PCES Live Q&A Replay
Meet your instructor: Dr. Sarah Duvall, PT, DPT, CPT
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What is the PCES course?
CEUs Available! Up to 34 hours of credit.
Timestamps and Links
1. How do you know if a person has a hypermobile sacrum? (3:02)
2. SI joint inflammation during pregnancy, why and how to prevent? And tailbone pain afterward-what’s the reason, and how to work with that? And why does glute activation during exercises become so challenging after having a baby? (6:48)
Getting Hamstrings without Glutes to Unstick Sacrum
Deep Butt Pain and Hip Tightness
3. How do you assess a postnatal client to know if they’re ready to progress to more load? How do I know if they’re using appropriate IAP? (14:24)
What is Pressure Management: Diastasis Recti Recovery, Pelvic Floor Recovery and Hernia Health
Abs Taking Over for the Pelvic Floor
Bringing Your Ribs Down - No Ab Bulging
4. How do I know if a client is breathing properly? What should I see? What’s the role of thoracic mobility and positioning on the pelvic balance? (18:38)
Proper Breathing Technique Playlist
What is Pressure Management: Diastasis Recti Recovery, Pelvic Floor Recovery and Hernia Health
5. I’ve started noticing a correlation between the flattening of a woman’s foot after baby and weakening ankle mobility, lower arch support, and plantar fasciitis. Does the PCES course provide any insight into that correlation or ways to provide relief and strengthening? (24:50)
6. Ligament pain vs muscular pain, spotting the difference in pregnant clients. (25:51)
7. Are there any essential movements to perform or test early in postnatal recovery prior to moving onto more typical exercise movements that you’ve found most beneficial? (27:05)
8. What recommendations should one follow for the most optimal post-birth recovery (either c-section or vaginal) to prevent worsening of prolapse and/or diastasis? (29:23)
10. How to spot rib flare, and how to heal it. (33:05)
What is Rib Flare? How Do You Fix It? Rib Positioning vs Rib Angle
Side Breathing For Rib Flare
What is Rib Flare?
11. Your best tips to help clients untuck their pelvis and stop clenching their glutes? (34:50)
12. My left side is my trouble side. It likes to stiffen up all the way from my arches up through my calf and hamstring. What can I do to help it? (38:40)
13. How do we know that a client is engaging TVAs and not internal obliques instead? (40:54)
14. Can postpartum problems be related to lifelong postural and physical issues? If so, is it more difficult to identify and treat the underlying causes of PFD and diastasis? (43:09)
15. Is this program appropriate for my goal of supporting peri and post menopausal women to strengthen their pelvic floor? How about the non-pregnant population and just those with pelvic floor tightness? (44:14)
16. How do you reverse prolapse? What are the best strategies? When is it time to consider surgery? (44:55)
Can Pelvic Floor Tightness Increase the Appearance of Prolapse?
17. Occasionally during heavy lifting, trainers teach their female clients to use the Valsalva Maneuver. In a gym setting, this can cause a straining and bearing down on the pelvic floor. Does this technique cause PFD in the long run? (54:36)
18. Can lifting heavy (or moderately heavy) in a gym setting cause PFD? (55:33)
19. What are the conditions under which a woman should absolutely not use the Valsalva Maneuver? (57:11)
20. I had prolapse (vaginal, rectal and uterine) due (in part) to immense tension and over gripping. I had a hysterectomy and surgery to repair it, and have gone through the rehab process of working on relaxing and strengthening muscles. On exam, my OB noted recurrence of the prolapse. I’m wondering what your thoughts are on rehabbing for post-menopausal women. Most of the info I’m finding is for more newly postpartum, and my babies are all grown now. (57:48)
21. Is it realistic to believe a prolapsed uterus (1-3 Grade) can be healed through exercise? If so, to what extent? What results can one expect to achieve through an online program stating they can heal a uterine prolapse? If you have a prolapsed uterus, does this mean you also have rectus abdominal separation? (1:00:21)
22. A question I have is what subjective and objective (aside from the internal exam) findings tell you if your client has a tight, higher toned, or a weak pelvic floor? What are your treatment strategies/exercise progressions for a client who has PFM tightness and prolapse? (1:03:36)
23. Can my pregnant client use diaphragmatic breathing during delivery to help 'push' the baby? By syncing her inhale or exhale with the contractions? (1:06:57)
24. Is there any danger to lifting with a full bladder? Could it be used as a challenge to test the effectiveness of pelvic floor rehab to prevent leaking? (1:08:37)
25. I'm a Pilates instructor and I’m working with a client who has prolapse and has been told NOT to do any crunches or planks. What do I do? (1:09:20)
Managing Pressure While Pushing a Cart
Are Planks the Best Core Exercise for the Pelvic Floor?
