What if the pain you've been living with for years was dismissed as normal? Join us as we sit down with Dr. Ginger Garner, a celebrated physical therapist and lifestyle medicine expert, who courageously shares her long-overdue diagnosis of endometriosis at age 50. Dr. Garner opens up about the impact of cultural conditioning, medical gaslighting, and limited access to care on her journey, and how integrative medicine became a beacon of hope, leading to the births of her three miracle children. Her evolution from orthopedics to pelvic health emphasizes the need to normalize discussions around pain and resilience.
Ever wondered how your pelvic floor impacts your voice? This episode provides an eye-opening exploration into the connection between vocalists' pelvic health and their voice. Dr. Garner reveals how early voice training techniques like pelvic tilts can shape posture and breath control, and how pain from conditions such as endometriosis can alter a singer's tone and inflection. We hear an engrossing account of a singer contending with the physical changes of pregnancy, highlighting how these shifts influence vocal performance and why this understanding is crucial for all singers.
The narrative takes a poignant turn as we delve into the story of a young mother navigating postpartum challenges without proper guidance. Despite her background in exercise physiology, she faced significant issues with urgency, frequency, and leakage post-childbirth, shedding light on the gaps in postpartum care within the U.S. healthcare system. Dr. Garner passionately discusses the importance of an integrative and trauma-informed approach to women’s health, advocating for better community support and medical care. This episode is a rallying call for empathy, education, and systemic change in how we address chronic pain and trauma in women's health.
More about Ginger:
Dr. Ginger Garner is a doctor of physical therapy (PT, MPT, DPT), board certified in Lifestyle Medicine (DipACLM) and retired athletic trainer (ATC-ret) with post-doctoral training in functional and integrative medicine, dry needling, and rehabilitative ultrasound imaging. Ginger has spent 26 years teaching integrative and lifestyle medicine internationally, speaking at over 30 conferences worldwide. She is the author of multiple book chapters and 2 medical textbooks, Medical Therapeutic Yoga and Integrative and Lifestyle Medicine in Physical Therapy, from which she developed certifications for PT's and OT's in therapeutic yoga and lifestyle medicine.
Based in Greensboro, NC, Dr. Garner runs Garner Pelvic Health and Living Well Institute, is the host of the Living Well Podcast, and is raising 3 sons. She is active in community service and holds leadership roles for American Physical Therapy Association (APTA) Academy of Pelvic Health, APTA North Carolina, and American College of Lifestyle Medicine. Additionally, she is a mentor and thought leader in areas like voice to pelvic floor connection, rehab ultrasound imaging, and trauma-informed practice. Visit Dr. Garner at her clinical practice, www.garnerpelvichealth.com, Institute, www.integrativelifestylemed.com, and on Instagram and YouTube @drgingergarner.com
What if the pain you've been living with for years was dismissed as normal? Join us as we sit down with Dr. Ginger Garner, a celebrated physical therapist and lifestyle medicine expert, who courageously shares her long-overdue diagnosis of endometriosis at age 50. Dr. Garner opens up about the impact of cultural conditioning, medical gaslighting, and limited access to care on her journey, and how integrative medicine became a beacon of hope, leading to the births of her three miracle children. Her evolution from orthopedics to pelvic health emphasizes the need to normalize discussions around pain and resilience.
Ever wondered how your pelvic floor impacts your voice? This episode provides an eye-opening exploration into the connection between vocalists' pelvic health and their voice. Dr. Garner reveals how early voice training techniques like pelvic tilts can shape posture and breath control, and how pain from conditions such as endometriosis can alter a singer's tone and inflection. We hear an engrossing account of a singer contending with the physical changes of pregnancy, highlighting how these shifts influence vocal performance and why this understanding is crucial for all singers.
The narrative takes a poignant turn as we delve into the story of a young mother navigating postpartum challenges without proper guidance. Despite her background in exercise physiology, she faced significant issues with urgency, frequency, and leakage post-childbirth, shedding light on the gaps in postpartum care within the U.S. healthcare system. Dr. Garner passionately discusses the importance of an integrative and trauma-informed approach to women’s health, advocating for better community support and medical care. This episode is a rallying call for empathy, education, and systemic change in how we address chronic pain and trauma in women's health.
More about Ginger:
Dr. Ginger Garner is a doctor of physical therapy (PT, MPT, DPT), board certified in Lifestyle Medicine (DipACLM) and retired athletic trainer (ATC-ret) with post-doctoral training in functional and integrative medicine, dry needling, and rehabilitative ultrasound imaging. Ginger has spent 26 years teaching integrative and lifestyle medicine internationally, speaking at over 30 conferences worldwide. She is the author of multiple book chapters and 2 medical textbooks, Medical Therapeutic Yoga and Integrative and Lifestyle Medicine in Physical Therapy, from which she developed certifications for PT's and OT's in therapeutic yoga and lifestyle medicine.
