
with the pregnancy relatedpelvic girdle piece.
Um, unfortunately

Natalie (47:56):
Well, that's okay.
I mean, you're here now andYeah.
I think a lot of times providersare not educated on twin vaginal
birth or breach vaginal birth,and so they just revert to
cesarean because that's whatthey know, which is unfortunate.
It's kind of a loot, like adying art almost.

Sinead (48:15):
yeah, I would agree with that.
I mean, one thing I would saythough, um, to be fair is as
I've kind of worked in this areanow, like very specifically for
about a close to a decade, Ihave seen some improvement with
some things, like some thingshave kind of, you know, gotten a
little bit better over time andone of the things is I have seen

(48:38):
more often twins, as long asthey're both head down, vaginal
births, you know, back to backvaginal births much more often.
So, so that is, that issomething that is moving in the
right direction.

Natalie (48:51):
That's awesome.
Good to hear.
For sure.
okay, so I wanna ask you ifsomeone is like, okay, I'm ready
to dive into more research andinformation, what are your
favorite resources, whetherit's, you know, social media
accounts or papers or books?
What are your favorite resourcesfor someone who wants to do more

(49:11):
research and, and look?

Sinead (49:13):
I would say.
First look at the clinicalpractice guidelines that have
been published.
In the last five years becauseclinical practice guidelines,
they are a nice synthesis of allthe research.
So it's a lot of the researchdone for you.
The guidelines are graded, soyou're able to kind of
accurately like wait out, likehow strong is the evidence.

(49:35):
There's a clinical practiceguideline that was published in
2017, specifically for thepregnancy context, and that was
for the American PhysicalTherapy Association.
So these guidelines are free.
If you go to the Pelvic HealthAcademy and their American
Physical Therapy Association,all of their clinical practice

(49:57):
guidelines are free.
Whereas their other journal, um,manuscripts aren't free.
You have to be a member.
Subscribe.
Right.
But their clinical practiceguidelines are free.
So that's the pregnancy one.
And then just this, this year,2022 January of this year, their
postpartum.
Pregnancy related pelvic girdlepain guidelines were published.

(50:20):
So I would start with looking atthe guidelines, right?
Rather than kind of like random,low rated papers.
And then another thing thatmight be helpful is myself and
um, four other physiotherapists,also Canadian physiotherapists
that are all out BritishColumbia.
They worked on an effort withme, really in the spirit of, so

(50:42):
we know what we need to.
It's just a matter of mostpeople don't read these clinical
practice guidelines.
So like those ones have been,you know, in circulation since
2017 and very few people haveeven read them, right?
So, you know, what might be abetter way to mobilize or
translate the science that weknow.

(51:04):
So we actually kind of turnedall the most updated science
that we have, those twoguidelines as well as a Delphi
consensus that was acollaborative effort from
researchers in New Zealand andEurope that was just published
last year.
So quite a robust bit of work,kind of gathering all the
perspectives and data.

(51:25):
So we kind of collated thesesort of three important, um,
documents and studies andcollated it and kind of
translated it into a summary,like an editorial summary with
an in associated infographic.
So that's something, Natalie, Ican even send you, um, if you
want to have it available in,uh, like your show notes or you

(51:49):
wanna have it available todisseminate

Natalie (51:52):
yeah.
Yes, please.
That would be love.

Sinead (51:55):
Yes.
The guidelines, I can't becauseI'm pretty sure they're free
anyways.
And because they're not my ownpieces of work, I can't do that.
But this other one, um, becauseI'm an ath on it, I can, I can
share that.

Natalie (52:08):
Awesome.
Yeah, that's great.
So if you were to boileverything down, which is a hard
task to like your number onepiece of advice for our
listeners, and you can do, youcould do two if you'd like, one
for the clinician and one forthe woman who's pregnant or
postpartum.
Um, what do you want people toknow?

Sinead (52:31):
Honestly, I want people to know that pregnancy related
kind of aches and pains is verydifferent than pregnancy related
pelvic girdle pain.
So it's important that peoplekind of understand that outta
the gate.
So that way if you self-identifyyourself in this now umbrella of
pregnancy related pelvic girdlepain, now where this, in this

(52:53):
noy plastic pain, you canimmediately understand you need
to go to someone to get someguidance and some help.
Ideally, someone who has someunderstanding and pain science
doesn't even matter if theydon't even live in your same
country.
Cuz most of this care can bedelivered really well virtually.
Sometimes you'll only need oneor two consultations with a

(53:14):
skilled person to be able tokind of figure things out and
get on track.
Okay, so, so what the differenceis probably most mamas would
say, At some 0.1 day, maybe morethan one day, they had a bit, a
little bit of soreness in theirback or hip or in one of their
joints.
But, and I would put myself intothis category, but you know, I

(53:34):
throw a heat pack on it.
I do a little bit of extraprenatal yoga, I rest a little
bit more and I sort it outright?
Then I don't have the issue.
Maybe a couple weeks later Ihave another little ache and I
can kind of sort it out.
So these little aches and painsthat kind of come and go
throughout the pregnancy, that'snot what we're talking about.
Of course, we're gonna expect acertain degree of that, given

(53:54):
the reality of what's happeningin pregnancy.
But what we're talking aboutwith this thing is this pain
experience that you can't justmanage on your own and it is
persisting.
And now it's to the point thatyou think, oh my gosh, like I
had to stop going for my walksbecause like now I'm walking and
this is a problem.
Or I almost needed help, likekind of getting dressed the

(54:17):
other day, or I really think I,I'm gonna have to come off work.
Like this is really becomingnow.
Distressing and disabling, likeas soon as you're crossing into
that category, that is when donot waste another millisecond,
you know, get some guidance fromsomeone who knows what they're
doing.

