I am super excited to introduce my first guest on the blog, Dr. Abby Bales. Dr. Abby and I first met years ago when we were Lululemon ambassadors and have stayed connected since. I’ve always been impressed and inspired by Abby’s passion and relentless work ethic so it is no surprise that she went on to become a physical therapist and start her own practice. Let me be blunt; Abby knows her shit. Specializing in pelvic health, Abby has a wealth of knowledge that is important to share.
I encourage you to follow Abby on Instagram @reformptnyc as she posts lots of great information, especially for my strong moms or moms to be out there!
Let’s get to our convo!
1. Finally, it feels like awareness around what happens to a woman’s body during pregnancy AND how she is impacted after giving birth is getting more attention. Tell me a little bit about why you decided to specialize in this area?
I learned early on in PT school that I am drawn to disorders of the pelvis/hips. I have always thought about that area as the center from which every other part of your body moves. When I was first treating patients, I realized I was missing out on so much by not better understanding the INTERNAL muscles of the pelvis, for both male and female patients. Once I applied what I was learning from my mentors and in my pelvic health training, I saw that I could serve ALL of my patients better by including a pelvic specialty in my education. On top of that, I saw a massive hole in the PT world where it came to understanding the intricacies surrounding pregnancy and postpartum patients. I look at everything from blood work to my patients’ menstrual history to my patients’ training log to breastfeeding and beyond to best serve my athletes and get them to a place where they can compete again. It’s a huge undertaking, but it requires me to incorporate endocrinology, nutrition, exercise physiology, and rehabilitation all into one practice. Basically, it means I’m always learning, which I love.
2. What are a few things every woman should know about pelvic health?
1. A healthy bowel, bladder, vagina/uterus is an important part of a woman’s overall health and wellness.
2. Sex should be enjoyable and if it’s not, a pelvic floor PT may be able to help get to the root of why.
3. All postpartum moms need pelvic floor PT.
3. Tell me a little bit about why pelvic floor awareness is so important during the pre/postnatal time.
The pelvic floor is the heart of your core. Organs depend on it for support and function, it’s an integral part of maintaining a healthy sex life, and the musculoskeletal system can develop all kinds of problematic compensatory movement patterns if it’s not functioning properly. During pregnancy, the pelvic floor is challenged by the ever-growing uterus, baby, and belly in a way that cannot otherwise be replicated. During a vaginal delivery, pelvic floor eccentrically contracts to push out baby and the placenta, stretching beyond its normal, healthy length-tension relationship and sometimes tearing in the process. During a c-section, things are shifted around, small nerves can be disrupted, and the abdominal cavity is put through a major operation to deliver baby. All of these scenarios alter the day-to-day function of the pelvic floor and all require rehabilitation postpartum to return mom to optimal capacity.
4. Are there any super simple exercises that women can do while pregnant to strengthen the pelvic floor?
I actually don’t recommend moms focus on their pelvic floors during pregnancy unless she is having a problem with it. I generally suggest a comprehensive fitness routine that includes upper/lower body and pregnancy-safe core exercises (I have a whole series on my IG stories). Mom’s whole body needs to be strong throughout pregnancy and caring for baby afterwards. Also, too many kegals or pelvic floor-focused exercises may do the opposite of what you might want them to do, which is tighten up too much, become overactive, and cause stress incontinence or pain during and after pregnancy. Best to see a pelvic floor PT if you’re experiencing issues, or better yet, prior to pregnancy to learn how to voluntarily engage the pelvic floor before baby pops into the picture at all!
5. Let’s discuss diastasic recti. What is it, and what is your advice for women who have it postpartum?
I’d say more than 80% of all pregnant women have some stretch of their rectus abdominis at their linea alba, commonly known as diastasis recti. An avulsion, or tear, from the linea alba is a hernia and may need to be addressed surgically. Often, a diastasis will decrease or disappear with rest pospartum and as the tissue reduces in stretch after the baby is delivered. I don’t even bother assessing a diastasis until after 6-8 weeks postpartum (3 months, if I can convince mom to wait!) because there is so much healing that happens between birth and 8-12 weeks that will naturally occur if mom is patient and not aggressive with returning to strenuous activity. If it’s assessed at 12 weeks and is either greater than 2 fingers width or accompanied by other postpartum issues (pain, incontinence, a feeling of looseness or tightness), then I’m happy to assess and address the tissue. Not all moms with a diastasis have issues or cannot contract their abdominal muscles. Some of the issues are cosmetic and some are voluntary contraction problems, both of which are valid and solutions should be explored if mom is concerned. I recommend moms get checked out by a pelvic floor physical therapist who is trained in how to properly grade and measure a diastasis AND knows how to treat it. This is not a job for a Ob/gyn, this is the job for a rehabilitation specialist.
6. As a working mom, I find work/life balance to be a “take it day by day” situation. You have two beautiful young children. In your experience, what was the best advice you were given (or you discovered on your own) around making it work.
The best advice I ever got was to do what works for your family. End of story. What works for us is to have a full-time nanny, my husband working full time, and me running my business for myself. In my opinion, there is no “balance”, there is what works for me on any given day or during a particular period of growth, either with my business or my family. Some days/weeks are work-heavy, some are family-heavy, it’s just dependent on what we’re dealing with at that time. It’s constantly changing, but we strive to give our kids a consistent routine with dependable people who love them and it works for us. They’re happy and healthy and we are able to pursue our careers and make time for our kids and each other.
Dr. Abby Bales is the owner and founder of Reform Physical Therapy, specializes in pelvic health and rehabilitation for pregnant and postpartum athletes. Abby received her Doctorate in Physical Therapy from NYU and holds her CSCS from the NSCA. In addition, Abby has completed extensive pelvic floor and women’s health courses with the renowned Herman and Wallace, as well as a variety of others with the Grey Institute, Barral Institute, Postural Restoration Institute, and VDOT coaching clinic, among others. Abby has consulted for some of the top boutique fitness studios in NYC, is an active member of the APTA Section on Women’s Health, and is a motivational speaker. Abby is a huge fan of fitness and lives in New York City with her two young children and husband.