Based in Greensboro, NC, Dr. Garner runs Garner Pelvic Health and Living Well Institute, is the host of the Living Well Podcast, and is raising 3 sons. She is active in community service and holds leadership roles for American Physical Therapy Association (APTA) Academy of Pelvic Health, APTA North Carolina, and American College of Lifestyle Medicine. Additionally, she is a mentor and thought leader in areas like voice to pelvic floor connection, rehab ultrasound imaging, and trauma-informed practice. Visit Dr. Garner at her clinical practice, www.garnerpelvichealth.com, Institute, www.integrativelifestylemed.com, and on Instagram and YouTube @drgingergarner.com
Welcome to EndoBattery, where I share about my endometriosis and adenomyosis story and continue learning along the way. This podcast is not a substitute for professional medical advice or diagnosis, but a place to equip you with information and a sense of community, ensuring you never have to face this journey alone. Join me as I navigate the ups and downs and share stories of strength, resilience and hope. While navigating the world of endometriosis and adenomyosis, from personal experience to expert insights, I'm your host, alana, and this is EndoBattery charging our lives when endometriosis drains us. Welcome back to EndoBattery, grab your cup of coffee or your cup of tea and join me at the table.
Speaker 1:
I'm joined by my guest, dr Ginger Garner. She's a doctor of physical therapy and board certified in lifestyle medicine. She's a retired athletic trainer with the postdoctoral training in functional and integrative medicine, dry needling and rehabilitative ultrasound imaging. With 26 years of experience, dr Garner has taught integrative and lifestyle medicine internationally, spoken at over 30 conferences and authored multiple book chapters and two medical textbooks. She developed certifications in therapeutic yoga and lifestyle medicine for PTs and OTs based on her books. Dr Garner runs Garner Pelvic Health and Living Well Institute in Greensboro, north Carolina, hosts the Living Well podcast and is a mother of three. She holds leadership roles in the American Physical Therapy Association and the American College of Lifestyle Medicine and is a mentor in areas such as voice to pelvic floor connection rehab, ultrasound imaging and trauma-informed practice. Please help me in welcoming Ginger Gardner. Thank you, ginger, so much for joining me today and I'm excited to finally see you again after we met at the summit and thank you so much for taking the time out of your busy schedule to join me at the table.
Speaker 2:
Thank you, alana, thanks for having me. I'm just, I'm excited about this conversation.
Speaker 1:
I am as well, because you have a unique perspective that I hadn't thought of until I sat down with you at the summit and we started talking about it. But before we get to what you're doing professionally, can you just invite us into your space to get to know you a little bit better? Who is Ginger Gardner? Us into your space to get to know you a little bit better.
Speaker 2:
Who is Ginger Garner? Oh my gosh, I always start out with kind of like this, a bit of sense of humor about all of it, because I learned so much about how to be resilient, develop resilience through music and I'm thinking in particular about friends that influenced me so deeply that taught me that sometimes you sense of humor about it because it was painful, because I do did have endometriosis and for me at um, at 50, it's a new diagnosis. It's one that because of our cultural conditioning and our social expectations and our busy schedules and medical gaslighting and well-meaning people that have low health literacy, you end up and also good care that prevents a proper diagnosis of being discovered, because you're doing all these things to control estrogen and inflammation and you know immune function and gut health. So I arrived last year with a unique situation because I'm a pelvic PT and had surgery for endo last year with the wonderful and amazing Dr Ken Cenervo at CEC in Atlanta, who I'll forever be grateful for for cleaning all the mess up from all these years.
Speaker 2:
But when I think all the way back, all the way back to the very beginning, things were always abnormal, things were always not quite right, but I had very unique circumstances of growing up in an area that was incredibly underserved, very low income, without access to care, and everything around you is normalized.
Speaker 2:
You know, all pain, all dysfunction is normalized, where, because of the circumstances, where you know, my family did the best they could with what they had, but we didn't have the benefits of that. We didn't come from, you know, sitting with that privilege at all. And so, you know, as I progressed through my journey, I went through a 10-year journey of infertility, again without answers, journey of infertility, again without answers, um, through fertility treatments, all all kinds of things that probably ultimately made things worse, right, fortunately. And then, through some absolute miracle I will credit integrative medicine for that miracle I was able to have three children without any intervention at all. Wow, and that, those, yeah, three miracles in a row, three miracles in a row there. But during that time, as a lot of us do who've been PTs for over a quarter of a century and we ended up in pelvic health. We didn't start there, right century and we ended up in pelvic health.