26. How do I stop bearing down and pooching out my belly when I cough? It’s creating pelvic floor heaviness. (1:12:04)
27. I would like to learn about what muscles to focus on during pregnancy to prevent diastasis, and why. Are there exercises I can do during pregnancy to help? (1:13:38)
28. What exercises to avoid during pregnancy and why? (1:16:16)
29. What is the ideal time period for repair to begin? (1:17:29)
30. When is it too late to start diastasis and/or pelvic floor work? (1:18:16)
31. Is there any gap too wide that can’t be worked on without surgery? (1:18:29)
32. How often/how long should one perform these diastasis/pelvic floor exercises? (1:20:01)
33. What to do about abs that are rectus dominant and result in a bread loaf appearance? (1:21:17)
34. Does having twins worsen diastasis more than having singletons? Does having a short torso play any role in diastasis? (1:22:55)
35. How do you know when to progress diastasis exercises? (I feel like I do not get much out of some of the lower level DR exercises, but I still struggle with DR.) (1:23:20)
36. Lifting heavy does not bother my diastasis but lightly jogging does. Why, and what can I do to work on it? (1:25:05)
37. What is your opinion on taping a diastasis? (1:26:14)
38. I have closed my own diastasis but still lack strength. Can't do full sit-ups and my tummy domes with double leg lowers. How do you suggest I improve my strength? (1:26:36)
39. I'm a personal trainer, but not a pelvic floor therapist. What should I look out for? (1:28:17)
40. Does the course offer specific ways to design a program for each phase of postpartum? (1:29:59)
41. Will the psoas muscle be covered during the anatomy class? (1:30:16)
42. Not sure how this works in the US. Is there any overlap between the exercises and what would be done by healthcare professionals such as midwives? Any focus on the perineum? (1:30:28)
43. I’ve heard great things about the Pelvis Pro class. Is some of the information from the course in the PCES course? (1:31:18)
44. Do I need to be a trainer to take this course and become certified? Do I need to be a personal trainer to understand the content? (1:33:12)
45. How long does it take, and how many hours per week? (1:35:00)
Do you find that prolapse patients are afraid to feel the PF expansion because it feels like they are making bulge worse
Yes, there can definitely be a fear and avoidance behavior that can go with it. This can result in gripping and a tight but weak pelvic floor that affects how your pelvic floor can actually function.
On the flip side, people can have limited expansion in their rib cage and do too much inhale down into the pelvic floor aka the path of least resistance. That's why you can choose positions to bias opening areas that are stiffer to balance out the expansion vs just "breath 360 in sitting or standing" off the bat. You can think of it as trying to have 90% of the expansion occur in the diaphragm/rib cage and then 10% occurring in the pelvic floor.
Best way to address that scar tissue in the lower abdomen?
Here's a video about c-section scar release (there's also one in the course as well). Then you can also refer someone out (or do it yourself if it's within your scope of practice) to do abdominal massage and visceral massage. You can also use myofascial silicon cups (also one advertised for cellulite) over that area as well or skin rolling.
Will the PCES course help us know how to create a training program that will not exacerbate or create PF issues or worsen them?
Yes! That’s the goal.
I had a DR for 30 years and finally got it fixed last year. What type of issues in my pelvic floor should I be looking for?
You'd still want to make sure you were good at managing pressure and load. Often after having DR surgery, you can think of it as now you have tension but maybe you're wrapped around the mid section. Before your pressure might have gone out through your DR, but now that that's blocked, you might be more prone to sending pressure down instead. This is why we find some women can focus too much on closing their DR without paying attention to what's happening at their pelvic floor and contributing to pelvic floor issues. It's about how the entire system functions together.
It's great that you can create tension across your abs now, but you'll still want to work on being able to expand well and eccentrically lengthen through your abs, free up any adhesions from the surgery, and still work on the same concepts of top down inhale, bottom up exhale with the 360 breathing concept.
Is this true for pooping as well? breathe the poop out not strain?
That's the general idea and why bowel and bladder habits are important in working through healing your pelvic floor and preventing pelvic floor dysfunction.
Annatina has some great videos on this as well as a part of our Inner Circle Membership.
What health and fitness professionals are saying:
"As a Physical Therapist and personal trainer, I can tell you that Sarah has created THE BEST training program for women. Hands down!"
Dr. Jill Zimmerman, DPT, CPT, Owner of Perfectly Fit
"I've taken several prenatal/postpartum focused courses in the past year, and the Postpartum Corrective Exercise Specialist course was by far the best! There is no comparison! Sarah is incredibly in-depth with this course, and I feel like I am by far a better trainer, and postpartum woman, because of this course!"
Gina Conley, CPT, Doula, Owner of MamasteFit
Registration opens September 26, 2022!
Join the presale list to receive special discounts and course information.
Dr. Sarah Ellis Duvall, PT, DPT, CPT, CNC
As a mom of 2, she knows personally what it takes to fully recover from having a baby. Her passion lies in helping women be stronger after baby and training those that help women. She is the creator of several online postpartum recovery programs and currently works with women and professionals all over the world. She feels strongly that becoming a mother should not hold women back from living life to the fullest.