Natalie (54:38):
Okay.

Sinead (54:39):
That's what I want people to know.

Natalie (54:40):
Yeah, I love it.
Um, how would you sort out theclinicians who know what they're
doing versus those who don't?
Is there something that you lookfor on their profile or their
bio of, of what they've studied?

Sinead (54:55):
Well, generally, you know, certainly the added
benefit of seeing a pelvichealth physiotherapist is you're
going to get some of that pelvichealth kind of understanding,
pelvic floor understanding.
And there is that role of thepelvic floor because it's
connected to the threatresponse.
And I do think that component'simportant.
So my bias probably would be fora pelvic health pt, but a pelvic

(55:18):
health PT that has tons oftraining in pain science because
the pain science part isactually a lot more important.
So that's kind of what my biaswould be.

Natalie (55:29):
Yeah.
No, that's really, reallyhelpful.
I know, um, there are severalregistries online that you can.
Search for pelvic PTs in yourarea or not if they do virtual
visits as well.
Um, and I can link those in theshow

Sinead (55:43):
Yeah, exactly.

Natalie (55:46):
Um, okay.
Something that I like to askevery single guest I have on my
show is what is your favoritewellness habit that you
incorporate into your dailylife?

Sinead (55:58):
For myself,

Natalie (56:00):
Yeah.
Mm-hmm.

Sinead (56:02):
yes it is getting for a walk first thing in the morning
when the morning sun is justcoming up, that low horizon.
Um, natural sunlight.
It's so important to actuallyset your circadian rhythm and
many of your biological systemslike, so to me it's the health
behavior that's gonna give youso much bang for your buck.

(56:25):
And I've just come to sort oflove that quiet time in the
morning, um, where I'm kind ofon my own.
It's kind of my mindful time,but then I know through that
little biohack I'm doing allsorts of great things for my
body, including setting myselfup for optimal melatonin
production at night in a good.

Natalie (56:44):
Amazing.
I'm over here just chucklingbecause our son just came up and
it's 11 in the morning here inAlaska, so we have a little bit
later sunrise these days.

Sinead (56:57):
Yes.
Fair enough.
Fair enough that that's, that'sa weed bit of a challenge.
You might need to get one ofthose lights or something to get
that effect, but uh, yes, inOntario it works reasonably
well.

Natalie (57:10):
That's amazing.
So, okay.
Where can listeners find youonline?
What services do you offer?
And then how would someone bookwith you if they're looking for
a virtual?

Sinead (57:22):
Yeah, so listeners can find me through the womb,
www.thewomb.ca, and you can bookwith me.
I worked, uh, at the Burlingtonsite, so even though I do a lot
of virtual care, it still needsto be booked through that site.
Um, so you can book with methere and you can kind of see
all the things I'm engaged withat the womb on the womb.

(57:44):
You can also connect with me,um, at my, uh, McMaster experts
webpage.
So it's literally www dotMcMaster experts slash uh, du
four.
And all of my researchpublications come up.
That same sort of, um, websiteis connected on my bio on my

(58:06):
Instagram.
So my Instagram is, um, dr dot,and so you can kind of find me
there.
I have some content onassis onpelvic girdle pain.
Uh, but you can link into my bioand just kind of see some of
like the other courses that Iteach and other things that is
truly just a professional, uh,Instagram page.

(58:27):
I really wish I was on theremore often.
I don't have a ton of time, butwhenever I do get on there, it's
all stuff on, on this topic.
So yeah, those are probably thebest ways to, to find me.

Natalie (58:39):
Perfect.
And I'll link all of those inthe show notes so they can find
them easily as well.
Shanee.
Thank you so, so much for beinghere, spending your time and
energy with me and explainingall of these things in a new
way.
I feel like all of our listenersare gonna, they're gonna have
just as much brain work to do,as I have after listening to

(59:00):
you.

Sinead (59:03):
Okay.
Well thank you so much forinviting me, Natalie.
This has been great to chat withyou and for all the work you do,
bringing this information toeveryone.
And hopefully people do findthat the infographic that's
gonna be available in your shownotes, we'll just be a nice sort
of summary, um, of a lot of thecontent I spoke about.
It might make it a little bitmore digestible.

(59:24):
So yeah, thank you.
My top takeaways from myconversation with Sinead was
figure out the root cause ofyour pain.
We know that often in the bodywhat's shouting, the loudest is
typically not the issue.
Find a provider who has anunderstanding of pain science,
and don't give up on feelingbetter.
I've linked all of the resourcesthat she mentioned as well as

(59:45):
her sites and social pages foryou to follow.
In the show notes for thisepisode.
Please remember that what youhear on this podcast is not
medical advice, but remember toalways do your own research and
talk to your healthcare teambefore making important
decisions about your wellness.
If you found this podcasthelpful, please consider leaving
a five-star review in yourfavorite podcast app.

(01:00:06):
It really helps other peoplefind the show.
Thanks so much for listeningi'll catch you next time