Speaker 2:
We didn't start there. When I started there there was no pelvic health and it's funny, not funny, right. There was no pelvic health. No woman was getting the care or men or anyone was getting the care that they needed in that area. And so I grew up in orthopedics right Orthopedic outpatient, pt, et cetera, in orthopedics, right Orthopedic outpatient, pt, et cetera. So you know, as you progress through all of that and you learn that, the stoicism that you carried for pain, I remember getting treatment at one point and it was a DO, it was an osteopath really kind, looked at the person who was with me and said she's really stoic. And the person was like, well, she did have three kids with no pain meds. So we all had a laugh. But you know, looking back on that, it's again, it's another funny, not funny because you normalize such incredible pain on a regular basis that you don't even think about it anymore, you know.
Speaker 2:
So, through about, let's say I would say about halfway through my career, pushing 26, 27 years so far, that's when I started to really really attend to the pelvic health aspect of things. And somewhere along the way, I do remember the moment in time where I was teaching at an integrative medicine conference. This is where things changed for me. I was teaching at an integrative medicine conference. This is where things changed for me because I was always a performing vocalist through various channels, mostly singing jazz. That was my kind of regular gig, you know moonlighting side job. But I ended up teaching integrative medicine.
Speaker 2:
I was talking about pelvic health and yoga at a medical yoga conference and it was in Copper Mountain, and the jazz festival was at the same time and somebody found out that I also do jazz. I guess they looked up YouTube or something like that, and so then they invited me to perform at the jazz festival at the same time that I was slated to speak and just before I went on stage and it was improv I'd never met these people I was going to perform with. We were just up there winging it, and how nerve wracking that was. But the cool thing was I talked about pelvic floor stuff and yoga and then I went directly from lecturing, got on the stage and performed jazz, and it's that point that things started to meld together for me and I realized there's a connection between the voice and the pelvic floor.
Speaker 2:
And then I started to present on it, talk about it, do lit reviews and stuff like that, and then now I teach, continuing education on it and have taught it for about a decade now. So that's kind of my evolution of understanding and appreciating, moving from just straight up ortho and into kind of the pain space, the integrative and lifestyle medicine space, and then ultimately realizing gosh, there is so much to be said and done when it comes to integrative care for endometriosis. But then also this other concept, speaking professionally as a clinician, you know, from the voice to pelvic floor side. So you know that's a little bit about my personal experience with it because quite frankly, it was difficult to sing sometimes because of interference of pain and turns out all these things that were happening in the background Right cultures of medicine, like yoga, like Chinese medicine, et cetera, can be helpful, you know with with endo and pelvic pain and and also how much it helped me personally.
Speaker 1:
Well, it's interesting that you know we can see a lot of our picture in the, in our direction. Right Like it, it is our map. A lot of times, what we experience is what pushes us to ultimately thrive in certain spaces, because we become passionate about it and we are seeing correlations and it helps us grow, not only as people or patients, but it's helping us help serve others, which I think is life-giving to be able to help others and then improve their quality of life. And something that I love that you're doing is the pelvic floor and the voice, and that's interesting to me. We started talking about this at the summit and both of us it struck a chord because I'm a vocalist as well and I hadn't really put those pieces together for myself, and we were talking about you know, you think about, as vocalists, what do we hear when we first start singing, like when we're starting to train at least for me, it's if you're going to sit, you sit up nice and tall and you like, and we actually did.
Speaker 1:
I'm thinking back to this when I first started doing voice and we had to like do pelvic tilts in voice? And I never put that together. I just thought it was because you wanted to, like you know, loosen up a little bit, get ready, get that diaphragm filled up, you know being able to sing and project out far as you possibly can while maintaining dynamics. So all of this kind of really intrigued me when you started talking about that. And then you put the pain piece with endometriosis on top of that and it's just I'm seeing so much of my story and what you were talking about in just that moment Because as a vocalist, you need to be able to sing pain-free or it comes through every single time and you can tell in inflections and you can tell in the tone that someone's singing with where they're at.
Speaker 2:
Yeah, you can see you can hear, you can tell so much about a person just by listening to their voice. We did a presentation on that one time at our national PT meeting called CSM combined sections, and the title was something like you know, are you listening to your patients? What you can tell you know about their pelvic floor by listening to their voice, and that's so true.
Speaker 1:
Yeah, can you kind of take us through some of what you've learned with that connection and some of the things and why it's so important to understand the connection between your voice and your pelvic floor and what that connection is?
Speaker 2:
Yeah, I think one of the easiest ways to kind of feel what's meaningful about the connection is to talk about like a real story, and one of the stories that is coming to my mind is well, of course I can share one personally from me.
Speaker 2:
Where I really began to understand the voice and pelvic floor connection is when I was pregnant and still trying to sing yes, yes, I was doing some fundraising at that time and because the bigger you get, then the wider your rib cage gets, and the wider your rib cage gets, the flatter your diaphragm gets and your diaphragm needs to be domed. And that's one of the things that I will image using ultrasound in practice in my clinic. And so as you get more and more pregnant, you know, the diaphragm gets a little flatter and so it does get harder to breathe, it does to get harder to sustain your phrase. But I remember being pretty close to the end because one of my sons I have three of them was really good at kicking me in the respiratory diaphragm and he kicked me in the middle of like a phrase. Was it your second?
Speaker 1:
I can't you know. I think it was. It's always the second one. They're the rogue ones.
Speaker 2:
He never slept. He kicked me all night long and I actually he kicked me so hard I stopped singing in the middle of a word in front of an audience and that was kind of embarrassing. But one of the audience members came up after and thought I had just run out of breath because I was pregnant and I was like, yeah, yeah, that's what happened. Not, he kicked me in the diaphragm in the middle and I really couldn't do anything. It just cut my, cut my breath off. You know entirely and my note off entirely, but one of the cases that I'm thinking about, someone had come in and they were this person who was a female, was really struggling with urgency having to go all the time, frequency so going all the time.
Speaker 2:
The sound of running water was like that was. She was leaking before she could get to the bathroom. And this is a young woman with three kids and of course, the standard for you may be shocked. You know, as listeners to find out, that the standard for postpartum care for rehab in the United States is nothing. We have no standards of care for postpartum and so A it wasn't her fault. She didn't even receive a referral In fact. No, you know who should have referred her said why do you need pelvic PT? We don't refer for that. You just had a baby, there's nothing wrong with you. So they come in with that shame that they've done something wrong, that they didn't do something right, you know. So if you're listening and you've had a baby and or you have endo and you've not been referred to pelvic PT, not your fault. Have endo and you've not been referred to pelvic PT, not your fault.
Speaker 2:
Someone is not giving you good care. So that's what happened with her. So she came in with these issues. On top of that was prolapse, pelvic organ prolapse. So you know, we also know that with endo there, can you know, sometimes it goes hand in hand with hypermobility. That means not just joint hypermobility but tissue issues. So tissue stretch and hypermobility, that means not just joint hypermobility but tissue issues. So tissue stretch and hypermobility, and that's. I had the same thing. So it wasn't just a joint. You know that was bendy. It's not just if you're watching on YouTube, it's not just the ability to pull your thumb back and touch your arm right or have your knee or your elbow hyperextended it's so much more than that.
Speaker 2:
And so she was having those issues really smart person with a master's in exercise physiology, right, so super knowledgeable and so she came and sat down and told me about the heaviness and the dragging and the frequency and the leakage and kind of like classic postpartum stuff that's never been attended to. So on top of that, she sat down and started to talk and she had a lot of hoarseness and her voice was scratchy. I could tell that like my voice a little today is pitched a little lower because I've been talking a lot this week, particularly in maybe less than healthy vocal practices yeah, this week particularly, and maybe less than healthy vocal practices, yeah. So I could tell that she was hoarse and I was like let me just ask you one more question do you have any vocal issues? Do you get worse or did you get laryngitis? And she's like, yes, I lose my voice every week, like on a regular basis. Interesting, I can't get through my job, wow. So, yeah, so it turns out.
Speaker 2:
So what I did was I went ahead and imaged her. I did a transabdominal, so just through the belly, ultrasound imaging, and I asked her to say some things and as soon as she started talking if her bladder is like the shape of my hand, so imagine a piece of toast right, a piece of bread and every time she spoke her bladder would bounce with every word. If I'm speaking now, imagine with every word your bladder is translating down, which is really not what it's supposed to do. It's supposed to just stay steady. Maybe if you sang really loud and powerful with very good technique, maybe sometimes it would go down, but for the most part it should do nothing. Or if you want real vocal power, it can come up. On imaging the bladder base would come up, but that's not what happened. She was, I call it, oblique speak and psoas speak.
Speaker 1:
And.
Speaker 2:
I have a couple of YouTube videos where you could just like Google Ginger Garner, psoas speaking, and it'll come up. Because that's what was happening Every time she said a word, her hip flexors were contracting. So if you're out there and you have chronic hip flexor tightness tightness in the abdominal region that just seems to never go away that could be what's happening.
Speaker 1:
It's voicing yeah, that's fascinating. How do you address those issues? How do you address it to the point where people can, yeah, gain better control of those things, or or maybe that loosen? I don't know.
Speaker 2:
Yeah, well, the word you used, control, is key.
Speaker 2:
I think it's retraining their nervous system. I call it resetting. I'll often say push the button, push the reset button, and when someone comes in, I'm like, okay, this is what we're going to do. These are the patterns that we've noticed, which I will usually identify either with my hands, manual therapy or with imaging, because imaging doesn't lie, it's just right there and they can see it, and I'll say you know, let's press the reset button, because we just need to retrain what your muscles are doing. You didn't do anything wrong. You didn't deliberately choose to do this.
Speaker 2:
Your body takes the path of least resistance and we use our voices every day. Every single one of us depend on our voice. It's critical, it's it's how we, you know, make a living, it's how we connect, it's how we communicate, it's how we create change, and so that's why it's easy to go to the voice as a pelvic floor treatment which is really applicable for endometriosis, because there's often so much trauma surrounding your delay in care, your delay in diagnosis, not having access to really good excision surgeons, really good pelvic PTs and OTs that specialize. So there's a lot of trauma around that and you can imagine that. Also a lot of pain. Usually the last thing someone with endo wants is to have another exam, right? Yes, another pelvic exam, checking more stuff and poking around in an area that is already so incredibly point, tender and can be with the bladder, the bowel. It's not just about the pelvic floor, right? So I look at the voice as an alternate way to start pelvic health care and treatment for endo, because this is easily accessible.
Speaker 2:
The voice is where we either feel empowered or disempowered. So oftentimes there's a lot of gentleness, compassion, empathy, care and concern that I will put into the language that I use, because I think treating the vocal area can be just as sensitive as treating the pelvic area, but it is more accessible in terms of if someone has a psoas's snarky further. So, as speaking and I think every woman with endo comes in have with trauma from the system, because rarely do they get the care that they need on time and appropriately. So every person that I see I use a trauma form informed approach. So let's say they come in, I'm using a trauma informed approach. I'm let's say they come in, I'm using a trauma informed approach. I'm using integrative medicine with a functional medicine approach. I might start orofacial releases. I have a YouTube video Orofacial Release Part One. I'll be quickly doing that, yeah, so check it out that I will teach basic orofacial release because of the fascial and neural connections to the diaphragm, the psoas, the hip flexors and the pelvic floor.
Speaker 1:
Oh my goodness, that is fascinating yeah it works so well.
Speaker 2:
Once you try that and you get into the flow of practicing it, then I know, even now, as I'm speaking right now, because I've had endo, I just had surgery a few months ago. I'm really aware of, you know, my pelvic floor. Is it totally, 100%, swimmingly wonderful? No, right, yeah, it's only been like a few months. It'll take a year, right, right, right, just like with any other major surgery. So every time I speak, I'm aware if I'm singing, which is currently in the car I don't currently perform anywhere, just singing in the car I'm aware. Am I creating downward pressure gradient? Am I pulling in too much abdominals or too much hip flexor? And if so, is it? Is it creating, you know, stress on the voice?
Speaker 1:
Because if there's stress in your voice, there's stress on your pelvic floor Interesting and I'm like sitting here thinking about just my journey and my story and like seeing so much of this becomes so relevant to what I have gone through personally. Again, I haven't sang in a really long time and I don't perform anymore, but I remember when I, prior to being diagnosed I was probably 18 at the time and I remember just being in so much pain and I had to go up and sing on stage and I I couldn't hit the notes I wanted to hit and I couldn't project the way I wanted to project and I couldn't. I just and it physically was not happening, like my mind connection was there. I knew the notes I needed to make but but I couldn't get them out and I know that I have hit these notes. I don't know how many times I've sang this song, I don't know how many times, but after I got up there, I just could not get it out and I just put that into.
Speaker 1:
Well, I'm in pain right now, but now there's a correlation between those things and I remember having to sit down because I was in so much pain and we didn't really know at that time I thought it was just kidney stone. Well, actually, what they thought it was was cancer at the time and I was 18 and they were like, well, it could be cervical cancer, it could be ovarian cancer Cause they really didn't know. And I remember feeling not only depressed and you could tell within my voice, but I the tension I was holding in my body. I just remember thinking back to that moment and I don't think about this moment often because particularly pleasant, but just looking at that correlation and how my body, how tight it was, and how I felt less than adequate with my mobility and my voice making so much more sense.
Speaker 2:
Yeah, it wasn't because you weren't trying hard enough.
Speaker 1:
It wasn't.
Speaker 2:
You know. It's not because your body doesn't know how, or you, because there is that mind body connection where you know exactly where you want to hit that E or that C and you just go for it. You just hit the note, you know, and then when you're in pain, so so much happens where and that's true with activity too you don't, you can't fully do the activity you want, whether it's singing or weightlifting or whatever it is that you love to do, you know, biking or hiking with your kids or whatnot. You just can't quite hit the blank. And so when someone comes in I've had multiple women come in never having been screened for endo at all investigation, you know, is necessary Because you can have some of those similar issues when you have voice, issues that actually can correlate and overlap with symptoms of endo that you know in the typical mainstream healthcare right that's very curative in nature and never really is looking for endo at all.
Speaker 2:
You can have painful breathing, painful respiration, and if you think about things like what we know with the existence of thoracic endometriosis now that should raise red flags. Of course, as a therapist I go and treat the things I would normally treat and if that pain persists. It sends up a red flag for me that I have treated the respiratory diaphragm, I have done the visceral mobilization and manipulation, I've done due diligence. It's still there, right. And then you begin to think okay, let's, let's dive a little bit deeper, which is where the functional medicine approach really is helpful.
Speaker 1:
Yeah, what are some things that people should be looking for when they're thinking about that connection in pelvic floor? What should they be feeling? That maybe should indicate that something's off or that they're doing okay? Because I think for me I can, now that I'm aware of you, know some of those connections. I'm going to be really paying attention to this, I'm going to be really trying to hone in, and that's probably just me, but I think there's others that might be intrigued to learn. What should we be aware of me?
Speaker 2:
but I think there's others that might be intrigued to learn. What should we be aware of? Yeah, that's a great question. Here's a very common scenario.
Speaker 2:
My caseload is consistently filled with women with endo who come in and they have a variety of symptoms. Quite often it can be headache, jaw pain. So they get misdiagnosed with like TMJD, which they could actually have. They have a lot of orofacial restriction here, so when someone's speaking you shouldn't be able to see. So if I turn my head, you can see this muscle standing out, but when I turn back and I'm just breathing and talking, you shouldn't see it. If there's resting tension in this whole neck and orofacial area, that's a red flag. If you constantly and chronically have headaches that no one can figure out what they are, that's a red flag.
Speaker 2:
If when you're trying to take your fingers and another YouTube video I have that is maybe helpful is a respiratory diaphragm release, where I teach you how to get up under the rib cage, not to just poke at the stomach and the liver, but to trap the diaphragm by coming around underneath your rib cage to make sure that the respiratory diaphragm is actually as mobile as it should be, or what we call clinically within kind of functional limits. And if that's not there, that's a red flag because coming on down, you know the kind of the snowball effect is headaches, jaw tightness, vocal issues, painful breathing, and then they'll have this kind of diffuse low back pain where sometimes it feels like a corset and wraps around. Sometimes it's central low back pain, sometimes it can feel like sacroiliac joint pain and then you get into the classic pelvic pain that everyone associates with endo but doesn't realize. Maybe that endo is a systemic issue that you can have kind of tip to toe pain and head to toe pain. So when they start having that back pain and pain that wraps around to the front of the abdominal cavity, if they're exquisitely point tender, when I go to press around where the small intestine or the large intestine would be, then I begin to rule out things like well, is it a snarky psoas right back to the hip flexors?
Speaker 2:
Is it an overactive internal oblique? Just picking some things out that are that are typical a lot of times when someone's been in pain for a while, just to speak, they're pushing so hard to get sound out that they are over-breathing and over-breathing ends up overly recruiting the internal oblique, among other things. Not just that, but you can see that on imaging. And that's where imaging comes in and is really handy, because the normal ratios you would see in the abdominal cavity aren't there. They have the reactive muscles. I call them trauma posturing muscles.
Speaker 2:
Think about when you're in pain. It hurts really bad. We've all been there. If you've had endo and you're just kind of curled up in a ball, you can't really stretch out. It hurts to breathe. It hurts to stretch out. It hurts really bad, we've all been there. If you've had endo and you're just kind of curled up in a ball, you can't really stretch out. It hurts to breathe. It hurts to stretch out. It hurts to walk. It hurts to weight bear. All those muscles that do that, the ones in the front of the neck, the abdominals, the hip flexor, the pelvic floor. They all shorten and tighten, just kind of like what you were describing when you were 18. It's a trauma posture. It's kind of like what you were describing when you were 18.
Speaker 2:
Yeah, it's a trauma posture, yeah, and if no one's there to help you out of it, you stay in it and your voice suffers for it, your pelvic floor suffers, you begin to over-breathe, the respiratory diaphragm gets shorter and tighter and shorter and tighter and then that's where the back pain comes in, which can implicate nerves sometimes.
Speaker 2:
So it's not unusual to have someone come in and have kind of like a sciatica issue, but it's really not sciatica, it's coming from other things. So those are some of the things kind of the voice to pelvic floor connection that you would look for, that you would want somebody voice to pelvic floor informed, or I just call it a V to PF approach, because they will look from head to toe at all of those things and make sure that they've cleared the voice, they've cleared the respiratory diaphragm and they've cleared the pelvic floor. And you know, and in terms of post-op, you know, endosurgery that's I swear by you know, using that full approach because, again, we all need our voice and so when I do, imaging I want to make sure that they can speak. If they sing, they can sing If they play an instrument for fun, or maybe that's their job, that they can do that and still move and use their voice and it not adversely impact the pelvic floor or their core.
Speaker 1:
Interesting. I'm. You know I'm sitting here thinking as you're describing this. So when I was probably just starting my menstrual cycle, I started having a really hard time breathing and they finally put me in therapy for vocal cord dysfunction.
Speaker 1:
Oh, my gosh with my pain and headaches were common all the time, even still sometimes. I'll get that where I'm like I can tell I'll do a release on this nerve right here, the vagal nerve right there, right along the neck line, there's that muscle that you're talking about. Right, I'll go in there and kind of massage it, because I can tell I'm really tight in my voice, my head is killing me, I'm having a harder time getting a deep breath in and I'm in that pain posture, I'm curled up right, and so that is just more validation to what you do, because I'm seeing my own story in everything you just said, and that's from years. That's from, I mean, I was probably gosh 10 or 11 when this started and they could not figure it out. So who knows? But wow, that is.
Speaker 2:
Yeah, you know, when you think about the 10 or 11 year old, and the first time I started having pain was I was a teenager, I was about 15, 16. And you think about those parts that 15-year-old that 10-year-old. That part was experience, that pain and trauma that nobody had an answer for for a lot of decades you know, after that, and that part still needs a voice too.
Speaker 1:
Yeah, they do, and it's hard to find that voice when we're trying to find our voice in the world.
Speaker 2:
Right, so you have yourself, as we're sitting here now right.
Speaker 2:
Yeah, our adult self no-transcript, that little girl, that little teenager, just like you have that. That part too needs to be reassured. You know like they need their it's. I'm really describing internal family systems. You know IFS therapy, but that's why it's so important, I think, to have a therapist that is aware of that. You know your providers need to be psych-informed, right, because it's not a psychosomatic issue. The pain is very real, but if you're not acknowledging those pieces and parts that were stuck in those trauma postures, then they're still there. Your psoas still remembers that, right. You know the respiratory diaphragm remembers that and um, and I think there's value in addressing that in an integrative way so you can fully heal.
Speaker 1:
Yeah, oh, I remember actually the first time I ever went to pelvic floor PT this is post excision and I hadn't really heard about pelvic.
Speaker 1:
I didn't even know what a pelvic floor was for, like probably till I went, but I had no idea that all of these connections played a part in my whole being Right. This isn't just like a pelvic thing, it's a whole body thing. And so I, after my excision, I went to my pelvic floor physical therapist and she goes do you have a good counselor or a good therapist? I was one of the first questions she asked me and it wasn't because she wanted to invalidate what I've been through or what I'm going through, but what she told me and I was like it made such an impact on me. She said, because you for years have been keeping this in and you are so tight, she goes, part of the release is talking this through with someone that can really help you release some of that tension and heal, and that's part of the healing journey. And so she refers all her patients out for help in that way because the impact of that on our bodies is significant.
Speaker 2:
Yeah, it's something that on our bodies is significant. Yeah, it's something that's not even been measured. Yeah, you know, or researched you think about. Most people who have a medical condition get care for it right away, but we go through usually typically decades of medical gaslighting and misdiagnosis. I had multiple surgeries that they always found something wrong and it was valid, but it wasn't the driver, it was always a secondary fallout piece of the puzzle. It was something that happened as a result of the endometriosis. It wasn't the primary, the root cause. What you said, too, is I just want to restate that for everyone that if you go to your pelvic PT or your endosurgeon and they suggest seeing someone for mental health, it isn't because they're trying to invalidate you or they don't believe your pain. It's that your pain is that important that it takes a team to address it.
Speaker 1:
And that's where that multidisciplinary approach is key in any care. But I think what you're doing adds a whole new level of understanding, gives even those physical therapists another tool to look at in the tool belt of figuring out the mapping of pain and the correlation of pain and kind of helping the patient decipher what to do next. I think this is huge. I mean, it's such a great, tangible way of us looking at our whole body and how that connection plays a big part in our overall wellbeing. I'm just so fascinated by this and for those of us that are really fascinated because I think a lot of us are going to be very fascinated by what you've talked about what are some resources that you have? You've talked about your YouTube pages. You also have a podcast.
Speaker 2:
What other things are you doing? Well, I always try to have free resources out there. So, from the free side of things, you can go to garnerpelvichealthcom and you can sign up for a voice to pelvic floor course. That's free and it's very yoga driven because it's really all about breathing. In that case that I mentioned earlier, we were able to change her urgency, frequency, leakage and prolapse just by changing a breathing technique. Interesting, yeah, it's like didn't require a single Kegel, yeah, In fact usually it doesn't?
Speaker 2:
Yeah, uh-huh, you know there's a place for them, but not typically alone or isolated, and usually not often. But I do have a free course, a free voice to pelvic floor course at GarnerPelvicHealthcom. People who are really interested or looking for resources. I do first consults free at GarnerPelvicHealthcom too. If you want to subscribe to my YouTube channel, I have a voice to pelvic floor, which I also call three diaphragm, the three diaphragm approach. I like it. I have a voice to pelvic floor playlist. It has, oh, 50 or so videos for voice to pelvic floor. Wow, that's at Dr Ginger Garner and I would love to interact with you guys on Instagram at Dr Ginger Garner.
Speaker 1:
Yes, and I mean you come out with so much great content Like I don't actually know how you do it all. I don't know how you do everything. You're like superwoman.
Speaker 2:
Oh gosh, yeah, I don't have a cape, I don't.
Speaker 1:
We need to get you one, because I don't know how you do it all.
Speaker 2:
Oh, I have music, music helps and yoga helps and you know all of those things. But it's just it's driven by a bunch of passion that I want other women to get care quicker and have it be comprehensive and if they can avoid medical gaslighting, that would be a profound and amazing thing. To end medical gaslighting. I forgot to mention my podcast, because that's what it's about. Yeah, the last way that you can interact with me is Living Well Podcast that's anywhere you get your podcasts and it is about ending medical gaslighting in women's and pelvic health. Oh, it's so fascinating, yeah, oh, and season four, which is coming up in the fall. I'm getting ready to do season three, which is all going to be about self-care and guided self-care activities, so all kinds of fun stuff for voice to pelvic floor. So subscribe to that. But then my next season in the fall, is going to be completely dedicated to endometriosis.
Speaker 1:
Oh, that's going to be incredible. That's going to be incredible, and you have some books as well.
Speaker 2:
I do. One is medical therapeutic yoga, and these are both for healthcare providers. So I tell people they're great for learning yoga and integrative lifestyle medicine and they're also great for propping up an uneven coffee table. They're medical textbooks and they're dry. Oh no, oh, man. So I have integrative and lifestyle medicine and PT that I co edited and wrote with Dr Joe Tata and then and medical therapeutic yoga, which is all about keeping yoga safe for gosh, really women and people with hypermobility. When it comes down to it, there are a lot of. You know there's a big spectrum of hypermobility, which includes endometriosis.
Speaker 2:
So that was one of my big issues is, you know, and yoga is like hip openers. It's like ditching the phrase hip openers and focusing on stability bio, psycho, social stability in yoga, instead of using yoga just for some kind of alphabet, cheerleading, stretchy mobility kind of thing.
Speaker 1:
See, I'm learning so much about this and it'd be interesting and maybe you know more and we can talk to them this another time but the hypermobility piece to your vocal cords and pelvic floor, because that would be fascinating to someone who has EDS to learn more about that.
Speaker 2:
Maybe we can do a part two. Let's do a part two sometime. There's so much to be said about that because, like I mentioned, I have hypermobility and endo and all the things, and so when I started to experience it in my own body, I knew that the yoga that was calibrated and and built for men and boys was not going to fit me at all. And it was the catalyst to to write medical, therapeutic yoga, because the way that I recalibrated it, it saved me from not just being hypermobile and getting hurt. It also prevented me from needing surgery to surgically stabilize my C-spine. So it saved me. It saved my life in many ways.
Speaker 1:
Yeah, oh, ginger, you're amazing. You're just. I'm such a wealth of knowledge and I'm so thankful that we were able to cross paths and just talk more about this, and I'm so impressed by everything you're doing. You're just amazing. So I want to learn more. And if you want to learn more, go ahead and follow Ginger on all her different platforms and continue to just thrive in that space, because I know that she will just impact your life with the knowledge that she has. And so thank you so much for joining me today and thank you for taking the time, and you're just so pleasant to be around and just I love learning from you.
Speaker 2:
Thank you, alana, thank you for what you're doing to your. The advocacy work that you're doing is is mind blowing to me, and it's it and it makes me wish I could do all that stuff too. But you know what it takes a village, and I'm so glad that you're out there doing it, because we can't do it all. No, we can't do it all but we can help each other, do it all, that's right.
Speaker 1:
That's right.
Speaker 1:
It does take a village. That's why we started, when we started the nonprofit it's called Indo Village for this region for support and advocacy and education, and we did it because it takes a village. It takes a village to create that change and that push forward, and, and all of us, all of you out there, are part of this change and you can be part of this village to sit down at the table with us, have these discussions and see where you can lend your gifts, skills and abilities to help our community heal and thrive, and I just I think you can make such a huge impact for so many different people. So, but, thank you again and until next time, everyone continue advocating for you and for those that you love.
